Education and Health

Part of Oral Answers to Questions — Prime Minister – in the House of Commons at 5:46 pm on 2nd June 2010.

Alert me about debates like this

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood 5:46 pm, 2nd June 2010

I listened with interest to the speech by Ed Balls. His case appears to be that the previous Government did no wrong and, in particular, that their economic policy represented global leadership and error-free judgments. If that is the basis on which he seeks the leadership of his party, I can only say that I wish him well.

I warmly congratulate my right hon. Friend Michael Gove, the new Secretary of State, on his appointment and on the way in which he spoke of the things that we have in common within the parties supporting the coalition Government and of the programme that the coalition Government have set before Parliament and the country, particularly on the reform of public services. There is obviously no doubt about the principal domestic challenge that faces the coalition: the fact that the deficit that we inherited from the previous Government is unsustainable and must be reduced. That is a matter not simply of accountancy but of creating the stability that is necessary to allow the process of wealth creation to be reignited and, particularly for the purposes of this debate, to provide the stability that is necessary if we are to secure our common objective of delivering high-quality public services. That is the core challenge facing the new Government.

A second challenge of equal importance to the country and to this House is the securing of our common objectives for the delivery of public services. That is a major opportunity for the coalition, because it represents a failure of our predecessors to deliver our constituents' objectives in health and education. It is also an opportunity for the coalition, as my right hon. Friend made clear in his speech, because within the coalition we share a commitment to a more localised and less bureaucratic approach that accords significantly greater respect to the professional people who work in those services.

I want in particular to talk about how those ideas are applied to the national health service. Let me begin with a brief piece of history. June 1990, exactly 20 years ago, was the month in which the purchaser-provider split was first legislated and brought into action in the health service. At that time, the introduction of accountability to purchasers was seen as an important means of driving accountability and quality into the health service, eliminating unaccountable practice variation and improving value for money.

The Select Committee on Health in the previous Parliament conducted an audit and progress review of where we had got to in achieving the objectives that were originally set out for the purchaser-provider process, which is now called commissioning. That report makes depressing reading. In today's health service, commissioning is seen as over-bureaucratic and as too much of a box-ticking process. The power still lies with the provider, and worst of all, the process is seen as excessively expensive and certainly not delivering the objectives that were originally set out for it 20 years ago. The Select Committee report poses the question whether we should therefore give up on the principle of commissioning and, by implication, although it does not say this, go back to a tradition of central planning. I hope that that is an entirely rhetorical question, and I am pleased to say that I believe my right hon. Friend the new Secretary of State for Health thinks so.

To give up on the principle of commissioning would be to give up on the requirement to set priorities and make resources follow those priorities, and on the principle of accountability. In short, it would be to give up on the ideals on which the health service was originally founded. I am pleased that the Queen's Speech makes it clear that the coalition and both parties within it are committed to following through the logic of empowered commissioning and to making the idea work and be successful.

I offer my right hon. Friend four thoughts on how to deliver that objective, all of which are in the coalition agreement. The first way is through greater local engagement, including with general practitioners, and the involvement of elected members in primary care trusts. That is needed so that local communities understand what is being done on their behalf. Secondly, we need greater engagement by the professions so that commissioning in the health service is not something that is done to professional people by managers but something that engages the professionals themselves in securing the objectives that we as lay people, and even more importantly the professionals themselves, have for the health service.

The third objective is that commissioning needs to be outcome-focused, so that we justify what we do in the health service through improved outcomes experienced by patients. Fourthly, there is an idea that the previous Government canvassed on but never followed through. We need to look for opportunities to bring external support into the commissioning process rather than imagine that we have the capacity in the NHS on an entirely home-grown basis. We need to bring in outside expertise from both within this country and overseas.

There is no party divide in the House about the principles on which the health service was founded. The Labour Government increased the resources available to the health service on an unprecedented scale, but they never followed through in a sustained way with the discipline required to deliver value for money and high-quality health care in return for those resources. That opportunity is open to the coalition-to maintain the resources available to the health service, as it is committed to do, but to add the commitment to deliver the results that, both as taxpayers and as patients, our constituents want the service to deliver.