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I reassure the noble Lord, Lord Selsdon, that I shall not be giving him a story of perpetual sunshine, which his political leader in the other place occasionally indulges in; and I assure him and the noble Earl, Lord Howe, that I accept that sometimes it rains in the NHS. But—and it is a “but”—I am pleased to have the opportunity to remind people about the past. I believe that one of the best predictors of future behaviour is past behaviour. I do not want to dwell on this too long but I have to remind people, painful though it may be, of the legacy that we inherited, and my noble friend Lord Graham has already reminded us of the situation before the NHS came into being.
When this Government came to office in 1997, the NHS had a largely Victorian infrastructure. According to the King’s Fund, in 1997, the average age of NHS buildings was older than the NHS itself. There were staff shortages: 37 per cent fewer doctors; 27 per cent fewer nurses; 36 per cent fewer allied health professionals; and 17 per cent fewer GPs; and the previous Government did not even bother to count separately healthcare scientists. Two dental
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I accept that there is still more to do if we are to have a 21st-century healthcare system. But, since 1997, we have seen far-reaching improvements, which many people have acknowledged today. There are now 404,000 extra staff: 85,000 more nurses; 122,000 more doctors; 61,000 more allied health professionals; and over 16,000 more radiographers and physiotherapists. Those are large increases by any stretch of the imagination. There are nearly 4,700 more GPs than there were in the past. Part of the reason why we have more GPs and other staff is that we pay them better, and I shall come to that a little later.
We are investing in more training places to secure future staffing levels: 10,600 more medical students have entered training since 1997; a major expansion of dental training is under way; and over 10,000 more nurses and midwives are being trained than in 1996-97. I accept that the money being spent on training in the current year has plateaued off, but it is doing so following huge growth, and the money that was allocated to SHAs in the current year for SIFT and other payments is roughly the same amount as was issued in the previous year. Of course, we have given SHAs authority to take account of local priorities in spending the money but, listening to some of the discussions, one would not have recognised the level of the increase in the money for education and training that has been put into the system.
We have literally hundreds more hospitals, GP surgeries and health centres, thanks in part to the private finance initiative; and there is no evidence that the PFI initiative has caused a huge number of deficits. It is worth remembering that all the trusts that entered into a PFI agreement were asked to test against rigorous guidelines the affordability of the project that they wanted to go forward with. All those projects were subject, as are LIFT and other projects, to Her Majesty’s Treasury’s value-for-money scrutiny. So we have a rigorous system in place.
We have improved services and access to those services. We have cut waiting lists—260,000 fewer people are waiting compared with six years ago; we have improved access to A&E departments and GPs; and there are improving mortality rates. For example, deaths from cancer in the under-75s fell by nearly 16 per cent between 1997 and 2004. That is not just a statistic; it is 50,000 lives saved—50,000 people are alive when they would not otherwise have been. And we are on track to reduce deaths from heart disease by 40 per cent—or 150,000 lives—by 2010.
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We have begun the process of implementing a national programme for IT. It is simply not true, as the noble Earl, Lord Northesk, suggested, that we have had little progress to date. I cannot go through all of it but, for example, more than 90 million digital images are now stored, with people using the picture archive and communication system packs. We are getting close to the point where 50 per cent of patients in the NHS will have their images on that picture-archiving system, instead of X-ray films. I shall give the noble Lord all the details and will circulate them to all other noble Lords.
My noble friend Lord Layard rightly paid tribute to the improvements that have taken place in mental health. There have been huge improvements, and I pay tribute to the work that he has done on talking therapies. We certainly want to continue working closely with him on them. Since we published the National Service Framework for Mental Health in 1999, planned spending on mental health has gone up by more than 25 per cent in real terms—nearly £1 billion a year.
Let me reassure my noble friend that there has been a huge shift in services from in-patient services to the community, with new roles for staff and new, more individual services for service users. For example, in 2005-06, almost 84,000 home treatment episodes took place for people who would otherwise have required in-patient admission. We have expanded community services for people with mental illness. One of the reasons why we need new mental health legislation is because the 1983 Act is out of date.
All these improvements have been delivered thanks to the dedication and commitment of 1.3 million NHS staff as well as the Government’s record levels of investment. I share the views of other noble Lords that these improvements are down to those staff and their hard work day in, day out. But their job is made easier by the fact that there are a lot more of them to do it than there were 10 years ago.
Of course, everything is not perfect, and probably never will be. But we have to consider what patients who experience the NHS have been telling us. They tell a different story from some of the stuff in the media. According to the most recent findings of the Healthcare Commission’s—not the Government’s—national patient survey programme, 92 per cent of adult in-patients rated their care as good or better, as did 94 per cent of adult out-patients and 88 per cent of those who had experienced A&E. That survey was carried out this year. In primary care, 97 per cent of patients said that the main reason they had for visiting their practice was dealt with to their satisfaction. When asked about their experiences, NHS users report a totally different NHS from that which we read about day in, day out, in many of our media outlets.
I am proud of what the NHS has already achieved in the face of fundamental and, sometimes, painful change. I acknowledge that change is difficult; it is tough; it is hard going. But more is inevitable, not just because the Government are dreaming it up, but because we have to make continuing improvements in health and social care.
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The noble Lord, Lord Crisp, drew attention to the experience overseas. All advanced countries with healthcare and social care systems experience the challenges that we are experiencing. There is no escaping those challenges, and I shall mention three in particular. I can understand why the right reverend Prelate and others want us to walk more slowly. I suggest that the challenges that I shall describe make it difficult for us to do so.
First, I refer to demographics. Our population is getting older and more of us are living with illness. By 2025 there will be two-thirds more over-85s. More and more people are living with long-term conditions, and more and more profoundly disabled babies are living to adulthood. This means a massive increase in demand on health and social services.
Our 21st-century lifestyles do not always help. By 2010 we expect almost 13 million adults to be clinically obese, and we are already seeing the associated rise in strokes, heart attacks and type 2 diabetes. The second challenge is that we are experiencing a revolution in medical technology. The noble Lord, Lord Crisp, rightly drew attention to the good track record in this country in biomedical science. Every week, new drugs and treatments are being developed. In a few years’ time, doctors will be able to use drugs that are tailored to the unique DNA of an individual patient. It is quite clear from a casual reading of the media that people want those drugs made available to them, especially when they deal with a life-threatening situation. These advances are, of course, to be celebrated. However, there is no escaping the impact they will have on the cost of treatment.
Finally, there is the inescapable fact that the expectations of our fellow citizens continue to rise—as do our own—as more opportunities to help people present themselves. Waiting times are shorter, but they are not short enough. People also want the NHS to provide them with the same level of control, choice and convenience that they expect from other services. We all expect that as individuals, so why should not everybody else? That presents a challenge. It is also a challenge to ensure that the groups to which my noble friend Lady Howells rightly referred share in those benefits. We must tackle health inequalities even more vigorously.
People want to be treated closer to home; they have made that clear. They want less invasive procedures. If most of us are confronted with a less invasive therapy or surgery, we will take the less invasive procedure. But that has consequences: consequences for the staff providing the treatment, consequences for the places where the treatment is provided and consequences for at least transitional costs. The Institute for Healthcare Improvement report published today makes it clear that providing care closer to home is undoubtedly possible. We want to make sure that the opportunities to do this are grasped. We want a health service, not just a sickness service, in this country. We want to rebalance the system towards ill health prevention and good health promotion. Our future-oriented White Paper, Our Health, Our Care, Our Say, published in January, set out a clear direction of travel. We are already making good progress in many
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Sexual health is a challenge, but it is one of the top six priorities for the NHS in 2006. That is why we are investing more money in modernising sexual health clinics and services. We will be debating some of these issues in more detail next week, so I shall not spend too much time on them now.
A number of noble Lords talked about some of the issues relating to reconfiguration of services. Technological advances pose a challenge, but they represent a golden opportunity to make services safer and produce much better outcomes for patients. They often represent an opportunity to improve efficiency. I recognise that the transition for that, to which a number of noble Lords referred, causes difficulties for those who have to change the way in which they work, or where they work. It also means reskilling programmes and often means a transition set of costs. No Government will find it easy to make cashable savings in acute hospitals as service configurations change. This is a tough challenge for any Government in any healthcare system.
Monday of this week saw the launch of the personal reports of Professor Sir George Alberti and Professor Roger Boyle, the national clinical directors respectively for emergency access and heart disease. Both of them are eminent clinicians with the best interests of patients paramount in their thinking.
Roger Boyle, in his Mending Hearts and Brains—a graphic title—showed us the evidence that it is safer to bypass the nearest local hospitals to make sure that a patient gets specialist treatment in the right setting from doctors and nurses with the right skills to save lives. A patient taken directly to a specialist angioplasty centre is likely to recover from a heart attack or stroke more quickly and without continuing debilitating illness. The way forward for many of the concerns about stroke that the noble Lord, Lord Rodgers of Quarry Bank, rightly drew attention to, is described by Roger Boyle in that document. I recognise that the glass needs to be fuller and that we must work on stroke services.
When the NHS reorganises, it does so primarily for the benefit of patients. Despite what our critics might say, reconfiguration is about providing better, safer and more convenient care. As the noble Baroness, Lady Murphy, said, transformation is sometimes accelerated by the need to look at how the money is spent. In producing their personal reports, the national clinical directors have highlighted how more patients are already being treated outside hospital. That trend will undoubtedly continue.
Your Lordships will be pleased to know that I shall not dwell on how much we have spent on the NHS, but expenditure improvements have been huge. It is not unreasonable to expect that, within that rising growth,
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I recognise that some parts of the NHS have reacted to years of staff shortages and underfunding by recruiting faster than was perhaps necessary. For example, we set several targets for increasing the number of nurses which, taken cumulatively, would have given a staffing level of 385,000 by 2008. This level of growth was achieved in 2003. We now understand that we are seeing a degree of accelerated recruitment. Of course, that will cause some trusts difficulty. Overall, however, I would sooner be in that position than the one the NHS faced in 1997.
I do not have time to continue far along this path, but the noble Lord, Lord James, was concerned about the absence of data. I commend to him the annual report of the Healthcare Commission on the state of the NHS and the performance of individual trusts, produced each year, which gives a lot of information about financial management and quality in those trusts. I also commend the six-monthly reports of the NHS Chief Executive—begun under the noble Lord, Lord Crisp—which give a wealth of data on how well the NHS is running. They give a lot more detail on how things are improving than the report which the noble Lord served up to the previous leader of the Conservative Party for the last election.
In conclusion, whichever way you look at it, the net outcome of our investment in the NHS and the changes already made are a good deal for patients, providing a good base for the future. We have preserved the founding principles of the NHS: the values of a publicly funded service, free to all, equally, at the point of need. We have safeguarded that for future generations.
2.35 pm
Lord Colwyn: My Lords, only a few seconds remain in this short debate. I thank all noble Lords who have taken part and recognise that their contributions have demonstrated a wide range of expertise and experience.
The Minister did not mention the dental treadmill, which is of particular importance to me. I hope that he will note the plea of the right reverend Prelate the Bishop of Worcester for targets for walking slowly and gentle, caring involvement. Perhaps the right reverend Prelate would consider joining the dental negotiating body for targets and recognition; that sort of advice is exactly what is needed to remove the treadmill and encourage dentists to talk to their patients without having to earn points for invasive treatment.
The NHS is a wide-ranging subject. I know it will be debated on many occasions in future. In the mean time, I beg leave to withdraw the Motion for Papers.
Motion for Papers, by leave, withdrawn.
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Adult Social Care
2.35 pm
Lord Bruce-Lockhart rose to call attention to the funding of local authority adult social services and the consequences for the rising numbers of elderly people; and to move for Papers.
The noble Lord said: My Lords, I am grateful for the opportunity to review the funding of local authority social services today, especially in the company of so many noble Lords with great experience in these matters. I declare an interest as chairman of the Local Government Association, although I speak for myself. I shall address three questions. First, is there clarity and consensus about demographic change? Secondly, what kind of care services do we need for the decade ahead? Thirdly, what is the funding requirement to respond to demographic change and change in service demand?
It has been said that you can judge a society by the way it treats and cares for its elderly people. That was never more so than it is today. I was pleased to see that the Treasury’s Comprehensive Spending Review 2007 set out just five factors of change and that one of them was rightly the challenge of demographic and social change. Rising to the challenge of demographic change will certainly be one of the “key tests” in judging CSR 2007.
The over-85s require the most urgent attention and the most intensive care. According to the Government’s actuaries, in 2005 there were 1.2 million over-85s and by 2050 there will be 4 million. For the first time, there are more people in England over 60 than under 16. In the Comprehensive Spending Review challenges report last month, the Chancellor focused only on the next 10 years, reporting a forecast 38 per cent increase in the number of over-85s. His report also drew attention to what he called the “baby boomers”—the increased birth rate in and after the Second World War—which, coupled with increasing life expectancy, now brings a dramatic increase in the number of over-65s. There is clear recognition of dramatic demographic change but, I am afraid, a failure to act on it.
In considering a changing service, we need to respond not only to the demographic change in numbers. Help the Aged, Age Concern, the King’s Fund, numerous charities and local authorities are also reporting a sharp increase in mental, learning and physical disability in old age. We must respond to this, too. At the same time, local authority adult social care budgets are also responsible for the 16-to-65 age group. In this group, we see that medical advances, coupled with better health and social care, mean that children with the most severe learning and physical disabilities are often living into middle age. Indeed, the director of social services in my own county of Kent reports that this financial demand is now even greater than the escalating demand from changing demography. Those vulnerable young people require and deserve intensive, high-quality care.
In 1991, the Government introduced a Bill on community care that allowed elderly people to receive care in their own homes for the first time. That radical
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The Wanless commission pointed to the need for a funding increase of some £20 billion for care of the elderly over the next 25 years, an increase of almost £l billion a year, yet we have had no response from the Government. However, the situation for elderly people and the facts from the Government, local authorities and many charities and voluntary groups are entirely clear. The Treasury forecast that in the next decade the number of people aged over 85 would increase by 3.8 per cent a year. The Local Government Association’s autumn statement showed a 6 per cent increase in the number of weeks of care commissioned by local authorities last year alone, but, to pay for that increase, half the social service authorities had an increase in government grant of 2 per cent or less this year. While the NHS has had a 90 per cent increase in real-terms funding over the past decade, local government services, including social care, have had an increase of just 14 per cent.
A year ago, social service directors reported that they started this year with a black hole from 2005-06, when they spent 13 per cent—£1.8 billion—more on adult social care than the Government estimated for funding. On top of that, there are numerous other factors, including cost pressures, the reduction in grant under the Supporting People programme and the new and additional costs from direct payments, to which a recent Audit Commission report drew attention. As a result of the new demand, the absence of any new funding or action from the Government, and because council tax payers cannot pay more, half the social service authorities in the country are reporting that they are raising eligibility criteria and so rationing care for the elderly. In a civilised society, that is unacceptable.
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