NHS Long Term Plan

Baroness Thornton Excerpts

Thursday 31st January 2019 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I start by congratulating my noble friend Lord Hunt on initiating this important debate. I also congratulate noble Lords on the discipline they have mostly shown in this debate, and on the spread and depth of the views that they have expressed.

I will not summarise the contents of the 10-year plan, because my noble friend did that extremely well in his opening remarks. Noble Lords have covered a great deal of ground in the last two hours, and presented the Minister with a veritable cornucopia of questions to answer—some of which I suspect she may pass over to the new Minister when she arrives here on Monday.

I intend to focus on implementation and finance—chapters 6 and 7—and also make some remarks on digital transformation. There is no doubt that this is an ambitious plan, and it needs to be ambitious. The key question is: how will it be delivered? As noble Lords have said, there are dozens of aspirations in the plan; so far it seems to have avoided the previous pitfalls of promising unrealistic productivity gains and savings from reducing demand.

I was struck by the pertinence of the remarks made by the noble Lord, Lord Kakkar, when we discussed the launch of this on 7 January. He said:

“How are Her Majesty’s Government going to go about developing the metrics to determine how success should be measured? How will they go about providing a baseline picture of the current situation in different parts of the National Health Service so that the purpose and ambition of this plan can be properly measured? Which part of the NHS is going to be responsible for measurement and implementation: NHS England, NHS Improvement or, indeed, the Department of Health and Social Care?”.—[Official Report, 7/1/19; col. 2076.]


Those remarks were echoed by my noble friends Lady Donaghy and Lady Massey. I could not have put it better myself, so I did not try. I hope the noble Lord might forgive me for repeating his questions, because I do not think they were adequately answered on 7 January. They will run through the course of the discussions we will have over the coming period.

These questions are important because the plan fails to set out what success looks like for the patients, carers and staff. It does not set out how worthy aims are to be achieved, and there is no coherent approach to the management of the necessary changes. My noble friend Lord Brooke’s description of obesity perfectly illustrates that.

On implementation, my question here also concerns the somewhat Delphic reference to legislation in the plan. Is this the rollback of the hideously complex and expensive competitive frameworks, with the accompanying bureaucracy, that exist at the moment, referred to by my noble friend Lord Hanworth? Is the Minister able to enlighten the House further as to when and to what purpose this legislation will be scheduled? Indeed, do the ICSs need primary legislation, and what will be the role of local government in them?

On finances, my noble friend Lord Hunt described the finances as “courageous”; I might add that they are rather heroic. As noble Lords will be aware, last summer the Prime Minister announced £20.5 billion extra funding for the NHS by 2023-24. While this is generous compared with other public services, all informed opinion suggests that it is barely enough to keep pace with growing demand for care. As Dr Anita Charlesworth from the Health Foundation says in her excellent analysis, which I recommend to Members of the House:

“This means trade-offs are inevitable, and these must be spelled out clearly so the public know what they can expect from the NHS”.


In a way, that was at the heart of what my noble friends Lady Wheeler and Lady Gale said about specific conditions.

Can the Minister explain how this settlement will do more than keep the show on the road? How much will be available for investment in the aspirations contained in the 10-year plan? Today we learn that a new five-year contract will provide billions in funding for GPs and primary care networks; this is excellent news and a good proposal, but is this money coming from existing budgets, from the £20 billion, or is it new money?

There is no sign of an end to the sustained cuts to public health, capital spending and workforce training budgets. We know that NHS hospitals are in deficit and that the waiting times targets for accident and emergency and planned operations have not been met for three years. There is a crisis in social care that we have to find the funding for, as well as investment for mental health, so there is an enormous amount to do. As my noble friend Lady Pitkeathley asked, how will we fund recognition of the work of carers, for example? The Minister needs to tell us how all these things will be funded.

The chapters concerning science, digital and data are important aspirations: the adoption of personalised medicine, the adoption of genomics to drive diagnosis and the selection of care, the development of a workforce that is able to apply innovation and genomic medicine to the routine care of patients, and the adoption of a digital strategy for patients and healthcare professionals to improve clinical outcomes. I welcome these; they are forward-looking, and in many ways they are the only way forward for a modern health service. The noble Lord, Lord O’Shaughnessy, has been driving this agenda in government, and the work of people such as my noble friends Lord Darzi and Lord Winston and the noble Lord, Lord Kakkar, is very exciting; building international partnerships will take this agenda forward, although I hope that Brexit does not cast a shadow and a cloud over this. I ask the Minister: what is the timetable for the digital rollout? As everyone is aware, the NHS has form on being challenged in delivering these ambitious digital programmes. How will NHS England ensure that it has the capacity to deliver this change, which will be so important?

I would like to raise one issue which we have discussed in your Lordships’ House in the past: the use of NHS data and how to harness the value of healthcare data from government. While the Government say they are committed to maximising the value of healthcare data, there is a growing consensus that a national approach is needed if the UK is not to reach a tipping point beyond which the value of NHS data assets depreciates relative to those invested in and made available on mutually beneficial terms elsewhere in the world—specifically, the complexities of data holdings across would-be integrated care systems. In addition, private sector providers are liable to render it near- impossible for local organisations not to undermine, inhibit or impact the ability of the NHS to maximise the value and use of NHS data. The noble Lord, Lord Freyberg, is right to pursue the idea of the creation of a framework, which he called a sovereign health fund, to ensure that the NHS benefits from this.

This is important because the amounts of money involved are absolutely enormous. For example, the noble Lord, Lord Drayson, says that, for publicly listed fund companies, knowledge assets account for 50% to 80% of the total value. The value held by the UK Government for NHS data could be as high as £1 trillion. That could be invested in our NHS, if we can get the infrastructure right. What is the Minister’s opinion of that? Such figures would make all the difference to our NHS, and I imagine they are very attractive to companies such as Google. It is important that the Government deal with that.

I close by thanking my noble friend Lord Hunt, other noble Lords and the many organisations which sent briefing materials—too many to mention. They tell me that we are at the beginning of a great discussion, and I suggest that noble Lords file debates about the different parts of the 10-year plan that so that we can have longer than three minutes on all the important issues that they raise. That will be a good way to welcome our new Minister to the House.