NHS Reorganisation

Kate Green Excerpts

Wednesday 17th November 2010 Commons Chamber

[Diana Johnson]

Absolutely. Although not all PCTs have operated as we would like, there is good practice throughout the country. We should focus on that and see what we can learn.

I am concerned about the coalition Government’s approach to public health, because the junk food industry seems to be helping them to make policy, as some of our national media have reported in the past few days.

[Kate Green (Stretford and Urmston) (Lab)]

Is my hon. Friend aware that the Government have decided to abolish the health in pregnancy grant, which would further assist pregnant mothers with healthy eating and preparing for the birth of a healthy baby?

[Diana Johnson]

Absolutely. My hon. Friend campaigned long and hard for families, especially low-income families, in a previous occupation. The health in pregnancy grant is going and the Sure Start grant will now be paid only for the first pregnancy, so we are starting to see what the Government really think about improving people’s health, especially that of women.

Of course, we must not forget that during the election campaign in May the Liberal Democrats made it very clear that they thought NHS funding should not be ring-fenced. The right hon. Member for Twickenham (Vince Cable) said that the NHS should not be treated as a sacred cow. Again, we see the Liberal Democrats being the more regressive part of the coalition.

I wish now to concentrate on GP commissioning, because there are major issues on which we need to focus. Many specialist groups, particularly the muscular dystrophy group in Yorkshire, have been in touch with me to say that they are concerned that local GPs will not understand their health needs. I have talked to patients in the local hospital and other people receiving health care locally, who are anxious about their particular needs being met.

For me, a bigger issue is the performance of GPs. PCTs have been particularly successful in holding to account GPs who do not perform as well as they should, and I am particularly concerned about who is going to hold the ring. Who will deal with GPs who do not meet the needs of their communities?

A number of hon. Members have mentioned the bureaucracy in the new system of GP consortiums. I believe that there will be more administrators, and I say to the Secretary of State that, if we are to focus on health outcomes, bureaucrats will be needed to put together information and statistics and we will not, therefore, see the massive reduction in backroom staff that the Secretary of State expects.

A lack of accountability at local and national level is a major problem. The new national board—the largest quango that we have ever seen—is being created, but to whom will it be accountable? It is not acceptable for the Secretary of State and his Ministers to come to the House and say, “That is for the national board”, or “That is for local decision making.” We need control over what happens to our NHS. As I asked in my intervention on the right hon. Member for Charnwood (Mr Dorrell), why cannot we have some pilot projects? If the change is to be so great, let us pilot it, see what happens and take a considered approach. Let us have some evidence to back up the White Paper.

I do not believe that any of the Government’s proposals will improve the health care of the people I represent. Of course we believe that clinical involvement is important, and of course doctors and other health care professionals should be involved. My hon. Friend the Member for Rochdale (Simon Danczuk) made the point that we should use the PCT structure to provide more clinical information and advice—we can have that involvement without throwing out the whole structure.

The Government must also consider other health care professionals, such as pharmacists. There are pharmacists on the high street in my constituency who really contribute to the health care of my constituents. People such as Mr Hall on Beverley road and Cath Boury on Newland avenue do face-to-face work to encourage people to give up smoking or reduce their weight. If we want to get clinicians involved, let us get all the clinical practitioners involved.

I finish with the “any willing provider” model in the White Paper. The Labour Government made it clear that the NHS was the provider of choice. That was exactly the right thing to do, because it recognised the important role the NHS has played over the past 60 years. It has staff with specialism and dedication, but the idea of “any willing provider” is just code for the private sector, is it not? The attitude is, “Let’s just roll it out and have the private sector run our NHS.” Most people in this country, particularly those who vote for the Liberal Democrats—I point to their Benches in saying this—will be shocked to know that their MPs are standing up for the private sector. It is disgraceful, and I hope very much that the White Paper will be amended to state that the Government support the NHS as the main provider of choice, rather than going down the road of the private sector and the Americanisation of the NHS.

--- Later in debate ---

[Mr Baron]

The answer to the hon. Lady’s question was supplied by my right hon. Friend the Secretary of State in answer to my question earlier. The one and five-year cancer survival rate figures will be published and presented, although how that will happen is in the melting pot. I very much welcome the work of the Office for National Statistics, the National Cancer Intelligence Network and the London School of Hygiene and Tropical Medicine. Whatever form the figures take, they will be in a performance table, not a league table, to ensure that all PCTs and then GP consortiums are tasked with improving performance, irrespective of how they compare with others. That will obviously include PCTs in deprived areas across the country.

I suggest to my right hon. Friend the Secretary of State that the focus on outcomes must include patient experience measures and longer-term quality of life measures, such as whether patients are able to return to work. That, too, is very important from the point of view of cancer patients.

As an aside, I suggest that there is a question mark about process-based targets such as waiting times in general. To return to the point made by the hon. Member for West Ham (Lyn Brown), the real problem when it comes to late diagnosis is not whether it takes one, two or four weeks for a patient to see a cancer specialist. It is how long it takes for the suspicion to be raised that cancer exists in that patient in the first place. Perhaps we should incentivise GPs to detect cancer earlier.

[Kate Green]

I absolutely appreciate the expertise that the hon. Gentleman brings to the debate, but I should like to ask his views on the issue of anxiety while waiting for an appointment. Whatever the physical outcomes of early treatment, there is a peace of mind issue for patients who are anxious to see their doctor as quickly as possible.

[Mr Baron]

I accept what the hon. Lady says, and I hope that the focus on outcomes will include matters such as patient experience surveys, which will incorporate that very point. It is an integral part of a patient’s experience, and it should be picked up when we start focusing on outcomes.

I return to GPs being incentivised to detect cancers earlier. In that vein, I very much support Cancer Research UK’s campaign to encourage greater access for GPs to diagnostic testing. That will be terribly important when it comes to detecting cancers earlier.

Moving on to GP commissioning of cancer services, there is no doubt in my mind that there is room for improvement in this area, and it would be naïve of Members to believe otherwise. There is often frequent confusion between the roles of strategic health authorities, cancer networks, PCTs and hospital trusts. The priorities of the cancer reform strategy are often not aligned with those of the PCTs.

I should like to play devil’s advocate and suggest to the Secretary of State that we need to tread carefully in dealing with the challenges ahead. The Secretary of State will be aware that GPs see only about eight new cancer cases a year, and that cancer is a set of 200-plus diseases with often complex care pathways. The GPs are often involved in the early and late stages of that care pathway, but the complex bit in the middle is often conducted by clinicians in hospitals.

Challenges lie ahead. We need to ensure that the responsibilities of the NHS commissioning board, the PCTs and the GP consortiums are clearly defined to avoid fragmentation of treatment across the cancer pathway. The reforms must help and not hinder the close working relationship between primary and secondary care doctors. The role of cancer networks in supporting GP consortiums needs to be clarified before those networks are broken up and their expertise is lost.

Furthermore, we must consider whether we need to redistribute the financial incentives to encourage more focus on the earlier and late stages of the care pathway. In other words, we must ensure that reward matches responsibility. Should a qualities and outcomes framework be realigned so that early diagnosis, survival and people dying in their place of choice are included?

In the last minute left to me I shall mention the cancer drugs fund. I have raised the issue with the Secretary of State before. There appears to be early evidence of disparity of access. When it comes to the cancer drugs fund, access should always be clinician-led. In some regions, approaches can be made to the PCT, and in others they are made to the cancer network, which, in turn, has access to the fund. Elsewhere, GPs are forming panels. May I suggest that best practice from the interim drugs fund is applied uniformly before the main drugs fund kicks off next spring? We do not want to add to cancer inequalities when it comes to access to treatment and drugs.

In the past, rarer cancers have had a very raw deal. I know that the Secretary of State is conscious of that and will ensure that those who suffer from rarer cancers will be treated much more fairly than in the past.

There is not time for the Secretary of State to answer all my questions now, but I hope that he will address them when he speaks at the Britain Against Cancer conference on 14 December, and I look forward to hearing what he has to say.

In short, the refocusing on outcomes is the greatest innovation and benefit to patients since the NHS began. However, that must not be undermined by the problems with GP commissioning.

--- Later in debate ---

[Kate Green (Stretford and Urmston) (Lab)]

Let me begin by wishing the hon. Member for Winchester (Mr Brine) and his partner well for the pending new arrival. I am sure that they will receive an excellent service in their local NHS hospital, and that the whole House wishes them the very best.

I should like to use this opportunity to raise a few of the concerns that have been brought to my attention by people in my constituency. Many do not fully understand how the new proposals will work to deliver the outcomes we hope for, and I hope that the Minister can answer for them this afternoon. Essentially, people are anxious that where they live and who they are will begin to determine the level and quality of their care.

I am sure we all agree that consistency and guarantees of standards must be an integral part of the operation model that the Government seek to introduce. That is especially important in relation to health outcomes for the poorest and most vulnerable. There is a high level of health inequalities in my constituency. The people who live in the poorest wards suffer much worse health outcomes than those in the better-off wards in the south of the borough of Trafford. The local authority was quite slow to recognise that, so how will health inequalities receive strategic attention in the proposed new structures?

What will be the role of the public health director, who will be placed within the local authority? I am keen to know how that public health role in the local authority will devolve and relate to those at the sharp end in all health settings—those who provide front-line care. I hope that the Minister can fully explain that in his winding-up speech so that my constituents can be clear about it.

My constituents and I are concerned about how the wider drivers of health inequalities—income, education, employment and so on—will be addressed in the new structure, particularly when so many national policies seem to be taking us in the opposite direction, as my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) pointed out earlier.

[Lisa Nandy]

Does my hon. Friend agree that as well as the vast inequalities in life expectancy, the lingering issue of care for those who live longer and longer with chronic illnesses needs to be addressed? Those people are suffering now. Does she agree that it is an absolute disgrace that the Government have decided to tinker with the structures rather than put in urgent investment to help those people, including people in my constituency of Wigan?

[Kate Green]

Labour Members want to know whether the money spent on the restructuring of front-line care in our communities is the best use of that money. As the Health Secretary himself pointed out, we continue to have poor health outcomes and standards compared with our European neighbours, so why does it make sense to put more money into reorganisation and less directly into front-line care? I look forward to hearing what the Minister says about that.

The second issue that I want to address involves patient voice. That, too, has been raised in my constituency. A particular concern of mine is to ensure that the poorest and most vulnerable are heard. I am concerned about the lack of voice of those who do not have the sharp elbows and the articulacy to speak up for themselves to secure the best for themselves and their families. We know that that is the fate of many in our poorer communities, and especially of those with mental health problems.

I have been told a number of times in my constituency, including by GPs, that GPs are not particularly expert in, or equipped to deal with, mental health needs. How will those patients’ needs be identified, recognised and responded to in the new structure? What help will be available to enable patients to articulate such needs? There is uncertainty in my constituency on the future structure. How will patient voice, choice and opinion feed in to the new model?

The Trafford patient LINk—local involvement network—service is uncertain about its future role and status. I very much hope that Ministers will be able to give us more information about how we will get a clear opportunity for advocacy, so that every patient’s voice can be properly heard, and for proper support for patients who are perhaps less able to articulate their needs and secure services for themselves.

I am concerned also because I know—not just from my constituency, but from my long experience of supporting and working with vulnerable families—that different values pertain among different doctors and practitioners. I am particularly concerned, for example, for the young woman who may present herself to a GP who does not feel it appropriate to offer her advice on contraception or abortion. How can those minimum standards be protected, so that everybody—wherever they live, whoever their doctor is and whatever the structure is—knows that they will be guaranteed the care that they need.

Thirdly, I would like to raise with Ministers the issues that have been raised with me by health practitioners and professionals—and which have been highlighted in this afternoon’s debate—relating to GPs’ ability and willingness to take on the management aspects of their commissioning role. Many GPs have said to me—perhaps the Minister will be able to reassure them this afternoon—that what they see tanking towards them is a heavy burden of management, albeit without the additional resource with which to manage it. Many GPs have said to me that they have not really had the training—they lack the expertise—to be health managers as well as good-quality health practitioners and providers of front-line health care. I am interested to know whether Ministers have plans for training GPs and developing those skills and abilities in GP practices, or whether, as many of us on the Opposition Benches fear, the proposal will in fact be used as an opportunity to privatise that management function. If that is the case—this is not an ideological point, but an efficiency point—I shall be keen to know what financial model Ministers expect to operate if a substantial amount or even a proportion of the money that would otherwise be held in GP practices will go to fund the profits of private providers.

Those are the issues being raised with me in my constituency. They are issues that I am afraid I do not feel equipped to answer, because I do not fully understand how the new structures will work well in practice and, in particular, how they will work well for the poorest.

In concluding, I would like to highlight a point that has been made by a number of my hon. Friends this afternoon. The injection of extra uncertainty and disruption into our national health service at this time is further—and considerably—stretching our capacity to deliver excellent front-line care. I would urge Ministers to listen to the many GPs who have said to me—and who I am sure are saying to them—that what is proposed represents an element of change and disruption that they cannot yet see the benefits of. What they can see is that there is considerable uncertainty in the way that they are now working. There is certainly concern in my primary care trust. I hope that Ministers can offer some reassurance on that point, because at the moment there is considerable instability, and that cannot be good for any patient outcomes.