NHS Long Term Plan

Baroness Neville-Rolfe Excerpts

Thursday 31st January 2019 Lords Chamber

[Baroness Neville-Rolfe (Con)]

My Lords, I refer to my interests, notably as a director of Health Data Research UK. I congratulate the noble Lord, Lord Hunt, and would like to join him in any meeting on data. I thank the Library for producing an excellent note for this debate.

I am quite new to health as a public policy issue—encouraged by the noble Lord Patel—and have considered the plan de novo. The response has shown that there is overwhelming public support for the NHS and we must take full account of that fact. However, that ought not to prevent us from recognising that the structure of the NHS has drawbacks. I will mention two. It is vast, and therefore bureaucratic, and all experience shows how difficult it is to maintain high levels of efficiency in large bureaucracies. Also the NHS, by its very nature, makes little use of market pricing, making the optimum allocation of resources close to impossible. We must do our best to eliminate inefficiencies, but the NHS is ordained to suffer from some of them.

Given my commercial experience, I regret the overuse of percentages in the plan and the lack of key overall numbers on expenditure and capital formation and on future demography, which is too often ignored in public investment. Value for money is also given very little prominence. Less surprising is the total absence of the notion of enterprise and incentives. This is a pity as GPs are small businesses, and the best are good businesspeople. The fact is that management skills are needed to deliver effective change. The “lean thinking” principles trained into retail could help to cut out waste and blockages. I was reminded of this by the example on page 19 of ambulance paramedics stuck on a hospital ramp with other calls piling up that they could not get to.

I commend the Government on the new focus on digital, personalisation and data. AI is improving the efficiency of drug trials, and there could be vast savings from introducing patient apps for patient records. This would allow easy migration and an end to the familiar cry, “They have lost the notes”. Apps could be introduced immediately for maternity and to replace the red baby book.

I would also like to see support for HDR UK’s digital innovation hubs for the safe sharing of data in R&D and better use of data to improve outcomes—for example, on cancer and antimicrobial resistance. This huge global health issue receives a modest mention on page 39. Are noble Lords aware that, without new antibiotics, routine operations could become too risky and that cancer and paediatric care could become extremely difficult? I welcome the Health Secretary’s initiative at Davos, but we also need worldwide efforts to reduce irresponsible antibiotic use for animals. I was glad to hear the CMO referencing the red tractor label, whose standards have helped to reduce antibiotics on farms by 40% over five years.

I look forward to an annual update on the whole long-term plan and to seeing some quick wins from this enormous investment of money, time and effort.