The Long-term Sustainability of the NHS and Adult Social Care - Motion to Take Note

Part of the debate – in the House of Lords at 1:21 pm on 26th April 2018.

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Photo of Baroness Bloomfield of Hinton Waldrist Baroness Bloomfield of Hinton Waldrist Conservative 1:21 pm, 26th April 2018

My Lords, I, too, add my congratulations to those of other noble Lords to the noble Lord, Lord Patel, and his team on this excellent report and its thoughtful, challenging recommendations to Her Majesty’s Government.

I have been exceptionally lucky in all my experiences with the NHS. An early diagnosis through a national screening programme and rapid follow-up led to successful treatment at the Royal Marsden, and here I defend from my noble friend Lord Prior its record of working with private, transformational biotechnology firms, such as Immunocore. I received a humbling level of capable, compassionate and cheerful care from everyone—just what one would want from the NHS for everybody.

However, I recognise my experience is not matched by that of others around the country. In many regions, the service is creaking under the weight of demographic challenges, patchy social care provision leading to late discharges of the elderly and increasingly expensive treatments. This is combined with overwhelming expectations of what we should expect of the NHS in the 21st century, and as wonderful new treatments emerge for hitherto untreatable conditions this pressure is likely to increase.

I believe that, broadly, we all want the same thing: excellent care for all, free at the point of need. We may differ in the way we believe we can achieve it, but we are all motivated by the long-term vision of delivering better care more affordably, and I agree wholeheartedly with the noble Lords, Lord Patel and Lord Willis, that a long-term plan can be achieved only through political consensus.

The guiding principles of the NHS state that:

“the NHS seeks to improve the health and wellbeing of patients, communities and its staff through professionalism, innovation and excellence in care”.

I want to focus my few comments on innovation, particularly technical innovation in the healthcare sector. This area comprised only eight pages of the report in a chapter that included productivity. Here I should declare my interest inasmuch as two of my children work in health tech, for eConsult and Lantum respectively. The former provides online GP services within the NHS, and the latter produces a workforce management tool connecting healthcare professionals with providers.

Heathcare is facing the kind of transformation not seen since the discovery of antibiotics and anaesthetics. Indeed, harnessing technology and digital innovation is critical to its long-term future. There is scarcely an area of medicine that cannot be improved upon by new technologies. Many of them can also have a transformative impact on disease prevention. In the energy market, which I know rather better, my view has always been that conserving energy is at least as important as energy generation in closing the energy gap, and so it must be that preventing illness will be a significant factor in narrowing the funding gap within the NHS.

Some £10 billion of the health service budget is currently spent on diabetes. NHS England’s pilot of digital diabetes prevention programmes is a good example of a national focus on tech. There were 87 applications for the five places for the trial, and the successful bidders to be investigated and trialled include Buddi Nujjer, Oviva, Liva Healthcare, OurPath and Hitachi. If we could only diagnose diabetes earlier and educate people into healthier lifestyles, it would lead to a lighter burden for the NHS as well as a better quality of life for patients. Simon Stevens commented:

“So much else in our lives is now about online social connection and support, and that now needs to be true too for the modern NHS. This new programme is the latest example of how the NHS is now getting practical and getting serious about new ways of supporting people to stay healthy”.

Depressingly though, both the chief executive of NHS Digital and Nicola Blackwood, in her report for PUBLIC, The Promise of Healthtech, talk of a silo mentality and technology inhibitor which discourages the uptake of new technology at scale. PUBLIC’s survey last year commented that,

“If startups take twice as long as you expect, healthcare startups take five times as long”.

Poor procurement practices are a major barrier to entry in certain parts of the country and in certain parts of the NHS. Many still rely on large IT vendors which fail to meet modern standards of interoperability. Cultural resistance, digital skills and the willingness to embrace technology also vary enormously across the NHS, so new companies need to understand issues of regulatory compliance and have evidence of clinical value in order to sell into the NHS successfully. Those that succeed will have focused their attention on areas where the NHS is most receptive to new technologies.

Primary care is an example. More care needs to be delivered through digital health solutions, giving GPs the time and ability to monitor and nudge behaviour remotely. Online consultations with GPs are now commonplace with companies such as eConsult. It was formed by a consortium of NHS GPs and helps to increase the capacity of GPs to see an ever-growing number of patients with increasingly complex health issues. Its remit includes spreading best practice throughout the country. Although there are still many sceptics within the profession who remain hostile to change, it is anticipated that by the end of this year many NHS patients in England will have digital access to their GP.

Dr Murray Ellender, writing in the Times earlier this week, stated that modern digital triage tools can now help to differentiate between serious conditions necessitating a face-to-face consultation and the more routine which can be dealt with remotely. Although he observes,

“if we use social media as a benchmark, digital consulting is still at the Friends Reunited … stage”,

there are grounds for optimism. The current cohort of digitally savvy medical students and the recently qualified are sure to be rather quicker to embrace new technologies than their perhaps less digitally aware seniors. The changes that innovations such as cloud computing, VR, 3D printing, genomics and AI are bringing to the NHS could not have been imagined even five years ago and, frankly, cannot come a moment too soon.