NHS: Long-term Sustainability

Lord Hunt of Kings Heath Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the noble Lord, Lord Patel, for opening the debate, and very much welcome my noble friend Lady Ramsey on the occasion of her maiden speech.

The noble Lord, Lord Patel, talked about the NHS being severely constrained, but we know that the NHS can work well. Fourteen years ago, the NHS was in rude health, with new hospitals, new services, and waiting times that had come down dramatically. In 2010, the British Social Attitudes survey reached the highest level of satisfaction ever at over 70%.

What have 14 years of coalition and Conservative Governments brought us? The latest survey, published three weeks ago, recorded the lowest levels of satisfaction since those surveys started in 1983, of 24%. Long waits have become the norm; access to GPs, dentistry and CAMHS services have become very difficult for many people; ambulance waits are outside safety targets, and social care is unreformed. As the noble Lord, Lord Patel, said, we have very poor health outcomes as well. If the NHS is to be sustained, it has to respond to health and care needs very different from those that existed in 1948. There are complex long-term conditions among a growing older population—yet the NHS at the moment seems woefully unprepared or, as the noble Lord, Lord Patel, said, it has not reached an equilibrium.

To turn this around, I agree with the noble Lord, Lord Patel, that we first have to start upstream, with a bolder preventive focus to reduce health inequalities and improve life expectancy. As my noble friend Lord Filkin, the noble Lord, Lord Bethell, and others say in their recent report, Health is Wealth, our nation’s poor health damages lives, communities and our economy. Then major surgery is required of the NHS. Wes Streeting has outlined a decade-long programme of modernisation, with plans to digitise massive amounts of NHS paperwork and to make proper use of the NHS app to give patients real control. What the noble Baroness said about genomics really fits into that model.

However, three major changes need to accompany this. First, we need a step change from the current overcentralised and bureaucratic NHS. As Nigel Edwards of the Nuffield Trust has said, we have a culture of checking, assurance, performance management and other manifestations of a controlling and low-trust approach, alongside a system with a very large number of priorities. I do not know whether the Minister is aware how much NHS England’s approach is despised and hated within the health service at the moment. I would suggest that that comes from the approach that Ministers are now taking to NHS England. It comes right from the top.

This has to go with the workforce. We need a fundamental change in how we treat our people working in the NHS. Bullying, problems of recruitment, retention and morale—these are everywhere in our health service. I have been fascinated to read the outcome of a King’s Fund and RCN project entitled Follow Your Compassion, which looked at the experience of 22 newly qualified nurses and midwives. The work that they do is high stakes, with significant and often disproportionate responsibility placed on them almost immediately after qualifying. Life, death and human suffering are everyday encounters, and the work of caregiving is emotionally demanding. But the overwhelming experience of participants was reported as their feeling unprepared, anxious, silenced and exhausted. You can have as many workforce plans as you like but, unless we get to grips with how our people are treated in the health service, you will never really sort the workforce problems out.

Finally, we must invest in leadership and management of the NHS. I remind the House that I am president of the Institute of Health and Social Care Management. Unlike the military and many private organisations and companies, the NHS does almost nothing to select, nurture and develop the next generation of executive leaders. Training and development are often sporadic, which, combined with the lack of a systematic appraisal, makes development and deployment of key talent almost impossible. The Government’s insistence on carving yet more managers out of the system at the moment is having a very damaging impact on their ability to take forward the kind of change that needs to happen.

If we do not sort this out, if we do not change the culture, if we do not put more trust in the NHS locally and if we do not sort out social care, all the other changes that we need to make will come to very little. This Government have now had 14 years; they have had their opportunity—it is time for change.