Managing Risk in the NHS

Debate between Liz Kendall and John Pugh

Wednesday 17th July 2013 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

Will the right hon. Gentleman give way?

[John Pugh (Southport) (LD)]

Will the right hon. Gentleman give way?

Social Care Funding

Debate between Liz Kendall and John Pugh

Thursday 10th November 2011 Westminster Hall

[Liz Kendall]

I could not agree more. The deal must not be done behind closed doors. There has to be a discussion between political parties, but most importantly, there has to be a discussion with the public—not just the current users of the system and their carers, but people who are not in the care system and younger people, who are working now and who will have to understand the issue. We have to have a full and proper debate.

[John Pugh]

During the previous general election, we all had a number of hustings meetings. Whenever the topic cropped up, a theme that came across forcibly from all members of the public was that they wanted the parties to discuss the issue together and that they were rather saddened by what happened immediately before the election.

[Liz Kendall]

I was not a Member of Parliament then, but from my own experience in hustings, I think that people feel let down when such an important issue becomes a political football. The hon. Member for North Norfolk (Norman Lamb), who was the health spokesperson for the Liberal Democrat party at the time, did not engage in that kind of behaviour. I do not want to go over old ground.

We need to discuss the matter, but it will be difficult. We all know what politics is like, and how parties use things to get at the other side. The issue will not be easy—it is about public spending and implications for individuals. What will they and taxpayers have to pay? We would be kidding ourselves if we thought that the issue would be an easy one.

I agree with all hon. Members who have said that the issue is one of the biggest challenges that we face, even if that is a cliché. We all think about it for our constituents and in our own families. I think about it, as many other hon. Members do, for myself, as I hope to live to a ripe old age. It will be a difficult challenge, but I hope that today’s debate shows that we are at least prepared to engage with the difficult issues to take the debate forward.

National Health Service

Debate between Liz Kendall and John Pugh

Wednesday 26th October 2011 Commons Chamber

[Liz Kendall]

The hon. Gentleman, who is a constituency neighbour of mine, would do better focusing his attention on the RCN and RCM in our area, which are asking us why the Government are not fulfilling their commitment on extra midwives. If he goes to the hospitals in Leicester, as his constituents do, he will know that there are concerns about that.

The Government deny that the number of front-line NHS staff is being cut, that waiting lists are rising and, worst of all, that there is still widespread and growing opposition to their NHS plans.

[John Pugh]

Does the hon. Lady seriously believe that the £20 billion-worth of savings required by the last Labour Budget could be achieved without cuts?

[Liz Kendall]

We have been clear on this side of the House. My right hon. Friend the Member for Leigh (Andy Burnham) took some difficult decisions when he was Secretary of State for Health, unlike the current Secretary of State. My right hon. Friend looked at what was happening in local hospitals and took the difficult decisions, based on clinical advice, to improve patient care. That is what this Government should be doing.

The Prime Minister says that

“the whole health profession is on board for what is now being done,”

but that is simply not the case. The RCN says that the Bill

“will have a seriously detrimental effect upon the NHS and the delivery of patient care”.

Four hundred of the country’s leading public health experts warn that the Government’s plans will cause “irreparable harm” and fail to deliver

“efficiency, quality, fairness or choice”.

The British Medical Association says that the Bill

“poses an unacceptably high risk to the NHS”.

Government Members now like to criticise the BMA, but before the general election they applauded everything the BMA said. They always want to have it both ways. Three quarters of GPs—the very people this Government claim they want to empower—have said through the Royal College of General Practitioners that the Bill should be withdrawn. [Interruption.] The Minister of State, the right hon. Member for Chelmsford (Mr Burns), says from a sedentary position that those groups—the RCN, public health experts, the BMA and the Royal College of General Practitioners—are self-selecting. That is the kind of dismissal of front-line staff that has caused such problems for the Government.

It is not just NHS staff whom the Government refuse to listen to. Organisations such as Age UK and Carers UK say that social care is in financial crisis too. The Government repeatedly claim that they have increased funding for social care, but eight out of 10 local councils are now restricting services to cover only those with substantial or critical needs. Two thirds say that they are closing care homes or day care centres too. The Government’s huge cuts to local council budgets mean that vital services and support for older people, their carers and their families are being eroded. That is not protecting the most vulnerable in our society, nor is it protecting taxpayers’ interests, because if we do not help older people to stay healthy and independent in their own homes, they end up in hospital.

In conclusion, when people think back to what the Prime Minister said before the election and the personal promises he made on the NHS, they now see the truth: a Government who are out of touch with what is really happening; a Government who refuse to listen to front-line staff; a Government in total denial about the true impact of their reckless NHS plans. This Government’s record on the NHS is one of promises cynically made and shamelessly being broken. I commend the motion to the House.

Health and Social Care (Re-committed) Bill

Debate between Liz Kendall and John Pugh

Tuesday 6th September 2011 Commons Chamber

[John Pugh]

Is there not a big difference between making fundamental decisions, as we accept Monitor will sometimes have to do, and what the hon. Lady has just described, which is about taking the lead in the integration and sourcing out of services, which presumably is what the commissioners do? If she has read the other bits of the Bill, as I am sure she has thoroughly, she will be aware that the commissioners have a pivotal role in determining the shape, structure and character of local services.

[Liz Kendall]

I should add that, as the hon. Gentleman will see, page 6 of the briefing notes that the Government published on the Bill says that clause 104 would

“give Monitor discretion in determining where it is appropriate to include standard licence conditions for the purposes of securing continuity of services”.

As the NHS Confederation asks, how will Monitor have the local information and intelligence to make such complex judgments? How should patients and the public be involved? Monitor then has to keep the level of risk of the service under review, as well as taking decisions about whether and how to set differential prices for providers, to ensure the continuity of the process. How it is supposed to do that and how Members of this House, patients, the public or local councils are meant to hold it to account for that process is far from clear.

My biggest concern about the proposals is that they leave Monitor to intervene proactively to prevent services from reaching the point of failure. None of us wants such an outcome, but it is completely unclear when or how Monitor would do that. Page 10 of the technical annexe to the proposals said that the Government would

“expect Monitor to establish transparent and objective tests to determine when intervention is necessary and what level of support a provider would require”,

and claims that

“This would provide certainty to patients and providers”.

However, we have seen none of those details, and nor do we have any way of changing or influencing what Monitor does about the process, which is a real issue for hon. Members. Even under this Government’s flawed approach, it is astonishing that they say that they would only “expect” Monitor to publish criteria for early intervention. Why is that not in the legislation? Why is Monitor not required to publish and widely consult?

I want briefly to set out a couple of other concerns about the process. If it ends up not being possible to prevent a service from failing, what happens next? A trust special administrator will be appointed to take control of the hospital and report to Monitor and then to the Secretary of State. However, there is nothing in the legislation to say that local clinicians, let alone locally elected representatives, have to agree or sign off such proposals. Indeed, page 15 of the technical annexe says that “where possible”, the trust special administrator should

“secure agreement from clinical senates and clinical advisers”.

The idea is that clinicians would not be required to sign off the decision—the trust special administrator might also consult the health and wellbeing board, for example—about which I know many Government and Opposition Members have been concerned. There is nothing in the proposals to say that Monitor has to look at the impact of decisions in one part of a hospital or service on either the rest of the hospital or the wider health community. With the abolition of strategic health authorities, which take that regional view, that becomes a real concern.

The reason these proposals are so important is that there is a risk that there will be more failing services in future, and not only because of the financial squeeze that the NHS is facing—many hon. Members have talked about the real issue out there, which is that services are struggling to keep going, experiencing problems in balancing books and keeping on NHS staff—but as a direct result of Government policy to drive a full market into every part of the service, albeit without any ability to manage the consequences. In fact, the Government’s own documents make it clear that that is the point of competition. Paragraph B112 of the explanatory notes to the Bill states:

“For competition to work effectively, less effective providers must be able to…exit the market entirely”.

The Secretary of State likes to try to explain his way out of this system, but he cannot have it both ways. Either he wants that—for services to fail and new providers to be brought into the system—or he does not.