Health and Social Care

Sarah Wollaston Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

As this is the first time that I have spoken in this Parliament, may I state for the record that I am married to a full-time NHS consultant forensic psychiatrist who also chairs the Westminster liaison committee for the Royal College of Psychiatrists and will shortly be taking up a role as the registrar of the Royal College of Psychiatrists? I also have a daughter who is a foundation junior doctor and another daughter who is a medical student. The House will be pleased to hear that my son has managed to escape; perhaps his handwriting was not quite bad enough.

I was honoured to have worked as a front-line clinician in the NHS for 24 years, and I wish to start by extending my thanks and paying tribute to all those colleagues who work across the NHS with such professionalism and compassion. In replying to the Gracious Speech, I wish to touch on four areas: the workforce challenge; the financial challenge; volunteering; and issues around prevention.

I was so pleased to see the Five Year Forward View right at the centre of our commitments in the Gracious Speech. I am talking about the commitment not just to back the Five Year Forward View but to the £8 billion that we will need by 2020. I ask the Government to front-load as much as possible of that £8 billion, because what we see alongside that £8 billion is the need to make £22 billion of efficiency savings. Ministers will know that in the previous Parliament those efficiency savings were largely achieved by pay restraint in the NHS, but in the long term pay restraint will start to have implications for recruitment and retention, which are already major challenges for the NHS.

I welcome today’s announcement because it was unsustainable to continue spending £3.3 billion a year on agency costs. Using agency staff not only leaches money from the NHS that could be better spent elsewhere, but has an undermining effect on permanent staff in the NHS. In fact, it starts to have a domino effect on the ability to retain staff, so it is simply unsustainable. When the Minister responds, I hope she will set out how the caps on those rates, which I welcome, will play in relation to the rates that are paid to NHS bank staff and give us more detail about the arrangements. Where there are crises in staffing, we need to know that safety will be paramount and how those caps will be overruled in emergencies. It is important that that clarity is delivered across the NHS.

Recruitment and retention are about not just pay rates but staff morale and the way that staff feel valued. They are also about the ability of staff to work in teams. We need to consider the effect of increased shift working across the NHS. I am talking about the effect of the structure of the service. There is also the burden of paperwork and administration on NHS staff. All those things are important when we consider how to retain permanent staff in the NHS and to move away from our reliance on agencies.

[Mr Steve Baker (Wycombe) (Con)]

Will my hon. Friend join me in welcoming the work of the Royal College of Emergency Medicine, which is trying to change the way that emergency medicine consultants work in order to retain more of them in their particular specialty? At the moment, far too many of them leave that specialty, creating some of the problems that we see across the country.

[Dr Wollaston]

Absolutely, and I recognise and value the work that has been done. We also need to look at the skill mix across the NHS. It is unsustainable to deliver the commitments to primary care and to improve access to primary care unless we look further at the skill mix across the wider NHS. For example, we talked in Health questions about the use of pharmacists. The one area of the NHS where there is not any kind of workforce shortfall is in pharmacy, and that industry has much to offer to primary care. We also need to consider the role of physician associates and nursing assistants, and look at how we can diversify and provide better continuing professional development across the NHS. All those things will be important as we move forward.

[Mr Jackson]

My hon. Friend will know that in the previous Parliament the Public Accounts Committee expressed concerns about the use of clinical excellence awards for senior clinicians and the very high levels of senior management pay. It felt that they were incongruous when compared with the restraint shown towards lower- paid and more junior staff. Does she think that Select Committees such as her own—if she is re-elected to it—and Ministers need to look at that in the future?

[Dr Wollaston]

I thank my hon. Friend for his points. There is an important piece of work that can be done by the next Health Committee in looking at all the wider workforce issues across the NHS, including those to which he refers.

I shall now touch on seven-day access for the NHS. Such a service is vital, but we must focus on safety. The primary focus of seven-day access must be eliminating the unacceptable variation in mortality rates across the NHS on different days of the week. It is important that we address the issue of reducing avoidable and unnecessary hospital admissions. Perhaps the Minister could look at the frailty service in Newton Abbot which considers how GPs can work together to prevent unnecessary hospital admissions. If we broadened access to general practitioners at the weekends, we might be able to reduce unnecessary admissions to hospital, for example of children with asthma. There is much that can be done, but if we are prioritising providing 8 till 8 access in very rural areas there might be unintended consequences in general practice. If we are diverting funding into areas where we are providing a service in which several practices over a large geographical area have to federate, we could inadvertently end up with patients having to travel further than they would to visit a local out-of-hours service.

Will the Minister carefully consider the unintended consequences when we implement seven-day access to ensure that we do not divert essential funds that could be used for safety and avoiding unnecessary admissions into something that is worth while in theory but that might not give the best outcomes for patients? I hope that the Minister will be able to reassure me that the Government will allow local CCGs to look carefully at what is best, while consulting local communities, and to be as flexible as possible.

I also ask the Minister to consider the importance of volunteering across the NHS. In all our constituencies there will be extraordinary organisations that work as partners with the NHS, but I have some concerns, one of which I would like to share with the Minister. In my area, a wonderful charity called Cool Recovery worked with users of mental health services and their families to provide an extraordinary level of support. Sadly, particularly given that I was a patron of this charity, I have to report that it is having to fold for the want of a relatively small amount of stable long-term funding. The voluntary sector—those partner organisations across the NHS—is calling out for access to stable long-term funds. Newly set-up charities gain access to very valuable funding sources, but when they apply for funds once they are established, the response is that it should be provided by commissioners. I ask the Minister to consider carefully how we can sustain some of the extraordinary charities working across the country by giving them access to stable long-term funding so that they can carry on with their work. This issue was raised with the Select Committee by the voluntary sector during our inquiry into children and adolescent mental health services, so it is an issue across the NHS that is causing real problems.

[Mr Speaker]

Order. I am listening intently to the hon. Lady, as always, and as I know the House will be. It is by accident that the clock is not operating as I had intended it to. In short, I had intended the seven-minute limit to apply to the hon. Lady. It would be unfair suddenly to apply it, but she ought to operate according to its spirit, and I know she is approaching what will be a very impressive peroration.

[Dr Wollaston]

A flourish! I apologise, Mr Speaker. I was indeed looking at the clock.

As a final flourish, let me mention prevention. We cannot address the financial challenges that face the NHS without considering prevention, and I congratulate the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), on everything she achieved in this regard during the previous Parliament. I hope that she will give us further detail on her plans to tackle childhood obesity, particularly as we face a tsunami of health inequality and need in our young people unless we go further.