Health and Care Bill

Lord Warner Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Warner (CB)]

My Lords, fancy having to follow that. I first congratulate the noble Lord, Lord Stevens, on his excellent maiden speech. I have known him, on and off, for several decades, and am pleased to see that, after seven years of managing the NHS, he retains his sense of humour.

I declare my interest as a member of the Dilnot commission and I certainly welcome the decision finally to implement our proposals, 10 years after we reported. I note that even now the Treasury cannot resist using a meaner means test than we proposed. That approach does not do much for the Government’s levelling-up agenda and I wonder whether Michael Gove’s department was consulted before the decision was made.

We must reverse this mean-spirited approach. The Dilnot commission’s proposed individual cap was served up to deal with a problem that we were asked to solve: the unpredictable high care costs that fell on individuals randomly and unfairly. We were not asked to deal with the underfunding of the adult social care system that has built up under successive Governments. However, back in 2011 we did say that there was an underfunding of £1 billion a year on annual expenditure of about £15 billion. That £1 billion a year has now risen to at least £8 billion, with no credible plan to rectify matters. Publicly funded adult social care faces an existential crisis, which this Government have simply failed to address and do not address in this Bill.

I will now identify a few issues that I shall be raising during the Bill’s passage. The first is the issue of timing, whatever the contents of this Bill. I have been involved with two NHS reorganisations. As a civil servant, I was involved with Keith Joseph’s disastrous and expensive 1974 reorganisation. In 2005, as the Minister for NHS reform, I was involved in tidying up someone else’s reforms. Like others, I am also a veteran of the passage of the 2012 Act, which this Bill is correcting. Perhaps I can give a little advice to the Government from this experience.

NHS reorganisations are always more expensive than their architects think. They take longer to complete than they think, and their implementation disrupts service delivery. The 2012 Act changes were estimated to have cost about £3 billion and to have disrupted NHS operations for about three years. A large number of deficiencies in this Bill have been identified this afternoon and evening, and these cannot easily be put right in time for the Bill to be implemented from next spring. I shall therefore raise the issue of a sunrise clause in the Bill, given the variable pandemic that the NHS is handling and the backlog of treatments it faces. There is a backlog of 5.8 million patients if we believe government estimates, or a queue of 13.6 million patients if we believe the recent estimate by the LCP health consultancy. Whichever one we plump for, this is hardly the right time to get a tired NHS staff distracted and anxious about another NHS reorganisation.

I turn very briefly to other issues. Clauses 18 and 68 deal with patient choice, which I welcome, but I hope to table amendments that would provide a mechanism to enable patients to exercise choice from among public or private providers of NHS services at NHS prices when they face long waits for treatment.

I do not have time to go into many other details, other than to raise again my intention to resurrect two recommendations, 33 and 34, from this House’s 2017 Select Committee report on the long-term sustainability of the NHS and adult social care. The recommendations proposed an independent office for health and care sustainability. Such a body would have no operational responsibility and it would report to Parliament regularly on issues around health and social care funding and the workforce. The recommendations were not taken up by Jeremy Hunt when he was Health Secretary. Since then, however, he seems to have had a change of heart and thinks that something along these lines is needed to keep Governments honest, as I think he said. Blessed is the sinner who repents, and we need to return to this issue in Committee on the Bill.