NHS: Independent Investigation

Baroness Merron Excerpts

Tuesday 8th October 2024 Lords Chamber

[Lord Scriven (LD)]

My Lords, I thank the Minister for bringing the Statement to the House. You do not have to be a mastermind to realise that the NHS is straining at its seams. It is only down to the great work of the many thousands of people who work in the NHS that millions of people get great care, even though some fall between the cracks.

The Darzi report is a very good medical history and it gives a diagnosis, but we all know that the treatment plan is going to be the important point if we are to deal with a reformed, new and productive NHS. There are some welcome themes in the report that are not new. Those who know the previous Darzi report will see have seen some of them before: prevention; moving resources from hospital care to primary and community care; dealing with the wider determinants of health; improvements in and parity for mental health; and a bigger role for public health.

I understand that the Minister will answer many questions by saying that we need to wait for the 10-year treatment plan, and probably the Budget, before such specific questions can be answered, but I have a few general questions for the Minister, to get at least a sense of the direction that the Government wish to take.

Is it the Government’s intention to restore the public health grant back its 2014 levels? Are there any general views about looking at changing the structure of public health, nationally or locally? On capital, what is the Government’s thinking about the general theme of allocation to hospital and non-hospital services, and how will this be managed and monitored? On data, what is the Government’s thinking on the workforce plan, particularly when there is a huge imbalance when it comes to digital and data between the private sector and skills within the NHS? That is not to say that there are not some good skills within the NHS, but there is clearly an imbalance.

Welcome as it is that the report talks about moving resources from hospital to non-hospital settings, I was a manager in the health service in the early 1990s and I know that this has been said since at least the 1970s. What are the Government going to do to be able to move resources from sunk costs in the acute sector into other sectors? What mechanisms will be put in place? How will this be monitored? More importantly, who will be held accountable for making sure that it actually happens? How will the new neighbourhood approach affect the existing workforce plan? If a new health service is anticipated, what will the effect be on the workforce plan and the implications for capital allocation?

We all want to see a productive and effective healthcare system that improves peoples’ health and independence, but that cannot be brought about if we do not have a strong, effective, well-funded social care system. I do not understand why social care has been kicked down to the next Parliament, or how we are going to solve the health and well-being of the population without that being done. If the major reforms of social care are in the next Parliament, what steps are the Government going to take in this Parliament to deal with the social care crisis?

I look forward to the Minister’s answers, but, more importantly, to the 10-year treatment plan’s arrival in the next few months.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I thank the noble Earl, Lord Howe, and the noble Lord, Lord Scriven, for their opening observations. I will seek to deal with as many of them as I can; I am sure a number will be iterated in the course of the Back-Bench contributions.

I start by expressing gratitude to the noble Lord, Lord Darzi—my noble friend, if I can call him that—for what I regard as an open, honest and thorough review. He is known as a man of great service, not just to your Lordships’ House but to the National Health Service. He has served Labour and Conservative Governments with distinction. As noble Lords will be aware, he is an eminent cancer surgeon who has driven innovation and speaks up for staff and patients. It is not surprising to me that the Secretary of State asked him to conduct this review, tasking him to provide what we might refer to as hard truths, warts and all. I realise that when one asks for that it can be uncomfortable, but I hope that we in your Lordships’ House can sit with discomfort in order to find a way forward for the National Health Service.

The noble Earl, Lord Howe, referred to the terminology that the NHS is “broken”. I understand that that is uncomfortable to hear, but when I speak to NHS staff they recognise that terminology. We are at great pains to say that we are not being critical of NHS staff, but unless we start in an honest and open fashion we will not be able to—as the noble Lord, Lord Darzi, referred to—restore the trust that is necessary. As the Secretary of State said in the other place, this Government have resolved to be honest about the problems faced and serious about fixing them. That is why he commissioned this independent investigation. I very much hope that noble Lords can be of assistance in finding the way forward, because we now have a diagnosis on which we can consult and then move on to the necessary prescription to improve the health of our National Health Service.

The noble Lord, Lord Scriven, referred to the 10-year plan. I am glad that he looks forward to it—as do I—but how will we get there? We now have a very clear explanation of where we are. It is evidenced and has widely involved many people and organisations. It should therefore be regarded with great respect, and I think it largely has been. However, the next stage for the 10-year plan will be to have what will be the biggest consultation we have ever had in this country on the National Health Service. It will involve patients, staff, parliamentarians, stakeholders—all those who have a vested and informed interest in it. That will lead us to the 10-year plan. On the question about this being top-down, this is very much a bottom-up exercise, with the Government’s commitment underlying it.

It is important to say that the 10-year plan does not mean that we will wait 10 years for everything. We will identify those areas in which we can make swifter progress and we can then look beyond. The fact is —this came out many times in the report from the noble Lord, Lord Darzi—that this has been a long time in the making and to turn it around will not be quick.

The noble Earl, Lord Howe, acknowledged that there were problems in the NHS. I am grateful for that and for his reference to the need for change. I also listened closely to his reference to what had been done under the previous Government. Facts are facts, but what matters is output. As we are discussing today, whatever the previous investment and previous actions, some of which were very much to be commended, the output has not delivered the results we need. That is why we have the report by the noble Lord, Lord Darzi.

On the issue of dedicated staff, the staff team to whom I pay tribute goes way beyond clinical staff, important as they are, and includes the cleaners, porters and administrators. Noble Lords will recall that, when the workforce plan was published, we said that this was a useful step forward. Our job now, as a new Government, as the noble Lord, Lord Scriven, said, is to adapt the plan to ensure that it brings in one of the three pillars we will be going for: hospital to community. That will absolutely be our focus.

I note that the noble Earl, Lord Howe, does not accept the assessment by the noble Lord, Lord Darzi, of the Health and Social Care Act 2012. I see the noble Lord, Lord Lansley, in his place; I am sure he will have a contribution to make. I have to part company with the noble Earl on that point, as the evidence in the review is that the Act did not work in the direction we were seeking to take.

On capital expenditure, we find ourselves with a massive backlog of capital works, such that the ability of the NHS to deliver is being held back by the buildings and facilities. We have therefore instructed a review of this, which we will then look to.

Finally, the noble Lord, Lord Scriven, was generous enough to say that he does not expect me to respond to the detailed questions about funding. However, I can assure him that all these matters are being considered—in other words, how we can best deliver the output and the improvements in health that the report of the noble Lord, Lord Darzi, seeks to achieve.

[Lord Patel (CB)]

My Lords, if this were a Committee stage, I would have been delighted to engage in a debate with the noble Earl, Lord Howe, who is a class act at presenting a case even though he might not believe in it. He is a lovely man. I would have taken issue with him on the 2012 Act—maybe not all of it, but a significant part of it.

I congratulate my noble friend Lord Darzi on his report. It is an honest report about the state of the NHS currently, whatever the genesis of that might be. As this is a Statement, I can only ask a question. One of the areas the report refers to is the need for capital investment. This has been neglected for some time, and without it, we are unlikely to be able to deliver quality care in all the aspects the report seeks. So, what is the Government’s plan for capital investment in the NHS?

[Baroness Merron (Lab)]

I begin by agreeing with the noble Lord, Lord Patel, in his assessment of the noble Earl, Lord Howe, as I am sure your Lordships’ House does. On the issue of capital, the total maintenance backlog stands at £11.6 billion, an increase of nearly 14% on the previous year. As I mentioned in my opening comments, this is holding back the productivity, ability and capacity of the National Health Service. Our financial situation is well documented, but we have asked the department and NHS England to review the health service’s capital requirements, and that includes NHS England’s assessment of long-term estate needs across a range of areas. We will have to establish the position and where we are to go from there, but I assure the noble Lord of the importance of this matter.

[Baroness Thornton (Lab)]

My Lords, I should declare an interest as a non-executive member of Whittington Hospital, and indeed as its maternity safeguarding champion. I have huge admiration and regard for the noble Lord, Lord Darzi, with whom I worked when he graced these Benches as a very successful and effective Minister. I agree with his analysis of the Health and Social Care Act 2012; I was opposite the noble Earl, Lord Howe, when we were debating that legislation—for what felt like many years—before it reached the statute book, and I agree that despite the challenges to the NHS, the vital signs remain strong.

Page 38 of the report addresses the question of inequality in maternity and neo-natal mortality, which is described. Does the Minister agree that after East Kent, Morecambe Bay and Shrewsbury, we do not need further research into understanding the challenges in our maternity services? What we need is leadership, attention and focus, so that our maternity services can benefit from the proposals in this report and the 10-year plan.

[Baroness Merron (Lab)]

I agree with my noble friend. I am pleased to inform the House that just this week I announced a number of pilot programmes, through which maternity staff will be taught and supported to better identify the signs of a baby in distress in labour, so that action can be taken more quickly, and which will help staff deal with obstetric emergencies during caesarean sections. Such actions help to avoid preventable brain injuries and are right for the baby and the mother. We also need to tackle the issue of the more than £4 billion cost of the lawsuits that have been brought over a number of years.

I have seen good examples of teamwork in Bristol and Surrey, to name just two, and there are many things that can be learned. We know what strategies work—one of which is listening to women—but the challenge is, how do we roll out what is successful, including from the pilot programmes? Following the recent report, which showed a devastating situation in maternity and neo-natal care, that is a high priority for this Government.

[Baroness Brinton (LD)]

My Lords, the excellent report of the noble Lord, Lord Darzi, refers to the stress our GPs are under and how patients are no longer flowing through the hospitals as they should. One issue is that hospitals are constantly referring patients back to their GPs when they are still on the same treatment pathway. Recently, a member of my family was at a post-op review following a pacemaker operation that had gone wrong. Her heart was still giving her problems, and she was told she had to go back to her GP to start the whole process again. Many patients in hospital clinics are being told to go back to their GP to get a scan or an MRI—which is one of the reasons why they were referred to the hospital. This is not fair on hard-pressed GPs and, above all, patients. Can this practice be stopped?

[Baroness Merron (Lab)]

I am sorry to hear of the circumstance that the noble Baroness raises. I agree with her about the pressure on GPs who, of course, are working harder than ever. We know, not just through the Darzi report but through much evidence, that discharge into the community has to take place at the right time and with the right support, and that is not the case at present. I will certainly take up the specific thing the noble Baroness asks for and look into it in far greater detail, because this is clearly a practice, as she described, that is not supporting patients or GPs but working against them.

[Lord Lansley (Con)]

A wholly different report could have been written based on the underpinning evidence. To that extent, the report may call itself independent but it was not objective. If the Minister subscribes to some of the hyperbolic criticisms of the 2012 Act, can she then explain how the NHS in Labour-run Wales—where the 2012 Act had no effect whatever—performed worse on almost every measure of performance? She said that output was what matters. Can she therefore confirm that productivity in the NHS rose after 2010, relative to the preceding period, up until the pandemic? Can she actually agree that it is outcomes that matter most? Will she say that the Government will maintain the progress that needs to be made in making the NHS accountable to the NHS outcomes framework that we established a decade ago?

Finally, to revert to what my noble friend and the noble Lord, Lord Scriven, rightly asked about, in the last decade the 10-year plan has been something that the NHS owned. There was the five-year forward view in 2014 and the 10-year plan in 2019, and now in 2024 the NHS should own the refresh of the 10-year plan, but I do not think that is going to be the case. Can the Minister explain why the Government are taking that earned autonomy away from the NHS?

[Baroness Merron (Lab)]

I do not recognise the description of taking autonomy away; I appreciate that that is the noble Lord’s opinion. The National Health Service is so key to not just our health and well-being but the economic health of this country. In my opinion, it is something of a backbone of the country. It is right that the Government have made this an absolute priority and have commissioned a very honest report—I hear his criticisms of the report; they are not ones that I share—and that the Government are held accountable. That does not mean taking away autonomy from the NHS. I accept the noble Lord’s point that it is outcomes that matter, and perhaps I should have put that better because by output I mean things not just being done but actually being effective. I thank him for that point.

On frameworks and meeting obligations, one of the points made not just in the Darzi report but elsewhere is on how many of the standards are not being met. We will return to a number of the standards to ensure that people can feel that they know what they are going to get and within what timeframe, and that that will be absolutely possible. We are interested only in what works. We are not interested in scoring points; we are interested in improving the health and well-being of the nation, and I hope noble Lords will want to join with that.

[Lord Fowler (CB)]

My Lords, I say straightaway that I entirely support the concept of an independent inquiry into the National Health Service. Indeed, it was something I advocated to the previous Government —not with notable success. I also pay tribute to the excellent National Health Service treatment and care I received when recovering from a recent heart attack. It was excellent in every way, from the ambulance service right through to the hospital treatment itself. In that context, does the Minister agree that the Government’s description of the National Health Service as “broken” is both unjust to the staff and an altogether false generalisation? It takes the language of the recent election into healthcare, and I would have thought that was one of the things we needed to avoid now.

[Baroness Merron (Lab)]

I am very pleased to see the noble Lord in the rudest of health and to hear of his positive experience. Of course, there are many positive experiences every single day, and the noble Lord is quite right to remind us of that and of the need to thank the whole NHS staff team who make that happen.

On the point about the NHS being broken, I understand the noble Lord’s view. However, I think it is important that we lay it bare and say what we have found. Having read the report by the noble Lord, Lord Darzi, I find it hard not to conclude that there are fundamental points within the National Health Service that are just not working. Of course there is good practice and there are brilliant outcomes in some areas, but it is not universal and that is what drives us to make that point. I hear what the noble Lord says. However, it is important to be honest, and that is what we have said we will be, uncomfortable though it might be at times.

[Baroness Pitkeathley (Lab)]

Does the Minister agree that integration between the different branches of the NHS, or rather a lack of it, is one of the problems? It is particularly a problem for patients. It works best when you cannot see the joins between various branches—when you cannot tell who the community nurse is working for, whether it is the hospital nurse and so on. Those are the things that puzzle patients. In thinking about the workforce, therefore, will the Government look at ways—for example, joint training—in which we can better integrate the staff, so that they work less in professional silos and much more across various branches of the NHS?

[Baroness Merron (Lab)]

Yes, I certainly agree with my noble friend about the need for better integration. Joint training is a very practical example and will be part of how we develop the workforce, because silo working clearly is not working, as we can see in the current state of affairs, particularly if we look at the relationship between the National Health Service and the social care service. It is not seamless, and individuals are suffering for that, so I very much agree with my noble friend.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests, in particular as chairman of King’s Health Partners and of the King’s Fund. In the report by the noble Lord, Lord Darzi, a picture is clearly painted of what now represents a very serious national challenge in securing the long-term sustainability of our health service and, as the Minister has recognised, the parallel need to consider questions of how we develop a long-term strategy for the provision of social care.

On 18 April this year, in a debate in your Lordships’ House initiated by my noble friend Lord Patel on the question of the long-term sustainability of the health and care systems, there was a discussion about how one might achieve consensus—consensus among the public, consensus among the professions and political consensus to ensure that a plan might be adopted which will require very difficult decisions and great courage and commitment over a sustained period of time to deliver the kind of objective about which we all agree. How will His Majesty’s Government go about developing that consensus in addition to developing the plan that must be applied?

--- Later in debate ---

[Baroness Merron (Lab)]

This will take us towards the 10-year plan. There will shortly—really shortly—be an announcement as to how the consultation will take place. It will be available to everybody with an interest in and a commitment to the National Health Service, and to those with lived experience, which is extremely important. It will be the biggest consultation that there has ever been on the National Health Service. I believe that is the way to achieve consensus, but you have to start by asking what the diagnosis is. Although I hear differing opinions in some areas of your Lordships’ House about the contribution of the report of the noble Lord, Lord Darzi, for me it makes a major contribution. If one does not know where one starts, one cannot end up in the right place. However, I absolutely agree with the noble Lord that consensus is key. We do not have the luxury of time for arguing the case, so this widespread consultation will get us to the right place.

[Baroness Tyler of Enfield (LD)]

My Lords, the forensic report of the noble Lord, Lord Darzi, shone a much-needed spotlight on the deteriorating state of children’s health services and worsening health outcomes for children, particularly the long waiting lists of over a year that some were facing before getting hospital treatment. What plans do the Government have to focus investment on children’s health services, which seem to have fallen behind adult health services, and to develop a children’s health workforce strategy as part of the overall NHS long-term workforce plan?

[Baroness Merron (Lab)]

I agree with the noble Baroness that that is unacceptable. There are just too many children and young people who are not receiving the care that they deserve. We know that waits for services are far too long and our determination is to change that—not least, as I am sure the noble Baroness has seen, given that children are at the heart of our opportunity and health missions, and rightly so. To ensure that every child has a happy and healthy start to life, among other measures we will train more health visitors and digitise the red book of children’s health records, so that parents and children can access the right support. We will be restricting vapes and junk food from being advertised to children, which will assist in the prevention of ill health, and we will ban the sale of high caffeine and energy drinks to under-16s. There will also be specialist mental health support in every school and walk-in mental health hubs in every community. I hope all of those will make a difference.

[Baroness Bloomfield of Hinton Waldrist (Con)]

My Lords, I draw attention to my entry in the register of interests as a trustee of the Royal Marsden Cancer Charity. The report of the noble Lord, Lord Darzi, discusses oncology services and life science research, both of which are at risk given NHS England’s planned closure of the paediatric oncology unit at the Royal Marsden in Sutton, cited alongside the Institute of Cancer Research as offering bench-to-bedside research and care. Does the Minister agree that such a closure would be devastating to the provision of paediatric cancer services, to research and to drug trials, and that it would undermine the recommendations of the report, which highlights the need to improve cancer survival rates and bolster our life sciences capability?

[Baroness Merron (Lab)]

I thank the noble Baroness for raising this important question, as she has done before with me. I know she is aware that I cannot comment on the individual case. What I can say is that research, diagnosis and treatment in all these areas, as we have heard from the noble Lord, Lord Darzi, are absolutely crucial to ensure that cancer patients are not being failed. We need to improve cancer survival rates, and we need to ensure that patients wait for no longer than they should. We have to research cancer, diagnose it on time and treat it faster.