---

NHS Expenditure (Reduction)

I thank the right hon. Gentleman, who made many points in a short time. I cannot hope to address them all. On stability, I absolutely agree. I do not believe that anyone will try to reorganise the health service crucially in the near future, for which we will all be grateful. Prevention is a huge subject, and I am afraid that I am taking that as read, because it is obvious that spending more money on prevention saves money in the long term. The huge problem is moving money out of acute care into prevention, but I am sure that the Minister will be well aware of that. I have spoken about patients and the public, and what they should be doing to improve how they look after themselves. Now, I want to speak about the staff. I am the first to praise staff for their tremendous hard work, but we must be realistic and ensure that they realise the problems afoot. I remind the Minister of the NHS Confederation's paper, "Dealing with the downturn", which was published in June 2009. It is useful because it lists first many bad ideas from history that do not work. If waiting lists are allowed to grow, quality is diluted. Indiscriminate cuts in expenditure can focus on cost rather than on value, and pay could get out of line, training might be cut or we could fail to protect curative services. Those measures have all been tried and have failed. They are doubtful things such as centralising support functions, mergers, structural change or reducing staff. The document contains a useful quote about price competition, which states that""this does not fit with patient choice. The risk is that providers can exploit this to obtain increases in prices – particularly when they have a monopoly. It can also lead to 'a race to the bottom' which reduces price and quality."" I believe that that has been one of the reasons behind the poor quality of out-of-hours care in some places. Let me move on to the more positive points in this document. There are several pages of suggestions of ways to do things differently in order to improve how services work and improve patient safety and quality of care. Some of those things will save money, such as the productive ward, which I am sure the Minister knows all about. I have seen that initiative in several hospitals that I have visited, and it is a scheme whereby all staff, from health care workers to the sister to the cleaners, get together on a regular basis and talk about how they are doing things. That can lead to obvious alterations, such as moving all the things that are necessary to set up an intravenous drip to one place, so that staff do not have to dash from place to place picking things up. That leads to improvements in ways of feeding patients, and can reduce wastage of time over meals. It can lead to nurses doing the nursing rather than lots of admin, so that they can spend more time with the patient. The document mentions the difficult matter of treatment prohibitions. However, as the National Institute for Health and Clinical Excellence has told us, relatively few treatments in use have no proof of effectiveness, so we cannot save billions of pounds by cutting out useless treatments. There is a mention of limiting the NHS package, which in my language is health care rationing. However, as is pointed out, that would require public debate and it would be difficult to sell to the public unless all other ways of saving had been exhausted. Productive wards are an initiative from the NHS Institute for Innovation and Improvement, which sadly seems to have rather a low profile. That organisation was responsible for the better care, better value indicators, the first tranche of which came out several years ago, and I believe that there have been further tranches. The indicators compare the performance of the NHS with the performance figures for the top 25 per cent. regarding that treatment or method of carrying out a service. The productive opportunity from those indicators is, I am told, £3 billion—something worth looking for. The King's Fund "Windmill" report makes specific recommendations for the Department of Health, regulators, strategic health authorities, commissioners and providers, and there are two interesting appendices. Appendix B apparently fell off the back of a lorry; it is a leaked Department of Health memo with a long list of possibilities for the emergency strategy committee to consider. That is encouraging as it shows that people at the Department of Health are using their brains and getting their staff to work on those sorts of things. Appendix C is a useful classified summary of the various approaches taken to reducing costs, improving efficiency and perhaps increasing income. In addition to the papers from the King's Fund, NESTA and the NHS Confederation, I have had a host of letters over the past few days from organisations making suggestions. Action on Smoking and Health—ASH—points out the cost-effectiveness of measures taken to reduce smoking, which can be highly effective. The Royal College of Nursing mentions the huge benefits and cost savings from community nurses, particularly specialist nurses, who can save a vast amount of time and money. There were suggestions for isolated drug economies, and suggestions from the Alzheimer's Society. I will return to my initial point: we must first change people by making them more informed and responsible for their own health care, not only for minor ailments but for long-term conditions. We must then change the workings of the NHS and give staff at all levels the chance to suggest innovation and better ways of working. I am conscious that I have not spoken much about prevention; there is no time for that, although it is a crucial matter. I conclude with something that Disraeli said towards the end of his first spell as leader of the country:""There can be no economy where there is no efficiency"."