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14 May 2009 : Column 314WH—continued
The right hon. Gentleman highlighted the importance of leadership and improving the work force. On that, the Government response to the Committee’s report was good, and we agree with much of it. It is essential to have incentives and standards, and to advocate improvement at all levels within the health service. The Government dealt with that point properly.
The hon. Member for Wyre Forest (Dr. Taylor) always makes extremely informed contributions to our health debates. He is right that, for once—I do not know whether he was criticising only the Department of Health—the Department’s response to a report is extremely logical and easy to comprehend and digest. That is not always the case, and is certainly not the case with other Departments.
However, I am sorry to have to tell the hon. Gentleman that the examples that he gave and the moving letters that he read out are not unique to his constituency. We could all do that, and I receive similar letters at my office relating to my constituency in rural Lincolnshire. Although there are centres of excellence and good hospitals, examples of poor practice can often be found. We need to deal with that collectively. However, he is right to highlight the concerns set out in the quality framework.
The hon. Member for Romsey is right in what she said about commissioning, and about the problems and patchiness that exist. Even if we could define what is meant by world-class commissioning, it is clear that many PCTs are struggling to implement it. Indeed, many are struggling to separate the conflicts that arise in their commissioning and provider arms. Indeed, the Minister will be aware that some PCTs are struggling to commission efficiently and effectively, and that the independent sector has been sent in to assist, but if PCTs cannot commission as they should, innovation can be harmed. Given the time, that is another theme to which I shall return.
I join the hon. Lady in thanking Lord Darzi for the tireless work that he put into the NSR. Like her and others, I picked up on the fact that he was bring criticised for not understanding primary care, but the NSR summarised many of the problems prevalent in the health service. However, the Select Committee report says that many of the key recommendations had been made before. Indeed, many were set out two years previously in the Department of Health White Paper “Our health, our care, our say”, and some themes are replicated in Lord Darzi’s report. The NSR is nevertheless a significant report, the difference being the wide range of consultation involved and the fact that people throughout the NHS participated.
The White Paper was the sixth on health since 1997. I would argue that few of the aspirations set out in them have been achieved. However, we do not need more reviews and more reorganisations. We need to focus on delivery and better patient outcomes through the NHS.
If I have a generic criticism of the NSR, it is that the responses to the issues highlighted in it are inevitably bureaucratic. They are centralised and do not focus on patient care. I give the Minister an example: out of the NSR and the regional reports that emerged from it, in the east of England alone, 12 new permanent bodies have been set up. That is a bureaucratic response, not a delivery-based and outcome-based response.
I want to turn to some of the specific issues highlighted in the Select Committee report and the Government response. Of course it is vital that the NHS focus on quality, but quality and standards should always have been right at the top of the priority list for the NHS. If one key issue is highlighted in the Select Committee report, it is the feeling that building capacity and access has been the significant priority, rather than improving quality. I would certainly argue that the two things are not mutually exclusive and should not have been treated as if they were.
Lord Darzi quite clearly sets it out that each trust should produce a quality report, and he hopes that the quality account will soon be as important to trusts as meeting their financial targets. However, I am concerned when I look at the draft produced by the Department of Health. I have it here. It is entitled “Sunnyview University Hospital Trust quality report 2008-09”. I do not know whether the Minister has had a chance to look through it, or even whether he has seen it in his ministerial box. If not, it is well worth looking at, because what it says to me is that quality equals targets, and as far as I am concerned that is not the perspective of the original Darzi review, or indeed the Select Committee report published afterwards.
There is a danger that many trusts will look at the draft produced by the Department and merely replicate it for their own use, inserting what is relevant to them. I suggest that the Minister and his team need to have a fundamental look at that issue.
Lord Darzi was absolutely right to say that quality can be achieved only by having much more accessible and comparable information; I believe that patient outcomes can be bettered only by having such information. Indeed, the Conservative party has produced a skeleton outline for an information strategy, which we will be fleshing out in the coming months.
However, I am not convinced that information should merely be disseminated through NHS Choices. There must be other avenues. We must ensure that we take information to patients, not just wait for patients to come and access that information.
I want to say a few words about outcomes. We in the Conservative party have been talking about an outcome-focused NHS for a long time, so I am pleased that there seems to be a drift in the original Darzi document towards that sort of conclusion. I am afraid that we still have some of the worst health outcomes in the whole of Europe, whether it be cancer survival rates, stroke and lung disease rates or cardiovascular mortality rates.
As the hon. Member for Wyre Forest mentioned, we need to say that tragedies such as Stafford demonstrate that there are still significant issues to be addressed in the system. I must say that the Stafford trust was criticised for focusing on a target culture and on financial savings, rather than on patient safety and outcomes. If there is one common theme that I hear as I travel around England talking to people who work in the NHS, it is that they agree with that comment. They agree that there is too much focus on process-driven targets and not enough focus on patient outcomes. We certainly want to change that perception.
Lord Darzi’s report clearly says:
“There will be no additional top-down targets beyond the minimum standards.”
Perhaps the Minister can clarify whether that means that there will be no more targets set centrally, or whether there are some targets hidden in the term “minimum standards”. Also, if the Department of Health accepts that there are some clinically distorting targets, why has there been no reduction in the top-down targets mentioned in Lord Darzi’s report?
I want to discuss GP-led health centres, or polyclinics. Other hon. Members have made the key points. The Select Committee report agrees with the position of the Conservative party, and I am pleased that the Liberal Democrat party now seems to agree with our position too. We were never against GP-led health centres. If they are based on clinical evidence, supported by patients and GPs, and of benefit to patients and the local NHS structures, we would be supportive of them.
However, it is imposition from the centre that we oppose. I was a little uncomfortable with how some campaigns on this issue developed, and I take the point that other hon. Members have made about that. Also, whatever the Minister says, we do not always agree with the British Medical Association. None the less, there was genuine concern expressed by patients, particularly in rural areas, that their GP surgery would not exist for much longer. Clearly, however, that will not be the case.
I suspect that the drive from the centre came from No. 10 Downing street and had much more to do with political outcomes than with health outcomes. I think that there were one or two chief executives of primary care trusts who said publicly—many more did so privately—that they did not want an imposed GP-led health centre and they thought that they could use those resources far more effectively by building services through existing GP practices.
I agree with the hon. Member for Romsey that we need to do more to reduce health inequalities. A major factor behind increasing health inequalities is lack of access to primary care, and we need to increase the accessibility of primary care in areas with socio-economic deprivation, including those with large ethnic minority communities, to enable the people there to access services that they currently find challenging to access.
The sentence in the Select Committee report that says it all is the one that has been mentioned before, but I will repeat it to put it on the record. The report says that there is
“the potential to waste taxpayers’ money and be grossly inefficient.”
The Department will need to look very carefully at that particular area.
I will not repeat what has been said before about piloting personal health budgets. We agree with piloting personal health budgets. It is essential that there is proper analysis and evaluation of the pilots. The complexities of that process have been set out before and the detail of delivering those personal budgets is very challenging indeed. However, it is certainly worth running these pilots. Again, the House will be aware that the Conservatives have been saying that for some considerable time. We are also pleased that Lord Darzi set out—again, we have been saying it for some time—the fact that we need to provide much greater choice of GP practice for people to register with.
I want to make a few comments on commissioning. The Select Committee report clearly acknowledges the fact that one of the largest barriers to implementing
many of the recommendations is the weaknesses that exist in many PCTs. That issue needs to be looked at extremely carefully. It is not just the lack of expertise and experience that matters; a careful look needs to be taken at the qualifications of some of the staff who are dealing with some of these complex commissioning issues. We think that the commissioning process needs to be reformed. As the House will know, we have set out proposals to remove some commissioning, or to put it down closer to the patients and allow GPs to work together in commissioning consortiums.
The Minister may respond to that by saying, “Well, it is already happening through practice-based commissioning,” but I am not sure that it is. Certainly, as I travel around, the response from GPs to practice-based commissioning is, to put it politely, extremely patchy. Practice-based commissioning has run into the sand; it does not involve real money or hard budgets. Indeed, the Select Committee report clearly states that
“practice based commissioning had failed to engage doctors”.
“We are not convinced that the Next Stage Review will succeed in reinvigorating the scheme.”
I think that there is real reluctance to engage with practice-based commissioning. Having said that, where I agree with the Government response to the Select Committee report is that we must build incentives into the system to encourage quality and to deliver better patient outcomes.
I want to mention public health very quickly. Clearly, the Conservative party has detailed proposals on how to change public health, including ring-fencing budgets and so on. One of the strange things that happened while Lord Darzi was undertaking his “once in a lifetime” review was that in January 2008 the Prime Minister came out with a speech in which he talked about “whole population screening”, without having talked or referred to the National Screening Committee or, as far as I could see, to many other people.
Of course, the Government have now resiled from that position and said, quite rightly, that they will have screening for diabetes, heart disease, stroke and kidney disease only for everyone between 40 and 74. It would be helpful if the Minister, if he has time, said how those health checks are going. I believe that they started earlier this month. It would also be useful if he said what the proposals are to roll that scheme out, and when information will be available to assess how effective the scheme is and how many people are using the facilities available to them through the scheme.
There are also big challenges in this area. I know that the take-up is slow in commissioning these screening services and that PCTs are finding that challenging. Most of those services are being delivered through existing GP practices. However, I feel that there is significant scope to use other providers; pharmacies are just one example. Pharmacists are extremely nervous because they feel that they are not being used and that their skills set is not being maximised for the benefit of patients.
Promoting and encouraging innovation, which are at the heart of the NHS, are fundamental if we are to see an improvement in patient care. The NSR recognises that, but again, the response is rather bureaucratic: the establishment of the Health Innovation Council, giving
strategic health authorities legal duties to promote innovation and regional funds to deliver prizes for innovation. Prizes are not needed to create innovation; instead, we need to set clinicians free. That might need to be incentivised.
What has happened to the Health Innovation Council? What has it achieved? What are the costs associated with establishing the organisation? I understand that the Wellcome Trust was supposed to make a significant contribution. Has that happened? If so, how is that money being used? Will the Minister also talk about the regional prizes being presented? What is the relationship between prizes and innovation?
We must set clinicians free to innovate, rather than insist on innovation being imposed from the top. We are determined to have a more patient-centred NHS, driven by outcomes, not central process targets, because this is the best way to achieve innovation, cost-effectiveness, accountability and, most importantly, high standards of patient care.
4.1 pm
The Minister of State, Department of Health (Mr. Ben Bradshaw): I am extremely grateful to the hon. Members on the Liaison Committee for giving the Chamber the opportunity to debate the NHS next stage review and, more generally, health policy. This debate has given all hon. Members time to breathe—often we have to rush through our points. I also apologise, on behalf—I guess—of business managers, for the unfortunate clash with the swine flu debate on the Floor of the House. It is just one of those unfortunate coincidences, I am afraid, and I do not think that anything could have been done to help.
Before I address hon. Members’ specific concerns, it is worth putting on the record—as I always try to do—the fantastic work done by NHS staff throughout the country in delivering a better than ever quality of health service, benefiting all our constituents. I am confident that they will continue to deliver an improving service in the years to come. In 1997, when this Government came to power, the NHS was in crisis; it was chronically underfunded, woefully understaffed and failing to provide a decent service to patients. In many cases, the quality of service was unacceptable.
The immediate answer had to be sustained and substantial investment, combined with a strong direction from the centre—emergency treatment to bring the patient back to life. There are now thousands more—and properly paid—doctors and nurses; hundreds of new or refurbished hospitals and GP practices; and, from a patient’s perspective, a radically improved NHS in every way. Waiting times are down from 18 months to an average of just eight weeks. Cancer treatment is better, faster and more effective, with survival rates rising every year. I accept that, as the hon. Member for Boston and Skegness (Mark Simmonds) mentioned, we remain, in some cases, behind the EU average, but some of the data often referred to have a time lag of one, two or even three years. I am confident that we are catching up rapidly and even, in some cases, overtaking others.
When a patient starts to recover—as the NHS has—their treatment is changed. They are not kept in intensive care. What was right for the NHS in the 1990s is not necessarily the most appropriate treatment today. That is why we published “High Quality Care for All”, through the next stage review, under my noble Friend
Lord Darzi. I would like to express my gratitude to hon. Members, especially the hon. Members for Boston and Skegness and for Romsey (Sandra Gidley), for their kind, personal words about my noble Friend. He has been an excellent addition to the Government. In my view, he is the most successful GOAT—Government of all the talents—and long may he stay in his role. He is a very good example of how we can improve the performance of government—not just the health service—by bringing in people with that level of expertise. He did a fantastic job of setting out a vision that should deliver high-quality care for everyone in everything that the health service does—an NHS that now provides greater choice and easier access for patients; is more innovative and responsive; is helping people to stay healthy; empowers front-line staff, and works in partnership with patients.
The hon. Member for Boston and Skegness asked how many nurses—I think—were consulted during the consultation. I cannot give him an exact figure on nurses, but I can tell him that, at the SHA level, 2,000 clinicians were involved, and many more were involved locally. Sixteen thousand people in total took part in deliberative events. It was the single biggest consultation that has ever taken place in the NHS. The resulting vision is founded on unprecedented engagement with staff, patients and communities.
What do I mean by high quality? Quality means protecting patient safety by eradicating things such as health care associated infections and avoidable accidents. It is about the effectiveness of care: from the clinical procedures that patients receive to their quality of life after treatment. It is about the patient’s entire experience of the NHS and about ensuring that they are treated with compassion, dignity and respect, in a clean, safe and well-managed environment.
During the debate, there was much discussion about quality, how we measure it and whether it is necessarily cheaper. The hon. Member for Wyre Forest (Dr. Taylor) asked how we will ensure that quality is achieved in the health service. We have a number of ways of doing that, and I shall deal with one of the most important now. He referred to our response to the two reports on the Mid Staffordshire hospital inquiry. The inquiry benefited from much greater patient and public involvement in decision making and much more accountable and open NHS boards. The inquiry supported the excellent work of the independent regulatory system, which was established under this Government, and led previously by the Healthcare Commission, and now by the Care Quality Commission.
The regulatory system helps to ensure that people make complaints. If the hon. Gentleman wants to pass on the terrible individual cases that he cited during the debate, I shall be very happy to look into them. I try to encourage anyone who writes to me, and encourage other hon. Members to do the same. It is desperately important that people complain, through the official complaints process, not only because, otherwise, no one will know about it, but because hospitals are now measured on the number of complaints that they receive, on how well they deal with them, on how well they learn the lessons, on the number of complaints passed on to the independent regulator and on the number upheld.
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