NHS Risk Register

Debate between Nigel Evans and Alan Johnson

Wednesday 22nd February 2012 Commons Chamber

[Mr Deputy Speaker (Mr Nigel Evans)]

May I advise all Members that they should not resort to a device such as this, as it is an argument in continuation of the debate. Many Back Benchers want to get into the debate, so Members should not misuse points of order. That was not a point of order for the Chair.

[Alan Johnson]

Thank you, Mr Deputy Speaker.

I believe I heard the Secretary of State say that he did not really want to talk about the risk register, and neither do I, but I think it is important to the Government’s basic problem and the threat to the national health service.

Three important and interlinked reforms can be summed up in five words: “better outcomes for lower costs”. Does the private sector have a role? Of course it does.

Let me say a word about the introduction of independent treatment centres, which seem to have been used by some in this debate to suggest that this Bill simply carries forward policies pursued by the Labour Government. ITCs were introduced to deal with the perennial problem in the NHS—long waiting lists. We should remember that in the late 1990s about one in 25 people on the cardiac waiting list died before they were operated on. Rudolf Klein, in his seminal history of the NHS, said that ever since it was created, there has been a tail of around 600,000 people on waiting lists. He said that the captain shouted his order from the bridge and the crew carried on regardless.

In 1995, after 16 years in power, the Government before the last one decided to reduce the guaranteed in-patient waiting time under the citizens charter from two years to 18 months. That was the best they could do after being so long in power. For us, it was an absolute priority. Let me say to Members of all parties that independent treatment centres transformed behaviour in the NHS. Suddenly, it became possible for surgeons to operate on Fridays and on Saturday mornings as hospitals reacted to the threat of competition.

--- Later in debate ---

[Alan Johnson]

I shall not be taking an intervention from the hon. Gentleman.

When it comes to integrating social care with health, people want an adult social care system that resembles the NHS, not an NHS that resembles the current adult social care system. The very real fears about the Bill, particularly in respect of commissioning, were highlighted recently by the Health Committee. If the necessary economies are to be made, the provision of health and social care must be planned together, and, despite its title, the Bill is hindering that process. Yes, it includes the word “integration”, at a late stage, but the word just sits there doing nothing more than suggest that this is the spirit that the Bill will introduce, and it is not.

The one sensible decision made by the Health Secretary was the one to retain the services of Sir David Nicholson as chief executive of the NHS. The goal of achieving efficiency savings of 4% a year to reinvest in patient services is a noble one, but its achievement will be particularly difficult for the acute sector. What seems to be happening at present is that hospitals are cutting services to save money. What needs to happen, and what the Nicholson challenge envisaged, is the transformation of services to eliminate waste by, for instance, reducing readmissions and bringing care much closer to the patient. Of the £80 billion spent by PCTs in 2009-10, nearly half went to hospitals, the most expensive form of care, while primary care received only a quarter.

When I asked the distinguished colorectal surgeon Ara Darzi to lead 2,000 clinicians in moving the NHS to the next stage of its development by focusing remorselessly on quality, he produced a report that was radical in its concept if a little boring in its detail. Government Members could do with a bit of “dull and boring” on the NHS at the moment. The proposals required no reorganisation and very little legislation.

At that time, the Conservative party was promising a bare-knuckle fight to defend the district general hospital, and siding with the British Medical Association to stop patients accessing GP surgeries later in the day and on Saturday mornings. If the Nicholson challenge is to work, it must be accepted that the vision of the district general hospital as all-singing, all-dancing, and capable of providing all clinical procedures must change. There is no political leadership on that, there is no leadership from the Government—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I call Mike Freer.