Health and Social Care in England

Lord Kakkar Excerpts

Thursday 11th July 2013 Lords Chamber

[Lord Kakkar]

My Lords, I, too, thank the noble Lord, Lord Patel, for having secured this important debate. I declare my interests as professor of surgery at University College London and as a consultant surgeon for University College London Hospitals NHS Foundation Trust.

We have heard that the National Health Service is a vital part of society’s infrastructure in our nation. It provides a unique reassurance by ensuring free and universal access to healthcare. In addition, it provides a most remarkable structure for the provision of public health and preventive strategies, which are vital in ensuring the nation’s long-term health and in containing costs. It also provides a unique environment for biomedical research. Indeed, the research infrastructure that we have heard about has resulted in much innovation and a change in clinical practice for the benefit not only of our own citizens but of people throughout the world. Furthermore, it provides the basis for a vibrant and important life sciences industry which makes a huge economic contribution to the welfare of our country. Beyond that, it is the social solidarity, or glue, that the National Health Service has provided to bind our society together that forms a vital part of the debate about its future.

During this debate we have heard from many noble Lords about the increased financial demands of the National Health Service. Some 50 years ago, it consumed 3.2% of our gross domestic product; last year, some 8.2%; and in 50 years’ time it will be some 20% of GDP if the rate of growth—the 4% per year that we have seen over the past 50 years—is sustained over the next 50 years.

Figures relating to the increasing financial requirements of the NHS produced by the Office for Budget Responsibility show that in 2032 the OBR expects £132 billion to be spent on NHS provision, whereas if the 4% growth that we have traditionally seen in the past 50 years is sustained, the figure will be closer to £170 billion. However, what is striking is the number of people employed in the NHS—currently one in 18 of the working population. If we continue at the same rate of growth with 20% of GDP consumption by 2062, one in eight of the working population will be employed by the NHS. What modelling is done in the Department of Health and the Treasury around this increasing consumption of healthcare resources? Does the noble Earl recognise these figures, and does he, as well as others in government, consider this a sustainable trajectory?

In terms of a solution, one that has been suggested during this debate is to increase taxation. There is a great fondness among our fellow citizens for the National Health Service but even providing one extra percentage point in GDP to be diverted towards health spending would require an increase in taxation of £570 per household per year, and that is a huge increase in taxation. Of course, we know that the demand is going to be much greater. We could settle on giving a greater proportion of public expenditure to health, but 20% of departmental spending is currently already devoted to the National Health Service. Is it sustainable to take more and more from other public services and divert it to health if we do not increase the income available?

A third potential option is to improve the effectiveness and efficiency of the services that we provide, and in this regard Her Majesty’s Government have to be congratulated. The report entitled Innovation, Health and Wealth, published last year, clearly focuses on ensuring that the National Health Service can improve the outcomes that it achieves for fellow citizens in a way that adds to economic growth rather than continuously draining economic resources, although I think that many would agree that it is not a drain of resources to ensure that our nation is healthy.

In establishing the outputs of Innovation, Health and Wealth and, in particular, in establishing the academic health science networks—I declare a further interest as chair for clinical quality at the recently designated academic health science network at UCL Partners—what metrics will be applied to determine whether the networks are successful in terms of the economic rather than just the health question? We know that, as part of the designation process, each of these networks across England has been asked to define high-impact innovations that will be applied across the population and to adopt NICE guidance to improve clinical outcomes, but both those sets of interventions should also have an impact on resource utilisation. Are metrics defined that we will be able to assess over time to determine whether a focus on improving efficiency and effectiveness in the NHS can also result in better utilisation of resource?