National Health Service: Sustainability

Lord Ramsbotham Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Ramsbotham (CB)]

My Lords, I, too, congratulate my noble friend Lord Patel on obtaining this debate, yet again confirming his wisdom, his expertise and his commitment to an issue about which I know he cares deeply. As a mere NHS user, I hardly dare add my voice to those of the many experts who are contributing, my only qualification being that, for two years, I chaired the Hillingdon Hospitals NHS Foundation Trust, having my noble friend Lady Flather as one of my non-executive directors.

Before making two points about the sustainability of the NHS, perhaps I may share the first of two wishes. I once worked for a general who banned the use of the words “significant”, “vital” and “basic” because they were merely pejorative and signified nothing. A distinguished psychiatrist said the same, in clinical terms, about the Home Office’s use of the words “dangerous” and “severe” to qualify a personality disorder. If I could ban one word from politics it would be “change”—pejorative for doing the opposite of what the other side did, under the delusion that it is a hallmark of political virility. In fact, change for change’s sake often leads to little more than unnecessary and expensive disruption, particularly when its consequence has not been fully assessed. In the public sector, evolution is invariably a better, or more appropriate, route to improvement than revolution. The debacle following the coalition Government charging ahead with change in their pre-planned Health and Social Care Bill, before examining the books and seeing what was possible or necessary, is a classic example of what I mean. Above all, it flew in the face of the priority plea of practitioners, which is for stability.

Sustainability depends on maintaining and not squandering resources. Quite clearly, the biggest problem facing the NHS is the rising cost of meeting the physical and mental health needs of an ageing population. My first point is that affordability requires the ruthless elimination of anything unnecessary or wasteful, such as silo working when more than one ministry is involved. There are two examples from the criminal justice system. First, I hoped that prisons and probation would be represented on local health and well-being boards, resulting in improved support for offenders. Not only are they not represented on all, but fewer than 20% of clinical commissioning groups realise that they are responsible for meeting the physical and mental health needs of those undergoing supervision in the community. Secondly, expensive lack of co-operation between ministries is exemplified by the Ministry of Justice’s proposal for what it calls a “secure college”, detaining 320 children aged between 12 and 17, the vast majority of whom have mental health or emotional well-being problems, on one site in the middle of Leicestershire, while at the same time NHS England’s Children’s Mental Health and Emotional Well-Being Task Force is piloting a scheme to ensure that such children are kept in their home areas to ensure consistency of treatment. The Chancellor must be fuming.

My second point concerns senseless waste of equipment and drugs. Almost four years ago my wife had four vertebrae fractured in a car accident and had to wear a plastic body brace for some weeks. When she asked the issuing NHS hospital what she should do with it when it was no longer needed, she was told that, because they did not re-use such things in case infection was passed on, she should throw it away. In the event, she was assessed by a consultant in a private hospital, who, on hearing this, asked whether he could have it because it was worth a lot of money and could be used many more times. Only last week I tried to decline a once-prescribed box of pills which I did not need, only to be told by the pharmacist that there was no point in handing it back because, once issued, it had to be destroyed. Individually these may be small items but, aggregated across the country, they add up to a considerable sum which the NHS surely ought to be able to find ways of saving. I hope that the current work of the NHS Confederation, working with other national bodies to explore how to make savings, will demonstrate to the Government the value of an NHS-led approach to this.

One of the qualities that I most admired in the marvellous people who worked at Hillingdon was applied common sense. Sadly, common sense is often a victim of adversarial party politics. That is why my second wish, in the interests of stability and sustainability, is that in addition to the independent commission called for by my noble friend and many others, the future of the NHS should be subject to cross-party consensus.