Health and Social Care Bill

Lord Lansley Excerpts

Tuesday 28th February 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the Health and Social Care Bill following a letter from the Deputy Prime Minister to MPs and peers and the Government’s response.

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

I am glad to have this opportunity again to set out the purposes of the Health and Social Care Bill. It will give patients more information and choice, so that they can share in decision-making about their care. It empowers front-line doctors and nurses to lead the delivery of care for their patients. It cuts out two tiers of bureaucracy and strengthens the voice of patients and the role of local government in integrating services and strengthening public health.

The values of the Bill are simple: putting patients first, trusting doctors and nurses, focusing on results for patients and maintaining the founding values of the NHS. We are constantly looking to reinforce those values, strengthening the NHS to meet the challenges it faces. We know change is essential; we will not let the NHS down by blocking change. Throughout the development and progress of this Bill, we have engaged extensively with NHS staff, the public, and parliamentarians.

The Health and Social Care Bill is the most scrutinised public Bill in living memory—[Interruption.] With over 200 hours of debate between the two Chambers and 35 days in Committee, we have ensured that Members and peers have had every opportunity to examine, understand and amend the Bill to—[Interruption.]

[Mr Speaker]

Order. I granted this question because I want Members to have the chance to scrutinise the Government of the day, but courtesy dictates that the Secretary of State’s statement must be heard.

[Mr Lansley]

Thank you, Mr Speaker.

We have made this legislation better and stronger. We have made significant changes to the Bill, including in response to the NHS Future Forum’s work and we have been open to any further changes that would improve or clarify the Bill. For example, so far in the Lords, the Government have accepted amendments tabled by a number of Cross-Bench, Liberal Democrat and Labour peers.

Yesterday, my right hon. Friend the Deputy Prime Minister and Baroness Williams wrote to their Liberal Democrat colleagues explaining their support for the Bill, with those changes and some further amendments they wish to see. They said, for example, how we must

“rule out beyond doubt any threat of a US-style market in the NHS”.

I wholeheartedly agree. The Bill is about quality, not competition on price. It will not permit any NHS organisation to be taken over by the private sector. It will put patients’ interests first. The Bill does not permit any extension of charging, and care will be free, based on need. Where the doctors and nurses on the ground know that competition is in the best interests of their patients—where it is based entirely on the quality of the care and treatment provided and not in any way on the price of that care and treatment—then competition can play an important role in driving up standards throughout the NHS.

We will not see a market free-for-all or a “US-style” insurance system in this country. I believe in the national health service. I am a passionate supporter of our NHS, and that is why I understand the passionate debate it arouses. It is also why I resent those Opposition Members who seek to misrepresent the NHS, its current achievements and its future needs. We—and I do mean all of us on the Government Benches—are using the debates in the Lords further to reassure all those who care about the NHS. I am grateful for this chance to reassure all my hon. Friends regarding the positive and beneficial effects of debate in the other place and about the work we are all doing to secure a positive future for the NHS.

[Andy Burnham]

On Friday, the Prime Minister promised there would be no more amendments, and yesterday lunch time the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) said that the whole Government backed the Bill as it stood, but hours later the Deputy Prime Minister called for changes to a flagship Bill that he has supported all the way. The Government appear to be in complete disarray—or perhaps this was pre-agreed coalition choreography for the Deputy Prime Minister to save face. Either way, this House is entitled to ask, “What is going on?” The NHS matters too much for us to allow it to be carved up in the unelected House in cosy coalition deals, so we are grateful, Mr Speaker, that you have brought Ministers here today to start providing some answers.

First, on the process, will the Secretary of State tell the House when he was first made aware of the Deputy Prime Minister’s letter? Was he consulted about its contents in advance and did he consent to the apparent change of policy or was he overruled by the Deputy Prime Minister? Who is in charge of health policy? Is anyone in charge?

Secondly, on policy, will the Secretary of State update the House on the precise detail of the changes that the Deputy Prime Minister is seeking in the five areas he identifies? For instance, we hear that the Deputy Prime Minister, having previously defended the 49% private patient income cap for foundation trusts, now wants “additional safeguards”. What are those safeguards? Are the changes still under discussion or do they now represent Government policy? Yesterday, the Liberal Democrats played up the changes, but the Secretary of State’s Department has dismissed them as minor. Is his view the same as ours that the amendments do not affect the substance of his Bill but rather are cosmetic changes designed to make the Deputy Prime Minister look good in advance of his spring conference?

The Prime Minister has been clear: this Bill is about competition at the heart of the health service. The Deputy Prime Minister has supported it all the way. Are not these just empty gestures designed to save face? This is a bad Bill that cannot be amended. Last week, the president of the Lib Dems spoke for his party when he admitted that the Bill should have been dropped. Does that not explain what this posturing is all about? In their heart of hearts the Liberal Democrats hate this Bill but have not had the guts to stand up to the Prime Minister and say so. Both coalition parties are putting their political pride before the best interests of the NHS. Is it not time for them to do what they said they would do at the start—listen to doctors and nurses and drop this Bill?

[Mr Lansley]

I am not sure the right hon. Gentleman even read the Deputy Prime Minister’s letter, judging from what he has just said. I will tell him exactly what the process is. The process is for detailed discussion in another place. There were 15 days of debate in Committee in another place. It is the habit in another place not to amend the Bill in Committee, but to use those debates in Committee as a basis for amendment on Report. The process is straightforward. My right hon. Friend the Deputy Prime Minister, together with Baroness Shirley Williams, explained to their Liberal Democrat colleagues some of the amendments on which we have been working together in order to make sure that there is further reassurance. [Interruption.] That is literally true.

Let me put the right hon. Gentleman right about something. What is at the heart of the Bill is improving the quality of care for patients. I note that he did not quote me or represent that he was quoting me. I have never said that competition is at the heart of the Bill. Competition is a means to an end, not an end in itself. The purpose of the Bill is to achieve quality. Where competition enables us to deliver better quality for patients, we should use it. Where integration of services and an absence of competition is in the interests of patients in delivering quality, that is the basis upon which the NHS should proceed. The Bill has been tremendously strengthened and is now a long-term sustainable basis for the NHS to deliver the quality of care for patients that we are looking for, while maintaining all the values of the NHS.

[Mr Stephen Dorrell (Charnwood) (Con)]

Has my right hon. Friend yet been able to understand how it can be that a party which, when in government, promoted practice-based commissioning that involved GPs in commissioning, promoted private sector investment in NHS institutions, and promoted the commissioning of care from private sector providers where that was in the best interests of patients now thinks all those principles undermine the national health service to which he, we and presumably the Opposition are still committed?

[Mr Lansley]

My right hon. Friend makes extremely good points. It is interesting that the right hon. Member for Leigh (Andy Burnham) appears to be trying to represent us as not agreeing about matters. He is chronically incapable of agreeing with himself. In June 2006 the then Prime Minister, Tony Blair, said that what the NHS needed in future was foundation trusts, practice-based commissioning, more involvement for the private sector and payment by results. The thing is that Labour in office did not achieve any of those things. It is only through the mechanism of the legislation that we are putting together that we are going to enable the NHS to achieve those things in a way that does not entail all the difficulties that Labour had, such as getting the private sector involvement with the NHS wrong. We are going to get those things right.

[Frank Dobson (Holborn and St Pancras) (Lab)]

Does the Secretary of State agree that the Salisbury convention requires the House of Lords not to reject a measure if it has an electoral mandate? As all the parties in the House were mandated not to totally reorganise the national health service, would it not be wholly proper for the Liberal Democrats in the Lords to have some guts, join with Labour and Cross Benchers and vote the whole measure down?

[Mr Lansley]

The right hon. Gentleman is completely wrong about that. Perhaps he was not here last Wednesday when we debated health matters. [Hon. Members: “He was.”] Well, then he did not listen. I set out very clearly how the Bill was responding to the manifesto mandate that we in our party had, and it was a manifesto mandate that the Liberal Democrats brought to the coalition Government, not least in relation to the role of local government, bringing greater democratic accountability, which is precisely how some of these things have been achieved. If the right hon. Gentleman is talking about a mandate in the Lords, he might like to tell his colleagues that at the last election his party was elected on the basis of supporting foundation trusts, for example, to be able to be free to increase their private income.

[Several hon. Members]

rose—

[Mr John Redwood (Wokingham) (Con)]

Am I right to tell my constituents that the purpose of this reform is to give more choice of care to patients, and to give more power to GPs to deliver better free treatment?

[Mr Lansley]

Yes, absolutely right.

[Mr Ben Bradshaw (Exeter) (Lab)]

Given that the right hon. Gentleman inherited an NHS with record short waiting times, record high public satisfaction and improving competitiveness, does he ever in his darkest moments wish that he had not embarked on this damaging and costly upheaval?

[Mr Lansley]

At the last election the average waiting time for in-patient treatment was 8.4 weeks. In December 2001, when the most recent data were published, it had come down to 7.7 weeks. The right hon. Gentleman might like to reflect on the fact that the number of people waiting more than a year for treatment in the NHS is now more than half what it was at the last election.

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

I thank the Secretary of State for accepting many of the amendments to the Bill proposed by our colleagues and others and thank his colleague in the House of Lords for accommodating not only Liberal Democrat and Cross-Bench peers, but Labour peers who have joined us in bringing forward such amendments. Will he give an undertaking to continue to work collaboratively to improve the Bill to the very end and reject Labour’s allegations that it did not force privatisation on the NHS, which we are definitely not doing?

--- Later in debate ---

[Mr Lansley]

I am grateful to my right hon. Friend and thank him for his positive remarks about my noble Friend Earl Howe. I attach to that my appreciation to Baroness Northover for the work she has been doing in another place and to the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), who is responsible for care services, who has been heavily engaged in discussing some of the amendments. I recall that nearly a year ago there was a clear expression of interest from the Liberal Democrats, as a party, on how they felt the Bill should be improved. I was pleased that we were able to bring forward changes that reflected virtually all those. Indeed, they are reflected directly in what my right hon. Friend the Deputy Prime Minister said in his letter yesterday.

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

If the competition in the Bill is just an extension of what the previous Government did by introducing independent sector treatment centres and everything else, why are more than 90 clauses writing into the law of the land that competition policy should run the NHS, not the NHS, as has been the case in the past?

[Mr Lansley]

I would not characterise this as an extension of the independent sector treatment centres programme. That is precisely what we do not need to do with the private sector. Under the Labour Government, the private sector was paid 11% more than the NHS, which was wrong, and in another place there is a legislative provision that will prevent discrimination in favour of the private sector. The Bill will carry forward exactly the principles and rules of co-operation and competition, as reflected in the panel set up under the previous Government. As NHS Future Forum set out, the reason for having that in the Bill, with Monitor exercising those responsibilities, is so that there will be a health sector regulator, rather than that being done without health expertise by the Office of Fair Trading.

[Nadine Dorries (Mid Bedfordshire) (Con)]

Some Conservative Members never criticised, and in fact supported, the previous Government when they introduced private health care providers into the NHS. In his letter, the Deputy Prime Minister said that the use of private health care firms has been explicitly prevented as a result of his involvement. Is that really true? If so, should someone not tell him who is running this Government?

[Mr Lansley]

My hon. Friend knows perfectly well that we are a coalition Government and, therefore, this is a coalition Bill that reflects the views of the whole coalition. To that extent, I reiterate to her and to the House that, as the Deputy Prime Minister has quite rightly said, the legislation will not allow discrimination in favour of the private sector in the way that the Labour party did.

[Mr Dennis Skinner (Bolsover) (Lab)]

All those royal colleges, all those nurses and all those doctors know that this Bill is about privatisation. Along come these tin-pot Liberals, who put forward an idea to make a few marginal shifts. It is the biggest con trick of all time. This is about trying to save the face of those people, who should have opposed the Bill from the very beginning. Drop this lousy Bill.

--- Later in debate ---

[Mr Lansley]

I will tell the hon. Gentleman exactly what the Bill is about: improving care for patients. That is what I care about, and it ought to be what he cares about. [Interruption.]

[Several hon. Members]

rose—

[Mr Peter Bone (Wellingborough) (Con)]

There is an old political saying that the Liberal Democrats say one thing at one end of their constituency and another thing at the other end. Will the Secretary of State lay that rumour absolutely to rest—that they are not saying one thing at this end of Parliament and another thing at the other end?

[Mr Lansley]

I am happy to be able to tell my hon. Friend that I, with my colleagues, have had very constructive engagement with my Liberal Democrat colleagues in government and, indeed, during the course of our debates in another place.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

Following the question from the hon. Member for Mid Bedfordshire (Nadine Dorries), can the Secretary of State tell us when he was aware of the letter, whether he was consulted on it and whether he had any input?

[Mr Lansley]

I believe that I answered that question. The point of the letter was to reflect the discussions that we have been having.

[Mr John Baron (Basildon and Billericay) (Con)]

Does my right hon. Friend accept that the debate so far risks ignoring the importance of the Bill’s renewed outcomes? In cancer, for example, such focus is instrumental in driving forward earlier diagnosis, which in itself could save quite literally thousands of lives.

[Mr Lansley]

My hon. Friend is absolutely right, and I am sure that in that context he shares with me the appreciation of the benefit that will come from campaigns to promote the early awareness of cancer, such as, following piloting, the roll-out of the national campaign for the awareness of bowel cancer symptoms.

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

Is not this another attempted PR and political fix for a mismanaged health Bill that is again in chaos? Which of the changes set out in the Deputy Prime Minister’s letter was not agreed in government first?

[Mr Lansley]

Would that be the same Bill that the right hon. Gentleman described as “consistent, coherent and comprehensive”?

[Conor Burns (Bournemouth West) (Con)]

May I ask the Secretary of State today to confirm again that when the Bill becomes law the national health service will remain funded through taxation and free at the point of use regardless of ability to pay? Opposition Front Benchers should stop scaring our constituents with grossly inappropriate scare stories.

[Mr Lansley]

My hon. Friend is absolutely right, and I share his deep resentment at the way in which Opposition Members misrepresent and distort what is in the legislation and then, when people write to us concerned about what is in the legislation, accuse us of not listening to them. Opposition Members should read what is in the Bill, find out that it achieves the purposes that my hon. Friend describes and not distort it.

[Mr Speaker]

Order. I simply say to the Secretary of State that to refer to somebody “distorting” something is perfectly in order, but I know that he would not want to use an unparliamentary term and talk about anything being “misrepresented”. I think he is accusing a Member of being erroneous. I think that is what he has in mind.

[Mr Lansley]

You are absolutely right, Mr Speaker. They are very erroneous.

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

There is clearly no mandate, either in this House or in the other place, for these huge changes and massive top-down reorganisation. Some 162,000 people have signed an e-petition calling on the Government to drop the Bill, so may I remind the Secretary of State that his own party’s election manifesto stated that

“any petition that secures 100,000 signatures will be eligible for formal debate”?

Does he not think that it is time for us to have a full debate about the issue, to find out who is in favour and who is against and to drop the Bill?

[Mr Lansley]

The hon. Gentleman, himself, was present at 40 sittings in Committee, during which his hon. Friend the Member for Halton (Derek Twigg), the shadow spokesman, said that the Bill had been thoroughly scrutinised. We have debated it; in another place they continue to debate it very fully and very constructively; and I believe that that will deliver us the right Bill for the NHS.

[Andrea Leadsom (South Northamptonshire) (Con)]

Will my right hon. Friend confirm that this Bill is superb news for patients, and that under the Secretary of State’s new Bill, my constituent who requires less invasive hip treatment in a neighbouring county will be able to choose to go to that other provider for a less expensive operation that will do him less harm and more good?

[Mr Lansley]

Yes, indeed. For the first time, not just through the legislation but through the modernisation of the national health service, patients will be able to see, through the data, the quality of the service provided in the NHS by a range of providers. When patients are asked whether they want—on that basis, as NHS patients with a free service based on their need—to be able to choose who should provide them with care, 81% say that they want that choice. We will give them that choice; Labour would not.

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

The Deputy Prime Minister’s letter promised

“additional safeguards to the private income cap”.

Will the Secretary of State explain what are these additional safeguards aimed at ensuring that foundation trusts cannot focus on private profits before patients?

[Mr Lansley]

We have already made it very clear in another place that the legislation will ensure that foundation trusts should have the freedom to increase their private income, not least in relation to international work. However, their principal legal purpose is for the benefit of NHS patients, and so they already have to make sure that they reflect that in their annual reports and in their annual plans. As the letter indicates, we are, with my hon. Friends in another place, working on a further corporate governance mechanism to ensure that foundation trusts reflect their principal legal purpose in all that they do. [Interruption.]

[Mr Speaker]

Order. I want to hear the questions and the answers. Members are a little overexcited and they need to calm down just a tad. A good example of such calm will now, I am sure, be provided by Mr John Hemming.

[John Hemming (Birmingham, Yardley) (LD)]

Under Labour, local democratic accountability in the NHS was reduced by the abolition, without consultation, of the community health councils. The letter refers to the creation of the health and wellbeing boards, which will increase local democratic accountability for the health service. Will the Secretary of State explain how that will ensure that local services in the health service better fit local health needs?

[Mr Lansley]

That is a very powerful and positive step forward. Through the joint strategic needs assessment and the strategy derived from that, local authorities and the NHS will now increasingly work together to deliver integrated services extending across health, social care and public health.

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

Will the Secretary of State please confirm whether all the changes outlined in the Deputy Prime Minister’s letter now represent Government policy?

[Mr Lansley]

The Deputy Prime Minister’s letter accurately reflects the discussions that we have been having in another place—[Interruption] I do not see why that is funny; it is very simple—in anticipation of the amendments that will be debated there on Report.

[Dr Phillip Lee (Bracknell) (Con)]

The previous Labour Government, of whom the shadow Secretary of State for Health was an active member, negotiated private finance initiative contracts that are costing the NHS almost £3,000 per minute. Will the Secretary of State detail what his Department and the Treasury are doing to help to alleviate this enormous level of debt, which has risked the viability of some NHS services?

[Mr Lansley]

We are helping all trusts with PFI contracts to manage the costs of those contracts. Seven trusts were left with unsustainable PFI contracts, and we have made it clear that we are willing to help support them. Labour Members—they are not even listening—are distorting the nature of this legislation, which does not permit privatisation. Given that during their time in office they left the NHS with 102 hospital projects owned, in effect, by the private sector, with a PFI debt of £67 billion, it is outrageous for them to sit there pointing fingers at us.

[Mr David Winnick (Walsall North) (Lab)]

If this is such a marvellous measure that protects the NHS, as the Secretary of State has been saying, why is it opposed by virtually all those in the medical profession and by most of the public, to the extent that he has become almost a hate figure? Is it because he lacks persuasiveness or because this is a worthless Bill that will undermine the NHS?

[Mr Lansley]

The hon. Gentleman should go and talk to the clinical commissioning groups across the country that are delivering on the clinical leadership that will modernise and improve the NHS rather than simply sitting reading the newspapers and imagining that he knows what is going on in the NHS.

[Philip Davies (Shipley) (Con)]

Does my right hon. Friend agree that when she was in government, Baroness Williams was one of the chief architects of ruining the state education system in this country? Given that, why would a Conservative-dominated Government wish to dance to her tune?

[Mr Lansley]

My right hon. and noble Friend Baroness Williams is now a member of the Liberal Democrat party, and in that respect I am not aware that she has ever transgressed in government.

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

Last year, when the Bill was in its infancy, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), gave me an assurance that NHS services in Trafford undergoing changes would not be privatised. In the light of all the amendments, is the Secretary of State able to offer me the same assurance, especially given that the Co-operation and Competition Panel in his Department has instructed the local NHS to devise a contract that is divided into six separate lots, with a warning that competition must be prosecuted, otherwise there will be severe consequences?

[Mr Lansley]

I can give the right hon. Gentleman the same reassurance that the Minister of State gave.

[Mrs Anne Main (St Albans) (Con)]

Will my right hon. Friend confirm that the previous Government were, in 2006, given the advice that it was neither possible nor desirable to ensure that competition was not allowed in the NHS because it is subject to EU competition rules?

[Mr Lansley]

I am glad that my hon. Friend has made that important point. People such as the former Chair of the Select Committee on Health, the right hon. Member for Rother Valley (Mr Barron), who is no longer in his place, are fond of asking why we are introducing competition into the NHS. We are not. The Bill does not introduce competition to or extend competition within the NHS. The legal advice disclosed in one of today’s national newspapers makes it clear that the previous Labour Government introduced the reach of competition law into the NHS by introducing the elective choice programme in 2006.

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

If the Health Secretary believes so much in the value of his Bill, why did he not take the time to explain it to voters before the general election, instead of promising that there would be no top-down reorganisation of the NHS?

[Mr Lansley]

I refer the hon. Lady to pages 46 and 47 of the Conservative party manifesto and, to understand the Bill fully, to the Liberal Democrat manifesto.

[David Tredinnick (Bosworth) (Con)]

I encourage my right hon. Friend to read the minutes of the Hinckley and Bosworth health and wellbeing partnership meeting. He will see that clinical commissioning groups are in place and that there is a priority on early intervention. There is support for the health and wellbeing board and its priorities. Does that not go completely against what we are hearing from Opposition Members?

[Mr Lansley]

I had the pleasure—before Christmas, I think—of meeting the local authority, the director of public health and the three clinical commissioning groups from across Leicestershire, who are all enthusiastic about the opportunities presented by the modernisation of the NHS legislation.

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

Is it not clear to even this Secretary of State that the Bill is now a dog’s breakfast? Given that doctors, nurses, the public, the Lords and many Government Members oppose the Bill, what mandate does he have for such a radical change of the NHS?

[Mr Lansley]

I refer the hon. Gentleman to the point I made about the mandate. Beyond the mandate, staff across the NHS have been clear for years that they want more clinical leadership and clinically led commissioning; they want local authorities to integrate health and social care services more effectively; and they support the transfer of leadership in health improvement into the hands of local authorities. The Bill achieves those principles. That is why all through last year, the Royal College of Nursing told me that it supported the Bill.

[Penny Mordaunt (Portsmouth North) (Con)]

The Secretary of State is not the only one who has noticed a shift in the Opposition’s stance on independent sector provision. I have started to receive letters from constituents who are concerned that Labour will next call for much-loved NHS services that are currently provided by the independent and charitable sectors to be shut down. Will he assure me that if those calls are made, he will fight them?

[Mr Lansley]

My hon. Friend makes an important point about what would happen if we followed the apparent views of the Labour party. More than 11% of mental health services in this country are provided by the private and charitable sectors. Recently, I was in Northampton, where St Andrew’s Healthcare provides important services. I opened its new building, which will provide first-rate, state-of-the-art care for mental health patients. The attitude of the Labour party is that all that should be shut down.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

Up and down the country, thousands of NHS staff have already been laid off—so much for no top-down reorganisation—and many of them are being re-employed at vast expense. When will the Secretary of State publish the costs to date, before the Bill is even law, of this overarching reorganisation?

[Mr Lansley]

I do not know whether the hon. Lady has read the latest monthly data on the NHS work force, but since the election the number of non-clinical staff has gone down by 15,000, including the number of managers by 5,800, and the number of clinical staff has risen, including more than 4,500 more doctors.

[Several hon. Members]

rose—

[Jane Ellison (Battersea) (Con)]

My constituency has considerable health inequalities, so I very much welcome the fact that tackling health inequalities is at the heart of the Bill. Does the Secretary of State share my surprise that the Opposition do not similarly welcome that?

[Mr Lansley]

I have to tell my hon. Friend that nothing much about the Opposition surprises me any more.

[Alex Cunningham (Stockton North) (Lab)]

Will the Secretary of State now accept that, contrary to the impression he is trying to create, the opposition to his muddled bill is not some plot by health workers or trade unions with vested interests, but is coming from many Liberal Democrats, the majority of the British public and almost the entire health community, to whom his Government promised to listen?

[Mr Lansley]

Opposition Members distort what is in the Bill and tell their constituents that it is something other than what it is, and then they come to the House and say, “Oh, it’s muddled.” It is not muddled at all; it is they who are muddled.

[Dr Sarah Wollaston (Totnes) (Con)]

I do not know any GPs who want to see inappropriate use of the private sector. They will be doing the commissioning and the public will be able to see what they are doing. Should we not let them get on with it?

[Mr Lansley]

My hon. Friend is absolutely right. I was very pleased to hear what was said by Dr Sam Barwell—I think her name is Barwell.

[Dr Wollaston]

Barrell.

[Mr Lansley]

Barrell. One had only to listen to how Dr Sam Barrell and her colleagues in the Baywide clinical commissioning group in my hon. Friend’s constituency are providing clinical leadership in south Devon and Torbay to be absolutely clear that the Bill is right to give them that responsibility and that they will use it extremely well.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

If the Deputy Prime Minister’s letter agreed with the Secretary of State, as the Secretary of State has confirmed today, can he explain why the Minister of State, Department of Health, the right hon. Member for Chelmsford, said on Radio 4 yesterday that there would be no further changes to the Government’s Bill?

[Mr Lansley]

My right hon. Friend and I are very clear that, as I explained—really quite carefully, I thought—it is customary in another place for some of the issues that have been debated to be reflected in amendments on Report, and that is what will happen.

[Charlie Elphicke (Dover) (Con)]

Can the Secretary of State confirm that the principles underpinning the Bill are that the NHS is and will remain free for all patients; that a person’s GP knows them and their needs best; and that although we are spending billions of pounds more than Labour would have done, every pound needs to work as hard as possible if the NHS is to be modern and provide care for the future?

[Mr Lansley]

My hon. Friend is right, not least on his point that the coalition Government are investing in the NHS, with real-terms increases each year. That contrasts with the Labour Government in Wales, who in the course of this Parliament intend to reduce spending on the NHS by more than 6% in real terms.

[Jim Shannon (Strangford) (DUP)]

At a very lively Conservative away-day last Friday, a document was issued that stated:

“If we changed or altered the bill now, we would end up in a no man’s land, and chaos.”

Four days later, can the Secretary of State confirm the Government’s position?

[Mr Lansley]

The Government’s position is that there has been very constructive debate in Committee in the Lords, and I look forward to that being reflected in equally constructive debates on Report.

[Duncan Hames (Chippenham) (LD)]

Liberal Democrats hate Labour’s health reforms, which result in hospitals being paid for operations whether they happen or not. Does the Secretary of State consider that the NHS, for which he remains responsible, would be in better health had Labour’s reforms been subjected to the parliamentary scrutiny that his have?

[Mr Lansley]

My hon. Friend makes an extremely good point. Many of the issues that have been the subject of some of the most heated debate on the Bill have been raised because Labour never addressed them. He is absolutely right that one result will be that in future, it will no longer be possible for £250 million to be paid to the private sector for operations that never take place.

[Helen Jones (Warrington North) (Lab)]

Can the Secretary of State explain why he is prepared to get into further discussions with the Liberal Democrats to help them to save seats in May, but not to do so with doctors, nurses and midwives, who all oppose the Bill? Is he engaged in patching up the coalition rather than in providing proper health care?

[Mr Lansley]

I think I made that perfectly clear not only in the course of the initial consultation on the White Paper, but then through the NHS Future Forum. Many thousands of NHS staff contributed their views to the NHS Future Forum, which made many recommendations and we accepted them all.

[Chris Skidmore (Kingswood) (Con)]

Is it not the case that the text of the letter merely reflects the Government’s amendments on Lords Report? The Opposition really should have done their homework, because it has been on the website since 1 February. They are four weeks out of date.

[Mr Lansley]

My hon. Friend is right up to a point. On Report in the other House, amendments reflecting the debate in Committee will be tabled. They might not all be Government amendments, but I am looking forward to constructive amendments. As I have said, if amendments from Liberal Democrat or indeed Labour peers are constructive and will help to improve the Bill, we will accept them.

[Thomas Docherty (Dunfermline and West Fife) (Lab)]

Will the Secretary of State clarify whether the changes are significant, as stated by the Deputy Prime Minister, or merely reassurance, as stated by the Prime Minister’s official spokesperson?

[Mr Lansley]

The amendments on Report that we will support will, by their nature, be significant.

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

Will my right hon. Friend assure my constituents that our NHS reforms will outlaw the practice common under the previous Government of the private sector being paid more than the NHS for exactly the same operation?

[Mr Lansley]

Yes, that is absolutely correct. For the first time, we will have a provision in law that prevents the kind of discrimination in favour of the private sector that was practised in government by the Labour party.

[Derek Twigg (Halton) (Lab)]

In an article in The Guardian on 13 February, Baroness Williams said:

“The way out of this mess is not hard to find… What that would mean for the bill would be dropping the chapter on competition”.

Will the Secretary of State clarify whether he is willing to accept such an amendment from Baroness Williams?

[Mr Lansley]

As I understand it, I have come to the House to answer questions about a letter, jointly signed by the Deputy Prime Minister and Baroness Shirley Williams, which does not say that.

[Christopher Pincher (Tamworth) (Con)]

In 2007, when he was Secretary of State, the shadow Secretary of State waxed eloquent, saying that he celebrated the private sector in the NHS. Has my right hon. Friend any clue to what changed the right hon. Gentleman’s mind?

--- Later in debate ---

[Mr Lansley]

I think opposition changed his mind.

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

The Secretary of State said this afternoon that competition will not be allowed to get in the way of sensible integration of services, so why is Trafford Healthcare proceeding with the commissioning of provider services in six penny packets, as described by my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins)? How can that support the sensible integration of services?

[Mr Lansley]

The hon. Lady must be aware that under the Bill, we will move from primary care trusts that, under current public procurement rules, are very often not capable of integrating services as they would want, to clinical commissioning groups, which will have the freedom and power to do so.

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

Will my right hon. Friend confirm that clauses 22 and 25 of the Bill remain, which for the first time ever put a duty on the Government to deal with health inequality.

[Mr Lansley]

I am grateful to my hon. Friend. That is indeed true, and it gives the lie, if you will forgive me, Mr Speaker, not to anybody in the House, but to those who would represent the legislation as having the effect of widening health inequalities. Health inequalities widened under the Labour Government. For the first time, our legislation will place on all NHS bodies and the Secretary of State a duty to tackle and reduce health inequalities.

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

The Secretary of State will know that Tower Hamlets clinical commissioning group in my constituency has decided today to ask the Government to drop the Bill, citing the bureaucracy it will generate as a key reason. When the structures he has established to advise him tell him that they want no part in the nightmare that he is creating, is it not time to think again and drop the Bill?

[Mr Lansley]

I have been to Sam Everington’s practice in Bromley-by-Bow, which has been gearing itself up. It will use the powers in the Bill and will do so very effectively.

[Harriett Baldwin (West Worcestershire) (Con)]

Foundation trusts will be given the freedom to increase private services and patients will have the right to choose any provider that meets NHS standards. Was the Secretary of State as surprised as I was to learn that that was in the Labour party’s 2010 manifesto?

[Mr Lansley]

I am grateful to my hon. Friend. I suppose that we should not be surprised that the Labour party in opposition has abandoned everything it said in government, but for it to abandon so quickly so many of the things it said even in its manifesto is pretty dramatic.

[Jonathan Ashworth (Leicester South) (Lab)]

If I may say so, I think that the Secretary of State and the Government have been at sixes and sevens over this issue in recent weeks and they would be better off dropping this disastrous Bill. However, may I press the right hon. Gentleman on the answer he gave to my hon. Friend the Member for Dunfermline and West Fife (Thomas Docherty)? If he now agrees that the amendments are significant, as the Deputy Prime Minister has boasted, does that mean that the Prime Minister’s spokesperson was wrong to downplay them as a mere reassurance?

[Mr Lansley]

I am clear that sometimes we need to ensure through amendments that we not only achieve the effect that we intend, but reinforce it in legislation. Some of them will reassure, and some will have significant effects directly on the governance of the NHS.

[Brandon Lewis (Great Yarmouth) (Con)]

To avoid the continuation of the erroneous—that is the word, I think—statements from the Opposition, will my right hon. Friend confirm that the GP survey continually referred to was filled in and returned by about 6% of GPs only, and therefore is not reflective of the views of GPs across the country, such as those at HealthEast, who are keen to get on with commissioning quality health care for their patients?

[Mr Lansley]

Yes, I have the benefit, as do many of my colleagues on the Government Benches, of talking to GPs across the country, individually and in clinical commissioning groups. The issue to address is not the distortion of legislation and its effects but realising benefits for patients. That is where we are. We want to achieve and improve quality for patients. That is where GPs are, where nurses are and where doctors and health professionals are. The legislation is part of the broader process of devolving responsibility to them and patients to allow that to happen.

[Caroline Lucas (Brighton, Pavilion) (Green)]

What is the Secretary of State most worried about: the frightening chaos of the billion pound commissioning underpinning the reforms that will benefit Circle health care, United Health, PricewaterhouseCoopers, KPMG, McKinsey and the rest at the expense of patients; or the personal embarrassment that he would feel if he did what he should do—if he listened to the professionals and the thousands of people who have signed the e-petition—and dropped the Bill?

[Mr Lansley]

I will tell the hon. Lady what most frightens me: it is that if we had carried on the inheritance from Labour, with waste and bureaucracy escalating and a year-on-year reduction in productivity in the NHS, in a financially challenged environment the quality of patient care would have suffered. At the moment, we have an NHS that is doing magnificently well at raising performance across the service while transforming itself to meet future challenges.

[Angie Bray (Ealing Central and Acton) (Con)]

This feels like groundhog day—nothing ever seems to change. Every time the Labour party brings this issue to the House, we hear the same statements, questions and scaremongering. Does the Secretary of State agree that we hear nothing new from the Labour party? All we hear is the same scaremongering—nothing new, no new thinking.

[Mr Lansley]

I bring good news to my hon. Friend. Out there in the real world, things are changing: there are clinicians, doctors and nurses across the country who are taking the opportunity of this responsibility to improve services for patients; there are patients who realise that they will get additional voice and choice; and there are local authorities that realise that, through their health and wellbeing boards, they can use this to drive improvements in health for their population. Those are the things that are changing. Unfortunately, not only is the Labour party not changing but it is going backwards.

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

I listened carefully to the Secretary of State’s answer to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), but it struck me as gobbledegook. Will he spell out in plain English the additional safeguards to the private income cap that the Deputy Prime Minister is seeking to ensure that foundation trusts cannot focus on private profit before patients?

[Mr Lansley]

The hon. Lady will have to look at the amendments tabled in the other place tomorrow.

[Jeremy Lefroy (Stafford) (Con)]

Will my right hon. Friend detail for the House how the Bill will help to improve patient safety and quality of care, which are so important to my constituents and those of everybody in the House?

[Mr Lansley]

I am grateful to my hon. Friend, because there are a number of ways in which I think this issue will be important. First, for the first time, how we improve patient safety will be published in a consistent way, as one of the five domains of the outcomes framework. Secondly, that will be demonstrated by achievement—for example, we have the lowest ever levels of methicillin-resistant Staphylococcus aureus and clostridium difficile infection. Thirdly, the NHS Commissioning Board, which will be established under the legislation, will take national responsibility for the delivery of patient safety, linking it directly to commissioning, whereas in the past the National Patient Safety Agency was an organisation on its own and was not directly linked to the exercise of commissioning responsibility.

[Stephen Mosley (City of Chester) (Con)]

In Chester, we are seeing the effects of tens of thousands of patients fleeing the NHS in Wales to seek better treatment in England. Will my right hon. Friend reassure my constituents that there is nothing in the Bill that will cause the English NHS to be as bad as what we see over the border in north Wales?

[Mr Lansley]

Not only are the Labour Government in Wales cutting the budget of the NHS, where we are increasing it, but the situation is as my hon. Friend describes, with 91.6% of patients in England being seen and treated within 18 weeks, whereas in Wales the comparable figure is just 68%.

[Jason McCartney (Colne Valley) (Con)]

This urgent question has been very much a repeat of last Wednesday’s lengthy debate. Does my right hon. Friend agree that the last 50 or so minutes has been more about spiteful politics than about policy and patient care?

[Mr Lansley]

I agree with my hon. Friend, but fortunately this urgent question has given me another opportunity to remind everybody in this House and beyond that this Government’s purpose is to empower patients, get front-line doctors and nurses in charge in the NHS, cut our tiers of bureaucracy and improve the quality of care for patients.

[Mr Speaker]

I thank colleagues for their succinctness, which enabled 53 Back Benchers to question the Secretary of State in 42 minutes of exclusively Back-Bench time. I am indebted to the House.

Under the terms of Standing Order No. 24, I now call Mr William Cash to make an application for leave to propose a debate on a specific and important matter. As I am sure the hon. Gentleman will know, he has three minutes in which to make such an application.

Health Select Committee Report on Public Expenditure (Government Response)

Lord Lansley Excerpts

Monday 27th February 2012 Written Statements

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

I have today laid before Parliament the Government response to the House of Commons Health Committee’s report “Public Expenditure: Thirteenth Report of Session 2010-12” (Cm 8283). The Committee’s report was published on 24 January 2012.

The modernisation and efficiency challenges we are seeking across health and social care are exceptional; ones that are vitally necessary to secure sustainable and improving services. They are also inextricably linked and mutually supportive. These changes are critical to bringing about a modern care system that is fit to deliver the high quality, responsive, personalised services wanted by people today. As a part of these reforms, we are protecting funding for the NHS and allocating additional funding for social care.

Care Quality Commission

Lord Lansley Excerpts

Thursday 23rd February 2012 Written Statements

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

I wish to inform the House that the Department is today publishing the report of its performance and capability review of the Care Quality Commission (CQC). The review is intended to provide robust assurance to the public, the Department and Parliament that CQC is improving its performance and that action will be taken to build and sustain its capability for the future.

The review ran from October 2011 to February 2012, and was led by a panel of senior departmental officials and external reviewers, chaired by the permanent secretary. The review gathered evidence from a range of external stakeholders and CQC staff. It also considered findings of the recent reports from the Health Select Committee and the National Audit Office.

The review sets out recommendations to challenge CQC and support its continuing improvement by providing clearer strategic direction, strengthening the CQC board and developing and delivering the underlying regulatory model. These recommendations will be important to ensure that CQC builds and sustains its capability for the future. The review also recognises that the Department has more to do as a sponsor and work is under way to strengthen accountability arrangements across all the Department’s arm’s length bodies.

I have today placed in the Library copies of a letters exchanged between the permanent secretary of the Department and the chair and chief executive of the CQC, together with a copy of “Performance and Capability Review: Care Quality Commission”. Copies are available to hon. Members from the Vote office and to noble Lords from the Printed Paper Office.

NHS Risk Register

Lord Lansley Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Andy Burnham]

As I was saying, the Government clearly are not following the statement of policy set out on the Treasury website, but the strange thing, as the House will hear shortly, is that NHS bodies across the country at local and regional level are following the policy closely. As I understand it, the Treasury’s theory is that the more widely the risks are understood and shared, the greater the ability to mitigate them. Indeed, I recall the Minister stating in a press release as recently as last October, the month before the commissioner’s ruling, that an open and transparent NHS would be a safer NHS. Two simple questions follow: why is the Department for Health not following stated Government policy and what it said in October was its own policy; and is the Department in breach of Government policy, or has it secured an exemption from it? I hope that the Health Secretary will shed light on this point today, because at present it does not look too good.

Let me turn to the Government’s other reasons for fighting publication. First, it is claimed that disclosure would

“jeopardise the success of the policy”

That is a moot point. The Information Commissioner said that it is a strange defence, given the Government’s other statements on openness and scrutiny building more robust plans. Secondly, it is claimed that it could have a chilling effect and that officials would be less frank in future. Given that risk assessment is a core part of all public servants’ responsibilities, not an optional activity, that claim was not accepted by the commissioner. Thirdly, it is claimed that the names of junior officials could be disclosed, but the commissioner has said that he was satisfied that the register would identify only senior civil service or senior NHS officials.

Fourthly, it is claimed that disclosure would set a difficult precedent and could lead to the publication in future of information relating to national security. The weakness of this argument, as the commissioner pointed out, is that a precedent has already been set, and it was set by the Labour party when we were last in government. A comparable risk register linked to the specific implications of a particular policy—the Heathrow third runway—was released by the previous Government in March 2009 following a ruling by the Information Commissioner on a request from the current Transport Secretary. Why are this Government not following the clear precedent set by the previous Government? That is the answer to the hon. Member for Weaver Vale. In truth, these four reasons seem to me to be the desperate defences of a desperate Government who have something to hide and a desperate Secretary of State.

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

Let me offer the shadow Secretary of State a view that has been put to the House previously:

“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1192W.]

Does he recognise that view?

[Andy Burnham]

The Secretary of State clearly was not listening. It is not a comparable situation. We are talking about a different document. Does he understand that? It is a different document. How more simply does he want me to say it? He was just talking about the strategic risk register. Today the House is debating the transition risk register, and I would be grateful if he did not continue to muddy those waters.

Why are the Government not following the precedent we set? I do not know whether they will try to produce any more desperate reasons today, but it looks to me as though they have no real defence, as the hon. Member for Cities of London and Westminster (Mark Field) has pointed out. People will be expected later to troop through the Lobby for the Government, without so much as a fig leaf of a principled argument to support their call. Liberal Democrats, who used to lecture us on the supremacy of freedom of information, will be exposed once again: spineless, co-conspirators against the NHS, acting out of nothing but gut loyalty to the suicide pact that is this coalition.

That brings me to my second point. What exactly are Government Members all so desperate to hide, and what precise risks are they running with the NHS? When the Prime Minister made his disastrous decision to allow the Health Secretary to break the promises that he had personally made to NHS staff—indeed, those promises were then enshrined in the coalition agreement—and to proceed with his top-down reorganisation, we warned that the hard-won improvements in waiting times over the Labour years would be placed at risk. That is exactly what has happened.

The Government inherited a strong, self-confident NHS, independently judged one of the best health services in the world, if not the best, and in just 20 months they have reduced it to a service that is demoralised, destabilised and fearful of the future. Throughout the country there are growing signs of an NHS in distress. A and E departments are under increasing pressure, with figures published last week showing that the Government missed their own lowered A and E target for the seventh week in a row.

Between December 2010 and December 2011, there was a 13% increase in the number of people waiting longer than 18 weeks and a 105% increase in people waiting longer than a year. The number of patients waiting more than six weeks for their diagnostic tests has more than doubled, and the number waiting more than 13 weeks has more than trebled.

We have a habit in this House of reeling off such statistics, but every single one represents a family living with worry, a life on hold. On Monday the Health Secretary said that

“pressure on hospitals is reducing.”

If ever I heard it, there speaks a voice from the bunker: a sure sign of what happens when you surround yourself with people who say only what you want to hear.

[Mr Lansley]

We must proceed from facts and be accurate. The number of patients waiting more than a year for treatment in May 2010—the time of the most recent election—was 18,458. In the latest figures, published for December 2011, that figure had more than halved, to 9,190.

[Andy Burnham]

I will trade figures with the right hon. Gentleman. He quotes a different time frame from the one that I quoted. If he is going to resort—

[Mr Lansley]

rose—

[Andy Burnham]

No, I have given way to the right hon. Gentleman. He resorts to those tactics and gives us the view that the pressure on hospitals is reducing, when all over the country hospitals are under intense pressure and A and E departments and wards are being closed, but, if he expects us to take those statements from him, he should know that we are not going to do so. This is not a man living in the real world, and he is not listening to the warnings that are coming from the NHS. It can be no surprise to people that the NHS is slipping backwards, because that is precisely what local and regional NHS bodies have been warning him. The fact is—[Interruption.] I will not give way. The fact is—

[Mr Lansley]

On a point of order, Mr Deputy Speaker. For the purposes of accuracy, I understand the right hon. Gentleman to have said that 105% more patients waited longer than a year for their treatment in December 2011 compared with December 2010, when he should know that the figure—[Interruption.]

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I wish to listen to this point of order.

[Mr Deputy Speaker]

Order. I will decide whether it is a point of order, Mr Campbell.

[Mr Lansley]

Thank you, Mr Deputy Speaker. For the purposes of accuracy, the figures published by my Department for December 2010 were 14,671, and for December 2011 were 9,190, a reduction of almost 5,000.

[Mr Deputy Speaker]

That is not a point of order for the Chair, Mr Lansley. As—[Interruption.] Order. As you well know, that is a point of debate.

--- Later in debate ---

[Mr Lansley]

It’s not actually going to happen.

[Andy Burnham]

The Secretary of State says that it is not actually going to happen, but that assessment was made after mitigation. The assessment states that it is likely, that it is major and that mitigating effects have not taken the risk away. He should probably learn to understand the risk register before he refuses to publish it.

NHS Surrey warns of

“performance measures as set out in vital signs for 18 weeks are not met due to a loss of capacity or focus or availability of funding”.

The rating is 16: extreme, likely to happen, with major consequences. The risk has not been mitigated.

What do the local risk registers say about care for cancer patients? Worryingly, some predict—[Interruption.] The Secretary of State would do well to listen; he is not good at listening. He would do well just to listen to what I am saying. Worryingly, some predict poorer treatment for cancer patients.

NHS Lincolnshire’s corporate risk register states:

“New risk in December—the continuation of the Cancer Service improvement, cancer network and the achievement of cancer waiting time targets”.

The risk rating is 16: extreme, likely to happen, with major consequences.

At NHS Bradford and Airedale again, there is a similar risk, with

“poor patient access to cancer waiting times 62 days urgent referral to first treatment, resulting in poor patient care.”

Its rating was 16: extreme, likely to happen, with major consequences.

--- Later in debate ---

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

Let me put a quotation to the shadow Secretary of State again:

“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1192W.]

I asked in an intervention on the shadow Secretary of State whether he recalled that quotation. It is what he said in an answer to this House in Hansard on 23 March 2007.

[Karl Turner (Kingston upon Hull East) (Lab)]

Will the Secretary of State give way?

[Mr Lansley]

I will in a moment.

Frankly, this is a broken-bat debate in the first place, because the shadow Secretary of State is trying to suggest that this Government should do something that he as a Minister and then as a Secretary of State steadfastly refused to do, using exactly the same arguments that the present Government have used.

I am afraid that the shadow Secretary of State’s bat was broken before he came to the crease, because at Prime Minister’s questions the Prime Minister put it to the Leader of the Opposition that, as he was devoting a whole Opposition day to this debate, he might want to make some argument or put some question to him on this subject, but such a point from the Leader of the Opposition came there none. The shadow Secretary of State is standing at the Dispatch Box without the support of his own leader.

[Karl Turner]

Does the Secretary of State think that his job is at risk and that it should perhaps be on a risk register?

[Mr Lansley]

I do not know about the debate being bad-tempered, Mr Deputy Speaker, but we at least have jokers in the House.

The shadow Secretary of State is out on his own. I will be kind to him and say that at least opposition is coming naturally to him. Whatever we propose, he opposes it, even to the extent of directly contradicting what he and his colleagues said in government. His contribution today was another shameless example. We have seen this before. The last Opposition day debate on this subject was a travesty of his previous views about the role of the private sector, the need for the private finance initiative and the role of competition in the NHS that he espoused in government. He has done a U-turn on those matters and now holds the polar opposite views from those that he held before. That may be a luxury of opposition and he may enjoy it for the moment—actually, I am not sure that he did enjoy it that much—but that kind of inconsistency will keep him in opposition for a very long time.

The shadow Secretary of State spoke for about 50 minutes and I heard not a word of appreciation for the staff of the NHS. We are asking the staff of the NHS to live in financially challenging times, but it is not mission impossible. He said that saving money in the NHS was mission impossible. That is certainly how the Labour party treated it in government. Spending money was about the only thing that it seemed to be capable of doing, but it never spent it well. We are asking the staff of the NHS to save and to reinvest, and to improve performance at the same time.

Did I hear one scintilla of appreciation from the shadow Secretary of State for what NHS staff are doing, or for the fact that we have the lowest number of hospital-acquired infections on record and the lowest ever numbers of patients waiting more than six months and more than one year for treatment? I did not. I put it on record again that whether we compare May 2010 with December 2011, during which time the number of patients waiting more than a year for treatment more than halved, or December 2010 with December 2011, in which time it went down from more than 14,000 to nearly 9,000, the number has gone down. For the shadow Secretary of State to stand at the Dispatch Box and say that it has doubled, which is transparently wrong, is a misrepresentation to the House and a travesty to the staff of the service. He ought to come to the Dispatch Box and withdraw it.

[Mr Edward Leigh (Gainsborough) (Con)]

Of course the views of staff are desperately important, but this is our NHS, and what is really important is the outcome for patients. It is because of the catastrophic decline in productivity that I say to my right hon. Friend that we urge him to keep going, with no more watering down of the Bill. His parliamentary party is 120% behind him.

[Mr Lansley]

My hon. Friend is absolutely right, and when he was Chair of the Public Accounts Committee he constantly told the last Government that they should do something to ensure rising productivity in the NHS. He was not alone in that.

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

Will the Secretary of State give way?

[Mr Lansley]

I will in a moment. Perhaps the hon. Lady would like to explain the views of not only my hon. Friend the Member for Gainsborough (Mr Leigh) but his successor as Chair of the Public Accounts Committee, the right hon. Member for Barking (Margaret Hodge), who said:

“Over the last ten years, the productivity of NHS hospitals has been in almost continuous decline.”

[Interruption.] I hear Labour Front Benchers ask, “What about the risk register?” I will tell them what the risk to the NHS was before we came into government. It was that a Labour Government would carry on failing to increase productivity in the NHS. Productivity would have declined, and the NHS would have been unable to provide patients with the service and care that it should provide, because Labour wasted money on bureaucracy instead of spending it on patient care.

[Emma Reynolds]

I am proud of our record on the NHS, given that patient satisfaction with the NHS is at an all-time high. Does the Health Secretary agree with the analysis of Professor Black in his report in The Lancet that Tory Ministers’ claims that productivity declined between 2000 and 2009 is based on a myth?

[Mr Lansley]

I have just quoted what the Labour Chair of the Public Accounts Committee said on the basis of advice from the National Audit Office, which is precisely in line with data published by the Office for National Statistics. I think I will rest on that.

I want to make it absolutely clear that I appreciate what NHS staff do and the fact that they are delivering improving outcomes. We published 30 indicators of NHS outcomes just two months ago, and 25 of them showed that performance had been maintained or improved. They had not all gone up, but that is why we are focusing on those outcomes, and not just waiting times. However, the average time for which in-patients waited for treatment was 7.7 weeks in December 2011, down from 8.4 weeks at the last election. For out-patient treatment, the average is down from 4.3 weeks at the election to 3.8 weeks now.

[Andrew George (St Ives) (LD)]

rose—

[Mr Lansley]

I know that my hon. Friend will join me in appreciating the success of the NHS in improving waiting times.

[Andrew George]

I do indeed welcome that news, and I do not question what the Secretary of State says about it. However, I am curious about the fact that on one hand the shadow Secretary of State says that it is all going terribly badly but opposes reform of the NHS, and on the other the Secretary of State says that outcomes have never been better but is pressing on with the Bill. Why is he doing so?

[Mr Lansley]

The curious thing, as I know my hon. Friend will appreciate, is that even the Leader of the Opposition says that reform is needed in the NHS because of the challenges that it faces. Of course we can debate what the nature of the reform should be, but the idea that we can simply stand still and that nothing in the NHS needs to change is not the view of NHS staff, patients, the Labour party or the Government. We therefore have to consider what the nature of that reform needs to be, and I believe in patient choice and empowering doctors and nurses on the front line to deliver care. I believe in cutting bureaucracy and removing whole tiers of management to enable that to happen, and in common with my Liberal Democrat friends and colleagues I believe in strengthening democratic local accountability in the NHS and strengthening public health services through local government operations.

The worst possible thing for me to do would be to say, “We need to reform the NHS because it is doing so badly.” I do not believe that, but I do believe we have to root out poor performance. I was shocked to hear the shadow Secretary of State and the right hon. Member for Exeter (Mr Bradshaw), who has disappeared, talking about Stafford hospital. They were the ones who never appreciated the risk of what was happening there. They know that they went through reorganisations without ever addressing the risk. The dreadful things there happened on their watch, so they might at the very least have come here and apologised. The right hon. Member for Exeter came to the Dispatch Box when he was a Minister and said, “Oh, it’s nothing to do with me, it’s all to do with the management of the hospital.”

I believe in foundation trust hospitals, which apparently the Labour party now does not. [Interruption.] The shadow Secretary of State is trying to have it both ways. He is trying to say that he is in favour of foundation trust hospitals, but that if they get into difficulties the best thing is for them to be run by the Secretary of State. He might talk to the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), who was the Secretary of State when, in the Maidstone and Tunbridge Wells NHS Trust, dozens, perhaps hundreds of patients died of clostridium difficile infection at the Kent and Sussex hospital. That was an NHS trust, not a foundation trust. The Department of Health and the Secretary of State have no God-given ability to run hospitals directly and do so better than they can be run by the doctors, nurses and managers in charge. The point is that there must be proper accountability, and through HealthWatch, local government and the responsibilities of Monitor we will have a proper accountability structure in the Bill.

[Andy Burnham]

I said that we would learn the lessons of what happened in the Mid Staffordshire trust, and I apologised at the time on behalf of the Government.

The first-stage Francis inquiry recommended the de-authorisation of foundation trusts. Why is the Secretary of State removing that power in the Bill before Robert Francis has reported again?

--- Later in debate ---

[Mr Lansley]

It is because we are clear that the reason he said that was that there was no mechanism available to Monitor in legislation for the maintenance of services and interventions. The Bill will mean that there is.

I sometimes think that the shadow Secretary of State has not actually read the Health and Social Care Bill. He keeps saying that this or that is in it, or that it does or does not do this or that, but for the first time since 2003, when his predecessor’s legislation stated that there should be a mechanism for dealing with hospitals that are failing, we are setting out a proper structure for the continuity of services. He says that it is just about de-authorisation, but it is not.

[Clive Efford (Eltham) (Lab)]

rose—

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

rose—

[Mr Lansley]

I am sorry, but unlike the shadow Secretary of State I have taken a lot of interventions. I will take more before I finish, but I need to say one or two things without trespassing too much on Back Benchers’ time.

The shadow Secretary of State does not really have anything of substance to talk about, so he wants to talk about the risk register. Let me tell him about our approach to transparency. We are international leaders in openness and transparency in government. Across government, we publish business plans, departmental staffing and salaries, full details of departmental contracts and summaries of departmental board meetings. We are legislating for foundation trust boards to meet in public, which the Labour Government never did; they resisted it. We are opening up the workings of government in ways that Labour rejected outright.

We have set our sights higher than that. In the NHS, we have opened up more information about services than was ever done under the last Government, shining a light on poor performance and promoting better performance. The NHS atlas of variation has been published for the first time, exposing the variation in outcomes for patients in different parts of the country. That was covered up by Labour, which would have said, “Oh, no, that’s the postcode lottery, we mustn’t publish that information.” We have set it out, because that is the route to improving performance.

I remember the shadow Secretary of State’s predecessors as Health Secretary going on the “Today” programme and saying, “Oh, no, nobody’s in mixed-sex accommodation any more. We’ve eliminated all that.” Well, we have published data on that for the first time, showing that 12,000 patients a month were being put into mixed-sex accommodation. Now, because we published those data and acted, that figure has come down by 95% since December 2010. The previous Government covered that information up; we are publishing and dealing with it.

[Several hon. Members]

rose—

[Mr Lansley]

I will give way in a moment.

We have published situation reports and real-time information on winter pressures, but the previous Government never did so. We are investing more in new information collections on A and E performance and new clinical quality indicators for A and E. We are collecting more data on ambulance performance and increasing the number of clinical audits. We are publishing the data on the things that matter to patients, all of which is helping the NHS understand the actual quality of care. We are open and transparent because we believe, as the previous Labour Government did not, that putting information out is in the public interest.

[Several hon. Members]

rose—

[Mr Lansley]

I will give way to the right hon. Member for Wentworth and Dearne (John Healey).

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

In January 2011, the Secretary of State's Department set up the audit and risk committee with a commitment to publish minutes of its meetings within three months. The last note of any meeting of that committee published on its website is from February 2011. Is that international leadership or the same cloak of secrecy that prevents him from publishing the transition risk register?

[Mr Lansley]

When the right hon. Gentleman was a Minister he and his colleagues never published such information, so I will not take any lessons on that. As a Treasury Minister, he refused to disclose a Treasury risk register.

Let me explain what risk registers are for, because an hon. Lady on the Opposition Benches keeps chuntering about them. A high-level risk register, such as those being considered by the tribunal on 5 and 6 March, is a continuously reviewed and updated document that enables officials, advisers and Ministers to identify and analyse the risks of, and to, particular policies. Risk registers present a snapshot of the possible risks involved at any one time. Their purpose is to record all risks, however outlandish or unlikely, both real and potential, and to record the mitigating actions that can ensure that such risks do not become reality.

For such a register to be effective and for it to serve the public interest, those charged with compiling it must be as forthright as possible in their views. The language of risk registers must be forceful and direct. That is essential for their operation, to enable Ministers and officials fully to appreciate those risks and to take the steps to mitigate them, or to redesign policy to avoid them.

It is important to note that such high-level risk registers are different to the risk registers of the organisations from which the shadow Secretary of State quoted, such as the risk registers of strategic health authorities. The latter concern operational matters and not matters of developing and designing policy, and they are written with publication in mind—they are intended to be published. By contrast, there are very clear reasons why Departments—under not just this Government, but previous ones—do not publish their high-level risk registers while they are still active and while policy development is ongoing.

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

The Justice Committee is currently inquiring into the workings of the Freedom of Information Act. It must identify where the proper boundary lines should fall to protect the ability of civil servants to advise Ministers, but that must be set in the context of legislation that the Government have committed themselves to supporting, and which the previous Prime Minister, Tony Blair, has now publicly disowned.

--- Later in debate ---

[Mr Lansley]

I entirely understand my right hon. Friend. My colleagues and I very much look forward to the conclusions of the Justice Committee’s post-legislative scrutiny of the Freedom of Information Act.

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

rose—

[Mr Lansley]

Further advice from my right hon. Friend, not only to me but to the Prime Minister, is always welcome.

[Simon Hughes]

I defend the Government’s record on the openness of information, and I am a clear believer that the Freedom of Information Act, which I and many Liberal Democrats supported, is the right way forward. Will the Secretary of State therefore confirm that the Government are doing nothing other than following the policy provided for in the Act, which is that when there is a dispute, including when the Government and the Information Commissioner have a different view, the matter properly goes to the tribunal, and the Government respond positively to the tribunal’s decision?

[Mr Lansley]

I am grateful to my right hon. Friend, because I had not intended to quote the Information Commissioner, who wrote an article in The Observer in which he rightly states that he is not infallible. The Government have the right to appeal to the tribunal and we have exercised that right. The tribunal is a proper place in which the public interest test can be applied.

Let me return to the reasons why we do not publish high-level risk registers, the first of which is candour. To be effective, a risk register requires all involved—not necessarily the officials responsible for the policy, but others—to be frank and open about the potential risks involved. It is their job to think the unthinkable and to look at worst-case scenarios. It is vital that nothing is done to inhibit the process of identifying risk. If people are in doubt about the confidentiality of their views, they will inevitably think twice before committing themselves to such direct and candid language in future. Without full candour, risk registers across the Government would be bland and anodyne. In effect, they would cease to be of practical value. Inevitably as a consequence, that would lead to a reduction in the quality of advice given to Ministers.

The second reason is that disclosure can increase the likelihood of some risks happening—it is like a self-fulfilling prophesy. When some risks are made public, those potentially affected are likely to act in a way that could increase the likelihood of the risk actually happening. Let us imagine publishing the risk registers of banks—no doubt the shadow Secretary of State would tell us that the risk registers of banks owned by the Government should be published. The consequence of publishing such risks would be to precipitate financial events.

Lord Turnbull, former head of the civil service, and not under this Government, said in another place:

“Managers might be reluctant to be frank in public about operational difficulties if that would undermine their ability to make contingency plans or could trigger an event before their plans are ready.”—[Official Report, House of Lords, 7 December 2011; Vol. 733, c. 729.]

The purpose of a risk register is to secure mitigation of those risks, not to precipitate them.

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

To see a sick baby survive in a specialist neo-natal unit is a joy; to lose a sick baby is a tragedy. Does the Secretary of State understand the concern expressed by Bliss, which represents the parents concerned, at more than 140 specialist nurses going, and at the risk and uncertainty inherent in the Government’s proposals? Will he agree to meet Bliss and me so that he can hear first hand the concerns of the parents?

[Mr Lansley]

I hope the hon. Gentleman knows that I attended Bliss receptions under the previous Government, at which it raised exactly the same issue.

[Jack Dromey]

So you have never met Bliss.

[Mr Lansley]

I have met Bliss—I just said so—and we discussed exactly those kind of issues. I would happily do so again.

The objective of the NHS—this is precisely what we have set out in our focus on outcomes—is to ensure that we seek a continuously improving quality of service for patients. I have many times been on specialist neo-natal intensive care units precisely to understand that. I remember having a long discussion just last year with the staff, including the neo-natal staff, at my local hospital, Addenbrooke’s, and hearing of the importance to them of recruiting an additional neo-natal nursing complement to ensure that they provide the right service. That is nothing to do with the Bill. It is about focusing in the service on delivering quality. That is why we are getting resources into the front line.

The third reason is that the publication of a risk register could take away directly or distract from policy development—the process that it is intended to support. Departmental officials and Ministers should work directly to deliver the policy rather than react to the risks associated with the development of policy before the policy has been agreed.

[John Pugh (Southport) (LD)]

Will the Secretary of State give way?

[Mr Lansley]

I will give way in a moment.

Fourthly, the publication of the risk register would distort rather than enhance public debate. We should remember that a risk register does not express the risks of not pursuing the policy—[Interruption.] Hon. Members should think about it. A risk register does not include the risks of not pursuing a policy and ignores the benefits of a policy—it presents only one side of the cost-benefit equation and is deliberately negative. Effectively, it is a “devil’s advocate” document, not a balanced one.

What is the balanced document associated the Bill? The impact assessment. I have with me a summary of the impact assessment, but there are hundreds more pages. We incorporate all relevant information in the impact assessment because it not only captures the same risks, but puts them alongside the benefits, costs and impacts, including the impact of not taking action.

The impact assessment is the proper evidential and informative basis for parliamentary and public debate. If any hon. Member is in any doubt about the public interest served by not releasing the risk register, I remind them of the advice received by the House nearly five years ago from the shadow Secretary of State. The argument that he put was precisely the argument that we are now putting.

[Duncan Hames (Chippenham) (LD)]

When pressed earlier, the shadow Secretary of State seemed to recognise some of the issues. He said that the publication of any document should be considered on its merits. May I invite the Secretary of State to stand by a simple principle and ensure that his Department always honours the full terms of the Freedom of Information Act?

[Mr Lansley]

We will, of course, fully abide by the terms of the Act. As my hon. Friend knows, and as the Information Commissioner himself said, we are proceeding precisely in line with the provisions of the Act.

[Andy Burnham]

Will the Secretary of State give way?

[Mr Lansley]

Let me make one additional point, and then I will give way to the right hon. Gentleman—again.

All the information was in the original impact assessment. Information was put into the revised impact assessment in September, as is customary on the introduction of a Bill to another place, but in recognition of the Information Commissioner’s decision on 2 November, the Minister in another place, my noble Friend Lord Howe, described—[Interruption.] I will if I need to, but I do not intend to read it all out. He set out the issues covered by the transition risk register to make Members in the other place aware of precisely what those risks were.

[Andy Burnham]

As I mentioned, there is a precedent here under the terms of the Freedom of Information Act. I refer to the request for the risk register on the Heathrow runway. The Information Commissioner having ruled on it, the previous Government published the register. The Government are not following that precedent but instead fighting it in a tribunal. If, on 5 and 6 March, the tribunal does not find in the Government’s favour, will he publish the risk register, or will he carry on fighting?

[Mr Lansley]

I heard the right hon. Gentleman mention his precedent, but it was not a precedent, because that was a risk register relating to an operational matter. I explained to him that the risk registers published by strategic health authorities relate to operational matters.

[Andy Burnham]

This is operational.

[Mr Lansley]

No, the risk register that the right hon. Gentleman is talking about relates to policy development, not an operational matter. It is a high-level risk register akin to others across Government that, if published, would be prejudicial to frank advice in policy development. [Interruption.] I am only repeating the position that he took when Secretary of State. Let me quote him:

“We have determined that the balance of public interest strongly favours withholding the information”.

I will take his advice and stick to my view: the release of the risk register does not serve the public interest, even if it might serve his political interest to make a song and dance about it. I have been clear about it, as has my noble Friend. The information on which any debate about the Bill should be conducted is already in the public domain.

[Rehman Chishti]

Will the Secretary of State clarify something? The point made by the shadow Secretary of State is complete nonsense. For him to give a commitment on something that might happen at a tribunal is bizarre, because the Secretary of State can use the rules under section 59 of the Freedom of Information Act to appeal to the High Court on a point of law. So he cannot give that commitment.

[Mr Lansley]

I bow to my hon. Friend on the procedures under the Freedom of Information Act. We have made it very clear that we are proceeding as the Act provides, as the Information Commissioner himself set out. I want to make it clear to the House that there is no information that it would be proper for the other place to have access to when considering the legislation, that it does not already have access to. The tribunal will be an opportunity not for politicians but for the likes of Lord O’Donnell, the former head of the home civil service, to set out clearly the process by which the free and frank expression of advice to Ministers in policy development needs to be protected under the Act.

I will tell the House about some of the risks that the NHS faced. It faced risks relating to the £67 billion private finance initiative repayment bill left to us by the right hon. Gentleman. He talks about hospitals being under threat, but we have had to offer exceptional financial support to seven hospitals to help them to back up their PFIs. Members might be interested to know that when I announced that decision on 3 February—just a fortnight or so ago—the shadow Secretary of State, who puts his view of these things on Twitter, wrote:

“I didn’t sign them off.”

He did not even use 140 characters. He managed it in even fewer. He said he didn’t sign them off—but oh yes, he did. What about Whiston hospital in St Helens and Knowsley? He signed that off. It is a pathetic attempt to escape responsibility for leaving the NHS in debt. [Interruption.] Oh, he is blaming his junior Minister now. It had nothing to do with him! When he refused to release the departmental risk register back in 2009, did he do that, or is he going to blame one of his junior Ministers? I have such excellent Ministers that I will never have to blame them for anything, but frankly I would never attempt to do so, and I hope they know that.

[Grahame M. Morris]

Will the Secretary of State give way?

[Mr Lansley]

No.

The NHS faced the serious risk under Labour of declining productivity, as has been so powerfully illustrated. Labour turned a blind eye to inefficiency. The reason why we have to plug a £20 billion productivity black hole in the NHS is that Labour let productivity fall year on year before the election. We are pushing productivity up, and already efficiency gains of £7 billion have been delivered.

[Mr Marcus Jones (Nuneaton) (Con)]

My right hon. Friend cited the large PFI contracts that the Labour party landed us with. Does he agree that those contracts have put under threat not only the PFI hospitals themselves but wider health economies and smaller district general hospitals, such as the George Eliot in my constituency? They have been affected too.

[Mr Lansley]

My hon. Friend makes an important point that I understand precisely. He has been a strong advocate on behalf of not only George Eliot hospital but the whole health service in his constituency. I appreciate that.

I shall give a practical example. When I was at the Stobart centre meeting hundreds of general practitioners from across the north-west, those from St Helens said, “We’re really worried about Whiston hospital”—a PFI approved by the previous Secretary of State—“and we can’t deliver the service that we want to for our patients, because all the money will be eaten up by the PFI project at Whiston.” That is precisely why we are tackling the risks that we inherited from Labour.

The NHS also faces risks from Labour’s failed approach to public health. Under Labour, public health budgets were raided and alcohol-related admissions to accident and emergency departments, and levels of obesity and sexually transmitted infections, all rose sharply. I was staggered to hear the Leader of the Opposition talking about fragmentation of sexual health services at the last election. The last Conservative Government—I hope that my coalition colleagues will forgive me for a moment, because I am talking about the Conservative Government before the Labour Government—acted on sexual health, not least in relation to HIV. As a consequence, not only were HIV rates among the lowest anywhere in Europe but sexual infection rates fell for a decade. After the 1997 election the Labour party failed on sexual health, and sexual infection rates rose for a decade. Labour’s position has no basis. We had some of the highest HIV rates at the end of the previous Government’s term. It is outrageous. The Opposition have completely wiped out their recognition of what went wrong under the Labour Government, including on sexual health matters. That is why we are dealing with those risks.

[Henry Smith (Crawley) (Con)]

rose—

[Mr Lansley]

I will mention one more risk, and then give way to my hon. Friend.

There is one more risk: Labour’s IT programme—not a small risk, but a risk of £7.4 billion-worth of contracts, and a risk not just of money not being spent properly or being wasted, but of the opportunity cost to the NHS of not getting high-quality IT in place. This morning I had the pleasure of launching a “Maps and apps” event, showing how we are promoting the use of the latest technologies across the NHS, not on the basis of the Government saying, “Here’s the single app that everybody must use in the NHS: it’s a centralised system,” but by allowing literally hundreds of people—enterprising people from across the NHS and beyond—to bring in new technology applications for the benefit of patients and clinicians across the service.

[Henry Smith]

I am grateful to my right hon. Friend for giving way. Going back to the Labour PFI burden that we have been left with, can he confirm a figure that I heard recently, which is that the burden on the NHS budget amounts to about £3,000 a minute?

--- Later in debate ---

[Mr Lansley]

I am sorry, but I cannot confirm that, short of being able to do that calculation very quickly in my head, but the simple fact is that a £67 billion commitment was made for the future. It is staggering that the right hon. Member for Leigh (Andy Burnham) and his colleagues used to say, “Look, we’re spending more than ever on the NHS,” and, “Look at all these brand new hospitals”—102 hospital projects. One might have thought that they were spending more than ever in order to build the hospitals. It turned out that they were not even building the hospitals with the money that the taxpayer was providing. The last Government left an enormous post-dated cheque for the NHS to deal with after the election, when they left a deficit for the whole of this country—a country mired in debt by a Labour Government and an NHS with a £67 billion debt around its neck.

There is one more risk that the Labour Government left us with: the escalating cost of bureaucracy. The right hon. Gentleman was in charge of the NHS in the year before the election. The cost of bureaucracy in the NHS in that year went up 23%. At the same moment that he was telling the NHS that there was going to be a £20 billion black hole, he launched the so-called Nicholson challenge, to save up to £20 billion. We did not launch it; it was launched when he was—[Interruption.] Actually, it was launched when the right hon. Member for Kingston upon Hull West and Hessle was the Secretary of State, but it was pursued when the right hon. Member for Leigh was the Secretary of State, and at the same time he allowed the cost of bureaucracy to go up by 23%.

[Ben Gummer (Ipswich) (Con)]

There is a further risk to my constituents in Ipswich as a result of the PFI scheme in the east of England, which is that services had to be stripped out of Ipswich hospital in order to provide funding and patient flow through Norfolk and Norwich hospital, which was the largest PFI scheme at the time.

[Mr Lansley]

It was, and it was staggering—my hon. Friend will remember this—that all the difficulties associated with building the Norfolk and Norwich PFI were evident to the last Government and yet they carried on. They carried on signing up to PFI projects that were frankly unsustainable, including, for example, the project in Peterborough—which, sadly, we had to include in the support that we are offering to unsustainable PFIs—which was signed off although Monitor had written to the Department to say that it did not support the project. I do not know, but perhaps the shadow Secretary of State wants to say something about that.

From my point of view, that is why we need to reform the NHS. It is why we were in the position of undertaking the work as the risk register was being published, because we had to avoid all those risks, reform the NHS and move forward to put doctors and nurses in charge, give patients and the public more control, strengthen public health services and cut bureaucracy.

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

rose—

[Charlie Elphicke]

rose—

[Mr Lansley]

I had better give way now, and then that will be the end of it.

[Charlie Elphicke]

I thank my right hon. Friend for giving way; he has been very generous with interventions today. I am proud of what this Government have been doing for the NHS. Indeed, we can see what happens when we protect NHS spending and when we have a cancer drugs fund. We do not need a risk register to see the difference that that makes; we can just look at Wales, where waiting times are rising and cancer patients are being denied access to life-saving drugs and having to wait longer. That is the benefit of the Conservative policies in England.

[Mr Lansley]

My hon. Friend is safely in Dover, a long way from Wales, when he says these things, but I go to Wales and he is absolutely right. It is staggering. The right hon. Member for Leigh and his colleagues can stand there and say, “Oh, well, you know, it’s only”—what is it?—“8% of patients who are not being seen within 18 weeks.” In Wales it is 32% of patients who are not being seen—

[Emily Thornberry (Islington South and Finsbury) (Lab)]

In Wales!

[Mr Lansley]

If the hon. Lady wants more, I will give her more. In this country—in England—we are increasing the NHS budget, despite the fact that her right hon. Friend the Member for Leigh said it would be irresponsible of us to do so. We are increasing the NHS budget in this Parliament in real terms each year. In Wales—

[Emily Thornberry]

Hooray!

[Mr Lansley]

Perhaps the hon. Lady ought to talk to her friends from Wales, because she is deriding Wales. The Wales Audit Office said that the Labour Government there were going to cut the NHS budget in Wales by over 6% in the course of this Parliament. The Wales Audit Office said that on present trends, by 2014-15—before the next election—expenditure on the NHS would be lower in Wales, under Labour, than in any other part of the United Kingdom. Come the next election, it will be Labour that has to defend its neglect of the NHS in Wales, while we in the coalition Government will be able, together, to defend and promote our stewardship of the NHS, including resources for the NHS.

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

I am grateful to the Secretary of State for giving way. As Opposition Front Benchers mock the statistics about Wales, my constituents, sadly, have to experience the performance of the NHS in Wales. Is it not the case that the ultimate risk to the NHS is Labour management of it, which is what my constituents have to put up with?

[Mr Lansley]

My hon. Friend is absolutely right, and that is why, according to the latest work force data, we have increased the number of clinical staff since the election by some 4,500 and reduced the number of administrative staff by some 15,000, including 5,800 fewer managers. The risks of not modernising the national health service are the greatest risks. Without clinical leadership, patients sharing in decision making or a relentless focus on improving outcomes, patients would have received worse care, and the changes needed to save and reinvest £20 billion across the NHS budget over four years would never have been achieved.

[Barbara Keeley]

Will the Secretary of State give way?

[Mr Lansley]

In a moment.

The Health and Social Care Bill underpins those reforms. We need to safeguard the NHS for future generations. The Bill does simple things—many things, but simple things. It cuts out two tiers of bureaucracy. It empowers the NHS Commissioning Board, which we promised in our manifesto. It empowers clinical leaders in local commissioning groups, which we promised in our manifesto. It empowers patient choice and voice, which we and Labour promised in our manifestos, but which only we are doing and Labour is now against. The Bill supports foundation trusts, which Labour said it was in favour of, but which we are going to act on. It introduces local democratic accountability, which the Liberal Democrats promised in their manifesto. It creates new, strong duties to improve quality continuously, reduce health inequalities, promote research and, yes, integrate services around the needs of patients. No fragmentation, no failure to connect up; for the first time, integration as part of the responsibilities, including those of Monitor; no change to NHS values; no undermining of the NHS constitution; strengthening the NHS constitution; free at the point of use, based on need; no privatisation, no charging—

[Barbara Keeley]

rose—

[Mr Lansley]

I will give way shortly.

The only change in the legislation in relation to the private sector is that the Health and Social Care Bill outlaws discrimination in favour of the private sector, which is what happened under the Labour Government, when the private sector treatment centres got 11% more cash for operations and £250 million for operations that they never performed. Perhaps the hon. Lady will explain that.

[Barbara Keeley]

I thank the Secretary of State for giving way—eventually. I want to get back to the risk register, which is the topic of this debate. I understand that staff from McKinsey and Co. attended meetings of the extraordinary NHS management board, which was set up to implement the Health and Social Care Bill. Can the Secretary of State tell us what parts of the transition risk register McKinsey and Co. has been given access to?

[Mr Lansley]

I am not aware of McKinsey getting any access to it, and I have to tell the hon. Lady that since the general election, I can personally say that I have not met McKinsey, so if it is involved in any of this stuff, it is not involved in it with me.

[Barbara Keeley]

rose—

[Mr Lansley]

No, I am not giving way again.

I asked about expenditure by the Department of Health on contracts with McKinsey, because I read about it in the paper and I thought, “Well what’s this all about?” I was told, “Ah, well, £5.2 million was paid to McKinsey in May 2010,” because it related to work done before the election—work done for Labour.

[Phil Wilson (Sedgefield) (Lab)]

Will the Secretary of State give way?

--- Later in debate ---

[Mr Lansley]

No.

I asked, “How much money has the Department of Health spent on contracts with McKinsey since the election?” The answer is £390,000. Well, I know McKinsey well enough from the past to know that we do not get an awful lot of advice for £390,000.

[Grahame M. Morris]

rose—

[Barbara Keeley]

rose—

[Mr Lansley]

No, I am not giving way.

Before the election, in 2009-10 when the right hon. Member for Leigh was Secretary of State, more than £100 million a year was spent by the Department of Health on management consultants; now less than £10 million is being spent on them, so we will take no lessons from the right hon. Gentleman.

We are managing the risks to the NHS. We have delivered £7 billion of efficiency savings and recruited 4,000 extra doctors, and there are 896 more midwives in the NHS than there were at the last election. We have cut the number of managers, 900,000 more people have gained access to an NHS dentist, and nearly 11,000 patients have had access to cancer medicines through the cancer drugs fund, which they would not have had under Labour. As I have said, waiting times are down, mixed-sex accommodation is down, and hospital infections such as MRSA and C. difficile are at record lows.

That is the progress we are seeing in the NHS today, but instead of celebrating it, the right hon. Member for Leigh has brought us a pointless debate. He talks about risk registers, which he himself refused to release. The debate is pointless, as the issue will come before the tribunal on 5 and 6 March, which is the proper place to examine these issues. It is a waste of Labour’s parliamentary time in an opportunistic attempt to divert attention from its lack of any alternative to the reform processes that the coalition Government are putting forward for the NHS. It is a futile motion, a pointless debate on Labour’s part, while we are supporting the NHS with reform through a Bill that has had unprecedented scrutiny. It has been consulted on through the NHS Future Forum, and through other routes continuously with thousands of NHS staff across the country, and we have listened and responded to everything they said. We are taking the responsible route by taking the NHS away from Labour risks towards a stronger future. I urge the House to reject the Labour motion.

[Several hon. Members]

rose—

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

Today’s debate has shown that we have a Government who refuse to be open about the risks of their health Bill and arrogantly reject the widespread concerns of patients, the public, and NHS staff. Instead of providing the leadership that the NHS needs, Ministers have left staff struggling to cope with the effects of their damaging Bill.

Unlike the Government, the NHS is facing up to its responsibilities by publishing local risk registers to try to mitigate the effects of the Government’s plans. NHS North of England warns that the Government’s reorganisation has a high risk of compromising patient safety, as knowledge about how to deal with mistakes and adverse patient events is lost. NHS Midlands and East says that there is a high risk that waiting times will suffer, primary care will be neglected, and joint working with councils will be undermined. As my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) said, NHS London warns that there is a high risk that clinical commissioning groups will not have the skills they need, and that the NHS will fail to deliver either the best outcomes for patients or the best value for taxpayers’ money. NHS Milton Keynes warns that there is a high risk of failure to deliver its statutory requirements, leading to significant harm or fatalities of children and vulnerable adults. That point was raised by several of my hon. Friends, and particularly eloquently by my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell).

However, the Government are not concerned about the risks that the Bill poses to patients, only to their own political prospects. In the past few weeks, we have witnessed the unedifying spectacle of Conservative Ministers scrambling to distance themselves from the wreckage of their Bill and desperately pointing the finger of blame. An anonymous source in No. 10 told The Times that the Health Secretary

“should be taken out and shot.”

Anonymous Cabinet Ministers have told ConservativeHome that the Bill is as bad as the poll tax, that it must be dropped and that the Secretary of State must be replaced. The Financial Times has said that the Chancellor is worried that the Bill will retoxify the Conservative brand. Apparently, the Deputy Prime Minister is furious that the Tory in-fighting is ruining his attempts to get his party and MPs on board. The Secretary of State accuses the British Medical Association of being “politically poisoned” in opposing the Bill; I say that the source of the poison is all on his own side.

[Mr Lansley]

Just so that the record is clear, when I referred to the phrase “politically poisoned”, I was not saying it myself, but quoting Aneurin Bevan’s description of the BMA.

[Liz Kendall]

I notice that the Secretary of State does not deny that members of his own Cabinet and Conservative and Liberal Democrat Back Benchers are concerned about the Bill.

Instead of fighting among themselves, the Government should be relentlessly focused on ensuring that the NHS meets the challenges of the future. Our ageing population, the increase in long-term conditions, and the huge medical and technical advances mean that the NHS must continue to change to improve patient care and deliver better value for taxpayers’ money. As my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) said, that means shifting the focus of services into the community and more towards prevention, so that people stay fit and healthy for longer. It means centralising some health services in specialist centres so that patients benefit from medical advances and get the best standards of care. It also means ensuring that local NHS and council services work together so that older and disabled people can stay living independently in their own home.

The NHS needs service reform, not structural reform. The Bill will make the changes impossibly hard to achieve. The recent Health Committee report on social care states that the best examples of integrated services have been achieved by care trusts, which were set up under the Labour Government, and yet those are being swept away by the Bill. In 2009, NHS London centralised stroke services into eight hyper-acute units. That decision was very controversial at the time, but within six months it had more than tripled the number of patients getting vital clot-busting drugs to the highest rate of any large city in the world. The Bill will put strategic service changes such as that at risk.

--- Later in debate ---

[Liz Kendall]

With the greatest respect to the right hon. Gentleman, I will not waste my time on that point when we have important issues about the future of the NHS to discuss.

Government Members should realise that GPs, nurses, midwives, health visitors, public health professionals, psychiatrists, physiotherapists, radiologists and Opposition Members are against the Bill, not because we are against change, but because it will prevent the changes that the NHS needs.

Government Members do not want to talk about part 3 of the Bill, because they know that people do not want their NHS run like any other market. The Secretary of State and the Prime Minister claim that their Bill is all about cutting bureaucracy and putting patients and clinicians in control, yet the Department of Health now admits in its fascinating document, “Design of the NHS Commissioning Board”, that there will be five layers of management in the Government’s new NHS, except in the performance and operations directorate, in which

“an additional layer (or layers) will be required”.

In place of strategic health authorities and primary care trusts, we will now have the NHS Commissioning Board, four commissioning sectors, 50 local offices, commissioning support units, clinical senates and clinical commissioning groups, as well as Public Health England and the health and wellbeing boards. Patients and staff have been left completely confused about who is responsible for running different services and how they will be held to account.

The Government say that the new structure will cost £492 million a year.

[Mr Lansley]

rose—

[Liz Kendall]

Let me continue to explain this point. I have given way to the Secretary of State already and I want to finish my point.

According to the Government’s own document, the cost of running commissioning support units and commissioning for Public Health England is not included in the costs that have been given. Indeed, it states:

“The costs of providing clinical advice to the wider system will be separately funded.”

That prompts the question, what are all those different organisations doing if they are not helping to improve clinical care? The Government are not cutting red tape, they are increasing it, and they are not liberating clinicians but suffocating them—not my words but those of the NHS Alliance and the National Association of Primary Care, which used to champion the Bill.

Perhaps the Secretary of State should listen to the advice of Dr Peter Bailey, a GP and former chair of a commissioning group in his own constituency. He recently told Pulse magazine that GPs have

“been duped…set up to fail…We stand baffled in the wreckage…put down the sledgehammer. Get rid of the Bill.”

The Secretary of State should listen to the good doctor’s advice. He should grant the freedom of information request submitted by my right hon. Friend the Member for Wentworth and Dearne (John Healey) and publish the risk register. He should listen to the 78 Opposition Members and 15 Liberal Democrat Members who have signed the early-day motion tabled by my admirable hon. Friend the Member for Easington (Grahame M. Morris) calling for the register to be published.

Even today, as this debate has taken place, the Information Commissioner has told the Evening Standard that he thinks the Government should publish the risk register while peers are still debating the Bill. He has said:

“Where proposals are particularly contentious and with far-reaching consequences, it’s better for more information to be available for a broader discussion about the pros and cons before everything’s decided. By enabling people to express their views on proposals, the final decision will be better informed and better understood.”

I say to Liberal Democrat Members that voting for the motion will show that they really support the early-day motion that they have already signed. It will show their constituents that on this issue, they mean what they say and are different from Conservative Members.

Parliament has a right to know the risks of the legislation that it is debating, and the public have a right to understand the true risks of the Government’s reckless NHS plans. I commend the motion to the House.

Oral Answers to Questions

Lord Lansley Excerpts

Tuesday 21st February 2012 Commons Chamber

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

9. What steps he is taking to address levels of PFI debt in NHS hospitals; and if he will make a statement.

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

The previous Government left 102 hospital projects with £67 billion of PFI debts. We have worked closely with NHS organisations for which PFI affordability is an issue to identify solutions for them, which have included joint working with the Treasury to reduce the costs of PFI contracts. Despite that, some trusts have unaffordable PFI obligations. On 3 February I announced how each of them could access ongoing Government support to help meet those costs.

[Chris Kelly]

I thank my right hon. Friend for that answer. Russells Hall hospital was expanded in 2003, but still has £1.8 billion of PFI debt attached to it—debt which will not be paid off until 2042. What steps is he taking to help reduce the PFI costs for hospitals such as mine that have not been completely crippled by Labour’s PFI and therefore do not qualify for central support, but none the less have high levels of debt?

[Mr Lansley]

I am grateful to my hon. Friend, who illustrates the precise issue with what Labour left. Labour talked of building new hospitals but left this enormous mortgage, in effect, of £67 billion. He refers to Russells Hall hospital, which, like others, is having its contracts reviewed for potential savings following the Treasury-led pilot exercise that I described, which was undertaken at Queen’s hospital, Romford.

[Oliver Colvile]

Given that the PFI process has been proven to have flaws in delivering value for money for taxpayers, what effect does my right hon. Friend feel that that will have on new commissioning boards?

[Mr Lansley]

My hon. Friend will know from the very good work being done by the developing clinical commissioning groups in Plymouth that they have a responsibility to use their budgets to deliver the best care for the population they serve. It is not their responsibility to manage the finances of their hospitals or other providers; that is the responsibility of the strategic health authorities for NHS trusts and of Monitor for foundation trusts. In the future, it will be made very clear that the providers of health care services will be regulated for their sustainability, viability and continuity of services but will not pass those costs on to the clinical commissioning groups. The clinical commissioning groups should understand that it is their responsibility to ensure that patients get access to good care.

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

The Secretary of State will recall that he cancelled the new hospital planned for my area shortly after the general election. Will he advise the House how many hospitals the Government are building that use models other than PFI?

[Mr Lansley]

The hon. Gentleman will recall that his foundation trust was looking to receive more than £400 million in capital grant from the Department, which went completely contrary to the foundation trust model introduced under the previous Government. I pay credit to North Tees and Hartlepool NHS Foundation Trust, which is developing a better and more practical solution than that which it pursued before the election—many of the projects planned before the election were unviable. The hon. Gentleman will know that projects are going ahead, and last November, together with the Treasury, we published a comprehensive call for reform of PFI. We achieve public-private partnerships and use private sector expertise and innovation, but on a value-for-money basis.

[Valerie Vaz (Walsall South) (Lab)]

John Appleby of the King’s Fund says that PFI represents less than 1% of the total annual turnover of £115 billion. Does the Secretary of State agree?

[Mr Lansley]

I gave the hon. Lady the figure: £67 billion of debt. Seven NHS trusts and foundation trusts are clearly unviable because of the debt that was left them by the Labour Government.

[John Pugh (Southport) (LD)]

Is the Secretary of State confident that subsidising hospitals burdened with PFI will not be deemed anti-competitive under forthcoming legislation, or state aid under EU legislation? Has he taken appropriate legal advice?

[Mr Lansley]

I always act on advice, and I am absolutely clear that the support we have set out for NHS trusts and foundation trusts will not fall foul of anti-competitive procedures.

--- Later in debate ---

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

4. What steps he is taking to address underperforming hospital management teams.

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

The performance of hospital management teams is the responsibility of their boards. Those are accountable to strategic health authorities for NHS trusts, and foundation trusts are accountable to their governors to ensure that they comply with Monitor’s framework. As part of our work to strengthen NHS trusts so that they can reach foundation trust status, we have published guidance on strengthening trust boards, their clinical leadership and management. We are further strengthening accountability through quality accounts and open reporting so that the public can see the absolute and relative performance of all NHS service providers.

[Dr Poulter]

I thank my right hon. Friend for that answer. It is absolutely right that managers take responsibility for the decisions that they take at a local level on behalf of patients and are held accountable for them. A doctor or nurse who fails in their duty can be struck off, so there is clear accountability, but there appears to be no clear accountability or traceability for the decisions of hospital managers. Who will hold those people properly to account when they have failed?

[Mr Lansley]

My hon. Friend knows that the management of trusts should be accountable directly to their boards. As I said, the management of foundation trusts are accountable, through their boards, to their governors. An important point that arose in relation to Mid Staffordshire NHS Foundation Trust is that we should ensure—we are looking at how to fulfil this—that there is also a code of practice to which managers are held accountable. He knows, as I do, that management must be accountable through their boards.

[Rosie Cooper (West Lancashire) (Lab)]

The Secretary of State has part-begun to answer this question, as he recently threatened to sack NHS boards that do not meet their financial and waiting time targets. The question is this: why is he abolishing those powers in the Health and Social Care Bill? Is he really saying that governors of foundation trust hospitals have the power and wherewithal to sack a board?

[Mr Lansley]

The hon. Lady should know that we intend to enhance the powers of foundation trust governors, but I am simply taking what was her Government’s policy before the election—that all NHS trusts should become foundation trusts, with the freedoms that go with that, and the responsibilities and accountability. We are putting that into place where her Government failed.

[Penny Mordaunt (Portsmouth North) (Con)]

5. What recourse patients have when denied facilities to which they are entitled under the NHS constitution.

--- Later in debate ---

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

8. What progress he has made in improving outcomes for NHS patients.

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

Last December, we published data against 30 indicators in the new NHS outcomes framework, which has been supported enthusiastically by patients, by professionals and internationally. The data show that for 25 of the new measures, the NHS improved or maintained performance, including MRSA infections being down by half and C. difficile infections being down by 40% since 2008-09. I expect continuing improvement over the coming years, as the focus on outcomes drives change and improvement.

[Iain Stewart]

Campaigns such as “Be Clear on Cancer” are invaluable in ensuring the early detection and treatment of serious conditions. Will the Secretary of State do what he can to ensure that there is proper co-operation between charities and local hospitals about the timing of such campaigns, to ensure that the spike in referrals that follows is dealt with as efficiently as possible?

[Mr Lansley]

I will indeed ensure that that happens. We work closely with the cancer charities. We are working with them as we roll out the campaign that was piloted in the east of England to encourage the awareness of symptoms and the earlier diagnosis of bowel cancer. I hope that we will ensure that the services, such as endoscopy services, are available to support that.

[Mr Ben Bradshaw (Exeter) (Lab)]

Is the Secretary of State aware of this week’s report from the distinguished health academic at Exeter university, Dr Mike Williams, which states that his NHS upheaval is putting patient safety at risk and making a Mid Staffordshire-style hospital scandal more likely? Given that, will he assure the House that he will publish the findings of the Mid Staffordshire public inquiry in time to inform the final outcome of the Health and Social Care Bill, if it ever gets through this place?

[Mr Lansley]

The right hon. Gentleman should know that the timing of the publication of Robert Francis’s public inquiry is a matter for the inquiry, not for me. It is pretty rich for him, who came to this Dispatch Box to disclaim all responsibility for what happened at Stafford hospital, to accuse us of being responsible for something like that. Something like that will not happen because our plans focus on quality for patients, which he failed to do.

[Mr Adrian Sanders (Torbay) (LD)]

The Secretary of State will be aware of the report today that more than 1.3 million diabetes patients have not been offered vital tests. Does that not re-emphasise the need for a plan post-2013, when the national service framework for diabetes comes to an end?

[Mr Lansley]

Yes, indeed. I share my hon. Friend’s view about the importance of this publication. For the first time, we are publishing the data so that we are absolutely transparent about performance in this and other areas. It is wrong that there are primary care trusts that are failing to meet the nine standards of care that are set out. That is why we published the atlas of variation. By focusing on that variation and through the commissioners’ responsibility to meet the standards, not least in the publication of the quality standards, we will deliver improving standards across the country.

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

But the Secretary of State must surely be aware that, for seven weeks running since the new year, the NHS has missed its target for 95% of patients to be seen within four hours at A and E. That is precisely what Labour warned would happen when this Government downgraded the waiting times standard. Is it not clear that he has lost control over waiting times while he focuses on the largest top-down reorganisation in the NHS’s history? That is why he is losing public trust on the NHS. He should focus on what matters to people and drop the Health and Social Care Bill.

[Mr Lansley]

Let me tell the hon. Gentleman that the average time that in-patients waited for treatment at the time of the last election was 8.4—[Interruption.] The hon. Gentleman asked a question and I am telling him the answer. The average time was 8.4 weeks. That has gone down to 7.7 weeks. For out-patients, the average waiting time was 4.3 weeks at the time of the election. That has gone down to 3.8 weeks. The number of patients waiting for more than 18 weeks at the time of the election was—

[Andy Burnham (Leigh) (Lab)]

A and E.

[Mr Lansley]

I made it very clear after the election that, on clinical advice, we would relax the 98% target to 95%. Patients are being seen within four hours in A and E far more consistently in England than in Wales, where there is a Labour Government. Let me remind the hon. Member for Denton and Reddish (Andrew Gwynne) that we have more than halved the number of patients who wait more than a year for treatment since the election.

--- Later in debate ---

[Chris Skidmore (Kingswood) (Con)]

14. What progress he has made on reducing the costs of PFI schemes in the NHS.

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

We have made a lot of progress. All PFI schemes are having their contracts reviewed for potential savings following a Treasury-led pilot exercise. We are providing seven of the worst affected PFI schemes with access to a £1.5 billion support fund, and we are working with 16 other trusts to address long-term sustainability. As I said, in November last year the Treasury announced plans for a complete reform of the current PFI model, using public-private partnerships, private sector expertise and innovation, but at a value-for-money price for the taxpayer.

[Chris Skidmore]

I thank the Secretary of State for that answer. The new Southmead hospital in Bristol will cost over £400 million, to be funded by PFI, yet it will take over 30 years, at £37 million per year, to pay that off. That cannot be good value for money for the taxpayer or for the NHS. What more can the Government do to ensure that these contracts can be renegotiated in future?

[Mr Lansley]

My hon. Friend will be aware of the difficulties involved in the contracts that we inherited; that is true for PFI, as well as for the NHS IT contracts and many others. We have to try to use PFI contracts more cost-effectively; on average, the Treasury exercise demonstrated a 5% saving on their costs. Beyond that, we have to ensure that from now on the NHS delivers a much more value-for-money approach to using private sector expertise, including proper transfer of risk.

[Nick Smith (Blaenau Gwent) (Lab)]

PFI enabled the building of many new hospitals and brought benefits to millions of patients. However, the Public Accounts Committee has found that lengthy procurement timetables led to increased costs. What will the Department do to sharpen its capital funding procurement model to get a good deal for the taxpayer?

[Mr Lansley]

That is a sensible question, and precisely why we are pursuing, as we said in November last year, a new approach to public-private partnership that does not entail the extreme costs, delays and burdens that past PFI projects have left. We are working with projects—for example, one at Alder Hey in Liverpool—to ensure that they demonstrate enhanced value for money compared with past PFI projects.

[Mr Stephen Hepburn (Jarrow) (Lab)]

15. What recent representations he has received from health care professionals on the Health and Social Care Bill.

--- Later in debate ---

[Nic Dakin (Scunthorpe) (Lab)]

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

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

My responsibility is to lead the NHS in delivering improved 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 to support and protect vulnerable people.

[Nic Dakin]

If the argument is that doctors are the best people to commission health and manage finances, why not listen to doctors themselves, who universally reject the Government’s plans? Why not listen to the royal colleges and patients groups and drop the Bill?

[Mr Lansley]

The hon. Gentleman just does not know what is happening around the country. All over the country doctors taking clinical leadership in foundation trusts and NHS trusts, and GPs and their nursing and medical colleagues taking responsibility in the new clinical commissioning groups, are demonstrating that they can improve the quality of care for the patients they serve. They hear what is said by the hon. Gentleman and some of his colleagues and think they are completely out of touch with the world in which they live.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

T5. I appreciate that the Government have allocated additional funding for social care, but what more will and can they do in the short term not only to address the current crisis in funding and ensure that funding is used creatively and efficiently locally, but to cater for those with lower-level needs through preventive measures and early intervention?

--- Later in debate ---

[Andy Burnham (Leigh) (Lab)]

The Secretary of State said that he would listen to doctors and nurses but yesterday shut the door of No. 10 Downing street in their faces. But now things take a sinister turn. Let me quote from a letter from an NHS director received last week by a respected clinician of many years’ standing:

“I understand that you are a signatory to a letter which highlights your personal concerns about the Health Bill. It is inappropriate for individuals to raise their personal concerns about the proposed Government reforms. You are therefore required to attend a meeting with the Chief Executive to explain and account for the actions you have recently taken.”

Will he confirm that it is now his policy to threaten NHS staff with disciplinary action if they speak out against his reorganisation?

[Mr Lansley]

No, it is not my policy. I do not know the letter to which the right hon. Gentleman refers, and if he had shown it to me beforehand I could have investigated it. Yesterday, I and the Prime Minister met doctors and medical professionals and they discussed precisely how to improve services for patients. I went to Queen’s hospital in Romford and met nurses, midwives and doctors working to make the trust one in which their public can have confidence and, in due course, a foundation trust. All these things—foundation trusts, clinical commissioning, patient choice—used to be things that he believed in. They are now things that we are achieving but which he has rejected.

[Andy Burnham]

It is, it would seem, the Secretary of State’s new top-down bullying policy, and it is happening right across the NHS. How does he reconcile that with what he used to say about whistleblowing? I remind him of what he once said:

“The first lines of defence against bad practice are the doctors and nurses”,

who

“have a responsibility to their patients to raise concerns if they see risks to patient safety. And when they do, they should be reassured that the Government stands full square behind them.”

Full square behind them so that he can plunge the knife straight into their backs! The truth about his mismanagement of the NHS is coming out: staff bullied into silence, professionals frozen out, crucial information in the risk register—

[Mr Speaker]

Order. We get the gist.

[Mr Lansley]

When the right hon. Gentleman has no argument, he resorts to abuse.

[Ben Gummer (Ipswich) (Con)]

T6. Dentists in Ipswich are increasingly concerned about having to put right work done by dentists from outside the UK who have received temporary registration from the General Dental Council, causing yet more cost to the NHS and trouble for those receiving care. How will Ministers measure the quality of those receiving temporary registration?

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

T2. Given that managed clinical networks for neuromuscular conditions can help to reduce the number of unplanned hospital admissions for patients with life-shortening illnesses and save the NHS money, will the Secretary of State commit to establishing such networks with funding from the NHS Commissioning Board?

[Mr Lansley]

As we have set out clearly, we want to promote clinical networks more widely, not just in relation to cancer and stroke, as has been the case in the past. I shall write to the hon. Lady about whether it would be appropriate for neuromuscular conditions and whether it is embraced in any plans that the NHS Commissioning Board and commissioning groups have in place already.

[Mr Philip Hollobone (Kettering) (Con)]

T7. Northamptonshire residents are rightly concerned that in the county in the last four months of 2011 the East Midlands ambulance service reached fewer than 69% of category A calls within eight minutes. The target is 75%. What hope can my right hon. Friend offer to local residents that this poor performance will rapidly improve?

--- Later in debate ---

[Mr Lansley]

I am grateful for the hon. Lady’s question, and I am glad to say that I had a useful meeting with Mark Goldring of Mencap. I have read his report and, in response to what the hon. Lady has said, I would be glad to write to her and put a copy in the Library.

[Karl MᶜCartney (Lincoln) (Con)]

T8. Is my right hon. Friend as concerned as I am that the employment tribunal of the former United Lincolnshire Hospitals Trust chief executive Gary Walker ended in secrecy? Does he agree that the NHS should stop using public money to impose gagging orders to suppress information that is not only in the public interest, but that impacts on patient safety?

[Mr Lansley]

My hon. Friend will know that it is the policy of the NHS not to use compensation agreements in order to suppress information that is in the public interest, and I will certainly write to him about the case that he raises.

[Kerry McCarthy (Bristol East) (Lab)]

T4. Before the election, the Conservative party and the then shadow Health Secretary received substantial donations from the chairman of the private health company Care UK and his wife. Does he agree with the then Liberal Democrat health spokesman, the hon. Member for North Norfolk (Norman Lamb)—who has now been promoted to Minister—when he said:“This is a staggering conflict of interest which completely undermines the Tories’ claim that the NHS would be safe in their hands”?

[Mr Lansley]

If not abuse, then smear. I never received any money personally from the chief executive of Care UK. The Conservative party solicited and received donations that were declared in the normal way. They had no influence, and we would never permit any such influence over our party’s policies.

[Simon Wright (Norwich South) (LD)]

T9. I recently met Norwich and District Carers Forum to hear about the work that it is undertaking, together with GP surgeries in Norfolk, to help identify carers in the county. What recent steps have Ministers taken to help identify and support carers in Norwich and elsewhere?

[Mr David Winnick (Walsall North) (Lab)]

If I was concerned only with the politics of the situation, I would be urging the Secretary of State to carry on with the Health and Social Care Bill, in view of the political fallout. However, does he realise that the strength of opposition throughout country—certainly among the medical profession, as well as the public—is based on the fact that they believe that the national health service will be seriously undermined if the measure goes through? Why is he not willing to listen to the voices of people who are so concerned that the institution—which we all believe is so necessary—will be threatened and damaged as a result of his measure?

[Mr Lansley]

The hon. Gentleman should go back to last year and recall that not only did we consult on the White Paper, but—following the listening exercise last year with dozens of independent health professionals, who conducted hundreds of meetings with thousands of professionals across the service, who made a substantial series of recommendations, and with the Future Forum clear that the principles of the Bill were supported, just as many organisations continue to say that they support them—we took on board and accepted those recommendations. That is why the Bill, which is in another place, was supported by a majority in this House and was supported by a majority there.

[Steve Brine (Winchester) (Con)]

There has been much talk today about improving outcomes of patient care—when we move beyond the politics—so will the Secretary of State commend the excellent hyper-acute stroke service that he saw with me in Winchester just a few weeks ago? As he knows, the service rightly enjoys the support of the emerging care commissioning group. Indeed, he also met those in the group and saw how positive they are about the changes.

[Mr Lansley]

Yes, and I am grateful to my hon. Friend for the invitation that he extended to me to visit Winchester, which is now forming part of the Hampshire Hospitals NHS Foundation Trust and looking to do so very successfully. I share with him the optimism derived from a meeting with the members of the West Hampshire clinical commissioning group. They, like others across the country, are demonstrating how they will use the responsibilities that they will be given to improve care for patients.

[Mr Dennis Skinner (Bolsover) (Lab)]

As the House will know, I have been a regular customer of the NHS over the last 12 years, and it hurts me to think of what is happening, after all the wonderful treatment that I had for cancer, as well as a bypass and a hip replacement. I am still here to tell the story because of the treatment by those nurses and doctors. Please stop this savage attack on the NHS, and drop this dreadful Bill.

[Mr Lansley]

The hon. Gentleman clearly has no idea of what is actually in the Bill or the modernisation process. It is only about simple things. It is about giving patients information and choice. It is about empowering doctors and nurses and health professionals, and it is about strengthening the ability of the NHS to improve care in the future. That is all that it is about, and it cuts the cost of bureaucracy in so doing. It will enable us and the NHS to do the things that his Government supported in the past—he might not have supported them, but his friends did—including commissioning by clinicians, patient choice and using the best qualified provider. Those are the things that his Government used to believe in, and they are the things that we are doing. There is no privatisation, no charging and no break-up of the NHS. There is only supporting the NHS.

[Nicky Morgan (Loughborough) (Con)]

Ministers will be aware of the Centre for Mental Health’s report last week, which showed that physical health outcomes are linked to mental health outcomes, and that both need to be treated at the same time. Can the Minister update the House on the Department’s progress on implementing its mental health strategy?

[Simon Danczuk (Rochdale) (Lab)]

Every week in my surgery, I hear more and more residents complaining about having to wait too long for an operation, if they can get on to the waiting list at all. This top-down reorganisation is clearly exacerbating the problem. Why do not the Government just drop the Bill?

[Mr Lansley]

The hon. Gentleman is going to have to explain why the NHS’s performance is improving, and why it is better than it was at the election. We have cut mixed-sex accommodation, more people have access to NHS dentistry and hospital infections are at a record low. He talks about waiting times. The number of people waiting over a year for treatment has halved since the last election. The total number of people waiting beyond 18 weeks is lower than it was at the election, and the average wait for patients is lower than it was at the election. I am afraid that the premise of his question is completely wrong.

[Ian Swales (Redcar) (LD)]

Following the closure of a specialist ME clinic in Bolton, will the Minister review the narrow NICE guidelines on the treatment of ME, so that patients can get the outcomes that work for them, and so that the doctors providing such treatment are not placed at risk of losing their licence?

[Mr Lansley]

My recollection is that NICE itself is undertaking a review of the guidelines relating to the commissioning and provision of services for ME. I will check to ensure that that is the case, and if I am wrong I will of course correct the record. I will write to the hon. Gentleman in any case. It is not for Ministers to write NICE guidelines; that is a matter for NICE to deal with independently.

[Several hon. Members]

rose—

NHS Property Services

Lord Lansley Excerpts

Wednesday 25th January 2012 Written Statements

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

I am announcing today our intention to create a Government-owned limited company, “NHS Property Services Ltd”. The company will take ownership of and manage that part of the existing primary care trust estate that will not transfer to national health service community care providers under the plans for healthcare reform set out in the Health and Social Care Bill.

This follows on from the announcement on 4 August 2011 that aspirant community foundation trusts, other NHS trusts, and foundation trusts are to be given the opportunity to acquire part(s) of the primary care trust (PCT) estate deemed “service critical clinical infrastructure”. A copy of the relevant guidance, “PCT Estate: future ownership and management of estate in the ownership of primary care trusts in England”, has previously been placed in the Library.

NHS Property Services Ltd will be wholly owned by the Department of Health. The arrangements for it will be finalised in the coming months, however its objectives will be to:

hold property for use by community and primary care services, including for use by social enterprises;

deliver value for money property services;

cut costs of administering the estate by consolidating the management of over 150 estates;

deliver and develop cost-effective property solutions for community health services; and

dispose of property surplus to NHS requirements.

Properties to be transferred to NHS Property Services Ltd will include some operational estate, estate with multiple occupiers, office and administration estate, estate to be occupied by social enterprises and surplus estate.

Estate that is clearly linked to the provision of clinical services and mainly occupied by NHS providers for that purpose will be transferred to them.

Existing contractual arrangements with service providers that deliver and maintain NHS properties will remain in place to support the needs of this property portfolio.

PIP Breast Implants and Regulation of Cosmetic Interventions

Lord Lansley Excerpts

Tuesday 24th January 2012 Written Statements

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

In my oral statement to the House of 11 January 2012, Official Report, columns 181-183, I described the immediate action which the Government are taking to address the concerns of women who have received breast implants made by the company Poly Implant Prothèse (PIP). I said that, in the light of these events, we needed both to review the lessons that could be learnt, and to consider the wider issues of ensuring the safety of people who are considering cosmetic surgery and similar treatments. I therefore announced two reviews, one to be led by my noble Friend the Parliamentary Under Secretary of State (Earl Howe) which will look at what happened in the United Kingdom in relation to PIP implants; and the second, to be led by the NHS Medical Director, Sir Bruce Keogh, to look at the wider issues of clinical safety and regulation.

The review to be carried out by Earl Howe will report by the end of March 2012 and the terms of reference are:

Review of actions of the MHRA and wider Department of Health

“In the context of current EC directives on the regulation of medical devices and the information generally available at the time on the risks associated with breast implants, to review:

1. what information about PIP implants was available from routine adverse reporting systems;

2. what external concerns about PIP implants were brought to the attention of the MHRA or the wider Department of Health, and when;

3. how these concerns and any related information were handled;

4. what advice was sought and from whom;

5. what information was shared between MHRA and its counterparts in other countries in the EU and elsewhere;

6. how decisions were taken, and who was involved in this process;

7. what action was taken to safeguard and advise patients;

8. whether action was sufficiently prompt and appropriate

The review will advise the Secretary of State on what lessons can be learned for application should similar circumstances arise in the future, and on implications for UK input to the ongoing review of the European Medical Devices Directives.”

The review to be carried out by Sir Bruce Keogh will begin in March 2012 and will report within 9-12 months, that is, at the latest by March 2013, and the terms of reference are:

Review of regulation of cosmetic interventions

“Taking into account the Government’s Better Regulation framework and the concurrent review by the EU of current arrangements for the regulation of medical devices:

1. To review the current arrangements for ensuring the quality and safety of cosmetic interventions posing a potential risk to physical or psychological health, and in particular to consider:

i. whether the regulation of the products used in such interventions is appropriate;

ii. how best to assure patients and consumers that the people who carry out procedures have the skills to do so;

iii. how to ensure that the organisations which deliver such procedures have the clinical governance systems to assure the care and welfare of people who use their services;

iv. how to ensure that people considering such interventions are given the information, advice and time for reflection to make an informed choice;

v. whether there should be a statutory requirement for such organisations to offer redress in the event of harm, and if so how this could be funded;

vi. what improvements are needed in systems for reporting patient outcomes, including adverse events, for central analysis and surveillance.

The review will consider issues of governance, data quality, record keeping and surveillance, as well as ensuring that sufficient information is provided to secure patients’ informed consent. It will include consideration of the feasibility of an outcomes-based register of commonly implanted devices.

2. To make recommendations to Ministers, including interim recommendations if appropriate, and to inform the UK contribution to the EU review.

The interventions to be considered for the purpose of this review could potentially include:

a. the surgical insertion of a medical device or prosthesis, or other surgery intended to change the appearance of the body

b. injection with any product, whether medicinal or otherwise

c. any other form of intervention at the discretion of the review team where the intervention is not clinically indicated to safeguard or improve the physical health of the recipient.”

NHS (Private Sector)

Lord Lansley Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

May I refer the hon. Gentleman to the motion? Its request to the Government is not unreasonable; it asks them “to revise significantly downwards” the cap they have proposed.

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

To what?

[Andy Burnham]

I remind the Health Secretary that he is the Secretary of State, not me. It is for him to bring forward proposals. Forty-nine per cent: in that proposal he is saying that NHS hospitals can give equal priority to the treatment of private patients—that it can be as legitimate an objective for an NHS facility, paid for by the taxpayers, to be used equally for the treatment of private and NHS patients. I put it to the hon. Member for Kingswood (Chris Skidmore) that I am not prepared to accept a cap on that scale. It could lead to an explosion of private sector work in NHS facilities and I do not think that is in the best interests of NHS patients. I would be prepared to accept the Government’s bringing forward proposals that fulfilled a modest loosening of the cap, to give the NHS more freedom at this difficult time, but I am talking in single figures. I am not talking about a doubt-digit, 50% cap—a recommendation that hospitals devote half their resources to private patients.

--- Later in debate ---

[Andy Burnham]

My hon. Friend is absolutely right: this proposal brings that conflict right to the heart of the NHS. At the moment, NHS hospitals have a paramount and overriding duty to the treatment of NHS patients, but considering a health care system whereby services would be delivered through a series of commercial contracts brings that conflict of interest into the health care system—shareholders on the one hand, patients on the other. That is why there is such deep disquiet among health professions about these proposals. It is why those professions applied so much pressure last year, and the pause was ordered. It is why, I am afraid, they are still unhappy today—the Government have not addressed their concerns.

[Mr Lansley]

Before the right hon. Gentleman continues with this wholly erroneous line of discussion, will he reflect on the fact that the Bill introduces, for the first time, a transparency in accounting between NHS activity and any private income in any foundation trust, which he did not put into legislation? The Bill introduces a transparency that there can be no cross-subsidisation between NHS resources and any private activity. It introduces a legal requirement for any foundation trust to explain to the public at its annual meeting how it has used any private income to the benefit of NHS patients. Will he reflect on the fact that the primary purpose of a foundation trust is to provide NHS services? For it to do anything that was to the detriment of NHS patients, involving private patients, would be contrary to its primary purpose and unlawful.

[Andy Burnham]

There are a lot of questions there. The Secretary of State discusses the safeguards, but he has introduced them precisely because he has made a major break with 63 years of NHS history. He needs them because he wants a different health care system in this country, in which much more work is done by private providers and in which the commissioning of services is largely handed over to the private sector. That is why he has had to introduce those safeguards. We had a health service that was planned, managed and publicly accountable, but he is throwing all of that away.

--- Later in debate ---

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

We start 2012, and what is the Labour party’s priority? Is it to welcome the NHS improvements in performance, as reported before Christmas—that waiting times are low and stable, that there are now 90% fewer breaches of mixed-sex accommodation standards than at the same time last year, that hospital infections are at their lowest ever levels, or that there are more doctors and fewer managers in the NHS than at the election? No, none of those was Labour’s priority. Was it to welcome the increase next year announced just before Christmas in NHS funding for primary care trusts, or since Christmas an increase in the funding available this year direct to clinical commissioning groups to enable them to meet the needs of their patients? No, it was not that.

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

I know that the Secretary of State was at Salford Royal hospital last week, where the abundance that he is describing does not seem to be around. That hospital—he went there to talk about nursing—will have to lose many hundreds of its nurses. It seems strange to us that we do not seem to see the abundance that he talks about and it certainly was not apparent at Salford Royal.

[Mr Lansley]

That is exactly the same question that the hon. Lady asked during oral questions. The Prime Minister and I did indeed go to Salford Royal hospital and we were tremendously impressed by what is being done there but, like other hospitals across the NHS, as part of a process of using resources more effectively and as part of the consequences of a transfer to supporting patients more in the community than in the acute sector, that hospital is changing the way it manages its services, and it is delivering cost improvements. We make no bones about that.

We delivered £4.3 billion of cost improvement in the NHS in the last financial year. We are aiming to do more this year. We delivered £2.5 billion, according to the deputy chief executive of the NHS, in the first two quarters. Every penny saved by reducing costs in the NHS is available to be reinvested in the NHS. That is why we are in a position to improve the performance. The hon. Lady did not talk about how that funding is becoming available through savings on central costs—for example, £150 million extra funding this year announced since Christmas for support for the integration of health and social care.

Was that Labour’s priority? No. Did Labour come to the House and say, “We want to welcome the way the NHS has achieved an increase in the flu vaccine uptake,” or the simple fact that flu activity at this stage is at its lowest level for the past 20 years? No, none of that. The hon. Lady talked about Salford Royal and the way nurses are engaging in some best practice—

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

Will the Secretary of State give way?

[Mr Lansley]

No. I am still answering the previous intervention. Nurses are engaging in best practice to improve the quality of care for patients in Salford Royal. Was that the basis upon which the right hon. Member for Leigh (Andy Burnham) chose to come to the House to talk about the things that matter to patients—the quality of care being delivered to patients? No, it was none of those things.

[Barbara Keeley]

Will the Secretary of State give way?

[Mr Lansley]

No. I answered the hon. Lady’s question.

Labour Members came to the House not to pursue the priorities of patients or of those who work in the NHS, but to pursue Labour’s priorities. They are not in 2012; they are not even in the 21st century. They are back in the past. Talking of the past and somebody who lives in the past, let us listen to the hon. Member for Easington (Grahame M. Morris).

[Grahame M. Morris]

The Secretary of State has quoted a series of statistics. Does he welcome the 29% increase in patients waiting more than 18 weeks since May 2010 as a result of dropping targets?

[Mr Lansley]

Let me explain to the hon. Gentleman. The average time that patients waited for in-patient elective procedures in the NHS according to the latest data was 8.4 weeks, which is exactly the same as at the time of the last general election. For out-patients it was 3.9 weeks, compared to 4.3 weeks at the election. For diagnostic tests, despite the fact that the NHS has performed 440,000 more diagnostic tests, the average waiting time is 1.8 weeks, the same as at the election. Long waits? The hon. Gentleman did not say that according to the latest data published the number of patients waiting more than a year for their treatment went down 40%, compared with what we inherited from the Government at the time of the last election.

The motion is all about Labour’s going back to the past. I am staggered. It is almost like revisiting Barbara Castle’s antipathy towards the private sector, or that of the right hon. Member for Holborn and St Pancras (Frank Dobson), the only former Labour Secretary of State now, even including himself, that the right hon. Member for Leigh seems to agree with.

I will ask the House to reject the motion, but in a way I am asking the House to reject those sentiments all over again, because we have been here before with this debate. Far from the House not having had an opportunity to consider issues including the private income cap, I remember having exactly this debate on Report. We were very clear about that. We discussed it when the White Paper was published, we discussed it when the Bill was debated on Second Reading, when it was in Committee and on Report, and it has been debated again in another place. I hope to use this opportunity to trample on some of the myths that the right hon. Member for Leigh and his friends are propagating about the Bill.

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

I have received information from inside King’s College Hospital NHS Foundation Trust that priority is being given to private cancer patients in both diagnosis and treatment. Will the Secretary of State either confirm or deny that that is a fact?

[Mr Lansley]

If the right hon. Lady has any such evidence, she should give it to me. Let me explain that at the moment any individual member of NHS staff would be acting contrary to the NHS staff code of conduct if they saw a conflict between private sector and NHS activity and gave priority to private patients to the detriment of NHS patients. Technically speaking, under the legislation we inherited it is not explicitly unlawful for a foundation trust to do that but, as I explained to the right hon. Member for Leigh, a whole series of specific safeguards relating to the relationship between private and NHS activities was introduced into the Bill in another place. It makes it clear that the principal purpose of a foundation trust is to benefit NHS patients and NHS services. To do anything that is to the detriment of NHS patients will be unlawful. There are specific safeguards stating that foundation trusts cannot cross-subsidise between NHS activities and services and private services. If the right hon. Lady has information of a particular instance, she might as well give it to me.

[Dame Joan Ruddock]

I am grateful to the Secretary of State for giving way again. Does he not understand that a person who has this information is terrified of putting it into the public domain—[Interruption.] I am sorry, but he is wrong. We are talking about someone’s job and livelihood. I simply asked him whether this is correct or not. Does he know?

[Mr Lansley]

I have no knowledge of what the right hon. Lady describes. Let me remind her that those working in the NHS have a responsibility to disclose anything that that they think is to the detriment of their patients’ interests, and under legislation on public interest disclosure they have protection. I announced just before Christmas that in the latest contract for an enhanced advice line there should be a whistleblower advice line.

[Kate Green]

I note what the Secretary of State says about staff who have concerns being encouraged to express them, but in the case of Trafford Healthcare NHS Trust, where a private company has just been commissioned to provide orthopaedic pain relief services, the staff had absolutely no knowledge that that commissioning was going on. How can he be sure that staff will be able to raise concerns when there is such a lack of transparency?

[Mr Lansley]

What the hon. Lady describes is precisely what has happened time and again under the legislation we inherited, which is not transparent. Primary care trusts were not accountable or transparent and an enormous amount of activity went on with tenders that involved the private sector and was not conducted in the way that we want, which is on the basis of a tariff and on the basis of which provider is best able to deliver the highest quality.

Let me deal with the first of the myths propagated by the right hon. Member for Leigh: that we have some kind of privatisation agenda. We do not. As I recollect, the only time any Government had a specific objective to increase the role of the private sector in the NHS was when he was a Minister, his hon. Friend the Member for Leicester West (Liz Kendall) was a special adviser to the Department for Health and Patricia Hewitt was Secretary of State. That was when they were saying they wanted to increase the role of the private sector to 10% or 15%, and the Health and Social Care Bill contains specific provision not to allow such discrimination in favour of private providers in future.

[Andy Burnham]

The Secretary of State says that he has no proposals to increase privatisation. Will he confirm that he has sent a letter through the Department asking clinical commissioning groups to identify three community services that will be subject to a compulsory competitive tender?

[Mr Lansley]

No, because it is not compulsory competitive tendering. It will extend access to any qualified provider—

[Andy Burnham]

That is the same thing.

[Mr Lansley]

It is not. The right hon. Gentleman, having been Secretary of State, ought to understand the difference between compulsory competitive tendering and any qualified provider. Under compulsory competitive tendering, it is the primary care trust that gets to choose who provides the service, but under any qualified provider it is patients who get to choose. One example is access to wheelchair services. Voluntary sector organisations, such as Whizz-Kidz, are setting out to provide a better service. From its point of view, that is not competitive tendering. Wherever Whizz-Kidz provides the service, patients in that area—[Interruption.] If he wants to have a conversation with other Members, he may by all means do so, but I will sit down.

I answered the right hon. Gentleman’s point and I am afraid that it proceeds from a fundamental misunderstanding of the difference between competitive tendering processes, which have been the stuff of primary care trusts—in the past it was they that decided who should provide services—and giving patients access to choice so that they can drive quality. Unlike competitive tendering, which was generally price-based tendering decided on cost and volume, under any qualified provider it is not about price, but about quality.

[Charlie Elphicke]

My right hon. Friend mentioned the provision of wheelchair services, which we have been looking at in Kent when considering how commissioning can be taken forward. Whizz-Kidz offers really great and radical ideas. Is it not the case that the Labour party would have condemned disabled people to the same standard-issue NHS wheelchairs rather than allowing them real choice across the spectrum?

[Mr Lansley]

My hon. Friend is absolutely right. That is precisely why on that basis, using the any qualified provider approach, the chief executive of the NHS can set out the ambition that a child who needs a wheelchair should get it in a day. In the past they would have to wait and then would not necessarily get the wheelchair they wanted, or in any reasonable time scale. This is about driving improvement and quality. Many NHS providers will respond positively to that and deliver the quality, but if they do not we ought to be in a position to believe that what really matters in the NHS is the quality of the service provided to patients. That used to be what the Labour party believed in, which I suppose was why its last manifesto, written when the right hon. Gentleman was Secretary of State, 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.”

That is a complete description of what we are setting out to do. It is a description of the any qualified provider policy and something that he has now completely abandoned, and he has abandoned patients in the process. It is absurd.

The objective of the Bill and of the Government is simple: continuously to improve care for patients and the health and well-being of people in this country, and that includes improving the health of the poorest fastest, and to ensure that everyone, regardless of who or where they are, enjoys health outcomes that are as good as the very best in the world. That is what we are setting out to do.

The motion states that the private sector already plays an important role in providing that care. Indeed, once upon a time the Labour party was in favour of it. The right hon. Gentleman said in May 2007:

“Now the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.”

Like my hon. Friends, I do not understand where he is coming from. The motion tries to face both ways, stating that Labour agrees with the private sector but also wants to have less of it. It agrees that the private sector can make a valuable contribution, but wants to stop it doing so. What matters to patients is the quality of care they receive, the experience of their care and the dignity and respect with which they are treated. Whether the hospital or community provider is operated by the NHS, a charity, a private company or a social enterprise is not the issue from the patient’s point of view. From our point of view, we should not make that the issue. The reason it will not matter is that, whoever is the provider of care, the values of the NHS—universal health care, paid for through general taxation, free and based on need, not ability to pay—will remain unchanged. No NHS patient pays for their care today; no patient will pay for their care in future under this Government. On that basis, I can absolutely restate what the Prime Minister said: under this Government and on our watch the NHS will not be privatised.

[Tom Blenkinsop]

With all due respect to the Secretary of State, I am afraid he cannot say that. We heard the excellent example of Whizz-Kidz, which is a fantastic organisation, but he cannot guarantee that it will get the contract, because Monitor, as we all know from the Bill, has primary control over who gets the service, and it will apply competition law, purely and simply. There is absolutely no guarantee that the third sector or co-operatives will get in, and in any case there is no guarantee that care quality will be applied in the decision.

[Mr Lansley]

Forgive me, Mr Deputy Speaker, but I hardly know where to start, given the degree of ignorance associated with that point. Monitor does not decide who gets the service; patients and commissioners do, and the clinical commissioning groups determine how they commission the services. Quality is absolutely at the heart of the Bill, and at the heart of how we structure the statutory duties of all organisations concerned, but the hon. Gentleman goes on about the application of competition law. Actually, there is no extension of competition law in the NHS and no extension of EU competition law as a consequence of the Bill; it simply enables the NHS to have a health-specific regulator so that the application of competition law and EU competition rules, in so far as they apply because the Bill does not change their application at all, is carried out by a health sector regulator.

Myth No. 2 is that the impact of a wider range of providers in the NHS will drive down the quality of care, but we will give patients more choice and more control over their health care. If people are given clear information about the quality of different providers, they will, with their doctors and nurses helping as their commissioners, choose the provider that is best for them, and the Health and Social Care Bill means that all providers will compete on the quality of their services, not on the prices that they charge.

There will be no incentive for doctors to encourage their patients to opt for the cheapest option, because there will be no cheapest option; there will only be the best-quality option.

[Tom Blenkinsop]

It will be Monitor’s option.

[Mr Lansley]

No, it is nothing to do with Monitor in those circumstances; those whom I have mentioned will make the choice.

The more choice there is, the more innovation there is, the more new ideas there are and the more pressure there is on all providers from all sectors constantly to raise their game for patients. The evidence supports that.

[Andy Burnham]

I have been listening to the right hon. Gentleman very carefully, and he made a statement a moment ago about there being no privatisation—that privatisation will not result from the Bill. Is he saying to us that his Health and Social Care Bill will lead to no additional privatisation of commissioning or provision in the national health service? It is a very clear question.

[Mr Lansley]

There will not be any transfer of responsibility for services from the NHS to the private sector; the NHS will continue to be responsible. The balance in the NHS—[Interruption.] No, I shall answer the right hon. Gentleman’s point. He is trying to interpret “privatisation” as every service currently provided by an NHS provider being provided by an NHS provider in the future, but whether services are provided by the NHS or by a private enterprise, a social enterprise or a charity will be determined by patients choosing who is the best-quality provider. So that is not privatisation; the service remains free, and it remains an NHS service. It is guaranteed to patients in exactly the same way, and there is no presumption in the legislation—in fact, it excludes any presumption—in favour of a private sector provider as against an NHS provider.

The right hon. Gentleman is in absolutely no position to make any criticism of that, because he served in a Government who introduced independent sector treatment centres. They went through the process of giving the private sector contracts that were not available to the NHS, with an 11% higher price on average and a guarantee that they would be paid even if they did not necessarily provide the treatment. The net result was £297 million spent on operations that never took place, and the private sector walked away with that money, so he is in absolutely no position to make any criticism, because we are going to exclude such practices. The contracts that the Labour party gave to the private sector when he was a Minister are exactly the contracts that our legislation will exclude.

[Henry Smith]

Will the Secretary of State confirm that, under the previous Administration, private sector involvement in the NHS went up by 78%?

[Mr Lansley]

Interestingly, under the so-called extended choice network that the Labour Government introduced, the number of elective operations conducted in the private sector went from, I think, 16,000 in 2005-06 to 208,000 in 2009-10—an enormous increase. From the right hon. Gentleman’s point of view, it was marginal capacity that did not really matter, but the point is that patients said that they thought it provided good quality care. In a Care Quality Commission survey, some 96% of NHS patients using independent facilities said that the elective surgery they received was “excellent” or “very good”. The figure for NHS facilities was 79%. On the NHS Choices website, nine of the top 20 highest-rated NHS-funded providers were run by the independent sector; there were no independent-sector hospitals in the bottom 20. The general proposition is that the private sector is worse in the NHS, but there is no evidence to support that.

The right hon. Gentleman will recall that the Royal College of Surgeons conducted a study of the quality of care, and its general conclusion was that the quality of clinical care offered to NHS patients by private sector providers was as good as the care offered by the NHS. So what is his point? He used the private sector, patients used the private sector and patients were happy. What is his point?

[Andy Burnham]

We did, and I have celebrated it already, because it delivered the lowest-ever NHS waiting lists, which I celebrate again. But I am listening to the right hon. Gentleman, and I get the impression that he is completely confused. He cannot admit that his Bill will lead to more privatisation, but that is at its core, and people listening to this debate would have more respect for him if he came to the Dispatch Box and made an argument for what he is trying to do—to create a market in health care. Is he just floundering around? He is no longer able to say what the Bill is really about. It is about more privatisation, so why does he not try to make an argument for what he is trying to do, instead of avoiding the issue?

--- Later in debate ---

[Mr Lansley]

When the right hon. Gentleman finds that his argument is not working, he resorts to abuse. It is very simple: the Bill is not about privatisation. Patients will have access to NHS-funded services; the commissioners of those services will be NHS commissioners who are accountable to the NHS through statutory bodies, and they will not be able to transfer that responsibility to the private sector. Provision will be determined by the choices that patients and their doctors and nurses make about who is the best-qualified provider, and that choice will be made on quality, not on any other basis.

On the simple fact that we are looking to use competition within a tariff system, studies from Imperial college and the university of Bristol have recently shown that when it is introduced quality increases. Indeed, research from the university of York’s centre for health economics suggests that, if anything, the use of such competition has tended to support a reduction in the inequalities of access and care, rather than to lead to greater inequalities.

Let me provide some examples, bearing in mind the path that the Labour party is looking to go down. The Eastbourne Wound Healing Centre, a social enterprise set up by a nurse and an occupational therapist, specialises in wound healing. Patients who go to their clinic often have wounds that have not healed over three years, but more than eight out of every 10 of them have those wounds healed in just six weeks. Should we prevent patients being seen there because it is not actually owned by the NHS?

The City Health Care Partnership in Hull provides palliative care at home for patients and does not put profit before patients. One carer said that

“this clinic is so different, the focus is about how the illness is affecting you and what can be done to support you through it.”

Should we stop it doing that?

Another example is Inclusion Healthcare, a social enterprise in Leicester, which the hon. Member for Leicester West might know. It provides specialist health care to the homeless. Jane Gray, its director of nursing and development, stated:

“We’re providing a better service than we did in the NHS. We’re able to innovate and shape our services without constraint.”

Should we shut it down? Would that reduce inequalities? No, it would make them worse.

[Andrew George (St Ives) (LD)]

I endorse entirely the Secretary of State’s criticism of the previous Government’s bias towards the private sector. I would be grateful if he clarified an issue in respect of the integration of health services. Does he agree that, particularly at the secondary and tertiary level, the question is not so much about privatisation because if the NHS was to lose its preferred provider status, the gradual loss of many aspects of secondary and tertiary services in, for example, an acute general hospital might undermine the viability of the hospital?

[Mr Lansley]

The position is very clear, as the hon. Gentleman should know from the debates that we have had. Continuity of access to services through the NHS is one of the central responsibilities of commissioners and of Monitor. If there is any threat to the continuity of those services, they can step in and take measures to ensure that the services continue, including by agreeing funding beyond the tariff to make that happen. If the extension of any qualified provider could lead directly to the loss of access to essential services for patients, the commissioners and Monitor do not have to go down that path. They can make those judgments.

I caution the hon. Member for St Ives (Andrew George) about hanging his hat on the NHS as preferred provider. Before the last election, the right hon. Member for Leigh said that the NHS should be the preferred provider. His philosophy said that the NHS should be allowed to get it wrong twice before the private sector gets a look in. From the patient’s point of view it is, of course, a very cheerful thought that they will be surrendered to the policy of NHS as preferred provider.

Curiously, in March 2010, before the election and at the same time as he said that his policy was the NHS as preferred provider, the right hon. Gentleman published the “Principles and rules for cooperation and competition”, which he seems to be very fond of and which we are maintaining. That document stated:

“Commissioners must commission services from providers who are best placed to deliver the needs of their patients.”

It also stated:

“Commissioners and providers must not take any actions which restrict choice against patients’ and taxpayers’ interests.”

The reason that the right hon. Gentleman published that document was that he knew that the policy of NHS as preferred provider was already going to be the subject of a legal challenge and that it would not survive that challenge. That is why he restated exactly the principles of co-operation and competition that we intend to incorporate directly and without amendment into the way in which Monitor does its job.

[Tom Blenkinsop]

Will the Secretary of State give way?

[Mr Lansley]

No, I am going to move on. There has to be time for people to contribute to the debate, so I do not want to go on for too long.

The Health and Social Care Bill will, for the first time, ensure that private and voluntary sector organisations have to meet the same exacting standards and be regulated in exactly the same way as NHS organisations when they provide NHS services. Because that extends to any organisation providing NHS services, whether it be private or voluntary, it is disingenuous at best and possibly disreputable for the right hon. Member for Leigh to draw any comparison with the PIP breast implants scandal. There is no comparison between the position of a private company working in the private sector providing private services and the role of a private company operating inside the NHS under NHS controls. He knows that there is no comparison. In the NHS, the patient will be wholly protected. It is our intention to ensure for the first time—this did not happen under the Labour Government—that when a private sector provider operates in the NHS, it has to provide equivalent indemnities to its patients as would be provided through the NHS. That did not happen when the independent sector treatment centres and other things were brought in. There will be better protection. The private sector operating outside the NHS is a different matter.

Myth No. 3 is that raising the cap on private income will lead to a worse deal for patients. The paradigm example is the Royal Marsden NHS Foundation Trust. Its private patient cap is set at 31%. That is because in 2002, 31% of its income was derived from private sources and that was the basis on which it became a foundation trust in 2004. Its current private patient income is 25.8% of its total income. The fact that it has a cap does not mean that it goes up to it. In fact, its private patient level has come down slightly. The effect of setting the cap at 10%, as suggested by the right hon. Member for Leigh, would be to take about a fifth out of the income of the Royal Marsden. The Royal Marsden, like Great Ormond Street, is a classic example of how having a thriving private income from research, joint ventures and patients coming from overseas can get a hospital to a place where it can also consistently be recorded as one of the most excellent hospitals in the NHS, where NHS patients get the best care. It has on one hand the highest level of private patient activity—or, strictly speaking, private income—and on the other hand the highest standard of NHS care. The two things are entirely compatible.

[Andy Burnham]

May I just ask the Secretary of State to correct what he has said about the statements that I made? I did not say that I would reduce the Marsden’s cap. I said that we would allow a small increase on the existing cap that is linked to trusts’ own historical levels of private work. It would help the debate if he would be careful to get my position right. I was not talking about an across-the-board, blanket 10% cap, I simply said that some trusts with a much tighter cap of 1% or 2% were asking for a little extra leeway, which I said should be provided. I am not proposing a 10% cap across the board.

[Mr Lansley]

I think I could be forgiven for not understanding what on earth the right hon. Gentleman was talking about, since he did not put it in his motion and my colleagues had to ask him three or four times before they got anything close to an answer—he was saying “10%, or in single figures, we’re not quite sure what it would be”.

We have always been clear that there is an inherent unfairness in some foundation trusts having a cap set at the maximum 31% and others having it set at 1.5%, as all mental health trusts did when they were allowed to become foundation trusts. Technically, all NHS trusts have no cap at all, and some of them use that flexibility. Great Ormond Street, for example, is an NHS trust, not a foundation trust, and it uses that freedom, mainly to treat patients from overseas. Are we to stop that happening? I ask the right hon. Gentleman where he would set the cap for Great Ormond Street. I will give way to him if he will tell me.

[Andy Burnham]

I am not defending the existing policy. The cap was set for each trust individually to reflect historical levels. The reason trusts such as the Marsden and Great Ormond Street have a more generous cap is the large amounts of private work that they carry out. [Interruption.] Yes, but if and when they become foundation trusts under the Secretary of State’s policy, they will have caps reflecting their historical levels of work if he adopts my suggestion. I have proposed that each individual cap be modestly loosened, but he proposes an across-the-board 49% cap applying to all NHS hospitals, effectively meaning that every NHS hospital could devote half their beds to the treatment of private patients. Will he confirm that that is the effect of the policy that he is bringing forward?

[Mr Lansley]

Answer came there none. The truth is, we are doing exactly what the right hon. Gentleman and his party intended to do. At the election, Labour said in its manifesto:

“Foundation Trusts will be given the freedom to expand their provision into primary and community care, and to increase their private services—where these are consistent with NHS values, and provided they generate surpluses that are invested directly into the NHS”.

That is what we are doing.

[Karl Turner (Kingston upon Hull East) (Lab)]

Will the Secretary of State give way?

[Mr Lansley]

No.

We are giving foundation trusts freedom to generate revenue from other sources that can be invested directly into the NHS. When Moorfields, for example, sets up a clinic in the middle east in a joint venture, should we say, “No, you’re not allowed to do that, because it might imperil your ability to support NHS patients”? Actually, it will help their ability to do so, with NHS Global encouraging the NHS.

I believe in the NHS and in the ability of NHS hospitals and providers, which in the past have had their horizons limited, to move beyond those horizons and deliver much better care. That can include turning them into international providers of choice in joint ventures across the world, and even joint ventures in this country, whether in research or the provision of additional services. However, as I explained to the right hon. Member for Leigh in an intervention, under the Health and Social Care Bill the principal purpose of any foundation trust will be the provision of NHS services. Doing anything that would be to the detriment of its provision of NHS services would be unlawful. Foundation trusts cannot cross-subsidise from NHS services into private services.

[Tom Blenkinsop]

Will the Secretary of State give way?

[Mr Lansley]

No.

Individual staff in the NHS have a duty not to allow their private activity to be to the detriment of their NHS activity. Foundation trusts will have an obligation to be transparent in accounting for the two sources of income, and they will have an obligation to report at their general meeting how they have used their private income to benefit their NHS patients.

I am afraid that what the right hon. Member for Leigh says is a tissue of nonsense. The 49% amendment was introduced only to make it abundantly clear that if the principal purpose of a foundation trust is the provision of NHS services, by extension that would not be consistent with the balance of its activity being private rather than NHS activity—hence 49%. There is no specific intention that NHS foundation trusts should increase their private income to any specific degree.

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

Is it not true that the cap is “up to” 49%? Does my right hon. Friend agree that the best decisions are made not at the Dispatch Box by plucking numbers out of the air, but by patients, clinicians and hospital trusts?

[Mr Lansley]

My hon. Friend is absolutely right. The Labour party appears to be going backwards. Its 2010 manifesto said:

“We will support an active role for the independent sector working alongside the NHS in the provision of care”,

but tonight’s motion says that Labour has abandoned that policy. I quoted earlier the Labour party’s commitment to giving patients the choice of the best available provider. Its policy tonight is to abandon patients, including the 81% who told a survey that they want to exercise choice. Labour’s manifesto said it would give foundation trusts freedom to expand and increase their private services. It has now abandoned that policy.

Why does Labour do that? Why did it abandon those policies? Perhaps it is because the Labour party is a wholly owned subsidiary of the trade unions. Labour is interested not in patients or the NHS, but in the trade unions, because its policy is all about the protection of trade union interests—vested interests. The guarding of the vested interests is the remaining activity of the Labour party, but it will diminish over time.

Let me tell the shadow Health Secretary very simply what we are setting out to do. Under this Government, the power to choose will increasingly lie in the hands of patients, doctors and nurses, and incentives will encourage all providers to integrate their care and improve the quality of their care. The result is not a fragmentation of the NHS or inequalities, but better, higher-quality care, and integrated NHS care that offers everyone the very best care available. We will use choice—patients’, doctors’ and nurses’ interests in delivering that choice—and the best quality provision to deliver better outcomes for patients. That is why I urge the House to reject the Opposition motion.

[Several hon. Members]

rose—

Breast Implants

Lord Lansley Excerpts

Wednesday 11th January 2012 Commons Chamber

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

With permission, Mr Speaker, I would like to make a statement about PIP breast implants. The House will be aware that approximately 40,000 women in this country have had implants manufactured by the French company Poly Implant Prothese, and that these implants could have been made of a non-medical grade silicone gel. My concern throughout has been for the safety and well-being of all these women. I wish now to update the House on what happened; how we are looking after the women concerned; and the further actions required.

In 1997, PIP received a European CE mark for its silicone breast implants. The CE mark was overseen by the German notified body, TUV Rheinland. The Medicines and Healthcare products Regulatory Agency adverse incident centre received a number of reports annually about PIP implants. Based on such reports, in 2008, the MHRA raised its concerns with the German regulatory authorities and the manufacturer. The MHRA was reassured by the notified body that the number of adverse reports was adequately explained by changes in the company’s reporting practices and by the increasing number of implants sold.

However, in March 2010, the French regulator discovered that rather than using medical grade silicone gel in the implants, PIP had in fact been using unauthorised silicone gel. This is in clear violation of the CE mark. The mark was promptly withdrawn and all EU member states immediately alerted. The MHRA immediately issued advice to stop using PIP breast implants in the UK. The French authorities are currently investigating this as a criminal matter, and the UK Government will help in any way we can with their investigation.

Initial toxicology tests in both France and the UK found no significant health risk to women with the implants. Also the MHRA could find no evidence of an increased risk of cancer. However, on 23 December 2011, following an increase in the number of reported ruptures, the French Ministry of Health announced that it was advising women, as a non-urgent precautionary measure, to consider having their PIP implants removed. The MHRA’s advice was that there was no scientific basis for recommending routine removal of implants in the absence of symptoms.

The available data, however, were incomplete. For this reason, I asked Sir Bruce Keogh, the NHS medical director, to form an expert group and to review the available data, including information from the French authorities, and to offer more definitive advice. I received the group’s interim report on Friday 6 January and a copy has been placed in the Library. I would like to thank the experts and members of the profession for their hard work and commitment in producing this rapid report.

The main findings of the expert group were, first, that there is no causal link between these implants and breast cancer. Secondly, the evidence on the rate of ruptures for PIP implants compared with other implants is incomplete and so this risk cannot be assessed definitively. Thirdly, although the rupture of implants or leakage of material can result in inflammation, there is no clear evidence that these problems are more serious in relation to PIP implants than other implants, or that they result in increased long-term health risks. Therefore, they have not recommended routine removal of the implants. Fourthly, there are risks inherent in the removal of breast implants, just as with any surgery, and these risks should be taken into account when taking any clinical decisions. However, for this particular group of women the risk is very low. Fifthly, the expert group recognises, as we have throughout, that women with PIP implants will be understandably concerned that they did not have the character of implant that they thought they did. The expert group advises, as we have, that we should give every woman an opportunity to secure advice, investigation and remedy.

The women who received the implants did so on the understanding that the implants met the requirements of the CE mark and were safe. That was not the case, and every provider has a responsibility to put things right. Although the majority of women will have received their implants privately, some—such as those who have had reconstructive surgery following mastectomy—will have received PIP implants through the NHS. All those patients will receive the highest possible standard of care. First, they will be contacted to inform them and give them all the relevant information and advice. Women who wish to will be able to speak to their GP or the surgical team that carried out the original implant to get advice on the best way forward for them. If the woman chooses, that could include an examination by imaging. If, when informed by an assessment of clinical need of the risks involved and the impact of any unresolved concerns, a woman decides with her doctor that it is right to do so, the NHS will remove and replace the implants, if the original operation was done by the NHS. Last week the NHS chief executive wrote to the service, and Dame Sally Davies, the chief medical officer, wrote to GPs and relevant health professionals. Copies of those letters are available in the Library.

It is right that those who received their care privately should also receive a similar level of service and reassurance from their care provider. However, I do not think it fair to the taxpayer for the NHS to foot the bill for patients who had their operation privately. Eight private health care companies, including Nuffield Health, Spire Healthcare and BMI, have confirmed that they will follow the same guidelines as those that I have set out for NHS patients. However, I want to be absolutely clear that the NHS will continue to be there to support any woman. If a clinic that implanted PIP implants no longer exists or refuses to remove the breast implants, where that patient is entitled to NHS services, the NHS will, in consultation with their doctor, support the removal of PIP implants in line with the guidance that I have just outlined. Any NHS service in that instance would cover only the removal of the implant, which would not include the replacement of private cosmetic implants. In such cases the Government would pursue private clinics to seek recovery of our costs.

These events highlight the need to ensure the safety of people having cosmetic interventions. It is clear from the information that we have received from the industry that the safety information that it collects and provides to the regulator is of variable quality. Without good data, we have no way of knowing when problems arise. I believe that there are a number of things that we now need to do. First, lessons need to be learned from this case and incorporated into the ongoing review of the EU medical devices directive. I spoke to Commissioner Dalli yesterday, and can confirm that this European work is under way. We also need to understand what happened in this instance in the United Kingdom. A review for that purpose will be led by the Minister for Quality, Earl Howe, with expert advice, and will shortly put its terms of reference in the Library. That review will investigate and report rapidly. The blame for what happened lies with PIP, but the review will enable us to learn lessons to improve future regulatory effectiveness and will feed into the Commission’s review.

In addition, the Care Quality Commission will conduct a swift review of private clinics. That review will look at evidence of compliance, patient safety and clinical quality, and the information and support given to their patients. Where a provider does not meet those requirements, the CQC has a wide range of enforcement powers that it can use to protect the safety of patients. The findings of that review will be published before the end of March.

Looking to wider issues of clinical safety and regulation, I have also asked Sir Bruce Keogh to reconstitute his expert group to look at how the safety of patients considering cosmetic interventions can be better ensured in the future. That will include treatments such as cosmetic surgery and dermal fillers. I expect his review to consider whether cosmetic products and interventions are appropriately regulated and have strong clinical governance; whether patients and consumers can be confident that the people who carry out procedures have the skills to do so; and whether the settings in which such procedures take place are able to ensure the care and welfare of people who use their services. That review will consider issues of governance, data quality, record keeping and surveillance, as well as ensuring that proper information is provided to secure patients’ informed consent.

I expect the review also to include consideration of an outcomes-based register of frequently implanted devices, covering everything from breast implants to heart valves and replacement joints, in order to provide the United Kingdom with a valuable asset for further innovation and safety improvement. There is already considerable clinical support for such a comprehensive register. The Government’s commitment is to provide effective reassurance and remedy for women with these implants, and also to learn the lessons to deliver safety and quality for the future. I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

I thank the Health Secretary for his statement, and for the steps that he is taking to help the thousands of women who have found themselves in this worrying situation. We welcome much of what he has just announced, including the further reviews that he has commissioned. I assure him that we will support him in his efforts to reach a resolution as quickly as possible for all those people who are affected, but I have to tell him that he has a lot of work to do, and a lot of ground to recover, as his response to date has not helped to build those people’s confidence.

Over the Christmas break, the mixed messages coming from the Government did not go unnoticed. They only added uncertainty in what has been an anxious time for many people. The Health Secretary has gone from downplaying the dangers on 23 December to announcing an urgent review on new year’s eve, then giving an inconclusive statement late last Friday evening. This has left the people affected struggling to make sense of what it means. For the vast majority whose implants were fitted privately, there was precious little practical advice or help from the Department of Health as they began approaching their private providers. Many women were unable to access their records or told that long delays would be involved. Others have been asked to pay large fees to access their records. Many have simply hit a brick wall when they have sought medical advice or removal, even where there is evidence of rupture.

What people needed at the earliest stages was a strong statement from the Government of what was expected of all private providers—namely, that records should be provided without delay and without charge; that consultations should be arranged when people were worried; and that removal should be arranged urgently when there was evidence of rupture. The reality is that the Government’s failure to provide that leadership from the outset has left people fending for themselves in the face of a self-serving and unaccountable industry.

The Health Secretary was right, however, to establish an urgent review of the evidence by the NHS medical director, Professor Sir Bruce Keogh. We welcome the speed with which that review was conducted, and we echo the Health Secretary’s thanks to the members of the review panel. We accept the Government’s judgment on the advice to women regarding the removal of implants on the basis of the data that they have seen, but what confidence can we have in the evidence and data on which those decisions were reached?

We note the Secretary of State’s public comments about the industry’s failure to provide quality information in a timely fashion, and the interim report’s finding that the evidence is subject to “considerable uncertainty”. The review concludes that it should reconvene in “about four weeks time” to examine any new evidence, and to consider whether to update its recommendation on removal. I have to tell the Health Secretary, however, that that feels way too vague and ad hoc. May I press him to give a clearer timetable for this further process of review on whether to change the recommendation on removal? People need absolute clarity on when further statements will be made, so that they can make informed decisions. This is of course a separate matter from the long-term reviews that he has announced today.

This is particularly important in the light of the different decisions that other Governments are beginning to make in response to the situation. Yesterday, the Welsh Government announced that all women who received PIP implants, including those treated privately, will be offered replacement implants on the NHS. That is of course different from what the Health Secretary has announced today. What discussions did he have with his counterpart Minister in the Welsh Assembly Government before their announcement was made? Will he assure the House today that all the data that were available to Welsh Ministers and officials were also available to, and considered by, the Keogh review? Governments around Europe have responded sooner, more decisively and with greater clarity than the coalition has done. By contrast, people here have found the Government’s statements in response to be both inconclusive and ambiguous.

We support the decision to help NHS patients to have PIP implants removed and replaced, but does the Secretary of State appreciate how that decision has added to the confusion that many people feel and was interpreted as contradictory to the review’s overall finding? The clear implication of the Keogh review is that the best course of action is, in fact, to have the implants removed, but again no practical help was offered beyond the statements of expectation for private providers to match the support on offer from the NHS and the reference made to “moral duty”.

I, too, commend the private providers, such as Nuffield, Spire and BMI, that have done the right thing by their patients, but in recent days we have heard how some of the leading cosmetic surgery clinics have simply ignored the Health Secretary’s appeal. Transform, which used PIP implants on over 4,000 patients, has said that all women affected will have to pay £2,800 for removal, while the Harley Medical Group, which has 13,900 patients with PIP implants, has offered to pay for the cost of the new implant, but only if the NHS pays the far greater bill for the surgery. I am sure the whole House will agree that this is an appalling response to this situation, and that the failure of these companies to face up to their duty of care for their patients leaves everybody, including the Government, in a difficult position. It is simply unacceptable for any woman in England to be left in a position where she is worrying about her health and thus has no peace of mind, but is unable to afford to do anything about it.

I appreciate what the Health Secretary has said today about helping people out of this predicament. I agree with his decision where private clinics no longer exist, but in accepting that the NHS will provide private treatment where private providers refuse to, is he not in danger of letting those providers off the hook? May I remind him that most people will not accept that the NHS should subsidise the failures of private companies, and will look to him to pursue them to the nth degree to get any costs back? For instance, has he fully explored the insurance position of these private providers as a means of recovering costs? He says he will pursue them, but what assumptions has the Department of Health made about the likelihood of his success, and how much money is expected to be recovered? Has he fully explored the position of the French Government and considered whether there is any residual liability on the device manufacturer in that company?

Let me turn briefly to questions of regulation. Can we support what the Secretary of State said today about the wider review of regulation of the cosmetic surgery industry? If there are any loopholes, we will support him in closing them down.

Finally, the right hon. Gentleman’s Health and Social Care Bill envisages a much expanded role for the private sector in the delivery of health care. I make no comment about that, but has he reflected on the Bill and revisited the assumptions behind it? Will he assure us that issues of quality and safety will be safeguarded in the NHS that he seeks to create? We want to be assured that he is giving careful consideration to all these issues, as he considers his response to this worrying situation.

--- Later in debate ---

[Mr Lansley]

I am grateful to the shadow Health Secretary for his welcome of my statement and the principles behind what we are setting out to do to look after the women affected by these implants.

I do not share the right hon. Gentleman’s view that there were any mixed messages. I am sure he would have been the first to complain if I had not identified the lack of available and consistent data and not asked an expert group to look into this. As we look at countries across the world, we can be confident that we have set an exemplary standard in looking after women through the NHS and in bringing together an expert panel fully to understand what would be the best advice for women. The advice that no identified specific safety concern justified the “routine removal” of these implants was true on 23 December and it remains true today. As we have recognised from the outset and as I said on 23 December, if women are worried or concerned about the possibility of not having the implant they thought they had, that provides a perfectly reasonable basis on which to seek advice and investigation. It would be right for some women to ask for removal, but we should not assume that women are choosing to have these implants removed on the basis of clinical advice—even in France.

The chief medical officer spoke to a clinical counterpart in the Welsh Assembly Government before the publication of the expert group’s work. I have made sure that they are informed, but I have to say that the Welsh Government made an announcement yesterday without previously informing us.

[Paul Flynn (Newport West) (Lab)]

It’s called devolution.

[Mr Lansley]

It may be called devolution. I respect the devolved Administrations and always inform them of what I am doing, where it is relevant to them. We do not recognise the advice that Wales received. Sir Bruce Keogh’s expert group, which included some of the foremost experts in plastic surgery, made clear recommendations last week for patients in England and concluded that there was no significant increased clinical risk in cases where implants are not replaced.

If the shadow Secretary of State commends what the Welsh Government have done—[Interruption.] Perhaps he did not, but if he or anyone were to commend it, they would need to recognise that it runs the risk of letting the private providers off the hook. I am very clear that they should provide an equivalent standard of care. As the right hon. Gentleman made clear, there are limitations on what can be done. I do not have powers and I did not inherit powers to control what the private providers do in the private sector. I have to tell the right hon. Gentleman, however, that I have reflected on the Health and Social Care Bill, which is a positive legislative step forward. Just as it allows Monitor as a health and social care sector regulator, on which we are consulting, to look at the prudential regulation of private providers in social care, so it would allow us to consider the role of Monitor as a health sector regulator in licensing private providers of private health care. It is thus a positive not a negative step forward. There is no comparison, as the right hon. Gentleman will recognise, between the role of the private sector providing private care and the private sector in the NHS, which is subject to the same duties and obligations as an NHS provider. The Bill does not lead to an increase in private sector provision, but in so far as there are private sector providers, they will be properly regulated in the NHS.

On the role of private providers, they may be insured and there may be warranties relating to these implants. We do not have data on this aspect, but I am clear that these providers have legal and, indeed, moral obligations. I particularly commend a letter issued this morning by the leaders of the profession—the two principal professional associations—to their surgical colleagues. Having talked about the standard of care in the NHS, the letter went on to say:

“Those working in the private sector are urged to support in similar fashion. We would hope that implanting surgeons would honour requests for replacement surgery free of surgical charge”.

The private providers that have not made this offer to the women for whom they are responsible can see that their surgical associates are willing to carry this out free of surgical charge, so I see no reason why they should not now step up and deliver the standard of care that women have a right to expect.

[Mr Stephen Dorrell (Charnwood) (Con)]

May I welcome my right hon. Friend’s statement and the prompt action he has taken over the last few weeks to address this issue? Does he agree that the first priority when these concerns came to light was to ensure that the women who have had these implants had clear, authoritative advice based on the evidence of the right way to treat them, and that the process he established under Sir Bruce Keogh has provided and will continue to provide exactly that authoritative evidence-based advice? Does he further agree that there are some longer-term policy issues around the regulation of this industry that need to be addressed, but in a more considered way and not tied up in the emotions of this immediate concern?

[Mr Lansley]

I am grateful to my right hon. Friend and agree with all his points. I would add that when the French Government informed us of their prospective announcement—I spoke to the French Health Minister the day before it—we gave the best advice to date, based on the MHRA’s knowledge of the toxicology tests and its discussions with the French regulator. What we have to do is to establish the extent to which surveillance of these implants over a number of years should have led to any different conclusion. It remains true, however, that there is no evidence of long-term health effects that would give rise—and would have given rise at that time—to a different recommendation from the one that we made.

[Ann Clwyd (Cynon Valley) (Lab)]

This is not a new issue, as the Secretary of State must know. Twenty years ago I raised the case of a constituent who had to have a double mastectomy because silicon implants had leaked in her body. As a result, we set up an organisation called SOS—Survivors of Silicon. We worked with Which? magazine and the Department of Health, and we helped to set up the register of implants, which was unfortunately not made compulsory. That is why the data are missing.

This is part of a wider issue, of the proper regulation of the cosmetic surgery industry, 70% of which is virtually unregulated. I hope that the Secretary of State will insert an amendment into the Health and Social Care Bill to ensure that there is proper regulation of the whole industry.

--- Later in debate ---

[Mr Lansley]

I completely understand the right hon. Lady’s point, but this activity is not unregulated. For example, the Care Quality Commission is responsible for the registration of providers, and for ensuring that they meet essential standards of safety and quality. However, for precisely the reasons cited by the right hon. Lady, I am asking Sir Bruce Keogh’s group to consider wider issues relating to the regulation of cosmetic surgery and cosmetic interventions.

The registry to which the right hon. Lady referred was discontinued in 2004 because a substantial number of women were not consenting to the addition of their names to the register. I believe that, given the positive experience that has followed the establishment of the National Joint Registry, we can reassure women that their data can be entered without prejudicing their patient confidentiality.

I should make it clear that as yet we have no evidence demonstrating any significant difference between the rupture and leakage rates of PIP breast implants and those of other implants. Last June the American Food and Drug Administration published the findings of a study of normal implants, two of which had a 10% to 13% rupture rate over a 10-year period. It is important to appreciate that implants in themselves pose a distinct risk of rupture and leakage.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome the clear commitment to putting women’s health needs first in this context, but is not the heart of the problem the obvious conflict of interests for private clinics when it comes to the provision of long-term safety statistics? Will my right hon. Friend ensure that any future system allows women to self-report to the registry—albeit with a follow-up from specialists for confirmation purposes—so that we can have a complete picture of the long-term complications caused by devices of this kind?

[Mr Lansley]

My hon. Friend is right. When Sir Bruce and his colleagues are considering the establishment of a wider registry, they will consider not only the possibility of self-registration but the possibility of making clinical professionals responsible for the publication of such data. The responsibility should not rest solely on providers or manufacturers.

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

I understand that a number of private clinics will not even scan a patient with PIP implants without charging. However, these goods were counterfeit. They were not of a medical standard, and they could be injurious to health. Should not the NHS be prepared to help women who must be worried sick, and perhaps cannot even afford to have a scan to reassure them? I cannot believe that the NHS would turn its back on a patient who was suffering after drinking counterfeit vodka, so why should it turn its back on these patients?

[Mr Lansley]

I am sorry that the hon. Lady framed her question in that way, because I thought I had made it clear that the NHS would always be there to support women. We will seek to recover the cost to the NHS if the original provider was a private provider: that approach has been adopted for years, and I am sure that it would have been adopted by my predecessors. No woman should have to feel that she will not be looked after, but I am making a different point—namely that, in the first instance, women should be looked after by the original providers, who have a continuing duty of care. They also have legal obligations—as well as the moral obligations to which I have referred—but it is not for me to advise on those.

[John Pugh (Southport) (LD)]

If the Government are paying for something that is needed, it is logical to assume that some private firms must be dodging their responsibilities. If those firms are not indemnified against the risks of surgery or willing to accept responsibility for its consequences, why on earth do we allow them to practise? Does the remedy not lie in our hands?

[Mr Lansley]

I entirely understand my hon. Friend’s point. The position we have inherited is that I have no powers in relation to the provision of private health care by private companies. As I said to the right hon. Member for Leigh (Andy Burnham), the Health and Social Care Bill provides for the establishment of Monitor as a health sector regulator that will license such providers. I am not making any judgment at this point on whether it would be appropriate for conditions to be attached to such licences in relation to the continuity of service to patients, but it is one option that we can consider.

[Chris Bryant (Rhondda) (Lab)]

May I suggest to the Secretary of State that the problems in the cosmetic intervention industry may be far more extensive than we have known thus far? A few years ago, I had my eyes lasered. I visited five clinics, four of which seemed to be trying to sell me an intervention rather than trying to do anything that would be in my general health interest. Will the Secretary of State add laser surgery clinics to his list, and also private dentists, many of which are encouraging patients to undergo operations that they certainly do not need?

[Mr Lansley]

I will reserve my position on dentistry, because there is a very wide range and cosmetic intervention constitutes a substantial proportion of overall dentistry activity, but I will happily consider whether there is an issue to be dealt with. As for laser eye surgery, I will ask Sir Bruce’s group to consider not only the establishment of a registry in relation to implants and devices, but cosmetic interventions more generally. I hope that we shall be able to reassure the hon. Gentleman when we publish the terms of reference.

[Several hon. Members]

rose—

[Margot James (Stourbridge) (Con)]

I commend the Black Country Partnership NHS Foundation Trust on conducting 517 breast implant operations in the decade before 2008 without the use of a single PIP implant.

What this furore has revealed to me is the existence of a growing private sector offering a vast array of cosmetic surgery that extends well beyond breast implants. I fear that the need for tighter regulation of the industry will prove widespread, and I therefore welcome the Government’s commitment to a review. Does my right hon. Friend expect to be able to charge the private sector for the costs of any additional regulation that the review group may deem necessary?

[Mr Lansley]

I am grateful to my hon. Friend for what she said about the NHS. I think that before considering whether there is a cost associated with regulation and how it might appropriately be met, we should consider what is necessary to assure patients of safety and quality.

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

I welcome the statement, but may I caution the Secretary of State against placing additional burdens on the Care Quality Commission without providing it with additional resources? May I also urge him to heed the advice of my right hon. Friend the Member for Leigh (Andy Burnham), and pause to listen and reflect on what lessons can be learned and what safeguards can be provided for the future? I am thinking both of the protection of patients’ safety and of future NHS liabilities when surgical procedures or treatments are carried out by the private sector, which is likely to become more frequent as the privatisation provisions of the Health and Social Care Bill are implemented.

[Mr Lansley]

For reasons that I have already explained, the hon. Gentleman is simply wrong about that. It is nonsensical to attempt—as the editor of The Lancet did this morning—to compare the regulation of private providers of private care with that of private providers of NHS care. There is no comparison at all.

The CQC will inspect a sample of providers of cosmetic surgery to check that they are meeting registration requirements, and will undertake a number of unannounced inspections as part of that. We expect the inspections to be completed by the end of the month, and expect the CQC to have published its report by the end of March. It has confirmed that it has enough resources to undertake the inspections within its existing budget.

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

I add my support and thanks to the Secretary of State for what he is doing on this very important issue which has caused so much distress to so many women. Does he agree that this episode flags up a wider issue in the cosmetic surgery industry, in that some practitioners performing medical procedures do not have any medical qualifications or knowledge of anatomy? Does he also agree that it is a problem that there is no psychological counselling and that a holistic look at patients is not taken, as this is an on-demand industry? Finally, does he agree that there must be a proper paper trail and record system in the industry, so that we can consider what is in the best interests of patients and so that there is proper accountability for all providers?

[Mr Lansley]

My hon. Friend makes a number of important and perceptive points. It is, and will continue to be, one aspect of NHS advice that psychological assessment can form an important part in the management of patients referred for low-priority procedures, including cosmetic surgery. However, although we will look at cosmetic interventions and their regulation more widely, we must recognise that the issue in this instance related to what was a criminal act—seeking to adulterate the material in the implants. Many private providers were using what they regarded as properly certified implants for a perfectly proper procedure. To that extent, they were not engaging in any improper behaviour. However, they have legal and moral obligations to their patients, and I am asking them to discharge those obligations.

[Fiona Mactaggart (Slough) (Lab)]

It saddens me that, despite previous reports recommending more effective regulation of the cosmetic surgery industry, it has taken this crisis, causing so much distress to so many women, for the issue to be taken seriously. I am nevertheless glad that it is being taken seriously. Will the Secretary of State consider ensuring that people seeking cosmetic procedures must have independent counselling and advice from a body that will not make a profit from that procedure, and whose whole concern is the health of the patient?

[Mr Lansley]

I am grateful to the hon. Lady for that suggestion, and I will ask Sir Bruce’s group to consider it.

[Penny Mordaunt (Portsmouth North) (Con)]

I welcome the statement. What has the Secretary of State learned from this episode about the quality and take-up of routine insurance products offered by private companies to protect both patients and providers when cosmetic surgery goes wrong?

[Mr Lansley]

I am grateful to my hon. Friend for her welcome for the statement. Those seeking cosmetic interventions must ask serious questions about not only the nature of the procedure but the quality and reputation of the provider organisation, and ask it how it would protect their interests if things went wrong.

[Sheila Gilmore (Edinburgh East) (Lab)]

The Secretary of State referred in his statement to the possibility that an organisation that had carried out operations had gone out of business. As there are long-term implications from such surgical interventions, has the Secretary of State considered instituting some form of levy or fund that would have to be paid into—nor do I want to let the private sector off the hook—so that if organisations go out business there would be a sum of money from which people could claim?

[Mr Lansley]

As I hope the hon. Lady will appreciate from what I said to the right hon. Member for Leigh (Andy Burnham), the Health and Social Care Bill introduces for the first time a comprehensive continuity of service regime for the NHS, and it also creates, through the health sector regulator, the potential for us to consider whether such continuity of service needs to be extended beyond the NHS.

[Ian Swales (Redcar) (LD)]

If the NHS stands behind private providers in such cases, it is effectively providing free indemnity insurance. Will the Secretary of State look at the insurance position of providers of such services and ensure that the taxpayer does not face open-ended liabilities?

[Mr Lansley]

As my hon. Friend points out, to that extent the NHS has always stood behind the private sector provision of health care. If things go wrong, people have the right to access NHS treatment as they must be looked after on the basis of clinical need. Referring back to points I made earlier, the Health and Social Care Bill gives us an opportunity to look more systematically at continuity of care for patients both in the NHS and the private sector and at the responsibilities of providers under their licence.

[Valerie Vaz (Walsall South) (Lab)]

I thank the Secretary of State for coming to the House and making this statement. How many clinics will the CQC be reviewing, and what will happens in respect of any clinics that are no longer practising? Presumably the CQC will not have access to their records.

[Mr Lansley]

I cannot tell the hon. Lady how many clinics the CQC will visit, but it will be a sample of providers, not all of them. As she may know from the material we published last Friday, there were 93 private providers. The operations were heavily concentrated in that a lot of them were carried out by a small proportion of providers, but about 87 other small providers, or even single-handed providers, are involved and accessing data from all of them will be difficult. I also recognise that, as the hon. Member for Edinburgh East (Sheila Gilmore) said, some may not be in business any longer, or there may be surgeons who have retired.

[Paul Uppal (Wolverhampton South West) (Con)]

I also thank the Secretary of State for making the statement. Following on from a vein of questioning that has already been explored, will he elaborate on the point about the Government pursuing firms to recover costs and explain what mechanisms are available to the Secretary of State to recover costs?

[Mr Lansley]

I will do so to an extent. It depends on the nature of the legal contract between a woman and her private provider. I hope that in many cases the legal obligations derived under that contract or under sale of goods and services legislation will clearly mean that the woman will get redress from her private providers or her insurers. If the NHS becomes involved, there may be compensation through the injury costs recovery scheme, so if the NHS incurs costs, we can go on to seek to recover them.

[Yasmin Qureshi (Bolton South East) (Lab)]

I thank the Secretary of State for his statement. As has been said, most of the cosmetic surgery industry is not regulated. What time frame are he and his staff working towards?

[Mr Lansley]

Given the nature of the work I am asking Sir Bruce Keogh and his group to undertake, it will take them some time to look at the range of cosmetic interventions and make any recommendations. They are coming together as rapidly as they can. Many of them have given up a great deal of time over the past two weeks to help us in this work. We must recognise that there are things we need to do rapidly to ensure that there is support and reassurance for any woman affected by PIP implants, and we are acting rapidly. There are lessons and wider implications to be learned. This particular area of cosmetic surgery was not without regulation. The question is to what extent things were properly regulated with surveillance and enforcement over a number of years.

[Steve Brine (Winchester) (Con)]

I welcome the Secretary of State’s statement. As he knows, I co-chair the all-party group on breast cancer and we will want to monitor how women are treated by the NHS and private providers, and we will certainly feed that into the Department. For women who have fought breast cancer and been through the trauma of reconstructive surgery, this will bring it all back and be tremendously upsetting. Does the Secretary of State therefore agree that speed is of the essence in respect of replacement surgery where it is wanted, so that those women can again put this nightmare behind them?

[Mr Lansley]

I am grateful to my hon. Friend and I completely recognise the points he makes. As he will know, the overwhelming majority of the approximately 3,000 women who had PIP implants through the NHS will have had them as breast reconstruction surgery following mastectomy. From day one, we were clear that we wanted all those women to be able to get advice, investigation and remedy, and removal and replacement, should they wish. If the NHS was responsible for the original operation, we will be responsible for the replacement with new implants, if that is what is wanted.

The NHS is very clear about this issue in the advice that was presented. I welcome the fact that my professional colleagues in the associations are making it clear that, through the NHS, replacement procedures for these women should be possible rapidly, but it should not prejudice the availability of urgent referral for cancer, which will continue to be an operational requirement in the NHS.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

The question arises of access to records in both the private and NHS sectors. Is it not time to look again at who is the keeper of medical records? Should it not be the patient—therefore bringing together the NHS and private provision, where applicable—rather than the institutions?

[Mr Lansley]

Of course, as the hon. Lady knows, we have been thinking hard about precisely this issue. The NHS Future Forum made further recommendations to us only yesterday about achieving access for patients to their own records by 2015 across the NHS. The NHS should keep records, but the patients themselves should have access to them. We will pursue that issue in the NHS, although frankly, I am not in a position to mandate that in the private sector. However, any patient would be well advised to say, “Why can’t I hold my own record from a private provider?”

[Bob Blackman (Harrow East) (Con)]

I welcome the Secretary of State’s statement, but PIP is not the sole supplier of breast implants across the industry. What assurances has he received from the industry that no other company has embarked on the practice of using non-medical grade silicon in its breast implants, so that women who have had such implants can feel safe?

[Mr Lansley]

I have no evidence of such behaviour on the part of other companies. My hon. Friend is right: PIP is only one of a number of suppliers, and in this country probably only one in seven breast implants were PIP implants. Other countries have looked at this, and across Europe the regulatory process should ensure the scrutiny of these implants, including proper testing. The European review must look at whether that surveillance, including unannounced inspections and appropriate testing, gives us the assurance we are looking for.

[Heidi Alexander (Lewisham East) (Lab)]

Yesterday, I was contacted by a constituent who had PIP implants inserted by the Harley Medical Group in 2006. She said:

“There is so much conflicting information at the moment, I feel as though I’m being pushed from pillar to post. To add absolute insult to injury nobody is keen on helping us, they are saying the NHS should help…or they say they will perform the procedures on us for an extra fee.”

Can the Secretary of State tell me precisely what further representations he will be making to private providers to ensure that all women get access to the advice and treatment they need?

[Mr Lansley]

We have been very clear about the advice we have given to women, and I hope that, through the NHS, any woman in those circumstances would go and see their general practitioner, who will have full access, from the chief medical officer, to the expert advice we have disseminated. I know that the Harley Medical Group has not shared with others the view that it can match the NHS’s standard of care; but given that, the professions are suggesting to surgeons that they should honour requests for replacement surgery free of surgical charge. I hope that gives a basis on which more of the private providers will now meet their full obligation of a duty of care.

[Mr Philip Hollobone (Kettering) (Con)]

What is the Department of Health’s central estimate of the number of women who have had breast implants through private clinics who will seek their removal through the NHS?

[Mr Lansley]

I am sorry to disappoint my hon. Friend but I cannot offer him such an estimate. We know that some 37,000 women had PIP breast implants. Clearly, not all those will necessarily want removal, and on advice, it might be any proportion of those; I cannot tell him what that figure would be. As we see in France, recommending the removal of implants does not mean that all women will have them removed.

[Mark Durkan (Foyle) (SDLP)]

I acknowledge the Secretary of State’s commitment to engaging proactively with the devolved Administrations on this issue. However, in his statement he used somewhat clumsy language regarding the third main finding of the expert group, saying that “there is no clear evidence that these problems are more serious in relation to PIP implants than other implants, or that they result in increased long-term health risks.” Is he not concerned that, put so clumsily, that will not only fail to reassure those with PIP implants but extend concern and alarm to those who have received other implants?

[Mr Lansley]

I am afraid that absence of evidence does not mean evidence of absence. We can be very clear, on expert advice, that there are no specific safety concerns that routinely require the removal of these implants, nor identification of any increased long-term health risks, in precisely the way I have described. I cannot go further and provide, on advice, absolute assurance, and the expert group was clear about that. That is why the French Health Minister, whom I was talking to last week, and I were clear that we should undertake additional toxicology tests on implants when they are explanted, in cases where they were implanted over a period of time, to begin to understand the extent to which they had adulterated filler material and what was in it.

[Andrew George (St Ives) (LD)]

I commend my right hon. Friend’s initiative. However, he said the following, which may have been sloppy wording: “those who have had reconstructive surgery following a mastectomy, will have received PIP implants through the NHS.” Of course, the majority will not have done so, and I have confirmed with surgeons in Cornwall that PIP implants have never been used in the NHS in Cornwall. Given that the Medicines and Healthcare products Regulatory Agency issued advice to stop using PIP implants in the UK in March 2010, can the Secretary of State confirm that this advice was acted on, no doubt within the NHS but across private clinics as well?

[Mr Lansley]

I hope I did not say what the hon. Gentleman ascribes to me. Some 3,000 women, we think, had PIP implants, and of course, that is only a fraction of the number having breast reconstruction surgery. I think I can offer him reassurance. The MHRA withdrew authorisation in March 2010, and given that there was only one distributor of these implants in this country—Cloverleaf—they will not have been distributed for use after that date.

[Toby Perkins (Chesterfield) (Lab)]

A constituent in Chesterfield contacted me who is at her wits’ end. She has been in considerable pain since having a PIP implant fitted, and has been told by the private provider that she will have to pay £3,600 to have it replaced. What more can the Secretary of State do to ensure that her private provider follows the example of the other eight providers that are doing this free of charge? Let us put some pressure on these companies to make sure that all of them do the same as the NHS and replace the products they have fitted.

[Mr Lansley]

I think I have made it clear that not only the Government but, helpfully, the professional associations are looking to give no reason why private providers should not match that standard of care, especially if the implanting surgeons are willing to offer replacement surgery free of surgical charge themselves. It would be very helpful if the hon. Gentleman and other Members gave us details of such cases on behalf of their constituents. Clearly, his constituent will have had that implant before March 2010. The adverse incident centre has had 478 reports of ruptures over the whole period, which extends back many years. One of the things we want to understand as part of our review is why, if there were ruptures and, more to the point, adverse health effects associated with these implants, they were not disclosed to the adverse incident centre. As yet, we have not seen a range of health effects over a period of time that, in themselves, distinguish these implants from other, normal implants.

[Mr Marcus Jones (Nuneaton) (Con)]

I contacted the Harley Medical Group on behalf of a concerned constituent this morning and was told that it would be making a decision on its response to this issue by Friday, although that is somewhat contradicted by the comments made by the shadow Secretary of State. Regardless of that, does my right hon. Friend not agree that the Harley Medical Group, or any other company, should step up to the plate, take full responsibility and work to make sure that it gives the people involved complete satisfaction, without any cost to the individual concerned?

[Mr Lansley]

My hon. Friend will understand that I cannot speak about the precise details of the situation with the Harley Medical Group. All I can say is that the group has told the media that it does not feel it can offer that standard of care completely, but that will have been before the professional associations wrote to their members asking them to support replacement surgery free of surgical charge. I know that the group has told members of the media that it is willing to offer to the Government that if we are responsible for the removal of implants, it will pay for implants to be available for replacement purposes. Frankly, if surgeons are willing to waive the surgical charge and the group is willing to pay for the implants, it is not too much to ask for it to be responsible for removal and replacement, where it is in the woman’s best interests to do that.

[Paul Flynn (Newport West) (Lab)]

Does the Secretary of State not regret failing to react to the call made last May for British patients to have the same protection against failures of all medical devices as that enjoyed in the United States? Is not the real scandal here, again, the chronic under-reporting by the industry and the MHRA of failures of devices and drugs? Is not the answer for this probe to look into the possibility of having a genuinely independent regulatory authority, instead of one that is entirely funded by the industry, because self-regulation is often no regulation?

[Mr Lansley]

The hon. Gentleman says that this body is entirely funded by the industry. It is true that in relation to pharmaceuticals the MHRA is funded by levies on the pharmaceutical industry, but much of the cost of the regulation of medical devices is actually met by the taxpayer. I regard the MHRA as operating in an independent fashion and its expert and scientific advice as independent from Ministers. None the less, as he says, the review that Earl Howe will lead will examine the lessons to be learned, including those about the effectiveness of regulatory surveillance and enforcement in this country, albeit that the regulatory failure occurred, in essence, in Germany, in the first instance, and in France.

[Richard Burden (Birmingham, Northfield) (Lab)]

The uncertainty that many women face relates to not only the level of risk associated with PIP implants, but whether the implants they had fitted were PIP implants. I accept what other hon. Members have said about problems with record keeping in the private sector, and that needs to be taken up. The Secretary of State said that the estimated 3,000 NHS patients will be written to. If they are to receive such a letter, will he reassure them about when that will be?

[Mr Lansley]

The chief executive of the NHS wrote to the NHS bodies last week. As the hon. Gentleman will realise, the numbers concerned in each organisation will not be very large, so I am looking for what he describes to happen rapidly.

[Mr Denis MacShane (Rotherham) (Lab)]

Will the Secretary of State send officials to investigate the Birkdale clinic in Rotherham and its executive, Mr Promod Bhatnagar? Scores of women have had PIP implants at the clinic and are now being told that they have to pay £2,900, in cash, to be screened and looked at again. Mr Bhatnagar has threatened groups in south Yorkshire with “unimaginable consequences” if they raise this issue. After his very unclear statement, will the Secretary of State finish by saying that as in every other European country, and standing with the women of Britain, taxpayers do not mind paying for a few hundred women to be properly investigated? My constituents have contacted me saying that the women of south Yorkshire should be able to go to their general practitioner, go straight into hospital and be seen to, and we should clear up all the fuss about bills afterwards.

[Mr Lansley]

I think I have been absolutely clear about what I expect to happen, in relation both to women treated through the NHS and what I expect of private providers. I have also made it clear that if private providers will not or are unable to meet that standard of care, the NHS is available to support women. It is absolutely wrong to say that we are somehow responding to women differently from other European countries, because across Europe countries affected by this are taking exactly the same view that we take.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement and I again highlight the concerns that a great many ladies have. Just today, I have been made aware that constituents of mine, as well as those from other regions of the United Kingdom, have had PIP breast implants carried out privately in the Republic of Ireland. When they contacted the firm, they found that it had gone bust, so what help can he give ladies, both financially and physically, who were NHS patients in the United Kingdom but had operations carried out outside the United Kingdom, specifically in the Republic of Ireland?

--- Later in debate ---

[Mr Lansley]

I refer the hon. Gentleman to what I said in my statement: if women are entitled to NHS treatment in those sorts of circumstances, they should come to the NHS and we will provide the standard of care that I outlined.

[Ian Mearns (Gateshead) (Lab)]

The Secretary of State has demonstrated his obvious concern for the women affected by this situation. Does he accept that they are gravely concerned about the difference of opinion that is emerging between Governments in the countries where these implants have been used, in particular, the difference between our Government’s advice and that of the country where the implants were manufactured, France? Will he also reflect on whether companies in the private sector that are giving either cosmetic or other treatments of this nature to women are properly insured, so that even if they go out of business the insurer will cover women for future treatments should something go wrong?

[Mr Lansley]

On the hon. Gentleman’s final point, I refer him to what I said earlier about how we might deal with that in the future. On the point about other countries, I have spoken to Commissioner Dalli and I have spoken to my French counterpart twice. What I want to be clear about is that the French authorities did recommend routine removal of implants, but from any individual woman’s point of view we are, in effect, recommending that the same thing should happen: any individual woman should see the clinician responsible, should be examined—by imaging, if necessary—and should consider, in the light of that and in a clinical decision with her adviser, what is right for her. That will be true in France and in Britain. I wish to emphasise that we have not seen, on advice, scientific evidence that justifies the recommendation of the routine removal of these implants. We are not saying to women that we think they should have them removed; we are saying that women should have access to imaging. Clearly, women with symptoms, or women for whom evidence of rupture or leakage has been provided through imaging, may well choose to have the implants removed, and we would support that.

Oral Answers to Questions

Lord Lansley Excerpts

Tuesday 10th January 2012 Commons Chamber

[Graham Evans (Weaver Vale) (Con)]

2. What recent representations he has received on access by NHS patients to drugs invented and developed in UK laboratories; and if he will make a statement.

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

Representations received have strongly supported the Government’s “Strategy for UK Life Sciences”, which was published on 5 September. Speeding up clinical trials approval, enabling the unique NHS clinical databanks to support research, the early adoption of new medicines and other initiatives will bring NHS patients the fullest benefit from innovation and will promote growth in UK biosciences.

[Graham Evans]

What steps are being taken towards closer collaboration between the NHS, industry and our world-class universities to drive improvement and innovation in the NHS for the benefit of current and future NHS patients?

[Mr Lansley]

I am grateful to my hon. Friend. He rightly highlights an area where we are clear that innovation can be considerably supported, and not only by the academic health science centres, which were established under the last Government. As the life sciences strategy set out in early September made clear, we want to create academic health science networks across the NHS so that higher education, industry and the NHS can work together to bring about the greatest possible innovation to the benefit of patients.

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

The current pharmaceutical price regulation scheme is able to recognise the fact that pharmaceutical companies based here and developing drugs here should be paid a little bit more for their drugs by the NHS on the basis of their worth for the general economy. Will the Secretary of State tell us whether his proposals for value-based prices will affect that?

[Mr Lansley]

The right hon. Gentleman will be aware that the existing PPRS does not in any sense directly fund innovation in the United Kingdom. Although it takes account of expenditure on innovation, it cannot identify that expenditure in the United Kingdom as a beneficiary through pharmaceutical pricing. As the right hon. Gentleman knows, we are continuing to discuss with the industry the shape of value-based pricing from January 2014, the purpose being to ensure that we fund the value associated with new medicines: the therapeutic value to patients, the innovative value—which will highlight the UK as a base for research and development—and the societal value.

[Jason McCartney (Colne Valley) (Con)]

3. If he will take steps to ensure that the safe and sustainable review of paediatric cardiac services is fully inclusive.

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

4. What recent representations he has received on access to the cancer drugs fund; and if he will make a statement.

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

We have received a number of supportive representations regarding the cancer drugs fund. Indeed, the Rarer Cancers Foundation recently praised the fund for making additional cancer drugs available to almost 10,000 patients in England since October 2010. It contrasted that access to medicines in England with the lack of such access in Wales.

[Mr Evennett]

My right hon. Friend has cited the view of the Rarer Cancers Foundation. Does he agree that this policy has put patients and doctors back at the heart of decision making, and has transformed the ability of cancer patients to obtain clinically effective treatment so that they can gain precious extra time with their families?

[Mr Lansley]

My hon. Friend is absolutely right. In the summer of 2010, we learnt from Sir Mike Richards’s review that patients in this country were less likely to have access to the latest cancer medicines within five years of their introduction than those in many other European countries. I am proud that so far the coalition Government have been able, through the cancer drugs fund, to help 10,000 patients to gain access to the latest cancer medicines.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for that response. Last year, Cancer Research UK revealed that cancer deaths were down 20% since 1985 and survival rates have doubled in the last 40 years. Does the Minister agree that we must continue to research proactively and thereby continue to reduce deaths and ensure continuity of life?

[Mr Lansley]

I am grateful to the hon. Gentleman, and he is absolutely right about that, of course. He will also be aware that Cancer Research UK highlighted not only the progress that had been made, but the variation in progress on different cancers. Harking back to the earlier point about innovation, we must focus on how some of these innovations will enable us to deliver improved survival rates for specific cancers, and I announced last month that we would be funding additional scanner facilities in this country—proton beam therapy scanning interventions—in order to enable some of the most difficult cancers, such as brain cancers in children, to be treated in this country effectively.

[Duncan Hames (Chippenham) (LD)]

A cancer patient in my constituency faces an avoidable further round of chemotherapy having waited for the strategic health authority to make an individual funding request decision on the drug Plerixafor, which is not included in the cancer drugs fund. Will the Minister consider broadening the scope of the cancer drugs fund to include such drugs that are critical in cancer patients’ care, in addition to their other uses?

[Mr Lansley]

I should be grateful if my hon. Friend would write to me about that. The cancer drugs fund is focused on an identified lack of access to cancer medicines, but if a drug is of particular benefit to a cancer patient, such as in the instance he describes, it should be possible for SHA panels to include it within the scope of the fund.

[Valerie Vaz (Walsall South) (Lab)]

Will the Secretary of State confirm whether those receiving treatment under the cancer drugs fund will also be guaranteed treatment under the new scheme?

[Mr Lansley]

The intention is that from January 2014 as new medicines are introduced through the value-based pricing system, the reimbursement price in the NHS will reflect their value and therefore, by extension, they will all be available through the NHS.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

5. What steps he is taking to ensure drugs approved by the National Institute for Health and Clinical Excellence are made available to all patients in the NHS.

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

The NHS is required to fund drugs and technologies recommended in NICE technology appraisals, in line with the NHS constitution. The NHS chief executive’s report “Innovation, Health and Wealth” sets out plans for the introduction of a compliance regime to ensure rapid and consistent implementation of NICE technology appraisal recommendations throughout the NHS.

[Stephen Metcalfe]

I greatly welcome the Government’s recent announcement on swift and proper implementation of NICE guidance that allows patients access to innovative treatments. In order for cost-effective treatments to secure NICE guidance approval, in the first instance will the Secretary of State ensure that NICE’s methodology review reinforces the importance of appraisal appropriately reflecting clinical practice when assessing new treatments?

[Mr Lansley]

I am grateful to my hon. Friend, who clearly understands that NICE is responsible for the methods it uses in the development of its guidance and that it is undertaking a review of its appraisal methods. I expect that that will be published for consultation this year. NICE should issue final guidance only after careful consideration of the evidence and public consultation with stakeholders, including patient and professional groups.

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

It is sometimes hard to follow the Secretary of State as he can get lost in his own jargon. Just to be clear: if NICE says that a drug should be available to patients on the NHS wherever they live and whatever their clinical commissioning group, will they get it? Can he give that guarantee today?

[Mr Lansley]

The right hon. Gentleman knows perfectly well that that did not happen under the last Government. The NHS chief executive’s innovation report of early December made it clear that we will make certain that when NICE gives a positive appraisal for a medicine, it is automatically included in formularies, and also that we will establish an effective compliance regime in respect of NICE appraisals and establish a new NICE implementation collaborative to make it happen. As the right hon. Gentleman knows perfectly well, the legislation is clear: when NICE gives a positive appraisal, a medicine should be available across the NHS. That was not achieved under his Government. We will achieve that, and the NHS chief executive is setting out to show how that will happen in the future.

[Mr Marcus Jones (Nuneaton) (Con)]

Under the current regime of primary care trust commissioning, my constituents in Warwickshire often complain to me that drugs approved by NICE are not always available locally but are available in neighbouring commissioning areas. What steps are being taken to ensure that new NHS commissioning boards and local commissioning groups promote the NHS constitution and the right of patients to access NICE-approved drugs?

[Mr Lansley]

My hon. Friend makes exactly the right point, in that what the last Government said happened did not happen: such medicines were not available, and there was a postcode lottery in accessing many of them. That, among other reasons, is why the chief executive of the NHS published his report, which will introduce the NICE compliance strategy. We will require all NICE technology appraisals to be incorporated automatically in the local drug formularies, and the NICE implementation collaboration will support the prompt implementation of NICE guidance.

[Fiona Mactaggart (Slough) (Lab)]

Last week in my constituency, a community pharmacist refused to issue a blind patient with dosage packs unless they paid an additional fee. What redress will such patients have in the newly reorganised NHS regarding actions such as this by community pharmacists, which in my view are against the Disability Discrimination Act?

[Mr Lansley]

I should be grateful if the hon. Lady wrote to me about that case and gave me the opportunity to look at it, which I would be pleased to do. From my point of view, we do not countenance such requirements, through charging, denying patients access to any NHS treatment.

[David Tredinnick (Bosworth) (Con)]

In addition to approving drugs, NICE has also approved acupuncture for lower back pain. Should this not be widely available on the health service now?

[Mr Lansley]

Of course, my hon. Friend will know very well that choice of treatment is a shared decision between patients and their clinicians. NICE appraisals are about whether treatments are available in the NHS and giving information to clinicians about their relative clinical and cost-effectiveness, not prescribing that treatments should be available in specific circumstances.

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[Fiona Bruce (Congleton) (Con)]

8. When he expects residents in Congleton constituency to benefit from investment in telehealth and telecare services by the NHS.

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

I am pleased to say that patients in Congleton who have health conditions such as heart failure or chronic respiratory disease can already benefit from these technologies. I am committed to supporting the use of telehealth and telecare services by working with industry to improve the lives of 3 million people across the country who are living at home with long-term conditions.

[Fiona Bruce]

I thank the Secretary of State for that reply, and indeed innovative schemes in my constituency and across the Cheshire East council area, such as DemenShare, are already using this technology. But what other schemes and advances will the Government introduce for an area that has the highest level of elderly people per population head in the north-west of England and where the number of over-65s will grow by 50% and the number of over-85s is set to more than double by 2025?

[Mr Lansley]

I am grateful to my hon. Friend for her question. She rightly talks about this increasing number of older people in the community and rightly says that we want to support them to be independent and to improve their quality of life.

The whole system demonstrator programme was the largest trial of telehealth systems anywhere in the world. In the three pilot areas of Kent, Cornwall and Newham, it demonstrated a reduction in mortality among older people of 45%; a 21% reduction in emergency admissions; a 24% reduction in planned admissions to hospital; and a 15% reduction in emergency department visits. Those are dramatic benefits, which is why we are so determined to ensure, over the next five years, that we reach out to older people who are living at home with long-term conditions and improve their quality of life in this way.

[Mr Philip Hollobone (Kettering) (Con)]

9. If he will consider proposals to introduce a national screening programme to detect group B streptococcus in pregnant women.

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[Margot James (Stourbridge) (Con)]

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

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

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

[Margot James]

My right hon. Friend will be aware that a significant number of private clinics that fitted women with Poly Implant Prothese breast implants are no longer in business. Will he advise the House on how he plans to strengthen not just the regulation of clinics offering cosmetic surgery, but the products that they use?

[Mr Lansley]

I am grateful to my hon. Friend. I not only laid before the House a written statement this morning, but will, with permission, make a statement on the subject tomorrow. We have been very clear about the support the NHS will give to women who have had implants through the NHS, and we expect private companies to do the same. Not all will do so, and to that extent I make it clear that the NHS is there to support women in their clinical needs, whatever their circumstances.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The Secretary of State will be aware that thousands of women are worried and frightened about this issue. The statements he has made are welcome, but what practical help can he offer women whose private providers have not yet committed to offering free replacements?

[Mr Lansley]

This is important, as the hon. Lady says. All the way through we have wanted to be absolutely clear that any woman who is worried should be able to go to her general practitioner. The NHS is there to support any women in their clinical needs, whatever their circumstances. I have made it clear that I expect private providers to match the NHS support through information and access to specialist advice, imaging and investigation, as necessary, and through the removal of implants if it is decided that that is necessary. If private providers will not do that, let me be clear, as I will explain further tomorrow, that the NHS remains available to support women in their clinical needs.

[Karl MᶜCartney (Lincoln) (Con)]

T5. Does my hon. Friend the Minister believe that the Government’s aim of stopping people smoking is in any way helped by the chairman of the all-party group on smoking and health, the hon. Member for Bristol West (Stephen Williams), using a private letter that I sent to him, and copied to the Minister, to castigate me and make untrue allegations in my local newspaper last Thursday?

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[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

T2. The people of Newcastle are more likely to die early from cancer, health disease and stroke. On average, a child born in Newcastle today is expected to die five years before a child born in the Secretary of State’s constituency, so why is he changing the health funding formula so that in Newcastle we will lose 2.5% of our funding, whereas his constituency will see a rise of 2.1%?

[Mr Lansley]

Let me remind the hon. Lady—she might not have noticed this—that before the Christmas recess I announced funding for the next financial year for all primary care trusts in England, and the increase for all primary care trusts is 2.8%. In contrast to the previous Government, we are setting out to reduce health inequalities, not least by focusing resources on public health on the basis of an objective measurement of disparities in health outcomes.

[Robert Halfon (Harlow) (Con)]

A BBC Essex investigation into Rushcliffe’s Partridge care home in my constituency has uncovered shocking allegations of abuse and neglect. Will the Minister urge the Care Quality Commission to step in now with an inquiry and take whatever legal action is necessary to protect the elderly residents? Will he meet me and my constituent Lesley Minchin who has a relative who has suffered as a result of what has been going on in the care home?

--- Later in debate ---

[Mr Lansley]

I do indeed agree with the Prime Minister, but I would not characterise what he said in the way that the hon. Gentleman does. I was very interested to see a number of letters in The Times just this morning that highlighted that in the past, under patient and public involvement forums and community health councils, there was a direct public interest in seeing what happened in hospitals and in inspection. Through the Health and Social Care Bill and the establishment of HealthWatch, we will enable the public—representatives of patients—to be involved directly in assessing the quality of the environment in which patients are looked after. They will not supervise nurses. Nurses will be responsible for the experience and care of patients, but the public have a right to be participants in inspection—

[Mr Speaker]

Order. I am grateful to the Secretary of State.

[Andrew George (St Ives) (LD)]

When the Government introduced the Health and Social Care Bill a year ago, they did so with the claim that the NHS fails in comparison with its European counterparts with regard to patient outcomes. Now we know that that is not the case, will the Government withdraw the Bill?

[Mr Lansley]

I do not agree with that characterisation of why we instituted the Health and Social Care Bill or of the current situation. For example, the OECD published in October its latest assessment of health in a number of countries. In too many respects—for example, in relation to serious respiratory disease—we have very poor outcomes relative to other countries. What we are setting out to do in any case is to deliver continuously improving outcomes and to get among the best in the world. In too many respects we are not yet among the best in the world.

[Karl Turner (Kingston upon Hull East) (Lab)]

T4. If the Prime Minister really wants to help nurses to focus on patient care, should the Secretary of State not listen to those nurses and drop this barmy, unnecessary Health and Social Care Bill?

[Mr Lansley]

It is precisely because the Prime Minister and I listen to nurses that we met them and made it clear that we will support best practice. The hon. Gentleman and his colleagues should support nurse leadership on the wards. Nurses can see—through best practice, if they talk to patients about their experience every hour—that they can deliver better care. We will support nurses to deliver better care; he should support us in doing so.

[Dr Sarah Wollaston (Totnes) (Con)]

I know the Secretary of State cares deeply about outcomes in health. Will he add his support to the campaign for a minimum price for alcohol in England and Wales?

[Mr Lansley]

The Government will shortly publish our alcohol strategy, which will set out how we hope to deliver continuing success in the reduction of alcohol consumption and abuse.

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

T6. In a written answer on 12 December, the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who has responsibility for care services, told me that the Government felt that:“Local community hospitals provide a vital community resource to support patients in need of rehabilitation, recuperation and respite care”—[Official Report, 12 December 2011; Vol. 537, c. 560W.]What steps will the Government take to prevent the closure of the Chaloner Ward at Guisborough hospital and financially secure that hospital’s vital future?

[Mr Lansley]

I am grateful for that question. I will certainly be happy to write to the hon. Gentleman on Guisborough hospital—I will not delay the House with the detail. I have those details, and will be happy to correspond with him.

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

The Prime Minister speaks of the “health and safety monster”; does the Minister believe it is right that advertising for personal injury lawyers should be displayed in hospital A and E departments, which many might think would feed the monster and make it bigger?

[Jim McGovern (Dundee West) (Lab)]

T8. Yesterday, I had a meeting with Patricia Osborne, the chief executive of the Brittle Bone Society, a UK-wide organisation that is headquartered in my constituency. It was made clear to me that given the current funding squeeze across the voluntary sector, the society is concerned about its ability to provide the vital services that it currently provides. Also troubling the society is the lack of support for adult sufferers of osteogenesis imperfecta. What can the Secretary of State tell me about the Government continuing to support that important society, and what more can they do to support adults with that condition?

[Mr Lansley]

The hon. Gentleman will know that the Department of Health continues to support the voluntary sector considerably through section 64 funding and related support. If he wishes to write to me about the specific circumstances of the Brittle Bone Society, I will be glad to reply to him.

[Chris Skidmore (Kingswood) (Con)]

I recently made a freedom of information request to all 170 acute trusts asking for the estimated total cost of missed out-patient and surgery appointments. So far, 61 have come back to me, and the cost is already over £1 billion. Will the Secretary of State seriously consider what we can do to tackle the enormous cost of missed appointments in the NHS?

[Mr Lansley]

Yes. My hon. Friend makes an important point, and it is something the NHS must focus on. There are considerable opportunities through new technologies substantially to reduce the extent of missed appointments, including through things such as text messaging. What is frustrating is that, sometimes, appointments are missed because patients have not been adequately contacted by hospitals. As for people who abuse the NHS, I hope we will give them no excuses for not meeting their obligation to attend appointments.

[Mike Gapes (Ilford South) (Lab/Co-op)]

Can the Secretary of State intervene with those involved with the health for outer north-east London programme to get them to allow the Barking, Havering and Redbridge University Hospitals NHS Trust to use the births and maternity capacity at King George hospital to take pressure off Queen’s?

[Mr Lansley]

As the hon. Gentleman knows, following the independent reconfiguration panel report, which I accepted in full, the Barking, Havering and Redbridge Trust is looking to manage safely its maternity services, while improving the quality at Queen’s. It is doing that in close co-operation with NHS London and, indeed, with the advice of the Care Quality Commission, following the commission’s inspections. I will continue to be closely involved in that, and we will continue to support the Barking, Havering and Redbridge Trust in improving services for the hon. Gentleman’s constituents and others.

[Mr Philip Hollobone (Kettering) (Con)]

In north Northamptonshire in 2010-11, there were 6,164 alcohol-related hospital admissions. That is four times the number just eight years before. What more can be done to tackle this horrendous increase in booze drinking?

[Mr Lansley]

Time does not permit me to mention all the things that could be achieved, but let me just say that we are clear about the need, for example, to tackle below-cost selling of alcohol, and we are doing that; to stimulate more community alcohol partnerships, and we are doing that; and to accelerate public understanding of the consequences of alcohol abuse, and we are doing that, not least through Change4Life, additionally, during this year. There is more, but we will say much more in our alcohol strategy soon.

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

When the Secretary of State, together with the Prime Minister, visited Salford Royal hospital last week to praise the nurse leadership, was he aware that the hospital has cut 200 posts this year and is about to cut a further 200 posts over the next two years as a result of having to take 15% out of its budget? Does he not agree that nurse leadership is important, but that we also need the nurses on the wards to be able to deliver effective patient care?

[Mr Lansley]

Of course I had an opportunity to talk to the chief executive, the nursing director and others at Salford Royal, and I was tremendously impressed, as was the Prime Minister, by the quality and leadership of the nursing, which demonstrated what he was saying about nursing—that there is best practice inside the NHS, and we need to spread it. The right hon. Lady is confusing a cost-improvement programme with a cut. I think Members on both sides of the House understand that the NHS is having to make efficiency savings, which involves shifting some resources from the acute sector and hospitals into the community. Right across the NHS, we have an increase of over £3 billion this year; next year, we have a 2.5% or 2.8% increase everywhere.