Localised Health Care
(10 years, 5 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Stephen Barclay (North East Cambridgeshire) (Con)
The new chief executive of the NHS was right two weeks ago to highlight the need to reshape the NHS around the priorities of patients, particularly elderly patients. As Simon Stevens pointed out:
“Two thirds of hospital patients are over retirement age.”
A solution to his challenge could be piloted in the perhaps unlikely setting of the Cambridgeshire fens, a rural area where we need clearer leadership in reshaping services in the way he articulated in that speech. Patients in North East Cambridgeshire continue to travel to hospitals for appointments that could take place in the community or even in their own homes. That would save them transport and parking costs, be less exhausting and more convenient, reduce the risk of secondary infections in hospitals and increase the likelihood that family and friends could support them throughout the pathway of their treatment.
In parallel, GPs are currently under considerable pressure in rural communities such as North East Cambridgeshire, where they are having to juggle the issues of accessibility, quality and affordability with the national challenge of rising demand, an older population and increasingly complex health needs. Yet GPs continue to undertake work that could be prevented through better use of other NHS resource, lightening our GPs’ workload and streamlining part of their workload through the use of equipment and better IT. However, too often the fractured lines of accountability in the NHS and the different tiers are getting in the way of the urgent need to localise health delivery outputs so that patients can receive treatment in the community and at home, rather than incurring journeys to hospital.
I want to start with a paradox. You may recall, Mr Speaker—perhaps with a shudder, as though it was a bad dream, rather than with the fond sigh of recalling happy memories—that the Health and Social Care Act 2012 was debated extensively in this House two years ago. However, once legislation becomes law, there is a tendency for Parliament to assume that the job is done—that it has been implemented and that therefore nothing further is required. But if we look at the variance in performance of clinical commissioning groups—and, indeed, NHS regional teams—and how the 2012 Act has been implemented, we see that much work remains to be done.
At the heart of the 2012 Act was a great advantage to patients. It was about empowering GPs and clinicians, who best understand the needs of their local community and patients, to act as informed buyers on their behalf, to drive innovation, challenge existing practice, change behaviours and shift treatment from hospitals into the community. The danger is that the great advantage of that legislation, which was debated at great length under your stewardship, Mr Speaker, has now slightly slipped from focus, as the media caravan and the political debate move on to other things. We are at risk of missing out on the central prize, which is how better to innovate and deliver things in a way that advantages patients more.
I want to share three examples of where the current delivery of patient services appears illogical. The first concerns patients suffering from the distress of cancer—you will have them in your constituency, Mr Speaker—and facing tiring journeys to hospital. I had the honour of opening at St George’s surgery in Littleport last month oncology services delivered in the community by Addenbrooke’s nurses: instead of the patients travelling to Cambridge, the nurses come to deliver those services in a more convenient and friendly setting. But where is the drive to ensure that that model is now rolled out by Hinchingbrooke nurses into Doddington, by Peterborough hospital nurses into Whittlesey, by King’s Lynn nurses into the North Cambs hospital? Where is the urgency, while cancer patients continue to make those journeys at cost—in petrol, parking, tiredness and other ways in which their needs are not met? It is time that we accelerated that change to meet the challenge that Simon Stevens has set out.
Secondly, there is intravenous therapy—the delivery of antibiotics through a drip. You will no doubt be staggered, Mr Speaker, to know that patients in Cambridgeshire are being admitted to hospital for five to seven days simply to have antibiotics three times a day, when we could train community nurses to deliver that service in the rural community. That is not only a huge waste of money but, more important, we are putting patients at risk of secondary infections in hospital, as well as providing a less convenient service for them. When some areas of the country have shifted in that way, I cannot see any reason why it has not been adopted in Fenland in north-east Cambridgeshire. It is simply illogical that we still require patients to be admitted for such a straightforward treatment.
A third area is near-patient blood testing. Again, Mr Speaker, this will no doubt be an issue that GPs in your constituency have to deal with. If someone has a suspected blood clot, they are often currently put in an ambulance and sent to hospital. Yet for just £3,000, we could have machines in GP surgeries to provide the results straight away. It would not take that many saved ambulance journeys and the cost of admissions to hospital to start to pay that back. It might be that businesses in the community would be willing to work with the GP practices to deliver that equipment, but the leadership is not accelerating the roll-out of such an approach.
Next week, supported by my local papers—the Cambs Times, Wisbech Standard, Fenland Citizen and Ely Standard—I will launch a community campaign, identifying a range of issues, such as the three I have provided a flavour of today, in respect of which patients want these services back in the community to deliver better clinical outcomes in a more cost-effective way. It seems remarkable that this holy grail, sought by the NHS, is not being grasped with the urgency it demands.
In parallel, we need to recognise that our GPs are under significant pressure. Let me flag up three areas where innovation and reform are needed. The first is health trainers, which have been proven as a means of relieving and preventing pressure on GPs. Yet in Chatteris, Doddington and Manea—areas with significant health needs—we still do not have health trainers to relieve pressure on our GPs. The Minister will know that the National Audit Office highlighted how smoking cessation and other programmes have an important role to play in addressing health inequalities among different regions.
Secondly, I am sure you will be as surprised as I was, Mr Speaker, to discover that within Cambridgeshire the area with the highest health needs is the area that gets the least money. I defy anyone, including the Minister, to explain that. It is largely down to historical reasons and the fact that the clinical commissioning group needs to reallocate funding. The Cornerstone practice in March receives just £62.50 per patient. The county average is between £75 and £80, and the highest-paid practice in Cambridgeshire receives £120. I know that the Minister faces constraints in terms of the overall budget, and of course the Government deserve credit for the fact that NHS spending in England—unlike that in Wales—has been ring-fenced, but I think that the funding allocation needs to be examined.
Finally, let me say something about a much maligned Cinderella service. At present, 65% of the children in my constituency who need mental health services must wait longer than 18 weeks. I know that, as a clinician, my hon. Friend will recognise the seriousness of that. As he will appreciate, it can lead to self-harm and even to suicide, and can damage life chances by affecting exam results, for instance. Furthermore, there are still problems relating to the handover from adolescent to adult mental care. The issue of mental health simply must be addressed if we are to tackle some of the health inequalities in North East Cambridgeshire, and, above all, if we are to meet the challenge set by Simon Stevens in relation to the reshaping of our services. I know that the Health Committee is examining mental health provision, and I hope that it will take account of the points that I have made.
The Health and Social Care Act allows us to deliver the benefits that I know my constituents want by reshaping community health care. The chief executive of the NHS has recognised the need to use levers within the service—such as the assurance role of NHS England, and the role of clinical commissioning groups—to deliver that reshaping, and my campaign next week will demonstrate that patients themselves want that to happen. I hope that the Minister will use his good offices to help the leadership to accelerate the innovation that is needed, so that community health care, which is currently languishing in the slow lane of change, can deliver the more patient-centred, localised treatment that will provide not only the best possible clinical outcomes for patients in North East Cambridgeshire, but the best possible value for money.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I pay tribute to my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay) for securing the debate and for his strong advocacy on behalf of his constituents and local patients. As he has continually reminded the House since his arrival here—I arrived at the same time—we, as a coalition Government, understand the importance of spending public money wisely and investing every possible penny in front-line patient care.
My hon. Friend raised a number of points, and I did not disagree with a word of what he said. In particular, he was right to emphasise the need for a radical transformation of the way in which we deliver care over the next five to 10 years. We need to deliver more care in the community, closer to people’s homes. It is a question not just of good health care economics, but of good patient care. It is right for people with complex care needs—people with diabetes, dementia and cancer—to be cared for as close to home as possible. That requirement is all the more acute and important in some of our more rural communities, such as my hon. Friend’s constituency in the fens.
We should bear in mind the challenge laid down by the former chief executive of the NHS and echoed by the current chief executive, Simon Stevens. We must ensure that we spend the NHS budget more wisely, and direct more money to front-line patient care. There have been real-terms increases in the budget, and, as a coalition, we are all proud of the fact that we are investing more money in the NHS even in difficult economic times. Nevertheless, we must ensure that that money is spent more wisely, and that the way in which care is delivered continues to become more efficient. We have an ageing demographic, and the effects of that are often experienced more acutely in rural areas. Our technology is continually improving, and patients rightly have rising expectations of the quality of care that they will receive. We must therefore ensure that we deliver care more effectively, and in a more patient-centred way.
To meet that challenge, more needs to be done on NHS procurement at local and national levels, as my hon. Friend highlighted. The Government support that. We need to do more in the health service to ensure that we reduce unnecessary administration and bureaucratic costs and back-office services. He highlighted that as a challenge for his local health economy.
It is crucial that we transform the way we deliver care. That means breaking down silos in Cambridgeshire and elsewhere, particularly between the hospital sector—Addenbrooke’s and Peterborough city hospital, for example—and the health care that is commissioned and delivered in the community by CCGs. That also applies to the social care sector run by the local authority. It is important that Cambridgeshire county council—my hon. Friend outlined the challenges—plays a key role in helping to transform the ways in which services are delivered. Sometimes, it will not be possible to decide whether an elderly and frail person in Cambridgeshire should receive care that is provided by social services or by the NHS. It is the same person; it is the same patient, and it is time that local authorities and the NHS dropped the silo working mentality, worked together and focused the money and attention on the patient. The better care fund that the Government are setting up will come into force next year. That will provide about £3.8 billion specifically to promote better integration of health and social care. I am sure that will be of great benefit in Cambridgeshire, including in the rural communities that my hon. Friend represents.
From an NHS perspective, there are three components to transforming the way services are delivered and to breaking down those silos. It is important we have the right leadership on the ground to deliver improvements. I know as a fellow east of England MP that we have had challenges sometimes in that regard. We need the right leaders to drive change. My hon. Friend was right to highlight that the changes under the Health and Social Care Act mean that we have clinical leadership through CCGs. That will bring benefits because decisions and resource allocations are being made by clinicians who understand where the money is best spent to improve patient care.
We also need the leadership from NHS England teams at an area level to be effective. I hope that my hon. Friend will agree that all MPs in Cambridgeshire and elsewhere need to hold those local area teams to account. We need to ensure that they are working to do their bit to support the clinical leadership on the ground at CCG level.
Hospital providers at Addenbrooke’s, Peterborough city hospital and elsewhere need to come together and work with the CCGs to deliver care. When we talk about delivering care in the community, one of the key aspects is having a work force who work across hospitals and the community—across both primary and secondary care. Far too often, a work force who work in, say, cancer services are based just in the hospital. In commissioning services, we need to recognise that the work force need to be commissioned across primary and secondary care. One example would be to have more specialist nurses in diabetes who not only work at the hospital base but are commissioned across the community. It is important to ensure that my hon. Friend’s CCGs work with the hospital provider, particularly Addenbrooke’s, a centre of international excellence, to deliver more holistic care for people with long-term conditions, and that the work force are not just based in the hospital but go out to where the patients are in the community. That is key to delivering improvements in care.
I want to highlight some of the important local issues that my hon. Friend has raised. I was pleased to hear him make the point about the St George’s surgery and that chemotherapy services are being delivered in the community. His constituents should be proud that they have a GP surgery that is delivering that sort of care in the community. Some of the sickest people, who often struggle to travel to hospitals, are being looked after close to home and receiving high-quality care in the local GP surgery. That sort of care needs to be regularly offered in the next five to 10 years in many more GP surgeries—not as an exemplar, but as a regular example of what good practice and good health care looks like. That is transforming services and delivering more care in the community. My hon. Friend should be very proud of the part he has played in helping to make that a reality, and proud of the fact that his constituents have a service many other people will be looking forward to having in the future.
We must also have the right preventive care so that people who do not need to go to hospital do not go there. My hon. Friend talked about intravenous therapy. Someone with an infection from a leg ulcer, for instance, who will need IV antibiotics could be given them in the community. Traditionally those patients have ended up in hospital not because that is the right place for them to be, but because the care in the community to provide IV antibiotic therapy was not available. That is not good for patients, nor is it good health care economics—it is expensive for the NHS. That is exactly the sort of service older people with complex care needs require, particularly in rural communities. I know my hon. Friend’s CCGs will want to prioritise that in the months ahead.
My hon. Friend highlighted the importance of having close-to-home blood testing facilities. Many older people may be on warfarin for atrial fibrillation or other medical conditions. It is important that for that, and other simple blood tests, the person is treated and looked after close to home by their general practice. In rural areas, particularly in Cambridgeshire and Suffolk, where my constituency is, the GP surgery is often the hub of care, so the more we can do to provide care in those environments and close to home, the better it will be for patients.
We will also find that more patients will turn up for their appointments. One of the major causes of non-attendance at appointments in rural areas is that frail older people struggle to get to where the care is. If that care is delivered by their GP much closer to home, that saves the health service money and makes those services much more accessible. Every general practice should be offering simple services such as blood testing and supporting patients with the management of warfarin. I am pleased my hon. Friend will be championing a campaign to make this a reality throughout Cambridgeshire.
If we are to deliver better services in the community, we must have the right training in place for our work force. We need to have a work force who have the right skills to look after people with complex care needs. Under our health care reforms, we now have Health Education England, with a £5 billion budget. At a local level there are now local education and training boards, which are responsible for delivering the right sort of training to staff in each locality. A particular priority for the local education training board in the east of England is recognising the rurality of places such as Cambridgeshire and making sure there is specialist training in dementia and other care areas that addresses the needs of rural communities and ensures that people can be treated close to home. We must have the staff with the right skills to make sure that that happens.
In that respect, there will be more specialist training for GPs in mental health and children’s health care. Much of GPs’ work load is in those areas, and it is extraordinary that in the past not all GPs have had the right training. Thanks to the changes we have made through the mandate to HEE, in future we will ensure not only that there are bespoke courses for GPs to specialise in these areas, but that the whole skill set of all GPs going through training is improved to provide better community-based care. That will bring benefits to my hon. Friend’s constituents.
My hon. Friend is right that the NHS has received real-terms increases in funding in this Parliament, and we are proud to have delivered that. Every CCG, including in Cambridgeshire, will be receiving increased funding. I can understand the frustration that perhaps the progress on changing the funding formula in accordance with the independent review findings has not been as quick as some of us representing more rural communities would have liked, but that is moving in the right direction. The funding formula is now set independently, away from political interference, and according much more to health care need rather than political drivers Ministers or others may set. We will see a funding formula that will be allocated much more in line with local health care needs, but NHS England will have an opportunity again this year to examine rurality as a factor in allocating the funding formula.
I hope my hon. Friend is reassured by some of the points I have made. More importantly, what has come from this debate is that we have seen that he is a champion for the local NHS and for local patients. In his work on the Public Accounts Committee, not only does he recognise the importance of spending taxpayers’ money wisely and putting money into front-line patient care, but he understands the long-term challenges involved in transforming care. We need much more collaboration between different GP surgeries. Local commissioners need to lead that, we need more back-office sharing to reduce costs in GP surgeries, and we need better management of estates. We recognise that many GPs are small businesses in their own right, but small businesses may need to work together in a publicly funded health service to realise economies and free up more money to deliver better patient care; and we need to invest in telehealth, telemedicine and the right technology to support people with long-term conditions at home.
We also need to ensure that the better care fund that comes into effect next year is used effectively to join up what social services do with the NHS, to focus more attention on the patient and to break down the historical silos between the NHS and social care. We also need to ensure that commissioners, involved in clinically led commissioning, drive this process. They need to challenge other commissioners to do the right thing and make sure that patients are always at the centre of what happens. That is the objective, it is what needs to happen, and I know that my hon. Friend will be championing the cause locally. The goal is there and I know that he will be at the heart of the debate locally to break down those silos and to transform radically the way care is delivered, because he cares about his local patients, and I know that his local clinical commissioning groups do too.
There will be different ways of doing things in future, but they will of course be to the benefit of patients. I am delighted that he is championing this agenda, and he can count on my full support and the support of the Government in taking it forward. Once again, I congratulate him on securing this debate and on the leadership he is showing to support his local NHS in delivering better care for patients.
Question put and agreed to.