Defending Public Services

Nicholas Dakin Excerpts

Monday 23rd May 2016 Commons Chamber

[Mr Hunt]

We need extra legislation to expedite the process. I point out to my right hon. Friend that that is another policy which has been opposed by the Labour party. All the time it says we should be doing more to get a grip on NHS finances and yet it opposes every policy we put forward in order to do precisely that. The answer to his question is that the issue with the NHS is primarily that we are not very good at collecting the money to which we are entitled from other European countries, because we are not very good at measuring when European citizens are using the NHS. This legislation will help us to put those measurement systems in place so that we can get back what we hope will be about half a billion pounds a year by the end of this Parliament.

We will no doubt hear later this afternoon the charge that the Government have lost control of NHS finances, but we strongly reject that charge. The House may want to ask about the credibility of that accusation from a party that is at the same time proposing a funding cut for the NHS and criticising the difficult decisions we need to take to sort out NHS finances.

[Nic Dakin (Scunthorpe) (Lab)]

Two months into this financial year, can the Secretary of State say whether or not the Department of Health broke its budget for last year?

[Mr Hunt]

We will find out those figures when the full audit is complete. I just say to the hon. Gentleman that efficiency savings are never easy, but a party with the true interests of NHS patients at heart should support those efficiency savings, because every pound saved by avoiding waste is one we can spend improving patient care.

Let me therefore outline to the House what we are doing to deliver those efficiencies, as well as to support NHS trusts to return to financial balance. First, we are taking tough measures to reduce the cost of agency staff, including putting caps on total agency spend and limits on the rates paid to those working for agencies. So far, that has saved £290 million, with the market rate for agency nurses down 10% since October and with two thirds of trusts saying that they have benefited. Our plan is to reduce agency spend by £1.2 billion during this financial year. Secondly, we are introducing centralised procurement under the Carter reforms. Already 92 trusts are sharing, for the first time, information on the top 100 products they purchase in real time, and we expect savings of more than £700 million a year during this Parliament as a result. Thirdly, given that the pay bill is about two thirds of a typical hospital’s costs base, we are supporting trusts to improve on the gross inefficiency of the largely paper-based rostering systems used at present. This should also significantly increase flexibility and the work-life balance for staff, as we announced last week. Finally, and perhaps most critically, we will reduce demand for hospital services by a dramatic transformation of out-of-hospital care, as outlined in the five-year forward view. If we meet our ambitions, we will reduce demand by more than £4 billion a year through prevention, improved GP provision, mental health access and integrated health and social care.

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[Nic Dakin (Scunthorpe) (Lab)]

It is a real pleasure to follow the hon. Member for Bexhill and Battle (Huw Merriman), who came to the debate from the viewpoint of people on the frontline. That is to be commended, because what they do on behalf of us and our constituents is most important. We should never move far away from focusing on that.

I want to speak about what the Queen’s Speech offered my constituents on the two biggest issues of concern to them: local health services and the future of our steel industry. Local health services are severely challenged. We were told last week that NHS trusts nationally had reported a deficit of £2.5 billion in 2015-16. When I asked the Secretary of State earlier whether he could rule out the books not being balanced at the end of the year, he was unable to do so. Some 121 of 138 acute trusts ended 2015-16 in deficit, so there is a real problem with the finances. Members on both sides of the House have echoed that today.

In the Scunthorpe area, our whole health economy is severely challenged financially. Balancing the books is a long-running problem for the clinical commissioning group and the local hospital. That raises the question, which hon. Members have asked today, of whether there is enough cash in the system to allow local health services to do the job we expect. There are wonderful people working in the system in the Scunthorpe area and elsewhere in the country—nurses, care workers, porters, doctors, paramedics, administrators and many others. They go to work every day determined to do a good job, but as my hon. Friend the Member for Southampton, Test (Dr Whitehead) said, they are being asked to do more for less, day in, day out, which produces a strain. As the hon. Member for South West Wiltshire (Dr Murrison) said, the system is at full tilt —or we might say at full stretch.

There have been challenging evaluations of our local health services during the past six months, and we have received poor Care Quality Commission reports for mental health, hospital and some care services, and most recently for ambulance services. People are not going to work to do a bad job, but there is strain in the system and that is reflected in issues of quality and delivery. Disproportionate cuts to social care are adding to the strain on the system.

Locally, there has been an ongoing review of health provision, “Healthy Lives, Healthy Futures”, and there is a general recognition that the way forward is to move resources into the community and closer to patients. That is the theory, but managing to deliver it is challenging because the acute demand at the secondary care end of hospitals, and people turning up at accident and emergency, does not get any less. How do we turn off the tap at that end so as to invest where we know it is needed?

As many Members have said, the real challenge is the ageing population. The Secretary of State said that there will be 1 million more people over the age of 70 by the end of this Parliament, which illustrates the challenge to the system. My hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), many other Members and I are wearing badges from Dementia Friends, which is a reminder of the growth in demands on mental health services, particularly with an ageing population. Despite the excellent work done by the Alzheimer’s Society and others, much more is needed to deliver what needs to be done.

There are massive challenges, and it would be good if it were easier for local services to develop their local workforce, so that healthcare assistants can be translated into nurses, and other innovative things can be done to meet local needs. Given the importance of community services, pharmacies are being challenged by the Government’s desire to take away £170 million of pharmacy funding. That is not a huge figure, but it seems to run counter to the desire to recognise pharmacies as deliverers of community services, particularly for older people who are close to the community, or those who suffer from mental health problems. Why challenge pharmacies in that way? The other week I was proud to present in this Chamber a petition signed by more than 800 local people that said, “Look after our local pharmacies.” As we consider the challenges to health services, we will see that much can be done intelligently to work with the situation and make it better.

I was disappointed that there was nothing in the Queen’s Speech—just as there was nothing in the Budget—to support the steel industry at its time of great challenge. A real industrial policy would make a difference to setting a strategic path, and give confidence to all players, be they employers, trade unions or other stakeholders in our manufacturing industry, especially our steel industry. The Government have been slow to respond to the challenges facing our steel industry, and I hope that in a week Tata long products will move into new ownership, and there will be a new and positive chapter for the future. Today is the closing date for expressions of interest in the ownership of the other part of the Tata empire from across the steel industry in the UK.

The fact that such things are happening does not mean that the Government can go to sleep. They must wake up and do more, including on business rates. When Tata invests in a new blast furnace at Port Talbot, or a reconditioned blast furnace at Scunthorpe, it is ridiculous that that capital investment should mean an increase in its business rates. That is the economics of madness. We should have a system to encourage investment in further production, not penalise it.

We must do more on procurement. The Government’s procurement policy has positive aspects, but when businesses such as DONG Energy develop the North sea wind farm, the test is whether they use UK steel or not. We need action against Chinese dumping, to address the lesser duty rule, and we must stop dragging our feet and stopping the European Union carrying out measures that would support our steel industry.

In those two big challenging areas—the local health economy and the steel industry—the Queen’s Speech does not offer a great deal at the moment. However, this debate, and contributions from across the House, can allow it to be developed into something much better.