NHS Future Forum

Grahame Morris Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend. It is because I believe in the NHS and the people who work in the NHS that I think it right to listen to and engage with those people, and to give them much greater control of the service that they provide for patients.

[Grahame M. Morris (Easington) (Lab)]

What can we conclude from the fact that the Prime Minister is not here with us this afternoon to support the Secretary of State, but is involved in a PR stunt at Guy’s and St Thomas’ NHS Foundation Trust? It was once said on the other side of the Atlantic that you could put lipstick on a pig, but at the end of the day it was still a pig. Is that not true of the Bill?

[Mr Speaker]

Order. We are starting to get involved in issues perhaps not of order, but certainly of taste.

Public Health Observatories

Grahame Morris Excerpts

Tuesday 17th May 2011 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

I am grateful to have this opportunity to raise the very important subject of the future of our public health observatories, which are an integral part of the national health service. They are responsible for public health intelligence work—collecting the evidence base and directing how different agencies work to improve public health. It might be useful if I give a definition of public health. The best definition I have been able to find is one from the World Health Organisation’s expert committee on public health administration that was published as long ago as 1952. It defined public health as

“the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts for the sanitation of the environment, the control of communicable infections, the education of the individual in personal hygiene, the organization of medical and nursing services for early diagnosis and preventive treatment of disease, and the development of the social machinery to ensure for every individual a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity.”

The Association of Public Health Observatories represents and co-ordinates a network of 12 public health observatories in Scotland, Wales, England, Northern Ireland and the Republic of Ireland. That body brings together joint public health intelligence work from all its organisations across the United Kingdom and Ireland and also works in collaboration with its counterparts across Europe. Without that range of high-quality and trustworthy knowledge, expertise and support from public health observatories, much of the work carried out by practitioners and, indeed, local authorities, policy makers and the wider community, would be carried out in the dark. That would, without doubt, result in a less focused and less effective service delivery. All that makes public health observatories central to both local and central Government health policy and decision making.

Public health observatories were set up to monitor the state of the public’s health and the causes of poor health and health inequalities, with the information being used by a range of organisations involved in providing health care, including the NHS. The White Paper, “Saving Lives: Our Healthier Nation”, which was published by the Department of Health in 1999, proposed the establishment of the public health observatories that were then set up in 2000 by the Labour Government. The Association of Public Health Observatories was also established in 2000. That umbrella group provides a link between regional public health observatories and national arrangements. It comprises representatives from all the regional public health observatories, the Department of Health and other partners, and one concern that I wish to raise is the fact that its funding has been removed this year.

I hope that the Minister will accept that improving the knowledge and evidence base behind health care was a key element of the previous Government’s policy and was instrumental in making progress in tackling health inequalities. The changes outlined by the Health Secretary in the Health and Social Care Bill move us away from a co-ordinated health service towards a competition-based health service. The public health White Paper, “Healthy Lives, Healthy People”, published on 30 November 2010, set out a new structure for public health in England. Its aim was to shift the balance of responsibility away from central Government to local authorities. There has also been much greater emphasis on the need for people to be supported in taking more responsibility for their own health—the so-called nudge philosophy.

There are many public health issues that I would like to discuss but unfortunately do not have time to develop tonight because of the shortage of time. I want to press on and put some points to the Minister, particularly about public health observatories, and I hope she will have the opportunity to respond to them.

[Jim Shannon (Strangford) (DUP)]

Prevention is key to having a healthier nation and perhaps this issue should be reconsidered in the NHS review, as it might help to improve the nation’s health.

[Grahame M. Morris]

I am grateful for that and I agree. It is fundamental to have a solid evidence base on which to plan health interventions.

As I mentioned, the Government propose in the Health and Social Care Bill to transfer health improvement functions from PCTs to local authorities, and to create a new body, Public Health England, to be rooted in the Department of Health. Public Health England is expected to take on full responsibility for overseeing the local delivery of public health services, as well as dealing with national issues such as flu pandemics and other population-wide health threats from next year. The majority of public health services will be commissioned by local authorities. However, the revolution under way in the NHS is just as important to the future of public health in England.

The Bill, which proposes the abolition of strategic health authorities and primary care trusts, raises more questions than it answers. The responsibilities currently held by PCTs could be moved to local authorities, to the Department of Health, to commissioning consortia or to the NHS commissioning board. How the important work of public health observatories will be safeguarded for the future is still unknown. The decision to divide public health responsibilities between the Department of Health and local authorities will fragment any cohesive approach to tackling health inequalities. Whether new commissioning consortia will carry out some functions is at this stage unknown.

There are further concerns about whether Public Health England should be outside the Department of Health to protect its independence. If it was placed within the NHS, perhaps as a special health authority, surely that would better meet the Government’s own aim, often stated, of liberating the NHS from political control.

The Minister will be aware of the response to the White Paper by the public health observatories in March 2011. That response calls for a sub-national level of organisation of Public Health England to be created, with sufficient critical mass to ensure that the outputs of Public Health England continue to be valuable locally as well as nationally. There are many examples where that is the case, not least in my own region, the north-east, where the public health observatory has done excellent work on addressing inequalities that affect people with mental health issues and inhibit their ability to access services. The lessons of that can be rolled out across the country.

The important work of the observatories over the past decade has been self-evident. On 24 June 2008 the health profiles for every local authority and region across England were published jointly by the Department of Health and the Association of Public Health Observatories, an organisation which, as I mentioned earlier, has lost all its funding. Using key health indicators, public health observatories were able to pinpoint national health statistics at a local level, providing valuable information to address health inequalities and improve health outcomes.

As the Minister at the time, my right hon. Friend the Member for Bristol South (Dawn Primarolo), now the Deputy Speaker, noted, the importance of those statistics was

“to target local health hotspots with effective measures to make a real difference.”

In my constituency, Healthworks, an excellent clinic established in Paradise lane in Easington and opened by Sir Derek Wanless, is a prime example of how that information collected by the observatories was used to great effect to target the areas in greatest need.

The Association of Public Health Observatories, with the Department of Health, also published a health inequalities intervention toolkit to enable every English local authority to model the effect of high-impact interventions on the life expectancy gap. As far back as 1977, the Department of Health’s chief scientific adviser, Sir Douglas Black, was asked to produce a report on the extent of health inequalities in the UK and how best to address them. The report proved conclusively that death rates for many diseases were higher among those in the lower social classes. It acknowledged that the NHS could do much more to address the situation. It called for increases in child benefit, improvements in maternity allowances, more pre-school education, an expansion of child care and better housing. A further report was subsequently produced by Professor Peter Townsend. Indeed, only last week I attended a seminar, in which the principal speaker was Sir Michael Marmot, on the impact of cold homes on health outcomes. The report indicated that the cost to the NHS of illness resulting from poorly insulated houses and cold homes is £2 million a year.

[Ian Lavery (Wansbeck) (Lab)]

Is my hon. Friend aware of the Marmot report—

[Ian Lavery]

The Marmot review, published in 2010, stated clearly, as one of its nine objectives:

“Economic growth is not the most important measure of our country’s success. The fair distribution of health, well-being and sustainability are important social goals. Tackling social inequalities in health and tackling climate change must go together.”

[Grahame M. Morris]

I am grateful to my hon. Friend for mentioning that important and contemporary report. I completely agree with Sir Michael Marmot’s findings— and Marmite is also very good for public health. Building on the work of Professor Townsend and Sir Douglas Black, Sir Michael Marmot states as one of his recommendations:

“Action taken to reduce health inequalities will benefit society in many ways. It will have economic benefits in reducing losses from illness associated with health inequalities. These currently account for productivity losses, reduced tax revenue, higher welfare payments and increased treatment costs.”

I mentioned the economic benefits of insulating houses. It would be a real step forward if the Marmot report’s six principal recommendations were incorporated and linked to quality standards in the public health outcomes framework that the National Institute for Health and Clinical Excellence is working on.

[Ian Mearns (Gateshead) (Lab)]

My hon. Friend mentioned the Black report, the Townsend report and the Marmot report, and I wonder whether Government officials and Ministers might in due course come to regard the Marmot review a little like Marmite—either loving it or hating it—in respect of its findings, because it is clear that the need to monitor what is going on in public health across the regions of England, such as the north-east, is vital for future policy developments.

[Grahame M. Morris]

Absolutely. That is a critical issue. In some respects, the Government have taken their eye off the ball. I will develop that point a little later and would like the Minister to respond to it.

As my hon. Friend pointed out, there is a clear and present danger of a reversal of health inequalities, which would be exacerbated by decisions taken elsewhere across Government. It is such an important issue, and one that I have long campaigned on. As someone who has worked in the health service and served on a local authority, I feel very passionately about it.

Remarkably, we are now considering proposals that risk losing our greatest weapon in tackling public health inequalities: evidence-based health intelligence. More recently, as my hon. Friends have noted, the Marmot review has restated the link between socio-economic factors and health, which are known as the wider determinants of health. One of the more serious threats to the future of public health intelligence is its future funding under the new arrangements proposed by the Government. In my view, the Secretary of State has shown little interest in the functioning of public health intelligence under these proposed structures.

Public health policies must take account of local circumstances as health inequalities remain stark, particularly in areas such as my constituency. For example, smoking-related deaths vary greatly across different parts of the country. Public health intelligence must drive public health practice. I appreciate that public health observatories self-generate revenue, alongside their Department of Health grant and moneys from primary care trusts and strategic health authorities. They also have opportunities to gain commissions from universities and charitable organisations, but it would be extremely risky to proceed down the Government’s proposed route without the certainty of their core Department of Health funding, which I understand is to be reduced by 30% this year.

Staff and people associated with the service have reported to me that valued employees are already being laid off at the north-west public health observatory, which is based at Liverpool John Moores university, and there is a similar situation at the north-east public health observatory. Local authorities commission the majority of public health services from a ring-fenced budget. What assurances can the Minister give me on safeguarding through this hiatus—this period of transition—and for the long term under the new arrangements?

I also thank David Kidney, the former Member for Stafford, who is now head of policy at the Chartered Institute of Environmental Health, for his assistance in preparing for this debate. The institute has stated its view that Public Health England must be established with a degree of independence, a point I made earlier, and with the ability to oversee arrangements for collecting, analysing and disseminating valuable data for public health services.

In short, it is now time for Ministers to provide concrete assurances that the role of public health intelligence, the collection of the evidence base and, in particular, public health observatories will be safeguarded for the future.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

rose—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. There are just over 10 minutes left, so is it by agreement that I call the hon. Member?

[Grahame M. Morris]

indicated assent.

[Madam Deputy Speaker]

I call Diane Abbott.

Future of the NHS

Grahame Morris Excerpts

Monday 9th May 2011 Commons Chamber

[John Healey]

My hon. Friend has been pressing that point with his local hospital, because it is quite clear that the hospital’s managers were forced to look at privatising it and having its management run by a private company. I fear that under the provisions of the Health and Social Care Bill, more hospitals will be driven to the brink and will have to face the prospect of insolvency or a takeover by the private sector companies that are lining up to make the most of the Government’s plans for the NHS.

[Grahame M. Morris (Easington) (Lab)]

On the transfer of responsibility for public health, can my right hon. Friend explain how withdrawing the funding for the public health observatories, which have informed health policy, will help improve public health?

[John Healey]

My hon. Friend gives good service on the Health Committee and follows the details of the matter more closely than most in the House. He has an important point, because the quality of health services for patients is inevitably affected by the deep and fast cuts in other areas. People in local authorities are experiencing difficulty in continuing to provide good social care, which is causing problems for the people who depend on that care and for the NHS.

--- Later in debate ---

[Grahame M. Morris]

Will the right hon. Gentleman give way?

[Mr Dorrell]

Will the hon. Gentleman forgive me? I want to cover what I regard as important ground.

I have expressed the challenge as an efficiency target, but the same target can be looked at differently, and it is important for the House to understand that this is a matter not just of dry health economics, but of the way in which the health service delivers clinical care, because so often in such debates we imagine that the normal health service patient is a normally healthy person who goes to see the GP and is referred for an elective acute procedure. It is as well to remember, however, that such patients constitute 11% of NHS expenditure, and sometimes I wish that we would devote the same attention to the remaining 89%, because that includes emergency patients, with 75% being expenditure on patients with long-term complex conditions, most of whose care would be better delivered by integrated services in the community.

The challenge that we ought to address when we think about the future of the health service involves not just another discussion about bureaucratic structures, but how we deliver the change in the service’s clinical model to ensure that it delivers efficient and high-quality care to the patients who present for care, rather than to the patients as so often described in the policy pamphlets.

That is why it is so important that the structures that emerge from this listening exercise achieve more radical integration than we have yet achieved in the health service—of primary care, community care and social care. It is why the GPs have to be engaged in the process. Once again, that is not a matter of party political debate; the point is made in all the world-class commissioning documents that I do not have time to quote.

My message for the House is that this is an intensely depressing debate, because it is as if the past 20 years never happened. The reality, when we look through the torrent of rhetoric, is that this policy is not a great break from the past; it is a desire on the part of my right hon. Friend to take ideas that were expressed and pushed through by Labour Ministers between 1997 and 2010, and to seek to make them effective in the context of the challenge that I have defined.

[Grahame M. Morris (Easington) (Lab)]

I pay tribute to the thoughtful contribution by the right hon. Member for Charnwood (Mr Dorrell), who chairs the Select Committee on Health.

I come to this debate as, I believe, one of the longest-standing opponents of the Bill, both as a member of the Health Committee and as a member of the Health and Social Care Bill Committee. As such, I have consistently raised serious concerns about not only some of the detail contained in the Bill but the direction of travel charted by these reforms since they have developed from manifesto to coalition agreement to White Paper, and finally morphed into the Bill itself. I have become accustomed to the protestations and rebuttals of Health Ministers on every issue that I have raised, so I am somewhat sceptical about the listening exercise.

Those issues include the pace and scale of reform, the lack of a credible large-scale pilot to assess the impact of the changes, the conflicts of interest inherent throughout the Bill, as identified in the Channel 4 “Dispatches” TV documentary, and the threat of privatisation by stealth. [Interruption.] Despite the protestations and groans of Government Members, there is nothing in the Bill to rule that out. I can cite some examples, not least in relation to the prison health contract that was recently awarded to Care UK to provide health services for eight prisons in the north-east of England, resulting in 120 NHS staff being displaced and made redundant. There is a clear and present danger of privatisation of the service.

Perhaps the strongest advocate of the Bill, as it stands prior to any changes, has been the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who is no longer in his seat, and who was the Lib Dem steward of the Bill in Committee. On 10 March, he said in an interview in The Guardian:

“This is a change that liberals can embrace.”

On 17 November, in the Commons Chamber, he called Labour’s record on the NHS a “failed status quo” and wholeheartedly backed the Tory NHS reforms. This year, we found out that the Department of Health had at that time been trying to suppress an internal Ipsos MORI poll of public satisfaction with the NHS. That is interesting, because the poll shows record levels of public satisfaction. Perhaps even more disturbing are rumours that next year the Department intends to cancel the commissioning of such a survey. Rather than saying that Labour has failed on the NHS, the survey showed the highest ever levels of public satisfaction.

An even bigger supporter of the Bill, until now, has been the Deputy Prime Minister. On 23 January this year, on the “Andrew Marr Show” he was asked by Mr Marr, of the Health and Social Care Bill,

“Was that in the Liberal Democrat manifesto?”

The Deputy Prime Minister responded:

“Actually funnily enough it was. Indeed it was…I agree it’s an ambitious programme of reform—but over time I think it’ll leave patients with the feeling that they are at the centre of it.”

I am slightly perplexed by the hasty posturing and sudden synthetic explosion of anger by senior Liberal Democrats in the coalition, perhaps in the wake of the meltdown following last Thursday’s elections. I take those criticisms with a pinch of salt.

[Tony Baldry (Banbury) (Con)]

The hon. Gentleman is a member of the Health Committee, so one would expect him to be well informed on these matters. I assume that he reads other reports of the House relating to health. I wonder what he would say about the report of the Public Accounts Committee that was recently published, under the chairmanship of one of his right hon. Friends, which says:

“The trend of falling NHS productivity will have to be reversed if the NHS is to deliver, by 2014-15, savings of up to £20 billion each year for reinvestment in healthcare.”

The PAC found that there were serious problems with productivity—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. Interventions, by their nature, must be brief, particularly when so many Members are waiting to speak.

[Grahame M. Morris]

I am grateful, Madam Deputy Speaker.

Indeed, that was the point that I wanted to make when the right hon. Member for Charnwood was speaking about the level of the challenge faced by the NHS. Sir David Nicholson rightly pointed out that major efficiency savings have to be made and he identified the figure. However, he did not advocate massive organisational change on top of the drive for efficiencies in the system.

During the 28 sittings of the Public Bill Committee, I raised countless issues and made numerous interventions against the health reforms. Unfortunately, the Secretary of State was unwilling to take them earlier in this debate. I have followed this matter very closely. The hon. Member for Banbury (Tony Baldry) asked if I had read the Bill. As a matter of fact, I have read it inside out and could probably give some lessons to a few Members who are in the Chamber. My conclusion is that the policy has remained basically the same, and that only the public relations strategy and the spin has changed.

[Mr Chuka Umunna (Streatham) (Lab)]

Will my hon. Friend give way?

[Grahame M. Morris]

I will give way just one more time.

[Mr Umunna]

My hon. Friend said that he sat on the Public Bill Committee and he is also a member of the Health Committee. Has any clarification been given during this reorganisation on the operation of the Transfer of Undertakings (Protection of Employment) Regulations 1981 and 2006 with regard to employees in the NHS?

[Grahame M. Morris]

That is a key point, and I know that whether TUPE will apply under the terms of the Bill is a legitimate concern of trade unions. However, I will leave it to the Minister to give a definitive response.

My argument is that we need an end to the gesture politics and a radical shift in policy. The Conservatives’ rhetoric and that of their coalition partners must match the reality on the ground. If the opportunity to

“pause, listen, reflect and improve”

is the Health Secretary’s chance to engage with NHS staff, the 98% vote of no confidence against him by the Royal College of Nursing must have been a major hiccup.

It seems to me that this week’s strategy is to let the Deputy Prime Minister flex his muscles. He said yesterday:

“Protecting the NHS, rather than undermining it, is now my number-one priority.”

Perhaps he can tell us what has changed since the White Paper was published in July last year. So far, we have heard that as a result of the listening exercise there may be tweaks to GP-led commissioning consortia to make them more inclusive and accountable, that scrutiny arrangements may be strengthened and that the pace of change from PCTs to GP consortia may be slowed. If that is all the Deputy Prime Minister can negotiate as No. 2 in the Government, it demonstrates, particularly to his own supporters, that he has prostituted his party and the NHS for a position in power.

The Deputy Prime Minister must take heed of the lesson from the Royal College of General Practitioners:

“Intensifying competition in the NHS will lead to the service breaking up, drive up costs, damage patient care, and mean less integration of services.”

The future of the NHS requires him to put aside gesture politics and use his clout to force out the central privatising elements of the Bill; drop Monitor, the economic regulator of the health service; protect national pay terms and conditions for NHS staff; and limit the ability of private health care companies to enter the NHS at every level. He must ensure that the Government do not privatise the health budget, but bring GPs and other health professionals into PCTs to achieve clinical excellence in commissioning, without there being ulterior motives for private profit.

I know that time is short and that many Members wish to speak. My final point is that if the Deputy Prime Minister is serious about protecting the NHS and achieving substantial and significant changes to the reforms, he must force his coalition partners to drop the Bill and start again.

--- Later in debate ---

[John Pugh (Southport) (LD)]

This is déjà vu. In the last Parliament, it seemed like every other Opposition day debate was a health debate, normally called by the Secretary of State as the then Opposition spokesman. I trust that his enthusiasm for these debates is undimmed, although given that he has left us, possibly it is.

The Opposition allege that the Bill prepares the ground for the complete privatisation and fragmentation of the NHS through the introduction of an open market, pricing and competition regulation and the general disengagement of Government. However, the often very pained response of Ministers—this was certainly true in the Bill Committee—is that they are building and improving on previous policy, linking clinical decision making to cost control and adding a dimension of accountability that has not existed hitherto. All those statements are true. I noticed that in the Bill Committee, Ministers talked all the time about “refracting mirrors”, “Opposition fantasies” and “deliberate distortions”. In turn, the Opposition talk of “hidden agendas”.

On reflection, I have come to the conclusion that there has to be an explanation for this strange phenomenon, this persistent conflict between interpretations of the same legislation, this clear non-meeting of minds.

[Grahame M. Morris]

Will the hon. Gentleman give way?

[John Pugh]

I was just about to give the answer, but I will give way.

--- Later in debate ---

[Grahame M. Morris]

Is there not a simple solution? It is the Government’s Bill, so why did they not explicitly rule out price competition in the Bill?

[John Pugh]

I have a different explanation, which is that both interpretations can be sustained by a reading of the Bill. It is a kind of Jekyll-and-Hyde thing. I have a vision of the Bill being drafted during the day by a sane, pragmatic Dr Jekyll-like Minister, but during the night some rabid-eyed Mr Hyde with right-wing ideology breaks into Richmond House and changes many of the sentences. That is the only way I can explain the fact that the explanatory notes to the Bill provided in Committee explained very little.

The House might know that I am a long-term critic of the Bill and the White Paper before it. At the annual Liberal Democrat conference in October, I and the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow) went around with a double act on the Bill—him for, me against. This is not, therefore, as the hon. Member for Easington (Grahame M. Morris) might think, a hissy fit following poor election results. Like nearly everyone in the House, I do not disagree with the Bill’s objectives: more clinical involvement, less bureaucracy and more local accountability. Like everyone else, I am concerned not about its objectives, but about its likely effects. I have met no one who takes issue with the Bill’s avowed intentions, but I have met many who dread its consequences.

According to one reading of the Bill—the Mr Hyde version—the eventual outcome of the Bill will be that the NHS opts out of direct health provision and becomes simply a funding body; NHS hospitals, services and clinics become indistinguishable from private ones; everyone competes on business terms for a slice of whatever funds the Government have allocated for health purposes; and what health care a person gets depends on what can be purchased on their behalf in a largely unconstrained, privately run health market. That is a perfectly consistent view of how a health service can be run, but in our country any party that advocates it commits political suicide. Furthermore, of course, it is likely to accentuate health inequalities and overall costs.

The question for us is this: what will prevent such a situation from arising out of a Bill that appoints a competition regulator along the lines of Ofgem to promote competition, that blurs many of the lines between private and public provision, and which removes the Government’s duty to provide a comprehensive health service? Hence the importance of today’s debate, which, knockabout apart, is crucial to the wider debate on the Bill. To be alarmed by the prospect I have set out is not to oppose competition in principle. The previous Government set up competition and collaboration panels to encourage a degree of challenge in the system. In fact, if hon. Members look at their record, they will see that they were knee-deep in competition initiatives. Neither is holding these concerns to be alarmed by the presence of private business in delivering NHS services. There is not a person here who has not used a private optician or a private pharmacist when they need it. There is a long tradition of involvement by the private sector in the NHS.

Rather, to be concerned about the proposals is to be alarmed by the fear of an unconstrained, uncontrolled market in health—this is a point that has been made previously—partly because it can lead to fragmentation, potential conflicts of interest, profiteering and so on, but mainly because identifying competition as the main engine of improvement in health care ignores the simply enormous gains in service quality, cost reduction, efficiency and patient experience that can be gained through co-operation, collaboration and integration of services.

The NHS is built on the principle of co-operation, in which we, the hale and hearty, make a moral compact to support the lame and the sick. To make commercial competition the main driver of improvement in the NHS, even if it is not competition on price, would be a serious mistake. It would be to subscribe to a perverse and misguided form of social Darwinism. Competition is a mechanism; it is not an end in itself. The role of competition in the NHS, as seen by the Government, is the real issue. The problem is made a lot worse by the hopeless lack of clarity over how European competition law will apply. We struggled with that issue in Committee. We did not resolve it, and I do not think that we will do so.

--- Later in debate ---

[Dr Poulter]

I can only say that my Conservative-run, Suffolk council is doing exactly the opposite of what the hon. Lady describes. The Government have committed to putting almost £2 billion into adult social care, looking at the demographic time bomb and looking at better integrating health care with adult social care. I would be very concerned to see councils doing what she describes, because that is not what they are given that money for. If she has had a problem with that at her local authority, she needs to take it up with that authority.

The key to unlocking potential in the health sector lies in cutting the red tape and pointless form-filling that wastes the time of so many front-line staff. Of course, our NHS must have a level of regulation that ensures that products and services are thoroughly tested and that ensures patient safety. However, the over-excessive regulation introduced by the previous Government has been damaging not only to patient care but to staff morale. It has also diverted vital resources away from the front line and away from patients, who are, after all, what health care should be all about. This Government are rightly looking to take simple, obvious and positive steps in improving the overall efficiency of the NHS by scrapping the health quangos that waste £2 billion a year—money that could be much better spent on front-line patient care.

Another issue that I want to highlight in the time left to me is another area of wasteful spending in our NHS—management. Under the previous Government, the number of managers and unproductive non-medical staff increased in the past decade, with the number of managers and senior managers in the NHS almost doubling to 42,000. In many hospitals, more new managers than new nurses were recruited in that time. That cannot be right—it is bad for patients and money is being misspent. As I witnessed at first hand, NHS managers were rewarded at a better rate than front-line staff—at around 7%, compared with 1.8% pay rises for front-line medical staff. That is not a good thing.

The Opposition are very concerned about staff morale, but let me tell them why staff morale is so low: it is because the contributions of front-line staff were badly undervalued by the previous Government while the contribution of managers were over-valued. I believe that what we and the Government need to do is make sure that more money goes into front-line patient care and front-line staff rather than being wasted on management and bureaucracy.

[Grahame M. Morris]

rose—

[Dr Poulter]

If the hon. Gentleman will forgive me I will not give way because time forbids it.

In conclusion, the NHS needs to be reformed and needs to improve the care it delivers to patients. We can no longer afford to sustain the amount of wasteful spending on management and bureaucracy that occurs in the NHS. We need a less bureaucratic NHS—a clinically led NHS that can once again put its patients first. The NHS has become obsessed with management and process but if we want to reform it, then it must be the patient who counts.

NHS Reform

Grahame Morris Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend. Labour Members sit and laugh about this, but they ought to realise that 1 million patients a day visit their local general practice surgery. GPs across the country who have come together to form pathfinder consortia—87% of the country—are doing it on the basis that they can improve services for patients. I suspect that they understand the needs of their local community and patients better than many Labour Members, who are not listening to their GPs locally.

[Grahame M. Morris (Easington) (Lab)]

I would like to thank the Secretary of State for single-handedly destroying the Government’s reputation on the NHS through this Bill. No amount of minor changes or slowing down of the pace will address the Bill’s fundamental failure to protect the public from privatisation by stealth. If he refuses to resign, is he worthy of his nickname, Broken Arrow—he doesn’t work and he can’t be fired?

[Mr Lansley]

The hon. Gentleman might like to talk to Dr Stewart Findlay, who is among those leading the pathfinder consortium in County Durham. He might like to talk to people locally who are piloting the new 111 telephone system, which will give better access and better urgent care to patients. Instead of sitting there making rather absurd political points, why does he not go and talk to people who are delivering services to patients? That is what the NHS is really about.

NHS (Public Satisfaction)

Grahame Morris Excerpts

Wednesday 30th March 2011 Westminster Hall

[Tony Baldry]

The hon. Gentleman, again, makes his own point in his own way. He says, and I understand him, that members of the public are satisfied with the NHS so nothing need change. I am not sure whether he has read the unanimous PAC report that was published only weeks ago, but I remind Members that it says:

“The level of hospital activity has not kept pace with the increased resources as hospitals focused on meeting national targets, but not on improving productivity, and productivity has actually fallen over the last decade…Though the increased money going into the NHS has helped to reduce waiting times, improve facilities, and deliver higher quality care, the Department promised at the same time to improve productivity. It failed and, in future, the Department needs to have a more explicit focus on improving hospital productivity if it is to deliver its ambitious savings targets without healthcare services suffering.”

[Grahame M. Morris (Easington) (Lab)]

Does the hon. Gentleman agree that it is notoriously difficult to measure productivity in crude terms—activity, outcomes and so on—and that the quality of the output, which perhaps reflects the greater investment of resources, is not included in the survey?

[Tony Baldry]

I am sorry to hear the apologia of Opposition Members, who are confronted with concerns about what is happening in the NHS. I commend to the hon. Gentleman the National Audit Office report published on 17 December 2010, “Management of NHS hospital productivity”. The NAO has no difficulty in measuring NHS productivity, and neither does the PAC. Before Opposition Members jump up, they should remember that the Labour party left the NHS with a huge, unpaid overdraft of £60 billion. It is a staggering fact that of the £65 billion of hospital building works carried out in the 13 years of the Labour Government, only £5 billion was paid for. Despite a number of very generous private finance initiative projects, the NHS still has an overdraft and must pay for £60 billion of hospital building works. The previous Government, while they may have put more money into the NHS, saw no improvement in outcomes and have left the NHS with a substantial overdraft.

As the Chair of the Health Committee, my right hon. Friend the Member for Charnwood (Mr Dorrell), has observed, even if, as intended, the Government manage to ensure that spending on the NHS is ring-fenced and runs ahead of inflation, the NHS, in the next few years, has to become substantially more efficient in how it uses its assets, and treats and looks after patients—hence the need for reforms. Let us be clear. The reforms are about cutting bureaucracy and improving patient care and have been proposed by the coalition Government to improve the NHS and to ensure that we maintain public satisfaction and support for the NHS. We need to ensure that the Health and Social Care Bill, which is going through Parliament, delivers those reforms in the best possible way.

I have no doubt that Ministers will give proper attention to the report next week of the Health Committee and that, in due course, the Government will have regard to any constructive suggestions from the other place to ensure that the Bill is as clear and effective as possible. In any health system, however, difficult decisions have to be made about how one best utilises finite resources. However much money as a country we commit to the NHS, that money will be finite. Choices will have to be made about how that money is best spent: at one end of the spectrum, about whether and in what circumstances people get treated for varicose veins; and at the other end of the spectrum about when, and how often, major and significant, complex and expensive invasive surgery takes place. It seems to me that it makes extremely good sense for those decisions to be made in a collegiate manner, on behalf of their patients, by GPs. It seems to me to make very good sense to allow GPs, individually and collegiately, to make value judgments about the quality of services being provided by individual hospital providers for their patients.

As the hon. Member for Leyton and Wanstead made clear when introducing this debate, patients trust their GPs and I see no reason why we should not, collectively, trust GPs to commission the best available services in the NHS. Critics of the reforms have sought to present them as something that they are not. However, as the Prime Minister has made clear on a number of occasions:

“we have ruled out price competition in the NHS.”

He went gone on to make it clear that

“we must avoid cherry-picking by the private sector in the NHS.”—[Official Report, 16 March 2011; Vol. 525, c. 292.]

--- Later in debate ---

[Grahame M. Morris (Easington) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bayley. I pay tribute to my hon. Friend the Member for Leyton and Wanstead (John Cryer) for securing this important debate on public satisfaction with the NHS. Some important issues have been raised by my right hon. and hon. Friends, but I will not rehearse them. Suffice it to say that we are having this debate because information has been released as the result of a debacle in the Department, and I am delighted that the information is now available. There may be a good reason for the Secretary of State wanting to keep the contents of the satisfaction report under wraps. It confirms the outstanding NHS legacy that Labour passed to the Health Secretary in 2010. He inherited a national health service that was rescued from 18 years of Tory mismanagement, and now enjoys the highest rate of public satisfaction in its history.

The Ipsos MORI survey, to which my hon. Friend the Member for Leyton and Wanstead referred, states:

“Public satisfaction with the running of the NHS remains very high at 72%. This high level of satisfaction has now been sustained for over a year making the public’s perception of the NHS a real success story.”

The real reason why the Health Secretary hoped that his Department had not published that report is that it shows him to be completely out of step with the British public. He cites his former boss, Lord Tebbit, as his political hero, but he does not understand what the public so value about the NHS. Instead, he is doing to it exactly what he did to the utilities in the 1980s, when he was working for his hero, Lord Tebbit, by applying 1980s privatisation principles and policies to the health service.

Current polls of public satisfaction with the NHS are all the more important when we consider that the revolution—that is what it is—now under way in the NHS was not described or set out for the British people until some months after the general election. The Conservative manifesto said the Conservatives would

“defend the NHS from Labour’s cuts and reorganisations”,

yet the Government are delivering a real-terms cut in spending, and a radical reorganisation that will undermine the NHS.

Nowhere did the Health Secretary explain his plan to apply 1980s-style privatisation mechanisms to the NHS; to create an economic regulator for health in the form of Monitor, costing upwards of £500 million over the lifetime of this parliament, an issue that was raised by the hon. Member for Banbury (Tony Baldry) in respect of the Government’s commitment to reduce bureaucracy; to expose the NHS to European competition law, which also applies to our utilities; or to handing the £80 billion NHS budget to private bodies with GPs as figureheads, but to which freedom of information provisions will not apply.

Instead, the Health Secretary spent the previous six years as Opposition spokesman doing everything possible to avoid giving any indication of his plans for radical change for the NHS. I am sure that there was no mention of removing the private patient cap to allow uncontrolled focus on profit-making in hospital trusts, a mechanism that will push NHS patients to the back of the queue.

The Secretary of State’s coyness had paid off, because the public, who are overwhelmingly satisfied with the NHS service that Labour had rebuilt over 13 years in government, did not suspect a thing. Health was not raised once in the last prime ministerial debate before the general election.

I want to focus my remarks on how public satisfaction, and in some areas dissatisfaction, might apply to the Health Secretary’s proposals in the Health and Social Care Bill. Now that the Ipsos MORI survey has found its way into the public domain, we may consider its implications for the current upheaval planned by the Secretary of State. Three specific polls in the survey give a clear indication of public preference for the future of the NHS, with between 63% and 65% agreeing with the following statements: first, the

“NHS provides good value for money to taxpayers”;

secondly, the

“NHS provides patients with the best treatment possible”,

and thirdly,

“people are treated with dignity and respect when they use NHS services.”

In-house NHS provision of a high quality is favoured by the public, but the Tory-led proposals in the Health and Social Care Bill threaten that. Over time, as the private sector wins contracts from NHS bodies, the NHS provider that is displaced will have to close, and there is a risk that we will be left with private companies competing with one another for multi-million pound contracts. That is the Lansley vision of the NHS, and it is completely out of step with British public opinion.

[John Pugh]

People were asked whether major changes or only minor changes were needed in their local health system. The figures for the UK show that 62% believe that only minor changes are needed, which is by far the highest figure on the graph of most of the comparable systems.

[Grahame M. Morris]

I thank the hon. Gentleman for that intervention. His point is a good one, and was well made. There is no need for the revolutionary change that we are facing.

Time is limited, so I shall conclude. Without polling and without understanding the facts, the Government would take a reckless step in the dark. If they do not consider public opinion in their annual surveys, they may end up with a shock in the biggest survey of all—the one planned for May 2015.

[Hugh Bayley (in the Chair)]

I shall call Mr Dromey to order at 3.40, so he has a few minutes in which to speak.

NHS Reorganisation

Grahame Morris Excerpts

Wednesday 16th March 2011 Commons Chamber

[John Healey]

I am just responding to the hon. Gentleman’s colleague, so I ask him to be patient. We set out exactly how we could reduce the costs and some of the bureaucracy. Perhaps the hon. Member for Crawley (Henry Smith) could ask his Front-Bench colleagues how bureaucracy will be cut when the function currently carried out by 150 primary care trusts in England will be carried out instead by more than double that number of general practitioner consortia.

[Grahame M. Morris (Easington) (Lab)]

Perhaps the Secretary of State, too, would share his thoughts about how money will be saved on bureaucracy when expenditure on Monitor, which will take on a new economic regulator role under clause 52 of the Health and Social Care Bill, will increase from £21 million a year under Labour to as much as £140 million a year—£500 million over the course of a Parliament. How is that saving money on bureaucracy?

[John Healey]

My hon. Friend does a great job in ensuring that this Government are held to account on the NHS through the Health Committee. He rightly says that Monitor’s budget is currently about £20 million and the impact assessment calculates that that could increase to as much as nearly £140 million—although Monitor’s core operating costs are not that entire total, the figure will be at least three times as high as it is now. That is not a decrease in bureaucracy and operating costs, it is an increase. Hon. Members would do well to read some of the documents, rather than the briefings they have been given by their Front Benchers.

--- Later in debate ---

[Mr Lansley]

My hon. Friend makes an extremely good point, and he made it to the shadow Secretary of State, who did not answer it.

[Grahame M. Morris (Easington) (Lab)]

Will the Secretary of State give way?

[Mr Lansley]

No.

The fact is terribly clear that before the election the Labour Government said that in three years the NHS would have to save between £15 billion and £20 billion. The Labour party never said in government that that money, if saved in the NHS, would be reinvested in the NHS. The other point is that when we came to the spending review, in which we agreed £10.7 billion extra for the NHS over the life of this Parliament, the shadow Secretary of State’s friends, who were then responsible, said that we should cut the NHS. We do not need to speculate about what they said they would do, because we can look at the example of Wales. The Labour-led Welsh Assembly Government are proposing to cut the NHS budget in Wales by 5%, while we are increasing it. We know exactly what Labour would do if they were in charge of the NHS: they would cut it. We have not cut it and are going to protect it.

--- Later in debate ---

[Mr Dorrell]

It is, but it is not even political opportunism that applies to a popular principle. Surely opportunism is normally motivated by some popular principle, yet defending the interests of a monopolist does not seem to me to be a very popular principle.

[Grahame M. Morris]

Will the right hon. Gentleman give way?

[Mr Dorrell]

I will give way to the hon. Gentleman, who is another member of the Health Committee.

[Grahame M. Morris]

I am doubly honoured, because the right hon. Gentleman has afforded me a courtesy that the Secretary of State would not. The concept of having greater clinical engagement—not just for GPs, but for doctors in secondary care—enjoys broad support across the parties. However, the framework laid out in the Health and Social Care Bill opens the service up to privatisation.

[Mr Dorrell]

I thought that the hon. Gentleman was going to make the point that he has made in the Select Committee—a point with which I agree—that the purpose of GP-led commissioning is to engage the entire clinical community, not just GPs, in the commissioning process. That is a principle that my right hon. Friend the Secretary of State agrees with. It is also a principle that Sir David Nicholson has made clear will be part of the principles that will be expected to be applied in GP-led commissioning consortia.

Before the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) led me down the road of competition policy, I was going through the principles that are consistent across the health policies implemented by all Health Secretaries since 1990, with the single exception of the right hon. Member for Holborn and St Pancras.

--- Later in debate ---

[Dr Poulter]

What we do know—the hon. Gentleman would do well to listen to this—is that the NHS currently spends £4.5 billion on bureaucracy, and that could be better spent on patient care. Under the previous Labour Government PCT management costs doubled by more than £1 billion to £2.5 billion, and that money could be better spent on patient care. By scrapping PCTs, we will have more money to give to GPs to spend on patients and front-line care, and that can only be a good thing.

Labour Members would do well to listen to a few more of the statistics on NHS bureaucracy that I am about to read to them. Under Labour, the number of managers increased faster than the number of nurses in the NHS. How can that possibly be right? Managers were paid better than nurses in the NHS. In 2008-09, top managers in NHS trusts received a 7% pay rise whereas front-line nurses received a rise of less than 3%. The Labour party was obsessed with bureaucracy, management and top-down targets, and we would much rather see that money spent on patients and front-line patient care.

[Grahame M. Morris]

We have heard about the layers of bureaucracy that the coalition Government propose to take away, but what does the hon. Gentleman have to say about the additional layers that they are imposing through the exponential growth of Monitor, which will be the economic regulator? They are increasing its budget from £21 million a year to as much as £140 million a year. How many more thousands of people will it employ? How many lawyers? It will cost £600 million over the course of a Parliament.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. We must have shorter interventions.

--- Later in debate ---

[Liz Kendall]

What patients want is their views and voices to be heard. As the hon. Lady well knows, eight of the country’s leading patient charities, including the Alzheimer’s Society, Asthma UK and Diabetes UK, have said that the patient and public voice is not strong enough under the Bill, and they have demanded changes. I respectfully ask that she look at their comments and act on their views.

The fundamental issues at the heart of the Bill are turning Monitor, which is currently responsible for foundation trusts, into a powerful new economic regulator to promote competition across the NHS, and enshrining UK and EU competition law into primary legislation on the NHS for the first time. That is not my view but the view of David Bennett, the new chairman of Monitor, expressed in his evidence to the Public Bill Committee. The Government are explicitly modelling the NHS on the gas, electricity, railway and telecoms industries. Government Members who are shaking their heads or looking blank should read the explanatory notes to the Bill, which make that absolutely clear.

[Grahame M. Morris]

May I point out that yesterday, in an Adjournment debate in Westminster Hall about the future of the blood services contract, the Under-Secretary of State said in response to a question from my hon. Friend the Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) that EU competition rules would apply?

[Liz Kendall]

The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), also said yesterday, in the Health and Social Care Bill Committee, that EU competition law would apply, and gave me some assurances that that would somehow not change anything. When I asked whether the Government had taken legal advice on that, he admitted that they had. I asked him then to publish that advice so that hon. Members did not have to take my word for it, and I shall do so again. Will he publish that advice so that hon. Members can see whether GP-commissioning consortia and providers will be subject to EU competition law? Sadly, it appears that he will not do so.

National Blood Service

Grahame Morris Excerpts

Tuesday 15th March 2011 Westminster Hall

[Jim Dobbin]

I thank the hon. Gentleman very much. That was a very positive contribution, based on his own specific experience. There is a petition about this issue, there are now some 35,000 signatures on it, and it is building up all the time.

[Grahame M. Morris (Easington) (Lab)]

I also congratulate my hon. Friend on securing a very important debate about an issue that is of great concern among the public. I wanted to ask him about the lessons from overseas countries where blood transfusion services have been privatised and where it is standard to pay for donated materials. What lessons can we learn from those countries about the safety of supply?

[Jim Dobbin]

I referred earlier to another privatisation that took place in the health service, when cleaning was put out to tender. Of course, the quality of the service was reduced. That is exactly what I fear will happen with the blood service, because if someone is in the business of making money and making profit they take short cuts. It is as simple as that.

The petition that I was talking about is building up. In addition, 300 people got in touch to say how much they valued the blood service. For many of those people, their loved ones personally benefited from the altruism of a fellow human being.

The blood service began before the national health service, around the time of world war two, when the demand for the service originated. So the blood service is older than the NHS.

I am very concerned. The Government are saying that only elements of the NHS blood transfusion service are under discussion at the present time but that is a dangerous route to go down. I hope that the Minister will take this issue back to the Government and the Secretary of State, and ask for a review of this particular service that the public so dearly love. The other thing that I will say is that if someone is looking for a big society in action, the blood service is it.

--- Later in debate ---

[Anne Milton]

I thank the hon. Gentleman for his intervention. What matters is that people get good value for money from the taxes that they pay. What also matters is that we do things effectively and efficiently, so we constantly market-test within NHS provision. We should do so. What matters to us is having a quality service. However, we are not selling off the blood service and we are not privatising it. As for performance, I am sure that the hon. Gentleman will agree that the performance of our blood service puts us in the top quartile compared with other European blood services. That is a fantastic achievement.

I reiterate the hon. Gentleman’s comments about what the improvements in the blood service mean. There has been a reduction in the price of a unit of blood, down by £15 from £140 in 2008-09 to £125 today. As he rightly pointed out, that reduction saves hospitals £30 million each year, which can be channelled straight back into patient care. Again, I pay tribute to the staff who have achieved that reduction.

It would be a huge oversight on my part if I did not also pay tribute to those who donate their blood for the benefit of others. I am pleased to learn that my hon. Friend the Member for Colne Valley (Jason McCartney) has donated blood himself. Every year, 1.4 million people donate blood, which means that 2 million units a year are donated in total. That equates to 7,000 new units of blood every day, or about five a minute. Statistics are wonderful when one is engaged in a debate such as this one; they show the scale of the donations that are made. Those donations have saved countless lives and continue to do so. Indeed, the altruistic donor system is one of the rocks that the NHS is built on and we will not do anything to jeopardise public confidence in it.

It would also be remiss of me not to mention organ donation. The one thing that we do not do often enough is to thank people who donate their organs and those of their loved ones, saving many lives in the process. We have made great improvements in organ donation, which is up by 28% since 2008, but we must continue to make improvements. I do not want anything, anyone or any public statement to jeopardise any of that. On the contrary, we want to carry out a review to help NHS Blood and Transplant to improve its operational efficiency even further and provide an even better service.

The blood service must be seen in the context of its role in the NHS. The hon. Member for Easington (Grahame M. Morris) mentioned courier services for getting blood around the place. We have been using courier services for many years—the previous Government did so as well—to deliver organs and tissue, and there is no question of putting the delivery of blood at risk.

[Grahame M. Morris]

Just for the record, it was my hon. Friend the Member for Bradford South (Mr Sutcliffe) who raised that issue, but it is one that I am concerned about.

Will the Minister address the new role of the economic regulator, Monitor, and the responsibilities that it will have regarding competition? Will its remit extend to the blood service?

[Anne Milton]

I apologise for confusing the hon. Gentleman with the Member who was sitting next to him. At least it gave me the opportunity to clarify the point. To ensure that I give the hon. Gentleman a precise answer, I will have to come back to him on Monitor because I do not have the information with me. I will happily do that after the debate.

The blood service is self-funding, in that it recovers the cost of collecting, testing and processing blood through the price paid by the NHS for each unit. The price of a unit is therefore directly related to the efficiency with which NHSBT conducts its operations; the one feeds into the other. If the cost of a unit of blood goes up, there is pressure on budgets, so the whole NHS has an interest in NHSBT being as efficient as possible and keeping the cost low. The £30 million that we have been able to put back in demonstrates that costs are being kept low, and more can be spent on patient care.

The review of NHSBT was announced in the report produced by the arm’s length bodies review in July 2010. The review is ongoing, and I cannot say what the outcome will be, but I would like to explain what the review is about, and in doing so, clarify what it is not about and hopefully reassure the hon. Member for Heywood and Middleton and all those who might share his concerns.

The review will identify opportunities both to help NHSBT further improve the efficiency of its operations, and to save money. Aspects of NHSBT’s activities covered by the review include IT, estates, testing, processing and logistics. NHSBT has recognised that those areas have room for improvement, in both developing services and increasing efficiency; such functions can often be carried out more efficiently. NHSBT already outsources some of its activities to private sector companies, for example facilities management, legal services and the call centre, so by exploring whether greater savings are possible, the review does nothing new. It simply takes a currently successful model, which has demonstrated that it can improve, and considers whether it would work if it were to be expanded.

As I said, we are looking to ensure maximum efficiency for NHSBT, and I am sure that the hon. Member for Heywood and Middleton agrees with that aim. We will do whatever works, and whatever can ensure a safe supply of blood to the NHS.

Health and Social Care Bill

Grahame Morris Excerpts

Monday 31st January 2011 Commons Chamber

[Dr Poulter]

My hon. Friend represents Eastbourne, which has a large elderly population. He is right to make that point. Under the Bill, health and wellbeing boards will be set up, which will deliver a proper partnership between GPs, hospitals and local councils. That will allow, for the first time, properly joined-up thinking about how we deliver social services care that is joined up with NHS care for older people. I am delighted that the Government will put in almost £1 billion to support that initiative, which can only be a good thing.

The second challenge facing the NHS, which my right hon. Member for Charnwood also mentioned, is that we are having to get more and more out of a limited resource, because people expect more and more from their health care, regardless of their age. People want, quite rightly, to be given the latest cancer drugs. They want to ensure that they have top-quality care and access to information that delivers that care. The problem with the bureaucracy that has been in place is that, far too often, it has taken too long to deliver higher quality care and a greater choice in treatment for patients. When we know that a cancer drug works, it should be available as soon as possible. It should not have to go through a process of two, three or four years of bureaucracy to be made available, and the Bill will help to change that. For those reasons, the Bill’s reforms to the NHS will provide an excellent framework in which to deliver better ways of spending limited resources and looking after our ever-ageing population.

A lot of health care professionals will be saying, as I did earlier, that far too often, medicine and health care have been reduced to a tick-box exercise, with targets and top-down bureaucracy getting in the way of patient care. Under the A and E targets delivered by the previous Government, equal priority was given to treating a patient with a broken toe as someone with potentially life-threatening chest pain. That cannot possibly be right. Putting doctors, nurses and other health care professionals in charge of making health care decisions will mean that clinical priorities and better patient care can be delivered.

[Grahame M. Morris (Easington) (Lab)]

Has the hon. Gentleman made any assessment of the reduction in the number of managers, consultants and other bureaucrats that will be caused by moving from 152 primary care trusts to potentially 500 or 1,000 GP commissioning groups?

[Dr Poulter]

The Opposition need to take on board the fact that the cost of running PCTs has gone up by about £1 billion a year since they were first put in place. The cost of bureaucracy and management in the NHS is unsustainable, and most of the money that we are putting into the NHS is going on salaries and bureaucracy rather than on front-line patient care. It is surely a good thing to remove the middle strand of bureaucracy—PCTs, strategic health authorities and other quangos that cost a lot of money but do not deliver front-line patient care. That will help deliver more money to the front line and to patients, and Members on both sides of the House should support such an initiative.

I shall elaborate on the point about how PCTs have been a great source of wasted money. In my part of the world in Suffolk, they have spent millions of pounds each year on external consultants to tell them how they should be doing the job that they should have been doing in the first place. There has also been a total disconnect between primary and secondary care and a breakdown in the relationship between them. For example, as the Secretary of State alluded to earlier, hospitals have wanted to put in place outreach clinics for mental health, dermatology and rheumatology, but too often, as in my area, they have been told that the PCT will not allow them to do that.

Hospitals have said that they value and need community hospitals, because they provide an excellent place for step-up and step-down care and for rehabilitation after an acute hospital stay, but PCTs have closed down community hospitals such as Hartismere hospital in my community. We know that that is not a good thing. Far too often, PCTs have been a barrier to joined-up thinking in the NHS between the primary care sector and hospitals.

--- Later in debate ---

[Grahame M. Morris (Easington) (Lab)]

One thing is clear: from whatever perspective we consider the reforms in the Bill—whether from that of Charnwood or Holborn and St Pancras—there is a serious and worrying lack of evidence base for the Government’s proposals. These are proposals identified by the King’s Fund as without doubt

“the biggest shake up of the NHS since it was established”.

While the Health Secretary was the Conservative party’s shadow health spokesman—from June 2004 until he took office in May last year—he was coy about his real intentions towards the NHS, as indicated by my right hon. Friend the Member for South Shields (David Miliband). When the Government published the Bill, six major health unions and professional bodies wrote in a letter to The Times:

“There is clear evidence that price competition in healthcare is damaging. Furthermore the sheer scale of the ambitious and costly reform programme, and the pace of change, while at the same time being expected to make £20 billion of savings, is extremely risky and potentially disastrous.”

Labour Members welcome greater clinical involvement in commissioning, but GPs are not the sole font of knowledge in best practice and other areas.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

Does my hon. Friend agree that in any one year some GPs will deal only with one or two patients with, in particular, a neurological condition? GPs might not be in the best position, therefore, to be the providers and commissioners of such services.

[Grahame M. Morris]

I agree completely with my hon. Friend’s point. According to evidence given to the Select Committee on Health, specialists in secondary care and the nursing and other professions could add their expertise to the commissioning process.

The shake-up of the NHS goes far beyond simply involving clinicians in spending decisions. GP commissioning is a red herring. We were told by the Secretary of State that these reforms are needed because productivity has fallen since Labour’s increased investment. However, after 18 years of mismanagement and under-investment under the Conservative party, it was obvious that on a crude measurement of productivity—inputs versus outputs—there was going to be a decline in supposed productivity, because obviously money had to be directed towards clearing up the mess left by the previous Tory government, to building new hospitals, accident and emergency units and maternity units, and to reducing waiting lists, which in many areas of the country were 18 months and longer.

The Secretary of State raised the satisfaction survey. Indeed, in December 2010, the National Centre for Social Research released its most recent report on British social attitudes. It found that public satisfaction with the NHS was at an all-time high, whereas in 1997, when Labour came to power, only 34% of people surveyed were satisfied with the NHS—the lowest level since the survey began in 1983. By 2009, satisfaction had nearly doubled to two thirds—to 64%. Given that most health unions, professional bodies, think tanks and the public did not call for such reforms, where did the Secretary of State’s motivation come from? These are not patient-led reforms; they are private health care-led reforms.

[Pat Glass (North West Durham) (Lab)]

Does my hon. Friend share my concerns that these plans will lead to high and low-tariff services, and cherry-picking, and that services such as child and adolescent mental health services, children’s health services and adult mental health services will lose out?

--- Later in debate ---

[Grahame M. Morris]

I agree with the concerns expressed by my hon. Friend. There are concerns about the removal of the tariff floor and the introduction of price competition into the service. That is radical and revolutionary; it is not evolutionary. Rather than open-market health care, the British Medical Association and others are calling for a

“cooperative and coordinated environment where patients are guaranteed the most clinically appropriate and cost-effective care. Price competition and a fully open market will make this impossible.”

Clause 63 allows the Secretary of State to impose requirements on consortia to promote competition between providers, and clause 64 makes it possible for Monitor to investigate any complaint of anti-competitive behaviour made against commissioners by any interested party. That might be a third party or an overseas private health care company, and would make it far more difficult for GPs to ensure that their patient services are integrated, inclusive and carried out in partnership. The Bill also forces trusts to achieve foundation status within three years and will lead to more important priorities, such as safe patient care, being compromised. Furthermore, the abolition of the private patient income cap set out in clause 150, removing the limit on the amount of income foundation trusts can earn from private operations and private health care, will create a two-tier health system. Foundation trusts forced into the market without protection will face financial pressures to turn a profit, and NHS patients will risk being pushed to the back of the queue.

To my mind, and according to evidence submitted to the Health Committee by the Royal College of Nursing in which it identified 27,000 nursing posts that will go, these reforms will result in tens of thousands of job losses and undermine national terms and conditions for NHS staff. The scrapping of targets has left the NHS open to a dangerous postcode lottery. The duty to tackle health inequalities is one of the few remaining powers to be held by the Secretary of State, but he will have nothing to back it up.

There is also no protection for the taxpayer from exorbitant and excessive behaviour by the consortia, an issue raised by my hon. Friend the Member for Blyth Valley (Mr Campbell). It is possible that we will see banker-style bonuses and the import of private sector pay into health care. [Interruption.] The Minister moans from a sedentary position, but there is nothing in the Bill to prevent that from happening. The Bill will also leave us, as Members of Parliament, with no voice in the NHS. This Tory-led Government seem to be trying to de-risk this political hot potato, which the Conservatives have never been able to manage properly. However, if Ministers think that the British public will allow them to wash their hands of the NHS without any comeback at the next general election, they should prepare to be shocked.

I would like to say one more thing in the time left—now that the hon. Member for St Ives (Andrew George) is back in his place and given what the hon. Member for Burnley (Gordon Birtwistle) said—about the combined impact assessment. I have received a letter from a GP saying that the practical significance of the Bill will be such that the many MPs who campaigned to save their local hospitals cannot vote for it in all honesty, knowing that in so doing they will be voting for a measure that is purposefully and expressly designed to prevent them from having any say and which will potentially lead to the very outcomes that they so vociferously campaigned against.

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 25th January 2011 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

T9. May I ask the Secretary of State directly about leaked documents seen by The Northern Echo? They show that a £53 million NHS contract to provide health care services to the prison service in the north-east was awarded to a private company, Care UK, even though the NHS provider was marked higher on quality, delivery and risk. Care UK beat the NHS provider only on price. Is this confirmation of the Minister of State’s remarks on Newsnight, that this Bill will create a full market and full competition?

[Mr Lansley]

The hon. Gentleman is asking about arrangements that we have inherited from his Government; they are from before the election and are nothing to do with the White Paper or the Bill. The contract to which he refers was let by the North East Offender Health Commissioning Unit. This was its procurement decision and it states that a competitive, robust and transparent process was followed. This was not a decision taken or influenced by the Department of Health.

Breast Cancer Screening (Young Women)

Grahame Morris Excerpts

Tuesday 30th November 2010 Westminster Hall

[Pat Glass]

I absolutely agree.

Going back to the risk factors—obesity, HRT, oral contraceptives and alcohol—all of them are likely to affect women under 50 more than women over 50, and yet women under 50 are not routinely offered screening of any kind. About 1.5 million women in the UK are screened for breast cancer each year, and we must congratulate those involved in the routine screening programme on the many lives they save. The previous Government extended the screening programme so that from 2012, all women aged 47 to 73 will be invited for routine screening. That extension will save many more lives, but it will do nothing to help identify breast cancer in younger women.

Concerns have been expressed that wider screening could lead to over-diagnosis, but recent research is showing that the benefits of mammographic screening in terms of lives saved are greater than the harm caused by over-diagnosis. Those same arguments about over-diagnosis were used in the past to argue against extending screening for womb cancer and cervical cancer, but the response to those arguments has always been that it is better to be safe than sorry, and that, in the case of breast cancer screening, between two and two and a half lives are saved for every over-diagnosed case. Despite that, however, women under 50 are not currently offered routine screening.

It is also argued that film mammograms are not as effective for pre-menopausal women as for post-menopausal, as the greater density of breast tissue in pre-menopausal women makes it more difficult to detect problems. That is absolutely right. Screening of women under 50 may not be as effective as screening of women over 50, but it can still be effective, certainly in the absence of any other screening programme.

It is also argued that routine screening of women under 50 is not necessary, because the incidence of breast cancer is lower in that age group. I would say, “Tell that to the hundreds or thousands of young women battling this disease”, who say that any arguments about numbers are outweighed by the increased virulence of the disease in the young.

We are told that, because breast cancer is less common in women under 50, research trials have shown that regular screening of young women does not help to save lives. It is even argued that in other trials, regular mammogram screening is more of a risk than not screening. However, I say to the Minister, “Tell that to the young women currently undergoing chemotherapy”.

It is absolutely clear that mammogram screening is most effective among women who have gone through the menopause, but recent research shows that it can also be effective among those aged 35 to 50 and that, despite all the counter-arguments, there is now increasing evidence that there are significant gains to be made by routine screening of women from the age of 35 upwards.

[Grahame M. Morris (Easington) (Lab)]

I compliment my hon. Friend on securing time for this important debate. On routine screening and the value of targeting a particular age group, I, too, have received information from Breakthrough Breast Cancer—an excellent organisation—pointing out that 1,400 lives a year are saved by routine breast screening. However, Breakthrough Breast Cancer also says that any woman aged 70 or over is not routinely invited to attend for breast screening. It may well be advantageous, in terms of improving the health outcomes of those women, if a screening programme targeted them, too, in view of the high incidence of breast cancer among post-menopausal women.

[Pat Glass]

I thank my hon. Friend for that intervention.

I ask the Minister to consider the arguments that have been put forward and the increasing weight of medical evidence calling for routine screening from the age of 35 onwards. In his response, I ask him not to pull out the one argument that the coalition Government seem to have for everything: that there is no money. If we could set aside £9 billion last week to build more trains to make commuting more comfortable, surely we can consider routine screening. If we can find £9 billion to lend to the Irish in their hour of need, surely we can find the money to save young lives.

I understand that the Minister is unable to announce that routine screening for breast cancer will start tomorrow, but he could consider a long-term plan—over five years, for example—to reduce the age of screening to 45 in year one, 42 in year two, 40 in year three, 38 in year four, and to 35 within five years. Such a policy would be universally welcomed and could save precious lives.

I am aware of the Breakthrough Breast Cancer campaign. In particular, it seeks early breast screening for women from the age of 35 where there is a history of breast cancer. We must learn lessons from the highly successful cervical cancer screening programme. Early intervention is cost-effective—it saves the country money in the longer term, and it saves lives.

--- Later in debate ---

[Paul Burstow]

Yes. It is entirely right for the hon. Gentleman to make that point. That is why this Government will publish the first ever NHS outcomes framework, which will focus much more clearly on how we ensure that the system delivers the right outcomes in terms of cancer survival. We will publish that shortly, along with a new cancer reform strategy in due course that will say even more.

The Government’s view at present is that the risks of the change proposed by the hon. Lady outweigh the benefits. However, I want to ensure that the evidence that she has discussed is properly evaluated by officials in the Department. We will consider those points and her representations carefully, and I will write to her after we have had an opportunity to do so. However, the Department’s view and the Government’s view about maintaining the status quo is shared by most countries in Europe, as well as the Council of Europe, which recommends a breast cancer screening age of 50 to 69. The United States recommends screening every two years for women aged between 50 and 74. The position that this country has adopted for a considerable time is based on international practice and the best available evidence. One must be open to changes in evidence; that is important in an evidence-based approach to developing policy.

[Grahame M. Morris]

On best practice and targeting available resources, the figures suggest that in some areas, as many as one third of women within the target group aged 50 to 70 do not attend routine screenings. There are various reasons for that. It might have to do with misconceptions about the nature of the screening test. In some urban areas, it might have to do with the fact that there is a large transient population. In my area, where we also have the problem of people failing to turn up for routine appointments, they may be reluctant or poorly educated, or a number of—

[Mr Clive Betts (in the Chair)]

Order. Interventions are meant to be brief.

[Grahame M. Morris]

I apologise. The Minister will see the point that I am trying to make.

[Paul Burstow]

I understand fully. Today, the Secretary of State will make a statement in the House setting out this Government’s new commitments on public health and the clear lines that we are drawing on tackling health inequalities. Some of the issues clearly involve a social gradient that we must address, and we will address them in our new cancer reform strategy and public health White Paper.