This week both Houses of Parliament are debating the contents of the speech delivered by King Charles, but written by the new Labour government. The state opening of parliament is a ceremony held at the beginning of every parliamentary session. The king’s speech is of great significance following a change of government as it sets out how the new prime minister intends to legislate for measures to take the country in a different direction.
What issues need to be addressed?
During the six-week election campaign I had canvassed extensively across seven of the constituencies which my party had hoped to gain, something that I began doing in Liverpool in the 1970s. I later went on to run election campaigns for the Liberal Party under Paddy Ashdown and Charles Kennedy and a key part of my job was analysing the responses people were giving on the doorsteps.
This experience led me to believe that by the end of the recent campaign, we would have at least 70 Lib Dem MPs. It was clear in talking to people this time around, that there was widespread apathy, and even feelings of contempt, amongst former Conservative voters who were dismayed by their party’s record in government over the last decade. When probing issues of concern with everyone I spoke to, my instinct was confirmed: our creaking health and ongoing care system topped their concerns.
There are many reasons for the huge pressure on these systems. They include growing life expectancy with more ill health in later life, the increasing prevalence of diabetes and obesity, and a great reluctance by politicians of all parties to ask people to pay more for the support that they need. Parties could not promise to ask people to pay more given the ongoing cost-of-living crisis, with prices rising rapidly and levels of economic growth remaining low. These economic conditions have been made significantly worse because of Brexit, but this fact was hardly mentioned during the election campaign when it would have been more honest to do so.
Did the king’s speech provide any answers?
We cannot tackle the crisis in the NHS without tackling the crisis in social care. Although there are some potential answers, it was disappointing that this was not specifically referred to in the king’s speech. Too many people are in hospital for too long, and they occupy beds at a cost of £3,000 a week. This, in turn, requires staff who might otherwise be attending to other patients also in real need of hospital treatment.
To ease the burdens on the NHS, we need to help people be discharged from hospital by providing proper care and support in the home environment. Ed Davey’s personal story about caring for his disabled son moved many people I spoke to. The Lib Dem leader argued for greater recognition and reward for those in caring roles. We also need to support people with appropriate adaptations and equipment, allowing them to live more independently at home, which tends to be a patient’s preference.
And we need to do much more to tackle the root causes of ill health. One in five children are obese by the time they leave primary school. The cost of treatment for all the related conditions they will face as they grow up, and the increased prevalence of diabetes with its associated complications, are enormous. We need to ensure the provision of healthy, nutritious, and free school meals at least until the age of eleven. We also need to end the discrimination in the tax credit system against families with more than two children, who often struggle to afford fresh food. Planning laws should be changed to reduce the prevalence of fried chicken and fast-food outlets near schools.
The ‘sugar tax‘, introduced by the previous government, has proved to be successful with the amount of sugar consumed daily in the UK falling by 11g in adults and 5 grams for children. The principle of it could be extended both to help improve the composition of food and to change habits. Powerful lobbying interests and the libertarian right of the Conservative Party negatively influenced several MPs resulting in the previous government’s obesity plan being blocked. This plan needs to be reinstated and to encompass other strategies such as reducing the impact of advertising for ultra processed foods and educating children at school about healthy eating and teaching them how to cook.
Why does weight still matter?
Men, as well as women, are often embarrassed to talk about their weight issues. I suffered bullying at school in Liverpool because of mine, whilst I received no education about what I should eat and, more significantly, neither did my mother.
Thirty years ago, when I was diagnosed with diabetes, I weighed 131 kilos. Fifteen years later, having been prescribed massive amounts of medication to sustain me, I was being warned that I had now become at high risk of a heart attack or stroke, and that I might not make it to 50. With great help and support from the NHS, I have lost 34 kilos, and I have kept it off. I am advised by my NHS consultant that a diabetic man my age (64) who takes insulin like I do will, on average, put on around a kilo a year. That may not sound much, but over 10 or 20 years weight gain like this can be catastrophic as it comes with an increased risk of all the complications associated with diabetes, including stroke or heart attack.
Avoiding this fate required major lifestyle changes and I, and many others who are in a similar situation, still need to make more of them. I have been helped by the continuous glucose monitoring system that I have, and I am very proud to have given significant help to the manufacturers in getting it approved by NICE and in use in the NHS. Such medical innovations will certainly help to reduce costs to the NHS in the long run.
The long-term cost of doing nothing
Too often, however, the Treasury ignores strategic long-term cost/benefit analysis in favour of short-term savings, and this will only cost the NHS more in the future, and may cost many patients their health. When I speak to people promoting innovative healthcare products, they are often frustrated by “short-termism,” and I tell them that whichever party wins the election, the Treasury stays in power.
Accessing the different types of support that you need can be very difficult. I have failed over several years to get the footcare I need from the NHS because demand so far outstrips supply. Failures to provide such support can cause many longer-term problems. People walk less and are therefore more sedentary when they have foot problems, and when things go wrong the result is that around 6,000 people in this country have foot amputations each year.
Much was made before and during the election about the number of working age people who are not in employment because of health conditions. Too little was made of the fact that we will not get more working age people in employment without reducing health inequalities. At a recent Diabetes UK event, I was told that around 360,000 working age people are not in employment because of diabetes related conditions.
One of the things I was most encouraged by in the king’s speech was the promised return of legislation to progressively ban sales of tobacco depending on your age. In debates in the House of Lords about health and smoking, I always point out that half the difference in life expectancy between the richest and the poorest in the UK is accounted for by smoking. Every percentage point decline in smoking brings people back to the workforce benefiting public finances by around £800mn. These preventative steps will more than pay for themselves and save lives.
We may have a government which lasts in office for at least ten years. It should not fear investing in health and care in ways which keep us all healthy and out of hospital for fear that long-term economic benefits will only help the next government and not the present one. Investing sensibly can reduce long-term costs to the Department of Work and Pensions, increase revenues to HMRC, and reduce the pressures and costs to the NHS in future decades.
