NHS: Reform

Debate between Lord Prior of Brampton and Baroness Blackstone

Thursday 16th July 2015 Lords Chamber

[Baroness Blackstone (Lab)]

My Lords, I declare an interest as the chairman of the Great Ormond Street Hospital Foundation Trust. Before I put my questions to the Minister, I will just make one brief comment on his remarks about the Opposition. I have no idea what the shadow Secretary of State for Health said in another place, but I will defend what my noble friend Lord Hunt has just said. He said that he agreed in principle with a great deal of the Statement, but it is legitimate for the Opposition to ask questions about how a Statement of this sort might be implemented, which is what he was doing.

I have two questions, the first about bureaucracy. The Minister said that he wished to see a reduction in bureaucracy. As a chairman of a trust, I entirely identify with that. However, some of the bureaucracy is in the regulators, and I hope that his attack on bureaucracy will cover the regulators. The Government are about to set up another outside agency, which will put further bureaucratic pressure on those who are delivering services upfront. Anything he can do to try to reduce that would be helpful.

My other question concerns seven-day services. Again, I entirely endorse what the Government wish to do with respect to seven-day services—if anything, they are overdue—but there are questions to be asked. What is the timetable for this, if it is only going to apply to new consultants? It will take a very long time to introduce seven-day services if only new consultants are going to go on to the new contract requiring them to work at weekends. I understand why the Government are doing that, but it will make for a very long delay. What steps will the Government take to try to encourage existing consultants, who will be far greater in number than the flow of new consultants, to adjust to a new approach where seven-day services are introduced in the interests of patients?

[Lord Prior of Brampton]

I can only agree with the noble Baroness on bureaucracy. The new body that we are setting up to look at incident reporting, as recommended by the PAC, will only look at big incidents so will not be an added bureaucracy for the day-to-day running of a trust. I am always struck by the figure that nurses spend only between 70% and 80% of their time dealing directly with patients because they are dealing with bureaucracy. The bureaucracy argument falls into two parts: it is partly about the way hospitals run their affairs and partly about external regulators. We believe fundamentally in intelligent transparency. I see the CQC, for example, as less a regulator and more a means of providing intelligent information to boards of hospitals and to patients. But I take on board what the noble Baroness says. We will do everything we can to reduce the level of bureaucracy.

As far as the timetable is concerned, junior doctors will switch over much more quickly than consultants, because they turn over much more quickly. It will take time for consultants to move over to the new contract, but we hope that we can make it more attractive to consultants and that it will be more of what I would call a professional contract, so that existing consultants will switch over to it as well as new consultants. We will have to watch that very carefully.