Health and Social Care in England

Lord Turnberg Excerpts

Thursday 11th July 2013 Lords Chamber

[Lord Turnberg]

My Lords, this debate is extremely timely and I congratulate the noble Lord on introducing it so well and on stealing some of my best lines. It is hard to get away from the fact that we are in for a rather prolonged period of constraint on public spending that will inevitably impact on funding for health and social care. It cannot be denied that we are falling behind as inflation in medical care runs ahead of general inflation.

There is a commonly held assumption that the NHS is a bottomless pit but that is just too simplistic. During the years of relative plenty, when the Labour Government dramatically increased funding, we saw a remarkable improvement in care: waiting lists virtually disappeared; GPs could be seen on the same day in most places; waits in A&E departments came down; patient satisfaction levels rose; and productivity, despite views to the contrary, rose too. The number of operations and other procedures rose by 50% during the decade starting in 2000 and hospital lengths of stay fell by 27% from an average of 10.5 days to 7.7 days. So money did talk but now, as we deal with the Nicholson challenge, we are failing to keep up. We are seeing a rise in waiting lists and a fall in staff numbers. The pips are squeaking and we are beginning to see a fall in standards.

So how do we fill this funding gap? The Wanless report of a few years ago suggested that we would need to find 10.6% of our GDP by 2021, while John Appleby, in his report for the Nuffield Trust, suggested that in 50 years’ time we would need to put 20% of our GDP into the NHS. Fifty-year predictions are just a little fraught but he said it would be affordable—that is an important point—if our total GDP increased threefold, illustrating the point that the better off a country is, the bigger proportion of its GDP it can afford to put into healthcare. We have not been short of ideas about how we might fill the looming gap but few are free of problems. Doing nothing is clearly not an option as we will just see a steady deterioration in standards and quality with a public backlash, voter disillusionment and a change of government, whoever is in office.

That leaves us with three options: become more efficient, find more money or ration what we provide for patients. First, there are always efficiencies in a system as huge as the NHS but there are limits and we are pretty close to them now. So-called reconfiguration of hospitals is a popular idea at the moment. Close a few and the community services will pick up the bill for caring for the patients. I am all for focusing specialised services in a few places, as it certainly saves lives, but, unfortunately, it does not save money. I am all for closing small, inefficient hospitals and moving money into community services, but simply redistributing funds does not give us any gain.

I agree here with my noble friend Lord Filkin but, in the face of the enormous pressures building up, I really cannot see that even more efficiency savings are sustainable for very long. As regards finding more government money, I cannot see much prospect of that either, at least in the short to medium term. It would mean taking a bigger slice of the cake and leaving less for everything else, which would not be very popular. Only when we manage to increase our GDP and reduce our debt would we be able to consider taking a bigger slice of the cake. Then we could look at limiting what we provide in the NHS; that is, we could define a basic package of care but stop funding some types of treatments. Again, that is not likely to be very popular and defining which treatments should not be available in the NHS will always raise hackles. As a way of controlling costs it was found to be pretty ineffective in Oregon a few years ago.

Then there is the possibility of co-payments by patients—we have heard about that. We have already broached that principle in the UK, but experience elsewhere is not encouraging. When they tried it in Germany, they saw a rise in the number of patients who avoided visiting their doctors when they were ill or who failed to fill their prescription. The impact of charges for care will have to be examined very carefully if we are not to see a fall in the number of patients who need care but who avoid getting it for financial reasons.

At the end of the day, we will have to choose between a number of unappealing and potentially unpopular options, but one thing is absolutely clear: doing nothing is not one of those options. It is essential that we have a more open debate with the public about these possibilities. A cross-party discussion is desperately needed, as many noble Lords have said. We certainly cannot keep our heads down for much longer.