Health and Social Care in England

Viscount Ridley Excerpts

Thursday 11th July 2013 Lords Chamber

[Viscount Ridley]

My Lords, I also congratulate the noble Lord, Lord Patel, on the timely nature of this debate, and it is an honour to follow the noble Lord, Lord Kakkar. They are a reminder of the great expertise that this House has on this subject.

I have learnt a lot already this morning, and expect to continue to learn more. I am particularly struck by the consensus among the noble Baronesses, Lady Jolly and Lady Boothroyd, who said that things cannot continue as they are. However, I want to come at this from the bottom up, as it were—from how technology and patient expectation will drive changes both to the structure and, by necessity, to the funding of healthcare services, and in particular, how digital and genomic innovation will have an effect on the National Health Service. It is a subject that has been much discussed at the International Centre for Life in Newcastle, of which I have the honour to be honorary president, and I declare my interest therein.

It is not all bad news. We are likely to see huge reductions in the cost of certain procedures as a result of innovation. IT, 3D printing in surgery and new materials are all helping to drive down various costs. I believe that the cost of a cataract operation has come down dramatically because of an increase in the speed of doing it and a decrease in the cost of the materials. This is, of course, bringing operations within the reach of the poor in other countries as well as in this country.

Genomic sequencing has come down from costing billions to thousands in the past decade alone. As we know, however, if we make things cheaper, people will want more of them. I suspect that, through new technology, we will soon be putting enormous demands on healthcare services. We will use our smart phones to find out precisely what kind of lurgy we have, rather than just accepting that we have one; what kind of allergy we have; which drugs work best for our particular condition; and indeed, checking our blood for early precursors of cancer. At the very least doctors will have to get used to dealing with us online. I have a friend who over lunch checked his electrocardiogram with a device on his iPhone and sent it to his cardiologist.

We would be sticking our heads in the sand if we hoped to prevent this end-user innovation, as it is called, turning medicine upside down, as it has done to so many other industries, and if we continued to think of medicine as a top-down business in which the doctor knows best. In the past, treatments have too often been designed to treat the population rather than the individual. For the patient, the change will be great in many ways, and there will no doubt be some savings. For example, we can have many more virtual appointments. As Eric Topol, who has written a book about this, says:

“I expect some 50% to 70% of office visits to become redundant, replaced by remote monitoring, digital health records and virtual house calls”.

This will keep down hospital-acquired infections as well. Overall, however, it will vastly increase costs because personalised medicine means not only more demand but more expensive sorts of demand. That is bound to push up costs well beyond what any pooled system can bear in terms of cross-subsidy, whether from the rich to the poor or through insurance. It will undoubtedly raise ethical issues. If precise genomic diagnosis or drug toxicity information is available to some individuals and not others, it will put enormous strain on the budget of the NHS and the principle of common access to it. There will then effectively be a form of rationing. Added to that, of course, is the growing burden of us all living much longer, as the noble Lord, Lord Filkin, said, and of having up to five conditions when we are old, which I believe is the average, not to mention the obesity epidemic which my noble friend Lord McColl mentioned.

It is obvious that we face rising healthcare costs as a proportion of household budgets. That is why it is vital to turn the NHS as far as possible into an organisation that tries to drive down its costs in a ruthless fashion. The Government have made a good start on this. The NHS is on track to make £20 billion of efficiency savings by 2015 and, we hope, more beyond that. However, as many noble Lords have said today, this will prove to be a drop in the ocean. Not even the NHS’s most ardent champions would at the moment call it a ruthless pursuer of cost-efficiency. It has none of the usual levers such as competition or fear of losing business to other providers that drive up efficiency and quality in the commercial world. No amount of top-down diktat will substitute for those trends. To meet the bottom-up challenge coming from patients and from technology, health funding needs to experience a form of bottom-up reform. Sixty years on from the founding of the NHS, as the noble Lord, Lord Patel, said, we need to be open-minded about all the models available for discussing the future of health reform.