Queen's Speech

Baroness Greengross Excerpts

Thursday 3rd June 2010 Lords Chamber

[Baroness Greengross]

My Lords, everyone in your Lordships’ House will welcome the Government’s intention to push forward the reform of health and social care and, in the case of social care, the establishment of an independent commission on the funding of long-term care and the breaking down of barriers between health and social care funding to incentivise preventative action. The greater rolling-out of personal budgets to both older and disabled people and carers will give more control and purchasing power, and the increase in direct payments to carers and better community-based provisions to improve access to respite care will also be warmly welcomed.

As for the health Bill, no one will argue that a sustainable national framework for the NHS which supports a patient focus on outcomes and delivers on the commitment to reduce bureaucracy by strengthening the voice of patients and the role of doctors is not a good thing. I hope that eliminating the top-down structural approach will make doctors and nurses accountable to patients and their carers, rather than to layers of NHS management. However, while welcoming this new accountability and patient focus, and supporting the reduction in bureaucracy, I speculate just how the removal of one quango layer, the strategic health authorities, and their replacement by another, the NHS board, will improve things in the short term. The expanded roles of both Monitor and the CQC should go some way to assuage those concerns, but we need more detail as to exactly how these agencies will work with the new board and I hope the Minister will be able to give us a little more information about that.

While welcoming the fact that the Government are also going to prioritise public health, I look forward to more detailed plans for this area, which I hope will emerge before too long. Whether this Government are able to tackle the economic and social determinants of poor health and reduce health inequalities will be a test of whether they can work effectively across departmental boundaries, something which, sadly, eluded their predecessors.

Often it is older people, in particular, who can find themselves on the front line of experiencing health inequality at first hand. An unacceptable variation in the quality of dementia care on general wards in hospitals across England, Wales and Northern Ireland was identified in a recent Alzheimer’s Society report. Dementia patients with an accompanying physical condition are staying far longer in hospital than those people who go in for the treatment of a physical ailment alone.

Health inequalities, however, are experienced not only by older people but right across the life course. The Healthy Ageing across the Life Course programme, funded by the New Dynamics of Ageing programme, shows that childhood social conditions, as well as adult social conditions, have a long-term impact on physical performance. However, Professor Marmot’s review into health inequalities, Fair Society, Healthy Lives, published earlier this year, reminded us that while health inequalities are traditionally regarded as a problem for the NHS, the NHS is but one player in this task. We must also address the social determinants of health, the housing and neighbourhoods where people live, education, income, standard of living, occupation and working conditions. Clearly the NHS cannot tackle these issues alone; central and local government departments, the third sector and the private sector, as well as individuals themselves, have a key role to play.

The big question is whether we are willing to invest for the future in a fairer society in which we can all enjoy a fuller and healthier life. For some people, particularly older people, the impact of the economic downturn on pension funds may mean that they will have to remain in work longer. Therefore, the proposed removal of the default retirement age must be accompanied by a concerted drive by government, employers and agencies to tackle stereotypes, to extend flexible working opportunities to all workers, and to meet the health, caring and work needs of people who are 50 and over so that they can remain economically active without it being detrimental to their health.

Most well intentioned observers would support the vision described in Our Programme for Government of a reformed health and social care system that puts people in control of their lives. While we all realise that this Government have to find radical, practical and affordable solutions to the issues that we face, the challenge will be to oversee the fair delivery of this reform in this era of new politics, responsibility and opportunity.