NHS Specialised Services

Debate between Bob Russell and Stephen Gilbert

Thursday 15th January 2015 Westminster Hall

[Stephen Gilbert]

The hon. Lady is entirely right. I will continue to set out the case that she so powerfully makes from personal experience.

In a board paper last November, NHS England published its next steps on specialised commissioning. Frankly, that was to the dismay of patient organisations, some of whom have been involved with specialised services for more than a decade, yet none was contacted or engaged with about the paper’s contents. It set out several principles for co-commissioning, perhaps the most alarming of which was the intention to move towards population accountability and lay the groundwork for place-based population budgets. That would essentially represent a return to the status quo ante under primary care trusts and, therefore, contravene Parliament’s wishes as embodied in the Health and Social Care Act 2012.

In particular, budgets allocated to local populations will usher in that patchwork quilt of provision for patients throughout England that hon. Members have referred to, with varying standards of care to match. NHS England suggests that its national standards would continue to apply, but experience shows that that would be untenable. The history of the PCTs is likely to be repeated, with the clinical commissioning groups going their own ways.

Despite opposition from key stakeholders, which I will touch on shortly, NHS England seems determined to implement its proposals. In December it took the unprecedented step of publishing notional local allocations of its own specialised commissioning budget. The sums have already been done and NHS England is now showing local CCGs the sheer scale of the budget that it expects to make accessible to them. Remarkably, only £1 billion of the £14.6 billion of allocated expenditure for 2015-16 is exclusively for national commissioning. Therefore, more than £13 billion of services that are currently commissioned nationally will be subject to co-commissioning. That is a huge transfer of resources and responsibility in the making, which surely requires prior, not retrospective, parliamentary and public scrutiny. Remember: that is funding for complex heart surgery, teenage cancers and chronic liver and blood diseases that affect some of the most vulnerable people in our community.

Why is this move so risky? First, we can say with certainty that local commissioning of such services does not work. As I alluded to already, before April 2013 responsibility for those services was with local commissioners. The 2006 Carter report brought about significant improvements, but the results remained mixed at best. The Select Committee on Health produced a report on commissioning in March 2010 that reviewed local primary care trusts’ performance in funding specialised services. It found that

“many PCTs are still disengaged from specialised commissioning…In addition, specialised commissioning is weakened by the fact that as a pooled responsibility between PCTs, it sits in a ‘limbo’, where it is not properly regulated, performance managed, scrutinised or held to account.”

In view of NHS England’s intention to move towards place-based budgets, it is also worth quoting the Committee’s remarks on the

“danger that the low priority”

given to specialised services by local commissioners

“will mean that funding for specialised commissioning will be disproportionately cut in the coming period of financial restraint.”

Perhaps because of that, patients’ groups and others have been emphatic in their opposition to local control of the specialised budget. Last year, the Specialised Healthcare Alliance, a coalition of more than 100 patient-related organisations and 15 corporate members that has campaigned on behalf of people who use specialised services for more than a decade, ran a survey of more than 100 representatives of patient groups, companies and expert clinicians that sought views on potential changes to commissioning arrangements for specialised services. It found that 90% of respondents preferred their service to remain part of specialised commissioning at a national level and none favoured leaving specialised commissioning arrangements. It also found that 82% favoured either no change to commissioning responsibilities for their service or for more of their service to be incorporated within specialised commissioning. Only 9% opted for more commissioning responsibilities to fall to CCGs. On co-commissioning, while respondents were open to collaboration between NHS England and local commissioners, only 15% would be happy to see that include pooling of budgets with CCGs.

I am grateful to the Muscular Dystrophy Campaign, the British Kidney Patient Association, the Cystic Fibrosis Trust, the Motor Neurone Disease Association, the Association of British Pharmaceutical Industry, the Royal College of Physicians, the NHS Clinical Commissioners, NHS Providers, the Medical Technology Group, AbbVie and Novartis for engaging with the debate. Uniquely, all the groups that have been in discussion with me share my concerns about the timing and content of these proposals.

Despite the clear views being expressed by the patient community and others, neither NHS England nor the Department of Health has opened any consultation on the developments. No stakeholder events have been held and NHS England has not even published full and explicit details of its plans for co-commissioning.

Given the magnitude of the plans, I hope that my right hon. Friend the Minister will give us assurances today. I ask for specific guarantees to satisfy the concerns that have been raised with me. First, will he commit to ensuring that NHS England will remain the sole budget holder for specialised services? Specifically, will he commit to that not just for 2015-16, but for the years that follow? That is crucial to clear accountability and consistency in those specialised services.

Secondly, will the Minister guarantee that national service standards and clinical access policies will remain in force throughout England, with no variation from the core standards permitted? Again, will he specifically give these assurances not just for 2015-16, but for future years?

[Sir Bob Russell (Colchester) (LD)]

My hon. Friend has been making a powerful case. As he draws to a close, will he join with me and agree that the work of the Prescription Charges Coalition is associated with his comments? Many people with lifetime illnesses and conditions are being subjected to paying prescription charges.

[Stephen Gilbert]

I thank my hon. Friend for his remarks, which are exactly on the money. Every organisation that I engaged with expressed real concern about the proposals. He puts on the record a further organisation that shares concerns on the direction in which NHS England is taking specialised health services.

Will the Minister give a commitment to openness, transparency and public engagement? The Government so often talk about that, yet NHS England has failed to demonstrate it. Will he also promise that any changes to specialised commissioning, including co-commissioning or collaborative commissioning, will be consulted on with patients, providers and the public before they are implemented?

In its leader article this week, the Health Service Journal asks whether specialised services should “pay the price” of NHS changes. It suggests that while that may be NHS England’s strategy, key decisions are being shunted until after the election to keep them out of the spotlight. I submit that this matter is too important to the House for us to see it treated in such a way. We all know that the NHS faces challenges, including those in specialised commissioning, but a policy of stealth is no way to proceed.

I leave the final word to my constituent, Nicola Hawkins, who has been on renal dialysis for eight years and secured more than 35,000 signatures to a petition about plans to remove renal dialysis from specialised provision altogether. She is just one of tens of thousands of people who will be affected. She says:

“I am a single mother of a 13 year old girl, I work full time hours to try and pay the mortgage and I am really struggling. I don’t understand why the changes are being made and I don’t know what the impact will be on my life. I’ve tried to engage with Government but heard nothing back, despite a 35,000 name petition. I don’t have an explanation of why the changes are happening or what they mean for me. I am worried that these changes could mean negative consequences for my health and wellbeing, my ability to support my family and that my care will fall to local GPs who don’t have expertise in my condition. I’m confused about the changes and frightened about the future.”

The changes are happening too fast and without proper consultation. Almost unanimously, they are seen to be a backward step. Nicola and the tens of thousands of people like her throughout our country deserve better.

HEALTH

Debate between Bob Russell and Stephen Gilbert

Thursday 20th December 2012 Commons Chamber

Sir Bob Russell (Colchester) (LD)

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These are difficult times for local councils, and with further financial constraints confronting them, I pay tribute to the councillors of all political persuasions and officers who find themselves in ever more difficult situations. This is not an experience that I faced as a council leader, but one thing I do understand is the importance of ensuring that public money is not wasted or used for purposes that are inappropriate for a local authority or ultra vires under local government legislation.

In the hope that the Department for Communities and Local Government will pursue the matter with vigour, I bring to the House’s attention the extraordinary situation involving the former leader of Essex county council, whose exploits have been much publicised in recent weeks in local newspapers and on local radio, and in some national newspapers. It has been revealed that, from March 2005 to January 2010, he spent £287,000 using the council tax payer-funded credit card that he had been issued. That equates to a rate of more than £1,000 every week for five years, all tax free. Items of expenditure included 62 overseas visits to such places as Uganda, New Zealand, China and the United States—not places normally associated with the local government activity of Essex county council—often accompanied by council officers and councillors.

I can now reveal, thanks to a Freedom of Information Act request that I made to the council, that the same leader first had a credit card issued in “mid-2002”. On the assumption that his spending pattern in the years from 2002 onwards was the same as that in the five years following the first published item on 9 March 2005—£89.21 for a lunch at the Barda restaurant in Chelmsford for the leader and an unnamed county councillor—it is likely that the leader’s credit card spending to fund his lifestyle of expensive tastes in the UK and overseas, paid for by Essex council tax payers, was in the region of £450,000. His last entry, funded by the good people of Essex, was on 27 January 2010 when, with an unnamed county councillor, he billed £77 for lunch at the Loch Fyne restaurant in Chelmsford. Last week, a motion was put forward at a meeting of Essex county council in respect of the credit card bills of the former leader, who resigned from the council in 2010, but it was not agreed.

I can perhaps best describe what happened by quoting distinguished journalist Mr Simon Heffer, who is a council tax payer in Essex, from his column in the Daily Mail of Saturday 15 December:

“Tory-controlled Essex County Council decided this week not to sue their disgraced former leader…for the £287,000 of ratepayers’ money he spent flying around the world with cronies and dining in style. This is a rash move. In four and a half months, the council is up for re-election. I am appalled that Essex Tories have such a cavalier view of financial accountability. Anyone who votes to put them back into office next May is mad. Did they take this view…because some of them, too, have things on their conscience?”

Simon Heffer may say that; I could not possibly comment.

In fairness, the current leader is a breath of fresh air. He was issued with a credit card on taking over in May 2010, and it was cancelled in August 2011 having never been used. That shows how much the previous leader abused his position and took Essex council tax payers to the tune of circa £450,000 to fund his expensive tastes and lifestyle. It is also fair to say that a new broom at county hall has ensured that new procedures will not allow such a situation to happen again, but it is not enough to clear up the stables—although pigsty might be a more appropriate description.

What has happened needs to be investigated. As the council is not prepared to have an independent investigation—I believe that is important; otherwise all county councillors will be tarred with the same brush—it must be for central Government to do so. Unless there is an independent inquiry, the stench will remain. That is not in the interest of Essex county council, its councillors and officers—a whitewash is not acceptable.

It is difficult to believe that the former leader was able for eight years to live the life of Riley paid for by Essex council tax payers, without others knowing. After all, many of the credit card bills refer to the leader being accompanied more often than not by officers and councillors. Why did the internal audit not notice the monthly credit card payments and ask questions? Why did the external audit not notice and ask questions?

On 17 October last year, a council spokesman said:

“All employee expenses are subject to audit and public scrutiny”—

but not, presumably, those of the former leader. How is it that the entire finance department and line management within it, leading in due course right into the office of the chief executive, did not notice and draw attention to it? Or is it the case, as has been put to me, that some people did try, but that there was a climate of fear and bullying at county hall? People were afraid to speak out for fear of losing their jobs. This attitude was not confined to the leader, as some councillors and some senior officers were involved. Only an independent inquiry can get into that barrel of apples to identify any rotten ones that are still in place.

I have been advised by a lawyer that he is prepared, at no personal cost to himself, to look at the paperwork and help draft a claim against the council and its officers for an apparent, and I quote,

“breach in fiduciary duty to Essex ratepayers who are owed the opportunity to see these matters rectified.”

It is said that the credit card records from 2002 to 2005 have been destroyed, but I believe the council’s records should still show the total credit card sums claimed by the former leader, even if the individual items cannot be listed. Perhaps the credit card company’s records exist, which an independent inquiry could look at.

The roll-call of countries visited by the former leader between 2005 and 2010 could well make him Britain’s most travelled politician. At 62 visits, that is probably more than the Prime Minister and Foreign Secretary, and it is certainly not what one would expect of the leader of a local authority. Usually with at least one officer, his Cook’s tour reads as follows: United States of America, eight times; Belgium, 15 times; Poland, twice; Croatia and Sri Lanka, twice; Cyprus, Bulgaria and Austria, three times; France, three times; Slovakia and Italy, three times; China, six times; Hungary, Germany, Holland and India, three times; Australia, New Zealand, Uganda, Hong Kong and Finland, twice; Vietnam, Albania and the Bahamas, ending with his last overseas trip to Canada. In December 2005 Essex council tax payers funded the leader, a councillor and an officer to attend the winter Olympics in Italy at a cost of circa £1,400.

Perhaps an example of the leader’s extravagance is a visit he made, accompanied by a council officer, to Hungary on 17 May 2006 for a one-day meeting described as the “First Assembly of European Regions”. Putting to one side the fact that the wonderful county of Essex is not a region, which begs the question why he was there in the first place, the visit was stretched out over a total of five days and involved staying in three separate hotels—two in Budapest, which is 230 km distant from where the one-day conference was held, one of them five-star, with the other described as “art-nouveau extravagance” and “the World’s most famous spa”—having expensive meals at restaurants and hiring a car. This is a grand total, including flights, of £1,530.

Other interesting entries, completely contrary to local government rules and expenditure legitimacy, relate to the council leader using his credit card to pay for attendance at Conservative party conferences for himself and up to three officers of Essex county council, including their travel and hotel accommodation costs. One of his popular watering holes was an establishment in Chelmsford called Muddy Waters where in December 2007 he treated county officers to a meal, paid for by council tax payers, which came to £736. In July 2008, he claimed £42.94 for a Little Chef breakfast. I know that the Little Chef Olympian breakfast is good, but I think customers can get four for the price he paid, as he pigged himself into some sort of record book. Another interesting item is the £327.50 he paid for

“gifts purchased for Transformation Awayday”

from the Crooked House gallery in Lavenham, Suffolk.

That list surely in itself comprises an appalling betrayal of the people of Essex by the then leader of the council, but I must now refer to a further abuse. Throughout this period, the leader was also based at another establishment for which five full-time employees of Essex county council had security passes. A sixth, listed as his secretary in the directory of this other establishment, was actually based at county hall, and taxpayers paid all the office costs. When not on council business, the leader was frequently chauffeured here and there at all times of the day and into the early hours by a car and driver provided by the council. The five council officers were providing services that were not part and parcel of the leader’s position with Essex county council, but the council tax payers of Essex were paying all the costs. It is difficult to estimate what they amounted to over what was an eight-year period.

Stephen Gilbert

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Does my hon. Friend agree that these outrageous claims must be properly investigated?

Sir Bob Russell

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I am most grateful to my hon. Friend.