Mr. Bernard Gloster:

The worst thing I could do is come in here say that I can do all of that. I will take it back to what I said about the OECD report. The OECD reported balanced very well the fact that, even where a service puts in long-term measures like new capacity, new beds and new staff, they get overtaken by demand. Healthcare demand is only going in one direction. That is not just due to the demographics of the population. It is also modern-day ways of practising medicine and people keeping themselves healthy as opposed to just looking for services when they are unwell. All of that plays into this.

We have to reduce the dependency on third-party insourcing and make our system productive. We still have to respond to people because it is a good thing to respond to people’s waiting times. One of the most harmful things to people is not being on a waiting list, but the length of time they are on it. Therefore, we will need outsourcing for a time to come. I absolutely believe that is the case. Ultimately, the Government will give us policy direction on that and how we get there.

If we want to reduce dependency on both insourcing and outsourcing, it is not as simple as going out today and building a certain number of hospitals or beds. It is also about the ways we work. It is about elective hospitals and separating elective care from emergency care. It is about reformed, modernised care pathways, which now take a treatment from five steps to two steps. It is about ways of working, clinical innovation and all of those things, and they take time. The first thing we have to do is deal with the third-party insourcing because of the risks I listed. Those risks are too high for the public for us to keep doing it, but we have to back out of it in a sensible way.