Tobacco Control Plan (England)
Lord Lansley Excerpts(13 years, 4 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
The Government are today publishing “Healthy Lives, Healthy People: A Tobacco Control Plan for England”.
The recently published “Healthy Lives, Healthy People” White Paper sets out the coalition Government’s determination to improve the health of the nation and to improve the health of the poorest, fastest. The White Paper recognises that reducing smoking rates represents a huge opportunity for public health, and makes commitments to publish a number of follow-on documents on how we will improve public health in specific areas. The tobacco control plan is the first of these.
Smoking remains one of our most significant public health challenges, and causes over 80,000 premature deaths in England each year. While rates of smoking have continued to decline over the past decades, 21% of adults in England still smoke. Smoking prevalence has fallen little since 2007 and we need renewed action to drive smoking rates down further.
Smoking has a devastating impact on health and well-being in our communities and we must keep up the momentum to reduce the health harms of tobacco use. Smoking contributes significantly to health inequalities and is the single biggest cause of inequalities in death rates between the richest and poorest in our communities.
Localism will be at the heart of the Government’s new radical approach to the delivery of public health services, with directors of public health, jointly appointed by local authorities, to be the strategic leaders for evidence-based public health. They will also lead action in their local communities to reduce health inequalities.
The tobacco control plan sets out how comprehensive tobacco control will be delivered over the next five years within the new public health system, and includes confirmation of our intentions for ending tobacco displays in shops and for further work to explore the plain packaging of tobacco products. The plan includes specific ambitions to reduce smoking prevalence by the end of 2015:
to 18.5% or less among adults (from a baseline of 21.2%);
to 12% or less among 15-year-olds (from a baseline of 15%); and
to 11% or less among pregnant mothers (from a baseline of 14%).
These ambitions represent faster reductions in smoking rates in these groups in the next five years than we have seen in the past five years.
The plan is built around the six strands of comprehensive tobacco control that are recognised internationally:
stopping the promotion of tobacco;
making tobacco less affordable;
effective regulation of tobacco products;
helping tobacco users to quit;
reducing exposure to second-hand smoke; and
effective communications for tobacco control.
Take-up of smoking by young people is a particular concern. Smoking is an addiction largely taken up in childhood and adolescence, and so it is crucial to reduce the number of young people taking up smoking in the first place. Nicotine is extremely addictive and young people can develop dependence on tobacco very rapidly. Each year in England an estimated 320,000 children under 16 first try smoking and the majority of adult smokers were smoking regularly before they turned 18 years of age. The plan recognises that we must do as much as we can to stop the recruitment of new young smokers.
We know that teenagers are susceptible to experimenting even when there is clear evidence of the dangers. We believe that eye-catching displays encourage young people to try smoking. They also undermine quit attempts by adults by tempting them to make impulse buys of tobacco.
This is why we are implementing legislation to end tobacco displays in shops. This will help to change perceptions of the social norms around smoking, especially by young people who are often the target of tobacco promotion.
While maintaining the expected public health gains, we will amend the display regulations to mitigate burdens on business. The growth review announced by the Chancellor of the Exchequer in November 2010 aims to reduce the regulatory burden on small and medium enterprises and micro businesses. In keeping with this approach, we will make the legislation more practical by:
giving retailers longer to prepare by delaying commencement until 6 April 2012 for large shops and 6 April 2015 for small shops;
increasing the size of temporary displays allowed when serving customers and re-stocking (from 0.75 square metres to 1.5 square metres); and
adding to the circumstances in which such displays can occur, for example, to carry out stock-taking and other activities necessary in running a business.
In this important area, I am interested in any measure with the potential to promote positive social norms around tobacco use and to diminish the impact of anything which promotes tobacco use, especially as this affects young people. We must continue to try new approaches, particularly those that may encourage behaviour change. We will, therefore, explore whether the introduction of plain packaging would bring additional public health benefits. The Government have an open mind on this and we want to hear what people think.
The tobacco control plan confirms a commitment to consult by the end of this year on options to reduce the promotional impact of tobacco packaging. To do this we must review the evidence and draw up an impact assessment on the costs and additional public health benefits of policy options. We will, as well, explore the competition, trade and legal implications, and the likely impact on the illicit tobacco market of options around tobacco packaging. While similar measures are currently being considered actively by a number of Governments around the world, we must be sure about the impacts of policy options in the legal and trading circumstances of tobacco control in this country. Only after this work, and gathering views and evidence from public consultation, will we be in a position to know whether, or how, to proceed.
An academic review “The Impact of Smokefree Legislation in England: Evidence Review” has been published today.
The Medicines and Healthcare products Regulatory Authority (MHRA) has also published today the outcome of the consultation on the regulation of nicotine-containing products. The MHRA will co-ordinate a period of further scientific and market research to inform decisions about the regulation of nicotine-containing products.
All documents have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Oral Answers to Questions
Lord Lansley Excerpts(13 years, 4 months ago)
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Nick Smith (Blaenau Gwent) (Lab)
9. How much funding he plans to allocate to local authorities to perform new public health duties in each of the next four years.
The Secretary of State for Health (Mr Andrew Lansley)
Through the Health and Social Care Bill, we will give local authorities the powers and resources they need to improve the health and well-being of their local populations and to improve the health of the poorest fastest. To support planning by local authorities, I will later this year announce shadow allocations for 2012-13 for the local ring-fenced public health budget.
Steve Rotheram
Will the Secretary of State explain whether reforms outlined in the public health White Paper “Healthy lives, Healthy people” allow for a new formula for public health spending that sufficiently compensates deprived areas that have higher health needs, such as Liverpool?
Mr Lansley
Yes, it is certainly our intention that that should happen. The consultation on the structure of the health premium, which does not close until 31 March, is specifically designed to secure responses so that we can design the health premium to support local authorities in delivering the greatest increment in health improvement among those populations that currently have the poorest health. We will also continue to get advice from the Advisory Committee on Resource Allocation so that that is technically supported by the best advice.
Luciana Berger
Will the Secretary of State give us more detail on how local authorities will be incentivised to innovate in public health, given that hospitals rather than councils will benefit financially from better public health?
Mr Lansley
In the first instance, local authorities have the direct incentive that they represent the people who elect them and so will want to use the public health resources available to them to deliver the best possible public health services to their local population. The intention of our proposals, which has been very strongly supported, not least by the British Medical Association, the Faculty of Public Health, the Local Government Association and others, is to put public health resources alongside the range of responsibilities of local authorities which will have the greatest impact on the overall determinants of health: education, employment, housing, environment, transport and the like.
Nick Smith
Will the Secretary of State assure us that the forthcoming tobacco plan will be both comprehensive and targeted to ensure that smoking rates are reduced? Will he promote what works, such as the use of smokers group help sessions, which the Public Accounts Committee found to be very effective, and will he limit the recruitment of new smokers by banning tobacco displays in shops?
Mr Lansley
In the public health White Paper, which was just mentioned, the Government committed to publish a tobacco control plan, and we will present that to the House shortly.
Nadine Dorries (Mid Bedfordshire) (Con)
A public health function which is funded by the Department of Health is carried out by the charity Marie Stopes. The last accounts available for this registered charity are from 2009 and, upon inquiry, it appears that no further accounts will be available for scrutiny until October 2011. Does the Secretary of State think that that is transparent? Is it good enough?
Mr Lansley
I am grateful to my hon. Friend for her question. As a registered charity, Marie Stopes is of course under an obligation to follow the rules and guidelines established by the Charity Commission on such matters. To that extent, these are not directly matters for me.
Annette Brooke (Mid Dorset and North Poole) (LD)
On international women’s day, what assurances can the Secretary of State give about the protection of reproductive and sexual services within the new framework?
Mr Lansley
My hon. Friend will know that through the plans set out in the Health and Social Care Bill the commissioning of those services will be the responsibility respectively of the NHS commissioning board and local authorities. Through local authorities, and as part of our public health responsibilities, we will be looking to promote good sexual health and high-quality support for people who need assistance with reproduction.
Bob Blackman (Harrow East) (Con)
My right hon. Friend has referred to the ring-fencing of the money that is going to be given to local authorities. Will he advise the House how long he expects that ring-fencing to last? Is it until such time as local authorities can be trusted to spend the money on public health?
Mr Lansley
The purpose of the ring-fencing is not to force local authorities to spend money on public health that they would not otherwise spend, but to be very clear that that NHS money is in the hands of local authorities to deliver health gain. We want that transparency, and we want to link those resources directly to the achievement of the public health outcomes that we set out in draft in our consultation on the public health outcomes framework. As there is that separate intention to deliver overall public health outcomes, linked to the local health improvement plans, we wanted to be clear that those resources would be deployed for that purpose. But local authorities will have very wide discretion about how they deliver those services locally to secure that health gain.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
Does the Secretary of State accept that the public could be forgiven for worrying that things will get worse, rather than better, in relation to public health? That is true of his health reforms across the piece, partly because, as we know, some local authorities are already cutting public expenditure given the budget cuts that they have to make, but also because of the difficulty in effectively ring-fencing the new funds that will be given to local authorities in due course.
Mr Lansley
In the first instance, I am not sure how the hon. Lady can argue that there is a difficulty with ring-fencing public health budgets, as they are not and will not be formally in the hands of local authorities until 2013-14. Clearly, there are no such practical issues at the moment. Further, she should have reflected the simple fact that we are already working between the NHS and local authorities to deliver much greater co-ordination in health, public health and social care. For example, this financial year, because we made savings in the Department of Health’s budget, we were able to provide, through primary care trusts, £162 million extra for the purpose of delivering improvements in social care in local authorities. Local authorities are having to deal with substantial reductions in their formula grant and some reductions in their spending power, but the NHS and social care are getting a substantial increase in support, both from the formula grant of my right hon. Friend the Secretary of State for Communities and Local Government and specifically through the NHS.
Chris Leslie (Nottingham East) (Lab/Co-op)
2. What steps he plans to take to reduce cancer mortality rates in deprived communities.
Mr Marcus Jones (Nuneaton) (Con)
5. What recent progress he has made on the introduction of GP commissioning consortia.
The Secretary of State for Health (Mr Andrew Lansley)
Last week I announced the third wave of general practice-led pathfinder consortia. I am sure my hon. Friend will be delighted that the Nuneaton and Bedworth pathfinder was announced as part of that. There are now 177 groups of GP practices covering in total 35 million people across England, piloting the future general practice-led commissioning arrangements. I expect further coverage in the coming months. Pathfinders are playing an increasing role in commissioning care for patients, so more and more people will benefit from clinical leadership in planning their care.
Mr Lansley
Yes, I can. Consortia will be able to reinvest any savings they make from their commissioning budgets for patients into improving patient care and health outcomes for patients for whom they are responsible. We have also proposed that consortia should receive a quality premium based on the outcomes achieved for patients, similar at a consortium level to the quality and outcomes framework for individual practices. That will incentivise the consortium as a whole to deliver improving outcomes for patients.
Emily Thornberry (Islington South and Finsbury) (Lab)
Some Government Members have supported the Government’s proposals for GP consortia because they believe that hospitals in their constituencies will be protected from closure, but yesterday’s leaked letter from the Foundation Trust Network to the Department of Health proves them wrong. It warns that financial stress is threatening the organisational survival of some foundation trusts. Now that they know that their hospitals are in danger, will the Secretary of State tell us all which faceless bureaucrats will be closing our hospitals and what extra powers, if any, local communities will have to stop them?
Mr Lansley
That will be the leak that took place when the head of the Foundation Trust Network gave it to the BBC.
The hon. Lady might not be very experienced in these matters, but she will know that at this time of year, in anticipation of the new financial year, hospitals tell their local primary care trusts how much money they would like to have, but that is not the same as the amount of money available in the whole system. That is part of the contract negotiations. She should also know that the necessity to deliver efficiency savings and redesign clinical services will mean that hospitals need to deliver 4% efficiency gains year on year, right across the NHS.
Mr Lansley
It will not be 6.5%, because things need to change so that efficiencies can be achieved within hospitals. That much is absolutely clear, and we have been clear about that. It does not threaten the future of hospitals, but incentivises to improve the design of clinical services and improve care for patients, providing more accessible care in the right place and at the right time.
Stephen Phillips (Sleaford and North Hykeham) (Con)
7. What steps his Department is taking to improve outcomes for cancer patients.
Stephen Mosley (City of Chester) (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.
Stephen Mosley
Prostate cancer is the most common form of cancer in men, with a quarter of a million men currently affected and one man dying every hour. This month is prostate cancer awareness month. What action is my right hon. Friend taking to help raise awareness of prostate cancer?
Mr Lansley
As the Minister of State, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), has set out in previous answers, our cancer outcome strategy commits more than £450 million a year over the spending review period to achieving earlier diagnosis of cancer, including access for GPs in the community to diagnostic tests such as non-obstetric ultrasound. At the heart of the strategy is the need to improve awareness and early diagnosis of all cancers, and we are working with the prostate cancer advisory group to help men who do not have symptoms to make decisions about whether to have a prostate-specific antigen test.
John Healey (Wentworth and Dearne) (Lab)
The Prime Minister promised to protect the NHS. What does the Health Secretary say to the people who are not getting the hip, knee and cataract operations that they need, and to the patients who are now having to wait longer for tests and treatment?
Mr Lansley
I will say three things. First, we did protect the NHS, contrary to the recommendations of the Opposition, who said that we should cut the NHS budget. Next year, primary care trusts across England will receive an average increase of 3% in cash. I went to Wales at the weekend, to Cardiff. The people of Wales are seeing a Labour-led Assembly Government cutting their NHS budget in real terms. That was what the Opposition recommended we should do, and we are not doing it.
Secondly, the number of hip and knee replacement operations went up in 2010 compared with 2009—the Patients Association figures were wrong about that. Thirdly, waiting times are stable, as we have set out, and the latest figures show that the average waiting time for diagnostic tests has gone down.
John Healey
The Secretary of State is a man in denial. What does he say to the chief executive of the Patients Association, who has said:
“It is a disgrace that patients are being denied access to surgical procedures that they would have had if they had needed them a year ago”?
What the Government are doing on the NHS is making things worse, not better. The Secretary of State is axing Labour’s patient guarantee on waiting times, he is breaking the promise of a real rise in NHS funding, he is wasting £2 billion on the Government’s top-down reorganisation and he is forcing market competition into all parts of the NHS. Does he not see that the NHS is rapidly becoming the Prime Minister’s biggest broken promise?
Mr Lansley
I can tell the right hon. Gentleman and the House exactly what we are doing. We are increasing the budget for the NHS by £10.7 billion over the next four years, contrary to what the Opposition told us they would do and what a Labour-led Assembly Government in Wales are doing. They are cutting the NHS budget in real terms.
Let me take one example. The number of hip operations in the first half of this financial year was 41,863, whereas in the previous period it was 39,114, and waiting times are stable, so the right hon. Gentleman’s assertion simply is not true. We are delivering an improving quality of care.
Let me give the right hon. Gentleman another example. As the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), said, not only are waiting times stable but infections are going down, with a reduction of 29% in C. diff rates and 35% in MRSA rates in our hospitals. Safer, higher-quality care—
Mr Speaker
Order. I am very grateful, but from now on we do need briefer answers—[Interruption.] No, we need briefer answers, because I want to accommodate Back-Bench Members. It is about them that I am concerned.
Philip Davies (Shipley) (Con)
T2. I believe that the introduction of plain packaging for cigarettes would be gesture politics of the worst kind, that it would have no basis in evidence and that it would simply be a triumph for the nanny state—and an absurd one at that. Given that, does the Secretary of State believe that I am still a Conservative, and if so, is he?
Mr Lansley
I am happy to believe that we are both Conservatives. The coalition Government made a commitment in our public health White Paper to publishing a tobacco control plan. We will do so shortly, and the purpose will be very clear: to secure a further reduction in the number of people smoking, and as a consequence, a reduction in avoidable deaths and disease.
Tristram Hunt (Stoke-on-Trent Central) (Lab)
T4. What assessment has the Secretary of State made of epilepsy helplines in helping to save NHS costs? I have constituents who are able to live happy and fulfilled lives by talking with epilepsy specialist nurses on the phone rather than going into hospital, but unfortunately, it seems as if that service is under threat from the University hospital of North Staffordshire. What is Government policy, and will he look at the situation in north Staffordshire?
Mark Lancaster (Milton Keynes North) (Con)
T3. The Secretary of State has visited Milton Keynes, so he will be well aware of the historical problems at the maternity unit there and, following the intervention of his Department, of the positive outcomes that have been achieved with one-to-one supervision for all mothers. I am convinced that the increased training of midwives has contributed to those outcomes, but may I press him to reassure the House that that level of training will continue?
Mr Lansley
Yes, I am very grateful to my hon. Friend and I share his wish for continuing improvement in the maternity services at Milton Keynes hospital. I can tell him and the House that we are delivering on our commitment to improve maternity services, which is at the heart of that wish. The number of midwifery training places commissioned for next year—2011-12—will be no less than this year, sustaining a record number of midwives in training. That will be on top of an increase between May and November 2010—after the coalition Government came in—of 296 additional midwives employed in the NHS.
John Robertson (Glasgow North West) (Lab)
T6. Following on from the question asked by my right hon. Friend the Member for Wentworth and Dearne (John Healey) on the £2 billion that the Secretary of State is using for his top-down reorganisation, does the Minister feel that that kind of money, which was not mentioned in the Conservative manifesto, would be better spent on health care and on building new hospitals?
Priti Patel (Witham) (Con)
T8. Witham town council and my constituents are deeply concerned about the lack of local medical facilities serving our town. Will the Secretary of State reassure my constituents that under the new commissioning arrangements medical provision in our town will be able to expand?
Mr Lansley
I can give my hon. Friend the reassurance that in future her local general practices—together in a commissioning consortium—and their other health care professionals, meeting with the health and wellbeing board in the local authority, will be able to bring democratic accountability in order to ensure that they have in her town and surrounding area the necessary services, based on a strategic assessment of need in their area.
Ms Karen Buck (Westminster North) (Lab)
T9. The NHS in north-west London is facing a £1 billion shortfall in funding over the spending period. Is the Secretary of State surprised, therefore, that yesterday’s NHS Confederation survey of managers found that just 13% of managers thought that supporting GP commissioning was the highest priority, compared with 63% who thought that the cash crisis was the highest priority? Is it not the case that financial pressures are dictating the NHS reform agenda, rather than the other way around?
Mr Lansley
I remind the hon. Lady again that next year we are increasing NHS resources in real terms. There will be a 3% increase across England in resources for primary care trusts, and as she will know, PCT managers in London are being brought together into PCT groupings. I do not understand the survey. They have a responsibility both to improve clinical commissioning by supporting their GP groups, which are coming together across London to do this, and to ensure strong financial control.
Simon Kirby (Brighton, Kemptown) (Con)
How can the Secretary of State ensure that HIV and sexual health services receive sufficient local political attention?
Mr Lansley
Local attention, through the public health responsibilities that currently lie with PCTs, but which in future will lie with local authorities, is a means by which we can improve health and the health of some of the groups most at risk of HIV. We have a number of pilot schemes that my hon. Friend might know about and that we are currently assessing, which have looked at opportunistic HIV screening for the many people who are currently undiagnosed with HIV. That is encouraging, and we might well be able to follow up on it.
Valerie Vaz (Walsall South) (Lab)
T10. Given that the chief medical officer does not have a background in public health, and despite the existence of Public Health England, should the Secretary of State not ensure that there is a public health expert on the national commissioning board, because that is where all the power lies?
Mr Lansley
I am surprised, because the hon. Lady is on the Select Committee on Health and should know that responsibility for public health will lie both with Public Health England, inside the Department of Health, and with local authorities. The NHS commissioning board will have a responsibility for prevention, but the population health responsibility will lie with Public Health England, and I have absolute confidence that Dame Sally Davies, the newly appointed chief medical officer, will be a leader in public health delivery, through Public Health England.
Jane Ellison (Battersea) (Con)
I represent a constituency with a young and highly mobile population. Younger women are very much over-represented among those who do not respond to routine invitations to screenings. Will Ministers promote the increasing use of mobile communications in inviting women to routine screening services?
Mr Ben Bradshaw (Exeter) (Lab)
Given that the Prime Minister has ordered his new communications director to order a shake-up of the health team because he is worried that they are losing the argument on the Government’s health upheaval, would it not save us all a lot of trouble if the Secretary of State admitted, not least to the Prime Minister, that it is not the public relations that is the problem, but the policy?
Mr Lansley
The right hon. Gentleman should not believe what he reads in the newspapers.
David Tredinnick (Bosworth) (Con)
The cancer drugs fund is available only for pharmaceutical drugs, but can it be used for wider support services, such as healers, aromatherapists, those using therapeutic touch and other such practitioners?
Mr Lansley
We are finalising the design of the future cancer drugs fund from April, and we will publish shortly. The interim cancer drugs fund is designed to support new effective medicines, based on clinical panels’ assessments of the needs of individual patients.
Mrs Jenny Chapman (Darlington) (Lab)
Today is international women’s day, so let me pass on the good wishes of the women of Darlington to the Secretary of State.
Mrs Chapman
Indeed. However, what does the Secretary of State have to say to those women when they are angry and concerned at the proposal from the County Durham and Darlington foundation trust to move their maternity services from Darlington to Durham, 20 miles away?
Mr Lansley
I would be grateful if the hon. Lady conveyed my very best wishes to the women of Darlington on international women’s day and said to them that I know from my visits to the north-east that a general practice-led commissioning pathfinder consortium has come together in their area. It is with that consortium and their local authority that they should look at which services they think should be provided in their area, and they will have the power to make that happen.
Stuart Andrew (Pudsey) (Con)
What plans does my right hon. Friend have to increase the number of single rooms in the NHS? Increasing their number will help to tackle mixed-sex accommodation, and increase privacy and dignity in end-of-life care.
Acupuncture, Herbal Medicine and Traditional Chinese Medicine
Lord Lansley Excerpts(13 years, 5 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
The issue of whether or not practitioners of acupuncture, herbal medicine and traditional Chinese medicine should be statutorily regulated has been debated since the House of Lords’ Select Committee on Science and Technology’s report in 2000 recommended statutory regulation for the first two of these groups.
We have today published an analysis of the 2009 consultation by the four United Kingdom Health Departments which sought views on the possible regulation of practitioners of acupuncture, herbal medicine and traditional Chinese medicine. This factual report has been placed in the Library and can be found on the Department of Health’s website at:
www.dh.gov.uk/en/Consultations/Responsestoconsultations/DH_124337
Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
I can now set out how we intend to take forward the regulation of herbal medicine practitioners and traditional Chinese medicines practitioners, specifically with regard to the use of unlicensed herbal medicines within their practice. As this matter is a devolved matter in Scotland and Northern Ireland we have had discussions with Health Departments in the three devolved Administrations which have been constructive and we are committed to a unified UK-wide approach to the regulation of these practitioners.
When the European Directive 2004/24/EC takes full effect in April 2011 it will no longer be legal for herbal practitioners in the UK to source unlicensed manufactured herbal medicines for their patients. This Government wish to ensure that the public can continue to have access to these products.
In order to achieve this, while at the same time complying with EU law, some form of statutory regulation will be necessary and I have therefore decided to ask the Health Professions Council to establish a statutory register for practitioners supplying unlicensed herbal medicines. This will ensure that practitioners meet specified registration standards. Practitioner regulation will be underpinned by a strengthened system for regulating medicinal products. This approach will give practitioners and consumers continuing access to herbal medicines. It will do this by allowing us to use a derogation in the European legislation to set up a UK scheme to permit and regulate the supply, via practitioners, of unlicensed manufactured herbal medicines to meet individual patient needs.
The Health Professions Council is an established and experienced statutory regulatory body which has the necessary experience to be able to successfully establish and maintain a statutory register for practitioners wishing to supply unlicensed herbal medicines. Subject to parliamentary approval, such practitioners who wish to supply unlicensed herbal products will be required by law to register with the HPC.
The four UK Health Departments will consult jointly on the draft legislation once it is prepared. This will give practitioners and the public the opportunity to comment. Subject to parliamentary procedures we will aim to have the legislation in place in 2012.
Until the new arrangements are in place the Medicines and Healthcare products Regulatory Agency (MHRA) will continue to take appropriate compliance and enforcement action where products are in breach of the regulatory requirements. In line with the MHRA’s normal approach, the action taken will be proportionate and will target products which pose a public health risk. Guidance issued by the MHRA makes clear their view that, where practitioners hold stocks of unlicensed products on 30 April 2011 that legally benefited from transitional arrangements under the European directive, the practitioner can continue to sell those existing supplies to their patients.
The 2009 consultation also looked at practitioners of acupuncture. The practice of acupuncture is not affected by the EU directive and, therefore, compliance is not required. I am confident that acupuncturists have their own voluntary regulatory measures in place which are sufficiently robust. Additionally, local authorities in England have powers to regulate the hygiene of the practice of acupuncture to protect against the risk of transmission of certain infectious diseases. Similar measures are also in place in Scotland, Wales and Northern Ireland.
I am pleased to say that this decision resolves a long-standing issue, to the benefit of both practitioners and the public who use herbal medicines.
Health Care Workers, Social Workers and Social Care Workers
Lord Lansley Excerpts(13 years, 5 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
Safe, respectful and effective care is essential and should be what all users of health and social care services experience.
The vast majority of those who work in health and social care are committed individuals with a strong sense of professionalism who aspire to deliver the highest standards. However, where there is poor practice or behaviour that presents a risk to the public, it is vital that swift action is taken, whether by employers, or by national regulatory bodies.
Ensuring a strong and effective system for regulating health and social care professionals is one of the cornerstones of our strategy for delivering improved outcomes for people who use health and social care services. The current system of professional regulation helps to ensure this by setting high standards of education, training, conduct and ethics and by taking action to remove unsuitable workers in the rare cases when things go wrong. Regulation of health care workers and social workers therefore makes an important contribution to safeguarding the public, including vulnerable children and adults.
However, the regulatory framework is also complex, expensive and requires continuous Government intervention to keep it up to date. More generally, reducing regulation is a key priority for the coalition Government. By freeing society from unnecessary laws, the Government aim to create a better balance of responsibilities between the state, business, civil society and individuals, and to encourage people to take greater personal responsibility for their actions.
While regulation of some professionals is vital to ensure high standards of care, it is only one component of a wider system of safeguards, controls and clinical governance and ultimate responsibility for the provision of high quality services must rest with employers and those contracting with health and social care workers. We believe that the approach to professional regulation must be proportionate and effective, imposing the least cost and complexity consistent with securing safety and confidence for patients, service users, carers and the wider public.
I have today laid before Parliament a Command Paper, “Enabling Excellence—Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers” (Cm 8008) setting out the Government’s proposals for how the system for regulating health care workers across the United Kingdom and social workers in England should be reformed, to sustain and develop the high professional standards of those practitioners and to continue to assure the safety of those using services and the rest of the public.
The reforms, many of which are being progressed through the Health and Social Care Bill, will give greater independence to those who work in health care across the UK and social care in England, to their employers, and to the professional regulatory bodies; balanced by more effective accountability in how they exercise that freedom.
We will seek to drive up standards for some groups of unregulated health and social care workers to improve service users’ experience through a system of assured voluntary registration. Employers and commissioners will be able to give preference to workers on voluntary registers to ensure that they contract with suitably skilled and qualified workers. In line with the Government’s overall social work reform programme, the proposals will also strengthen social work as a profession in England.
“Enabling Excellence—Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers” is available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Mental Health
Lord Lansley Excerpts(13 years, 5 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
The Government are today publishing “No health without mental health: A Cross-Government mental health outcomes strategy for people of all ages” for England.
At least one in four of us will experience a mental health problem at some point in our life, and around half of people with lifetime mental health problems experience their first symptoms before the age of 14. The society-wide costs of mental health problems have recently been estimated at £105 billion, and the costs of treatment alone are expected to double in the next 20 years.
We knew that change is needed and there are two powerful themes to our new approach. The Government must deliver a co-ordinated cross-Government focus, which genuinely supports local action. Equally, local strategies and more equal patients’ voices enable more decisions about mental health to be taken locally based on evidence of effective practice and delivering the best value for our society.
Our approach is based on the principles that Government have laid down for all their health reforms:
patients would be more involved in decisions about their treatment and care so that it is right for them—there will be “no decision about me without me”;
the NHS would be more focused on results that are meaningful to patients by measuring outcomes such as how successful their treatment was and their quality of life, not just processes like waiting list targets;
clinicians would lead the way—GP-led groups will commission services based on what they consider their local patients need, not on what managers feel the NHS can provide;
there will be real democratic legitimacy, with local councils and clinicians coming together to shape local services; and
they will allow the best people to deliver the best care for patients—with those on the front line in control, not Ministers or bureaucrats.
It is clear that the coalition Government’s success will be measured by the nation’s well-being, not just by the state of the economy. We know the conditions that foster well-being and, in recent years, much more about the interconnections between mental health, housing employment and safe communities. This strategy builds on that knowledge and the Government are investing around £400 million on psychological therapies to support people who need them across England. In all, this strategy captures this Government’s ambitious aim to mainstream mental health in England and our commitments include:
making mental health a key priority for Public Health England, the new national public health service;
agree and use a new national measure of well-being;
ensure that mental health remains high on the Government’s agenda by asking the Cabinet Sub-Committee on Public Health to oversee the strategy at national level; and
challenge stigma by supporting and working actively with the “Time to Change” programme.
“No health without mental health: A Cross-Government mental health outcomes strategy for people of all ages” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Health and Social Care Bill
Lord Lansley Excerpts(13 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Andrew Lansley)
I beg to move, That the Bill be now read a Second time.
The purpose of the Bill can be expressed in one sentence—to improve the health of the people of this country and the health of the poorest fastest. While the previous Government increased funding for the national health service to the European average, they did not act similarly to increase the quality of care. We spent more, but others spent better. In important areas, the NHS performs poorly compared with other countries. An expert study found that out of 19 OECD countries that were investigated, the UK had the fourth-worst death rate from conditions that are considered amenable to health care. If NHS outcomes were as good as the EU15 average, we would save 5,000 lives from cancer and 4,000 lives from stroke every year. We would also prevent 3,000 premature deaths from respiratory disease and 1,000 premature deaths from liver disease every year. This cannot go on: things have to change to protect the NHS and deliver better results for patients.
Mr Kevin Barron (Rother Valley) (Lab)
I do not dispute what the Secretary of State says about European comparators, but what does he say to Professor John Appleby, who said last Friday that all those markers, some of which are not direct comparisons, are getting nearer to European targets? Professor Appleby suggested that the disruption that is going to take place in the health service will not help us to do that.
Mr Lansley
I would say two things to Professor John Appleby. First, the latest data published in EUROCARE-4, which I know the right hon. Gentleman will have seen, are clear about the gap between cancer survival rates in this country and others, and in recent years that gap has not diminished as it should have. He can read in last week’s Lancet an authoritative study of cancer survival rates in this country and a number of others demonstrating that the gap remains very wide and that we have to close it. Secondly, the King’s Fund supports the aims of the Bill and Professor Appleby, as a representative of the King’s Fund, clearly understands, as we do, that if we are to deliver the change that is needed, we need the principles in the Bill.
People trust the NHS, and its values are protected and will remain so—paid for from general taxation, available to all, free at the point of delivery and based on need rather than the ability to pay. However, a system in which everyone is treated the same is not one that treats everyone as they should be treated. Our doctors and nurses often deliver great care, but the system does not engage and empower them as it should.
Geraint Davies (Swansea West) (Lab/Co-op)
On the John Appleby point, does the Secretary of State accept that what he actually said was that the rate of deaths from heart disease would be better in Britain than in France by 2012, on current trends, even though France spends 28% more on its health service? Is not that a ringing endorsement of what is happening now rather than a prescription for blowing up the system as the Secretary of State suggests?
Mr Lansley
First, I have just answered the point about John Appleby. It is true in a number of respects, as I have made clear, that although there have often been improvements in the NHS, they have not been what they ought to have been. It was a Labour Prime Minister, back in 2001, who said that we must raise resources for the NHS to the European average, but he did not achieve results that compared with the European average.
Let me give the hon. Gentleman some examples. A recent National Audit Office report showed that as many as 600 lives a year could be saved in England if trauma care were managed more effectively. Too often, the latest interventions, which are routine in other countries, take too long to happen here. John Appleby used heart disease to illustrate his point. Primary PCI— percutaneous coronary intervention—using a balloon and stent as a primary intervention to respond to heart attack was proven to be a better first response years ago. I knew that because cardiologists across the country told me so several years ago. I remember a cardiologist at Charing Cross telling me, “I have a Czech registrar working for me who says that in the Czech Republic PCI as a response to a heart attack is routine, but it hardly ever happens in this country.” Since then, it has been better implemented in this country, but that started to happen only when the Department of Health gave permission for its adoption.
The same was true of thrombolysis for stroke. That happened too late in this country, after such changes had taken place in other countries, because health care professionals there were empowered to apply innovation to the best interests of patients earlier.
Nadine Dorries (Mid Bedfordshire) (Con)
Does my right hon. Friend agree that, given the disparity in survival rates in trauma care and in many illnesses, including cancer care and heart attacks—citizens in this country are twice as likely to die of a heart attack as those in France—the NHS is in desperate need of modernisation?
Mr Lansley
My hon. Friend is right. We need not only to match European spending, as we do now, but to ensure that we achieve European-level results. It is not just about benchmarking, which we know we must do. We must benchmark ourselves against the best in the world if we are to deliver the best results for patients. We must also constantly make sure that we achieve a modernised health service that delivers the best possible care—sometimes going ahead of what others achieve, and applying innovation more quickly.
In some ways, as we know—for example, in mortality rates from accidents and from self-harm, and in equity of access to health care—the NHS leads the world, but our doctors and nurses are regularly hobbled by a system that treats equality as sufficient, when what we need is both equity and excellence.
Mr Denis MacShane (Rotherham) (Lab)
Given the Secretary of State’s praise for health care systems in Europe, which we are all connected to, will he consider allowing British patients to seek such health care in Europe, paid for by the NHS?
Mr Lansley
With his knowledge of European matters, the right hon. Gentleman knows that we are in the later stages of the collective approval through the European Union of the European cross-border health directive, which allows precisely that and makes it clear that the same criteria are applied to patients seeking health care in other countries as would apply were they to seek it through the NHS in this country.
Mr Lansley
In a moment. I have just answered one question.
Why did spending more not deliver better results? We know why that is—[Interruption.] No, better results should have been achieved. Opposition Members need to realise this, because it has been at the heart of their failure in public service reform over the past decade: the Office for National Statistics said a few weeks ago that productivity in the NHS fell in every one of the past 10 years. It fell by 1.4% a year in hospital services.
Despite a huge amount of money rightly invested in the NHS, taxpayers and patients were not getting the service that they should have had. Billions of pounds have also been wasted on an ever-growing bureaucracy, taking money away from the front line and away from patient care. The number of managers doubled under Labour. I give way to the Chair of the Public Accounts Committee.
Margaret Hodge
I thank the right hon. Gentleman. He is right to draw attention to the fact that productivity has fallen in the past 10 years, but should he not consider whether it is wise in those circumstances to distract people from driving up productivity and achieving savings by the unnecessary institution of reform? That is just taking people away from the thing that they should be concentrating on.
Mr Lansley
The right hon. Lady should understand, as I will go on to explain, that we are not distracting the NHS from the need to improve services for patients. We are enabling the NHS to improve services for patients. In her role on the Public Accounts Committee, she should understand that right across the public services, one of the consequences of dealing with the deficit is that we will have to reduce the costs of bureaucracy and administration.
We will do that in the NHS as much as anywhere else, but we will not do it in the way that the Labour party pressed us to do, which was to cut the NHS budget—[Hon. Members: “What?”] Yes, Opposition Members did exactly that. We will increase the NHS budget. As we set out in the spending review, we will increase the NHS budget by £10.7 billion over the life of this Parliament—investment that Labour opposed—and we are determined to get far more for British taxpayers’ money.
Angie Bray (Ealing Central and Acton) (Con)
My right hon. Friend will be aware that there has recently been an excellent reorganisation of stroke treatment in London, with a number of hospitals earmarked as emergency centres, all of which, crucially, are within 30 minutes of every Londoner. Once patients have been through the emergency procedures and are stabilised, they are returned to local stroke centres, which are also earmarked as part of the whole programme. Can he reassure me that that kind of regional organisation of hospitals, which has delivered good results, will not suffer through some of the proposed reforms?
Mr Speaker
Order. I remind Members that interventions should be short. There are 57 Members seeking to speak in the debate, so interventions must be pithy.
Mr Lansley
Thank you, Mr Speaker. I can give my hon. Friend the Member for Ealing Central and Acton (Angie Bray) precisely that reassurance. I was with NHS London at the beginning of last week, and it is clear that GP commissioning groups are coming together with providers to develop those kinds of commissioning plans, going beyond trauma and stroke care, which has already happened in London, to look, for example, at the integration of diabetes care between primary care and hospital services.
Under the Bill, patients will come first and will be involved in every decision about when, where, by whom, and even how, they are treated—“there must be no decision about me, without me.” The 2002 Wanless report called for patient engagement, but that did not happen. Now it will. Because patients cannot be empowered without transparent information, an information revolution will give them more detailed information than ever before, showing them and their doctors the consultants who deliver the best care, giving them control over their own care records and enabling everyone to access the care they need at the right place and at the right time. Patients and their doctors and nurses will be able to see clearly which health care provider offers the best outcomes and to make their decisions accordingly.
Mr Bernard Jenkin (Harwich and North Essex) (Con)
May I assure my right hon. Friend that this is not being greeted by local GPs in my constituency as some disruptive revolution, but as a logical extension of all the debate and development in the NHS over the past 20 years or more on giving patients more power and GPs more control over the allocation of resources?
Mr Lansley
I agree with my hon. Friend. In effect, that gives the lie to what the hon. Member for Wrexham (Ian Lucas) suggested. The coalition agreement states:
“We will strengthen the power of GPs as patients’ expert guides through the health system by enabling them to commission care on their behalf.”
Our manifesto stated that we would strengthen the power of GPs,
“putting them in charge of commissioning local health services.”
Mr Lansley
I am sorry, but 57 Members wish to speak, as you have rightly told us, Mr Speaker. I will give way as often as I can, but more than one intervention from each Member is excessive. [Interruption.] I have just quoted from the coalition agreement and our manifesto, so hon. Members have heard both.
Through the outcomes framework, which we published in December, we will stop the top-down, politically motivated targets that have led to real quality being sidelined. We will ensure that we focus on the outcomes that really matter and back them up for the first time with quality standards that are designed to drive up outcomes in all areas of care. Those standards have not been dreamt up in Whitehall, but are being developed by health professionals themselves. Similarly, doctors and other health professionals will not be told by us how to deliver those standards. The standards will indicate clearly what is expected, but it will be up to clinicians to decide how to achieve them. At every step, clinical leadership—that of doctors, nurses and other health professionals—will be right at the forefront. It will be an NHS organised from the bottom up, not from the top down.
The shift in power away from politicians and bureaucrats will be dramatic. The legislation none the less builds on what has gone before. It is not a revolution, but as the shadow Secretary of State said just a fortnight ago:
“The general aims of reform are sound—greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes—and are common ground between patients, health professions and political parties.”
Emma Reynolds (Wolverhampton North East) (Lab)
The right hon. Gentleman quoted the National Audit Office earlier. Does he agree with the statement in its report that his revolution in and upheaval of the NHS risk undermining the quality initiative—the so-called QIPP programme—that the previous Government introduced?
Mr Lansley
No, far from it—actually, quite the contrary. It is only by virtue of our ability to engage front-line clinicians more strongly in the management and design of care that we will deliver those quality, innovation, productivity and prevention ambitions; and it is only if we cut bureaucracy and the costs of bureaucracy that we will be able to get those resources on to the front line more effectively. I made it very clear, and the shadow Secretary of State endorsed the view, that there is consensus about the purposes of reform, but if Labour now voted against the Bill, although we do not know whether it will, it would abandon that consensus and, indeed, its own policies when in government.
Mr Jim Cunningham (Coventry South) (Lab)
Can the right hon. Gentleman say how many jobs will go in front-line services and how many hospital closures there will be as a result of his policies?
Mr Lansley
I just wish that the hon. Gentleman would look at the latest published data. Since the election, we have reduced the number of managers in the health service by almost 4,000 and increased the number of doctors. For the first time, there are more than 100,000 doctors in the NHS, and we are increasing the number of health visitors, after years of their numbers being reduced under the previous Government. He should get his facts right before he starts flinging accusations about.
Mr Ronnie Campbell (Blyth Valley) (Lab)
Will the right hon. Gentleman give way?
Mr Lansley
No. I am going to make some progress.
The Labour party, when in government, pioneered patient choice; Labour said, “We must have patient choice.” I remember John Reid, when he was a Member, saying that the articulate and the well-off negotiated their way through the health service, and that he wanted to give choice to everybody in the health service. He was right. The social attitudes survey in 2009 found that more than 95% of people felt that they should have more choice, but that fewer than half of patients actually experienced it. The Labour party started down the road of extending choice; we will complete that journey.
Andrew George (St Ives) (LD)
On patient choice in health service design, is the Secretary of State aware that in Cornwall the primary care trust has engaged in the transfer of community hospitals and services without adequate public consultation and at breakneck speed? If “no decision about me, without me” is to apply to service design and patient involvement, is he prepared to intervene to ensure that the public are involved in such important decisions?
Mr Lansley
I am grateful to my hon. Friend for that point. I have not previously been asked to comment on the matter, nor have I received information about it, but from my visits to Cornwall I entirely endorse his view about the importance of community hospitals in accessing services. He will see that, in the Bill, a specific duty is placed on the commissioning board and each commissioning consortium to reduce inequalities in access to health care. He will see also that, through the Bill, we will strengthen accountability where major service change takes place, because it will require not only the agreement of the commissioning consortium, representing as it were the professional view, but the endorsement of the health and wellbeing board, which includes direct, local, democratic accountability. Points have been made about what was in manifestos, but the Liberal Democrat manifesto was very clear about the need for democratic accountability in health service commissioning—and so there will be.
Let me return to the point, because the previous Government also went down the route of practice-based commissioning. It was their policy, but, as the shadow Health Minister, the hon. Member for Leicester West (Liz Kendall) said, many GPs felt that
“they didn’t always get the power, responsibility and resources they might have wanted.”
Well, now they will, and we will give it to them.
On our definition of quality, Opposition Members say “quality matters”. It does, and it was under the Labour Government that Ara Darzi pioneered the thought that quality must be at the heart and an organising principle of the health service. It is we now who are going to make that happen. We are publishing quality standards. We are putting into this legislation a duty to improve quality that extends to all the organisations that commission and provide NHS services.
Mr Ronnie Campbell
Will there be public accountability for the private companies that will come in and do the commissioning for the doctors? I can see their people getting top salaries—the executive getting £200,000 and the financial officer getting £250,000. That is the sort of thing that we are trying to stop. What will happen when these companies run things for doctors?
Mr Lansley
The accountability in the NHS will be for the quality of the service being provided. The hon. Gentleman may not have agreed with the last Labour Government on this, and perhaps many in the Labour party are now changing their view on what was pursued by that Government, but it was that Government who introduced and encouraged a policy of “any willing provider”. In 2003, Alan Milburn said:
“If I can get a private-sector hospital to treat an NHS patient, then for me the person remains an NHS patient.”
Everybody in the NHS who provides NHS services will be accountable through the—[Interruption.] The money will follow. The Chair of the Public Accounts Committee is here. Where public money goes, accountability for its use will follow.
Mr Lansley
Let me complete this point, then I will give way to my hon. Friend the Member for Basildon and Billericay (Mr Baron). On the point of allowing the independent sector to be a provider to the NHS, I should say that it was the right hon. Member for Leigh (Andy Burnham), the shadow Secretary of State’s predecessor, who said that
“the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.”—[Official Report, 15 May 2007; Vol. 460, c. 250WH.]
Well, Labour Members are not celebrating it now; they have reverted to type.
Mr Baron
The Government’s increased focus on improving outcomes is long overdue and very welcome, but will the Secretary of State address the issue of cancer networks and the concern that some of the expertise may be lost because of the funding gap between the end of funding for the cancer networks themselves and GP commissioning fully taking effect? Can the Government do anything to bridge that gap so that we allow GP consortia to be better informed in making decisions about what services to commission?
Mr Lansley
My hon. Friend rightly takes a close interest in these matters. When I was with him and other colleagues at the Britain against cancer conference, I made it clear—and he made it equally clear—that the cancer networks funding is guaranteed during the course of 2011-12. There is not a gap, because from April 2012 onwards the NHS commissioning board will take up its responsibilities. There will then be decisions by the commissioning board about how it will structure that.
Let me come back to what the last Labour Government did. They introduced the concept of payment by results. Unfortunately, however, payment tended to be by activity and not by results. We will now make it payment by results and really make that happen.
To complete the picture, I should say that throughout the Bill there are elements of policy that we are taking forward, such as foundation trusts. The Bill follows the brainchild of Alan Milburn and Tony Blair back in 2002. In 2005, the Labour Government said that every NHS trust should become a foundation trust by December 2008. That just did not happen. Again, it will be our task to make modernisation in the NHS consistent and comprehensive.
Mr David Lammy (Tottenham) (Lab)
Will the Secretary of State say how many GP contractors he estimates will be private companies? Will he also make it clear to the House that none of the private medical providers that funded his office in opposition will gain from the change?
Mr Lansley
There are two points to make. First, we have made no estimate of the extent to which GP-led commissioning consortia will contract with independent sector providers, so I cannot give the right hon. Gentleman such an estimate. Secondly, I did not receive money directly from a private health company for my office while in opposition. So there we are.
Labour’s reforms were piecemeal and incoherent. Under the previous Conservative Government, the internal market and fundholding of the early 1990s failed to promote quality and risked conflicts of interest among GPs. We have learned from those mistakes and from the failings of a Labour Government over the past 13 years. This Bill is different. It views the NHS as a whole service, every bit of it geared towards meeting patients’ needs. This Government understand that the best health care comes from the close partnership between patients and their clinicians. Every part of the NHS, every incentive, every structure and every decision must support and strengthen that relationship.
First, we will place the individual needs of each patient above all else, encouraging, wherever possible, a personalised approach to health care, tailoring services to have the greatest individual, and greatest overall, impact. Secondly, decisions made in the consulting room, in local service design, in commissioning, and in the services any particular provider offers, will be local decisions—real autonomy and real devolution of power.
Mr David Blunkett (Sheffield, Brightside and Hillsborough) (Lab)
Will the Secretary of State give way?
Mr Lansley
In a moment. [Interruption.] The right hon. Gentleman’s Front Benchers have been asking me to explain what the Bill does, and I am doing that.
Thirdly, there will be relentless focus on quality, embedded within a new legal duty. Fourthly, there will be a diverse and vibrant social market for health care. We will encourage NHS staff to set up social enterprises and foundation trusts, and we will encourage new capacity in delivering services through social enterprises, charities, private companies, and, indeed, NHS providers.
We want clinicians and their patients to lead the NHS, but they cannot do this while they sit under a vast hierarchy of regional and local organisations, all reporting to Whitehall. Everyone agrees that top-down command and control gets in the way of clinicians doing their job, so we need to dismantle the structures that sustain that interference; that is why we will abolish primary care trusts and strategic health authorities. There are many excellent people working in those organisations. Many will move to be with the new general practice-led commissioning consortia, to local authorities and to the NHS commissioning board. Some will want to set up their own new social enterprises. But even the best people cannot deliver the NHS that patients need if things stay as they are, so we will also introduce direct local democratic accountability. Councillor-led health and wellbeing boards will oversee and work with local NHS consortia, working to bring together the NHS, social care and public health services, and bringing a strategic coherence to the health and well-being of local communities.
Mr Blunkett
On bottom-up decision making at a local level, will the Secretary of State give a guarantee to the House that if the GPs now coming together in consortia decide that they wish to employ the expertise residing in the current primary care trust, he and the future health board will not intervene to stop them doing that? Will he also guarantee that he will not insist on redundancies that cost a fortune and preclude that expertise being available to the existing local consortia, with private enterprises then employing them to do the job that they were doing in the first place?
Mr Lansley
Let me make two points to the right hon. Gentleman. First, in the impact assessment that we published with the Bill on 19 January, we set out very clearly our estimates—they are no more than estimates since they will have to be decided by the general practice commissioning consortia and local authorities—that between 50% and 70% of the staff in primary care trusts would be employed in the successor organisations.
Secondly, the idea that somehow general practice-led commissioning consortia would engage the private sector where that has not happened up until now is, I am afraid, completely contradicted by the facts. Under the Labour Government, in the two years leading up to the election, there was an 80% increase in the use of management consultants, while at the same time the number of administrators and managers in those same organisations was rising dramatically. We arrived at the point where there were 50,000 administrators in primary care trusts, and they were still spending nearly £300 million a year on top for management consultancy. That all has to change.
One thing that Labour abjectly failed to do was to empower patients with a real voice in the health service. Through this Bill we will establish local healthwatch organisations that will represent the patient’s voice in the design of local services and help individual patients, especially the most vulnerable, to make the most of the choices available to them and to help them when things go wrong. Sitting within the Care Quality Commission, the national healthwatch organisation, too, will act as the eyes and ears of the quality regulator, and work to give the local organisations real teeth in their dealings with their local NHS—something that was completely, abjectly destroyed by the Labour Government when they abolished community health councils. Indeed, I know that families of those treated at the Mid Staffordshire hospitals welcome the additional powers for patients to have a voice.
Mr Lansley
I give way to the hon. Gentleman. I will give way to my hon. Friend the Member for Stafford (Jeremy Lefroy) in a moment because I referred to Staffordshire.
Clive Efford
The right hon. Gentleman will know that the Bill introduces European competition law into the national health service, and removes the existing protection once and for all. His Government have just taken the decision to put billions of pounds into stopping Irish banks failing. If a local hospital fails under the new market arrangements, will he step in and save it?
Mr Lansley
Time does not permit me to explain the extraordinary ignorance of that series of points. First, the Bill sets out that the regulator will have a responsibility to establish a failure regime. In 2003, when the predecessors of those currently on the Labour Front Bench took the health legislation through the House, they said that they would introduce a failure regime, to be implemented by Monitor, in legislation. They never did so. At the moment, there is therefore no proper failure regime.
Secondly, European competition law—indeed, competition law—applies in this country. A body was established in the national health service under the previous Labour Government called the co-operation and competition panel, the express purpose of which was to apply competition rules in the NHS. To that extent, all the Bill will do is to ensure that the rules that already apply are applied fairly, consistently and transparently across all providers.
Jeremy Lefroy
The Secretary of State referred to the Mid Staffordshire NHS Foundation Trust, into which an inquiry is taking place. What lessons from the various investigations have been applied in the Bill to address the concerns that have been raised?
Mr Lansley
I am grateful to my hon. Friend for that question. In addition to the measures on healthwatch and patient voice, we are strengthening the responsibilities of commissioners. As I suspect he knows from his local knowledge, general practitioners knew in many cases that the services at Stafford hospital were not meeting the quality of care that they ought to have met. However, there was no transparency in the outcomes, and there was no responsibility collectively among general practices and local health professionals to intervene. There was no mechanism that enabled or incentivised them to do so. We are going to change that. When Sir Robert Francis’s report is published in due course, I hope that the Bill, by strengthening patient voice, commissioning and the regulatory structure, will give the opportunity for whatever recommendations he makes to be implemented rapidly.
Mr Lansley
I apologise, but I have taken longer than I had intended, and 57 Members are waiting to speak.
I will explain further what the Bill will do. Local authorities, with a ring-fenced budget, will bring public health to the front and centre of public policy. This is not just about the NHS, but about improving the health of the whole population. That is why we are putting local authorities at the heart of it. The health of the general public is as much about the environment, the economy, housing and transport as what happens in the NHS. Health and wellbeing boards will make the link between health and social care, which have too often been in silos. We understand how intertwined those things are and how they must work together.
Mr Lansley
No, not at the moment.
The unions, of course, are against this modernisation of our public services. I suspect that they are the “forces of conservatism” that, more than a decade ago, the former Prime Minister told us he had to fight against. They oppose the principles of our plans, or so they say, but do they have an alternative? No. That contrasts completely with the reaction of general practitioners and health care professionals in GP pathfinders.
Mr Lansley
I have given way to the right hon. Gentleman before.
General practitioners and health care professionals in GP pathfinders are, in contrast to the unions, enthusiastic about what we are trying to achieve. For example, Dr Paul Zollinger-Read, a general practitioner and the chief executive of NHS Cambridgeshire, said recently:
“In our area, the GPs got together and focused on quality of care. They looked at diabetic care, for example, and services in this area improved. That means fewer diabetics will need to go to hospital in an emergency, there will be fewer amputations and less heart and kidney disease.”
Far from GPs being reluctant at the thought of taking on new responsibilities, applications to be pathfinder consortia were over-subscribed.
Mr Lansley
No, not at the moment. Sorry.
There are now 141 pathfinders, covering more than 28 million patients. More than half the population are already benefiting from the clinical leadership of their local health professionals. I have met some of the pioneers, such as in Redbridge, where they are pioneering bringing ophthalmology and dermatology services out into the community, and in Bexley, where they have pioneered better access to cardiology services for their patients. [Interruption.] Opposition Members say that they were doing that, but my whole point is that we are turning the exceptional cases in which GPs have had such opportunities in the past into the opportunity for all GPs across the country to do so. The Opposition might like to talk to the new chair of the clinical cabinet in Bexley, one Dr Howard Stoate, whom they will recall as a Member of the House before the election.
It is not only GPs who are anxious to get on with it. We are already working with 25 early implementer health and wellbeing boards that want to start bringing benefits to their communities. By April, we expect to be working with up to half of all local authorities, and the Bill will create that framework. Whereas the previous Government often talked a good game, we will put our ambitions and the new roles into law. The Bill explicitly defines roles and responsibilities that were previously at the discretion of Ministers. Until now, legislation on the NHS has more or less said, “The NHS is whatever the Secretary of State chooses to make it at any given moment.” That was why, in the past, reorganisations took place on a practically annual basis under the Labour Government, without there ever being any consistency or coherence to them. I intend to be the first Secretary of State in the history of the NHS who, rather than grabbing more power or holding on to it, will give it away.
As well as devolving decision making, the Bill will transfer power back to Parliament and strengthen the accountability and transparency of the NHS. It will protect the NHS constitution, ensuring that the rights in it are reflected within NHS commissioning and regulation. It contains a number of new duties, including a duty on the Secretary of State, the NHS commissioning board and each commissioning consortium to seek continuous improvement in the quality of services, and to seek to reduce inequalities in access and health outcomes.
The Bill contains a duty of autonomy, so that politicians allow providers and commissioners to provide the best care as they see fit, minimising burdens wherever possible. There is a duty on Monitor to protect and promote the interests of patients, through competition where appropriate and through regulation where necessary. The role of local authorities will increase greatly, including not only the scrutinising of local health services but a duty to promote integrated working between the NHS, social care services and public health services.
As I have said, in 2003 Labour promised a proper regime in the event of the failure of any provider of NHS care. They did not provide that; this Bill will. Should a provider fail, there will be a transparent process for maintaining designated services, to ensure continuity of services for patients.
Monitor will be empowered to set up a “risk pool”, to which providers will pay a levy that will meet the costs of maintaining key services. There will also be a clear and transparent process for setting the NHS tariff for different services. The National Institute for Health and Clinical Excellence will develop quality standards, give advice and make recommendations on the clinical effectiveness of medicines and treatment. As the shadow Secretary of State said a fortnight ago, the Bill is “consistent, coherent and comprehensive”. It will put patients first and improve health outcomes.
Mr Lansley
I must conclude and allow other Members to contribute to the debate.
The Bill will change structures, abolish bureaucracy and inject added competition, but those are only the means to a much greater end. As large and complex as it is, there is one simple objective behind the Bill—better care for patients, measured not by political targets but by real results for patients. It is about gearing the entire system towards supporting the relationship between doctor and patient—a “meeting of experts”, as Tuckett would have called it, with the patient being an expert on themselves and the clinician being an expert on their clinical management and condition. It is about bringing the two together based on trust, transparency and the best available treatment from the best available provider.
Previous changes have tinkered with one piece of the NHS or another, when what was needed was comprehensive modernisation to create an NHS fit for the demands of the 21st century. That is precisely what this Health and Social Care Bill will deliver. What we see from the Labour party is nothing but opposition for its own sake—opposition to the modernisation that the NHS needs—and most of it is inconsistent with Labour’s own manifesto. It is clear that Labour opposes not only our investment in the NHS and our cuts in NHS bureaucracy but our modernisation of the NHS, which it pursued while in government.
The House knows my passion for the NHS, my respect for those who work in it and my ambition for it to be the best health care service in the world. This Bill, and the modernisation of which the Bill is just a part, are about that passion for the NHS and for securing its future. I commend the Bill to the House.
John Healey
Characteristically, my right hon. Friend is absolutely right. These changes to the NHS and the Bill—[Interruption.]
John Healey
I shall answer my right hon. Friend the Member for South Shields (David Miliband), then I will give way.
My right hon. Friend is absolutely right. The Government will talk about some changes, but not about others. The changes are like an iceberg, with big, substantial, ideological changes hidden from public sight.
Mr Lansley
The edifice of an argument from the right hon. Member for South Shields (David Miliband), which is repeated by others, is based on one fact: in December 2009, the operating framework said that commissioners in the NHS could set a maximum price and not just a fixed price. That was December 2009. The right hon. Gentleman and the shadow Health Secretary were in the Government who put that measure into the operating framework. This Government did not put it in; the previous one did.
John Healey
The point made by my right hon. Friend the Member for South Shields is based on page 42 onwards of the Health Secretary’s impact assessment of the Bill, which mentions a premium for private providers of £14 per £100. The Bill allows the system to pay a premium and a bung to private sector providers.
Commissioning and Public Expenditure
Lord Lansley Excerpts(13 years, 5 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I have today laid before Parliament the Government’s responses (Cm 8007 and Cm 8009) to the House of Commons Health Select Committee reports “Public Expenditure: Second Report of Session 2010-11”, which was published on 14 December 2010 and “Commissioning: Third Report of Session 2010-11”, which was published on 18 January 2011.
We accept the level of challenge presented in our modernisation of health and social care but we are clear that these changes are necessary and that the funding announced during the 2010 spending review, coupled with more efficient delivery systems, will allow the required change to take place across the health and social care sectors. These changes will bring about closer working across the sectors creating services that will be more responsive, more personalised and more preventative with better outcomes for those who use them.
The starting point for the Committee’s inquiry into commissioning has been the previous Committee’s findings on the significant shortcomings of the current arrangements for commissioning in the NHS. We welcome the Committee’s conclusion that more effective commissioning is the key to delivery of efficiency gains. The White Paper, “Liberating the NHS”, sets out a new direction for the future of commissioning, intending to put commissioning decisions in the hands of those who are closest to patients themselves—GPs.
The Health and Social Care Bill introduced into Parliament on 19 January takes forward the changes to the NHS set out in the White Paper and further developed in December’s “Legislative framework and next steps”.
The programme of modernisation we have set out is essential both to drive efficiency in the short-term, and help ensure that the NHS meets the ambition to achieve outcomes for patients that are among the best in the world.
Today’s publications are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Oral Answers to Questions
Lord Lansley Excerpts(13 years, 5 months ago)
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Christopher Pincher (Tamworth) (Con)
11. What recent progress he has made in introducing GP commissioning consortia.
The Secretary of State for Health (Mr Andrew Lansley)
Last week, I announced the second wave of GP-led pathfinder consortia. There are now 141 groups of GP practices piloting the future GP commissioning arrangements. Those groups are made up of more than 4,000 GP practices, with over half the population starting to benefit from services that better meet their needs and improve outcomes for patients. The Health and Social Care Bill, which had its First Reading last week, sets out the legislative framework that supports our reforms.
Mark Lancaster
Consortia in Milton Keynes have been given £1 per patient as a transition fund. That money is most welcome. It will rise to £2 per head next year. The problem, however, is that the fund is proving hard to access because of the bureaucratic nature of the local primary care trust. Will the Secretary of State look into that and ensure that the money is accessible?
Mr Lansley
I entirely understand my hon. Friend’s point. The PCT’s role is to support the development of consortia, not inhibit it. The operating framework that was published last month sets out the range of support that PCTs should be offering emerging consortia. Milton Keynes PCT has confirmed that it will actively support Premier MK, one of two consortia in the area, with its application to become a pathfinder, and that it is actively working with another consortium in the Milton Keynes area.
Stephen Mosley
Pathfinder consortia will play a crucial role in improving the NHS, so it is imperative that any problems are sorted out as quickly as possible. How does my right hon. Friend propose to help any pathfinder consortium that finds itself in the unfortunate position of failing to deliver the results expected of it?
Mr Lansley
My hon. Friend makes an important point. He will recall that before the election, the Select Committee on Health severely criticised the way in which primary care trusts were going about commissioning. We are looking to consortia because they are clinically led and responsive to patients in designing far better clinical services, and they will have considerable support in doing so. Over the next two years, we will enable them to develop support arrangements, whether through existing primary care trust teams, local authorities, the NHS commissioning board, or a range of voluntary and independent sector organisations.
Nick de Bois
Will the Secretary of State outline the role that charities and voluntary organisations will play under GP commissioning to ensure that the needs and views of patients are at the heart of services?
Mr Lansley
To give my hon. Friend one example, last Friday I spoke to the Motor Neurone Disease Association, which has developed a commissioning support organisation with the Multiple Sclerosis Society and Parkinson’s UK. The voluntary sector can therefore be involved directly in helping GP consortia to commission for those critical diseases more effectively. My hon. Friend might have seen what Sir Stephen Bubb, the chief executive of the Association of Chief Executives of Voluntary Organisations, said last week:
“These reforms could herald a new and dynamic relationship between local GPs and charities that both deliver good services and act as a powerful voice for patients.”
Mr Lansley
My hon. Friend might like to speak to general practitioners in Redbridge in London who, as a pathfinder consortium, have been pioneering GP-led commissioning for 18 months. They have redesigned care for patients with diabetes and coronary artery disease, and are shifting care in ophthalmology and dermatology to primary care settings. They are demonstrating how this form of locally and clinically-led commissioning is more responsive to patients and more effective.
Christopher Pincher
As we shift from PCTs commissioning services to GP consortia doing so, can my right hon. Friend confirm that the important work done by pharmacies, such as providing anti-smoking clinics and the supervised consumption of drug substitutes, will not be left out in the cold?
Mr Lansley
My hon. Friend enables me to say that I and my colleagues entirely understand and endorse the stronger role that pharmacies can play, including by assisting with the provision of services such as minor ailments services and medicines use reviews, which will be commissioned through arrangements led by the NHS commissioning board. In addition, the services that he describes, such as stop smoking services, will be commissioned as part of the public health efforts, which will be led by local authorities through their local health improvement plans.
Emma Reynolds (Wolverhampton North East) (Lab)
Will the Secretary of State comment on the apparent conflict between, on the one hand, a general practitioner being an advocate for their patient and taking purely clinical decisions and, on the other hand, GPs having to allocate resources in the new system? Will that conflict not lead to a breakdown of trust in the relationship between the GP and their patients?
Mr Lansley
I am afraid the hon. Lady sees a conflict where, to GPs, there is none. It is their responsibility—[Interruption.] No, their first duty is always to their patients, whose best interests they must secure. When she has an opportunity to look at the Health and Social Care Bill, which we published last week, she will see that it makes very clear the duty to improve quality and continuously to improve standards. We all know that we have to achieve that with finite resources, but we will do that much better when we let clinical leaders influence directly how those resources are used rather than letting a management bureaucracy tell them how to do it.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Can the Secretary of State explain why, at a time when front-line NHS staff in my constituency and elsewhere across the country are in fear of their jobs, it is proposed that the NHS commissioning board will be able to make bonus payments to a GP consortium if, to quote the Bill,
“it considers that the consortium has performed well”,
and that a GP consortium may
“distribute any payments received by it…among its members”?
Is that not the worst kind of excess? We do not want to see it in our banking system, and we certainly do not want to see it in our NHS.
Mr Lansley
I am glad to have the opportunity to welcome the hon. Lady to the Opposition Benches and wish her well in representing Oldham East and Saddleworth. I am sorry that she did not take the opportunity to welcome in particular the Government’s commitment to the new women and children’s unit at the Royal Oldham hospital.
For years, general practices have been remunerated partly through a quality and outcomes framework. The principle is that if they deliver better outcomes for patients, they should have a corresponding benefit from doing so. In the same way, if the commissioning consortia deliver improving outcomes for patients, that should be recognised in their overall reward.
John Healey (Wentworth and Dearne) (Lab)
The Secretary of State talks a lot about GPs using £80 billion of public money to commission services, but if they are to carry on being family doctors, the planning, negotiating, managing and monitoring of hundreds of commissioning contracts will be done not by GPs but in their name, either by the people who do it now in primary care trusts or by the big health companies that are already hard-selling the service to new GP consortia. Is he not deliberately disguising the true purpose of his changes, which is to open up all parts of the NHS to big private health care companies?
Mr Lansley
On the contrary, the purposes of the Bill are very clear to see—for example, the duty to improve quality and raise standards throughout the health service. I hope that the shadow Secretary of State will acknowledge that putting clinical leadership at the heart of the system is essential. I entirely understand that leadership is not the same thing as management, as do general practitioners. The Prime Minister and I will meet the first wave of pathfinder consortia tomorrow, and we will support them in taking clinical leadership in designing services for patients and bringing to bear the best management support in doing so.
John Healey
Why will the right hon. Gentleman not be straight with the public? I have with me the White Paper—57 pages and only three references to the market, all of them to the social market. He talks about GP commissioning, but not about the hard-line political ideology that underlines these changes. The Bill puts no limit on the use of NHS beds and staff to treat private patients, it puts no limits on big private health care companies undercutting and undermining local hospitals, and it puts at the heart of the new system an economic regulator charged not with improving services but with guaranteeing and enforcing competition. Is this NHS reorganisation not like an iceberg, with the substantial ideological bulk being kept out of the public’s sight?
Mr Lansley
The shadow Secretary of State cannot actually criticise what we put forward in the White Paper or the Bill and is resorting to inventing something else and attacking that. Let me tell him that the one thing we will not do with the private sector is rig the market so that private companies get contracts and guaranteed money whether or not they treat patients. We are not going to give them 11% more money than the NHS would get for doing the same work. We will give NHS organisations a proper chance to deliver services for patients.
Liz Kendall (Leicester West) (Lab)
Whatever the Secretary of State claims about his reorganisation, a King’s Fund survey showed that more than three quarters of doctors do not believe that it will improve patient care, and even his Department’s impact assessment on the Health and Social Care Bill says that the reorganisation risks distracting staff and making them less focused on patient care.
Will the Health Secretary now confirm that the number of patients waiting more than six weeks for their cancer test has already doubled under this Government, and that routine operations are being cancelled? Will he finally listen to the Royal College of Nursing and the British Medical Association, which have told him that his plans are
“extremely risky and potentially disastrous”
for the NHS and patient care?
Mr Lansley
I find it astonishing that the hon. Lady should attack the NHS because some elective operations have been cancelled. We have been through a flu outbreak and very severe weather, and that is what happens as a consequence. She should not try to make a political point out of it.
It is also astonishing that the hon. Lady gets up and says that she does not agree with our policy. On 3 December, she is quoted in GP news as saying that
“it is ‘absolutely right’ that GPs are ‘better involved’ in commissioning services.”
She supported it. The truth is that before the election the Labour Government instituted practice-based commissioning, introduced foundation trusts, started payment by results and said that patient choice was right. The shadow Secretary of State said just last week that
“these plans”—
our plans—
“are consistent, coherent and comprehensive”,
and indeed they are.
Tim Farron (Westmorland and Lonsdale) (LD)
Cumbria’s current health commissioners—the PCT—chose to scrap the heart unit at Westmorland general hospital, despite medical, clinical and public opposition. Will the Secretary of State confirm that new GP fundholding arrangements allows the possibility of returning services that are clinically supportable, such as a heart unit at Westmorland general?
Mr Lansley
I know, not least from visiting that hospital, how strongly people in my hon. Friend’s area feel about their access to services locally. I am pleased to say that he will see in the Bill that one of the duties of the NHS commissioning board is to reduce inequalities in access to health services, and GPs can do precisely that.
Mr Stephen Hepburn (Jarrow) (Lab)
The Secretary of State knows fine well that the British public knew nothing at the general election of his plans dramatically to dismantle and privatise the NHS. Will he give them a say now and have a referendum on the issue?
Mr Lansley
Since we have no plan either to dismantle or to privatise the NHS, it is no surprise that people were not told of any such plan. Before the election and in the Conservative manifesto, people were told of our determination to cut bureaucracy and get money to front-line care. They were told of the determination of both parties in the coalition to get decision making close to the front line, to enhance accountability, including democratic accountability, and to give greater responsibility to clinicians to lead the development of services.
Charlie Elphicke (Dover) (Con)
2. What steps he plans to take to increase cancer survival rates.
David Rutley (Macclesfield) (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 national health service in delivering improved health outcomes in England, to lead a public health service which 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.
David Rutley
Cheshire East council is working closely with local health care partners in my constituency to tackle the growing challenge of alcohol abuse, which not only causes serious illness and injury but costs our local primary care trust £34 million a year. Does my right hon. Friend agree that that is the right way in which to tackle this growing problem, and will a member of his ministerial team meet me, along with representatives of the council, to help secure the best possible outcomes in Macclesfield?
Mr Lansley
Of course we will support the efforts of my hon. Friend and his local council to tackle alcohol abuse. He will have heard what was said earlier by the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), which I entirely endorse.
Local authorities and their communities should have a greater say in what happens in their areas. We will enable them to do so, through the Health and Social Care Bill, the establishment of local health improvement plans, and—as my hon. Friend the Under-Secretary said—the alcohol strategy that we will introduce following the public health White Paper later in the year.
Ian Lavery (Wansbeck) (Lab)
T3. Does the Secretary of State envisage a time when GP consortia may be purchased by foreign companies, and operated and administered thousands of miles away across the globe?
Mr Lansley
No, I do not. I am glad that the hon. Gentleman has asked that question, because I think that there is a world of difference between the question of the exercising of clinical leadership by general practices as members of a consortium in an area and the question of from whom they derive management support. I believe that many will derive it from existing PCT teams, the voluntary sector and local authorities. Sometimes the independent sector will be involved, but it is a question of the consortium choosing where to go rather than being taken over.
Margot James (Stourbridge) (Con)
T2. Some care homes that have received critical reports from the Care Quality Commission are reopening under the same management but with different names. The CQC’s practice is to remove earlier poor reports from its website, leaving potential customers in the dark about the poor record of those homes. Will the Minister remind the CQC of its responsibility to highlight poor practice in care homes, and request that it change its practice?
Paul Blomfield (Sheffield Central) (Lab)
T5. A year ago, writing in The Sun, the Prime Minister made a firm and passionate pledge to increase the number of midwives by 3,000. Last week, the chief executive of the NHS told the Public Accounts Committee that the NHS is now short by 4,500 midwives. Will the Secretary of State tell the House when he intends to implement plans to honour the Prime Minister’s pledge—or can we take it that it is just another Conservative broken promise on the NHS?
Mr Lansley
Well, I do not wish to embarrass the chief executive of the NHS, but actually, he told me he made an error—he was referring to health visitors, not midwives, when he was talking to the Public Accounts Committee. We are short of health visitors precisely because, through the life of the last Government, the number was continuously going down, and we are going to recruit more. Actually, we share the last Labour Government’s commitment to increase the number of midwives, not least because of the increase in the number of births, and to do so in pace with that. As a consequence, in conversations that the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), and I have had with the Royal College of Midwives, we have made it clear that we will do all we possibly can. We already have more midwives in training than at any other time in our history.
John Stevenson (Carlisle) (Con)
T4. As Ministers are aware, GPs in north Cumbria are supportive of GP commissioning and are already working hard for its success. However, given the rural nature of the area, what support will be given to the local hospitals to ensure that they can provide secondary health care within the new regime, when they have to accommodate the additional costs of providing health care in a rural environment?
Mr Lansley
Yes, I entirely endorse what my hon. Friend says about GPs in Cumbria. They are indeed very forward-looking and show that, even under the last Government, practice-based commissioning was demonstrating its benefits, and we are building on that. I mentioned earlier the duty in the Health and Social Care Bill on the NHS commissioning board to reduce inequalities in access to health care. That will be important for rural areas. The pricing arrangements, led by the commissioning board and Monitor, must also take into account varying costs associated with the delivery of care in different localities.
Mr Tom Harris (Glasgow South) (Lab)
T8. If the Government will not even trust GPs with the responsibility of ordering flu vaccine, how on earth can they trust them with commissioning the care and treatment of cancer victims?
Mr Lansley
Of course, it was the last Government who agreed the arrangements with GPs. It was the last Government who, in 2007, undertook a flu review when central procurement of flu vaccine was recommended, but did nothing about it. The public health responsibility is distinct from the commissioning responsibility for health care of patients. We will look at, and we have still to make a decision about, how we procure flu vaccine in future years. We may do it through central procurement or through continuing GP procurement; but either way, we will make sure that we improve on the system we inherited.
David T. C. Davies (Monmouth) (Con)
T6. Can the Minister tell us how much money is spent each year on disposable surgical instruments, and whether any thought has been given to greater use of properly sterilised reusable instruments?
Grahame M. Morris (Easington) (Lab)
T9. May I ask the Secretary of State directly about leaked documents seen by The Northern Echo? They show that a £53 million NHS contract to provide health care services to the prison service in the north-east was awarded to a private company, Care UK, even though the NHS provider was marked higher on quality, delivery and risk. Care UK beat the NHS provider only on price. Is this confirmation of the Minister of State’s remarks on Newsnight, that this Bill will create a full market and full competition?
Mr Lansley
The hon. Gentleman is asking about arrangements that we have inherited from his Government; they are from before the election and are nothing to do with the White Paper or the Bill. The contract to which he refers was let by the North East Offender Health Commissioning Unit. This was its procurement decision and it states that a competitive, robust and transparent process was followed. This was not a decision taken or influenced by the Department of Health.
Karen Lumley (Redditch) (Con)
T7. In support of national obesity fortnight, which is currently running, I wish to raise awareness of this serious condition, which causes numerous deaths and other serious health conditions. Redditch has high levels of obesity compared with the average in England. NHS Worcestershire is doing a fantastic job, but what more can the Government do to ensure that the NHS will not be overly burdened with increasing obesity problems?
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
The Minister of State referred earlier to Labour Members cherry-picking quotes, but I do not believe that Laurence Buckman, chair of the British Medical Association’s GP committee, was mincing his words when today he described the Government’s reorganisation plans as “fatally flawed”, warning that they
“would see the poor, elderly, infirm and terminally ill in large parts of the country losing out”.
Why does the Secretary of State believe that he knows better than Dr Buckman?
Mr Lansley
I do not recall the BMA ever agreeing with the previous Government. Let me provide one quote to the hon. Lady:
“The general aims of reform are sound—greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes—and are common ground between patients, health professions and political parties.”
The shadow Secretary of State said that last week.
Duncan Hames (Chippenham) (LD)
The NHS Litigation Authority has presented NHS Wiltshire with a bill for more than £3.5 million in clinical negligence scheme payments this year. Nationally, among closed claims, legal fees made up more than a third of costs last year. How does the Minister propose to switch this expenditure away from lawyers and towards front-line health services?
Mr Lansley
I wish, first, to say two things, but there may be further to add. First, my right hon. and learned Friend the Secretary of State for Justice is working on the implementation of the Jackson review. That, in itself, will help considerably in reducing the extent to which these costs are consumed in legal fees, rather than proper compensation for clinical negligence. As we made clear in response to Lord Young’s report, we will also pursue the question of whether we can have a fact-finding phase following up a claim against the national health service, so as to mitigate what is otherwise considerable additional cost on conditional fee arrangements and getting expert witnesses.
Mr Dennis Skinner (Bolsover) (Lab)
Why is it that the Secretary of State does not compliment the Labour Government on providing £110 billion, starting with £33 billion in 1997? Is it not a fact that waiting times have fallen as a result of the nurses, the doctors and that money? Is he frightened to utter the words because in 2001 every single Tory MP marched through the Lobby not to give the money to the national health service?
Mr Lansley
Let me remind the hon. Gentleman that at the general election we just fought we were the party that was committed to increased resources for the national health service. We are the coalition Government who, over this Parliament, will increase resources for the national health service by £10.7 billion, even in the face of the deficit we inherited from Labour. The hon. Gentleman’s party’s response was to tell us that we should cut the NHS, and we are not going to do it.
David Tredinnick (Bosworth) (Con)
Will my right hon. Friend the Secretary of State please explain why it is taking so long for him to come to the House about the regulation of herbal medicine? He has to do that before April to comply with European legislation. What is the hold-up?
Dr William McCrea (South Antrim) (DUP)
Specialists in the field state that the figures that point to a more than 50% rise in young drinkers ending up in hospital are a gross underestimate of the serious problem. What further steps can the Department and the Government take to address this important problem?
Mr Lansley
As the hon. Gentleman will recall from earlier exchanges, it is absolutely right that we must have a series of measures to tackle alcohol abuse. Price is part of it, as is the enforcement of legislation. Community alcohol partnerships have been very promising. We must have better alcohol education, and I spoke at the first annual conference of Drinkaware yesterday, encouraging it in the work that it does. We must understand that we have to change people’s behaviour and that the damage that can be done is intense. As a consequence of chronic alcohol abuse, large numbers of people are coming in and out of intensive care units, presenting an enormous burden to the health service as well as doing great damage to themselves.
Gordon Birtwistle (Burnley) (LD)
The College of Emergency Medicine recently stated that if a hospital A and E unit is to be downgraded to an urgent care centre, the nearest A and E unit should be no more than 12 miles away. Will the Secretary of State revisit the cases of A and E units that were recently downgraded by the previous Government to urgent care centres when the nearest A and E unit is more than 12 miles away?
Mr Lansley
Yes. My hon. Friend makes a very important point. I promise I will discuss with John Heyworth of the College of Emergency Medicine precisely the point that my hon. Friend has raised. The College of Emergency Medicine says that it does not recognise what an urgent care centre is. From its point of view, hospitals should either have an emergency department or an A and E or they should not. If they do not, it is very important to be clear that they do not. I feel that we need to be much clearer about the nature of the service provided in A and E departments and the distinction between that and the service provided in minor injury or minor illness centres.
David Wright (Telford) (Lab)
Do not the reorganisation plans for the NHS, coupled with cuts to local authority budgets, mean that public health projects in this country will effectively be binned?
Mr Lansley
No, they will not. We are making very clear our determination to ring-fence public health budgets so that prevention does not suffer, as it did under the hon. Gentleman’s Government. In 2005-06, the first things to disappear as a consequence of financial pressures were the public health budgets and public health staffing. We will not allow that to happen.
Zac Goldsmith (Richmond Park) (Con)
I welcome the Government’s commitment to ending mixed-sex wards, but does the Secretary of State agree that it is both unnecessary and extreme to extend that policy to children’s wards and to enforce it with the threat of fines?
Mr Lansley
I entirely understand my hon. Friend’s point, and the rules we have set out for the NHS are very clear. We are also clear that we will ensure, through the NHS, that people have access to the privacy and dignity they have a right to expect, contrary to what the hon. Member for Leicester West (Liz Kendall) has said. She said that as long as they get the treatment through the NHS, it does not matter whether they are in mixed-sex accommodation, but that is not our policy. It does matter, and we will enforce it.
Strategy for Cancer
Lord Lansley Excerpts(13 years, 6 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
Today, I formally launch “Improving Outcomes: A Strategy for Cancer”, which outlines the coalition Government’s plans to deliver health outcomes for cancer patients that are among the best in the world in a reformed national health service. Although significant improvements have been made in recent decades—and we welcome the work of all those involved in driving these improvements—outcomes for patients in England continue to lag behind those in countries of comparable wealth.
The strategy translates the three underpinning principles of the coalition Government’s reforms of the health and care services into the steps we need to take to drive improvements in cancer outcomes. In order to put patients, service users and members of the public at the heart of decisions about their care, this strategy sets out the actions we will take to tackle the preventable causes of cancer, to improve the experience of cancer patients and support the increasing number of cancer survivors; describes the ways in which choice for patients in their cancer care will be extended and implemented; and identifies the gaps in information on health outcomes that are crucial to ensuring patients are empowered.
In order to ensure that health and care services are orientated towards delivering the improvements in outcomes for people with cancer we wish to see, the strategy sets out the work which the public health service will be charged with undertaking to deliver the necessary improvements in prevention, raising awareness of cancer symptoms and achieving earlier diagnosis; outlines the resources the NHS commissioning board will be able to draw on to drive improvements in the quality of NHS cancer commissioning; and identifies ways in which best practice approaches to cancer commissioning can be disseminated for use by pathfinder consortia through the transition and beyond.
In order to empower local organisations and front-line professionals to encourage the delivery of improved cancer care, the strategy provides possible future models for the delivery of advice and support on cancer commissioning at the national level; reports on the review of cancer waiting time standards, recommending that current cancer waiting time standards are retained; and announces plans to harness the innovation and responsiveness of the charitable sector further in cancer care, to build on the important work done to date to promote healthier lifestyles, encourage earlier diagnosis and provide information and support for those living with cancer.
The strategy sets out how—in cancer care—we will bring the approach we have set out for health and care services to bear in order to improve outcomes for all cancer patients and achieve our aim of improving cancer survival rates, at the same time as working more efficiently so that cancer services make a significant contribution to meeting the quality and productivity challenge the NHS has been set in this spending review.
Through the approaches this strategy sets out, we aim to save an additional 5,000 lives every year by 2014-15, aiming to narrow the inequalities gap at the same time. The strategy is backed with more than £750 million investment over this spending review, which includes over £450 million to support earlier diagnosis of cancer.
“Improving Outcomes: A Strategy for Cancer” 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.
Swine Flu
Lord Lansley Excerpts(13 years, 6 months ago)
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John Healey (Wentworth and Dearne) (Lab) (Urgent Question)
Thank you, Mr Speaker, for allowing this urgent question to ask the Secretary of State for Health if he will make a statement on the Government’s preparations for and response to the current flu outbreak.
The Secretary of State for Health (Mr Andrew Lansley)
Every winter, flu causes illness and distress to many people. It causes serious illness in some cases and, unfortunately, some deaths. I know that each death is a tragedy that will cause distress to family and friends.
The NHS is again well prepared to respond to the pressures that winter brings—it has responded excellently this year. I thank in particular general practitioners, who each year work tirelessly to look after the health of their patients—especially this winter when the weather, as well as flu and other viruses, has presented challenges.
The rate of GP consultations for influenza-like illness is currently 98 per 100,000 people, down from 124 per 100,000. Those figures are lower than the numbers recorded during the pandemic in 2009-10 and below epidemic levels, which are defined as 200 per 100,000 people. The most recent data showed that 783 people were in critical care in England with influenza-like illness.
Where necessary, local NHS organisations have increased their critical care capacity, in part by—regrettably—delaying routine operations that require critical care back-up. That is a normal local NHS operational process; critical care capacity is always able to be flexible according to local need. We have also increased the number of extracorporeal membrane oxygenation beds, for patients with the most severe disease, from five to 22. A seasonal flu vaccine is again available this year. Our surveillance data show that the vaccine is a good match to the strains of flu that are circulating.
GPs in England order seasonal flu vaccine direct from the manufacturers, according to their needs. Vaccine supply is determined in the early part of the year, for autumn delivery. We recently became aware of reports of flu vaccine supply shortages in some areas in England. We are working with the NHS locally to ensure available supplies of surplus vaccine are moved to where they are needed. In addition, the H1N1 monovalent vaccine is now available to GPs for patients who are eligible for the seasonal flu vaccine.
The Government continue to take expert advice from the Joint Committee on Vaccination and Immunisation. Last year, the JCVI advised for the first time that, in addition to usual risk groups, healthy pregnant women should be vaccinated with seasonal flu vaccine. It did not recommend that children under the age of five outside the at-risk groups should be vaccinated. On 30 December, the JCVI assured me that this advice remains appropriate.
The number of deaths in the UK this winter from flu, verified by the Health Protection Agency, currently is 50. The number of deaths from seasonal flu varies each year, with over 10,000 deaths from seasonal flu estimated in the winter of 2008-09.
Antiviral medicines can also help clinical at-risk groups who have been exposed to flu-like illness. We notified clinicians that the use of antiviral medicines in these groups was justified and, at their discretion, with other patients. We have given access to the national antiviral stockpile to support that.
We are making publicly available for the first time a range of winter performance information, published on the Winterwatch section of the Department’s website. I wrote to all Members last week to inform them of the NHS response to flu, and updated them further in a written statement published this morning.
John Healey
I thank the Health Secretary for that statement, but the truth is that he has been slow to act at every stage of this outbreak, and that is putting great pressure on the NHS across the country. It is working flat-out in our local hospital in Rotherham. We have had to open extra beds, and since last Tuesday have cancelled all non-urgent surgery. Four of the 50 patients in the UK who have so far died linked to this flu have been in Rotherham, and two were constituents.
The Health Secretary talks about seasonal flu, but we knew this would not be like normal winter flu because we knew swine flu would be dominant, so the central question for the Health Secretary is why he made less preparation for a flu outbreak that was expected to be more serious. Why did he axe the annual autumn advertising campaign to help boost take-up of the flu jab and help the public understand who is at risk and what treatment is available? We know it works, and this was a serious misjudgment.
Why was the Government’s first circular to midwives, urging them to help get pregnant women to take up the flu jab, not sent out until 16 December? Why has there been no move to offer vaccines through antenatal clinics, and why are the Government not publishing details of the numbers of pregnant women who are seriously ill or who have died, as they are with other groups that are most at risk?
With proper planning and preparation, we should not have seen GPs and pharmacies running out of the vaccine in some areas last week, nor should we have seen parents confused about the treatment available for their young children. I hope last week’s figures mean we may be over the worst, but, with 783 people in critical care and a long winter still ahead, what steps will the Health Secretary take if the numbers of ill people continue to rise? Can he now, today, give the House the reassurance he has failed so far to give the public, which is that he really has got a grip on this situation? Finally, when all the bodies he is relying on to sort out this situation will be abolished under his internal organisation, what assurance can he give the public that this will be any better handled in the future?
Mr Lansley
I share the right hon. Gentleman’s deep sadness at the deaths in Rotherham and join him in expressing clearly my condolences to the families of his and other Members’ constituents who have died. Regrettably, there will, I fear, be further deaths from flu—that is in the nature of the winter flu season—but I have to explain to him that we are in the midst of a seasonal flu outbreak that has not reached epidemic levels. Neither is it a pandemic, which is clearly a different situation in which a novel virus, to which there is not acquired immunity, is in circulation.
The right hon. Gentleman asked some specific questions. First, on having to cancel operations, I have made it clear that that is, unfortunately, a consequence: if the NHS’s critical care capacity is under pressure, it cannot admit large numbers of patients for elective operations that might require critical care back-up. The seasonal winter flu outbreak has led to an increase in the number of patients with flu in critical care beds, although they still constitute only about one fifth of the total number of critical care beds, and I pay tribute to hospitals across the country that have increased their critical care capacity, particularly in intensive care, to deal with the situation.
We are also providing assistance to the NHS. I am sorry that the right hon. Gentleman did not refer to my important announcement last Tuesday that, because we made savings in the Department of Health’s central budgets, on things such as management consultancy costs and the IT scheme, we have been able to issue this financial year—in other words, starting now—an additional £162 million to primary care trusts throughout England. They will be able to use that money directly with their local authorities to facilitate the discharge of patients. There are currently about 2,500 patients in hospital who could be discharged if the appropriate arrangements were in place. That will accelerate the relationship with social care that we are looking for.
It is pretty rich for the right hon. Gentleman and the Labour party to say that there should not have been any shortages. The number of vaccines supplied to the United Kingdom was determined before the Government took office. It was determined under the previous Administration, in the early part of last year, not by this Administration. Furthermore, it was equally not just presumptuous but unhelpful for him, during the Christmas period, to talk inaccurately about whether children under the age of five should be vaccinated. He knows perfectly well that like his predecessors we take advice from the Joint Committee on Vaccination and Immunisation. With the chief medical officer, we asked the committee to look at the issue again, and it met on 30 December and reiterated its advice that young children should not be vaccinated. So for him to stimulate press reports suggesting that parents should have their children vaccinated, when the expert advice was not that that should be done, was deeply unhelpful.
The right hon. Gentleman’s final point was about the organisations. It is clear to me that, by abolishing the Health Protection Agency and bringing its responsibilities inside the Department of Health under the new Public Health England, we will have a more integrated and more effective system for responding to seasonal flu in future years.
Nicky Morgan (Loughborough) (Con)
The Secretary of State is right that general practitioners are on the front line, and it is to them that patients will turn. Does he have any thoughts on the case of a constituent of mine who contacted me yesterday to say that he has been trying to get a vaccination, but has been unable to do so because he wants to have one after 4 o’clock in the afternoon, when he can get away from work? He does not want to jeopardise his job and is finding it difficult to access the vaccination before then, but GPs would rather vaccinate in the morning.
Mr Lansley
The arrangements that individual GP surgeries make for ordering and administering doses of the vaccine have been, since October, for them to make. From our point of view, as soon as we were aware that local supply would not necessarily match local demand in the places it should, we took the decision last week to make available the NHS stockpile—there are 12.7 million doses of the H1N1 vaccine—and I can tell my hon. Friend that 20,000 doses began to be distributed this morning. There is no reason why we cannot meet the requirement for vaccinations, whether through GPs’ own doses and local arrangements, through issuing NHS prescriptions that can be fulfilled at local pharmacies or through surgeries ordering the H1N1 vaccine from us.
Sir Gerald Kaufman (Manchester, Gorton) (Lab)
Happy new year, Mr Speaker. Is the right hon. Gentleman aware—he should be because I have written to him about this—of serious concerns in my constituency about the shortage of flu vaccine, including for chronically sick people? Will he tell the House, in the most specific way, what action he is taking to ensure that sufficient flu vaccine is available in the city of Manchester and in Greater Manchester?
Mr Lansley
May I reiterate to the right hon. Gentleman that the amount of vaccine supplied to the United Kingdom is determined by manufacturers on the basis of discussions with not only the Department, but others, and that the vaccines are ordered by individual GP surgeries? The total amount of vaccine was 14.8 million doses, which is comparable to the level in previous years. Although GP surgeries have shortages, because of the preparations made during the pandemic in 2009 and given that the principal strain of flu circulating is the H1N1 strain—it is not the only strain, but it is the most relevant to guard against for many in the at-risk groups under the age of 65—we made it clear that we would back up GPs who had any shortages with access to our stockpile of H1N1 vaccine. Orders have come in and they are being filled.
John Pugh (Southport) (LD)
Governments do not control diseases yet, but in my constituency elective surgery has been cancelled and pharmacies have run out of vaccine. What is the serious long-term alternative to the over-provision of last year and the localised under-provision of this year?
Mr Lansley
I do not think one can say that there was over-provision during the pandemic, because one could not have been at all clear about the nature of the progress of H1N1. However, what that meant is that we have the stockpile of vaccine available to back up the NHS this year. My hon. Friend makes a very good point, because there is clearly an issue to deal with regarding how this is properly managed. Before Labour Members start talking from a sedentary position, they might wish to re-examine the 2007 flu review. It was conducted by the Department of Health under the previous Administration and recommended that there should be central procurement of flu vaccine in England, but the previous Administration did nothing about it.
Mr Kevin Barron (Rother Valley) (Lab)
Can the Secretary of State tell us why the midwives association was not written to until 16 December?
Mr Lansley
We made it very clear that everyone in the at-risk groups was going to be contacted through their GP surgery, and it is the responsibility of GPs to have done that.
Mark Pawsey (Rugby) (Con)
I am grateful to my right hon. Friend for the information that he has provided so far, but I wonder whether he could reassure the parents of a 13-year-old boy. They came to see me on Saturday because their son is egg allergic and also suffers from asthma, and they are concerned about the availability of a flu vaccine this year.
Mr Lansley
I will certainly write to my hon. Friend about this, but I am confident that one of the number of vaccines that are available will be suitable for his constituent.
Hugh Bayley (York Central) (Lab)
Last week, 30 beds at York hospital were occupied by people with suspected or confirmed cases of flu. That is costing the local NHS £7,500 a day—£50,000 a week—and that money could be spent on treating patients with unavoidable conditions. What lessons will the Secretary of State learn from the failure to promote the uptake of the flu vaccine this year to ensure that we do not encounter a similar problem next year?
Mr Lansley
The hon. Gentleman’s question is based on a false premise, because the level of vaccine uptake this year among over-65s is 70% and among under-65s is 45.5%, which is comparable to previous years. He did not refer to this, but because we made savings we provided the NHS with considerable additional resources in the last three months of the year precisely to manage winter pressures and ensure that beds in hospitals are available.
David Tredinnick (Bosworth) (Con)
I congratulate my right hon. Friend on the increase in the critical case capacity and in the number of extra corporeal membrane oxygenation—ECMO—beds from five to 22, which has made a difference. Will he also pay tribute to others who help in these situations, such as the manufacturers of homeopathic medicines and homeopathic chemists? They provide preparations that may be suitable for people, such as the constituent of my hon. Friend the Member for Rugby (Mark Pawsey), who are unable to take flu vaccines and others who choose not to do so.
Mr Lansley
I am grateful to my hon. Friend for that question. His local hospital, the Glenfield in Leicester, leads on specialised ECMO bed services. In this country, we have increased the number of ECMO beds; we have more per head of population than any of the developed health economies, including the United States. As for treatments and vaccinations, I continue to rest upon the scientific and expert advice. Indeed, I hope that patients will consult their clinicians about their treatments.
Valerie Vaz (Walsall South) (Lab)
Will the Secretary of State say whether he took the decision to delay the advertising campaign and, if so, when?
Mr Lansley
I announced just after Christmas the “catch it, bin it, kill it” campaign. I had not—[Interruption.] Let me explain to Opposition Members. In 2009, the campaign took place in November. Why? It was because the spread of flu took place in late October, early November. Therefore, it occurred at the point at which there was a substantial spread of the influenza in the community. That is precisely what we did this year.
Henry Smith (Crawley) (Con)
As an asthma sufferer, I am pleased to report that just this morning I had the benefit of the flu jab and it was professionally and painlessly administered. However, constituents have come to me concerned about, in one case, a child who has had the respiratory syncytial virus, or RSV and, in another case, an adult who has had pneumonia, who have been denied the flu vaccine. Will he examine how the guidance to GP practices can be amended to include such groups?
Mr Lansley
I will of course write to my hon. Friend about the nature of the advice provided by the joint committee, but we follow and have followed at each stage the advice given to us by that independent expert committee, the Joint Committee on Vaccination and Immunisation. I will certainly write to him to explain how it has determined the at-risk groups for these purposes.
Mr John Spellar (Warley) (Lab)
Earlier, the Secretary of State made the astonishing admission that he has done nothing since the Labour Government left office. He rightly drew attention to the work being done for at-risk groups. However, emergency planning requires the sustaining of the emergency services. Why is he not giving priority to those who work for the emergency services—the police, the fire and ambulance services?
Mr Lansley
I have two points for the right hon. Gentleman. First, all NHS staff, including ambulance staff, are eligible for the vaccine. Regrettably, when I last looked, under 20% had availed themselves of that opportunity. I wish that it were higher.
Liz Kendall (Leicester West) (Lab)
“Wish”? Does the Secretary of State think wishing is enough?
Mr Lansley
They are all offered it, so they can all be provided with it. I am not in a position to require people to take a vaccine. We are not providing mandatory vaccination in this country yet, and I do not suppose that we shall.
Secondly, I was not admitting that I had done nothing—on the contrary. What the right hon. Gentleman perhaps does not understand is that one cannot simply order additional large-scale supplies of a vaccine. A long process of manufacture is required, as it is an egg-based culture system. The amount is ordered in the spring for autumn delivery, so the amount was determined in the spring. When I entered office in May, there was not any reason particularly to think that we would need more than in other flu seasons, and we knew that we had the back-up of the H1N1 vaccine if we needed it. In early August, I made it clear that I intended to review further the system of procurement, distribution of flu vaccine and its supply. That review is ongoing and will be published shortly.
Jeremy Lefroy (Stafford) (Con)
Does my right hon. Friend agree that the reason that acute beds are under such pressure at this time of swine flu is that we do not have sufficient step-down or community beds into which people can transfer from acute beds?
Mr Lansley
My hon. Friend makes an important point. Primary care trusts and local authorities working together should now be able to have confidence that the resources are available in this financial year—and £648 million will be available in the next financial year, and more in years beyond—to improve the relationship between health and social care not only through things such as step-down beds, but through operating, for example, hospital at home services, community equipment services and home adaptations to ensure that only those people who need to be in hospital are in hospital.
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)
There have been several reports about children having to travel extremely long distances to access critical care in children’s hospitals. Is the Secretary of State satisfied that there is sufficient capacity for paediatric intensive care and high dependency care?
Mr Lansley
Yes, I am. The hon. Lady will know that there have always been occasions when paediatric intensive care capacity in a particular hospital is full and when it is necessary for children to be taken a distance. On Christmas eve, I was at the intensive care unit at Alder Hey and I want to pay tribute to the tremendous work done by staff there. They acknowledge that this was not just about H1N1. One reason the committee did not recommend vaccinating all children under the age of five was that children, particularly very young children, were in intensive care because of a combination of H1N1 and/or bronchiolitis and RSV. A range of conditions was impacting at that moment on very young children.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
Several chemists and GPs’ surgeries in Merseyside have run out of the flu vaccine, leaving at-risk patients unable to obtain the jab. The Health Protection Agency has highlighted Liverpool as having significantly higher rates of swine flu than the English average. Will Liverpool therefore receive a higher proportion of the £162 million that the Secretary of State has made available to primary care trusts to help those affected?
Mr Lansley
The £162 million will be allocated to primary care trusts based on the social care allocation formula, which will be the same for next year. Any GP surgery, or for that matter the primary care trust in Merseyside, is free to come to us to order supplies from the national stockpile of the H1N1 vaccine to ensure that those who require vaccination can receive it.
Kevin Brennan (Cardiff West) (Lab)
In his answer to my hon. Friend the Member for Walsall South (Valerie Vaz), the Secretary of State was clearly giving an after-the-fact justification for his failure to act on the winter awareness campaign earlier in the year. He is fond of telling anyone who ventures to criticise him that they are completely wrong. Will he admit that on this occasion, as far as the awareness campaign is concerned, he was the one who was completely wrong?
Mr Lansley
No, absolutely not. I was simply pointing out to Opposition Members that the principle that applied in 2009, which was that the point at which flu was circulating in the community was the point at which the “catch it, bin it, kill it” campaign was initiated, was precisely the same principle that I applied this year.
May I say in response to the hon. Member for Liverpool, Wavertree (Luciana Berger) that the supplies of vaccine provided to primary care trusts or GPs’ surgeries from the national stockpile of swine flu vaccine will be provided free?
Chris Leslie (Nottingham East) (Lab/Co-op)
To be absolutely clear on that answer, does the Secretary of State have any regrets whatsoever about not proceeding with the flu publicity campaign?
Mr Lansley
No. I have made it perfectly clear that the principle we applied is exactly the same and was based on the medical advice given to me, which was to pursue an awareness campaign on respiratory and hand hygiene at the point at which flu was circulating in the community. That is what I was asked and that is the decision I took.
Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op)
Will the Secretary of State comment on the worrying media reports emanating from Scotland that at a time when there were shortages of vaccine the Department of Health was scrabbling around trying to get supplies from other countries when there was a surplus in Scotland, but it never asked the Scottish Government? Is that the case, or is it nationalist mischief making from Edinburgh?
Mr Lansley
All I can tell the hon. Gentleman is the simple truth. In the early part of last week, we asked manufacturers whether they had additional supplies. I believe that some additional seasonal flu vaccine that is licensed for use in this country probably will be made available. In any case, we have the H1N1 vaccine to support the immunisation, where required. Early last week, we did ask Scotland. The amounts that would have been available in the short run were not significant at all, so it was better for them to be retained in Scotland because there might be a continuing need for the vaccine there, rather than here.
Miss Anne McIntosh (Thirsk and Malton) (Con)
Will the Secretary of State explain when in the course of the year the vaccine would normally be ordered?
Paul Flynn (Newport West) (Lab)
H1N1 deaths are especially tragic because they involve people with expectations of a long life. Last year, 65,000 deaths were anticipated but fewer than 500 died with swine flu and 150 died of swine flu. If the priorities of the health service are not to be distorted, should not we approach this problem with a sense of both caution and proportion?
Mr Lansley
I share the hon. Gentleman’s deep regret. H1N1, unlike many previous flu strains, does not particularly impact on the elderly; it impacts on younger people and on younger adults in particular. That is the principal reason why we are seeing a relatively larger number of people occupying critical care beds. The NHS response has been to accelerate the provision of critical care capacity and of ECMO beds in particular.
Ian Paisley (North Antrim) (DUP)
The Secretary of State will be aware that tragically there have been 14 flu-related deaths in Northern Ireland during this winter. Given that that figure is proportionately higher than in other parts of the United Kingdom, what discussions has he had or does he intend to have with his counterpart in Northern Ireland to assess why the proportion is so much higher and whether there is a black spot with regard to that disease?
Mr Lansley
The figure of 50 deaths to which I have referred is the total number of deaths verified by the Health Protection Agency. There have been more deaths than that, but they have not been verified to have been caused by flu. I cannot comment on the relationship between the number that I quoted for the United Kingdom as a whole and that for Northern Ireland, because we are not dealing with comparable figures. My colleagues in the devolved Administrations and I will continue to keep in touch. It is important for us not to be simplistic about this. There are differences in vaccine take-up between Administrations—they are not major, but they exist. There are differences in the prevalence of swine flu, and the prevalence of flu in Northern Ireland is very high compared with England—it is even a great deal higher than that in Scotland. Happily, the number of deaths is only ever a very small proportion of the people who contract flu. To that extent, it is difficult to draw from the number of deaths conclusions about the nature of the response to flu overall, not least because the prevalence is overwhelmingly among people who are not in the at-risk groups, who, I hope, were vaccinated.
Mr Denis MacShane (Rotherham) (Lab)
Mr Speaker, I am not sure whether you have noticed that since the Secretary of State started making his excuses for this problem, Government Front Benchers and Back Benchers have looked more and more unwell. Will the Secretary of State confirm that he has had the flu jab and that he has made sure that his Front-Bench team have had it?
Mr Lansley
I take this issue seriously, even if the right hon. Gentleman does not. As it happens, I fall into one of the at-risk groups, because I had a stroke in 1992, so I have had the flu jab. I would not ask members of my ministerial team who are not in the at-risk groups to have the vaccination, because it is not recommended.
Toby Perkins (Chesterfield) (Lab)
The biggest tragedy is that the Secretary of State has learned no lessons whatsoever from what has happened. As a result, it is likely that the same mistakes will be made in the future. His answers about the advertising campaign are completely unconvincing. Will he explain why he cancelled the advertising campaign, which GPs were demanding at the time, to increase the take-up of vaccinations?
Mr Lansley
I cancelled no campaign; I proceeded only with the awareness campaign on respiratory and hand hygiene. An advertising campaign aimed at the general population would not have been effective, and I was advised that there was no evidence that it would be effective. We knew who the at-risk groups were, and it was possible to reach them directly rather than engaging in wider advertising.
Owen Smith (Pontypridd) (Lab)
Will the Secretary of State tell us what role primary care trusts and strategic health authorities are playing in dealing with the crisis? Will he explain what dismantling the SHAs and PCTs will do in terms of central planning for future crises?
Mr Lansley
The role of SHAs and PCTs is, as in previous years, to manage the NHS response to winter pressures. In future, the commissioning consortiums together with the NHS Commissioning Board, will fulfil similar responsibilities. In future years, there will be a stronger ability to integrate the response of the Department of Health and the Health Protection Agency, working together as one new organisation, Public Health England, which will have a stronger public health infrastructure.