Managing Risk in the NHS

Debate between Lord Beamish and Frank Dobson

Wednesday 17th July 2013 Commons Chamber

[Frank Dobson (Holborn and St Pancras) (Lab)]

I do not wish to get involved in great party turmoil on this matter, but it seems to me that a characteristic of any health care system is whether it is entirely devoted to managing risk. When people are ill or injured, their lives and health are at risk, and it is also possible that any treatment they may be offered will itself be risky.

The principal problem faced by doctors, nurses and midwives is that of uncertainty, and they want to give the right diagnosis. It is statistically true, for example, that the average GP will be confronted by 1.5 patients who are suffering from meningitis in a 35-year career, yet we expect them to make the right diagnosis. It is difficult. If the GP has made the right diagnosis—I am not necessarily talking just about meningitis—we expect them to come up with the right treatment, which involves another judgment and a great deal of uncertainty. Even if the diagnosis and choice of treatment are right, it may be that the treatment will, for one reason or another, go wrong.

Nevertheless, within the national health service, most people, most of the time and in most places, get very good treatment. Over the past 15 or 16 years, there has been a big reduction in mortality in hospitals, a big improvement in people’s recovery from treatment for a serious illness, and we have been catching up with some countries that had a better record than us. Despite all the criticism, general satisfaction with the national health service remains high. If people are asked what they think of the national health service, about 60% say it is pretty good. If they are asked how the NHS treated them or a member of their family, the percentage of those who are satisfied is usually in the high 80s or low 90s. Any political party or political leader would love that sort of satisfaction rating.

People working in the NHS have very demanding jobs and they need help in doing those jobs. The first thing we must do is try not to make their lives more difficult than they are already. We should ensure, for instance, that they are not in a decrepit hospital without enough beds and that the equipment they have is reliable.

[Mr Kevan Jones]

Does my right hon. Friend agree that one of the achievements of the previous Labour Government was the capital investment we put into hospitals? In 1997, for example, the hospital in my constituency was housed in the old workhouse, and we now have a brand-new hospital thanks to Labour. That has made a difference not just to patient care but to the working environment of the people we are asking to care for those patients.

[Frank Dobson]

That is certainly the case and applies to many parts of the country, including areas represented by Government Members.

I do not think any hospital has had more money spent on it than University College hospital in my constituency, the rebuilding of which, I freely admit, was authorised when I was Secretary of State. I understand that it is the hospital in this country from which one is least likely to come out dead. It is a good place that has modern and reliable equipment and is not, generally speaking, short of staff. It is quite clear that staff shortages in parts of the country have endangered the standard of care provided.

People’s pay and conditions are also important. The Cavendish report, produced only last week by a journalist for The Daily Telegraph, Ms Cavendish, stated that she regarded the pay and conditions of large numbers of people providing services outside hospitals to people who need them as disgraceful, shocking and a condemnation of our society. She is quite right.

One thing concerns me most, however. I remember when I first became Secretary of State for Health being telephoned by a very good friend who was then a professor in the medical school at Nottingham and said—I shall have to bowdlerise this—“For Lord’s sake, leave us alone. Do not reorganise; do not distract people from their usual jobs.” That is what too many Governments have done, including this one, but I do not want to go ranting on about it.

One thing I want to talk about is not mentioned very often. It became fashionable to say that the money must follow the patient and that we did not want to hand over big lumps of money to hospitals and other parts of the health service as that did not provide the right incentives. The only trouble is that as a result NHS transaction costs went up from 4p in the pound to what is estimated now to be between 12p to 15p in the pound. That is a lot of money—about £8 billion, £9 billion or £10 billion extra, just because of the new method of funding. If we want to release funds to help people who are being treated in the health service and who want to be treated there, to provide the buildings, equipment and staff, and to encourage the staff, we must think about the money being squandered on transaction costs. Unless we do something about that, it will only get worse under the new system.

Electoral Registration and Administration Bill

Debate between Lord Beamish and Frank Dobson

Monday 25th June 2012 Commons Chamber

[Frank Dobson (Holborn and St Pancras) (Lab)]

The annual canvass has been, and for the moment still is, the principal method by which we keep the electoral register up to date and accurate, in so far as it is up to date and accurate. I do not think that anyone believes that the current situation is satisfactory, but what we want is improvement, not reduction.

My constituency is rather strange in nature, not simply because it has elected me in eight successive elections, but because it has a huge electorate. It numbered some 87,000 people at the last general election and I understand from the registration officer that the total is now 94,000 electors. That gives me 26,000 more electors than the Deputy Prime Minister and, remarkably, 26,000 more than the Parliamentary Secretary, Cabinet Office, the hon. Member for Forest of Dean (Mr Harper).

Equally different is the turnover of electors, which in my constituency is phenomenal. It has always been high, partly because of the large number of students and young people in the area. People arrive and get a job, and then they decide that they would be better off doing the same job in Lincoln, Scunthorpe or Bolton, usually because the cost of renting or buying a house would be much lower.

We have a massive turnover all the time, and the Government’s proposed housing benefit changes, which will be introduced at the same time as proposals in the Bill, will also lead to an increased movement of people—they will certainly move out of the area, but I am not sure whether they will come in—so the coalition’s social cleansing policies will have an effect on the need for the canvass. The Prime Minister’s latest essay—he wants to knock off housing benefit given to anyone under 25—is also likely to increase turnover in my area.

It is worth reporting that, last year, for the whole of Camden, the annual canvass added 27,000 electors, but also deducted 27,000 electors, which reflects the massive turnover in both my constituency and the Hampstead and Kilburn constituency. It also indicates that the annual canvass is important from the point of view not just of numbers, but of accuracy—it is the principal means by which people who are no longer entitled to vote disappear off the register. The Government and some outside the House who are fanatical about their proposals seem to ignore that.

The annual canvass is the bedrock of the current system—it is not peripheral; it is at the heart of it. Any other means that the Government propose to improve electoral registration, both so that the 6 million people who are entitled to be on the register get on it, and so that the register is accurate, must be introduced only to augment the annual canvass. The canvass still does an important task, and is likely—this is my opinion, and no more—to carry it out more effectively than the proposals.

It seems totally improper to suggest that the annual canvass could disappear before we know the overall effects of all the new changes. Even if the Opposition have tabled no amendment to that effect in Committee, we should perhaps table one on Report. I would hope all hon. Members agree that an annual canvass must be carried out if the numbers come down as a result of the changes, and that we cannot accept a reduction in the number of people on the registers.

Government Members have once or twice quoted judges who have said that registration is currently like something we might find in a banana republic. I suspect that most banana republics would like to give a Minister, without parliamentary approval, the right to end an annual canvass. Nothing should be left to the Minister’s discretion. If anything, the decision should come straight to the House from the Electoral Commission.

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

Any hon. Member who has played the role of election observer in different parts of the world will know that electoral observation organisations apply themselves to one key thing: ensuring the accuracy of the electoral register. As my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) said, the canvass is an integral part of the electoral system, not only to ensure that there is no fraud—cases in certain communities have been highlighted—but to ensure that the register is as accurate and up to date as possible. As an ex-local councillor and an MP, I think it would give the person elected at a local council or other election confidence if they knew that the majority of electors were registered to vote. I accept that the annual canvass is more difficult to undertake in certain parts of the country than in others, but it will concentrate people’s minds on ensuring that they are on the electoral register.

Finance Bill

Debate between Lord Beamish and Frank Dobson

Tuesday 28th June 2011 Commons Chamber

[Frank Dobson]

Let us turn to a bit of history. When the previous scheme was introduced, neither the Department of Health nor the Treasury made any calculation whatever of what it would cost the taxpayer. It was a decision flying blind—[Interruption.] I notice the Financial Secretary looking to the Box, but if those in the Box give him an honest answer, he will have to confirm that the Treasury made no calculation of the cost of introducing the scheme originally and neither did the Department of Health. When I had the scheme abolished, I found it very difficult to discover how much it had cost. It took the Treasury quite a bit of time, too, because it had not logged the effect of the scheme—which it introduced.

The proposition is that, if people have private health insurance, they will not place any demands on the national health service. First, however, they would get the tax concession most of the time, but, during the years—one would hope that there were many of them—when they did not need any health care at all from anybody, they would not be relieving demand on the national health service because they would not have any demand to supply.

Secondly, as my hon. Friend the Member for North Durham (Mr Jones) has already pointed out, large numbers of people—certainly if they have a difficult or complex operation—do not resort to their private health insurance, because private providers are not up to providing them with the quality of care that is needed, so they resort to the national health service.

I remember a proposal to build a private hospital on the Odeon site on Tottenham Court road, and the brochure that the projectors of this brilliant scheme provided had a paragraph that can be summarised as stating, “It doesn’t matter if anything goes wrong in our private hospital, because you’ll be next door to the world-famous University College hospital, so you’ll be transferred there and then you’ll be okay.” Almost all intensive care is provided in the national health service; private sector providers do not generally provide it, so when things go wrong people are shifted.

[Mr Kevan Jones]

Does my right hon. Friend agree that, if we wanted to move to the market-led initiative that some Government Back Benchers have put forward, we would find that private hospitals had to train all the nurses and doctors whom they currently get through state-subsidy and training in the NHS?

[Frank Dobson]

The private sector creams off the straightforward, relatively simple and less risky operations for people who are otherwise healthy, leaving the national health service to provide similar operations for people who are unhealthy, which can be much more complex. For instance, if someone needs their hip joint replaced, and they are okay apart from their bad hip, that is fairly straightforward, but, if they have a dickey heart or something wrong with a kidney, it is altogether more complex, and you can bet your boots that that operation will take place in an NHS hospital. Similarly, an NHS hospital will provide intensive care, accident and emergency care and emergency beds, and it will carry out the training that by and large the private sector does not.

All those burdens stay with the NHS, none of it transfers to the private sector, and we are being asked to provide a tax incentive for people to do something that they do already. There was no evidence in the 1990s of any increase in the use of private health insurance as a result of the Government’s tax benefit.