Healthcare

Lord Turnberg Excerpts

Thursday 28th October 2010 Lords Chamber

[Lord Turnberg]

My Lords, I have no problem in endorsing the principles described in the White Paper—patients at the centre, devolving responsibility and so on—but they sound rather familiar. There seems to be a close resemblance to the aspirations that came out of the many NHS White Papers and Bills that we have seen in this House over the past few years. I have watched these come and go, as someone who worked for many years as a consultant in the NHS and as a past president of the Royal College of Physicians. The question, as always, is how to implement these fine ideas.

I shall focus on the proposal to change the PCTs to GP consortia. If this sounds familiar, just remember GP fund-holding; the new proposals sound only subtly different. So, if fund-holding and PCTs failed, why should GP consortia work? Success always depended on the enthusiasm and skills of GPs, and unfortunately these are not evenly spread. GP commissioners have to assimilate large amounts of data about their patient populations and their diseases, know about financial and risk management and have statistical skills and an ability to develop contracts—and none of that can be done between seeing patients or after the evening surgery. Little wonder that few have expressed any enthusiasm to take on these responsibilities in the past, nor have they now. GPs will certainly need help. That can come only from re-employing either experienced staff made redundant when the PCTs are disbanded or those from the private sector, who are unlikely to be in the game for charity.

We know that PCTs are not uniformly good at their job; some are excellent while others are less so. The reason is that there just are not enough of the skills needed to go around all 160 of them. If we have a similar, or greater, number of GP commissioners, we will run into the same problems. All this points to a need to keep the numbers small—I reckon no more than 20 or 30. That would allow a small cohort of committed GPs to work with a few experienced managers. The projected cuts in management of 45 per cent just endorse the need to keep the numbers small. What ideas do the Government have about the number of GP commissioners that they envisage?

The numbers are not the only problem, though. The system seems designed to divide primary and secondary care still further. We can talk glibly of “seamless care” between hospital and community, but there are many ways in which these need to be co-ordinated. Indeed, any complicated disease—one has to think only of geriatrics, mental illness, stroke and so on—requires hospital specialists and GPs to work closely together in designing packages of care. It is vital for commissioning bodies to have the direct involvement of specialists in developing contracts for what should be integrated care. What efforts will be made to ensure this vital close collaboration in a competitive climate?

Then there is the question of commissioning for education and training and for research. I have many concerns that, as these are devolved to the local level, they will be lost in the hurly-burly of commissioning for efficient and economical care in the face of savings targets of £20 billion. There is little evidence that GPs will pay more than lip service to the aspiration in the White Paper to “embed research” in the NHS. A recent survey showed that GPs were antipathetic to their being involved in research using patient data, and were unhappy with the extra work involved in obtaining consent from their patients. When key commissioners are so uninterested, it does not bode well for the future of research or teaching in the NHS.

I do not want to say much about the involvement of the private sector in commissioning, save that it is quite unclear what incentives they will have to encourage education, training and research. How will the Government ensure that they will not be damaged in the change to the new arrangements?