NHS Reorganisation

Rosie Cooper Excerpts

Wednesday 17th November 2010 Commons Chamber

[John Healey]

Part of the problem is that there is so little detail in the White Paper that we simply cannot see how the bodies taking big decisions about taxpayers’ money will be accountable to the public. I lost count of the number of times during the last Government when Health Ministers came to this House and to Westminster Hall and had meetings with Members in order to respond to and sort out the problems that their constituents were experiencing with NHS services.

What the Secretary of State says he wants from the White Paper plan is to put patients first, to improve health care outcomes, to cut bureaucracy and to improve efficiency. These are “motherhood and apple pie” aims. We can support his aims, but we cannot support the action he is taking or the breakneck speed with which he is forcing these changes on the NHS. He wants shadow GP consortiums to be in place by April, and he will remove primary care trusts entirely two years after that. What he is doing is rushed and reckless. Almost every respondent to the White Paper has warned of the risks and said, “Slow down.”

[Rosie Cooper (West Lancashire) (Lab)]

Is my right hon. Friend aware that yesterday the Health Committee was told by health service organisations that some London PCTs would close by March 2011? Is anything happening in that regard? We know that there was a suggestion that PCTs would close in 2012, but we heard for the first time yesterday that they might close in 2011.

[John Healey]

I am very concerned if those plans are being speeded up rather than slowed down, because that would be entirely contrary to the view that has been consistently expressed by patients groups, experts in the NHS and professional bodies in response to the consultation on the White Paper. “Too far, too fast,” says the King’s Fund. According to the NHS Confederation:

“It will be exceptionally difficult to deliver major structural change and make £20 billion of efficiency savings at the same time.”

The Alzheimer’s Society says:

“The pace of structural change has the potential to undermine the progress made in services for people with dementia and their families, unless handled carefully”.

Almost every other group representing patients says the same. Even the chief executive of the NHS has written to the Secretary of State saying:

“Implementing the White Paper will require us to strike the right balance between developing early momentum for change and allowing enough time to properly test the new arrangements. Getting this balance right will be critical to maintaining quality and safety”.

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[Mr Lansley]

Yes, my hon. Friend makes a good point. What we are looking for is not a league table at all, as health care should not be regarded in that way; we are looking for proper benchmarking to take place. We are going to benchmark this country’s performance against that of the best health care systems around the world—the Labour party never did that—and we are going to ensure that there is a culture of continuous improvement in the NHS in respect of both the one-year and the five-year cancer survival rates, which my hon. Friend rightly mentioned.

The reforms that I was talking about are not a radical departure from the past. The principles of the White Paper should be what the NHS has always been about, but it has been distracted too often by the bureaucratic processes that the Labour party was always supporting. Let me make it clear that many of the things that we are doing were championed by former Labour Ministers. When John Reid was Health Secretary he championed patient choice, and we know why. His view was, rightly, that in the NHS, in a bureaucratic system, the articulate middle classes get access to the best health care, and it is only through institutionalising and embedding patient choice—shared decision making for every patient—that we will ensure that the most disadvantaged in society get the right access to health care.

As for GP-led commissioning, the Labour party was supposed to have introduced practice-based commissioning.

[Rosie Cooper]

rose—

[Mr Lansley]

I am not giving way, so the hon. Lady must sit down. [Interruption.]

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[Rosie Cooper (West Lancashire) (Lab)]

I often comment that when I became an MP I did not get two items that would have made life so much easier—tarot cards and a crystal ball. In considering the coalition Government’s health policy, they would be essential tools for the job, because before the general election, the statements of the Leader of the Opposition—now the Prime Minister—gave us the impression of a future for the NHS that was completely different from the one we now face. He said:

“We are the only party committed to protecting NHS spending…I’ll cut the deficit, not the NHS.”

He spoke about a period of organisational stability in the NHS. Those were broken promise No. 1 and broken promise No. 2. Instead, we are faced with a vision from the Secretary of State which could set us back 20 years. I say so not as political rhetoric, but from 30 years’ direct involvement in the NHS, including 10 years as chair of a hospital.

The press seems to share that pessimistic view—“extraordinary gamble,” “cocktail of instability,” “accident waiting to happen”—hardly a ringing endorsement of the Government’s health policy. For me, it is a recipe for disaster: one part reduced financial resources, two parts structural reform and three parts break-neck speed—

[Lyn Brown]

Does my hon. Friend agree that the estimated cost of £2 billion to £3 billion for the reorganisation could be far better spent on outcomes for our citizens and treatments for our children?

[Rosie Cooper]

Absolutely. I am sure the Secretary of State will give due cognisance to the comments being made, especially about putting resources right there on the front line, delivering for the very people who are paying the wages.

In his evidence to the Select Committee on 20 July, the Health Secretary set out five aims of the White Paper, and he went through them here today. I shall review some of those in the light of the dribbles of information that we have received, and see how they stand up. The first aim was creating a patient-led NHS. Let us start with the Secretary of State’s glib catch-phrase, “No decision about me without me”—

[Mr Lansley]

Glib?

[Rosie Cooper]

Yes, glib. Where is the substance? Will it make any difference if the GP consortiums do not agree with the Secretary of State? Will those consortiums meet in private or in public? Will he listen to those patient voices? Will he be able to hear them?

[Jim Shannon (Strangford) (DUP)]

Does the hon. Lady agree that when it comes to prevention and early diagnosis of diseases, the GP and what happens at the clinic and the surgery is critical? Money can be saved in the long term. Perhaps that is what the Government should be doing—making sure that money is there on the front line, in the GP surgeries and in the clinics.

[Rosie Cooper]

Nobody could disagree with that.

The NHS will be one where the area and street where people live will determine whether they have access to certain drug treatment, because of the weakening of NICE and a shift back to value-based pricing, placing drug companies back in control, and a return to postcode prescribing—an NHS where people may or may not get certain operations. Already in my area, across Lancashire, primary care trusts are reviewing funding for 70 procedures, so if patients require an endoscopic procedure for their knee or back, or a hysterectomy, those may no longer be available.

How far people travel to their hospital depends on whether they have a hospital close by that offers the treatment that they need. On 26 October at the Select Committee, various witnesses gave evidence that hospital closures will be necessary to release moneys back into the wider health service. How many patients would agree that such a state of affairs is part of a patient-led NHS? Not many, I bet.

Improving health care outcomes was the Secretary of State’s second aim. It seems highly unlikely, given that the ability to deliver improved outcomes is reliant on front-line services and the availability of the staff to deliver them. The Royal College of Nursing expects to lose 27,000 front-line jobs. That is the equivalent of losing nine Alder Hey children’s hospitals. The work of the RCN suggests that under the guise of 45% management cuts, the NHS will lose health care assistants, nurses and medical staff—front-line cuts by stealth.

All this must be set in the context of what was said to be the lowest financial settlement since the 1950s, reputed to be 0.1%—as we heard today, that is already disputed—together with massive pressure on NHS budgets from increased VAT costs—[Interruption.]—redundancy payments, budget short-falls and hospitals having tariffs frozen—[Interruption.]

[Madam Deputy Speaker]

Order. The Secretary of State does not need to shout across the Chamber. He has had his time.

[Rosie Cooper]

It would help if I could hear the right hon. Gentleman, but never mind.

The difficulties are topped up with increasing demand for services, an ageing population, an increase in the number of people with complex illnesses and the rising cost of treatment. That is all very worrying.

At the Select Committee the Secretary of State spoke about increasing autonomy and accountability in the NHS. I have raised that with him on a number of occasions and I tried to intervene today. It is a further example of the two health policies of the Administration, one mythological and the other the reality. Perpetuating the myth, the Secretary of State said at the Select Committee that

“the conclusion that we reached was that we could achieve democratic accountability more effectively by creating a stronger strategic relationship between the general practice-led consortia and the local authority.”

We might imagine that that meant patients and elected representatives at the heart of decision-making, and that the consortiums would operate with councillors on the board, who would be able to vote, but no. Scrutiny will come from well-being boards, which means that patients and councillors will not be there offering their opinions and able to vote. Well-being boards, like the current NHS overview and scrutiny arrangements, may as well not exist because they will be nothing more than a focus group.

I said at the Select Committee that those arrangements were nothing short of throwing snowballs at a moving truck—they would make little or no difference. The Government are giving a budget of more than £80 billion to GPs who just want to practise medicine and not get involved in the experiment.

[Lisa Nandy (Wigan) (Lab)]

May I mention the issue of GPs and safeguarding, the key role that GPs play in keeping children safe, and the fact that if they are spending time commissioning services, who will fulfil that vital function?

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[Rosie Cooper]

We need to get more GPs to do that, and I think that is what the Secretary of State is trying to say.

The Government plan no testing or pilots, just a big bang, using consortiums as a shield to deflect criticism from them, rather as they currently use the Liberal Democrats.

The fourth aim was promoting public health. Everybody agrees that prevention is key to easing the cost burdens further down the health pathway, so if we were serious, we would be doing more about promoting public health. Simply allocating 4% of the NHS budget and giving it to cash-strapped local authorities does not seem the best and most effective way of promoting public health. We await more detail, although that might be as difficult to follow as the Department of Health’s £1 billion allocation to social care.

That brings me to the fifth aim of the White Paper. Following the publication yesterday of “A Vision for Adult Social Care” by the Department, the foreword gives us a sense of where we are heading with the Government’s policy. Under the third value, responsibility, it states:

“Social care is not solely the responsibility of the state. Communities and wider civil society must be set free to run innovative local schemes and build local networks of support.”

I wonder whether that is code for “We’ve got no real money to invest. Local authorities are not going to be able to meet the demand. Oh well, you’d better get on with it yourself.”

It is no use the document quoting Frederick Seebohm from 1968, as that might not reflect the world of today. As an ideal, it is great, but not every family and every individual can offer the help and support that are required. There are incredible strains on hard-working families and individuals trying to make ends meet while struggling to provide care for ill and elderly relatives—

[Madam Deputy Speaker]

Order. Time is up.

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[Mr Brine]

No, there is absolutely no reason for them to do that. My right hon. Friend the Secretary of State for Communities and Local Government will make an announcement on council funding, but the Secretary of State for Health has already announced in the comprehensive spending review that the Government have allocated moneys for social care.

I know that the Labour party will try to rubbish our proposals, and that is their choice. My point is this: the people I represent do not care much about how the NHS is structured, but they care a great deal about ensuring that their NHS is there when they need it. They pays their money, and they expect the NHS to be there when they need it, free at the point of use. That is the cornerstone of what we are proposing.

I am very happy to defend outcome-focused, GP-led commissioning for my constituents. Every health care system in the world worthy of the name has the GP-patient relationship at its heart, and our proposals for GP consortiums seek to strengthen that for the sake of all the people we represent. Why on earth would we propose anything different? GP consortiums are an enormous opportunity for the NHS, and the perfect way to further the “no decision about me without me” agenda that is so important. I do not think that that is glib, as an Opposition Member said earlier. It is about rejecting the “Like it or lump it—this is the service you’re going to get” view that we have heard for far too long in our health service.

[Rosie Cooper]

I would like to state on the record that the expression is glib when it is uttered by a Secretary of State who does not back it up, who does not place patients at the centre, who will not have patients or their elected representatives serving on consortiums and who makes grand statements that are baseless and meaningless.

[Mr Brine]

I am sorry I gave way; I expected something else. I do not think for one minute that it is glib. We are not suggesting that every single patient will be involved in every single element of their care, but how could anybody disagree with “no decision about me without me”?

GP consortiums are an opportunity for the health service finally to realise one of its original aims—the sophisticated management and prevention of illness through the intelligent use of the patient list. That is still a largely untapped resource in our national health service.

GPs I speak to are up for their new role in commissioning for their patients. Of course they have questions—it would be strange if they did not—but they are not calling, as the Opposition’s motion is, for us to ditch our plans because things have got difficult and they have a fear of change. The Opposition cannot have it both ways. They support our plans for more GP involvement in patient care, but call plans for GP consortiums inefficient and secretive.

I see my job as a Member of Parliament as being an important link in helping GPs to answer some of those questions about consortiums that are coming down the line. I know that my right hon. Friend the Secretary of State has met groups of GPs in other areas of the country, and I ask him today to check his inbox because an invitation from me is coming his way.

As we know, following the establishment of GP consortiums, primary care trusts will no longer have NHS commissioning functions. It would be nonsense to create GP consortiums and keep two other tiers of management commissioning alongside them. Investment in the NHS has not been matched by reform. Yes, we will protect NHS investment, but our reform agenda builds on the best of the reform process over the previous 20 years. An Opposition Member said that we reject everything that went on under the previous Government, but of course we do not. We have made that very clear. These proposals build on Labour Government measures such as practice-based commissioning and NHS foundation trusts, and rightly so.

I sometimes hear it said—I heard it put to my right hon. Friend the Secretary of State yesterday morning on the “Today” programme—that the Government’s health policy was a bit of a surprise to everybody. I do not know why that would be. I mentioned earlier that the Health Secretary visited the Royal Hampshire county hospital. That was in May 2008, and he discussed the policy with people there then. He will remember the visit.