National Health Service Funding

Philippa Whitford Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Madam Deputy Speaker (Natascha Engel)]

Order. Before I call the SNP spokesperson, I must inform hon. Members that, including her speech, we have calculated, generously, that every speaker will have five minutes, but we will probably have to go down to four minutes at some point.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Does that include five minutes for me also?

[Madam Deputy Speaker]

Obviously the hon. Lady has no speech limit, but the speech limit has been calculated with her mind. I am just saying that the longer someone speaks for, the less time everyone else will have.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Okay, well that is fairly disappointing, given what I have prepared.

UK-wide, the NHS faces sustainability issues. One of the key issues is the increase in demand from an ageing population and the increasing complexity of those demands. The way to tackle that demand is through public health and social care that ensures that those people do not end up in the most expensive place. Secondly, we have a lack of staff, both nurses and doctors. The lack of training nurses has been referred to. We also face the threat of losing some of our staff from the EU. The third threat to sustainability is money, but the money is the one we can fix, because money is a decision; the others will take a decade each to fix—by training more nurses and doctors, preventing illness and finding better ways to look after an ageing population.

As I have said in the Chamber before, I welcome the idea of STPs, because they should mean a return to place-based planning and integration and a move away from fragmentation and competition. The problem is, however, that they have to be based on patient-centred care, whereas, according to what is leaking out, they are being discussed on the basis of budget-centred care. We heard in the Health Committee that the STP groups were being given a figure that they had to meet by 2021 and then were working back from that. That will never work.

If we want to decrease inefficiency and increase efficiency we need to target the inefficiencies in the system, not just take an axe to the whole thing. When hospitals or GPs run out of money and take urgent action, it will be poorly thought out and immediate-survival action. We need to look at where the fat is and at the natural inefficiencies in the system, and some of that comes down to the lack of integration. STPs are a great opportunity but an opportunity we will look back on as missed if we do not do it properly.

The Secretary of State says that there is no privatisation in the NHS, but there certainly is marketisation and outsourcing. I graduated in 1982, so I have lived through every single iteration from both sides and three Governments. In 1982, we were just skimped. Basically, the NHS got 5% of GDP and it dropped to 4.5% over the ’80s. Instead of increasing that to where it is now, what we had was constant redesign.

The first was the internal market and GP purchasing. A GP would refer to our clinic, but if I decided the patient was not surgical and I referred them to gynaecology, the GP would refuse to pay. What started to happen? Surgeons and clinicians began sending the patient back to the GPs, so that they would refer them. Of course patients fell through the cracks; some never got that second referral and things were missed.

After the purchaser-provider split, we started to change the whole shape. We went from 100 health authorities to 300 primary care trusts, even though the leaders of the PCTs earned the same money as the leaders of the health authorities. People were made redundant and transitional change was hugely expensive. In the mid-2000s, we went from 300 PCTs to 150—again with redundancy and transition. As we move on, we start to see the private finance initiatives. As has been said, the NHS has paid over £60 billion for £11 billion-worth of buildings. That was not an effective thing to do.

Eventually, of course, we come to the Health and Social Care Act 2012, which got rid of the 150 PCTs and replaced them with 211 clinical commissioning groups. This is described as “putting power in the hands of the GPs”, but following a freedom of information request I know that less than 18% of CCGs have a GP majority on them. Some 47% of CCGs do not even have a clinical majority, so the idea that CCGs give power back to primary care is, I am afraid, a complete fallacy.

What we have seen, I am afraid, has come from all Governments. It was the Labour Government who took the purchaser-provider split and introduced independent treatment centres, giving them block grants. All the talk about patient choice was not really patient choice at all: the GP had to send the patient to the ITCs for their hips, because it had already been paid for. To try to counteract that, we have seen payment by results, which was the forerunner of the tariff. What that did was increase activity, so it helped with waiting lists and waiting times, but what we now have is activity that is just growing and growing. Hospitals get paid for activity, not for whether that activity is right.

In Scotland, we abandoned trusts in 2004, and we abandoned primary care trusts in 2009. Let us look at our costs book, which publishes the costs of administration. This is not just the costs of the market; it deals with all the administration of the NHS. Ours has fallen from 7.6% in 2006-07 to 6.7% in 2015-16. When it comes to the Department of Health or NHS England, no one has any idea. A piece of work was done for the Department of Health in 2005, which estimated admin costs at that time as 14%. I suggest that the current market is an awful lot more complex than it was then.

I think some things can be done around procurement. In Scotland, our national procurement gives hospitals a choice of 9,000 items. The supply chain in England has 600,000 items. It is not limiting; it is not national procurement. Our logistics division, which delivers that, will pick items per ward and deliver them all the way from a central depot to that ward. That allows us to cut some of the costs, as suggested in the Carter review.

We absolutely need to keep agency prices down. It is important to try to keep staff on a staff bank rather than get them through agencies. Why are we not asking the bigger question? Why are nurses choosing to work for an agency rather than the NHS? Is it that they earn more money? Is it flexibility? Is it family-friendliness? Would it not be better to look at how we let them work, so that they work for us rather than feeling that they have to go and work in an agency? From the point of view of job quality and job satisfaction, they would all rather be in one place than be in a different place every week.

There are things that could be done. There could be a better use of community pharmacies, and a better use of community hospitals for “step up” and “step down” services. It is crucial that we fund social care so that elderly people are looked after in their own homes. I think that STPs have potential. However, I ask the Secretary of State not to go on and on with marketisation, given that no cost-benefit analysis has ever been carried out and there is no evidence of benefit from it. The NHS could save an amount that is estimated conservatively at £5 billion a year, and that would have a significant impact on the debt.

The right hon. Member for Surrey Heath (Michael Gove) suggested that we needed to bring solutions. I am offering the ones that I can think of from Scotland, and I recommend them to the Secretary of State.