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International Healthcare Outcomes

Volume 822: debated on Thursday 19 May 2022


Asked by

To ask Her Majesty’s Government what assessment they have made of the report by Civitas International Health Care Outcomes Index 2022, published in April; and in particular, the factors that ranked the UK healthcare system 18th in a league table of 19 comparable countries.

I assure the noble Baroness that I am only too happy to answer the Question standing in her name.

The Government value the use of robust international comparisons to help improve and reform health services, and work closely with the OECD in compiling such statistics. The Civitas report is based on data already known to the Department of Health and Social Care, which highlights both where the NHS is world-beating as well as where it needs to improve.

My Lords, the recent Civitas report on international health outcomes does not make pretty reading, showing the UK to be the worst for stroke and heart attack survival. With the NHS and patients facing record waiting times and soaring turnover and vacancy rates in the workforce, and no corresponding social care proposals in the Queen’s Speech to alleviate pressure, will the Government finally commit to a proper workforce plan with projections of future need and a proper plan to meet those requirements?

I should refer Members to my interests. When I thought I had retired from politics a couple of years ago, I took up two posts: one as a professor of politics and international relations and the second as an academic research director of a think tank. That meant engaging with a number of think tanks across the spectrum, including Civitas—phew, I have got that off my chest.

I have always admired the noble Baroness for her diligence, particularly during the passage of the Health and Social Care Bill. Given that, I was puzzled by the premise behind the Question. It refers to the UK being ranked 18th out of 19 overall. I found no such ranking in that Civitas report when I was reading it for my homework last night.

My Lords, my noble friend asked a very specific question about workforce. We are 100,000 short of NHS staff. The last NHS workforce plan was 19 years ago in 2003 under a Labour Government. When will we have the next one?

As the noble Baroness will be aware, during the debates on the Health and Social Care Bill, we made quite clear the different approaches to the workforce strategy. Indeed, Health Education England has been asked to compile a strategy. The NHS has the people recovery task force, which involves health and well-being and is not only for retention. Also, in our recruitment, we are on track to meet our manifesto commitment of 50,000 nurses. We had over 30,000 more nurses by February 2022. We are looking at different areas, not only from the department but from the ground, bottom up.

My Lords, does the Minister think that the government target of diagnosing 75% of all cancers at stage 1 and 2 by 2028 needs revising?

When one looks at these reports, one sees that one area where the UK clearly needs to improve is on cancer. One of the great issues of this is diagnosis. As many noble Lords will know, when we look at the waiting lists and the backlog, we see that 80% of those people are waiting for diagnosis. It is essential that we tackle that. For children, the one-year survival rate has risen in recent years. We will continue to focus more on diagnosis, including community diagnosis centres.

My Lords, in discussing the various factors involved, does the Minister agree that one of the main ones is that 71% of the British people are overweight or obese? Obesity impairs the immune system and leaves patients vulnerable to all kinds of illnesses which put an enormous burden on the NHS. Does he agree that the answer is for people to buy fewer calories and put fewer calories into their mouths?

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.

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.

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.

Does my noble friend the Minister accept that, last year, the United Kingdom spent, as a percentage of GDP, a higher amount than any other country in the EU? Does he, therefore, also accept that all these internationally poor comparisons cannot be attributed to a lack of money?

My noble friend makes an important point. When you look at the Civitas report, there are a number of statistics where the UK does quite well, but they were not always highlighted. This comes back to the point that this is not only about money; it is about how you spend that money and ensure that you focus on outcomes. One thing we are looking at is better use of the money, for example by using new technology to identify the waiting list and prioritise based on need, as opposed to waiting time.

My Lords, the Civitas report shows that UK deaths from haemorrhagic strokes have increased by over a third over the last nine years, compared to an average fall of 5% elsewhere, with a stark increase in deaths from 2017 onward. This coincides with the Government’s introduction of category 1 and category 2 calls for ambulance services, and the downgrade of suspected strokes to category 2. South Western Ambulance Service figures have shown that the current ambulance wait for category 2 is now one hour and 20 minutes. Will the Government now move strokes into category 1 as a matter of urgency?

When we looked at the statistics, which clearly included data from the OECD, some were repeated from the Civitas report, which ranked the UK as quite good in some places and as needing more work in others. In 2019, the UK was ranked as having the fifth highest mortality rate out of 21 countries. Given that, in a long-term plan published in January 2019, the Government outlined commitments to improving stroke services, including better stroke rehabilitation services. Because we have a better understanding of strokes, we also have new ways of tackling the issue.

My Lords, I think everyone agrees that primary care is in disarray. I met a young general practitioner, aged 51, who was about to retire because she could not stand the pressures being placed on her. It is not simply a matter of manpower or workforce planning; it is a matter of doing something urgent now. What are the Government’s plans?

I had a meeting only a few days ago with the person responsible for primary care—a doctor herself. One of the issues we discussed is how we make more effective use of different levels of primary care. What is interesting here is that primary care has, over time, taken on some of the services that used to be provided by secondary care. At the same time, some of those primary care services are now being contracted out or delegated out to, say, pharmacists or physiotherapists, et cetera. We are looking at a solution-focused way of tackling these issues, rather than focusing on who provides the care.

My Lords, as part of a solution-focused diagnosis, NICE has recently made a recommendation to reduce the waiting list for breast cancer diagnosis by suggesting the use of magnetic diagnosis. What acceptance will the department give to this proposal from NICE?

I regularly read recommendations from NICE, as do the relevant policy officials. Yesterday, for example, I was asked to the review the NICE business plan for the next few years, so the department will review the NICE recommendations. However, if the noble Baroness will allow me, I will have to write to her on the exact details.