Health and Social Care Bill
David Miliband Excerpts(12 years, 9 months ago)
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David Miliband (South Shields) (Lab)
I rise today to make a simple point to Ministers and their supporters: however acute the embarrassment of giving up on the Health and Social Care Bill at this stage, it will pale into insignificance compared with the embarrassment, never mind the trauma and cost, of ploughing ahead with this health reform and making it the template for health policy for the rest of this Parliament.
The Bill has achieved a remarkable feat since we contributed to the Second Reading debate. First, it has taken the Government hostage. It is the political equivalent of the Stockholm syndrome: falling in love with your captor. The Prime Minister insists, in one breath, that he must have the Bill to save the NHS and, at the same time, at Prime Minister’s questions, he insists that 95% of the country has already had the benefit of the reforms that he claims the Bill will put through.
Secondly, in the real world—many miles from the claims of Ministers that they wanted an unprecedented consensus between politicians and professionals—this Bill is without friends. Even more remarkable, and shocking to me, is that it is a Bill that has lost friends at each and every stage of its passage through Parliament. Every compromise, every “concession” and every retrofit has cost the Bill coherence, cost the Bill support and raised levels of anxiety about the Bill.
The reason for that is simple: the Prime Minister, the Secretary of State and the Deputy Prime Minister have made it their calling card to say that the choice is between this Bill and inertia. I know that tactic, as I have written those speeches and those articles, but in this case the problem is that that is not true. The Leader of the Opposition and the shadow Secretary of State for Health have put forward practical proposals to achieve some of these aims that are shared across the House.
The Secretary of State will recognise that more reform is going on in the English health service than in any other health service in the world at the moment—that is the product of what was done under the previous Government. That is perhaps one reason why it is improving faster than those anywhere else. The choice is between good reform and bad reform, and this Bill is bad reform: it gives reform a bad name. In fact, it threatens to set back the cause of reform for a generation, and I want to explain why.
As amendment has been piled on amendment, the Bill has gone from being wrong to being the most half-baked, quarter-thought-out shambles that the NHS has ever seen. I want to give three examples that go to the heart of the issues raised by the Secretary of State and the Prime Minister in their speeches to launch the Bill. The first and most important is managing service change. That is most important, because everyone agrees that the health service has to change to deal with the challenges of demography, drug costs and medical technology, and that means changing in the way in which services are organised. Yet in its hatred of planning and confusion about competition the Bill makes change at a local level not more likely but less. Why? The levers of change have been neutered. Clinical commissioning groups are too small and weak as replacements for primary care trusts, the NHS Commissioning Board is too remote and gargantuan and, as the Palmer study of reorganisation in south-east London shows, market forces on their own will not reconfigure services in a coherent way.
Stella Creasy (Walthamstow) (Lab/Co-op)
This weekend I met 80 women from Walthamstow who are desperately concerned because we do not have a sexual health service there, so we have very high levels of teenage pregnancy and repeat abortion, as there are doctors in the constituency who will not provide contraceptives. Does my right hon. Friend agree that the changes could make dealing with such problems harder, not easier?
David Miliband
My hon. Friend makes an important point. Far from driving the health service towards a coherent vision of the future, the Bill promises frenetic gridlock as professionals try to make the best of the bad job they have been left by the Health Secretary.
The second example is promoting efficiency. The Select Committee on Health stated:
“The reorganisation process continues to complicate the push for efficiency gains.”
It is, of course, right. The story today that senior GPs are spending four days a week coping with reorganisation rather than treating patients is, I predict, only the first step on that road.
The third example is accountability. If there was a germ of an idea in the original Bill presented by the Secretary of State, it was to align clinical and financial responsibility. In May last year he said that the key question was to
“put the right people in charge”.
After a year, it is completely inexplicable who is in charge: not GPs, because they are overseen by the greatest behemoth of them all, the national NHS Commissioning Board; not hospital trusts, because they are answerable to Monitor and the competition authorities; not the sectoral replacements for strategic health authorities, because they are only temporary; not the managers, because they are being sacked just before they reapply for their old jobs, which now have new names; and not the clinical senates, because their purpose has not yet been defined.
In truth, the new system hardly deserves the title of a system at all. It is not just that people do not support what the Government are doing, but that they simply do not understand what the Government are doing. I warn the House that the real danger for the NHS is a perfect storm of rising costs, rising demand and opaque and inexplicable decision-taking structures.
The Government promised clarity but have delivered complexity. They promised devolution but have had to create the biggest quango of them all. They promised efficiency and they have delivered bureaucracy. The result is that at the end of this Parliament we will once again be back in a debate that I thought we had buried for ever, about whether a tax-funded health service free at the point of need could deliver for the whole population of Britain. That is the last debate we should be having, but it will be the product of the shambles now being created.
I believe the Secretary of State when he says he supports the NHS passionately, but by the end of this Parliament, when the structural flaws of the plan are clear, he will not be around to defend it. That is the true danger of this misconceived and unloved Bill, and that is why this Secretary of State, in his last act of kindness to the NHS, should kill the Bill.
Oral Answers to Questions
David Miliband Excerpts(13 years, 6 months ago)
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Mr Lansley
In 2011-12, NorthYorkshire and York primary care trust will receive £1,207.3 million. That represents a cash increase over last year of £34.7 million, or 3%. That exactly represents our coalition Government’s commitment to protect the NHS and to increase its budget in real terms, and it is in stark contrast to what we were told we should do by the Labour party and what the Labour Government in Wales have done, which is to impose a 5% real cut in NHS spending in Wales.
David Miliband (South Shields) (Lab)
Can the Secretary of State confirm my figures that over £20 million has been spent in the north-east of England sacking PCT staff, that that money has come from funds previously earmarked for hospitals, and that there will be at least as many commissioning groups under his arrangements as there are currently PCTs employing managers in those roles? Does not that show that his plans are lunacy not reform, and that they should be taken away and put in the dustbin, not given a simple pause?
Mr Lansley
I can tell the right hon. Gentleman that in contrast to the last Labour Government it is our intention to increase the front-line staffing of the NHS relative to the staffing of the administration in the NHS. That is why, since the general election, there are 3,800 fewer managers in the NHS and 2,500 more doctors.
Health and Social Care Bill
David Miliband Excerpts(13 years, 10 months ago)
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John Healey
It is true that we encouraged many of the GP commissioning models that the Health Secretary now champions, but that process was always within a planned and managed system, and it was never implemented at the expense of other clinicians or patients being in charge. We used private providers when they could add something to the NHS and help it to raise its game, and when they could add capacity so that we could clear waiting lists. Of course there is a role for them in the future, but that is not the question at the heart of the Bill. I will come back to the hon. Gentleman’s question later, however. People saw big improvements in the NHS under Labour, but they now realise that many of those gains might be at risk as a result of the decisions that this Government are taking.
David Miliband (South Shields) (Lab)
Does my right hon. Friend agree that the most significant change in the Bill was not mentioned by the Secretary of State? It is that the Bill introduces price competition into a market that, up to now, has allowed competition only on quality. The London School of Economics, citing academic evidence, states clearly that
“most international evidence suggests that, whereas hospital competition with fixed prices can improve quality, simultaneous price and quality competition can actually make things worse”.
John Healey
Characteristically, my right hon. Friend is absolutely right. These changes to the NHS and the Bill—[Interruption.]
David Miliband (South Shields) (Lab)
It is a pleasure to follow the hon. Member for Central Suffolk and North Ipswich (Dr Poulter). I congratulate him on his important and interesting speech, and I wish to pick up his challenge. The choice is not between no reform and reform; it is between good reform and bad reform. I believe that the proposals in front of us represent not a curate’s egg, with some good reforms and some bad, but a set of poison pills for the NHS.
The first poison pill is the massive upheaval that the Bill proposes at the time of an unprecedented efficiency drive. The right hon. Member for Charnwood (Mr Dorrell) said that it was precisely because of the efficiency drive that we should have massive upheaval, but he must know that all the evidence from reorganisations throughout the years is that projected savings are double the out-turn, and projected costs turn out to be half the actual level. When the Prime Minister says that there is a £300 million difference between the costs and the savings—£1.7 billion of savings and £1.4 billion of costs—he is actually treating us to a reorganisation that will end up costing money and causing redundancy costs at a time when hospitals and GPs are trying to get the job done.
The Minister of State, Department of Health (Mr Simon Burns)
May I correct the right hon. Gentleman before he goes too far down that path? The impact assessment suggests that the one-off cost will be £1.4 billion, and that the savings from that investment over the life of this Parliament will be £5 billion. By the end of the decade, the saving will be £13.6 billion, which is £1.7 billion a year after 2013-14.
David Miliband
I am happy to wager the hon. Gentleman that the costs will turn out to be more like double those estimated and the savings more like half.
The Bill is myopic, or “deluded”, to use the word of the British Medical Journal, in three key areas, which I wish to mention. First, it assumes that all GPs are ready now to take on hard budgets in the commissioning framework. It took the previous Tory Government six years to get 56% to be GP fundholders. Secondly, it will deepen the divide between primary and secondary care. The hon. Member for Central Suffolk and North Ipswich raised that matter, which is vital. We all know that in our constituencies, collaboration between primary and secondary care is key, especially for chronic conditions. The Bill will make the divide worse, because collaboration will be deemed anti-competitive.
Thirdly, the Bill has absolutely nothing to say about quality control of GPs. In fact, it will remove the local drivers for improvement that I have seen in my constituency. The hon. Member for Basildon and Billericay (Mr Baron) mentioned cancer survival rates, and the Appleby research shows that we in this country have made more progress over the past 30 years than any other country in Europe, and will overtake France in 2012. It also shows that the extent to which we are behind can be explained by late diagnosis in the first year of cancer, which is the responsibility of GPs. They should focus on improving their cancer treatment, not commissioning care.
David Miliband
No, I have given way once and I want to make some progress. If I have time, I will come back to the hon. Gentleman.
All the matters that I have mentioned are to service a vision of health care as a regulated industry. The Secretary of State has engaged in a ding-dong about which operating framework is more important—the 2009 or the 2010 one. Two points, though, have not been contested. The first is that in 2011-12, for the first time, there will be competition according to price—page 54 of the operating framework says that. The second is that the academic evidence is absolutely clear that price competition results in lower prices, yes, but also in lower quality.
The hon. Member for St Ives (Andrew George) asked the Secretary of State, “What about my community hospitals?”, but of course the Secretary of State does not want to make decisions about community hospitals. His predecessor but six, eight or 10, Nye Bevan, said that he wanted a bedpan falling in Tredegar to be heard in the corridors of Whitehall. The Secretary of State does not want to hear bedpans falling; he wants to say that it is GPs who should be making decisions, or the commissioning board, or, in the ultimate irony that my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) pointed out, the European Court of Justice under European competition law. He pointed out the irony of the Lisbon treaty being critical, but at this very time the House is passing a Europe Bill that calls for referendums when any power is transferred to the EU, including on matters as puny as the appointments system for the Court of Auditors, never mind on a vital part of NHS provision.
Frank Dobson
Does my right hon. Friend agree that the hon. Member for St Ives (Andrew George) is perhaps being a little ungrateful? He might have mentioned that the NHS wanted to close all his community hospitals in Cornwall, and that the dreaded centralist top-down Dobson stopped it.
David Miliband
The benefits of memory are useful in politics, and perhaps my right hon. Friend’s intervention will help the hon. Member for St Ives to decide how to vote in the Lobby tonight.
Many people have asked why the Government are making these proposals at such breakneck speed. Surely it is not to solve a political problem on health. After all, the Conservative party spent the whole of the last Parliament doing everything possible to avoid any policy on health that might hint at radical change. That paid off, because in the last prime ministerial debates before the general election, not a single question on health was put to any of the party leaders. It would be massively in the interests of my party and all Labour Members if the next general election were dominated by debates on the health service. On that basis, we should be urging the Government to plough ahead and make the next general election a referendum on health. Frankly, however, the cost would be far too high, and the consequences would be far too great for the national health service.
The truth is that a radical Secretary of State would do something that too few of his predecessors have been willing to do—namely, to say, “On my watch, there will be no reorganisation of the national health service.” Such a Secretary of State would dedicate himself to implementing the reforms that are working today. It is not the case that the only choice is between no reform at all and the reforms now being offered. According to health experts, there is more reform going on in the English health service now than in other health system in Europe. Our Scottish and Welsh friends might benefit from some of the changes that are taking place in England, because those changes have made the English health service a fast-improving one in Europe.
There is always room for improvement in the national health service to strengthen commissioning, to link health authorities and local government, to get people out of hospitals and to align with social care. The Dilnot commission has just been appointed to review the funding of social care, but it will not report until July. At exactly the time when we are looking at the localisation of health provision, the Government have appointed someone to look at the nationalisation of social care provision and its funding. This is not a Health and Social Care Bill; it is a health without social care Bill.
“The real choice is not between stability and change, but between reforms that are well executed and deliver results for patients and reforms that are poorly planned and risk undermining the NHS”.
Those are not my words but those of the chief executive of the King’s Fund. The Hippocratic oath says that we should “Do no harm”. The Bill fails that test. It aims at irrevocable change and threatens real harm, and that is the reason to oppose it in the Lobby tonight.
Oral Answers to Questions
David Miliband Excerpts(14 years ago)
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Mr Lansley
Yes, I do. I was delighted by the response of general practice to the emerging consortiums, because one of the central reasons it wants to make progress quickly is to shape clinical service redesign, which is at the heart of delivering the efficiency savings that will enable us all to improve outcomes.
David Miliband (South Shields) (Lab)
The Secretary of State has said that GPs are the best people to manage the health service. Will he confirm that in the eight years of GP training, not a single hour is dedicated to the commissioning work that he has described?
Mr Lansley
The right hon. Gentleman should understand that what I said was that GPs are the best people to commission services. Commissioning and management are not the same thing. GPs are already responsible for commissioning most services in the NHS, but they have no power over resources and contracting. I intend to ally clinical leadership and commissioning decisions with commissioning support that involves management. The people who should determine the shape of local services to meet the needs of patients are those who are already at the heart of designing services and referring patients.
Oral Answers to Questions
David Miliband Excerpts(14 years, 1 month ago)
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Mr Lansley
Yes; my hon. Friend is absolutely right. As we implement our plans for the value-based pricing of medicines from 2014, NICE’s role will change. It will focus on advising how best to use treatments and to develop quality standards for the NHS, rather than recommending whether patients should be able to access particular drugs. We want patients to have access to the medicines that their clinicians believe are best for them.
David Miliband (South Shields) (Lab)
I wonder whether the Secretary of State can provide some reassurance to residents of Cleadon Park estate in my constituency who are concerned about the consequences of primary care trust abolition for the PCT-owned, PCT-organised and PCT-financed health centre that brings together primary and secondary care, and local authority and community services. Is there not a real danger of the sort of expensive “anarchy” of which Professor Tony Travers of the London School of Economics has warned?
Mr Lansley
Happily, I can offer the right hon. Gentleman’s constituents great reassurance that not only will the relationship between community health care and specialist health care in hospitals be improved by general practice-led commissioning—because clinicians will speak to clinicians—but the services they rely on will be improved, because we will no longer spend so much money on PCT administration. He will know that in 10 years under his Government the number of managers in the NHS increased by more than 60%.