NHS (Public Satisfaction)

Debate between John Pugh and Hugh Bayley

Wednesday 30th March 2011 Westminster Hall

[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.