My Lords, I, too, add my congratulations to the noble Lord, Lord Darzi, on his excellent speech and his constructive IPPR report. He and I have both had a go at reforming the NHS, and I think we can at least congratulate ourselves on not creating a mess on the scale of the Health and Social Care Act 2012, from which the NHS still suffers.
The NHS has been a key part of our welfare state and a great piece of communal risk pooling and social cohesion. It has survived some difficult years with its funding veering around from famine to feast and back again. It has become like David Attenborough and Judi Dench: a national treasure. However, the trouble with national treasures is that they can end up like Danny Boyle at the 2012 Olympics, engaging in a fantasy view of something that badly needs to change but gets frozen in the national psyche.
The NHS and its staff are tired in part because its business model and operations badly need a major overhaul. The NHS still operates the organisational silos created 70 years ago. It has not integrated its own services very well, let alone integrated with social care. It is still largely a sickness service rather than a health service. Public health, mental health and adult social care remain Cinderella services financially, while the acute hospitals remain the financial preoccupation of most elected politicians. The patient base of the NHS now lives much longer than in 1948, with a set of comorbidities that come largely from lifestyle choices, but the service delivery system has changed little, despite countless reorganisations. It certainly does not deliver consistent quality across the country.
The way services are delivered needs to change radically and swiftly. Simply giving giving the NHS shedloads of new money without a credible and enforceable long-term reform plan would be a waste of taxpayers’ money. The NHS England long-term plan promised for this autumn needs to provide for a radical shake-up of the way in which services are delivered outside hospital, the way in which staff are trained, treated and deployed, and the way in which technology and regulatory change are to be implemented. There needs to be a sweeping away of the 2012 governance and accountability arrangements. This plan must lock funding into reformed services outside hospitals and will need regular parliamentary scrutiny on its delivery. It must also be supported by a new, credible and sustainable funding system for adult social care, which remains in a parlous state both financially and through the growing collapse of the publicly funded social care provider market. Unless the Government show a greater sense of urgency about a new funding system for social care, they are setting up the NHS to fail.
Let us be clear. There is no Brexit dividend for the NHS. The OBR forecasts show the UK economy flattening out, flatlining at about 1.5% growth a year after Brexit. This will make it very difficult to sustain a 3.4% real-terms annual increase for the NHS over a long period. So the NHS had better get on and reform itself quickly while the financial sun shines briefly for a moment.