My Lords, I, too, thank my noble friend Lord Turnberg for securing this debate and congratulate the noble Baroness, Lady Watkins, on her excellent maiden speech. I also declare my interests as being those on the register.
We have heard that the public value the NHS so greatly, and we know from the Commonwealth Fund studies that we rank very highly in healthcare systems in the world, yet something is clearly wrong. We need to address the question of funding, but in this brief speech I should like to focus much more on what we need to do now in the short-term to equip the Minister to go back to have those necessary arguments with the Treasury to secure the correct level of funding.
The interesting thing is that we have a great system. Somebody said the other day that we have done everything right once. What we have failed to do is build on the great experience that we have built up in a number of areas. If we look at quality or use of resources, we see unwarranted variances right across the system. The noble Lord, Lord Lansley, asked about procurement. The fact is that in some hospitals we are sometimes paying double and using twice as many staff to get the same outcomes. We need to work on a national system which delivers consistency, not only in quality through the CQC but in the new arrangements that are being put in place through the NHS improvement agency, to make sure that everyone is doing the same thing right. We have not learnt from the great achievements that we have in many places in the system.
The second area is one on which many people have spoken: the whole question of the right care in the right place, the flow through the hospitals—people call it workflow in industrial situations and increasingly in healthcare. One big thing that has emerged from the speeches of other noble Lords is the whole question of discharge from acute hospitals. There are 130,000 acute hospital places in England, and probably 10% of them are blocked, so 13,000 beds are being used inappropriately.
The third point is collaboration. Others have talked about integrated care. Salford is a wonderful example. Northumbria proves what we can do: integrated acute, community and social care. We know how to do all this; we do not need to look to consultants to tell us. The NHS knows that what we have to do is organise to deliver it. Critical to that will be the 1.4 million people who work in the NHS. I think it is equalled only by the Chinese army and Indian railways in size of workforce—and possibly Walmart. I suggest that the other three have a high degree of leadership. We probably need to get away from leadership by bullying to leadership by leadership, so that the system can actually deliver.
I repeat that we need to equip the noble Lord, Lord Prior, to go back with those right arguments. Those of your Lordships who read the Guardian on Monday may have noted Matthew D’Ancona’s little piece. I end with this quotation:
“The custodian of the NHS”— we are all custodians, I suggest—
“who truly seeks to safeguard its future must fight for internal efficiency, restless reform and the changing needs of patients, as well as for extra cash”.