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Commonwealth Fund Report: NHS Ranking

Volume 814: debated on Tuesday 14 September 2021


Asked by

To ask Her Majesty’s Government what assessment they have made of the report by the Commonwealth Fund Mirror, Mirror 2021: Reflecting Poorly, published on 4 August, and, in particular, the United Kingdom’s National Health Service dropping from first to fourth place in their rankings of countries’ health care systems; and what steps they intend to take as a result.

My Lords, we are very grateful to the Commonwealth Fund, based in America, for its very important report and its updated rankings. I note that the criteria in the report have changed considerably over the years. On the report’s key points, I agree that there is more that we can do on patient equity. The Government have put health inequality at the centre of their agenda, and we are working hard on implementation. On care process—the other key finding of the report—we do not recognise the report’s analysis.

Well, how convenient. The UK’s drop in rank in the Commonwealth Fund’s five-yearly research into the performance of the world’s wealthiest 11 countries’ healthcare systems from first to fourth still seems to be associated, as the noble Lord has said, with access to care and with equity. This is important because the key differences between the top-performing countries, of which we are still—just—one, and the worst performing healthcare systems, of which the USA is, by a long way, the outlier, concern universal coverage, removal of cost barriers, investment in primary care systems, reducing bureaucratic burdens and investment in social services, particularly for children and working-age adults. Can the Minister explain to the House how the announcement on social care last week and the current NHS reform Bill before Parliament will contribute to the UK’s healthcare performance and ranking in the next five years?

My Lords, the noble Baroness half answers her own question. When it comes to universal coverage, I am extremely proud of the NHS and the service that we provide to the British public. There is no other health system like it anywhere in the world. The report makes cogent points on equality, and we have put that at the centre of our agenda, and in the NHS long-term plan, the prevention Green Paper and the newly implemented Office for Health Improvement and Disparities. We are doing that work through the obesity plan, the NHS health checks, the tobacco control plan and the vaccination plan. We are highly committed to this agenda, and we are making an impact.

My Lords, of course we must protect the NHS and support social care but, given the proposed tax increase, can my noble friend the Minister explain to taxpayers on low incomes how they will know whether their money is well spent?

My Lords, we raise taxes with huge hesitation. My noble friend is entirely right to hold the system to account for delivering value for money and to question productivity, but I reassure him that we have one of the most efficient health systems in the world. The money spent by the department on behalf of taxpayers is very wisely invested, and we are extremely grateful to those in social care and the NHS for the incredibly effective way in which they go about their business.

My Lords, my noble friend Lady Thornton has asked about the key features which enhance the delivery of healthcare; I am sorry that the Minister was so dismissive of the report. We know that countries differ in how they organise healthcare, and that vulnerable groups in all societies need special attention. What measures will the Government take to ensure that children, for example, especially those identified in the Leadsom report, are given the support that they and their families need to overcome their disadvantage and to thrive?

My Lords, I pay tribute to Andrea Leadsom for her report and all those who collaborated in drafting it. The noble Baroness is entirely right that those in the first 1,000 days of their lives are the people we should focus on—that is why we commissioned the report in the first place. We have embraced many of the recommendations and we will continue to see through their implementation.

My Lords, the report points out that, although the UK is fourth overall in the rankings, we are ninth out of 11 on health outcomes. As the noble Baroness, Lady Thornton, outlined, the top three countries are particularly good at investment in preventive services and primary care, but the report also talks about wider social care, including housing, nutrition, transportation and early years services. All these investments tackle inequity and deprivation, as covered in both the Leadsom report and the Marmot report. Given the Chancellor of the Exchequer’s statement that there is no money for anything other than the NHS and social care, what are the Government proposing to do to address investment in these vital areas?

My Lords, we are investing a tremendous amount in preventive care, and I agree with the noble Baroness that this is key to the future—to better and longer lives and, on my noble friend’s point, to increasing the productivity of our healthcare system. I have already mentioned the key components of our preventive agenda and I add to that list the £325 million that we have allocated to the diagnostic fund precisely to catch disease earlier, to give people the treatments they need earlier, and to bring down the cost of our healthcare service.

My Lords, is one of the reasons for this decline the fact that we have fewer doctors per head than almost any other country in the OECD? When the Prime Minister announced 6,000 new doctors, did he know that it takes six years to train a doctor? In fact, the numbers have gone down rather than up, so what will the Minister and his colleagues do now to improve the position?

My Lords, we are grateful to GPs and doctors for the work that they do. Of course, the way to get more GPs is partly by training them, partly by retaining them, and partly by working with GPs from overseas who come and serve in the NHS. That is how we are meeting our commitments on raising the number of GPs in the NHS.

I hope my noble friend has seen recent reports from NHS doctors in the Daily Mail and elsewhere about the slowness of the NHS to embrace obvious change. Does he think that there are sufficient resources such as GPs, hospital doctors, nurses and medical equipment, to allow the new money being made available announced last week—for which, thank you—to be spent effectively, thereby lowering waiting times? I worry that it will just boost pay cheques, as we saw under a previous Administration.

My Lords, I take my noble friend’s point: there are hot spots of innovation and change in the NHS, of which we should be proud, but she is right that the NHS is a large organisation and change can be challenging. In particular, I pay tribute to the Office for Life Sciences, the Accelerated Access Collaborative and NHSX—three organisations within the NHS that are driving change. I also pay tribute to the People Plan, which is putting innovation at the centre of the culture within the NHS. I agree with my noble friend that more can be done in this area.

The report says little about the important area of services for mental health, because of a shortage of comparative data. However, a new measure has been introduced into this report for the first time, dealing with access to counselling and treatment for mental health issues. Is the Minister concerned that the data in the report shows that the UK lags behind the comparators in this important area of mental health?

My Lords, I have not studied the report’s comments on mental health but, in the broad terms in which the noble Lord describes the issue, I agree. We are very committed to improving access to mental health in this country—we have invested in it, but there is more to be done. It is an area of our health system that requires more investment, which is why we have committed more money to it.

My Lords, reference has been made to healthcare outcomes, where we are nearly at the bottom. It is rather like saying, “Everything went well but the patient died.” One of the functions of the NHS is to provide care but, because it is such a bureaucracy, there is very little competition. Can the Minister look at ways to preserve the NHS which include some sort of built-in incentive to innovate?

My Lords, I remind my noble friend that the report looks at 10 countries, so although we are at the bottom, it is bottom of a very small list. There is competition within the NHS—the 2012 Act organised that. My experience of working in healthcare, which has only been for one and a half years, is that collaboration, rather than competition, is the key to productivity. Getting diagnosis and the patient journey right requires a huge number of experts to work together and huge expertise, often in many different organisations. We are keen to use technology and modern techniques to make sure that collaboration is at the heart of the way in which the NHS works.