Francis Report: Update and Response

Chris Skidmore Excerpts

Wednesday 11th February 2015 Commons Chamber

[Mr Hunt]

I hope the hon. Lady will be pleased to know that we have now made it a criminal offence to supply false or misleading information, but let me respond to the broad point that she has made, because I think it is important.

The publication of data is indeed welcome, but we do not want it to cause the entire NHS to focus on gaming the system, or changing the way in which data are collected in order to make its organisation look better. The purpose of data is to identify issues. The CQC then makes rounded judgments on the performance of institutions, which are based not just on data but on visits and conversations with patients, doctors and nurses. I think that that system can provide us with the best understanding of how well those institutions are actually doing.

[Chris Skidmore (Kingswood) (Con)]

As the Secretary of State will know, my hon. Friend the Member for Bristol North West (Charlotte Leslie) and I wrote to him about Southmead hospital after a large number of our constituents had written to us about poor quality care there. Today the CQC published its report on North Bristol NHS Trust and Southmead, which states that the urgent and emergency services are inadequate and causing a

“serious risk to patients’ safety”,

and also states:

“Several staff told us they were ‘ashamed’ of the standard of care”

at Southmead.

I have just received a letter from the chief executive of North Bristol trust, which makes no mention whatsoever of the fact that Southmead A and E had been declared inadequate. Instead, she simply refers to

“some teething problems which are being dealt with”.

Does that letter not illustrate the overall culture problem in the NHS, namely that there is active denial among some chief executives who will not admit what is going wrong in their local hospitals?

[Mr Hunt]

I have not seen the letter, so I hope that my hon. Friend will understand if I do not comment on it, but I strongly agree with his broader point. Any chief executive or manager in the NHS needs to understand that the best way in which to reassure the public, and to reassure Members of Parliament who speak out for their constituents, is to be honest about the problems.

My local trust was the first in the country to be given an “outstanding” rating. When I last went to see its chief executive, I said that I had three constituency problems, and I raised all three of them with him. He said, “Yes—we were wrong on that one; we should not have done that; and we were wrong on that one.” One of the best trusts in the country was being totally honest about its problems, and wanted to do better. We need to make managers understand that that is the right thing to do, and that we will back them if they do it.

National Health Service

Chris Skidmore Excerpts

Wednesday 21st January 2015 Commons Chamber

[Chris Skidmore (Kingswood) (Con)]

I thank the Department for recent rises in health care funding in South Gloucestershire. Only yesterday, I received a written answer to a parliamentary question showing that South Gloucestershire CCG will receive £263 million for 2015-16, which is up from £249 million in 2014-15 and from £239 million in 2013-14. That 7% increase in per person funding, from £921 in 2013 to £997 today, is the 16th largest rise out of 211 CCGs. Tomorrow, I will attend the opening of the Leap Valley medical centre in Emersons Green, which is a brand-new, multi-million pound GP centre for the benefit of my constituents in Downend and Emersons Green. Things are therefore looking up for NHS funding in South Gloucestershire and Kingswood.

I was pleased to have a meeting with the Chancellor at which my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) and I convinced him to give £1 million from LIBOR funds to the Great Western air ambulance, about which the chief executive has said that he is absolutely delighted. As the local MP, I have been pleased to be able to push for such improvements in health care.

I want to raise my concerns about the health care situation in Bristol, particularly in relation to Southmead hospital, a brand-new hospital under a £500 million private finance initiative contract that was signed and sealed under the previous Government. As a consequence of the opening of Southmead hospital, Frenchay accident and emergency was closed. It is no coincidence that Southmead has struggled since that closure. As a candidate and as an MP, I fought to keep the A and E open, after the decision to close it was taken in the Bristol health services plan for 2004 to 2006.

I still believe that the closure of Frenchay A and E was an absolute disgrace for our local community. We all know that it happened when the local North Bristol NHS Trust decided to prioritise Southmead over Frenchay because Frenchay’s more expensive land could be used to build a housing estate. We are now seeing the consequence of the reorganisation that took place under the previous Government. It happened despite the fact that 50,000 people signed a petition to get the then Secretary of State, Patricia Hewitt, to refer the decision to the Independent Reconfiguration Panel, which she refused to do. It was a total mistake for the previous Government to decide to prioritise Southmead over Frenchay.

Cossham hospital, another hospital in my patch, was threatened with closure in 2004. The Save Cossham Hospital campaign group was fantastic in opposing that potential closure by the health chiefs of North Bristol NHS Trust as part of the disastrous Bristol health services plan. As a result, Cossham hospital has had a £19-million refurbishment and looks fantastic. I believe that the shadow Secretary of State visited it a couple of months ago.

However, there is a gaping hole, because the minor injuries unit that was promised for Cossham hospital is yet to be delivered. Along with all the parties and the fantastic Save Cossham Hospital group, which is led by Reg Bennett, we have collected well over 17,000 signatures to call for the minor injuries unit. I have secured several debates in Parliament, as the Minister well knows, to call for a Cossham MIU. Regardless of the status of the minor injuries unit, we were promised it because Frenchay A and E was closing. That decision was taken by the previous Government, as I said, and the final contracts were signed in February 2010.

Having been promised this health resource in Kingswood after Frenchay A and E closed, we deserve to get it. It is too far to get round to the other side of Bristol and there are no proper bus services to Southmead hospital. We must remember that NHS services are funded by the taxpayer, so every taxpayer deserves equitable treatment and access to local health care services. I do not believe that my constituents are getting that because Frenchay A and E has closed and Southmead is too far away. We need our minor injuries unit at Cossham hospital.

Only today, there was a meeting of the public health and health scrutiny committee of South Gloucestershire council. On 19 November, I spoke at the committee in person to call for the decision about the minor injuries unit to be referred to the Secretary of State. The committee agreed in principle. I contacted the Department this week, having had regular meetings with the Health Secretary to discuss Cossham and Frenchay, only to find that no letter has been sent by the committee to the Health Secretary. The Department of Health simply has not received such a letter. Today, it turns out that the committee is yet to refer the decision to the Health Secretary. Without that official referral by the committee, the Health Secretary cannot refer the decision to the Independent Reconfiguration Panel.

I call on South Gloucestershire’s public health and health scrutiny committee to get a move on, pull their finger out and send the letter to the Health Secretary. I hope that Ministers will confirm that once they receive the letter, they will be able to refer the decision about Cossham minor injuries unit to the Independent Reconfiguration Panel. It is simply not good enough for the committee to have this month-on-month delay without sending the referral letter to the Health Secretary. People in Bristol have waited too long. They saw Frenchay A and E close, which was a disgrace and will always be Labour’s worst legacy in my local area. We need the minor injuries unit at Cossham hospital and I will continue to fight for it every single day.

A and E (Major Incidents)

Chris Skidmore Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

I am aware of the situation in Leicester. The hospital has had significant space pressures in its emergency department, and a couple of nights ago it had a high in-flow during one night, but it is absolutely on the case in trying to resolve this. What are we doing? We have put in £9.2 million of winter pressures money to make sure that whatever people decide the right solution is, it is not through lack of resources that they cannot do it.

[Chris Skidmore (Kingswood) (Con)]

Last Saturday night, while I was visiting my wife’s family in Leicestershire, my baby daughter suddenly became quite ill. Rather than going to A and E, we rang the 111 service and were quickly referred to Loughborough urgent care centre, where we had fantastic treatment; I pay tribute to the staff. Does this not go to show that we need to prioritise new models of urgent care, as set out in Simon Stevens’s review?

[Mr Hunt]

We absolutely do that. Telephones and the internet provide different ways to get the right advice to people quickly. The 111 service is taking a considerable amount of strain at the moment, and we have put in more money to support it. We are investing a lot more in tele-health and tele-medicine, and a lot more to help GPs who want to give people out-of-hours appointments. In the long run, that is the way we will reduce the kinds of pressures that my hon. Friend talks about.

Tobacco Products (Standardised Packaging)

Chris Skidmore Excerpts

Thursday 3rd April 2014 Commons Chamber

[Jane Ellison]

The Government have a tobacco strategy that has been published. Today, I am presenting a statement about standardised tobacco packaging and nothing else.

[Chris Skidmore (Kingswood) (Con)]

In my constituency the printer Amcor prints more than 5 billion cigarette packets a year and is one of the largest manufacturing companies of its kind in the country. The factory employs 150 local people and there is a manufacturing train of more than 1,000 local people. I support any measures that will reduce smoking among impressionable young people, but when the Minister talks of standardised packaging, is there any chance that after the review is conducted she can talk of “standardised and complex” packaging, to secure those local jobs at Amcor and other printing companies across the country?

[Jane Ellison]

My hon. Friend is right to draw attention to the fact that standardised packaging is complex and far from the plain brown paper packs sometimes portrayed. Sir Cyril mentions that issue and draws a clear distinction in his report. I would welcome my hon. Friend making a submission to the consultation about the impact of this measure on employment in his constituency. That will of course be weighed in the balance, but it is important constantly to remind the House of the enormous economic impact of the burden of disease on our population.

Health Care (Gloucestershire)

Chris Skidmore Excerpts

Wednesday 19th March 2014 Commons Chamber

[Chris Skidmore (Kingswood) (Con)]

My hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) and I have been calling for this debate for some time, so we are grateful for the opportunity to discuss health care provision in south Gloucestershire.

In 70 days’ time, the accident and emergency department at Frenchay hospital in south Gloucestershire will close its doors. The decision on this is not recent, as it was taken in 2005 under the Labour Government, who then refused to allow it to be referred to the independent reconfiguration panel, despite a 50,000-signature petition from local people. The decision to close the A and E was also voted through locally by Labour councillors against Conservative opposition. When my hon. Friend and I were elected to this place in 2010, we called a debate on the future of Frenchay hospital in which it was confirmed that contracts had already been signed under the Labour Government to close Frenchay’s A and E, making the decision irreversible. The downgrading of Frenchay will forever be Labour’s legacy to the people of south Gloucestershire. My hon. Friend will speak later about the hospital and the continuing uncertainty over the health care provision that will be based there.

For the first time, this Government allowed South Gloucestershire council’s health scrutiny panel to refer recent decisions by health care managers temporarily to relocate beds to Southmead hospital while the final provision of beds at Frenchay was investigated by the independent reconfiguration panel—something that the previous Government resolutely refused to do. As local MPs, we submitted our own statements in support of Frenchay to the IRP along with local campaigners, and they are listed in the report’s appendix, yet we were surprised to see that no statements of support were made by the local Labour party or by its candidates.

The publication of the IRP report on Frenchay this week highlights—

--- Later in debate ---

Motion made, and Question proposed, That this House do now adjourn.—(Mr Gyimah.)

[Chris Skidmore]

The publication of the IRP report on Frenchay this week highlights for the first time real concerns about the reconfiguration of health care provision in south Gloucestershire. These concerns are so damning that it is right that we as local MPs raise them now on the Floor of the House. The IRP rightly observed not only that health care provision had been subject to continual alteration since 2005, but that

“there is considerable public disquiet with the process to date”,

that

“residents of the area should feel exasperated by the years of delay”,

that

“the overall process to date has shown a marked lack of empathy for patients and the public who have a right to expect better”,

and that

“progress to date has suffered from a lack of trust from the public”.

The IRP goes on to recommend that

“a new approach to pubic engagement and involvement is required that demonstrates mutual co-operation and ensures that the public can have confidence in a quality service”.

Importantly, the IRP also notes that

“concerns remain about access to outpatients and diagnostics, capacity for rehabilitation services particularly in light of housing developments, and the absence of external clinical assurance”.

The IRP has finally put on record what local people and groups such as the Save Frenchay Hospital group have long been saying. North Bristol NHS Trust and health care bosses must now listen to them, and to the IRP in the light of its damning conclusions.

I am concerned, however, that history is about to repeat itself at nearby Cossham hospital. As a member of the league of friends at Cossham hospital, and someone who volunteers at the café there—I hope that that will suffice as a declaration of interest—I know at first hand how cherished Cossham hospital is within the Kingswood community. In 2004, the hospital was threatened with closure. Then—a story all too familiar—the health care bosses said that they knew best and that there were strong clinical reasons for shutting the hospital, yet they underestimated the determination and resolve of the Save Cossham Hospital campaign group, which mounted a remarkable cross-party campaign to save the hospital from closure.

In the end, the decision to close Cossham was reversed, and the hospital underwent a £19 million refurbishment. So far, this has included a new renal dialysis unit, an X-ray and scanning department, physiotherapy and out-patient appointments, and Bristol's first free-standing, midwife-led birth centre, which has already delivered hundreds of babies. But the minor injuries unit at Cossham hospital, which was promised as part of the Bristol health services plan, and reaffirmed by the 2009 business plan for the hospital—signed and sealed, as it were—has not been delivered. Instead, the commissioning group is now considering installing a rapid assessment centre for the elderly in its place. Obviously we must consider an ageing population, but in this particular case we should be considering the needs of the entire health care community in south Gloucestershire.

As the local MP for Kingswood, I feel that not to have a minor injuries unit for Cossham is unacceptable. With Frenchay A & E closing in just 70 days, if local people are in need of treatment for an injury, they will have to travel 11 miles to Yate, or have to travel across Bristol to Southmead hospital or to the Bristol royal infirmary. As many local people know, public transport to Yate and Southmead is woeful, with the bus often taking several hours. Without a minor injuries unit at Cossham, I remain concerned about health care provision for the east side of the Bristol region. I set out the case for a minor injuries unit in my letter to the Health Secretary on 26 February, and I would welcome the opportunity for the reformed Save Cossham Hospital group to meet the Minister to present the case in detail. There is a clear and present need for a minor injuries unit at Cossham, and a clear and present danger to our local community if it is not delivered.

I cannot impress enough on the Minister that I believe that, just as in the case of Frenchay hospital, and in the light of the highly critical IRP report on its changing services, the ability of health care bosses continually to chop and change health care services at Cossham and in the south Gloucestershire area without regard to public opinion and confidence is extremely damaging. Above all, it raises questions about why local people, who pay for their health service through their own taxes, should feel, as the IRP report states, “exasperated” by the uncertainty surrounding the health care for which they have paid.

The people of Kingswood and south Gloucestershire, as the IRP has firmly stated, “deserve better”. We also deserve better when it comes to the provision of a minor injuries unit at Cossham. We were promised a minor injuries unit, we want a minor injuries unit, and for the sake of the health and safety of local people in my community, we need a minor injuries unit at Cossham hospital.

Oral Answers to Questions

Chris Skidmore Excerpts

Tuesday 22nd October 2013 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

I pay tribute absolutely to that local initiative, which is exactly the sort of direction we are going in. I have made the point several times that we cannot get great care on the back of exploiting workers. The idea that people should not be paid while they are travelling from one house to another is, in my view, unacceptable. When employers and care providers breach the minimum wage legislation, we should be absolutely clear that that is completely unacceptable. To ensure great care, the Government are introducing in 2015-16 the £3.8 billion integrated transformation fund, which will pool resources between the NHS and social care to ensure that we shift the focus to preventing ill-health and deterioration, and I think that that can make a real difference.

[Chris Skidmore (Kingswood) (Con)]

T7. I and my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) have long campaigned for the maximum hospital facilities at Frenchay hospital, including a community hospital with an outpatients clinic—as was agreed as part of the Bristol health services plan in both 2005 and 2010. Now it seems that NHS managers are attempting to revisit these plans, something to which I am opposed, as is my hon. Friend the Member for Filton and Bradley Stoke, who has recently written to the Secretary of State to ask for a meeting to look into the situation. Will the Secretary of State agree to meet us both and investigate the situation?

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I am always happy to meet colleagues for discussions, particularly when they are championing important health care facilities in their local area. I can confirm that the Secretary of State has received a formal referral from South Gloucestershire council in relation to these proposals, and has referred them to the Independent Reconfiguration Panel. He will of course consider the panel’s recommendations before making a final decision, and I am sure that my hon. Friend would agree that it would be inappropriate to pre-empt those deliberations.

NHS Commissioning Board

Chris Skidmore Excerpts

Tuesday 5th March 2013 Commons Chamber

[Norman Lamb]

When the hon. Lady talks about back-door privatisation of the NHS, I am not sure of her view of the previous Government’s commitment to spend £250 million on independent sector treatment centres, whether or not they undertook any operations. I am not sure that she agreed with it, but that is what her Government did. There will be no privatisation of the NHS, and the rules we introduce will make it absolutely clear that the power lies with clinical commissioning groups to use the tools available to them—co-operation and integration, but also competition where it drives up standards, just as her Government recommended.

[Chris Skidmore (Kingswood) (Con)]

Last year, the right hon. Member for Leigh (Andy Burnham) claimed that there were less than 72 hours to save the NHS. Yesterday, when referring on his Twitter feed to the regulations, he claimed that there were two weeks to save the NHS. Does not the Minister believe that in fewer than 140 characters, the right hon. Gentleman has shredded any credibility that he might once have had? [Interruption.]

[Norman Lamb]

I think my hon. Friend makes a valuable point. [Interruption.]

NHS Funding

Chris Skidmore Excerpts

Wednesday 12th December 2012 Commons Chamber

[Andy Burnham]

The priorities are all wrong. The Government are spending the money on a reorganisation that none of us wanted in the north-west, and as my hon. Friend says, cancer networks are being cut and are shedding staff. As my hon. Friend the Member for Leicester West revealed this week, they are cutting back on the vital work that they do—and there could be no more vital work. Yet we continue to have a false version of events given to us. Ministers must think we are daft, but we are telling the facts to the country today and people will judge for themselves.

When we put the whole picture together, what we see is a tissue of obfuscation and misrepresentation of the real position on NHS spending. The hon. Member for Mid Bedfordshire (Nadine Dorries), who is, sadly, not in the House today, once made some interesting observations about those on the Government Front Bench, but it is not just that they

“don’t know the price of pint of milk”.

The arrogance of which she spoke seems to give them a feeling that they can claim that black is white and expect everyone to believe it. If they say it is so, then it must be so. Well no, actually. The intelligence of the House need not be—

[Chris Skidmore (Kingswood) (Con)]

On a point of order, Mr Deputy Speaker. Has the right hon. Member for Leigh (Andy Burnham) informed the hon. Member for Mid Bedfordshire (Nadine Dorries) that he would be making comments about her in the debate today?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

That is not a point of order.

Regional Pay (NHS)

Chris Skidmore Excerpts

Wednesday 7th November 2012 Commons Chamber

[Chris Skidmore (Kingswood) (Con)]

It is a pleasure to follow my constituency neighbour, the hon. Member for Bristol East (Kerry McCarthy). I apologise for not attending the earlier Westminster Hall debate secured by the right hon. Member for Exeter (Mr Bradshaw); I will read the Hansard report to see what was said. I want to talk about the background to the debate and the south-west pay, terms and conditions consortium, which affects my constituency. We heard the right hon. Member for Leigh (Andy Burnham) and a few other Opposition Members talk of cartels. It is rather unfortunate that such language has been used, because we want trusts to work together to come up with productive solutions to the problems we face in the NHS.

I have heard from constituents, many of them nurses, who are concerned about what is happening. To be honest, I think that they are concerned because there is a lot of scaremongering and a lot of knowledge has not been put out in the open, partly because the unions that are driving the campaign are refusing to speak to the consortium and engage. We need that engagement from the unions, so I urge them to get around the table.

I wrote to the chief executive of the south-west pay, terms and conditions consortium, Chris Brown, to ask for his reasoning as to why the consortium was formed and why it has put the measures on the table—they are not definite and are there to be discussed by individual trusts. This is about flexibility for individual trusts. As has been discussed, the previous Labour Government provided that flexibility. It will be up to the trusts to decide. We should have faith in local foundation trusts to make the decisions that need to be made.

[Mr Robert Buckland (South Swindon) (Con)]

I am grateful to my hon. Friend for breaking down the language that has been used, because one of the worries my constituents have is that Swindon is right on the edge of the south-west region. The prospect of a wholesale regional pay structure causes them real concern. Is not the issue local pay bargaining and how local trusts run their services to the best of their ability?

--- Later in debate ---

[Chris Skidmore]

The debate is not so much about regional pay because, as my hon. Friend says, there are local considerations to be taken into account; it is about what is the right pay. The right pay is not about lowering pay in poor areas, but about having the right pay in all areas. The right pay is the market rate for an individual, a professional with an individual mix of skills, expertise and experience. One of the problems with the national pay structure is that if trusts want to pay someone more, perhaps an expert, they will be prevented from doing so, which I think is wrong.

[John Pugh (Southport) (LD)]

The hon. Gentleman objected to the use of the word “cartel”. In what sense is it inappropriate in this context?

[Chris Skidmore]

I believe that “cartel” is a rather offensive word to use in this context, because it has connotations that are inappropriate for health care professionals who are doing their best to ensure that the NHS survives in the long term. That is the crux of the debate. Let us look at staffing costs. The Labour Government made a significant investment in the NHS over 13 years. It would be churlish to deny that, but it would also be churlish to deny the fact that a huge proportion of those costs were soaked up in pay.

[Jack Dromey]

The hon. Gentleman has just spoken about paying people the market rate. Sadly, there is a low-wage economy in much of the south-west. That is precisely why regional pay was rejected in the lead-up to “Agenda for Change”. It would lead to the market rate being applied in much of the south-west, driving down pay and conditions of employment. Does he, as a south-west Member of Parliament, support regional pay bargaining for the south-west?

[Chris Skidmore]

What I support is south-west trusts coming together as health care professionals and working out what is best for them in order to survive financially for the future.

I want to read from Chris Brown’s reply to my letter:

“The Consortium was established in response to the serious financial and operational challenges facing the NHS, both now and in the future, and will work to identify ways in which taxpayer funding may be more efficiently used in order to protect both employment and the continued delivery of high quality healthcare.”

There is a significant point in that. I do not want redundancies in the NHS, but if we do not come up with a workable solution for the future, that is what Opposition Members will see, and it will be on their watch if they believe that we should follow the national pay structure. I do not want to see redundancies, and neither do the trusts, which is why they have come together constructively, and they should not be scolded for doing so.

Mr Brown’s letter continued:

“More than two thirds of NHS expenditure is on staffing costs. In recent years NHS organisations have largely exhausted other avenues of potential cost-saving (including reducing reliance on bank or agency staff and implementing service improvement initiatives). Monitor, the independent regulator for NHS Foundation Trusts, has also estimated that NHS organisations with a turnover or around £200m will need to produce savings of around £9m a year for each year until at least 2016/17 to remain in financial health.”

That is why the consortium has been formed. We cannot forget the financial challenge.

[Andy Burnham]

The hon. Gentleman said that the Labour Government gave too much to nurses and midwives in pay—[Interruption.] He said that we spent too much on pay. He also said that the market rate of pay should apply in his area. I want to ask him a direct question. Does he think that his constituents who work in the NHS are overpaid?

[Chris Skidmore]

No, I think that the right hon. Gentleman is misrepresenting what I said. The fact is that we have got to the point—[Interruption.] Nurses, doctors and health care professionals should be paid according to their skills. They should be paid according to what the trusts can afford. The problem we have is that, with an ageing population—

[Andy Burnham]

So they should be paid less?

[Chris Skidmore]

No, they should not be paid less. The right hon. Gentleman should stop splitting hairs. If we want a health care service that is viable for the future, where will the money come from? Perhaps he can answer that. What would he do to be able pay for the future of the NHS, given the demographic challenge we face?

[Andy Burnham]

If the hon. Gentleman gets rid of national pay in the south-west, does he think that the trusts in the consortium, or cartel, should receive a national tariff that factors in a national rate of pay, or should they be paid less for the work they do?

[Chris Skidmore]

What I find so frustrating about this debate is that the right hon. Gentleman has thrown his principles out of the window. He once defended flexibility for foundation trusts, but he now no longer trusts professionals in the way he really should.

[Mr Dorrell]

My hon. Friend asked the shadow spokesman a question as though it was academic, but actually it is not academic. When the right hon. Gentleman was responsible for these things, we know what he thought because it is there on the record. The policy was

“to increase regional and local flexibility in public service pay systems.”

That is what he thought was necessary when he had responsibility.

[Chris Skidmore]

I thank my right hon. Friend for his intervention, which is much appreciated.

The key point is that staffing costs will have to be managed for the future. We cannot get away from that fact. If I am honest in making that point, I am sorry, but we all, regardless of political parties, have to understand the financial pressures the NHS will come under in the decades to come. Staffing costs make up between 70% and 75% of NHS spend. The Nicholson challenge is absolutely vital, and it is not just over four years, as the right hon. Member for Leigh well knows; it will be for ever. We will have to commit to making those efficiency savings so that they can be reinvested in the service if we are to keep the NHS free at the point of delivery. I want an NHS that is free at the point of delivery for my children, yet to be born, and I want it to be there at the end of the century. In order to do that, we need to be responsible about where savings will be made. We are pushing savings at the moment on the outside staffing costs of 20%. The pay freeze has managed to save around £2.5 billion for the Nicholson challenge, as we have heard Mike Farrar from the NHS Confederation explain.

There is a problem, in that the NHS pay freeze will come to an end next year and will have to be renegotiated. Rather than cutting staff numbers, the NHS Confederation is pushing for us to be responsible about what is put into the NHS. That is what we have to consider. We cannot get away from this challenge. It is irresponsible to fly in the face of reorganisation. We need to make savings so that they can be reinvested for the future. That is why it is responsible for the trust and the south-west consortium to take the issue seriously, and it will be up to the individual trusts to decide at the end of the year.

I cannot see any reason why local trusts and health care professionals, who know what is best for their local areas, should not be able to take advantage of the regulations for local flexibilities set out in “Agenda for Change” to ensure that the NHS has the best possible productivity. Let us not forget that the NHS is not free; it is paid for by taxpayers, who deserve the best possible value for money. If the south-west consortium can deliver that, it should be applauded.

--- Later in debate ---

[Alison Seabeck]

The hon. Lady speaks from a wealth of experience of working in the NHS. She is absolutely right on that point, which I will make more of later in my speech.

The public have a right to know what the Government’s position is, but as with so much else, confusion reigns. The Deputy Prime Minister has said at times that he is not in favour of regional pay, but it will be interesting to see how he votes today. The Chancellor of the Exchequer is clearly in favour, but the Prime Minister says nothing. The Secretary of State for Health has not helped to clarify matters today. The amendment, which is in the name of the Chief Secretary to the Treasury, is interesting. It states that the Government will not go down the route of regional pay

“unless there is strong evidence and a rational case for proceeding”.

How will the Government consult and gather the evidence to decide whether there is a rational case for regional pay? When will the Minister make the evidence available to Members of the House?

The Government must understand that the proposal is causing huge concern. The debate is not just about public sector pay restraint. Labour Members have accepted that there needs to be restraint in the public sector. We are not saying that that should not happen in times of austerity, but there is a need for equal pay for equal work. It is wrong if a nurse in Plymouth, working the same hours, doing the same job and providing the same high-quality care, is paid less than her counterpart in a hospital in Peterborough or Preston.

[Chris Skidmore]

Does the hon. Lady therefore disagree with the concept of London weighting, which has been around since the 1920s? There are 44 London MPs in the London area, so I would be interested in her views on London weighting.

Winterbourne View

Chris Skidmore Excerpts

Tuesday 30th October 2012 Commons Chamber

[Norman Lamb]

I shall certainly consider the hon. Lady’s point and am happy to discuss it further with her. At the end of the day, we must ensure that people in highly vulnerable situations are adequately protected. I want to ensure that all the steps we take are aimed at that goal.

[Chris Skidmore (Kingswood) (Con)]

The Minister has mentioned raising the standard and quality of care providers. Will he consider the introduction of a starred grading system for care providers, so that we have absolute transparency on how well they are performing, and so that we know the most excellent care providers and the worst?

[Norman Lamb]

My hon. Friend raises an important point. One thing we are doing on the NHS Choices website is having quality indicators for every care home, nursing home and so on. That means that any individual looking for a care home for a loved one will be able to find out much more about the quality of the care that an organisation provides. In due course, the website will include user reviews, so that people who have experienced care in those homes will have their voices heard. That openness of information could have a transformational effect in driving up standards.