NHS: Five Year Forward View

Earl Howe Excerpts

Thursday 23rd October 2014 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, I shall now repeat in the form of a Statement the Answer given by my right honourable friend the Secretary of State for Health to an Urgent Question earlier this morning in another place. The Statement is as follows.

“NHS England, along with other NHS organisations, has today published its independent Five Year Forward View, which sets out its view of how the health service needs to change over the coming years.

It is a report that recognises the real challenges facing the NHS but is essentially positive and optimistic. It says that continuing with a comprehensive tax-funded NHS is intrinsically doable, and that there are,

‘viable options for sustaining and improving the NHS over the next five years’.

The report says that the challenges of an ageing population can be met by a combination of increased real-terms funding, efficiencies and changing the models of care delivered. It also says that,

‘decisions on these options will need to be taken in the context of how the UK economy overall is performing’.

In other words, a strong NHS needs a strong economy.

The report suggests detailed new models of care, putting out-of-hospital services front and centre of the solution, delivered through greater integration between primary, community and specialised tertiary sectors alongside national urgent and emergency networks. These can help reduce demand significantly for hospital services and give older people in particular the personal care that we would all want for our own parents and grandparents. It talks about continued opportunities for efficiency savings driven by innovation and new technology, and suggests that they could be increased above the long-term run rate of efficiency savings in the NHS. It talks about reducing variation in the quality of care in the wake of the tragedy in Mid Staffs and how the new CQC inspection regime is designed to drive up standards across the system. It says that to do this we will need to move to much greater transparency in outcomes across the health and social care system. Finally, it makes important points about better integrating the public health agenda into broader NHS activity, with a particular focus on continued reductions in smoking and obesity rates.

The Government warmly welcome this report as a good blueprint for the direction of travel needed for the NHS. We will be responding to its contents in detail in due course but we think it is an important contribution to the debate. We are proud of how the NHS has coped with the pressures of financial constraint and an ageing population in the last four years, but we also know that to sustain the levels of service people want it needs to face up to change: not structural change, but a change in culture about the way we care for people.

Given that the report has been welcomed by all sides of the House, I also hope that this can be the start of a more measured and intelligent debate about the future of the NHS, where all sides of the House recognise our shared commitment to its future and focus on the best way to achieve the strong and successful NHS the whole country desires”.

My Lords, that concludes the Statement.

--- Later in debate ---

[Earl Howe]

My Lords, I am grateful to the noble Lord for his welcome of the report which I am sure is shared by all noble Lords. It is, as the Statement says, a very useful set of conclusions jointly reached by the leaders of our health service and their partners. The noble Lord is right to say that there are common areas of agreement between the Government’s view of how we should move forward in the NHS and the view of the Official Opposition. I refer in particular to the role of integration, not only integration between health and social care, but also between hospital care and out-of-hospital care and between public health and health services. The report endorses the direction of travel that the Government are already taking in initiatives such as the Better Care Fund.

I turn now to the noble Lord’s specific questions. On GPs, we are not of the same mind as regards making GPs salaried employees of the health service. The independent practitioner model has served the country well and we do not think that there is any appetite in the general practitioner community to move in the direction that the party opposite would like. However, I certainly agree that there is a powerful role for health and well-being boards to play, and in many areas they are already doing so by bringing together the key players in a local area to decide on the health priorities of that area and to work out the right strategies to meet them.

On public health, as the Five Year Forward View emphasises, obesity is one of our major public health challenges and will continue to be so. I do not agree that the responsibility deal has been inadequate. It is only a part of a menu of options which the Government have available. We have seen major advances resulting from the responsibility deal and we should not throw those away. It means bringing business along willingly with us: business with its power and reach which goes far beyond that of the Government to influence consumer behaviour.

On GP services, I agree that many GP practices are under strain, but our vision and, I am pleased to say, the vision in this report, really centres around remodelling primary care in the round so that GPs consider themselves part of a wider primary and community care team. Yes, we need more GPs, and we have undertaken to ensure that the NHS has at least 5,000 more by 2020, but more broadly we should look at the multidisciplinary mix of those teams and expand nurse numbers and allied health professional numbers to supplement the work that GPs do.

On parity of esteem, we shall have a useful Oral Question next week which will give us a short opportunity to debate it. As I am sure the noble Lord is aware, a lot of work is going on to make parity of esteem a reality, including for the very first time defining waiting times for mental health patients and ensuring that mental and physical health are looked at on a par by both commissioners and providers.

[Lord Fowler (Con)]

My Lords, the strategy seems to be very sensible, but I hope that not only the Government but also all the parties will do what the chief executive of the National Health Service said on the radio this morning and recognise that there is no appetite inside the health service for any further top-down reorganisation. Will they also recognise that we need to put much more emphasis on preventing ill health? Pharmacists, who are highly qualified and well trained, should have a much bigger role to play, which would reduce the present burden on general practitioners.

[Earl Howe]

My noble friend is absolutely right in what he says. The report lays great emphasis on the prevention agenda, not only through the work done in the public health arena by Public Health England and local authorities, but also through secondary prevention by the NHS itself: preventing the need for people to enter hospital in the first place. I fully agree with my noble friend about the potential role of pharmacists. Actually, that role has been enlarged over the past few years in an encouraging way with such things as medicines use reviews and the Healthy Living Pharmacy agenda. We want to go further and pharmacists are keen that we should do so.

[Lord Kakkar (CB)]

My Lords, I declare my interest as chairman of University College London Partners. This ambitious programme will require very strong leadership. What arrangements are going to be put in place to develop strong clinical leaders across the different sectors and environments of the health delivery system that will be required to ensure that this become reality?

[Earl Howe]

One of the great features of the Government’s reforms is to put clinical leaders in charge of designing the way that care is delivered throughout the country. That point is often overlooked. It is, of course, the quality of that leadership that we should focus on. That quality is variable and why NHS England, Health Education England and partners in the system are looking as carefully as they can at how to improve that quality of leadership. I direct the noble Lord’s attention to certain passages in the Forward View, which talk about the need for all the bodies in the system to work together: NHS England, Monitor, the NHS Trust Development Authority, the Care Quality Commission, Health Education England, NICE, Public Health England—all working together to achieve greater alignment and greater common purpose in the way that these proposals are implemented.

[Baroness Blackstone (Lab)]

My Lords, on the subject of the prevention of obesity, can the Minister say what steps the Government are taking to introduce a tougher regulatory environment for food companies whose products are damaging the health of many thousands of people in this country?

[Earl Howe]

Many food companies—not all, but many of the larger ones—have already taken steps, for example, to reduce the levels of salt and saturated fat in their products. We need to go further. This has been done by the previous Administration and the current Government on a voluntary basis. We think that that has worked well. Nevertheless, we have never excluded the possibility of regulation, where we think that it is justified. At present, we believe that there is sufficient scope to make progress without regulation, but that is a matter we will keep under review.

[Baroness Brinton (LD)]

My Lords, from the Liberal Democrat Benches, we also welcome the five-year report, particularly because it accepts that the business-as-usual model needs to move on. In particular, we welcome the public health aspects and the fact that strong democratic accountability with councillors and local authorities is providing substantial change in public health. Does the Minister agree with the report that there should be more enhanced powers for local authorities to develop this further? If so, can he guarantee that there will be cross-departmental discussions to make sure that there are more responsibilities, powers and funding?

[Earl Howe]

My noble friend has alighted on an area to which the whole Government will have to give very careful thought. It is not simply a matter for my department. This will entail cross-departmental scrutiny and agreement. However, on the strength of the performance of local authorities in grasping the public health agenda, as they have very enthusiastically, I am sure that we should look at that particular proposal very constructively.

[Baroness Hanham (Con)]

My Lords, as chairman of Monitor, which is one of the signatories and contributors to this document, may I ask the Minister to confirm further that the Government will not see any wholesale managerial reorganisation in the health service, which is not what the document is looking for, but that they will see change coming about in the way that services are developed? Will they ensure that services will not all be developed in the same way, but that there will be local elements? Will they also support initiatives to help the organisations make this a realisable objective within five years?

[Earl Howe]

I agree with my noble friend. We neither want nor need further structural reorganisation; but we do need cultural reorganisation. I also agree that a one-size-fits-all model will not work: indeed, the Forward View expressly states that. We need to allow local areas to work through the solutions that are best for them. That can be done on a collaborative basis, with the benefit of health and well-being boards, which are now working so well in many areas.