My Lords, NHS spending has increased in real terms by £5 billion over this Parliament, underlining the priority the Government place on the NHS. NHS England’s Five Year Forward View set out a range of future scenarios. While NHS funding beyond 2015-16 will be a matter for the next spending review, the Government believe that changes in the way that services are delivered are essential, both to moderate rapid increases in demand and to improve efficiency.
My Lords, I first declare an interest as president of the Society of Chiropodists and Podiatrists, a small trade union professional association that has members working in the health service.
Is the noble Earl aware of the concerns of the BMA and others that the recent changes to NHS structures, particularly funding structures, actually risk worsening health inequalities? What will the noble Earl do to ensure that that does not come to fruition?
My Lords, tackling health inequalities is one of the major tasks facing NHS England. It is built not only into its mandate but into legislation, and we expect NHS England to address it at every level—both in the acute area and in the community. It is of course up to local commissioners to prioritise their funding, but we expect to see over the next few years a shift from care in the acute sector to care in the community, both to prevent acute admissions and to ensure that people stay healthy for longer in their own homes.
My Lords, the 2004 GP contract, which was introduced by the party opposite, forced GPs to come off on-call rotas at night and at weekends, thus removing them from out-of-hours services. The impact of this on our emergency departments has been quite dramatic. Will my noble friend confirm that the introduction of the Better Care Fund will go a long way not only to integrate these services between primary and secondary care but to remove pressure on our A&E services in the acute sector?
I agree with my noble friend that the primary purpose of the Better Care Fund is clearly to make care better, but it is also a major step forward in making our health and care services more sustainable, and moving to a preventive model that delivers care closer to home and keeps people healthy in the community. GPs have a major part to play in this and I am encouraged by the extent to which they are now engaging in the task of addressing the BCF.
Will the noble Earl correct the inadvertent misleading of the House by the last noble Lord who spoke? The obligation for doctors to serve at weekends and in the evenings was not removed in 2004 but many years before—as it happens, under the Conservative Government. What happened in 2004 was that although they were not serving at weekends or in the evenings, as had been allowed by the previous Conservative Government, doctors were spending an increasing amount of time on the bureaucracy of finding a replacement doctor. That bureaucratic burden was what was removed from them. Will he confirm that that was the case, not for the first time but for the second time, because I asked him last year and he confirmed that by 2004 almost 90% of doctors had already opted out of night work and weekend work?
The noble Lord has huge experience in this area and his outline is of course right, in that before 2004 we had largely a system of co-operatives in which GPs could elect to work out of hours if they wished. The 2004 contract gave individual GPs and GP practices the option not to do that. While there was no obligation to move away from out-of-hours care, many GPs have chosen to do that.
My Lords, as it is nearly Christmas I have not given the Minister the advantage of seeing the question beforehand, but with his dexterity in answering I am sure that he will answer it straight. Can he predict which party, elected into government next May, will keep the NHS free at the point of need?
My Lords, the NHS five-year review clearly highlighted that there was a need to upgrade preventive and public health services. Can my noble friend the Minister say how this will be done, particularly when you go back to the 2011 WHO agreement on 25 goals, under which 25% of deaths have to be reduced by 2025?
My noble friend is right to highlight the role of public health. That is why many people are encouraged that health and well-being boards, which now oversee the planning and prioritisation of healthcare in their local areas, are taking those public health goals into account and building them into the strategic health assessments. So the co-ordination of healthcare and public health is in a much better position than it was before the reforms.
My Lords, the Minister referred to the Better Care Fund. How does he respond to the criticisms made by the National Audit Office in the last few days? It said that the programme had poor management and hugely unrealistic expectations, and that it was not going to reduce emergency admissions. Can the Minister explain why the NAO concluded that the programme had no national leadership, limited risk analysis and no analysis of local planning capability?
My Lords, that report is somewhat out of date. Plans have now been through the nationally consistent assurance review. The results have been published and shared with local areas, which have stated some clear ambitions. They are to have 163,000 fewer stays in A&E, to make £532 million savings for health and care services, and to have 101,000 fewer unnecessary delays spent in hospitals, along with other goals besides. We are very satisfied with progress reached in producing the Better Care Fund plans. Not all plans have been approved, but we are well on course.