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18 Mar 2009 : Column 292WH—continued
The figures are heartening overall, but we must not be complacent. That is why Digital UK’s promotional work will continue until switchover and beyond to ensure that everyone understands what is happening and what they need to do in order to benefit. That is more difficult for some than others, which is why the
Government and the BBC have set up the digital switchover help scheme, funded from the licence fee. About 7 million households are eligible for help from this scheme, which will be rolled out in each TV region as switchover approaches. All eligible people will be entitled to be provided with equipment that meets their particular needs, as long as that equipment complies with the revised core receiver requirements. After a public consultation, these new requirements were published on 11 November last year.
There is one change in those requirements that is relevant to this debate. That is the change that says that any equipment offered as standard must have one-button access to audio description services from remote control handsets. In other words, someone just has to press a button to receive audio description; they do not have to press a button and then scroll through a menu and press other buttons to receive it. So one-button audio description does what it says; it allows the user to access audio description with the press of a single button.
The Government will continue to keep the core receiver requirements under review, because technology changes and with technological changes come new needs. In addition, we have established an emerging technologies group to assess new developments as they come on stream, such as the electronic programme guides that are currently being developed by the RNIB. That process will give visually impaired people the chance to prepare and plan their viewing, rather than just accessing a new development as it emerges. Furthermore, we have not forgotten those who do not qualify for the help scheme but who could still benefit from audio description. That is why the digital television group has set up a sub-group of its usability group to examine how audio description can be readily accessed through consumer equipment.
In addition to getting the transmission and technology behind audio description right, we must ensure that the number of programmes on which this service is available is also right, which is the nub of my right hon. Friend’s
argument. In 2003, the Government passed legislation that set a minimum target of 10 per cent. of programmes made by licensees to be audio described within a 10-year period. That legislation also gave Ofcom the responsibility of ensuring that broadcasters meet these requirements. As my right hon. Friend’s list of figures showed, broadcasters generally exceed these requirements, although not hugely. Ofcom will be investigating the awareness, take-up and usage of audio description as part of its 2009 access services review.
Ofcom will also conduct an analysis of the social and financial implications of any possible increase in audio description targets, before deciding whether or not to recommend an increased target to the Government. Ofcom will launch this review in April, and it plans to meet with stakeholders for briefing sessions before publishing a consultation document in the summer. It hopes to be able to report on its findings before the end of this year.
In the meantime, the Government welcome the recent announcement by Sky voluntarily to increase its provision of audio description to 20 per cent. of its programmes. That shows a good understanding of community and it is also good business. With an ageing population and as people’s eyesight gets worse as they get older—my right hon. Friend and I now both wear glasses—I am sure that many new people will benefit from audio description services.
This news indicates the success of the awareness-raising activities of my right hon. Friend and the RNIB in this area. They are doing this country a great service, and I commend them for it.
Mr. Martyn Jones (in the Chair): Order. As the Minister is not present for the next debate, I adjourn proceedings until 4.30 pm.
4.24 pm
NHS Resources
4.28 pm
Dr. Richard Taylor (Wyre Forest) (Ind): Thank you very much, Mr. Jones, and I am very grateful to the Minister for turning up two minutes early, which means I might be able to go on for 17 minutes, but we will see how it goes.
I am delighted to see the Minister in the Chamber. He and I are quite used to swapping reminiscences and points of view with other Members in a packed Westminster Hall, but I appreciate a one-to-one with him. It is absolutely great.
As the Minister knows, I am usually trying to help the NHS and not trying to make any party political points at all. As he also knows—well, he probably does not know—I qualified as a doctor 50 years ago, so the NHS has been part of my life for a very long time and I am still absolutely dedicated to it.
The Order Paper never gives the full title of a debate, but the full title of this debate was, “Suggestions for better use of resources in the NHS”. I am really returning to a recurrent theme of mine. With increasing longevity, the greater scope of possible treatment and the fact that—although the Government have poured lots of extra money into the NHS, we are now coming to the stage of limited resources—we cannot expect the bonanza of money in the NHS to go on increasing, so we have to push for maximum efficiency and the minimisation of waste in the NHS.
When addressing his constituents, in 1868, Disraeli said:
“There can be no economy where there is no efficiency.”
That absolutely stands today, and the first issue that I want to consider is what the Government are doing in that regard already. I hope to get a bit of an update on that from the Minister. Then I shall suggest some things that the Government should consider doing, but I do not expect to get answers on them today, because I have not warned the Minister about any of them.
What are the Government doing to eliminate waste and inefficiency? I am sure that you saw huge advertisements in the Sunday papers over the weekend, Mr. Jones, to mark European antibiotic awareness day, which was a tremendous step. One advertisement said:
“If a cold is making you feel under the weather, antibiotics aren’t going to help”.
It is terribly sad that we have to tell people that, but I sympathise with the poor GPs, because time and again it might be easier simply to give out an antibiotic than to spend time explaining that it will not do one a power of good. That advertisement was something, and it was good.
Bob Spink (Castle Point) (Ind): The hon. Gentleman has immediately touched on an important area where there is a possibility of saving money—managing health care acquired infections. The Government’s policy of dealing with them when they arise is extremely costly. Would it not be better if they changed their policy to focus on prevention by providing each patient with an individual kit to stop the spread of infections such as methicillin-resistant Staphylococcus aureus and clostridium difficile?
Dr. Taylor: I am grateful for that intervention. Of course, I shall come to that issue, because the prevention of health care acquired infections is terribly important. The Government are doing something about that problem, as opposed to the situation with other preventive measures. One thing that they are doing involves the better care, better value indicators, which originally identified 10 general practitioner and hospital practices through which we could save the country about £2 billion a year if best practices were followed for all of them. I should very much like to know the progress of those indicators. I think that a second wave has been launched, but they have come out so quietly that I do not know about them. I hope that primary care trusts and the people who should know about them do. I should like an update on that.
Last week, in the Select Committee on Health’s public hearing on the operating framework for the NHS in England, we asked the Secretary of State about efficiency savings. His answer was rather negative. He said that the savings would come from the “back office”, from better procurement and from better use of the NHS estate, but he then went on to list a lot of negatives. He said that savings would not come from patient care—
“not getting rid of staff, not restricting drugs, not expanding waiting times”
“important developments in patient care.”
He left a lot to the imagination about what we could do.
The last Government measure that I shall touch on briefly is quality, which is absolutely essential. It saves money, not least by avoiding complaints and litigation. As I have said before, there are four Cs for quality, the first of which is care, which means safety and using evidence-based, up-to-date treatments. The second is compassion, which does not need any explanation. The third is continuity of care, which is threatened by the European working time directive, and the fourth is communication, which includes communication between doctors and patients, doctors and nurses, and doctors and other doctors. Communication is cut down by stress and overwork.
The importance and potential cost of quality has been emphasised today by the Healthcare Commission’s report on the Mid Staffordshire NHS Foundation Trust disasters. The questions that were posed and answered today, following the Secretary of State’s statement, showed that there is much more to be found out. To me, the main message was that Monitor, which decides on foundation trust status, must surely take more note of quality of care, as it currently makes decisions based on finance and good governance. The standardised mortality ratio in Stafford was known in 2007, but that trust acquired foundation status in February 2008. There has to be much more evidence about quality.
Let me make some suggestions about what we ought to be doing. We should, as my hon. Friend the Member for Castle Point (Bob Spink) has said, spend more on prevention, which is far cheaper than treatment. The first example of where work can be done on prevention is with health care associated infections. To give the Government their due, they have made that a tier 1 priority for the Care Quality Commission’s inspections, so that is of paramount importance. The figure put on that saving is £75 million.
I am sure that the Minister will know, as I have mentioned it in his presence before, that I am absolutely desperate that the prevention of venous thromboembolism in hospitalised patients is given the same sort of priority as the prevention of health care acquired infections. When the Health Committee inquired into the prevention of venous thromboembolism in 2005, we learned that there were about 25,000 preventable deaths a year—at least a lot of them were preventable—and that coping with that problem would save about £640 million a year. That is far more than could be saved by preventing health care associated infections, but it is not a priority. The relevant risk assessment, which is so essential, costs nothing, and the treatment cost is peanuts. This issue was mentioned in the report on what happened in Stafford. I have not read every word of that enormous report yet, but I have found that it blamed some of the deaths on the lack of risk assessment and the occurrence of venous thromboembolism. I hope that that might push the idea that risk assessment has to be mandatory and must be assessed by the CQC.
Stillbirths and neo-natal deaths could also be prevented. The Stillbirth and Neonatal Death Society charity has drawn attention to the fact that there are 17 stillbirths or neo-natal deaths a day, which is about 6,500 a year, many of which could be prevented if research were done into the factors required to prevent them. The savings in litigation alone would be enormous.
Prevention of HIV is another issue. There are huge treatment costs, and the numbers are increasing. The National AIDS Trust tells us that 7,800 people are newly diagnosed each year in this country, and that there are estimated to be more than 80,000 people with HIV, a quarter of whom do not know that they have it. The trust has made several recommendations as to what the Government should do, including giving support to teachers, so that they can talk confidently in sex and relationship education. Other recommendations are training all health care professionals in primary and relevant secondary care specialties on HIV testing, introducing financial incentives for GPs in relation to HIV testing and pilot home sampling for HIV on the NHS.
I do not think that the Minister will be surprised if I talk about NHS pathways yet again, because I have mentioned the subject to him many times. The programme is preventive in that, with the correct use of triage, it can prevent people from going to the wrong place. Just last week, I had a letter from a constituent saying that she turned up at one place that was not right, she was sent to another place that was not right and, because it was late at night, she had to be admitted to hospital for the night. That wasted a vast amount of money.
If NHS pathways had been in place, I wonder whether the problems at Stafford might have been eased. We know that the accident and emergency department there was clogged with minor problems because the report states that, instead of concentrating on the severely ill, staff were diverted to deal with some of the minor problems and get them out of the way to meet the targets. NHS pathways would have prevented those minor cases being there at all, because the people concerned would have gone to the appropriate place. After the recent announcement that NHS pathways had been passed for use by ambulance trusts, I met the director of NHS pathways and the director of operations of NHS Direct. I appeal to the Minister to promote co-operation
between those two triage systems, so that we can work towards the same triage system throughout the country as a whole, which would make a huge difference.
There are two other matters that have occurred to me literally in the past couple of days. The paediatric incontinence forum is worried that it will be pressurised into using the cheapest single-use catheters, but that could be a false economy because they are not as good at preventing infections. There is also a risk that financial stringencies mean that nurse specialists, who are the absolute experts in assessing the use of the right appliance, could be cut down. Nurse specialists will not necessarily choose the cheapest appliance, but in the long term, the cheapest is probably not the best.
The Health Committee has done a lot of work on the issue of smoking and in the recent “Health Inequalities” report we point out that smuggled cigarettes and hand-rolled tobacco are the smoking materials of quite a high proportion of 16 to 24-year-olds, and a much higher proportion of the least well-off. I learned today that there is an answer to tobacco smuggling that is almost too good to be true because it would put precisely 1p on the cost of a packet and there would be no other costs at all. The proposal is a security solution, about which I will give the Minister details after the debate, so that his officials can look into it. SICPA Security Solutions has a track-and-trace system that is already in use in several countries. The system allows smuggled cigarettes to be tracked and traced, which would surely cut down the amount of smuggled cigarettes fairly quickly. Her Majesty’s Revenue and Customs focuses on detection, but the idea that I have mentioned focuses on prevention, which is far better.
I have spoken for a number of minutes without mentioning prioritisation or the dreaded word “rationing”, because there is much to be done before we fall back on to rationing. At last, I have found an excellent definition of rationing in health care settings in a 2007 paper from the primary care trust network and the NHS Confederation. The paper is entitled “Priorities Setting: An Overview” and is by Dr. Daphne Austin, who is a public health consultant and an adviser to the Health Committee. She defines rationing as:
“a consequence of priority setting. A patient can experience rationing in many ways, including being denied access to a treatment or service, experiencing a delay or poor quality services which impact on the clinical outcome. It is advisable not to use the term ‘rationing’ as a verb; to do so is to imply that rationing is an optional activity. All positive decisions to fund are inextricably linked with a rationing consequence somewhere in the system.”
I will leave the Minister with that and the fact that in a resource-limited situation, for every decision to fund something extra, something else falls off the bottom of the ladder. We must avoid getting to that stage by making the NHS as efficient and waste free as we possibly can.
4.45 pm
The Minister of State, Department of Health (Mr. Ben Bradshaw): I congratulate the hon. Member for Wyre Forest (Dr. Taylor) on securing the debate. Given his long professional background in the field, few hon. Members have a better understanding of the importance of the sensible use of resources when it comes to health care spending.
Before responding to one or two of the specific points that the hon. Gentleman made, I thought it might be helpful to put the matter in context. Often when people talk about value for money and productivity in the NHS, they come to it from a sort of widget-factory-based approach to productivity, rather than from the idea of productivity that he and I share and think is important. For example, people could conclude from the latest productivity reports from the Office for National Statistics that the NHS did not spend money efficiently. However, of course, ONS defines productivity as the amount of measurable output for a given input. By that measure, when the Government started their major investment in the NHS, productivity fell. Between 2001 and 2005, it fell by about 2 per cent. a year and by 2006 it had levelled off. So, even according to that measure, the tide was turning as long as three years ago.
However, my difficulty with the crude assessment of productivity applied to the NHS is that it not only lags behind investment, but is an inappropriate way of measuring the success, value for money and efficiency of the organisation. I shall give a couple examples in relation to that. The advances in health care provision and increases in staff numbers mean that many patients can now be treated in their own home and community. That is clearly better for their recovery and patients invariably prefer it. However, that can appear as a fall in measured productivity. Similarly, the hon. Gentleman mentioned the length of GP consultations. The average length of GP consultations has increased from eight to 12 minutes. Indeed, many good GP practices offer consultations that last a lot longer than that. I think that we would all agree that that period of time is better for the patient and the GP and that it can lead to better outcomes for the patient. However, as a crudely measured productivity statistic, that period of time spent with a patient will come across as a fall in NHS productivity.
A more helpful and objective way of measuring the productivity and value for money of the NHS is to look at what international studies say about the NHS compared with other health care systems. The prestigious Commonwealth Fund in Washington has recently rated the NHS as one of the highest performing health services for the past three years. It specifically praised the NHS for managing chronic illnesses and access to primary care, and it also highlighted the NHS as one of the most cost-effective health care systems anywhere in the world.
With the recent election of Barack Obama, it is instructive and topical to make a simple comparison with the United States. The US spends twice as much on health care as we do, as a proportion of gross domestic product, but has worse health outcomes, and tens of millions of Americans are not covered by their private health insurance system. A number of other recent international comparator studies have shown that the NHS is better at containing costs, because we have a single purchaser system and we do not have the wasteful and profit-seeking involvement of insurance companies, private doctors and the pharmaceutical industry calling the shots.
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