Health and Care Services

Phillip Lee Excerpts

Wednesday 3rd July 2013 Commons Chamber

[Mr Dorrell]

I do not wish to detain the House for the whole of the time available for this debate, but my hon. Friend raises an important question about how that demand is made up. The interesting thing about the drivers of demand—rising expectations, the cost and availability of modern medicine and the implications of an increasingly elderly population—which each new Front-Bench spokesman reveals as a newly discovered truth, is that they were first discovered by Rab Butler when he became Chancellor of the Exchequer in 1951. He set up a commission to ask whether the health service was an insupportable burden. The conclusion reached then, and by every successive Government since, in this and in similar processes in other countries, is that demand can be met, but it requires a serious analysis of the nature of the demand and how resources are used effectively to deliver it.

There is a danger in discussing health and care as if they were purely an economic question, especially for those of us who have been employed in the Treasury—like you, Madam Deputy Speaker, and me. There is a danger of sounding like a Treasury Minister and implying that the economic questions are the only issues in this regard. I need only offer names to the House to demonstrate that economics is not the only issue here—Winterbourne View, Mid Staffordshire and Morecambe Bay. Our system faces huge challenges, not just to do with economics but in respect of the quality of service that is delivered on a daily basis. Put simply, it is not enough just to go on delivering the service as it is now because, too often, it fails. Implicit in the Nicholson challenge is the requirement to face profound quality challenges, as they exist in the system, at the same time as squaring the financial circle I have been describing. In some quarters, it is suggested that that is a counsel of despair—that the circle is unsquareable.

The Committee disagrees, which is why the report states, at paragraph 30:

“At a time when steadily rising demand for health and care services needs to be met within very modest real terms funding increases for the NHS and even tighter resource constraints on social care, the Committee remains convinced that the breadth and quality of services will only be maintained and improved through the full integration of commissioning activity across health and social care.”

In other words, it is the Committee’s cross-party view that it is the integration—the reimagining of what health and care need to look like—that is the answer to the questions posed both by the Nicholson challenge and the quality challenges implicit in the names that I mentioned. It is important to be clear why that is the Committee’s view.

Efficiency, as implicit in the context of the Nicholson challenge, is not just about buying a bit more cleverly or holding down costs. It is about understanding what the demand is that we are trying to meet and putting in place the structures—incidentally, I do not mean the management structures—for the delivery of care that are likely to be able to meet the demands placed on them, not over the last 50 years but over the next 20. It is reimagining and driving a process of change through the health and care system that is the only realistic challenge to the financial and quality challenges that I have articulated.

[Dr Phillip Lee (Bracknell) (Con)]

Talking of efficiency, is my right hon. Friend as shocked as I am to hear that the Department of Health spent almost £74,000 on outside consultancy to prepare for just one Public Accounts Committee hearing? If that is the case, the Department might want to lead from the front on efficiency.

[Mr Dorrell]

I am sure that my hon. Friend will forgive me if, faced with an estimate of £103 billion, I do not go through every £70,000 of expenditure. However, he has made his point.

This is where I believe the Committee has held the Government to account, although not always comfortably for the Government of the day. There is no solution to the Nicholson challenge purely through adjusting the numbers—to use a non-emotive phrase. It has been reported to the Committee that in the first two years of the Nicholson challenge, 73% of the efficiencies that have so far been delivered are attributable as follows: 16% to pay freezes, which is the point made by my hon. Friend the Member for St Ives (Andrew George)—yes, holding down wages does reduce the cost of delivery and is, in the short term, a form of economic efficiency, but it is not a long-term solution to the Nicholson challenge—and, most implausibly, 45% to just changing the tariff between the commissioner and the provider. That is not an efficiency; that is an internal transfer, a bookkeeping entry, accounting, make believe. Another 12% over the two years is put down as “other”, which is an old accounting technique for concealing not very much, usually.

--- Later in debate ---

[Dr Phillip Lee (Bracknell) (Con)]

The nature of this debate is such that one can talk about anything to do with the NHS, be it local or national, in the context of the estimates of costs. The figures in the documents are immense—£1 billion here, £50 billion there; perhaps we need to plant some money trees in this country—and will only increase, as we all know. It has been interesting to listen to Members on both sides of the House this afternoon. Everybody accepts that demands are rising. Obesity is increasing—26% of adults are obese and the proportion is rising—and our population is ageing, so that by 2030 almost 25% of the population will be over 60. On top of that, there are advances in medical technology and the costs thereof to deal with—today’s cancer drugs can cost upwards of £5,000, £6,000 or £7,000 per month per patient.

Given those demands and costs, maintaining the current service will inevitably become nigh on impossible. I sense, even in the Chamber, and certainly outside it, that the public are beginning to realise that. I will say a few words about that before going local and discussing some of the things I have been suggesting in my region, and “region” is the key word here, rather than constituency.

The figures are really quite shocking. It has been suggested that by 2025 around 25% of the NHS budget will be spent on type 1 and type 2 diabetes alone. Only this morning a colleague told me that he had been diagnosed with type 2 diabetes. It affects all groups in society. Around 21% of the population smoke and around 28% of the adult male population drink too much—the figure is about 20% for women.

The number of prescriptions in 2009 was 886 million. The total cost of the NHS drugs budget in 2009 was between £13 billion and £14 billion, and it increases by £600 million each year. We are getting cleverer at inventing new drugs and classes of drugs, so I suspect that those costs will continue to increase, because it is human nature for someone to want the very best drug, the drug that will cure their cancer or extend their life.

Cases of dementia are set to double over the next 10 years, which will have a profound impact on health and social care. There will be a huge impact on the economy, as families will increasingly have to spend more time looking after the vulnerable, rather than going to work. The ramifications are immense.

I have detected some recognition in the Chamber today, particularly from my right hon. Friend the Member for Charnwood (Mr Dorrell), that there needs to be some cross-party agreement on this. I suspect that we will be arguing over the next 10 to 15 years about how we pay for health care. I have been brave enough to suggest that relying solely on general taxation to fund health care is not practical in the medium to long term. It is difficult politics—trust me, I saw my Twitter account explode at that point—but I think that we are likely to have a debate on that, and an argument, across the House, and that is as it should be.

However, where we should not disagree is about the way health care is structured in this country. I think that for both parties—it is a plague on both houses—the introduction of the market into hospital health care and the use of private finance initiative contracts, particularly over the past 10 years, has made it extremely difficult to reconfigure hospitals in certain parts of the country, which is unfortunate.

I have also heard that the introduction of competition law and its possible implications with regard to reconfiguration is also looming large in the national health service. Government Front Benchers might want to look at that, because I am persuaded—I have spoken about this on many occasions—that in future we will need fewer acute hospitals but more community hospitals. The majority of care will increasingly be offered closer to home, or indeed in the home, but the clever stuff, such as the life-saving stuff shown in the television series that the BBC is currently broadcasting on Thursdays, cannot and will not be offered in the number of district general hospitals that we currently have. Anybody who thinks that it can be does not understand. I suggest that it is increasingly becoming good politics to save lives, not to defend the indefensible, and I think that Members on both sides of the House should reflect on that.

One example from that television series was a nasty accident involving a head-on collision 30 minutes north of Addenbrooke’s hospital. The injured did not go to the local hospital, which had recently opened, because it could not care for them; they went 30 minutes down the road to be treated at Addenbrooke’s. In other words, a hospital that had been built in the past few years was already not fit for purpose. We should reflect on that.

Reconfiguration is essential, and it has been shown—not least in respect of London stroke services—to save lives and improve care. That should be replicated across the country.

[Mr Kevan Jones]

The hon. Gentleman is speaking a lot of sense. The stroke unit in the north of County Durham has just been specialised, and the results are already showing the benefits, although in parts of the region there was a lot of opposition to the move.

Does the hon. Gentleman think that long-term health should be managed not only by doctors but by pharmacists and others, who can play a key role?

[Dr Lee]

I am pleased that services are improving in County Durham; as the hon. Gentleman knows, I have family roots in his part of the world that go back centuries. I am not persuaded of the role of pharmacies, although I am persuaded of the role of pharmacists. I distinguish between the two because I personally think that all GP surgeries should be dispensing drugs. I do not see why the taxpayer should be subsidising pharmacies.

It is no surprise to me that Boots was the biggest ever private equity buy-out in the history of British industry, given that the taxpayer is outside the front door: “Come here for your amoxicillin, and while you’re here you can get your shampoo, conditioner and royal jelly.” I am not convinced about the role of pharmacies in the longer term; pharmacists most certainly have a role and should be included. Community pharmacists should be checking drugs, particularly when patients have polypharmacy—when they have a multitude of medications, another pair of eyes is always appropriate.

To return to the reconfiguration, in my locality we have a number of district general hospitals. Historically, Bracknell itself has been under-served by acute services since it was created in the late ’50s or early ’60s. We have seen services diminish in the area for a variety of reasons and under Governments of both parties, and we are sensitive about that.

Before I was elected as Member of Parliament for Bracknell—I stress that it was before I was elected—I suggested as part of my campaign that we needed to close hospitals in the area and consolidate to improve clinical outcomes. I am not aware that my result at the election was adversely impacted by that. Having worked in the area as a GP for a number of years and looked after 50,000 patients, I guess that people trusted what I was saying, and I recognise that.

I was trying to argue that we could consolidate acute services on a single site and improve community hospital services in appropriate locations around the region. I stress the word “appropriate”, as the problem is often that, for a variety of legacy reasons, hospitals are in inappropriate locations. They are not often on motorways, but on land bequeathed before the war. In my part of the world, the Astor family bequeathed the land for Heatherwood hospital. The local farmer outside Slough bequeathed some land because his daughter was looked after well. People thought, “Okay, we’ll build a hospital in the middle of a farm field nowhere near the population that it seeks to serve.”

There is a legacy problem. There is some need to close and relocate, while in some parts current locations can be enhanced. In my locality, there is the problem with Heatherwood hospital. I must put on the record something bizarre that frustrates me. It is “blue on blue”; if I was in a defence debate, it would be called friendly fire. The Royal Borough of Windsor and Maidenhead has called for a judicial review of the relocation of a minor injuries unit just three miles down the road, would you believe, to Bracknell—an urban centre in a better location and away from a place opposite the Royal Ascot racecourse. That judicial review will delay the move and cost money. I find that baffling and bizarre. It is evidence of the problem that I guess all colleagues of both political colours experience in local politics with regard to health care and trying to change services for the improvement of clinical outcomes, because it is not about cost, although obviously that is a factor, but about improving clinical outcomes. That frustrates me, and I will certainly be dealing with it robustly in local terms. At the moment, it is in the best interests of the general public to have fewer acute hospitals.

[Andrew Percy (Brigg and Goole) (Con)]

My hon. Friend is making an interesting point. Does he agree that in applying solutions such as those he is espousing, we must be careful that we do not apply an urban solution to rural areas? Moving an A and E three miles might be acceptable, but moving it 30 miles would not be acceptable to a lot of us.

[Dr Lee]

My hon. Friend is right: in a rural location the distances become further. I do not know the particular situation in his region, but I would suggest that there are probably location issues with regard to existing hospitals.

Moving neatly on, that is why—yes, you heard it here first: a Conservative calling for a Soviet-style central plan—I have called for a national plan for acute and emergency care. By definition, we cannot have a market interfering in that; we need to look at it in the round and say, “Where would we put these hospitals? Where are the motorways? What is the population density? Where is the rural location? Where is the urban location?” The problem is that if we reconfigure in isolation—I have seen this locally—it has a knock-on effect on other hospital services which then say, “Where are we getting our patients from?”

We should have a national plan that everyone from both parties has bought into. We should have—dare I say it?—a cross-party party committee looking into this. We should take it out of the political exchanges that we all engage in. We know what is going to happen in certain quarters in 2015—it will become a political football. I know that my hon. Friend the Minister is very aware of this. That is dreadful when we are talking about saving lives. Let us try to take this out of party politics. We can have robust exchanges, on principle, about payment, about how services are commissioned or not commissioned, and about whether there should be top-down reorganisation, but the fundamental question of where hospitals—acute and community hospitals—are located should be decided nationally; otherwise we could have perverse decisions whereby some services wither on the vine and we end up with gaps in emergency and acute care across the country. I make a plea for some cross-party activity on this.

Let us put the national health service’s budget into context. This country has debts and liabilities in excess of five times the size of our economy, and the situation is getting worse. Almost 40% of spending is on health and welfare, and it is growing. We know that that will happen; we have heard it this afternoon. Let us be realistic: there is only so much we can afford. I genuinely want a service that is based on clinical need. I genuinely want somebody to arrive at the appropriate location and get the very best care available. I fear that if we continue along this path of denial as regards how the service is paid for and, more important, structured, we will end up with more and more scandals. There are more in the pipeline. The chief executive of Tameside hospital has just resigned.

The public out there want more from us. They want us to make some difficult decisions, for sure, but using evidence, not party politics. I make that plea to everybody. If we can do that, we can structure a service that becomes the envy of the world; it is not that at the moment. However long I end up staying in this House, if that is achieved in the time I have been here, I will retire a happy man.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Before I call the Front Benchers, may I remind Members that if they are going to bring mobile phones into the Chamber they must be on silent and that they should not wait for them to ring? This is not the first time I have said that, but I certainly want it to be the last. Has the hon. Member for Strangford (Jim Shannon) taken that on board? Excellent.