NHS: Long-term Strategy

Debate between Aaron Bell and Luke Evans

Wednesday 11th January 2023 Commons Chamber

[Dr Luke Evans (Bosworth) (Con)]

As a parliamentary candidate, I was once asked by a journalist, “We have 30 seconds left on the panel. How would you solve the NHS?” I said, “If I had that answer, I would not be sitting here with you.” Mr Deputy Speaker, you have given me four minutes to do it, and I will do my best.

My hon. Friend the Member for Erewash (Maggie Throup) made an important point about context, and it goes back to when the NHS was formed in the 1940s and 1950s. We have an ageing population. In the last two decades we have seen a 50% increase in the number of 100-year-olds. Many people over 70 have four, five or six medical conditions and are on multiple medications. Technology has moved far forward, too.

When I started training, a cholecystectomy to remove the gallbladder was open surgery that required a person to be in hospital for a week. It can now be done within 24 hours. When we started people on routine blood pressure medications such as ACE inhibitors—many Members will know ramipril—they had to stay in hospital to have their kidneys checked. We now start it routinely for millions of people across the country.

That is the pace at which we are moving in the west and the developed world, and we have to try to keep up. Throw in a pandemic and workforce shortages, and we can see why every western country with a developed care system is struggling. That is the backdrop of what we are dealing with.

On top of that, demand and supply have gone up, but they have not gone up equally. Services are working hard to provide more tests and more appointments than ever before, yet demand is growing partly because the pandemic led to later and more complex presentations. In the Health and Social Care Committee we have heard that there are 27.5 million GP appointments a month, which is up by 2 million on 2019, yet it is still not enough.

In my area of Leicestershire and Rutland, we have enough GP appointments for everyone to be seen seven times a year, but the problem is that appointment rates are disproportionate. Some young people never need to go, and many older people need routine follow-ups. This is the backdrop we are dealing with. Members on both sides of the House talk a lot about long-term plans, but I would like to focus on day-to-day stuff.

[Aaron Bell]

I am grateful to my hon. Friend for bringing us his experience from before he came into this place, and he is right to look at the long-term demographic challenges. Does he agree that they will require the NHS to become even more efficient and productive? That is not just something we are asking for; it is what the staff in the NHS want, because they are aware that they are still delivering analogue services in a digital age.

[Dr Evans]

My hon. Friend has hit the nail on the head, and that is where I want to focus my remarks, because simple day-to-day changes to make the working clinician’s life better in turn improve productivity, patient care and patient satisfaction.

As with the Sky cycling team, looking for percentage gains brings big outcomes. So let us go through a quick list of some things we could do. We could have a root-and-branch review of prescribing. How much time is spent with patients waiting for prescriptions in hospitals to be dispensed? How much time is wasted by GPs signing prescriptions on paper? We have electronic prescribing but the prescriptions still get printed out to be signed. A root-and-branch review of prescribing all the way through would solve that problem, making this system more streamlined and fit for the 21st century. It would also save wastage, because there is an estimated £1 billion-worth of medication in Mr and Mrs Jones’s back cupboard just in case.

What about the IT? I am talking not about singing and dancing robots, but simply about making the IT for the day-to-day clinician work like their mobile phone does. That is not too much to ask. We could address the interface between primary and secondary care, allowing secondary care to be able to book blood tests into primary care and vice versa. This stuff does not happen. We no longer send faxes but we still send letters instead, and we pay someone to scan them so that a doctor can have a look at them and sign them off. We could cap list sizes, on a graded time for GPs. We are recruiting more GPs and it is going to take time, but that is a way of ensuring demand and at the same time continuity of care.

What about all the other stuff associated with the administrative time of looking after doctors to make sure they are fit for purpose? There is so much red tape when someone tries to join a performers list or come off one, or start an induction in a hospital. This is simple stuff we can change now, today. We can further do that by enabling the new ICBs, because my biggest worry with them is that they are going to ask for permission not for forgiveness. These 42 regional areas will be able to design the difference that can stick for the future.

I was hoping we might be able to spend these few hours today talking about the wider picture, because this all comes from context. The biggest question this House has to answer is what is the purpose of the NHS and what should it do? We all agree with the principles of clinical need and not to have to pay, but how do we deliver that for the 21st century?