Oral Answers to Questions

Lord Lansley Excerpts

Tuesday 18th October 2011 Commons Chamber

[George Eustice (Camborne and Redruth) (Con)]

14. What steps he is taking to reduce NHS hospital indebtedness.

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

The national health service is forecasting a surplus for 2011-12, but the previous Government left a legacy of up to six hospital trusts whose private finance initiative payments are a risk to their financial sustainability and up to 24 trusts with such high levels of debt, following years of bail-outs, that they might not meet tests of their future financial sustainability. We are working with all of those to identify their individual needs so that we can help trusts to achieve consistent standards of quality and financial sustainability, and I will make an announcement on that later this year.

[Mr Rob Wilson]

I thank my right hon. Friend for spelling out the appalling debt that some parts of the NHS inherited from the previous Government. Can he assure me and the House that this Government will deal with the root causes of hospital debt, rather than with the continuing bungs and bail-outs that the previous Government left?

[Mr Lansley]

My hon. Friend is absolutely right. We are determined to root out poor performance, by which I mean not only that we should deal with waste, inefficiencies and poor value for money in the NHS, but that we must identify where standards and quality of care are being met. Both are equally important, and one depends on the other. He will know from the Royal Berkshire NHS Foundation Trust how important it is to sustain finances and quality through foundation trust status. We are seeking to ensure that many NHS trusts reach foundation trust status, something that the previous Government failed to achieve and we aim to achieve.

[George Eustice]

The Secretary of State will be aware of the indebtedness of the Royal Cornwall Hospitals NHS Trust, and that Cornwall as a whole has suffered a disadvantage for many years as a result of the previous Government’s funding formula, having actually received less than the Department’s target budget for many years. Does he agree that such factors should be taken into account when deciding how to reschedule the debts of such trusts?

[Mr Lansley]

My hon. Friend will know, from our conversations and from my visit to Cornwall and the Royal Cornwall Hospitals NHS Trust, the steps that we are taking alongside other NHS trusts to bring them up to high standards of care and financial sustainability. In that regard, the 3.1% increase in revenue allocations for the Cornwall and Isles of Scilly primary care trust between last year and this year will help Cornwall as a whole towards greater financial sustainability.

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

I am grateful, Mr Speaker. On indebtedness, the National Audit Office has produced a report on NHS procurement in England, which it describes as “fragmented” and “poor value for money”. The report shows that £500 million could be saved each year if trusts came together to buy products more collaboratively. Is this further evidence that the Government are wrong to pursue an agenda of competition, rather than co-operation?

[Mr Lansley]

I am afraid that the hon. Gentleman is completely wrong about that. In procurement throughout the NHS, what we have had is fragmentation, and what we need is better co-ordination. That is precisely why, since the election, for example, we have instituted a consistent bar-coding system, allowing procurement throughout the NHS to be undertaken more effectively; and why under the quality, innovation, prevention and productivity programme, the improvement in procurement —reducing the costs of procurement—is intended to achieve those savings and more.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Labour is proud of its legacy, with more than 100 new hospitals built to replace the crumbling Victorian buildings that we inherited in 1997, and it is not just the National Audit Office that has blown a hole in the Secretary of State’s assertion that 22 hospital trusts are on the brink of financial collapse due to PFI. John Appleby of the King’s Fund said:

“The…pressures on hospitals are not to do with PFI but…the need to generate £20bn worth of productivity improvements.”

Is not the real issue that the Secretary of State has tied up the NHS in a distracting and wasteful reorganisation that will cost more money than it will save, and take money away from patient care?

[Mr Lansley]

I welcome the hon. Gentleman to the Opposition Front-Bench position. We are looking forward to the exchanges with him and his colleagues, including during questions today.

Twenty-two trusts have told us, in the course of our looking at where the impediments are to their financial sustainability for the future, that the nature of the PFI contracts entered into by the previous Government is a significant problem in this respect. It is absolutely right for the NHS to build hospitals, which is why we are, for example, building a new hospital at Whitehaven in the hon. Gentleman’s constituency. [Interruption.] I beg his pardon—in the constituency of the hon. Member for Copeland (Mr Reed); we are building so many new hospitals. The nature of the PFI projects we enter into must be to provide value for money and be sustainable in the future. That is something that the previous Government failed to achieve.

[Steve Baker (Wycombe) (Con)]

3. What representations he has received on the reorganisation of urgent care in the past six months.

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[Adam Afriyie (Windsor) (Con)]

7. What recent representations he has received from Berkshire East primary care trust on the future of Heatherwood hospital in Ascot.

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

I have received no such representations.

[Adam Afriyie]

My constituents are shocked to discover that yet again, the future of Heatherwood is under threat. I have had sight of a major petition, and I am actively campaigning with hard-working local councillors, activists and residents to uncover why Heatherwood’s future is under threat when the funding from the Government to the region has increased. Does my right hon. Friend agree that the Berkshire East PCT must cut its bureaucracy costs and introduce efficiencies before threatening the money to Heatherwood hospital and other local services?

[Mr Lansley]

I am grateful to my hon. Friend and completely understand what he is saying. In this financial year compared to the previous one, revenue available to Berkshire East PCT increased by £16.3 million. That is just one part of the £3.8 billion increase in revenue resources available to the NHS this year compared with last year.

Although I very much welcome the shadow Secretary of State to his new position, we will miss his predecessor. We welcome the new shadow Secretary of State not least because he might begin to explain to the NHS why he thought it was irresponsible to increase resources to the NHS in real terms by about £3.8 billion—

[Mr Speaker]

Order. I am grateful to the Secretary of State, but we have a lot to get through. He will resume his seat—and I know he will do so happily.

[Fiona Mactaggart (Slough) (Lab)]

One reason for those increases in resources is the growing birth rate in that part of Berkshire. Slough mums who want to use the Ascot birthing centre at Heatherwood have been locked out since the end of September because of a lack of midwives. If the Government had provided the 3,000 midwives they promised, that centre would not be shut. What does the Secretary of State say to that?

[Mr Lansley]

As the hon. Lady knows, I am very familiar with Heatherwood, because I have two daughters who were born there in the days when it had an obstetrics service, which disappeared under the previous Government. She also knows that I visited Wexham Park in September last year to announce support to the trust in the form of loans, based on commercial principles, totalling £18 million. There is no shortage of midwives under this Government compared with the previous one. Since the election, 522 additional midwives have been recruited, and we are maintaining a record level of midwifery training places.

Decisions made locally are a matter for local commissioners. If they seek to change services, they must meet the four tests that I set out shortly after the election.

[Mr Jamie Reed (Copeland) (Lab)]

The hon. Member for Windsor (Adam Afriyie) is absolutely right to raise concerns about the future of Heatherwood hospital, as are Members on both sides of the House who raise such concerns about their hospitals, such as Chase Farm.

The Health Service Journal reports that the Department of Health is discussing a hospital closure programme, and yet the Prime Minister has promised to fight bare knuckled against any hospital closures. Will the Secretary of State tell us today categorically—yes or no—whether it is still his policy to have a moratorium on hospital closures? If so, for how long will the moratorium last?

[Mr Lansley]

I welcome the hon. Gentleman to his position. The Government are rebuilding his hospital, so it is slightly ironic that he attacks us on that point.

The answer to the hon. Gentleman’s question is that the Government are pursuing no plan for hospital closures. We are doing precisely what I said we are doing: we are working with hospital trusts across the country to ensure that before they reconfigure their services, they must meet key tests on patient access and choice, local authority support, commissioners’ views, and the clinical safety and evidence base. We are working with many of the NHS trusts that the previous Government left in a serious position to ensure that they reach quality and financial sustainability.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

8. When he expects to make a final decision on the safe and sustainable review into children’s heart surgery units in England.

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

This is a clinically led, independent review, within the NHS. The joint committee of primary care trusts, on behalf of NHS commissioners, will make decisions on the future pattern of children’s heart surgery services in England. The review is expected to report before the end of the year.

[Andrew Jones]

I am sure that the Secretary of State recognises the huge and spirited campaign by local people to retain the children’s heart unit at Leeds general infirmary. Will he confirm that option E, which would retain the Leeds unit, will receive full and equal consideration by the joint committee of primary care trusts?

[Mr Lansley]

The review will develop the recommendations to ensure that children’s heart surgery services deliver the very highest standard of care for children and their families. The joint committee of primary care trusts will consider all the relevant evidence before making a decision on the future configuration of children’s heart surgery services, and I hope that that will reassure my hon. Friend.

I should emphasise that no aspect of this review is driven by money: it is entirely about how to ensure sustainable high-quality surgery. The issue is in how many and which centres surgical teams should be based in order to maintain that high-quality care.

[Angela Smith (Penistone and Stocksbridge) (Lab)]

There is a deep-rooted belief that this review is biased against the survival of the Leeds unit. Will the Minister therefore please assure the House that the decision will be made purely on the evidence, and not on the basis of any preconceived idea of which units should survive and which should not?

[Mr Lansley]

It is an independent review and I can assure the hon. Lady that that is indeed the case. It will be based on the evidence. I am sure that she will have heard the response to a debate earlier in the year by the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), who said that while the review has put forward options for consideration, it should not be constrained to consider only those options.

[Nicky Morgan (Loughborough) (Con)]

Will my right hon. Friend confirm that the criteria for the review remain the same; that the rather strange remarks—about more people having voted for one option but more organisations having voted for another—have not affected them; and that those criteria will be used to judge the decision?

[Mr Lansley]

Happily, I can entirely confirm that.

[Kerry McCarthy (Bristol East) (Lab)]

This review came about as a result of the tragic Bristol heart babies scandal in the 1990s, and it is a measure of the quality of services at Bristol children’s hospital that it is now being considered for all four options under the consultation. A few weeks ago, I abseiled down the children’s hospital for Wallace & Gromit’s Grand Appeal, which is an excellent charity. However, will the Secretary of State assure me that, with the move to fewer and larger specialised units, they will be properly funded and will not rely on MPs throwing themselves off tall buildings?

[Mr Lansley]

I am grateful to the hon. Lady. All the representations that we have received in the debates in this House are ample evidence of the high regard and support that Members have for their children’s heart surgery services. None of this is about saving money or resources. It is entirely about what delivers the best quality surgical services for children with cardiac problems. To that extent, the intention is that those services—once the decision has been made—are fully funded.

[Chris Skidmore (Kingswood) (Con)]

9. What progress he has made on reducing the number of foreign nationals using NHS services without payment.

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[Andrew Rosindell (Romford) (Con)]

15. What progress he has made on reducing rates of hospital-acquired infections.

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

The NHS is making significant process toward the zero-tolerance approach that we have made it clear it should adopt in respect of all avoidable health care-associated infections. Over the past 12 months MRSA bloodstream infections have fallen by 29% and C. difficile infections have fallen by 17%.

[Andrew Rosindell]

I thank the Secretary of State for his reply. Will he confirm that the Government will continue with the zero-tolerance approach to hospital-acquired infections as the only sure way to resolve and eradicate this problem?

[Mr Lansley]

Yes, my hon. Friend is absolutely right; indeed, we are extending the range and frequency of the publication of data relating to infections to support the NHS in that work. With his commendable consistency, my hon. Friend asked a question on exactly this subject on 8 March, when he raised the issue of the Barking, Havering and Redbridge trust. I am pleased to be able to report that in the past five months C. difficile infections in the trust have fallen by 57% in comparison with the same five months of 2010, while MRSA bloodstream infections have been reduced by 25%. I expect the trust to continue to bear down on those and other infections in future.

[Kerry McCarthy (Bristol East) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

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

My responsibility is to lead the NHS in delivering improved health outcomes in England; to lead a public health service that improves the health of the nation and reduces health inequalities; and to lead the reform of adult social care which supports and protects vulnerable people.

[Kerry McCarthy]

In the wake of the former Defence Secretary’s resignation and the fact that 40 peers who voted on the Health and Social Care Bill have private sector health interests, and given the Secretary of State’s known connections with private health care companies, can he assure the House that he has been as transparent as possible about the influence of private health care companies on the passage of the Bill?

[Mr Lansley]

I am sorry, but I think the hon. Lady should withdraw that. I have no connection with private health care companies, and if I did, I would have entered it in the register of Members’ interests.

[Mr Speaker]

I am grateful to the Secretary of State, who has put the position very explicitly on the record.

[Gordon Henderson (Sittingbourne and Sheppey) (Con)]

T2. The coalition agreement states:“Doctors and nurses need to be able to use their professional judgement about what is right for patients and we will support this by giving front-line staff more control of their working environment.” That being the case, can my right hon. Friend explain why, despite national clinical guidelines, GPs in my constituency face financial penalties if they do not meet targets for reducing the cost of the drugs that they prescribe?

[Mr Lansley]

I am grateful to my hon. Friend, and I understand that Kent and Medway primary care trust is working to incentivise the optimisation of medicines usage. We provide advice through the National Prescribing Centre and in other ways, and we support that work with GPs through the structure of the quality and outcomes framework. However, this is about incentivisation for best prescribing practice, not about financial penalties.

[Liz Kendall (Leicester West) (Lab)]

Many families will be deeply concerned about standards of care for older people in hospitals following the Care Quality Commission’s recent report. Patients and the public must be confident that all the necessary steps are being taken immediately to tackle this issue. Months after its initial inspections, will the Minister confirm that the CQC has revisited only six of the 17 hospitals that were failing to ensure that older people had enough food and drink, and if so, can he explain why?

[Mr Lansley]

Let me make it clear to the hon. Lady, whom I welcome to her new responsibilities, that the reason the Care Quality Commission undertook unannounced nurse-led inspections in hospitals to look at issues of dignity and nutrition was that I asked it to. As an independent regulator, it must make its own decisions about what it does, but I have been clear in my conversations with the Care Quality Commission that it is moving from the tick-box regulatory approach inherited from Labour to one focused on going out there and finding out where there is poor performance. The CQC is shining a light—not least at our request—on poor performance and poor care in the NHS, and it will continue to do so.

[Several hon. Members]

rose—

[Jeremy Lefroy (Stafford) (Con)]

T4. Several of my constituents, including members of the Cure the NHS group, have raised concerns over the way in which “Do not attempt resuscitation” notices are used in hospitals. Will the Secretary of State tell the House what the NHS is doing to ensure that the national guidance is followed?

[Mr Lansley]

This is an area in which the medical director of the NHS, the General Medical Council and others issue guidance to the NHS. I will gladly write to my hon. Friend setting out the details.

[Huw Irranca-Davies (Ogmore) (Lab)]

T3. I know that I am not alone in being an MP who represents pharmacists who are struggling on a daily basis to access life-saving drugs to treat asthma, diabetes and cancer, even to the point at which some of them are running out of those products. What more can the Secretary of State do to ensure that manufacturers and wholesalers have those life-saving drugs that people’s lives depend on? This is not good enough. What more can the Government do?

[Mr Lansley]

The hon. Gentleman will know that we inherited significant supply problems to pharmacies from the previous Government, not least because of the exchange rate and the possibility of countertrade. We have worked with the industry to resolve those issues. The hon. Gentleman would be well advised to talk to the Welsh Assembly Government about the fact that patients in Wales cannot access the latest cancer medicines, as patients in England can do under the cancer drugs fund.

[Mr Peter Bone (Wellingborough) (Con)]

T6. Today is anti-slavery day, and our excellent Prime Minister will be hosting a reception at Downing street tomorrow to promote the new Government anti-trafficking strategy. That strategy includes a requirement for the health service to be proactive in identifying victims of trafficking. What progress has been made on that?

[Mr Lansley]

I am sure that we all share my hon. Friend’s view of the great importance of this matter. The Department of Health leads on ensuring that health care is available to people who have been rescued by the police from human trafficking. We also lead on promoting an awareness that local government has multi-agency safeguarding processes to assist in supporting people who have been abused and harmed. There is more to say, but I will write to my hon. Friend on the subject.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

T5. In the evidence session on the Health and Social Care Bill, the Secretary of State told me that he was committed to reducing health inequalities. We also heard from the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton) on that subject a few moments ago. Will the right hon. Gentleman therefore explain why he made a political decision last December, against the advice of the Advisory Committee on Resource Allocation, to reduce the health inequalities component of primary care trusts’ target funding from 15% to 20%, in effect shifting funding from poor health areas such as my constituency to richer health areas such as his own? The Government are saying one thing—

[Mr Lansley]

I made no decision contrary to the advice of the Advisory Committee on Resource Allocation. If the hon. Lady cares to look at the increase in revenue allocations to primary care trusts across the country, she will see that many of the lowest allocations are in richer areas and the highest are in the most needy areas.

[Mr Rob Wilson (Reading East) (Con)]

T8. Last week, a survey found that 80% of people want more choice in how and where they are treated. Does that not show that the Government are absolutely right to press on with modernising the NHS?

[Mr Lansley]

Yes, it was absolutely clear that the public wanted choice of treatment. That is one of the reasons that we have published some of the patient decision aids for the first time, and we will continue to do more. People want a choice in the consultant-led team that will provide their treatment, and in the hospital where that will happen. In the past few weeks, we have set out the details of how we are going to give patients the choice that they seek.

[John Mann (Bassetlaw) (Lab)]

T7. I have noticed a growing creeping privatisation of cleaning contracts in the NHS this year. Does this signify a return to the old Tory days of longer waiting lists and dirty hospitals?

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[Mr Speaker]

We are grateful.

[Mr Lansley]

I will not interrupt the hon. Member for Leicester West (Liz Kendall) who is replying from a sedentary position. I agree with my hon. Friend. What we heard under the Labour Government appears to be very much at odds and not at all in keeping with what we hear from the Labour Opposition now. Let me remind my hon. Friend that the South Gloucestershire primary care trust has received a cash increase of £10 million, or 3%, this year. Like every other part of England, it is receiving increases in resources this year that the shadow Health Secretary opposed.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

May I ask the Secretary of State to look back at issues of public health? What is he doing to provide leadership in this sector, especially when we talk to people at the top of the health service who say that there are real problems with obesity in nurses and smoking among doctors? Where is the leadership coming on those issues?

[Mr Lansley]

Let me just give the hon. Gentleman one or two examples. In the last few days, we have published an obesity call to action, which sets out national ambitions to reduce calorie consumption to a point where people can maintain a healthy weight or reduce their weight. We have set out a tobacco control plan, which is regarded as a leader across the world. About three weeks ago, I attended the United Nations General Assembly in order to join in debates with colleagues on reducing the tide of non-communicable diseases across the world. There is also the work of Sir Michael Marmot, which we share with him; he knows that we are taking it forward nationally and internationally to tackle the wider social determinants of health. That is why we have put local government leadership on health improvement at the heart of the Health and Social Care Bill.

[Stephen Gilbert (St Austell and Newquay) (LD)]

Mr Paul Eccles is a constituent of mine. He is a qualified care assistant who wants to go freelance and set up his own business, helping people in their own homes. However, the annual up-front £1,000 charge of the Care Quality Commission is preventing him from starting this new venture. Will the Secretary of State meet me so we can find a way to help my constituent get his business off the ground?

[Ann Coffey (Stockport) (Lab)]

Stockport is one of only five PCTs in the country that does not provide any in vitro fertilisation treatment—in spite of recommendations from the National Institute for Health and Clinical Excellence. Does the Secretary of State think it fair that my constituents, who pay the same taxes as everybody else, do not get the same access to this treatment as people living elsewhere?

[Mr Lansley]

The hon. Lady will know, I hope, that the deputy chief executive wrote to primary care trusts a few weeks ago further to remind them of the need to respond to NICE clinical guidelines. It was the hon. Lady’s Secretary of State, John Reid who, when NICE published its guidelines, told PCTs in 2004 that they should not follow them.

[Dr Julian Lewis (New Forest East) (Con)]

The news that the Woodhaven hospital in my constituency is threatened with closure only eight years after it was opened as a state-of-the-art mental health facility is causing great concern. Will my right hon. Friend endeavour to look into what is proposed for the closure of acute in-patient beds because the “hospital at home” alternative is simply not good enough?

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[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

PCTs in Staffordshire are pre-empting legislation by merging and reorganising now, which has led to plans to close the high street practice in Newcastle-under-Lyme simply because it is run by salaried GPs. Is that really NHS policy? If not, what will the Secretary of State do to help 5,000 patients rescue a much-needed surgery?

[Mr Lansley]

Nothing that is being done pre-empts legislation. What is being done in relation to primary care trust clusters is being done under existing legislation, and was necessary not least to enable us to achieve a reduction of £329 million in management costs in the first year following the election. In contrast, there was a £350 million increase in the year before the election under the hon. Gentleman’s right hon. Friend the Member for Leigh (Andy Burnham).

I do not know the circumstances of the centre to which the hon. Gentleman referred because the decision will have been made locally and will not have involved me, but I will gladly write to him about it.

[John Pugh (Southport) (LD)]

The full roll-out of 111 services is now proceeding. Is the Secretary of State satisfied that imploding PCTs can get the procurement right in the time allowed?

[Mr Lansley]

I am confident that we will make the progress that we seek. If we are not ready in any location, we will not be able to proceed with that procurement, but the PCTs will act on the basis of an evaluation of four pilots. To that extent, the character of what they are procuring through the 111 system will be well defined through piloting.

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

What progress has been made since the launch of the Secretary of State’s tobacco control plan last March in changing the behaviour of people who smoke in cars in the presence of children?