Motion to Take Note
My Lords, the report is the Public Services Committee’s first. The committee was established in February 2020 and is the first in this House to hold the Government to account on a range of issues that cut across public services and on policy areas that are the responsibility of multiple departments and so, too often, are the priority of none. It is a Standing Committee, so will continue to work for many years, I hope. I have the enormous privilege of being the first chair and am working with an outstanding group of Members from across the House, who have all worked with energy, commitment and challenge throughout. We have also been served by similarly outstanding officials, and I want to say thank you to all involved.
The establishment of the committee coincided with Covid-19 and it soon became clear that the pandemic was the most testing experience that our public service model had faced for several generations. It would reveal its strengths and weaknesses, and would be an opportunity, some might say a critical juncture, for reform. This became the focus of our first report.
We heard from 165 organisations and individuals, and I am enormously grateful to them. Unfortunately, no government Minister found it appropriate to come and talk to the committee. However, much of what we heard has informed our follow-up work on commissioning and data sharing, as well as our current inquiry on child vulnerability. How public services are organised, how they are funded and how effectively that funding is spent, how different services work together and, most importantly, how services are experienced by the people and communities that use and need them are the priorities for the committee.
Covid-19 has been a national tragedy for the United Kingdom. We have lost more than 130,000 people to the virus and Covid-related pressures have pushed many families to crisis point. After 18 months of tireless service, our front-line workers are exhausted and their well-being is at an all-time low.
However, the inquiry also gave us cause for hope. Amid all this despair were incredible innovation and civic action, often at local level, to support communities to stay resilient under unprecedented pressure. Decisions that before the pandemic took months or even years were made in minutes. National government worked with councils to accommodate 15,000 rough sleepers. Many of those had access to addiction and mental health services for the first time.
We were inspired by the surge in voluntary action: there are now more than 4,000 mutual aid groups across the UK. Innovative local authorities played a key role in co-ordinating volunteers to support hard-to-reach groups. For example, Agatha Anywio, 76 years old from London, relied on her local Age UK group to support her during the first lockdown. A few weeks ago the committee heard from her again. She told us that she was still getting support from the local voluntary sector to connect her to her local community. Age UK even organises two virtual exercise classes a week, which she participates in and loves.
We also saw how digital technology was used more widely and more successfully than ever before. Changing Lives, a charity working with vulnerable adults, moved many of its addiction recovery services online during the pandemic. This gave service users greater flexibility and responsibility. They were not given daily scripts by the NHS, but weekly ones instead. This meant that they were more empowered. It was risky, but, actually, it resulted in increased engagement with services, a reduction in the relapse rate and, ultimately, fewer drug- related deaths.
However, while these innovations are impressive, unless government acts urgently to lock in such changes, this good work will be lost, and we heard evidence that this is already happening. Shay Flaherty is recovering from addiction and now volunteers in Birmingham with the charity Revolving Doors. At a follow-up evidence session last month, he warned us that much of the good work with rough sleepers during the early stages of the pandemic had already been undermined. He said that, once people had been moved out of temporary accommodation, their point of contact with mental health and addiction workers was often lost. Many have relapsed and returned to the streets.
Moreover, Covid-19 revealed how innovation and community resilience are too often undermined by fundamental weaknesses in the way we deliver public services in this country. Going into the crisis, the national Government too often did not take local expertise seriously. This played out with disastrous consequences. Jessica Studdert, who is the deputy chief executive of the New Local Government Network, told us that, during Covid’s early stages, too many local authorities did not get the information that they needed from the NHS about shielded groups, even though it was the local authorities’ responsibility to deliver food and essential supplies.
We found that our poorest communities went into the pandemic with incredibly low levels of resilience. Witnesses told us that the funding of preventive and early intervention services had not been a priority in the years preceding Covid-19. This had placed greater pressures on the NHS and increased costs to the state through poorer education, employment and justice outcomes for the most vulnerable.
Sir Michael Marmot reported to the committee that cuts to local authorities’ public health grants had fallen disproportionately on the most deprived areas. Since 2014, England as a whole has seen a cut in public health budgets of £13.20 per person: in the Midlands, it was £16.70 per person; in the north, it was £15.20; and the north-east has been worst affected, with cuts of £23.24 per person in the public health budget. Witnesses told us that the upshot of those cuts was that obesity and associated diseases such as diabetes were concentrated in our very poorest communities and among our most marginalised groups. That made them extra vulnerable.
Covid-19 mortality rates in the most deprived areas were almost twice as high as those in the least deprived. Diabetes was mentioned on 21% of death certificates where Covid was also mentioned. The proportion was 43% among Asian people and 45% among black people. It was higher in all BAME groups than in the white British population.
Pre-existing inequalities have only deepened during the last 18 months. Sir Kevan Collins, who resigned as a government adviser over school catch-up funding, recently told the committee that disadvantaged children had fallen even further behind their better-off peers as a result of lost school time. His resignation should be a wake-up call to the Government that such disparities cannot be left unaddressed.
The pandemic influenced innovative local areas to break down long-standing barriers between the NHS, local authorities and other services, but in much of the country we found that collaboration between agencies was wanting. Many did not share crucial data on people’s needs. During the crisis, the lack of integration and parity of esteem between health and care saw patients discharged from hospitals into care settings without testing, resulting—we believe—in thousands of unnecessary deaths. The proposals in the Future of Health and Care White Paper and the subsequent legislation to strengthen co-ordination between the two services are welcome and necessary. True integration will depend on delivering real parity of esteem between the NHS and social care. It is deeply disappointing that the legislation to put adult social care on a secure financial footing has been delayed yet again—until, we are now told, later this year. Can the Government confirm whether the forthcoming legislation will include proposals for the reform and integration of social care, alongside any new funding settlement, to increase the resilience of the sector?
To address fundamental weaknesses in public services, strengthen the resilience of our communities to future crises and ensure that the innovations from the pandemic are not lost, the committee called for a national programme of reform. In carrying out this essential task, we asked that the Government should be guided by eight key principles. These included the Government and public service providers recognising the vital role of preventive services and early intervention.
In its response to the report, the Government said that they were committed to levelling up life expectancy. They have not yet set out how they will invest in preventive services in order to meet their 2019 general election manifesto commitment to extend healthy life expectancy by 2035, and to narrow the gap between the richest and the poorest. Health prevention and early intervention in education were not a focus of the March 2021 Budget. To date, levelling-up announcements have largely focused on physical infrastructure and skills. How will the Government address this in the forthcoming spending review? The role of charities, community groups, volunteers and the private sector as key public service providers must also be recognised. They must be given appropriate support and encouragement.
Witnesses told us that the procurement guidance, introduced by the Cabinet Office in response to the pandemic, granted local public service commissioners greater flexibility to award long-term funding and contracts based on social value, rather than just the lowest cost. We were disappointed that the Transforming Public Procurement Green Paper failed to embed those flexibilities. It did not differentiate between the commercial purchasing of goods from the private sector and the commissioning of services for people, whether delivered by the voluntary sector or by other organisations to meet the needs of the local community. In recent letters to the Government, we have urged them to work with the voluntary sector and with commissioning experts to ensure that the procurement Bill promotes social value and delivers long-term funding agreements for charities delivering services. Can the Minister update us on progress in engaging the voluntary sector on this issue?
Another principle is that public services require a fundamentally different, vastly more flexible approach to data sharing. The Information Commissioner wrote to us as part of our current inquiry on children’s vulnerability. In her letter, she acknowledged that the current threshold for sharing data on children was too high and that her office would be working with the Department for Education to update its data-sharing guidance. Can the Minister tell us how this important work is progressing?
We argue that integrating services to meet the diverse needs of individuals and communities is best achieved by public service providers working together at local level. This should be supported by joined-up working across government departments at national level. I welcome the establishment of a Cabinet committee. Will the Minister set out how this committee will co-ordinate government activity to improve data sharing and integration? Local services and front-line workers must be given the resources and autonomy to improve, and innovate in, the delivery of services. How will the Government use the forthcoming levelling-up and devolution White Papers to achieve this?
People themselves are best placed to understand how services should meet their needs, strengthen their resilience and support them to thrive. I am running out of time, so I cannot go into this in detail. It is critical that the government strategy for public service reform takes this as its core in the months and years ahead. If people and places are to be resilient in the face of future crises, services must have political and financial support, as well as autonomy, to be truly preventive and integrated around the needs of their local area and people. They must have the places and the people they serve at their heart. I beg to move.
My Lords, I remind the House that I am a vice-president of the Local Government Association. First, I congratulate the committee on its report and thank the noble Baroness, Lady Armstrong, for her introduction. She is absolutely right in calling for us to learn the lessons of how public services have been delivered—or, indeed, not delivered—during the pandemic. She also talked about the importance of resilience and of engagement with people and communities. I subscribe to everything that she said.
As the title of the report says, this is a critical juncture for public services. The committee was right to use those words. It is urgent that we learn the lessons of the Covid pandemic. It brings into stark relief the delay in this report reaching the Floor of the House for debate. It was published in November 2020. The Government replied three months later, but it has taken a further five months for this House to hold a debate. Can the Minister explain why there has been such a delay?
I want to make one crucial point this afternoon, and it is this: you cannot run England out of London. The Government’s replies to paragraphs 117, 139, 140 and 141 of the report, on the need for decentralisation and local integration of services, are, frankly, inadequate. I submit that it is not enough to promise a White Paper “in due course” based on directly elected combined authority mayors and regional partnerships such as the Midlands Engine and the Northern Powerhouse. This leaves out counties, public health structures and local government generally. It does not address the need for a single, unified health and social care service and for greater investment in prevention, which could in turn save public money, as the report makes clear.
Crucially, and as the report also makes clear, we cannot continue with a system of overcentralised delivery of public services, poor communication from the centre and a tendency for service providers to work in silos. This, my Lords, is a hub and spoke model, so beloved of bureaucracies, which promotes silo working rather than service integration. As the committee has pointed out, local authorities often receive divergent messages from different government departments. As worrying was the need for local areas to interpret public announcements by the Government without prior consultation.
I said earlier that you cannot run England out of London. We do not try to run Scotland like that, nor Wales, nor Northern Ireland, so why, for example, do we run Yorkshire like that? The argument the Government have used has been that decisions have had to be made quickly. Of course they have, but that is no excuse for national attempts at recruiting volunteers not being aligned with locally co-ordinated responses, nor for national public health executive agencies not using local public health resources effectively, nor for the expertise of local authority contact-tracing teams being unused in the design of test and trace. These are fundamental matters. It is vital that local areas are seen as partners with far greater decision-making powers.
Very wisely, the committee, on page 14, described the German public health system, which has local and regional governance structures with 375 local health offices empowered to make decisions. We could learn much from them, and I hope we will.
I want to raise a final issue, which relates to schools and which the noble Baroness, Lady Armstrong, mentioned. The Prime Minister appointed an adviser, Sir Kevan Collins, as education recovery commissioner. He produced a report, supported, it seems, by the Prime Minister, calling for substantial funding over three years to assist pupils who had lost school time, but the Treasury refused to fund it. Just £1.4 billion was allocated for one year—about a 10th of the money asked for, albeit over three years. The commissioner resigned. This is not joined-up government.
Covid has exposed serious flaws in our systems of government. I hope this is understood by the Minister and his colleagues, because they have the power to drive the change we need.
My Lords, I begin with a tribute to the noble Baroness, Lady Armstrong, who chaired our committee with tact and skill. Her professional background in social work has been a real advantage, not just in putting witnesses at ease but in managing any neuroses from committee members. We were well-served by our clerk, Tristan Stubbs, our policy analyst, Mark Hudson, and our operations officer, Claire Coast-Smith, who navigated the virtual network between us and our witnesses.
We are a collegiate committee with a broad range of relevant expertise, and our discussions have been non-partisan and good humoured. Thanks to Zoom, I am now familiar with my colleagues’ tastes in literature, paintings, casual dress and light refreshment. In our report, we mentioned what went well during the pandemic—often overlooked by the commentariat: the success of DWP in coping with a huge number of claimants for universal credit, and introducing the £20 supplement; the Treasury’s furlough scheme and wider support for business; and, of course, the stunning success of vaccine procurement and distribution. But we also identified a number of structural problems, some touched on by the noble Lord, Lord Shipley: over-centralisation, departmental silos, underinvestment in preventive measures and ill-preparedness for emergencies, themes that are recurring in our current inquiries.
I want to focus on the lessons to be learned from the three countries from which we took evidence: New Zealand, Taiwan and Germany. They are all different, but they are grappling with identical viruses with the same range of policy options and the same information about the disease.
I have three points to make about New Zealand. First, like Great Britain, it is an island—or, rather, two islands—but unlike us it challenged the early WHO advice that border restrictions were unnecessary, and in retrospect it was absolutely right.
Secondly, to deal with departmental silos, it has just set up interdepartmental boards, which they call joint ventures. We were told that
“all the interesting and difficult public policy issues are on the interface”,
by which was meant that they cross departmental boundaries. Here, NHS Health and local authority social care spring to mind. The joint ventures bid direct to the treasury for funds and a cabinet Minister is in charge, but instead of a permanent secretary, a board of the relevant permanent secretaries delivers the policy. My noble friend might like to ask the Cabinet Office to keep in touch with New Zealand on this, as it is often ahead of the game in the development of public policy
Thirdly, public confidence in the Government rose as the pandemic progressed, whereas the opposite has happened here. We did not press too hard for the reasons—again, the Government might want to pursue that further—but it was ascribed to firm leadership, a strong culture of co-operation and robust dealing with fake news.
Taiwan’s approach avoided lockdown entirely and last year it recorded record GDP growth, but its experience may not be entirely representative as it had the background of coping with SARS and a tradition of wearing masks, which was described to us as the equivalent of a vaccine.
Its equivalent of Eat Out to Help Out was more broadly based, focused on retail spending rather than just spending in restaurants, and those on low incomes were included, receiving vouchers worth about £80, whereas our scheme was much narrower and arguably regressive. Ninety-eight per cent of the population in Taiwan participated, and you got a bonus if the money was spent out of doors.
I turn finally to Germany, with its federal structure, where health and education is devolved to the Länder, which managed most of the Covid response. Perhaps the most remarkable contrast was on health spending, where there are no government-imposed cash limits, as insurance picks up the tab. I quote verbatim what we were told:
“There is no room for refusing somebody an operation that he needs or a pharmaceutical drug that she needs for financial reasons … There is no place in the German health system for refusing money because somebody is 90 years old and has a life expectancy of only seven more years. In that case … if it does not medically kill them and they can stand the operation—then go for it and the finance system has to follow that.”
That, of course, has wide ramifications for how we fund the NHS, but against the current background, I thought it worth mentioning.
I make one final point on Germany. The local authorities there all have equal powers. Our witness, John Kampfner, told us:
“It is one thing to advocate the devolution of powers within England to local authorities; it is quite another to be able to deliver that within the patchwork quilt of local government that we have at the moment, which in my view is really not fit for purpose to deal with a crisis like this, as distinct from what exists in Germany.”
Clearly, it is easier to manage devolution if the bodies you are devolving to have equal powers. At the end of the session on Germany, we asked for a key message. “Plan for the future and build in some slack”, was the reply.
I hope the Minister in response to our debate will recognise that the present system of running the country is capable of improvement—without wholly adopting the Cummings agenda of hard rain—and can tell us that the Government have an open mind on some of the radical implications of our report.
My Lords, as a member of the committee I welcome this debate, partly because it gives me an opportunity to warmly thank both the noble Baroness for the way in which she has chaired the committee and the staff for the quite exceptional way in which they have supported us.
Some of us have spent many happy hours down the years talking to empty rooms about the need to reform government, not because we long for some bureaucratic nirvana but because we were convinced that without reform some of the most disadvantaged people in our society would continue to experience poor, difficult-to-access services, and we as a nation would continue to waste scarce public money. So I was pleased that for its first report the committee chose to look at what the pandemic could teach us about our public services, and I was not surprised that it concluded that there was now an overwhelming case for reform, notwithstanding the outstanding commitment of so many of our public servants. That view seems now to be shared by the Government themselves because in their own Declaration on Government Reform, published just a few weeks ago, they accepted that the pandemic
“has … exposed shortcomings in how government works.”
I hope the Government will now revisit the committee’s recommendations, particularly the eight principles of reform that the chair referred to earlier.
For today, I shall focus on four of those principles which, surprisingly, the declaration of reform barely mentions. The first, as has been said, is the need to prioritise prevention and early intervention. Our system of government is designed to respond to problems rather than prevent them, and the pandemic has demonstrated how short-sighted that can be. Covid hit hardest those with preventable disease, such as obesity and type 2 diabetes, living in poorer communities. It is not just in the field of health that we need to prioritise prevention. Our prisons are full of people who have been failed by the education system, whose mental health problems have never been addressed and whose addictions have been left untreated. We are now seeing the cost of responding too slowly to the impact of climate change, measured in terms of the human misery caused by flooding and pollution. Any credible vision for the future and the reform of government has to prioritise a shift from response to prevention.
It also needs to tackle the issue of sharing data. The declaration of reform mentions data only as a way of enhancing the accountability of services. While that is important, the committee found countless—and I mean countless—examples of how the failure to share data between services has stood in the way of improving those services and providing essential services. We were told that schools are often not aware that a pupil is receiving support from social services, GPs are not told that a family is involved in a child protection process and criminal gangs are able to exploit teenagers in county lines because of the failure to share information between the police, children’s social care and health. We found some excellent examples of how, during the pandemic, services had found new ways of sharing data—usually at the local level—to benefit clients, but in a governance system that is now so fragmented we have to find better permanent ways to share information across bureaucratic boundaries if we are ever to reform government.
As the chair has said, the committee also saw many great examples of how charities, community groups, volunteers and the private sector had delivered essential services, often supported by their local councils. These non-statutory services, not for the first time, showed how they could respond quickly, how they could innovate and make services more accessible and how they were more trusted than traditional providers. To be fair, we saw many examples of how statutory services had helped them by introducing new flexibilities, not least in the way in which services were commissioned. Again, though, our concern was that these changes would not survive the return to normality. We felt strongly that the new normal should be about services for public good being provided by a coalition of providers, some statutory, some voluntary, with those in the voluntary sector being given real parity of esteem as professionals in their own right.
Lastly, the committee became persuaded that, in future, public services should be designed and delivered with a great deal more user involvement. We heard how the failure to do that in the past had resulted in services being provided in the wrong place, at the wrong time and in the wrong way. Civil servants and local officials need to find new ways to involve citizens and users, children included, not via ever more sophisticated consultations but by way of genuine co-design and co-production. That is especially important if the inequality of access experienced by minority groups is to be tackled.
The pandemic exposed serious flaws—we need to be honest about that—but the innovative response from so many points us to how we should change by creating a system where public services are more devolved, co-designed with users, focused on prevention, delivered through diverse providers and better at working in partnership and sharing data. That should be our future.
I declare my interest as a Cumbria county councillor.
This report from our Public Services Committee, chaired by my noble friend Lady Armstrong, is one of the best things that I have ever read on the reform of public services. It sets out an ambitious agenda, drawing on the lessons of the Covid crisis and international experience. It shows what a cross-party consideration of these issues can achieve and how a remarkable degree of consensus on principles for reform can be established.
However, I am afraid my question is whether our politics is up to the challenge. We saw a very weak response from the Government to this report, both in their refusal to engage in the work of the committee and in their very weak response. The response popularised by the Government is the so-called levelling-up agenda, but we saw in the recent Prime Minister’s speech how empty that is. When you come out with a proposal for a £10 million plan for dealing with chewing gum on the streets, that shows that you do not really have sensible principles for reform in your head. It seems to be a splash of central government paint to cover up fundamental cracks in our society.
I agree with the noble Lord, Lord Shipley, in his condemnation of overcentralisation. Not only is that a very inefficient way of trying to tackle deprivation and complex problems of poverty at local level but it is, frankly, quasi-corrupt; it is getting near to pork-barrel politics, and that is not where we should be going.
We need fundamental reform in governance and funding. At present, the Government are levelling down, not levelling up: the proposal to withdraw the universal credit supplement will plunge many poor families further into poverty; the rejection of Sir Kevan Collins’s plan for educational catch-up was a very bad sign; and, despite all the talk, there is still no long-term funding solution for the NHS and social care.
Yet the present moment is an ideal time for a Government to make difficult tax and spending choices. Everyone is aware of the cracks exposed in public services, but at the moment we are seeing the Government allowing a manifesto commitment that they made on taxes to trump the lessons of Covid—and of course that commitment came well before the Covid crisis. The point about manifesto commitments applies equally to my own party: some in my party want to elevate the 2019 manifesto to semi-sacred status, but really we should be looking at the lessons of the Covid crisis and developing policies for public services along the lines of the committee’s report.
It is not enough to simply say, “Let’s spend more money”; we also have to have a credible agenda for reform. On reform of the NHS, we have to recognise that, despite its achievements, the NHS has failed so far to provide an equal opportunity for people to live a healthy and full life, and the emphasis has got to shift to prevention. In education, we have got to recognise that there are many problems of deprivation leading to poor educational opportunities and schools where standards need to be raised.
We know that people in public services work very hard, but they often work in silos. We have to be prepared to use the charity and the voluntary sectors and even, at times, the private sector, which we must see not as an enemy but as a potential partner. We have got to avoid hidebound, bureaucratic approaches that lead to inadequate data sharing, as we have heard.
We need an ambitious agenda of public service reform. I hope that a Labour Government would be prepared to follow the principles of this committee report, which are so sensible and so wise. I thoroughly commend the committee on its work.
My Lords, I draw the attention of the House to my relevant interests recorded in the register as a member of Kirklees council and as a vice-president of the Local Government Association. As a member of the Select Committee, I too wish to praise the leadership of the committee by the noble Baroness, Lady Armstrong.
My abiding memory from the witnesses who gave oral evidence to the committee was of the dedication of all those involved in providing public services. Service providers rose to the multiple challenges posed by the pandemic and overwhelmingly put first the needs of the people they served. As we know, some of them literally gave their all. I pay tribute to all those in public service for their heroic actions during this continuing pandemic.
As we have already heard, this is a wide-ranging report and I wish to focus my comments on the response of services provided by local government. What struck me most in listening to the witnesses was that staff were energised by the challenge of continuing to provide services in a different way. They were almost always motivated to continue providing the best services they could and determined to find ways round the barriers rather than be intimidated by them. The result, we heard, was that innovative practices were introduced. Some were the result of government initiatives and funding. As we have already heard from the noble Baroness, Lady Armstrong, 15,000 rough sleepers were rehoused in hotel accommodation very quickly thanks to a government grant and local government action. This was a significant success and one that had other benefits for homeless people.
Innovations were also sparked by practitioners from different services and organisations, such as NHS community services and local government social care working more closely together and with local and national charities and voluntary groups. They described how they felt empowered by the challenges of the pandemic to pay less heed to existing service guidance and just find a better way of doing their job.
One of the examples in the report is of social care and the NHS in the Leicestershire area establishing what they call their “care home cell” to ensure co-ordination. That is an example of dependence on already very good working relationships across the organisations. The importance of effective personal relationships was repeated by other witnesses.
It was also vital in another strong theme that emerged: the importance of local, place-based services. Time and again we heard evidence about topdown control being less effective than local solutions. For instance, as someone in the Local Government Association described it:
“Guidance came out in dribs and drabs. One of my [local authority] colleagues said it was like trying to construct a piece of Ikea furniture with a piece missing and the instructions being posted daily in bits and pieces.”
Another example of topdown instruction not being as effective came from my own local authority. Early in the pandemic there was a significant outbreak in a meat processing factory in Kirklees. The central data provided was so poor that the council’s public health director asked the council’s digital service to provide the data in a more meaningful and accurate way. This was successfully achieved.
However, it was clear from the witnesses that local services of all kinds were in a fragile state following years of austerity. Age UK wrote that the pandemic had revealed the
“true extent of the impact that underfunding, structural issues and market instability have had on the system’s ability to respond”.
Local government was described as much less resilient as a result of very significant funding cuts.
One of the lessons was best described by users. They said that where providers have listened to them and then changed their practice as result, their needs were much more effectively met and there was a reduction in duplication. This co-production—codesign— was much the best way forward for users who gave evidence.
This is a valuable report; I have touched on just a small part of its deliberations and conclusions but to me the lessons are clear. First, we should reduce central control and have much more local, place-based definition of service provision. Secondly, we should enable coproductions to flourish. Thirdly, we should recognise the enormous contribution of people and personal relationships in innovating and overcoming adversity, and value those people. Finally, underfunding services on which our society relies cannot continue if care for the more vulnerable among us is important to society as a whole. The challenge for the Government is how these vital lessons are to be at the forefront of their thinking and funding decisions. I hope the Minister will explain how the Government intend to respond to these very significant challenges.
It is a real pleasure to follow the noble Baroness, Lady Pinnock and to speak this afternoon as a member of the Public Services Committee on the first report of the committee. This was a very revealing inquiry prompted by the unfortunate and unexpected arrival of the Covid-19 pandemic.
I pay tribute to the chair, the noble Baroness, Lady Armstrong, and the committee staff who worked under extreme pressure, frequently producing documents and suchlike at very short notice. I also pay tribute to my fellow committee members whose depth of knowledge and diversity of life experience made this inquiry so interesting and worth while. This was the first inquiry that I had been party to since joining your Lordships’ House, and I found it quite thought-provoking.
I say that it was a revealing inquiry because it highlighted areas of government that hitherto had been accepted as perhaps good working practice or, at the very least, accepted as the norm, with no real incentive for change. The Covid pandemic certainly put many of these previously accepted practices to the test, and they were found wanting when the chips were down. The report identifies many of these, a recurring theme being that of data sharing and, as it says clearly and is very well evidenced, Covid-19 has highlighted the inadequate data sharing between national agencies and local services.
As can be seen, we identified a number of conclusions and recommendations. If I were to choose an area from the inquiry that really caught my attention, it would undoubtedly be the overcentralised delivery of public services. We heard compelling evidence from a large number of witnesses identifying a clear lack of involvement at local level. In many cases they had been left in the dark as to the support that they were entitled to but denied due to confusion and a deficiency of clarity caused by a very centralised approach.
This was made abundantly clear by a number of witnesses. I too want to mention Agatha Anywio from Wandsworth, who told us of her experience in the early days of lockdown. She said that
“I had a letter from the Government telling me that I should officially shield, but nothing happened … It was about four weeks into lockdown before I was actually recognised, only because I persisted … If I had kept quiet and done nothing about it, I have a feeling that I might have been completely forgotten.”
Debra Baxter from Wigan, who is 55 years old and has cerebral palsy, told the committee that she was now a full-time wheelchair user. She said:
“My personal experience was that if it was not for the support of my daughter, who is here beside me, during lockdown I would not have been able to cope … I also felt that this pandemic, shall we say, took us all by surprise, and there were no actual structures with the social care setting to deal with emergencies like this. If it were not for my daughter and the friendly neighbours who live around me, I would struggle a great deal during lockdown.”
The impression left by front-line public service providers who gave evidence was that there was no co-ordinated communication strategy across government departments. Dr Jeanelle de Gruchy, president of the Association of Directors of Public Health, told us that her colleagues from central government
“often failed to draw on local resources because they were unaware of the role played by local authority public health teams”.
“There was a really poor understanding and recognition of the role of the director of public health, the local public health system and indeed local government as a key partner in managing this pandemic”.
The Government’s response has been to recognise the importance of public services working together, saying:
“We are evaluating how Government can be more joined up for local government. The recent Spending Review outlines Government’s ‘Focus on Outcomes’ … and as part of this HM Treasury has been driving a X-Whitehall approach on outcomes, and evidencing impact and public value.”
It cannot come soon enough.
In contrast, there was a very constructive aspect of the response of government to the pandemic. I refer to the way in which the homeless were taken off the streets and found accommodation.
“The Government’s March 2020 ‘Everyone in’ initiative requested that all local authorities provide accommodation for rough sleepers in their area, often in hotels or hostels … by May 2020 a total of 14,610 people in England who were sleeping rough, or who were at risk of sleeping rough, had found emergency accommodation.”
I am bound to say that that was quite some achievement.
We heard from Revolving Doors, a truly remarkable organisation which aims to help people with substance misuse, mental health problems, domestic or sexual violence, homelessness or who have had frequent contact with police and the criminal justice system. Shay Flaherty, who I have already mentioned, a volunteer with Revolving Doors who gave evidence to the committee, is nine years into recovery from alcohol addiction and helps support homeless people in Birmingham. He was keen to tell the committee that the help the homeless were getting
“in the premises they happen to be in, whether hotels or hostels, has given them a start in life and a chance to get access to addiction services and support workers.”
“I have been amazed at how the Government and councils have managed to get the entrenched homeless off the streets … This might be the first step to getting a roof over their heads permanently.”
The important point here is that, when push comes to shove, government can be innovative. As we point out in the report,
“the Government and public services must now act to ensure that the progress made is not lost.”
Shay Flaherty told us that some innovations were being abandoned:
“Slowly but surely, the guys are coming back out on to the streets … because the accommodation is being withdrawn.”
That is disappointing, to say the least. There is no doubt that the Government’s approach to rough sleeping during the pandemic has proved what can be done by working with local authorities.
I ask—I hope—that this report will galvanise the efforts of government departments to learn from the experience of Covid-19 and acknowledge the deficiencies of a centralised government approach, in order that those less fortunate members of society may benefit. This report is worthy of recognition and of being acted upon at all levels of government. I am delighted to have been involved in the inquiry.
My Lords, I declare my non-executive membership of the Cabinet Office. It is a pleasure to follow the noble Lord, Lord Davies of Gower, a colleague in the police service, the House of Lords and this Select Committee.
I add my own thanks to the noble Baroness, Lady Armstrong, for this debate and her determined and human leadership throughout the Select Committee—no easy task, given that the committee was new, the membership had not worked together and it had to be arranged virtually. I would also like to thank the clerks of the committee, who were flexible and very hard-working, for keeping the committee and the witnesses well briefed and cared for: a great achievement.
I fully endorse this report and our recommendations but wish to talk about only two issues, which were themes running through the evidence. The first is whether prevention is truly prioritised by the Government. The second is the ability of our public services to share data for the benefit of our citizens. Covid and the consequent lockdowns have brought both into sharp relief.
Nearly every public service claims that prevention of harm is its principal objective. This must be true logically; it is better that someone does not contract a disease or become a victim of crime if it can possibly be avoided. They will not suffer harm and the public service can either be allocated fewer resources in the future or—more likely—use the resources for other priorities. However, Covid showed that we did not prevent the spread of the disease and that we did not have a clear plan for how to prevent the spread of the disease.
It is also true that each public service struggles to articulate a detailed plan for how they will implement a preventive strategy. To take policing, all chief constables say they have a clear preventive strategy, but, when you ask for details of how they will do it, there is no detail. They cannot clearly indicate in their budget the resources allocated for this purpose. Yet we know that the design of products, for example cars, and places really helps reduce crime. People could not steal cars until recently because they were designed not to be stolen. Reasonable alcohol-control strategies, not allowing drug markets to get out of control, special measures to help and protect young people, and giving information to potential victims about how to avoid becoming a victim, will all have an impact. Health has a similar list.
The pandemic showed that we do not have clear and measurable preventive strategies and 10 to 20-year plans for either of these particular challenges. The UK was particularly affected by this pandemic because of obesity and diabetes making people more vulnerable to serious and sometimes fatal side-effects; both obesity and diabetes being preventable problems to some extent. So I urge the Government to take prevention seriously. It is not, as it is often portrayed, a soft, woolly subject; it is as hard-nosed a discipline as engineering, and susceptible to hard-nosed, effective measurement.
In terms of data sharing, we heard some excellent examples during the pandemic that local public service partners had found imaginative, effective and radical ways to overcome hurdles to sharing data. This was excellent news, but the question must be asked: why did they need to be so creative? Why did it take a world- wide pandemic to create the perfect circumstances for such a leap forward? The various regulators cannot understand why the public services say they cannot share data. Well, I am afraid, “They would, wouldn’t they?”
The reality is that legislation is designed generally to prevent the sharing of data: we have privacy legislation to protect our confidentiality and data protection legislation to stop the inappropriate sharing of private data held digitally. This is, of course, commendable. However, I do not think Parliament, when seeking to prevent the inappropriate sharing of private data, also intended to inhibit public services from sharing personal and mass data for the purpose of giving benefits to citizens in terms of health and security—as just two example. But this seems to have been the outcome.
At the very least, public service practitioners and leaders believe there is a problem, and there is clear evidence that poor data sharing is leading to poorer outcomes. The regulators say they will produce yet more guidance to reassure the practitioner. I believe that it is time consider legislative change to change the landscape. I propose that a statutory defence should be created for public services that share data. It is a simple “reasonableness” defence. If they share data believing it is to carry out their duties and help a citizen, they should have a full defence in law to any breach of privacy or data sharing breaches.
The pandemic has allowed public servants to take risks on our behalf in the sharing of data. However, they should not have to take those risks and, by providing a clear defence in law, the Government will reassure our public services and improve their efficiency for the collective good.
My Lords, I was delighted to be appointed to the new Committee on Public Services. I knew that under the chairmanship of my noble friend Lady Armstrong it would be a lively experience, and I join others in paying tribute to her and the clerks who supported us so well.
Of course, when we began, we had no idea that we should be producing our first report during a pandemic, nor that that report would focus on how those public services we were investigating would react to that pandemic. I must record what a privilege it was to work with a group of such experienced, wise and committed Members, and to reach a degree of consensus which was, and is, part of the pleasure of our work together.
A Critical Juncture is the title we chose for our report, which we are debating today, recognising that Covid represented an unprecedented challenge to our public services to which they responded with innovation and commitment. The outcomes are critical in terms of lessons learned, what can be retained from such excellent outcomes, and how resilience against any further challenges can be built up.
We have had some wonderful and heart-warming examples of how services responded to the pandemic: huge upscaling of provision, rapid decision-making and the breaking down of long-standing barriers by the urgent needs of the moment, but of course the virus further disadvantaged those already left behind. Black and minority-ethnic groups and those on the margins suffered disproportionately, and the years of underfunding of preventative and early intervention services came home to roost. Poor children’s education attainment got worse and the ability of local services to understand the needs of their communities was sometimes ignored in favour of some overcentralised and needlessly bureaucratic national service provision.
Lessons must be learned if we are to reap the benefits we have gained and not slip back to old ways as soon as the pandemic is over. Nowhere is this more important than in the issue of co-production, already mentioned by the noble Lord, Lord Bichard, and the noble Baroness, Lady Pinnock, where the users of services are involved in their design and planning and treated as equal partners. Our witnesses emphasised that this approach could have helped to predict and short-circuit some of the problems that came up. On the rough sleepers initiative, already mentioned by some of my colleagues, that separate sleeping accommodation was required by male and female rough sleepers would not have been a sudden surprise to providers if they had talked to rough sleepers before they set up a service which did not provide it, wasting time, money and good will. We must remember that most users when consulted—and I mean really consulted, not presented with a plan once it has been agreed—do not ask for the moon, as many providers think they do; on the contrary, their asks will usually be modest and far less than expected. If more services adopted this approach, it would be possible to maintain some if not all the innovation we saw over Covid. We must never undervalue the lived experience of users and customers—that is a very important lesson.
This lesson must be learned by public services, and they must similarly hear that the way really to engage with their consumers is most likely to be not through statutory service providers but through the voluntary and community sector. If you are single mother with addiction problems, you do not want to talk to your social worker for fear that you will lose your children, but through a local support group where you meet other mums in the same situation, share your fears and get advice and, above all, support; you will learn to deal with your difficulties, gain in confidence and become a reliable mother to your children. Time and again, we had examples of these experiences, but time and again too, we heard charities and community groups say that were treated like poor relations, did not have a seat at the table and were patronised and talked down to. Many of those barriers were broken down due to the simple urgency of the situation. The speed of acting may be much easier for a charity or community group, and many were able to mobilise services quickly without going through the various procedures and permissions which are inevitable in the statutory sector. We must commend the courage and willingness to take risks which was shown not only by staff and volunteers in charities but by their trustee boards. Often thought to be resistant to risk taking, they stepped up magnificently to support innovation and speed of delivery. The better relationships and increased respect which were gained in the pandemic must not be allowed to slip away. Not only will it provide more satisfactory services, meeting the needs of users rather than the notions of providers, but it will often save money too.
I hope the Minister will be able to confirm the value the Government place on the voluntary sector and their willingness to support it, not only in terms of funding but in ensuring that both the sector and the users on whose behalf it advocates are treated as equal partners in the provision of services, and in ensuring that the voice of users is strong and influential whenever public services are planned.
My Lords, it has been a pleasure and a privilege to serve on the Public Services Committee under the exemplary leadership of the noble Baroness, Lady Armstrong. I too thank our excellent committee staff.
Our first inquiry offered a unique opportunity to examine the state of public services in response to the pandemic, to acknowledge the positives, the amazing innovations to meet the Covid challenges and the incredible dedication of front-line workers, and to identify what needs to change as part of a major programme of public service transformation.
As we have already heard, the committee identified a number of fundamental weaknesses which must be addressed to make services resilient enough to withstand future crises. These included insufficient support for prevention and early intervention, overcentralised delivery of public services, poor communication from the centre, a tendency for service providers to work in silos and a lack of integration, especially in services working with vulnerable children and between health and social care. None of this is new—indeed, it will be depressingly familiar to many in your Lordships’ House—so why has it proved so difficult to move the dial: inertia, lack of political will or not?
As we have heard, the committee identified a number of key principles for public service reform which will require a fundamentally different mindset. I highlight just three: first, the vital role of preventive services in reducing the deep inequalities that have been exacerbated by Covid; secondly, central government and national service providers radically improving how they communicate and co-operate with local-level service providers; and, thirdly, the much-needed integration of services—the joining up of the silos—which is best achieved by public service providers working together, certainly at the local level but, critically, supported by joined-up working across government departments at the national level.
Other noble Lords have already highlighted the importance of preventive action. One of the report’s key recommendations was that an approach to public health that focused on preventing health inequalities would pay real dividends by increasing the resilience of communities and reducing the pressure on the NHS when a crisis occurred. The committee heard that many deaths from Covid could have been avoided if preventive public health services had been better funded. Therefore, I am disappointed that the Government have not committed to publishing a public health strategy to reduce health inequalities to fulfil their 2019 general election manifesto commitment to
“extend healthy life expectancy by five years by 2035”.
I join other noble Lords in asking the Minister when the Government intend to set out their plans for doing this. What assurances can he give that the Health and Care Bill will place clear duties on integrated care boards to reduce health inequalities, with sharp lines of accountability?
On the lack of integration between health and social care, our conclusions were stark. They were that
“the Government’s own pandemic planning … identified that social care would need significant support during the outbreak of a disease like COVID-19, yet social care was the poor relation to the NHS when it came to funding”
and allocation of PPE during the first lockdown. Discharging people from hospitals into care settings without testing and with inadequate PPE led to the tragic loss of the lives of thousands of older and disabled people. Our evidence suggested that the failures in adult care resulted from insufficient planning coupled with years of underfunding. The Nuffield Trust told us that although the Government’s 2016 pandemic planning exercise, Exercise Cygnus, had shown that care homes and domiciliary care
“would be in need of significant support in a pandemic”,
no advance arrangements were put in place to meet those needs. It concluded that integration between health and social care hinged on reform in three key areas: first, parity of resources; secondly, equal visibility and priority in policy-making, and, thirdly, commitment to better data collection and sharing. These things lie at the very heart of the report’s findings.
A further key issue revealed in our excellent international evidence, already referred to by the noble Lord, Lord Young, was on health system resilience—specifically, the need to build in spare capacity rather than have the NHS run continually at red-hot levels of bed occupancy. It was salutary to learn that the UK has 2.7 hospital beds per 1,000 of the population, compared to an EU average of 5.2—far lower than Germany with 8.2 and France with 6.2.
The committee produced 41 recommendations for government, including recognising the vital role of preventative services and early intervention and committing to interim funding to ensure that adult social care gets sufficient support to protect older and disabled people in any further waves of coronavirus and future pandemics. In short, it came up with a comprehensive agenda for change to address the systematic weaknesses revealed by the pandemic to deliver lasting and transformative reform.
Being charitable, as I like to be, I can only describe the Government’s response as lacklustre. While they largely agree with the committee’s main conclusions—it would be hard not to—their response contains very little detail on how or whether they plan to address its recommendations. It is, to say the least, disappointing that after tantalising rumours in the press that the PM is finally going to bring forward his proposals to reform adult social care before the Summer Recess, they appear to have been relegated to the long grass again.
Covid has been a serious wake-up call for this country and particularly for the way we plan and fund our public services. There really is a chance to build back better if the Government are prepared to do things differently and invest in the areas highlighted in this report.
My Lords, the House of Lords Public Services Committee was established to consider the operation and future of public services, including health and education. It started work in February 2020, and the committee recognised very quickly, following the outbreak of Covid-19, that
“the pandemic would have an enormous impact on the delivery of public services in the years to come.”
Therefore, it set up an inquiry to examine what the experience of the coronavirus outbreak can tell us about the future role, priorities and shape of public services. The committee found five key weaknesses in public service provision, which it argued made the response to the pandemic more challenging. One of them was
“insufficient support for prevention and early intervention services,”
which I will come to.
The committee made various recommendations, and one of those that I want to focus on was:
“Recognising and supporting charities, community groups, volunteers, and the private sector as key public service providers.”
If one word stands out throughout the pandemic, it is “collaboration.” Last year, at the beginning of the pandemic, I was privileged to be appointed a trustee of the National Bereavement Partnership right from its outset. It has carried out inspirational work throughout the pandemic under the leadership of our inspirational CEO Michaela Willis. The National Bereavement Partnership has made a difference to the emotional well-being of callers. These are people who call in with very sad and tragic situations. The National Bereavement Partnership provides emotional support and therapeutic intervention and is a conduit between other services, enabling long-term well-being. It adds value to NHS services; it saves the Government money; and it keeps people out of the mental health system. So here we are where the public sector and charities work hand in hand to the benefit of each other.
When it comes to prevention and early intervention, the committee cited evidence highlighting the disproportionate impact of Covid-19 on BAME communities, including:
“almost a third of all patients critically ill with COVID-19 in hospitals were from BAME backgrounds—despite making up just 13 per cent of the UK population—
that is, almost double the proportion of the population being critically ill—
“and … people of Bangladeshi background in England were twice as likely as white British people to die if they contracted COVID-19.”
The committee recommended that the Government take an approach to public health that focused on preventing health inequalities over the longer term.
The pandemic has highlighted the potential of the NHS to drive forward large-scale change and new approaches in a short period of time. There are so many examples of this. The vaccines are a great example; we have a world-leading vaccine programme with Kate Bingham, a private sector individual, appointed by the Government in May last year. On 8 December, we had the first vaccination. We had six vaccines on order and 400 million doses for a population of 67 million. Today, almost 90% of the adult population have had their first dose and almost 70% have been double-jabbed.
Again, this could not have happened with the public sector on its own; it is due to the public sector working with the private sector, with Oxford University, with the university sector, and with the Serum Institute of India in Pune, the largest vaccine manufacturer in the world, which now has a 1 billion-dose contract with the Oxford AstraZeneca vaccine. Of course, it is international collaboration: AstraZeneca is a Swedish-British company headquartered in Cambridge.
The way we worked with the ventilator challenge was amazing. We got 20 years’ worth of essential ventilators in 12 weeks. So was the way we created the Nightingale hospitals, such as the 4,000-bed centre at the ExCeL centre—the first where you had the private sector, the Armed Forces, universities and the NHS all working together.
All this underlines the importance of the health and life sciences sector. As president of the CBI, we have launched our economic strategy for the next decade, called Seize the Moment. Within that, one of the pillars is:
“A healthier nation, with health the foundation of wellbeing and economic growth”,
which is absolutely crucial.
“COVID-19 has put the health of the nation under the spotlight. Firms have stepped up, with a significantly increased emphasis on the health and wellbeing of their employees. And, for us as a country, the crisis has been a wake-up call, bringing the pervasive impacts of health inequalities into stark focus, underlining the importance of health to people’s personal and professional success, and reinforcing just how vital our life sciences capability is to the UK’s progress now and in the future.”
Poor health is expensive: 63% of years lost to poor health are in the working-age population. This costs the UK £300 billion in lost economic output annually, excluding health costs. So, life sciences and health can be a major driver of economic success for the UK, with the global market in pharmaceuticals and medtech worth £1.2 trillion in 2020; and it is expected to see a strong growth of around 5% a year through to 2030. The secret, again, is collaboration between the public sector, charities and the private sector.
People talk about building back better. Well, I chaired a CBI event with the mayor of Athens, and he said, “We do not talk about building back better; we talk about building forward better.” So, let us build forward better.
My Lords, it is a great pleasure to follow the noble Lord, Lord Bilimoria, who spoke compellingly about collaboration. It has been a pleasure and an honour to be a member of the Public Services Committee, which has behaved throughout in a collegiate and constructive way, and I thank my committee colleagues. Like others, I would like to thank our excellent chair, the noble Baroness, Lady Armstrong of Hilltop, who has demonstrated throughout hard work, dedication and great good humour. Thanks also go to our secretariat—the team of Tristan Stubbs, Claire Coast-Smith and Mark Hudson —for their utter professionalism.
Our first report, as has been stated, commenced physically in February last year, before the first lockdown, but we quickly moved to working virtually. Work was carried out remarkably smoothly on our report A Critical Juncture for Public Services: Lessons from COVID-19, which was published in November last year. I thank officials, broadcasters and all who made this possible. I will focus on three areas in particular, although, as has been demonstrated by those serving on the committee, our report was wide-ranging. I would like to look at prevention and early intervention, then at local delivery, and then at the importance of voluntary organisations.
On prevention and early intervention, a key area, the evidence that we saw was clear. People who are obese, who smoke, who are diabetic and who live in unhealthy social, economic and physical environments are at a far higher risk of dying from Covid-19. That seems now almost beyond challenge. The Prime Minister himself nailed the danger of obesity when he spoke of Covid-19. Yet the Government in their response to the report did not recognise these factors explicitly, rather surprisingly, saying that further analysis of the evidence will inform our learning. I hope that the Government accept the very clear evidence, and it will be good to hear from the Minister on this.
Our inquiry heard from Sir Michael Marmot about the underfunding of prevention services, and we heard that obesity rates were highest in deprived areas. It is laudable that the Conservative manifesto of 2019 commits to extension of healthy life expectancy by five years by 2035. A litmus test of the Government’s approach will be the attitude to the recently published national food strategy, the Dimbleby report, the last part of which was published last week. That report is clear on action at producer level to reduce salt and sugar in foods, just as we have done successfully under a Conservative Government for soft drinks. That action would produce results. I hope that the murmurings of some on the libertarian extremes, who suggest that exhortation is sufficient, are ignored, given that they are the voices of a few people who have not been following the evidence of the pandemic, and who are committed to an imagined libertarian Valhalla. Not only will positive action help hundreds of thousands, if not millions, of our fellow country men and women, it will also of course ease pressures on the NHS and, indeed, on the economy from the impact of ill health. The details of how the Government are to carry out future arrangements are awaited with interest.
The importance of preventive services in the Ministry of Justice and the Home Office is also highlighted in our report. The Government’s response does not pick up on how there will be investment here in preventive services for those who have been impacted by addiction, homelessness and poor mental health—evidence that we received on this from Revolving Doors. By the same token, early intervention on education, particularly as disadvantaged children have fallen further behind, is crucial. Beyond the existing pupil premium, we need to pick up the proposals on catch-up that Sir Kevan Collins put forward.
On localisation, in the memorable phrase spoken earlier by the noble Lord, Lord Shipley, running England out of London is not on. I agree with that, as does the report. Local provision, whether through the public sector or voluntary organisations, is vital; it is familial, trusted, responsive and fleet-footed, and it is more likely to be flexible. We need to recognise that through public health teams and more local funding, not just because of a democratic deficit but because of lack of local provision, certainly contributing to the disease and to death. I welcome the progress that has been made on metro mayors, and I anticipate more—but much more than that is needed for the localisation that is necessary.
The third area of our report that I wanted to cover related to the importance of voluntary organisations. As I have indicated, they are trusted and familial. Their reach is extraordinary, as I found during our inquiry. For example, Ian Jones, the chief executive of Volunteer Cornwall, told us of 4,500 Cornish charities. Many local councils pick up and work with the voluntary sector. Camden Council, for example, relies on Hampstead Volunteer Corps to help with food distribution, and we welcome the development of the new outsourcing playbook by the Cabinet Office. It is welcome, but we need to see it being followed by ensuring that public service commissioners prioritise social value when contracting services. We look forward to that.
In short, there is a lot to do, and I look forward to hearing from the Minister on taking things forward—in all our interests, but particularly in the interests of those most disadvantaged, which, as we have heard, includes the BAME community, as well as the Gypsy, Roma and Traveller communities. Generally, those at the bottom of the pile have been hardest hit, and the Government must do more to help them.
My Lords, I thank the noble Baroness, Lady Armstrong of Hill Top, for this debate and the Public Services Committee for its immensely insightful report. Future generations will wonder how their Government permitted nearly twice the number of their citizens to die during the Covid pandemic than all the civilians who died during the Second World War. Yes, we need to transform public services, but that cannot be done without transforming politics, and economic and social policies. We need a visible politics of care and compassion. The fact that the Prime Minister was comfortable with 83,000 Covid fatalities in the age group 18 or over is really a sad low point in British values. Front-line workers, including hospital staff, care home workers, transport staff and retirees feature disproportionately on the Covid death list.
As Sir Michael Marmot’s recent report demonstrates, the main reason is that, due to low incomes, people have poor access to good food, housing, healthcare and personal space. The pandemic has shown us that poverty and inequalities cause death, but the Government have done little to check that; indeed, they continue with their wage freezes, without any impact assessment on the lives of people or the capacity of the country to manage pandemics. In 1976, the workers’ share of the gross domestic product was 65.1%, and just before the pandemic it dropped to 49.4%—a decline unmatched in any other industrialised country. The average wage was stagnant in the decade preceding the pandemic. This economic legacy has weakened the people’s resilience to pandemics. Many people tested positive for Covid but could not find a safe place to isolate, as they lived in cramped accommodation, all because they are poor.
To manage pandemics, countries need institutional memories and capacities; we lack both. The NHS lacked investment before the pandemic. To manage the crisis, the Government hired expensive and often ineffective private sector consultants for their test and trace programme, which has not augmented the long-term capacity of the NHS. Consultants quickly enter and exit an organisation and leave little trace of their activities. This makes it harder to build a pool of experience and draw lessons.
The Government need to look at their own obsession with privatisation, a key factor in the deaths in care homes. Since 2010, central government grants to local authorities have been cut by 38% in real terms; this accelerated the privatisation of social care. In care homes owned by private equity, nearly 11% of revenues vanish in servicing contrived debt. Private equity also expects a return of 12% to 14% on its investment, which meant that 20% to 25% of the revenues of private equity disappeared in returns, leaving very little for care home residents. Care home workers and residents suffered. Of the 1.49 million workers in care homes, only 50% are full time—nearly 24% are on zero-hour contracts. Almost 42% of the domiciliary care workforce is on zero-hour contracts, and staff turnover is nearly 30%.
In March 2020, the real-term median hourly pay of staff was just £8.50 an hour. In these circumstances, it is difficult, if not impossible, for carers to get to know patients and provide personalised care. Low-paid staff cannot afford to isolate or take time off to recover. It is hard to recall any government concerns about the negative outcomes from privatisation of social care. We cannot build capacity to tackle future pandemics by just creating poverty.
The Government’s economic policies are also creating new dangers and diseases—just look at the water industry, where almost every water company has been fined for anti-social practices. Southern Water is the latest example. The company illegally dumped tonnes of raw sewage into rivers and seas, increasing the likelihood of diseases. Its directors calculated that it was better to pay fines than to treat the sewage, so they dumped it. The puny £90 million fine is no deterrent: Southern’s chief executive has just received a bonus of £551,000 for boosting profits. I cannot recall seeing any health impact that accompanied the Government’s two-thirds cut in the Environment Agency’s budget or deregulation, which expects water companies to self-report their illegal practices.
I hope the Government will reflect on how their political, economic and social policies have inflicted death on thousands and sadness upon millions of innocent people, but I am not too optimistic.
My Lords, I declare my interest as a vice-president of the Local Government Association and I congratulate the noble Baroness, Lady Armstrong of Hill Top, and all the members of the Select Committee. Although I put my name down for this debate, I seem to be one of the few people speaking today who did not sit on that committee. When I put my name down, I did not think the report would be this good—I had not read it—so I would like to say that it is an absolutely amazing report and I thank the committee for achieving it. It is wonderful to see such excellent cross-party working, which is often true of Select Committees.
It is good that the noble Lords, Lord Young of Cookham and Lord Davies of Gower, mentioned the positives about the Government because, quite honestly, looking through this it is hard to pick out the positives. The way that homelessness was dealt with was one of them, but unfortunately homeless people are now being thrown out and are back living on the streets—I see evidence of that every day. I hesitate, being one of the few speakers today who was not on the Select Committee, to comment on every issue, but there are three areas I want to speak to, because they seem so important.
The deep, ongoing inequalities in our society are well documented and clearly had an impact on our ability to deal with the disease, for individuals and for organisations. From a green point of view, we always argue for less inequality, because if people cannot feed their children, clothe themselves, pay their bills and their rent, it is very hard for them to care about other issues, such as the climate emergency. We are better as a nation if we are more equal. That has always been true, and it is something the Government have not grasped and acted upon. The report says:
“People … who live in unhealthy social, economic and physical environments are at higher risk of dying from COVID-19.”
The greater the inequality, the more people will die from a disease such as Covid-19. The Government have to be aware of that and change their actions on this issue. Their job, as a Government, is to care for us all, to reduce inequality, to lift people out of poverty and to prevent worse poverty in the future. What part of government is actually working on a plan to reduce inequality, now and for the future? Of course, many children are likely to be disadvantaged in the long-term by the first lockdown, possibly—probably—leading to much worse life outcomes for them. As a nation, we lose their potential, their skills. So, what do the Government plan to do to make sure that those children catch up as quickly as possible?
I do not get the feeling that the Government understand just how important the National Health Service is and how they need to resource it better. Better resourcing does not mean selling bits of it off. I do not know whether this is still true, but earlier I read that there was going to be a 3% pay rise for NHS staff, and it was going to come out of national insurance. Obviously, that was a few hours ago and the government policy could have changed in that short time, as it sometimes does; however, I want to know why that 3% rise might come out of national insurance when it should come out of tax, so that everybody who is on a higher income would pay more and people on a lower income would pay less. That seems much fairer to me than what the Government are planning to do.
It is a common view that the Government completely messed up on the pandemic. We have heard about a few areas where they did not, but they were incredibly lucky that the NHS did the heavy lifting, made them look better and saved many lives. Of course, the NHS is still saving lives. There are still people with Covid-19, the numbers are rising once again, and the Government have instituted a “Freedom Day”, which is essentially the freedom to get a nasty disease and possibly die.
The third area is why the Government did not send anybody to the Select Committee to give oral evidence. That seems to me to be a derogation of duty and it shows a lack of respect for the House of Lords, which clearly does immensely good work, time and again. It also fits with the Government’s refusal to launch an inquiry. They keep saying, “Now is not the time, because it would distract people”, but of course it will not be the same people dealing with the pandemic at the moment who would be looking into what actually happened. The committee has said that it is not trying to look at all the failings but to set out a road map for the future, which is fair enough. As people dealing with the inquiry would be different from those coping with the pandemic, why are the Government still resisting? Are they hoping people’s memories will have faded? Why cannot an inquiry start immediately? Why not tomorrow?
We cannot afford to deny that this has been a disaster. This report is an excellent way forward. I think the Government should learn from it and accept that the road map being offered is an excellent one. I urge the Government to follow it.
My Lords, as the noble Lord, Lord Shipley, pointed out, your Lordships’ committee wrote this paper some nine months ago—sufficient time for events to prove the committee right or wrong. Events have proved it overwhelmingly right and the Government’s response totally inadequate.
For example, the paper speaks of overcentralised delivery of public services. Thanks to a report earlier this week by the National Audit Office, we are able to compare the centralised procurement in England, using companies without experience of PPE—but, incidentally, with connections to the Conservative Party—and companies new to test and trace, with the Welsh procurement, where local authorities carrying out this work used trusted and experienced suppliers. Not surprisingly, the result was that the cost per head of the test and trace and PPE in Wales was half the cost in England, with no decline in quality and service. As a result, Welsh businesses were supported more generously. In Wales there were winners all round. Surely one of the first lessons learned must be the need for careful analysis of whether services are best delivered from the centre or locally.
The committee calls for a more flexible approach to sharing data. Surely, there is no better example of this than the speed at which an effective vaccine was produced and distributed. Years of research, financed and carried out in the public sector, produced the revolutionary RNA system of vaccines, which enabled the private sector to produce and distribute a Covid vaccine within months, instead of the years previously needed. It was this that enabled the Government quickly to vaccinate a large part of the population. Surely, the lesson learned here is to encourage this co-operation as a matter of course, not as an exception when there is a crisis.
The report also calls for radical improvement in the way government communicates and co-operates with local service providers. This means that the Government must provide clarity to local authorities and businesses. We are currently suffering exactly from this, because the 10-day stay-at-home alerts are advisory rather than legal obligations. Also, there is now inconsistency over wearing masks and social distancing, caused by abrogating responsibility to local authorities, businesses and each one of us individually. Only yesterday, the British Chambers of Commerce said that companies were struggling to make sense of which staff were defined as critical workers and so were eligible to continue working when pinged by the NHS app or by test and trace.
By asking us to make sensible decisions without clear guidance and without providing the tools to make these decisions, the Government are guilty not only of creating uncertainty by mixed messaging but of further endangering public health. Indeed, this lack of clarity has become a defining feature of this Government. The Joint Committee on Statutory Instruments, of which I am a member, almost weekly takes the Government to task over lack of clarity in one or more of their instruments. These examples show that the committee is absolutely right to call on the Government to make public services more resilient and more able to withstand any future crises. As my noble friend Baroness Armstrong explained in her excellent opening speech, this lack of resilience has taken a huge toll on human life and caused enormous physical and psychological damage—as well as damage to the economy. The committee is right: we must learn the lessons, so that we are better prepared if it happens again.
I thank my noble friend Baroness Armstrong and her colleagues for this excellent report. It is a true road map for the Government to follow, coming out of Covid and taking us forward—not building back but building forward. We must look forward and ensure that we go forward and put the correct finance behind this.
I was very disturbed on reading the two pieces in the report about education and inequality. We know that for a child, from the time it is born, equality, food and care are important, as is education. We have seen throughout this pandemic that money for young children and mothers has been cut. There have been no Sure Start start-ups, and no real efforts to provide free nursery education. There is the whole question of food banks and benefits for food. We know that children cannot concentrate without food, and their lungs and the rest of their body are affected too. We are talking about the future generations of this country. Promises have been made but not kept by the Education Minister, and it is a disgrace. We were so lucky that teachers stayed and continued to try to work.
I must ask this Government to think seriously about education. It is not an issue I am known to speak about often, but I find it impossible not to address the way the Government have dealt with it. This report really makes the case, and the road map is here. We must look not only at education from the point at which a child is born, but at the way mothers are treated in hospital and the care they need. We have seen, through this report, how vulnerable mothers from certain sectors are. They need more care, and their babies need care. We also know that a child’s brain, if it is not helped, is not going to grow well; and again, I mention the lungs.
I ask the Minister to undertake that she will ask the Government and the Department for Education to look yet again at children’s education from the very start. We need to have Sure Starts. We cannot rely, as we do, on the voluntary organisations and others that help to make this happen. Sure Starts in all primary schools also have to be brought back. They help not only the children but mothers who are working from home; they need this social contact with each other. Further, we have to give a better undertaking in respect of food banks and how the associated cards operate—when you pay for food, the money is not on them. Why are we using agencies and consultants that cannot deliver? As many noble Lords have said, we pay lots of money to consultants, but nothing is given back. Also, we must look again at the benefits system as we come through Covid. If people cannot look for work, they need benefits to keep themselves and their families going. That is absolutely vital; otherwise, this is going to cost the health service much more, as the report says.
I support all my colleagues in what they have said today. I look forward to hearing what the Minister has to say.
My Lords, since coming here 10 months ago, I have read a lot of legislation and reports and to be honest, it has all been a bit of a chore. However, this report sparkled. I know it has had lots of plaudits, but I commend the noble Baroness, Lady Armstrong of Hill Top, and all the members of the Public Services Committee for an accessible, informative and thought-provoking document. There is lots in it I disagree with, but it was just so useful—and unusual for these toxic times, in that it was free from rancour and “gotchas”. As it says itself, it is not about apportioning blame for past failures, but making constructive suggestions for future reforms—a great relief.
One caveat: in general, I am wary of any sphere allowing the normal of the pandemic to automatically become a new normal by default. The call in the report is to lock in innovations, but that makes me nervous. Yes, it is very useful to kickstart debate, but not to institutionalise as a rigid fait accompli. For example, we all know that digital technology may have facilitated everything from working from home to digital health consultations. But as the report itself points out, Zoom teams and the like could never, and should never, replace face-to-face services. I note with concern that too many GPs and, for example, university lecturers and senior managers, seem reluctant to resume real-life interaction, at the expense of service users.
One striking feature of the report that I would like to make explicit is the cost of treating the NHS as almost a sacred cow public service. It is understandable to celebrate and almost sacralise the health service in a health pandemic, but this can be at the expense of other services. Testimony in the report noted that support for the NHS, especially during the initial part of the pandemic, might have been necessary but should not have come at the expense of preventive and public health services. I agree.
The Nuffield Trust is quoted as noting how the Covid crisis highlights the startling inequality between health and social care services. Many of us felt uncomfortable that that initial “clap for the NHS” neglected care workers. Even today, all the focus is on the pay rise for the heroic NHS staff, whereas social care is plagued with poor wages and awful employment conditions; and now we have even singled out social care workers as the only workforce facing mandated vaccines or the sack.
So, it is important that the report highlights that, long before Covid, successive Governments prioritised funding the NHS—especially acute services—and neglected funding social care. The Nuffield Trust notes that the NHS received generous emergency funding from the Treasury in the early stages of the pandemic, which then enabled a dramatic expansion of capacity. Care providers, in contrast, said that extra funding did not reach them. Also, and related, the deputy director of the New Local Government Network contrasted the experience of local government with the NHS. The NHS had its costs met in full and deficits written off unquestioningly, but that was a privilege not afforded to councils or other public services. I do wonder about this hierarchy of priorities.
The consequences go beyond material funding. As ADASS points out, the historical tendency to prioritise the NHS has influenced policy decisions, sometimes with tragic consequences. In the name of saving the NHS, rather than the NHS saving lives or the public, we now face the collateral damage of non-Covid deaths from cancer and heart disease and huge waiting lists for many in dire need of medical interventions, with the terrible news of an increase of 50% of under-20s hospitalised with eating disorders. In a different debate earlier today, we also heard about the use of “do not resuscitate” in hospitals. We cannot ignore these things.
But perhaps the greatest horror associated with the focus on the mantra of protecting the NHS was the scandal of patients being discharged from hospital into care homes without testing—what the Nuffield Trust called, as quoted in the report, a
“rapid clearing of hospital beds in the early stages”,
regardless of the
“lack of preparedness of the care settings”.
The most vulnerable died as a consequence and, at the very least, it is important that we be able to query NHS policies without being shut down as somehow disloyal to NHS staff who, I agree, have been and are heroic and hard workers—but so are other workers. I do not think that you should be called a traitor to the institution if you query it.
Another striking aspect I read from the report is the wasted potential of civil society in helping deal with the pandemic. On a positive note, of course, the report gives lots of examples of innovation happening because bureaucracy was swept away. In fact, sometimes to tear up the red tape is caricatured as a laissez-faire, careless approach, but the removal of overly bureaucratic hurdles allowed public services to work alongside charities and community groups and volunteers, and the private sector stepped up. Altogether, this played a huge role in delivering services.
The surge of civic action, such as the 4,000 Covid-19 mutual aid groups and the local WhatsApp and Facebook groups I am sure we were all in as volunteers, showed a real appetite for providing practical solidarity in the emergency from so many people. We saw the generosity of 750,000 people signing up in four days when NHS England’s Royal Voluntary Service was launched in April 2020, but sadly that was wasted. The Institute for Volunteering’s research rightly notes in the report that overcentralised co-ordination was not aligned to locally organised activities, significant time was taken to respond, enthusiasm dwindled and people became demoralised. I think it was just so sad when volunteers could have helped, for example, relieve the pressure on social care workers, or indeed NHS workers.
In general, the official approach to Covid was to demobilise the public—to squash initiative and volunteerism. The report notes how the German public health service, in contrast, mobilised and seconded public servants from across departments: forestry, museums—
My Lords, I am delighted to take part in this debate. I too congratulate my noble friend Lady Armstrong on her skilled chairing of the Select Committee and the clerk and his staff for their excellent work.
As the report says, the pandemic represented an unprecedented challenge to the United Kingdom’s public services. I take the positives from it: many of them rose to that challenge. Many public service providers developed remarkable innovations, as the noble Baroness, Lady Fox, just referred to. Decisions which before the pandemic took months were made in minutes. Good personal and organisational relationships broke down long-standing barriers between the statutory and voluntary sectors. New ways to deliver services flourished. I agree with the noble Baroness, Lady Fox, that we do not want to lock in certain behaviours, and we need to tackle the issue of the difficulty of face-to-face interventions. Yes, the NHS does have its challenges. I agree about the issues around “do not resuscitate” and the transfer of patients with Covid into care homes. But I would say to the noble Baroness that, when you look at the comparative statistics, the NHS has fewer beds, doctors and nurses than any comparable healthcare system, and we have to consider that in terms of funding decisions for the future.
Of course, it is not all good. We heard as a committee that the overall public health response was at times hampered by overcentralised, poorly co-ordinated and poorly communicated policies that were designed and delivered by central government, even though local-level providers were often better equipped. One of the key questions the committee poses is: how do we hold on to the positive behaviours we saw during the pandemic? I want to concentrate on just one issue: the over- centralisation of public services.
My noble friend Lord Liddle asked if our politics is up to the challenge of tackling this centralisation. The Government’s response was pretty wet, although the Prime Minister’s recent speech on levelling up did at least cover some of the ground. He spoke about the country being the most centralised of all the developed countries. He acknowledged that the big metro mayors were championing their hometowns, and that in the rest of the country, including the counties, local leaders needed to be given the tools to make things happen. Does this suggest a possible big move to decentralisation or even devolution? Well, up to a point, because I wonder whether the Government have themselves taken note. Last week in the Commons, the Health and Care Bill had its Second Reading. It did not show much commitment to devolving or decentralising power. Indeed, it faces the other way, with a power grab by Ministers and an imposition of powers of direction for the Secretary of State on the NHS. This suggests that there is a little way to go before government and Whitehall understand that devolution requires a huge shift in thinking.
In a really interesting paper about this, the Institute for Government has pointed out that, in recent decades, UK parties of all political persuasions have made commitments to decentralise power but in reality, coming into government, have found it very hard to do so. The institute’s analysis suggests that decentralisation requires at least three main groups to either support or acquiesce to reforms: national politicians, local politicians and, of course, the public. These groups often have different interests, are not internally cohesive and have different priorities and values—all factors which make securing sufficient support difficult. As important, all these groups have considerable, and not to be underestimated, power to block or undermine reforms they dislike.
Each of the obstacles the institute identifies is linked to one of these groups: national government lacks trust in regional or local government competence; those leading decentralising reforms are often unsuccessful at persuading other departments or Ministers to give away powers; taking powers from existing local politicians to give to a new sub-national government layer creates opposition; and the public generally lack interest in regional and local government reform and are sceptical of the value of more politicians. This goes perhaps some way to explaining why the bold talk of decentralisation is not always matched by deeds—and yet you come back to the conclusions of our report and to the argument that decentralisation could boost economic growth, better reflect differences in local identities and preferences and allow more variation and innovation in public services.
This, in the end, is the challenge for the noble Lord, Lord True, and the Government. Are they really serious about levelling up? If they believe that decentralisation and devolvement of powers is the way forward, if they want to build on the fantastic local innovation in evidence over the last 16 months, their forthcoming White Paper must be ambitious. I hope it will be.
My Lords, I declare my interests as a vice-president of the Local Government Association and a vice-chair of the All-Party Group on Coronavirus and the All-Party Group on Adult Social Care. I start by thanking on behalf of these Benches the noble Baroness, Lady Armstrong, and her committee, as well as those who gave evidence, for their time and for this excellent report. I agree with the noble Baroness, Lady Jones of Moulsecoomb, that it is outstanding and should act as a blueprint for any future Government to use for public service reform—which, frankly, should happen straightaway, but, having read the Government’s response, I am not convinced it will happen soon.
Like many others, I find it quite extraordinary that no Minister found it appropriate to give evidence. Even today, in an earlier Statement, the Health Minister said that the best time for reflecting was after the pandemic. We have learned since the publication of this report last November that lessons could have been learned; mistakes were repeated because they were not.
My noble friend Lady Tyler talked of the dedication of all public sector workers. These Benches agree. There is often high performance and a strong sense of duty and they go beyond what is called for. Most of the problems outlined here are cultural and structural, and no reflection on the individuals who work in beleaguered public services, often trying to cope with cuts with no reduction in their responsibilities.
The noble Baroness, Lady Armstrong, rightly said that action is needed urgently and that the Government should not delay. The noble Lord, Lord Haskel, made the vital point that, since the report’s publication, lessons should have been learned and that the Government were therefore doomed to repeat mistakes.
The noble Lord, Lord Bichard, rightly focused on the need for substantial reform, setting out eight areas. His noted expertise in local government means that, along with other members of the committee, he understands the real practical stumbling blocks of public services in our society and the ways of managing them.
The noble Baroness, Lady Fox, is right that challenge is vital in every single way we do things. From my experience of local government over the years, giving professionals and the people they are working for the chance to find value-for-money solutions can frequently result in better public services in their area.
The noble Lord, Lord Young, helped us with lessons from other countries. I will briefly mention Taiwan, which, in addition to the points the noble Lord raised, from day one, early in January, closed its borders to make sure that the virus was not brought in. It was also completely frank with the public, explained why it was doing things and put in place strong support for those who had to self-isolate, bringing them food and helplines. That, plus daily television programmes on which scientists were quizzed about what was happening, remains one of the absolute strengths in its community.
The noble Lord, Lord Young, also made the point about local authorities in Germany having equal powers, which is very helpful. Our mixed democratic structures and different local authority economies are just not fit for purpose in the 21st century. However, the answer is not more metro mayors. Things need to be clear, simplified and accountable to the people in ways they can understand.
As the noble Lord, Lord Liddle, said, our public emphasis must move to prevention, but it must be funded. It has not been over the last few years. Levelling up was not evident in March’s Budget, but it is critical in dealing with early intervention and prevention, as other noble Lords have said. I echo the request of my noble friend Lady Tyler and others that Ministers say clearly when their public health strategy—and the funding for it—will be published. Public health cuts over the years are one of the reasons why levelling up will not happen any time soon under this Government.
The noble Lord, Lord Bourne, spoke of the importance of the need for positive action on food reform; the Dimbleby review, key parts of which were immediately dismissed by the Prime Minister on its publication, has many lessons for us. Yet the sugar tax on soft drinks, and other pressures, mean that our large supermarkets have started to move to reformulate. While the results are encouraging, the 2024 target must be met and pressure must be maintained. Educating children and their parents about good food choices is vital, too, but the cost of healthy food, especially fruit and vegetables, often means that the most nutritious foods are out of reach for the poorest families, thus building in poor health and other problems in yet another generation.
Sir Michael Marmot’s evidence, as well as an enormous amount of data, has shown that inequality and disadvantage put people not just at much higher risk but, in the pandemic, at risk of death. The noble Lord, Lord Bilimoria, reminded us of the high percentage of severe death and disease in our ethnic-minority communities. Frankly, as a country, we should hang our heads in shame. Where health inequalities are baked into our public services, it is too easy to turn a blind eye, but this appalling death rate is a wake-up call to us all. He is also right to say that poor health costs the economy. That is why we need the innovative thinking about how investment in public health and education will act as a driver for the economy and for productivity.
The noble Baroness, Lady Goudie, rightly reminded us that early years support, through schemes such as Sure Start, are vital in deprived communities. America learned this through the Tennessee STAR project over three decades ago. We have still not learned that lesson fully.
The example given by the noble Baroness, Lady Pitkeathley, of the user voice and coproduction in pandemic provision for the homeless was important, breaking down barriers with those people who are hardest to reach and getting to the root of the problem and solving it. We must not lose that experience.
One problem very evident in the pandemic was the way that officials—whether health, education or local authorities—failed to listen to parents of disabled children when they explained that they were struggling without their essential regular respite care. The result was that they were often criticised by social services; some were even threatened with having their children taken away from them. That must not happen again. Contrast that with my noble friend Lady Pinnock’s example of the Leicestershire cell for social care. It is vital that we mark and learn where things have worked and find mechanisms to make sure that this good practice is not just debated in your Lordships’ House but is in every community in our country.
The noble Lord, Lord Sikka, outlined one of the key crises in our adult social care sector over the last 30 years, which is increasingly moving from public sector provision to commercial companies. That is not bad in itself, but it now includes hedge funds and others who should not be in the business of care and certainly not using a business model that exploits the cheapest labour and expects low retention of staff when caring for other human beings. Now a combination of Brexit and the pandemic has shown that the social care workforce deserves to have a proper plan, to be paid in parity with their health opposite numbers and to have proper career pathways like those in the NHS. There are currently over 120,000 vacancies in social care. Government proposals must tackle the root and branch, not just the funding of beds, and ensure that we have a reliable and functioning social care sector as the baby boomers move into their old age.
The noble Baroness, Lady Armstrong, is right that the Government have focused in their procurement White Paper on commercial contracts, when this report demonstrates that, by empowering local services and communities and using the voluntary sector, many key services can be joined up.
My noble friend Lord Shipley’s point that you cannot run England from Westminster is vital, too. I hope that the Minister and the Government really understand that. The hub and spoke models of central bureaucracy never trust local areas. Often in the pandemic, that is where things went wrong. There were national attempts at recruiting volunteers when local councils had already done so; local councils got people to help people who had been asked to shield and then suddenly an NHS scheme was announced and nobody knew who was running the volunteer scheme. That is so easily avoidable, but the NHS, in its towers, just felt that it would start a new scheme at short notice without referring back to local government.
My noble friend Lady Pinnock commented that local staff, whether in local authorities or working in the community, wanted to rise to the challenging circumstances and to work differently, embracing innovation and feeling empowered. Again, we must capture that for the future. It is not just a pandemic issue but about our life in our communities. She also referred to codesign and coproduction as a powerful way of real innovation, value for money and value to individuals involved in receiving this public service.
The noble Lord, Lord Bichard, said that the committee found countless ways in which data sharing worsened the lives of people. Those points were extraordinarily well made and we must resolve that. However, this is not just about giving everyone the data. It must be safe and secure, and for public service.
Finally, it is vital that fundamental reform comes soon. It means, as with social care 10 years ago, cross-party working and the Government working with other parties to make it happen. I hope that the one message that the Minister will take away from this debate is that they need to be spurred into action now to deliver the recommendations in the report and take our communities and the agencies that work with them into a 21st century that will be safe and secure for them.
It is a pleasure to follow the noble Baroness, Lady Brinton, and I begin by echoing the thanks that she gave to my noble friend Lady Armstrong of Hill Top for her introduction to this debate and the work she did in leading the committee. Her commitment to improving public services is second to none and, speaking personally, I have long been inspired by the tenacity that she has shown in that endeavour over many years. The work that she and her fellow committee members undertook in the preparation of the report is admirable and I get the impression, having listened to the debate, that all Members thought it to be a thought-provoking and paradigm-challenging experience—as well as, if I am reading between the lines correctly, about as much fun as is allowed in the course of parliamentary duties on Zoom.
It is regrettable, though, that the Government chose not to give evidence and, as the noble Lord, Lord Shipley, observed, to delay this debate for as long as it has been delayed. I hope that that does not reveal a wider reluctance to engage in scrutiny of the delivery of services during the pandemic. Perhaps the Minister can reassure us on that in his response. Ministers must guard against giving the impression that they are either insufficiently curious to learn lessons or perhaps fearful of what will be revealed. It is essential that any such misgivings are not allowed to interfere with learning from what has happened. I am sure that the Government will want to make sure that they can learn from this compelling report when finally they begin their own investigation.
I hope that my noble friend Lady Armstrong does not mind me saying this, and does not take it the wrong way, but, when I saw that she was leading this debate, I kind of knew what she was going to say, because she is such a respected voice on these issues. I have heard her talk passionately many times about the need for early intervention and the urgency of addressing the lack of co-ordination between health and social care in particular—but she has never been more right to say these things than she is now.
The report identifies fundamental weaknesses, insufficient prevention and early intervention, overcentralised delivery and silo working, lack of integration, problems with data sharing, and lack of user voice. As others have said, none of those observations is especially new, but Covid has exposed them starkly and that is why I encourage the Government to build on this report and proceed quickly with their own inquiry. For grieving families, the sense of loss never fades, even though the anger, shock and pain can ease with time. However, the ease with which precious lessons can be learned will fade with time. That is why this report at this time is so valuable.
There is clearly much to be proud of in the way in which our public services responded. The resilience shown, especially in the early months, was awe-inspiring. The way in which the public, private and voluntary sectors joined forces has been hugely beneficial to us all. The deployment of new technology has been rapid and impressive. Although the app is driving people mad at the moment, the ability to access health information and share it securely with providers could be game-changing. Remote consultations, used appropriately, could make accessing services permanently easier for patients. We should ask ourselves how we take this innovation, as my noble friend Lady Armstrong said, where it is good and lock it in. My noble friend Lord Haskel highlighted the success of the Welsh Government in sourcing PPE, which seems a good example of a lesson that could be learned and shared, to the benefit of all, as a consequence of a future government inquiry.
If the global financial crisis in 2008 did not persuade small-government advocates of the need for an active, flexible and engaged state at a national and local level, coronavirus surely must.
The noble Lord, Lord Young of Cookham, provided a detailed and revealing description of how other countries have coped. We need to contrast the outcomes of countries where political leaders stepped up and took decisive action, such as New Zealand, with those who wilfully neglected their citizens’ well-being, such as Brazil.
My noble friend Lord Hunt explained how comparatively poorly resourced our health services are. The UK’s death toll stands at almost 130,000. I do not want to stand here and point the finger at the Government—that is not what today has been about—but it is undeniable that weaknesses identified in the report should have been tackled sooner. Health inequalities are well known and we are going backwards. This must change. The committee points out that, while it is important to learn lessons from the data and the workforce, it is equally important to hear the voices of service users. Co-production is recommended and I look forward to learning more about that process.
Inevitably, our debate focused on health services and it has been good to hear noble Lords attending to the impact that the pandemic has had on the justice system, rough sleepers and our youngest citizens. The scarring on the education and mental health of all children, especially the disadvantaged and those who have lost as much as six months of education, will shame us forever unless we take urgent steps to correct it. The potential harm to them as individuals is not yet known, but neither is the harm to our society and future prosperity. The message to the Government could not be clearer: “Fix this. Fix it quickly, before it’s too late and the scarring is too deep to heal”.
The catch-up tsar may have resigned in despair, as many noble Lords have pointed out. That is always embarrassing, but this is not just about tsars and special projects. As my noble friend Lady Goudie said so compellingly, we need to see every lever pulled in every school, family and community for years to come to make sure that no child’s life chances are permanently damaged.
My noble friend Lady Armstrong hammered home the need to invest in thinking further ahead, intervening and preventing problems. So perhaps the most important lesson of all from this pandemic will be that short-term, reactive, politically driven decision-making costs lives. This report shows us that there is another, better way.
My Lords, this has been an outstanding debate on, frankly, what I thought was a really outstanding report. I thank those who worked on it and all those who have spoken to it, and I commend the spirit in which most have spoken. It has been a wide-ranging debate on a wide-ranging subject and I will respond as much as I can and as best I can in the time available.
However, I should stress, as all noble Lords have, the importance of awareness of cross-cutting services, and the interrelation and collaboration between services at all levels and across all sectors. These matters are vital and I had the privilege of chairing a committee of your Lordships’ House looking at intergenerational matters. I know that many will feel that those kinds of issues run across services and are not always adequately considered inside Parliament—or, indeed, outside it. This report makes a great contribution and I hope that it will not sail off into the mists.
I think we are all agreed that the past year has been unlike anything in living memory, and we have had to come together in an extraordinary national effort to overcome a virus which has threatened our very way of life. The Covid-19 pandemic exposed areas in our economy and, yes, inequalities in our society that mean the most vulnerable people have been hit the hardest. As we recover, we have an opportunity, as my right honourable friend the Prime Minister said, and as the report of your Lordships’ committee asserts, to build back and build forward better and stronger than before.
I apologise that we were not able to engage with the committee sooner. The Government take their duties to Parliament seriously and thank the committee for its work. I offered to speak to the committee in March, not on this report but on ongoing work, but that was declined. It does not serve much to throw stones at each other. We should all seek to do better in engaging in the ongoing dialogue between Parliament and government, and I shall always seek to do that.
At the forefront of all our efforts are our public services. I have spent a lifetime in public services, and from hospitals to classrooms, and job centres to courtrooms, the work of the United Kingdom’s public servants has been nothing short of heroic, as so many of your Lordships have said today. I would certainly like to add my thanks to all those, from every walk of life, who have been involved in responding to the pandemic and keeping our country going. I appreciate what the noble Baroness, Lady Armstrong—who clearly did a magnificent piece of work in bringing this committee report together—said about the swift adaptations made by so many in public service. It is important that this is acknowledged.
The United Kingdom Government have worked strategically and at scale to save jobs and support communities throughout the United Kingdom, working alongside the devolved Administrations to keep every citizen safe and supported, no matter where they live. As the noble Lord, Lord Bilimoria, said so eloquently, collaboration between charities, the third sector, the private sector and all levels of the public sector is vital.
The noble Lord, Lord Liddle, asked whether the Government simply had the desire to get involved in public service reform. My right honourable friend the Chancellor of the Duchy of Lancaster chairs the National Economy and Recovery Taskforce (Public Services) Committee precisely in order to drive public sector recovery and reform. Key cross-cutting government priorities are also overseen by Cabinet sub-committees: for example, the Crime and Justice Taskforce. In addition, the Government have strengthened cross-government accountability through appointing Ministers whose portfolios sit across at least two departments. For example, my noble friend Lord Agnew sits across the Cabinet Office and the Treasury. At the Civil Service level, we have put in place multi-departmental boards. Efforts are certainly being made to improve cross-departmental working and avoid the kind of silos to which some noble Lords referred.
The Government have an ambitious policy agenda; government needs to operate as effectively as possible to deliver the recovery we need. In June, the first joint Cabinet meeting of Ministers and Permanent Secretaries agreed the Declaration on Government Reform, committing to immediate action on three fronts: people, performance and partnership. The declaration set out 30 actions that will be taken in the first year to begin the process of modernisation and reform. I am pleased to say that the response to the declaration was positive overall. The Institute for Government called it
“a statement very much to be welcomed”,
Prospect said it was a “welcome first step”, and the FDA union was pleased with the “tone of collaboration”. We are already making progress. We have already committed to early funding on a variety of projects, including over £600 million to fix legacy IT. These changes are also about increasing the skills and capability we have in government. We will do this through developing the skills and experience of existing civil servants as well as bringing in skills from outside.
We welcome the Commission for Smart Government’s contribution to the intellectual effort—the debate about government reform. My right honourable friend the Chancellor of the Duchy of Lancaster was present at the launch of the report and made it clear that the case the commission made overall is powerful. The report aligns with the Declaration on Government Reform in its focus on digital and data transformation—something which your Lordships have underlined today—and capability and accountability as priority areas for reform, and progress will be made here. I undertake that the Government will of course continue to look closely at the commission’s recommendations but also at those of other contributors to the debate on government reform, including the distinguished report of your Lordships’ committee, and we will report back on progress with reform. Yes, we should be collaborative, and government reform should not be seen a zero-sum game.
Many noble Lords spoke in the debate about the challenges we face and the task of rebuilding. In particular, we know—as the noble Lord, Lord Shipley, and a succession of other noble Lords pointed out—that the impact of the pandemic has been felt most heavily by disadvantaged children and young people, so it is vital that we target support towards those children. In June we announced an additional £1.4 billion to support high-quality tutoring and great teaching. This package was the next step towards recovering from the impacts of Covid. It built on the £1.7 billion already announced, providing more than £3 billion in all to support education recovery in schools, 16-to-19 providers and early years settings, whose importance was rightly stressed by the noble Baroness, Lady Goudie. This will have a material impact in closing gaps that have emerged.
The Government are committed to an ambitious, long-term education recovery plan. The next stage will include a review of time spent in school and 16-to-19 education and the impact that that could have in helping children and young people catch up. The findings of the review will be set out later in the year to inform the spending review. We will also continue to monitor how effectively pupils are catching up. For most pupils, being back in the classroom itself will have a positive impact on learning, and evidence published in June suggests that primary pupils recovered some of the learning they lost once in-person teaching for all resumed.
Ensuring that vulnerable children remain supported and visible during the outbreak has been a critical focus of the Government’s work. That is why, from the outset of the pandemic, including the period of national lockdown announced on 4 January, the Government kept primary and secondary schools, alternative provision, special schools and further education open to vulnerable children and young people. Where vulnerable children and young people cannot attend, we have asked local authorities, children’s social care and educational settings to ensure that they have systems in place to continue support and keep in touch with them and their families.
Throughout all restrictions to date, children’s social care services and early help services have continued to support vulnerable children and young people and their families. We established a vulnerable children and young people survey for local authorities to make sure that we had an accurate picture of contact between children and their social workers, and we will continue to monitor this.
We have invested millions of pounds in charities and other services which work with vulnerable children and their families to support them and spot the signs of abuse and neglect more quickly. Doing that more quickly was underlined by so many of your Lordships who spoke; prevention is vital. This includes the See, Hear, Respond programme, backed by £11 million of government funding, which reached more than 100,000 children and their families.
The noble Baroness, Lady Jones, asked who is in charge of cross-party activity. My honourable friend the Minister for Rough Sleeping and Housing leads in this area, and the Changing Futures programme is a £64-million, three-year-long, joint-funded initiative between the Government and the lottery fund, funding local organisations and working in partnership to better support those with multiple disadvantages.
Many noble Lords referred to adult social care, which of course has never been under as much pressure as in the last year; the noble Baroness, Lady Tyler of Enfield, spoke eloquently about that issue. Throughout the pandemic we have been working with the social care sector to ensure that all recipients of care receive the support they need. There are lessons to be learned from that experience and we are aware of the long-term challenges facing the social care system. Our objective remains to join up health and care around people and meet the needs of individuals, giving them personalised care to help them to live life to the full. We are working closely with local and national partners to ensure that our approach to reform is informed by diverse perspectives, including those with lived experience of the care sector. I agree with all those who made the point that user knowledge and experience are vital. We are providing councils with access to an additional £1 billion and more to fund social care in 2021-22. The Government are committed to reforming the adult social care system and will bring forward proposals in 2021.
Many, such as the noble Baronesses, Lady Jones and Lady Pitkeathley, and the noble Lord, Lord Davies, spoke of health inequalities. This issue is at the heart of the NHS plan. All major national programmes in every local area across England are required to set out measurable goals and mechanisms by which they will contribute to narrowing health inequalities. NHS England has committed to inclusive recovery from the Covid-19 pandemic. The NHS has set eight actions to reduce inequalities in its restoration of services, including reporting on providing services to the 20% of poorest neighbourhoods and black and Asian parents. We will improve joined-up local working on population health and reducing health inequalities through integrated care systems. We will reinforce the role of local authorities as champions of health in local communities and enhance the NHS’s public health responsibilities to act on prevention. Reducing health inequalities will be a core aim of the new office for health promotion. Under the professional leadership of the Chief Medical Officer, the OHP will systematically tackle the top preventable risk factors, improving the public’s health and narrowing health inequalities.
A question was asked about life expectancy. We are determined to level up health and life expectancy across our country. We are committed to ensuring that people can enjoy at least five extra years of healthy independent life by 2035 and to reducing the gaps between rich and poor.
The noble Baroness, Lady Tyler, and others asked about timing. The prevention Green Paper, Advancing Our Health: Prevention in the 2020s, outlined commitments with varying timelines regarding the services that we received, the choices that we make and the conditions in which we live. I acknowledge that the Government’s response to the consultation has been delayed due to the Covid-19 pandemic, but we will update on the response to the prevention Green Paper in due course.
To respond to my noble friend Lord Bourne, the noble Lord, Lord Hogan-Howe, and others on prevention, I assure the House that as we begin the recovery from Covid, now is the time to redouble our efforts to transform the nation’s health. That is why in March the Government published their policy paper about transforming and reforming the public health system, setting out our plans for a refreshed public health system. These reforms will embed a stronger focus on prevention right across the system and ensure that we have the structures and capabilities in place to level up health. Our response to the consultation on advancing our health has again been delayed by the need to focus on the pandemic response. Again, I assure noble Lords that we will bring forward a response to the consultation in due course.
However, we have not waited for the response to take action; we are already taking action on the main drivers of ill health—for example, obesity, which has been referred to, including £100 million in extra funding for healthy weight programmes, and bringing forward legislation to restrict advertising of junk food and on labelling requirements for food. In January we published our mental health White Paper, which aims to reduce mental health inequalities, a subject of profound importance and concern.
Having spent all my life in local government, I agree with all that was said about the importance of public services working together to provide an integrated approach. That informs our programmes overall, including in relation to helping vulnerable families. Supporting Families was launched for this financial year in March and is backed by £165 million of new money. The next phase of the programme will include a focus on building the resilience of vulnerable families.
In March the Government launched a new £8 million local data accelerator fund and invited local areas and their partners to bid for funding to support data projects and improve services for children and families. I agree that ideas must flow up and across, not just from the top down. We hope to announce successful applicants shortly.
Later this year we will publish the levelling-up White Paper, setting out new interventions to improve livelihoods across the country. We remain committed to devolving power to people and places across the UK. That must be genuine devolution. Our plans for strengthening local accountable leadership will be included in the levelling-up White Paper, which will include county deals. The White Paper will be led by the Prime Minister personally. A new No. 10/ Cabinet Office unit will be set up to drive through work on the White Paper, and the Prime Minister has appointed Mr Neil O’Brien, MP for Harborough, as his levelling-up adviser. The White Paper will replace the English devolution White Paper. Full details on county deals will be included in the White Paper. These again will be bottom- up, enabling local partners to come together with powers exercised at the right level to make a difference for local communities.
Central government cannot do it all on its own. Our towns, cities and regions have a greater chance of levelling up when local people have more of a say over their own destinies, and that is our objective. Devolution must go with the grain of local identity and we want to give places the tools that will bring economic, social and environmental benefits alongside improving local services. We know that a mayoral combined authority will not work everywhere, which is why we are keen to work with areas on developing other options. I am sure, from reading the report and hearing what many noble Lords have said, that that will be welcome.
Data sharing has been emphasised as vital by many, including the noble Lord, Lord Bichard, and the noble Baronesses, Lady Pinnock and Lady Brinton. The data-sharing playbook was established as part of an objective to support a step change in the way that the Government use and share data. It works as a cross-government virtual team. The Data Standards Authority was established in April as a multidisciplinary team, working with experts across the wider public sector and helping to improve services in this area.
We are working with government departments to build services that reflect the lives that citizens live rather than the silos of government departments. For example, to start a business in the UK, a citizen now has to interact with 10 departments. That must end.
I agree with the points about social value. We are committed to that. I will write to noble Lords specifically on these issues since my time is running out, but we intend to extend the use of the Social Value Act, and that will inform ongoing work on public procurement.
I am sorry that I have not been able to cover every aspect that has been brought forward in this fascinating and, I think, hugely important debate, but I profoundly appreciate the work done by the committee and the opportunity to listen to your Lordships’ House today.
My Lords, I thank everyone for their contribution to today’s debate. I said at the beginning how privileged I was to chair this committee, and I know that the speeches that its members have made will have reinforced for noble Lords their quality, expertise and enthusiasm. I thank them again for the contribution that they have made in the past and today. I thank everyone else who contributed too; everyone brought something specific to the debate that meant it reflected the work of the committee and the work that went into its first report.
Running through the speeches today, I was very pleased to hear, was a thread that reinforced that the report offers practical ways forward—through decentralisation of power, longer-term investment in early intervention and preventive work, more effective activity across services; and by the involvement of the voluntary sector, the community sector, civil society and the private sector in helping to make places work for people, wherever they live.
Of course, we also heard from lots of Members today about the importance of hearing the voices of people with lived experience. This is a really important issue for the House, as well as the Government. We had enormous support from the teams in the House to engage people with lived experience and the organisations that they often work with to bring them to the committee to give evidence. My colleague, the noble Lord, Lord Davies, mentioned Debra from Wigan, who has cerebral palsy and is very much a community activist in Wigan but has really struggled. Her words give us a real call to action. She said that, from her experience of the NHS and social services in the past 16 months, services were delivered at her rather than with her, and, when she attempted to discuss her needs, she felt belittled, patronised and ignored. That should be a wake-up call to all of us.
I thank the Minister for his response. I think he knows that the committee worked in a very cross-party way, and we look forward to engaging with him and other Ministers on how we can properly prioritise what is needed in public services so that they work for Debra and others. I look forward to making sure that we establish good relationships with him and his colleagues so that we can all take this work forward. There is a lot to do, and we all have a responsibility to play our part in making sure it happens. I commend the report to the House.
My Lords, the time limit for the following Motion to Take Note debate is one and a half hours.