Chris Skidmore MP: Fewer people will be talking about their NHS treatment than NHS car parking

Chris Skidmore is MP for Kingswood and a Member of the Health Select Committee. His report can be read on his personal website. Follow Chris on Twitter.

At the weekend, the Daily Mail ran a story highlighting the results of a recent Freedom of Information investigation I conducted into the cost of hospital car parking. This involved asking every hospital trust in England how much income they had received through charging for car parking, for each year since 2001. This issue has always been an emotive one, which strikes a chord with many people’s experience of the NHS. It is easy to understand the concerns people have when the data revealed that hospital trusts have received over £1 billion in car parking charges in the last ten years, £160 million in the last year. This has more than doubled in the last decade. Incidentally such charges only exist in England- they were outlawed in Scotland and Wales in 2009. An average trust receives just over a million pounds a year from car parking.

Not all hospitals feel the need to charge to excess - for example Hinchingbrooke Hospital under Circle’s management has introduced a flat daily rate of £2.50 for all visitors, and have scrapped the instant fine system for those without tickets. Moreover, Trafford Hospital in Manchester abolished parking fees entirely in 2010, making the reasonable point that visiting a hospital was already costly enough in terms of stress and time. If some of the best trusts in the country realise that patient experience- including before they enter the hospital building- is central to achieving better quality treatment, then it seems clear that other trusts should be following their lead.

The issue of NHS car parking charges has always been a thorny one. After all, it still costs money to operate a car park and at a time when budgets are tight it is important to scrutinise them line by line for potential savings. That said, in their present form parking charges hit the elderly, the chronically ill and the poorest hardest- as a flat fee they could barely be more regressive. It is also the sort of bread-and-butter issue that genuinely affects patients and their families each and every day. Attending a hospital can be a difficult and stressful experience without having to continually watch the clock before the meter runs out, or worry about being heavily charged for parking or fined.

Chris Skidmore MP, Kwasi Kwarteng MP, Dominic Raab MP, and Priti Patel MP: Britain’s best days are not behind us

By Chris Skidmore MP, Kwasi Kwarteng MP, Dominic Raab MP, and Priti Patel MP.

Our new rivals in the world economy are working harder than us, taking their studies more seriously, keeping their debt low, and taking more risks. If Britain is to remain competitive, we must learn from their example. Britannia Unchained is a rallying cry for the 21^st Century.

Britannia Unchained backs the current government’s deficit reduction strategy as a vital first step to restoring economic growth. Here our model should be that of Canada in the 1990s. Between 1992 and 2000, Canada converted an annual deficit of 9% of GDP to a surplus of 3%, cutting federal spending by around 20% between 1992 and 1997. In contrast, British public spending has continued to grow since 2007, and the deficit has been reduced by a quarter.

On education, we should be looking eastwards for positive role models, to arrest our decline in the PISA world rankings - we have fallen as low as 28^th in maths. Britain has the lowest proportion of students studying maths post-16 of any developed country, at 15%. By contrast, in Japan, 85% of students achieve the equivalent of maths A-level, and Indian students study maths and science for twice as long each week at high school as their British counterparts.

On innovation, Britain can emulate the success of Israel, in supporting high tech entrepreneurship, and the USA, in accepting the benefits of risk-taking and losing our fear of failure. The difference between Silicon Valley and Britain is astonishing. In 2005, 3,867 patents were awarded to businesses and individuals in San Jose, a city of fewer than a million people. The total number of patents awarded in Britain the following year was only 2,978.

Chris Skidmore MP: Five steps to tackle foreign citizens' abuse of the NHS

Chris Skidmore is MP for Kingswood and a Member of the Health Select Committee. His report can be read on his personal website. Follow Chris on Twitter.

There will be many issues facing the new Health Secretary Jeremy Hunt as he inspects his in tray this week. Crucially, there remains the challenge of finding 20% savings to be reinvested in frontline care. Already Andrew Lansley's reforms have managed to save £7.5 billion in management and bureaucratic costs, something that should be rightly highlighted. Yet to meet the target by 2015, no stone should be left unturned - after all, the NHS is not free, it is paid for by taxpayers who deserve to know that every penny is being wisely spent, and above all not wasted.

Over the past two years, I have been investigating the issue of foreign nationals using the NHS without paying for its services, something which costs the NHS over £100 million, though it seems that this figure, given data is not collected effectively and primary care remains free for foreign nationals, is just the tip of the iceberg. ConservativeHome has already highlighted this issue, which if tackled effectively would be a popular measure, demonstrating our commitment to protecting the NHS as a service funded by taxpayers who want a service free at the point of use, not abuse. So today, I have sent the new Secretary of State a copy of a new report I've released – The Missing Millions — that gathers together the results of a long-running investigation, and offers advice on how to deal with the problem.  Ronald Reagan famously said that there are no easy answers, but there are simple answers. Here then, are five recommendations which I shall be submitting to the Department of Health.
 
1. All trusts should be legally obliged to collect data on the cost of treating individuals not entitled to free NHS care, and those treated under the EHIC scheme. This is the subject of a Ten Minute Rule Bill that Henry Smith MP is introducing to Parliament on Tuesday. It is a vital measure - it is clear that from Freedom of Information requests from trusts that currently not all trusts are recording or keeping the data needed to charge foreign national patients. Without this information, it is impossible to operate a watertight system.

Chris Skidmore MP: Andrew Lansley's clinical commissioning groups are already improving health services by making them more localist

Chris Skidmore is the Member of Parliament for Kingswood, and a Member of the Health Select Committee. Follow Chris on Twitter.

It's fair to say that one of the most controversial pieces of legislation to pass through this Parliament has been the Health and Social Care Act. Parliament devoted hundreds of hours to the bill, rightly so given the esteem that the NHS is held in. Sadly, the political debate ended up becoming more about paranoid speculation than the practical content of the bill itself, with Andy Burnham championing the interests of the middle-managers rather than professionals and patients, claiming that there was "72 hours to save the NHS". For someone who in the final months of the Labour government was championing GP-led commissioning, it was an unfortunate corner to be backed into. Months on, the NHS remains alive and well: it has not crumbled, as some feverishly predicted. Importantly, we are now seeing the early benefits of creating clinical commissioning groups, the centrepiece of Andrew Lansley’s legislation. 

Clinical commissioning groups (CCGs), are anticipated to take full control of commissioning NHS services from April 2013. The replacement for cumbersome Primary Care Trusts, they currently are in "shadow" form, though many are already being given powers, funds and responsibility for services in their local area.

The results are encouraging. For example, the Kettering locality of Nene CCG in Northamptonshire noticed that too many patients with minor injuries were presenting at Accident and Emergency Departments. Not only does this cost money, but it also increases queues unnecessarily. To ameliorate this, they have trained their nurses to provide minor injuries care, even eliminating the need for many patients to see a GP, let alone make a trip to a local hospital. Simple, straightforward, and an example of where local knowledge and the freedom to innovate can save money and provide better care. At a time when the NHS is tasked with making £20 billion of efficiency savings by 2015, the cumulative effect of these small interventions is potentially transformative.

Chris Skidmore MP: By embracing Dilnot, this Government, unlike the last, is finally getting to grips with elderly care

Chris Skidmore is the Member of Parliament for Kingswood, and a Member of the Health Select Committee. Follow Chris on Twitter.

Although somewhat overshadowed by A-level results day, perhaps the biggest story in today's news are the reports suggesting that the Government intend to commit to funding the Dilnot Commission’s proposals on social care in full. Most notably this includes a £1.7 billion annual commitment, to allow for the capping of the cost to the individual of social care at £35,000. It is suggested that the proposals will be implemented from 2017, with the money being allocated in the next spending review. This is a sensible course of action, rather than announcing a significant spending commitment above and beyond what is presently accounted for. It should also allow for the proposals to be funded through rationing elsewhere in government spending, rather than increased borrowing or taxation.

Clearly any new spending should also be met with a sharp intake of breath by fiscally responsible Conservatives, with a reasoned analysis of whether it is necessary and appropriate. We should always resist the siren call to throw taxpayers’ money at a problem. However, within this Conservative spirit is an acknowledgment that there are obligations that the government has a duty to fulfil - to our ageing and vulnerable - particularly those with a lifetime of hard work and contribution to their name. Then there is the simple fact of an ageing population, the demographics of which, particularly when compared to the ratio of those in working age, will become one of the most dominant themes in public service reform for decades.

Chris Skidmore MP: Introducing a more humane way of caring for elderly people

Chris Skidmore is the Member of Parliament for Kingswood, a Member of the Health Select Committee and recently authored 'The Social Care Market' for the Free Enterprise Group.  Follow Chris on Twitter.

Much of the debate over the Care and Support White Paper has, to date, focussed on the big question of how we pay for long-term care for the elderly. This is fair enough - funding will always be a prerequisite for any policy. However, it is also as important to look at how we care for older people, not just how it is paid for. And this is an area where we can learn from innovation and excellence abroad.

The next generation of older people will be culturally very different to their parents. For we are now approaching the time when the baby-boomer generation are retiring - not only are they the most affluent generation in history, but they are also steeped in the principles of consumer choice and the expectations of high quality services. Unlike their parents, who lived through the war years and unprecedented austerity, this is a cohort which is not content to settle for adequacy. One suspects that this will be equally true when it comes to long-term care- and with the advent of greater personalisation we can expect them to exercise this choice.

One of the most exciting examples of innovative care for the elderly comes from Dr William Thomas, an American who specialises in elderly care, and in particular its deinstitutionalisation. Dr Thomas pioneered the ‘Green House’ model of care, and there are now projects based on this principle in each of the 50 states.

Chris Skidmore MP: Labour’s Social Care failure - 13 years in the long grass

Chris Skidmore is the Member of Parliament for Kingswood and a Member of the Health Select Committee.  Follow Chris on Twitter.

The gathering storm over how we best care for our rapidly aging elderly population has been brewing for some decades. The arguments over an aging population, over funding and over quality of care are familiar ones- it remains the case that to date there are too many questions and too few answers to the problem. One thing that no one can deny is that the challenge we face in tackling the funding of social care for the future is a challenge created by the Labour Party’s determination in government never to grasp the nettle of reform.

Indeed, the scale of inaction and procrastination that took place under the previous government is the subject of a report that I have published today—Thirteen Years in the Long Grass: Labour’s Social Care Failure. In 1997, a Labour government swept into power on a landslide, with a mandate for change, ambitious pledges and a booming economy. Thirteen years later, as Gordon Brown tendered his resignation to the Queen, the social care system remained unreformed – with Labour’s last contribution to the debate a wildly impractical and uncosted National Care Service.

Labour's 1997 General Election manifesto pledged to ‘establish a Royal Commission to work out a fair system for funding long-term care for the elderly.’  This commission on Long-Term Care for the Elderly reported in 1999. Its main recommendation was that ‘The costs of long-term care should be split between living costs, housing costs and personal care. Personal care should be available after assessment, according to need and paid for from general taxation: the rest should be subject to a co-payment according to means.’ When in 2000 the government responded, they rejected the Commission’s findings.

All was then quiet on the social care front until 2005, when the Department of Health published a Green Paper on social care, which it said would provide ‘a vision for adult social care over the next 10 to 15 years’. However, the paper contained no mention of the funding problems in long-term care and how they would be addressed. The subsequent 2005 Labour General Election manifesto was completely silent on social care funding.

Chris Skidmore MP: Saving enough for care means caring enough to save

Chris Skidmore is the Member of Parliament for Kingswood, a Member of the Health Select Committee and author of the Report: ‘The Social Care Market: Fixing a Broken System’. Follow Chris on Twitter.

We all know that, when it comes to delivering care for our rapidly ageing population, change needs to come: we know that without reform, our creaking, patchwork system of social care cannot be sustained. To tackle a problem that will affect the next generation as much as our own, we must seek to tackle both how this system is funded, and how it is delivered. Of course there remains the eternal political temptation to kick the can down the road, and delay the inevitable, as the Labour government did in 1997 with endless commissions and vague promises. To do this would be a disservice to everyone in this country, whether they need care, will need care, or care for someone else. Knowing this, the government will be publishing a White Paper on how best to deliver social care for the future. So far, there has been cross-party consensus that the current situation cannot continue: we cannot afford to put off reform; neither can we afford for any one party to play politics with the most vulnerable.

Increased life expectancy will mean more people eventually needing care and support. This in turn means that funds will need to be found. The Personal Social Services Research Unit’s modelling of future expenditure for Dilnot predicts that by 2030, the total annual spending on long-term care for people will have risen from £20.6 billion to £44.8 billion, of which £26.3 billion is state funding. This would constitute a rise in spending in services as a % of GDP from 1.63% to 2.31%.

The contributory principle that used to form the central pillar of our welfare system has been eroded over time - yet the remnants that continue to operate mean that many people feel an entitlement to free social care that simply does not exist. Ultimately we will all end up having to contribute more to our future care needs - and the time to begin cannot be delayed inevitably. At present it is the tax paid by people of working age that funds a great deal of care. This is unsustainable when you consider that by 2030, the ratio of working people to those aged 70 and over may well have fallen from 5.3:1 (as in 2010) to around 3.7:1.

Chris Skidmore MP: A letter to Ed Miliband - will he condemn tomorrow's doctors' strike?

Chris Skidmore is the Member of Parliament for Kingswood.  Follow Chris on Twitter.

"Dear Ed,

I am writing as a Member of the Health Select Committee, asking if you might be able to clarify precisely what the Labour Party’s position on the BMA strike taking place this Thursday will be.

While the Shadow Health Secretary Andy Burnham has rightly urged doctors “to pull back from any form of action that damages patient care, including disruption to non-urgent care” there seems to be no one consistent position from the Labour Party. For instance, on 16 May 2012, The Shadow Minister for Public Health, Diane Abbott, in an interview with Pulse Magazine, was asked: “Would the Labour Party be in favour of industrial action that wouldn't harm patient safety, which the BMA has confirmed?” Ms Abbott replied, “Yes, as long as they are not compromising patient safety” adding, ‘We have a lot of sympathy for the BMA’. Your adviser, Dr Kailash Chand, has also previously called for strike action from the BMA.

Chris Skidmore MP: How the Government should tackle health tourism

Chris Skidmore is the Member of Parliament for Kingswood.  Follow Chris on Twitter.

How we should tackle the issue of "health tourism" is one which has recently been raised on ConservativeHome, while stories of foreign nationals, ineligible for free NHS care still obtaining operations and treatment appear frequently in newspapers and the media? The background to the issue is straightforward: too many of those visitors required to pay for NHS treatment do not, and too many people are being registered by GPs who are not eligible for free NHS care.

It was not until 1989 that a British government began to require certain overseas visitors to pay for hospital treatment, and 2004 that these charges were extended to cover refused asylum seekers. The current guidance places “a legal obligation on the trust providing treatment to identify those patients who are not ordinarily resident in the United Kingdom; establish if they are exempt from charges by virtue of the Charging Regulations; and, if they are not exempt, make and recover a charge from them to cover the full cost of their treatment.”

However, there is no guarantee that the requisite money will be recouped. My own investigation, using Freedom of Information requests to every NHS foundation trust, revealed that over £40 million pounds had either been written off or was still uncollected - considering that only two thirds of trusts were able to provide practical data the true figure is likely to be much higher.

Chris Skidmore MP: Personal health budgets would be a good deal for both patients and taxpayers

Chris Skidmore is the Member of Parliament for Kingswood.  Follow Chris on Twitter.

This week saw the publication of the Government’s response to the consultation on its special educational needs and disability Green Paper. The headlines so far have focused on the rigorous screening methods that could potentially remove hundreds of thousands of children from the register who do not need to be there. However, it is the expansion of personal budgets for parents and children, reflecting the wider principles of choice, control and competition, that reflects what might be one of this Government’s greatest achievements: the personal revolution.

Under the SEN reforms, parents will be able to take charge of personal budgets for their children, allowing them to shop around for the most suitable specialist help. This is far superior to relying on monopolistic local authority provision - and will allow alternative providers to flourish, especially in the voluntary sector. Importantly, it also promises a single streamlined assessment, for an ‘Education, Health and Care’ plan, which will allow superior integration of budgets between the various services used by those with special educational needs.

We are already seeing the rise of personal revolution taking place under this Government in social care. In England, their uptake has doubled from April 2010 to March 2011, to almost 340,000 service users. The Government is committed to more: after all, the current level is still only about 35% of eligible users and carers. And although the increase in personal budgets is welcome, it has come in the form of local authority managed budgets, rather than individual direct payments, which make up only 26% of that 340,000.

Chris Skidmore MP: Direct payments for social care could save £1bn a year

Chris Skidmore is the Member of Parliament for Kingswood.  Follow Chris on Twitter.

Today sees the publication of the latest Free Enterprise Group report, The Social Care Market: Fixing a Broken System.  We know that long-term care for the elderly will present one of the greatest challenges for the future: the number of over-85s will double by 2030, yet it is estimated that 75% of people over 65 will eventually require some form of care. Recognising the demographic challenge, the government will be publishing a White Paper on Social Care shortly, in light of the recent proposals by the Dilnot Commission to look at how to fund social care for the future.

Yet as the report demonstrates, we need to also consider how to make the existing social care market more flexible and simpler for those who need care and their families. Above all, we should focus on allowing individuals and their carers the opportunity to decide upon what care they should have by liberalising social care budgets currently in the grip of local authorities- and give those in need of care the opportunity to access their individual budgets as cash payments.

In doing so, we would be following the example of Germany and the Netherlands. In Germany, individuals who have been assessed as needing care at one of three levels of severity are offered a choice between a cash payment, services in kind (including residential care), or a tailored combination of the two. Importantly, the cash payment is significantly lower than the value of the services. 49% of people eligible to receive care opted for a straight cash payment, rather than the alternatives, because they value the freedom that this gives them. 

Chris Skidmore MP: History is becoming a dead subject in schools. It must be brought back to life.

Chris Skidmore is the Member of Parliament for Kingswood.

At a time when the government is still carrying out its review of the National Curriculum, this is the perfect opportunity to stand up for History in schools - with a particular emphasis on making the subject compulsory to 16. In December 2011, I published a report on History in schools. The data in this report shows an alarming trend: that there is an educational divide opening up in our schools between affluent quarters where History is studied and deprived areas where it has been shunned.

The most shocking statistic of all pertains to a single local authority, Knowsley in Lancashire, where in 2010 just 11 pupils took A-Level History, and only four of them passed. At GCSE the story was hardly any better - only 16.8% of pupils took History, and barely 50% scraped at least a C grade. On a national level, there were 159 schools where not a single pupil was entered for GCSE History at all.

Chris Skidmore MP: Labour has become the anti-reform, anti-competition, anti-choice, and above all, anti-patient party

Chris Skidmore is the Member of Parliament for Kingswood and a Member of the Health Select Committee.

Several months ago, I wrote how Andy Burnham would seek to make Labour the party of anti-reform, placing party politics above the need to find genuine solutions to reforming the NHS. This prediction has proved correct: to listen to Andy Burnham, you would be forgiven for thinking that he was never a keen Blairite reformer of our public services. As Secretary of State for Health, he helped oversee an expansion of new providers in the NHS, particularly Independent Treatment Centres, the same expansion that this government backs, and that he now derides as privatisation. It was Andy Burnham who was happy to back an increase of £10 billion going to the private sector, between 2006-2010.  It was Andy Burnham who fought an election on a manifesto pledge to ”support an active role for the independent sector working alongside the NHS in the provision of care, particularly where they bring innovation.”

What a difference opposition makes. One of his first actions as Shadow Secretary was to fly in the face of expert consensus and declare that it was ‘irresponsible to increase NHS spending in real terms’, turning against the Coalition's real-terms increases in NHS spending, despite knowing that the NHS is facing the toughest efficiency program in its history. He proved that he and Labour would rather see money spent on the existing bureaucratic and manager-led structure of the NHS than an increase in the funds available for frontline care. In his rush to oppose any change whatsoever, Burnham has even set himself against the current transitional structure, which the British Medical Journal describes as, "leaner and less costly than any the NHS has known in the past two decades".

Burnham and Labour have set their face against an NHS that is centred around the needs of the patient, precisely what the Coalition's reforms seek to achieve. They have become the party of anti-reform, anti-competition, anti-choice, and above all, anti-patient. Putting the appropriate name to this shameful display of opportunism would be ruled unparliamentary language, were we in the House of Commons. But as Andy Burnham said last week, "there has to be some integrity otherwise you will come a cropper." He could do worse than heed his own advice.

Chris Skidmore MP: How I unearthed the scandal of millions of pounds of unpaid NHS bills by foreign nationals

Chris Skidmore is the Member of Parliament for Kingswood.

No-one would deny that in recent years far too much of the NHS budget has been wasted, leading to a poor deal for taxpayers. One particular area that has recently attracted attention is the amount of unpaid bills by foreign nationals, who are required to pay for NHS treatment if their country does not have a reciprocal arrangement with the UK. I began last January by asking the Secretary of State for Health how much money had been written off by the NHS, which was owed by overseas patients. The answer suggested that £35 million between 2002 and 2010 alone. However, reading the small print of the minister’s response showed that this did not include data from NHS Foundation Trusts. Clearly this was just the tip of the iceberg.

I decided to investigate this further, sending a Freedom of Information request to every NHS Foundation Trust. By October 2011, I had gathered responses from over 118 trusts, showing that that more than £40 million had been written off or was still outstanding - and past performance suggested that even the payments still due were unlikely to be recovered in their entirety. Guys and St Thomas’ managed to rack up the most impressive deficit, with over £6 million being written off since 2004. Whilst I was waiting for trusts to respond, I spoke in the Summer Adjournment debate, reporting some of my initial findings and asking the minister for an update on the government’s plans to tackle the problem. I was reassured to receive confirmation that the department was reviewing the rules and practices in place for foreign nationals, and committed to providing the full results of my own research when it was complete.