Management of the National Health Service

Part of Opposition Day — [15th Allotted Day] – in the House of Commons at 6:35 pm on 9 May 2006.

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Photo of Nicholas Soames Nicholas Soames Conservative, Mid Sussex 6:35, 9 May 2006

I begin by saying how fascinated I was by the speech of my right hon. Friend Mr. Dorrell, and how right I think he is in his remarks about the nurses. I deeply regret the way the nurses treated the Secretary of State. It was a mistake on their part. It was clearly organised, and it was a foolish demonstration. I agree with Dr. Stoate that nurses are far better paid than they were, and so they should be. That manifestation was not about pay at all. It was about the constant rate of change in the health service, which is proving so destabilising and bringing such great uncertainty not only to those who work in the health service, but in the long term to patients.

In speaking to the motion, I commence with the words of the magnificent Jeff Randall, one of our foremost economic correspondents, who remarked in his column the other day that it takes a very special, not to say a unique, genius to triple state expenditure on the NHS in 10 years to £96 billion, while simultaneously creating a financial crisis of such severity that perfectly good hospitals are closing, wards are having to be shut down and services cut, thousands of highly trained nurses are losing their jobs and there are few jobs for newly qualified doctors.

In the south-east of England a health care crisis is developing throughout the region, and dealing with it will be extremely difficult. The Chancellor made a colossal error by announcing massive increases in public expenditure on health without demanding substantial productivity gains and further reforms. A very great deal of taxpayers' money has been wasted and is about to be so again, and there is a substantial managerial failure which lies at the door of the Department of Health. It is not a failure, by and large, at local level.

Let us start where credit is due. The NHS needed more money spent on it. There has been a broad improvement in a substantial range of services and the right hon. Lady is to some extent right to feel that the press, as always, concentrates too much on the reporting of people's negative experiences. All of us Members of Parliament know that serious complaints are made, but on the whole my postbag is filled not with complaints, but with letters from people saying how well they were treated and how grateful they are to the doctors and nurses for their skill and care.

However, much too much money is being wasted in the health service. For example, after seven years of wasted planning time, St. Mary's hospital, Paddington decided not to replace its Victorian buildings with a new hospital, by which time the trust had spent £14 million on consultants' fees. That is not acceptable, and there are many such examples.

There is a mixed picture, and in respect of my own constituency I shall say something about the Princess Royal hospital and the Brighton and Sussex University Hospitals NHS Trust. I have raised these matters on the Floor of the House on a number of occasions and at a series of meetings with Ministers, and I do not want to go over old ground. As I have said before, the trust is £21.3 million in debt, with no possibility, in my judgement, of paying it off in the time scale required. A similar point was made earlier.

I warned the Government at the time the trust was created what would inevitably happen when the two hospitals were merged. The position now is that a turnaround team has reviewed the situation with the trust managers and it is my firm conviction that, unless the debt is dealt with in a sensible manner—we must leave headroom and time to support a full recovery process—the trust inevitably will have to make substantial cuts in services, close wards and reduce vital services for local people. That cannot be what the Government want and it is certainly not what my constituents want. It would be a disaster locally and would, I am afraid, further damage my constituents' confidence; already bruised following the "best care, best place" consultation.

I appeal to the Minister to accept that the trust is struggling with long-term financial burdens; they are not its fault and are, frankly, beyond resolution. The Government should not reward poor financial stewardship, but where such a situation exists—as it does with this trust and many others in the country— alongside a genuine commitment from the management and capacity to reform and increase transparency, the Secretary of State should act in a sympathetic and understanding manner.

I want to speak briefly about the future of the NHS. The national health service employs 1.3 million people. In Surrey and Sussex alone—my part of the world—the budget is £2.8 billion and the NHS employs more than 50,000 people. On any one day, 4,500 people will be occupying a hospital bed and 1,100 will be admitted to hospital, of whom 720 will return home that day. About 2,350 people will attend an accident and emergency department on any one day in Surrey and Sussex, of whom about 560 will be admitted.

The local Surrey and Sussex health economy is now in great difficulty, from which it will be difficult to extricate itself. It is not possible any longer to run an organisation of this size as it is, and I believe that change is required, particularly around the issue of accountability at all levels. I applaud the work that the Government are carrying out to try to get that done, but I firmly believe that we need significant devolution of responsibility, autonomy and accountability at the local level and that it will be possible and equitable only if managers and clinicians are able together to set local strategies, targets and service delivery. They should be agreed by the strategic health authority, monitored according to that agreement and set within the SHA's financial framework, aligned to the strategy of the Government of the day.

The NHS will never work efficiently and truly effectively until empowerment and ownership of services and service delivery are an absolutely integral part of the success of achievement. At present, many of the clinicians to whom I speak are, as my right hon. Friend the Member for Charnwood argued so effectively, feeling disillusioned and disconnected from the process and restrained. Managers who, given their heads, could do a much better job, feel disempowered and are unable to take initiatives that they know to be right. Only in genuine partnership will clinicians and managers be able to deliver the sort of dynamic service that is really responsive to the needs of patients. We need that to happen now and the Secretary of State needs to do more to encourage it and to make it happen.

It has always been my experience in public life that pay is not the only driver for those who work in the NHS or elsewhere in the public services. Job satisfaction, improving patient outcomes, applying new and valuable initiatives and good systems changes, alongside feeling valued and respected, are just as important. Ethos matters very much to most public servants. There are some outstanding managers in the NHS, but there are also too many inadequate ones who are recycled from job to job. The good ones need to be nurtured and developed. Initiative, and particularly risk taking, needs to be encouraged and managed.

I have a suggestion for the Minister, which he is at liberty to use. I believe that the Government should set up a staff college, based on the services model, to which all managers marked out for further and higher command above a certain level in the NHS have to attend. Such a course could be run at business schools throughout the country to ensure that only the very best managers go on to the most important jobs. As in any other business, the leadership or senior management is absolutely crucial to the success of the enterprise. The NHS should be no different, so my right hon. and hon. Friends are right to be critical of the Secretary of State in that respect.

In the last five years, the NHS budget has increased by 40 per cent. in real terms, while output has increased by less than half that. In its doctors and nurses, the NHS has one of the most committed work forces in the country, yet management has significantly failed to motivate and engage those dedicated professionals towards a common goal of increased productivity.