Health and Social Care Bill

Geraint Davies Excerpts

Monday 31st January 2011 Commons Chamber

[Mr Lansley]

I would say two things to Professor John Appleby. First, the latest data published in EUROCARE-4, which I know the right hon. Gentleman will have seen, are clear about the gap between cancer survival rates in this country and others, and in recent years that gap has not diminished as it should have. He can read in last week’s Lancet an authoritative study of cancer survival rates in this country and a number of others demonstrating that the gap remains very wide and that we have to close it. Secondly, the King’s Fund supports the aims of the Bill and Professor Appleby, as a representative of the King’s Fund, clearly understands, as we do, that if we are to deliver the change that is needed, we need the principles in the Bill.

People trust the NHS, and its values are protected and will remain so—paid for from general taxation, available to all, free at the point of delivery and based on need rather than the ability to pay. However, a system in which everyone is treated the same is not one that treats everyone as they should be treated. Our doctors and nurses often deliver great care, but the system does not engage and empower them as it should.

[Geraint Davies (Swansea West) (Lab/Co-op)]

On the John Appleby point, does the Secretary of State accept that what he actually said was that the rate of deaths from heart disease would be better in Britain than in France by 2012, on current trends, even though France spends 28% more on its health service? Is not that a ringing endorsement of what is happening now rather than a prescription for blowing up the system as the Secretary of State suggests?

[Mr Lansley]

First, I have just answered the point about John Appleby. It is true in a number of respects, as I have made clear, that although there have often been improvements in the NHS, they have not been what they ought to have been. It was a Labour Prime Minister, back in 2001, who said that we must raise resources for the NHS to the European average, but he did not achieve results that compared with the European average.

Let me give the hon. Gentleman some examples. A recent National Audit Office report showed that as many as 600 lives a year could be saved in England if trauma care were managed more effectively. Too often, the latest interventions, which are routine in other countries, take too long to happen here. John Appleby used heart disease to illustrate his point. Primary PCI— percutaneous coronary intervention—using a balloon and stent as a primary intervention to respond to heart attack was proven to be a better first response years ago. I knew that because cardiologists across the country told me so several years ago. I remember a cardiologist at Charing Cross telling me, “I have a Czech registrar working for me who says that in the Czech Republic PCI as a response to a heart attack is routine, but it hardly ever happens in this country.” Since then, it has been better implemented in this country, but that started to happen only when the Department of Health gave permission for its adoption.

The same was true of thrombolysis for stroke. That happened too late in this country, after such changes had taken place in other countries, because health care professionals there were empowered to apply innovation to the best interests of patients earlier.

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[John Healey]

If the hon. Gentleman was worried about the past, he should be a good deal more worried about the future, and, a bit like the Health Secretary, he should spend a lot less time talking about the Labour Government and what we did to the health service and more time talking about the plans and big changes to come.

[Geraint Davies]

Does my right hon. Friend accept that the core difficulty with the Bill is that it is not about patient choice but about a movement towards general practitioner choice and GP consortia choice? They want to maximise not medical outcomes but profitability. That is what this is about, and the reason is the same as what was said about flexible pricing.

[John Healey]

My hon. Friend is right. For the first time in the NHS we are facing, first, the potential for profit at the point of commissioning and, secondly, commissioning—in other words, decisions about rationing as well as referral—being made at the individual patient level, not at the collective area level, and we are looking at them being made by bodies and individuals who are not publicly accountable, including to the House.

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[Henry Smith]

I dispute that reading of the Bill. Maternity was taken away from my local community in 2001 and is now 10 miles up the road, in another county, and accessible only by single-carriageway roads, which is at best inconvenient, and at worst dangerous for patients.

The sorry tale goes on. In 2005, under Labour, Crawley hospital lost its A and E unit to East Surrey hospital—10 miles up the road, in another county—which has been seriously detrimental to my constituents, and something that they and I very much regret.

I was struck by many of the comments of my hon. Friend the Member for Wyre Forest (Mark Garnier), because he mentioned things very similar to our experiences in Crawley—and listening to other right hon. and hon. Members, there seem to have been similar experiences across the country as well. I can speak only from my local experience, but there was an eerie resonance in the sort of downgrading of services under the Labour Government.

[Geraint Davies]

Does the hon. Gentleman accept that what his community, like other communities, will face is a local monopoly—the GP consortia—that will focus on the most profitable lines of treatment, rather than on the best treatment? Surely this is not the right direction.

[Henry Smith]

I do not see how multiple providers is a definition of a monopoly. However, I must make progress in the short time left to me.

My constituents are pleased that for the first time in many years health decisions will be made in Crawley, rather than, as has happened up until now, on the south coast, in east Surrey or up in Whitehall, and that more decisions will be made by local people.

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[Geraint Davies (Swansea West) (Lab/Co-op)]

I am glad to be called to speak at this hour, Mr Deputy Speaker. It is my joy to celebrate the achievements of the health service that was started by Nye Bevan from Wales and to celebrate the successes of the previous Government, such as the 2 million extra people a year who are now operated on, the 44,000 extra doctors and the 94,000 extra nurses. The question to ask is: why devastate and break a system that already works well?

The Bill risks stripping out the heart and mind of the NHS, in terms of equality and planning, and replacing it with a market of GP business consortia that will focus increasingly on profit maximisation through negotiation of the best prices, bulk purchasing and threatening to withdraw custom from hospitals that cannot survive without them. Huge health retailers will evolve with local monopolies over patient communities. It is all very well saying that patients will have choice, but there will be big consortia saying, “This is what is best for you—buy this”, focusing on the areas of highest profitability. Those consortia might prefer to deal in cataracts rather than, for argument’s sake, chronic conditions. They might choose to focus in certain demographic areas with different health trends. A business focus will be applied according to the returns that can be gained in different areas rather than simply focusing on what is right for each person.

[Neil Carmichael (Stroud) (Con)]

Is it not possible that doctors’ consortia will simply make the right decisions for patients, focusing on giving proper value for money and decent care and on responding properly to local requirements and needs? Would not that apply across the piste in terms of community hospitals and acute hospitals?

[Geraint Davies]

The taxpayer invests in GPs to provide medical and clinical excellence so that they can diagnose people’s health problems. The taxpayer does not invest in them to become small business people who go around trying to maximise profit and work out rates of return on different sorts of health care. That is the problem with introducing privatisation and marketisation: the thought in the back of the business person’s head is how to make money, not simply what is the best diagnosis. The customers whom GPs are facing—patients—are to a large extent ignorant. It is not like buying electricity from npower: patients do not know what is wrong with them. They are in the hands of their GP and they do not know whether what they have been prescribed—perhaps a cheaper drug that makes a higher profit but is not as effective—is right: they just have to guess.

[Mr Graham Stuart]

Rationing is inevitable in any system, but who should best do it? Should remote managers do it away from patients’ needs, or should GPs do it in a way that involves managing and being aware of a budget but trying their best, within that budget, to deliver the best health outcomes for all their patients? Who is better—PCT managers or GPs?

[Geraint Davies]

A GP must always ask what the best treatment for the patient is rather than what the best treatment for their business’s profitability is. That is why this is fundamentally wrong.

[Neil Carmichael]

rose—

[Geraint Davies]

I shall not give way.

The Bill is setting up an incentive system that will make GPs make the wrong choices. It will return the NHS to a sort of pre-Nye Bevan, atomised system of health, rather than a planned system that uses resources efficiently. The system will lend itself, in the new era, to duplication, profiteering, businesses going bust and waste. What is more, there is no political mandate for the Bill; it is a Trojan horse of privatisation that no one knew would come. The changes will probably cost £3 billion or £4 billion to administer and will clearly set us back a number of paces before we move forward—if we do move forward.

A few people have mentioned the excellent work of John Appleby, the chief economist of the King’s Fund, who wrote in the British Medical Journal that the rate of deaths from heart disease is falling much faster here than in any other European country. It is falling to such an extent that it will be lower than the rate in France by 2012 even though we are spending 28% less. In terms of relative efficiency, we are doing well. Breast cancer rates have fallen by 40%, compared to 10% in France. I am not complacent and I do not pretend that there should not be greater productivity. If I had to point to one area in which there should be greater productivity, it would be the fact that we pay GPs too much money. That is the fault of the previous Government for negotiating a situation in which GPs can make more and more money. Now, it seems, we are encouraging them along that track, as though making a load of money were the primary focus.

My basic point is that if it ain’t broke, don’t fix it. Reform, yes: breaking the system, no. The Bill is not evidence-based. We are hurtling ahead, although people do not know the likely downside—the duplication, the amount of profit, the failures and possible hospital closures. The Bill is not economically sound or robust.

I have mentioned other difficulties one of which is that we make GPs subcontractors who want to maximise profit. In Wales, there is a move towards directly employing consultants and GPs, as opposed to giving them free rein on profit maximisation. Assuming that the Labour party wins in the Assembly election in May, we will see over the next five years the emergence of parallel systems, one of which will be a modernised version of the traditional health service and the other a marketised system. There is a conflict of interest between the profit motive and patient care, particularly in chronic conditions.

If aggregate supply is to be provided by a group of GPs, as opposed to a PCT, there is the risk of local shortages—of flu vaccines, for example. There might be local shortages in one area and excess supply and waste in other areas because of the absence of a strategic plan to deliver the right aggregate and match supply and demand.

In terms of customer and consumer watch, something called HealthWatch is to be introduced. Given the Government’s record in getting rid of Consumer Focus and bundling it in with Citizens Advice, I have little faith in the effectiveness of HealthWatch in looking after patients who, as I mentioned, are relatively ignorant of the product they are offered and face a local monopolist.

With reference to lifting the cap on private patients, as my right hon. Friend the Member for Croydon North (Malcolm Wicks) said, there is a risk that BUPA, for example, might suddenly funnel a lot of its patients in one direction because of discounted purchases, crowding out patients in a certain area. That would lead to unpredictability in the system.

We are asked to believe that the abolition of 150 PCTs and 10 strategic health authorities will miraculously save us some 45% of current expenditure. The people of Wales will make the right decision in May.