Managing Risk in the NHS

Valerie Vaz Excerpts

Wednesday 17th July 2013 Commons Chamber

[Valerie Vaz (Walsall South) (Lab)]

It is always a pleasure to follow the hon. Member for Bracknell (Dr Lee). I do not think that hon. Members have had a chance properly to mention that the NHS is 65 years old.

We now have two figureheads atop the NHS: the Secretary of State and the chief executive of NHS England. Hon. Members might have missed the change of name from the NHS Commissioning Board to NHS England. Such is the power of the chief executive that he neither had to come to Parliament nor to deal with elected representatives to achieve that. The two of them sit there like Laurel and Hardy, whose catchphrase was, “Here’s another fine mess you’ve gotten me into.” We know there is a mess, as there is a host of ongoing reviews.

Let me start by referring to the Francis report, which was produced by a leading QC who started his work in 2009 after being picked by my right hon. Friend the Member for Leigh (Andy Burnham), so that was something he got right. Some £10 million later, after sifting the evidence and hearing bereaved people give their testimony, Robert Francis produced a report with 290 recommendations. At the time, it appeared that they had been accepted in full, but all is not as it seems, because apparently there needs to be a review on its implementation.

Yesterday, we received Sir Bruce Keogh’s thoughtful review. It is actually a model report, as it gives clarity on what needs to be done. The Secretary of State mentioned Don Berwick’s report on the Francis review, which is due in the autumn. Camilla Cavendish has reported on health care and social care assistants. My right hon. Friend the Member for Cynon Valley (Ann Clwyd) and Tricia Hart will review how patients make complaints, although no date has been given for when that will report. Sir Bruce Keogh is busy again, as he is producing a further report on a plan for vulnerable older people, which I think is also due in the autumn.

You would be forgiven for thinking that that was the end of it, Mr Speaker, but that is not quite the case. The chief executive of NHS England announced to the Health Service Journal—not to the Secretary of State nor to Parliament—that he would do some work to determine what NHS England’s strategic direction might be. One would have thought that he would already know, and the process seems somewhat late given when the body was set up. He told me that the cost would be £3 million over three years, but how many doctors and nurses would that buy?

What has been the response of the Secretary of State to date? Urgent care boards and chief inspectors—PR and an extra layer of bureaucracy. The Health Committee heard evidence that urgent care boards were the management that was removed by what happened to the strategic health authorities. What are the costs? The Treasury has already clawed back £3 billion from the NHS. According to the National Audit Office, the efficiency gains of £5.8 billion that were made in the first year were a result of reducing the tariff to providers and the public sector pay freeze, but how long can that carry on?

The NAO has published interesting statistics following the passage of the Health and Social Care Act 2012. The reported cost of the reforms was £1.1 billion. The Secretary of State told the Health Committee that he had seen—he did not know—a figure of between £1.5 billion and £1.6 billion. Professor Kieran Walshe has put the figure at £3 billion.

The NAO said that of the 170 organisations closed down, 240 have been opened, and 10,094 full-time equivalent staff have been made redundant. It is a shame, when there is an underspend of £3 billion, that the College of Emergency Medicine is crying out for extra emergency doctors and consultants, and at least half a million pounds is spent on locums in A and E, and all before we have even looked at integration.

Many have endorsed what is rapidly becoming known as the Burnham plan, including the right hon. Member for Charnwood (Mr Dorrell). The Health Committee has seen the work at Torbay, which was piloted in 2004-05—by the previous Government, incidentally—but we were told that the Health and Social Care Act could affect the way it works.

I want to ask the Secretary of State to do something fairly useful: ask someone at the Department of Health to pull together and publicise best practice from across the country. The Health Committee heard evidence that some of the A and E hospitals had got it right by moving elderly people directly to consultant geriatricians.

Finally, it is very easy for those of us who are exposed to the world of NHS structures to say how we can fix it, but Robert Francis took evidence from those who use the service directly on how they came across the inaction and indifference of a large institution. Sir Bruce Keogh has done the same with his report. They talked directly to those on the front line and those who use the service, not just those in the boardroom. They are the ones who should be listened to—all those who work in the NHS and have to provide a service when their pay is frozen. The people who use our NHS want professional people who are competent at their job caring for them when they are at their most vulnerable. Only if we listen to them will we be able to wish the NHS many happy returns in future.