Queen’s Speech

Lord Stirrup Excerpts

Wednesday 12th May 2021 Lords Chamber

[Lord Stirrup (CB)]

My Lords, the events of the past 14 months have reminded us, if we needed reminding, how much we as a society benefit from our National Health Service. It is worth remembering, though, that even before the pandemic, the NHS faced serious challenges, and these have not disappeared. Some were temporarily obscured by the Covid crisis and some were thrown into even sharper relief by it, but the fundamental problems remain.

Perhaps the most urgent pre-pandemic issue was poor morale among large sections of the clinical staff, who were experiencing unsustainably heavy workloads with no immediate prospect of relief. They nevertheless responded magnificently to the crisis, with an all-out effort that took little or no account of the personal costs involved. Their performance was superb, and they earned our heartfelt gratitude, but we owe them much more than that. As the pandemic recedes, they are left not just exhausted from the struggle, not just contemplating a return to the already debilitating status quo ante, but facing the daunting additional challenge of the clinical backlog that has built up over the past 15 months. Something must be done to address this.

Part of the solution is to embed more efficient processes and better ways of working, such as the continued use of telephone consultations for certain cases; the faster and more efficient flow of clinical information, where the NHS continues to suffer from severe shortcomings; and addressing the total lack of digital connectivity between clinical and social services. These and similar issues require urgent attention. I therefore welcome, in principle, many of the proposals set out by the Government in their White Paper on integration and innovation in health and social care, and the subsequent legislation referred to in the gracious Speech, but I want to make three points about the overall approach.

First, the initiative will fail if it focuses too much on reorganisation. I accept that some changes may be necessary, but I speak from bitter experience when I say that constant shuffling of the deckchairs diverts effort and energy from those things that really matter—in this case, improving health outcomes and the work/life balance of NHS staff. It also seldom gets to the heart of things. No large endeavour such as the NHS can be managed effectively as a monolithic structure. It has to be divided up somehow, and the divisions will introduce boundary and interface issues which can hamper efficiency. Reorganisation does not solve such issues; it simply moves them elsewhere. What is needed is the development of a culture that ensures efficient management across such boundaries, and this requires not just legislation but many years of strong leadership and sustained effort.

Secondly, I return to a point that I have made in this Chamber before: healthcare is an inherently ungoverned system of ever-increasing demand and ever-increasing technological opportunities. The growth in pressure has already outstripped the new resources that have been promised in recent years. Left to itself, demand will always exceed supply, wherever we set the level of funding. We have to exercise control over the outputs as well as the inputs, but I see little sign of this in the Government’s current proposals.

Thirdly, the issue of morale cannot wait. NHS staff clearly need some immediate relief from the pressures under which they have laboured for so long, and which they continue to face. Pre-Covid, the Interim NHS People Plan made some proposals in this regard, but a number of them were neither specific nor quantifiable, so when will we see a comprehensive and detailed plan of action for the urgent relief of the pressures on NHS clinical staff, to include milestones and accountable persons? How will progress on these measures, and their impact on NHS morale, be assessed and reported?

We urgently need a way forward on the future provision of health and social care in the round. The foundation of the NHS was perhaps only made possible by the upheaval and dislocation of a world war. The global Covid crisis now gives us the necessary impetus to ensure that Beveridge’s legacy is made fit for the 21st century; we must seize the moment.