Operational Productivity in NHS Providers

Jim Shannon Excerpts

Wednesday 1st July 2015 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Thank you, Mr Pritchard. I apologise for having had to step out of the Chamber for a minute or two. I expected the speech of the hon. Member for Bristol South (Karin Smyth) to be a wee bit longer. It is always a pleasure to speak on these issues, and I thank the hon. Member for Hendon (Dr Offord) for bringing this subject to the House for our consideration.

The Carter report is important. Members will know that health is a devolved matter in Northern Ireland, and the responsibility for health falls clearly on the Northern Ireland Assembly and my party colleague Simon Hamilton, but it is important that we consider the issues and the recommendations in the report. I will speak to that in a few minutes, but first I pay tribute to all those who, despite the numerous difficulties facing us, make our NHS one of the premier care services in the world.

The tireless work of the doctors, nurses, surgeons, technicians, pharmacists, auxiliaries, cleaners, cooks, porters and those who work in admin behind the scenes has not gone unnoticed. I am sure everyone here would start by thanking them for their contributions, their efforts and the exhausting work they do. I thank them for their smiles to the patients and families, sometimes when the workers are so exhausted they can barely stand. I thank them for staying those extra 10 and 15 minutes beyond what they are paid for to make a patient comfortable. I thank them for choosing to come to work and sometimes having to face abuse from tired and perhaps frightened people. I thank them for retaining their dignity and helpful nature. In this debate, we do not stand in judgment on the NHS or the workers; rather, we look at the procedures in place and how we as Members of Parliament can help to make the NHS, which we are fortunate to have across all the regions, more effective for everyone.

[Mr Jim Cunningham]

The hon. Gentleman mentioned long hours. Some of the young trainee doctors are doing a 12-hour day, seven days a week. That can go on for months. That is not exactly conducive to good morale in the national health service, is it?

[Jim Shannon]

None of us here said that it was. It is important that our doctors and the staff are not over-tired.

The Carter report sets out how efficiencies can be delivered. The hon. Member for Angus (Mike Weir) who spoke before me clearly outlined the issues. The title of the debate refers to Lord Carter’s review of productivity in hospitals, and the interim report of that review, “Review of operational productivity in NHS providers”, which was published on 11 June. We all know that Lord Carter of Coles was appointed by the Health Secretary to chair the NHS procurement and efficiency board in June 2014, to review the operational productivity of NHS hospitals and to establish the opportunities for efficiency savings across the NHS. To do that, Lord Carter and the review board worked with a group of 22 NHS providers across England, and I think that what they have found in England will be replicated for us in Northern Ireland and for our colleagues in Scotland and Wales. There are lessons to learn, so we should take note of what the report says.

As I said, an interim report was published on 11 June outlining the work that has been carried out and the interim recommendations and next steps. The full report is to come in the autumn, and I look forward to seeing what it says. Back home, people are sick to death of the term “efficiency savings”, the idiotic behaviour of Sinn Féin and the Social Democratic and Labour party and others and the funding penalties we are facing. Our NHS is being asked to do the impossible and be more efficient than it is, but when I look at the findings of the interim report, I see things that may extend to our running of the NHS in Northern Ireland. That is what the Carter report is about, and I am sure the Minister will give his thoughts on that shortly. The report sets out ways we could ease the pressure off front-line services and enable the functioning of our country while we wait for action to cease the penalties and see Northern Ireland receiving what she is entitled to—what we would be getting, were it not for the inability of Sinn Féin to do what its Members were elected to do and work for the people. That, however, is a different debate for another day, and I accept that.

The interim report suggests that the NHS in England could look to make savings of some £5 billion per annum by 2019-20 and reports three major areas of opportunity. The first is hospitals getting a stronger grip on the utilisation of resources, particularly in four areas: workforce, hospital pharmacy and medicines, estates management and procurement. The second is achieving greater productivity in hospital workflow—how patients move through the system—and the subsequent use of assets such as operating theatres. I have always felt we could look at that, and the Carter report has examined it and offered some ideas on how it could work. The final area is gaining a better understanding of the need for hospitals to develop sub-acute services, either on their own or in collaboration with others, to facilitate the discharge of patients. It is about making it work better together.

We need a way of ensuring the highest quality of patient care, delivered at the lowest price possible to ensure that more funding can be diverted to cancer drugs. Members will know that I have advocated ensuring the availability of cancer drugs across the whole United Kingdom, rather than that being down to postcode. In Northern Ireland, we would like to use prescription charges to put some money towards cancer drugs. I know that the Government have given a commitment and that there is some help for the devolved Administrations when it comes to cancer drugs, but not to the extent that we would like. We also need more funding diverted to research and other areas.

I was surprised to see in the report that one hospital could save up to £750,000 a year by improving the way it deals with staff rosters, annual leave, sickness and flexible working. That was just one example, which would regain the £10,000 a month the hospital was losing due to people claiming too much annual leave. That is an easy way of getting money back into hospitals. Ensuring every hospital pays the best price for medicines and supplies would save money that could be invested in front-line care. One hospital with 23 operating theatres improved the way it tracks the products used during surgery and saved £230,000 in the first year alone. I am not saying that every hospital could do that, but it is an example of what can be done, and it would be unwise to ignore it.

When the Hansard report of this debate becomes available, I will send a copy to my colleague, the Health Minister in Northern Ireland, Simon Hamilton, to make him aware of the Carter report and this debate. Helpful lessons may emerge that we could use. For example, a hospital was using the soluble version of a steroid for multiple illnesses and paying £1.50 a tablet when the solid version costs just 2p a tablet. Using the soluble version only for children and patients who have trouble swallowing saved £40,000 every year. Those may be small examples, but they collectively show how something could happen. I have some concerns. Cheap is not always best, and we have many examples of the copying of tablets in China and elsewhere. Those tablets are not as effective and may be harmful, so we have to monitor how we best ensure that cheaper drugs are effective and tackle the diseases they are designed to tackle.

We must take these issues in hand if we are to see the best possible use of funding. With the publication of the full report in the autumn, we will have a better idea of where we are. I hope that that report will be seen not as a stick to beat the NHS with—if it is, that will be for the wrong reasons—but as a ray of light that will help make things better. I very much look forward to seeing what it says about how we can improve things here in England, because we will then, I hope, be able to use that example to improve things across the water in Northern Ireland and perhaps in Scotland, for my colleague and friend, the hon. Member for Angus.

--- Later in debate ---

[Ben Gummer]

I do not want to ruin the hon. Lady’s nascent reputation by agreeing with her again—happily, there are very few Opposition Members present to notice, although that is not an implied criticism—but she is absolutely right. We are lucky that nursing places are quite significantly over-subscribed. The position is popular, but she is absolutely right that we need to not only make far greater use of apprenticeships but widen the skills base in nursing full stop. We are actively working on that in the Department—I have spent much of the day on it, and I am sure there will be more to come.

To help chief executives in this interim period, we have forced all agencies that want to offer their services to ensure that they are doing so through framework contracts, and we are ensuring that there is an hourly cap on the rate that can be charged. We have also taken additional measures on managerial salaries, along with a few other measures, to ensure that managers have the opportunity to be able to manage costs as they wish. We understand, however, that this is the first stage of a much deeper programme of reform that is needed. Lord Carter’s report points in that direction by suggesting that we use our existing workforce far better, so that people are doing the job that they are suited to and qualified for and that their time is not wasted. That is the great win, not only for efficiency and patient care, but for staff enjoyment of their jobs.

The hon. Member for Coventry South (Mr Cunningham) made some helpful interventions about NHS workers’ quality of life. It has been a sad but persistent truth of the NHS for many years—decades, in fact—that staff-reported incidents of harassment and bullying have been higher than the national average and that workforce stress and illness is higher than average. Some of that is to be expected—parts of the NHS are extremely stressful working environments—but we can do much more. Part of that is about ensuring, when people turn up to work, that they are doing the job they wanted to do, with a suitable but not excessive degree of pressure, and that the system is not wasting their time. If we make them happier in their jobs, their patient care will improve and their commitment to the service will be even greater. I am therefore aware of the prize, not just in pounds, shillings and pence, but in an improvement to staff morale and therefore patient care.

[Jim Shannon]

One of the things that concerns me from a Northern Ireland perspective—this has also been raised in discussions with other Members in the Chamber today and outside—is that the NHS greatly relies on, in our case, Filipino workers, which is an immigration issue. Has the Minister had any discussions with the Minister for Immigration, the right hon. Member for Old Bexley and Sidcup (James Brokenshire), to ensure that there will be no shortfall when the gaps left by those who are here on work visas need to be filled and that the quality service in the NHS will not be lost? The hon. Member for Bristol South (Karin Smyth) referred to training people to ensure that keen, interested and able replacements are available. Has the Minister given any thought to that?

[Ben Gummer]

I was going to come on to that, so I shall do so now that the hon. Gentleman has prompted me. There have been long and deep discussions about this. Our estimate is that no more than 700 nurses will be affected by the time the new rules are in place, which is a different number from that given by the Royal College of Nursing, whose number we do not recognise. It is small challenge given the scale of the workforce and one that we will surmount at the time, but we must see it within the broader policy of reducing immigration to this country from the hundreds of thousands to the tens of thousands—a policy that has broad support across the House and certainly in the country at large. It would be wrong for the largest employer in the country—one of the largest employers in the world—to exempt itself from that overall ambition.

In the end, we will achieve a sustainable workforce in this country only if we do all we can to ensure that those who are British and have grown up here and want to work in the NHS have the opportunity to do so. That is why it is important that we widen and open the avenues into working in the NHS, as the hon. Member for Bristol South suggested, over the next few years, in order to meet the challenge to which the hon. Member for Strangford alluded.

I want to quickly run through the other issues raised by my hon. Friend the Member for Hendon. On master vendors, he has a specific issue regarding some constituents with whom he has been dealing, but I understand that master vendors are managed under a series of arrangements with the Crown Commercial Service. Officials will meet with that organisation soon to discuss the overall issues around master vendors. It is for individual trusts to make such purchasing decisions, but I understand the issue he has raised and the terms in which he put it, and I will ensure that it is investigated properly.

My hon. Friend identified two areas involving agencies and fraud. Fraud is of course unacceptable, and the NHS has quite good systems for identifying it. Given the scale of the NHS, I find it surprising—it is entirely to the credit of those who work in the NHS—that fraud makes up such a tiny proportion of the excessive costs in the NHS.

On the revalidation of locum doctors, for which the General Medical Council is responsible, some doctors find it difficult to gather all the required supporting information needed for revalidation due to the peripatetic nature of the work. To help with that, specific guidance is available for both the doctors and their employers via NHS England and NHS Employers. Locum doctors are part of a larger issue about agency spend and foreign workers working in the NHS. I imagine that the three organisations will come together in the next few years to produce a more stable situation.

[Mr James Gray in the Chair]

Let me turn to the remaining points of the hon. Member for Bristol South. On the stability of the system, I hope and anticipate that one product of the general election is that the system will be broadly stable over the next five years. We intend to continue with the current structure of the NHS. There will be some small changes, such as that identified by my right hon. Friend the Secretary of State last week concerning the NHS Trust Development Authority and Monitor, but we are broadly content with how the system is set up. We must now proceed to ensure that it works.

The shadow Minister made a point about structures and fragmentation. There will always be a genuine dilemma here, because one can approach any system and say that change can be achieved by altering structures, but changing structures can lead to the same outcome. That has been the story of the NHS since its inception. It would be a mistake to think—the hon. Member for Bristol South and the shadow Minister were not suggesting this—that a structural change would somehow produce the outcomes that we all want. The priority is to ensure that the system’s wiring works correctly—that everyone’s interests are aligned and that the incentives are correct—so that people want to sit around the table and come to a considered decision, which can too often not be the case when there is an adversarial relationship between providers, producers and purchasers. That is why I hope that the system’s stability over the next five years will allow us to focus on the significant challenges mentioned by the shadow Minister.