Localised Health Care

Steve Barclay Excerpts

Wednesday 11th June 2014 Commons Chamber

[Stephen Barclay (North East Cambridgeshire) (Con)]

The new chief executive of the NHS was right two weeks ago to highlight the need to reshape the NHS around the priorities of patients, particularly elderly patients. As Simon Stevens pointed out:

“Two thirds of hospital patients are over retirement age.”

A solution to his challenge could be piloted in the perhaps unlikely setting of the Cambridgeshire fens, a rural area where we need clearer leadership in reshaping services in the way he articulated in that speech. Patients in North East Cambridgeshire continue to travel to hospitals for appointments that could take place in the community or even in their own homes. That would save them transport and parking costs, be less exhausting and more convenient, reduce the risk of secondary infections in hospitals and increase the likelihood that family and friends could support them throughout the pathway of their treatment.

In parallel, GPs are currently under considerable pressure in rural communities such as North East Cambridgeshire, where they are having to juggle the issues of accessibility, quality and affordability with the national challenge of rising demand, an older population and increasingly complex health needs. Yet GPs continue to undertake work that could be prevented through better use of other NHS resource, lightening our GPs’ workload and streamlining part of their workload through the use of equipment and better IT. However, too often the fractured lines of accountability in the NHS and the different tiers are getting in the way of the urgent need to localise health delivery outputs so that patients can receive treatment in the community and at home, rather than incurring journeys to hospital.

I want to start with a paradox. You may recall, Mr Speaker—perhaps with a shudder, as though it was a bad dream, rather than with the fond sigh of recalling happy memories—that the Health and Social Care Act 2012 was debated extensively in this House two years ago. However, once legislation becomes law, there is a tendency for Parliament to assume that the job is done—that it has been implemented and that therefore nothing further is required. But if we look at the variance in performance of clinical commissioning groups—and, indeed, NHS regional teams—and how the 2012 Act has been implemented, we see that much work remains to be done.

At the heart of the 2012 Act was a great advantage to patients. It was about empowering GPs and clinicians, who best understand the needs of their local community and patients, to act as informed buyers on their behalf, to drive innovation, challenge existing practice, change behaviours and shift treatment from hospitals into the community. The danger is that the great advantage of that legislation, which was debated at great length under your stewardship, Mr Speaker, has now slightly slipped from focus, as the media caravan and the political debate move on to other things. We are at risk of missing out on the central prize, which is how better to innovate and deliver things in a way that advantages patients more.

I want to share three examples of where the current delivery of patient services appears illogical. The first concerns patients suffering from the distress of cancer—you will have them in your constituency, Mr Speaker—and facing tiring journeys to hospital. I had the honour of opening at St George’s surgery in Littleport last month oncology services delivered in the community by Addenbrooke’s nurses: instead of the patients travelling to Cambridge, the nurses come to deliver those services in a more convenient and friendly setting. But where is the drive to ensure that that model is now rolled out by Hinchingbrooke nurses into Doddington, by Peterborough hospital nurses into Whittlesey, by King’s Lynn nurses into the North Cambs hospital? Where is the urgency, while cancer patients continue to make those journeys at cost—in petrol, parking, tiredness and other ways in which their needs are not met? It is time that we accelerated that change to meet the challenge that Simon Stevens has set out.

Secondly, there is intravenous therapy—the delivery of antibiotics through a drip. You will no doubt be staggered, Mr Speaker, to know that patients in Cambridgeshire are being admitted to hospital for five to seven days simply to have antibiotics three times a day, when we could train community nurses to deliver that service in the rural community. That is not only a huge waste of money but, more important, we are putting patients at risk of secondary infections in hospital, as well as providing a less convenient service for them. When some areas of the country have shifted in that way, I cannot see any reason why it has not been adopted in Fenland in north-east Cambridgeshire. It is simply illogical that we still require patients to be admitted for such a straightforward treatment.

A third area is near-patient blood testing. Again, Mr Speaker, this will no doubt be an issue that GPs in your constituency have to deal with. If someone has a suspected blood clot, they are often currently put in an ambulance and sent to hospital. Yet for just £3,000, we could have machines in GP surgeries to provide the results straight away. It would not take that many saved ambulance journeys and the cost of admissions to hospital to start to pay that back. It might be that businesses in the community would be willing to work with the GP practices to deliver that equipment, but the leadership is not accelerating the roll-out of such an approach.

Next week, supported by my local papers—the Cambs Times, Wisbech Standard, Fenland Citizen and Ely Standard—I will launch a community campaign, identifying a range of issues, such as the three I have provided a flavour of today, in respect of which patients want these services back in the community to deliver better clinical outcomes in a more cost-effective way. It seems remarkable that this holy grail, sought by the NHS, is not being grasped with the urgency it demands.

In parallel, we need to recognise that our GPs are under significant pressure. Let me flag up three areas where innovation and reform are needed. The first is health trainers, which have been proven as a means of relieving and preventing pressure on GPs. Yet in Chatteris, Doddington and Manea—areas with significant health needs—we still do not have health trainers to relieve pressure on our GPs. The Minister will know that the National Audit Office highlighted how smoking cessation and other programmes have an important role to play in addressing health inequalities among different regions.

Secondly, I am sure you will be as surprised as I was, Mr Speaker, to discover that within Cambridgeshire the area with the highest health needs is the area that gets the least money. I defy anyone, including the Minister, to explain that. It is largely down to historical reasons and the fact that the clinical commissioning group needs to reallocate funding. The Cornerstone practice in March receives just £62.50 per patient. The county average is between £75 and £80, and the highest-paid practice in Cambridgeshire receives £120. I know that the Minister faces constraints in terms of the overall budget, and of course the Government deserve credit for the fact that NHS spending in England—unlike that in Wales—has been ring-fenced, but I think that the funding allocation needs to be examined.

Finally, let me say something about a much maligned Cinderella service. At present, 65% of the children in my constituency who need mental health services must wait longer than 18 weeks. I know that, as a clinician, my hon. Friend will recognise the seriousness of that. As he will appreciate, it can lead to self-harm and even to suicide, and can damage life chances by affecting exam results, for instance. Furthermore, there are still problems relating to the handover from adolescent to adult mental care. The issue of mental health simply must be addressed if we are to tackle some of the health inequalities in North East Cambridgeshire, and, above all, if we are to meet the challenge set by Simon Stevens in relation to the reshaping of our services. I know that the Health Committee is examining mental health provision, and I hope that it will take account of the points that I have made.

The Health and Social Care Act allows us to deliver the benefits that I know my constituents want by reshaping community health care. The chief executive of the NHS has recognised the need to use levers within the service—such as the assurance role of NHS England, and the role of clinical commissioning groups—to deliver that reshaping, and my campaign next week will demonstrate that patients themselves want that to happen. I hope that the Minister will use his good offices to help the leadership to accelerate the innovation that is needed, so that community health care, which is currently languishing in the slow lane of change, can deliver the more patient-centred, localised treatment that will provide not only the best possible clinical outcomes for patients in North East Cambridgeshire, but the best possible value for money.