NHS: Independent Investigation

Lord Scriven Excerpts

Tuesday 8th October 2024 Lords Chamber

[Earl Howe (Con)]

My Lords, I am glad we are having this debate on the report by the noble Lord, Lord Darzi, even if the tone set by the Statement—which I am sure noble Lords have read—is, as far as I am concerned, rather regrettable. It is regrettable because the noble Lord, as one would expect of that most distinguished man, has produced a thoughtful and carefully argued diagnosis and set of prescriptions for the NHS. It would have been better to treat those findings on their own terms rather than as an excuse for a highly charged political rant. Having said that, I hope that, in this House at least, we can maintain debate on a rational and civilised level.

There are indeed problems in the health service that are there for all to see and others that are less immediately visible. These problems are real and indeed require sustained remedial effort. The noble Lord, Lord Darzi, attributes them to a mixture of causes, one being inadequate central government funding. I do not expect the noble Lord to be an apologist for the previous Government, but it would have been nice if he had acknowledged more fully that, despite so-called austerity, health service funding rose in real terms in every year since 2010 and in the last five years by nearly 3% in real terms per annum. The problem, as Sir John Bell has pointed out, is not a lack of money: it is that too much of the money has been sucked, suboptimally, into acute care settings and not enough into the community. The noble Lord goes on to say that very thing. But let no one conclude from that that community funding has been neglected. The last Government oversaw the opening of 160 community diagnostic centres. As my right honourable friend said in the other place, this is the largest central cash investment in MRI and CT scanning capacity in the history of the NHS.

Is there more to be done? Yes—but the results are there and proving their worth. The NHS is currently treating 25% more people than it did in 2010. It is delivering tens of millions more out-patient appointments, diagnostic tests and procedures than it did when the coalition Government came into office. Some of the community services are being delivered by staff employed by acute trusts—the statistics tend to hide those numbers. Yes, we can talk about the need for greater productivity, but this progress—it is indeed progress—is all down to the efforts of the dedicated clinical staff across the health service on whom we all rely, and who are more in number than at any time in the service’s history.

Please do not criticise the last Government for focusing on the numbers. The imperative of planning ahead to train the right number of staff for the right care settings was amply fulfilled in the last Government’s workforce plan—a publication heralded by the NHS chief executive as

“one of the most seminal moments”

in the NHS’s history.

Can the Minister nevertheless say, despite the fact that the report is not mentioned by the noble Lord, Lord Darzi, whether the Government will embrace the workforce plan and take it forward as the NHS clearly wants and needs? Can she also say whether the Government will adopt the productivity plan announced in the last Government’s Spring Budget? That plan—again, unaccountably not mentioned in the report—would deliver the “tilt towards technology” that the noble Lord rightly advocates, with a big productivity gain to boot.

I said that the noble Lord, Lord Darzi’s report was carefully argued, but not all of it is well argued. I cannot allow his colourful statements about the 2012 Health and Social Care Act to go unchallenged. To attribute the NHS’s current difficulties and challenges in large part to that Act is, frankly, ridiculous. What that Act did was to complete the process that the noble Lord himself started, which was to ingrain quality into the commissioning and delivery of healthcare based on clearly defined standards and outcomes, meaning that providers would be competing with each other based on the quality of care and treatment that they delivered to patients.

The noble Lord, Lord Darzi, now says that we need to move away from the whole idea of competition, but I suspect he has misled himself, because he goes on to say:

“The framework of national standards … incentives and earned autonomy … needs to be reinvigorated”,


along with patient choice. What is that framework if it is not a framework of healthy competition between providers based on quality? Therefore, what role does the Minister see for competition alongside collaboration —I do not think the two are mutually exclusive—in driving up the quality of NHS care?

I have a few final questions. We are told that a 10-year plan will be produced based on the findings of the noble Lord, Lord Darzi. Whose plan will that be? Will it be the Government’s plan, and if so, how will the Government avoid what might look like a prescriptive top-down set of instructions to the health service? Does the Minister think it important that the NHS takes ownership of the plan and, if so, how will that be achieved?

In essence, the noble Lord, Lord Darzi, believes that we need to get from point A to point B—in other words, from acute settings to community settings; from tired old premises to brand new ones; et cetera. Does the Minister agree that we cannot transition from point A without first finding the money to create a functioning point B? In other words, will she and her fellow Ministers urge the Chancellor to commit to the capital expenditure necessary to achieve that?

Lastly, I quote the noble Lord, Lord Darzi:

“The vast array of good practice that already exists in the health service should be the starting point for the plan to reform it”.


Does the Minister agree with that and, if so, how does she reconcile those sentiments with the Government’s mantra—which is so discouraging to the men and women of the health service—that the NHS is “broken”?

[Lord Scriven (LD)]

My Lords, I thank the Minister for bringing the Statement to the House. You do not have to be a mastermind to realise that the NHS is straining at its seams. It is only down to the great work of the many thousands of people who work in the NHS that millions of people get great care, even though some fall between the cracks.

The Darzi report is a very good medical history and it gives a diagnosis, but we all know that the treatment plan is going to be the important point if we are to deal with a reformed, new and productive NHS. There are some welcome themes in the report that are not new. Those who know the previous Darzi report will see have seen some of them before: prevention; moving resources from hospital care to primary and community care; dealing with the wider determinants of health; improvements in and parity for mental health; and a bigger role for public health.

I understand that the Minister will answer many questions by saying that we need to wait for the 10-year treatment plan, and probably the Budget, before such specific questions can be answered, but I have a few general questions for the Minister, to get at least a sense of the direction that the Government wish to take.

Is it the Government’s intention to restore the public health grant back its 2014 levels? Are there any general views about looking at changing the structure of public health, nationally or locally? On capital, what is the Government’s thinking about the general theme of allocation to hospital and non-hospital services, and how will this be managed and monitored? On data, what is the Government’s thinking on the workforce plan, particularly when there is a huge imbalance when it comes to digital and data between the private sector and skills within the NHS? That is not to say that there are not some good skills within the NHS, but there is clearly an imbalance.

Welcome as it is that the report talks about moving resources from hospital to non-hospital settings, I was a manager in the health service in the early 1990s and I know that this has been said since at least the 1970s. What are the Government going to do to be able to move resources from sunk costs in the acute sector into other sectors? What mechanisms will be put in place? How will this be monitored? More importantly, who will be held accountable for making sure that it actually happens? How will the new neighbourhood approach affect the existing workforce plan? If a new health service is anticipated, what will the effect be on the workforce plan and the implications for capital allocation?

We all want to see a productive and effective healthcare system that improves peoples’ health and independence, but that cannot be brought about if we do not have a strong, effective, well-funded social care system. I do not understand why social care has been kicked down to the next Parliament, or how we are going to solve the health and well-being of the population without that being done. If the major reforms of social care are in the next Parliament, what steps are the Government going to take in this Parliament to deal with the social care crisis?

I look forward to the Minister’s answers, but, more importantly, to the 10-year treatment plan’s arrival in the next few months.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I thank the noble Earl, Lord Howe, and the noble Lord, Lord Scriven, for their opening observations. I will seek to deal with as many of them as I can; I am sure a number will be iterated in the course of the Back-Bench contributions.

I start by expressing gratitude to the noble Lord, Lord Darzi—my noble friend, if I can call him that—for what I regard as an open, honest and thorough review. He is known as a man of great service, not just to your Lordships’ House but to the National Health Service. He has served Labour and Conservative Governments with distinction. As noble Lords will be aware, he is an eminent cancer surgeon who has driven innovation and speaks up for staff and patients. It is not surprising to me that the Secretary of State asked him to conduct this review, tasking him to provide what we might refer to as hard truths, warts and all. I realise that when one asks for that it can be uncomfortable, but I hope that we in your Lordships’ House can sit with discomfort in order to find a way forward for the National Health Service.

The noble Earl, Lord Howe, referred to the terminology that the NHS is “broken”. I understand that that is uncomfortable to hear, but when I speak to NHS staff they recognise that terminology. We are at great pains to say that we are not being critical of NHS staff, but unless we start in an honest and open fashion we will not be able to—as the noble Lord, Lord Darzi, referred to—restore the trust that is necessary. As the Secretary of State said in the other place, this Government have resolved to be honest about the problems faced and serious about fixing them. That is why he commissioned this independent investigation. I very much hope that noble Lords can be of assistance in finding the way forward, because we now have a diagnosis on which we can consult and then move on to the necessary prescription to improve the health of our National Health Service.

The noble Lord, Lord Scriven, referred to the 10-year plan. I am glad that he looks forward to it—as do I—but how will we get there? We now have a very clear explanation of where we are. It is evidenced and has widely involved many people and organisations. It should therefore be regarded with great respect, and I think it largely has been. However, the next stage for the 10-year plan will be to have what will be the biggest consultation we have ever had in this country on the National Health Service. It will involve patients, staff, parliamentarians, stakeholders—all those who have a vested and informed interest in it. That will lead us to the 10-year plan. On the question about this being top-down, this is very much a bottom-up exercise, with the Government’s commitment underlying it.

It is important to say that the 10-year plan does not mean that we will wait 10 years for everything. We will identify those areas in which we can make swifter progress and we can then look beyond. The fact is —this came out many times in the report from the noble Lord, Lord Darzi—that this has been a long time in the making and to turn it around will not be quick.

The noble Earl, Lord Howe, acknowledged that there were problems in the NHS. I am grateful for that and for his reference to the need for change. I also listened closely to his reference to what had been done under the previous Government. Facts are facts, but what matters is output. As we are discussing today, whatever the previous investment and previous actions, some of which were very much to be commended, the output has not delivered the results we need. That is why we have the report by the noble Lord, Lord Darzi.

On the issue of dedicated staff, the staff team to whom I pay tribute goes way beyond clinical staff, important as they are, and includes the cleaners, porters and administrators. Noble Lords will recall that, when the workforce plan was published, we said that this was a useful step forward. Our job now, as a new Government, as the noble Lord, Lord Scriven, said, is to adapt the plan to ensure that it brings in one of the three pillars we will be going for: hospital to community. That will absolutely be our focus.

I note that the noble Earl, Lord Howe, does not accept the assessment by the noble Lord, Lord Darzi, of the Health and Social Care Act 2012. I see the noble Lord, Lord Lansley, in his place; I am sure he will have a contribution to make. I have to part company with the noble Earl on that point, as the evidence in the review is that the Act did not work in the direction we were seeking to take.

On capital expenditure, we find ourselves with a massive backlog of capital works, such that the ability of the NHS to deliver is being held back by the buildings and facilities. We have therefore instructed a review of this, which we will then look to.

Finally, the noble Lord, Lord Scriven, was generous enough to say that he does not expect me to respond to the detailed questions about funding. However, I can assure him that all these matters are being considered—in other words, how we can best deliver the output and the improvements in health that the report of the noble Lord, Lord Darzi, seeks to achieve.