Oral Answers to Questions

Lord Lansley Excerpts

Tuesday 22nd November 2011 Commons Chamber

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

4. What steps he is taking to reduce the burden of debt for NHS hospitals.

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

Although the overall financial position remains healthy, we will continue to focus on the small number of organisations in the NHS that are struggling to manage their finances. We are working to help all NHS trusts to be sustainable providers of high-quality health care and move forward to foundation trust status. That will include, where appropriate, agreeing solutions to resolve the regrettable legacy of debt from the previous Government.

[Sarah Newton]

Despite the fact that the staff of the Royal Cornwall Hospitals NHS Trust have made big strides forward in improving patient care while delivering efficiency savings, the trust is saddled with historic debt, largely as a result of Labour accountancy measures. Does my right hon. Friend agree that that is grossly unfair and will he meet me to find ways of writing off the remaining Labour debt so that my constituents can stop worrying about the future of the only acute hospital in Cornwall?

[Mr Lansley]

I am grateful to my hon. Friend and completely concur. I have had the privilege of visiting Treliske hospital and seeing the good work that is being done there. In the course of the last financial year, the trust returned a surplus and it is projecting a surplus this year. As she knows, it has a legacy of debt that is being financed by a working capital loan. As with other NHS trusts, we are looking to ensure that through the process of becoming a foundation trust it will move from having legacy debts from the previous Government’s regime to being financially sustainable year-on-year while meeting the viability and balance sheet criteria for foundation trust status.

[Mr Dave Watts (St Helens North) (Lab)]

When will the Secretary of State get a grip and sort out the problems of PFI long-term funding—[Laughter]—given the fact that Ministers promised to do that six months ago and that we are no nearer a resolution than we were before?

[Mr Lansley]

I do not know whether Hansard will record it, but the mirth with which that remark was met is an indication from Members that they know perfectly well, as the hon. Gentleman ought to know, that the previous Labour Government left a terrible legacy of unaffordable PFI projects that were poor value for money when they were introduced. He knows perfectly well the position his local trust has been put in. We are working through that, and out of the work that has been done to resolve that poor legacy, we identified 22 NHS trusts which said that their PFI was an impediment. We are working with all of them to resolve that.

[Emma Reynolds (Wolverhampton North East) (Lab)]

5. What plans he has to allocate resources to local authorities when they assume responsibility for public health.

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[Nick de Bois (Enfield North) (Con)]

6. What steps he is taking to raise the standards of care provided by health care workers and care assistants.

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

I have commissioned Skills for Health and Skills for Care in partnership with employers, unions, regulators, educators and others to develop a code of conduct and minimum training standards for health care support workers and adult social care workers in England. This will give employers and patients confidence in the employment and standards of staffing at all levels. I expect the final report and recommendations by September 2012.

[Nick de Bois]

The Secretary of State knows that I believe in less, not more, regulation, but given the increasing role and responsibilities of health care assistants, particularly with the elderly, does he agree that the time has come both to recognise their increased responsibilities and to provide safeguards at a national level by requiring them to be on a national register?

[Mr Lansley]

My hon. Friend will know that health care and social care support workers do responsible jobs and that the responsibility for them lies principally with their employers and the staff who supervise them. We made provision in the White Paper we published last December for a process of assured voluntary registration. What I announced and referred to a moment ago will give a code of conduct and standards that will form a basis for an assured voluntary registration scheme in future.

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

One key care standard is the time that people have to wait for their treatment. Labour got waiting times down to an historic low, and we warned the Secretary of State what would happen if he relaxed the 18-week standard. Figures show that the number of patients waiting longer than 18 weeks is up by 43% and, despite the U-turn that the Government have made on the use of targets, is not the problem that they have been so fixated on their top-down reorganisation that they lost control of waiting lists? Surely it is time for them to drop the Health and Social Care Bill and focus on the things that really matter to the people using and working in the NHS.

[Mr Lansley]

I am sorry, but that was all completely synthetic anger on the hon. Gentleman’s part. The average time that patients have been waiting in the NHS for treatment continues to be between eight and nine weeks. It has been so ever since the last election. The operational standard under the previous Government and now for the 18-week waiting time is that at least 90% of patients who are admitted for treatment should be admitted and treated within 18 weeks, and 95% of outpatients. Both of those operational standards continue to be met. Last week I made it clear that whereas the previous Government abandoned people who went beyond 18 weeks—and there were 250,000 of them who went beyond 18 weeks—we will not abandon those forgotten patients. We will make sure that they, too, are brought into treatment as soon as possible.

[Mr Speaker]

I call Sajid Javid. Not here.

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

12. What steps his Department plans to take to assist hospitals with the cost of PFI payments.

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

A Treasury review identified savings opportunities of up to 5% on annual payments in NHS PFI schemes. The lessons learned from the PFI savings pilot will be applied to all schemes in the PFI pipeline. The previous Government left a £50 billion post-dated cheque to pay for their hospital building programme. Much of it was unaffordable and poor value for money. We are dealing with that unfortunate legacy, including the 22 NHS trusts that identified this as a constraint on their future sustainability.

[Mr Jones]

I thank my right hon. Friend for his response. PFI schemes have undoubtedly undermined the financial stability of many local health economies, as is the case in Coventry and Warwickshire. Can my right hon. Friend assure my constituents that any solution to assist PFI schemes, such as at the University Hospitals Coventry and Warwickshire NHS Trust, will not be to the detriment of my constituents who use the George Eliot hospital in Nuneaton?

[Mr Lansley]

Yes, I believe I can give my hon. Friend that assurance. Through the process of working with NHS trusts to see what is necessary for them to become foundation trusts—for example, we are working with University Hospitals Coventry and Warwickshire NHS Trust—it is clear that action taken locally with support can deliver viability and sustainability for the future. I hope the same will be true for the George Eliot hospital, but as a separate trust it will not be as a direct consequence of the steps that are taken at Walsgrave.

[Mr Evennett]

I welcome my right hon. Friend’s response to the original question. Poorly negotiated PFI deals for hospitals in the South London Healthcare NHS Trust are causing real financial problems and have led to the downgrading of Queen Mary’s hospital in my borough of Bexley. Does he share my concerns about this injustice, and will he ensure that my constituents get the first-class health care that they need and deserve and look again at this PFI situation?

[Mr Lansley]

Yes, of course. My hon. Friend understands very well indeed how difficult are the circumstances of his trust, which includes two PFI hospitals, and Queen Mary’s at Sidcup has suffered from the consequences of those PFIs. I am looking forward to the proposals on the future provision of health services on the Queen Mary’s Sidcup site. South London Healthcare is clearly an extremely challenged trust and we inherited very substantial problems there. We are looking to resolve them with it, but it will need additional national support.

[Claire Perry (Devizes) (Con)]

In addition to struggling hospital trusts, many, many community hospitals throughout the country, such as Savernake hospital near Marlborough, are also labouring under the burden of an enormous PFI contract and having the indignity of vital local services hollowed out under that lot’s leadership on the Labour Benches. Will the Secretary of State please tell me what he will do to help those smaller hospitals with vital local services?

[Mr Lansley]

As my hon. Friend knows from her conversations with the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns), we are very sympathetic to her concerns. By devolving commissioning responsibilities to clinical commissioning groups, I expect the local clinical leadership, understanding fully the contribution that community hospitals can make, to be supportive of that in their commissioning intentions in her constituency and others.

[Dr Julian Huppert (Cambridge) (LD)]

14. What plans he has to ensure balanced political and geographical representation on health and wellbeing boards.

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[Guy Opperman (Hexham) (Con)]

15. What plans he has to ensure that the NHS is prepared for winter pressures.

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

The NHS and social care systems are well prepared for winter. Our Winterwatch summary was first published last Thursday. It showed higher flu vaccination uptake, and I announced additional extracorporeal membrane oxygenation—ECMO—capacity, which will be in place by December. There is always more pressure on the NHS during winter. This year will be no different, but the preparations are in place.

[Guy Opperman]

Given the director of immunisation’s recent report on the take-up by medical staff of the flu jab and the local efforts of Dr Alastair Blair, the chair of the Northumberland clinical commissioning group, will the Minister expand on the need for patient protection in the form of flu jabs in hospitals and surgeries around the country?

[Mr Lansley]

I would like to take this opportunity not least to commend the work that the chief medical officer has done this year in encouraging health care workers to have their seasonal flu jab. The latest figures are that 29% have done so, compared with 11% at the same point last year. We heard earlier from my hon. Friend the Member for Kettering (Mr Hollobone) how well Kettering has done, and there are hospitals that are demonstrating that a higher level is entirely achievable. I urge staff across the NHS to have their flu vaccination. It is the ethical thing to do, not least to provide protection to their patients.

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

One of the things that makes the problem of winter pressures much greater is the NHS coping with the biggest reorganisation ever. The public have a right to know the risks that the Government’s policies are placing on our NHS. The Information Commissioner agrees and has judged that the Secretary of State must now release the risk assessments and register for his NHS reorganisation. Will he now obey the law and end his 12-month cover-up?

[Mr Lansley]

I have been very clear and published all the cost-benefit and risk information relating to the modernisation of the NHS, and the impact assessment was published when the legislation was presented to the House of Lords.

[David Morris (Morecambe and Lunesdale) (Con)]

The Care Quality Commission and Monitor are looking into the affairs of the University Hospitals of Morecambe Bay NHS Foundation Trust. Will my right hon. Friend assure my constituents that whatever the findings, the Government will act upon them quickly?

[Mr Lansley]

I entirely understand my hon. Friend’s point. I of course will not prejudice whatever might be said in relation to that, but I will look at the report very carefully when it is presented.

[Liz Kendall (Leicester West) (Lab)]

Social care is vital for reducing winter pressures on the NHS by helping to keep older people out of hospital, but the Government are cutting funding for older people’s social care by £1.3 billion. Delayed discharges from hospitals are already up 11% from this time last year. The Minister responsible for care said in Westminster Hall on 10 November:

“cuts to front-line adult social care services are really beginning to bite.”—[Official Report, 10 November 2011; Vol. 535, c. 178WH.]

Does the Secretary of State agree?

[Mr Lansley]

I have to say to the hon. Lady that it was this Government who, through the spending review, gave priority to social care. More than £7 billion was added to the social care budget as a consequence of the steps taken by my right hon. Friend the Secretary of State for Communities and Local Government and by the NHS. This year the NHS is providing an additional £648 million specifically to support adult social care. In addition, I have announced our Warm Homes Healthy People funding for this winter, which will provide additional support for those most urgently in need.

[John Mann (Bassetlaw) (Lab)]

16. How many accident and emergency departments have reduced their on-site service provision in the last 12 months.

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

18. What steps he is taking to improve the training of nurses and doctors.

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

Our reforms aim for excellence in education and training and for a better patient experience by ensuring greater accountability for employers in planning and developing their work force while being professionally informed and underpinned by strong academic links. I have always been clear that I want to see greater professional ownership of the standards of education and training, and greater employer engagement in getting work force planning right. We will publish more details on that when the NHS Future Forum reports shortly.

[Mr Sheerman]

Does the Secretary of State share the concerns that I have picked up in my constituency? First, although we have very good nurses in Huddersfield, national stories about a lack of care for elderly people make all of us worried about the quality of training of some nurses in some institutions. Secondly, will he remember that, with his demolition of the health service, we are moving to a system in which no management training is given to any doctor or GP? Is that not a recipe for chaos?

[Mr Lansley]

On the latter point, I have been talking to those in training, and part of their education increasingly includes leadership. That is what we are looking for—clinical leadership, not to turn clinicians into managers. They will work with managers, but they will provide leadership.

On nursing training, the Care Quality Commission’s recent inspection reports, in particular, illustrated the sheer variability of care—sometimes even between wards in the same hospital. On that basis, we should not in any sense damn the quality of nurse training; we need to focus on the quality of nurse leadership—ward by ward, and hospital by hospital.

[Mr Peter Bone (Wellingborough) (Con)]

The new Government’s strategy on human trafficking requires the NHS to ensure that victims of human trafficking are recognised in hospitals and reported. One way of doing that is to improve training for nurses. I have just returned from Moldova, where nurses have a course on human trafficking as part of their training, so that they can recognise victims and help them. Is that something that we could incorporate here?

[Mr Lansley]

I am interested to hear my hon. Friend’s experience. I certainly look forward to hearing more from him about it, and to taking it on board in considering how we respond to those obviously tragic victims.

[Kerry McCarthy (Bristol East) (Lab)]

19. What assessment he has made of the effects of publishing his Department’s strategic risk register on his restructuring of the NHS.

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[Helen Jones (Warrington North) (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.

[Helen Jones]

Is the Secretary of State aware that plans to remove vascular services from Warrington hospital will threaten services such as diabetes care, renal cancer care and the co-operation on stroke that has been built up with Whiston hospital? What will he do to protect those services, or is this part of the plan he discussed in February with NHS North West to reduce the number of acute beds and increase competition?

[Mr Lansley]

I am glad that on Monday the hon. Lady will have an opportunity for an Adjournment debate where this subject can be—

[Helen Jones]

Answer the question!

[Mr Lansley]

I will of course answer the question. The answer is that this is entirely driven by clinical issues in a local context. I can tell the hon. Lady that it is very much about trying to improve vascular services, and the judgments being made are local and clinical.

[Iain Stewart (Milton Keynes South) (Con)]

T2. What leadership role do the Government expect the new health and wellbeing boards to play in determining significant NHS service changes in each local area?

[Mr Lansley]

The health and wellbeing boards will have a role not only in leading improvements in public health and social care but, through the joint strategic needs assessment and the strategy derived from that, in establishing how services should respond to the needs of the local population. The clinical commissioning group should respond directly to that, and any specific service configuration changes should form part of the commissioning plan. In addition, the local authority, through its scrutiny role, will have a continuing ability to refer those plans for review.

[Mrs Mary Glindon (North Tyneside) (Lab)]

T4. Will the Secretary of State agree to meet me, and families living with muscle disease, to discuss the urgent problem of primary care trusts refusing to fund vital cough assist machines, which help to prevent serious and very costly winter respiratory infections for those who are unable to use their lung muscles to cough?

[Mr Lansley]

Of course I, or one of my colleagues, will be glad to meet the hon. Lady to discuss that. I might also say that it was important to have announced, as I did last week, the expansion of ECMO—extracorporeal membrane oxygenation—facilities across England. Those facilities present a life-saving opportunity for people with the severest respiratory disease.

[Sajid Javid (Bromsgrove) (Con)]

T3. My apologies, Mr Speaker, for having missed my question on the Order Paper earlier.Every five minutes someone in the UK suffers from a stroke, and over 1 million people are living with the effects of stroke. That is why I welcome the establishment of the first “life after stroke” centre—a £2 million investment in my constituency. Will my right hon. Friend join me in welcoming this excellent initiative by the Stroke Association?

[Mr Lansley]

Yes, of course I will join my hon. Friend in paying tribute to all the work that I know personally that the Stroke Association has done over a number of years in raising public awareness of the importance of developing stroke services, which has had an impact inside the NHS. We have improving figures in terms of reducing stroke mortality, and I now want to go further in ensuring that we enable people not only to survive stroke but to recover as many as possible of their abilities afterwards.

[Paul Goggins (Wythenshawe and Sale East) (Lab)]

T5. Will the Minister with responsibility for public health update the House on her plans to review the criteria whereby people with haemophilia who have been infected with hepatitis C can claim stage 2 payments from the Skipton fund? Specifically, will she tell us how she intends to involve patients and carers in that review?

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

What is the Secretary of State’s estimation of the number of NHS doctors and nurses who, in an astoundingly demoralising way, are having their pay grades downgraded?

[Mr Lansley]

I do not have a figure for that. If the hon. Lady and others want to discuss it, I would be glad to see evidence of it—and so should NHS employers, because as part of the implementation of “Agenda for Change”, staff should be banded in grades according to independent criteria.

[Mr David Amess (Southend West) (Con)]

T9. Last year in Westminster Hall, the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton) rightly praised the work of midwives and the Royal College of Midwives. Does she share my concern that locally, there could be a downgrading of community midwives, leading to an overall reduction in the number of midwives in our area?

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[Phil Wilson (Sedgefield) (Lab)]

The coalition agreement states that public sector employees, including health care employees, will be given a new right to set up employee-led co-operatives to run services. Can the Minister detail how many NHS co-operatives have been established and how many employees are involved in them?

[Mr Lansley]

I will gladly write to the hon. Gentleman if my recollection is wrong, but I think that something in the order of 25,000 staff have been transferred into social enterprises since the election. That represents something like £900 million-worth of NHS activity across England.

[Tracey Crouch (Chatham and Aylesford) (Con)]

Pension reform is important to those of my constituents who work in the public sector—and, indeed, to the taxpayers who do not. With that in mind, does the Secretary of State agree that the heath service unions should work constructively with the Government on public sector pension reform rather than go on strike next week, potentially putting patients’ lives at risk?

[Mr Lansley]

Yes, I am grateful to my hon. Friend. It is very important to me that NHS staff, and other public servants, are valued in their remuneration, including the pensions that they receive. That is precisely why I have myself engaged in discussion with the NHS trade unions and staff side and continue to be engaged directly in negotiations with them about that, on the basis of the conditional offer that the Chief Secretary to the Treasury announced to the House recently, which I think would be fair to NHS staff and to taxpayers. On that basis, I think it is completely irresponsible and unacceptable for some unions in the NHS—not the Royal College of Nursing or the British Medical Association—to intend to go on strike next week.

[Mr Speaker]

We are immensely grateful to the Secretary of State. He is testing the knee muscles of colleagues very considerably, and we are grateful to him for that, I am sure.

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[Tessa Munt (Wells) (LD)]

There are 3,000 cases each year of early stage inoperable lung cancer, but as yet no national stereotactic body radiotherapy treatment for lung cancer. What number of patients does the Secretary of State consider to be the appropriate threshold at which he will instruct his Department to establish a national lung cancer tariff?

[Mr Lansley]

I am grateful to my hon. Friend for that question. I do not think I am in a position to say what figure is appropriate, but the national clinical director for cancer has already indicated to the NHS that he wishes us to develop a national tariff for stereotactic radiotherapy. A quarter of centres across the country already provide it, and our intention is to ensure that that is supported by a national tariff as soon as possible.

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

Regrettably, there are still many thousands of attacks by dangerous dogs every year that end up with people in A and E, and occasional fatalities. Has the Secretary of State carried out any assessment of the cost to the NHS of treatment for attacks by dangerous dogs? If not, may I ask him to instruct his officials to do so?

[Mr Lansley]

I do not have those figures to hand, but I will gladly see whether we have them available, and I will write to the hon. Gentleman.

[Several hon. Members]

rose—