NHS Annual Report and Care Objectives

Lord Lansley Excerpts

Wednesday 4th July 2012 Commons Chamber

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

With permission, Mr Speaker, I would like to make a statement about my first annual report to Parliament on the health service, published today alongside the report on the NHS constitution and the draft mandate to the NHS Commissioning Board.

This year the NHS has made major progress in the transition to a new system: a system based on clinical leadership, patient empowerment and a resolute focus on improving outcomes for patients. In a year of change, as the annual report shows, NHS staff have performed admirably. Waiting times remain low and stable, below the level at the election, and the number of people waiting over a year is the lowest ever. Today only 4,317 patients are waiting more than a year for treatment, dramatically fewer than in May 2010. Nationally, all NHS waiting time standards for diagnostic tests and cancer treatment have been met. The £600 million cancer drugs fund has helped more than 12,500 patients to gain access to drugs that were previously denied to them.

We have extended screening programmes, potentially saving an extra 1,100 lives of sufferers from breast and bowel cancer every year by 2015. More than 90% of adult patients admitted to hospital—about a quarter of a million every week—are now assessed for venous thromboembolism, or blood clots, in what is a world-leading programme of its kind. In 2011-12, 528,000 people began treatment under the expanded improving access to psychological therapies programme—up from just 182,000 in 2009-10—and almost half have said that they have recovered. Following the success of the telehealth and telecare whole system demonstrator programme, which included a 45% fall in mortality, we are on course to transform the lives of 3 million people with long-term conditions over the next five years.

The NHS is also improving people’s experience of care. Patients are reporting better outcomes for hip and knee replacements and hernia repairs. In the latest GP patient survey, 88% of patients rated their GP practices as good or very good, and the result of the out-patient survey shows clear improvements in the cleanliness of wards and the number of patients reporting that they were treated with respect and dignity. MORI’S independent “Public Perceptions of the NHS” survey shows that satisfaction with the NHS remains high, at 70%. Mixed-sex accommodation breaches are down by 96%, MRSA infections are down by 25%, and clostridium difficile infections are down by 17% in the year.

Real progress is also being made in public health. More than 570,000 families have signed up to Change4Life, and our support for the School Games and Change4Life sports clubs in schools is helping to secure the Olympic legacy. The responsibility deal has seen the elimination of artificial trans fats, falling levels of salt in our diets, and better alcohol labelling. By the end of the year, more than 70% of high street fast food and takeaway chains will show the number of calories on their menus. To drive forward research in key areas such as dementia, I have announced a record £800 million for 11 National Institute for Health Research centres and 20 biomedical research units.

All that, and a million more people have access to NHS dentists; every ambulance trust is meeting its call response times; 96% of patients are waiting less than four hours in accident and emergency departments; quality, innovation, prevention and productivity—QIPP—savings across the NHS were £5.8 billion in the first year of the efficiency challenge; and NHS commissioning bodies delivered a £1.6 billion surplus, carried forward into the current financial year. All that, and a new system is taking shape. The NHS Commissioning Board has been established; health and wellbeing boards are preparing to shape and integrate local services; 212 clinical commissioning groups, which are already managing more than £30 billion in delegated budgets, are preparing to lead local services from April next year; and we are starting to measure outcomes comprehensively for the first time. Far from buckling under pressure, NHS staff—with the right leadership and the right framework—are performing brilliantly.

As well as the NHS annual report, I am today publishing a report on the NHS constitution. The Health and Social Care Act 2012 strengthens the legal foundation for the constitution, and includes a duty for commissioners and providers to promote and use it. This report—the first by a Secretary of State—will help commissioners and providers to assess how well the constitution has reinforced the principles and values of the NHS; the degree to which it has supported high-quality patient care; and whether patients, the public and staff are aware of their rights.

I am grateful to the NHS Future Forum and its chair, Professor Steve Field, for their advice on the effect of the NHS constitution. I have asked them whether there is further scope to strengthen the principles of the constitution before a full public consultation in the autumn. Any amendments would be reflected in a revised constitution, published by April 2013.

Rooted in the values of the constitution, we will drive further improvement across the NHS through a set of objectives called the mandate to the NHS Commissioning Board. I am publishing the draft mandate today. The mandate will redefine the relationship between Government and the NHS, with Ministers stepping back from day-to-day interference in the service. Through the mandate, we will set the board’s annual financial allocation and clearly set out what the Government expect it to achieve with that allocation, based on the measures set out in the NHS outcomes framework. Those include both measures of quality, such as whether people recover quickly from treatment, and the experience of those cared for, including whether they are treated as well as they would expect, and whether they would be happy for family and friends to be cared for similarly. The mandate will promote front-line autonomy, giving clinical commissioners the freedom and flexibility to respond to local needs—freedoms balanced by accountability.

Each year, the board will state how it intends to deliver the objectives and requirements of the mandate, and it will report on its performance at the end of that year. The Secretary of State will then present to Parliament an assessment of the board’s performance. If there are particular concerns, Ministers will, for example, ask the board to report publicly on what action it has taken, or ask the chair to write a letter setting out a plan for improvement.

Today’s publication of the draft mandate marks the beginning of a 12-week consultation. I look forward to working with patients, clinicians, staff and other stakeholders to finalise the mandate in the autumn.

These documents show how a new, exciting chapter is opening up for the NHS. Starting with strong performance and robust finances, we are driving towards integrated services and community-based care. This heralds a new era for the NHS, based on openness and transparency and focused on what matters most to patients: health outcomes, care quality, safety and positive experience of care. It heralds an era in which every part of the NHS—the Secretary of State, the NHS Commissioning Board, clinical commissioning groups and health-care providers—is publicly held to account for what is achieved. For the first time, Parliament, patients and the public will know exactly how the NHS is performing locally, nationally and by way of international comparison. This will be a new era in which patients are more in control, where clinicians lead services, and where outcomes are among the best in the world.

I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

The Secretary of State today presents his first annual report—an annual report on a lost year in the NHS. Just when the NHS needed stability to focus all its energy on the money, what did he do? He pulled the rug from underneath it, with a reorganisation no one wanted and that this Prime Minister promised would never happen.

In fact, we have had not one, but two lost years in the NHS, as this Secretary of State has obsessed on structures and inflicted an ideological experiment on the NHS that made sense to him but, sadly, to no one else. It was his decision to allow the dismantling of existing structures before new ones were in place, which has led to a loss of financial grip at local level in the NHS. He mentioned QIPP savings. The truth is that two-thirds of NHS acute trusts—65%—are reported to have fallen behind on their efficiency targets. So we see temporary ward and accident and emergency closures, a quarter of walk-in centres closing across England, panic plans to close services sprouting up wherever we look, and crude, random rationing across the NHS, with 125 separate treatments—including cataracts, hip replacements and knees—being restricted or stopped altogether by one primary care trust or another. This is an NHS drifting dangerously towards trouble, or, in the words of the chief executive of the NHS Confederation,

“a supertanker heading for an iceberg”.

Let us remember that even before the added complexity of today’s mandate, the Secretary of State has already saddled his new board with an Act of Parliament that even the chair of that board, whom he appointed, calls “unintelligible”. Listening to the Secretary of State today, one could not but conclude that he cannot be looking at the same NHS as the head of the NHS Confederation. The statistics he just reeled off do not include the people who give up waiting in A and E, who have their operation cancelled, who cannot get a GP appointment for days or who cannot get into hospital in the first place because his Government are restricting access to operations. Perhaps that explains why the year that he hails as a great success was the same year that saw the biggest ever fall in public satisfaction with the national health service according to the British social attitudes survey.

Let me challenge the Secretary of State on this growing gap between Ministers’ statements and people’s real experience of the NHS. He has said that there will be no rationing by cost, but I have news for him: it is happening on his watch, right across the system, with a whole host of restrictions on important treatments and a postcode lottery running riot. Where is the instruction in the draft mandate to stop it and deliver on the promise that he and the Minister of State, the right hon. Member for Chelmsford (Mr Burns), made to patients? It is not there.

Let me turn to bureaucracy and targets. First, the Government said that they would scrap the four-hour A and E and 18-week targets; then they brought them back. Now they have gone further and adopted Labour’s guarantees, but they have gone even further today and have added a whole new complex web of outcomes and performance indicators for the NHS. The NHS needs simplicity and clarity, but what it has received today from this Secretary of State is a dense document with 60 outcome indicators grouped within five domains. I hope it is clear to him, because it will not be clear to anyone else. Will he treat the House again to his explanation of the difference between an outcome indicator and a target? The fact is there is not one and he is loading a whole new set of targets and burdens on to a NHS that is already struggling to cope with the challenges it is facing.

It will not have escaped people’s notice that today the Secretary of State was silent on the biggest issue of all: the unfolding crisis in adult social care. Out there in the real world, councils are not coping, services are collapsing and that is placing intolerable pressure on hospitals. He promised a White Paper soon on service change, but nothing on funding. Has he given up on the Dilnot proposals and the challenge of finding a fairer and more sustainable funding system?

Before we let the Secretary of State go today, the House needs to ask to whom this mandate is being given. We are witnessing the democratic responsibility and accountability to this House for the organisation that matters more to our constituents than any other being outsourced and handed over to an unelected and unaccountable board.

Another major announcement is taking place today on the review of the arrangements for children’s heart surgery. It will not have escaped people’s notice, however, that the Secretary of State did not mention that review in his statement. He said that Ministers are stepping back, and I think people in this House know what that means—it is now nothing to do with him. All these changes will take place and he will not be responsible.

What assurances can the Secretary of State give to right hon. and hon. Members that his new board will listen to their concerns? Who are the people on that board? With trademark catastrophic timing, we learn that he has given a leading role in the running of the NHS to—yes—the vice-chair of Barclays, none other than Mr Diamond’s right-hand man and someone who has given £106,000 in donations to the Conservative party. If that does not sum up this Government, I do not know what does.

We know the real mandate that the Secretary of State has given his new board—and that is a mandate for privatisation. He promised it would not happen, but it is happening with community services being outsourced. No wonder there is a crisis of leadership, with one third of directors of public health not planning to transfer to local authorities. Is it not the simple truth that the Secretary of State inherited a successful, self-confident NHS and, in just two years, has reduced it to a service that is demoralised, destabilised and fearful of the future? The man who promised to listen to doctors has completely ignored them, and now they are calling for his resignation. Despite all his claims today, the supertanker is still heading towards an iceberg. He gave us a new mandate when what we really needed was a change of direction and a change of personnel.

[Mr Lansley]

At no point did the shadow Secretary of State express any appreciation for what the staff of the NHS have achieved in the past year. A party political rant populated with most of his misconceptions and poorly based arguments does not get him anywhere.

The right hon. Gentleman went around the country trying to drum up something he could throw at us about things that he believed were going wrong in the NHS. Do you know what he ended up with, Mr Speaker? He ended up by saying the NHS was rationing care. What was the basis for that? That parts of the NHS have restrictions on weight-loss surgery, because people have to be obese before they have access to it. That is meaningless. I wrote to the shadow Secretary of State this morning, and went through his so-called health check. There is no such ban on surgery as he claims. Time and again, he says, “Oh, they are rationing.” They are not, because last year, the co-operation and competition panel produced a report that showed where there had been blanket bans on NHS services under a Labour Government. We introduced measures to ensure that that would not happen in future across the service. Not only is he not giving the NHS credit for the achievements that I listed in detail in my statement but he is now pretending that the NHS is somehow in chaos or financial trouble. It is complete nonsense. Across the NHS, only three primary care trusts out of 154 were in deficit at the end of the year. The cumulative surplus across all the PCTs and strategic health authorities is £1.6 billion carried forward into this financial year.

That means that the NHS begins 2012-13 in a stronger financial place than anyone had any right to expect, because it is delivering better services more effectively, with GP referrals reduced, and reduced growth in the number of patients attending emergency departments. The right hon. Gentleman asked, “What about patients who leave A and E without being seen?” Under the Labour Government, no one ever measured whether patients left A and E without being seen. For the first time, we are measuring that, and we publish the results in the A and E quality indicators. There was a variation between about 0.5% and 11% of patients leaving without being seen when we first published that, but since then the variation has reduced. The average number has gone down, and it is now at 3%, so he ought to know his facts before he stands up at the Dispatch Box and begins to make accusations. We published those facts for the first time.

I will not reiterate the A and E target, because I mentioned it in the statement, but 96% of patients are seen within four hours in A and E. The right hon. Gentleman should withdraw all those absurd propositions that the NHS is not delivering. He should get up when next he can and express appreciation to the NHS for what it is achieving. Patients do so: last year, 92% of in-patients and 95% of out-patients thought that they had good or excellent care from the NHS, which is as high as in any previous year. That is what patients feel. Staff should be proud of what they achieve in the NHS, and the Labour party should be ashamed of itself.

[David Tredinnick (Bosworth) (Con)]

My right hon. Friend’s statement, which is very positive, will be widely welcomed, particularly what he said about low waiting times. He said that patients in future will be more in control. Is he referring to the personal health budgets in the Health and Social Care Act 2012, and does he expect a greater range of treatments to be available on the health service in future?

[Mr Lansley]

I am grateful to my hon. Friend. There are many ways in which we can improve the control that patients can exercise, including greater opportunities for patients to exercise choice. In my announcement today, that includes the opportunity for patients to choose alternative providers of NHS care if, for example, the standard of 18 weeks that the constitution sets is not met. I might say that, at the last election, 209,000 patients were waiting for treatment beyond 18 weeks. That number has been brought down to 160,000.

My hon. Friend makes an important point about the exercise of control on the part of patients, who have an opportunity to access clinically appropriate care through the NHS. We will make sure that that is available and, as he knows, in relation to homeopathic treatments, for example, we have maintained clinicians’ ability across the service to make such treatments available through the NHS when they think that it is appropriate to do so.

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

I have not been able to read the annual report in the last few minutes, but may I ask the Secretary of State for Health whether it gives any information on the benefits of high-street pharmacy companies taking over the running of hospital pharmacies?

[Mr Lansley]

No, the annual report makes no reference to that. It refers—I hope, for the first time—in detail to the performance of the NHS over the past year. If the right hon. Gentleman wishes to raise any issues about that, I shall be glad to respond to him separately.

[Alun Cairns (Vale of Glamorgan) (Con)]

I welcome the statement from the Secretary of State and the annual report. Is he aware that the National Audit Office published a report last week on variations in the NHS across the United Kingdom? It specifically reported that life expectancy in Wales was lower than in other parts of the UK; there were fewer GPs per patient; longer hospital stays in Wales; and longer hospital waiting lists. Will he reassure me, in the light of his statement and of the NAO report, that he will not take any lessons from the Labour party, because it is responsible for running the health service in Wales that my constituents have to put up with, sometimes tragically?

[Mr Lansley]

My hon. Friend makes an excellent point—in fact, an excellent series of points. On his behalf I am glad to send to the Minister for Health and Social Services in the Labour Government in Wales a copy of the annual report for England, perhaps inviting her to publish a similar report in Wales. As the NAO said, and, indeed, as the Wales Audit Office said, only 60% or, on the latest data, only 68% of patients in Wales waiting for treatment accessed it within 18 weeks—the right under the NHS constitution—whereas in the NHS in England, the figure is 92%.

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

NHS staff and patients simply do not have the same rosy view of the NHS as the Secretary of State. When a Government-commissioned survey asked people last summer what they thought of the NHS, why had satisfaction with the NHS plummeted from 70% to 55% in just a year under the Secretary of State?

[Mr Lansley]

The right hon. Gentleman makes an interesting point, because MORI conducted an independent survey last December after the survey conducted on behalf of the King’s Fund. The survey said that 70% of people were satisfied with the running of the NHS; 77% agreed that their local NHS provided a good service; and 73% agreed that England had one of the best national health services in the world—the highest level ever recorded in that survey.

[Andrew George (St Ives) (LD)]

I am pleased and reassured by the comments from the Secretary of State on outcomes, which he said were among the best in the world. In view of that, would he perhaps reconsider whether it is wise to press ahead with such disruptive and damaging reforms?

[Mr Lansley]

One reason why the NHS continues to deliver such significant improvements in performance is that through the transition, we are increasing clinical leadership, which will make an important, positive difference, and can already be shown to have done so. For example, we are managing patients more effectively in the community, and reducing reliance on acute admission to hospital. The number of emergency admissions to hospital in the year just ended went down, which is a strong basis on which to develop services in future, and that is happening not least because of leadership in the primary care community. I hope that my hon. Friend from Cornwall, along with other Members, supports the assumption of clinical leadership through clinical commissioning groups by those clinicians.

[Valerie Vaz (Walsall South) (Lab)]

Like my right hon. Friend the Member for Rother Valley (Mr Barron), the former Chair of the Select Committee on Health, I have not had sight of the report, but will the Secretary of State say what the cost to the public purse of the pause and the reorganisation will be?

--- Later in debate ---

[Mr Lansley]

I think that the hon. Lady knows that the figure is in the order of £1.2 billion to £1.3 billion. She also knows that, during this Parliament, we will deliver, as a result of the changes, reductions in bureaucracy and administration costs across the NHS, which cumulatively will be of the order of £5.5 billion.

[David T. C. Davies (Monmouth) (Con)]

Is the Minister also aware that the National Audit Office report shows without doubt that deep and damaging cuts are taking place within the national health service, but that they are all happening in Wales? Does he agree that the last thing we need is to see that repeated in England by allowing these people control of our NHS?

[Mr Lansley]

My hon. Friend is right. There is only one part of the United Kingdom where the health service is being run by a Labour Government—in Wales, and that is the only part of the United Kingdom where the Government are deliberately cutting the budget of the NHS. We should not be surprised. The right hon. Member for Leigh (Andy Burnham), the shadow Secretary of State, at the time of the last election and afterwards, told people that they should cut the budgets, and Labour in Wales did it.

[Several hon. Members]

rose—

[Keith Vaz (Leicester East) (Lab)]

May I declare my interest as a type 2 diabetic and say how disappointed I am that the Secretary of State did not mention diabetes in his statement today? Fifty per cent. of adult diabetics have not had the nine care processes that are necessary. Will he ensure that commissioning groups are asked to ring-fence resources to help with diabetes prevention?

[Mr Lansley]

There are many conditions from which patients suffer that I did not mention in the statement because the purpose of the draft mandate to the NHS Commissioning Board is to improve the quality of services across the board, and the objectives we are looking for are about improvement across the whole service, rather than trying to isolate and identify individual conditions. But the NHS Commissioning Board will indeed go about the task of doing so. In recent years we have increased the proportion of patients with diabetes who have access to the nine recommended processes, and I know we will increase the number in future. I draw to the right hon. Gentleman’s attention, among the figures reflected in the report, the fact that, at the end of 2011-12, 99% of people with diabetes had been offered screening for diabetic retinopathy in the previous 12 months—an increase from 98.6% in the preceding quarter.

[Dr Sarah Wollaston (Totnes) (Con)]

I particularly welcome the inclusion of the patient experience in the outcome framework. May I urge my right hon. Friend to make sure that commissioners and communities can clearly access the patient experience data so that they can see the real value that communities can place on community hospitals, and may I urge him to set out a clear database of community hospitals across England so that it can be much more readily available?

--- Later in debate ---

[Mr Lansley]

I am grateful to my hon. Friend. I agree that measuring patients’ experience of care is very important. Although there was and continues to be an NHS patients survey, there are many areas of patients’ experience that it did not reflect. For example, we received yesterday the first of the VOICES—views of informal carers for the evaluation of services—a survey of the experience of bereaved families of the quality of end-of-life care that their family member received. That is part of the process of ensuring that for the future we understand, measure and respond to the views of bereaved families about the quality of care they received. That is just one illustration. Another is for the very first time measuring the experience of care reported by young people below the age of 16. There is a complex inter-relationship with the specific benefits of community hospitals in individual locations, but I hope that one of the things we will be able to do is look at the data, which will be disaggregated across the country, and increasingly see what most contributes to the high levels of patient experience in different parts of the country.

[Derek Twigg (Halton) (Lab)]

I join the Secretary of State in congratulating NHS staff on their hard work and dedication, which is even more remarkable given the disastrous reorganisation they are having to work through at present. The Secretary of State talks about the new era. Can he today in Parliament rule out any additional charges anywhere in the NHS for patients who use the NHS in the next few years?

[Mr Lansley]

I am grateful to the hon. Gentleman. I said during the passage of the Health and Social Care Act 2012 that it had been intensively considered in its every aspect. The Act expressly rules out the introduction of any charges across the NHS, other than by further primary legislation, and there is no primary legislation to permit such a thing. So I reiterate the point: there will be no additional charging for treatment in the NHS.

[Chris Skidmore (Kingswood) (Con)]

Many of my constituents are concerned that under the Labour Government £11 billion of PFI contracts were signed, which will cost the NHS over £60 billion to pay back. They are concerned that PFI, Labour’s toxic legacy to the NHS, has the potential to bankrupt many health trusts. Can my right hon. Friend reassure my constituents about possibly renegotiating some of these contracts?

[Mr Lansley]

My hon. Friend makes an important point. When the shadow Secretary of State was attempting to suggest that there were trusts in trouble across the country, he might have had the humility to admit that the hospital trusts in the greatest difficulty are the ones that were saddled with unsustainable debt by the Labour Government’s poorly negotiated PFI projects. He might have instanced Peterborough and Stamford Hospitals NHS Foundation Trust. Monitor wrote to him and his colleagues, telling them that that PFI project should not have proceeded. The Labour Government went ahead with it anyway and it is now unsustainable.

We have been very clear. We have gone through a process of identifying where trusts can manage, not least with us assisting them. In the latter part of last year we identified seven trusts that we will step in and support if we believe that they are otherwise unable to restore their finances to good health. It will entail about £1.5 billion of total support for them to be able to pay for their PFI projects. Where there are opportunities for renegotiation we will exercise them, but unfortunately it is in the nature of coming into government that we inherit what the previous Government left us. We were left with 102 hospital—[Interruption.] The shadow Secretary of State says from a sedentary position that they were our PFI schemes. No NHS PFI scheme was signed before the Labour Government took office in 1997. Two years ago we inherited 102 hospital projects with £73 billion of debt, yet the Opposition thought that in the years before they had used taxpayers’ money to build these new hospitals. No, they did not. They saddled the NHS for 30 years with that debt.

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

Talking about waste, will the Secretary of State explain why his Department has wasted hundreds of thousands of pounds on consultancy fees looking at my acute trust, and why his Department refuses to publish the reports? Could it be that they are a complete waste of time?

[Mr Lansley]

In the year before the election the Department of Health spent about £110 million on consultancy and we reduced it to £10 million. I will tell the hon. Gentleman about waste. In the past two years we have already racked up £1.4 billion of administration savings across the NHS—money that goes straight back into the front line. The Department is having to do work in relation to the hon. Gentleman’s hospital at Whiston only because of the PFI deal that his Government signed before the last election. We will have to help St Helen’s and Knowsley trust deal with that debt in the future.

[David Rutley (Macclesfield) (Con)]

Will my right hon. Friend join me in welcoming the progress that East Cheshire clinical commissioning group is making in building a collaborative approach to delivering health care in the Macclesfield area? Does he believe that other areas could benefit from observing the constructive approach being taken there?

[Mr Lansley]

Yes. I am grateful to my hon. Friend. He is absolutely right. I had the pleasure of meeting Dr Paul Bowen from his clinical commissioning group when I visited Blue Coat school in Liverpool. Leaders of clinical commissioning groups from across the north-west came together and many of them are already exercising 100% delegated responsibility for local commissioning budgets and showing how they can improve services using that. We know that in a financially challenging environment reducing cost is important, but redesigning services to deliver care more effectively with the resources available is even more important, and that is precisely what the clinical leadership in those groups is doing.

[Gloria De Piero (Ashfield) (Lab)]

In Ashfield in the past year the number of people waiting in accident and emergency for more than four hours has almost doubled, we have lost our NHS walk-in centre, and there are now proposals to close our community hospital. Why does the Secretary of State think these things are happening?

[Mr Lansley]

As I made clear in my statement, according to the latest data 96.5% of patients in A and E are assessed, treated and discharged within four hours. The right hon. Member for Leigh (Andy Burnham) asked about the difference between a target and an outcome, but the point is that it is not enough to measure whether a patient has been seen and treated within four hours; the issue is the quality of treatment they receive, which is why our A and E quality indicators go further. The hon. Lady and I have had correspondence on this—I will be glad to look back and ensure that I have kept it up to date—so she knows that there has been a review of walk-in centres and that there is a need for people to have access not only to emergency departments, but to urgent care in a way that does not entail having to wait for a long time in A and E. I do not remember all the details, but I recall that some of the services offered in one walk-in centre in her constituency were being transferred to another that was adjacent to the A and E.

[John Pugh (Southport) (LD)]

I welcome the statement. In order fully to fulfil the NHS mandate, we need to raise NHS staff morale. What plans does the Secretary of State have for doing that?

[Mr Lansley]

I think that what most gives staff a sense of motivation and morale, in any organisation in any walk of life, is being more in control of the service they deliver. That is evidenced across many areas of economic and service activity. That is what we are doing for the NHS. Whether in foundation trusts or clinical commissioning groups, staff will feel that they have more control over the service they deliver. Consequently, I believe that as we see the figures improve it will be less a case of politicians interfering, or even trying to take credit, and much more a case of NHS staff taking credit for the services they deliver.

[Hugh Bayley (York Central) (Lab)]

Last week the board of the NHS North Yorkshire and York primary care trust cluster received a financial position statement that identified the need for cuts of £230 million, plus unfunded costs pressures of £55 million a year, and noted that

“the risks would grow even greater as it moved from a single organisation…to five much smaller clinical commissioning groups.”

Many treatments are already not available to patients in North Yorkshire and York, even though they are available to those in neighbouring areas. Bariatric surgery, for example, is available to people elsewhere with a body mass index of 40, but people in North Yorkshire and York have to be much more obese, with a body mass index of 50, to get it. Will the Secretary of State look at that report, make a thoughtful response and put both in the Library of the House so that Members can see how this financial crisis in the North Yorkshire and York primary care trust is being dealt with?

[Mr Lansley]

Identifying cost pressures and risks is, of course, a necessary part of the process of managing those risks, but I am afraid that the claim by the outgoing primary care trust that the risks cannot be managed by the incoming clinical commissioning groups is contrary to the experience of everybody in the hon. Gentleman’s part of the world, as he must know from the experience of the primary care trusts in North Yorkshire. The primary care trusts of the past did not cope, and it is up to the new clinical leadership in Yorkshire to make these things happen more effectively. The PCT did not finish last year in deficit; only three in the whole of England did—Barnet, Enfield and Haringey. I will make sure—[Interruption.] If he listens to my answer, he will hear that we, along with the NHS Commissioning Board, intend all the new clinical commissioning groups across England to start on 1 April 2013 with clean balance sheets and without legacy debt from primary care trusts. That will give them the best possible chance of delivering the best possible care. On bariatric surgery, he must know that the NICE guidance recommends that it should be available to those with a BMI index of over 40, depending on their clinical circumstances.

[Hugh Bayley]

So why is it 50—

[Neil Carmichael (Stroud) (Con)]

Does the Secretary of State agree that one of the lasting achievements of the Health and Social Care Act 2012 will be the integration of health and social care, which will be excellent news for people recovering from strokes or meningitis?

[Mr Lansley]

My hon. Friend is absolutely right. The Labour party completely ignores the fact that one of the central points is that the creation of health and wellbeing boards—I pay credit to my Liberal Democrat friends in the coalition for that—the involvement of democratic accountability and the opportunity to create joint strategies that integrate public health, social care and the NHS and impact additionally on the wider and social determinants of health will be absolutely instrumental in the improvement of services and health in future.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

Will the Secretary of State confirm that shortly after taking office he downgraded the standard that the NHS should see A and E patients within four hours from 98% to 95% and that many A and E units are now failing to meet even that relaxed target? Does he believe that that was the right move, and does he have any other plans to change it again?

[Mr Lansley]

I did indeed reduce the standard to 95%, on clinical advice, and currently the NHS is achieving 96.5%.

[Nigel Mills (Amber Valley) (Con)]

On a recent visit to observe the excellent work of my local ambulance station in Alfreton, I was shown the widely different times it takes certain hospitals to admit patients arriving by ambulance, which leads to ambulances being off the road for longer than they need to be. Is there anything the Secretary of State can do to strengthen the guidance on how hospitals should handle this process to avoid the problem?

[Mr Lansley]

My hon. Friend makes an important point. Part of the measurement of the performance of ambulance trusts, together with their hospitals, is to record the number of occasions when ambulances wait more than 15 minutes before discharging their patients into the service. The Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), is very concerned and pursues precisely those issues, so I will ask him to look into the matter further and respond to my hon. Friend.

[Bill Esterson (Sefton Central) (Lab)]

The Secretary of State told us earlier that every ambulance trust was meeting core response times, but I have to tell him that that is not the experience of my constituents, including Mrs Taylor, who had to wait 90 minutes after falling down stairs. Is not the truth that this is the result of reorganisation and the resulting cuts are making it impossible for ambulance trusts up and down the country to hit the times he says they are hitting, because they are not actually doing it?

[Mr Lansley]

No, and I do not think that the staff of ambulance trusts will appreciate the hon. Gentleman generalising from the particular. I have not said that ambulance trusts reach every case in the time we intend, but the figures show that all ambulance trusts across England have met the category A target for responding consistently at a level they have not previously achieved.

[Andrew Bridgen (North West Leicestershire) (Con)]

I welcome the reforms and improvement to the NHS that the Secretary of State is delivering. However, the NHS paid out £1.3 billion in compensation claims last year, a rise of almost 50% on the year before. A spokesman has said that that is partly due to aggressive marketing by no-win, no-fee lawyers. Does my right hon. Friend agree that the current level of compensation claims in this country, in both the public and private sectors, is completely unsustainable and that it is now time to curtail the out-of-control compensation culture?

[Mr Lansley]

My hon. Friend makes an important point. From our point of view, the legislation that passed through this House in the last Session, led by the Under-Secretary of State for Justice, my hon. Friend the Member for Huntingdon (Mr Djanogly), will be important and will help us in relation to some of these matters, not least on the use of no-win, no-fee arrangements. From time to time it has been deeply frustrating for us all to see that, of the money paid out by the NHS as a result of negligence claims, sometimes more is paid in fees, not least to lawyers, than is provided in compensation to those who have suffered harm. In the NHS we recognise the need to provide compensation when harm has occurred. It is extremely costly. The costs have risen and we want to minimise them. Reducing harm in the NHS will be important, but ensuring that we respond to complaints and offer redress more openly will also help us to manage the extent to which people resort expensively to the courts.

[Chris Ruane (Vale of Clwyd) (Lab)]

Of the 150 lines in the Secretary of State’s statement, only six referred specifically to mental health, despite the fact that between 1991 and 2011 the number of antidepressant prescriptions increased from 9 million to 46 million, a 500% increase. In 2004 NICE recommended mindfulness, a non-drug self-help therapy with no side effects, as better, more efficient and less costly than drug therapy, but it has not been taken up. I am not blaming him, but will we have an inquiry into the reasons for the massive increase in the prescription of antidepressants and the reason why mindfulness has not been taken up?

--- Later in debate ---

[Mr Lansley]

I reiterate to the hon. Gentleman and to the House that the purpose of reports across the NHS is not to isolate individual conditions and to report on all of them, because if we attempted to do so the resulting document would be not the size of the one before me, but 10 times that. The object is to improve outcomes across the board.

Let me make two points. First, one thing that the NHS did achieve last year involved 528,000 people having access to talking—psychological—therapies, and that in itself should substantially reduce dependence on medication for depression. Secondly, and I think importantly, of the 22 overall objectives established in the NHS Commissioning Board’s draft mandate, the ninth is about making mental health as important as physical health—creating a parity of esteem between the two. The measure is in the Health and Social Care Act 2012, it is being carried through into the objectives of the NHS Commissioning Board and it will, in itself, be important when carried through into practice.

[Bob Blackman (Harrow East) (Con)]

I warmly welcome the improvements in screening, diagnostics and treatment for those suffering from cancer, but patient outcomes are wildly different. For some, 10% of treatment will be successful, for others, 85% will be, and this means that we need more research to highlight which drugs and treatments should be introduced. May I make a bid for part of the surplus to be directed to the expensive equipment that is required to make such research happen, so that treatment and outcomes can be improved?

[Mr Lansley]

My hon. Friend makes a very important point, and I was happy to announce earlier this year that in response to the report by Professor Sir John Bell and his colleagues we will now put resources behind the establishment of genetic testing centres throughout the NHS, which will enable us to undertake what is known as stratified medicine. This means that, by identifying when medicines have particular benefits for patients with certain genetic characteristics or phenotypes, we will be able to target such treatments, as we will be much more certain of their effectiveness and be able to reduce, as my hon. Friend rightly says, the many cases in which medicines are prescribed but turn out not to be effective in a particular patient’s circumstances.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

If the Secretary of State really believes that people will accept Ministers standing back from the consequences of their decisions, will he hear from families in my constituency, who are going to be devastated if, after all the turmoil—of which he is well aware—and after the forthcoming review, they are forced to travel for an hour and for 50 miles to receive consultant-led maternity services?

[Mr Lansley]

I do not construe what we are doing as Ministers stepping back from the consequences of our decisions. The Secretary of State will continue to be responsible for the comprehensive health service, and I fully expect, in the same way as I am making a statement today on the first annual report, that I and my successors will make statements in years to come on annual reports and be held to account for the performance of the service.

The point is that delivering the best possible care is not achieved by Ministers interfering on a day-to-day basis in how the NHS goes about its task. We have been very clear, through today’s mandate, about what we are looking for the NHS to achieve: consistently improving outcomes. We are not trying to tell the NHS to do so.

Any particular service change, such as the one the hon. Gentleman describes, has to meet four tests: being of clear clinical benefit; responding to the needs and wishes of local service commissioners; responding to strong patient and public engagement; and maintaining and protecting patient choice. If there are any questions and objections, stating that such a service change does not achieve those aims, his local authority has the right under legislation to refer the matter to the Secretary of State for its reconsideration, so I am not taking the Secretary of State out of the process completely.

The safe and sustainable review was set up independently by his right hon. Friend the Member for Leigh, and it has been conducted completely independently, but, in the same way as I have just described, if local authorities have grounds for objections, they have also a mechanism, if they wish to use it, for referral.

[Guto Bebb (Aberconwy) (Con)]

I applaud my right hon. Friend for his statement today and the publication of the annual report, from which I note that 12,500 patients in England have been able to access specialist cancer treatment as a result of the cancer drugs fund. The corresponding figure in Wales is zero, because the Labour Government in Cardiff refuse to put in place a similar scheme in Wales. Does my right hon. Friend agree that cancer patients in Wales deserve access to the same treatment as cancer patients in England?

[Mr Lansley]

Yes, I could not agree more. It was precisely because Professor Sir Mike Richards undertook an inquiry and produced a report identifying a lack of access in this country to new cancer medicines in the first year after their introduction that we instituted the cancer drugs fund. It is a matter of considerable regret to many of us that that example was not followed in a similar way in Wales.

[Mr Andy Slaughter (Hammersmith) (Lab)]

What message does the Secretary of State have for the 2 million people in west London, four of whose nine major hospitals are set to lose their A and E departments, including both Hammersmith and Charing Cross, in my constituency? That is the Secretary of State’s policy. He cannot pass the buck to the NHS on this or, indeed, on the threat to the Royal Brompton hospital’s children’s services; he has to answer for it.

[Mr Lansley]

No. Let me reiterate to the hon. Gentleman the point I have just made, because what he describes is not my policy. If there are proposals, they are proposals that have been generated in north-west and west London, and the safe and sustainable review is an independent review. It is not establishing the Government’s policy; it is an independent review in the NHS, looking at how services can be improved.

The review was not in any sense about costs; it was entirely about how we sustain the highest quality of excellent care for patients. The same will be—needs to be—true in relation to services in west London for emergency care. I will not go through this all again, but I reiterate that, if people object and say that such an aim will not be achieved, it is open to a local authority to refer the matter to a mere Secretary of State on the basis that the tests I have set down have not been met.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

I welcome the encouraging and successful results of the work of our NHS staff in delivering the outcomes that the Secretary of State has reported in this first annual report. A vox pop in one of our local papers last month showed that everybody bar one thought that the NHS was doing a good job. The only complaint was that one person had to wait a little too long to be seen by their GP.

One thing that would encourage people also is to know that, if there ever are proposals to discontinue NHS services or to transfer them from NHS management to private or voluntary sector management, they will always be subject to consultation and proceed only with the consent of the public.

[Mr Lansley]

I am grateful to my right hon. Friend. Let me just separate those two parts. First, when there are changes in a service, such as when there is a proposal to change the provider of community services from, for example, an NHS-owned provider to an independent sector provider, they will be a subject for local consultation.

Secondly, the right hon. Gentleman will recall that, when there is any proposal not to provide a service, the Secretary of State is responsible under legislation for the provision of a comprehensive health service. It is not open, as I have made clear to the right hon. Member for Leigh, to the NHS to discontinue the provision of NHS services. It has to—[Interruption.] He says from a sedentary position, “It is doing so,” but he is completely wrong. I wrote to him this morning.

We have stopped precisely the things that he said used to happen under the Labour Government, and it is precisely the case that trusts and future commissioners will have to maintain a comprehensive health service. They can apply clinical criteria and judge certain treatments to be of relatively poor value, but they must always maintain a service and show how they are responding to the clinical needs of their patients.

[Mr Peter Bone (Wellingborough) (Con)]

Ever since I was elected to Parliament, I have campaigned for an urgent care centre in a hospital in my constituency. Labour took NHS provision out of my constituency, but with the new Nene Valley clinical commissioning group we are going for the first time to have that urgent care centre. So I should welcome the Secretary of State to Wellingborough, but I must warn him that he would be carried shoulder-high through its streets—with people cheering him.

[Mr Lansley]

I cannot resist the enticement of such an invitation from my hon. Friend. It will reiterate what I found a year or so ago when I visited the nascent Nene Valley commissioning organisation. People there are really taking hold of things and showing how they can improve services in Northamptonshire.

[Tessa Munt (Wells) (LD)]

Over the past year, the Department of Health has made statements about the fact that radiotherapy is eight times more effective than drugs. It is said that the cancer drugs fund is £100 million underspent and the figures of £150 million and £750 million have been mentioned in connection with new radiotherapy and radiosurgery services. Will the Secretary of State consider transferring at least that underspent funding into radiotherapy and radiosurgery services so that new services in the south-west do not depend on charitable funding?

[Mr Lansley]

I am grateful to my hon. Friend. The issue is important. In the cancer outcomes strategy, we responded positively to the recommendations of the National Radiotherapy Advisory Group. There was a £400 million programme for the support of radiotherapy; more recently, I have added to that a commitment to build two new centres for proton beam therapy. From about 2015, patients requiring such therapy will not have to go abroad to access it.

My hon. Friend makes an important point. In the early part of this year, we made additional resources available to the NHS supply chain so that more radiotherapy machines could be readily available for purchase or lease through the NHS without costs being incurred over the same period. I will look at what my hon. Friend has said. I think that in the cancer outcomes strategy we have set out all the investment in radiotherapy that we think is clinically indicated, but I will continue to review it.