My Lords, I first congratulate my noble friend Lord Stevens on an excellent maiden speech. I agree with him that there are substantial opportunities in this Bill, although some things are missing, some of which he referred to, such as mental
health and determinants of health. As other noble Lords have discussed, however, I feel the complexity of some of these processes and the difficulty of getting one’s mind around how this will actually work.
I agree with so much that has been said about social care, particularly on the cap. I trust that your Lordships’ House will send this back to the other place rapidly for it to think again. I also agree with many points that have been made on the workforce, although I would make a single observation—that we need to pay attention to changing roles as well as to numbers. In the case of primary care, it will not look in 15 years’ time as it does now. This is for all kinds of reasons, including the way that nurses are taking on a much bigger role; they will continue to do so, and I suspect they will be the lead providers in primary care in 15 years’ time. That is a simple prediction that I may come to regret.
When you make a change such as this, you disrupt the system and some arrangements that used to work. There are two more specific points that I should like to explore in Committee. One is how we ensure that primary care—GPs, but primary care more generally—still has a significant role in approving plans. I recognise that there are practicalities around that, but it is vital that it retains some impact. I also think it is very important that foundation trusts can maintain sufficient independence of action. I know that the concern of NHS Providers is about control of capital in that regard. Some things need to be explored further.
However, my main observation is to follow other noble Lords in saying that we are talking here about integrating health and social care, but that is 20% of the issue; there is so much more outside that. We know all about social determinants; many have mentioned them. We know the massive impact of education, employment, training and housing—both positive and, I may say, negative—on health, and we know the science that underpins that: about relationships, how social isolation leads to dementia; how exercise, exposure to nature, and such aspects, make change. We need to capitalise on that.
I want to make two points that are slightly different from what others have said. First, this is not just about prevention. Prevention is about the causes of ill health; we need to be thinking also about the causes of health, and the two things are often run together in ways that are unhelpful. Creating health is about creating the conditions for people to be healthy and helping them to flourish. It is about human flourishing, eudaimonia, if one wants to go back to Aristotle.
The second point, which goes alongside it, is that the health of the individual is intimately connected with the health of the community in which they live. This is a point that the noble Lord, Lord Mawson, in particular, exemplified with his discussion about Well North, but also his early experience in Bromley by Bow. There are now examples all over the country of people starting to bring together the things that improve communities with the things that improve individual health. That is a vital part of the future. We have known that for years, but we have not known how to connect it properly with the NHS. I speak as a former chief executive of the NHS in England who failed to make that happen.
My question to the Minister is: how will the Government ensure that those other groups in society—voluntary organisations, housing associations, employers, schools, educators and so on—contribute to creating health and, thereby, supporting the NHS to do its vital work? We need to see health in terms of wonderful healthcare and services and prevention of disease, but also creating the conditions for people to thrive. The underpinning thought here is that our health as individuals is intimately connected with the health of our communities, of society at large and, ultimately, of the planet.
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