NHS Pay

Andrew Selous Excerpts

Wednesday 13th September 2017 Commons Chamber

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

I warmly congratulate the hon. Member for Portsmouth South (Stephen Morgan) on a polished maiden speech, and we all wish him the very best in his time in this House.

Conservative Members agree with what the hon. Gentleman said about the wonderful work that public sector workers do, not least in our NHS. The NHS saved my life when I was 24. I have two children heading to work in the NHS, one of whom worked as a healthcare assistant over the summer. Members of my family are also frequent users of the NHS.

Over the last few months, I have had the pleasure of spending a day at the Bassett Road GP practice in Leighton Buzzard, and I am full of admiration for the doctors and practice nurses I saw working there. I also spent time at my local hospital, the Luton and Dunstable, which has the best accident and emergency service in the country, and we are learning lessons from it all around the country, which are being spread by the Department of Health. Really importantly, I have also spent time with the social care staff of Central Bedfordshire Council and elsewhere, and seen the independent living schemes that will be key to the sustainability and transformation plans in my area.

In these debates, we seem to focus entirely on the top line of departmental budgets. In 2016-17, the Department of Health had a departmental expenditure limit of £120.6 billion and annually managed expenditure of £16.2 billion—£136 billion in total. We need to reflect on the words of Jon Thompson, a permanent under-secretary at the Ministry of Defence, speaking to the Institute of Government recently about the attitude, often, of Select Committee members from across this House:

“They seem to live in a resource unconstrained world…in the end I’ve got a limited amount of money and I have to prioritise.”

Those are words we need to hear.

There is another way to free up money within that £136 billion and improve outcomes for patients that could lead to our having more money for NHS staff— that is, to focus on improving quality, something that hardly ever gets a look-in in this House. If we look at the work that the Government are doing with the Getting It Right First Time programme, we see a 25-fold variation in infection rates for patients. Not only is going through that a deeply unpleasant experience for a patient, but the cost of surgical infections can vary from £75,000 to £100,000. If we get this right, not only do we treat patients better but there is more money to put into staff pay.

It goes on and on. Many hospitals are not using the right hip implants—they are using more expensive non-cemented hip implants. We get better outcomes with cemented implants that actually cost less.

[Dr Whitford]

It is really important that we are very careful about things that will be implanted permanently in a patient. We have had debates about mesh in this place, and we will be having debates about Essure, which is designed to obstruct the fallopian tubes and is also causing problems. Non-cemented implants are for younger people who may need another implant later on. I would be very careful—think of the PIP breast implants scandal—about cutting the quality of what is left in a patient.

[Andrew Selous]

I am talking about the data available in the national registry, now, for the first time ever, being properly compiled in every hospital. We should follow the evidence and look at the clinical outcomes, as the hon. Lady has done herself on the Health Committee.

Forty-five per cent. of surgeons are doing five or fewer complex hip and knee revisions, yet we know that clinical outcomes are better where surgeons do 35 or more a year. As a result of doing only a few operations with worse outcomes, which cost more, they also have to hire in expensive loan kits. Hospitals are spending, on average, some £200,000 a year on loan kits—some hospitals, £750,000 a year. Professor Tim Briggs, with whom I have had the honour of working over the past nine years on the Getting It Right First Time programme, said that

“there is no way right now I would ask for more money for the NHS. The waste and variation out there is unbelievable and we have got to get our act together across all the specialties to improve quality and unwarranted variation and complications. And it is not just orthopaedics.”

We are now, for the first time ever, looking at variations in litigation rates—huge amounts of money go out on litigation—in infection rates, and in revision rates. We are making progress, because litigation rates, which went up by 8% in orthopaedics in 2013-14, are down by 5% in 2014-15 and down by 8% in 2015-16.

This is a really powerful way to get better outcomes for patients and make sure that there is more money for NHS staff. That is exactly what the sustainability and transformation plans are there to do. As Simon Stevens has said, this is

“the biggest national move to integrating care of any major western country.”

If we can end our fragmented, silo-ed care through a massive expansion of out-of-hospital care, we will get better outcomes, save money, prioritise prevention, and keep patients out of hospital. If we do that, we will free up precious budget in order to pay NHS staff the decent rates we all want to pay them.