NHS: Long-term Sustainability

Baroness Tyler of Enfield Excerpts

Thursday 18th April 2024 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I, too, thank the noble Lord, Lord Patel, for the debate and I congratulate the noble Baroness, Lady Ramsey, on her outstanding and moving maiden speech. As we have already heard today, public satisfaction with the NHS has fallen to an all-time low but, despite this, there is still strong support for its three founding principles: free at the point of delivery, primarily funded through taxation and available to everyone.

Last year, the King’s Fund published a report on the performance of the NHS compared with the health systems of 17 other OECD countries. Essentially, it was a scorecard which showed that, on the plus side, the NHS performs well in protecting people from some of the “catastrophic costs” of falling ill, and a relatively low share of the UK’s health budget is spent on administration—some might be surprised at that. On the minus side, the report concluded that the NHS has fewer key resources than its peers, below-average health spending per person, fewer doctors and nurses, less equipment such as CT and MRI scanners, and fewer hospital beds. In addition, the report said the NHS performs noticeably less well on outcomes such as survivable cancers, treatable mortality and life expectancy.

Various independent commentators have concluded that changing the funding model is not the primary answer. Nor, of course, is it either desirable or feasible to always just pour more money in. The important thing, as the Health Foundation has argued, and I concur, is to get the current NHS model to work better—that is, to reform the way it works. The key, surely, is to increase capacity in the right places. That is so simple to say but so hard to do. It is indisputable that funding growth is skewed towards the acute sector. Despite the majority of daily NHS activity happening in general practice and the community, a large proportion of expenditure on health and social care goes towards acute hospital trusts.

In my view, the answer to overcrowded hospitals is not simply more hospitals. As the noble Lord, Lord Patel, and others have said, the health and care system must be radically refocused to put primary and community care at its core if it is to be effective and sustainable and so that people can get access to their GP, a pharmacist and a district or mental health nurse.

That was one of the key findings of the Select Committee on Integration of Primary and Community Care, on which I had the privilege to sit, which was so expertly chaired by the noble Baroness, Lady Pitkeathley. The committee found a lack of co-ordination between the everyday primary and community services relied on by people using the NHS, which was leading to substandard care, missed opportunities for home or community-based treatments and overstretched hospitals being put under even further strain.

I turn now to productivity. Respected health commentators have been looking at what is called the productivity conundrum. A recent Institute for Government report found that, despite increased spending, much of which has gone on increasing staff numbers, there has been no resultant rise in productivity, if measured against metrics such as the number of patients treated. We really need to understand why this is. The report drew particular attention to the fact that most hospitals are running at above full capacity. They do not have enough beds and it is estimated that each day around 13,000 beds are occupied by people who do not need to be there but cannot be discharged because of lack of community and social care. We all know that, after years of neglect and underfunding, our social care system is in crisis.

Secondly, despite notable increases in the headline number of staff, the NHS is losing too many experienced employees and they are being replaced with junior staff who are naturally less experienced and need more support. Staff burnout, low morale and pay concerns are cited as the principal reasons for this. A recent IFS report also concluded that, while

“It is difficult to measure productivity … the NHS is less productive now than pre-pandemic”,


particularly in hospitals. The report was at pains to say that was not about staff not working hard but pointed the finger at Victorian estates, too few diagnostic machines and outdated IT systems causing communications problems within and between hospitals.

I believe that there should be far greater focus on retention and making the NHS an attractive place to work. That should be central to the NHS workforce plan, and we need a plan for social care, too. If not, we shall never clear the backlog or reduce waiting lists. We also know that valuable NHS equipment and operating theatres too often stand idle in the evenings and at weekends. Can the Minister say what plans the Government have to address this and whether they might include bringing in independent clinical teams from outside the NHS—a point raised by the noble Lord, Lord Reid.

Finally, are we going to see a productivity plan to set out how the productivity increases announced in the spring Budget, alongside the £3.4 billion additional capital investment will be achieved? In my view, Parliament needs to be scrutinising these plans.