One of the new faces heading up the Department of Health is Alistair Burt, minister of state for community and social care. He speaks exclusively to The Commissioning Review about the challenges ahead.
Burt, Conservative MP for north east Bedfordshire since 2001, has a wide-ranging brief which covers adult social care, mental health, older people, the GP contract and primary care commissioning policy to name a few.
Q: What opportunity does being Minister for health in a majority government present? What can you do now you couldn't before? Will you keep in touch with Norman Lamb?
A: We have a great opportunity in this Parliament to continue the work of making sure the NHS becomes the safest and most compassionate healthcare system in the world. That means a service available for you and your family, seven days a week. I’m delighted to be part of the ministerial team delivering that. I have a good relationship with Norman and I’ve already discussed my brief with him.
Q: It’s said that integration between health and social care is a Lib Dem idea. How far would you like to see it go? Would you like to see ‘Devo Manc’ replicated and would you like councils' health and wellbeing boards to manage health care budgets?
A: Integration is a vision that has been talked about for many years by successive governments and NHS leaders. I want to see that vision become a reality. That’s why our £5.3 billion Better Care Fund is already joining up health and social care services – getting different teams working together to provide people with better care at the right time and in the right place. Health and Wellbeing boards have played a central role in this, working with local NHS and councils to develop plans for joined up care in their area.
Manchester has big plans to integrate health and social care, and I look forward to seeing them develop. There will be different solutions put forward in different parts of the country, but the government is totally committed to better integrated services.
Q: Chief concerns among commissioners in terms of integration are around a drain of money from health into social care. Is there any foundation to this? Can you give any assurances it won't happen?
A: The NHS has outlined its plan for the future, and it is loud and clear that we need to change the way we deliver care; to make sure the NHS is sustainable in the future. Our Better Care Fund is aiming to save half a billion pounds this year, as well as cutting around 160,000 emergency admissions – far from draining money. Every local NHS and council worked together to develop their plan for joining up services in their area and these were signed off by the both the NHS and local government, so this programme is backed up by a thorough and robust process.
Q: Last parliament was about the Health and Social Care Act and the setting up of CCGs. What are your expectations of CCGs over the next five years? Simon Stevens said he'd get tougher on poorly performing CCGs - do you agree? What do you think about CCGs in deficit?
A: The Health Secretary’s central mission is to create the safest health system in the world. The recent Commonwealth report said we were world leaders in efficiency but we still need to do more to eliminate variation and make sure every patient receives compassionate care.
CCGs will have a central role to play. Over the next five years, we expect CCGs to have wider influence and accountability to their local health economies - continuing to commission hospital care, expanding their role as co-commissioners of specialist services and primary care – with the potential to jointly commission social care and public health with local authorities. This approach will best help to improve care and prevent ill health.
However, for them to achieve this, we will need absolute transparency on the quality of care.
We know that by publishing the significant data the NHS collects we can improve care and make services more efficient. That is why the health secretary has asked The King’s Fund to develop a CCG scorecard. This will make it much easier for the local NHS to benchmark health outcomes against other local areas and drive improvements.
With regard to CCGs in deficit, it’s essential that CCGs show tight financial grip and live within their means, and we welcome NHS England’s plans to tackle issues that are identified.
Q: You've said you'll focus on primary care this parliament with pledges of 5,000 more GPs and seven day access... but what else are you hoping to do to redress the balance between primary and secondary care? Will you change the way that trusts are funded or give more powers to allied health professionals?
A: GPs are pivotal to any improvements we want to make to health and care, which is why general practice was the focus of the secretary of state’s first speech and why this will be central to my role as minister. The NHS has set out its vision for the next five years, which I’m proud to say my government has committed to back with an extra £8bn by 2020. It is vital that we transform the way in which we care for patients and the Five Year Forward View sets out a huge opportunity for GPs to lead this, by offering more services closer to people’s homes.
But primary care is so much more than general practice and that is why we have committed to providing 10,000 primary and community care staff by 2020. That figure will consist of not only 5,000 GPs, but also practice nurses, district nurses, physician associates and pharmacists. We also want to enable community pharmacists to play a greater role in providing support to patients which will help to reduce pressure on GPs and improve patient safety. That is why we are investing up to £7.5 million of the primary care infrastructure fund for this year to support community pharmacists with training and tools so they can access a patients’ summary care record where appropriate.
We will also focus on improving services like mental health and cancer care, as well as care for dementia patients. And we’ve already outlined our plans to improve access to services with a truly seven day NHS, while continuing to integrate health and social care.
Q: Will you make/back unpopular decisions to close hospital services?
A: By the end of this parliament we will have one million more over 70s than we do now – as the population increases and demand on services increases we will continue to need a strong hospital sector. But as I’ve already said, we need to continue to look at how we deliver care, because patients deserve the best possible care, regardless of where they live.
Local doctors and nurses, who know best what their patient needs, are best placed to decide what form this care should take. And I will always support clinical decisions, made in the interests of patients.
Q: Do you accept that the privatisation in the NHS debate will always haunt a Tory government? Is there anything you can do about it? Does it matter who provides care if it's good for patients?
A: The NHS has commissioned a proportion of health care services from other providers for many years. These independent sector providers include local authorities, social enterprises, community interest companies and charities like Macmillan nurses and Age UK.
It’s vital that patients get the best possible care, so when other providers of care have vast experience, knowledge and the capability, and it is in the patient's best interests, then we will continue to make use of those providers, as we have done for many years.
It is important to note that use of the private sector amounts to only six pence in every pound the NHS spends, an increase of just one penny since May 2010.
It is vital to ensure a false debate about ‘privatisation’ that isn’t happening doesn’t obscure the real debate about quality of care as we saw in Mid Staffs.
Q: Do you think the Transatlantic Trade and Investment Partnership (TTIP) will have any impact on the NHS?
A: No. TTIP won’t affect the way the NHS takes decisions about who best should provide NHS services, and any suggestion that TTIP could change this is completely untrue. TTIP can’t force European countries to privatise public services. It is - and will remain - up to the UK and devolved governments to decide how to run public services.
Q: Do you think seven day 8-to-8 working will work against you in recruiting 5,000 GPs? How can a career as a GP be made more attractive?
A: You are absolutely right that we need to make primary care an attractive career path for aspiring doctors. But we can’t do that job alone; we need to work with the profession. Dr Maureen Baker, Chair at the Royal College of General Practitioners recently said: “It is the best time in a generation to become a GP”, and she’s absolutely right. The NHS’s Five Year Forward View will empower primary care like never before, so there has never been a more exciting time to join general practice. We now need to make sure the next generation of doctors see the profession in the same way.
We’ve set out our commitment to delivering at least 10,000 extra primary and community care staff by 2020, including 5,000 GPs. At the Secretary of State’s first speech on general practice, he set out a number of ways we plan to deliver those staff, including a national marketing campaign to attract the best and brightest students to the profession and incentives such as an extra year of specialist training to attract new recruits.
We also have to change the way the profession works. Part of that involves bringing a wider range of skills into primary care, so that GPs can focus their time on caring for their patients. That’s why our commitment is to delivering a range of primary and community care staff – practice nurses, district nurses and physician associates – who can help reduce GP workload. We are also looking at how to free up GPs’ time by reducing bureaucracy even further and we are investing £1bn over four years to improve the facilities and infrastructure that can hold some surgeries back from giving the range of services they want to.
But the biggest change to the way we work has to be in our offer to patients. People don't just get ill Monday to Friday 9 to 5, evidence shows us that Sunday is second busiest day in our A&Es. We collectively need to address this issue, not just to help our hospitals but to respond to the needs of busy working families who cannot always take time off to see their GP.
Extended access isn’t about individual GPs working seven days a week – it’s about surgeries linking up and working together to provide this service for the benefit of their patients. Many practices are already doing this and by the end of this financial year, 18 million patients will have access to a GP through appointments available from 8am — 8pm Monday to Friday, and on weekends, or skype and email access. Clinicians and senior leaders across the NHS support the principle of seven day working and general practice must play its part.
Q: Given the financial pressures facing NHS do you think there will come a time for an open debate with the public on what the NHS can and can't provide?
A: I’m clear that the NHS will remain free at the point of use. Our commitment is clearly demonstrated by our pledge to invest an extra £8bn which the NHS identified it needs by 2020 to deliver its five year plan. This comes on top of significant investment since 2010 and at a time when other government departments are being asked to make considerable savings. But the public must also play its part by considering what demands are made on the NHS that might be unreasonable, and what we can do to ease these pressures.
Q. Will you ask for justification for CCG exec/chair and GP pay which exceeds the prime minister's wage?
A: The health secretary has already written to all CCGs requesting that if they appoint senior managers with a salary higher than the prime minister, then they should be able to justify that to ministers and to NHS England. I know that there are some great leaders in the NHS and people who do a good job for patients should be rewarded fairly, but the NHS is a public service and needs to show restraint on handing out generous pay packages as a matter of course.
Q: Will you go further on the responsibility deal to help combat childhood obesity and diabetes? What can government do here to hold powerful and false marketing to account?
A: The responsibility deal has made great strides by working with industry to reduce salt, fat and calorie content. We have seen some excellent examples where companies are leading the way in making products healthier by reformulating the content, improving calorie labelling, and giving consumers healthier options as the default. We know there is more work to be done - and it’s clear in our manifesto that tackling obesity is a major priority for this Government.
In terms of advertising and promotions, there is already a total ban in place on the advertising of foods high in fat, sugars and salt during children's television programmes, and we will continue to do more to help families make healthier choices.
Q: How committed are you to parity of esteem and what do you propose to do to achieve it?
A: We have gone further than ever before to put mental health on a par with physical health, and we invested another £300 million in mental health last year. I want to make sure that if you have a mental health condition, you get the care and treatment you need, without a delay close to home. The new waiting time targets - similar to those that exist for physical health - will help us to achieve this and encourage further improvements and funding to local services.
I know there are big challenges ahead, but doing even more to support those with mental health conditions and significantly improving Child and Adolescent Mental Health Services (CAMHS) services, is one of my top priorities.
Q: Can you shed further light on how you'll deliver £8 billion a year by 2020?
A: We delivered over £7 billion in real terms during the last parliament – and we’re pledging the £8 billion on the back of a strong economy to help the NHS fulfil its plan for the future.