The NHS

Lord O'Shaughnessy Excerpts

Thursday 5th July 2018 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy) (Con)]

My Lords, I join other noble Lords in congratulating the noble Lord, Lord Darzi, on an inspiring and typically incisive speech, and thank him for his leadership both in this House and in the NHS. We are truly grateful to him. I also want to thank all noble Lords for their contributions to the debate. Most of all, I want to thank the millions of people who work in the NHS and social care services because they look after us so expertly every day. Noble Lords have shared their personal experiences and we all have our own reasons to be thankful for the service. For me, it was the care that we received before, during and after the very complicated birth of our third child. It was simply world class. I am pleased to say to the noble Lord, Lord Winston—as I think I have before—that the birth was at the Queen Charlotte’s and Chelsea Hospital. All my children were born there and I am delighted to hear that his grandchild has been delivered successfully there too.

I want to take up the spirit channelled by the noble Lords, Lord Winston and Lord Hennessy, about consensus. As I said at Question Time this morning, it is important to recognise that politicians from all the main parties had founding roles in the NHS. The noble Baroness, Lady Jolly, talked about the role of William Beveridge. My noble friend Lord Lexden reminded us of the White Paper published in 1944 proposed by the Conservative Health Minister Henry Willink, and of course many noble Lords reminded us about the founding of the NHS by that very special and particular politician, Nye Bevan, on the principles—as the noble Lord, Lord Murphy, pointed out—of the Tredegar Medical Aid Society. It is also important to acknowledge the point made by the right reverend Prelate the Bishop of Carlisle that it was also an expression of Christian purpose, something that Nye Bevan himself acknowledged. As the noble Lord, Lord Hennessy, said, it was the nationalisation of altruism. It is also, as the noble Lord, Lord Bird, reminded us, part of our national effort to end poverty; that is what is at stake. My view, which I shared with noble Lords during a debate initiated by the late and much-missed Baroness Jowell at the beginning of this year, is that the NHS’s enduring popularity is not just because of the service it delivers but because of the many noble ideas it represents: reassurance, compassion, service to others and hope.

In delivering world-class care over the past 70 years, the NHS has changed enormously. The budget has gone up by 10 times. As my noble friend Lady Harding pointed out, the NHS is rated as the best health system in the world. The reasons for that were set out compellingly by the noble Lord, Lord Darzi, in his speech. Over those seven decades, the NHS has led the world in a great many aspects of healthcare. In 1958, the NHS introduced the first public vaccination programme; in 1968, the first heart transplant in Britain and the 10th in the world; in 1978, Louise Brown was born, the first baby ever successfully conceived by IVF; in 1986, we had the world’s first major government-sponsored national AIDS health campaign; and, as the noble Baroness, Lady Gale, reminded us, in 1988 the national breast cancer screening programme was set up. In 1994, the NHS established the first national organ donation register, while in 2002, doctors at Great Ormond Street carried out the world’s first successful gene therapy. Moreover, just last year, the NHS introduced the world’s first trial of 3D-printed bionic hands for children. That is an extraordinary and ongoing record of success.

But while the NHS has an enviable record, as noble Lords pointed out, of delivering world-class care, we know that it can get better. I read with great interest the excellent review of the NHS from the noble Lord, Lord Darzi, which he wrote with my noble friend Lord Prior of Brampton. I also note the improvements in care quality and safety that he says have been achieved since his original review in 2008. But we are all agreed—as my noble friend Lady Finn, the noble Lord, Lord Hunt, and others have pointed out—that there are great challenges ahead. Our cancer survival rates are not good enough, not least because of late diagnosis. Mental health services, which I will return to, still lag behind. Poverty is still a factor in outcomes. Too many babies and their mothers are lost at birth, and our growing and ageing population presents us with entirely new pressures.

There is an urgent need to address these challenges, as we all agree, and to provide an NHS fit for the future. It is for precisely that reason that the Government have announced that there is to be a five-year funding settlement for the NHS of, on average, 3.4% a year. The noble Baroness, Lady Tyler, the noble Lord, Lord Hunt, and others have talked about whether that is enough and mentioned 4%. It is important to point out, as Simon Stevens has done, that the NHS has got more productive than the UK economy overall. When you add in those productivity gains that is a big increase in the effective budget. Over the timeframe of that five-year funding settlement that will take us up to the level of France in terms of the percentage of GDP spent.

Noble Lords have talked about leadership. It is an act of leadership by the Prime Minister and my right honourable friends the Secretary of State and the Chancellor. It provides us with a unique opportunity for the NHS to develop a long-term plan to transform the service and, as the noble Baroness, Lady Donaghy, and the noble Lords, Lord Dubs and Lord Warner, pointed out, to avoid the feast-and-famine approach that has bedevilled us.

Several noble Lords have pointed out that only the NHS is included in this plan. That is quite right at this point in time. Nevertheless, it is important to point out that public health and social care were specifically mentioned in the settlement insomuch as, whatever the funding settlement for those in the spending review, it will not put extra pressure on NHS services. We will of course deal with those in the spending review next year.

The NHS plan will be led and developed by clinicians and patients. I promise the right reverend Prelate the Bishop of Carlisle that it will be inclusive. It is based on six key principles: focusing on the prevention of ill health; significantly improving access to good mental health; driving forward the integration of health and social care; spreading best practice and eliminating variations; embracing the opportunities of technology; and building the workforce we need for the future. Contrary to the suspicions of the noble Lord, Lord Dubs, Simon Stevens, the head of the NHS, has said himself that, together with his plan, the money will enable us to do more than just stand still. We have before us the opportunity—as the noble Lord, Lord Hennessy, said, the golden opportunity—to transform health and social care in the years ahead.

The right reverend Prelate the Bishop of Carlisle pointed out quite rightly that, first and foremost, we must continue to focus on prevention, not least because, as the noble Baroness, Lady Jolly, pointed out, unhealthy behaviours are associated with a significant number of early deaths in the UK. Each year there are around 80,000 deaths related to smoking, a point alluded to by the noble Lord, Lord Faulkner; 30,000 deaths related to obesity; and 7,000 deaths related to excessive alcohol consumption. This must change.

The noble Lord, Lord Faulkner, spoke powerfully about the pernicious impact of smoking. Our tobacco plan lays out an ambition to reduce smoking among adults in England to 12% or less. I confirm to the noble Lord that that aligns with the Royal College of Physicians’s proposals. We are making all NHS estates smoke-free by next year.

As noble Lords will know, to fight childhood obesity—a hot topic in this House—there are new taxes on sugary drinks, and we are helping children to exercise more and cutting sugar and calories. As we have shown in our most recent chapter, chapter 2, of the obesity plan, we are prepared to take radical steps to beat this epidemic. I am also grateful to my noble friends Lord Colwyn and Lady Gardner for pointing out the essential role that NHS dentistry has in delivering a truly preventive care service. However, we all agree that there is a need to go further. We want to help people to develop the right habits for healthy living. The noble Lords, Lord Hunt and Lord Brooke, my noble friend Lord Naseby and the noble Baronesses, Lady Finlay and Lady Watkins, all quite rightly said that we need to take more personal responsibility for our health, not just relying on it being delivered by others.

As we know, mental health problems affect people of all ages and all backgrounds. There is an unacceptable difference between the way that people with physical health and those with mental health problems are treated. We know that we have legislated for parity of esteem, but we have not yet delivered it. As a first step, this Government are investing more than ever in mental health services. We invested nearly £12 billion last year and aim to create 21,000 new posts by 2021 as part of the mental health workforce plan, with the first waiting time standards and an expansion of support for schools. In response to the question of the noble Baroness, Lady Tyler, on percentages, as long as less than 100% of those with mental illness do not receive the care that they need, we will not have succeeded. The challenge for the NHS as it develops its plan is how close we can get to that magic figure in the next 10 years.

Probably more than any topic that has been discussed today, integration is key to delivering the outcomes that we want. We have to break down barriers. As my right honourable friend the Prime Minister said, we have to deliver “integrated patient-focused care”. I am incredibly grateful to the noble Baroness, Lady Emerton, for sharing her experiences, although it is slightly depressing that we still face the same arguments about how to deliver truly integrated care.

My noble friend Lady Morris and the noble Baroness, Lady Watkins, talked about the fact that current health and social care services can be difficult to navigate, particularly for those who are frail, elderly or have multiple comorbidities. Increasingly, that is the typical NHS patient. We have made some progress, with the better care fund encouraging local health and care system leaders together. The noble Baroness, Lady Watkins, mentioned the vanguard areas, where we are making significant progress in reducing pressure on A&E. We are now giving the best-integrated local areas the chance to become integrated care systems, giving them more freedoms and the ability to join up systems in their area. Several noble Lords talked about Greater Manchester, which is indeed a shining example in this area. On the challenge from the noble Lord, Lord Parekh, we need to demonstrate that more areas are capable of leading that kind of work.

The noble Lords, Lord Warner and Lord Hunt, have deep concerns about the legislative framework and whether it hinders care today and will do so tomorrow. It is right to focus on the signal given by the Prime Minister to the NHS about wanting to heal the barriers to the provision of integrated care, legislative and otherwise, that are out there. That was a genuine and open offer. There is a desire to build consensus on this if consensus emerges on the need for change.

My noble friend Lord Naseby joined the noble Lord, Lord Darzi, the noble Baroness, Lady Watkins, and my noble friend Lady Gardner in saying that more care needs to be delivered closer to home. I absolutely agree with that idea of neighbourhood care. Having met the noble Lord, Lord Mawson, to talk about his work, I applaud him for leading that very local integration of care. I would absolutely recommend that noble Lords who are not aware of it investigate his work and find out more about it.

Quite rightly, many noble Lords talked about the future of social care. We know that there are funding needs. Over three years, about £9 billion of extra funding has gone into social care in the short term. Clearly, there is a need for a fundamental settlement. A Green Paper is coming, and it is a golden opportunity. We know that successive Governments have failed in this area. I hope that we can solve this, not just as one party but with all parties working together. The noble Lord, Lord Hunt, asked about the means test, the cap and floor. I can confirm that that will be in there. As my noble friend Lady Verma pointed out, this is not just about funding; the paper also has to address the many iniquities and inequalities that exist not only in the social care system but between the social care and NHS systems. Those words are very well taken.

As the noble Lord, Lord Hunt, pointed out, variation in care has been the NHS’s Achilles heel. The Care Quality Commission’s latest state of care report found substantial variation in care quality in and between services, in the same sector, between different sectors and geographically—and historically, between genders, as pointed out by the noble Baroness, Lady Gale. That is clearly unacceptable. As we would expect, the noble Lord, Lord Darzi, made a very profound recommendation in his IPPR report that we should,

“revitalise quality as the organising principle of health and care”.

We quite agree, as does my right honourable friend the Secretary of State, who has made quality—particularly patient safety—the leitmotif of his work in the health service.

That is one reason why we are funding the “getting it right first time” programme—I do not know how many noble Lords are aware of it, but I encourage those who are not to look at it—where data from front-line medics helps eliminate unwarranted variation and spread best practice. Since it began in 2016, GIRFT’s recommendations have helped trusts reduce the length of stay for hip and knee operations for the sportsmen of today that the noble Lord, Lord Selsdon, talked about, freeing up 50,000 beds a year and finding £50 million in savings over two years. That is just in one specialism, orthopaedics, although GIRFT is now looking at 35 different clinical specialities nationally. However, I take the point of the noble Baroness, Lady Masham, that with greater specialisation in services there is a need for greater transparency to prevent closed cultures. There are a number of programmes, however, as is often the case, aimed at reducing variation—GIRFT, RightCare, the Model Hospital, regional medicines optimisation committees—and one of the goals of the long-term plan must be to bring these efforts together into a single, co-ordinated approach to eliminate unwarranted variation.

The noble Lord, Lord Darzi, and others talked about tilting towards tech: I could not agree more. Despite being, as my former boss said of the then Chancellor, a slightly analogue politician in a digital age, noble Lords may know that I have become a passionate advocate for the unique opportunities of technology in the NHS. I quite agree with the noble Lord, Lord Bhattacharyya, and the noble Baroness, Lady Finlay, about the importance of patient data—giving them more control over their data to drive that technological change. It has to be recognised that the NHS, and the universities and life science companies that work with it, are wonderfully innovative. Being creative in coming up with new ideas is our great strength. Spreading those ideas throughout the NHS is often where we fall down, as my noble friend Lady Finn, and the noble Lords, Lord Bhattacharyya and Lord Hunt, pointed out. It is one of the reasons that I was so delighted last month to be able to appoint the noble Lord, Lord Darzi, as the new chair of Accelerated Access Collaborative—he may need to add that to his lengthy list of declarations—which brings together leaders from the NHS, industry and government to fast-track access to transformative medical innovations. We are expecting great things.

The noble Lord, Lord Winston, asked about academic health and science centres. They are very much in our thoughts as we work towards our improvement of the innovation landscape in the NHS. We have also commissioned Dr Eric Topol to lead an independent review of how advances in genomics, digital medicine, artificial intelligence and robotics can improve clinical staff skills, to make the most of those technologies. The noble Baroness, Lady Finlay, talked about the use of virtual reality in care and the noble Lord, Lord Bhattacharyya, talked about the use of AI in pathology and radiology. Those are just some of the areas in which we are making great advances: we could talk about genome sequencing or the new NHS app. There is an opportunity for the NHS to lead the global healthcare revolution in technology in the years ahead.

Finally, we all agree that the NHS is nothing without its wonderful people. We are absolutely committed to ensuring it has the staff it needs to meet increasing patient demand, both now and in the future. I agree with the noble Baroness, Lady Donaghy, when she pointed out that more of these should be recruited locally. I also agree with my noble friend Lord Naseby about the need for more GPs and district nurses. It is one of the reasons we announced a 25% increase in training places for doctors, nurses and midwives. I congratulate my noble friend Lady Morris, and more specifically the University of Bolton, for achieving that number one rating in nurse training. My noble friend Lord Astor spoke about the fact that not only are we increasing the number of doctors, but we are opening new medical schools in Sunderland, Lancashire, Canterbury, Lincoln and Chelmsford.

It is important to reflect on the point made by many noble Lords about the role that staff from outside the UK have played, not just in the founding of the National Health Service but in the National Health Service today, whether it is the Windrush generation, people from the Commonwealth or people from the European Union. We salute the work that they have done. We know there has been some anxiety around because of Brexit and it is important that we now have the settled status opportunity: the route is out there, it has been publicised and we have written out to the NHS and social care to make sure that our social care and healthcare workers can take advantage of that opportunity.

Later, alongside the long-term plan that we are publishing, there will be an integrated health and social care workforce strategy, making sure that we have the right number of staff, with the right skills and the right level of morale, to deliver the care of the future. My noble friend Lady Harding and the noble Lord, Lord Parekh, were on the money in pointing out the importance of leadership in actually changing some of the negative cultural problems that unfortunately persist.

To conclude, as we celebrate the NHS’s 70th birthday, we can look ahead to what the next 70 years might look like: powered by technological innovation, fuelled by intelligent uses of data and increasingly personalised. This future would be barely recognisable to the founders of the NHS in its speed of innovation, power to fight disease and ability to deliver care to people at the right place and time. But it is still a future where, I and the Government believe, the founding idea of the NHS—free at the point of need for everyone—remains its shining principle. This Government are committed to that future, as our five-year funding settlement has shown. After 70 successful years, the NHS’s own 10-year plan will set out the next part of its life-changing journey. I look forward, as all noble Lords do, to seeing what it brings.