NHS: Long-term Sustainability

Lord Allan of Hallam Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I am very grateful to the noble Lord, Lord Patel, for this opportunity and for the reminder of the time of the coalition Government, which I think we might accurately describe as the last sustained period of strong and stable government that we had in this country. It is a moment to remember the work done by my friend Norman Lamb, who I think was recognised as an excellent Minister for mental health and care. Essentially, the good bits were ours and the bad bits were theirs, including the pointless NHS reforms, and that is all we really need to reflect on with regard to the coalition Government.

I have enjoyed hearing a wide range of interesting contributions, including those from my noble friends Lord Scriven and Lady Tyler. I was also very moved by the excellent maiden speech of the noble Baroness, Lady Ramsey of Wall Heath. I share with her having two children born in St Thomas’s Hospital, although, unlike her, I did not have to do the hard work: I was a mere spectator.

I will not cover the issues to which others have applied their much greater expertise but focus on the role of information technology, on which I have some expertise and which has become universally recognised, including in this debate, as a key enabler of the productivity increases that we need in order to make the NHS sustainable. The noble Lord, Lord Kakkar, called for areas where we could have cross-party work; I think this area is particularly conducive to that. I and most geeks do not really care who is in government. We have the phrase, “Code wins arguments”. Unfortunately, elections do not work that way but, in the world of code, if you design a better product that runs more quickly, that is the one you should implement. There is a large community of people who believe in the NHS and can apply those technical skills but do not care who is in government. I ask the Minister whether we could make immediate progress in that area with a non-partisan approach.

I want to talk not about whizzy, cutting-edge technology, which we often go into, but the foundational elements where some of the biggest gains could quickly be realised, because there is a large amount of low-hanging fruit. I will raise five areas with the Minister—essentially, layers that together would form a platform for improved services.

First, we need a comprehensive catalogue of the collection, storage and use of data across our social care and healthcare systems. That does not exist today. The noble Lord, Lord Carter of Coles, referred to this; we do not have a comprehensive catalogue so there are enormous inefficiencies built into the system. There is a natural tendency when building technology to look at the shiny front end and at apps, but that is useful only when you have the back end set up properly. For the NHS and care, that is frequently not the case. It is the boring bit, but it is essential that we walk through and audit all the many systems that we use and document our data. Openness here can really build trust. If people out there can see who has what data and what they are using it for, that will generate trust. When people see it as a black box, trust dissolves and they start to withdraw their consent. An open database is essential.

Along with that, we need openness around the processes and tools used to work with that data. These days, a lot of the code can be open. You can make it reusable. We could reasonably aspire to a position where a new entrant into the market could say to a service such as ChatGPT, “Here’s the data model, some example code and the processes—build me a system”. That is where we will get increased competition in areas such as GP systems, which have come to the fore these days. There are two major suppliers and people ask why there are not more. We could make it a lot easier for people to come in and compete not only on cost but, importantly, with innovative features. We do that by making sure that the data model, the processes and the code base are open.

Once you have that foundation sorted out, the third area is thinking about the content and messaging. There is a very current debate about the fact that online platforms such as TikTok are really good at getting people to engage with them. We see that as devious and dangerous behaviour, but that is what we need in the NHS. When running a screening programme, you want the kind of skills that get people to click on it and sign up for the appointment. We saw some of that with the encouragement for Covid vaccinations, but we get a hell of a lot of other communication from the NHS that is not of that quality. If you are going to set up a screening programme, it is a real waste not to have the kind of skills you need. Software engineers—my profession—are not the people to write this stuff, but a lot of the stuff we get looks like it was written by them. There are really good people who know how to get people to engage, which is what the health service needs. As a general maxim, the systems we use to engage with our healthcare should be at least as good as the ones we use to share cat videos—and I think healthcare ranks a little higher in importance. We can all see that the gap is enormous at the moment.

The fourth area is around ownership. Committees do not own things; named people own things. In the tech sector, when you want something delivered, you say to somebody “Here’s your target—you need to deliver this product”. Often, working in a massively matrixed organisation, you need to get lots of other people who do not work for you to deliver the product, but you need to know who the person delivering the product is and not allow it just to be put into a committee where everyone can pass the parcel.

It requires persuasion, support and, crucially, a service culture. It was interesting that the noble Lord, Lord Hunt, said that “people hate NHS England”. That is a real problem if NHS England is signing up and buying services, such as the federated data platform, and it has to roll them out to a massive variety of organisations—some of them are brilliant; in some, there are two IT support people who are busy trying to help people change their passwords—and you come along and say, “Can you implement this system?” Well, they can, if someone helps them to do it. We need somebody, somewhere, to have that kind of service culture—somebody who owns it and has the tools to say, “I need to get that trust to implement the system, and the way I am going to do it is not just by sending out a directive. I am going to go and hold hands, and help them, and find out what the barriers are. I don’t care what they are—I am going to address them”.

The fifth element has come up in discussion today: integration with other systems. I sometimes feel there is a nervousness about talking about stuff that is outside the NHS. Increasingly, that is where people are; it has been said in the debate today that people might be consulting an online GP service. We have negative phrases such as “worried well”. I think it is quite nice to be a bit more worried about your blood sugar level or diet, or about lumps and bumps where we should not have them. There is a range of things we should be worrying about, and we have opportunities to get tests done, but there is very little integration between all that and the core NHS. That is something we could fix; again, it is one way to make it sustainable. In many cases, we—or our workplaces—are paying for health check-ups. If the system is right, once we have collected the data, let us get it integrated. We have systems such as Patients Know Best, which are trying to do this. These have been paid for, but they are not universally rolled out and in use.

To pull all that together into an example, let us think of something really boring and old fashioned, like blood pressure checks, which the noble Lord, Lord Patel, rightly raised as a key way of stroke prevention. If you have a standard data model for how to deal with blood pressure checks, or if you had standard code for how it is collected—on a phone or in a private clinic—and put into your record, and if you had an owner of a blood pressure screening programme whose job is to get 80% of the target group screened once a year, we could say, “We do not care how you do it, just be creative and figure out what is the right way. Is it text messages? We don’t care, as long as you get that 80% data”. If it was integrated, that person’s job would be to hustle, hassle and help people, and to work with all providers of mobile phones and workplace networks to get it done. That is the kind of thing that could make a difference.

I hope it is helpful to the Minister to describe a model that could be applied more generically across a lot of the challenge areas that the NHS faces. At the moment, a lot of people know what “good” looks like and what they want, but the structure militates against it because responsibility is too widely distributed, and there are too many people doing individual things in silos. At the moment, the only model we have to overcome that is a directive from NHS England. That is not what you need; you need detailed grunt work on the ground to get us from where we are today to where we want to be, which, as a patient or an NHS staff member, is using systems at least as good as those we use to share cat videos.