NHS Risk Register

Richard Graham Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Sajid Javid (Bromsgrove) (Con)]

rose—

[Richard Graham (Gloucester) (Con)]

rose—

[Alan Johnson]

I will give way again later.

The most important reforms that are necessary now are to integrate health and social care, to improve care for people with long-term conditions and to move from a hospital-based service that was designed for a different age. All three reforms—

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[Richard Graham]

On a point of order, Mr Deputy Speaker. As the business of the day is specifically focused on the publication of the NHS risk register, is it in order to describe the register as a secondary issue?

[Mr Deputy Speaker (Mr Nigel Evans)]

May I advise all Members that they should not resort to a device such as this, as it is an argument in continuation of the debate. Many Back Benchers want to get into the debate, so Members should not misuse points of order. That was not a point of order for the Chair.

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[Alan Johnson]

My hon. Friend makes an important point.

As Health Secretary, I cancelled ITC contracts where there was sufficient NHS capacity, and I approved them where there was not. I recall a visit to the Derwent centre in Bournemouth, where the NHS had taken over a hospital from BUPA and was doing knee and hip replacements more quickly than the private sector. That transformed elective surgery, but although competition is good for elective surgery it is far less important than collaboration in managing chronic disease. I agree with the NHS Future Forum, which said in a report last year:

“The place of competition should be as a tool for supporting choice, promoting integration and improving quality. It should never be… an end in itself.”

The NHS is not a collection of separate and autonomous units of varying degrees of independence, responding to the invisible hand of the market. It is, above all, an integrated health care system. The fear of the vast majority of clinicians is that the Bill will damage that crucial principle.

[Richard Graham]

rose—

[Alan Johnson]

I shall not be taking an intervention from the hon. Gentleman.

When it comes to integrating social care with health, people want an adult social care system that resembles the NHS, not an NHS that resembles the current adult social care system. The very real fears about the Bill, particularly in respect of commissioning, were highlighted recently by the Health Committee. If the necessary economies are to be made, the provision of health and social care must be planned together, and, despite its title, the Bill is hindering that process. Yes, it includes the word “integration”, at a late stage, but the word just sits there doing nothing more than suggest that this is the spirit that the Bill will introduce, and it is not.

The one sensible decision made by the Health Secretary was the one to retain the services of Sir David Nicholson as chief executive of the NHS. The goal of achieving efficiency savings of 4% a year to reinvest in patient services is a noble one, but its achievement will be particularly difficult for the acute sector. What seems to be happening at present is that hospitals are cutting services to save money. What needs to happen, and what the Nicholson challenge envisaged, is the transformation of services to eliminate waste by, for instance, reducing readmissions and bringing care much closer to the patient. Of the £80 billion spent by PCTs in 2009-10, nearly half went to hospitals, the most expensive form of care, while primary care received only a quarter.

When I asked the distinguished colorectal surgeon Ara Darzi to lead 2,000 clinicians in moving the NHS to the next stage of its development by focusing remorselessly on quality, he produced a report that was radical in its concept if a little boring in its detail. Government Members could do with a bit of “dull and boring” on the NHS at the moment. The proposals required no reorganisation and very little legislation.

At that time, the Conservative party was promising a bare-knuckle fight to defend the district general hospital, and siding with the British Medical Association to stop patients accessing GP surgeries later in the day and on Saturday mornings. If the Nicholson challenge is to work, it must be accepted that the vision of the district general hospital as all-singing, all-dancing, and capable of providing all clinical procedures must change. There is no political leadership on that, there is no leadership from the Government—

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[Mike Freer (Finchley and Golders Green) (Con)]

The issues underpinning the debate are purely ideological, and no amount of amendment—[Interruption.] Exactly. It is not about making the NHS better; it is about purely ideological opposition to reform.

[Richard Graham]

I am very grateful to my hon. Friend for giving way, which the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) did not do.

Does my hon. Friend agree that the speech we have just heard from the right hon. Gentleman had nothing whatsoever to do with the motion under discussion? He did not mention the NHS risk register once, except to say that it was a “secondary issue”. To all the rest of us here, it is “the” issue under discussion. Was not the right hon. Gentleman’s speech simply a whitewash of his own time as Secretary of State for Health?

[Mike Freer]

My hon. Friend has made a very good point. The issues that have been raised have nothing to do with the risk register. This is simply a new stick with which to beat the Government. No amount of amendment and no amount of rational argument will appease those who are simply philosophically opposed to reform of the NHS.