South London Healthcare NHS Trust

Lord Lansley Excerpts

Thursday 12th July 2012 Written Statements

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

I wish to inform the House that I have made an order to appoint a trust special administrator to South London Healthcare NHS Trust. The order will be laid in the House shortly with a report setting out the basis of my decision, in accordance with chapter 5A of the National Health Service Act 2006, as introduced by the Health Act 2009.

My decision is based on the recommendation of the NHS chief executive and the responses to my recent statutory consultation with the trust board, the strategic health authority and local NHS commissioners on the proposal to place the trust in the trust special administrator’s regime. In accordance with the legislation, I have decided it is in the interests of the health service and, in particular, of the patients the trust serves to put South London Healthcare NHS Trust in the trust special administrator’s regime.

I have appointed Matthew Kershaw as the trust special administrator. Mr Kershaw’s role will take effect on Monday 16 July and I will issue him with terms of appointment. From this point, Mr Kershaw will assume full control of South London Healthcare NHS Trust, replacing the functions of the trust board and assuming the role of the accountable officer. He will be responsible for maintaining services for patients as well as developing recommendations to secure a sustainable future for services provided by the trust for me to consider. At this point, and pending the outcome of the regime, the chair and directors are suspended from their board duties in accordance with the legislation. However, some of the executive and non-executive directors will support the trust special administrator in the work he leads during the regime. How this is organised is a decision for the trust special administrator.

My key objective for all NHS providers is to ensure they deliver high-quality services to patients that are clinically and financially sustainable for the long term. The purpose of the trust special administrator’s regime is to ensure that services provided by any NHS trust subject to the regime meet that objective.

The regime, included by the last Government in the Health Act 2009, offers a time-limited and transparent framework to provide a rapid resolution to problems within a significantly challenged NHS trust and its health economy. This is to ensure long-term sustainability and the protection of access to quality services for local patients. In addition to maintaining the provision of services during the period of the regime, the duty of a trust special administrator appointed to an NHS trust is to develop and consult locally on a draft report, making recommendations to me in a final report about what should happen to the organisation and the services it provides. The objective is that high-quality, sustainable services are delivered to the local health economy. I must make a final decision based on the recommendations made in the trust special administrator’s final report, publishing that decision and the reasons for it in Parliament.

The trust special administrator’s regime is not a day-to-day performance management tool for the NHS or a back-door approach to reconfiguration. The purpose is to deliver a rapid and robust process when the widest range of other solutions to improve and maintain sustainability have been tried, implemented and not delivered the results required. It is for this reason that Parliament agreed to set challenging milestones for any appointed trust special administrator and for the Secretary of State to make a final decision about an organisation within a usual maximum period of 120 working days from the date the order is made.

I am using my powers to extend by order the overall time frame by 30 working days. For South London Healthcare NHS Trust, it means I will make a final decision on the fixture of the organisation within 145 working days from 16 July 2012 and, therefore, by 4 February 2013 at the latest. The issues affecting South London Healthcare NHS Trust are particularly complex; they are long standing and are built on a history of trust mergers, changes in commissioning arrangements and affect a range of providers within the trust’s area. This is also the first time the regime has been used. Therefore, the trust special administrator in this case is starting, effectively, with a blank canvas and will be unable to draw on learning and processes developed by previous trust special administrators.

Furthermore, the future of services at Orpington are about to be consulted upon, following a public health driven and commissioner-led needs assessment. Extending the time period in which a draft report would be produced by the trust special administrator by 30 working days would allow him to take into account responses to that consultation, so far as they are relevant, as he develops his own recommendations in the draft report, assuming that consultation goes ahead. It is crucial that the first use of the regime is robust and has the greatest possible chance of success. I believe that the particular complexities and issues that affect South London Healthcare NHS Trust, coupled with this being the first ever use of the regime, and the opportunity to take into account responses to the planned consultation on Orpington, mean that this is an exceptional case which warrants an extension to the time frame in the interests of the health economy and, most importantly, the patients of south-east London.

Despite recent improvements in quality of services and access times, there is a long-standing history of underperformance, particularly around financial management and some key access targets, within the area now served by South London Healthcare NHS Trust. There has been a consistent inability by the trust to deliver high-quality services whilst balancing income with expenditure over the last seven years. A number of solutions have been implemented to attempt to resolve the worsening problems and ensure the NHS in this area can provide consistent quality services to patients and the public within the designated budget. These systemic, long-standing challenges mean that South London Healthcare NHS Trust has historically underperformed against key quality, performance and finance requirements outlined in the national NHS performance management framework. The trust has also failed to make progress towards a viable foundation trust application. In 2011-12, it incurred the largest financial deficit of any of the 248 NHS provider organisations in England, at over £65 million. The deficit equates to an average weekly overspend of £1.3 million of taxpayers’ money on top of an average allocated weekly income of £8.4 million.

For South London Healthcare NHS Trust, the regime will be used because of the particular nature and scale of the financial and performance challenges, the complex interrelationship, the failure to make the scale of change required in the trust and with its partners and the absence of any viable, alternative strategy to ensure long-term clinical and financial sustainability.

The trust special administrator, working with clinicians, staff, commissioners, patients and the public, and other stakeholders, must now prepare recommendations for a sustainable solution for South London Healthcare NHS Trust as part of the south-east London health economy. The scale of the challenge means that Mr Kershaw will be expected to engage with, and consider the implications of any recommendations he makes with regard to the South London Healthcare NHS Trust on, other providers. Whilst it is not possible to speculate on the effect any decision may have pending the outcome of the regime, providers in the south London health economy could be affected and will be engaged throughout the process.

The trust special administrator will also constitute a clinical advisory panel, comprising prominent clinical leaders, to support and advise him in developing his recommendations. This will provide further reassurance that the TSA’s proposals are based on strong clinical evidence and are in the interests of local patients.

In accordance with my statutory duty, I have published guidance for trust special administrators appointed to NHS trusts, to which they must have regard in undertaking their legal duties. This can be found at: www.dh.gov.uk/health/2012/07/statutory-guidance-tsa/

A copy has been placed in the Library.

Care and Support

Lord Lansley Excerpts

Wednesday 11th July 2012 Commons Chamber

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

With permission, Mr Deputy Speaker, I would like to make a statement on the future of care and support for adults in England.

The coalition programme said that reform is needed urgently. We inherited a system that too often let people down and was unfair; a system that was complex and confusing, and which responded to a crisis, but too rarely prevented it. For many years, people have called for a system fitted around the needs of care users, not the preferences of the service; one that puts people at the heart of the service and delivers high-quality care with dignity and respect.

We knew two years ago that we had to offer urgent support to social care. In the spending review 2010, we provided an additional £7.2 billion for social care over the course of this Parliament, including nearly £3 billion from the NHS to deliver more integrated care. This gives the current system resource backing, but not reform. We need also to build a better service for the long term.

The White Paper I am publishing today represents the greatest transformation of the system since 1948. The practical effect will be to give service users, their carers and their families more peace of mind. Services will be organised around each individual's care and support needs, their goals and aspirations. Intervention will be earlier, promoting independence and well-being.

The White Paper will support people to remain active in their own communities, connected to their families, friends and support networks. We will invest an additional £200 million over five years in the development of specialised housing for older and disabled people, so that people can stay independent in their own homes for as long as possible. The role of carers is critical, so we will transform how the system views and treats carers. We will extend rights for carers to have an assessment and for the first time provide a clear entitlement to the support they need to maintain their own health and well-being.

The measures in the White Paper will make it easier for people to understand how care and support services work, and what their entitlements and responsibilities are. To give people greater consistency of access, we will introduce a national minimum eligibility threshold, as the Dilnot commission suggested. We will require councils to start supporting people as soon as they move into a new area, so that it is easier for people to choose to move home, to be nearer, for example, to their relatives. Local authorities will be under a duty to ensure continuity of care, and that care users are able to take their assessments with them if they move area.

We will establish a single website to provide clear and reliable information about all care and support services for self-funders and local authority supported users and carers. As well as these improvements to national information, we will invest £32.5 million to ensure that there is better local information about the range of local care and support services available in each area.

We want people to be confident that the care and support they receive is delivered by a compassionate and caring work force. We will place dignity and respect for care users at the heart of a new code of conduct and minimum training standards for care workers. Alongside the new minimum standards, we will train more care workers, with 50,000 more apprenticeships by 2017.

A key requirement is for people to be confident that they will be treated with dignity and respect, and that providers deliver high-quality care at all times. We will rule out the crude practice known as “contracting by the minute” that can so undermine people’s dignity and choice. We should contract for quality and service, not by the clock. We will call on local HealthWatch organisations to make active use of their new power of entry, allowing them to visit care services in their local area, and to make recommendations to the providers and to local authority commissioners.

People should also be entitled to expect that services will be maintained if a provider fails. Working with local government and the care sector, we successfully handled the consequences of the Southern Cross crisis, but we also learned lessons, so we will consult on how we can anticipate and act to ensure continuity of care if a provider goes out of business. Care itself, not the provider of care, is the most important factor.

A key theme of the White Paper is that those receiving care and support know what is best for them. It is right that they must be in control of their care and support. We will make sure everyone is entitled to a personal budget, so they can be in control of their own care. We will offer all who want it a personal budget, and by 2015 support that with a legal right to request this as a direct payment. To make it easier for people to get the care they want, we will ensure that they have better access to independent advice. We will make it easier for people to see whether a care provider is good or not so that they can make real choices through an online “quality profile” for each provider. We will work with a range of organisations to develop comparison websites so that people can give feedback and compare the quality of care for themselves.

Integrated care is important for everyone, regardless of age or the reason they need care and support, but getting integration right is particularly important for those moving from one service to another. That is why we will transfer an additional £100 million in 2013-14 and £200 million in 2014-15, beyond previous plans, from the NHS to support social care services that benefit people’s health and well-being and promote better integrated care.

The White Paper will help people get better joined-up care at key points in their lives. We will legislate to give adult social care services a power to assess young people under the age of 18, and we will ensure protection so that no young person goes without care while waiting for adult support to start. We want people to receive the best possible care at the end of their lives, including a choice over where they die. The palliative care funding review recommended that all health and social care should be funded by the state once someone reaches the end of life and is entered on the end-of-life care locality register. We think that there is much merit in this and will be using the eight palliative care funding pilot sites to collect the data and experience we need to assess the proposal.

Alongside the White Paper, I am today publishing the draft Care and Support Bill. Many of the White Paper reforms need new legislation to make them work, but the draft Bill is also a major reform in its own right. The law for adult social care is complex and outdated. All those involved know how it has made the system harder to work in. The draft Bill sets out a single, modern statute for adult care and support. It brings together and simplifies provisions from at least a dozen Acts of Parliament, reflecting the recommendations of the Law Commission. It builds the law around people’s well-being and needs and outcomes—clear principles, clearly set out in law.

I am also today publishing a progress report on funding reform. In July 2010 I asked Andrew Dilnot to review the funding of the system of care and support in England. I can confirm today the Government’s support for the principles of the Dilnot commission’s report as the right basis for any new funding model: financial protection through capped costs and an extended means test. As Andrew Dilnot himself has said, that would enable people to plan and prepare so that they are not so vulnerable to the arbitrary impact of catastrophic care costs.

The progress report sets out a detailed analysis of the funding model, giving us a better basis for making decisions on how these changes can be funded. Of course, any proposal that includes extra public spending needs to be considered alongside other spending priorities, including the demographic pressures on social care services. The right and necessary time to do that is at the next spending review. Our talks with the Labour party were constructive, but no plan for funding Dilnot was agreed or, indeed, proposed by either side. A decision at the next spending review will allow time for continuing discussions with stakeholders and between the parties, and we can undertake open engagement on detailed implementation issues and options. These discussions will include the level of the cap, whether a voluntary or opt-in approach is a viable option in addition to the universal options and whether legislative provision is required.

However, as the report makes clear, we are also taking definitive steps now by accepting a number of the Dilnot commission’s recommendations. Most notably, we will introduce a universal deferred payments scheme. This will mean that no one will be forced to sell their home in their lifetime to pay for care. Provisions for this are included in the draft Bill.

The White Paper, the draft Care and Support Bill and the progress report on funding together set out our commitment to a modern system of care and support, one designed around the needs of individual people, one with dignity and respect at its heart, and one that brings care and support into the 21st century. These reforms are also the product of immensely helpful reviews by the Law Commission and the Dilnot commission and a positive and wide-ranging engagement with the care sector and the public, which is helping us to design the kind of care services and support that we would all like to see for ourselves and our families. We are determined to secure these reforms to achieve in this Parliament that which our predecessors failed to achieve in over 13 years. I intend to continue and develop an open and co-operative approach in developing these reforms. I commend this statement to the House.

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[Mr Lansley]

I am grateful to the right hon. Gentleman for welcoming the announcements about access to universal deferred payments, national eligibility criteria, and the work that we are undertaking on promoting free care at end of life. I am surprised, however, that his final remarks seemed to be completely contrary to what he said at the outset. Let me be very clear: the White Paper is the product of the priorities of the people with whom we have engaged throughout the “Caring for our future” process. It directly reflects the priorities of the care and support sector, and I would therefore be surprised if anybody in the sector failed to recognise that and to support it. It is focused on delivering quality and promoting the work force. For the first time, it gives access to legal rights for carers in terms of support. It is very clear about the issue of personal budgets, where there has been a dramatic expansion over the past two years.

Let me deal with the right hon. Gentleman’s specific questions. Since we came into office, we have continually recognised the need for support for social care and for the funding of local authorities for this purpose. That is why we made provision for £7.2 billion of additional support, £3 billion of which comes from within the NHS. As he will see from page 64 of the White Paper, the £300 million of additional resources that it announces more than meets the cost of the White Paper to local government. We are continuing to support social care within the NHS. The latest figures from the Association of Directors of Adult Social Services suggest that only about 13% of total savings took the form of reductions in any service for care users, with the rest relating to efficiency savings redirected into the service that is being provided.

It is simply not the case that we are adopting a pick-and-mix approach to the commission of Andrew Dilnot and his colleagues. We are proceeding with some of its recommendations—for example, on eligibility criteria and deferred payments—and supporting the principles for a new funding model based on the capped cost and extension of the means test. The right hon. Gentleman said that we have to be able to pay for it; yes, indeed we do. That is why we will continue to engage with him and his colleagues and with the wider sector. It is very important that we take people with us on this.

It cuts no ice for the right hon. Gentleman to say that after 13 years of a Labour Government he published a White Paper days before the announcement of the last general election. If he wants to go back to the proposal that he made at that time, which was to impose a tax in order to pay for this and to means-test access to disability benefits, then let him say so, but that is not the basis on which we are proceeding. Andrew Dilnot considered those proposals and did not recommend them. We need a proposal that garners wider consensus and support than was evident for the right hon. Gentleman’s White Paper. I am determined to try to secure that, and we will continue to engage with the sector to make it happen.

[Several hon. Members]

rose—

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[Mr Stephen Dorrell (Charnwood) (Con)]

I welcome the package of measures that my right hon. Friend has announced, which represent important progress towards the delivery of many objectives that are, as we have heard, shared across the House. May I ask him two specific questions? First, he has published a welcome draft Bill showing that many of these aspirations can be brought into effect. Do the Government expect to be able to provide time to make that draft Bill law in the next Session of Parliament? Secondly, in the context of that Bill, does he hope that the continuing cross-party talks may yet provide the basis for answering the funding question that has bedevilled those talks for so long?

[Mr Lansley]

I am grateful to my right hon. Friend. It was neglectful of me not to mention that the White Paper and the announcement that I have made also drew on the recommendations and work of the Health Committee, and I am pleased to have been able to respond to its report as well.

First, matters relating to the legislative programme for the next Session will be announced in the normal way in the Gracious Speech. Secondly, I am determined that we will not only, I hope, have continuing cross-party talks but that they will be conducted, as I think that the shadow Secretary of State himself would wish, with the sector in a more open, public debate. If we were able to arrive at a position whereby, notwithstanding the fact that funding decisions might be made in the spending review, there was scope to put in place legislative provisions that allowed that to happen and could be agreed in time for the introduction of the draft Care and Support Bill, then we would look to make that happen. However, that is conditional at this stage.

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

The Secretary of State seems to forget two things. First, his Government did not implement the Personal Care at Home Act 2010, which would have made a difference to people. Secondly, they did not ask Dilnot to consider where the money was coming from, so he can hardly be blamed for not putting forward suggestions. The Secretary of State has committed to a few of Dilnot’s principles but ignored the fact that he advised the closure of the current funding gap in social care. Will he back Labour’s call for the Treasury to use £700 million of this year’s health underspend to close that funding gap, which is the cause of the crisis in social care?

[Mr Lansley]

First, it is ironic that the shadow Secretary of State said that local authorities would be aghast if they were asked to do extra things without resources given that we are providing those resources and that the Personal Care at Home Act was completely unfunded, which is why local government was desperate for us not to proceed with it. Andrew Dilnot and his colleagues are very clear, as are we, that there are, as I said in my statement, baseline funding pressures on local authorities in relation to social care. That will be addressed in the next spending review, as it was necessarily addressed in the previous spending review in direct response to recommendations that Andrew Dilnot gave us in 2010.

[John Pugh (Southport) (LD)]

I welcome the statement, which contains many good things, but without financial clarity we risk offering an unsustainable solution to an unsustainable problem. What can coalition Back Benchers do to get the Treasury to go further and faster?

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[Mr Lansley]

The statement I have made is a Government statement. We are working closely with our colleagues across Government to secure these proposals. I know that my hon. Friend understands these things very well. He will know that if there are significant public expenditure implications beyond the current spending review period, they must be dealt with in the context of a spending review. All Government Members are committed to deficit reduction. Understanding where, within those constraints, our priorities lie is the essence of a spending review.

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

This is a much more important issue than Lords reform. It is important to millions of people in this country and I am happy to have the opportunity to discuss it. There is clearly a huge shortfall and a crisis of funding in social care. The Secretary of State is not hoodwinking anybody by suggesting anything other than that. What has changed since he walked away from the cross-party talks led by my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown)? The Secretary of State dressed up the proposal made before the general election as a “death tax”, yet he has come back with a proposal that is broadly similar.

[Mr Lansley]

I am not attempting to hoodwink anybody. I have made the point very clearly that in this financial year the Association of Directors of Adult Social Services is making total savings of £891 million, of which only 13%, some £113 million, is being achieved through reductions in services. We are investing in and supporting such services. In 2012-13, £930 million of extra funding will go to local authorities through formula grant to support social care. The NHS is transferring £622 million and we are doubling last year’s figure so that £300 million will be available through the NHS for re-ablement. Those are major additions to the support for care.

On the other point that the hon. Gentleman made, even the right hon. Member for Leigh did not try to return to the debate that we had before the election, and rightly so. The right hon. Gentleman eschewed party political point scoring; the hon. Member for Easington (Grahame M. Morris) did not. I think he should have done.

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

I warmly welcome the statement. There is clear commitment in a number of good areas, including improving the portability of services, providing greater support for carers, improving respite care and having more joined-up working between the NHS and adult social services, which will save social services and the NHS money, and improve the care that is delivered to patients. Does the Secretary of State agree that when local government commissions services, it should do so with a view to improving the quality of care and moving away from the care-by-the-minute mentality to which many local care providers seem to adhere?

[Mr Lansley]

My hon. Friend is absolutely right in all respects. I know that local government will welcome the philosophy of commissioning for quality, rather than commissioning simply on the basis of watching the clock. That will also be welcomed by older people who are in receipt of care.

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

It is clear that the Secretary of State is moving on from causing chaos in the NHS to causing it in the care service. Given the crisis in the budgets of social services, will he set up an independent body to look at how much money local authorities require to provide high-quality social care?

[Mr Lansley]

I am sorry, but the hon. Gentleman simply demonstrates his ignorance of what is in the White Paper. Those who work in social care, those who represent care users, care recipients and carers want the changes in legislation and in support to focus on looking after people. That is absolutely our agenda. We know that there are funding needs. That is why, in the spending review, we have provided the sums that I have set out. That will enable local authorities to maintain their eligibility to care. This year, only six authorities have reduced their level of eligibility to care from moderate to substantial.

[David Tredinnick (Bosworth) (Con)]

My right hon. Friend’s statement will be widely welcomed, especially the loans aspect and the emphasis on personal care budgets. Will he confirm that his Department’s trials are showing that personal care budgets are very effective in empowering patients, reducing costs and bringing in a wider range of services and greater patient choice?

[Mr Lansley]

My hon. Friend is absolutely right. A study published in the latter part of last year demonstrated exactly what he has set out. There has been a major increase in access to personal budgets. When we came to office, about 168,000 people had access to a personal budget. The latest figures show that we have reached 432,000 people. We are aiming for everyone who wants it to have access to a personal budget by April 2013. The draft Bill that we have published today would give legal backing to that and to access to direct payments.

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

On 5 December last year, the Minister with responsibility for disabled people said in a written ministerial statement that a consultation on the independent living fund would be published in conjunction with a White Paper on social care this year. Will the Secretary of State say how a consultation on a review of the independent living fund will be meshed with the proposals in the White Paper? Will he assure me that there will be a coherent approach in Government to deal with the ILF in the context of the proposals that he is announcing today?

[Mr Lansley]

I am grateful to the hon. Lady, because she gives me the opportunity to say that my colleagues at the Department for Work and Pensions will publish a document shortly. That will enable her and other hon. Members to see the relationship between the two documents.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome my right hon. Friend’s statement, and in particular the recognition of the role of housing in helping people to live independently in their own homes. Will he elaborate further on how the £200 million extra may be spent by local councils? Does he support the recommendation of the Health Committee that we have a single commissioner for health, social care and housing?

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[Mr Lansley]

The £200 million over a period of five years that I have announced today will be able to be leveraged, with the involvement of private sector investment and social landlords, to provide an opportunity for several thousand additional places in specialist housing for older people and those with disabilities. We are talking about the kind of extra-care homes that give people the sense that they are moving into their own home, but with care available. That will be available in people’s own communities to a greater extent if we can increase the supply.

[Derek Twigg (Halton) (Lab)]

The Secretary of State says that he can give no commitments past the spending review in 2015. However, he said that by 2017—two years after that—we will have 50,000 more care workers. There is a big question over how that money will be found. He makes a big point of saying he has given local authorities all these extra resources to deal with the extra tasks that they will have. In the discussions on that, have local authorities said they are satisfied that he is providing enough money for them to carry out those extra tasks?

[Mr Lansley]

I know that the hon. Gentleman will not have had a chance to look in detail at the White Paper, but it makes it clear that the costs in the spending review period are more than adequately met by the additional resources. [Interruption.] The hon. Gentleman and his colleagues are confusing two different things. The White Paper looks at specific additional tasks—for example, in the provision of independent information and advice, including local information about access to care services. That is more than fully funded. The figure he mentioned referred not to the number of care workers but to the number of care apprenticeships that are being developed with the sector.

[Sir Tony Baldry (Banbury) (Con)]

As co-chair of the all-party parliamentary group on carers, I welcome the new rights for carers that are proposed in the White Paper. However, a couple of things follow from that. First, GPs, social workers and others have a responsibility to do everything possible to identify carers, because unless people identify themselves as carers, they will not be able to access those rights. Secondly, we should support carers by developing training programmes for them, so that those who find themselves in that position are empowered to undertake their caring role.

[Mr Lansley]

I am grateful for the work of my hon. Friend and the all-party group. This is an important moment. If the House approves the draft Bill, the rights and entitlements of carers to assessment and support will be set out in law for the first time, in the same way as we have done for those for whom they care. He makes an important point. The draft mandate for the NHS that I published last week gives specific attention to the need to identify and support carers. I hope that these proposals will also enable the NHS and social care to join together in support of carers.

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

May I return to the point that my hon. Friend the Member for Halton (Derek Twigg) made? Have local authorities confirmed that they are satisfied that the funding that has been made available will cover the new duties they have to undertake?

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[Mr Lansley]

We have consulted not only the Local Government Association but my colleagues at the Department for Communities and Local Government, and I can assure the hon. Lady that that is indeed the case.

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

There is much to be welcomed in today’s announcement. After so many years, people all over the country will be pleased that so much progress has been made, particularly for carers and in improving the quality of care and professional standing of paid-for carers. Will the Secretary of State confirm what I think I heard him say—that if the Opposition were to redouble their efforts and the whole country were to engage in the debate that today’s announcement will trigger, the mechanisms to solve the bigger problem of how the funding can be provided could be included in the forthcoming Bill within the next 12 months?

[Mr Lansley]

Yes, and I am grateful to my hon. Friend. I will not reiterate what I said in response to the Chair of the Health Committee, but I hope that as we make progress we will be able to see what legislative provisions are required and make them available at the earliest opportunity. She makes an important point, because we must not lose sight of the opportunity to improve quality. There are certain things that require resources, such as access to quality profiles of care providers so that people can make proper assessments of the quality of service that they will receive, increasingly using their personal budgets or direct payments. There is dramatic potential in that. Starting today, quality profiles of 12,000 care providers will be made available.

[Jack Dromey (Birmingham, Erdington) (Lab)]

A delayed solution to the growing crisis in social care is no solution. In Birmingham, there are none more noble than those who care and none who deserve our support more than those in need of care. Does the Secretary of State not recognise that in failing to act now he is both surrendering a historic opportunity for a new settlement based on Dilnot and letting down the most vulnerable in our country?

[Mr Lansley]

I know it is difficult for hon. Members when documents are published alongside a statement and they have not had an opportunity to read them, but when the hon. Gentleman does so he will know that what he has just said was utter nonsense.

[Glyn Davies (Montgomeryshire) (Con)]

I, too, greatly welcome today’s statement and congratulate my right hon. Friend on taking forward this important policy. Health and social care is devolved to the Welsh Government, but it is inevitable that statements, decisions and policy changes in England have a major effect on Wales as well, because some of the services provided to people in Wales are over the border in England. As well as cross-party talks, may we have cross-border talks to ensure that the system works well in Wales?

[Mr Lansley]

My hon. Friend makes an important point. We want people who move from England to Wales or from Wales to England to have continuity of care, so I will make it clear to my counterpart in Wales that I am entirely open to discussions about that. Given that it is a devolved matter, it is better in a sense if the initiative for those discussions comes from Wales, because I do not want to be interpreted as trying to impose any solution on Wales, but if the Welsh Government look for such discussions I will be open to them.

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

In response to the White Paper, the NHS Confederation has said that people are

“staying in hospital longer…because the right services are not in place to allow them to go home when they are medically fit to do so.”

Given that it is estimated that delayed discharges from our hospitals cost some £18 million a month, what action are the Government taking to get rid of that waste of public money?

[Mr Lansley]

The total number of delayed discharges is broadly the same as it was last year and, I believe, from memory, the year before—I will correct the record if not. Some 29% of the delays in discharge from hospital are due to the inability to access social care. Most of them arise because people are awaiting further assessment or treatment in the NHS. We have all the details of delayed discharges and are working actively to reduce them.

[Margot James (Stourbridge) (Con)]

I very much welcome many of the measures that my right hon. Friend has announced, particularly on the improvement that he wishes to see in the dignity and respect accorded to those in our care homes and NHS hospitals, especially older people. Will he say a little more about the minimum standards for staff working in the care sector, and about the qualifications that people who apply for care apprenticeships might require to provide the right quality of care?

[Mr Lansley]

Yes, I am glad to do so. Through the work that we are doing with Skills for Health and Skills for Care, we will set out more clearly the training requirements for those undertaking care work and care assistance in the NHS. In addition, we set out in the White Paper that there should be a code of conduct, and I hope that across the service the philosophy of commissioning for quality, not simply commissioning or contracting by the minute, will help push us towards improvements in the dignity and respect with which care users are treated.

[Hazel Blears (Salford and Eccles) (Lab)]

There are 800,000 people in this country with dementia, a devastating condition for themselves and their families. Many of them rely on the support of community-based services, which means that they are not admitted to residential care and may have a crisis that results in hospital admission. It is a false economy not to support community services. If the Secretary of State were really in touch, he would know that there are massive cuts across the country in exactly those services. Will he go back to the Chancellor now and say, “We need some money now to deal with the crisis”? Otherwise, the integration that he talks about in the White Paper will not happen and the crisis in local authority care will continue.

--- Later in debate ---

[Mr Lansley]

I am sorry that the right hon. Lady does not seem to recognise that in addition to what I have announced today, about three months ago the Prime Minister launched the dementia challenge. It provides resources in the NHS, through the commissioning for quality incentive, for the identification of patients with dementia and for follow-up assessments and support. It is doubling research into dementia and supporting a programme for the creation of dementia-friendly communities. As part of that dementia challenge, local authorities and the health service will work actively together to make communities far more dementia-friendly and more effective in treating dementia.

[Matthew Hancock (West Suffolk) (Con)]

Like carers and many vulnerable people across the country, I warmly welcome the White Paper and the progress that is being made. People are keen to see a continued political consensus, which existed, and on which the Opposition were to be congratulated, until about half an hour ago. May I urge the Secretary of State to do everything he can to ensure that that consensus continues? Will he also set out a bit more about what the national minimum eligibility threshold will mean, so that people across the country know what they are entitled to?

[Mr Lansley]

On the latter point, my hon. Friend will be aware that the national eligibility threshold that we are legislating for will come into effect in 2015. We will of course make it clear before that at what level it will be set. I cannot provide that information at the moment, not least because we have reservations about the overall effectiveness of the classification of need under the fair access to care services system in the intervening period. If we can improve the eligibility framework, we will set out to do so.

I say to the right hon. Member for Leigh and his colleagues that I am very happy to continue to talk. I know that he did not want us to proceed on a unilateral basis from the progress report, but in truth what we published did not represent our making decisions unilaterally but instead reflected the point that we had reached. I am happy for further talks to take us beyond that point.

[Tony Lloyd (Manchester Central) (Lab)]

If we are to offer people the dignity and respect that the Secretary of State has talked about and prevent the type of abuse that both shocks the nation and frightens care users and their families, although training is very important, so is monitoring. Will he guarantee that the money necessary for monitoring will be available to HealthWatch, the Care Quality Commission and similar agencies? At the moment, people do not believe that those agencies are requested to monitor them properly.

[Mr Lansley]

The hon. Gentleman will know that we are making resources available for HealthWatch. It also has additional powers and a remit that extends in a way that the remit of LINks never did. There is therefore a patient and care users’ voice, and a much more effective power to enter, view and report. The link of HealthWatch England to the Care Quality Commission is important. We have increased the resources of the latter. I am sure that when he sees its annual report, he will appreciate the steps it is taking to extend its inspection more reliably on an unannounced basis, including into domiciliary care provision.

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

I have a great deal of respect for the Secretary of State, but I agree with the chief executive of the Alzheimer’s Society, who has said:

“Every day without a funding decision is another day where people…with dementia…face huge costs for…substandard care.”

Will the Secretary of State therefore take this opportunity to assure the House that any new system of funding will end the current dementia tax, under which those with dementia are penalised as a result of their condition with some of the highest social care costs?

[Mr Lansley]

In this instance, I completely understand where the Alzheimer’s Society is coming from. We all want to achieve what Andrew Dilnot made very clear in presenting his report. Any of us or any members of our families could be subject to catastrophic care costs as a consequence of a diagnosis of dementia and several years’ need for care. We want people to be able to plan and prepare, and to protect themselves against that. From the Government’s point of view, and as I have said today, the Dilnot commission’s report is the basis for a funding model for that, but it must be paid for. As with anything else, we are not going to start promising things that we do not know we can pay for. We therefore have a job of work to do, and I am determined that we will do it as speedily as we can.

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

The Secretary of State referred to deferred payments. In the time before the individual dies, who will pay for that care? Is there any estimate of how much the care will cost? It seems to be an extremely bad deal for the individual if they must also carry the interest rates of that loan. Will it be administered by local authorities? Who will fund that local authority?

[Mr Lansley]

From the care user’s point of view, it will be funded by local authorities. Central Government will back that up.

[Laura Sandys (South Thanet) (Con)]

The residents of Thanet will be reassured by the paper, particular when it comes to caring by the minute, which shows so little respect and dignity for the elderly. However, I urge the Secretary of State to look at the culture of social care, in which funds go more to crisis management than to prevention. I urge him to understand that we could introduce many new measures that will keep people healthy as they get older rather than ambulance-chase after a crisis.

[Mr Lansley]

I agree with my hon. Friend. That is why we want the focus to be on maintaining well-being and independence. More specialist housing will help with that. The doubling this year compared with last year of resources from the NHS to support re-ablement—when people are discharged from hospital after, for example, a fall and a hip fracture—will directly enable people to be more independent. A lot of the resources that the NHS is putting in with social care is directed towards that kind of preventive work rather than to crisis response. I hope we can do more of that in future.

[Mark Durkan (Foyle) (SDLP)]

Without underestimating the inherent challenges, may I welcome the statement and commend the approach of the shadow Secretary of State? The draft care and support Bill makes provision in respect of the portability of care packages between local authorities in England, but it does not yet provide for the “passportability” of care packages to Northern Ireland and Scotland. Historical migration factors mean that many Irish people are lonely and in remote care settings in England who would much rather be in a care setting in which they can enjoy the support and contact of their families—their families want them there too. When will that finally be addressed?

[Mr Lansley]

As I told my hon. Friend the Member for Montgomeryshire (Glyn Davies), I completely understand the problem. I will be entirely open to representations from, and discussions with, the Wales and Northern Ireland Administrations on the scope for achieving continuity of care for those who move between different parts of the UK. There are differing systems, but we can at least try to ensure that we build continuity of care around the needs of the individual care user rather than constantly being obsessed with the characteristics of our own systems.

[Fiona Bruce (Congleton) (Con)]

As the Member of Parliament who represents the area with the highest elderly population in the north-west of England per head, I welcome the statement and the importance that the Government place on care and support, which is the most challenging issue authorities such as Cheshire East council will face over the next few years. The Secretary of State is right to talk about working with local authorities, but how will this work on greater support for carers include greater support for, and, importantly, dialogue with, community and voluntary organisations, such as Crossroads Care Cheshire East, which does excellent work and provides real added value? It tells me that it could do so much more if it was given such support.

[Mr Lansley]

I am grateful to my hon. Friend. I know how important the work of Crossroads Care is in my constituency and others. The “Caring for our future” engagement over a number of months was a major contributory process to the White Paper. I believe we have accurately reflected in the White Paper the priorities set out then. This is not the end of the process. We have important and positive messages to take forward, and further work to do, not least on funding. I hope we can do that equally in close co-operation with the Care and Support Alliance and its members.

[Alison McGovern (Wirral South) (Lab)]

Given the scale of the care crisis in Wirral, I have listened to my constituents at a number of public meetings. They tell me that their priority is for loved ones to live at home with dignity, but local authority cuts make that harder, and—I am sorry—the NHS reorganisation is just a distraction. Contracting by the minute, which the Secretary of State mentioned, is far from the only problem. How will he tackle other problems in the care industry, such as older people being disrespectfully told what time to go to bed and get up?

--- Later in debate ---

[Mr Lansley]

As I said in the statement, we absolutely intend for care services to be responsive to the needs of patients, and to their goals, aspirations and wishes. That is not only a cultural shift, but a financial one—the availability of personal budgets and direct payments for everybody in the social care system will give patients the financial levers to make that cultural shift happen. However, the situation in the Wirral she describes is not how it was described to me when I was there in April. I was told that the health and wellbeing board brings together social care, public health and the NHS so that they are far more effective in the delivery of services locally.

[Mr David Nuttall (Bury North) (Con)]

I thank my right hon. Friend for making progress on this problem, which is a worry for so many of my constituents. They will welcome the proposals, but does he agree that the proposals for paying for care fees by way of a one-off insurance premium, which are contained in the Conservative party manifesto, would have been far better in promoting personal responsibility?

[Mr Lansley]

My hon. Friend will see in the progress report that we need to discuss both the universal options for paying for the Dilnot model of care and voluntary, opt-in systems. The latter could have a character not dissimilar to that he describes.

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

I welcome many measures in the paper, including on the transition from being a child needing care to becoming an adult needing care, and on allowing people to choose where they want to end their life in palliative care. I represent a coastal constituency. Many people retire to the coast to enjoy the benefits of the sea air. Will he assure me that Suffolk county council will not be penalised by the fact that, in bringing families together, they will not take on extra care burdens for which they had not planned?

[Mr Lansley]

I completely understand my hon. Friend’s point. We very much reflect the need for care and health care in the allocation of resources to local authorities through the formula grant, and the allocation of resources to the NHS through the NHS resource allocation.

[Bill Esterson (Sefton Central) (Lab)]

Councils have faced a £1 billion cut in their funding for care of the disabled and elderly since the right hon. Gentleman’s Government came to power. Without the cash, the White Paper will be meaningless. How confident can he and everybody else in the country be that the Treasury will cough up, given the track record so far of a £1 billion cut to councils?

[Mr Lansley]

I am sorry, but I simply do not recognise the figures that the hon. Gentleman is using. The Association of Directors of Adult Social Services has suggested—these are not my figures—that this year the service reduction in adult social care budgets on a monetary basis was £113 million and last year it was £226 million. The great majority of the figures he is quoting are actually not cuts at all; rather, they are service efficiencies, which are being reinvested for the benefit of maintaining eligibility.

[Sheila Gilmore (Edinburgh East) (Lab)]

My constituent who has been campaigning on portability of care packages outwith England will be extremely disappointed, because he was given to understand in correspondence from the Secretary of State that this would be covered in the White Paper and it clearly has not been. While we are thinking about Scotland, does the Secretary of State accept that the problem will not be solved even by shifting some of the costs of care from the individual to the state? We have had free personal care in Scotland for some years, but it has not resolved the problems because no additional money was put into the system.

[Mr Lansley]

I will not attempt—not least because of time—to give an analysis of the difficulties that have been experienced in Scotland. From my point of view, I had understood that what we have set out to do in the White Paper is very much to ensure continuity of care, so that when people move—certainly in England, for which I am responsible—local authorities have a duty to ensure continuity of support. If we can make it so that this happens across the United Kingdom, I am absolutely open to having the discussions necessary to do so.

[Heidi Alexander (Lewisham East) (Lab)]

The Health Secretary has spoken about the catastrophic costs that face some older adults suffering from dementia. My nan was one of those people. She had to sell her home and spent more than £100,000 on her care costs. Under the loan scheme proposed by the Government today, would somebody like my nan not just end up paying more for the costs of their care? Can the Health Secretary also clarify whether the interest payments would eat into the small amount of money that people like my nan can pass on to their families?

--- Later in debate ---

[Mr Lansley]

We are very clear—I hope I have been clear—that the adoption of a universal deferred payment scheme gives people an opportunity. We are not talking about something that people are required to do; rather, they can choose to do it. One of the things that has most distressed some of those who go into residential care settings is that, as a consequence, they are required to sell their homes—they are forced to do it. What we have announced gives people an opportunity for that not to happen, but as the White Paper and the progress report make clear, we would like to proceed on the basis of a funding model, based on the Dilnot commission, that enables people also to have a cap on their care costs. If we can do that, the combination of the two will be an effective solution.

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

Without a cap on costs, which is what the Dilnot commission proposed for universal deferred schemes, will this measure not potentially leave some families with massive debts to pay when their loved ones die, far in excess of the £35,000 cap that the commission proposed?

[Mr Lansley]

I am sorry that the hon. Gentleman has read out the Whips’ question, but he did not listen to the last answer. We are both implementing the universal deferred payment scheme and proposing in the draft Bill that we should legislate for that. We are, as I have made clear, supporting the principle of Dilnot that we should implement a capped-cost model with an extended means test, but we have to demonstrate, as we know, that it needs to be paid for, and if those decisions involve public expenditure, they must necessarily be held for the spending review.

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.

PIP Breast Implants

Lord Lansley Excerpts

Monday 18th June 2012 Written Statements

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

The Department is today publishing the final report of the expert group chaired by Sir Bruce Keogh, the NHS medical director, on the silicone breast implants manufactured by the firm Poly Implant Prothese (PIP). I am very grateful to Sir Bruce and to all the members of the expert group for the expertise and commitment they have brought to this task.

The expert group had available considerably more information than when they published their interim report in January. The new information includes the results of a major collection of data on explantation of PIP and other breast implants over the period 2001-11, as well as chemical analyses of a representative sample of batches of PIP and other implants. This makes it possible for the first time to make a valid comparison of the rates of rupture between PIP and other brands of breast implant, as well as to comment on the clinical significance of ruptures and silicone bleeds.

The group have concluded that:

rigorous chemical and toxicological analyses of a wide variety of PIP implants have not shown any evidence of significant risk to human health;

PIP implants are significantly more likely to rupture or leak silicone than other implants;

in a proportion of cases, failure of the PIP implant results in local reactions but these are readily detected by outward clinical signs—“silent” ruptures (ruptures which came to light only on explantation) are not generally associated with these local reactions; and

there remains no evidence of any longer-term, systemic adverse effects from breast silicone implants.

The group have reiterated and amplified their earlier advice that:

all providers of breast implant surgery should contact any women who have or may have PIP implants—if they have not already done so—and offer them a specialist consultation and any appropriate investigation to determine if the implants are still intact;

if the original provider is unable or unwilling to do this, a woman should seek referral through her GP to an appropriate specialist;

if there is any sign of rupture, she should be offered an explantation;

if the implants still appear to be intact she should be offered the opportunity to discuss with her specialist the best way forward, taking into account the factors listed in the report;

if in the light of this advice a woman decides with her doctor that, in her individual circumstances, she wishes to have her implants removed her healthcare provider should support her in carrying out this surgery; and

if a woman decides not to seek early explantation, she should be offered annual follow up in line with the advice issued by the specialist surgical associations in January 2012. Women who make this choice should be encouraged to consult their doctor if they notice any signs of tenderness or pain, or swollen lymph glands in or around their breasts or armpits, which may indicate a rupture. At the first signs of rupture, they should be offered removal of the implants.

We recognise that this remains a very worrying time for all women who have received PIP implants. This report should give them some reassurance that they will not suffer long-term ill effects from their implants and, in particular, that the silicone gel used in PIP implants is not in itself harmful. Nevertheless, our advice remains that if any woman with PIP implants remains concerned she should seek a consultation with her specialist and discuss, in the light of these findings, the best way forward for her. As we made clear in January, the NHS is ready to help and support women in these circumstances. If the implant was originally provided on the NHS, the NHS will remove and replace the implants if a woman and her doctor decide that this is the right course. If the original operation was carried out in the private sector, and the private provider is unwilling or unable to help, the NHS will remove (but not normally replace) the implants.

The report has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed paper Office.

Oral Answers to Questions

Lord Lansley Excerpts

Tuesday 12th June 2012 Commons Chamber

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

17. What progress clinical commissioning groups have made in improving care for patients.

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

This year, developing CCGs have delegated responsibility for more than £30 billion of local commissioning. Clinical leadership is using NHS resources more effectively, as part of improvements in care. In particular, we are seeing many improvements in community-based services—for example, a pulmonary exercise programme in Durham; a community spinal service in Reading; and a new musculoskeletal service in the Vale of York CCG.

[Claire Perry]

I thank the Secretary of State for that reply. During the Easter recess, I helped to organise a number of health question times in my constituency, where we brought together the commissioning groups, doctors, people from acute hospitals and hundreds of interested constituents to talk about how we would improve local health care. The good news was that doctors and clinicians—

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[Claire Perry]

Will the Secretary of State help by telling me how we can communicate out this example so that other MPs can repeat this valuable exercise?

[Mr Lansley]

I am very grateful to my hon. Friend for demonstrating how these new developing relationships that CCGs and local authorities are creating with NHS providers and care providers are delivering improvements in care for the constituents we all represent. I urge other hon. Members to follow her example in stimulating exactly those relationships.

[Nadhim Zahawi]

The CCG covering my constituency is interested in improving patient care by looking at new methods of contracting and management, but it has been told that it must use a clinical support service set up by the primary care trust, staffed by ex-PCT staff and most likely based in Birmingham, rather than south Warwickshire, at a cost of £4 million a year. Could the Secretary of State—

[Nadhim Zahawi]

I apologise, Mr Speaker. Will the Secretary of State confirm that there is no need for the CCG to use such an organisation and that it is free to form its own commissioning structure without incurring redundancy and wind-up costs from the PCT?

[Mr Lansley]

Yes, I can confirm that CCGs have the freedom to decide which commissioning activities they will do themselves and which they choose to secure from external organisations, thus enabling them to carry out their functions effectively. They can, if they wish, develop their own organisations and staff or contract with other organisations, and they are not required to contract with the commissioning support services hosted by the NHS Commissioning Board.

[Derek Twigg (Halton) (Lab)]

In order for the CCGs to be able to carry out and improve their services, they need appropriate funding. Will the Secretary of State therefore tell me why the Halton CCG has had less funding than it was promised originally?

[Mr Lansley]

If the hon. Gentleman is talking about the management budget for CCGs, I can tell him that we set out clearly that it would be up to £25 per head across England, and that is indeed the sum that will be made available.

[Keith Vaz (Leicester East) (Lab)]

Has the Secretary of State seen the letter to The Times this morning from six diabetes experts? What steps are the local groups taking to do more to prevent diabetes?

[Mr Lansley]

Yes, I read that letter this morning. Today, elsewhere in the House, the permanent secretary to my Department and the chief executive of the NHS will give evidence to the Public Accounts Committee on precisely that issue. In the context of doing so, they will demonstrate how we have continued over the past two years to achieve a substantial year-on-year increase in the number of patients with diabetes who are accessing best-practice services.

[Mr Stephen Dorrell (Charnwood) (Con)]

I welcome the successful development of clinical commissioning groups, but does my right hon. Friend agree that their success in refashioning care throughout the whole of the health and social care system will depend on close relationships not just in the health service but across into social care and the world of social housing, too?

[Mr Lansley]

I do believe that and the legislation requires it of clinical commissioning groups and health and wellbeing boards. The relationship being built up between clinical leadership in the NHS and democratic leadership through health and wellbeing boards is an instrumental part of delivering that integrated care.

[Andy Burnham (Leigh) (Lab)]

The year 2011 saw the biggest ever fall in public satisfaction with the national health service. It was also the right hon. Gentleman’s first full year in office. Does he think that those two facts are in any way related?

[Mr Lansley]

No, I do not. The right hon. Gentleman might also care to note that the same survey demonstrated a lower level of satisfaction with the NHS in Wales than in England, but let us leave that to one side.

That survey of 1,000 people asked whether they were satisfied with the way in which the NHS was being run. I was not satisfied. We were in the midst of reform, and we are changing how the NHS is run. Government Members were demonstrating to the public that improvement is necessary and possible in the NHS and that we should not be satisfied with the situation. What is more interesting is that a survey of 70,000 people that we published today demonstrates that 92% of the public—an unprecedentedly high level—who received care from the NHS said that it was good, very good or excellent.

[Andy Burnham]

How out of touch can he get, Mr Speaker? I would have suggested some work shadowing on the NHS front line to get him back in touch, but I forgot that he cannot go into a hospital without a police escort these days. Let me tell him why satisfaction with A and E is down: he lowered the target and missed it repeatedly, leaving nearly a quarter of a million people waiting longer than four hours. Today we have found out why his waiting list statistics do not match people’s real experience: managers are changing clinical criteria and removing people from lists. If he wants to regain people’s trust, why not start today by ordering an immediate inquiry and ending this unacceptable practice of waiting list recategorisation?

[Mr Lansley]

I spend more time in hospitals than the right hon. Gentleman has hot dinners, I suspect—[Interruption.] The weekend before last, I spent two days in hospitals and I did not require any policemen to be there.

Let me make it clear. In A and E, we have 96.6% of patients being seen, treated and discharged within four hours. More to the point, the latest data on A and E show that the average time spent there came down from 57 minutes to 49. On the question of referral to treatment, we inherited more than 209,000 patients across the NHS who were waiting beyond 18 weeks for their treatment. According to the latest data, that figure went down by nearly 50,000. We are delivering for patients better and improving care. I wish the right hon. Gentleman would get on his feet—perhaps he will do it now—thank the NHS and congratulate it on the improving care, rather than trying to find the one thing wrong with it—

[Mr Speaker]

Order. I do not want to be unkind, but every month the Secretary of State’s answers are too long. Perhaps he can make this the first month in which he is rather more economical.

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[Shabana Mahmood (Birmingham, Ladywood) (Lab)]

16. What recent representations he has received on regional pay variation in the NHS.

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

I have not received any such representations. The Government’s evidence to the NHS Pay Review Body shows that market-facing pay has the potential to enable NHS organisations better to achieve their need to recruit and retain staff within the “Agenda for Change” framework for pay. The pay review body will take evidence from all parties and make its recommendations in July.

[Robert Flello]

It can often be harder to work on the NHS front line in more deprived parts of our country, so would the Secretary of State like to join me on a busy Friday night in A and E in Stoke-on-Trent, where he can explain to the staff why their work is worth less than that of someone working in a more affluent part of the country?

[Mr Lansley]

I had the privilege and pleasure of visiting the University hospital of North Staffordshire about eight weeks ago. I very much enjoyed being there, meeting the staff, who I thought were doing a terrific job, and talking in particular to a substantial number of nurses. We did talk about that issue, and implicitly the hon. Gentleman is criticising the existing “Agenda for Change” framework, because there are high-cost areas in some parts of the country. The proposals and my evidence to the NHS pay review body do not recommend cutting anybody’s pay; they suggest that within the “Agenda for Change” framework we should extend high-cost areas.

[Shabana Mahmood]

Will the Secretary of State confirm that highly paid senior managers working in the new bodies established by the NHS reorganisation will be exempt from his plans for regional pay variation? Does he think that that is fair?

[Mr Lansley]

Yes, I do—in the same way as, for example, we are not including doctors and dentists in the same market-facing proposals. The reason why is that they do not work in what are essentially local labour markets; rather, they work in national labour markets.

[John Pugh (Southport) (LD)]

The most recent available statistics show that 50% of public sector jobs outside London were vacant for more than eight weeks, compared with 13% in the private sector. How will lower regional pay improve that situation?

[Mr Lansley]

I simply reiterate to my hon. Friend the point that I have already made. We are not proposing to cut anybody’s pay; we are proposing to give NHS organisations a greater mechanism through the “Agenda for Change” framework so that they can secure the recruitment and retention of staff. That is precisely the issue. Whatever their needs may be in terms of the recruitment and retention of staff, their pay should be better able to adjust to that.

[Ms Margaret Ritchie (South Down) (SDLP)]

Given the extent of social deprivation and the fact that £450 billion will be taken out of the pockets of people in Northern Ireland, particularly those on low incomes, will the Secretary of State confirm that there are no plans to introduce regional pay into the national health service in Northern Ireland during this parliamentary term or in future, as this would have a detrimental impact on the economy?

[Mr Lansley]

Clearly, that is a matter for the devolved Administration in Northern Ireland, not for me.

[Andrew George (St Ives) (LD)]

If, as the Secretary of State says, it is not his intention to see pay cut, does he hope that as a result of this measure lower-paid health workers in poor regions will be paid more?

[Mr Lansley]

At the risk of repetition, let me say that in any part of the country NHS organisations, like organisations in other fields, should have the ability to set pay levels that reflect to a greater extent local labour market conditions and their need to recruit and retain staff. My hon. Friend will recall that a number of south-west trusts are looking at going down the path of setting their own pay arrangements. It was in fact the previous Administration who in 2004, under the “Agenda for Change” pay framework, gave trusts and foundation trusts precisely the freedoms that they are proposing to use, so I cannot understand how Labour Members can possibly object to those freedoms now.

[Mr Jamie Reed (Copeland) (Lab)]

The Secretary of State may wish to call this market-facing pay, but he has rather let the cat out of the bag with his previous answers. In fact, he has proposed lower pay for NHS staff in poor areas—a move that would create a deeply divided, two-tier NHS and undermine the NHS in the communities that need it most. We know that the Secretary of State does not take advice from medical professionals, but will he perhaps take some from one of his own Back-Bench colleagues, the hon. Member for Hexham (Guy Opperman), who said that

“someone working in the NHS in a deprived part of the North East probably deserves more pay, certainly not less, than a nurse in leafy Surrey”?

Will the Secretary of State commit today, yes or no, to withdraw these disastrous proposals?

[Mr Lansley]

If I may say so, I think that the hon. Gentleman wrote his question before he had listened to my earlier answer. I am not proposing to reduce anybody’s pay. It is very simple. The NHS Pay Review Body will have the opportunity to make recommendations. I gave evidence to it on the basis that we should retain a national framework for pay through the “Agenda for Change” framework. However, it is transparently the case that the “Agenda for Change” framework has not thus far enabled NHS organisations, as they say themselves, to adopt a pay structure locally which better reflects the market in which they are employing.

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

8. What steps he is taking to improve the sustainability of NHS trusts.

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

We are working directly with all NHS trusts to enable them to achieve foundation trust status—for the great majority, by April 2014. Achieving foundation trust status means that NHS trusts have achieved high and sustainable levels of clinical quality and financial governance.

[Andrew Jones]

It is possible that North Yorkshire and York primary care trust will this year declare a deficit based on inherited debt from the merger of PCTs several years ago. I am concerned that the new clinical commissioning groups might have to pick up that deficit. Will my right hon. Friend look at all the options to ensure that clinical commissioning groups can be given the best possible start by having a clear balance sheet?

[Mr Lansley]

No primary care trust should plan for a deficit in 2012-13. Primary care trusts carrying legacy debt into 2012-13 must clear it in accordance with the 2012-13 NHS operating framework. As at the end of 2011-12, the primary care trust my hon. Friend mentions had legacy debt that has been managed and absorbed locally by the strategic health authority. As at the end of 2011-12, the PCT is not forecasting any legacy debt.

[Nicholas Soames (Mid Sussex) (Con)]

No-shows and people failing to keep appointments in out-patient departments are costing Brighton and Sussex University Hospitals NHS Trust nearly £6 million a year. Does my right hon. Friend agree that this is extremely selfish, and would he propose sanctions on those who fail to show up for their appointments?

[Mr Lansley]

I am grateful to my right hon. Friend. I have no proposals for sanctions, but I commend to him and his trust the many mechanisms that are available, which they may know about, such as sending text messages to mobile phones. I have seen them in practice, and they do stimulate patients to attend their appointments and so reduce what has been an unacceptable level of non-attendance.

[Andrew Selous (South West Bedfordshire) (Con)]

9. What recent progress the NHS has made in improving outcomes for orthopaedic patients.

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

Substantial progress has been made through innovative approaches and improved risk management, leading to increased survival after fragility fracture, improved trauma care and better governance of hip implants. The latest results to December 2011 show improvements in patient reported outcomes for both hip and knee replacements.

[Andrew Selous]

Does my right hon. Friend share my concern about the significant increase in hip and knee revisions over the past five years or so? Does he support Professor Tim Briggs’ proposals to deal with that in his report, “Getting it right first time”, which is supported by all the professional associations and which NHS London is looking to adopt?

[Mr Lansley]

An increased number of hip and knee revisions is one of the consequences of an ageing population. I welcome Tim Briggs’ report, “Getting it right first time”. His recommendations are sensible. I am pleased to note that it has the support of the British Orthopaedic Association, as well as clinicians in London. It will help us build on the progress that is being made, to which I referred. The latest figures show that the proportion of hip fracture patients who receive all elements of the best practice tariff has risen from 24% in 2010 to 37% in 2011, and to 55% in 2012. That achievement has attracted international interest and is undoubtedly saving lives.

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

10. What improvements in public health outcomes he anticipates by the end of the decade.

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

The responsibility deal has brought together 392 partners, a doubling in number since its launch a year ago. Working together, we have removed artificial trans fats in foods, reduced salt content, put calories on high street menus, improved alcohol labelling, set out ambitious future plans for calorie and alcohol reduction, promoted enhanced physical activity and strengthened employers’ support for health in the workplace. Transparent monitoring and evaluation are vital, and our partners’ assessment of the delivery of their pledges will be published on our website. We are making up to £l million available to fund an independent evaluation of the responsibility deal.

[Nick Smith]

The Mayor of London supports a ban on the sale of mega-sized sugary soft drinks at entertainment venues, which will help fight obesity. Will the Government consider such a measure as part of their nationwide responsibility deal?

[Mr Lansley]

As I said to the hon. Gentleman, as part of the responsibility deal we are considering an ambitious programme of removing 5 billion calories a day from the diet in England. A range of programmes, such as behaviour change programmes and the reduction of saturated fats and sugars in foods by the industry, will make that happen. All those issues will be considered as part of how we can deliver that ambitious programme.

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

22. I congratulate the Secretary of State on yet another initiative that has helped to ensure that patients in England have a better standard of health service than their counterparts in Wales. What is his message to Welsh Members of Parliament who call on him to stop various reforms and expect him to impose the second-class standards of health service that we see in Wales thanks to the Welsh Assembly?

[Mr Speaker]

With reference purely, of course, to the public health responsibility deal.

[Mr Lansley]

Yes indeed. There are serious public health challenges to be faced up to in Wales, and it would be much better if the Labour Government in Wales, instead of cutting the budget by 6.5% as they are planning to do, increased it in real terms as the coalition Government are doing in England.

[Nadine Dorries (Mid Bedfordshire) (Con)]

13. What improvements in health inequalities he anticipates by the end of the decade.

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[Mark Lancaster (Milton Keynes North) (Con)]

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.

[Mark Lancaster]

The strategic health authority has ruled out the locally preferred option for the transformation of community health services in Milton Keynes. Given the Government’s commitment to localism and their preferred approach to the integration of services, will the Secretary of State look at this matter again?

[Mr Lansley]

It is for the primary care trust to appraise the options and decide which is best for local people. The SHA has a role in providing assurance in that process, but I would urge both the PCT and the SHA to ensure that they meet the test that we are looking for, which is that any decision must be in the best clinical interests of patients and must meet the views of clinical commissioners in the future and, indeed, those of the public, not least as expressed through the local authority. I would urge the PCT and the SHA to make progress on that, and, if it would be of any assistance to my hon. Friend, I would be glad if he were able to meet me, the PCT and the local authority to help to resolve the issue.

[Liz Kendall (Leicester West) (Lab)]

In their 2010 NHS White Paper, the Government promised legislation on a new legal and financial framework for social care. However, last month’s Queen’s Speech included only a draft Bill, on social care law alone. We cannot tackle the care crisis without tackling the funding crisis, so will the Secretary of State now agree to Labour’s call for legislation on a new system for funding social care in this Parliament? Yes or no?

[Mr Lansley]

The hon. Lady will know very well that last year we made it clear that we intended to publish both a White Paper on the reform of social care law and, alongside it, a progress report on the reform of the funding of adult care. We still intend to do both those things, and to do so soon.

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[Paul Blomfield (Sheffield Central) (Lab)]

T2. Speaking on 24 April, the Secretary of State indicated that the NHS distribution formula should no longer take account of deprivation. That would have cost Sheffield £73 million a year and benefited Surrey by £400 million. His ministerial colleague, the Minister of State, the right hon. Member for Chelmsford (Mr Burns), seems to have denied that that is the case. Will the Secretary of State therefore confirm that this is the Government’s latest U-turn?

[Mr Lansley]

No, I will do no such thing, because the premise of the hon. Gentleman’s question is completely wrong. I never said any such thing. What I made perfectly clear is that, as has been the case in the past, age will continue to be the principal determinant of health need, and therefore, by extension, that age will be the largest factor in determining the allocation of resources to the NHS. That was true under the last Government; it will continue to be true under this one.

[Dr Sarah Wollaston (Totnes) (Con)]

T5. On 21 June, conscientious, hard-working doctors will be putting their patients before the British Medical Association’s ill-judged call for industrial action. Can the Secretary of State confirm to the House, however, how many surgeries, operations and clinics will be needlessly cancelled, and how much all this will cost the NHS?

[Mr Lansley]

I entirely understand my hon. Friend’s concern, and I applaud the way in which she has expressed it. The BMA’s proposed action could result in up to 30,000 operations being cancelled, as many as 58,000 diagnostic tests being postponed, and more than 200,000 out-patient appointments being rescheduled. I do not think that the House will understand why the BMA would risk patient safety in that way, when it knows perfectly well that its action will have no benefit and that we cannot now go beyond the basis for pension reform that has been agreed with the majority of the NHS trade unions, especially in circumstances in which doctors will continue to receive an extremely generous pension worth up to £68,000 a year at the end of their working lives. I think that the right hon. Member for Leigh (Andy Burnham) and I share the view that this is not a justified position for the NHS to take. The pension is intended to be a generous one. Through the negotiations with the BMA and the other trade unions, we arrived at a very generous pension scheme.

[Bill Esterson (Sefton Central) (Lab)]

T3. Thanks to the staff at St Thomas’ hospital in London, and at Aintree in Liverpool, I have had excellent health care myself in the past three weeks, but, in order to build the morale of staff across the NHS, will the Secretary of State instruct all NHS trusts not to cut anyone’s pay?

[Mr Lansley]

I am glad that the hon. Gentleman has had excellent care; he might like to tell those on his own Front Bench about it, as they are constantly denigrating the NHS. I will simply reiterate what he will have heard me say previously, which is that I have made no proposals to cut anybody’s pay in the NHS.

[Julian Smith (Skipton and Ripon) (Con)]

T6. What progress has been made in discussions with primary care trusts on the transfer of assets to NHS Property Services Ltd?

[Heidi Alexander (Lewisham East) (Lab)]

T7. We have learned today that public satisfaction with the NHS has fallen dramatically. We also know that satisfaction with GP services has fallen for the second consecutive year, and that satisfaction with accident and emergency services is going down by 7% each year. The Prime Minister promised that the NHS would be his priority. Is it not about time that this Government lived up to that promise?

[Mr Lansley]

We have learned no such thing. Indeed, we published on the Department’s website today a survey that asked people who had been looked after by the NHS how well they thought their care had been provided to them. It showed that 92% of the patients said their care had been good, very good or excellent. In my view, that survey of 70,000 patients who had received care from the NHS completely trumps a survey that asked 1,000 people what they might have thought about the NHS in relation to the media activity that took place last year.

[David Mowat (Warrington South) (Con)]

T8. The Cheshire and Merseyside treatment centre has been closed for just over a year, since the private sector contract let by the last Government expired. Can the Minister confirm that the centre is now going to be brought back into the NHS as a fully fledged part of the Warrington and Halton hospitals trust, and will he give me an indication of the time scale involved?

[Rosie Cooper (West Lancashire) (Lab)]

In written responses to questions about clinical commissioning groups, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) incessantly replies—most recently on 18 April—that CCGs do not yet exist, so how can he offer assurances, as he has done today, that any real progress is being made by the CCGs, when they are currently being supported by PCTs? And will he explain his “now you see them, now you don’t” response?

[Mr Lansley]

I will tell the hon. Lady how we can talk about the progress made by CCGs—because we actually go and talk to them. I recall visiting the Blue Coat school in Merseyside a few weeks ago and speaking to the leaders of clinical commissioning groups—from Liverpool, Lancashire, Manchester, Warrington, Knowsley and St Helens—and many of them had 100% delegated responsibility for budgets this year. They explained to me the opportunities they were taking to improve the care of their patients by using that responsibility.

[Mr Douglas Carswell (Clacton) (Con)]

T9. Clacton was promised a new renal unit several years ago. While they are waiting, local people have had to travel long distances for treatment. I am due to meet the commissioning authority to discuss the endless delay. If it fails to make progress soon-ish, could I meet the relevant Minister and his officials to work out what we can do to prod the commissioning authority into getting a move on?

[Mr Lansley]

My hon. Friend will be aware—and, I am sure, will understand and support—the devolution of commissioning responsibilities locally. He is right to pursue the matter in the way he proposes. Over a number of years, including under the previous Administration, efforts were made to secure additional access to dialysis. For a long period, we in this country had lesser access to dialysis than in other countries—particularly when people were not only working but likely to be on holiday. I welcome the point my hon. Friend is pursuing and, when he has had his conversation locally, perhaps he would like to tell me the outcome.

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

The Government blocked Labour’s plans to introduce public health as one of the licensing conditions. I wonder whether, in the spirit of localism, this power should now be given to health and wellbeing boards.

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

May I emphasise to my right hon. Friend the strength of local feeling in Milton Keynes that we should retain our integrated community health service, which has worked incredibly well and provides a good role model for elsewhere in the country?

[Mr Lansley]

I am grateful to my hon. Friend. The four tests for service change that we have set out—I think rightly—are not just about the tests that must be met before changes can be introduced; they also involve the same considerations that should drive the design of services. If local commissioners, the local authority and local people are supportive of a particular form of organisation, including community services, I would hope that that would provide the basis on which the design of services would proceed.

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

Last evening, I attended the launch of UKCK—a group of charities coming together to raise funds to purchase advanced radiotherapy equipment. Will the Minister explain why, despite his previous assurances, regions like the north-east are having to turn to charities to raise funds to buy this potentially life-saving equipment?

[Greg Mulholland (Leeds North West) (LD)]

In an Adjournment debate last year on the safe and sustainable review, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) confirmed the minimum number of operations at 400 a year, saying that it was based on the level of activity needed to provide good quality care around the clock. Does he share my astonishment that the chairman of the joint committee of PCTs has said that he can give no assurance that that will be included in the final review? Does that not undermine this unhappy process?

[Mr Lansley]

My hon. Friend will be aware, as other Members are, that this is an independent review conducted by the joint committee of primary care trusts. On that basis, I will not comment directly on anything said in that context. I simply reiterate what was made clear in last year’s debate that the joint committee will not conduct its review solely on the basis of the options set out in its original consultation.

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

Regarding the answer given to my hon. Friend the Member for Leicester West (Liz Kendall), the Government did not promise to give us a progress report on funding, but to legislate in this Session to reform social care funding. Social care is now widely seen as being in crisis. When will the Secretary of State commit to acting urgently—because urgency is needed now—to tackle this crisis?

[Mr Lansley]

I must correct the hon. Lady. We did not say that we would legislate in the current Session. What we made clear was that we would publish a White Paper—which we will do—and that we would publish a progress report on funding reform. We were also clear—as we still are—about the fact that, as part of the coalition programme, we would act urgently, and we will continue to do so.

[Mr Speaker]

Last but not least, I call Anne McIntosh.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

The Department of Health is to be asked to sign off the business case for the transfer of services from Lambert Memorial community hospital to the new extra care housing scheme—sometimes called an extra sheltered accommodation scheme—in updated community facilities. Will the Secretary of State give me a personal assurance that there will be no sign-off until the future of Thirsk’s community hospital is guaranteed for its current purposes?

[Mr Lansley]

I cannot give my hon. Friend that assurance, not least because such decisions are led locally by local organisations. However, if the tests for service change were not met and the local authority referred the matter to me, I would of course take advice through the independent reconfiguration panel, and consider it in the light of that advice.

Consultation on Shared Decision Making

Lord Lansley Excerpts

Wednesday 23rd May 2012 Written Statements

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

Today I am publishing “Liberating the NHS: No decision about me, without me—Further consultation on proposals to secure shared decision-making”. This publication forms the Government’s response to the “Liberating the NHS: Greater choice and control” consultation.

“Liberating the NHS: No decision about me, without me” sets out detailed proposals to implement the Government’s commitment to giving patients more say over their care and treatment through more choice and control, informed by the consultation process. A further shorter consultation is to be carried out. A small number of focused consultation questions have been included which seek views on whether our proposals are realistic and achievable.

The accompanying document “Liberating the NHS: Greater choice and control—A summary of responses” summarises the large number of comments received during the consultation period. The Government consulted on broad proposals to implement the commitments to give patients and service users more choice and control over their care and treatment and to make the goal of “no decision about me, without me” a reality. The views of patients, the wider public, health care professionals and the NHS were sought on how these plans might best be achieved.

The NHS Future Forum ran a listening exercise between April and May 2011. Its recommendations and the Government’s response to its report have been taken into account when producing our detailed proposals.

The final round of consultation will run for eight weeks. Views from patients, the wider public, organisations, health professionals and the NHS will again be sought.

Copies of the response and the summary or responses have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Health and Social Care (Information Strategy)

Lord Lansley Excerpts

Monday 21st May 2012 Written Statements

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

Today I am publishing “The Power of Information: Putting all of us in control of the health and care information we need”. This information strategy for health and social care in England is our response to “Liberating the NHS: An Information Revolution— A consultation on proposals” which sought views on proposals to transform the way information is collected, analysed, controlled and used in NHS and social care across England and is underpinned by provisions in the Health and Social Care Act 2012.

I am grateful to the many people who provided valuable input into this consultation and to the NHS Future Forum for the excellent work it undertook throughout its listening exercise. Building on the wealth of experience, viewpoints and insights gained through the consultation and the NHS Future Forum’s work, this document sets out the overall ambition and early actions to transform our health and our care services to meet our needs and expectations, for now and the future.



For citizens, patients and users of care services, this strategy sets out how a new approach to information and IT across health and care can lead to more joined up, safer, better care for all. The strategy spans information for patients, service users, carers, clinicians and other care professionals, managers, commissioners, councillors, researchers, and many others.

Unlike previous information strategies, this new information strategy does not reinvent large-scale information systems or set down detailed mechanisms for delivery on a national template. Rather, it provides a 10-year framework and a route map to lead a transformation in the way information is collected and used. It starts from the purposes for which information is required, and the opportunities it offers for quality improvement. It aims to harness information and new technologies to achieve higher quality care and improve outcomes for patients and service users. It enables local leadership and innovation alongside national standards.

There are three key themes in the strategy:

modern, convenient information access—new online services such as booking general practitioner appointments, access to records online, a new integrated national website and 111 phone number;

modern information and technology for professionals—improving safety and quality. Standards ensuring systems can talk to each other, consistent use of the NHS “number”, work to allow new technologies in maternity services, piloting new barcode technology in care homes to improve medication safety and encouraging “clinical portals” for professionals to view records; and

patient and citizen rights—information support as a service, and potential changes to the NHS constitution around right to feedback online, access to records online and support for understanding information.

In summary, this strategy sets out the overall ambition and the early actions that will enable information to transform our health and our care services to meet our needs and expectations, for now and the future.

“The Power of Information: Putting all of us in control of the health and care information we need” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Health Transition Risk Register

Lord Lansley Excerpts

Thursday 10th May 2012 Commons Chamber

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

With permission, Mr Speaker, I would like to make a statement on the publication of the Department of Health’s strategic and transition risk registers. In November 2010 the right hon. Member for Wentworth and Dearne (John Healey) submitted a freedom of information request asking for the publication of the transition risk register relating to the planned Health and Social Care Bill. A similar request by Nic Cecil, a journalist with the Evening Standard, for publication of the Department’s strategic risk register followed in February 2011. The Government refused both requests on the grounds that the risk registers related to the formulation and development of policy and, as set out in the Freedom of Information Act 2000, were not required to be published.

Appeals were then made by the applicants to the Information Commissioner. In both instances, the commissioner ruled against the Government, arguing that the balance of the public interest lay in public disclosure. The Government’s view, to the contrary, is that the public interest is best served in this instance by officials and Ministers being able privately to consider such issues, including any risks. We therefore appealed the commissioner’s decision, under the terms of the Freedom of Information Act, to the first-tier tribunal.

The tribunal was asked to consider whether the Information Commissioner was correct to find that, on balance, the public interest required disclosure of the risk registers. On 5 April this year the tribunal made public the reasons for its decision. For the Department’s strategic risk register it found in favour of the Government and so did not order its disclosure, but it came to the opposite conclusion with regard to the transition risk register.

I have carefully considered the tribunal’s decision and discussed it thoroughly with Cabinet colleagues. Following these discussions, I have decided to exercise the ministerial veto, as allowed by the Freedom of Information Act, in relation to the disclosure of the transition risk register. This decision represents the view of the Cabinet. I have decided to veto rather than appeal the decision to the upper-tier tribunal, because the disagreement is on where the balance of the public interest lies and is a matter of principle and not a matter of law, as would be the focus of any further appeal. I recognise that this is an exceptional step; it is not one that is taken lightly. There is no doubt that reform of the NHS has attracted huge public interest, but my decision to veto, while an exceptional case, is also a matter of wider principle and not just about the specific content of the transition risk register.

In all Departments, Ministers are required to balance the public interest in terms of disclosure with the need properly to consider complex areas of public policy. Good government demands that the analysis and management of risk is thorough and robust, whichever party is in power. It is an essential aspect of good government, in the formulation and development of policy, that officials have a “safe space” within which to formulate sensitive advice to Ministers, that they feel free to use direct language and to make frank assessments, and that the Government should, in exceptional circumstances, be able to reserve such privacy absolutely.

The right hon. Member for Blackburn (Mr Straw) said in his evidence to the Select Committee on Justice last month:

“There has to be a space in which decision makers can think thoughts without the risk of disclosure, and not only of disclosure at the time, but of disclosure afterwards.”

He said also that there have been

“some rather extraordinary decisions by the Freedom of Information Tribunal, in which they suggested that it”—

the exemption—

“can apply only while policy was in the process of development but not at any time thereafter. That is crazy and it is not remotely what was intended.”

The Freedom of Information Act was drafted specifically to allow a safe space for the development of policy, and I have acted throughout in strict accordance with its provisions.

The risk assessment process, carried out by civil servants and detailed in those registers, is an integral part of the formulation and development of Government policy. It is strongly in the public interest that this process be as effective as possible. When the request for the transition risk register was made, many aspects of the policy were still at an early stage of their development: the Command Paper, responding to the consultation, had not been published; and the Bill had not been published. It is therefore incorrect to say that the transition risk register does not relate to the development of policy, because it fed, and continues to feed, directly into the advice given to Ministers.

The Bill may have become an Act in March, but we are still developing policy at the next level of detail. The value of risk registers is directly linked to the form and manner in which they are expressed—with the use of direct language. They do not, however, show the benefits of a policy, and they are not, as impact assessments are, intended to reflect considered calculations of both costs and benefits. They are simply about identifying possible risks in order to stimulate action to mitigate them.

If such registers were disclosed at sensitive times in relation to sensitive issues, as would have happened in the case before us, it is highly likely that they would be open to misinterpretation and misuse, with the impact that future risk registers would become anodyne documents of little use. Potential risks would be more likely to develop without adequate mitigation, and that would be detrimental to good government and very much against the public interest. Reflecting that, a detailed statement of reasons for my decision to exercise the ministerial veto in this case has been laid before Parliament.

This decision to veto the disclosure of the register is not in any way a criticism of the Freedom of Information Act. The Act always envisaged times when the Government would need to protect the process of policy development. This is one of those times. The Government’s right to make just such a veto is written into, and is a proper use of, the Act.

We have always been as open as possible about the risks and issues involved in the modernisation of the NHS. There was the full public consultation, a thorough examination by the NHS Future Forum and 50 days of detailed debate in both Houses, in addition to the detailed risks published in the impact assessment. Very few pieces of legislation have ever received that degree of public and parliamentary scrutiny.

On Tuesday I went further and published a separate document that includes the risk areas covered in the transition risk register, as previously set out not least by my noble Friend Lord Howe in another place on 28 November 2011. That document also includes the actions taken to mitigate those risk areas.

I have also published a “Scheme for Publication”, which sets out our proposals for reviewing and releasing material relating to the transition programme in future. Both documents are available in the Library and on the Department’s website. They further confirm that the purpose of the veto was not in any sense to restrict public access to relevant information, but was to establish that publication of the risk register in December 2010 would have been contrary to the public interest. This Government, more than any before us, are committed to openness and transparency. Across government we publish business plans, departmental staffing and salaries, full details of departmental contracts and summaries of departmental board meetings. In the national health service, we have published more information about services than was ever the case—not only shining a light on poor performance, but helping to root it out. We now publish the NHS atlas of variation, exposing variations in outcomes throughout the country; we have published data on mixed-sex accommodation, leading to a dramatic 95% reduction in breaches; and we have invested in new information collections on A and E performance, on ambulance performance and on clinical audits.

The decision to veto is about long-term principles and good government, not about limiting in any way the scrutiny of NHS reform. Information relating to much of the content of the risk registers is now in the public domain, but the important principle of the right not to publish has been maintained, and I commend this statement to the House.

--- Later in debate ---

[Andy Burnham]

The Deputy Leader of the House said that

“it would also be right to publish as much of what is contained in the risk register as possible”.

He said that this week—that the risk register should have been published. How many more Ministers and coalition MPs do not agree with the Cabinet’s decision?

Most worrying, however, is the confusion over freedom of information policy. The Secretary of State, in his statement earlier this week, said:

“If such risk registers were regularly disclosed, it is likely that their form and content would change”.

But later in the same statement he said that this was an “exceptional case”. Which is it? Do the Government now have a blanket ban on the publication of any risk register, even if ordered to do so by a judge, or was this an exceptional case? If it was the latter, how did it meet the exceptional criteria that Government rules require? We need answers, as again this Government are breaking the precedent set by the last Government. Following a ruling from the Information Commissioner, we released the Heathrow third runway risk register. We never called for the publication of all risk registers, but said that each case should be judged on its merits. Inconveniently for the Minister and the Conservative party, that ruling makes a clear differentiation between the strategic risk register on the one hand and the transition risk register on the other, as I have argued all the way through this discussion.

The Secretary of State’s argument today hinges on the “safe space” argument—he says that if we did not have a safe space, it may change future risk registers. Is he aware that the tribunal considered that point in detail but concluded that there was no evidence presented to us that the release of the Heathrow risk register had a chilling effect on their use by Government? Was the Secretary of State’s argument not tested in court and did it not fail in court? Is he not now showing a blatant disregard for the law? He said today that it “is a matter of principle and not a matter of law”, but it is a matter of principle and of law—freedom of information is the principle and the Freedom of Information Act is the law. He should be following the law that enacts that principle, but he has taken a step away from it today.

The Treasury website still has this statement on risk policy:

“Government will make available its assessments of risks that affect the public, how it has reached its decisions, and how it will handle the risk. It will also do so where the development of new policies poses a potential risk to the public.”

I ask again: if that is no longer the Government’s policy on risk management, when will it be removed from the Treasury’s website?

In conclusion, the Government are in disarray on many fronts. The NHS belongs to the people of this country, not Ministers. If Ministers cannot be open about the risks that they are taking with the NHS, they should not be taking those risks. That is a simple principle.

The truth is that this has been a cowardly decision from a Government on the run who are now too frightened to face up to the consequences of their own incompetence. The real reason for the veto is that publication would have shown that the warnings from doctors, nurses, midwives and patients were echoed in private by civil servants but the Government just ignored them. This is a Cabinet cover-up of epic proportions—a Government closing ranks and covering each other’s backs because they know that the public would never forgive them if they could see the scale of the risks that the Government are taking with the national health service.

[Mr Lansley]

Most of that was synthetic indignation. I am really surprised; the right hon. Gentleman cannot have read any of the review of the risk register that I published on Tuesday. That set out, in detail, all the risk areas carried in the risk register and the mitigating actions that have been taken. There is in no sense any area of risk identified 18 months ago that has not been put into the public domain in a proper form—one that reflects not only the character of those risks, but how those risks have been subsequently addressed.

The right hon. Gentleman is completely confused about the issue. The point of the veto was to confirm that it was not in the public interest for the risk register in December 2010 to be published in relation to the November 2010 document. That point was made very clearly. Acting as we did was not in any sense above the law; it was absolutely in accordance with the law. It is in accordance with the Freedom of Information Act and with the structure of the management of risk. For the further clarification of the House, on Tuesday I published the risk management strategy associated with the transition programme, so the right hon. Gentleman can see that it is exactly in line with how the Government manage such risks.

The right hon. Gentleman asked about our intention to publish the risk register. We will publish it at a point when it would not prejudice the exemption for officials for the formulation and development of policy. There will come a time when it is appropriate to do so, when doing so will not prejudice that exemption under the Freedom of Information Act.

The right hon. Gentleman is completely wrong to suggest that no evidence was presented to the first-tier tribunal relating to the potentially damaging effect of publication under these circumstances. As the former Cabinet Secretary, Lord O’Donnell made those risks very clear to the tribunal. Who is better placed than him to say that? He must know that in another place, during debates on this precise issue of publication and relevance to the legislation, other Cabinet Secretaries and Members clearly stated their view that the publication of the transition risk register would run that risk.

The right hon. Gentleman is speaking directly contrary to his own view. When he was a Minister, he said in relation to a request for publication of a departmental risk register:

“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents.”—[Official Report, 23 March 2007; Vol. 458, c. 1192W.]

He is making an absolutely spurious distinction between the transition register and the strategic register. [Interruption.] It is no good him shouting. The overlap between the two registers and the character of the formulation and development of policy—

[Mr Speaker]

Order. I appeal to the House to calm down. I say to the shadow Secretary of State that he has asked a series of questions and must await the answers. I say to the hon. Member for Islington South and Finsbury (Emily Thornberry), a distinguished practitioner at the Bar, that if she conducted herself in the court room as she has here, the judge would not be amused—and I am sure that she would not do it.

[Mr Lansley]

Thank you, Mr Speaker. Let me be clear. The right hon. Gentleman, as a Minister, refused requests for the publication of risk registers. This risk register, the transition risk register, at the point when it was requested and formulated, was absolutely part of the formulation and development of policy and has continued to be used as part of the development of policy.

To make it clearer what the Labour party actually thinks about the issue, I should say that a Conservative party member recently submitted a request for a risk register to the one place where the Labour Government remain in power—in Wales. What did the Labour Government say? On 12 April 2012, less than a month ago, the Welsh Assembly Labour Government said:

“Release of the risk register would inhibit the way in which such risks are expressed, which potentially makes the management and mitigation of risk more difficult. This in turn would impair the quality of decision making when determining the most appropriate response to an identified risk. Ultimately this could impede the delivery of Ministerial priorities and inhibit the effective management of NHS performance, in both delivery and financial terms.”

That request to a Labour Government for an NHS risk register was turned down for precisely the reasons we have rejected the request for risk registers in relation to the NHS. The Labour party says one thing, but in government it did another and in government in Wales it does another.

Instead of spending his time debating an 18-month-old document—it is now out of date, frankly—the right hon. Gentleman ought to be recognising the reality of what is happening in the NHS. Instead of the risks that he keeps talking about happening, NHS performance is improving, and he should celebrate that. Waiting times are down, there are more diagnostic tests, and waiting times for diagnostic tests have been maintained. There is extra access to dentistry, cancer drugs and new cancer medicines. Health care-acquired infections in the NHS are at their lowest-ever level and the performance of the NHS is continually improving. As shadow Secretary of State, he would be better off celebrating the performance of the NHS than trying to run it down.

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

My right hon. Friend quoted some of the evidence that the Justice Committee is receiving, including very interesting evidence from the right hon. Member for Blackburn (Mr Straw). It would help the Committee if it had an understanding of whether this instance is a special and particular case or whether it is seen by quite a lot of people in the civil service as a test case of whether there really is a safe space in which they can freely advance arguments about risk.

[Mr Lansley]

I am grateful to my right hon. Friend. This case is seen and was judged by me and my colleagues on its particular circumstances; as I made clear, it is an exceptional case. One of the arguments that underlay our decision was necessarily the one about the principle that we were assessing. That principle is very clear: the Freedom of Information Act envisages that there should be an exemption for the formulation and development of policy, and that under those circumstances the public interest in the proper development of policy could outweigh the public interest in disclosure.

In this case, we are very clear—and my colleagues have been very clear—that the risk register, when it was produced, was at that time instrumental to the formulation and development of policy and that therefore the public interest did not require its disclosure.

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

On Tuesday, the Health Secretary said that the veto was justified because the NHS risk register case is exceptional. On Wednesday, Earl Howe, the Health Minister, said:

“This isn’t just about the NHS. The Cabinet collectively took a decision that this was a matter that extended across Government.”

On Tuesday, the Health Secretary said that he was blocking publication, but on Wednesday, the same Health Minister said:

“We have every intention of publishing the risk register”.

This is a conspiracy and a cock-up. Is it not typical of this Government—too incompetent even to organise a decent cover-up?

--- Later in debate ---

[Mr Lansley]

I am afraid that the right hon. Gentleman knows perfectly well that I took the decision to veto the publication of the risk register, in justification of the Government’s view that it should not be disclosed, in December 2010. I am now making it very clear that I have put all the risk areas covered in the risk register in the public domain in the document that sets them out. The issue is not about the publication of the risk register now; it is about whether it was right to refuse its publication in December 2010. He knows perfectly well that that is the question and that is the judgment we made.

[Stephen Barclay (North East Cambridgeshire) (Con)]

If the position of Labour Members is that the ministerial veto should apply only to Cabinet discussions, is it not odd that the legislation they passed does not contain that description? Is it not the case that the right hon. Member for Blackburn (Mr Straw) spoke for the reality of government rather than the opportunism of opposition?

[Mr Lansley]

I am grateful to my hon. Friend. I am sorry that the right hon. Member for Blackburn is not here; I told him that I would quote from his evidence to the Justice Committee. I will therefore not attempt further to interpret what his view might be. I think that what he said to the Justice Committee was consistent with the view that those implementing the FOI Act should bear it in mind that there was an exemption for the formulation and development of policy, as my hon. Friend implies. There was not an exemption for Cabinet collective discussion; there was an exemption for the formulation and development of policy. In each case, we have to weigh the public interest very carefully. Clearly, there will be many circumstances in which the public interest in disclosure outweighs the necessity for there to be a safe space for private discussions about issues of risk. In this case, in December 2010 my colleagues and I were clear that it would have been wholly wrong, and disruptive and damaging, to the policy development process for the document to be published at that time.

[Nic Dakin (Scunthorpe) (Lab)]

What does the Secretary of State so fear about what is in the risk register that he refuses to show it the light of day and defies a tribunal ruling?

[Mr Lansley]

I know that I cannot ask the hon. Gentleman a question, but I wonder whether he has read the document I published on Tuesday about what is in the risk register. I bet he has not.

[Karen Bradley (Staffordshire Moorlands) (Con)]

Has the Secretary of State of State seen any previous risk registers, and does he think that their early publication may have affected the policy development of the previous Government?

[Mr Lansley]

I have seen many risk registers. Of course, I do not have access to the documents of the previous Government, so I cannot judge what the precise circumstances were in which the right hon. Member for Leigh (Andy Burnham) refused to publish a risk register, his predecessor as Secretary of State for Health refused to publish a risk register, or, indeed, the right hon. Member for Wentworth and Dearne (John Healey) refused to publish a risk register when he was a Treasury Minister.

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

In my constituency, the future of our hospital services, especially our accident and emergency service, is deeply uncertain. GP commissioning is colliding with massive cuts to social care budgets, creating considerable uncertainty about how that will pan out. Our ambulance services are being reconfigured—we are losing an ambulance to Salford—and our community services are being broken up and contracted out in penny parcels. Given all this uncertainty as transition begins to take its course in Trafford, what guarantees can the Secretary of State give to my constituents that they will be fully informed of the risks associated with such change when he is setting such a bad example nationally?

[Mr Lansley]

If the hon. Lady had looked at the document I published on Tuesday, she would realise that none of the issues she is talking about—quite properly, on behalf of her constituents—was addressed in November 2010 in the risk register. In so far as there were issues concerning the transition, not only have they been addressed but we have set out how we have mitigated them, with the specific objective of ensuring that during the process of transition there is not only business as usual in the NHS but performance is improved. That is why Labour Members should take on board the point that I made at the end of my response to the right hon. Member for Leigh: the performance of the NHS is improving during this process of transition.

[David Rutley (Macclesfield) (Con)]

Has my right hon. Friend received any representations from Labour Front Benchers about releasing the 2009 risk register, which they refused to publish when they were in office?

[Mr Lansley]

My hon. Friend may be surprised to know that I have received no such representations from Labour Members.

[Yvonne Fovargue (Makerfield) (Lab)]

Is not the real reason the Secretary of State is vetoing publication of the risk register that it shows what the doctors, the nurses and the midwives warned of all along—that this reorganisation is dangerous and reckless, and actually puts patients at risk?

[Mr Lansley]

It does not say that. Before Labour Members get up to read out the Whips’ handouts, why do they not read the document that was published on Tuesday about what is in the risk register and how we have mitigated these risks? The hon. Lady’s point is unjustified, not least as regards nurses, because the general secretary of the Royal College of Nursing, in April 2011 and again in December 2011, sat in my office and told me, “We support the Bill.”

[Damian Hinds (East Hampshire) (Con)]

Will my right hon. Friend detail the changes in Department of Health policy on the publication of risk registers before or since May 2010?

[Mr Lansley]

The Department of Health’s risk management strategy is the same now as it was in 2009 or 2010.

[Alex Cunningham (Stockton North) (Lab)]

The risk register that the Government fear publishing apparently points to potential major failures, including financial ones, in their plan for the NHS. Within weeks of coming to power, the Government ditched Labour plans for a new hospital for my constituents as it was considered too costly or financially risky, yet several hospitals could be built with the money wasted through their reorganisation. When will they recognise that and give their backing to the new financial plan for our hospital?

[Mr Lansley]

The hon. Gentleman knows perfectly well that the reason we refused that support is that his local trust is a foundation trust. It was never contemplated that foundation trusts undertaking major capital projects in excess of £400 million should simply expect the Department to supply a capital grant for that purpose. Without commenting on the merits of the proposal, I think that his trust has since developed new and improved proposals. I am not sure that they have come to me in any sense at this stage, but when they do I will certainly be willing to look at them very carefully with the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns).

[Craig Whittaker (Calder Valley) (Con)]

Will my right hon. Friend tell the House how many times, under the previous Government’s many reforms of the NHS, risk registers were routinely published as a matter of course?

[Mr Lansley]

rose—

[Mr Speaker]

Order. The difficulty with that question, although I am sure that it was sincerely intended, is that it relates to the policies of a previous Administration, for which of course the Secretary of State has no responsibility.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

Should the Information Commissioner and the tribunal decide to approve the release of other risk registers, be it those that cover other work by his Department or the work of other Departments, such as the Work programme, has the Cabinet already decided also to veto their release?

[Mr Lansley]

No. The hon. Gentleman should know that in accordance with the FOI Act, if a ministerial veto were to be considered, it would be considered on the merits of any individual case.

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

Will my right hon. Friend confirm that he has followed the policy laid down by the previous Government on the application of the Act and that nothing has changed in that respect in policy terms?

[Mr Lansley]

Of course, Mr Speaker, I cannot comment on the policies of the previous Labour Government. I would be happy, if the right hon. Member for Leigh agrees, to publish the risk management strategy that the Department of Health had in place in 2009, which was not placed in the public domain at that time.

[Derek Twigg (Halton) (Lab)]

It is no surprise that the Secretary of State is running scared of publishing the risk register, because, as the House should not forget, an awful lot of measures now come through secondary legislation because the Government left a lot of detail out of the Health and Social Care Bill. In his statement—this is not from a Whips’ spreadsheet, let me add—he said: “If such registers were disclosed at sensitive times in relation to sensitive issues, as would have happened in the case before us, it is highly likely that they would be open to misinterpretation and misuse”. At what point does he think that there will cease to be “sensitive times”, and will he publish before the next general election?

[Mr Lansley]

I will repeat what my noble Friend Earl Howe said: we have every intention of publishing the risk register, but will do so when it is no longer directly relevant to the formulation and development of policy.

[Bob Blackman (Harrow East) (Con)]

Having been involved in the production of risk registers for many years, I know that they are pertinent to the point in time at which they are produced and require free thinking by those who put them together. There must then be a mitigation strategy to prevent the risks from ever happening. The key issue is this: what does my right hon. Friend think would happen to the policy advisers who put together risk registers for Ministers if these highly sensitive documents were put in the public domain?

[Mr Lansley]

I am grateful to my hon. Friend. To be absolutely clear, some risk registers are designed to be published. For example, strategic health authorities publish risk registers, and have done for a period of time, because they are designed to be published. The way in which the Labour party used the risk registers published by strategic health authorities, I think at the last Health questions, amply demonstrated that not only are they open to misrepresentation and misuse, but that the Labour party is very keen to misuse and misrepresent them. Even more so would it misrepresent and abuse the information in risk registers that were designed for the frank expression of advice if they were published. I do not need to speculate further in reply to my hon. Friend, because Lord O’Donnell, the former Cabinet Secretary, made it very clear that we would end up with bland, anodyne documents that did not serve the management purpose for which they were created.

[Bob Stewart (Beckenham) (Con)]

May I follow up the point made by my hon. Friend the Member for Harrow East (Bob Blackman)? If civil servants did not trust that what they said to Ministers was said in confidence, we would get poor advice. Some things must remain confidential until the time is right for their publication. Does my right hon. Friend agree with that?

[Mr Lansley]

I am grateful to my hon. Friend, and I do agree with him. The Freedom of Information Act recognises explicitly that what he says is true, and that a judgment should therefore be made by Ministers about where the balance of public interest lies. That is what we have done.

Bills Presented

Electoral Registration and Administration Bill

Presentation and First Reading (Standing Order No. 57)

The Deputy Prime Minister, supported by the Prime Minister, Mr Chancellor of the Exchequer, Mr Secretary Kenneth Clarke, Mr Secretary Moore, Mr Mark Harper and Mr David Heath, presented a Bill to make provision about the registration of electors and the administration and conduct of elections.

Bill read the First time; to be read a Second time on Monday 14 May, and to be printed (Bill 6) with explanatory notes (Bill 6-EN).

Civil Aviation Bill

Presentation and resumption of proceedings (Standing Order No. 80A)

Mrs Theresa Villiers, supported by the Prime Minister, the Deputy Prime Minister, Mr Secretary Hague, Mr Chancellor of the Exchequer, Mrs Secretary May, Secretary Vince Cable, Secretary Justine Greening, Mr Secretary Paterson, Secretary Michael Moore, Mrs Secretary Gillan and Mr Francis Maude, presented a Bill to make provision about the regulation of operators of dominant airports; to confer functions on the Civil Aviation Authority under competition legislation in relation to services provided at airports; to make provision about airport security; to make provision about the regulation of provision of flight accommodation; to make further provision about the Civil Aviation Authority’s membership, administration and functions in relation to enforcement, regulatory burdens and the provision of information relating to aviation; and for connected purposes.

Bill read the First and Second time without Question put (Standing Order No. 80A and Order, 30 January); to be read the Third time on Monday 14 May, and to be printed (Bill 3) with explanatory notes (Bill 3-EN).

Defamation Bill

Presentation and First Reading (Standing Order No. 57),

Mr Secretary Kenneth Clarke, the Prime Minister, the Deputy Prime Minister, Mr David Willetts, Mr Edward Vaizey and Mr Jonathan Djanogly, presented a Bill to amend the law of defamation.

Bill read the First time; to be read a Second time on Monday 14 May, and to be printed (Bill 5) with explanatory notes (Bill 5-EN).

Finance Bill

Presentation and resumption of proceedings (Standing Order No. 80B)

Mr Chancellor of the Exchequer, the Prime Minister, the Deputy Prime Minister, Secretary Vince Cable, Mr Secretary Duncan Smith, Mr Secretary Davey, Danny Alexander, Mr Mark Hoban, Mr David Gauke and Miss Chloe Smith, presented a Bill to grant certain duties, and to amend the law relating to the National Debt and the Public Revenue, and to make further provision in connection with finance.

Bill read the First and Second time, clauses 1, 4, 8, 189 and 209 and schedules 1, 23 and 33 as reported from a Committee of the whole House were laid upon the Table without Question put, and the Bill stood committed to a Public Bill Committee in respect of clauses 7, 9 to 188, 190 to 208 and 210 to 227 and schedules 2 to 22, 24 to 32 and 34 to 38 (Standing Order No. 80B and Order, 16 April); and to be printed (Bill 1).

Financial Services Bill

Presentation and resumption of proceedings (Standing Order No. 80A)

Mr Chancellor of the Exchequer, the Prime Minister, the Deputy Prime Minister, Secretary Vince Cable, Danny Alexander, Mr Mark Hoban, Mr David Gauke, Miss Chloe Smith and Norman Lamb, presented a Bill to amend the Bank of England Act 1998, the Financial Services and Markets Act 2000 and the Banking Act 2009; to make other provision about the exercise of certain statutory functions relating to building societies, friendly societies and other mutual societies; to amend section 785 of the Companies Act 2006; to make provision enabling the Director of Savings to provide services to other public bodies; and for connected purposes.

Bill read the First and Second time without Question put (Standing Order No 80A) and Order, 6 February); to be further considered on Monday 14 May, and to be printed (Bill 2) with explanatory notes (Bill 2-EN).

Local Government Finance Bill

Presentation and resumption of proceedings (Standing Order No. 80A)

Mr Secretary Pickles, the Prime Minister, the Deputy Prime Minister, Mr Chancellor of the Exchequer, Secretary Vince Cable, Danny Alexander, Mr Oliver Letwin, Andrew Stunell, Robert Neill and Mr David Jones, presented a Bill to make provision about non-domestic rating; to make provision about grants to local authorities; to make provision about council tax; and for connected purposes.

Bill read the First and Second time without Question put (Standing Order No. 80A and Order, 10 January); to be considered on Monday 14 May, and to be printed (Bill 4) with explanatory notes (Bill 4-EN).

Consultation on Standardised Packaging of Tobacco Products

Lord Lansley Excerpts

Monday 16th April 2012 Written Statements

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

The Government have today published a consultation on the standardised packaging of tobacco products. The consultation is being undertaken, with the agreement of the devolved Administrations, on a UK-wide basis.

In March 2011, the Government published “Healthy Lives, Healthy People: A Tobacco Control Plan for England” which set out how our comprehensive, evidence-based programme of tobacco control will be delivered, within the context of the new public health system, over the next five years. The tobacco control plan included a commitment to consult on options to reduce the promotional impact of tobacco packaging, including standardised packaging.

Smoking remains one of the most significant challenges to public health across the United Kingdom and is the primary cause of preventable death, accounting each year for over 100,000 deaths in the United Kingdom. One in two long-term smokers will die prematurely from a smoking disease. Smoking harms those around smokers too. The Royal College of Physicians estimate that about 2 million children currently live in a household where they are exposed to cigarette smoke.

Treating smoking diseases is costly. In England, around 5% of all hospital admissions among adults aged 35 and over are attributable to smoking.

Reducing the uptake of smoking by children and young people is a key public health goal. Most smokers take up smoking regularly before they turn 18 years old. In England alone, an estimated 330,000 young people under the age of 16 try smoking for the first time each year.

Most smokers say they want to quit. Quitting smoking can be difficult, but smokers who quit for good can quickly reduce their risk of smoking diseases and live longer, whatever their age.

The United Kingdom is recognised across the world for having comprehensive, evidence-based tobacco control policies. But we need to do more to stop young people taking up smoking and to help those smokers who want to quit.

Health and well-being in our communities would be significantly improved in the long term if smoking rates were substantially reduced. Between 2007 and 2010, the rates of smoking in England remained static. While smoking rates have more recently started to decline again, we need to secure significant further reductions if we are to meet the national ambitions we set out in “Healthy Lives, Healthy People: A Tobacco Control Plan for England”.

Standardised packaging for tobacco refers to measures that may be taken to restrict or prohibit the use of logos, colours, brand images or promotional information on packaging other than brand names and product names that are displayed in a standard colour and font style. Standardised packaging is sometimes referred to as “plain packaging”.

The Government have an open mind at this stage about introducing standardised packaging. Through the consultation, we want to understand whether there is evidence to demonstrate that the standardised packaging of tobacco products would have an additional public health benefit, over and above existing tobacco control initiatives. The consultation asks whether standardised packaging could improve public health by:

reducing the appeal of tobacco products to consumers;

increasing the effectiveness of health warnings on the packaging of tobacco products;

reducing the ability of tobacco packaging to mislead consumers about the harmful effects of smoking; and

having a positive effect on smoking-related attitudes, beliefs, intentions and behaviours, particularly among children and young people.

Through the consultation, we are also interested in exploring whether there might be other implications if standardised packaging requirements were introduced, including any potential effect on the illicit tobacco market.



The consultation will be open for responses from 16 April to 10 July 2012. Any person, business or organisation with an interest is encouraged to respond.

Consultation on the standardised packaging of tobacco products has been placed in the Library. Copies are available to hon. Members from the Vote Office and noble Lords from the Printed Paper Office .The consultation document is available from and consultation responses can be submitted online at: http://consultations.dh.gov.uk.

Any decisions to take further policy action on tobacco packaging will be taken only after full consideration is given to consultation responses, evidence and other relevant information.

Oral Answers to Questions

Lord Lansley Excerpts

Tuesday 27th March 2012 Commons Chamber

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

1. What plans he has to improve individual choice and standards for end-of-life care.

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

We are developing a new patient funding system for all providers of palliative care. It will be fair and transparent and deliver better outcomes for patients and better value for the NHS. Just last week, I announced that we are investing £1.8 million in eight pilot sites to help us in that work. Marie Curie Cancer Care is also providing £2.5 million of funding to support those pilots. The new system will be in place by 2015.

[Andrew Bridgen]

I thank the Secretary of State. Does he agree that current state funding for end-of-life and palliative care provision is at best patchy across the country and needs to be improved? Will he outline the role that he sees for voluntary and charitable organisations in the delivery of improved palliative and end-of-life care in future?

[Mr Lansley]

My hon. Friend will know very well of the vital role that the voluntary sector already plays, whether through the hospice movement or through Marie Curie and other voluntary organisations. As he implies, we not only want to secure more consistent, high-quality end-of-life care, to which effect we are already implementing the end-of-life care strategy and the National Institute for Health and Clinical Excellence quality standard for end-of-life care, but through the implementation of the palliative care funding review pilot schemes we want to ensure that the voluntary sector and other providers are equally able to provide the services that patients and their families desire.

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

For both end-of-life care and social care more generally, the Budget was a real missed opportunity, in that the Government did not signal what they were going to do about the future funding of social care. Will the Secretary of State now update us on the discussions that he has had with the Treasury about what will be done about the gap in the future funding of social care?

[Mr Lansley]

On the contrary, the Chancellor set out very clearly his intention that a White Paper on the reform of social care would be published in the spring. The hon. Lady may wish to know that we are in direct discussions with the Opposition to seek consensus about the long-term reform of social care funding.

[Mr David Crausby (Bolton North East) (Lab)]

2. What his most recent estimate is of the cost of NHS reorganisation.

--- Later in debate ---

[Ian Lucas (Wrexham) (Lab)]

4. What discussions he has had with Ministers in the Welsh Government on the treatment by the NHS of patients with defective breast implants.

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

My officials have kept colleagues in the Welsh Government closely informed about the advice of Sir Bruce Keogh’s expert group and about our plans for the NHS treatment of patients with PIP breast implants.

[Ian Lucas]

The Secretary of State has said that private providers have a moral duty to replace faulty implants for free. Will he tell the House how many private providers have carried out that moral duty?

[Mr Lansley]

I will write to the hon. Gentleman with the latest figures and place a copy of the letter in the Library. Overall, however, I am aware of 5,232 referrals to private providers, as a result of which 2,704 scans have been conducted. Consequently, the decision to explant breast implants has been taken in 298 cases. Some 75 such operations have been completed.

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[Guy Opperman (Hexham) (Con)]

8. What his policy is on the rationalisation of PFI deals in the north-east for the purposes of making savings on long-standing PFI hospitals; and if he will make a statement. [R]

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

Any plan to rationalise a PFI contract, such as that being considered by Northumbria Healthcare NHS Foundation Trust, would be a local decision. Any trust will need to satisfy itself of the value for money of any proposal. Northumbria Healthcare is a foundation trust, so Monitor is also considering its plans.

[Guy Opperman]

Many hospitals around the country are struggling under PFI debt. What plans does the Secretary of State have to ensure that other types of organisations, aside from Northumbria NHS Foundation Trust, will benefit from the new deal, just as my constituents in Hexham are?

[Mr Lansley]

I am grateful to my hon. Friend. We have recently made it clear that where there is unsustainable PFI debt—as is the case for seven PFI contracts—we stand ready to support those trusts in meeting some of those costs, which we inherited from the last Government. Beyond that, working with the Treasury, we have undertaken a pilot project that has demonstrated how 5%, on average, can be taken out of the cost of PFI contracts through the better management of them. I hope that will be applied across the country. I welcome, as I know my hon. Friend does, the way in which Northumbria Healthcare, with its local authorities, is looking at resolving its PFI debts, and if that represents value for money, I am sure that others across the country will benefit from the experience.

[Stephen Barclay (North East Cambridgeshire) (Con)]

9. What steps his Department is taking to develop more effective performance management of GPs.

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[Miss Anne McIntosh (Thirsk and Malton) (Con)]

11. What recent representations he has received on the 111 pilot telephone service; and if he will make a statement.

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

I have received representations from the British Medical Association and the NHS Alliance, both of which support the NHS 111 model, requesting an extension of the roll-out deadline of April 2013. I am actively considering that, and will be discussing it with the clinical commissioning groups who are leading the development of NHS 111 in their areas.

[Miss McIntosh]

Will the Secretary of State accept representations from me? I have used the 111 service on behalf of a family member, and I know that it is not working as well as it might, which is quite distressing. The call time and the script do not allow a person receiving a particular type of care to be fast-tracked to a clinician. I believe that there is a case for delaying its roll-out, and that the service would be infinitely better if the Secretary of State took my representations on board.

[Mr Lansley]

I will of course accept representations from my hon. Friend and, indeed, from anyone else. Pilot schemes are under way in County Durham and Darlington and in Nottingham, Lincolnshire and Luton. The system is also live in Derbyshire, the Isle of Wight, Cumbria, parts of Lancashire and parts of London. An evaluation will be published shortly by the university of Sheffield, but an interim evaluation suggested that 93% of patients were pleased with the service that they had received, and, most important, 84% felt that it had delivered them to the right place first time.

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

Will the Secretary of State confirm the provision in regulation, reinforced by his new guidance, that no GPs should use 0844 numbers for their surgeries? Some patients are having to pay over the odds to contact their GPs.

[Mr Lansley]

We have made it very clear that GPs should not be using 0844 numbers for that purpose and charging patients for them. One of the benefits of NHS 111 is that it will be a free service for patients, and will give them an opportunity to gain access to integrated urgent care wherever they are in the country. That is why we want to roll it out as soon as we can.

[John Pugh (Southport) (LD)]

Given the importance of 111 contracts, should we not delay assigning them until the clinical commissioning groups are properly in place?

[Mr Lansley]

My hon. Friend will recall from my first answer that I am looking to discuss the timing of the roll-out with clinical commissioning groups. I do not want that to be unduly delayed, because there are clear benefits to patients in the 111 system in that it gives them a more integrated single point of access to the NHS.

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

12. If he will introduce proposals to require a minimum ratio of nurses to patients in hospitals.

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[Greg Mulholland (Leeds North West) (LD)]

14. What recent progress he has made on the review of adult congenital cardiac services.

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

The review of adult congenital heart services is a clinically-led NHS review, independent of Government. I understand that an expert advisory group has been established and its first task will be to develop designation standards and a model of care that commissioners can use to help determine the future pattern of services.

[Greg Mulholland]

I thank the Secretary of State for that answer, but adult cardiac patients in Yorkshire are both disfranchised and extremely worried because of the review of the children’s heart unit, as if it is closed, they, too, would lose access to surgeons. Does the Secretary of State agree that it does not make sense to have two separate reviews, and that they should instead be brought together?

[Mr Lansley]

My hon. Friend will know that no decision has yet been taken on the location of children’s or adult congenital heart surgery centres in England. Neither the draft adult clinical standards nor the proposed standards for children’s services require services for children and adults to be collocated.

[Nic Dakin (Scunthorpe) (Lab)]

Will the Secretary of State ensure that the relationship between adult and children’s cardiac services is properly considered as part of the review?

[Mr Lansley]

On both children’s and adult congenital heart services, all relevant clinical factors should be taken into account in the review, but I reiterate the point that I made to my hon. Friend the Member for Leeds North West (Greg Mulholland): the standards for those services do not require children’s and adult services to be collocated.

[Neil Carmichael (Stroud) (Con)]

15. What assessment he has made of the provision of vision screening for children.

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[Jo Swinson (East Dunbartonshire) (LD)]

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.

[Jo Swinson]

An estimated 50,000 people, mostly men, are misusing anabolic steroids to build muscle, which can result in liver cancer, depression, a damaged immune system, kidney problems and cardiovascular disease. Will the Secretary of State examine the public health implications of the 56% rise in steroid misuse over five years? Will he work to address its causes, such as body image anxiety, as well as just treating the problem?

[Mr Lansley]

I am grateful to my hon. Friend for making a good and important point. My right hon. Friend the Home Secretary will be subjecting these drugs to greater control under the Misuse of Drugs Act 1971, restricting their illegal import into this country. Controlling supply is one part of the effort. Prevention is also important; people need to be fully aware of the risks to their health. The FRANK service, which provides advice to young people and parents about drugs misuse, will make it clear that the misuse of steroids is dangerous. I would encourage local areas to work with local businesses, such as gyms and fitness centres, to publicise those risks.

[Nick Smith (Blaenau Gwent) (Lab)]

T2. The Department’s latest estimate shows that alcohol misuse costs the NHS £3.5 billion every year. Will the Secretary of State now champion a 50p minimum unit price? That would save more than 3,000 lives a year, rather than 1,000 a year, which is what his public health responsibility deal is expected to secure.

[Mr Lansley]

The hon. Gentleman should have welcomed the alcohol strategy that my right hon. Friend the Home Secretary published last Friday. Not only did we see the Government’s intention to introduce a unit price, but on that day 35 business organisations across the country collectively, under the responsibility deal, pledged themselves to take 1 billion units of alcohol out of the UK market in the course of a year.

[Simon Wright (Norwich South) (LD)]

T7. Many hospitals, including the Norfolk and Norwich university hospital, have reported a dramatic increase in alcohol-related admissions over the past 10 years, so I welcome the latest alcohol strategy. But what steps is the Secretary of State taking to support the expansion of treatment and early interventions for dependent and harmful drinkers in Norfolk and elsewhere?

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

T3. We now know that the Conservatives have received more than £8 million in donations from private health care companies since 2001. This goes beyond simply cash for access to a much more sinister issue of cash for policy influence. Ministers have said that they do not expect any increase in private sector provision in the NHS, but how will this be measured in years to come?

[Mr Lansley]

Nobody buys influence over the policy of the Conservative party or the coalition Government. That is in complete contrast to the situation with the right hon. Member for Leigh (Andy Burnham) and his friends on the Opposition Front Bench, who are the wholly owned subsidiaries of the trade unions.

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

T4. At a time of major upheaval in the national health service, the people of west Lancashire and other areas of Lancashire are being failed by the chief executive of the Lancashire primary care trust cluster. Living in Yorkshire and working from Lancaster, Janet Soo-Chung has failed to meet with me or other colleagues, including my hon. Friend the Member for Chorley (Mr Hoyle). Can the Secretary of State assure me that the necessary time and development is being invested in health services in west Lancashire to ensure that authorisation takes place in a timely way without conditions and that the health services provided to my constituents are good?

[Mr Lansley]

I will, of course, ask Janet if she will meet the hon. Lady and her colleagues, but I think the hon. Lady might have noted that the NHS is performing magnificently. The quarter document published just this morning gives details of 14 performance measures across the NHS, in five of which performance has been maintained and in nine of which there has been improvement, so there has been no deterioration in performance. When the hon. Lady gets to her feet she should say to the NHS, “Well done for improving performance.”

[Stuart Andrew (Pudsey) (Con)]

Currently, there is a review into paediatric cardiac services going on. I recognise that that is independent of Government, but we now have the independent analysis of patient flows, which says exactly what we have been saying—that patients in south and west Yorkshire will not go to Newcastle. Does my right hon. Friend agree that this is an important development and that the options should reflect that because this is a serious problem for heart services in the north of England?

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[Andrew George (St Ives) (LD)]

What reassurance can the Secretary of State give to Members of Parliament representing areas that have received an allocation from the formula which has been significantly below their target, given the change in arrangements to clinical commissioning groups in future?

[Mr Lansley]

My hon. Friend will be aware that the distance from target on the existing formula for Cornwall in particular has narrowed and is only just over 2%. For the future, I hope that he and all hon. Members will take considerable reassurance from the fact that not only will the formula continue to be the subject of independent advice, but new statutory provisions will set out that it should be intended to reflect the prospective burden of disease in each area, so it should be matched as closely as possible to the need for services in each area.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

T6. The Government say that clinicians understand patients best, but there are doctors in Walthamstow who will not provide contraceptives to local women, and we now have one of the highest rates of teen pregnancy and repeat abortions in the country. Will the Ministers agree to meet women from my constituency and help them understand who, under the new system and the new layers of bureaucracy, they can hold to account for these problems—yes or no?

[Mr Lansley]

The hon. Lady should first have expressed a welcome for the fact that there has been a further reduction overall in the numbers of teenage pregnancies. As she knows, in her constituency there are doctors who, as she says, do not provide contraceptives, but there are also many other practices that do—17 out 18 GP practices in Walthamstow provide contraceptive services. There was a 60% increase in a decade in the number of managers in her area and the result seems to be that she does not understand how services were managed in Walthamstow. Under local authorities and the clinical commissioning groups in the future, there will be a clearer system.

[Mr Speaker]

No one could accuse the Secretary of State of being other than comprehensive. We are grateful to him.

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[Bill Esterson (Sefton Central) (Lab)]

One NHS consultant told me that

“NHS reorganisation could mean that you are forced to spend around 10% of your income on private health care insurance.”

Does the Secretary of State accept that the doctor is right to say that people will either wait longer for care or they will have to pay for it?

[Mr Lansley]

That is complete rubbish. The legislation is absolutely clear that it does not lead to privatisation, it does not promote privatisation, it does not permit privatisation and it does not allow any increase in charges in the NHS. It simply creates a level playing field so that NHS providers will not be disadvantaged compared to the private sector, as they were under a Labour Government.

[Steve Baker (Wycombe) (Con)]

The present Wycombe hospital consultation has proceeded with a number of hiccups, not least because of the false sense of local accountability engendered by Labour’s top-down system of health management. Will the Secretary of State meet me and a small delegation of my constituents to discuss how things will improve under his reforms?

[Mr Lansley]

Of course. I will be glad to meet my hon. Friend and his constituents. I recall how he has been an advocate on their behalf in the past and a vocal advocate of services in Wycombe. I emphasise to my hon. Friend that we are looking towards not only the clinical commissioning groups, but the local authorities injecting further democratic accountability so that in his constituency and those across the country we see much greater local ownership and accountability for the design of services.

[Mark Durkan (Foyle) (SDLP)]

The Chancellor’s evidence to the independent pay review body chairs last week contained curious if not dubious references to nursing pay and non-nursing pay, and possible outcome linkages of those. Does the Secretary of State understand those and can he explain them?

[Mr Lansley]

The hon. Gentleman will know that we have asked the pay review bodies to look at the aspects of pay related to market conditions, and I do not want to prejudice that. They will come back with their advice on that.

[Mark Menzies (Fylde) (Con)]

I welcome the Prime Minister’s announcement yesterday on dementia care. What assurances can the Secretary of State give me that this will be an aggressive strategy, looking at matters such as new access to drugs, early diagnosis and support for carers of those with dementia?

[Mr Lansley]

Not only were there the announcements made yesterday, but as part of that there was the establishment of three sets of champions, including Angela Rippon and Jeremy Hughes from the Alzheimer’s Society, working together as champions to raise awareness and understanding, Ian Carruthers and Sarah Pickup as champions on improving treatment and care, and Dame Sally Davies, the chief medical officer, and Mark Walport from the Wellcome Trust, as champions for research. Their objective is specifically, as the Prime Minister told them, to hold our feet to the fire, not only for the ambitions we set out yesterday, but for going further and faster.

[Simon Danczuk (Rochdale) (Lab)]

On 24 February, my constituent, Audrey Kay, died after a litany of poor treatment. Will the Minister meet her son and me to hear Audrey’s treatment story?

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[Valerie Vaz (Walsall South) (Lab)]

One year on, are the pledges under the responsibility deal working?

[Mr Lansley]

One year on in the responsibility deal we are seeing successes, including the elimination of artificial trans fats, further reductions in salt in manufactured foods, and over 8,000 high street outlets sharing and showing calorie information. The monitoring and evaluation of the deal is vital. We are committed to this and we are making up to £1 million available to fund an independent evaluation.

[Several hon. Members]

rose—