Care Bill [Lords]

Debate between Grahame Morris and Stephen Dorrell

Tuesday 11th March 2014 Commons Chamber

[Grahame M. Morris]

I hold the Chairman of the Select Committee in high regard for his expertise. Let me point out, though, that he analyses this on the basis of two cases in five years, but in fact the situation has changed rather dramatically. The information presented to our Committee is that about a third of NHS trusts are predicting deficits, and, as we heard earlier, 32 are in severe financial difficulty. Those may not be the exceptional circumstances that the Minister would have us believe, and that should be a cause for concern for Members on both sides of the House.

[Mr Dorrell]

Saying that a trust is in deficit is not the same as saying that it is heading into administration. It lies within the power of the commissioners and the trust management regime to avoid administration, which everyone in the House agrees is the preferred outcome. Indeed, it is striking that each of the Members from Lewisham and from Staffordshire identified the difficulties that the TSA regime creates and the difficult circumstances that arise when a TSA is appointed. Some Labour Members have suggested that this is a back-door means of driving change without consultation by appointing TSAs to trusts all around the country. If I thought that that was anywhere near to being anybody’s intention, I would oppose clause 119. However, the important point about clause 119 is that if it were the Government’s intention, which I do not remotely believe that it is, they could pursue that policy whichever way the Division goes.

The point about clause 119 is that it raises an extremely narrow question: should the TSA take into consideration only the institution that has been demonstrated historically to be unsustainable, or should the TSA look outside that immediate health economy for solutions that will better serve the needs of patients in that area? It seems to me that we need only pose the question in that precise and, I believe, accurate way for it to be seen to be a rhetorical question.

[Mr Dorrell]

I do not always agree with every word my hon. Friend says, but I agree with everything he said in that intervention, so I am delighted that I gave way to him. His argument is that commissioners and the trust management should get ahead of the trust administrator. Nobody should sit around waiting for an administrator to be appointed; the objective should be to avoid trust administration along precisely the lines identified by my hon. Friend.

[Grahame M. Morris]

I want to make a few points in support of amendment 30, which would delete clause 119 on the basis that the TSA was never designed to deal with reconfigurations across an entire region. Despite the assurances given by the right hon. Member for Charnwood (Mr Dorrell) and Government Front Benchers, the potential remains for this mechanism to be used as a back-door route to making changes and closures at hospitals.

I also declare my support for new clause 16. However, although it would ameliorate the worst parts of clause 119 by ensuring that local commissioners in non-failing areas had a veto over any decisions affecting their trust, it is not, as colleagues have said, a perfect solution.

Clause 19—or, as 38 Degrees and other campaigning groups refer to it, the hospital closure clause—should not stand part of the Bill. I had the honour to serve on the Bill Committee for what is now the Health and Social Care Act 2012 and I attended 39 out of 40 sittings. I missed one because I attended a Health Committee sitting at which the then Health Secretary was giving evidence about NHS England, which was previously called the NHS Commissioning Board, and I did not want to miss that.

I sat through that Bill Committee and listened to the Government’s reasons for their reorganisation. We were told that it would deliver a decentralised service and put power in the hands of clinicians. To be frank, clause 119 makes a mockery of that claim. Far from delivering a decentralised service that puts power in the hands of clinicians, the Secretary of State seems to be seeking to take power away from GPs and local communities in order to further reconfigure the NHS for purely financial reasons.

To suggest that the trust special administrator regime is a natural extension of the existing legislation is a gross distortion. The TSA process was never intended to be used as a back-door way to make unpopular reconfigurations. Potentially, clause 119 could take control of every NHS trust and foundation trust away from the public, leaving no hospital bed in the country safe. It should not stand part of the Bill.

If the Bill is enacted, clause 119 will mean that the NHS in England will face further wholesale, top-down reorganisations. The clause could be used as a method to achieve that. I do not think that anyone in this House wishes that to happen. I am sure that, in their hearts, some Government Members do not want that, and certainly no one in the country voted for it. Our problem is that there would be virtually no accountability to local people.

The successful legal challenge brought by the London borough of Lewisham and the Save Lewisham Hospital umbrella campaign—I pay tribute to their efforts, which have brought about this situation—showed conclusively that the Secretary of State did not have the power to axe Lewisham’s accident and emergency and maternity wards as a solution to problems in the neighbouring South London Healthcare NHS Trust.

Clause 119 is designed to allow the Secretary of State to do what he failed to do in Lewisham—to close down thriving and financially sustainable hospitals on a whim, without full and proper consultation. To suggest, as was said in Committee, that a tokenistic meeting with a local authority overview and scrutiny committee would assuage public concerns does not hold water. We must rebuild trust: we need full and proper consultation with patients and the public, and we need agreements with clinical commissioning groups. I am somewhat surprised at the willingness of Government Members, who have championed the cause of GP-led commissioning, to subvert the role of CCGs in that respect.

Care Bill [Lords]

Debate between Grahame Morris and Stephen Dorrell

Monday 10th March 2014 Commons Chamber

[Mr Dorrell]

I agree with the thought that my right hon. Friend identifies. I have been choosing my words with care—I hope—in inviting the Minister to chart a course towards a more joined-up concept of commissioning. Almost as I offer my critique of the commissioning structures, I can feel officials in the Box writing the next version of the legislation that will have another go at providing the perfect solution to deliver something that is better than we have ever dreamt up before. I emphasise that what I am looking for from the Minister is a route map or journey—a process, not an event—and preferably one that builds on existing institutions rather than committing what I regard as the mistake of starting again with a clean sheet of paper.

[Grahame M. Morris]

The idea that the right hon. Gentleman propagates, which he has long held—that fragmentation is a bad thing and integration and joined-up services are a good thing—is one that I subscribe to, but does he share my concerns at reports that the commissioning functions through the clinical commissioning groups are to be privatised? Is that likely to make for more joined-up services or greater fragmentation?

[Mr Dorrell]

The hon. Gentleman knows that I do not entirely share his concern about who holds the share certificate for a particular service. I am more concerned about the accountability of a public authority for the use of public money to deliver a public service. On that, the hon. Gentleman and I are probably as one. I am also concerned that the system, from the perspective of the patient and service user, does not rely on them finding their way under their own steam through an impenetrable morass, but is designed with their needs and instincts in mind. That is a test that our current system simply does not pass and has not passed for many years.

--- Later in debate ---

[Grahame M. Morris]

My right hon. Friend has hit the nail on the head, because there has been a catalogue of mismanagement. What we need to do if we believe in the importance of such a database is to ensure that we rebuild public trust. The Government have an opportunity to do that, but it will not be a simple matter. We have to look carefully at the implications of what the Government propose and give the necessary assurances.

The assurance that the official gave to the Health Committee had a gap that a coach and horses could be driven through. Several multinational companies could get round it by establishing a subsidiary based in the UK that would have access to the data, if that were the only safeguard.

[Mr Dorrell]

I want to return to a theme that we were discussing in an earlier debate this evening. The true nature of the hon. Gentleman’s concern is unclear. If his concern is that sensitive patient information should be made available only on the basis that the identity of the individual can never be traced and the data remain properly anonymised and confidential, I think that concern would be shared on both sides of the House. But is that his real concern, or is it that the information might be used by a private sector body for the purpose of improving the delivery of health care? I am not clear, provided that the information is anonymised and patient identity is properly secured, what his objection could be.

[Grahame M. Morris]

I thought I was being fairly clear. In the debate on the earlier group of amendments, we discussed the privatisation of the clinical commissioning function. My concern is that that would lead to greater fragmentation, not greater co-operation. On data sharing, I think it was my hon. Friend the Member for Leicester West (Liz Kendall) who gave the example of a questionnaire she was asked to fill in by her GP, which contained questions relating to alcohol consumption, smoking and so on. If that information was made available to a private health care company and, as a consequence, premiums were increased, people would have concerns. The Minister said that that has been ruled out and that it would not happen, but it is an example of why such concerns have been raised.

Health and Care Services

Debate between Grahame Morris and Stephen Dorrell

Wednesday 3rd July 2013 Commons Chamber

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

It is always a pleasure to follow the right hon. Member for Charnwood (Mr Dorrell) who chairs the Health Committee with such authority and distinction. He gave a thoughtful and helpful explanation of the Committee’s report, and made some suggestions about integrating commissioning and budgets. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) and the hon. Member for Bosworth (David Tredinnick) also highlighted several issues, and I am proud to serve with them on the Health Committee.

We need to look at the background of what is happening because in many respects, the Government have created a situation in which the NHS is in crisis. I often refer to how we measure satisfaction with the national health service, and one established measure was the public satisfaction survey. We have seen a record fall in public satisfaction with the NHS under this Government.

The hon. Member for Bosworth referred to evidence that the Secretary of State gave yesterday to the Health Committee, in which he cited the cost savings that reorganisation had brought about. However, we must also think about some of the hidden costs of that reorganisation such as clinicians’ time. How many clinicians carrying out a management function in clinical commissioning groups in other providers find that their time is not accounted for properly? What about the opportunity cost in skills and training applied for the benefit of patients if those clinicians are engaged in a management capacity? What about the loss of experience for managers at every level? Some people may have spent a number of years working in the health service and taken an interest in structures, but we seem to be going round in circles. We broke up what we described as large monolithic structures, formed separate mental health trusts and separated community services. It seems that the wheel has now turned full circle and we are realising the benefits of efficiencies of scale and integration.

With the new structure, however, we have lost some management expertise in commissioning, organising and troubleshooting—again, that point was highlighted effectively by the Health Committee. The Secretary of State and his team respond that there has been a cost saving, but in fact the vacuum had to be filled by new structures. Strategic health authorities—an unloved institution—were swept away, but local area teams were created. It is necessary to have a strategic dimension to plan health care, particularly restructurings and reorganisations.

In my view and, I suspect, for many Members across the House, this top-down reorganisation—it was not initiated by people on the ground—has impacted on front-line services and resulted in considerable expense and disruption at a time when the NHS is facing unprecedented pressures due to budgetary constraints and growing demands on the service. We have seen that manifested at the coal face, the fulcrum, in the crisis in accident and emergency departments. Unless we seriously address those issues, there is a risk to the long-term financial stability of the NHS.

Yesterday in Committee I put on the record a rather controversial point about the Government’s claim to be maintaining funding in real terms, despite NHS inflation, which is higher than inflation in the normal economy. As right hon. and hon. Members have said, there are also a number of financial manoeuvrings—I do not know whether that is an accounting term. One concern relates to how the underspend is reallocated or returned to the Treasury, and I suspect that despite assurances from Ministers, we have seen an actual reduction in funding.

Let me draw the House’s attention once more to the letter sent to the Secretary of State by Andrew Dilnot CBE, chair of the UK Statistics Authority, following representations by my right hon. Friend the Member for Leigh (Andy Burnham). Mr Dilnot wrote that

“we would conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10.”

[Mr Dorrell]

rose—

[Grahame M. Morris]

The right hon. Gentleman has risen to the bait and I will happily give way.

[Mr Dorrell]

The hon. Gentleman might like to read the next sentence from the same letter.

[Grahame M. Morris]

I am grateful for that. We have argued for a number of months about the real position, and we have had a number of debates in the House about whether there has been a real-terms increase or a small decrease. I heard the arguments about NHS inflation and so on as recently as yesterday.

[Mr Dorrell]

The next sentence.

[Grahame M. Morris]

I will not read that out because I will come on to the issue in a moment. First I want to talk about integration, so I will press on. Statistics published in Public Spending Statistics in July 2012 show that real expenditure on the NHS fell by 0.02% in 2011-12 and 0.69% in the fiscal year before that. I understand that those are small percentages, but we are dealing with a budget of £105 billion, including the capital element, and I think the public would be concerned because those sums are not insignificant. Those percentages equate to £740 million over two years, and we should think about what that money could buy. In my area, one of the first schemes to be cancelled when the coalition came to power was a new hospital. It was not funded through a private finance initiative but through Department of Health capital resources. That hospital would have cost £464 million, but we are still waiting for it. The figures I mentioned would have built two such hospitals.

Health and Social Care (Re-committed) Bill

Debate between Grahame Morris and Stephen Dorrell

Tuesday 6th September 2011 Commons Chamber

[Mr Dorrell]

I agree that the sustainability of essential services—or, in the Government’s wording, the continuity of essential services—is a key role of Monitor. If I may interpret what my right hon. Friend the Secretary of State said, the patient’s interest is continuity of service, but not necessarily from the same provider for ever more. There has to be a commitment to sustain the service, and if there is to be a change of provider, the service has to be sustained through the change of provider, but the service does not necessarily have to be sustained by the same provider. Nor has there ever been such sustained service. There are not many people who rely on the service once provided by the Westminster hospital, as it is now a block of flats. I believe, however, that the service delivered to patients in this part of London is better as a consequence of the change that resulted from that decision.

[Grahame M. Morris]

As always, the Chairman of the Health Select Committee, is making a powerful contribution. He has really hit the nail on the head. The fundamental point, as evidenced in the Bill, is not that the provider could change—that has happened in the past, as he said, although the provider has always been a public sector provider, either in an NHS trust or an NHS foundation trust—but that, under the Bill, the provider could well be a private sector provider.

[Mr Dorrell]

I am grateful to the hon. Gentleman, who is a member of the Select Committee, because he provides me with a link to my next point—I was beginning to wonder how I was going to get on to it.

The health service has not always provided services from a public sector provider. Until this Bill and the powers it gives to Monitor, regulatory bodies in the public sector had not had the opportunity to inquire into the sustainability of services provided by private sector providers. My right hon. Friend the Secretary of State made the point that the role of Monitor under the Bill is to ensure first—if I may repeat myself—that foundation trusts are of a high quality when they are launched; secondly, that they are accountable for retaining their high standards; thirdly, that we intervene early if they start to go off the rails; and, fourthly, that if they get into serious difficulty, we have the capacity, through Monitor, to continue to deliver continuity of service to those who rely on public health provision, whether from an NHS foundation trust or, as a result of the Bill, for the first time from the private sector. I regard that as a significant step forward in the delivery of continuity of care for NHS patients, whether provided, as the vast majority still will be, by public sector institutions or by some of the independent sector treatment centres introduced by the previous Government.

Future of the NHS

Debate between Grahame Morris and Stephen Dorrell

Monday 9th May 2011 Commons Chamber

[Grahame M. Morris]

Will the right hon. Gentleman give way?

[Mr Dorrell]

Will the hon. Gentleman forgive me? I want to cover what I regard as important ground.

I have expressed the challenge as an efficiency target, but the same target can be looked at differently, and it is important for the House to understand that this is a matter not just of dry health economics, but of the way in which the health service delivers clinical care, because so often in such debates we imagine that the normal health service patient is a normally healthy person who goes to see the GP and is referred for an elective acute procedure. It is as well to remember, however, that such patients constitute 11% of NHS expenditure, and sometimes I wish that we would devote the same attention to the remaining 89%, because that includes emergency patients, with 75% being expenditure on patients with long-term complex conditions, most of whose care would be better delivered by integrated services in the community.

The challenge that we ought to address when we think about the future of the health service involves not just another discussion about bureaucratic structures, but how we deliver the change in the service’s clinical model to ensure that it delivers efficient and high-quality care to the patients who present for care, rather than to the patients as so often described in the policy pamphlets.

That is why it is so important that the structures that emerge from this listening exercise achieve more radical integration than we have yet achieved in the health service—of primary care, community care and social care. It is why the GPs have to be engaged in the process. Once again, that is not a matter of party political debate; the point is made in all the world-class commissioning documents that I do not have time to quote.

My message for the House is that this is an intensely depressing debate, because it is as if the past 20 years never happened. The reality, when we look through the torrent of rhetoric, is that this policy is not a great break from the past; it is a desire on the part of my right hon. Friend to take ideas that were expressed and pushed through by Labour Ministers between 1997 and 2010, and to seek to make them effective in the context of the challenge that I have defined.

NHS Reorganisation

Debate between Grahame Morris and Stephen Dorrell

Wednesday 16th March 2011 Commons Chamber

[Mr Dorrell]

It is, but it is not even political opportunism that applies to a popular principle. Surely opportunism is normally motivated by some popular principle, yet defending the interests of a monopolist does not seem to me to be a very popular principle.

[Grahame M. Morris]

Will the right hon. Gentleman give way?

[Mr Dorrell]

I will give way to the hon. Gentleman, who is another member of the Health Committee.

[Grahame M. Morris]

I am doubly honoured, because the right hon. Gentleman has afforded me a courtesy that the Secretary of State would not. The concept of having greater clinical engagement—not just for GPs, but for doctors in secondary care—enjoys broad support across the parties. However, the framework laid out in the Health and Social Care Bill opens the service up to privatisation.

[Mr Dorrell]

I thought that the hon. Gentleman was going to make the point that he has made in the Select Committee—a point with which I agree—that the purpose of GP-led commissioning is to engage the entire clinical community, not just GPs, in the commissioning process. That is a principle that my right hon. Friend the Secretary of State agrees with. It is also a principle that Sir David Nicholson has made clear will be part of the principles that will be expected to be applied in GP-led commissioning consortia.

Before the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) led me down the road of competition policy, I was going through the principles that are consistent across the health policies implemented by all Health Secretaries since 1990, with the single exception of the right hon. Member for Holborn and St Pancras.

NHS Reorganisation

Debate between Grahame Morris and Stephen Dorrell

Wednesday 17th November 2010 Commons Chamber

[Mr Dorrell]

I cannot summarise the Government’s proposals in the White Paper in three minutes, but one of their key drivers is to deliver far greater clinical engagement in the commissioning process than was achieved in the lifetime of the previous Government, in my time as Secretary of State or at any time in the 20-year history of health service commissioning. We want to achieve a step change in the engagement of the clinical community in the commissioning process. As long as commissioning is something that is done to clinicians by managers, it will fail. It has to engage the clinical community on both sides of the argument. That, as I understand the Secretary of State’s White Paper, is one of his core objectives, and if it is, it has my full-hearted support.

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

In advancing that idea, does the right hon. Gentleman accept that the power to commission is being given to clinicians only in primary care, and that clinicians who work in a hospital setting are not being empowered or involved in the commissioning process at all?

[Mr Dorrell]

The hon. Gentleman is a fellow member of the Select Committee and I know from our discussions that the principle of clinical engagement in commissioning is broadly supported in the Committee. It is fair to say that none of us would support the view—I suspect the Secretary of State would not either—that clinical engagement means only GP engagement. We should see the GP as the catalyst for broader clinical engagement in the commissioning process if we are to deliver our objectives.

To deliver the Nicholson challenge, we must have strong commissioning, with clinical engagement, and we have to remove unnecessary processes that do not add value. We cannot afford to waste money on them. We must have greater local accountability for the commissioning process in order to embrace public support for change on this unprecedented scale.