Health and Social Care in England

Lord Hunt of Kings Heath Excerpts

Thursday 11th July 2013 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, I declare an interest as president-elect of GS1 UK, as chair of an NHS foundation trust and as a consultant and trainer with Cumberlege Connections.

I, too, thank the noble Lord, Lord Patel, for his opening remarks, but also for allowing us to debate one of the key social issues that we will face over the next few years. I warm to the noble Lord’s optimism, although there is no doubt that the NHS is in the midst of an unprecedented financial challenge. The supply of funding is not keeping pace with the growing rate of demand for healthcare. More people need care and they want it to be better than it has been before, but we know that growing pressures on finance could impact on the quality and experience of patient care. As Sir David Nicholson said today, hospitals are staring down the barrel of having to cut doctors and nurses from their employment, actions that could lead to another Mid-Staffordshire scandal unless the NHS radically reforms. I know that my noble friend Lord Desai warns us, I suspect with good cause, to be wary of long-term financial projections. However, there seems to be a general consensus around the work of the Nuffield Trust, which says that cost pressures on the NHS are likely to grow by around 4% a year up to 2021-22 due to the growing demand for healthcare to meet the needs of a population that is ageing, growing in size and experiencing more chronic disease.

We also need to factor in the impact of social care. There is no doubt, looking at public sector finances, that local authorities have borne the heavy brunt of the reductions. As adult social care is the largest part of discretionary spend within local government, it has inevitably been affected. A&E services were under the cosh this last winter. There can be no doubt that one of the main reasons for this was a reduction in social care provision and in the additional burden that our carers have had to face because of the reduction in support services available to them. Sir David Nicholson’s response was to call for a dramatic reconfiguration of services, including the centralisation of specialist services. I should like to put that point to the noble Earl, Lord Howe. Will Ministers support radical reconfiguration of services? So far, we have seen little sign of that occurring. Will the Minister also ensure that clinical commissioning groups get on with approving radical changes instead of, as seems to be the case at the moment, resisting big change and being protective towards local services?

On that reconfiguration of services, I want to ask the Minister about today’s decision of the Competition Commission to reject the proposed merger of two hospital trusts in Dorset. That must be the most ridiculous decision that has ever been taken in relation to the necessary reconfiguration of services. His right honourable friend the Secretary of State has spent his time in office going around attacking the NHS. It would be nice to think that the Secretary of State might issue a mite of criticism of the Competition Commission for what it has done. The signal this will give to the health service is that reconfiguration of services will not be allowed because of the Competition Commission’s ludicrous intervention. I hope that the noble Earl will be able to say something positive about what Ministers will do to stop the Competition Commission doing this in the future. It will be impossible for services to be reconfigured if in Dorset, a small county, two small district general hospitals are prevented from merging. This is very serious indeed.

Is it all doom and gloom? Will the NHS descend into mediocrity and inevitably become a second-rate service for poorer people? Will charges be introduced, with all the costs and perverse incentives to which my noble friend Lord Turnberg referred? I hope not. Like the noble Lord, Lord Patel, I am more optimistic than some noble Lords. My noble friend Lord Graham, in his marvellous speech, will also recall, as I do, the beloved and late Lord Donald Bruce, who was Nye Bevan’s PPS. He sat just behind the noble Earl when Nye Bevan introduced the NHS Act 1946, when the Commons was using the Lords as its Chamber. Nye Bevan always said that the NHS will always be with us as long as people want it so. It is my contention that whatever the pressures and challenges we face, the British public want it to continue with us.

Of course, it is clear that muddling through is unlikely to be feasible, and spending more will always have to be an option. My noble friend Lady Hollis made a very powerful case for redistributing priorities. The noble Lord, Lord Owen, argued for earmarked taxation. Some noble Lords have argued that higher spending on health and social care should not be seen solely as a debt or a burden but as an improvement and an investment in the economy and the economic and health well-being of people’s lives. I have no doubt that the public will continue to expect the NHS to be a tax-funded system free at the point of need. However, public finances will remain tight.

The noble Viscount, Lord Ridley, doubted the efficiency achievement of the NHS in the absence of a market. All international evidence suggests that the more marketised a health system is, the more wasteful it is. My grounds for optimism are based on international comparisons. The Commonwealth Fund in the US, which is a very authoritative comparator of healthcare systems, ranks the NHS number two. It ranks it number one for effective care and for efficiency. We should not throw that away. Despite all the challenges, the NHS has a lot going for it.

The noble Lord, Lord Cormack, could have made his speech in every decade going back to the 1950s—perhaps he did make that speech in the 1950s. The Guillebaud Committee was set up in the early 1950s when debates took place about whether we could afford the NHS. Professor Bryan Thwaites in the 1980s came out with speeches that the NHS was unaffordable. Here we are, 30 years on from that, still debating this issue.

If the NHS is to survive of course it has to be more efficient and there are three areas where I suggest efficiencies. First, the Government at a stroke could stop the marketisation of the NHS. The amount of money that is going to have to be wasted in compulsory tendering of services is extraordinary—£3 billion has already been spent on the stupidest reorganisation the health service has ever gone through and much more money will be wasted in the future. Secondly, in central government there is heavily centralised procurement. I welcome that. The Government are not allowing individual government departments to procure separately. We should do the same for the health service. We cannot afford to have 500 different organisations procuring. Thirdly, I agree with the noble Baroness, Lady Tyler, about avoidable admissions, caused either by the public not turning up when they should do or turning up when other facilities should be on offer.

There is much to be gained. The shift to prevention offers much. The need to integrate health and social care is becoming broadly accepted everywhere. People need to shift from being passive consumers of care to active partners in their own health. The system needs to become much more open and transparent. Above all, I put my money on innovation. In this country we have fantastic scientists who are inventing new medical treatment and equipment day after day but we are very slow to use that in everyday practice. The academic health science networks, NHS England’s specialist commissioning facility and the assurance that NICE guidance is aggressively adopted would give us a foundation for an efficient health service where innovation is adopted quickly and the benefits are seen not just in the quality of patient care but also because the global pharmaceutical industry will see that the NHS continues to be a strong place in which to invest in the future. We must want to get to where health and wealth run closely together. If we can do that, the future of the NHS is a good one.