Clinical Commissioning: North Durham

Lord Beamish Excerpts

Wednesday 23rd November 2016 Westminster Hall

[Mr Kevan Jones (North Durham) (Lab)]

I congratulate my hon. Friend the Member for City of Durham (Dr Blackman-Woods) on securing the debate.

The decision of the North Durham CCG raises some fundamental questions about how the NHS is run in North Durham, and our constituents’ relationship with the NHS. As my hon. Friend described, there was no consultation of my constituents about the decision, which was taken in secret. There was no transparency at all, nor any consultation with Members of Parliament in the CCG area or any local elected officials. The decision changes the fundamental relationship of trust between a patient and their GP. My constituents have never been asked for permission for our private medical information to be passed to a private company—and neither have I or my hon. Friend. We have not been asked whether the company has our individual permissions. In many cases I do not think constituents have even been told by their GPs that the information is being passed to a private company.

What is the legal position on the giving of my private medical information, and that of my constituents, to a third party? Who is responsible for ensuring that it is secure? Do I have a right, given that it is my personal medical information, to withhold permission for it to be passed to a private third sector organisation? I certainly do not think that patients in North Durham are being told that that is happening. As my hon. Friend the Member for City of Durham said, the website does not give the impression that the information is being given to a third party.

The way the decision was taken was shameless. As my hon. Friend has already said, we met the CCG in September and there was no mention of the contract at all. I want to ask why. One of my constituents, Keith Johnson, raised concerns and the CCG responded:

“GPs have responsibility to make best use of NHS resources and need up to date evidence and advice to be able to treat patients in practice or to refer on appropriately. Unnecessary outpatient appointments are a large cost to the NHS.”

I do not think anyone would disagree, but that is the job of GPs; it is not up to a private sector organisation, or anyone else who has never seen the patient, to decide whether they should be referred to a specialist.

My concern is not just the way the decision is being implemented, but the fact that it fundamentally breaks down the trust that we all value, and the confidentiality between us and our GP. I am also concerned that the more articulate constituents and patients will insist on getting care; some others will not. There will be rationing of care, depending on people’s ability to make their case. That goes to the principle at the heart of the NHS—care being free at the point of need.

I have questions about the way the contract was let. We have had no information about how that happened. Was it by competitive tender? Did any individuals employed by the CCG have any pecuniary interest in awarding the contract? How will it be evaluated? What ability will patients have to say whether they agree with the outcomes? I challenge the North Durham CCG to publish the contract and all information and decision making about how it was awarded, because the cloak of secrecy around it is a disgrace. I also challenge it to scrap the contract and answer a basic question: why is it treating its patients with such contempt?

--- Later in debate ---

[David Mowat]

I was explaining the purpose of the policy and the fact that this referral mechanism was used widely in 2007. A King’s Fund report from 2010 sets out the pros and cons of using referral management—I suggest the hon. Lady reads it.

These things are not new. They are a mechanism by which a consultant, or a GP with a specialist interest in the area of what is being referred—there are six areas of referral in this CCG, as the hon. Lady said—has two to three days to either accept that the referral goes on to the secondary system, or to contact the GP and have a discussion about what the best alternative pathway might be. There is an appeals process if the GP does not agree with that decision.

The hon. Lady asked where else such referral management was being done across the NHS in England. It was introduced in 2007, as I said, and it is being done very commonly. It is being done in Bromley, Cambridge, Peterborough, Imperial in London, and Southampton. I saw a similar system in Tower Hamlets to the one working in her area—indeed, the GP was very proud of the way they reacted, with an email referral system, when there was every possibility of things not going ahead.

This is not rationing. It is completely wrong to say that. It was brought in by the CCG, which is GP-led. If the GPs in the CCG do not agree with it, they have the mechanism to replace the chairman of the CCG.

[Mr Kevan Jones]

I understand what the Minister is saying, but what about the patient? Where does the patient come into this? If I go to my GP and he says I need a referral, that is between me and my GP. If it was not for my hon. Friend the Member for City of Durham (Dr Blackman-Woods) or the BBC raising this, none of my constituents—or myself and my hon. Friend, who are patients of the CCG—would have known about it. Will the Minister please answer the point about the patients?

[David Mowat]

The point I was in the middle of making—which I will finish making—is that if the GPs in the CCG have difficulty with the scheme, they have the mechanism to replace the CCG chairman and therefore to not go ahead with the scheme, so the GPs in his area are presumably content with it.

[Mr Jones]

The patients are not being consulted.

[David Mowat]

The fact is that the GPs vote for the head of the CCG who has put the scheme into place. On the patient issue, which is a fair one, if the patient expresses a preference to go to a secondary or an acute hospital and have an appointment, which could typically be six to eight weeks away, of course that is part of the process, and of course the referral management schemes will take that into account.

[Mr Jones]

I am sorry, that is not the case. In North Durham, patients have not been told about it. If I went to a GP who said I needed a referral, I would not be told that. What the Minister is saying is in complete contrast to what he told me during a debate on coeliac disease a few weeks ago, in which he condemned CCGs for not consulting people before awarding contracts.

[David Mowat]

We are moving around a little bit here, but I will come to the point about consultation. The GP that the hon. Gentleman refers to is a part of a CCG that has made the decision to extend the North Tyneside pilot to North Durham. All I am saying is that those GPs are part of the CCG and that presumably the CCG is doing this because it believes the clinical out-turns are right. We have a locally driven system. I will make some progress on the benefits of this for patients.

--- Later in debate ---

[David Mowat]

I am going to talk about the About Health situation and the people who have been awarded the contract in North Durham. It is a one-year pilot that builds on the one-year scheme in North Tyneside. I think it started last month; it covers six disciplines and it does not cover urgent referrals, in particular cancer. All the national requirements for referral-to-treatment times still count in exactly the same way. The local CCG performed a risk analysis before it decided to take the scheme forward and build on what happened in North Tyneside, and the scheme is monitored.

I have been told that a very important feature is that there is a clear GP appeals process. If they are not happy with a decision that has been taken, that process can happen very quickly.

[Mr Kevan Jones]

What about the patients?

[David Mowat]

The GP represents the patients in the health system; that is the fact of the matter. If there are out-turns that are detrimental to patients, as the hon. Member for City of Durham implied, that is a serious situation and should be investigated.

About Health is CQC-regulated—with all that goes with that—in exactly the same way as a GP practice. It is staffed by NHS consultants and GPs with a particular interest. As I said, there is a two or three-day turnaround, and they have to have the same indemnity cover as everybody else. Part of what the CCG is doing is to save money—that is true. Inappropriate outpatient appointments mean that more people than necessary are working. If that can be reduced, there is a cost saving to the national health service. It is about optimising pathways.

[Mr Jones]

Will the Minister give way?

[David Mowat]

I will make a little bit more progress and let the hon. Gentleman in later.

This is about stopping inappropriate treatment; it is absolutely not about rationing. If it was about rationing, the whole referral management system would not have been first introduced by the last Labour Government. I think it is incredible that that point has not come across more strongly.

One of the concerns is that About Health is a private company. It is a private organisation that has won the contract, and the local CCG made that decision. Fair questions were asked about the confidentiality of patient records, in terms of them going across a boundary to a private company. My first point, which is an obvious one, is that GP practices are all private companies. Every partner that works in a GP practice works in a private company, in the same way that the GPs who work for About Health are working for a private company. However, all the requirements around patient confidentiality that About Health needs to make sure are in place apply in exactly the same way as they do in every other part of the national health service.

[Mr Jones]

The point about that is that I, as a patient, have not given permission for that. The way this has been done—with no consultation, which the Minister says is wrong—means that no one knows what is actually happening.

[David Mowat]

I was going to come to the point about consultation—I do not have a great deal of time left now. It is right to say there was no consultation on this, and that is because this is an administrative process change. There is no service change—

[Mr Jones]

That is absolute nonsense.

[Geraint Davies (in the Chair)]

Order.