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the local headquarters of the NHS
and it gives them power to control their areas. We can see what that means, as the Darzi review document proposed 21 new bodies at a regional level for the East of England SHA. The Secretary of State talks about local decision making, so will he stop the regionalisation of the NHS and the growth of a new regional bureaucracy on top of everything else?
The Secretary of State proposes to create Medical Education England, but he views it as an advisory body, not as the body responsible for commissioning medical education and training to meet work force needs, as agreed between health care employers and staff. The real power of commissioning is given toguess whothe strategic health authorities. The plan claims to be bottom-up, so will the Secretary of State abandon the top-down insistence on polyclinics and let the local NHS decide how primary care services are best provided? How can the Secretary of State talk about GP access and then want to shut down local and accessible GP surgeries? Clinicians care about continuity of care, so why do the Government undermine it?
On health care-associated infections, where is the zero-tolerance strategy that patients are demanding? If the South East Coast SHA can pledge in its Darzi review that there will be no avoidable cases of hospital-acquired MRSA by 2011, why cannot others? Why are C. difficile rates in the UK 10 times those of other health economies?
Apparently, the Government are claiming that they will promote home births. How can that be so when 15 local maternity units have been closed or have lost their obstetric service and 26 more are threatened? The simple fact is that if obstetric care is taken further away, home births or birth centres simply cannot be offered.
The Secretary of State has followed our lead in a number of areas: extending personal budgets to include some patients with long-term conditions; enabling palliative care patients to choose where their care is provided; and publishing more data on outcomes reported by patients. Let us be clear about outcome measurement. Mortality rates for hip replacements are of limited value. Patient-reported outcomes need to extend to subsequent information on mobility, return to work, ability to look after oneself and absence of pain. Narrow outcome measures are only a little better than narrow targets.
The Secretary of State said nothing about public health services. Obesity, binge drinking, drug misuse and resurgent infections threaten our health and the future of the NHS. Health inequalities are widening. Improving public health is critical to long-term health outcomes and the ability of the NHS to meet demands successfully. The lack of preventive action is a scandal, yet no response in todays statement is remotely proportionate to the challenge.
The Secretary of State also now says that patients will not be subject to a postcode lottery. How often have Members heard that? Time and again. In reality, there is
nothing new in what he announced today. It is already the case that primary care trusts should not refuse access to drugs on cost grounds alone while awaiting evaluation from NICE. If NICE approves a drug, they are already obliged to make it available within the NHS within three months. Last year, the Government promised to speed up NICE evaluations, yet today we are still among the countries with the slowest uptake of new medicines, despite being world leaders in research.
We thank all those who have contributed to the review. The local clinical work will be valuable, but we must regret the fact that the Government appear unable to recognise that quality in the NHS depends on responding to patients needs and expectations, the exercise of choice within a competitive environment, the freedom to innovate and a focus on the importance of outcomes for patients. It does not requireindeed, it will be impeded bytop-down process targets, excessive bureaucracy, incoherent policies and a command-and-control approach.
Alan Johnson: I am very disappointed by that response, particularly as so many cliniciansnot just the 2,000 who have been working with Lord Ara Darzi, but 60,000have had an input into this. Those visions, for which todays final report from Ara Darzi is the enabling report, were developed locally, not dreamed up in a strategic health authority. The hon. Gentleman attacks it on the basis that there is too much top-down bureaucracy
Alan Johnson: The hon. Lady says that there is, but this is an example of our having freed up clinicians and people working in the health service, patients and carers, the staff and the public to set out their framework for the future.
The hon. Member for South Cambridgeshire (Mr. Lansley) says that we should scrap the targets. The position of Conservative Members is that there should be no greater access to GP surgeries, no 18-week maximum wait for surgery and no maximum of four hours in A and E. He mentioned the patients charter. I have the patients charter in front of me. What does it refer to? This, after 16 years of Conservative government:
For hip or knee replacements and cataract operations, a waiting time guarantee of 18 months.
From April 1995, the NHS is broadening
to cover all admissions to hospital.
[Interruption.] The point is that we could have done with someone setting some targets, getting to grips with the issue, before we came into government, but that is the best that they could offer after 16 years in power 18 months of waiting.
The hon. Member for South Cambridgeshire also said that we followed the Conservative lead on the constitution. I am sorry, but I have traced this back to a
Fabian pamphlet produced by my right hon. Friend who is now the Secretary of State for Culture, Media and Sport long before the ideas from the Opposition were put forward in relation to this independent NHS. They want the NHS to be a giant unelected quangoan idea that was ridiculed again this week by The Lancet, as well as by the Kings Fund and every other organisation that has looked into it.
The hon. Gentleman then said that we should have bottom-up solutions. Polyclinics were developed in London by London clinicians, in a part of the world where 54 per cent. of GPs are either single or double-handed, where a third of all practices do not even have disabled access and where 50 per cent. of A and E cases involve people who should be in primary care.
The Opposition reject a local solution enabling GPs to come together in services that can provide diagnostics, blood tests and X-rays, or to stay in their own services while being linked through a hub-and-spoke system. It is preposterous that the Opposition should oppose a move envisaged by Bevan in 1948.
The hon. Gentleman spoke of maternity units. For the first time in 40 years, we stood up for clinicians in Manchester who said that three large neonatal specialist units were needed at the expense of four other units in the area. That will save the lives of between 30 and 40 babies a year, and will cost an extra £60 million. The Opposition were first against it and then for it, but the reconfiguring of services means that clinicians are able to say This is how best to improve patient care. Although the Oppositions response is disappointing, it will not stop us from working with clinicians, staff, patients and carers to improve the quality of care in the NHS.
Norman Lamb (North Norfolk) (LD): I thank the Secretary of State for early sight of his statement. It contained much in terms of aspiration on which we can all agreeit refers to the pursuit of quality and prevention in health care, access to medicines and the importance of empowering patientsbut the main issue is how those goals can be achieved. There was little, if anything, in the statement to suggest that the Government have learned that change cannot be dictated from Whitehall.
Doctors may be accommodated there instead of in their own surgeries.
I suppose that what goes around comes around, but is not the current imposition of GP-led health centres, or polyclinics, yet more evidence that the Government have not learned that this issue cannot be approached through command and control from Whitehall?
The Secretary of State has previously acknowledged the democratic deficit and lack of accountability in the health service. He is still the only democratically accountable person in the service: nothing has changed as a result of his statement. Have they got to him, or does he still acknowledge the democratic deficit in the NHS?
We strongly agree about the need to speed up access to drugs and to speed up the NICE process, but what about all the drugs already on the market that have not been NICE-approved? It seems to me that the postcode
lottery will remain with a vengeance in the case of all the drugs that came on to the market before NICE existed. Does the report contain any proposals to examine the criteria that NICE applies in deciding whether to approve a drug? It is currently not possible to take into account the interests of carers and others in relation to dementia drugs, and despite a recommendation from the Select Committee on Health, there was nothing about that in the statement.
As for the constitution, although I endorse the case for clarity on rights and responsibilities, will patients be given legally enforceable rights or is this a motherhood and apple pie statement of ultimately meaningless intent? What will be done, for example, to end the scandal of the mixed-sex wards that still exist in our hospitals, particularly in the mental health sector?
I am very concerned about the lack of any reference to mental health in the statement. The Secretary of State will be aware of yesterdays devastating analysis of the state of mental health services by the new president of the Royal College of Psychiatrists. The 18-week target is absolutely irrelevant to anyone with a mental health problem. Can it be right for this to continue? Is it not bizarre that patients will have a legal right to a drug to suppress their condition, but no right to the treatment that could cure them? Surely that is ridiculous.
The statement also made no reference to tackling the health inequalities that scar our country to this day, and appear on many indices to be worsening. Is that no longer a priority for the Government? Surely if it were a priority, it would have been headlined in the statement.
The statement contained much good rhetoricand much good new Labour rhetoric, such as the reference to a clinical dashboard. I was, at least, relieved that the Secretary of State denied any responsibility for that ludicrous concept. The proposals have good aspirations, but also some notable and serious omissions. One is left with the sense that, when the dust has settled, nothing much of significance will change.
Alan Johnson: The hon. Gentleman at least damns the proposals with faint praise. He is wrong about dictating from Whitehall. There has been an ongoing debate about that within the NHS for 60 years. The original concept of the NHSthis was also central to the debate within the Cabinet at the time between Morrison and Bevanwas that hospitals should be taken out of the control of local municipalities and charities. Bevans vision for the national health service was one that, in a sense, needed to be driven from the centre. I accept, as we all do, that what we are discussing today is not simply a question of providing more autonomy, but of how we do that in a system that we might describe as one of subsidiarity, in which the centre still has a responsibility through elected politicians to ensure that, for instance, waiting times and health care-acquired infections are tackled and that pay is determined centrally. What the public said time and again as we went through this process is that, in terms of health, they are not as concerned about devolving to the local level as they are about ending the postcode lottery and of having a more uniform system from the centre. That is what the debate is about.
The hon. Gentleman talked about accountability. In terms of the constitutionI think this is what he was referring towe looked at whether we should impose
greater accountability on primary care trusts. In the end, we decided that a lot is happening at the moment and we should not impose something from the centre, and I was delighted to discover that the Local Government Associationit set up a commission on which the right hon. Member for Charnwood (Mr. Dorrell), a previous Secretary of State, satcame to the same conclusion. It said:
On balance, further restructuring of PCT boards or changes to
responsibilities...would be an unfortunate distraction and likely to do more harm than good in the short to medium term.
We agree. That is not to say that what is happening in terms of accountabilityfoundation trust models, councillors sitting on the local board of the PCTshould not continue. We just should not impose something over the top from the centre.
When the hon. Gentleman reads the document, he will see that it covers some of the matters he referred to, including the clinical dashboardwhich I assure him surgeons and clinicians love, so those who wish to interfere with it, do so at their peril. He mentioned health inequalities. First, it is important to mentionas Professor Michael Marmot, the world-renowned expert on this, points outthat the health of everyone in the UK has got better. If the basis had been just the health of the poorest improving in terms of life expectancy and infant mortality, we would not just be closing a 10 per cent. gap, but we would have closed the gap completely since 1997; but, quite rightly, the health of other, more prosperous, groups has improved. We published the health inequalities strategy two weeks ago. There is a reference to the minimum practice income guarantee, which is important because that militates against health inequalities.
On mental health, all the eight clinical pathways from maternity through to palliative care looked at mental health as well, and mental health also had its own group. Also, in all the 10 reports from each of the regions around the country, mental health is dealt with in terms of the right for people with long-term conditions to have a care plan, the right to get much better practice into local and community practice and the right for patients to be empowered over their own care. That applies to mental health as much as to any other form of illness.
Mr. Ronnie Campbell (Blyth Valley) (Lab): I welcome the statement, but may I ask about the polyclinics and their relationship to general practitioners? In my area, they wrote an open letter to the local newspaper criticising the polyclinics. I think they are a pretty good idea, but how are we going to get the GPs to work with the polyclinics, because many people do not realise that they are private operators within the health service?
The hon. Member for North Norfolk (Norman Lamb) mentioned the 1948 leaflet that went through every door and that said that health centres would come eventually. They never did, either through lack of funding or professional opposition. What would really help would be to get away from the deliberate misconception about these centres. The first argument is that they will all have 25 GPs. They will notthey will have about five. The second argument is that people
will have to leave their own GP to go there. Wrongpeople can go to one of the GP-led health centres and still remain registered with their GP. The third argument is that they will all be run by private companies. Obviously, there is a tendering process and we want to see quality, particularly in under-doctored areas, where we are increasing the number of GPs to provide a proper service. However, we expect the vast majority to be run by GP consortiums. Once people see that all these dreadful distortionsin part, exaggerated by the Conservative partyare just not true and that we are increasing capacity, they will see that this is a frankly long overdue increase in capacity in primary care.
Mr. Iain Duncan Smith (Chingford and Woodford Green) (Con): One reason why people in my area of Waltham Forest are very resistant to any of these new plans is that, rather like many other people, they have just survived a fit for the future programme that was a disaster, in which the PCT managers rode roughshod over all the publics views and attempted to close down one of their hospitals. That was stopped eventually, such was the outcry, but they remain very sceptical about this.
For example, people are told that, in north-east London, stroke centres will save lives, but we know now from clinicians that unless someone gets to a stroke centre within two hours and starts the treatment, it will have no further effect on them and they might as well be at their local hospital. Given the problem of diagnostics, is not the reality that this will not apply at all to the majority of stroke victims?
Alan Johnson: I am sometimes confused whether people want central command and control. The one consistent thing through all 10 SHA reports is the need to specialise in heart disease, stroke disease and serious traumas. Now, right across London and around the country, there is a real focus, and the stroke strategy that we published in December was probably the most widely welcomed Government health document that we have ever seen. Indeed, the hon. Member for South Cambridgeshire praised the philosophy behind it. So it is no good pretending that people will get as good stroke care in hospitals where the clinicians experience these problems only once in a blue moon. They need specialist care, and that is how we are beginning to bring down the number of deaths from strokes and to ensure that we compare favourably with all the health services in Europe.
Dr. Brian Iddon (Bolton, South-East) (Lab): Between the poorest parts of my constituency and the better-off parts of Bolton, there is 15-year mortality gap. To address that problem, Bolton PCT has just launched a major programme to screen by March next year all 45-year-olds44,000 altogetherwho have not had basic health checks recently. Will my right hon. Friend send Bolton PCT his congratulations, along with mine? In 1997, its precursor would not have had the resources that it has today to carry out such programme.
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