National Health Service: Sustainability

Lord Kakkar Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I, too, join in congratulating my noble friend Lord Patel on introducing this vitally important debate in such a thoughtful way. I declare my own interests as professor of surgery at University College London and chairman of University College London Partners’ academic health science system.

The question of sustainability regarding the NHS is not merely one of how we preserve existing services in a prolonged period of further austerity, but rather how we develop a new framework that can deal with the changing environment in which healthcare will have to be delivered, with expanding need that will exist for decades to come. We have already heard in this insightful debate that the 1.9 million of our fellow citizens currently living with more than one long-term condition will increase by 2018 to some 2.9 million. The number of people living with arthritis will double by 2030, and the number of those living with diabetes, and of those living with dementia, will double by 2050. Success in healthcare through the application of technology, advancements and the application of knowledge derived from medical research have resulted in greater cancer survivorship, for example, but those who survive malignant disease are more likely to see a specialist in any given year and to avail themselves of general practice services. Wherever we look, we will see increased demand.

Much thought has been given to the need for change and innovation among providers of healthcare services, and a consensus now indeed exists. There was recognition only recently of the need for greater flexibility to be given to healthcare providers to ensure that they can start to address these challenges. The review published by Sir David Dalton last year began to address this issue. It rightly identifies the need to ensure that clinical services are consistently delivered across the country, but in focusing on variation it potentially consolidates a cultural problem that makes it difficult for providers to show the courage to experiment and introduce into clinical practice new models of care, some of which may succeed and some of which may fail, but with those that succeed adopted more broadly across the system to improve clinical outcomes and drive efficiency.

In the past, part of the proposed solution to improve the performance of providers was to introduce new legislation. The hope was that such legislation would improve the opportunity for providers to show greater flexibility and to be more innovative. Examples include the introduction of foundation trusts in 2004, and the ability for a multiplicity of providers to offer services afforded by the Health and Social Care Act 2012. Do Her Majesty’s Government believe that the current legislation, which offers significant opportunities for providers to show flexibility and innovate, is being fully exploited by healthcare providers in both the public and private sectors? Do they believe that further legislation is the answer to improving the ability of providers to innovate? What evidence is there that, two years after their creation, academic health science networks, which were designed to enable the introduction of innovation at pace and scale across health economies, are delivering the advances, improvements in care and efficiency improvements that were anticipated? In this regard, I remind noble Lords that I chair an academic health science network associated with University College London.

Beyond legislation and driving a culture change regarding innovation, there has been increasing emphasis on trying to determine how our NHS sits in comparison with other healthcare systems. There appears to be some disparity in the conclusions reached. For instance, last year the Commonwealth Fund published its regular analysis of 10 healthcare systems and concluded that the NHS remains the number one healthcare system in terms of safe, effective, patient-centred care. As we have heard already in this debate, the Quality Watch report by the Nuffield Trust and the Health Foundation, which was published last week, concludes that among 14 OECD countries with similar increases in demand in their healthcare system, the NHS does not perform as well, with relatively high mortality rates at 30 days for stroke and myocardial infarction and relatively poor survival rates at five years for malignant disease. What role do Her Majesty’s Government believe that international comparisons play, and what methodology is the most effective for us to refer to in trying to analyse where our healthcare system sits in comparison with others?

What analysis have Her Majesty’s Government made of other healthcare systems that are committed to equity of access and universal coverage—such as those in Germany and the Netherlands—but which use different models of funding that care, and what can we learn from those models? Have they addressed similar challenges in a more effective fashion? Have those models and systems of care been more effective at dealing with prevention as well with the management of patients with chronic conditions, at providing autonomy for healthcare providers, and at ensuring that innovation can be applied and adopted in the most effective and rapid fashion?

Finally, how do Her Majesty’s Government propose to go about building the long-term consensus that all noble Lords who have contributed to this debate believe is vital if the longer-term sustainability of our healthcare system is to be secured? Do Her Majesty’s Government believe that there is need for an independent commission to establish cross-party consensus on this matter and to inform public debate, which is vital if we are to carry our fellow citizens with us as we address what will be one of the most challenging and important questions facing those responsible for public policy in the coming years?