NHS: Long-term Sustainability

Lord Scriven Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord Scriven (LD)]

My Lords, what a pleasure it is to follow the noble Lord, Lord Hunt of Kings Heath, who like myself is a former NHS manager and who clearly understands the difficulties and nuances of the future challenge of the NHS. I am also thankful to the noble Lord, Lord Patel, for this very timely debate.

The current performance of the NHS worries many and therefore needs to be improved urgently before it can be a stable platform for us to rise to the challenge of the significant technological and demographic changes that will take place if it is to become sustainable. The NHS’s current performance is distressing to say the least, despite the gallant efforts of many staff within the system. People in need of care and treatment are unable to see an appropriate medic or professional, with some waiting up to three years just to get on the NHS dentist list. People are waiting in the back of ambulances outside A&E for hours, while people waiting for a cancer diagnosis are not getting access to timely treatment, which can be life threatening, and people in great pain and agony are waiting far too long for planned operations. The Government have allowed this to happen and now try to placate the public with a list of office-generated statistics and playing catch-up. It is not good enough. People deserve far better than this.

Despite this picture of appalling failure by the Government, this debate makes us think very carefully about the future of our NHS. I am sure that the debate will be framed around two themes: one is how to make the NHS more productive, efficient, and innovative, while the other theme will be the wider context of the demographic, economic and social issues in which the NHS will have to work. The reality is both these themes will have to be addressed for a sustainable NHS.

Time today is limited, so I cannot go into depth about what is required across both themes, but I shall throw these issues in as a starter for 10. The 1948 orthodoxy on which the NHS stands has to be addressed, if we are going to see an NHS that can meet future need. For instance, why do we have a fixed view which is over 70 years old of what a hospital should be? Why are emergency and elective services always in the same building? Is it time to think more laterally about emergency hospitals and elective hubs? The model of primary care needs to be questioned. Why have we had the same model and front door system for over 70 years? This needs significant change, for those who need significant primary care needs due to comorbidities and those who occasionally dip in and out of primary care. Maybe a different type of service delivery is required, as the integrated electronic health record takes hold, with no longer just one model of GP and primary care access.

As technology, robotics, AI and data-driven services become central in predicting, planning and delivering healthcare, appropriate leadership skills at all levels of the NHS will need to be addressed to maximise the potential of these issues, as well as to minimise the risks. Is it time to end the leadership model based predominantly on managing efficient siloed organisations by moving to leaders who are experts in maximising health gain and facilitating community action to bring about complex change?

Societal issues, such as housing, education and the environment will have to be addressed, as the NHS does not work within a vacuum. A population that is ageing with comorbidities, and the balance between the working-age population and the non-working-age population—and, of course, climate change—needs to be addressed. Some key issues that we need to think about across government to support the NHS maximising health gain are supporting people to age with dignity and independence, tackling deep-rooted worklessness, and an absolute laser-sharp determination to narrow the health inequalities, as well as having a long-term and fully understood funding formula for both the NHS and social care.

All this will take long-term, focused action by government and society. I am not sure that the siloed structure of central government can deal with these challenges effectively at present. The approach must be a community health-based model, to maximise healthiness and improve health outcomes.

One simple way of supporting this would be for the Treasury to set up designated funds that can be used in communities and the NHS to invest for health. That would break down the problem of pretending we can move existing NHS budgets, which are mainly sunk, fixed costs, into prevention and reducing health inequalities.

Talking of funds, it is vital, as the noble Lord, Lord Patel, said, that we sort out, once and for all, the social care crisis. The NHS can never be sustainable if, as a nation, we have not dealt with social care funding. After the general election, I think it is the duty of all politicians, from all parties, to sit down and work out a cross-party solution to this difficult problem that has been left for far too long. We need to take a different approach and think about some fundamental questions if we are to have a sustainable NHS.