NHS: Long-term Sustainability

Lord Reid of Cardowan Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord Reid of Cardowan (Lab)]

My Lords, I congratulate my noble friend Lady Ramsey and I thank the noble Lord, Lord Patel, not only for securing the debate but for his sweeping overview of the coming years. I have a much more modest aim. I would like to tackle just one issue: the 7.5 million people who are on the waiting list, suffering sometimes pain and very often distress. I will look at the reforms to the NHS in the years 2000-05 and how they were tackled. There are a number of former Ministers in the House, and they will be well aware that think tanks rarely look back with kindness and positivity at our efforts. I was therefore somewhat surprised and pleased that the King’s Fund report of 2022, Strategies to Reduce Waiting Times, was unusually positive. Indeed, it argues that some of the NHS reforms I was involved in, along with the noble Lords, Lord Crisp and Lord Warner, actually worked. That was a first, I think, for a think tank’s review of ministerial activity.

The report starts with the overall judgment that:

“The years following the NHS Plan in 2000 provide important lessons for tackling long waits … successfully”.


I suggest, therefore, that we might look at some of the levers that we used, because we have so many people waiting in pain and distress at the moment, as I said. The simple judgment of that report is important, because it means that we do not need to be fatalistic about the large number of people waiting in care. We faced the issue before, and as a nation we succeeded in solving it, so let us briefly mention the reform levers that the Government might want to consider or to enhance.

From 2002 we developed the policy of paying NHS trusts more money if they carried out more work. Put like that, it sounds very simple, but at the time it was portrayed as an extremely controversial, right-wing point of view. Ironically, that came from some of the people who naturally assumed that if they produced more at work, they would get paid more, but they felt somehow that it was wrong for NHS entities to work on that basis. They argued at the time that it would undermine the NHS. It did not. It acted as a clear incentive to do more work, and because more work got carried out, waiting lists, among other things, began to fall.

Secondly, we realised that there was no point in providing an incentive to a trust to obtain more resource by carrying out more work if at the year end the trust had to give back any surplus to the centre. That is why in 2004 we created foundation trusts, which could roll forward the resources they made and reinvest them. Again, arguing for this caused many to attack the Government at the time for being too right-wing.

Thirdly, from 2002 we started to offer patient choice to those who had been waiting for more than six months. I was told at the time, as was my predecessor Alan Milburn, that this was no use because patients did not have the knowledge, the ability or the capacity to exercise that choice. Funnily enough, of course, that too was proved wrong because, rather than wait longer, most patients chose to go somewhere other than their local hospital, despite the disadvantages of travel, because they valued the shorter time before treatment.

Fourthly, the money followed that patient choice, putting patients, not providers of healthcare, in the driving seat and rewarding those carers who best met patients’ needs and satisfactions.

Fifthly, we not only used the private sector to provide services for NHS patients but created, through the independent sector treatment centres, a new form of private sector that increased productivity by each concentrating on one form of treatment.

Taken together, those were the reforms that effectively reduced massively the waiting lists. Of course, there were extra resources. The only criticism I would make of the noble Lord, Lord Patel, is that he referred to Tony Blair’s promise of a 6% increase per annum as uncosted. It was not uncosted. We costed it—we just had not told the Chancellor. That was the controversy. As I said, with each reform there was great political controversy.

My final point is that thereafter there is a mystery, because you would assume that after the Labour Government left office, the Conservative Governments that came in consecutively would not only adopt those practices but turbocharge them. In fact they dropped them and the practices disappeared, apparently disintegrating, until last year. I pay credit to the Minister who is replying today, because he was one of those who pushed for their readoption. The lessons of those five things are very important for any future Government, and I hope they will be taken on board by a future Labour Government.

Children’s Cancer Services

Lord Reid of Cardowan Excerpts

Wednesday 20th March 2024 Lords Chamber

[Lord Markham (Con)]

Yes, and the Royal Marsden has a very good track record on that. As was explained to me on the Cambridge visit, having all those services together under one roof is a definite advantage. When the pros and cons are weighed up, that will definitely be a pro.

[Lord Reid of Cardowan (Lab)]

My Lords, the Minister will be aware by now that there is considerable doubt, controversy and concern around this decision. He has said—and we all take it in good faith—that the Secretary of State is calling this in at this stage for fact finding. When does he anticipate that such a review of the facts might be finished?

[Lord Markham (Con)]

It is only now that the facts are starting to come to us. On something as important as this, we definitely do not want to be hurried into it. Normally, I would be saying at this Dispatch Box that I want to “go, go, go”, but on something as profound as this I want to make sure that we are not hurrying into it. All noble Lords will agree that we have a very good service in operation. For instance, I looked at the Royal Marsden’s stats on speed of treatment and diagnosis, and they are excellent. I am afraid I cannot give a timetable because, quite deliberately, I want to make sure that we do not rush into any decision until we know all the facts.

NHS GP Surgeries: Purchase by US Companies

Lord Reid of Cardowan Excerpts

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

I totally agree with my noble friend. I like to think that we will take advice from whoever is best placed to give it, whether they are public sector, private sector, UK or international.

[Lord Reid of Cardowan (Lab)]

My Lords, I thank the Minister for referring to me in the context of patient choice. I am proud of that and would like to see more of it. The problem as regards GPs is that it is not just the right to choose but the ability to exercise that right that is prevented if every GP’s list of patients is so large that you cannot jump from one GP to another. The key to exercising the quality and the choice that the Minister quite correctly mentioned is to create more GPs. As long as we have a shortage of GPs, we will negate the choice of the patients.

[Lord Markham (Con)]

The noble Lord is absolutely correct that it is all about supply and the quality of that supply. That is why, again, I am pleased to say that we have a record number of GPs in training. We can learn from innovative measures. I have been looking at an advanced draft of the workforce plan. The number of doctors in the most advanced medical systems in the world—those of Japan and the US—is lower per head of population than here, but the number of nurses is higher. They have altered their staff mix to get the optimum performance, and we should be open to these innovative approaches to get the best output.

NHS Waiting Times

Lord Reid of Cardowan Excerpts

Tuesday 22nd November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord. As I have said previously, innovation, and being able to back that up with investment, is key. The House will see that we have protected a lot of the research funds so that we can do exactly that. That is the direction of travel. The new hospital programme, which I look after, is very much about looking at best practice and innovation around the world and making sure that we employ the best in our new hospitals and across all our trusts.

[Lord Reid of Cardowan (Lab)]

My Lords, the Minister is relatively new to his department, but even in the number of weeks he has been there, he must recognise that, whatever statistics on inputs he announces at the Dispatch Box, it is not working. There was a time, two decades ago, when we managed as a Government to reduce the maximum waiting time from three years to 18 weeks and the numbers on the waiting list from 1 million to 500,000. There are now 7.2 million on the waiting list—incidentally, there were 4.2 million before Covid. Whatever the Government have been doing for 10 years is not working and people are remaining in pain for prolonged periods, quite apart from the effect on the economy. Will the Minister institute an immediate review centred particularly around patient choice, which is the only thing that will drive down waiting times and waiting lists? It should never have been abandoned in the way it has been by the Government.

[Lord Markham (Con)]

I believe that customers—call them patients—should drive performance and improvements. Inputs are important, but I totally agree that in a performance culture outputs are very important. I give credit to the work done in the early 2000s, from which I have tried to learn in the short time I have been here, to really bear down and create a performance culture to get waiting lists down by holding trusts, and now the new ICB CEOs, to account. That is definitely the direction of travel, and I am very happy to learn from things that have worked well in the past.

NHS: Winter Challenges

Lord Reid of Cardowan Excerpts

Monday 10th October 2022 Lords Chamber

[Lord Markham (Con)]

I do not have the detail on the 12-hour wait-list at this moment, but I will come back to the noble Baroness with a detailed written response.

[Lord Reid of Cardowan (Lab)]

My Lords, I welcome the Minister. I am delighted that he has his position but I have to say that I do not envy him. Some months ago, I pointed out to his predecessor—who, very fortunately, is sitting next to him—that the number of people on waiting lists had increased over the past 20 years from 0.5 million, which the last Labour Government still regarded as far too high, to 4 million before Covid and 6 million when I asked the question. I asked the then Minister what the Government were doing about it. He kindly explained what they would do, but since that time the number on waiting lists has moved from 6 million to 6.8 million. Since that means that 6.8 million people are waiting in pain, trepidation and fear, will the Minister make it his highest priority to bring what business acumen he can to make sure that choice is extended to patients? It is choice for patients that will bring down the waiting lists, whether they wish to go to another NHS hospital or to a hospital in the private sector provided free at the point of need.

[Lord Markham (Con)]

I agree with those excellent points. As someone who is also responsible for the new hospital build programme, which can give that choice and make sure we have the most effective system, that is top of my agenda.

Polio

Lord Reid of Cardowan Excerpts

Thursday 23rd June 2022 Lords Chamber

[Lord Kamall (Con)]

Part of the public health message has been focused on making sure that people come forward, even before this was detected in the sewage works. One thing we saw as a result of lockdown was that some parents in some areas had not taken their young children to their doctor to have the vaccine. Let me be clear: at eight, 12 and 16 weeks, a child gets a 6-in-1 vaccine; at three years and four months, as part of the 4-in-1 preschool booster, they get it; and at 14 years they get one at school as a teenage booster. Some of those are pre school. We are encouraging people to check their red book, check their vaccination record and make sure they take their child in for their vaccine.

[Lord Reid of Cardowan (Lab)]

My Lords, one of the paradoxes of ministerial Statements on issues such as this is that the more transparent Ministers are, the more the risk that it will create a sense of concern in the public. The history of public health problems over the past 50 years gives us the knowledge that the best way to deal with these issues is the maximum transparency at the most regular and immediate opportunities. That is the way ultimately to relieve concern and I recommend it to the Minister. On a specific issue, can the Minister give a little more detail on the decline in vaccinations throughout the country, particularly in London, during the Covid pandemic? I assume that the natural concern with vaccination for Covid led to a fairly substantial decline in vaccinations for other diseases. Can he give us a little more information on that?

[Lord Kamall (Con)]

First, I thank the noble Lord for his recognition of one of the challenges of ministerial office, as he will know from his own experience. It is important that we recognise that vaccine-derived polio has the potential to spread, but it is rare and the risk to the public overall is limited. The majority of Londoners are fully protected against polio and will not need to take any more action, but the NHS will begin reaching out to parents of children under five in London who are not up to date. But we are asking for it both ways and for parents to check their records. Let us be clear that the UK is considered to be free from polio, but we recognise a potential risk given our world-leading surveillance of sewage.

On the noble Lord’s specific question, we are quite clear that people must come forward for all vaccines. Sometimes during lockdown people were unable to see a doctor or nurse in person, and the NHS is catching up with that anyway, but the NHS will keep sending the message to try to identify people who have not been vaccinated. At the same time, we are encouraging people to check their records. Let us be clear: we detected this very early in the chain, and it has perhaps come from someone who took an oral vaccine overseas and has excreted it into the system.

International Healthcare Outcomes

Lord Reid of Cardowan Excerpts

Thursday 19th May 2022 Lords Chamber

[Lord Kamall (Con)]

The Government are doing a lot on the anti-obesity strategy in conjunction with the Office for Health Improvement and Disparities. We have brought together a number of issues. We have existing actions to halve childhood obesity by 2030 with new interventions. We have invested large amounts in weight management services. However, it is not only about reducing the calories taken in but about burning off those calories and getting the right balance between activity and consumption.

[Lord Reid of Cardowan (Lab)]

My Lords, just over 20 years ago, the waiting list for operations in the National Health Service was around 1 million people. That figure was considered so horrific that there was a massive effort in finance, recruitment and restructuring which over four years reduced the waiting list to 400,000—still too high but significantly better. The waiting list is now 6.1 million people. It cannot be blamed on Covid, because even before Covid it was over 4 million. What are the Government going to do to take those people out of fear and out of pain?

On a lighter note, given the Minister’s previous concern about my spring booster jab, within three days of my birthday, I received an invite and had it two days ago, and it all went very well.

[Lord Kamall (Con)]

I appreciate the fact that the noble Lord has had his spring booster. I would love to take some credit for it, but that must go to our wonderful health and care staff and how they deal with these issues.

The noble Lord is absolutely right: the waiting list, however big, is too big. However, when we analyse the waiting list on the backlog, we see that 80% of people on it are waiting for diagnosis, not surgery. Of those waiting for surgery, 80% can be seen within a day and do not need to stay overnight. We understand the granularity of the waiting list and are taking targeted action to ensure that it is focused on needs.

NHS: Pre-pandemic Facility Levels

Lord Reid of Cardowan Excerpts

Tuesday 29th March 2022 Lords Chamber

[Lord Kamall (Con)]

My noble friend will be aware from when he was a Minister that there were other priorities in tackling Covid, trying to get a vaccine and procuring much-needed equipment. This was therefore all delayed, but we are now working with stakeholders to ensure that the updated capital strategy sets a clear direction for the system, taking into account significant events since the first publication. The multiyear settlement confirmed for 2021 allows us to take the next step forward. We expect the paper to be published at some time in 2022.

[Lord Reid of Cardowan (Lab)]

My Lords, did not the noble Lord, Lord Austin, hit the nail on the head when he said, regarding GPs, to give the patients choice? Back in the days when we reduced the waiting list from 1.1 million to just under 400,000, we reduced waiting times in hospitals from over three years down to 18 weeks. We did that primarily by giving the patients the choice to go to another hospital if they were not getting the service they needed and making the money follow the patient’s choice. Is that not the way to solve the GP problem?

[Lord Kamall (Con)]

Yes.

Covid-19: Restrictions

Lord Reid of Cardowan Excerpts

Monday 14th March 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for those questions and will try to answer them as best I can. We are now transitioning to a stage where we are able to live with Covid, and we have just announced our living with Covid strategy. At the same time, we are looking at the best way to help those who are particularly vulnerable medically or economically, who should still be entitled to free tests, for example, and issues such as affordability. We continue to monitor the new variants, the BA2 and the deltacron, and we will also continue to have the ONS surveys.

[Lord Reid of Cardowan (Lab)]

My Lords, given the fact referred to by the noble Baroness, Lady McIntosh, about the reversal of what was a very welcome decline in numbers, has any advice been given to the Government by the bodies to which the Minister referred about a further, fourth jab—another booster jab—for the elderly population? I suppose I should declare an interest.

[Lord Kamall (Con)]

I thank the noble Lord for declaring an interest. We are reviewing all scientific advice and looking at the spread and potential of new variants. Advice has been given on an additional booster, particularly for those over 75. I will not ask the noble Lord his age, but I commit to write to him.

Covid-19: Vaccination Programme

Lord Reid of Cardowan Excerpts

Wednesday 24th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, we were alert to the issue of housebound priority cohorts from the very beginning, which is why we have put in place mobile vaccine units. We work closely with community pharmacists and GPs in order to take the vaccine to housebound individuals. While we do not report on them publicly, I understand from the front line that the progress of that has gone extremely well.

The issue of areas of deprivation is really troubling. It is often those areas where the disease is most prevalent and where the vaccine rollout has been the slowest. We are working extremely hard with local community groups, faith groups, marketing experts and influencers to get the message through to the right people and to take the vaccine delivery into the right contexts.

[Lord Reid of Cardowan (Lab) [V]]

My Lords, the vaccination programme has been one bright spot in what has otherwise been a less than illustrious handling of the pandemic, but the number of daily doses administered on Monday fell significantly, week on week, for the fifth day running. Can the Minister explain why? Can he further explain the apparent discrepancy between the vaccination rate in London and other regions of the country? It appears that some regions have a rate 50% higher than London. What are the reasons for that and what is being done to narrow the gap?

[Lord Bethell (Con)]

My Lords, I do not agree with the noble Lord’s analysis. We are sometimes constrained by supply, but I am reassured that we will hit the targets that I articulated. London has a younger demographic, which is why the rollout percentages can seem lower than in other areas.