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

Baroness Redfern Excerpts

Thursday 26th April 2018 Lords Chamber

[Baroness Redfern (Con)]

My Lords, I am pleased to take part in this long-awaited debate. I thank the committee’s chairman, the noble Lord, Lord Patel, for his diligence and commitment. It was a privilege to serve as a member of the committee. I also thank the special advisers and clerks of the committee who ably supported us in producing this report.

Our main values may not have changed over the past 70 years, but what has changed, and is to be welcomed, is that we now see an average life expectancy for UK citizens of more than 80 years. To accommodate a growing population with its increasing expectations and demands, we have to have an NHS that is fit for the future. Clearly, just protecting the NHS budget will not address the financial challenges that lie ahead, but to survive it must change its aim to raise performance and deliver a safe, high-quality, as well as good value for money, service.

The overriding consensus throughout was a need for a future settlement far longer than the five-year forward view, rather than intermittent budgets being added on, however welcome. I do not wish to minimise that extra funding; it is welcome.

From witnesses interviewed, there would appear to be a lack of a comprehensive national long-term strategy to secure the appropriately skilled, well-trained and committed workforce that the health and care system will need over the next 10, 15 or 20 years. It is therefore essential that workforce planning is based on predicted need rather than what budget is available at that place and time.

This report highlights the issue of there being a limited workforce strategy with too much reliance on overseas recruitment. With insufficient attention being paid to training the existing workforce, there will be a need for radical reform of many training courses for medical recruits to keep pace with change. Evidence submitted supported a need to be smarter at addressing the changing mix of skills required by a changing patient population. There needs to be attention on education and training to deliver efficiency and greater productivity, with good, clear career progression and opportunities to take on other career roles. We need to increase morale and bring back more enthusiasm.

The future of the health service relies on the NHS having the trained staff it needs to deliver services, in terms of both numbers and the appropriate staff to deliver care in a different way.

As witnesses stated, we must not again face the problem of a stop/go approach if, for example, we are to achieve world-class cancer outcomes. Staff shortages cannot be allowed to have an impact on the delivery of cancer diagnosis and care.

Before I go further it is important to have on record thanks to all the hardworking NHS staff, who perform above and beyond their remit, and to acknowledge the Government’s long-awaited lifting of pay restraint.

Systems, too, have to change, beginning with the need to reduce bureaucracy. Given the amount of paperwork and pressure on the front line from all quarters, there is an urgent need to move to one single dataset to increase productivity, especially because unacceptable variations in patient outcomes are undermining the effectiveness and efficiency of the NHS. The NHS needs to show good performance throughout the UK.

The NHS has the potential to be a world leader in the use of data for research and service improvement but its digital infrastructure needs transforming as a matter of priority. Big data technologies have the potential to improve both NHS services and the research underpinning advances in healthcare.

It is critical for citizens to have confidence, when data is used in the public interest, that strong safeguards provide a firewall. Data-sharing needs to become a priority and not be left to remote national bodies. Evidence has shown that when people are involved, decisions are made better and quicker, health outcomes are improved and money is better targeted.

The UK is a leading force in medical innovation and has a history of research excellence, but the uptake of new medicines in the NHS is far too slow, with evaluations and financial approvals significantly reduced. Patient access, therefore, to new medicines is finally balanced on finances. We need to develop ways to improve that situation. Information we received showed that the key is to develop a culture in which innovation can be rapidly adopted and spread across the system, as solutions are found in the intellectual capital of people working in the healthcare system and the patients and citizens who use it.

More preventive care is needed, particularly around screening: screening tests are one of the best ways of engaging the general public. When diagnostic results are produced at an earlier stage people are more likely to survive cancer: the evidence is that more than nine in 10 people survive cancer when diagnosed at stage 1. That has been a great success.

I look forward, also, to the FIT bowel-screening test, which comes online this month. I hope the Minister will tell me that that is still on track. A bowel-screening target has been set of 70% uptake by 2020, compared to just 56% in 2016-17. We need good outcomes.

There are opportunities for improving the quality of services for patients while improving efficiency, lowering costs and providing more care outside hospitals. A strong, progressive capital strategy and investment in the maintenance backlog are also essential. If we accelerate this opportunity in the short term, it will deliver cost savings by using existing premises and in certain areas rationalising the estate to provide outcomes that are better for both patients and the public purse.

The need, therefore, is to develop a really strong, robust capital strategy to determine the investment required. Then we need to take swift action to accelerate change and build momentum in the system, in order to capitalise on short-term opportunities to save running costs and to cut waste through better utilisation of existing premises—even before rationalisation of the estate is initiated. Finally, funding needs to be more smartly targeted in the long term to help deliver a strong public service.

I have mentioned opportunities many times during my allotted few minutes, and I believe that there will be more. We have to act and deliver on those opportunities to provide a robust, safe, caring NHS that is fit for the 21st century—and, importantly, free at the point of need.