The Parliamentary Under-Secretary of State, Department of Health
and Social Care (Lord O’Shaughnessy) (Con) My Lords, with
permission I will repeat the Statement made yesterday in the other
place by my right honourable friend the Secretary of State for
Health and Social Care about the Prime Minister’s announcement of a
new, long-term funding plan for the NHS. The Statement is as
follows: “The NHS...Request free
trial
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The Parliamentary Under-Secretary of State, Department of
Health and Social Care (Lord O’Shaughnessy) (Con)
My Lords, with permission I will repeat the Statement made
yesterday in the other place by my right honourable friend
the Secretary of State for Health and Social Care about the
Prime Minister’s announcement of a new, long-term funding
plan for the NHS. The Statement is as follows:
“The NHS was built on the principle that good healthcare
should be available for everyone, whatever their background
and whatever their needs. Seventy years on, it remains this
country’s most valued public service—an institution that is
there for every family, everywhere, at the best of times and
the worst. No one in this House underestimates the importance
of putting the NHS on a steady financial footing, not just
for the sake of their constituents but for their own families
and loved ones. That is why I am proud today that this
Government have announced their commitment to a long-term
funding settlement for the NHS.
From vaccinations and IVF to radiotherapy and next-generation
immunotherapies, the NHS has always been at the forefront of
excellence in medicine. However, as only the sixth universal
healthcare system in the world, it has also come to symbolise
equity both at home and abroad. Despite pressures in recent
years, the Commonwealth Fund rates the NHS as the best
healthcare system in the world; cancer survival rates are at
a record high; stroke mortality is improving faster than
almost anywhere else in the OECD; and heart disease mortality
rates continue to fall. All this is thanks to NHS staff, who
continue to work tirelessly day in, day out, to make it the
world-class service that it truly is.
However, alongside advances in medicine, demographic
pressures pose a potentially existential threat to the NHS as
we know it. With the number of over-75s expected to increase
by 1.5 million in the next 10 years, these pressures, far
from reducing, will intensify. So in March the Prime Minister
made the bold decision to commit to a 10-year plan for the
NHS, backed up by a multiyear funding settlement. Since then
I have been working closely with the Prime Minister and the
Chancellor, and I can announce today that the NHS will
receive an increase of £20.5 billion a year in real terms by
2023-24—an average of 3.4% per-year growth over the next five
years. The funding will be front-loaded, with increases of
3.6% in the first two years, which means £4 billion extra
next year in real terms, with an additional £1.25 billion
cash to cope with specific pension pressures. Others talk
about their commitment to the NHS, but this settlement makes
it clear that it is this Government who deliver, and the
details will shortly be placed in the Library of the House.
This intervention is only possible due to difficult decisions
made by the Government, opposed by many, to get our nation’s
finances back in order and our national debt falling. Some of
the new investment in the NHS will be paid for by us no
longer having to send annual membership subscriptions to the
EU after we have left. But the commitment that the Government
are making goes further, and we will all need to make a
greater contribution through the tax system in a way that is
fair and balanced. My right honourable friend the Prime
Minister said that we will listen to views about how we do
that, and my right honourable friend the Chancellor will set
out the detail in due course. I pay particular tribute to the
Chancellor, whose careful stewardship of the economy,
alongside that of before him, is what
makes today’s announcement possible.
The British public also rightly want to know that every pound
in the NHS budget is spent wisely. It is therefore critical
to the success of the plan that the whole NHS improves
productivity and efficiency; eliminates provider deficits;
reduces unwarranted variation in the system so that people
get consistently high standards of care wherever they live;
gets better at managing demand effectively; and makes more
effective use of capital investment. We have set the NHS five
key financial tests to show how it will play its part in
putting its service on a more sustainable footing, and I
expect the NHS to give this work the utmost priority. The
tests will be a key part of the long-term plan.
However, this is more than just a plan to get finances back
on track. In its 70th year, we also want our NHS to make
strides towards being the safest, highest-quality healthcare
system in the world. That means making a number of
improvements to the treatment and care currently offered,
including getting back on track to delivering agreed
performance standards, locking in and further building on the
recent progress made in the safety and quality of care, and
transforming the care offered to our most frail and
vulnerable patients so that we prioritise prevention as much
as cure. It also means transforming our cancer care, where we
still lag behind France and Germany despite record survival
rates. There is no family in this country that has not been
touched by cancer, so the whole House will want to know how
the NHS intends to make our cancer treatment and care among
the best in Europe.
Many of our constituents worry about the mental health of
their loved ones, families and friends. Again, I am proud of
this Government’s record here: investing more in mental
health than ever before and legislating for true parity as
part of one of the biggest expansions of mental health
provision in Europe. A critical part of the plan will be to
decide what next steps will enable us to claim not just that
we aspire to parity of provision with mental health but that
we are actually delivering it.
For our most vulnerable citizens with both health and care
needs, we also recognise that NHS and social care provision
are two sides of the same coin. It is not possible to have a
plan for one sector without having a plan for the other.
Indeed, we have been clear with the NHS that a key plank of
its plan must be the full integration of the two services. As
part of the NHS plan, we will review the current functioning
and structure of the better care fund to make sure that it
supports that. While the long-term funding profile of the
social care system will not be settled until the spending
review, we will publish the social care Green Paper ahead of
that. However, because we want to integrate plans for social
care with the new NHS plan, it does not make sense to publish
it before the NHS plan has even been drafted, so we now
intend to publish the social care Green Paper in the autumn,
around the same time as the NHS plan.
Finally, there are two further elements crucial to putting
the NHS on a sustainable footing. Alongside the 10-year plan,
we will also publish a long-term workforce plan, recognising
that there can be no transformation without the right number
of staff, in the right settings and with the right skills.
This applies to both new and existing staff. As part of this,
we will consider a multiyear funding plan for clinical
training to support this aim. Similarly, we know that capital
funding is critical for building the NHS services of the
future and, again, we will consider proposals from the NHS
for a multiyear capital plan to support the transformation
plans outlined in the long-term plan.
Given the national economic situation, yesterday’s
announcement is bold and ambitious. For the first time,
national leaders of the NHS will develop a plan for the next
decade that is clinically led, listens to the views of
patients and the public and is backed by five years of core
funding. We want to give the NHS the space, certainty and
funds to deliver a comprehensive, long-term plan to transform
health and care and to ensure that our children and
grandchildren benefit from the same ground-breaking health
service in the next 70 years as we all have in the first 70.
That is the Government’s commitment to our NHS, and I commend
this Statement to the House”.
My Lords, that concludes the Statement.
3.16 pm
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(Lab)
My Lords, I thank the Minister for repeating this
Statement. I also declare an interest as a member of a
local clinical commissioning group.
It would indeed be churlish to say that an injection of
funding into our NHS is not welcome right now. However, the
70th birthday present is an uplift in funding of below the
60-year average—from 1948, the birth of the NHS, to 2010,
it is just on 4%. Of course, we would all, not least the
patients and staff, welcome not having to face another
winter crisis like the one we have just had. After what, I
suspect, were some serious tussles within the Government
about quantum, timing and explanation of where the funding
will come from, the Minister and his colleagues must be a
little disappointed in the headlines that have been
generated so far. The IFS said, with respect to the Brexit
dividend that,
“over the period, there is literally zero available”.
“Sky News” has done a data poll which suggests a majority
of people do not believe there will be a Brexit dividend to
help to boost NHS funding, a reaction made more unpalatable
to the Government because the same polls show that a
majority of people, 54% to 38%, say that they would be
happy to pay more tax to fund the NHS, which we in the
have known for quite
some time. In 2002, when the then Prime Minister made a commitment to
massively increased funding to the NHS, he also announced
an increase in national insurance to pay for it. He and
then Chancellor had spent two years
preparing for that announcement and preparing the plans for
the investment in the NHS that was necessary to turn it
round from the previous 18 years of Conservative neglect
and underfunding and to deliver the waiting list targets,
cancer treatment targets and A&E targets which then
followed. So when says, as she did over the
weekend, that Labour spent only half of the increased
expenditure on patient care, that is completely misleading
and plain wrong. If she means that replacing falling-down
buildings and worn-out equipment, paying staff decent
wages, and investing in massively increasing the number of
doctors and nurses available is in some way not spending
money on patient care, one has to question the right
honourable lady’s understanding of what the NHS is and what
it does.
Leaving aside the issue of how the £20 billion will be
raised, we do indeed need to address how it can best be
spent. We recognise that it will take time and planning to
work out how to make the best use of this funding over 10
years. The challenge is huge because the prevailing state
created by a combination of cuts for both health and social
care, and the overcomplex bureaucracy of the NHS as a
result of the Health and Social Care Act, make this a
serious challenge. Waiting lists of 4 million last winter
in the NHS were so severe it was branded a humanitarian
crisis. Some 26,000 cancer patients are waiting more than
60 days for treatment. There have been billions in cuts to
local government and social care.
My questions to the Minister start with three basic ones
about the legal obligations of the NHS. These were also
asked by my honourable friend . Will the waiting
list for NHS treatment be higher or lower this time next
year than the 4 million it is today? This time next year,
will there be more or fewer patients waiting more than 60
days for cancer treatment? This time next year, will there
be more than 2.5 million people waiting beyond four hours
in accident and emergency or fewer—a target not met since
2015.
If the Secretary of State wants, as he says he does, to
transform the health and social care system, how will he do
this when every economic expert, from the Institute for
Fiscal Studies to the Health Foundation, tells us that with
a growing ageing population—which the Minister
mentioned—increasingly living with long-term conditions,
this announcement will do nothing more than see the NHS
stand still? As my honourable friend put it yesterday:
“We cannot put the NHS on a steady financial footing
without a proper funding settlement for social care, yet
the Secretary of State now says that that will not happen
until the spending review, which in reality means no
substantial extra money for social care until 2020 at the
earliest. We cannot transform care for older people or
reduce pressure on the NHS until we look at the two
together”.—[Official Report, Commons, 18/6/18; col. 63]
Why are the Government still ducking that vital integration
issue?
Why is the social care Green Paper delayed yet again, and
how can this funding be used to mitigate the £7 billion in
cuts and 400,000 people losing care support? How will the
Government bring together health, social care, parity in
mental health and the essential preventive work of public
health, when they are scattered across different delivery
bodies, often with differing commissioning regimes and
accountable sometimes to different regulatory regimes? How
will that be done under the proposals for the 10-year plan?
Will this injection of funding ensure that we have a
service with new models of care fit for the 21st century?
Finally, we have a £5 billion repair bill facing our NHS
right now, and outdated equipment. When will the Government
start investing in the fabric and equipment of the NHS?
-
(LD)
My Lords, I too thank the Minister for his Statement. I
welcome any increase in funding. Should the Chancellor be
wondering how to pay for it, we on these Benches would be
quite happy to see a 1% increase on income tax, for
starters. The IFS has said that increases of close to 4%
are needed for social care, as well as a funding boost for
the NHS. Yet the Statement had nothing to say on this vital
issue. We all know that the NHS cannot function efficiently
unless social care is working well too. Many local
authority leaders are indignant that the Green Paper has
been moved further down the track, so when the new funding
does arrive there is already a sizeable deficit to claw
back. They are extremely anxious about the situation with
adult social care funding being insufficient for this
financial year.
What conversations have been held with the LGA, local
council leaders and the Ministry of Housing, Communities
and Local Government in advance of these statements? We are
also dismayed about the silence on mental health, public
health and community health funding. One in four of us will
be affected by mental illness, there is an obesity epidemic
among our children, too few health visitors, and we are
critically short of psychiatric social workers. Is the
Minister confident that these issues can wait until the
autumn NHS plan and the Budget?
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I thank the noble Baronesses, Lady Thornton and Lady Jolly,
for their questions. I think that our debate on the report
of the Lords Select Committee on the sustainability of the
NHS and social care was revealing, in that we got a hint
that, while the settlement would receive a broad welcome
across the House, the party opposite might not be in quite
the same positive mood, and, unfortunately, we have had
that confirmed today. Perhaps that might generously be
described as a cautious welcome.
The noble Baroness asked about the funding of this
settlement. We were very clear yesterday that it will come,
effectively, from three sources: from taxation, from
economic growth, and from the fact that, as we are leaving
the European Union, we will not be paying annual
subscriptions any more. It will be a combination of those
factors that determines the spending. Indeed, the Treasury
is confident in that, and it would not have signed off this
deal if it had not been.
On the noble Baroness’s specific questions about the legal
obligations under the NHS constitution, actually the money
that was given to the NHS at the Budget was to help it to
get back on target—in the case of A&E, by the end of
this financial year and, for elective procedures, to halt
the growth in the expansion of the waiting list. Clearly,
one of the reasons for this settlement, which is set out
explicitly, is to get back to those key standards, which we
know are the yardsticks by which people judge their
everyday experience of the NHS.
On the point about there not being enough money, there can
always be arguments for more, but it is instructive that
two former Health Ministers, one from the and one from the
Conservative Party—my noble friend and the noble Lord,
Lord —set out last week that
they felt that 3.5% was the right figure, which we have got
very close to. We should take the suggestion of those two
very experienced and knowledgeable former Health Ministers
as a good yardstick for our achievement.
The noble Baroness asked about social care funding, as did
the noble Baroness, Lady Jolly. The intention behind the
delay in the Green Paper—which I recognise is a source of
regret for people in this House and elsewhere—is to make
sure that integration, which we all agree has got to be at
the heart of this 10-year plan, actually happens in
planning terms and policy terms as well as in announcements
and delivery. That is why there is that co-ordination
between the two. Again, it is worth stating that, over the
current three-year period, at previous Budgets an extra £2
billion was put into the social care budget, which is
rising now for the first time in a number of years, and
that is obviously important as we put together that
long-term solution.
Finally, let me deal with two other points. On the repair
bill and the capital settlement, again at previous Budgets
the Chancellor has pledged £10 billion through a number of
sources towards the capital settlement for the NHS, but we
are expecting the NHS, through this process, to come
forward with long-term, multi-year capital proposals,
because clearly that underpins so much of the
transformation.
In terms of the impact on other elements of the broader
health budget, mental health is included in there,
including a clear commitment to deliver on parity of esteem
within this period. Public health and community health will
be dealt with in the next spending review process, which
will be happening in the next year. Again, there are clear
commitments that there will not be additional pressures, if
you like, created for the NHS by what happens to the public
health and social care budgets in the future. Ahead of a
spending review process, that is a clear indication that
there is not a desire to create trouble, if you like, in
those budgets that would land at the feet of the NHS.
3.28 pm
-
(CB)
My Lords, could the Minister say something about the
economic literacy of this announcement? As I understand it,
the Conservative chairman of the Health Select Committee,
, has said that the
Brexit dividend idea is “tosh”. If we write that one out of
the script, can he say something about what economic
assumptions the Government are making on the growth of GDP
in each of the next five years?
-
I know that the noble Lord no longer serves the , but he might be
interested to know that the Labour leader said in February
that,
“we will use the funds returned from Brussels after Brexit
to invest in our public services”.
Clearly, we are not alone in believing that, once we leave
the European Union—and, as a party, we are committed to
leaving the European Union—we will no longer be sending
subscriptions to Brussels but using them for the NHS. For
further detail on the funding settlement, the noble Lord
will need to wait until the Budget, when the Chancellor
will outline the plans.
-
(Con)
My Lords, I welcome this report, but note that the
Statement refers to the number of over-75s increasing by
1.5 million, which will prove a challenge in the future.
One of the recommendations of the long-term sustainability
report was that we should look at other methods for
ensuring funding. I was very pleased to hear the noble
Baroness, Lady Thornton, say that the review suggests that
the public are prepared to pay more towards the NHS. I
suggest that if we look at the experience of Japan, where
people over the age of 40 start making contributions
towards their long-term care, we may well have an
opportunity to resolve this problem. If the public are
willing, the Government should look seriously at this in
the context of social care.
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We have in this debate just started the lively conversation
that we will be having on taxation in the next few months.
Clearly there are a number of ideas; they have been voiced
by Members on the Liberal Democrat and Labour Benches as
well as those on my Benches and the Cross Benches. We know
that there are a number of ways that this could be done;
the Prime Minister has shown incredible leadership to admit
that this necessary. These are very difficult decisions: in
polls, people say that they want to pay more tax but when
it comes to the crunch they often feel slightly
differently. True leadership is being able to take us
through that situation, and that is what the Prime Minister
is showing.
-
(Lab)
I thank the Minister for taking the trouble to repeat the
Statement made yesterday in the other place. Of course we
welcome the money, but let us not get carried away. Every
health trust charity believes that the increase needs to be
at least 4%. Secondly, this still leaves only one country
in the G7 paying less towards healthcare than we are.
May I ask the Minister three very brief questions? I saw a
report saying that the training costs of doctors and nurses
were not included in these figures. Is that correct?
Secondly, when we pursue the Government’s concept, which is
right, of bringing the NHS and social care together, hence
delaying the plan, will the extra costs of social care come
out of the 3.4%? Finally, when it is discovered that there
is no exit bonus when we leave the EU, will the Government
guarantee that that shortfall will be made up from
elsewhere?
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The noble Lord mentions the figure of 4%. I have looked at
a number of think tank reports and their assumptions on
what is required. They make some very cautious assumptions
of the productivity improvements that the NHS is making,
based on historical performance. The improvements in
productivity over the last five years are very healthy—in
fact, in the last year the NHS became more productive at a
rate of 1.8%. If you add that to the 3.4%, that gives an
increase of more than 5% in terms of bang for your buck. It
is incumbent on us during this process not only to put in
more money but to make sure that we are driving those
productivity gains that we have seen in the last five
years. If that then gives a 5% effective increase in
funding, that is what we will need to deal with the
long-term pressures that the noble Lord has quite rightly
highlighted.
On the three questions, there is an explicit commitment to
deliver this workforce strategy that the NHS comes up with
as part of its plan. On the extra costs of social care, we
clearly need a social care settlement that delivers the
funding for those rather than their being covered by the
NHS. That is what we mean about the commitment not to
create extra pressures. As I have said, the funding will
come from three sources—whatever the mix, the funding will
be there.
-
(LD)
Will the Minister accept that in terms of productivity, one
of the issues that is holding us back in developing things
at speed is the overregulation of the whole of the health
system? We have two systems regulators and seven
professional regulators; we were promised in 2014 that
there would be legislation to simplify the regulatory
system. Can the noble Lord assure the House that we will
have a bonfire of regulations and put the right regulations
in place to move this agenda forward?
-
The noble Lord speaks with great insight and makes a very
important point. There is broad agreement on the need to
simplify the structure of the health system but there has
not to date been broad agreement on how we should do so. We
are expecting in the next few months to explore the
potential for the kind of streamlining that he is talking
about. I hope that that can be done as a collaborative
effort and, if it comes to primary legislation, that we can
deliver it as a collaborative effort too.
-
(CB)
My Lords, I declare my interest as chair of University
College London Partners Ltd. Although this substantial
increase in funding has quite rightly been welcomed,
important questions remain. It is essential that real
progress is made in integrated care—integrated care between
the community and secondary and tertiary sectors, and
integrated care between hospitals and social care. It is
vital that progress is made in the rapid adoption of
innovation at scale and pace across entire health
economies. It is also vital that a programme is put in
place to ensure that there is a transformation of the
healthcare workforce so that those who have committed
themselves to being healthcare professionals can continue
to be developed and serve their fellow citizens across an
entire professional career. How do Her Majesty’s Government
propose to achieve this? There has been much good intention
and great commitment in this area over the past two
decades, but we are now at a critical moment where a
failure to deliver the transformation required will result
in failure to achieve the long-term sustainability to which
we are all committed.
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Lord O’Shaughnessy
The noble Lord makes excellent points. It is right at this
moment to applaud the wisdom and far-sightedness of the
Lords Select Committee on the long-term sustainability of
the health and social care system. It called for, among
other things, funding of growth in line with GDP,
delivering integration, a 10-year workforce strategy, a
commitment to reduce variation and a joined-up Department
of Health and Social Care, all of which, if we were not
able to deliver it in time for our response to the report,
we are delivering in short order afterwards.
One of the first ways in which we shall do it is to draw on
the wisdom that resides in the NHS, in Parliament and
elsewhere in the profession. In the Statement given by my
right honourable friend, I point again to the commitment to
take on integrated care, that being one of the tests of
success. Equally, there is the commitment to transformation
of the workforce, to make sure not just that we have enough
people but that we have enough flexibility and digital
skills, for example.
The final point, on innovation, is very close to my
heart—and indeed the Secretary of State’s. We know that
doing things in the same way will not deliver the standards
we need. We really need a transformation in how we deliver
healthcare, much greater digitalisation of the entire
sector and the ability to take the amazing innovations that
we develop in our laboratories and universities, such as
the noble Lord’s own, and get them into use across the NHS.
That is one reason why I was so delighted that we were able
to announce today that the noble Lord, Lord , will be chairing our
Accelerated Access Collaborative. It is hard to think of
anybody more committed to this agenda than him.
-
(Con)
My Lords, I seem to recollect that some years ago there was
a royal commission on social care. Is there any wisdom to
be gained from it? I do not think much action was taken on
it when it reported.
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Lord O’Shaughnessy
My noble and learned friend is quite right: these
commissions do not always produce action. I realise that
there is some frustration in the House over the delay to
the social care Green Paper. I hope noble Lords will
respect the fact that it is sometimes difficult to fight
battles on many fronts. We have made some progress on the
NHS and the army moves on to win the war on social care as
well.
-
(Lab)
My Lords, I for one from these Benches welcome the influx
of funds. We have been waiting quite a while for it so it
is well received. Everyone knows, however—we have heard
today—that without changes and improvement in social care,
this 3.5% will go down the drain as well. It is not just
that we need to do both together; we need provision for
social care at the same time as, if not in front of, the
influx of funds for the NHS.
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Lord O’Shaughnessy
I agree with the noble Lord and thank him for his welcome.
We all agree; indeed, the Statement sets out clearly that
the two must go hand in glove. I should point out that
additional money for social care in the short term was put
in a previous Budget by the Chancellor—£2 billion extra
over three years, a budget that is now growing. Clearly
that was a short-term measure. Now we need to find that
long-term settlement that goes hand in hand with the NHS
and ensure that we have true service integration as well.
-
(CB)
My Lords—
-
(LD)
My Lords—
-
(Con)
It is the turn of the Liberal Democrat Benches.
-
My Lords, first, the Statement mentions £1.25 billion cash to
cope with specific pension pressures. Is that because so many
doctors are retiring early, and therefore drawing their
pensions early, because of the pressures of the job? I know
three GPs who are retiring far too early because of those
pressures, so will the NHS be able to spend some of that
money to relieve those pressures? Secondly, the Statement
mentions that the Government want to prioritise prevention
and that the NHS should get better at managing demand
effectively. There are two factors that limit its ability to
do that: social care has been mentioned by many noble Lords
but I would also mention prevention. Can the Minister assure
us that, when we get the spending review, the amount of money
that goes to local authorities co-operating with the NHS on
the prevention of ill health will not just be enough to make
up for the cuts they have suffered over recent years but
enough to really go forward and transform prevention
measures?
-
To answer the noble Baroness’s first question, I believe that
changes in actuarial calculations were the driver of that
change. However, it is a technical issue and I will write to
her and place a copy of the letter in the Library so that
other noble Lords can see the rationale for it. Regarding her
question about public health funding, obviously it is not for
me to make predictions about exactly what will be in the
spending review, save to say again that there was a clear
commitment in the Statement that we would not create further
pressures for the NHS through the settlements delivered for
social care and public health.
-
My Lords—
-
(CB)
My Lords—
-
My Lords, it is the turn of the Cross Benches.
-
My Lords, there is much concern in this House about social
care. Can the Minister confirm that the now-promised social
care plan will address not only the needs of older people but
the needs of all vulnerable people of all ages? It is a
little-known fact that the cost of meeting the needs of
people with learning disabilities will soon overtake the cost
of care of the growing number of older people. It is really
important to address that.
-
The noble Baroness is quite right to highlight the care for
this vulnerable group of adults. As she knows, there has been
a parallel work stream alongside the work for the Green
Paper. Those are two allied but separate pieces of work. At
this point in time I do not have a specific date for when
that work will emerge into a report or a review, but I will
write to her with the details because the Government agree
with her that this issue is of equal importance.
-
(Con)
My Lords, given the Administration’s traditional objection to
the hypothecation of revenue, does my noble friend agree that
the Chancellor is likely to be reluctant to say that he is
putting up taxation specifically for the NHS? In any case,
would it be more acceptable to the public for the money to be
raised by way of an increase in national insurance
contributions rather than through general taxation?
-
I should not like to put any words in the mouth of my right
honourable friend the Chancellor. What I do know, as was
evident yesterday, is that he has committed to deliver the
finances required to fulfil the plan that the NHS puts
forward. Clearly, as my noble friend points out, there are a
number of ways that we can do that. Polling suggests that
some forms of taxation are more popular than others, and we
know that technical challenges are associated with
hypothecation. As I said, this is a very important and
valuable conversation in which this House has a leading role
to play in making sure that we get the right outcome.
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(Lab)
My Lords, this otherwise very welcome announcement was
accompanied by quite misleading and—I hope the noble Lord
will agree—deplorable PR spin about a Brexit dividend. Does
he accept that the OBR, which provides the government
economic statistics, has said that there is no such thing as
a Brexit dividend? There is a Brexit penalty, because the
reduction in tax revenue as a result of lower economic
activity than would otherwise have taken place is
significantly greater than the saving of our net contribution
to the Union. Is it not the case that, in trying to pretend
that there is a dividend, the Government have actually tried
to mislead the public, and is that not something that, on
reflection, the noble Lord would agree is most unfortunate?
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I would not agree with that because it is clearly the case
that once we have left the European Union we will not be
paying for membership of it—and it is those funds which will,
in part, go towards helping us solve the funding challenge
that we have set ourselves for the NHS.
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(Con)
My Lords—
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(LD)
My Lords—
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My Lords, we have plenty of time. It is the turn of the Lib
Dem Benches.
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My Lords, further to the question from the noble Lord, Lord
Davies, is it not true that the OBR forecast budget deficit
is twice our net EU contribution? We will also be making
continuing payments for participation in EU programmes and
agencies, let alone the £39 billion divorce Bill. Is not the
Brexit dividend claim on the No 10 website—which is a
government website, not a Tory Party website—a breach of the
Government’s duty to ethics, truth and accuracy?
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No.
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Does the Minister agree that the obesity epidemic is costing
well over £25 billion a year? Would he consider having an
all-out campaign— including every man, woman and child, every
institution, school and government department—not to tell
people what to do but to tell them the truth? For instance,
there are 4 million people with type 2 diabetes due to
overeating. If they ate less the savings would be terrific
and most of them would be cured of their diabetes.
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My noble friend sets a tremendous personal example in this
case. He is a fearless and tireless campaigner on the causes
of obesity. He knows that it is our hope and intention that
we will return to this topic so that we can start to reduce
this plague on children and adults.
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(Lab)
My Lords, in the Statement the Minister referred to full
integration between health and social care. Does he mean full
integration of services, work force and budgets? If so, is he
confident that it can be done without the kinds of
reorganisation that all of us dread?
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The noble Baroness makes a good point from her experience.
There is agreement across the House—and, indeed, across both
services—that there needs to be an integrated service. It is
clearly not satisfactory to delineate in the way that we have
done historically. How we get there will obviously be
difficult. We need the NHS and local government to take the
lead and to come up with proposals. If we believe that those
proposals will deliver what we want without creating
upheaval, it is incumbent on us all to get behind them.
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(CB)
I welcome this additional contribution to the health service.
However, have there been overoptimistic algorithms on
improving productivity? We know that staff are currently
stretched, and to expect continued productivity increases
before we invest in modern technology will result in more
staff leaving, and that would not be rational.
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The noble Baroness makes an excellent point. We know that NHS
staff do a wonderful job and work incredibly hard. In talking
about productivity it is wrong to think of it only in terms
of getting more out of the same people. The wage bill, I
think, makes up around 40% of the total NHS spend, a great
deal of which is on buildings, on items and on technology. We
need to use more technology so that we can deliver the
productivity gains that we need.
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