Government Response to NHS Future Forum
Lord Lansley Excerpts(13 years, 6 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
As I informed the House on 14 June 2011, the Government have accepted the core recommendations of the NHS Future Forum’s report. A list of the key changes the Government intend to make as a result has already been placed in the Library.
I have today laid before Parliament “Government Response to the NHS Future Forum”, Cm 8113, a detailed explanation of how the Government plan to implement improvements to their plans for NHS modernisation. Some, but not all, of these changes require amendments to the Health and Social Care Bill.
On 16 June the Government tabled a motion to recommit the relevant parts of the Health and Social Care Bill to a Public Bill Committee. The House will debate this motion tomorrow.
I am also laying before Parliament later today “Government Response to the House of Commons Health Select Committee Fifth Report of Session 2010-11: Commissioning”, Cm 8100.
“Government Response to the NHS Future Forum”, Cm 8113 is in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. Copies of “Government Response to the House of Commons Health Select Committee Fifth Report of Session 2010-11: Commissioning”, Cm 8100, will be available later today.
NHS Future Forum
Lord Lansley Excerpts(13 years, 6 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
With permission, Mr Speaker, and further to the written ministerial statement I laid in the House earlier today, I wish to make a statement on the Government’s response to the NHS Future Forum.
We established the independent Future Forum on 6 April, under the chairmanship of Professor Steve Field, to look again at our proposals on the modernisation of the NHS. Yesterday it published its report and recommendations. I would like to thank Professor Field and his 44 senior colleagues from across health and social care who have worked so hard these past eight weeks. I would also like to thank more than 8,000 members of the public, health professionals and representatives from some 250 stakeholder organisations who attended some 250 events across the country—and also the tens of thousands who wrote to us with their views. I want also, if I may, to thank the many officials in my Department who supported this unprecedented engagement across the country.
Two months ago, I said to the House that we would pause, listen, reflect and improve our plans. Our commitment to engage and improve the Bill has been genuine and has been rewarded with an independent, expert and immensely valuable report and recommendations from the Future Forum. I can tell the House that we will ask the forum to continue its work, including looking at the implementation of proposals in areas including education and training and public health.
In his report, Professor Field set out clearly that the NHS must change if it is to respond to challenges and realise the opportunities of more preventive, personalised, integrated and effective care. The forum said that the principles of NHS modernisation were supported: to put patients at the heart of care, to focus on quality and outcomes for patients, and to give clinicians a central role in commissioning health services.
The forum set out to make proposals for improving the Bill and its implementation, to provide reassurance and safeguards, and to recommend changes where needed. As Professor Field put it, it did this not to resist change, but to embrace it, guided by the values of the NHS and a relentless focus on the provision of high-quality care and improved outcomes for patients.
We accept the NHS Future Forum’s core recommendations. We will make significant changes to implement those recommendations and, in some cases, offer further specific assurances that have been sought. There are many proposed changes and we will publish a more detailed response shortly. However, I would now like to tell the House some of the main changes that we will make.
The Bill will make it clear that the Secretary of State has a duty to promote a comprehensive health service, as in the National Health Service Act 1946, and is accountable for securing its provision and for the oversight of the national bodies charged with doing so. We will also place duties on the Secretary of State to maintain a system for professional education and training within the health service, and to promote research.
One of the most vital areas of modernisation to get right is the commissioning of local services. For commissioning to be effective, the process of designing services must draw on a wide range of people, including clinicians, patients and patient groups, carers and charities. We will amend the Bill so that the governing body of every clinical commissioning group will have at least two lay members, one focusing on public and patient involvement and the other overseeing key elements of governance, such as audit, remuneration and managing conflicts of interest. Although we should not centrally prescribe the make-up of the governing body, it will have to include at least one registered nurse and one secondary care specialist doctor. To avoid any potential conflict of interest, neither should be employed by a local health provider. The governing bodies will meet in public and publish their minutes. The clinical commissioning groups will also have to publish details of all their contracts with health service providers.
To support commissioning, the independent NHS commissioning board will host “clinical senates”, which will provide expert advice on the shape and fit of health care across wider areas of the country. Existing clinical networks will be developed and will advise on how specific services, such as those for cancer, stroke or mental health, can be better designed to provide integrated and effective care.
Building on that multi-professional involvement, clinical commissioning groups will have a duty to promote integrated health and social care with regard to the needs of their users. To encourage greater integration between social care and public health, the boundaries of clinical commissioning groups should not normally cross those of local authorities. If they do, clinical commissioning groups will need to demonstrate to the NHS commissioning board a clear rationale for doing so in terms of benefit to patients.
I have always said that I want there to be “no decision about me, without me” for patients when it comes to their care. The same—[Interruption.]
Mr Speaker
Order. Let us hear the Secretary of State’s statement with some courtesy.
Mr Lansley
Thank you very much, Mr Speaker.
We will further clarify the duties on the NHS commissioning board and clinical commissioning groups to involve patients, carers and the public. Commissioning groups will have to consult the public on their annual commissioning plans and involve them in any changes that would affect patient services.
One of the main ways in which patients will influence the NHS is through the exercise of informed choice. We will amend the Bill to strengthen and emphasise the commissioners’ duty to promote patient choice. The choice of any qualified provider will be limited to areas where there is a national or local tariff, ensuring that competition is based solely on quality. The tariff development, alongside a best-value approach to tendered services, will safeguard against cherry-picking.
Monitor’s core duty will be to protect and promote the interests of patients. We will remove its duty to promote competition as though that were an end in itself. Instead, it will be under a duty to support services integrated around the needs of patients and the continuous improvement of quality.
It will have a power to tackle specific abuses and restrictions of competition that act against patients’ interests. Competition will be a means by which NHS commissioners are able to improve the quality of services for patients.
We will keep the existing competition rules introduced by the last Government—the so-styled “Principles and rules for co-operation and competition”—and give them a firmer statutory underpinning. The co-operation and competition panel, which oversees the rules, will transfer to Monitor and retain its distinct identity. We will also amend the Bill to make it illegal for the Secretary of State or the regulator to encourage the growth of one type of provider over another. There must be a level playing field.
We will strengthen the role of health and wellbeing boards in local councils, ensuring that they are involved throughout the commissioning process and that local health service plans are aligned with local health and wellbeing strategies.
In a number of areas, we will make the timetable for change more flexible to ensure that no one is forced to take on new responsibilities before they are ready, while enabling those who are ready to make faster progress. If any of the remaining NHS trusts cannot meet foundation trust criteria by 2014, we will support them to achieve that subsequently. However, all NHS trusts will be required to become foundation trusts as soon as clinically feasible, with an agreed deadline for each trust.
We will ensure a safe and robust transition for the education and training system. It is vital that change is introduced carefully and without creating instability, and we will take the time to get it right, as the Future Forum has recommended. During the transition, we will retain postgraduate deaneries and give them a clear home within the NHS family.
The extension of “any qualified provider” will be phased carefully to reflect and support the availability of choice for patients. Strategic health authorities and primary care trusts will cease to exist in April 2013. By that date, all GP practices will be members of either a fully or partly authorised clinical commissioning group, or one in shadow form. There will be no two-tier NHS.
However, individual clinical commissioning groups will not be authorised to take over any part of the commissioning budget until they are ready to do so. Individual GPs need not take managerial responsibility in a commissioning group if they do not want to, and April 2013 will not be a “drop dead” date for the new commissioners. Where a clinical commissioning group is not able to take on some or all aspects of commissioning, the local arms of the NHS commissioning board will commission on its behalf. Those groups that are keen to press on will not in any way be prevented from becoming fully authorised as soon as they are ready.
I told the House on 4 April that we would secure proper scrutiny for any changes that we made to the Bill. In order to do that without trespassing on the House’s time to review the Bill as a whole on Report, we will ask the House to recommit the relevant parts of the Bill to a Public Bill Committee shortly.
Through the recommendations of the NHS Future Forum and our response, we have demonstrated our willingness to listen and to improve our plans; to make big changes, and not to abandon the principles of reform, which the forum itself said were supported across the service. However, we are clear that the NHS is too important, and modernisation too vital, for us not to be sure of getting the legislation right. The service can adapt and improve as we modernise and change, but the legislation cannot be continuously changed. On the contrary, it must be an enduring structure and statement, so it must reflect our commitment to the NHS constitution and values and incorporate the safeguards and accountabilities that we require. It must protect and enhance patients’ rights and services, and it must be crystal clear about the duties and priorities that we will expect of all NHS bodies and local government in the future.
Professor Field’s report says that it is time for the pause to end. Strengthened by the forum’s report and recommendations, we will now ask the House to re-engage with delivering the changes and modernisation that the NHS needs. I commend this statement to the House.
John Healey (Wentworth and Dearne) (Lab)
I thank the Secretary of State for an advance copy of his statement, although I learned more from the Prime Minister’s press conference than from the statement.
Humiliating! The Health Secretary has had health policy taken out of his hands. He spent the last nine months telling anyone who criticised the Government’s health plans that they were wrong, and that they did not understand. Today, he admits that he is wrong. How can he argue for this latest blueprint for the biggest reorganisation in NHS history with any credibility or integrity? The man who messed up so badly last year is telling us how he will mess up next year too.
Why no apology to NHS patients and staff for the wasted year of chaos, confusion and incompetence? Why no apology for breaking the coalition agreement to stop top-down reorganisations? Why no apology for patients, who are already beginning to see the NHS go backwards again because of this reorganisation? More than one in 10 people now waits 18 weeks for operations, three times the number of patients wait more than six weeks for tests, and casualty waits are at a six-year high.
This is the first Prime Minister who has been forced to ask 45 experts for a report on how to protect the NHS from his own Government’s policies. Now he is reorganising his reorganisation. The Future Forum report yesterday was a demolition job on the Government’s misjudgments and mishandling of the health service. Why is he wasting £800 million on redundancy payments when some of the same people will be re-hired to do the same job? Why is he holding back £2 billion promised for patient care when it could fund 55,000 nurses? Why is he ploughing on with the Health and Social Care Bill when what he announced today could largely be done without legislation, and certainly without the risk and cost of the biggest reorganisation in NHS history?
This is a political fix, not a proper plan for improving care for patients, or for a better or more efficient NHS that can meet the big challenges that it must face for the future. Make no mistake, today’s plans will mean that the NHS is mired in more complex bureaucracy, more confusion and more wasted cost in the years to come. In the battle of spin, with all parts of the divided Government claiming a win, the big losers will be NHS patients. The Opposition and the public will judge the Government on what they do, not on what they say.
I lost track of the bureaucracy that the Health Secretary announced in his statement. Will he admit that this reorganisation creates five new national quangos, set to spend tens of billions of pounds? Will he admit that this reorganisation replaces one local body—the primary care trust—with at least five others, all of which will play a part in commissioning? Will he admit that the plans still cut hospitals loose from the NHS, with no limits on treating private patients while NHS patients wait longer, and no support from the NHS if they run into financial trouble? Will he admit that hospitals will no longer have the protection as a public service from the full force of competition law?
What was a very bad Bill will still be a bad Bill. This House should be allowed to do its proper democratic job, as the only elected House, and scrutinise in full in Committee the whole Bill. At its heart, the Bill will still be the Tory long-term plan to see the NHS set up as a full-scale market, and the NHS broken up as a national public service, so that patients increasingly see the services on which they depend subject to the lottery of where they live.
The public have rumbled the Prime Minister. They know that they cannot trust him with the NHS. Fewer than one in four now trusts him to keep his NHS promises, and more than half believe that the Conservative party’s plans for the NHS are just a way to privatise the health service. Today, the Government have recycled their plans for the NHS when they should have been scrapped. People are right to conclude that they cannot trust the Tories with our NHS.
Mr Lansley
Well, I was hoping that, having got past the abuse, the right hon. Gentleman would tell us whether he agreed with the NHS Future Forum, but he did not even mention it. He welcomed the listening and engagement exercise that we announced—he said it was the right thing and that it would be good government to do it—but then when an independent group of experts reports and makes recommendations, he ignores it and says he will oppose the Bill regardless. He did not listen to what people in the NHS were saying. I think it was shameful how he dismissed everything that has happened over the past year as though it did not matter at all—a year in which the coalition Government said we would increase resources to the NHS. We have done that and are committing to investing an extra £11.5 billion in the NHS over the next four years. That is money that, as we will continue to remind the British public, the Labour party told us we should not give to the NHS.
In the past year, the coalition Government and the NHS across the country have implemented a cancer drugs fund from which 2,500 more patients have benefited, and in the past four months, we have cut the number of breaches of the single-sex rule by three quarters, and the number of hospital infections by 22% and C. difficile infections by 15%. Some 750,000 more people are accessing dentistry, and waiting times for people going into hospital are down compared with March 2010. We said that we would reduce management costs, and we will do so, and we have taken 3,800 managers out of the NHS since the election, while the number of doctors has gone up. Six months ago, the right hon. Gentleman said that he supported the reform principles in the Bill. All he said today was sheer opportunism, but it will come back to haunt him, because the NHS will benefit from the changes we are proposing today. It will take greater ownership of its own service; patients will be empowered; and clinicians across the service will be empowered and will deliver better outcomes for patients, and when that happens, we will be able to say, “The Labour party would have denied the NHS the resources and the freedom and responsibility to deliver those better outcomes.”
Mr Stephen Dorrell (Charnwood) (Con)
Is not the key challenge facing the national health service today the need to reverse a decade of declining productivity bequeathed to us by the Labour party? Does my right hon. Friend agree that his statement today provides the basis for us to do that based on the evolution of effective commissioning engaging the entire clinical community, which will address the fragmentation of service and progress the integration of service around the needs of individual patients?
Mr Lansley
Yes, I agree with my right hon. Friend. It is precisely that process of engaging clinicians, who will come together to design services around the needs of patients in a way that delivers not just improving productivity, but improving quality of services for patients, that is at the heart of the shift from primary care trusts and strategic health authorities. Let’s face it: the Labour party spent a decade presiding over declining productivity, while the costs of bureaucracy and management in the NHS doubled. We will empower people in the NHS to deliver improving services and reduce bureaucracy. [Interruption.]
Mr Lansley
It is slightly confusing, because the right hon. Gentleman’s right hon. Friend on the Opposition Front Bench, the Member for Wentworth and Dearne (John Healey), was just telling us—erroneously—that we could have done this without legislation anyway, but now the right hon. Gentleman is accusing us of proceeding without legislation. It is not true: we are doing things in the NHS by way of changes that are absolutely essential in any case. I have to tell him and the House that sustaining the structure that we inherited from the Labour party, with all the strategic health authorities and all the primary care trusts—this vast bureaucracy— could never have happened. We had to take out administration costs in the service, and empower clinicians and patients, and we are doing it now regardless of whether the legislation has made progress.
John Pugh (Southport) (LD)
I welcome the statement and the change. I have a list here. The Government’s response has satisfied 70% of the demands for change on that list, but it is seemingly not enough—nor can it be enough—because ironically, it is the list of amendments tabled by the Labour party in Committee. Why does the Secretary of State think that it is so hard to build consensus? Given that in many cases the amendments are ones that Labour has asked for, why is the Labour party being so pointlessly churlish?
Mr Lansley
I am grateful to my hon. Friend. There are many things that are beyond many of us to understand. One of them is the Labour party and the way it approaches policy. As he and the House will know, the fact is that the Labour party has no policy; it simply had opposition for opposition’s sake.
Mr Ben Bradshaw (Exeter) (Lab)
In fact, the last Labour Government left record low waiting times and record levels of public satisfaction with the NHS. I welcome the fact that Professor Steve Field has said what many of us in the Opposition have been saying for at least a year. How much has this year’s shambles cost the NHS, and how much has it damaged patient care?
Mr Lansley
It has not damaged patient care. The right hon. Gentleman should not denigrate the NHS. In May 2010, at the last election, patients waiting to be admitted to hospital waited 8.4 weeks for their treatment; on the latest figures, that went down to 7.9 weeks. Out-patient waiting times for May 2010 were 4.3 weeks on average; that went down to 3.7 weeks, and that in the midst of rising demand on the NHS and continuously improving performance.
Dr Sarah Wollaston (Totnes) (Con)
This is clear evidence of a listening Government. Does the Secretary of State agree that what the NHS now needs is consensus across all political parties, and for everybody to put their money where their mouth is and support the NHS and these changes as we move forward?
Mr Lansley
I am grateful to my hon. Friend, who makes a very good point. The Future Forum made the point that what people across the NHS want now is the certainty of knowing what the policy is and to move forward to make that happen.
Alan Johnson (Kingston upon Hull West and Hessle) (Lab)
In view of the NHS Future Forum’s comments about the
“importance and relevance of the NHS Constitution”
in guiding its work, does the Secretary of State accept that the seven principles set out in the constitution were more effective in protecting the NHS from a hostile Government than the Prime Minister’s five pledges?
Mr Lansley
No, I do not accept that. The Prime Minister’s commitments are absolutely what the public and the people working in the NHS expect and wish to see. They are vital, and they would not have been true under a Labour Government. For example, a Labour Government would not have increased resources for the NHS. The only part of the United Kingdom where there is now a Labour Government is Wales, where resources for the NHS are being cut this year by 5% in real terms compared with last year. When I went to north Wales in the middle of the recess, I saw on the front page of the Liverpool Daily Post that the number of patients waiting more than 36 weeks for their operations had risen from 16 to 989.
Mr David Ruffley (Bury St Edmunds) (Con)
I welcome the proposals, but will the Secretary of State give details of the safeguards against cherry-picking of the kind that, if unchecked, could fatally undermine rural district hospitals such as the West Suffolk hospital in my constituency?
Mr Lansley
Yes; we have to ensure that commissioners are increasingly able to use a tariff involving an established national or local price to determine the service that they commission, and that that does not allow the private sector—or anyone else, for that matter—to cherry-pick services by undercutting on price. We also need to ensure that that price reflects the cost of the treatment for the conditions involved, including complex conditions. This is why we have committed to carry out work, not least with the Royal Colleges, to identify where we need to develop tariffs in order to ensure that that happens.
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)
I welcome the statement, not least because it pays tribute to the future of the NHS commission. What is the Secretary of State’s thinking on the forward planning for the commission?
Mr Lansley
If I may, I will interpret the hon. Lady’s question in relation to the NHS Future Forum. I freely acknowledge that I wish that we had instituted the Future Forum after the publication of the White Paper last year. Although we had a full, formal consultation process at the time, to which 6,000 people replied, the character of the engagement that has been achieved over the past two months has been superlative. As we make further progress on the development of education and training proposals, for example, I want to ask the NHS Future Forum to continue that process of engagement in that and other areas across the service.
Mr Charles Walker (Broxbourne) (Con)
I have a great deal of time for most GPs—in particular for the one sitting in front of me, my hon. Friend the Member for Totnes (Dr Wollaston)—but what part of the Bill would allow communities to rid themselves of underperforming GP practices?
Mr Lansley
That would need to be initiated by the NHS commissioning board. Under the legislation, the board would respond to the health and wellbeing board in the local authority in question, or to the local clinical commissioning group. In my hon. Friend’s area of Hertfordshire, the health and wellbeing board will provide a new and powerful means by which the voice of the public can be expressed to challenge all the poor performance that occurs in the service.
Mr Kevin Barron (Rother Valley) (Lab)
The Secretary of State must know that the biggest threat to the stability of the national health service is the introduction of competition law into clinical services. Will the clause that says that the mergers of NHS trusts will be a matter for the Office of Fair Trading and the Competition Commission be removed from the Bill?
Mr Lansley
The right hon. Gentleman should be aware that the Future Forum has recommended that the powers to be held by the Office of Fair Trading or the Competition Commission should be exercised by Monitor. That is because it believes it to be in the interest of the NHS for them to be exercised by a health service-specific regulator that is sympathetic to and has an understanding of NHS interests.
Andrew Bridgen (North West Leicestershire) (Con)
Primary care trusts and strategic health authorities are part of a top-down management structure that has led to waste and bureaucracy and tolerates poorer patient outcomes. Will my right hon. Friend confirm that they will be abolished, and that the £5 billion that that will save over this Parliament will be ploughed back into front-line medical services?
Mr Lansley
Yes, I am grateful to my hon. Friend; I can do that. It is essential to move to a world where we reduce administration costs, relieve bureaucracy in the service and free those providing services by offering them the resources to deliver improving care without the burden of bureaucracy, cost and waste inflicted by a Labour Government in the past.
Mr Dennis Skinner (Bolsover) (Lab)
Does not the Secretary of State understand that when the Labour Government were in power, they increased spending from £33 billion to £111 billion in one decade, and that we are now witnessing, at a cost of £2 billion, a new Frankenstein monster all to pacify these tin-pot Liberals? Judas only got 30 pieces of silver.
Mr Lansley
I have a mission for the hon. Gentleman— he should head to Wales. In England, this coalition Government have committed to increasing the NHS budget in real terms in the life of this Parliament. The King’s Fund reported the other week that in Wales, a Labour Government intend to reduce the NHS budget in real terms by over 8%.
Duncan Hames (Chippenham) (LD)
I believe that the very act of listening to patients and the public will have done a lot to improve these proposals—as, I suspect, once the dust has settled, it will have done for the Health Secretary’s reputation, too. Given the requirement for greater local accountability in these proposals, will the right hon. Gentleman make the same recommendation to local clinical commissioners in the changes they are yet to make for health services in their areas?
Mr Lansley
I am grateful to my hon. Friend for his kind remarks, but I have to tell him that I am not looking to achieve anything in terms of reputation; I just want a positive outcome for the NHS. I have said before that this is not about me; it is about achieving for the NHS the opportunity to deliver better services for patients. That is all I am interested in.
The proposals on public and patient involvement illustrate what we needed to do—and will now do in response to the Future Forum—as many people wanted to see set out in detail in the legislation how patient and public involvement would work in the respective NHS bodies. The legislation had set out the fact that these bodies existed, but the detail was not prescribed. There is always a balance to be struck in legislation between the degree of prescription and the degree of freedom. Clearly, through engagement with the NHS, we have approval for putting much more of the detail into the Bill, now that it is clear that it will engage patients and the public.
Kate Hoey (Vauxhall) (Lab)
Along with the vast majority of the public, I welcome most of the changes announced today. I always welcome U-turns when they bring about the right thing. I am very concerned, however, that the bureaucracy that will be around after all these changes have gone through could be worse than what we have at the moment. I would genuinely like to be reassured on that point.
Mr Lansley
I am grateful to the hon. Lady for her support for the majority of the recommendations. The bureaucracy will reduce in the NHS as a consequence of the changes for one very simple reason—because we are shifting the ownership of commissioning and the responsibility for the design and delivery of services from what is essentially a distant managerial organisation into one that is locked into the clinical decision making of doctors and nurses across the service. Let us be clear: this is about delivering benefit to patients by empowering the doctors and nurses who care for them. That in itself will cut the bureaucracy.
Sajid Javid (Bromsgrove) (Con)
Can the Secretary of State confirm that the Government have no plans to decrease the budget for the NHS—unlike the plans of the Labour party to slash it by £30 billion?
Mr Lansley
Yes, my hon. Friend makes an important point. If we had listened to the Labour party last year, we would have cut the NHS and would not have increased the resources going into it. The £20 billion efficiency savings required to respond to demand and cost would have been £30 billion, which would have put an unsupportable degree of pressure on the NHS. As it is, we are giving the NHS not only resources but the opportunity to deliver improving care.
Valerie Vaz (Walsall South) (Lab)
After the White Paper was published in July last year, 6,000 representations were received from health professionals and from the Select Committee on Health asking the Secretary of State to think again about breaking up the NHS, so this “listening exercise” has been a waste of public money. Either the Secretary of State was wrong then, or he is wrong now. Which is it?
Mr Lansley
I am afraid I have to say that that was all nonsense. As the hon. Lady knows, we responded positively to the consultation last year and made changes then. However, as the details of the Bill have been emerging, people have been trying to work out how they will make it all work in the future. They have been saying, “We want to set out in the legislation precisely how it will work.” There is no better way of making that process effective than talking to people in the NHS, engaging with them, listening to them, and then implementing the changes.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
I am sure the Secretary of State agrees that the single biggest challenge facing health care in the United Kingdom is the economic and human challenge of looking after an ageing population. Does he also agree that the key to that is better integration of health care services—better integration of hospital services with community and social services—and that these reforms are a good way of going about that?
Mr Lansley
I agree very much with that. The Future Forum’s report, particularly the part that deals with clinical advice and leadership, has given us a robust structure for engagement with the range of professions that are capable of delivering that kind of integrated, joined-up and more effective care.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Can the Secretary of State reassure us that no services or hospitals will be taken over by the private sector?
Mr Lansley
There are no plans in the legislation or, indeed, in the Future Forum’s recommendations that would lead to that. In particular, as the hon. Lady will see in the detail published with the written ministerial statement this morning, we have proposed that Monitor should have no power to allow the private sector access to NHS facilities for reasons of competition and to take them away from NHS providers.
Mr Peter Bone (Wellingborough) (Con)
We have a Prime Minister who loves the NHS, a Secretary of State who is the most experienced Member in the House when it comes to the NHS, and a coalition Government who have done something that the Labour Government never did. They listened, and they were willing to improve their Bill. This is a great day for democracy. I congratulate the Secretary of State on that, and on referring the Bill back to a Committee—and if he is looking for volunteers for the Committee, I am available.
Mr Lansley
I am grateful to my hon. Friend. It is because I believe in the NHS and the people who work in the NHS that I think it right to listen to and engage with those people, and to give them much greater control of the service that they provide for patients.
Grahame M. Morris (Easington) (Lab)
What can we conclude from the fact that the Prime Minister is not here with us this afternoon to support the Secretary of State, but is involved in a PR stunt at Guy’s and St Thomas’ NHS Foundation Trust? It was once said on the other side of the Atlantic that you could put lipstick on a pig, but at the end of the day it was still a pig. Is that not true of the Bill?
Mr Speaker
Order. We are starting to get involved in issues perhaps not of order, but certainly of taste.
Mr Lansley
If you will forgive me, Mr Speaker, I do not think that I will favour that question with an answer.
Mark Lancaster (Milton Keynes North) (Con)
Will the Secretary of State expand on the support that organisations such as the Spinal Injuries Association can expect through specialised commissioning?
Mr Lansley
I believe that as a result of our proposals the NHS commissioning board will be able to provide more consistency in much specialised commissioning, and I hope that that will apply to people with spinal injuries. I am well acquainted with the work of the Spinal Injuries Association: I think that it has done terrific work, and we have already worked closely with it in trying to ensure that we improve commissioning and services for those with spinal injuries.
Karl Turner (Kingston upon Hull East) (Lab)
It is utterly disgraceful that Liberal Democrats and Tories are scrapping with each other to claim credit for the alleged listening exercise. Will the Secretary of State now apologise to my colleagues and me for not listening to us when the Bill was in Committee?
Mr Lansley
Yes, in relation to the changes we are now bringing forward, I do indeed give credit to some of my colleagues—very much so—but I also give credit to the Prime Minister and the Deputy Prime Minister for the time and trouble they have taken; they have spent a great deal of time listening, and engaging with people across the health service. We give credit, too, to the NHS Future Forum and the thousands of people across the NHS who have now made their contribution to the NHS’s future, and I think they will be very disappointed to hear Opposition Members just wanting to denigrate that, and to make political capital out of it, rather than supporting the NHS in its future objectives.
Tony Baldry (Banbury) (Con)
GPs collectively throughout Oxfordshire told the Field commission that they wanted to get on with GP commissioning, and that they were wholeheartedly committed to it because they believed they could be catalysts for change and better design NHS services for local people. When are GPs in Oxfordshire going to be able to get on with GP commissioning?
Mr Lansley
I can assure my hon. Friend that I know his local GPs, and that they want to work with their professional colleagues across their area and to get on with that now. We will continue to be able to delegate commissioning responsibilities to all commissioning groups who are ready to do that; if they show that they are ready, we can give them the capacity to do it through existing NHS structures.
Clive Efford (Eltham) (Lab)
This is not a U-turn; it is a body-swerve around the Liberals. The Secretary of State has spent the last year telling us that cherry-picking for profit in the NHS will not be possible under his Bill, yet today’s report has told us that he must take action to prevent such cherry-picking. Does the Secretary of State understand that this is now an issue of trust, and that nobody trusts him on the NHS—made in Britain by Labour, stolen by the Tories, and given away to his fat cat friends?
Mr Lansley
I will not attempt to compete with the hon. Gentleman on any driving analogies, but we have been clear that we will not countenance cherry-picking against NHS providers. The Future Forum has made recommendations on that, but they are not all to do with the Bill: for example, the processes I described of using a tariff lie outside the scope of the Bill. The Future Forum is making recommendations, and we are responding positively to them.
Dan Byles (North Warwickshire) (Con)
Does my right hon. Friend agree that the discourtesy and mock anger from Opposition Members demonstrate why it is so important to take politics out of the day-to-day running of the NHS, so that we avoid this sort of political football nonsense every time we try to implement sensible reforms of this vital public service?
Mr Lansley
My hon. Friend is absolutely right, and that may be why Opposition Front-Bench Members have not told us whether they agree with the Future Forum. The truth is that they know they have to agree with it, because it makes good sense, but they are also trying not to let their political opportunity drift away from them. People will be deeply disappointed, and in some cases angry, that they cannot abandon trying to turn the NHS into a political football.
Mr Michael Meacher (Oldham West and Royton) (Lab)
Will the new, revised GP consortia still be allowed to outsource commissioning, either in whole or in part, to private health care firms, many of them probably American, which would create a major conflict of interest?
Mr Lansley
The clinical commissioning groups will be statutory bodies, and will therefore not be able to delegate the responsibility for such commissioning to any other organisation, including a private sector organisation.
Karen Bradley (Staffordshire Moorlands) (Con)
My constituents will be reassured to hear the Secretary of State say that it remains the duty of the Secretary of State to deliver a comprehensive health service, but was that duty ever at risk?
Mr Lansley
It was always clear that we would retain section 1(1) of the 1946 Act, which states that the Secretary of State will have a continuing duty to promote a comprehensive health service in England. What has been asked of us is that the Secretary of State should have not only that duty but a duty to secure the provision of that health service and an oversight responsibility in relation to the national bodies charged with providing it, and we will respond positively to that request.
Nic Dakin (Scunthorpe) (Lab)
This is a sorry tale of the Government going too far, too fast. What we have now is in danger of being a dog’s breakfast and the worst of all possible worlds. How much has this top-down reorganisation cost the UK taxpayer so far?
Mr Lansley
The listening exercise has to date—on 14 June—cost £36,640.97. The process of modernisation in the NHS is saving hundreds of millions of pounds every month. We know that we have to not only increase resources to the NHS but deliver continuously improving productivity and efficiency in the NHS. The Labour party always ignored that and failed on that; we will not fail on that.
Simon Hughes (Bermondsey and Old Southwark) (LD)
Today’s proposals are clearly winning the support of the health professionals and of political colleagues, but to win the support of the public and the patients I hope the Secretary of State will be able to give one further assurance that these plans will give greater local democratic accountability for the NHS than ever before and will therefore mean no enforced local privatisation of services, which happened under the previous Labour Government.
Mr Lansley
Yes, I can give my right hon. Friend that assurance. He will know that in our response to the Future Forum we will strengthen the role of health and wellbeing boards, deliver more integrated care and ensure that the local health and wellbeing strategy is a central document in determining the shape of commissioning in the NHS, social care and public health. The powers, including those for service reconfiguration in an area, will be maintained so that they must continue to meet the four tests I set out last year. The public voice will therefore be at the forefront of the response to any changes in the local service.
Lyn Brown (West Ham) (Lab)
Given that the Secretary of State is about to waste £2 billion on this reorganisation—money that would be better spent on patient care—will he give us an assessment of how many A and E departments will close over the next two years?
Mr Lansley
That is pretty rich. When I became Secretary of State, I found that all over the country there were threats to accident and emergency departments and to maternity departments generated under a Labour Government. Let me tell the hon. Lady that this is about delivering continuously improving care and cutting costs. We set out very clearly that although there are costs involved in reorganisation, they will be recouped severalfold over the course of this Parliament, saving in total some £5 billion in reduced administration costs.
Mr David Nuttall (Bury North) (Con)
My right hon. Friend will be aware that tens of thousands of families throughout my constituency are deeply concerned about the reduction of services at Fairfield hospital in Bury. Will any of the changes that my right hon. Friend has outlined enable that process to be reversed?
Mr Lansley
My hon. Friend and I have visited Fairfield hospital on a number of occasions and I have every sympathy with him and his constituents. He inherited as a Member of Parliament, as I did as Secretary of State, very advanced plans for changes to services at the hospital. What will now come to the forefront is the ability of the local authorities, through the health and wellbeing board and the clinical commissioning group, to bring clinical staff and the public together to say that in his area, north of Manchester, they can take greater ownership of the design of services to meet local needs.
Jim McGovern (Dundee West) (Lab)
I am sure that I am not the only Member who noticed that the title given to the urgent question required only one consonant to be added for us to use it for the ministerial statement: “Wasted Review”—[Interruption.] Wasted review—was that the sound of a large penny dropping? Given that the Minister is constantly dodging questions about the cost of the review, will he tell us how many nurses and doctors could have been put in post using the money the review cost?
Mr Lansley
The latest figures on the changes in staffing in the NHS since the general election have shown a reduction of 3,800 managers, an increase of 2,500 in the number of doctors and no reduction in the number of nurses.
Charlie Elphicke (Dover) (Con)
In Dover and Deal, we have dynamic GPs, many of whom want to get involved in commissioning, but not every GP wants to do so. Will the Secretary of State confirm that no individual GP will be forced to be involved in the work of the commissioning group and that that was always the case under his reforms?
Mr Lansley
My hon. Friend makes a good point. Many GPs across the country understand that clinically led commissioning is the right thing to do, but they do not personally want to be involved in that process. There are, however, leaders who do, and leaders across the country have already come forward through pathfinder consortia and will be a basis on which we can create much greater clinical leadership across the service. The Future Forum was very clear that leadership from within the service, from doctors, nurses and other health professionals, will be instrumental in improving care in the future.
Chris Williamson (Derby North) (Lab)
Everyone knows that the Conservatives opposed the introduction of the national health service and that they brought it to its knees when they were last in power. Now they are trying to undermine it by wrapping it up in bureaucracy. With waiting lists increasing, what assurances can the Secretary of State give the House that they will not increase further as a result of the measures he is bringing forward in the Bill?
Mr Lansley
I do not think that the hon. Gentleman listened to or heard the Prime Minister when he made absolutely clear our commitment to keeping waiting times low. Not only did the Prime Minister make that commitment, but it is in the constitution. In practice, the opportunity for patients increasingly to see the performance of the hospitals to which they can choose to go will help to drive increases in performance. As I told the House in response to an earlier question, waiting times are now lower for in-patients and out-patients than at the time of the last election. I am also old enough to remember that in June 1944, Winston Churchill, as the leader of a coalition Government, went to the Royal College of Physicians and set out an ambition for a national health service that would give everybody in the country access to the highest quality health care, free for all, regardless of means.
Jeremy Lefroy (Stafford) (Con)
The Cure the NHS group, founded by Julie Bailey in Stafford, has rightly stressed the importance of a culture of caring and zero harm to patients—something that my right hon. Friend has always emphasised. How does he think the recommendations of Professor Field’s report will help with embedding such a culture across the NHS?
Mr Lansley
As my hon. Friend knows, much can contribute to that change of culture, not least making safety one of the central domains for measuring outcomes in the NHS. In addition, it must be personal to each member of staff in the NHS that they have that responsibility. We have too often seen cases in which people have been professionally responsible but have not acted in line with that responsibility. A central part of what we need to do is not about organisations and structures but about creating that sense of personal responsibility in professionals across the service to look after their patients and those for whom they care and to blow the whistle if there is harm or abuse; and we must protect and secure that whistleblowing when it happens.
Helen Jones (Warrington North) (Lab)
The Secretary of State promised to reduce bureaucracy, but he has now spent more than £760 million on a botched reorganisation that gives us commissioning consortia, senates, a whole host of national quangos and PCTs being abolished to transfer their staff somewhere else. Is it not time he accepted that this is a botched reorganisation and withdrew the Bill?
Mr Lansley
Most of that was pure invention, including all the numbers. We are going to save money with these changes to the NHS. We are going to transfer resources from bureaucracy, management and administration into front-line care. Through clinical commissioning groups we are going to empower staff in the NHS, and abolishing two tiers of management in the NHS will save us, in total, a third in real terms out of administration costs.
John Glen (Salisbury) (Con)
Will the Secretary of State confirm that despite the existence of clinical senates the primary driving role in commissioning will remain with GPs, who know their patients best and know which services they require?
Mr Lansley
My hon. Friend makes an important point. General practice—not just general practitioners but general practice—has a central role for patients because there is a long-term relationship with patients and an understanding of the whole population and the health of a whole area. However, GPs recognise that in order to get the right services for patients, they have to design services alongside the range of professionals whose job it is to deliver them.
Mr Ronnie Campbell (Blyth Valley) (Lab)
Let us be clear: this is just a dog’s dinner and these amendments have proved it. What we have here is a slow-privatisation-of-the-NHS Bill that is backed by the Rag, Tag and Bobtail party—the Liberal Democrats. This is the beginning of the privatisation of the health service and it is time it stopped.
Mr Lansley
This Bill and our proposals were never to support privatisation; they are not to support privatisation and they will not be to support privatisation. The hon. Gentleman should have attacked the Labour Government who gave the private sector £250 million for operations it never carried out; they paid it 11% more than they would have paid the NHS for that. They tried to push the NHS out of the provision of services when it could have provided them and competed. The Labour Government did that, and we shall legislate to make it illegal for a Secretary of State or any regulator to engage in that kind of preferential treatment for the private sector in future.
Gavin Barwell (Croydon Central) (Con)
I welcome the revised proposals, in particular the focus on competition not as an end in itself but on informed—[Interruption.]
Gavin Barwell
Thank you, Mr Speaker.
I welcome the focus not on competition as an end in itself, but on informed patient choice to improve patient care. Can my right hon. Friend confirm that, unlike the Opposition, the Government believe that NHS patients in my constituency deserve the best that the public, private and voluntary sectors can offer them?
Mr Lansley
I understand. What my hon. Friend says is absolutely clear. We know that informed choice for patients is a serious contributory factor in improving outcomes for patients. When there is informed choice, of necessity we must have a diversity of providers to support it. There is no doubt that to that extent competition is an essential part of delivering improving care in the future, but it is not an end in itself. It should not be elevated to that point, over and above delivering the integrated services that best give patients the care they need.
Chris Bryant (Rhondda) (Lab)
My constituent Rosie Edwards suffers from a rare congenital heart condition, known as Fallot’s tetralogy. Fortunately, for all her life, both as a child and now as an adult, she has had to have all her treatment at the Royal Brompton hospital in London. Unfortunately, the Government are proposing that that paediatric cardiac service is terminated—[Hon. Members: “Not true.”] It is completely true. There is no provision in the suggestions that have been brought forward for the service to continue. My constituents are asking whether, if reorganisation will cost a lot of money, it would not be better to spend that money on protecting those services.
Mr Lansley
I am sorry the hon. Gentleman tried to characterise that as he did. The joint committee of primary care trusts is conducting a consultation. The Government are not doing it; I am not doing it; the committee is doing it, and the consultation closes on 1 July. People across the country are quite properly making representations to the consultation, including on the Royal Brompton and other units. The committee has not made recommendations to me; it will come to its conclusions after that consultation, which has absolutely nothing to do with the structure of the proposals I am referring to today.
Steve Baker (Wycombe) (Con)
My constituents will not be interested in hard left, old school scaremongering. They simply want to know whether the Bill will put local health services under a greater degree of local control.
Mr Lansley
My hon. Friend will know that many of us in the House were deeply frustrated in the past that Ministers would say at the Dispatch Box that primary care trusts were responsible for local decisions, and then nobody found locally that the PCT was in any practical sense accountable to them or the population they represented. In future, there will be proper accountability: clinical accountability through the commissioning groups and democratic accountability through local authorities.
Angela Smith (Penistone and Stocksbridge) (Lab)
Will the Secretary of State apologise to the people of this country for a botched process that will lead to nothing but chaos and confusion in the NHS?
Mr Lansley
I think the hon. Lady should read the NHS Future Forum report where she will find that right across the service there is support for the principles we set out, and agreement that change is necessary. I do not know where she imagines that change will come from if not by going through a process of the kind we have engaged in.
David Rutley (Macclesfield) (Con)
Public health continues to be an important priority, particularly in Cheshire East which, surprisingly, is ranked 15th in the league table for hazardous drinking. Can my right hon. Friend tell the House what remit he is giving the Future Forum in this important area?
Mr Lansley
I am grateful to my hon. Friend. The Future Forum has made recommendations in relation to public health. One of them, which I announced today, is that we want to combine the direct integrated work on health protection and response to emergencies through Public Health England with continuing independence for expert advice, so I am proposing that Public Health England should be established as an executive agency. What is critical is that we create through the legislation a greater opportunity for local authorities to lead health improvement plans locally, so issues such as alcohol abuse and problem drinking will need not only national leadership, which we will give, but local leadership, which the Bill will empower.
Barbara Keeley (Worsley and Eccles South) (Lab)
Accountability is not at all clear. The Secretary of State said that clinical accountability will be in one place and democratic accountability in another. We are replacing one organisation—the PCT—with five. My constituents will just want to know where the accountability lies for important local NHS decisions. That has not become clear from the statement so far.
Mr Lansley
I repeat: from the public’s point of view, we know that what they wanted was genuine accountability, in the sense that the doctors, nurses and other health professionals who care for them should be able directly to design and influence the shape of services locally to meet their needs, but they also want a patient voice and a public voice. That has not existed in the past; we will enable it to happen. They will come together at the health and wellbeing board, where they will establish a strategy for their area.
Matthew Hancock (West Suffolk) (Con)
In the commendable listening exercise, was it not clear that there is now broad support for the principles of reform? Is it not better that we now take that forward, rather than being opposed to reform and opposed to the resources for the NHS, as the Opposition are?
Mr Lansley
I am grateful to my hon. Friend. That is indeed the message that came through to us from the NHS Future Forum and its extensive engagement with the NHS and beyond. I will not go down the path urged on us by the Opposition, which for the NHS seems to be spend less, do nothing and let the crisis happen when it will.
Richard Burden (Birmingham, Northfield) (Lab)
The Secretary of State is still talking about the Bill as if it is a way of promoting localism and local accountability, but is it not still the fact that most of the extension of locality commissioning that that would involve could happen without the Bill? I refer the Secretary of State to the role of the national commissioning board. What is that, if not a massive and bureaucratic centralisation of power?
Mr Lansley
With respect, the hon. Gentleman misses the point entirely. Without the legislation we could not transfer out of the hands of a managerial top-down bureaucracy into the hands of clinicians and local people, but he is right—it is not just the localisation of decision making. There is also in the NHS a nationally funded service with an expectation of national standards, and many services that require high levels of national consistency in commissioning. There is a job for the national commissioning board, which we will establish. That in itself will inject a considerable level of consistency in standards and quality, and considerable efficiency in commissioning some services.
David Morris (Morecambe and Lunesdale) (Con)
I congratulate the Secretary of State on his reforms. I know how hard he has worked and conducted consultation across the political spectrum. That should be respected by the Opposition. The reforms empower our medical practitioners—doctors and nurses—and in doing so, as I am sure he would agree, will stop the litigation culture that has galloped away over the past 13 years under the previous Government.
Mr Lansley
I understand the point that my hon. Friend is making. We need—not least in a further emphasis on safety and some of the other measures that we as a Government, including my colleagues at the Ministry of Justice, have said we would bring forward—to try to offset a rising tide of litigation and cost associated with clinical negligence cases in the NHS. My hon. Friend is kind to me about working hard. I never imagined I would not do so, but if I have worked hard over the past eight weeks, it is nothing compared to the leaders of the NHS Future Forum who, in the space of just eight weeks, produced excellent work which will be of enduring significance.
Alison McGovern (Wirral South) (Lab)
Last year, the NHS in Wirral tried to respond quickly to the Secretary of State’s top-down reorganisation and has since spent months in uncertainty and stress. Will the Secretary of State apologise now to staff and patients on the Wirral for all the unnecessary problems he has caused them and all the money he has wasted?
Mr Lansley
I met many of the previous practice-based commissioning groups in the Wirral and south Merseyside, who came together to tell me how enthusiastic they were about the possibilities for designing clinical services more effectively in future. They are doing that. They want to get on with it and the Future Forum is right: we need to give them the opportunity to get on with that now.
Alun Cairns (Vale of Glamorgan) (Con)
What assurance can the Secretary of State give that his plans will abolish the rigged market introduced by the previous Government that ended up giving £250 million to the private sector for delivering nothing?
Mr Lansley
My hon. Friend is absolutely right. We will legislate to stop precisely that distortion and that favouritism to the private sector. The private sector must know that it will have to provide additional services to the NHS on the basis of quality, not on the basis of any preferential system, as under the previous Government.
Joan Ruddock (Lewisham, Deptford) (Lab)
I remember that under the previous Conservative Government people died while on waiting lists. [Hon. Members: “Oh!”] It is a fact. I was a Member of Parliament at the time and it happened. Labour’s targets transformed that. The Secretary of State has been forced today to retake responsibility for the delivery of the NHS. He has talked about what has been happening. Will he make a specific promise today about the future waiting lists under his jurisdiction?
Mr Lansley
I will make clear to the right hon. Lady, as the Prime Minister has made clear, that we will not let waiting times rise. We will continue to maintain downward pressure, but it is very important that we do not treat waiting times in the NHS as the only measure of performance. It is more than that: it is the quality of care that is provided, not just the access to care.
Andrew George (St Ives) (LD)
I am very sorry to say that the Secretary of State demonstrated a creative interpretation of the coalition agreement when he launched his policy last July. What can he say to the House to reassure us that he will not make the same creative interpretation of the Future Forum’s recommendations, particularly in relation to the risk of the marketisation of health services?
Mr Lansley
The hon. Gentleman will know that when I came forward with the White Paper last year, or the Command Paper in December, or the Bill, we did so collectively as a Government, and I can assure him and all my colleagues that we will continue collectively to agree on the basis on which we take all these issues forward.
Kevin Brennan (Cardiff West) (Lab)
Some say that the reason the Secretary of State went too far, too fast and has now come up with a fix that is too little, too late is that he has a bit of a tendency to be pig-headed and cloth-eared when people disagree with him. I do not agree with those who say that, but could he now find the humility and courage at least to say sorry for the mess he has made?
Mr Speaker
Order. I remind the House of the wise stipulation in “Erskine May” that moderation and good humour are the defining features of parliamentary language.
Mr Lansley
In that spirit I thank the hon. Gentleman for the generosity of his remarks and encourage him likewise to apologise for the performance of a Labour Government in Wales who are cutting the NHS budget by 5% and seeing the performance of health care in the NHS in Wales deteriorate considerably relative to that in England.
Harriett Baldwin (West Worcestershire) (Con)
My constituency has borders with Gloucestershire, Herefordshire and Shropshire. The NHS Future Forum has recommended that commissioning group boundaries should not normally cross local authority boundaries, but will my right hon. Friend confirm that my local commissioning consortia can work with doctors in other areas?
Mr Lansley
The Future Forum is perfectly clear that there is a benefit associated with integrating health and social care if clinical commissioning groups do not normally cross local authority boundaries. But it is clear, and we are clear, that they should be able to make a case to do so if they think it appropriate. We have the benefit of being able to look at the pathfinder consortia, of which there are 220 and I think that 16 cross local authority boundaries, so it is already the exception rather than the rule.
Diana Johnson (Kingston upon Hull North) (Lab)
Will the NHS be the preferred provider of choice for health care services for my constituents?
Mr Lansley
No, I have said that we will legislate to ensure a level playing field, so her constituents should have access to whichever provider their clinical commissioning group views as best able to deliver quality care.
Christopher Pincher (Tamworth) (Con)
The Government are incorporating the co-operation and competition panel into Monitor to advise the NHS on competition rules. Given that the Opposition seem to be engaged in collective amnesia this afternoon, will my right hon. Friend remind the House which party first established the CCP and the concept of competition in the NHS?
Mr Lansley
My hon. Friend makes an interesting point, because, as the Future Forum report acknowledges, the Bill does not extend the application of competition rules in the NHS, which were introduced under the Labour Government. The co-operation and competition panel was established under the Labour Government in 2009. The rules that we will maintain as a process of evolution, rather than revolution, are the ones that were consulted on in January 2009 and most recently published by a Labour Government in March 2010. To that extent, and despite all the hot air from the Labour party on competition in the NHS, we are adopting an evolutionary approach and starting precisely from the situation that applied under the Labour Government.
Jeremy Corbyn (Islington North) (Lab)
In his earlier answer to my right hon. Friend the Member for Oldham West and Royton (Mr Meacher), the Secretary of State, if I understood him correctly, said that commissioning consortia would have to do the commissioning themselves and could not franchise it out to private providers. Will he confirm that that is the case and that he has powers to limit the number of private patients who can be taken into NHS facilities under the regulations he is proposing in the Bill?
Mr Lansley
I reiterate that the clinical commissioning groups will be statutory bodies with a statutory responsibility for commissioning, so it would not be legal for them to delegate that to another body that was not subject to the same obligations. As far as access to private patients is concerned, we have made it clear—I do not believe that the Future Forum makes any recommendations on this—that foundation trusts, which often have arbitrary rules relating to limits on their income from private patients, should have that cap lifted, but we propose to put additional safeguards in place to make it clear that, if they do so, not only must that income be separately accounted for so that there is no subsidisation from NHS facilities, but the trusts must demonstrate how that will support their continuing primary purpose of providing services to the NHS in England.
Mr John Baron (Basildon and Billericay) (Con)
Having very much supported the listening exercise, I know that for many of us the most important aspect of these reforms has always been the new focus on outcomes, as illustrated by the inclusion of the one and five-year cancer survival rates in the outcomes framework. Will the Secretary of State assure me that the Future Forum’s suggestions will in no way detract from that new focus on the quality of care?
Mr Lansley
I can give my hon. Friend that assurance. Indeed, I can go further and say that one of the reasons the Future Forum has made no recommendations on the outcomes framework is that it found enthusiasm across the NHS for focusing on quality and outcomes and nothing but approval for the framework. Of course, the Labour party ignores the fact that, as stated in the White Paper we published last year, that is one of the central aspects of what we are setting out to do. He is right that the focus on outcomes, which enables people to see how this country performs in health, relative to other countries, and continuous improvement in health outcomes, rather than just a small number of focused targets, is instrumental in continuous improvement.
Kate Green (Stretford and Urmston) (Lab)
The Secretary of State is aware of the situation faced by Trafford acute trust. Will he reassure my constituents that there is no prospect of Trafford General hospital being either broken up or taken over by a private company?
Mr Lansley
The hon. Lady will have a further opportunity to discuss that shortly. She will know that the NHS trust in Trafford is examining whether it might merge with one of two possible foundation trusts and whether it might change its corporate configuration, as it were, but entirely within the NHS.
Andrew Percy (Brigg and Goole) (Con)
Last Friday, I met two members of the local Labour party in my constituency who presented me with an apparently independent petition on the NHS reforms. At that meeting, they told me that it was a fact that our reforms would lead to the removal of a comprehensive health service; we now know that that is a load of old nonsense. They also told me that it was a fact that these changes would open up the NHS to European Union competition law in a way that it is not at the moment. Is that a fact, or is it just shameless scaremongering?
Mr Lansley
It is entirely scaremongering. My hon. Friend might like to look at what the Future Forum report says in relation to choice and competition, which sets out very clearly that the extent to which EU competition rules apply in the NHS will not change as a consequence of this Bill.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
So far, £768 million has been wasted on this failed reorganisation. In my region, Freeman hospital’s cardiac unit for children is under threat, South Tees Hospitals trust has had £20 million removed by the Government, and the Government are proposing a national commissioning board that sits in private, is unelected, produces no minutes, remunerates itself and sets its own sub-committees. Where is the front-line quality of care for people?
Mr Lansley
I am afraid that that is a further repetition of invention by Labour Members, who appear to have been given one or two figures of their own. It is complete nonsense. In the impact assessment associated with the Bill, which we will now revise to reflect these changes, we explained that there was an estimated £1.4 billion total cost of reorganisation, but that that would lead to a £1.7 billion recurring annual benefit in savings, which would accumulate to more than £5 billion over the course of the Parliament.
Dr Thérèse Coffey (Suffolk Coastal) (Con)
Building on the question from my hon. Friend the Member for West Worcestershire (Harriett Baldwin), HealthEast pathfinder consortium in my constituency crosses two district councils—in fact, it crosses two counties—and it might be appropriate for GPs from a third council area to join it. Will my right hon. Friend assure me that no barriers will be put in the way of what should be effective care for patients rather than simply political boundary lines?
Mr Lansley
As I have said, we will expect, and the Future Forum says, that commissioning groups should not normally cross local authority boundaries—in this respect, boundaries for social authorities—but they should be able to make a case for doing so based on benefit to patients. The one thing I would urge is that they are very clear with their local authorities about how they can secure the continuing integration of health and social care at a local level.
Bill Esterson (Sefton Central) (Lab)
Is not the reason the Secretary of State has so much support from the right wing of his party that they know that this will lead to privatisation of large parts of the NHS, as he confirmed in his answer on preferred suppliers?
Mr Lansley
I hope that my colleagues would support me in saying that I have support from colleagues right across the coalition, because the coalition Government are supporting the NHS in enabling it to deliver improving services. That is what it is all about.
Mr Edward Leigh (Gainsborough) (Con)
It is appropriate that I am last, because I come at this from a different direction from everybody else. Given that no extra cash is available—we know that—how will the watering down of Monitor’s duty to promote core competition help to deliver the efficiency gains that are the future of the NHS? How will the Secretary of State now achieve that?
Mr Lansley
I say three things to my hon. Friend. First, let us be clear that there is £11.5 billion of additional cash available to the NHS over the course of this Parliament—but we have to use it better and deliver greater quality and effectiveness. The job of the commissioners and Monitor together is to deliver that—partly through tariff development in ensuring that they get those efficiencies by the price that they set, based on benchmark-to-best practice prices, but also through using their commissioning strength to design services. We all know that if we simply said every year to the NHS, “You must save money by cutting the price of what is paid to you”, its response would be to cut services, cut staffing or cut quality. In fact, achieving greater quality and effectiveness is about the redesign of clinical services—the transfer of services into the community and keeping people well at home rather than through emergency admissions to hospital. It is about clinical leadership and clinical redesign, and that is what these proposals will bring to the forefront.
Owen Smith (Pontypridd) (Lab)
Given the Secretary of State’s manifest interest in Wales, I invite him to come to Wales to meet some Welsh patients with me to find out at first hand which party they trust to safeguard the heritage of the NHS—Labour or the Tories. I suspect that the answer would be revealing for him. How much Welsh taxpayers’ money has been wasted on this needless reorganisation of the NHS?
Mr Lansley
The hon. Gentleman must know that the money available to the NHS in Wales is available to the NHS in Wales, and that it is separate from England. The Labour Welsh Assembly Government have made their own decisions about the priority that they attach to the national health service in Wales, and the result is, as the King’s Fund says, that they plan to reduce its budget by 8.3% in real terms. We are going to increase the NHS budget in real terms. The result can be seen in waiting times, which we were talking about. In England, the proportion of patients admitted to hospital who are seen within 18 weeks, according to the latest data, is 89.6%. He might like to reflect on the fact that the figure for Wales is 64.5%.
Rosie Cooper (West Lancashire) (Lab)
Although it has been difficult to hear during this debate, I would like to address my comments to the statement made by the Secretary of State.
Rosie Cooper
Question, sorry. [Interruption.] Let us get to the point and stop playing around. The Secretary of State said in the statement that consortia will now have one nurse and one secondary care doctor and that:
“To avoid any potential conflict of interest, neither should be employed by a local health provider.”
How will the Secretary of State apply that rule to GPs? Would not the Secretary of State and his reforms be best described as like Schrodinger’s cat—in a state of uncertainty and both alive and dead at the same time?
Mr Lansley
The hon. Lady misses the point. If GPs were providers as well as providing primary medical services, they would be unable to make decisions about those responsibilities because of a conflict of interest. Of course, as primary medical services providers in their area, they are not commissioned by the clinical commissioning groups—if the hon. Lady is listening to the answer at all—because the commissioning of primary medical services is undertaken by the NHS commissioning board, not by the local groups.
Sheila Gilmore (Edinburgh East) (Lab)
Will the Secretary of State accept that he would not be in the position he is in today had there been proper pre-legislative scrutiny of this Bill? Will he recommend to his Cabinet colleagues that that process is used for all future legislation? It is a case of more haste, less speed.
Mr Lansley
We as a coalition Government are engaging in more pre-legislative scrutiny than any of our predecessors. In this instance, I do not accept the hon. Lady’s proposition. What has been done by the NHS Future Forum could not conceivably have been achieved in pre-legislative scrutiny, because it was essentially about engaging people across the service in how we will implement principles that are widely supported across the service. It is very much of the here and now, rather than something that could have been done in advance.
Gregg McClymont (Cumbernauld, Kilsyth and Kirkintilloch East) (Lab)
I ask the Secretary of State to answer a straightforward question with a straightforward answer. How much money has so far been outlaid on this NHS reorganisation?
Mr Lansley
I have made it very clear that the impact assessment set out that we expect the total cost of the reorganisation—these figures will be revised because of the changes—to be about £1.4 billion, but that it will deliver recurring savings of £1.7 billion a year, leading to something approaching a £5 billion net saving in administration costs over the life of this Parliament.
Mr Speaker
I am grateful to the Secretary of State. All 65 Back-Benchers who stayed in the Chamber and sought to catch my eye were successful in doing so. I hope that the House’s inquisitorial appetite has been satisfied on this matter, at any rate for today. I was going to come to the ten-minute rule motion, but not before we have entertained a point of order from the hon. Member for Rhondda (Chris Bryant)—nothing new there.
NHS Future Forum
Lord Lansley Excerpts(13 years, 6 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
As I informed the House on 7 June, the listening and engagement in relation to the Health and Social Care Bill and related issues has been very successful. The NHS Future Forum has now reported to the Government.
I am today publishing a list of the key changes the Government intend to make as a result of the NHS Future Forum’s report. Some, but not all, of these changes require amendments to the Health and Social Care Bill.
These changes follow the Government’s decision on 6 April to take advantage of a natural break in the legislative process to pause, listen and reflect on the national health service modernisation plans and to make any necessary improvements to the Health and Social Care Bill. The NHS Future Forum, a group of 45 senior professionals from across health and social care, was established to help drive an intensive eight-week period of engagement, beginning on 6 April and ending on 31 May.
Members of the NHS Future Forum attended around 250 events and heard opinions on the Government’s plans for modernisation from over 8,000 people, including some 250 stakeholder organisations. Following a period of reflection, the Future Forum yesterday published their report; a copy of this has already been placed in the Library.
The Future Forum confirmed that the principles underpinning our plans for modernisation are the right ones, but also set out where we could make improvements, for patients and the NHS.
The Government have accepted the core recommendations of the report from the NHS Future Forum and will now make improvements to their modernisation plans. A document listing these improvements has been placed in the Library and we will provide more detail on exactly how we plan to implement these changes, including amendments to the Health and Social Care Bill, shortly.
The fundamental principles of our plans remain the same as those we set out in our White Paper, “Equity and excellence: Liberating the NHS”. The Government are committed to creating a modernised NHS that achieves among the best health care outcomes in the world. Our proposals are rooted in the principles of empowering, focusing on health care outcomes and quality, and giving front-line professionals more capacity to design and deliver services around the needs and expectations of patients.
The Government remain firmly committed to the ideals of the NHS—a comprehensive health service, funded from general taxation, based on need and not ability to pay.
I would like to give my thanks to all of the Future Forum’s members and to its chair, Professor Steve Field, for their work, as well as those who contributed to the engagement exercise. I have asked the Future Forum to continue to advise on the way that our proposals are developed and put into practice.
In order to ensure that Parliament is given sufficient opportunity to scrutinise the Government’s proposed changes, I can confirm that our intention is to recommit the relevant parts of the Health and Social Care Bill to a Public Bill Committee. Exact details will be announced in due course.
Oral Answers to Questions
Lord Lansley Excerpts(13 years, 6 months ago)
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Nigel Adams (Selby and Ainsty) (Con)
2. What assessment he has made of the financial performance of the NHS in 2010-11; and if he will make a statement.
The Secretary of State for Health (Mr Andrew Lansley)
Financial performance in the NHS in the last year has been strong. As at quarter three of financial year 2010-11, the strategic health authorities and primary care trusts were forecasting an overall surplus of £1,269 million, and the NHS trust sector was forecasting an overall surplus of £132 million. I expect the 2010-11 final year-end surplus to be no less than this forecast, representing about 1% of the budget, broadly in line with plans.
Nigel Adams
I am grateful to the Secretary of State for his response. My constituents will be pleased that the NHS performed on a sound financial basis nationally. What increases will the NHS receive in my local area of north Yorkshire in 2011-12, and can my right hon. Friend confirm that those increases are the result of the Government’s decision to protect the NHS?
Mr Lansley
In 2011-12, NorthYorkshire and York primary care trust will receive £1,207.3 million. That represents a cash increase over last year of £34.7 million, or 3%. That exactly represents our coalition Government’s commitment to protect the NHS and to increase its budget in real terms, and it is in stark contrast to what we were told we should do by the Labour party and what the Labour Government in Wales have done, which is to impose a 5% real cut in NHS spending in Wales.
David Miliband (South Shields) (Lab)
Can the Secretary of State confirm my figures that over £20 million has been spent in the north-east of England sacking PCT staff, that that money has come from funds previously earmarked for hospitals, and that there will be at least as many commissioning groups under his arrangements as there are currently PCTs employing managers in those roles? Does not that show that his plans are lunacy not reform, and that they should be taken away and put in the dustbin, not given a simple pause?
Mr Lansley
I can tell the right hon. Gentleman that in contrast to the last Labour Government it is our intention to increase the front-line staffing of the NHS relative to the staffing of the administration in the NHS. That is why, since the general election, there are 3,800 fewer managers in the NHS and 2,500 more doctors.
Mr Stephen Dorrell (Charnwood) (Con)
Can my right hon. Friend confirm that it is a key priority of the Government to reverse a decade of declining productivity in the health service in order to ensure that the resources that are committed by the Government deliver improved access and improved quality of patient care?
Mr Lansley
Yes, I can. My right hon. Friend is absolutely right about that. Over the last year in hospitals in particular we saw what was approaching a 15% reduction in productivity. That is why we are proceeding with ensuring that across the NHS we recognise not only that there are increasing demands on the NHS, which is why we are increasing the NHS budget by £ll.5 billion over four years, but that that money must be used increasingly effectively to deliver efficiency savings in excess of 4% each year so that we can improve the quality of services for patients.
John Healey (Wentworth and Dearne) (Lab)
The Secretary of State spoke in glowing terms of the last year, but the last year has been a catalogue of confusion, incompetence and broken promises. So will he now accept that the Government’s massive mishandled NHS reorganisation is piling extra pressure on NHS services, with nearly £2 billion promised for patient care being wasted on the internal changes? Will he admit that it is patients who will suffer as front-line NHS staff lose their jobs, treatments are cut back and waiting times start to rise again under the Tories?
Mr Lansley
The right hon. Gentleman asked about performance last year. I told him what the financial performance was. Let me also make it clear that, for example, for hospital in-patients, referral to treatment waiting time has gone down from 8.4 weeks in May 2010 to 7.9 weeks in the latest figures in March, and for out-patients the figure has gone down from 4.3 weeks in May 2010 to 3.7 weeks in the latest figures, so waiting times have improved. We have established the cancer drugs fund, with more than 2,500 patients benefiting from that. We have published and driven down the number of breaches of the single sex accommodation rules: a 77% reduction in those breaches, which Labour never achieved. In the last year we have reduced the number of MRSA infections in hospitals by 22% and C. difficile infections by 15%. I applaud the NHS—
Mr Speaker
Order. I think we have got the thrust of it and are most grateful.
John Healey
The Secretary of State mentioned a lot of things, but I notice that he did not mention the Prime Minister’s five new guarantees. [Interruption.] The Secretary of State shakes his head as if they do not matter, but perhaps he was not consulted on them. People have seen the Prime Minister make and then break promises on the NHS before, but this time he is breaking his pledges as he is making them. The King’s Fund says that waiting times are going up and the Nuffield Trust says that health funding is being cut in real terms. Privatisation, the break-up of integrated care and the removal of national standards at the heart of the health service are exactly what his health Bill is designed to do. Is that not why MORI shows public concern about the NHS rising rapidly and why people are right to conclude that they cannot trust the Tories on the NHS?
Mr Lansley
My right hon. Friend the Prime Minister has made it very clear that we will not let waiting times rise and that we will improve performance in the NHS right across the board, which was what I was illustrating. I remind the right hon. Gentleman again that waiting times in hospitals are down from 8.4 weeks to 7.9 weeks for in-patients and from 4.3 weeks to 3.7 weeks for out-patients. That is what we are committed to. Chris Ham of the Kings Fund was on the “Today” programme this morning and said on waiting times, “There hasn’t been a great deal of change since the election.” What has changed since the election is that we are improving performance, driving down the number of breaches of the single-sex rules, increasing access to dentistry, cutting the number of managers and increasing the number of doctors. Those are the things we are doing in the NHS, and it is to the benefit of patients that we do.
Mr John Baron (Basildon and Billericay) (Con)
3. What steps he is taking to enable GP consortia to commission integrated cancer services.
Chris Heaton-Harris (Daventry) (Con)
6. What assessment he has made of trends in outcomes for NHS patients since May 2010.
The Secretary of State for Health (Mr Andrew Lansley)
I am determined to focus on the results that matter most to patients. For example, in the year ending March 2011, the number of MRSA bloodstream infections decreased by 22% and C. difficile infections decreased by 15% on the year before. These are key outcomes in the drive to protect patients from avoidable harm. We also want to see continuous improvements in patients’ experience of their care. For example, between December last year and April this year, we took action on breaches of the single sex accommodation rules, and the number of breaches reduced by 77%. The NHS outcomes framework will drive up quality across services as well as providing evidence of the overall progress of the NHS.
Chris Heaton-Harris
I thank the Secretary of State for his answer. He has rightly identified patient experience as a key outcome that has improved over the past year. Given that tens of millions of patients every year experience accident and emergency as their first point of contact with the NHS, what steps has he taken to improve the quality of care that patients receive in A and E wards?
Mr Lansley
In the past, the only measure of activity and performance in A and E departments was whether patients had been discharged from the department within four hours. That meant, for example, that the emergency department at Stafford hospital was able to tick the box marked “Four-hour target met” in circumstances where patients were discharged completely inappropriately and patients suffered and died. We have now published, for the first time, quality indicators agreed with clinical professionals across emergency services that indicate what A and E quality should look like regarding not only time waited but the time before patients are seen by a qualified professional, re-attendance rates for the same problems, and mortality and related outcomes.
Mr Ben Bradshaw (Exeter) (Lab)
The Secretary of State is using a highly selective reading of waiting times. Will he confirm that breaches of the four hour target for A and E waits and the 18 week target for operations have increased massively in the past year? If they have not, why did the Prime Minister today confirm his support for those Labour targets?
Mr Lansley
The Prime Minister made it clear that we will focus on outcomes for patients, not just on individual targets. In 2010-11, the financial year that has just ended, only 2.6% of people who attended at A and E waited for more than four hours, despite an additional 870,000 people attending A and E departments.
Mr Gary Streeter (South West Devon) (Con)
7. What plans he has for access to NHS speech therapy services for children.
Stephen Hammond (Wimbledon) (Con)
16. What recent assessment he has made of the operation of the cancer drugs fund; and if he will make a statement.
The Secretary of State for Health (Mr Andrew Lansley)
I have received representations from hon. Members, noble Lords and members of the public on how the fund has operated. A number have welcomed the additional support that we are giving to cancer patients in need. More than 2,500 patients have already benefited from the additional funding provided up to the start of April 2011, and the further £600 million that we have committed for next three years will improve the lives of thousands more cancer sufferers.
Andrew Stephenson
Can my right hon. Friend confirm that the cancer drugs fund is helping cancer specialists tailor treatment regimes to patients in areas including my constituency, and helping to provide a more personal and responsive cancer service?
Mr Lansley
Yes, I can reassure my hon. Friend on that point. Indeed, I cannot do better than to quote Mike Hobday, head of policy at Macmillan Cancer Support, who said:
“The £200 million Cancer Drugs Fund will make sure every cancer patient has a better chance to get the drugs their doctor prescribes for them. This is particularly important for those with a rarer cancer, who have historically lost out on getting drugs on the NHS.”
Stephen Hammond
I am sure the whole House will welcome my right hon. Friend’s announcement today that 2,500 people have already benefited from the interim cancer drugs fund. Can he give the House some indication of whether people with the more difficult types of cancer will benefit from it?
Mr Lansley
My hon. Friend will be aware that in the run-up to the election and since, the Rarer Cancers Forum has mentioned the number of applications to the exceptional cases panels of primary care trusts that have been turned down, and pointed out how often patients in this country have not got access to new cancer medicines that are regularly available to patients in other European countries. That was the basis on which we estimated the level of demand for the cancer drugs fund, and it has actually turned out to be a very good predictor of demand. Patients are now receiving second-line or new medicines for a range of cancers, including prostate and bowel cancer. People with common cancers as well as rarer ones are getting access to new medicines that are increasing their quality of life or life expectancy.
Liz Kendall (Leicester West) (Lab)
Today the Prime Minister pledged to increase NHS funding, protect universal coverage and keep waiting times low, but his promises are already being broken on cancer care. Three quarters of the cancer drugs fund is not additional money, as the Secretary of State claims, but money taken from other patients, and half as many new cancer drugs are available in some parts of the country as in others. Whatever he claims, can he now confirm that the number of patients waiting more than six weeks for their diagnostic test, including for cancer, has doubled since this time last year?
Mr Lansley
The hon. Lady seems to have forgotten that we were very clear at the time of the election that we would establish the cancer drugs fund not least on the basis that under this Government, the NHS would not have to pay the additional employer’s national insurance contributions that it otherwise would. The money available for the NHS is being used for the benefit of patients, and it represents additional resources.
I might also remind the hon. Lady that before the election, her party was not committed to protecting the NHS budget. The Leader of the Opposition was completely wrong today when he said that Labour was going to protect NHS spending, as we did. That is not true. Actually, it was committed to only 95% of NHS funding, which was that for the PCTs. It was going to cut the rest, and centrally funded budgets such as the cancer drugs fund are precisely what would have disappeared.
The hon. Lady asked about diagnostic tests. The figures show that a year ago, the average waiting time was 1.7 weeks, whereas the latest figure is 1.8 weeks.
Pat Glass (North West Durham) (Lab)
12. What recent assessment he has made of the ability of all NHS hospital trusts to become foundation trusts by 2014.
Nick de Bois (Enfield North) (Con)
13. What recent assessment he has made of progress by GP pathfinder consortia in delivering improvements in NHS services.
The Secretary of State for Health (Mr Andrew Lansley)
We have taken time to pause, to listen and to reflect on our reforms; none the less I am pleased to report that there remain 220 pathfinder consortia, covering nearly 90% of England. In my hon. Friend’s constituency, the Enfield consortium group is established and is focusing on quality and productivity improvements to local health care services. I have been greatly encouraged by the initiative that clinicians have taken to improve patient services, and examples are available at the pathfinder learning network, a forum through which we are supporting their development.
Nick de Bois
My right hon. Friend the Secretary of State knows my view on the need to ensure that there is a comprehensive network of commissioning consortia across the whole country by April 2013. Does he share my view that that essential requirement will not only improve patient choice but ensure that we can pass a further £5 billion in savings back into front-line services?
Mr Lansley
Yes, I think my hon. Friend is absolutely right about that. What has been interesting in the listening exercise is the clear expression—on the part of front-line clinicians, general practitioners, doctors, nurses and other health professionals—of a desire to take greater responsibility for commissioning. They are only too aware of a decade of decline in productivity in the NHS, in which administration costs and staffing ballooned while front-line staffing did not increase to anything like the same extent. They want to deliver better clinical services for their patients, and to have the responsibility to do so. We are determined to give that to them.
Mr Steve Brine (Winchester) (Con)
14. Whether his Department has considered the merits of introducing a supplemental ultrasound breast screening examination as part of the NHS breast screening programme.
The Secretary of State for Health (Mr Andrew Lansley)
The Department is currently in the process of working with NHS London to establish timetables for each NHS trust and agree the actions required to achieve foundation trust status by April 2014. This work is ongoing; once it is finalised, plans will be published locally.
Gavin Barwell
In 2010-11 Croydon Health Services NHS Trust delivered an operating surplus of £4.5 million. May I commend its FT application to my right hon. Friend in the hope that in future years, that money can be reinvested in local health services in my borough?
Mr Lansley
Yes, I understand and entirely sympathise with my hon. Friend’s desire to see Croydon Health Services NHS Trust achieve foundation trust status. He will know that the trust was recently the subject of a responsive review visit by the Care Quality Commission, which revealed areas in which further assurance will be needed ahead of its foundation trust application going forward. He will appreciate, as I do, that in the past foundation trust status did not depend sufficiently on the achievement of high-quality services, rather than merely viable services. We intend that in future, foundation trust status will depend on both.
Nicky Morgan (Loughborough) (Con)
17. What steps he is taking to improve mental health services.
Karl MᶜCartney (Lincoln) (Con)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Andrew Lansley)
My responsibility is to lead the NHS in delivering improved health outcomes in England, to lead a public health service that improves the health of the nation and reduces health inequalities, and to lead the reform of adult social care, which supports and protects vulnerable people.
Karl MᶜCartney
I thank the Secretary of State for that answer. Will my right hon. Friend reassure me, and my Lincoln constituents, that whatever the outcome of the Government’s consultation, our NHS still requires some measure of reform—and that if a provider is qualified to deliver NHS standards at NHS costs, and if patients, with the support of their doctor, want to be treated there, this Government should do nothing to stand in their way, regardless of any political posturing by our flip-flopping coalition partners? [Hon. Members: “ Ooh!”] And further to—
Mr Speaker
Order. I apologise for having to interrupt the hon. Gentleman, but topical questions must not be statements or essays; they must be very brief questions. I think we have got the thrust of his question, and we are grateful to him.
Mr Lansley
Through the listening exercise and in response to the report of the NHS Future Forum, which we hope to see shortly, we hope to be able further to strengthen the principles of the Bill and its implementation of the White Paper, so that patients can share in decisions about their care and access the services that give them the best quality. That includes, in many instances, patients having access to a choice of providers as well.
Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)
T5. Doctors, nurses and PCT staff in my area tell me that the Government’s pausing of the health reforms has had no impact whatever on the ground, and that implementation of the Health and Social Care Bill is proceeding just as it was before. Does the Secretary of State believe that that is wrong—and if not, does it not mean that this whole consultation period is an absolute farce?
Mr Lansley
No, not at all. We were very clear—indeed, I was clear to the House on 4 April when I announced the pause to listen, to reflect on and improve the Bill—that it was specifically related to achieving in the legislation the necessary support for the many changes happening across the NHS. It cannot be right, however, that people across the NHS who are engaging in delivering improved care, redesigning clinical pathways—or designing clinical services to deliver the best outcomes for patients—should be told to stop making those positive changes. They are engaging with those positive changes and we are not preventing them from doing so.
Duncan Hames (Chippenham) (LD)
T2. I am wearing neither sandals nor flip-flops, Mr Speaker. Given that local GPs typically charge £500 a day, what action is the Minister taking to ensure that GP consortium board members do not cost the NHS as much as £25,000 each a year for just one day’s work a week?
Mr Lansley
Among the intentions that we have made clear from the outset is our intention to reduce the running costs of management in the NHS. We propose to cut administration costs by a third in real terms, including the running costs of the commissioning consortia when they are established. There will be a constantly tight envelope for running costs, which means that whoever is working for a commissioning consortium, it must deliver value for money.
Hazel Blears (Salford and Eccles) (Lab)
T7. For the 200,000 people in the country with dementia who are currently in residential care, the recent horrific events at Winterbourne View and the financial problems at Southern Cross have caused huge anxiety. The Minister is now proposing to make local authority safeguarding boards mandatory, at a time of huge cuts in social care budgets. What extra resources will he make available to ensure that the system works and protects the most vulnerable people in our country?
Gavin Barwell (Croydon Central) (Con)
T6. Croydon University hospital recently took on responsibility for community care, which will allow much better integration of acute and community services. What scope does my right hon. Friend think exists for wider application of that model in our NHS?
Mr Lansley
As my right hon. Friend the Prime Minister made clear today, we continue to believe that we can achieve more integrated services for patients, and we are determined to do so. That must be at the heart of the way in which reform and modernisation of the NHS deliver improving outcomes for patients. For patients, the results of care, and indeed their experience of it, will be greatly enhanced if it is designed and integrated to meet their needs. We know that that is effective, we know that it works for patients, and we are determined to make it happen. My hon. Friend has given just one example, and an important one, of the way in which hospital and community services can be integrated.
Mrs Mary Glindon (North Tyneside) (Lab)
The Prime Minister has stated this afternoon that competition will be an integral part of patient choice. How will the Secretary of State ensure that all patients are able to make a fully informed choice of treatment when market forces fully exist?
Mr Lansley
I do not accept the hon. Lady’s premise. We do not intend that there should be an unrestricted market—or a free market, as she described it—in the NHS. It is a regulated, social market with powerful regulations governing how the participants in the provision of care meet their responsibilities. We are very clear that competition is a means to an end. It is not an end in itself; it is there to support the integration and delivery of services in the best interests of patients, but it does include giving patients choice. The hon. Lady highlights an important point. In our consultation earlier this year on the information revolution in the NHS, we set out how we felt we could empower patients, including those for whom in the past the NHS has provided a rather impenetrable route to getting the best treatment. I hope that when we respond to that consultation, we will demonstrate how we will make that better for all patients.
Nigel Mills (Amber Valley) (Con)
T10. Does the Minister agree with my constituent Susan Garrity that licensed treatments for multiple sclerosis such as Sativex should be accessible to all people, wherever they live?
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Can the Secretary of State or the Minister confirm whether they will take up the offer from my Front Bench for bipartisan discussions about the future of adult social care—or will he put political interests before the public interest?
Mr Lansley
We were very clear that the commission that we established, led by Andrew Dilnot, should look at the reform of long-term social care funding in such a way as to secure maximum understanding, consensus and agreement. Andrew Dilnot has gone about that process in an exemplary manner, and the right thing for us to do now is await his report, which should then form a basis for taking things forward.
Mr Peter Bone (Wellingborough) (Con)
Does the Secretary of State agree that the competition measures in the Health and Social Care Bill will drive up standards and quality outcomes for the NHS?
Mr Lansley
I am sure that my hon. Friend is aware of the evidence—for example, in reports published by the London School of Economics and by Imperial college, London—on this country’s experience of the Labour party’s implementation of choice in elective care and the impact that had on the quality of services. What is clear from that evidence is that where there was an NHS price—a tariff structure—the more competitive areas of the country secured greater improvements in quality.
Valerie Vaz (Walsall South) (Lab)
I thank the Secretary of State for writing to me on 12 May about the listening exercise and its cost, although he could not quantify that. Now that the listening exercise is over, can he say how much the cost to the public purse has been?
Mr Lansley
I will, by all means, write again to the hon. Lady. The cost is not dramatic. Many organisations and people across the NHS have participated, giving freely of their time. Some 8,000 people have participated in the listening exercise events, of which there were more than 250. This has been immensely valuable; its value far exceeds any costs involved.
Pauline Latham (Mid Derbyshire) (Con)
A constituent of mine who suffers from bowel cancer has so far failed to be funded for Avastin on the NHS via the east midlands cancer drugs fund. She has already spent more than £40,000 of her own money. Her oncologist has written before on her behalf to appeal, but as not one of his appeals has been successful, for her or for any of his other patients, he is reluctant to write again to appeal for her, although she desperately needs this. What assurance can the Secretary of State give my constituent and her consultant?
Mr Lansley
My hon. Friend is assiduous in representing her constituent, and I will gladly discuss this matter further with her to see what the situation is. I should, however, emphasise that these are decisions being made in the use of the resources to deliver access to new cancer medicines for patients by clinical panels in each region—in each strategic health authority. To that extent, I am not seeking to substitute my judgment for that of the senior clinicians involved. None the less, if it would help my hon. Friend I will also arrange for the national clinical director for cancer services to have a discussion with her constituent’s consultant to examine this case.
Mr David Ruffley (Bury St Edmunds) (Con)
The Labour Government paid independent sector treatment centres 11% more, on average, than they were prepared to pay NHS hospitals. Will the Secretary of State confirm that such a practice forms no part of his health reforms?
National Health Service Modernisation Listening Exercise
Lord Lansley Excerpts(13 years, 6 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(13 years, 6 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, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
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, 8 months 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, 9 months 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, 9 months 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.