King’s Speech

Baroness Browning Excerpts

Thursday 9th November 2023 Lords Chamber

[Baroness Browning (Con)]

My Lords, health and social care did not feature prominently in the gracious Speech. The mental health Bill, about which we have heard, was a much-needed reform, as was social care reform. I welcome the measures to reduce smoking, both for individuals and for the cost benefit this would bring to the NHS.

Here lies my concern. I worked in the National Health Service in the 1970s, and my family have been regular users of the NHS. Like many, we have much to be grateful for. However, we should not allow that to cloud our judgment: the NHS is not what it was; reform is needed. There are too many critical incidents across the country and in different disciplines. Only today, we heard the BMA state that NHS Wales is not fit for purpose.

It is not just health and social care that need to be integrated; within the health service itself, people work in silos. Bureaucracy rules. It saps time and resources; it affects the delivery of the all-important health service free at the point of use. I fully agree with the noble Baroness, Lady Barker, about the need to sort out the data problems. Until that is done, we will not have a fully integrated computer system within the NHS, which would almost certainly be of great benefit not just to patients but to those who work in the NHS.

Across too many disciplines, the standard of service fails. I want to emphasise just one of those services: that for the elderly at the end of life. Our generation, if I may call it that, has seen the rapid development of technology, genetics, pharmacology and, now, AI, but little is said about how we as a nation will manage the results of those advances. People will continue to live longer and the age of the retired population will be even higher than it is now. But how and where will people die? Marie Curie states today that one in four people does not receive the care they need at the end of life. With old age comes frailty, disease and loneliness. At primary care level, the lack of continuity fails older people. The “family doctor” is now just a euphemism. In hospitals, people in the final year of life have endless waits in A&E, overlong stays in noisy wards and delayed discharges.

I looked up the NICE guidance on this. NG142, on the last year of life, states:

“There are wide ranging benefits to be gained from identifying people who may be nearing the end of life … Reducing the burden of treatments that may be unnecessary and minimising the risk of inappropriate hospital admission are potential benefits to be gained from effective identification of this cohort”.


I quite agree with that, but, in practice, where do the eyes on the patient come from to identify what is a very complex and sensitive area?

On care homes, I am particularly concerned that people funded by local authorities cannot be guaranteed that they will stay in the care home to which they were originally admitted, not because there has been a significant change in their circumstances but purely because the funding does not follow the patient. Frankly, when there is just a reassessment for the purpose of moving somebody somewhere else when they are in their 80s or 90s, that is an act as predictable as smoking to kill you.

An NHS free at the point of use needs major reform. It may be the last year of this Parliament, but I really regret that the Government did not grasp this nettle. I say to my noble friend that there are solutions, particularly for people at the end of life, which will not necessarily be the most expensive things that the Treasury has ever had to contemplate. For example, a coalition of health and social care organisations is calling on the Government to tackle failings in the way that older people are cared for in their final years of life. The new Coalition of Frontline Care for People Nearing the End of Life, which includes Care England, the British Geriatrics Society and the Gold Standards Framework Centre, is calling for enhanced core training in end-of-life care for the UK’s 3 million front-line health and social care workers. It also wants a step change in health and care integration from the new integrated care boards and heightened recognition of end-of-life care by the regulator, the CQC.

While people are dying in conditions and circumstances that are very often a great burden to carers trying to do their best for them, at home particularly, we cannot honestly say that in serving this group of people the NHS that we see today is the gold standard or a national treasure. I hope that my noble friend, whether this is the final year of this Parliament or not, will take that on board and try to move things along for this group of people.