NHS: White Paper

Debate between Earl of Onslow and Baroness Thornton

Monday 12th July 2010 Lords Chamber

[Baroness Thornton]

My Lords, I thank the Minister for repeating the Statement made in the other place. It was certainly a help to me to read the contents of the White Paper in the Daily Telegraph and in other media outlets over the weekend. However, the coalition Government must recognise that it is far from satisfactory that Parliament should be the last place to learn about matters of such importance.

In opposition, the Conservatives promised that there would be no more pointless reorganisations. The Prime Minister gave this promise to the Royal College of Nursing last year. The coalition agreement states:

“We will stop the top-down reorganisations of the NHS that have got in the way of patient care”.

However, now it is in government, the coalition proposes the biggest structural upheaval in the NHS for 60 years —for which GPs are unprepared, which NHS staff do not want and about which patients were never asked. Inevitably, my first question to the Minister is: why have the Government broken their word on this matter? The Minister will be aware that I have never said that there was not more that could be done to make the NHS better, or indeed to give more say to patients and clinicians.

In the past two weeks, there have been two sources of independent comment on the effectiveness of today’s NHS. A couple of weeks ago, the Commonwealth Fund said that the changes Labour had made had given the NHS a fantastic rating on quality, and that it was the most efficient health service in the world. I am sure that we all welcome the report published today on the survival rates for sufferers from bowel, lung and ovarian cancer. It shows huge progress and experts have said that this is due to the waiting guarantees that Labour introduced on access to cancer specialists, so that people have their cancers diagnosed early. Of course, that is another part of the system that Andrew Lansley is now wiping away. My question is: why is this great upheaval necessary when we have a health service that is providing good care to the vast majority of people and when waiting times are as low as they have ever been? Does this policy mean that there will be a grave risk that the NHS will go backwards?

This Statement is full of “coulds” and “might bes”: it is remarkably lacking in doing words. If the coalition Government had found an appalling situation, as we did in 1997, they might have had some justification for radical solutions; but this is not the case. The White Paper and the Statement talk throughout of building on the work done by the previous Administration, which is all well and good, and which I welcome, but I am very sorry that, in our view, it has led them to the wrong conclusion.

Today, the NHS is not on its knees. We saved it by investment and commitment to its values. A period of stability is needed so that energy can be focused on the financial challenges ahead and to do that it needs a confident and motivated staff to continue the development of the many services that we initiated; for example, specialist trauma services; the reconfiguration that has been necessary to deliver stroke services; the co-ordination of partnerships to make the best use of expertise for diabetic care at local level; and the investment in and the building of special expertise for kidney dialysis so that more people can look after themselves at home.

What will happen to all those services which require regional and local strategies and—a matter close to the heart of many in this House—how will the many hundreds of GP practices in London cope with the way in which TB manifests itself and spreads in London? A pan-London strategy is needed. How will a bottom-up service cope? It would be unsurprising if people conclude that this White Paper and the proposals that it contains are ideologically driven. That is why there is a betrayal of the promises that were given by the coalition. With that betrayal one also has to take a second glance at the patient voice mantra that we hear from the Secretary of State. We have to question whether that is a convenient cover for a concerted attempt to change completely the way in which healthcare is delivered in this country and is part and parcel of the determination of the Conservative Party to shrink the state. It is best to be honest about such matters and I ask the other partner in the coalition to say whether that is its view too.

Many will believe that this is tantamount to the privatisation of the commissioning function of the NHS. Will there be any restrictions on the use of the private sector to support GPs? Added to that, the Government are bringing in a series of market reforms for hospitals. The Secretary of State has previously admitted that his plans would allow hospitals to go bust. Can he confirm that if a foundation trust got into financial difficulty he would step in to protect it, or would he allow it to fail? Even more important, if all the NHS delivery is done through foundation trusts, what will that mean for patients?

Frankly, I do not believe it is good enough to conduct a huge experiment on an organisation that is delivering for its patients an improving service. The staff of the NHS do not need years of uncertainty about the future of their organisation and their jobs. The NHS needs confident, motivated staff, but today the noble Earl has opened up uncertainty for the 1.3 million people who work for it.

Let us turn to accountability for £80 billion of public expenditure. I ask the noble Earl to confirm that the Treasury also had something to say about accountability in this respect. GP practices are mostly small enterprises; they are small businesses. If, for example, another network of small businesses, such as the Federation of Newsagents, was about to be handed £80 billion of public money from the Treasury and told to spend it how it liked, I suggest there might be some small concern. We support a strong role for GPs but we have to question the wisdom of wiping away oversight and the handing over of £80 billion of public money to GPs, whether they are ready or not.

We are not alone in our concerns about this. Michael Dixon, chair of the NHS Alliance, says that only about 5 per cent of GPs are ready to take over commissioning responsibility. So what will happen to the other 95 per cent? Sir David Nicholson has judged that even the best GP practice-based commissioners are only about a three out of 10 in terms of the quality of their commissioning and that is not good enough to give them £80 billion of public money to spend. So what sound evidence does the noble Earl have that 100 per cent of GPs are ready, willing and able to commission services for the entire population?

The Statement talked of rewarding commissioners who hit outcomes. Does that mean yet more money for GPs and, if so, how much?

How many jobs do the Government expect to be lost, and how much money have they put aside for redundancy costs? What guarantees can the Minister give the House that people will not simply be paid off by the NHS to be re-employed, doing the same job, by someone else? Crucially, where is the public accountability and the accountability to Parliament? The Patients’ Association has said that nothing can replace the accountability of the ballot box. I absolutely agree, and I invite the noble Earl to join me in that support.

How will GPs be held to account for the £80 billion of public money for which they will be responsible? Chris Ham of the King’s Fund has questioned whether the independent NHS board, the world's biggest quango, will be able to hold more than 500 GP consortia to account in an effective fashion. What does it mean for the accountability to Parliament if the Government go ahead and set up the NHS board? An annual report is not sufficient. Those of us who work with a lot of voluntary organisations in the health sector know that they will not think that that is sufficient. MPs at the other end of the building will really think that that is not sufficient when they want to raise questions asked by their constituents.

[The Earl of Onslow]

My Lords, the noble Baroness has spoken for nine minutes. I thought, and it has been my experience in 30 or 40-odd years in this House, that you are supposed to ask questions concisely, not to make a 10-minute speech—because I see that she has some more pages to read.

[Baroness Thornton]

We are the Opposition, and the only Opposition here. I have asked five or six questions so far and I have more.

That leads us to look at the bureaucracy involved in the proposals. The White Paper has managed to unite progressive views in opposition to it with the unlikely figure of Melanie Phillips of the Daily Mail. She wrote:

“Oh dear. The last thing that's needed right now is yet another massive reorganisation, which may well incur even greater costs … it could mean yet more paperwork - and that GPs would be likely to demand more money for the additional responsibilities”.

Well, quite.

In my experience, PCTs are staffed with decent, hard-working public servants who care greatly about the NHS and its patients. How does the Minister think that they felt when they read the quote from a senior Department of Health source—I apologise to the House for the language—who anonymously briefed the Health Service Journal this week, and said:

“PCTs are screwed. If you’ve got shares in PCTs I think you should sell”.

Is that any way to treat staff who have served the NHS loyally? What does the Minister think about bureaucracy. The Government may find that what they think of as bureaucracy is the system for accounting for the expenditure of public money. Can the Minister tell me precisely how the replacement of 130 PCTs by more than 500 GP practices and consortia will reduce bureaucracy and paperwork?

The White Paper represents a roll of the dice that puts the NHS at risk in a giant political experiment with no consultation, no piloting and no evidence. The sadness is that the Government are taking an £80 billion gamble with the great success story that our NHS is today. Of course we welcome positive change and benefits for patients. We saved this NHS. At a stroke, this Government are removing public accountability, demoralising NHS staff at a time when we need them. For patients, it opens the door to a new era of postcode prescribing which will vary from street to street. We know that the streets and the patients who will suffer most are those whom we on this side of the House are determined to defend. We will be challenging the proposals along those lines.