NHS Reorganisation

Jonathan Reynolds Excerpts

Wednesday 17th November 2010 Commons Chamber

[Yasmin Qureshi]

I entirely agree with my hon. Friend. She and I have almost adjoining constituencies, and many of the issues and problems of her constituents are very similar to those in my area. When we were in power, £345 million was set aside for disabled children, for respite and all-night breaks. All of those children will now suffer because the White Paper makes no mention of funding for disabled children after March 2011. Yet, we have £3 billion to pay for reorganisation. On 2 November 2009, the Prime Minister, then Leader of the Opposition, told the Royal College of Pathologists that under the Conservatives, there would be no more restructuring of the NHS.

On 20 May, the coalition Government said:

“We will stop the top-down reorganisations of the NHS that got in the way of patient care.”

What are they doing? They are carrying out exactly that reorganisation. If the Government want to make some real improvements to the NHS, the principle of “no decision about me without me” should be considered. The Health Secretary should reconsider the NHS reorganisation and try to think of a better way to use that money for patients.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

My hon. Friend says that the reorganisation is ideologically driven. Is not it the case that when one intends to spend up to £3 billion, one needs an evidence base and proof that that spending—whatever it is on—will be money well spent? As my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) said, there have been no trial programmes or pathfinders. The money could be spent without a shred of evidence that it will make one bit of difference.

[Yasmin Qureshi]

I agree. I was about to discuss the impact of the reforms, with GP consortiums replacing PCTs. We know that there will be huge differences in the arrangements for health care in different areas. With the formation of up to 500 GP consortiums, all free to set their own priorities, a highly visible two-tier service will develop. Patients will be forced to move GPs or be reallocated to another area to get the care that they need.

The financial success of each consortium will also affect the service that patients receive. It will influence the type of care provided and how long it lasts. Some patients who need hospital treatment will inevitably be told by their GP, “Sorry, you’ll have to wait until next year.” Evidence has shown that making providers compete for patients and providing more choice to patients has done little to improve quality. Most people who are offered a choice of hospitals opt for their local provider. Choice may be important, but for patients, it comes below the quality, speed and accessibility of care.

The proposals do not make it clear whether the patients of the commissioning GP do the choosing. However, the GPs’ new contract will have a powerful incentive to hit commissioning targets. How, therefore, do patients know whether they are being prescribed the best or just the cheapest treatment going?

Again, there is no evidence to show that the restructuring would reduce the bureaucratic load. Hospitals alone will have at least three times the number of commissioners with whom to communicate and contract. Five hundred GP consortiums, each with its own set-up and administrative costs, will replace the current 150 PCTs. Huge differences in the arrangements for health care will emerge between areas. A postcode lottery will develop.

--- Later in debate ---

[Mr Steve Brine (Winchester) (Con)]

I shall be brief as I know that many hon. Members wish to speak. I am pleased to speak in the debate as someone who is about to see rather a lot of our national health service. My wife and I are due literally any day now—some may say tomorrow—to have our second child at the Royal Hampshire county hospital in Winchester, so all, including my Whips, will forgive me if I miss the Adjournment debate tonight.

Perhaps I am a little biased, but the Royal Hampshire in my constituency is in many ways the sort of institution that I see as the cornerstone of our national health service. It is a classic district general hospital, with a full service, and maternity and A and E departments at its heart. Elderly care services are first rate and infection rates are among the lowest in the NHS. We have a neonatal baby care unit, for which many similar sized institutions would give their right arm, and a bustling out-patients unit. Of course, the hospital would like to do more, but it sits at the heart of the community in Winchester and the surrounding areas because it is continually strengthened by the fact that the people who work there—the nurses, the midwives, the consultants and the cleaners—live in and around the city of Winchester. Of course, the NHS is more than its physical hospital buildings, but I view the Government’s equity and excellence White Paper in the context of institutions such as the Royal Hampshire and the locally connected NHS services that cluster around it.

My local NHS trust will undergo many changes in the coming years as it prepares, with its partners, to make the gear change to foundation status. That is absolutely right in my view to liberate our NHS. As I have often said to my trust and to the people I represent, I am not hung up on the name at the top of the wage slip for individual employees of the NHS in Winchester or anywhere else; I am merely concerned about the services that the NHS in Winchester offers the people I represent. I suspect that no hon. Member would disagree with that.

Equally, I am concerned about protecting the services in the financial context in which we find ourselves and the enormous national debts under which we labour. I am proud that my right hon. Friend the Prime Minister put the NHS at the heart of his programme for government. He must have been watching closely because I did the same in Winchester. I am especially proud to be elected as a new member of the new Government, who made the political choice—it is a choice; we did not have to do it—to protect health spending in the recently announced spending round. I know that Labour Members do not believe that and that at every turn they will try to rubbish it, as we have seen from part of the motion’s wording today. I guess that part of me, were I in their position, would do the same. It must really rankle. There is a new coalition Government, led by a Conservative Prime Minister, who are pledged to protect the NHS and put it at their heart. I am proud of that.

[Jonathan Reynolds]

Does the hon. Gentleman think that the terrible cuts that our local authorities will face in adult social care and other core services will absorb the ring-fenced money for health simply because they will not be able to provide in future the sort of services that they currently provide?

[Mr Brine]

No, there is absolutely no reason for them to do that. My right hon. Friend the Secretary of State for Communities and Local Government will make an announcement on council funding, but the Secretary of State for Health has already announced in the comprehensive spending review that the Government have allocated moneys for social care.

I know that the Labour party will try to rubbish our proposals, and that is their choice. My point is this: the people I represent do not care much about how the NHS is structured, but they care a great deal about ensuring that their NHS is there when they need it. They pays their money, and they expect the NHS to be there when they need it, free at the point of use. That is the cornerstone of what we are proposing.

I am very happy to defend outcome-focused, GP-led commissioning for my constituents. Every health care system in the world worthy of the name has the GP-patient relationship at its heart, and our proposals for GP consortiums seek to strengthen that for the sake of all the people we represent. Why on earth would we propose anything different? GP consortiums are an enormous opportunity for the NHS, and the perfect way to further the “no decision about me without me” agenda that is so important. I do not think that that is glib, as an Opposition Member said earlier. It is about rejecting the “Like it or lump it—this is the service you’re going to get” view that we have heard for far too long in our health service.

[Mr Brine]

I am sorry I gave way; I expected something else. I do not think for one minute that it is glib. We are not suggesting that every single patient will be involved in every single element of their care, but how could anybody disagree with “no decision about me without me”?

GP consortiums are an opportunity for the health service finally to realise one of its original aims—the sophisticated management and prevention of illness through the intelligent use of the patient list. That is still a largely untapped resource in our national health service.

GPs I speak to are up for their new role in commissioning for their patients. Of course they have questions—it would be strange if they did not—but they are not calling, as the Opposition’s motion is, for us to ditch our plans because things have got difficult and they have a fear of change. The Opposition cannot have it both ways. They support our plans for more GP involvement in patient care, but call plans for GP consortiums inefficient and secretive.

I see my job as a Member of Parliament as being an important link in helping GPs to answer some of those questions about consortiums that are coming down the line. I know that my right hon. Friend the Secretary of State has met groups of GPs in other areas of the country, and I ask him today to check his inbox because an invitation from me is coming his way.

As we know, following the establishment of GP consortiums, primary care trusts will no longer have NHS commissioning functions. It would be nonsense to create GP consortiums and keep two other tiers of management commissioning alongside them. Investment in the NHS has not been matched by reform. Yes, we will protect NHS investment, but our reform agenda builds on the best of the reform process over the previous 20 years. An Opposition Member said that we reject everything that went on under the previous Government, but of course we do not. We have made that very clear. These proposals build on Labour Government measures such as practice-based commissioning and NHS foundation trusts, and rightly so.

I sometimes hear it said—I heard it put to my right hon. Friend the Secretary of State yesterday morning on the “Today” programme—that the Government’s health policy was a bit of a surprise to everybody. I do not know why that would be. I mentioned earlier that the Health Secretary visited the Royal Hampshire county hospital. That was in May 2008, and he discussed the policy with people there then. He will remember the visit.

[Jonathan Reynolds]

Will the hon. Gentleman give way?

[Mr Brine]

No, I want to finish my remarks. My right hon. Friend will remember discussing with those professionals his ideas, which were published. He referred to those ideas in 2006, and they eventually made it through to our manifesto and the coalition agreement. They certainly should not have been a surprise to anyone who was watching.

I know that my colleagues will all be speaking to their PCTs and strategic health authorities, as am I. I have had a positive dialogue with NHS Hampshire in the months since I was elected, and I pay tribute to its chief executive who takes the responsible view that her job is to ensure that the NHS in Hampshire has what she calls a safe landing and a smooth transition to GP consortiums.

On public health and local accountability, as we know, a key part of the coalition plans for health involve the transfer of public health to local authorities, who will employ a director of public health. I know that these directors will be responsible for health improvement using a ring-fenced public health budget according to the needs of the local population, and I warmly welcome the move. However, I sound a note of caution about local authorities leading in public health. I urge Ministers, perhaps through partnership-working with the Local Government Association, to ensure that councillors are taken into every single step of the process and that sufficient training is given. I know that the cult of the amateur has held sway in many parts of our public service, but this is one area in which we need to support locally elected representatives as much as possible.

As co-chair of the all-party group on breast cancer, it would be remiss of me not to mention the very real concerns that we have about access to specialist nurses in the NHS, which traditionally have been an easy target for cuts. That must not happen under the new arrangements. It would be a false economy for any GP consortium to do that.

The coalition plans for health reform are not a gamble; nor are they ideological. They are about recognising that we live in the shadow of appalling national debts, and we remember where they came from. Protecting the front line, pushing power down to the local level and dealing with the national debt crisis are what “Equity and excellence” is all about, and that is why I will not be supporting the motion.