NHS Specialised Services

Jamie Reed Excerpts

Thursday 15th January 2015 Westminster Hall

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to serve under your chairmanship, I think for the first time, Sir David, although you do look an awful lot like someone we used to call Mr Amess. I extend my genuine thanks to the hon. Member for St Austell and Newquay (Stephen Gilbert), whom I congratulate on securing this debate and on raising these issues in such detail. That is extremely important.

I pay tribute to all hon. Members who have spoken today. I single out my hon. Friend the Member for Luton North (Kelvin Hopkins), who made a superb contribution. He will be pleased to know that a Labour Government would increase spending on the NHS, more so than any other party. I am keen to give my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) the engagement that he seeks at a time of his convenience. I commend my hon. Friend the Member for Alyn and Deeside (Mark Tami) for his compelling personal testimony. Every contribution has been very important. I also pay tribute to the Backbench Business Committee for ensuring that this and other important debates go ahead.

[Mr Peter Bone in the Chair]

Tens of thousands of people across the country rely on specialised health services. Far from being for the very rarest conditions, those with relatively common illnesses and diseases regularly depend upon specialised services. Those conditions and services include, but are by no means limited to, epilepsy, haemophilia, many cancers, HIV and cystic fibrosis. The list also includes fertility treatments such as in vitro fertilisation. The hon. Member for St Austell and Newquay gave a much more detailed list. The issue not only covers a wide range of conditions but accounts for £14.6 billion of the NHS budget, meaning that more than £1 in every £7 spent by the NHS is on specialised health care.

How those services are commissioned and provided is not a peripheral issue. It has a meaningful impact on the health and well-being of many thousands of families throughout the country. As we have heard today, we represent many constituents who require such specialised services. That is why it is right that these issues are debated in detail.

What is of real concern to those of us who use the NHS is the ability to access high-quality care and services. While access is available, many will not be concerned by the commissioning process, but widespread changes to the process could damage services and therefore patient care. The fundamental issues being debated today are the proposed co-commissioning of specialised services and, as has been mentioned, the proposed tariff change for these services. Each presents challenges that the Government must address. I am sure that the Minister will speak at length about how it is now the responsibility of NHS England, but Government must share responsibility for services and their performance. The public and the House expect it.

The Health and Social Care Act 2012 made NHS England the sole national commissioner for prescribed specialised services. The intended effect was to ensure that access and services were uniformly available across the country. It was meant to ensure that all patients would have access to available treatments. The rationale behind the change was that local funding and commissioning of specialised services had led to variable access and quality for patients.

National service specifications ensure that all patients, no matter where they live, have access to the same standard of care. They are currently underpinned by national access policies, expert advisory groups and national accountability for services. The proposed changes that we are discussing and the adoption of co-commissioning could pose a risk to those national standards. Many stakeholders have expressed concerns that specialised services are not easy to plan for on a local level. The Specialised Healthcare Alliance has said that

“given the highly variable incidence of rare and complex conditions, individual CCG allocations will not be aligned with actual need in-year.”

The Government should give assurances to hon. Members, stakeholders and patients about plans to change how such services are commissioned. For example, where will the budget rest? Will it be divided between NHS England and local clinical commissioning groups? Will clinical commissioning groups have any degree of autonomy in decisions about which services to commission in their locality? Why does the Minister believe that the changes will not result, as hon. Members have said they will, in a postcode lottery of services where patients in one area will have no access to some services on which they rely, but other patients will?

On 30 September last year, NHS England published its commissioning intentions 2015-16 for prescribed specialised services. Section 11 states clearly that NHS England has recommended to the prescribed services advisory group that renal dialysis should no longer be commissioned by NHS England and should instead be commissioned by CCGs. The National Kidney Foundation and its members have expressed deep concerns about the change. Patients are anxious about how the changes will affect services that keep them alive. There are 52 centres at present, each with a number of CCGs. How would those arrangements change as a result of the new commissioning framework?

The Cystic Fibrosis Trust has also echoed similar concerns. It is worried that the result of the changes could be

“ a lack of accountability and wide differences in provision of care across the country.”

Will the Minister reassure those stakeholder groups that that will not be the case as a result of the proposals?

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

I apologise that I could not be here for most of this debate, but among the conditions that my hon. Friend is mentioning, I urge him and the Minister not to forget sickle-cell anaemia. Sufferers feel that there is a damaging variability in the quality of treatment available throughout the country and feel that a move away from national commissioning to local-only commissioning might exacerbate that problem.

[Mr Reed]

I thank my right hon. Friend for that intervention. He will be pleased to learn that other hon. Members have made that point as well. Sickle-cell anaemia and the needs of people with that condition must be at the forefront of commissioning intentions and guidance.

It is absolutely clear that there is widespread opposition to the changes among key stakeholders. When the Specialised Healthcare Alliance conducted a survey of patient organisations, expert clinicians and industry representatives, asking for their views on specialised commissioning, 90% of respondents preferred their services to remain part of specialised commissioning. Co-operation between NHS England and CCGs should be welcomed in order to ensure best outcomes for patients, but wherever there is a risk that provision could suffer, NHS England must clearly retain sole responsibility for such services.

Patient care is central to the debate, as it is to all health debates. CCGs could not accurately predict the demand on some key services across a small population, so they are not in a position accurately to commission those services. Many CCGs are already overwhelmed; are they truly capable of doing what is being proposed? The ability to commission effectively will inevitably differ from CCG to CCG, which runs contrary to the initial intentions behind specialised commissioning.

Another concern is the speed with which the proposed changes will be implemented. NHS England plans to begin implementing co-commissioning arrangements in April this year, but it has yet to confirm which services will be co-commissioned. Such fog is damaging for patients and medical professionals alike. The Government and NHS England must be clear about their intentions to allow for proper planning and effective service provision. Perhaps the lessons of the 111 fiasco, for which the Minister was in no way responsible—the service was rolled out even though Ministers knew it was not ready—should now be heeded. These are real concerns expressed by those who will be most affected by the changes, and I hope that the Minister will reflect on that.

On the proposed tariff changes, in November 2014, NHS England and Monitor published a consultation notice on the national tariff payment system 2015-16. The consultation notice included a proposal for a 50:50 gain and loss share arrangement between NHS England and providers of acute prescribed services, meaning that for any service whose value exceeds national base levels, providers would receive payment only for the national base plus 50% of the difference, whereas on any service costing less than national base levels, the commissioner could save 50% of the difference between the actual value and the national base. That will give commissioners a financial incentive to restrict access to treatments for non-clinical reasons, which I find unacceptable.

Given the financial difficulties facing many CCGs throughout the country, that incentive might proving damaging and counterproductive in some cases. Will the Minister commit to undertaking an impact assessment on the tariff change and publish that assessment? If the tariff change has any detrimental impact on patient care, it cannot continue. I hope that when he responds to the debate, he will tell us whether he accepts that view. Will he also consider the views of the specialist hospital network? There is potential to do real damage to such hospitals: not only to the service that they provide, but to their research and development work as well, as my hon. Friend the Member for Luton North mentioned.

The Government’s engagement with stakeholders on health policy throughout this Parliament has been woeful. At best, it has been characterised by a refusal to engage in discussions about what is best for services, professionals and patients; at worst, by wilful ignorance of what experts, clinicians and patients need. A “carry on regardless” attitude has permeated most Government policy across all Departments, but nowhere is it more prevalent than within the national health service. The proposals represent the end of “no decision about me without me”. Stakeholder after stakeholder is calling on the Government to rethink their plans for the commissioning of specialised services.

The 2012 Act is seemingly never-ending; it appears to be changing yet again. The NHS has been plunged into never-ending reorganisation. It is an object lesson in bad law. Again, in fairness to the Minister, that happened before he arrived in post. Let us try to restore consensus on this issue and give commissioners the comfort, certainty and predictability that they and patients deserve. Let us put patients first and stop what could be a retrograde step. I look forward to the Minister’s response.