The Long-term Sustainability of the NHS and Adult Social Care

Lord Kakkar Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I join in congratulating my noble friend Lord Patel on the extraordinary way in which he chaired the committee; I had the privilege of being one of its members. I also thank him for the remarkable leadership that he has provided in your Lordships’ House when matters of health are debated, and to me personally—he was a supporter when I was introduced to your Lordships’ House some eight years ago. He has been my mentor and has helped me understand how best to contribute to the work of this House.

I declare my interests as professor of surgery at University College London and chairman of University College London Partners. It is also a privilege to follow the noble Lord, Lord Willis of Knaresborough. He made the very important point that the NHS is about people—the people the NHS has the privilege to serve and those who ensure that the service can be delivered through their commitment and sacrifice.

As we move towards the 70th-year celebration of the NHS, it is very important for us to understand the contribution of those who have served in the NHS and have come from abroad to do so, particularly those from many Commonwealth nations. Their contribution has ensured that we are in a position today to have this debate to talk about the future sustainability of the NHS. Without those countless tens of thousands of contributions, frequently unrecognised, we would not have been in a position to establish a service that has had such a profound impact, not only on the health of our nation but on social cohesion. Will the Minister ensure that all those contributions, including of those who have come from overseas to serve our NHS, are properly recognised as part of the celebrations?

That is also an important point in understanding why the service is at times seen as demoralised. People need to be motivated. Regrettably, the NHS has become an organisation frequently defined by regulation and targets rather than by a commitment to a professional vocation—which was definitely a founding element of the NHS in 1948. Some way needs to be found to reinvigorate that professional vocational commitment so that it once again represents a foundation for the way care is delivered, while of course recognising that standards have to be met and quality must be at the heart of delivery of the National Health Service.

As we have heard, the committee considered the fundamental question of the long-term sustainability of health and care. In that regard, a need to develop consensus in three important areas was identified: on how a future NHS should be funded, on how a future NHS and care system should be delivered, and on what should be delivered as part of the nationally agreed consensus on health and care. It is vital for government and other leaders—political, professional and, more generally, public—to determine how a consensus is to be achieved among those different constituencies and between them to ensure that a sustainable model can be adopted for the future.

On the first question, of a consensus around funding, the reality is that most public debate and discourse about the NHS and broader delivery of care focuses on funding. That is a principal topic of debate. The issues have been well described: how will we understand the impact of changing demographics on the need for the delivery of both healthcare and social care? How do we model the impact of changes brought about by the adoption of new working practices and technology as they offset the increased demands created by such change in demographic? How will that balance be understood and modelled over time? How will we create a political consensus that ensures that a funding strategy is secured and available over a prolonged period well beyond the life of a single Parliament and, potentially, a single Government?

A second area where consensus is needed is on how care is delivered. There is no question that the delivery of primary care, secondary hospital-based care and specialist care requires radical transformation to ensure the adoption of innovation and technology that will improve clinical outcomes—which, as we have heard from my noble friend, Lord Patel, patients rate above almost anything else. How will we achieve a consensus on the reform of primary care? How will we achieve a consensus in driving a strategy for true integrated care that understands the lifetime needs and broad chronic disease needs of individual patients, rather than looking specifically at institution-based care, be it in hospital or out of it? How will we achieve consensus on transforming the principal focus of the NHS from being on illness to being on preventing ill health so that it becomes fundamentally sustainable in the decades to come? These are complicated questions. Although we have seen since the royal commission of 1975 many subsequent commissions, reports, reviews and reorganisations, all well-meaning and making small steps towards longer-term sustainability for the NHS, none to date has delivered what was needed or ultimately expected to secure the fundamental base that will give us a sustainable NHS.

Thirdly, there is the very sensitive issue of what the NHS and social care should deliver. This has become an increasingly difficult political question. Frequently, decisions on what should be provided are taken on an ad hoc basis, with different decision-making in different parts of the country. Frequently, that is seen as unfair and unjust in a system designed principally as a national service there at the point of delivery for all our fellow citizens, with every citizen able to be confident that they will receive just as good care and access to innovation and to the potential to a clinical outcome, wherever they live and whatever their background.

Such challenges are not new to this Parliament. I had a very interesting conversation with the right honourable Member for Birkenhead in the other place, who brought to my attention a period in the 1830s with a similar national institution. On that occasion, the Church faced very serious problems, and a royal commission was established by Grey in 1832 to address the question of the Church and how it disposed of its funding, and the changing needs and demographics of the British people. In 1835, the Ecclesiastical Revenues Commission was established by Peel and, on that occasion, a commission with a slightly different remit, which had the ability to inquire and identify problems and suggest solutions but also to act and implement with the supervision of Parliament. I do not suggest that that is the solution at the moment, but it must be for Her Majesty’s Government to identify a way at this important time—with these important challenges and on the basis of this detailed report—to find a method to achieve a consensus and move forward the national debate, addressing what is now becoming a critical problem.