National Health Service Funding
Andrew Murrison Excerpts(7 years, 5 months ago)
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Dr Andrew Murrison (South West Wiltshire) (Con)
I start by commending all the hard-working people in our national health service—doctors and nurses—for the increased activity in our NHS over the past several years. The NHS has never worked harder. We have never seen so many patients treated in our NHS and standards are certainly improving. However, we must face up to the fact that indices of mortality and morbidity that are amenable to healthcare are poor against reasonable international comparators. I am not satisfied by comparing the UK with the OECD average; I want to compare the UK with countries with which my constituents would wish it to be compared, such as France, Germany, Holland, Belgium and Denmark. I am afraid that our performance is behind the curve on such comparisons, and that is the challenge that we face.
Like my hon. Friend the Member for Totnes (Dr Wollaston), I am increasingly cautious about the £10 billion figure, so I urge my Front-Bench colleagues to provide clarity on it. We need to be clear about what it actually relates to. I commend the Government for spending this amount on our NHS, despite the opposition from Labour Members. If we are to have a collaborative and collegiate debate, we need some humility from them on this point, as Labour undoubtedly opposed such an amount at the last general election. However, we need to understand what the £10 billion is and what it is not. According to the Nuffield Trust, the King’s Fund and the Health Foundation, we are more likely to be talking about £4.5 billion. The reason for that, which was elegantly laid out by my hon. Friend, relates to which year we use to baseline, which year we use to base our prices on, and whether we include or exclude the money that has been removed from the public health function of local government and from Health Education England. I would contend, as I believe she would, that those moneys need to be included in the sum total for healthcare in this country, and I think that that is what our constituents would understand as the totality of healthcare. That alternative figure therefore seems to be more reasonable.
I am also worried about the £22 billion in savings on which Simon Stevens based his five year forward view. The National Audit Office report published today suggests strongly that this process is not likely to result in anything like £22 billion and that those savings are “untested”—that is polite speak for unachievable. We know that the deficit is being dealt with through a transfer from capital to revenue, and from the sustainability element of the sustainability and transformation fund. That is not sustainable in the long term. We want more transformation; we do not want to have to rely increasingly on the sustainability bit.
Tomorrow, we must look for a big cash injection to sort this out, but I submit that we then need a long-term commission—perhaps not a royal commission, as royal commissions take for ever and cost the earth—that will involve a debate about how we pay for our health service in the long term, given the pressures that we face. That might involve a hypothecated tax. The end to the triple lock could save £2.1 billion by 2020-21, and that money could then be hypothecated to the NHS in the interests of generational fairness, given that the elderly consume the largest portion of healthcare spend. We also need to look at fiscal incentives relating to employees’ private medical insurance. But we need to do all this within a Beveridge envelope that delivers an NHS that is free at the point of need.
Justin Madders
I am delighted that the hon. Gentleman has actually seen his STP; many Members have still not got hold of theirs.
Dr Murrison
How much worse does the hon. Gentleman think that the deficit in South West Wiltshire would have been had Labour won in 2015 and uprated NHS spending by just £2.5 billion, rather than the figure we are currently enjoying?
Justin Madders
Our manifesto was very clear that we would put in £2.5 billion immediately, plus whatever was needed. Indeed, research by the House of Commons Library has shown that if health spending had continued at the levels maintained by the previous Labour Government, there would be an extra £5 billion a year by 2020.
The NHS has deteriorated on every headline performance measure since the Health Secretary took office. It now faces the biggest financial crisis in its history, with providers reporting a net deficit of almost £2.5 billion last year. That deficit was covered only by a series of one-off payments and accounting tricks that do not disguise the true picture of a service that is creaking at the seams, of a workforce stretched to the limit, and of a Health Secretary in denial about his own culpability for this shocking state of affairs. While he rightly paid tribute to the work of NHS staff, he must know that when morale is so low, his platitudes are just not enough.
Oral Answers to Questions
Andrew Murrison Excerpts(7 years, 6 months ago)
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Mr Dunne
I wonder whether the hon. Gentleman included in his survey the fact that the reduction in the establishment payment to each pharmacy will be of the order of £200 a week from 1 December, and £400 a week from 1 April. How many of those pharmacies in Dudley will not be able to sustain that reduction in Government subsidy? We use community pharmacies to undertake flu vaccinations for which they will be paid.
Dr Andrew Murrison (South West Wiltshire) (Con)
What can be done to reduce the effect of winter pressures on the bed state of our acute hospitals and thus reduce the awful phenomenon of bed blocking this winter?
Mr Dunne
As my hon. Friend knows, we are taking steps, in particular through the sustainable transformation plans, to increase the integration of social care and the health sector. For this winter, we are working hard on delayed transfers of care, to try to ensure that there is more rapid patient flow through our hospitals. That involves closer integration with social care professionals to encourage quicker discharges from the hospitals.
Community Pharmacies
Andrew Murrison Excerpts(7 years, 6 months ago)
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Jonathan Ashworth
My right hon. Friend is absolutely correct. She was not only an exceptional Chief Whip but an exceptional pharmacies Minister in the last Labour Government, and she knows how foolhardy it would be to make cuts in the pharmacy sector.
Jonathan Ashworth
I should like to make a bit of progress, if I may. As I said earlier, I am extremely conscious that other Members wish to speak.
As we have heard, the former Health Minister said that 3,000 community pharmacies could close. When pressed about the figures last month, the current Minister said
“no community will be left without a pharmacy.”—[Official Report, 17 October 2016; Vol. 615.]
I hope he will confirm that he still stands by that statement. He also claimed:
“Nobody is talking about thousands of pharmacies closing”. —[Official Report, 17 October 2016; Vol. 615, c. 602-3.]
He obviously did not receive the memo from the right hon. Member for North East Bedfordshire. But what did he say when he was pressed by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) about the number of closures? What soothing, reassuring words did he offer to all our constituents? He said, “I do not know.”
I am sorry that the Minister has not got a clue, but I hope that when he winds up the debate he will be able to tell us how many pharmacies will close as a result of these cuts. If he is not prepared to tell us that, will he tell us how many services will be cut?
Jonathan Ashworth
I do not need to say what I think; I need to say what the sector thinks, and the sector has made it clear today that it will have to cut services such as the delivery of medicines to some of the most elderly and vulnerable members of society.
Jonathan Ashworth
My right hon. Friend is another experienced former Health Minister, and he is right. As we learned this week, the Health Committee has completely blown apart the Government’s figures on the financing of the NHS.
Jonathan Ashworth
If I may, I shall make some progress. I promise to give way to the hon. Gentleman in a few moments, but I know that others wish to speak.
The Government will say that they are mitigating the cuts by introducing a pharmacy access scheme, but the scheme takes no account of the needs of the most deprived communities. The four constituencies that top the health deprivation and disability indices are Liverpool Walton, Blackpool South, Manchester Central and Blackley and Broughton. Not one pharmacy in those constituencies is eligible for the pharmacy access scheme. The least deprived constituencies are Chesham and Amersham and Wokingham. In Chesham and Amersham, 28% of pharmacies are eligible for this mitigating scheme, while in Wokingham 35% are eligible. [Interruption.] The Minister says that it is a disgrace, but those are the figures. Only this Department, which spins figures all the time and which has been discredited for the way in which it uses them, can call a pharmacy cuts package an “access scheme”.
Today, in an article in The Times, the Minister himself focuses on cities such as Leicester and Birmingham. He claims that if you walk
“along roads in Leicester you will see 12 pharmacies within ten minutes of each other”.
As the Member of Parliament for Leicester South, I walk along roads in Leicester every day. I do not know whether the Minister has actually walked along any of those roads; he has never told me that he has. Let me therefore extend an invitation to him to come to Leicester, where he will see numerous community pharmacists in areas with a high proportion of black and ethnic minority communities providing specialist services for families who have relied on them for 20 or 30 years, often dealing with elderly people and speaking to them in Gujarati, Urdu and Punjabi. Many of those people will have to go to GPs’ surgeries and A & E departments if the pharmacies are closed. The Government’s assessment takes no account of the disproportionate effect that the cuts will have on black and ethnic minority communities in cities such as Leicester and Birmingham.
Jonathan Ashworth
If the hon. Gentleman wants to tell his constituents he is in favour of closing pharmacies, good luck to him.
Of course it is not just pharmacy closures that we will see. The National Pharmacy Association has reported today that that 81% of community pharmacies will have to restrict services that help elderly people and 86% will have to restrict free services such as delivering medicine to housebound patients. Does that not confirm that the elderly and the most vulnerable will be hit the hardest by the cuts to community pharmacies, and the Government are entirely to blame?
Jonathan Ashworth
I give way to the hon. Gentleman, who has been very patient.
Dr Murrison
Surely the hon. Gentleman accepts that we have to get the most efficiencies we possibly can from the system? His party colleague the right hon. Member for Doncaster Central (Dame Rosie Winterton) made a serious point about engaging with pharmacies to see how we can do it better. Does he agree—I would be interested to know why this is not in his motion—that category M clawbacks, which are levied exclusively on small independent pharmacies, might be extended to vertically integrated wholesalers as a way of making sure the system is more efficient than at present?
Jonathan Ashworth
The hon. Gentleman talks of efficiencies; he will presumably have seen the research that says if people cannot get to a pharmacy one in four will go to a GP. We will see greater demand on GP surgeries and A&E departments. That is not efficient. It is a false economy, which is why the Pharmaceutical Services Negotiating Committee has said the proposals are
“founded on ignorance of the value of pharmacies to local communities, to the NHS, and to social care, and will do great damage to all three. We cannot accept them.”
It is why the chief executive of Pharmacy Voice described the decision as
“incoherent, self-defeating and wholly unacceptable”,
and it is why charities such as Age UK have said the plans are
“out of step with messages encouraging people to make more use of their community pharmacists, to relieve pressure on overstretched A&E departments and GP surgeries.”
Age UK has hit the nail on the head: these cuts to community pharmacies completely contradict everything we have been told by Ministers over recent years and will lead to increased pressures and increased demands on GP surgeries and A&E departments.
David Mowat
I want to continue.
The third area I wish to address is value for money, and I make no apology for doing this. According to recent OECD analysis, the UK now spends above the OECD average on healthcare, but however much money we spend, every penny needs to be spent as efficiently as possible. If that does not happen, waiting lists can become too long, treatments can be denied to patients and drugs might not be available. We also know that efficiency savings are required of every part of the NHS, and community pharmacy must play a role in contributing to the £22 billion of savings that we need to find. I do not apologise for that.
Dr Murrison
I certainly support the amendment on the Order Paper today, but does the Minister agree that, in relation to efficiencies, the issue of category M clawback is an important one? I tried to extract an answer to that question from the hon. Member for Leicester South (Jonathan Ashworth) earlier. Also, I ask the Minister to think again about the ownership-blind point that he just made. There is not an equal playing field at the moment, and there is a real risk that small independent pharmacies will continue to be done in.
David Mowat
I do accept that point. We are working on the category M clawback, and I hope to be able to make some progress on that matter soon.
Health Service Medical Supplies (Costs) Bill
Andrew Murrison ExcerptsMonday 24th October 2016
(7 years, 6 months ago)
Commons ChamberRead Full debate Health Service Medical Supplies (Costs) Act 2017 View all Health Service Medical Supplies (Costs) Act 2017 Debates Read Hansard Text Read Debate Ministerial Extracts
Mr Hunt
My hon. Friend is right in that we see demand for NHS services, which includes treatment and drugs, increasing by a total of around £30 billion over the next five-year period, which is a huge amount and certainly more than we as a country can afford without changing practice. That is why we are implementing a very challenging series of efficiency reforms designed to make sure that we can afford to continue current levels of NHS service on the £10 billion increase this Government are putting in. Part of that is indeed measures such as those in this Bill to control the drugs bill. My hon. Friend is also right that going forward over the next 25, rather than five, years we will be seeing the bigger issue of the accelerating pace of innovation in science. That provides great opportunities for the NHS, but potentially great pressures for the budget, and I am sure we will continue to discuss those issues extensively in this House.
Dr Andrew Murrison (South West Wiltshire) (Con)
What assessment has my right hon. Friend made of the impact this Bill might have on the parallel trade in pharmaceuticals, which he will know has both costs and benefits for the NHS and for patient care?
Mr Hunt
My hon. Friend obviously knows about these matters in a great deal of detail and should be reassured that this Bill should prevent people who are part of the current voluntary pharmaceutical price regulation scheme—PPRS—from parallel-importing through European subsidiaries, which currently under single market rules we are not able to do anything about. That loophole will be closed.
The first element of the Bill relates to controls on the cost of branded medicines. For many years the Government have had both statutory and voluntary arrangements in place with the pharmaceuticals industry to limit the overall cost of medicines to the NHS. Companies can choose to join either the voluntary scheme or the statutory scheme. Each voluntary scheme typically lasts for five years before a new scheme is negotiated.
The current voluntary scheme is the 2014 PPRS. The objectives of that agreement include keeping the branded health service medicines bill within affordable limits while supporting the availability and use of effective and innovative medicines. For industry, the PPRS provides companies with the certainty and backing they need to flourish both in the UK and in the global markets.
The current PPRS operates by requiring participating companies to make a payment to the Department of Health of a percentage of their NHS sales revenue when total sales exceed an agreed amount. So far the PPRS has resulted in £1.24 billion of payments, all of which have been reinvested back into the health service for the benefit of patients.
NHS Sustainability and Transformation Plans
Andrew Murrison Excerpts(7 years, 8 months ago)
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Ms Abbott
It was the NHS England director of STPs, Michael McDonnell, who said that they
“offer private sector and third sector organisations an enormous amount of opportunity”.
We know that PricewaterhouseCoopers has been heavily involved in the formulation of a large number of these plans, and we know that—as was mentioned earlier—GE Healthcare Finnamore, which was taken over by General Electric in the United States, has been heavily involved in the formulation of plans in the south-west and possibly more widely. The strong suspicion is that a combination of cuts, the reorganisation of services on a geographical basis, and the growth of hospital “chains” will facilitate greater privatisation of the NHS.
Mr Dunne
Many trusts were in deficit in the last financial year, and those deficits were funded by the Department of Health. Looking forward, we are using the financial discipline of control totals not to instigate cuts, as the hon. Member for Hackney North and Stoke Newington suggested, but to hold the accountable managers to account for delivering within the financial envelope that those control totals represent. That is what a responsible Government do—we give money to public services and expect them to live within those means. This year the NHS has received one of the largest cash settlements it has ever had, three times more than the rate of inflation.
Dr Murrison
I am very grateful to my hon. Friend for giving way, a courtesy not extended by the Opposition Front Bencher.
May I ask my hon. Friend to look very closely at STP footprints? The experience of those of us who represent rural areas is that aligning our areas with more urban centres can often mean that our constituents get a raw deal, and since my footprint includes urban areas in Bath and Swindon I am slightly concerned that the same thing may happen again.
Mr Dunne
If I manage to get there, I am going to come on to the footprints and how it was that 44 areas were identified, but in rural areas in Wiltshire and Shropshire we do look to urban areas to provide the acute care for all our local residents, so it is appropriate that the footprint areas encompass both the acute and the full range of primary sectors.
Dr Whitford
As I said, the proposals leave only £300 million. We cannot transform a system on the scale that is being considered with £300 million.
As I said, the guidance talks about prevention. We need to be tackling health inequalities. We need to be focusing on health and wellbeing—and by that I do mean physical and mental wellbeing. We need to be strengthening public health—something else that has been cut. We need to be looking at the quality of health and care, and that means right across into social care. We must fund social care, because it can make a difference to things like delayed discharges. We are not even three years into the integration in Scotland—we are only two and a half years into it—but delayed discharges have dropped 9%. Yet, the last time the Secretary of State was in the Health Committee, they had gone up 32% in NHS England. So literally just moving things around and allowing one part of the system to fail will mean that the entire system fails.
Dr Murrison
I always listen with great care to what the hon. Lady has to say, and I agree with a great deal of it. Does she agree that part of the problem in England in relation to delayed discharges has been that we have seen a retrenchment of community hospitals and their beds, which have provided step-up, step-down care—intermediate care beds. Unfortunately, they are no longer available, which means inevitably that hospital discharges are delayed, with all the distress that causes.
Dr Whitford
I totally agree with the hon. Gentleman. I think it is about care in the home for those who are able to have that and convalescence for those who require it; that, basically, is the step up, step down. In my health board in Ayrshire and Arran, we have rebuilt the three cottage hospitals. They are now modern, state-of-the-art, small units. That means that our population has less far to travel and that older people will not, in the end, need to come to hospital. Now, we are still in that transition; those units are not doing everything they have the potential for—indeed, we are a rural population. However, certainly in Scotland, there is much more recognition that we need intermediate care between people being at home and being looked after by their GP, and people ending up in a very expensive acute unit. It is not just about finance; any Member who has been in hospital knows they do not want to be there, and nor do our elderly population. These levels of care are therefore crucial, and it is important that that grows out of the STPs. I see that as a crucial opportunity for the NHS, which cannot be missed.
Dr Wollaston
I thank my hon. Friend for that invitation. In fact, I have visited the Community Hospitals Association on many occasions, to hear from community hospitals around the country. I will continue to do so and I commend them for the valuable role that they play.
Dr Murrison
Does my hon. Friend agree that community hospitals can also keep the bean counters happy? If they get the case mix right, it is much more affordable to treat people in community hospital beds than in an acute unit, which is extraordinarily costly. Furthermore, that would clearly give patients what they would like, which is care close to their homes, as my constituents in Warminster—we still have community hospital beds—will attest. I know that my hon. Friend the Member for North Dorset (Simon Hoare) would say the same for Shaftesbury.
Dr Wollaston
Members on both sides of the House are aware of how valuable and important community hospitals are to our constituents. Taking that a step further, I would say that the best bed for any patient is their own bed, provided that they can be given the right package of care close to home. We know that there are many people even in community hospital beds who do not need to be there. They are there for want of the right social care package that could enable them to be at home.
In welcoming STPs, we should be realistic about the financial challenge that they also face and the costs sometimes of providing those services. That is a huge challenge for them. In my area alone the STP is facing a £572 million shortfall by 2021 if no action is taken. I can understand why, for example, it will look at the relative cost of providing care to people in acute hospitals, in community hospitals and at home, and make an argument that sounds very reasonable about how a larger number of people could be much better cared for at home.
I return to the point that the hon. Member for Central Ayrshire (Dr Whitford) made. Access to the transformation part of the sustainability and transformation plans is necessary to be able to put those services in place and very often to build the infrastructure that we need. For example, in Dartmouth in my area, the possibility of providing more care closer to home within a community hub will require the up-front funds to build a new centre that allows the workforce to be developed and more services to be provided closer to home. Unfortunately, what we often see is the closure of a much loved facility without the new service in place.
As the sustainability and transformation plans progress, I would like to see a genuine focus on the opportunities to provide more care closer to home. I fear that we will miss that opportunity because, as we have heard, £1.8 billion of the £2.1 billion sustainability and transformation fund is going towards the sustainability bit, for which read “plugging provider deficits”, and only £300 million is left nationally to put in place all these plans.
We know also that part of the way that the Government have managed to fulfil their promise to NHS England in respect of the funding that it asked for has been by taking funding out of capital budgets because those are essentially flat cash, and also by taking money out of Health Education England budgets and public health budgets. It concerns me that many of the principles behind the sustainability and transformation plans are put at risk by other parts of the system being squeezed. We have heard the point about prevention. Central to the achievements of the sustainability and transformation plans is the prevention piece—the public health piece. It is a great shame that public health budgets have been squeezed, limiting the ability of those aims to be achieved.
I know that many Members wish to speak so I shall move on and make some asks of the Minister, if I may. There is more that the Government can do. We on the Health Committee were very disappointed that none of the witnesses who came before us from NHS England, NHS Improvement or the Department of Health was able to set out the impact of cuts to social care on health planning. We need to do much better at quantifying the cost to the NHS of cuts to the social care budget.
The Minister needs to take the long view on prevention and help the service by implementing policies that could help local authorities to make changes. For example, I suggest making health a material consideration in planning and licensing, in order to provide the levers to make a difference. We need a much greater focus on workforce, because the STPs cannot achieve their aims if the workforce to achieve them is not in place. Finally, will the Minister kindly visit my area to look at the proposals in the sustainability and transformation plans in south Devon, and at the opportunities and how we would achieve them?
Junior Doctors: Industrial Action
Andrew Murrison Excerpts(7 years, 8 months ago)
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Mr Hunt
The pressures in the NHS mean that there is a need for more doctors for all sorts of reasons, and we do not have as many doctors as we need at the moment. That is why this Government are training more doctors and putting an extra £10 billion into the NHS. The manifesto that the hon. Lady stood on just over a year ago would not have put that sort of funding into the NHS and would have meant that we were unable to train that number of extra doctors. We are doing that, but it takes time and we need to ensure that services are safe while we are getting there.
Dr Andrew Murrison (South West Wiltshire) (Con)
I congratulate my right hon. Friend on his balanced and reasonable approach in the negotiations despite provocation from people who really should know better. Does he agree that there cannot have been a single occasion in the history of the NHS other than this in which the General Medical Council—the body responsible for professional standards—has effectively had to intervene to stop a strike? Will he also admit that we might have underscored the centrality of Sir Bruce Keogh’s four clinical standards a little more when introducing the notion of the seven-day NHS?
NHS Spending
Andrew Murrison Excerpts(7 years, 10 months ago)
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Dr Philippa Whitford (Central Ayrshire) (SNP)
God, the pressure.
We recognise that this figure of £350 million a week chimed with people in the country, because people are concerned about the funding of the NHS. The Secretary of State for Health talks about an extra £8 billion going forward, plus the additional £2 billion that was added to that, which was for bailing out massive debts. However, that is a change of description. Normally, funding is described as being for the Department of Health, but that is just NHS England. Public Health England and Health Education England were facing cuts of £3.5 billion. Therefore, the extra money going forward is only £4.5 billion. We have heard Members talk about their local trusts being in deficit. This is now so widespread, it cannot be blamed on management.
Despite the fact that the NHS somehow always managed to come out just in the black up to April 2013 and has been careering into the red ever since, the Secretary of State never seems to accept that this is to do with the Health and Social Care Act 2012 changes and the huge administration costs of outsourcing and fragmentation. The Secretary of State lays the blame for all this with agency staff.
Given the debate that we have just had on EU nationals working in this country, particularly in our public services, I have to say that we could be facing an absolute meltdown. We have 50,000 nurses and doctors from the EU in the NHS, and almost 80,000 careworkers. The Minister for Immigration hinted that those who have been here for over five years can stay, but that their benefits and rights may not be quite the same. So my husband, who is from Germany, can stay, but is his pension going to disappear? He has worked here for 30 years, but what protections will he no longer have? What about the people who have been here for less than five years—the high-flying researchers, academics or medics —who could go somewhere else? Do the Government really think that these people are just going to sit at home with their families until the last possible minute? No, we are going to lose them, and agency costs for nurses and doctors will go through the roof. For social careworkers, it will not matter: they do not earn over £35,000, so they are unlikely to get to stay, and we are unlikely to be able to replace to them.
As well as the fact that the £8 billion we always hear about is not actually £8 billion, we know that local government has faced huge cuts and, as was referred to earlier, that social care is where the real problem lies. The NHS money is just going to haemorrhage out the back door.
The £350 million a week figure that was painted on that bus was a disgrace. The shadow Health Secretary, the hon. Member for Hackney North and Stoke Newington (Ms Abbott), talked about it being an Eton game, but I think that it was an Eton mess. People were just playing with the facts. The rebate was not included. Public service payments, such as the common agricultural policy and regional funds, were not included. However, as the Secretary of State says, when we get down to the £110 million or so a week, that does not include all the other benefits that support the NHS and our economy. How much will it cost us to take part in Horizon 2020? How much does Switzerland have to pay to be part of this?
This is going to cost a lot of money. The Secretary of State said that it would take a 0.06% fall in GDP to negate the £100 million, but economists estimate that the fall will be between 1% and 3%. We do not want that to happen, but all the experts agreed that that was the likely outcome.
Like most people in Scotland, I absolutely believed in the remain campaign, but to me there was a poverty to the debate. Why are we having these two debates today instead of before 23 June? We had very little open discussion of the issues in this place. One of the problems is that we have never talked about anything good that we have got from the EU in the past 40 years. Of course, I have been lucky—I got my other half from the EU—but, to be honest, most of us have had many gains. We have cleaner air and cleaner water, and we have tackled acid rain. We have cleaner beaches. We have a single European medicines agency, so new drugs get to patients quicker. That agency is located here in London, but it is unlikely to remain here.
Dr Andrew Murrison (South West Wiltshire) (Con)
I always listen very carefully to what the hon. Lady says, but is she not being a little unfair on the United Kingdom? I seem to remember that the Clean Air Act 1956 set the bar for the European Union in the regulation of one of the areas that she has identified—namely, the cleanliness of the air that we breathe.
Dr Whitford
I was not on the planet in 1956, so I do not quite remember. We know from the recent cheating that there is a lot more work to be done on the control of car emissions, which cause a lot of ill health, but some of the progress in that area has come from EU regulation. Problems such as poor air quality and climate change cannot be dealt with by one country alone; we need to work together. In a health sense, we have had massive gains in the past 40 years, but politicians have never talked about that.
The EU has been a great whipping boy. All that the public have heard about the EU in the last 40 years is, “It wasnae my fault; the EU made me do it,” or stories about straight bananas. That is the responsibility of everyone who has had access to a microphone or spoken in this place about the EU. We should not be surprised that when people had the £350 million figure drummed into them by it being on that bus and on the news every night, they would fall for it. The mainstream media have a lot to answer for in not challenging these figures and not asking, “Exactly what is your plan? Exactly where is that money going to come from?” We should not blame people who want extra money for the NHS for wishfully accepting those claims, even when the cracks appeared around the edges.
Part of the problem has been the quality of the debate. Several of my colleagues warned people who believed in remain not just to go for a “Project Fear” type campaign, and I think that running such a campaign was a mistake. People think that “Project Fear” worked in Scotland, but in actual fact Better Together support started, as a percentage, in the mid-60s and fell to 55%. We started at 27%, and we ended up at 45%. “Project Armageddon” clawed back a little bit in the last two weeks, when we were told that the supermarkets would go and the banks would go, and that we would have no money and no food to buy, but a negative campaign of saying that the sky will fall does not lead to success.
Junior Doctors Contract
Andrew Murrison Excerpts(7 years, 10 months ago)
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Mr Hunt
Health Education England is absolutely clear that it has to run national training programmes, and that is why it has to have standard contracts across the country. As the hon. Lady knows well from her previous role on the Front Bench, in reality foundation trusts have the legal right to set their own terms and conditions, but they currently follow a national contract; that is their choice, but because they do that, I used the phrase “introduction of a new contract” this afternoon. I expect, on the basis of current practice, that the contract will be adopted throughout the NHS.
I enjoyed working with the hon. Lady when she was shadow Health Secretary, but on this issue, she was quite wrong, because she saw the WhatsApp leaks, which revealed that the British Medical Association had no willingness or desire for a negotiated settlement in February, precisely when she was saying at the Dispatch Box that I was the one being intransigent. She gave a running commentary on the dispute at every stage, but when those leaks happened, she said absolutely nothing. She should set the record straight and apologise to the House for getting the issue totally wrong.
Dr Andrew Murrison (South West Wiltshire) (Con)
I congratulate my right hon. Friend on the patience that he has shown on this matter, and on the deal that was agreed back in May—it is a good deal. Apropos of the remarks of the hon. Member for Hackney North and Stoke Newington (Ms Abbott), who speaks for the Opposition, does the Secretary of State agree that it is indeed important to maintain morale in the health service? We need to be very careful about striking special deals for one particular part of the workforce, and the perception that that might be unfair. Would he further agree that we need to avoid the temptation of addressing every single grievance of a particular workforce? That is more properly within the bailiwick of managers locally than national contracts.
Mr Hunt
My hon. Friend obviously speaks from experience and very sensibly on this issue. In this House, of course, we think about the actions of politicians, Ministers and so on, but for doctors in a hospital, the most important component of their morale is the way that they are treated by their direct line manager. One of the things that worries me most in the NHS, looking at the staff survey, is that 19% of NHS staff talk about being bullied in the last year. That is ridiculously high. We need to think about why that is. The reality is that it is very tough on the frontline at the moment. There are a lot of people walking through the front doors of our NHS organisations, and we need to do everything that we can to try to support doctors and nurses, who are doing a very challenging job.
Comparative Healthcare Economics/NHS Finance
Andrew Murrison Excerpts(7 years, 11 months ago)
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Dr Andrew Murrison (South West Wiltshire) (Con)
I need to start by confessing an interest as a doctor. We are now 18 months into the five year forward view, and the big question really is: what next? “What next?” really means bringing English healthcare outcomes up to the standard enjoyed in peer group European nations, and I am afraid that means much more money. I hope that, in the next few minutes, I can suggest how we might go about achieving that.
The average age of Members of Parliament is 51. That means that most Members of this House have tipped, or are tipping, into the demographic twilight zone in which the incidence of common and chronic diseases begins to accelerate—it is sad but true. That focuses the mind on what a successful healthcare economy looks like and what it delivers for patients.
When those 51-year-olds enter the danger zone in a few years’ time, what will success look like? Success will mean accommodating the great advances in medicine that we believe we are on the cusp of achieving, and that we hope will add years to life and life to years, and I know that my hon. Friend the Minister is particularly exercised about those matters. Success will mean dealing with the healthcare needs of an ageing demographic, an expanding population, and more chronic diseases of lifestyle, which will amount to a 3% per annum uplift in demand, according to NHS England and the Nuffield Trust. Success will mean satisfying the legitimate demands of a less deferential, consumerist, better educated society that will not be content with second best. Success will mean closing the gap between healthcare outcomes here and in northern European countries with which we can reasonably be compared, and therein lies the “What next?”
In July 2010, the Government White Paper “Equity and excellence” exposed relatively poor health outcomes in the UK, compared with other countries. Our healthcare system was delivering poorer results in terms of mortality and morbidity. The most recent OECD statistics, published last year, have confirmed Britain’s relatively poor performance across pretty well the complete spectrum of common diseases—common cancers, ischaemic heart disease, cerebrovascular disease and the rest. Crucially, the number of unnecessary deaths—mortality amenable to healthcare—is substantially higher in the UK than in neighbouring countries.
However, healthcare is not just about reducing deaths. What about other measures of quality? Measures such as post-operative sepsis, pulmonary embolism, deep vein thrombosis, obstetric trauma and diabetic complications are worryingly unimpressive in the UK, compared with countries we would consider to be in our peer group. Although the teenage pregnancy rate has improved in recent years, the UK bumps along the bottom of the EU league table with recent accession states. The list goes on.
The Swedish-based and well-respected, if drug firm-funded, Health Consumer Powerhouse has been reporting on the performance of Europe’s healthcare economies since 2005. The UK’s position in its Euro Health Consumer Index has always been mediocre, but in January the UK was ranked 14th out of 35—just above Slovenia, Croatia and Estonia, and below European countries that most Britons would regard as peers.
Jim Shannon (Strangford) (DUP)
I congratulate the hon. Gentleman on bringing this matter forward. This may seem a bit like politicking, but it none the less needs to be said. There is no doubt that the Transatlantic Trade and Investment Partnership has the potential to threaten the very nature of our NHS. What is even clearer is that we are sending millions of pounds every week to the EU that could be invested in our NHS, where that money is much needed. Does the hon. Gentleman agree that there is great potential to properly resource and liberate our great NHS, were we to vote to leave the EU?
Dr Murrison
I think the hon. Gentleman and I are on the same side of the Brexit debate, and I certainly would welcome the extra money that would be spent on the NHS in the event that we leave the European Union, so fingers crossed for 23 June.
The Health Consumer Powerhouse report highlights poor accessibility and an “autocratic top-down management culture” here, in contrast to top-performing Holland’s removal of what Health Consumer Powerhouse calls “healthcare amateurs”—that is to say, politicians and bureaucrats—from decision making. Unhappily, that sounds rather familiar. Earlier this year, Dame Julie Moore slated fellow senior NHS managers for “gross incompetence” and poor leadership.
The question is, what, apart from its management, accounts for the UK’s lacklustre ranking? Despite the UK’s innovative cancer drugs fund, Health Consumer Powerhouse found, for example, relatively poor availability of the latest oncology interventions and therapeutics, including radiotherapy. Sadly, that rings true, and we remember the high-profile case of Ashya King, the five-year-old with medulloblastoma, who was taken by his parents in 2014 from Southampton general hospital to Spain and then the Czech Republic for proton beam therapy, which was not available here.
The much-vaunted Commonwealth Fund report that some use to claim that the NHS is super-efficient and effective actually contains just one element that deals directly with health outcomes—a composite of deaths amenable to medical care, of infant mortality and of life expectancy at 60, it puts the UK 10th out of 11, the US being bottom. Tenth out of 11 sophisticated healthcare economies is not where I want the UK to be, and not where the Minister wants the UK to be either. The British public would expect us to be doing rather better against a raft of healthcare outcomes where the UK is firmly in the wake of our immediate northern-European neighbours France, Germany, Holland, Belgium and Denmark.
Can we explain why UK healthcare outcomes are not as good as those of peer group nations through differences in the level of healthcare funding? We can expect an opinion from the House of Lords, which last week set up a Select Committee under Lord Patel to examine the sustainability of the NHS—that is, the “what next?” question. I would be very surprised if it did not conclude that the answer is to bring spend up to the level enjoyed in countries such as France, Germany and Holland. After all, closing the gap with the EU15 in health spending as a proportion of GDP was a goal explicitly set in 2000. However, Conservative Members tend to be somewhat wary of making spend a proxy for outcome. It is not enough just to write big cheques and consider the job done. Can we do better with what we have? There are apologists for our low spending on health who cite the supposed efficiency of the NHS, but simply asserting that the NHS is more efficient than health services in other countries does not make it true.
I do not know what is in the Minister’s speaking notes, but there is a very good chance that he will use the New York-based Commonwealth Fund analysis on comparative healthcare to support a contention that the NHS is very efficient and thus ameliorates the relatively low UK spend on healthcare. The report’s methodology rewards close examination. I am sure he will have read it thoroughly, but if not, I commend it to him. In my opinion, its methodology renders the sorts of deductions that have been made unsafe. The only reliable element of the analysis that is used to claim that the NHS is relatively efficient is the percentage of national expenditure spent on administration and insurance, meaning that the UK comes in at fifth out of 11. Given that the nature of our system means that insurance and transactional costs are very low, that is hardly something to crow about. Other markers of efficiency rely on patient and practitioner surveys and include items such as time spent filling out financial transaction forms. UK-relevant metrics, such as rehospitalisation rates, were found to be comparatively poor. I conclude that it would be unsafe to make claims about the relative efficiency of the NHS based on contestable reports like that of New York’s Commonwealth Fund.
Let us suppose for one moment that the NHS is fairly efficient—not very efficient, because Carter and others suggest that that would be unwise, but fairly efficient. Indeed, I have no reason to suppose that it is institutionally profligate. If it is fairly efficient, we will not be able to squeeze many more efficiencies from it beyond the Stevens assumptions, but we will still be left with relatively poor outcomes and still needing to know “what next?” Simon Stevens still believes that we can squeeze £22 billion in efficiencies from the NHS. Much of this, presumably, is predicated on productivity gains that are contingent on holding down salaries and wages—a challenge if incomes in the economy rise. This is what I think he means by “strong performance”—strong indeed, because the implied productivity gains of 2.4% are well in excess of anything that has been achieved by the NHS historically and well beyond expectations for the wider economy. It also depends on sustained spending on social services and public and preventive health. Both, in the event, have been impacted by cuts to local government funding—cuts that I supported and accept were entirely necessary to repair the public finances, but cuts nevertheless.
So “what next?” will inevitably mean a step change in input—in money—if not by the end of the five year forward view period, then without doubt during the next decade and beyond. Here again, it is instructive to look across the channel, where we find some good news for Ministers. The Office for National Statistics has just tweaked its approach to health accounting to comply more closely with that of the OECD, and obligingly, this increases the UK’s spend on public and private healthcare combined from 8.7% of GDP to 9.9%. Most of this is due to re-badging a slice of publicly funded social care as healthcare spend. Of course, none of this accountancy changes by one penny the amount spent on care, but it impacts on the international spending league table. It means that we overtake southern European countries such as Spain, Portugal, Italy and Greece. However, we still lag well behind Germany, France and the Netherlands—my chosen basket of similar European countries.
So what next? Data from the Kings Fund and the Institute for Fiscal Studies suggest that income tax must rise by at least 3p in the pound simply to offset the fall in NHS spending as a proportion of GDP predicted over the rest of the decade. But all that will do is arrest the UK’s relative downward trajectory towards being the sick man of Europe. To bring spend up to the EU15 average would now involve an 8p increase. That eye-watering sum may be toned down a little bit by the new Office for National Statistics method for calculating healthcare spend, but probably not greatly if the comparison we actually want to make is with our closest European neighbours France, Germany and the Netherlands.
So, if we accept that big fistfuls of money are needed, the question becomes, “How are we to get it?” The Labour party does not know. It has yet to say how much it thinks the NHS budget should be, despite every encouragement from me and others to do so. All we know is that the party opposed the Stevens uplift at the general election. Maybe the unaccustomed reticence about pledging money from the party of fiscal incontinence is an indication of the sheer scale of the spending challenge that even Labour has perceived in a rare lucid moment.
Although I have every confidence in my right hon. Friend the Chancellor, a precipitous growth in the economy seems unlikely, and further borrowing should not be an option. In fact, half the £350 million per week that we send to the EU—a figure, net of rebate and subsidy, that I personally rely on—would, by my reckoning, halve the difference. I fervently hope that it will be in play after 23 June, but it would still leave a gap. How will that gap be closed? It is said that if we want a social healthcare system, we must choose between Bismarck and Beveridge. For my part, I cannot see how the transaction costs implicit in insurance-based models or large-scale schemes of co-payment would improve productivity or efficiency in our NHS—this despite the fact that the UK healthcare economy is distinguished from others by the small scale of its private provision.
For me, the Bismarck versus Beveridge debate is pretty much settled. However, I would expect a commission to examine all possible funding streams, drawing on experience from other countries. I would expect it to look closer to home at incentives that can be given to encourage subscription to mutuals, such as the Benenden Healthcare Society, formed in 1905 by and for Post Office workers, whose headquarters in York I visited recently.
But affirming that the great bulk of healthcare in the UK should continue to be funded through general taxation does not just mean more of the same. A variable hypothecated tax would be an easier sell to the public than a general tax hike. Treasury officials, or course, hate hypothecation, but the Treasury has been softening its approach in recent years and we are now, of course, wedded to the far less economically literate practice of hypothecated spend as a proportion of GDP for selected areas of public expenditure. Despite the Treasury’s reluctance, if we are talking about several pence in the pound to bring UK health spending up to the average of neighbouring similar countries, we have to find a politically acceptable and publicly palatable way of doing so. Either way, gathering a consensus on this most sensitive and complex of public policy areas, using a vehicle on a spectrum from royal commission to non-departmental public body, surely makes sense. As a model, may I suggest the influential Pensions Commission, chaired by Adair Turner, during the last Labour Government?
If the NHS is the closest we have to a national religion, its critical friends are often seen as heretics. We saw that even at the height of the Mid Staffs scandal. How, then, are we to uphold this rallying point for national morality, decency and righteousness with the more prosaic imperatives to save and lengthen life, make sick people better, prevent ill health and match health outcomes in comparable countries? I hope that the Minister will agree that the proposal for a commission and associated national conversation—made by me and others in this House, in the other place and elsewhere—has merit. I warmly congratulate Ministers on successfully arguing the NHS’s corner at a time of austerity. However, I urge the Government to give serious thought to establishing a commission that will examine how we can properly and sustainably fund healthcare and close the widening gap that exists between us and our European neighbours.
Jo Churchill (Bury St Edmunds) (Con)
I do not think that a commission is the right way to go, but does my hon. Friend agree that we sit on a new horizon, with molecular diagnostics, personalised medicine and so on, and that it is really important that we take a broader look at what our healthcare needs will be in future and how we can embrace more self-responsibility and new techniques for ensuring good patient outcomes? I said in this place in 2010 that we were lagging behind; sadly, we still are.
Dr Murrison
My hon. Friend is absolutely right: we are lagging behind. I hope that in the course of my remarks I have made it very clear that we are lagging behind countries with which we can reasonably be compared, particularly Germany, France and the Netherlands. The challenge is to bring our spend up to that level and to anticipate new developments and technologies. We should welcome that, because it will extend our lives and it will make us healthier for longer, but we do have to decide where the money will come from. Since the sums, I fear, will be so great, I believe that a commission would be a reasonable way to approach this matter and to have the conversation with the public about how the money will be raised.
The sands are fast running through the five year forward view hourglass. I believe it is time for Ministers to consider, “what next?”
NHS Commissioning (Pre-Exposure Prophylaxis)
Andrew Murrison Excerpts(7 years, 11 months ago)
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Jane Ellison
It is probably worth clarifying that we asked NICE to undertake an evidence review, not a technology assessment. What drugs are licensed for are matters for drug companies to address. The Government do not initiate the process on whether a drug is licensed— the drug company must initiate it. It also worth noting that when a drug is licensed for a new purpose, as would be the case for Truvada in PrEP, the company could apply for the patent to be extended to cover this new use. Again, that is something that the drug company would do.
On the hon. Lady’s first point, I agree that we need to consider the impact on women in the circumstances she described. That is one of the arguments for carefully planning this pilot programme and taking those sorts of factors into account.
Dr Andrew Murrison (South West Wiltshire) (Con)
The process that the Minister has outlined is correct, but does she recognise that the French Government have already approved Truvada for pre-exposure prophylaxis, and does she understand the urgency in this? The results of the UK PROUD study, funded by the MRC, are quite unequivocal, so we really need to get this going. Will she also reflect on the fact that the study showed no difference in the incidence of other sexually transmitted diseases, because Truvada does not protect against them, so the message has to go out that a condom is absolutely essential?
Jane Ellison
My hon. Friend is quite correct on his latter point about the impact of PrEP. Whether it was commissioned or not, and whoever it was commissioned by, we would still have the significant challenge that he describes around STIs. Drug-resistant gonorrhoea, for example, is a problem that we are increasingly aware of.
There are international comparisons that we can look at, as my hon. Friend mentions. I have looked at the matter in some detail, and the picture across the world is that many countries are in broadly the same position as the UK. They are trying to understand, leaving aside the question of clinical effectiveness, more about how PrEP can be used as part of an HIV prevention programme in broader cost-effectiveness terms, and how it compares in cost-effectiveness terms with other available interventions. My hon. Friend is right that there is work to do, and we are not resting easy on this. We are moving forward, and we are working on and planning these pilots now.