NHS: Reform — House of Lords, 2015-07-16
Topic: Health
Philip Alexander Hunt (Labour, Centre-left): My Lords, I thank the Minister for his Statement. The Opposition support much of what he had to say. I will focus my remarks on the plan for seven-day working and then touch on a number of the other issues that he raised Ensuring our health services are there for everyone whenever they are needed, be it a weekday or a weekend, is essential to keeping people well and making the NHS sustainable. Of course the Opposition support the principle of what the Government are trying to achieve with seven-day working, and we will certainly work with them on making that possible. Where I urge some caution is in the manner in which the Government are attempting to achieve those changes The Minister will be aware that the NHS is in a rather fragile state at the moment. A&E performance has been very disappointing in the face of enormous pressures. He will know that primary care services are overwhelmed. We discussed in Oral Questions the failure of some ambulance services to meet their performance targets. We talked particularly about the London Ambulance Service. There is a shortage of staff and an overreliance on agency workers and undoubtedly patients are suffering as a result—on this Government’s watch. Staff are feeling pretty demoralised and rather unloved by the Government. It is important that the way the Government approach seven-day working does not make matters worse I am entirely unclear as to how seven-day working is to be achieved without significantly impacting the rest of the NHS. The real danger here, given the way the NHS will approach this kind of target, is that more staff will be produced at the weekend by cutting staff during the week. The Minister will be aware of the study published in Health Economics, which concluded: "There is as yet no clear evidence that 7-day services will reduce weekend deaths or can be achieved without increasing weekday deaths" Clearly, it would be an absolute nonsense if we reduced weekend deaths but the price was an increase in weekday deaths The Government have produced no facts or evidence for the assertions they are making. If we are to take this seriously, we need to know a bit more about how the resources challenge and the current acute shortages in many staffing areas are going to be met—bearing in mind that the Government are cracking down on the use of agency workers; the ludicrous 2012 Immigration Rules, which mean that nursing staff who are not earning £35,000 a year after six years will be sent back to their country of origin; and the serious issue of staff morale The Minister mentioned the 2003 contract but will he confirm that the contract negotiated then was actually very largely based on the one negotiated by the previous Conservative Government in the 1990s? How does he think the Government intend to work in partnership with NHS staff to make those changes? The briefing from his department—phrases such as "declaring war on NHS staff"—does not seem to have got this policy off to the right start. The kind of provocative statements that are currently emanating from his department, no doubt under the authority of the Secretary of State, do nothing to create the conditions in which people in the NHS will actually want to work with the Government on developing these policies I also want to mention the impact of another five years of, in effect, real-terms pay cuts. What impact does the Minister think the Chancellor’s announcement on pay will have on future staff numbers and retention? I want to raise one issue with him, which is the subject of a statutory instrument in your Lordships’ House. If the pay of NHS staff is to be held down, how can he justify the 12% increase in fees by the HCPC, one of the key staff regulators for the healthcare profession? Will he withdraw this regulation? Does he not agree that it is absolutely disgraceful that staff are being asked to pay more money by what essentially is a government-owned quango when their own pay is being held down? It is utterly unacceptable Can the Minister tell me how this is going to be funded? Either the staff are going to be thinned out during the week or extra staff will have to be found. It is not just consultants and nursing staff; it has to be the whole infrastructure to make this work, including community services and primary services, and there will be a knock-on impact on social care costs. How is this going to be paid for? If he says that the Government are giving £8 billion to the health service overall, he knows that is dishonest. We know that that will probably be paid in 2021, according to the Treasury briefing. We also know that £30 billion per annum will be needed by then. Nobody I know in the health service thinks that it has any chance at all of closing that gap because the kind of efficiency saving required has never been achieved in this or any other health service. The excellent report on efficiencies by the noble Lord, Lord Carter, in itself will produce only £5 billion by 2017-18 On whistleblowing, I welcome the Freedom to Speak Up report, which contained a number of important recommendations to foster a more open culture. The Minister will know that in recent years there have been a number of other examples of appalling care in social care settings, including Orchard View, Oban House and, of course, Winterbourne View. Many of those scandals were exposed only once undercover reporters infiltrated the care home. Of course, we welcome the action the Government are taking, but does the Minister agree with the point I have made to him previously: that if the Government really want an open culture in which people can raise their concerns, that has to apply right up the line, meaning that the leaders of NHS organisations can speak openly about their own concerns about the direction of policy and the actions of Ministers? He will know that at the moment those people are slapped down if they make any criticism at all of the Government. You will not get an open culture until everyone in the system feels that they can be open. At the moment they cannot We support the steps in the Kirkup report to improve the regulation of midwives but if the Government are so concerned about modernising regulation, why have we not had the Law Commission Bill containing a comprehensive approach to the modernisation of health regulation for individual professionals? Why are we carrying on with this antiquated approach and these wretched Section 60 orders, which cause a lot more expense and delay in the Minister’s department? Why has the new speeded-up system of dealing with regulation, for regulators such as the Nursing and Midwifery Council, been held up for many months now? Of course, one of the reasons why it has had to increase its fees is that the Government will not agree to this legislation coming before Parliament to streamline its proposals It is pretty disgraceful that the Rose report, which was mentioned, was not published alongside the Statement. Why are we having to wait until after this Statement to look at it? The noble Lord knows that Ministers received it months ago. What is in the report that they do not want the public to see On the merger of Monitor and the NHS Trust Development Authority, I welcome the appointment of Mr Ed Smith, who is a high-calibre chair. He is also pro-chancellor of Birmingham University, which is a very strong recommendation. I also like the name "NHS Improvement". But how many staff in Monitor and the NHS Trust Development Authority have any concept of improvement, given their current record of bullying, hectoring and intimidating the agencies they are responsible for? Can I assume that there is going to be a drastic change of personnel in that combined organisation? Will the Minister confirm that no one employed in that organisation will earn more money than the Prime Minister, given that the Government have chosen to attack NHS chief executives in relation to their salaries? Will he also confirm that they will not use agency staff? Does he not find it rather ironic that Monitor, in order to instruct NHS bodies not to use agency staff, has employed temporary staff? What is sauce for the goose is sauce for the gander There is a dangerous gap between the kind of fantasy land that Ministers talk about in the health service and the reality of life on the ground. On the ground, people are struggling every day to meet the pressures with limited money and no support from the Government. The health service is in real danger of falling over. The Government should stop blaming the NHS and take responsibility.