My Lords, I begin by declaring my interest as the chair of NHS Improvement and thanking the noble Lord, Lord Darzi—my esteemed colleague on the NHS Improvement board—for his masterful introduction to the debate. After listening to various noble Lords who have contributed their whole working lives to the NHS, and thinking about the more than 5,000 NHS staff members who are still working there after more than 40 years’ service, I have to say that I feel like a bit of an impostor in this debate, having all of seven months’ experience of working in the NHS, in NHS Improvement. I have tried to hold three things in my head as an employee of the NHS who is still learning. The first is that the NHS is undoubtedly the best health service in the world. In the round, taking everything into account, it is the fairest service and is definitely the most efficient one. As my noble friend Lady Finn said, clearly there is room for improvement, but I would contend that it is one of the most cherished institutions in the land. While we look at how to improve it, it is really important to remember, in everything that we say and do, how brilliant it is.
Secondly, it could be so much better. The variation in outcomes for patients across the country is just not acceptable. You only have to be a patient or the carer of a patient for 10 minutes to see how money is being wasted. We could be more efficient and at the same time deliver better outcomes. Thirdly, we are all living longer. Technology is enabling us to live well for longer, which is a good thing. It is a problem of success, not failure, but it is none the less a problem that must be faced, and in reality it is one that will require more money for the health and social care system.
What should we do? Many noble Lords have talked about the important need to integrate care in the health and social care system: the governance, the structures and the money flows. I would like to focus on the people: the 1.7 million people across the United Kingdom who are working for the NHS. They are our greatest asset and it is really important that we help and support them by preparing them for the future. If we are to deliver integrated services, we will need to drive considerable change in the NHS. That will include organisational change, process change and technology change. Change is hard for everyone, however clever and experienced they are. It means that the NHS needs to improve significantly the way in which we manage and lead.
Just as there is variation in clinical practice and operational processes, there is enormous variation in management and leadership capability in the NHS. I have met some of the very best managers I have ever seen in any walk of life in the last seven months, but unfortunately our NHS staff tell us very clearly in their staff survey that that is not uniformly the case. I have been shocked by the results of the NHS staff survey, first by how small a percentage of staff actually fill it in—50% to 60% filling it in is deemed as a huge success in the NHS. Best practice in industry would tell you that 80% to 90% just filling the survey in is a measure of real engagement. The percentage of people who say that they have been witness to or have experienced bullying is terrifying. On average it is 24% of staff and at the worst trust it is 41%. All this points to a management and leadership culture that needs to change to prepare us for the future.
We need to instil a consistently just and learning culture. We need to root out bullying and replace it with honest and open management, and to encourage much more flexible working and the greater diversity in leadership styles that reflect the way our society is changing. These are not “nice to dos”; these are the essential building blocks if we are to transform the NHS to meet the challenges that various of your Lordships have set out. I know that it is tempting at this national political level to focus on money, organisational structures, regulatory levers and command and control, but it is the people of the NHS who have made it the national treasure that it is today. Focusing a bit more on supporting and developing the people in the NHS, their culture and ways of working will be the essential ingredient for success in the next 70 years.