National Health Service

Thérèse Coffey Excerpts

Wednesday 26th October 2011 Commons Chamber

[Andy Burnham]

A moment ago, the hon. Gentleman acknowledged that I protected the NHS front line as Health Secretary. As Health Secretary, I would not have introduced a £2.5 billion reorganisation when the NHS is facing severe financial stress.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

Is it fair to say that under his leadership of the NHS, Monitor suggested that it needed to make efficiency savings? Those are coming through now, but the right hon. Gentleman is trying to present them as cuts to front-line services.

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[John Pugh (Southport) (LD)]

May I take it as read that the NHS will struggle to find the £20 billion savings agreed in the Labour Budget? May I take it as read that that will impact on services and that people will notice and probably blame this Government’s legislation regardless of whether or not it compounds the problem? The debate we have been having on how NHS spending is or is not to be ring-fenced is almost a sideshow, compared with the huge challenge that is consistently emphasised by the Chairman of the Health Committee.

I draw Members’ attention to the fact that serious financial trouble is already breaking out in the acute sector. Seven of the 19 foundation trusts in the north-west have a red light, and that region is one of the more stable ones that we could consider. I cannot see any obvious happy endings, even without the Bill. Without the Bill we would still have competition by price, competition law would still be applicable, PCTs would still be capable of looking for the lowest common denominator and we would still have an unaccountable NHS.

To add to the general misery I am trying to perpetuate, on Saturday I had a severe abscess on my tooth, which was extraordinarily painful and unpleasant. After taking large doses of ibuprofen, which gave me a little relief for an hour, and my face being swollen and peculiar—a little more peculiar than it currently is—I sat up in bed in the middle of the night with my iPad looking up home remedies on the internet—cloves, bicarbonate of soda and so on. I found forums populated by desperate sufferers looking for a fix. What surprised me most were the American contributors, a considerable number of whom were obviously afraid to go to a dentist, despite the fact that the US is a rich country with no shortage of good dentists. They were settling for severe and continuous pain or for hit-and-miss experimentation, rather than risking debt and bankruptcy. Thankfully, I was in the UK and we have the NHS. On Sunday night, almost unbelievably, I was seen at 6.15 by an emergency dentist, a Polish dentist at the former Litherland town hall, which is now a busy Sefton NHS walk-in centre with a pharmacy attached—a service I did not know existed prior to these events.

Thankfully, the NHS is an institution built on solidarity. Through the state, we guarantee by our taxes each other treatment according to need and irrespective of means. It is a moral compact and Governments have been prepared to carry out that compact by ensuring that the services that are needed exist. Historically, they have done this in two ways: first, by buying services on our behalf; and secondly by providing services directly on our behalf. Governments and the people working in the NHS have done this relatively well and relatively efficiently, as the Wanless report and the Commonwealth Fund report have rigorously and exhaustively demonstrated. That is indisputable.

What is strange about recent developments is the Government shying away from their role as a provider of health care. The original debate was over the renouncing of the Secretary of State’s role as a provider, but we can also see the cutting loose of all hospitals as free-standing foundation trusts; the blurring of boundaries between NHS providers and other sorts of providers, with NHS providers doing more private work and the private sector doing more public work; the forcing—genuine forcing in some places—of non-hospital staff working for the NHS to become independent social enterprises; the neutrality of the Department of Health on whether individual NHS providers or provider networks survive, a neutrality that will be severely tested in the months to come; and the willingness to make NHS provision contestable as a matter of principle, rather than one of pragmatism. Not many people have noticed the ending of the Secretary of State’s powers to create a new foundation trust or hospital post-2015. We might have seen the last new NHS hospital opened by a Secretary of State in this country.

I found the Secretary of State’s unwillingness to stick to the wording of the Health Act 2006 slightly bizarre, if only because that would easily have brought peace, and may have brought peace now, depending on what exactly has happened in the House of Lords. In a sense, we all know that the Secretary of State does not, has not and cannot provide all the services himself and should not try to micro-manage. I did not seriously expect him to turn up at Litherland town hall on Sunday—visions of Marathon Man come before me. What concerns me is the ideological presumption that the Secretary of State should only be a purchaser or commissioner. There is a good reason for that concern; it is only possible to purchase in a market what that market offers. Markets are splendid things, offering choice and variety, but they do not have a guarantee that people will get what they are entitled to, and they do not ensure that health inequalities, or any sort of inequality, can be eroded, and they do not guarantee that public resources are spent and used in the most efficient way. They may lead to that, but not necessarily. Direct state provision is often a better option.

[Dr Thérèse Coffey]

I respect my hon. Friend’s point of view, but surely what matters is quality of care for patients, which can be provided as well in the private sector as it can in the public sector, and it is not necessarily guaranteed in the public sector, as events at the Mid Staffordshire hospital have shown.

[John Pugh]

I did not say that it was guaranteed by the public sector. That is not the point I was making at all. Guaranteeing entitlement, addressing inequalities and ensuring public value are, to be blunt, largely the point of the NHS. I can quite understand—I partly regret it—that a degree of cynicism might exist about the public service ethos, and a sort of nostalgic support for that can sometimes be in place when the reality is that it is not there. There is doubt about its true impact and people inside and outside the NHS sometimes show that degree of cynicism, which is regrettable. I can understand the worry that NHS providers can become lax or inefficient or unambitious if they are not challenged, but the answer to that is not necessarily or obviously to get out of the provision business full stop, embrace the market, set up strange control markets with huge transactional costs, strange tariffs and the multiplicity of bean counters that go along with that. Of course there is also greater legal complexity. The end result of that is something that has few of the virtues of a real market and most of the vices. The Labour Government were to some extent part and parcel of producing such a market. I see no reason to make the state just a purchaser and never a provider, and it is not obvious to me that the answer is to hand over the money to one set of providers, the GPs, particularly if the pretext for doing so is to harden the commissioner-provider split, because GPs are providers.

In conclusion, publicly funded provision—public service infused with the right ethos—is often the most efficient and effective option, provided that it is coupled with genuine, local and rigorous accountability. That is what happens in many successful systems, such as Sweden’s, and it is a liberal solution. So far, there is not enough of it, although the Bill makes laudable moves in that direction, with health and wellbeing boards and so on, but this strange, unargued and ideological withdrawal from provision or interest in provision taints everything and leaks poison into the system—like an abscess.

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[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

It is always a pleasure to follow the hon. Member for Central Suffolk and North Ipswich (Dr Poulter). I do not want to impugn his integrity, or to suggest that what he wants for the NHS is not exactly what I want. The issue is how we do that. Unfortunately, some unhelpful remarks were made in the run-up to the general election. At the least, they were disingenuous; at worst they were duplicitous. This debate is about trust, and there are serious questions about whether we can trust the Government with our NHS.

My right hon. Friend the Member for Leigh (Andy Burnham) has argued that pre-election pledges have been broken, and I want to speak specifically about how that relates to NHS funding. The first broken promise came within months of the general election. We have heard about the posters that we all saw as we went round our constituencies, showing a congenial right hon. Member for Witney (Mr Cameron), now the Prime Minister, promising to

“cut the deficit, not the NHS”.

Last October’s spending review seemed to support that position, with a 1.3% increase in NHS resource spending and real-terms growth of what seemed to be 0.4%. The Secretary of State, who is just returning to his place, was unable to answer my question on that. I want to talk abut management costs, because the Department is focusing on that spending. It is important to be clear about management costs in the NHS budget. In 1999, they were less than 3%; in 2010, they were just over 3%. Independent research has shown that, if anything, the NHS is under-managed rather than over-managed. [Interruption.] I can certainly provide evidence for hon. Members.

[Dr Thérèse Coffey]

Will the hon. Lady give way?

[Debbie Abrahams]

No, I am sorry; I am not going to give way.

We should compare our health care management costs with those in the United States, where they run at over 20%. We need to be very careful about what we are talking about.