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Health and Social Care: State Pension

Volume 768: debated on Thursday 21 January 2016


Asked by

To ask Her Majesty’s Government what is their response to the suggestion by the Chief Executive of NHS England that they should look at all the options for adequately funding health and social care, including revisiting the guaranteed annual increases in the state pension until 2020.

My Lords, the Government are committed to both a state pension system that ensures financial security in retirement, and a sustainable health and social care system. We are increasing funding for the NHS by £10 billion a year in real terms to fully fund the NHS’s plan. Alongside this, local authorities have been given access to up to £3.5 billion extra a year by the end of the Parliament with the social care precept and additional investment.

I am grateful to the noble Lord. He mentioned billions of pounds, but he will know that the analysis by the King’s Fund shows that over the five years of this Parliament the real-terms growth rate for the NHS is actually less than in the last Parliament, and social care will see a continuation of the cuts. Research published today shows that 25 other countries spend more of their share of GDP than we do on health; we have fewer doctors and nurses and less equipment and access to new drugs than many comparable countries. The NHS is facing a huge crisis. When are Ministers going to tackle this and get a grip?

My Lords, the NHS produced its five-year forward view 18 months ago, which called for additional spending in real terms from the Government over the five-year period of £8 billion. The Government have met that in full and are front-loading that investment, as the noble Lord knows, spending £3.8 billion in the forthcoming year. So the Government are fully supporting the NHS’s plan.

My Lords, there are two issues here. One is the short-term funding issue, and the noble Lord, Lord Hunt, is absolutely right to say that there is a crisis. Simon Stevens’s reference was about much more than just the pension; there are intergenerational fairness issues and a whole string of other things. My honourable friend in another place, Norman Lamb, suggested that there should be a cross-party commission to look at these issues, which cannot be resolved overnight. Is there progress on the Government accepting the principle of this cross-party commission and, if so, when might an announcement be made?

The Government believe that we have a plan—it is the NHS’s plan, which we fully support—and that to set up an alternative commission or other kind of look at the future would be a distraction at this time.

My Lords, it is over 70 years since Beveridge and almost 70 years since the foundation of the National Health Service. In the debate brilliantly introduced by my noble friend Lord Fowler last week, there were many calls for a commission or an inquiry from all parts of the House—from the Cross Benches and all the political parties. Cannot my noble friend give us some hope that he has a chink of an open mind?

My Lords, I am afraid that I cannot today give my noble friend that chink or that hope, because we are supporting the NHS’s plan, which was developed and produced by the NHS. We believe that it would be wrong to set up an alternative at this stage.

My Lords, would my noble friend agree that, while the Government are fully funding the NHS five-year forward view, which is very welcome, the sustainability of NHS funding depends on the sustainability of social care services as well? Before establishing any other commissions, would not it be advisable for the Government to make progress on implementing the Dilnot commission’s recommendations? In that respect, will the Government specifically consider enabling that to proceed by removing the exemption on one’s principal personal residence when calculating the means test for domiciliary social care?

My Lords, as my noble friend knows, the Government accepted the findings of the Dilnot review but felt that now was not the right time to introduce them, given the financial pressures on local government. We are committed to introducing the Dilnot reforms by the end of this Parliament.

Is not the plan inadequate? Many noble Lords come with requests for quite justifiable changes to health services and the Minister very generously and kindly kicks them back because of inadequate resources to meet those demands. Surely it is the case that in looking at the plan we need to look at the longer term and not just the short term in five years.

The NHS plan is for the whole five-year period—the lifetime of this Parliament. It was signed up to by all the arm’s-length bodies within the NHS. The Government support that plan and are front-loading the financing to support the plan as well, so we believe that the plan is achievable.

Is not the key point exactly the one that has just been made? We are talking not about the five-year plan but about the years that come after that and how you get a National Health Service which can be financed over the long term. Surely that is what we should also be looking at, apart from the Government’s own plan.

I know my noble friend feels very strongly that we should have a royal commission to look at the long-term affordability and funding of the NHS. That is not the Government’s view.

My Lords, in last week’s NHS debate, which very helpfully explored a number of areas, a number of noble Lords referred to the independent American research pointing out that among the—I think—11 most developed countries, our health service came out right at the top, except in the area of prevention. The worry that many of us have is that a lot of the money is being front-loaded on to the NHS, which is responding to immediate needs, but that the long-term need for a cross-party agreement on how we get much better at preventing illness and having health programmes is lacking. Can we yet again press the Minister to see how we can get some sort of cross-party agreement on this proactive approach?

The right reverend Prelate is right to remind the House of the report by the Commonwealth Fund which indicated that the National Health Service is the most efficient and overall the best healthcare system in the world. He also referred to prevention. The childhood obesity prevention strategy is due to be announced by the Government in the next couple of months. We have made huge progress on reducing smoking and in other areas of prevention, but I agree with the right reverend Prelate that prevention is a critical part of our long-term approach to healthcare.

My Lords, the Minister talks about the support for the five-year forward view, but is he aware that more than 80% of finance leads within the health service do not believe that the five-year forward view can achieve the savings that it says it can? It just cannot be done without extra resources. Surely, particularly with the state of affairs in social care, where the Government’s extra money is being back-loaded, not front-loaded, we need to take an overall holistic look at health and social care and how much we should be spending as a country and how we are prepared to raise that money fairly.

My Lords, I think that the same question is being asked in slightly different terms by many different noble Lords. I cannot really add to what I said before. We are supporting the NHS’s plan. By the end of this Parliament we will be putting another £3.5 billion into social care through the social care precept and an extra £1.5 billion into the better care fund. We believe that we have a plan for social care and healthcare over the course of this Parliament.