NHS (Government Spending)

Debate between Dan Poulter and Chris Leslie

Wednesday 28th January 2015 Commons Chamber

[Chris Leslie]

We have to do far more to create a joined-up health service and social care system. That is very much part of the 10-year plan for the NHS that we announced yesterday. Yes, this is a debate about resources and getting the investment in, but we have to do more than that.

I question why the Conservatives are not putting their plans for funding the NHS on the record. Is it that they do not have any plans to pay for it or, which is more likely, that they are committed to shrinking public service investment in this country? The Conservatives and the Liberal Democrats have signed off on projections that would shrink public services to just 35% of GDP by the end of the coming Parliament. [Interruption.] I say to the hon. Member for Daventry (Chris Heaton-Harris) that there was nothing in the charter for budget responsibility about shrinking the state to 35% of GDP. That is his plan. Public services have not been at that level since the late 1930s—before the NHS even existed.

That is the Conservatives’ vision, but what would it mean for the NHS? We are fortunate in this country that charging makes up just 10% of a patient’s out-of-pocket expenses. That includes prescriptions, optical services and dental services. Let us just look at how it works in those countries where public services form just 35% or less of GDP. There are four such countries across the OECD. In Switzerland, where public services make up 32.8% of GDP, more than a quarter of a patient’s income goes towards the cost of treatments. It has an insurance system in which the patient effectively pays an excess: as with a car insurance system, the patient has to pay the first amount and it is deducted from the total bill. Patients in Switzerland typically pay £1,800 out of their own pockets. In Mexico, charging makes up 44% of out-of-pocket expenses, in Chile it is 32% and in Korea it is 36%. Korea has a co-payment system, which means that up to half the hospital costs have to be borne by the patient.

Such things happen in every country where less than 35% of GDP goes towards public services. The Conservatives want to head us in the direction of such pressures. An NHS free at the point of use is not sustainable under the Conservative plans, and the risk that charges will be introduced is great.

The Conservatives have form on this issue, because their 2005 manifesto, which the Prime Minister and the Chancellor authored, encouraged people to go private. They wanted a patient passport that would have introduced charges for people who wanted to jump the queue. I wonder whether my hon. Friends recall that. The Prime Minister and the Chancellor wanted such charges for basic medical treatments. I have another question for the Minister and, again, I will give way to him. Would the Conservative party still introduce those plans in the dreadful event that they won the next general election? I will give way to the Minister if he wants to say that that is categorically not part of his party’s plans.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I am sure that the hon. Gentleman can be patient. I will reply to him in a few moments when he finishes his speech.

[Chris Leslie]

It was quite a simple question. The Minister could have dealt with it there and then, and pushed the matter to one side. I half expected him to do so. But no, that is not the answer he gave. Perhaps we are seeing the return of Michael Howard. The patient passport rears its head again.

What else can we expect from the Conservatives? More privatisation and more market-based changes.

--- Later in debate ---

[Dr Poulter]

My hon. Friend makes a very good point. The mansion tax, which is alluded to as a major plank of the Opposition’s funding plans for the NHS, has already been spent three times—that is economic incompetence if nothing else.

[Chris Leslie]

The Minister claims to be spending NHS resources effectively. Let us put to one side the £3 billion that he wasted on the NHS reorganisation—difficult though that is to do—and address the issue of clinical negligence in the NHS. My understanding is that it was at about 0.8% of NHS expenditure, but it has now gone up to an astonishing 1.1%. More than £20 billion has been set aside for clinical negligence provision because clinicians do not have the time they need to do the job and stop problems occurring. Should not the Minister apologise for that?

[Dr Poulter]

That is frankly not true and a misrepresentation of the facts. We have a very safe health service, and that was recognised by the Commonwealth Fund. We also know that even in a very safe health service bad things sometimes happen. This is not a controversial point: it is a sensible and important point. In some areas, such as obstetrics, we have very safe care in the main, but sometimes there can be a very high quantum of claims, such as £7 million for a lifetime of care in one case. We have to make sure that in the rare cases when things go wrong we look after people properly. That is uncontroversial.

The projected future trajectory for the litigation bill spend was exactly the same under the previous Government as it is now, and we are looking at dealing with lower value claims to save money on litigation in the future and removing the sometimes adversarial nature of litigation, which is much more beneficial for patients and their families.

[Chris Leslie]

To focus on the detail and take the politics out of this issue, I think that the Minister said that the clinical negligence bills have not gone up under this Government compared with those under the previous Administration. If he wishes to repeat those words, I am sure that his officials and others will correct him. Does he really think that there are no further clinical negligence liabilities under his watch?

[Dr Poulter]

The point is that the figures for the expected trajectory of clinical negligence were the same under the previous Government as under this Government. We know that even though the NHS and its front-line staff deliver safe and effective care in the main, the costs of looking after people—who may not previously have survived into adulthood, but do so now because care has improved—are now much greater. As a result, the quantum of settlements is sometimes greater than it used to be because our NHS is doing better at helping people, who previously might have died in childhood, to live longer. That means a greater lifetime of care costs, which the previous Government would have been familiar with when they looked at future litigation spending. We are, rightly, asking where we can save money on NHS litigation and we will announce soon the results of work on reducing the adversarial nature of low quantum claims, which will also benefit NHS finances.

As senior figures in the Labour party made clear this week, if the previous Labour Government had delivered efficiencies on the scale that we have delivered in our NHS, £40 billion more would have been available for front-line patient care. Let us remember that it was under Labour that £10 billion was wasted on a failed NHS IT contract; that hospitals were crippled by eye-watering PFI repayments, which currently total £2 billion a year; and that the pay bill for NHS managers doubled. Indeed, in the last year under the right hon. Member for Leigh (Andy Burnham), the number of managers in the NHS went up six times as fast as the number of nurses.

--- Later in debate ---

[Dr Poulter]

Frankly, the previous Government’s record on investing in mental health was woeful. To reassure the hon. Lady—I think it would perhaps be worth her noting the points I have raised—we have increased the mental health budget this year by £302 million. I will talk a little more about support for children with mental ill health later in my remarks.

We have also put a lot of investment and support into tackling perinatal mental health. By 2017, for the first time, mums will have specially qualified and trained staff in every birthing unit to provide support for perinatal mental health. [Interruption.] The hon. Lady says that is not treatment. I am a doctor. I work in maternity. It is absolutely right that we put in place the right support for perinatal mental health. I am sorry, but frankly that is misunderstanding the clinical reality of what it is like to look after patients. It does the hon. Lady—and those on the Opposition Front Bench—a great disservice.

At a time of continued pressure on the public finances, the additional funding announced by the Chancellor in the autumn statement further highlights the priority the Government place on our NHS. The extra money we have provided will enable our NHS to continue to meet significant and rapidly rising patient expectations and demands in the short term, while allowing us to make important investment in new models of community-based care in order to realise the vision set out in NHS England’s “Five Year Forward View”.

The Government’s commitment to our NHS is clear. By ensuring a strong economy, we will also ensure that our NHS remains sustainable in the long term as a health service that is free at the point of need and of use—the health service we all believe in.

[Chris Leslie]

Because I’m a doctor.

Health

Debate between Dan Poulter and Chris Leslie

Wednesday 26th February 2014 Ministerial Corrections

[Chris Leslie]

To ask the Secretary of State for Health what his Department's 10 largest contracts let since the financial year 2010-11 are; what savings have been made in such contracts; what the level of overspend or underspend was in each such contract; and what steps his Department has taken to monitor the performance of each supplier of such contract following the contract award.

[Official Report, 21 January 2014, Vol. 574, c. 146-7W.]

Letter of correction from Dr Daniel Poulter:

An error has been identified in the written answer given to the hon. Member for Nottingham East (Chris Leslie) on 21 January 2014.

The full answer given was as follows:

[Dr Poulter]

The 10 largest contracts that have been let by the Department since the financial year 2010-11 are as follows: