NHS (Public Satisfaction)

Lord Cryer Excerpts

Wednesday 30th March 2011 Westminster Hall

[John Cryer (Leyton and Wanstead) (Lab)]

I would like to thank the Speaker’s Office for selecting the subject of public satisfaction with the NHS for debate. I will focus on three pieces of research, and on the Government’s attempts to prevent information getting into the public domain, to prevent scrutiny of policy and to cut funding for future sources of information, all while failing to inform Parliament. The three surveys are “Public Perceptions of the NHS and Social Care” by Ipsos MORI from March 2010, the general lifestyle survey by the Office for National Statistics, and the British social attitudes survey by the National Centre for Social Research.

The first survey, “Public Perceptions of the NHS and Social Care” by Ipsos MORI, has been carried out every six months since 2000. It recently emerged that the latest results, from last year, were being withheld from the public domain. Ministers were accused of burying good news because the information clearly shows increasing levels of public satisfaction. On 22 March 2011, the Secretary of State was questioned about that by the Select Committee on Health, and particularly by my hon. Friend the Member for Walsall South (Valerie Vaz). The Secretary of State’s defence was that as previous surveys had not been released, he would not release the information from March 2010. The reality is that the previous data were only ever released following questions by the Opposition. From March 2007, the then Opposition stopped asking for the information, and we can only assume that that was because the level of public satisfaction was increasing, and it did not exactly serve their purpose to draw that information into the public domain.

[Mr Andrew Love (Edmonton) (Lab/Co-op)]

I want to emphasise what my hon. Friend says. I can recount a conversation I had with a local general practitioner, who told me that in the 1980s, a constituent of mine in need of a hip replacement came to see him. He could not get her a place anywhere within the health service. My constituency is deprived, and it was impossible for her or her family to get treatment privately, so she had to suffer in silence. That would not happen nowadays. My GP, who represents my constituents, told me that that has not happened to him since the early 1990s. Is that not the evidence we need to show that the health service has improved significantly in recent years?

[John Cryer]

I agree with my hon. Friend. I have had exactly the same experience. We were both elected in 1997, and when I became an MP, I regularly had people come to see me with orthopaedic problems who had been waiting for operations for two to two and a half years. Some of them were in serious pain and unable to work. In the past few years, the complaints I have been hearing are that people have not had an operation for four or six months. It is a completely different world.

[The Minister of State, Department of Health (Mr Simon Burns)]

May I put the hon. Gentleman out of his misery before we start the debate on a false premise? He is absolutely right: the previous Government did not publish the 2008, 2009 and 2010 surveys, to which he refers. It may be of interest to him to know that the 2010 report was published following a written answer by the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow) in December 2010, and placed in the Library.

[John Cryer]

If the Minister will calm down a bit, I will come to that. After the Secretary of State appeared before the Health Committee, it emerged that data until 2010 had been placed in the Library, and the results until December 2009 are on the Ipsos MORI website. I was granted this debate on 24 March and the data were released the following day, Friday 25 March, on the Department of Health website. Previously, the data had not been on the Department’s website. It might be a coincidence, but it struck me that that was a fairly good time to bury good news: it was the day before 500,000 people tramped through central London on the TUC march in opposition to the cuts. The fact that the data were not initially released is unsurprising, given that polling showed a 72% satisfaction rating. Ipsos MORI concluded in the report:

“This level of satisfaction has now been recorded for over a year…suggesting that there has been a…positive shift in the public’s perceptions of the NHS. Pride in the NHS also continues to climb and is at its highest recorded level”.

Pride in the NHS is at its highest ever recorded level—an interesting statistic. We might hear a comment from the Minister about that.

[Mr Love]

The report has some very good news about public attitudes to the NHS. Why would Government, who are in control of the NHS, not want to publish such a report?

[John Cryer]

I will leave that to the Minister to answer, because I have not finished my comments about the suppression of statistics.

My story does not end with the original survey on public perceptions of the NHS. The second of the three surveys is the general lifestyle survey, carried out every year by the ONS on behalf of Government Departments, but that has had its funding withdrawn by the NHS information centre, for reasons best known to the Government. However, Sir Michael Scholar, head of the UK Statistics Authority, has warned that the decision may break the Government’s rules on consultation. I should point out that the general lifestyle survey provides statistics on public health and does not involve NHS satisfaction rates. It produces figures, information and statistics for testing Government policy and holding Governments to account; it is important that the information be available for holding Ministers to account. If the decision to withhold funding for the general lifestyle survey stands, the information will not be available to us in future.

The Department of Health also intends to withdraw funding for health and NHS satisfaction questions in the British social attitudes survey. The survey will be familiar to many Members. It is carried out annually by the NCSR, which is a pretty respected body, both nationally and internationally. The withdrawal of funding was not announced to the House of Commons, but was leaked over the weekend to Health Policy Insight, which published an interesting editorial that condemned the decision to withdraw funding in fairly colourful language.

The British social attitudes survey charts how NHS satisfaction started at 55% in 1983, which was the year the first survey was published. That plummeted to 35% by the time the Conservative Government left office in 1997. The latest satisfaction rate is 64%, which, according to John Appleby from the King’s Fund, is the highest level of satisfaction since the survey began in 1983, and part of a continuous upward trend since 2002. He said:

“The NHS must have been doing something right to earn this extra satisfaction”.

There is also an interesting quote from the director of the Nuffield Trust, Jennifer Dixon:

“I suspect that public satisfaction will decline because the pressurised financial climate will result in staff unrest, cuts, and the spectre of rationing but also because of the relaxation of some of the process targets that the public hold dear, such as waiting times.”

She continued:

“To overload reform on top of that is the problem and to do both at the same time is very risky.”

I emphasise “very risky”.

The reason for killing off such research is fairly clear. The aim is to obscure the results of Government policies so that they cannot be exposed to the proper scrutiny that we all want, and to prevent comparisons with the records of previous Governments—Labour and Tory. If the information is not available, the records of previous Governments cannot be compared with the record of this Government.

There are a number of questions that I should like the Minister to answer. Will the “Public Perceptions of the NHS and Social Care” survey by Ipsos MORI continue to be funded and to be reported on? If it is not to be continued, will the research be replaced? The research is very detailed and heavyweight. I can provide it to the Minister, although I assume he already has it. I do not intend to imply that Ministers intend to cut funding for that research, but because of other decisions, we start to wonder whether that might be the conclusion.

The Government have decided, apparently without telling Parliament, to axe funding for two other crucial pieces of independent research: the British social attitudes survey, which I mentioned, and the general lifestyle survey, conducted by the ONS, which I also mentioned. Ministers have sneaked out the information that funding is to be cut in a fairly underhand way. Many Labour Members suspect that it is being done so that we cannot draw comparisons with previous Governments. The information will not be available to allow us to say, “Government policies were working but funding has been cut, which is having an effect on public perceptions and services.”

Public perception is crucial. My impression and that of piles of research is that public perceptions are improving and are at an all-time high, but that does not satisfy Ministers, who are engaging in the biggest reorganisation of the NHS since Nye Bevan created it in 1947. If information is in the public domain showing that the public are very happy with the NHS, particularly acute and GP treatments, it does not serve the purposes of a Government who are committed to the wholesale reorganisation of one of the most beloved institutions of British society. I look forward to what the Minister has to say.

[Several hon. Members]

rose—

--- Later in debate ---

[Tony Baldry]

I have not missed the point at all. The point being made by the hon. Member for Leyton and Wanstead is that nine out of 10 people are satisfied with their GPs, so somehow all is well with the NHS and nothing need change. If my hon. Friend the Member for Southport (John Pugh) had read the report of the Public Accounts Committee, chaired by the former Labour Minister of State, the right hon. Member for Barking (Margaret Hodge), he would know that it concludes that although the previous Government increased the amount of money going into the NHS that did not lead to greater outputs. The report makes sobering reading, and I am concerned that more parliamentary colleagues have not read it and that it has not received the attention in the House that it deserves.

[John Cryer]

The point effectively made by the hon. Member for Southport (John Pugh) is that satisfaction rates are not remaining level but climbing markedly. The British social attitudes survey shows that in 1983 satisfaction stood at 55% and plummeted to 35% in 1997. It is now up to 64%. According to Ipsos MORI, 90% of outpatients, 88% of inpatients and 81% of accident and emergency patients are satisfied—the highest levels ever recorded.

[Tony Baldry]

The hon. Gentleman, again, makes his own point in his own way. He says, and I understand him, that members of the public are satisfied with the NHS so nothing need change. I am not sure whether he has read the unanimous PAC report that was published only weeks ago, but I remind Members that it says:

“The level of hospital activity has not kept pace with the increased resources as hospitals focused on meeting national targets, but not on improving productivity, and productivity has actually fallen over the last decade…Though the increased money going into the NHS has helped to reduce waiting times, improve facilities, and deliver higher quality care, the Department promised at the same time to improve productivity. It failed and, in future, the Department needs to have a more explicit focus on improving hospital productivity if it is to deliver its ambitious savings targets without healthcare services suffering.”

[Tony Baldry]

I am sorry to hear the apologia of Opposition Members, who are confronted with concerns about what is happening in the NHS. I commend to the hon. Gentleman the National Audit Office report published on 17 December 2010, “Management of NHS hospital productivity”. The NAO has no difficulty in measuring NHS productivity, and neither does the PAC. Before Opposition Members jump up, they should remember that the Labour party left the NHS with a huge, unpaid overdraft of £60 billion. It is a staggering fact that of the £65 billion of hospital building works carried out in the 13 years of the Labour Government, only £5 billion was paid for. Despite a number of very generous private finance initiative projects, the NHS still has an overdraft and must pay for £60 billion of hospital building works. The previous Government, while they may have put more money into the NHS, saw no improvement in outcomes and have left the NHS with a substantial overdraft.

As the Chair of the Health Committee, my right hon. Friend the Member for Charnwood (Mr Dorrell), has observed, even if, as intended, the Government manage to ensure that spending on the NHS is ring-fenced and runs ahead of inflation, the NHS, in the next few years, has to become substantially more efficient in how it uses its assets, and treats and looks after patients—hence the need for reforms. Let us be clear. The reforms are about cutting bureaucracy and improving patient care and have been proposed by the coalition Government to improve the NHS and to ensure that we maintain public satisfaction and support for the NHS. We need to ensure that the Health and Social Care Bill, which is going through Parliament, delivers those reforms in the best possible way.

I have no doubt that Ministers will give proper attention to the report next week of the Health Committee and that, in due course, the Government will have regard to any constructive suggestions from the other place to ensure that the Bill is as clear and effective as possible. In any health system, however, difficult decisions have to be made about how one best utilises finite resources. However much money as a country we commit to the NHS, that money will be finite. Choices will have to be made about how that money is best spent: at one end of the spectrum, about whether and in what circumstances people get treated for varicose veins; and at the other end of the spectrum about when, and how often, major and significant, complex and expensive invasive surgery takes place. It seems to me that it makes extremely good sense for those decisions to be made in a collegiate manner, on behalf of their patients, by GPs. It seems to me to make very good sense to allow GPs, individually and collegiately, to make value judgments about the quality of services being provided by individual hospital providers for their patients.

As the hon. Member for Leyton and Wanstead made clear when introducing this debate, patients trust their GPs and I see no reason why we should not, collectively, trust GPs to commission the best available services in the NHS. Critics of the reforms have sought to present them as something that they are not. However, as the Prime Minister has made clear on a number of occasions:

“we have ruled out price competition in the NHS.”

He went gone on to make it clear that

“we must avoid cherry-picking by the private sector in the NHS.”—[Official Report, 16 March 2011; Vol. 525, c. 292.]

[John Cryer]

Will the hon. Gentleman give way?

[Tony Baldry]

I am happy to give way to the hon. Gentleman, but I would just make the observation that I suspect that quite a number of his colleagues wish to contribute to the debate, and that every time I allow an intervention it probably reduces the time that they have.

[John Cryer]

I am very grateful to the hon. Gentleman, both for giving way and for his valuable advice that I will hold dear to my heart.

May I just point out that, although the exposure to EU competition laws—he is referring indirectly to that—is not in the Bill, primary care trusts are officially regarded as state enterprises? As state enterprises, they are not exposed to EU competition law. The new consortia that will replace them, because they are not state enterprises, will be exposed to EU competition law, and will therefore expose the NHS, generally, to EU competition law. Does he support that?

[Tony Baldry]

Again, that is a slightly bizarre argument from the hon. Gentleman. There has been much talk about competition in the NHS, which is surprising as the Labour party appeared to be in favour of competition in its own election manifesto. The coalition Government have made it clear that the only competition that will exist in the NHS is competition on quality, not price. The Secretary of State could not have made that clearer in the House when he said:

“At the point when a patient exercises choice or a GP undertakes a referral, the price of providers will be the same. By extension, competition must be on the basis of quality.”—[Official Report, 16 March 2011; Vol. 525, c. 387.]

To deal with another misrepresentation, EU competition law already exists and the health reform proposals do nothing to change that. They do not, in any way, extend competition law. The Bill makes it absolutely clear that any competition can only be on quality, not on price. In any event, I find it strange that the Labour party and others suddenly seem to be coming forward to express concerns about the private sector in the NHS, when it was the previous Labour Government who, for example, in Banbury set up a privately run, privately managed, privately owned independent treatment centre and a privately managed, privately owned independent Darzi GP centre. The previous Labour Government, bizarrely, gave the private sector—because their contracting was so poor—some £250 million for operations that were never carried out. However, given that they have left the NHS with an overdraft of £60 billion, I suppose that they would consider £250 million thrown away on operations that were never actually carried out as, possibly by their standards, small change.

We have to realise, with an ageing population, more extensive treatments and new drugs becoming available, that we have to tackle bureaucracy in the NHS. We need to reform the NHS to make sure that it is as efficient and as effective as possible. We are ensuring that patients have choice—choice based on quality and from whom they receive care. There is simply no issue on this, in that the Labour Party said in its manifesto at the general election, and I am sure that the hon. Member for Leyton and Wanstead has read it:

“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality”.

We have made it absolutely clear, under the coalition Government, that the NHS will remain free at the point of need, paid for from general taxation, and be based entirely on need, not on the ability to pay. Those are fundamental principles of the NHS. They have been fundamental principles of the NHS ever since it came into being, and the coalition parties are, I am sure, determined not to undermine, in any way, any of the rights in the NHS constitution. Indeed, the coalition Government are seeking to protect the NHS, throughout the duration of the Parliament, by increasing NHS funding by £10.7 billion. A substantial number of GP groups, all over England, have volunteered as pathfinders to demonstrate how GP commissioning can work. GPs throughout Oxfordshire are coming together to form a suitable GP consortium.

Let me tell the House what is being said by those in my constituency who are involved in the GP consortium. Local GP Dr Judith Wright, who is co-ordinating the north Oxfordshire GPs, has said:

“Andrew Lansley’s proposals will give power to local GPs to decide how that budget should be spent to meet local health needs. Priorities will be decided by doctors through a process informed by patients, local authorities, public health and secondary care”.

Dr Wright went on to observe:

“I believe that GPs are best placed to be able to meet this challenge. Collectively they know the health needs of their local population. They can act as a catalyst for change. They will have a role in deciding the destination of local services and the route to get there.”

Andrew McHugh, who is the practice manager at Horsefair surgery in Banbury, observed:

“The health budget is a finite resource. Andrew Lansley’s proposals will give power to local GPs to decide how that budget is spent in order to meet local health needs. Priorities will be decided by doctors through a process informed by democratically accountable public and patient involvement. We need to be looking for innovative ways of spending the health budget wisely.”

In a recent issue of Prospect magazine, Ali Parsa pointed out that, as a nation:

“We used to spend 3 per cent of our GDP on healthcare in the 1980s…6 per cent in the 1990s, 9 per cent now and on our way to 12 per cent.”

In the current financial climate, that is unsustainable. Business as usual is not an option. We need to review what treatments are provided to ensure they are clinically effective and cost-effective—in other words, evidence-based practice. I think that Dr Judith Wright and Andrew McHugh’s comments are extremely balanced and sensible.