GPs: Anti-depressants and Alcohol

Lord Sikka Excerpts

Wednesday 16th November 2022 Lords Chamber

[Lord Markham (Con)]

First and foremost, it is the role of the GP and the local clinician to monitor that. Again, the guidance given by NICE is that we very much back up and work with the NHS performance teams to make sure that things are integrated. Not only is there the meeting of the patient with the GP in the first place, but these are reviewed very frequently, on a six-monthly basis, to ensure that exactly the issues mentioned by the noble Lord are controlled.

[Lord Sikka (Lab)]

My Lords, the Government can help to reduce the use of anti-depressant drugs by tackling the root causes, which are anxiety, insecurity and poverty inflicted by the Government’s own policies. Will the Minister tell us when the Government will be in a position to reduce the NHS waiting lists back to the numbers they were at in 2010?

British Heart Foundation: Tipping Point Report

Lord Sikka Excerpts

Tuesday 8th November 2022 Lords Chamber

[Lord Markham (Con)]

Yes, the more that we can educate people to self-diagnose and take a stake in their own health, the better. Again, many of us now have Fitbits, Apple watches and so on, which can be vital early-warning indicators.

[Lord Sikka (Lab)]

My Lords, austerity kills: 334,000 people have died from it in the period from 2012 to 2019. The Government publish monthly statistics on GDP, inflation, wages and much more. However, we do not get monthly data on excess deaths attributable to government policies. Will the Minister provide this information every month? Secondly, can he ensure that the impact assessment accompanying each Bill shows the human cost arising from that Bill?

[Lord Markham (Con)]

The House will agree that we provide some very detailed information on excess deaths. That is quite sufficient at this time.

Cost of Living: Public Well-being

Lord Sikka Excerpts

Thursday 20th October 2022 Lords Chamber

[Lord Sikka (Lab)]

My Lords, I would like to congratulate my noble friend Lady Drake on securing this vital debate. Opinion formers and mainstream media have latched on to the phrase “cost of living crisis”. In reality, it is a crisis of poverty, inequality, failed economic policies, an irresponsive state and democracy that is preventing millions of people from living a fulfilling life. The crisis has been incubating for years, and the main reason for that are the failed ideologies that the party opposite seems to venerate.

There is a twofold attack on people’s well-being—first, by shrinking their disposable incomes and, secondly, through an escalating cost of living, with inflation as measured by RPI already at over 12%, taxes at a 70-year high and, just last month, food prices increasing by nearly 15%. The weak pound means that we also importing inflation. Yet the Government have no strategy for dealing with corporate profiteering at all. If anything, the Government’s mantra is to further shrink people’s disposable income by cuts in real wages, pensions and public services that enable people to get healthcare and related services.

Due to government policies, the richest 250 people in this country are now worth nearly £711 billion compared to only £658 billion the year before. Clearly there is no cost of living crisis for the rich—or the rich people who donate to the Conservative Party. However, there is a cost of living crisis for the rest of the people. While many have been getting rich, the living standards of the masses are now lower than the average for developed countries. The Financial Times reported that the poorest 20% in Ireland have a standard of living almost 63% higher than the equivalent poorest in the UK. In 1976, workers’ share of GDP in this country, in the form of wages and salary, was 65.1%. Following attacks on trade unions, zero-hour contracts, fire and re-hire and other policies, that share is now down to 50%. It is not really surprising that people cannot get access to good food, housing, education, pensions, healthcare and much more.

Even before the pandemic and the energy price crisis, some 14.5 million people were living in poverty. This included 8.1 million working-age adults and 4.3 million children. That number is expected to hit 16 million to 18 million before long. Thanks to the Government’s policies, 21 million adults in this country have an annual income of less than £12,570. Has any Minister tried to live on that and see how they manage? Even with the freezing of energy tariffs announced by the Truss Government—we do not know what the next one will be called—some 6.7 million households are in fuel poverty. If the Government do not continue their support beyond next April, that number is expected to rise to over 11 million.

Some 800,000 children do not even get free school meals because their parents have income of more than £7,400. The tax system favoured by the Government clobbers the poorest. The poorest 10% of households pay 47.6% of their gross income in direct and indirect taxes. The richest 10% pay only 33.5%

In the face of the Government abandoning their duties to their citizens, people have to rely on charity for survival. Teachers, nurses and the police are relying on food banks. There are 1,400 Trussell Trust food banks and, in addition, nearly 1,200 independent food banks. They dished out 2.1 million emergency food packages in the last year, and 832,000 of them went to children.

Our senior citizens are taking endless bus trips and huddling in libraries, shopping malls and warm hubs just to stay warm. In case the Minister wheels out the slogan, “We are providing energy help”, I remind him that even with that help, energy prices have more than doubled. The Government have somehow managed to find a magic money tree and conjured up £65 billion to bail out the gilts market, but the same magic tree is never really plucked to eradicate poverty, reduce inequalities or make investment in public services.

This Government have set unprecedented records: let me give the House some examples. A study published in the peer-reviewed Journal of Epidemiology and Community Health has reported that there were 334,000 excess deaths in the period from 2012 to 2019. The cause was austerity. In 2016, Exercise Cygnus concluded that the NHS would struggle to cope with a serious outbreak of flu—an epidemic. The Government’s response was not to fund the NHS properly; they reduced the number of beds per capita in the UK. Despite the heroic efforts of NHS staff, 208,000 people died from Covid. Within the NHS, 117,000 people died last year while waiting for hospital appointments. The charity Marie Curie has reported that 93,000 people died from poverty in 2019. No previous Government have killed so many of their own people. Why have this Government not reflected on this organised democide in the name of their defunct economic ideology? We need a public inquiry into the real human cost of what the Government have done, and we need it as soon as possible.

The Government are not reflecting on what they have done to the people. We have Chancellors who are promising even more austerity, saying, “Yes, every public department has to be cut; there will have to be more cuts to people’s wages and benefits”. At the same time we have patriotic millionaires urging the Government, “Please tax us more”, but the Government will not do it. The Government could easily raise billions, for example by taxing unearned income at the same rate as earned income. If they applied that to capital gains it would raise £25 billion, which could be used to reduce inequalities, but the Government are not going to do that. Finally, I say: for God’s sake, please go and let the Labour Government do the proper thing for the country.

--- Later in debate ---

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

My Lords, I thank the noble Baroness, Lady Drake, for securing this important debate, and all noble Lords across the Chamber who have contributed to the constructive and thoughtful discussion. To answer the noble Baroness, Lady Smith, I found the debate fascinating and respond with pleasure.

I thank the noble Baroness, Lady Drake, for framing the debate in terms of the ONS study on public welfare and for highlighting that to me ahead of time. I welcome the contributions from the noble Lord, Lord Layard—it is good to see my ex-lecturer at LSE— and the thoughtful contributions from the noble Lord, Lord O’Donnell, and the right reverend Prelate the Bishop of Oxford. I believe this is an excellent basket of measures which should act as a North Star for the Government. Many moons ago, I worked a lot in Nigeria setting up digital TV, and I learned that one of the poorest countries in the world can actually be one of the happiest.

I would like to look at the impact of the cost of living on those 10 measures. I have excluded two—the environment and governance—because I was not sure how much the cost of living impacted them. I am not so sure on the governance point now, but that may be above my pay grade anyway. As I reply, I will look at how the cost of living measures impact the other areas: personal well-being, our relationships, our health, what we do, where we live, our personal finance, the economy, education and skills. I will not pretend today to have all the answers, but what I will try to do, crucially, as requested by the noble Baroness, Lady Gohir, is set out what the Government are doing to ameliorate the impact of the cost of living in these areas.

I turn first to energy prices, which we probably all agree is having the biggest cost of living impact. Of course, it is driven by the Russian war in Ukraine, but brought home to us here on our doorsteps. Many speakers today have mentioned this, including the noble Baronesses, Lady Tyler, Lady Smith, Lady Primarolo and Lady Janke, and the noble Lord, Lord Sikka. It impacts our personal finance in terms of the well-being measures, the economy and, as many have said, our health. As the noble Baroness, Lady Merron, said, its impact is as much as £1.4 billion a year.

I think we all agree that the price freeze was bold and decisive and has united support from all sides of the political spectrum. It gave peace of mind to all households. To echo the point made by the noble Baroness, Lady Drake, 77% of households are anxious about the impact of fuel prices on the cost of living. A measure that seeks to address this for all households will go a long way towards removing that anxiety, bringing financial stability to many households and helping them with their health and well-being.

At the same time, I think we probably accept the comments about whether we should have more targeted support. We will review that after six months. It is probably a sensible thing to do to make sure that we are using such a large investment of public money in the best way possible. In the meantime, in addition to the price freeze, the Government have sought to act to make sure that the 8 million poorest households receive an extra £650 per year.

Thirdly, I turn to the price freeze for business and institutions. To answer the noble Baroness, Lady Janke, that also applies to schools for the next six months. The price freeze will help the whole economy because industry, schools and hospitals are all impacted by the increase in the cost of fuel. It will help the whole economy and jobs and, by helping to keep inflation down by as much as 5%, it will have knock-on benefits in terms of the level of interest rates needed to contain inflation.

Undoubtedly, as mentioned by many speakers, including the noble Baronesses, Lady Sherlock and Lady Tyler, and the noble Lord, Lord Monks, all this has had an impact on interest rates and inflation. While I am sure we all recognise the need to increase interest rates to reduce inflation and the impact that that has on mortgage costs, it would be blind not to recognise the turbulence in the markets caused by the mini-Budget, as mentioned by the noble Lords, Lord Howarth and Lord Monks, and the noble Baroness, Lady Smith.

The impact on the cost of government debt, mortgages and our ability to finance our spending plans is crucial and affects us all in terms of public well-being. So I think we would all agree that the inescapable truth from the past few weeks is that we must find a way to make sure that, as necessary as energy price caps are and as important as investment in health and other services is, we show financial discipline and show that we can live within our means. We have to give confidence to the markets to bring down the cost of government debt and mortgages, which we know have such an impact on every single household.

To that point, I welcome the comment on the stability of Ministers. Speaking as a Minister of only three weeks, I wish for some stability. However, again, I believe that that is above my pay grade.

I want to place what we are doing in the context of needing to work within this fiscal constraint. The markets have demonstrably proved that we must live within our means.

I turn next to food prices; again, this point was recognised by many speakers, including the right reverend Prelate the Bishop of Oxford and the noble Baroness, Lady Merron. Food insecurity clearly has an impact on health, but it also impacts productivity, the economy, education and skills—all key measures of quality of life and well-being. That is why it is so important that we make sure that our children have a nutritious upbringing, which is why the free school meals programme is so important. All infant school kids get a free school meal, as introduced by the Government. Today, that 37.5% level is the highest on record, I believe.

So we are trying to give children a good foundation by having a healthy start and healthy food at school. We are also expanding that with a £200 million holidays and activities food programme to make sure that children can enjoy that when school is out. We also have the Healthy Start scheme to help 300,000 lower-income households. At this time, I thank the right reverend Prelate the Bishop of Oxford, the Church and all those who have a role in helping with food banks, because I know that that area provides a lot of comfort to people.

I turn to the impact of all this on mental health. The point was ably made by the noble Lords, Lord Hendy and Lord Layard, and the noble Baroness, Lady Gohir, among others, that the cost of living crisis causes more stress and anxiety. That is why the £2.3 billion of additional funding per annum that has been put in place to fund mental health services for an extra 2 million people per annum is a key recognition on the part of this Government of the importance of mental health to our general well-being. I believe that all areas have now set up a 24/7 urgent helpline to assist people in this. On a wider scale, the Treasury has set up the Breathing Space programme to assist people and give them breathing space when they need to manage their debts. These are difficult times and I will take this opportunity to urge anyone struggling with their mental health to seek support. Help is out there.

I turn to the pressures on the NHS. Again, many noble Lords’ comments recognised this issue today and, in terms of the broader measures of public well-being, how crucial health is in that—and, therefore, how NHS delivery is crucial to the health and well-being of our country. As a new Minister, I am under no illusions about the cost of living pressures and how they might add to the NHS challenges.

I have spoken previously about our plan for patients. I am confident that our focus on ABCD is the right approach. I will not repeat those points now. At a time of unprecedented investment in the NHS and a larger workforce than ever, my focus is to make sure that, by working with the NHS management team, we really are driving performance as well.

We have all seen examples of NHS brilliance—I had the chance to see some recently at Chase Farm in Watford—but we have all seen examples of poor performance that we know is not good enough. With tight budgets and the cost of living, maximising our return on this investment is more important than ever. That is why a lot of my focus is on making sure that not only are we expanding bed capacity by 7,000, we are expanding capacity in the right places. We must make sure that the beds are being used to most effect to relieve the pressures. Again, this will benefit the whole flow through the system, right back to ambulance and A&E waiting times. At the same time, we must make sure that the 50 million extra GP appointments we are delivering are available to meet demand in the places that need it most.

The noble Lords, Lord Layard and Lord Pendry, also mentioned the key part that adult social care plays in this whole system. As we all know, how we look after our loved ones is key to our relationships, to how we feel about ourselves and to our decency as a nation. Freeing up 13,000 hospital beds—13%—is key to ensuring that our loved ones are cared for in the right place: in care homes and not hospitals. It is also key to creating capacity in our hospitals to improve the flow right the way through the system, so that we can make sure that ambulance and A&E wait times improve. The £500 million discharge fund is a welcome addition to help solve this problem. Again, my job is very much making sure that we spend it in the right places to ensure that it is making a real difference.

In response to the point made by the noble Lord, Lord Pendry, at the same time we are working to recruit staff. Key to that, in the age of full employment, is looking to overseas workers, in the fine tradition of the NHS. I am glad that they have been added to the essential worker list so that we can have access to these markets. As the noble Lord, Lord Pendry, said, we must help people to see acting in the care sector as a vocation, not just a job.

I echo the points made by the noble Lords, Lord Howarth, Lord O’Donnell and Lord Hendy, around the role of work and employment. Work is not only key to our personal finances, it is key to our skills, our health and our own sense of worth and personal well-being. It is also key to a public sense of well-being and of benefit to the economy. In short, work pays. While I am delighted that unemployment is at a record low, as has been mentioned, we need to attract millions of people back into the workplace. Many people in their 50s stopped working during Covid. As the noble Lord, Lord O’Donnell, said, we need to find ways of attracting them back. As a former lead NED at the Department for Work and Pensions, I know about the work that the new Secretary of State, Chloe Smith, is putting in to help people on disability benefit back into the workplace. That is not only good for them and their income; it is good for their self-worth and vital to the economy. That is why we have put £1.3 billion into supporting disabled people and people with health conditions to help them back into work. It is good for them, good for their income and good for the economy.

In closing, I am grateful for the thoughtful contributions from noble Lords and to the noble Baroness, Lady Drake, for securing this debate.

[Lord Sikka (Lab)]

My Lords, will the Minister respond to my request for a public inquiry into the deaths caused by the Government’s policies? I referred to austerity, Covid deaths, deaths while people have been waiting for NHS appointments and poverty. I am aware that there are people here in the Gallery whose families and friends died. They are suffering anguish and they want an inquiry.

[Lord Markham (Con)]

No, I am not going to respond to that point at the moment.

The Government recognise how important it is to protect and promote the well-being of the British people, particularly the most vulnerable. The measures I have outlined today will do just that. We are delivering unprecedented levels of support due to the rising costs of living, and this will already be helping millions of people across the country. The increased costs of living are impacting everyone in a variety of ways, particularly the most vulnerable in society. The situation is very fast moving and I hope noble Lords will share my enthusiasm for continuing an open dialogue as the Government closely monitor the impact felt to ensure that the right support is delivered.

NHS Dental Services

Lord Sikka Excerpts

Tuesday 24th May 2022 Lords Chamber

[Lord Kamall (Con)]

I know the noble Baroness has been trying to get that question on the agenda as a Private Notice Question, so I congratulate her on asking it now. Clearly, it is right that we address this issue. The recent delay was only because of certain promotions, because we wanted to see this holistically with the cost of living crisis. Restrictions or a ban on, for example, where products can be placed will still go ahead in premier areas. Overall, it is right that we get balance to this, as any Government must. There are clearly concerns about affordability, which is why we have delayed those measures, but let us be quite clear that this is a delay; we are not kicking this into the long grass.

[Lord Sikka (Lab)]

My Lords, in England, only a third of adults and half of children have access to an NHS dentist. There are reports of people extracting their own teeth because they cannot find a dentist. As a precursor to any reforms, can the Minister explain which government policies have created this dire state of affairs?

[Lord Kamall (Con)]

It depends which Government the noble Lord is referring to. I was listening to a podcast today in which there was an interview with the BDA, which said that some of these problems go back to 2006 and the UDA. We have to look at these concerns and what we have learned from the mistakes of the Government at that time, and make sure that we address them, particularly in areas that are dental deserts.

Social Care Sector: Private Equity

Lord Sikka Excerpts

Thursday 27th January 2022 Lords Chamber

Asked by

[Lord Sikka]

To ask Her Majesty’s Government what assessment they have made of the impact of private equity on the social care sector.

[Lord Sikka (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and draw attention to my interests in the register, which states that I am an unpaid adviser to Tax Justice Network.

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

Under the Care Act 2014, it is the responsibility of local authorities to shape their local markets, which are largely made up of privately owned and third sector services. No assessment of the impact of private equity on the sector has been made, but, as of December 2021, 84% of care providers are rated “Good” or “Outstanding”. The market oversight scheme mitigates the risk of a sudden failure of potentially difficult to replace care providers.

[Lord Sikka (Lab)]

My Lords, I thank the Minister for that reply, which is really unsatisfactory because private equity is a disaster for the care home sector. To take one example, HC-One, which is the largest care home operator, is siphoning off 20% of its revenues to offshore affiliates through intra-group transactions, leaving very little for front-line services. Since 2011, it has declared a loss every year except one and paid no corporation tax but paid dividends of £48.5 million. Can the Minister explain why the Government tolerate such abuses? When will there be an independent inquiry?

[Lord Kamall (Con)]

We value the role of independent and third sector care homes. It is important that we have that right mix. Some private companies will include private equity, and it is important not to tar all private equity with the same brush. Private equity plays a role in many companies in turning them around and retaining jobs. The important thing for us is that, if any companies are potentially in financial trouble, we have the market oversight scheme to ensure that, if they go bust, there is an ability to transfer patients elsewhere.

Medical Schools: Training Places

Lord Sikka Excerpts

Monday 13th December 2021 Lords Chamber

[Lord Kamall (Con)]

The focus and priority for the next three weeks is on omicron and making sure that people get their boosters as quickly as possible. It is not only doctors who are involved: nurses, pharmacists and, incredibly, a number of civil servants are now taking part in that programme. For the next three weeks, the focus is on getting more jabs into arms.

[Lord Sikka (Lab)]

My Lords, successive Governments have poached doctors from comparatively poor countries to meet the shortages here. As the Minister knows, it costs a vast amount of money to educate and train a doctor, so developing countries have been deprived of their talents. Will the Minister explain that, or give an undertaking that the Government will provide compensation to poorer countries for stealing their assets?

Health and Care Bill

Lord Sikka Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Sikka (Lab)]

My Lords, the NHS was founded on the principle of not for profit and serving all people equally, with dignity and respect for patients and staff. This Bill violates those principles. It accelerates privatisation of the NHS. At my local hospital many services, such as physiotherapy, have already been privatised, and employees had to reapply for their jobs on inferior terms. The Bill neither protects employees nor prioritises patient care. It enables private companies to secure NHS contracts even though they do not deliver value for money. A typical cataract operation is 50% to 100% more costly in the private sector than on the NHS. It is the same story for knee and hip replacements.

Around 11% of the annual NHS budget goes to private companies, which have shareholders and overpaid executives to appease. Up to 25% of the amounts paid to the private sector disappear in dividends, interest payments, lease payments, rents and other intragroup transactions, often to an offshore affiliate. This leaves very little for front-line NHS services, and the waiting lists inevitably grow. The likes of Virgin healthcare have milked the system and pay little or no corporation tax. This Bill will facilitate even more of the same and rob the NHS.

The 42 independently run integrated care systems would be responsible for commissioning and delivering services to a group of people on a geographical basis. This heralds further fragmentation of the NHS and will create another postcode lottery.

The Minister, like many others, has mentioned integrating the health and care services, but the issue of merging the budgets is highly problematic. Take the NHS: it is free at the point of delivery, but social care is not—it is means tested. The Bill offers absolutely no clarity about how the budgets are to be merged, and there is nothing in it to prevent some NHS treatments or services being reclassified as social care and thus force people to pay more for the services. Social care budgets are fixed and capitated; overspends are not allowed. If the same was to be applied to the NHS, many people would simply not receive the treatment to which they are entitled. I hope that the Minister will clarify these issues.

Of course, we could eliminate lots of problems simply by accepting the principle that social care must be free at the point of delivery and paid for through taxation. However, I fear that a party or Government addicted to hurting the poor will somehow not accept that new policy, so we have a problem.

The Government have made some cosmetic adjustments to the Bill, but employees or personnel from private healthcare companies can still sit on the boards of the 42 ICSs and influence NHS commissioning decisions. This creates conflict of interest and must be absolutely banned. I do not recall any public marches or petitions urging the Government to ensure that individuals from Centene, UnitedHealth, Bupa, Spire and other private companies must somehow make NHS decisions. This is an ideological decision by the Government; there is no other explanation. I hope the Minister will explain the ideological basis of this meddling by the private sector.

It is also a matter of concern that the Bill gives the Secretary of State numerous powers and that he is accountable to nobody, least of all Parliament. There is no real public accountability. Should we really be trusting things to Ministers? We have already seen how they have abused their position in awarding lots of Covid-related contracts to cronies and party donors, without any public accountability. We are still awaiting details of those. What is there to prevent the Minister abusing his or her power in the future? There are absolutely no guarantees in this Bill.

Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)

Lord Sikka Excerpts

Wednesday 20th October 2021 Grand Committee

[Lord Sikka (Lab)]

My Lords, it is an honour to follow the noble Lord, Lord Winston. I wish him a speedy recovery. I congratulate the noble Lord, Lord Patel, and members of the Science and Technology Committee on producing this thorough report. I urge the Government to adopt all its recommendations.

Technology plays a great role in every walk of life. However, it must not be a substitute for caregivers or human interactions. We have already seen that face-to-face appointments to see GPs are becoming rare. In online appointments, patients are expected to describe their medical condition. This is impossible to do with any degree of certainty, especially when patients have not encountered a similar health problem before. Technology can be a boon but it can also damage your health; just ask anyone addicted to online gambling, for example, hence the need for regulation.

That said, people’s welfare requires that they must have access to digital technology. However, that access is constrained by institutionalised inequalities. About 1.5 million homes in the UK do not have internet access at the moment. Around 20% of children did not have any access to a device for online learning while schools were closed recently. Those without access to the internet are most likely to be people aged over 65 or households with low incomes or financial vulnerability. Free broadband was a radical Labour policy at the last general election and would have helped many to benefit from the digital revolution. The Government have already plagiarised many of Labour’s policies and revarnished them; I urge the Minister to do the same with the broadband policy.

The noble Baroness, Lady Young, and the noble Lord, Lord Browne, indicated that economic inequalities are a key determinant of healthy life expectancy, but the Government’s policies have accelerated those inequalities and denied millions of people good food, housing, education, internet and participation in democracy to inform policies that can improve their lives. Even before Covid, 14.5 million people were living in poverty. The poorest 50% of people in the UK have just 9% of its wealth and 42% of all disposable household income is in the hands of 20% of people, while only 7% of it goes to the lowest 20%. Some 18.4 million individuals have an income less than the income tax threshold of £12,570. Only 58% of the adult population pays income tax because the other 42% is too poor. Some 6.2 million people have an income of less than £8,844. With such an economic predicament, a large number of people cannot easily access technology and harness its benefits, yet the Government continue to neglect this challenge. Hopefully the Minister will explain why they are so committed to hurting the poorest and most vulnerable people in our society.

Income tax is payable on incomes above £12,570, but the new Johnson tax—a 1.25% hike in national insurance—applies to incomes above only £8,844. As has already been mentioned, universal credit has been cut, and the average state pension is only around £8,000—about 25% of average earnings—which is the lowest in the industrialised world. Some 2.1 million retirees live in poverty. It is estimated that around 3 million people in the UK are undernourished, and 1.3 million of them are retirees. Every year, around 25,000 of them will die because of the cold and related problems. Nearly 6 million people are awaiting hospital treatment in England and there is no relief in sight.

On top of that, the Government have adopted regressive taxation policies. Even before Covid, the poorest 10% of households paid 47.6% of their income in direct and indirect taxes, while the richest 10% paid only 33.5%. I hope that the Minister will be able to tell us how he is going to address that situation, because the redistribution of income and wealth is the key to unlocking the door to healthy life expectancy—but Ministers do not utter the “R” word. None of the Ministers at the annual Conservative Party conference mentioned it; hopefully the Minister will put that record right.

On several occasions, the Government have published impact assessments of their policies, but I am yet to see an assessment that explains the impact of their policies on women, senior citizens, children or other marginalised groups in our society. Nothing is said about the impact of matters such as the suspension of the triple lock, the cut in universal credit, the new Johnson tax, wage freezes and cuts in public services on inequalities or healthy life expectancy. Late last year, the 107-page Budget document said absolutely nothing about these things; indeed, the word “women” appeared in it only three times. Can the Minister give an undertaking that, from now on, all government policies will be accompanied by an assessment of their impact on women, senior citizens, children, marginalised groups, inequalities and healthy life expectancy?

Finally, I want to say a few words about the pharmaceutical industry. Two issues have a direct relevance to this debate. First, the pharmaceutical industry has been profiteering through drugs pricing, thereby depriving many people of vital medicines that affect the quality of their lives. Secondly, the pharmaceutical industry does not have the zeal of people like Edward Jenner to eradicate anything; it increasingly creates dependency. You can see that people are dependent on drugs for blood pressure, asthma, cholesterol and many other things because the industry wants more customers. Indeed, some of these drugs themselves have side-effects that affect quality of life, but it seems to me that the drugs industry is off the Government’s radar. Its business model must be examined.

Social Care in England

Lord Sikka Excerpts

Thursday 14th October 2021 Lords Chamber

[Lord Sikka (Lab)]

My Lords, it appears that the noble Baroness, Lady Greengross, is not here; I am next in the queue. I begin by thanking the noble Baroness, Lady Pitkeathley, for this debate.

I will talk about the elephant in the room, which so far has attracted very little discussion: the privatisation of social care and its consequences. The noble Baroness, Lady Donaghy, briefly touched on some of the issues. Privatisation is not really being challenged by the Government or many other people in your Lordships’ House, but it has really reduced the resources for front-line services, fuelled executive pay and given us low wages, which has been talked about.

Care home staff are dedicated but really poorly paid, because the corporate model is to squeeze workers as hard as possible to improve the bottom line. There are some 1.52 million care home employees in England working in 18,500 organisations, but around 24% are on zero-hours contracts. Almost 42% of the domiciliary care workforce is on zero-hours contracts. Care workers’ median real-terms pay last year was £8.50 an hour, less than the average pay for shop workers and cleaners.

Low wages, zero-hours contracts and almost 30% staff turnover mean that personalised care is almost impossible to offer. Visiting some relatives in care homes, we saw care assistants we had never seen before; every time we went, there was a different person. One can see the huge problem of trying to offer staff training, because they are simply not around long enough. I hope the Minister can explain what changes in employment law the Government would make to address this issue.

Meanwhile, executive pay in care homes has soared to around 120 times the pay of care assistants, and record dividends are being paid by care homes owned by corporations. Until the 1980s, around 90% of care beds were in local authority control. Now around 90% are offered by profit-making and non-profit-making organisations. Corporations view care homes as investments. What they are interested in is the return and the bottom line.

Many of the owners are registered outside the UK. These include private equity, real estate investment trusts and US hedge funds. The ultimate controllers of these entities have no contact with staff, patients or the citizens of this country; they live in an elevated world somewhere else altogether. The big 26 providers of care homes are part of large corporate groups that include 2,500 companies. This provides plenty of scope for intragroup transactions to extract returns in the form of rental payments, debt payments, royalty management and anything else you can think of. The Centre for Health and the Public Interest states that some 10.83% of the money is sucked out through internal transactions, which obviously means that less is available for front-line services.

Private equity is the worst culprit. The typical business model is to load the entity with debt—usually artificial debt from an offshore affiliate—charge interest on it and charge anything else they can to inflate the costs. It is estimated that some 16% of the income of private equity care homes disappears in debt repayments, which did not happen when these care homes were owned by local authorities. The five largest private equity owners of care homes have a debt of around £35,072 for each bed and extract interest charges of £102 per bed per week. This amounts to almost 16% of the weekly cost of a bed. Obviously, this is enriching a few people but doing nothing for the rest of us.

The financialisation of care homes has been disastrous. Southern Cross and Four Seasons were just some of the examples of corporate exploitation of care homes. In 2014 the Government responded by creating the Care Quality Commission, which has not been able to check financial engineering in this sector. Indeed, I doubt it has the know-how equivalent to that of the Prudential Regulation Authority for banks to even do the calculations.

I will briefly mention the levy and the finances. The 1.25% Johnson tax is utterly inadequate and does not really provide any basis for the long-term funding of social care. In my talk on Monday, I recommended that the Government think about raising the ceiling, abolishing the 2% rate of national insurance on incomes above £50,300 and charging the full 14% on everything to raise £14 billion, as well as taxing capital gains in the same way as earned income to raise £17 billion, plus £8 billion on national insurance. As a welcome to the new Minister, I invite him to answer why the Government do not wish to consider the financial alternatives I have just pointed out.

Social Care Funding: Intergenerational Impact

Lord Sikka Excerpts

Thursday 16th September 2021 Lords Chamber

[Lord Sikka (Lab)]

My Lords, I thank the noble Baroness, Lady Greengross, for this debate. Nearly 50% of social care expenditure is on working-age adults in this country, and every one of us is just one event away from the need for social care—so it is an issue not just for the elderly but for the whole society. With 18.4 million individuals on an annual income of less than £12,500 and median gross household savings in this country of only £11,000, hypothecated taxes, a higher basic rate of national insurance for the masses or insurance for the benefit of the rich property owners is not really the answer.

The best legacy that we can give future generations is a system in which social care is free at the point of delivery. Governments have bailed out banks, provided £895 billion of quantitative easing to speculators, thrown billions at contracts for cronies and continue to give billions in subsidies to railway, gas, oil and other companies. The Government can surely find resources to improve people’s welfare, too.

If the Government want to think in old-fashioned ways of tax and spend, they still have plenty of options without increasing the basic rate of income tax or national insurance contributions for the masses. Redistribution, as earlier speakers mentioned, is the key. Here are some things that the Government could do.

By taxing capital gains at the same marginal rates of tax as earned income, some £17 billion in tax, plus another £8 billion in national insurance, can be raised. Taxing dividends as earned income can raise £5 billion plus nearly £600 million in national insurance. By abolishing the current regime of tax reliefs on pension contributions, which mainly benefits the 40% and 45% taxpayers, and instead giving all pension savers a flat rate of 20% relief, another £10 billion can be raised. Currently, 12% national insurance is levied on earned income below £50,284, and only 2% is levied above that—a highly regressive practice. An additional £14 billion a year can be raised by extending the 12% rate to all income. However, the Government do not wish to inconvenience their rich friends.

Those proposals redistribute income and wealth by removing anomalies and tax perks for the few. They do not impose higher taxes on the young or most workers. There are no shortages of resources for free universal social care; there is only a shortage of political will to improve social welfare.

[The Deputy Speaker (Lord Brougham and Vaux)]

The noble Baroness, Lady Brinton, is taking part remotely. I invite her to speak.