Patient Choice

Thursday 25th May 2023 Commons Chamber

12:47

[The Secretary of State for Health and Social Care (Steve Barclay)]

May I begin by joining colleagues from across the House in paying tribute to the former hon. Member for Redditch? I entered the House at the same time as her. She was a much-loved and popular colleague. I send, as I know so many do, condolences to her family and her many friends.

With permission, Madam Deputy Speaker, I shall make a statement about the action the Government are taking to improve patient choice as a way to help reduce NHS waiting times, one of the Government’s five key priorities.

There are currently significant variations in waiting times across the country, and sometimes even within the same integrated care system. Analysis from the Patients Association suggests that improved patient choice can reduce waiting times by up to three months. When he took office last year, the Prime Minister promised to make it easier for patients to make a meaningful choice and to raise public awareness of the patient’s right to choose.

Because of the pandemic, we have an NHS waiting list of over 7.3 million. Of that number, around 80% are waiting for outpatient appointments and around 20% are waiting for operations. Greater patient choice will help us address this built up demand including, where appropriate, opening more routes for NHS patients to get treatment free at the point of access in the independent sector, provided it meets NHS costs and standards, because we should use all available capacity in tackling the pandemic backlogs. For example, for patients currently waiting for ear, nose and throat treatment in London, the wait could be up to four months shorter with another provider, or with trauma and orthopaedics in the north-west, choosing another provider in the same region could cut someone’s wait by three months.

Empowering patients to exercise their right to choose was one of the recommendations of the elective recovery taskforce, which identified it as a vital way of delivering the post-pandemic recovery. While we were addressing the 78-week backlog, analysis showed that 50% of those who were waiting more than 78 weeks for elective care were in just 11 trusts, which reinforced the opportunity offered by raising awareness of patient choice and making it easier for patients to exercise that choice in a meaningful way.

As well as cutting waiting lists, choice empowers patients to decide which aspects of the hospital service matter most to them. Patients themselves can prioritise the speed of care, alongside other factors such as distance travelled and the Care Quality Commission rating of the provider, or they may have had previous care from a consultant-led team and want to return to that team. We believe that empowering the patient is an intrinsically good thing, and we also believe that it cannot be the preserve of the groups with the sharpest elbows; it must be open to all. Research from the King’s Fund has found that

“older respondents, those with no qualifications, and those from a mixed and non-white background were more likely to value choice.”

When we combine improved patient choice with better real-time data and greater transparency, we can drive up standards. When patients know much more about how their local hospital is performing, the pressure is on poor performers to close the gap with their near neighbours, where patients are often being treated more quickly.

The case for patient choice is clear, so with the aim of improving it, we are announcing significant changes in a number of areas. The first is technology. More than 30 million people have now signed up for the NHS App, and our target is for three quarters of all adults in England to be registered by next March. The app is already giving patients an improved “front door” for NHS services, and we are continuing to build on that. When GPs make a referral, they will make a shortlist of the five most suitable providers, and patients will be able to choose from the shortlist on the app. In March we completed the work of supplying a single list of providers for these shortlists, irrespective of whether the services are commissioned locally or nationally. While the Opposition’s plan to organise waiting lists on a regional basis might look like a good idea on paper, in reality it would add an extra layer of bureaucracy, whereas national lists under this Conservative Government will empower patients to choose treatment wherever they like. For example, a patient registered in Sheffield might happily choose to receive treatment in Manchester, particularly if family members there could help with the patient’s care and recovery.

The second area of work is improving the experience of those who are already on waiting lists, so that they can obtain treatment more quickly. From October this year, patients who have waited more than 40 weeks for an appointment, or who have a decision to treat but do not have a treatment date, will be able to request a transfer to another provider with a shorter waiting list. It is our ambition to expand that offer to other groups of long waiters, progressively lowering the waiting time towards 18 weeks as fast as is clinically possible.

Our third focus is on communications. We want to increase public awareness of today’s announcement through a national campaign, with the particular aim of reaching the groups who are most likely to benefit from greater choice as well as those least likely to exercise it. We will also ensure that general practitioners, and others who refer patients for consultant-led care, are offering more patient choice and are supported with the right training and technology.

Fourthly, we will focus on transparency. Real-time information on performance will be made more transparent to patients so that they can gain a clearer understanding of the variations from place to place, which will help them to exercise informed choice. We have worked to make ratings by the Care Quality Commission available and accessible to all, and we are merging the “My Planned Care” platform with the NHS website.

The Labour party has been busy announcing initiatives that we already have under way, such as expanding the NHS App, embracing virtual wards and stopping kids from vaping, but while its members have been busy talking in England and failing to act on behalf of patients in Wales, we have been busy acting to empower patients, and today’s announcement is another example of that. We are committed to cutting NHS waiting lists, and the measures that we have announced will help us to do that—by empowering patients to gain access to faster treatment in hospitals with available capacity; by giving patients technology enabling them to exercise their right to choose, and giving them the information that will help them to make that choice; by increasing communication to raise public awareness of the right to choose; and by fostering much greater transparency and, through funding, following the patient, to encourage trusts to improve their offer to patients to better match the service offered in hospitals elsewhere.

Taken together, those measures will enable patients to access treatment more quickly and meet the Government’s priority of reducing NHS waiting lists. I commend this statement to the House.

12:55

[Wes Streeting (Ilford North) (Lab)]

I thank the Secretary of State for advance sight of his statement. I also join him in paying tribute to the late Karen Lumley and, even more important, extending condolences to her family and her many friends on both sides of the House —but particularly on the Conservative Benches—for their loss. I know that the sadness is felt very deeply throughout the Chamber.

Let me now turn to the first of today’s two statements from the Health Secretary. It seems that quantity is not matched by quality. In a week in which the Leader of the Opposition announced Labour’s plans to give patients more choice, with regional waiting lists for care and more power through the NHS App, the Conservatives’ big idea to cut waiting times is to give patients a choice that they already have. It is thanks to the last Labour Government that patients waiting for planned treatment already have a right to choose an alternative provider if they have been waiting too long.

Beneath the spin, the Health Secretary’s announcement is actually a watering down of the measures that are already in place. He says that patients will have the right to choose an alternative provider if they have been waiting longer than 40 weeks, but in 2019 the Conservatives said that they should have that right after 26 weeks—which, even then, was worse than the 18-week standard to which patients were already entitled thanks to the last Labour Government. Is it not the case that he is once again shifting the goalposts because he cannot even meet his own standards, let alone those that patients expect?

The Health Secretary concluded his statement by talking about his Government’s record. That was a bold move, because 7.3 million people— the highest number on record—are currently waiting for planned treatment in England. As usual, the Health Secretary said that that was because of the pandemic, but the figure was already at a record high before the pandemic. Behind this shocking statistic are real people, waiting, waiting, waiting in agony. It does not matter how often the Health Secretary says that the Government are committed to reducing the waiting lists; people can see with their own eyes the numbers that do not lie, which show that waiting lists are getting higher and things are getting worse, not better.

The Health Secretary’s total incompetence when it comes to preventing strike action in the NHS has inflicted untold misery on patients. So far the total number of appointments affected by NHS strikes in recent months is more than half a million, a figure that the Health Secretary called “deeply disappointing”. Well, that is something on which he and I can agree, for once, but with another round of strike action planned by junior doctors, he must surely see the risk to patient choice and waiting lists. What is his plan? Ministers blame strikes as if they were mere bystanders, but it was their refusal to speak to nurses, paramedics and junior doctors that forced them out on strike in the first place. I am afraid the Health Secretary’s warm words today are not going to cut it, when all he is doing is giving more patients more choice over where their next appointment or operation is to be cancelled because of the strikes that he and the Prime Minister have failed to prevent.

Finally, let me turn to the supermassive black hole that is at the heart of today’s announcement. I will keep on reminding the Health Secretary of this until the penny drops. It does not matter which hospital patients choose; they can only receive care on time if there are enough staff to treat them—so why are we still waiting for the NHS workforce plan that the system is crying out for? Why do we have net migration at the highest level ever, with the Government over-reliant on recruiting staff from overseas because they cannot be bothered to train home-grown talent? Where is the plan to train the doctors and nurses whom the NHS is so desperately short of? Labour has set out our plan to double medical school places and train 7,500 more doctors and 10,000 more nurses a year, which we would pay for by abolishing non-dom tax status. [Interruption.] I am afraid that Conservative Members like non-doms more than they like nurses, but the public are not with them on that. Let me once again, in the spirit of generosity, before we break for the recess, offer the Secretary of State our fully costed, fully funded plan. It is available to him—[Interruption.] Conservative Members should not laugh too much now. I wager that, before we break for the summer, the Government will finally swallow their pride and announce the doubling of medical school places. We will wait and see.

After 13 years of Conservative Government, people can see for themselves where it has landed this country and compare it with 13 years of Labour Government, which delivered the shortest waiting times and the highest patient satisfaction in history. We will offer real choice and cut waiting times, so that the NHS is there when people need it. We did it before; we will do it again. We have the ideas and we have the plan. That is why only Labour can build an NHS that is fit for the future.

[Steve Barclay]

Not since the famous 1p on income tax from the Lib Dems, which was to be spent on every issue going past like a passing bus, have we heard of money being spent in as many different ways as the non-dom money. No wonder the hon. Member for Ilford North (Wes Streeting) said it with a smile; the whole House could see how credible that proposal is.

The theme of the hon. Gentleman’s response was comparison, so I think we should compare the substance of the announcement on patient choice with the situation where Labour is in office. In Wales, patients do not have the ability to choose where they receive treatment; that right is not offered to patients. In NHS Wales, patients registered with a GP in Wales do not have a statutory right to choose at which hospital they receive treatment. We can compare what a Government in England are doing—empowering patients, giving them that choice as well as the information and technology they need to make it—with NHS Wales, run by the Labour party, which deprives patients of their choice.

I hesitate to draw the comparison with Wales, however, because another Labour Front Bencher, the hon. Member for Denton and Reddish (Andrew Gwynne), says that he does not want Labour to be judged on its record in Wales. That is slightly confusing because the leader of the Labour party, no less, says that he wants Labour in Wales to be

“a blueprint for what Labour can do across the UK”.

So they cannot even compare among themselves, never mind compare between England and Wales.

The hon. Member for Ilford North talked about strike action but seemed to skirt around the fact that the Government have reached a deal with the NHS Staff Council in relation to Agenda for Change staff—a deal that his own union, Unison, voted 74% in favour of. His own union—the union that gives him money—supported the deal. He chides us about junior doctors, but those of us who were present in the Chamber the last time heard him say that he did not support the junior doctors’ demand for 35%. When we did negotiate with them, they even increased their demand to 49%, when next year is added in, further confusing the position.

It will come as no surprise to the House to discover that people in Wales are almost twice as likely to be waiting for treatment as people in England. That is the true comparison that we are addressing. We can see that situation play through to people waiting more than 18 months. In England, we have virtually eliminated 78-week waits—at the end of March, it was under 11,000—but in Wales, it will come as no surprise to Members, the number was closer to 75,000, and of course Wales has a smaller population. So we can compare waiting times, which we in England are bringing down. We have an electives plan, we cleared virtually all the two-year waits in the summer and over 90% of the 18-month waits at the end of March, which contrasts with the situation in Wales. We are giving patients choice, enabling them to move if they want to in order to get quicker treatment elsewhere. We are on the side of patients. We can see what the Labour party is doing by its disastrous performance in Wales.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the Chair of the Select Committee.

[Steve Brine (Winchester) (Con)]

This form of patient choice has of course been available for at least 15 years; it just has not been made available to patients. Can the Secretary of State confirm that the referral management centres sitting at integrated care board level will be compelled, not asked, either to change that or to get out of the way altogether? Given that the vast majority of people on the waiting lists are already there with a specific trust, how exactly will they be given the option either to stick where they are, or to twist and exercise that choice to receive treatment sooner?

[Steve Barclay]

My hon. Friend, as ever, makes a shrewd point. Yes, the referral centres are part of this system. The key focus is on the initial GP referral and how we facilitate that with better data, transparency and tech, but the referral centres are a part of this. We want to roll it out to the 40-week waits from October, and to bring waits down to 18 weeks. There is a clear plan to achieve that wider scope, and that is what I have set out to the House today.

[Valerie Vaz (Walsall South) (Lab)]

Karen Lumley was indeed a wonderful woman. Our thoughts and prayers are with her family at this difficult time.

The statement is admirable, but how will patients have a choice if the Secretary of State does not address the workforce issue? When will he do that? When will he speak to the junior doctors?

[Steve Barclay]

As I touched on in my statement, the choice is there now; it is available right now, but only about 10% of patients exercise it. There is massive variation in the system now, with the existing workforce. We are increasing the workforce. We have made a commitment to produce a workforce plan, but the point is that there is variation within the system now. What patient choice is about is empowering patients to take advantage of it and to access treatment sooner, for example, by being willing to travel often short distances to access it.

[Greg Smith (Buckingham) (Con)]

I really do welcome the revolution in patient choice that my right hon. Friend has outlined, but as chair of the all-party parliamentary group on minimally invasive cancer therapies, it is clear to me that some cutting-edge technologies and treatments are available only in certain trusts under certain consultants. Can he confirm that, within the choice available to them, patients will be able to choose centres that provide unique treatments, rather than the universal treatments that are available everywhere?

[Steve Barclay]

Yes, I can. Part of this is allowing patients to choose according to a number of factors. Some may have had treatment previously and want to go back to a particular consultant-led team. Some may want to look at CQC ratings and other performance metrics. Some may want the convenience of not travelling—relatively small numbers say they are not willing to travel; far more are willing to do so. Patients will look at a range of factors when shaping their decision. The key is to have transparency and the technology that enables patients to take control.

[Daisy Cooper (St Albans) (LD)]

Of course we all want to see real patient choice, but for millions of people who are waiting in pain, a choice between travelling miles away or paying to go private is no choice at all. We all know that the key to unlocking millions of people from the NHS backlog is tackling the crisis in the workforce. Why on earth are we spending precious parliamentary time talking about the NHS app instead of the NHS workforce?

[Steve Barclay]

We are talking about the wider workforce. The hon. Lady mentions private capacity. This patient choice will enable people to make much better use of the independent sector and to do so free at the point of access. Given the size of the challenge of pandemic backlogs, the question is: how can we make full use of capacity across the NHS and in the independent sector?

[Dr Kieran Mullan (Crewe and Nantwich) (Con)]

The problem of variation in waiting times is symbolic of all sorts of variations across the NHS. My previous employer, the national clinic audit programme commissioner, focused on identifying and spreading good practice. Will the Minister join me to meet the programme’s CEO, Jane Ingham, to hear her insights on how to tackle this challenge, and also join me in paying tribute to her as she retires after 10 years of dedicated public service in this role?

[Steve Barclay]

I am very happy to join my hon. Friend in paying tribute to Jane Ingham, who, as he says, is retiring after 10 years in that post. She has a long history of working to improve the quality of healthcare in the NHS and it is right that we pay tribute to her. I am sure the ministerial team are keen to engage with her on lessons to be learnt from her career.

[Marsha De Cordova (Battersea) (Lab)]

The Secretary of State’s words on patient choice will ring hollow until he addresses the NHS workforce crisis. In ophthalmology, 80% of eye units do not have enough consultants to meet current demand, and 65% of eye units had to rely on locums last year. Labour has a fully funded plan for the biggest workforce expansion in NHS history. Where is his plan? He has not answered previous questions. Can he say whether this workforce plan will actually address the deficit in eye health and ophthalmology?

[Steve Barclay]

As the record shows, numbers have been increasing. There are 37,000 more doctors and 52,000 more nurses within primary care than in 2010. We have already reached our manifesto commitment on additional roles in primary care to deliver more appointments. We have repeatedly said that we will bring forward a workforce plan and we are committed to doing so shortly.

[Sir Edward Leigh (Gainsborough) (Con)]

I congratulate my right hon. Friend on promoting more choice than in the socialist republic of Wales, which is a pretty low bar, but can we go further and promote real choice by adopting two previous Conservative policies? Both would be wildly popular. The first is a patient passport, by which a patient could get a free operation on the NHS, or take the same cost to a private or charitable hospital, which would promote choice and accountability. The second is tax relief for private health insurance, which is a matter for the Chancellor, but the Secretary of State could have a quiet word with him.

[Steve Barclay]

My right hon. Friend has lobbied me on this issue a number of times, including outside the Chamber. As such a senior parliamentarian, he well knows that tax is a matter for the Chancellor, who I am sure will have noted his wider point.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his very positive statement. He referred to long waiters, the second area of work. One oft-neglected area is access to specialist in-patient services for eating disorders. My constituents in Northern Ireland do not have access to a clinic to allow them a choice between a weekly weigh-in with their GP and specialised treatment. What discussions, and practical and physical assistance, can he offer the Department of Health at the Northern Ireland Assembly to help people with eating disorders?

[Steve Barclay]

As so often, the hon. Gentleman raises an extremely important point about how we tackle the serious issue of eating disorders. As he knows, we are increasing our funding for mental health. It is a key priority in the long-term plan, which is providing an extra £2.3 billion a year. On different approaches, we are looking much more actively at our use of digital apps and platforms, which is an area that the Chancellor specifically funded in the last Budget. We are also looking at how we address mental health issues earlier, particularly for children. We are rolling out mental health support teams in schools because, obviously, early intervention has significant benefits and targeting schools is a great way to do that.

[Kit Malthouse (North West Hampshire) (Con)]

I, too, congratulate the Secretary of State on a profoundly Conservative step forward in dealing with the waiting list issue. Does he agree that the provision of greater patient choice holds out the possibility of stimulating more investment in private sector capacity, particularly for volume procedures such as hips and knees? However, the private sector, to make such heavy investments in facilities, requires long-range certainty. As waiting lists fall, will he review the threshold—the time limit—at which patients can seek private sector assistance in getting their operation done more swiftly, so that the efficiencies of the private sector can be realised for the system as a whole in the longer term?

[Steve Barclay]

My right hon. Friend raises a very good point. As he knows, there is interaction between what is and is not on the balance sheet. His point particularly relates to the roll-out of diagnostic centres. I have looked at the facility in Blackpool that is using artificial intelligence in endoscopy and picking up 20% more cases than would be seen with the human eye. We are thinking about how we use the private sector to add more capacity at scale and pace, and how it can use the latest technology. Obviously, we need to do that in a way that is compliant with Treasury rules. Ensuring there is greater capacity in the system—but doing so where it is free at the point of access to NHS patients—is an area where we have already done quite a lot. However, there is always scope to look at it afresh.

[Robbie Moore (Keighley) (Con)]

I commend my right hon. Friend for the statement, which will undoubtedly help waiting lists in my Keighley and Ilkley constituency. Can he confirm that this expansion will be available first to those who have been waiting longest?

[Steve Barclay]

I can confirm that, from October, we will roll this out to those who have been waiting more than 40 weeks, and we will look to bring down that threshold over time. We will focus first on the longest waits.

[Mr Louie French (Old Bexley and Sidcup) (Con)]

I share my right hon. Friend’s desire to increase patient choice and reduce waiting times. One way to do that in south-east London is to expand further the number of services at Queen Mary’s Hospital, Sidcup, which is an excellent modern hospital with the capacity to expand services. However, there needs to be a will within NHS leadership, especially within the new integrated care boards, to get on with doing so, particularly for community diagnostics. Will my right hon. Friend please agree to meet me to discuss further how we can improve patient choice and patient outcomes in Bexley?

[Steve Barclay]

I share my hon. Friend’s desire. As part of this announcement, payment will follow patients to incentivise trusts to take on more, which further underpins patient choice. We are actively engaged on accelerating the diagnostic centres and, as a result of ministerial intervention, we have speeded up the diagnostic centre programme. I look forward to updating the House on how many additional scans and tests will now be done this year, as opposed to the original plan for those tests to be done in 2024. I am very happy to have further discussion with him.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I normally allow a bit of movement between statements, but it seems that a change of scene and personnel is not necessary as everyone is already in place.