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14 May 2009 : Column 327WH—continued
I was glad to hear someone—it was either the hon. Member for Wyre Forest or my right hon. Friend the Chair of the Select Committee—speak up in defence of managers. We need good managers in the NHS, and they often get a lot of stick. Although the vast majority of managers meet high professional standards, I am afraid that a minority sometimes suffer lapses in performance or conduct that threaten to undermine the confidence of their staff, their organisations and patients. An advisory group chaired by Ian Dalton, chief executive of the NHS north-east strategic health authority, will consider how senior NHS managers can demonstrate publicly that they have reached and are maintaining
high professional standards, in order to ensure and enhance confidence in the profession.
The clinical excellence awards scheme is currently under review. We will examine how leadership skills can best be reflected in the criteria for awarding CEAs. The national management training schemes recruit and develop talented individuals who have the potential to become directors or chief executives within the NHS. The scheme has already produced some of our most outstanding leaders—the current NHS chief executive, David Nicholson, is an alumnus—and the scheme came fifth in The Times top 100 graduate employers in 2008 as voted by graduates, up from sixth in 2007. I would not be surprised, given the current economic climate, if it continued to rise up the league table. It is a very reputable and high-quality scheme.
The hon. Member for Boston and Skegness asked about innovation. He is absolutely right: creating an environment in which innovation can flourish is vital to improving quality. We announced the creation of five new academic health science centres in March. Last month, the Government launched a range of measures to drive innovation and ensure that innovative ideas and practices are disseminated across the service. They include a new £220 million innovation fund to support faster innovation and the universal spread of best practice; a new legal duty for SHAs to promote innovation, which will be important in driving innovation through the system; and a series of challenge prizes to reward those who have excelled in creating and diffusing innovative ideas and encourage others to do likewise.
I saw the challenge prizes rubbished in the press when they were announced, but the idea is an exciting and interesting one. We are not giving people lots of money for doing things that they should be doing anyway; we are encouraging innovation and imagination at the local level, so that ideas can come up from the bottom, as the hon. Member for Boston and Skegness himself highlighted.
We are also introducing a new IT system, NHS Evidence, to improve access to information and support for better clinical and commissioning decisions. Medical Education England provides independent, expert advice on training and education for doctors, dentists, health care scientists and pharmacists. MEE is supported by professionals and has developed as a result of extensive consultation with stakeholders. We are developing similar bodies for the other professions that will be in place by September 2009.
I am incredibly grateful not only for the Select Committee report but for the contributions and comments made today. This has been a constructive discussion. I expect that we will continue to have a robust debate about GP-led health centres for a while, at least until they are up and running everywhere in the country, and then I hope that people will make a different judgment on them. I invite the Health Committee to revisit the issue when it feels that it has something interesting to say.
The quality of today’s debate reinforces how important the future of the NHS is to us all. I have been heartened by the strong support for how the NSR was conducted and the vision that it sets out. This debate and the Health Committee report will help us considerably in getting the implementation right. That is the most important thing about all reviews and reports: not that we publish them, but that we get the implementation right and see it through.
There will, of course, be challenges ahead, but I am confident that because the review has generated a deep feeling of local ownership and genuine enthusiasm, we will deliver its vision for the NHS. By placing power in the hands of local PCTs and patients, we will make high-quality care for all more than the title of a report. It will be exactly what we will achieve.
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Mr. Barron: I will not keep hon. Members for too long; I would just like to respond to one or two things that my hon. Friend the Minister and the Opposition spokesman said. First, though, I must comment on the remarks made by the hon. Member for Wyre Forest (Dr. Taylor)—not just on the letters that he read out, but on his experienced view of how important interpersonal skills are in health care. He has brought his wisdom to the Select Committee. I am pleased that my hon. Friend has decided to take away those letters and look at how the patients were treated. Quality is not just about clinical outcomes, although we all want the best clinical outcomes; quality goes a lot more widely, and the hon. Gentleman gave us all a lesson on exactly how things should be for the patient. I am grateful to him for what he said.
The hon. Member for Romsey (Sandra Gidley) and my hon. Friend the Member for Lewisham, West (Jim Dowd) commented on primary care centres, or polyclinics. I must say to the hon. Member for Boston and Skegness (Mark Simmonds) that it is a bit of a stretch to say that the Select Committee agrees with Conservative policy on polyclinics. I am tempted to ask my hon. Friend the Member for Lewisham, West whether he agreed with the Conservative press release last year on polyclinics in London in which the word was spelled “polly”.
Mr. Bradshaw: It might be of assistance to my right hon. Friend to remind him that the shadow Health Secretary said in June 2008:
“Patients and family doctors are right to be worried about losing a valued local service. It’s time Labour faced up to their concerns and called a halt to their unpopular polyclinics scheme.”
When asked in April 2008 whether he would scrap our extended GP opening hours target, he said, “Yes, we would.” The Leader of the Opposition also said in April last year, on the GP-led health centre scheme,
“Now they are trying to abolish the family doctor service.”
If there has been any rewriting of history, as the hon. Member for Boston and Skegness accuses me of doing, it has been on the other side.
Mr. Barron: As the non-party political Chairman of the Health Committee—inasmuch as I can be—I will not be drawn into that debate. I just thought that I ought to mention it.
Jim Dowd: Before my right hon. Friend gets too far away from the spelling of polyclinic, I am sure that he will recall that, when we were looking for a definition of polyclinic during our inquiry, someone offered the idea that it is where one goes when one is as sick as a parrot.
Mr. Barron: Yes, and we have some twitchers on the Committee, in the form of the hon. Member for Wyre Forest and myself.
Overall, I would not say that we go along with the Opposition, but we want more primary care. Yes, it does disturb the balance, and, yes, it might disturb capitation fees, but my argument and the Committee’s argument is that, if it based on the need of the local population, it is time that things moved on. We cannot have things set in aspic. The way that GP practices are formed has not changed a lot since 1948. New ones come along now and again, but someone usually takes over a business that someone else has been running, so there is a need for more. Although last year was a bit disruptive given what was said on either side of the debate, I am pleased that we will get people more access to primary care, which can be no bad thing.
I completely agree with the hon. Member for Boston and Skegness about quality in standards and outcomes. I hesitate to agree that we should get rid of all centrally set, top-down targets, because smoking cessation targets, for example, will prove very beneficial in years to come to the health care of the nation. That issue cost my PCT a star a few years ago, which it was upset about, but if we look at the incidence of smoking and the incidence of ill health from smoking in my constituency and the borough that I represent a third of, it is right and proper to keep some of those targets in place. It would be too easy to get away from those targets, which are rightly challenging.
Mark Simmonds: Let me clarify this point. I agree with the right hon. Gentleman, and we have clearly said that we will retain targets in the public health sphere, such as the smoking example that he has given, for the very reason that he is explaining.
Mr. Barron: Another example to consider is the 18-week wait. We talk about choice in the NHS, but, five years ago, in one or two hospitals in my part of South Yorkshire, if someone had wanted orthopaedic surgery, some consultants, but not all, would have said that there was a two-year wait for a new knee, or that “You could have it next week if you want to go to a hospital in Sheffield, and I’ll do it for you.” Getting rid of that kind of choice has been a good thing. Such targets have been designed to do things that may not be obvious, and they have worked. The 18-week target may not have worked very well for some consultants’ bank accounts, but it has worked very well for my constituents. People have been able to get things done far more quickly and cheaply—other than the general tax that they pay—as a result of those targets being set and the local health service being asked to look at them.
I agree entirely with the hon. Member for Boston and Skegness that innovation must remain at the heart of the health service, as that is how we have improved it. We all accept that it could be better still, but it has improved in the past six years because people have been allowed to innovate. There are many places of excellence in areas such as spinal injury, because there has been innovation by individuals in those areas. Those places are not always where we would want them to be geographically, but they have come about because the health service has allowed individual practitioners to work to improve the service and to specialise in those areas.
We must be the envy of large parts of the world, even developed economies—so we need innovation. The one hesitation I have in agreeing with the hon. Gentleman is
to say that that approach applies across the piece, including with information technology, and we might have a debate on that at another time. Health professionals and others would be helped in improving health care in the 21st century by having good, competent systems in which people have confidence.
I want to pick up on three issues that my hon. Friend the Minister discussed. He talked about the new quality board not being top-down and about the national leadership council. I hope that he and other Ministers will make sure that those measures are working, so that we get the right leadership in the right place and the right managers with the right experience. I do not blame managers who find it difficult to do a job if it is something that they have never trained for and that has been put on them from above, or wherever. The essence of this is to make sure that they have the support to do the job and that they are not simply dismissed on the ground with, “We don’t think you’re up to it, so we’re going to bring someone else in.” There are issues about developing the whole work force, and management is clearly a major part of that.
My hon. Friend talked about effective commissioning. World-class commissioning came in just a few years ago, after the weakness of commissioning in our system was recognised, and I wish him well with that. He talked about bringing something forward next April on what we are learning about the four areas in which PROMs are being measured. I would be very happy if he shared that information with the Committee—if we are still around next April, which I suspect we will be—as soon as he gets it. I think that it will be crucial to bringing the NSR into being and really bringing quality into the workplace as far as patients are concerned.
In conclusion, I am very pleased with the intent of the report, and I add my name to those who have complimented Lord Darzi on his work. Like the Minister, I hope that we will all see major aspects of the review being put into action.
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