Health Secretary Andrew Lansley answered questions from the public – including health care professionals – as part of a series of interviews with him on BBC Radio 4’s PM programme. The topics included patient choice, rare diseases, competition, GP commissioning and the morale of the NHS workforce.
Here we present a selection of the questions and answers.
- Patient choice
- Rare diseases
- Primary care trusts
- GP commissioning
- Provision of regional services
- Cancer care
- NHS staff morale
- Cost of reorganisations
- Private health companies
Question: I’m interested in your thoughts about improving health outcomes and offering patient choice for patients with complex or palliative needs who have the choice of having their care delivered at home but unfortunately this is not always possible due to local health and social care resources.
Andrew Lansley: Firstly: we are going to make it clear that the NHS and local authorities and their social care responsibilities will work much more closely together, and that’s set out in the Health and Social Care Bill, including a specific duty to make that happen and we have provided resources directly to tie them together. Secondly: I asked Tom Hughes-Hallett, who is the Chief Executive of Marie Curie Cancer Care, to lead a review looking at how we can deliver improving end-of-life and palliative care. And I hope that will enable us to deliver much more responsive care, because we know there are many people who die in hospital when they would prefer to die at home or in a hospice.
Question: How will you ensure that difficult and rare diseases like Motor Neurone Disease will be managed in the new NHS, when a GP will only ever see one or two people with MND in their career?
Andrew Lansley: I met the Motor Neurone Disease Association this morning and a number of both MND patients and those who look after them. And they said to me that primary care trust commissioning for their services has not worked.
I’m not looking for individual GPs to be commissioning for these kind of complex neurological conditions. I am expecting, and the GPs themselves would expect, that their commissioning consortia would either be of a sufficient scale to do it or, perhaps even more particularly, come together in a broader network in order to commission.
The same is true for cancer and a range of other complex conditions, sometimes reasonably rare – it does need to be brought together at a larger population, and we can now put those commissioning arrangements in place. And what I think is really interesting is how it’s an opportunity for some of the voluntary sector to really put themselves forward. So, the neurological charities like Motor Neurone Disease Association, Parkinson’s Disease, and the MS Society have come together to form a commissioning support organisation and I think that’s a real opportunity for us.
Primary care trusts
Question: Why are PCTs being abolished? The functions they perform will need to be carried out by someone, and doctors won’t want to do this as they’re not trained for it.
Andrew Lansley: The functions need to be performed but, essentially, they are going to be distributed to better places to be performed better. The GPs getting together in groups will provide the clinical leadership to design services better and then commission local and regional health services better for their patients; because the public health responsibilities will go to local authorities and we will involve local authorities more in providing democratic legitimacy for the decisions that are made about health services locally, whereas the PCTs had no democratic legitimacy. And some of those responsibilities will go to the National Commissioning Board because, actually, they are better done at a national level rather than a particularly local level.
Question: Will GP consortia be able to refuse to take patients who would require expensive treatment.
Andrew Lansley: No, they won’t. They will have a responsibility for the whole of the population in their area.
Question: I’m a speech and language therapist. I work with children who are not ill, I often see them in school. Will a GP consortia be interested in the service I provide? If so, will they commission me to provide for the children in their own consortium, or the children at the schools in their consortium? How do I and the children fit in to these reforms?
Andrew Lansley: Yes, they will be responsible for commissioning these services and I’m sure they will do so, and they will be responsible for the schools in their area and commissioning for the care for those children who are resident in their area.
Michael Gove and I met the representatives of the charities involved in communications difficulties. One of the things I encouraged them to do was for those charities to come together – they know that commissioning in the past has been poor – to show how they can do commissioning better to support them.
Question: As a GP, how can I support my very good local hospital if a private provider offers an alternative, cheaper service? Surely, Monitor will enforce European competition laws?
Andrew Lansley: No. The competition law simply means that if your hospital and another hospital want to provide a service, they’re able to provide a service. As an individual GP or as an individual patient, you will be able choose where you want to go or refer where you want your patients to go.
Question: In the unfortunate event that you required major surgery, how would you feel about the operation being performed by the lowest bidder?
Andrew Lansley: No, it will not be like that, we are absolutely clear: we are setting out to have competition on quality. The GP consortia have a responsibility and an incentive to get the best possible care for their patients. They will look for competition, yes, but it will be competition on quality, and where, actually, the best way to deliver quality is through collaboration and integration they can do that too.
Provisional of regional services
Question (Dr Chris Hammond Consultant Interventional Radiologist in Leeds): My question relates to the provision of regional and super-regional services such as trauma networks, cancer networks and highly specialised services such as my own, interventional radiology. These services can’t be provided effectively by single Trusts in isolation and require Trusts to co-operate, not compete. And how will that be achieved in the framework of competition that you’ve outlined?
Andrew Lansley: It will be achieved, firstly, by continuing to commission services that require to be done nationally; the highly specialised services will be commissioned by the NHS Commissioning Board. But also, I’ve made it very clear, we’re going to support cancer networks, and as I said earlier in relation to the Motor Neurone Disease Association, I am very keen that the commissioning consortia work together in order to commission at the right level. For cancer, very often, it is best to commission for about 1 million to 1.5 million patients. It doesn’t mean we have to abandon the benefits of local GP groups leading their local commissioning in order for them to be able to come together at a sensible population in order to correspond to how hospital trusts across their region should be working in order to deliver the best service.
Dr Chris Hammond: I think the National Commissioning only works for a very small set of specialities such as transplant surgery and so on. I’m talking about rather more regional and super regional services that are commissioned more locally. Our experience with trying to implement regional commissioning for these, is that it’s been very, very difficult to do that because Trusts have their own patches that they’re largely trying to protect because of the competition and marketplace economics that have been introduced. It makes it very difficult at a regional level when you’re actually trying to make these organisations work, to actually get that co-operation.
Andrew Lansley: It has been difficult in the past to achieve the thing I’m describing. That’s why I’m rather hopeful that the new arrangement will make it easier to do that in the future because the GP commissioning groups will recognise the benefit of themselves coming together in order to commission at a level that corresponds to what they’re looking for. But I will say this: you talk about competition, but actually if what they want is for the hospitals and the community services, the specialists, to be working together in order to provide them a service for their patients, that’s the service they can commission.
They’re not required to divide the hospital trusts up so, for example, if you’ve got a specific network of hospitals that are best placed to deliver a specialised cancer service, then they can commission for that service and there’s nothing to stop them doing that.
Question: Cancer treatment in the United States allows direct access to a specialist so that if cancer is suspected a patient can go directly to the oncologist. The oncologist will have all the tests completed, many of which are carried out in the office of the oncologist, and treatment will start in the office within three days of the first phone call.
A patient suspecting cancer has to get a referral to the specialist through the GP, losing very valuable time. In view of the very poor cancer survival rates in the UK compared with most other countries, is this really the way we should be moving?
Andrew Lansley:: I’m not proposing that we encourage people simply to self-refer themselves into specialist cancer services, because in America that’s how they’ve ended up with patients having seven times as many CT scans and five times as many MRI scans as we do in this country. What we do need, however, is to have much better earlier diagnosis. So, for example, only last week we made clear that we’re going to support GPs with additional resources so that they can access diagnostic tests in the community, and we need to be very clear with our General Practice colleagues about the benefits of early identification of symptoms and early referral. I know from talking, for example, to the Marsden in south west London, a centre of excellence in cancer care, that they would rather have more patients referred to them early in order to be able to identify where there is cancer and deal with it, and actually it’s far more cost effective for patients than waiting until later.
NHS staff morale
Question: How concerned are you about the morale, motivation and mental health of the current NHS workforce that keeps the NHS functioning despite constant reform?”
Andrew Lansley: Actually, the staff of the NHS are, along with patients, my principal and overriding concern.
What drives motivation and morale: it’s about people having much more control of the service they provide to patients. I’ve got consultants, nurses and GPs for years been telling me that what is really de-motivating is that they’re highly qualified professionals but they are not able to exercise their judgement to be able to deliver the care that they think is right for their patients, when and where they think they should.
And actually treating the staff of the NHS as though they’re on a production line and patients as though they’re on a production line has been one of the major failings of the past and I’m not going to go down that route.
Cost of reorganisations
Dr Mark Levy, GP: In these reforms, what thought has been given to the loss of trained managers, the withdrawal of frontline GPs into management roles, the training needs of staff, and also the wasted resources resulting from repeatedly scrapping systems with a lack of any long-term national planning, all because of these reorganisations often by uninformed politicians?
Andrew Lansley: Firstly, I think this is a highly efficient set of modernisation proposals because, as the evidence we published this week shows, it will deliver £5 billion of savings from administration costs in this Parliament for an initial cost of just £1.4 billion.
It is not about changing now and then we change again in the future. We made it very clear this is in order to secure the transfer of responsibility to the frontline and to patients that is absolutely essential for the long term. What I’d also say is I don’t think I’m doing this on the basis of ignorance. I’ve been shadow secretary of state for 6 years – and what it has taught me is that right across the NHS there are many thousands of leaders who have the capacity to lead the service but are not currently able to do so.
Dr Mark Levy: I’ve been around for a long time and I’ve seen many reorganisations and one of the problems is that there doesn’t ever seem to be any publication of any of the true costs of these reorganisations, which often take a couple of years to take effect. Now, you say this is for the long term but will the true cost of this reorganisation be published – i.e. the cost of redundancies, the lost expertise, the redeployment and retraining of health service staff and also, as was mentioned earlier, the cost of the extreme stress and pressure that the frontline staff are working under with these constant changes?
Andrew Lansley: I can’t publish in advance what the outcome is, but I can publish now a very detailed assessment of what the costs are. You will be able to see in the way in which we report on the results we achieve and the resources and the value for money. Because after a decade of lost productivity in the NHS, I’m looking for a decade of constantly improving the quality and the efficiency of what we do.
The good managers in the NHS have a future. What I’m absolutely clear about, though, is we cannot carry on having, for example, 50,000 administrators in primary care trusts. What we’ve absolutely got to do is to bring down the numbers of managers and the degree to which there is a superstructure of management in the NHS. But those who have a commitment to the NHS, those who want to be managers in the NHS, they will have a future in the NHS.
Private health companies
Question: Is it morally right for private health companies to profit from the taxpayer?
Andrew Lansley: Well, private companies profit from, for example, providing medicines to the NHS. Pharmacies all over the country provide excellent services to people who go to them, including lots of NHS services dispensing medicines. Most GP practices across the country are independent contractors to the NHS and they make a profit. I mean, the fact is, if we get the best possible care for patients, if it meets NHS values and principles – that is, it’s a comprehensive service, free to patients, based on their need – and we are constantly improving the service we provide, I think that’s our priority.