NHS Efficiency

Debate between Paul Bristow and Luke Evans

Tuesday 2nd November 2021 Westminster Hall

[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.

Social Care

Debate between Paul Bristow and Luke Evans

Tuesday 25th February 2020 Commons Chamber

[Paul Bristow]

I accept what the hon. Gentleman says —pay is indeed a factor in the recruitment and retention of social care staff, but I also agree that it is not the only factor. Terms such as “low-skilled worker” are far too commonly used in relation to care staff. That language and perception need to be challenged. We need a greater emphasis on professional structures, career development and appropriate reward.

We also need to celebrate these roles and show how rewarding and fulfilling they can be. After all, this is about looking after people. These people are our grandparents, our fathers, our mothers, our uncles, our aunts and, in some cases, our children. One day it is likely to be us. I will never forget a constituent telling me about his job in social care. He said that each and every day, he got to look after, talk to and listen to people who became his friends, and he felt he was almost cheating by calling it work.

[Dr Luke Evans (Bosworth) (Con)]

I agree with the hon. Gentleman in my professional capacity as a GP. It is invaluable to have people who know those they care for: they can pick up when there are problems, and they can inform professionals. Does he agree that we need this kind of relationship—people who understand the people they are caring for—because it saves the NHS money? That is not in any statistic that we may see, but that professionalism, dedication and care make the real difference not only to the person but for the wider NHS.

[Paul Bristow]

I agree entirely with my hon. Friend. Those social care staff and the relationships they have with the people they care for can save our service money.

Don’t get me wrong. Social care is hard, sometimes literally requiring heavy lifting and involving emotional distress, yet it is a career that can be rewarding. The Government are keen to build the same consensus on social care that already exists on our national health service, and that is the right thing to do. I hope that we can build parity of esteem for our social care workers.

Of course, there are millions who undertake social care roles without any pay. I listened with great interest to some hon. Members’ comments about unpaid carers. The 2011 census—obviously some time ago—identified that one in 10 residents in England and Wales, or 5.8 million people, are spending at least part of their week caring for disabled, sick or older relatives and friends. As with careers in social care, carers can often enjoy their work and it can be positive and rewarding. There are, however, a lot of reasons why carers need support. Carers’ own health and wellbeing problems are often exacerbated or caused by their caring role. Carers are entitled to a social care assessment of their own needs, and subsequently support, if the assessment shows that they need it; but not enough carers are being identified and subsequently assessed, and that means that they are going without support for their needs, putting their own health and wellbeing at risk. Support for carers should be embedded in funding for social care, and evidence shows that supporting carers can save money in adult social care services and the NHS, while improving the life of the carer and the person with care needs.

I would like to make a quick mention, if I may, of the social care work that goes on in my constituency. Some of the most enjoyable time I spent on the campaign trail was at two hustings that were organised in Peterborough. One was the general election hustings for adults with learning and social disabilities. I found it one of the most rewarding aspects of that campaign, because I learned a huge amount about the experiences of those particular constituents and of those who care for them. I would like to pay tribute to Klayr Lynch, the facilitator of Club 73, and her team for all the hard work they undertake each and every day for some of my most vulnerable constituents. They do a truly brilliant job. The same can be said of the disability hustings organised by Disability Peterborough and the Cambridgeshire Deaf Association, organised by my old school friend Andrew Palmer.

Colleagues will learn much about social care from their own constituencies. In this place we rightly often talk about hard-working doctors and nurses. Understanding the crucial work that those in social care undertake, may I make a plea that hon. Members, especially my right hon. Friends on the Front Bench, remember to include a reference to social care workers when they talk about hard-working doctors and nurses.