NHS and Social Care Funding

David Rutley Excerpts

Wednesday 11th January 2017 Commons Chamber

[Dr Whitford]

The whole issue comes down to sustainability, which is obviously the idea behind the sustainability and transformation plans. As those who have heard me speak about STPs will know, I support the idea in principle. The idea is to go back to place-based planning on an integrated basis for a community. The difference in Scotland is that we have focused on integration. We got rid of hospital trusts in 2004, and we got rid of primary care trusts in the late 2000s—in 2009 or 2010. Since April 2014, we have set up integration joint boards, where a bag of money from the NHS and a bag of money from the local authority are put on the table and a group sit around it and work out the best way to deal with the interface and to support social care. Anyone in the Chamber or elsewhere with family members who have been stuck in hospital will know that people get into a bickering situation: Mrs Bloggs is in a bed so the local authority is not interested, because she is safe there, and the local authority is instead busy with Mrs Smith, who has fallen off a ladder trying to put up her curtains and who is not considered safe because she is leaving the gas on. Such boards get rid of all that perverse obstruction.

[David Rutley (Macclesfield) (Con)]

The hon. Lady is making an important point, and I welcome the tone that she, unlike the shadow Secretary of State, has brought to this debate. She makes the point that the integration of care—social and health—is important, but does she agree that, with further devolution to the sub-regions and major cities in England, there is a huge opportunity to move forward that agenda south of the border?

[Dr Whitford]

The whole idea of STPs is to go back to areas. We simply have geographical health boards—the only layer we have—so we are not wasting huge amounts of money on having layers and layers, which could be integrated. For an STP to work it must make sense geographically, which might be a county or something bigger or smaller. I think that they should be put on a statutory footing. We have 211 CCGs. There will be an average of six CCGs for every STP, so that is a waste of layers, and it will be very difficult to integrate.

One of the biggest differences is that, in 2004, we got rid of the purchaser-provider split. In the past 25 years, there has been no evidence of any clinical benefit from the purchaser-provider split, the internal market or, as it now is, the external market. It is estimated that the costs of running that market are between £5 billion and £10 billion a year. That money does not actually go to healthcare, but on bidding, tendering, administration or profits. We cannot have an overnight change, but if we simply made a principled decision to work our way back to having the NHS as the main provider of public health treatment and to integrate care through the STPs, we could reach a point of sustainability.

As I said earlier, we must protect things such as community hospitals and community services and, indeed, invest in them. Our health board has rebuilt three cottage hospitals as modern hospitals, because that is where we should put an older person who is on their own and has a chest infection, who just needs a few days of antibiotics, TLC and decent feeding. We do not want them in big acute hospitals; we want them to be close to home. The danger is that under the STPs people will see community hospitals as easy to get rid of, but that is an efficiency saving only if it gets rid of inefficiency. If we slash and burn, we will end up spending more money in the end.