Health and Social Care Budgets

Karin Smyth Excerpts

Tuesday 14th March 2017 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bailey, and also to serve on the Public Accounts Committee.

Whatever the right level of funding is, there must be agreement on what that is and, crucially, on what it can provide. In our Select Committee sittings over the past year, we have come to the conclusion that the promised programme cannot be delivered with the money available. Via the NHS mandate, which sets out each year what is expected, we know what the NHS is set to provide and what money is available. However, today is 14 March and we have not really had sight of what is mandated for next year.

The mandate is a requirement of the Health and Social Care Act 2012; it sets the direction for the NHS, helps to ensure accountability to Parliament and, crucially, sets objectives. We know from this year’s mandate that the indicative budget from April is £109,853,000 and the capital is £310 million, but it would be useful to hear from the Minister today when we can expect to see next year’s mandate.

The second crucial document in this debate is the NHS constitution, which we do not talk about enough. The constitution sets out the rights to which patients, the public and staff are entitled, including consultant-led care within 18 weeks of a referral from a GP and a specialist referral from a GP for urgent cases when it comes to suspected cancer. It sets out pledges and people’s responsibilities.

I agree that we need to involve the public much more in this debate. Waiting times will, I think, quickly start to increase. We have already seen today information from the King’s Fund on what is happening with hip operations. We will, invariably, go back to the days of the 1990s, with longer lists. Access to GPs and other professionals will continue to decrease and, largely, we will start to depend more on families and local care—not just for social care, but because of the consequences of not having well-accessed healthcare. Staff will become more demoralised and we know that morale is crucial for patient safety.

What I want to hear from the Government today, therefore, is how we are going to include the public in the trade-offs that are now necessary with the sustainability and transformation plans in local communities. How will that be done? Will Parliament start to debate the erosion of the NHS constitution and the rights that people have come to expect? Crucially, will the Minister say when—within the next two and a half weeks—we will see the mandate, so that we will know what funds are available and what they are set out to do?

Health and Social Care

Karin Smyth Excerpts

Monday 27th February 2017 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to be part of this debate among so many informed Members. Members may not realise that the debate is timely because the Public Accounts Committee, of which I am a member, published today our “Financial sustainability of the NHS” report, upon which I will base many of my comments. At the beginning of the report, we ask for an end to the years of arguing in public about the level of NHS funding and for the Department, NHS England and Downing Street to start working together in the interests of patients instead of bickering about funding levels.

I want to highlight two issues. One is about the work that has been done behind the scenes on the NHS accounts. You are a keen supporter of the work of Select Committees, Mr Speaker, but today’s debate was secured with the help of not only the Health Committee, the Public Accounts Committee and the Communities and Local Government Committee, but other contributors alongside Parliament. I thank the National Audit Office for the support that it has given to me and many other hon. Members to help us understand and interrogate this year’s accounts, including a meeting in a very quiet Portcullis House in the middle of August—perhaps when other hon. Members were on a beach somewhere. Helping Members to understand the accounts and what they mean for our constituents is an important and oft-neglected part of what the public hear about Parliament.

The NAO’s report on the accounts was unprecedented, and it is worth looking at what the Comptroller and Auditor General said about them. Several one-off actions were taken this year to bring the Department within its expenditure limit, some of which were worrying and some of which were just incredibly fortunate. Given the rigour involved in the accounts, the Department’s inability to find the extra £417 million that had been incorrectly given from the national insurance fund was quite extraordinary. There were the £100 million super-dividend from the Medicines and Healthcare Products Regulatory Agency and many central readjustments, and the capital-to-revenue transfers have been discussed. I also draw attention to the guidance that NHS providers were given by Monitor and the NHS Trust Development Authority—I use the word “guidance” carefully. That and the transaction reviews commissioned by the Department, whereby two accountancy firms undertook a review of accountancy policies and how they were adopted, happened so that provider results came out much more favourably than they perhaps would otherwise have done. Again, that demonstrates the incredible lengths that the Department and all its bodies went to this year to bring the accounts barely within the expenditure limit voted for by the House.

From whistleblowing accounts, reports from health and care conferences, the board papers that some of us read, discussions with chief executives, and reports in the specialist media, it is clear that the pressure on individuals within the service is immense, which is not good for anybody. I praise staff in all parts of the health service and the Department’s work, including clinical staff and managerial staff, of which I was proud be a part for many years, but the pressure, particularly on finance directors, to produce the right result and the right answer is deeply worrying due to the effect on safety. Only a few weeks ago we had the intervention of Sir Robert Francis, who, based on his previous work, raised concerns about clinical safety in our health service.

The international comparisons on funding have been mentioned, and they are very clear. We are probably spending the money to be like Mexico, not France or Germany. My constituents expect to be treated in the same way as their European opposites. Whatever the right level of funding is, there must be agreement on that level and, crucially, on what it can provide. Over the past year, the Public Accounts Committee has held 11 or 12 sessions on what the service has promised to deliver for the money available, which takes me to my second point.

We are now in the realm of political choices, which is our responsibility as MPs. The taxpayer, the voter and the patient are not different people; they are one and the same, and they are wise. They understand that we get what we pay for, but they have to be informed. Currently, the scrappy, ill-informed public debate and the unedifying blame game are not informing them but letting them down.

It is clear to me and to many hon. Members that the Government are not inclined to fund the service to the standards that we have become used to, that we expect, that the NHS constitution gives us the right to expect and that our European neighbours have, so the Government need to be honest about the trade-offs and choices. The STP process allows that to happen. I have listened carefully to the debate, and particularly to Conservative Members. They cheer when the Prime Minister and the Secretary of State for Health say that they have increased the money given to the NHS or that the NHS was given what it asked for, but they then make passionate pleas for their own community hospital or for the various services in their area, as is their wont.

The STPs bring into sharp focus the trade-off between finance and quality, and I define quality in terms of patient experience, clinical effectiveness and efficiency. The STPs have given us a clear trade-off between the money and the mandate, and I hope the refresh of NHS funding that we expect from the “Five Year Forward View” in March, as discussed in the Public Accounts Committee, will be clear and that the public will be able to have that information at their fingertips.

Currently, patients do not have the information, and they should. They should know where the best-run and the worst-run hospitals are. I agree with the hon. Member for Lewes (Maria Caulfield) that it is unacceptable that hospitals a few miles apart with virtually the same population are operating completely differently. Patients need to know where the outcomes are best. It is not good enough to hold that information nationally and hide it from patients, or to leave it to well-informed people to interrogate board papers, and so on, to find out the answers.

The way forward is clear: waiting times will continue to increase; we will go back to the long waiting lists of the 1990s; access to GPs and other professionals will continue to decrease; the service will become largely an emergency one; the family, where there is one, will increasingly bear the cost and responsibility of social care; and access will continue to be restricted. The Government now have to be honest not just about the costs but about access. They have to be honest that there is no more money, if there is not going to be any, and they have to be honest about what that means for expectations, particularly with regard to the NHS constitution.

I look forward to the Minister’s response.

--- Later in debate ---

[David Mowat]

The 0.7% budget for overseas aid is not being discussed here today and it is not my ministerial or my Department’s responsibility. I am proud that we are one of the few countries in the world that meets that commitment, and many of the other countries among our EU partners that have been mentioned do not make that commitment. However, I shall not be diverted any further down that road today.

We have of course had a difficult winter in the NHS. We know that A&E targets are on about 86% rather than the 95% we expect; and ambulance targets are at 60% rather than the 75% we expect. As we have heard, delayed transfers of care—not “bed blocking”—have probably doubled over the past three years. In response, I make one point that I am always keen to raise in these discussions: we do not talk enough about cancer. There are cancer metrics, and we should be proud of the fact that NHS England, is meeting seven of our eight cancer metrics. The trend is towards meeting them more easily than in the past. We have heard quite a lot this evening about how well they are doing in Scotland. In fairness, to redress the balance that we have heard about in respect of A&E, I make the point that Scotland is doing somewhat worse than we are on those cancer metrics.

[Karin Smyth]

I regret to say that it has been a disappointing response thus far. We have had a very informed debate, so we do not need to have the figures regurgitated to us as if we have not. Will the Minister address my comment that the money is what it is, but is it sufficient to deal with the programme of care and support in the NHS that has been promised? That has been the subject of the Public Accounts Committee’s report for every single month since last January. Is the money enough to do what has been promised?

[David Mowat]

The money is what we were asked to provide by NHS England’s senior management, and we provided it. At that time, the chief executive said that the Government had listened and acted. That is what we did, and that money is now available. That is not the same as saying that we do not accept that the system is under pressure in certain ways. Again, though, we talk about the money that is being spent in France and Germany. In Munich, 15 of the city’s 19 hospitals stopped taking people in over this winter. Right across the world—this is the point—there are challenges in national health systems, and we need to work to ensure that money is spent as effectively as possible. We know that £120 billion will be in our health system in 2020. What this Government have to do and what this ministerial team is doing is ensure that every penny is spent as effectively as possible.

We have talked about the five year forward view, and I accept that we are two years into it, but we know that the health system must tilt back towards community health, and the STPs are part of making that happen. We know that we need to get better than we are so far in terms of mental health and parity of esteem.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 7th February 2017 Commons Chamber

[Nicola Blackwood]

My hon. Friend has raised this difficult case with me before, and my sympathies go to his constituent. He is right that the High Court has judged that the current provisions for parental orders are discriminatory. The Government are obliged to act within a reasonable timescale, so we will be introducing a remedial order this spring. I am pressing for that to happen by May, but I am in the hands of the business managers. I shall keep the House and my hon. Friend updated.

[Karin Smyth (Bristol South) (Lab)]

6. What plans he has to ensure that the implementation of recommendations in Sir Robert Naylor’s review on the NHS estate is compatible with local sustainability and transformation plans.

[The Minister of State, Department of Health (Mr Philip Dunne)]

Sir Robert Naylor’s report on the NHS estate will be published shortly. In developing his recommendations, he has worked and engaged with leaders from across the NHS. This will ensure that his recommendations are informed by sustainability and transformation plans, and are designed to help to support their successful delivery.

[Karin Smyth]

I look forward to seeing the report, which has been due “shortly” for a while. Knowle West health park in my constituency is exactly the sort of community-based model that we should be promoting in STPs. It was established by the NHS and the council to prevent illness, to promote good health and to assist recovery after medical treatment. However, the NHS Property Services regime means that its bill has increased more than threefold—from £26,000 to £93,000. What assurances can the Government give that the Naylor report will ensure that there is co-operation on estates planning so that my constituents, who rely on the health park’s contribution to preventing ill health, can face the future with confidence?

[Mr Dunne]

We have already accepted one of Sir Robert Naylor’s recommendations ahead of the publication of his report, which is to look into bringing together NHS Property Services and other estates services in the NHS. With regard to allocations to the clinical commissioning group, the Department of Health has provided £127 million to CCGs precisely to contribute towards increases in the move towards market rents for property.

Social Care

Karin Smyth Excerpts

Wednesday 16th November 2016 Commons Chamber

[Barbara Keeley]

It is dreadful. The deficit in Greater Manchester is £1.75 billion, so the problem is the same up and down the country.

We have had six years of Government cuts to local authority budgets, and that has seen local authority spending on the care and support needs of older and disabled people fall by 11% in real terms. In fact, the number of people getting publicly funded support has plummeted: 400,000 fewer now than in 2009-10. Such facts are shocking, but behind the statistics are real issues: the impact that cuts to social care are having on the NHS, on people who need care and on unpaid family carers.

First, I will deal with the issues that the crisis in social care causes for the NHS. As the Nuffield Trust states:

“Hospitals have struggled to meet the needs of the older age group in a timely way, in both emergency departments and inpatient admissions”.

The most visible manifestation of the pressures caused by cuts to social care budgets is the rapid growth of delayed transfers of care from hospital. The September figure of over 196,000 delay days is another record—the highest figure for six years—and it comes not in winter but at the end of summer. That means for the NHS 6,700 patients stuck in hospital. The most common causes are waiting for a care home placement and waiting for a nursing home placement.

The funding that was supposed to help with these issues is the better care fund, but there is no extra funding for social care in the fund this year and only £100 million next year.

[Karin Smyth (Bristol South) (Lab)]

My hon. Friend is making an excellent speech. Does she agree that it would be useful to remind Conservative Members of the Conservative party manifesto? Page 65—I do not want anyone to struggle to find it—outlines the promise to the people concerned. It says that they would not have

“to sell their home to pay for care”,

and that there would be a cap on charges to give people “peace of mind” and protection. All that is in the Conservative party manifesto—“peace of mind” and protection “from unlimited costs”. It amounts to a cruel disservice to that generation that the Government went back on that promise just two months into this Session.

[Barbara Keeley]

It is, and I agree with my hon. Friend that care costs are just running away with themselves, making the situation much harder for people.

The bulk of the extra funding that the Government promised to social care from the better care fund comes in 2018-19 and 2019-20. We have had six years of cuts to local authority budgets, and the extra funding promised for social care is backloaded to those later years in this Parliament.

--- Later in debate ---

[Mr Hunt]

Everyone will have input into the plan, but the hon. Gentleman might want to ask his council why it is complaining about pressures on the social care system when it has refused to use the social care precept and raise extra money, which could be desperately used for social care. That would make a real difference to his constituents.

Where councils and local NHS organisations are working together, we are seeing some real financial savings that are having a big impact. For example, Northumberland has saved £5 million through integrated services with Northumbria NHS Trust, and there has been a 12% reduction in demand for residential care as a result. In Oxfordshire, where the local authorities, clinical commissioning groups and trusts are all working together, discharge delays are down 40% in six months, and those due to social care have more than halved.

[Karin Smyth]

We are having an interesting tour of various councils around the country. I referred earlier to the fact that people have been let down after the 2015 Conservative manifesto, which promised them that they would be secure in their own homes. The proposal to that effect in the Care Act 2014 was postponed because so many councils put pressure on the Government to delay. The Public Accounts Committee has been told that the proposal will be introduced in April 2020. What work is happening in the Department to ensure that that proposal will come forward so that people will be secure in their own homes?

[Mr Hunt]

We are doing work, and I would simply say that we have also delivered on that promise because we have introduced the deferred payment scheme, which means that no one will need to sell their home because of social care costs.

I will wind up now, because I know that many hon. Members want to speak. When we have local authorities and the NHS working together, what is our objective from that process? We want a seamless transition for patients between the health and social care system. We want shared electronic health records so that patients are not asked the same questions time after time. We want a single assessment system so that people are not assessed twice by different organisations trying to get different results. We want to see the pooling of budgets, we want to get rid of delayed transfers of care, and we want multidisciplinary teams. Most importantly, we want there to be a single plan for every vulnerable person, to which everyone who is involved in their care adheres. Those are the objectives.

In the face of enormous pressure, the best solution for local authorities and local NHS organisations that are finding things challenging right now is not to slow down those vital changes, but to accelerate the pace of change, so that we eliminate waste and improve patient care at the same time. Councils that do so will have the full support of the Government. I urge the House to support the Government’s amendment.

Capita Contract (Coventry)

Karin Smyth Excerpts

Tuesday 8th November 2016 Commons Chamber

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

I thank the Speaker for granting this debate. It is timely, because while the issue has been raised by local GP practices and their senior managers in Coventry, I am well aware, following a gracious call from the Minister’s office and given the presence of other hon. Friends, that the problem has a wider significance and that it has echoes in many other parts of England, at least. I thank Jane Moxon and others who came to see me—all very senior practice managers in Coventry. They alerted me what is evidently a growing problem throughout the country.

The Minister, who is aware of the situation emerging across the country, kindly asked whether she should address the wider issue, or concentrate on Coventry. The topic of the debate is the impact on patient care and the health service in Coventry of the privatisation of the thoroughly well-executed existing service for GPs in our area. The same thing is happening in other areas, however, and I will be very happy to give way to my hon. Friends. Sufficient time is available—not that I want to detain you unnecessarily, Madam Deputy Speaker, or the Minister or other Members, but if there is interest, I am sure that we can accommodate others, such as my hon. Friends the Members for Coventry South (Mr Cunningham) and for Coventry North East (Colleen Fletcher); all three Coventry Members are properly on parade this evening to take part in the debate.

The position was very simply summarised by the senior practice manager from Broomfield Park, Jane Moxon, when she came to see me. She acted as chair for the group, and still does. Warwick University is in the same position: students from the EU face the loss, absence or lateness of their patient records. Allesley Park hosted our meeting; Kevin Arnold is the practice manager there. They have all alerted me to the fact that GPs are simply unable to do their job without having their patients’ records to hand.

An excellent manual service was provided under the national health service, but the Government were taken in by the lure of apparent savings and the prospect of cutting 40% from a £1 billion bill, and they contracted the work out to Capita, of all people. Only last week, we saw what could happen in the absence of a properly thought-through privatisation programme. These contracts are gaily handed out to companies that do not have the skills, preparation or sheer commitment necessary to provide the service.

[Karin Smyth (Bristol South) (Lab)]

I am grateful to my hon. Friend for initiating this debate. I have been contacted by my GP practices in Bristol South about this issue. In a previous role, I worked in a commissioning group and I have employed GPs. The arrangements for doing that are very complex, requiring specialist local knowledge and a lot of experience. Does he agree that the decision to put the entire service out to a national tender was driven by a desire to make massive wholesale savings, and that the savings target completely ignored the service need locally? Does he also agree that we are in a very poor situation across the country? I hope that the Minister can address that point.

--- Later in debate ---

[Mr Robinson]

I entirely agree with every single word my hon. Friend says. I would add, by way of a warning, that it is not a question of trying to punish the private sector by making it pay for this. Capita has to put the necessary resources into trying to correct the problem, and that must be its first priority. Something must give in the drive for profit, the drive to cut the costs of the services and the drive to improve the services. Those are irreconcilable objectives to start with, and in rectifying them the first thing that has to go is the drive for profit. Capita must realise that when it comes to put this right, it has to put the resources behind that. Compensation for GPs is important—I do not disagree with my hon. Friend for a minute on that—but I put it secondary to the provision of resources to get the contract right. I am sure that she would agree.

One other aspect of this shows an unacceptable, unpleasant and displeasing aspect of the privatisation process. It appears—I do not know this first hand—that Capita has turned to CitySprint to deliver these things. The effect of that is that we are employing drivers with no contracts, no sickness benefits and no breaks. This continual turning of the screw downwards is leading to a low-wage, low-productivity, low-output and impoverished economy. The workforce is suffering from that and it seems to be characteristic in many areas. For the public service to be involved in that process and almost to accelerate it, tightening that screw, is unacceptable.

This is another aspect of the commitment to negotiation and to the evaluation and validation process. The Government must learn to consider the quality of the service being provided and the quality of the means by which they intend to provide that service. CitySprint does not measure up to the standards we would expect from a good public sector contractor or employer.

To return to the main theme of tonight’s debate, what do we learn from this? The Government—principally the civil service, but Ministers, too—must learn to evaluate and validate the process of contracting out services. They cannot be driven by short-term savings, which are invariably illusory, but must consider the quality of the underlying contract. That is an art that must be learned, but I think it can be.

[Karin Smyth]

My hon. Friend is being generous with his time. I do not know whether he is aware that the Public Accounts Committee recently held an evidence session on the contract awarded to UnitingCare in Cambridgeshire. Many of the issues he has rightly outlined about the scoping of such contracts and expertise within the NHS were highlighted, particularly as regards whether the expertise was there to do the sort of detailed and specialist work he mentions. Should that expertise be built back into the NHS, so that it can conduct those contracts in the spirit of good public service as opposed to yet more taxpayers’ money being spent on expensive external consultants?

[Mr Robinson]

We are ranging wide of the debate, but again I have to say that I entirely agree with my hon. Friend, and I saw something about that Public Accounts Committee hearing. That is absolutely right; the problem is getting these lessons learned by the Government. I do not know what it is; it is as if there is an institutional or cultural inhibition leading to resistance to doing the technical job properly. People can be brought in to do it, but—I think that this was my hon. Friend’s point—there is a wealth of knowledge and expertise about the health service in the NHS that needs to be released and employed. Being able to do that is the art of management.

That is my plea. Yes, we want to bash Capita tonight, but more than bashing Capita and hitting out at incompetence and inexperience in the civil service, the real point of tonight is to tell Capita it is in disgrace and needs to get this right. It is obviously a nationwide—an England-wide—problem and it is not just restricted to Coventry. Capita’s overriding No. 1 objective is to put it right. That is our message tonight: “Get your finger out, put it right. Put the resources into putting this whole problem right and do not go for the short-term solution.”

--- Later in debate ---

[Nicola Blackwood]

The hon. Lady is absolutely right to raise the impact on GP services in recent weeks and months, and I will move on to that point later.

Capita has piloted a new way to move medical records. I think that is the pilot in west Yorkshire to which the hon. Member for Stretford and Urmston referred, but it was not a pilot for the overall Capita project. Capita assures me that ultimately it will be more reliable and secure by tracking the end-to-end movement of every record. It is piloting that approach in west Yorkshire and plans to be ready to roll it out nationally in March 2017. I am aware that some GPs were left short of basic supplies as a result, including syringes, and that they have had to source those from other suppliers at their own expense. NHS England tells me that it has reimbursed practices for any costs incurred from having to buy local supplies of needles and syringes.

I know that many of the hon. Members’ GP constituents have experienced frustration with Capita’s contact centre. I share those frustrations. Capita assures me that the contact centre has improved the way it responds to urgent queries by investing in more staff, improved processes and enhanced training. Capita is confident that these measures will deliver a quality service to customers. We will monitor its progress closely, including through meetings.

[Karin Smyth]

I am listening carefully to the Minister, and it is obviously reassuring to know that Capita, NHS England and the Minister are having these conversations at a national level. In those discussions, has any consideration been given to my point about the loss of local, specialist knowledge and expertise? Is any consideration being given to putting back some of those local arrangements, given the importance of primary care to the entire system?

[Nicola Blackwood]

I shall come a little later to the problems with the existing system that meant it needed to be replaced. However, the hon. Lady’s point about the value of institutional knowledge, especially among NHS workers and personnel in other roles, is very important. They have been engaged in a lot of consultation processes as we try to put this issue right with NHS England and Capita. If the hon. Lady writes to me, I will be happy to give her more detail.

I also expect Capita to address issues with the courier service. I am aware of several steps that have been taken to ensure that all practices receive regular collections and deliveries. Both NHS England and Capita have taken steps to demonstrate that they are committed to restoring their reputation and re-establishing a quality service, and I am encouraged to see them working in partnership to do so. That said, I recognise that GPs, and ophthalmologists in particular, have suffered financial detriment as a result of late processing of payments. NHS England is working with Capita to explore what can be done to support affected stakeholders, and I have made it clear to Capita that I expect it to consider compensation as an option.

Some have suggested that the old model for provision of primary care support should be reinstated, but we must remember that it relied on localised services that did not connect with one another, with much duplication across processes. The quality of these services varied greatly—in some areas, it was outstanding; in others, it was quite poor. That was simply unsustainable. Furthermore, the system was unable to generate useful management information and so, honestly, issues such as the ones that we now face would be very unlikely to have surfaced. They would have gone unreported.

A new model, with efficient and modernised processes, is the right approach to deliver to our primary care providers the service that they deserve. The Department and I will continue to closely scrutinise Capita and NHS England as they work to resolve current problems and build a quality service that is sustainable. I acknowledge fully that there is a long way to go before the service can be considered acceptable and that Capita has much to do to earn the trust of practitioners and patients.

This is clearly a live issue. I want to be clear today: I am listening. The issue is at the top of my priority list and will remain there until I am satisfied that an efficient and effective service is being delivered that meets the needs of patients and providers.

Question put and agreed to.

A&E Departments: Winter Pressure

Karin Smyth Excerpts

Thursday 3rd November 2016 Commons Chamber

[Dr Wollaston]

I thank my hon. Friend, and I welcome him to the Health Committee. Yes, he is absolutely right that one of the initiatives that has been put forward is to look at streaming at the front door, but what we heard is that this is quite nuanced. If very senior staff are tied up seeing every single person at the front door, that can be a waste of resources. However, if the patients who are most at risk of needing admission—the sickest individuals —are identified early on and seen by the most senior doctors available, then yes, absolutely, that makes a difference.

[Karin Smyth (Bristol South) (Lab)]

I had a little smile to myself at the Minister’s response. When I was a commissioner, we often said to each other, “It’s another A&E plan—it must be winter again.” On Monday, I asked the Secretary of State about the £2.4 billion protection for general practice, and I am afraid that there was not a satisfactory answer and the money will not plug the hospital deficits. There are very severe general practice problems in south Bristol and very worrying reports about sustainability. I am looking forward to the report, but will the hon. Lady say something about the role of general practice in the winter pressures issue?

[Dr Wollaston]

We have to think of A&E winter pressures as a marker for the whole system. The hon. Lady is absolutely right and I welcome her reference to primary care, because if people cannot get an appointment in primary care, they are more likely to end up in A&E. Luton and Dunstable is now co-locating primary care so that people arriving at the front door who are more appropriately seen there can be seen directly in that setting. There is, however, another viewpoint: co-locating can sometimes end up creating demand, meaning that more people go there directly, so our report calls for better evaluation of the different models. One of the things that Luton and Dunstable does particularly well is apply evaluation at every stage to the changes it makes. The answer is complex, in that co-location may be absolutely the right thing for some systems, but not necessarily the right thing across the board. I absolutely agree with the hon. Lady that people need to have decent, timely access to primary care.

SELECT COMMITTEE ON HEALTH

Karin Smyth Excerpts

Thursday 3rd November 2016 Commons Chamber

Dr Wollaston

- Hansard - - Excerpts

I thank my hon. Friend, and I welcome him to the Health Committee. Yes, he is absolutely right that one of the initiatives that has been put forward is to look at streaming at the front door, but what we heard is that this is quite nuanced. If very senior staff are tied up seeing every single person at the front door, that can be a waste of resources. However, if the patients who are most at risk of needing admission—the sickest individuals —are identified early on and seen by the most senior doctors available, then yes, absolutely, that makes a difference.

Karin Smyth (Bristol South) (Lab)

- Hansard -

I had a little smile to myself at the Minister’s response. When I was a commissioner, we often said to each other, “It’s another A&E plan—it must be winter again.” On Monday, I asked the Secretary of State about the £2.4 billion protection for general practice, and I am afraid that there was not a satisfactory answer and the money will not plug the hospital deficits. There are very severe general practice problems in south Bristol and very worrying reports about sustainability. I am looking forward to the report, but will the hon. Lady say something about the role of general practice in the winter pressures issue?

Dr Wollaston

- Hansard - - Excerpts

We have to think of A&E winter pressures as a marker for the whole system. The hon. Lady is absolutely right and I welcome her reference to primary care, because if people cannot get an appointment in primary care, they are more likely to end up in A&E. Luton and Dunstable is now co-locating primary care so that people arriving at the front door who are more appropriately seen there can be seen directly in that setting. There is, however, another viewpoint: co-locating can sometimes end up creating demand, meaning that more people go there directly, so our report calls for better evaluation of the different models. One of the things that Luton and Dunstable does particularly well is apply evaluation at every stage to the changes it makes. The answer is complex, in that co-location may be absolutely the right thing for some systems, but not necessarily the right thing across the board. I absolutely agree with the hon. Lady that people need to have decent, timely access to primary care.

Community Pharmacies

Karin Smyth Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Dr Whitford]

I agree with the Government about looking for more services, but this is not the way to work with the profession, given that they want those in it to do more work and to work differently. Sadly, during my time in the House, we have repeatedly seen the Government not sitting down with a profession and saying, “Why not look for where savings can be made?”, but simply making a cut.

[Karin Smyth (Bristol South) (Lab)]

I was going to intervene on the Minister to follow up the point made by the Chair of the Health Committee. We are looking at bottom-up planning in England for the first time for a number of years with the sustainability and transformation plan process, so this is completely the wrong time to be making these irrational and random cuts.

[Dr Whitford]

We recently debated STPs and the potential they provide. The danger is that at the moment we are seeing finance-centred care, instead of patient-centred care. Going back to place-based planning, which is what we have kept in Scotland, where we still have health boards, means that we can look at integrating services, and pharmacies definitely need to be part of that. They have the potential to be a significant front-line player.

--- Later in debate ---

[Karin Smyth (Bristol South) (Lab)]

Madam Deputy Speaker, if you were to walk along a busy shopping street in Bedminster in my Bristol South constituency today, you would pass seven pharmacies within a mile or so. However, if you were to walk through the Knowle West estate or Hartcliffe, which are two of the most deprived wards in the country, you would see many fewer pharmacies.

I have spent time in pharmacies in Filwood Broadway and Bedminster, and like most hon. Members, I have been contacted by pharmacists and constituents who are worried about the plans. The greatest fear in my constituency, which has a relatively high density of pharmacies, is its severe problem with GP recruitment and with the sustainability of primary care. We stand to lose disproportionately from those twin concerns. As hon. Members have said, we all know the valuable role that pharmacies play in our communities. This is not just about the damage to healthcare as a result of some of the cuts, but about the impact on our wider economy in some of our most deprived areas.

Madam Deputy Speaker, if you were to wander around my constituency in two years’ time, how many pharmacies—and, crucially, which ones—would still exist? As hon. Members are aware, the NHS-wide process of sustainability and transformation planning is currently being undertaken with the aim, finally, of taking a strategic overview of the whole system. This is the first bottom-up, system-wide planning that has taken place since the disastrous Health and Social Care Act 2012. We are bringing back planning to the system, which is long overdue. This is also about saving a lot of money.

In that context, the delayed Government funding announcements on pharmacies, followed by rushed ones, are the opposite of the STP process. It shows an absence of planning, and a failure to include the vital role that the community pharmacy can play. Where is the sense, when communities need stability, in forcing through a cut of this magnitude at this time? The Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), said that earlier.

In my area, the local pharmacy committee is represented on the STP board. All the local players are working hard, collaboratively, in the best interests of patients, to find a solution to our local healthcare needs. However, as has been said by the chair of the LPC, Lisa Fisher, who runs a pharmacy at Whitchurch in my constituency, this measure is a “devastating blow”. It runs totally counter to the process that Ministers want to succeed.

The Bristol CCG reported earlier this year on the root cause of the waste of medicines, and made recommendations to address the problems in the system. The figures are eye-watering. It estimates that medicine waste amounts to £5.7 million a year in Bristol, and that we can save £2.8 million a year. It made 15 recommendations for such work, but none covers having fewer pharmacies in our community.

The Minister may stand in front of pharmacies and lament the way in which the market has produced clusters in some areas, but will a large supermarket chain housing a pharmacy decide the floor space is better utilised for a café, and will the pharmacy that does the most deliveries in areas of greatest health need and that offers the most self-care advice close? How does he know? He does not. Crucially, how will my constituents know, and how can they influence the service provided to them?

In Ministers’ minds, is any consideration being given to starting from community need, not from market forces at such a time? If they were putting forward a new model that was genuinely built on pharmacies being at the forefront of Government thinking in addressing the challenges of our healthcare system, that would be good, but they are not doing so. This is not a modernisation package, but a fig leaf. It is a missed opportunity, and that is a great shame at this time.

NHS Funding

Karin Smyth Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. Although I was not personally responsible for the decision in Corby, I am very happy to take credit for it.

[Karin Smyth (Bristol South) (Lab)]

Representatives of the Department of Health and NHS England have appeared before the Public Accounts Committee eight times so far this year. We have taken a detailed look at the Department’s accounts, following the Comptroller and Auditor General’s unprecedented explanatory note, and I am glad that the Health Committee has said that it will examine the issue further.

The Secretary of State said that prevention was better than cure. The “General Practice Forward View” refers to a £2.4 billion increase in investment by 2020. Can the Secretary of State assure us that that crucial investment in primary care will be protected and not used to plug hospital deficits?

[Mr Hunt]

It is a vitally important investment. The first speech that I made as Health Secretary after the last election was made to GPs, and I said then that we wanted to deliver an extra 5,000 doctors working in general practice. It is vital that we eliminate hospital deficits, but we are making good progress in doing so.

Community Pharmacies

Karin Smyth Excerpts

Monday 17th October 2016 Commons Chamber

[David Mowat]

The hon. Gentleman makes a good point: I should not just reach out to pharmacists at posh dinners. In the past three weeks, I have visited a number of pharmacists. I have even opened a new pharmacy. I bow to no one in my view of the value that they can add, but they agree, and I think most Members in the House agree, that the community pharmacy network must move from a model based on dispensing to a model based more on services. We are going to help pharmacies to do that, and these proposals in the round will achieve that.

[Karin Smyth (Bristol South) (Lab)]

As we have said, primary care is the cornerstone, indeed the foundation, of the NHS, and pharmacies represent a successful public-private model. This proposal does seem to be a totally counter-intuitive one. When I, on the Public Accounts Committee, questioned the chief executive of the NHS last month about the Department of Health accounts, he expressed surprise that there may be a reprieve for pharmacies, because the reality is that this is an in-year cut that is already happening; it is part of NHS England’s delivery of savings this year. Can the Minister clarify the reports over the weekend—what are the figures we are talking about? The reports were that the cuts would be £113 million in 2016-17 and £208 million in 2017-18. Are those the correct figures?

[David Mowat]

The figures to which the hon. Lady refers were announced in the consultation in December 2015. The only change since those figures were announced in that consultation in 2015 is that, because of the delay in looking at this again, the in-year saving this year is likely to be lower.