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NHS: Budget

Volume 719: debated on Wednesday 23 June 2010


Asked By

To ask Her Majesty’s Government what assessment they have made of economies available within the National Health Service’s budget.

My Lords, the Government have guaranteed that health spending will increase in real terms in each year of the Parliament. However, it is clear that funding growth will be constrained and, in order to meet rapidly rising demands and to realise our ambitions for improved health outcomes, substantial improvements in economy and efficiency will be required across all areas of health spending. Full plans for delivering these improvements will be developed during the spending review.

My Lords, recognising the relationship between transparency and the economic use of resources, will the Government consider amending the National Health Service pharmaceutical regulations to require manufacturers of prescribed products and appliances to indicate on the label of the packaging the tariff price of a generic product or the manufacturer’s list price of a branded product? Can he refer this whole matter to the transparency unit that his Government have set up?

My Lords, on an instinctive level, I completely understand the noble Lord’s concerns and I can tell him that the department has looked very carefully at this whole issue. The worry, based on research, is that labelling medicines with prices has a much more complex impact on patients’ attitudes towards their medicines than one might expect. A high or a low price on a medicine could lead to a patient doing the opposite of what one wants in terms of taking medication appropriately. Therefore, I am afraid that we have reached the conclusion that this is not something that should be pursued at the moment.

Does the Minister accept that for some years the National Health Service has been beset by the activities of an intolerable quangocracy? In fact, no fewer than 50 organisations have the right to inspect and assess the performance of health service bodies. In their proposed bonfire of the quangos, will the Government look first at whether it is necessary to continue with the mechanism of looking over the activities of the individual regulatory authorities? Is it necessary to continue with that supervisory body or with, for example, the National Clinical Assessment Authority? Have not these two bodies probably outlived their usefulness?

My Lords, I am very much in tune with the noble Lord’s general theme. As I said in the House last week, it has to make sense for us to look at each and every arm’s-length body. We need to consider what it does and what it was designed to do, decide how critical those functions are and how well they are fulfilled and then decide whether we can achieve better value for money by doing things differently. I do not want to promise the noble Lord a bonfire, as I have not yet taken any decisions, but I assure him that I will be rigorous in my approach to this whole exercise.

My Lords, as a former chairman of a hospital trust, I know that when staff are consulted about the way in which savings can be made they come up with very constructive ideas. Could not the cumulative effect of many hospitals seeking the comments and advice of their staff lead to considerable savings and improved efficiency in running the hospitals?

My noble friend makes an extremely good point. Much of the thrust of what we are trying to do is to achieve much greater local ownership by clinicians, staff and managers of the problems that we can all identify. The ideas that my noble friend has put forward already operate in many trusts, but they should be imposed more widely.

My Lords, in his review will the Minister encourage his ministerial colleagues to enhance the coalition Government’s reputation for taking tough decisions by looking seriously at the number of acute hospitals that are failing financially and are unsustainable, especially in London? Is he willing to market-test the provider side of PCTs, which the Department of Health has identified as inefficient?

My Lords, the noble Lord, with his knowledge of London, speaks with great authority and he will know that reconfiguration is high on the agenda in London. Efficiencies can be created, but we want to see local buy-in to those changes rather than any top-down prescription. On his second point, we are keen on the split between the commissioning and the provision of community services, so that we can get greater plurality of provision in community services.

My Lords, have the Government yet managed to conduct an assessment of the NHS IT budget? If so, what conclusions have they reached?

My Lords, I declare an interest in that the Church of England is a provider of sessional chaplains in the National Health Service. Given the importance of chaplains to the well-being and recovery of patients and given the value of their work with staff, especially those under stress, will the Minister encourage NHS trust hospitals to resist reducing those services?

My Lords, as I hope was apparent from our debate in the House the other day, the Government attach great importance to chaplaincy in the NHS. The kind of encouragement that the right reverend Prelate speaks of is something that I will consider. I need to be sure in my mind of how best to do that, but his point is well made and I will take it back to the department to see what we can do.

My Lords, will the noble Earl assure the House that in looking for economies in the health service—I am sure that there are opportunities to do that—he will safeguard the vanguard policy of the last Government, which is fortunately retained by this Government, to ensure that patients’ experience comes first and foremost? Would he also perhaps take an idea from me to look at how we deal with patients who do not attend—DNAs, as we call them—despite having had prior notice? Failure to attend is costly and inefficient for the health service.

The noble Baroness is quite right that patients who do not attend their appointments cost the NHS a great deal. How do we deal with the issue—I am sure that the previous Government wrestled with it, too—if we are to avoid charging patients for failing to turn up? I would resist the idea of charging because I do not think that it is a road down which we should be going in secondary or primary care. However, the ways in which we can encourage patients to turn up on time should attract greater focus in our efforts towards achieving efficiency.

My Lords, will the Minister assure us that trained nurses, physiotherapists and occupational therapists will not be replaced by cheaper care assistants?

My Lords, to ensure that the quality of NHS services continues to improve in a climate of constrained growth, we must achieve greater productivity, but that means designing services for better quality and value for money. It does not mean downgrading the quality of the services. It is for local NHS bodies to decide how services can best be delivered most efficiently. I would be very surprised if that kind of dilution of expertise formed a part of any such plans.

Would it not be quite wrong for the Department of Health to prejudge what the transparency unit might say on the price labelling of prescribed products?

My Lords, I do not think that we have prejudged it because extensive work has already been done in the department. It found that if, for example, a medicine has a high price attached to it, people might be deterred from taking it because of their fear of being a burden on the NHS. Equally, if a medicine has a low price put on it, someone might wrongly perceive that the lower price was linked to lower quality. That is based on research. It is not simply civil servants reacting to an idea; there is a lot of work behind it.