Operational Productivity in NHS Providers

Debate between Jim Cunningham and Mike Weir

Wednesday 1st July 2015 Westminster Hall

[Mike Weir (Angus) (SNP)]

I am glad to speak in this important debate under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Hendon (Dr Offord) on securing it.

Obviously, in Scotland the situation is slightly different, because the NHS is devolved, but many issues cross over, wherever our health services are located. I was very interested in some of the points made. NHS Scotland has produced a framework for efficiency and productivity going up to 2015. We recognise that it is essential to be more efficient and productive, to ensure careful use of the public purse.

To an extent, the situation in Scotland is slightly different, because the NHS budget has been protected from cuts as a result of the Scottish Government’s action. However, we still face inflationary pressures arising from demographic changes and increasing drugs and staff costs, which mean that NHS boards will need to make a minimum of 3% efficiency savings just to break even.

I was interested in what the hon. Gentleman said about the many issues faced by the NHS, particularly in England. I understand that much of the savings to date have been made by freezing staff salaries, squeezing prices paid to hospitals for the treatment they provide and cutting management costs. I wonder whether there is a correlation between those savings and the frauds and difficulties in some hospitals, which he mentioned. We all want to cut management costs, but sometimes there is a cost to doing that, because if management is cut back it cannot have the same hands-on experience of what is going on in all areas of the operation. That has to be weighed in the balance when we consider such savings.

The hon. Gentleman talked about the Carter review and the time spent by people on the frontline, whether with patients or doing other things. Again, that has to be built in. The hon. Member for Coventry South (Mr Cunningham) made a good point about the difference between productivity and efficiency. A staff member could be deemed much more efficient if they just dealt with patients, but down time for staff has to be worked into the system, because any doctor, nurse, or other NHS staff member will be working at a high level for very long periods. There are dangers if down time is not built in.

All of us would want savings made where they can be safely made, but the hon. Member for Bristol South (Karin Smyth) made an interesting point about the King’s Fund, which estimates that another £30 billion of savings will be required by 2020-21. The Government have made much of the fact that they will put another £8 billion into the NHS. Although I am sure that is welcome, it still leaves £22 billion in savings to be achieved through productivity improvements. With the best will in the world, I find it difficult to envisage £22 billion of savings being made through productivity improvements in the NHS. If it can be achieved, that is fair and well, but it does seem a very tall order, as the King’s Fund stated.

An organisation cannot keep freezing staff wages forever; there will have to be a change in that regard. Management costs cannot be cut indefinitely, because, again, management is needed to run the system.

[Mr Jim Cunningham]

Admittedly, it has been some years since I was involved in negotiations relating to productivity, and so forth, but the fact remains that there are consequences if people are not paid a decent wage. I worked in industries where wages were frozen and saw the consequences. The only way to increase productivity in the NHS and maybe save money—I use the word “maybe” advisedly—is by having incentives. That is the only way it can be done. It was not clear, in the speech made by the hon. Member for Hendon (Dr Offord), what percentage of people would have time off. There is a tolerable, acceptable percentage in that regard, but I was not clear what the percentages were.

[Mike Weir]

The hon. Gentleman makes a good point. He is right about incentives. A happy workforce will be a much more productive workforce. There is a danger of putting increasing pressure on the workforce, especially in the NHS, where mistakes can be disastrous and can do a lot of damage in the long term, both to the system and patients. We have to be careful about some of these things. I was interested in what the hon. Member for Hendon said about the cost of agency workers. I think we would all agree on that point. It would be preferable to have full-time staff in the NHS, but agency workers are used for a reason: shortages.

The hon. Gentleman also talked about people from outside the EU working in the NHS, but again, this shows that there needs to be a more holistic Government policy. The Government recently announced an earnings threshold of £36,000, under immigration policy, for those who have been working in this country for six years. Many nurses working in the NHS throughout the United Kingdom are not earning that sort of money and have been in the NHS for many years. The Royal College of Nursing stated that if this policy was imposed, thousands of nurses could leave the NHS and could have to leave the UK. That is not in the best interests of the health service at the moment. When considering efficiency savings and how the NHS can better work for all our constituents throughout the UK, we have to think about such things .

[Mike Weir]

The hon. Gentleman read my mind: that was my next point. Agency nurses are causing a drain on resources, because we have to employ so many already. That will not get any better if nurses cannot work in the NHS because of immigration policy. These people did not come to this country a few months ago; some have been here for many years. Many of these nurses are working in hospitals in all parts of the UK, whether Scotland, Northern Ireland or England. They are also working in the care system.

The Government are making a bad situation worse, perhaps because of other pressures on them to do with immigration, and are not dealing with the realities of the health service. Training new nurses to take the place of those who may leave will not happen overnight. It takes years to train a nurse properly. If these people have to leave suddenly, they will leave a huge hole in the NHS. That raises a question about the sustainability of the system. In summing up, the Minister might like to consider that; and perhaps he will take the matter up with Home Office colleagues and discuss the impact this policy may have on the NHS.

Efficiency savings are fine where they can be made. We are all looking for efficiency savings, and we understand that there can be some. For example, there are some interesting responses in the Carter review on medicines and prescriptions. Savings could be made there. A lot of medicines can be wasted if prescriptions are too large. Such system changes can save money, but it is wrong to look for the silver bullet that is going to change things and produce the £22 billion in efficiency and improvement savings.

[Mr Jim Cunningham]

If the hon. Gentleman thinks back 12 months or so, he may remember that it took a long time for the Secretary of State to reach an agreement with the pharmaceutical companies because some issues were held up. We should consider that. It seems to me that a gun was held to the Secretary of State’s head on costs.

[Mike Weir]

Again, the hon. Gentleman makes an excellent point. One difficulty with the NHS is the cost of medicines. All our constituents are pushing us to get costly new medicines on the NHS for diseases, including rare diseases. They might be extremely costly in the first instance for good reasons, but demand always increases costs in the system, and it is difficult to deal with that. The pharmaceutical companies have a role to play in that, because much of their business comes through the national health service. If cost savings can be made by negotiating with those companies, that should be done. I am sure that the Secretary of State will at all times try to persuade them on that point, but I am not so sure how well he will do, given the competing pressures from constituents and Members for new drugs to be made available on the NHS. None of these issues are easy, and I have some sympathy for Ministers who are struggling with them, especially given the pressures on all areas of Government spending, but I urge caution in looking for simple solutions.

Badger Cull

Debate between Jim Cunningham and Mike Weir

Wednesday 11th December 2013 Westminster Hall

[Mr Mike Weir (in the Chair)]

Order. Quiet in the Chamber. A lot of people want to speak in this debate, so I ask for quiet and for short interventions.

[Mr Jim Cunningham (Coventry South) (Lab)]

Does not the evidence show that, even with the cull, the targets cannot be achieved? More importantly, would it not be better to use the Scottish system?