NHS

Valerie Vaz Excerpts

Wednesday 5th February 2014 Commons Chamber

[Valerie Vaz (Walsall South) (Lab)]

I am grateful to the hon. Member for Strangford (Jim Shannon) for being so concise in his remarks. It is always a pleasure to follow him.

This debate takes place against a background of confusion and contradiction in the NHS. I hope that we will not end up with a national health disservice. We read all the documents and hear all the announcements about efficiency savings, but we still have not heard the lesson that people and patients should be at the heart of the NHS.

Many of the policy makers in the health service who appeared before the Health Committee warned us that there was not much detail in the lead-up to the Health and Social Care Act 2012. There was no pre-legislative scrutiny and then there was a pause. Not for the first time, the Government rushed to get legislation through without proper scrutiny and without an electoral mandate.

That played into the hands of the people who think that this Government and this country are up for sale to the highest bidder, and that there is no commitment to the people of this country. The Shard is an example. I understand that a number of its floors have been allocated to a private hospital. That is somewhere where pearly kings and queens cannot afford to live—they cannot even afford to go up to see the view.

I am pleased to see a number of my colleagues on the Health Committee in the Chamber. We hear a lot of first-hand evidence. At a time when there are concerns about A and E, the Government seem to be intent on fiddling about with name changes. The NHS Commissioning Board is now known as NHS England. The integration transformation fund is now known as the better care fund. Interestingly, the Chancellor announced in the spending review in July that the £3.8 billion that has been allocated to the integration transformation fund—aka the better care fund—will only be available in 2015-16. However, the problem needs to be addressed now.

That £3.8 billion is not extra money, but money that has been underspent in the NHS over the past few years. The underspend was £2.2 billion in 2013 and £1.4 billion in the previous year. When I asked the Secretary of State on 26 November last year why the underspend was not used for the NHS, he said that I should ask that question of Labour Ministers. I do not know whether he meant that I should do so in 2015. As I pointed out in an aside, which was not picked up by the Official Reporters, I am not a time traveller like Dr Who and was only elected in 2010. The rules of the House say that I should have had a proper response, rather than a dismissive one.

Another issue is that people have been fired and then rehired. One in five of the 19,000 staff who have been given redundancy payments has returned to the NHS. That is more money that has been wasted and that should have been spent on patients. Primary care trusts were disbanded and then re-formed with a different name. Urgent care boards were set up—their name was then changed to working groups—to ensure that there was a forum to replace the PCTs. All of that has strained resources and made staff suffer, without any increase in pay. There is job creation. However, it is not in front-line services, but in the appointment of a chief inspector, which was not suggested by the Francis report, and of assistant chief inspectors. There may well be assistant assistant chief inspectors as well.

The Select Committee heard evidence that the pay policy was significant in enabling the NHS to fill the gap, and NHS England said that, so far, around 25% of efficiency gains had come from pay. Ask A and E doctors who are struggling with working unsocial hours while locums without continuity in patient care are paid more, and they will say, “We need more staff; it is more money wasted on locums and agencies.” Perhaps Ministers should think about golden handcuffs for A and E staff, or the equivalent of an A and E special allowance to recognise the work of those doctors and staff in A and E. That might go some way towards ensuring that we keep them in their place and provide a safe service while doctors are trained. The College of Emergency Medicine has made repeated calls for such measures, and the emergency medicine taskforce made recommendations in 2011, yet we are still waiting for action.

Many Members will know from their own hospitals that patients are suffering from delayed discharge. I have seen that first hand at Manor hospital after the closure of the accident and emergency department at Stafford hospital, where perhaps the relationship with local government is not at the same stage as it is with the local authority in Walsall, for example, and it takes longer to discharge patients. We are still waiting for the £4 million that is needed because we have had to take the strain of the closure at Stafford hospital.

When giving evidence, Sir Bruce Keogh, the NHS medical director, acknowledged that 20% to 25% of people in hospital should have been discharged. The Secretary of State said that himself, having spoken to chief executives of hospitals with approximately two wards full of people who could be discharged. Our House of Commons Library says there have been £1.8 billion of cuts in social care, but apparently, the boffins at NHS England have not “dissected out” why people are in hospital when they do not need to be there. They are working on it now—that serious work on delayed discharges has apparently only just started, despite there being a problem for some time.

The urgent and emergency care review suggested that there should be emergency centres and major emergency centres. Sir Bruce said that NHS England was still listening to that proposal, but in a contradictory view, the Committee was told in the same evidence session that the clinical commissioning groups and other working groups are organising their networks to ensure that that is the outcome. Worse still, it was admitted that they have no intention of stopping any reconfigurations during that review.

[Barbara Keeley]

Will my hon. Friend give way?

[Valerie Vaz]

I am sorry; I have no time. The Secretary of State wants to reconfigure but he does not want a national debate. He gives himself extra powers if he does not like what the courts and local people say. We need that debate. We need to tell people the truth based not on ideology but on fact, because it impacts on the type of medical work undertaken, and on how we train the next generation of doctors, nurses and health care professionals and what specialties there will be.

The Nuffield Trust gave evidence to the Select Committee and said that people have made the easy savings and now they are running out. People’s memories are long. They have paid their taxes and expect the state to look after them when they need it; not to have to show their credit card as soon as they walk into an emergency centre, or a major emergency centre—whatever it will be called. People do not want prime NHS property in the centre of a city to be sold off so that they have to travel further to get to hospitals.

Chaos, confusion, contradiction, and finally, from the Secretary of State an admission. In evidence last December he said that hospitals want to employ another 4,000 nurses compared with a year ago—an admission that 4,000 nurses have gone missing on his watch. The shadow Health Secretary, my right hon. Friend the Member for Leigh (Andy Burnham), made it clear that he does not want a further top-down reorganisation, and he started the conversation about whole-person care in the 21st century in a speech in January last year. Finally, Margaret Mead the anthropologist said:

“Never doubt that a small group of committed citizens can change the world…indeed, it’s the only thing that ever has”

We have in the staff, patients and people of this country a group of citizens who want to save their NHS.