Health and Social Care Bill

Mark Simmonds Excerpts

Monday 31st January 2011 Commons Chamber

[Mark Simmonds (Boston and Skegness) (Con)]

It is always a pleasure to follow the right hon. Member for Rother Valley (Mr Barron). Although I did not agree with much of his speech, I strongly agree with his last point about the importance of keeping the foot on the accelerator to try to narrow health inequalities. That is right at the top of the priorities of Health Ministers. This is a very important and complex Bill. We all want to see high-quality care and value for the taxpayer in the provision of health care. I think it is fair to say that there has never been a better-informed, more knowledgeable and better-prepared incoming Secretary of State than we have at the moment.

The opening speeches by my right hon. Friend and by the shadow Secretary of State stood in stark contrast to one another. I feel rather sorry for the shadow Secretary of State. He is clearly an intelligent man, but he is cornered by the supplicatory role that his leader is playing to the trade union movement. I am sure that the shadow Secretary of State agrees with the Government’s introduction of independent treatment centres. I am sure that he also agrees with the previous Government’s introduction of the independent sector into provision and into commissioning, “any willing provider”, practice-based commissioning, payment by results—although it was payment by activity then—and national tariff ceilings within quality standard frameworks. However, he could not say so because he is cornered.

Listening to some Labour Members, one would think that there were no improvements to be made—that the national health service was a utopian structure prior to the last general election. Let me point to 10 things that I sketched out this morning: too much money spent on administration and bureaucracy and not enough on front-line patient care; too little patient-centric information to inform decision making; too little innovation; too little clinical input into decision making; too much inertia and hostility to reform, as we have seen today; too much process-driven target culture distorting clinical decision making; falling productivity; poor outcomes across a range of clinical indicators; too often, weak commissioning of servicing; and widening health inequalities in the past 10 years, in addition to the scandals that occurred in Staffordshire and Kent. That is hardly a situation that makes the status quo desirable.

[Mr Lee Scott (Ilford North) (Con)]

At the risk of being accused of management-bashing, may I point out that somebody in my own trust who worked up a deficit in excess of £100 million was rewarded with a large pay-off when he left the NHS? Can that possibly be right?

[Mark Simmonds]

My hon. Friend is absolutely right. I remember him fighting tirelessly and vociferously to try to prevent those in the health service and the then Health Secretary from allowing that to happen.

Another thing that Labour Members have to understand is that we must move the NHS towards being a service that is centred on the patient, not one where the patient revolves around the system. To enable that to happen, we must measure and improve outcomes on a continuing basis, and we must do it with patient-centric information that will enhance patient choice, not only about the choice of the provider and the location of their treatment, but about the treatment that they receive for their ailment. This Bill deals with all the failings that were present when the Labour party was in charge.

There are three or four areas where the detail still needs to be discussed, and I want to make some suggestions. There must be an opportunity for integrated care and for improved patient pathways. I would very much like acute clinicians, pharmacists and others who deliver patient care to be involved in GP consortia and the commissioning process. Some of the more forward-thinking consortia are already involving acute clinicians, and this needs to be implemented across the board. We need to find a non-prescriptive architecture to enable consortia to work together to collaborate where appropriate, not only in the all-important area of cancer, as appropriately highlighted by my hon. Friend the Member for Basildon and Billericay (Mr Baron), but in acute stroke services. This has been done successfully, and it must continue to be done.

Performance management is absolutely critical. The Bill seems to make no specific mention of out-of-hours care. My right hon. Friend the Secretary of State will remember only too clearly the terrible case of Mr Gray, who was killed by Dr Ubani, the out-of-hours doctor who flew in from Germany and prescribed him the wrong dose of a drug. That was a performance management failure. The SHA failed to monitor the PCT, which was failing to monitor the provider. We must ensure that GPs are involved in driving improvements in out-of-hours care as well as in-hours care.

We need to look at GPs’ contracts. It is rather perplexing that a PMS—personal medical services—contract could be held by a national commissioning board. Who will be in charge of revalidation, training and performance lists? We must move GPs’ quality and outcomes framework towards one that is outcome-based rather than process-based.

[Mr Graham Stuart]

Like my hon. Friend, I will support the Bill. Does he hope, as I do, that the Government will look very carefully at any conflicts of interest? As we rightly give the power down to clinicians, we need to ensure that they always take decisions in the interests of the patient and not for their own financial gain.

[Mark Simmonds]

I entirely agree with my hon. Friend. My understanding is that the NHS commissioning board will have a significant monitoring role to ensure that GPs commission services not automatically from themselves but from providers who provide the best outcomes for the patients they are trying to look after.

I would like to make one final point to the ministerial team. Information is the key that will drive improvements in the NHS, and that information must be comparable, easily accessible and easily understandable in order to inform patients’ decision making processes. It should not just be on the internet. We should not just wait for patients to access information—we have to find ways of taking it to them, particularly those living in socio-economically deprived areas.

The Bill is a significant step in the right direction. It preserves the best of the national health service—equality of access—while creating opportunities to improve the provision of health care in the UK, so that it can become among the best in the world, rather than lag behind. Excellence for all should be the goal.

--- Later in debate ---

[David Miliband]

I am happy to wager the hon. Gentleman that the costs will turn out to be more like double those estimated and the savings more like half.

The Bill is myopic, or “deluded”, to use the word of the British Medical Journal, in three key areas, which I wish to mention. First, it assumes that all GPs are ready now to take on hard budgets in the commissioning framework. It took the previous Tory Government six years to get 56% to be GP fundholders. Secondly, it will deepen the divide between primary and secondary care. The hon. Member for Central Suffolk and North Ipswich raised that matter, which is vital. We all know that in our constituencies, collaboration between primary and secondary care is key, especially for chronic conditions. The Bill will make the divide worse, because collaboration will be deemed anti-competitive.

Thirdly, the Bill has absolutely nothing to say about quality control of GPs. In fact, it will remove the local drivers for improvement that I have seen in my constituency. The hon. Member for Basildon and Billericay (Mr Baron) mentioned cancer survival rates, and the Appleby research shows that we in this country have made more progress over the past 30 years than any other country in Europe, and will overtake France in 2012. It also shows that the extent to which we are behind can be explained by late diagnosis in the first year of cancer, which is the responsibility of GPs. They should focus on improving their cancer treatment, not commissioning care.

[Mark Simmonds]

Will the right hon. Gentleman give way?

[David Miliband]

No, I have given way once and I want to make some progress. If I have time, I will come back to the hon. Gentleman.

All the matters that I have mentioned are to service a vision of health care as a regulated industry. The Secretary of State has engaged in a ding-dong about which operating framework is more important—the 2009 or the 2010 one. Two points, though, have not been contested. The first is that in 2011-12, for the first time, there will be competition according to price—page 54 of the operating framework says that. The second is that the academic evidence is absolutely clear that price competition results in lower prices, yes, but also in lower quality.

The hon. Member for St Ives (Andrew George) asked the Secretary of State, “What about my community hospitals?”, but of course the Secretary of State does not want to make decisions about community hospitals. His predecessor but six, eight or 10, Nye Bevan, said that he wanted a bedpan falling in Tredegar to be heard in the corridors of Whitehall. The Secretary of State does not want to hear bedpans falling; he wants to say that it is GPs who should be making decisions, or the commissioning board, or, in the ultimate irony that my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) pointed out, the European Court of Justice under European competition law. He pointed out the irony of the Lisbon treaty being critical, but at this very time the House is passing a Europe Bill that calls for referendums when any power is transferred to the EU, including on matters as puny as the appointments system for the Court of Auditors, never mind on a vital part of NHS provision.