Report of the House of Lords Committee on the Long-term Sustainability of the NHS 24 October 2017

Committee Video

As promised, here is a summary of the Long Term Sustainability of the NHS committee meeting.

Having only ever seen Prime Ministers Questions on the news, the prospect of watching a debate was not very appealing. The idea of watching people talking over each other and cajoling and being unruly isn’t my idea of fun, but I actually enjoyed watching most of it (there was a point where my attention wandered and I wasn’t following everything they were saying). The committee was made up of health professionals who were either current or previous NHS employees as well as GPs and surgeons. There were also members of the House of Lords who had medical connections. They were all very agreeable, listened to each other and actually answered questions appropriately!

Here is the background to the report.

The meeting lasted about 2 hours and I have summarised the points I found interesting and relevant. The timings I have used are approximate as I was stopping and starting the footage to write notes.

14.35 – Summary of report

The authors of the report summarised their findings by saying that all sectors of the NHS worked in a culture where only the short-term was considered – a sort of fire fighting the immediate problems. The only long-term thinking is the 5 Year Forward Plan. Here is a link to a document about the plan. Health Education England were attempting to plan longer term but were thwarted by clashes with other ministerial objectives.

The recommendation was that the 5 year plan was not sufficient.

The Government have not yet responded to the report. The reasons given were that the Election got in the way and there was an email from the Department of Health saying that a response will be given after the Budget.



They discussed the recommendation to set up an Office for Health and Care Sustainability which would look 15-20 years ahead. It would be an Independent Advisory Body which would produce evidence in data form. As this would be an independent body the public would have more confidence in its findings. The lack of long-term planning was partially because Health Ministers change quite frequently and therefore do not have the motivation to think to the future. Therefore an independent agency would be more effective as it would be non political. The body would focus on:

  1. Demographic population changes which might affect health
  2. Requirement for workforce planning
  3. Prevention


They discussed forward thinking about workforce needs. Regarding the length of time it takes to train doctors and nurses it was deemed necessary to plan ahead for what sort of skills would be needed in the future.


They discussed the role of GPs, the need for integration between Primary, Secondary and Social care and the need for change in working practices.


Current Regulation is a barrier to workforce reform and workforce planning. They discussed the need for existing staff to receive on the job training to keep up with new ideas and practices.

This part surprised me as I know a Physiotherapist who works in the Private sector. She goes for regular retraining sessions which I believe is a requirement for membership of the society.


A question was asked about the effect of Brexit on staffing levels. Figures were given about how many EU and non EU staff the NHS employs. It was agreed that the culture of relying on other countries to provide staff is wrong. An example was given that hiring staff from developing countries adversely affects their country of birth as it deprives them of medical staff which they desperately need.

Retention of staff, career structures and low morale amongst staff were also discussed and the report puts forward that these issues need to be addressed.


The training issue was broached again with two examples:

  1. A Mental Health nurse not being able to treat a wound
  2. A general nurse not being able to treat mental health patients

The conclusion was that the initial training of all staff should include basic training in disciplines other than those being specialised in

15.40 Funding

This is where I zoned out a bit, but I did understand that the current situation is that the funding of social care is with Local Government but Social Care Policy sits with the Department of Health. It was suggested that the two be brought together.

They also discussed a proposal for a Social Insurance system which would provide personal funding to be spent on social care when needed. Japan and Germany already have such a scheme in place.

16.20 Public health prevention

There is currently no central strategy for keeping people healthy. The UK is 2nd in the world league table for obesity behind the USA. It was noted that preventable diseases cost the health service a lot of money in care that could be used for other people


There was a brief discussion on a prevention strategy for mental health. It was noted that the idea that mental health being equal to physical health still had a long way to go.

The topic of Mental Health funding will be discussed on 21st November. 

16.33 Patient responsibility

The report also dealt with patient responsibility. This ties in with the area of prevention and it was deemed necessary that a mixture of Government Regulation and effective education could help to keep people healthier for longer.

I will watch out for any other items of interest, especially the Mental Health Funding discussion in November.








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