Health and Social Care

Rosie Cooper Excerpts

Monday 27th February 2017 Commons Chamber

[Rosie Cooper (West Lancashire) (Lab)]

The Department of Health explanatory memorandum on the supplementary estimates sadly has the feel of rearranging the deckchairs on the Titanic. The estimates and the reports highlight the extensive range of issues facing the NHS. My involvement in health issues in West Lancashire, from individual constituents’ cases to the commissioning of multimillion pound contracts, tells me that my constituency is a microcosm of the questions to which the multitude of bodies within the NHS need to find answers. My constituents can wait up to a week for a telephone conversation with a GP to assess whether they need an appointment—they then have a further wait for the appointment—so is it any wonder that people turn to A&E and minor injuries units?

Clinical experience at the top is laudable and to be welcomed, but there is a shortage of GPs and lost capacity because of the time GPs spend on clinical commissioning group governing bodies. In West Lancashire, CCGs have handed community health and urgent care services contracts to private providers, potentially threatening the future of Southport and Ormskirk Hospital NHS Trust by removing services and essential financial turnover. The chair of the CCG is a local GP who spends three days a week on CCG business. Five further GPs have executive lead responsibilities. Apart from the loss of capacity, there are the financial considerations of GP remuneration for their work on the governing body. One GP earns more than £100,000 a year for that three-day week, while the chief accounting officer is also on approximately £100,000.

There is a fundamental lack of direct accountability of CCGs, which I understand are the responsibility of NHS England. GPs hand out contracts to private providers in the face of significant and substantial local opposition in West Lancashire, and there is no mechanism for meaningful accountability for how those GPs spend taxpayers’ money. My constituents did not get to vote on who represents them on a CCG, and they have no means by which to replace them if they do not believe the GPs act in their best interests.

The question arises whether NHS England and NHS Improvement have enough resources to deal with the increasingly complex contracts and structures they are supposed to supervise within the NHS. Threats to the smaller acute trusts come both from local GPs and from the sustainability and transformation process, the name of which is increasingly a misnomer. The plans were quietly generated by small groups of people without the involvement of most of those who need those services or their public representatives both locally and nationally. Some of us miss strategic health authorities. I would be interested to hear from Ministers whether the STP process will provide capital resources to enable hospital trusts to develop transformational change projects.

Increasingly, NHS Improvement and NHS England cannot agree on the current state of NHS finances. NHS Improvement’s forecast for this financial year has worsened in each financial quarter. Currently in quarter three, it forecasts a deficit of £873 million, while NHS England appears confident that the final deficit figure will be no more than £580 million. I took a deeper look at the figures for quarter three. A huge question appears when we look at the sustainability and transformation fund moneys the Government have given to trusts. Admittedly, trusts retain the allocated funding only if they achieve certain financial targets at the end of the financial year. If they do not achieve those targets, the extra funding disappears like snow in July. The system deficit could therefore be much greater.

The Department of Health’s funding of the NHS has a consequential impact on services, but we are also witnessing savage cuts to local authority budgets. As the provider of social care, Lancashire County Council is perilously close to being bankrupt in the next five years based on current funding projections. We talk about health and social care as if they are absolutely intertwined, yet the Government allow the competitive existence between the two services to continue. As both systems seek to survive financially, each body makes decisions to seek to minimise their expenditure. The social care system is unable to get people out of hospital, while hospitals seek urgently to discharge medically fit patients. I have a great fear that, as each day passes, the struggle for survival owing to the ever-tightening financial strictures imposed by the Government, and their lack of solutions, means that patients are getting lost. Organisational form and financial considerations mean that patients are a distant third on the priority list.

I do not know whether creating chaos and turmoil within the system is part of a longer-term strategy to lead us to a new healthcare system of private providers and health insurance—the Secretary of State will have to answer that one. What I see from the estimates provided for the transfer of moneys between budgets is that we are just tinkering at the edges of a system that needs to be properly financed. We cannot just shove a few pennies into the left hand while taking pounds from the right. Our NHS and our constituents deserve so much better.