Adult Social Care

Graham Stuart Excerpts

Monday 16th July 2012 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

I beg to move,

That this House notes the growing crisis in adult social care; welcomes many of the proposals in the Care and Support White Paper including national minimum standards on eligibility, stronger legal rights for family carers, portability of care packages and improvements to end-of-life care; notes that many of these ideas were proposed by the previous administration, but believes they are now in danger of appearing meaningless without the ability to properly fund them; is concerned that the Government is considering a cap on individual costs as high as £100,000; is committed to the important Dilnot Commission principle that protection against the risks of high care costs should be provided for everyone; and calls on the Government to honour the commitment in its 2010 NHS White Paper to introduce legislation in the second session of this Parliament to establish a legal and financial framework for adult social care.

The issue of how we provide decent care for older and disabled people and their families is one of the biggest challenges facing Britain today. Ten million people in the United Kingdom are now over 65, and that figure will rise to more than 15 million by 2030. The number of over-80s is growing even faster, and is set to double to nearly 6 million in 20 years’ time. Medical advances also mean that people with disabilities are living longer than ever before.

The fact that we as a nation are living longer is something that we should celebrate. There have been many improvements in adult social care over the past 10 years, and I shall say more about that in a moment. However, too many people still face a daily struggle to get the care and support that they need if they are disabled or become frail and vulnerable in their old age. The ways in which we provide and fund care need major reform if we are to deliver a better, fairer and more sustainable system. That reform is vital for older and disabled people and their families who want and deserve a decent system of care and support, but it is also vital for our economy. The Office for Budget Responsibility’s fiscal sustainability report states that the primary pressure on the public finances is our ageing population. Without major changes to pensions and, crucially, to health and social care, the long-term growth of our economy and the sustainability of our public finances could be put at risk.

Last week, the Government had the chance to show that they were prepared to meet the challenge of fundamentally reforming care and support, and many of the promises in their White Paper and draft Bill on social care are welcome. They build on Labour’s achievements when we were in government. Indeed, many of the Government’s announcements were put forward by Labour in our White Paper, “Building the National Care Service”, more than two years ago. They included a shift in the focus of local council and NHS services towards prevention and early intervention to help more older and disabled people to stay living independently in their own homes, and more joined-up NHS and council care to stop families having to struggle with the different services to get the support that they need.

[Mr Graham Stuart (Beverley and Holderness) (Con)]

I am experiencing a sense of déjà vu. Those of us who take an interest in these matters pleaded with the previous Government in debate after debate to take action and to make some tough decisions to ensure that we looked after our ageing population, but, time and again, they failed to take any real action. We are not building on what they did; we are having to go into the space where they failed to act.

[Liz Kendall]

I always respect the hon. Gentleman’s interventions, but he seems to forget that we faced up to those difficult decisions and choices on adult social care in “Building the National Care Service”. We tried to get cross-party agreement on those proposals, but they became a political football at the last general election. The hon. Gentleman should be encouraging those in his Front-Bench team to engage seriously in cross-party talks and to take the difficult decisions that need to be taken.

Community Hospitals (North-East)

Graham Stuart Excerpts

Wednesday 20th June 2012 Commons Chamber

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

In December 2011, the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow) told me:

“Local community hospitals provide a vital community resource to support patients in need of rehabilitation, recuperation and respite care”,

and that they support

“a rapid return to independence and good health.”—[Official Report, 12 December 2011; Vol. 537, c. 560W.]

It was a pleasant surprise to find myself agreeing with him. Unfortunately, community hospitals, especially those in my constituency and in the north-east, are facing ever more challenges.

Hospitals such as East Cleveland hospital and Guisborough hospital play an essential role in the communities that they serve. My constituents prefer and would ordinarily choose to receive care near their home and their family, whether it be palliative, minor injuries or maternity care. That is also the case elsewhere in the north-east and north Yorkshire, where my colleagues and local residents have been speaking out to protect and extend the services in their local community hospitals and district general hospitals, which are increasingly under threat.

Demographic change means that we are increasingly dealing with social care. Given that community hospitals tend to be truly local and cherished, and the need for health and social care to be seamlessly integrated, it should be painfully obvious that local community hospitals are able to provide effective liaison between NHS staff and local adult social services, especially when discussing arrangements for the discharge of elderly patients and their continued need for community-based care facilities and services. The Government are, at least nominally, following the previous Labour Government’s good example of recognising the importance of patient choice.

[Mr Graham Stuart (Beverley and Holderness) (Con)]

The hon. Gentleman is giving a powerful speech that rightly highlights the importance of community hospitals. Does he, like me, regret the fact that more than 3,000 beds in community hospitals were closed by the last Labour Government? Does he recognise that only a huge campaign across this House made them see the error of their ways and reverse their savage cuts to this most vital of local assets?

[Tom Blenkinsop]

Any intervention in this debate must be put in the context of the fact that more than £600 million from my region is going to be relocated to the south-east. I know that, as a Yorkshire MP, the hon. Gentleman will be concerned about the news of the cuts to Yorkshire’s health care services that came out only today in The Northern Echo. We can talk about the whys and wherefores of that, but there is certainly a kernel of truth in it. Community hospitals and secondary hospitals, such as James Cook university hospital on the border of my constituency, are having to consolidate and centralise their services far more than has been the case before.

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[Mr Burns]

I certainly note the point the hon. Gentleman makes, and I have read a number of his local newspapers, in which he and a number of his hon. Friends have been making it too. I am delighted that he accepts my argument that every single penny that is saved from the £20 billion of efficiency savings—which, of course, we inherited from the last Government and accepted, because it was the right policy to pursue—will be reinvested in the NHS.

I think the hon. Gentleman attended Health questions on 12 June, at which the right hon. Member for Newcastle upon Tyne East (Mr Brown) raised the funding formula and the basis for it with me. I explained that a variety of factors, of which health is one, will determine the allocation of funding—just as it was determined under his Government—and that the question was also being looked at by an independent body. I have seen the newspapers, and I fully appreciate that the hon. Gentleman and his hon. Friends are trying to drum up a storm by suggesting that they are going to be hard done by. However, if he reads the answer I gave to his right hon. Friend the Member for Newcastle upon Tyne East in Hansard, I hope it will reassure him, on reflection, about the current situation.

[Mr Graham Stuart]

The Minister will recognise that community hospitals in the north-east, as well as in Beverley and Holderness, were starved of funding under the last Government. We saw gross distortions in funding, as the formula used deprivation as a way of pouring funding into urban areas, where there were young people who, regardless of their social background, were not in need of health funding. That starved the community hospitals serving ageing populations, which did need the funding. What we need is not reverse gerrymandering, but health funding that follows clinical health need. We did not have that under the last Government, who starved rural community hospitals of funding. I congratulate the Minister on having the courage to face down the vested interests of the Labour party.

[Mr Burns]

Let me return my hon. Friend’s compliment in kind by saying that I am grateful for the valid points he makes. He knows as well as I do that this Government, under the leadership of my right hon. Friend the Member for Witney (Mr Cameron), are totally committed to community hospitals. I know that he will also be reassured that, unlike with the last Government, there is no question whatever of this Government gerrymandering the funding formula.

I know that the hon. Member for Middlesbrough South and East Cleveland is aware of the scale of the challenge facing his local NHS. Like every local NHS economy, the NHS organisations that commission and provide services in his constituency must take some fairly tough decisions to deliver sustainable health services in future. Let me also say to him—in the nicest possible way, because I respect him—that we are in the situation of protecting the NHS budget and giving it a modest real-terms increase, given our commitment to the NHS, simply because of the economic mess that we inherited, thanks to the actions of his Government, under the stewardship of the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown). That meant that there was not enough money to sustain the levels of real-terms investment that might have been available earlier this century.

I turn now to Guisborough hospital. I am aware that Chaloner ward, which provided palliative care and rehabilitation, closed permanently in February 2012. I am advised, however, that services were transferred to the hospital’s larger Priory ward, which I am assured has adequate room and staffing to continue to provide high quality care. I understand that the decision to close Chaloner ward was based on the need to deliver services safely, efficiently and effectively, as the ward had been under-utilised and was not making the best use of nursing resources. Staff were engaged on the decision. In fact, they advised closure—I hope that the hon. Gentleman heard that. The staff advised closure, and staff at the ward were redeployed within Guisborough hospital and to the nearby Redcar primary care hospital.

I am also aware that temporary changes were made to the opening times of the minor injury unit at Guisborough hospital. The MIU now opens between 9 am and 5 pm from Monday to Friday, and between 8 am and 8 pm at weekends. I understand that patients requiring treatment outside those hours use Redcar hospital, local GP walk-in centres or the accident and emergency department at the James Cook university hospital. I have been informed that the MIU is staffed by a small team of nurses, and that the changes enabled the unit to continue to provide a safe service for patients. I also understand that the South Tees Hospitals NHS Foundation Trust is looking at whether other staff can provide support to the unit.

I have been informed that, in the longer term, South Tees Hospitals NHS Foundation Trust is reviewing the provision of acute and community services across all its sites, including Guisborough hospital. The review is aimed at ensuring the future safety, quality and sustainability of services. The trust has been working with GPs, commissioners and local authorities to establish models of care that will enable more patients to be cared for at home and avoid unnecessary admissions to hospital—whether at the larger acute hospital, James Cook, or community hospitals such as Guisborough. Once that work is completed, the trust expects to take a more definitive view of the future role of community hospitals such as that at Guisborough. It is not yet clear when the review will conclude. However, I am assured by the local NHS that there are no plans in the near future for further service changes at Guisborough hospital. I hope that that will reassure the hon. Gentleman. Should there be any changes in the longer term, once the trust has completed its review of service provision, local stakeholders and the public will be engaged in this process. He might be aware that my right hon. Friend the Secretary of State has set out strengthened criteria for service changes. Any proposals for major service change need to be assured by the local NHS against the Secretary of State’s four tests for service change and, when necessary, to be subject to public consultation.

I am aware that the hon. Gentleman met the chief executive of South Tees Hospitals NHS Foundation Trust to discuss these matters in February 2012. I also understand that the trust provides him with regular briefings on these issues, and I hope that he finds that helpful and useful in formulating his views on the provision of health care in his area. I hope that being briefed personally by his local health service providers will allow him to have a more open mind in regard to what is actually going on in the NHS, rather than simply accepting the propaganda that all too often distorts his views. I strongly encourage him to continue that dialogue with the trust as it completes its review of service provision.

Question put and agreed to.

Oral Answers to Questions

Graham Stuart Excerpts

Tuesday 10th January 2012 Commons Chamber

[Anne Milton]

Yes, we are supporting the development of social investment and outcome-based funding models, and I am pleased that the hon. Gentleman has raised the issue of being innovative about how we do that, because it is important. We had a rather static situation previously, so I welcome his interest in developing and testing a payment-by-results scheme in Nottingham, and we will be interested to see his detailed proposals and how that develops locally soon. What matters are the results that we get from the schemes.

[Mr Graham Stuart (Beverley and Holderness) (Con)]

I pay tribute to the hon. Member for Nottingham North (Mr Allen) for his work on early intervention and applaud the efforts made by the Minister to recruit more health visitors, but when will the Government be able to deliver the additional health visitors on the ground, trained and in service, in order to reverse the cuts in the health visitor service under the previous Government?

[Anne Milton]

My hon. Friend is right; we picked up a very depleted and demoralised health visitor work force. We have 26 health visitor early-implement sites and, as I said, a 200% increase in planned training commissions for health visitors. Turning this round takes a long time. I am sorry that we could not get started on it earlier, but this will have the critical impact: 4,200 health visitors by the end of this Parliament will give us the results that we need in turning round the fortunes of some of the most vulnerable families in this country.

Future of the NHS

Graham Stuart Excerpts

Monday 9th May 2011 Commons Chamber

[Mr Lansley]

No, not at all, and I do not believe that Monitor believes that either. The hon. Lady can see that the proposal in the Bill is clear. It was the Labour Government who established Monitor as a regulator and who introduced competition into the NHS. The Labour Government did all those things, but Monitor’s job is not to impose competition rules but to deliver what is in the best interest of patients.

[Mr Graham Stuart (Beverley and Holderness) (Con)]

The shadow Secretary of State is a decent man and an experienced Minister. The reason his speech was so weak is that he had no conviction because he has been forced by the union paymasters of the Labour party and of the shadow Leader of the Opposition to deliver the sort of speech previously given by the far left who inhabit the Benches way over there. My right hon. Friend should not listen to those voices; he should press ahead and make a difference for patients, not politicians.

[Mr Lansley]

I agree with my hon. Friend that the shadow Health Secretary is a decent man, and at the turn of the year he quite decently expressed his support for the Bill’s principles and his understanding that it was consistent, coherent and comprehensive. It makes one wonder what happened to him in the interim. Did the trade unions—the paymasters of the Labour party—get to him and tell him that they did not like the idea that patients should be able to get the care they need or the idea that we should get resources into the front line rather than into the vested interests of the NHS?

What we are going to do is put patient care at the heart of our reforms. We are not going to let hospital productivity continue to decline as it did over the last decade. Under Labour, we saw a 15% decline in productivity, yet we heard nothing from the shadow Health Secretary about that. It is this Government who are taking action to improve hospital performance by changing the way hospitals are paid to reward excellence—for example, by not paying for unnecessary readmissions of patients who are discharged too soon.

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[Dan Jarvis]

I did not say the market should be ignored. The point that I was making is that ultimately it is a matter of priorities.

What will be the cost of making NHS staff redundant, before the additional cost of rehiring by the GP commissioning bodies? To me, none of this makes sense, and it leads many health officials to question whether the Health Secretary fully understands what impact the reforms will have on the front line morally, economically and logistically, and in this confusion the NHS is placed at risk.

Why not use the facilities that the Labour Government spent £100 billion building over the past decade? Would it not be simpler to keep the PCTs? Surely it makes far more sense to increase GP involvement to allow for clinical oversight, and use the facilities and the staff base that we have spent the past decade investing in. Of course there are problems in the NHS which need solving, but the Government’s plans are not just a misguided attempt at privatisation by stealth; they fail to acknowledge that the past 13 years of reforms ever happened.

As well as issues of cost, the proposed reforms are a threat to the accountability of the NHS—at a local level, with the removal of the non-executive directors, and nationally, with the transfer of responsibility from Whitehall to the NHS board. How will we know whether we are getting value for money? What impact will the reforms have on local waiting times? If the Secretary of State genuinely believes in these reforms, what accountability mechanism is he introducing to judge how well they are working? The Department of Health has not explained how the reforms will address the challenges of longer life expectancy, advances in technology and greater public expectations.

[Mr Graham Stuart]

I am grateful to the hon. Gentleman, who is making a thoughtful speech. The incoming Government inherited an NHS which has had a massive increase in expenditure, yet has seen a 15% drop in productivity over time. Does he have any thoughts on what reforms do need to be made? Despite having money thrown at it, the NHS was not delivering in terms of productivity and was thereby letting patients down. What is his prescription to make the NHS stronger?

[Dan Jarvis]

Although I am new to this business, if hon. Members and the Secretary of State had such faith in the reforms, it is confusing to me why they were not put in the manifesto and the people of this country given the opportunity to vote on them at the general election.

GPs will be substituting the calculator for the stethoscope. That is bad for the NHS and bad for patients. Given how far we have come, would not the first year of the Secretary of State’s tenure in the Department of Health have been better spent, for example, on a concentrated investment of effort in cancer care? We must fight the war on bureaucracy, but not at the expense of the war on cancer.

Would not the Secretary of State have better spent his time learning from our European partners how to educate our constituents about the dangers of an unhealthy lifestyle—diet, drink and drugs—and their effect, particularly with regard to cancer treatment? We need to address why a cancer sufferer in Barnsley is less likely to survive than a sufferer in Barnet. These are the NHS reforms that would make a positive difference and that the country expects us to deliver. Instead, in my constituency, the scale and pace of the Government’s cuts are making it virtually impossible for Barnsley hospital to plan ahead. Budgets are being cut while patient numbers are going up.

The Government are proposing the biggest reorganisation of the NHS since its inception—

Health and Social Care Bill

Graham Stuart Excerpts

Monday 31st January 2011 Commons Chamber

[Frank Dobson (Holborn and St Pancras) (Lab)]

I make no apologies for the policies that were pursued while I was Secretary of State for Health, because I set about implementing every item in Labour’s election manifesto. I know that implementing promises in election manifestos has gone out of fashion on the Government Benches, but it has not gone out of fashion with me. Before I became Health Secretary, while I was Health Secretary and since, most doctors, nurses, midwives and others in the health service have said above all, “For God’s sake, leave us alone, stop diverting our attention into reorganisation and let us get on with the job of looking after patients and raising standards of treatment and care.” Presumably, that was why the Conservative manifesto and the coalition programme both stated:

“We will stop the top-down reorganisations of the NHS”.

They claim that their proposed reforms are not top-down, but I cannot think of anything more top-down than an Act of Parliament set out in 353 pages and 61,344 words, and yet it is still a broken promise.

The NHS, as we all know, is doing better than ever before: waiting lists have come down dramatically; waiting times have been massively reduced; and survival rates are dramatically improving. Most people, in most places, and most of the time, are getting a very good deal from the health service, which is why it is more popular than ever before.

[Mr Graham Stuart (Beverley and Holderness) (Con)]

Will the right hon. Gentleman give way?

[Frank Dobson]

No, I do not have time.

Those improvements have come about not as a result of any structural changes, but because the Labour Government put into the NHS more money than ever before, built more new hospitals than ever before, put in more new equipment and, above all, recruited record numbers of doctors and nurses. We also put more emphasis on standards and on trying to ensure that we spread best practice right across the health service.

I accept that we need more clinician involvement in decision making, but we do not need to go to GP commissioning to bring that about. All we need do is get more of them on primary care trusts with more influence there. Why is it just confined to GPs? There is no reference to greater involvement of hospital specialists and there is nothing in the 61,000-odd words about giving hospital doctors a bigger say, and they have some expertise in these matters. Many GPs, as we know, do not support the proposals, and many of them want to get on with just being doctors.

One great deception that is being promoted is saying to patients, “You and your GP will decide where you will get treated.” That is simply not true. Unless the consortium of which the GP is a compulsory member has a contract with a particular hospital, the patient will not be able to go there from their GP.

The NHS is essentially a co-operative organisation in principle and in practice, and now it will be forced to compete: every part of the health service competing with the other parts and the private sector on price. It is rather remarkable, considering all the Eurosceptics on the Government Benches, that the Government are going to force our NHS to comply with European competition rules set out in the Lisbon treaty—the Lisbon treaty that the Tories voted against. Who is most likely to benefit from those rules? The answer is American health corporations, almost all of which have been indicted in the United States for defrauding US taxpayers, doctors, patients and, sometimes, all three. I asked the Secretary of State whether he would rule out any of those outfits obtaining contracts, and I am afraid his answer was, “I can’t say.”

The next question is, how will we know what is going on? How will we and local TV, radio and newspapers know what is being decided? In the Bill, there is no serious obligation for hardly any of the decision-making bodies to hold their meetings in public; there is no obligation on declaration of interests; and there is no obligation on consultation. If anyone says, “Well, freedom of information will cope,” we know what the answer will be, “Commercial confidentiality; you can’t have it.” If we are to have a competitive system, almost everything will be commercial and, therefore, almost everything will be confidential.

These proposals will divert people in the NHS from their job of looking after people. The Government are privatising the NHS, they are fragmenting the NHS, they will cost us a fortune and do little or no good for anybody.

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[Mr Barron]

That is an interesting comment, but the Bill does not represent that. In my borough, the PCT—as was; it still is, although it is now Rotherham NHS—will become the GP commissioning consortium. Let us not get away from that. The idea that getting rid of the strategic health authorities or anything else is going to save massive amounts of money is palpable nonsense.

Does anybody think that top-down meddling is going to end because of this reorganisation? If the local GP consortium does not offer provision as it should, the national commissioning board will tell it what to do. If that is not top-down, I do not know what is. Those will be the people responsible for whether local residents, particularly those who need specialised commissioning, are going to get the services or not. The idea that those people are going to be responsible for NHS dentistry in my constituency is nonsense. There has now been a move away from midwifery, and that was going to be commissioned nationally. The changes are nonsense; they have been ill thought out.

[Mr Graham Stuart]

rose—

[Mr Barron]

I give way for the last time.

[Mr Stuart]

The Chair of the Health Committee also set out the central challenge, which was recognised by the previous Government: to make major savings, year on year, for the next four years, at a time when budgets will not be able to increase—or at least not by much. How does the right hon. Gentleman think that that issue could best be addressed? Suggesting, as he did at the beginning, that we could just carry on as we were would not be sustainable.

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[Mark Simmonds]

My hon. Friend is absolutely right. I remember him fighting tirelessly and vociferously to try to prevent those in the health service and the then Health Secretary from allowing that to happen.

Another thing that Labour Members have to understand is that we must move the NHS towards being a service that is centred on the patient, not one where the patient revolves around the system. To enable that to happen, we must measure and improve outcomes on a continuing basis, and we must do it with patient-centric information that will enhance patient choice, not only about the choice of the provider and the location of their treatment, but about the treatment that they receive for their ailment. This Bill deals with all the failings that were present when the Labour party was in charge.

There are three or four areas where the detail still needs to be discussed, and I want to make some suggestions. There must be an opportunity for integrated care and for improved patient pathways. I would very much like acute clinicians, pharmacists and others who deliver patient care to be involved in GP consortia and the commissioning process. Some of the more forward-thinking consortia are already involving acute clinicians, and this needs to be implemented across the board. We need to find a non-prescriptive architecture to enable consortia to work together to collaborate where appropriate, not only in the all-important area of cancer, as appropriately highlighted by my hon. Friend the Member for Basildon and Billericay (Mr Baron), but in acute stroke services. This has been done successfully, and it must continue to be done.

Performance management is absolutely critical. The Bill seems to make no specific mention of out-of-hours care. My right hon. Friend the Secretary of State will remember only too clearly the terrible case of Mr Gray, who was killed by Dr Ubani, the out-of-hours doctor who flew in from Germany and prescribed him the wrong dose of a drug. That was a performance management failure. The SHA failed to monitor the PCT, which was failing to monitor the provider. We must ensure that GPs are involved in driving improvements in out-of-hours care as well as in-hours care.

We need to look at GPs’ contracts. It is rather perplexing that a PMS—personal medical services—contract could be held by a national commissioning board. Who will be in charge of revalidation, training and performance lists? We must move GPs’ quality and outcomes framework towards one that is outcome-based rather than process-based.

[Mr Graham Stuart]

Like my hon. Friend, I will support the Bill. Does he hope, as I do, that the Government will look very carefully at any conflicts of interest? As we rightly give the power down to clinicians, we need to ensure that they always take decisions in the interests of the patient and not for their own financial gain.

[Mark Simmonds]

I entirely agree with my hon. Friend. My understanding is that the NHS commissioning board will have a significant monitoring role to ensure that GPs commission services not automatically from themselves but from providers who provide the best outcomes for the patients they are trying to look after.

I would like to make one final point to the ministerial team. Information is the key that will drive improvements in the NHS, and that information must be comparable, easily accessible and easily understandable in order to inform patients’ decision making processes. It should not just be on the internet. We should not just wait for patients to access information—we have to find ways of taking it to them, particularly those living in socio-economically deprived areas.

The Bill is a significant step in the right direction. It preserves the best of the national health service—equality of access—while creating opportunities to improve the provision of health care in the UK, so that it can become among the best in the world, rather than lag behind. Excellence for all should be the goal.

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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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[Dr Wollaston]

I am very confident, because I have discussed that question with the Secretary of State, who has assured me that the reforms are about competition not on price, but on quality. All doctors know that if they get it right the first time, they provide not only better care, but better value care.

GPs and PCTs throughout Devon are rolling up their sleeves and getting on with the job in hand, but to deliver the undoubted benefits of integrated care, they need to be able to work closely with colleagues in hospital, as well as with people in the community, to design those logical pathways. As I just mentioned, the Secretary of State has reassured me on the question of price versus quality competition, but it would help to spell out explicitly in the Bill that that will be protected. Professionals are understandably scared, and I hope the Minister will make the position absolutely clear in his winding-up speech.

Commissioners will not feel liberated if they are liberated from the Secretary of State but shackled to Monitor. Fundamental to the outcome of the reforms will be the powers of Monitor. I should like those powers to be carefully constrained in the Bill, so that it does not take on an unintended role. Focusing on quality and not on cost would help to bring all the professionals back into thinking that this is a positive step forward, because that remains a concern.

[Mr Graham Stuart]

My hon. Friend rightly emphasises quality ahead of cost, but surely both should be considered. In a time of constrained budgets, it is entirely right that commissioners use a service of comparable quality, which can deliver for patients at a lower cost, when they can find one, precisely so that they have additional funds available to look after other patients.

[Dr Wollaston]

I am confident that commissioners will consider the impact of those decisions across the health care spectrum, which is very important.

In the limited time I have left, I should like to ask the Secretary of State to consider how we will monitor the quality of primary care. Who will be responsible for performers’ lists, audit, and identifying poorly performing doctors? As I understand it, all GP contracts will be held with the NHS commissioning board. What powers will GPs within consortia have to deal with those whom they feel are underperforming if they have no control over their contracts? What will be done about the ongoing, disgraceful situation regarding doctors from the EU with poor English skills, over whom we have few powers to protect patients until there has been a problem?

Professionals are also concerned about the make-up of consortia. Will they have the flexibility to include consultants and other specialists—

--- Later in debate ---

[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.

Oral Answers to Questions

Graham Stuart Excerpts

Tuesday 7th December 2010 Commons Chamber

[Mr Speaker]

Order. I think we understand what the Minister is trying to get at.

[Mr Graham Stuart (Beverley and Holderness) (Con)]

I welcome the Minister’s responses and his firm proposals to reduce administration costs. However, it is not just a matter of management costs rising massively under the last Government, as productivity fell. The last time productivity increased in the NHS was under the last Conservative Government in the early 1990s. What plans do the Government have to ensure that productivity is increased, because only by doing can we deliver better health?

[Mr Speaker]

Let us have the answer.