NHS England: Staff Costs

Question

15:09:00

Asked by

To ask His Majesty’s Government what impact assessments have been undertaken, including analysis of regional effects, regarding the 50% reduction in staff costs for NHS England that is currently in progress.

My Lords, work is progressing at pace to develop the operating model for the future department. I can confirm that there will continue to be seven regional teams. It is only right that the potential impacts of the reforms are carefully assessed and understood. The Government are committed to ensuring that, once the necessary appraisals are finalised, all relevant information is made accessible to Parliament. This includes the impact assessment that will accompany the primary legislation.

My Lords, in the absence of any assessment, including the work that NHS England does on health inequalities, coupled with last week’s decision to cut £100 million of support from five integrated care boards, three of which serve highly deprived areas, on what basis can the Minister guarantee that this course of action will not jeopardise efforts to reduce health inequalities or indeed risk widening them further?

Tackling health inequalities is one of the priorities of this Government, but the noble Lord raises an important point. It is a sad fact that, around the country, people’s experience of health services and health outcomes are very variable. However, we need to allow the people looking into this to do their work and bring forward solutions, working with ICBs and looking at how we can become far more efficient in our delivery of services. That will ultimately have an enormous benefit to patients.

My Lords, I draw noble Lords’ attention to my registered interest as chairman of King’s Health Partners. At the time when the decision was taken for NHS England to be fully incorporated into the Department of Health and Social Care, two other important agencies were completing their incorporation into NHS England—namely, NHS Digital and Health Education England. The functions of those two agencies in marshalling NHS data and its analysis and in providing for the continuing development of the NHS workforce are critical. Is the Minister able to confirm how those important functions are being protected during this period of transition of NHS England into the department?

The noble Lord, as always, raises exceptionally important points. The three shifts under the 10-year plan, particularly around moving from analogue to digital, answer the question on the need to focus on digital. These are ongoing discussions and, while the workforce will come down, it is critical that work is allowed to be done to assess what needs to be done and how we can move the health service, and therefore health outcomes, forward in the most productive and successful manner.

My Lords, have the Government ever undertaken an audit of the NHS estate—for example, in York and North Yorkshire—to see whether there are a number of redundant buildings following successive reorganisations of the NHS? If it were to emerge that some of these buildings were redundant, would the Government be minded to sell them off and raise money for the NHS in that way?

The point that the noble Baroness raises is not a new one. As anyone from the local government sphere will know, there are always ongoing conversations about the estate, where it lies, its ownership and how we can move it into the future, and I do not think anything has changed. What we know is that, through these changes, the alignment of public services is going to be fundamental. The use of buildings is a vexed issue across the public sector and will need to be on the table.

My Lords, to come back to the Question from the noble Lord, Lord Scriven, about an impact assessment, does the Minister think it might be a good idea to do an impact assessment of NHS England itself, which both the parties opposite forced through in 2011, at a cost of £3.5 billion? As a result, waiting times increased, staff disenchantment increased and patient satisfaction went down. Should we not have an impact assessment on that?

My Lords, the evidence for that is becoming only too clear. That is why the Government have taken the action that they have to move at pace towards dealing with the situation. Too much money is going into bureaucracy and therefore not enough into front-line services. That needs to change, and this has been welcomed from all sides of the House.

My Lords, following the previous questions, I am sure that many noble Lords would agree with reducing staff, especially where there is duplication or where it may make more resources available for front-line staff. However, given that there was no impact assessment before the announcements were made—as the noble Lord, Lord Scriven, said, and as the noble Lord, Lord Hunt, has called for—will the Minister tell the House how the Government will ensure that front-line services will not be impacted, especially in areas of high deprivation?

There is an absolute commitment running throughout this that front-line services will not be affected by the work that continues. The decision was taken to move swiftly, and impact assessments will be done as we go through the journey. The Government have also committed that this will be as transparent a process as possible. Parliament will be kept fully apprised of the work that is done, particularly of how front-line services are being protected.

My Lords, it has been decided that it is no good just throwing more money at the NHS; you have to reform it at the same time. Is that not an important factor—the need to reform the NHS, making sure that it provides better services, rather than just thinking that more money is the answer to the problem, when we know that this has not been the case in the past?

I think my noble friend is referring to the layers of bureaucracy that make up NHS England. Anyone trying to find a way through that bureaucracy struggles to have direct lines of accountability, for example. He is absolutely right: reform is essential. This Government have grasped the nettle and are moving forward and working at pace, bringing in all the senior people from all the different affected parties to work together and, most importantly, to keep Parliament apprised of progress.

My Lords, the Question was about the 50% reduction in staff costs in the NHS. Has the Minister or her department discussed this with resident doctors, who, shamefully, will apparently have plenty of spare time to give their advice?

We made a Statement just last week on the situation with resident doctors, and we make absolutely no bones about saying that we do not approve of the action they are taking. We have to work together to make sure that NHS England moves forward and merges with the Department of Health and Social Care. The 50% is not a definitive decision; it will be done based on need and delivery of services.

My Lords, I was very taken with my noble friend Lord Hunt’s forensic analysis of the coalition Government’s performance on health. He mentioned the £3.5 billion figure. I know that my noble friend the Minister is not able to respond to that now, but would it not be very useful and enlightening for us all if we knew precisely how much money was wasted by the coalition Government at that time?

I can only say that the ongoing forensic work will uncover what has happened over the past few years, but I think we all know that, at the moment, the NHS is not fit for purpose; there needs to be radical change. This Government are absolutely committed to that, and we will make sure that it happens at pace and safely, putting patients front and centre in the delivery of health services in this country.

To return to the Question from my noble friend Lord Scriven on health inequalities and how they might be impacted by the proposed changes, will the Minister please reassure us that the widening health inequalities that we know exist around the country will not get worse, particularly for the most vulnerable and those with learning disabilities, whom we know face tremendous access problems? There have been numerous studies on how accessing primary healthcare is a real challenge for those with learning disabilities. Can she reassure us that that will not be dropped?

My experience of the Covid virus taught me about the impact of health inequalities and where people suffered the most. It is absolutely imperative for this Government to look at health inequalities, and everything in the 10-year plan is based on that premise. We know how unequal services are and how unequal life expectancy is. We know that people living just a few miles down the road from others in the same city can have a more than 10-year difference in life expectancy. This is absolutely at the centre of the 10-year plan and why we are doing it and will deliver for patients in this country.