NHS (Public Satisfaction)

Simon Burns Excerpts

Wednesday 30th March 2011 Westminster Hall

[John Cryer]

I agree with my hon. Friend. I have had exactly the same experience. We were both elected in 1997, and when I became an MP, I regularly had people come to see me with orthopaedic problems who had been waiting for operations for two to two and a half years. Some of them were in serious pain and unable to work. In the past few years, the complaints I have been hearing are that people have not had an operation for four or six months. It is a completely different world.

[The Minister of State, Department of Health (Mr Simon Burns)]

May I put the hon. Gentleman out of his misery before we start the debate on a false premise? He is absolutely right: the previous Government did not publish the 2008, 2009 and 2010 surveys, to which he refers. It may be of interest to him to know that the 2010 report was published following a written answer by the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow) in December 2010, and placed in the Library.

[John Cryer]

If the Minister will calm down a bit, I will come to that. After the Secretary of State appeared before the Health Committee, it emerged that data until 2010 had been placed in the Library, and the results until December 2009 are on the Ipsos MORI website. I was granted this debate on 24 March and the data were released the following day, Friday 25 March, on the Department of Health website. Previously, the data had not been on the Department’s website. It might be a coincidence, but it struck me that that was a fairly good time to bury good news: it was the day before 500,000 people tramped through central London on the TUC march in opposition to the cuts. The fact that the data were not initially released is unsurprising, given that polling showed a 72% satisfaction rating. Ipsos MORI concluded in the report:

“This level of satisfaction has now been recorded for over a year…suggesting that there has been a…positive shift in the public’s perceptions of the NHS. Pride in the NHS also continues to climb and is at its highest recorded level”.

Pride in the NHS is at its highest ever recorded level—an interesting statistic. We might hear a comment from the Minister about that.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

As others have said today, Mr Bayley, it is a pleasure to serve under your chairmanship.

We have had an interesting debate. Some speeches were a continuation of what has been said in the Health and Social Care Bill Committee, and they bordered on fantasy. Other speeches were extremely informative. The speech of my hon. Friend the Member for Banbury (Tony Baldry) was in the latter category, and my hon. Friend the Member for Southport (John Pugh) made a reflective and interesting speech. I listened with extreme interest, as I always do, to the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke), who made a typically thoughtful speech about an area of health and social care on which he is an acknowledged expert. I listened to the hon. Member for Easington (Grahame M. Morris), as I often do these days, and to the hon. Members for Birmingham, Erdington (Jack Dromey) and for Blaydon (Mr Anderson). It was rather like a curate’s egg—parts of it, depending on which hon. Member was speaking, were all right, and other parts slightly broached on to fantasy island.

I congratulate the hon. Member for Leyton and Wanstead (John Cryer) on securing this important debate. He may be surprised to hear that I am in considerable agreement with him on certain areas. I wish to clear up a number of his questions about the surveys. In an intervention on the hon. Gentleman, I alluded to the Ipsos MORI survey. There is something slightly ironic about claiming that we refused to publish it because of its content, given that the previous Government failed to publish similar surveys in 2007, 2008, 2009 and 2010. To say that they did not publish it because the Opposition did not table parliamentary questions asking for it to be published shows breathtaking gall.

The fact is that we published the March 2010 survey following a written answer in December from the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), who is responsible for social care. It was placed in the Library, but it was not placed on the Department of Health website, for which I offer an apology. Some Members referred to the comments of my right hon. Friend the Secretary of State. Those statements were made in good faith but he was given the wrong advice. That is unfortunate, but he made that statement some three months after the results of the survey had been published.

The hon. Member for Leyton and Wanstead asked whether we will continue with the survey. I can tell him that a further survey has been done. It has not been completed, in so far as it has not yet been given to the Department, but that will happen in due course. What happens in future remains to be seen, as no decision has been taken on future exercises. The hon. Gentleman also mentioned the general life-style survey. Again, no decision has been taken. In light of that information, it is incorrect to say that we will not allow it to proceed.

On the question of the British social attitudes survey, things are a little more complex. The hon. Gentleman will be aware that the Department of Health is not the only Department involved; it is a cross-Government survey, and the Department of Health has some interest in it, but not exclusively so. Again, that is being considered, so I cannot give a definitive answer as to what will happen.

Many hon. Members, including the hon. Member for Leyton and Wanstead, pointed out that the last survey published by Ipsos MORI said that public satisfaction with the NHS was relatively high. That is self-evident, and I suspect that all hon. Members, as constituency MPs, will be aware of that from their constituents, their correspondence and just talking to people. As we heard, the most recent research puts overall satisfaction rates at 72%.

If we were discussing the future of any other public service, perhaps the debate would end there. However, we are not here today to discuss other public services, such as local bus services or rubbish collections, vital as they are. We are here to discuss the national health service, which for the public is literally a matter of life and death, and they have a high regard for it. People expect the NHS to be there when they are at their most vulnerable, or when their family members are in greatest need.

One cannot quantify what the NHS means to the people of this country with a smattering of national statistics, however comforting they might seem. The public have never been over-inclined to set great store by the pronouncements of politicians about the brilliance of the NHS, however familiar such pronouncements might be. However, people do not live their lives through the monochrome of MORI’s painstaking statistical analyses. They do not judge the NHS on the numbers. They judge the NHS on their experience of it; it is the NHS staff that they meet, and what they say and do, that ultimately informs their opinion.

The fact that satisfaction rates are relatively high is without doubt a tribute to the fact that those staff treat thousands of patients every day. I am sure that Members on both sides of the Chamber are united in their admiration for the work of staff across the board, and we should congratulate them on doing it day in, day out, when looking after our constituents, ourselves and our families. They do a fantastic job. We should never forget that we owe them a debt of honour and gratitude.

[Mr Anderson]

Will the Minister give way?

[Mr Burns]

No. If the hon. Gentleman will forgive me, I do not have much time.

We should not kid ourselves that that is the whole story. Although some may be only too content with the fact that three quarters of people are happy with the NHS, I am not. High levels of public satisfaction are a genuine compliment to the work of NHS staff, but they do not undermine the case for modernisation or imply that the NHS is perfect or should never change. There is plenty of room for improvement, building on the high satisfaction rates that we already enjoy, as shown by the various surveys mentioned today.

The House will know that although the money going into the NHS has dramatically increased over the last decade, which I welcome, productivity has not. In fact, it has fallen by 0.2% every year since 1997. In hospitals, it has fallen further—by 1.4% a year between 1997 and 2008. However, such statistics can sound quite abstract. We should think about what they actually mean for patients.

Some of the targets and incentives in the current system are simply perverse; far from promoting good-quality care, they encourage poor care. Take maternity services. With antenatal care, the more visits or scans providers can record, the more they are paid. It is in the financial interests of the hospital to provide care on a purely reactive basis, dealing with problems as they arise, rather than preventing them from happening.

The result is poorer health outcomes for the mother and child and a bigger bill for the taxpayer. No midwife or doctor would ever organise the system in such a way. No doctor or nurse working in acute care would design a system in which a hospital would be paid for a mistake rather than be penalised for it. For example, would they pay if a patient were discharged from hospital only to be bounced back into A and E a week or so later because they were not properly treated? No health professional would choose to work in an environment in which they and their colleagues are rewarded not for how well they treat patients, but for how well they process them through the health system.

Hon. Members claim that there is no rationale for our reforms, but they are wrong. I do not claim that the NHS is failing; there is much that is good about it, and much of what it does is internationally acclaimed. None the less, if hon. Members were honest they would accept that there is room for improvement, as was shown by the Ipsos MORI poll.

I do not think that it is right that pensioners over the age of 75 in the primary care trust that serves the constituency of the hon. Member for Leyton and Wanstead are almost twice as likely to be admitted to hospital in an emergency than those over the age of 75 in Devon or Cornwall. I do not think that it is right that, in some parts of the country, people are more than five times more likely to die of heart disease.

In its current form, the NHS cannot hope to cope with the rising demand from our ageing population and the relentless rise in the cost of drugs and treatment. Our health system is no longer battling with infectious disease. The typical patient is not a young man with TB or polio, as it might have been in the 1940s, but someone who is over 75 with probably two, if not more, long-term conditions and social care needs, too. It is a very different problem that requires a very different kind of health service.

Even more importantly, as a nation, we should be aspiring to be as healthy and to live as long as our European neighbours. A recent OECD report found that, if the NHS were to perform as well as the best-performing health systems, we could increase life expectancy by three years. The argument for change could not be clearer.

The ultimate objective of modernisation is to ensure that the quality of care that people receive is on a par with the best available anywhere in the world. To do that, we need to make fundamental changes to the NHS. For example, we need to ensure that it is the GP and not a manager or civil servant in Whitehall who determines the needs and requirements of their patients. A radical extension of patient choice would allow patients to choose not only where they are treated, but which consultant-led team will treat them. Patients could choose their GP and even, where appropriate, their treatment.

There should be greater accountability and transparency in the NHS to give patients the information that they need to make choices and to drive up quality. As the Society for Cardiothoracic Surgery said only last week, publicly reporting on the performance of hospitals and surgeons treating patients with heart disease can improve mortality rates by 50%.

There should also be more independence and freedom for clinicians, so that if local health and social care professionals think that they can deliver better services to support stroke patients, they can set up a social enterprise that will do that. We will give genuine freedom to foundation trusts, so that they can strive to provide the best possible outcomes for patients.

In conclusion, there have been a lot of disingenuous statements about privatisation of the health service and the quality of care. If hon. Members are prepared to listen, I will assure them that we have no intention of privatising the health service. We just want to improve patient care.