NHS: Future Forum

Debate between Lord Blackwell and Earl Howe

Tuesday 14th June 2011 Lords Chamber

[Earl Howe]

My Lords, I am extremely grateful to the noble Lord, Lord Darzi, and would reassure him—I am sure that I do not need to—that our ambition is to carry through the agenda that he began when he was Minister of raising the quality of care throughout the NHS. He will see that we have defined quality in the Bill. It is the one part of the Bill that I do not think anybody has quibbled with. We have used his definition and I hope that no amendments will be tabled to change that.

The noble Lord said “competition when necessary” and I thoroughly agree with that. What we do not want to see is competition as an end in itself. It is never that. It can be there only to support better care of patients and buttress patient choice. If we believe in patient choice then we must inevitably believe in an element of competition. The key is making that competition work for patients properly, as we all would wish. Over the past few years we have seen how it can do that.

The listening exercise will not come to an end. We have asked the Future Forum to remain in being and to continue its work in a number of other areas. I am pleased to say that it has agreed to do so. Education and training will be one such area, public health another.

Finally, the noble Lord is absolutely right to direct our attention to the importance of good management. I think I read the other day in an article that he published that, if anything, the NHS has been over-administered and under-managed. I would agree with that analysis. We need good quality managers. I have never been one to denigrate managers. They are of the highest importance if we are to have a first-rate NHS. I hope to have further news on that front before long.

[Lord Blackwell]

My Lords, I add my congratulations to my noble friend on his Statement which has certainly reassured me that the principles in the White Paper have been maintained. Can he elaborate a little more on the development of competition and choice to which he referred? The Statement says that Monitor’s core duty will be to protect and promote the interests of patients, not to promote competition as if it were an end in itself. Can I take it from what my noble friend has said that the Government continue to believe that competition and choice are key drivers of improving the interests of patients and quality in the health service?

Following on from that, on the Government’s commitment to extending patients’ choice of any qualified provider, which is reasserted in the Statement, how will the phasing of the introduction or further expansion of alternative providers evolve in a way that will give those alternative providers the confidence to make the investments necessary so that they can play their full part in providing quality services under the NHS?

[Earl Howe]

I thank my noble friend for raising this important topic. I cannot provide him with the kind of detailed replies that he seeks. Those should emerge over the next few days as we work through our response fully. But I can tell him that we will amend the Bill to strengthen and emphasise the commissioner’s duty to promote choice in line with the right in the NHS constitution for patients to make choices about their NHS care and to receive information to support those choices. We believe in patients’ choice and in competition, as I have already indicated, where that is appropriate. As recommended by the Future Forum, the Secretary of State’s mandate to the board will set clear expectations about offering patients choice.

We will maintain our commitment to extending patients’ choice of any qualified provider, but we will do this in a much more phased way. We will delay starting until April 2012, and the choice of any qualified provider will be limited to services covered by national or local tariff pricing to ensure that competition, where it occurs, is based on quality. We will focus on the services where patients say they want more choice—for example, starting with selected community services—rather than seeking blanket coverage. Of course, with some services such as A&E and critical care, any qualified provider will never be practicable or in patients’ interests.

I have already referred to the changes in the duties of Monitor, in its competition functions. The NHS Commissioning Board, in consultation with Monitor, will set out guidance on how choice and competition should be applied to particular services, guided by the mandate set by Ministers. That includes guidance on how services should be bundled or integrated.

NHS Reform

Debate between Lord Blackwell and Earl Howe

Monday 4th April 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Lord needs to bear in mind that the forecast surplus for 2010-11 represents a very small proportion of the department’s budget. It is greatly to the credit of the health service and the department that they have managed to come in on the right side of the line and by a margin that, in the scheme of things, is not significant. I say that without being at all blasé about the figure of £1.4 billion. I suggest to the noble Lord that that represents good financial management. Yes, the money that represents the surplus cannot be carried forward into the subsequent year but that is not the same thing as saying that providers, for example foundation trusts, may not use their carry-forward balances. That is still possible at provider level. I hope, on reflection, that the noble Lord will not think too badly of the way the service has been run in the past few months.

[Lord Blackwell]

My Lords, I am sure the Minister must be correct that, in a reform of this scale and magnitude, it is right to take as much advantage as possible to listen to those who can help in the implementation and timing of the reforms. I hope he can also assure the House that the Government will not be diverted from the essential purpose of these reforms by those who have never accepted that public services do not need to be run by a central organisation in a public monopoly. As my noble friend will be well aware, we were already some way down this road in 1997 with GP fundholder practices. We wasted five years when the then Government reversed those changes and went back to a centralised organisation before realising that that would not work and had to restart the process of introducing delegation and alternative providers into the NHS.

We are now 10 years further on from that and it is important that the changes are not lost in the voices that will always oppose changes that are necessary to reform the way that the NHS works. I hope that, while listening to those voices, the Minister can assure us that these essential reforms will be carried through and that the period of uncertainty for the NHS will not be any longer than it needs to be before we can get to the kind of reformed NHS that we all want to see.

[Earl Howe]

My Lords, I am grateful to my noble friend and can give him those assurances. He is right: we have somehow got ourselves into the position of having a National Health Service that is, in essence, managerially and administratively led instead of being clinically led. That has happened by a process of accretion and slow and steady development. We need to get back to one of the principles that the incoming Labour Government articulated in 1997 when they introduced primary care groups. That was an attempt by them to do exactly what we are trying to do: to have clinically led commissioning in the health service. Unfortunately, to my mind, primary care groups morphed into primary care trusts and thereby became administrative units which became more and more divorced from clinical decision-making.

I can reassure my noble friend that we do not want to dilute the principle of clinically led commissioning. We believe that it is right and that we can build on the experience of the past; not just primary care groups, but also the good parts of fundholding, which had some good elements, and practice-based commissioning groups, which the previous Government introduced. This is an important opportunity, as I said earlier, to capitalise on the NHS as it now is and to shed some of the unhelpful elements that get in the way of driving quality and patient care.