The NHS

Lord Parekh Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord Parekh (Lab)]

My Lords, I am prepared to loan the noble Lord a second of my time.

I thank and congratulate my noble friend Lord Darzi on introducing this debate so beautifully. Having only three and a half minutes to talk about the NHS, I shall simply say that the NHS is a product of its time. That is very important to bear in mind, because the fact that it was born in 1947-48 penetrates its inspirational principles as well as its structure.

On the division between healthcare and social care, healthcare is free at the point of delivery, whereas social care is means tested, and that binary division is itself a product of its time and was introduced into the structure. There is also a distinction between physical and mental health. When the National Health Service was created, it should have meant the national physical and mental health service, but it tended to mean physical health. Mental health was added later and has enjoyed a Cinderella status; it has not enjoyed parity of esteem in the National Health Service.

My first point is that these various strands that the NHS has inherited have to be integrated, but the question is about how you do that when they are moving in different directions. We need to integrate but in a manner that respects the differences between the strands.

The second way in which the NHS has historicity is in the role of the GP. The GP began as a family doctor—an old tradition in this country—but he is now a gatekeeper. There is a division between the GP and the hospital, and that division also affects the relationship between the GP and his patients.

The third important feature of the NHS that is worth noting is that it began as a highly centralised institution. Those were the days of centralisation, with everything done from the centre. Now, there is an increasing realisation that that is not the way to deal with many of the problems, because problems are localised and so are the solutions. How do we move from a centralised to a decentralised structure? It is not just a question of decentralising an already centralised structure; it is a question of designing it from below and asking fundamental questions.

Here, I want to emphasise the important distinction between the way in which the NHS was conceived, based on excellent principles, and the way in which it has developed certain flaws. Some flaws are adventitious; others are structural, and the structural flaws need to be addressed very carefully—the fact that many of our doctors leave the NHS and leave the country rather than stay here; the fact that there is low morale; and the fact that hospitals are structured in such a way that the management takes over and the doctors count for very little. Those are some of the flaws. Therefore, while we celebrate the achievements of the NHS, we will celebrate them more sincerely and honourably if we are also alert to the weaknesses that it has developed.

When we talk about what we should do for the next 70 years, I simply urge a note of caution. Given the way we have tried to change it over the years, if we can get it right for the next 20 years, I shall be more than happy. Due to the way in which mental and physical health problems are distinguished and new insights into medicine and human health appear, there will be new questions, new divisions and new ways of organising our hospitals. In the light of that, let us think of the next 20 years, rather than the next 70.