My Lords, this is a watershed Bill at a watershed time for the National Health Service. I shall touch on a few issues but many more will come up in Committee. Before I do anything else, I offer my congratulations to Her Majesty’s Government on two dimensions. First, for the first time in my experience, Her Majesty’s Government, the NHS and the pharmaceutical industry have got together, worked endlessly and furiously—spending money, yes—and succeeded in producing vaccines that no other country has done at the same pace. That is a huge achievement. Secondly, I thank the NHS front-line staff and our new noble friend, who led them so well.
Of course there are problems. I declare an interest. My wife was phoned while at a party conference and asked to take over a practice because the doctor had disappeared. There were only about 600 or 800 patients. We scrubbed down the old butcher’s shop in Biggleswade and started up, and she built up as a full-time doctor the largest practice in east Bedfordshire. My son served in the Armed Forces as an Army doctor, so I know a little bit about that world.
The greatest thing for me as a marketing man is that, if you are going to solve the problem, you have to look at what is going wrong. I shall highlight a few areas. Frankly, the GP system today is not working. It is poor. The problem arose in 2014 when—I do not say
anything party political here—GPs were absolved from looking after patients 24 hours a day, 365 days a year. They were given the opportunity to opt out. Some 90% did so. We went on to this new system and so it has developed. It is not a good system. The worst bit of it is that, when we hit a real crisis, as we have done, we see where it has all gone wrong.
I know it is wonderful to have all these magical technical things but triage is not working. You cannot get through to a doctor. How many people have told me that as a politician? You get through to a receptionist only after you have started at number 15 or 16 in the queue. There are no home visits. My dear wife got really bad Covid. Yes, 111 came out three times, but not once did we see our GP, although we had a couple of phone calls. She is recovered and well. Did we get a home visit afterwards? No. Does anyone who is elderly get a home visit? No, hardly anyone does. Even worse, yesterday’s newspaper said that 300,000 of our citizens are housebound. Every one of those is on a GP’s list, so I hope that every GP who covers those 300,000 people will be out next week ensuring that every one of them gets a jab.
Secondly, I have gone on about medical schools. I asked a Question about them in this Chamber on 26 October 2016. The point was made that medical school places were going to go up by 25%, with an additional 1,500 of them. Yes, that happened, but it was not enough. The crunch, as I said in my supplementary question to my noble friend Lord Prior of Brampton, the then Parliamentary Under-Secretary, was this:
“Today, 56% of the intake of medical students is female.”
That was five years ago; it is worse than that now. I have nothing against that—I am quite happy with 50/50—but, as I said then,
“70% of female GPs today work part-time, and a recent survey by the King’s Fund says that 90% of all medical students in training want to work part-time.”—[Official Report, 26/10/16; col. 197.]
Given the cost of £200,000-plus to train a GP, I proposed at that point that we have a situation, as in Singapore, where you have to sign on for four or five years to work in the NHS, which has paid for your career. I was told that that was perfectly “reasonable” and that the Government would consult on four years. Nothing has happened. If Singapore can work this, why on earth can we not? Our young people, male and female, after they have been given a superb education, should give back to society for four or five years. My son in the Armed Forces had to do that, so the precedent has been set.
One area that will need to be looked at is obesity. The Government are working with the industry, which has worked with the Government before. We need to have a situation where we look closely with industry, and not at the proposals that are currently in the Bill.
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