NHS: Long-term Sustainability

Lord Parekh Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord Parekh (Lab)]

My Lords, the NHS is neither a leader nor a laggard, as shown in a comparative study of several countries. I think that broadly captures what many of us feel about the NHS. It embodies some fine values, such as equality of treatment, being free at the point of delivery of service, a strong incentive to regulate expenditure, and maintaining the self-respect and confidence of individuals that when they are in trouble they will be looked after and not have to worry about payment. All these are great virtues that the NHS embodies.

Sadly, it is also the product of its time. If you cast your mind back to 1948 and what followed afterwards, one begins to see an authoritarian culture where the experts know what is best. This is the ethos that is embodied in the culture of the NHS. For example, you can have a long waiting time and people do not see anything wrong with it, or no choice of the consultants or doctors you will see—it is decided for you—or your path to the consultant is already heavily guarded and not something that you can choose. There is poor investment in staff and diagnostic technology, so that you have machines for MRIs, CT scans and other things lying idle because they are supposed to be used only during working days. For all these reasons, we have reached a situation where the NHS does a lot of good and embodies a lot of good values but does a lot of work that many of us regret.

The NHS needs to be improved—radically, in some respects—and the question is not simply how we can maintain its sustainability; the question is whether we want to sustain it in its current form, what other changes we want to see made and whether those changes can be sustained over a period of time. I shall share my thoughts on this briefly.

The British people by and large cherish the NHS but not uncritically, which is why when they begin to discover its defects they increasingly become critical of it. Some 24% of people are heavily alienated from the NHS, and that number is increasing. That should be a source of concern to those of us who value the institution.

So how do we maintain the NHS? How should it be funded? We have relied on taxation as the source of revenue, and it is right that we should do that. I do not have time now, but I argue that compared to, for example, social health insurance or personal health insurance, taxation is a much better way. It gives the individual a sense of ownership of the organisation—he feels that this is his organisation because he has paid for it, and so on. Naturally, though, taxation is subject to party conflicts and divisions, and is never going to produce enough.

The revenue that taxation brings therefore has to be supplemented by other sources of revenue, but what other sources are available to us? There are two: reducing costs and increasing income in the NHS. When it comes to reducing the cost, one can think of a variety of ways in which expenditure could be cut. Lots of work is being done, for example, on why medicines for patients are lying unused—they are used for a day or two while the ailment lasts and then they are completely forgotten, and eventually wasted and thrown away. There are ways in which you can use electronic technology to alert the patient that it is time for him to take his medicine, and various ways in which you can control that.

On raising revenue, I was told by several people who have worked in this area in the United States and elsewhere, “Why don’t you have research, so that you have people who work with the NHS providing abundant data, with the state having access to these people and these diseases? Why don’t you have research done on this, resulting in innovations of medicines and instruments that can then be marketed?” It is not impossible for the NHS to think in terms of research scholarship.

I should have thought there were ways in which the NHS’s revenue could be increased and its expenditure decreased. That is the goal towards which the British public themselves seem to be moving. The NHS should be based on the principle of social solidarity but also have introduced into it the principle of personal responsibility.