NHS Future Forum
Debbie Abrahams Excerpts(14 years, 7 months ago)
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Mr Lansley
I agree very much with that. The Future Forum’s report, particularly the part that deals with clinical advice and leadership, has given us a robust structure for engagement with the range of professions that are capable of delivering that kind of integrated, joined-up and more effective care.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Can the Secretary of State reassure us that no services or hospitals will be taken over by the private sector?
Mr Lansley
There are no plans in the legislation or, indeed, in the Future Forum’s recommendations that would lead to that. In particular, as the hon. Lady will see in the detail published with the written ministerial statement this morning, we have proposed that Monitor should have no power to allow the private sector access to NHS facilities for reasons of competition and to take them away from NHS providers.
Oral Answers to Questions
Debbie Abrahams Excerpts(14 years, 7 months ago)
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The Parliamentary Under-Secretary of State for Health (Anne Milton)
I thank the hon. Lady for her question. She raises an important point about children’s exposure to such imagery from a variety of media sources. It is crucial for the future public health of our country that children get help and support over this and are able to learn the skills they need, and we are determined to get that right. Many of our plans are laid out in the White Paper, and we look forward to seeing them become a reality.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Can the Secretary of State or the Minister confirm whether they will take up the offer from my Front Bench for bipartisan discussions about the future of adult social care—or will he put political interests before the public interest?
Mr Lansley
We were very clear that the commission that we established, led by Andrew Dilnot, should look at the reform of long-term social care funding in such a way as to secure maximum understanding, consensus and agreement. Andrew Dilnot has gone about that process in an exemplary manner, and the right thing for us to do now is await his report, which should then form a basis for taking things forward.
Future of the NHS
Debbie Abrahams Excerpts(14 years, 8 months ago)
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Debbie Abrahams (Oldham East and Saddleworth) (Lab)
It is a pleasure to follow the hon. Member for Southport (John Pugh). A lot of water has passed under the bridge since the middle of March, when we last debated the NHS. The Committee tasked with scrutinising the Health and Social Care Bill, on which I served—a baptism of fire—finished its deliberations at the end of March. I believe that it was the longest running Bill Committee since 2002, so it was a marathon stint in which we debated 280 clauses and 600 amendments. During those eight weeks, the Government did not accept a single amendment. Some hon. Members made exceptional speeches, dissecting the Bill in detail and arguing against it. I remember in particular a debate about regional specialist services and how they would be commissioned in future. I am afraid, however, that that was as far as it went when it came to changing the Bill. I was therefore nonplussed when, the day after the Committee finished its proceedings, the Prime Minister and the Deputy Prime Minister expressed their concerns about the Bill and announced a pause in its enactment.
At the same time as the Public Bill Committee was sitting, we saw growing public anxiety about what the Bill would mean to patients and their families. I was contacted by hundreds of my constituents and received a petition signed by nearly 300,000 people from across England. Perhaps that was the motivation for the Government’s change of heart, or was it just political rhetoric with the elections looming? There has certainly been no pause in NHS reorganisation in many areas, including my own, where, as I mentioned the other week, it has actually been brought forward.
The public are beginning to see an erosion of the considerable improvements made in the NHS under Labour, and this is what is fuelling public concern. In Greater Manchester, as Peter Thornborrow, one of my constituents found out to his cost, there are much stricter criteria for cataract surgery, as there are for hip and knee replacements.
Andrew Bridgen (North West Leicestershire) (Con)
Recent OECD research shows that, despite the last Government’s spending splurge on the NHS, Britain still has the eighth worst record of all its members for preventable deaths—we are down there with Poland, the Czech Republic and Mexico. It also shows Britain has the seventh highest potential for efficiency savings in health care—that is, for improving patient outcomes without spending any more money. Is that not a damning indictment of the last Government’s health policy and does it not mean that reform is essential for the future of the NHS and for improving patient outcomes?
Debbie Abrahams
How will breaking up the NHS improve that? The hon. Gentleman should be concerned that some of the measures PCTs are having to take are increasing the risks of cardiovascular disease for many patients. As for international comparison of our NHS, it is known to be one of the most cost-efficient health systems in the world.
Bariatric surgery provides another example of where the National Institute for Health and Clinical Excellence guidelines have been replaced with more stringent criteria, rationing access to care in order to balance the books. There are many other examples. According to one survey published last week, demands for bariatric surgery have risen by 17%, but approval for such surgery has fallen by 22%. These are the so-called efficiency savings, as we heard from the Secretary of State, of £20 billion nationally and 4% each year.
Guto Bebb (Aberconwy) (Con)
We hear a lot about the effect of efficiency savings on the NHS in England. Under Labour party proposals, Wales is not suffering from efficiency savings, but from cuts of £435 million in the NHS budget this year and £1 billion in the next four years.
Debbie Abrahams
Does not the hon. Gentleman think that that is why we won the election in Wales?
The savings required are 4%, and if the Government get their way with the new economic regulator Monitor, they could go as high as 7% each year—far more than our NHS is capable of coping with.
My constituent, Peter, was refused a cataract operation, yet his vision was so poor that he was able to see the world only through a haze; as a precision engineer, furthermore, he was not able to do his job and faced the threat of redundancy. In other cases, non-compliance with NICE guidelines—on familial hypercholesterolaemia, for example—is leaving people at extreme risk of untreated cardiovascular disease.
Health professionals have almost without exception castigated the Bill for what it will do to the NHS in completely opening it up to the market, with competition law applying in full and allowing private health care providers to cherry-pick profitable services. A hospital medical director said last week that he did not know how his hospital could continue to provide care for unprofitable patients.
The unprofitable services for most hospitals are elderly care, mental health, paediatrics and maternity, which are essential services for all communities. Instead of service providers and commissioners working together to provide the best quality care they can for their patients, the trend is for hospital trusts to maximise income and compete against each other. We are already seeing that lack of co-operation when PCTs look at alternatives in commissioning. Trusts are reluctant to collaborate when they see that it might reduce their income, even if it improves the quality of patient care. Similarly, the Bill gives GPs a financial interest in restricting or refusing treatment in order to make savings and to get bonus payments from the NHS commissioning board.
Labour wants genuine savings that will enhance patient outcomes rather than produce the diminishing effect that we are currently seeing, and we believe that we can achieve that. We want hospital specialists and GPs to work together to deliver clinical care pathways that improve the quality of patient care and bring care closer to home. One local PCT is trying to introduce the use of drugs that are cheaper—and unlicensed—to treat age-related macular degeneration, but it is under severe pressure from the pharmaceutical industry. That is another way in which we could reduce costs.
There is no doubt in my mind that, unamended, the Bill threatens the founding principles and values of the NHS. It removes the duty to provide a comprehensive health service, and provides an opportunity for the new NHS commissioning board and GP consortia to charge for services. It involves a costly, ideologically driven reorganisation of the NHS that has no mandate from the British people, and no support from health professionals and that will mean the end of the NHS that we know and love. As I have said before, the NHS is not just an organisation that plans and provides our health care; it reflects the values of our society on which this country set such store.
I know that there are many members on this side of the House—
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
I agreed with very little of what the hon. Member for Pontypridd (Owen Smith) said when we were on the Public Bill Committee together, and I am afraid that I will not change my view after hearing what he has said today. He touched, however, on the important issue of health economics. In a thoughtful speech, the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) made some good points about health economics. Much as I would rather talk just about patient care, given my medical background, health economics are at the centre of the discussion about how we will reform and improve the NHS.
The comprehensive spending review announced that the NHS would see its funding rise by 0.4% in real terms over the next four years. Despite the current economic climate, the Government have stood by their commitment to increasing NHS funding over this Parliament—we are very proud of that—but, even so, it is the smallest increase in NHS funding for decades. Ever-increasing patient demand for health care coupled with Britain’s demographic time bomb means that over the next few years the NHS will have to achieve value for money for its patients on an unprecedented scale.
Our NHS needs to make efficiency savings just to stand still and to continue to deliver high-quality patient care. My right hon. Friend the Member for Charnwood (Mr Dorrell) hit the nail right on the head when he said that we need to think about not just the worried well but the 80% to 85% of patients who have serious medical co-morbidities or present as emergencies with acute medical problems in accident and emergency. That desire lies at the heart of the Government’s proposed reforms.
People are living longer, and as they do the number of people living with multiple medical co-morbidities also increases. The majority of people require their health care in the later stages of their lives and if we are to have an NHS that is truly responsive to the demographics of this country, we need to ensure better integration of health and social care. We must stop the silo working that often exists between local authorities and the NHS and ensure that we have a more locally responsive NHS. At the heart of the Bill is a desire to see better integration of adult social care and NHS care, which can only be a good thing in view of this country’s demographics and of the health economics of looking after people in the later years of their lives.
Debbie Abrahams
Does the hon. Gentleman share the concern that many councils that will be responsible for the delivery of public health are not ring-fencing the money and are using it to offset some of the cuts that they face?
Dr Poulter
I can only say that my Conservative-run, Suffolk council is doing exactly the opposite of what the hon. Lady describes. The Government have committed to putting almost £2 billion into adult social care, looking at the demographic time bomb and looking at better integrating health care with adult social care. I would be very concerned to see councils doing what she describes, because that is not what they are given that money for. If she has had a problem with that at her local authority, she needs to take it up with that authority.
The key to unlocking potential in the health sector lies in cutting the red tape and pointless form-filling that wastes the time of so many front-line staff. Of course, our NHS must have a level of regulation that ensures that products and services are thoroughly tested and that ensures patient safety. However, the over-excessive regulation introduced by the previous Government has been damaging not only to patient care but to staff morale. It has also diverted vital resources away from the front line and away from patients, who are, after all, what health care should be all about. This Government are rightly looking to take simple, obvious and positive steps in improving the overall efficiency of the NHS by scrapping the health quangos that waste £2 billion a year—money that could be much better spent on front-line patient care.
Another issue that I want to highlight in the time left to me is another area of wasteful spending in our NHS—management. Under the previous Government, the number of managers and unproductive non-medical staff increased in the past decade, with the number of managers and senior managers in the NHS almost doubling to 42,000. In many hospitals, more new managers than new nurses were recruited in that time. That cannot be right—it is bad for patients and money is being misspent. As I witnessed at first hand, NHS managers were rewarded at a better rate than front-line staff—at around 7%, compared with 1.8% pay rises for front-line medical staff. That is not a good thing.
The Opposition are very concerned about staff morale, but let me tell them why staff morale is so low: it is because the contributions of front-line staff were badly undervalued by the previous Government while the contribution of managers were over-valued. I believe that what we and the Government need to do is make sure that more money goes into front-line patient care and front-line staff rather than being wasted on management and bureaucracy.
NHS Reorganisation
Debbie Abrahams Excerpts(14 years, 10 months ago)
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Debbie Abrahams (Oldham East and Saddleworth) (Lab)
This costly reorganisation of the NHS has no mandate from the British people, and no support from health professionals or, apparently, the Liberal Democrats. It will be the end of the NHS that we know and love. As I have said before, the NHS is not just an organisation that plans and provides our health services; it also represents the values of our society by which this country sets much store. Contrary to the assertions from the Government Front Bench, the NHS reorganisation defined in the Health and Social Care Bill will wipe out the founding principles of the NHS in one fell swoop.
For the first time since the NHS was established in 1948, the Secretary of State for Health will not have a duty to provide a comprehensive health service. I will let that sink in. Instead, it is to be replaced with duties to “promote” and to
“act with a view to securing”
health services—weasel words that beggar belief. The original duty is fundamental to protecting the provision of a universal, comprehensive health service. It is the foundation on which the NHS was established. Without it, we will no longer be sure that a comprehensive national health service will be provided, and Members of Parliament will no longer be able to hold the Secretary of State to account on behalf of the constituents who elected them.
Rather embarrassingly for the Secretary of State, he might recall that, when he presented evidence to the Health and Social Care Bill Committee, I questioned him on this and asked him why he was repealing that fundamental duty. He said that he was not. However, it is absolutely clear from the Bill’s explanatory notes that that is exactly what will happen. Paragraph 64 states that clause 1
“removes the current duty on the Secretary of State in subsection (2) of section 1 to provide or secure the provision of services for the purposes of the health service.”
That duty is absolutely core: the NHS was established to provide a universal, comprehensive health service, but that will soon be gone. It is worrying that the Secretary of State did not appear to understand the implications of competition law, or to know what was being repealed in his own Bill.
The Government have suggested that these functions will now be the duty of the NHS commissioning board and the GP consortia, but the exercise of the functions will be discretionary. There will be no requirement to provide those services. So I repeat that the Bill will take away the duty to provide a comprehensive, universal health service.
Debbie Abrahams
No, I am sorry, I am going to make progress so that everyone gets a chance to speak.
The Government have also said that the NHS commissioning board will ensure that NHS delivery is free from political control, but I am not so sure about that. The Bill contains a variety of contradictions, particularly in relation to the Secretary of State’s appointments to the various quangos. Another of the founding principles under threat from this Government is that treatment should be based on clinical need and not the ability to pay. We heard the Secretary of State say that that would be protected, but the Government’s reorganisation of the NHS will result in opening up that fundamental principle. The NHS commissioning board and the GP consortia will have the power to generate income, perhaps by charging for non-designated services. What constitutes designated and non-designated services has yet to be defined, however. My hon. Friend the Member for Leicester West (Liz Kendall) tried to get some elucidation on that, but none was forthcoming.
Debbie Abrahams
No, I am sorry, I want to make some progress—[Hon. Members: “Give way!”]
Debbie Abrahams
Not only are the founding principles of the NHS in danger of being wiped out, but its culture—the reason that most of its employees work for the NHS—will go as well. The whole ethos of the NHS will change. It will now be driven by competition and consumer interests—[Interruption.]
Debbie Abrahams
My first question to the Secretary of State was about the proposal that the NHS commissioning board will be able to award bonuses to the GP consortia that it deems to be adopting innovative measures. The Bill states:
“The Board may make payments as prizes to promote innovation in the provision of health services.”
That means bonuses within the NHS based on innovation, which is anathema to the NHS and not what we want for it. This is indicative of the Bill as a whole. Central to the reforms are increasing competition across the NHS and opening it up to providers from the private and voluntary sectors. The Government claim that increasing competition drives down costs and improves quality, but there is evidence from across the world—in the US and Europe—that that is not the case. It does not improve quality at all in health care systems.
Although I am glad to see that the Government have reversed their position on price competition, as of yesterday they were still wedded to establishing Monitor as a powerful economic regulator with the duty to promote competition. As has been pointed out, our health services will be subject to EU competition law for the first time. By forcing these GP consortia to put any services out to competitive tender—even if they are working well and patients and the public are happy with them—the Bill encourages “any willing provider” to—
Health and Social Care Bill
Debbie Abrahams Excerpts(15 years ago)
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Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Thank you for calling me to make my maiden speech in this debate today, Mr Speaker. I am deeply honoured to have been elected as the Member of Parliament for Oldham East and Saddleworth in the recent by-election—the first woman MP for Oldham. The circumstances for the by-election were indeed unusual, and it is only right to mention that many constituents and colleagues from across the House have remarked on my predecessor Phil Woolas’s intellect, his incredible attention to detail and the kindness he showed to them. [Hon. Members: “Hear, hear.”]
My constituency is a beautiful place with a remarkable history. For example, it was not only where the Independent Labour party was born and where Winston Churchill started his political career, but where the suffragette Annie Kenney originated from. Oldham’s first parliamentary representatives were of course the radicals William Cobbett and John Fielden, and I intend to be equally radical in my own way.
As beautiful and as varied as my constituency is, what I care most about are the remarkable people. During the by-election, I met thousands of constituents from all walks of life, some of whom supported me and some of whom did not. Regardless of their political affiliation, however, they were invariably polite. Of course, there were one or two who chased me down their garden paths, but, fair dos, it was Christmas day! [Laughter.] Their tolerance and decency reflect something very special about our society: a social conscience that values fairness, treating people as they would like to be treated, while recognising that different people have different needs and merits. As we know, both intuitively and from research, fairer societies do better, and are better for everyone. Of course, all political parties have claimed that they are the party of fairness, but I think most people will agree that action speaks louder than words.
I promised the people of Oldham East and Saddleworth that I would stand up for them and fight against unfairness. I believe—there is increasing evidence to support this—that the Government’s policies are deeply unfair and, contrary to their assertions, unwarranted. As history has shown, Governments set the tone for the culture of a society. The tone being set by this Government threatens the country’s sense of fair play and social justice.
I asked to deliver my maiden speech on Second Reading of the Health and Social Care Bill because, as some people will know, my professional background is in health. I am passionate about the NHS. For me, it not only plans and provides our health services, but reflects the very values of our society.
In ’97, the NHS was on its knees. Staff were leaving in droves, and the level of spending on health was one of the lowest in Europe. Labour more than trebled investment in the NHS, enabling us to recruit more doctors and nurses and to improve access to care. Gone are the days when people waited two years or more for a hip replacement or to have their cataracts removed.
The shift to improving health, preventing illness and providing care closer to home has made real, positive differences to the nation’s health. The Bill threatens not just those developments, but the very future of the NHS. I have expressed my concerns in the past about the marketisation of our NHS, but the Bill is in another league—it is about the total privatisation of our NHS. Some fear that all that will be left will be the name.
Where is the mandate for that from the British people? We can all sign up to the Bill’s objectives, but there is no evidence to support the idea that the proposals will deliver better health outcomes. The reforms are based on the notion that increasing competition drives down costs and improves quality. However, the overwhelming evidence from the UK, the US and elsewhere, is that that is not how competition works in health care.
I have heard some Government Members ask, “What does it matter who provides our health care as long as it is free at the point of need?” I say to them that that does matter. I have seen how the decisions about which patients those providers treat are based on whether they are profitable or not; they are not based on clinical need.
The reforms will affect the choice of medicines prescribed, and what type of treatments are provided and what kind of patients are prioritised. Certainly, that will not mean those with complex conditions. Unprofitable patients can expect short shrift from this evolved NHS. At my surgery last week, one of my constituents, who is in remission from leukaemia, came to see me because she fears that the drugs that she has been prescribed will be unavailable under the new reforms. What am I going to tell her?
Abolishing primary care trusts as part of the costly NHS reorganisation is yet another broken promise from this Government. Putting £80 billion of the NHS budget into the hands of a few GPs who enjoy managing a business might sound liberating, but in my experience, the vast majority of GPs want only to care as well as they can for their patients. In reality, the commissioning of health services will also be done by private health care companies, and there are significant conflicts of interests when those companies are both commissioners and providers of care.
The impact on equitable access to health care is another real issue. The Bill does not require GP consortia to work together, which leaves the possibility of neighbouring consortia taking different decisions about services, giving rise to a new postcode lottery. By forcing those GP consortia to put all services out to competitive tender, the Bill encourages any willing provider to cherry-pick profitable slices of NHS services. The introduction of price competition for the first time is a disastrous step, with the potential to undermine the quality of patient care.
In public health, which is my field, I have little confidence that the move of the public health service to local authorities will lead to health gain. That depends on an independent and well-resourced public health work force. The Bill also fails to define what will be covered by the ring-fenced budget that is given to local authorities. Thank you again, Mr Speaker, for calling me.
Oral Answers to Questions
Debbie Abrahams Excerpts(15 years ago)
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Mr Lansley
I am afraid the hon. Lady sees a conflict where, to GPs, there is none. It is their responsibility—[Interruption.] No, their first duty is always to their patients, whose best interests they must secure. When she has an opportunity to look at the Health and Social Care Bill, which we published last week, she will see that it makes very clear the duty to improve quality and continuously to improve standards. We all know that we have to achieve that with finite resources, but we will do that much better when we let clinical leaders influence directly how those resources are used rather than letting a management bureaucracy tell them how to do it.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Can the Secretary of State explain why, at a time when front-line NHS staff in my constituency and elsewhere across the country are in fear of their jobs, it is proposed that the NHS commissioning board will be able to make bonus payments to a GP consortium if, to quote the Bill,
“it considers that the consortium has performed well”,
and that a GP consortium may
“distribute any payments received by it…among its members”?
Is that not the worst kind of excess? We do not want to see it in our banking system, and we certainly do not want to see it in our NHS.
Mr Lansley
I am glad to have the opportunity to welcome the hon. Lady to the Opposition Benches and wish her well in representing Oldham East and Saddleworth. I am sorry that she did not take the opportunity to welcome in particular the Government’s commitment to the new women and children’s unit at the Royal Oldham hospital.
For years, general practices have been remunerated partly through a quality and outcomes framework. The principle is that if they deliver better outcomes for patients, they should have a corresponding benefit from doing so. In the same way, if the commissioning consortia deliver improving outcomes for patients, that should be recognised in their overall reward.