National Health Service

Baroness Williams of Crosby Excerpts

Thursday 14th January 2016 Lords Chamber

[Baroness Williams of Crosby (LD)]

My Lords, this is a very important debate and I wish there were more time for it to be conducted. I thank the noble Lord who initiated it. However, we are living in a fairyland in which we are talking about further improvements in the NHS, most notably a 24/7 service, at a time when the existing structure is under the most desperate threat. As we all know, another £200 million is to be cut from preventive measures but no one has so far mentioned the £22 billion of savings that the NHS is supposed to find through productivity agreements over the next five years. The ideal that we all share of bringing together social care and the NHS is largely vitiated by the Treasury’s inclination to continually cut local authority spending at a time when we are talking about improvements in, for example, preventive measures. That shows we are still denying the harsh facts in front of us.

It will be a great advance if we can even keep the NHS together for another couple of years. The noble Lord, Lord Winston, rightly said that it is being preserved at present through the extraordinary dedication and commitment of its badly paid staff, whose work is inadequately recognised. We owe them a great deal for keeping the NHS going but we simply cannot continue to think that we do not have to address the central issue of steady, consistent and adequate funding. We are nowhere near doing that.

In listening to the comments of the noble Lord, Lord Fowler, I remembered the very detailed study of the Barker commission published in October 2014, which was drawn up with the aid of the King’s Fund but has still not been discussed in this House or anywhere. It proposed that spending on health and social care should reach a figure of between 11% to 12% of GDP by 2025. We are still not discussing that proposal and still pretending that it does not exist. The noble Lord, Lord Fowler, rightly mentioned two difficulties. First, can a royal commission provide an adequate response within a year, or even less, because it is crucial that it does? Secondly, it is absolutely essential that any measures adopted are supported by all parties. We have to have an all-party response for which we all bear responsibility and we must not invent new ways to spend money that we do not have. If I may say so, in the noble Lord, Lord Prior, we have the kind of person who can go to the Treasury and say, “It is no good taking away with one hand what you give with the other because that simply leads to extreme frustration and even to desperation”.

We need a royal commission that conducts its business much more rapidly than is usually the case. We also need to debate the Barker report. However, we must recognise that, more than anything else, we need sustainable, steady and consistent funding, including funding drawn from taxation, because without that we will not be able to save the NHS.

--- Later in debate ---

[Lord Hunt of Kings Heath (Lab)]

My Lords, if the Minister is going to have any time at all, I should cut my contribution short. First, I declare an interest as president of the Health Care Supply Association and the barcoding association GS1, because I want to comment on the remarks of my noble friend Lord Carter on efficiency.

I very much welcome this debate. I was very taken with my noble friend’s description of the ideal world. I wonder if noble Lords think, as my noble friend Lord Carter does, that elements of that are in existence in the NHS at the moment, and that the issue is how to get that going in every part of the NHS. That is one of the essential conundrums.

I will focus also on the very important contribution of my noble friend Lord Winston, who talked about the risks to our medical research. Our medical research has always been one of the best in the world. On it our whole life science sector has depended. The fact is that we in this country have always had a very strong, innovative pharmaceutical and diagnostic industry. When my noble friend says that all of that is at risk, we need to listen.

There is no doubt—I pick this up consistently—that there is a hostility in the NHS to the kind of time that is needed for doctors to practise in research, and even to take part in Royal College activities. This has really got to stop. Seeing the noble Lord, Lord Lansley, here, I have to say that the introduction of NHS England does not help, because, for all the fine words that are in both the mandate and what NHS England says, I do not see any commitment in NHS England to these kinds of issues.

I will raise one further issue in aid of that. Our record on the introduction of new, innovative medicines in this country is a disgrace. We have some fantastic inventions, but the NHS is pathetically slow in introducing them. The noble Lord probably knows very well that we have an accelerated access review under the chairmanship of Sir Hugh Taylor. The word on the street is that it is simply not going to get anywhere because the NHS is not going to play ball and is not going to insist that NHS bodies invest in these medicines. A whole sector of our economy is at risk because of this. I know that the Minister is as concerned as I am and I hope that he might say something.

I come to the issue of junior doctors—not to talk about the dispute but because both my noble friends Lord Winston and Lord Mitchell raised the issue of why junior doctors are so disengaged. Anyone who has met them will know how angry they feel. It is partly about the Secretary of State’s manipulation of statistics—which, frankly, given the brightness of junior doctors, was always going to be very unwise. It is also about their distrust of management. Part of the problem is that they just do not believe that, locally, NHS employers will do the right thing.

My noble friend is right. Why are junior doctors treated so abominably by NHS employers? Why can they not get access to decent hot food at night? Why are the junior messes not in places where they can go and meet? I do not know what can be done to get this home to the NHS. Anyone who meets our juniors knows that they are the brightest of the bright and are hugely committed—yet, somehow, we seem to have made them wholly disenchanted with the NHS. It is a very serious issue.

This brings me to the issue of leadership, which my noble friend mentioned. In June last year, the noble Lord, Lord Rose, produced an excellent report on how to enhance and improve leadership in the NHS. He asked the Government three questions. How do we get better leadership? How to we recognise it? How do we find and mature the people who are needed to lead the NHS? I am afraid that there has been virtually no response to this from the Government. That is very disappointing. In fact, all that has happened is that the turnover of chief executive officers has continued at an alarming rate. Again, as one of my noble friends said, we have got to get rid of leadership by bullying. There is a bullying culture throughout the system and it is having a corrosive impact on the ability of people locally to lead organisations.

Of course, funding is very important. I do not need to repeat all the arguments that noble Lords have put forward. Essentially, they concern growing population and demographic pressures. We in this country spend less on health than any comparable country. The OECD figures that came out just before Christmas were very convincing on this. The Government’s claims in the Autumn Statement frankly do not ring true. We know that they are front-loading some of the money for the next five years, but the annual increase from here to 2020 will be 0.85%— even less than the average increase from 2010 to 2015.

At the same time, we know that half of that extra money has come from raiding the budgets of Health Education England and Public Health England, from capital funds and from the cost of pension payments. At the same time, what do Ministers do? They pile on more pressure. Not a week goes by without another press release from the Department of Health or an announcement by the Secretary of State that something else has got to be done. No wonder his credibility is shot in the NHS.

Of course, the gap between the money that is going in and the £30 billion per annum that it is generally believed will be required by 2020 is huge. I pay great tribute to my noble friend Lord Carter, because obviously he is helping the NHS to see if it can close part of that gap. I am sure that is right and that, on procurement in particular, a much more cohesive national approach is needed—but at the end of the day, there is still going to be a gap.

Should there be a royal commission? I cannot help repeating Harold Wilson’s famous diktat that royal commissions take minutes and waste years. That is, of course, when they are used simply to postpone a decision. I understand why noble Lords want some kind of neutral and impartial commission to look into those issues. However, we have already had the Barker commission, and I doubt whether anyone is going to improve on that. In the end, it is a matter of political will. I say to the Minister that, at the very least, what we seek is some honesty from the Government: admit that the financial gap is not going to be met and stop piling on the pressure.

[Baroness Williams of Crosby]

I apologise to the noble Lord, but there is a question that is central to this: would he and his party be prepared to take part in an all-party commission, possibly a parliamentary one, in order to get the quickest possible effective answer for the terrible crisis that has been outlined in this debate?

[Lord Hunt of Kings Heath]

My Lords, this is a time-limited debate and I want to leave the Minister a little time to respond. I would certainly be very happy to discuss the issues with noble Lords here—I like the idea of a group of politicians in this House looking at it. On the subject of a royal commission, I do not think I can go as far. In the end, we sometimes have to have the courage of our convictions and come up with proposals to sort this out.