The Long-term Sustainability of the NHS and Adult Social Care

Baroness McIntosh of Pickering Excerpts

Thursday 26th April 2018 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, it is a pleasure to follow the noble Lord. This is a wide-ranging debate and touches on a number of major issues. We are greatly indebted to the noble Lord, Lord Patel, and his committee, and I congratulate him on securing this debate. My father and my brother were country GPs and my uncle was a surgeon. They devoted their working lives to the health service. My father was one of the first NHS GPs in 1948. In the days when home visits were the norm, he worked on duty, on call every second night and every second weekend. Whatever the weather, Dr Mac would be there to look after the patient. I yield to no one in my admiration for those who work at every level in the health service.

I would like to look at ways of enhancing the long-term sustainability of the NHS, particularly in rural areas. I work with the board of the Dispensing Doctors’ Association. Its national headquarters are in Kirkbymoorside in North Yorkshire. I recognise the great work that such doctors do dispensing in sparsely populated rural areas that are not well served by community pharmacies. Undoubtedly, providing all public services, not least healthcare, in rural areas is more challenging and more expensive, and it is not generally recognised in NHS funding.

There are further challenges, such as the lack of good access to rural broadband. It is important to acknowledge that it is very difficult for those practising in rural areas to access NHS Digital. I refer, for example, to the electronic prescription service, which is a particular challenge in rural areas. It seems bizarre that at the moment the health service seems to be putting more money into allowing patients to access wi-fi in the waiting room before a GP consultation than into beefing up the broadband available to rural GPs.

Historically, Conservatives in government have always emphasised rurality and sparsity factors in both funding and delivering healthcare. Given the vast areas that GP practices cover and the often long distances patients have to travel to general hospitals, community hospitals play a central role in delivering healthcare in rural areas. It is a matter of anger tinged with sadness that a decision was taken by the local clinical commissioning group to close the Lambert hospital temporarily, then permanently. More recently, NHS Property Services has decided to sell the site on which the hospital is situated. In terms of delivering healthcare locally, this is a retrograde step. To the local community, selling a facility that was gifted to the people of Thirsk and surrounding villages in perpetuity by the Lambert family is ethically and morally questionable. In my view, it is indefensible. It was a fantastic facility, offering step-up, step-down rehab after a fall, stroke or operation, making patients safe before they returned home. I take this opportunity to seek an assurance from the Minister that he will either intervene, block the sale of the site and permit the Lambert site to be converted into a health hub for the local community, which is what GPs in Thirsk are requesting, or ensure that the proceeds of the sale are returned and used for healthcare in Thirsk.

Primary care is currently the less-favoured arm in NHS funding compared with secondary care. This point was made by the noble Baroness, Lady Tyler. This imbalance needs to be addressed. The idea of hypothecating national insurance contributions to pay for the NHS has some merit but, as I mentioned in my earlier intervention, taking 1% out of the health service by increasing this charge is immediately to remove funding that would normally go to front-line care, so that potential gap in the finances has to be filled.

I welcome the idea of a royal commission to look at sustainable, long-term funding for the NHS, particularly if it were against a background of cross-party consensus. Such a commission would be a wonderful opportunity to review the balance of spending in favour of primary care, particularly in rural areas where costs are higher owing to rurality and the sparsity of the population, which I mentioned earlier.

I favour the model of GPs working in partnership, but we face a ticking time bomb. A number of GPs face retirement over the next five to seven years, and fewer GPs want the responsibility of being partners. It is not just that positions are difficult to fill in London, which the noble Lord, Lord Winston, referred to; they are difficult to fill in rural areas too.

My question to the Minister today is: where is the parliamentary scrutiny and accountability of NHS England and NHS Property Services? They operate independently of government and appear totally unaccountable to Parliament. I am aware of the mandate agreed between the Department of Health and Social Care and NHS England, but I question where the adequate parliamentary scrutiny is. For the sustainability of general practice and with a view to allocating more funds to delivering healthcare in rural areas, the balance between rural and urban areas should be addressed as a matter of urgency. Enabling GPs to treat patients swiftly after appointments at their surgery would prevent an increasing dependence on admissions to accident and emergency departments and prevent a troubling ailment becoming acute.