Primary and Community Care: Improving Patient Outcomes

Viscount Eccles Excerpts

Thursday 8th September 2022 Lords Chamber

[Viscount Eccles (Con)]

My Lords, it is a great privilege to follow those four opening speeches. However, I knew that I was getting myself into quite unnecessary trouble by putting my name down for this debate. Having had no internal experience of the National Health Service, I cannot follow the catalogue of problems which we have so far heard.

I start by declaring an interest: I am in receipt of community care. I will not go into detail, but I was in hospital two or three times and the NHS picked up that this would probably lead to the need for aftercare. Lo and behold, community care appeared. It has been very interesting and extremely helpful, but it raises two matters.

First, there was no explanation for why this was happening; it just happened. There has been no explanation which might lead one to understand the objectives or the value of the work, and possibly even the value for money of the work, being done in what is undoubtedly an endeavour to ensure independence—an endeavour for which I am very grateful.

The second matter that has arisen is that I cannot any longer understand whether there is a borderline—and if there is, where it is—between primary care and what might loosely be called hospital-based care. Because of my short stays, two hospitals have picked me up and are determined to monitor all sorts of aspects of what they found during their investigations. A lot of that work is what I would describe as primary care. I will not go into details, as that is not the point of such a presentation, but, for example, skin trouble, which has been persistent and different and has apparently quite complicated causes, seems to have moved away from primary care.

The other aspect of these experiences means that, for various reasons, I have not been able to create any personal relationship with a general practitioner. I have been responsible for some of the changes that have led to that, but so has the medical centre, where the people change quite rapidly.

When thinking about these experiences and about what I do not understand about the National Health Service and how it is organised and run, I am very thankful for what has happened in the delivery of my medical services; I have every reason to be grateful. There have been glitches along the way—a rare side effect, which affects only 1% of the population, but that just proves that I am an awkward person, as so many people are. I am truly grateful for the way in which the NHS has dealt with the various problems that I have had—and here I am, past my sell-by date.

When thinking about that, I reflect on my two grandfathers. They were both medical men, and they were both involved in the negotiations which led up to the Aneurin Bevan health service Acts. If they were with us today, they simply would not understand what is going on. The changes have been so radical—in society, in the behaviour and reaction of people in society, in the medical profession, and in the technology that has come over the past 74 years—that they would not understand what is going on and why it is going on in the way that it is. This leads me to think that we must be coming to a need to discuss, rethink and maybe alter the Aneurin Bevan settlement.

There have been so many efforts over that time, and yet we have heard the catalogue of the first four speeches of this debate. It is clear that something is amiss and that we need to think about this very big organisation, with its huge difficulties. The gearing in such a large organisation and the importance of that fact that, when medical services are delivered, it is very personal—they are essentially between two people; you and some medical practitioner who has been through a long training and has the knowledge—means that it will either work as it should or will run into troubles.

In thinking about where we are, I hope that the first thing that we will consider very carefully is the relationship between the political sector—this is a nationally provided service, funded from taxation and free at the point of delivery—and the medical profession. There is no natural fit between politics and medicine. There was not at the beginning of the health service, and indeed there were compromises made at that time which we still live with. In starting a discussion, we must go back to fundamentals, and we certainly need the medical profession to stand up and be counted on how it sees the way in which the delivery of medical services should be shifted. What is the borderline between primary care and secondary or hospital-based care? What are the fundamental questions which must be asked and answered if we are to go forward?