NHS

Paul Burstow Excerpts

Wednesday 5th February 2014 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

May I start by agreeing with the right hon. Member for Rother Valley (Kevin Barron)? The issue of alcohol has been ducked by successive Governments for a very long time. He is absolutely right to campaign on it, and I absolutely agree that we need to see the introduction of minimum unit pricing. However, we should not in any way give the impression that that of itself is the entire solution to what is a broad societal problem. None the less, it most certainly would make a significant contribution. I hope that, at the next election, it will be part of my party’s platform on public health issues.

My hon. Friend the Member for Stafford (Jeremy Lefroy) was right to call for a debate on the Francis report. I hope we will be granted Government time to debate it. If not, I would certainly join him in an application to the Backbench Business Committee for a debate on the Floor of the House. We should have the opportunity to bring Ministers here to debate the report.

Before addressing some of the comments made by the shadow Secretary of State, I wish to place on the record my thanks to the staff at my local hospital, St Helier, for all the work they do not just over the winter period when the pressure is undoubtedly at its most acute, but right across the year. Having been in the hospital over the Christmas period singing carols, which hopefully did not discomfort people too much, I saw for myself just how that pressure can build. I also saw how well the staff are perceived by their patients.

I want to register a frustration with the Minister today about something that has been going on in my patch for several years now. For almost as long as I have been an MP, clouds have from time to time gathered over the future of my local hospital. In 2010, the previous Labour Government signed off an outline business case for the rebuild and refurbishment of St Helier’s hospital. That was great news, and a culmination of work by my right hon. Friend the Member for Carshalton and Wallington (Tom Brake), the hon. Member for Mitcham and Morden (Siobhain McDonagh) and me. We secured funding from the Government worth some £219 million. Then there was a change of Government; a coalition came in. Given the spending review and the desire to tackle the public borrowing problem, it was far from certain whether that funding would stay in the Budget. Again, the three of us lobbied hard, and we were delighted when my right hon. Friend the Chief Secretary to the Treasury was able to confirm the funding.

However, in the dying days of the primary care trusts, a review was launched of accident and emergency and maternity services in south-west London. It was called Better Services Better Value, but it offered neither. It has been an absolutely crystal clear case study of everything that is bad and wrong about NHS change management. There are some really good examples of change management, stroke care in London being the exemplar. However, we have to refer to that example too often, as there are too few other really good examples of change having been managed well. All too often the public feel left out of such processes, and it is no wonder they mount the barricades to oppose change of which they feel no ownership.

My right hon. Friend the Member for Carshalton and Wallington and I were repeatedly told during the process by the then chief executive of the primary care trust, Ann Radmore, that the rebuild of St Helier was a fixed point in the whole process. It was not to be touched; it was sacrosanct and the rebuild would happen regardless. I have to say, however, that the events of the past three years have left me feeling betrayed and lied to. As a result of the uncertainty caused by BSBV, three years on—despite GPs having now declared BSBV’s proposals unviable, and having gone back to the drawing board—my local trust and clinical commissioning group are saying they cannot proceed with that £219 million. They lack the will and vision to take it forward, and I hope the Minister can confirm today that the £219 million is still in the Department’s budget lines and that he will encourage my local NHS to work with my local councils and Members of Parliament to bring forward these plans.

The motion moved by the shadow Secretary of State today feels a bit thin, and a little like a re-editing of its previous two incarnations in an attempt to create the sense of a febrile environment of a looming and predicted crisis and calamity that is about to engulf us all. That tactic has been adopted by the Opposition time and again, and time and again it has not been borne out on the ground. The analysis of the right hon. Member for Leigh (Andy Burnham) is deeply political, and let me give just one example. He lays the blame for delayed discharges principally at the door of budget pressures on social service departments. That is not true. If he looks at the figures, he will see that the bulk of the pressure is caused by delayed discharges in the NHS, not social services. I do not pretend for one moment that there are not parts of the country where social service cuts are impacting on delayed discharges, but the picture is more nuanced and complicated, and I wish the shadow Secretary of State had the courage to say that, rather than repeating a uniformly gloomy picture that is not true.

[Barbara Keeley]

I refer the right hon. Gentleman to the Select Committee on Health’s report on the matter. The data were completely conflicted. Again and again, individuals from the NHS told us that social care was the problem, as Sir Bruce Keogh, whom I quoted earlier, said to me just a few weeks ago. Our report said that NHS England should sort this out. There are figures that the right hon. Gentleman could quote and figures that my right hon. Friend the Member for Leigh (Andy Burnham) could quote, and we should not be confused about this.

[Paul Burstow]

I entirely agree that if there is any doubt about the figures, it needs to be resolved, but there seems to be a disconnect between what people think is happening and what the figures show. I have been to events at which clinicians have said that the problem is the local social services, but when they are shown the figures they are surprised. Perhaps that is why we need, as the hon. Lady says, to ensure that there is an agreed way in which such things are reported, which is what, I think, was put in place by the previous Labour Government. These figures have been collected for a long time, and they have consistently shown that social care is not the principal driver of delayed discharges.

[Mrs Main]

I am sorry to have missed the beginning of my right hon. Friend’s speech, but as he knows there is a big lobby going on. That was the point I was trying to make to the Secretary of State, although obviously I did not make it very well. Under the previous Government, West Hertfordshire Hospitals NHS Trust had a significant number of delayed discharges—although that is coming right down now—and the figures were not on the books, so to speak, thanks to a very creative form of accounting. It is nuanced and there have been problems on all sides. To try to paint it as one-sided is totally wrong and it certainly is not a new phenomenon; it has been going on for a considerable time.

[Paul Burstow]

That is absolutely right. For example, in continuing health care there is often a great deal of contestability that leads to discharge delays, but they are NHS-caused delays. I am not saying that the NHS should be blamed any more than social services, but I want some honesty about how the figures are presented as they do not bear close scrutiny in the argument made by the right hon. Member for Leigh. His solution is simplistic, too. It is good to have a debate about competition policy—I remember Labour Ministers trumpeting the introduction of the first competition policies in the NHS and the establishment of the competition and collaboration committee in the Department of Health. Labour established those policies.

Monitor’s role is to protect the interests of patients—that is what it says in the Health and Social Care Act 2012—not to promote competition. The idea that we can solve the problem by sweeping away Monitor opens the doors to competition red in tooth and claw. Of course, the Competition Act 1998, the EU’s competition legislation and procurement law would still apply without any of the fetters, barriers or protections that Monitor can and should be providing in its role as the regulator of competition in the NHS.

[Kevin Barron]

It is interesting that the right hon. Gentleman says that, because he knows from his time on the Health Committee that European competition law is not used in any health care system across the European Union.

[Paul Burstow]

The problem is that EU competition law was brought into our law through the 1998 Act. That was what opened this particular box, and by bringing Monitor into the picture and giving it the mission of protecting the interests of patients, we put that issue back in its box—and the right hon. Member for Leigh would sweep that away.

[Andy Burnham]

The right hon. Gentleman seems to be arguing that the Health and Social Care Act 2012 is perfect—[Interruption.] It was his Act; he was a Minister. I quoted him in my speech as saying that it now needs to be amended. Will he be straight with the House this afternoon: does it need to be amended to remove the role of the OFT?

[Paul Burstow]

The right hon. Gentleman must be reading my notes as that was my very next point. One thing about our politics is that it is very difficult for people to admit their mistakes, so let me do just that today. I regret that we included in the 2012 Act a provision for the OFT to deal with the specific issue of mergers. At the time, the argument was that the OFT had the expertise, but it clearly did not. Monitor should have that role. I want to address that issue either through agreement—the Secretary of State has suggested how that might happen—or by amending the legislation. That is my view based on how things have developed over time, and one cannot be more straightforward than that.

[Andy Burnham]

Fair enough.

[Paul Burstow]

I thank the right hon. Gentleman.

The right hon. Gentleman spoke about Hinchingbrooke hospital and the franchising arrangement. The process started and was two thirds of the way through by the time the previous Government left office. There were only private sector providers in the competition when the previous Government left office—

[Andy Burnham]

indicated dissent.

[Paul Burstow]

I hope the right hon. Gentleman has had the opportunity to go and see what is happening at Hinchingbrooke, because it is doing fantastically well. It is being led by clinicians and is making a huge difference as a result. We should take heart from that.

Let me end by drawing out one point about A and E pressures. The situation is complex and driven by a multifactoral set of problems. There are seasonal changes, with high-volume, less complex A and E attendance in the spring and summer, and a pattern of fewer but more complex cases in the autumn and winter that often drive up admissions. It is also important to note that it is a question not just of an ageing society but of a rise in co-morbidity, which drives the pressures in our A and E departments. There are also changes in behaviour as people regard A and E as the first point of access for any ailment, driven by the fact that nine out of 10 GPs opted out.

In conclusion, the motion is flawed and does not celebrate the successes of this Government, not least in driving integration in a way that the previous Administration failed to do. For that reason and many others besides, it should not be supported and the Government amendment should be supported instead.

[Several hon. Members]

rose—