Lord Hunt of Kings Heath
To ask Her Majesty’s Government what is their response to the rejection by National Health Service Trusts of the financial tariff proposals drawn up by Monitor for 2015–16.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, we recognise the frustration and uncertainty this delay will cause providers and commissioners. My department is working closely with Monitor and NHS England to consider which option to pursue that provides the fairest settlement for different NHS organisations while ensuring that patients continue to receive the best possible care.
Lord Hunt of Kings Heath (Lab)
My Lords, I thank the noble Earl for that reply. Can he confirm that this is the first time that NHS trusts have rejected the tariff on the grounds that they can no longer provide safe and quality care and meet financial targets next year on the basis of the tariff laid down by Monitor? Can he also confirm that the finance director of the NHS Trust Development Authority told Monitor that he does not consider that the efficiency requirement for next year can be met without risking quality of care? When will the Government take responsibility for the financial disaster coming upon the NHS?
Earl Howe
My Lords, it should not cause us any surprise that, at a time of financial stringency in the NHS and increasing demand, it should have proved more difficult than usual to arrive at a settled position on the tariff. The process is undoubtedly complex and challenging but we will continue to work with and support Monitor and NHS England in managing this in a way that attempts to be as fair as possible to all parts of the system.
Baroness Barker (LD)
My Lords, given the historic underfunding of mental health services in this country, will the Government make representations to Monitor to ensure that mental health trusts are not required to make savings at the same rate as other trusts?
Baroness Howarth of Breckland (CB)
My Lords, a great deal of concern has been expressed by specialist providers, particularly in the heart field where there is a review ongoing at the moment, that there might well be a reduction in funding. That would be disastrous for services. Can the Minister reassure those groups that there will be a fair assessment in relation to specialist provision?
Earl Howe
It is the view of Monitor and NHS England that providers of specialised services should make every effort to deliver care that is both clinically appropriate and cost-effective in order to manage demand—where, after all, their clinicians have significant influence. NHS England considers the proposed rule to be warranted—this is about the 50:50 split in the tariff—because rapidly growing expenditure that exceeds population prevalence growth is unlikely to reflect efficient and effective services, which, when one thinks about it, are in patients’ best interests overall.
Baroness McIntosh of Hudnall (Lab)
Going back to the question asked by the noble Baroness, Lady Barker, I am sure the Minister will have seen recent reports showing that there is a serious shortage of mental health beds in the health service at the moment. Indeed, I believe that at one point in the very recent past there were no more than four or five available in the entirety of the UK—or certainly in England. Parity of esteem is a fine phrase, but is it really being played out in practice?
Earl Howe
My Lords, it would require a full-scale debate for me to lay out in full all the things that we are doing to promote parity of esteem in the health service. The noble Baroness is right that in certain parts of the country there has been acute pressure on bed numbers, but bed numbers have been increased in some of those areas, and NHS England is paying close attention to the need to ensure that those who need in-patient treatment receive it.
The Earl of Listowel (CB)
My Lords, will the Minister look carefully at the bureaucratic burden on clinicians? A number of clinicians have raised with me the fact that there is too heavy a burden, and that because of that burden, they are not being as efficient as they might be.
Earl Howe
My Lords, yes of course the bureaucratic nature of commissioning needs to be minimised and we do all we can to achieve that. However, the need to ensure that we make a careful distinction between commissioners and providers does, I am afraid, mean that rather a lot of numerical work has to go along with that and, as is right, discussion between commissioners and providers to ensure that the system works smoothly.
Baroness Manzoor (LD)
My Lords, Choose and Book has been a success story for the Government. It is a hidden gem. Will this be affected by the level of tariffs that are to be offered and will patients have a real choice?
Lord Harris of Haringey (Lab)
My Lords, given the appalling performance of ambulance services—certainly in London, and, I suspect, in the rest of the country—what steps are the Government taking to ensure that the tariff means that people will receive the emergency call-outs that they would expect on the basis of the funding that should be being made available?
Earl Howe
This is part and parcel of the discussions going on at the moment. There is a balance of interests here—above all, the interests of NHS patients, but within the system, the interests of those who hold the budget and the interests of those who provide the service. The risks relate, on the one hand, to affordability, and, on the other hand, to financial and service stability, and the need not to sacrifice quality in the process.
Baroness Farrington of Ribbleton (Lab)
My Lords, would the Minister care to comment on his former colleague in his department who views the reorganisation of the National Health Service as the biggest mistake this Government made? As we come towards the end of this coalition Government, some of us watch in horror as an increasing number of people within the coalition stand up and say, “It weren’t me, guv”, and, “I didn’t agree with it”. Does the Minister accept that his party, this coalition and the Liberal Democrats did not actually ask the people whether they should do this? They told them that they would not do it.
Earl Howe
My Lords, I remain a staunch defender of the 2012 Act. In this context, the 2012 Act did two things that were different. It gave responsibility for setting the tariff to an independent body instead of to the Department of Health and Ministers. I believe that that was a good thing. It also provided a statutory right, which did not exist before, for the NHS to be consulted on the tariff. I believe we should keep those two elements of the Act—as well as the rest of it.