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NHS Resources

I am grateful for that intervention. Of course, I shall come to that issue, because the prevention of health care acquired infections is terribly important. The Government are doing something about that problem, as opposed to the situation with other preventive measures. One thing that they are doing involves the better care, better value indicators, which originally identified 10 general practitioner and hospital practices through which we could save the country about £2 billion a year if best practices were followed for all of them. I should very much like to know the progress of those indicators. I think that a second wave has been launched, but they have come out so quietly that I do not know about them. I hope that primary care trusts and the people who should know about them do. I should like an update on that. Last week, in the Select Committee on Health’s public hearing on the operating framework for the NHS in England, we asked the Secretary of State about efficiency savings. His answer was rather negative. He said that the savings would come from the "back office", from better procurement and from better use of the NHS estate, but he then went on to list a lot of negatives. He said that savings would not come from patient care—""not getting rid of staff, not restricting drugs, not expanding waiting times"" and not including""important developments in patient care."" He left a lot to the imagination about what we could do. The last Government measure that I shall touch on briefly is quality, which is absolutely essential. It saves money, not least by avoiding complaints and litigation. As I have said before, there are four Cs for quality, the first of which is care, which means safety and using evidence-based, up-to-date treatments. The second is compassion, which does not need any explanation. The third is continuity of care, which is threatened by the European working time directive, and the fourth is communication, which includes communication between doctors and patients, doctors and nurses, and doctors and other doctors. Communication is cut down by stress and overwork. The importance and potential cost of quality has been emphasised today by the Healthcare Commission’s report on the Mid Staffordshire NHS Foundation Trust disasters. The questions that were posed and answered today, following the Secretary of State’s statement, showed that there is much more to be found out. To me, the main message was that Monitor, which decides on foundation trust status, must surely take more note of quality of care, as it currently makes decisions based on finance and good governance. The standardised mortality ratio in Stafford was known in 2007, but that trust acquired foundation status in February 2008. There has to be much more evidence about quality. Let me make some suggestions about what we ought to be doing. We should, as my hon. Friend the Member for Castle Point (Bob Spink) has said, spend more on prevention, which is far cheaper than treatment. The first example of where work can be done on prevention is with health care associated infections. To give the Government their due, they have made that a tier 1 priority for the Care Quality Commission’s inspections, so that is of paramount importance. The figure put on that saving is £75 million. I am sure that the Minister will know, as I have mentioned it in his presence before, that I am absolutely desperate that the prevention of venous thromboembolism in hospitalised patients is given the same sort of priority as the prevention of health care acquired infections. When the Health Committee inquired into the prevention of venous thromboembolism in 2005, we learned that there were about 25,000 preventable deaths a year—at least a lot of them were preventable—and that coping with that problem would save about £640 million a year. That is far more than could be saved by preventing health care associated infections, but it is not a priority. The relevant risk assessment, which is so essential, costs nothing, and the treatment cost is peanuts. This issue was mentioned in the report on what happened in Stafford. I have not read every word of that enormous report yet, but I have found that it blamed some of the deaths on the lack of risk assessment and the occurrence of venous thromboembolism. I hope that that might push the idea that risk assessment has to be mandatory and must be assessed by the CQC. Stillbirths and neo-natal deaths could also be prevented. The Stillbirth and Neonatal Death Society charity has drawn attention to the fact that there are 17 stillbirths or neo-natal deaths a day, which is about 6,500 a year, many of which could be prevented if research were done into the factors required to prevent them. The savings in litigation alone would be enormous. Prevention of HIV is another issue. There are huge treatment costs, and the numbers are increasing. The National AIDS Trust tells us that 7,800 people are newly diagnosed each year in this country, and that there are estimated to be more than 80,000 people with HIV, a quarter of whom do not know that they have it. The trust has made several recommendations as to what the Government should do, including giving support to teachers so that they can talk confidently in sex and relationship education. Other recommendations are training all health care professionals in primary and relevant secondary care specialties on HIV testing, introducing financial incentives for GPs in relation to HIV testing and pilot home sampling for HIV on the NHS. I do not think that the Minister will be surprised if I talk about NHS pathways yet again, because I have mentioned the subject to him many times. The programme is preventive in that, with the correct use of triage, it can prevent people from going to the wrong place. Just last week, I had a letter from a constituent saying that she turned up at one place that was not right, she was sent to another place that was not right and, because it was late at night, she had to be admitted to hospital for the night. That wasted a vast amount of money. If NHS pathways had been in place, I wonder if the problems at Stafford might have been eased. We know that the accident and emergency department there was clogged with minor problems because the report states that instead of concentrating on the severely ill, staff were diverted to deal with some of the minor problems and get them out of the way to meet the targets. NHS pathways would have prevented those minor cases being there at all, because the people concerned would have gone to the appropriate place. After the recent announcement that NHS pathways had been passed for use by ambulance trusts, I met the director of NHS pathways and the director of operations of NHS Direct. I appeal to the Minister to promote co-operation between those two triage systems so that we can work towards the same triage system throughout the country as a whole, which would make a huge difference. There are two other matters that have occurred to me literally in the past couple of days. The paediatric incontinence forum is worried that it will be pressurised into using the cheapest single-use catheters, but that could be a false economy because they are not as good at preventing infections. There is also a risk that financial stringencies mean that nurse specialists, who are the absolute experts in assessing the use of the right appliance, could be cut down. Nurse specialists will not necessarily choose the cheapest appliance, but in the long term, the cheapest is probably not the best. The Health Committee has done a lot of work on the issue of smoking and in the recent "Health Inequalities" report we point out that smuggled cigarettes and hand-rolled tobacco are the smoking materials of quite a high proportion of 16 to 24-year-olds, and a much higher proportion of the least well-off. I learned today that there is an answer to tobacco smuggling that is almost too good to be true because it would put precisely 1p on the cost of a packet and there would be no other costs at all. The proposal is a security solution, about which I will give the Minister details after the debate so that his officials can look into it. SICPA Security Solutions has a track-and-trace system that is already in use in several countries. The system allows smuggled cigarettes to be tracked and traced, which would surely cut down the amount of smuggled cigarettes fairly quickly. Her Majesty’s Revenue and Customs focuses on detection, but the idea I have mentioned focuses on prevention, which is far better. I have spoken for a number of minutes without mentioning prioritisation or the dreaded word "rationing", because there is much to be done before we fall back on to rationing. At last, I have found an excellent definition of rationing in health care settings in a 2007 paper from the primary care trust network and the NHS Confederation. The paper is entitled "Priorities Setting: An Overview" and is by Dr. Daphne Austin, who is a public health consultant and an adviser to the Health Committee. She defines rationing as:""a consequence of priority setting. A patient can experience rationing in many ways, including being denied access to a treatment or service, experiencing a delay or poor quality services which impact on the clinical outcome. It is advisable not to use the term ‘rationing’ as a verb; to do so is to imply that rationing is an optional activity. All positive decisions to fund are inextricably linked with a rationing consequence somewhere in the system."" I will leave the Minister with that and the fact that in a resource-limited situation, for every decision to fund something extra, something else falls off the bottom of the ladder. We must avoid getting to that stage by making the NHS as efficient and waste free as we possibly can.