"Healthy Lives, Healthy People"
Lord Lansley Excerpts(12 years, 10 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
Today I am laying before Parliament “Healthy Lives, Healthy People: Update and way forward” (Cm 8132), which sets out the progress we have made in developing our vision for public health, and a timeline for completing the operational design of this work through a series of public health system reform updates.
The White Paper “Healthy Lives, Healthy People: Our Strategy for public health in England” (Cm7985), described a new era for public health, with a higher priority and dedicated resources. It set out that local authorities would take new responsibilities for public health, tackling the wider determinants of health, supported by a ring-fenced budget, with directors of public health leading on this work locally. A new integrated public health service, Public Health England, would bring together in one body the diverse range of public health expertise to provide public health advice and support at all levels of the system.
The White Paper generated real enthusiasm for a new approach to public health. We want to maintain this momentum, and by setting out progress to date, and clear next steps, we aim to reduce uncertainty and encourage local authorities and public health professionals to continue to plan and build the local relationships and partnerships that will be key to implementing the new public health system.
This policy statement sets out how we expect the reformed public health system to work and the progress we have made in a number of areas, including the role and functions of Public Health England as an executive agency. It sets out greater clarity about the role of the Director of Public Health within local government, including how public health advice will be provided to help inform NHS commissioning. It provides an update in relation to commissioning routes for public health funded activity and provides greater clarity around roles and responsibilities for preparedness, resilience and response to health protection incidents and emergencies. It also indicates the functions we plan to mandate of local authorities, and what general conditions we intend to place on the ring-fence grant.
The high-quality of consultation responses received also helped us to identify where we need to do further work to address concerns raised around a number of policy and implementation issues. We will continue to engage with key stakeholders to ensure that by the autumn we have developed credible policy and implementation solutions for those issues which need further development. We will produce a series of public health system reform updates to complete the operational design of the public health system including on: the public health outcomes framework; the Public Health England Operating Model, public health in local government and the role of the Director of Public Health; public health funding; and a workforce strategy.
Copies of “Healthy Lives, Healthy People: Update and way forward” are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
The document is also available at:
www.dh.gov.uk/en/Publichealth/Healthyliveshealthypeople/index.htm
Oral Answers to Questions
Lord Lansley Excerpts(12 years, 10 months ago)
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Karl MᶜCartney (Lincoln) (Con)
1. What arrangements are in place to ensure increased funding for the NHS during the comprehensive spending review period.
The Secretary of State for Health (Mr Andrew Lansley)
We will increase NHS funding in real terms in each year of this Parliament. Compared to the level of expenditure in the national health service in the last financial year, the resources available to the NHS will increase by £12.5 billion by the end of the spending review period. The budget available for the NHS in the financial year 2011-12 is 3.9% higher than spend in the previous year, 2010-11.
Karl MᶜCartney
Can my right hon. Friend give me any examples of how the increased funding this Government have promised here in England is, unlike what is happening in Wales, delivering better care for our NHS services?
Mr Lansley
Yes, I can indeed do that. We are committed to real-terms increases in the NHS budget in England. According to an analysis by the King’s Fund, the Welsh Assembly Government—a Labour-led Welsh Government —are going to reduce the NHS budget by 8.3% in real terms by 2013-14 in comparison with 2010-11. That might be one reason why it is already the case that in Wales, 26.4% of patients in April 2011 waited more than 18 weeks for treatment.
Chris Leslie (Nottingham East) (Lab/Co-op)
Will the Secretary of State confirm that his definition of a real-terms increase is based on a 2.9% figure? Will he also confirm that the retail price index actually stands at 5%, so any claim that he is increasing the NHS budget in real terms is a complete and total con?
Mr Lansley
I think that it has been conventional over many years for the calculation of real terms in public accounting to use the GDP deflator. Given that it includes the prices of investment goods, Government services and exports and subtracts the price of UK imports, it gives a more appropriate overall measure of inflation.
Henry Smith (Crawley) (Con)
Does my right hon. Friend welcome the increase in the NHS West Sussex budget of £35 million this year, which, coupled with the provisions of the Health and Social Care Bill, means that we will have far greater patient choice in our local area?
Mr Lansley
Yes, I do indeed welcome that. We all know that last year, this year and in future years, increases in the NHS budget in real terms will not be the kind of real-terms increases we saw in the past, but they will be real-terms increases. What we are already seeing in the NHS—we saw it last year—is that with a 2.2% increase in cash spending, there is none the less an ability to sustain, and in many respects improve, performance.
John Healey (Wentworth and Dearne) (Lab)
In spite of the spin, the truth is that the Prime Minister’s personal promise to give the NHS a real rise in funding is being broken. It is not just how much that counts; it is how well the money is spent. Today it is one year to the very day since the Health Secretary launched the Government’s plans to “liberate” the NHS. He told the House:
“we will phase out the top-down management hierarchy”—[Official Report, 12 July 2010; Vol. 513, c. 663.]
He said that he would reduce “the number and cost” of NHS-related quangos, so why is he setting up the new national commissioning board, set to employ 3,500 people, when even its chief executive says that it
“could become the greatest quango in the sky we have seen”.
Why is the right hon. Gentleman setting up more than 500 public bodies in the NHS when 161 do the job now, and why are the Government wasting precious NHS funding on the biggest reorganisation in history, when it could and should be spent on patient care?
Mr Lansley
Since the election we have reduced the number of managers in the NHS by more than 4,000 and increased the number of doctors by more than 2,000. The NHS commissioning board—I did not hear from the right hon. Gentleman whether he supports it—is part of our strategy to give the NHS not only local clinical leadership but national leadership through it. The functions covered by the board are currently undertaken by something approaching 8,000 staff; the number delivering those functions in future will go down to 3,500 staff, so the reduction in administration will be dramatic.
John Healey
We had plans to reduce bureaucracy, which were published, and we also said that the Government should keep Labour’s waiting time guarantees for patients, which the Health Secretary told the House a year ago today were “unjustified” targets, which he would remove. The Prime Minister has now promised to keep waiting times low, but after one wasted year of NHS reorganisation by the right hon. Gentleman’s Government, an extra 25,000 patients a month are waiting more than four hours in accident and emergency departments, an extra 12,000 patients a month are waiting more than six weeks for tests, and an extra 2,300 patients a month are waiting more than 18 weeks to get into hospital for the treatment they need. The NHS deputy chief executive has called the rise in long waiting times this year “unacceptable”. Does the Health Secretary agree?
Mr Lansley
As we said in the NHS constitution, we do not intend patients to be waiting for more than 18 weeks. [Hon. Members: “They are!”] The April figures show that we met the operational standard, which is that more than 90% of admitted patients and more than 95% of non-admitted patients should be treated within 18 weeks. The right hon. Gentleman’s analysis of waiting times did not include the fact that the average time for which patients waited for treatment in April was 7.7 weeks, down from 8.4 weeks in May 2010. The average time for which patients wait is being reduced.
Bill Esterson (Sefton Central) (Lab)
2. What assessment he has made of the conclusions and recommendations of the recent report by the Commission on Funding of Care and Support.
The Secretary of State for Health (Mr Andrew Lansley)
The first NHS outcomes framework includes a number of outcomes relevant to people with cancer. For example, domain 1, on preventing people from dying prematurely, includes progress in improving one-year and five-year survival rates for breast, lung and colorectal cancers. A number of indicators will also be relevant to patients with cancer, such as health-related quality of life for people with long-term conditions, and improving the experience of care for people at the end of their lives. Clinical commissioning groups will be held to account for their contributions to improving those national outcomes through the commissioning outcomes framework.
Mr Baron
The all-party group on cancer and others lobbied for a greater focus on outcomes, but the one-year and five-year cancer survival rates may now be less statistically robust, as CCGs cover smaller population sizes than primary care trusts. Will the Government therefore give added priority to the excellent work of the National Cancer Intelligence Network in producing a set of evidence-based process measures to complement, not replace, other evidence so that CCGs can be held accountable?
Mr Lansley
The House will know of my hon. Friend’s consistent support, through the all-party group, for patients with cancer. I entirely agree that a number of proxy measures and process measures will be relevant in the context of the commissioning outcomes framework. There may be measures that are attributable to CCGs individually in some respects. For example, the quality of life of people living with long-term conditions, to which I referred, would be relevant to a small population. For other measures, however, it may be appropriate for the CCGs to be held to account at the level of, for example, a cancer network, using cancer registry data.
Mr David Blunkett (Sheffield, Brightside and Hillsborough) (Lab)
The considerable improvement and focus on breast, lung and bowel cancer is very welcome, but groups campaigning on prostate and ovarian cancer are extremely worried about both the lack of update guidance and the failure to reverse premature death, especially in ovarian cancer, over the last 30 years. Has the Secretary of State anything new to tell us about the direction in these areas?
Mr Lansley
The right hon. Gentleman will doubtless be aware that we published a quality standard for ovarian cancer, and that the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), published the outcomes strategy for cancer, which will have been relevant to many of the issues to which the right hon. Gentleman refers. I continue to look forward to the results of a major trial on screening for ovarian cancer, but I am afraid that I anticipate that we shall not be able to see the results and recommendations for nearly three years.
Simon Hughes (Bermondsey and Old Southwark) (LD)
4. How many 24-hour GP services are in operation; and if he will make a statement.
Mark Lancaster (Milton Keynes North) (Con)
6. What steps he has taken to increase access to NHS dentistry since May 2010.
The Secretary of State for Health (Mr Andrew Lansley)
I am pleased to be able to tell my hon. Friend that the number of people with access to NHS dentistry has increased by nearly three quarters of a million over the past year.
Mark Lancaster
I am grateful to my right hon. Friend for that answer. In Milton Keynes in recent years we have seen greater access to dentistry. One area of particular concern is access to dentistry for children, so may I press my right hon. Friend on how exactly he will address that problem?
Mr Lansley
I agree with my hon. Friend. We have made it very clear that, contrary to the practice of the previous Government, we are not looking for dentists to deny access to NHS dentistry to children whose parents are not registered with them. Alongside increasing access to dentistry as a whole, we intend specifically to secure increased access for children to NHS dentistry. That will be even more the case in the pilots that we will start this month, which are specifically intended to secure a more preventive approach to dentistry, which maintains good oral health. That is especially important for children.
Andrew Gwynne (Denton and Reddish) (Lab)
Does the Secretary of State not understand that there has been real progress with the Tameside and Glossop primary care trust and their “access, booking and choice” facility, which guarantees access to NHS dentistry when they require it for anyone not already registered with an NHS dentist? Does he not understand that there are real concerns that with his reorganisation, and without that priority focus by the primary care trust, those advances may be lost?
Mr Lansley
On the contrary, with the progressive transfer of responsibilities to the NHS commissioning board there will be much more consistency in contracting for access to NHS dentistry, which at the moment is often a lottery in different places across the country, with the amounts paid per unit of dental activity varying dramatically between neighbouring practices. The new pilots are intended to achieve something that was not achieved under either of the two previous dental contracts, by securing a much stronger preventive approach based on capitation and registration for dentists. It has been welcomed by the dental profession and it promises a great deal for a new contract.
Sir Paul Beresford (Mole Valley) (Con)
You will be aware, Mr Speaker, that I have some slight interest in this subject. Access to NHS dentistry is related to what is on offer. Does the Secretary of State agree that with the huge advances in dentistry, we should be reviewing what is and is not available, and what should or should not be available, from NHS general dental practitioners?
Mr Lansley
My hon. Friend will know that under the new dental contracts, I want to arrive at a point where everybody who wishes to has access to NHS dentistry. I was pleased to see that when we set out the details of the piloting proposal, the chair of the British Dental Association’s general dental practice committee, Dr John Milne, said:
“we are encouraged that the Department of Health is to begin testing new ways of delivering care. We are pleased that two principles that we believe are particularly important—quality of care and a continuing care relationship between practitioner and patient—are central to what is being piloted.”
As in other areas, we are moving from a system that simply incentivises activity to one that is much more focused on quality and outcomes.
Mark Pawsey (Rugby) (Con)
8. What guidance his Department issues on the use by GP surgeries of premium rate telephone numbers.
Mr Matthew Offord (Hendon) (Con)
9. What steps he is taking to improve NHS patient outcomes.
The Secretary of State for Health (Mr Andrew Lansley)
I am committed to ensuring that the NHS achieves improved outcomes for patients. The NHS outcomes framework will drive continuous improvement in those outcomes. By way of example, we have made good progress in reducing the number of health care associated infections. In the year ending March 2011 the number of MRSA bloodstream infections decreased by 22% and clostridium difficile infections decreased by 15%, compared with the year before. Those are key positive results in the drive to protect patients from avoidable harm.
Mr Offord
I applaud the Minister for his work in those areas, and I draw attention to the increased work in cancer care, which I also applaud. However, may I ask him to assure the House that he will not lose focus on other areas, such as mental health, and that the Government will continue to address problems in those areas, which have such consequences across the country?
Mr Lansley
I certainly will. Indeed, the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), and I launched the outcomes strategy for mental health earlier this year, in order to make it absolutely clear that across the NHS, and indeed public health, we ensure that mental health services attract the right priority and focus as we develop outcome measures.
Liz Kendall (Leicester West) (Lab)
The Prime Minister has promised that waiting times will not rise despite his massive NHS reorganisation, but we now know that in May 15,500 patients waited more than six weeks for their diagnostic tests—four times as many as last year—and that 1,800 waited more than three months, which is 10 times as many as last year. Average waits for diagnostic tests are also up. Does the Minister agree with the Royal College of Physicians that those increased waits, including waits for vital tests to diagnose cancer, will harm patient care: yes or no?
Mr Lansley
No, we have met the standard that patients should not wait longer than 18 weeks—a 90% standard for admitted patients and 95% for non-admitted patients. If I recall correctly, the latest data for diagnostic tests showed that there was a 1.9 week average wait for diagnostic tests, which compares with 1.8 weeks in May last year. On cancer waiting times we have achieved an improvement—up to 96%—in the number of patients who are seen by a specialist within two weeks. The hon. Lady really needs to go back and talk to her colleagues in Wales, where 26% of patients wait longer than 18 weeks, compared with less than 10% of patients here; indeed, many patients in Wales wait more than 36 weeks. We have a contrast between a coalition Government in England who are investing in the health service, with improving performance, and a Labour Government in Wales who are cutting the NHS budget and seeing performance decline.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
10. What steps his Department is taking to provide funding for healthcare infrastructure projects.
Rachel Reeves (Leeds West) (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 national health service 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 that supports and protects vulnerable people.
Rachel Reeves
Having met families and patients who use the children’s heart unit in Leeds, I know the value of that service. Does the Secretary of State agree that asking families to travel across the country, which is the stark reality they face if the unit is closed down, puts at risk the family support that is so important to children during these difficult times, and will he pledge to do all he can to keep the heart unit open?
Mr Lansley
I am sure that the hon. Lady will have heard the reply from the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns), who explained the continuing process that the joint committee of primary care trusts will undertake. In the context of her question, it is important to make it clear that the intention of the review is not to close paediatric cardiac centres. Surgery in some of the centres might cease, depending on the conclusions the committee reaches, but they will continue to provide specialist non-surgical services for local populations. The review intends to ensure that as much non-surgical care is delivered as close to children’s homes as possible through the development of local congenital heart networks.
Claire Perry (Devizes) (Con)
T2. Under the previous Government, Savernake hospital in my constituency was redeveloped. As a result, taxpayers have got stuck with nearly £1 million a year in private finance initiative unitary charges and local services offered have been cut drastically. Will the Minister undertake to look at all hospitals labouring under uneconomic PFI burdens and meet me to discuss the Savernake hospital situation specifically?
Mr John Spellar (Warley) (Lab)
T3. NHS West Midlands is cutting nurse training next year by a fifth and predicting a reduction of 7.25% over five years in the qualifying work force—not bureaucrats, but nurses—thereby denying youngsters in this country training for a worthwhile profession and career. Is not this a scandal and a shambles, and what is the Minister going to do about it?
Mr Lansley
The right hon. Gentleman may not know this, but following representations made directly to me I have looked at this very carefully. The strategic health authority is currently responsible for the number of nursing commissions that it undertakes. It has assessed the number of commissions that it should undertake based on its future work force requirements and has reached the conclusion that it is indeed reducing the number of commissions in the west midlands. That is not true to the same extent in other strategic health authorities across the country. In the listening exercise conducted by the NHS Future Forum, further recommendations were made about how we can reform education and training, and we will be taking those forward to try to ensure that there is greater collective understanding of work force requirements.
Mr David Ward (Bradford East) (LD)
Recent figures show that just over 40% of Bradfordians have not visited a dentist in the past two years, and many of my constituents say that that is simply because they cannot get an NHS dentist. Does the Minister agree that it would be extremely difficult for a centralised national commissioning board to deal with this insufficient supply of NHS dentists at a local level?
Mr Lansley
I am interested in my hon. Friend’s point. As he will have heard in response to an earlier question, we are already increasing access to NHS dentistry, with a 0.75 million increase in the space of a year. In fact, it is probably possible to address more effectively some of these questions of access to dentistry through a consistent national contract that can be responded to locally through the work of the health and well-being boards, which will be able to make their own recommendations through the joint strategic needs assessment.
Yvonne Fovargue (Makerfield) (Lab)
T4. Given that the UK has the worst one-year and five-year survival rates for lung cancer compared with Australia, Canada, Norway, Sweden and Denmark, as has been highlighted today by the Roy Castle Lung Cancer Foundation report, what measures is the Secretary of State taking to improve the detection of lung cancer symptoms in primary care?
Mr Lansley
The hon. Lady will know that we are focusing, as I said in response to an earlier question, on improving survival rates at one and five years for lung cancer, among other cancers. One essential task is to improve public awareness of the symptoms of lung cancer, and we are already piloting means by which we can do that. At the same time, there have been research trials on the effectiveness of X-ray screening for lung cancer, and we will look at the results shortly.
Mary Macleod (Brentford and Isleworth) (Con)
I have been contacted by a constituent who has just graduated in dentistry but has been unable to find a placement for his dental foundation year. What support are we giving such students so that we increase access to NHS dentistry?
Mr Lansley
I understand that more dentists are currently employed in the UK than ever before. My hon. Friend makes an important point and if she is able to provide further details, I will pursue it, because one objective of deaneries should be to ensure that the major investment that we put into the initial education of dentists is followed through in professional training.
Anas Sarwar (Glasgow Central) (Lab)
T5. Some 3,500 residents at 98 Southern Cross care homes, including 48 residents at Arcadia Gardens in my constituency, are facing an uncertain future. The Scottish Government have today said that they will work on the presumption that those people will still be in their homes after this crisis. What discussions has the Secretary of State had with Scottish Ministers about finding new operators and a solution that does not show complacency, but delivers continuity of care for the residents?
Andrew George (St Ives) (LD)
It is acknowledged that the rising rates of norovirus are worse where there is a shortage of acute hospital beds. How does the Secretary of State square the understandable desire to get on top of hospital-acquired infections with his zeal to reduce acute hospital beds?
Mr Lansley
I am grateful to the hon. Gentleman. He will understand that each hospital trust or acute trust must be responsible for ensuring that there is not an excessive length of stay for patients and that it has the ability to isolate patients if necessary. Norovirus is one circumstance in which trusts often have to open additional capacity. In my experience of hospitals, that is precisely what is generally done. There is an ability to open new capacity if necessary when norovirus strikes.
Mrs Jenny Chapman (Darlington) (Lab)
Consulting on changes to health services is not an easy thing to get right. I think that the Secretary of State would agree with that. Will he undertake to look at the consultation taking place in County Durham and Darlington on acute stroke services, because I and the local council believe it to be misleading?
Mr Lansley
I will, of course, look at that consultation, with which I am not directly familiar. The four tests that I set out shortly after the election—understanding patients’ current and prospective choice; understanding what is demanded by clinical safety and evidence; understanding the view of the public, as represented through the local authority; and understanding the intentions of commissioners, particularly the clinical commissioning groups that are being established—give a much stronger basis for understanding future configuration decisions.
Stephen Metcalfe (South Basildon and East Thurrock) (Con)
I am sure that my right hon. Friend is aware of the campaign group Transplant 2013, which aims to increase the number of people on the organ donor register by 60% by 2013. Will he join me in encouraging people not only to sign up to the register, but to discuss that action with their families, so that when the time comes their whole family is aware of their wishes?
Mr Lansley
Yes, I join my hon. Friend in that. I have signed up to the organ donor register and have discussed that with my wife so that she knows my wishes. I encourage others to do the same. In the last few days, I have been to the retirement event of John Wallwork, who was the first surgeon to undertake a successful heart and lung transplant in this country. He has led the charitable activities on transplant over recent years. I know that he would share our desire for more organs to be available for this vital activity.
Grahame M. Morris (Easington) (Lab)
Has the Secretary of State had an opportunity to pause, reflect and listen to the NHS foundation trusts, particularly North Tees and Hartlepool NHS Trust, which serves part of my area, given the uncertainties created by the Health and Social Care Bill and the difficulties that they are encountering in raising capital for new build and modernisation? In particular, will he indicate what consideration he has given to detailed safeguards?
Kerry McCarthy (Bristol East) (Lab)
The number of patients waiting more than four hours in A and E went up by 76% in the past year, which is an extra 200,000 people. I think we all know what a hellish experience waiting in A and E can be. Does the Secretary of State agree that that is a backward step, and that he ought to take steps to rectify it?
Mr Lansley
Shortly after the election we took clinical and expert advice that made it very clear that the expectation that 98% of patients should be seen within four hours was not clinically appropriate in some cases, so we relaxed the 98% limit to 95%. As it happens, I believe that according to the latest data, between 97% and 97.5% of patients are being seen in under four hours.
Jo Swinson (East Dunbartonshire) (LD)
Hospital admissions for food allergy went up by 500% between 1990 and 2006, and there are 15 million hay fever sufferers, which has a real impact on productivity, so we urgently need better allergy services. When will the Government report on the pilot in the north-west of England of a new model of allergy services?
Mr Lansley
I fear that I do not know when that will be available, but I will certainly write to the hon. Lady. I have visited the allergy unit at Addenbrooke’s hospital in my constituency, and I know how effective, and indeed cost-effective, such work can be in treating allergies.
Health Act 2006 (Post-legislative Assessment)
Lord Lansley Excerpts(12 years, 10 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I have today laid before Parliament “Post-Legislative Assessment of the Health Act 2006”, Cm 8115, the Government’s memorandum to the Health Select Committee, which provides a preliminary assessment of the Health Act 2006. The main purposes of the Act are to ensure protection from the health dangers of second-hand tobacco smoke; to provide a statutory footing to reduce levels of health care associated infection; and to provide for safer management of controlled drugs, and improvements to pharmacy and ophthalmic services, as well changes to the administration of the NHS.
Copies of the memorandum are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Queen's Ambulance Service Medal
Lord Lansley Excerpts(12 years, 10 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I am pleased to be able to inform the House that Her Majesty the Queen has graciously approved a proposal for the issue of a Queen’s Ambulance Service Medal (QAM) to recognise distinguished service by the ambulance service. I am laying before Parliament a Command Paper, Cm 8140, instituting the QAM.
Further information on the criteria for eligibility, along with details on how to nominate individuals for the medal, has been placed in the Library.
Copies of all documents are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. They are also available at:
www.dh.gov.uk/en/Healthcare/urgentandemergency care/DH_113435.
Reform of Social Care
Lord Lansley Excerpts(12 years, 10 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
With permission, I wish to make a statement on the reform of social care.
The coalition Government have from the outset recognised that reform of the care and support system is needed to provide people with more choice and control and to reduce the insecurity faced by individuals, carers and their families. By 2026, the number of people over 85 years old is projected to double. Age is the principal determinant of need for health and for care services. It is further estimated that in 20 years’ time, 1.7 million more people will have a potential care need than do today.
People often do not think about how they might meet the costs of care in later life. They assume that social care will be provided free for all at the point of need, but since the establishment of the welfare state that has never been the case. Currently, people with more than £23,250 in assets, often including their home, face meeting the whole cost of care themselves.
The cost of care can vary considerably and it is hard for people to predict what costs they may face. The average 65-year-old today will face lifetime care costs of £35,000, but as the Commission on Funding of Care and Support notes, costs are widely distributed: one in four will have no care costs, but one in four will face care costs of more than £50,000 and for one in 10 it will be more than £100,000. The lack of understanding of how the system works and uncertainty about costs means that it is difficult for people to prepare to meet potential care costs, and there are currently few financial products available to help them. This means that paying for care can come as a shock to many families and have a severe impact on their financial security.
Change is essential. That is why we took immediate action last July by establishing the Commission on Funding of Care and Support, which was tasked with making recommendations on how to achieve an affordable and sustainable funding system for care and support for all adults in England. In response to its initial advice, we allocated an additional £2 billion a year by 2014-15 in the spending review to support the delivery of social care as a bridge to reform. This represents a total of £7.2 billion of extra support for social care over the next four years, including an unprecedented transfer of funds from the NHS to support social care services that will also benefit health.
Since then we have taken forward wider reform. Last November we published our vision for adult social care, setting out our commitment to a more responsive and personalised care and support system that empowers individuals and communities, including the objective that all those who wish it should have access to a personal social care budget by 2013. In May, after three years of work, the Law Commission published its report on how to deliver a modernised statute for adult social care. Making sense of the current confused tangle of legislation to deliver a social care statute will allow individuals, carers, families and local authorities to understand more clearly when care and support will be provided.
Andrew Dilnot’s report comes at the same time as the final report from the palliative care funding review, which I received last week. Tom Hughes-Hallett and Sir Alan Craft have made an excellent start in looking at this complex and challenging issue. We want to see integrated, responsive and high-quality health and care services for those at the end of life. We will now consider the review team’s proposals in detail before consulting stakeholders on the way forward later this summer. We will also consider how best to undertake substantial piloting, as recommended in the report, in order to gather information on how best to deliver palliative care services.
We are also responding to events at Southern Cross, which have caused concern to residents in Southern Cross care homes and their families. We welcome the fact that Southern Cross, the landlords and the lenders are working hard to come up with a plan to stabilise the ownership and operation of the care homes. We have also made it clear that we will take action to ensure proper oversight of the market in social care. That is why we are seeking powers through the Health and Social Care Bill to extend to social care the financial regulatory regime that we are putting in place in the NHS, if we decide that that is needed as part of wider reform.
A central component of those wider reforms will be the long-term funding of care and support. Over the past 12 months Andrew Dilnot, who chairs the Commission on Funding of Care and Support, together with the noble Lord Warner and Dame Jo Williams, has engaged extensively with many different stakeholders. They have brought fresh insight and impetus to this most challenging area of public policy. We welcome the commission’s excellent work and its final report. I would like to thank Andrew Dilnot, Lord Warner and Jo Williams for their work, which has made an immensely valuable contribution to meeting the long-term challenge of an ageing population.
The report argues that people are unable to protect themselves against the risk of high care costs, leaving them fearful and uncertain about the future. The commission’s central proposal, therefore, is a cap on the care costs that people face over their lifetime of between £25,000 and £50,000—it recommends £35,000. Under the commission’s proposals, people who cannot afford to make their personal contribution would continue to receive means-tested support, but it proposes that the threshold for receiving state help for residential care costs would rise from £23,250 to £100,000. People would make some contribution to their general living costs in residential care, but the commission suggests that this should be limited to between £7,000 and £10,000.
The commission also proposes the following standardised, national eligibility for care, which would increase consistency across the country; universal access to a deferred payments scheme for means-tested contributions; improvements in information and advice; improved assessments for carers and better alignment between social care and the wider care and support system; and considering changing the means test in domiciliary care to include housing assets. The commission makes recommendations about how as a society we can organise and fund social care. We will consider the recommendations as a priority.
The commission recognises that implementing its reforms would have significant costs. In the current public spending environment, the Government will have to consider the recommendations carefully against other funding priorities and calls on our constrained resources. 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 intend to engage with stakeholders on those issues, including on the trade-offs involved.
Reform in this area will have to meet a number of tests, including whether the proposals would promote closer integration of health and social care and increased personalisation, choice and quality; support greater prevention and early intervention; whether a viable insurance market and a more diverse and responsive care market would be established as a result of the proposals; what is the level of consensus that additional resources should be targeted on a capped costs scheme for social care; and what a fair and appropriate method of financing the additional costs would be.
The Government have set out a broad agenda for reform in social care. We want to see care that is personalised; that offers people choice in how their care needs are met; that supports carers; that is supported by a diverse and flourishing market of providers; that has a skilled work force who provide care and support with compassion and imagination; and that offers people the assurances they expect of high-quality care and protection against poor standards and abuse. Andrew Dilnot’s report was never intended to address all those issues, but it forms a vital part of that wider agenda.
To take the matter forward, we will work with stakeholders in the autumn, using Andrew Dilnot’s report as the basis for engagement and as a key part of the broader picture. That engagement will look at the fundamental issues for reform in social care, such as improving quality, developing and assuring the care market, integration with the NHS and wider services, and personalisation. We want to hear stakeholders’ views on the priorities for action from the commission’s report and on how we should assess the proposals, including in relation to other priorities for improvement in the system. As the right hon. Member for Wentworth and Dearne (John Healey) and I have discussed, the Government will engage directly with the official Opposition to seek consensus on the future of long-term care funding.
We will set out our response to the Law Commission and the Dilnot commission in the spring. There will be full proposals for the reform of adult social care in a White Paper and a progress report on funding reform. It remains our intention to legislate to this effect at the earliest opportunity. The care of the elderly and of vulnerable adults is a key priority for reform under this Government, and I commend this statement to the House.
John Healey (Wentworth and Dearne) (Lab)
I thank the Health Secretary for the copy of his statement, and for making it to the House himself.
We welcomed the Hughes-Hallett report last week and we welcome the Dilnot report on social care today. The Dilnot report sets out important recommendations on capping the catastrophic costs of care; lifting the wealth threshold for state help; immediate free support for children with care needs on becoming adults; universal disability benefits continuing as now; a standard national needs test; and better information and advice, led by local councils.
The important elements in the Dilnot report are similar to the plans that we set out in government in the care White Paper in March last year. Our concern was and is to protect the one in 10 people who have to pay more than £100,000 for the cost of their care in older age; our concern was and is to protect hard-working people on modest incomes, who are more likely to care for their relatives and a lot less likely to get any help in doing so; and our concern was and is to protect people from the lottery of where they live, rather than what they need, determining their assessment for care and the level of support.
It should be a cause for celebration and pride that one in five of us in this country who are alive today will live to 100, and that our children are likely to spend a third of their lives in retirement. Instead, too many of us approach our older age in fear—fear that we will need care that will not be there; fear that our savings will be wiped out by the open-ended costs of care; fear that we cannot protect our families from that risk; and fear of becoming a burden or being left alone.
Today’s report from Andrew Dilnot is a starting point, but it is what the Government do with it now that counts. My right hon. Friend the Leader of the Opposition has made a big offer to the Prime Minister to put politics aside and work to see a better, fairer and lasting system of support for our older and disabled people in England. Labour is willing to talk to and work with the Government and all other parties to do so, because we know that any new system of care must give all of us long-term confidence about what will be on offer for us and our families as we plan and prepare for older age.
That requires the Prime Minister to give the lead, because discussing and agreeing an affordable, sustainable system and how we pay for it involves important parts of Government beyond the Health Secretary. It requires the Prime Minister to give a guarantee that the Government will not kick Dilnot’s recommendations into the long grass, because as Dilnot says, the system needs “urgent and lasting reform”. If the Government are serious, we are serious; and if they are serious, we need to hear more. Dilnot recommends a White Paper by December this year, so why are the Government already saying that it will be spring before publication?
Any solution is a solution only if it is available and affordable to everyone, so what assurance can the Government give that the voluntary insurance protection will be an option for all? Dilnot states that the current system is
“under extreme strain, and people are experiencing tightening eligibility and reduced care packages.”
Do the Government accept his conclusion that additional public funding for the means-tested system is urgently required?
The corporate crisis at Southern Cross is causing extreme anxiety for many people living in its homes. Do the Government accept that there is a case for regulating business standards as well as care standards, to give people greater confidence in their care?
The Secretary of State said that he would engage directly with me. I thank him, but this is a big challenge not just for him but for the Chancellor and the Prime Minister. Will the Government accept that cross-party talks are required across Government? This is a once-in-a-generation chance, and the House and the public will need to hear from the Prime Minister himself to believe that his Government are determined, as we are, to build a better, fairer and lasting system of care in our country.
Mr Lansley
I am grateful to the right hon. Gentleman for the welcome that he gives to the report by Andrew Dilnot and his colleagues, and indeed to the report that Tom Hughes-Hallett and Alan Craft produced on palliative care. They are both immensely valuable.
The right hon. Gentleman rightly says that it is important for us to move beyond many of the suggestions that have been made in the past. One of the essential purposes of the Dilnot commission was to seek something that was affordable and sustainable, that met tests of choice, fairness, value for money and ease of understanding, and that would be sustainable for the longer term. Dilnot has responded immensely well to the issues that we put to him, but that is part of a broader process of reform. In that sense we have not waited for Dilnot, because we have made progress on the wider aspects of reform. Now we have to ensure that we bring them together in a way that is coherent and works to deliver long-term, sustainable reform across the whole social care sphere.
The right hon. Gentleman rightly points to the fact that we inherited a fragile system in which there had already been a substantial tightening of eligibility and loss of care and support, with increasing levels of unmet need. That was precisely why, in an interim report last year, Andrew Dilnot and his colleagues asked us to make additional resources available in the spending review. I set out in my statement precisely how we have done so.
The concerns in relation to Southern Cross are particular to that company, and the Minister of State, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), has made clear to the House how we are interacting with those who are involved with the company. We are making it very clear to the public—I reiterate it today—that we are prepared to act to secure the interests of individuals if there were any threat to their position in care homes. We are working with the Association of Directors of Adult Social Services and local authorities to ensure that those contingencies are in place. What I said today in the statement, and which people have not previously recognised, is that as early as last year we set out in the Health and Social Care Bill that we were prepared for regulatory powers to be available to ensure the future viability of social care providers, as we intend to do in relation to health care providers.
Let me may make one final point. I believe that my statement makes it absolutely clear that we will engage on the basis of the Commission on Funding of Care and Support, and that we will do so on a timetable that will work and that gives stakeholders and the public, and indeed the Government and the Opposition, an opportunity to come forward with a consensus. I discussed that timetable with Andrew Dilnot, and he is clear that he supports it. It will lead to a White Paper in the spring and an associated progress report on funding reform. I am clear that that assures stakeholders that we will take this forward as a priority.
Sarah Newton (Truro and Falmouth) (Con)
I very much welcome the report and the Secretary of State’s statement. It was the previous Government who kicked the fixing of our broken care system into the political long grass. Will my right hon. Friend reassure me that we will work with all parties in both Houses to find a lasting solution?
Mr Lansley
Yes, I agree with my hon. Friend. That is indeed what we will set out to do. There have been many false starts, and not just under the previous Government. It is important for us to make progress, and for us to do so on a basis that is sustainable for the longer term.
Meg Munn (Sheffield, Heeley) (Lab/Co-op)
The Secretary of State will be aware that all sorts of new and innovative ways of caring for elderly and disabled people are developing. The terms “domiciliary care” and “residential care” will become obsolete as services are provided in different ways. Will he ensure that whatever funding mechanism is being developed does not limit the type of services that can be provided, because providing for elderly people to be cared for in their own homes and in settings where they can live in a more normal way will be enormously important in future?
Mr Lansley
The hon. Lady very well illustrates one reason why Andrew Dilnot’s commission is, among its recommendations, looking to eliminate discrimination between residential and domiciliary care services. We should not have a system that tends to provide perverse incentives to go into residential care, or indeed one that prevents that from happening when it is the right thing. However, part of the reason why the Dilnot commission should be seen in its wider context is that we are looking towards innovative and more effective means of supporting people’s independence at home. The Department is now looking towards the evaluation of the telehealth whole system demonstrator pilots, the world’s largest randomised controlled trial of telehealth, which should come in a matter of weeks.
John Pugh (Southport) (LD)
Will the Secretary of State acknowledge that it will be easier to get agreement on the principles underlying the proposals than on the mathematics and the cost? Does he agree that only a renewed NHS focus on the chronic diseases of old age will ultimately make the latter bearable?
Mr Lansley
My hon. Friend is absolutely right. Although we are looking to ensure that we have a sustainable system of social care and support both for social care and the NHS, the linked priority of our Department and our Government is to improve and increase the effectiveness of our public health services. That is why I was this morning with the Faculty of Public Health to discuss precisely how we can improve health planning at local level, not least with local government, to try to reduce the prospective burden of disease in future.
Mr David Blunkett (Sheffield, Brightside and Hillsborough) (Lab)
As a vice-president of the Alzheimer’s Society, and like many hon. Members, I am aware that it is dementia awareness week. The most enormous resource is needed to help both individuals and their carers, particularly with residential support. Is not my hon. Friend the Member for Sheffield, Heeley (Meg Munn) entirely right to draw attention to the fact that even within Andrew Dilnot’s acknowledgement of the perverse incentives, there is still an emphasis on the care market and the drive to encourage people to take up, or to consider the option of, residential care? Do we not need to put the glue back by supporting families and neighbourliness, so that we can keep people independent in their own homes as long as is humanly possible?
Mr Lansley
I understand the point that the right hon. Gentleman makes and in the past some of the criticisms of previous proposals have been made because they would have led to a situation in which informal care and family care would not have been properly supported—indeed, there would have been perverse incentives for people not to have family carers. We need to support family carers rather than bypass them.
I am glad that the right hon. Gentleman raises the issue of dementia. It is tremendously important that we understand it is one of the principal reasons for such a rising burden of disability and requirement for care and support. It is why we are looking to the longer term, not least to improve research into dementia. I am grateful to the Minister of State, my hon. Friend the Member for Sutton and Cheam, who has chaired the work on research into dementia, and he was able to announce substantial additional funding to support dementia research just the week before last.
Oliver Colvile (Plymouth, Sutton and Devonport) (Con)
I declare an interest as I have an elderly step-mother who is in a home and this will be very important news for her family and my family. Have there been discussions with the Treasury, and does it recognise that this is one of the key issues? How far have those discussions reached, or if they have not started, when will they do so?
Mr Lansley
My hon. Friend will be pleased to know that the statement I have made is the product of collective discussion, which of course fully involved the Treasury.
Mr Dennis Skinner (Bolsover) (Lab)
Does the Secretary of State agree that it would be a big mistake to miss this opportunity for root-and-branch change of the present system? Would it not be handy if local authorities played a bigger role than the billionaires who run Southern Cross, Winterbourne and the rest? Would it not also be nice for him to acknowledge that when he blurted out about the death tax he got it all wrong?
Mr Lansley
On the hon. Gentleman’s point about local government, he should remember that the overwhelming majority of the residents in Southern Cross care homes are funded by local authorities, and that is precisely why we are working with local authorities to ensure that those residents’ interests will be protected. I recognise the problems that we have seen with Southern Cross, although I do not know of any other companies in a similar position. None the less, it is one of the reasons why we seek the powers in the Health and Social Care Bill to regulate social care provision in the same way as health care provision.
Mrs Anne Main (St Albans) (Con)
If we are to see elderly and disabled people needing more carers, my right hon. Friend will need to work with the Secretary of State for Education to enhance the status of those who work in the care industry, because we will need far more people willing to work in it and with the skills, qualifications and commitment needed to give the enhanced care that people would like to receive.
Mr Lansley
I am grateful to my hon. Friend. During the engagement that we are undertaking, one of the areas that we should certainly pursue is the work force development strategy in relation to care and support—and we will do that.
Mr Ronnie Campbell (Blyth Valley) (Lab)
Can the Secretary of State tell us why one part of the UK gets care free and the other has to pay? Is it because the other part—Scotland—pays more taxes?
Oliver Heald (North East Hertfordshire) (Con)
I welcome the fact that the Secretary of State has gone wider than the Dilnot report today. It was at least two years ago that the Commission for Social Care Inspection, the regulator, called for wider powers to deal with financial regulation, and it is very welcome that that is to happen. Does my right hon. Friend agree that the level at which the cap is set under the Dilnot regime will be important in deciding whether an insurance market can develop? If it is set too low, the risk that is being shared will not be great enough, and if it is set too high, it will be too expensive.
Mr Lansley
I am grateful to my hon. Friend. That is precisely why we drafted the Health and Social Care Bill in the way we did. I hope that people will bear that in mind when debating the need for, and appropriateness of, this further regulatory measure. He made a perfectly valid point, and it is one reason we need to ensure engagement. It is not only a matter of whether the insurance and financial services industry would respond: along with stakeholders and the public, we need to understand what the public’s attitude would be were they to have greater clarity about potential care costs and if they were willing to engage with financial services products in meeting those care costs. If they were, significant benefits would be derived, not least through bringing additional resources to bear and through creating organisations with a direct incentive to undertake more prevention.
Jack Dromey (Birmingham, Erdington) (Lab)
Dilnot offers a new dawn but not for three years, and in the meantime the fabric of social care is coming apart at the seams because the Government have imposed a 28% cut on local government, leading to such councils as Birmingham cutting care all over England. Will the Secretary of State act now to ensure that in the meantime the elderly and the disabled get the support that they deserve and which any civilised society should provide?
Mr Lansley
The hon. Gentleman should be aware that the maximum reduction in local authorities’ spending power this year compared with last year is 8.8%. We removed the ring fence from Department of Health social care grants but we did not reduce the scale of those grants. In addition, he must remember that, as is not always recognised, the NHS is making specific provision to support social care. This financial year, £150 million will go to support reablement, and £648 million will be transferred, as I said, to support social care, which will also have health benefits. That will be spending power in the hands of local authorities to support adult social care.
Margot James (Stourbridge) (Con)
I welcome the Dilnot proposals, but does my right hon. Friend agree that he should resist the demands from the shadow Health Secretary to rush into a White Paper this side of Christmas? It is more important to get it right, and there may well be ways to improve on the Dilnot proposals, particularly with regard to the cap and by making provision more affordable and fairer.
Mr Lansley
My hon. Friend makes a fair point. It was clear that had we sought to publish a White Paper before Christmas, the net effect would have been that we did not give the public, stakeholders or the official Opposition the time needed to discuss the issue and to do the job properly .
Barbara Keeley (Worsley and Eccles South) (Lab)
It is clear that there are two issues: not just the future funding of social care but the current funding—the crisis referred to by my hon. Friend the Member for Birmingham, Erdington (Jack Dromey). Only 15% of councils are now meeting moderate need, but that figure used to be 50%. The Secretary of State cannot say that there is no crisis. It seems to me that building a future funding solution rests on not letting current provision deteriorate much further—but it is deteriorating rapidly. What, then, will Ministers do beyond the excellent cross-party work that probably will go forward to do something about the resources that are leaking away and the current crisis in provision?
Mr Lansley
I do not believe I did say that there was no crisis. The hon. Lady and the House must recognise, however, that last year the Dilnot commission, in an interim report, sought additional support specifically for social care and that we provided it through the local government grant and a transfer of resources from the NHS. She says that few authorities now provide social care for those with moderate needs, but that has been the product of years of change—it has been happening for many years. That creates a risk, but we are addressing that risk through the transfer of NHS resources and by helping people with lower levels of need through home adaptations, community equipment and reablement if they leave hospital, in order to make certain that we avoid the risk that we are running: of large numbers of people with moderate need falling rapidly into severe need.
Dr Sarah Wollaston (Totnes) (Con)
I understand the need for the timetable to allow for adequate consultation, but Andrew Dilnot’s excellent report draws attention to several areas including a lack of transparency, a lack of information available to families making decisions about care homes and, in particular, a lack of portability, which results in many patients being trapped and unable to move closer to loved ones. Does the Secretary of State feel that he could expedite any of the report’s recommendations to allow such proposals to receive more detailed consideration?
Mr Lansley
I entirely understand my hon. Friend’s point. In the course of the engagement during the latter part of this year, some of those issues will certainly come to the fore. My colleagues and I felt that it was better for us not to cherry-pick Andrew Dilnot’s report now, but rather for us to give people an opportunity to comment on the recommendations in full. That will, however, take place over the space of weeks rather than many months.
Emma Reynolds (Wolverhampton North East) (Lab)
I should remind Government Members that this issue has already been delayed because the Conservatives broke ranks before the election in order to score political points. However, there is now cross-party support for the recommendations, so why has the Secretary of State let the timetable slip from the autumn to next spring? Can he reassure the House and the country that there will be no further slippage in the timetable?
Mr Lansley
I am afraid that I do not accept the hon. Lady’s premise. I am not going to revisit the past, but the truth is that, since I became directly involved, I initiated cross-party discussions before the election on the reform of social care, and I did not leave those discussions. It was her former Prime Minister who effectively broke them down.
Tony Baldry (Banbury) (Con)
I think everyone knows where we want to get to on palliative care. We want to provide those people who want it with a much better opportunity to die at home or to die in a hospice while being properly cared for and supported. How does my right hon. Friend see us getting from here to there? What process will be involved, and who is going to drive that process to improve palliative care?
Mr Lansley
I am grateful to my hon. Friend for his question. This is very much about ensuring that, at the same time as engaging on the palliative care report, we build pilots that will enable us to see how the proposals would work in a number of places across the country. I know that some areas of the country are ready and willing to do that. The essence of what we are doing is to be increasingly clear about what quality services for those at the end of their lives look like, and to be sure that we can integrate those services by developing a system of per-patient funding. That would enable the providers to work together within the funding framework, without the current constraints and demarcations, and without the silo system that currently divides palliative care and end-of-life care services in a way that makes the system immensely confusing and difficult for people at the end of their lives. This is a real opportunity that has been fashioned by Tom Hughes-Hallett and Alan Craft’s report.
Alison McGovern (Wirral South) (Lab)
Funding for care is clearly a hugely important issue, but so is the quality of the care that older people receive. The parliamentary ombudsman and even the Financial Times have reported the need for greater respect and dignity for those receiving care. When will the Secretary of State return to the House and inform us in detail of the standards of care that older people can expect?
Mr Lansley
The hon. Lady will know that we are continuously seeking to improve the standards of care that older people receive, and, in so doing, we sometimes have to tackle what are clearly serious abuses. In the wake of the Winterbourne View events, for example, we will bring forward a report to Parliament on standards and the means by which they are to be met. With regard to hospital care, it was I who asked the Care Quality Commission to undertake specific unannounced nurse-led inspections to look at dignity and nutrition. We will work continuously to ensure that we deliver the standards of care that people have a right to expect.
Nick de Bois (Enfield North) (Con)
My right hon. Friend might be aware that more than 100,000 people a year are not receiving the palliative care that they need. Can he assure the House that that will be a key priority, following the issue of this report?
Mr Lansley
My hon. Friend is right. I very much welcomed and encouraged the dialogue that took place between Andrew Dilnot’s team and Tom Hughes- Hallett’s team, and they have made complementary recommendations. My hon. Friend is absolutely right to say that, as far as end-of-life care is concerned, there is widespread unmet need. The disparity in the quality of care and the services provided in different parts of the country is staggering. Just as the Dilnot commission deals with care and support, we certainly aim to deliver greater consistency in eligibility and in the quality of care provided.
Mr Jim Cunningham (Coventry South) (Lab)
I am sure that the Secretary of State is aware that there are concerns nationally—and locally in Coventry—about Southern Cross. Can he be more positive, because so far the answers we have received from the Government have been very vague? Equally, there is concern about the regulator being undermanned, so how does he intend to improve that and improve the quality of care?
Mr Lansley
I am sorry if the hon. Gentleman feels that the Government have been anything other than absolutely clear about what we are setting out to do. This is a problem that derived from the commercial decisions that the company made and it should be resolved by further commercial discussions between the company, its landlords and its lenders. We are constantly in touch with all of those, but it is not the Government’s responsibility to step in and take those decisions. What is the Government’s responsibility, which we are clear about and ready to take action as necessary, is to ensure that individuals in those care homes and their families are not abandoned and do not fall through the gaps or find themselves without access to the care and support they need. I hope that, in the midst of the perfectly legitimate concerns being expressed, people do not stray into causing people to be more fearful than they need be.
Mr Marcus Jones (Nuneaton) (Con)
Will my right hon. Friend confirm that the Government are taking the action necessary to ensure that residents in Southern Cross care homes, such as Harmony house in my constituency, will not be left without the care that they need?
Mr Lansley
My hon. Friend is absolutely right. I have a Southern Cross care home in my constituency and I am sure that most Members do. We cannot know precisely how the commercial discussions will turn out, but what we can be sure about is that we have put together with the directors of social services in local authorities clear contingency plans to protect the residents if need be.
Mr Dave Watts (St Helens North) (Lab)
The Secretary of State will be aware that many people both inside and outside the House believe that this matter is going to be kicked into the long grass by the Government. Can the Secretary of State set out the time scales for the consultation process and for the introduction of the legislation that will be needed?
Mr Lansley
Many people would therefore be wrong in that respect, because we are clear about taking this report forward as the basis for engagement in the autumn, publishing a response and carrying out other related work on palliative care in the spring, publishing a White Paper and a progress report on funding reform and legislating at the first available opportunity thereafter.
Julian Sturdy (York Outer) (Con)
Through the broad principles of the Dilnot report and the work already carried out by the Government, we at last have a framework that we can work towards to bring security, dignity and fairness back to elderly care, which I believe is really important. Will my right hon. Friend assure us, however, that we have a sensible and workable time frame within which to deliver?
Mr Lansley
My hon. Friend is absolutely right. At the heart of this, we know that additional resources have to be brought to bear and that given the financial circumstances we face, we also know that this will have to be a partnership between taxpayers, families and individuals—it cannot simply be handing costs over to the state. Although Andrew Dilnot makes no specific recommendations about how to pay for his proposals, he is very clear that even if it were to be through a tax mechanism, he believes it should come from an existing tax and should bear particularly on the same groups of older people rather than be a further intergenerational transfer from working age adults. What that immediately points to is the necessity of engaging fully with some of the stakeholder groups such as Age UK and others and of engaging properly with the public so that before we embark on this major reform, they can feel confident that they understand those trade-offs and precisely how these costs are to be met.
Catherine McKinnell (Newcastle upon Tyne North) (Lab)
The increased availability of care at home is to be welcomed, but it also poses increased challenges for safeguarding vulnerable adults. Given that personal budgets can be spent on unregistered and therefore unregulated care providers, what steps will the Secretary of State take to ensure that taxpayers money can be spent only on good quality and safe care provision where the rights of care workers are also fully respected?
Mr Lansley
The hon. Lady makes a number of important points. As the Minister of State, my hon. Friend the Member for Sutton and Cheam, made clear recently, one purpose of legislation in due course will be to put the safeguarding on a statutory basis, which is important. Working with the CQC, we must ensure that in domiciliary care as well as in residential care homes, mechanisms are in place that enable us to assess the quality of care and get feedback from residents. The social care outcomes framework must be developed in a way that captures an understanding of the experience of care users, their families and supporters.
Nicky Morgan (Loughborough) (Con)
I thank the Secretary of State for his statement and I welcome the Dilnot review. As other Members have said, however, hundreds of thousands of families across the country are already worrying about how they will pay for care bills for their relatives, including the Strachan family in my constituency, who said publicly this morning that they have only two months’ money left to pay care home bills and are not sure what they will do after that. When my right hon. Friend launches the consultation, may I urge him not to forget the needs of those already in the care system who are worrying about paying bills, as well as being rightly concerned about those facing future care bills?
Mr Lansley
My hon. Friend’s point relates to the degree of uncertainty and insecurity that the current system tends to engender. It is important that we deal with that, and that people understand the circumstances in which the state pays and will continue to pay. We should not give people who have no assets the sense that they will be required to pay when they have no means of doing so. The state will be there to support them. There will be a safety net, and the commission makes recommendations about how further to develop it in future. Beyond that, we must arrive at a place where people are able to understand better the nature of the care costs that they might meet, and where there are good, affordable, secure mechanisms through which they can prepare for those costs, so that they do not have the gross insecurity that exists at the moment.
Mr David Nuttall (Bury North) (Con)
Does my right hon. Friend agree that improved palliative care will be enormously helpful to those of us who wish to resist the calls for the legalisation of euthanasia, and that a reduction in the number of deaths in hospital could save tens of millions of pounds each year for reinvestment in patient care?
Mr Lansley
I share with my hon. Friend the feeling that if we can improve the quality of end-of-life care and give people an understanding of the recent great developments in symptom control at the end of life, people’s perception of the decisions that they might have to make about end-of-life care might change, and that might give them greater confidence that they can have what most people would regard as a good death.
Anne Marie Morris (Newton Abbot) (Con)
I welcome the Dilnot report’s many practical suggestions, which will be very important in Devon because it has the highest level of retired people—22%. With regard to the need for any new funding proposal to cover a range of different provision, given the change in relation to when people need to go into residential care, the contracting will need to be looked at carefully. Does the Secretary of State agree that if we are to have contracts, they need to be standardised? For example, the contracts that councils enter into with care homes are not standard, so although in theory they offer the same quality of care—
Mr Speaker
Order. I am extremely grateful to the hon. Lady, but I think that that is an excellent subject for her to pursue in an Adjournment debate, and I feel sure that she will.
Mr Lansley
There is the nub of a very good question there. If we develop greater national consistency in eligibility and in assessment, we might also start to engender greater consistency in quality, including the contracting that supports it.
Bob Stewart (Beckenham) (Con)
My local borough, Bromley, tries very hard to use its resources for social care as efficiently as possible. Might boroughs such as Bromley and others throughout the country be given more resources to help them to ring-fence funds for social care, particularly palliative care?
Mr Lansley
As my hon. Friend will know, local authorities were keen for many of the grants that we provided not to be ring-fenced in future, including the social care, public health and learning disability grants. We aim to give local government more flexibility, but, through the NHS, we are providing additional resources—in Bromley and elsewhere—to support preventive interventions that benefit both social care and the NHS, and I think that that will make a big difference in Bromley. As we know, however, all local authorities are, of necessity, having to seek greater efficiencies, and we are working with local government to identify where they can be delivered. There is still a dramatic variation between the costs of care services provided in different parts of the country.
Charlie Elphicke (Dover) (Con)
As we know, going into a home is long on cost but short on life expectancy. I particularly welcomed my right hon. Friend’s comments about greater prevention. What more can be done to promote access to—and promote in general—day care and respite care?
Mr Lansley
We have made specific additional provision to support respite care. I hope that people will be given more independence and support at home not only as a result of NHS support—the £648 million that will be provided this year is a great deal of money, which will substantially increase access to such facilities as community equipment, home adaptations, reablement and rehabilitation —but through, for instance, telehealth, which I mentioned in response to an earlier question. I think that we can transform the quality of care and health services provided at home.
Christopher Pincher (Tamworth) (Con)
Because Haunton Hall nursing home in Tamworth is owned by Southern Cross, its fate is of grave concern to residents and their families. Will my right hon. Friend confirm that any advice he receives from the regulator about companies such as Southern Cross, which the Labour party unfortunately ignored, will not go unheeded by him?
Mr Lansley
In the past, Governments received advice from the regulator about the desirability of their being able to undertake proper scrutiny of the financial circumstances—the financial viability and sustainability—of organisations. No powers in that regard have been taken in the past, but we are seeking such powers in the Health and Social Care Bill, and one of the debates that we will need to have concerns the extent to which it will be right for us to use them in the future.
Mr Philip Hollobone (Kettering) (Con)
How will the Secretary of State ensure that the very best examples of the hospice movement, such as Cransley hospice in Kettering, can become involved in the establishment of the new framework for palliative care, so that best practice is extended throughout the country?
Mr Lansley
As my hon. Friend will know, Tom Hughes-Hallett, the chief executive of Marie Curie Cancer Care—who is leading the palliative care review—has engaged fully with Help the Hospices and the hospice movement. I understand from my conversations with hospice representatives over a number of years that they do not want their funding to be subject to the vagaries of public expenditure. Individual block grants that vary from year to year give them no confidence about the services that they provide. They do not want additional resources as much as clarity about what resources will be provided for the individuals who seek their care. They particularly hope that there will be a corresponding transfer of resources to hospices which provide services that replace the NHS and support people at home, as many are increasingly doing.
Graham Evans (Weaver Vale) (Con)
I have four Southern Cross homes in my constituency. Does my right hon. Friend agree that the Southern Cross situation highlights the need for a dedicated financial regulator for social care services?
Mr Lansley
As I said earlier, this is one of the issues on which I hope we will have further discussion as part of the debate on wider social care reform leading to the White Paper.
Jason McCartney (Colne Valley) (Con)
End-of-life care is massively enhanced by Kirkwood hospice in my part of west Yorkshire, and the construction of a new children’s hospice has just begun on the outskirts of Huddersfield, funded by the West Yorkshire Forget Me Not Trust. Does my right hon. Friend agree that when considering the hospice movement in our country, we must always remember the children’s hospice movement?
Mr Lansley
My hon. Friend is absolutely right. The children’s hospice movement has done immensely good work over the years. I am aware of that in my own constituency through the work of East Anglia’s Children’s Hospices, and I am sure many Members also completely understand. That movement’s work has been done in circumstances in which a very small proportion of the resources for children’s hospices comes from state sources. The palliative care funding review addresses both adult’s and children’s end-of-life care and palliative care and identifies per-patient funding for children as well as adults, and it therefore offers children’s hospices precisely the same kind of security in the future as adult hospices.
Paul Uppal (Wolverhampton South West) (Con)
Does my right hon. Friend agree that the Dilnot report goes some way to addressing the long-standing issue that for many years the current system has been punitive to those who have been prudent and frugal in planning for their old age?
Mr Lansley
Yes I do, and one of the essential reasons why the Dilnot commission was rightly established is that there are many people who have worked hard, saved and accumulated assets and expected to be able to enjoy them in their older age or to pass them on to their families, but who instead found that all those assets were destroyed as a result of the sheer chance event of, for example, long-term disability or dementia. That is a tragic situation, and as Andrew Dilnot well puts it, if people have a health care need and are seriously ill the NHS will look after them, and if their house burns down or they have a car crash there is insurance for that, but here we have a potential catastrophe in people’s lives for which the state will not provide and nobody else is willing or able to offer them that similar kind of protection. It is therefore vital that we take forward the Dilnot recommendations in the way we are proposing.
David Rutley (Macclesfield) (Con)
I welcome the statement, and it is particularly welcome in Cheshire east where we anticipate a 120% increase in the number of people living beyond 85 in 10 years’ time. The Dilnot report stresses the importance of the awareness campaign. Does my right hon. Friend envisage an active role for third sector organisations such as Age UK and Citizens Advice not only in delivering the awareness campaign, but in helping to shape it, and is there also a wider role for such organisations within the Dilnot framework?
Mr Lansley
My hon. Friend makes a very good point, and I hope we will be able to take up and develop that during the coming weeks.
Neil Carmichael (Stroud) (Con)
Does my right hon. Friend agree that in a modern, responsive and caring social care system, we need more transparent and effective decision making and improved integration with the NHS, so that the person in need of care can navigate their way around the system?
Mr Lansley
I agree with my hon. Friend, and in his county the early implementation of health and wellbeing boards, which are to be legislated for under the Health and Social Care Bill, will provide precisely that opportunity for the integration of health and social care services.
Andrea Leadsom (South Northamptonshire) (Con)
A constituent of mine who is 61 years old is the full-time carer for both her disabled husband, who lives with her, and her elderly mother, who does not. Since she drew her state pension, she has not been allowed any kind of carer’s allowance. Will my right hon. Friend join me in praising all retired people who do such work, which saves the taxpayer a fortune, and will he look into what we can do to provide more support for such people?
Mr Lansley
I am grateful to my hon. Friend for asking that question, and I will, indeed, join her—and, I am sure, the whole House—in expressing our support for those who care for their relatives. It is absolutely vital work, and we should understand and support it. As my hon. Friend will know, my right hon. Friend the Secretary of State for Work and Pensions is currently reforming welfare, and he has made it clear that although carer’s allowance does not form part of universal credit, it is important for us to continue to understand how it should in future meet its aim of supporting carers.
Mr Speaker
I am grateful to the Secretary of State and all colleagues who participated.
Commission on the Funding of Care and Support
Lord Lansley Excerpts(12 years, 10 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
The final report of the Independent commission on the funding of care and support, “Fairer Care Funding”, has been published today and a copy has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
I shall make an oral statement later today.
Government Response to NHS Future Forum
Lord Lansley Excerpts(12 years, 10 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
As I informed the House on 14 June 2011, the Government have accepted the core recommendations of the NHS Future Forum’s report. A list of the key changes the Government intend to make as a result has already been placed in the Library.
I have today laid before Parliament “Government Response to the NHS Future Forum”, Cm 8113, a detailed explanation of how the Government plan to implement improvements to their plans for NHS modernisation. Some, but not all, of these changes require amendments to the Health and Social Care Bill.
On 16 June the Government tabled a motion to recommit the relevant parts of the Health and Social Care Bill to a Public Bill Committee. The House will debate this motion tomorrow.
I am also laying before Parliament later today “Government Response to the House of Commons Health Select Committee Fifth Report of Session 2010-11: Commissioning”, Cm 8100.
“Government Response to the NHS Future Forum”, Cm 8113 is in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. Copies of “Government Response to the House of Commons Health Select Committee Fifth Report of Session 2010-11: Commissioning”, Cm 8100, will be available later today.
NHS Future Forum
Lord Lansley Excerpts(12 years, 11 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
With permission, Mr Speaker, and further to the written ministerial statement I laid in the House earlier today, I wish to make a statement on the Government’s response to the NHS Future Forum.
We established the independent Future Forum on 6 April, under the chairmanship of Professor Steve Field, to look again at our proposals on the modernisation of the NHS. Yesterday it published its report and recommendations. I would like to thank Professor Field and his 44 senior colleagues from across health and social care who have worked so hard these past eight weeks. I would also like to thank more than 8,000 members of the public, health professionals and representatives from some 250 stakeholder organisations who attended some 250 events across the country—and also the tens of thousands who wrote to us with their views. I want also, if I may, to thank the many officials in my Department who supported this unprecedented engagement across the country.
Two months ago, I said to the House that we would pause, listen, reflect and improve our plans. Our commitment to engage and improve the Bill has been genuine and has been rewarded with an independent, expert and immensely valuable report and recommendations from the Future Forum. I can tell the House that we will ask the forum to continue its work, including looking at the implementation of proposals in areas including education and training and public health.
In his report, Professor Field set out clearly that the NHS must change if it is to respond to challenges and realise the opportunities of more preventive, personalised, integrated and effective care. The forum said that the principles of NHS modernisation were supported: to put patients at the heart of care, to focus on quality and outcomes for patients, and to give clinicians a central role in commissioning health services.
The forum set out to make proposals for improving the Bill and its implementation, to provide reassurance and safeguards, and to recommend changes where needed. As Professor Field put it, it did this not to resist change, but to embrace it, guided by the values of the NHS and a relentless focus on the provision of high-quality care and improved outcomes for patients.
We accept the NHS Future Forum’s core recommendations. We will make significant changes to implement those recommendations and, in some cases, offer further specific assurances that have been sought. There are many proposed changes and we will publish a more detailed response shortly. However, I would now like to tell the House some of the main changes that we will make.
The Bill will make it clear that the Secretary of State has a duty to promote a comprehensive health service, as in the National Health Service Act 1946, and is accountable for securing its provision and for the oversight of the national bodies charged with doing so. We will also place duties on the Secretary of State to maintain a system for professional education and training within the health service, and to promote research.
One of the most vital areas of modernisation to get right is the commissioning of local services. For commissioning to be effective, the process of designing services must draw on a wide range of people, including clinicians, patients and patient groups, carers and charities. We will amend the Bill so that the governing body of every clinical commissioning group will have at least two lay members, one focusing on public and patient involvement and the other overseeing key elements of governance, such as audit, remuneration and managing conflicts of interest. Although we should not centrally prescribe the make-up of the governing body, it will have to include at least one registered nurse and one secondary care specialist doctor. To avoid any potential conflict of interest, neither should be employed by a local health provider. The governing bodies will meet in public and publish their minutes. The clinical commissioning groups will also have to publish details of all their contracts with health service providers.
To support commissioning, the independent NHS commissioning board will host “clinical senates”, which will provide expert advice on the shape and fit of health care across wider areas of the country. Existing clinical networks will be developed and will advise on how specific services, such as those for cancer, stroke or mental health, can be better designed to provide integrated and effective care.
Building on that multi-professional involvement, clinical commissioning groups will have a duty to promote integrated health and social care with regard to the needs of their users. To encourage greater integration between social care and public health, the boundaries of clinical commissioning groups should not normally cross those of local authorities. If they do, clinical commissioning groups will need to demonstrate to the NHS commissioning board a clear rationale for doing so in terms of benefit to patients.
I have always said that I want there to be “no decision about me, without me” for patients when it comes to their care. The same—[Interruption.]
Mr Speaker
Order. Let us hear the Secretary of State’s statement with some courtesy.
Mr Lansley
Thank you very much, Mr Speaker.
We will further clarify the duties on the NHS commissioning board and clinical commissioning groups to involve patients, carers and the public. Commissioning groups will have to consult the public on their annual commissioning plans and involve them in any changes that would affect patient services.
One of the main ways in which patients will influence the NHS is through the exercise of informed choice. We will amend the Bill to strengthen and emphasise the commissioners’ duty to promote patient choice. The choice of any qualified provider will be limited to areas where there is a national or local tariff, ensuring that competition is based solely on quality. The tariff development, alongside a best-value approach to tendered services, will safeguard against cherry-picking.
Monitor’s core duty will be to protect and promote the interests of patients. We will remove its duty to promote competition as though that were an end in itself. Instead, it will be under a duty to support services integrated around the needs of patients and the continuous improvement of quality.
It will have a power to tackle specific abuses and restrictions of competition that act against patients’ interests. Competition will be a means by which NHS commissioners are able to improve the quality of services for patients.
We will keep the existing competition rules introduced by the last Government—the so-styled “Principles and rules for co-operation and competition”—and give them a firmer statutory underpinning. The co-operation and competition panel, which oversees the rules, will transfer to Monitor and retain its distinct identity. We will also amend the Bill to make it illegal for the Secretary of State or the regulator to encourage the growth of one type of provider over another. There must be a level playing field.
We will strengthen the role of health and wellbeing boards in local councils, ensuring that they are involved throughout the commissioning process and that local health service plans are aligned with local health and wellbeing strategies.
In a number of areas, we will make the timetable for change more flexible to ensure that no one is forced to take on new responsibilities before they are ready, while enabling those who are ready to make faster progress. If any of the remaining NHS trusts cannot meet foundation trust criteria by 2014, we will support them to achieve that subsequently. However, all NHS trusts will be required to become foundation trusts as soon as clinically feasible, with an agreed deadline for each trust.
We will ensure a safe and robust transition for the education and training system. It is vital that change is introduced carefully and without creating instability, and we will take the time to get it right, as the Future Forum has recommended. During the transition, we will retain postgraduate deaneries and give them a clear home within the NHS family.
The extension of “any qualified provider” will be phased carefully to reflect and support the availability of choice for patients. Strategic health authorities and primary care trusts will cease to exist in April 2013. By that date, all GP practices will be members of either a fully or partly authorised clinical commissioning group, or one in shadow form. There will be no two-tier NHS.
However, individual clinical commissioning groups will not be authorised to take over any part of the commissioning budget until they are ready to do so. Individual GPs need not take managerial responsibility in a commissioning group if they do not want to, and April 2013 will not be a “drop dead” date for the new commissioners. Where a clinical commissioning group is not able to take on some or all aspects of commissioning, the local arms of the NHS commissioning board will commission on its behalf. Those groups that are keen to press on will not in any way be prevented from becoming fully authorised as soon as they are ready.
I told the House on 4 April that we would secure proper scrutiny for any changes that we made to the Bill. In order to do that without trespassing on the House’s time to review the Bill as a whole on Report, we will ask the House to recommit the relevant parts of the Bill to a Public Bill Committee shortly.
Through the recommendations of the NHS Future Forum and our response, we have demonstrated our willingness to listen and to improve our plans; to make big changes, and not to abandon the principles of reform, which the forum itself said were supported across the service. However, we are clear that the NHS is too important, and modernisation too vital, for us not to be sure of getting the legislation right. The service can adapt and improve as we modernise and change, but the legislation cannot be continuously changed. On the contrary, it must be an enduring structure and statement, so it must reflect our commitment to the NHS constitution and values and incorporate the safeguards and accountabilities that we require. It must protect and enhance patients’ rights and services, and it must be crystal clear about the duties and priorities that we will expect of all NHS bodies and local government in the future.
Professor Field’s report says that it is time for the pause to end. Strengthened by the forum’s report and recommendations, we will now ask the House to re-engage with delivering the changes and modernisation that the NHS needs. I commend this statement to the House.
John Healey (Wentworth and Dearne) (Lab)
I thank the Secretary of State for an advance copy of his statement, although I learned more from the Prime Minister’s press conference than from the statement.
Humiliating! The Health Secretary has had health policy taken out of his hands. He spent the last nine months telling anyone who criticised the Government’s health plans that they were wrong, and that they did not understand. Today, he admits that he is wrong. How can he argue for this latest blueprint for the biggest reorganisation in NHS history with any credibility or integrity? The man who messed up so badly last year is telling us how he will mess up next year too.
Why no apology to NHS patients and staff for the wasted year of chaos, confusion and incompetence? Why no apology for breaking the coalition agreement to stop top-down reorganisations? Why no apology for patients, who are already beginning to see the NHS go backwards again because of this reorganisation? More than one in 10 people now waits 18 weeks for operations, three times the number of patients wait more than six weeks for tests, and casualty waits are at a six-year high.
This is the first Prime Minister who has been forced to ask 45 experts for a report on how to protect the NHS from his own Government’s policies. Now he is reorganising his reorganisation. The Future Forum report yesterday was a demolition job on the Government’s misjudgments and mishandling of the health service. Why is he wasting £800 million on redundancy payments when some of the same people will be re-hired to do the same job? Why is he holding back £2 billion promised for patient care when it could fund 55,000 nurses? Why is he ploughing on with the Health and Social Care Bill when what he announced today could largely be done without legislation, and certainly without the risk and cost of the biggest reorganisation in NHS history?
This is a political fix, not a proper plan for improving care for patients, or for a better or more efficient NHS that can meet the big challenges that it must face for the future. Make no mistake, today’s plans will mean that the NHS is mired in more complex bureaucracy, more confusion and more wasted cost in the years to come. In the battle of spin, with all parts of the divided Government claiming a win, the big losers will be NHS patients. The Opposition and the public will judge the Government on what they do, not on what they say.
I lost track of the bureaucracy that the Health Secretary announced in his statement. Will he admit that this reorganisation creates five new national quangos, set to spend tens of billions of pounds? Will he admit that this reorganisation replaces one local body—the primary care trust—with at least five others, all of which will play a part in commissioning? Will he admit that the plans still cut hospitals loose from the NHS, with no limits on treating private patients while NHS patients wait longer, and no support from the NHS if they run into financial trouble? Will he admit that hospitals will no longer have the protection as a public service from the full force of competition law?
What was a very bad Bill will still be a bad Bill. This House should be allowed to do its proper democratic job, as the only elected House, and scrutinise in full in Committee the whole Bill. At its heart, the Bill will still be the Tory long-term plan to see the NHS set up as a full-scale market, and the NHS broken up as a national public service, so that patients increasingly see the services on which they depend subject to the lottery of where they live.
The public have rumbled the Prime Minister. They know that they cannot trust him with the NHS. Fewer than one in four now trusts him to keep his NHS promises, and more than half believe that the Conservative party’s plans for the NHS are just a way to privatise the health service. Today, the Government have recycled their plans for the NHS when they should have been scrapped. People are right to conclude that they cannot trust the Tories with our NHS.
Mr Lansley
Well, I was hoping that, having got past the abuse, the right hon. Gentleman would tell us whether he agreed with the NHS Future Forum, but he did not even mention it. He welcomed the listening and engagement exercise that we announced—he said it was the right thing and that it would be good government to do it—but then when an independent group of experts reports and makes recommendations, he ignores it and says he will oppose the Bill regardless. He did not listen to what people in the NHS were saying. I think it was shameful how he dismissed everything that has happened over the past year as though it did not matter at all—a year in which the coalition Government said we would increase resources to the NHS. We have done that and are committing to investing an extra £11.5 billion in the NHS over the next four years. That is money that, as we will continue to remind the British public, the Labour party told us we should not give to the NHS.
In the past year, the coalition Government and the NHS across the country have implemented a cancer drugs fund from which 2,500 more patients have benefited, and in the past four months, we have cut the number of breaches of the single-sex rule by three quarters, and the number of hospital infections by 22% and C. difficile infections by 15%. Some 750,000 more people are accessing dentistry, and waiting times for people going into hospital are down compared with March 2010. We said that we would reduce management costs, and we will do so, and we have taken 3,800 managers out of the NHS since the election, while the number of doctors has gone up. Six months ago, the right hon. Gentleman said that he supported the reform principles in the Bill. All he said today was sheer opportunism, but it will come back to haunt him, because the NHS will benefit from the changes we are proposing today. It will take greater ownership of its own service; patients will be empowered; and clinicians across the service will be empowered and will deliver better outcomes for patients, and when that happens, we will be able to say, “The Labour party would have denied the NHS the resources and the freedom and responsibility to deliver those better outcomes.”
Mr Stephen Dorrell (Charnwood) (Con)
Is not the key challenge facing the national health service today the need to reverse a decade of declining productivity bequeathed to us by the Labour party? Does my right hon. Friend agree that his statement today provides the basis for us to do that based on the evolution of effective commissioning engaging the entire clinical community, which will address the fragmentation of service and progress the integration of service around the needs of individual patients?
Mr Lansley
Yes, I agree with my right hon. Friend. It is precisely that process of engaging clinicians, who will come together to design services around the needs of patients in a way that delivers not just improving productivity, but improving quality of services for patients, that is at the heart of the shift from primary care trusts and strategic health authorities. Let’s face it: the Labour party spent a decade presiding over declining productivity, while the costs of bureaucracy and management in the NHS doubled. We will empower people in the NHS to deliver improving services and reduce bureaucracy. [Interruption.]
Mr Lansley
It is slightly confusing, because the right hon. Gentleman’s right hon. Friend on the Opposition Front Bench, the Member for Wentworth and Dearne (John Healey), was just telling us—erroneously—that we could have done this without legislation anyway, but now the right hon. Gentleman is accusing us of proceeding without legislation. It is not true: we are doing things in the NHS by way of changes that are absolutely essential in any case. I have to tell him and the House that sustaining the structure that we inherited from the Labour party, with all the strategic health authorities and all the primary care trusts—this vast bureaucracy— could never have happened. We had to take out administration costs in the service, and empower clinicians and patients, and we are doing it now regardless of whether the legislation has made progress.
John Pugh (Southport) (LD)
I welcome the statement and the change. I have a list here. The Government’s response has satisfied 70% of the demands for change on that list, but it is seemingly not enough—nor can it be enough—because ironically, it is the list of amendments tabled by the Labour party in Committee. Why does the Secretary of State think that it is so hard to build consensus? Given that in many cases the amendments are ones that Labour has asked for, why is the Labour party being so pointlessly churlish?
Mr Lansley
I am grateful to my hon. Friend. There are many things that are beyond many of us to understand. One of them is the Labour party and the way it approaches policy. As he and the House will know, the fact is that the Labour party has no policy; it simply had opposition for opposition’s sake.
Mr Ben Bradshaw (Exeter) (Lab)
In fact, the last Labour Government left record low waiting times and record levels of public satisfaction with the NHS. I welcome the fact that Professor Steve Field has said what many of us in the Opposition have been saying for at least a year. How much has this year’s shambles cost the NHS, and how much has it damaged patient care?
Mr Lansley
It has not damaged patient care. The right hon. Gentleman should not denigrate the NHS. In May 2010, at the last election, patients waiting to be admitted to hospital waited 8.4 weeks for their treatment; on the latest figures, that went down to 7.9 weeks. Out-patient waiting times for May 2010 were 4.3 weeks on average; that went down to 3.7 weeks, and that in the midst of rising demand on the NHS and continuously improving performance.
Dr Sarah Wollaston (Totnes) (Con)
This is clear evidence of a listening Government. Does the Secretary of State agree that what the NHS now needs is consensus across all political parties, and for everybody to put their money where their mouth is and support the NHS and these changes as we move forward?
Mr Lansley
I am grateful to my hon. Friend, who makes a very good point. The Future Forum made the point that what people across the NHS want now is the certainty of knowing what the policy is and to move forward to make that happen.
Alan Johnson (Kingston upon Hull West and Hessle) (Lab)
In view of the NHS Future Forum’s comments about the
“importance and relevance of the NHS Constitution”
in guiding its work, does the Secretary of State accept that the seven principles set out in the constitution were more effective in protecting the NHS from a hostile Government than the Prime Minister’s five pledges?
Mr Lansley
No, I do not accept that. The Prime Minister’s commitments are absolutely what the public and the people working in the NHS expect and wish to see. They are vital, and they would not have been true under a Labour Government. For example, a Labour Government would not have increased resources for the NHS. The only part of the United Kingdom where there is now a Labour Government is Wales, where resources for the NHS are being cut this year by 5% in real terms compared with last year. When I went to north Wales in the middle of the recess, I saw on the front page of the Liverpool Daily Post that the number of patients waiting more than 36 weeks for their operations had risen from 16 to 989.
Mr David Ruffley (Bury St Edmunds) (Con)
I welcome the proposals, but will the Secretary of State give details of the safeguards against cherry-picking of the kind that, if unchecked, could fatally undermine rural district hospitals such as the West Suffolk hospital in my constituency?
Mr Lansley
Yes; we have to ensure that commissioners are increasingly able to use a tariff involving an established national or local price to determine the service that they commission, and that that does not allow the private sector—or anyone else, for that matter—to cherry-pick services by undercutting on price. We also need to ensure that that price reflects the cost of the treatment for the conditions involved, including complex conditions. This is why we have committed to carry out work, not least with the Royal Colleges, to identify where we need to develop tariffs in order to ensure that that happens.
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)
I welcome the statement, not least because it pays tribute to the future of the NHS commission. What is the Secretary of State’s thinking on the forward planning for the commission?
Mr Lansley
If I may, I will interpret the hon. Lady’s question in relation to the NHS Future Forum. I freely acknowledge that I wish that we had instituted the Future Forum after the publication of the White Paper last year. Although we had a full, formal consultation process at the time, to which 6,000 people replied, the character of the engagement that has been achieved over the past two months has been superlative. As we make further progress on the development of education and training proposals, for example, I want to ask the NHS Future Forum to continue that process of engagement in that and other areas across the service.
Mr Charles Walker (Broxbourne) (Con)
I have a great deal of time for most GPs—in particular for the one sitting in front of me, my hon. Friend the Member for Totnes (Dr Wollaston)—but what part of the Bill would allow communities to rid themselves of underperforming GP practices?
Mr Lansley
That would need to be initiated by the NHS commissioning board. Under the legislation, the board would respond to the health and wellbeing board in the local authority in question, or to the local clinical commissioning group. In my hon. Friend’s area of Hertfordshire, the health and wellbeing board will provide a new and powerful means by which the voice of the public can be expressed to challenge all the poor performance that occurs in the service.
Mr Kevin Barron (Rother Valley) (Lab)
The Secretary of State must know that the biggest threat to the stability of the national health service is the introduction of competition law into clinical services. Will the clause that says that the mergers of NHS trusts will be a matter for the Office of Fair Trading and the Competition Commission be removed from the Bill?
Mr Lansley
The right hon. Gentleman should be aware that the Future Forum has recommended that the powers to be held by the Office of Fair Trading or the Competition Commission should be exercised by Monitor. That is because it believes it to be in the interest of the NHS for them to be exercised by a health service-specific regulator that is sympathetic to and has an understanding of NHS interests.
Andrew Bridgen (North West Leicestershire) (Con)
Primary care trusts and strategic health authorities are part of a top-down management structure that has led to waste and bureaucracy and tolerates poorer patient outcomes. Will my right hon. Friend confirm that they will be abolished, and that the £5 billion that that will save over this Parliament will be ploughed back into front-line medical services?
Mr Lansley
Yes, I am grateful to my hon. Friend; I can do that. It is essential to move to a world where we reduce administration costs, relieve bureaucracy in the service and free those providing services by offering them the resources to deliver improving care without the burden of bureaucracy, cost and waste inflicted by a Labour Government in the past.
Mr Dennis Skinner (Bolsover) (Lab)
Does not the Secretary of State understand that when the Labour Government were in power, they increased spending from £33 billion to £111 billion in one decade, and that we are now witnessing, at a cost of £2 billion, a new Frankenstein monster all to pacify these tin-pot Liberals? Judas only got 30 pieces of silver.
Mr Lansley
I have a mission for the hon. Gentleman— he should head to Wales. In England, this coalition Government have committed to increasing the NHS budget in real terms in the life of this Parliament. The King’s Fund reported the other week that in Wales, a Labour Government intend to reduce the NHS budget in real terms by over 8%.
Duncan Hames (Chippenham) (LD)
I believe that the very act of listening to patients and the public will have done a lot to improve these proposals—as, I suspect, once the dust has settled, it will have done for the Health Secretary’s reputation, too. Given the requirement for greater local accountability in these proposals, will the right hon. Gentleman make the same recommendation to local clinical commissioners in the changes they are yet to make for health services in their areas?
Mr Lansley
I am grateful to my hon. Friend for his kind remarks, but I have to tell him that I am not looking to achieve anything in terms of reputation; I just want a positive outcome for the NHS. I have said before that this is not about me; it is about achieving for the NHS the opportunity to deliver better services for patients. That is all I am interested in.
The proposals on public and patient involvement illustrate what we needed to do—and will now do in response to the Future Forum—as many people wanted to see set out in detail in the legislation how patient and public involvement would work in the respective NHS bodies. The legislation had set out the fact that these bodies existed, but the detail was not prescribed. There is always a balance to be struck in legislation between the degree of prescription and the degree of freedom. Clearly, through engagement with the NHS, we have approval for putting much more of the detail into the Bill, now that it is clear that it will engage patients and the public.
Kate Hoey (Vauxhall) (Lab)
Along with the vast majority of the public, I welcome most of the changes announced today. I always welcome U-turns when they bring about the right thing. I am very concerned, however, that the bureaucracy that will be around after all these changes have gone through could be worse than what we have at the moment. I would genuinely like to be reassured on that point.
Mr Lansley
I am grateful to the hon. Lady for her support for the majority of the recommendations. The bureaucracy will reduce in the NHS as a consequence of the changes for one very simple reason—because we are shifting the ownership of commissioning and the responsibility for the design and delivery of services from what is essentially a distant managerial organisation into one that is locked into the clinical decision making of doctors and nurses across the service. Let us be clear: this is about delivering benefit to patients by empowering the doctors and nurses who care for them. That in itself will cut the bureaucracy.
Sajid Javid (Bromsgrove) (Con)
Can the Secretary of State confirm that the Government have no plans to decrease the budget for the NHS—unlike the plans of the Labour party to slash it by £30 billion?
Mr Lansley
Yes, my hon. Friend makes an important point. If we had listened to the Labour party last year, we would have cut the NHS and would not have increased the resources going into it. The £20 billion efficiency savings required to respond to demand and cost would have been £30 billion, which would have put an unsupportable degree of pressure on the NHS. As it is, we are giving the NHS not only resources but the opportunity to deliver improving care.
Valerie Vaz (Walsall South) (Lab)
After the White Paper was published in July last year, 6,000 representations were received from health professionals and from the Select Committee on Health asking the Secretary of State to think again about breaking up the NHS, so this “listening exercise” has been a waste of public money. Either the Secretary of State was wrong then, or he is wrong now. Which is it?
Mr Lansley
I am afraid I have to say that that was all nonsense. As the hon. Lady knows, we responded positively to the consultation last year and made changes then. However, as the details of the Bill have been emerging, people have been trying to work out how they will make it all work in the future. They have been saying, “We want to set out in the legislation precisely how it will work.” There is no better way of making that process effective than talking to people in the NHS, engaging with them, listening to them, and then implementing the changes.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
I am sure the Secretary of State agrees that the single biggest challenge facing health care in the United Kingdom is the economic and human challenge of looking after an ageing population. Does he also agree that the key to that is better integration of health care services—better integration of hospital services with community and social services—and that these reforms are a good way of going about that?
Mr Lansley
I agree very much with that. The Future Forum’s report, particularly the part that deals with clinical advice and leadership, has given us a robust structure for engagement with the range of professions that are capable of delivering that kind of integrated, joined-up and more effective care.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Can the Secretary of State reassure us that no services or hospitals will be taken over by the private sector?
Mr Lansley
There are no plans in the legislation or, indeed, in the Future Forum’s recommendations that would lead to that. In particular, as the hon. Lady will see in the detail published with the written ministerial statement this morning, we have proposed that Monitor should have no power to allow the private sector access to NHS facilities for reasons of competition and to take them away from NHS providers.
Mr Peter Bone (Wellingborough) (Con)
We have a Prime Minister who loves the NHS, a Secretary of State who is the most experienced Member in the House when it comes to the NHS, and a coalition Government who have done something that the Labour Government never did. They listened, and they were willing to improve their Bill. This is a great day for democracy. I congratulate the Secretary of State on that, and on referring the Bill back to a Committee—and if he is looking for volunteers for the Committee, I am available.
Mr Lansley
I am grateful to my hon. Friend. It is because I believe in the NHS and the people who work in the NHS that I think it right to listen to and engage with those people, and to give them much greater control of the service that they provide for patients.
Grahame M. Morris (Easington) (Lab)
What can we conclude from the fact that the Prime Minister is not here with us this afternoon to support the Secretary of State, but is involved in a PR stunt at Guy’s and St Thomas’ NHS Foundation Trust? It was once said on the other side of the Atlantic that you could put lipstick on a pig, but at the end of the day it was still a pig. Is that not true of the Bill?
Mr Speaker
Order. We are starting to get involved in issues perhaps not of order, but certainly of taste.
Mr Lansley
If you will forgive me, Mr Speaker, I do not think that I will favour that question with an answer.
Mark Lancaster (Milton Keynes North) (Con)
Will the Secretary of State expand on the support that organisations such as the Spinal Injuries Association can expect through specialised commissioning?
Mr Lansley
I believe that as a result of our proposals the NHS commissioning board will be able to provide more consistency in much specialised commissioning, and I hope that that will apply to people with spinal injuries. I am well acquainted with the work of the Spinal Injuries Association: I think that it has done terrific work, and we have already worked closely with it in trying to ensure that we improve commissioning and services for those with spinal injuries.
Karl Turner (Kingston upon Hull East) (Lab)
It is utterly disgraceful that Liberal Democrats and Tories are scrapping with each other to claim credit for the alleged listening exercise. Will the Secretary of State now apologise to my colleagues and me for not listening to us when the Bill was in Committee?
Mr Lansley
Yes, in relation to the changes we are now bringing forward, I do indeed give credit to some of my colleagues—very much so—but I also give credit to the Prime Minister and the Deputy Prime Minister for the time and trouble they have taken; they have spent a great deal of time listening, and engaging with people across the health service. We give credit, too, to the NHS Future Forum and the thousands of people across the NHS who have now made their contribution to the NHS’s future, and I think they will be very disappointed to hear Opposition Members just wanting to denigrate that, and to make political capital out of it, rather than supporting the NHS in its future objectives.
Tony Baldry (Banbury) (Con)
GPs collectively throughout Oxfordshire told the Field commission that they wanted to get on with GP commissioning, and that they were wholeheartedly committed to it because they believed they could be catalysts for change and better design NHS services for local people. When are GPs in Oxfordshire going to be able to get on with GP commissioning?
Mr Lansley
I can assure my hon. Friend that I know his local GPs, and that they want to work with their professional colleagues across their area and to get on with that now. We will continue to be able to delegate commissioning responsibilities to all commissioning groups who are ready to do that; if they show that they are ready, we can give them the capacity to do it through existing NHS structures.
Clive Efford (Eltham) (Lab)
This is not a U-turn; it is a body-swerve around the Liberals. The Secretary of State has spent the last year telling us that cherry-picking for profit in the NHS will not be possible under his Bill, yet today’s report has told us that he must take action to prevent such cherry-picking. Does the Secretary of State understand that this is now an issue of trust, and that nobody trusts him on the NHS—made in Britain by Labour, stolen by the Tories, and given away to his fat cat friends?
Mr Lansley
I will not attempt to compete with the hon. Gentleman on any driving analogies, but we have been clear that we will not countenance cherry-picking against NHS providers. The Future Forum has made recommendations on that, but they are not all to do with the Bill: for example, the processes I described of using a tariff lie outside the scope of the Bill. The Future Forum is making recommendations, and we are responding positively to them.
Dan Byles (North Warwickshire) (Con)
Does my right hon. Friend agree that the discourtesy and mock anger from Opposition Members demonstrate why it is so important to take politics out of the day-to-day running of the NHS, so that we avoid this sort of political football nonsense every time we try to implement sensible reforms of this vital public service?
Mr Lansley
My hon. Friend is absolutely right, and that may be why Opposition Front-Bench Members have not told us whether they agree with the Future Forum. The truth is that they know they have to agree with it, because it makes good sense, but they are also trying not to let their political opportunity drift away from them. People will be deeply disappointed, and in some cases angry, that they cannot abandon trying to turn the NHS into a political football.
Mr Michael Meacher (Oldham West and Royton) (Lab)
Will the new, revised GP consortia still be allowed to outsource commissioning, either in whole or in part, to private health care firms, many of them probably American, which would create a major conflict of interest?
Mr Lansley
The clinical commissioning groups will be statutory bodies, and will therefore not be able to delegate the responsibility for such commissioning to any other organisation, including a private sector organisation.
Karen Bradley (Staffordshire Moorlands) (Con)
My constituents will be reassured to hear the Secretary of State say that it remains the duty of the Secretary of State to deliver a comprehensive health service, but was that duty ever at risk?
Mr Lansley
It was always clear that we would retain section 1(1) of the 1946 Act, which states that the Secretary of State will have a continuing duty to promote a comprehensive health service in England. What has been asked of us is that the Secretary of State should have not only that duty but a duty to secure the provision of that health service and an oversight responsibility in relation to the national bodies charged with providing it, and we will respond positively to that request.
Nic Dakin (Scunthorpe) (Lab)
This is a sorry tale of the Government going too far, too fast. What we have now is in danger of being a dog’s breakfast and the worst of all possible worlds. How much has this top-down reorganisation cost the UK taxpayer so far?
Mr Lansley
The listening exercise has to date—on 14 June—cost £36,640.97. The process of modernisation in the NHS is saving hundreds of millions of pounds every month. We know that we have to not only increase resources to the NHS but deliver continuously improving productivity and efficiency in the NHS. The Labour party always ignored that and failed on that; we will not fail on that.
Simon Hughes (Bermondsey and Old Southwark) (LD)
Today’s proposals are clearly winning the support of the health professionals and of political colleagues, but to win the support of the public and the patients I hope the Secretary of State will be able to give one further assurance that these plans will give greater local democratic accountability for the NHS than ever before and will therefore mean no enforced local privatisation of services, which happened under the previous Labour Government.
Mr Lansley
Yes, I can give my right hon. Friend that assurance. He will know that in our response to the Future Forum we will strengthen the role of health and wellbeing boards, deliver more integrated care and ensure that the local health and wellbeing strategy is a central document in determining the shape of commissioning in the NHS, social care and public health. The powers, including those for service reconfiguration in an area, will be maintained so that they must continue to meet the four tests I set out last year. The public voice will therefore be at the forefront of the response to any changes in the local service.
Lyn Brown (West Ham) (Lab)
Given that the Secretary of State is about to waste £2 billion on this reorganisation—money that would be better spent on patient care—will he give us an assessment of how many A and E departments will close over the next two years?
Mr Lansley
That is pretty rich. When I became Secretary of State, I found that all over the country there were threats to accident and emergency departments and to maternity departments generated under a Labour Government. Let me tell the hon. Lady that this is about delivering continuously improving care and cutting costs. We set out very clearly that although there are costs involved in reorganisation, they will be recouped severalfold over the course of this Parliament, saving in total some £5 billion in reduced administration costs.
Mr David Nuttall (Bury North) (Con)
My right hon. Friend will be aware that tens of thousands of families throughout my constituency are deeply concerned about the reduction of services at Fairfield hospital in Bury. Will any of the changes that my right hon. Friend has outlined enable that process to be reversed?
Mr Lansley
My hon. Friend and I have visited Fairfield hospital on a number of occasions and I have every sympathy with him and his constituents. He inherited as a Member of Parliament, as I did as Secretary of State, very advanced plans for changes to services at the hospital. What will now come to the forefront is the ability of the local authorities, through the health and wellbeing board and the clinical commissioning group, to bring clinical staff and the public together to say that in his area, north of Manchester, they can take greater ownership of the design of services to meet local needs.
Jim McGovern (Dundee West) (Lab)
I am sure that I am not the only Member who noticed that the title given to the urgent question required only one consonant to be added for us to use it for the ministerial statement: “Wasted Review”—[Interruption.] Wasted review—was that the sound of a large penny dropping? Given that the Minister is constantly dodging questions about the cost of the review, will he tell us how many nurses and doctors could have been put in post using the money the review cost?
Mr Lansley
The latest figures on the changes in staffing in the NHS since the general election have shown a reduction of 3,800 managers, an increase of 2,500 in the number of doctors and no reduction in the number of nurses.
Charlie Elphicke (Dover) (Con)
In Dover and Deal, we have dynamic GPs, many of whom want to get involved in commissioning, but not every GP wants to do so. Will the Secretary of State confirm that no individual GP will be forced to be involved in the work of the commissioning group and that that was always the case under his reforms?
Mr Lansley
My hon. Friend makes a good point. Many GPs across the country understand that clinically led commissioning is the right thing to do, but they do not personally want to be involved in that process. There are, however, leaders who do, and leaders across the country have already come forward through pathfinder consortia and will be a basis on which we can create much greater clinical leadership across the service. The Future Forum was very clear that leadership from within the service, from doctors, nurses and other health professionals, will be instrumental in improving care in the future.
Chris Williamson (Derby North) (Lab)
Everyone knows that the Conservatives opposed the introduction of the national health service and that they brought it to its knees when they were last in power. Now they are trying to undermine it by wrapping it up in bureaucracy. With waiting lists increasing, what assurances can the Secretary of State give the House that they will not increase further as a result of the measures he is bringing forward in the Bill?
Mr Lansley
I do not think that the hon. Gentleman listened to or heard the Prime Minister when he made absolutely clear our commitment to keeping waiting times low. Not only did the Prime Minister make that commitment, but it is in the constitution. In practice, the opportunity for patients increasingly to see the performance of the hospitals to which they can choose to go will help to drive increases in performance. As I told the House in response to an earlier question, waiting times are now lower for in-patients and out-patients than at the time of the last election. I am also old enough to remember that in June 1944, Winston Churchill, as the leader of a coalition Government, went to the Royal College of Physicians and set out an ambition for a national health service that would give everybody in the country access to the highest quality health care, free for all, regardless of means.
Jeremy Lefroy (Stafford) (Con)
The Cure the NHS group, founded by Julie Bailey in Stafford, has rightly stressed the importance of a culture of caring and zero harm to patients—something that my right hon. Friend has always emphasised. How does he think the recommendations of Professor Field’s report will help with embedding such a culture across the NHS?
Mr Lansley
As my hon. Friend knows, much can contribute to that change of culture, not least making safety one of the central domains for measuring outcomes in the NHS. In addition, it must be personal to each member of staff in the NHS that they have that responsibility. We have too often seen cases in which people have been professionally responsible but have not acted in line with that responsibility. A central part of what we need to do is not about organisations and structures but about creating that sense of personal responsibility in professionals across the service to look after their patients and those for whom they care and to blow the whistle if there is harm or abuse; and we must protect and secure that whistleblowing when it happens.
Helen Jones (Warrington North) (Lab)
The Secretary of State promised to reduce bureaucracy, but he has now spent more than £760 million on a botched reorganisation that gives us commissioning consortia, senates, a whole host of national quangos and PCTs being abolished to transfer their staff somewhere else. Is it not time he accepted that this is a botched reorganisation and withdrew the Bill?
Mr Lansley
Most of that was pure invention, including all the numbers. We are going to save money with these changes to the NHS. We are going to transfer resources from bureaucracy, management and administration into front-line care. Through clinical commissioning groups we are going to empower staff in the NHS, and abolishing two tiers of management in the NHS will save us, in total, a third in real terms out of administration costs.
John Glen (Salisbury) (Con)
Will the Secretary of State confirm that despite the existence of clinical senates the primary driving role in commissioning will remain with GPs, who know their patients best and know which services they require?
Mr Lansley
My hon. Friend makes an important point. General practice—not just general practitioners but general practice—has a central role for patients because there is a long-term relationship with patients and an understanding of the whole population and the health of a whole area. However, GPs recognise that in order to get the right services for patients, they have to design services alongside the range of professionals whose job it is to deliver them.
Mr Ronnie Campbell (Blyth Valley) (Lab)
Let us be clear: this is just a dog’s dinner and these amendments have proved it. What we have here is a slow-privatisation-of-the-NHS Bill that is backed by the Rag, Tag and Bobtail party—the Liberal Democrats. This is the beginning of the privatisation of the health service and it is time it stopped.
Mr Lansley
This Bill and our proposals were never to support privatisation; they are not to support privatisation and they will not be to support privatisation. The hon. Gentleman should have attacked the Labour Government who gave the private sector £250 million for operations it never carried out; they paid it 11% more than they would have paid the NHS for that. They tried to push the NHS out of the provision of services when it could have provided them and competed. The Labour Government did that, and we shall legislate to make it illegal for a Secretary of State or any regulator to engage in that kind of preferential treatment for the private sector in future.
Gavin Barwell (Croydon Central) (Con)
I welcome the revised proposals, in particular the focus on competition not as an end in itself but on informed—[Interruption.]
Gavin Barwell
Thank you, Mr Speaker.
I welcome the focus not on competition as an end in itself, but on informed patient choice to improve patient care. Can my right hon. Friend confirm that, unlike the Opposition, the Government believe that NHS patients in my constituency deserve the best that the public, private and voluntary sectors can offer them?
Mr Lansley
I understand. What my hon. Friend says is absolutely clear. We know that informed choice for patients is a serious contributory factor in improving outcomes for patients. When there is informed choice, of necessity we must have a diversity of providers to support it. There is no doubt that to that extent competition is an essential part of delivering improving care in the future, but it is not an end in itself. It should not be elevated to that point, over and above delivering the integrated services that best give patients the care they need.
Chris Bryant (Rhondda) (Lab)
My constituent Rosie Edwards suffers from a rare congenital heart condition, known as Fallot’s tetralogy. Fortunately, for all her life, both as a child and now as an adult, she has had to have all her treatment at the Royal Brompton hospital in London. Unfortunately, the Government are proposing that that paediatric cardiac service is terminated—[Hon. Members: “Not true.”] It is completely true. There is no provision in the suggestions that have been brought forward for the service to continue. My constituents are asking whether, if reorganisation will cost a lot of money, it would not be better to spend that money on protecting those services.
Mr Lansley
I am sorry the hon. Gentleman tried to characterise that as he did. The joint committee of primary care trusts is conducting a consultation. The Government are not doing it; I am not doing it; the committee is doing it, and the consultation closes on 1 July. People across the country are quite properly making representations to the consultation, including on the Royal Brompton and other units. The committee has not made recommendations to me; it will come to its conclusions after that consultation, which has absolutely nothing to do with the structure of the proposals I am referring to today.
Steve Baker (Wycombe) (Con)
My constituents will not be interested in hard left, old school scaremongering. They simply want to know whether the Bill will put local health services under a greater degree of local control.
Mr Lansley
My hon. Friend will know that many of us in the House were deeply frustrated in the past that Ministers would say at the Dispatch Box that primary care trusts were responsible for local decisions, and then nobody found locally that the PCT was in any practical sense accountable to them or the population they represented. In future, there will be proper accountability: clinical accountability through the commissioning groups and democratic accountability through local authorities.
Angela Smith (Penistone and Stocksbridge) (Lab)
Will the Secretary of State apologise to the people of this country for a botched process that will lead to nothing but chaos and confusion in the NHS?
Mr Lansley
I think the hon. Lady should read the NHS Future Forum report where she will find that right across the service there is support for the principles we set out, and agreement that change is necessary. I do not know where she imagines that change will come from if not by going through a process of the kind we have engaged in.
David Rutley (Macclesfield) (Con)
Public health continues to be an important priority, particularly in Cheshire East which, surprisingly, is ranked 15th in the league table for hazardous drinking. Can my right hon. Friend tell the House what remit he is giving the Future Forum in this important area?
Mr Lansley
I am grateful to my hon. Friend. The Future Forum has made recommendations in relation to public health. One of them, which I announced today, is that we want to combine the direct integrated work on health protection and response to emergencies through Public Health England with continuing independence for expert advice, so I am proposing that Public Health England should be established as an executive agency. What is critical is that we create through the legislation a greater opportunity for local authorities to lead health improvement plans locally, so issues such as alcohol abuse and problem drinking will need not only national leadership, which we will give, but local leadership, which the Bill will empower.
Barbara Keeley (Worsley and Eccles South) (Lab)
Accountability is not at all clear. The Secretary of State said that clinical accountability will be in one place and democratic accountability in another. We are replacing one organisation—the PCT—with five. My constituents will just want to know where the accountability lies for important local NHS decisions. That has not become clear from the statement so far.
Mr Lansley
I repeat: from the public’s point of view, we know that what they wanted was genuine accountability, in the sense that the doctors, nurses and other health professionals who care for them should be able directly to design and influence the shape of services locally to meet their needs, but they also want a patient voice and a public voice. That has not existed in the past; we will enable it to happen. They will come together at the health and wellbeing board, where they will establish a strategy for their area.
Matthew Hancock (West Suffolk) (Con)
In the commendable listening exercise, was it not clear that there is now broad support for the principles of reform? Is it not better that we now take that forward, rather than being opposed to reform and opposed to the resources for the NHS, as the Opposition are?
Mr Lansley
I am grateful to my hon. Friend. That is indeed the message that came through to us from the NHS Future Forum and its extensive engagement with the NHS and beyond. I will not go down the path urged on us by the Opposition, which for the NHS seems to be spend less, do nothing and let the crisis happen when it will.
Richard Burden (Birmingham, Northfield) (Lab)
The Secretary of State is still talking about the Bill as if it is a way of promoting localism and local accountability, but is it not still the fact that most of the extension of locality commissioning that that would involve could happen without the Bill? I refer the Secretary of State to the role of the national commissioning board. What is that, if not a massive and bureaucratic centralisation of power?
Mr Lansley
With respect, the hon. Gentleman misses the point entirely. Without the legislation we could not transfer out of the hands of a managerial top-down bureaucracy into the hands of clinicians and local people, but he is right—it is not just the localisation of decision making. There is also in the NHS a nationally funded service with an expectation of national standards, and many services that require high levels of national consistency in commissioning. There is a job for the national commissioning board, which we will establish. That in itself will inject a considerable level of consistency in standards and quality, and considerable efficiency in commissioning some services.
David Morris (Morecambe and Lunesdale) (Con)
I congratulate the Secretary of State on his reforms. I know how hard he has worked and conducted consultation across the political spectrum. That should be respected by the Opposition. The reforms empower our medical practitioners—doctors and nurses—and in doing so, as I am sure he would agree, will stop the litigation culture that has galloped away over the past 13 years under the previous Government.
Mr Lansley
I understand the point that my hon. Friend is making. We need—not least in a further emphasis on safety and some of the other measures that we as a Government, including my colleagues at the Ministry of Justice, have said we would bring forward—to try to offset a rising tide of litigation and cost associated with clinical negligence cases in the NHS. My hon. Friend is kind to me about working hard. I never imagined I would not do so, but if I have worked hard over the past eight weeks, it is nothing compared to the leaders of the NHS Future Forum who, in the space of just eight weeks, produced excellent work which will be of enduring significance.
Alison McGovern (Wirral South) (Lab)
Last year, the NHS in Wirral tried to respond quickly to the Secretary of State’s top-down reorganisation and has since spent months in uncertainty and stress. Will the Secretary of State apologise now to staff and patients on the Wirral for all the unnecessary problems he has caused them and all the money he has wasted?
Mr Lansley
I met many of the previous practice-based commissioning groups in the Wirral and south Merseyside, who came together to tell me how enthusiastic they were about the possibilities for designing clinical services more effectively in future. They are doing that. They want to get on with it and the Future Forum is right: we need to give them the opportunity to get on with that now.
Alun Cairns (Vale of Glamorgan) (Con)
What assurance can the Secretary of State give that his plans will abolish the rigged market introduced by the previous Government that ended up giving £250 million to the private sector for delivering nothing?
Mr Lansley
My hon. Friend is absolutely right. We will legislate to stop precisely that distortion and that favouritism to the private sector. The private sector must know that it will have to provide additional services to the NHS on the basis of quality, not on the basis of any preferential system, as under the previous Government.
Joan Ruddock (Lewisham, Deptford) (Lab)
I remember that under the previous Conservative Government people died while on waiting lists. [Hon. Members: “Oh!”] It is a fact. I was a Member of Parliament at the time and it happened. Labour’s targets transformed that. The Secretary of State has been forced today to retake responsibility for the delivery of the NHS. He has talked about what has been happening. Will he make a specific promise today about the future waiting lists under his jurisdiction?
Mr Lansley
I will make clear to the right hon. Lady, as the Prime Minister has made clear, that we will not let waiting times rise. We will continue to maintain downward pressure, but it is very important that we do not treat waiting times in the NHS as the only measure of performance. It is more than that: it is the quality of care that is provided, not just the access to care.
Andrew George (St Ives) (LD)
I am very sorry to say that the Secretary of State demonstrated a creative interpretation of the coalition agreement when he launched his policy last July. What can he say to the House to reassure us that he will not make the same creative interpretation of the Future Forum’s recommendations, particularly in relation to the risk of the marketisation of health services?
Mr Lansley
The hon. Gentleman will know that when I came forward with the White Paper last year, or the Command Paper in December, or the Bill, we did so collectively as a Government, and I can assure him and all my colleagues that we will continue collectively to agree on the basis on which we take all these issues forward.
Kevin Brennan (Cardiff West) (Lab)
Some say that the reason the Secretary of State went too far, too fast and has now come up with a fix that is too little, too late is that he has a bit of a tendency to be pig-headed and cloth-eared when people disagree with him. I do not agree with those who say that, but could he now find the humility and courage at least to say sorry for the mess he has made?
Mr Speaker
Order. I remind the House of the wise stipulation in “Erskine May” that moderation and good humour are the defining features of parliamentary language.
Mr Lansley
In that spirit I thank the hon. Gentleman for the generosity of his remarks and encourage him likewise to apologise for the performance of a Labour Government in Wales who are cutting the NHS budget by 5% and seeing the performance of health care in the NHS in Wales deteriorate considerably relative to that in England.
Harriett Baldwin (West Worcestershire) (Con)
My constituency has borders with Gloucestershire, Herefordshire and Shropshire. The NHS Future Forum has recommended that commissioning group boundaries should not normally cross local authority boundaries, but will my right hon. Friend confirm that my local commissioning consortia can work with doctors in other areas?
Mr Lansley
The Future Forum is perfectly clear that there is a benefit associated with integrating health and social care if clinical commissioning groups do not normally cross local authority boundaries. But it is clear, and we are clear, that they should be able to make a case to do so if they think it appropriate. We have the benefit of being able to look at the pathfinder consortia, of which there are 220 and I think that 16 cross local authority boundaries, so it is already the exception rather than the rule.
Diana Johnson (Kingston upon Hull North) (Lab)
Will the NHS be the preferred provider of choice for health care services for my constituents?
Mr Lansley
No, I have said that we will legislate to ensure a level playing field, so her constituents should have access to whichever provider their clinical commissioning group views as best able to deliver quality care.
Christopher Pincher (Tamworth) (Con)
The Government are incorporating the co-operation and competition panel into Monitor to advise the NHS on competition rules. Given that the Opposition seem to be engaged in collective amnesia this afternoon, will my right hon. Friend remind the House which party first established the CCP and the concept of competition in the NHS?
Mr Lansley
My hon. Friend makes an interesting point, because, as the Future Forum report acknowledges, the Bill does not extend the application of competition rules in the NHS, which were introduced under the Labour Government. The co-operation and competition panel was established under the Labour Government in 2009. The rules that we will maintain as a process of evolution, rather than revolution, are the ones that were consulted on in January 2009 and most recently published by a Labour Government in March 2010. To that extent, and despite all the hot air from the Labour party on competition in the NHS, we are adopting an evolutionary approach and starting precisely from the situation that applied under the Labour Government.
Jeremy Corbyn (Islington North) (Lab)
In his earlier answer to my right hon. Friend the Member for Oldham West and Royton (Mr Meacher), the Secretary of State, if I understood him correctly, said that commissioning consortia would have to do the commissioning themselves and could not franchise it out to private providers. Will he confirm that that is the case and that he has powers to limit the number of private patients who can be taken into NHS facilities under the regulations he is proposing in the Bill?
Mr Lansley
I reiterate that the clinical commissioning groups will be statutory bodies with a statutory responsibility for commissioning, so it would not be legal for them to delegate that to another body that was not subject to the same obligations. As far as access to private patients is concerned, we have made it clear—I do not believe that the Future Forum makes any recommendations on this—that foundation trusts, which often have arbitrary rules relating to limits on their income from private patients, should have that cap lifted, but we propose to put additional safeguards in place to make it clear that, if they do so, not only must that income be separately accounted for so that there is no subsidisation from NHS facilities, but the trusts must demonstrate how that will support their continuing primary purpose of providing services to the NHS in England.
Mr John Baron (Basildon and Billericay) (Con)
Having very much supported the listening exercise, I know that for many of us the most important aspect of these reforms has always been the new focus on outcomes, as illustrated by the inclusion of the one and five-year cancer survival rates in the outcomes framework. Will the Secretary of State assure me that the Future Forum’s suggestions will in no way detract from that new focus on the quality of care?
Mr Lansley
I can give my hon. Friend that assurance. Indeed, I can go further and say that one of the reasons the Future Forum has made no recommendations on the outcomes framework is that it found enthusiasm across the NHS for focusing on quality and outcomes and nothing but approval for the framework. Of course, the Labour party ignores the fact that, as stated in the White Paper we published last year, that is one of the central aspects of what we are setting out to do. He is right that the focus on outcomes, which enables people to see how this country performs in health, relative to other countries, and continuous improvement in health outcomes, rather than just a small number of focused targets, is instrumental in continuous improvement.
Kate Green (Stretford and Urmston) (Lab)
The Secretary of State is aware of the situation faced by Trafford acute trust. Will he reassure my constituents that there is no prospect of Trafford General hospital being either broken up or taken over by a private company?
Mr Lansley
The hon. Lady will have a further opportunity to discuss that shortly. She will know that the NHS trust in Trafford is examining whether it might merge with one of two possible foundation trusts and whether it might change its corporate configuration, as it were, but entirely within the NHS.
Andrew Percy (Brigg and Goole) (Con)
Last Friday, I met two members of the local Labour party in my constituency who presented me with an apparently independent petition on the NHS reforms. At that meeting, they told me that it was a fact that our reforms would lead to the removal of a comprehensive health service; we now know that that is a load of old nonsense. They also told me that it was a fact that these changes would open up the NHS to European Union competition law in a way that it is not at the moment. Is that a fact, or is it just shameless scaremongering?
Mr Lansley
It is entirely scaremongering. My hon. Friend might like to look at what the Future Forum report says in relation to choice and competition, which sets out very clearly that the extent to which EU competition rules apply in the NHS will not change as a consequence of this Bill.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
So far, £768 million has been wasted on this failed reorganisation. In my region, Freeman hospital’s cardiac unit for children is under threat, South Tees Hospitals trust has had £20 million removed by the Government, and the Government are proposing a national commissioning board that sits in private, is unelected, produces no minutes, remunerates itself and sets its own sub-committees. Where is the front-line quality of care for people?
Mr Lansley
I am afraid that that is a further repetition of invention by Labour Members, who appear to have been given one or two figures of their own. It is complete nonsense. In the impact assessment associated with the Bill, which we will now revise to reflect these changes, we explained that there was an estimated £1.4 billion total cost of reorganisation, but that that would lead to a £1.7 billion recurring annual benefit in savings, which would accumulate to more than £5 billion over the course of the Parliament.
Dr Thérèse Coffey (Suffolk Coastal) (Con)
Building on the question from my hon. Friend the Member for West Worcestershire (Harriett Baldwin), HealthEast pathfinder consortium in my constituency crosses two district councils—in fact, it crosses two counties—and it might be appropriate for GPs from a third council area to join it. Will my right hon. Friend assure me that no barriers will be put in the way of what should be effective care for patients rather than simply political boundary lines?
Mr Lansley
As I have said, we will expect, and the Future Forum says, that commissioning groups should not normally cross local authority boundaries—in this respect, boundaries for social authorities—but they should be able to make a case for doing so based on benefit to patients. The one thing I would urge is that they are very clear with their local authorities about how they can secure the continuing integration of health and social care at a local level.
Bill Esterson (Sefton Central) (Lab)
Is not the reason the Secretary of State has so much support from the right wing of his party that they know that this will lead to privatisation of large parts of the NHS, as he confirmed in his answer on preferred suppliers?
Mr Lansley
I hope that my colleagues would support me in saying that I have support from colleagues right across the coalition, because the coalition Government are supporting the NHS in enabling it to deliver improving services. That is what it is all about.
Mr Edward Leigh (Gainsborough) (Con)
It is appropriate that I am last, because I come at this from a different direction from everybody else. Given that no extra cash is available—we know that—how will the watering down of Monitor’s duty to promote core competition help to deliver the efficiency gains that are the future of the NHS? How will the Secretary of State now achieve that?
Mr Lansley
I say three things to my hon. Friend. First, let us be clear that there is £11.5 billion of additional cash available to the NHS over the course of this Parliament—but we have to use it better and deliver greater quality and effectiveness. The job of the commissioners and Monitor together is to deliver that—partly through tariff development in ensuring that they get those efficiencies by the price that they set, based on benchmark-to-best practice prices, but also through using their commissioning strength to design services. We all know that if we simply said every year to the NHS, “You must save money by cutting the price of what is paid to you”, its response would be to cut services, cut staffing or cut quality. In fact, achieving greater quality and effectiveness is about the redesign of clinical services—the transfer of services into the community and keeping people well at home rather than through emergency admissions to hospital. It is about clinical leadership and clinical redesign, and that is what these proposals will bring to the forefront.
Owen Smith (Pontypridd) (Lab)
Given the Secretary of State’s manifest interest in Wales, I invite him to come to Wales to meet some Welsh patients with me to find out at first hand which party they trust to safeguard the heritage of the NHS—Labour or the Tories. I suspect that the answer would be revealing for him. How much Welsh taxpayers’ money has been wasted on this needless reorganisation of the NHS?
Mr Lansley
The hon. Gentleman must know that the money available to the NHS in Wales is available to the NHS in Wales, and that it is separate from England. The Labour Welsh Assembly Government have made their own decisions about the priority that they attach to the national health service in Wales, and the result is, as the King’s Fund says, that they plan to reduce its budget by 8.3% in real terms. We are going to increase the NHS budget in real terms. The result can be seen in waiting times, which we were talking about. In England, the proportion of patients admitted to hospital who are seen within 18 weeks, according to the latest data, is 89.6%. He might like to reflect on the fact that the figure for Wales is 64.5%.
Rosie Cooper (West Lancashire) (Lab)
Although it has been difficult to hear during this debate, I would like to address my comments to the statement made by the Secretary of State.
Rosie Cooper
Question, sorry. [Interruption.] Let us get to the point and stop playing around. The Secretary of State said in the statement that consortia will now have one nurse and one secondary care doctor and that:
“To avoid any potential conflict of interest, neither should be employed by a local health provider.”
How will the Secretary of State apply that rule to GPs? Would not the Secretary of State and his reforms be best described as like Schrodinger’s cat—in a state of uncertainty and both alive and dead at the same time?
Mr Lansley
The hon. Lady misses the point. If GPs were providers as well as providing primary medical services, they would be unable to make decisions about those responsibilities because of a conflict of interest. Of course, as primary medical services providers in their area, they are not commissioned by the clinical commissioning groups—if the hon. Lady is listening to the answer at all—because the commissioning of primary medical services is undertaken by the NHS commissioning board, not by the local groups.
Sheila Gilmore (Edinburgh East) (Lab)
Will the Secretary of State accept that he would not be in the position he is in today had there been proper pre-legislative scrutiny of this Bill? Will he recommend to his Cabinet colleagues that that process is used for all future legislation? It is a case of more haste, less speed.
Mr Lansley
We as a coalition Government are engaging in more pre-legislative scrutiny than any of our predecessors. In this instance, I do not accept the hon. Lady’s proposition. What has been done by the NHS Future Forum could not conceivably have been achieved in pre-legislative scrutiny, because it was essentially about engaging people across the service in how we will implement principles that are widely supported across the service. It is very much of the here and now, rather than something that could have been done in advance.
Gregg McClymont (Cumbernauld, Kilsyth and Kirkintilloch East) (Lab)
I ask the Secretary of State to answer a straightforward question with a straightforward answer. How much money has so far been outlaid on this NHS reorganisation?
Mr Lansley
I have made it very clear that the impact assessment set out that we expect the total cost of the reorganisation—these figures will be revised because of the changes—to be about £1.4 billion, but that it will deliver recurring savings of £1.7 billion a year, leading to something approaching a £5 billion net saving in administration costs over the life of this Parliament.
Mr Speaker
I am grateful to the Secretary of State. All 65 Back-Benchers who stayed in the Chamber and sought to catch my eye were successful in doing so. I hope that the House’s inquisitorial appetite has been satisfied on this matter, at any rate for today. I was going to come to the ten-minute rule motion, but not before we have entertained a point of order from the hon. Member for Rhondda (Chris Bryant)—nothing new there.
NHS Future Forum
Lord Lansley Excerpts(12 years, 11 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
As I informed the House on 7 June, the listening and engagement in relation to the Health and Social Care Bill and related issues has been very successful. The NHS Future Forum has now reported to the Government.
I am today publishing a list of the key changes the Government intend to make as a result of the NHS Future Forum’s report. Some, but not all, of these changes require amendments to the Health and Social Care Bill.
These changes follow the Government’s decision on 6 April to take advantage of a natural break in the legislative process to pause, listen and reflect on the national health service modernisation plans and to make any necessary improvements to the Health and Social Care Bill. The NHS Future Forum, a group of 45 senior professionals from across health and social care, was established to help drive an intensive eight-week period of engagement, beginning on 6 April and ending on 31 May.
Members of the NHS Future Forum attended around 250 events and heard opinions on the Government’s plans for modernisation from over 8,000 people, including some 250 stakeholder organisations. Following a period of reflection, the Future Forum yesterday published their report; a copy of this has already been placed in the Library.
The Future Forum confirmed that the principles underpinning our plans for modernisation are the right ones, but also set out where we could make improvements, for patients and the NHS.
The Government have accepted the core recommendations of the report from the NHS Future Forum and will now make improvements to their modernisation plans. A document listing these improvements has been placed in the Library and we will provide more detail on exactly how we plan to implement these changes, including amendments to the Health and Social Care Bill, shortly.
The fundamental principles of our plans remain the same as those we set out in our White Paper, “Equity and excellence: Liberating the NHS”. The Government are committed to creating a modernised NHS that achieves among the best health care outcomes in the world. Our proposals are rooted in the principles of empowering, focusing on health care outcomes and quality, and giving front-line professionals more capacity to design and deliver services around the needs and expectations of patients.
The Government remain firmly committed to the ideals of the NHS—a comprehensive health service, funded from general taxation, based on need and not ability to pay.
I would like to give my thanks to all of the Future Forum’s members and to its chair, Professor Steve Field, for their work, as well as those who contributed to the engagement exercise. I have asked the Future Forum to continue to advise on the way that our proposals are developed and put into practice.
In order to ensure that Parliament is given sufficient opportunity to scrutinise the Government’s proposed changes, I can confirm that our intention is to recommit the relevant parts of the Health and Social Care Bill to a Public Bill Committee. Exact details will be announced in due course.
Oral Answers to Questions
Lord Lansley Excerpts(12 years, 11 months ago)
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Nigel Adams (Selby and Ainsty) (Con)
2. What assessment he has made of the financial performance of the NHS in 2010-11; and if he will make a statement.
The Secretary of State for Health (Mr Andrew Lansley)
Financial performance in the NHS in the last year has been strong. As at quarter three of financial year 2010-11, the strategic health authorities and primary care trusts were forecasting an overall surplus of £1,269 million, and the NHS trust sector was forecasting an overall surplus of £132 million. I expect the 2010-11 final year-end surplus to be no less than this forecast, representing about 1% of the budget, broadly in line with plans.
Nigel Adams
I am grateful to the Secretary of State for his response. My constituents will be pleased that the NHS performed on a sound financial basis nationally. What increases will the NHS receive in my local area of north Yorkshire in 2011-12, and can my right hon. Friend confirm that those increases are the result of the Government’s decision to protect the NHS?
Mr Lansley
In 2011-12, NorthYorkshire and York primary care trust will receive £1,207.3 million. That represents a cash increase over last year of £34.7 million, or 3%. That exactly represents our coalition Government’s commitment to protect the NHS and to increase its budget in real terms, and it is in stark contrast to what we were told we should do by the Labour party and what the Labour Government in Wales have done, which is to impose a 5% real cut in NHS spending in Wales.
David Miliband (South Shields) (Lab)
Can the Secretary of State confirm my figures that over £20 million has been spent in the north-east of England sacking PCT staff, that that money has come from funds previously earmarked for hospitals, and that there will be at least as many commissioning groups under his arrangements as there are currently PCTs employing managers in those roles? Does not that show that his plans are lunacy not reform, and that they should be taken away and put in the dustbin, not given a simple pause?
Mr Lansley
I can tell the right hon. Gentleman that in contrast to the last Labour Government it is our intention to increase the front-line staffing of the NHS relative to the staffing of the administration in the NHS. That is why, since the general election, there are 3,800 fewer managers in the NHS and 2,500 more doctors.
Mr Stephen Dorrell (Charnwood) (Con)
Can my right hon. Friend confirm that it is a key priority of the Government to reverse a decade of declining productivity in the health service in order to ensure that the resources that are committed by the Government deliver improved access and improved quality of patient care?
Mr Lansley
Yes, I can. My right hon. Friend is absolutely right about that. Over the last year in hospitals in particular we saw what was approaching a 15% reduction in productivity. That is why we are proceeding with ensuring that across the NHS we recognise not only that there are increasing demands on the NHS, which is why we are increasing the NHS budget by £ll.5 billion over four years, but that that money must be used increasingly effectively to deliver efficiency savings in excess of 4% each year so that we can improve the quality of services for patients.
John Healey (Wentworth and Dearne) (Lab)
The Secretary of State spoke in glowing terms of the last year, but the last year has been a catalogue of confusion, incompetence and broken promises. So will he now accept that the Government’s massive mishandled NHS reorganisation is piling extra pressure on NHS services, with nearly £2 billion promised for patient care being wasted on the internal changes? Will he admit that it is patients who will suffer as front-line NHS staff lose their jobs, treatments are cut back and waiting times start to rise again under the Tories?
Mr Lansley
The right hon. Gentleman asked about performance last year. I told him what the financial performance was. Let me also make it clear that, for example, for hospital in-patients, referral to treatment waiting time has gone down from 8.4 weeks in May 2010 to 7.9 weeks in the latest figures in March, and for out-patients the figure has gone down from 4.3 weeks in May 2010 to 3.7 weeks in the latest figures, so waiting times have improved. We have established the cancer drugs fund, with more than 2,500 patients benefiting from that. We have published and driven down the number of breaches of the single sex accommodation rules: a 77% reduction in those breaches, which Labour never achieved. In the last year we have reduced the number of MRSA infections in hospitals by 22% and C. difficile infections by 15%. I applaud the NHS—
Mr Speaker
Order. I think we have got the thrust of it and are most grateful.
John Healey
The Secretary of State mentioned a lot of things, but I notice that he did not mention the Prime Minister’s five new guarantees. [Interruption.] The Secretary of State shakes his head as if they do not matter, but perhaps he was not consulted on them. People have seen the Prime Minister make and then break promises on the NHS before, but this time he is breaking his pledges as he is making them. The King’s Fund says that waiting times are going up and the Nuffield Trust says that health funding is being cut in real terms. Privatisation, the break-up of integrated care and the removal of national standards at the heart of the health service are exactly what his health Bill is designed to do. Is that not why MORI shows public concern about the NHS rising rapidly and why people are right to conclude that they cannot trust the Tories on the NHS?
Mr Lansley
My right hon. Friend the Prime Minister has made it very clear that we will not let waiting times rise and that we will improve performance in the NHS right across the board, which was what I was illustrating. I remind the right hon. Gentleman again that waiting times in hospitals are down from 8.4 weeks to 7.9 weeks for in-patients and from 4.3 weeks to 3.7 weeks for out-patients. That is what we are committed to. Chris Ham of the Kings Fund was on the “Today” programme this morning and said on waiting times, “There hasn’t been a great deal of change since the election.” What has changed since the election is that we are improving performance, driving down the number of breaches of the single-sex rules, increasing access to dentistry, cutting the number of managers and increasing the number of doctors. Those are the things we are doing in the NHS, and it is to the benefit of patients that we do.
Mr John Baron (Basildon and Billericay) (Con)
3. What steps he is taking to enable GP consortia to commission integrated cancer services.
Chris Heaton-Harris (Daventry) (Con)
6. What assessment he has made of trends in outcomes for NHS patients since May 2010.
The Secretary of State for Health (Mr Andrew Lansley)
I am determined to focus on the results that matter most to patients. For example, in the year ending March 2011, the number of MRSA bloodstream infections decreased by 22% and C. difficile infections decreased by 15% on the year before. These are key outcomes in the drive to protect patients from avoidable harm. We also want to see continuous improvements in patients’ experience of their care. For example, between December last year and April this year, we took action on breaches of the single sex accommodation rules, and the number of breaches reduced by 77%. The NHS outcomes framework will drive up quality across services as well as providing evidence of the overall progress of the NHS.
Chris Heaton-Harris
I thank the Secretary of State for his answer. He has rightly identified patient experience as a key outcome that has improved over the past year. Given that tens of millions of patients every year experience accident and emergency as their first point of contact with the NHS, what steps has he taken to improve the quality of care that patients receive in A and E wards?
Mr Lansley
In the past, the only measure of activity and performance in A and E departments was whether patients had been discharged from the department within four hours. That meant, for example, that the emergency department at Stafford hospital was able to tick the box marked “Four-hour target met” in circumstances where patients were discharged completely inappropriately and patients suffered and died. We have now published, for the first time, quality indicators agreed with clinical professionals across emergency services that indicate what A and E quality should look like regarding not only time waited but the time before patients are seen by a qualified professional, re-attendance rates for the same problems, and mortality and related outcomes.
Mr Ben Bradshaw (Exeter) (Lab)
The Secretary of State is using a highly selective reading of waiting times. Will he confirm that breaches of the four hour target for A and E waits and the 18 week target for operations have increased massively in the past year? If they have not, why did the Prime Minister today confirm his support for those Labour targets?
Mr Lansley
The Prime Minister made it clear that we will focus on outcomes for patients, not just on individual targets. In 2010-11, the financial year that has just ended, only 2.6% of people who attended at A and E waited for more than four hours, despite an additional 870,000 people attending A and E departments.
Mr Gary Streeter (South West Devon) (Con)
7. What plans he has for access to NHS speech therapy services for children.
Stephen Hammond (Wimbledon) (Con)
16. What recent assessment he has made of the operation of the cancer drugs fund; and if he will make a statement.
The Secretary of State for Health (Mr Andrew Lansley)
I have received representations from hon. Members, noble Lords and members of the public on how the fund has operated. A number have welcomed the additional support that we are giving to cancer patients in need. More than 2,500 patients have already benefited from the additional funding provided up to the start of April 2011, and the further £600 million that we have committed for next three years will improve the lives of thousands more cancer sufferers.
Andrew Stephenson
Can my right hon. Friend confirm that the cancer drugs fund is helping cancer specialists tailor treatment regimes to patients in areas including my constituency, and helping to provide a more personal and responsive cancer service?
Mr Lansley
Yes, I can reassure my hon. Friend on that point. Indeed, I cannot do better than to quote Mike Hobday, head of policy at Macmillan Cancer Support, who said:
“The £200 million Cancer Drugs Fund will make sure every cancer patient has a better chance to get the drugs their doctor prescribes for them. This is particularly important for those with a rarer cancer, who have historically lost out on getting drugs on the NHS.”
Stephen Hammond
I am sure the whole House will welcome my right hon. Friend’s announcement today that 2,500 people have already benefited from the interim cancer drugs fund. Can he give the House some indication of whether people with the more difficult types of cancer will benefit from it?
Mr Lansley
My hon. Friend will be aware that in the run-up to the election and since, the Rarer Cancers Forum has mentioned the number of applications to the exceptional cases panels of primary care trusts that have been turned down, and pointed out how often patients in this country have not got access to new cancer medicines that are regularly available to patients in other European countries. That was the basis on which we estimated the level of demand for the cancer drugs fund, and it has actually turned out to be a very good predictor of demand. Patients are now receiving second-line or new medicines for a range of cancers, including prostate and bowel cancer. People with common cancers as well as rarer ones are getting access to new medicines that are increasing their quality of life or life expectancy.
Liz Kendall (Leicester West) (Lab)
Today the Prime Minister pledged to increase NHS funding, protect universal coverage and keep waiting times low, but his promises are already being broken on cancer care. Three quarters of the cancer drugs fund is not additional money, as the Secretary of State claims, but money taken from other patients, and half as many new cancer drugs are available in some parts of the country as in others. Whatever he claims, can he now confirm that the number of patients waiting more than six weeks for their diagnostic test, including for cancer, has doubled since this time last year?
Mr Lansley
The hon. Lady seems to have forgotten that we were very clear at the time of the election that we would establish the cancer drugs fund not least on the basis that under this Government, the NHS would not have to pay the additional employer’s national insurance contributions that it otherwise would. The money available for the NHS is being used for the benefit of patients, and it represents additional resources.
I might also remind the hon. Lady that before the election, her party was not committed to protecting the NHS budget. The Leader of the Opposition was completely wrong today when he said that Labour was going to protect NHS spending, as we did. That is not true. Actually, it was committed to only 95% of NHS funding, which was that for the PCTs. It was going to cut the rest, and centrally funded budgets such as the cancer drugs fund are precisely what would have disappeared.
The hon. Lady asked about diagnostic tests. The figures show that a year ago, the average waiting time was 1.7 weeks, whereas the latest figure is 1.8 weeks.
Pat Glass (North West Durham) (Lab)
12. What recent assessment he has made of the ability of all NHS hospital trusts to become foundation trusts by 2014.
Nick de Bois (Enfield North) (Con)
13. What recent assessment he has made of progress by GP pathfinder consortia in delivering improvements in NHS services.
The Secretary of State for Health (Mr Andrew Lansley)
We have taken time to pause, to listen and to reflect on our reforms; none the less I am pleased to report that there remain 220 pathfinder consortia, covering nearly 90% of England. In my hon. Friend’s constituency, the Enfield consortium group is established and is focusing on quality and productivity improvements to local health care services. I have been greatly encouraged by the initiative that clinicians have taken to improve patient services, and examples are available at the pathfinder learning network, a forum through which we are supporting their development.
Nick de Bois
My right hon. Friend the Secretary of State knows my view on the need to ensure that there is a comprehensive network of commissioning consortia across the whole country by April 2013. Does he share my view that that essential requirement will not only improve patient choice but ensure that we can pass a further £5 billion in savings back into front-line services?
Mr Lansley
Yes, I think my hon. Friend is absolutely right about that. What has been interesting in the listening exercise is the clear expression—on the part of front-line clinicians, general practitioners, doctors, nurses and other health professionals—of a desire to take greater responsibility for commissioning. They are only too aware of a decade of decline in productivity in the NHS, in which administration costs and staffing ballooned while front-line staffing did not increase to anything like the same extent. They want to deliver better clinical services for their patients, and to have the responsibility to do so. We are determined to give that to them.
Mr Steve Brine (Winchester) (Con)
14. Whether his Department has considered the merits of introducing a supplemental ultrasound breast screening examination as part of the NHS breast screening programme.
The Secretary of State for Health (Mr Andrew Lansley)
The Department is currently in the process of working with NHS London to establish timetables for each NHS trust and agree the actions required to achieve foundation trust status by April 2014. This work is ongoing; once it is finalised, plans will be published locally.
Gavin Barwell
In 2010-11 Croydon Health Services NHS Trust delivered an operating surplus of £4.5 million. May I commend its FT application to my right hon. Friend in the hope that in future years, that money can be reinvested in local health services in my borough?
Mr Lansley
Yes, I understand and entirely sympathise with my hon. Friend’s desire to see Croydon Health Services NHS Trust achieve foundation trust status. He will know that the trust was recently the subject of a responsive review visit by the Care Quality Commission, which revealed areas in which further assurance will be needed ahead of its foundation trust application going forward. He will appreciate, as I do, that in the past foundation trust status did not depend sufficiently on the achievement of high-quality services, rather than merely viable services. We intend that in future, foundation trust status will depend on both.
Nicky Morgan (Loughborough) (Con)
17. What steps he is taking to improve mental health services.
Karl MᶜCartney (Lincoln) (Con)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Andrew Lansley)
My responsibility is to lead the NHS in delivering improved health outcomes in England, to lead a public health service that improves the health of the nation and reduces health inequalities, and to lead the reform of adult social care, which supports and protects vulnerable people.
Karl MᶜCartney
I thank the Secretary of State for that answer. Will my right hon. Friend reassure me, and my Lincoln constituents, that whatever the outcome of the Government’s consultation, our NHS still requires some measure of reform—and that if a provider is qualified to deliver NHS standards at NHS costs, and if patients, with the support of their doctor, want to be treated there, this Government should do nothing to stand in their way, regardless of any political posturing by our flip-flopping coalition partners? [Hon. Members: “ Ooh!”] And further to—
Mr Speaker
Order. I apologise for having to interrupt the hon. Gentleman, but topical questions must not be statements or essays; they must be very brief questions. I think we have got the thrust of his question, and we are grateful to him.
Mr Lansley
Through the listening exercise and in response to the report of the NHS Future Forum, which we hope to see shortly, we hope to be able further to strengthen the principles of the Bill and its implementation of the White Paper, so that patients can share in decisions about their care and access the services that give them the best quality. That includes, in many instances, patients having access to a choice of providers as well.
Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)
T5. Doctors, nurses and PCT staff in my area tell me that the Government’s pausing of the health reforms has had no impact whatever on the ground, and that implementation of the Health and Social Care Bill is proceeding just as it was before. Does the Secretary of State believe that that is wrong—and if not, does it not mean that this whole consultation period is an absolute farce?
Mr Lansley
No, not at all. We were very clear—indeed, I was clear to the House on 4 April when I announced the pause to listen, to reflect on and improve the Bill—that it was specifically related to achieving in the legislation the necessary support for the many changes happening across the NHS. It cannot be right, however, that people across the NHS who are engaging in delivering improved care, redesigning clinical pathways—or designing clinical services to deliver the best outcomes for patients—should be told to stop making those positive changes. They are engaging with those positive changes and we are not preventing them from doing so.
Duncan Hames (Chippenham) (LD)
T2. I am wearing neither sandals nor flip-flops, Mr Speaker. Given that local GPs typically charge £500 a day, what action is the Minister taking to ensure that GP consortium board members do not cost the NHS as much as £25,000 each a year for just one day’s work a week?
Mr Lansley
Among the intentions that we have made clear from the outset is our intention to reduce the running costs of management in the NHS. We propose to cut administration costs by a third in real terms, including the running costs of the commissioning consortia when they are established. There will be a constantly tight envelope for running costs, which means that whoever is working for a commissioning consortium, it must deliver value for money.
Hazel Blears (Salford and Eccles) (Lab)
T7. For the 200,000 people in the country with dementia who are currently in residential care, the recent horrific events at Winterbourne View and the financial problems at Southern Cross have caused huge anxiety. The Minister is now proposing to make local authority safeguarding boards mandatory, at a time of huge cuts in social care budgets. What extra resources will he make available to ensure that the system works and protects the most vulnerable people in our country?
Gavin Barwell (Croydon Central) (Con)
T6. Croydon University hospital recently took on responsibility for community care, which will allow much better integration of acute and community services. What scope does my right hon. Friend think exists for wider application of that model in our NHS?
Mr Lansley
As my right hon. Friend the Prime Minister made clear today, we continue to believe that we can achieve more integrated services for patients, and we are determined to do so. That must be at the heart of the way in which reform and modernisation of the NHS deliver improving outcomes for patients. For patients, the results of care, and indeed their experience of it, will be greatly enhanced if it is designed and integrated to meet their needs. We know that that is effective, we know that it works for patients, and we are determined to make it happen. My hon. Friend has given just one example, and an important one, of the way in which hospital and community services can be integrated.
Mrs Mary Glindon (North Tyneside) (Lab)
The Prime Minister has stated this afternoon that competition will be an integral part of patient choice. How will the Secretary of State ensure that all patients are able to make a fully informed choice of treatment when market forces fully exist?
Mr Lansley
I do not accept the hon. Lady’s premise. We do not intend that there should be an unrestricted market—or a free market, as she described it—in the NHS. It is a regulated, social market with powerful regulations governing how the participants in the provision of care meet their responsibilities. We are very clear that competition is a means to an end. It is not an end in itself; it is there to support the integration and delivery of services in the best interests of patients, but it does include giving patients choice. The hon. Lady highlights an important point. In our consultation earlier this year on the information revolution in the NHS, we set out how we felt we could empower patients, including those for whom in the past the NHS has provided a rather impenetrable route to getting the best treatment. I hope that when we respond to that consultation, we will demonstrate how we will make that better for all patients.
Nigel Mills (Amber Valley) (Con)
T10. Does the Minister agree with my constituent Susan Garrity that licensed treatments for multiple sclerosis such as Sativex should be accessible to all people, wherever they live?
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Can the Secretary of State or the Minister confirm whether they will take up the offer from my Front Bench for bipartisan discussions about the future of adult social care—or will he put political interests before the public interest?
Mr Lansley
We were very clear that the commission that we established, led by Andrew Dilnot, should look at the reform of long-term social care funding in such a way as to secure maximum understanding, consensus and agreement. Andrew Dilnot has gone about that process in an exemplary manner, and the right thing for us to do now is await his report, which should then form a basis for taking things forward.
Mr Peter Bone (Wellingborough) (Con)
Does the Secretary of State agree that the competition measures in the Health and Social Care Bill will drive up standards and quality outcomes for the NHS?
Mr Lansley
I am sure that my hon. Friend is aware of the evidence—for example, in reports published by the London School of Economics and by Imperial college, London—on this country’s experience of the Labour party’s implementation of choice in elective care and the impact that had on the quality of services. What is clear from that evidence is that where there was an NHS price—a tariff structure—the more competitive areas of the country secured greater improvements in quality.
Valerie Vaz (Walsall South) (Lab)
I thank the Secretary of State for writing to me on 12 May about the listening exercise and its cost, although he could not quantify that. Now that the listening exercise is over, can he say how much the cost to the public purse has been?
Mr Lansley
I will, by all means, write again to the hon. Lady. The cost is not dramatic. Many organisations and people across the NHS have participated, giving freely of their time. Some 8,000 people have participated in the listening exercise events, of which there were more than 250. This has been immensely valuable; its value far exceeds any costs involved.
Pauline Latham (Mid Derbyshire) (Con)
A constituent of mine who suffers from bowel cancer has so far failed to be funded for Avastin on the NHS via the east midlands cancer drugs fund. She has already spent more than £40,000 of her own money. Her oncologist has written before on her behalf to appeal, but as not one of his appeals has been successful, for her or for any of his other patients, he is reluctant to write again to appeal for her, although she desperately needs this. What assurance can the Secretary of State give my constituent and her consultant?
Mr Lansley
My hon. Friend is assiduous in representing her constituent, and I will gladly discuss this matter further with her to see what the situation is. I should, however, emphasise that these are decisions being made in the use of the resources to deliver access to new cancer medicines for patients by clinical panels in each region—in each strategic health authority. To that extent, I am not seeking to substitute my judgment for that of the senior clinicians involved. None the less, if it would help my hon. Friend I will also arrange for the national clinical director for cancer services to have a discussion with her constituent’s consultant to examine this case.
Mr David Ruffley (Bury St Edmunds) (Con)
The Labour Government paid independent sector treatment centres 11% more, on average, than they were prepared to pay NHS hospitals. Will the Secretary of State confirm that such a practice forms no part of his health reforms?