My Lords, the report from the committee of the noble Lord, Lord Patel, is exemplary in its response to the evidence it received and in its sensible recommendations. Sadly, we can almost guarantee that it will not be acted on. The response so far has been underwhelming, as other noble Lords have said. We do not need just a five-year plan or a 10-year one; as others have said, we need a 20-year plan, minimum. We have understood the demographics of our ageing population for 50 years—the trajectory is there before us—but heads have remained in the sand. My question is not how we can sustain the current system but why we would want to, given its sad state. I do not have any neat solutions, although I may echo some of the words of the noble Lord, Lord Turnberg.
I think that the situation is far worse than people believe. I have worked in the NHS all my working life, as a doctor, psychiatrist, academic and a manager; in fact, it was Roy Griffiths who persuaded me to become a manager when he did his report. I am now ashamed when I compare the healthcare here in England with what is available in other European countries. In particular, the primary care system of which we were so proud is now so poor at delivering access to people that, according to the OECD, we are the fourth-worst country for people being unable to access care and ending up in A&E as a result. Only three countries in Europe are worse than us: Slovenia, the Czech Republic and Slovakia. That is how bad access to primary care is here.
Our primary care system no longer provides a 24-hour service. Primary care and hospital systems have become even more fearsomely bureaucratic, strung up by regulation. Morale among doctors and nurses is as bad as I have ever witnessed. Last year, I went to a conference for young psychiatrists in Nottingham and I was shocked by their tales of the way the system impacts on their training experience and the way they are sent around and told what to do. It seemed a total anathema to the way I did my training. Our mental health system remains outrageously, chronically underfunded and the CCG system still allows money to be transferred sideways into other services that shout louder.
We smugly criticise the US for allowing the homicide by guns of 8,000 people every year. We tut about its gun laws. Yet, according to WHO statistics for 2015, we in the UK are five times more likely than Americans to die, once diagnosed, of mesothelioma, nearly three times as likely to die of oesophageal cancer, twice as likely to die of stomach cancer and nearly twice as likely to die of prostate and bladder cancer. Many more thousands of people in the UK die of poor treatment and inadequate follow-up. For example, prevention services would help diabetes not to become a crisis.
Why are we not scandalised by these figures? We should be. It is not that we have worse screening systems, but because our treatment, follow-up and aggressive care of people to provide better outcomes is simply not as good as many American and European systems.
Forty years ago I was really proud to be at the forefront of delivering dementia care services that I honestly believe were the best in the world. Forty years on we have fallen woefully behind. It has been demonstrated by research that it is now easier to get better care if you are impoverished in Texas than if you are a middling well-off person in the United Kingdom.
Yet the NHS is so beloved by the general population that when he was Chancellor, Nigel Lawson—now the noble Lord, Lord Lawson—said that the closest thing the English have to a religion is the NHS. How true that is. Because it is funded directly out of taxation, it is often starved of funds when tax revenues are inadequate or when the Government, as now, have a different approach to what should be funded and what should not. When we get these bursts of funding, as the noble Lord, Lord Prior, said, much of the money goes into increased staff salaries. Productivity, which is already appallingly low, goes down and the incentive is often to do less work rather than more. The investment must go into reshaping the system. We need a long-term settlement and political consensus about how to do it.
We have heard that perhaps one change that would make a huge difference is an integrated care system—by which I mean health and social care working together in clinical teams. We have known for many years that just having a joint budget, as they have in Northern Ireland, does not work adequately. We need proper care management systems working together—as we have heard happens well in Salford—but we really need case management working around clinical teams. That creates the elite feeling that people enjoy working in where they are really producing better outcomes for people. If I had one change to make, it would be to integrate funding and delivery of social and health care across the nation. I do not believe that that would fundamentally undermine the principles of the NHS.
My final point is that we need to look at how people understand where funds come from and where they go to. At the moment they see no relation between what they pay and what they get. It is time to ensure that the general public really understand that they are getting a cheap system that is poorly funded. They could have it so much better if they knew what they were putting into it and could see where it went from their own taxes. So I support hypothecated funding to help people understand where it is going.