NHS Reorganisation

Stephen Dorrell Excerpts

Wednesday 17th November 2010 Commons Chamber

[John Healey]

Of course Sir David was talking about the two together, because the Select Committee was understandably probing both matters. In the quote that I gave, he was talking about the significant efficiency savings required of the health service at this time of an unprecedented financial squeeze. Many would say that that is the toughest financial test in the NHS’s history.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will the right hon. Gentleman give way?

[John Healey]

Of course I will give way to the Chairman of the Health Committee.

[Mr Dorrell]

The right hon. Gentleman is right to say that Sir David was talking about the £15 billion to £20 billion efficiency challenge, and as my right hon. Friend the Secretary of State said, that programme has its roots in the time of the last Government. Will the right hon. Gentleman confirm that his party still supports the QIPP challenge—quality, improvement, productivity, prevention—that was first articulated when his right hon. Friend the Member for Leigh (Andy Burnham) was Secretary of State?

[John Healey]

If the right hon. Gentleman reads the official record, he will see I have just said that I will back plans to get the efficiency savings out of the NHS. They are needed and they have to happen, and I will back them as long as all the savings are reused for front-line services to patients.

Faced with the toughest test in its history, the least NHS patients and staff can expect is that the Government keep their funding promise. At this time of all times, the last thing the NHS needs is a big internal reorganisation. The Prime Minister ruled out such a reorganisation before the election, saying:

“With the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS”.

The right hon. Gentleman, now the Secretary of State, ruled it out, saying that the NHS

“needs no more top-down reorganisations”.

The coalition agreement was clear and reassuring on this point. In it, the Prime Minister and the Deputy Prime Minister pledged:

“We will stop the top-down reorganisations of the NHS that have got in the way of patient care”.

That was before the Secretary of State’s White Paper plans, which the head of the King’s Fund has called

“the biggest organisational upheaval in the health service, probably since its inception”.

Promise made in May, broken in July. Promise made by the Prime Minister, broken by the Secretary of State.

There is a story doing the rounds in the media of a journalist being briefed by No. 10, early on the morning of the publication of the White Paper, and told

“there’s nothing much new in it.”

When did the Secretary of State tell the Prime Minister that he was breaking his promise? When did he tell the Prime Minister that he was not only breaking the Government’s promise but forcing the NHS through the biggest reorganisation in its history, with a £3 billion bill attached, at a time when all efforts should be dedicated to achieving sound efficiencies and improving care for patients? This is high cost and high risk; it is untested and unnecessary.

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[Mr Stephen Dorrell (Charnwood) (Con)]

In the brief time available, I do not want to follow the hon. Member for Sheffield Central (Paul Blomfield) in a detailed discussion of children’s hospitals, but I congratulate him on the first part of his speech, because he reminded us of what we are here to talk about—the delivery of high-quality care to patients, often in circumstances of extreme distress to them and their families.

I welcome the fact that the debate is taking place, but it is important for us not to imply that there is a choice to be made by politicians in 2010 about whether the health service faces the need for fundamental reform. The truth is that the health service, by which I mean the pattern of delivery of health care to patients, needs fundamental reform, as has been acknowledged since at least 2009. The shadow Secretary of State was good enough to confirm in his contribution that he recognises the need for that fundamental reform, which was set out by Sir David Nicholson in the £15 billion to £20 billion efficiency challenge. The purpose of the Nicholson challenge is to reconcile continuing rises in demand for health care, which we must assume will continue their long-term trends, with the inevitable fact that health budgets are more constrained, and will be more constrained in the years ahead, than during the period of the Labour Government. That was recognised before the general election, which is why the Nicholson challenge was articulated.

[Diana Johnson (Kingston upon Hull North) (Lab)]

But does the right hon. Gentleman agree that instead of taking such a big gamble with the NHS at this stage, it would be better to pilot some of the initiatives and changes to see whether they actually deliver better health outcomes?

[Mr Dorrell]

I shall come to the White Paper later, but I want to focus on what I regard as the key, unavoidable reforms that have to be delivered during this Parliament. I do not think the hon. Lady will find them controversial. They are the continued development of improvements in the delivery of primary care; the priority need to address unnecessary admissions to hospital, which have been identified by the National Audit Office as running at 30% of non-emergency hospital admissions; the need to address the requirement the health service faces to use its most expensive resource, clinicians’ time, more effectively; the need to improve links between social care and health-care, because if they do not work effectively there is no way we can deliver the aspirations we all share for high quality care delivered by the national health service; and the need to deliver better patient, user and local community involvement in the design and delivery of health care.

All those things are the challenges the health service faces over the lifetime of this Parliament. They are not a matter of political choice; they were articulated by Sir David Nicholson during the previous Government. They were endorsed by the previous Secretary of State and this afternoon they have been endorsed again by the shadow Secretary of State. It is simplest to summarise them by describing them in total as the need to deliver a 4% efficiency gain through the entire national health service system for four years running.

A few weeks ago, when Sir David Nicholson was before the Health Committee, which I have the privilege to chair, we asked him to set that challenge in context and he described it—as the shadow Secretary of State was right to say—as the most substantial challenge not just anywhere in the public service, but anywhere in the economy. The challenge has no precedent in any advanced health care system in the world. The challenge is huge: a 4% efficiency gain throughout the NHS, four years running. We are looking to deliver a wholly unprecedented efficiency gain. Against that background, what is the importance of the White Paper?

I ask the House to consider for a moment the counterfactual. Is it possible to deliver that kind of efficiency gain in the health service without effective empowered commissioning driving change? If effective empowered commissioners will not do it, who on earth will? Secondly, is it possible to imagine effective empowered commissioning that does not engage the clinical community in the process more effectively than we have yet done?

[Simon Danczuk (Rochdale) (Lab)]

If there is a requirement for more clinical involvement—for GPs to be more involved in commissioning—why do the Government not simply put GPs on the boards of primary care trusts? That would be a simpler, easier solution and would not cost as much. Is it not the case that the Government would rather open up commissioning to the private sector? Is that not the reality of their proposals?

--- Later in debate ---

[Mr Dorrell]

I cannot summarise the Government’s proposals in the White Paper in three minutes, but one of their key drivers is to deliver far greater clinical engagement in the commissioning process than was achieved in the lifetime of the previous Government, in my time as Secretary of State or at any time in the 20-year history of health service commissioning. We want to achieve a step change in the engagement of the clinical community in the commissioning process. As long as commissioning is something that is done to clinicians by managers, it will fail. It has to engage the clinical community on both sides of the argument. That, as I understand the Secretary of State’s White Paper, is one of his core objectives, and if it is, it has my full-hearted support.

[Grahame M. Morris (Easington) (Lab)]

In advancing that idea, does the right hon. Gentleman accept that the power to commission is being given to clinicians only in primary care, and that clinicians who work in a hospital setting are not being empowered or involved in the commissioning process at all?

[Mr Dorrell]

The hon. Gentleman is a fellow member of the Select Committee and I know from our discussions that the principle of clinical engagement in commissioning is broadly supported in the Committee. It is fair to say that none of us would support the view—I suspect the Secretary of State would not either—that clinical engagement means only GP engagement. We should see the GP as the catalyst for broader clinical engagement in the commissioning process if we are to deliver our objectives.

To deliver the Nicholson challenge, we must have strong commissioning, with clinical engagement, and we have to remove unnecessary processes that do not add value. We cannot afford to waste money on them. We must have greater local accountability for the commissioning process in order to embrace public support for change on this unprecedented scale.

[Dr Pugh]

rose—

[Mr Dorrell]

I have only 40 seconds left for my speech, so if my hon. Friend will forgive me I should like to conclude.

My key message is that as we look at the lifetime of this Parliament, I do not see the White Paper as the linchpin of reform, but as a key tool in the delivery of the reforms that are neatly encapsulated in what I have described as the Nicholson challenge.