Valerie speaks in debate on Lord Darzi’s Review

A debate was held on Monday 7 October 2024 on Lord Darzi’s independent investigation into NHS performance. This was a comprehensive report and i was called to speak however there was a 3 minute limit on speeches as so many MPs wanted to speak in the Debate. The Offical Report ( Hansard) reprints what is said in the Chamber but i have also added below that my full speech which I was unable to give to the House.   

The Official Report:

The report is a tour de force from Lord Darzi, and I thank him for his work. The Secretary of State rightly commissioned the report as a benchmark for future improvement. I was a member of the Health Committee from 2010 to 2015. Given the evidence we heard, there was no alternative but to pause the Bill—the Committee played an important role in that. Chapter 10 of the report sets out the structure. Lord Darzi points out that the 2012 Act was three times the size of the original Act setting up the NHS. The 2022 Act moved into integrated care, and in paragraph 15 on page 121, he raises some concerns about how the ICBs—integrated care boards—operate, and their accountability. Could there be a review into how they operate? Paragraph 37 highlights that trust chief executives’ pay is based on the turnover of the organisation, which encourages trusts to “grow their revenue rather than to improve operational performance.”

Some are even paid more than the Prime Minister.

The flow of patients is important, which is where working with local authorities is so important. We can move planes around the world, but it seems we cannot move people out of hospital. The Select Committee visited Torbay, which was set up in 2009. We followed Mrs Smith from a single point of contact all the way through. As Lord Darzi said on page 77, collaboration is not the same as integration. On page 5, paragraph 13, he points out that too great a share of the money is spent in hospitals rather than in the community. On page 81, he said that “GP…contracts are complex” and doing the right thing for patients is the wrong thing for GP income. He said, “That cannot be right.”

Our mantra should be “prevention, prevention, prevention”. In our report, we said that public health should be moved into local authorities. As Lord Darzi said, health visitors are dropping. He also said that the NHS is missing an opportunity to intervene early. We had Sure Start, which is where health visitors were focused. He talked about clinical negligence. Some £2.9 billion— 1.7%—of the budget is spent on settling claims. Can the Secretary of State pursue the duty of candour and ask each trust to look at whether they can move cases into arbitration?

Sadly, disparities by ethnicity make very grim and sad reading. Paragraph 24 refers to the median age at death as 62 for white people, 40 for black people, 33 for Asian people and 30 for those from a mixed background. There was supposed to be a chart in the report, but it is not there. Will the Secretary of State look at producing it?

Lord Darzi’s report gives the Secretary of State and the health team an important opportunity to re-set the NHS. It is the envy of the world and free at the point of use. As Lord Darzi said, we cannot afford not to have an NHS.

Here is my full Speech

A tour de force from Lord Darzi, and I want to thank him for this wide-ranging report, which appears to have covered the entire NHS. He has acknowledged the responses he received, which enabled him to produce such a report in such a short time. I hope we, as honourable and right honourable members, can also get a speedy and full response.

This is the “State we are in,” and the Secretary of State has rightly commissioned this as a benchmark for future improvement.

I was a member of the Health Select Committee from 2010 to 2015, chaired by the right honourable Stephen Dorrell, a former Secretary of State for Health, and also clerked by David Lloyd.

Given the evidence we heard at the Committee, there was no alternative but to pause the Bill, and the Committee played an important role in that.

I wish to concentrate my remarks on a few sections.

NHS Structure

I know it seems odd to start with the last chapter—Chapter 10—but it sets out the background to the Health and Social Care Act 2012- and as Lord Darzi points out, it is three times the size of the original Act that established the NHS in 1946.

The reorganisation was described at that time as being so big, you could see it from space.

But despite having to put that right, everyone was terrified of having another top-down re-organisation.

But as the new 2022 Act moved towards integrated care, paragraph 15 on page 121 throws some concerns about how the Integrated Care Boards (ICBs) operate, and their accountability.

I would ask the Secretary of State to consider a review of how these boards operate.

Paragraph 37 highlights that the salary of the Chief Executive of a trust is based on the turnover of the organisation, which encourages Trusts to focus on growing their revenue rather than improving operational performance. In some cases, Chief Executives are paid more than the Prime Minister.

The flow of patients is important, and that’s where working with local authorities is so important, as mentioned on page 86.

The Select Committee visited the integrated care set up in Torbay in 2009, and we saw how there was a single point of contact, and what happened to Mrs Smith, as she made that contact either to request a shower and equipment or for more serious situations when Mrs Smith had to go into and out of Hospital.  We saw the entire process from start to finish was handled by the point of contact. 

The 2012 reforms made this more difficult.

Lord Darzi quite rightly praised the workforce throughout the report, we saw how people were upskilled at Torbay.

We also saw a “halfway house” where people like Mrs Smith could be moved out of hospital and into a care home until she was ready to return home. Virtual wards also do this.

We can move planes around the world, but it seems we cannot move people out of hospital. A review is necessary to ensure we improve the flow of patients across the system. Lord Darzi points out that what gets measured is what gets funded.

On page 77, Lord Darzi reminds us that collaboration is not the same as integration.

On page 5, paragraph 13, Lord Darzi notes that too large a share of NHS spending is spent in hospitals rather than the community.

This is where GPs come in; There are certain tasks, such as ear syringing, that don’t need to be done by GPs—patients can have these procedures at places like Specsavers.

But I agreed with the Secretary of State that GPs should be salaried. Too often, GP practices are run as businesses, and the partners don’t want to appoint other partners, so they take on locums and there is no continuity of care.

Page 81 points out that contracts are complex, and doing the right thing for patients is often the wrong thing for GP income. “That cannot be right.”

The mantra should be: “prevention, prevention, prevention”.

I recall that we said in one of our Select Committee reports that public health should be a director level appointment in local authorities, but I don’t think that is the case in every area.

On page 82, paragraph 42, Lord Darzi highlights the fall in the number of health visitors. He has said that we need to start with children, and we once had Sure Start centres that offered this support. Parents were given advice, and health visitors played a key role. In Palfrey, we had a Sure Start Centre rated as outstanding twice.

Lord Darzi says that the NHS is “missing an opportunity to intervene early”, and I fully agree. Sure Start, or an equivalent programme, needs to be restored.

Clinical Negligence

On page 61, paragraphs 70 and 71, Lord Darzi focuses on clinical negligence. I recall the case of Dr Raj Mattu, who raised concerns and was then accused of bullying. He was pursued by the then-Chief Executive, and the case took 12 years to resolve and his career was destroyed.

In the meantime the Chief Executive was rewarded with a CBE and ended his days as a Chief Executive, despite votes of no confidence in him from the doctors who worked with Dr Mattu.

Clinical negligence costs the NHS £2.9 billion in 2023/24, which is 1.7% of the budget. As Lord Darzi neatly puts: this is equivalent to the budget for every GP in the Midlands, serving 10 million people.

I would ask if the Secretary of State can he ensure that the duty of candour applies, and ask that every Trust should be required to update the Secretary of State on cases, with all cases being referred to arbitration.

Disparities by Ethnicity

The section on disparities by ethnicity, on page 69, paragraphs 22 to 24, makes for grim and upsetting reading. Most notably, paragraph 24 refers to the median age at death as 62 for white people, 40 for black people, and 33 for Asian people, with 30 for those of mixed ethnicity. The report refers to a chart, but none was printed. Could I ask that the chart be published? This “extraordinary difference” must be a priority.

Conclusion

Lord Darzi’s report gives the Secretary of State and the health team an opportunity to:

• Reset the NHS away from a system where “what gets measured gets funded,” as highlighted on page 81;
• Upgrade outdated equipment, including scanners;
• Review the ICBs to ensure there is accountability to the Secretary of State from Trust boards;
• Ensure the recommendations in this report are not forgotten, but are constantly reviewed.

How can only 4.3% of stroke patients have access to mechanical thrombectomy, a life-saving treatment, simply because of where they live? Why isn’t this procedure rolled out everywhere?

The Secretary of State needs to take a stake in any research and development in the NHS, particularly in areas like vaccines.

Most importantly, could the Cabinet Office establish a committee that brings together health, education, and housing, which all play a part in the health of the nation. as Nye Bevan said : When a bedpan falls, it should be heard in Whitehall.  

This is about saving lives and a system that is the envy of the world, and free at the point of use. We cannot afford NOT to have an NHS.