Care and Support

Bill Esterson Excerpts

Wednesday 11th July 2012 Commons Chamber

[Mr Lansley]

I completely understand my hon. Friend’s point. We very much reflect the need for care and health care in the allocation of resources to local authorities through the formula grant, and the allocation of resources to the NHS through the NHS resource allocation.

[Bill Esterson (Sefton Central) (Lab)]

Councils have faced a £1 billion cut in their funding for care of the disabled and elderly since the right hon. Gentleman’s Government came to power. Without the cash, the White Paper will be meaningless. How confident can he and everybody else in the country be that the Treasury will cough up, given the track record so far of a £1 billion cut to councils?

[Mr Lansley]

I am sorry, but I simply do not recognise the figures that the hon. Gentleman is using. The Association of Directors of Adult Social Services has suggested—these are not my figures—that this year the service reduction in adult social care budgets on a monetary basis was £113 million and last year it was £226 million. The great majority of the figures he is quoting are actually not cuts at all; rather, they are service efficiencies, which are being reinvested for the benefit of maintaining eligibility.

NHS Annual Report and Care Objectives

Bill Esterson Excerpts

Wednesday 4th July 2012 Commons Chamber

[Mr Lansley]

My hon. Friend makes an important point. Part of the measurement of the performance of ambulance trusts, together with their hospitals, is to record the number of occasions when ambulances wait more than 15 minutes before discharging their patients into the service. The Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), is very concerned and pursues precisely those issues, so I will ask him to look into the matter further and respond to my hon. Friend.

[Bill Esterson (Sefton Central) (Lab)]

The Secretary of State told us earlier that every ambulance trust was meeting core response times, but I have to tell him that that is not the experience of my constituents, including Mrs Taylor, who had to wait 90 minutes after falling down stairs. Is not the truth that this is the result of reorganisation and the resulting cuts are making it impossible for ambulance trusts up and down the country to hit the times he says they are hitting, because they are not actually doing it?

[Mr Lansley]

No, and I do not think that the staff of ambulance trusts will appreciate the hon. Gentleman generalising from the particular. I have not said that ambulance trusts reach every case in the time we intend, but the figures show that all ambulance trusts across England have met the category A target for responding consistently at a level they have not previously achieved.

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 12th June 2012 Commons Chamber

[Mr Lansley]

I entirely understand my hon. Friend’s concern, and I applaud the way in which she has expressed it. The BMA’s proposed action could result in up to 30,000 operations being cancelled, as many as 58,000 diagnostic tests being postponed, and more than 200,000 out-patient appointments being rescheduled. I do not think that the House will understand why the BMA would risk patient safety in that way, when it knows perfectly well that its action will have no benefit and that we cannot now go beyond the basis for pension reform that has been agreed with the majority of the NHS trade unions, especially in circumstances in which doctors will continue to receive an extremely generous pension worth up to £68,000 a year at the end of their working lives. I think that the right hon. Member for Leigh (Andy Burnham) and I share the view that this is not a justified position for the NHS to take. The pension is intended to be a generous one. Through the negotiations with the BMA and the other trade unions, we arrived at a very generous pension scheme.

[Bill Esterson (Sefton Central) (Lab)]

T3. Thanks to the staff at St Thomas’ hospital in London, and at Aintree in Liverpool, I have had excellent health care myself in the past three weeks, but, in order to build the morale of staff across the NHS, will the Secretary of State instruct all NHS trusts not to cut anyone’s pay?

[Mr Lansley]

I am glad that the hon. Gentleman has had excellent care; he might like to tell those on his own Front Bench about it, as they are constantly denigrating the NHS. I will simply reiterate what he will have heard me say previously, which is that I have made no proposals to cut anybody’s pay in the NHS.

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 27th March 2012 Commons Chamber

[Mr Simon Burns]

I hope I can reassure my hon. Friend. PCTs carrying legacy debt into 2012-13 must clear it. Clinical commissioning groups will not be responsible for resolving primary care trust legacy debt that arose prior to 2011-12. It is expected that aspirant CCGs will continue to work closely with primary care trusts and primary care trust clusters in 2012-13 to ensure that no PCT ends 2012-13 in a deficit position.

[Bill Esterson (Sefton Central) (Lab)]

One NHS consultant told me that

“NHS reorganisation could mean that you are forced to spend around 10% of your income on private health care insurance.”

Does the Secretary of State accept that the doctor is right to say that people will either wait longer for care or they will have to pay for it?

[Mr Lansley]

That is complete rubbish. The legislation is absolutely clear that it does not lead to privatisation, it does not promote privatisation, it does not permit privatisation and it does not allow any increase in charges in the NHS. It simply creates a level playing field so that NHS providers will not be disadvantaged compared to the private sector, as they were under a Labour Government.

Health and Social Care Bill

Bill Esterson Excerpts

Tuesday 13th March 2012 Commons Chamber

[Andy Burnham]

I agree with the hon. Lady. It is that ideology that the NHS and health professionals are rejecting. They want to work in an essentially collaborative health service. They do not accept the vision that pits hospital against hospital and doctor against doctor.

Barely anybody has a good word to say about this busted flush of a Bill, which has lurched from one disaster to another. The unprecedented pause did not address the real concerns, but simply added bureaucracy and complexity. The 1,000-plus amendments are not a sign of improvement, but of confusion, complexity and contradiction. They have left a mess of a Bill that even the Health Secretary cannot recognise as his own. If that was not bad enough, an unfolding communications disaster has alienated the very people the Government are depending on to implement their Bill. A Downing street summit was called to discuss the implementation of a reform that is about clinical leadership, but doctors’ and nurses’ leaders were shut out of Downing street. It was hard to see how the situation could get any worse, but it just has.

First, on Friday, the Information Tribunal ruled against the Government and in favour of my right hon. Friend the Member for Wentworth and Dearne (John Healey). I pay tribute to the assiduous way in which he has pursued his principled case. The tribunal ruled against the publication of the strategic risk register, but in favour of the publication of the transition risk register, vindicating our position and dismissing the Prime Minister’s claims against my actions as Health Secretary.

Let us be clear about what that ruling represents. It is an incredible state of affairs for any Government to suffer such a serious legal reversal at this stage of a protracted parliamentary process. It is an indictment of the judgment, or lack of it, of the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) and others in the Department, in their handling of the Bill. Where is the Minister’s good grace in defeat? It is simple: my right hon. Friend the Member for Wentworth and Dearne won and the Government lost. What are they waiting for? They must publish the risk register today and give Parliament the courtesy of knowing all the relevant information on Ministers’ plans before they ask us to approve them. Instead, what do we get? Silence and playing for time. They are hoping to string it out until after 20 March. That is simply not good enough.

[Bill Esterson (Sefton Central) (Lab)]

My right hon. Friend is, as ever, making the case for the NHS, not for the privatisation that the Tories and their Lib Dem friends are pursuing. We are talking about the future of the NHS, so let me quote Victoria Roberts, a student nurse from Merseyside, who starts her training in two weeks. She says:

“I am a student nurse due to start my training in 2 weeks. This is not the NHS I want to serve or work in, but rather will help only those who can pay the most.”

Does my right hon. Friend agree with that assessment of where the Tories are taking the NHS?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. We must have shorter interventions. A lot of people want to speak and we have got to get on with it.

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

I want to speak in support of the motion, which notes the e-petition and declines to support the Bill in its current form. As has been said but deserves repeating, the Conservative-led Government have no democratic mandate for the Bill; quite the opposite, given the Prime Minister’s promise that

“with the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures”

of the NHS. Yet this reckless and unnecessary top-down reorganisation will cost £3.5 billion, which could be spent on patient care.

Already in my local area and many others, patients are losing services, waiting longer and receiving poorer treatment than before. Salford primary care trust has ended its active case management service for people with long-term conditions—the service had been both popular and effective. NHS budget cuts have meant that a community matron service was ended in a local area.

The Select Committee on Health recently dealt with the impact of the NHS reorganisation in its report on public expenditure—my right hon. Friend the Member for South Shields (David Miliband) quoted it. The report concluded:

“The reorganisation process continues to complicate the push for efficiency gains...it more often creates disruption and distraction that hinders the ability of organisations to consider…effective ways of reforming service delivery and releasing savings.”

Cuts are having a direct effect on treatment. A staff member of the local branch of the Parkinson’s Disease Society told me recently that NHS cuts mean that GPs and pharmacists are switching to cheaper brands of drugs for patients with Parkinson’s, many of which are much less effective. One person was admitted to hospital. She became ill following a switch to a cheaper, less effective medicine. The hospital staff told her that she should be “firm with her GP” and insist on the more expensive brand.

The Bill brings competition into the NHS at a level that is unhealthy and unwanted. The PIP breast implants saga showed us the dangers for the NHS of a vast increase in private provision when regulation of medical products for use in surgery is so poor. In January, 14 consultants, GPs and public health experts wrote a letter to The Times about the expansion of private provision and the issues arising from PIP implants. They warned that the Health and Social Care Bill

“provides much less protection for patients should their provider fail than is available to people booking package holidays”.

With PIP implants and private surgery, there was a strong marketing sell to patients of the benefits of surgery but little information about risks, and little or no interest in aftercare. That is an important warning. We know that there are potential health issues with metal-on-metal hip implants, yet there will be pressure on patients waiting for a hip or knee replacement to go for private surgery to avoid the waiting lists that we know are building up.

The Bill risks creating a two-tier NHS and a return to the long waiting lists experienced under Conservative Governments in the 1990s—the Government have already watered down guarantees on NHS waiting times. I recall meeting a patient in 1997 who had been waiting up to two years for vital heart surgery, yet more recently in my constituency I have met people whose lives have been saved in a matter of days by the rapid diagnosis and treatment of cancers.

A number of local GPs have written to me calling on the Government to drop the Bill because they feel it undermines the bond of trust between doctor and patient. One GP told me:

“The reforms are being made on the cheap. GPs are being asked to do the work of the PCTs with half of the funding and all of the blame when problems arise. The Bill drives a wedge between primary and secondary care.”

That GP actually supports the theory of clinicians being given more input and supports a reduction in bureaucracy, but says that the Bill “does the exact opposite” because it introduces new layers of bureaucracy such as the clinical senate. He says that people coming in

“are doing so at different levels of understanding…leading to confusion.”

He feels that, ultimately,

“it will be the patients who will suffer…no one has asked the patients what they want.”

[Bill Esterson]

My hon. Friend describes a GP in her constituency, but a GP in mine described his concern to me. He said that he is there to be a doctor and wants to care for patients, and that he does not have the expertise to be a manager. That is the overwhelming concern of his colleagues around the country. Does she agree that that is the danger of that part of the Bill?

[Barbara Keeley]

I very much agree. Only quite recently have GPs expressed such concern. I have never known GPs to come to their MPs in numbers, as they are doing, to complain about the implementation issues they are already finding. As I said, the GP I quoted supported the idea of GPs being more involved with decisions about patients, but he now thinks that the Bill is

“simply a mask for a cost cutting exercise…a way to deal with the NHS on the cheap. A way of farming out support systems…e.g. clinical support, into the private sector.”

He says:

“More money will be taken out of the NHS and put into the private sector.”

The hon. Member for South West Bedfordshire (Andrew Selous) asked us to trust the wisdom of our GPs. That is a damning indictment by a Salford GP, and one that I believe is echoed by GPs up and down the country. Trusting the wisdom of my local GP, I urge hon. Members to support the motion.

--- Later in debate ---

[Grahame M. Morris]

That is precisely our fear, and I hope to develop that argument in a moment.

The national health service was established in 1948, against the background of the devastation following a world war. Men and women with a vision for a better, fairer society set in law the guiding principles and values of our NHS. Let us not forget that, during the post-war period, this country faced a bigger deficit as a proportion of our national wealth than we are facing today.

[Bill Esterson]

Will my hon. Friend give way?

[Grahame M. Morris]

I am afraid not, as I have very little time.

Those people knew that the value of money would be worthless if it did nothing for ordinary people. Nye Bevan stated:

“No longer will wealth be an advantage, nor poverty a disadvantage. Healthcare will be provided free of charge, based upon clinical need and not on ability to pay”.

In contrast, this Government seem to see any money spent by public sector providers as somehow wasteful unless it is trickled through their friends in the private sector who can turn a profit. I am concerned that their whole philosophy is antagonistic towards the public sector. I was outside the Lib Dem conference on Saturday, lobbying the delegates. I hope that Lib Dem MPs will support the motion tonight.

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 12th July 2011 Commons Chamber

[Mr Lansley]

As we said in the NHS constitution, we do not intend patients to be waiting for more than 18 weeks. [Hon. Members: “They are!”] The April figures show that we met the operational standard, which is that more than 90% of admitted patients and more than 95% of non-admitted patients should be treated within 18 weeks. The right hon. Gentleman’s analysis of waiting times did not include the fact that the average time for which patients waited for treatment in April was 7.7 weeks, down from 8.4 weeks in May 2010. The average time for which patients wait is being reduced.

[Bill Esterson (Sefton Central) (Lab)]

2. What assessment he has made of the conclusions and recommendations of the recent report by the Commission on Funding of Care and Support.

[Chris Ruane (Vale of Clwyd) (Lab)]

7. What assessment he has made of the conclusions and recommendations of the recent report by the Commission on Funding of Care and Support.

--- Later in debate ---

[The Minister of State, Department of Health (Paul Burstow)]

As the Secretary of State said in his statement to the House last week, the Government welcome the report of the Commission on Funding of Care and Support and will consider its recommendations carefully.

[Bill Esterson]

The Government may say that they welcome the report, but can the Minister explain why the White Paper on social care will now be published in spring 2012 rather than in December 2011, as the commission’s report recommends? Do the Government want it to be kicked into the long grass because of Treasury interference?

[Paul Burstow]

The hon. Gentleman is entirely wrong. The Government’s approach is to have discussions with the official Opposition and to engage fully with stakeholders from Age UK, Carers UK and many other organisations, not just about funding reform—which is an important part of our reform of social care—but about questions of quality and law reform.

Southern Cross Care Homes

Bill Esterson Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

What I have told the House is that the process in hand, following the statement made yesterday by Southern Cross, will ensure a smooth transition of every home to a new operator over the next four months.

[Bill Esterson (Sefton Central) (Lab)]

This will be of great concern to many people who live and work in homes that are not run by Southern Cross. Many other people will be affected. The Minister has spoken about regulation and care home standards. Will he bring forward proposals to consider the business regulation, and can he tell us when he will do that? That is the way to provide reassurance and security for many people who live and work in homes other than the 31,000 in Southern Cross.

[Paul Burstow]

My right hon. Friend the Secretary of State for Business, Innovation and Skills has already made statements and commitments about looking at the business model and at why it was thought to be appropriate for this sector.

Health and Social Care Bill (Programme) (No. 2)

Bill Esterson Excerpts

Tuesday 21st June 2011 Commons Chamber

[John Pugh (Southport) (LD)]

I will briefly specify three linked reasons, good and bad, why we support the Government’s programme motion. We oppose the Opposition’s amendment to the motion because it would simply lead to unnecessary delay. The Government have identified through the listening exercise, perhaps belatedly, the controversial, difficult and unworkable aspects of the legislation and want to change them. In deference to the people they have consulted, they want to change those aspects promptly and subject them to proper scrutiny, not only in Committee, but in an evidence session that we will also have.

Surprisingly, many areas of the Bill are relatively uncontentious and ought not to detain the House a great deal longer, such as the aspects relating to social work, the health and care professions or the National Institute for Health and Clinical Excellence. Those areas are relatively uncontentious and need not be massively reconsidered. In addition, there is the summer recess, as the right hon. Member for Wentworth and Dearne (John Healey) said, which means that after the Committee has concluded its considerations there will be ample time for him and anyone in the NHS, including all the consultees, to make adequate representations. The Bill will then go to the Lords and return for our further consideration.

[Bill Esterson (Sefton Central) (Lab)]

The hon. Gentleman will have been lobbied by constituents in the same way that I and other Members have been. Does he agree that the public’s real concern is the potential for cherry-picking by private companies, even with the amendments that are being made, and that this approach will be unable to stop such a process?

[John Pugh]

The public are perfectly entitled to an answer on whether the Bill contains cherry-picking or not, but it is better that they have that answer sooner rather than later. There is a second reason—[Interruption.] May I just set my stall out? The second reason why this must be done properly is that the Bill has so far led to uncertainty and the implosion of primary care trusts. Whoever’s fault it is—[Interruption.] People will know that I did not support the original Bill. It has led de facto to the implosion of PCTs and to some irregular adjustments and appointments being made on the hoof—Members can ask their constituents about that—and to some premature arrangements being made.

NHS Future Forum

Bill Esterson Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

As I have said, we will expect, and the Future Forum says, that commissioning groups should not normally cross local authority boundaries—in this respect, boundaries for social authorities—but they should be able to make a case for doing so based on benefit to patients. The one thing I would urge is that they are very clear with their local authorities about how they can secure the continuing integration of health and social care at a local level.

[Bill Esterson (Sefton Central) (Lab)]

Is not the reason the Secretary of State has so much support from the right wing of his party that they know that this will lead to privatisation of large parts of the NHS, as he confirmed in his answer on preferred suppliers?

[Mr Lansley]

I hope that my colleagues would support me in saying that I have support from colleagues right across the coalition, because the coalition Government are supporting the NHS in enabling it to deliver improving services. That is what it is all about.

NHS Reform

Bill Esterson Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend. Perhaps having increased the number of managers in the NHS by 70%, the Labour party thought that it would be swept to victory on the votes of NHS administrators. That did not happen. People in the NHS knew that waste, inefficiency and excess bureaucracy were not the way to deliver the best care for patients. That was Labour’s way; it will not be our way.

[Bill Esterson (Sefton Central) (Lab)]

Given that the Secretary of State will not instruct NHS managers to take a natural break in implementing his so-called reforms, does he understand why his intention to make changes after the natural break might be questioned? As colleagues have suggested, is the natural break just like every other Tory consultation—a sham?

[Mr Lansley]

There is nothing sham about this. This is serious business, not a political game, as it appears to be for Opposition Members. Tens of thousands of people across the NHS are engaged in managing and developing new services, which will deliver improving outcomes and be more responsive to patients, through devolved decision making in the NHS. I think that we should simply help and support them, not least by listening to them.