My Lords, I first declare my interest as chairman of UCLH. The Select Committee has produced an outstanding report and I pay tribute to the noble Lord, Lord Patel—I was going to say my noble friend. He is a mentor to not only the noble Lord, Lord Kakkar; I regard him as a mentor to me as well in this place.
I make the obvious point: after 70 years, the NHS is still a remarkable institution. I do not think anyone in this House today is going to say that the NHS should be disbanded or that it is no longer fit for purpose. That is pretty remarkable after 70 years; there are very few organisations that have weathered so well. If you look around the world at other social insurance-funded systems or private insurance-funded systems, there is no doubt that the NHS—which pools the risks, whether genetic or social, of a whole nation—can deliver both fair and efficient healthcare. When Theresa May became Prime Minister she talked about social justice, and no institution better embodies those words than the National Health Service.
I will make four points, the first of which is on money. If we look back over the life of the NHS, there is a correlation between the amount of money that goes in and the productivity that comes out. It goes in fits and starts. One Government come in and put too much money in, and productivity goes down. The last Labour Government, who the noble Lord, Lord Hunt, referred to, got the NHS to make huge progress, but during much of that time in the early 2000s a lot of waste and inefficiency went along with that extra money going into the system. We need a long-term settlement so that people in the NHS can plan for the future. It is not hard to create a long-term settlement, because the spending on the NHS is so determined by demography and technology that it is quite easy to predict. As some noble Lords will know, the IPPR has made a prediction of £50 billion extra by 2030. Whether it is £50 billion or £40 billion, surely that figure can be agreed on. If we are to have a cross-party view on this, exactly where we could have one is on what those requirements are for the NHS. However that is financed—whether through some form of hypothecation from general taxation, charging or productivity increases—that seems a perfectly legitimate area for proper political debate.
Secondly, on reform, by fragmenting the commissioning system into 212 clinical commissioning groups the Health and Social Care Act—my noble friend Lord Lansley, who was here a minute ago, was the architect of that—has made the process of integration more difficult. It also did not address the foundation trust issue, which was of course set up by the Labour Party when it was in government, and which has made integration much more difficult. If you are a foundation trust, you are solely interested in your own financial results and performance, and not in the performance of the system for the population as a whole which you service. We therefore have to address not only the consolidation of CCGs but have to look again at the regulation of foundation trusts. There is now evidence that where acute care and primary care work together in integrated systems, we reduce the number of emergency admissions into hospitals so that people are treated outside acute hospitals, which is all to the good.
The second area where the Health and Social Care Act was not helpful was in the split roles between NHS Improvement and NHS England, which has led to a fairly high degree of frustration and split responsibilities. To bring those two organisations together could well be part of the future. However, there is one caveat. Here I pay tribute to the noble Lord, Lord Carter of Coles, his team at NHS Improvement and their work on the Model Hospital and on the Getting It Right First Time initiative, led by Professor Briggs and Professor Evans. That “improvement” part of NHS Improvement should not be part of the regulator. You cannot be both a regulator with a big stick and a genuine improvement agency. However, the work the noble Lord has done in NHS Improvement should not be lost; it should be taken out of a combined NHS Improvement and NHS England organisation and treated separately.
The last part of any reform programme must be to emphasise prevention, as the noble Lord, Lord Patel, has already mentioned. We cannot regard the NHS purely as an organisation which cures the sick; it has to prevent people being sick in the first place. That has not received enough emphasis over the last six years.
I would like the Minister to address two other points in winding up. The first is that there should be a greater obligation on the NHS to support the life sciences industry in the UK. At the moment, it seeks to meet its own budgets and deliver care at the lowest possible cost but, for the economy and the country as a whole, the life sciences industry is absolutely essential. When it comes to developing cell and gene therapies and encouraging the convergence of data science and medical science in this country, for example, the NHS ought to have a greater obligation to support those initiatives and to become a test bed for British technology and science. However, the work that the NIHR has done under the leadership of Sally Davies and Chris Whitty in driving translational research in this country over the last five years has been terrific.
I should like to end on a point about Brexit. The Minister will know that my views and his on Brexit are very different but, whatever the outcome of the negotiations, there are three aspects of it which he may be able to give me some assurance on today: first, that we will remain part of any EU research programme such as Horizon 2020; secondly, that we will have a visa programme, not just for doctors and nurses but for the brightest and the best researchers, that is flexible and allows us to attract the best in the world to this country; and, finally, that we will remain part of the regulatory system in the European Union for medicines. If we do not, the chances of this country manufacturing these new advanced cell and gene therapies will disappear. We lost monoclonal antibodies from this country 10 or 15 years ago; we must be able to manufacture cell and gene therapies in this country. If we have to go through enormous compliance issues with customs at the borders, we will not be able to do so. I hope that we can have an assurance on that point.