Health and Social Care Bill

Grahame Morris Excerpts

Monday 31st January 2011 Commons Chamber

[Dr Poulter]

My hon. Friend represents Eastbourne, which has a large elderly population. He is right to make that point. Under the Bill, health and wellbeing boards will be set up, which will deliver a proper partnership between GPs, hospitals and local councils. That will allow, for the first time, properly joined-up thinking about how we deliver social services care that is joined up with NHS care for older people. I am delighted that the Government will put in almost £1 billion to support that initiative, which can only be a good thing.

The second challenge facing the NHS, which my right hon. Member for Charnwood also mentioned, is that we are having to get more and more out of a limited resource, because people expect more and more from their health care, regardless of their age. People want, quite rightly, to be given the latest cancer drugs. They want to ensure that they have top-quality care and access to information that delivers that care. The problem with the bureaucracy that has been in place is that, far too often, it has taken too long to deliver higher quality care and a greater choice in treatment for patients. When we know that a cancer drug works, it should be available as soon as possible. It should not have to go through a process of two, three or four years of bureaucracy to be made available, and the Bill will help to change that. For those reasons, the Bill’s reforms to the NHS will provide an excellent framework in which to deliver better ways of spending limited resources and looking after our ever-ageing population.

A lot of health care professionals will be saying, as I did earlier, that far too often, medicine and health care have been reduced to a tick-box exercise, with targets and top-down bureaucracy getting in the way of patient care. Under the A and E targets delivered by the previous Government, equal priority was given to treating a patient with a broken toe as someone with potentially life-threatening chest pain. That cannot possibly be right. Putting doctors, nurses and other health care professionals in charge of making health care decisions will mean that clinical priorities and better patient care can be delivered.

[Grahame M. Morris (Easington) (Lab)]

Has the hon. Gentleman made any assessment of the reduction in the number of managers, consultants and other bureaucrats that will be caused by moving from 152 primary care trusts to potentially 500 or 1,000 GP commissioning groups?

[Dr Poulter]

The Opposition need to take on board the fact that the cost of running PCTs has gone up by about £1 billion a year since they were first put in place. The cost of bureaucracy and management in the NHS is unsustainable, and most of the money that we are putting into the NHS is going on salaries and bureaucracy rather than on front-line patient care. It is surely a good thing to remove the middle strand of bureaucracy—PCTs, strategic health authorities and other quangos that cost a lot of money but do not deliver front-line patient care. That will help deliver more money to the front line and to patients, and Members on both sides of the House should support such an initiative.

I shall elaborate on the point about how PCTs have been a great source of wasted money. In my part of the world in Suffolk, they have spent millions of pounds each year on external consultants to tell them how they should be doing the job that they should have been doing in the first place. There has also been a total disconnect between primary and secondary care and a breakdown in the relationship between them. For example, as the Secretary of State alluded to earlier, hospitals have wanted to put in place outreach clinics for mental health, dermatology and rheumatology, but too often, as in my area, they have been told that the PCT will not allow them to do that.

Hospitals have said that they value and need community hospitals, because they provide an excellent place for step-up and step-down care and for rehabilitation after an acute hospital stay, but PCTs have closed down community hospitals such as Hartismere hospital in my community. We know that that is not a good thing. Far too often, PCTs have been a barrier to joined-up thinking in the NHS between the primary care sector and hospitals.

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[Grahame M. Morris (Easington) (Lab)]

One thing is clear: from whatever perspective we consider the reforms in the Bill—whether from that of Charnwood or Holborn and St Pancras—there is a serious and worrying lack of evidence base for the Government’s proposals. These are proposals identified by the King’s Fund as without doubt

“the biggest shake up of the NHS since it was established”.

While the Health Secretary was the Conservative party’s shadow health spokesman—from June 2004 until he took office in May last year—he was coy about his real intentions towards the NHS, as indicated by my right hon. Friend the Member for South Shields (David Miliband). When the Government published the Bill, six major health unions and professional bodies wrote in a letter to The Times:

“There is clear evidence that price competition in healthcare is damaging. Furthermore the sheer scale of the ambitious and costly reform programme, and the pace of change, while at the same time being expected to make £20 billion of savings, is extremely risky and potentially disastrous.”

Labour Members welcome greater clinical involvement in commissioning, but GPs are not the sole font of knowledge in best practice and other areas.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

Does my hon. Friend agree that in any one year some GPs will deal only with one or two patients with, in particular, a neurological condition? GPs might not be in the best position, therefore, to be the providers and commissioners of such services.

[Grahame M. Morris]

I agree completely with my hon. Friend’s point. According to evidence given to the Select Committee on Health, specialists in secondary care and the nursing and other professions could add their expertise to the commissioning process.

The shake-up of the NHS goes far beyond simply involving clinicians in spending decisions. GP commissioning is a red herring. We were told by the Secretary of State that these reforms are needed because productivity has fallen since Labour’s increased investment. However, after 18 years of mismanagement and under-investment under the Conservative party, it was obvious that on a crude measurement of productivity—inputs versus outputs—there was going to be a decline in supposed productivity, because obviously money had to be directed towards clearing up the mess left by the previous Tory government, to building new hospitals, accident and emergency units and maternity units, and to reducing waiting lists, which in many areas of the country were 18 months and longer.

The Secretary of State raised the satisfaction survey. Indeed, in December 2010, the National Centre for Social Research released its most recent report on British social attitudes. It found that public satisfaction with the NHS was at an all-time high, whereas in 1997, when Labour came to power, only 34% of people surveyed were satisfied with the NHS—the lowest level since the survey began in 1983. By 2009, satisfaction had nearly doubled to two thirds—to 64%. Given that most health unions, professional bodies, think tanks and the public did not call for such reforms, where did the Secretary of State’s motivation come from? These are not patient-led reforms; they are private health care-led reforms.

[Pat Glass (North West Durham) (Lab)]

Does my hon. Friend share my concerns that these plans will lead to high and low-tariff services, and cherry-picking, and that services such as child and adolescent mental health services, children’s health services and adult mental health services will lose out?

--- Later in debate ---

[Grahame M. Morris]

I agree with the concerns expressed by my hon. Friend. There are concerns about the removal of the tariff floor and the introduction of price competition into the service. That is radical and revolutionary; it is not evolutionary. Rather than open-market health care, the British Medical Association and others are calling for a

“cooperative and coordinated environment where patients are guaranteed the most clinically appropriate and cost-effective care. Price competition and a fully open market will make this impossible.”

Clause 63 allows the Secretary of State to impose requirements on consortia to promote competition between providers, and clause 64 makes it possible for Monitor to investigate any complaint of anti-competitive behaviour made against commissioners by any interested party. That might be a third party or an overseas private health care company, and would make it far more difficult for GPs to ensure that their patient services are integrated, inclusive and carried out in partnership. The Bill also forces trusts to achieve foundation status within three years and will lead to more important priorities, such as safe patient care, being compromised. Furthermore, the abolition of the private patient income cap set out in clause 150, removing the limit on the amount of income foundation trusts can earn from private operations and private health care, will create a two-tier health system. Foundation trusts forced into the market without protection will face financial pressures to turn a profit, and NHS patients will risk being pushed to the back of the queue.

To my mind, and according to evidence submitted to the Health Committee by the Royal College of Nursing in which it identified 27,000 nursing posts that will go, these reforms will result in tens of thousands of job losses and undermine national terms and conditions for NHS staff. The scrapping of targets has left the NHS open to a dangerous postcode lottery. The duty to tackle health inequalities is one of the few remaining powers to be held by the Secretary of State, but he will have nothing to back it up.

There is also no protection for the taxpayer from exorbitant and excessive behaviour by the consortia, an issue raised by my hon. Friend the Member for Blyth Valley (Mr Campbell). It is possible that we will see banker-style bonuses and the import of private sector pay into health care. [Interruption.] The Minister moans from a sedentary position, but there is nothing in the Bill to prevent that from happening. The Bill will also leave us, as Members of Parliament, with no voice in the NHS. This Tory-led Government seem to be trying to de-risk this political hot potato, which the Conservatives have never been able to manage properly. However, if Ministers think that the British public will allow them to wash their hands of the NHS without any comeback at the next general election, they should prepare to be shocked.

I would like to say one more thing in the time left—now that the hon. Member for St Ives (Andrew George) is back in his place and given what the hon. Member for Burnley (Gordon Birtwistle) said—about the combined impact assessment. I have received a letter from a GP saying that the practical significance of the Bill will be such that the many MPs who campaigned to save their local hospitals cannot vote for it in all honesty, knowing that in so doing they will be voting for a measure that is purposefully and expressly designed to prevent them from having any say and which will potentially lead to the very outcomes that they so vociferously campaigned against.