NHS: Long-term Sustainability

Lord Reid of Cardowan Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord Reid of Cardowan (Lab)]

My Lords, I congratulate my noble friend Lady Ramsey and I thank the noble Lord, Lord Patel, not only for securing the debate but for his sweeping overview of the coming years. I have a much more modest aim. I would like to tackle just one issue: the 7.5 million people who are on the waiting list, suffering sometimes pain and very often distress. I will look at the reforms to the NHS in the years 2000-05 and how they were tackled. There are a number of former Ministers in the House, and they will be well aware that think tanks rarely look back with kindness and positivity at our efforts. I was therefore somewhat surprised and pleased that the King’s Fund report of 2022, Strategies to Reduce Waiting Times, was unusually positive. Indeed, it argues that some of the NHS reforms I was involved in, along with the noble Lords, Lord Crisp and Lord Warner, actually worked. That was a first, I think, for a think tank’s review of ministerial activity.

The report starts with the overall judgment that:

“The years following the NHS Plan in 2000 provide important lessons for tackling long waits … successfully”.


I suggest, therefore, that we might look at some of the levers that we used, because we have so many people waiting in pain and distress at the moment, as I said. The simple judgment of that report is important, because it means that we do not need to be fatalistic about the large number of people waiting in care. We faced the issue before, and as a nation we succeeded in solving it, so let us briefly mention the reform levers that the Government might want to consider or to enhance.

From 2002 we developed the policy of paying NHS trusts more money if they carried out more work. Put like that, it sounds very simple, but at the time it was portrayed as an extremely controversial, right-wing point of view. Ironically, that came from some of the people who naturally assumed that if they produced more at work, they would get paid more, but they felt somehow that it was wrong for NHS entities to work on that basis. They argued at the time that it would undermine the NHS. It did not. It acted as a clear incentive to do more work, and because more work got carried out, waiting lists, among other things, began to fall.

Secondly, we realised that there was no point in providing an incentive to a trust to obtain more resource by carrying out more work if at the year end the trust had to give back any surplus to the centre. That is why in 2004 we created foundation trusts, which could roll forward the resources they made and reinvest them. Again, arguing for this caused many to attack the Government at the time for being too right-wing.

Thirdly, from 2002 we started to offer patient choice to those who had been waiting for more than six months. I was told at the time, as was my predecessor Alan Milburn, that this was no use because patients did not have the knowledge, the ability or the capacity to exercise that choice. Funnily enough, of course, that too was proved wrong because, rather than wait longer, most patients chose to go somewhere other than their local hospital, despite the disadvantages of travel, because they valued the shorter time before treatment.

Fourthly, the money followed that patient choice, putting patients, not providers of healthcare, in the driving seat and rewarding those carers who best met patients’ needs and satisfactions.

Fifthly, we not only used the private sector to provide services for NHS patients but created, through the independent sector treatment centres, a new form of private sector that increased productivity by each concentrating on one form of treatment.

Taken together, those were the reforms that effectively reduced massively the waiting lists. Of course, there were extra resources. The only criticism I would make of the noble Lord, Lord Patel, is that he referred to Tony Blair’s promise of a 6% increase per annum as uncosted. It was not uncosted. We costed it—we just had not told the Chancellor. That was the controversy. As I said, with each reform there was great political controversy.

My final point is that thereafter there is a mystery, because you would assume that after the Labour Government left office, the Conservative Governments that came in consecutively would not only adopt those practices but turbocharge them. In fact they dropped them and the practices disappeared, apparently disintegrating, until last year. I pay credit to the Minister who is replying today, because he was one of those who pushed for their readoption. The lessons of those five things are very important for any future Government, and I hope they will be taken on board by a future Labour Government.