Health and Social Care (Information Strategy)
Lord Lansley Excerpts(12 years, 7 months ago)
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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(12 years, 7 months ago)
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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.
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?
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 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(12 years, 8 months ago)
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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(12 years, 9 months ago)
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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.
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.
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.
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.
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.
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.
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.
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?
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.
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?
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.
Dementia
Lord Lansley Excerpts(12 years, 9 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
Today, the Prime Minister launches his challenge on dementia to tackle one of the most important issues we face arising from an ageing population. The challenge sets out the Government’s ambition to increase diagnosis rates, raise awareness and understanding and to strengthen substantially our research efforts.
Dementia is one of the biggest challenges we face as a society and we are determined to transform the quality of dementia care for patients and their families. In England today an estimated 670,000 people are living with dementia, a number that is increasing with one in three people set to develop dementia in the future.
England was one of the first countries in the world to have a national dementia strategy and progress has been made since the launch of the strategy in 2009. But we are determined to do more to address this challenge.
The Prime Minister’s challenge sets out three key areas where we want to go further and faster, building on the progress made through the national dementia strategy. The three areas are:
driving improvements in health and care;
creating dementia-friendly communities that understand how to help; and
better research.
We know that we need to do more to raise diagnosis rates for people with dementia, with an estimated 42% of people with dementia currently having a diagnosis. Only when the condition is diagnosed can people and their families and carers get the support they need to help them. As well as when they normally see their general practitioner, the five-yearly NHS health check will be also used as an opportunity to identify risk factors for dementia such as hypertension, alcohol and obesity. Over 65 year olds will also be made aware of memory services and those at risk will be referred on.
We are also making sure that the NHS has the right incentives to identify signs of dementia when people are in hospital. From April 2012, £54 million will be made available through the dementia commissioning for quality and innovation to NHS hospitals in England for those who assess over 75 year olds admitted to hospital to check for signs of dementia. From April 2013, we will build on that incentive so that hospitals are rewarded for demonstrating good quality care for people with dementia.
The Government will also take further steps on research. The United Kingdom is world renowned for dementia research, but we still do not know enough about this devastating condition and the level of public participation in dementia research trials remains low. The funding for research into dementia and neurodegenerative disease will double to over £66 million by 2014-15 (compared to 2009-10). The Medical Research Council will be making major funding available for BioBank with a view to scanning the brains of 50,000 to 100,000 participants. This will build a world-leading resource for research into dementia and other neurodegenerative diseases. We also want to see more people with dementia taking part in research. Inviting patients to participate in research will become part of a quality marker for memory clinics.
Finally, the challenge of dementia is not one for Government alone, but for all society. We want to develop awareness and understanding, and tackle stigma, so that all parts of society can contribute. The Government will continue to fund awareness campaigns for dementia and by 2015 the aim is to have at least 20 cities, towns and villages working together as dementia-friendly communities, where local businesses, organisations and individuals come together to support people to live well with dementia, helping them remain independent for longer.
Three champion groups will be convened to bring together the leading organisations and groups with an interest in dementia to support the delivery of the Prime Minister’s challenge. The champion groups will report on progress to Department of Health Ministers who will report to the Prime Minister in September 2012.
“The Prime Minister’s challenge on dementia” 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.
I will update the House on progress in due course.
Abortion Act 1967
Lord Lansley Excerpts(12 years, 9 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
There have recently been a number of serious allegations involving potential breaches of the Abortion Act 1967. The Metropolitan Police, Greater Manchester Police and the West Midlands Police, the Care Quality Commission (CQC), the General Medical Council (GMC) and the Nursing and Midwifery Council (NMC) are investigating the allegations into sex-selection at a number of abortion services. The chief medical officer has written to all abortion providers reminding them of their duties under the Abortion Act. The GMC interim orders panel has suspended or placed restrictions on the three doctors named in the press reports. Decisions on the registration and approval of the clinics are awaiting the investigations by the CQC and Department of Health officials into compliance with the Act and registration requirements.
Registration inspections by CQC in February also identified cases where doctors had signed the required certificate of the ground for the abortion (HSA1 forms) before the woman had been seen in the clinic. The Act requires two doctors to certify that at least one (and the same) ground for abortion exists in relation to a specific woman. The pre-signing of these forms is potentially a criminal offence and is being investigated by the CQC and the police and may lead to further referrals to the GMC or NMC.
In the light of the serious nature of these allegations, CQC are this week conducting a series of unannounced inspections of all abortion providers. Any evidence of failure to comply with the Act and registration requirements will be investigated by CQC, the police and other regulatory bodies. I will consider withdrawing an independent abortion provider’s approval to conduct abortions if the requirements of the Act are not being met. Any provider’s registration to carry out termination of pregnancy may also be suspended or cancelled by the CQC. I will provide further final details of actions taken when the initial investigations are complete.
In addition, my officials will work with the CQC and other regulatory bodies to examine compliance with the Act and relevant statutory and professional requirements in order to inform the planned revision of the Procedures for the Approval of Independent Abortion Providers for consultation later this year.
Health and Social Care Bill
Lord Lansley Excerpts(12 years, 9 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
Your generosity of spirit is legendary, Mr Speaker, and you were characteristically generous in accepting the submission of the right hon. Member for Leigh (Andy Burnham) that there was an emergency warranting this debate. I regret that he has let you down. It turns out there was no emergency, there was no argument, and there was no point.
Ostensibly, the debate is to consider the Department of Health’s transition risk register. The House considered that on 22 February, and by a majority of 53 the House decided that it did not support the publication of the risk register. We further considered that matter in the debate on 13 March. I think that the views of this House should be respected.
Yesterday, in another place, Lord Owen proposed an amendment, the purpose of which was to delay consideration of Third Reading in the House of Lords until the publication of “reasons” by the first-tier tribunal and the Government’s response. That amendment was defeated by a majority of 115. I remind the House that the Government do not command a majority in the House of Lords. That proposal was defeated by a substantial majority on the balance of the argument.
I will not repeat what I said in the debate on 22 February, but let me just add three things. First, as my noble Friend Lord Howe told the House of Lords yesterday, the risks and other impacts of the Bill were fully disclosed, not least in the impact assessments—a 200-page document—published alongside the Bill; in the NHS operating frameworks; in transition letters from the NHS chief executive and others; and in the full description of the risk headings that Lord Howe set out to the House of Lords on 28 November. I regret to say that it sounds to me that no Labour Members—with, I suspect, the exception of the right hon. Members for Wentworth and Dearne (John Healey) and for Leigh (Andy Burnham)—have taken the trouble to read the debates in the House of Lords.
Secondly, as my hon. Friend the Member for Banbury (Tony Baldry) made clear, Lord Wilson of Dinton, a former Cabinet Secretary, told the House of Lords yesterday that he has deep concerns about the Information Commissioner’s decision and its negative impact on the safe space within which officials give frank advice and act as a “devil’s advocate” to Ministers.
John Healey
The right hon. Gentleman argues that one of the principal reasons why the Government have not accepted the decision to disclose the risk register is that information about risks has been disclosed to the public already. The Information Commissioner considered that. Will the right hon. Gentleman recognise that, in his legal decision, the Information Commissioner said that he did not accept the argument that the Government advanced, and that he considers that
“disclosure would go somewhat further in helping the public to better understand the risks associated with the modernisation of the NHS than any information that has previously been published”?
Mr Lansley
The right hon. Gentleman knows perfectly well that in the debate on 22 February we made it clear that we felt that our appeal to the tribunal was justified, and indeed it was, because we won at appeal on the question of the publication of the strategic risk register. The Government’s objection and my objection to the publication of the risk register is precisely that risk registers are not written for publication. They are written in that safe space within which officials give advice to Ministers.
Mr Lansley
No.
Risk registers do not represent a balanced view. They are not a prediction of the future. They set out a worst-case scenario to challenge decision making. My hon. Friend the Member for Totnes (Dr Wollaston) captured the understanding of what a risk register is very well. The point is that we have looked precisely at the balanced view in the impact assessment, which captures where the risks and the benefits of the Bill lie. However, publication of the risk register, as my right hon. Friend the Member for Charnwood (Mr Dorrell) made perfectly clear, would prejudice the frankness and integrity of the decision-making processes of government and the Government are opposed to their publication.
As I mentioned, we won on appeal in relation to the strategic risk register, but not on the transition risk register. In the absence of the reasons for those decisions by the tribunal, and given the nature of the overlap between the strategic risk register and the transition risk register, I cannot comment further on that, or indeed on what our response will be to the tribunal’s decisions.
Duncan Hames (Chippenham) (LD)
The Secretary of State consistently makes the distinction between policy development issues and operational matters in respect of risk registers and other plans that have been published. Once this Bill has become law and the NHS becomes engaged in the operational matter of implementing his reforms to the health service, will he then encourage NHS trusts to publish, in due course, the risk mitigation plans that they might have, in order to reassure the communities they serve?
Mr Lansley
As the House has noted, risk registers designed for publication form part of the papers prepared for the boards of trusts. Of course, the legislation further strengthens the openness of foundation trust boards, for example, in respect of meeting in public and publishing their documents. But, as my right hon. Friend the Member for Charnwood rightly pointed out, there is an enormous difference between the frank expression of officials’ worse-case scenarios to Ministers in order to challenge decision making—as I say, it was anticipated that that was not intended for publication—and the preparation of risk registers by NHS bodies and trusts, which are designed for publication. Indeed, the national risk register is also designed for publication on that basis. As I said, those in the House of Lords yesterday agreed, by a substantial majority when voting on an amendment, that not only had the consideration of the Bill received unprecedented scrutiny, but that they also had the information they required.
Thirdly, let me just remind the House that the right hon. Member for Leigh, as a Minister, refused to publish the Department’s risk register. He said:
“Whilst we are conscious that there will be public interest in the contents of the Strategic Risk Register being made freely available, we have also taken into account the public interest in preserving the ability of officials to engage in the discussions of policy options and risks without apprehension that suggested courses of action may be held up to public or media scrutiny before they have been fully developed or evaluated. We also take into account the fact that ministers and their officials need space in which to develop their thinking and explore options, and that this disclosure may deter them from being as candid in the future, which will lead to poorer quality advice and poorer decision-making. Having regard to all these factors, we have determined that the balance of public interest strongly favours withholding the information.”
I could not have put it better myself, because that is precisely the point. He talks about the difference between the strategic risk register and the transition risk register, but the one requested was a risk register at the point at which policy was being formulated, and there is a substantial overlap between the strategic risk register and the transition risk register.
The right hon. Gentleman did one thing when he was a Minister and he argues the opposite now. The same thing seems to be happening in so many other fields. When he was a Minister he said that he was in favour of clinical commissioning, and practice-based commissioning was in the Labour manifesto in 2005. In 2006, he said that his ambition was to introduce
“practice-based commissioning. That change will put power in the hands of local GPs to drive improvements in their area”.—[Official Report, 16 May 2006; Vol. 446, c. 861.]
Now he wants to block a Bill whose purpose is to give clinicians—doctors and nurses across the NHS—the power to commission and design services in their area. We just do not know the position. Once more, we heard nothing positive from him about what Labour would offer the health service; all we heard was a denigration of the performance of the NHS and a determination to block the Bill. We are still hearing from him about what Labour Members are opposed to; we just do not hear about anything he is in favour of.
The curious thing is that last Tuesday, on an Opposition day debate, I said, “We are hearing from Labour Members and Labour activists all over the country about their opposition to £20 billion of cuts.” Hon. Members will remember, because this happened only a week ago, that the right hon. Gentleman was shouting at me from the Labour Front Bench, “No, no, no. We are in favour of that.” I said to him, “Look, it is in the manifesto”, because Labour’s manifesto said that
“we will deliver up to £20 billion of efficiencies in the frontline NHS”.
Yesterday, the right hon. Gentleman turned up with his hon. Friends at the Department of Health to deliver a petition from Wigan and Leigh. It said:
“We the undersigned are opposed to the Government’s Health and Social Care Bill and £20 billion of ‘unmandated’ cuts in NHS funding”.
He sat there last Tuesday saying, “No, we are in favour of £20 billion of efficiencies”, yet he is wandering all around the country with his hon. Friends saying, “No, it is £20 billion of cuts.” Frankly, Mr Speaker, if I recall correctly, that is what you would have me describe as an erroneous view.
The NHS across the country is a service that not only will use reform positively but is using reform positively now. We are seeing the reforms being implemented. On 1 April, clinical commissioning groups will take responsibility for more than £60 billion-worth of delegated responsibility for commissioning. I am tired of hearing the right hon. Gentleman denigrate NHS performance when what we have, since the election, is the lowest ever number of patients being admitted to mixed-sex wards, with numbers down 95%; the lowest ever number of patients waiting more than six months for treatment, with numbers down from 100,000-plus to 70,000; the lowest ever number of patients waiting more than a year for treatment, with numbers down from more than 18,000 to below 6,000; and the lowest ever number of patients waiting more than 18 weeks from referral to treatment. In May 2010, that figure was 209,000 but the latest figure is down to 182,000. Also, fewer people than ever are acquiring infections in hospital, with methicillin-resistant Staphylococcus aureus down 36% and clostridium difficile down 25%.
I have searched in vain for a point to this debate. I think that the only point was so that the right hon. Gentleman and his friends could put out a press release about having 24 hours to save the NHS—I think I have heard that one before. The Labour party is never knowingly over-clichéd. Only the Daily Mirror bothered to notice the press release, putting it on page 6; if it had really thought that this was about saving the NHS, it might at least have put in on page 1. No, the truth is that this is political opportunism dressed up as principle. This is a debate for no purpose and the only effect of this one and a half hour debate is to delay the consideration by this House of the amendments made in another place. Given the full and constructive character of the debate in the Lords over 25 days, I think it is a disservice to the other place that this House’s time has been wasted on having this debate. The Labour party has shown that it is interested not in what is in the Bill, but only in the political opportunity of opposing it. We are interested not only in what is in the Bill but in the opportunity it presents—not for the sake of the Opposition’s politics but for the NHS to improve and strengthen in the future.
Health and Social Care Bill
Lord Lansley Excerpts(12 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Andrew Lansley)
In commenting on the level of nursing staff, will the hon. Gentleman observe that since the election, there has been a 5% improvement in the ratio of nurses to occupied beds in general and acute wards?
Andrew George
I am not in a position to doubt that figure. The question is whether the ratio is sufficient to ensure that there is safe staffing in our hospitals now, as the RCN identified after a recent survey. I understand the argument advanced by Ministers that it comes down to the management and the management of paperwork within hospitals, and is not just about staff-to-patient ratios. I do not want to have a debate just about staff -to-patient ratios, but that issue has been raised today and I believe that it resonates with people out there in the country, who can see that nurses in particular are struggling to provide adequate services within their hospitals. Those ratios have an effect on the level of care that nurses can provide, as has been found by a variety of reports. The problem is not down to the callousness of the nurses or untrained care assistants who provide the services—where that exists, it should clearly be rooted out of the service—but to whether staff resources are sufficient to maintain safe services on our hospital wards. I think the RCN is right to raise that issue.
That concern is relevant to ensuring that we have adequate local healthwatch services because it shows that we need independent scrutiny of the health service by a body that is not in the pocket of anyone, including the local authority, but that is able to scrutinise hospitals and speak out about staffing levels in its area. We cannot be dependent on the RCN reporting such matters to the Department and on there being top-down diktats that impose mandatory staffing levels that apply in all circumstances. Rather, there should be a local healthwatch that looks at the guidance and recommendations of the professional bodies and ensures that the services in its local hospitals are adequate to provide safe nursing and hospital care. That is why it is important to ensure that the local healthwatch bodies are, as far as is possible, independent of any external influences, whether from the Department, the NHS Commissioning Board, clinical commissioning groups or the local authority. That is where I shall take my arguments.
Health and Social Care Bill
Lord Lansley Excerpts(12 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Andy Burnham
No. I have been listening to the strictures from the Chair, and I want to get into my speech so that Back-Bench colleagues have a chance to contribute.
That takes us straight to the heart of the predicament in which we find ourselves. There is huge concern in the country about the Bill, but the Government and Parliament—
The Secretary of State for Health (Mr Andrew Lansley)
Will the right hon. Gentleman give way?
Andy Burnham
I will in a moment.
There is huge concern in the country about the Bill, but the Government and Parliament are seen simply not to be listening. I give way to the Secretary of State, and I hope that he might prove us wrong.
Mr Lansley
I am grateful to the right hon. Gentleman, but before we move beyond that point will he confirm that Dr Chand is an adviser to the Labour party, which inspired the petition? Further, given that Dr Chand has called on the British Medical Association to take strike action against the Bill, does the right hon. Gentleman share that view, or will he disown him?
Andy Burnham
Dr Chand is not an adviser to the Labour party, and the Secretary of State, in seeking to inject that party political note so early on in today’s debate and to claim that the petition of 170,000 people is a political petition, continues, it suggests to me, to misread the mood of this country on his unnecessary Bill.
The Secretary of State for Health (Mr Andrew Lansley)
As a learned man, Mr Deputy Speaker, you will recall that Plato said that
“empty vessels make the loudest sound”.
The right hon. Member for Leigh (Andy Burnham) has been a study in this: as his arguments have diminished, so his tone has become more strident. By the end of his speech, he was simply shouting slogans. I listened carefully to his speech, but in vain, for evidence of an argument, still less of an Opposition policy.
I ask the House to reject the motion, which is a desperate ploy from a desperate party. The House scrutinised and approved the Bill, with amendments. following a substantial and highly constructive engagement right across health and care services and with the independent NHS Future Forum. We accepted all their recommendations. The chairman of the British Medical Association Council said at the time that the recommendations
“address many of the BMA’s key concerns”.
Dr Clare Gerada, the chair of the Royal College of General Practitioners, said that
“we are reassured that things are moving in the right direction”.
Yes, things have moved in the right direction, including, apparently, Dr Gerada, encouraged by her council.
In the other place, things have moved in the right direction, too. We have had hours of constructive debate leading to further positive amendments, including amendments to put beyond doubt the Secretary of State’s responsibility and accountability with respect to a comprehensive health service, and a duty on the Secretary of State to have regard to the NHS constitution; amendments to make it clear that Monitor will have the power to require health care providers to promote integration of NHS services, enabling Monitor to use its powers to support integration and co-operation in the interests of patients; and amendments conferring new responsibilities on the NHS Commissioning Board and clinical commissioning groups to play an active role in supporting education and training, and requiring providers to co-operate with the Secretary of State when exercising his duty to secure an effective education and training system. All those amendments were positively accepted in the Lords.
Mr George Howarth
The Secretary of State quoted Plato earlier. Does he recall the advice that Cromwell gave to Members of the Long Parliament—that they had stayed in their place for too long and to no useful purpose? Is that not advice that he might take?
Mr Lansley
I do not think the right hon. Gentleman should quote Cromwell to a Cambridgeshire MP; I think I know more about Cromwell than he does. [Hon. Members: “Ooh!”] I might also tell him—
Michael Dugher (Barnsley East) (Lab)
What do you know about the health service?
Mr Lansley
What do I know about the health service? I have been at the Government and Opposition Dispatch Boxes for nearly nine years speaking on behalf of the national health service. Before that I was on the Select Committee on Health, looking out for the interests of the health service, and before that my father was working—[Interruption.]
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Front Benchers need to be a little calmer. A lot of Members want to be called, and we want to hear the Secretary of State.
Mr Lansley
Let me just say this to the hon. Member for Barnsley East (Michael Dugher), who is sitting on the Opposition Front Bench. There may be many things that we can debate in this House, including the policies, but I deeply resent any implication that I do not care about the national health service. I believe that I have demonstrated that I do; and his hon. Friends—and, to be fair, the right hon. Member for Leigh—have made that absolutely clear, time and again. Dr Clare Gerada, on behalf of the Royal College of General Practitioners, has said clearly that she recognises the Prime Minister’s and my passion and commitment and that of the Prime Minister to support the national health service.
Stewart Hosie (Dundee East) (SNP)
The Secretary of State said some moments ago that the Bill had all been debated in this House, but of course it has not. Possibly the most damaging aspect financially to the NHS outside England is the increase in usage of the private sector in the NHS in England to 49%. That has never been debated in this House, has it?
Mr Lansley
I am afraid that the hon. Gentleman is completely wrong. The private income cap for foundation trusts was debated fully in Committee in this House, and it has been debated again in another place. The reason for the so-called 49% was simply that Members in another House said that they wanted to be absolutely clear that the principal legal purpose of foundation trusts is to provide services to the NHS, and therefore that, by definition, a foundation trust could not have more of its activity securing private income than NHS income, hence the 49%. But in truth, the safeguards that are built in make it absolutely clear that, whatever the circumstances and whatever their private income might be—from overseas activities or overseas patients coming to this country—foundation trusts must always demonstrate that they are benefiting NHS patients. That is why, I remind the House again, the foundation trust with the highest private income—27%—is the Royal Marsden, which delivers consistently excellent care for NHS patients.
Mrs Anne Main (St Albans) (Con)
Does my right hon. Friend share my absolute astonishment at Labour Members’ collective amnesia when it comes to the 13 years of mixed-sex wards and rising levels of MRSA and C. difficile that they presided over, along with a failed patient record system that has cost billions?
Mr Lansley
My hon. Friend is absolutely right, and I will come to some of those points. However, I might just say that, in the space of the last few days, we have had an opportunity to demonstrate that Labour signed up to an enormous, centralised, top-down NHS IT scheme that was never going to deliver, was failing to deliver and was costing billions.
Karl Turner (Kingston upon Hull East) (Lab)
Will the Secretary of State give way?
Mr Lansley
No.
In the space of under two years, my right hon. and hon. Friends at the Department and I have delivered a reduction approaching £2 billion in the cost of the NHS IT programme. That will enable us to empower services right across the country to be better users and deliver better IT systems.
Duncan Hames (Chippenham) (LD)
Further to the list of changes to the Bill that the Health Secretary has outlined, will he confirm that it no longer imposes reviews by the Competition Commission on the NHS, therefore ensuring that it is not treated in the same way as any private industry would be?
Mr Lansley
That is indeed true, and my hon. Friend will also be aware—the Future Forum was clear about this—that the NHS benefits from the transfer of competition powers. The Bill does not create any new competition powers in the NHS; it transfers the exercise of competition powers from the Office of Fair Trading to Monitor, as a sector-specific regulator, as we agreed in the coalition agreement. That is what the Bill does, and that is a better protection for the NHS compared with what would otherwise be the application of competition rules, and before—[Interruption.] Labour Members mutter, but it has become apparent over recent weeks that in 2006, when the right hon. Member for Leigh was a Health Minister, it was their Government who received legal advice that demonstrated that their changes had introduced the application of EU competition rules into the NHS.
Simon Hughes
Will the Health Secretary amplify his answer to our Scottish National party colleague, the hon. Member for Dundee East (Stewart Hosie), and make it quite clear that both Government policy and, now, the construction of the Bill not only prevent private sector activity from going out of the health service in terms of finance, but restrict the method of expanding private sector activity? The controls are now in the Bill, even if they were not at the beginning.
Mr Lansley
There is absolutely nothing in the Bill that promotes or permits the transfer of NHS activities to the private sector. Of course, NHS trusts are technically able to do any amount of private activity at the moment, with no constraint. The Bill will make absolutely clear the safeguard that foundation trusts’ governors must consent if trusts are to increase their private income by more than 5% in the course of one year, and that they must always demonstrate in their annual plan and their annual reporting how that private activity supports their principal legal purpose, which is to provide services to NHS patients.
Labour sought to oppose the Bill in another place, but its motion was defeated by 134 votes. We have reached a stage at which the Labour party, and the right hon. Member for Leigh in particular, having embraced opposition —for which they are well suited—now oppose everything. They even oppose the policies on which Labour stood at the election. Labour’s manifesto stated that
“to safeguard the NHS in tougher fiscal times, we need sustained reform.”
The trade unions have got hold of the Labour party in opposition, and it is now against reform. Its manifesto also stated that
“we will deliver up to £20bn of efficiencies in the frontline NHS, ensuring that every pound is reinvested in frontline care”.
I remind Labour Members, who are all wandering around their constituencies telling the public that there are to be £20 billion of cuts to the NHS, that that £20 billion was in their manifesto. Now they are talking about it as if it were cuts; it is not. We are the ones who are doing it, and they are the ones who are now opposing it. They scare people by talking of cuts—[Interruption.] They do not like to hear this. Actually, this year, the NHS has an increased budget of £3 billion compared with last year, and in the financial year starting this April there will be another increase of £3 billion compared with this year. The Labour manifesto also stated:
“Foundation Trusts will be given the freedom to expand their provision into primary and community care, and to increase their private services”.
John Pugh (Southport) (LD)
The right hon. Gentleman has just mentioned reform. In 2009, he said in this place:
“Organisational upheaval and reform do not seem to correlate well.”—[Official Report, 19 November 2009; Vol. 501, c. 225.]
What did he mean by that?
Mr Lansley
We know that it is necessary for us to reform in order to deliver the improvements that the NHS needs, as well as the sustainability that it needs. We are not even speculating about this; we can demonstrate that it is happening. This is in contrast to what the right hon. Member for Leigh said. He said that he was not scaremongering, then he got up and did just that. He scaremongered all over again. He went to a completely different set of data on the four-hour A and E provision, for example. He went to the faulty monitoring data, which are completely different from the ones that we have always used in the past—namely, the hospital episodes statistics data, which demonstrate that we are continuing to meet the 95% target.
When we look across the range of NHS performance measures, we can see that we have improved performance while maintaining financial control. The monitoring data from the NHS make that absolutely clear, and that is in contrast to what happened when the right hon. Gentleman was a Minister in the Department, when Labour increased the NHS budget and lost financial control. That happened when the hon. Member for Leicester West (Liz Kendall) was a special adviser in the Department. Now, we have financial control across the NHS and we have the NHS in financial surplus.
Let me return to the Labour manifesto—[Interruption.] Labour Members do not like to hear this. It stated:
“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs.”
Yes—choice and any qualified provider are in the Labour manifesto. We are doing what Labour said should be done in its manifesto—and it is now opposing it.
Let us find out what it is that the right hon. Member for Leigh opposes in the Bill. I did not find that out in his speech; I heard generalised distortions, but I genuinely want to know. Let us take some examples. Is it the Secretary of State’s duty in clause 1 to promote a comprehensive health service free of charge, as now? No, he cannot possibly be against that. Is it that the Bill incorporates for the first time a duty on the Secretary of State to act to secure continuous improvement in quality—not just access to an NHS service, but putting quality at the heart of the NHS? Is he against that? No, surely not. Anyway, that approach began with Ara Darzi, and we have strengthened it.
Mr Lansley
Let us try this one. For the first time the Bill introduces in clause 3 a duty that embeds the need to act to reduce inequalities firmly within the health system. After 13 years of widening health inequalities under Labour, surely he cannot be against that—or is he? No. Well, what about clinically led commissioning, with doctors and nurses who are responsible for our care given the leadership role in designing services? We heard earlier about one CCG, but 75 leaders of clinical commissioning groups wrote to The Times a fortnight ago. Let me quote them, because it is instructive of what is happening. They said:
“Since the…Bill was announced, we have personally seen more collaboration, enthusiasm and accepted responsibility from our GP colleagues, engaged patients and other NHS leaders than through previous ‘NHS re-organisations’”.
They continued:
“Putting clinicians in control of commissioning has allowed us to concentrate on outcomes through improving quality, innovation and prevention”—
precisely the things that the NHS needs for the future.
Now the right hon. Gentleman says, “Oh, yes, we can do GP commissioning”, but let us recall that in 2005, practice-based commissioning was in the Labour manifesto, and that in 2006, he said he was in favour of it. He said that he was
“introducing practice-based commissioning. That change will put power in the hands of local GPs to drive improvements in their area”—[Official Report, 16 May 2006; Vol. 446, c. 861.]
Mr Lansley
I will give way in moment. The right hon. Gentleman said he was in favour of practice-based commissioning. In 2010, he was the Secretary of State and was in charge of the manifesto, yet practice-based commissioning disappeared out of the Labour manifesto —it was not there at all. After the election, he pops up and says, “Oh, we are in favour of it again”. The truth is that practice-based commissioning was always the right idea: the Labour Government did not do it; the primary care trusts suppressed it. The Bill makes it possible for clinical commissioning groups to take responsibility and for doctors and nurses to design and deliver better services. Because of this Bill, it will happen—and it will not be suppressed by a top-down bureaucracy.
Andy Burnham
I made the Secretary of State an offer in my opening remarks. I said I would work with him to introduce his vision of clinically led commissioning, but he seems strangely silent about that and is pursing a very partisan tone. Will he confirm that he could introduce GP-led commissioning without any need for legislation—and without all the upheaval that is coming with his reorganisation?
Mr Lansley
The short answer to that is no. If one wishes to arrive at a place where the clinical commissioning groups have responsibility for budgets and proper accountability—including democratic accountability for what they do—legislation is required to get there. That is why we are putting legislation in place to make it happen.
Angie Bray
I thank my right hon. Friend for that, and I thank him, too, for coming to Acton last week and spending a long evening in a room full of health professionals—doctors, dentists and pharmacists. Does he agree that there was a real desire in that room to engage constructively in discussion on the reforms rather than to turn their back on them, as the Labour party would?
Mr Lansley
I am grateful to my hon. Friend for her initiative in bringing doctors, dentists and nurses together to have that conversation. I really appreciated it, and I thought that it illustrated exactly what I have found—that, although not everybody in the room agreed with the Bill—[Laughter]—many did. Contrary to what I see on the Labour Benches, they all wanted to design better services for patients. They cared about patients and engaged in a proper debate about how to achieve that.
I am still trying to find out what it is in the Bill that the right hon. Member for Leigh is against. Is it the fact that the Bill strengthens the NHS constitution? He should be proud of that; he introduced it. For the first time, however, the Bill requires the Secretary of State to have regard to it and the NHS Commissioning Board and clinical commissioning groups to promote it. He is not against that, I presume.
What about the fact that, for the first time, the NHS Commissioning Board and commissioners will have a duty to promote integration throughout health and social care? Is the right hon. Gentleman against integrated care? I do not know. Let me try another question. What about the prohibition in clauses 146, 22 and 61 of discrimination in favour of private providers, which is in legislation for the first time? The right hon. Gentleman may be against that, because when his party was in office, that is what the Government did. They discriminated in favour of private sector providers, and we ended up with £250 million being spent on operations that never took place and the NHS being paid more for operations when it was not even allowed to bid for the work.
What about the creation of a strong statutory voice for patients through HealthWatch? The Labour Government destroyed the community health councils, they destroyed patient forums, and they left local involvement networks neutered. When they were in office, they were pretty dismissive of a strong patient voice. Well, we on the Government Benches are not, and the Bill will establish that patient voice. Is the right hon. Gentleman against all trusts becoming foundation trusts? The Bill will make that happen, and will support it—oh, no, I forgot: according to the Labour party manifesto, Labour wanted all trusts to become foundation trusts.
Let us keep moving through the Bill. Is the right hon. Gentleman against directly engaging local government in the commissioning of health services, integrating health and social care, and leading population health—public health—improvement plans? I ask the question not least because Labour local authorities throughout England are in favour of that. They want to improve the health of the people whom they represent. Is the right hon. Gentleman against local democratic accountability? The list could go on. Is he against the provision of a regulator—Monitor—whose duty is to protect the interests of patients by promoting quality, stopping anti-competitive practices that could harm patients, supporting the integration of services, and securing the continuity of services? Is he against that? It is in the coalition agreement, but I do not know whether the right hon. Gentleman is against it or not, because he does not say.
Is the right hon. Gentleman against statutory backing for the National Institute for Health and Clinical Excellence to support its work on quality? I do not know; we have not heard. Is he against developing the tariff so that it pays for quality and outcomes, not for activity? He knows that that has to happen, and he knows that it has been the right thing to do for the best part of a decade, but we have no idea whether he is against it now.
I cannot discover what the right hon. Gentleman is actually against. He sits there and says that he is against the Bill, but he is not against anything that is in the Bill. He is against the Bill because he has literally made up what he claims it says. He says that it is about privatisation—
Mr Lansley
All right, I will give way to the right hon. Gentleman one more time. Come on, then: let us find out what he is against.
Andy Burnham
I will tell the Secretary of State what I am against. I am against the rewriting of the entire legal structure of the national health service to plant market forces at the centre of the system, and to pit doctor against doctor and hospital against hospital. That is what I am against, it is what 170,000 people signed a petition against, and it is what the overwhelming consensus of health professionals is against. Would the Secretary of State not do well to listen to them for once?
Mr Lansley
So now we know, Mr Deputy Speaker. It is sheer invention. There is nothing in the Bill that creates a free-for-all. There is nothing in it that creates a market of that kind. The Bill means competition for quality, not price. It gives patients choice—and the Labour party’s manifesto was in favour of giving patients choice. Competition is not being introduced to the NHS by the Bill; it is being channelled in the interests of patients to support quality throughout the NHS.
The Opposition talk about privatisation. As I said to my right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes), there is nothing in the Bill that allows any privatisation of NHS services. There is nothing in it that promotes such a privatisation.
The left-leaning papers talk about privatisation at Hinchingbrooke hospital because Circle is an independent mutual organisation. That is interesting, because the process for the franchising out of the management of Hinchingbrooke was started by the right hon. Gentleman when he was Secretary of State. So there we are: the only secret Tory plan that Labour can find turns out to be a Labour plan.
Paul Uppal (Wolverhampton South West) (Con)
The real issue in the debate is between long-termism and short-termism. Is not the reality that the Labour Government went aggressively down the route towards private finance initiatives, burdening so many of our foundation trust hospitals with debt that was unnecessary?
Mr Lansley
My hon. Friend makes an important point. When Labour Members talk about the private sector in the NHS, they leave out of account the fact that not only did they give the private sector a sweetheart deal to get it into the independent sector treatment centres, but they have left us with 102 hospitals that were built by the private sector and £67 billion of debt to the NHS. They wandered around the country saying, “Look how we’re spending all your money to build all these new hospitals,” but they did not spend the money to build the new hospitals. They have left the NHS to have to deal with it now, which is why I am having to support hospitals that have unsustainable private finance initiative debt that the right hon. Member for Leigh and his colleagues did not deal with.
What do we have? We have policies that the right hon. Gentleman disowns, and we have nothing to replace them with. We have political opportunism, distortions dressed up as arguments, and a shameful campaign to scare people about a Bill that, in reality, is about strengthening the NHS for the benefit of patients.
Of course, if we want to see what Labour would do, we only have to look at the situation in Wales. I have to hand a Wales Audit Office bar chart; I shall hold it up so Opposition Members can see it. One bar shows rising real-terms expenditure on the NHS in England, and the blue bar shows rising real-terms expenditure on the NHS in Scotland, while the green bar shows the rate for Northern Ireland, where the rise is lower. Another bar, however, shows a very large real-terms cut in NHS spending in Labour-run Wales. Labour in Wales did not just agree with the right hon. Gentleman that it would be “irresponsible” to increase NHS spending; Labour in Wales went further, and cut spending.
In order to see the result of that, we must look at performance. In England, 91% of patients are seen and treated within 18 weeks, compared with just 68% in Wales. In England, only 1.4% of patients waited over six weeks for diagnostic tests; in Wales, 29% waited over six weeks. In Wales, Labour says it wants to insulate the NHS against reform. It ought to adopt it, however, because all that is happening in Wales is that the Labour party is, once again, putting politics before patients.
It is patients who should be at the heart of the NHS —patients and those who care for them. This Bill is simply the support to a far more important set of changes, which make shared decision-making with patients the norm across the NHS, which bring clinical leadership to the forefront of the design and delivery of health and care services, which make local government central to planning for health and care, which strengthen the patient voice, and under which the NHS is open about the results we achieve and how to improve those results so we genuinely match the best in the world. We will continue to work with the royal colleges, and others with an interest in the future of the NHS, to implement our plans, so that we provide the best possible care for patients. The right hon. Gentleman’s motion and speech gave no credit to the NHS for what it is achieving, but I will.
We are proud of the services we deliver for patients: the lowest ever number of patients waiting over six months for treatment—[Interruption.] Labour Members do not like to listen to this, but it is the reality. Average time spent waiting for treatment is lower than at the last election. The number of patients waiting over a year for treatment has more than halved since the election. MRSA and C. difficile are at their lowest ever levels. There are more diagnostic tests—up by 300,000 over a year. There is more planned care, and there are fewer unplanned emergency admissions to hospital. Some 11,800 patients have benefited from the cancer drugs fund, and 990,000 more people have had access to NHS dentistry, while mixed-sex accommodation is down by 95%.
Mr Lansley
No, because I am going to tell the right hon. Gentleman what he did not admit. Reform is going ahead. We are delivering efficiencies across the NHS.
Mr Lansley
All right, I will give way, but the right hon. Gentleman might like to explain why in the year before the election the administration costs of the NHS rose by 23% and he added more than £320 million to the administration costs of primary care trusts and strategic health authorities, but in the year since, we have cut those costs. Absolutely contrary to what he said—because he was completely wrong—we are on track to deliver the Nicholson challenge. We delivered £2.5 billion in savings in the first six months of this year, having delivered £4.3 billion in savings during the course of the last financial year. Come on: explain that one.
Andy Burnham
I should just point out that the Secretary of State is trading on the successful legacy he inherited from Labour: the lowest ever waiting lists; the highest ever patient satisfaction. Let me leave that to one side, however. We on the Opposition Benches have noticed that he has not once mentioned his tribunal defeat on the NHS risk register, and all the achievements he just reeled off are at risk, are they not, because of this misguided reorganisation? I ask him to answer this point today: will he now comply with the ruling of the Information Tribunal, publish this risk register today, and let the public know the full truth about what he is doing to their national health service?
Mr Lansley
I was right, was I not, that the weaker the right hon. Gentleman’s argument, the stronger the tone? My noble Friend Earl Howe answered a private notice question in the other place yesterday, and the position is absolutely as he described it: we were right to go to appeal, as the appeal demonstrated, because the tribunal agreed that we should not publish the strategic risk register. The decision of the tribunal was that it took the view that we should publish the transition risk register, but it did not publish its reasons. Given the simple fact that there is considerable overlap between the strategic register and the transition risk register, I find it extremely difficult to know what the tribunal’s reasons are, so we will see what its reasons are.
Mr Lansley
I will not give way.
Let me just make it absolutely clear that reform is happening and it will be supported by the Bill: nearly £7 billion has already been saved to reinvest in front-line care; we have 15,000 fewer non-clinical staff; we have 5,800 fewer managers and 4,100 more doctors—since the election, we have had more qualified clinical staff; there are 890 more midwives since the election and a record number in training; we have 240 clinical commissioning groups covering England, leading on commissioning from April on up to £60 billion-worth of services; and the ratio of nurses to beds in hospital has gone up.
Labour’s motion is politics masquerading as principle, and it is synthetic anger. I would take the right hon. Gentleman’s campaign more seriously if his own leader could have been bothered to turn up to his NHS rally, rather than taking a Rolls-Royce to a football game. This is empty rhetoric from an empty vessel; this is no policy, only politics; and this is a leader who treats his party’s campaign with disdain. The House should have no truck with them, and I ask it to reject the Labour motion.
Valerie Vaz
I am sorry, but I have nearly finished my speech and must press on.
There was a chorus of disapproval from professionals when the White Paper was published, as they wanted more information. As Rogers and Walters say in the sixth edition of “How Parliament Works”, if there is pre-legislative scrutiny, Ministers have less political capital at stake and changes are not seen as defeats; the scrutiny of a Bill in draft gives higher quality legislation. That is not a description of the Health and Social Care Bill. The pre-legislative scrutiny was in the Secretary of State’s head, not in a draft Bill.
What about my constituent Stephen Wood, who went to his local GP’s surgery only to be told that doctors would only refer him to a consultant privately, not on the NHS, as he had apparently used up his budget?
Valerie Vaz
It is true. This has become personal. The NHS is an organisation in which miracles sometimes happen, which is why people are fighting to protect and save the very essence of its existence. Those who have paid their taxes do not want the Bill, and the health professionals do not want it. From all parties, professionals and patients in the NHS, we can say that we oppose the Bill, and when the NHS unravels, as it is now beginning to, we can say, “We told you so.” I support the motion.
NHS Pay Review Body
Lord Lansley Excerpts(12 years, 9 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I am responding on behalf of my right hon. Friend the Prime Minister to the 26th report of the NHS Pay Review Body (NHSPRB). The report has been laid before Parliament today (Cm 8298). Copies of the report are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. I am grateful to the chair and members of the NHSPRB for their report.
We welcome the NHS Pay Review Body’s 26th report, note its observations and accept its recommendations in full. In the light of a tough economic climate, I am pleased to confirm that lower paid NHS staff earning £21,000 or less will receive a flat rate increase of £250 from 1 April 2012. This will support continuing NHS service improvements and the position of lower paid NHS staff.