NHS: Long-term Sustainability

Lord St John of Bletso Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord St John of Bletso (CB)]

My Lords, I join others in thanking and congratulating my noble friend Lord Patel on introducing this topical debate, and in congratulating the noble Baroness, Lady Ramsey, on her very moving maiden speech.

As the last to come to the crease before the closing speeches, I shall be very brief, and just make a few observations. I come to this debate not as a medical expert, though like my noble friend I suffer from peripheral neuropathy, but for the past 20 years I have been a company doctor, fixing companies large and small, though not on all occasions helping them to become more efficient and profitable. My first observation on the NHS is the apparent failure of effective leadership. I know many GPs, specialists and junior doctors, and one junior doctor I spoke to yesterday commented that he had been on strike not just because of the money but because he and others felt disfranchised.

We live in an exciting time of digital transformation and artificial intelligence, and we are seeing huge advances in quantum computing. By analysing vast amounts of medical data, including electronic health records and genetic information, we can uncover patterns, predict outcomes and improve diagnosis and treatment. Ultimately, however, the focus must be on effective, adaptable and accountable leadership. There is a danger that many in the medical fraternity are too focused on following protocols rather than guidelines and get bogged down in red tape.

I recently read the book, 2030: The Future of Medicine by Professor Richard Barker, a specialist in longevity research. I mention as an aside that it is my noble friend Lady D’Souza’s 80th birthday today—happy birthday. At 80 in your Lordships’ House, she is but a youngster. The observations that Professor Barker made when he wrote this book in February 2011 pertain as much today as they did then. In essence, he called attention to the need to re-architect the NHS and provide more effective time management to NHS GPs. Many GPs complain that they spend far too much time on administration and far too little time using their medical skills to diagnose and treat acute conditions. In this regard, a lot of elderly patients are not getting the treatments that they need and deserve. One of his observations was the need to focus on preventative medicine. We have seen huge advances in oncology and cardiology, but a lot more can and should be done on preventive medicine, including more focus on tackling obesity, on gut health and on lowering cholesterol.

The noble Baroness, Lady Blackwood, spoke very eloquently on the profound impact of genomics on personalised medicine. With the ability to sequence entire genomes rapidly and affordably, we are entering an era where treatments can be tailored to an individual’s genetic make-up, leading to far more effective, targeted therapies.

Time precludes me from debating the need for more effective procurement within the NHS. A huge amount could and should be done to save costs through shared services. I agree with my noble friend Lord Kakkar that the long-term sustainability of the NHS is a joint effort and requires commitment from all stakeholders—the Government, healthcare professionals, patients and the public sector. Will the Minister, in winding up, advise us as to what measures have been taken to conduct a global best-practice study on the long-term sustainability of public healthcare? I agree with the excellent suggestion of my noble friend Lord Warner of assimilating the Singapore healthcare system.

In conclusion, there are a lot of positive developments in the NHS and people should be congratulated and appreciated for their hard work, but my call is a simple one: we need to focus on effective and adaptable leadership, on effective procurement and on patient care; and to continue to focus on prevention. More funding in the NHS does not necessarily solve the problem. We need to get smarter.