Building an NHS Fit for the Future

Paul Bristow Excerpts

Monday 13th November 2023 Commons Chamber

[Paul Bristow (Peterborough) (Con)]

It is a great pleasure to speak in this debate following the first King’s Speech in more than 70 years. I refer the House to my entry in the Register of Members’ Financial Interests.

The debate is entitled, “Building an NHS fit for the future”. In my view, we face no bigger public policy challenge. To build an NHS fit for the future and make the right financial choices, we need to get a grip on how much we spend. Money alone does not provide improved outcomes for patients; the investment we make—or, in other words, our spending—needs to deliver value. The NHS is not cheap, and it is certainly not free: it costs around £180 billion, or £2,700 per person, a year. The NHS is not underfunded, but workforce challenges, escalating costs and an increasing level of non-clinical activities are putting a strain on it. We need to debate how that money is spent, and I want to contribute by highlighting three areas.

First, I will address procurement. “Value-based procurement” is a term that has been used in the NHS for many years—it is not new. Whether or not we use that term, it is clear that the tariff, and other systems and culture, need to change to embed value into the system. What do I mean? Well, we need a transactional relationship in our NHS that goes way beyond the simple purchase of a commodity or a technology. We need long-term relationships between suppliers and our NHS that deliver better outcomes for patients and good value for money for the taxpayer. That requires a cultural change among procurement leads, yes, but for others as well.

As well as that partnership approach, savings need to be made across the whole treatment pathway—from referral to discharge—rather than just on the acquisition of an individual commodity or therapy. Pathway change is required, and “We have always done it this way” can no longer be the answer. Trust leaders should be told what is expected of them in that regard, and then they can flow that cultural change throughout the entire organisation. That should be exciting and rewarding for NHS staff, managers and teams. We need mechanisms and systems that not only incentivise that, but insist on payment and tariff systems focused on reducing expensive overnight hospital stays, prioritising day cases, early diagnosis and referral, and putting patient outcomes at the centre of things.

Secondly, I will address innovation. Recently, I accompanied Health and Social Care Committee colleagues on a trip to Singapore, where we saw how digital technology and artificial intelligence can transform efforts to tackle cancer. The Committee is conducting a future cancer inquiry. There was a rather amusing moment—I found it amusing, anyway; others might not—when I asked a couple of questions about the inspiration for that approach and about the regulatory and reimbursement models for technology. It was clear to us all that the inspiration for the approach was actually the UK, especially the 100,000 Genomes Project and the Galleri test from Grail. On regulatory and reimbursement models, we were given a presentation that looked almost exactly like NICE—I have sat through numerous presentations on NICE, reimbursement and all that, so one more would not make any difference. Obviously, Singapore has different funding models for its healthcare system, but how it judges whether something is cost effective looks remarkably similar to NICE.

Although some of our systems, and our clinical research, are admired around the world—about which we can rightly be proud—we need to be flexible to allow those innovations to be effectively reimbursed. There is still no specific tariff for digital technologies, but one is vital if we are to adopt such technology at pace and scale. We must not lose the advances and potential that AI could have for patient outcomes and diagnosis simply because there is no effective way of assessing, reimbursing and embedding the technology in the NHS. The technology can and should make it easier for the NHS to save money, and we must learn how to pay for it.

Finally, we need to end the one-year NHS funding cycle. Muti-year financial settlements—or funding arrangements that reward outcomes rather than activity—need to be embedded across the whole system, including at trust and ICB level. That will save money, and we must move it forward. In-year savings incentivise only short-term cost gains. The drastic change needed to embed innovation and new pathways that focus on patient outcomes, and to generate savings by doing things differently, is possible only by changing single-year funding models.

We want those innovations to be a must-have, not a nice-to-have. Time and again, innovation has dried up when the one-off funding pot has ended. I could bore the House with countless examples of that—hon. Members will be pleased to hear that I will not, but they will be familiar with what I am saying. It is the same in any big bureaucracy, be it the NHS or local government: short-term decision making, cost escalation, cultural resistance to change, and innovation treated as a nice-to-have. We cannot go on like this; we must move on from that system. We cannot have a situation in which other countries take inspiration from us in research and technology but do it much better, while we remain in an analogue age not because of a lack of ambition, but because our system does not embrace ways to spread those things at pace and scale.