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Q9. [147232] Miss Anne McIntosh (Vale of York) (Con):
Will the Prime Minister join me in extending our sympathies to all those who have been flooded across the country, but particularly in Yorkshire? I understand that several flood defence schemes that would have gone ahead were cut, because of the single farm payment disaster and the Environment Agency budget being cut. Those included defences that would have helped Sheffield and Doncaster. Is he also aware that his Government are, for the first time, introducing a
financial assistance scheme to help business communities? I am sure that that will be most welcome, but will he ensure that north Yorkshire businesses qualify as well as south Yorkshire businesses?
The Prime Minister: I am grateful to the hon. Lady for raising the question of floods. The loss of life is to be regretted and we will do everything that we can to support those people who have been moved from their homes and are homeless. I have telephoned the leaders of the local councils in the areas and said that we will do what we can to give them support.
I must correct the hon. Lady on the issue of the prevention of floods and coastal defences. The budget for that will rise over the next few years —[ Interruption. ] Oh yes. The budget will rise from £600 million a year to £800 million a year over the course of the next few years, so that we may have in place proper flood defences in our country.
NHS Next Stage Review
12.32 pm
The Secretary of State for Health (Alan Johnson): With permission, Mr. Speaker, I wish to make a statement about the NHS. Next year marks the 60th anniversary of the creation of the national health service. If the welfare state represented the crowning achievement of Attlee’s post-war Labour Government, the NHS was the jewel in that crown—one of the great civilising influences of the 20th century.
After the carnage of the second world war and the poverty and deprivation that went before, the advent of the NHS heralded a new era of equity, with medical care available for all—the weak, the sick and the vulnerable, as well as the wealthy and privileged. Nye Bevan said that the NHS made society
“more wholesome, more serene and spiritually healthier”.
That is as true today as it was in 1948. However, great change has occurred in the intervening 59 years, presenting new challenges for that cherished institution.
We are living longer, partly thanks to the NHS and partly owing to incredible scientific advances, with groundbreaking research emerging every day, bringing new cures but also extra costs. We are more discerning as consumers: we have gone from the old ration-book culture to a new iPod age, in which we increasingly expect choice and convenience. And we are more prosperous, with a range of goods and devices—at one level improving our quality of life, but also leading to an increase in lifestyle diseases, such as obesity and diabetes.
Society cannot stand still in the face of scientific and social change, and neither can the NHS. We have trebled spending to £90 billion a year, so there are now 80,000 more nurses and 36,000 more doctors. That unprecedented investment has been matched by new ways of working, from practice-based commissioning to NHS Direct and foundation hospitals.
On most objective measures, the NHS is performing better than ever, with more than 1 million extra operations taking place every year. Waiting lists are down, while satisfaction levels are up. Ninety two per cent of patients describe the treatment that they receive as “good”, “very good” or “excellent”. Only a few weeks ago, a global study by the Commonwealth Fund ranked the NHS first in a comparison with five other developed countries, including the US, Canada and Germany.
Yet, subjectively and anecdotally, there has been confusion and frustration in the NHS. The public are rightly concerned to know that their taxes are being wisely spent to build a health service that will meet their needs. Doctors, clinicians and nurses complain that they are fed up with too many top-down instructions, and they are weary of restructuring. They want a stronger focus on outcomes and patients, and less emphasis on structures and processes. That lack of confidence matters, because of the impact that it has on the operational capacity of the service. If the morale and good will of the profession is dissipated, our capacity for bringing about improvement for patients diminishes.
Restoring the NHS was one of the Government’s top priorities and, following almost two decades of neglect, a huge amount of reform in a short period of time was unavoidable. That was, as it were, the “emergency room” approach and, in the early stages it brought about substantial achievements. However, we now need to forge a new partnership with the profession.
Having addressed the funding shortfall, and put the necessary reforms in place, we will give the NHS the sustained period of organisational and financial stability that it requires. I can announce today that there will be no further centrally dictated, top-down restructuring to primary care trusts and strategic health authorities for the foreseeable future.
But we need to do more to make sure that the NHS keeps up with the changing demands and expectations of patients. New drugs, new medical technologies and better clinical practices provide huge opportunities, while lifestyle diseases and an ageing population present major challenges. To set us on the path to the next stage of the transformation of the NHS, my right hon. Friend the Prime Minister and I have asked Professor Sir Ara Darzi, one of the world’s leading surgeons, to carry out a wide-ranging review of the NHS. This is a once-in-a-generation opportunity to ensure that a properly resourced NHS is clinically led, patient-centred and locally accountable.
The review, the first of its kind, will directly engage patients, NHS staff and the public on four critical challenges. First, we want to work with NHS staff to ensure that clinical decision making is at the heart of the future of the NHS and of the pattern of service delivery. Secondly, we want to improve patient care, including providing high-quality, joined-up services for those suffering long-term or life-threatening conditions, so that patients are treated with dignity in safe, clean environments.
Thirdly, our aim is to ensure that more accessible and convenient care is integrated across primary and secondary providers, reflecting best value for money and offering services in the most appropriate settings for patients. Fourthly, we will establish a vision for the next decade of the health service that is based less on central direction and more on patient control, choice and local accountability, and which ensures that services are responsive to patients and local communities. The terms of reference for the review have been placed in the House of Commons Library, and I have written today to all NHS staff to explain the importance of this new approach.
Professor Darzi will complete an initial assessment in three months’ time to inform the comprehensive spending review. He will produce his full report in the new year, setting out a new vision for a 21st-century NHS, coinciding with the 60th anniversary celebrations.
I know that the review will not succeed if it is controlled from above: the best of the NHS sits not at the top of the organisation but in the millions of complex and diverse relationships that exist across the country between dedicated, devoted professionals and their patients. The success of the review will depend on gaining access to those relationships and stimulating a range of lively, local, provocative debates. The scale of our discussions with staff, patients and the public will be unprecedented, harnessing Professor Darzi's wide experience of building engagement as part of his work in London and elsewhere.
Patients must have the chance to shape the kind of NHS they want, to say how they wish to access services as they manage increasingly complex lives, juggling competing demands. They should have the chance to say how they feel about services delivered through pharmacies, the internet and other new technologies. We must respond by ensuring that they have more convenient services, open when they need them, making it easier to book timely appointments. Patients should also have the chance to say how we can make services more personal to them, particularly in long-term care.
Although it is right that we look forward, we must also deal with the problems at hand. A major immediate concern for patients is the cleanliness of hospitals. Last year, NHS staff successfully brought about a reduction in MRSA bloodstream infections as well as stemming the increase in C. difficile reports. Today, I am providing funding for each director of nursing in every strategic health authority to work with front-line nurses to ensure that they get the support they need to provide clean, safe wards. I am also doubling the size of the infection improvement teams, so that all trusts struggling to meet the MRSA target can have access to doctors and nurses who are experts in infection control, to help them get back on track.
Public services cannot be transformed by going against the grain of public service, or without support from the professionals who know the NHS best. As Secretary of State, I am determined to establish a new, closer, more robust social partnership between patients, practitioners and policy makers, based on trust, honesty and respect. That is why Professor Darzi is leading the review, supported by a team of leading clinicians across the country. He will engage directly with front-line staff, not just the great and the good of the health world, but those working in every primary care trust and hospital trust up and down the country.
As part of the review, we must look at how we make decisions on the shape and location of hospital services. The way we do so must be transparent, open and accountable. People need to know that decisions are being made for the right reasons by clinicians, and are based on the best available medical evidence. While the review is under way I will, as a matter of course, ask the independent reconfiguration panel—our expert clinical group—for advice on any decisions made at local level that have been referred to me by overview and scrutiny committees. I will make sure that any changes made are made on the basis of clinical need and patient care.
At the end of the review, we will consider the case for a new NHS constitution, with respect for the needs of patients and the judgment of professionals at its heart, ensuring that power is devolved to those who know the service best. That will ensure that the service is genuinely led by the needs of patients, providing value to the taxpayer as we move to the next stage of improvement. It will protect the enduring, cherished principles of universal health care, free at the point of need, which lay behind the establishment of the NHS, and ensure that this precious institution continues into the 21st century in ruder health than ever. I commend the statement to the House.
Mr. Andrew Lansley (South Cambridgeshire) (Con): I thank the Secretary of State for advance notice of his statement. But is that it? The NHS an immediate priority for the Prime Minister? And what is the immediate priority? An 11-month review. If the Secretary of State really thinks we shall leave him alone for a year while he finds out what is going on in the NHS, he has another think coming.
It is 4 July today: I thought that it would be NHS independence day, but it did not turn out to be. I was disappointed by what I heard, and—notwithstanding a letter from the Secretary of State—NHS staff, along with the public, will be disappointed.
For a start, we need to know what on earth is going on. A fortnight ago, the NHS chief executive said in his report:
“in the autumn we will set out a clear, strategic direction for the NHS going forward”.
That report is now so much chip paper. The Secretary of State has started with the same self-congratulatory material as we got from his predecessor. He cited the Commonwealth Fund report. I hope that he has read it; yesterday, this incoming Secretary of State did not seem to have read much.
The Commonwealth Fund report compares Britain with only one other European country. On page 9, it says that the UK is worst on hospital-acquired infections; contrary to the Secretary of State’s self-congratulatory statement, levels of C. difficile have not been stemmed, but are continuing to rise. On page 15, the report places the UK worst on access to out-of-hours GP services and worst for waiting times. On page 21, it states that the UK has the highest mortality rates after adjusting for factors unrelated to health care— [Interruption.]
Perhaps the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw) has read it, if the Secretary of State has not. He says that the UK comes out best overall. Does he know why? The report puts into the equation what it regards as an efficiency measure, which it calculates on the basis of how much is spent. It adjusts the whole table on the basis of the fact that we spend less in the United Kingdom than Germany, Canada, Australia or New Zealand. Spending less is the main reason why the Secretary of State and his Ministers think that UK health care is best.
The only thing that the Secretary of State seems genuinely to have understood is that morale in the NHS is at rock bottom. In a recent Health Service Journal survey, NHS staff were asked whether morale was good or poor: 4 per cent. said that it was good, 0 per cent. said that it was excellent and 66 per cent. said that morale was poor or very poor. What on earth have we heard in the Secretary of State’s statement that would change any of that? We know what has to happen. We have published a White Paper that sets out direction and leadership. If the Secretary of State would only look at that, he would find things that clearly need to be done.
First, the core principles of the NHS need to be entrenched in statute. We are prepared to do that; apparently, the Secretary of State’s predecessors were prepared to as well, although with the exception of the principle that public funds for health care should be
devoted solely to NHS patients. We subscribe to that principle. Will the Secretary of State now say that he will do the same?
Secondly, we need no more pointless organisational upheaval. My right hon. Friend the Member for Witney (Mr. Cameron) has been saying that for a year, and finally Ministers have accepted it, so we can put that one down. Thirdly, the Government need to set the resources and objectives, but not to interfere in the day-to-day decisions of the national health service. In a recent poll, 67 per cent. of NHS staff and 71 per cent. of the public agreed with that proposition. Where is that today? If there were such an acknowledgement by the Secretary of State, he would scrap targets immediately.
Fourthly, we need to take decisions close to patients. I am astonished that the incoming Secretary of State said nothing today about the centrality of the family doctor service and primary care, having a primary care-led service and strengthening commissioning. Fifthly, we need independent regulation of health care providers; even his predecessor acknowledged that we needed independent regulation. We need not a review but legislation in the next parliamentary Session to achieve those things.
I have mentioned five long-term reforms, of which the Secretary of State has acknowledged only one. The NHS desperately needs leadership and direction. Reform in the NHS is confused and incoherent, and on its own admission, the Department of Health has no vision of where the NHS is going. We set out a blueprint. Come on, Secretary of State, steal our clothes! We need to show the NHS that politicians can work together for the long term to give it the framework that it really needs. Only if there is that long-term framework can we deal with the real challenges of demography, technology, productivity and improving public health outcomes.
The Secretary of State said that he was dealing with immediate issues, but he mentioned only one, with something that should have been done years ago. Will he abolish the top-down centralised targets that stop NHS professionals doing their jobs and distort clinical priorities? Will he make the allocation of NHS resources fair and independent? We have asked for that, the Health Committee has asked for it, and two weeks ago his predecessor said that she thought it was the right thing to do.
Will the Secretary of State stop major service reconfigurations? He is apparently going to put a brake on them and use the independent reconfiguration panel. When he goes to his new colleague, Sir Ara Darzi, and mentions that he is going to do that, Sir Ara Darzi will be amused, because in Hartlepool he was used by Ministers to bring forward proposals on reconfiguration, which were promptly overturned by the independent reconfiguration panel. That is not much of a recommendation for the policy-making skills of Sir Ara Darzi.
Will the Secretary of State tell the House how it can be right, in terms of clinical need and patient care, for accident and emergency departments in Surrey and Sussex that treat up to 300,000 people to be shut down, while in Bishop Auckland hospital in Durham, which serves the former Prime Minister’s constituency, an accident and emergency department that treats 125,000 people is apparently absolutely fine?
Will the Secretary of State create additional training posts and assure well-qualified UK-based junior doctors that they will have an opportunity for specialty training? How can an incoming Secretary of State for Health not recognise that the crisis in junior doctor training is an immediate issue to be tackled? If the Secretary of State is so keen on a review, will he today initiate the independent review that we have called for on NHS IT—one that really listens to the people working in the NHS?
Five long-term reforms are required. There are five urgent issues. What have we got? Two. Two out of 10: those are the Secretary of State’s marks so far. We would give the NHS the priority that it really needs by taking the action required. Where is the immediate priority that the Prime Minister promised? Where is the autonomy and accountability that the NHS is calling out for? Where is the leadership and the direction that the NHS so badly needs? The NHS is there for us. Why will not the Government trust NHS staff to deliver?
Alan Johnson: I am tempted to ask—to echo the hon. Gentleman’s predictable response—“Is that it?”. It is a shame, because he thinks about these things, and he sent me a letter about having a dialogue on resolving these issues. His response will not be shared by NHS staff. NHS staff right across the country will be pleased that we are initiating the biggest consultation exercise we have ever had—a genuine dialogue about how we move to the next phase of the NHS. The hon. Gentleman said that we were asking Members on the Opposition Benches to sit silent for a year—but as I said in my statement, we are asking Ara Darzi to report first in October. The second part of the report will be next year, but certainly not 12 months away.
The hon. Gentleman said that he thought this was going to be NHS independence day. I take issue with him about the Conservative party’s policy on independence for the NHS. It is a fundamental central plank—
Mr. Lansley: You said you hadn’t read the document.
Alan Johnson: That was yesterday. I have had time to read it overnight, and I am deeply unimpressed. There is some tinkering around with detail that I would be pleased to talk to the hon. Gentleman about—particularly in the context of GP practitioners, which is an important issue—but the central plank of Conservative party policy is that we ought to hand the NHS over to some kind of 1960s public corporation, and it should be run completely independently by that huge quango. That will not work. I cannot think of a worse recipe for addressing the problems that we have in the NHS, which are about the work force believing that their views have been completely ignored in the context of the issues that have led to change, and that they are being talked down to by Whitehall, rather than their having a role in deciding the issues, based on clinical need, and patient care being an absolute priority.
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