Contribution
My Lords, we on these Benches welcome the Minister to her place. I know that, when I say that we hope that she is not too long in her place and that the noble Baroness, Lady Merron, is with us again soon, she will understand that I say it in the nicest possible way.
From these Liberal Democrat Benches, our unwavering commitment to the NHS remains absolute. We welcome any stated ambition to improve the health service, particularly with a focus on prevention, leveraging technology and moving care closer to people’s homes. However, our support is contingent on plans being genuinely deliverable, properly funded and, crucially, addressing the interconnected crisis in social care. We have long championed that you cannot fix the NHS without fixing social care.
I confess that, as I read the Government’s new 10-year plan, a familiar echo resonated through my mind. Having started my career in the early 1990s as a manager in the health service, much of what is proposed sounds eerily familiar. This plan speaks of a network of new neighbourhood-based care that provides services between general practice and traditional general hospitals. This mirrors strikingly similar initiatives from previous governments—echoing, for example, the advocacy of the noble Lord, Lord Darzi, for polyclinics in 2007.
What does history teach us about such wholesale shifts of care from hospital? It tells us that this inevitably involves running the old and new systems simultaneously, which is, without exception, expensive. Hospitals will continue to perform their essential functions, and their fixed costs will remain. The new community service demands significant new investment in buildings, staff and technology, and there are no immediate savings to fund the shift. Let us not forget the stark reality: we currently lack the capital simply to repair our existing crumbling health estate, let alone build numerous new hubs.
Crucially, for any plan that speaks of shifting care out of hospitals, the most frequent users of the NHS are our elderly population. Keeping them well and out of acute settings profoundly depends on effective social care, yet this essential pillar remains largely absent from this new plan. We search in vain for a decade-long funding and development road map for social care, or for a stand-alone, fully resourced social care strategy. This is a crucial strategic failure, undermining the very foundation upon which this shift to community is based.
Moreover, while the enthusiasm for digital transformation is understandable, the detailed implementation plan of how to do it is absent. The app is a diagnostic tool; it does not provide direct care, it does not give the jabs and it does not provide the treatment. The King’s Fund has shared its concern on this:
“AI scribes can only transform the productivity of the NHS if staff don’t need to spend 30 minutes every morning logging into multiple out-of-date IT systems”.
The fundamental question remains unanswered: how will this be delivered? The plan is ambitious, but it has been launched into an incredibly chaotic delivery environment marked by significant structural change within the health system bureaucracy. The key question for the Government is how this will be delivered. I therefore have a few questions for the Minister.
What precise funding strategy is embedded within the 10-year plan to deliver the necessary reform and integration of adult social care? Given the dual running costs of new neighbourhood health facilities, can the Minister provide a year-by-year financial breakdown of expenditure and demonstrate how these investments will lead to overall system efficiencies and net savings? Will the Minister commit to publishing within the next four months a comprehensive, independently overseen delivery road map for this 10-year plan that details specific year-by-year objectives and names leads and mechanisms for public reporting on progress? While we wish the ambitions well, the key challenge for this Government is how they will deliver and being open and transparent on that.