NHS and Social Care Funding

Debate between Philippa Whitford and Victoria Prentis

Wednesday 11th January 2017 Commons Chamber

[Dr Whitford]

The whole idea of STPs is to go back to areas. We simply have geographical health boards—the only layer we have—so we are not wasting huge amounts of money on having layers and layers, which could be integrated. For an STP to work it must make sense geographically, which might be a county or something bigger or smaller. I think that they should be put on a statutory footing. We have 211 CCGs. There will be an average of six CCGs for every STP, so that is a waste of layers, and it will be very difficult to integrate.

One of the biggest differences is that, in 2004, we got rid of the purchaser-provider split. In the past 25 years, there has been no evidence of any clinical benefit from the purchaser-provider split, the internal market or, as it now is, the external market. It is estimated that the costs of running that market are between £5 billion and £10 billion a year. That money does not actually go to healthcare, but on bidding, tendering, administration or profits. We cannot have an overnight change, but if we simply made a principled decision to work our way back to having the NHS as the main provider of public health treatment and to integrate care through the STPs, we could reach a point of sustainability.

As I said earlier, we must protect things such as community hospitals and community services and, indeed, invest in them. Our health board has rebuilt three cottage hospitals as modern hospitals, because that is where we should put an older person who is on their own and has a chest infection, who just needs a few days of antibiotics, TLC and decent feeding. We do not want them in big acute hospitals; we want them to be close to home. The danger is that under the STPs people will see community hospitals as easy to get rid of, but that is an efficiency saving only if it gets rid of inefficiency. If we slash and burn, we will end up spending more money in the end.

[Victoria Prentis (Banbury) (Con)]

Much of what the hon. Lady says is music to my ears as somebody who is campaigning to save their local general hospital. May we have the benefit of her views on the role of consultation with patients and the wider community when sustainability and transformation plans are being considered?

[Dr Whitford]

Public consultation is important, and not just in the way it has often been done in the past—“We’ve made a decision, it’s a fait accompli, and we’re coming and telling you about it.” Unfortunately, that is very much what we have heard about the STP process, partly because it has been so short and partly, I am afraid, because it is about budget-centred care, not patient-centred care. Areas have been given a number and told, “If you’re not reaching this number, don’t bother submitting your plan,” and they are working back from that. That will not achieve an efficient, integrated service, so the public must be involved.

Frontline clinicians must also be involved. They work in a service and know exactly what the bottlenecks are and exactly what horseshoe nail is missing and holding a service back. If we have clinician-led redesign, such as I was involved in for breast cancer in my health board 17 years ago, we can track a patient’s path. We can quickly imagine ourselves as a patient, see the bottlenecks and focus investment on them.

I read an article yesterday stating that three hospitals in Manchester have spent £6 million on management consultants to say, “Shut a ward, sack hundreds of people and jack up the parking charges.” I am sorry, but that was not good value for £2 million each.