National Health Service Modernisation Listening Exercise
Lord Lansley Excerpts(12 years, 11 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
On 6 April the Government announced that they would 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 professionals from across health and social care, was established to help drive the engagement process. The eight-week intensive listening period came to its conclusion on 31 May.
In order to hear from as wide a range of people as possible throughout the pause, various methods of engagement were employed. Some 250 events were held and over 8,000 people took part directly in providing their views. These meetings and events were attended by Ministers and NHS Future Forum members and involved over 250 stakeholder organisations, including patient groups, professional bodies and unions, voluntary sector groups and local authorities, as well as patients and members of the public. In addition, strategic health authorities across the country supported the listening exercise by encouraging staff, patients and communities to share their views both online and at their own regional events.
In addition to listening events, people were encouraged to air their comments and concerns through digital channels. The modernisation of health and care website recorded over 2,400 public posts alongside a further 970 privately submitted comments. Feedback was also received through in excess of 500 engagement questionnaires.
The NHS Future Forum is reflecting on what they have heard and will be reporting to the Government shortly. The Government will then respond, setting out the improvements they intend to make to the modernisation plans and the Health and Social Care Bill. The forum’s report will be placed in the Library.
E. coli Outbreak (Germany)
Lord Lansley Excerpts(12 years, 11 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I wish to inform the House of how the Government are taking all possible measures to monitor the serious E. coli 0104 outbreak that is centred in Germany and to assess and deal with any associated risks should any arise for consumers in the UK.
Over the weekend the German authorities indicated the potential source of the outbreak is thought to be a sprouted seed mix consisting of alfalfa seeds, fenugreek, lentil and azuki beans from a farm in northern Germany. This link has been identified through epidemiological studies. However, initial test results reported yesterday (6 June) were negative. The German authorities are carrying out further tests and investigations to try to confirm the source of the outbreak.
I want to reassure the House that I am advised by the UK Food Standards Agency that there is no evidence that any of these products are present in the UK food chain. Information received to date indicates that all of the potentially affected produce was distributed locally in Germany and has been withdrawn from the German market. The 11 cases of illness we have in the UK apparently linked to this outbreak are all in people with a history of recent travel from Germany, and no new cases in the UK have been identified since Friday.
As soon as they heard of the outbreak in Germany, the Department of Health made sure that clinicians in the NHS were alerted to watch out for cases of this illness and the Health Protection Agency issued advice to people travelling to Germany. The Health Protection Agency is also liaising closely with the authorities in Germany and counterparts across Europe.
In addition to the 11 people who have fallen ill in the UK there have been 2,231 reported cases in Germany and 102 elsewhere in Europe, again associated with travel from Germany. The strain of E. coli associated with this outbreak has the potential to cause life-threatening illness and, unfortunately, 21 people in Germany and one person in Sweden have died. My sympathy and condolences go to all those who have suffered in this outbreak.
The Food Standards Agency is in daily contact with the European Commission to ensure that the Government have the most up-to-date information on the ongoing investigations into the source of the outbreak. The Food Standards Agency is also working closely with the Health Protection Agency, which is reporting immediately any cases of illness in the UK associated with this outbreak. Both agencies are in regular contact with the Department of Health, DEFRA and other key partners to maintain an up-to-date assessment of the risk to UK consumers.
I should like to assure the House that immediate action would be taken to alert consumers, withdraw food from shops, and ban imports should the Food Standards Agency suspect that contaminated product associated with this outbreak is in the UK or may be imported into the UK. In the meantime, the clear advice to consumers is that they should follow the usual best practice in preparing and consuming fruit and vegetables, peeling and cooking where this is appropriate or otherwise thoroughly washing fruit and vegetables where these are to be eaten raw. People should also be reminded that washing hands before eating and after handling raw food is always advisable.
I will give further updates to the House on this important issue as new information becomes available.
Future of the NHS
Lord Lansley Excerpts(13 years ago)
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John Healey
No. What I am referring to is the provision in the Bill to allow the job of commissioning to be outsourced to private companies. That has never been done before. It is there in the Bill and it is a big risk for the future.
The Prime Minister made the NHS his most personal pledge before the election.
The Secretary of State for Health (Mr Andrew Lansley)
Will the right hon. Gentleman just be clear to the House and get it accurate? The Bill sets out that commissioning consortia are statutory bodies covering the whole of the country in the public sector. Therefore, if they use private sector commissioning expertise—which the Bill does not require them to do—that is not commissioning responsibility. In the two years leading up to the election, primary care trusts increased their use of management consultancy by 80%, so they did use the private sector, whereas commissioning consortia do not have to.
John Healey
The point about the Health Secretary’s legislation is that it allows consortia to outsource in whole the job of, not the responsibility for, commissioning. He made the point that the consortia are public bodies, but they meet none of the standards of public governance. They can meet in private. As the right hon. Member for Charnwood (Mr Dorrell) has said, that serious job should be done by properly constituted and governed public authorities, but that is a loophole in the Bill.
The Secretary of State for Health (Mr Andrew Lansley)
The right hon. Member for Wentworth and Dearne (John Healey) has not only presented a weak motion to the House but managed to make a weak speech in support of it. The motion is completely silent about the problems that the NHS faced when we came to office. It is completely ignorant of the challenges that the NHS faces, and completely devoid of any recognition of the ongoing efforts of NHS staff to offer the very best standards of patient care, day in and day out. I am happy to make it clear, however, that I support the staff of the NHS every day, as we all must. I am not interested in a motion that ignores that; I am interested in supporting NHS staff to deliver the best possible care for patients.
This debate is supposed to be about the future of the NHS, but the right hon. Gentleman had nothing to say about its future. He wanted to talk only about politics and the Health and Social Care Bill. What happens in the NHS every day is not the same as the content of the Bill, important though that is; it is about quality of care and the outcomes that are being achieved for patients. I will ask the House to reject the motion, because I intend to use the debate to be positive and to show how we will give the NHS a stronger future.
Toby Perkins (Chesterfield) (Lab)
I am glad to hear that the Secretary of State supports the staff of the NHS, but is it not the truth that the staff of the NHS do not support him?
Mr Lansley
That is complete nonsense. This is not about me: it is about what the staff of the NHS want. They want the ability to be able to deliver care for patients without being told what to do by the top-down bureaucracy and targets of the Labour Government. They want the ability to deliver the care that patients need, to join up health and social care and to integrate the pathways of care. Our Bill is about giving them the structure that will allow them to do that. They want every penny that we as taxpayers provide to the NHS to get into the hands of front-line staff, and for the absolute minimum to go in waste and inefficiency. That is what they want, and that is not about me, it is about them.
A stronger NHS will require change, so that it no longer spends £5 billion a year on bureaucracy.
Mr Lansley
Perhaps the hon. Gentleman will explain why all that money was being spent on bureaucracy.
Mr Watts
Given that today and on previous occasions the Secretary of State has claimed that the Government are not trying to privatise our hospitals, will he publish all the documents that have passed between his Department and my NHS trust, because they will demonstrate that that is exactly what he intends to do? He intends to try to privatise my hospital.
Mr Lansley
The hon. Gentleman will know, because the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns) has told him in the past, that when NHS trusts are moving to foundation trust status, there will be an agreement, but it is not about privatisation. When the hon. Gentleman’s party was in government, it said that the only way Hinchingbrooke NHS trust could turn its management around was for it to be prepared to look for the best possible management. That is the extent of what we are talking about, and it was done under his Government.
This will require change. We are not going to spend £5 billion on bureaucracy. We are not going to let the number of managers double in future as it did under Labour, and we are not going to let the number of managers increase six times as fast as the number of nurses. Since the general election, we have 3,500 fewer managers and, as a consequence, 2,500 more doctors and 200 more nurses.
Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)
On 19 March, the interim chief executive of Monitor said that under this Bill, doctors talking to providers about health care would be the same as Marks & Spencer talking to their suppliers about which brand of washing powder to buy. Is that the Health Secretary’s vision for the future of the national health service?
Mr Lansley
No, not at all, and I do not believe that Monitor believes that either. The hon. Lady can see that the proposal in the Bill is clear. It was the Labour Government who established Monitor as a regulator and who introduced competition into the NHS. The Labour Government did all those things, but Monitor’s job is not to impose competition rules but to deliver what is in the best interest of patients.
Mr Graham Stuart (Beverley and Holderness) (Con)
The shadow Secretary of State is a decent man and an experienced Minister. The reason his speech was so weak is that he had no conviction because he has been forced by the union paymasters of the Labour party and of the shadow Leader of the Opposition to deliver the sort of speech previously given by the far left who inhabit the Benches way over there. My right hon. Friend should not listen to those voices; he should press ahead and make a difference for patients, not politicians.
Mr Lansley
I agree with my hon. Friend that the shadow Health Secretary is a decent man, and at the turn of the year he quite decently expressed his support for the Bill’s principles and his understanding that it was consistent, coherent and comprehensive. It makes one wonder what happened to him in the interim. Did the trade unions—the paymasters of the Labour party—get to him and tell him that they did not like the idea that patients should be able to get the care they need or the idea that we should get resources into the front line rather than into the vested interests of the NHS?
What we are going to do is put patient care at the heart of our reforms. We are not going to let hospital productivity continue to decline as it did over the last decade. Under Labour, we saw a 15% decline in productivity, yet we heard nothing from the shadow Health Secretary about that. It is this Government who are taking action to improve hospital performance by changing the way hospitals are paid to reward excellence—for example, by not paying for unnecessary readmissions of patients who are discharged too soon.
Jesse Norman (Hereford and South Herefordshire) (Con)
Hereford hospital is labouring under a very expensive private finance initiative contract. Does my right hon. Friend not think it a tragedy that the last Government cast good sense and good economics away, forcing so many hospitals into PFI?
Mr Lansley
My hon. Friend makes an important point—that it was under the Labour Government that many of these projects were undertaken, and they are leaving an enormous bill in the NHS for future taxpayers and future NHS organisations to meet. A contract is a contract, as the right hon. Gentleman and the House will understand, and we inherited contracts from the Labour Government, many of which were very bad contracts, such as the ones on IT that we have had to renegotiate. Frankly, it is due to my right hon. and hon. Friends in the Treasury and ourselves at the Department of Health that people have been put into the Queen’s hospital in Romford to look at how we can resolve some of these PFI problems and reduce those costs. We need to increase productivity in the NHS and cut out much of the waste in it.
It is us who will usher a new era of transparency into the NHS, shedding light on those areas that the previous Administration sought to cover up. Before the election, how often were patients having to go into mixed-sex accommodation when the rules on single-sex accommodation were breached? We did not know, because when Labour Members were in government they would not tell us. Since we started publishing the data in December, the number of patients put into mixed-sex accommodation without justification has halved.
Mr Pat McFadden (Wolverhampton South East) (Lab)
The Secretary of State talks of service to patients. Does he accept that the amount of time for which patients must wait for treatment is extremely important to them? Does he also accept that the number of people waiting more than four hours to be treated in accident and emergency departments is at its highest for six years, and that the number of people waiting more than 18 weeks for non-urgent operations is at its highest for three years?
The Secretary of State attacks our targets, describing them as “top-down bureaucracy”. Does he not accept that they are actually a guarantee that people who cannot afford to go private and pay will not have to wait in pain, but will be treated within a reasonable time frame?
Mr Lansley
I do not accept the right hon. Gentleman’s premise. Waiting times in the NHS are stable. We had a conversation about that during the last session of Health questions, but perhaps the right hon. Gentleman was not in the Chamber and did not hear it. The average waiting time is nine weeks. The operational standard requires 90% of admitted patients to be seen within 18 weeks—that is in the NHS constitution—and it has been maintained, although the figure was 89.9% in February after a winter during which critical care beds were full because of flu.
The right hon. Member for Wentworth and Dearne talked of four-hour waits in A and E as if the fact that a patient had been discharged within four hours were the only issue. He should go and talk to the families of patients who, in the past, were discharged from the emergency department at Stafford general hospital and left to die.
What matters is how long it is before a patient is seen by a qualified professional, and how long it is before that patient is treated. What about those who leave without being seen? What about those who are not given the care that they need, and have to return to the emergency department? Those are the things that matter to patients, and those are the things that are now part of the accident and emergency quality indicators which, this April, we said that we would publish for the first time. It is we who are focusing on services for patients. Labour Members had 13 years to look at what really mattered to patients and at the real quality of what was delivered to patients, but they did not do it, and we are going to do it.
Nadhim Zahawi
Pausing and listening and getting the detail right are about grown-up politics. Opportunism and flip-flopping are about the Opposition.
Mr Lansley
I give way to my hon. Friend the Member for Gainsborough (Mr Leigh), the former Chairman of the Public Accounts Committee.
Mr Edward Leigh (Gainsborough) (Con)
Sadly, despite massive increases in funding over 15 years, there has been an undoubted catastrophic decline in NHS productivity. Does my right hon. Friend accept that many of us on the Government Benches feel that if we are to save the NHS there is no alternative to more co-operation with the private sector, and that he should stick to his guns?
Mr Lansley
My right hon. Friend made that point when he chaired the Public Accounts Committee, and it should silence Labour Members, because the Public Accounts Committee has said exactly the same thing since the election under the chairmanship of the right hon. Member for Barking (Margaret Hodge)—that productivity in the NHS declined consistently under Labour.
Let me make clear that if we are going to make—[Interruption.]
Mr Speaker
Order. The House is in a very excitable state. The issues are of the highest importance and they provoke strong feelings, but the debate must be conducted in an orderly way, and the Secretary of State is entitled to a decent hearing.
Mr Lansley
Thank you, Mr Speaker.
I remember Labour’s scaremongering during the election about cancer waits, for example, but in 13 years in government they never actually looked at cancer survival rates. They never looked at the results for patients. It took this Government to publish the first outcomes strategy for cancer, which made clear that what matters to patients—
Mr Lansley
I will give way in a moment. That strategy made it clear that what matters to patients is not only how quickly they see a consultant, but whether they survive.
Mr Bradshaw
If things were so terrible under the Labour Government, why was public satisfaction with the NHS at record levels when we left office, and why were waiting times at record lows? Both are now going in the wrong direction. Will the Secretary of State please tell us—we have not yet received an answer to this question—what will happen in those areas now that GP consortia are to be voluntary? He has already abolished the primary care trusts, so who will be responsible?
Mr Lansley
It was also a period during which complaints to the NHS reached their highest ever levels. If we ask the public who they think are best placed to design the services patients need, we will find that the answer is their general practitioners, hospital doctors and nurses, not politicians on either the Government or the Opposition Benches. This is about doctors and nurses being in charge, not politicians.
It took this Government to focus on cancer outcomes. It took this Government to provide the drugs patients need through the cancer drugs fund. Under Labour, patients went without new cancer medicines that patients in every other European country were getting access to. It is this Government who are investing in more diagnostic equipment, and more screening and early diagnosis, so that we get better outcomes.
Angela Smith (Penistone and Stocksbridge) (Lab)
I must say that I admire the consistency with which the Secretary of State defends his proposed legislation. However, will he tell us what he plans to concede, given the threatened veto by the Deputy Prime Minister and the Liberal Democrats?
Mr Lansley
I do not want to correct the hon. Lady, but everything I have been saying up until now has been about defending the NHS and defending our focus on delivering better results by giving the NHS greater front-line devolved responsibility. That is not a matter of debate and disagreement between the coalition parties; we are all in favour of that. The point is this: how can the Bill best support the principles on which we are agreed? I thought the right hon. Member for Wentworth and Dearne and the Labour party were agreed on those principles; that seemed to come out from his interview last week. Indeed, at the end of his speech today I was not quite sure whether or not he agreed with us.
Mr Baron
Given that our cancer outcomes are well below the European average, the need for NHS reform is well established. However, as my right hon. Friend the Secretary of State will know from my having raised the issue with him previously, the entire cancer community will breathe a sigh of relief if the guaranteed funding for cancer networks can be extended to 2014 when the transition period for GP commissioning comes to an end, as we would risk losing a lot of expertise if we were to end it in 2012. Will he address that point?
Mr Lansley
The support for cancer networks will continue during the course of this year and the start of next year, but when the NHS commissioning board takes responsibility for commissioning, including the relationship with consortia, it will need to decide how to manage its commissioning responsibilities. However, as I have told my hon. Friend in the House previously, it is now looking—we will look at this over the coming months—at how it can use networks as a basis for having precisely the kind of commissioning structures we want, and it is my expectation that that would include cancer networks that are not only helpful for providers, but that tie together commissioners and providers in understanding the future strategy for cancer.
Mr Lansley
If my hon. Friend will forgive me, I will give way again a little later, but first I want to make a couple of further points.
The House knows of my commitment to the NHS; Opposition Members know of that, too. They know that I have not spent seven and a half years as shadow Secretary and Secretary of State to see the NHS undermined, fragmented or privatised. They know that that was never my intention; it is not my intention. Before the last election, we were absolutely clear that we would protect the NHS, but we are doing more than just protecting it; we are strengthening it. We are enabling clinicians to lead a more integrated, responsive, accountable NHS—not fragmented, not privatised, not based on access to insurance, and not compromising quality for price—and, equally, an NHS that is not run by a top-down, unaccountable bureaucracy, but that is locally led and locally accountable.
As the right hon. Member for Wentworth and Dearne admitted, this is a comprehensive, consistent and coherent vision, and it is an evolution of the better policies of the last 20 years. It was the last Labour Government who introduced patient choice; we will extend it and give patients the information they need to make it work. It was the last Labour Government who introduced practice-based commissioning; we will make it real, with health professionals designing integrated pathways of care with decision-making responsibilities. It was the last Labour Government who introduced foundation trusts; we will deliver on their broken promise to take all NHS trusts to foundation status. It was the last Labour Government who introduced payment by results, but left it half baked, distorting services and hindering joined-up care; we will change it so that it genuinely supports the best care for patients. Of course, it was the last Labour Government who brought the independent sector and competition into the NHS, but we will not follow their lead by giving the independent and private sector providers the opportunity to cherry-pick services and by giving them financial advantages over NHS providers.
Gordon Birtwistle (Burnley) (LD)
Will the Secretary of State confirm that the meeting patients needs programme put forward by the previous Government, which closed down many accident and emergency units and many children’s wards, will not happen again under this new regime? Will he confirm that that is because local people and local GPs will be consulted first, as opposed to having the programme driven through with no support and no consultation, as under the previous Government?
Mr Lansley
I completely understand and agree with my hon. Friend. I thought it was outrageous for the shadow Secretary of State to say, “Oh, they promised a moratorium and now some closures are taking place.” Why? Because we were left what were, in effect, faits accomplis by the previous Government and it was impossible to change them. [Interruption.] My hon. Friend the Member for Maidstone and The Weald (Mrs Grant) would feel the same as my hon. Friend the Member for Burnley (Gordon Birtwistle).
Andrew George
I can confirm that we agree on the issue of principle and that I am not questioning the Secretary of State’s personal commitment. The issue remains one mentioned in the motion: the extent to which the policy in the Health and Social Care Bill is not just another top-down reorganisation of the sort that the coalition Government said they would stop and the extent to which the policy being driven through Parliament, on which a listening exercise is taking place, delivers what is in the coalition agreement. The debate is about the extent to which the Bill reflects the coalition programme agreement.
Mr Lansley
My hon. Friend will know that the coalition agreement supports, in essence, all the principles of the Bill, with the exception of the specific consequence of the abolition of the strategic health authorities and primary care trusts. As with the whole of the Bill and its related measures, that proposal was the subject of collective agreement and it flows directly from the belief, shared not least by him and his Liberal Democrat colleagues, that we need much stronger local democratic accountability in the NHS. We are constructing health and wellbeing boards as an integral part of local authorities, and he will know that the overwhelming majority of local authorities which have volunteered to be early implementers of that approach believe precisely that democratic accountability is an essential part of the future of the NHS.
Mr Lansley
Let me just make some progress. We need this modernisation for the NHS because of the challenges it faces in the future. We need to deliver £20 billion of efficiencies over the next four years. I remind the House that that requirement was set out originally under a Labour Government in 2009 without the merest hint of irony—I say that given that they created the inefficiencies in the first place. Today, I can give the House some figures that the Labour party would wish that people did not know. If Labour’s spending plans for the NHS at the last election had been implemented over this spending review period, the NHS budget would have been cut by £30 billion compared with what we have put into the NHS over the spending review period. So let the right hon. Member for Wentworth and Dearne get up now and explain: how was the NHS going to deal with £20 billion of efficiencies while he was cutting £30 billion out of it, instead of it getting the extra £11.5 billion it is getting from taxpayers through this coalition Government?
John Healey
After 20 minutes of the Health Secretary’s speech, the hon. Member for St Ives (Andrew George) finally brought him to his own plans and he was clearly very uncomfortable. What does he say when the Prime Minister wonders how he got the Government into such a mess over his plans? What does he think of the chair of Monitor’s observation that the approach being taken is a combination of
“previously unannounced policies, a complete failure to build the necessary political and professional consensus and an apparent disdain for the detailed planning of implementation”?
That was said by one of the Government’s allies.
Mr Lansley
I suppose the one thing the right hon. Gentleman has learned about being in opposition is that it is best for a party to try to forget everything that it did in government, because it will not be held to account for it. He has also recognised that the best thing is to have no ideas of his own. He does not even seem to know whether he agrees with our ideas or opposes them. We do not have any answers from him. The right hon. Gentleman’s quotation was from the former, not current, chair of Monitor, who knows perfectly well that these measures were in our respective manifestos and were brought together in the coalition agreement. They have a mandate. From my point of view, this is not just about the electoral mandate but about how we can deliver the best care for patients and see through principles that I thought the right hon. Gentleman’s party, as well as ours, believed were right.
Let me make it clear that the challenges in the NHS are about more than just clearing up Labour’s mess. We must recognise that there are now more pensioners than children under 16, alcohol-related admissions to hospital have doubled and emergency admissions have risen by 12% in just four years. Obesity in this country has doubled in the last 25 years. Under Labour, the demand for health care was rising while productivity was falling. The only way that Labour could cover those risks was by massively increasing the budget and that is no longer an option. Mounting pressure on the NHS is inevitable and the status quo, as Labour recognises, is not an option. The NHS needs modernisation.
Nadine Dorries (Mid Bedfordshire) (Con)
Will the Secretary of State give us an update on the tally of the number of GPs who have signed up to the new consortia to support the NHS reforms?
Mr Lansley
Yes, I will. Some 220 pathfinder consortia have come forward, representing the equivalent of 45 million patients across England—that is, 90% of the population. They are not obliged to do so. They have volunteered to come forward to demonstrate that they can deliver better services for patients.
Mr Speaker
Order. I am going to try to be helpful to the hon. Member for Easington (Grahame M. Morris). When a Minister gives no indication of giving way, a Member must not simply stay on his or her feet. The situation is clear: the Secretary of State is not giving way at the moment. Once again, I appeal for the restoration of some sort of calm. The Secretary of State should be heard with a degree of civility—[Interruption.] Order. I ask Members to reflect on how our proceedings are regarded by members of the public whose support we sought not that long ago.
Mr Lansley
Thank you, Mr Speaker.
The principles we are pursuing are simply stated as
“a greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes”.
The right hon. Member for Wentworth and Dearne will no doubt recognise those words, because they are his own from January, when he said that he supported the general aims of our reform.
We are already delivering on our vision. We are extending patient choice and involving patients more in decisions about their care. We are cutting back Labour’s waste and reducing the bureaucracy that stifles and undermines doctors and nurses. We are putting clinicians at the heart of commissioning, with almost 90% of the country now covered by new pathfinder consortia.
We are driving down hospital-acquired infections, sustaining and improving the performance of the NHS, stopping Labour’s arbitrary box-ticking and focusing on the outcomes that matter. We have a world-leading framework for the results that matter to patients: reducing avoidable mortality; enhancing recovery after treatment; improving quality of life for those with chronic conditions; maximising safety and cutting the number of infections; and continually improving patients’ experience of their health care. Those are the outcomes for which we and the NHS will be accountable.
Let me be clear: there will be substantive changes to the Bill to deliver improvements for patients. There is only one issue for me, however: will it deliver better care for patients? That is why we will pursue NHS modernisation and why we will stick to our principles. It is why we are listening to improve the Bill. That is what the coalition Government are committed to. Today, led by the NHS future forum, we are engaging with the health service and beyond to ensure that the legislation delivers on those principles.
Unlike the Labour party, which has retreated to its union-dominated, regressive past, we will not retreat. We will be progressive with those principles. Just last week, the right hon. Gentleman called for a return to Labour’s top-down targets and for GPs to be stripped of all their financial responsibility. He has called for the NHS to be run by a bureaucracy, not by doctors and nurses. Critics of the Bill must answer this question: if they do not want patients, doctors and nurses to be in charge of the NHS, then who do they want to be in charge?
The right hon. Gentleman has turned his back on two decades of NHS modernisation. We will never accept the Labour party’s prescriptive, top-down bureaucracy or its waste. We did not accept Labour’s plan, which would have meant taking £30 billion out of the NHS in England over this Parliament and we will not follow the route that the Labour party in Wales has taken, where it is cutting the NHS. Instead, we are increasing the NHS budget over this Parliament by £11.5 billion. We will equip the NHS to deliver better and improving services by using more resources more effectively. We will empower patients with information and with choice. We will empower doctors and nurses to shape services for their patients. We will bring together the NHS, public health and social care in a combined local strategy. We will make the NHS genuinely locally led, while meeting national standards. We will focus relentlessly on the quality and outcomes we achieve for patients. We will protect the NHS and strengthen it. We will do that not by living in the past, but by modernising for the future. We want a modern service that is true to its core values. The Labour party’s motion offers no future for the NHS. We on the Government side will give the NHS a stronger future, and I urge the House to reject the Labour party’s motion.
Oral Answers to Questions
Lord Lansley Excerpts(13 years ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Simon Hughes (Bermondsey and Old Southwark) (LD)
3. What processes he has put in place to allow lay members of the public and elected public representatives to contribute to discussions on the reform of the NHS.
The Secretary of State for Health (Mr Andrew Lansley)
Following formal consultation last year, and as I told the House on 4 April, we are taking this opportunity to pause, listen, reflect and improve the Health and Social Care Bill. A total of 119 events have already been organised centrally, and the regional and local NHS will organise many more. Those events will allow us to hear a full range of views from professionals, the public and patients.
Simon Hughes
The Health Secretary knows that colleagues welcome the pause and the opportunity to reflect on what changes might be beneficially made to the legislation. Will he assure us that lay people and elected representatives, such as councillors and others, will be fully engaged in the process? The professionals have had their say, and they have very strong views, but the patients and elected people need to have their say, too.
Mr Lansley
Yes. I am grateful to my right hon. Friend, and I can give him that assurance. Indeed, one reason why it is important to pause and to listen now is not least that shadow health and wellbeing boards have been put forward by 90% of relevant local authorities in England, and it is an opportunity for them to be very clear about how we can improve patient and public accountability. I hope that they and others will take that opportunity. As my right hon. Friend knows, the Bill already substantially improves both the public and the patient voice in the NHS, and we have to ensure that we take every opportunity now further to improve it.
Mr Kevin Barron (Rother Valley) (Lab)
If the Government do come back with some major changes to the Bill, will those changes go out to public consultation, and will this House have the opportunity to oversee and to look in detail at any further proposals they may make?
Mr Lansley
I think I made it clear to the right hon. Gentleman in the House on 4 April that we were looking to pause, to listen, to reflect and to improve the Bill, and we are taking the opportunity to do so now, before Report and Third Reading.
Mr Stephen Dorrell (Charnwood) (Con)
Can my right hon. Friend confirm that in the listening exercise it is his intention, in addition to listening to representatives of local authorities and the public, to ensure that we fully take account of the views of representatives of the full range of clinical opinion within the health service—nurses, hospital doctors and community-based clinicians as well as GPs?
Mr Lansley
Yes. My right hon. Friend will know that we have done that in the past, and we continue to do so. Just as early implementers of health and wellbeing boards have an important voice in how local authorities will strengthen public accountability and democratic accountability, we also now have an opportunity that we did not have in the consultation last year for the new pathfinder consortia, as they come together—88% of the country is already represented by them—to have their voices heard. I hope that the public generally will exercise this opportunity too. I know that groups representative of patients are doing so and very much want to get involved in these discussions.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The Secretary of State will be aware that if Lib Dem MPs were seriously opposed to this reorganisation, they could have voted against it on Second Reading—so how can he expect the public to take these discussions and the listening exercise seriously? Are they not just a device to get the coalition through the May elections, and is he not determined to get away with as little substantive change as he can manage?
Mr Lansley
On the contrary—the hon. Lady should know, because I made it clear on 4 April, that my objective, and that of the Prime Minister, the Deputy Prime Minister and all of the Government, is further to strengthen the NHS, and we will use this opportunity to ensure that the Bill is right for that purpose. The reason Government Members supported the Bill on Second Reading, and Labour Members should have done so, is that, as the right hon. Member for Wentworth and Dearne (John Healey) said, the general aims of reform are sound.
Mark Pritchard (The Wrekin) (Con)
As part of the listening exercise, will the Secretary of State confirm that the public, patients and medical professionals will be listened to? Many of them want to see root-and-branch reform of the NHS in order to improve its effectiveness and efficiency and improve patient outcomes.
Mr Lansley
Yes, my hon. Friend is right. We have an opportunity, which we want to realise to its fullest potential, to improve many of the ways in which patients and the public are involved. For example, we want to arrive at a point where patients feel that the invariable response of the NHS to their need is that there is no decision about them without them. We are proposing in the Bill to strengthen the scrutiny powers of local authorities. We are also proposing to bring in a patient voice through HealthWatch and HealthWatch England that has not existed since the Labour Government abolished community health councils, and we are going to strengthen substantially democratic accountability through health and wellbeing boards.
Keith Vaz (Leicester East) (Lab)
4. What his policy is on funding for a national framework and quality of service guidelines for diabetes patients.
Chris White (Warwick and Leamington) (Con)
9. What steps he is taking to maintain front-line services in the NHS.
The Secretary of State for Health (Mr Andrew Lansley)
We are increasing funding for the NHS in each year of this Parliament, amounting to an increase of £11.5 billion over its course. Over the next few years, planned improvements in the efficiency of use of NHS resources, increasingly led by front-line staff, will support modernisation of the NHS to respond to rising demand and new technologies. Not least, we are cutting administration costs across the system by one third, saving £1.7 billion a year, every penny of which will be available for reinvestment in front-line services.
Chris White
Will the Secretary of State join me in praising the work of chief executive, Glen Burley, and the excellent team of health professionals at Warwick hospital, who are improving community care while seeking to reduce management costs? Will the Secretary of State also take the opportunity to visit Warwick hospital to discuss how those things can be done at local level?
Mr Lansley
I am glad to endorse my hon. Friend’s congratulations to the staff and team at Warwick hospital. I hope to have an opportunity to visit that hospital at some future date. Across the NHS, we are setting out not least to increase productivity and efficiency, stimulate innovation, reduce administration costs and put more decision-making responsibility into the hands of those who care for patients, which the Labour party failed to do.
Clive Efford (Eltham) (Lab)
How can the Secretary of State convince people that he is protecting front-line services when a flagship Bill such as the Health and Social Care Bill is in such disarray? While he is pausing and listening and reflecting on that Bill, will he also consider whether the House will have a further opportunity to consider his reflections, because we are through the Committee stage? Will there be another Committee?
Mr Lansley
The hon. Gentleman misses the point that what matters to the public is the quality of services that are provided to them. When he asked his question, he might have reflected on the simple fact that the Labour party told us before the spending review to cut the budget of the NHS. We refused to do that, which means that this financial year, £2.9 billion more will be available for the NHS to spend than it spent last year.
Harriett Baldwin (West Worcestershire) (Con)
A crucial front-line service is the provision of stroke care. Can the Secretary of State confirm that under his proposed reforms, local clinical practitioners will have much more influence over the location of those stroke services than in the current situation, when management can make somewhat arbitrary changes?
Mr Lansley
Yes, I can confirm that. We are looking for commissioning consortia not only to lead from a primary care perspective on behalf of patients, but to work on commissioning services with their specialist colleagues. Of course, the stroke research network has formed a strong basis upon which such commissioning activity can take place.
There have been many improvements in stroke care. Over the last year, we have seen a significant improvement in performance in relation to responses to transient ischaemic attack, and I hope we continue to see improvements in future.
Liz Kendall (Leicester West) (Lab)
Last year, the Prime Minister made a very clear pledge to protect front-line NHS services. Will the Secretary of State confirm that in the run-up to next year’s Olympics, which will bring around 1 million extra people to the capital, the London ambulance service is cutting 560 front-line staff? Will the Secretary of State also confirm that nationally, A and E waits of more than four hours are up 65%, that the number of patients waiting more than six weeks for their cancer test has doubled, and that more patients are waiting for longer than 18 weeks than at any time in the last two years? Will he now admit that the Prime Minister’s pledge to protect front-line care is unravelling even faster than the Secretary of State’s chaotic Health and Social Care Bill?
Mr Speaker
There were three questions there, but I know that the Secretary of State will provide a characteristically succinct reply.
Mr Lansley
Thank you, Mr Speaker. None of those questions reminded the House that the Labour party wanted to cut the budget of the NHS, nor that in Wales, a Labour-led Welsh Assembly Government are cutting the NHS budget in real terms—there is no increase at all.
Let me tell the hon. Lady that waiting times in the NHS are, on average, nine weeks for patients who are admitted and three and a half weeks for those who are not admitted. That is broadly stable.
The hon. Lady will know that the chief executive of the London ambulance service, Peter Bradley, has made it clear that the ambulance service, like the NHS, needs to maintain front-line services while continually improving efficiency. That will happen in the ambulance service and it will happen right across the NHS.
Neil Parish (Tiverton and Honiton) (Con)
11. 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)
I am delighted that nearly 90% of the country is now covered by pathfinder consortia, including my hon. Friend’s constituency, where the eastern Devon consortia chairs board pathfinder is up and running. I know that one area on which these emerging consortia are focusing is providing better, more flexible services for patients in community settings. We are supporting all the pathfinders through the pathfinder learning network, which is already showing a wide range of examples of where clinician-led commissioning is delivering benefits for patients.
Neil Parish
I welcome the Secretary of State saying that the consortium in my constituency is up and running. Will he also take this opportunity to ensure that through these consortia patients can get better access to their doctors? Labour paid doctors a great deal more money, but patients actually got less access to their doctors.
Mr Lansley
That, indeed, will be one of the areas on which the quality and outcomes framework for individual GP practices will focus. In addition, however, through the commissioning outcomes framework for the NHS as a whole, one area in which we want to see continuing improvement in quality is patient experience and outcomes as reported by patients. GPs and their clinical colleagues will therefore be incentivised continuously to improve quality.
Valerie Vaz (Walsall South) (Lab)
Can the Secretary of State tell us how much this consultation exercise is costing the public purse?
Mr Rob Wilson (Reading East) (Con)
The Secretary of State knows that many of us have received e-mails from constituents, the majority of which have been cut and pasted from a left-wing website. The impression given of the role of the GP consortia bears little relationship to that of GP leaders in my constituency such as Elizabeth Johnston. Will he confirm that he will listen very carefully to the experience and expertise of my local GP leaders, and not a left-wing motivated campaign?
Mr Lansley
My hon. Friend will know, like I do, that his GPs in Reading have already commissioned a new care pathway for people with lower back pain, which means that instead of having to go to hospital appointments, patients can be seen in their own homes by physiotherapists or occupational therapists offering practical advice and assistance in managing pain. Those are practical steps led by front-line staff, the purpose of which is to improve care for patients.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
12. What arrangements he has made for continuity of provision of existing hospital services under his proposed reforms of the NHS; and if he will make a statement.
Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)
16. What amendments he plans to table to the Health and Social Care Bill.
The Secretary of State for Health (Mr Andrew Lansley)
As I told the House on 4 April, we are taking the opportunity presented by a natural break in the legislative process to pause, listen, reflect and improve our plans for modernisation of the health service. We will consider what amendments are required in the light of this.
Jonathan Reynolds
The Health and Social Care Bill is undoubtedly one of the most controversial pieces of legislation being proposed by the coalition. May I push the Secretary of State a little further on some of the answers that he has given my hon. Friends and ask him exactly how he will ensure adequate parliamentary time to scrutinise the amendments that he will bring forward?
Mr Lansley
I am not sure that I necessarily subscribe to the hon. Gentleman’s premise. This issue is important and it warrants the kind of attention that we are giving to it, and there is an opportunity to listen, reflect and improve the Bill because we want to ensure that we can thereby strengthen the NHS. On strengthening the NHS, I am surprised that the hon. Gentleman did not take the opportunity to refer to the £12.9 million increase in the budget for Tameside and Glossop PCT this year—something that Labour would not have offered. The truth is that we are going to strengthen the NHS through the Health and Social Care Bill, as we are strengthening it through our commitment to the priorities of the NHS.
David Tredinnick (Bosworth) (Con)
Has my right hon. Friend had any further thoughts on the effect of HealthWatch England’s representatives being included in local health and wellbeing boards? Does he think that the provisions are sufficiently robust to ensure that they have an impact on commissioning?
Mr Lansley
As my hon. Friend knows, we intend health and wellbeing boards to bring together HealthWatch, plus councillors, commissioning bodies and providers, as part of the process of local representation, so that we can link up NHS commissioning with public health and social care, to see how they collectively meet the joint strategic needs assessment led by the local authority.
Derek Twigg
Thank you, Mr Speaker. I think there was some confusion between questions 13 and 16.
We obviously want to see important improvements to the Bill, including the deletion of part 3, which drives competition to the heart of the NHS, and of clause 150, which removes the private patients’ income cap. I also want to ask the Secretary of State a specific question. On 16 March, during the Bill’s passage through the House, the Prime Minister said to the Leader of the Opposition:
“Perhaps he would like to…support our anti-cherry-picking amendment.”—[Official Report, 16 March 2011; Vol. 525, c. 292.]
Will the Secretary of State tell us whether it is still the Government’s policy to table such an amendment in this House, or whether they intend to do so at a later stage?
Mr Lansley
As I said earlier, when we have completed this process of listening and reflecting, we will table amendments to the Bill. I will tell the House about them then, just as I told them on 4 April that we were going to go through this process. Let me make it clear that we are intending not to allow cherry-picking. We intend to make it absolutely clear to the private sector or anybody else that they must not be able to compete with the NHS on uneven terms because, actually, that is what the last Labour Government did. Under that Government, we ended up with £250 million being spent on operations in private hospitals that never took place because of the poor nature of the private sector provision that they put in place. We are not introducing competition into the NHS through this Bill. Why does the hon. Gentleman suppose that the last Labour Government set up the competition and co-operation panel, if not—
Mr Speaker
Order. I am grateful to the Secretary of State. I call Diana Johnson.
James Morris (Halesowen and Rowley Regis) (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.
James Morris
The Alzheimer’s Society predicts that by 2021, there will be a million sufferers from dementia in this country. Will the Secretary of State reassure my constituents that those people suffering from it will get the support they need—now and in the future?
Mr Lansley
Yes, I can tell my hon. Friend that the response to dementia is a key priority for this coalition Government. I think we have already demonstrated it in our commitment to dementia research. We need to improve both earlier diagnosis of dementia and the possibilities for treatment. We have demonstrated our commitment to improving standards in dementia care, both in hospitals and in care homes, and, indeed, in the further work we have done on reducing the use of anti-psychotic medicines.
John Healey (Wentworth and Dearne) (Lab)
How does the Health Secretary square the Prime Minister’s promise to pause in his changes to the NHS with the NHS chief executive saying a week later:
“I want to stress very firmly that we need…to maintain momentum on the ground.”
With the Government’s health Bill, are we not seeing both rushed pre-legislative implementation and confused post-legislative policy making? If the Prime Minister really gets cold feet about his NHS changes, let me ask the Health Secretary for a fourth time whether the Government will guarantee the extra time needed for this House to examine the changes fully?
Mr Lansley
Let me be clear about the right hon. Gentleman’s point. Both things are entirely compatible because there are 220 GP-led consortia that have come together as pathfinders to demonstrate how they can improve commissioning and the service to their patients; 90% of local authorities have come together in health and wellbeing boards; while at the same time, we have to deliver the challenge of improving productivity, quality and efficiency. All of that requires us, on the ground, to continue the momentum of improvement for patients. At the same time, we are listening not least to all those clinicians and members of the public who want to be sure that the Bill will provide them with the opportunities for involvement and the safeguards they are looking for in the NHS in the future.
John Healey
The Health Secretary ducked for the fourth time this afternoon the question of whether he will do right by this House in allowing sufficient time for proper scrutiny of any changes to the Bill that come forward. While he is listening, will he consider the risks he is running with the NHS? The Prime Minister promised a real rise in NHS funding, yet this year more than nine out of 10 hospitals are faced with cutting costs by more than 4%; one in seven by more than 8%; while nearly £2 billion for patient care is being held back to cover the costs of the internal NHS reorganisation. Will he admit that this reorganisation is now piling extra pressure on NHS funding and services so that patients are seeing waiting times rise, operations cancelled and front-line staff jobs cut as the NHS starts to go backwards again under the Tories?
Mr Lansley
I find the hon. Gentleman’s cheek astonishing. It was his party which, before the election, announced its intention of making up to £20 billion of efficiency savings, it was his party which told us after the election that the NHS should be cut, and it is his party which is actually cutting the NHS in Wales. It is the coalition Government who have made decisions that will give the NHS £2.9 billion—a 3% cash increase—and, because of the way in which we are tackling the costs of management, will put more people on the front line. Following the election, there are 3,500 fewer managers and 2,500 more doctors and nurses.
Greg Mulholland (Leeds North West) (LD)
T2. The Secretary of State is well aware of concern in the Yorkshire area about the review of children’s heart units, and I thank him for his recent letter, but does he accept that there is a contradiction between the logic applied to the south of England and that applied to the north, where 14 million people rely on the fact that the children’s heart unit in Leeds is only a two-hour drive away?
Mr Lansley
I should make it clear that the review is being led by the Joint Committee of Primary Care Trusts, not by the Department of Health, and that it is being conducted by an independent team who are employing an independent consultative process. My colleagues and I have made no decisions so far, but we will expect all the points made by the hon. Gentleman and others throughout the country about paediatric cardiac surgery to be taken fully into account in the consultation.
Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)
T4. The Secretary of State will be aware that, according to the quarterly monitoring report from the King’s Fund, waiting times have hit a three-year high. Does he accept that that is a direct result of his actions, particularly the abolition of the centrally managed target in June last year?
Mr Lansley
I can tell the hon. Gentleman that waiting times in the NHS are stable. The average waiting time for patients who are admitted to hospital is nine weeks, and the average waiting time for out-patients is three and a half weeks. I think that people in the NHS might reasonably say that it is not fair to cite February 2011, when patients waiting for elective operations could not be admitted because critical care beds were occupied in the immediate wake of a severe winter and the largest flu outbreak since 1999.
David Morris (Morecambe and Lunesdale) (Con)
T3. According to recent press reports, hospitals have used money earmarked for front-line NHS services to pay salaries to trade union officials. Does my right hon. Friend consider it acceptable to spend taxpayers’ money on paying union hatchet people, and will he order an investigation?
Diana Johnson (Kingston upon Hull North) (Lab)
T6. Given that, according to the King’s Fund, waiting times are increasing as a result of the reorganisation, does the Minister expect things to improve now that the financial squeeze is starting to bite?
Mr Lansley
As I have already explained, I do not accept the premise; but would the hon. Lady apply the same logic to the fact that the number of cases of hospital-acquired and health care-acquired infection has fallen substantially over the past year, the fact that access to services for strokes and transient ischaemic attacks has improved, and the fact that diabetic retinopathy and bowel cancer screening are improving? Would she argue that those developments are a result of our reforms? No, because our reforms have not been implemented., but we are making the investment in the NHS that the Labour party would not make, and we are giving the NHS the credit, which the Labour party would not do.
John Mann (Bassetlaw) (Lab)
T7. If Bassetlaw council refers the reconfiguration of accident and emergency, paediatric and maternity services at Bassetlaw district general hospital to the Secretary of State, what criteria will he use to make a decision?
Mr Lansley
Under those circumstances, if a referral is made to me, I will wish to apply the kind of criteria that I set out last year for reconfigurations across the country for the first time: that they must meet the tests of being consistent with the result of any public consultation and with the public’s view, with the views of prospective future commissioners—such as the commissioning consortia that are coming together as a pathfinder in the hon. Gentleman’s constituency—and with the future choices made by patients about where and how they want services to be provided to them, and that they must meet clinical criteria for safety and quality.
Philip Davies (Shipley) (Con)
May I join my hon. Friend the Member for Leeds North West (Greg Mulholland) in urging the Secretary of State to protect the children’s heart unit at Leeds hospital as it is a very worthwhile facility for people in Yorkshire, and does my right hon. Friend the Secretary of State agree with me that doctors should go to where the patients are, rather than the other way around by expecting patients to travel for many hours to get to such an important service?
Mr Lansley
I am grateful to my hon. Friend for his question, but in response I will simply reiterate what I said to our hon. Friend the Member for Leeds North West: that these matters are currently the subject of consultation by an independent group representing the primary care trusts collectively, and not by the Department of Health at this stage.
Yvonne Fovargue (Makerfield) (Lab)
T8. Given the concerns of researchers and medical research charities and their belief that the research provisions in the Health and Social Care Bill should be strengthened, what discussions has the Secretary of State had with the medical research community during this pause?
Mr Lansley
The hon. Lady will know that the Health and Social Care Bill does make specific provision for NHS organisations to have regard to the needs for research. She will, I hope, also be very well aware that, by virtue of decisions made by this Government in the spending review, we have been able to sustain the level of research in the NHS. In particular, I was recently able to announce a new 30% increase in funding for translational research funded through the NHS.
Dr Julian Lewis (New Forest East) (Con)
When the consultation on the future of children’s heart surgery units is complete, will the Secretary of State bear it in mind that it would be a preposterous and perverse conclusion that the unit in Southampton, which is one of the two best in the country, should be threatened with closure?
Mr Lansley
I am, of course, aware of these issues, which have been raised by colleagues on both sides of the House. At this stage, may I simply reiterate that the consultation team should consider the points that I know my hon. Friend and others are making to it? After the consultation team has fully reflected on all the points, I hope Members will be able to see that it has fully taken them into account in whatever proposals it brings forward.
Gavin Shuker (Luton South) (Lab/Co-op)
T9. The Secretary of State has just appeared to blame the rise in waiting times on, as it were, the wrong kind of snow. Can we infer from that that if waiting times continue to rise over the coming months, he will reinstate the targets that brought waiting times down and kept them low?
Mr Lansley
The point I made was that average waiting times are stable. Maximum waiting times continue to be a right of patients under the NHS constitution. I recommend that the hon. Gentleman should go to Luton and Dunstable hospital and discuss with the staff there how they dealt with a combination of circumstances that led to there being unprecedented pressure on critical care beds. He must know that if hospitals do not have critical care beds immediately available, it is not in the patients’ interests for the hospitals to bring some patients in for elective surgery. That had an inevitable consequence on waiting times for a small minority of patients.
Annette Brooke (Mid Dorset and North Poole) (LD)
I have received representations from constituents regarding the reclassification by the primary care trust of elderly relatives for continuing health care funding, with severe needs apparently becoming moderate over time. Does the Secretary of State share my concern about this, and how widespread is this practice in the current climate?
Stuart Andrew (Pudsey) (Con)
May I join my hon. Friends the Members for Leeds North West (Greg Mulholland) and for Shipley (Philip Davies) in supporting the children’s heart unit in Leeds? If the review fails to take full account of, and reflect on, the issues raised, what steps will the Secretary of State take to ensure that that is done so that we can fully understand the problems that would face families in Yorkshire?
Mr Lansley
I understand my hon. Friend’s concern and that of colleagues in other locations across the country. If—I repeat the “if”—the consultation were not to arrive at what he or others in any specific location regarded as justified conclusions, it would be open to them, as this is a service reconfiguration of the NHS, to seek a referral of the proposal to me as Secretary of State.
Jim Shannon (Strangford) (DUP)
Diabetes UK has a strategy to reduce the number of people with diabetes across the whole UK. Will the Minister tell the House what discussions he has had with the Northern Ireland Assembly—the matter is devolved in Northern Ireland—to ensure that the strategy of prevention, awareness and education is followed across the whole of the UK?
Duncan Hames (Chippenham) (LD)
Professional autonomy need not come at the expense of transparency in the provision of public services. Given that the Department for Education was able to extend the Freedom of Information Act to academy schools, does the Minister agree that it would be healthy for the Act to apply also to GP consortia in the NHS?
Mr Lansley
I am grateful to my hon. Friend for that. The Health and Social Care Bill establishes the commissioning consortia as public statutory bodies and, as such, that Act will apply to them.
Stephen Twigg (Liverpool, West Derby) (Lab/Co-op)
As part of his consultation exercise on NHS reform, the Secretary of State recently visited Liverpool, where he met nurses. When he was listening to the nurses at the Royal College of Nursing conference, what did he hear?
Mr Lansley
I heard many things, including the nurses’ concerns about front-line services, which I share; Dr Peter Carter has said time and again that he is very worried that the NHS might go through a process of trying to salami-slice services to the detriment of patients when it is actually possible to deliver greater efficiency through cutting out waste, administration and bureaucracy. I agree with many of the things I heard and I want to make sure, as a matter of urgency, that right across the country that efficiency is achieved and we do not act to the detriment of front-line services.
Richard Graham (Gloucester) (Con)
Will the Secretary of State join me in congratulating GP practices in Gloucestershire, all of which have decided to participate in the single consortium taking forward the commissioning of health services? Will he reassure those of my constituents who still have concerns that this whole process is about protecting front-line services and that it is absolutely not about the back-door privatisation of the NHS?
Mr Lansley
Yes. My hon. Friend makes an extremely important point and his pathfinder consortium in Gloucestershire is focused on how it can deliver more integrated services. One of the things that we are looking for is the integration of services, which has not happened sufficiently in the past. In Gloucestershire, both in the commissioning consortium as it comes together and in the work done by the local authority, we can see how, on the ground, there is determination and enthusiasm to make the modernisation of the NHS work for patients. We must ensure that the legislation supports it.
NHS Reform
Lord Lansley Excerpts(13 years, 1 month ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Andrew Lansley)
With permission, Mr Speaker, I should like to make a statement about NHS modernisation. Modernisation of the national health service is necessary, is in patients’ interests and is the right thing to do to secure the NHS for future generations. The Health and Social Care Bill is one part of a broader vision of health and health services in this country being among the best in the world; world-leading measurement of the results we achieve for patients; patients always experiencing “No decision about me without me”; a service where national standards and funding secure a high-quality, comprehensive service available to all, based on need and not the ability to pay; and where the power to deliver is in the hands of local doctors, nurses, health professionals and local communities.
The House will know that the Bill completed its Committee stage last Thursday. I was also able to announce last week that a further 43 GP-led commissioning consortia had successfully applied to be pathfinder commissioning groups. We now have a total of 220 groups representing 87% of the country; that is 45 million patients whose GP surgeries are committed to showing how they can further improve services for their patients. In addition, 90% of relevant local authorities have come forward to be early implementers of health and well-being boards, bringing democratic leadership to health, public health and social care at local level.
That progress is very encouraging. Our desire is to move forward with the support of doctors, nurses and others who work in the NHS and make a difference to the lives of so many of us, day in and day out. However, we recognise that the speed of progress has brought with it some substantive concerns, expressed in various quarters. Some of those concerns are misplaced or based on misrepresentations, but we recognise that some of them are genuine. We want to continue to listen to, engage with and learn from experts, patients and front-line staff within the NHS and beyond and to respond accordingly. I can therefore tell the House that we propose to take the opportunity of a natural break in the passage of the Bill to pause, listen and engage with all those who want the NHS to succeed, and subsequently to bring forward amendments to improve the plans further in the normal way. We have, of course, listened and improved the plans already. We strengthened the overview and scrutiny process of local authorities in response to consultation, and we made amendments in Committee to make it absolutely clear that competition will be on the basis of quality, not price. Patients will choose and GPs will refer on the basis of comparisons of quality, not price.
Let me indicate some areas where I anticipate that we will be able to make improvements, in order to build and sustain support for the modernisation that we recognise is crucial. Choice, competition and the involvement of the private sector should only ever be a means to improve services for patients, not ends in themselves. Some services, such as accident and emergency or major trauma services, will clearly never be based on competition. People want to know that private companies cannot cherry-pick NHS activity, undermining existing NHS providers, and that competition must be fair. Under Labour, the private sector got a preferential deal, with £250 million paid for operations that never happened. We have to stop that. People want to know that GP commissioning groups cannot have a conflict of interest, are transparent in their decisions, and are accountable not only nationally, but locally, through the democratic input of health and well-being boards. We, too, want that to be the case. People want to know that the patient’s voice is genuinely influential, through HealthWatch and in commissioning. Doctors and nurses in the service have been clear: they want the changes to support truly integrated services, breaking down the institutional barriers that have held back modernisation in the past.
As I told the House on 16 March, we are committed to listening, and we will take every opportunity to improve the Bill. The principles of the Bill are that patients should always share in decisions about their care; that front-line staff should lead the design of local services; that patients should have access to whichever services offer the best quality; that all NHS trusts should gain the freedoms of foundation trust status; that we should take out day-to-day political interference, through the establishment of a national NHS commissioning board and through strong independent regulation for safety, quality and effectiveness; that the public’s and patients’ voices must be strengthened; and that local government should be in the lead in public health strategy. Those are the principles of a world-class NHS which command widespread professional and public backing. All those principles will be pursued through the Bill, and our commitment as a coalition Government to them is undiminished.
We support and are encouraged by all those across England who are leading the changes nationally and locally. We want them to know that they can be confident in taking this work forward. Our objective is to listen to them and support them, as we take the Bill through. No change is not an option. With an ageing and increasing population, new technologies and rising costs, we have to adapt and improve. Innovation and clinical leadership will be key. We want to reverse a decade of declining productivity. We have to make productive care and preventive services the norm, and we must continue to cut the costs of administration, quangos and bureaucracy. The House knows my commitment to the national health service and my passion for it to succeed. To protect the NHS for the future must mean change—not in the values of the NHS, but through bringing forward and empowering leadership in the NHS to secure the quality of services on which we all depend.
Change is never easy, but the NHS is well placed to respond. I can tell the House today that the NHS is in a healthy financial position. Waiting times remain at historically low levels, as promised under the NHS constitution. Patients with symptoms of cancer now see a specialist more quickly than ever before. MRSA is at—[Interruption.]
Mr Lansley
MRSA is at its lowest level since records began. We have helped more than 2,000 patients have access to new cancer drugs that would previously have been denied to them. All that is a testament to the excellent work of NHS staff up and down the country, and we thank them for their efforts to achieve these results for their patients. The coalition Government are increasing NHS funding by £11.5 billion over this Parliament, but the service cannot afford to waste any money. We can sustain and build on those improvements only by modernising the service to be ever more efficient and effective with taxpayers’ money.
The Bill is a once-in-a-generation opportunity to set the NHS on a sustainable course, building on the commitment and skills of the people who work for it. Our purpose is simple: to provide the best health care service anywhere in the world. I commend this statement to the House.
John Healey (Wentworth and Dearne) (Lab)
I thank the Secretary of State for Health for a copy of his statement shortly before he made it this afternoon. So Mr Speaker, in the middle of confusion, chaos and incompetence, the Prime Minister has pushed the Health Secretary out of the bunker to try and tell people what exactly and what on earth they are doing with the NHS. Why is the Health Secretary here and not the Prime Minister? After all, we have been told that the Prime Minister has taken charge and it was he who made his most personal pledge to protect the NHS and to stop top-down reorganisations that have got in the way of patient care. It is the Prime Minister who is now breaking his promises on the NHS.
Will the Health Secretary tell us why the Tories did not tell people before the election about the biggest reorganisation in NHS history? Why did they not tell the Lib Dems about the reorganisation before the coalition agreement was signed? Whatever the Government say or do now, there is no mandate—either from the election or the coalition agreement—for this reckless and ideological upheaval in the health service. In truth, the Health Secretary is here only because there is a growing crisis of confidence over the far-reaching changes that the Government are making to the NHS.
There is confusion at the heart of Government, with briefings and counter-briefings on all sides, and patients starting to see the NHS go backwards again under the Tories—with waiting times rising, front-line nursing staff cut and services cut back. Yet the Health Secretary has done nothing to restore public confidence in the Government’s handling of the NHS and nothing to convince people to back the Tories’ reorganisation plans. Everything he said today the Government were told about in the consultation—and they ignored it. Everything he said today the Government were told in Committee—and they rejected it.
This is not just a problem with the pace of change; simply doing the wrong thing more slowly is not the answer. It is not just a problem with presentation. In fact, the more people see the plans, the more concerned they become about them. That is why there is growing criticism of the Tories’ plans for the NHS—from doctors, nurses, patients’ groups, NHS experts, the Health Select Committee, the Lib Dems and peers of all parties in the House of Lords. I have to hand it to the Health Secretary: it takes a special talent to unite opposition from Norman Tebbit and MC NxtGen. That is why Labour has been saying that the reorganisation requires a root-and-branch rethink and that the legislation requires radical surgery.
There are fundamental flaws in what the Government are doing, not just in what they are saying. The test is whether the Prime Minister will now deal with these fundamental flaws. Will he radically safeguard commissioning to draw on the full range of NHS expertise, to prevent conflicts of interests, bonus payments to GPs and to guarantee that important decisions are taken in public not in private? Will he radically strengthen local accountability to the public and to patients? Will he delete the one third of the Bill that breaks up the NHS and makes it into a full-blown market ruled by the forces of market regulation and EU competition law? Will this be just a public relations exercise or will real changes be made in the NHS plans—or has the Prime Minister not yet told the Health Secretary? This is no way to run a Bill; this is no way to run a Government; this is no way to run the NHS.
Mr Lansley
We heard from the Leader of the Opposition earlier that the NHS needed to change, but once again we have heard nothing from Labour Members about how it needs to change. It is not unusual to hear nothing from them. They say that we need to tackle the deficit, but they will not say how. They say that we must change the NHS, but they will not say how.
Interestingly, in January the right hon. Member for Wentworth and Dearne (John Healey) said that he agreed with the aims of the Bill. He said that he supported a
“greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes”.
At the last election, his manifesto said that he wanted all NHS trusts to become foundation trusts. It said that he wanted patients to have access to every provider, be it private sector, voluntary sector or NHS-owned. Now we do not know what the Labour party’s policy is at all, but what I do know is that the Government will give leadership to the NHS, and that we will give the NHS a strategy enabling it to deliver improving results in future.
The right hon. Gentleman clearly wrote his response to the statement before reading it. In fact, we have made it clear that we will listen to what is said about precisely the issues on which people in the NHS and people who depend on the NHS are united. They know which issues are really important. They know that we must be clear about accountability, and that there must be transparency. Clinicians throughout the health service want to work together, and want the structure of the service to help them to work together so that they can deliver more holistic and joined-up services to patients. We want that, and they want that. We will back up our strategy with detail, but from the right hon. Gentleman we heard no strategy, no detail, and no answers whatsoever.
We are clear about the principles that we are pursuing through the reform and modernisation of the national health service. We are listening, and we are engaging with those principles. We are listening to the people in the health service who have come together to implement those principles, so that we can help them to do so effectively. Labour Members have not even listened to those who threw them out at the last election, because they are still wedded to the past and to a failed, top-down, centralised, bureaucratic approach.
Mr Stephen Dorrell (Charnwood) (Con)
All who genuinely wish the NHS well and consider it to be an important part of our national heritage will welcome my right hon. Friend’s commitment to ensuring that clinical practice delivered by the NHS is kept up to date with the best available medical practice, and responds effectively to the wishes of patients. Will he continue to develop effective commissioning as the best way of delivering that, building on 20 years of commitment to the principle of commissioning under Governments of all political complexions since 1990?
Mr Lansley
I am grateful to my right hon. Friend. He knows and I know—and past Secretaries of State, with the exception of the right hon. Member for Holborn and St Pancras (Frank Dobson) also knew—that in order to deliver the best possible care in the NHS, we needed to engage clinical leadership more effectively. That is what these reforms are about. The modernisation of the NHS is about better and stronger clinical leadership delivering better commissioning of care and thereby helping to deliver better provision of care, and about allying that with democratic accountability at a local level. Neither of those things has happened sufficiently in the past, but both are at the heart of our Bill.
Mr Ben Bradshaw (Exeter) (Lab)
Contrary to what the Secretary of State has claimed, waiting times are already lengthening and the quality of service to patients is already deteriorating as a result of his ill-conceived upheaval of the health service. Why does he not abandon it, rather than just pausing for the Easter holidays, before he squanders all the improvements that were achieved under Labour Governments?
Mr Lansley
I am sorry that the right hon. Gentleman should denigrate what staff in the NHS have achieved over the past year. He will not have read the deputy chief executive’s report on NHS activity, which shows improvements in breast screening rates, improvements in bowel screening rates—[Interruption.]
Mr Speaker
Order. I apologise for interrupting the Secretary of State. I recognise that this subject inflames passions and that there are very strongly held views about it, but there is too much noise on both sides of the Chamber. I gently say to the hon. Members for Middlesbrough South and East Cleveland (Tom Blenkinsop) and for Kingston upon Hull East (Karl Turner) that they should cease to yell at the Secretary of State from a sedentary position. It is very unseemly.
Mr Lansley
Thank you, Mr Speaker. I shall not go through a long list, but many services in the NHS have improved and continue to improve. Our objective is very clear: it is to support that improvement, including improvement in waiting times. For example, last year the median wait in January for non-admitted patients was 4.8 weeks, whereas last year it was 4.9 weeks. For diagnostic tests, the average wait this year is 1.6 weeks, exactly the same as last year. Meanwhile, many other factors are continuing to improve as well.
Sir Paul Beresford (Mole Valley) (Con)
As the Secretary of State may know, I still have a faint link with the NHS and medicine in general. The GPs I have met in my constituency and elsewhere are very much in favour of the proposals. In contrast, the complaints are circular letters that have been well organised. Does the Secretary of State agree that GPs will be devastated if there is any reversal and backtracking?
Mr Lansley
I am grateful to my hon. Friend for his remarks. He and other Surrey Members will be aware of that primary care trust’s past failure to manage effectively within its budget. The GPs in Surrey are, like many others across the country, coming together and demonstrating that they can achieve much greater service improvement within NHS resources—and those resources will increase in future years.
Mr Kevin Barron (Rother Valley) (Lab)
Does the Secretary of State recognise that the reorganisation and introduction of competition under this Bill have created chaos inside the national health service? What message does he have for the 40% of people who work for Rotherham PCT who have now taken redundancy, and who are getting out because they know they are aboard a sinking ship?
Mr Lansley
As we have demonstrated, NHS performance is continuing to improve, and it will improve further with clinical leadership, but we can achieve that effectively only if we achieve a £1.9 billion a year reduction in administration costs in the NHS. We have started that process: since the election, we have reduced the number of managers in the NHS by 3,000 and increased the number of doctors by 2,500.
Sarah Newton (Truro and Falmouth) (Con)
I very much welcome the Secretary of State’s continued support for the NHS in Cornwall, with the cash increases this year, the long overdue integration of adult social care with the NHS, and the real opportunity of giving power to local people through the health and well-being boards. Will he ensure that the central changes he wants to introduce to achieve the aim of “no decision about me without me” are kept absolutely at the heart of what he does?
Mr Lansley
I will indeed do that, and I am very grateful to my hon. Friend for her comments. She represents a Cornwall seat, and she and I know that over the years many people in Cornwall have felt they wanted a greater sense of ownership of the decisions made in the health service, not only for individuals but for the health service in Cornwall itself. That is precisely what we are going to make available through both local commissioning and local authorities.
Glenda Jackson (Hampstead and Kilburn) (Lab)
The Secretary of State listed in his statement concerns to which he intends to listen, but every single one of them has been raised with him before, going back to the time of the publication of his White Paper. As he did not listen to those concerns then, why should any of us believe his positive commitment to listen to them now?
Mr Lansley
I am afraid the hon. Lady is completely wrong about that. We have continuously listened. After the publication of the White Paper, we had a full 12-week consultation with more than 6,000 responses, and in December’s Command Paper we set out a whole series of changes that were consequent on that, including to the structure of commissioning and the timetable for the transfer of NHS trusts into foundation trusts. In Committee, we have introduced further amendments, not least to make it clear that competition in the NHS will be on the basis of quality not price, which is very important because that is a concern that people raised.
Sajid Javid (Bromsgrove) (Con)
I warmly welcome my right hon. Friend’s efforts in modernising the NHS. The concept of GP commissioning has been widely supported by politicians from all parties for many years. May I urge my right hon. Friend to keep putting patients first by increasing GP involvement in the NHS?
Mr Lansley
I am grateful to my hon. Friend for his remarks. We have now—earlier than any of us had imagined—arrived at the point where most of the country has pathfinder consortia in place. It is absolutely the right moment to engage with them to discuss how we can ensure that the concerns that have been properly raised, about transparency and accountability in governance and the avoidance of conflicts of interest, will be dealt with in the legislation. We want the legislation to work for them and the people we serve.
Meg Munn (Sheffield, Heeley) (Lab/Co-op)
The Secretary of State has spoken a great deal about ill people, but the health service is also, very importantly, about promoting health. With local authorities taking the lead in the public health strategy, what is his mechanism to ensure that GPs are fully involved and contribute fully to the wide range of initiatives on which primary care trusts took a lead, such as those on child protection, teenage pregnancy, diet and exercise, child safety and obesity?
Mr Lansley
If the hon. Lady reads the Bill, she will see that one of its changes that has been most widely supported, including by local authorities across England, has been the transfer of public health leadership into the health and well-being boards, with ring-fenced budgets for local authorities. The previous Government could have done that, but they did not. Such an approach will allow continued engagement with general practitioners and their practices, both because they are participants in the health and well-being boards and because Public Health England and the local health and well-being board will be able to influence directly the quality and outcomes framework, which incentivises GPs in the work that they do.
Mr John Redwood (Wokingham) (Con)
Colleagues on this side of the House will know that the Secretary of State has a great passion for the health service, and great mastery of his brief. Will he confirm, for the sake of all hon. Members, that the object of getting rid of PCTs and top-down targets is to free a lot of money for patient care? That should be in the interests of all hon. Members and their constituents.
Mr Lansley
I am grateful to my right hon. Friend. Before the election, the previous Labour Government said that it was necessary to save up to £20 billion in efficiencies in the NHS, but they never said they would reinvest that money in the NHS. We have said that we will reinvest it. In order to deliver those efficiencies, 10% of that gain will be achieved by cutting the costs of bureaucracy and administration. We have set out how we will do that, but the previous Government never did.
Mr George Howarth (Knowsley) (Lab)
Does the Secretary of State understand that those who care about the future of the NHS believe not only that he got his presentation wrong, but that his Bill is fundamentally wrong in principle?
Mr Lansley
No, I do not accept that for a minute. The right hon. Member for Wentworth and Dearne, who sits on the Opposition Front Bench, has freely acknowledged that I have met and talked to many people in the NHS over the course of seven and a half years, and that I am passionately committed to the NHS. If one set of beliefs lies at the heart of the reforms and the Bill, it is the belief in the NHS as a free, comprehensive, high-quality service that delivers some of the best health care anywhere in the world. We will never achieve that without the clinical leadership that is essential to delivering high-quality health care.
John Pugh (Southport) (LD)
I thank the Secretary of State for having the grace and courage to respond to legitimate concerns. Given the agreement that exists in the House—not about the effects of the Bill, on which there is no agreement, but about its aims—does he agree that we should not get hung up about whether substantial changes will in future be referred to as “tweaking”, “surgery” or, possibly, “surgical tweaking”? Is not the main thing to get a Bill that carries the broad support of Parliament, NHS professionals and the country? We do not need to sell this Bill better; we need to take the spectre of salesmanship out of the NHS.
Mr Lansley
The hon. Gentleman and I know one another well enough to know that we share a commitment to the NHS and that I am determined. Perhaps I sometimes get very close to all of this because I am very close to the NHS. I spend my time thinking about this subject and I spend my time with people in the service. I spend my time trying to ensure that the Bill is a once-in-a-generation opportunity to get it right for people in the NHS—they want to be free. The British Medical Association made it clear that it wants an end to constant political interference in the NHS. We can do that only if we secure the necessary autonomy for the NHS, and if we make accountability transparent, rather than having constant interference from this place or from Richmond house.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
How many managers who have lost their jobs will be re-employed during this pause?
Mr Lansley
I do not have a figure for how many have been re-employed. The hon. Lady will know that under the process by which people agreed with the NHS to take resignation and, more recently, in voluntary redundancy terms, after six months there is an opportunity for people to take jobs—we are not depriving them permanently of the ability to take jobs. Indeed, one of the responsibilities of the commissioning consortia will be to find the best people, but we are doing that now. That is why we continue to make progress on the ground by the assignment of PCT staff to commissioning consortia and to local authorities, in order to ensure that they are beginning to take on their responsibilities.
Conor Burns (Bournemouth West) (Con)
My right hon. Friend will know that many GPs are very excited by the opportunity that his reforms will give them to serve the needs of their local communities even better. Can he assure those GPs that he has no plans to water down that strengthening of their pivotal role in the national health service?
Mr Lansley
I am very grateful to my hon. Friend. This is born not of political opportunism, as it seems to have been characterised by the Opposition, but of a determination to support those people in constituencies that my hon. Friends on this side of the House have been talking to and listening to. As he knows, GPs in his area have come together. For example, when I met people at Southampton hospital recently, they were able to talk about how they were working together on improving the clinical design of services for patients in his area.
Malcolm Wicks (Croydon North) (Lab)
Why has the Secretary of State waited until now, after the passing of the Bill through its Committee stage, to announce a so-called natural break in which to listen to and engage with the public? Perhaps I am old-fashioned, but would not the normal process involve getting the brain into gear to avoid putting the foot in the mouth?
Mr Lansley
If I did not come to the House to make a statement, I would be accused of not doing so, but when I do so, the Opposition ask why. The reason is very simple: it is because we are going to listen, and to engage with people actively over the course of the coming weeks, and I did not want the House to see that happening during the recess without having been told about it beforehand.
Mr Bernard Jenkin (Harwich and North Essex) (Con)
Does my right hon. Friend agree that only the most cynical people could criticise him for wanting to consult more about the changes that he wants? [Laughter.] And that only the most cynical could treat the NHS as a laughing matter? Will he maintain the goal of delivering the prize, which is to give local people, through their local GPs, more control over the resources that the NHS spends in their name?
Mr Lansley
Yes, I agree. Indeed, in north-east Essex, the consortium under Dr Shane Gordon’s leadership is doing exactly that. I personally think that leadership and listening are not mutually exclusive, and we are going to continue to do both.
Valerie Vaz (Walsall South) (Lab)
In the spirit of openness, will the Secretary of State please place in the House of Commons Library a copy of the legal advice on whether EU competition law will apply to the provisions in the Bill?
Mr Lansley
The hon. Lady should know, as a member of the Health Select Committee, that I wrote to the Chair of the Committee just last week and set out the position very fully. The Bill does not extend the scope or application of competition law at all.
Mr David Evennett (Bexleyheath and Crayford) (Con)
I welcome my right hon. Friend’s statement. Does he agree that reduced bureaucracy and better local scrutiny and accountability will ensure a better NHS for all?
Mr Lansley
Yes, my hon. Friend is absolutely right. Locally, he can see how that is happening as GP leaders—including Dr Howard Stoate, whom Members will fondly remember, as the chair of the clinical cabinet in Bexley—are coming together to look at issues that the previous Government never dealt with, including those relating to the South London Healthcare NHS Trust and to Queen Mary’s hospital in Sidcup. They are coming forward with proposals to improve services for local people, and I applaud that kind of clinical leadership.
Joan Ruddock (Lewisham, Deptford) (Lab)
Before the general election, the right hon. Member for Witney (Mr Cameron) promised an extra 3,000 midwives. Has the Secretary of State noted the alarming rise in preventable maternal mortality? Would the Secretary of State not do better to deliver on his Prime Minister’s promises and abandon his reckless reorganisation?
Mr Lansley
The right hon. Lady must know that we continue to have a record number of midwives in training, and that the number of midwives in the health service has continued to increase since the election. In the financial year that is just starting, the number of commissions for training will continue to be at a record level.
Gordon Birtwistle (Burnley) (LD)
The Secretary of State is aware that under the Labour Government, accident and emergency and children’s services were transferred from Burnley to Blackburn. The transfer was opposed by the majority of GPs and 95% of the local community. It was supported only by the bureaucrats in the PCT and the SHA and by prima donna consultants. Will the Secretary of State confirm that under his new proposals that will never happen again and that such decisions will be taken only following full consultation and agreement with GPs and local communities, rather than being driven through as they were by the previous Government?
Mr Lansley
I am grateful to my hon. Friend. In Burnley and other places—I think not least of Maidstone—decisions were made in the past, under a Labour Government, that clearly did not meet the tests that we now apply, which are about public engagement, the support of the local authority, engagement with general practices leading commissioning, the clinical case and the responsiveness to patient choice. Those tests will be met in future. As we go through the painful process of examining how they are applied to the situations that we have inherited, on occasion we can say things to help colleagues, but sometimes we cannot.
Mr Gerry Sutcliffe (Bradford South) (Lab)
It is not only the Health Secretary who cares about the NHS. Most people in the House support the NHS in their constituencies and the work that it carries out, but the mistakes that the Secretary of State has made—I hope he will admit that he has made mistakes by not listening—mean that there will already be costs to the health service because of the Bill. Will he publish an impact assessment of the costs to the health service so far of his failed policies?
Mr Lansley
I am afraid the hon. Gentleman is wrong on a number of counts. First, we have listened and we will continue to listen. Secondly, of course there are costs in reducing the number of managers in the NHS, but it is absolutely essential that we reverse the decade of declining productivity in the NHS that took place as the number of managers went up by 78%. How can that be the right way forward? Under Labour, we had more managers and less productivity.
Andrew Percy (Brigg and Goole) (Con)
The Secretary of State will be keen to know that many of the GPs I have met in my constituency are keen on the idea of GP commissioning, but there is undoubtedly concern about the exact role of the private sector in the NHS. May I urge the Secretary of State to use these next few weeks or months to ensure that in the country and if necessary in the Bill we make it perfectly clear that the private sector will not be allowed to undercut or undermine our local hospitals?
Mr Lansley
Yes. I am grateful to my hon. Friend. Our manifesto was clear that patients should be able to have access to a provider who gives them the best quality, be it the NHS, a private sector provider or a voluntary provider. That was in the Liberal Democrat manifesto and in the Labour manifesto. It is always about ensuring that that provider is properly qualified and that the basis of that choice is quality, not price. There cannot be a race to the bottom on price. We make it very clear in the legislation—it is important to set this out—that the commissioners of local services will also, through designating services, be able to ensure that where patients need services to be maintained and need continuity of services they can set that out themselves.
Mr Dennis Skinner (Bolsover) (Lab)
Why does the Secretary of State not admit that the policy is unravelling before the eyes of the British public? The thousands that have been writing to MPs in every constituency now know that the truth is out. Instead of waiting for the natural break, and then a reshuffle, and then a resignation, he should do the honourable thing now and resign today.
Mr Lansley
I will tell the hon. Gentleman one thing: I and my colleagues on the Government Benches talk to people in the constituencies who are getting on with this. That is what is so impressive. People across the NHS are seeing the opportunity to bring more clinical leadership and more democratic local accountability to fashioning an improving health service. That is what I am determined to achieve.
Priti Patel (Witham) (Con)
Excessive bureaucracy and a record level of managers have dominated health care provision in mid-Essex. Will my right hon. Friend assure my constituents that, under his reforms, the funding for that excess will go to front-line patient care in the constituency of Witham?
Mr Lansley
Yes, I can. Under the coalition Government, in mid-Essex there has been a 3.2% increase in cash for the NHS this year compared with last year. Not only that, but more of that money will, as a consequence of our changes, get to the front line to deliver improving services for patients.
Clive Efford (Eltham) (Lab)
“No decisions about us without us” could apply to every single person who works in the NHS who has been telling the Secretary of State that these are reckless changes. Throughout the country changes are taking place. Now he says that he is going to be listening. If so, we can anticipate some more changes. Will he therefore instruct everyone in the NHS who is currently restructuring on the basis of the Bill to stop that restructuring until we know exactly what the Government intend to do?
Mr Lansley
No, I will not, because we are very clear about the strategy and the principles of the Bill. We are equally clear that now we have the opportunity to work with the developing GP pathfinder consortia, the health and well-being boards in local authorities and the wider community to ensure that the implementation of the Bill and its structure support those developing organisations.
Mr Steve Brine (Winchester) (Con)
I thank the Secretary of State for his helpful and useful update this afternoon, and welcome his assurances that the coalition wants to reform and modernise our NHS, right in line with its founding principles. He knows that I will continue to argue for greater transparency for the new GP consortia, and I hope we can still find a way to do that, but I warmly welcome his listening exercise, the measures contained in the Bill and the way he has made himself freely available to colleagues since taking up his post last year. May I urge him to continue doing that both in the House and, of course, outside it?
Mr Lansley
I am grateful to my hon. Friend. We will do that, not only formally across the country but in the informal manner that we do in the House. His point of view exactly illustrates the purpose of my statement. He served on the Committee that debated the Bill. Notwithstanding the good progress that the Bill has made and that we are making around the country, people have legitimate concerns and questions. They want to raise those and to know that we will listen and act on them.
Barbara Keeley (Worsley and Eccles South) (Lab)
Can the Secretary of State say more about the future of care trusts? Integration of health and social care is vital to all our constituents. With all the uncertainty, staff are being lost and more could be lost. During this natural break, what can the Secretary of State say to preserve the continuity of those people doing that vital work and the continuing support for care trusts?
Mr Lansley
I reiterate the point that I made a moment ago. There is nothing in what I have said today that should do other than give people on the ground confidence that they are building the improvement of services that they need for the future. At the heart of that is the integration of health and social care. We as a Government have made available in this new financial year £648 million through the NHS specifically to build that kind of integration between health and social care. It has been insufficient in the past; we are building it now. As the hon. Lady knows, the Bill allows care trusts to continue in formation, but it is also possible for care trusts to redesign around commissioning consortia on the one hand and health and well-being boards on the other.
Margot James (Stourbridge) (Con)
The Leader of the Opposition stated his willingness to work with the Government on the NHS reforms. Does my right hon. Friend agree that a good place for him to start would be with a re-reading of his party’s manifesto at the last election, which supported virtually every principle in our NHS Bill, with one important difference—it was without the additional funding to match?
Mr Lansley
My hon. Friend makes a very good point. I am not sure which Labour party we would be expected to engage with—the one whose manifesto agreed with us, the one for which the right hon. Member for Wentworth and Dearne spoke at a King’s Fund meeting in January when he agreed with us, or the one that we saw in Committee, which opposed everything, tried to wreck the Bill and clearly has gone back to the Holborn and St Pancras view of the NHS.
Mr Jim Cunningham (Coventry South) (Lab)
It is obvious that the public are extremely concerned about the Bill. Why does the Secretary of State not suspend the Bill and bring forward new proposals that we can all support?
Mr Lansley
I am afraid the hon. Gentleman does not seem to understand that the public support the principles of the Bill. The public want patient choice. When they are exercising their choice over treatment, they want to be able to go to whoever is the best provider. Patients believe that general practitioners are the best people to design services and care on their behalf. Patients, the public and professionals support the principles of “no decision about me without me”, focusing on outcomes and delivering an outcomes framework, and the devolution of responsibility. What we are talking about now is ensuring that other important principles, such as governance, accountability, transparency and multi-professional working, are genuinely supported by the structure of the Bill.
Dr Thérèse Coffey (Suffolk Coastal) (Con)
My constituents in Suffolk were very concerned at the last election about the fact that only two doctors covered them for out-of-hours care, and that was for 600,000 patients. They welcome the reforms in the Bill. Indeed, Waveney and Great Yarmouth have come together as one pathfinder consortium and resumed out-of-hours care. Will the Secretary of State assure me that such important changes will continue to be important for patient delivery in the new Bill?
Mr Lansley
Yes, my hon. Friend makes an important point. When people talk about primary care trust commissioning, they might care to look at the report produced by the Care Quality Commission on how primary care trusts went about commissioning out-of-hours care. The answer is that they pretty much did it on the basis of cost and volume, rather than quality, and once they had a contract they did not monitor it, follow it up or ensure that the right quality was there, including the right calibre of doctors. It is clear that general practice-led commissioning consortia will take a wholly different and preferable approach to that kind of commissioning.
Alison McGovern (Wirral South) (Lab)
The Prime Minister’s commission on the future of nursing and midwifery reported a year ago in March 2010. Of the 20 recommendations, all related to improving the quality of care in the NHS, which is my constituents’ priority, not top-down reorganisation. During the pause that the Secretary of State has announced today, will the Government finally find time to respond to that important report?
Richard Drax (South Dorset) (Con)
Can the Secretary of State reassure me that any further listening will mean that retaining local community hospitals, which are much loved across the country and particularly in South Dorset, remains top of the agenda?
Mr Lansley
I can assure my hon. Friend that one of the central beauties of the Bill is that in future it will matter less what my priorities are and much more what the priorities are of his local communities and general practitioners and others who are responsible for commissioning in his area. On that basis, I have no doubt about the importance and priority that they will attach to community hospitals.
Nic Dakin (Scunthorpe) (Lab)
I share and welcome the Secretary of State’s commitment to reduce bureaucracy, so I am concerned to know why Monitor’s budget is increasing by 600% over four years to police the marketisation of the NHS. Is that not poor value for money?
Mr Lansley
The Government are introducing for the very first time a clear limitation and reduction on the running costs of the NHS. That will include the Department of Health, the arm’s length bodies, the strategic health authorities and the primary care trusts—the whole shooting match. We will reduce those costs by more than a third in real terms. Monitor forms part of that. We have made it clear that its estimated total running costs will be between £50 million and £70 million. That is more than at present because its responsibilities will be considerably larger than they are at present.
Mr Mike Hancock (Portsmouth South) (LD)
As the Secretary of State will be aware, I chaired the majority of the Public Bill Committee’s sittings. It was the longest Bill Committee for 12 years. During that time, more than 100 amendments were voted on in formal Divisions, and many hundreds of others were agreed to. If we are taking several months to look at this again, how on earth will the time be found to ensure that this House has enough time to scrutinise properly any changes, bearing in mind how much time has been spent on the Bill as it stands? I want an assurance, as I hope the whole House does, that we will be given sufficient time and that the Bill will not be steamrollered or bulldozed through the House.
Mr Lansley
I know that the whole Committee will have been grateful to my hon. Friend for his chairmanship, because what was achieved in Committee, as was acknowledged by the hon. Member for Halton (Derek Twigg), was that every inch of the Bill was scrutinised. It is our intention to secure proper scrutiny for any changes that result from our engagement.
Jim Shannon (Strangford) (DUP)
The Public Bill Committee was one of the busiest since 2002, according to the Clerk, with 26 sittings and more than 100 Divisions. Does the Secretary of State not agree that that reflects the level of concern that the general public have, but that they will exercise theirs at the next general election?
Mr Lansley
No, I am afraid I do not accept that. All that 100 Divisions demonstrate is that time and again the Labour party was simply trying to divide the Committee in order to delay or, indeed, to wreck the Bill.
Tony Baldry (Banbury) (Con)
GPs in Oxfordshire want to be catalysts for change. Collectively and collegiately, they want to be able to design NHS services for the best and optimal benefit of the people of Oxfordshire. Can my right hon. Friend confirm that this statement means that they can continue to design those services and continue to plan to have an Oxfordshire-wide GP consortium, knowing that they will be able to go forward in the future to plan the best health services for the people of Oxfordshire?
Mr Lansley
Yes, I can indeed confirm that. Having joined my hon. Friend in Banbury in the past and met GPs there, I know and can say that, if they had been more fully engaged, as our plans would have meant, in the design of clinical services in Banbury or in the future of the Horton general hospital, for example, we would have had better and earlier outcomes than was in fact the case.
Barry Gardiner (Brent North) (Lab)
The Secretary of State, in his letter to me of 23 March, dismissed my request that he discuss with the Comptroller and Auditor General concerns about the conflicts of interest which might arise from GP commissioning. The Secretary of State, in his statement today, refers to the concerns about those specific conflicts of interest. Will he now engage in a discussion with the Comptroller and Auditor General to receive best advice on methods of Government procurement?
Mr Lansley
I do not think I dismiss anybody; I might not agree with people, but I do not dismiss them. If I recall correctly, I did not agree with the hon. Gentleman’s suggestion because he misunderstood the fact that the consortia are separate statutory bodies, not private bodies, and separate from GP practices, which are individual contractors to the NHS. The confusion between those two things meant that his point was not valid.
Duncan Hames (Chippenham) (LD)
My constituents, who have watched primary care trusts halve the number of community hospital medical beds in Wiltshire, know that NHS reform is needed to make decision makers accountable, so how does the Secretary of State propose to strengthen the public and patient voices on the boards of the GP consortia that will replace them?
Mr Lansley
Clearly, this is an area that we will engage in over the coming weeks, but the Bill is already clear that the consortia must engage the public and patients directly. We can look at how we can strengthen that, but we must never lose sight of the fact that, through local health and wellbeing boards, we are creating for the first time a very much stronger public representative voice in relation to all such decisions, including commissioning and planning, and that, through HealthWatch, we are creating for patients an altogether stronger, more comprehensive patient voice, which will have a statutory right to be consulted and to express a view on all those commissioning issues.
Diana Johnson (Kingston upon Hull North) (Lab)
Exactly how long will the natural break be, and how will we know whether the Secretary of State has listened?
Mr Lansley
I think the hon. Lady must accept that, because I have come to the House and made it very clear that we are going to do this thing. We are going to set it out, I have done so before the recess, and it will take place during the recess and beyond. But, from my point of view, I think that in the formation of the policy and its introduction there has been a genuine process of listening. It is now a genuine process of listening and engaging to ensure that we get the implementation right.
Mr Peter Bone (Wellingborough) (Con)
This has been a very good day for the coalition Government, a great day for the Secretary of State and a superb day for Parliament. What Opposition Members do not seem to understand is that this is about Parliament scrutinising a Bill and improving it. Does the Secretary of State agree that he should listen not to those dinosaurs but to Parliament?
Mr Lansley
I am grateful to my hon. Friend. My objective is to ensure that the statutory structure for the NHS moves on from one that had virtually no serious accountability. As Secretary of State, I could have done most of this without the legislation: I could have just abolished most of the primary care trusts and strategic health authorities. Previous Secretaries of State behaved in that cavalier fashion, but we are not doing that; we are giving Parliament the opportunity—a once-in-a-generation opportunity—to give the NHS greater autonomy and, in the process, to be transparent about the structure of accountability.
Kate Green (Stretford and Urmston) (Lab)
Is the Secretary of State aware of the instability that we are experiencing in the management of NHS services in Trafford, with provider services off at Ashton-under-Lyne, Wigan and Leigh on a temporary basis, with Trafford Healthcare NHS Trust forced to find a new partner for its management, and the primary care trust forced, first, to combine with other Greater Manchester care trusts for one year, before splitting into GP consortia next year? In view of all that instability and the uncertainty that it is causing to staff in the NHS and at Trafford, will the Secretary of State ensure that he has the adequate support in terms of project and change management that appears to be so lacking at present?
Mr Lansley
Let me make it clear to the hon. Lady that many of the things she is describing in Trafford are the result of things that the last Labour Government failed to do. For example, the last Labour Government said that all NHS trusts should meet the criteria to become foundation trusts by December 2008, but they did not do it. We are now having to help NHS trusts to meet the kind of quality and viability standards that they did not meet in the past, which is at the heart of many of the problems she describes. Do we have management resources? Yes, we do. That is one of the reasons I invited Sir David Nicholson, as chief executive of the NHS, to be the chief executive of the new NHS commissioning board so that the design of commissioning for the future will be completely consistent with the transition and the management of the change in the NHS today.
Mary Macleod (Brentford and Isleworth) (Con)
I thank my right hon. Friend for standing firm in his desire to improve the NHS. Will he join me in commending the work of the Great West commissioning consortium in London and others, who have approached these reforms with professional leadership and commitment to make the NHS more efficient and improve public health, ensuring better care for all patients?
Mr Lansley
Yes, I do join my hon. Friend in applauding the Great West commissioning consortium, because it and others across London are demonstrating that instead of having the top-down diktat of how services should be changed in London, they are in the process of designing, from the point of view of the populations they serve, what the requirement is for them and their services in their area. That is a better and more sustainable basis on which to design community-led and primary care-led services for the future.
Mr David Anderson (Blaydon) (Lab)
This debate was confused before today. Can the Secretary of State put in writing exactly what things will be put on hold and what things will carry on? For example, he said that he is taking a natural break but GP commissioning groups can still continue to be set up. If the natural break is a good idea, surely that is a pointless exercise.
Mr Lansley
No, the hon. Gentleman misunderstands. I was very clear in my statement and in subsequent responses to questions. Right across the country, there are thousands of people who are developing the pathfinder consortia, taking NHS trusts through to foundation trust status, and building the health and well-being boards and new public health structures in local government. They should be confident in doing that, because the Government continue to be committed to achieving those changes. In the process of doing so, we will engage with them to ensure that the legislation specifically gives them the support that they need.
Nadhim Zahawi (Stratford-on-Avon) (Con)
I congratulate my right hon. Friend on engaging and listening. We have all received the 50 or so e-mail circulars from constituents who are concerned, but that does not reflect the evidence on the ground. GPs in Shipston in my constituency are absolutely passionate about the reforms and want to engage fully with them, as do 220 other groups—87% of the country. May I make a suggestion to the Secretary of State? Perhaps we should bring all those people who are passionate about this reform and want to take party politics out of it together with Labour Members on a platform so that we can take this forward without petty politics derailing a brilliant piece of legislation.
Mr Lansley
I am grateful to my hon. Friend. Labour Members sit and laugh about this, but they ought to realise that 1 million patients a day visit their local general practice surgery. GPs across the country who have come together to form pathfinder consortia—87% of the country—are doing it on the basis that they can improve services for patients. I suspect that they understand the needs of their local community and patients better than many Labour Members, who are not listening to their GPs locally.
Grahame M. Morris (Easington) (Lab)
I would like to thank the Secretary of State for single-handedly destroying the Government’s reputation on the NHS through this Bill. No amount of minor changes or slowing down of the pace will address the Bill’s fundamental failure to protect the public from privatisation by stealth. If he refuses to resign, is he worthy of his nickname, Broken Arrow—he doesn’t work and he can’t be fired?
Mr Lansley
The hon. Gentleman might like to talk to Dr Stewart Findlay, who is among those leading the pathfinder consortium in County Durham. He might like to talk to people locally who are piloting the new 111 telephone system, which will give better access and better urgent care to patients. Instead of sitting there making rather absurd political points, why does he not go and talk to people who are delivering services to patients? That is what the NHS is really about.
David Rutley (Macclesfield) (Con)
In east Cheshire, there is no lament for the passing of the PCTs. In fact, there is a positive response to GPs having a greater say in how health care is delivered locally. Will the Secretary of State tell the House how GPs will be updated on progress over the coming weeks?
Mr Lansley
I am grateful to my hon. Friend. We are not only developing communication with GPs in pathfinder consortia, but, more importantly, creating a learning network among GPs in pathfinder consortia, so that these groups across the country will not only learn from each other, but, we hope, arrive at a set of views that help us to design a service that supports them.
Toby Perkins (Chesterfield) (Lab)
The Secretary of State, who tells us how much he studies the NHS, must know that the King’s Fund tells us that under the Labour Government, Britain’s NHS was the most efficient in the entire world. On that basis, a broad coalition of people, including health experts and the Liberal Democrats, is telling him that this policy is wrong. He apparently came here today to tell us why he is right and all those people are wrong. Is this a genuine consultation, or is it just a pause to get through the local elections before he does what he wants to do anyway?
Mr Lansley
The hon. Gentleman is wrong on almost every count. We have seen a decade of declining productivity in the NHS. The Office for National Statistics and the National Audit Office set that out recently. We have seen an NHS that, despite record increases in funding, which are welcome, is still not meeting the best European cancer survival rates, as was made clear by the NAO. We need to improve the NHS. The Government are not discounting anybody’s views on how we can best achieve that. In the spirit of continuous improvement in the NHS, there is a spirit of continuously listening about how to make that happen.
Dan Byles (North Warwickshire) (Con)
Does the Secretary of State share my amazement that in recent months the Labour party seems to have U-turned on patient choice and on any willing provider, and does not appear to support putting clinicians in charge of commissioning health care? Its only policies seem to be “Save the PCTs”, “Save the SHAs” and “Save NHS bureaucracy”.
Mr Lansley
I am grateful to my hon. Friend. Perhaps having increased the number of managers in the NHS by 70%, the Labour party thought that it would be swept to victory on the votes of NHS administrators. That did not happen. People in the NHS knew that waste, inefficiency and excess bureaucracy were not the way to deliver the best care for patients. That was Labour’s way; it will not be our way.
Bill Esterson (Sefton Central) (Lab)
Given that the Secretary of State will not instruct NHS managers to take a natural break in implementing his so-called reforms, does he understand why his intention to make changes after the natural break might be questioned? As colleagues have suggested, is the natural break just like every other Tory consultation—a sham?
Mr Lansley
There is nothing sham about this. This is serious business, not a political game, as it appears to be for Opposition Members. Tens of thousands of people across the NHS are engaged in managing and developing new services, which will deliver improving outcomes and be more responsive to patients, through devolved decision making in the NHS. I think that we should simply help and support them, not least by listening to them.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
The Secretary of State told my hon. Friend the Member for Scunthorpe (Nic Dakin) that the budget for Monitor will be between £50 million and £70 million, but the Health and Social Care Public Bill Committee, on which I sat, heard that it would be between £40 million and £130 million. Does that not show that not only are the Government not listening to this side of the country but are not even listening to their own facts?
Right to Provide Initiative
Lord Lansley Excerpts(13 years, 1 month ago)
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The Secretary of State for Health (Mr Andrew Lansley)
Today I am formally launching the Department’s guidance to support the Government’s new right to provide initiative and can announce that the Government will be investing at least £10 million through the Social Enterprise Investment Fund (SEIF) in 2011-12.
The new right to provide guidance “Making Quality Your Business” sets out the Department’s guidelines to support public sector employees who are thinking about taking up the right to provide. The guide sets out a process for people working in NHS trusts who have the right to propose the development of a staff-led enterprise.
The right to provide programme will enable staff across health and social care to explore setting up staff-led mutuals to take over and run services. It builds on the successful right to request scheme for community health services, which will see almost 25,000 community NHS staff set up social enterprises to take over the services they provide. Right to provide extends the opportunities provided by right to request to others working in health and social care.
We are committed to the big society approach, making public services answerable to the people that use them. Right to provide devolves power to front line staff at a local level who know how things can be done better and gives them the opportunity to put their ideas into practice. Employee ownership, combined with strong staff engagement, has demonstrated that it can deliver successful enterprises in a commercial context; we believe it can do as well in public service.
The Department’s Social Enterprise Investment Fund invests via loans and grants in new and existing social enterprises operating within health and social care. In the last year alone the fund has invested over £40 million in social enterprises in the health and social care sector, including support for community healthcare services through the transferring community services programme, and since its launch SEIF has supported over 450 social enterprises,
I am pleased to announce the investment of at least £10 million in the SEIF in 2011-12, which will demonstrate our continuing commitment to support the social enterprise sector and new organisations being created through the right to provide.
The Department’s guidance has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Health Select Committee Report (Revalidation of Doctors)
Lord Lansley Excerpts(13 years, 1 month ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I have today laid before Parliament the Government’s response (Cm 8028) to the House of Commons Health Select Committee’s report “Revalidation of Doctors: Fourth Report of Session 2010-11” which was published on 8 February 2011.
Patients and the public have the right to expect that the doctors who care for them are up to date and fit to practise. This is why this Government are supporting the work of the General Medical Council and other partners to design and properly test a proportionate and streamlined system for revalidation that is right for the profession, the health sector, patients and the public. Revalidation, if implemented sensitively and effectively, is something that will support all doctors in their innate professional desire to improve their practice still further.
We have made clear our commitment to revalidation and have pressed ahead with the responsible officer regulations which came into force on 1 January 2011. Responsible officers will play a key role in supporting doctors to improve the quality of care they provide and in ensuring that prompt action is taken to protect patients where concerns arise about the practice of individual doctors.
The Government welcome this report by the Health Select Committee. The next year of testing revalidation will help develop a clearer understanding of the costs, benefits and practicalities of implementation so that it can be paced in a way that is affordable, supports high-quality care and makes effective use of doctors’ time while providing assurance to patients and the public.
Copies of the Government’s response are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
UK Influenza Pandemic Preparedness Strategy
Lord Lansley Excerpts(13 years, 1 month ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I am publishing today, for consultation, a new “UK Influenza Pandemic Preparedness Strategy”. This cross-Government strategy updates the previous national framework, published in 2007, in the light of the experience from the H1N1 (2009) pandemic including the findings of the independent review chaired by Dame Deirdre Hine and the latest scientific evidence. The strategy has been developed jointly with the devolved Administrations.
It is vital that we remain prepared for a new pandemic, the threat of which remains undiminished. Given the uncertainty about the scale, severity and pattern of development of any future pandemic, three key principles underpin the new strategy. These are that the response to a new pandemic should be precautionary, proportionate and flexible. The draft strategy sets out our proposed strategic approach to apply these principles to pandemic preparedness.
The strategy is intended to inform the development of updated operational plans by local organisations and emergency planners. As a result of their experience in the H1N1 (2009) influenza pandemic, many other organisations and individuals have extensive experience of the challenges that can be posed by a pandemic and will have given these challenges much thought. The Government are keen to ensure that this experience is fully reflected. Therefore, we are inviting comments and views on the strategy set out in this document. The consultation runs until 17 June 2011. We intend to publish the finalised strategy later this year.
The strategy 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. The document is also available at www.consultations.dh.gov.uk
A plan for improving the response to seasonal influenza will be published shortly.
NHS Pay Review Body
Lord Lansley Excerpts(13 years, 1 month ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I am responding on behalf of my right hon. Friend the Prime Minister to the 25th report of the NHS Pay Review Body (NHSPRB). The report has been laid before Parliament today (Cm 8029). Copies of the report are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. I am grateful to the chair and members of the NHSPRB for their report.
We welcome the NHSPRB’s 25th report and accept its conclusions in full. We will take forward the suggested actions, which will help us continue to improve our support for the NHSPRB’s important work.
NHS Reorganisation
Lord Lansley Excerpts(13 years, 1 month ago)
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John Healey
We were doing what the manifesto said before the election. [Interruption.] We were doing it where the private sector and competition could add capacity to clear waiting lists, or do something new that the NHS was not doing. We did it in circumstances that were carefully planned, properly managed and always publicly accountable. If the hon. Gentleman is going to swallow the guff from those on his Front Bench that this is somehow an evolution of Labour’s policy, he will have to ask the Health Secretary why he needs legislation that is more than three times longer than the Act that set up the NHS in the first place.
Why do we say what we do in the motion before the House? In truth, this is a Tory reorganisation, and the legislation has been mis-sold. It is not just about getting GPs to lead commissioning or looking to cut layers of management; it is setting up the NHS as a full-scale market driven by the power of the competition regulator and the force of competition law. The reorganisation and legislation is designed to break up the NHS, open up all areas of the NHS to private health companies, remove requirements for proper openness, scrutiny and accountability to the public and to Parliament, and make the NHS subject to both UK and European competition law. The Tories are driving the free market political ideology through the heart of the NHS.
The Secretary of State for Health (Mr Andrew Lansley)
On precisely that point about scrutiny and accountability, we have been talking about independent sector providers. Under Labour, if scrutiny committees in local authorities wanted to investigate the activities of independent sector providers they could not do so. Under our legislation, they will be allowed to do so. Wherever NHS money—the public pound—goes, scrutiny will be able to follow. That is a change for the better.
John Healey
That is simply not true. The people who will make the big decisions about £80 billion of spending—the GP consortia—will not need to meet in public or to publish minutes of their meetings. They will not be subject to scrutiny by this House or proper public accountability.
Let me turn now to the question of subjecting the NHS to UK and European competition law. The Prime Minister clearly did not know about that at Prime Minister’s questions today—he clearly did not know that a third of his legislation sets up this new free market NHS. Perhaps the Health Secretary has only told him half the story about the legislation—
John Healey
Shall I finish what I have to say? Then I will give way. If the Health Secretary has not told the Prime Minister, he certainly has not told the public or this House, so let me spell it out—[Interruption.] The Health Secretary says that I have made it up, but why not wait for me to explain to the House, and then he can say whether what I am about to explain to the House is in my words or his?
Clause 52 of the Health and Social Care Bill, entitled “General duties”, sets up the new competition regulator, Monitor, and says:
“The main duty of Monitor in exercising its functions is to protect and promote the interests of people who use health care services—
(a) by promoting competition where appropriate, and
(b) through regulation where necessary.”
The new regulator is given legal competition powers, as well as functions under the Competition Act 1998 and the Enterprise Act 2002, and there are provisions on reviews by the Competition Commission and co-operation with the Office of Fair Trading.
John Healey
The Secretary of State can speak in a minute; I will finish this point. The regulator can investigate complaints about competition, force services to be put out to competitive tender, remove licences and fine the commissioner or provider up to 10% of their turnover. Helpfully, the Government’s new chair of Monitor confirms that. In The Times last month, he said:
“We did it in gas, we did it in power, we did it in telecoms, we’ve done it in rail, we’ve done it in water, so there’s actually 20 years of experience in taking monopolistic, monolithic markets and providers and exposing them to economic regulation”.
Mr Lansley
It is dead simple: the Health and Social Care Bill does not extend the application of EU competition law, or the application of domestic competition law. The powers given to Monitor as a sector regulator are the same as those now available to the Office of Fair Trading. The Bill does not change the scope of competition law at all.
John Healey
The right hon. Gentleman was involved, so he knows better than anyone else that the Tories are now setting out to do to the public services, including the NHS, what they did to the public utilities in the 1980s.
The Secretary of State for Health (Mr Andrew Lansley)
The Labour motion is interesting. I will ask the House to reject it, but it is an interesting motion. The first half of it accepts the principles of our reforms—it even does so in the same terms in which we have expressed them—but in the second half it goes on to say, “Not yet. Don’t make us do it yet.” Labour Members are turning their backs on the change that we need in the national health service and even on the policies they pursued in government.
But it is time for change. The public agree—65% of adults in England think that fundamental changes are needed in the national health service. The need to improve results for patients demands it. The need to empower clinical leadership demands it. The need to cut bureaucracy and invest in front-line care for patients demands it. As a coalition Government, we do not shirk our responsibilities. We have been absolutely clear that the NHS will remain free at the point of need, paid for from general taxation and based entirely on need and not on the ability to pay.
Those values are not, and never will be, threatened by this Government. The Health and Social Care Bill will not undermine any of the rights in the NHS constitution. It is for those same reasons that we, in a coalition Government, are protecting the NHS in the life of this Parliament by increasing NHS funding by £10.7 billion.
Clive Efford (Eltham) (Lab)
Will the Secretary of State distance himself from the comments of Dr Charles Alessi, a GP alleged to have been one of the architects of GP commissioning in this Bill and one of the people invited to No. 10, who is of the opinion that too many people in his area are receiving treatment for macular degeneration? Is that not rationing services and nothing whatsoever to do with providing them on the basis of clinical need?
Mr Lansley
All GPs and their colleagues who were part of the first wave of pathfinders were invited to No. 10—there were far more than we ever expected—and Charles Alessi was one of them. It is a complete illustration. I do not know what Charles said or why he said it, but he is the doctor, not me. Frankly, I think that it is clinical leaders in the NHS who are responsible for what they say, not me.
Nadhim Zahawi
Does my right hon. Friend agree that the way in which the Opposition are conducting themselves, when they proposed a 20% cut to the NHS, is scaremongering among our constituents and entirely irresponsible?
Mr Lansley
My hon. Friend makes an extremely good point, and he made it to the shadow Secretary of State, who did not answer it.
Mr Lansley
No.
The fact is terribly clear that before the election the Labour Government said that in three years the NHS would have to save between £15 billion and £20 billion. The Labour party never said in government that that money, if saved in the NHS, would be reinvested in the NHS. The other point is that when we came to the spending review, in which we agreed £10.7 billion extra for the NHS over the life of this Parliament, the shadow Secretary of State’s friends, who were then responsible, said that we should cut the NHS. We do not need to speculate about what they said they would do, because we can look at the example of Wales. The Labour-led Welsh Assembly Government are proposing to cut the NHS budget in Wales by 5%, while we are increasing it. We know exactly what Labour would do if they were in charge of the NHS: they would cut it. We have not cut it and are going to protect it.
Simon Hughes
I share absolutely my right hon. Friend’s view that the protection of the budget and the commitment to the principles of the NHS, which he has just enunciated, are really valuable and that Labour’s record in forcing privatisation undermines its whole argument. He knows that there are concerns. Having come back from the debate in my party, I ask him straightforwardly whether he will take on board the concerns expressed and look at ways to strengthen and further improve the Bill as it passes though this House and the House of Lords.
Mr Lansley
My right hon. Friend was busy in Sheffield over the weekend, but he might have heard me say on Sunday that where there are legitimate concerns, founded in reality rather than myth, about how we will secure the NHS and its modernisation for the future, we will listen. We have listened and changed the policy before the Bill was introduced. We have already amended the Bill during the course of its passage so far and will always look to clarify and improve it as it proceeds.
Mr Lansley
I will give way to the hon. Gentleman, and perhaps he can explain why the Labour party leading the Welsh Assembly Government will cut the NHS by 5% while we are going to increase the budget by £10.7 billion.
Michael Dugher
I might be new to Parliament, but we ask the questions and he is supposed to answer them. The Secretary of State knows full well that patient groups, health charities, doctors and nurses oppose the Bill—even that shower opposite opposed it at their conference. Is it not just arrogance on the part of the Government—
Madam Deputy Speaker
Order. It was not an opportunity to ask another question, either.
Mr Lansley
The hon. Gentleman has now learned that, if one is trying to pray somebody in aid, it is best not to insult them at the same time.
We have made it clear that we need to protect the NHS now and for future generations through modernisation. Under the Labour party—
Mr Lansley
Ah! Now we really do have somebody who can explain why in Wales the Labour party is cutting the NHS budget while we are increasing it. Come on!
Owen Smith
That is happening as a result of the very difficult decisions being taken in Wales, having seen the Welsh Assembly budget cut by £1.8 billion by the right hon. Gentleman’s Government. What we are not doing in Wales, however, is effectively privatising the NHS, exposing it to competition law or stuffing the mouths of private companies with public gold.
Mr Lansley
Let us remember that, when we decided to support the NHS here, through the Barnett formula by extension, money was provided to the devolved Administrations, but the hon. Gentleman confirms that a Labour-led Welsh Assembly Government chose not to invest in the NHS, while we in England chose to do so. I urge Welsh voters to remember that when they come to the elections in May.
Under the trade union thumb, Labour is turning its back on modernisation in the NHS, but the NHS cannot be preserved for the future and protected by neglect; it is not something that sits in a static format. It has to change to improve. When the number of managers in the NHS doubled under Labour, when results for patients in many conditions remain way below those achieved in other countries, and when the number of patients placed in mixed-sex accommodation runs into the thousands every month, the NHS needs to change.
Brandon Lewis (Great Yarmouth) (Con)
Does my right hon. Friend agree that some GPs are seeing the potential benefits to their local areas of improving the service for patients, and will he join me in congratulating GPs, such as those in Great Yarmouth, who are moving forward, several years ahead of schedule, with the pathfinder projects?
Mr Lansley
Yes. My hon. Friend will know that we have already arrived at the point where 177 GP groups, representing 35 million patients all over England, have volunteered as pathfinders to show how they can demonstrate such work. [Interruption.] Labour MPs who are insulting general practitioners might like just to remember—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Come on; we want to see the debate continue. A lot of Members want to speak and to intervene, but we cannot have so many of them on their feet at once.
Mr Lansley
I remember that if we ask the public whom they trust in public service, we find that general practitioners are at the top of the list. Members of Parliament and politicians are pretty near to the bottom of the list, so the public might take it pretty amiss that Labour politicians are insulting general practitioners by thinking that they are in it for the money. They are not; they are in it for the patients.
Kate Green (Stretford and Urmston) (Lab)
Will the right hon. Gentleman give way?
Joan Ruddock (Lewisham, Deptford) (Lab)
Will the right hon. Gentleman give way?
Mr Lansley
In a moment.
Only yesterday, the Public Accounts Committee said that over the past 10 years the productivity of NHS hospitals had been in almost continuous decline, and that taxpayers were getting less for every pound invested in the NHS: Labour, leaving us to sort out the mess. The truth of the matter is that the NHS needs to change to meet the rising demand for and cost of health care.
The changes that the NHS needs are simple: more investment, less waste, power to front-line doctors, nurses and health professionals, and to put patients first.
Mr Nick Raynsford (Greenwich and Woolwich) (Lab)
Will the right hon. Gentleman give way?
Mr Lansley
No. I will give way to the right hon. Member for Lewisham, Deptford (Joan Ruddock) first.
Joan Ruddock
The right hon. Gentleman speaks of the respect that patients have for their GPs, and that is certainly the case in my area, where GPs do an incredibly difficult and demanding job. How does he think, therefore, patients and the doctors themselves regard the pressure being put on them to become managers, to adopt skills that they do not have, and being forced to do it, when they say to me that the plans are untested, potentially divisive and will take them away from their patients? Those things are actually happening. Does he think that it is ethical to pay GPs £300,000 to cut services to patients?
Mr Lansley
The Royal College of General Practitioners has said that it believes that there should be more clinician-led commissioning, and yesterday the British Medical Association reasserted its view that general practice-led commissioning is the right way forward. The Labour Government set up practice-based commissioning but, as the shadow Health Minister, the hon. Member for Leicester West (Liz Kendall), said, GPs were not given the power, responsibility and opportunity to do it. I am afraid that the right hon. Member for Lewisham, Deptford is speaking against the evidence and the experience of GPs all over the country.
Andrew Bridgen (North West Leicestershire) (Con)
Does my right hon. Friend agree that the words of the shadow Secretary of State in this debate seem to contrast somewhat with his words back in January, when he said that
“the general aims of reform are sound—greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes”?
Why does my right hon. Friend think he has changed his mind?
Mr Lansley
Yes, that is one possibility. Another is that Labour Members are paid for by the trade unions.
Our changes are driving real improvement. Our investment means that more than 1,300 patients are now getting the life-extending cancer drugs they need; that is investment in cancer drugs that the Labour party opposed.
Mr John Baron (Basildon and Billericay) (Con)
My right hon. Friend is absolutely right to make no apology about the need for reform when cancer outcomes in this country remain well below the European average. The all-party group on cancer and, most recently, the Public Accounts Committee have made the case for recording staging data, which provide an insight into early diagnosis. Will he assure the House that, under these reforms, the importance of this issue will be pursued by the Government?
Mr Lansley
Yes. I am grateful to my hon. Friend and pay tribute to his work in this area, which is much respected. He is absolutely right—we will be doing that. Indeed, we can see the benefit already. A few weeks ago, I launched the bowel cancer awareness campaign in the east of England. The reason we were able to start that awareness campaign in that region is that we had good staging data arising out of the cancer networks in the area, which means that we will be able to make valid comparisons between the past and the future in terms of the stage at which patients are presenting for diagnosis of cancer.
Mr Lansley
No, I have given way to the hon. Gentleman before. [Interruption.] He only gets one shot.
Let me make it very clear. Our cuts in bureaucracy—
Mr Lansley
No, I will not give way—Labour Members might like to hear this.
Our cuts in bureaucracy have led to 2,000 fewer managers since the general election and 2,500 more doctors. We are already shifting resources to the front line. More than 5,000 surgeries across the country are now part of the pathfinder groups taking responsibility for front-line services. Some 25,000 front-line NHS staff are taking the opportunity to come together in social enterprises. All this is the modernisation that Labour now opposes. It is the modernisation that is delivering the results that matter, and will matter in future even more as we get to the outcomes that people really care about—whether they live, whether they recover, whether their treatment is successful, whether they have successful lives at home with long-term conditions.
At the same time, waiting times are stable and hospital infections are down, with C. diff down by a fifth and MRSA down by more than a quarter. The number of patients who are in mixed-sex accommodation when they should not be has also come down.
Mrs Anne Main (St Albans) (Con)
Does my right hon. Friend agree that we should totally dissociate ourselves from the disgraceful remarks implying that our reforms will somehow encourage GPs to make choices that are not best for their patients?
Mr Lansley
My hon. Friend makes a very important point. I caution Labour Members not to put political opportunism in place of the relationships that they should have in future with GPs, doctors and nurses and local foundation trusts in their constituencies. They are not speaking for their constituencies—they are just speaking for the trade unions.
The coalition Government are listening to patient groups, professional bodies and independent experts. We have had eight separate substantial consultations on our proposals, and we have changed policy as a result. For example, we have amended the Health and Social Care Bill on an important point, which greatly concerned the BMA, and clarified that the measure supports competition on quality, not price. At the point when a patient exercises choice or a GP undertakes a referral, the price of providers will be the same. By extension, competition must be on the basis of quality. That is important.
Malcolm Wicks (Croydon North) (Lab)
Given the removal of the limit on private patients who can go to an NHS hospital, my constituents will be concerned that, in conditions of scarcity, clinical need for a bed will be trumped by the weight of a wallet. Will the Secretary of State reassure my constituents that money will not trump the needs of patients?
Mr Lansley
Yes. I can entirely reassure the right hon. Gentleman’s constituents because the Bill makes it clear that even if private patient income is available to foundation trusts, it must support the principal purpose, which is provision of services to patients through the NHS. If the right hon. Gentleman wants an example, he might like to go along the road into the constituency of the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), and meet people from the Royal Marsden, which is a foundation trust that attracts, from memory—I may not be entirely up to date—approximately 25% of income from private patients. It has consistently recorded the highest scores of excellence for its quality of service to patients.
Mr Lansley
I want to make progress. I have given way several times.
The right hon. Member for Wentworth and Dearne (John Healey) said that we planned to get rid of regional system management in the NHS, but that was Labour’s policy when it introduced NHS foundation trusts. Through introducing health and well-being boards in local authorities, we will have a genuine, system-wide view that looks at the NHS, public health and social care. He complains about the commercial insolvency regime, but Labour introduced that under the legislation that set up the foundation trusts eight years ago. He said that our plans introduce EU competition law. No. EU competition law already exists and the Bill does nothing to change that—it does not extend the application of competition law. [Interruption.] No, it does not. In Committee, the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), explained the current position, which the Bill does not change.
The right hon. Member for Wentworth and Dearne and other Labour Members talk about price competition. We have clarified the Bill to ensure that the competition is on quality. What happened under Labour? The private sector was paid 11% more than the NHS. Under Labour, private sector providers were paid £250 million for operations that they did not perform. Under Labour, NHS hospitals were barred from tendering to provide the capacity that Labour offered to the independent sector. Labour Members favoured the private sector. A Liberal Democrat manifesto commitment stated that we would not in future allow the private sector to be given advantages and the NHS to be shut out. We will implement that.
I want to know a bit, because although the right hon. Member for Wentworth and Dearne said that it was the Opposition’s job to ask questions today, I have done many Opposition day debates on health when I was asked many times what our policy was, and I answered those questions. Is it Labour’s policy to extend the use of voluntary sector providers in the NHS? That was in the Labour party’s manifesto. Indeed, Labour said that it wanted to use the independent private sector, too. Is it still the policy? No answer. We do not know. Is it Labour’s policy to make every trust an NHS foundation trust? Again, it was in the Labour party manifesto. Is it still the Labour party’s policy—yes or no? No answer. Again, we do not know. Is it Labour’s policy to promote competition in the NHS, as quoted from the Labour party manifesto in the debate? The right hon. Gentleman has just made a speech opposing that. Does he wish to intervene?
John Healey
I am grateful to the Secretary of State for giving way. We had the NHS as the preferred provider and were ready to use other providers when they could help, and we did so. The great improvements in the NHS happened because we were prepared to put in the investment and to make the reforms. The Secretary of State talks about policies. The problem with what he is doing to the NHS—the reorganisation, the legislation and the ideological change at the heart of it—is that he did not tell the people about it before the election and he did not tell the Lib Dems about it before they signed the coalition agreement. This top-down reorganisation is exactly what he promised not to do.
Mr Lansley
The right hon. Gentleman was not satisfied with his first speech, so he had to have a go at a second one. He did not answer any of my questions. The Labour party said in its manifesto that it would use the private and voluntary sectors alongside NHS providers. The reason for that was simple: having the NHS as the preferred provider meant that the patient could be let down time after time before another quality provider could be permitted. We are going to allow competition on quality, but the quality has to be there. Patients will get the best possible service from whoever is best placed to provide that care.
Our changes are being seen across the country already.
Mr Edward Leigh (Gainsborough) (Con)
This party political ding-dong is great fun, but what worries me is that we have an ageing population, there are rightly more and more expensive techniques, and the taxpayer cannot put any more money in. Who is going to save the NHS if there is no co-operation with the private sector?
Mr Lansley
Over many years as Chair of the Public Accounts Committee, my hon. Friend challenged the failure of the previous Government to secure the improvement and value for money that is necessary patients. I make no bones about it: I think that if we give NHS organisations freedom and opportunity through foundation trust status, they will be competitive. I do not think that we will see a big expansion in the number of private sector providers, because the NHS has the enterprise and innovation to succeed. However, we have to make sure that they are open to that test. We test whether voluntary and independent sector providers meet the right quality, and we must expose the NHS to that test.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The Secretary of State has decided that he is not going to give way. That is his decision. He has given way already. We need to have a little less noise so that we can hear the Secretary of State.
Mr Lansley
Thank you, Mr Deputy Speaker. I have to conclude to ensure that we do not trample on Members’ time.
We will hold the NHS to account for what it achieves, but not tell it how to achieve it. We want continuous improvements in outcomes and more personalised care. We are going to change accountability in the NHS. In the past, the only question in accident and emergency was whether people were seen within four hours. We will ask whether a patient was seen by the right person, whether the quality of care they received was appropriate, and whether they recovered. From April, we will know those things for the first time. On mental health, we will ask whether we are helping people with serious mental health problems to live longer, and whether we are helping them to get a job. We will ensure that we find out those things and that we know which services provide the right care.
Beyond the NHS, we will make changes that increase accountability. As of today, 134 local authorities with social care responsibilities—almost 90% of such local authorities in England—have signed up to be early implementers of health and well-being boards. Those are the bodies that will finally tear down the walls between the NHS, public health and social care; and they will strengthen local accountability to the public and patients. Local authorities will finally have the powers that they need to scrutinise all NHS-funded providers of care, be they public, voluntary or private sector providers.
The coalition Government were elected to protect the NHS and that is what we are doing. We are protecting the NHS in this Parliament through increased investment, and protecting it for future generations through modernisation. We need an NHS in which every system, process and incentive encourages excellence in health care and weeds out poor performance. Labour now opposes that. It has turned its back on the NHS. It wants to drag the NHS back into politics; I want the NHS to be freed from political interference so that it can deliver the best possible care and results for patients. This Government will always support the NHS. We have a simple aim: to create an NHS that is up there with the best in the world. Our modernisation plans will do just that.
Debbie Abrahams
No, I am sorry, I am going to make progress so that everyone gets a chance to speak.
The Government have also said that the NHS commissioning board will ensure that NHS delivery is free from political control, but I am not so sure about that. The Bill contains a variety of contradictions, particularly in relation to the Secretary of State’s appointments to the various quangos. Another of the founding principles under threat from this Government is that treatment should be based on clinical need and not the ability to pay. We heard the Secretary of State say that that would be protected, but the Government’s reorganisation of the NHS will result in opening up that fundamental principle. The NHS commissioning board and the GP consortia will have the power to generate income, perhaps by charging for non-designated services. What constitutes designated and non-designated services has yet to be defined, however. My hon. Friend the Member for Leicester West (Liz Kendall) tried to get some elucidation on that, but none was forthcoming.
Debbie Abrahams
No, I am sorry, I want to make some progress—[Hon. Members: “Give way!”]