NHS (Public Satisfaction)

David Anderson Excerpts

Wednesday 30th March 2011 Westminster Hall

[Tony Baldry]

Again, that is a slightly bizarre argument from the hon. Gentleman. There has been much talk about competition in the NHS, which is surprising as the Labour party appeared to be in favour of competition in its own election manifesto. The coalition Government have made it clear that the only competition that will exist in the NHS is competition on quality, not price. The Secretary of State could not have made that clearer in the House when he said:

“At the point when a patient exercises choice or a GP undertakes a referral, the price of providers will be the same. By extension, competition must be on the basis of quality.”—[Official Report, 16 March 2011; Vol. 525, c. 387.]

To deal with another misrepresentation, EU competition law already exists and the health reform proposals do nothing to change that. They do not, in any way, extend competition law. The Bill makes it absolutely clear that any competition can only be on quality, not on price. In any event, I find it strange that the Labour party and others suddenly seem to be coming forward to express concerns about the private sector in the NHS, when it was the previous Labour Government who, for example, in Banbury set up a privately run, privately managed, privately owned independent treatment centre and a privately managed, privately owned independent Darzi GP centre. The previous Labour Government, bizarrely, gave the private sector—because their contracting was so poor—some £250 million for operations that were never carried out. However, given that they have left the NHS with an overdraft of £60 billion, I suppose that they would consider £250 million thrown away on operations that were never actually carried out as, possibly by their standards, small change.

We have to realise, with an ageing population, more extensive treatments and new drugs becoming available, that we have to tackle bureaucracy in the NHS. We need to reform the NHS to make sure that it is as efficient and as effective as possible. We are ensuring that patients have choice—choice based on quality and from whom they receive care. There is simply no issue on this, in that the Labour Party said in its manifesto at the general election, and I am sure that the hon. Member for Leyton and Wanstead has read it:

“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality”.

We have made it absolutely clear, under the coalition Government, that the NHS will remain free at the point of need, paid for from general taxation, and be based entirely on need, not on the ability to pay. Those are fundamental principles of the NHS. They have been fundamental principles of the NHS ever since it came into being, and the coalition parties are, I am sure, determined not to undermine, in any way, any of the rights in the NHS constitution. Indeed, the coalition Government are seeking to protect the NHS, throughout the duration of the Parliament, by increasing NHS funding by £10.7 billion. A substantial number of GP groups, all over England, have volunteered as pathfinders to demonstrate how GP commissioning can work. GPs throughout Oxfordshire are coming together to form a suitable GP consortium.

Let me tell the House what is being said by those in my constituency who are involved in the GP consortium. Local GP Dr Judith Wright, who is co-ordinating the north Oxfordshire GPs, has said:

“Andrew Lansley’s proposals will give power to local GPs to decide how that budget should be spent to meet local health needs. Priorities will be decided by doctors through a process informed by patients, local authorities, public health and secondary care”.

Dr Wright went on to observe:

“I believe that GPs are best placed to be able to meet this challenge. Collectively they know the health needs of their local population. They can act as a catalyst for change. They will have a role in deciding the destination of local services and the route to get there.”

Andrew McHugh, who is the practice manager at Horsefair surgery in Banbury, observed:

“The health budget is a finite resource. Andrew Lansley’s proposals will give power to local GPs to decide how that budget is spent in order to meet local health needs. Priorities will be decided by doctors through a process informed by democratically accountable public and patient involvement. We need to be looking for innovative ways of spending the health budget wisely.”

In a recent issue of Prospect magazine, Ali Parsa pointed out that, as a nation:

“We used to spend 3 per cent of our GDP on healthcare in the 1980s…6 per cent in the 1990s, 9 per cent now and on our way to 12 per cent.”

In the current financial climate, that is unsustainable. Business as usual is not an option. We need to review what treatments are provided to ensure they are clinically effective and cost-effective—in other words, evidence-based practice. I think that Dr Judith Wright and Andrew McHugh’s comments are extremely balanced and sensible.

[Mr David Anderson (Blaydon) (Lab)]

I just came from a meeting of the British Medical Association about two hours ago. Its members asked me very clearly to pass this message on to the party on the Government Benches: will they please stop using the fact that GPs are becoming involved to suggest that they support the moves? They see becoming involved in terms of having no alternative—they say that it is being forced on them and that they are becoming engaged in the interests of their patients, not because they believe in what is being done.

[Tony Baldry]

May I suggest to the hon. Gentleman and to others that they actually start listening to what is being said? They might start by noting what was said in their own election manifesto. They might start listening to what the Prime Minister and the Secretary of State are saying on the Floor of the House of Commons, and the hon. Gentleman might as well do them the courtesy of just listening to what GPs in my constituency are saying on the record. It is clear that he is not listening. If he wishes to have a dialogue of the unlistening, that is a matter for him. The changes that the NHS needs are straightforward: less waste, more involvement, power to GPs and front-line doctors, nurses and other health professionals, and putting patients first. There is not really an intellectual divide on this matter. Indeed, the shadow Secretary of State earlier observed:

“The general aims of reform are sound—greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes”.

I could not have put it better. As for less bureaucracy, ever since the coalition Government came to office, one of the things they have cut in the NHS is bureaucracy. That has resulted in 2,000 fewer managers since the general election, but, interestingly, 2,500 more doctors.

I have every confidence in the Secretary of State for Health. He and his ministerial team, while we were in opposition, took considerable efforts to visit Banbury on a number of occasions to understand the challenges being faced by the Horton general hospital and to meet with GPs. As he observed to local GPs before the general election, GP commissioning will enable those GPs in north Oxfordshire, south Northamptonshire and south Warwickshire who wish to send their patients to the Horton hospital to do so, confident that the money will follow the patient.

Again, I do not think it surprising that the shadow Secretary of State should have observed:

“No one in the House of Commons knows more about the NHS than Andrew Lansley—except perhaps Stephen Dorrell. But Andrew Lansley spent six years in Opposition as shadow health secretary. No one has visited more of the NHS. No one has talked to more people...in the NHS…these plans are consistent, coherent and comprehensive. I would expect nothing less from Andrew Lansley.”

If Opposition Members are not willing to listen to me, perhaps they would be willing to listen to the shadow Secretary of State.

The Secretary of State, when in opposition, visited my constituency at least three times, and I believe I am correct in saying that every member of the Government ministerial team in the Commons visited my constituency at least once, to understand the challenges and needs of hospitals such as the Horton. The Royal College of General Practitioners said that it believes that there should be more clinical commissioning. Even the British Medical Association has confirmed that it believes that GP-led commissioning is the right way forward. Indeed, the only opponents to the proposals appear to be the Labour party and the trade unions, but, given what the Labour party did when it was in office, and what it stated in its manifesto and even more recently, one can only conclude that, now that it is in opposition, it seeks to jump on every passing bandwagon, feels obliged to say whatever will keep the trade unions happy and seeks to block every sensible reform.

The views of the trade unions on all of this are as depressing as they are, perhaps, predictable, and in the category of trade union I also place the BMA. It is right to recall that the BMA opposed GP fundholding, longer opening hours for GP surgeries, which clearly would have been for the benefit of patients, and foundation hospitals. In fact, I cannot think of a single NHS reform over the years which it has not opposed, or a single one on which it has been in the vanguard.

No one pretends that health care systems around the world are facing anything other than enormous challenges. That is no less so in the UK. We need to be sure that patients and taxpayers get the best value possible for every pound spent in the NHS. We need the best possible outcomes in the NHS, whether for stroke victims, heart attack victims or those who have long-term medical conditions. The reforms are about building on the strengths of the NHS, improving it and making it better able to tackle the challenges of the 21st century. That is how we will ensure that people will rightly continue to be supportive of, and satisfied and happy with, the NHS, which we all want to be the best possible health service in the world.

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[Mr David Anderson (Blaydon) (Lab)]

I congratulate my hon. Friend the Member for Leyton and Wanstead (John Cryer) on getting this debate. Like the hon. Member for Banbury (Tony Baldry), I stand here as the son of a nurse, though she stopped work before the NHS was created. Through her lifetime she saw the improvements in the NHS. I also stand as a man whose niece is fighting for her life in intensive care in the Royal Victoria Infirmary, Newcastle. She is a young girl of 40 years old. I call her a girl because from the day she was born she has been hit by muscular dystrophy. She has needed the NHS from the first minute of her life. It has been there for every moment, as it was for one of my sisters, who sadly died at 53 of the same disease. The NHS was always there for them, never perfect, but second to none when compared with health services around the world. Those of us fortunate to have better health have always been prepared to pay to ensure that those who need help were able to get it.

Due to my experience with muscular dystrophy, I have the privilege of being the chairman of the all-party parliamentary group on the subject. That group has shown what we as parliamentarians can do together. We have come together, across the parties, and made huge improvements in the past few years in ensuring that specialist commissioning groups have worked with the all-party group here and with PCTs on the ground, making real improvements in the lives of people suffering from muscular dystrophy. We had a meeting about a month ago in this House. People came from across the country and across the political spectrum, and there were also professionals in the health service. They were all concerned about the direction of travel on which the Government are bent. Their concerns are: will they still be able to access the things they need? Will specialised commissioning groups still be able to work together to deliver the services they want? They have genuine concerns that the all-party group will take forward with the Minister as the debate continues.

This debate is about satisfaction. Why is satisfaction up? There are a number of reasons. Although I have some issues with the hon. Member for Banbury, I agree with him in that I have campaigned against the private finance initiative since before the previous Government took office, since the early 1990s, when the idea was first floated by the former Secretary of State for Health and now Lord Chancellor and Secretary of State for Justice, the right hon. and learned Member for Rushcliffe (Mr Clarke). I opposed it back then, and I have thought it the wrong direction for my Government to take over the past 13 years. The truth is that my Government had to do something.

The hon. Member for Banbury hit the nail on the head when he said that spending on health was 3% of GDP in the 1980s. We know it was 3% because people were being looked after in Victorian hospitals. As my hon. Friend the Member for North Durham (Mr Jones) regularly says, in his area people were being looked after in an old workhouse. That was not good enough for the Labour party, and it was not good enough for the people of this country. That is why we decided that over the period we would increase investment in the NHS, and we increased it by 300%. The people of this country went along with that, including when we put 1% on national insurance contributions. People supported that move because they believed in the service that the NHS delivered. We should never forget that.

During discussions on developing a more capital-intensive NHS, into which a lot of money went, we saw real moves on staff harmonisation, recognising the roles of staff and increasing the responsibilities of people at different levels in the health service. A huge amount of work went into that. While that was happening, other work was being done on improving public health across the board.

The hon. Member for Southport (John Pugh) raised the issue of productivity. It is strange how he defined productivity. I would be interested to read the report from the NAO on defining it, and I am glad that he has brought it to my attention. Productivity used to be measured in the health service by recording when an episode concluded. An episode could be concluded when someone died. A hospital where more people died was more successful in terms of productivity than one where somebody kept coming back and that episode was not concluded. That is a perverse way to look at productivity. The real measure of productivity is that there are twice as many people alive at 85 and over than there were 20 years ago. Should we not celebrate that? Is that not a productivity increase of which we can all be proud? That is the result of the work done.

I am not going to pretend the NHS is perfect. We know it is not perfect; every one of us as constituency MPs will have dealt with issues.

[Ian Mearns (Gateshead) (Lab)]

It is not a question of not thinking that it is perfect, but one of wanting constantly to improve it. The hon. Member for Southport (John Pugh) offered a view, with which I concur, that an individual’s experience of the NHS is different from their broad view, based on what they read in the press. The personal experience of the vast majority of people is either positive or very positive. The broad view is less so, which is hardly surprising, since the vast majority of editors of news journals in this country do not regard good news as news at all. It is also true that many people have a positive view of services they perceive to be under threat. Take the example of a local school. There is always a more positive view if it is under threat. The problem in this country is that millions of people, sadly, believe the NHS to be under threat.

[Mr Anderson]

I thank my hon. Friend and neighbour: I will discuss that with him later.

As a constituency MP, I have had three cases over the past six years of supporting people making complaints against the NHS. We took them as far as we could, trying to raise resolutions. However, none of those people opposed the NHS as an organisation; it was the specific treatment they had received that they were complaining about. There have actually been hugely improved outcomes, as I know from talking to thousands of ordinary folk across the constituency. How happy they are that we built—thankfully, before this Government got in—a new health and leisure centre in Gateshead. Unlike the Building Schools for the Future money, that was not stopped. We got it built before 7 May last year: thank God for that. The real people who matter—the public—are concerned about where we are going.

We should be thankful for the people who work in the NHS. I get really frustrated and annoyed when I hear coalition Members and the Secretary of State, who seems to take real pleasure in denigrating trade unionists, as if trade unionists were removed from this. The vast majority of trade unionists who represent health workers are hands-on professionals. They are not sitting in an office all day; they are at the coal face. They are not just talking about representing people; they are doing it, day in, day out. It is a disgrace that a party pretending to be the party of the big society should denigrate the people who are part of the largest voluntary group in the country. They stand up for people day in and day out. At the same time as standing up for their colleagues, they work in the service, they represent the service and they fight for the people they take care of. Their voice is important; their voice is informed and should not be ignored.

What do we see? We see Ministers refusing to listen to groups within the health service. I just picked up a report of the Second Reading, when I referred to one of those groups, the King’s Fund. Others include the Ministers’ own colleague, the hon. Member for Totnes (Dr Wollaston); the British Medical Association, denigrated here by the hon. Member for Banbury; the Royal College of Physicians; the Royal College of Nursing and the head of Arthritis Care. Every one of those has been ignored by the Government, on the basis of “We know best.”

Most Conservative Members have had a degree of education way beyond mine. However, in this debate, the words of my hon. Friend the Member for Bolsover (Mr Skinner) should be heeded, when he said that a lot of them have been “educated beyond their intelligence”. If this debate does not show that, nothing else does. The truth is that constantly over the past 13 years, health professionals have said to us, “Let us get on with the job.” The promise the Conservative party gave in opposition was that it would do exactly that; it would let them get on with the job, because there has been far too much meddling in the health service. I agree with that but, now, instead of letting them get on with the job, the Government are turning the health service upside down. Not only will it not work, it will make it much worse. It is a disgrace that it is happening.

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[The Minister of State, Department of Health (Mr Simon Burns)]

As others have said today, Mr Bayley, it is a pleasure to serve under your chairmanship.

We have had an interesting debate. Some speeches were a continuation of what has been said in the Health and Social Care Bill Committee, and they bordered on fantasy. Other speeches were extremely informative. The speech of my hon. Friend the Member for Banbury (Tony Baldry) was in the latter category, and my hon. Friend the Member for Southport (John Pugh) made a reflective and interesting speech. I listened with extreme interest, as I always do, to the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke), who made a typically thoughtful speech about an area of health and social care on which he is an acknowledged expert. I listened to the hon. Member for Easington (Grahame M. Morris), as I often do these days, and to the hon. Members for Birmingham, Erdington (Jack Dromey) and for Blaydon (Mr Anderson). It was rather like a curate’s egg—parts of it, depending on which hon. Member was speaking, were all right, and other parts slightly broached on to fantasy island.

I congratulate the hon. Member for Leyton and Wanstead (John Cryer) on securing this important debate. He may be surprised to hear that I am in considerable agreement with him on certain areas. I wish to clear up a number of his questions about the surveys. In an intervention on the hon. Gentleman, I alluded to the Ipsos MORI survey. There is something slightly ironic about claiming that we refused to publish it because of its content, given that the previous Government failed to publish similar surveys in 2007, 2008, 2009 and 2010. To say that they did not publish it because the Opposition did not table parliamentary questions asking for it to be published shows breathtaking gall.

The fact is that we published the March 2010 survey following a written answer in December from the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), who is responsible for social care. It was placed in the Library, but it was not placed on the Department of Health website, for which I offer an apology. Some Members referred to the comments of my right hon. Friend the Secretary of State. Those statements were made in good faith but he was given the wrong advice. That is unfortunate, but he made that statement some three months after the results of the survey had been published.

The hon. Member for Leyton and Wanstead asked whether we will continue with the survey. I can tell him that a further survey has been done. It has not been completed, in so far as it has not yet been given to the Department, but that will happen in due course. What happens in future remains to be seen, as no decision has been taken on future exercises. The hon. Gentleman also mentioned the general life-style survey. Again, no decision has been taken. In light of that information, it is incorrect to say that we will not allow it to proceed.

On the question of the British social attitudes survey, things are a little more complex. The hon. Gentleman will be aware that the Department of Health is not the only Department involved; it is a cross-Government survey, and the Department of Health has some interest in it, but not exclusively so. Again, that is being considered, so I cannot give a definitive answer as to what will happen.

Many hon. Members, including the hon. Member for Leyton and Wanstead, pointed out that the last survey published by Ipsos MORI said that public satisfaction with the NHS was relatively high. That is self-evident, and I suspect that all hon. Members, as constituency MPs, will be aware of that from their constituents, their correspondence and just talking to people. As we heard, the most recent research puts overall satisfaction rates at 72%.

If we were discussing the future of any other public service, perhaps the debate would end there. However, we are not here today to discuss other public services, such as local bus services or rubbish collections, vital as they are. We are here to discuss the national health service, which for the public is literally a matter of life and death, and they have a high regard for it. People expect the NHS to be there when they are at their most vulnerable, or when their family members are in greatest need.

One cannot quantify what the NHS means to the people of this country with a smattering of national statistics, however comforting they might seem. The public have never been over-inclined to set great store by the pronouncements of politicians about the brilliance of the NHS, however familiar such pronouncements might be. However, people do not live their lives through the monochrome of MORI’s painstaking statistical analyses. They do not judge the NHS on the numbers. They judge the NHS on their experience of it; it is the NHS staff that they meet, and what they say and do, that ultimately informs their opinion.

The fact that satisfaction rates are relatively high is without doubt a tribute to the fact that those staff treat thousands of patients every day. I am sure that Members on both sides of the Chamber are united in their admiration for the work of staff across the board, and we should congratulate them on doing it day in, day out, when looking after our constituents, ourselves and our families. They do a fantastic job. We should never forget that we owe them a debt of honour and gratitude.

[Mr Anderson]

Will the Minister give way?

[Mr Burns]

No. If the hon. Gentleman will forgive me, I do not have much time.

We should not kid ourselves that that is the whole story. Although some may be only too content with the fact that three quarters of people are happy with the NHS, I am not. High levels of public satisfaction are a genuine compliment to the work of NHS staff, but they do not undermine the case for modernisation or imply that the NHS is perfect or should never change. There is plenty of room for improvement, building on the high satisfaction rates that we already enjoy, as shown by the various surveys mentioned today.

The House will know that although the money going into the NHS has dramatically increased over the last decade, which I welcome, productivity has not. In fact, it has fallen by 0.2% every year since 1997. In hospitals, it has fallen further—by 1.4% a year between 1997 and 2008. However, such statistics can sound quite abstract. We should think about what they actually mean for patients.

Some of the targets and incentives in the current system are simply perverse; far from promoting good-quality care, they encourage poor care. Take maternity services. With antenatal care, the more visits or scans providers can record, the more they are paid. It is in the financial interests of the hospital to provide care on a purely reactive basis, dealing with problems as they arise, rather than preventing them from happening.

The result is poorer health outcomes for the mother and child and a bigger bill for the taxpayer. No midwife or doctor would ever organise the system in such a way. No doctor or nurse working in acute care would design a system in which a hospital would be paid for a mistake rather than be penalised for it. For example, would they pay if a patient were discharged from hospital only to be bounced back into A and E a week or so later because they were not properly treated? No health professional would choose to work in an environment in which they and their colleagues are rewarded not for how well they treat patients, but for how well they process them through the health system.

Hon. Members claim that there is no rationale for our reforms, but they are wrong. I do not claim that the NHS is failing; there is much that is good about it, and much of what it does is internationally acclaimed. None the less, if hon. Members were honest they would accept that there is room for improvement, as was shown by the Ipsos MORI poll.

I do not think that it is right that pensioners over the age of 75 in the primary care trust that serves the constituency of the hon. Member for Leyton and Wanstead are almost twice as likely to be admitted to hospital in an emergency than those over the age of 75 in Devon or Cornwall. I do not think that it is right that, in some parts of the country, people are more than five times more likely to die of heart disease.

In its current form, the NHS cannot hope to cope with the rising demand from our ageing population and the relentless rise in the cost of drugs and treatment. Our health system is no longer battling with infectious disease. The typical patient is not a young man with TB or polio, as it might have been in the 1940s, but someone who is over 75 with probably two, if not more, long-term conditions and social care needs, too. It is a very different problem that requires a very different kind of health service.

Even more importantly, as a nation, we should be aspiring to be as healthy and to live as long as our European neighbours. A recent OECD report found that, if the NHS were to perform as well as the best-performing health systems, we could increase life expectancy by three years. The argument for change could not be clearer.

The ultimate objective of modernisation is to ensure that the quality of care that people receive is on a par with the best available anywhere in the world. To do that, we need to make fundamental changes to the NHS. For example, we need to ensure that it is the GP and not a manager or civil servant in Whitehall who determines the needs and requirements of their patients. A radical extension of patient choice would allow patients to choose not only where they are treated, but which consultant-led team will treat them. Patients could choose their GP and even, where appropriate, their treatment.

There should be greater accountability and transparency in the NHS to give patients the information that they need to make choices and to drive up quality. As the Society for Cardiothoracic Surgery said only last week, publicly reporting on the performance of hospitals and surgeons treating patients with heart disease can improve mortality rates by 50%.

There should also be more independence and freedom for clinicians, so that if local health and social care professionals think that they can deliver better services to support stroke patients, they can set up a social enterprise that will do that. We will give genuine freedom to foundation trusts, so that they can strive to provide the best possible outcomes for patients.

In conclusion, there have been a lot of disingenuous statements about privatisation of the health service and the quality of care. If hon. Members are prepared to listen, I will assure them that we have no intention of privatising the health service. We just want to improve patient care.