Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 21st February 2012 Commons Chamber

[Mr Burns]

It is a bit rich for the former Secretary of State to bleat about that. What I want is the finest health care for patients so that they are treated more effectively and quickly and their long-term conditions are managed in a way that enhances the patient experience.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

4. What steps he is taking to address underperforming hospital management teams.

[The Secretary of State for Health (Mr Andrew Lansley)]

The performance of hospital management teams is the responsibility of their boards. Those are accountable to strategic health authorities for NHS trusts, and foundation trusts are accountable to their governors to ensure that they comply with Monitor’s framework. As part of our work to strengthen NHS trusts so that they can reach foundation trust status, we have published guidance on strengthening trust boards, their clinical leadership and management. We are further strengthening accountability through quality accounts and open reporting so that the public can see the absolute and relative performance of all NHS service providers.

[Dr Poulter]

I thank my right hon. Friend for that answer. It is absolutely right that managers take responsibility for the decisions that they take at a local level on behalf of patients and are held accountable for them. A doctor or nurse who fails in their duty can be struck off, so there is clear accountability, but there appears to be no clear accountability or traceability for the decisions of hospital managers. Who will hold those people properly to account when they have failed?

[Mr Lansley]

My hon. Friend knows that the management of trusts should be accountable directly to their boards. As I said, the management of foundation trusts are accountable, through their boards, to their governors. An important point that arose in relation to Mid Staffordshire NHS Foundation Trust is that we should ensure—we are looking at how to fulfil this—that there is also a code of practice to which managers are held accountable. He knows, as I do, that management must be accountable through their boards.

NHS (Private Sector)

Dan Poulter Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

The Minister of State says that is right, and he is free at any point to get up and challenge what I say or to prove how he can make that statement. I will give him the opportunity to do so soon.

The Prime Minister could not have been clearer—“no privatisation”. Similar statements were made during the pause by the Deputy Prime Minister. On the Marr programme on 8 May, he promised that safeguards would be brought forward in the health Bill. He said:

“What you will see in this legislation are clear guarantees that you are not going to have back-door privatisation of the NHS.”

He followed that up on 14 June with this promise:

“Patients, doctors and nurses have spoken. We have listened. Now we are improving our plans for the NHS. Yes to patient choice. No to privatisation. Yes to giving nurses, hospital doctors and family doctors more say in your care. No to the free market dogma that can fragment the NHS.”

Those statements from the Prime Minister and the Deputy Prime Minister were significant for two reasons. First, they revealed an understanding at the top of Government about how, more than anything else, fears about privatisation and the market in the NHS were driving professional disquiet about the Health and Social Care Bill—a Bill that was sold as putting doctors in charge but that had a hidden agenda of breaking up the structures of the national planned health system to allow a free market in health. Secondly, they implied that major changes to address those concerns would be made to the Bill and that there would be a return to the existing policy of the managed use of the private sector within a planned and publicly accountable health system.

Let me be clear. As our motion states, we believe that there is a role for the private sector in helping the NHS to deliver the best possible services to NHS patients, and that was the policy we pursued in government. Without the contribution of private providers, we would never have delivered NHS waiting lists and times at historically low levels, but let us put this in its proper context. Our policy was to use the private sector at the margins to support the public NHS. So, in 2009-10, 2.14% of all operations carried out in the NHS were carried out in the independent sector and spend in the private sector accounted for 7.4% of the total NHS budget. I would defend those figures, because that helped us to deliver the best health care to the people of this country.

Furthermore, we supported a system allowing foundation trusts to generate income at the margins of their activity from treating private patients but with a clearly defined cap to protect the interests of NHS patients at all times.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Does the right hon. Gentleman accept that the cap was not clearly defined but was very variable according to the hospital, and will he now say that it was wrong for the previous Government to set the cap at over 30% for the Royal Marsden hospital, which is a centre of excellence?

[Andy Burnham]

I agree that the cap varied according to historical levels of private sector activity within the different trusts. The hon. Gentleman is absolutely right about that, but he must agree that it was clearly defined in respect of every individual NHS hospital. They had a clear number and local people were able to hold them to account for that number. Where hospitals had large numbers, the cap froze their level of activity at the level when the cap was introduced.

--- Later in debate ---

[Andy Burnham]

There are a lot of questions there. The Secretary of State discusses the safeguards, but he has introduced them precisely because he has made a major break with 63 years of NHS history. He needs them because he wants a different health care system in this country, in which much more work is done by private providers and in which the commissioning of services is largely handed over to the private sector. That is why he has had to introduce those safeguards. We had a health service that was planned, managed and publicly accountable, but he is throwing all of that away.

[Dr Poulter]

I thank the right hon. Gentleman for giving way; he is very generous. Does he not agree that the two hospitals with the highest patient cap—the Royal Marsden and the Royal Brompton—use the money that they make through private income very effectively, and put it back in to make them centres of excellence for all patients, particularly their NHS patients?

[Andy Burnham]

That was the policy of the previous Government, but the cap was clearly defined. It was a tight cap, and it reflected historical levels of work. What we are talking about is a liberalising measure to enable the private sector to double if not quadruple the amount of work that it is doing, which is why we are debating the motion.

I shall pose a question for the Health Secretary, who mentioned safeguards. If it is all fine to create a different NHS in which we have many more private contracts, might not the NHS risk register have something to say about the risks of creating such an NHS and the additional challenges of delivering health care through a system based on commercial contracts? Might it not lead to a diversion of spending on lawyers and consultants, away from patient care? Is there not a great irony, as we have heard the Health Secretary bemoan a lack of ability to intervene in the recent situation while, at the same time, here he is promoting a Bill that removes his ability to do so on a much wider basis? He wants to hand over his ability to intervene to the independent NHS Commissioning Board. The irony of his position will not be lost on many people listening to the debate.

--- Later in debate ---

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is always a great pleasure to follow the right hon. Member for Holborn and St Pancras (Frank Dobson), but he was rather disingenuous about my right hon. Friend the Member for Charnwood (Mr Dorrell). My right hon. Friend said—I think we all agree about it—that where the private sector can add value for money and add value to patient care that always has to be a good thing, as well as something that I think Members on both sides of the House agree on.

My right hon. Friend made the point, which was also well made by the right hon. Member for Leigh (Andy Burnham), that this is not a debate about whether the private sector is a good thing or a bad thing in the NHS; it is a good thing, clearly, where it improves care for patients and offers high-quality patient care. The debate is about whether having a cap on the role of the private sector in foundation trusts is a good thing.

It appears that the private patient cap is set arbitrarily and varies from trust to trust. On the basis of what we know, it is difficult simply to argue that having the private sector heavily involved in the workings of a trust is necessarily a bad thing. We know that the 30% private sector activity at the Royal Marsden is hugely beneficial—not only to the private patients, but to those patients looked after by the Royal Marsden who are NHS patients. We see the same at the Royal Brompton, Moorfields and many other hospitals with a relatively high private patient cap. At those hospitals, the money raised from private activities and the private sector is pumped back into the hospital to improve research and to provide high-quality patient care for all NHS patients at those hospitals. Simply saying that having the private sector involved in a hospital to a larger extent is a bad thing because it compromises patient care is plainly not the case. Some of the best hospitals make the case that, in fact, a cap set at a high level is right. As my right hon. Friend the Secretary of State said, at hospitals such as the Marsden, even when they could set 30% private activity, they use only a proportion of that cap, because what they look at first is their primary duty to their NHS patients and their primary duty to provide high-quality care.

It is difficult to argue for a cap set at an arbitrary level, because what everyone in the NHS is interested in, and what we in Parliament are interested in, is producing high-quality patient care. In that respect, my right hon. Friend the Member for Charnwood was absolutely right. Tony Blair believed that, and it was at the heart of his health care reforms. In that respect, the Government are carrying forward the mantra of patients’ best interests.

I have discussed a little the fact that an arbitrary cap does not work, and is not in patients’ best interests. I have also discussed the benefits that involving the private sector in hospitals can bring to NHS patients. The good thing about those hospitals, particularly the Royal Brompton and the Royal Marsden, which are centres of excellence, is the fact that private sector involvement improves the quality and the output of medical research. That is another reason why those hospitals are pioneering examples of high-quality patient research, which benefits patients, particularly in the NHS. This is a good motion, as it endorses the role of the private sector, which can be a good thing as long as it is for the benefit of patients. However, it is a bad thing to impose arbitrary caps that do not benefit patients.

Breast Implants

Dan Poulter Excerpts

Wednesday 11th January 2012 Commons Chamber

[Mr Lansley]

For reasons that I have already explained, the hon. Gentleman is simply wrong about that. It is nonsensical to attempt—as the editor of The Lancet did this morning—to compare the regulation of private providers of private care with that of private providers of NHS care. There is no comparison at all.

The CQC will inspect a sample of providers of cosmetic surgery to check that they are meeting registration requirements, and will undertake a number of unannounced inspections as part of that. We expect the inspections to be completed by the end of the month, and expect the CQC to have published its report by the end of March. It has confirmed that it has enough resources to undertake the inspections within its existing budget.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I add my support and thanks to the Secretary of State for what he is doing on this very important issue which has caused so much distress to so many women. Does he agree that this episode flags up a wider issue in the cosmetic surgery industry, in that some practitioners performing medical procedures do not have any medical qualifications or knowledge of anatomy? Does he also agree that it is a problem that there is no psychological counselling and that a holistic look at patients is not taken, as this is an on-demand industry? Finally, does he agree that there must be a proper paper trail and record system in the industry, so that we can consider what is in the best interests of patients and so that there is proper accountability for all providers?

[Mr Lansley]

My hon. Friend makes a number of important and perceptive points. It is, and will continue to be, one aspect of NHS advice that psychological assessment can form an important part in the management of patients referred for low-priority procedures, including cosmetic surgery. However, although we will look at cosmetic interventions and their regulation more widely, we must recognise that the issue in this instance related to what was a criminal act—seeking to adulterate the material in the implants. Many private providers were using what they regarded as properly certified implants for a perfectly proper procedure. To that extent, they were not engaging in any improper behaviour. However, they have legal and moral obligations to their patients, and I am asking them to discharge those obligations.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 10th January 2012 Commons Chamber

[Anne Milton]

As I said, my colleagues in DECC are working closely with the energy companies. I point out to the hon. Gentleman that this coalition Government are the first to put in place the cold weather plan to reduce those 27,000 excess winter deaths. Perhaps his local paper would like to contact the Welsh Assembly Government to see what they are doing.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Fuel poverty clearly shows the link between housing, health care and well-being. Last week, the Prime Minister called for a merger of health and social care. Does the Minister agree with me that if we are to have a true merger of health and social care, housing—through health and wellbeing boards and other mechanisms—has to be a key ingredient of that?

[Anne Milton]

Of course, my hon. Friend is absolutely right that the integration of health and social care is critical, particularly for issues such as this. The changes we are making to public health and the movement of public health into local authorities will only ensure better integration, so that we can reduce those 27,000 excess deaths.

Organ Donation

Dan Poulter Excerpts

Wednesday 9th November 2011 Westminster Hall

[Paul Uppal]

I thank the hon. Gentleman for his intervention. No one in the Chamber would in any way, shape or form underestimate the suffering of those who need a transplant. I am a trustee of a Sikh temple, and I have been approached specifically about the matter and people’s real concern about it. I have felt the pain that many families feel. We may leave the main thrust of the debate today, but I am sure that we will revisit the issue. I accept completely what the hon. Gentleman says, but for the time being we must go along the path of sequential progress.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my hon. Friend on securing this debate. He highlighted very well the fact that organ donation in urban areas is much lower than in more rural areas. That is partly due to population churn, but also because, as he rightly highlights, it is difficult to persuade people in black and ethnic minority communities to come forward and agree to organ donation. There are some cultural barriers to organ donation. How can we break down those barriers and focus on what really matters—ensuring that people have a chance of life?

[Paul Uppal]

I thank my hon. Friend for his intervention. As I said, I am a trustee of a Sikh temple, and I think it is important that we continue to spread that message in mosques, gurdwaras, mundas and temples in any shape or form. It needs to be consensual. It is about breaking down stigmas and prejudices that may be out there in certain communities. I would be very much in favour of anything that does that, and I have personally done that in my own constituency.

--- Later in debate ---

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

I congratulate the hon. Member for Wolverhampton South West (Paul Uppal) on securing this debate, and on squeezing so much in. There were so many interventions that it felt almost as if a 90-minute debate had been fast-forwarded to include everything. I appreciate his approach, and the substantive contributions that we have heard during the short time in which we have debated this important issue. Transplantation is one of medicine’s great success stories, and I know that the hon. Gentleman has taken a keen interest in the subject for a considerable time. He is right to hold the Government’s feet to the fire when it comes to ensuring that we maintain progress in such an important area.

The coalition Government are absolutely committed to increasing the number of organs available for transplantation, and we believe that as many people as possible who need a replacement organ should be given the opportunity to benefit from a transplant. In many ways, the success of transplantation surgery and advances in technology have led to the current challenges of unmet need that have been described so powerfully and with personal examples.

Some 10,000 individuals now require a transplant, and tragically about three adults or children die every day either waiting for a transplant or after being taken off the list because they have become too ill. The hon. Member for Newport West (Paul Flynn) mentioned a blog that details the suffering and misery endured by families while they wait for a transplant, and that speaks volumes about why we must do more work in that area.

The Organ Donation Taskforce’s recommendations, published in its first report, “Organs for transplants”, in January 2008, were broadly based around the need for investment in the donation infrastructure. That is to ensure that the UK maximises its potential for donation rates, and makes organ donation a usual part of health care.

The Welsh Government’s recently published White Paper on organ donation has been referred to, and we will study their proposals carefully. In 2008, however, the independent Organ Donation Taskforce also examined the case for moving to an opt-out system but recommended against it, concluding that, although such a system might have the potential to deliver benefits, it would also present significant difficulties.

My hon. Friend the Member for Montgomeryshire (Glyn Davies) rightly drew attention to Spain, and the fact that, despite the enactment of a similar opt-out scheme in 1979, a significant transformation in the level of performance took place only after investment in infrastructure in 1989. The taskforce has drawn lessons from the Spanish experience, and it is right that we are guided by evidence.

I was asked about the taskforce’s intention that we achieve a rate of organ donation of at least 50% by 2013. That is certainly our aim, and we are on track to deliver it. Significant resources have been made available to implement the taskforce’s recommendations—largely through NHS Blood and Transplant—to increase the number of specialist nurses, who are a critical part of the system, and to appoint clinical leads, donation committees and donation chairs in acute trusts to drive improvement locally.

[Dr Poulter]

As the Minister will be aware, in 1994, there were 2,500 people on the organ donor waiting list, and last year there were over 7,500. Only 29% of the UK population are signed up to organ donation, which is woefully inadequate given that 552 people died last year while waiting for an organ transplant, excluding those who were taken off the list because they had become too unwell. It is a big problem; people are living longer, sometimes with multiple medical co-morbidities, which means that more people will need transplants. The problem will become an increasing challenge for health care providers and the Government.

Philosophically, I agree with the Minister and I am not in favour of compulsion. Does he agree, however, that we need a more targeted community-focused approach and, as with the cot death campaign that reduced cot deaths from 2,000 to about 300—

[Philip Davies (in the Chair)]

Order. Interventions must be brief.

Obesity

Dan Poulter Excerpts

Wednesday 9th November 2011 Westminster Hall

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I am grateful for the opportunity to contribute to this debate. I will not speak for very long, but it is worth highlighting some of the issues that have been raised in a comprehensive way. I congratulate the hon. Member for East Londonderry (Mr Campbell) on securing this debate.

Obesity in the UK is a growing problem. In 1993, only 13% of men and 16% of women were obese, but in 2009, 22% of men—and 24% of women—were obese, which represents almost a doubling of the number of men with obesity. I am not talking about people with a body mass index of between 25 and 30, which means that they are overweight; I am talking about obesity. Almost a quarter of the UK population is obese and I am sure that we all find that unacceptable.

How can we deal with obesity effectively, because whatever previous Governments have done, obesity has not been addressed in a way that has worked or has been effective? First, I will briefly outline how Government policy is moving towards more community-based interventions on obesity, and I will explain how that approach, through the health and wellbeing boards that will be set up under the health care reforms, will be effective and work well. Secondly, I will talk a little about nudge theory, because I am more hopeful and optimistic about it than my medical colleague, my hon. Friend the Member for Totnes (Dr Wollaston). There is good evidence elsewhere, particularly in Iceland, that it has worked, and I hope it will also work effectively in relation to obesity.

[Jim Shannon]

While the hon. Gentleman is giving us his thoughts, and given his experience in his previous job, will he comment on gastric band operations? Just two weeks ago, I had occasion to visit the Northern Ireland Health Minister, Edwin Poots, with some of my constituents. These people had tried everything to lose weight; they had tried dieting and exercise—some of them were not able to exercise, which was the other problem—but they had clear medical and health problems. As a last resort—this really is the last chance saloon, or the last chance restaurant, perhaps—should regions and Health Ministers set aside money specifically for gastric band operations?

[Dr Poulter]

We certainly have to look at how the Government can help people to take more responsibility for their own health care. That is fundamental to obesity issues, and it is a particular challenge in more deprived areas. People often require gastric bands at the point where the medical problems associated with obesity—diabetes, the risk of heart attack or stroke, or high blood pressure—pose a potentially life-threatening risk. Such people may not have that long to live if a gastric band is not put in place, so it is the only feasible mechanism for dealing with obesity in such cases. Gastric bands have been shown to be an effective mechanism for looking after that part of the population, and there is good medical evidence to support their use. There is also good evidence in terms of the health care economics, as helping people to become slimmer will lessen the burden on the NHS.

The gastric band is good for the patient, because their health improves dramatically when it is used effectively, but the challenge with obesity is to bring about long-term lifestyle change, and the question with gastric bands is whether they necessarily deal with long-term lifestyle changes. In a medical sense, there needs to be greater emphasis on the education that goes with the bigger issues around obesity and lifestyle at the same time as the gastric band is fitted. I hope that that helps to answer the hon. Gentleman’s question.

[Andrew Bingham (High Peak) (Con)]

Does my hon. Friend share my concern that celebrities regularly have gastric bands fitted, with the result that the bands are now seen as a shortcut to losing weight? People think that celebrities have them, so we must all have them.

[Dr Poulter]

That is a good point. There is good evidence that the celebrity culture around dieting causes anorexia in young girls. It would be much better for us and for many of our constituents if celebrities sometimes showed greater responsibility in the way in which they behaved. Gastric bands are an effective way of dealing with severe obesity, but they should not be used as a general method of bringing about weight loss. Weight loss is about education and people taking responsibility for their own weight and lifestyle. It is also about putting support in place in communities to let people do that, particularly in more deprived areas.

[Mr Dodds]

I have heard constituents talk about the use of statins and polypills. These medications have enormously beneficial effects for many people, and many people need them, but people almost seem to think, “Well, we have this magic pill available. We can eat and drink as much as we like, and then we can go on this pill.” Does the hon. Gentleman share my concern that we need more education about the use of such medications? At the moment, people are under the impression that there is something out there that can solve all these problems without their having to do anything to change their lifestyle.

[Dr Poulter]

Yes, certainly. There is an issue about how physicians prescribe effectively. Statins are an effective way of controlling cholesterol, and there is good evidence that they benefit people with heart disease and high cholesterol and that they increase life expectancy. There has been a lot of research, and I believe that it has been shown that statins may have beneficial effects in reducing the risk of breast cancer, although the Minister will correct me if I am wrong.

The right hon. Gentleman touches on the wider point that the emphasis in this debate needs to be on effective community-led interventions that tackle obesity and health care, and my hon. Friend the Member for North Swindon (Justin Tomlinson) discussed that very effectively. However, we need to ask how we will make those community health care measures effective.

The Government are setting up health and wellbeing boards, which are a very useful part of their health care reforms, because they will, for the first time, bring together different organisations in a meaningful way. Local councils in certain towns may run good community initiatives that connect GPs with leisure centres, exercise and sport, and some schools may encourage sport and physical activity in an effective way or have good links with local sports clubs. However, that does not often happen in a co-ordinated way across whole counties or, indeed, across the country. Health and wellbeing boards will help to bring together different organisations to address key public health problems, and obesity is a key public health challenge in all our constituencies.

As part of the health care reforms, the health and wellbeing boards will be able to address issues such as obesity. For example, if we know that there is an issue with teenage pregnancy or obesity in certain schools or among certain schoolchildren in my constituency, targeted interventions can be put in place in a much more community-focused way by getting the local authority together with health care representatives at a much more strategic level. That must be a good thing, because it allows much more targeted interventions.

The second thing I want briefly to discuss—I do not want to speak for much longer—is nudge theory. My hon. Friend the Member for Totnes has a slightly different view of it. I have more faith in nudge theory than she does, and I say that because we have had debates about agriculture—some of the Opposition Members here today were present—in which we discussed the need for corporate firms and supermarkets to show greater corporate responsibility on issues such as food labelling. We have now seen active movement from some supermarkets on honest food labelling. For example, we talk about food in a store being labelled British only if it is actually farmed in Britain, and not if it is merely processed or sliced here. We are beginning to see such initiatives come through, with supermarkets supporting British farmers. Morrisons is a good example of a supermarket where the British food stamp actually means something, and that allows consumers to make an informed choice. Supermarkets are therefore able to show corporate responsibility when they are asked to do so, although things are not entirely perfect, as we all know.

In a similar vein, the Government have introduced a public health responsibility deal, and it is a good initiative. Almost 200 different companies have signed up to the deal, including supermarkets such as Asda, the Co-op, Morrisons, Marks and Spencer, Sainsbury’s, Tesco, Waitrose and many others. Fast-food outlets such as McDonald’s, Pizza Hut and KFC have pledged to remove trans fats and introduce calorie labelling as a result of this initiative. Those are all pleasing and beneficial steps in the right direction.

[Dr Wollaston]

Does my hon. Friend share my concern, however, that organisations such as Asda, which have signed up to the new responsibility deal, are in some ways undermining it by offering hugely discounted alcohol products?

[Dr Poulter]

There are areas of obvious concern, where supermarkets can go further. As I said earlier, when we were talking about the agricultural sector, even though several supermarkets are backing honest food labelling, and showing responsibility in food labelling and calorie counting to tackle obesity, it is right to highlight the areas in which they need to show greater corporate responsibility. Cut-price alcohol is one of those, and we will continue to monitor it carefully in our work on the Select Committee on Health, and as physicians. My hon. Friend makes a good point.

In preparing for the debate, although I do not normally take an active interest in children’s TV, I found out about an Icelandic TV show called “LazyTown”—the Minister may want to expand on the subject a little later. The show is watched by children all over the world, and we have it in Great Britain as well. There is a healthy sports superhero character, called Sportacus, who motivates children to eat healthily and be active. In Iceland several “LazyTown” initiatives have been run in partnership with the Government and the private sector. For example, children between four and seven years old were sent an energy contract, which they and their parents signed, in which they were rewarded for eating healthily, going to bed early and being active. In one supermarket chain, all the fruit and vegetables were branded “sports candy”, which is the “LazyTown” name for fruit and vegetables. That led to a 22% increase in sales at that supermarket, and improved health and reduced obesity levels in Iceland.

The fact that Iceland’s child obesity levels have started to fall as a result of initiatives of that kind is good evidence in support of such corporate responsibility. Those initiatives are designed to support supermarkets coming together with Government, to make effective use of the nudge theory of improving behaviour, and they can work—and have worked. For that reason, we must support what the Government are doing, because there is evidence that it can work. It is a good thing and the evidence from Iceland is that we need to do what works, with children and communities.

I understand, and I am sure that the Minister will confirm, that the Department of Health has set up a partnership with “LazyTown” and is interested in expanding that initiative in the United Kingdom. We need more such approaches. The reason supermarkets sign up to such deals and initiatives is that it is good not just for the children, who become healthier and less obese, but for the supermarket and its brand image. Supermarkets see that working with corporate responsibility—we see it in our constituencies with Tesco schools vouchers—can enhance their image and custom, and do real good, for example, by reducing obesity levels.

I have greater faith in the nudge theory than my hon. Friend the Member for Totnes, and we need to allow similar initiatives to take root in the future. What has been done in the past has not worked very well; obesity levels have been going up. We have good evidence, from examples of corporate responsibility, that things can be tackled, so let us give nudge theory a chance. Let us also look to those health and wellbeing boards to provide community-based interventions that will work. If we do not do something, things will get worse, and the boards are a good way to address the problem.

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[Mr Burns]

I will give way in a moment. It is also important to say that, if we can get an agreement with commercial companies to change the way they behave and some of their practices, it will be far quicker to achieve that and put it in place than to wait for the heavy hand of Government legislation, which can take a minimum of a year and sometimes years. Why wait for the heavy hand of legislation that might take a long time, if we can get a voluntary agreement that will work quicker and more effectively to start dealing with the problem?

[Dr Poulter]

rose—

[Mr Burns]

I will give way to the hon. Member for Hackney North and Stoke Newington first, because I promised her, then my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), and then I will make progress.

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[Mr Burns]

I understand the hon. Lady’s point, because the charge has been made on a number of occasions and I have considerable sympathy with it. The supermarket at which I shop each week—I shall not name it, because I do not want to advertise for it—does not do that any more. I think that the hon. Lady will find that, throughout the country, the responsible supermarkets have stopped that practice, for the very reasons that she has mentioned.

[Dr Poulter]

Does my right hon. Friend agree that we need to be careful about introducing regulation for alcohol and other relevant products? It could be a very crude measure and have unforeseen consequences. For example, on alcohol, we may be concerned about the cheap sale of white cider, but the bigger issue is that introducing legislation may impact on brands that market themselves responsibly to responsible drinkers. We have to be careful about that sort of thing.

[Mr Burns]

My hon. Friend makes a valid point.

I will address a number of issues that some of my hon. Friends have raised. My hon. Friend the Member for Totnes (Dr Wollaston) talked about the important issue of weighing and measuring children. I hope that she will be reassured by the national child measurement programme. It measures children in reception class—four to five-year-olds—and in year 6. Those measurements and weights are fed back to parents, so that they can not only know the information, but make informed choices about the lifestyles of their children.

My hon. Friend the Member for North Swindon (Justin Tomlinson) made some valid and good points about the planning regime and open spaces that enable parents and children to exercise. His points were well made and sensible. It would be worthwhile for local government, which has responsibility for the issue, to read what he has had to say, particularly, as the hon. Member for Hackney North and Stoke Newington has said, because certain inner-city areas do not have the advantages of some of the more rural and smaller town constituencies, which have far more access to open spaces.

As a Government, our general approach to tackling the problem is based on the latest scientific evidence on the underlying issues and causes of obesity, as well as what has worked best previously. Ultimately, there is a simple equation: people put on weight because they consume more calories than they need.

Patient Security (Mental Health System)

Dan Poulter Excerpts

Monday 7th November 2011 Commons Chamber

[Nicky Morgan]

I am grateful to my hon. Friend. I have seen the subject of his Adjournment debate later this week. Unfortunately, I did not have the opportunity to go into that level of detail, but I shall come to the quality of care and to demonstrate that it has a huge impact on the absconding rate for patients. As I shall come on to mention, this is an issue on which the Department of Health and the trusts could work together. Interested Members or other interested parties should see the link between absconding and the quality of care given. There is no doubt that there are innovative ways of ensuring that patients do not feel the need to abscond, and that if they are outside the environment, of ensuring that they will come back because they know that they will receive therapeutic treatment.

As I was saying, despite all the caveats, the numbers are simply too high for organisations that owe their patients a duty of care. The fifth agreed objective in the Government’s mental health strategy launched earlier this year stated:

“Fewer people will suffer avoidable harm—people receiving care and support should have confidence that the services they use are of the highest quality and at least as safe as any other public service.”

This is, of course, an objective that anyone who has an interest in any health service, but particularly mental health services, would want to see met. The fact is that guidance is already in place for mental health trusts and for those working within them to follow, although it would be fair to say that a lot of that guidance deals with how to react to an incident of absconding rather than offering concrete guidance on prevention. In the case of my constituent, the coroner expressly found that

“it would appear that the hospital had a system and policies in place to protect and supervise Kirsty from harm but at all material times those caring for her did not follow those policies.”

That is just not acceptable.

The Minister will remember the long sessions earlier this year discussing the Health and Social Care Bill in Committee Room 10 upstairs—how could we forget them? One of the recurring themes was not just that we all want to see high-quality services but how we ensure our health and social care services are of high quality and that everyone is focused on the primary objectives of the health system. Do we do so through inspections? Do we hope that everyone working within the health system works to their own high standards, as many thousands of employees surely do? Do we ensure that guidance is not only available but followed? And do we ensure that when things go wrong, as in the case of my constituent, thorough investigations follow and lessons are learned? Surely it must be a combination of all those things.

As I mentioned, hospital wards are meant to be places of therapy, but too often, especially in the case of mental health wards, they are anything but. In a recent report, the Centre for Social Justice said:

“Hospitals tend to be untherapeutic and dangerous places”.

In helping me to prepare for this debate, Mind sent me a note saying:

“The quality of care quite clearly has an impact on a patient’s decision to abscond. Unfortunately, as Mind’s forthcoming acute and crisis care campaign will show, people in inpatient settings often experience substandard quality, with no meaningful activities, little or no interaction with staff or each other, and at worst, lack of safety, abuse and coercive treatment.”

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Does my hon. Friend agree that one problem—she has done well in bringing this debate before us this evening—is the fact that people often become labelled when they are in a mental health care setting, whereas what we need to do if we are to deal with the issue properly is to break down and challenge those labels, so that the patient is not seen just as a mental health patient but as a person? All the therapies and preventive measures she is talking about relate to that issue. If we can get that right, we will be able to look at people and treat them in the way that they deserve—with respect, which will help to prevent the episodes of absconding or escape that my hon. Friend mentions.

[Nicky Morgan]

I entirely agree with my hon. Friend, who is a qualified NHS practitioner and knows far more about these matters than I do. Everything that he has said confirms the fact that we must not forget that people are at the heart of all cases of this kind—not just patients, but their families. The sooner patients receive good therapeutic treatments and can resume their place in society, the better. My hon. Friend made another important point: for too long a stigma has been attached to mental ill-health conditions, and people do not talk about them. I hope that tonight’s debate will mark the beginning of more open discussion of such conditions, in the House and beyond.

Kirsty's father told me that he believed that there was nothing to do at the unit where she was being treated. He said that there were no constructive therapies.

Rethink Mental Illness and the Royal College of Psychiatrists drew my attention to a 2010 report that had been prepared as part of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. According to the report, between 1997 and 2006 absconders accounted for 25% of all in-patient suicides and 38% of suicides that occurred off the wards. Absconding patients were also significantly more likely to have been under high levels of observation, but clinicians reported more problems in the observation of those who had absconded owing to ward design or other patients in the ward. The report made three recommendations for improvement: that staff need to pay better attention, not just to patients but to ward exits; that observation methods should improve, as there was little evidence regarding the protective effect of close observation, and high levels of observation may be ineffective for people who are intent on leaving the ward; and that there should be an increased focus on engagement and support by staff when patients are admitted.

However, as Mind pointed out to me, there is evidence that when wards take a more innovative approach to in-patient care, there are fewer incidences of both aggression and absconding. There is already an incentive for our mental health trusts to do better in terms of the treatment and care that they offer to in-patients.

Let me end by drawing all those thoughts together. First, we need more research in order to understand the scale of the problem. The information that I have obtained is, I hope, a good start, but I think that the Department could insist that trusts use one set of definitions so that numbers can be properly compared, and that trusts with low incidences of absconding could share their experiences with those whose absconding rate is very much higher. The Department could also insist on publication of the information that I had to obtain under the Freedom of Information Act.

Secondly, trusts should not only follow existing guidance, but work out how they do their best to prevent patients, when they are at their most vulnerable, from absconding and causing harm to themselves. My office did not have to look very far to find seven newspaper reports about patients who had absconded this year. Six of those cases tragically ended with the patients taking their own lives, and in one case the patient killed someone else. I believe that only by encouraging trusts to take those steps will the Department stand a chance of fulfilling the fifth objective in its laudable mental health strategy.

Finally, I should like us all to remember that at the heart of this are usually very ill people and their families. Mr Brookes said to me in July this year, “We trusted the system. We paid our taxes, and we expected the best care for those who are at their most vulnerable.”

We talk a lot in the House of Commons about physical health outcomes, but the time has come for mental health to get a proper look in. As someone speaking at one of the all-party meetings on mental health said, “We all have mental health; it is just that some people’s is better than that of others.”

We are talking about people, so there are no absolutes, and there will always be those who are determined to take their own lives, but I hope that tonight, by focusing on one part of the mental health system—the security of patients being treated in hospital settings—the House can begin to make clear its desire to see real parity between physical and mental health conditions in the context of funding and treatment. I believe that if we do not do that, we will be storing up huge trouble for the country, and there will be more tragic deaths of patients like Kirsty which could perhaps be prevented.

National Health Service

Dan Poulter Excerpts

Wednesday 26th October 2011 Commons Chamber

[Andy Burnham]

I am not sure whether I should thank the hon. Lady for reminding me that I am now a shadow of my former self, but I thank her for her words. I will come to the precise question that she asks. I did indeed say those words, and I will explain why in a moment.

I was talking about the three headline promises that the Prime Minister made on the wards. They were part of a calculated and self-serving political strategy to detoxify the Tory brand, not a genuine concern for the NHS. It was cynical because, as we will show today, those were cheques for the NHS that the Tories knew they could not cash, and promises that they had no real intention of keeping. Let us take the Prime Minister’s three personal promises in turn, starting with the one on NHS funding. It will be good to get to the bottom of that once and for all.

At the last election, Labour promised to guarantee to maintain NHS front-line funding in real terms. The now Prime Minister, by contrast, offered real-terms increases. How big those increases would be was undefined, but that did not matter. The important thing was that, according to the requirements of the detoxification strategy, it sounded as though the Tories were planning to spend more.

I remember well our resulting exchanges with the then shadow Health Secretary, now the Heath Secretary, on the hustings. Indeed, the Prime Minister has in recent weeks been quoting what I said then, as the hon. Member for Chatham and Aylesford (Tracey Crouch) did a moment ago. I did indeed say that it was cynical and irresponsible to make those promises, and I repeat that today.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Does the right hon. Gentleman consider “protecting the front line” to be the closure of many hospitals throughout the UK, mergers and the loss of vital cardiac services in such places as Ipswich? That was exactly what happened when he was Secretary of State.

[Andy Burnham]

The hon. Gentleman goes right to the heart of my speech today. We made those difficult decisions to get the NHS ready for the future. We grasped the nettle and took services out of hospitals and moved them into the community, because that is what has to happen if we are to have an NHS that is sustainable for the future. He stood on an election manifesto that promised the opposite. It was a dishonest pledge, and I will come to it in a moment.

I said a moment ago that it was irresponsible to promise real-terms increases. I say that because I completed a spending review of the NHS in March 2010 and knew the figures inside out. I had also been in detailed discussions with the Treasury on the funding of adult social care, in preparation for a White Paper. The implication of what the Conservatives featured on an election poster—cutting the deficit on an accelerated timetable while giving the NHS real-terms increases—could mean only one thing: unpalatable cuts to other public services, particularly adult social care, on which the NHS relies.

Despite that, the election pledge was carried over into the coalition agreement, which could not be clearer. It states:

“We will guarantee that health spending increases in real terms in each year of the Parliament”.

A year ago, at the time of the comprehensive spending review, the official figures claimed that that had been delivered, with a 0.1% settlement—essentially the same as Labour promised at the election.

--- Later in debate ---

[Andy Burnham]

I am grateful to my hon. Friend for those words and I shall come to precisely that point, but let us be clear about this one: the Prime Minister promised a real-terms increase, but he has delivered a real-terms cut. He stands at the Dispatch Box week after week boasting about increasing health funding when he has not. All the while, NHS staff deal with the reality on the ground of his NHS cuts. Does he not realise how hopelessly out of touch he sounds? Hospitals everywhere are making severe cuts to services, closing wards, reducing A and E hours and closing overnight, making nurses redundant, and cutting training places. Last week, The Guardian revealed the random rationing that is taking place across the country. There are cuts to pay for management services, one third of neo-natal units are reducing the number of nurses, and midwife places are being cut despite the Prime Minister’s promise to recruit 3,000 more.

[Dr Poulter]

The right hon. Gentleman is making a great deal out of cuts. The Government have committed an extra £15 billion to the NHS over the lifetime of this Parliament, but the Opposition have consistently failed to agree to commit to any additional funding. Will he make that commitment now?

[Andy Burnham]

A moment ago, the hon. Gentleman acknowledged that I protected the NHS front line as Health Secretary. As Health Secretary, I would not have introduced a £2.5 billion reorganisation when the NHS is facing severe financial stress.

--- Later in debate ---

[Grahame M. Morris]

I am grateful for that intervention from my right hon. Friend and I should like to place on record, because the Secretary of State did not take the opportunity to do so, that the cap on private patient work, which had been set at 5%, is to be raised by the Bill. That must have a detrimental impact on the NHS in general, and on non-private patients, as resources are directed to the private sector and private patients.

[Dr Poulter]

Will the hon. Gentleman give way?

[Grahame M. Morris]

I shall not, if the hon. Gentleman does not mind, because I do not think I will get any injury time if I do so and I have rather a lot to get through.

I have mentioned the transfer of resources from the NHS budget to meet the growing costs of social care. We have also discovered, from evidence that was given to the Select Committee, that there has been an underspend of almost £2 billion—much of it from the capital budget, with some of it, presumably, being saved by cancelling the new hospital that was to serve my area. Meanwhile many NHS trusts are sitting on hundreds of millions of pounds of debt, and figures produced by the Department of Health show that six large NHS trusts in London are predicting year-end deficits of £170 million. The pressures on the system are enormous and will inevitably show through in reductions in services, having an impact on the front line.

The reductions in tariffs for operations and the further pressures in that area will also mean that foundation and NHS acute trusts will bear the brunt of financial pressures within the system. Again, that means that the buck and the spotlight of transparency are being passed away from the Secretary of State to the NHS Commissioning Board, although he might have to reconsider that after last night’s Lords amendments.

Another area of pressure in the NHS comes from the huge redundancy costs being incurred as a consequence of the premature closure of primary care trusts and strategic health authorities, which is estimated to cost the taxpayer more than £1 billion. The opening up of the NHS entirely to the private sector, and the prospect of the £103 billion NHS budget being taken out of the public sector and placed within the remit of shareholders in private health care companies, is anathema to the majority of the British public. The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) is cringing, but the majority of the British public are cringing at the thought of this proposal.

--- Later in debate ---

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is always a pleasure to follow the right hon. Member for Rother Valley (Mr Barron). He would be surprised if I agreed with everything he said, but he made some good points in the first half of his speech.

Today’s debate has been a wasted opportunity for the Opposition, because nothing positive has come out of it—nothing about how we will better look after patients or how we will address very real needs in all our constituencies. There has been a lot of mud-slinging but very little talk about what will benefit patients and how we will deliver a patient-centred NHS.

That is to the detriment of the Opposition and to the way in which they have addressed the motion. It is disingenuous of Opposition Members to attack the Prime Minister and the Secretary of State for Health, and to try to give the impression that my right hon. Friends do not care about the NHS. All politicians and, I believe, everyone in the country care about the NHS, but we have slightly different views about how the service should be run.

I have a great deal of time for the hon. Member for West Lancashire (Rosie Cooper) and I like her very much on a personal level, but some of her points were wrong. In particular, it was wrong to bring the Prime Minister’s personal experience into the debate. He had a difficult family circumstance, and of course someone with that background will understand the NHS very well.

[Rosie Cooper]

rose—

[Dr Poulter]

The hon. Lady did not make her point very well, and she did not allow me to intervene on her. I am sure that the Minister will address the points that she made about the letter.

[Mr Simon Burns]

It might be useful at this stage to clear up the point about the letter. The hon. Member for West Lancashire (Rosie Cooper) said that my right hon. Friend the Secretary of State had not replied to her letter, as though it had been sent months ago. It was dated 12 October, so I presume that it arrived in the Department of Health on 13 or 14 October, about 12 or 13 days ago. Hon. Members know that the guidelines, which the Department rigorously keeps to, state that it may take up to 20 days to receive a response. My right hon. Friend has not been discourteous, and the hon. Lady will receive a reply within the time scale.

[Dr Poulter]

I thank my hon. Friend for clarifying an earlier point.

I will not engage in mud-slinging, but will talk about what hon. Members on both sides of the House want to emerge from the NHS. The right hon. Member for Leigh (Andy Burnham) was absolutely right that some service reconfiguration is necessary to deliver services in communities, improve community care and build an integrated health service with integrated health care. The right hon. Gentleman spoke specifically about an integrated system and better integrating adult social care, especially for the elderly, with current NHS providers, breaking down some of the silos between primary care, the hospital sector, and adult social services.

[Barbara Keeley]

Was the hon. Gentleman as concerned as I was at the Select Committee on Health on Tuesday when I asked Richard Humphries of the King’s Fund how the Health and Social Care Bill will impact on integrated commissioning? Richard Humphries said that there is a danger to integration because people are leaving PCTs, working relationships are being disrupted and broken up, and partnerships are being disrupted. As my right hon. Friend the Member for Leigh (Andy Burnham) said, we face years of disruption. That is the danger. Progress on the integration agenda was slow, but it is chaotic now.

[Dr Poulter]

I thank the hon. Lady for her intervention. Any period of transition will be difficult, and must be managed. Will the mechanisms and bodies that the Health and Social Care Bill will put in place be better able to deliver community-focused, integrated care than the existing system? I want to consider two matters that we will come to later: health and wellbeing boards, and basing commissioning fundamentally in the community. Both are good mechanisms for delivering better integrated care, and I will return to that.

We have too many silos in the NHS. The primary care sector often does not integrate with the secondary care sector as well as we would like. For example, hospitals are paid by results, but they have no financial incentive to ensure that they prevent inappropriate hospital admissions. We talk about better looking after the frail elderly and about ensuring that we prevent people with mental health problems from reaching crisis point and having to be admitted, but there are no financial incentives and drivers in the system to ensure that that is achieved to the extent we would like. A and E admissions in many hospitals are rising year on year—in rural areas that is partly because we do not have an adequate out-of-hours GP service—and far too often the frail elderly are not properly supported in the community.

If we put the majority of commissioning into the community with local commissioning boards, that will provide a more integrated and joined-up approach to local commissioning, which will undoubtedly help to prevent inappropriate admissions. We no longer want an NHS in which people with mental health problems or the elderly present in crisis because they have not been supported in the community. That must be the focus of care, and the focus of delivery of services.

[Sarah Newton]

I wholeheartedly agree with my hon. Friend about the importance of integrating social care and the NHS. I want to share with him the good, concrete steps that are being taken in Cornwall, where we have a pilot health and wellbeing board, and the beginning of integration. That has not happened before in Cornwall, and we are about to have the first joint commissioning of services. That is the way forward to improve patient experience in the NHS.

[Dr Poulter]

I thank my hon. Friend for a helpful intervention, which makes the point very well that we need integration through community-based commissioning.

The other key factor is how better to integrate adult social care—the right hon. Member for Leigh made the point, as did the Secretary of State—into the current NHS system. At the moment, integration of services is sometimes variable. There is a good example in Torbay of a more integrated system, but what are the Government proposing that will at least facilitate the integration of services? Local health and wellbeing boards are definitely a step in the right direction because for the first time they will bring together adult social care from local authorities with housing providers, the NHS, and primary and secondary care. That must be a step in the right direction for delivering the integrated care that we all want. It will help to provide more community-focused care.

I referred to the concern about inappropriate admissions, and the fact that elderly people are not supported in their own homes. The savings in adult social care from doing things well are NHS savings, but at the moment there are different cultures in two different organisations, which do not always talk to each other in different parts of the country, and that will not benefit patients. Bringing people together on a health and wellbeing board must be good for patients and integrated care.

For all those reasons, I hope that we will have more positive Opposition day debates on the NHS, and I hope that the Opposition will at least concede that some good things are happening as a result of health care reform.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 18th October 2011 Commons Chamber

[Anne Milton]

I think that public health in areas such as Hull will do exceptionally well. I point out to the hon. Lady that under the previous Government, what happened in practice was that public health budgets were raided constantly and we did not get improvements. If she looks at the figures, she will see that inequalities in health widened.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Does my hon. Friend agree that despite the previous Government’s good intentions on public health, health inequalities have widened, as she has rightly said, obesity rates are going up, smoking among young girls is going up, and alcohol abuse is a serious problem? Does she agree that it is right to deliver services with local authorities and to get into local communities and schools if we want to address these big public health challenges?

[Anne Milton]

My hon. Friend is absolutely right. Local authorities have a long and proud tradition of improving the public’s health. Public Health England will bring together a fragmented system and strengthen our national response on emergencies and health protection. It will help public health delivery at a local level with proper evidence and leadership.

Health and Social Care (Re-committed) Bill

Dan Poulter Excerpts

Wednesday 7th September 2011 Commons Chamber

[Mark Pritchard]

rose—

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

rose—

[Ms Abbott]

I shall give way to the hon. Member for Central Suffolk and North Ipswich (Dr Poulter).

[Dr Poulter]

The hon. Lady is making an excellent speech and has outlined the fact that there is adequate provision for counselling in the status quo. Doctors, nurses and other medical professionals who must deal with such situations every day have adequate measures in place, as the Royal College of Obstetricians and Gynaecologists has outlined. They do not look only at the medical consultation, but at the whole patient, as we have heard. If that means that counselling is required, they will ensure that their patient gets it. Does she agree that this is not the place for the amendment, which serves no purpose, and that we need to get on and debate the Bill?

[Ms Abbott]

I am grateful to the hon. Gentleman, who is, of course, a practising doctor who knows a great deal more about these matters than many of us in the House.

As hon. Members have heard, the amendments deal with matters that are amply covered by existing law and regulations that are well known to doctors and nurses. They deal with matters that must, at the end of the day, be between a woman and a doctor. I deprecate the extent to which amendment 1 is an attempt to import American sensationalism, confrontation and politicisation into these issues in a way that will be of no benefit to ordinary women.

There is no evidence base for the amendments, and on the basis of all the recent polls there is no substantive support for amendments of this nature. Legislation addressing the issues raised by Government Members is already in place. This House should have more respect for the medical profession and for the vulnerable women who put themselves forward for abortion in one of the most difficult periods in their lives, rather than support an amendment of this nature, which is spurious and baseless. I urge the House emphatically to reject the amendment.

--- Later in debate ---

[Owen Smith]

I am ever so grateful to the hon. Lady for that intervention, because it is profoundly rich for anybody on the Government Benches to suggest that we should prevail upon an independent organisation to publish the instructions that it offered to an independent QC, when the Government will not even publish the independent advice that they have commissioned. They have refused to do so repeatedly. They will tell us that they do not agree with this independent opinion, but they absolutely will not publish their own. I suggest that she makes representations to those on her Front Bench, and I will do the same to 38 Degrees if I have a chance.

The independent legal advice goes on to say:

“Encouraged by the structure and clear intention of the Bill to give consortia autonomy from the Secretary of State,”—

which is, of course, in clause 4 of the new Bill—

“there is a real risk of an increase in the ‘postcode lottery’ nature of the delivery of some services, depending on the decisions made by consortia.”

That increase in the postcode lottery takes me on to the second set of proposals that I wish to touch on, which we believe would stop the Government effectively legislating to hardwire the postcode lottery into our NHS. We accept that it is already too variable across the country and that there needs to be greater equity and standardisation, with excellence provided to everybody across the country. That will become all the more difficult with the new provisions.

New clauses 10 and 11, which were tabled by the Labour Opposition, are designed to combat some of the possible malign consequences of the changes that hand to clinical commissioning groups the ability to determine the needs of the local health population and to set their priorities without interference or support from the Government, or indeed from regional strategic health authorities.

[Dr Poulter]

rose—

[Owen Smith]

I am delighted to give way to the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who has such an acute interest in Wales.

[Dr Poulter]

The hon. Gentleman is making some good points. Does he accept that within a national framework of gold standard and good treatment, there will be regional or local variations in the needs of patient groups? For example, given health care inequalities, mental health and the higher rates of cardiovascular problems in ethnic minority populations, patients in Bradford may have very different health care needs and priorities from patients in the area of rural Suffolk that I represent. Does he agree that the Bill goes some way towards allowing local flexibility that will better address some of the different local health care needs?

[Owen Smith]

I accept that there are obviously different needs and that there is a good case for a needs-based assessment model being used by PCTs in the current situation or by CCGs. Indeed, one of the amendments tabled by Liberal Democrat Members on a needs-based assessment is excellent and I wish that we had tabled it. However, the crucial difference, which I alluded to earlier, is that previously the Secretary of State has had a direct duty under section 3 of the National Health Service Act 2006 to provide and secure a whole range of relevant and necessary pieces of the health ecosystem, such as hospitals, within a given area. Under the Bill, that duty will pass to clinical commissioning groups. That is a further crucial removal of responsibility and accountability from the Secretary of State and transference of them to CCGs.

Under the aegis of the Bill, many CCGs may well plan well for their local population, and perhaps better than primary care trusts, but what if they do not? What if they get it wrong and determine for clinical reasons—or, dare I say it, because in this new world they are sitting cheek by jowl in the boardroom with commercial players who have a stake and a skin in the game financially—that they no longer feel it is “reasonable”, as the Bill puts it, to provide certain services? I think that is perfectly foreseeable.

We already know that because of the cost pressures that PCTs are under, they are having to make difficult decisions about which services they will provide and which they will not. They have always had to do that. It is just possible that CCGs will make duff decisions with which local residents disagree. As we heard earlier from my hon. Friends on the Back Benches, they will not be able to be held to account in the way that the Secretary of State, and eventually PCTs through the Secretary of State, can currently be. Those changes are critical, and I suggest that the Minister reflects on them.

Another crucial change to the Bill that we would like to be brought about is in respect of the costs of bureaucracy. We are changing from 150 PCTs to more than 250 clinical commissioning groups and counting. The latter are smaller and less strategic, and certainly less experienced in commissioning, than PCTs or strategic health authorities, and they are arguably too small to compete equitably with very large and financially powerful foundation trusts. That is a real risk. Crucially, they will also increase transaction costs, bureaucracy and administration costs.

That is why, in new clause 11, we have decided to ask the Government to put their money where their mouth is. The Minister asked earlier why we had chosen an “arbitrary” figure of 45% for a cap on the volume of expenditure on administration by CCGs. The answer is simple: it was the number that the Secretary of State came up with. He said that that was how many percentage points he was going to trim off the administration and bureaucracy costs of the NHS. He boasted that he could deliver 45% savings, so we are calling on him today to put his money where his mouth is and legislate for that. Let us measure him against that, because there is not going to be much else that we can hold him accountable for.

We have tabled new clause 10, on waiting times, because targets and standards absolutely matter in the NHS. No matter what the Government keep telling the public, we still believe in clinical targets, including some that the Government would denigrate as “bureaucratic” or “administrative” targets. In new clause 10, we ask the Government to take the power to set transparent regulations relating to waiting times. Waiting times are going up under this Government. There have been 400,000 people with long waits since the Tories came to power. The trajectory and the sense of history repeating itself are depressingly clear to me and my hon. Friends.