Health and Social Care Bill

Sarah Newton Excerpts

Monday 31st January 2011 Commons Chamber

[Sarah Newton (Truro and Falmouth) (Con)]

Thank you, Madam Deputy Speaker, for calling me to speak in this most important debate. The scope of the Bill is far reaching and other Members have covered many aspects in their contributions, so I want to focus on one area—that of the future governance of the NHS.

The Secretary of State has identified a powerful and simple concept that resonates with people across the country—that “No decisions taken about me should be taken without me.” While this concept is usually applied to the individual relationship between the patient and clinician, I believe it is just as applicable to the communities that the NHS serves in any particular area.

As we have seen from campaigns across the country, people do not want decisions about the health and care services available to them in their community to be taken without the opportunity to get involved in the decision: “No decisions about us without us.” Over the last few years, I have seen the lack of openness, the lack of transparency, the lack of consultation and the consequent fear and suspicion that that brings.

I realise that not everyone will want to become involved in local decision-making and that many are happy to leave it to others, but I believe that we are right to enable more resilient and empowered communities to shape their own futures. Giving more power to the people is as important in the context of decisions about health and well-being as it is in the context of decisions about planning, homes and the environment.

The Bill is nothing short of a revolution in terms of the devolution of decision-making power to people in their communities, accountability, and the governance of health and care services. First, it links two crucial services. For too long the separation of those services, and the silo mentality governing the care delivered by local authorities and health services commissioned by primary care trusts, have prevented care pathways from being developed effectively in a way that works for the patient, which has often closed off the vital role played by families, carers and volunteers in supporting people. There cannot be a Member in the House who has not had personal experience of that, or shared the experiences of elderly constituents who have been bundled around the system, described as bed-blockers and made to feel a burden.

Of course, in some parts of the country health and care services have been integrated, but they are in the minority. The Bill, and the money that the Government are making available to help fund the integration, will enable all parts of the country to develop the high-quality, joined-up services that are currently available only to a few.

[Stephen Lloyd]

I agree with much that my hon. Friend is saying about integration and the need to work with the community, and I applaud many of the changes made by the Bill. For years we have all talked of using pharmacists in a smarter way. Does not the Bill provide an opportunity for much more integration of community pharmacy with the consortia, and for the Government to support the consortia in that endeavour?

[Sarah Newton]

As someone who represents a rural area of Cornwall where GPs’ delivery of pharmaceutical services is vital, I think that that is an extremely good idea.

Secondly, the new responsibilities of Monitor and the Care Quality Commission will make possible independent regulation of both quality and safety of care and value for money. I have observed the problems that have occurred in recent years when managers have evaluated their own compliance with standards. Good decisions can be made only with sound evidence. The powers of the National Institute for Health and Clinical Excellence and the Information Centre will be enshrined in legislation for the first time, and their independence from Government will thus be guaranteed.

Thirdly, the Bill creates a new role for local authorities in public health. Directors of public health, jointly appointed by Public Health England and local authorities, will play a leading role in the discharging of authorities’ public health functions. Arguably, it was the initiatives of local authorities in past centuries—such as the introduction of fresh water, drains, sewage management and the controlling of vermin—that led to some of the most significant improvements in life expectancy.

[Anne Marie Morris]

Is not one of the real strengths of making public health part of the role of local government the fact that housing, which is a critical issue to public health, can be viewed in the round?

[Sarah Newton]

I entirely agree with my hon. Friend, who has anticipated a point that I was about to make.

The returning of more responsibility to local authorities—along with the considerable social determinants of health for which they are already responsible, such as the availability of good-quality housing and the regulation of places of work, environmental health and leisure services—has the potential to improve health outcomes, and to close the ever-widening gaps in health equalities in this country.

The Bill will ensure that every upper-tier authority establishes a health and wellbeing board consisting of the director of public health, GP consortia, children’s services, adult services, care providers from all sectors, and local health watch organisations. Such boards should provide local leadership and a strategic framework for the co-ordination of health improvement and the addressing of health inequalities in their areas. The joint strategic needs assessment will be integral to the process, and will influence the commissioning of services. The local health and wellbeing boards will, in effect, hold the ring when it comes to the health and care services provided in their communities. Local authorities will maintain and extend their role as scrutineers of all services, whether they are commissioned locally or nationally and whether they involve health or social care. They will also be able to commission complaints and advocacy services from any provider, rather than just from the local or national health watch.

The Local Government Association has warmly welcomed the proposed changes. The best local authorities have good experience of working with public, private and not-for-profit organisations as well as the charity sector in delivering integrated care. They are used to planning person-centred and personalised care.

I believe that—along with the changes that the Secretary of State has already made to the operating framework of the NHS in relation to the reconfiguration of services—the Bill, when effectively implemented in communities across the country, will lead to greater openness, greater accountability, and greater confidence for all those working in health and care, as well as for the ordinary people up and down the land who have lost so much confidence in the way in which decisions are made. These changes will take time, but I am confident that within the next four years, when we ask the people of this country, “Do you feel that decisions are being taken about you and with you?”, many more people will say “Yes” than would do so if asked that question today. That is a result that I shall be proud to have played my part in achieving.

--- Later in debate ---

[Dr Sarah Wollaston (Totnes) (Con)]

It is easy to see why politicians continuously want to fix the NHS. The perspective from the green Benches is very different from the perspective one gets as a GP—I say that having worked in the health service for 24 years. My surgeries and postbag, and I am sure those of other Members, are full of stories of delays, frustrations and sometimes really poor practice. The trouble is that not enough people write to their MP to tell them how sensitively or compassionately they have been treated, or how the NHS saved their life. They do feel those things, however, and they do appreciate the NHS. That is why they are understandably wary of any changes, proposed by whatever Government.

Here are the things in the Bill that I welcome. I really welcome clinical leadership. We should be in no doubt about this: there is clear evidence that commissioning works best when there is clinical leadership backed up by excellent management. The Bill will go some way to pushing us towards true clinical leadership in all parts of the NHS.

The provisions will also result in an information revolution. That will involve information about not only whether someone’s treatment worked but what the experience was like—a kind of TripAdvisor for the NHS. We all know that, with information, daylight is the best disinfectant. If people know that their performance is going to be compared with that of others, that is likely to drive up performance in the NHS.

The provisions will allow for that early scan that can make all the difference in an early diagnosis of cancer. When GPs can commission very good early diagnostics much more quickly, we will see a difference. The changes will also give GPs much greater flexibility to respond to their own area. In Devon, for example, community hospitals are really important, but they might not be so important in inner cities. The provisions should also give better choice to services such as mental health, and bring in opportunities for the voluntary sector. I recently met a group of carers for patients suffering from mental health difficulties, and they told me that they wanted better access to talking therapies. Rather than the support that has traditionally been supplied to them, they want better access to other kinds of support. I also really welcome putting public health back where it belongs, with local authorities.

Our spending now matches the European average, and I genuinely congratulate the Labour party on that, but I am afraid that that has also been a wasted opportunity. It is unforgivable that so much of that money was squandered, and that we have seen flat-line productivity. For that level of spending, patients should be able to expect the kind of services that people receive in France or Germany. I am sure that we have all heard instances of people coming back from a holiday on the continent with a minor condition, having had a scan and treatment within a week. We should be able to deliver that here. Health care workers should not have to spend three weeks chasing down a patient’s results. I am sure that we have all heard instances of that, as well.

The challenge is to improve aspects of the NHS, to look at the detail, to listen to patients and professionals and to ensure that we get this right. In Torbay, they have been getting it right for some time. It has been part of a national pilot of integrated care. Baywide, a not-for-profit company of local GPs, commissions health and social care from a pooled budget.

[Sarah Newton]

My hon. Friend mentions GPs working together on a not-for-profit basis. Does she share my huge disappointment at some of the terribly derogatory comments made by Opposition colleagues about GPs’ motivation, comparing them to the worst kind of bankers in the City? Is it not disappointing that they are so disrespectful to GPs?

[Dr Wollaston]

I agree with my hon. Friend. We have heard some terrible slurs about GPs profiteering and lining their own pockets. I am absolutely confident that that is not what we are going to see.

Torbay has been highly successful because it has pooled budgets and it can design integrated care. That saves lives and money. No one should be in any doubt that improving the quality of care, and thereby the quality of life, for those with complex, long-term conditions is the key to improving health care and cutting costs.