NHS: Long-term Sustainability

Lord Mawson Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord Mawson (CB)]

My Lords, I thank the noble Lord, Lord Patel, for this timely debate. My colleagues and I at the Bromley by Bow Centre have been at the cutting edge of innovation in primary healthcare for 35 years. We entered this space by accident following the tragic death of a local resident, Jean Vialls, in an East End housing estate in May 1991. Jean’s death led to a senior-level inquiry at a London hospital, which picked apart the lives of an East End family in very challenging circumstances who had been badly let down by the NHS and its siloed culture. The inquiry also challenged the NHS on its lack of attention to detail, its management systems and its culture, which had forgotten who the customer was. Sound familiar.

We were told at the time that lessons would be learned but, 35 years on, I can assure noble Lords that few lessons have actually been learned by the NHS. Indeed, my GP colleagues tell me that getting up stream and creating more integrated responses to health needs gets harder to do, not easier. In the course of this well-documented and tragic encounter, we began to realise that in poor communities at least 70% of the determinants of health are social and not biomedical; they have nothing to do with doctors. The NHS business model was absolutely the wrong way around and there was a desperate need to get up stream into the prevention agenda.

Our practical response, as an increasingly entrepreneurial culture took root in Bromley, was to build the first working model of an integrated primary healthcare centre that moved beyond just health and social care and embraced housing, employment, business, the arts and education, and so on. We have created 97 businesses with local people over the years. We started to join the dots. Even with the support of the then Prince of Wales, now the King, this work was done against a prevailing culture in the NHS that talked about innovation but rarely grasped the nettle. Today, the Bromley by Bow Centre is responsible for 55,000 patients on four sites, and has been taken national through the Well North programme, which I lead—here I declare my interest. The centre today hosts 2,000 visitors each year, from across the world. There has been all this work and learning, but so little in practice has actually changed. One hospital medical director we work with described the NHS as a blancmange when it comes to innovation: it wobbles when innovative ideas and practice are first introduced but always returns to shape and form. This is not a sustainable culture.

What needs to be done? Here are seven brief steers, based on many years of practice. First, we must stop treating the NHS like a religion and be honest about its condition: it is ill and broken. Business as usual is not an option. It needs radical surgery over a 10 to 20-year period.

Secondly, we need cross-party agreement to stop the constant meddling of countless politicians and endless restructuring. I was involved in the 2012 Olympics programme for 19 years, from day one. Our focus was on creating a real legacy in east London from this once-in-a-lifetime opportunity. Early on we focused on gaining cross-party support for a 25-year programme—go and have a look at the results.

Thirdly, we must take seriously Dr David Haslam’s concern that if we carry on with the present NHS business model, it will absorb 100% of GDP by 2070. It is not sustainable; we are creating a dependency culture.

Fourthly, we must create a learning-by-doing culture, and move away from so many expensive, outdated reports that few read.

Fifthly, the modern world is about people and relationships, not processes, and so we must nurture them at all levels of the NHS.

Sixthly, technology is not the answer to everything but it is a fantastically useful tool. We must start small, interfacing the technology with people and their practice, and use it to grow organic cultures that work. Stop trying to land big solutions from above.

Seventhly, we have always found, right across the country, individuals and localised groupings that were able to deliver this more joined-up, entrepreneurial approach. At the moment, this is true, for example, in Bradford, York, Rotherham and east London, among others. However, they are not in general supported and encouraged, and thus the approach does not become established more broadly. As has recently been observed, the NHS has more pilots than British Airways—why not get behind these good people, long-term, and build a culture based on innovation, integration and entrepreneurship.

My question to the Minister, and to the Opposition if they were to come into government, is this: given the present spending trajectory and business model, what percentage of the UK’s GDP does the Government estimate that the NHS will soak up by 2070, and what are they doing about this challenge? Who in the department is thinking about this problem?