NHS Outcomes Framework 2012-13
Lord Lansley Excerpts(13 years ago)
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The Secretary of State for Health (Mr Andrew Lansley)
The White Paper “Equity and Excellence: Liberating the NHS” (Cm 7881) outlined a vision of an NHS that achieves health outcomes that are among the best in the world. It explained that an NHS outcomes framework would be developed to provide national level accountability for the outcomes that the NHS delivers.
I have today published “The NHS Outcomes Framework 2012-13”. This refreshes the first NHS outcomes framework published for England in December 2010 and includes updated definitions for some of the indicators in the framework.
The framework has three main purposes, which remain the same in this updated version:
to provide a national level overview of how the NHS is performing against certain outcome measures;
to act as a mechanism for the Secretary of State to hold the NHS Commissioning Board to account for delivering improvements in outcomes, from April 2013; and
to act as a catalyst for driving improvement and a focus on outcomes throughout the NHS.
A copy of “The NHS Outcomes Framework 2012-13” 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.
Life Sciences
Lord Lansley Excerpts(13 years, 1 month ago)
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The Secretary of State for Health (Mr Andrew Lansley)
With permission, Mr Speaker, I would like to make a statement about the strategy for UK life sciences that the Prime Minister is launching this afternoon at a leading life sciences conference. The life sciences industry is one of the most promising areas for growth in the UK economy. It has consistently shown stronger growth than the United Kingdom as a whole, and it accounts for 165,000 UK jobs and totals more than £50 billion in turnover. Pharmaceuticals alone account for more than a quarter of our total industrial research and development spend. Global pharmaceutical sales are predicted to grow by up to 6% a year in the coming years, and in emerging economies medical technology is achieving growth rates of more than 12%. A flourishing life sciences sector is essential if we want to build a more outward-looking, export-driven economy. The partnership between industry, the NHS and our outstanding universities is not just essential to economic growth; it will benefit millions of future and current NHS patients, fuelling the more rapid development of cutting-edge treatments and earlier access to those treatments for NHS patients.
Like many industries, the life sciences industry is undergoing rapid change. The old “big pharma” model of having thousands of highly-paid researchers working on a pipeline of blockbuster drugs is declining. A new model has emerged—one that is more about collaboration, the outsourcing of research and early clinical trials on patients. Excessive regulation can mean that the uptake of new treatments and technology is slow. That is a challenge felt acutely by an industry that sometimes feels that the return is not there quickly enough to satisfy investors. It is felt even more acutely by patients, who understandably expect that they should be able to access the latest and most effective treatments, and that new innovations in care should be adopted rapidly by the NHS.
We have a leading science base, four of the world’s top 10 universities and a national health service that is uniquely capable of understanding population health characteristics, but those strengths alone are not enough to keep pace with what is happening. We must radically change the way we innovate and the way we collaborate.
The life sciences strategy we launch today, alongside the NHS chief executive’s review on innovation, health and wealth, sets out how we will support closer collaboration between the NHS, industry and our universities, driving growth in the economy and improvements in the NHS. All the documents have been placed in the Library.
Among other key measures, we will set up a new programme between the Medical Research Council and the Technology Strategy Board to bring medical discoveries closer to commercialisation and use in the NHS. There are many medical products being developed to treat patients and the cost of developing them is high because they take a long time to develop and test. Investors want to see at least some evidence that the products might work in people and robust validation of the quality of the research and development work being undertaken, as well as of the capability of the company to bring the product to market, before they will finance the development of the products. That means that some of the best medical innovations are not making it through to patients. We are already providing investment to address that, but we believe that we can do more to support the development of these products across funding organisations and the successive stages of product development, which will support the development of promising innovations and help to increase the number of treatments made available to patients. We are therefore introducing a £180 million catalyst fund for the most promising medical treatments.
It can take more than 20 years from the first discovery of a drug until patients can be prescribed it by their doctor and we have already taken steps to address that. Through the National Institute for Health Research, we are investing £800 million in new research centres and two major translational research partnerships that will help cut the time between the development of new treatments and their application in the NHS—from the bench to the bedside.
Now, we are going further. As part of a major drive to improve innovation and access to medicines in the NHS, we are announcing proposals on a new early access scheme that could allow thousands of the most seriously ill patients to access new cutting-edge drugs up to a year earlier than they can now. Through the early access scheme, the medicines regulator, the Medicines and Healthcare products Regulatory Agency, would provide a scientific opinion on the emerging benefits and risks of very promising new drugs to treat patients with life-threatening or debilitating conditions for whom there are no satisfactory treatment options. That will mean that seriously ill patients of any age who have no other hope of being treated or having their life extended could benefit from drugs more quickly, around a year before they are licensed.
We must also ensure that we make better use of our unique NHS data capability. It is often said that the NHS is data-rich but information-poor. As a national health service, it contains more data about health than any other comparable health system in the world, but neither the NHS nor scientists developing new drugs and treatments have always been able consistently to make good use of the data or to use them to drive further scientific breakthroughs.
We have seen how powerful the release of data can be. For example, South London and Maudsley NHS Trust and the Institute of Psychiatry now have access to a database covering 250,000 patients. It includes their brain scans, medical records and notes—a wealth of information, all consented to and all anonymised, that is helping them find new answers in the fight against dementia.
We need powerful data-handling capacity and the skills to write the software to mine them. That is why we are investing in e-infrastructure, which will provide secure data services to researchers. The clinical practice research datalink is being introduced by the MHRA in partnership with the NIHR and will provide a specialised service to the research and life sciences communities. Let me reassure the House that we will take all necessary steps to ensure safeguards for patient confidentiality.
We will also make sure that more UK patients get the opportunity to take part in national and international clinical trials and play a much greater role in the development of cutting-edge treatments. We believe that patients should have the right to access new treatments and be involved in research to develop new medicines.
We have responded to calls from research charities and clinicians for Government to get patients more involved in supporting research. A recent Ipsos MORI poll in June found that 97% of people believed it is important that the NHS should support research into new treatments and, in addition, 72% would like to be offered opportunities to be involved in research trials. We will therefore consult on changing the NHS constitution so that there is an assumption, with the ability to opt out, that data collected during a patient’s care by the NHS may be used for approved research.
That would make it clear that researchers and companies with new and potentially life-saving medicines could access the data of patients and could approach patients whom they feel could benefit in order to discuss their involvement in research studies. This would encourage growth in the life sciences industry as more people and more detailed data would be available for the important trials and research needed to get breakthrough treatments used more widely.
Additionally, we have set out actions to improve incentives for investment in innovation and to reduce regulatory bureaucracy. With the creation of the Health Research Authority, we will streamline regulation and improve the cost-effectiveness of clinical trials. As the NHS chief executive’s review of innovation has shown, the NHS needs to be quicker and smarter in adopting new technologies and approaches to care that can both save more lives and cut costs.
Sometimes, it is a question of evidence. Until recently, we could not say with certainty that telehealth could keep people out of hospital and save lives, and there was understandable reluctance among parts of the NHS and councils to invest in untried technology. However, as early results from the whole system demonstrator pilots show, the potential of telehealth is nothing short of remarkable, with dramatic reductions in mortality, in hospital admissions, in emergency visits and in the number of hospital bed days. To make the most of this, we will support the NHS and work in partnership with industry and councils dramatically to spread the use of telehealth over the next five years. In doing so, we are looking to transform the lives of 3 million people in this country.
We will become a global leader in the management of chronic and long-term conditions, generating massive opportunities for UK companies developing this technology. It will be innovation in practice and we will foster other proven innovations such as fluid management technology techniques that were developed for use in high-risk surgery and critical care to help clinicians administer fluids and drugs safely. In March 2011, the National Institute for Health and Clinical Excellence published guidance recommending that this technology should be used for patients undergoing major or high-risk surgery. Currently, it is used for fewer than 5% of applicable patients despite evidence showing that it could benefit 800,000 patients and save the NHS £400 million. We will launch a national drive to make sure that fluid management technology is used in appropriate settings across the NHS. That is one example of many.
The innovation review sets out how we will address all the barriers to innovation in the NHS, whether they involve culture, leadership, training, use of information or lack of incentives and investment. We will also introduce a NICE compliance regime that will mean that medicines approved by NICE will be available on the NHS much more quickly. The plans set out in today’s strategies will help to drive the development of new technologies to diagnose and treat the most complex diseases in this country for the benefit of NHS patients. This is a strong package of measures that will support economic growth and innovation in the NHS and will drive significant improvements in patient care. I commend this statement to the House.
Andy Burnham (Leigh) (Lab)
May I thank the right hon. Gentleman for his statement and start by setting out two points of common ground with the Government? First, we too have pride in Britain’s life sciences industry and its strength. We agree that the industry needs Government support and focus if its potential to contribute to the country’s industrial future is to be maximised. Secondly, we agree that there are huge potential benefits to British patients from closer collaboration between the NHS and the industry. We all want patients to have the quickest possible access to the latest life-saving and life-enhancing treatments.
It was for those two principal reasons that Labour, when in government, prioritised the life sciences sector and established the Office for Life Sciences. In Lord Drayson, we created a life sciences Minister who was a contact point for the industry—someone of huge experience and with real personal commitment to the industry. One of our criticisms of this Government is that they have allowed the momentum that Labour had established in promoting the industry to fall away. Progress has stalled because of the Government’s failure to understand that economic growth needs a proper partnership between the public and private sector and because of the combined effect of a number of their policies. Such policies include: damaging 15% real-terms cuts to the science budget; the loss of the regional developments agencies, many of which were heavily involved in this area; cuts to regional investment; and the destabilising effect of the unnecessary reorganisation of the NHS, particularly the disintegration of the strategic health authorities, which played a role in promoting research. The unexpected closure of Pfizer earlier this year exposed a Government asleep at the wheel and was a wake-up call, and now we see a Government playing catch-up.
Although we welcome their belated recognition of the importance of the sector, there are sensitive issues involved and Ministers need to tread carefully so as not to undermine public trust. What they are fond of calling red tape are, to others, essential safeguards. Some areas will always need proper regulation and the use of patient data is most certainly one of them. As we have heard from patients groups today, some have been caused real anxiety by this media-briefed statement from the Government and the lack of accompanying detail.
Ministers need to be aware that people with terminal illnesses and long-term conditions will react differently from others to a statement of this kind, so for them we seek direct assurances today from the Secretary of State that he failed to give in his statement. Will all patients have the ability to opt out of the sharing of their data, even in anonymised form? Surely that fundamental principle of consent should form the bedrock of any new system, and that control of data should be possible in today’s information age. If the Secretary of State cannot give that assurance, why not? How can he justify that?
Did patients’ representatives walk away from the Department of Health working group on these important matters and, if so, why? One representative said on the radio this morning that the whole process “stinks”. Does the Secretary of State not accept that he and his Department will need to do better than this to uphold public confidence in the process or risk undermining trust in the whole principle? What safeguards will there be to ensure that patient data are stored securely? Does he not need to articulate a more positive statement of patients’ rights in this important area, rather than the loose opt-out he proposes in the NHS constitution?
Is it the case that the anonymity of data cannot always be guaranteed? If so, what are those circumstances and, again, why not? Even within anonymised datasets, particularly dealing with small numbers of very specific conditions, it is possible to identify individual patients. What steps are being taken to guard against those risks? Will the Secretary of State give a categorical assurance that data cannot be used for purposes other than research—passed on to third parties or used by the same company to target people for other products and services?
Today’s announcement also needs to be considered in the context of the Government’s reorganisation of the NHS. Does not a more market-based health system with a greater number of private providers create much greater challenges for the control of data? I had many dealings with senior figures in the pharmaceutical industry in my time as a Minister. They were clear that it was the national structure of the NHS, and the ability to collaborate and share information across a whole health system, that was a huge attraction to the industry and a competitive strength for this country.
Does not the Secretary of State’s Health and Social Care Bill risk turning the NHS into a competitive market, where collaboration is discouraged in an any-qualified-provider free-for-all? So how can he guarantee that that competitive strength will be there in the future and will continue to be used by the pharmaceutical industry? Although he will not admit it today, were not many of the measures he has announced, particularly the expansion of telecare, made possible by the steps that we took to invest and modernise NHS IT?
More broadly, this announcement raises questions about the Government’s policy on the involvement of the private sector in the NHS. The Government need to set out what, if any, limit they see on the involvement of the private sector in the NHS. The Prime Minister has said that he wants the NHS to be a fantastic business. Let me quote from a recent leaked document on NHS commissioning, “Towards Service Excellence”. It says:
“The NHS sector . . . needs to make the transition from statutory function to freestanding enterprise.”
It is no wonder that, on the back of these worrying words, the British Medical Association has adopted a position of outright opposition to the Secretary of State’s Bill. Our worry is that, in their desperation to develop a credible industrial strategy, Ministers seem ready to put large chunks of the NHS up for sale.
Patient data are not the Secretary of State’s to give away. The NHS is not his to sell. The truth is that the Government are running huge risks with patient confidentiality and patient safety by opening up the NHS to the private sector and reorganising at a time of financial stress, but we do not yet know the full scale of those risks.
Andy Burnham
It is.
The great irony is this: while Ministers are happy to offer up other people’s data, they continue to withhold the NHS risk register, which shows the risk they are running with our NHS. Is that not why people are increasingly asking what the Secretary of State has to hide?
Mr Lansley
I am afraid that the last sentence was not really worth it, Mr Speaker. The right hon. Gentleman, while talking about things that were completely irrelevant to my statement, asked a number of questions. Will patients be able to opt out? Yes. It is clear that they will be able to opt out, as I have said. Are there risks relating to a small number of patients being identified? No. As he should know, and as has been done in relation to the general practice research database, where there are small populations of patients in which it might be possible to indentify individuals, or where a small number of patients have very specific sub-sets of conditions and there is a risk of identification, it is perfectly possible to ensure that that information cannot be accessed through the database. We have made it clear that data would be not only anonymised—in fact, it would be double anonymised—in order to ensure that it cannot be recreated, but viewed in such a way that will make it impossible to identify from the circumstances of the data where the patient comes from.
The right hon. Gentleman asked whether the database must be used for approved research or could be used for other purposes. It must be used for approved research and cannot be used for other purposes. It is not a database that people, whoever they may be, whether from universities or pharmaceutical research companies, can simply access in order to go mining for information; they must do so only through the MHRA and for approved research purposes.
Finally, the right hon. Gentleman asked—frankly, I think it is irrelevant—about the extent of the private sector’s role. Unlike his predecessor, Patricia Hewitt, who was Secretary of State when he was a Health Minister, and who said that she was aiming for 10% or 15% private sector involvement, we are not looking for a specific level of private sector involvement or creating a free market in the NHS. It will continue to be a national health service with the national characteristics that we would expect, funded through taxation and available to all based on need, not ability to pay, and in this context it will continue to be a national NHS. The simple fact that, among other measures in the life sciences strategy, we are able to show how we can bring data sets together, including the general practice database, the hospital episodes statistics, the cancer registries and so on, in order to show the power of data across the whole NHS to support research for new treatments is a complete vindication of the fact that it will be a national health service—that it will change in that respect and that patients will benefit from both the national health service and the research that comes with it.
Mr David Burrowes (Enfield, Southgate) (Con)
May I be the first warmly to welcome the Secretary of State’s statement and to make a bid for the catalyst fund for regenerative medicine, which not only offers great hope for the future but is providing life-saving treatment through umbilical cord blood? I refer him to the recommendation the UK stem cell strategic forum made last year for collaboration between universities, hospitals and farming industries to make greater use of the application of cord blood now and in future.
Mr Lansley
I am grateful to my hon. Friend and heartily welcome his support for the opportunities in regenerative medicine. I was fortunate enough to meet at the UK Stroke Forum last Thursday, among those exhibiting, a company that is based in England but undertaking trials and research activity in Scotland and is looking precisely at how it can use foetal-derived stem cells for regenerative purposes. The right hon. Member for Leigh (Andy Burnham) talked about Pfizer. In my constituency, it has been one of the companies leading the development of new regenerative medicine techniques. That is clearly one of the areas that this country has tremendous potential in developing. The technology innovation centre for regenerative medicine was announced in the “Plan for Growth” published alongside the Budget earlier this year, and I hope that it will be one of the areas in which we will see those developments.
Mr Kevin Barron (Rother Valley) (Lab)
The Health Committee, in its report on the electronic patient record, published in September 2007, stated that the highly detailed data captured had “outstanding” prospects for new and improved research, but it also asked that the best balance be found between
“the opportunity to improve access for research purposes with the ongoing need to safeguard patient privacy”.
Do the Government believe they can get that right, so that we can go ahead and use the enormous amount of data that we have in this country to improve health care for patients not just here, but throughout the world?
Mr Lansley
I am glad that the right hon. Gentleman is here and able to ask that question, because he was the Chair of the Health Committee in September 2007, when it stated that the secondary use of data in the NHS was “vital” for the development of the NHS, including for research use. I hope that he is one of those who recognise that what we are setting out in the life sciences strategy—in particular, with the clinical practice research datalink—will enable precisely all those secondary uses for research to be developed.
Dr Julian Huppert (Cambridge) (LD)
As the Secretary of State will know well, the Cambridge area is world leading in life sciences, both in academia and in industry. This strategy, and the investment to go with it, is very welcome indeed and will, I am sure, support a lot of activity in Cambridge and in South Cambridgeshire. There is one slightly sour note about private data, however, so I hope that the details will be published of exactly how the steps to which the Secretary of State referred will be taken to protect that, but, on clinical trials and what will happen to regulation, will he implement in full the recommendations of the Academy of Medical Sciences?
Mr Lansley
I am grateful to my hon. Friend. He and I share a vigorous and vibrant life sciences sector, and I hope that the strategy that we have announced today will be taken up rapidly in our constituencies. He asks about the Academy of Medical Sciences. Back in the “Plan for Growth” in the Budget, we responded precisely to that point, and on 1 December, as a consequence of the positive response to what the academy said, I brought into effect the Health Research Authority to ensure that we simplify the process of approval for clinical trials. Through the National Institute for Health Research, as we said earlier in the year, we are seeking to arrive at a point where there is a maximum of 70 days for the first recruitment of patients to clinical trials, and that will get us into an internationally competitive position.
Mr Frank Field (Birkenhead) (Lab)
May I ask the Secretary of State a further question about the rights of people to opt out of the scheme? Will he extend the right of opt-out for those people who refuse to participate in the scheme to include a refusal of the advantages that come from sharing such information, which will be gained by the generosity of spirit of their fellow citizens who participate?
Mr Lansley
I understand the right hon. Gentleman’s point, but the ethical approach is for everyone to have access to the latest and best available treatments through the NHS. That is the principle that we apply, but we should be aware that, although we offer people the right to opt out, we have seen—for example, in relation to the general practice research database, where patients have the equivalent right to opt out, and in two pilots conducted on the proposals that we have announced—that the rate of opt out is 0.1%.
Dr Sarah Wollaston (Totnes) (Con)
I warmly welcome the Secretary of State’s statement, as this strategy will reduce the delay between discovery and dispensing and, undoubtedly, bring great benefits to patients and to our pharmaceutical industry, but in return will he ask the industry to go further and publish negative trial data, as well as positive trial data, as a gesture to improve the quality of research data?
Mr Lansley
I am grateful to my hon. Friend for that point. The industry has done quite a lot in recent years in publishing more data, including data that do not necessarily support the positive case that it is looking for, because all of us, and especially those working in the field, learn a great deal and, sometimes, as much from clinical trials that produce a negative result as we do from those that produce a positive result. So, I will certainly take her point away, explore it with my colleagues and write to her if we can take further steps in that direction.
Hywel Williams (Arfon) (PC)
Are the patient data proposals to be England-only or UK-wide? If so, what is the relationship with projects such as the SAIL—Secure Anonymised Information Linkage—database in Swansea and Biobank? I foresee some ethical problems, as Biobank operates specifically on a voluntary basis with a written, sought-for consent. Does the Secretary of State see that there might be some problems there?
Mr Lansley
I am grateful for that question. What we are setting out is hosted by the Medicines and Healthcare products Regulatory Agency, which will be able to link datasets for which it is responsible, which do, in some cases, have a UK basis rather than an England-alone basis.
John Pugh (Southport) (LD)
I welcome the statement. The Secretary of State mentions telehealth, which is currently making greater progress in Scotland than in England. Has this anything to do with less structural reform or more strategic leadership?
Mr Lansley
My hon. Friend might like to know that while initial and very positive steps were taken in Scotland —for example, in Lanarkshire—we have now undertaken, through the whole system demonstrator pilots, the world’s largest randomised control trial of telehealth technology, and that gives us a strength from which we can develop telehealth systems that is unparalleled anywhere in the world. In so far as there is a capacity to provide telehealth systems and provide for their use across health care systems, I suspect that we shall shortly see England overtake Scotland in that respect. It is a form of competition that I am perfectly happy to be engaged in—and if the Scots can do better than us, then good luck to them. However, we are showing, through these pilots, how we are ready to go at developing something of great benefit to patients.
Andrew Miller (Ellesmere Port and Neston) (Lab)
It is good to see that the Secretary of State is now on the same side of the debate as me regarding NO2ID and similar issues. Nevertheless, there is an important issue about ensuring the greatest public buy-in to the issue of data sharing, and careful work is needed on that. May I specifically ask him about the catalyst fund? To what extent is this new money? Can he assure the House that money from patient care is not being transferred into the catalyst fund? Will the Technology Strategy Board be able to control its use, or will it be directed by Government?
Mr Lansley
In the first instance, the £180 million to which I referred consists of £90 million from the Medical Research Council, which is new money within its existing budget but not at the expense of any other programmes. The other £90 million is provided by the Treasury to the TSB and is new money. None of this comes out of any NHS resources. The implementation will be led by the Medical Research Council, so to that extent it will not be driven by Government.
Iain Stewart (Milton Keynes South) (Con)
Does my right hon. Friend believe that there is a threat that parts of the UK pharmaceutical industry might relocate overseas if this package of reforms does not proceed?
Mr Lansley
There is always that risk because, as my hon. Friend entirely knows, international competition is intense, particularly in the pharmaceutical sector. Following the measures that were announced alongside the Budget in the plan for growth, not least the availability of the patent box from April 2013, it is clear from discussions that my right hon. Friends and I have had with many of the boards of leading international pharmaceutical companies that the United Kingdom is now becoming a better location for investment in pharmaceutical activity than used to be the case. Those companies look very positively at the steps we have taken on regulatory activity and clinical trials, at the steps we are taking on promoting innovation through the value-based pricing system, and in particular, understandably, at the tax measures that my right hon. Friend the Chancellor announced, especially on the patent box.
Paul Goggins (Wythenshawe and Sale East) (Lab)
The Secretary of State’s statement raises a number of important ethical issues. Will he take a close look at the emerging proposals for a medipark that is close to Wythenshawe hospital and part of Greater Manchester’s airport city enterprise zone? This has tremendous potential to attract investment from global bioscience and pharmaceutical companies, which would make a massive difference in my constituency and way beyond that. Will he look to see what support can be offered?
Mr Lansley
I will gladly do so. As the right hon. Gentleman knows, the designation of an academic health science centre in Manchester has supported many developments. We want to go further. In today’s life sciences strategy, we are making it clear that not only do we want to maintain the academic health science centre designation as a world-class designation for comprehensive research centres, but we want to go further and ensure that such centres are used to diffuse and spread innovation across the NHS more effectively. Next spring, we will set out how we will enable academic health science networks to be designated. That will happen during 2012-13. I will happily look at the circumstances in south Manchester and at how this matter will apply there. I hope that partnerships will be forged between the NHS, universities and the private sector of the kind that he and I know will be successful.
John Howell (Henley) (Con)
Does my right hon. Friend agree that there is a world of difference between streamlining regulation, to use his phrase, and the picture of the indiscriminate abolishment of regulation that the Opposition tried to create? Such streamlining is essential to cut the time from invention to adoption.
Mr Lansley
I am clear, and I know that my hon. Friend agrees, that we must ensure that the regulatory processes are effective and that the medicines that are available in this country are of the necessary quality, safe and effective. However, we must not allow the delays that are inherent in some of these processes to prevent information from being provided on the basis of which clinicians, with the active, informed consent of patients, can access what they regard as potentially effective medicines. In the overall context of patient safety, we do patients a serious disservice if we know that there is a potentially effective medicine available and do not give them the first possible opportunity to access it.
Julie Hilling (Bolton West) (Lab)
The Secretary of State says that his proposals reflect his commitment to the national health service. If GPs will be commissioning treatments, how will he ensure that they commission new and more effective treatments that might be more expensive?
Mr Lansley
As the hon. Lady will know, the Health and Social Care Bill that is being considered in another place will, for the first time, place a direct legal duty to support innovation on clinical commissioning groups. That will be supported by the process of commissioning from the acute sector, in which the quality increments in the tariff will directly drive innovations in best practice.
David Rutley (Macclesfield) (Con)
I welcome the Secretary of State’s statement. These proposals are vital for the competitiveness of life sciences and pharmaceuticals, which are vital for the UK and for the local economy in Macclesfield. Will he tell the House how these steps will reduce the time that is taken to establish clinical trials, which has been a barrier for far too long?
Mr Lansley
The principal impact that we are having relates to the National Institute for Health Research, which, through its contracts with the NHS and other partners, is driving the time to the first recruitment of clinical trials down to 70 days. That will get us to a competitive position. We are also working in partnership with the pharmaceutical industry, for example to look at how some of the new stratified medicines will be available. Today, we are entering into partnership with AstraZeneca, which is close to my hon. Friend’s constituency, to understand what specific compounds are likely to be of benefit to some subsets of the population with cancer through the use of targeted new medicines.
Paul Flynn (Newport West) (Lab)
As the policy rests on the trust in the regulatory body that was tardy in protecting patients against the adverse side effects of Vioxx and Seroxat, is it not time that we had a fully independent MHRA and not one that is funded entirely by the pharmaceutical industry? As big pharma pays the piper, is it not possible that it will call the tune for its own commercial interests?
Mr Lansley
I think that the hon. Gentleman is wrong about that. The MHRA operates, in scientific and expert terms, in an independent fashion. In so far as it is accountable, it is accountable to me as Secretary of State and to this House. It is not accountable to the pharmaceutical industry. If he is proposing a major transfer of costs from the pharmaceutical industry to the taxpayer, I am afraid that I do not agree with him.
Nick de Bois (Enfield North) (Con)
I warmly welcome the commitment to telehealth and the expansion of it over the next five years. Does the Secretary of State agree, however, that that represents a step change for patients? Will it be the responsibility of councils and stakeholders to demonstrate the value and benefits of telehealth to their patients, so that there is full buy-in?
Mr Lansley
I am grateful to my hon. Friend. The figures from the evaluation of the 6,000 or so patients who have participated in the three pilots in Cornwall, Kent and Newham suggest that if telehealth is appropriately and properly provided, there are benefits. There was a total reduction of 45% in mortality, about 21% in accident and emergency visits, about 15% in planned admissions and bed stays in hospital and about 8% in costs. Those are dramatic benefits, but the most important aspect is the empowerment that telehealth gives patients so that they can be at home and be confident about their care, rather than be prey to rapid crises leading to admission to hospital.
Mr Dennis Skinner (Bolsover) (Lab)
Is this whole idea not being driven by the pharmaceutical industry in order to make money? In the real world, when I have been in hospital in these past 10 or 15 years for all sorts of different problems, all of us have relied on the care and attention of the doctors and nurses. There was an increase of about 30,000 doctors and 80,000 nurses, because we put a lot more money in. I did not meet anybody at all who ever said to me, “I’ve just been given some drugs to look after my heart, but I don’t like them and I want something else”. The whole thing is a money-making exercise by the pharmaceutical industry, which has friends in the Tory party. We are supposed to be short of money in this country and in the health service. What we really need is to stop sacking nurses, which will make it a lot better.
Mr Lansley
The hon. Gentleman will have to talk to the right hon. Member for Leigh (Andy Burnham), who claimed to be the friend of the pharmaceutical industry. The truth is that we should all be friends of it and support it. Why? Because it has the capacity to bring in new medicines and new treatments that are to the benefit of patients. From my point of view, it is not about the profitability of the pharmaceutical industry, it is about working with those who have the greatest potential to bring investment to this country for economic benefit and, more importantly, to improve benefits for patients. The hon. Gentleman, who has no doubt been the beneficiary of many therapeutic improvements generated by investment in the pharmaceutical industry, should not decry it.
Mr Skinner
Yes, but in a free health service, not a privatised health service, which it will be—
Mike Crockart (Edinburgh West) (LD)
Key to the strategy announced today is the ability to translate primary research into early adoption and commercial outcomes. Does the Secretary of State agree that Edinburgh’s BioQuarter is uniquely placed to do that, as it already shares a campus with the state-of-the-art royal infirmary of Edinburgh and is hopefully soon to be joined by the excellent sick children’s hospital, providing a base for the commercialisation of the innovative work being carried out by Edinburgh’s universities?
Mr Lansley
My hon. Friend makes a very good point, and far be it from me to comment further. He explained very well the benefits associated with investment and developments in Edinburgh and how the universities, the pharmaceutical industry and the NHS are working together there. That is also happening in locations in England, and across the United Kingdom we are providing real opportunities for international investment in biosciences.
Stuart Andrew (Pudsey) (Con)
During my time working within the hospice movement, it was my privilege to meet many patients and families. They naturally wanted everything at their disposal that would extend patients’ lives or at the very least make them more comfortable. At times, they would feel frustrated that patients in other countries benefited from drugs before they could, even though they were invented here. What is the Secretary of State doing to try to rectify that problem?
Mr Lansley
My hon. Friend makes a very good point from his personal experience. It is precisely because we recognised that patients in Britain were not getting access to the latest cancer medicines as quickly as patients in other countries that we were clear at the election that we would introduce a cancer drugs fund. Since the introduction of the fund in October 2010, more than 7,500 patients have accessed new cancer medicines through it. The early access scheme that I have described will go even a step further in anticipating the successful, efficacious introduction of new medicines in a way that allows patients and clinicians sometimes to access medicines even before the point at which they are licensed.
Andrew Bridgen (North West Leicestershire) (Con)
As a graduate in biological sciences, I welcome the Secretary of State’s commitment to life sciences in this country. In my opinion, there has been too much of a disconnect between vital research at universities and in the private sector and the NHS. How will the Secretary of State ensure that the biggest beneficiaries of the release of these valuable data are UK patients and universities, and UK-based companies?
Mr Lansley
I would instance two things in that respect, the first of which is the developing collaborations that were started under the academic health science centres and that will be continued through the networks that we want to extend. Those partnerships are specifically designed—£800 million was allocated in August, based on a competition—to enable the translation of discovery into new medicines in this country.
Secondly, the £180 million catalyst fund, which the MRC and Technology Strategy Board will implement, is specifically designed to take those ideas—the MRC says that it has some 360 such potential developments in medicines and treatments—through to the point at which they can be developed. Of course, that will be in this country.
Mr Philip Hollobone (Kettering) (Con)
Given that Northamptonshire has one of the most rapidly growing populations of patients in older age of anywhere in the country, I am sure my constituents will welcome the Secretary of State’s commitment that this country will become the global leader in the management of chronic and long-term conditions. We want to realise that praiseworthy ambition, but how far behind the curve are we at the moment?
Mr Lansley
The answer to that question varies depending on which conditions one is talking about. When one looks at the OECD “Health at a Glance” data that was published on 23 November, one sees how relatively poor are our mortality outcomes in relation to respiratory and chronic obstructive pulmonary diseases. By contrast, we are slightly better than average in relation to diabetes. However, I have seen for myself how well patients with COPD can manage their conditions at home. For example, they can see their blood oxygen levels day-by-day and have supplies of medicines at home, including steroids. They can therefore anticipate and deal with any exacerbations of their condition so that they do not end up in an ambulance going to hospital late at night.
Duncan Hames (Chippenham) (LD)
From earlier access to potentially life-saving medicines through to releasing the power of information in the NHS, there is much to welcome in this statement. Given the importance of techniques such as pseudonymisation, how satisfied is the Secretary of State with the priority afforded to developing the informatics capability of NHS staff?
Mr Lansley
My hon. Friend makes an important point, to which I fear I do not have time to respond fully. One thing that I hope we can do as a consequence of abandoning the previous Government’s failed NHS IT structure is empower many individual hospital trusts and general practices once more to develop their own informatics expertise, which will stretch beyond IT infrastructure to the positive uses of data and information for the benefit of patients.
Oral Answers to Questions
Lord Lansley Excerpts(13 years, 1 month ago)
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Sarah Newton (Truro and Falmouth) (Con)
4. What steps he is taking to reduce the burden of debt for NHS hospitals.
The Secretary of State for Health (Mr Andrew Lansley)
Although the overall financial position remains healthy, we will continue to focus on the small number of organisations in the NHS that are struggling to manage their finances. We are working to help all NHS trusts to be sustainable providers of high-quality health care and move forward to foundation trust status. That will include, where appropriate, agreeing solutions to resolve the regrettable legacy of debt from the previous Government.
Sarah Newton
Despite the fact that the staff of the Royal Cornwall Hospitals NHS Trust have made big strides forward in improving patient care while delivering efficiency savings, the trust is saddled with historic debt, largely as a result of Labour accountancy measures. Does my right hon. Friend agree that that is grossly unfair and will he meet me to find ways of writing off the remaining Labour debt so that my constituents can stop worrying about the future of the only acute hospital in Cornwall?
Mr Lansley
I am grateful to my hon. Friend and completely concur. I have had the privilege of visiting Treliske hospital and seeing the good work that is being done there. In the course of the last financial year, the trust returned a surplus and it is projecting a surplus this year. As she knows, it has a legacy of debt that is being financed by a working capital loan. As with other NHS trusts, we are looking to ensure that through the process of becoming a foundation trust it will move from having legacy debts from the previous Government’s regime to being financially sustainable year-on-year while meeting the viability and balance sheet criteria for foundation trust status.
Mr Dave Watts (St Helens North) (Lab)
When will the Secretary of State get a grip and sort out the problems of PFI long-term funding—[Laughter]—given the fact that Ministers promised to do that six months ago and that we are no nearer a resolution than we were before?
Mr Lansley
I do not know whether Hansard will record it, but the mirth with which that remark was met is an indication from Members that they know perfectly well, as the hon. Gentleman ought to know, that the previous Labour Government left a terrible legacy of unaffordable PFI projects that were poor value for money when they were introduced. He knows perfectly well the position his local trust has been put in. We are working through that, and out of the work that has been done to resolve that poor legacy, we identified 22 NHS trusts which said that their PFI was an impediment. We are working with all of them to resolve that.
Emma Reynolds (Wolverhampton North East) (Lab)
5. What plans he has to allocate resources to local authorities when they assume responsibility for public health.
Nick de Bois (Enfield North) (Con)
6. What steps he is taking to raise the standards of care provided by health care workers and care assistants.
The Secretary of State for Health (Mr Andrew Lansley)
I have commissioned Skills for Health and Skills for Care in partnership with employers, unions, regulators, educators and others to develop a code of conduct and minimum training standards for health care support workers and adult social care workers in England. This will give employers and patients confidence in the employment and standards of staffing at all levels. I expect the final report and recommendations by September 2012.
Nick de Bois
The Secretary of State knows that I believe in less, not more, regulation, but given the increasing role and responsibilities of health care assistants, particularly with the elderly, does he agree that the time has come both to recognise their increased responsibilities and to provide safeguards at a national level by requiring them to be on a national register?
Mr Lansley
My hon. Friend will know that health care and social care support workers do responsible jobs and that the responsibility for them lies principally with their employers and the staff who supervise them. We made provision in the White Paper we published last December for a process of assured voluntary registration. What I announced and referred to a moment ago will give a code of conduct and standards that will form a basis for an assured voluntary registration scheme in future.
Andrew Gwynne (Denton and Reddish) (Lab)
One key care standard is the time that people have to wait for their treatment. Labour got waiting times down to an historic low, and we warned the Secretary of State what would happen if he relaxed the 18-week standard. Figures show that the number of patients waiting longer than 18 weeks is up by 43% and, despite the U-turn that the Government have made on the use of targets, is not the problem that they have been so fixated on their top-down reorganisation that they lost control of waiting lists? Surely it is time for them to drop the Health and Social Care Bill and focus on the things that really matter to the people using and working in the NHS.
Mr Lansley
I am sorry, but that was all completely synthetic anger on the hon. Gentleman’s part. The average time that patients have been waiting in the NHS for treatment continues to be between eight and nine weeks. It has been so ever since the last election. The operational standard under the previous Government and now for the 18-week waiting time is that at least 90% of patients who are admitted for treatment should be admitted and treated within 18 weeks, and 95% of outpatients. Both of those operational standards continue to be met. Last week I made it clear that whereas the previous Government abandoned people who went beyond 18 weeks—and there were 250,000 of them who went beyond 18 weeks—we will not abandon those forgotten patients. We will make sure that they, too, are brought into treatment as soon as possible.
Mr David Evennett (Bexleyheath and Crayford) (Con)
12. What steps his Department plans to take to assist hospitals with the cost of PFI payments.
The Secretary of State for Health (Mr Andrew Lansley)
A Treasury review identified savings opportunities of up to 5% on annual payments in NHS PFI schemes. The lessons learned from the PFI savings pilot will be applied to all schemes in the PFI pipeline. The previous Government left a £50 billion post-dated cheque to pay for their hospital building programme. Much of it was unaffordable and poor value for money. We are dealing with that unfortunate legacy, including the 22 NHS trusts that identified this as a constraint on their future sustainability.
Mr Jones
I thank my right hon. Friend for his response. PFI schemes have undoubtedly undermined the financial stability of many local health economies, as is the case in Coventry and Warwickshire. Can my right hon. Friend assure my constituents that any solution to assist PFI schemes, such as at the University Hospitals Coventry and Warwickshire NHS Trust, will not be to the detriment of my constituents who use the George Eliot hospital in Nuneaton?
Mr Lansley
Yes, I believe I can give my hon. Friend that assurance. Through the process of working with NHS trusts to see what is necessary for them to become foundation trusts—for example, we are working with University Hospitals Coventry and Warwickshire NHS Trust—it is clear that action taken locally with support can deliver viability and sustainability for the future. I hope the same will be true for the George Eliot hospital, but as a separate trust it will not be as a direct consequence of the steps that are taken at Walsgrave.
Mr Evennett
I welcome my right hon. Friend’s response to the original question. Poorly negotiated PFI deals for hospitals in the South London Healthcare NHS Trust are causing real financial problems and have led to the downgrading of Queen Mary’s hospital in my borough of Bexley. Does he share my concerns about this injustice, and will he ensure that my constituents get the first-class health care that they need and deserve and look again at this PFI situation?
Mr Lansley
Yes, of course. My hon. Friend understands very well indeed how difficult are the circumstances of his trust, which includes two PFI hospitals, and Queen Mary’s at Sidcup has suffered from the consequences of those PFIs. I am looking forward to the proposals on the future provision of health services on the Queen Mary’s Sidcup site. South London Healthcare is clearly an extremely challenged trust and we inherited very substantial problems there. We are looking to resolve them with it, but it will need additional national support.
Claire Perry (Devizes) (Con)
In addition to struggling hospital trusts, many, many community hospitals throughout the country, such as Savernake hospital near Marlborough, are also labouring under the burden of an enormous PFI contract and having the indignity of vital local services hollowed out under that lot’s leadership on the Labour Benches. Will the Secretary of State please tell me what he will do to help those smaller hospitals with vital local services?
Mr Lansley
As my hon. Friend knows from her conversations with the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns), we are very sympathetic to her concerns. By devolving commissioning responsibilities to clinical commissioning groups, I expect the local clinical leadership, understanding fully the contribution that community hospitals can make, to be supportive of that in their commissioning intentions in her constituency and others.
Dr Julian Huppert (Cambridge) (LD)
14. What plans he has to ensure balanced political and geographical representation on health and wellbeing boards.
Guy Opperman (Hexham) (Con)
15. What plans he has to ensure that the NHS is prepared for winter pressures.
The Secretary of State for Health (Mr Andrew Lansley)
The NHS and social care systems are well prepared for winter. Our Winterwatch summary was first published last Thursday. It showed higher flu vaccination uptake, and I announced additional extracorporeal membrane oxygenation—ECMO—capacity, which will be in place by December. There is always more pressure on the NHS during winter. This year will be no different, but the preparations are in place.
Guy Opperman
Given the director of immunisation’s recent report on the take-up by medical staff of the flu jab and the local efforts of Dr Alastair Blair, the chair of the Northumberland clinical commissioning group, will the Minister expand on the need for patient protection in the form of flu jabs in hospitals and surgeries around the country?
Mr Lansley
I would like to take this opportunity not least to commend the work that the chief medical officer has done this year in encouraging health care workers to have their seasonal flu jab. The latest figures are that 29% have done so, compared with 11% at the same point last year. We heard earlier from my hon. Friend the Member for Kettering (Mr Hollobone) how well Kettering has done, and there are hospitals that are demonstrating that a higher level is entirely achievable. I urge staff across the NHS to have their flu vaccination. It is the ethical thing to do, not least to provide protection to their patients.
John Healey (Wentworth and Dearne) (Lab)
One of the things that makes the problem of winter pressures much greater is the NHS coping with the biggest reorganisation ever. The public have a right to know the risks that the Government’s policies are placing on our NHS. The Information Commissioner agrees and has judged that the Secretary of State must now release the risk assessments and register for his NHS reorganisation. Will he now obey the law and end his 12-month cover-up?
Mr Lansley
I have been very clear and published all the cost-benefit and risk information relating to the modernisation of the NHS, and the impact assessment was published when the legislation was presented to the House of Lords.
David Morris (Morecambe and Lunesdale) (Con)
The Care Quality Commission and Monitor are looking into the affairs of the University Hospitals of Morecambe Bay NHS Foundation Trust. Will my right hon. Friend assure my constituents that whatever the findings, the Government will act upon them quickly?
Mr Lansley
I entirely understand my hon. Friend’s point. I of course will not prejudice whatever might be said in relation to that, but I will look at the report very carefully when it is presented.
Liz Kendall (Leicester West) (Lab)
Social care is vital for reducing winter pressures on the NHS by helping to keep older people out of hospital, but the Government are cutting funding for older people’s social care by £1.3 billion. Delayed discharges from hospitals are already up 11% from this time last year. The Minister responsible for care said in Westminster Hall on 10 November:
“cuts to front-line adult social care services are really beginning to bite.”—[Official Report, 10 November 2011; Vol. 535, c. 178WH.]
Does the Secretary of State agree?
Mr Lansley
I have to say to the hon. Lady that it was this Government who, through the spending review, gave priority to social care. More than £7 billion was added to the social care budget as a consequence of the steps taken by my right hon. Friend the Secretary of State for Communities and Local Government and by the NHS. This year the NHS is providing an additional £648 million specifically to support adult social care. In addition, I have announced our Warm Homes Healthy People funding for this winter, which will provide additional support for those most urgently in need.
John Mann (Bassetlaw) (Lab)
16. How many accident and emergency departments have reduced their on-site service provision in the last 12 months.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
18. What steps he is taking to improve the training of nurses and doctors.
The Secretary of State for Health (Mr Andrew Lansley)
Our reforms aim for excellence in education and training and for a better patient experience by ensuring greater accountability for employers in planning and developing their work force while being professionally informed and underpinned by strong academic links. I have always been clear that I want to see greater professional ownership of the standards of education and training, and greater employer engagement in getting work force planning right. We will publish more details on that when the NHS Future Forum reports shortly.
Mr Sheerman
Does the Secretary of State share the concerns that I have picked up in my constituency? First, although we have very good nurses in Huddersfield, national stories about a lack of care for elderly people make all of us worried about the quality of training of some nurses in some institutions. Secondly, will he remember that, with his demolition of the health service, we are moving to a system in which no management training is given to any doctor or GP? Is that not a recipe for chaos?
Mr Lansley
On the latter point, I have been talking to those in training, and part of their education increasingly includes leadership. That is what we are looking for—clinical leadership, not to turn clinicians into managers. They will work with managers, but they will provide leadership.
On nursing training, the Care Quality Commission’s recent inspection reports, in particular, illustrated the sheer variability of care—sometimes even between wards in the same hospital. On that basis, we should not in any sense damn the quality of nurse training; we need to focus on the quality of nurse leadership—ward by ward, and hospital by hospital.
Mr Peter Bone (Wellingborough) (Con)
The new Government’s strategy on human trafficking requires the NHS to ensure that victims of human trafficking are recognised in hospitals and reported. One way of doing that is to improve training for nurses. I have just returned from Moldova, where nurses have a course on human trafficking as part of their training, so that they can recognise victims and help them. Is that something that we could incorporate here?
Mr Lansley
I am interested to hear my hon. Friend’s experience. I certainly look forward to hearing more from him about it, and to taking it on board in considering how we respond to those obviously tragic victims.
Kerry McCarthy (Bristol East) (Lab)
19. What assessment he has made of the effects of publishing his Department’s strategic risk register on his restructuring of the NHS.
Helen Jones (Warrington North) (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 health outcomes in England, to lead a public health service that improves the health of the nation and reduces health inequalities, and to lead the reform of adult social care, which supports and protects vulnerable people.
Helen Jones
Is the Secretary of State aware that plans to remove vascular services from Warrington hospital will threaten services such as diabetes care, renal cancer care and the co-operation on stroke that has been built up with Whiston hospital? What will he do to protect those services, or is this part of the plan he discussed in February with NHS North West to reduce the number of acute beds and increase competition?
Mr Lansley
I am glad that on Monday the hon. Lady will have an opportunity for an Adjournment debate where this subject can be—
Mr Lansley
I will of course answer the question. The answer is that this is entirely driven by clinical issues in a local context. I can tell the hon. Lady that it is very much about trying to improve vascular services, and the judgments being made are local and clinical.
Iain Stewart (Milton Keynes South) (Con)
T2. What leadership role do the Government expect the new health and wellbeing boards to play in determining significant NHS service changes in each local area?
Mr Lansley
The health and wellbeing boards will have a role not only in leading improvements in public health and social care but, through the joint strategic needs assessment and the strategy derived from that, in establishing how services should respond to the needs of the local population. The clinical commissioning group should respond directly to that, and any specific service configuration changes should form part of the commissioning plan. In addition, the local authority, through its scrutiny role, will have a continuing ability to refer those plans for review.
Mrs Mary Glindon (North Tyneside) (Lab)
T4. Will the Secretary of State agree to meet me, and families living with muscle disease, to discuss the urgent problem of primary care trusts refusing to fund vital cough assist machines, which help to prevent serious and very costly winter respiratory infections for those who are unable to use their lung muscles to cough?
Mr Lansley
Of course I, or one of my colleagues, will be glad to meet the hon. Lady to discuss that. I might also say that it was important to have announced, as I did last week, the expansion of ECMO—extracorporeal membrane oxygenation—facilities across England. Those facilities present a life-saving opportunity for people with the severest respiratory disease.
Sajid Javid (Bromsgrove) (Con)
T3. My apologies, Mr Speaker, for having missed my question on the Order Paper earlier.Every five minutes someone in the UK suffers from a stroke, and over 1 million people are living with the effects of stroke. That is why I welcome the establishment of the first “life after stroke” centre—a £2 million investment in my constituency. Will my right hon. Friend join me in welcoming this excellent initiative by the Stroke Association?
Mr Lansley
Yes, of course I will join my hon. Friend in paying tribute to all the work that I know personally that the Stroke Association has done over a number of years in raising public awareness of the importance of developing stroke services, which has had an impact inside the NHS. We have improving figures in terms of reducing stroke mortality, and I now want to go further in ensuring that we enable people not only to survive stroke but to recover as many as possible of their abilities afterwards.
Paul Goggins (Wythenshawe and Sale East) (Lab)
T5. Will the Minister with responsibility for public health update the House on her plans to review the criteria whereby people with haemophilia who have been infected with hepatitis C can claim stage 2 payments from the Skipton fund? Specifically, will she tell us how she intends to involve patients and carers in that review?
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
What is the Secretary of State’s estimation of the number of NHS doctors and nurses who, in an astoundingly demoralising way, are having their pay grades downgraded?
Mr Lansley
I do not have a figure for that. If the hon. Lady and others want to discuss it, I would be glad to see evidence of it—and so should NHS employers, because as part of the implementation of “Agenda for Change”, staff should be banded in grades according to independent criteria.
Mr David Amess (Southend West) (Con)
T9. Last year in Westminster Hall, the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton) rightly praised the work of midwives and the Royal College of Midwives. Does she share my concern that locally, there could be a downgrading of community midwives, leading to an overall reduction in the number of midwives in our area?
Phil Wilson (Sedgefield) (Lab)
The coalition agreement states that public sector employees, including health care employees, will be given a new right to set up employee-led co-operatives to run services. Can the Minister detail how many NHS co-operatives have been established and how many employees are involved in them?
Mr Lansley
I will gladly write to the hon. Gentleman if my recollection is wrong, but I think that something in the order of 25,000 staff have been transferred into social enterprises since the election. That represents something like £900 million-worth of NHS activity across England.
Tracey Crouch (Chatham and Aylesford) (Con)
Pension reform is important to those of my constituents who work in the public sector—and, indeed, to the taxpayers who do not. With that in mind, does the Secretary of State agree that the heath service unions should work constructively with the Government on public sector pension reform rather than go on strike next week, potentially putting patients’ lives at risk?
Mr Lansley
Yes, I am grateful to my hon. Friend. It is very important to me that NHS staff, and other public servants, are valued in their remuneration, including the pensions that they receive. That is precisely why I have myself engaged in discussion with the NHS trade unions and staff side and continue to be engaged directly in negotiations with them about that, on the basis of the conditional offer that the Chief Secretary to the Treasury announced to the House recently, which I think would be fair to NHS staff and to taxpayers. On that basis, I think it is completely irresponsible and unacceptable for some unions in the NHS—not the Royal College of Nursing or the British Medical Association—to intend to go on strike next week.
Mr Speaker
We are immensely grateful to the Secretary of State. He is testing the knee muscles of colleagues very considerably, and we are grateful to him for that, I am sure.
Tessa Munt (Wells) (LD)
There are 3,000 cases each year of early stage inoperable lung cancer, but as yet no national stereotactic body radiotherapy treatment for lung cancer. What number of patients does the Secretary of State consider to be the appropriate threshold at which he will instruct his Department to establish a national lung cancer tariff?
Mr Lansley
I am grateful to my hon. Friend for that question. I do not think I am in a position to say what figure is appropriate, but the national clinical director for cancer has already indicated to the NHS that he wishes us to develop a national tariff for stereotactic radiotherapy. A quarter of centres across the country already provide it, and our intention is to ensure that that is supported by a national tariff as soon as possible.
Huw Irranca-Davies (Ogmore) (Lab)
Regrettably, there are still many thousands of attacks by dangerous dogs every year that end up with people in A and E, and occasional fatalities. Has the Secretary of State carried out any assessment of the cost to the NHS of treatment for attacks by dangerous dogs? If not, may I ask him to instruct his officials to do so?
Mr Lansley
I do not have those figures to hand, but I will gladly see whether we have them available, and I will write to the hon. Gentleman.
UK Influenza Pandemic Preparedness Strategy
Lord Lansley Excerpts(13 years, 1 month ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Andrew Lansley)
I am today announcing the publication of the “UK Influenza Pandemic Preparedness Strategy 2011” and the Government response to the consultation launched on 22 March 2011.
The majority of comments on both policy and operational detail were in strong agreement with the overall approach set out in the strategy. All comments have been considered when finalising the updated strategy.
Each of the UK Governments will produce separate health and social care facing documents, which will address the operational detail.
We plan to publish the English health and social care document in the next few months and it will be subject to the agreement of the new health system in England.
This strategy and Government response 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 strategy can also be found at:
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_130903.
The consultation response also can be found at:
www.dh.gov.uk/en/Consultations/Responsestoconsultations/DH_130901.
National Health Service
Lord Lansley Excerpts(13 years, 2 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Andy Burnham
I think I should refer the hon. Gentleman back to the King’s Fund speech, because I did not say the NHS should be the preferred provider regardless of the quality of care it provided. I believe that the public NHS should have the first chance to change, and that was the preferred provider policy. We did not want to pull the rug from under the public NHS with a policy of “any willing provider”. If the NHS needed to change, we wanted to tell it, “You have to rise to the challenge, and you have a chance to do so. If you cannot, other providers will get a chance to come in.” That was the preferred provider policy, and I would be grateful if he did not misrepresent it.
As I said, a year ago the Government provided a 0.1% increase—or that was the headline, but the fine print began to emerge and their case began to fall apart from day one. It soon became clear that for the years 2011-12 to 2014-15, that figure included an annual £1 billion transfer to local government, ostensibly for social care but not ring-fenced, so councils would be free to spend it as they saw fit. The health funding settlement therefore already went below a real-terms increase. That transfer turned the apparently minuscule real-terms increase into a real-terms cut.
That still leaves 2010-11. When the coalition came into government, it immediately required primary care trusts to cut spending by increasing waiting times and restricting access to treatment, to generate an underspend in 2010-11.
The Minister of State, Department of Health (Paul Burstow)
indicated dissent.
Andy Burnham
I will give way in a moment.
I mentioned that the Prime Minister is out of touch, and that he promised to recruit 3,000 more midwives and then handed out redundancy notices to them. However, if the Prime Minister is out of touch, I worry that the Secretary of State is in outright denial. On 11 October, when my hon. Friend the Member for West Lancashire (Rosie Cooper) asked him about the practice of hospitals re-grading or down-banding nursing posts to cut their costs, he replied:
“I am not aware—my colleagues may be—of…trusts…seeking to manage their costs by the downgrading of existing staff. If you are aware of that, then, by all means, tell us, but I was not aware.”
The very next day, that version of events was directly contradicted by Janet Davies of the Royal College of Nursing, who said that
“the Royal College of Nursing has raised the issue of downbanding with the Secretary of State on a number of occasions, alongside other concerns such as recruitment freezes and redundancies in the NHS…Our members’ survey released earlier this month also revealed that 7% of nurses expect to be downbanded in the next 12 months”.
If the Secretary of State would like to correct the evidence that he gave to the Select Committee on Health and confirm that he was aware of the practice of down-banding, he can be my guest right now.
Mr Lansley
I am grateful to the right hon. Gentleman. I do not change a word of what I told the Health Committee—it was entirely accurate. I have checked the records, and at no stage had the RCN raised that issue with me.
Andy Burnham
The Secretary of State directly contradicts, on the record, a spokesperson from the Royal College of Nursing. If he stands by his evidence, will he publish the minutes of his meetings with the RCN in which it states that the issue of down-banding was specifically discussed?
Andy Burnham
When I am ready.
Will the Secretary of State promise today to publish those minutes?
Mr Lansley
Yes, I shall publish the minutes of those meetings, but I resent the implication from the right hon. Gentleman that I would stand at this Dispatch Box or sit before a Select Committee and say anything other than what I believed to be the complete truth.
Andy Burnham
If that is the case, I respectfully ask the Health Secretary why he has not responded to a letter from my hon. Friend the Member for West Lancashire—
Andy Burnham
My hon. Friend is nodding. Why has the Secretary of State not responded to the letter that my hon. Friend sent to him several weeks ago pointing out the discrepancy between his evidence and the statements from the RCN? If he wants to adopt a pious tone in the House, he needs to reply to his letters on time and put his facts on the record.
Andy Burnham
Is the right hon. Gentleman telling or asking? [Interruption.] I give way to the right hon. Gentleman.
Mr Lansley
If the right hon. Gentleman is going to insult me, he ought at least to give way. I have seen no letter from the hon. Member for West Lancashire (Rosie Cooper). I have seen a letter from the Chairman of the Health Select Committee, to which I approved an answer.
Andy Burnham
Well, that is no good to me. We have not seen that answer. The right hon. Gentleman needs to reply to hon. Members’ correspondence in a timely fashion, especially when it relates to serious issues about discrepancies between his evidence and statements made by the RCN.
The Secretary of State for Health (Mr Andrew Lansley)
I ask the House to reject the motion. I am sorry about the tone of much of what the right hon. Member for Leigh (Andy Burnham) said. This was his first opportunity to make a speech about the NHS and I thought that he might take the trouble to thank NHS staff for what they have achieved over the past year, rather than disparage and denigrate everything they have been doing. I also thought that he might take the opportunity to approach the issues facing the NHS from the standpoint of patients, rather than simply playing politics with the service, but he did not. Insulting me was the least of the problems in his speech. It seemed like the Burnham memorial speech—clearly no hard feelings about losing the election, then. Having spent 13 years in the House in opposition, I shall—at the risk of patronising him—give him a few words of advice: do not keep fighting the election that you lost. It is not the way to win any future election, and it will carry absolutely no credibility in the NHS.
Equally, the right hon. Gentleman will carry no credibility by wandering around telling people that he was not planning to cut the NHS budget, given that he made it absolutely clear in The Guardian last year that that was exactly what he intended to do and that he told us, in the run-up to the spending review, that it would be irresponsible to increase the NHS budget in real terms. I searched the Labour manifesto for any commitment to funding the NHS in real terms, but there is none. In March 2010, he might have said that he knew all these things, but he did not tell the public about any of it—[Interruption.] Well, it is here in his manifesto. The only reference to any kind of investment in the NHS is a plan to
“refocus capital investment on primary and community services”.
Mr Lansley
In a moment.
We know what that meant, because when we opened the books on arriving in the Department we saw that Labour was planning to slash by more than half the capital budget of the NHS. Every Member of Parliament who has a major hospital building programme in their constituency would have been affected by that. That might include my hon. Friend the Member for Harrow East (Bob Blackman), who has the Royal National Orthopaedic hospital in his constituency, or Members from Liverpool, who have the rebuild of the Royal Liverpool and Broadgreen hospitals and, all being well, the rebuilding of Alder Hey. That might also include the hon. Member for Copeland (Mr Reed). The last Labour Government, before the election, cut the capital budget, and his project—the West Cumberland hospital at Whitehaven—could have been at risk as a consequence of that. [Interruption.]
The Minister of State, Department of Health (Mr Simon Burns)
No, he saved it.
Mr Lansley
I went with my colleagues; in fact, the Chief Secretary to the Treasury stood here at the Dispatch Box and reconfirmed support for that project, so I will not have any nonsense from the hon. Member for Copeland. [Interruption.] Withdraw that. I have not misled the House. The Chief Secretary to the Treasury came here and reconfirmed support for that project. I will not put up with being told from a sedentary position that I am misleading the House. I ask the hon. Gentleman to withdraw that accusation.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I am sure that it was not intentional, and I am sure that the hon. Member for Copeland (Mr Reed) would not wish to leave it on the record. [Hon. Members: “Withdraw. The hon. Gentleman has been asked to withdraw.”] Order. I do not need any advice. I am sure that it was not intentional, and that the hon. Member for Copeland would not wish to leave it on the record.
Mr Deputy Speaker
Order. I think that we have established that it was not intentional. I call the Secretary of State.
Mr Lansley
Thank you, Mr Deputy Speaker. I will now give way to the hon. Member for West Ham (Lyn Brown).
Mr Lansley
One of the reasons that the House should reject the motion is that it is deeply flawed. Let me just take up the hon. Lady’s argument. What an own goal it is for Labour to say that NHS funding fell in 2010-11. That was the last year of the Labour Government’s spending plans, not ours. The amount available to the NHS in 2010-11—[Interruption.] I am answering the hon. Lady’s question. The amount available to the NHS in 2010-11 was exactly the same amount as the last Labour Government determined under their spending plans. So if Labour is accusing the NHS of having a reduction in real terms in 2010-11, that is a complete own goal, because it happened as a consequence of its decisions, not ours.
Andy Burnham
May I just explain to the Secretary of State the difference between projected budgets and out-turn figures, as published by the Treasury? Will he confirm that the figures published in the Treasury’s public expenditure statistical analysis will be the figures that go into the historical record, and that they will record a real-terms cut because of underspends that he ordered?
Mr Lansley
That is absolutely not true, because we ordered absolutely no cuts in the NHS budget in 2010-11 compared with the spending plans that we inherited. So that is a complete own goal on the right hon. Gentleman’s part. And in regard to all that stuff that he talked about the support that the NHS is giving to social care, I can tell him that, with the exception of the underspend in the departmental central budgets, because we cut back on all of its bureaucracy and its IT programme, we spent over £150 million, or whatever it was—
Mr Lansley
Sit down for a minute. I am answering the shadow Secretary of State. As I was saying, more than £150 million was generated from underspends in the departmental central budget in the last three months of the last financial year, and it was spent with local authorities in supporting social care. The rest of the social care support is for 2011-12, so what the right hon. Gentleman said cannot be a reason for the underspend in 2010-11. The amount spent was all in PCT allocations; there was no mechanism by which the Department of Health could go out and ask PCTs to spend less—the money was allocated to them. The shadow Secretary of State shakes his head, but he knows it is true. The money was allocated to the PCTs and they were free to spend the money they had.
The first reason to reject the motion is that it is a spectacular own goal. The second reason to reject it—
Andy Burnham
The right hon. Gentleman says it is not true that PCTs were asked to set aside funds and generate underspends, so may I remind him of a letter sent by the chief executive of the NHS shortly after the White Paper was published, telling primary care trusts to set aside funding for the cost of transition? That is clear; it is in black and white. He did ask PCTs to generate those funds to spend on the costs of his reorganisation.
Mr Lansley
I am sorry, but that is another spectacular own goal. Both before and after the election, the chief executive of the NHS set aside, as the right hon. Gentleman had planned before the election, £1.7 billion for non-recurrent expenditure for the costs of NHS reorganisation. It was done before the election; we never changed the figure. It is not a consequence of any of our plans, but a precise consequence of the right hon. Gentleman’s. He said he accepted the Nicholson challenge, and the £1.7 billion non-recurrent set aside in 2010-11 was to fund that challenge. That was set out before the election, not after it. I thought that one of the benefits of the former Secretary of State coming here to debate matters would be that we would be treated to a bit of knowledge of the NHS and of how it works, but that does not seem to be the case at all.
Mr Lansley
No, I want to make a bit of progress. Strictly speaking, I have not yet said anything I intended to say.
Mr Lansley
The second reason the House should reject the motion is that it fails to pay tribute to the hard-working staff of the NHS. I participated in many debates such as this when I was shadow Secretary of State and I thought that they provided an incredibly good opportunity for Members to raise issues relating to their own constituencies. I hope that that happens in this debate, as it is important. Every one of us has in our constituencies thousands of committed and hard-working NHS staff who want to know that we recognise it. I do not see any of that in the motion.
Mr Lansley
In this motion, there is nothing to recognise the contribution from NHS staff; it just denigrates them. It says nothing about people who rely on the NHS to care for them.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Three Members are trying to catch the Secretary of State’s eye. I am sure that he has noted that and that he will give way, but we cannot have three Members continuously on their feet.
Mr Lansley
It is surprising that I am being embarrassed by so many interventions from the Labour Benches, because there are so few Labour Members here. I remember that before the election it was my recurrent experience that when we held Opposition day debates on the NHS, the Labour or Government Benches were nearly empty while our Benches were pretty full of Members who, because of our commitment to the NHS, were seeking to make points about it. Funnily enough, it does not seem to have happened in reverse. The Government Benches are still full while the Opposition Benches are nearly empty. [Interruption.]
Paul Farrelly
Staff of the High Street medical practice at Newcastle-under-Lyme are dedicated and hard working, yet that practice, which has 5,000 patients, is being forced to close. The Secretary of State has written me a letter, from which it is quite clear that closing directly run GP practices with salaried doctors is NHS policy. It is also clear that the closures are pre-empting proposed legislation to abolish PCTs, which is yet to go through Parliament. If the Secretary of State believed in a patient-focused NHS, surely he would be trying to save such practices, not encouraging their closure.
Mr Lansley
I will not delay the House at length with further explanation of what I wrote in my letter, as the hon. Gentleman quite properly raised the matter with me at topical questions. It is our intention to move to more consistent commissioning of primary care across the country through the NHS Commissioning Board, but the driver for that is still local decisions about what GP services should be available in an area and which practices are involved. The hon. Gentleman knows from my letter that this is the view of the local primary care trust. In future, it will be for the health and wellbeing boards, not least the clinical commissioning groups, to look at whether primary medical services can be provided with or without the sort of facilities that the hon. Gentleman mentioned.
Barbara Keeley
The Secretary of State asked for some examples of the impact on constituencies; I can give him two. First, the savings being forced on Salford PCT have led to the shutting of the NHS walk-in centre in one of our most deprived wards, which was serving 2,000 patients a month. Secondly, there is the serious issue of the closedown of active case management for long-term conditions. Patient services in Salford are being downgraded as a result of the savings and cuts that have to be made.
Mr Lansley
The hon. Lady will forgive me for not commenting in detail on that. If my memory serves, that has been the subject of a referral by the local authority to me, which I have sent to the independent reconfiguration panel for initial advice. It would be unhelpful and improper for me to prejudice that.
Mr Lansley
Yes, I will, as I am interested to hear what the hon. Gentleman has to say.
Mr Love
A year or 18 months into this Administration, does the right hon. Gentleman regret the announcement he made on the steps of Chase Farm hospital? Does he accept that the four tests have seriously misled local people about the future of the health service in their area? Does he recognise the demoralisation that that has caused in the local health service in Enfield, and what steps will he take to try to recover the situation and move forward?
Mr Lansley
The hon. Gentleman also intervened on the shadow Secretary of State. I am afraid that I do not recognise his description. I said before the election that we would have a moratorium on top-down and forced closure programmes affecting A and E and maternity services—and that is exactly what we did. A moratorium means what it says; it provides an opportunity to stop, to take stock and to subject something to the right tests. I set out for the first time the tests that needed to be met—that proposals needed to be consistent with prospective patient choice, consistent with the views of the local community, not least as expressed through the local authority, consistent with the views of the commissioners in the area, especially the developing clinical commissioning groups, and consistent with clinical evidence of safety.
In the context of Enfield and Chase Farm, the hon. Gentleman knows—because he was a participant in these discussions—that that moratorium was applied, that the opportunity was given to the local authority and the general practice community in Enfield to come forward with alternative solutions. We should also remember that among those four tests is the one about clinical evidence and safety. However, when those community groups came back and said, “We don’t have a specific alternative, but we just don’t want things to change”, I had to ask the independent reconfiguration panel to examine it. Its view was that that was not clinically sustainable.
Mr Lansley
No. I have given way many times. I am answering the hon. Member for Edmonton (Mr Love). It was very clear that we could not proceed on that basis.
I have another point for the hon. Member for Edmonton about what I found in a number places. Although this was not true of the moratorium in Maidstone and Chase Farm, the moratorium has led to substantially improved outcomes for local services elsewhere, as with Burnley, Solihull, Sidcup, Ealing, the Whittington hospital and other places.
Mr Lansley
No. I am still answering a point raised in an earlier intervention. In all those places and others, the moratorium has led to better solutions.
Mr Lansley
No. I think that the moratorium has led to a better way forward even in Enfield. It is in the hands of the commissioners and the local authority in Enfield collectively, to make decisions for Enfield. Within two months I shall receive a report from NHS London advising whether it would be better organisationally for Chase Farm to be combined with North Middlesex rather than Barnet, and I should be interested to know the hon. Gentleman’s view on that. We continue to seek not top-down forced reconfigurations, but reconfigurations that consistently meet the four tests, and do so in the best interests of the NHS.
Tony Baldry
The right hon. Member for Leigh (Andy Burnham) implied that my right hon. Friend should have completely ignored the advice of the independent reconfiguration panel. Can my right hon. Friend tell us whether, when the right hon. Gentleman was Secretary of State for Health, there were any occasions on which he sought to ignore the panel’s advice?
Tony Baldry
What is the point of having such a panel if it is to be ignored?
Mr Lansley
The right hon. Member for Leigh says from a sedentary position that he did not ignore the panel’s advice. I do not believe that a Secretary of State has directly sought to contradict the panel since its establishment, or has sought not to comply with its recommendations. After all, it is there for a reason. The point is that, as I have made clear, the panel should be involved in the application of those four tests, and in the past that has tended not to happen.
Let me explain why I am asking the House to reject the motion. I believe—and this was always my approach in opposition—that when we table such a motion, we ought at least to be clear about what our alternative solution would be, but there is no such solution in the motion. Let me remind the new, or recycled, shadow Secretary of State what his old friend James Purnell wrote last February:
“The Tories appear to have the centre ground. Labour need to take it back—by coming out in favour of free schools and GP commissioning”.
The right hon. Gentleman did not come out in favour of free schools. He now says that he is coming out in favour of GP commissioning. If he believed in GP commissioning, why did he do nothing about it? Why did everyone in the general practice community, throughout the length and breadth of the country, believe that practice-based commissioning had come to a virtual halt? Why did David Colin-Thomé, the right hon. Gentleman’s own national clinical director for primary care, effectively say that it had completely stalled and was not going anywhere?
I know that the right hon. Gentleman agreed with this at one time. Back in 2006, he said of GP commissioning:
“That change will put power in the hands of local GPs to drive improvements in their area, so it should give more power to their elbow than they have at present. That is what I would like to see”.—[Official Report, 16 May 2006; Vol. 446, c. 861.]
If the right hon. Gentleman wants that to happen, he must support the Bill that will make it happen. The same applies to health improvement and public health leadership in local government, and to our finally arriving at a point when, as was the last Labour Government’s intention, all NHS trusts become foundation trusts. We are going to make those things happen, but in order to do so we must have a legislative structure that supports them. That is evolutionary, not revolutionary. However much the right hon. Gentleman rants about the changes being made in the Bill, the truth is that it will do—in what his predecessor, the right hon. Member for Wentworth and Dearne (John Healey) described as a “consistent, coherent and comprehensive” way—much of what was intended by our predecessors as Secretaries of State under the last Government. The fact that the right hon. Gentleman turned his back on that at the end of his time in office—mainly at the behest of the trade unions, which seem to be the dominant force in Labour politics—does not absolve him of his responsibility to accept that we are now delivering the reforms that he talked about.
Grahame M. Morris
The Secretary of State told my right hon. Friend the Member for Leigh (Andy Burnham) that there had been no cuts in the NHS budget. Does he recall cancelling the building project for a new hospital serving my constituents in south Easington as part of the comprehensive spending review?
Mr Lansley
On the occasion when the Chief Secretary to the Treasury told the House that we were supporting a number of hospital projects, we made it clear that the hon. Gentleman’s local trust was a foundation trust. As his colleagues should tell him, the point of a foundation trust is that it should take more responsibility for securing the resources—
Mr Lansley
I am answering the hon. Gentleman’s question. The point of a foundation trust is that it should take more responsibility for securing the resources enabling it to undertake its own building projects. Foundation trusts cannot walk into the Department of Health imagining that they will receive a capital grant of more than £400 million. That is simply not the way it works. It is to the credit of the hon. Gentleman’s local trust that it accepted that, and is working, as a foundation trust, on a better solution for the hon. Gentleman’s area.
Mr Lansley
No, because I have already given way to the right hon. Gentleman many times. Let me tell him this. If he was going to offer to try to work with others on GP commissioning, he ought at least to have demonstrated before the election that he was going to do something about it; and using a transparent political ploy to try and interfere with the passage of the legislation in another place carries no credibility with me or with anyone else. Labour’s tabling of a motion in the other place in an attempt to block the Bill completely showed no willingness to work together, and the fact that it was defeated by 134 votes ought to have given the right hon. Gentleman a reason—and sufficient humility—not to try to return to the subject by tabling today’s motion.
As I said earlier, I find it regrettable that neither the right hon. Gentleman’s motion nor his speech made any attempt to deal with what has happened in the NHS over the past year. Let me tell him, and the House—for I know my right hon. and hon. Friends will be interested as well—what has, in truth, happened during that time.
At the end of the last Labour Government, the average in-patient wait was 8.4 weeks. According to the latest available figures, that has fallen to 8.1 weeks. The average waiting time for out-patients was 4.3 weeks at the time of the last election; it is now 4.1 weeks. Over the last year, the number of MRSA bloodstream infections in hospitals has fallen by a third, and the number of clostridium difficile infections by 16%. Nearly three quarters of a million more people have access to NHS dentistry. Nearly 2 million people have access to the new 111 urgent care service, and the whole country will be covered within the next 18 months. When we came to office, I discovered that there had been talk about a 111 telephone system, but nothing had been done. It is now happening.
More than 75% of stroke patients now spend 90% or more of their hospital stay in a stroke unit. That is a 20% increase in two years. The Cancer Drugs Fund has given more than 5,000 patients access to the drugs that they desperately need, and which under the last Government’s regime would not have been available to them. We have embarked on an £800 million investment in translational research, increasing our financial support for it by 30%, to help to secure the United Kingdom as a world leader in health research.
The NHS is leading the way in the prevention of venous thromboembolism, with 86% of patients receiving an assessment for the condition. I believe that that constitutes an increase of some 30% in the last year. The bowel cancer screening programme is enabling many more patients and members of the public to be screened, there is more screening for diabetic retinopathy than ever before, and there were 188,000 more diagnostic tests in the three months to August than there were last year. Pathfinder clinical commissioning groups have been established virtually through England, and there are 138 health and wellbeing boards in local authorities, meeting and putting together their strategies to deliver population health gain across their areas.
In a single year, the year preceding the election, the right hon. Member for Leigh presided over a 32% increase in NHS management costs. That was the year after the banks had gone bust. It was the year when it was obvious that Government deficits were out of control. It was the year when the debt crisis was just about to crash over the whole public sector. What happened on the right hon. Gentleman’s watch? There was a 23% increase in management costs in a single year, to £350 million. In the year that followed, we reduced those costs to £329 million.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Can the Secretary of State tell us what the percentage of senior managers is, and how that compares with the percentage in the private sector?
Mr Lansley
Does the hon. Lady act as parliamentary private secretary to the shadow Secretary of State? Ah, she does. Well, she has the merit of consistency. I am reminded that in June 2006, when for a short period she was chair—I think—of Rochdale primary care trust, she resigned. She said that she resigned because the radical changes happening under the then Labour Government in 2006 would
“destroy the NHS as we know it.”
The hon. Lady has the merit of being consistent: she is against every Government and every change. She does not think that any steps will make the NHS into what it ought to be. I will not take any lectures from her, therefore.
I was explaining to the hon. Lady and the House what has been achieved. We have stripped out pointless bureaucracy. The number of managers more than doubled under Labour, but we have cut their number by more than 5,000, and we have increased the number of doctors in the NHS by more than 1,500. The Bill includes measures to abolish primary care trusts and strategic health authorities, but in the meantime we have clustered PCTs and SHAs together.
We are reducing the cost of bureaucracy in the NHS not only because it is necessary to do so. The transfer to clinically led commissioning in the NHS, for which there is a very good case of course, also involves reducing such costs. As the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), has frequently made clear, as part of the transfer process we will deliver £4.5 billion in savings in administration costs this year across the national health service. The transition itself involves costs of course, but they will be recovered by the end of 2012-13, and by the end of the Parliament we will have gone on to save more than £4.5 billion in total.
Chris Leslie (Nottingham East) (Lab/Co-op)
Will the Secretary of State give way?
Mr Lansley
No.
Productivity fell in every single year that Labour was in charge of the NHS. However, according to the Audit Commission, in the last year—2010-11—we saved £4.3 billion. As the deputy chief executive of the NHS has reported, PCTs are intending to save a further £5.9 billion in 2011-12. Contrary to what the right hon. Member for Leigh repeatedly said, the NHS is not failing to deliver on the quality, innovation, productivity and prevention challenge; it is on target to meet that challenge. The modernisation that is at the heart of the Bill and the White Paper is not about frustrating the NHS in that endeavour; it is about enabling it to meet the QIPP challenge.
Last summer, I announced that we would be measuring mixed-sex accommodation and then driving down the extent to which patients were put in such accommodation when they should not have been. The right hon. Gentleman said at the time:
“This hollow announcement is an attempt by Mr Lansley to claim credit for something Labour has done”.
That is absolutely wrong. The evidence showed that almost 150,000 patients a year were being placed in mixed-sex accommodation in breach of the rules. We ensured that figures were published for the very first time. The first set of results was published in December, and it showed that in that month alone there were well over 11,000 such patients. Since then, there has been a 91% reduction in the number of patients put into mixed-sex accommodation. The right hon. Gentleman was prepared to see issues of care, service and standards in the NHS covered up. We are determined to shine a light on where the NHS can, and should, improve its performance; we are determined to enable the NHS to do so and to challenge it wherever it is not doing so.
Mr Lansley
I will give way to the hon. Gentleman shortly.
If the public want to know how the NHS in England would have fared under Labour since the last general election, they should look across the border at what has happened in Wales—I am not sure whether any Members representing Welsh constituencies are present. We are protecting the NHS and increasing its budget in real terms. However, I have brought along to the Chamber a report by the Auditor General for Wales that was published just a few days ago, on 14 October 2011. If I could, I would enter it in evidence, but I can at least hold it up in order to show Members a series of bar charts. They demonstrate that in England there is real-terms growth in the NHS, in Northern Ireland there is small real-terms growth that is unevenly distributed across the years, in Scotland there is tiny real-terms growth, and in Wales there is a large downward curve, which shows the reduction in real-terms spending on the NHS in Wales. Wales is the only part of the UK that is run by Labour, and there are real-terms cuts in the NHS budget there.
Chris Leslie
The right hon. Gentleman must know that “real terms” means taking account of inflation. For the record, can he tell the House what the retail prices index was for the last month for which figures are available? That will give us a sense of what “real terms” ought to mean in this context.
Mr Lansley
The hon. Gentleman is a shadow Treasury Minister, so he must know that the expression “real terms” has consistently been used in relation to the GDP deflator, which is independently estimated by the Office for Budget Responsibility. That is the basis on which we do these calculations, so the Wales Audit Office will have calculated the real-terms changes in budgets in each of the countries of the United Kingdom on that basis. John Appleby from the King’s Fund has estimated an 8.3% real-terms cut in the NHS budget in Labour Wales.
Simon Hughes (Bermondsey and Old Southwark) (LD)
The Secretary of State is, justifiably, giving a robust performance. He said that his job is to shine a light into the NHS to make sure there is a better service for patients. Can he assure us that the recent findings about the care of the elderly in our hospitals and the recommendations of the Cavendish report on that issue will receive the Department’s full attention, as that is one of the areas where the NHS often fails to fulfil the expectations of patients and their families?
Mr Lansley
I agree with my right hon. Friend, and I appreciated the opportunity to talk with Camilla Cavendish and to read much of what she has written.
In January, I asked the Care Quality Commission to undertake dignity and nutrition inspections. They were nurse-led, unannounced inspections across NHS hospitals. The reasons for doing so were clear. I do not say this to denigrate the NHS, but many of us were concerned about two issues. First, although patients admitted to hospitals might get very good clinical care, the standards of personal care were often not as good as they should be, and they were seriously deficient in some cases. Secondly, the last Labour Government had star ratings for hospitals, the net effect of which was as follows. On the Healthcare Commission website, there would be a green dot against a hospital, which was often taken to mean, “This hospital is fine.” However, we all knew that some hospitals had tremendous reputations and world-beating clinical care in some respects and some wards where care was fantastic, but that care in neighbouring wards could be seriously deficient. The dignity and nutrition inspections have addressed that.
The CQC will follow up wherever it has found concerns. In addition, it will undertake similar unannounced inspections of learning disability services and there will be 500 unannounced inspections of care homes, to seek out and expose poor performance or poor care in those areas—and, I hope, demonstrate where good care is provided. There will be an additional follow-up inspection of a further 50 NHS hospitals.
Simon Hughes
I am grateful to my right hon. Friend for his comments. May I raise a linked point? One of the issues most frequently raised with me both in my constituency and elsewhere is that families and patients often do not feel that they have consistent contact with just one person who is responsible for the management of the care in a hospital. Instead, there is a range of people whom they do not know, except for what is printed on their name badges. They know the consultant, but they do not know who is responsible on a day-to-day basis for the delivery of 24-hour care. Can my right hon. Friend assure me that that is also on his agenda?
Mr Lansley
I entirely agree with my right hon. Friend. That is not only the case in hospitals, where people can sometimes ask, “Under whose care is my husband?” It is also especially true in community care. I hope that there will be more integrated services in the community, but although there may be a range of providers, there must be an integrated service with a clear line of accountability.
Mr Lansley
No, as I need to conclude my speech. [Interruption.] I am sure what the hon. Lady says is true.
The NHS in Wales is not cutting its budget because everything is going well. Labour Members are fond of citing waiting times, but the latest figures on waiting times show that in England 90.4% of admitted patients and 97.3% of non-admitted patients were referred to treatment within 18 weeks, whereas the figures for Wales are 67.6% and only 74% respectively.
Let me tell the House about infection rates. In 2007, the clostridium difficile mortality rates in England and Wales were similar—in fact, the rate was slightly higher in England. However, in the latest year for which figures are available there were 23.4 deaths per million for men and 23.5 deaths per million for women in England, whereas the figures for Wales were 54.9 deaths per million for men and 59.5 deaths per million for women, so the level in Wales is more than twice that in England. In four years, the gap has widened to the point where Wales has double the number of deaths from C. diff infections relative to England. Less money, less innovation and less good care is what has been happening in Wales under a Labour Government.
I must make it clear that we are going to put patients at the heart of the NHS. We are going to focus on the NHS delivering excellent care every time. Labour focused on the targets and the averages, and never got to the place of really caring about the specifics. A patient about to go into hospital for knee replacement surgery does not want to know about the national figure; they want to know about their hospital, their ward and what will happen to them. The same is true for mixed-sex accommodation. Labour turned a blind eye to variation in performance. We are going to open it up to clinical and public scrutiny, so that we can reward and celebrate achievement and excellence across the service, and shine a light on poor performance.
Joan Ruddock
Two weeks ago, I had an operation in Guy’s hospital. Because of possible complications, I had to ask my consultant directly, “Would you advise me to go ahead or not?” He advised me to do so, and I had complete trust in him. He was not thinking about whether he had to fulfil a quota, whether there was competitiveness in his hospital or his department, or whether a private patient would be preferred in the bed that I was to occupy. He was someone I could trust. In the health service that the Secretary of State proposes in his Bill, I could never have that confidence. I ask him please to abandon this Bill.
Mr Lansley
The right hon. Lady is simply wrong. There is nothing in the legislation that will do anything other than support clinicians to exercise their judgments in order to deliver the best care for their patients. It was under her Government, when people were told to pursue 18-week targets, that managers were literally walking in to speak to consultants who were about to do waiting lists and surgery lists and telling them that, because of the 18-week target, they had to treat a certain patient rather than another whose interests would mean that they would be seen first. So I will not take any lectures about that. We are going to put clinicians at the heart of delivering care and put patients at the heart of the service that is delivered.
The Labour motion does not reflect reality. It is based on a misleading set of interpretations and representations. Labour Members have a very short memory, but I am afraid that they have left us a shocking legacy. The motion contains no appreciation of the challenges the NHS faces, no appreciation of the care the NHS has provided to patients day in, day out over the past year, and no vision of how the NHS can be better in the future. Modernisation of the NHS will deliver an NHS that we can rely on for future generations, that is based on need, not ability to pay, and that is able to deliver the best outcomes for patients. I urge the House to reject the motion.
Grahame M. Morris
I think we saw an unprecedented period of growth with the building of new hospitals and new facilities. I have some sympathy with the hon. Member for Enfield North (Nick de Bois) and what he is going through with the Chase Farm downgrading, because in my area the Hartlepool accident and emergency facility is also being downgraded to an urgent treatment centre. That is a cause of consternation among the public.
Grahame M. Morris
Well, it is being done under the Secretary of State’s Administration when an impression was given that there would be a moratorium and that we would not face such downgrading and closures. That was clearly a con that was sold to the public, so I do not accept the contention that the hon. Member for Crawley (Henry Smith) has put forward.
Let me press on, because time is limited. The NHS is hurting under this Government and these reckless reforms. On the promises for a real-terms increase, we know that health inflation has surged and that the spending power of the NHS is going down, so will the Minister now admit that the NHS is receiving a real-terms cut? This is not just about the NHS being held hostage to inflation. It is facing real financial pressures on the front line—which Labour promised to protect—for a number of reasons including the Government’s decision to push through this latest reorganisation, which is the biggest the NHS has ever faced, at the same time as pushing through £20 billion-worth of efficiency savings. The figure of £1 billion a year is being taken from the NHS’s existing budgets to meet the growing and ever-increasing costs of social care. The Select Committee on Health is now looking into that issue and I hope that we are able to come forward with some positive ideas that the Minister will consider.
Oral Answers to Questions
Lord Lansley Excerpts(13 years, 2 months ago)
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George Eustice (Camborne and Redruth) (Con)
14. What steps he is taking to reduce NHS hospital indebtedness.
The Secretary of State for Health (Mr Andrew Lansley)
The national health service is forecasting a surplus for 2011-12, but the previous Government left a legacy of up to six hospital trusts whose private finance initiative payments are a risk to their financial sustainability and up to 24 trusts with such high levels of debt, following years of bail-outs, that they might not meet tests of their future financial sustainability. We are working with all of those to identify their individual needs so that we can help trusts to achieve consistent standards of quality and financial sustainability, and I will make an announcement on that later this year.
Mr Rob Wilson
I thank my right hon. Friend for spelling out the appalling debt that some parts of the NHS inherited from the previous Government. Can he assure me and the House that this Government will deal with the root causes of hospital debt, rather than with the continuing bungs and bail-outs that the previous Government left?
Mr Lansley
My hon. Friend is absolutely right. We are determined to root out poor performance, by which I mean not only that we should deal with waste, inefficiencies and poor value for money in the NHS, but that we must identify where standards and quality of care are being met. Both are equally important, and one depends on the other. He will know from the Royal Berkshire NHS Foundation Trust how important it is to sustain finances and quality through foundation trust status. We are seeking to ensure that many NHS trusts reach foundation trust status, something that the previous Government failed to achieve and we aim to achieve.
George Eustice
The Secretary of State will be aware of the indebtedness of the Royal Cornwall Hospitals NHS Trust, and that Cornwall as a whole has suffered a disadvantage for many years as a result of the previous Government’s funding formula, having actually received less than the Department’s target budget for many years. Does he agree that such factors should be taken into account when deciding how to reschedule the debts of such trusts?
Mr Lansley
My hon. Friend will know, from our conversations and from my visit to Cornwall and the Royal Cornwall Hospitals NHS Trust, the steps that we are taking alongside other NHS trusts to bring them up to high standards of care and financial sustainability. In that regard, the 3.1% increase in revenue allocations for the Cornwall and Isles of Scilly primary care trust between last year and this year will help Cornwall as a whole towards greater financial sustainability.
Grahame M. Morris (Easington) (Lab)
I am grateful, Mr Speaker. On indebtedness, the National Audit Office has produced a report on NHS procurement in England, which it describes as “fragmented” and “poor value for money”. The report shows that £500 million could be saved each year if trusts came together to buy products more collaboratively. Is this further evidence that the Government are wrong to pursue an agenda of competition, rather than co-operation?
Mr Lansley
I am afraid that the hon. Gentleman is completely wrong about that. In procurement throughout the NHS, what we have had is fragmentation, and what we need is better co-ordination. That is precisely why, since the election, for example, we have instituted a consistent bar-coding system, allowing procurement throughout the NHS to be undertaken more effectively; and why under the quality, innovation, prevention and productivity programme, the improvement in procurement —reducing the costs of procurement—is intended to achieve those savings and more.
Andrew Gwynne (Denton and Reddish) (Lab)
Labour is proud of its legacy, with more than 100 new hospitals built to replace the crumbling Victorian buildings that we inherited in 1997, and it is not just the National Audit Office that has blown a hole in the Secretary of State’s assertion that 22 hospital trusts are on the brink of financial collapse due to PFI. John Appleby of the King’s Fund said:
“The…pressures on hospitals are not to do with PFI but…the need to generate £20bn worth of productivity improvements.”
Is not the real issue that the Secretary of State has tied up the NHS in a distracting and wasteful reorganisation that will cost more money than it will save, and take money away from patient care?
Mr Lansley
I welcome the hon. Gentleman to the Opposition Front-Bench position. We are looking forward to the exchanges with him and his colleagues, including during questions today.
Twenty-two trusts have told us, in the course of our looking at where the impediments are to their financial sustainability for the future, that the nature of the PFI contracts entered into by the previous Government is a significant problem in this respect. It is absolutely right for the NHS to build hospitals, which is why we are, for example, building a new hospital at Whitehaven in the hon. Gentleman’s constituency. [Interruption.] I beg his pardon—in the constituency of the hon. Member for Copeland (Mr Reed); we are building so many new hospitals. The nature of the PFI projects we enter into must be to provide value for money and be sustainable in the future. That is something that the previous Government failed to achieve.
Steve Baker (Wycombe) (Con)
3. What representations he has received on the reorganisation of urgent care in the past six months.
Adam Afriyie (Windsor) (Con)
7. What recent representations he has received from Berkshire East primary care trust on the future of Heatherwood hospital in Ascot.
The Secretary of State for Health (Mr Andrew Lansley)
I have received no such representations.
Adam Afriyie
My constituents are shocked to discover that yet again, the future of Heatherwood is under threat. I have had sight of a major petition, and I am actively campaigning with hard-working local councillors, activists and residents to uncover why Heatherwood’s future is under threat when the funding from the Government to the region has increased. Does my right hon. Friend agree that the Berkshire East PCT must cut its bureaucracy costs and introduce efficiencies before threatening the money to Heatherwood hospital and other local services?
Mr Lansley
I am grateful to my hon. Friend and completely understand what he is saying. In this financial year compared to the previous one, revenue available to Berkshire East PCT increased by £16.3 million. That is just one part of the £3.8 billion increase in revenue resources available to the NHS this year compared with last year.
Although I very much welcome the shadow Secretary of State to his new position, we will miss his predecessor. We welcome the new shadow Secretary of State not least because he might begin to explain to the NHS why he thought it was irresponsible to increase resources to the NHS in real terms by about £3.8 billion—
Mr Speaker
Order. I am grateful to the Secretary of State, but we have a lot to get through. He will resume his seat—and I know he will do so happily.
Fiona Mactaggart (Slough) (Lab)
One reason for those increases in resources is the growing birth rate in that part of Berkshire. Slough mums who want to use the Ascot birthing centre at Heatherwood have been locked out since the end of September because of a lack of midwives. If the Government had provided the 3,000 midwives they promised, that centre would not be shut. What does the Secretary of State say to that?
Mr Lansley
As the hon. Lady knows, I am very familiar with Heatherwood, because I have two daughters who were born there in the days when it had an obstetrics service, which disappeared under the previous Government. She also knows that I visited Wexham Park in September last year to announce support to the trust in the form of loans, based on commercial principles, totalling £18 million. There is no shortage of midwives under this Government compared with the previous one. Since the election, 522 additional midwives have been recruited, and we are maintaining a record level of midwifery training places.
Decisions made locally are a matter for local commissioners. If they seek to change services, they must meet the four tests that I set out shortly after the election.
Mr Jamie Reed (Copeland) (Lab)
The hon. Member for Windsor (Adam Afriyie) is absolutely right to raise concerns about the future of Heatherwood hospital, as are Members on both sides of the House who raise such concerns about their hospitals, such as Chase Farm.
The Health Service Journal reports that the Department of Health is discussing a hospital closure programme, and yet the Prime Minister has promised to fight bare knuckled against any hospital closures. Will the Secretary of State tell us today categorically—yes or no—whether it is still his policy to have a moratorium on hospital closures? If so, for how long will the moratorium last?
Mr Lansley
I welcome the hon. Gentleman to his position. The Government are rebuilding his hospital, so it is slightly ironic that he attacks us on that point.
The answer to the hon. Gentleman’s question is that the Government are pursuing no plan for hospital closures. We are doing precisely what I said we are doing: we are working with hospital trusts across the country to ensure that before they reconfigure their services, they must meet key tests on patient access and choice, local authority support, commissioners’ views, and the clinical safety and evidence base. We are working with many of the NHS trusts that the previous Government left in a serious position to ensure that they reach quality and financial sustainability.
Andrew Jones (Harrogate and Knaresborough) (Con)
8. When he expects to make a final decision on the safe and sustainable review into children’s heart surgery units in England.
The Secretary of State for Health (Mr Andrew Lansley)
This is a clinically led, independent review, within the NHS. The joint committee of primary care trusts, on behalf of NHS commissioners, will make decisions on the future pattern of children’s heart surgery services in England. The review is expected to report before the end of the year.
Andrew Jones
I am sure that the Secretary of State recognises the huge and spirited campaign by local people to retain the children’s heart unit at Leeds general infirmary. Will he confirm that option E, which would retain the Leeds unit, will receive full and equal consideration by the joint committee of primary care trusts?
Mr Lansley
The review will develop the recommendations to ensure that children’s heart surgery services deliver the very highest standard of care for children and their families. The joint committee of primary care trusts will consider all the relevant evidence before making a decision on the future configuration of children’s heart surgery services, and I hope that that will reassure my hon. Friend.
I should emphasise that no aspect of this review is driven by money: it is entirely about how to ensure sustainable high-quality surgery. The issue is in how many and which centres surgical teams should be based in order to maintain that high-quality care.
Angela Smith (Penistone and Stocksbridge) (Lab)
There is a deep-rooted belief that this review is biased against the survival of the Leeds unit. Will the Minister therefore please assure the House that the decision will be made purely on the evidence, and not on the basis of any preconceived idea of which units should survive and which should not?
Mr Lansley
It is an independent review and I can assure the hon. Lady that that is indeed the case. It will be based on the evidence. I am sure that she will have heard the response to a debate earlier in the year by the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), who said that while the review has put forward options for consideration, it should not be constrained to consider only those options.
Nicky Morgan (Loughborough) (Con)
Will my right hon. Friend confirm that the criteria for the review remain the same; that the rather strange remarks—about more people having voted for one option but more organisations having voted for another—have not affected them; and that those criteria will be used to judge the decision?
Kerry McCarthy (Bristol East) (Lab)
This review came about as a result of the tragic Bristol heart babies scandal in the 1990s, and it is a measure of the quality of services at Bristol children’s hospital that it is now being considered for all four options under the consultation. A few weeks ago, I abseiled down the children’s hospital for Wallace & Gromit’s Grand Appeal, which is an excellent charity. However, will the Secretary of State assure me that, with the move to fewer and larger specialised units, they will be properly funded and will not rely on MPs throwing themselves off tall buildings?
Mr Lansley
I am grateful to the hon. Lady. All the representations that we have received in the debates in this House are ample evidence of the high regard and support that Members have for their children’s heart surgery services. None of this is about saving money or resources. It is entirely about what delivers the best quality surgical services for children with cardiac problems. To that extent, the intention is that those services—once the decision has been made—are fully funded.
Chris Skidmore (Kingswood) (Con)
9. What progress he has made on reducing the number of foreign nationals using NHS services without payment.
Andrew Rosindell (Romford) (Con)
15. What progress he has made on reducing rates of hospital-acquired infections.
The Secretary of State for Health (Mr Andrew Lansley)
The NHS is making significant process toward the zero-tolerance approach that we have made it clear it should adopt in respect of all avoidable health care-associated infections. Over the past 12 months MRSA bloodstream infections have fallen by 29% and C. difficile infections have fallen by 17%.
Andrew Rosindell
I thank the Secretary of State for his reply. Will he confirm that the Government will continue with the zero-tolerance approach to hospital-acquired infections as the only sure way to resolve and eradicate this problem?
Mr Lansley
Yes, my hon. Friend is absolutely right; indeed, we are extending the range and frequency of the publication of data relating to infections to support the NHS in that work. With his commendable consistency, my hon. Friend asked a question on exactly this subject on 8 March, when he raised the issue of the Barking, Havering and Redbridge trust. I am pleased to be able to report that in the past five months C. difficile infections in the trust have fallen by 57% in comparison with the same five months of 2010, while MRSA bloodstream infections have been reduced by 25%. I expect the trust to continue to bear down on those and other infections in future.
Kerry McCarthy (Bristol East) (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 health outcomes in England; to lead a public health service that improves the health of the nation and reduces health inequalities; and to lead the reform of adult social care which supports and protects vulnerable people.
Kerry McCarthy
In the wake of the former Defence Secretary’s resignation and the fact that 40 peers who voted on the Health and Social Care Bill have private sector health interests, and given the Secretary of State’s known connections with private health care companies, can he assure the House that he has been as transparent as possible about the influence of private health care companies on the passage of the Bill?
Mr Lansley
I am sorry, but I think the hon. Lady should withdraw that. I have no connection with private health care companies, and if I did, I would have entered it in the register of Members’ interests.
Mr Speaker
I am grateful to the Secretary of State, who has put the position very explicitly on the record.
Gordon Henderson (Sittingbourne and Sheppey) (Con)
T2. The coalition agreement states:“Doctors and nurses need to be able to use their professional judgement about what is right for patients and we will support this by giving front-line staff more control of their working environment.” That being the case, can my right hon. Friend explain why, despite national clinical guidelines, GPs in my constituency face financial penalties if they do not meet targets for reducing the cost of the drugs that they prescribe?
Mr Lansley
I am grateful to my hon. Friend, and I understand that Kent and Medway primary care trust is working to incentivise the optimisation of medicines usage. We provide advice through the National Prescribing Centre and in other ways, and we support that work with GPs through the structure of the quality and outcomes framework. However, this is about incentivisation for best prescribing practice, not about financial penalties.
Liz Kendall (Leicester West) (Lab)
Many families will be deeply concerned about standards of care for older people in hospitals following the Care Quality Commission’s recent report. Patients and the public must be confident that all the necessary steps are being taken immediately to tackle this issue. Months after its initial inspections, will the Minister confirm that the CQC has revisited only six of the 17 hospitals that were failing to ensure that older people had enough food and drink, and if so, can he explain why?
Mr Lansley
Let me make it clear to the hon. Lady, whom I welcome to her new responsibilities, that the reason the Care Quality Commission undertook unannounced nurse-led inspections in hospitals to look at issues of dignity and nutrition was that I asked it to. As an independent regulator, it must make its own decisions about what it does, but I have been clear in my conversations with the Care Quality Commission that it is moving from the tick-box regulatory approach inherited from Labour to one focused on going out there and finding out where there is poor performance. The CQC is shining a light—not least at our request—on poor performance and poor care in the NHS, and it will continue to do so.
Jeremy Lefroy (Stafford) (Con)
T4. Several of my constituents, including members of the Cure the NHS group, have raised concerns over the way in which “Do not attempt resuscitation” notices are used in hospitals. Will the Secretary of State tell the House what the NHS is doing to ensure that the national guidance is followed?
Mr Lansley
This is an area in which the medical director of the NHS, the General Medical Council and others issue guidance to the NHS. I will gladly write to my hon. Friend setting out the details.
Huw Irranca-Davies (Ogmore) (Lab)
T3. I know that I am not alone in being an MP who represents pharmacists who are struggling on a daily basis to access life-saving drugs to treat asthma, diabetes and cancer, even to the point at which some of them are running out of those products. What more can the Secretary of State do to ensure that manufacturers and wholesalers have those life-saving drugs that people’s lives depend on? This is not good enough. What more can the Government do?
Mr Lansley
The hon. Gentleman will know that we inherited significant supply problems to pharmacies from the previous Government, not least because of the exchange rate and the possibility of countertrade. We have worked with the industry to resolve those issues. The hon. Gentleman would be well advised to talk to the Welsh Assembly Government about the fact that patients in Wales cannot access the latest cancer medicines, as patients in England can do under the cancer drugs fund.
Mr Peter Bone (Wellingborough) (Con)
T6. Today is anti-slavery day, and our excellent Prime Minister will be hosting a reception at Downing street tomorrow to promote the new Government anti-trafficking strategy. That strategy includes a requirement for the health service to be proactive in identifying victims of trafficking. What progress has been made on that?
Mr Lansley
I am sure that we all share my hon. Friend’s view of the great importance of this matter. The Department of Health leads on ensuring that health care is available to people who have been rescued by the police from human trafficking. We also lead on promoting an awareness that local government has multi-agency safeguarding processes to assist in supporting people who have been abused and harmed. There is more to say, but I will write to my hon. Friend on the subject.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
T5. In the evidence session on the Health and Social Care Bill, the Secretary of State told me that he was committed to reducing health inequalities. We also heard from the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton) on that subject a few moments ago. Will the right hon. Gentleman therefore explain why he made a political decision last December, against the advice of the Advisory Committee on Resource Allocation, to reduce the health inequalities component of primary care trusts’ target funding from 15% to 20%, in effect shifting funding from poor health areas such as my constituency to richer health areas such as his own? The Government are saying one thing—
Mr Lansley
I made no decision contrary to the advice of the Advisory Committee on Resource Allocation. If the hon. Lady cares to look at the increase in revenue allocations to primary care trusts across the country, she will see that many of the lowest allocations are in richer areas and the highest are in the most needy areas.
Mr Rob Wilson (Reading East) (Con)
T8. Last week, a survey found that 80% of people want more choice in how and where they are treated. Does that not show that the Government are absolutely right to press on with modernising the NHS?
Mr Lansley
Yes, it was absolutely clear that the public wanted choice of treatment. That is one of the reasons that we have published some of the patient decision aids for the first time, and we will continue to do more. People want a choice in the consultant-led team that will provide their treatment, and in the hospital where that will happen. In the past few weeks, we have set out the details of how we are going to give patients the choice that they seek.
John Mann (Bassetlaw) (Lab)
T7. I have noticed a growing creeping privatisation of cleaning contracts in the NHS this year. Does this signify a return to the old Tory days of longer waiting lists and dirty hospitals?
Mr Lansley
I will not interrupt the hon. Member for Leicester West (Liz Kendall) who is replying from a sedentary position. I agree with my hon. Friend. What we heard under the Labour Government appears to be very much at odds and not at all in keeping with what we hear from the Labour Opposition now. Let me remind my hon. Friend that the South Gloucestershire primary care trust has received a cash increase of £10 million, or 3%, this year. Like every other part of England, it is receiving increases in resources this year that the shadow Health Secretary opposed.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
May I ask the Secretary of State to look back at issues of public health? What is he doing to provide leadership in this sector, especially when we talk to people at the top of the health service who say that there are real problems with obesity in nurses and smoking among doctors? Where is the leadership coming on those issues?
Mr Lansley
Let me just give the hon. Gentleman one or two examples. In the last few days, we have published an obesity call to action, which sets out national ambitions to reduce calorie consumption to a point where people can maintain a healthy weight or reduce their weight. We have set out a tobacco control plan, which is regarded as a leader across the world. About three weeks ago, I attended the United Nations General Assembly in order to join in debates with colleagues on reducing the tide of non-communicable diseases across the world. There is also the work of Sir Michael Marmot, which we share with him; he knows that we are taking it forward nationally and internationally to tackle the wider social determinants of health. That is why we have put local government leadership on health improvement at the heart of the Health and Social Care Bill.
Stephen Gilbert (St Austell and Newquay) (LD)
Mr Paul Eccles is a constituent of mine. He is a qualified care assistant who wants to go freelance and set up his own business, helping people in their own homes. However, the annual up-front £1,000 charge of the Care Quality Commission is preventing him from starting this new venture. Will the Secretary of State meet me so we can find a way to help my constituent get his business off the ground?
Ann Coffey (Stockport) (Lab)
Stockport is one of only five PCTs in the country that does not provide any in vitro fertilisation treatment—in spite of recommendations from the National Institute for Health and Clinical Excellence. Does the Secretary of State think it fair that my constituents, who pay the same taxes as everybody else, do not get the same access to this treatment as people living elsewhere?
Mr Lansley
The hon. Lady will know, I hope, that the deputy chief executive wrote to primary care trusts a few weeks ago further to remind them of the need to respond to NICE clinical guidelines. It was the hon. Lady’s Secretary of State, John Reid who, when NICE published its guidelines, told PCTs in 2004 that they should not follow them.
Dr Julian Lewis (New Forest East) (Con)
The news that the Woodhaven hospital in my constituency is threatened with closure only eight years after it was opened as a state-of-the-art mental health facility is causing great concern. Will my right hon. Friend endeavour to look into what is proposed for the closure of acute in-patient beds because the “hospital at home” alternative is simply not good enough?
Paul Farrelly (Newcastle-under-Lyme) (Lab)
PCTs in Staffordshire are pre-empting legislation by merging and reorganising now, which has led to plans to close the high street practice in Newcastle-under-Lyme simply because it is run by salaried GPs. Is that really NHS policy? If not, what will the Secretary of State do to help 5,000 patients rescue a much-needed surgery?
Mr Lansley
Nothing that is being done pre-empts legislation. What is being done in relation to primary care trust clusters is being done under existing legislation, and was necessary not least to enable us to achieve a reduction of £329 million in management costs in the first year following the election. In contrast, there was a £350 million increase in the year before the election under the hon. Gentleman’s right hon. Friend the Member for Leigh (Andy Burnham).
I do not know the circumstances of the centre to which the hon. Gentleman referred because the decision will have been made locally and will not have involved me, but I will gladly write to him about it.
John Pugh (Southport) (LD)
The full roll-out of 111 services is now proceeding. Is the Secretary of State satisfied that imploding PCTs can get the procurement right in the time allowed?
Mr Lansley
I am confident that we will make the progress that we seek. If we are not ready in any location, we will not be able to proceed with that procurement, but the PCTs will act on the basis of an evaluation of four pilots. To that extent, the character of what they are procuring through the 111 system will be well defined through piloting.
Mr Kevin Barron (Rother Valley) (Lab)
What progress has been made since the launch of the Secretary of State’s tobacco control plan last March in changing the behaviour of people who smoke in cars in the presence of children?
“Healthy Lives, Healthy People: A Call to Action on Obesity”
Lord Lansley Excerpts(13 years, 2 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
The Government are today publishing “Healthy Lives, Healthy People: A call to action on obesity in England”.
The public health White Paper “Healthy Lives, Healthy People: Our strategy for public health in England” sets out the coalition Government’s commitment to improve the health of the nation, and to improve the health of the poorest, fastest. It describes the radical shift that we are making in the way we tackle public health challenges.
The White Paper committed us to publishing a number of follow-on documents on how we will address specific public health challenges. The call to action is the second of these documents, and sets out how our vision for public health will enable us to achieve a new level of ambition in addressing overweight and obesity.
England has some of the highest rates of obesity in the developed world. It is a major risk factor for diseases such as cancer, heart disease and type 2 diabetes and costs the NHS more than £5 billion each year. Alongside the serious ill health it can lead to, it can impact on employment, self-esteem and mental health.
Such a pressing issue calls for bold action—by Government and across the range of partners with a role to play. Our White Paper underlined the importance of taking a life course approach to public health issues, and the call to action reflects this by setting out two new national ambitions to achieve a downward trend in overweight and obesity in both children and adults by 2020. Given that more than 60% of the adult population is already overweight or obese, we must tackle the major problem that we already have as well as continuing to focus on prevention.
Our approach to obesity is based on the latest scientific evidence, including advice from a group of independent experts which has estimated the extent of our over-consumption of calories. Being overweight and obese are a direct consequence of taking on more calories through food or drink than we need. We need to be honest with ourselves and recognise that we need to make some changes to control our weight. For most of us who are overweight and obese, reducing the amount of calories we consume is key to weight loss. Increasing physical activity can also be helpful alongside calorie reduction in achieving weight loss and sustaining a healthy body weight, as well as improving overall health.
In setting our new national ambitions, we are clear that it is for each of us to make our own decisions about how we live our lives. But it is important that people are equipped to make the best choices for themselves and their families, and that the healthier choice becomes the easier choice. Everyone has a role to play in this—including businesses in the food and drink and physical activity sectors, employers who can support the health of their work force, and local NHS staff in talking to people about overweight and obesity and its consequences.
We are also calling on business to play a greater and leading role (alongside Government and others) in supporting the population in reducing its calorie intake by 5 billion calories a day to help close the crucial imbalance between energy in and energy out. It is important for business to reduce the calorie content of everyday foods and drinks, making our environment less likely to lead to weight gain, as it is for each of us to avoid eating too much.
As set out in the White Paper, localism is at the heart of the new approach to public health and local leadership will be critically important in preventing and tackling overweight and obesity. Local authorities will have a new enhanced role, supported by a ring-fenced budget, and will bring together local partners with a role in providing effective interventions—including the NHS. The call to action sets out the opportunity that this will bring and the way in which it will help to ensure that action on obesity is tailored to meet the needs of different communities and address health inequalities, rather than imposing a top-down approach.
As reducing levels of overweight and obesity is “everybody’s business”, it is important that everyone with a part to play to knows what progress is being made. The new national ambitions provide a clear goal to aim for, and a new national ambition review group for obesity will draw together a wide coalition of partners to assess progress.
The Government invite all those committed to preventing and tackling overweight and obesity to respond to this call to action and play their part.
“Healthy Lives, Healthy People. A call to action on obesity in England”, as well as the Change4Life marketing strategy—also published today—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.
Choosing a Named Consultant-led Team (Government Response)
Lord Lansley Excerpts(13 years, 2 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
Today I am publishing the “Liberating the NHS: Greater choice and control—Government response: choice of named consultant-led team” and associated guidance. The response, the contract implementation guidance and the impact assessment have been placed in the Library. Copies of the response are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
This is the response to the questions associated with the proposal to offer patients choice of named consultant-led team in “Liberating the NHS: Greater choice and control—A consultation on proposals”. The response to these questions is being published now to help the NHS plan for the next financial year. A fuller response covering all of the remaining questions in the greater choice and control consultation document will follow later this year.
This consultation sought views on the choice commitments first set out in the White Paper “Equity and Excellence: Liberating the NHS” (Cm 7881). The consultation period ran from 18 October 2010 until 14 January 2011 and I am delighted to report that hundreds of engagement activities were undertaken and 617 unique responses were received. We have heard from patients, service users, clinicians, care professionals, systems providers, voluntary sector organisations and many others. All these contributions have been analysed and have informed the ongoing development of our policy direction reflected in today’s publication.
A significant majority of respondents supported our proposed approach to implementing proposals to offer patients a choice of named consultant-led team at referral as set out in the consultation document. A range of issues were also raised around the need for good quality information to support choice; the impacts on providers’ ability to manage capacity and waiting times; and the development of specialist knowledge by consultant-led teams.
The issues raised in the responses to choice of named consultant-led team have been taken into account in drafting the contractual guidance published alongside this response, and the accompanying impact assessment.
Care and Support (Stakeholder Engagement)
Lord Lansley Excerpts(13 years, 3 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
Today, the Government launched “Caring for our future: shared ambitions for care and support” an engagement with people who use care and support services, carers, local councils, care providers, and the voluntary sector about the priorities for improving care and support. The engagement will last until early December, and we are requesting written comments by 2 December to help inform discussions.
In recent months, two independent commissions have reported to Government on two different aspects of care and support. In May, the Law Commission published recommendations for modernising and simplifying the social care legal framework (available at www.justice.gov. uk/lawcommission/docs/lc326_adult_social_care.pdf), and in July the Commission on Funding of Care and Support published recommendations for reforming the way that people pay for care and support (available at: https://www.wp.dh.gov.uk/carecommission/files/2011/07/Fairer-Care-Funding-Report.pdf). These recommendations will form the basis for our discussions.
We have also received a report from the “Palliative Care Funding Review”, which sets out how we could create a fair and transparent funding system which ensures integrated, responsive, high-quality health and care services for those at the end of life. This report has been placed in the Library.
All these reports contain important and valuable proposals to help us decide our approach to changing the care and support system. However, the Government have a broad agenda for reform of care and support. These reports were never intended to look at all our priorities. For the White Paper on social care reform and the progress report on funding reform, which we will publish next spring, we have an opportunity to get reform right so we want to have a wider discussion about every aspect of the system to inform Government decisions.
We have already said, in our “Vision for Adult Social Care”, that we want to see a care and support system where care is personalised, people have choice in how their needs and ambitions are met, and carers are supported. We want high-quality care to be delivered by a diverse range of providers and a skilled work force that can provide care and support with compassion and imagination. People must be confident that they are protected against poor standards and abuse.
Making changes to the care and support system is not simple. The challenges of an ageing society are being faced by most developed countries. There are no easy answers, and we can not make all the changes at once. We know that, as a country, we will need to spend more on care and support as our society ages. In this challenging economic environment, we need to weigh up what the priorities for reform are and produce a realistic road map for change.
So, over the next three months, we will be engaging with a range of people and organisations involved with care and support about their priorities for reform.
“Caring for our future” will consist of six themes:
Quality: what are the priorities for improving quality and developing the future work force?
Personalisation: what are the priorities for promoting increased personalisation and choice?
Shaping local care services: what are the priorities for creating a more diverse and responsive care market?
Prevention: what are the priorities for supporting greater prevention and early intervention?
Integration (in partnership with the NHS Future Forum): how can we take advantage of the health and social care modernisation programme to ensure services are better integrated around people’s needs?
The role of financial services: what role could the financial services sector play in supporting care users, carers and their families?
Making changes to the funding system for care and support, as discussed in the Commission on Funding of Care and Support’s report, would impact on all aspects of the care and support system. So we also want to consider the implications of the Commission’s recommendations as part of these discussions.
We have asked a key leader from the care and support community to help the Government to lead the discussions for each of these six areas. We want to work collaboratively, drawing upon the networks of expertise and experience that have developed over many years. So, together, we will be attending events, holding meetings, listening to the views of user organisations, carers’ representatives, care providers, and local councils on what the priorities for improving care and support should be.
The leaders for each of the discussion strands are:
Quality: Imelda Redmond (Chief Executive, Carers UK);
Personalisation: Jeremy Hughes (Chief Executive, Alzheimer’s Society);
Shaping local care services: Peter Hay (President, Association of Directors of Adult Social Services);
Prevention: Alex Fox (Chief Executive, NAAPS);
Integration (in partnership with the NHS Future Forum): Geoff Alltimes (Chief Executive, Hammersmith and Fulham Council) and Dr Robert Varnam (Practising GP, Manchester); and
The role of financial services: Nick Kirwan (Assistant Director of Health and Protection, Association of British Insurers).
As part of “Caring for our future”, we also want to hear people’s views on the recommendations made by the Commission on Funding of Care and Support and how we should assess these proposals, including in relation to other potential priorities for improvement. The Commission’s recommendations present a range of options, including on the level of a cap and the contribution that people make to living costs in residential care, which could help us to manage the system and its costs. We want to hear people’s views on these different options, and the trade-offs involved. Later in the autumn, as part of the engagement process, we will ask the six discussion leaders to bring together the views they have gathered on support for the Commission’s proposals, and the wider priorities for change.
As we said in our response to the Commission on Funding of Care and Support, we face difficult economic times. Given this, the Government will have to weigh up different funding priorities and calls on their constrained resources carefully before deciding how to act.
A copy of the public discussion document 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. This contains more details on how people can feed their views into the discussion.
The Government have said that they will engage with the official Opposition, as part of this process.
“Caring for our future” will run until early December. At the end of the engagement, the discussion leaders will bring together views about the priorities for change and will discuss these with the Government. We have committed to publishing a White Paper in spring 2012, alongside a progress report on funding reform, and to legislating at the earliest opportunity. The White Paper and progress report will include a response to the Law Commission and Commission on Funding of Care and Support and will set out our approach to reform, to start the process of transforming our care and support system.
Health and Social Care (Re-committed) Bill
Lord Lansley Excerpts(13 years, 3 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Owen Smith
Yes. The current situation is clear: the Secretary of State has a legal duty placed upon him in the legislation to secure and provide—not just to promote—a comprehensive health service in this country, and to issue direction to PCTs and SHAs, such that they so do. Those two crucial aspects of the current legislation are being changed in the Bill, and I intend to discuss them in a moment.
In version 1 of the Bill, the Government were less coy, because it actually excised section 1 of the original 1977 Act. After the deluge of criticism, however, they decided that they needed to put it back in, making it explicit, as they put it, that the Secretary of State will be responsible, as now, for promoting a “comprehensive health service”.
Section 1 of the Act was duly reinstated, as was the duty to promote, but there was a critical change, in clause 1(2) of the new Bill, which diluted the traditional duty to provide and secure. Ultimately, it placed a duty on the Secretary of State only to
“exercise the functions conferred by the Act so as to secure that services are provided”.
I shall come on to the reason why that is significant, but equally significant and allied to it was the retention—against the advice of Opposition Members and many others—of clause 10, which amends section 3 of the 2006 Act, thus keeping commissioning bodies, not the Secretary of State, as the parties with a legal duty to provide health care in England.
The net effect of those changes—despite what the Minister said earlier, and despite what the Secretary of State has said on several occasions, including notably on Second Reading—is no change. The Secretary of State is still, as the Minister put it, washing his hands by divesting himself not of the NHS but of a direct duty to provide a comprehensive health service. That is the distinction which the Minister failed to make today. The Secretary of State is palming off that precious duty, which has been placed upon successive Secretaries of State, and handing it on, via the mandate, to a quango and to unelected commissioning bodies.
The Secretary of State for Health (Mr Andrew Lansley)
If the shadow Minister is so concerned about the Secretary of State’s legal ability directly to provide services, will he answer me a question? Does he know the last time the Secretary of State for Health actually directly provided any services? In the Department of Health, we cannot find out when it was.
Owen Smith
With the greatest respect to the Secretary of State, who I have to confess knows a lot about the NHS and about the health service in this country, I think that that question is completely erroneous—a total red herring. As I said earlier, the practical reality is that the Secretary of State delegates—[Interruption.] No, no, no. The Secretary of State delegates to PCTs and SHAs his powers to provide, but, as I am going to tell the Secretary of State, he will know that under the aegis of this new Bill he will not have the power to direct clinical commissioning groups to do what he says, so he will not have a direct personal duty to provide. On the courts, we heard another interesting thing earlier from the Minister of State. He said that it was okay, because the Secretary of State will be able to justify in court when he directs a CCG to act. That is very important, and I am keen to hear the Secretary of State’s response to it, but I do not think that he has one that will convince us.
Mr Lansley
The hon. Gentleman has admitted that for decades the Secretary of State has not directly provided services, and I know that that is true. The issue is about having a legal duty, not to provide services but to secure the provision of services. He admits that that is done through delegation, which is in the structure of the Bill through the delegation of that responsibility to the national health service commissioning board and the CCGs. The mandate, which my hon. Friend the Minister has clearly explained, is much more transparent and accountable to Parliament for the manner in which the Secretary of State secures the discharge of those duties.
Owen Smith
With respect, there is not a legal duty on the Secretary of State to provide, as there has been in successive health Bills. When Bevan talked about hearing the bedpan dropped on the ward in Tredegar, he did not mean that he wanted to pick it up. [Interruption.] I do not know whether the Secretary of State wants to listen. Bevan did not mean that it needed to be picked up by the Secretary of State, but he certainly meant that he would like to be able to direct those responsible operationally for picking it up so to do.
The critical difference in this Bill is that the Secretary of State will divest himself of not only the duty to provide that service, but the power to direct the operational parts of the NHS, save for—[Interruption.] The Minister is waving his head, nodding or something; I know what he is going to say. Under the Bill, save for in cases of crisis or emergency, the Secretary of State will not have responsibility for running the day-to-day operations of the NHS.
Valerie Vaz (Walsall South) (Lab)
It is always a pleasure to follow the hon. Member for Hexham (Guy Opperman), and it is good to see him sitting in his place. I welcome him back to the House and commend him on his great recovery. He is actually looking better than before, if I may say so.
Let me take up one point that the hon. Gentleman made. As a barrister, he will want people to go to litigation, but as a solicitor I mostly counsel people not to. It is the most terrible, prolonged and costly event—but I appreciate that he wants litigation, because that is his bread and butter.
As for the legal advice, I asked on a number of occasions for the legal advice that the Department had and it was refused on all those occasions. The hon. Gentleman can talk about 38 Degrees, but thankfully that organisation is interested in the public and knows that they need the legal advice that was not provided, even though it was paid for with taxpayers’ money. I challenge the Secretary of State to lay it in the House of Commons Library, if the other advice is so hurtful to him. What is the problem? His Bill is being discussed and there is nothing to hide. I say that he should place his legal advice in the Library.
I am a Member of the Select Committee on Health and Sir David Nicholson, the new chief executive of the NHS commissioning board, appeared before us when I was first elected. He was then on the verge of retirement—
Valerie Vaz
He was: he had a very big smile on his face and he said, “I’m about to retire.” [Interruption.] With the greatest respect, the Secretary of State was not there. Sir David was asked to stay on to preside over the NHS commissioning board, which he has described as
“the greatest quango in the sky.”
I think that the NHS commissioning board is going to be the new Secretary of State for Health, with all the powers but none of the accountability. The NHS has been quangoed—not coloured orange, as in the advert, although that might happen when the Bill goes to the other place, but coloured the blue of betrayal. These are not reforms: they are a complete dismantling and looting of our precious resource. This is not selling off the family silver, but selling off the whole estate, the freehold and the family crest.
It is not just Opposition Members who are concerned about accountability. There are widespread concerns about the accountability of the NHS commissioning board and commissioning consortia regarding public money.
Rushanara Ali
I will not give way, because there is not much time left.
The borough is one of the poorest in the country, with high levels of health inequalities, and the change will have a direct and damaging effect on the health of my constituents and many others around the country.
Rushanara Ali
I will not give way, because the Secretary of State has had long enough to speak. He has had far too long to speak, and I have two minutes left.
The change will have a very damaging effect on my constituents, and if the formula is applied across the country it will increase inequality. I ask the Secretary of State again to show leadership and take responsibility—
Rushanara Ali
The Secretary of State has spoken for long enough—[Interruption.] He has spoken, but there has not been much content—[Interruption.]
Mr Lansley
I beg to move, That the Bill be now read the Third time.
The national health service is among our most valued and loved institutions. Indeed, it is often described as the closest thing we have to a national religion. I am not sure that that was always intended to be complimentary, but I think it should be. People in this country believe in the NHS wholeheartedly, share in its values and the social solidarity it brings, and admire the doctors, nurses and staff who work in it.
It is because I share that belief that I am here. Over eight years, I have supported, challenged and defended the NHS. As a party, and now as a Government, we have pledged unwavering support for the NHS, both in principle, because we believe in the values of the NHS, and in a practical way because we are reforming the NHS to secure its future alongside the additional £12.5 billion of taxpayer funding over the next four years that we have pledged for the NHS in England.
Nicola Blackwood (Oxford West and Abingdon) (Con)
Will my right hon. Friend give way?
Mr Lansley
If my hon. Friend will forgive me, I will not give way because other Members wish to speak on Third Reading.
In Wales, a Labour Government are cutting the budget for the NHS. The coalition Government’s commitment to the NHS will not waver. The Government and I, as Health Secretary, will always be accountable for promoting and securing the provision of a comprehensive health service that is free and based on need, not ability to pay.
What matters to patients is not only how the NHS works, but, more importantly, the improvements that the modernisations will energise—a stronger patient voice, clinical leadership, shared NHS and local government leadership in improving public health, and innovation and enterprise in clinical services. Everyone will benefit from the fruit that the Bill and the reforms bring. There will be improved survival rates, a personalised service tailored to the choices and needs of patients, better access to the right care at the right time, and meaningful information to support decisions. The Bill provides the constitution and structure that the NHS needs to work for the long term.
Patients know that it is their doctors and nurses—the people in whom they place their trust—who make the best decisions about their individual care. The Bill is about helping those people to become leaders. It is not about turning medical professionals into managers or administrators, but about turning the NHS from a top-down administrative pyramid with managers and administrators at its zenith into a clinically led service that is responsive to patients, with management support on tap, not on top. It is about putting real power into the hands of patients, ensuring that there truly is “no decision about me without me”. My only motivation is to safeguard and strengthen the NHS, and that is why I am convinced that the principles of this modernisation are necessary.
Of course, the Bill has been through a long passage. There have been questions and new ideas, and many concerns and issues have been raised. We have done throughout, and will continue to do, what all Governments should do—listen, reflect, then respond and improve. The scrutiny process to this point has been detailed and forensic. There were the original 6,000 responses to the White Paper consultation, many public and stakeholder meetings and 28 sittings in Committee, after which the hon. Member for Halton (Derek Twigg) acknowledged that “every inch” of the Bill had been scrutinised, but we were still none the less determined to listen, reflect and improve.
I wish to thank the NHS Future Forum, under Steve Field’s leadership, for its excellent and continuing work. I also thank more than 8,000 members of the public, health professionals and representatives of more than 250 stakeholder organisations who supported the Future Forum and the listening exercise and attended some 250 events across the country. That forum and those people represented the views of the professionals who will implement and deliver the changes, and we accepted all their core recommendations. We brought the Bill back to Committee—the first such Bill since 2003—and we have continued to listen and respond positively. The Bill is better and stronger as a result.
Mr Lansley
No.
At the heart of the changes is support for clinical leadership, which has always been key in putting health professionals, and not only managers, at the heart of decision making in the NHS. That was why we strengthened the Bill to ensure that all relevant health professionals would be involved in the design and commissioning of services at every level and in the leadership of clinical commissioning groups. They will also be brought together through clinical networks on specific conditions and services, as they often are now, such as in the case of cancer networks. They will be brought together in broad geographic areas, through new clinical senates, to look across services and advise.
The Bill was strong in transparency and openness from the outset, and that now flows through every aspect of modernisation. Indeed, the Future Forum is taking forward another of our central principles of reform, which is to develop high-quality and integrated services. Properly integrated services are essential for the quality of individual care and for the most efficient operation of the NHS. That was why we proposed health and wellbeing boards, to bring together all the people who are crucial to improving health across an area and having a real impact on the causes of ill health. We can bear down on the inequalities in health that widened under the previous Government.
The Bill now makes our commitment to integration explicit. Clinical commissioning groups will have a duty to promote integrated health and social care based around the needs of their users, and we will encourage greater integration with social care by ensuring that CCG boundaries do not cross those of local authorities without a clear rationale.
The Bill has deserved the attention and passion that it has attracted, and which I am sure it will continue to attract. I thank all Members who have taken part in the scrutiny of it on Second Reading, in Committee, on recommittal and during the past two days. I especially thank my ministerial colleagues, who have steered the debates and led the preparation of and speaking on the Bill. I thank all colleagues throughout the House who have contributed, especially many of my colleagues who I know have given an enormous amount of time, energy and hard work to supporting the Bill. I also thank the Whips.
I thank the Officers of the House and, especially on this occasion, my departmental officials who have responded tirelessly not only to our requests for information and advice but to those of many hon. Members and thousands of people across the country and in stakeholder organisations.
The intensity of debate and the brightness of the spotlight shone upon the Bill have made it a better Bill than when it was first laid before the House. I believe that it will set the NHS in England on a path of excellence, with empowered patients, clinical leadership and a relentless focus on quality. Let us look at what we have already achieved as a Government: more investment in the NHS, higher quality despite increased demand, waiting times remaining low, MRSA at the lowest level ever, mixed-sex accommodation breaches plummeting, and thousands more people getting access to cancer drugs. The Bill will pave the way for even more progress towards the world-class NHS that patients want, which will be able to deliver results that are truly among the best in the world. I commend it to the House.