Future of the NHS Debate

20th July 2017

Philip Dunne responds to a an Adjournment debate on the future of the NHS.

It is a great pleasure to join you in the House for the last debate before the summer break, Mr Deputy Speaker.

I congratulate my hon. Friend the Member for South Dorset (Richard Drax) on securing this debate and commend his timing, as it is two days after we laid the Department of Health and NHS entities’ 2017 accounts before Parliament. He will note from what I am sure will be his diligent scrutiny of those accounts that provider deficits have been much reduced in the year that has just ended compared with the figure he cited for the previous year. That is a tribute to the focus of managers and trust leaders on securing the financial balance that the NHS as a whole has delivered over the past year.

To put all that in context, this is a time when more people than ever are using the health service. In 2016-17, some 23.4 million people attended A&E departments in England—2.9 million more than in 2010. The overwhelming majority of patients continue to be seen within four hours, and the NHS overall sees more than 1,800 more patients within the four-hour standard every day compared with 2010. In the previous year, the NHS carried out 11.6 million operations—some 1.9 million more than in 2010. That provides the context of the achievement and the treatments that have been given to patients throughout the land.

I am pleased that my hon. Friend recognised the excellent care that the NHS provides, which has been demonstrated for the second year running by the Commonwealth Fund report: in its international study published last week, the UK was ranked as the No. 1 health system in a comparison of 11 countries. That is a testament to NHS staff. The patients who benefit from those treatments rate their experience of care highly. The adult in-patient survey, which was released in May, shows that the majority of patients report that their overall experience was good, with 85% rating it as at least seven out of 10—a slight improvement on the previous year.

Looking to the future, which is the subject of the debate, the Government are committed to increasing the NHS budget to ensure that patients get the high-quality care they need. By 2020-21, NHS spending will increase by £8 billion in real terms from the 2015-16 baseline. That will deliver an increase in real funding per head of the population for every year of this Parliament. Nevertheless, my hon. Friend is right to point out that whatever funding we provide, it is important that we spend it to achieve the best possible outcomes for patients.

It is essential that we ensure that the NHS continues to make the most effective use of its resources to deliver high-quality patient care, so I recognise what I think was my hon. Friend’s motivation in securing this debate and raising this subject before the House rises for the summer recess. We all agree that it is important to target NHS funding to frontline services, which is why we are investing in the workforce and there are already more than 33,800 extra clinical staff, including almost 11,700 more doctors and almost 13,000 more nurses on our wards since May 2010.

NHS management is an important element of ensuring an efficient NHS, but of course we are keen to ensure that an increasing proportion of NHS funding goes to patient-facing services. Between 2010-11 and 2016-17, the proportion of the NHS pay bill spent on managers declined from 6.5% to 5.8%, which I am sure my hon. Friend will welcome. We are also reducing the number of people involved in management, which he called for. Between May 2010 and March 2017, the number of managers and senior managers in NHS providers and support organisations reduced from some 37,000 to around 31,000—I think that is similar to the effective percentage to which my hon. Friend referred. We are also looking to manage the rate of pay of senior managers, again to ensure that as much as possible is focused on the frontline.

It is important that we recognise that leadership is as important in the NHS as it is in any organisation—we must ensure that we have high-quality leadership across organisations. I for one am keen not to bash the managers in a somewhat traditional manner, but to recognise that high-quality leadership in our NHS organisations is important in driving high-quality performance for patients. That is why I have been working with the leadership academy in Health Education England to ensure that we have two things: a pipeline of talent so that we can identify quality individuals at the beginning of their careers in the NHS and track them as they pursue their careers, identifying the leaders of tomorrow, in a similar system to that with which my hon. Friend will be familiar from his service in the military; and some consideration of how we can get more clinicians involved in leadership roles in their organisations. Clearly, we have directors of nursing and medical directors in all provider trusts, but too few go on to take up the most senior leadership positions as chief executives.

I am listening carefully to the Minister. Would it be naive to say that what we want to see is matron, in the form of Hattie Jacques, back on the wards and to hand far more administrative work, if that is the right phrase, back to clinicians, with whom it originally lay?

I am not keen to hand administrative work to clinicians, but I recognise that there is a role for ensuring that senior clinicians are present and in charge of activity in wards. That is the experience I am seeing as I visit acute hospitals around the country: senior members of staff, normally coming out of nursing staff —so they are a matron or other senior nursing officer—are responsible for what happens on their ward.

My hon. Friend says that an independent review might be appropriate, and I say gently to him that we think that the right way to drive improvement across the NHS and help position it for the challenges of the future is to back the plans prepared by the leadership of NHS England with colleagues from across the system through the five year forward view. This is the NHS’s own plan for change and it lays out how the NHS can transform services and improve standards of care while building a more responsive modern health service. We are backing this plan, enabling the NHS to deliver Government objectives including seven-day services and improved access to cancer treatments and mental health services. We agree that the answer to the challenges faced by the NHS lies in modernising services and keeping people well and independent for longer.

The NHS is using the sustainability and transformation partnerships mentioned by my hon. Friend to deliver that vision through transformation across local areas. These are clinically led, locally driven and can deliver real improvements for patients. The five year forward view also announced the development of new care models and we are already seeing the results.

My hon. Friend referred to the announcement yesterday about the first allocation of capital funding for the most advanced STP areas, including Dorset, which covers his constituency. It is fortuitous that the largest single beneficiary of capital through the STP allocation was Dorset, and what a great day for him to secure this debate and give an albeit somewhat guarded welcome to that significant capital injection. I am aware that he has a number of issues with how that money will be spent.

It was totally unguarded. I am extremely grateful, as I am sure all clinicians and all those who work in the NHS in Dorset will be.

That applause is on the record, and I am delighted that my hon. Friend takes that view.

We see this investment as backing the exemplar STP plans that have been published thus far, and we hope that other areas, whose plans are in less good shape, will be encouraged to look at those that have succeeded to see what they can do to follow their example for the next phase of the roll out in the coming years.

I will conclude with a couple of comments about how we drive efficiency through the NHS and make best use of resources. My hon. Friend referred to the Carter and the Naylor reviews. Carter is driving heavily towards using best practice and removing variability across the NHS, whether in clinical practice or in financial performance, in areas such as procurement. Alongside that, Naylor is looking at how we drive out inefficiency from back-office functions, from estates and from the facilities management element of running such a substantial network of hospitals and facilities across the country. There is scope to do more. That will appeal to my hon. Friend’s desire to put more resources on the frontline. We are looking at encouraging organisations to share back-office facilities—as he called for—to bring down cost and drive up efficiency and operational productivity, which is the right way to go.

I conclude by confirming that we are making good progress in small steps. We need to continue to make progress to try to raise the depth of the tread of the steps that we are taking to ensure that the NHS is fit to serve the health needs of this population for the future.

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