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“to providing a healthcare system organised around the needs of the patient.”
That goes to the core of determining the future of our health service and making sure that it is fit for the 21st century.
The key question is who decides the needs of the patient. The Labour Government’s approach so far has been for Whitehall to determine the needs of the patient. My view, and my passion, is that patients should be empowered to make decisions about their health care, not just about which hospital to be treated in, but about all aspects of their treatment.
I was fascinated to see the Conservative amendment. It refers to empowerment, but is that empowerment of patients? No, it is empowerment of professionals. Clearly, it is important for professionals to be empowered to do their jobs without national targets distorting and interfering with their clinical judgment, but surely the key issue is ensuring that patients are empowered to make decisions about their own health care. That is not just an aspiration. It is a necessity to empower the patient, particularly to self-care.
When Wanless first advised Government on future investment in the health service, he made the point that unless patients were empowered—enabled—to look after their own health, the health service would end up bankrupt. Too often in today’s health service, patients are treated as passive citizens. They get what they are given. It is not just about investment. It is about ensuring that the patient is treated as the most important element of the equation.
There are three areas where I expect even the Government would admit a failure to meet their own standards of ensuring that services are organised around the needs of the patient. I shall deal first with health inequalities, which mean that people in disadvantaged communities are getting poorer health outcomes, and often poorer access to services. The Department of Health’s departmental report this year contained a section dealing with health inequalities, which had an optimistic title, “Progress on health inequalities”. It set a target of 10 per cent. reduction by 2010, but the conclusion in the Department’s own report was that the long-term trend is of widening inequalities. That is still continuing.
Let us look at the facts in modern Britain. Accident of birth determines one’s chances of survival as a child. People from the poorest communities are three times more likely to die in childhood than those from the wealthy suburbs. There is a gap of 10 years in life expectancy between men in Manchester and men in Kensington and Chelsea. If that is narrowed down to individual wards in cities, the inequalities are even greater. In Sheffield, there is a 14-year gap between the poorest wards in that city and the wealthiest suburbs.
I find that unacceptable—as, I suspect, do many Labour Members. Surely it is unacceptable— [Interruption.] The hon. Member for North Durham (Mr. Jones) laughs, but I regard this as an important issue. After 10 years of a Labour Government, it is a disgrace for health inequalities to have widened.
In a recent report the NHS Confederation examined the causes of inequalities and highlighted, for example, the number of people who are not accessing health care. The report refers to the British Lung Foundation. There are 2 million people in Britain with chronic obstructive pulmonary disease who are not diagnosed. Lung disease is preventable and treatable, if only those people were getting access to treatment. According to Diabetes UK, there are 750,000 people with undiagnosed diabetes. If only they could be diagnosed and treated, their quality of life would be dramatically improved.
On the big public health challenge, obesity, the Foresight report recently warned of
“continued polarisation of the population, into the junk food eating, less-educated poor and functional food eating, better-informed higher classes”.
We should all be concerned about that. The report draws attention to the importance of improving educational attainment in those deprived communities in order to address the problem.
Derek Wanless was brought in by the Government to advise them on the future of the health service. His conclusion about the Government’s record on public health is that it is impossible to track trends in public health spending because it is not monitored, so we do not know what is happening. He goes on to say:
“It is...indicative of the relatively low priority given to public health that, while non-public health medical staff...have increased by nearly 60 per cent since 1997, the number of public health consultants and registrars has”
fallen. We have massive challenges on public health, yet we now employ fewer specialists than when Labour came to office. That is also a disgrace. Wanless says in his conclusion:
“tackling recent financial difficulties in the NHS by raiding public health budgets”—
anyone on the Health Committee will know that it gathered evidence of that—
“has not been in the long-term interests of the public health of the nation.”
That is the legacy of the financial mess in the NHS over which the Government have presided.
When times and finances are difficult, the most vulnerable usually end up suffering, and that has happened in respect of the cuts in public health budgets. [Interruption.] Yes, there have absolutely been cuts; in many areas of the country, public health budgets have been cut—and the Health Committee, with its Labour Chairman, has confirmed that view.
What do the Government say they are doing about health inequalities? Lord Darzi has proposed that there should be 100 new GP practices in deprived communities, and on the same page discusses 150 new GP-led health centres; I do not know whether that makes 250 in total. That would make a difference. However, the NHS Confederation has already highlighted the fact that in the current GP contract there are disincentives against practices working in deprived communities. The confederation has put forward suggestions that could change those disincentives now, and I hope that the Government will listen.
Mr. Lansley: Does the hon. Gentleman recall, as I do, that the NHS plan in 2000 included the intention that by 2004 there would be an extra 200 personal medical services contracts in the most deprived areas? We have heard all this before; it just did not happen.
Norman Lamb: I agree, and I know that that was in the NHS plan. Commitments to make all sorts of changes are of absolutely no value unless action follows.
In the current GP contract, there is the minimum practice income guarantee, which pays sums based on historic funding levels for GP practices. The NHS Confederation concludes that the way in which that works disadvantages practices in deprived communities. Why was the contract negotiated in a way that had that result?
Dr. Howard Stoate (Dartford) (Lab): I am sure that the hon. Gentleman is aware that the NHS Confederation actually negotiated the GP contract. If it was so upset about those issues during the negotiations, it should have driven a better deal. The hon. Gentleman is concerned that the confederation is worried now—but it negotiated the contract.
Norman Lamb: I do not care what the GPs think about the situation or whether it is of concern to them— [Interruption.] Listen to the answer. I am concerned about whether sufficient numbers of GPs are working in deprived communities. The statistics show that there are fewer GPs per 100,000 of population in poor communities, in which there are greater health problems, than there are in the wealthier suburbs. That is a fact, and it is unacceptable. It is ludicrous that the GP contract should provide disincentives for GPs to work in deprived communities.
Norman Lamb: I shall not give way now, although I shall in a moment. Let me finish my point about the GP contract. The quality and outcomes framework—the method of incentivising GPs through further payments—also works to the disadvantage of practices working in deprived communities. The NHS Confederation confirmed that under QOF, rates of achievement in deprived communities are lower than those of wealthier suburbs, so practices in the former end up getting paid less.
Under QOF, GPs get paid more working in a wealthy suburb than if they work in a deprived community. Remarkably, QOF remunerates at a lower rate practices with a higher disease prevalence. The NHS Confederation gives an example of that. The hon. Member for Dartford (Dr. Stoate) looks bemused, but he should read the confederation’s report on health inequalities.
Dr. Stoate: I am not bemused about that, but about the fact that the hon. Gentleman is talking about the NHS Confederation, which is the body designed to negotiate such issues with the British Medical Association. If it has such issues, it should involve itself in the QOF talks, which are carried out each year to ensure that the GP contract is modernised.
I have one further point. The hon. Gentleman talked about deprived communities, and I entirely agree with him, but Lord Darzi has proposed 100 new GP practices and 150 new GP-led health centres for deprived areas. That is precisely to meet the problems that the hon. Gentleman has raised.
Norman Lamb: I have no idea whether the NHS Confederation is culpable, but ultimately the Government are in charge. The confederation now says to the Government that they ought to change the GP contract to remove the disincentives to practices working in deprived communities. What is the hon. Gentleman saying? Should we ignore the confederation? That is a ludicrous proposition.
Dr. Stoate: The hon. Gentleman is being generous in giving way. The NHS Confederation should be negotiating; if it does not like the GP contract, it should renegotiate it. I assure the hon. Gentleman that GPs would be happy to look at the GP contract again to improve on some of the issues that he has raised.
Norman Lamb: I do not know what we have achieved through these interventions.
Norman Lamb: No, I shall not give way. The hon. Member for Dartford seems to abdicate completely from the Government’s responsibility to ensure that the GP contract removes disincentives for practices working in deprived communities. He seems unable to understand that point.
The NHS Confederation says that at the extremes, a practice working in an area of high disease prevalence could end up receiving £13 per patient under QOF, whereas a practice in a leafy suburb could get £26,600 per patient. That is a perverse and outrageous outcome— [Interruption.] The hon. Gentleman should read the report. It is remarkable that the Government should have been prepared to preside over a system that so disadvantages practices working in deprived communities.
I want to move on to the next area where the Government have completely failed to ensure that health services are provided on the basis of the patient’s need. I refer to mental health. The Secretary of State’s announcement of £170 million to develop therapy services is certainly welcome. However, I
suspect that if the Government were to measure mental health services against the test set by the Queen’s Speech—that services should be based
“around the needs of the patient”—
they would accept that the service had been found severely wanting. Mental health has again been one of the main casualties of cuts when primary care trusts have faced heavy deficits in the past two years.
A psychologist with whom I recently spoke in Sheffield said that some of the most vulnerable people, with severe and complex needs, had been on her waiting list for more than two years. She said that cognitive behaviour therapies, which will be provided under the Layard reforms, would not be sufficient for many of those patients. Given that some have to wait more than two years for access to therapies, and that in many parts of the country there is no access at all to talking therapies, the service is not based around the needs of the patient—that rather bland commitment that the Government made in the Queen’s Speech.
Mental health patients should have an entitlement to treatment within a defined period. We should also tackle the wholly unacceptable state of many mental health wards around the country. The condition of many of those wards would not be accepted in any other acute hospital, yet they are there behind closed doors in many of our mental health hospitals. There needs to be a revolution in mental health. It is a disgrace that after 10 years of this Government, and so much investment going into the health service, that has not yet happened.
Mr. Kevan Jones (North Durham) (Lab) rose—
Norman Lamb: I will not give way at the moment.
It is also a disgrace that people with mental health problems are discriminated against in terms of their physical health. People with mental health problems have a life expectancy of 10 years less than the rest of the population because they do not get equal access to health services for their physical health needs. That is unacceptable.
The third area that I want to deal with in assessing Government performance against the tests set out in the Queen’s Speech is care of older people. The spending review contained a 4 per cent. real-terms increase for the health service and a 1 per cent. real-terms increase in social care funding. Why the distinction? What possible explanation or justification could there be for it? The hon. Member for Dartford is nodding; I am glad that he is acknowledging that. Our big challenge is an ageing population. We know what is going on in social care. In the vast majority of local authorities, the criteria for accessing domiciliary care have been cut right back so that only the most urgent crisis cases are getting access to such care. Fees have rocketed. Over the past 10 years, there has been a 25 per cent. reduction in the number of households accessing domiciliary care from local authorities, at a time when the number of older people is significantly increasing. Again, that is unacceptable.
It is extraordinary that 10 years into a Labour Government and nine years after the royal commission report, we get to a point where the Government are announcing a process that will lead to a consultation
that will lead to a Green Paper, which might in due course lead to the possibility of reform of a grossly unfair system. The means-testing system for the funding of care for older people is scandalous. Niall Dickson of the King’s Fund described the way in which old people are treated as one of the unrecognised scandals of our time. The brutal truth is that many older people, particularly those on lower incomes, do not get access to the support that they need in their own home, and often the quality of care in care homes is not good enough. There is a chasm between the bland assertions in the Queen’s Speech and the reality of what we see on the ground. This Queen’s Speech, quite apart from those in previous years, should have included a commitment to legislate to ensure that older people get the funding support that they need for care at home or in care homes.
Dr. John Pugh (Southport) (LD): Does my hon. Friend want to remark on the fact that there is only a 1 per cent. increase in the local authority budget for elderly people?
Norman Lamb: Absolutely. One gets from local authorities the clear impression that they have a crisis in the funding of services for older people.
Let me turn to the Conservative position. The Conservatives say that the NHS is their No. 1 priority—that is what we heard at their conference—but they offer a tax cut of nearly £300,000 for estates worth over £1 million, yet would do nothing at all for people who lose everything as a result of getting dementia or Alzheimer’s and end up having to sell their home because they cannot afford to pay for care. Their priority is to give tax cuts to millionaires and their families; our priority is to help those who miss out on means-tested benefits but have worked hard all their lives to gather together a small nest egg only to see everything go because of a pernicious system of means-testing.
That brings me to the rest of the Conservatives’ vision for the future of the health service; it will not take me too long. On the radio this morning, the Conservative leader talked about the Conservative party being the party of localism. I nearly choked on my muesli—being a good Liberal Democrat—because that is a contradiction in terms. The Conservative plan is for a national quango with no local democratic accountability. Having read through their paper—it was rather turgid, but I got through it—I asked myself, “What would happen under the Conservative paradigm when a hospital is threatened with closure?” The answer is that an unelected national quango would make the ultimate decision about whether to close a hospital in, say, Sidcup. That is their localism—it is utterly meaningless—and once people realised that their hospital was to be closed by an unelected quango in London, they would lose any enthusiasm that they might have had for it.
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