By Jonathan Isaby
Last month Andrew Lansley wrote exclusively for ConHome here about the Government's Health and Social Care Bill.
The Bill had its Second Reading in the Commons yesterday, during which new Oldham East and Saddleworth MP Debbie Abrahams gave her maiden speech and David Miliband gave his first full speech as a backbencher since losing the Labour leadership.
But here a snapshot of the contributions from the Conservative backbenches.
"During the lifetime of this Parliament the national health service faces a genuinely unprecedented challenge, first articulated not by my right hon. Friend the Secretary of State in the present Government, but by the chief executive of the health service before the general election in May 2009, when he drew attention to the fact that demand for health care should be expected to continue to rise at roughly 4% per annum, as it has done throughout the recent history of the national health service. However, because of the budget deficit situation, we will not see the health budget continue to rise to absorb that rise in demand, in the way it has done over the past decade.
"Therefore, during the lifetime of this Parliament, we will have to see, in the national health service, a 4% efficiency gain four years running-something that not merely our health care system, but no other health care system in the world, has ever delivered. The Select Committee has referred to that as the Nicholson challenge, reflecting the fact that it was first articulated by the chief executive and endorsed by the previous Government. Again, this is a case of a shared agenda across the House of Commons.
"Given the Budget deficit, the only way we can continue to meet the demand for high-quality health care, which we all want to see, is by delivering an unprecedented efficiency gain in the NHS for four years running. That is why I support the Bill. I support it because to my mind it is inconceivable that we can deliver such an efficiency gain without delivering more effectively than we have done yet on the ideas, which have been endorsed over the past 20 years, about greater clinical engagement in NHS commissioning, which I have been talking about. Commissioning cannot be successful if it is something that is done to doctors by managers; it must engage the whole clinical community. We must address the democratic deficit, because we cannot bring change on the scale that we need to deliver the efficiency gain without engaging local communities."
Boston and Skegness MP Mark Simmonds listed ten things that he felt could be improved in the health service:
"Listening to some Labour Members, one would think that there were no improvements to be made-that the national health service was a utopian structure prior to the last general election. Let me point to 10 things that I sketched out this morning: too much money spent on administration and bureaucracy and not enough on front-line patient care; too little patient-centric information to inform decision making; too little innovation; too little clinical input into decision making; too much inertia and hostility to reform, as we have seen today; too much process-driven target culture distorting clinical decision making; falling productivity; poor outcomes across a range of clinical indicators; too often, weak commissioning of servicing; and widening health inequalities in the past 10 years, in addition to the scandals that occurred in Staffordshire and Kent. That is hardly a situation that makes the status quo desirable."
"A lot of health care professionals will be saying, as I did earlier, that far too often, medicine and health care have been reduced to a tick-box exercise, with targets and top-down bureaucracy getting in the way of patient care. Under the A and E targets delivered by the previous Government, equal priority was given to treating a patient with a broken toe as someone with potentially life-threatening chest pain. That cannot possibly be right. Putting doctors, nurses and other health care professionals in charge of making health care decisions will mean that clinical priorities and better patient care can be delivered."
"In those 62 years [since the NHS was established], drug research and development have advanced hugely. Medical technologies have advanced in a way that could not even have been imagined 62 years ago. As a result of the internet and the information now available, patients expect and demand to have a say in how their condition is managed. They want more information and they want to discuss their care with their GPs. The Bill will put the patient right at the heart of the NHS, and that is why I so passionately support it. The central tenet of the Bill is: "No decision about me without me". It will ensure that, for the first time, each and every patient can almost become their own lobbyist, sitting in front of their GP and discussing their condition and treatment in an open way, where they have information and the GP will have to engage with them. That does not happen today, and certainly not in hospitals."
Truro and Falmouth MP Sarah Newton talked about the importance of devolving decision-making:
"I realise that not everyone will want to become involved in local decision-making and that many are happy to leave it to others, but I believe that we are right to enable more resilient and empowered communities to shape their own futures. Giving more power to the people is as important in the context of decisions about health and well-being as it is in the context of decisions about planning, homes and the environment.
"The Bill is nothing short of a revolution in terms of the devolution of decision-making power to people in their communities, accountability, and the governance of health and care services… It links two crucial services. For too long the separation of those services, and the silo mentality governing the care delivered by local authorities and health services commissioned by primary care trusts, have prevented care pathways from being developed effectively in a way that works for the patient, which has often closed off the vital role played by families, carers and volunteers in supporting people. There cannot be a Member in the House who has not had personal experience of that, or shared the experiences of elderly constituents who have been bundled around the system, described as bed-blockers and made to feel a burden.
"Of course, in some parts of the country health and care services have been integrated, but they are in the minority. The Bill, and the money that the Government are making available to help fund the integration, will enable all parts of the country to develop the high-quality, joined-up services that are currently available only to a few.
"I think that GPs are interested in taking on commissioning and the proposed changes. Three consortia in Leicestershire and Rutland have stepped forward so far. My primary care trust is working extremely closely with them, particularly on transferring community services, and I welcome their close working relationships. The GPs commissioning arrangements will mean that GPs listen to what patients want. GPs will be responsible for community services in Leicestershire and Rutland, including the walk-in centre in the middle of Loughborough and out-of-hours services, which have not been mentioned in the debate. One of the things that patients feel most passionately about is the fact that some GPs, particularly in the part of the country I represent-I cannot speak for everywhere-are not responsible for delivering out-of-hours services. What patients say to me more than anything else is that when they call someone in the middle of the night, they want their GP or someone who has access to their records to answer the telephone, not a call centre."
Finally, two MPs with connections to the NHS had concerns they wanted to air.
"I understand that under the new GP commissioning process, GP consortia will, in effect, be given control of two budgets: the budget for clinical services and a small budget to cover the management costs of taking over the commissioning process. I also understand that they will not be permitted to transfer unspent funds from the management budget to the clinical budget. If my understanding is correct, I urge the Minister to reconsider that restriction. In giving the consortia a budget for management that cannot be transferred to the clinical budget, there is no incentive for them to drive down their back-office costs.
"For the process to work most efficiently, GP consortia must have an incentive to drive down their back-office costs in the knowledge that it will allow them to spend more on their patients. To do otherwise gives the incentive to use up the management budget regardless of need-to hire that extra secretary, not because there is a need, but because the budget is there to do so. Such unfortunate incentives from central Governments over the years have led to many productivity problems throughout the public sector and to a use-it-or-lose-it culture. I urge the Minister to look again at that restriction, which seems to go against the new culture of efficiency and responsibility for budgets that we are trying to instil across the public sector."
"GPs and PCTs throughout Devon are rolling up their sleeves and getting on with the job in hand, but to deliver the undoubted benefits of integrated care, they need to be able to work closely with colleagues in hospital, as well as with people in the community, to design those logical pathways. As I just mentioned, the Secretary of State has reassured me on the question of price versus quality competition, but it would help to spell out explicitly in the Bill that that will be protected.
"Professionals are understandably scared, and I hope the Minister will make the position absolutely clear in his winding-up speech. Commissioners will not feel liberated if they are liberated from the Secretary of State but shackled to Monitor. Fundamental to the outcome of the reforms will be the powers of Monitor. I should like those powers to be carefully constrained in the Bill, so that it does not take on an unintended role. Focusing on quality and not on cost would help to bring all the professionals back into thinking that this is a positive step forward, because that remains a concern."
The Bill was given a Second Reading by 321 votes to 235, with all Tories and Lib Dems in the lobbies voting in favour; it was opposed by Labour and MPs from the DUP, SDLP, Plaid Cymru and the Green Party.