NHS: Performance and Innovation

Lord Scriven Excerpts

Thursday 15th June 2023 Lords Chamber

Moved by

[Lord Scriven]

That this House takes note of the current performance of the NHS and innovation in the health service.

[Lord Scriven (LD)]

My Lords, I clearly need to put a different aftershave on tomorrow.

I wanted to have this debate because I feel that the time is right for a discussion to be had in this Parliament that really focuses on the future of the NHS and that asks some fundamental questions that will hopefully stimulate further discussion in senior positions in government, NHS England, the professions in the service and the population. Today I want us to have a discussion based on mature politics, rather than the normal knock-around. I think the Minister will be quite surprised that I, of all people, am saying that. It is fascinating that most of the debate on the NHS and health—when they are discussed in this building, in both Chambers—is predominantly about how to tinker with or improve the existing system. It is very rare that we step back and ask some fundamental questions about the system itself and the outcomes that it achieves.

I could go in depth into the performance of the NHS and the processes and measures that are in place that dictate the behaviour about how people in the NHS then perform and what is seen as important. It could be about the 7 million people waiting for care. It could be about the lack of fast access to some cancer services or the length of time it takes to get an appointment with a GP. It could be about the length of time it takes an ambulance to arrive if you ring 999. It could be about the inability to get good oral health through having access to an NHS dentist. It might be about the real lack of parity of health services between mental health and physical health. I could point out the rate at which community pharmacies are closing and the effect that that has within communities. Again, I could point out the poor access to, and rising wave of problems in, sexual health services. Of course, one cannot discuss the performance of the health service without saying that the crisis in social care has a direct effect on the health of the population.

If I do that, however, the Minister will come back with a ream of figures about what the Government are doing to improve the present system. The Minister will come back with a platitude of figures about what is happening. That is all about the process, but we need to start from the outcomes of what the health service is trying to do. What we are trying to do is to fix the infrastructure of a health service devised in the 1940s for a 21st-century Britain.

Let me give the House an example of how this could change. I work with a country in Africa where people said, “We do not have enough pharmacists”. This is a rural country with three urban centres and a massive rural area the size of Italy. “We do not have enough pharmacists; we need more pharmacists,” they said. However, when you start asking what the purpose is of pharmacy and pharmacists, and what their role is in the healthcare system to improve the outcomes of patients, part of the answer is that it is about the distribution of the correct drugs at the correct time to the correct people, so that they can lead as independent a life as possible. They got to the point of thinking about posing the question slightly differently. The answer was not about more pharmacies; what they did was to innovate, based on a different question. They got drones with compartments for drugs going to a central depository and then flying, docking on solar-panel charges; the compartment for that village opened; somebody in that village had been given a job to distribute to that village; and then the drone went to the next village. It was not extra pharmacists that were required; it was access to drugs that was required. By asking a different question and starting with the outcome, you stop just going absolutely focused on process.

I am sure that, at some point in this debate, the Minister will tell us that new hospitals are being built. I am not going to go into numbers of hospitals, but we never question what a 21st-century hospital is. What are we actually building? Are we building the existing model, which in some way replicates the problem of people not being able to get access to planned elective care, because emergency care pushes it out? I know lots of medical people—doctors, nurses and others—and they all say that the reason why I cannot get my hip replacement or I cannot get my ophthalmic eye problem seen to is that emergency care takes over the theatres. One of the things we have to do, therefore, is to say that hospitals need to be different.

It is the same with primary care. We have to think about what primary care will be needed for the future. I will come on to some of the ideas that I have, but innovation is not just about technology and data. It starts with culture, leadership and thinking. It is really important. The Government will tell us—when I go into some of the things that I am suggesting—“Oh, we already have that with ICBs and ICSs”. No, we do not; what we have is a governance structure. ICBs and ICSs become obsessed with structure and governance, and they are not given the space to innovate.

A key, central issue with the NHS that we need to address as a nation is that in some areas, we might just be doing the wrong things a little bit better. It was telling that, in all the great briefings that we had for this debate—many organisations gave us excellent ones— most of them focused on the acute sector and what was needed to improve it. That is quite clearly a vision of health shared by many people who work in the health service. Therefore, if we start with a different view on performance and the purpose of the NHS, we will start with a very different discussion about what is required to innovate, to improve outcomes and not just to tinker with the present system.

If we start to look at the purpose of the NHS as to reduce health inequalities, it might lead to a different discussion—a different focus on innovation to improve outcomes and reduce health inequalities, not just to keep the system running a bit better than it is. If we say that the purpose of the health service is to help in partnership to increase the number of healthy years lived and to ensure that people retain their independence and dignity, the focus on behaviour, structures and systems will be different. That will lead to the NHS having to think much more about population and community health approaches. It will lead to a step change in what is seen as vital to improve health, so it is not just about drugs, doctors and operations in the present but about a shift in who does what, where and how. I do not suggest that hospitals and operations are not important—of course they are—but they are only part of the jigsaw, and too many people see them as the only part of it.

I will suggest some changes. I am not suggesting that these changes need to be adopted but that we just need to think about a different approach. Some of the innovations that might be required might be the following. Do we have different types of hospital: acute hospitals and non-acute hospitals, tertiary hospitals and planned elective hospitals? There are pros and cons for the existing and alternative models, but the issue is what we actually do so that for those who have a planned operation, the whole system works and innovates to meet their needs and they are not stopped going to their emergency care.

Where are step-down services? What innovation do we have around those, so that when people are in the recuperation phase, services are provided? Should the primary care model exist in its present form? Should we have a different type of approach to primary care, so that people like me, who probably go to my GP once every six, seven or eight years, have a different model from those who have ongoing care needs with comorbidities?

I will go further. Do I have to register with a GP at all? If we are going to unleash the potential of pharmacists, who say that now, with the correct funding and system, they could do away with 30 million GP appointments a year, should I register with a pharmacist? A pharmacist can build services around them, linked to IT, to data, and to my healthcare record. I do not suggest that that would work—there would be problems—but we have to ask some fundamental questions.

What is the role of the people who provide care and health provision for people allied to medicine—the OTs and physiotherapists? Predominantly, it is still an acute service. There are people in the community sector. There has to be a huge shift. If we are looking at outcomes, keeping people in hospital to have their OT or physiotherapy is ridiculous. We have to think about how we do this. With older people, for example, one of the biggest issues when you look holistically is social isolation. Yet the health service, for reasons to do with efficiency, has moved that provision back into somebody’s house rather than thinking more holistically about independence and dignity and what can be done in the community with other partners to provide not just the physical part of healthcare but the well-being in terms of stopping social isolation.

Central to all this is people’s lived experiences and that being central to part of healthcare planning and provision. That is something big. Innovation is not just about the data or the technical stuff but about the people. It is about leadership, both clinical and non-clinical, and the type of training that is required. In the future it will not just be about technical specialists but about a community-based approach which will mean that people will have to be great facilitators and bringers-together of networks to be able to build services around shared outcomes based on real people’s lived experiences. That has a big impact for the forthcoming workforce plan. It has to be a workforce plan for the future, not just on how we are going to fit the gaps that already exist in the service, otherwise we will be on a merry-go-round—so I will be quite interested to know the Government’s thinking on this.

In finishing, I say that this debate has to be about the future. It has to be about data, IT and artificial intelligence, but it also has to be about the culture and leadership, and about a community approach which completely changes just tinkering with the existing system, thinking instead about what is required and what innovation is needed for a future health service provision. I beg to move.

--- Later in debate ---

[Lord Scriven (LD)]

My Lords, I thank everybody who participated in this debate, including the Minister, for approaching this in the spirit of the debate’s framework, which was to concentrate not just on the problems but on some of the innovative solutions that can help to take forward not the health service but the health of the nation.

I will finish with a quote from a GP in south Cumbria, who said:

“I feel frustrated that I am working in a health and care system that increasingly fails to meets the needs of people. It is not fair for people to have to keep returning cyclically without us making a fundamental difference to the root causes of their problem”.


There are three or four things I want to take away from this debate and make sure the Minister really understands. The first is that the centre has to move away from an obsession with governance and actually support people a little more in terms of how to innovate. It needs to give people a little more space to evolve some of the issues.

The other thing is that this is about people, people, people. It is not necessarily about the big bells and whistles. The technology is fine, but if the underlying people problems still exist, no matter what app you get, that system is not solved; it just replicates on a digital platform the real issue that is going on behind it. Also, people’s experiences—I mean not just staff but real people, those we call patients—are really important.

My final tip to the Minister is sometimes to go to areas that do not have good practice. I did that when I was leader of Sheffield City Council. The Minister’s officials will want to go to the areas of good practice, but he should go to some of the areas where take-up or innovation are not great, because he will get a different perspective that will then help support the rollout. With that, I thank everybody who has taken part.

Motion agreed.