National Health Service: 75th Anniversary

Lord Allan of Hallam Excerpts

Thursday 30th November 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I am not able to go back to the foundation of the NHS like the noble Lord, Lord Dubs, but I will start by going back half way, to 37 and a half years ago, when I was starting to travel the world, having just left school. I got into those conversations where you compare countries, and I was asked what was so special and interesting about the NHS. I could not say that it was all public, because it has always been mixed, and I could not say that it was all free, because there have always been charges for some elements of it. The best way I found of explaining why the NHS was special was that, in the UK, we can go to bed not worrying about getting help if we fall ill in the night, or if something happens to our parents or, God help us, to our children. That is certainly not true in all parts of the world. This reflects the promise that was in the newsreel that the noble Lord, Lord Lexden, cited at the beginning of our debate. It is a wonderful freedom that we enjoy, and it means that most of us can change jobs, move across the country, have children, and live far away from our families, all without worrying about whether those decisions will harm our healthcare and that of our families. These freedoms are underpinned by knowing that the NHS is there.

By contrast, a family member in the United States brings home to me what it is like not to have this freedom when he jokes that he has to stay with his spouse because of his health insurance—funny, but not funny. When I left my job with a US company in 2019, access to healthcare was irrelevant to my decision. It had a private health insurance policy, which meant it could get me back to work quickly because it needed me there, but I was much more interested in the free food; I did not see the private health insurance as essential because I had the NHS. I compare that with former colleagues who live in the United States or other countries, for whom the loss of their job vastly increases their health risks.

The NHS represents a significant form of freedom, but this applies only as long as it passes a key test: that we feel that it is sufficient and that we do not need something else. That proposition is holding up remarkably well, even though it has been under severe pressure many times. However, it is not certain that it will hold for the next 25 or 75 years without herculean efforts. In his introduction, the noble Lord, Lord Hunt, rightly talked about previous phases when there were herculean efforts. I was at the other end in the Parliament of 1997, and the work that Labour Ministers did then was remarkable and necessary. I feel that we are in that phase again and we need remarkable efforts to hold up.

The front-line staff have rightly been praised in this debate as critical, but I hope we also take a moment to recognise those who do the hard work of prioritisation. Administrative staff who manage waiting lists do not do fashionable or glamorous work, but it is essential to making sure that people feel that the service can deliver. Staff at the National Institute for Health and Care Excellence spend their time evaluating new forms of treatment and are often only in the headlines when they are being criticised, but their work prioritising new treatments means that that promise can be sustained. My noble friend Lady Walmsley mentioned IT staff, with whom I have a particular affinity, having been one for some years of my professional life; they keep the information flowing that allows patients to keep flowing and people to maintain confidence in the service.

There is no world in which some form of rationing of finite resources becomes unnecessary, but the key is the right allocation of those resources to where most people agree, most of the time, with the way the services are being prioritised. That is the key point I want to make in my contribution: that trust and confidence depend on not allowing the gap between people’s reasonable expectations and their actual experience of the service to grow too wide. Neither side of this equation is static, but will evolve over time.

Expectations are very different today, as we live longer and patterns of behaviour have changed, but we have also changed our expectations in wanting more information about and involvement in decisions. It is often said that the age of deference is dead. That is certainly true: we are in a very different world from 1948, when you were grateful for whatever the doctor gave you; now, people want to question and be involved in decision-making about prioritisation. My main ask of the Minister in this debate is for him to focus on that link between information and trust. It is about not data as an end in itself, but how we can turn data into useful information that feeds into a good process of deliberation, which means that we reach decisions about the allocation of NHS resources that win widespread trust and confidence.

I declare an interest in open data—I realise that I also spoke on this earlier in the week—as I am a non-executive director of the Centre for Public Data, which is a not-for-profit organisation campaigning to make more data public. I joined that organisation because of a long track record of believing in the value of open data, precisely because I think that transparency and not black boxes leads to trust in our much more inquisitive, non-deferential age.

We need to flesh out the narratives, as well, and not just get the raw data. It is interesting to know how many GPs there are—the Government just tell us that we have X number of GPs—and how many appointments they are serving but, for a complete picture, we need qualitative information, as my noble friend Lady Walmsley mentioned. We need to know how many of those GP appointments were useful, how many would have been better directed to other healthcare professionals, how many urgent consultations were stuck in a queue behind less urgent ones, and what could be done about improving the identification and prioritisation of those appointments.

I hope the Minister agrees that we need this kind of open, informed and above all honest discussion about how choices and prioritisation are done to maintain public confidence. This is not an alternative to providing additional resources, as many previous speakers have said, but is complementary to it, as people will feel that the additional resources they are putting in will really make a difference, according to their priorities for what they want to get out of the service.

On honesty and transparency, I note that the focus of the Government’s Autumn Statement on simply tax cuts, without telling us what impact they will have on public spending, was extraordinarily unhelpful. Certainly, the choices have been noted as a reflection of the Government’s priorities.

The prize here is that our children and grandchildren enjoy the same freedoms we have—freedom from worrying about getting help for their own health and about whether their elderly parents or young children will be cared for. This is a huge benefit in which it is worth investing, but it can easily slip away. Trust takes years to build, and the NHS still has bucketloads of it, despite the many challenges it has faced.

But if we as political leaders allow this trust to leak away, the drip may turn into a flood. Every detail matters in this debate, and in preventing the horrible outcome of a lack of trust in our National Health Service—and I know the Minister is a details man. I hope he will commit today to taking the measures needed to maintain trust, and that he is willing to agree with the proposition that a British Government, of any political colour, will have failed if the people of this country can no longer go to bed at night free from worries about where they will get healthcare when they need it.