NHS and social care commission debate

NHS Commissioning NHS Funding

Speech delivered in the House of Commons – 28/01/2016

Many Hon. Members have raised the seriousness of the financial challenge facing our health and care system. They are right to do so. Many Hon. Members have also been right to say that we need a big, honest national debate about what excellent care services look like and how we might pay for them.

I’ve been the Shadow Secretary of State for Health now for just over 4 months. In that time, it has become blindingly obvious to me – if it wasn’t at the outset – that the NHS and care system in our country is on the verge of collapse. Huge hospital deficits, care home providers on the brink of failure, older people in hospital because they can’t get the support they need at home, more critically ill people than ever before waiting too long for ambulances and large chunks of the workforce so demoralised that they want to up sticks and head for the Southern hemisphere.

For many people who use the NHS, this picture may sound unfamiliar. For the majority, it still provides excellent care – and it is important to recognise that and to thank the thousands of dedicated staff who ensure that happens. But for many others, the system fails them and the risk is that it starts to fail more and more people as time goes on.

When I was asked to do this job, I knew that the NHS and care system was under pressure. I knew that demographic change and the march of technology – both in and of themselves, good things – were placing demands on a system designed for a different century. As a constituency MP, I had visited isolated older people, many feeling like prisoners in their own homes, surviving with the help of a meagre care package or the support of family and friends if they were lucky. As a councillor before that, I had seen the soaring demand for adult social care and the woefully inadequate budget to deal with it. Demand which is growing because of our ageing population – but also because of advances in medicine which enable babies who may not previously have survived at all, to not only survive into childhood but adulthood too.

On a personal level, I knew that in my own family, my grandmother had spent the last few years of her life in and out of hospital on an almost weekly basis – driven as much by crises of loneliness as by a deterioration of her COPD.

And I knew that my other nan was forced to sell her own home to pay for her own care when she developed vascular dementia, meaning that all but £23,000 of her £140,000 estate disappeared.

All of these things I knew before I became the Shadow Secretary of State but it was only when I visited hospital after hospital, up and down the country, that my eyes were really opened. The image of frail, elderly people, perched alone on beds in emergency admissions units or in rehabilitation wards is THE abiding picture which stays with me following my first 4 months in this job. It made me feel uncomfortable. As a childless 40 year old woman, would that be me in 40 years’ time? Was it the best place to be? Was it the best we as a country could do? The image may have been uncomfortable, but the numbers say it all: 1 in 4 hospital beds occupied by people with dementia, half of all people admitted to hospital aged over 65, 300,000 people aged over 90 arriving at A&E by ambulance every year.

When we get older – and it will come to all of us, hopefully – hospital will sometimes be necessary but it shouldn’t become the norm. I know that we have to address this problem. The system needs to be redesigned so it gets the right sort of support to people at the right time and in the right place to prevent problems from escalating. But we have to be honest and say that there is a price tag attached to this.

Yes, there are still savings that can be made, ways to make the system more efficient and less wasteful but there are simple underlying pressure that can’t be wished away. Every day that goes by there are more and more, older people living with more and more complex, often multiple, conditions. Some say family members need to step up to care for elderly relatives. Others say that’s unrealistic. Every day that goes by, new drugs and treatments become available at not insignificant cost. It may be tempting to brush these uncomfortable truths under the carpet but we can’t and we would be failing generations to come were we to.

So, that brings us to the proposal we are discussing today to establish an independent, nonpartisan commission to establish what a long term financial settlement for the NHS and social care might look like. I understand the superficial attraction of this idea. I’ve been stopped on the street and in the gym by people I’ve never met before saying “why can’t the politics be put to one side when it comes to the NHS?” I understand that sentiment. Politicians aren’t the most popular bunch of people out there and too often we are seen to be advancing our own party’s interests and not those of the public. But for me, I think the question of how we fund elderly care going forward is THE most deeply political question our country faces over the next decade.

It’s political because it’s about who pays and who benefits.

Whilst the NHS is a universal, taxpayer funded system, free at the point of use, social care provision is a mixed bag – those with money, pay for it themselves, those without rely upon councils to provide what support they can. It’s been a make do and mend approach to social care in recent times but our changing population means that it no longer an option.

I spoke about my Nan earlier. A woman of limited means who experienced catastrophic care costs because she developed dementia. My family is not a rich family. We are not a poor family either. We are like many families up and down the country. When I was growing up my dad decided to take us on a two week holiday to Spain each year, instead of paying into a pension. He’s never bought a brand new car in his life but he never let his children go without either. The costs of care which fell upon my Nan and my family, fell randomly.

Is it right that a woman of limited means who dies of dementia at 85 passes nothing meaningful onto her family when a wealthy man who dies of a heart attack at the age of 60 does? What about those who plan their financial futures having invested in expensive tax advice to avoid the costs of care? It is my view that these are deeply political questions.

In order to adequately fund the NHS and care system in the future, the truth is that a political party needs to be elected to Government having stood on a manifesto that sets out honestly and clearly how we pay for elderly care and how we manage in a fair and transparent way the rising costs of new treatments, new drugs and new technology.

No matter how well researched, well intentioned, well-reasoned the recommendations from an independent commission, someone at some point will have to take a tough decision.

When I think about the cross-party work that has been done on this in the past, I think I can also be forgiven for being cautious. Take the discussions that took place between by predecessor, the Rt Hon Friend the Member for Leigh and the then Conservative and Liberal Democrat Opposition prior to the 2010 election. Just weeks out from the election, the Conservatives pulled the plug on those talks and accusations of “death taxes” were suddenly being hurled – so much for a grown up debate to answer the difficult questions. Take also the attempt at cross-party agreement in the last parliament which led to some of the Dilnot proposals on capping the costs of care. These proposals were in the Conservative Party’s manifesto, but were swiftly kicked into the long-grass just weeks after the election. I’m not sure that attempts to take the politics out of inherently political decisions have worked.

Even if we take something which should be straightforward – a new runway for example – an independent commission hasn’t exactly led to consensus on how to proceed – just more delay. As the well-respected Nuffield Trust has said: “Experience shows that independent commissions into difficult issues can have little impact if their recommendations do not line up with political, local or financial circumstances.”

How we pay for elderly care is one of the most difficult decisions facing our generation. The truth is it will require political leadership. A political party needs to own the solutions and be determined to make the case for them. I am not ashamed to say that I want the Labour Party to lead this debate. I want us to build on some of the excellent work that has already been done in this area, in particular that of Kate Barker and The King’s Fund. And I want us to spend time talking to people up and down the country about the kind of health and care service they want to see and to have a frank and honest discussion about what some of the different options to pay for that service might be.

I must also be honest though and say that I think it was a profoundly political decision in the last parliament to cut the amount of money available to councils to pay for adult social care. I say gently to the Hon Member for North Norfolk that he stood at that dispatch box opposite and defended the cuts that his Government were making to social care – he dismissed many of warnings that my hon friend the Member for Leicester West was making when she was the Shadow Care Minister about delayed discharges, about cuts to home care, and reductions in other vital services like meals on wheels and home adaptations. So I don’t think it is either realistic or right to pretend we don’t have fundamental differences on this issue.

Any attempt at finding consensus must begin with an acknowledgement of the damage done to social care over the last five years.

The public are crying out for some honesty in this debate. They understand the pressures created by rising demand and new technologies and they want to be treated like adults. To suggest that this can be all neatly sewn up by an independent commission with the politics taken out of it sounds attractive but I worry it just won’t deliver. For the millions of people who depend on our NHS and social care system, we can’t afford to have yet another Parliament where we fail to grasp the nettle. I know this proposal is well intentioned but I fear it is not the answer.