Review Body on Doctors' and Dentists' Remuneration

Lord Lansley Excerpts

Tuesday 13th March 2012 Written Statements

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

I am responding on behalf of my right hon. Friend the Prime Minister to the 40th report of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB). The report has been laid before Parliament today (Cm 8301). Copies of the report are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. I am grateful to the chair and members of the DDRB for their report.

We welcome the 40th report of the Review Body on Doctors’ and Dentists’ Remuneration and note its observations and recommendation to the Scottish Government. The Scottish Government are still considering the recommendation and expect to be in a position to make a decision by the end of the month. We will take forward the suggested actions, which will help us continue to improve our support for the DDRB’s important work.

NHS Pension Scheme (England and Wales)

Lord Lansley Excerpts

Monday 12th March 2012 Written Statements

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

On December 2011, I reported to the House that a heads of agreement had been reached on a new NHS Pension Scheme for England and Wales for introduction in 2015. The heads of agreement set out the Government’s final position on the main elements of scheme design.

Following this, my Department has been engaged in detailed discussions with health sector trade unions and employer representatives over the remaining details for the new NHS pension scheme. I can now report to the House that these discussions have concluded and the outcome reflected in a proposed final agreement. The headline elements of the proposed final agreement remain unchanged from those set out in my previous statement to the House concerning pension reform on 20 December 2011.

The Government have made it clear that the proposed final agreement represents our final position on scheme design. The final scheme design is conditional on acceptance by trade unions of the proposed final agreement. Trade unions have agreed to take this proposed final agreement to their Executives as the outcome of negotiations. Furthermore, the proposed final agreement includes a commitment by trade unions to seek Executives’ agreement to the cessation of any further industrial action on pension reform.

The core parameters of the new scheme are set out below:

a. a pension scheme design based on a career average revalued earnings methodology;

b. an accrual rate of l/54th of pensionable earnings each year with no limit to pensionable service;

c. revaluation of active members’ benefits in line with the consumer price index plus 1.5% per annum;

d. a normal pension age equal to the state pension age, which applies both to active members and deferred members (new scheme service only). If a member’s state pension age rises, then their normal pension age will do so too for all post-2015 service. Those within 10 years of their current normal pension age are excluded and accrued rights will also be related to current normal pension age;

e. pensions in payment to increase in line with inflation (currently consumer price index);

f. benefits to increase in any period of deferment in line with inflation (currently consumer price index);

g. member contributions on a tiered basis to produce a total yield of 9.8% of total pensionable pay in the scheme;

h. optional lump sum commutation at a rate of £12 of lump sum for every £1 per annum of pension foregone up to the maximum limit on lump sums permitted by HM Revenue and Customs;

i. the current flexibilities in the 2008 section will be included in the 2015 scheme—early/late retirement factors on an actuarially neutral basis, draw down of pension on partial retirement and being able to retire and return to the pension scheme;

j. ill-health retirement pensions to be based on the current ill-health retirement arrangements but with enhancement for higher tier awards to be at the rate of 50% of prospective service to normal pension age;

k. spouse and partner pensions to continue to be based on an accrual rate of 1/160th. For deaths in retirement, spouse and partner pensions will remain based on pre-commuted pension;

l. the current arrangements for abatement (for service accrued before and after 2015) will be retained;

m. the lump sum on death in service will remain at twice actual pensionable pay;

n. for members who in the new scheme have a normal pension age higher than 65 there will be an option in the new scheme to pay additional contributions to reduce or, in some cases, remove any early retirement reduction that would apply if they retire before their normal pension age. Only reductions that would apply in respect of years after age 65 can be bought out and the maximum reduction that can be bought out is for three years (that would apply to a member with a normal pension age of 68 or higher);

o. added years contracts in the 1995 section will continue on compulsory transfer to the 2015 scheme;

p. arrangements to purchase additional pension will continue;

q. the public sector transfer club will continue and further consideration will be given to the best way of operating it in the reformed schemes; and

r. there will be an employer contribution cap.

The Government Actuary’s Department (GAD) has confirmed that this scheme design does not exceed the cost ceiling set by the Government on 2 November 2011. The proposed final agreement and GAD verification have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. The documents are also available at:

www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_133003.pdf

Reviewing and Strengthening the NHS Constitution

Lord Lansley Excerpts

Thursday 8th March 2012 Written Statements

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

As Secretary of State for Health, I have a duty, under the Health Act 2009, to publish a report on how the NHS constitution has affected patients, staff, carers and the public by 5 July 2012.

The Government are committed to the common set of principles and values established by the NHS constitution, and have made a number of amendments to the Health and Social Care Bill to strengthen its influence on the NHS.

The statutory requirement for a report on the impact of the NHS constitution provides an excellent opportunity to assess the contribution it has made to reinforcing the principles and values of the NHS, supporting high quality patient care and ensuring that patients, the public and staff are aware of their rights, as well as what they can contribute. The report will help to inform efforts to fully embed the constitution in the everyday work of the NHS, including the plans of the NHS Commissioning Board (NHSCB) and clinical commissioning groups (CCGs) to fulfil their duties to promote the NHS constitution.

In order to make the most of this opportunity, I am keen to have a wide range of advice and I have therefore asked Professor Steve Field to chair an independent Future Forum working group to advise me on the NHS constitution. The Future Forum group will use a wide variety of information, including surveys, workshops, performance data, and patient experience reports to examine what effect the constitution has had on the NHS and will then advise me on how best to reflect this in my report.

Following the report, I have also asked the new Future Forum group to advise me whether there is any scope for strengthening the NHS constitution to support the fair and effective operation of the NHS. Both the group and the Government will engage with key NHS, professional and patient organisations in considering the potential for changes, before a full public consultation in autumn 2012. Any amendments to the NHS constitution would then come into effect by April 2013.

Between them, this work and the new duties on the NHS constitution contained in the Health and Social Care Bill, which will require NHS bodies to have regard to the constitution and for the NHSCB and CCGs to promote the constitution, will strengthen both the contents of the NHS constitution and the role it plays in the NHS.

Whistleblowing and the NHS Constitution

Lord Lansley Excerpts

Thursday 8th March 2012 Written Statements

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

On 9 June 2010, I announced a full inquiry into the failings at Mid Staffordshire NHS Foundation Trust and gave a commitment to

“Reinforce the NHS constitution to make clear the rights and responsibilities of NHS staff and their employers in respect of whistleblowing”.

The Department of Health ran a full public consultation on a set of proposals for changes to the NHS constitution in respect of whistleblowing and published the Government’s response to that consultation, on 18 October 2011, setting out a commitment to making the changes in early 2012.



I have today published a revised NHS constitution which highlights the existing rights of NHS staff to raise concerns without fear of detriment and makes it clear that it is the right and duty of all NHS workers to report bad practice or any mistreatment of patients receiving care from the health service at the earliest opportunity.

Changes to the constitution add:

an expectation that staff should raise concerns at the earliest opportunity;

a pledge that NHS organisations should support staff when raising concerns by ensuring their concerns are fully investigated and that there is someone independent, outside of their team, to speak to; and

clarity around the existing legal right for staff to raise concerns about safety, malpractice or other wrongdoing without suffering any detriment.

These changes are part of a series of measures intended to highlight the importance of whistleblowing in the NHS. This Government have already issued unequivocal guidance to NHS organisations that all their contracts of employment should cover staff whistleblowing rights and amended the NHS staff terms and conditions of service handbook for those staff on Agenda for Change terms and conditions to include a contractual right to raise concerns. We have also issued guidance to the NHS on supporting and taking action on concerns raised by staff.

Enshrining whistleblowing in the constitution will contribute to further raising the profile of whistleblowing and play an important role in creating a culture where staff will be able to raise genuine concerns in good faith, without fear of reprisal.

I recently announced that the Department of Health has put in place a new and improved contract for the provision of a confidential whistleblowing helpline for NHS staff to provide them with advice on how to raise concerns and what legal protections are available to them when they do. The new contract provides for a free phone service and extends the provision of the contract to staff working in social care.

The revised NHS constitution has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Health 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.