NHS Next Stage Review

Part of Oral Answers to Questions — Prime Minister – in the House of Commons at 12:32 pm on 4 July 2007.

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Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health 12:32, 4 July 2007

I thank the Secretary of State for advance notice of his statement. But is that it? The NHS an immediate priority for the Prime Minister? And what is the immediate priority? An 11-month review. If the Secretary of State really thinks we shall leave him alone for a year while he finds out what is going on in the NHS, he has another think coming.

It is 4 July today: I thought that it would be NHS independence day, but it did not turn out to be. I was disappointed by what I heard, and—notwithstanding a letter from the Secretary of State—NHS staff, along with the public, will be disappointed.

For a start, we need to know what on earth is going on. A fortnight ago, the NHS chief executive said in his report:

"in the autumn we will set out a clear, strategic direction for the NHS going forward".

That report is now so much chip paper. The Secretary of State has started with the same self-congratulatory material as we got from his predecessor. He cited the Commonwealth Fund report. I hope that he has read it; yesterday, this incoming Secretary of State did not seem to have read much.

The Commonwealth Fund report compares Britain with only one other European country. On page 9, it says that the UK is worst on hospital-acquired infections; contrary to the Secretary of State's self-congratulatory statement, levels of C. difficile have not been stemmed, but are continuing to rise. On page 15, the report places the UK worst on access to out-of-hours GP services and worst for waiting times. On page 21, it states that the UK has the highest mortality rates after adjusting for factors unrelated to health care— [Interruption.]

Perhaps the Minister of State, Department of Health, Mr. Bradshaw has read it, if the Secretary of State has not. He says that the UK comes out best overall. Does he know why? The report puts into the equation what it regards as an efficiency measure, which it calculates on the basis of how much is spent. It adjusts the whole table on the basis of the fact that we spend less in the United Kingdom than Germany, Canada, Australia or New Zealand. Spending less is the main reason why the Secretary of State and his Ministers think that UK health care is best.

The only thing that the Secretary of State seems genuinely to have understood is that morale in the NHS is at rock bottom. In a recent Health Service Journal survey, NHS staff were asked whether morale was good or poor: 4 per cent. said that it was good, 0 per cent. said that it was excellent and 66 per cent. said that morale was poor or very poor. What on earth have we heard in the Secretary of State's statement that would change any of that? We know what has to happen. We have published a White Paper that sets out direction and leadership. If the Secretary of State would only look at that, he would find things that clearly need to be done.

First, the core principles of the NHS need to be entrenched in statute. We are prepared to do that; apparently, the Secretary of State's predecessors were prepared to as well, although with the exception of the principle that public funds for health care should be devoted solely to NHS patients. We subscribe to that principle. Will the Secretary of State now say that he will do the same?

Secondly, we need no more pointless organisational upheaval. My right hon. Friend Mr. Cameron has been saying that for a year, and finally Ministers have accepted it, so we can put that one down. Thirdly, the Government need to set the resources and objectives, but not to interfere in the day-to-day decisions of the national health service. In a recent poll, 67 per cent. of NHS staff and 71 per cent. of the public agreed with that proposition. Where is that today? If there were such an acknowledgement by the Secretary of State, he would scrap targets immediately.

Fourthly, we need to take decisions close to patients. I am astonished that the incoming Secretary of State said nothing today about the centrality of the family doctor service and primary care, having a primary care-led service and strengthening commissioning. Fifthly, we need independent regulation of health care providers; even his predecessor acknowledged that we needed independent regulation. We need not a review but legislation in the next parliamentary Session to achieve those things.

I have mentioned five long-term reforms, of which the Secretary of State has acknowledged only one. The NHS desperately needs leadership and direction. Reform in the NHS is confused and incoherent, and on its own admission, the Department of Health has no vision of where the NHS is going. We set out a blueprint. Come on, Secretary of State, steal our clothes! We need to show the NHS that politicians can work together for the long term to give it the framework that it really needs. Only if there is that long-term framework can we deal with the real challenges of demography, technology, productivity and improving public health outcomes.

The Secretary of State said that he was dealing with immediate issues, but he mentioned only one, with something that should have been done years ago. Will he abolish the top-down centralised targets that stop NHS professionals doing their jobs and distort clinical priorities? Will he make the allocation of NHS resources fair and independent? We have asked for that, the Health Committee has asked for it, and two weeks ago his predecessor said that she thought it was the right thing to do.

Will the Secretary of State stop major service reconfigurations? He is apparently going to put a brake on them and use the independent reconfiguration panel. When he goes to his new colleague, Sir Ara Darzi, and mentions that he is going to do that, Sir Ara Darzi will be amused, because in Hartlepool he was used by Ministers to bring forward proposals on reconfiguration, which were promptly overturned by the independent reconfiguration panel. That is not much of a recommendation for the policy-making skills of Sir Ara Darzi.

Will the Secretary of State tell the House how it can be right, in terms of clinical need and patient care, for accident and emergency departments in Surrey and Sussex that treat up to 300,000 people to be shut down, while in Bishop Auckland hospital in Durham, which serves the former Prime Minister's constituency, an accident and emergency department that treats 125,000 people is apparently absolutely fine?

Will the Secretary of State create additional training posts and assure well-qualified UK-based junior doctors that they will have an opportunity for specialty training? How can an incoming Secretary of State for Health not recognise that the crisis in junior doctor training is an immediate issue to be tackled? If the Secretary of State is so keen on a review, will he today initiate the independent review that we have called for on NHS IT—one that really listens to the people working in the NHS?

Five long-term reforms are required. There are five urgent issues. What have we got? Two. Two out of 10: those are the Secretary of State's marks so far. We would give the NHS the priority that it really needs by taking the action required. Where is the immediate priority that the Prime Minister promised? Where is the autonomy and accountability that the NHS is calling out for? Where is the leadership and the direction that the NHS so badly needs? The NHS is there for us. Why will not the Government trust NHS staff to deliver?