National Health Service: Sustainability

Lord Desai Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Desai (Lab)]

My Lords, it is a pleasure and a privilege to follow the noble Lord, who has such vast experience in both Houses.

I thank my noble friend Lord Patel for introducing this debate. I think that I have spoken in every health debate that he has initiated. He is quite right to say that there ought to be a royal commission, but I expect that the Government will pour cold water on that. Any royal commission appointed any time soon would report around the time of the next election, and no Government want a royal commission report on their hands when they are trying to fight an election. Perhaps, as the noble Lord, Lord Cormack, said, we will continue this debate—and perhaps all the debates in your Lordships’ House on the National Health Service, collected together in one volume, might by themselves tell us a lot about how to cure the NHS.

As a lot of people have said, there is a consensus that we all love the National Health Service. A number of individual experiences, including those of the noble Lord, Lord Mawhinney, tell us that it is extremely helpful and valuable to our lives. At the same time, in all the years that I have been in this country—more than 50—there has never been a time when people have not said that the NHS is in crisis. We can sustain the National Health Service only by believing that it is perpetually in crisis and that something has to be done about it.

We tend to look at the NHS from the supply side, which involves asking how we can get more money and increase productivity, and how can we reorganise it. Every party reorganises the health service when in power and, when in opposition, criticises any reorganisation carried out by the Government. We have sustained a good National Health Service but, in my view—I have said this before in your Lordships’ House—so far we have not done anything on the demand side. Because we promise to deliver healthcare for free to whomever demands it, we have taken it for granted that all the adjustments have to be on the supply side, not the demand side.

I believe that there are a number of things that we ought to be able to do, as some noble Lords have mentioned, to, as it is called, “nudge” the behaviour of the public who demand healthcare. If there is ever a health commission, it ought to examine how to bring about behavioural change, perhaps by providing incentives to people to change their behaviour. Yesterday, the Chancellor revived the idea of using vehicle excise duty for road building. I had always thought that the Treasury did not like hypothecated taxes but here we have a hypothecated tax. There is no reason why the Chancellor should not tax sugar and salt and link the tax quite explicitly to the health service—even though it would finance only a very small proportion of the costs. We are worried about obesity and diabetes but we do nothing about salt and sugar in food. However, there is absolutely no reason why we cannot do this. We ought to urge the Government to explore things that will influence behaviour.

Another suggestion that I have made before in your Lordships’ House is that, although we do not want anyone to feel that they are being charged for using the health service, we ought to make clear to people the cost of providing it. People think that because it is free, it is costless—but it is not. We often worry about people missing GP appointments, so I propose a sort of health Oyster card for every citizen. Every time they used the National Health Service, they would have to swipe their Oyster card and a certain number of points would be deducted. The Oyster cards could be recharged. At the end of the year, people would get a bill showing how many points had been used and on which health service facilities. If people missed a GP appointment, 15 points would be deducted rather than two—things like that. Perhaps something like that could be done to make it clear to people that a free National Health Service is not a costless one. If we can somehow get people involved as patients and potential patients so that they modify their behaviour in demanding healthcare, it may solve some of the problems of the National Health Service.