Future of the NHS

Stephen Dorrell Excerpts

Monday 9th May 2011 Commons Chamber

[John Healey]

It is in the impact assessment; I suggest that the right hon. Gentleman take a good look at it.

[Mr Stephen Dorrell (Charnwood) (Con)]

The right hon. Gentleman has just implied that the Government were proposing to introduce, for the first time, private sector expertise into the commissioning process of the health service. Will he correct that statement to the House by confirming that under the world-class commissioning programme, the previous Government explored exactly that proposal?

[John Healey]

No. What I am referring to is the provision in the Bill to allow the job of commissioning to be outsourced to private companies. That has never been done before. It is there in the Bill and it is a big risk for the future.

The Prime Minister made the NHS his most personal pledge before the election.

--- Later in debate ---

[Mr Stephen Dorrell (Charnwood) (Con)]

I do not agree with everything that the hon. Member for Barnsley Central (Dan Jarvis) has just said, but I congratulate him on a thoughtful speech and wish to pick up on two points with which I entirely agree. The first was his moving tribute to the NHS staff who provided the care for his late wife. The second point, which is of immediate concern to us, was his recognition that the health service, like all human institutions, must embrace the need for change.

The question before the House this afternoon is how we can ensure that the need for change that the health service faces can be embraced and made a force for good. I open my remarks on that point by agreeing with the shadow Health Secretary, who said only a few short months ago, on 20 January —his words have already been quoted to him—that

“these plans are consistent, coherent and comprehensive. I would expect nothing less from Andrew Lansley”

Nor would I. I agree that that is a fair description of my right hon. Friend the Secretary of State’s proposals. I particularly congratulate my right hon. Friend, and the Government at large, on the fact that, despite that being a fair description of their proposals, they are now engaged in a listening exercise, the purpose of which is to improve a set of proposals that were described by the shadow Health Secretary in the terms I have already quoted.

I particularly welcome the fact that my right hon. Friend and the Prime Minister have made it clear that this will be a listening exercise on the policy substance, not just a process of balancing political forces in order to cobble together a compromise. If we are to be true to our commitment to the health service, as my right hon. Friend is, we need to ensure that we focus on the problems it faces and put in place structures that will deliver solutions.

[Mary Macleod (Brentford and Isleworth) (Con)]

Does my right hon. Friend agree that the Prime Minister has not broken any promises on the NHS, as the shadow Health Secretary has suggested, and that the Government are investing in the NHS and there is no question of privatising it?

[Mr Dorrell]

I entirely agree with my hon. Friend. The Prime Minister and the Secretary of State made clear during the listening exercise their determination to ensure that proposals are brought forward that improve the capacity of the structures of the health service to deliver the objectives my hon. Friend has just articulated.

[Emma Reynolds (Wolverhampton North East) (Lab)]

Will the right hon. Gentleman give way?

[Mr Dorrell]

I will give way once more and will then have to make progress, because I have very limited time.

[Emma Reynolds]

Does the right hon. Gentleman agree that it would have been possible to make the current structures work better? The coalition agreement states, on page 24:

“We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust”.

It is possible better to democratise the PCTs and give greater clinician involvement in them, so does he support some of the calls from the professionals to keep the cluster PCTs?

[Mr Dorrell]

I want to make my speech in my own way. The hon. Lady asked at the beginning of her intervention whether I agree that it would have been possible to introduce quite a lot of this without the need for a long Bill. She does not need to put that question to me, because the Health Secretary made the same point during the last health questions. We are seeking in the Bill to provide a holistic basis—a structure for the health service going forward, and that is an objective, starting from where we are, that it seems entirely reasonable to embrace.

I was seeking to identify the problem that my right hon. Friend’s measures must be designed to tackle, because as he and the Prime Minister have said repeatedly, no change is not an option. That should not be a matter of party political debate because the definition of the core problem facing the health service can be found in the NHS annual report for 2008-09, which was published 12 full months before the general election. I quote from it a single sentence:

“We should also plan on the assumption that we will need to release unprecedented levels of efficiency savings between 2011 and 2014—between £15 billion and £20 billion across the service over those three years.”

That is what we on the Health Committee referred to as the Nicholson challenge, because it was first articulated in the chief executive’s report a full 12 months before the election. That is the challenge that my right hon. Friend has to address, because it is the inescapable challenge in front of the national health service.

In point of fact, my right hon. Friend has made the challenge rather easier than it was in the days of the previous Labour Government, because there is a commitment to real-terms growth in the health budget throughout this Parliament, and because he has given the health service four years to respond to the Nicholson challenge, whereas the original articulation was focused on the three years ending in 2014.

But the substance of the need to deliver unprecedented efficiency gains out of the health service is the constant between the previous Government and the current Government. The articulation of it in the chief executive’s report was “£15 billion to £20 billion”; I have always preferred to articulate it as, “4% efficiency gain, four years running”.

That is what the health service has to deliver against the background of it never having delivered 4% efficiency in a single year, and of no health care system anywhere in the world having delivered a 4% efficiency gain, four years running. So, Sir David Nicholson, 12 months before the general election, was 100% right to say, “This is an unprecedented challenge,” and the challenge was embraced by the previous and current Governments.

[Grahame M. Morris]

Will the right hon. Gentleman give way?

[Mr Dorrell]

Will the hon. Gentleman forgive me? I want to cover what I regard as important ground.

I have expressed the challenge as an efficiency target, but the same target can be looked at differently, and it is important for the House to understand that this is a matter not just of dry health economics, but of the way in which the health service delivers clinical care, because so often in such debates we imagine that the normal health service patient is a normally healthy person who goes to see the GP and is referred for an elective acute procedure. It is as well to remember, however, that such patients constitute 11% of NHS expenditure, and sometimes I wish that we would devote the same attention to the remaining 89%, because that includes emergency patients, with 75% being expenditure on patients with long-term complex conditions, most of whose care would be better delivered by integrated services in the community.

The challenge that we ought to address when we think about the future of the health service involves not just another discussion about bureaucratic structures, but how we deliver the change in the service’s clinical model to ensure that it delivers efficient and high-quality care to the patients who present for care, rather than to the patients as so often described in the policy pamphlets.

That is why it is so important that the structures that emerge from this listening exercise achieve more radical integration than we have yet achieved in the health service—of primary care, community care and social care. It is why the GPs have to be engaged in the process. Once again, that is not a matter of party political debate; the point is made in all the world-class commissioning documents that I do not have time to quote.

My message for the House is that this is an intensely depressing debate, because it is as if the past 20 years never happened. The reality, when we look through the torrent of rhetoric, is that this policy is not a great break from the past; it is a desire on the part of my right hon. Friend to take ideas that were expressed and pushed through by Labour Ministers between 1997 and 2010, and to seek to make them effective in the context of the challenge that I have defined.