Health and Social Care in England

Lord Bhattacharyya Excerpts

Thursday 11th July 2013 Lords Chamber

[Lord Bhattacharyya]

My Lords, it is a privilege to speak in a debate led by the noble Lord, Lord Patel. The noble Lord spoke with his customary wisdom. I have learnt a lot discussing medical problems with him.

There are many healthcare experts speaking today. I am a little more of an outsider. From my perspective, it seems that we constantly read of reports, inquiries and investigations into the problems of our health and care services. Whether it is care assistants, inspections, waiting times or long-term care, every day seems to bring a new story about how our health service is struggling.

Of course, when you consider the great changes of the past 60 years, it is remarkable how the NHS has met the health needs of the nation, and done so in a very cost-effective way. However, that does not mean that this will continue in future. Just this week, we saw how health and social care funding faces three major pressures. Just 24 councils now offer adult care for those with moderate needs, and national eligibility standards will restrict this further. The cost of long-term care will expand significantly, with Ministers this week telling the insurance industry that it must fill the gap left by their proposed cap. Finally, as we heard this morning, NHS England faces a £30 billion shortfall by 2020, with the NHS director for patients saying:

“We are about to run out of cash in a very serious fashion”.

If I did that in my industry, I would be bankrupt.

Each of these tensions is a major challenge to the aim of a comprehensive, universal health and care system. So what can be done? The truth is that if we want good, comprehensive, universal care, we will have to find a way to pay for it. The obvious route is taxation, whether direct or in the form of a levy or giving tax benefits to private health insurance. Yet such new taxes will be hard to sell to the public. Why? Because while the NHS generally delivers good care for a reasonable cost, many patients feel that social care is of a low quality. Others have witnessed inefficiency and poor treatment in their local hospitals. They will not be content to see taxes go up simply to pay for more of the same. Of course, for more management consultants, not hospital consultants, that would be fantastic. So we must demonstrate how we will improve our care system, not just fund it.

To do so, we must develop new skills and structures for workers throughout the National Health Service. I have a personal interest, as my wife has been a midwife and a tutor. She knows first-hand how better and up-to-date training and career development for those on the front line can transform patient care. However, many of our health career structures and much of our training still seem stuck in the 19th century. From care assistants to consultants, from matrons to health technologists, we need to rethink career development in the health service totally. Even our definition of what a doctor is will have to change in the future.

One reason we need to change how we develop our people is that technology is radically shifting how patient needs are identified and treated, as the noble Lord just mentioned, in everything from social care to heart transplants. To take just one example, the Scripps Research Institute is developing embedded sensors in the bloodstream to alert users if they are at increased risk of heart attacks. Such advances create new treatment routes for those seeking better health, which means that new ways of offering care will be needed, such as advising people at risk on how to improve their health, and monitoring their progress. Is that a role for a doctor or a nurse, or a new role entirely?

Technological changes also mean that individuals will seek greater control over their care. Therefore, despite the promises of consolidation of services, there will be more demands, so although the service improves, the savings will not automatically follow. Yes, we should expand personal budgets so that people in continuing care can choose their care packages. But we should go further, removing the divide between health commissioning and social care to create whole person care. This will raise some fundamental issues about what is included in universal healthcare. Does it make sense that we offer little support to people who wish to maintain good health, but expect no contribution from people who visit their GPs 10 or 20 times? The answers to these questions will be controversial, but they must be found if we are to find an equitable, affordable way of meeting expanding expectations and increasing routes to access healthcare.

To address these challenges we need major innovation in people, technology and funding. That will be difficult and controversial. However, if we tackle them head-on, we will be as bold as a Butler in Education, a Beveridge in welfare or a Bevan on the NHS. That is an ambition well worth fighting for.