NHS (Public Satisfaction)

Tony Baldry Excerpts

Wednesday 30th March 2011 Westminster Hall

[Tony Baldry (Banbury) (Con)]

The hon. Member for Leyton and Wanstead (John Cryer) makes his own points in his own way. Both my parents started to work for the NHS on the day it came into being: my father as a doctor and my mother as a nurse. Throughout the 60-plus years of its existence there has been enormous pride in the NHS, among those who work in it and among the community as a whole.

The interesting notion advanced by the Opposition is that because people are generally satisfied with their doctors, all is well with the NHS. Of course people are overwhelmingly happy with their GPs. By and large, we have freedom of choice over our GP, and if we are not happy with services we change our GP. It is of concern that a recent survey of NHS users found that one in five failed to get a prompt GP appointment when they asked for it, but that notwithstanding it is not surprising that nine out of 10 patients are satisfied with their GP surgeries. That is not the point. The point is that we have an ageing and more complex population who will rightly make increasing demands on the NHS. Unsurprisingly, most people have greatest contact with the NHS in the last years of their lives.

[John Pugh (Southport) (LD)]

I do not want to put the hon. Gentleman off his stride, but is he not slightly missing the point made by the hon. Member for Leyton and Wanstead (John Cryer), which was not simply that people are satisfied with the NHS but that they are progressively more satisfied, which is a more surprising finding, is it not?

[Tony Baldry]

I have not missed the point at all. The point being made by the hon. Member for Leyton and Wanstead is that nine out of 10 people are satisfied with their GPs, so somehow all is well with the NHS and nothing need change. If my hon. Friend the Member for Southport (John Pugh) had read the report of the Public Accounts Committee, chaired by the former Labour Minister of State, the right hon. Member for Barking (Margaret Hodge), he would know that it concludes that although the previous Government increased the amount of money going into the NHS that did not lead to greater outputs. The report makes sobering reading, and I am concerned that more parliamentary colleagues have not read it and that it has not received the attention in the House that it deserves.

[John Cryer]

The point effectively made by the hon. Member for Southport (John Pugh) is that satisfaction rates are not remaining level but climbing markedly. The British social attitudes survey shows that in 1983 satisfaction stood at 55% and plummeted to 35% in 1997. It is now up to 64%. According to Ipsos MORI, 90% of outpatients, 88% of inpatients and 81% of accident and emergency patients are satisfied—the highest levels ever recorded.

[Tony Baldry]

The hon. Gentleman, again, makes his own point in his own way. He says, and I understand him, that members of the public are satisfied with the NHS so nothing need change. I am not sure whether he has read the unanimous PAC report that was published only weeks ago, but I remind Members that it says:

“The level of hospital activity has not kept pace with the increased resources as hospitals focused on meeting national targets, but not on improving productivity, and productivity has actually fallen over the last decade…Though the increased money going into the NHS has helped to reduce waiting times, improve facilities, and deliver higher quality care, the Department promised at the same time to improve productivity. It failed and, in future, the Department needs to have a more explicit focus on improving hospital productivity if it is to deliver its ambitious savings targets without healthcare services suffering.”

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

Does the hon. Gentleman agree that it is notoriously difficult to measure productivity in crude terms—activity, outcomes and so on—and that the quality of the output, which perhaps reflects the greater investment of resources, is not included in the survey?

[Tony Baldry]

I am sorry to hear the apologia of Opposition Members, who are confronted with concerns about what is happening in the NHS. I commend to the hon. Gentleman the National Audit Office report published on 17 December 2010, “Management of NHS hospital productivity”. The NAO has no difficulty in measuring NHS productivity, and neither does the PAC. Before Opposition Members jump up, they should remember that the Labour party left the NHS with a huge, unpaid overdraft of £60 billion. It is a staggering fact that of the £65 billion of hospital building works carried out in the 13 years of the Labour Government, only £5 billion was paid for. Despite a number of very generous private finance initiative projects, the NHS still has an overdraft and must pay for £60 billion of hospital building works. The previous Government, while they may have put more money into the NHS, saw no improvement in outcomes and have left the NHS with a substantial overdraft.

As the Chair of the Health Committee, my right hon. Friend the Member for Charnwood (Mr Dorrell), has observed, even if, as intended, the Government manage to ensure that spending on the NHS is ring-fenced and runs ahead of inflation, the NHS, in the next few years, has to become substantially more efficient in how it uses its assets, and treats and looks after patients—hence the need for reforms. Let us be clear. The reforms are about cutting bureaucracy and improving patient care and have been proposed by the coalition Government to improve the NHS and to ensure that we maintain public satisfaction and support for the NHS. We need to ensure that the Health and Social Care Bill, which is going through Parliament, delivers those reforms in the best possible way.

I have no doubt that Ministers will give proper attention to the report next week of the Health Committee and that, in due course, the Government will have regard to any constructive suggestions from the other place to ensure that the Bill is as clear and effective as possible. In any health system, however, difficult decisions have to be made about how one best utilises finite resources. However much money as a country we commit to the NHS, that money will be finite. Choices will have to be made about how that money is best spent: at one end of the spectrum, about whether and in what circumstances people get treated for varicose veins; and at the other end of the spectrum about when, and how often, major and significant, complex and expensive invasive surgery takes place. It seems to me that it makes extremely good sense for those decisions to be made in a collegiate manner, on behalf of their patients, by GPs. It seems to me to make very good sense to allow GPs, individually and collegiately, to make value judgments about the quality of services being provided by individual hospital providers for their patients.

As the hon. Member for Leyton and Wanstead made clear when introducing this debate, patients trust their GPs and I see no reason why we should not, collectively, trust GPs to commission the best available services in the NHS. Critics of the reforms have sought to present them as something that they are not. However, as the Prime Minister has made clear on a number of occasions:

“we have ruled out price competition in the NHS.”

He went gone on to make it clear that

“we must avoid cherry-picking by the private sector in the NHS.”—[Official Report, 16 March 2011; Vol. 525, c. 292.]

[John Cryer]

Will the hon. Gentleman give way?

[Tony Baldry]

I am happy to give way to the hon. Gentleman, but I would just make the observation that I suspect that quite a number of his colleagues wish to contribute to the debate, and that every time I allow an intervention it probably reduces the time that they have.

[John Cryer]

I am very grateful to the hon. Gentleman, both for giving way and for his valuable advice that I will hold dear to my heart.

May I just point out that, although the exposure to EU competition laws—he is referring indirectly to that—is not in the Bill, primary care trusts are officially regarded as state enterprises? As state enterprises, they are not exposed to EU competition law. The new consortia that will replace them, because they are not state enterprises, will be exposed to EU competition law, and will therefore expose the NHS, generally, to EU competition law. Does he support that?

[Tony Baldry]

Again, that is a slightly bizarre argument from the hon. Gentleman. There has been much talk about competition in the NHS, which is surprising as the Labour party appeared to be in favour of competition in its own election manifesto. The coalition Government have made it clear that the only competition that will exist in the NHS is competition on quality, not price. The Secretary of State could not have made that clearer in the House when he said:

“At the point when a patient exercises choice or a GP undertakes a referral, the price of providers will be the same. By extension, competition must be on the basis of quality.”—[Official Report, 16 March 2011; Vol. 525, c. 387.]

To deal with another misrepresentation, EU competition law already exists and the health reform proposals do nothing to change that. They do not, in any way, extend competition law. The Bill makes it absolutely clear that any competition can only be on quality, not on price. In any event, I find it strange that the Labour party and others suddenly seem to be coming forward to express concerns about the private sector in the NHS, when it was the previous Labour Government who, for example, in Banbury set up a privately run, privately managed, privately owned independent treatment centre and a privately managed, privately owned independent Darzi GP centre. The previous Labour Government, bizarrely, gave the private sector—because their contracting was so poor—some £250 million for operations that were never carried out. However, given that they have left the NHS with an overdraft of £60 billion, I suppose that they would consider £250 million thrown away on operations that were never actually carried out as, possibly by their standards, small change.

We have to realise, with an ageing population, more extensive treatments and new drugs becoming available, that we have to tackle bureaucracy in the NHS. We need to reform the NHS to make sure that it is as efficient and as effective as possible. We are ensuring that patients have choice—choice based on quality and from whom they receive care. There is simply no issue on this, in that the Labour Party said in its manifesto at the general election, and I am sure that the hon. Member for Leyton and Wanstead has read it:

“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality”.

We have made it absolutely clear, under the coalition Government, that the NHS will remain free at the point of need, paid for from general taxation, and be based entirely on need, not on the ability to pay. Those are fundamental principles of the NHS. They have been fundamental principles of the NHS ever since it came into being, and the coalition parties are, I am sure, determined not to undermine, in any way, any of the rights in the NHS constitution. Indeed, the coalition Government are seeking to protect the NHS, throughout the duration of the Parliament, by increasing NHS funding by £10.7 billion. A substantial number of GP groups, all over England, have volunteered as pathfinders to demonstrate how GP commissioning can work. GPs throughout Oxfordshire are coming together to form a suitable GP consortium.

Let me tell the House what is being said by those in my constituency who are involved in the GP consortium. Local GP Dr Judith Wright, who is co-ordinating the north Oxfordshire GPs, has said:

“Andrew Lansley’s proposals will give power to local GPs to decide how that budget should be spent to meet local health needs. Priorities will be decided by doctors through a process informed by patients, local authorities, public health and secondary care”.

Dr Wright went on to observe:

“I believe that GPs are best placed to be able to meet this challenge. Collectively they know the health needs of their local population. They can act as a catalyst for change. They will have a role in deciding the destination of local services and the route to get there.”

Andrew McHugh, who is the practice manager at Horsefair surgery in Banbury, observed:

“The health budget is a finite resource. Andrew Lansley’s proposals will give power to local GPs to decide how that budget is spent in order to meet local health needs. Priorities will be decided by doctors through a process informed by democratically accountable public and patient involvement. We need to be looking for innovative ways of spending the health budget wisely.”

In a recent issue of Prospect magazine, Ali Parsa pointed out that, as a nation:

“We used to spend 3 per cent of our GDP on healthcare in the 1980s…6 per cent in the 1990s, 9 per cent now and on our way to 12 per cent.”

In the current financial climate, that is unsustainable. Business as usual is not an option. We need to review what treatments are provided to ensure they are clinically effective and cost-effective—in other words, evidence-based practice. I think that Dr Judith Wright and Andrew McHugh’s comments are extremely balanced and sensible.

[Mr David Anderson (Blaydon) (Lab)]

I just came from a meeting of the British Medical Association about two hours ago. Its members asked me very clearly to pass this message on to the party on the Government Benches: will they please stop using the fact that GPs are becoming involved to suggest that they support the moves? They see becoming involved in terms of having no alternative—they say that it is being forced on them and that they are becoming engaged in the interests of their patients, not because they believe in what is being done.

[Tony Baldry]

May I suggest to the hon. Gentleman and to others that they actually start listening to what is being said? They might start by noting what was said in their own election manifesto. They might start listening to what the Prime Minister and the Secretary of State are saying on the Floor of the House of Commons, and the hon. Gentleman might as well do them the courtesy of just listening to what GPs in my constituency are saying on the record. It is clear that he is not listening. If he wishes to have a dialogue of the unlistening, that is a matter for him. The changes that the NHS needs are straightforward: less waste, more involvement, power to GPs and front-line doctors, nurses and other health professionals, and putting patients first. There is not really an intellectual divide on this matter. Indeed, the shadow Secretary of State earlier observed:

“The general aims of reform are sound—greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes”.

I could not have put it better. As for less bureaucracy, ever since the coalition Government came to office, one of the things they have cut in the NHS is bureaucracy. That has resulted in 2,000 fewer managers since the general election, but, interestingly, 2,500 more doctors.

I have every confidence in the Secretary of State for Health. He and his ministerial team, while we were in opposition, took considerable efforts to visit Banbury on a number of occasions to understand the challenges being faced by the Horton general hospital and to meet with GPs. As he observed to local GPs before the general election, GP commissioning will enable those GPs in north Oxfordshire, south Northamptonshire and south Warwickshire who wish to send their patients to the Horton hospital to do so, confident that the money will follow the patient.

Again, I do not think it surprising that the shadow Secretary of State should have observed:

“No one in the House of Commons knows more about the NHS than Andrew Lansley—except perhaps Stephen Dorrell. But Andrew Lansley spent six years in Opposition as shadow health secretary. No one has visited more of the NHS. No one has talked to more people...in the NHS…these plans are consistent, coherent and comprehensive. I would expect nothing less from Andrew Lansley.”

If Opposition Members are not willing to listen to me, perhaps they would be willing to listen to the shadow Secretary of State.

The Secretary of State, when in opposition, visited my constituency at least three times, and I believe I am correct in saying that every member of the Government ministerial team in the Commons visited my constituency at least once, to understand the challenges and needs of hospitals such as the Horton. The Royal College of General Practitioners said that it believes that there should be more clinical commissioning. Even the British Medical Association has confirmed that it believes that GP-led commissioning is the right way forward. Indeed, the only opponents to the proposals appear to be the Labour party and the trade unions, but, given what the Labour party did when it was in office, and what it stated in its manifesto and even more recently, one can only conclude that, now that it is in opposition, it seeks to jump on every passing bandwagon, feels obliged to say whatever will keep the trade unions happy and seeks to block every sensible reform.

The views of the trade unions on all of this are as depressing as they are, perhaps, predictable, and in the category of trade union I also place the BMA. It is right to recall that the BMA opposed GP fundholding, longer opening hours for GP surgeries, which clearly would have been for the benefit of patients, and foundation hospitals. In fact, I cannot think of a single NHS reform over the years which it has not opposed, or a single one on which it has been in the vanguard.

No one pretends that health care systems around the world are facing anything other than enormous challenges. That is no less so in the UK. We need to be sure that patients and taxpayers get the best value possible for every pound spent in the NHS. We need the best possible outcomes in the NHS, whether for stroke victims, heart attack victims or those who have long-term medical conditions. The reforms are about building on the strengths of the NHS, improving it and making it better able to tackle the challenges of the 21st century. That is how we will ensure that people will rightly continue to be supportive of, and satisfied and happy with, the NHS, which we all want to be the best possible health service in the world.