NHS Efficiency

Dan Poulter Excerpts

Tuesday 2nd November 2021 Westminster Hall

[Paul Bristow (Peterborough) (Con)]

I beg to move,

That this House has considered NHS efficiency.

It is a pleasure to serve under your chairmanship, Sir Gary. I draw Members’ attention to my entry in the Register of Members’ Financial Interests.

Our NHS is in my DNA. Both of my parents were nurses and worked in the NHS for most of their working lives. It was the NHS that brought my family to Peterborough when I was just five years old, and I have worked in NHS policy for 20 years. My commitment to our NHS and its principles is clear. Few things inspire as much national pride as our national health service, and I want to keep it that way.

The NHS has lost its ranking as the best healthcare system in a study of 11 rich countries by an influential US think tank. Most worryingly of all, it fell to ninth when it came to healthcare outcomes. We must do something about this. We must ensure that the record investment that we are putting into our NHS is spent well. I suggest that that money should come with some very specific key performance indicators that would ensure that it is not wasted.

I feel strongly that the money should be in the gift of Ministers in the Department of Health and Social Care, who are accountable to Parliament, rather than NHS England or NHS Improvement. Like the Department for Levelling Up, Housing and Communities would do with a local authority that does not run a balanced budget or provide statutory services, the Department of Health and Social Care should be able to intervene directly, or at least provide incentives. Recipients would not get their share of the extra cash unless they addressed the challenge of access to care and improved outcomes.

I am keen to help Ministers. I almost feel thwarted, because progress on many of the things that I spoke about at the party conference last month have started to be reflected in Government announcements. That is obviously a good thing, but extra money must come with strengthened incentives to do the right thing and, quite honestly, consequences for not doing the right thing.

The first area in which we need to make progress is local NHS management. Local government has had to make a series of savings in recent years. Armies of local government managers all doing the same jobs in neighbouring local authorities have been an easy target for those defending the interests of taxpayers. However, local authorities have done rather a good job of sharing senior officers. For instance, the chief executive of Peterborough City Council is also the chief executive of Cambridgeshire County Council. As a former Hammersmith and Fulham councillor, I also remember the 2011 tri-borough shared services agreement in west London, between Westminster, Kensington and Chelsea, and Hammersmith and Fulham, which saved over £33 million in just four years. Labour-controlled Hammersmith and Fulham petulantly took their toys home a couple of years later, but the bi-borough arrangement is still saving the taxpayer millions, and this practice is replicated across the country.

That practice is unheard of in our NHS, but why is that? There are no reasons why NHS trusts and new integrated care systems cannot share officers and back-office functions. Let us do away with every NHS trust having its own specific CEO, finance director, human resources director, estates director or diversity director. It is not controversial to ask our NHS to learn from local government. If certain localities cannot make those management savings, are unwilling to share back-office functions, cannot look to make savings, why would we give them the extra cash? I suggest a KPI on a reduction in management costs and back-office costs. I think it would be warmly welcomed by the taxpayer and those in our NHS who know that money is wasted.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I draw colleagues’ attention to my declaration of interest as a practising NHS doctor. Does my hon. Friend agree that one of the challenges is attracting good expertise, perhaps from the business world, into the NHS and that that sometimes costs money and resources? While he is wishing, correctly, to make savings in back-office costs, we should not be too prescriptive because we need to make sure the best people are coming into the NHS, both from within and without, to deliver the productivity gains he desires.

[Paul Bristow]

That is a characteristically well-made point by my hon. Friend. In the current system, NHS chief executives spend 18 months in one trust, then travel to another, spend 18 months there and then travel to another. That is no time at all to get to grips with the challenges that these organisations face. We absolutely need people from the private sector to come in and do these jobs. If they were doing these jobs on a larger scale, that would be welcome. I am specifically requesting that we look to local government, where people have come in and transformed services. I suggest we do the same in our NHS.

My second point is on innovation and new ways of working. Innovation is the way an organisation develops. It should be a constant process—trying to do things better, improving outcomes for patients and trying to be more productive. Across the NHS there are those that innovate with new technology, those that adopt new pathways and service delivery, and clinicians who want to train and learn new techniques. However, the NHS can be poor at spreading best practice at pace and scale. Like any bureaucracy, it can be slow at looking at new ways of working.

There have been attempts to address this. We spent millions funding organisations such as Getting It Right First Time—GIRFT—under Professor Tim Briggs, which is a national programme designed to improve the treatment and care of patients and collect best practice. We created the National Institute for Health and Care Excellence—NICE—which, when it was created, was considered to be a model for the world to emulate on determining the cost-effectiveness of technologies and drugs. NICE also produces quality standards that set out priority areas for quality improvement in health and social care. After all this work has been done and all this money has been spent, many parts of our NHS just ignore it. They say things such as, “This can’t possibly apply to us,” or, “This is merely guidance, and we don’t need to do this here.”

The use of insulin pumps and implantable cardiac defibrillators or vascular technologies should not depend on where someone lives, but it does. The solution is certainly not to reduce GIRFT’s budget from £22 million to £10.8 million, but that is what has happened. GIRFT should be empowered to develop best practices in primary and community care, and we should look at the GIRFT model of hot emergency and cold elective centres to help us power through the backlog.

What is the solution? How do we make outliers adopt best practice and do the right thing? A KPI, and perhaps even GIRFT or NICE, can help us with technology and pathway adoption, which could transform productivity, powering us through the backlog. Backed up with an incentive such as a generous and workable best practice tariff, a KPI could focus attention. If outliers persist in a practice that has been shown to be outdated and to follow pathways that do not lead to optimum outcomes, why would we give them the extra money?

On capacity, staffing is recognised to be a risk factor in delivery for our NHS. The money is there, but it takes a long time to train a doctor, GP or nurse. That is why every hour of a medical professional’s time is valuable. We have to make sure that they are doing what they are paid for and what they went into medicine to do.

--- Later in debate ---

[The Minister for Care and Mental Health (Gillian Keegan)]

It is a pleasure to serve under your chairmanship, Sir Gary.

I welcome the idea and the timeliness of this debate. My hon. Friend the Member for Peterborough (Paul Bristow) has raised an important issue, and I know many hon. Members present have great experience of various parts of the NHS, including my hon. Friends the Members for Watford (Dean Russell), for Bosworth (Dr Evans) and for Central Suffolk and North Ipswich (Dr Poulter). I thank them for their contributions to the debate.

We all have a responsibility to taxpayers to make sure that the NHS uses its resources as effectively as possible. To do that, we need to ensure that productivity grows every year, which is why the NHS long-term plan includes financial test 2:

“The NHS will achieve cash-releasing productivity growth of at least 1.1% per year.”

I make it clear that increasing productivity does not mean making staff work harder or making cuts. It means getting the most out of every £1 the NHS spends, and making sure that as much as possible is spent on frontline care. It means doctors and nurses doing the tasks they are trained to do and that nobody else can do. It means buying the right drugs at the right price. It means more patients getting the right treatment in the right place at the right time. That is good for patients, good for clinicians and good for the taxpayer.

Thanks to the hard work and innovative mindset of many NHS staff, the NHS is regularly recognised as one of the world’s most efficient health systems, although I take the point made by my hon. Friend the Member for Watford that there are different ways of measuring efficiency globally. In fact, in the decade before the pandemic, productivity growth in the NHS was faster than in the wider economy, as was independently verified by the Office for National Statistics.

Furthermore, the UK spends only around 2% of healthcare expenditure on administration—we spend a lot on the NHS, but only 2% of it on administration—and managers make up only 2.6% of the NHS workforce of 1.35 million. They might be an easy target for criticism, but good managers are of course essential to making services work, and many of us will have had experience of that throughout our various careers. If there were no managers, clinicians would have to manage their own workforce, logistics, finances and websites, and spend less time with patients. None the less, we want to improve the quality of management further, which is why we have asked General Sir Gordon Messenger to lead a review of leadership in health and social care.

[Dr Poulter]

I refer to my earlier declaration about my entry in the Register of Members’ Financial Interests, as a practising NHS doctor. On the point that the Minister just made, of course we want to promote clinical leadership in the NHS in senior management positions, because we know that that benefits patients and leads to efficiencies, but we also need to consider the fact that although there are many good NHS managers, a lot of them have never had experience of life outside the NHS. I wonder whether my hon. Friend the Minister could briefly say how we can draw in better business experience and other experience, so that NHS managers have broader experience, and can bring that benefit to the NHS and drive efficiencies.