Health and Social Care Bill

Emma Reynolds Excerpts

Monday 31st January 2011 Commons Chamber

[Mr Lansley]

I am sorry, but 57 Members wish to speak, as you have rightly told us, Mr Speaker. I will give way as often as I can, but more than one intervention from each Member is excessive. [Interruption.] I have just quoted from the coalition agreement and our manifesto, so hon. Members have heard both.

Through the outcomes framework, which we published in December, we will stop the top-down, politically motivated targets that have led to real quality being sidelined. We will ensure that we focus on the outcomes that really matter and back them up for the first time with quality standards that are designed to drive up outcomes in all areas of care. Those standards have not been dreamt up in Whitehall, but are being developed by health professionals themselves. Similarly, doctors and other health professionals will not be told by us how to deliver those standards. The standards will indicate clearly what is expected, but it will be up to clinicians to decide how to achieve them. At every step, clinical leadership—that of doctors, nurses and other health professionals—will be right at the forefront. It will be an NHS organised from the bottom up, not from the top down.

The shift in power away from politicians and bureaucrats will be dramatic. The legislation none the less builds on what has gone before. It is not a revolution, but as the shadow Secretary of State said just a fortnight ago:

“The general aims of reform are sound—greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes—and are common ground between patients, health professions and political parties.”

[Emma Reynolds (Wolverhampton North East) (Lab)]

The right hon. Gentleman quoted the National Audit Office earlier. Does he agree with the statement in its report that his revolution in and upheaval of the NHS risk undermining the quality initiative—the so-called QIPP programme—that the previous Government introduced?

[Mr Lansley]

No, far from it—actually, quite the contrary. It is only by virtue of our ability to engage front-line clinicians more strongly in the management and design of care that we will deliver those quality, innovation, productivity and prevention ambitions; and it is only if we cut bureaucracy and the costs of bureaucracy that we will be able to get those resources on to the front line more effectively. I made it very clear, and the shadow Secretary of State endorsed the view, that there is consensus about the purposes of reform, but if Labour now voted against the Bill, although we do not know whether it will, it would abandon that consensus and, indeed, its own policies when in government.

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[Emma Reynolds (Wolverhampton North East) (Lab)]

There is much disquiet and concern among health professionals about the speed and scale of the reforms outlined in the Bill, with various respected organisations warning that they are a “significant risk” and “could be disastrous”.

It is important to see the Government’s plans in the context of the progress and the health legacy that this Tory-led Government inherited from Labour—patient satisfaction in the NHS at record levels, a world-class public service transformed by Labour, record numbers of doctors and nurses, and new hospitals. Contrary to some of the claims from the Government Benches about the statistics, survival rates for the most serious conditions are improving, and we will have the lowest mortality rates of any European country for heart disease by next year. The Government would do well to recognise this progress.

One of the Government’s central arguments is that massive restructuring is necessary to drive efficiencies in the NHS. I beg to differ. By overhauling the system, the Government are putting at risk the very drive for efficiencies that we support. According to the Royal Society of Physicians,

“Achieving both efficiency savings and reorganisation simultaneously will be an unprecedented challenge for both commissioners and providers”.

In government we recognised the efficiency challenges that we faced in the NHS. That is why in the last Labour Budget the Department of Health committed to £4.35 billion of savings over two years, with a further commitment to save £20 billion in the next five years. We demanded that primary care trusts reduce their management costs by 30% over a three-year period. The choice between doing nothing or modernising the NHS is a false choice, as I think the Government know.

Evidence from the previous reorganisation suggests that the disruption will extend well beyond the period of the reform. Even one of the Government’s Back Benchers, the hon. Member for Totnes (Dr Wollaston), a GP herself, has said:

“To my mind, it felt a bit like someone had tossed a grenade into the PCTs. These people have so much uncertainty about their position that they are haemorrhaging in a rather uncontrolled fashion.”

The transition process is not only disruptive, but will undermine efficiency and quality. This risk was recognised by the National Audit Office in its report, where it said that the previous government’s initiative, the so-called quality, innovation, productivity and prevention programme, is at risk because of the overhaul proposed by the present Government. What is more, their obsession with driving down costs using price competition carries a very real risk of decline in the quality of care, according to professional organisations such as the BMA, the Royal College of Nursing and the Royal College of Midwives.

[Mr Graham Stuart]

The hon. Lady is giving a powerful speech, making the case that every Government must look for efficiencies and suggesting that the previous Government did. One of the key failings under the previous Government, who did see improvements in the NHS with vast increases in expenditure, was on productivity. According to the National Audit Office, which the hon. Lady just mentioned, productivity, after improving in the 1990s before Labour came to power, fell during the Labour years, despite the massive investment of additional funds. Turning that around is the central challenge for this Government. What views does she have about how best that can be made to happen?

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[Emma Reynolds]

I have already said that we on the Labour Benches recognise the need to drive efficiencies and, as part of that, we recognise the need to increase productivity. We made massive strides in the 13 years that we were in power, and Government Members would do well to remember that.

The allocation of resources in the NHS is all about economics and the tension created by infinite demands and finite resources. Difficult questions that are at the heart of commissioning need to be answered at a macro level—questions such as how do we value the improvement or lengthening of one person’s life compared with another’s; and what is the cost of investing in one drug compared with another or with an existing treatment? These are not easy questions to answer, and clinicians are making decisions at a micro level.

Faced with a limited budget, clinicians will call for more resources to be allocated to their field. Oncologists will argue for a greater share of the budget to be spent on cancer treatment. Paediatricians will argue for more money for paediatrics. As well as prioritising primary care, GPs might well bid for more resources for treatment or minor surgery that their practice offers—a potential conflict of interests against which the Bill does not safeguard sufficiently.

GPs are trained to be advocates of their patients, and rightly so, treating them as individuals, not as a particular percentage of the population. Their training does not equip them with the tools to make the tough, unpopular decisions about the allocation of limited resources. Perhaps in his winding-up speech the Minister will tell the House what percentage of GPs he thinks have had to grapple with the complexities of the modified Portsmouth scoreboard or the quality-adjusted life years measure. Those are the instruments used day in, day out by people who make commissioning decisions.

As my right hon. Friend the Member for South Shields (David Miliband) said so eloquently, the choice is not between reform or no reform. We are not against reform or driving efficiencies, but we are against the ill-considered, costly, reckless reform contained in the Bill, which will undermine the drive for efficiency, jeopardise quality of care and fails to take into account the fact that GPs do not have the expertise or the training to make the macro-level decisions on the allocation of resources.

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[Nicky Morgan]

I entirely agree with my hon. Friend. It just shows that GPs, if they are given the responsibility, will step up to the plate and deliver what their patients need.

In the limited time available, I wish to focus on what the proposed changes will mean for mental health services. I speak as a member of the all-party group on mental health, and as someone with a family interest in mental health issues. The NHS in England spends more on mental health services than on any other disease category, including cancer and heart disease, and one in four people will experience mental ill health at some point in their lives. The public health strategy has so far not been mentioned in the debate. I entirely welcome the Government’s emphasis on public health and the emphasis on good mental health as well as good physical health. I recently spoke with Charnwood mental health forum, which is based in my constituency, whose members told me that prevention of mental health problems and supporting people who are perhaps heading down the road to depression and more serious conditions is incredibly important.

There are four keys areas that I want to mention in the time available. My first point, which has already been mentioned by the Opposition, is that we must ensure that GPs get proper support to commission effective mental health services and other specialised services. That support can come from the national commissioning board, third sector organisations and patients. That is why I think GPs will step up to the plate, because they will ask their patients and listen to them when designing and commissioning services.

A recent Rethink survey of GPs found that 31% of GPs did not feel equipped to commission mental health services, compared with 75% who felt that they could commission diabetes and asthma services. It also revealed that 42% of the GPs said that they had a lack of knowledge about specialist services for people with mental illness, and 23% said that they had a lack of knowledge about mental illness in the first place. I will cite a recent case study from my Loughborough constituency, in which I was told that one of my constituents was suffering from complex mental health conditions, but his GP appeared to have no knowledge of personality disorders and saw the problem as largely behavioural. The relationship between the constituent and the GP deteriorated and therefore the local Rethink carers group stepped in to help find another GP. With consortia, a GP in a different practice could have that specialisation, and the first GP, realising their limitations, could speak with that other practice and engage with carers groups, such as Charnwood mental health forum or Rethink to ensure that there are special services available for patients.

[Emma Reynolds]

Is the hon. Lady as concerned as I am that a recent survey by Rethink showed that 95% of GPs did not feel that they had sufficient expertise to commission mental health services?

[Nicky Morgan]

I was just talking about that, but the point that has been made is that GPs do not feel that they necessarily have the specialist skills to commission mental health services. That says not that the underlying plan set out in the Bill is wrong, but that GPs recognise their limitations. From the conversations that I have had with GPs, I think that they will know where to go to commission those services and they will get the support from the national commissioning board.