The Secretary of State for Health (Mr Jeremy Hunt)
The legislative programme presented to Parliament last week by Her Majesty the Queen builds on four years in which we have not shirked our duty to the British people to restore confidence in disastrous public finances; to lead the country from the deepest recession since the second world war to the strongest growth in the G7; and to implement a plan that secures our long-term economic future. As part of that programme, we have been following a long-term plan to transform our NHS and help it to meet the challenges of an ageing population. However, we must remember that without the difficult decisions made to restore faith in our public finances, the NHS would have been in a very different position.
In Ireland, the health pay bill was slashed by 16% because it ran out of money. In Greece, health spending was cut by 20%. In Portugal, the public were asked to double their personal contribution to the cost of health care, but in England difficult decisions meant that we were able to protect the NHS budget, unlike the Labour party, which plans to cut it in England, and did indeed cut it by 8% in Wales, with disastrous consequences. Labour made the wrong call on the economy and the wrong call on NHS finances. Because we made the right call, the NHS is now doing extremely well in very challenging circumstances.
Later, Members will hear the right hon. Member for Leigh (Andy Burnham) talk about operational pressures facing the NHS. He is right: it is tough out there. This week, we will announce new measures to help the service to meet the challenges that it faces. We will no doubt also hear attempts to politicise what are essentially operational pressures, but what we will not hear is how much better the NHS is doing than it ever did when he was Health Secretary. The facts speak for themselves. Every single day—[Interruption.] This is difficult for Labour Members to listen to, but they would do well to listen. Compared with when he was Health Secretary, every single day we are referring 1,000 more people with suspected cancers to specialists. We are transporting 1,000 more patients—
Mr Hunt
I am going to make some progress and then give way. The right hon. Gentleman needs to listen. We are doing much more now compared with what was done when he was Health Secretary. If he listens, he might learn something.
This is what is happening every single day: 1,000 people with suspected cancers are being referred, and 1,000 more patients are being transported in ambulances in emergencies. Every day we are performing 2,000 more badly needed operations, we are seeing 3,000 more vulnerable people in A and E departments, and every day we are providing around 6,000 more GP consultations for members of the public and 10,000 more vital diagnostic tests. At the same time, MRSA rates have almost halved, mixed-sex wards have been virtually eliminated, and fewer people are waiting for 18 or more weeks for their operation.
Andy Burnham
The Health Secretary is standing there claiming everything is fine and giving a litany of successes. Let us just consider cancer care. He said the NHS was worse when we were in government. So that we are absolutely clear, will he confirm that the last set of figures show that the NHS is now for the first time missing its standard of treating cancer patients within 62 days?
Mr Hunt
The right hon. Gentleman should have listened to what I said: I said he was right to say it is tough out there, and I also said that this week we will be announcing measures to help the NHS deal with operational pressures. He talks about how long people are waiting for operations, so let us look at one particular statistic that sums up what I am saying: the number of people waiting not 18 weeks but a whole year for a vital operation. Shockingly, when the right hon. Gentleman was Health Secretary, nearly 18,500 people were waiting over a year, and I am proud that we have reduced that to just 500 people. Those results would not be possible without the hard work and dedication of front-line NHS staff, and whatever the political disagreements today, the whole House will want to pay tribute to their magnificent efforts.
Mr Andy Slaughter (Hammersmith) (Lab)
Will the Health Secretary comment on the shambles he has reduced the NHS to in west London, where he is closing A and E departments, like that at Hammersmith on 10 September, while there are inadequate numbers of beds at the only hospital people have been directed to? It means that there is no acute care, and primary care is in such a state that there is an emergency in-year redistribution of money across north-west London. How is he going to sort that out?
Mr Hunt
What is happening in north-west London is going to make patient care better. It involves the seven-day opening of GP surgeries, over 800 more professionals being employed in out-of-hospital care, and brand new hospitals. That is a huge step forward, and the hon. Gentleman is fighting a lone battle in trying to persuade his constituents that it is a step backwards.
This Government recognise the pressure that the NHS is under, as I was telling the shadow Health Secretary. The fact that the population is ageing means that the NHS now needs to perform 850,000 more operations every year than when he was in office, which we are doing. That means that some patients are not receiving their treatment as quickly as we would like, so NHS England is this week announcing programmes to address that, ensuring that we maintain performance while supporting the patients waiting longest for their treatment, something that did not happen when he was in office. We will not allow a return to the bad old days when patients lingered for years on waiting lists because once they had missed their 18-week target, there was no incentive for trusts to treat them.
A and Es, too, are facing pressure and are seeing over 40,000 more patients on average every week than in 2009-10. NHS staff are working incredibly hard to see and treat these patients within four hours, and it is a tribute to them that the median wait for an initial assessment is only 30 minutes under this Government, down from 77 minutes under the last Government. However, as we did last year, we will continue to support trusts to do even better both by improving their internal processes and working with local health economies to reduce the need for emergency admissions. This will be led by NHS England, Monitor and the NHS Trust Development Authority.
David T. C. Davies (Monmouth) (Con)
We have heard some comments from Opposition Members about waiting times. My right hon. Friend will be aware that fewer than 2% of patients in England wait for more than six weeks for diagnostic treatment, but is he aware that the figure is 42% of patients in the Labour-run NHS in Wales?
Mr Hunt
I am aware of those shocking figures, and I am also aware that the Royal College of Surgeons says that 152 people died on waiting lists in Wales at just two hospitals because they did not get their treatment in time. I gently suggest to the shadow Health Secretary that the Labour party might want to fix what is going on in Wales if it is really serious about patient care, because how Labour is running the NHS in Wales is an absolute disgrace.
Mr Hunt
I am going to make some progress, and then I will give way.
The NHS is about more than just getting through difficult winters. Looking to the future, this Government will continue to take the bold steps necessary to prepare our NHS for the long-term challenges it faces. There are two key areas for action if we are to rise to this enormous challenge. First, we must never turn the clock back on Francis. The NHS will never live up to its founding ideals if it tolerates poor or unsafe care. The last Government presided over an NHS in which doctors or nurses who spoke out were bullied, in which problems at failing hospitals were brushed under the carpet and in which vulnerable older people were ignored and, tragically, on occasions, treated with contempt and cruelty. This Government have stood up for the patient, championing high standards with a new culture of compassionate care which is now transforming our health and care system.
Alex Cunningham (Stockton North) (Lab)
The Secretary of State has already admitted some of his own failures this afternoon. Does he not think that some of the money he invested in his £3 billion reorganisation of the national health service could have been used to ensure that the NHS was hitting its targets today?
Mr Hunt
Perhaps the hon. Gentleman would like to look at the facts relating to the actual cost of the reorganisation. The net saving as a result of it has been more than £1 billion a year, and we are now employing 7,000 more doctors and 3,000 more nurses than when his party was in office. Last year, as a result of this programme—
Mr Hunt
This might not be something the Opposition agree with, but they should listen. I need to tell the House that we have put 10% of all acute trusts into special measures, and that in each and every one of them the warning signs were there under the last Government. The George Eliot hospital, for example, had one of the worst mortality rates in the country back in 2005. Tameside had to pay £9 million compensation for mistakes in just two years, and at the Queen’s hospital in Romford in 2006, a lady gave birth in a toilet, leading to the tragic death of her child.
Mr Brian H. Donohoe (Central Ayrshire) (Lab)
The Secretary of State will be aware of a problem that is affecting thousands of women. It relates to medical implant devices that a court in America has banned. What is he prepared to do to deal with the situation in this country that is affecting thousands of women, both north and south of the border?
Mr Hunt
The hon. Gentleman mentioned to me earlier that he was going to raise that point. I will look closely at the issue, as it sounds like an extremely important one.
I want to look at what has changed under this Government. One of the trusts that has been in special measures is the Basildon and Thurrock University Hospitals NHS Foundation Trust. When the right hon. Member for Leigh was in office, inspectors at the hospital found blood stains on floors and curtains, blood spattered on trays used to carry equipment, and badly soiled mattresses. When the Care Quality Commission published those findings, it was allegedly leant on to tone down its press release. This Government put Basildon into special measures, and it now has 183 more nursing staff. I asked one of those nurses what the difference was. She said:
“It’s very simple. When we raised a concern before, they weren’t interested. Now, they listen to us.”
It gives me great pleasure to inform the House that the chief inspector of hospitals has today recommended that Basildon should be the first trust to exit special measures, and that Monitor has ratified that decision. The hospital has received an overall rating of “good” and has been praised for its excellent leadership. The chief inspector found that the trust had made significant improvements in a number of areas, including maternity services, which were rated as “outstanding”—[Interruption.] The Opposition might not care about what is happening at a trust in special measures, but we on this side of the House do.
Mike Gapes
On a point of order, Mr Speaker. The Secretary of State knows very well the issue I am trying to raise, because I raised it during the business statement last week. I want him to respond to an important fact. A leaflet was circulated in my borough on 20 May, two days before polling day. It was quoted in the local papers, and it related to the A and E department at King George hospital in my constituency. I simply want to ask him to confirm whether the announcement from the Secretary of State for Health referred to in the leaflet was made with his authority, or by him, during the week before polling day.
Mr Speaker
The hon. Gentleman is an ingenious and indefatigable Member. He probably knows that I can best describe that as an attempted point of order, because it is not a matter for the Chair. That said—[Interruption.] Order. That said, the hon. Gentleman has made his point forcefully, and it would certainly not be in any way disorderly for the Secretary of State to respond to it if he wished to do so.
Mr Hunt
I am most happy to respond to what—I agree with you, Mr Speaker—is a thinly disguised point of order. I will happily say this: what I said was completely in order because I was simply restating information publicly available on the trust’s website.
I want to go back to talk about Basildon hospital, because of the remarkable turnaround there. Chief executive, Clare Panniker, and her team deserve huge credit for the changes that they have made, which will truly turn a corner for patients who depend on their services.
Mr Speaker
As I said, they are coming up very soon, and I am grateful to the hon. Member for Weston-super-Mare (John Penrose) for concurring with my suggestion that “very soon” does indeed include tomorrow. There will also be opportunities at all times for the hon. Member for Ilford South (Mike Gapes) to table questions with the advice of the Table Office. I have known him for 20 years and more, and he is not very readily put off his stride. I have no doubt that he will continue to gnaw at the bone until he achieves an outcome that he regards as satisfactory. Meanwhile, we must continue with the debate and the oration of the Secretary of State.
Mr Hunt
The decision to place 11 trusts into special measures last summer was not taken lightly, but we can see today that it was the right decision. Across the whole NHS, the number of people who think they would be safe in an NHS hospital is as high as it has ever been, the number of people who think that people are treated with dignity and respect has risen by six percentage points over the year and the number of people who think that people are treated with compassion has gone up by eight percentage points. This Government have introduced new chief inspectors of hospitals, general practice and adult social care to oversee the toughest, most transparent and most independent rating system of any country anywhere. We have improved accountability with a statutory duty of candour, and we are supporting staff by publishing ward-level nurse staffing levels for every trust.
Jackie Doyle-Price
I thank my right hon. Friend for giving way. I am sorry that his congratulations to Basildon hospital were so dreadfully interrupted earlier, because its journey since 2009, when real deficiencies were highlighted, to where we are now with the special measures being lifted is, as he has said, real testament to the leadership of the hospital’s new management and the commitment of the staff. I thank him for the impetus that he has given that process, because it is only by admitting when things go wrong that we can put them right; that is the difference between the Government and the Opposition.
Mr Hunt
I congratulate my hon. Friend for her work campaigning for higher standards at her local hospital, and I agree with her. Why is it that interventions to do with improving safety and compassionate care are coming only from Government Members and that the Opposition are not interested? I just challenge Labour Members on whether they are really on the right side of the big changes that need to happen in our NHS.
Mr Speaker
Order. There is now a kind of institutionalised rowdiness about this debate, epitomised by the hon. Member for Swansea West (Geraint Davies) on the third row. It would be seemly if he would calm himself. I do not refer to people outside this place, but this debate is being keenly attended by a large number of citizens, who would expect Members to behave in as seemly a fashion as I feel sure they do on a day-to-day basis.
Mr Hunt
Despite the amount of work that has been done in the past year, there is still much to do to improve safety and care. According to a study based on case note reviews, around 5% of hospital deaths are avoidable. That equates to 12,000 avoidable deaths in our NHS every year, or a jumbo jet crashing out of the sky every fortnight. On top of that, every two weeks, the wrong prosthesis is put on to a patient somewhere in the NHS. Every week, there is an operation on the wrong part of someone’s body. Twice a week, a foreign object is left in someone’s body. Last spring, at one hospital, a woman’s fallopian tube was removed instead of her appendix. Last summer, the wrong toes were amputated from a patient. This spring, a vasectomy was given to the wrong man. To tackle such issues, we need to make it much easier for NHS staff to speak out when they have concerns. We need to back staff who want to do the right thing, and we are currently looking at what further measures may be necessary to achieve that.
Today, this Government vow never to turn back the clock on the Francis reforms, and I urge the shadow Health Secretary to do likewise when he stands up. Another vital set of reforms that we need to make if we are to prepare the NHS for the future involves the total transformation of out-of-hospital care. We know that prevention is better than cure and that growing numbers of older people, especially those with challenging conditions such as dementia, could be better supported and looked after at home in a way that would reduce their need for much avoidable and expensive care. This year, three important steps have been taken towards that vital goal. First, the new GP contract brought back named GPs for the over-75s—something that was so shamefully abolished by Labour in 2004. Older people often have chronic conditions that make continuity of care particularly important. However, Labour scrapped named doctors, and we are bringing them back.
We are also acting to break down the silos between the health and social care systems with an ambitious £3.8 billion merger between the two systems. The better care programme is, for the first time, seeing joint commissioning of health and social care by the NHS and local authorities, seven-day working across both systems and electronic record sharing, so that patients do not have to repeat their story time after time and medication errors are avoided.
Barbara Keeley
The Secretary of State touches on a couple of issues, including safety, but ignores one of the most important ones, which is nurse-to-patient ratios. A safe patient-to-nurse ratio has been adopted at Salford Royal, and it could be adopted elsewhere. He is now talking about the better care fund. There is no new money in that fund, and if he is worried about pressure on the NHS, surely he should think about the £2.68 billion that is being taken out of adult social care. In my local authority of Salford this year, 1,000 people will lose their care packages. How is that good for alleviating pressures on the NHS?
Mr Hunt
Perhaps I can reassure the hon. Lady on those matters. First, the better care fund is the first serious attempt by any Government to integrate the health and social care systems and eliminate the waste caused by the duplication of people operating in different silos. The Government require all trusts to publish nurse-staffing ratios on a website that will go live this month. It is an important, radical change, and we are encouraging trusts to do exactly what she says is happening in Salford. It is important to say that, where other Governments have talked about integration, we are delivering it. We are doing one more important reform: we are taking the first steps to turn the 211 clinical commissioning groups into accountable care organisations with responsibility for building care around individual patients and not just buying care by volume.
From next year, CCGs will have the ability to co-commission primary care alongside the secondary and community care they already commission. When combined with the joint commissioning of social care through the better care fund, we will have, for the first time in this country, one local organisation responsible for commissioning nearly all care, following best practice seen in other parts of the world, whether Ribera Salud Grupo in Spain, or Kaiser Permanente and Group Health in the US—[Interruption.]
Mr Speaker
Order. I say to the hon. Member for Rhondda (Chris Bryant), who has just published an extremely cerebral tome on the history of Parliament, that he should not be yelling and exhorting from a sedentary position as though he is trying to encourage a horse to gallop faster. It is not an appropriate way to behave.
Mr Speaker
Interventions should be brief—the hon. Gentleman is experienced enough to know that.
Mr Hunt
I agree with the new chief executive of NHS England. There is an incredibly important role for community hospitals and, indeed, for smaller hospitals. He was making the point that it is not always the largest hospitals that have the highest standards. One reason why the public like smaller hospitals is that they are more personal, and very often the doctors and nurses know people’s names, which makes a difference. They are also closer to people’s homes and easier to get to for relatives wishing to visit people in hospital.
Mr Hunt
I am drawing to a close, so I shall continue by saying that a long-term plan for our NHS that recognises immediate challenges and the need to reform going forward is what the Government have put into practice. It is not easy to implement, but it is the right thing to secure its future, and the right thing for our country. When the right hon. Member for Leigh rises to speak in a moment, he will say—he told The Independent that he would—that the NHS should have been included in the Queen’s Speech, ignoring the Bill to introduce additional child-care subsidies that will benefit thousands of NHS employees and ignoring the impact on NHS finances of the Bill to curb excessive redundancy payments—something for which his Government were largely responsible. He will not mention the straightforward security that the Government offer the NHS by sticking to a long-term economic plan that is working, so that we have the best possible chance to ensure that the NHS can be properly funded going forward.
If the right hon. Gentleman does not address those points, I hope that he will use his speech to show that he has learned from some of the big challenges facing the NHS over recent years. Does he accept that, without the reorganisation of about 20,000 administrators, the NHS would not be able to afford 7,000 more doctors and 3,000 more nurses? Does he accept that, without restoring named GPs, we will not be able to offer the joined-up care to vulnerable older people that he claims to champion? Most importantly, will he say publicly that, without honesty about poor care—honesty that he has repeatedly criticised as running down the NHS—we would not now be turning round 15 failing hospitals such as Basildon? In that spirit, will he categorically retract his statement, as reported in the Health Service Journal last week, that Mid Staffs was a local failure whose significance for the NHS has been exaggerated by this Government? If he does not do so, I have to say that we disagree profoundly on the biggest change that our NHS needs. We can state that change in just three words: put patients first. It is what NHS staff want to do, and they all want support to do it, but it is simply not possible unless they have the administrative and political leadership that puts patients first in every policy, target and announcement. The Government are proud of our record on the NHS: proud of record levels of high-quality care given to record numbers of patients, proud of tough economic choices that enabled us to protect the NHS budget and, most of all, proud of 1.3 million NHS staff who work hard day in, day out, to make our NHS so remarkable. We will not let them or the country down.
Andy Burnham (Leigh) (Lab)
Last week, the Secretary of State told the NHS Confederation that patient safety was crucial to the future sustainability of the NHS. Let me begin on a note of agreement. The Health Secretary is right to continue to send the clearest message to the NHS that patient safety must be its top priority. He knows that he has our support in introducing measures to implement the Francis report and, indeed, learning all the lessons from the terrible failings at Stafford hospital. A question arises that is perhaps more for the Government to answer than the right hon. Gentleman: why is the Secretary of State’s important priority not reflected in the Gracious Speech? It is approaching 18 months since the publication of the Francis report, yet many of its recommendations are still to be implemented. The failure to make progress in this legislative programme undermines the Secretary of State’s message today.
The Francis report recommended new legislation to modernise the regulation of doctors and nurses and speed up the handling of complaints. The regulatory bodies said that progress is urgently needed, and they were expecting a Bill in the Gracious Speech to implement those reforms. Not surprisingly, both reacted negatively to the decision to drop it. Niall Dickson, chief executive and registrar of the General Medical Council, said:
“We are disappointed that the government has not taken this opportunity to improve patient safety”,
and Jackie Smith, chief executive and registrar of the Nursing and Midwifery Council, said:
“Both the NMC and the public it protects now continue to be left, indefinitely, with a framework that does not best serve to protect the public.”
I hope the Secretary of State will explain why that Bill was dropped and answer the concerns of Jackie Smith and Niall Dickson.
Mr Hunt
The right hon. Gentleman said he would start on a note of consensus on the Francis report, so does he now retract his comments last week that what happened at Mid Staffs was “a local failure” and that the Government were exaggerating its significance for the rest of the NHS? That was a very damaging thing to have said.
Andy Burnham
The Francis report found that the failing at Stafford hospital was principally a failure of the local board. I served in the previous Government, who inherited problems from the preceding one—care failings at Bristol royal infirmary and Alder Hey, and the Shipman murders. Contrary to what the Secretary of State said today, we acted on those failures to bring more transparency to the NHS. We introduced independent regulation to the NHS. He needs to look at the statements that he has made over the past year and consider whether his response has always been appropriate. He has used language such as
“Cruelty became normal in our NHS”—[Official Report, 19 November 2013; Vol. 570, c. 1097.]
Does he stand by such statements and does he think that is fair to the thousands of NHS staff who give their all every day, doing their best to serve patients?
Andy Burnham
I will give way to the right hon. Gentleman once more, but he needs to answer those concerns of staff, who feel that he has been running down the NHS.
Mr Hunt
Let me be absolutely clear. I have never blamed NHS staff for what happened at Mid Staffs. I blame the policy failures of the right hon. Gentleman’s Government. It is not just I who say so. Robert Francis said in his report:
“Stafford was not an event of such rarity or improbability that it would be safe to assume that it has not been and will not be repeated”
in the rest of the NHS. He continued:
“The consequences for patients are such that it would be quite wrong to use a belief that it was unique or very rare to justify inaction.”
Will the right hon. Gentleman now retract his comment that this was “a local failure” whose impact has been exaggerated?
Andy Burnham
I am quite clear in what I said. I said that the finding of the Francis report was that it was a local failure, but of course there were lessons to be learned. That is why I brought in Robert Francis in the first place to begin inquiries at Stafford. The claim that we just brushed everything under the carpet could not be more wrong. The Secretary of State needs to drop it and start dealing responsibly with these issues.
The right hon. Gentleman wanted to distract the House from what I was saying—that a Bill should have been brought forward in this Gracious Speech to modernise professional regulation in the NHS. I quoted strong sentiments from Niall Dickson and Jackie Smith. There was no room for such a Bill, but it is hard to find measures in the rest of the Gracious Speech that may be considered more important than that Bill. The Speech found space, for instance, for measures on pubs and plastic bags, but not on patient safety. There was a time when the Prime Minister used to say that his priorities could be summed up in three letters—NHS. Not any more. Those letters did not appear in the Gracious Speech and received only a cursory mention when the Prime Minister addressed this House.
So what explains the relegation of health down the Government’s list of priorities? One commentator writing last Thursday offered an explanation. He said that
“there was no mention of the health service in the Queen’s Speech. Indeed, the Tories have had little to say on the subject at all recently.
I’m told that there is a precise reason for this: Lynton Crosby has ordered them not to.”
I do not know whether that is true, but it does not look good, does it? It creates the clear impression that the shape of the Gracious Speech had more to do with the political interests of the Conservative party than the public interest of the country.
Andy Burnham
It is well documented that the policies of this Government in a range of areas are damaging the health of the nation, but what we get instead is drift from the Government on public health. There is no momentum at all to improve children’s health and the Queen’s Speech had absolutely nothing to say on it. Where are the measures that the Minister has been proposing? What has she been doing? Why does she not introduce them?
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
The right hon. Gentleman will be aware that the legislation for both the measures to which he alludes has already been passed by this House.
Andy Burnham
But regulations are needed. If the Minister does not know that—[Interruption.] It was the Opposition who brought forward the vote on smoking in cars and she committed to introduce regulations to implement it. She cannot duck the question. When will she do that? If she does not realise that she is going to introduce regulations, she needs to go back and do a bit more homework.
It is not hard to guess why the Government want a period of silence. On every measure, the evidence is clear that the NHS is getting worse. When the Prime Minister was challenged—
Gordon Birtwistle
I am delighted to hear that, and I would like Wiltshire to become a standard that everyone else copies. I would hope that my constituency and the rest of Lancashire copies that. There are great companies—I know a few good companies that really care about the customer. These elderly people are customers: if Tesco treated people like some of those carers, they would shop somewhere else. Unfortunately, elderly people cannot go anywhere else, because a contract has been organised, and they have to use it. I urge the Minister to consider those suggestions and look at ways of improving the service that we deliver to our old people. I would be very happy if he did so, and I am sure that he would be too.
The Minister of State, Department of Health (Norman Lamb)
I completely agree with what my hon. Friend is trying to achieve. I hope that he is reassured that the Government have effectively introduced compulsory minimum training for all care assistants for the first time. I think he will welcome that.
Gordon Birtwistle
I do welcome it, and I am delighted to have heard that. I just hope that we make it a major condition of all Government and local authority contracts that all companies deliver that service to our elderly people. We will all become elderly—I am catching up very quickly—so who knows how soon it will be before someone comes to my house to say, “Gordon, it’s bedtime. It’s 8 o’clock—it’s toilet time.” That’s the worst thing I think I have ever heard—someone coming in and saying that it is toilet time. An old man said to me: “I do not want to go to the toilet, but I am told that it is time to go to the toilet.” It is just not acceptable to do that to an elderly man. I am delighted to hear what the Minister said, and I hope that we ensure that it continues in future so that we really respect and care for the people who have put us where we are today.
Dr Sarah Wollaston (Totnes) (Con)
May I start by paying tribute to my predecessor, Anthony Steen, for his tireless work in bringing in a modern slavery Bill?
Today, however, is for talking about health, which is a great passion for me in this place and outside it. The NHS touches people’s lives 1 million times every 36 hours, which is a staggering figure. I believe that the NHS is worth every penny of the nearly £110 billion that we spent on it in the last financial year. I am very proud that this Government have protected the health budget, but that does not of course mean that there are not enormous financial pressures. We are now in the fifth year of effectively near-flat funding, and the issues set out by the hon. Member for Ilford South (Mike Gapes) are part of those pressures. We know that whichever Government were in power, there would have been serious challenges.
If the NHS is to be sustainable, we need to listen to the new chief executive of NHS England, Simon Stevens, who has called on all staff members to think like a patient and act like a taxpayer—we must do that to get every ounce of value out of our NHS—and to address issues of patient safety and of how we keep people out of hospital in the first place and get on with implementing the measures. The nature of the challenge has been set out in exhaustive detail; now we need to get on with the measures that have been put in place to help to prevent hospital admissions, to treat people at the right time in the right place, and to integrate health and social care. I want us to look carefully at the better care fund and the plans for getting best value out of it, and at the issues of patient safety that were mentioned earlier.
Given the absence of much legislation in the Gracious Speech, there is one regret that I want to point out: the absence of the Law Commission’s draft Bill on the regulation of health and social care. I hope that in summing up this debate, the Minister will give some reassurance that he can use secondary legislation to bring forward at least some of the measures in that draft Bill. It covers issues that touch 1 million people across 32 professions that are covered by nine regulatory bodies. Unless we clarify the language so that there is a common language in respect of patient safety across all those regulators, it will be difficult to implement some of the core messages from Francis and to act quickly in response to emerging threats to protect the public.
Every year for three years, the Health Committee has called on the Government to allow the General Medical Council to appeal panel decisions that clearly have not protected the public. Likewise, the Nursing and Midwifery Council would like powers to reopen cases in which it has been judged there is “no case to answer” if serious new evidence emerges. Alongside that, the General Pharmaceutical Council would like to implement transparency and to be able to take enforcement action. Those are all simple measures that I hope the Minister will mention in summing up. I also want the unacceptable level of delays to be addressed.
Norman Lamb
I want to give a quick confirmation that we will do what we can through secondary legislation to do what the hon. Lady requests.
Dr Wollaston
I am very pleased to hear that.
There will not be an absence of debates on health in this place. Two Bills will probably come here from the Lords in this Session: the Medical Innovation Bill and the Assisted Dying Bill. I will briefly put some of my concerns about the Medical Innovation Bill on the record while there is time for it to be amended. I have no doubt that it was introduced with the best of intentions to bring forward innovative treatments. However, I fear that it will have the reverse effect: it could undermine research and open the door to the exploitation of people when they are at their most vulnerable.
Currently, clinical negligence law provides redress for patients who have been harmed as a result of treatments that would not be supported by anybody of medical opinion. There is insufficient evidence that doctors are not introducing new treatments or are put off from doing so because of the fear of litigation. The NHS Litigation Authority has made it clear that doctors are protected from medical litigation in that respect. However, the briefing note for the Saatchi Bill talks about a doctor being able to use a novel treatment if he is “instinctively impressed” by it. In other words, doctors will be able to use an anecdotal base for treatments, rather than a clear evidence base. There are dangers in going down that route.
There have been some amendments to the Bill. Lord Saatchi has accepted that a doctor should have to consult colleagues and their medical team, but not that they should consider a body of opinion or consult ethics committees. I fear that we could be turning the clock back. We should rightly be proud of the advances that we are making in the field of medical research. We should rightly be proud of the push towards greater transparency, particularly in respect of open data and drug trials. However, I fear that if we allow people to access innovative treatments that have no evidence base, we will open the door to the purveyors of snake oil, rather than those who want to allow patients to enter controlled trials to establish a clear medical evidence base.
We should not underestimate the extent to which the purveyors of snake oil are out there. I put on the record my congratulations to Westminster city council and its trading standards department on fighting two successful prosecutions under the Cancer Act 1939 against two individuals, Errol Denton and Stephen Ferguson, for peddling so-called nutritional microscopy to people who were at their most vulnerable—cancer patients and patients with HIV—and telling them that it was an alternative to evidence-based treatments.
We must therefore be careful in how we move forward with such legislation. We should take more notice of the concerns of the Medical Research Council, the Wellcome Trust and the Academy of Medical Royal Colleges, who feel not only that the Bill is unnecessary, but that it could turn the clock back on evidence-based medicine. I hope that the Government will look at the concerns that have been expressed about the Bill in its current form.
Finally, Lord Falconer’s Assisted Dying Bill would enable competent adults who were terminally ill to have assistance to end their lives, but it would require the involvement of a medical practitioner. Although the Bill comes under the responsibility of the Ministry of Justice, it would have profound implications for end-of-life care and medical practice. It would fundamentally change the relationship between doctors and patients. There is a risk that the right to die would slide into a duty to die. I have seen how often patients who are towards the end of their lives fear being a burden on their families, and they often go through periods of profound depression. I do not feel that this Bill is the way forward.
The Minister of State, Department of Health (Norman Lamb)
I thank all right hon. and hon. Members who have contributed to today’s debate. It has been a wide-ranging debate stretching well beyond the NHS, as the shadow Minister said. I think that we all enjoyed the alternative Queen’s Speech from the hon. Member for Blyth Valley (Mr Campbell). His Front-Bench colleagues looked horrified, but it was the authentic voice of Labour.
Norman Lamb
Well, let us just make sure that Opposition Front Benchers listen to the hon. Gentleman.
We can be justifiably proud, it seems to me, of the action we have taken in health and care over the course of this Parliament. The hon. Member for Scunthorpe (Nic Dakin) made a speech that faded away from agreement, but at the very start he made the point that we should all pay tribute to a really remarkable work force in the NHS—1.3 million people doing incredible work. We want to free those people up as much as possible to do the very best they can.
Andy Burnham
Would not the best way to pay tribute to those thousands of staff in the NHS be to honour the 1% pay increase that the Chancellor promised them?
Norman Lamb
That is equivalent to about 6,000 nurses a year. The right hon. Gentleman has to demonstrate how that would be paid for. The fact is that there is an average wage increase of 3% as a result of annual pay increments under Agenda for Change. We have ensured that at least everyone will get a 1% increase. If he is arguing for something different, he has to say where the money would come from to pay for it and how he would cope with 6,000 fewer nurses, which would be the result of his action.
For the first time, it is this Government who have made decisive moves to join up the care and health system and focus more on preventing ill health. Contrary to the shadow Secretary of State’s claims, the better care fund has been widely welcomed, and it has initiated action across the country to join up a very fragmented system. We have sent out the signal that we encourage innovation and change, driven by clinicians from the bottom up, not from the top down. Brilliant pioneers across the country are ending this fragmented system that has interrupted patient care for so long and failed patients. Those pioneers are combating loneliness, which my hon. Friend the Member for Burnley (Gordon Birtwistle) spoke passionately about. It is so far removed from the caricature offered by the shadow Secretary of State and the tired old refrain about privatisation. It was, after all, a Labour Government who mortgaged the future of the NHS to the tune of billions of pounds with their private finance initiative programme, giving massive windfall profits to private consortiums—a scandal of historic proportions. Yet Labour Members continue to argue that the Government are privatising—an argument that is based on thin air, not substance.
Tom Blenkinsop
Will the Minister tell the House at what point the provisions of the Competition Act 1998 were introduced into the Bill that became the Health and Social Care Act 2012? I think it was this Government who did that. In the Public Bill Committee, I commented on the fact that they were exposing the NHS and undermining the category B status of the European competition regulations by putting the Competition Act at the very heart of the Bill.
Norman Lamb
I am sorry to disappoint the hon. Gentleman, but it was under the Labour Government that it was made clear that competition law applied to the health care system. Indeed, the Labour Government’s guidelines on the NHS replicated exactly the regulations under section 75 of the Competition Act that this Government have introduced. Time and again, we hear false claims by Labour Members.
This Government have developed a new health and care system that is totally patient-centred, led by health professionals, and focused on delivering world-class health outcomes. The difficult decisions that we have made on public finances have meant that we have been able to protect the NHS budget. The shadow Minister spoke as though the Government have had to face no financial challenge at all. She knows that across Europe, Governments have slashed pay for health workers and introduced co-payments. We have done none of that. We have protected the budget for the NHS, and we are proud of doing so; Labour did not commit to that in its manifesto at the last election. The truth is that the NHS is doing extremely well under a great deal of pressure.
This Government have laid solid foundations to transform our NHS to help it to meet the challenges of an ageing population, drive up standards, and focus absolutely on compassionate care. My hon. Friend the Member for Mid Worcestershire (Sir Peter Luff) spoke movingly about his experience of the importance of compassionate care. We have introduced tough, robust inspections overseen by new chief inspectors of hospitals, of social care, and of general practice. We have introduced ratings of hospitals, care homes and GP practices so that people know how good their local services are. We have introduced, for the first time, fundamental standards and the ability to prosecute—to hold to account organisations and directors who seriously fail patients. We have introduced a fit and proper person test for directors; for the first time, compulsory training for health and care assistants; and—I am particularly proud of this—a statutory duty of candour to ensure that there is openness when things go wrong in the NHS or the care system.
Geraint Davies
Given the Minister’s focus on accountability and transparency, why will he not support the regulation of psychotherapists and counsellors? My private Member’s Bill would have protected 1 million people. He or I could set up shop as psychotherapists tomorrow and see these vulnerable people who are currently at risk. Why will he not protect them?
Norman Lamb
The Government are not convinced by the argument for statutory regulation. The hon. Gentleman and I have had this debate many times, and I am happy to continue to discuss the matter with him.
In the wake of Francis, the Government are clear that poor or unsafe care will not be tolerated. There will be consequences for those who fail patients.
Opposition Members have criticised the lack of health legislation in the Gracious Speech, yet, as several of my hon. Friends, including the Members for Witham (Priti Patel) and for Rochford and Southend East (James Duddridge), have noted, people are not out there on the streets demanding a new NHS Act of Parliament; they want safe, good, compassionate care.
The Government remain committed to legislating on professional regulation when parliamentary time allows.
Norman Lamb
Let me complete this point.
This is a complex area and we should not rush to legislate. We will keep making progress to respond to the scandal of Mid Staffordshire for the remainder of this Parliament. We are working closely with the regulators to ensure that key provisions, such as a faster fitness to practise test for nurses and midwives and English-language checks for all health care professionals, are in place during this Parliament.
The shadow Secretary of State quoted selected statistics on access to a GP, yet 86% of patients are satisfied with their GP practice. The Government have introduced a £50 million challenge fund, which will support more than 1,000 practices to develop innovative and flexible services. That will include Skype and e-mail consultations, as well as extended hours, and will benefit more than 7 million people.
The right hon. Member for Cynon Valley (Ann Clwyd) again spoke extraordinarily passionately, giving a voice to those who feel they have no voice in our system. We should all express our gratitude to her for her continued campaigning on this critical issue, which demonstrates that we still have a long way to go if we are to ensure that we have a system of which we can all be genuinely proud. Like the right hon. Lady, I hope that one day the flood of letters on poor care will stop. We are doing what we can through the actions we are taking and we are grateful to her for the enormously valuable work she did on the complaints system. I hope the Labour Administration in Wales will do the same, especially after she eloquently highlighted the problems there in a recent BBC documentary.
Norman Lamb
I have given way quite a lot; I need to make some progress.
The right hon. Member for Newcastle upon Tyne East (Mr Brown) asked about allocations. It is right that the allocation of funding is no longer a political football but in the hands of experts. NHS England is seeking to make progress on reducing inequalities.
The hon. Member for Blyth Valley talked about charging in the NHS. Access to NHS services is based on clinical need, not on an individual’s ability to pay. That is fundamental to the NHS, and for as long as this coalition Government are in power the NHS will remain free.
We heard from Members on both sides of the House —my hon. Friend the Member for Bracknell (Dr Lee) and the hon. Member for Westminster North (Ms Buck)—that health care needs to change so that care is provided more locally. The better care fund establishes a £3.8 billion pooled fund, to help people to stay healthy and independent.
Norman Lamb
Of course it is not new money—this is a different way of working. We have never claimed that it is new money; this is to ensure that we use the money more effectively. Indeed, the hon. Lady’s Front-Bench colleagues have made the argument that by pooling the health and social care budgets, we can achieve more with the money available.
Norman Lamb
No, I will not; I have given way many times. The fund is the largest financial incentive by any Government to promote integrated care, and it would be better if Opposition Members applauded the initiative rather than constantly criticising it.
At the start of this Parliament, this Government had five priorities for health and social care. We have delivered on all of them. Through the Care Act 2014, we have delivered the most profound change to the care and support system for a generation. After a decade of inaction under the previous Labour Government, we have introduced, for the first time, a cap on care costs and extended means-tested support. No one will have to sell their home during their lifetime to pay for care.
Under the leadership of Public Health England, we have created a new public health service, giving public health the priority it deserves in local government alongside other local services. As my hon. Friend the Member for Newbury (Richard Benyon) outlined, it is vital that we prevent ill health in the first place, as opposed to repairing the damage once it is done.
We are transforming health and care so that services are integrated around the needs of patients and users. We have revolutionised NHS accountability and seen a successful transition to a new health and care system. Finally, by focusing on outcomes rather than top-down diktat, we can identify what works and where we need to give additional support to help the system do more.
Mr Jamie Reed
I always enjoy the hon. Gentleman’s emollient Dr Jekyll, in contrast to the Secretary of State’s Mr Hyde. Will he be following the Crosby diktat and keeping his head down and his mouth shut about the Government’s record on the NHS between now and the general election, or will the Liberal Democrats be doing something rather different?
Norman Lamb
I am very happy to speak for myself, and I will do so in due course. I am sure that the Secretary of State is enormously grateful to the hon. Gentleman for his description of him.
In the final session of this Parliament, the Government will continue to ensure that the new health and care system works with both integrity and purpose, delivering safe and compassionate care to patients, their families and friends.
Ordered, That the debate be now adjourned.— (Mr Gyimah.)
Debate to be resumed tomorrow.