NHS: Long-term Sustainability

Baroness Merron Excerpts

Thursday 18th April 2024 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I congratulate the noble Lord, Lord Patel, on securing this debate and for introducing it with his characteristic authority, insight and care, with which we are so familiar in your Lordships’ House.

I am delighted that my noble friend Baroness Ramsey of Wall Heath chose this debate in which to make her excellent maiden speech. How proud her mother and father would have been today, and what a difference she made to the life of her late sister, and, indeed, to the National Health Service; and what a difference I know she will make to your Lordships’ House.

To give some context to the need for long-term sustainability, over the last 14 years, as we have heard, the health service has acquired the undesirable distinction of having the longest waiting lists, the lowest patient satisfaction and the worst strikes in its history. The noble Lords, Lord Patel and Lord Kakkar, not only described the harsh realities and inequalities of the current systems but asked what all parties would do about correcting it. I am flattered to be invited to give some flavour of how an incoming Labour Government—if there is to be such a thing—would approach the challenges ahead.

On that point, I am glad that my noble friends Lord Hunt and Lord Reid and the noble Lord, Lord Crisp, recognised the positive impact on the health of the nation of the last Labour Government, in which I had the honour of serving as a Public Health Minister. That allows me to say to noble Lords, including the noble Lords, Lord Bethell and Lord St John, and the noble Baronesses, Lady Boycott and Lady Finlay, that, when it comes to prevention and a focus on the broader improvement of health, I am totally signed up.

My noble friends Lord Hacking and Lord Parekh have brought a welcome analysis to today’s debate. I agree with my noble friends Lord Hunt and Lord Turnberg and the noble Baroness, Lady Hollins, that bullying, burnout and pressure on the workforce is no way to retain or get the best out of people—we need only talk to people in other sectors to remind us of that.

This change will require a change in culture on so many levels. The noble Lord, Lord Crisp, spoke of the fundamental need for shared vision, hope and energy. It struck me that they are exactly what is missing at present in health and social care. As we have heard today and so many times before, social care is inextricably linked to the health service. I remind any incoming Government, including a Labour one, that there are a number of first-rate and considered Lords reports, including on social care, primary and community care, and long-term sustainability. Therefore, any Government would be extremely well advised to delve into them. Wes Streeting, shadow Secretary of State, has been very clear about the measures that need to be taken on social care, emphasising the need for long-term planning, thinking and funding.

The right reverend Prelate, the noble Baroness, Lady Cavendish, and my noble friends Lord Turnberg, Lady Pitkeathley and Lady Warwick were absolutely right to speak about the invisibility of unpaid carers and the poor treatment of employed care staff. That is not sustainable—and neither are the record levels of sickness and long-term conditions that affect the workforce, which my noble friend Lord Davies and the noble Lord, Lord Londesborough, spoke about so clearly.

I do not consider myself a technological expert, but rather a technological convert, which I am sure the noble Lord, Lord Allan, will be very pleased to hear. So I have looked to countries such as Israel, which I believe to be at the cutting edge, which is where the UK needs to be. At the emergency department of the Sourasky Medical Center, people register digitally, identify themselves through facial recognition and measure their own blood pressure, temperature and heart rate in self-triage booths. Patients are given a barcode and a number is sent to their phone, which they can track on a screen. The most serious cases are seen within minutes, and virtually no one waits more than an hour. Last month, this Tel Aviv hospital became the first in the world to integrate an AI chatbot into its triage process.

What is the driving force behind that? This Israeli hospital is designing healthcare around the needs of the patient, which my noble friend Lord Carter and many other noble Lords called for. Sadly, that is very much in contrast with Britain, where our NHS reels from crisis to crisis, while the political debate circles around funding, staffing and pay. The way that we bank, shop, travel and work has been digitised in the past decade, yet the NHS remains largely outdated. There are multiple IT systems in the NHS and no requirement for them to be interoperable.

That means that systems cannot talk to each other, sometimes even within the same hospital, let alone between institutions or between primary and secondary care. There are at least 21 different types of electronic patient records in hospitals and 34 apps to book an appointment. No company would be able to survive with productivity like this, as the noble Baroness, Lady Tyler, said. Let me ask the Minister: how has the Government allowed the NHS to develop like this?

NHS England’s digital lead, Joe Harrison, estimates that every pound spent on technology generates between £3.50 and £4 in savings. Such an approach makes sound financial sense, as well as good health sense. While the case for reform is overwhelming, too often the innovators are thwarted by a fragmented system or vested interests. What is being done to overcome this?

We know that an estimated 13.5 million hours of doctors’ time is wasted every year due to inefficient IT. Fixing that would be the equivalent of 8,000 new doctors joining the NHS. That is the difference between the huge staff shortages that we see and filling almost every vacancy for a doctor. With our country’s population ageing, the health of the public worsening and chronic disease rising, the sustainability of the NHS is crying out for change.

I recently went to the National Theatre’s production of “Nye”, as I know many other noble Lords have done. When he created the NHS in the 1940s, Nye Bevan had absolutely no idea of the scientific revolution ahead. Regrettably, if we dropped Nye Bevan into the NHS today, he would see the modern-day pressures of an NHS that is overly hospital-based and gets to patients too late, at greater cost and with worse outcomes.

If Labour does get into government, we will arm the NHS with the modern technology it needs, doubling the number of scanners, and putting AI into every NHS hospital, so that patients are diagnosed earlier. We will get rid of the unnecessary bureaucracy whereby innovators have to tout their technology to each individual NHS trust; we would stop the need to sign separate agreements with each of them. We will streamline the route in for innovators and put the entire NHS in partnership with the technology and life sciences sector.

Following the pandemic, more than 32 million of us carry the NHS app in our pockets. That provides the potential to transform how the NHS interacts with patients, promotes good health and increases people’s control over their own healthcare. We would make the NHS app not just something to assist the NHS in healthcare but a key component in delivering care—both preventive and curative—and empowering patients.

Finally, what do the health and care leaders want? They know that investing in primary and community care results in a lower demand in hospital emergency care. For every pound invested in the NHS, £4 comes back to the economy. The greatest economic returns come from investing in primary and community care, where we see a £14 economic return for every pound invested. If Labour is to be in government, this is the step change that we will make.