NHS Reform

Lord Lansley Excerpts

Monday 4th April 2011 Commons Chamber

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

With permission, Mr Speaker, I should like to make a statement about NHS modernisation. Modernisation of the national health service is necessary, is in patients’ interests and is the right thing to do to secure the NHS for future generations. The Health and Social Care Bill is one part of a broader vision of health and health services in this country being among the best in the world; world-leading measurement of the results we achieve for patients; patients always experiencing “No decision about me without me”; a service where national standards and funding secure a high-quality, comprehensive service available to all, based on need and not the ability to pay; and where the power to deliver is in the hands of local doctors, nurses, health professionals and local communities.

The House will know that the Bill completed its Committee stage last Thursday. I was also able to announce last week that a further 43 GP-led commissioning consortia had successfully applied to be pathfinder commissioning groups. We now have a total of 220 groups representing 87% of the country; that is 45 million patients whose GP surgeries are committed to showing how they can further improve services for their patients. In addition, 90% of relevant local authorities have come forward to be early implementers of health and well-being boards, bringing democratic leadership to health, public health and social care at local level.

That progress is very encouraging. Our desire is to move forward with the support of doctors, nurses and others who work in the NHS and make a difference to the lives of so many of us, day in and day out. However, we recognise that the speed of progress has brought with it some substantive concerns, expressed in various quarters. Some of those concerns are misplaced or based on misrepresentations, but we recognise that some of them are genuine. We want to continue to listen to, engage with and learn from experts, patients and front-line staff within the NHS and beyond and to respond accordingly. I can therefore tell the House that we propose to take the opportunity of a natural break in the passage of the Bill to pause, listen and engage with all those who want the NHS to succeed, and subsequently to bring forward amendments to improve the plans further in the normal way. We have, of course, listened and improved the plans already. We strengthened the overview and scrutiny process of local authorities in response to consultation, and we made amendments in Committee to make it absolutely clear that competition will be on the basis of quality, not price. Patients will choose and GPs will refer on the basis of comparisons of quality, not price.

Let me indicate some areas where I anticipate that we will be able to make improvements, in order to build and sustain support for the modernisation that we recognise is crucial. Choice, competition and the involvement of the private sector should only ever be a means to improve services for patients, not ends in themselves. Some services, such as accident and emergency or major trauma services, will clearly never be based on competition. People want to know that private companies cannot cherry-pick NHS activity, undermining existing NHS providers, and that competition must be fair. Under Labour, the private sector got a preferential deal, with £250 million paid for operations that never happened. We have to stop that. People want to know that GP commissioning groups cannot have a conflict of interest, are transparent in their decisions, and are accountable not only nationally, but locally, through the democratic input of health and well-being boards. We, too, want that to be the case. People want to know that the patient’s voice is genuinely influential, through HealthWatch and in commissioning. Doctors and nurses in the service have been clear: they want the changes to support truly integrated services, breaking down the institutional barriers that have held back modernisation in the past.

As I told the House on 16 March, we are committed to listening, and we will take every opportunity to improve the Bill. The principles of the Bill are that patients should always share in decisions about their care; that front-line staff should lead the design of local services; that patients should have access to whichever services offer the best quality; that all NHS trusts should gain the freedoms of foundation trust status; that we should take out day-to-day political interference, through the establishment of a national NHS commissioning board and through strong independent regulation for safety, quality and effectiveness; that the public’s and patients’ voices must be strengthened; and that local government should be in the lead in public health strategy. Those are the principles of a world-class NHS which command widespread professional and public backing. All those principles will be pursued through the Bill, and our commitment as a coalition Government to them is undiminished.

We support and are encouraged by all those across England who are leading the changes nationally and locally. We want them to know that they can be confident in taking this work forward. Our objective is to listen to them and support them, as we take the Bill through. No change is not an option. With an ageing and increasing population, new technologies and rising costs, we have to adapt and improve. Innovation and clinical leadership will be key. We want to reverse a decade of declining productivity. We have to make productive care and preventive services the norm, and we must continue to cut the costs of administration, quangos and bureaucracy. The House knows my commitment to the national health service and my passion for it to succeed. To protect the NHS for the future must mean change—not in the values of the NHS, but through bringing forward and empowering leadership in the NHS to secure the quality of services on which we all depend.

Change is never easy, but the NHS is well placed to respond. I can tell the House today that the NHS is in a healthy financial position. Waiting times remain at historically low levels, as promised under the NHS constitution. Patients with symptoms of cancer now see a specialist more quickly than ever before. MRSA is at—[Interruption.]

[Mr Speaker]

Order. The Secretary of State must be heard.

[Mr Lansley]

MRSA is at its lowest level since records began. We have helped more than 2,000 patients have access to new cancer drugs that would previously have been denied to them. All that is a testament to the excellent work of NHS staff up and down the country, and we thank them for their efforts to achieve these results for their patients. The coalition Government are increasing NHS funding by £11.5 billion over this Parliament, but the service cannot afford to waste any money. We can sustain and build on those improvements only by modernising the service to be ever more efficient and effective with taxpayers’ money.

The Bill is a once-in-a-generation opportunity to set the NHS on a sustainable course, building on the commitment and skills of the people who work for it. Our purpose is simple: to provide the best health care service anywhere in the world. I commend this statement to the House.

[John Healey (Wentworth and Dearne) (Lab)]

I thank the Secretary of State for Health for a copy of his statement shortly before he made it this afternoon. So Mr Speaker, in the middle of confusion, chaos and incompetence, the Prime Minister has pushed the Health Secretary out of the bunker to try and tell people what exactly and what on earth they are doing with the NHS. Why is the Health Secretary here and not the Prime Minister? After all, we have been told that the Prime Minister has taken charge and it was he who made his most personal pledge to protect the NHS and to stop top-down reorganisations that have got in the way of patient care. It is the Prime Minister who is now breaking his promises on the NHS.

Will the Health Secretary tell us why the Tories did not tell people before the election about the biggest reorganisation in NHS history? Why did they not tell the Lib Dems about the reorganisation before the coalition agreement was signed? Whatever the Government say or do now, there is no mandate—either from the election or the coalition agreement—for this reckless and ideological upheaval in the health service. In truth, the Health Secretary is here only because there is a growing crisis of confidence over the far-reaching changes that the Government are making to the NHS.

There is confusion at the heart of Government, with briefings and counter-briefings on all sides, and patients starting to see the NHS go backwards again under the Tories—with waiting times rising, front-line nursing staff cut and services cut back. Yet the Health Secretary has done nothing to restore public confidence in the Government’s handling of the NHS and nothing to convince people to back the Tories’ reorganisation plans. Everything he said today the Government were told about in the consultation—and they ignored it. Everything he said today the Government were told in Committee—and they rejected it.

This is not just a problem with the pace of change; simply doing the wrong thing more slowly is not the answer. It is not just a problem with presentation. In fact, the more people see the plans, the more concerned they become about them. That is why there is growing criticism of the Tories’ plans for the NHS—from doctors, nurses, patients’ groups, NHS experts, the Health Select Committee, the Lib Dems and peers of all parties in the House of Lords. I have to hand it to the Health Secretary: it takes a special talent to unite opposition from Norman Tebbit and MC NxtGen. That is why Labour has been saying that the reorganisation requires a root-and-branch rethink and that the legislation requires radical surgery.

There are fundamental flaws in what the Government are doing, not just in what they are saying. The test is whether the Prime Minister will now deal with these fundamental flaws. Will he radically safeguard commissioning to draw on the full range of NHS expertise, to prevent conflicts of interests, bonus payments to GPs and to guarantee that important decisions are taken in public not in private? Will he radically strengthen local accountability to the public and to patients? Will he delete the one third of the Bill that breaks up the NHS and makes it into a full-blown market ruled by the forces of market regulation and EU competition law? Will this be just a public relations exercise or will real changes be made in the NHS plans—or has the Prime Minister not yet told the Health Secretary? This is no way to run a Bill; this is no way to run a Government; this is no way to run the NHS.

[Mr Lansley]

We heard from the Leader of the Opposition earlier that the NHS needed to change, but once again we have heard nothing from Labour Members about how it needs to change. It is not unusual to hear nothing from them. They say that we need to tackle the deficit, but they will not say how. They say that we must change the NHS, but they will not say how.

Interestingly, in January the right hon. Member for Wentworth and Dearne (John Healey) said that he agreed with the aims of the Bill. He said that he supported a

“greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes”.

At the last election, his manifesto said that he wanted all NHS trusts to become foundation trusts. It said that he wanted patients to have access to every provider, be it private sector, voluntary sector or NHS-owned. Now we do not know what the Labour party’s policy is at all, but what I do know is that the Government will give leadership to the NHS, and that we will give the NHS a strategy enabling it to deliver improving results in future.

The right hon. Gentleman clearly wrote his response to the statement before reading it. In fact, we have made it clear that we will listen to what is said about precisely the issues on which people in the NHS and people who depend on the NHS are united. They know which issues are really important. They know that we must be clear about accountability, and that there must be transparency. Clinicians throughout the health service want to work together, and want the structure of the service to help them to work together so that they can deliver more holistic and joined-up services to patients. We want that, and they want that. We will back up our strategy with detail, but from the right hon. Gentleman we heard no strategy, no detail, and no answers whatsoever.

We are clear about the principles that we are pursuing through the reform and modernisation of the national health service. We are listening, and we are engaging with those principles. We are listening to the people in the health service who have come together to implement those principles, so that we can help them to do so effectively. Labour Members have not even listened to those who threw them out at the last election, because they are still wedded to the past and to a failed, top-down, centralised, bureaucratic approach.

[Mr Stephen Dorrell (Charnwood) (Con)]

All who genuinely wish the NHS well and consider it to be an important part of our national heritage will welcome my right hon. Friend’s commitment to ensuring that clinical practice delivered by the NHS is kept up to date with the best available medical practice, and responds effectively to the wishes of patients. Will he continue to develop effective commissioning as the best way of delivering that, building on 20 years of commitment to the principle of commissioning under Governments of all political complexions since 1990?

[Mr Lansley]

I am grateful to my right hon. Friend. He knows and I know—and past Secretaries of State, with the exception of the right hon. Member for Holborn and St Pancras (Frank Dobson) also knew—that in order to deliver the best possible care in the NHS, we needed to engage clinical leadership more effectively. That is what these reforms are about. The modernisation of the NHS is about better and stronger clinical leadership delivering better commissioning of care and thereby helping to deliver better provision of care, and about allying that with democratic accountability at a local level. Neither of those things has happened sufficiently in the past, but both are at the heart of our Bill.

[Mr Ben Bradshaw (Exeter) (Lab)]

Contrary to what the Secretary of State has claimed, waiting times are already lengthening and the quality of service to patients is already deteriorating as a result of his ill-conceived upheaval of the health service. Why does he not abandon it, rather than just pausing for the Easter holidays, before he squanders all the improvements that were achieved under Labour Governments?

[Mr Lansley]

I am sorry that the right hon. Gentleman should denigrate what staff in the NHS have achieved over the past year. He will not have read the deputy chief executive’s report on NHS activity, which shows improvements in breast screening rates, improvements in bowel screening rates—[Interruption.]

[Mr Speaker]

Order. I apologise for interrupting the Secretary of State. I recognise that this subject inflames passions and that there are very strongly held views about it, but there is too much noise on both sides of the Chamber. I gently say to the hon. Members for Middlesbrough South and East Cleveland (Tom Blenkinsop) and for Kingston upon Hull East (Karl Turner) that they should cease to yell at the Secretary of State from a sedentary position. It is very unseemly.

[Mr Lansley]

Thank you, Mr Speaker. I shall not go through a long list, but many services in the NHS have improved and continue to improve. Our objective is very clear: it is to support that improvement, including improvement in waiting times. For example, last year the median wait in January for non-admitted patients was 4.8 weeks, whereas last year it was 4.9 weeks. For diagnostic tests, the average wait this year is 1.6 weeks, exactly the same as last year. Meanwhile, many other factors are continuing to improve as well.

[Sir Paul Beresford (Mole Valley) (Con)]

As the Secretary of State may know, I still have a faint link with the NHS and medicine in general. The GPs I have met in my constituency and elsewhere are very much in favour of the proposals. In contrast, the complaints are circular letters that have been well organised. Does the Secretary of State agree that GPs will be devastated if there is any reversal and backtracking?

[Mr Lansley]

I am grateful to my hon. Friend for his remarks. He and other Surrey Members will be aware of that primary care trust’s past failure to manage effectively within its budget. The GPs in Surrey are, like many others across the country, coming together and demonstrating that they can achieve much greater service improvement within NHS resources—and those resources will increase in future years.

[Mr Kevin Barron (Rother Valley) (Lab)]

Does the Secretary of State recognise that the reorganisation and introduction of competition under this Bill have created chaos inside the national health service? What message does he have for the 40% of people who work for Rotherham PCT who have now taken redundancy, and who are getting out because they know they are aboard a sinking ship?

[Mr Lansley]

As we have demonstrated, NHS performance is continuing to improve, and it will improve further with clinical leadership, but we can achieve that effectively only if we achieve a £1.9 billion a year reduction in administration costs in the NHS. We have started that process: since the election, we have reduced the number of managers in the NHS by 3,000 and increased the number of doctors by 2,500.

[Sarah Newton (Truro and Falmouth) (Con)]

I very much welcome the Secretary of State’s continued support for the NHS in Cornwall, with the cash increases this year, the long overdue integration of adult social care with the NHS, and the real opportunity of giving power to local people through the health and well-being boards. Will he ensure that the central changes he wants to introduce to achieve the aim of “no decision about me without me” are kept absolutely at the heart of what he does?

[Mr Lansley]

I will indeed do that, and I am very grateful to my hon. Friend for her comments. She represents a Cornwall seat, and she and I know that over the years many people in Cornwall have felt they wanted a greater sense of ownership of the decisions made in the health service, not only for individuals but for the health service in Cornwall itself. That is precisely what we are going to make available through both local commissioning and local authorities.

[Glenda Jackson (Hampstead and Kilburn) (Lab)]

The Secretary of State listed in his statement concerns to which he intends to listen, but every single one of them has been raised with him before, going back to the time of the publication of his White Paper. As he did not listen to those concerns then, why should any of us believe his positive commitment to listen to them now?

[Mr Lansley]

I am afraid the hon. Lady is completely wrong about that. We have continuously listened. After the publication of the White Paper, we had a full 12-week consultation with more than 6,000 responses, and in December’s Command Paper we set out a whole series of changes that were consequent on that, including to the structure of commissioning and the timetable for the transfer of NHS trusts into foundation trusts. In Committee, we have introduced further amendments, not least to make it clear that competition in the NHS will be on the basis of quality not price, which is very important because that is a concern that people raised.

[Sajid Javid (Bromsgrove) (Con)]

I warmly welcome my right hon. Friend’s efforts in modernising the NHS. The concept of GP commissioning has been widely supported by politicians from all parties for many years. May I urge my right hon. Friend to keep putting patients first by increasing GP involvement in the NHS?

[Mr Lansley]

I am grateful to my hon. Friend for his remarks. We have now—earlier than any of us had imagined—arrived at the point where most of the country has pathfinder consortia in place. It is absolutely the right moment to engage with them to discuss how we can ensure that the concerns that have been properly raised, about transparency and accountability in governance and the avoidance of conflicts of interest, will be dealt with in the legislation. We want the legislation to work for them and the people we serve.

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

The Secretary of State has spoken a great deal about ill people, but the health service is also, very importantly, about promoting health. With local authorities taking the lead in the public health strategy, what is his mechanism to ensure that GPs are fully involved and contribute fully to the wide range of initiatives on which primary care trusts took a lead, such as those on child protection, teenage pregnancy, diet and exercise, child safety and obesity?

[Mr Lansley]

If the hon. Lady reads the Bill, she will see that one of its changes that has been most widely supported, including by local authorities across England, has been the transfer of public health leadership into the health and well-being boards, with ring-fenced budgets for local authorities. The previous Government could have done that, but they did not. Such an approach will allow continued engagement with general practitioners and their practices, both because they are participants in the health and well-being boards and because Public Health England and the local health and well-being board will be able to influence directly the quality and outcomes framework, which incentivises GPs in the work that they do.

[Mr John Redwood (Wokingham) (Con)]

Colleagues on this side of the House will know that the Secretary of State has a great passion for the health service, and great mastery of his brief. Will he confirm, for the sake of all hon. Members, that the object of getting rid of PCTs and top-down targets is to free a lot of money for patient care? That should be in the interests of all hon. Members and their constituents.

[Mr Lansley]

I am grateful to my right hon. Friend. Before the election, the previous Labour Government said that it was necessary to save up to £20 billion in efficiencies in the NHS, but they never said they would reinvest that money in the NHS. We have said that we will reinvest it. In order to deliver those efficiencies, 10% of that gain will be achieved by cutting the costs of bureaucracy and administration. We have set out how we will do that, but the previous Government never did.

[Mr George Howarth (Knowsley) (Lab)]

Does the Secretary of State understand that those who care about the future of the NHS believe not only that he got his presentation wrong, but that his Bill is fundamentally wrong in principle?

[Mr Lansley]

No, I do not accept that for a minute. The right hon. Member for Wentworth and Dearne, who sits on the Opposition Front Bench, has freely acknowledged that I have met and talked to many people in the NHS over the course of seven and a half years, and that I am passionately committed to the NHS. If one set of beliefs lies at the heart of the reforms and the Bill, it is the belief in the NHS as a free, comprehensive, high-quality service that delivers some of the best health care anywhere in the world. We will never achieve that without the clinical leadership that is essential to delivering high-quality health care.

[John Pugh (Southport) (LD)]

I thank the Secretary of State for having the grace and courage to respond to legitimate concerns. Given the agreement that exists in the House—not about the effects of the Bill, on which there is no agreement, but about its aims—does he agree that we should not get hung up about whether substantial changes will in future be referred to as “tweaking”, “surgery” or, possibly, “surgical tweaking”? Is not the main thing to get a Bill that carries the broad support of Parliament, NHS professionals and the country? We do not need to sell this Bill better; we need to take the spectre of salesmanship out of the NHS.

[Mr Lansley]

The hon. Gentleman and I know one another well enough to know that we share a commitment to the NHS and that I am determined. Perhaps I sometimes get very close to all of this because I am very close to the NHS. I spend my time thinking about this subject and I spend my time with people in the service. I spend my time trying to ensure that the Bill is a once-in-a-generation opportunity to get it right for people in the NHS—they want to be free. The British Medical Association made it clear that it wants an end to constant political interference in the NHS. We can do that only if we secure the necessary autonomy for the NHS, and if we make accountability transparent, rather than having constant interference from this place or from Richmond house.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

How many managers who have lost their jobs will be re-employed during this pause?

[Mr Lansley]

I do not have a figure for how many have been re-employed. The hon. Lady will know that under the process by which people agreed with the NHS to take resignation and, more recently, in voluntary redundancy terms, after six months there is an opportunity for people to take jobs—we are not depriving them permanently of the ability to take jobs. Indeed, one of the responsibilities of the commissioning consortia will be to find the best people, but we are doing that now. That is why we continue to make progress on the ground by the assignment of PCT staff to commissioning consortia and to local authorities, in order to ensure that they are beginning to take on their responsibilities.

[Conor Burns (Bournemouth West) (Con)]

My right hon. Friend will know that many GPs are very excited by the opportunity that his reforms will give them to serve the needs of their local communities even better. Can he assure those GPs that he has no plans to water down that strengthening of their pivotal role in the national health service?

[Mr Lansley]

I am very grateful to my hon. Friend. This is born not of political opportunism, as it seems to have been characterised by the Opposition, but of a determination to support those people in constituencies that my hon. Friends on this side of the House have been talking to and listening to. As he knows, GPs in his area have come together. For example, when I met people at Southampton hospital recently, they were able to talk about how they were working together on improving the clinical design of services for patients in his area.

[Malcolm Wicks (Croydon North) (Lab)]

Why has the Secretary of State waited until now, after the passing of the Bill through its Committee stage, to announce a so-called natural break in which to listen to and engage with the public? Perhaps I am old-fashioned, but would not the normal process involve getting the brain into gear to avoid putting the foot in the mouth?

[Mr Lansley]

If I did not come to the House to make a statement, I would be accused of not doing so, but when I do so, the Opposition ask why. The reason is very simple: it is because we are going to listen, and to engage with people actively over the course of the coming weeks, and I did not want the House to see that happening during the recess without having been told about it beforehand.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

Does my right hon. Friend agree that only the most cynical people could criticise him for wanting to consult more about the changes that he wants? [Laughter.] And that only the most cynical could treat the NHS as a laughing matter? Will he maintain the goal of delivering the prize, which is to give local people, through their local GPs, more control over the resources that the NHS spends in their name?

[Mr Lansley]

Yes, I agree. Indeed, in north-east Essex, the consortium under Dr Shane Gordon’s leadership is doing exactly that. I personally think that leadership and listening are not mutually exclusive, and we are going to continue to do both.

[Valerie Vaz (Walsall South) (Lab)]

In the spirit of openness, will the Secretary of State please place in the House of Commons Library a copy of the legal advice on whether EU competition law will apply to the provisions in the Bill?

[Mr Lansley]

The hon. Lady should know, as a member of the Health Select Committee, that I wrote to the Chair of the Committee just last week and set out the position very fully. The Bill does not extend the scope or application of competition law at all.

[Mr David Evennett (Bexleyheath and Crayford) (Con)]

I welcome my right hon. Friend’s statement. Does he agree that reduced bureaucracy and better local scrutiny and accountability will ensure a better NHS for all?

[Mr Lansley]

Yes, my hon. Friend is absolutely right. Locally, he can see how that is happening as GP leaders—including Dr Howard Stoate, whom Members will fondly remember, as the chair of the clinical cabinet in Bexley—are coming together to look at issues that the previous Government never dealt with, including those relating to the South London Healthcare NHS Trust and to Queen Mary’s hospital in Sidcup. They are coming forward with proposals to improve services for local people, and I applaud that kind of clinical leadership.

[Joan Ruddock (Lewisham, Deptford) (Lab)]

Before the general election, the right hon. Member for Witney (Mr Cameron) promised an extra 3,000 midwives. Has the Secretary of State noted the alarming rise in preventable maternal mortality? Would the Secretary of State not do better to deliver on his Prime Minister’s promises and abandon his reckless reorganisation?

[Mr Lansley]

The right hon. Lady must know that we continue to have a record number of midwives in training, and that the number of midwives in the health service has continued to increase since the election. In the financial year that is just starting, the number of commissions for training will continue to be at a record level.

[Gordon Birtwistle (Burnley) (LD)]

The Secretary of State is aware that under the Labour Government, accident and emergency and children’s services were transferred from Burnley to Blackburn. The transfer was opposed by the majority of GPs and 95% of the local community. It was supported only by the bureaucrats in the PCT and the SHA and by prima donna consultants. Will the Secretary of State confirm that under his new proposals that will never happen again and that such decisions will be taken only following full consultation and agreement with GPs and local communities, rather than being driven through as they were by the previous Government?

[Mr Lansley]

I am grateful to my hon. Friend. In Burnley and other places—I think not least of Maidstone—decisions were made in the past, under a Labour Government, that clearly did not meet the tests that we now apply, which are about public engagement, the support of the local authority, engagement with general practices leading commissioning, the clinical case and the responsiveness to patient choice. Those tests will be met in future. As we go through the painful process of examining how they are applied to the situations that we have inherited, on occasion we can say things to help colleagues, but sometimes we cannot.

[Mr Gerry Sutcliffe (Bradford South) (Lab)]

It is not only the Health Secretary who cares about the NHS. Most people in the House support the NHS in their constituencies and the work that it carries out, but the mistakes that the Secretary of State has made—I hope he will admit that he has made mistakes by not listening—mean that there will already be costs to the health service because of the Bill. Will he publish an impact assessment of the costs to the health service so far of his failed policies?

[Mr Lansley]

I am afraid the hon. Gentleman is wrong on a number of counts. First, we have listened and we will continue to listen. Secondly, of course there are costs in reducing the number of managers in the NHS, but it is absolutely essential that we reverse the decade of declining productivity in the NHS that took place as the number of managers went up by 78%. How can that be the right way forward? Under Labour, we had more managers and less productivity.

[Andrew Percy (Brigg and Goole) (Con)]

The Secretary of State will be keen to know that many of the GPs I have met in my constituency are keen on the idea of GP commissioning, but there is undoubtedly concern about the exact role of the private sector in the NHS. May I urge the Secretary of State to use these next few weeks or months to ensure that in the country and if necessary in the Bill we make it perfectly clear that the private sector will not be allowed to undercut or undermine our local hospitals?

[Mr Lansley]

Yes. I am grateful to my hon. Friend. Our manifesto was clear that patients should be able to have access to a provider who gives them the best quality, be it the NHS, a private sector provider or a voluntary provider. That was in the Liberal Democrat manifesto and in the Labour manifesto. It is always about ensuring that that provider is properly qualified and that the basis of that choice is quality, not price. There cannot be a race to the bottom on price. We make it very clear in the legislation—it is important to set this out—that the commissioners of local services will also, through designating services, be able to ensure that where patients need services to be maintained and need continuity of services they can set that out themselves.

[Mr Dennis Skinner (Bolsover) (Lab)]

Why does the Secretary of State not admit that the policy is unravelling before the eyes of the British public? The thousands that have been writing to MPs in every constituency now know that the truth is out. Instead of waiting for the natural break, and then a reshuffle, and then a resignation, he should do the honourable thing now and resign today.

[Mr Lansley]

I will tell the hon. Gentleman one thing: I and my colleagues on the Government Benches talk to people in the constituencies who are getting on with this. That is what is so impressive. People across the NHS are seeing the opportunity to bring more clinical leadership and more democratic local accountability to fashioning an improving health service. That is what I am determined to achieve.

[Priti Patel (Witham) (Con)]

Excessive bureaucracy and a record level of managers have dominated health care provision in mid-Essex. Will my right hon. Friend assure my constituents that, under his reforms, the funding for that excess will go to front-line patient care in the constituency of Witham?

--- Later in debate ---

[Mr Lansley]

Yes, I can. Under the coalition Government, in mid-Essex there has been a 3.2% increase in cash for the NHS this year compared with last year. Not only that, but more of that money will, as a consequence of our changes, get to the front line to deliver improving services for patients.

[Clive Efford (Eltham) (Lab)]

“No decisions about us without us” could apply to every single person who works in the NHS who has been telling the Secretary of State that these are reckless changes. Throughout the country changes are taking place. Now he says that he is going to be listening. If so, we can anticipate some more changes. Will he therefore instruct everyone in the NHS who is currently restructuring on the basis of the Bill to stop that restructuring until we know exactly what the Government intend to do?

[Mr Lansley]

No, I will not, because we are very clear about the strategy and the principles of the Bill. We are equally clear that now we have the opportunity to work with the developing GP pathfinder consortia, the health and well-being boards in local authorities and the wider community to ensure that the implementation of the Bill and its structure support those developing organisations.

[Mr Steve Brine (Winchester) (Con)]

I thank the Secretary of State for his helpful and useful update this afternoon, and welcome his assurances that the coalition wants to reform and modernise our NHS, right in line with its founding principles. He knows that I will continue to argue for greater transparency for the new GP consortia, and I hope we can still find a way to do that, but I warmly welcome his listening exercise, the measures contained in the Bill and the way he has made himself freely available to colleagues since taking up his post last year. May I urge him to continue doing that both in the House and, of course, outside it?

[Mr Lansley]

I am grateful to my hon. Friend. We will do that, not only formally across the country but in the informal manner that we do in the House. His point of view exactly illustrates the purpose of my statement. He served on the Committee that debated the Bill. Notwithstanding the good progress that the Bill has made and that we are making around the country, people have legitimate concerns and questions. They want to raise those and to know that we will listen and act on them.

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

Can the Secretary of State say more about the future of care trusts? Integration of health and social care is vital to all our constituents. With all the uncertainty, staff are being lost and more could be lost. During this natural break, what can the Secretary of State say to preserve the continuity of those people doing that vital work and the continuing support for care trusts?

[Mr Lansley]

I reiterate the point that I made a moment ago. There is nothing in what I have said today that should do other than give people on the ground confidence that they are building the improvement of services that they need for the future. At the heart of that is the integration of health and social care. We as a Government have made available in this new financial year £648 million through the NHS specifically to build that kind of integration between health and social care. It has been insufficient in the past; we are building it now. As the hon. Lady knows, the Bill allows care trusts to continue in formation, but it is also possible for care trusts to redesign around commissioning consortia on the one hand and health and well-being boards on the other.

[Margot James (Stourbridge) (Con)]

The Leader of the Opposition stated his willingness to work with the Government on the NHS reforms. Does my right hon. Friend agree that a good place for him to start would be with a re-reading of his party’s manifesto at the last election, which supported virtually every principle in our NHS Bill, with one important difference—it was without the additional funding to match?

[Mr Lansley]

My hon. Friend makes a very good point. I am not sure which Labour party we would be expected to engage with—the one whose manifesto agreed with us, the one for which the right hon. Member for Wentworth and Dearne spoke at a King’s Fund meeting in January when he agreed with us, or the one that we saw in Committee, which opposed everything, tried to wreck the Bill and clearly has gone back to the Holborn and St Pancras view of the NHS.

[Mr Jim Cunningham (Coventry South) (Lab)]

It is obvious that the public are extremely concerned about the Bill. Why does the Secretary of State not suspend the Bill and bring forward new proposals that we can all support?

[Mr Lansley]

I am afraid the hon. Gentleman does not seem to understand that the public support the principles of the Bill. The public want patient choice. When they are exercising their choice over treatment, they want to be able to go to whoever is the best provider. Patients believe that general practitioners are the best people to design services and care on their behalf. Patients, the public and professionals support the principles of “no decision about me without me”, focusing on outcomes and delivering an outcomes framework, and the devolution of responsibility. What we are talking about now is ensuring that other important principles, such as governance, accountability, transparency and multi-professional working, are genuinely supported by the structure of the Bill.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

My constituents in Suffolk were very concerned at the last election about the fact that only two doctors covered them for out-of-hours care, and that was for 600,000 patients. They welcome the reforms in the Bill. Indeed, Waveney and Great Yarmouth have come together as one pathfinder consortium and resumed out-of-hours care. Will the Secretary of State assure me that such important changes will continue to be important for patient delivery in the new Bill?

[Mr Lansley]

Yes, my hon. Friend makes an important point. When people talk about primary care trust commissioning, they might care to look at the report produced by the Care Quality Commission on how primary care trusts went about commissioning out-of-hours care. The answer is that they pretty much did it on the basis of cost and volume, rather than quality, and once they had a contract they did not monitor it, follow it up or ensure that the right quality was there, including the right calibre of doctors. It is clear that general practice-led commissioning consortia will take a wholly different and preferable approach to that kind of commissioning.

[Alison McGovern (Wirral South) (Lab)]

The Prime Minister’s commission on the future of nursing and midwifery reported a year ago in March 2010. Of the 20 recommendations, all related to improving the quality of care in the NHS, which is my constituents’ priority, not top-down reorganisation. During the pause that the Secretary of State has announced today, will the Government finally find time to respond to that important report?

[Mr Lansley]

Yes.

[Richard Drax (South Dorset) (Con)]

Can the Secretary of State reassure me that any further listening will mean that retaining local community hospitals, which are much loved across the country and particularly in South Dorset, remains top of the agenda?

[Mr Lansley]

I can assure my hon. Friend that one of the central beauties of the Bill is that in future it will matter less what my priorities are and much more what the priorities are of his local communities and general practitioners and others who are responsible for commissioning in his area. On that basis, I have no doubt about the importance and priority that they will attach to community hospitals.

[Nic Dakin (Scunthorpe) (Lab)]

I share and welcome the Secretary of State’s commitment to reduce bureaucracy, so I am concerned to know why Monitor’s budget is increasing by 600% over four years to police the marketisation of the NHS. Is that not poor value for money?

[Mr Lansley]

The Government are introducing for the very first time a clear limitation and reduction on the running costs of the NHS. That will include the Department of Health, the arm’s length bodies, the strategic health authorities and the primary care trusts—the whole shooting match. We will reduce those costs by more than a third in real terms. Monitor forms part of that. We have made it clear that its estimated total running costs will be between £50 million and £70 million. That is more than at present because its responsibilities will be considerably larger than they are at present.

[Mr Mike Hancock (Portsmouth South) (LD)]

As the Secretary of State will be aware, I chaired the majority of the Public Bill Committee’s sittings. It was the longest Bill Committee for 12 years. During that time, more than 100 amendments were voted on in formal Divisions, and many hundreds of others were agreed to. If we are taking several months to look at this again, how on earth will the time be found to ensure that this House has enough time to scrutinise properly any changes, bearing in mind how much time has been spent on the Bill as it stands? I want an assurance, as I hope the whole House does, that we will be given sufficient time and that the Bill will not be steamrollered or bulldozed through the House.

--- Later in debate ---

[Mr Lansley]

I know that the whole Committee will have been grateful to my hon. Friend for his chairmanship, because what was achieved in Committee, as was acknowledged by the hon. Member for Halton (Derek Twigg), was that every inch of the Bill was scrutinised. It is our intention to secure proper scrutiny for any changes that result from our engagement.

[Jim Shannon (Strangford) (DUP)]

The Public Bill Committee was one of the busiest since 2002, according to the Clerk, with 26 sittings and more than 100 Divisions. Does the Secretary of State not agree that that reflects the level of concern that the general public have, but that they will exercise theirs at the next general election?

[Mr Lansley]

No, I am afraid I do not accept that. All that 100 Divisions demonstrate is that time and again the Labour party was simply trying to divide the Committee in order to delay or, indeed, to wreck the Bill.

[Tony Baldry (Banbury) (Con)]

GPs in Oxfordshire want to be catalysts for change. Collectively and collegiately, they want to be able to design NHS services for the best and optimal benefit of the people of Oxfordshire. Can my right hon. Friend confirm that this statement means that they can continue to design those services and continue to plan to have an Oxfordshire-wide GP consortium, knowing that they will be able to go forward in the future to plan the best health services for the people of Oxfordshire?

[Mr Lansley]

Yes, I can indeed confirm that. Having joined my hon. Friend in Banbury in the past and met GPs there, I know and can say that, if they had been more fully engaged, as our plans would have meant, in the design of clinical services in Banbury or in the future of the Horton general hospital, for example, we would have had better and earlier outcomes than was in fact the case.

[Barry Gardiner (Brent North) (Lab)]

The Secretary of State, in his letter to me of 23 March, dismissed my request that he discuss with the Comptroller and Auditor General concerns about the conflicts of interest which might arise from GP commissioning. The Secretary of State, in his statement today, refers to the concerns about those specific conflicts of interest. Will he now engage in a discussion with the Comptroller and Auditor General to receive best advice on methods of Government procurement?

[Mr Lansley]

I do not think I dismiss anybody; I might not agree with people, but I do not dismiss them. If I recall correctly, I did not agree with the hon. Gentleman’s suggestion because he misunderstood the fact that the consortia are separate statutory bodies, not private bodies, and separate from GP practices, which are individual contractors to the NHS. The confusion between those two things meant that his point was not valid.

[Duncan Hames (Chippenham) (LD)]

My constituents, who have watched primary care trusts halve the number of community hospital medical beds in Wiltshire, know that NHS reform is needed to make decision makers accountable, so how does the Secretary of State propose to strengthen the public and patient voices on the boards of the GP consortia that will replace them?

--- Later in debate ---

[Mr Lansley]

Clearly, this is an area that we will engage in over the coming weeks, but the Bill is already clear that the consortia must engage the public and patients directly. We can look at how we can strengthen that, but we must never lose sight of the fact that, through local health and wellbeing boards, we are creating for the first time a very much stronger public representative voice in relation to all such decisions, including commissioning and planning, and that, through HealthWatch, we are creating for patients an altogether stronger, more comprehensive patient voice, which will have a statutory right to be consulted and to express a view on all those commissioning issues.

[Diana Johnson (Kingston upon Hull North) (Lab)]

Exactly how long will the natural break be, and how will we know whether the Secretary of State has listened?

[Mr Lansley]

I think the hon. Lady must accept that, because I have come to the House and made it very clear that we are going to do this thing. We are going to set it out, I have done so before the recess, and it will take place during the recess and beyond. But, from my point of view, I think that in the formation of the policy and its introduction there has been a genuine process of listening. It is now a genuine process of listening and engaging to ensure that we get the implementation right.

[Mr Peter Bone (Wellingborough) (Con)]

This has been a very good day for the coalition Government, a great day for the Secretary of State and a superb day for Parliament. What Opposition Members do not seem to understand is that this is about Parliament scrutinising a Bill and improving it. Does the Secretary of State agree that he should listen not to those dinosaurs but to Parliament?

[Mr Lansley]

I am grateful to my hon. Friend. My objective is to ensure that the statutory structure for the NHS moves on from one that had virtually no serious accountability. As Secretary of State, I could have done most of this without the legislation: I could have just abolished most of the primary care trusts and strategic health authorities. Previous Secretaries of State behaved in that cavalier fashion, but we are not doing that; we are giving Parliament the opportunity—a once-in-a-generation opportunity—to give the NHS greater autonomy and, in the process, to be transparent about the structure of accountability.

[Kate Green (Stretford and Urmston) (Lab)]

Is the Secretary of State aware of the instability that we are experiencing in the management of NHS services in Trafford, with provider services off at Ashton-under-Lyne, Wigan and Leigh on a temporary basis, with Trafford Healthcare NHS Trust forced to find a new partner for its management, and the primary care trust forced, first, to combine with other Greater Manchester care trusts for one year, before splitting into GP consortia next year? In view of all that instability and the uncertainty that it is causing to staff in the NHS and at Trafford, will the Secretary of State ensure that he has the adequate support in terms of project and change management that appears to be so lacking at present?

--- Later in debate ---

[Mr Lansley]

Let me make it clear to the hon. Lady that many of the things she is describing in Trafford are the result of things that the last Labour Government failed to do. For example, the last Labour Government said that all NHS trusts should meet the criteria to become foundation trusts by December 2008, but they did not do it. We are now having to help NHS trusts to meet the kind of quality and viability standards that they did not meet in the past, which is at the heart of many of the problems she describes. Do we have management resources? Yes, we do. That is one of the reasons I invited Sir David Nicholson, as chief executive of the NHS, to be the chief executive of the new NHS commissioning board so that the design of commissioning for the future will be completely consistent with the transition and the management of the change in the NHS today.

[Mary Macleod (Brentford and Isleworth) (Con)]

I thank my right hon. Friend for standing firm in his desire to improve the NHS. Will he join me in commending the work of the Great West commissioning consortium in London and others, who have approached these reforms with professional leadership and commitment to make the NHS more efficient and improve public health, ensuring better care for all patients?

[Mr Lansley]

Yes, I do join my hon. Friend in applauding the Great West commissioning consortium, because it and others across London are demonstrating that instead of having the top-down diktat of how services should be changed in London, they are in the process of designing, from the point of view of the populations they serve, what the requirement is for them and their services in their area. That is a better and more sustainable basis on which to design community-led and primary care-led services for the future.

[Mr David Anderson (Blaydon) (Lab)]

This debate was confused before today. Can the Secretary of State put in writing exactly what things will be put on hold and what things will carry on? For example, he said that he is taking a natural break but GP commissioning groups can still continue to be set up. If the natural break is a good idea, surely that is a pointless exercise.

[Mr Lansley]

No, the hon. Gentleman misunderstands. I was very clear in my statement and in subsequent responses to questions. Right across the country, there are thousands of people who are developing the pathfinder consortia, taking NHS trusts through to foundation trust status, and building the health and well-being boards and new public health structures in local government. They should be confident in doing that, because the Government continue to be committed to achieving those changes. In the process of doing so, we will engage with them to ensure that the legislation specifically gives them the support that they need.

[Nadhim Zahawi (Stratford-on-Avon) (Con)]

I congratulate my right hon. Friend on engaging and listening. We have all received the 50 or so e-mail circulars from constituents who are concerned, but that does not reflect the evidence on the ground. GPs in Shipston in my constituency are absolutely passionate about the reforms and want to engage fully with them, as do 220 other groups—87% of the country. May I make a suggestion to the Secretary of State? Perhaps we should bring all those people who are passionate about this reform and want to take party politics out of it together with Labour Members on a platform so that we can take this forward without petty politics derailing a brilliant piece of legislation.

[Mr Lansley]

I am grateful to my hon. Friend. Labour Members sit and laugh about this, but they ought to realise that 1 million patients a day visit their local general practice surgery. GPs across the country who have come together to form pathfinder consortia—87% of the country—are doing it on the basis that they can improve services for patients. I suspect that they understand the needs of their local community and patients better than many Labour Members, who are not listening to their GPs locally.

[Grahame M. Morris (Easington) (Lab)]

I would like to thank the Secretary of State for single-handedly destroying the Government’s reputation on the NHS through this Bill. No amount of minor changes or slowing down of the pace will address the Bill’s fundamental failure to protect the public from privatisation by stealth. If he refuses to resign, is he worthy of his nickname, Broken Arrow—he doesn’t work and he can’t be fired?

[Mr Lansley]

The hon. Gentleman might like to talk to Dr Stewart Findlay, who is among those leading the pathfinder consortium in County Durham. He might like to talk to people locally who are piloting the new 111 telephone system, which will give better access and better urgent care to patients. Instead of sitting there making rather absurd political points, why does he not go and talk to people who are delivering services to patients? That is what the NHS is really about.

[David Rutley (Macclesfield) (Con)]

In east Cheshire, there is no lament for the passing of the PCTs. In fact, there is a positive response to GPs having a greater say in how health care is delivered locally. Will the Secretary of State tell the House how GPs will be updated on progress over the coming weeks?

[Mr Lansley]

I am grateful to my hon. Friend. We are not only developing communication with GPs in pathfinder consortia, but, more importantly, creating a learning network among GPs in pathfinder consortia, so that these groups across the country will not only learn from each other, but, we hope, arrive at a set of views that help us to design a service that supports them.

[Toby Perkins (Chesterfield) (Lab)]

The Secretary of State, who tells us how much he studies the NHS, must know that the King’s Fund tells us that under the Labour Government, Britain’s NHS was the most efficient in the entire world. On that basis, a broad coalition of people, including health experts and the Liberal Democrats, is telling him that this policy is wrong. He apparently came here today to tell us why he is right and all those people are wrong. Is this a genuine consultation, or is it just a pause to get through the local elections before he does what he wants to do anyway?

[Mr Lansley]

The hon. Gentleman is wrong on almost every count. We have seen a decade of declining productivity in the NHS. The Office for National Statistics and the National Audit Office set that out recently. We have seen an NHS that, despite record increases in funding, which are welcome, is still not meeting the best European cancer survival rates, as was made clear by the NAO. We need to improve the NHS. The Government are not discounting anybody’s views on how we can best achieve that. In the spirit of continuous improvement in the NHS, there is a spirit of continuously listening about how to make that happen.

[Dan Byles (North Warwickshire) (Con)]

Does the Secretary of State share my amazement that in recent months the Labour party seems to have U-turned on patient choice and on any willing provider, and does not appear to support putting clinicians in charge of commissioning health care? Its only policies seem to be “Save the PCTs”, “Save the SHAs” and “Save NHS bureaucracy”.

[Mr Lansley]

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

[Bill Esterson (Sefton Central) (Lab)]

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

[Mr Lansley]

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

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

The Secretary of State told my hon. Friend the Member for Scunthorpe (Nic Dakin) that the budget for Monitor will be between £50 million and £70 million, but the Health and Social Care Public Bill Committee, on which I sat, heard that it would be between £40 million and £130 million. Does that not show that not only are the Government not listening to this side of the country but are not even listening to their own facts?

[Mr Lansley]

I answered that question earlier.