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.

Alert me about debates like this

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health, Liberal Democrat Spokesperson (Health) 12:32, 4 July 2007

I thank the Secretary of State for the advance copy of his statement. As an aside, the new Government, under the new Prime Minister, have said that they want to strengthen Parliament. May I suggest that providing copies of statements a little earlier than traditionally happens would be a sensible reform? That would mean that there could be a much more informed debate, rather than Members trying to come up with an intelligent response in the 35 minutes before the statement is made. I would be grateful if that could be considered.

The statement is surely something of an admission of failure, given that after 10 years of the Government's stewardship of the NHS, they are still searching a strategic direction. It comes after the Cabinet Office's review of the Department, which was pretty scathing about the leadership offered and the lack of strategic direction. Nevertheless, I give it a cautious welcome, provided that the Government are prepared to examine fundamentally the serious weaknesses in their stewardship of the NHS, primarily the far too great centralisation of the way in which the service is run. I welcome the fact that consideration will be given to a constitution, because that approach seems entirely sensible.

I am worried that it appears that the process will be entirely led by clinicians and health professionals. Will it involve patient representatives, other groups with a direct interest and the public? I appreciate that the public will be consulted, but will only clinicians and health professionals make all the decisions and recommendations?

There are some fundamental weaknesses regarding the four areas that the review will examine. I was amazed that no reference was made to health inequalities and fairness. I raised that point during yesterday's debate. Health inequalities have increased under the Government in recent years, not reduced, despite the Government target on cutting such inequalities. Will the Secretary of State reassure me that even though there was no reference to health inequalities in the statement or the terms of reference, the review will examine them as a central issue?

The proposals are pretty thin on the question of productivity. More and more people tell me that despite the enormous record investment, which we supported, money could be used much more effectively to achieve outcomes for patients who need help. Will there be a central look at how to improve productivity in the NHS?

There has been a series of contradictory reforms over the past 10 years. Structural changes have subsequently been reversed, so I welcome the fact that there will be no more such changes. However, will the review address something that the former Secretary of State recognised in a speech that she made just before she stood down: the local democratic deficit in the NHS? She said that there was a need to strengthen local accountability. Yesterday, the Prime Minister said that he would look to devolve power genuinely. How seriously will the review address providing genuine democratic accountability locally in the NHS?

The Secretary of State said that existing problems needed addressing, but he referred to only one: hospital-acquired infections. He said that he would commit additional resources to tackling that problem, but how much extra will he provide for the strategy? Will this not be, again, too much of a top-down approach, and will it sufficiently engage staff? The Department was supposed to be producing a guidance note on the use of antibiotics, which is critical to tackling hospital-acquired infections, but so far that has not appeared.

Finally, a number of existing problems need to be addressed, especially regarding out-of-hours care and access to NHS dentistry. Will the review examine those problems, too?