NHS Annual Report and Care Objectives

Hugh Bayley Excerpts

Wednesday 4th July 2012 Commons Chamber

[Mr Lansley]

I think that what most gives staff a sense of motivation and morale, in any organisation in any walk of life, is being more in control of the service they deliver. That is evidenced across many areas of economic and service activity. That is what we are doing for the NHS. Whether in foundation trusts or clinical commissioning groups, staff will feel that they have more control over the service they deliver. Consequently, I believe that as we see the figures improve it will be less a case of politicians interfering, or even trying to take credit, and much more a case of NHS staff taking credit for the services they deliver.

[Hugh Bayley (York Central) (Lab)]

Last week the board of the NHS North Yorkshire and York primary care trust cluster received a financial position statement that identified the need for cuts of £230 million, plus unfunded costs pressures of £55 million a year, and noted that

“the risks would grow even greater as it moved from a single organisation…to five much smaller clinical commissioning groups.”

Many treatments are already not available to patients in North Yorkshire and York, even though they are available to those in neighbouring areas. Bariatric surgery, for example, is available to people elsewhere with a body mass index of 40, but people in North Yorkshire and York have to be much more obese, with a body mass index of 50, to get it. Will the Secretary of State look at that report, make a thoughtful response and put both in the Library of the House so that Members can see how this financial crisis in the North Yorkshire and York primary care trust is being dealt with?

[Mr Lansley]

Identifying cost pressures and risks is, of course, a necessary part of the process of managing those risks, but I am afraid that the claim by the outgoing primary care trust that the risks cannot be managed by the incoming clinical commissioning groups is contrary to the experience of everybody in the hon. Gentleman’s part of the world, as he must know from the experience of the primary care trusts in North Yorkshire. The primary care trusts of the past did not cope, and it is up to the new clinical leadership in Yorkshire to make these things happen more effectively. The PCT did not finish last year in deficit; only three in the whole of England did—Barnet, Enfield and Haringey. I will make sure—[Interruption.] If he listens to my answer, he will hear that we, along with the NHS Commissioning Board, intend all the new clinical commissioning groups across England to start on 1 April 2013 with clean balance sheets and without legacy debt from primary care trusts. That will give them the best possible chance of delivering the best possible care. On bariatric surgery, he must know that the NICE guidance recommends that it should be available to those with a BMI index of over 40, depending on their clinical circumstances.

[Hugh Bayley]

So why is it 50—

[Mr Speaker]

Order. The hon. Gentleman should not keep shouting out. He has asked his question and had the answer. We will now move on.

NHS Risk Register

Hugh Bayley Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Alan Johnson]

Thank you, Mr Deputy Speaker.

I believe I heard the Secretary of State say that he did not really want to talk about the risk register, and neither do I, but I think it is important to the Government’s basic problem and the threat to the national health service.

Three important and interlinked reforms can be summed up in five words: “better outcomes for lower costs”. Does the private sector have a role? Of course it does.

Let me say a word about the introduction of independent treatment centres, which seem to have been used by some in this debate to suggest that this Bill simply carries forward policies pursued by the Labour Government. ITCs were introduced to deal with the perennial problem in the NHS—long waiting lists. We should remember that in the late 1990s about one in 25 people on the cardiac waiting list died before they were operated on. Rudolf Klein, in his seminal history of the NHS, said that ever since it was created, there has been a tail of around 600,000 people on waiting lists. He said that the captain shouted his order from the bridge and the crew carried on regardless.

In 1995, after 16 years in power, the Government before the last one decided to reduce the guaranteed in-patient waiting time under the citizens charter from two years to 18 months. That was the best they could do after being so long in power. For us, it was an absolute priority. Let me say to Members of all parties that independent treatment centres transformed behaviour in the NHS. Suddenly, it became possible for surgeons to operate on Fridays and on Saturday mornings as hospitals reacted to the threat of competition.

[Hugh Bayley (York Central) (Lab)]

Does my right hon. Friend agree that performance in the NHS was transformed only because the NHS published clear data on the costs and outcomes of procedures in independent treatment centres, compared with those in other NHS hospitals? If the present Government do not publish comparable information from all providers, including private providers, we will get chaos, confusion, declining standards of care and rising costs.

[Alan Johnson]

My hon. Friend makes an important point.

As Health Secretary, I cancelled ITC contracts where there was sufficient NHS capacity, and I approved them where there was not. I recall a visit to the Derwent centre in Bournemouth, where the NHS had taken over a hospital from BUPA and was doing knee and hip replacements more quickly than the private sector. That transformed elective surgery, but although competition is good for elective surgery it is far less important than collaboration in managing chronic disease. I agree with the NHS Future Forum, which said in a report last year:

“The place of competition should be as a tool for supporting choice, promoting integration and improving quality. It should never be… an end in itself.”

The NHS is not a collection of separate and autonomous units of varying degrees of independence, responding to the invisible hand of the market. It is, above all, an integrated health care system. The fear of the vast majority of clinicians is that the Bill will damage that crucial principle.

--- Later in debate ---

[Mark Simmonds]

I am grateful to my hon. Friend for that intervention. He is absolutely right. Certainly, some of the communicating that both Government parties need to do will be myth-busting on what is being portrayed as the future of the NHS and its services. They will be improved and enhanced, as will patient outcomes and services, as a direct result of the reforms that we hope to implement though the Health and Social Care Bill. They will not go backwards, as Opposition Members suggest.

Two distinctions can be drawn between the Government and Opposition sides of the House on this matter. First, we on the Government side are committed to increasing resources and investment in the NHS—in contrast to the Labour party. We can see that distinction in the enhancement of services in England and the deceleration and paucity of services in Wales. Secondly, Government Members understand the necessity of reform, whereas Labour Members do not. I accept that there are some exceptions, such as the previous Health Secretary, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), who I think understands the importance of reform. Maintaining the status quo in the NHS is the greatest risk; it is not an option.

I think that today’s debate is a red herring and a cloak. My hon. Friend the Member for Kingswood (Chris Skidmore) completely destroyed the argument about the necessity of publishing the risk register, because it is no longer relevant. I am sure that the ministerial team would have been looking at that risk register and changing policies in order to mitigate and negate the initial impact of the risks recorded in it. Every former Government Minister who has spoken from the Labour Benches today, whether in a speech or an intervention, has form in refusing to put risk registers in the public domain when they had a chance to do so in office, and they know very well that risk registers can be misleading. Even the Information Commissioner, in his judgment, said that safe space was required.

[Hugh Bayley]

The hon. Gentleman said a few moments ago that he believed that increased competition, with private providers competing against NHS providers within the NHS, would improve outcomes. Does he therefore agree that there should be a common standard by which all care providers paid for with NHS money report on the cost and outcome of procedures? If so, why is that not in the Health and Social Care Bill?

[Mark Simmonds]

I am grateful to the hon. Gentleman for his intervention. That is not exactly what I said, but I will get to the nub of what he is talking about. I do think that comparable information is needed to inform patient choice, and not just on cost, but on outcomes and patient satisfaction and experience, so that it is on a comparable level—

[Hugh Bayley]

Why is it not in the Bill?

[Mark Simmonds]

I am sure that the information centre in Leeds is working on that as we speak, because I know that it is important to the ministerial team.

--- Later in debate ---

[Hugh Bayley (York Central) (Lab)]

I believe that the Government should publish the risk register relating to the Health and Social Care Bill, and I wrote to the Secretary of State last year to urge him to do so. I received a reply from a junior Minister in the Lords that gave the arguments that were advanced to the Information Commissioner about why it would be dangerous, including the suggestion that civil servants would pull their punches if their risk assessments were made public. The commissioner rejected those arguments, but even after he made his decision they were still being advanced by the Government, and we heard them advanced once again in the Chamber today.

The Government have got themselves into an utterly impossible position. Dozens of constituents have written to me, and I have been told by people with very high posts in the NHS, including senior clinicians, senior mangers and professors of health policy, that the Government ought to publish the register. Underneath this all is a growing belief that the only reason the Government can possibly have for not publishing the register is that it would be politically embarrassing for them to do so. [Interruption.] The Minister shakes his head, but the hon. Member for Southport (John Pugh) drew an interesting parallel. When the former Speaker in the previous Parliament sought to overturn the Information Commissioner’s decision that the information on MPs’ expenses should be published, I tabled a motion stating that we should publish the figures for second-home allowances. This was before The Daily Telegraph exposed what it did, and, had the House published at that stage there would have been a public outcry, but there would not have been the loss of public trust in this House, which came when we were seen to be hiding the data and seeking to overturn a reasonable decision, made by the Information Commissioner, that it should be made public.

The Government have got themselves into precisely that position because if, after the tribunal, they are told that the information has to be published, the embarrassment that they know they will face, they will face, but they will face it against a background of public cynicism that would not have existed if they had published in the first place. If, however, they win their case and the information on the register is not published, the public will still believe that the Government have something to hide, so my advice to them is, “You’re in a hole, stop digging and publish.”

The Secretary of State said in his speech to the House that all the information that is relevant to the debate about the Bill is in the impact assessment so there is no need to publish the risk register. But if all that we—and the public—need to know about the Bill has already been published, the Government have nothing to lose by publishing the risk register.

If we look at the impact assessment, we see that from time to time the Government have redacted certain figures, so if one or two things, for some particular reason, had to be kept secret, they would still be able to publish 99.99% of the risk register, and they would satisfy this House and public opinion and build greater confidence.

There is public fear because there are inevitably risks to increasing competition in the provision of NHS services. Increasing competition is not in itself a bad thing. The Labour Government increased competition between acute London hospitals in coronary care and achieved better coronary care outcomes, but when we contract to private providers we inevitably create risk. I should not need to tell Government Members that risk is what private companies take, and that it is given as a justification for making profit and reward, but if risk applies to profit it can and does apply to the quality of patient care.

Several Government Members have said that they want to drive up the quality of patient care and to drive down the cost of care, but they will do so only if they publish comparable data on outcomes and cost for every supplier of service to the NHS. The Government need to commit to do that and to include it in the Bill; otherwise, members of the public will fear that the consequence of the reforms, forcing competition on the NHS, will mean that some care standards will fall, which is what happens when we have unregulated—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. I call Ben Gummer.

NHS (Public Satisfaction)

Hugh Bayley Excerpts

Wednesday 30th March 2011 Westminster Hall

[Several hon. Members]

rose—

[Hugh Bayley (in the Chair)]

Five Members wish to speak and we have about 50 minutes for debate; they can do the calculations for themselves.

--- Later in debate ---

[John Pugh (Southport) (LD)]

Putting aside his conspiracy theory, I congratulate the hon. Member for Leyton and Wanstead (John Cryer) on initiating this important and timely event. I say that it is timely, but it is not timely for the poor Minister, who was unwell yesterday, and who does not look too good today. I understand that his colleague, the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), is now also smitten, so the casualties from the Committee considering the Health and Social Care Bill are on the increase.

There may be good reasons for substantial change in the NHS, and one of those that has been given is not that the public are not satisfied with the NHS, but that they should not be satisfied with it. It must be conceded, of course, that the case for radical change is lessened a little if the public are increasingly satisfied with what goes on. The hon. Gentleman has drawn attention to, and put beyond all doubt, the fact that the public are satisfied with the NHS, and we should have that important truth out in the open. Whatever we do in policy, it is important that we are evidence-led, and a wanton disregard for evidence when making policy is wicked and morally irresponsible.

If we ignore the conspiracy theory aspects of the hon. Gentleman’s contribution, it is clear that he has done the House a service by drawing attention to the truth that the public are broadly satisfied with the NHS. We cannot be as confident, however, about the explanations for that. It is most unlikely that public satisfaction is unconnected with things such as decreased waiting lists and increased investment. It is also most unlikely that it is unconnected with the dedication and skill of NHS staff, which remain no matter what politicians decide in this place.

However, satisfaction can be linked to other things, such as sentiment. Some years ago, research into the NHS produced some rather puzzling outcomes. If people in general were asked about the NHS, they had a fairly negative view, but if they were asked about their personal treatment at the hands of the NHS, they were thoroughly satisfied. That was explained by the way in which the media portrayed the NHS and the way in which stories about the NHS appeared in the media.

Another interesting bit of data, which the hon. Gentleman did not allude to, indicates that we are talking not just about a switch in what the media, and therefore the public, are saying. Reports about the NHS by NHS workers themselves have been increasingly positive. Worryingly, there was a stage when a lot of them would give a rather bad account of what was going on in the NHS when they were asked about it. Recently, the data have shown quite conclusively that people working in the NHS speak more positively about it. Such people are more immune to changes in media tone.

The debate so far, however, has been not so much about whether people are satisfied, which we can all take as read, as about whether they should be satisfied. Clearly, that depends not on whether they are satisfied with the NHS, but on whether the NHS actually does its job, which is to make people more healthy, not more satisfied. To give an example, people often feel very satisfied and contented with small maternity units, but such units sometimes have higher infant mortality rates, and outcomes are actually less satisfactory.

Patient-reported outcome measures—PROMs—sometimes show a different picture from clinical outcomes. We have mentioned independent treatment centres, and a lot of evidence seems to show that people are very satisfied with them, although the satisfaction is more to do with the catering and reception arrangements than with the clinical outcomes.

The moot question, therefore, is whether patients have reasonable grounds for dissatisfaction or satisfaction with NHS, whether or not they actually express any—always bearing it in mind that what the public are reluctant to fund, they should not complain about. However, the real question, given the funding that the public have set aside for the NHS, is whether the NHS has delivered the outcomes that people could rationally expect.

When pressed on the issue, senior Government politicians, up to and including the Prime Minister, talk about three issues: cancer and heart disease outcomes, bureaucracy and unimpressive productivity, which are presented as legitimate gripes. It is sometimes tempting to believe that politicians need to find faults in public services because they like reforming them, and I am sometimes inclined to think that we should redefine public services as anything a politician wants to reform. However, there is a need to find out whether there are any real grounds for dissatisfaction with the service we currently have. Unless we can find genuine grounds for people to be dissatisfied, whether or not they are, we should not have overly radical disturbance or upheaval in the system.

Can we make a case for public dissatisfaction? Let me briefly take the three issues I mentioned in turn. We certainly should not bang on about the cardiovascular field. I had the unnerving experience the other day of listening to the Prime Minister at Prime Minister’s questions tell the House how poor our outcomes were when set against those of comparable countries. Later, I attended an event organised by the British Heart Foundation to celebrate world-beating progress. That was a very puzzling experience. The King’s Fund has adequately exposed the myth about heart disease outcomes, and no one in the Department of Health should embarrass the Prime Minister any longer with briefings that disappoint and depress those who are better informed on this issue.

Last week, the Prime Minister notably stuck to the safer ground of cancer outcomes. To be fair, despite sharp falls in mortality among males and excellent progress on breast cancer treatment, we do not seem to excel our peers, and there is clearly work to be done. When looking at the issue, however, we should not use just the old research done by Professor Coleman 10 years ago, because the data on the issue is quite weak. If there are poor outcomes on cancer, however, it is not obvious why it therefore follows that structural and organisational upheaval is the solution, particularly as the prime cause of poor cancer outcomes, as far as I can tell, is late referral by GPs, and the prime solution is a more integrated service and strong regional clinical networks. It is a fact that we spend less on the treatment of cancer than the countries we compare ourselves with.

Turning to the other flaws, there are legitimate objects for criticism from time to time. On bureaucracy, I assume that everybody here understands that the administrative costs of running the NHS compare very favourably with those of running health systems in other parts of the world; that is not a debateable point. Even if those costs are higher than we would wish, they certainly compare favourably.

It is quite true, as the hon. Member for Banbury (Tony Baldry) and the Public Accounts Committee have said, that productivity has not increased linearly or proportionally with investment, but that is true of business sectors, too. That is a common phenomenon; every extra pound does not give us the same amount in increased productivity. The wonder is that people expect life to be that simple. If that is a real problem, however, it is a poor argument for giving GPs all the money to spend, especially when the National Audit Office research, which has been quoted, shows that giving GPs extra money under the contract would not necessarily give us a vast increase in overall productivity. If we drew a graph showing the rise in income and the outcomes at GP surgeries—I can give hon. Members copies of the PAC report—we would find a phenomenon similar to that described by the hon. Member for Banbury with respect to hospitals. There does not, therefore, seem to be quite as clear-cut a case as one might wish to justify a case for public dissatisfaction, and the public might have a case for not being as dissatisfied as all that.

I want to refer Members to an excellent document from the Commonwealth Fund, which contains up-to-date research on many health systems across the world that are comparable to that in the UK. The research includes a number of indicators that are very favourable to our system, and this is copper-bottomed research. It shows that the UK has lower than average spending; that, according to UK citizens, our system needs less changing than those of our peers—that is what people in our country say and what people in other countries do not say to the same extent; that it inspires the greatest confidence in terms of effective treatment; that it requires the citizen to fork out the fewest additional payments; and that it is among the best for quick appointments, access and diagnosis. It is not perfect, and I have not undermined the case for all sorts of changes in the NHS, but as we say in Lancashire, “Mustn’t grumble.” There is a case for looking at what we have delivered and perhaps celebrating it.

As Government, as parties and as politicians in general, we can certainly make a case for reform, and that case can be made independently of this debate. What I cannot convince myself of at the moment—indeed, none of us can—is that the public are dissatisfied with the NHS. They are not. Nor can I convince myself that they have grounds for dissatisfaction that go beyond those one would find in any health service, anywhere in the world at any time.

[Hugh Bayley (in the Chair)]

It might help Mr Anderson and Mr Morris if I say that the two Front Benchers have each agreed to speak for 10 minutes, which leaves a further 20 minutes for debate: 10 minutes for each of you. Mr Anderson.

--- Later in debate ---

[Grahame M. Morris]

I thank the hon. Gentleman for that intervention. His point is a good one, and was well made. There is no need for the revolutionary change that we are facing.

Time is limited, so I shall conclude. Without polling and without understanding the facts, the Government would take a reckless step in the dark. If they do not consider public opinion in their annual surveys, they may end up with a shock in the biggest survey of all—the one planned for May 2015.

[Hugh Bayley (in the Chair)]

I shall call Mr Dromey to order at 3.40, so he has a few minutes in which to speak.

Health and Social Care Bill

Hugh Bayley Excerpts

Monday 31st January 2011 Commons Chamber

[Clive Efford (Eltham) (Lab)]

rose—

[Hugh Bayley (York Central) (Lab)]

rose—

[Mr John Baron (Basildon and Billericay) (Con)]

rose—

--- Later in debate ---

[Mr Dorrell]

Indeed it did. I offered the right hon. Gentleman four consistent themes of policy. He accurately quoted my comments about a specific element of bureaucracy. One of the questions that the Select Committee addressed was why, since all these broad themes are so broadly supported, we went down the road of replacing the PCTs with the consortia. That is a question that the Select Committee said in its report had not been adequately explained, but that is a relatively minor question of bureaucratic presentation when compared with the broad themes of policy that were articulated in the debate by my hon. Friend the Member for Grantham and Stamford. Which of these key policies does Labour now wish to dissent from?

[Hugh Bayley]

rose—

[Mr Dorrell]

I give way to the hon. Gentleman, an expert on health policy from the Back Benches, who may able to answer the question that the shadow Secretary of State wishes to avoid.

--- Later in debate ---

[Hugh Bayley]

I wonder whether the Select Committee agrees that private contractors, where they are engaged, should be required to publish the same information about cost, quality and outcomes as NHS providers, to ensure a level playing field and real, true comparison.

[Mr Dorrell]

I have been here long enough not to presume to speak on behalf of a Select Committee on a question that the Select Committee has not addressed, but I think there would be broad support across the House for the principle that where the private sector provides a service to a public sector commissioner, the private sector provider should be accountable to that commissioner on precisely the same terms as the public sector provider. As my hon. Friend the Member for St Ives (Andrew George) mentioned in his intervention on the shadow Health Secretary, one of the problems about the independent sector treatment centre programme was exactly the point that the hon. Gentleman makes—the accountability expected of a private sector provider was different from the accountability expected of a public sector provider.

Therefore, I agree with the hon. Gentleman and hope that he can persuade his right hon. and hon. Friends on the Front Bench to endorse the principle of common accountability for public and private sector providers providing a service to a public sector commissioner. I see my right hon. and hon. Friends on the Government Front Bench endorsing the principle. I hope that I am not misrepresenting the way that they are reacting to the hon. Gentleman’s question.

This is a consistent set of themes. Why is it consistent? I want to move the debate on. The House of Commons loves debating structures in the national health service. The inference from what I have said so far might be that that means it is all business as usual—that what has gone on, with the exception of the period when the right hon. Member for Holborn and St Pancras was in charge, is a seamless development of policy since 1990.

However, the truth is that during the lifetime of this Parliament the national health service faces a genuinely unprecedented challenge, first articulated not by my right hon. Friend the Secretary of State in the present Government, but by the chief executive of the health service before the general election in May 2009, when he drew attention to the fact that demand for health care should be expected to continue to rise at roughly 4% per annum, as it has done throughout the recent history of the national health service. However, because of the budget deficit, we will not see the health budget continue to rise to absorb that rise in demand, in the way it has over the past decade.

Therefore, during the lifetime of this Parliament, we will have to see, in the national health service, a 4% efficiency gain four years running—something that not merely our health care system, but no other health care system in the world, has ever delivered. The Select Committee has referred to that as the Nicholson challenge, reflecting the fact that it was first articulated by the chief executive and endorsed by the previous Government. Again, this is a case of a shared agenda across the House of Commons.

Given the Budget deficit, the only way we can continue to meet the demand for high-quality health care, which we all want to see, is by delivering an unprecedented efficiency gain in the NHS for four years running. That is why I support the Bill. I support it because to my mind it is inconceivable that we can deliver such an efficiency gain without delivering more effectively than we have done yet on the ideas, which have been endorsed over the past 20 years, about greater clinical engagement in NHS commissioning, which I have been talking about. Commissioning cannot be successful if it is something that is done to doctors by managers; it must engage the whole clinical community. We must address the democratic deficit, because we cannot bring change on the scale that we need to deliver the efficiency gain without engaging local communities.

Finally, the NHS must also be a national service that is accountable through the commissioning consortia, the commissioning board and the Secretary of State to this House, because it is ultimately the taxpayers who pay for it. Those are the principles that were set out by the Health Committee, and it is those that we will seek to review as the Bill goes through Parliament.

--- Later in debate ---

[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.

[Hugh Bayley]

Will the hon. Gentleman give way?

[Dr Poulter]

No, I have taken two interventions and I will not take any more.

The Bill will allow health care to become more localised. Some of our constituencies have urban needs and some have rural needs, and allowing GPs to set up localised consortia that are more responsive to the needs of local communities will enable them to recognise those health care needs. For example, the area of my hon. Friend the Member for Eastbourne (Stephen Lloyd) has an ageing population, so the GP consortia and health and wellbeing boards will rightly focus on looking after the older population. In areas of the country such as our some of our inner cities, including parts of Bradford and Manchester where there are huge health care inequalities, the Bill will provide a real opportunity for the health and wellbeing boards and local GPs to tailor their services much more effectively to tackling local problems. For instance, they may face problems such as heart disease, diabetes and obesity more acutely than other areas.

The Bill is a good thing. It will bring to the NHS framework and the national care standards a much more focused, much less bureaucratic and much more patient-centred approach, which will be much more responsive to the needs of local communities. I am proud to speak in favour of it.

--- Later in debate ---

[Henry Smith]

My hon. Friend is indeed legendary at Crawley hospital, and it is great to take part in this debate with him. Unlike him, I do not have a health background. My wife used to work in the NHS, but my background is as a local elected representative of my community and as a patient, and as someone whose family has had experience of the NHS.

I am afraid that I shared the bitter experience of many in Crawley during the 13 years in which the Labour party was in government. On 1 May 1997, when Labour took office, Crawley had an A and E department and a maternity unit. I am sorry to say that in 2001, Crawley hospital lost the maternity unit. At the time of a rather joyous occasion for my family, it was saddening that my children could not be born in our local hospital.

[Hugh Bayley]

The hon. Gentleman champions localism, but has he picked up that maternity services will be taken away from GP consortia under the Bill? Is that a good thing?

[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.

--- Later in debate ---

[Hugh Bayley (York Central) (Lab)]

The Government White Paper said some sensible things: it promised to increase NHS spending in real terms, to improve patient choice, to devolve decision making, to reduce management costs and to hold doctors to account for their clinical outcomes. Indeed, the objectives are very similar to many of those of the former Labour Government. The problem, however, is that the Bill will undermine many of those good aspirations.

Health spending is, as we know, falling because the amount by which the Government increased the NHS budget is lower than the rate of inflation. [Interruption.] For my health authority, it is 0.3% lower than the rate of inflation. Patient choice will remain limited to where GPs choose to commission services. Centralising many services under the NHS commissioning board—a new layer of bureaucracy—means that NHS dentistry, community pharmacy, optometry services, regional and sub-regional specialties and, indeed, some more complicated local services will be commissioned at national level by that board rather than at local level by a primary care trust, as in the past, or by a commissioning consortium in future.

I am sure that the Government will try to reduce NHS management costs. Every Government since the creation of the NHS have sought to do so, but this Government need to explain how creating 500 or 600 commissioning consortia—each with the skills to commission services—will cost less than the 150 PCTs that currently do the job. They are likely to lose economies of scale and the decisions taken could well lead to the fragmentation of some services such as dermatology or pathology. Such services are currently commissioned by a PCT for the whole PCT area, but in future could be commissioned in three or four different ways by different consortia. Small, less well resourced GP commissioning consortia will, I believe, be less effective than PCTs and strategic health authorities in controlling the costs of powerful hospital foundation trusts.

The Government are right to stress the importance of measuring clinical effectiveness and outcomes, but that makes it extraordinary that they have put primary care in the driving seat. We know a lot about the work of hospital doctors from the hospital episode statistics, but there are no national data on GP consultation rates or the thresholds they employ before they intervene with treatment or on GP outcomes, yet GPs are being put in charge of demanding this from everybody else.

Running through the Bill is the idea that transparency and accountability will drive up performance, so here are some questions to the Minister, which I hope he will address in his concluding speech. The Bill is designed to reduce health inequalities, yet there are enormous inequalities in GP services. Some GPs are very good; others less so. There are differences in their prescribing and referral rates, so how are the Government going to measure GPs’ clinical performance? How will a GP commissioning consortium hold erring GP practices to account? What sanctions will be employed?

How will patients hold their GPs to account for their commissioning decisions? We are, of course, familiar with GPs being sued for bad clinical decisions, which is why they take out medical insurance and have to pay increasingly more for it each year. Will patients sue their GPs for bad commissioning decisions? How will the consortia hold hospitals to account?

How much will the GP commissioning consortia receive in management allowance per patient, because the Government’s success in making administrative savings will depend on that? What sanctions will be imposed on a GP commissioning consortium to ensure that it commissions effectively and uses a good evidence base for its decisions?

The Government tell us that PCT deficits will be written off before the consortia take over, but what help will the commissioning consortia get in areas such as mine where there has been a difficult structural deficit—brought into balance by the previous Labour Government, but out of balance once again under the new Administration—to stop them falling into deficit? What will happen if they do go into deficit? Will their budgets and the services they provide to patients be cut as a result?

[Mr Dorrell]

The hon. Gentleman is making a thoughtful speech and asking, if I may say so, some very good questions, with all of which I agree. There is an implication behind his speech, however, which is that if all those questions can be answered, as I hope and believe they can, he will support the Government’s policy. Is that implication correct?

[Hugh Bayley]

If I were convinced that they could be answered, I would indeed support the Government, but unfortunately I am far from convinced that it is the case.

Let us take another issue. The Government are providing a lesser increase in funding to the NHS this year, which amounts to a cut in real terms when the rate of inflation is taken into account. They think they will get away with this because the NHS staff wage bill is being frozen for a two-year period. What thought have they given to the wage bounce that will inevitably come in two years’ time? There will be enormous wage pressure on the NHS budget; are the Government intending to increase it significantly at that time?

[Mr Dorrell]

I am anxious to provide the hon. Gentleman with extra minutes so that he can tell us whether he approves, in principle, of the idea of practice-based commissioning, which was originally introduced by the previous Government?

--- Later in debate ---

[Hugh Bayley]

I certainly do not agree with the way in which it is being introduced. The right hon. Gentleman will probably know that before the last election, I made a proposal to strip out one level of NHS bureaucracy—the PCT level—and do commissioning where it was needed at the SHA level. That would have achieved administrative: savings. Instead of that, however, the Government have decided to replace 150 bureaucracies—PCTs as commissioning bodies—with some 500 or 600 bureaucracies: the GP commissioning consortia. I do not think that that will achieve administrative savings. With the NHS budget so tightly squeezed by the current Government, if more money is taken away to meet the costs of bureaucracy, less money will be available for treating patients. That is the crux of the issue.

I believe that those are some very serious questions, which the Government need to answer if they going to convince the public of their plans. There is an intellectual incoherence in many of their proposals. They have not looked either at how some of their goals—on patient choice, for instance—might conflict with other goals such as increasing efficiency. Will a doctor be able to insist that patients have the most efficient treatment even if they do not choose that option themselves? Would it not make sense to pilot these changes before imposing them, untried and untested, on the NHS?

--- Later in debate ---

[Nicky Morgan]

I was just talking about that, but the point that has been made is that GPs do not feel that they necessarily have the specialist skills to commission mental health services. That says not that the underlying plan set out in the Bill is wrong, but that GPs recognise their limitations. From the conversations that I have had with GPs, I think that they will know where to go to commission those services and they will get the support from the national commissioning board.

[Hugh Bayley]

Will the hon. Lady give way?

[Nicky Morgan]

I am afraid that I must make some progress.

My second point relates to joined-up care, which carried on from my previous point. People with mental health problems have complex needs and need a clear pathway of care, which might involve the GP, psychiatric care at secondary care level, a social worker and community support services, such as drop-in services. That is essential, and that is what we want to see happen in the NHS.

Swine Flu

Hugh Bayley Excerpts

Monday 10th January 2011 Commons Chamber

[Mr Lansley]

I will certainly write to my hon. Friend about this, but I am confident that one of the number of vaccines that are available will be suitable for his constituent.

[Hugh Bayley (York Central) (Lab)]

Last week, 30 beds at York hospital were occupied by people with suspected or confirmed cases of flu. That is costing the local NHS £7,500 a day—£50,000 a week—and that money could be spent on treating patients with unavoidable conditions. What lessons will the Secretary of State learn from the failure to promote the uptake of the flu vaccine this year to ensure that we do not encounter a similar problem next year?

[Mr Lansley]

The hon. Gentleman’s question is based on a false premise, because the level of vaccine uptake this year among over-65s is 70% and among under-65s is 45.5%, which is comparable to previous years. He did not refer to this, but because we made savings we provided the NHS with considerable additional resources in the last three months of the year precisely to manage winter pressures and ensure that beds in hospitals are available.

Oral Answers to Questions

Hugh Bayley Excerpts

Tuesday 7th September 2010 Commons Chamber

[Mr Burns]

My right hon. Friend is absolutely right. It is, of course, not only a question of correctly identifying those people who should use A and E; the other assistance given through the health service is also important. We need a first-class and relevant out-of-hours service as well.

[Hugh Bayley (York Central) (Lab)]

11. What recent assessment his Department has made of the clinical effectiveness of facet joint injections; and if he will make a statement.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

Recommendations on facet joint injections were made by the National Institute for Health and Clinical Excellence in its 2009 clinical guidelines on low back pain. NICE did not find sufficient research evidence that strongly supported the effectiveness of facet joint injections and recommended that more research should be done. I understand that the National Institute for Health Research is looking at whether it will commission further research.

[Hugh Bayley]

Access to these injections is restricted in North Yorkshire and York PCT, although it is widely available on the NHS in other areas. The consultant in charge of York’s pain clinic believes that the PCT is not following the most recent NICE guidelines. What are the Government doing to reduce this kind of postcode lottery? Will the Minister contact the PCT and arrange for it to meet me and the consultant to discuss how these guidelines ought to be applied in North Yorkshire and York?

[Anne Milton]

I thank the hon. Gentleman for his remarks and point out that it is precisely because of the situation that he describes that we are bringing in some of our reforms. It is important that decisions about treatment and care are made by clinicians—GPs and a large number of other people, including some voluntary and charitable organisations—and that they are clinically led, evidence-based and also include patient choice.