National Health Service Debate
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Paul Burstow
Main Page: Paul Burstow (Liberal Democrat - Sutton and Cheam)Department Debates - View all Paul Burstow's debates with the Department of Health and Social Care
(9 years, 3 months ago)
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Paul Burstow (Sutton and Cheam) (LD)
It was a pleasure to listen to the right hon. Member for Holborn and St Pancras (Frank Dobson). I was particularly struck by the point he made about the important case for investing in our health and care system. I dare say that the note that he mentioned will in due course be published under the 30-year rule, and that we shall then have a chance to read the full text. It must be said, however, that it took nearly four years for the argument he was advancing to be understood and acted on, and that those were lost years during the a 13-year Labour Administration.
Frank Dobson
I should point out that, partly as a result of earlier negotiations, we had secured an increase of £20 billion.
Paul Burstow
I may return to that point later, but first I want to talk about my own experiences of my local national health service, and in particular about a visit that I paid to my local trust, Epsom and St Helier University Hospitals NHS Trust, at the beginning of the month. During the visit I had a chance to meet staff, including A and E staff. I pay tribute to the hard work that is done in the trust, and especially to the work that is done in the A and E department. Last week Epsom and St Helier was placed sixth among all the London trusts in terms of the time for which people were having to wait in A and E, when measured against the standard, and, according to figures that were published yesterday, 99% of people are seen within the standard four hours. That is an example of great performance. The trust is facing great pressure, but it is doing a fantastic job none the less, and that side of the story ought to be told. We ought not to focus only on hospitals that may not have learnt some of the lessons that have been learnt by my local trust.
The A and E staff members whom I met made it clear that there was no single cause of the pressures in their department. In fact, the precise mix of factors varies from one hospital to another, and from one area to another. St Helier, however, has made excellent use of the winter funding it has received. It has added capacity to A and E, and has introduced examples of good practice. For instance, there are daily reviews of patients to ensure they are being given the right treatment in the right place; patients who are ready to be discharged are identified on the previous day so that arrangements can be made in good time; and there is a system of “ward buddies”, enabling corporate staff to provide additional administration support at times of extreme pressure—such as the present time—in order to assist safe discharge. A further welcome boost is the news that an extra £325,000 has been provided to assist people’s safe discharge to their own homes or to step-down care.
A piece of work examining the position in the Sandwell and west Birmingham area revealed huge variations between attendance rates by practice. Its authors found that some people considered A and E attendance to be the norm, and that a fifth of attenders made a conscious decision to go to A and E on the previous day. They also found that many A and E attenders believed that it was not even worth trying to access primary care in the first place. There are issues relating to communication, understanding of the system, and how we explain it. That cannot be dealt with in a universal, national way; it must be tailored to patients’ preferences and their expectations of the system at local level. That piece of work has already helped those in Sandwell to think about how to target messages more effectively in order to ensure that people have access to the support they need at the time they need it.
Sir Oliver Heald (North East Hertfordshire) (Con)
Does my right hon. Friend agree that there should be a proper investigation into winter planning in each area? As he says, factors vary greatly. In my area, for instance, the factors affecting Addenbrookes hospital are very different from those affecting the Lister hospital in Stevenage. I think that planning needs to improve. This year, the same thing happened throughout the country. The A and E departments asked for £700 million, the Government gave it to them, and yet there have been all these problems.
Paul Burstow
I think it important for the system to learn lessons from the areas where winter planning has worked well, and for us to ensure that those lessons are transferred and replicated around the country. The NHS is not always as good as it could be at ensuring that lessons are not just stuck in one place.
James Morris (Halesowen and Rowley Regis) (Con)
Will the right hon. Gentleman give way?
Paul Burstow
I must make some progress if others are to have a chance to speak.
The NHS has grappled with a productivity challenge during the current Parliament, but it should be noted that it was first set up and signed off by the last Administration. The target was £20 billion, and it was to be delivered within a shorter period than the coalition Government set in their 2010 spending review. The Labour productivity programme was set in 2009, and it was clear then that the NHS was on notice that it faced a very tough settlement regardless of which party was in government after the 2010 general election. Reducing management overheads has been a key part of our efforts to balance the books during this Parliament. Focusing on the management overhead costs of the commissioning side of the NHS in the legislation that went through the House at the beginning of the Parliament was sensible, and increasing clinical involvement in commissioning was another important move.
Paul Burstow
I will not, because I want others to have a chance to make their speeches. I hope that the right hon. Gentleman will forgive me.
In fact, that legislation did not change the configuration and organisation of hospitals, although that is how it is routinely portrayed by Opposition Members. As a result of the change to commissioning, £1 billion a year is now being saved, and there are 13,000 more front-line staff in the NHS. Having laid the blame for the pressures on A and E on a reorganisation of the NHS, which is the central proposition advanced by him today, the shadow Secretary of State then tells us that the solution is another comprehensive reorganisation. Is he now suggesting that that is not the case?
Andy Burnham
The right hon. Gentleman clearly was not listening to my speech. The central proposition is that what I described as the “root cause” of the A and E crisis was the imposition of devastating cuts in social care, which are leaving people unsupported in their own homes. Will the right hon. Gentleman now say—because he was there—that it was wrong of him and his colleagues to allow social care to be cut in that way, given that the cuts are now presenting the NHS with an enormous productivity and efficiency problem?
Paul Burstow
The right hon. Gentleman is right to raise that question. I wanted to ask him a question that relates directly to his point, and, indeed, answers it. I hope that he will agree with me—and, indeed, with the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb)—that we need a fundamental review of NHS and care spending, in the round, and that finances in that area need to be addressed before the spending review that any Government will carry out later in the year. We need to ensure that we are clear about the level of investment that will go into our health and social care system. So far, I have heard no clear indication from the right hon. Gentleman of his relative spending priorities when it comes to health and social care, and they need to be made clear if we are to establish a consensus.
Andy Burnham
My answer to the right hon. Gentleman’s question is that I want a single service: a single service for the whole person. I want a national health and care service. We should no longer have two budgets; we should have a single budget, and we should then use the money as best we can to support people, starting in their own homes—and we are going to invest an extra £2.5 billion.
The right hon. Gentleman did not answer the question that I asked him. I asked him whether he and his Government colleagues, in those early days, made a mistake in allowing social care to be cut to the bone? Every week I am accused of saying that it is irresponsible to give real-terms increases. The right hon. Gentleman allowed social care to be raided. Should we not receive an apology for that today?
Paul Burstow
Let me deal quickly with that and then come on to what we need to do next.
As a result of the 2010 spending review, we invested £7.2 billion extra in social care over the life of this Parliament. I regret the fact that not every local authority has fully spent that resource on social care, and although the right hon. Member for Leigh (Andy Burnham)wants to make this an issue of blame I want to try to try to analyse the problem. It has already been said that some local authorities have struggled purposefully to reorganise their services to make the best use of the resources available and have delivered better outcomes, not least by investing in services such as re-ablement, which significantly reduced the call on ongoing care services.
It was right for the Government to put the resources in and make the commitments we did and it was right in the autumn statement this year to commit the £2 billion for the NHS as a down payment to deliver Simon Stevens’ NHS Forward View. Although that is good news, I want to flag up a couple of concerns. First, there needs to be clarity about the funding commitment in every subsequent year during the course of the next Parliament. We have had some indications from the Labour party and some from the Liberal Democrats, but we have not yet had clarity from the Conservatives about how they would address the £8 billion gap.
Secondly, despite the commitment of £7.2 billion for social care during this Parliament, not all that money has got through to social care. I acknowledge the efforts that councils have made already, but we cannot ignore the fact that social care has been a poor relation of the NHS not just during this Government’s lifetime but under successive Administrations of parties of both persuasions over a very long time. I have asked the Secretary of State to ensure that social care benefits from some of this £2 billion and urge him again today to do just that. It is unacceptable that some councils are paying fees for care that condemns staff to rates of pay below the national minimum wage and it is no wonder that as a result we have among the highest staff turnover rates of any part of our economy and that it is so difficult to recruit.
To conclude—although I could go on a little longer—I want to address the comments made by the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson). In a debate that had been about much heat but not a great deal of light, he cast important light on one of the key challenges for whoever is in government after the election, which is how we ensure that we reform our mental health care system to deliver the parity of esteem the Government have set out as an ambition and have started down the road of delivering. We still have a long way to journey, however.
We still have a separation in our health care system between the service that delivers for physical health and the service that delivers for mental health, yet those two things are inextricably linked. We know that half of lifelong mental health problems start in adolescence and need to be addressed at that point. The goal of parity of esteem, which is shared across the House, is right. We need parity of esteem in outcomes, rights and resources and I welcome the investments made by the Government, the commitment to continue the improving access to the psychological therapies programme that was started by the previous Government and has continued under this one, the launch under this Government of a children and young people’s IAPT programme and the emergency care concordat. I thank the Minister of State, who is on the Front Bench today, for launching the children and adolescent mental health services review, which must provide a route map for reforming CAMHS for whoever sits in the Secretary of State’s office after the general election. If it does not, it will have failed in its task. We need a plan and we need that plan to be implemented through the spending review after the general election.
The debate has highlighted yet again that we are yet to reach consensus in this Chamber on how to improve our NHS. There are people of passion and commitment on both sides of the House who have in their heart and at their core a desire to maintain a national health service that is free at the point of use and available on the basis of need. We need to extend that to ensure that our social care system is no longer left behind in the way it has been by successive Governments.
Dr Huppert
The hon. Gentleman can intervene if he wants to talk about why PFI is a great thing, but otherwise I will move on.
The Government have been too slow to move to the new formula, which properly takes account of ageing populations. We know that the elderly cost more in terms of health care. Cambridgeshire receives £961 per head, whereas West Norfolk, for example, receives £1,255. That is a huge difference. I asked for extra money during the debate that I mentioned, and I am delighted that we have managed to secure an extra £20 million as a result of the recent allocation. That will provide much more funding for mental health, on top of the extra £1.5 million that has been provided this year and the extra £2.2 million that will be provided for IAPT—improving access to psychological therapies—next year. That will make a big difference, and will reverse some of the challenges that we face.
We need that extra cash, but we still need more in Cambridgeshire and throughout the country. Simon Stevens called for an extra £8 billion by 2020, after savings and efficiencies had been taken into account. He said that an extra £8 billion, in real terms, was needed if the NHS was to keep going. I think that that is important, and we as a party think that it is the right thing to do. One of the problems with the motion is that it does not deliver what Simon Stevens has said is needed for the NHS. I am not all that keen to support the provision of less than a third of what is needed to keep the NHS going, especially after hearing from the shadow Secretary of State that, despite what the motion says, the money is not all for the NHS but constitutes the entire offer for the NHS and social care, which also needs its own funding. We need that £8 billion.
I voted against the Health and Social Care Act 2012 as I did not agree with much of it. There are some issues, such as parity of esteem, that are very good and that I hope will never be repealed. I also disagree, however, with many of the things that the Labour party did to bring in the private sector in some damaging ways, with people being paid for things that never happened.
The fact is, as was mentioned by the hon. Member for Brighton, Pavilion (Caroline Lucas), under the previous Government medical spending on private provision went from £1.1 billion a year in 1997 to £7.5 billion in 2009-10. That is a vast increase. I have no problem with people who say that they support that and that it was the right thing to do, but to suggest that that large increase was excellent for the NHS while the fact that it has continued at essentially the same rate under this Government is a disaster for the NHS strikes me as a rather bizarre claim.
I have criticisms of this Government, the previous Government and the one before that. I want the NHS to spend more of its time focusing on patients or, even better, avoiding the need for people to be patients in the first place. That needs a trained, motivated and well-paid staff—I think they should get the money from the independent review. It needs a focus on prevention and public health and proper funding—that is, the £8 billion by 2020.
Paul Burstow
On that point, does my hon. Friend agree that the better care fund, which is now being launched in April, is a key way in which we can deliver the joined-up care that he is talking about and that we need to have an ambition that by 2018 all CCG budgets, primary care budgets and social care budgets are in that pot?
Dr Huppert
My right hon. Friend is right, of course, and I pay tribute to him for the work he has done on this and on many other health measures. We must ensure that that integration happens so things work together and that is why token amounts such as a couple of billion pounds from the Conservatives, who need to go a lot further, and the £2.5 billion across health and social care from Labour—and by the way, please correct me if I am wrong, but according to The Guardian that is from 2017 onwards —will not go far enough. We need integration through the better care fund and we need that £8 billion. That is the proper funding that is needed.
Finally, we in this House ought to have a proper debate about how to fix problems and cut back on the amount of partisan bickering that happens in this place. That does not do us proud. We are all prone to it, including me. It is much better to talk about what we can do to promote health, whether it is physical or mental.