NHS Reorganisation

Diana Johnson Excerpts

Wednesday 17th November 2010 Commons Chamber

[Mr Stephen Dorrell (Charnwood) (Con)]

In the brief time available, I do not want to follow the hon. Member for Sheffield Central (Paul Blomfield) in a detailed discussion of children’s hospitals, but I congratulate him on the first part of his speech, because he reminded us of what we are here to talk about—the delivery of high-quality care to patients, often in circumstances of extreme distress to them and their families.

I welcome the fact that the debate is taking place, but it is important for us not to imply that there is a choice to be made by politicians in 2010 about whether the health service faces the need for fundamental reform. The truth is that the health service, by which I mean the pattern of delivery of health care to patients, needs fundamental reform, as has been acknowledged since at least 2009. The shadow Secretary of State was good enough to confirm in his contribution that he recognises the need for that fundamental reform, which was set out by Sir David Nicholson in the £15 billion to £20 billion efficiency challenge. The purpose of the Nicholson challenge is to reconcile continuing rises in demand for health care, which we must assume will continue their long-term trends, with the inevitable fact that health budgets are more constrained, and will be more constrained in the years ahead, than during the period of the Labour Government. That was recognised before the general election, which is why the Nicholson challenge was articulated.

[Diana Johnson (Kingston upon Hull North) (Lab)]

But does the right hon. Gentleman agree that instead of taking such a big gamble with the NHS at this stage, it would be better to pilot some of the initiatives and changes to see whether they actually deliver better health outcomes?

[Mr Dorrell]

I shall come to the White Paper later, but I want to focus on what I regard as the key, unavoidable reforms that have to be delivered during this Parliament. I do not think the hon. Lady will find them controversial. They are the continued development of improvements in the delivery of primary care; the priority need to address unnecessary admissions to hospital, which have been identified by the National Audit Office as running at 30% of non-emergency hospital admissions; the need to address the requirement the health service faces to use its most expensive resource, clinicians’ time, more effectively; the need to improve links between social care and health-care, because if they do not work effectively there is no way we can deliver the aspirations we all share for high quality care delivered by the national health service; and the need to deliver better patient, user and local community involvement in the design and delivery of health care.

All those things are the challenges the health service faces over the lifetime of this Parliament. They are not a matter of political choice; they were articulated by Sir David Nicholson during the previous Government. They were endorsed by the previous Secretary of State and this afternoon they have been endorsed again by the shadow Secretary of State. It is simplest to summarise them by describing them in total as the need to deliver a 4% efficiency gain through the entire national health service system for four years running.

A few weeks ago, when Sir David Nicholson was before the Health Committee, which I have the privilege to chair, we asked him to set that challenge in context and he described it—as the shadow Secretary of State was right to say—as the most substantial challenge not just anywhere in the public service, but anywhere in the economy. The challenge has no precedent in any advanced health care system in the world. The challenge is huge: a 4% efficiency gain throughout the NHS, four years running. We are looking to deliver a wholly unprecedented efficiency gain. Against that background, what is the importance of the White Paper?

I ask the House to consider for a moment the counterfactual. Is it possible to deliver that kind of efficiency gain in the health service without effective empowered commissioning driving change? If effective empowered commissioners will not do it, who on earth will? Secondly, is it possible to imagine effective empowered commissioning that does not engage the clinical community in the process more effectively than we have yet done?

--- Later in debate ---

[Diana Johnson (Kingston upon Hull North) (Lab)]

I am delighted to have an opportunity to say a few words in this debate.

Labour’s investment in health care over the past 13 years has produced huge strides. When we think about the position in 1997, with long waiting lists and hospitals in desperate need of refurbishment, we realise that we have come a very long way. I am disappointed that the new coalition Government, instead of deciding to build on the very successful investment over the past 13 years, are now engaged in an ideological approach to the NHS to bring in the private sector and to destroy a lot of the very good work that has been done.

I pay tribute to all NHS staff, clinical, non-clinical and administrative, who do their best and work very hard for patients. One of the most upsetting things I have heard since May is Government Front Benchers’ denigration of our NHS managers and administrators. That is very wrong.

My main starting point is to look at whether the coalition’s proposals will improve the health of my constituents in Hull. I do not think they will. I am absolutely appalled that the Government are to spend £3 billion on reorganisation when there is such a tight financial settlement for the NHS. Their focus should be on ensuring that patient care is maintained over the next few years, not on reorganisation.

Hull has a very good primary care trust. I pay tribute to the excellent and innovative work of Chris Long, the chief executive, and of Wendy Richardson, the jointly appointed director of public health with the local authority. As a spearhead PCT, Hull received additional money under the previous Government. It introduced projects such as the health trainers who have done so much in working with communities that have high levels of health inequality, for which different ways of working must be adopted. It has also done work on domestic violence and worked with its perpetrators.

The reason I am such a fan of Hull PCT is that, unfortunately, we have a Liberal Democrat-controlled council that does not seem to have any focus on its responsibilities for public health. The previous Labour council introduced free healthy school meals in all the city’s primary and special schools, rather than wait for an evaluation after three years of the pilot project, but the Lib Dems came in and scrapped it. The project was trying to do something about the high levels of obesity and poor performance in schools—to get to our youngsters early to ensure that they eat well. When that Lib Dem council is given the agenda for public health, I do not have much faith in it taking it seriously.

Hon. Members will recall the introduction of the free swimming initiative in the previous Parliament, which got our young people active through swimming and engaged our councils. Of course, Lib Dem-controlled Hull city council said, no, it was not going to get involved, and at the same time it put up the costs to our youngsters of attending sports clubs in the city. I am therefore very sceptical about the proposed public health agenda being taken on by Lib Dem local authorities.

[Lyn Brown]

My hon. Friend will know about the health needs in Newham, where the incidence of TB is rising and the rate of HIV is very high. The people who have helped me and my constituents most in managing these health needs have been the people at the PCT, who have been very responsive to my requests and requirements. Has she found the same in Hull?

[Diana Johnson]

Absolutely. Although not all PCTs have operated as we would like, there is good practice throughout the country. We should focus on that and see what we can learn.

I am concerned about the coalition Government’s approach to public health, because the junk food industry seems to be helping them to make policy, as some of our national media have reported in the past few days.

[Kate Green (Stretford and Urmston) (Lab)]

Is my hon. Friend aware that the Government have decided to abolish the health in pregnancy grant, which would further assist pregnant mothers with healthy eating and preparing for the birth of a healthy baby?

[Diana Johnson]

Absolutely. My hon. Friend campaigned long and hard for families, especially low-income families, in a previous occupation. The health in pregnancy grant is going and the Sure Start grant will now be paid only for the first pregnancy, so we are starting to see what the Government really think about improving people’s health, especially that of women.

Of course, we must not forget that during the election campaign in May the Liberal Democrats made it very clear that they thought NHS funding should not be ring-fenced. The right hon. Member for Twickenham (Vince Cable) said that the NHS should not be treated as a sacred cow. Again, we see the Liberal Democrats being the more regressive part of the coalition.

I wish now to concentrate on GP commissioning, because there are major issues on which we need to focus. Many specialist groups, particularly the muscular dystrophy group in Yorkshire, have been in touch with me to say that they are concerned that local GPs will not understand their health needs. I have talked to patients in the local hospital and other people receiving health care locally, who are anxious about their particular needs being met.

For me, a bigger issue is the performance of GPs. PCTs have been particularly successful in holding to account GPs who do not perform as well as they should, and I am particularly concerned about who is going to hold the ring. Who will deal with GPs who do not meet the needs of their communities?

A number of hon. Members have mentioned the bureaucracy in the new system of GP consortiums. I believe that there will be more administrators, and I say to the Secretary of State that, if we are to focus on health outcomes, bureaucrats will be needed to put together information and statistics and we will not, therefore, see the massive reduction in backroom staff that the Secretary of State expects.

A lack of accountability at local and national level is a major problem. The new national board—the largest quango that we have ever seen—is being created, but to whom will it be accountable? It is not acceptable for the Secretary of State and his Ministers to come to the House and say, “That is for the national board”, or “That is for local decision making.” We need control over what happens to our NHS. As I asked in my intervention on the right hon. Member for Charnwood (Mr Dorrell), why cannot we have some pilot projects? If the change is to be so great, let us pilot it, see what happens and take a considered approach. Let us have some evidence to back up the White Paper.

I do not believe that any of the Government’s proposals will improve the health care of the people I represent. Of course we believe that clinical involvement is important, and of course doctors and other health care professionals should be involved. My hon. Friend the Member for Rochdale (Simon Danczuk) made the point that we should use the PCT structure to provide more clinical information and advice—we can have that involvement without throwing out the whole structure.

The Government must also consider other health care professionals, such as pharmacists. There are pharmacists on the high street in my constituency who really contribute to the health care of my constituents. People such as Mr Hall on Beverley road and Cath Boury on Newland avenue do face-to-face work to encourage people to give up smoking or reduce their weight. If we want to get clinicians involved, let us get all the clinical practitioners involved.

I finish with the “any willing provider” model in the White Paper. The Labour Government made it clear that the NHS was the provider of choice. That was exactly the right thing to do, because it recognised the important role the NHS has played over the past 60 years. It has staff with specialism and dedication, but the idea of “any willing provider” is just code for the private sector, is it not? The attitude is, “Let’s just roll it out and have the private sector run our NHS.” Most people in this country, particularly those who vote for the Liberal Democrats—I point to their Benches in saying this—will be shocked to know that their MPs are standing up for the private sector. It is disgraceful, and I hope very much that the White Paper will be amended to state that the Government support the NHS as the main provider of choice, rather than going down the road of the private sector and the Americanisation of the NHS.