Lord Scriven (LD)

My Lords, it is always a pleasure to follow my noble friend Lady Walmsley; I will pick up on her final theme. I thank my noble friend Lady Janke for initiating this important debate. As the vice-chair of the APPG on Pharmacy, I think the case for extra investment has been made by both her and my noble friend Lady Leaman. When the Government took office nearly two years ago, they came with a narrative of transformation. They promised people a fundamental shift away from the expensive, reactive walls of acute hospitals and toward a proactive, preventative “neighbourhood health service”. But looking at the NHS ledger of the 2026-27 financial year, they are forced to confront a recurring theme: the Government’s policy is built on hope while the NHS is living a different reality. The Government stated their hope that primary and community care would finally receive the financial engine required to keep people well for as long as possible at home. The reality under their watch is that the gravitational pull of the acute sector is still as strong as ever, accounting for between 75% to 80% of total NHS spend. The data from integrated care boards for the year ahead show this. Out of a combined £139 billion allocation, the total identified for neighbourhood health transformation activity is a measly 0.25%—and this is to fund the flagship policy of the Government’s health strategy. The reality is that local efforts to invest in community, primary and preventive services have been actively crushed by top-down directives prioritising acute hospital performance. The Derbyshire, Lincolnshire, and Nottinghamshire ICB cluster tried to deliver the Government’s vision, with a £33 million fund dedicated to community transformation. Yet, within days of launching it, national performance directives forced it to withdraw the whole funding and redirect it to acute services. The Government’s financial priorities are also written clearly in their capital budgets. They have earmarked £2 billion this year for acute emergency care, yet allocated only £200 million for their flagship neighbourhood health centres. When you contrast £2 billion for the emergency machine against the £200 million for new community infrastructure, their true priority is laid bare. Nowhere is the gap between the Government’s rhetoric and reality more damning than in community support for learning disabilities. Over the past 24 months, we have witnessed the continuation of the systematic hollowing out of the infrastructure that keeps these people safe and alive. Evidence published only last week by the Royal College of Nursing exposes what is happening right now under this Government’s watch. In its report, Safety, Equity and Expertise, the RCN warned that the specialist learning disability nursing workforce is in absolute crisis. In autumn 2025—the first academic intake under this Government—we see a catastrophic collapse in the pipeline. Fewer than 500 student learning disability nurses enrolled across the entire UK. In the south-east, the intake was exactly zero. The workforce is evaporating because community budgets are being raided. What is the human cost? For someone with a learning disability, there remains a shocking 20-year life expectancy gap compared with the general public. When the Government force ICBs to pull transformation funds and look the other way as the specialist nursing pipeline dries up, they engage in a false economy of the highest order. When a vulnerable young person loses their community safety net, they land, eventually, in an acute crisis bed. The taxpayer pays a premium for this systematic failure. This is not just a policy failure but a profound human failure which is all too real for my family. Why have the Government spent the last two years forcing local health systems to continue to feed the acute vacuum? When will they finally align the reality of NHS budgets with the hope of their rhetoric?