The National Health Service (NHS) is a “national religion” but it is “in crisis” in England, a major report has warned.

A House of Lords committee states the NHS is “an iconic part of Britain’s social fabric” but flags up stark fears for the future of health and adult social care.

The report is focused on England but the authors hope it will win the attention of the devolved administrations as well as NHS staff and patients in each of the UK nations.

The Welsh Conservatives have welcomed its call for politicians to work across party divides to agree the best way forward for vital services.

Short-termism is a key problem

The peers launched a major investigation into the “long-term sustainability of the NHS and adult social care” and came away convinced that a “culture of short-termism” must be tackled.

Their report flags up concern about ageing GPs, noting that in 2015 23% of those in Wales and 20.8% of England’s were aged 55-plus.

They propose the creation of an independent Office for Health and Care Sustainability that would examine the needs the services will face in the next 15-20 years. It would investigate issues ranging from funding to skills and the changing picture of health across the population.

They also stress the need for a political consensus on the future of the health and care system, arguing this is “not only desirable” but “achievable”. The peers push for “cross-party talks” and a meaningful “national conversation”.

The authors identified “threats” which could undermine the future of the NHS, including increases in obesity and other preventable illnesses, as well as an “over-reliance” on hospitals and a “funding crisis” in English adult social care.

Welsh Conservatives pledge to consider the proposals

A spokesman for the Welsh Conservatives welcomed the report, saying: “It is clear that the NHS in Wales has for far too long suffered from a lack of long-term planning, which has negatively impacted patient care and the quality of services. No single party has a monopoly on good ideas and we would welcome cross-party cooperation in finding solutions to some of the perennial issues facing our health service.

“The report proposes some interesting ideas, which we will be considering carefully.”

The committee’s members want the NHS to remain a tax-funded health service free at the point of use but stated that in the years ahead this will require “a shift in government priorities or increases in taxation”.

They emphasised the need to “counter the endemic NHS disease of ‘short-termism’” and took successive Westminster governments to task for failing to plan ahead.

NHS staff will receive a below-inflation pay rise in the next financial year. The BMA and RCN Wales have criticised the decision.
Will taxes have to rise to sustain NHS services?

Change is vital to save the NHS

The peers stress that the NHS can be saved but not without change, stating: “Our NHS, our ‘national religion’, is in crisis and the adult social care system is on the brink of collapse. No one who listened to the evidence presented by the vast array of expert witnesses who appeared before us can be in any doubt about this. Immediate measures are indisputably needed to alleviate the situation in the short term…

“Our conclusion could not be clearer. Is the NHS and adult social care system sustainable?

“Yes, it is. Is it sustainable as it is today? No, it is not.

“Things need to change.”

Social care in England is in danger of breakdown

Highlighting a particular concern about the state of services in England, they write: “The funding crisis in adult social care is worsening to the point of imminent breakdown… Pressures in social care are the greatest external threat to the long-term sustainability of the NHS.”

They also urged ministers to consider introducing an insurance-based scheme to cover care costs, pointing to examples in Japan and Germany. These involve compulsory long-term care insurance, shared between an employer and employee on a similar model to workplace pension schemes in the UK.

Committee chairman and cross-bench peer Lord Patel gave a scathing assessment of the situation in England, saying: “There is a shocking lack of long-term strategic planning in the NHS. This short-sightedness stems from the political importance of the NHS and the temptation for politicians to reach for short-term fixes, not long-term solutions.”

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