NHS Long Term Plan

Lord O'Shaughnessy Excerpts

Thursday 31st January 2019 Lords Chamber

[Lord O'Shaughnessy (Con)]

My Lords, it is an honour to be given the opportunity to follow the typically penetrating speech of the noble Lord, Lord Hunt. I congratulate him on securing the debate today and thank him for giving this House the opportunity to celebrate the historic investment that the Conservative Government are making in the NHS—I am sure that was his motivation—while giving us the chance to debate how that funding ought to be spent. Constructing a three-minute speech is probably a good discipline for us all, so I will focus my comments today on two issues which are of great significance: integration and innovation.

On integration, the structural centrepiece of the long-term plan is the joining up of healthcare delivery in combined authorities called integrated care systems. This marks a significant departure from 30 years of Conservative and Labour health reform, which had previously focused on creating competition within layers in the healthcare system—primary, secondary and so on. My belief, which I think is reflected in the long-term plan, is that this approach has run its course, not least because it increasingly goes against the grain of the healthcare needs of our people. The median patient is now older, has more complex needs and co-morbidities, and constantly moves between different bits of the NHS to receive their care, so having a vertically integrated healthcare system makes perfect sense.

However, I have two questions for my noble friend that flow from this approach, which as I said is the right one. First, achieving this goal may need primary legislation. Is this something that the Government are prepared to do? If they are, and given the support for integration on the Opposition Benches, the question is whether the Opposition would be prepared to back the Government. Secondly, one concern that has been expressed about these ICSs is that they could create again unaccountable local monopolies. How will the Government counter that risk?

Just as important as making sure that our health service is truly joined up is making sure that patients continue to be able to access life-saving therapies. The NHS has a great history in this area through pioneering surgery, novel drug development, and so on. But as the noble Lord, Lord Hunt, pointed out, the NHS can sometimes look at innovation as something that costs it money rather than making it perform better. I believe that this mindset is changing: look at the sophisticated arrangement between Novartis and NHS England that has led to CAR-T therapies being available here, with the first patient successfully treated; or the sequencing by the NHS of 500,000 genomes in the next five years, bringing truly personalised medicine to people with cancer and rare diseases.

We are making progress, but one critical way in which we can build on that further is to increase the UK’s medical R&D budget. Can my noble friend assure the House that during the upcoming spending review, her department will make a very strong case to the Treasury for a major uplift in the budget of the National Institute for Health Research, which has had a flat-cash settlement over the last eight years? Making the UK the place in the world in which to do clinical research will ensure that NHS patients are among the first in the world to get life-saving and life-changing therapies.