Health and Care Bill

Paul Bristow Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Paul Bristow (Peterborough) (Con)]

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests.

I want to focus on two main areas of the debate: the role of patients in accountability and transparency; and tariffs—the way in which we pay for procedures and care. I support the Bill, but I hope that we have the means to address the deep-rooted cultural issue of regarding patients’ views as less valuable than those who work in our national health service. Before I was elected, I was often involved in advocacy campaigns. Patient groups would want to challenge NHS England’s commissioning policies or service specifications. These policies govern the technologies and procedures that are used to treat conditions, but the patient groups would find the decision-making processes totally impenetrable, as would the clinicians and health policy experts advising them. What chance do individual patients and relatives have to make their voices heard?

The same impenetrability applies to clinical commissioning groups. Patient access to established procedures and technologies is blocked by local policies, but people have to be dedicated to find these policies on convoluted websites or page 178 of a 256-page document. For example, CCGs regularly restrict patient access to hip and knee procedures for patients with a body mass index of over 30. Extraordinarily, some CCGs allow procedures only for patients who have a BMI of less than 25. I would confidently predict that that would disqualify the vast majority of hon. and right hon. Members, and we should call it out for what it is, which is rationing.

Such rationing was routine before covid created massive backlogs in NHS waiting lists in some CCGs. Transparency and openness is the solution to these problems. A formal role for patients on ICS boards, a formal role for patients in the development of commissioning policies and creating a national appeals board for challenging commissioning decisions are all ideas that I hope Ministers might consider as the Bill progresses.

Finally, on tariffs, national tariffs are not perfect but they do incentivise providers to treat as many patients as they possibly can. The Bill states:

“NHS England must publish…‘the NHS payment scheme’”—

a document “containing rules for determining” the prices to be paid in future, including, for example, for hip and knee procedures. Tariffs have led to hip and knee procedures and other procedures being done at volume and at scale, certainly, at least, when commissioners agree to pay for them. High volumes of elective procedures have been a good thing and the current elective backlog is probably the biggest challenge that the NHS faces coming out of the pandemic, so whatever ends up in that document, it needs to be clear, transparent and provide incentives for high-volume procedures to be carried out at pace and at scale.

Health and Care Bill

Paul Bristow Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Edward Argar]

I will not give way. I want to make some more progress.

[Paul Bristow (Peterborough) (Con)]

Will my hon. Friend give way?

[Edward Argar]

I want to make a little more progress. I will not give way to one of my hon. Friends or to the hon. Lady at this moment.

This will be done by amending the provisions to clearly describe the information that must be included in a personal budget so that individual contributions count towards the cap at the local authority determined rate, and to ensure that personal budgets and independent personal budgets work as they were originally intended when being used in conjunction with the cap.

Before turning to integrated care boards, let me put it on record that, once again, this must be regarded as part of a package of measures that improves significantly on the current provision in place for those funding care.

--- Later in debate ---

[Edward Argar]

I did wonder whether I would regret that intervention. It was typically courteous, although I have to say that when a Member of the Opposition says that, “We’re here to help you”, I am not always sure. [Interruption.] Of course, when the hon. Lady does it, I know that she is sincere about it. The point I make is that this important change is necessary to deliver on the pledge we have made. It is being introduced on Report. While ICBs and integrated care systems, which we will speak about shortly, are hugely important, I suspect that this matter will dominate the debate in this group on Report. Equally, I suspect that it will be fully debated and scrutinised in the other place.

[Paul Bristow]

Does the Minister agree that we have been on a journey? The context of this needs to be considered. We are starting a conversation, but other things will come. There will be bumps in the road, but the context that we need to consider is that this is the first Government to tackle the issue of social care in decades. That is the right way to look at this piece of legislation. It should not be looked at in a short-term way.

[Edward Argar]

I am grateful to my hon. Friend, a member of the Health and Social Care Committee, for his intervention. He makes the point well that this is another step on the journey, but it is a journey that only this Government have actually got round to starting. Previous Governments have failed to make that progress. The previous Labour Government produced two Green Papers, one Royal Commission, and one spending review and nothing was done, so this Government are making significant progress.

Health and Care Bill

Paul Bristow Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

There are two aims on the non-surgical side, because we have to beef up the regulation as well. I say to the Minister that if we do not get that in this Bill, I am not sure where we are going to get it. If the amendment is not accepted for technical reasons, I and, I am sure, the right hon. Member for Romsey and Southampton North and others, would like to work with him to draft an amendment before the conclusion of the Bill that brings in the regulation that was promised. The evidence is behind it, as is the Keogh review. It will not only give people confidence that procedures have been carried out safely, but drive the cowboys out of the sector, so that they will not be able to practise and harm vulnerable people.

[Paul Bristow (Peterborough) (Con)]

I rise to speak to amendment 10 in the name of my right hon. Friend the Member for South West Surrey (Jeremy Hunt). I refer Members to my entry in the Register of Members’ Financial Interests.

I have spoken in the House before about being involved in health policy for about 20 years. The same thing tends to happen every three or four years: the NHS says it needs more money, it needs more capacity and it needs a plan, and that is what we are doing again in the Bill. When we talk about more capacity, we mean not just more hospitals, more theatres and more diagnostics, but a bigger workforce. Thanks to this Government and the investment that has been made, I do not think anyone with any credibility can now say that the NHS does not have enough money. NHS England’s resource budget will rise to £162.6 billion in 2024-25—a 3.8% average annual real-terms increase. The Government also plan to spend a further £8 billion to tackle the elective backlog. This is the biggest ever catch-up programme in our NHS for elective surgery. Department of Health and Social Care capital spending will rise to £11.2 billion by 2024-25. I repeat: I do not think that anyone can say with any credibility that our NHS is now underfunded. We have the new diagnostic centres. We have the new pathways that should be adopted to increase NHS productivity. A long-term deal with the independent sector can ensure that we have the capacity to power through the elective backlogs—the hip and knee, hernia and cataract procedures that make up the vast majority of cases.

Of course, we need the nurses, the doctors and the consultants—the workforce—to carry out those procedures. This is a historical problem; it did not just happen overnight. All past Governments and, I dare say, past Secretaries of State for Health and Social Care have a degree of responsibility for this. As my right hon. Friend the Member for South West Surrey said, there are an estimated 93,000 vacancies in our NHS—consultants, GPs, nurses and allied health professionals. I was proud to stand on a manifesto at the last election that pledged to increase the number of healthcare workers in our NHS, and I know that considerable progress has been made, but just as the Government are doing with social care by putting in place a plan that focuses, laser-like, on resolving some of the long-term issues we face in that sector, we need the same laser-like focus to deal with some of the challenges with our NHS workforce. Any changes we make to our NHS workforce, or any long-term plans, need to reflect the real needs of our NHS. That is incredibly important. Some sort of duty to report independent figures about how we will make up the workforce is a very sensible measure.

Many years ago, I worked with the British Society of Interventional Radiology. The proposals we made and the work that we called for then were about workforce. Some argued that a lot of people were reaching the end of their professional career and retiring and there was a lack of new people coming through, so ultimately this would have an impact on patient care—on the number of procedures that could be carried out. The same arguments are now being made across a number of disciplines. Since I became an MP, I have met the Royal College of Surgeons and the Royal College of Physicians, and the same arguments are being made there. It is sobering to think about these challenges, and that is why this laser-like focus has to be considered very carefully.

We have talked about overseas recruitment. I heard what my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell), who is no longer in his place, said about that, and he made a very powerful argument. In some ways, we are going to have to use overseas recruitment to plug the gaps in our NHS, but there are other solutions. We have heard hon. Members talk about retention. I was alarmed and shocked by the number of healthcare professionals who—understandably—wish to work part-time because they are parents and they have childcare responsibilities. I understand that, but it is going to leave our NHS with recruitment challenges.

When I speak to clinicians—members of the Royal College of Surgeons and others—they talk to me about the ability to work independently and autonomously. Many clinicians want that ability, but do not feel that they have it. There is also the idea that they want to be part of something bigger than their own small team. It is not that they want to be part of this thing called the NHS and that they are all working towards that goal; it is more that, once we have come through the challenge of the pandemic—once we have got ourselves over that mountain—there is an even bigger mountain ahead of them, which is dealing with the elective backlog, where they feel that things never change. That is what I have been told, and those are very powerful things.

What are the solutions to this problem? Ministers need to think about how we can encourage our consultants, our GPs and our medical professionals to practise at the top of their licence. Speaking to medical professionals, I have been told alarming things. About 40% of a GP’s time is spent on sickness notes or providing medical records to insurance companies and other people. That is admin staff work. As valuable as those admin staff are, that is not what GPs and medical professionals went into their professions, and went to medical school for all that time, to do. It is absolutely right that that burden be lifted from our medical staff and placed elsewhere. Nurse-led prescribing has existed for quite some time, but we have not really had the push and the drive there that we should have. GPs should not be spending their time prescribing very simple things such as the pill. We can certainly be doing a lot better and working a lot more productively, as my hon. Friend the Member for North East Bedfordshire (Richard Fuller) said. This is not about working harder; it is about working smarter.

[Clive Lewis (Norwich South) (Lab)]

Listening to the hon. Member’s speech, I think he is giving the game away in some ways, because what I am hearing, if I understand him correctly, is that he wants to see a core of healthcare provided by the NHS and then the more lucrative parts of the NHS—administration and other parts—siphoned off to the private sector, which is a model we have seen in the US and which this Bill makes so much easier.

[Paul Bristow]

I would ask the hon. Member to listen a bit more carefully, because nowhere have I said admin should be carried out by the private sector. I said that it should not be carried out by medical professionals. They did not go to medical school to work in admin; they went to medical school to treat the sick. That is what we want our medical professionals doing—operating at the very top of their licence.

I also do not want to see situations where untold numbers of consultants are spending just one day a week in the operating theatre. I understand that consultants need the opportunity to train junior colleagues and to continue their own professional development, but they should be operating in our theatres a lot more frequently than that.

[Dr Whitford]

I gently point out that surgeons do not just operate—we run clinics; we run endoscopy lists and colonoscopy lists—so it is not that they are only working one day a week. They investigate the patient before they operate, and that is one of the strengths of the system in the UK in comparison to other countries, where surgeons only operate and someone else has done the diagnostics.

[Paul Bristow]

I agree with the hon. Lady that surgeons work incredibly hard. What I am talking about is operating at the top of the licence and for our consultants to be able to do the things that we want them to do. She is absolutely right; they are doing vital work in other areas running clinics and so on, but ultimately what we have is an elective challenge, and we need to ensure that we spend as much time addressing that elective challenge.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

Does my hon. Friend agree that one of the challenges for primary care is that general practitioners have absorbed a great deal of the role of social advocacy in our society? People are trying to get a face-to-face GP appointment, and it is sometimes being suggested to them that such things as getting a fitness note or a letter to go to a school might be better served by someone else in the wider multi-disciplinary team. People are getting frustrated, because our messaging about how to use the health service and the different range of roles and responsibilities offered is sometimes getting a bit diluted.

[Paul Bristow]

My hon. Friend speaks with much experience and makes a powerful point. I think he would agree that that core admin function is not what he went into medicine to do. He went into medicine to treat patients. I am grateful that the Minister laid out some of the plans that the Government have to deal with this issue. It is right that we should be looking to the long term, and the 15-year framework for future workforce is to be welcomed, but there also needs to be a much more regular reporting mechanism attached to that to ensure that we as Members are informed, but more importantly the NHS is informed, about how that challenge is going. The integration between NHS England and Health Education England—aligning the delivery arm and the workforce capacity arm—is probably also the right thing to do.

I end with this point: the challenges around workforce will be addressed not only by employing and training more NHS staff, although that is crucial—that is why I have some sympathy for amendment 10—but by ensuring that we work more productively by asking clinicians to operate at the top of their licence. It is also about ensuring that the NHS works smarter. We have created organisations such as Getting It Right First Time and NICE and asked them to go away and do the hard work of coming up with the most cost-effective and efficient ways of delivering care. If we ask those organisations to come up with the pathways and the ways of doing these things, surely it is only right that the NHS then adopts them instead of sitting there and saying, “These things will not necessarily work here.” We ask experts to come up with the right way of performing procedures; I suggest we go ahead and adopt them.

[Sarah Olney (Richmond Park) (LD)]

I rise to speak in support of amendment 10, tabled by the right hon. Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee, because the amendment reflects the key issue facing the NHS and all our health and care services at this time: the workforce. Access to healthcare services is the No. 1 issue raised with me by constituents at the moment, and I know that concern is being echoed in other constituencies across the country.

People are experiencing the issue in many different ways. Some are struggling to get a GP appointment. I regularly speak to parents in great distress because of the lack of available help for their children’s mental health needs. The accident and emergency department at Kingston Hospital in my constituency has regularly had to ask patients to consider whether there are more appropriate sources of help for their needs. Patients waiting in the backlog of elective procedures are regularly having appointments rescheduled or cancelled. Ambulances do not always arrive when called.

The impacts are many and various, but when I speak to health service leaders in my local area, the answer is pretty much the same: there is a lack of available staff. Even in cases where lack of funds is not in itself a limiting factor, the lack of people with the relevant skills makes it impossible to fill all the vacancies they are able to pay for.

Many of these problems are covid-related. The current NHS waiting list is estimated to be over 6 million, and it is clear that much of that is because so many elective treatments were delayed during lockdown. Demand for mental health services has accelerated because of the impact of the lockdown, particularly on young people. Covid is still with us, of course, and workforces in every part of the economy are being impacted by the need for individuals to isolate when they have symptoms or test positive. Healthcare staff need to be more vigilant than the rest of us.

Many of these problems are also Brexit related. A lot of young Europeans decided to return to their home countries at the start of lockdown and have not since returned. Brexit has stymied our ability to recruit from the EU, shutting off an extremely important supply for all parts of the labour market, but the effect is being felt most markedly in health and social care, since it is having to manage the extraordinary demand of a global pandemic at the same time.

Many of these problems are also the result of a long-term failure to correctly predict or prepare for workforce demand. One of the huge advantages of a national health service is that it is possible to get clear data from right across the sector and to make appropriate plans and decisions. For some reason, that has not been done, and it is absolutely right that the Government should adopt amendment 10 to start to put that right.

I want to amplify a Backbench Business debate that I was able to bring to this Chamber a few weeks ago, in partnership with the right hon. Member for South Northamptonshire (Dame Andrea Leadsom) and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell). It was on the subject of giving every baby the best start in life, and it was the firm view of all who attended that debate that the health visiting workforce needs to be substantially boosted to enable all new parents to receive a home visit from a trained healthcare professional. During the course of that debate, we heard of the many ways in which a health visiting workforce can support new families and the critical role they play in supporting babies and their families. One estimate is that the cost of poor parental mental health in the first year of life is more than £8 billion. It is clear that the cost of boosting our health visiting workforce would more than pay for itself in a very short time.

I also want to reflect briefly on a conversation I had with a constituent in the street in Richmond town centre on Saturday. Despite having two degrees, she was working in the care sector, and she was talking to me about her terms and conditions of work. She is employed by an agency and is not allowed to engage with any other agency. She is on a zero-hours contract, so she has to sit at home and wait to hear how many hours she might be required to work the following week. For various reasons that suits her, but I feel that it underpins the recruitment crisis we are experiencing in our social care sector, because that is no way to retain skilled and committed staff.