The Long-term Sustainability of the NHS and Adult Social Care

Lord Parekh Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord Parekh (Lab)]

My Lords, I too begin by congratulating the noble Lord, Lord Patel, and his committee on this report on the long-term sustainability of the NHS and adult social care.

When Lord Beveridge submitted his report, he told his 26 year-old research assistant, Harold Wilson, the following:

“From now on, Beveridge is not the name of a man; it is the name of a way of life”.


It is important to bear that in mind. The NHS was supposed to embody a particular way of thinking and living. The way of living was based on three major values: first, wherever there is human suffering it needs to be redressed; secondly, it does not matter whose suffering it is; and, thirdly, redressal of the suffering is the responsibility of the entire society. In other words, relief of suffering, equality and solidarity are the three great values represented by the NHS.

In so far as these values are represented by the NHS, it is rightly loved by the country; it is almost a part of our religious practice. One hopes that the entire society will be based on these values but the NHS implies that, even if the rest of society is colonised by other values, it will be an island where these values are worshipped and cherished.

I want to explore what has happened to these values over the past 70 years. There was never an idyllic stage where everything was fine and dandy. I remember that in olden days there were all kinds of complaints about the NHS: for example, its hierarchical character, where consultants would behave like local potentates, and the way in which junior doctors were exploited—all kinds of things happened. Over the years, in some respects these things have changed for the better and in other respects they have changed for the worse.

If we look at the situation now, we begin to see many problems, structural and functional. Morale is low—people are leaving the country or retiring early—and I am told there will be a shortage of about 10,000 GPs by 2020. There is also a wastage of medication and equipment; a wastage of time by asking people to fill in all kinds of forms; and a wastage of money by employing management consultants who contribute little to the working of a hospital. The NHS is also perceived as rather remote. The patient has no direct contact with the consultant, and the GP’s contact with the consultant is intermittent.

With all these things going on, a radical rethinking is needed on how we should structure and fund the NHS and whether its role in a society like ours is consistent with the three values that it represents. It is in this context that one should look at the report of the noble Lord, Lord Patel. I am impressed by the amount of thinking that has gone into it and I wish to use the next two or three minutes that I have to contribute to that thinking and take it a little further.

I cannot do that at all levels but I shall try to do it at two levels. One concerns the financial side of it. In this country there are fewer hospital beds, doctors and nurses than the OECD averages. Obviously more money is needed. That money can come only from general taxation, for the kinds of reasons the report explains. However, there will never be enough. The demand is insatiable: the population will continue to age; new technology will continue to appear; and new medicines will emerge in the market. For all these reasons, there will never be enough money and we will have to find new ways of raising it.

Here I am reminded, having been a university professor, of the way in which universities were asked to diversify their sources of funding. Over the course of years they came up with various answers and perhaps some of them will be applied across the board. For example, there could be major endowments by individual donors. My university has recently been the beneficiary of a gentlemen donating about £2 million.

Secondly, the university has increasingly begun to wake up to the importance of cultivating the alumni culture. There is no reason why hospitals cannot similarly cultivate individual patients—those whose children have been born or those who have benefited from hospitals—and encourage them to contribute to the work of the hospital. In this way, one can give the local community a stake in the NHS. The NHS is not simply seen as a national tree, planted in the middle of an area; rather, it grows out of the area and has organic ties with the city in which it is located.

There is also a good deal to be said for research in the NHS, resulting in discoveries, inventions that will be patented. I have seen this happening in the United States; there is no reason why it could not happen here. For example, the NIHR receives money from the NHS, which could then support projects that would result in patents. Those patents could raise money for the NHS.

There is also the question of the amount of medicine wasted. A lot of patients forget to take their medicine. There is no reason why technology for this cannot be developed. In fact, technology is being developed where electronic tags could be attached to medicines so that, at a particular time, the patient is reminded that it is time to take their medicine. The pharmacist connected to the patient can also ring them and tell them that it is time for their medication. In this way, an enormous amount of money can be saved.

Although I do not think that this subject is worth exploring at this stage, I have often wondered about the whole business of merit awards. I cannot see any other profession where people can receive merit awards; certainly there is no chance of someone giving me, a university professor, £10,000 a year, even if I won a Nobel Prize. Doctors get this and I must ask the House to take a second look at why it was introduced, why it is deserved and whether it should be continued in the current climate.

My last point is simple. Ultimately, the report says that any medical institution, such as hospitals and GPs, depends on the good will of individual patients. Patients must therefore not make unreasonable demands on doctors. They should take care of their lives and take charge of their destiny, rather than expecting doctors to take care of them. That kind of individual responsibility must be cultivated and can come only if there is an organic bond between the individual and the hospital or GP. Once we begin to embed a local medical institution in the life of the community, giving the community a sense of responsibility for and ownership of the local health service, things can begin to produce miracles.