Future of the NHS

Debate between Emma Reynolds and Stephen Dorrell

Monday 9th May 2011 Commons Chamber

[Mr Dorrell]

I entirely agree with my hon. Friend. The Prime Minister and the Secretary of State made clear during the listening exercise their determination to ensure that proposals are brought forward that improve the capacity of the structures of the health service to deliver the objectives my hon. Friend has just articulated.

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

Will the right hon. Gentleman give way?

[Mr Dorrell]

I will give way once more and will then have to make progress, because I have very limited time.

--- Later in debate ---

[Emma Reynolds]

Does the right hon. Gentleman agree that it would have been possible to make the current structures work better? The coalition agreement states, on page 24:

“We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust”.

It is possible better to democratise the PCTs and give greater clinician involvement in them, so does he support some of the calls from the professionals to keep the cluster PCTs?

[Mr Dorrell]

I want to make my speech in my own way. The hon. Lady asked at the beginning of her intervention whether I agree that it would have been possible to introduce quite a lot of this without the need for a long Bill. She does not need to put that question to me, because the Health Secretary made the same point during the last health questions. We are seeking in the Bill to provide a holistic basis—a structure for the health service going forward, and that is an objective, starting from where we are, that it seems entirely reasonable to embrace.

I was seeking to identify the problem that my right hon. Friend’s measures must be designed to tackle, because as he and the Prime Minister have said repeatedly, no change is not an option. That should not be a matter of party political debate because the definition of the core problem facing the health service can be found in the NHS annual report for 2008-09, which was published 12 full months before the general election. I quote from it a single sentence:

“We should also plan on the assumption that we will need to release unprecedented levels of efficiency savings between 2011 and 2014—between £15 billion and £20 billion across the service over those three years.”

That is what we on the Health Committee referred to as the Nicholson challenge, because it was first articulated in the chief executive’s report a full 12 months before the election. That is the challenge that my right hon. Friend has to address, because it is the inescapable challenge in front of the national health service.

In point of fact, my right hon. Friend has made the challenge rather easier than it was in the days of the previous Labour Government, because there is a commitment to real-terms growth in the health budget throughout this Parliament, and because he has given the health service four years to respond to the Nicholson challenge, whereas the original articulation was focused on the three years ending in 2014.

But the substance of the need to deliver unprecedented efficiency gains out of the health service is the constant between the previous Government and the current Government. The articulation of it in the chief executive’s report was “£15 billion to £20 billion”; I have always preferred to articulate it as, “4% efficiency gain, four years running”.

That is what the health service has to deliver against the background of it never having delivered 4% efficiency in a single year, and of no health care system anywhere in the world having delivered a 4% efficiency gain, four years running. So, Sir David Nicholson, 12 months before the general election, was 100% right to say, “This is an unprecedented challenge,” and the challenge was embraced by the previous and current Governments.