NHS Long Term Plan

Lord Stirrup Excerpts

Thursday 31st January 2019 Lords Chamber

[Lord Stirrup (CB)]

My Lords, I refer the House to my interests in the register and to the fact that I have family connections with the NHS. In the three minutes allotted to us in this important debate I can really make only one point: that the NHS Long Term Plan contains many worthy initiatives and objectives, but delivering the improvements that it seeks will be an extraordinarily difficult task, especially as we have no overarching strategy for health within the UK. I say this because a strategy must bring together ends, ways and means in a balanced and coherent way. No one issue can be addressed without the others.

When we talk about a fully funded health service, for example, we come face to face with the fundamental problem confronting the NHS and all other health services around the world. How does one constrain cost in a system of open-ended demand and ever-increasing technological opportunity? Without such constraint, healthcare is in effect an unbounded system; we could end up spending 100% of our GDP on it and still not satisfy every demand. The only rational answer is to balance resources and tasks by controlling both, rather than just one of them. This of course means limiting the care that is provided. That already happens, but in an often random and unplanned way. So the question we should be asking ourselves is: what is the most equitable system of rationing?

Whatever system is chosen, it will sometimes lead to unfortunate and perhaps tragic cases which frequently become political causes célèbres, so if we are to decide on the fairest and most efficient system of healthcare rationing, it must be done on a cross-party basis. As long as healthcare is treated as a political football, effective solutions to this conundrum will continue to elude us.

Let me caution against the pursuit of apparently attractive but, in the long term, chimerical solutions. One of the most common is the cry for greater efficiency. The idea that this can be used to wish away the underlying financial dilemma is ill-considered at best and mendacious at worst.

Nor should we think that restructuring healthcare will make the problem any easier. Preventive measures to improve long-term health are important, but they are unlikely to moderate demand for NHS services. We will all, alas, continue to suffer physical, and perhaps mental, deterioration over time. The clinical causes of the deterioration may change, but they will still need to be treated or ameliorated. It therefore follows that improved public health programmes, while essential, will over time likely result in greater expenditure rather than less.

The NHS Long Term Plan covers many important areas and sets out some laudable ambitions. But unless we find a sustainable way of balancing ends, ways and means, we will still not have an effective healthcare strategy.