Future of the NHS

Lilian Greenwood Excerpts

Monday 9th May 2011 Commons Chamber

[Valerie Vaz (Walsall South) (Lab)]

It is always a pleasure to follow the hon. Member for Totnes (Dr Wollaston) and to serve with her on the Select Committee on Health.

I welcome this debate, which is the first chance that the House has had to debate the NHS after the pause—the listening, reflecting and engaging exercise—since Second Reading of the Health and Social Care Bill. Something about this debate made me think of the words of The Beatles song “Hello, Goodbye”. Madam Deputy Speaker, you can imagine the discussion in No. 10 between the Secretary of State for Health and the Prime Minister: “You say stop, I say go. You say, ‘Why?’ I say, ‘I don’t know.’” I promise it sounds better when sung. We can see now why The Daily Telegraph said this Saturday that the Secretary of State was to get first aid from the No. 10 spin doctors.

It is right that the Government should take on board the voices in this House and outside—those of the experts, the patients, our constituents—not in reselling their proposals, but in fundamentally changing them. I wish to cover three main areas: accountability, costs and other concerns. On accountability, as a member of the Health Committee, which is so ably chaired by the right hon. Member for Charnwood (Mr Dorrell), we have heard evidence from expert after expert—from the BMA, which I promise was not whingeing, to GPs, nurses and public health clinicians—all of whom expressed concerns about the lack of detail on the ideas in the White Paper. Matters did not become much clearer even on Second Reading.

Our latest report, “Commissioning: further issues”, published on 5 April, said that there should be no doubt that the Secretary of State has ultimate responsibility, but that is not clear from the Bill. We have concerns about accountability and the governance arrangements for the consortia that will be responsible for £60 billion of public money, but that issue is not clear in the Bill. There are concerns that private and voluntary providers will not be covered by the Freedom of Information Act 2000, which is not dealt with in the Bill either. Concerns remain about conflicts of interest in respect of GPs who are commissioners and providers, but that is not clear in the Bill.

Some PCTs were working with clinicians to provide a more integrated service. A more evolutionary and cost-effective approach would be to remove the non-executive directors of the PCT boards and replace them with GPs. That would have been not a top-down reorganisation, but a progressive and less disruptive approach.

I am staggered by the uncertainty surrounding how much this reorganisation will cost the taxpayer. The proposals in the White Paper were neither costed nor explained, and the spending is not committed, so it must come out of revenue. Professor Kieran Walshe, of Manchester Business School, put the cost at £2 billion to £3 billion, but the Government’s figure is £1.4 billion. The redundancy costs alone amount to £852 million. Sir David Nicholson said that the running-cost envelope was £5.1 billion for the running of the current service and the development of the consortia. In an written parliamentary answer to me, the Minister said that the spend and operational arrangements of pathfinder consortia are not being monitored. That smacks of fiscal incompetence and a Department that has lost control of its budget. It is so out of control that the head of Monitor wrote to foundation trusts, telling them that the NHS must find savings of 6.5% rather than 4%. That is an extra £1.1 billion on top of the savings demanded by the Department.

Members will be interested to know that the head of Monitor compared the NHS under the Government’s proposals to privatised utilities. Does Ofgem have trouble regulating the utilities? It was ineffective in dealing with companies’ unfair pricing practices and companies that made large profits during the recent severe weather.

[Lilian Greenwood (Nottingham South) (Lab)]

Does my hon. Friend agree that the Government’s plan to abolish the cap on income from private patients is a real concern when hospitals are starved of cash, because it could result in them putting private, fee-paying patients ahead of NHS patients?

[Valerie Vaz]

I absolutely agree with my hon. Friend.

We were told by Sir David Nicolson that very little work has been done on what will happen in 2013-14. Just for the record, the UK had the second-lowest debt in the G7 in 2007-08, before the global financial crisis. Which Government are out of control with their spending?

Finally, there are many unanswered questions. I have tried to obtain the legal advice on whether EU competition law applies to the provisions of the Bill from the Secretary of State, but apparently, it is in the public interest not to disclose that to the public. However, in a recent article in the British Medical Journal, Rupert Dunbar-Rees, a GP, and Robert McGough, a solicitor, say that

“the technical argument reinforces the logical argument that the reforms further open up the NHS to EU competition law.”

Who will account for the training of doctors, and indeed health care professionals? That cannot be left at a local level. In A and E, an increased percentage of patients wait more than four hours, the maternity service in Maidstone has been closed despite GP opposition—

Child Health (Nottingham)

Lilian Greenwood Excerpts

Tuesday 6th July 2010 Westminster Hall

[Chris Leslie]

My hon. Friend takes the words entirely out of my mouth. I was explaining that the problem is still significant, but thankfully some good progress has been made, particularly through partnership work. That crucial support is funded through the working neighbourhoods fund, but recent Treasury announcements suggest that Nottingham’s fund will cut by £1.2 million. The name on the tin—“working neighbourhoods fund”—does not say what it will do; supporting the programmes that help reduce teenage pregnancy is one purpose. It is incredibly important that we hear about its good work as well as about the shocking statistics.

I want to take the opportunity offered by this debate to highlight the issues of poor child dental health. Although the statistics and methodology of calculating such issues change from time to time, recent reports suggest that Nottingham children have, on average, three decayed missing or filled teeth each compared with just over one in typical parts of the rest of England. Shockingly, in some schools in Nottingham, a few children have been reported to have nearly six missing, decayed or filled teeth. Fluoride in toothpaste is improving matters, but the main factors are still poor diet and nutrition and poor oral hygiene. Although programmes such as the City Smiles dental health promotion programme and community-based services have promoted good oral hygiene and the use of fluoride varnish on teeth, much more still needs to be done. I want the funding for the City Smiles campaign to be confirmed and redoubled by the PCT, and I hope that the Minister will pass on that request. Moreover, we must think about the contentious issue of fluoridation of the water supply. In areas where fluoride is naturally occurring or where it is added, there is some protection against dental decay. Although I cannot claim to be a scientific expert in this area, I none the less hope that the PCT and the east midlands health authority will speed up their review and put some options on the table within the next year if possible.

There is not enough time to address all the crucial issues, which include young people leaving care, children with learning difficulties and serious disabilities and how people can access services. I want to pay tribute to the NHS staff who work so hard in Nottingham. They have recently consolidated the children’s services of City hospital with those of the Queen’s Medical Centre to create the Nottingham Children’s hospital at the QMC site with 15,000 inpatient occurrences and 50,000 outpatient contacts taking place annually. The hospital is very strong in renal and urology services, with 13 kidney transplants taking place last year. It is world renowned for its child integrated cancer services, with 135 children being treated there in 2009. There are also cystic fibrosis services and many others. None the less, there is still room for improvement. In particular, there is not enough accommodation for parents whose children are in hospital. It is important that young patients have the support of their family around them. I urge the Minister to find a way to provide capital support for the PCT and the hospital to ensure that more bed space is provided.

I am also concerned to hear that Nottingham’s speech and language therapy budgets, which are supported by the PCT, may be squeezed because of the financial pressures. Tragically, between 5% and 8% of pre-school children have speech and language problems, so there is a lot of concern about the loss of such resources in the Nottingham area.

I hope that the Minister will address recent policy changes. Childhood obesity and poor nutrition is one of the key underlying causal factors that come up time and again. A third of 10-year-olds in Nottingham are overweight or on the brink of the obesity category. Tragically, the free school meals pilot that had been on the cards has now been cancelled.

[Lilian Greenwood (Nottingham South) (Lab)]

Does my hon. Friend not agree that there are concerns over the cut in the health in pregnancy grant from next January? Such a grant can be used to support breastfeeding mothers—breastfeeding is vital to children’s health, and results in fewer infections and reduces the likelihood of children developing allergies. It also protects them from the very thing that my hon. Friend was talking about, which is the likelihood of people becoming obese, developing diabetes and, in the longer term, cardiovascular disease.

[Chris Leslie]

My hon. Friend is entirely right. It looks as if we will lose not only the opportunity to roll out greater nutritional standards through the free school meals pilot but the £190 health in pregnancy grant. To me, that was one of the most pernicious, mean-spirited decisions in the Budget. Young mums-to-be need not just warm words but financial support to back up what can be an expensive change in lifestyle. Folic acid and fresh fruit and vegetables do not come cheap. It is important that the support is there.

When we consider the other changes in the recent Budget announcement, the Minister needs to explain how young families can support some of the costs that are involved in healthy lifestyles. I am referring not only to the change in the health in pregnancy grant, but to the restriction on the maternity allowance to the first child only. Not much thought has been given to the effect that that will have on siblings. Cots, prams and children’s clothes are expensive. Those are all issues affecting the decent lifestyles of young families in our city. From next year, the Government will remove the baby element from the child tax credit and reverse the settlement for one and two-year olds, which was due in 2012 and 2013. When those measures are combined with others, such as the freezing of child benefit and, as a tangent to that, the removal of the child trust fund, there is a sense that children’s issues, which cover good child health, education and well being, are not as far to the front as I would hope.

I have mentioned some exceptionally serious issues and complex health problems. I have run over the key issues that need real action. In particular, I am referring to the partnership working that my hon. Friend the Member for Nottingham North discussed about. It is all very well suggesting that there will be increases in real terms for front-line health services, but health inflation goes far and above the retail prices index plus 0.5%. There will undoubtedly be pressures affecting hospital and ancillary services as well. The cuts in funding for local authorities and other public services—25% over the next four or five years—are unnecessarily fast and steep. Alternative strategies could be used. I fear that we will jeopardise some of the inroads that we have made into these problems. I hope that the Minister will do better than his other colleagues in government. There is a whole range of serious issues affecting child health in Nottingham, and I urge the Government to take them seriously.

Oral Answers to Questions

Lilian Greenwood Excerpts

Tuesday 29th June 2010 Commons Chamber

The Secretary of State was asked—

[Lilian Greenwood (Nottingham South) (Lab)]

1. What steps he is taking to improve rates of early detection of cancer.

[The Secretary of State for Health (Mr Andrew Lansley)]

Late detection of cancer is one of several reasons why our cancer survival rates are below the European average. That is why we will focus on improving those outcomes and achieving better awareness of the signs and symptoms of cancer. These aims will be part of our future cancer strategy.

[Lilian Greenwood]

Over half the men who receive a testing kit under the national bowel cancer screening programme throw it away. What action is the Secretary of State taking to improve the take-up of screening, particularly by men, and what provision has he made within the NHS budget for the extra costs of increased take-up?

[Mr Lansley]

I am grateful to the hon. Lady for that question, and I have had the privilege of twice visiting the national bowel cancer screening programme at St Cross hospital in Rugby—it looks after people in parts of the midlands and the north-west—and indeed, I have visited the Preston royal infirmary, which deals with bowel cancer screening follow-up. As I said in my first reply, one of the things we aim to do is to increase awareness of the signs and symptoms of cancer. It is unfortunate that, as a recent study established, only 30% of the public had real awareness of what the symptoms of cancer would be, beyond a lump or a swelling. We have very high rates of bowel cancer, so it will be part of our future cancer strategy to increase awareness of those symptoms and to encourage men in particular to follow up on them.