Health and Social Care Bill

Geoffrey Robinson Excerpts

Monday 31st January 2011 Commons Chamber

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

I am pleased to follow the hon. Member for Totnes (Dr Wollaston), who speaks with a great deal of experience in such matters. The House will share her aspirations for the positive involvement of GPs in commissioning, for the improvement in the provision of secondary care by involving primary care, and for the organisation of primary care. Those aspirations may be shared, but the Government’s hopes, and the evidence on which they are based, of carrying out this huge reorganisation and achieving its alleged aims are flimsy indeed.

In the history of Government-led reorganisations—it little matters whether they are bottom-up or top-down—this reorganisation is massive. The former Health Secretary, the right hon. Member for Charnwood (Mr Dorrell), referred to the view of the NHS chief executive. He said that the Nicholson challenge is to carry out successfully such a huge, large-scale reorganisation in the time proposed—the two challenges that need to be pulled off. I think I quote Nicholson accurately when I say that the first challenge is to do in four years something so massive that it can be seen from the moon—together with the great wall of China—and that that would be unbelievable. The second challenge—the other inherent part of the two-part challenge—is that that has to be done while achieving a 4% reduction in costs over four successive years; and

“To pull off either of these challenges would therefore be breathtaking; to believe that you could manage both of them at once is deluded.”

I do not know why David Nicholson is still in his position. I do not know how the chief executive of the national health service can think that the Government must be deluded to put forward a proposal such as the one that the Secretary of State has proposed and remain in his place, but he clearly does not believe it. I do not want to cast any aspersions on the Secretary of State’s mental health, although I note that the editorial of the last edition of the British Medical Journal read:

“What do you call a government that embarks on the biggest upheaval of the NHS in its 63 year history, at breakneck speed, while simultaneously trying to make unprecedented financial savings? The politically correct answer has got to be: mad.”

Government collective responsibility obviously applies.

It is difficult to understand why the Secretary of State is going down this route, because there is no evidence that these sorts of reorganisations—top-down, bottom-up—in the health service or anywhere else bring the benefits, cost reductions and performance improvements expected of them. If any Government Members want to correct that, I will willingly give way, even in the limited time available. However, there simply is no evidence for it. Indeed, the National Audit Office, in looking at nine reorganisations carried out in the last five years of the Labour Government, found no evidence at all. They all cost far more, and the benefits, so far as they could be identified, were much less.

Similarly, it is pretty obvious that the something like 15 structural reorganisations, particularly in primary and secondary care in the health service, were not successful either. We only have to read through them. Kieran Walshe has described the bewildering array of forms and structures put in place to run primary care and commission secondary care—[Interruption.] I see that anybody who does not agree with the Secretary of State is dismissed automatically—that is a sign of hubris and is not a good approach. A similar approach was taken towards Professor Appleby, who was dismissed as someone of no importance. Yet these are people who are looking at the facts—Appleby looked at improvements in the health service. The conclusion is that

“there have been family practitioner committees, health authorities, GP fundholders, total purchasing consortiums, GP multifunds, primary care groups, primary care trusts, and external commissioning support agencies.”

I freely admit that a lot of those came from the Labour Government. However, I cannot imagine why the Government refuse to learn from our mistakes. That applies also to one of the most serious developments in this whole proposed reorganisation relating to the introduction of price competition. It is feeble of the Government Front-Bench team to say, “Well, your Government intended to do it, so we are going to do it.” They spend hours every day criticising everything the Labour Government did. This is one thing they did not do—apparently they intended to do it—but suddenly it is so welcome that the Government insist on doing it. The fact is, however, that it will happen.

We have a huge change but with no evidence that it will bring any good; we have the fact that the NHS has to make savings that nobody believes will be achieved; and we have the fact that we are opening it up to competition. The position of the consortia becomes very questionable, as does the position of the NHS commissioning board itself. Other Members have raised these points. What sanctions have been provided for? To whom will the consortia report? Is the Secretary of State abdicating any responsibility for their performance? It is not clear from the legislation, as far as I can see—there are 61,000 words of it—what the Government’s role will be in the control, functioning and performance of these new boards.