The Liberal Democrat spokesperson for Health and Social Care talks about the disconnect between how healthcare and social services are funded.
Helen Morgan, Liberal Democrat MP for North Shropshire, and the party’s spokesperson for health and social care, talked to Healthcare Today about why the current disconnect between health and social services needs urgent reform and her vision about how it could be fixed.
There has recently been a huge amount of talk and rumour about the healthcare sector. At its heart seems to be an attempt by the government to create a leaner NHS. Do you think this is the right approach?
Most people who have visited a healthcare setting, particularly a hospital, in recent years would likely agree that there is some level of waste within the NHS and that resources could be used more effectively. There is broad recognition that a shift in how money is spent within the NHS is needed, with a greater focus on frontline and community-based services. As such, I have some sympathy with efforts to reduce duplication and inefficiency. The recent announcement about reducing headcount at NHS England, if it genuinely targets unnecessary duplication, seems reasonable in principle. However, without specific details, it is difficult to offer a definitive verdict.
“The concept of private provision is already well-established within the NHS, particularly in areas like general practice and dentistry.”
One of the biggest stories that we’ve seen this year has been the acknowledgement that there’s going to be greater use of the private sector to reduce NHS waiting times. Is this a threat, an inevitability or is it something to be welcomed?
What ultimately matters are the outcomes for patients. If the use of private providers leads to faster treatment, maintains or improves the quality of care, and does not significantly increase costs for the NHS, then I don’t have an ideological objection to their involvement. After all, the concept of private provision is already well-established within the NHS, particularly in areas like general practice and dentistry.
That said, the key focus must remain on the patient experience. If patients encounter difficulties accessing care or receive a poorer experience because private providers prioritise profits over patient care, that would be deeply problematic.
The true measure of success will be in the results – how these changes impact patients and the overall efficiency of the health service.
You campaigned for re-election on ambulance waiting times. This year was the worst on record for emergency services. What is the answer?
It used to be unheard of for an ambulance not to arrive within a reasonable time, yet this is now a reality in some areas. The problem appears to be more acute in certain hospital trusts and ambulance services than in others. For example, ambulance services in Westminster have faced significant challenges, largely driven by specific issues at individual hospitals within their area, where ambulances are forced to wait for hours to hand over patients.
This winter, a perfect storm of factors exacerbated the situation, including an early flu season, ongoing COVID-19 pressures, and outbreaks of norovirus. While these challenges were widespread, some areas have managed to perform better than others. This disparity suggests that we should look to high-performing areas to understand what they are doing differently and seek to replicate their successes in areas that are struggling.
Take Shrewsbury and Telford, for example, which consistently ranked among the worst performers last winter. This year, they have only had one critical incident so far and data indicates that the situation is improving due to operational changes they have implemented.
That said, there are limits to what individual trusts can achieve without addressing broader systemic issues. Improving access to primary care, fixing social care, and investing in prevention are all critical to creating a sustainable solution.
“We are currently spending in the wrong areas, and this misallocation is driving inefficiencies.”
Is the answer just more money? Would money fix this?
We are currently spending in the wrong areas, and this misallocation is driving inefficiencies. For instance, treating someone in a hospital is significantly more expensive than treating them at home. At home, patients can maintain their independence and benefit from the comfort of familiar surroundings. This approach is not only more cost-effective but also leads to better outcomes for patients.
Lord Darzi’s report underscores this point very clearly. For decades, there has been widespread agreement that we should invest more in prevention and community-based care. Yet, in practice, the system has continued to prioritise hospital-based treatment, which is far more expensive.
While additional funding is undoubtedly needed in some areas, the real issue is how we use the resources we already have. By investing in prevention and community-based support, we can reduce the strain on hospitals, improve patient outcomes, and create a more sustainable healthcare system.
You mentioned the disconnect between health and social services. How do the Liberal Democrats plan to integrate health and social care services to improve patient outcomes?
A local health system can run a deficit, whereas a council is required to balance its budget. This creates a fundamental tension when trying to move patients into social care rather than keeping them in hospital, even when doing so would be more cost-effective. From the council’s perspective, taking on additional social care responsibilities is financially burdensome, so there is little incentive to do so.
The system, however, has been designed in such a way that councils seek to limit demand for social care, while the NHS can operate at a deficit without triggering a major local crisis.
This structural imbalance is a significant issue. Ultimately, patients and their families do not care which budget funds their care; they just want services to be delivered efficiently and effectively.
And how would you fix that?
This issue is precisely why we are pushing for cross-party talks with the government and other parties on social care. The current approach – funding social care through council tax – is clearly neither fair nor effective. Areas with a low council tax base often have higher social care needs – whether due to an ageing population or a greater number of people requiring intensive support – but they generate less revenue from local taxation. This creates significant regional disparities. The current system is simply not working, and it must be reformed.
“Addressing inequalities must be a priority for central government, but the causes are complex.”
As Healthcare Today has reported, cancer death rates are nearly 60% higher for people living in the most deprived areas of the UK. The Liberal Democrats have often advocated for more localised decision-making. How would this work in practice?
Health disparities should be a concern for everyone. The data is clear: cancer rates, maternal mortality and overall life expectancy are all significantly worse in deprived areas. Addressing these inequalities must be a priority for central government, but the causes are complex.
Take obesity, for example. A recent debate in Parliament highlighted that obesity rates are far higher in deprived areas. Multiple factors contribute to this, from the prevalence of fast-food outlets to the nature of people’s jobs, which may make it harder to maintain regular, healthy eating habits. While central government can implement broad policies, it is local authorities that are best placed to address the specific challenges within their communities.
As a final question. If you could give Wes Streeting three pieces of advice right now, what would they be?
Social care reform requires urgent, collaborative action. The challenges in social care are a ticking time bomb.
Another key priority should be strengthening primary care. Far too many people end up in A&E when they might have been treated more effectively elsewhere.
Finally, mental health must not be overlooked. A significant number of people are unable to work due to poor mental health, and accessing treatment is often frustratingly difficult. Ensuring proper support is available is not just a healthcare issue – it is a social and economic imperative.
