NHS Efficiency

Paul Bristow Excerpts

Tuesday 2nd November 2021 Westminster Hall

[Sir Gary Streeter (in the Chair)]

Before we begin, I encourage Members to wear masks when they are not speaking, in line with current Government and House of Commons Commission guidance.

[Paul Bristow (Peterborough) (Con)]

I beg to move,

That this House has considered NHS efficiency.

It is a pleasure to serve under your chairmanship, Sir Gary. I draw Members’ attention to my entry in the Register of Members’ Financial Interests.

Our NHS is in my DNA. Both of my parents were nurses and worked in the NHS for most of their working lives. It was the NHS that brought my family to Peterborough when I was just five years old, and I have worked in NHS policy for 20 years. My commitment to our NHS and its principles is clear. Few things inspire as much national pride as our national health service, and I want to keep it that way.

The NHS has lost its ranking as the best healthcare system in a study of 11 rich countries by an influential US think tank. Most worryingly of all, it fell to ninth when it came to healthcare outcomes. We must do something about this. We must ensure that the record investment that we are putting into our NHS is spent well. I suggest that that money should come with some very specific key performance indicators that would ensure that it is not wasted.

I feel strongly that the money should be in the gift of Ministers in the Department of Health and Social Care, who are accountable to Parliament, rather than NHS England or NHS Improvement. Like the Department for Levelling Up, Housing and Communities would do with a local authority that does not run a balanced budget or provide statutory services, the Department of Health and Social Care should be able to intervene directly, or at least provide incentives. Recipients would not get their share of the extra cash unless they addressed the challenge of access to care and improved outcomes.

I am keen to help Ministers. I almost feel thwarted, because progress on many of the things that I spoke about at the party conference last month have started to be reflected in Government announcements. That is obviously a good thing, but extra money must come with strengthened incentives to do the right thing and, quite honestly, consequences for not doing the right thing.

The first area in which we need to make progress is local NHS management. Local government has had to make a series of savings in recent years. Armies of local government managers all doing the same jobs in neighbouring local authorities have been an easy target for those defending the interests of taxpayers. However, local authorities have done rather a good job of sharing senior officers. For instance, the chief executive of Peterborough City Council is also the chief executive of Cambridgeshire County Council. As a former Hammersmith and Fulham councillor, I also remember the 2011 tri-borough shared services agreement in west London, between Westminster, Kensington and Chelsea, and Hammersmith and Fulham, which saved over £33 million in just four years. Labour-controlled Hammersmith and Fulham petulantly took their toys home a couple of years later, but the bi-borough arrangement is still saving the taxpayer millions, and this practice is replicated across the country.

That practice is unheard of in our NHS, but why is that? There are no reasons why NHS trusts and new integrated care systems cannot share officers and back-office functions. Let us do away with every NHS trust having its own specific CEO, finance director, human resources director, estates director or diversity director. It is not controversial to ask our NHS to learn from local government. If certain localities cannot make those management savings, are unwilling to share back-office functions, cannot look to make savings, why would we give them the extra cash? I suggest a KPI on a reduction in management costs and back-office costs. I think it would be warmly welcomed by the taxpayer and those in our NHS who know that money is wasted.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I draw colleagues’ attention to my declaration of interest as a practising NHS doctor. Does my hon. Friend agree that one of the challenges is attracting good expertise, perhaps from the business world, into the NHS and that that sometimes costs money and resources? While he is wishing, correctly, to make savings in back-office costs, we should not be too prescriptive because we need to make sure the best people are coming into the NHS, both from within and without, to deliver the productivity gains he desires.

[Paul Bristow]

That is a characteristically well-made point by my hon. Friend. In the current system, NHS chief executives spend 18 months in one trust, then travel to another, spend 18 months there and then travel to another. That is no time at all to get to grips with the challenges that these organisations face. We absolutely need people from the private sector to come in and do these jobs. If they were doing these jobs on a larger scale, that would be welcome. I am specifically requesting that we look to local government, where people have come in and transformed services. I suggest we do the same in our NHS.

My second point is on innovation and new ways of working. Innovation is the way an organisation develops. It should be a constant process—trying to do things better, improving outcomes for patients and trying to be more productive. Across the NHS there are those that innovate with new technology, those that adopt new pathways and service delivery, and clinicians who want to train and learn new techniques. However, the NHS can be poor at spreading best practice at pace and scale. Like any bureaucracy, it can be slow at looking at new ways of working.

There have been attempts to address this. We spent millions funding organisations such as Getting It Right First Time—GIRFT—under Professor Tim Briggs, which is a national programme designed to improve the treatment and care of patients and collect best practice. We created the National Institute for Health and Care Excellence—NICE—which, when it was created, was considered to be a model for the world to emulate on determining the cost-effectiveness of technologies and drugs. NICE also produces quality standards that set out priority areas for quality improvement in health and social care. After all this work has been done and all this money has been spent, many parts of our NHS just ignore it. They say things such as, “This can’t possibly apply to us,” or, “This is merely guidance, and we don’t need to do this here.”

The use of insulin pumps and implantable cardiac defibrillators or vascular technologies should not depend on where someone lives, but it does. The solution is certainly not to reduce GIRFT’s budget from £22 million to £10.8 million, but that is what has happened. GIRFT should be empowered to develop best practices in primary and community care, and we should look at the GIRFT model of hot emergency and cold elective centres to help us power through the backlog.

What is the solution? How do we make outliers adopt best practice and do the right thing? A KPI, and perhaps even GIRFT or NICE, can help us with technology and pathway adoption, which could transform productivity, powering us through the backlog. Backed up with an incentive such as a generous and workable best practice tariff, a KPI could focus attention. If outliers persist in a practice that has been shown to be outdated and to follow pathways that do not lead to optimum outcomes, why would we give them the extra money?

On capacity, staffing is recognised to be a risk factor in delivery for our NHS. The money is there, but it takes a long time to train a doctor, GP or nurse. That is why every hour of a medical professional’s time is valuable. We have to make sure that they are doing what they are paid for and what they went into medicine to do.

[Dr Luke Evans (Bosworth) (Con)]

My hon. Friend is making a fantastic speech. Does he agree that every hour of a clinician’s time is valuable? The average clinician loses about 10% of their workload simply chasing up letters, following up blood tests or trying to find scans, which is a complete nonsense in our current system. It could easily be ironed out by joining up simple IT between primary and secondary care. Is that a KPI my hon. Friend could support?

[Paul Bristow]

My hon. Friend is a champion of efficiency in the NHS and in his profession, and he makes such points regularly in the meetings of the Select Committee on Health and Social Care. Perhaps he has already read my speech, because I think that the winter access fund is an excellent start. It will address what many GPs have rightly complained about for some time, which is the amount of time they spend on fitness notes and chasing appointments, as well as something that I only realised when I met GPs in my constituency. I want to give a quick shout out to the super Dr Neil Modha and his team at the Thistlemoor surgery, who are doing a fantastic job in a very challenging catchment area. What I realised was how much time GPs spend providing medical records to insurance companies and other bodies, which just is not their job.

We need clinicians to practise at the top of their licence. We need GPs seeing ill patients, not prescribing things a nurse could easily do. Nurse-led prescribing has been around for a long time, but it has not been rolled out across as many areas as it should. We need a revolution in physician associate and nurse-led prescribing, which will free up the time for GPs and consultants to do what they need to do.

That same waste of clinician time happens in secondary care. We need surgeons using their skills in the cath lab or the operating theatre. They should not be in theatre only one day a week; they need to be there multiple days a week, every week. I hope surgical hubs and other initiatives will help, but I fear that without a strict KPI on clinician time on highest-skill, highest-value activity—and I am not opposed to backing that up with financial incentives—we will not make the savings in clinicians’ time that we need. Only with such a KPI, together with an effort to demonstrate how valued our clinicians are, will we ensure that their valuable time is not wasted. If an integrated care system or the management structure at an NHS trust cannot or will not do that, we should make it dependent on the extra cash.

Finally, much of this is dependent on greater transparency. I was very pleased to hear the Secretary of State for Health and Social Care say this morning to the Health and Social Care Committee that we are going to be able to see more data relating to the performance of GP practices, but that needs to happen with ICSs as well. In the past, clinical commissioning groups in this country could be guilty of hiding commissioning policies, rationing hip and knee surgeries to those with a body mass index of below 30—or even 25 in a handful of cases—on page 145 of a 278-page document on a website that no one ever reads.

NHS England is just as guilty of doing that with national service specifications and commissioning policies, and politicians have very few means of challenging that as politics has been taken out of the NHS. We need to open up the windows and let the light in. Accountability and transparency have always been the way to improve performance and efficiency, so let us have the Ofsted-style rating for ICSs and other NHS bodies. Let us know who does well and who does not. Together with clear KPIs, transparency and accountability, we can ensure that the record cash injection, which my constituents applauded, is spent well. The NHS is a source of national pride, but its performance post-pandemic can and should improve. I offer Ministers a few ideas—a few acorns—for how we might do that.

--- Later in debate ---

[Paul Bristow]

I am impressed by the Minister’s response. She talked a lot about how the NHS will improve efficiency and productivity post pandemic. I remind her of the plea that I made at the very end of my speech: the key to this issue is transparency and accountability. If we do not open the windows and let the light in, the Government’s ambitions will not be realised, and money will be wasted through other means. Let us try to create an NHS that is as transparent as possible and accountable to Ministers, then we might be able to see some of the changes that the Minister talked about in her speech.

Question put and agreed to.