National Health Service: Sustainability

Lord Mawhinney Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Mawhinney (Con)]

My Lords, I, too, congratulate the noble Lord, Lord Patel. I very much appreciated his kind personal comment at the beginning of his speech.

This debate is about the sustainability of the NHS, not its desirability. If you talk about its sustainability, hard words about the NHS are likely to follow. Those who issue hard words might conceivably be charged as not being as supportive of the NHS as they ought to be, so I want to make two personal statements before I start. First, for the majority of this year I have been in the intimate care of the NHS. I owe my life to Steven Tsui and to the doctors, nurses and technical staff who have looked after me so well over the past few months. Anyone who has been through what I have has to be an NHS fan. Secondly, for the record, apart from the years when I lived and worked in the United States, I have never had any private health insurance; I have been an NHS man all my life.

I start by setting a context. When the NHS started, in its first year it employed 144,000 employees. On 30 September 2014 the UK employment total was 1.6 million. The first NHS budget was £437 million, which in today’s money is about £9 billion. This year, as the noble Lord, Lord Patel, reminded us, we are going to spend around £116 billion. In the first year we spent 3.5% of our GDP on it; as we have been reminded, this year we are going to spend around 9%. That trajectory is not sustainable.

I turn to money. The recent King’s Fund report said that,

“financial problems are now endemic among NHS providers, with even the most prestigious and well-run hospitals forecasting deficits”,

this year. Are we relaxed about that? More than 25% of trusts are in deficit, some in deep deficit, and most of the rest of them are heading in that direction. In the seven years between 2006-07 and 2012-13, over and above the normal financial arrangements, the department slipped about £1.8 billion worth of cash to hospitals in addition, just to keep them going. There is one hospital in this country that in the last few years was in receipt of £1 million per week over and above its normal financial arrangements, just to keep going. I am told that one of the London teaching hospitals is £200 million in debt. Monitor predicts that by 2021 the NHS will be £30 billion in debt—and if there is one thing you can say about that figure, it is that it will be an underestimate when we get to 2021.

I turn from money to service. I had the honour of being a member of the Select Committee on Public Services and Demographic Change. We said in 2013 that,

“the current healthcare system is not delivering good enough healthcare for older people”.

I noticed the president of the Royal College of Emergency Medicine saying recently that the treatment of patients at A&Es is “inhumane”. I noticed the Alzheimer’s Society saying that GPs are reluctant to diagnose patients with dementia because they feel there is nothing that the NHS can do. And it is a disgrace that if you go into hospital at weekends, you are 15% more likely to die than if you go in during the week.

We have had a lot of nice things said about the NHS Five Year Forward View. I shall read one sentence from it:

“The traditional divide between primary care, community services, and hospitals”,

increases the barrier to the type of care that people need. None of that even hints at sustainability.

The NHS is not only a sort of religion, it is a political football. If I were a Labour Member, I would be really pleased that we had started it. As a Conservative, I am really pleased that we have looked after it for more years than anyone else. Both sides have played their part in keeping this political football moving backwards and forwards, but it is time to blow the whistle—it is time to stop. I want to be the third ex-Health Minister, and there may be more yet to speak, who says that it is time for an independent review. It is time for an independent national commission to recommend how we should move from unsustainability to sustainability. Will the Minister’s department undertake to put pressure on the rest of the Government to set up a royal commission, or would it prefer that an independent commission was set up, independently generated?