Rt Hon Sir Norman Lamb, Former Minister for Care and Support, Department of Health
The COVID crisis has really exposed the cracks and frailties in both the NHS and the social care system. For years, we have run the NHS on close to breaking point with little spare capacity. By international comparison, for example, we have a very low number of intensive care beds.
In social care, the position going into this crisis was even more precarious. Many providers faced challenging finances. The numbers of older people, including many with dementia, who receive help with their care needs has been in decline for years as local authorities tried to cope with significant cuts to their funding from central government. Care staff are under-valued and under-paid.
Then COVID hit. Thankfully, the NHS was not, ultimately, overwhelmed but it has been a torrid time for so many staff working on the front line. Many doctors and nurses have experienced real trauma, and total exhaustion, as the death toll rose. They have felt let down by inadequate stocks of PPE.
As for social care, yet again, the sense is that it is the poor relation. With all the focus on what was happening in acute hospitals, it felt like care homes had been forgotten. Patients discharged from hospital into care homes without being tested for COVID, wholly inadequate supplies of PPE and yet here we had the greatest concentration of people who were most vulnerable to fatal consequences of contracting COVID.
So, as we look ahead, the first conclusion is that lessons must be learnt, not just for the next time we are hit by a pandemic, but to repair and rebuild a fragile and inadequately resourced health and care system.
I had spent the last four years of my Parliamentary career leading efforts to persuade the Government to establish what I called a ‘Health and Care Convention’ in order to build a consensus for a new settlement for the NHS and for social care. The case for this is now overwhelming. Getting people to pay more for public services is always challenging politically. Parties become wedded to the idea that the public would never stomach an increase in taxation. And so election manifestos always fall short. Surely, therefore, we have a duty to the people of this country to bury our differences and to work together to come up with solutions.
William Beveridge, back in 1948, proposed the founding of the NHS. Now, 72 years on, is the time for a refresh – and it is time to recognise that you can’t achieve a sustainable solution for the NHS unless you also sort out the funding of social care. What’s more, you can’t achieve effective support for people unless we join up our fragmented system so that care is based around the needs of the person, rather than focussing on organisational boundaries and demarcation disputes about who should pay.
Capacity and resource
As we seek to learn lessons from this crisis, we should also look at how other countries coped. The truth is that we spend less on health and social care than many other leading European countries. And look at Japan and Germany, which have confronted the failures of their social care system and implemented more sustainable funding arrangements.
We will have to ask ourselves the uncomfortable question about why it is that healthcare systems around Europe based on social insurance tend to be better resourced and have, for example, more intensive care capacity.
So now is the time to confront these questions. For the sake of those who rely on health and care services, this cannot wait. And it cannot just become another political football smashed back and forth whilst people suffer.
This COVID crisis has led to much soul-searching. It has helped many of us reorder our priorities. My dream is that we grasp this moment; that we involve the people of this country in a national discussion and that we commit to building a modern, joined up health and care system.
Decentralised and joined up
Here are some basic principles to guide us. It must aspire to be, genuinely, the best in the world in terms of outcomes for people. It must have equitable access – whatever your wealth or income, you must have the same right of access to great care. We must focus much more on prevention of ill health. We must seek to empower people and families. There has to be equality between mental and physical health. It should not matter whether you have cancer or dementia – your right to outstanding support should not cause catastrophic financial loss.
Finally, we should learn another important lesson from this pandemic. Command and control from the centre has not worked. More decentralised systems seemed to have fared better. By joining up our health and care services in each locality and by pooling recourses, we are likely to achieve better results for people.
Sir Norman Lamb was Liberal Democrat MP for North Norfolk from 2001 to 2019. After serving as a minister in the Department for Business, Innovation and Skills, he was appointed Minister of State for Care and Support at the Department of Health in September 2012 until the end of the Coalition Government in May 2015.
As Health Minister, Norman worked to reform the care system and led the drive to integrate health and social care, with a greater focus on preventing ill health. He also challenged the NHS to ensure that mental health was treated with the same priority as physical health, including the introduction of access and waiting standards in mental health for the first time. He was the Liberal Democrat Health spokesperson between 2015 and 2017 and Chair of the Science and Technology Select Committee between 2017 and 2019.
In the Queen’s 2019 Birthday Honours, Norman received a knighthood with the citation noting in particular his mental health campaigning, with Norman establishing a mental health and wellbeing fund in Norfolk after standing down from Parliament in 2019. Norman has more recently taken on the role of Chair of the South London and Maudsley NHS Foundation Trust and Chair of the Children’s and Young People’s Mental Health Coalition.