Health select committee chairman backs investment in primary care

Health select committee chairman Stephen Dorrell tells Marina Soteriou the NHS must change to reflect flatlining resources.

'If you want to make a difference in politics,' says health select committee chairman Stephen Dorrell, 'you march resolutely towards the sound of gunfire.'

The Conservative MP for Charnwood, Leicestershire, hoped this mantra, borrowed from former Liberal Party leader Jo Grimond, would define his approach to the select committee role.

But sitting in his House of Commons office in Westminster, overlooking the glass roof of Portcullis House, he reflects that it may not have been a sensible choice. 'Once or twice I am not sure that has been helpful. You seem to be surrounded by the sound of gunfire.'

Mr Dorrell, once the youngest MP in the House of Commons and later health secretary under John Major, was widely touted as the man most likely to replace Andrew Lansley.

He remains outside the government, and says that the committee's role is to engage in the mainstream of current health policy debate.

Nicholson challenge

Since Mr Dorrell's chairmanship began in 2010, the committee's focus has been the 'Nicholson challenge' - the £20bn NHS efficiency savings target. 'We have drawn attention to the fact the health service has to meet rising demand for the first time in its history out of flat real resources,' he says.

The target can only be met if resources move out of hospitals and into primary, community and social care, he warns. Care needs to be integrated, more focused on prevention and less on picking up the pieces in acute hospitals, he adds.

Tilting the NHS system away from acute care and designing services to meet rising demand will be the challenge for CCGs, Mr Dorrell argues.

Although the Health and Social Care Act will take effect in just two weeks, Mr Dorrell downplays its significance, calling it just another 'management change'.

But are CCGs and health and wellbeing boards ready to take over on 1 April in England?

'There is a variation around the country and it would be absurd not to recognise that. I'm pretty certain the basic administration will be carried on. I am not concerned about that.'

Video: Stephen Dorrell discusses plans to change GP contract


In parts of the country, CCGs will need to plan how to 'reconfigure' NHS services so they remain sustainable. Commissioners must show the changes as the 'inevitable consequence of changing technology, changing patient conditions and patient demands' to get the public and professionals onside, Mr Dorrell says.

In the past, plans have been 'a reaction to a crisis' or materialised only once the 'existing structure runs out of money'.

A long-term advocate of integration, Mr Dorrell believes this approach must play a key part in reshaping services.

He first made the case for closer links between health and social care in a 1997 White Paper. 'It's a sobering thought, given how little progress we have made,' he says.

Health and wellbeing boards alone are 'certainly not' enough to integrate health and social care but are a 'step in the right direction'. Their democratic mandate 'legitimises' local changes, he argues.

Mr Dorrell says he would like to see a merged NHS, social care and social housing budget and for IT links to 'flow' around the different systems. But he is adamant that integration does not mean free social care for everybody, 'which we have never delivered in this country since 1948 or before'.

Labour plans to merge health and social care budgets are right, he says. But the opposition has yet to address the 'difficult questions of how you achieve it'. 'I'd be amazed if the Labour Party went into the next election with a fully tax-funded, integrated health and social care system as a manifesto commitment. I don't see how that is affordable.'

Francis inquiry

Mr Dorrell says the challenge post-Francis inquiry is to tackle 'cultural failures' which led to failings at Mid Staffordshire NHS Foundation Trust.

Sacking NHS chief executive Sir David Nicholson is not part of the solution. 'I am not in favour of a lynch mob.'

This is a critical time for the NHS, Mr Dorrell admits, although he can't remember a time that wasn't. GPs may take some small comfort that in these turbulent times an influential politician in Westminster is backing investment in primary care as part of the solution.

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