Health and Social Care (Re-committed) Bill
Debate between Dan Poulter and Owen Smith(13 years, 2 months ago)
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Owen Smith
I am ever so grateful to the hon. Lady for that intervention, because it is profoundly rich for anybody on the Government Benches to suggest that we should prevail upon an independent organisation to publish the instructions that it offered to an independent QC, when the Government will not even publish the independent advice that they have commissioned. They have refused to do so repeatedly. They will tell us that they do not agree with this independent opinion, but they absolutely will not publish their own. I suggest that she makes representations to those on her Front Bench, and I will do the same to 38 Degrees if I have a chance.
The independent legal advice goes on to say:
“Encouraged by the structure and clear intention of the Bill to give consortia autonomy from the Secretary of State,”—
which is, of course, in clause 4 of the new Bill—
“there is a real risk of an increase in the ‘postcode lottery’ nature of the delivery of some services, depending on the decisions made by consortia.”
That increase in the postcode lottery takes me on to the second set of proposals that I wish to touch on, which we believe would stop the Government effectively legislating to hardwire the postcode lottery into our NHS. We accept that it is already too variable across the country and that there needs to be greater equity and standardisation, with excellence provided to everybody across the country. That will become all the more difficult with the new provisions.
New clauses 10 and 11, which were tabled by the Labour Opposition, are designed to combat some of the possible malign consequences of the changes that hand to clinical commissioning groups the ability to determine the needs of the local health population and to set their priorities without interference or support from the Government, or indeed from regional strategic health authorities.
Owen Smith
I am delighted to give way to the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who has such an acute interest in Wales.
Dr Poulter
The hon. Gentleman is making some good points. Does he accept that within a national framework of gold standard and good treatment, there will be regional or local variations in the needs of patient groups? For example, given health care inequalities, mental health and the higher rates of cardiovascular problems in ethnic minority populations, patients in Bradford may have very different health care needs and priorities from patients in the area of rural Suffolk that I represent. Does he agree that the Bill goes some way towards allowing local flexibility that will better address some of the different local health care needs?
Owen Smith
I accept that there are obviously different needs and that there is a good case for a needs-based assessment model being used by PCTs in the current situation or by CCGs. Indeed, one of the amendments tabled by Liberal Democrat Members on a needs-based assessment is excellent and I wish that we had tabled it. However, the crucial difference, which I alluded to earlier, is that previously the Secretary of State has had a direct duty under section 3 of the National Health Service Act 2006 to provide and secure a whole range of relevant and necessary pieces of the health ecosystem, such as hospitals, within a given area. Under the Bill, that duty will pass to clinical commissioning groups. That is a further crucial removal of responsibility and accountability from the Secretary of State and transference of them to CCGs.
Under the aegis of the Bill, many CCGs may well plan well for their local population, and perhaps better than primary care trusts, but what if they do not? What if they get it wrong and determine for clinical reasons—or, dare I say it, because in this new world they are sitting cheek by jowl in the boardroom with commercial players who have a stake and a skin in the game financially—that they no longer feel it is “reasonable”, as the Bill puts it, to provide certain services? I think that is perfectly foreseeable.
We already know that because of the cost pressures that PCTs are under, they are having to make difficult decisions about which services they will provide and which they will not. They have always had to do that. It is just possible that CCGs will make duff decisions with which local residents disagree. As we heard earlier from my hon. Friends on the Back Benches, they will not be able to be held to account in the way that the Secretary of State, and eventually PCTs through the Secretary of State, can currently be. Those changes are critical, and I suggest that the Minister reflects on them.
Another crucial change to the Bill that we would like to be brought about is in respect of the costs of bureaucracy. We are changing from 150 PCTs to more than 250 clinical commissioning groups and counting. The latter are smaller and less strategic, and certainly less experienced in commissioning, than PCTs or strategic health authorities, and they are arguably too small to compete equitably with very large and financially powerful foundation trusts. That is a real risk. Crucially, they will also increase transaction costs, bureaucracy and administration costs.
That is why, in new clause 11, we have decided to ask the Government to put their money where their mouth is. The Minister asked earlier why we had chosen an “arbitrary” figure of 45% for a cap on the volume of expenditure on administration by CCGs. The answer is simple: it was the number that the Secretary of State came up with. He said that that was how many percentage points he was going to trim off the administration and bureaucracy costs of the NHS. He boasted that he could deliver 45% savings, so we are calling on him today to put his money where his mouth is and legislate for that. Let us measure him against that, because there is not going to be much else that we can hold him accountable for.
We have tabled new clause 10, on waiting times, because targets and standards absolutely matter in the NHS. No matter what the Government keep telling the public, we still believe in clinical targets, including some that the Government would denigrate as “bureaucratic” or “administrative” targets. In new clause 10, we ask the Government to take the power to set transparent regulations relating to waiting times. Waiting times are going up under this Government. There have been 400,000 people with long waits since the Tories came to power. The trajectory and the sense of history repeating itself are depressingly clear to me and my hon. Friends.
NHS Reorganisation
Debate between Dan Poulter and Owen Smith(13 years, 8 months ago)
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Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
It is a great pleasure to speak after the great tour de force that we heard from my right hon. Friend the Member for Charnwood (Mr Dorrell). He dispelled a huge number of the myths that the Opposition have been trying to put forward today and during our entire Committee proceedings on the Health and Social Care Bill—one would almost believe that they had not been in power for the past 13 years. It is clear that one of the main reasons why we need to reform the NHS is not just to build on what the previous Government have done in terms of using private sector providers, but to make sure that we put a lot of things right. We are cutting bureaucracy and putting more money into front-line care—that is one of the main purposes of the Bill.
Before I develop my arguments about bureaucracy, I wish to pick up on what my hon. Friend the Member for Gainsborough (Mr Leigh) said in his intervention. He talked about the challenges of dealing with an ageing population. This country undoubtedly faces a big problem in providing health care as a result of many people living a lot longer, although that is a good thing. A lot of people have multiple medical comorbidities as they get older and they need to be looked after properly. The key financial challenge to the NHS is in ensuring that we look after our ageing population, and properly resource and fund their care, so when we cut bureaucracy and put more money into front-line patient care, that is what that is about.
When we talk about the need to ensure that the NHS has local health care and well-being boards—an NHS that is more responsive to local health care needs—it is a response to the fact that some parts of the country, such as, Eastbourne or my county of Suffolk, have an increasing older population, who need to be properly looked after in terms of funding. That is why it is so important that this Government have committed £1 billion to adult social care and are increasing that. It is also why we are putting an extra £10 billion into the NHS budget over the lifetime of this Parliament—the Labour party would not have done that.
On bureaucracy, it is worth reminding the Labour party of a few things it did when it was in power. Under Labour the number of managers in the NHS doubled. In 1999, there were 23,378 managers and senior managers in the NHS, but that figure had almost doubled by 2009, having increased to 42,509.
Dr Poulter
The hon. Gentleman might wish to listen to this, but I will take his intervention.
Owen Smith
The hon. Gentleman has returned to this point about bureaucracy many times during our proceedings in the Public Bill Committee. Does he not share my concern about our shared ignorance as to how many managers and how much bureaucracy there will be under the new structure in the GP consortia and in the regional presence of the national commissioning board? Does he know what bureaucracy there will be under this Bill, because I do not?
Dr Poulter
What we do know—the hon. Gentleman would do well to listen to this—is that the NHS currently spends £4.5 billion on bureaucracy, and that could be better spent on patient care. Under the previous Labour Government PCT management costs doubled by more than £1 billion to £2.5 billion, and that money could be better spent on patient care. By scrapping PCTs, we will have more money to give to GPs to spend on patients and front-line care, and that can only be a good thing.
Labour Members would do well to listen to a few more of the statistics on NHS bureaucracy that I am about to read to them. Under Labour, the number of managers increased faster than the number of nurses in the NHS. How can that possibly be right? Managers were paid better than nurses in the NHS. In 2008-09, top managers in NHS trusts received a 7% pay rise whereas front-line nurses received a rise of less than 3%. The Labour party was obsessed with bureaucracy, management and top-down targets, and we would much rather see that money spent on patients and front-line patient care.