Health Service Medical Supplies (Costs) Bill

Philippa Whitford Excerpts

Tuesday 25th April 2017 Commons Chamber

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I thank the hon. Gentleman for his extremely kind words, and for his courtesy, which he always shows at the Dispatch Box and in the Chamber.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Like the hon. Member for Ellesmere Port and Neston (Justin Madders), this will be my last time speaking in the Chamber before Dissolution, and as a newbie I also want to pay tribute to the staff of the House, who made coming here much easier than we had expected it to be. I am also glad that my final speech before Dissolution is on a Bill that, despite some of our disagreements, we have worked on on a cross-party basis to produce a piece of work that we all agreed needed to be done.

I, too, welcome Government amendment (b), although I would have laid out the three paragraphs the other way around, because the whole point of the NHS, and the whole reason we are discussing this, is patient access: that is the No. 1 concern. I would have put patients first, not third. The fear of not getting access to drugs is a great issue for patients. As the hon. Gentleman mentioned, we have a significant delay that is measurable in comparison with other countries. For certain types of cancer, our performance in relation to patients with early disease is as good as anywhere, but we fall down in dealing with people with difficult or advanced disease. That is because of the delay.

I want briefly to mention the interaction of the budget impact assessment with our no longer being part of the European Medicines Agency. I am not talking about the United Kingdom losing the agency itself; I am talking about our no longer being part of the scheme. We know that there is a danger that drugs are presented for licensing in the United Kingdom at a later date than in the United States and the European Union, which are major markets. It is likely that we could also be behind Japan. I am not suggesting that we should simply hand over any amount of money, but if we were also seen as a hostile market in which there was an expected delay of three years for expensive drugs, there would be a danger that international pharma would simply say, “You know what? We’ll license everywhere else, then we’ll come back to the UK in a few years.” That could result in significant delayed access for our patients.

We need to think about how all this feeds into trials and research, and into the life sciences system. If we are not using what is considered to be the gold standard drug at the time of a new international trial, we will not be able to take part in the comparison of the gold standard with the new drug. The UK has led the EU research network, which is the biggest research network in the world. We have been a major player in that, and it is important to realise how building in this delay from NHS England could undermine that. Surely this should be part of the NICE process. It should be clear to pharma, when it comes with a drug at a price, what process it will have to go through, what evidence it will have to bring forward and how it will have to negotiate a price. I fear that there will be delays in drugs being licensed.

This will affect us in Scotland even though NICE decisions do not apply to us. If a drug were simply not licensed here, it would be irrelevant that the Scottish Medicines Consortium chose to fund it—as it did the other week with Kadcyla—because it would still be an unlicensed medicine. We need to look at how the loss of the European Medicines Agency will work in this regard. There should not be a separate procedure after NICE that could suddenly hit pharma with another barrier to jump over. This will hit new cancer drugs, because they are expensive. It will particularly hit drugs for rare diseases, which the EMA has led on, because they are bespoke and therefore inevitably expensive. The £20 million limit would mean that if someone came up with a fabulous cure for dementia, for example, a budget impact assessment would be triggered.

[Mr Jim Cunningham (Coventry South) (Lab)]

I agree with what the hon. Lady says about the European Medicines Agency. I have had a lot of letters from people who are very concerned about that issue. There is another factor involved in the delays that can occur in the Government agreeing a price. I think that the drugs companies often take the Government to the cleaners.

[Dr Whitford]

I thank the hon. Gentleman for his intervention. That is obviously why the Government are introducing the Bill. They are trying to achieve a degree of control and to prevent runaway drugs costs. Of course we agree with that objective, which is visible in the Bill. The Government are trying to establish a predictable system of licensing in the UK, so that a pharmaceutical company knows what it has to bring to the table. That might mean a bit more flexibility during the NICE process, because we could appear hostile if a drug goes through that process and is defined as cost- effective, only to be hit with another, less predictable, barrier. The danger is that that will affect Scotland just as much as England, regardless of our drug funding decisions, because licensing is a reserved matter. The Government need to take that into account, because patients come third in the order set out in the amendment, and I believe that they should come first.

Contaminated Blood

Philippa Whitford Excerpts

Tuesday 25th April 2017 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Will the hon. Gentleman give way?

[Sir Peter Bottomley]

Of course.

[Dr Whitford]

I know that the Penrose inquiry is always cast up as having dealt with this issue, but that was a Scottish inquiry and it was not able to summon people from the rest of the UK who did not want to attend. Therefore, the idea that Penrose has dealt with this is fallacious. We must have a system where we can summon people to give evidence right across the United Kingdom.

[Several hon. Members rose—]

Oral Answers to Questions

Philippa Whitford Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Hunt]

I absolutely welcome that, and I know my right hon. Friend has personally championed it as a local MP. The historical mistake that those on both sides of the House have made is not to do long-term workforce planning for the NHS, and that is something we want to put right.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Plans to train more UK doctors are absolutely welcome, but the Secretary of State knows that it takes at least 10 years to train a doctor, so what is his response to the surveys by the British Medical Association and the GMC showing that, having been left hanging for nine months, 40% to 60% of EU doctors are thinking of leaving?

[Mr Hunt]

My response is the one I give many times in this House, which is to stress to all those doctors how valued they are as critical parts of the NHS. We do not see any evidence of the number of doctors joining from the EU going down. The NHS is one of the best health services in the world, and it is a great place for people from other countries to work and train.

[Dr Whitford]

The workforce is one of the biggest challenges right across the nations of the UK, and particularly in rural areas, as we heard earlier. With a 92% drop in the number of EU nurses coming to the UK and a 60% increase in the number who left last year, how does the Secretary of State plan to avoid an NHS staffing crisis immediately post-Brexit, before there is time to train anybody extra?

[Mr Hunt]

The hon. Lady needs to be very careful in her use of statistics, because she will know that one reason for the drop in the number of nurses coming from the EU is that prior to the Brexit vote we introduced much stricter language tests, as that is better for the safety of patients and a very important thing that we need to get right. We are very confident that nurses will continue to want to work in the NHS, because it is a great place to work.

Health Service Medical Supplies (Costs) Bill

Philippa Whitford Excerpts

Ping Pong: House of Commons
Wednesday 15th March 2017 Commons Chamber

It is vital to ensure that we roll out novel medicines much faster. It is wholly unacceptable that many products that are routinely available in western Europe are not available in the UK within a reasonable timeframe. It is hardly surprising that healthcare outcomes for common forms of disease in this country lag behind those in countries such as France, Germany and the Netherlands. I hope that the Bill will go some way to ensuring that we spend our moneys as effectively as possible and will start to narrow that gap, but we must ensure that medicines are rolled out rapidly once they are approved by NICE on a cost-effectiveness basis.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I, too, welcome the principle of the Bill. We have discussed it in a lot of detail as it has gone through Parliament, and the legislative consent motion was passed by the Scottish Parliament last month. I welcome the fact that the Minister listened to our previous discussions, and I therefore welcome Lords amendment 1, which deals with specials—individually produced medicines, usually within dermatology. While the numbers involved may be small, the costs are often eye-watering. In Scotland, that process is controlled through a procurement method, but it was certainly clear that NHS England was simply being ripped off, and I am glad to see that that is being addressed.

I also welcome Lords amendment 6, which will bring in, as I suggested, a consultation on how to maintain the quality of products. We discussed surgical gloves as a perfect example. People talk about quality marks, but they are often simply manufacturing quality marks, not necessarily a mark of suitability for the task. The Medicines and Healthcare Products Regulatory Agency could be involved, or there could be some other process, but it is important that we do not drive down quality by trying to drive down price.

The main thing that we are discussing is the Government’s plan to disagree with Lords amendment 3, which would insert a new clause. The NICE board is today discussing this extra layer behind NICE. We are talking about drugs that NICE has already decided are cost-effective, and giving NHS England the ability to delay them further without negotiation. The amount of antivirals such as sofosbuvir for hepatitis C that hepatologists can prescribe is rationed, even though we know that the most important group to treat are those who are well—not those who are almost bed-bound or near the end of life with cirrhosis—because they are the ones out in society spreading hepatitis C to other people.

It is important to consider the delay, which has two aspects. The first relates to very expensive drugs, which are usually for rare diseases. Looking back, almost none of the drugs that have got through in recent years would pass the new limit. Secondly, the total of £20 million means that regardless of how effective a drug is, perhaps for a common disease, it would not get through. If someone comes up with a wonder drug for type 2 diabetes, it would hit the slowing mechanism if it cost more than £20 million because of the sheer number of people that we would be dealing with.

The hon. Member for Ellesmere Port and Neston (Justin Madders) mentioned the impact of our withdrawal from the European Medicines Agency, but while he focused on the impact on the pharmaceutical industry, the impact on the patient is much bigger. Drugs are launched in America and Europe due to the sheer scale of the market, and countries such as Canada and Australia wait longer. The UK will also wait a little longer because we will no longer be part of a market of 500 million people.

The UK may also be seen as a hostile market, because it takes three to five years for cancer drugs to get into the NHS. As other doctors in this place will know, our patients face a delay in accessing new drugs, and anyone who thinks otherwise is fooling themselves. Pharmaceutical companies will simply think, “Well, we’re not going to get into the NHS for five years, so let’s go and do Australia and Canada. We’ll come back and deal with the UK later.” That delay to licensing in the UK would be a real problem, and it would extend to Scotland, too, because at the moment licensing is a UK-wide process. The drugs would therefore not be available to us outside the European Medicines Agency.

This issue is also important to UK research. If we fall so far behind that we do not use what is considered standard treatment, we will not be able to take part in trials of standard plus new. There is an absolute need to control the cost of drugs, but perhaps we need different discussions with pharmaceutical companies about how drugs come on. We need something more radical than this to find the sweet spot between the companies getting a return on their money, the NHS controlling the cost and patients getting access.

We also need to think about realistic medicine. Not every patient even wants access to the newest chemotherapy, and perhaps we need some hard discussions, and to be much more open with patients about what a drug will and will not do.

Question put, That this House disagrees with Lords amendment 3.

Health and Social Care

Philippa Whitford Excerpts

Monday 27th February 2017 Commons Chamber

[Meg Hillier]

It may well be, as my hon. Friend says, a false economy.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The early figures that have come out from NHS England suggest a 23% drop in applications. Obviously, that is a significant change.

[Meg Hillier]

The key thing, of course, is how that figure comes through the pipeline and how we fill the gap. While the Minister is on his feet at the end of the debate, it would be helpful if he said what analysis the Department of Health has done of the impact of Brexit and any changes it may herald for our NHS workforce, because a high percentage of them are from Europe. We are hearing the right sounds from the Government, but we have not yet had any action on securing the future of those European citizens currently resident in the UK. If the Minister is able to give us any comfort on that, it would be very welcome.

I am heartened that so many Members are in the Chamber to discuss this important issue. I should mention that the Public Accounts Committee has also been working with the Procedure Committee to try to ensure that the House can discuss the financial details of estimates rather than just the general principles, although I have obviously strayed into those, too. Hopefully, we can base these debates on the figures we have spent so much time looking at in the Public Accounts Committee. It is unedifying for the public to hear anonymous briefings and public argument; that does not wash with them. We need to be on top of this issue so that we hold the Government’s feet to the fire and make sure that, every step of the way, they know we are watching the budget. We will not let you get away, Minister, with raiding the capital budget to fund the accounts this year.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I certainly welcome the fact that, in recent months, since the hearing of the Health Committee, the Secretary of State for Health has stopped using the £10 billion figure and has recognised the £4.5 billion figure, which is much closer to reality. Spending is normally allocated on the basis of health spending, not just NHS England spending. The increase in NHS England spending was at the cost of significant cuts to public health, even though we all recognise the need for prevention, and cuts to Health Education England, despite the attempt to have 1,500 extra doctors every year, extra nurses and 5,000 extra GPs, which is therefore rather a challenge.

As has been said, last year was the good year before we come to the lean years. I am not going to go into details of the pockling that was required to get anywhere close to the required outturn, which was missed by £207 million, as that has been so clearly explained by those on the Public Accounts Committee. That results in what the Auditor General has described as short-termism—people simply working to meet the bottom line instead of lifting their chins up and looking at what the real challenges are.

There are three big challenges. We have talked about the ageing population, we recognise that we have significant workforce challenges, and we all know that money is tight and does not grow on trees. Those three things create a conflict. People are sometimes putting in a short-term patch that will actually cost more money in the end. Providers across England can be recognised for getting their agency costs down, although they are still more than twice what they are in Scotland, but what is lying ahead? How will we meet the challenge of providing the workforce after Brexit—not just the challenge of people leaving, but of how we recruit in future? The turnover at the level of nurse and social care worker is about 25%, and we need a constant stream. A Government Member mentioned the tiny proportion of population below the age of 65—of working age. That is exactly why we needed immigration in the first place. Are we going to end up with more agency workers, or will the Government take action to make sure that we can attract nurses, doctors and social care workers from Europe?

A lot of these problems are blamed on an ageing population. In fact, Scotland’s demographics are worse than England’s, and going through the hard winter that we have all faced, we did not meet our A&E target either. However, in Scotland the A&E department four-hour achievement level was 92.6%, while in England it was 79.3%—the worst level since records began. That shows that there is a real crisis. This is not meant to be a measure for us to attack each other with. In general, this has been a great debate compared with what some of our debates are like. Rather, it is meant to be a thermometer to take the temperature of the whole system—not just the whole hospital system from A&E to discharge, but from home to GP, to A&E, to hospital, to getting back home again. The problem lies in the significant cuts made outside the Department of Health but within social care. Obviously patients require the support to be able to get back into the community, and preferably even back to their own homes.

Why are we are managing, despite our demographics, to keep our nostrils above water when NHS England is not? It is partly because in Scotland we have focused absolutely on integration rather than financial competition. The convoluted system that now exists between CCGs and outsourcing contracts, bidding and tendering is estimated to take £5 billion to £10 billion out of NHS England’s budget. That would be enough to cover the deficits—to plug the social care hole—and yet the Department of Health does not even keep data on it, so it is not keeping track of how these administration costs are growing. There is no possibility of a cost-benefit analysis of bringing in outside providers and causing this fragmentation instead of people being able to work together.

In Scotland, as I have said before, we have gone down the route of integrated joint boards between health and social care, taking money from both sides so that we do not have the argument over whose purse is funding a patient. We have used other innovative approaches such as community pharmacies, which we have debated here previously, and minor ailments units within community pharmacies. As a result, in the past five years attendance at A&E in Scotland has increased by 3.4%, while in England the figure is 11.8%—three times our attendance rate.

The situation with admissions is similar. Our emergency admissions have increased by 4.6%, while those in England have increased by 14%. That is all because the effort is not being made in the community.

There is a lot of talk, all the time, about the five year forward view. Frankly, we are halfway through the five years, so we are left with a two-and-a-half year forward view. That does not look far enough ahead. Scotland did “2020 Vision” back in 2011, and we are now working on 2030, by which time the number of people aged 85 and over will have doubled. That is what we need to think about: how do we design not only our social care services, but out health services around the ageing population?

Our Cabinet Secretary is focused on what keeps people independent. Members may think that that is because I represent the Scottish National party, but I am talking about people being independent and living high-quality lives. What is it about? It is about hip replacements, knee replacements and eye surgery. If someone cannot see or walk and they are stuck in their house and lonely, we are going to have to look after them. Therefore, we have invested in—this is often laughed at here—free prescriptions so that people take medication to control chronic illnesses. We have also invested in giving free personal care to people in their own homes so that they do not land in hospital and get stuck there. That is why last year our delayed discharges went down by 9%, while here they went up by between 25% and 30%.

People also laugh at free bus passes. The hon. Member for South West Bedfordshire (Andrew Selous) mentioned loneliness, an issue that was championed by Jo Cox. It is as big a killer as diabetes. Older people in our community are out and about. They are taking day trips and going shopping, and they love it. They are not stuck in their houses. This is about starting with looking at that population.

STPs are the best change going forward, but at the moment they are being handed a bottom line and told to work back from it. It cannot be budget-centred care; it must be patient-centred care. All of us across the House can recognise that place-based planning for a community will provide the best service to those patients and our constituents. That is what we should be doing. We need to get real about public health and preventing chronic ill health in later life, and that means addressing health in all policies. It is really bad that, day by day, this House considers individual decisions that completely contradict each other. We should always ask of every decision, “Will this make the health and wellbeing of our citizens better or worse?” If it makes it better, in the end it will save money. That includes poverty—the biggest cause of ill health.

I call on Members to consider the systems and how we do things, but we need to provide the care in the community before we take it from the hospital. Let us also think a little more broadly in some of the other decisions that we make.

--- Later in debate ---

[David Mowat]

I will come on to social care. We have covered the NHS, which this Parliament will get a real-terms increase of 8% or 9%. Let us accept that and move on. On social care, a 5% or 6% real-terms increase has already been made available—that is not the Budget; I do not know what is in the Budget. Again, we can argue about whether that is enough, given the demographics, but we cannot argue whether it is true.

I want to spend a little time on the international comparisons, about which we heard some discussion earlier. According to the OECD, in 2014 this country spent 9.9% of its GDP on health. The OECD average is 9%, so that is 1% more, but it is true that the OECD average includes countries such as Mexico with which we would not necessarily wish to compare ourselves. The average for the EU15, which by and large does not include the newer states in the east, is 9.8%. So in 2014 we spent more than the EU average. It is true that we spend less than some of our comparator countries—we spend less than France and Germany—but it is completely wrong to say that there is a massive gap between us and the EU.

[Dr Philippa Whitford]

I thank the Minister for giving way, but 2014 was three years ago, and are we not heading towards a figure of less than 7%, which will put us 13th out of 15 among the EU15?

[David Mowat]

No. The 2014 figures are the most recent available—and they do not include the comparatively large settlement on healthcare and the front-loaded money in the spending review.

The Government spend 1.2% of GDP on social care—we spend another 0.6% privately. That is more than countries such as Germany—the Chair of the Communities and Local Government Committee talked about Germany—which spends 1.1%, and more than Canada and Italy. Again, it is less than some countries—Holland, an exemplar country in this respect, spends considerably more; I accept that there are choices to be made—but it is wrong to pretend that we are massively out of kilter with the sorts of countries we would regard ourselves as equivalent to.

NHS Shared Business Services

Philippa Whitford Excerpts

Monday 27th February 2017 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for her sensible contribution. She is right that, although the process of sending on these particular documents has been taken in-house, other parts of the contract were taken on by a company called Capita—[Interruption.] The hon. Member for Leicester South (Jonathan Ashworth) cannot stop, can he? Let me repeat that the work in question has been taken in-house. The other work, which is being done by Capita, has had some teething problems, of which we are very aware. We know it has been causing problems for GPs. The Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood) has been meeting Capita and people relating to that contract on a fortnightly basis to try to identify the problems.

My hon. Friend the Member for Totnes (Dr Wollaston) is right that the aim in the long run is to give people control of their records. I am proud that, under this Government, we have become the first country in the world to give every patient access to their own records online. From September, people will be able to do that without having to go to their GP’s surgery.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I am sure that everyone across the House is glad that these 750,000 incidents have not, so far, resulted in patients suffering. Frankly, that is luck, rather than plan, for which we should all be grateful. This is yet another situation similar to that of Concentrix and others we have seen. When we are outsourcing and taking on these companies, what is the basis of the contract and what is the governance? The Secretary of State mentioned the other incidents of transferring data when a patient moves to another GP’s surgery, and that has also been an issue. When will data in England become more digital so that things are not sent by post? We have not used that method for several years in Scotland, and it is holding back the entire primary care and hospital system here. When will the Secretary of State’s vision for that come about?

[Mr Hunt]

The hon. Lady is always very good at telling the House things that Scotland does better than the NHS in England; there are, indeed, some. She is a little bit coyer about things that Scotland does less well than the NHS in England. If we put aside those issues, I think we can both agree that the sooner the NHS across the whole UK goes electronic, the better. That has been a big priority for this Government, and we have made big progress. More than two thirds of hospital A&E departments can now access a summary of people’s GP records, and we are going further every month.

Oral Answers to Questions

Philippa Whitford Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Dunne]

I urge the right hon. Gentleman not to indulge in scaremongering about the number of people applying to become nurses. There are more than two applications for each of the nursing places on offer to start next August. He needs to be careful about interpreting this early the figure for applications from EU nationals, which has gone down significantly, because it coincided with the introduction of the language test for EU nationals.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

With the reduction of 23% in applications to English nursing schools, the Minister might want to re-look at the policy. There has been a significant drop—a 90% drop—in EU nationals applying. With one in 10 nursing posts in NHS England vacant and a cap on agency spend, who exactly does the Minister think should staff the NHS?

[Mr Dunne]

I say gently to the hon. Lady that there are 51,000 nurses in training at present. The number of applications through the UCAS system thus far suggests that there will be more than two applicants for each place. As I have just said to the right hon. Member for Leigh (Andy Burnham), the reduction in application forms requested by EU nationals has coincided with the introduction of a language test.

[Dr Whitford]

Language test applications were more than 3,500 last January, so the reduction after the language test was from that to 1,300. In December, there were only 101 applications. This cannot all be blamed on the language test, so what is the Minister going to do to protect nursing numbers?

[Mr Dunne]

There are over 13,000 more nurses working in the NHS today than there were in May 2010. As I have just said to the hon. Lady, the language test came into effect from July last year, since when the number of applicants has been somewhat steady. It is down very significantly, but that is because, frankly, we have had applications from nurses from EU countries who have not been able to pass the language test.

Agenda for Change: NHS Pay Restraint

Philippa Whitford Excerpts

Monday 30th January 2017 Westminster Hall

[Mr Nigel Evans (in the Chair)]

I call Dr Philippa Whitford.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I thought I would be called to speak at the end.

[Mr Nigel Evans (in the Chair)]

No Members indicated that they wished to speak by standing in their place, but I can be flexible, with your permission.

[Dr Whitford]

Yes; I would expect to speak at the end, if other Members wish to speak.

[Andy Burnham (Leigh) (Lab)]

rose—

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

It is an honour to serve under you, Mr Evans.

We seem to have been in this place before. We had a lot of debate about the nursing bursary, and these things are connected, because it comes down to how we are treating people and valuing them, as has been said. In Scotland, we also have a pay cap of 1%, but one difference is that that is being paid each year, whereas for three of the last six years, nurses in England have faced a freeze—an award of 0%. What they are told is, “Well, your increment gives you a rise.” The increment is how people move through the Agenda for Change structure, so if they are not getting any cost of living rise, the increment structure of Agenda for Change is being undermined.

The Scottish Government are a real living-wage employer and are recognised and registered as such, so people earning less than £22,000 get £400 to keep them above the real living wage. Starting in the next financial year, 2018-19, those in the lower bands in England will fall below the national minimum wage; they do not come anywhere close to a proper living wage. We know the Government’s living wage as “the pretendy living wage”, because people cannot actually live on it. That term should not be used because it is confusing. The result is that at band 1 or 2, a nurse or healthcare assistant in Scotland will earn £881 more than their equivalent in England. The common band for a nurse graduate is band 5, and at the top of that band, the nurse in Scotland will earn £284 more than the nurse in England.

Scotland has had no compulsory redundancies since the crash. In England, there have been 20,000. That seems bizarre when we are short of nurses. The vacancy rate in England is 9.5%; in Scotland it is 3.5%. We get what we pay for. If we treat people badly, eventually they go away, or, if they are approaching retiral, they do not go on working; they finish, because frankly they are burnt out. Nursing is a hard, heavy and stressful job. Nurses in Scotland feel stressed because of the gap caused by vacancies, the increased demand, the ageing population and the complexity of the cases they look after, so we can only imagine what it must be like in hospitals in England, with almost 10% of places not being filled and having to be covered by agency staff, which, as we have heard, is just a circular, self-defeating argument.

[Lady Hermon]

On the hon. Lady’s point about how difficult and wearisome the work of a nurse is—it is hard work—those nurses born in the 1950s who are affected negatively by the Government’s pension policy cannot now retire until they are 65, 66 or, indeed, 67. Has there not been a double whammy for those nurses who want, for the love of the job, for the love of the patients and for the love of service of the community, to stay in post? The Government have an opportunity to recognise that contribution. If they will not do something on pensions—I hope that they will change their mind on that—they could at least remove the pay freeze.

[Dr Whitford]

The whole message that is sent by nurses, particularly those who are in their late 50s and approaching 60, is that they are burnt out; they do not feel valued. When they have to work hours and hours beyond their shifts, doing what is frankly heavy labour—coming from that background, I can vouch for its being heavy physical work—they will of course leave as soon as they can manage to do so. The problem is that that exacerbates the pressure on all their colleagues, and that is what we are seeing with the huge shortage of thousands of nursing posts across England.

We have to recognise that we will face more increased demand and more complexity as our population ages. When patients in their early 70s were coming to me with breast cancer, they had multiple morbidities. By that stage, they had had a heart attack, were type 2 diabetic, had a bit of kidney failure and were severely immobile from arthritis, obesity or one of the many other conditions that people are getting. The nurses were trying to deal with all those things. Going forward, we will face more cases of dementia and Alzheimer’s, which is a particularly challenging morbidity for patients and the staff looking after them. Working in that environment, where everyone around them is having a bad day at the same time that they are having a bad day, means that people do not enjoy going to work. If there is any chance to get out, they are going to take it.

We need to attract more nurses to deal with demand. As was mentioned earlier, approximately a third of nurses are due to retire within the next 10 years, and we need to prepare for that. Some of that relates to the expansion that we had under Labour; when there is a big expansion in a profession, a whole lot will tend to retire at the same time. Unless succession planning is ongoing and established, we will reach an absolute crisis.

That brings us to the other difference: the nursing bursary. In Scotland, we still pay a nursing bursary of more than £6,500. We also have free tuition, which is equivalent to £27,000. We have additional funding for nurse trainees with additional support needs. They tend to be older—they are around their late 20s and early 30s —so they get more than £2,000 for childcare, a dependency allowance if they have either an adult or children dependent on them and a single-parent allowance.

The Scottish Government know that we have a challenge to recruit and retain nurses to grow the nursing profession, and they are putting that money in. They are not putting it in by giving high pay awards each year, but they are the only Government that actually accepted the independent review body’s recommendation of 1% on top of any steps within Agenda for Change. What is the point in doing all the work around a review body, if the Government do not bother listening to it?

I suggest that the Government need to show nurses that they are valued. They need to look at the decision to get rid of the nursing bursary, because we already know from NHS England that there has been a decrease of 20% to 25% in applications, so it is having exactly the opposite effect than the Government talked about. We know from the Nursing & Midwifery Council that registrations from the EU have dropped by 90% since last July. That means that whole source is drying up, regardless of rules, because people do not want to take the risk of moving here. We cannot shut down every possible source for having enough nurses. A lot of this is about calling on the Government to change their attitude and realise that this is a difficult job. We need to attract people into it and we need to retain people for as long as we can. Nurses are worth every penny they are not being paid.

--- Later in debate ---

[Mr Dunne]

I can say to the hon. Lady that there are 51,000 nurses in training today—I cannot tell her whether that is a record number, but it is a very significant number. There are 1,600 paramedics in training, which I believe is a record number. She and one or two other hon. Members have given anecdotes today about applications for new courses starting in the autumn, but I cannot tell her what the figures will be, because I have not yet seen any numbers published by UCAS. I think that they are due in the coming days, so we will have to see.

[Dr Whitford]

Will the right hon. Gentleman give way?

[Mr Dunne]

I will, although I am not actually right honourable.

[Dr Whitford]

Honourable but not right—I accept that. The figures from NHS England itself suggest a drop in nursing applications of at least 20% to 25%.

[Mr Dunne]

The hon. Lady must have access to figures that my Department and I do not have. My information is that we have yet to receive any formal numbers from UCAS; there may be some early indications, but they do not represent the actual numbers. We will just have to wait for them. There is no point in speculating any further.

A number of hon. Members mentioned the potential impact of Brexit on EU staff, who currently represent a significant number of the professionals working in the NHS. Some 43,000 non-UK-born nationals work in the NHS—about 15% of the workforce—and about half of them come from the EU. It is very important that none of those staff are unnecessarily concerned about their future. The Prime Minister has sought to make it clear on several occasions that she wants to protect the status of EU nationals who are already living here and that the only circumstances in which that would not be possible would be those in which the rights of British citizens living in EU member states were not protected in return. We wish to provide as much reassurance as we can, both to NHS workers and to their employers, that they have a constructive future here in the UK.

However, it is important that we move towards a self-sustaining workforce. Frankly, that is at the heart of the reason behind the change in funding for nursing places, which is to bring nurses in line with doctors and those doing other degrees in England, so that from this autumn onwards they receive funding through student loans rather than bursaries.

--- Later in debate ---

[Mr Dunne]

The hon. Gentleman will not be surprised to hear that I cannot give him any reassurances on that. We will have to see what the recommendations are and then take a view. However, we are not very far away from that point now.

The hon. Member for Foyle (Mark Durkan) referred to the national living wage. I got the impression from him that some NHS staff members in Northern Ireland are earning only the national living wage; I can reassure him that no NHS staff in England are earning only at that level.

[Dr Whitford]

Looking at the graph going forward, however, those on bands 1 and 2 of Agenda for Change will fall not only below the real living wage, which they are already below, but below the national living wage, which is the minimum wage, in the coming years—2018-19 and 2019-20.

[Mr Dunne]

Once again, the hon. Lady is speculating about what might happen in future, and I am afraid that not only can I not comment on that, but I am not sure whether she is correct or not. There are some assumptions in what she said about what will happen to the national living wage. The Government are making some assumptions, but what the Government choose to do about the matter we will have to see. At present, the policy is certainly that nobody will be paid less than the national living wage. I can reassure her about that.

[Mark Durkan]

Just to clarify, like the hon. Member for Central Ayrshire (Dr Whitford), I was referring to the living wage and not to the national living wage, which is a figment of Government policy.

[Dr Whitford]

rose—

[Sir Roger Gale (in the Chair)]

Order. You cannot take one intervention following another intervention. I call the Minister to speak.

[Mr Dunne]

I am very happy to give way to the hon. Lady.

[Dr Whitford]

I was basing my assumptions and suppositions on what the Government themselves announced when they said that the pay freeze would continue in the next four years. That was announced in the comprehensive spending review, so I am not just making it up, and if pay goes on the trajectory that was announced last year, it will fall below the national living wage, which is obviously due to rise towards 2020.

[Mr Dunne]

I have made the Government’s current position clear and we will have to see what emerges from the NHS Pay Review Body’s recommendations, and then how those are implemented over the coming years. I think it is fruitless to speculate on what might happen in future years, based on the suppositions that the hon. Lady made—

[Dr Whitford]

Why?

--- Later in debate ---

[Mr Dunne]

No. The hon. Lady has had a fair crack. I will make a bit more progress.

I was challenged in this debate to refer to what the Government are investing in the NHS and I obviously take some relish in responding to that challenge. We are investing an additional £21.9 billion in nominal terms, which is equivalent to £10 billion in real terms, to fund the NHS’s own plan for the future. By doing so, we believe that we are playing our part, through the measures announced over the last 12 months or so, to help the NHS achieve its five year forward view. It needs to do that not only by realising benefits from the Carter review to improve productivity, but by clamping down on rip-off staffing agencies and encouraging employers to use their own staff banks for temporary staffing needs, so that they can invest in their permanent workforce. That has been referred to by a number of right hon. and hon. Members.

Agency and bank working provide an opportunity for NHS staff to engage in more flexible working to suit their own circumstances, so I would not want to characterise all agency working as bad. What is challenging is when NHS organisations need, in some cases, to go out to external agencies beyond their immediate bank and pay significantly higher rates. That is why the Department introduced, a year ago, a number of measures to start to limit the ability of agencies to charge the NHS such high fees, and we have had some success in that. In the period for which I have figures—roughly the middle of last year—the agency costs to the NHS had been reduced by 19% over the equivalent period the year before, so we are doing something about those fees. We are apprised of the problem and are bringing down the cost to the NHS of employing agency staff.

This issue is not just about pay. NHS staff, like many people, work hard to improve our public services. They have families and commitments, and they deserve to be rewarded fairly for what they do. However, as has been said, pay alone will not necessarily persuade the skilled and compassionate people that we need to choose a career in the NHS. It would be wrong to see the NHS employment package as just about headline pay. NHS terms and conditions have been developed over many years, in partnership with trade unions, and they recognise that it is a combination of pay and non-pay benefits, which need to keep pace with a modern, changing NHS, that help to recruit, retain and motivate the workforce.

[Dr Whitford]

Certainly the nurses I met during the lobby here, who had come from all over England, but particularly from London, described literally struggling and facing great financial hardship. That is very difficult for them. They work so hard for the benefit of all of us, yet feel that they cannot go on in their profession because they simply cannot keep their families here in London.

[Mr Dunne]

I have already explained to the hon. Lady that we have a London weighting, which reflects the increased costs of living in London. I have also explained to her that average pay for nurses is significantly above the national average pay. She herself referred to average nursing pay of some £31,000—

[Dr Whitford]

indicated dissent.

[Mr Dunne]

If not her, then another hon. Member referred to it, and that is from the latest available workforce statistics.

Picking up on the hon. Lady’s point, it is important that NHS staff are confident that their employment package is competitive. We want employers to make better use of the full package in their recruitment and retention strategies. NHS Agenda for Change staff have access to an excellent pension scheme, far in excess of arrangements in the wider economy, which includes life assurance worth twice the annual salary, and spouse, partner and child benefits. They have annual leave of up to 33 days—six and a half weeks—plus the eight bank holidays, which is far better than that which is available in the private sector, and in many other elements of the public sector. They have sickness and maternity arrangements that go well beyond the statutory minimum and, as I have touched on, there are flexible working, training and development opportunities for staff at all grades. For too long, the NHS employment package has been a well-kept secret and we want leaders to make the very best use of the overall NHS employment offer to help recruit and retain the staff they need.

Defibrillators in Public Areas

Philippa Whitford Excerpts

Monday 16th January 2017 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I am not sure whether the hon. Lady is aware of the impact that these defibrillators have in cardiac ambulances. When I qualified, an ambulance just picked someone up and took them to a hospital, but the big, boxy ambulances have more equipment in them than was in a casualty unit in those days. Even in professional hands, this technology has transformed out-of-hospital cardiac arrest.

[Maria Eagle]

I thank the hon. Lady for that very useful information, from her own experience as a doctor. It is important that the availability of this kit is widened across our society in order to save lives.

Current legislation surrounding public access to defibrillators is practically non-existent. Last year, the Government produced a guide for schools recommending the purchase of AEDs. While I welcome that move to highlight the issue, the Government should do more. Will the Minister undertake to meet Mark and Joanne and the OK Foundation to discuss a realistic programme of providing AEDs in public places and training for people such that they feel confident to use them? Will he facilitate a meeting with the Prime Minister? I know that the OK Foundation would welcome an opportunity to argue its case at the highest possible level of Government.

NHS and Social Care Funding

Philippa Whitford Excerpts

Wednesday 11th January 2017 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Here we are again debating the NHS. [Interruption.] I am all on my own because obviously this is predominantly a crisis in NHS England, not a crisis in NHS Scotland, as I will discuss as we go on.

The problem is that we are talking about patients who are suffering—who may suffer from more infections, as we have heard. We are talking about staff who are in tears and who are desperate, and who feel that they cannot deliver the care they would expect to deliver. This is not just a matter of isolated stories of “Joe from Wiltshire” and “Mike from Leeds”: it is happening on a major scale. We hear from NHS Improvement that only one trust out of 152 met the four-hour target in December, and only nine made it to over 90%. Fifty out of 152 trusts declared a black or red situation over December, and there were 158 diversions of ambulances over that time. This is not just about normal winter pressures. It is not what the hon. Member for Lewes (Maria Caulfield), who is an A&E nurse, and people like me and other medics in the Chamber have seen in our careers—it is a really bad winter. Yet we have not had bitter weather and we have not had a flu epidemic.

The most recent four-hour data were published in October, when NHS England managed to achieve the four-hour target for 83.7% of the time. That is 5% down on the same time in the previous year, and it compares with 93.9% in Scotland. Scotland managed 93.5% in Christmas week. We have our challenges in Scotland, but the crisis is not the same as what is being discussed here.

[Sir Simon Burns (Chelmsford) (Con)]

Will the hon. Lady confirm, though, that throughout the whole of 2016, which includes winter, summer, autumn and spring, the Scottish Government’s A&E target was met in only seven out of the 52 weeks?

[Dr Whitford]

I would be delighted to agree with that, but NHS England did not make it over 90% at any point in 2016, so perhaps the right hon. Gentleman might want to check the NHS England figures before having a punt at me.

NHS England is performing 8% to 10% lower than NHS Scotland, which has been the top performing of the nations for the past 19 months. We have not done that by magic. We face exactly the same ageing population, exactly the same increased demand and complexity, and exactly the same—indeed, often worse—shortages of doctors as NHS England does, because of our rurality. We are not using a different measure—we use exactly the same measure—but the data show that there is a significant difference, and it is being maintained.

The Secretary of State is right: winter is always challenging. Summer is often busier for attendances at A&E, because the kids are on the trampolines and people go out and do silly things, but hospitals are under pressure in winter because of the nature of admissions—the people who go to A&E are sicker, older and more complicated. However, we have not seen any summer respite in NHS England. The worst performance in the summer was 80.8%; the best was 86.4%. NHS England is under pressure in the summer, and when winter is added on top of that, it is no wonder that we are talking about the situations that doctors, nurses, patients and relatives are describing to us.

My first health debate after my maiden speech in this House was an Opposition day debate on the four-hour target. At the time, I commented, and still maintain, that this target is not a stick for each party to hit each other over the head with, but it is a thermometer to take the temperature of the acute service, and it does that really well, because it measures not just people coming in through the front door but how they are moving through the hospital and out the other end. At the moment, the system is completely overheated. The comments about this not being anything unusual but just a normal winter, and everyone whingeing, show that the Government are not recognising the problem. The first step to dealing with any problem is to recognise it, because then we can look at how we want to tackle it.

[Victoria Atkins]

I remind the hon. Lady of the point the Prime Minister made in Prime Minister’s questions, which is that on the Tuesday after Christmas, A&E received the highest number of visitors it has ever received in its history. Does that not show the challenges facing the NHS both nationally and locally? These are extraordinary figures, and the Secretary of State is very much doing his best to help the NHS, with the professionals, to deal with them.

[Dr Whitford]

I totally accept that the NHS has been under inordinate pressure with, absolutely, the busiest day in its history, but given an ageing population that has been discussed for years, we should have been able to see this coming.

If, in the next couple of months, we get a massive flu epidemic, we are going to see things keel over. We have already had debates in this Chamber about STPs taking more beds away. I totally agree with the Secretary of State that part of the issue is that patients could be seen somewhere else. However, it is not a matter of changing the four-hour target and saying to someone who turns up, “You’re not going to count;” it is simply a matter of providing better alternatives. If we provide better alternatives, people will go to them. The House has discussed community pharmacy use, and it has been recognised that the minor ailments services we have in Scotland can deal with 5% to 10% of those patients. We have co-located out-of-hours GP units beside our A&Es, so someone is very easily sent along the corridor or into the next-door building if they need a GP and not A&E. We do need to educate the public, but the public will use an alternative service if it is there. If it is not, they know that if they turn up at A&E and just keep sitting there, eventually someone will see them, and we should not blame them for that.

[Toby Perkins]

The hon. Lady is right to say that we have an ageing population but that is predictable. Does she think it is also significant that in 2008 the UK was spending about the same as all the major EU nations, whereas the OECD now says that we are spending considerably less than most of the other major nations? Is that not actually causing this problem?

[Dr Whitford]

Money is not the only problem. I accept that part of it is about how things are done. The Secretary of State talks about variations and many hospitals performing well, but, as I said, only one trust is meeting the target and only nine are at over 90%, so it is not that the majority are doing well and a few are failing.

The ability to look at how we deliver the NHS is crucial, but change costs money. We must therefore invest in our alternatives so that our community services and primary care services can step up and step down to take the pressure off. One of the concerns about the STPs is that because people do not have enough money, a lot of them start by thinking that they will shut an A&E, shut a couple of wards, or shut community beds—even though those are what we need more of—to fund change in primary and social care. Then the system will fall over. We need to have double running and develop our alternatives and then we will gradually be able to send the patients there.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I always enjoy listening to the hon. Lady’s well-informed remarks. I agree that most people do not want to go to A&E if they can avoid it. Does she agree that part of the problem is that when people phone general practices, they tend not to be offered an appointment that they regard as being within a reasonable timeframe, or they cannot get to see the doctor with whom they are closely associated, which particularly applies to people with chronic and long-term conditions? As today’s National Audit Office report makes clear, we need to address that as a matter of urgency. Paradoxically, seven-day-a-week general practice may militate against being able to provide people with such continuity of care during core hours.

[Dr Whitford]

Many doctors in general practice would accept the argument for having access to a GP on Saturday morning, particularly for people who are otherwise at work. However, someone who cannot see their favourite doctor is very unlikely to go to A&E and wait eight hours to see a doctor they have never seen before in their life. This is not about that; this is about the fact that people feel they cannot find an alternative. If it takes three or four weeks to get any appointment with their GP and they do not yet have a community pharmacy offering such a service, they will eventually end up at A&E. It is therefore the service of last resort for people who go there and just stay there. We have to develop alternatives first, but as the hon. Gentleman says, no one in their right mind would choose to go and wait four hours in A&E if they could be seen in half an hour in a community pharmacy.

[Dr Murrison]

The hon. Lady is being very generous in giving way. I have to disagree with her, because winter pressures and the pressures we are seeing at the moment tend to involve not people with short-term, self-limiting conditions, but the chronically sick. Those people in particular, and with good reason, want to have a relationship with a particular practitioner who understands their needs and their family context. That is surely the essence of general practice.

[Dr Whitford]

I totally agree, but in fact the chance that their doctor will be on duty would actually be lower on a Saturday morning or a Sunday afternoon. One of the things we have done in Scotland with SPARRA—Scottish patients at risk of readmission and admission—data is to identify that 40% of admissions involve 5% of the patients. Those patients are all automatically flagged and will get a double appointment no matter what they ring up about, because it will not just be a case of a chest infection or a urine infection, but of having to look at all their other comorbidities.

That is the challenge we face; it is not a catastrophe of people living longer. All of us in the House with a medical background will remember that that was definitely the point of why we went into medicine, and it is the point of the NHS. However, we are not ageing very well. From about 40 or 50 onwards, people start to accumulate conditions that they may not have survived in the past, so that by the time they are 70 they have four or five comorbidities that make it a challenge to treat even something quite simple. My colleagues and friends who are still working on the frontline say that it is a question not just of numbers, but of complexity. Someone may come in with what sounds like an easy issue, but given their diabetes, renal failure and previous heart attack, it is in fact a complex issue.

That is part of the problem we face, and we need to look forward to prepare for it. We need to think about designing STPs around older people, not around young people who can come in and have an operation as a day case and then go away, because that is not what we are facing. Older people need longer in hospital, even medically, before they reach the point of being able to go home. It takes them a couple of days longer to be strong enough to do so. They probably live alone and do not have family near them, so they will need a degree of convalescent support and they may need social care. That is really where the nub of the problem lies. Social care funding has gone down, and therefore more people are stuck in hospital or more people end up in hospital who did not actually need to be there in the first place.

[Andrew Selous (South West Bedfordshire) (Con)]

On the frailties of older people, does the hon. Lady think that just as Scotland led the way with St Ninian’s primary school in Stirling introducing the daily mile, there is something we could learn from countries, such an Andorra, that have a real focus on exercise for older people, so that they are a lot less frail in their 70s and 80s?

[Dr Whitford]

The whole prevention and public health message is crucial, and that is one of our other challenges. I am very grateful to the Secretary of State for no longer talking about a figure of £10 billion, because the increase in the Department of Health’s budget is actually £4.5 billion. Part of that relates to the reduction in public health funding, just at a time when we need to move it on to a totally different scale. Whether that is children or, indeed, adults doing the daily mile—perhaps we should run up to Trafalgar Square and back every lunchtime, which I am sure would do us all a power of good—we need to invest in such preventive measures. One of my points is that when we end up desperate—patching up how the NHS runs, or dealing with illnesses we did not bother to prevent—we always end up spending more money.

[Graham Evans]

The hon. Lady knows how much I respect her and what she says. As the chairman of the all-party group on running, I endorse the daily mile and encourage all adults to do it. Park runs, which happen across the nation, are a good example. There is huge expertise in Scotland, so can NHS England learn from Scotland? What is best practice, and will she give us some examples of it in hospitals and hospital trusts in Scotland that we can take away and learn from?

[Dr Whitford]

The whole issue comes down to sustainability, which is obviously the idea behind the sustainability and transformation plans. As those who have heard me speak about STPs will know, I support the idea in principle. The idea is to go back to place-based planning on an integrated basis for a community. The difference in Scotland is that we have focused on integration. We got rid of hospital trusts in 2004, and we got rid of primary care trusts in the late 2000s—in 2009 or 2010. Since April 2014, we have set up integration joint boards, where a bag of money from the NHS and a bag of money from the local authority are put on the table and a group sit around it and work out the best way to deal with the interface and to support social care. Anyone in the Chamber or elsewhere with family members who have been stuck in hospital will know that people get into a bickering situation: Mrs Bloggs is in a bed so the local authority is not interested, because she is safe there, and the local authority is instead busy with Mrs Smith, who has fallen off a ladder trying to put up her curtains and who is not considered safe because she is leaving the gas on. Such boards get rid of all that perverse obstruction.

[David Rutley (Macclesfield) (Con)]

The hon. Lady is making an important point, and I welcome the tone that she, unlike the shadow Secretary of State, has brought to this debate. She makes the point that the integration of care—social and health—is important, but does she agree that, with further devolution to the sub-regions and major cities in England, there is a huge opportunity to move forward that agenda south of the border?

[Dr Whitford]

The whole idea of STPs is to go back to areas. We simply have geographical health boards—the only layer we have—so we are not wasting huge amounts of money on having layers and layers, which could be integrated. For an STP to work it must make sense geographically, which might be a county or something bigger or smaller. I think that they should be put on a statutory footing. We have 211 CCGs. There will be an average of six CCGs for every STP, so that is a waste of layers, and it will be very difficult to integrate.

One of the biggest differences is that, in 2004, we got rid of the purchaser-provider split. In the past 25 years, there has been no evidence of any clinical benefit from the purchaser-provider split, the internal market or, as it now is, the external market. It is estimated that the costs of running that market are between £5 billion and £10 billion a year. That money does not actually go to healthcare, but on bidding, tendering, administration or profits. We cannot have an overnight change, but if we simply made a principled decision to work our way back to having the NHS as the main provider of public health treatment and to integrate care through the STPs, we could reach a point of sustainability.

As I said earlier, we must protect things such as community hospitals and community services and, indeed, invest in them. Our health board has rebuilt three cottage hospitals as modern hospitals, because that is where we should put an older person who is on their own and has a chest infection, who just needs a few days of antibiotics, TLC and decent feeding. We do not want them in big acute hospitals; we want them to be close to home. The danger is that under the STPs people will see community hospitals as easy to get rid of, but that is an efficiency saving only if it gets rid of inefficiency. If we slash and burn, we will end up spending more money in the end.

[Victoria Prentis (Banbury) (Con)]

Much of what the hon. Lady says is music to my ears as somebody who is campaigning to save their local general hospital. May we have the benefit of her views on the role of consultation with patients and the wider community when sustainability and transformation plans are being considered?

[Dr Whitford]

Public consultation is important, and not just in the way it has often been done in the past—“We’ve made a decision, it’s a fait accompli, and we’re coming and telling you about it.” Unfortunately, that is very much what we have heard about the STP process, partly because it has been so short and partly, I am afraid, because it is about budget-centred care, not patient-centred care. Areas have been given a number and told, “If you’re not reaching this number, don’t bother submitting your plan,” and they are working back from that. That will not achieve an efficient, integrated service, so the public must be involved.

Frontline clinicians must also be involved. They work in a service and know exactly what the bottlenecks are and exactly what horseshoe nail is missing and holding a service back. If we have clinician-led redesign, such as I was involved in for breast cancer in my health board 17 years ago, we can track a patient’s path. We can quickly imagine ourselves as a patient, see the bottlenecks and focus investment on them.

I read an article yesterday stating that three hospitals in Manchester have spent £6 million on management consultants to say, “Shut a ward, sack hundreds of people and jack up the parking charges.” I am sorry, but that was not good value for £2 million each.

[Jo Churchill (Bury St Edmunds) (Con)]

I thank the hon. Lady for, as ever, eloquently expressing issues that face us all, no matter where we come from and who we are. Does she agree that having good healthcare data for clinicians enables patients to be put through the system seamlessly? Many individuals do not realise that their data do not go from their GP into acute care and then back into social care. If we could improve that—I make a plug for my private Member’s Bill on Friday—it would help patients.

--- Later in debate ---

[Dr Whitford]

I would not say that we are super IT wizards in Scotland, but we did not get involved in care.data, which unfortunately is a black shadow over the whole issue of NHS data in England, and now all our referrals are electronic, so nothing goes in the post. All our letters back are also electronic—I dock my dictation machine during a clinic, and when I finish I sit and check it, and the letters go off. After a Friday morning bad news clinic, the letters are on their way by 2 o’clock. A GP can email my colleagues and say, “I don’t know whether you need to see this person.” I have heard clinicians here in England say, “No, we can’t email about a patient.” Unfortunately, the wrong move that was made on care.data has ended up holding people back.

Our GPs in Scotland use a care summary. If they have a palliative care patient who has been accepted as being in terminal care, that patient’s care summary will be put on the out-of-hours system. If there is a call about the person, the doctor who goes to see them knows that they will not be throwing them in an ambulance but will be keeping them comfortable. The discussion has already been had, and the aim is for them to be at home. England has to gain the ability not just to analyse data at a later point but to share information as a first step.

In finishing off my speech—[Interruption.] I am sorry if I was taking too long for an hon. Lady at the back of the Opposition Benches. Integration is the key, and it is possible to get it through the STPs—but only if they are designed around patients, safety and services, rather than just starting with the bottom line and working backwards.

[Several hon. Members rose—]

--- Later in debate ---

[Sir Simon Burns]

I certainly agree that, under the leadership of the Department of Health, we should work with anyone and everyone to come up with a solution.

I was the Social Care Minister in the late 1990s, before we left office. Integrating health and social care was then at a very early, formative stage, and the ambitions were immense and tremendous. I am afraid that the reality has not matched the ambitious nature of what was being said in the 1990s, which is why I was particularly interested by the comments of my hon. Friend the Member for Totnes. Yes, we must think about that, but what we must also think about—let me push the funding element to one side for the moment—is building on the work of my right hon. Friend the Secretary of State for Health, particularly his investment in patient safety, the raising of standards, dignity for patients in our hospitals and throughout the health system, and the cutting out of waste and inefficiencies.

In 2010, when I was at the Department of Health for the second time, we had the Nicholson challenge, which was to save £20 billion over three or four years by cutting out waste and sharing best practice to improve the quality of care. I know from a debate that we had just before Christmas that the NHS achieved £19.4 billion of those savings. The beauty of that was not just that it created greater effectiveness and efficiency in the delivery of healthcare and the sharing of best practice, but that the Treasury did not receive £19.4 billion with which it could do as it wished. The £19.4 billion was reinvested in patient care.

[Dr Whitford]

Was not a significant proportion of that saving due to wage freezes for NHS medical and nursing staff? That is not something that can easily be repeated.

[Sir Simon Burns]

The hon. Lady is absolutely right. There was a wage freeze for those who were earning more than £20,000 a year, but that was in keeping with the policy throughout the public sector, which included Ministers and other Members of Parliament.

The important point is that it was possible to achieve that saving by a variety of means. One of them was a pay freeze, but others were improving the delivery of service, cutting out inefficiencies and ineffective ways of operating and getting rid of nearly 20,000 surplus managers, so that the NHS could concentrate on enabling clinicians, nurses, ancillary workers and everyone else to work on patient care. That is the right way forward, and we cannot give up on it. We must continue to think about where we can make savings.