---

NHS Expenditure (Reduction)

I am delighted to see the Minister in his place. I do not mean to imply that not all Ministers have his qualities, but I know that he is a receptive and thinking Minister. I am grateful that he will respond to my suggestions, which are intended to be helpful to the future of the national health service, which we all know is vital to our constituents and beloved by the large proportion of staff who work in it and the patients who receive treatment. The extra money that has been provided has seen dramatic improvements, especially in cancer care, cardiac care and the increasing scope and success of the various treatments that are now available. A crisis therefore looms. The NHS Confederation estimates funding cuts of £8 billion to £10 billion in the next two or three years, and £15 billion in the next five years. The King's Fund has produced a useful document, "Windmill 2009: NHS response to the financial storm", which opens with the words:""The health service is about to enter a new era. After years of unprecedented growth, it faces the prospect of unprecedented austerity."" I want to talk about ways of addressing that challenge without widespread cuts. A high proportion of NHS expenditure is on staff, so if there are cuts, they are likely to be in the number of staff, which would not be helpful as the numbers in some areas are already inadequate. By lucky coincidence, my medical colleague on the Health Committee, the hon. Member for Dartford (Dr. Stoate), started this debate on Friday last week, and I believe that the Minister responded to it. The hon. Gentleman made the point that it is estimated that increasing self-care of patients with minor ailments could save the NHS £2 billion. I was joining the train at Kidderminster station at about the time when the ban on smoking in public places came in, and a member of staff who had drawn the short straw and was sweeping up the fag ends outside said, "We might be able to change policies, but it's a job to change people." That was extraordinarily perspicacious at that time, and it is absolutely true that it is extremely difficult to change people. We can easily write new policies, but we must change people and how they use the NHS. The hon. Member for Dartford quoted the Proprietary Association of Great Britain, which has described five clear steps to ensure that self-care increases. Following on from that, a discussion paper that I found extremely useful was produced by the National Endowment for Science, Technology and the Arts. It is headed, "The Human Factor", has a sub-heading, "How transforming healthcare to involve the public can save money and save lives". It was drawn to my attention recently, and was written by Laura Bunt and Michael Harris, and published by The Lab and NESTA. In this short debate, I can only point the Minister to that discussion paper, and give a brief flavour of it. The authors considered long-term conditions in particular, and how to change the way people cope with such conditions by educating them. I am thinking particularly of diabetics who, if they know how to control their disease, need much less help. The paper recommends a mixture of redesigning care with user involvement and more effective prevention. User involvement is crucial, and the NHS constitution has picked that up. One public responsibility on patients from the NHS constitution is this:""You should recognise that you can make a significant contribution to your own and your family's good health and well-being and take some personal responsibility for it"." If NESTA's suggestions were taken up and led to a 10 per cent. reduction in the cost of treating long-term conditions, that could save £6.9 billion a year, which is not to be sneezed at. I cannot resist giving one of my favourite quotations. I do not know whether you have read Sir Walter Scott recently, Mr. Jones—I have only just rediscovered him—but one of his last novels was "The Surgeon's Daughter". He was writing about the burgesses of a Scottish borough and said:""There the mothers of the state never make a point of pouring, in the course of every revolving year, a certain quantity of doctor's stuff through the bowels of their beloved children. Every old woman…can prescribe a dose of salts, or spread a plaster; and it is only when a fever or a palsy renders matters serious, that the assistance of the doctor is invoked"" What a lesson for all of us. Has the national health service limited people's ability to look after themselves and spoiled them with the help that they receive. We must change that so that they have the help of medical and nursing staff—the clinicians—only when they really need it.