NHS Sustainability and Transformation Plans
Debate between Diane Abbott and Simon Burns(8 years, 2 months ago)
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Ms Abbott
It is indeed the case; rather than being an anodyne managerial exercise, the sustainability and transformation plans are designed to make up the missing £22 billion.
One of the most alarming aspects of the STPs is their secrecy. England has been divided into 44 regional footprints, and it is worth noting that they are called footprints to distract from the fact that they are ad hoc regional structures—they are the exact same regional structures that the Tory health Bill was supposed to sweep away. Because they are ad hoc and non-statutory, they are wholly unaccountable. In the world of the STPs, the public have no right to know.
Ms Abbott
I am grateful to the right hon. Gentleman. For nearly the whole time I have been in Parliament, there have been attempts to reconfigure hospitals and close A&Es and make other changes in London. We have found that when the local community does not take ownership of the plans, it is impossible to take them forward. That secrecy runs counter to making the reorganisations we might have to make.
Ms Abbott
Initially, the STPs were discouraged from publishing their draft plans, freedom of information requests were met with blank replies, and enquirers were told that no minutes of STP board meetings existed. We are therefore bound to ask: if the plans are really in the interests of patients and the public, why has everyone been so anxious to ensure that patients and the public know as little as possible?
Ms Abbott
I entirely agree with my hon. Friend. All STPs should publish who is on them, what their financial interests are, and how far advanced they are in planning. However, thanks to the work of organisations such as Open Democracy and 38 Degrees—and, frankly, thanks to leaks—the picture of what STPs will mean is becoming clearer.
We know from the information we have been able to glean that the reality of STPs is quite concerning. For instance, in the black country there are plans for major changes to frontline services at the Midland Metropolitan hospital, including the closure of the hospital’s accident and emergency. The plans also propose to close one of the two district general hospitals as part of a planned merger. We know that by 2021 the health and social care system in the black country is projected to be £476.6 million short of the funds it needs to balance its books. [Interruption.] Government Members may shout now, but they are going to need an answer for their constituents when the reality of some of these proposed closures becomes apparent.
In Leicester, Leicestershire and Rutland, there are apparently plans to reduce the number of hospitals in the area from three to two. By 2021, the health and social care system in the area will be £700 million short of the money it needs to balance its books. In Suffolk and north-east Essex, the STP plan refers to the
“reconfiguration of acute services within our local hospital, Colchester Hospital University Trust”.
The whole House knows that, historically, reconfiguration in the NHS has meant cuts. There are also plans to close GP practices.
The context of these plans, of which I have given an idea, is the current NHS financial crisis. Most recently, we have heard from NHS providers about this financial crisis. They represent the NHS acute, ambulance, community and mental health services. NHS providers say that despite the best efforts of hardworking staff, including junior doctors, hospital accident and emergency performance is the worst it has ever been. Waiting lists for operations, at 3.9 million, are the highest they have been since December 2007. We ended the last financial year with trusts reporting the largest deficit in the history of the NHS: £2.45 billion.
Ms Abbott
I have to make a little progress.
Many STPs will be facing a large financial deficit. [Interruption.] I have to say to Government Members that they do not seem to be taking this debate seriously. When their constituents come to them asking about these cuts and closures, they will have to take it seriously. Many STPs will be facing a large financial deficit, which is subject to “control totals”—that is, cuts. In the case of north-west London, which does not have the largest projected deficit by any means, spending on acute care is projected to fall in nominal terms over a six-year period, despite a population that is both increasing and ageing, and despite cost pressures such as the sharply rising cost of drugs.
STPs have made an assessment of their own deficits by 2020-21. Researchers have disclosed that approximately 29 of the 44 STPs have projected substantial deficits.
Ms Abbott
So when the STPs talk about efficiency, they actually mean cuts. Increasingly at the heart of these STPs are asset sales of land or buildings to cover deficits. No wonder the leader of Hammersmith and Fulham Council, Stephen Cowan, has said of his local STPs that
“this is about closing hospitals and getting capital receipts”.
He went on:
“It’s a cynical rehash of earlier plans. It’s about the breaking up and the selling off of the NHS.”
Ms Abbott
I am anxious to complete my remarks so that Conservative Members will all get a chance to intervene in the debate.
The Health Select Committee's recent report on the impact of the 2015 spending review stated:
“At present the Sustainability and Transformation Fund is being used largely to ‘sustain’ in the form of plugging provider deficits rather than in transforming the system at scale and pace. If the financial situation of trusts is not resolved or, worse, deteriorates further, it is likely that the overwhelming majority of the Fund will continue to be used to correct short-term problems rather than to support long-term solutions”.
Ms Abbott
My hon. Friend has made an important point.
The danger is that, in a blizzard of apps and Skype, patients—particularly the elderly—will find it harder to access one-to-one care, and that those who can afford it will find themselves forced into the private sector.
Let me now say a word about the increasing private sector involvement in the NHS.
Ms Abbott
It was the NHS England director of STPs, Michael McDonnell, who said that they
“offer private sector and third sector organisations an enormous amount of opportunity”.
We know that PricewaterhouseCoopers has been heavily involved in the formulation of a large number of these plans, and we know that—as was mentioned earlier—GE Healthcare Finnamore, which was taken over by General Electric in the United States, has been heavily involved in the formulation of plans in the south-west and possibly more widely. The strong suspicion is that a combination of cuts, the reorganisation of services on a geographical basis, and the growth of hospital “chains” will facilitate greater privatisation of the NHS.
Ms Abbott
Let me now draw my speech to a close. It is absolutely right that health and social care stakeholders should come together to plan for the future. It is absolutely wrong that social transformation plans should be hatched in secret and used as a cover for cuts and hospital closures—and it is increasingly clear that STPs may be a stalking horse for more privatisation. Conservative Members may not take this issue seriously—[Interruption]—and Conservative Members’ response may be to shout, but I stress to the House that the consequences of these STPs will be very material for all our constituents.
National Health Service
Debate between Diane Abbott and Simon Burns(9 years, 10 months ago)
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Mr Burns
First, competition was introduced on the current scale by the Blair-Brown Government, and secondly, there is nothing wrong, per se, with competition to get the best providers providing the best care for patients, so long as they keep to the sole ethos of the NHS, which is that that good care be provided free at the point of use for NHS patients. We saw that under his Government and under the Major Government, and this Government have used the private sector to ensure that patients are treated more quickly. We want them to be treated as quickly as possible, and if there is not enough capacity in the NHS, and if a private provider can provide the capacity, I see nothing wrong with that, and neither do most people in this country, if they are treated more quickly.
Returning to the walk-in centre, there were 40,000 attendances last year, 10,000 of which were by people beyond the Mid Essex CCG area. Of the remaining attendances, one third should have been self-caring or using their community pharmacy or 111, which the CCG is paying for, and another third should have been using their community pharmacy or GP, which the NHS is paying for. The CCG was therefore paying twice for the same care for the same patients, which is an utter waste of money. That money should be being used to care for more patients quicker, which is why the CCG has taken the decision it has. It is a rational decision, because the centre is failing to meet the aims it was set up for and instead ensuring that the NHS pays twice for the same patient to be treated. In place of the walk-in centre, there will now be an urgent care service at the local hospital for those people who should be going there. Sometimes, politicians have to do the right thing, regardless of political point scoring. Where it is in the interest of patients and the configuration of services, they should take the right decision, be reasonable and responsible and explain why it is the case.
In conclusion, I am delighted to see the hon. Member for Hackney North and Stoke Newington (Ms Abbott) in her place. I am fascinated to note that the nub of the motion is a call for an extra £2.5 billion for the NHS, which I am sure she strongly supports. What worries and concerns me—she may have a problem when it comes to voting at 7 o’clock tonight—is that the motion goes on to say that it is going to be
“funded by measures including a tax on properties worth over £2 million”.
Given the battle the hon. Lady had on the radio with a member—a right hon. Member— of her party from a southern Scottish constituency, I imagine that she is in turmoil, wondering how to justify that funding from that source.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
I am in no turmoil whatever. I will be walking through the Lobby with pride behind my hon. Friends. We cannot know exactly how much a mansion tax, if levied, would raise towards the national health service. What we do know is that the British people who want to save the national health service from the depredations of Government Members have to vote Labour. We have to vote for my right hon. Friend the Member for Leigh (Andy Burnham) to become Secretary of State for Health—
Health and Social Care Bill
Debate between Diane Abbott and Simon Burns(12 years, 8 months ago)
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Ms Abbott
She will, you know. Does she agree that it is apparent over the years that it is one thing to see an intention built into a Bill, but quite another to see it implemented on the ground? It is the contention of Opposition Members that, worthwhile as the statements in the Bill are, in the context of this particular car crash of a Bill, some of those intentions around public health will be dead on arrival.
Oral Answers to Questions
Debate between Diane Abbott and Simon Burns(12 years, 9 months ago)
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Mr Burns
The straightforward answer is no, because everyone, including the right hon. Member for Leigh (Andy Burnham), accepts that the NHS has to evolve to keep up and meet its challenges. What matters to patients is not who delivers their care but the quality of the care that they receive, their experience of that care and the dignity and respect with which they are treated at all times. Cutting bureaucracy by a third to reinvest £4.5 billion in front-line services between now and 2015 is the way forward. Frankly, if one goes and talks to doctors around the country, one finds that they wish that Labour’s party political squabbling would stop so that they can get on with implementing the modernisation programme.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The Minister talks about party politics. Is he not aware that not a day goes past without an organisation representing doctors and nurses coming out against his Bill? Most recently, the Royal College of Physicians is having to hold an extraordinary general meeting because of pressure from its members. The Royal College of Paediatrics and Child Health is consulting its members. Why should anyone in this House support a Bill to which the men and women who work in the health service are so opposed and which even Tory Cabinet Ministers are briefing against?
Mr Burns
I suspect that the hon. Lady does not get out and about much to meet doctors who are beginning to commission care for their patients. If she did, she would know that the mantra she is repeating from organisations that are not representative of doctors in this country—[Interruption.]
Obesity
Debate between Diane Abbott and Simon Burns(13 years ago)
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Mr Simon Burns
I have been listening carefully to the hon. Lady, who is making some valid points. The danger has to do with not simply the age of computer games but the age of television before that. For some parents—this is a generalisation—the easy option is to let their children spend hours watching television or playing games, because it involves less effort on the parents’ part. One must try to educate people that that is not only an easy option but an unfair one.
Ms Abbott
I am loth to agree with the Minister, but I think that he is right on that point. A particular interest of mine is the education of urban children and the challenges of getting them to achieve their educational potential. As part of working with parents, especially in urban communities, we must teach them that just putting their children in front of a television set is not necessarily the best thing for their health or their education.
I agree entirely with what has been said about exercise and sport, but we also need a particular focus on girls and exercise. Statistics show that girls give up exercise younger; after they leave school, they do not continue to exercise, as boys do. I was interested to hear about, was it ice hockey—
The Minister of State, Department of Health (Mr Simon Burns)
It is a pleasure to serve under your chairmanship, Mrs Riordan, during this extremely interesting and thoughtful debate, to which there have been a number of erudite and imaginative contributions across the range.
I congratulate the hon. Member for East Londonderry (Mr Campbell) on securing the debate and giving us the opportunity to discuss one of the major public health issues of modern times. He has spoken repeatedly on the subject in the House and should be congratulated on doing so. He knows, of course, the scale of the problem. Most adults in England, 61%, are overweight. Sadly, one third of those are clinically obese, giving us one of the highest obesity rates in the world. As for children, almost a quarter of four to five-year-olds are overweight or obese, rising to one third in 10 to 11-year-olds. I am sure that we all agree that those figures are genuinely shocking. The hon. Gentleman will be aware that the scale of the problem in Northern Ireland, to which he alluded during the course of his remarks, is similarly daunting, with 59% of adults and 22% of children overweight or obese.
As recently as the 1980s, obesity rates among adults were a third of what they are now. Although figures for the last few years show that levels of obesity may be stabilising, that is simply not good enough, because excess weight has serious consequences for individuals, the NHS and the wider community. Not only does it cause day-to-day suffering such as back pain, breathing problems and sleep disruption, but it is a major risk factor for diseases that can kill. An obese man is five times more likely to develop type 2 diabetes, three times more likely to develop colon cancer and two and a half times more likely to develop high blood pressure than a man with a healthy weight, and women face equally serious risks. That is not to mention liver disease, heart disease, some cancers and miscarriages, all of which are linked to excess weight.
Although the real and present danger of obesity in terms of immediate health risks is seen largely in adults, obesity also has significant effects on children and young people, as many hon. Members have mentioned. Obese children are likely to suffer stigmatisation, and there are growing reports of obese children developing type 2 diabetes. We also know that if a child is obese in their early teens, there is a high chance that they will become an obese adult, with related problems later in life.
As waistlines expand, so does the amount of money that we spend on the issue. As a number of Members have said, excess weight is a burden of approximately £5 billion each year, and costs billions more through days of work and incapacity. Neither can we ignore the link between obesity and health inequalities. Data from the national child measurement programme show a marked relationship between deprivation and obesity. The Marmot review in 2010 showed the impact that income, ethnicity and social deprivation have on someone’s chances of becoming obese. As things stand, the less well-off a person is, the more likely they are to be carrying excess weight, so we are talking about an issue of social justice, as well as a narrow health issue involving exercise and healthy living.
The hon. Members for East Londonderry and for Hackney North and Stoke Newington (Ms Abbott) both asked, in effect, whether the Department of Health should work with companies that produce and sell products that contribute to the nation’s obesity and alcohol problems. Up to a point, it is the responsibility of the individual how much they consume and what they consume. How do we make sure that people know what they are eating—the calorie, salt and fat content and so on? To my mind, that means clear, easily understandable labelling, and education about what is healthy and what is the best approach.
On the narrow point of the issue mentioned by both hon. Members, improving the health of the public is clearly a priority for the Government, but we need a whole-society approach to tackle the health problems caused by poor diet, alcohol misuse and lack of exercise. To change people’s behaviours, we need to make the healthier choices the easier choices for everyone.
Commercial organisations have an influence on and can reach consumers in certain ways that Governments cannot. They have a key role in creating an environment that supports people to make informed, balanced choices that will enable them to lead healthier lives. Through their position of influence, they can address some of the wider factors that affect people’s health, such as how healthy our food is and how easy it is to access opportunities to be more physically active. Through the work on the public health responsibility deal, despite what the hon. Member for Hackney North and Stoke Newington has said, we are tapping into that unrealised potential to help improve the public’s health.
Mr Burns
I will give way in a moment. It is also important to say that, if we can get an agreement with commercial companies to change the way they behave and some of their practices, it will be far quicker to achieve that and put it in place than to wait for the heavy hand of Government legislation, which can take a minimum of a year and sometimes years. Why wait for the heavy hand of legislation that might take a long time, if we can get a voluntary agreement that will work quicker and more effectively to start dealing with the problem?
Ms Abbott
On changing commercial practices, when will the Government do something about the practice of so many supermarkets whereby they place rows of sweets next to the checkout? If a parent has fought off their children and not bought sweets on their way around the supermarket, the children then have 10 minutes to whine while the parent waits to pay for their shopping.
Oral Answers to Questions
Debate between Diane Abbott and Simon Burns(13 years, 4 months ago)
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Mr Burns
My hon. Friend makes an extremely important point, because not only are his figures correct, but thereafter until the end of the decade there will be savings of £1.7 billion a year, on current projections. Every single penny of that will be reinvested in front-line services for patients.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The Minister continues to insist that his reorganisation will result in savings that will be reinvested in patient care. Yet even before we have the impact assessment for the changes in the legislation, we know, as will Members across this House, that on a daily basis people are leaving primary care trusts with their redundancy money. That totals £800 million and upwards, and it has not been costed. We also know that the Royal College of General Practitioners has said that we will have gone from having 163 statutory organisations to having 521. Are not the costs of this misconceived car crash of a reorganisation spiralling out of control?
Mr Burns
The reality is that the hon. Lady does not understand, or will not accept, the figures published in the impact assessment. What she does not like is the fact that by the end of this Parliament there will be savings of about £5 billion, and thereafter of £1.7 billion until the end of the decade. That will all be reinvested in front-line services. The hon. Lady will not accept, and wishes to misrepresent to members of the public, the resulting benefits in improved and enhanced patient care.
Oral Answers to Questions
Debate between Diane Abbott and Simon Burns(13 years, 10 months ago)
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Mr Burns
Ambulance services will be commissioned through the GP consortia at the local level. What I envisage—this is not prescriptive from the Department of Health, but what I think will develop—is that, just as ambulance services are currently commissioned for geographical areas in England through one PCT, the consortia will appoint lead consortia to commission the services for that area.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
Does the Minister agree with the representations of the Select Committee on Health, chaired by the hon. Member for Charnwood (Mr Dorrell), when it said that it was
“surprised by the change of approach between the Coalition Programme”
in May
“and the White Paper”
in July? The Committee continued:
“The White Paper proposes a disruptive reorganisation of the institutional structure of the NHS which was subject to little prior discussion and not foreshadowed in the Coalition Programme.”
If he cannot convince his hon. Friend the Member for Charnwood, how is he going to convince the rest of us?
Mr Burns
Let me begin by congratulating my, in fact, right hon. Friend the Member for Charnwood on the report that his Committee produced. The Government will give a full response to it in due course, as is usual. What I would tell the hon. Lady is that what happened in the Bill and the White Paper was what we and our coalition colleagues, the Liberal Democrats, had outlined in our election manifestos, which—[Interruption.] Hon. Members may say that, but I suggest that they look at pages 45 to 47 of the Conservative manifesto, which probably very few of them have bothered to do. GP commissioning, along with “any willing provider” et al, are there, and if one looks at the Liberal Democrat one—[Interruption.]