My Lords, it is an honour for me to wind up for the Opposition in this debate. Because I am going to refer to NHS management, I remind the House of my presidency of the Institute of Healthcare Management, the Health Care Supply Association and the Hospital Caterers Association.
I start by expressing my thanks to my noble friend Lord Darzi for his magisterial opening speech. The vision that he set out was profound and inspiring in urging us to revitalise quality as the organising principle of health and care, investing in health and not just healthcare and investing in the talent of our staff as well as tilting, as he said, towards technology to create a digital-first health and care system. My noble friend Lord Bhattacharyya really very much reinforced that. He also said something very important—that he saw the NHS as the expression of a moral principle that no one should be denied healthcare because of their means. I could not help thinking that Nye Bevan would have approved. In his essay “In Place of Fear”, he uncannily anticipated the wretched outcome of the Government’s attempt to marketise the NHS when he said:
“Preventive medicine, which is merely another way of saying health by collective action, builds up a system of social habits that constitute an indispensable part of what we mean by civilization. In this sphere values which are in essence Socialist challenge and win victory after victory against the assertions and practice of the competitive society”.
Amen to that, my Lords.
The intervention from the noble Lord, Lord Lexden, in response to the noble Lord, Lord Pendry, about the history of the Conservative Party and the NHS was very interesting. However, at the end of the day, the party voted 21 times in that Bill on the formation of the NHS. I say to the noble Lord, Lord Lexden, that I think Bevan was entirely right to believe that Henry Willink’s plan to leave the voluntary and local authority hospitals in their existing ownership would have led to a much patchier and second-rate service.
The remarkable speech of the noble Lord, Lord Hennessy, recalled the profoundly positive impact of the lifting of the financial fear of the consequence of illness. It is right to celebrate that—but I am with noble Lords who want a sober analysis of the NHS and the challenges that it faces. The BBC should be commended on commissioning a report on the relative strengths and weaknesses of the NHS, from the Health Foundation, the IFS, the King’s Fund and the Nuffield Trust. You could not look to better institutes than that for it—and it was sober. It said that, although the NHS leads the world in terms of equity of access and ensuring that people do not suffer financial hardship and performs well in managing long-term conditions, such as diabetes and kidney disease, and is relatively efficient compared to other systems, outcomes are its Achilles heel.
Although the NHS is closing the gap in a number of areas, we still lag behind in saving lives when treating many of the leading causes of death, including several types of cancer, heart attacks and stroke. It is comparatively poorly resourced. I do not think that having average GDP spend for the whole of Europe is actually anything to be proud of, given that we are the fifth or sixth-wealthiest country in the world. We are poorly resourced. We have markedly fewer doctors and nurses than comparable health systems. We have the lowest number of hospital beds, CT scanners and MRI scanners. We are one of the slowest nations to take up new medicines and new developments. We have a long way to go. Although international comparisons are always subject to the caveat of being a partial picture, it is clear that we enter the eighth decade in uncertain health.
Funding is a clear issue. Of course we welcome the injection of £20 billion for the NHS over the next five years, but it is not the long-term solution that my noble friend Lord Winston and other noble Lords have called for. It is nowhere the near the 4% per year that most organisations reckon should be the base funding. Of course, that money does not cover public health, training, capital spending and social care.
All my noble friends have talked about the need for a fundamental change in social care. The Green Paper is awaited in the autumn. All I have to say to the Government is that they had better deliver on this. Frankly, there is no chance of integrated care in the way they talk about unless we deal fundamentally with the problem of the current means test and find a way to cap the cost for individuals having to pay for their own care. Nothing else will deliver the kind of integrated care that we need.
Noble Lords have talked to an extent about other forms of funding. The noble Baroness, Lady Finn, implied that we need to look at those. I repeat what my noble friend Lord Darzi said: by far the most efficient, dignified and lowest-cost way is to create a universal service free at the point of need. As he said, it is a fundamental error of logic to say that because something is unaffordable we should move to something more expensive and, indeed, more inefficient.
Noble Lords have raised many issues. On mental health and public health, I echo their points, but I want to end on the workforce. The NHS faces some pretty fundamental issues in relation to its workforce. One in nine nursing posts is unfilled and the number of unfilled vacancies among GPs is soaring, as is that of young doctors qualifying, leaving the NHS and going abroad. Morale is probably the most serious issue that we face. My noble friend Lord Parekh suggested, I think, that front-line workers were inhibited by managers. In my role as president of the Institute of Healthcare Management, I want to defend the role of managers in the health service, but I accept, as my noble friend Lord Darzi said in his report, that poor leadership and demotivated staff are a precursor of system failure. That echoes one of the most incisive reports on NHS leadership and management, by the noble Lord, Lord Rose, when asked to look at this in 2014. The Secretary of State did not like the response, so nothing happened because of it, but it talked about the,
“level and pace of change”,
being “unsustainably high”, with,
“the administrative, bureaucratic and regulatory burden fast becoming insupportable … The NHS has committed to a vast range of changes”,
“there is insufficient management and leadership capability to deal effectively with the scale of challenges”— that echoed what the noble Baroness, Lady Harding, said. However, I have to say to her that it is no good just blaming managers. There is a combination of overbearing regulators, an absence of leadership from Ministers, the complexity of the 2012 Act, the tightness of funding, the risk aversion and the widely prevalent bullying culture—which starts with the Secretary of State, with his insistence on sacking chief executives willy-nilly. It is no good the Secretary of State talking about bullying in the health service until he looks at his own behaviour and how he and the regulators relate to people in the service, because no one locally will believe in this unless the people they are answerable to change their own behaviour.
We come now to the issue of the disastrous Health and Social Care Act 2012. It was the most ill-conceived piece of legislation that the health service has ever seen. As was said earlier in the debate, in an extraordinary speech made on
No one can pretend that the future is going to be easy for the NHS and social care. The challenges are formidable and the solutions are tough. Moreover, the demands will not go away. However, the NHS is resilient. It has brilliant people and it enjoys huge support. My noble friend Lord Darzi said that in 30 years’ time, he hopes to see the centenary of the NHS. I am pretty confident that he will and that the people of this country will demand nothing less.