Value-Based Pricing (Consultation)

Lord Lansley Excerpts

Thursday 16th December 2010 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

I am launching today a consultation entitled: “A new value-based approach to the pricing of branded medicines”.

The consultation document sets out this Government’s proposals for introducing a system of value-based pricing for medicines, as stated in the coalition agreement. Such a system would enable patients to access the medicines and treatments their doctor advises they need by establishing a closer link between the price of a new branded medicine and the value which it offers in terms of benefits to patients, reflecting unmet need, therapeutic innovation, and where appropriate, benefit to society.

While the current system of pricing medicines has tried to achieve a balance between reasonable prices for the NHS and fair return for the industry to develop new medicines, it does not promote innovation or patient access in the way that we are looking for. We have committed to honouring the terms of the Pharmaceutical Price Regulation Scheme 2009 until its expiry, but there is a need to reform the way in which we pay for medicines from 2014 onwards. As we have made clear through the establishment of the cancer drugs fund prior to 2014, we are enabling NHS clinicians to have better access to the medicines required for their patients.

This consultation is an important opportunity to engage with different groups in order to gain their views on how we should best reflect the value of medicines in order to deliver the best health outcomes for patients. This consultation sets out the Government’s initial thoughts and invites engagement from interested parties in order that we can begin to develop a future model of medicines’ pricing.

Copies of the consultation document 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.

NHS Consultation, Operating Frameworks and PCT Revenue

Lord Lansley Excerpts

Wednesday 15th December 2010 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

Today I am laying before Parliament “Liberating the NHS: Legislative framework and next steps” (Cm 7993), the Government’s response to the consultation on implementing the White Paper reforms set out in “Equity and excellence: Liberating the NHS”. Sir David Nicholson, the NHS chief executive, is also today publishing the NHS operating framework and revenue allocations to primary care trusts (PCTs) for 2011-12. The operating framework and revenue allocations have been placed in the Library. Copies of all documents are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

“Liberating the NHS: Legislative framework and next steps” shows how the Department has developed its plans in the light of consultation and sets out further detail on the reforms and a timetable for implementation. The document also sets out a timetable for implementation and explains how the consultation has shaped the health and social care Bill, planned for introduction in January. Overall, the document reaffirms the Government’s commitment to reforming the NHS so that it:

puts patients right at the heart of decisions made about their care;

puts clinicians in the driving seat on decisions about services; and

is focused on delivering health outcomes that are comparable with, or even better than, those of our international neighbours.

The Department received over 6,000 consultation responses from patients and members of the public, clinicians, voluntary organisations, patient representative groups, local authorities, local involvement networks (LINks), NHS organisations and staff, independent providers, pharmacists, academics, professional bodies and royal colleges, think-tanks and trade unions.

Responses contained a broad mix of support, suggestions for improvement and critical challenge. The insights and suggestions we have heard in consultation have not only strengthened our belief that the reforms are necessary but have also helped us refine our proposals in several areas. In particular, the Government have decided to:

significantly strengthen the role of health and well-being boards in local authorities, and enhance joint working arrangements through a new responsibility to develop a “joint health and well-being strategy” spanning the NHS, social care, public health and potentially other local services. Local authority and NHS commissioners will be required to have regard to this;

create a more distinct identity for Health Watch England, led by a statutory committee within the Care Quality Commission;

increase transparency in commissioning by requiring all GP consortia to have a published constitution;

change our proposal that maternity services should be commissioned by the NHS Commissioning Board;

extend councils’ formal scrutiny powers to cover all NHS-funded services, and give local authorities greater freedom in how these are exercised;

phase the timetable for giving local authorities responsibility for commissioning NHS complaints advocacy services, and allow flexibility to commission from other organisations as well as from local Health Watch;

give GP consortia a stronger role in supporting the NHS Commissioning Board to drive up quality in primary care; and create an explicit duty for all arm’s length bodies to co-operate in carrying out their functions, backed by a new mechanism for resolving disputes.

Equally important, the feedback we received through consultation has also helped us refine our approach to implementation, in order to create flexibility, empower local leadership, and support the significant cultural change and staff engagement that respondents highlighted would be needed to make our reforms a success. The Department has therefore decided to:

allow a longer and more phased transition period for completing our reforms to providers;

create a clearer, more phased approach to the introduction of GP commissioning, by setting up a programme of GP consortia pathfinders; and

accelerate the introduction of health and well-being boards through a new programme of early implementers.

To take forward these changes the Department has put in place a single, integrated programme for the whole of the transition across the health and care system. This will help sustain performance under the existing regime at the same time as building the leadership to implement the changes. Transition will occur through a carefully designed and managed process, phased over the next four years, to allow for rapid adoption, system-wide learning, and effective risk-management. It will be aided by the creation of a number of specific time-limited transitional vehicles, with a focus on sustaining capability and capacity.

Alongside “Liberating the NHS: Legislative framework and next steps”, the NHS chief executive, David Nicholson, has today published the NHS operating framework for 2011-12, which sets out the priorities for the next year. This includes how the NHS will go through a strong and stable transition over the next year to begin to deliver the vision of the White Paper. By the end of 2011-12 we expect NHS organisations to have made significant progress in moving towards a more liberated NHS. Organisations should be working across traditional boundaries to improve the quality of patient care while maintaining the quality and safety of NHS services.

I have also written today to every hon. Member in England detailing their PCT’s allocations for 2011-12, which PCTs will use to deliver our vision for reform and our national priorities as set out in the operating framework.

Total revenue investment in the NHS in 2011-12 will grow to over £102 billion. The allocations I am announcing today will provide PCTs with £89 billion to spend on the local front-line services that matter most, an increase of £2.6 billion, or 3%. This funding includes an increase of £1.9 billion in PCT recurrent allocations (including £150 million for re-ablement), £69 million in primary dental services, pharmaceutical services and general ophthalmic services non-recurrent allocations, and £648 million to support joint working between health and social care.

The recurrent allocations are based upon a revised weighted capitation formula that includes improvements, such as a new mental health formula. This lays the groundwork for the switch to allocations to GP consortia and local authorities from the NHS Commissioning Board and Public Health England respectively for 2013-14. These organisational changes will free the NHS from political interference, support the transfer of decision making and responsibility for local health services to the front line, and ensure that public health programmes are safeguarded.

PCTs and local authorities will use the funding for re-ablement and joint working to agree a work plan based on local joint strategic needs assessments to deliver services which may include current services, in particular telecare, re-ablement packages and home adaptations.

The allocations announced today place PCTs in a strong position to deliver the coalition Government’s vision for reform, as originally set out in “Liberating the NHS” and today reaffirmed in “Liberating the NHS: Legislative framework and next steps”. and our national priorities, today set out in the NHS operating framework.

Oral Answers to Questions

Lord Lansley Excerpts

Tuesday 7th December 2010 Commons Chamber

[Alun Cairns (Vale of Glamorgan) (Con)]

12. What recent representations he has received on the operation of the interim cancer drugs fund; and if he will make a statement.

[The Secretary of State for Health (Mr Andrew Lansley)]

Clinically led arrangements are in place in all strategic health authorities for determining the best use of the additional funds that we have made available for cancer drugs from 1 October 2010. Information provided by SHAs shows that, as of 15 November, funding had been agreed for the treatment of more than 250 patients in England. I have received representations from hon. Members, noble Lords, and members of the public on how the interim arrangements for cancer drugs funding are operating. Many of those representations have welcomed the additional support we are giving to cancer patients in need.

[Nigel Adams]

I am grateful to the Secretary of State for his response. Last week, my constituent, Trudy Cusworth, received the news that she is to be given the cancer drug Avastin, despite the panel at St James’s university hospital, Leeds initially refusing to do so. In this case, the emergency cancer drugs fund has done its job, but what can the Secretary of State say to assure other cancer patients in North Yorkshire who are also in desperate need of such life-prolonging drugs and who are currently being denied access to them?

[Mr Lansley]

I am grateful to my hon. Friend for his question. Indeed, I want to thank him for the support he has given to Trudy Cusworth. I am very pleased that she was able to take her case, with her clinicians, to the panel and that it has been approved. There are a number of people in the York and Selby area for whom that is true. The panels are working across the country to ensure additional access to cancer drug treatments where a clinical case is made for that.

[Alun Cairns]

My constituents are pretty angry and disappointed that the cancer drugs fund will not apply to them because health matters have been devolved to the National Assembly for Wales. Will the Secretary of State give an assurance that he will champion the merits of the policy in the hope of convincing the Welsh Assembly Government to follow the lead that he is offering?

[Mr Lansley]

I agree with my hon. Friend, who is obviously an advocate for his constituents to the Welsh Assembly Government. These are matters for the devolved Administrations and they must decide how to allocate their resources. In this instance we have shared with the devolved Administrations the consultation on the cancer drugs fund, which will start next April, although the policy proposed will apply in England alone.

[Toby Perkins (Chesterfield) (Lab)]

2. What recent representations he has received on the effect of the abolition of primary care trusts on the co-ordination of preventive health care.

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[Mark Lancaster (Milton Keynes North) (Con)]

13. What recent progress he has made on the introduction of GP-led commissioning consortiums.

[The Secretary of State for Health (Mr Andrew Lansley)]

On 21 October, I invited general practice-led commissioning consortiums to put themselves forward as pathfinders, and I have been absolutely delighted by the response. The pathfinder consortiums will be announced shortly. They have formed in response to the needs of local communities, and there is, sensibly, variation around the country to take account of those differing needs. Some consortiums map on to local authority boundaries; others organise themselves around catchments for hospitals or smaller populations. This bottom-up, locally determined approach is exactly in line with what we envisaged in the policy framework.

[Henry Smith]

Under the previous Government, Crawley hospital saw the removal of services such as accident and emergency and maternity. Can my right hon. Friend explain how, under the new GP-led consortiums, doctors will have the freedom and the flexibility to be able to refer their patients to local services if they so choose, as well as to new services?

[Mr Lansley]

That is exactly what our reforms will allow. We are putting not only the freedom to refer in the hands of general practices but choice in the hands of patients, and allying that to the power on the part of commissioners to commission services that meet the needs of their local community. That is precisely the change that will empower front-line clinicians and patients.

[Mark Lancaster]

Having consulted widely in Milton Keynes, I am pleased to say that the Government’s plans have been broadly welcomed. However, one area of concern that has been raised with me by patients, in particular, is the amount of time that they will get to spend face to face with their GP. Can the Secretary of State reassure my constituents and outline the administrative support that GPs will get in fulfilling their new functions?

[Mr Lansley]

I am grateful to my hon. Friend. In Milton Keynes, GP Healthcare MK and Premier MK consortiums are shaping their services in order to be able to deliver better and improved services for their patients. We do not intend that all GPs individually should become managers, by any means; there will be clinical leadership, but the consortiums should have commissioning support. The primary care trust in Milton Keynes has had some good commissioning support arrangements, as I know from having visited it in the past. It is open to the new commissioning consortiums to take teams from the primary care trust into their new consortium support arrangements, but they can go elsewhere. They can look to the local authority and to the independent sector to provide them with the commissioning support that they need so that clinicians provide leadership but continue to be responsible for clinical care.

[Mr Ben Bradshaw (Exeter) (Lab)]

What impact does the Secretary of State think that this change and the rest of the upheaval that he is inflicting on the health service will have on hospital waiting times?

[Mr Lansley]

I think that the reforms will have a positive impact on performance right across the NHS, because they will enable patients who want to exercise choice to see the quality and standard of services, including waiting times. Unlike in the past, they will be able to see waiting times for individual hospitals, rather than just a single target. They will be able to make choices based on information about the quality of services.

[Derek Twigg (Halton) (Lab)]

If the reforms are so good, why have they been criticised by the chairman of the Royal College of General Practitioners, Dr Clare Gerada? She said:

“I think it is the end of the NHS as we currently know it, which is a national, unified health service”.

The British Medical Association has expressed concerns about competition, and we hear in this morning’s edition of The Independent from an unnamed “ally” of the Secretary of State that

“There is no wobble. No 10 and the Treasury are fully behind the principle of the reforms”—

obviously a very brave ally. Why has the Prime Minister asked the Cabinet Office Minister who is in charge of Government policy to review the plans? Is it because the Secretary of State is the only one who believes in them?

[Mr Lansley]

The hon. Gentleman should not believe all that he reads in the newspapers. The curious thing is that the Minister with responsibility for Government policy is engaged with Government policy. That is a good and positive thing. The hon. Gentleman referred to the Royal College of General Practitioners and to Dr Gerada. In response to the White Paper, the RCGP said:

“General Practice is the central plank in our world-class healthcare system. The College thoroughly agrees that it makes a great deal of sense to give GPs, with their unique patient-centred perspective, a central role in commissioning and directing healthcare services.”

Dr Gerada said:

“I fully support placing clinicians at the centre of commissioning decisions”.

[Mr Stephen Dorrell (Charnwood) (Con)]

I very much welcome the steps that my right hon. Friend is taking to encourage the early emergence of pathfinder consortiums, so that the shape of the new commissioning structure is made clear as quickly as possible. Given the nature of the quality, innovation, productivity and prevention challenge—QIPP—that the health service faces, does he agree that the process must be carried forward as quickly as possible so that the new framework is clear for all concerned as quickly as possible?

[Mr Lansley]

Yes, I do. I was delighted by the response of general practice to the emerging consortiums, because one of the central reasons it wants to make progress quickly is to shape clinical service redesign, which is at the heart of delivering the efficiency savings that will enable us all to improve outcomes.

[David Miliband (South Shields) (Lab)]

The Secretary of State has said that GPs are the best people to manage the health service. Will he confirm that in the eight years of GP training, not a single hour is dedicated to the commissioning work that he has described?

[Mr Lansley]

The right hon. Gentleman should understand that what I said was that GPs are the best people to commission services. Commissioning and management are not the same thing. GPs are already responsible for commissioning most services in the NHS, but they have no power over resources and contracting. I intend to ally clinical leadership and commissioning decisions with commissioning support that involves management. The people who should determine the shape of local services to meet the needs of patients are those who are already at the heart of designing services and referring patients.

[Andrew Stephenson (Pendle) (Con)]

4. What recent representations he has received on management and administration costs in the NHS; and if he will make a statement.

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[Annette Brooke (Mid Dorset and North Poole) (LD)]

7. What assessment he has made of the Health Protection Agency’s recent report on the incidence of tuberculosis.

[The Secretary of State for Health (Mr Andrew Lansley)]

I welcome the Health Protection Agency’s recent report on tuberculosis in the UK. There were 8,286 cases of TB in England in 2009, an increase of 4.3% on 2008. The rise has occurred mainly in people infected in countries where TB is common, who go on to develop active TB disease later in life.

[Annette Brooke]

I understand that that is a 30-year high. Evidence from New York shows that a co-ordinated approach across the city has made a real impact in controlling TB. How will the Secretary of State ensure that such co-ordination takes place, especially in cities, when GP-led commissioning is introduced?

[Mr Lansley]

The treatment services for individual patients will be commissioned through GP consortiums, but the identification and preventive work on TB is a public health responsibility. To that extent, I believe that we will be better placed to deal with it in future. Many local authorities—for example, in Birmingham, Manchester or Leeds—will be well placed as cities to respond to any incidence or outbreaks of TB on a preventive basis, using their powers as public health authorities.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

In response to my question on the publication of the White Paper about the more than 500 TB cases in Birmingham the Secretary of State confirmed that there would be no changes to what such cities could do to control TB outbreaks. Will he elaborate on his answer? What more can Birmingham do under the new arrangements to prevent such exceedingly high numbers?

[Mr Lansley]

We can do a number of things. For example, the Department has funded TB Alert, which is the UK’s national TB charity, to raise awareness of TB among public and primary health care professionals, which will help. In London, we have supported a find-and-treat outreach service. In a similar vein, that could happen in cities where there is a rising prevalence of TB. TB is not general across the country, but likely to occur in particular areas. Those kind of initiatives enable us to identify TB outbreaks, and we can then structure services around that.

[Penny Mordaunt (Portsmouth North) (Con)]

8. What assessment he has made of the merits of steps to increase the standard of end-of-life care in an acute setting; and if he will make a statement.

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[Mr David Blunkett (Sheffield, Brightside and Hillsborough) (Lab)]

10. What decisions he has reached in respect of additional funding for the purpose of the tariff applying to specialist children’s hospitals.

[The Secretary of State for Health (Mr Andrew Lansley)]

Following a very constructive meeting with the specialist children’s hospitals on Friday 3 December, I am pleased to be able to tell the House that we are working on a proposal to set the top-up payment for specialised services for children at 60%, over and above tariff prices. In addition, I intend to help the trusts by extending the number of procedures that will attract the top-up payment in 2011-12. I believe that the children’s hospitals will find that entirely acceptable.

[Mr Blunkett]

I would like—uniquely—to thank the Secretary of State for signing off the technical agreement from last Friday, and to say that the specialist children’s hospitals will welcome his announcement this afternoon. Is it not time to take the uncertainty away from the children’s hospitals and have a system that allows them to put in place a forward plan that does not result in this annual farrago? Would it not also be nice to congratulate the staff of the children’s hospitals on their terrific work, not least the dedicated way in which they will be working with these children over Christmas?

[Mr Lansley]

Yes, I am very glad to do so. I have visited Sheffield children’s hospital, and I very much applaud the work that it does. I am sure that those at the hospital are grateful to the right hon. Gentleman, as I am, for the way in which he has represented their interests. I entirely agree with him: the purpose of developing the payment-by-results system is to arrive at a point where it is predictable and delivers a relevant payment, related to the costs that are genuinely incurred in the provision of that treatment. We are not in that position yet. The specialist top-up was put in place to reflect that, but I hope that it is temporary rather than permanent.

[Mr John Leech (Manchester, Withington) (LD)]

11. What progress has been made on improving the provision of specialist neuromuscular physiotherapy for people with muscular dystrophy and related neuromuscular conditions; and if he will make a statement.

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[Gareth Johnson (Dartford) (Con)]

14. What recent assessment he has made of the adequacy of provision of IVF treatment across the country.

[The Secretary of State for Health (Mr Andrew Lansley)]

Many primary care trusts have made good progress towards meeting NICE guidance recommendations on the provision of IVF treatment. However, I am aware that a small number of PCTs with historical funding problems have temporarily suspended local NHS provision of IVF services. I have already expressed my concerns about that approach. I expect all PCTs to have regard to the current NICE guidance and to recognise fully the significant distress and impact that infertility has on people’s lives.

[Gareth Johnson]

I am grateful to my right hon. Friend for his answer. He will be aware that Robert Edwards, the British inventor of IVF treatment, is due to receive the Nobel prize this week for his work. I am sure that Professor Edwards would be dismayed that PCTs have suspended their IVF provision, so would my right hon. Friend join me in urging those PCTs that have taken that step to reconsider their decision on this important issue?

[Mr Lansley]

Yes, I am indeed aware of that, not least because the Bourn Hall clinic, where Robert Edwards and Patrick Steptoe did their groundbreaking work, is in my constituency. As a former vice-chair of the all-party infertility group, I feel strongly that the reason the NICE guidance was written as it was, way back in 2004, was to recognise both the distress and the extent of the difficulties that couples face, and the need for them to be assured not only of good-quality investigation, but of good quality follow-up provision in fertility services throughout the NHS. I urge PCTs to have regard to the NICE guidance in their commissioning decisions.

[Mr Kevin Barron (Rother Valley) (Lab)]

If this unfair situation in the commissioning of infertility services continues, and if the reconfiguration goes ahead, would it be the responsibility of the national commissioning board to address it?

[Mr Lansley]

Beyond 2012 it would indeed. The reason we are in this position is not least because when NICE produced its guidance, my predecessor, John Reid, in effect told PCTs that they should not feel obliged to have regard to it and arbitrarily changed it. It is precisely that kind of political interference with what should be a clinically-led decision about the appropriate structure of commissioning services that I am proposing to do away with.

[Chris White (Warwick and Leamington) (Con)]

15. What support his Department plans to provide for front-line services in adult social care.

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[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

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.

[Jonathan Reynolds]

The Secretary of State will be aware that primary care trusts across the country are being asked to cut between 35% and 50% from their management costs. This inevitably leads to job losses, but can he confirm that he is confident that the jobs being lost as a result of this policy are purely management roles and that there are no losses of jobs that combine some management role with front-line clinical responsibilities?

[Mr Lansley]

We have been very clear that we are asking the whole of the NHS administration—we are applying the same discipline inside the Department, to arm’s length bodies and across the whole of government—to secure a reduction by a third of real-terms administration costs over four years. In the NHS in particular, I am looking for a reduction in management costs of 45% in cash terms. By that, I mean specifically the costs of managers and senior managers. By definition, that does not include clinical staffing.

[Ian Swales (Redcar) (LD)]

T3. In the light of the recent damning report by the Care Quality Commission into Redcar and Cleveland council’s adult social care services, what steps is the Secretary of State taking to improve adult social care and will he meet me to address the issues raised in the report?

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[John Healey (Wentworth and Dearne) (Lab)]

May I welcome the Secretary of State’s sensible rethink and change of mind on the funding of specialist children’s hospitals after Labour Members raised concerns during the previous Health questions? During those questions he also got his NHS funding figures in a twist, so what has he got to say about the updated inflation forecasts on page 83 of last week’s Office for Budget Responsibility report? They show that for the next four years the inflation increase will be bigger than the cash increase in the NHS—in other words, the NHS will get a real cut in funding, not a real increase. Does he accept the OBR figures? Does he accept that they are hard proof that the Government are breaking their promise to protect NHS funding?

[Mr Lansley]

Let me tell the right hon. Gentleman that it is not a change on specialist children’s hospitals. The previous Government initiated a study by York university, which reported. I made it clear, when we discussed it last, that we were examining the results of that together with the specialist children’s hospitals. We have reached what I regard, as I hope they do, as a very acceptable outcome.

The spending review gave a real-terms increase in NHS funding. That was the commitment we gave and it was set out in the spending review, and it remains true that revenue funding for the NHS continues to rise in real terms.

[John Healey]

Perhaps I should have asked the Secretary of State whether he has even seen the OBR report. Let me try to help him. The OBR’s inflation figures mean that the NHS will not get the 0.4% real increase that he bragged about and that was stated in the spending review; the NHS will get a 0.25% decrease—a cut—in funding, as has been confirmed today for me by the House of Commons Library. No wonder the Prime Minister is rattled and is asking what on earth the Health Secretary is doing with the NHS. Does the Health Secretary accept that this confirms that the coalition’s pledge to guarantee that health spending rises

“in real terms in each year of the Parliament”

is being broken? How does he explain that to the Prime Minister and how does he explain it to the public?

[Mr Lansley]

No, I do not accept that for a minute. At the spending review we set out what met our commitment. I am very clear that, as I just told the right hon. Gentleman, revenue funding for the NHS will increase in real terms. It will do so because we did not listen to the advice of the Labour party in the run-up to the spending review, which was to cut the NHS budget. We did not do that and we were committed at the spending review to an increase in real terms. The gross domestic product deflator will move from time to time, but the commitment that we set out was clear and will continue.

[Mr Speaker]

Just as the answers from the Minister of State, the hon. Member for West Chelmsford, were too long, those questions were too long as well.

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[Michael Ellis (Northampton North) (Con)]

T6. Every day, ambulance service staff in my constituency and around the country deliver life-saving care to our constituents, but they are themselves occasionally put in harm’s way. What steps are Her Majesty’s Government taking to ensure that the protection that our ambulance staff get in my constituency and around the country is the best that we can provide?

[Mr Lansley]

I join my hon. Friend in paying tribute to the staff in ambulance service—in the current circumstances, with the winter pressures being what they are, we should especially do so. But those staff can come under particular threat from time to time and we have to prepare for all eventualities. For example, if an attack involving firearms takes place, as it did recently in Cumbria, it is possible that ambulance staff would be working alongside other emergency services in responding to it. It is only right, therefore, that they are offered as much training and equipment as possible to carry out that work.

[Paul Goggins (Wythenshawe and Sale East) (Lab)]

T2. This morning, the Justice Secretary said that he was working with the Health Secretary on plans to divert more mentally ill offenders away from prison. I broadly welcome that, but could the Health Secretary tell us how much new money will be made available for that initiative, especially given the comments made by my right hon. Friend the Member for Wentworth and Dearne (John Healey) about the cut in the real value of health spending?

[Mr Lansley]

The right hon. Gentleman is in no position to make that point, given that his party wanted to cut the NHS budget. What my right hon. and learned Friend said this morning about our working together is indeed true. However, this is not a case of our diverting patients; it is about ensuring that people who have mental health problems are dealt with appropriately rather than there being a failure to deal with them. That applies whether they are in prison or in hospital. We are working together on that, and I know that my right hon. and learned Friend will be making a statement shortly.

[Richard Graham (Gloucester) (Con)]

T8. Can Ministers reassure me that, given the relative health deprivation in Gloucester, the ring-fenced funding promised in the White Paper on public health will in fact benefit people there?

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[David Tredinnick (Bosworth) (Con)]

Is my right hon. Friend aware of the rally being held here in Westminster tomorrow by qualified herbalists who are coming to lobby for statutory regulation, which my right hon. Friend is obliged to provide under European law? When will he do that, please?

[Mr Lansley]

I am indeed aware of that, as my hon. Friend would expect. He will know that we are considering how we can give effect to the proper regulation of herbal practitioners and we will make an announcement shortly.

[John Mann (Bassetlaw) (Lab)]

T5. If a hospital service’s reconfiguration is demonstrably and overwhelmingly rejected by a local population, what notice will the Secretary of State take of the patients’ voice?

[Mr Lansley]

It was only under this Government, after the election, that tests were set out that such reconfigurations should meet. Those tests clearly included recognition of the voice of the public and of the local authority as well as current and prospective patient choice. To that extent, for the very first time, reconfigurations are not being dictated by an NHS administration but are responding to the views of patients and clinicians.

[Duncan Hames (Chippenham) (LD)]

The NHS Litigation Authority estimates an outstanding liability for clinical negligence claims of £15 billion, a sum that increased by £2 billion in the last year alone. How will the Minister bring that spiralling cost to the NHS to a halt?

[Mr Lansley]

I understand exactly my hon. Friend’s point. The increase in liabilities was, in part, an expression of the change in the discount rate rather than necessarily an increase in the number of cases coming through. It is a worrying figure and costs the NHS not far short of £1 billion a year through contributions to the clinical negligence scheme for trusts. My noble Friend Lord Young, in the course of his review of health and safety and other issues, made recommendations on dealing with conditional fee arrangements and clinical negligence. It set out that we would consider, for example, how we implement NHS redress arrangements, including whether there should be a fact-finding phase before any question of legal intervention. We will do that and report back to the House.

[Pat Glass (North West Durham) (Lab)]

T7. My local hospital, Shotley Bridge hospital in Consett, has faced a degree of certainty over its future in recent years. However, with the demise of the local PCT, which owns the hospital and the land, uncertainty has returned. Is the Minister prepared to meet me and a delegation from the hospital to consider the future?

[Mr Lansley]

I am sure that I or one of my hon. Friends will be happy to meet the hon. Lady. I do not know why she thinks that the abolition of the PCT will make that change. We have yet to set out how PCT assets will be dealt with when they are abolished. She must talk to her local GPs as I know that GPs in Durham have come together in a consortium and they will be well placed to give precisely the kind of assurance about the security of services in the future that she is looking for.

[Nick de Bois (Enfield North) (Con)]

The Secretary of State will be aware that the Barnet, Enfield and Haringey clinical review has been concluded. It notes that the Secretary of State’s four tests have been passed, despite health scrutiny establishing that they have not. In addition, the majority of Enfield GPs do not support the proposals. Will the Secretary of State therefore conclude that the four tests have not been passed?

[Mr Lansley]

My hon. Friend will know that all that has not yet come to me, so I will not prejudge this issue. However, I have made it clear, not least in a letter I recently sent to Baroness Margaret Wall, who is the chair of the Barnet and Chase Farm Hospitals NHS Trust, that I expect us to examine not only the Barnet, Enfield and Haringey proposals, but any other proposals that the trust might put forward about the level of acute services provided through Chase Farm.

[Toby Perkins (Chesterfield) (Lab)]

T9. The Secretary of State seemed to suggest, in his answer to the shadow Secretary of State, that his definition of a real-terms increase includes changes in inflation. If he does not accept the Office for Budget Responsibility verdict that the increase in inflation means a real-terms cut in 2012, which definition of inflation is he using?

[Mr Lansley]

What I said to the shadow Secretary of State was entirely accurate.

[Gordon Birtwistle (Burnley) (LD)]

Does the Secretary of State agree that the abolition of unelected quangos such as primary care trusts and strategic health authorities will bring an end to the decisions they are taking to remove services from local hospitals against the wishes of GPs and local residents?

[Mr Lansley]

The reforms we propose will bring far greater accountability not only through local authorities but through patient choice and through front-line clinicians being able to commission services.

Let me also tell my hon. Friend that I have today referred to the independent reconfiguration panel, for initial appraisal, the question referred to me by Lancashire county council about the children’s ward at Burnley hospital.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Will the Secretary of State join me in deprecating the outrageous behaviour of the Prime Minister’s aides who told the Financial Times that the Secretary of State, on his reorganisation, has all the answers—unfortunately to all the wrong questions?

[Mr Lansley]

The hon. Gentleman should not believe what he reads in the papers and when he is trying to quote from them, he should do so accurately.

[Caroline Dinenage (Gosport) (Con)]

Blake maternity unit in Gosport is temporarily shut and its long-term future is by no means 100% secure. In conversations with local health care bosses, I have learned that it is not because of cost but because of a national shortage of midwives. Are there any policies or plans to address this issue?

[Mr Lansley]

I do not know the particular circumstances in Gosport, but I shall happily write to my hon. Friend. Nationally, we have more midwives than we have ever had—[Interruption.] I am being provoked by those on the Opposition Front Bench. There was a 16% increase in the number of live births in this country, but only a 4.5% increase in the number of midwives. That is the point I was about to make. The Government of whom the hon. Member for Halton (Derek Twigg) was a member failed to invest in midwifery when there was an increase in live births. That is why hospitals across the country have too few midwives, and that is why we are putting the investment in—because we did not listen to the Labour party when it said, “Cut the NHS budget.”

[Fiona Mactaggart (Slough) (Lab)]

Will waiting times for in-patient treatment in hospital increase or decrease next year?

[Mr Lansley]

They will respond positively to patient choice and GP referral.

[Joseph Johnson (Orpington) (Con)]

I am grateful to the Secretary of State for agreeing to visit Queen Mary’s, Sidcup, tomorrow, recognising the strength of local opinion there about the closure of accident and emergency and maternity services temporarily over the winter period. I hope that on his return he will reassure my constituents in Orpington that the closure will not mean that the review of reconfiguration of local NHS services will be prejudged and will not put neighbouring hospitals such as those in my constituency under undue pressure.

[Mr Lansley]

I am grateful. Tomorrow, I hope to assure myself, among other things, that the closure is temporarily demanded by virtue of the inability to secure enough staff to maintain a safe service for the time being and that it will not and does not pre-empt the question of availability of services at Queen Mary’s, Sidcup, on which a decision has not yet been reached locally or referred to me.

[Mr Dennis Skinner (Bolsover) (Lab)]

On the NHS campaign against obesity, does the Secretary of State welcome the magnificent support of the thousands of schoolchildren who have come down to demonstrate for school sports funding outside No. 10 Downing street? Will he fight in the Cabinet against the Education Secretary’s silly proposal, which will damage children’s health?

[Mr Lansley]

The Secretary of State for Education rightly believes in schools making decisions about how they should best use their resources, including for school sport. I hope the hon. Gentleman will welcome the fact that through my Department we have supported school sports clubs under Change4Life and intend to expand them.

Public Health White Paper

Lord Lansley Excerpts

Tuesday 30th November 2010 Commons Chamber

[The Secretary of State for Health (Mr Andrew Lansley)]

With permission, Mr Speaker, I would like to make a statement on public health. Today, the Government have published a public health White Paper with two clear aims: first, to protect and improve the health of the nation; and secondly, to reduce health inequalities by improving the health of the poorest fastest.

The need for this White Paper is beyond question. Britain currently has among the highest rates of obesity and sexually transmitted infections in Europe. Smoking still claims 80,000 lives a year. Alcohol-related admissions to hospital have doubled in the last seven years. In recent years, inequalities in health have widened, rather than narrowed.

Professor Sir Michael Marmot’s review to my Department said that

“dramatic health inequalities are still a dominant feature of health...across all regions.”

There is a seven-year gap in life expectancy between the richest and poorest neighbourhoods, but a gap of nearly 17 years for disability-free life expectancy. About a third of all cases of circulatory disease, half of all cases of vascular dementia and many cancers could be avoided by reducing smoking, improving diet and increasing physical activity.

We need to do better, and we will not make progress if public health continues to be seen just in terms of NHS provision and state interventions. Two thirds of our potential impact on life expectancy depends on issues outside health care. Factors such as employment, education, environment and equality are all determinants of health. They are, as Michael Marmot put it,

“the causes of the causes”—

the underlying factors leading to poorer health. Unhealthy behaviours, such as drinking too much, smoking or taking drugs, are part of a complex chain of individual circumstances and social causes, typically rooted in poor aspiration, adverse peer pressure and low self-esteem.

The human cost of poor health is obvious, and so too is the financial one. Alcohol abuse costs an extra £2.7 billion and obesity an extra £4.2 billion each year to the NHS alone. Although there are things we can do to help, we cannot resolve all the difficult issues from Whitehall. Hence the White Paper has one clear message above all others: it is time for politicians to stop telling people to make healthy choices, and start helping them to do it. There will be a profound shift in tone, attitude and outlook. Rather than nannying people, we will nudge them by working with industry to make healthy lifestyles easier; rather than lecturing people about their habits, we will give them the support they need to make their own choices; and rather than dictating policies from the centre, we will support leadership from communities, by giving local authorities more power to develop the right approaches for their communities.

The White Paper is a genuine cross-Government strategy. Through the Cabinet Sub-Committee on Public Health, we will put good health and well-being at the heart of all our policies. To do so, we will recognise that we need to provide support at key times in people’s lives. We will not only measure general well-being; we will seek to achieve it. For instance, because we know a mother’s health is key to a child’s health and development, we are investing in 4,200 more health visitors working with Sure Start children’s centres to give families the support they need; because we know those who are unemployed for long periods are more likely to be admitted to hospital and more likely to die prematurely, we are transforming the welfare system, ending the benefits trap and making sure that work always pays, through a single universal credit; and because we know more people would cycle to work or school more often if there were safer routes for them to use, the Government are investing £560 million in sustainable transport.

Subject to parliamentary approval, there will be a new dedicated public health service—Public Health England—which will provide the resources, the ideas, the evidence and the funding to support local strategies. Public Health England will bring together, within the Department of Health, expertise from a range of public health bodies, including the Health Protection Agency, the National Treatment Agency for Substance Misuse and the chief medical officer’s department. It will work with industry and other Government Departments to shape the wider environment as it affects our health. It will also develop health protection plans and screening programmes to protect people from health risks.

The foundations of good health are rooted in the community, often at a neighbourhood level, so we must strengthen and renew local leadership to ensure that these efforts reach deeply into communities and match their unique circumstances. Under the White Paper, the lead responsibility for improving health will pass to local government for the first time in 40 years. We intend to give local authorities new powers to plan, co-ordinate and deliver local strategies with the NHS and other partners, and to embed the foundations of good health in ways that fit local circumstances. Directors of public health will provide strong and consistent leadership within local councils. We also intend to establish the new local statutory health and well-being boards as a way of bringing together the NHS and local government.

Whereas before, public health budgets were constantly raided by other parts of the NHS, we will prioritise public health spending through a new ring-fenced budget. We will look to the highest standards of evidence and evaluation to ensure this money is spent wisely. The new outcomes framework for public health, on which we will consult shortly, will provide consistent measures to judge progress on key elements across all parts of the system—national and local. The framework will emphasise the need to reduce health inequalities, and will be supported by a new health premium, incentivising councils that demonstrate progress in improving the health of their populations and so reducing health inequalities.

We have learned over the last decade that state interventions alone cannot achieve success. We need a new sense of collective endeavour—a partnership between communities, businesses and individuals that transforms not only the way we deliver public health, but the way we think about it. Through the public health responsibility deal, the Government will work with industry to help people make informed decisions about their diet and lifestyle, to improve the environment for health, and to make healthy choices easier. Through greater use of voluntary and community organisations, we will reach out to families and individuals, and develop new ways to target the foundations of good health. Reflecting the framework in the ladder of interventions developed by the Nuffield Council on Bioethics, we will adopt voluntary and less intrusive approaches, so that we can make more progress more quickly and resort to regulation only where we cannot make progress in partnership.

This is a time when the NHS and social care are under intense pressure from an ageing population and higher costs—a time when we must therefore put as much emphasis on preventing illness as we do on treating it. In the past, public health has been a fragmented and forgotten branch of the health service. This White Paper will make it a central part of everything that we do, and we will bring forward legislation in the new year to enact these changes. By empowering local authorities, strengthening our knowledge of what works, and establishing the right incentives to drive better outcomes, this White Paper will deliver the strategy and support needed to reduce health inequalities and improve the nation’s health. I commend this statement to the House.

[John Healey (Wentworth and Dearne) (Lab)]

I thank the Secretary of State for advance sight of his oral statement. I am sure that the House will also thank him for the advance copies of the White Paper, which were available before he made his statement.

On Sunday the Health Secretary promised a White Paper that would

“take a radical new approach to public health”.

Today he has published the White Paper, and it falls far short of his hype. He has had six years in opposition and six months in government to prepare for this White Paper, but it will disappoint many of those who are most committed to better public health in this country and most concerned that we still have a great deal further to go. For the most part, this White Paper is not new. It is not clear how it will help to improve public health, and it is not a guarantee that the big gains made in the last decade—in cancer screening, healthy food in schools, stopping smoking and free flu vaccines, as well as the big cut in deaths from heart disease—will be continued.

However, in the spirit of responsible opposition, let me tell the Health Secretary that we can offer general support for his aims, which are very similar to those that we set out in our White Paper in 2004. I can promise him close scrutiny of his actions and those of his Government, because as the White Paper says, good public health depends on much more than what the NHS does. As he said in his statement, education, employment, environment and equality are the causes of the causes of poor health. However, the Government’s wider policies, which will lead to higher unemployment, poorer housing, greater poverty and an end to the Sport for All programme in schools, will do more damage to public health than his White Paper will do good, and more to increase health inequalities than his plan will do to reduce them.

So what did the Health Secretary say to the Chancellor about policies that will see a third of a million public sector staff on the dole? How hard has he argued against the Education Secretary’s plan to axe the school sports partnerships, which have seen three times as many children playing competitive sport than six years ago, and nine out of 10 children playing more than two hours of sport each week? Why is it that everyone else in the Government is set to make announcements affecting public health—on alcohol taxation or pricing, for example —except the Health Secretary? Far from being, as he said, a genuine cross-Government strategy, the White Paper—like his last one, on NHS reform—shows that this a Health Secretary working alone and operating largely in isolation from the rest of Government.

There is nothing new in “nudge”, except the soundbite and how hard the Secretary of State is pushing it. We set out the importance of individual decisions and incentives, alongside the need for support services and Government action, in our White Paper on public health in 2004. The test for the Health Secretary is whether the Government will act when they can and when they are needed, especially to protect children. The legislation is in place to end point-of-sale displays of cigarettes. The evidence is there and the experts are clear. Cancer Research UK says that

“we need to put tobacco out of sight and out of mind to protect all young people. The Government has the opportunity to act with conviction and reduce the devastating impact that tobacco has on so many lives.”

Will the Secretary of State do that: yes or no?

There is little new in this White Paper, and little is clear about how its plans will improve health and reduce health inequalities. It is 96 pages long but short on detail. We welcome in principle the lead responsibility for improving health being passed to local government, but can the Secretary of State guarantee the powers and the funds that it will need to do the job? Will he confirm that public health outcomes will also be part of the operating frameworks for the NHS and social care, because it would be a disaster if the NHS were now to decide that public health was not its job?

We are concerned about the Secretary of State’s responsibility deals. What exactly does he mean by that? What influence will industry have over future health policy? What does he say to the Liverpool health expert and Tory adviser, Professor Simon Capewell, who said that health experts on the public health commission

“were outnumbered and outvoted by people from Tesco, Diageo, and other food and drink manufacturers—and the Commission went with what the industry wanted…which is a scandal”?

What does he say when one of his own advisers offers that view?

We welcome the health inclusion board and the new national public health service, although we thought that this Government were committed to cutting, not creating, quangos. But is not the fact that the inclusion board will tackle the health needs of groups such as homeless people, drug users, alcoholics and sex workers an admission that GPs on their own do not know, and will not commission, what they need for the future?

Is not this one of the first in a series of bodges that will be needed to make the Secretary of State’s massive reorganisation plans for the NHS actually work? Whatever he says, we and the public will judge him on what he does. Will he ensure that his £3 billion internal reorganisation of the NHS does not damage public health? Will he take tough decisions about Government action on tobacco? Will he make and win the big arguments in government about the damage to health that comes from no work, poor housing and bad education? In government, it is deeds that count, not words.

--- Later in debate ---

[Mr Lansley]

I am grateful to the right hon. Gentleman for his support for the strategy that is set out in the White Paper. However, he then proceeded to aim off in every other direction. He said that I was in opposition for six and a half years, and, indeed, I made it very clear six years ago that when we came back into government, we intended to ring-fence the public health budget, to create directors of public health who were accountable to the NHS and to local authorities, and to establish a public health service that was more independent and more effective. His Government could have adopted those proposals six years ago, but they simply did not do so.

What was the record of the right hon. Gentleman’s Administration? Obesity rates in this country are way above average; in fact, they are among the highest in Europe. Alcohol-related admissions to hospital have doubled in seven years. Sexually transmitted infections are up by more than two thirds in the last decade. Even smoking rates have not changed. Parliament approved a smoking ban in public places, but in the most recent years, there has been persistent prevalence of smoking. It has not gone down in the past year. One in five of the population are experiencing mental ill health at any given time. Those are the records of the Labour Government on public health. Inequalities have widened. In life expectancy, the gap has widened. In infant mortality, the gap has widened. On their own measures, the Labour Government failed in public health, and we are going to put in place a strategy that is truly effective.

Some of the leading international experts, including Sir Michael Marmot, have welcomed what is in the public health White Paper today. The public health profession also welcomes it, because it knows that we are committed to addressing the wider determinants of health. My colleagues across Government are direct participants in the Cabinet Sub-Committee that is delivering this strategy, which is the starting point for public health delivery. Not all the details are in here. We are going to move on to a tobacco control strategy, a physical activity plan, an obesity strategy, alcohol strategies and a range of other responses to the public health threats that we face, and we are going to do that across Government. Only today, my right hon. Friend the Chancellor of the Exchequer announced that we would do what we said we would do, and increase duty on the strongest beers while reducing it on some of the weaker ones, thus beginning the process of incentivising and nudging.

The right hon. Gentleman asked about the responsibility deal. Let me give him an example. In 2004, the last Labour Government said that they would introduce front-of-pack food labelling. They wanted to introduce a single traffic-light system. All that fell apart in utter confusion. There was never a consistent front-of-pack food labelling system. The last Government never worked with industry; they worked against industry, and what was the result? A variety of different systems, and nothing consistent for the public to look at.

Only by working together on a voluntary approach will we start to make progress more quickly, whether it is on labelling, reformulation or activity with employers in the workplace. We will make progress, we will do it more quickly, and we will regulate only when necessary, rather than resorting to regulation and, as the Labour Government did, failing to make any progress and failing to regulate. That is not a basis on which we can deliver the public health improvements that we need.

This is a starting point for a public health strategy that will deliver the improvements in public health that the country requires. We are a Government who are committed to those improvements. They are central to improving well-being, and our strategy will deliver them.

[Several hon. Members]

rose—

[Mr Stephen Dorrell (Charnwood) (Con)]

I congratulate my right hon. Friend the Secretary of State on a White Paper that redeems his pre-election pledge to raise public health to a higher level of priority than was accorded to it not merely by the last Labour Government, but by the Conservative Government in which I held my right hon. Friend’s responsibilities. I congratulate him on delivering the first step towards that commitment, and particularly on the transfer of public health responsibility to local government. The White Paper proposals will fulfil the promise to make public health a cross-Government responsibility, and will deliver what has been described as the “fully engaged scenario”. That is the only way in which we can deliver our broader public health objectives.

[Mr Lansley]

I am grateful to my right hon. Friend for his comments. Derek Wanless said that we needed an “engaged” scenario back in 2002, but it simply did not happen. I know that many in public health feel that the transfer giving local government the lead responsibility on public health—which is radical and new—will, in many respects, bring public health back home. It allies the public health initiative and resources to the responsibilities of local government on economic development, the environment, planning, housing and education in precisely the ways that will influence the wider determinants of health.

[Frank Dobson (Holborn and St Pancras) (Lab)]

I welcome the Secretary of State’s proposal to return public health to local authorities, from which a Tory Government took it away, but why did he not mention housing in his statement? It is widely accepted that homelessness, poor-quality housing, overcrowding and insecurity of tenure are major causes of both mental and physical ill health, and a major cause of inequalities in health.

[Mr Lansley]

I am grateful to the right hon. Gentleman for his support. In fact, I did mention housing. However, I have also established in the Department a health inclusion unit—derided by those on the Labour Front Bench as a quango, although it is not one—whose purpose will be to focus specifically on some of the most excluded communities, such as the homeless and Traveller groups. Life expectancy in some of those groups can be in the 40s, and the gap in life expectancy and the health inequalities are a scandal. I have appointed Professor Steve Field, formerly of the Royal College of General Practitioners, to lead it, and I think that he will do a fantastic job in ensuring that the NHS, as well as local authorities, reaches out to deliver the health improvement that is needed.

[Stephen Williams (Bristol West) (LD)]

I welcome the White Paper in general, and particularly welcome the commitment to rigorous and evidence-based policy-making. I commend to the Secretary of State the latest report of the all-party group on smoking and health, which I chair, entitled “Inquiry into the effectiveness and cost-effectiveness of tobacco control”. May I give the Secretary of State and his ministerial colleagues a strong nudge to implement as soon as possible the orders on control of the display of tobacco that were passed in the last Parliament?

[Mr Lansley]

I am grateful to my hon. Friend for his comments. As in a number of other areas I have mentioned, we will publish a strategy in due course, and a tobacco control strategy will be published in the new year. Parliament voted for the display regulations and we are looking into that, but we have to balance the evidence on health improvements with the impact of such a measure, particularly the burdens on small retailers. We are also currently examining the option of plain packaging of cigarettes, which the last Government did not do. That might in itself be an important measure to reduce both the visibility of cigarettes and the initiation into smoking of young people in particular.

[Mr David Blunkett (Sheffield, Brightside and Hillsborough) (Lab)]

Not so much nudge as fudge on this issue. Why will the Secretary of State not accept that giving those displaying tobacco and cigarettes time to adjust by allowing them to implement the regulation this time next year is good common sense? Is it not the case that the Government’s refusal to acknowledge the implementation of this regulation passed by Parliament can only be explained by there being an ideological objection to protecting young people in particular from the incitement to buy?

[Mr Lansley]

I am afraid the right hon. Gentleman is simply wrong about that: we have made no announcement, and I have said we are considering it. More to the point, I have said we are also considering the question of plain packaging of cigarettes, which is being pursued by a Labour Administration in Australia, and which his Administration did not pursue.

[Nadine Dorries (Mid Bedfordshire) (Con)]

The White Paper states that we are going to provide easy access to confidential non-judgmental sexual health services. Will that include better counselling for women seeking an abortion, and will that counselling include the information that has so far been withheld from women seeking a termination?

[Mr Lansley]

The support for women seeking the termination of a pregnancy should include the fullest possible information about the nature of that procedure and its consequences. Consent should always be fully informed.

[Mr Kevin Barron (Rother Valley) (Lab)]

There is much merit in what the Secretary of State has announced. Will the new outcomes framework, which will provide consistent measures to judge progress on key elements, include smoking cessation figures? As he well knows, 50% of our health inequalities in this country are created by tobacco use.

--- Later in debate ---

[Mr Lansley]

We will publish a consultation on the outcomes framework soon, but smoking cessation and the absence of initiation into smoking are clearly very important. Smoking is still the single largest avoidable cause of early mortality, and we must try to reduce further the prevalence of smoking. It has not been reduced in the last couple of years, and we need to reduce it.

[Julian Smith (Skipton and Ripon) (Con)]

May I urge the Secretary of State to ensure that councils serving very rural communities do not lose out under the new regime?

[Mr Lansley]

All councils will be supported to develop health improvement strategies. When we come to publish the consultation on the funding of the public health budget, that will set out how, in addition to the resources used nationally, there will be significant resources in a ring-fenced budget for local authorities. Because of the nature of the health premium, that budget will be significantly weighted towards areas of greatest disadvantage and poorest health outcomes.

[Joan Walley (Stoke-on-Trent North) (Lab)]

Whatever Government were in power, I would welcome an enhanced role for environmental health officers in improving public health policy. Given the depth of the coming cuts to local authority budgets, however, there is real concern, regardless of the ring-fencing statement we have had, as to whether there will be sufficient resources and capacity for environmental health officers. Does the Secretary of State intend to have an environmental health officer at chief officer level inside the Department of Health?

[Mr Lansley]

I have had discussions with environmental health officers and they are enthusiastic about the opportunity for much greater synergy between their work and public health responsibilities. They see their role as integral to the achievement of public health. Indeed, some of the greatest public health improvements of the past were initiated in local government and through responsibilities that are currently within environmental health legislation, so I am looking to the health and well-being boards to bring these responsibilities together more effectively.

[Dr Sarah Wollaston (Totnes) (Con)]

Is my right hon. Friend aware that about 30,000 people a year in this country die as a result of alcohol, and that Department of Health modelling has shown that if we were to increase the minimum price per unit to 50p we would save over 2,000 lives a year? Will he look at the proposals published in the British Medical Journal to have variable rates of VAT so we can increase the price without penalising the on-licence trade?

[Mr Lansley]

My hon. Friend will know that the Chancellor of the Exchequer made an announcement today about the level of duty on beers, in particular. We have made it clear, in the coalition agreement and since, that we will act to ban the below-cost selling of alcohol. I think that that will make a significant difference. We will also in due course publish an alcohol strategy, through which we will examine a range of ways in which we can not only enforce the current legislation more effectively, but create an environment in which we progressively reduce the abuse of alcohol. It is very important for us to understand that we must distinguish between our relationship with tobacco, whose use we want to minimise—we want to encourage people never to use tobacco—and our relationship with alcohol, where we are seeking its responsible use, rather than seeking to penalise people who engage in responsible drinking.

[Alex Cunningham (Stockton North) (Lab)]

Which part of the health service or the Sure Start budgets will be cut to fund the new army of health visitors, and where are they going to come from?

[Mr Lansley]

The health visitor programme is not funded by cutting anything else; it comes from within the NHS budget, because we regard providing support to families when babies first come home and offering a universal health visiting service that signposts other resources to help families as absolutely integral to the improvement of health in the future. That is funded from within what was an historic commitment from this Government to protect the NHS budget and to increase it in real terms over the next four years. We are going to fund this from within the NHS resources.

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

Males in the Blackpool part of my constituency have only a 56% probability of reaching the age of 75. Can the Secretary of State tell me what measures in the White Paper will help to promote the act of ageing and allow more of my constituents to reach a milestone that many of us take for granted?

[Mr Lansley]

I am grateful to my hon. Friend for his question. Many aspects of the White Paper and subsequent strategies relate to these issues. In the long run, his constituents will find that the measures that have an impact early in life or which work through early intervention will make the biggest difference, as was made clear in Sir Michael Marmot’s review, in which he talked of a universal proportionality. Such measures include, for example, our universal health visiting service and family nurse partnerships, which are intervening at that stage. If we have not succeeded through early intervention, however, or many people have chronic ill health, we will continue to ensure through our screening programmes and local health improvement plans that people are identified early and opportunities are created for them to make lifestyle decisions that will improve their chances of disability-free life expectancy thereafter.

[David Cairns (Inverclyde) (Lab)]

I welcome the acknowledgement in the White Paper that about 25% of HIV cases in this country are currently undiagnosed. Will the Secretary of State therefore lend his support to the “Halve It” campaign, which is being launched tonight by the all-party group on HIV and AIDS, which I chair, with the Terrence Higgins Trust and others? The campaign aims to halve that number by 2015. That will mean fewer early deaths, fewer cases of HIV being spread and, ultimately, significant savings for the NHS.

[Mr Lansley]

I agree with the hon. Gentleman. Almost 22,000 people with HIV are unaware of their condition. We need to ensure, through the sexual health services, that people have consistent access to HIV testing and are encouraged opportunistically to ensure that they are HIV tested so that we can deliver the services they need. What he describes is one of the opportunities that we can examine when considering how the outcomes framework will measure the performance of local health improvement plans.

[Mr Charles Walker (Broxbourne) (Con)]

I have just learned that for the past year Hertfordshire primary care trust has been plotting to close the enormously successful urgent care centre in Cheshunt. If that happens, can the local authority step in, if its finances allow, to run the urgent care centre?

[Mr Lansley]

I was not aware of what my hon. Friend describes, and strictly speaking it does not relate to the White Paper. None the less, it will remain the case that local authorities, through current overview and scrutiny arrangements or future scrutiny arrangements, have the ability to ensure that major service changes of that kind are subject to scrutiny. If such changes are not justified in the interests of local people, they can be referred to me and I can seek the independent reconfiguration panel’s advice.

[Emma Reynolds (Wolverhampton North East) (Lab)]

The Health Secretary rightly underlined in his statement the importance of tackling obesity. Is there any truth in the suggestion that he has expressed concerns that plans to dismantle the school sport partnerships will exacerbate the problem of tackling childhood obesity and has he discussed those concerns with the Education Secretary?

[Mr Lansley]

No; the hon. Lady should not believe what she reads in newspapers. The Education Secretary is not scrapping the school sport partnerships; he is providing the resources directly to schools so that they can make the decisions on how they promote sport. From my point of view, I have always made it clear—this has been the burden of my conversation with my colleagues—that we are already supporting school sports clubs in secondary schools through Change4Life. We intend to maintain that and to expand the role of Change4Life, linking in to primary schools so that we stimulate activity and exercise for young people overall. That is entirely complementary to how schools, using their own resources, stimulate sport. With regard to competitive sport, they will be assisted additionally through infrastructure funding for the new school Olympics.

[Dr John Pugh (Southport) (LD)]

I congratulate the Secretary of State on his long-standing and personal commitment to public health as the best way of dealing with health inequalities. How do we stop GPs operating in silos and prescribing pills where they might prescribe exercise? How do we join up the pieces?

[Mr Lansley]

I am grateful for that question. The answer has two parts. First, the general practice-led commissioning consortiums will be members of the new health and well-being boards in local authorities to which I referred. They will participate in the joint strategic needs assessments and strategies through the commissioning framework, the outcomes framework and the quality and outcomes framework, which applies directly to general practice. The less we focus on processes, and the more we focus on outcomes for patients, the more general practice will be focused on preventive solutions, because they will deliver good outcomes at relatively low cost. To that extent, the preventive agenda in general practice and community health services will be incentivised through a focus on outcomes.

[Simon Danczuk (Rochdale) (Lab)]

What proportion of the NHS budget will go to local authorities to provide for public health and how will the funding reflect local health inequalities?

[Mr Lansley]

I must disappoint the hon. Gentleman. We will publish shortly—I hope before Christmas—the consultation on the funding arrangements. We started by establishing the baseline spend for public health, which was never identified under the last Government. It has taken months even to get to the point where we can establish what it looks like—[Interruption.] The hon. Member for Leicester West (Liz Kendall) mentions Julian Le Grand from a sedentary position. He did good work, but it included the whole of maternity services as a public health service. Julian Le Grand and Health England’s work arrived at the figure of £4 billion. In fact, the baseline is in excess of £4 billion, but its composition is completely different. We will set out shortly the structure and proposals for funding local authorities’ public health activity.

[Mike Weatherley (Hove) (Con)]

Given my right hon. Friend’s voting record in the last Parliament, and indeed that of most Government Members, will he advise the House what specifically he is looking to achieve through the tobacco display ban analysis?

[Mr Lansley]

Through our tobacco control strategy, I am looking to achieve, as we will set out, a continuing reduction in smoking prevalence. In particular, I want to identify how we can substantially reduce the initiation into smoking among young people.

[Kate Green (Stretford and Urmston) (Lab)]

I genuinely welcome the Secretary of State’s recognition of the importance of a cross-Government approach to tackling health inequalities. He will be aware that Sir Michael Marmot identified income as one of the most important determinants of health. Will the Secretary of State make representations to his colleagues the Chancellor and the Secretary of State for Work and Pensions to ensure that everyone can have an adequate income, from those reliant on out-of-work benefits to those who are in employment?

[Mr Lansley]

I understand the hon. Lady’s point. Sir Michael Marmot has generously welcomed the White Paper’s proposals and its thrust. He made a specific proposal about a specific standard of living related to health—effectively a basic income proposal. That is not the Government’s proposal, but we intend to act on the other five domains in his report, the effect of which, among other things, will be to ensure that the welfare to work programme—the most ambitious and comprehensive programme ever initiated by any Government in this country to take people off benefits into work—will support people not only through better disability benefit assessments, which will help in health assessments, but by ensuring that people in work are healthier because they are less likely to be poverty and more likely to be free of the distress associated with unemployment.

[Mrs Anne Main (St Albans) (Con)]

In St Albans we are lucky that people live for quite a long time, but often elderly care packages are not put in place to allow elderly care patients to come out of hospital and into adult social care services. Will the proposals in the White Paper to give local government more control help to ease this problem?

[Mr Lansley]

As my hon. Friend may know, we are acting already. Through the spending review we have made very clear the NHS commitment to support local authorities in the delivery of adult social care responsibility, particularly through the integration of health and social care. That includes £70 million this year for re-ablement, £150 million in the next financial year for more re-ablement activity and nearly £650 million in the next financial year in direct support from the NHS for preventive and other activities to support social care. That will make a big difference to her constituents.

[Diana Johnson (Kingston upon Hull North) (Lab)]

Hull city council’s recent record is of raising sports charges, blocking free swimming, axing free healthy school meals, dragging its feet on smoking and allowing junk food outlets to open near schools. In the light of that record, I am concerned about local authorities taking control of public health. What safeguards will there be regarding local authorities whose public health agenda is more from the era of “Life on Mars”?

[Mr Lansley]

There we have it: the Labour party as the opponent of local government. I am sure that people will recognise that when we arrive at local government election time. The Labour party has never trusted local government but we are going to trust it. We are going to give it not only greater freedoms but greater powers and responsibilities. Not every local authority will be brilliantly successful, but at least local authorities are directly accountable to the people who elect them—those for whom the authorities will deliver services.

[Philip Davies (Shipley) (Con)]

Many of the measures that my right hon. Friend proposes, such as the plain packaging of tobacco, forcing responsible drinkers to pay more for alcohol in supermarkets than they otherwise would and, bizarrely, forcing employers to allow women to breastfeed at work are a triumph not for public health but for the nanny state—something that we thought had gone out with the previous Government. Why is he still so wedded to the nanny state?

[Mr Lansley]

I am wedded to achieving improvements in public health. Interestingly, today I have been accused both of being an exponent of the nanny state and of having abandoned it in favour of “nudge”. The truth is that, as one sees in the White Paper, there is a clear philosophy here that we will pursue a voluntary approach, regulate only where necessary and seek to have less intrusive and less interventionist approaches in order to make more progress more quickly. If we do not make progress through voluntary approaches, we will of course still have to protect the public’s health and we will seek other measures to do so, but they have been tested to destruction by the previous Administration. It did not happen—they did not succeed and they did not improve public health—but we are determined to do so.

[Clive Efford (Eltham) (Lab)]

The Secretary of State consistently comes to the House and announces policies that seem to have been written on the back of a fag packet from the Minister of State, Department of Health, the hon. Member for Chelmsford (Mr Burns), but in his explanation on this morning’s “Today” programme the Secretary of State could not even make his mind up about the fag packet. Does he understand that the time allowed for the implementation of legislation that has been passed by the House was meant to allow people who are consequential in delivering that policy enough time to plan for it? The delay that he has introduced has made it more difficult for people such as the newsagents whom he spoke about in his statement because they have to prepare. Are we going to have branding or not? Will packets be on display or not? What is the Government’s policy?

[Mr Lansley]

I think that I have already answered that question. The hon. Gentleman at least among Opposition Members seems to have understood what it is to be in opposition: the point is simply to oppose and that is all he is doing. This is a positive statement and he should address it in that light.

[Mr Edward Timpson (Crewe and Nantwich) (Con)]

Does the Secretary of State agree with local GPs in my constituency that one way to help reduce health inequalities and spend money in the NHS better is to review reporting mechanisms in the NHS and how they impact on referral decisions, particularly in-house referrals?

[Mr Lansley]

Yes. I know that the GPs in Cheshire are a very go-ahead group and I am looking forward to seeing how they take on these responsibilities. I have seen GPs recently make presentations showing that they can really take a grip on referral patterns. They can see referrals not just in terms of trying to interpret patterns and numbers, but on the basis of clinical judgment. The combination of clinical judgment and understanding and knowledge of commissioning and contracting leverage is the basis from which we can improve overall the commissioning of activity for patients.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The Secretary of State mentioned that the Government are investing £560 million in encouraging sustainable forms of transport, such as walking and cycling, but given that the Department for Transport is systematically un-ring-fencing many of the transport budgets for local government, what guarantees can he give that that pot of money will be spent on that specific purpose?

[Mr Lansley]

We have been very clear in the spending review and subsequent announcements that we will take the ring fence off many of the grants provided to local government, because we trust local government and we expect those in local government who are responsible for such things to be accountable to their electors. Where public health is concerned—this is separate from the point the hon. Gentleman makes—NHS money will be ring-fenced in the hands of local authorities for health gain. There will be many appropriate uses, so the ring fence will in no sense, I hope, have a constraining effect.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I am sure that, like me, the Secretary of State recognises that different population groups offer and present different public health challenges; for example, the Asian community has higher rates of cardiovascular disease. Does he agree that the White Paper presents an excellent opportunity for local authorities to address specific local concerns that are relevant to their NHS populations?

[Mr Lansley]

Yes, I do. My hon. Friend is absolutely right. The structure proposed in the NHS reform White Paper in July was to bring local authorities and the NHS together to undertake joint strategic needs assessments leading to a combined strategy. Understanding the causes of ill health, and understanding where ill health is occurring and where the greatest areas of unmet need are in a community, will impact positively both on NHS commissioning and on local authorities.

[Fiona Mactaggart (Slough) (Lab)]

I welcome the proposal to give public health responsibility to local government, but will the Secretary of State assure the House that his intention is to build on proven successful initiatives, such as the family nurse partnership that works with teen mothers in my constituency, and health advocates? In contrast to GPs who, when offered an opportunity to give out membership of slimming clubs, managed to give only one in six months, health advocates managed to gain about 2,000 regular participants in slimming clubs, thus helping to deal with the obesity problem in Slough.

[Mr Lansley]

I am grateful to the hon. Lady. At least I know that she supports the proposal to transfer the responsibility to local government—not something I discovered from the reply of the right hon. Member for Wentworth and Dearne (John Healey). The short answer is that I have already announced that over the next four years we will double the number of family nurse partnerships, so we shall indeed support them. More than that, as Sir Michael Marmot made clear, it is vital that we combine the targeted support that the FNPs can give and a restored universal health visiting service to help every family as they start out.

[Mark Lancaster (Milton Keynes North) (Con)]

One of the clearest indicators of health inequalities is life expectancy. In two near-neighbouring wards in Milton Keynes, there is a variation of 12 years, which is a staggering figure. How can we address this problem?

[Mr Lansley]

My hon. Friend is absolutely right. The truth is that we know we have to take action nationally, and we will, not only through health protection but through much more effective health screening, immunisation programmes and an early start in the health visitor programme, for example. It will be for his local authorities and communities to get together to ask how they can address the inequalities. That will be vital to achieving health improvement in his community.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

Last year, Birmingham had about 500 confirmed cases of tuberculosis and there were calls for the city council to have compulsory city-wide inoculation programmes. Under the Secretary of State’s newly conferred powers, is that something that local authorities could now do?

[Mr Lansley]

No; the response to infectious diseases will continue to be the responsibility of the Department of Health, with a more integrated Public Health England incorporating the responsibilities of the Health Protection Agency and recommendations from the Joint Committee on Vaccination and Immunisation and others. There was a lot of important debate about the discontinuation of the BCG inoculation. My view is that targeted action in areas with high prevalence of TB—as there is in a small number of places—is more appropriate than the introduction of any generalised inoculation at this stage.

[Charlie Elphicke (Dover) (Con)]

But when and how will action be taken on the evil of cheap supermarket booze?

[Mr Lansley]

My hon. Friend will not have to wait long for announcements from hon. Friends of mine in the Government.

[Pat Glass (North West Durham) (Lab)]

Is not part of the problem the way in which Departments continue to operate in silos, so the Secretary of State for Education can cut the school sports initiatives with no impact on educational outcomes, but massive impacts on health? The Department of Health can consistently underfund children’s health services such as speech therapy and mental health, with very little impact on the Minister’s Department but massive impact on education outcomes. Is the statement not just evidence of more silo working?

[Mr Lansley]

That is all complete nonsense. On sport and activity in schools, my right hon. Friend the Secretary of State for Education is supporting schools and mainstreaming funding for sport and physical activity into school budgets; my right hon. Friend the Secretary of State for Culture, Olympics, Media and Sport is working to support competitive sport and the sport Olympics; and I am working to stimulate physical activity through Change4Life school sports clubs, increasingly in the primary sector as well as in the secondary sector. We are working on all that together and it is entirely complementary.

[Dr Julian Lewis (New Forest East) (Con)]

Given the commitment to popular choice, can my right hon. Friend confirm that when responsibility for putting fluoride into drinking water is taken away from strategic health authorities, the people who have the final say on the matter will be the people who drink the water?

[Mr Lansley]

The responsibility will be transferred to local authorities, and they will have the same obligation to consult their population as exists in the present legislation. In my view, local authorities are more accountable to the population that they serve than strategic health authorities have been in the past.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

The Secretary of State said in his statement that politicians need “to stop telling people to make healthy choices” and actually help them to do it. He said that they need to stop nannying people, but nudge them “to make healthy lifestyles easier”, and that “rather than lecturing people…we will give them the support they need to make their own choices”. Can he explain how failing to implement the tobacco display policy is forwarding those aims?

[Mr Lansley]

The hon. Lady does not seem to understand. We have made no announcement in relation to the tobacco display regulations—[Interruption.] They were approved by Parliament before the election. We have made it clear that we are looking at a tobacco control strategy. I made it clear just now at the Dispatch Box that, beyond anything done by the previous Government, I am considering the question of the plain packaging of cigarettes, which in itself could be a significant additional weapon in our armoury to reduce the initiation of smoking among young people and the visibility of cigarettes. When we publish a tobacco control strategy, we will weigh up the wide range of such factors.

[Robert Halfon (Harlow) (Con)]

Harlow parents will welcome the extra support for Sure Start, particularly after the scares from the Opposition at the last election. Will my right hon. Friend set out the measures that the White Paper takes to support other local charities that do so much to combat drug and alcohol abuse in my constituency and elsewhere?

[Mr Lansley]

I entirely agree with what my hon. Friend says. I appreciated visiting a children’s centre in Roehampton just this morning to see how it was bringing together all the opportunities. Important among those was the relationship with health visitors and their signposting role in relation to that service and others. Through the White Paper, we will, in a number of respects with which I shall not detain the House now, focus on how we can work with social enterprises, the voluntary sector and charities in order to deliver health improvements. As that will involve factors such as behaviour change, the ability of charities to work with people at a personal level and to be highly innovative will be important in making it successful.

[Margot James (Stourbridge) (Con)]

I welcome the liberation of public health from its ivory tower. It will be able to do much more good in the real world. Can my right hon. Friend say a little more about how the health and well-being partnerships might work with businesses, the police and other relevant agencies to reduce alcohol-related admissions to hospital?

[Mr Lansley]

When we publish the alcohol strategy, there will be more to say about that, but it is already clear that we can do much more on local community alcohol partnerships, which have demonstrated their success in places such as St Neots in Huntingdonshire, so that enforcement and work to prevent young people from purchasing alcohol when they should not do so is much more successful. We can also work much more effectively on improving alcohol labelling, and we are working through the responsibility deal to look at those opportunities, too.

[James Morris (Halesowen and Rowley Regis) (Con)]

I welcome the Secretary of State’s statement. Does he agree that in local areas it is important for local government to work closely with the voluntary sector, particularly on preventive mental health services?

--- Later in debate ---

[Mr Lansley]

Yes, I entirely agree. The extent to which charities and the voluntary sector can initiate new ideas is woefully underestimated. This is not just about local authorities, and still less about central Government saying, “Here is a programme, would charities like to bid to run it?” Even more importantly, we must be clear that charities should now come forward to anticipate the resources needed to improve public health, and to suggest their own innovations to deliver better health for their communities.

[Mr David Burrowes (Enfield, Southgate) (Con)]

My right hon. Friend will recognise the description of alcohol treatment as a Cinderella service, which is sadly not just a seasonal description but often the soft target of cuts by PCTs. I therefore welcome the opportunity in the White Paper for pooled budgets and for co-ordination between public health service directors and children’s services directors to prevent and tackle alcohol misuse.

[Mr Lansley]

I am grateful to my hon. Friend, because I think that through these measures we will help to integrate drug, alcohol and sexual health services, rather than see them in silos. Even in primary care trusts, those services have often been treated as completely discrete activities, because they have been related to specific targets that central Government have set, rather than part of an holistic community view of how we improve health.

Inside the NHS we are shifting public health to that degree of protection, because back in 2005 when the Labour party was in charge, the Chief Medical Officer said:

“There is strong anecdotal information from within the NHS which tells a…story for public health of poor morale, declining numbers and inadequate recruitment, and budgets being raided to solve financial deficits in the acute sector.”

Under Labour, public health was raided and denigrated; under this Government, public health will be given the place it deserves.

[Andrew Percy (Brigg and Goole) (Con)]

I support any moves to reduce the use of tobacco throughout the country, and that is why I support the smoking ban so much, but will the Secretary of State assure us that when we look at the tobacco display ban we will consider all the international evidence from countries such as Canada and Ireland, which have found that the ban has not been the slightest bit effective in reducing the number of people who smoke?

[Mr Lansley]

Yes, and I believe very strongly that we must work on the basis of evidence in public health, rather than simply on anecdote and assumptions.

[Mr David Evennett (Bexleyheath and Crayford) (Con)]

I welcome my right hon. Friend’s statement and, in particular, the ring-fenced public health budget and the increased role for local authorities. Is he aware that under the previous Government many PCTs cut funding for public health and plugged gaps elsewhere?

[Mr Lansley]

My hon. Friend makes a very important point, and that was not all that happened. On the money available to primary care trusts for what is termed the healthy living programme, there is no correlation between how much trusts spend relative to health deprivation, so in places with the poorest health outcomes trusts on average do not spend any more on discretionary health improvement activity. That is why our proposed health premium is so important. The places with the poorest health outcomes will clearly have the money they need to undertake specifically preventive work to raise health outcomes.

[Bob Blackman (Harrow East) (Con)]

I warmly welcome the proposals to transfer public health to local authorities and, indeed, the ring-fencing, but will my right hon. Friend clarify how we will enforce the spending of that money on public health, so that there are no blurred edges and local authorities cannot fund their other services from within that ring-fencing?

[Mr Lansley]

I bow to my hon. Friend in his understanding of local government. My experience and understanding of local government is such that I know that the people involved are very concerned about improving health in their communities, and these resources will be available for that. Those people will not only be accountable to the people who elect them but accountable through the incentive mechanism of the health premium for the delivery of improving outcomes in the reduction of health inequalities. They will have an in-built incentive in the funding system to use those resources to deliver the outcomes that are collectively agreed, co-produced with local government. If they do not do so—if they spend the money elsewhere—they will not see the increase in resources that would otherwise flow.

[Anne Marie Morris (Newton Abbot) (Con)]

Given the Secretary of State’s support for Sure Start, will he clarify his plans for Home-Start, as several families in my constituency are concerned that it will lose funding?

[Mr Lansley]

I will write to my hon. Friend about that. We are very clear that we are going to introduce a universal health visitor service, which has been lost in recent years. That element of universal support to all families when babies first come home is an absolutely integral part of getting them on the right path. We think that not just targeted but early support for all families will have disproportionate benefits in the long run.

[Andrew Griffiths (Burton) (Con)]

I applaud the Secretary of State’s commitment to tackling alcohol misuse and his determination to ban below-cost selling. However, does he share my concern that a definition of below-cost selling that is duty plus VAT, which would still allow supermarkets to sell a bottle of wine for £1.90 or a can of lager more cheaply than a can of Coca-Cola, will fail to deliver the outcomes that he is looking for?

[Mr Lansley]

My hon. Friend tempts me to pre-empt announcements which properly fall to my colleagues in the Home Office. I will leave it to them, if I may, to make those announcements, and we will debate the issue then.

[Mr David Nuttall (Bury North) (Con)]

Is my right hon. Friend aware that in Bury people will be happy and prepared to take responsibility for their own health provided that there are fully functioning children’s and maternity, and accident and emergency, departments at Fairfield hospital?

--- Later in debate ---

[Mr Lansley]

My hon. Friend and I have shared visits to Fairfield hospital on a number of occasions. I know how strongly his constituents feel about their access to services at Fairfield hospital and how well he has represented those at the hospital in their case for the retention of those services.

NHS Reorganisation

Lord Lansley Excerpts

Wednesday 17th November 2010 Commons Chamber

[John Healey (Wentworth and Dearne) (Lab)]

I beg to move,

That this House believes that the Government is pursuing a reform agenda in health that represents an ideological gamble with successful services and has failed to honour the pledges made in the Coalition Agreement to provide real-terms increases each year to health funding; further believes that the Government is failing to honour its pledge in the Coalition Agreement by forcing the NHS in England through a high-cost, high-risk internal reorganisation as set out in the health White Paper; is concerned that the combination of a real cut to funding for NHS healthcare and the £3 billion reorganisation planned by the Secretary of State for Health will put the NHS under great pressure and that services to patients will suffer; supports the aims of increasing clinician involvement and improving patient care, but is concerned that the Government’s plans will lead to a less consistent, reliable and responsive health service for patients which is also more inefficient, secretive and fragmented; and calls on the Secretary of State for Health to listen to the warnings from patients’ groups, health professionals and NHS experts and to rethink and put the White Paper reforms on hold, so that in this period of financial constraint the efforts of all in the NHS can be dedicated to improving patient care and making sound efficiency savings that are reused for frontline NHS services.

The motion is set in similar terms to the motion standing in the name of my right hon. Friend the Member for Leigh (Andy Burnham), the shadow Education Secretary, which we will debate a little later. That is because in both health and education we are seeing many of the same broken funding promises, much of the same free market ideology, many of the same problems of big changes forced through without considering or caring about the consequences, and many of the same risks that the poorest and most vulnerable will lose out and that comprehensive, consistent public services will be broken up. Beyond the spending cuts, we are starting to see the pattern of what public service reform means in Tory terms.

The Prime Minister told Britain before the election:

“We are the only party committed to protecting NHS spending.”

In his coalition agreement with the Deputy Prime Minister, he went further, saying:

“We will guarantee that health spending increases in real terms in each year of…Parliament”.

The Government whom the Prime Minister leads are now breaking the promises that he made to the British people. The Secretary of State has been caught out double-counting £1 billion in the spending review as both money for the NHS and money to paper over the cracks in social care. Let me quote from a Library research paper, which confirms:

“Including the (social care) funding is critical to the description of the settlement as a ‘real terms increase’; without it, funding for the NHS falls by £500 million—0.54% in real terms.”

There we have it—the facts in the figures. There is no real-terms rise in NHS funding, but a real-terms cut over this Parliament by this Government—[Interruption.]

The Secretary of State says “Nonsense” from a sedentary position. If he wants to deny the figures in the Green Book, deny the report in the Library research paper, and take issue with the Nuffield Trust, who all say the same, he should do so. He should by all means take credit for funding social care, but he should not double-count the credit by including it for both NHS funding and social care funding.

[The Secretary of State for Health (Mr Andrew Lansley)]

I do indeed deny that. It is very simple. The total NHS budget will rise in real terms. Resource funding will rise by 1.3% in real terms over four years. Even if the money to be transferred to local authorities were taken out, that is an increase in resource funding for the NHS in real terms.

The right hon. Gentleman must consider that if a health service buys rehabilitation for patients returning home after being in hospital so that they do not need another emergency hospital admission, or puts telehealth in someone’s home so that their independence at home is maintained, that is health spending. It is the normal approach of the NHS to providing preventive services.

[John Healey]

There is a good case for more funding in social care, but the truth is, as Age UK says, that in this Parliament it will be cut by an average of 7% in real terms. Social care may help the health service, but if money is spent on social care, it is not spent on NHS services, and it cannot be double-counted as NHS funding. When that is taken into account, and when the Secretary of State stops fiddling the figures, we see that the country and the NHS will get a real-terms cut, not a real-terms rise during this Parliament.

[Mr Lansley]

I have a simple question for the right hon. Gentleman. Is he in favour of the budget that we announced for the NHS, and does he wish to spend more or less?

[John Healey]

My right hon. Friend the shadow Chancellor said in response to the Chancellor’s spending review:

“We support moves to ring-fence the”

NHS

“budget”.—[Official Report, 20 October 2010; Vol. 516, c. 968.]

People saw Labour’s big investment in the NHS bring big improvements—50,000 extra doctors, 98,000 more nurses, deaths from cancer and heart disease at an all-time recorded low, the number of patients waiting more than six months for operations in hospital down from more than 250,000 in 1997 to just 28 in February this year, and more than nine in 10 patients rating their experience of hospital care as good, very good or excellent.

--- Later in debate ---

[John Healey]

The hon. Lady is right, and there is plenty of scope to do that. We recognised that, and we had plans to take out many of the managerial costs. I will come to that later, but it is hard to understand how creating three or even four times as many GP consortiums doing the same job as primary care trusts is likely to reduce rather than increase bureaucracy in the NHS. My right hon. Friend the Member for Leigh says that in Wigan there is one PCT, but it is set to have six GP consortiums. The same job will be done six times over in the same area. How is that a cut, or an improvement in the bureaucratic overheads and costs of the NHS?

In the spending review, the NHS is set for the biggest efficiency squeeze ever. On 12 October, the NHS chief executive, David Nicholson, told the Health Committee:

“It is huge. You don’t need me to tell you that it has never been done before in the NHS context and we don’t think, when you look at health systems across the world, that anyone has quite done it on this scale before.”

Money is tight, and something must happen, but that can be done by building on Labour’s big improvements in the NHS over the last decade. It will be tough, but I will back the Government, as long as all savings are reused for better front-line services to patients.

[Mr Lansley]

Before the right hon. Gentleman continues, may I remind him that the “it” that Sir David Nicholson was talking about was the achievement of between £15 billion and £20 billion of efficiency savings, which is a substantial improvement in productivity that is expected over the next four years? That is in complete contrast with a Labour Government who had declining productivity over the whole of the last decade. The efficiency savings of £15 billion to £20 billion that Sir David was talking about were set out by the last Labour Government in late 2009. We are continuing with that, but we will make it happen, and Labour did not.

[John Healey]

I have read David Nicholson’s transcripts, and he was indeed talking about £15 billion to £20 billion of efficiency savings, which were not achieved, as the Secretary of State said, but planned. That is a big test for the NHS, and it will be more difficult because of his plans for reorganisation, which I will come to.

--- Later in debate ---

[John Healey]

This is precisely why those who understand the health service, including those who run it, say that it is going to be so hard, at a time when the NHS has never faced such a tough financial challenge, to see through the biggest reorganisation in its history at breakneck speed.

Whether on funding, reorganisation or the role of the PCTs, the Secretary of State is doing precisely the opposite of what was set out in the coalition agreement. He is running a rogue Department with a freelance policy franchise, in isolation from his Government colleagues. He claimed on the “Today” programme yesterday that he had been saying all this for four years before the election. So when did he tell people, and when did he tell the Prime Minister, that GPs will be given £80 billion of taxpayers’ money—twice the budget of the Ministry of Defence—to spend? When did he tell people that, in place of 150 primary care trusts, there could be up to three times as many GP consortiums doing the same job? When did he tell people that GP consortiums will make decisions in secret and file accounts to the Government only at the end of the year?

When did the Secretary of State tell people, and the Prime Minister, that nurses, hospital consultants, midwives, physiotherapists and other NHS professionals will all be cut out of care commissioning decisions completely? And when did he tell the Prime Minister that hospitals will be allowed to go bust before being broken up, if a buyer can be found for them? When did he tell people that NHS patients will wait longer, while hospitals profit from no limit on their use of NHS beds and NHS staff for private patients? When did he tell people that lowest price will beat best care, because GPs will be forced to use any willing provider? When did he tell people that essential NHS services will be protected only by a competition regulator, similar to those for gas, water and electricity? And when did he say that he was creating a national health service that opens the door for big private health care companies to move in?

[Mr Lansley]

I am grateful to the right hon. Gentleman, who is generous in giving way. It is never an ideal thing to quote yourself, but let me risk doing so:

“We have been clear about the need for improvement in the NHS: responsive to patient choice; where budgets are in the hands of GPs; where hospitals are set free; where professionals are released from targets and bureaucracy; where the independent sector has a right to supply to the NHS; where competition delivers efficiency; and where patients have the assurance that NHS standards of care are based on the founding principle of the NHS—free at the point of use and not based on the ability to pay.”

I said that in a letter to The Daily Telegraph on 10 March 2006—four years ago.

[John Healey]

The real question is why the right hon. Gentleman, if he had these plans, did not tell the Prime Minister and the Deputy Prime Minister when they were writing the coalition agreement what he wanted to do on funding, on reorganisation and on the role of primary care trusts. Why did he allow his Government to make these pledges to the British public in May and then break their promises two months later in the White Paper? Whatever the boss of Tribal health care says about the private health care companies, he described the White Paper as

“the denationalisation of healthcare services”.

He went on to say that

“this white paper could result in the biggest transfer of employment out of the public sector since the significant reforms seen in the 1980s.”

This is not what people expected when they heard the Prime Minister tell the Conservative conference last month that the NHS would be protected.

--- Later in debate ---

[The Secretary of State for Health (Mr Andrew Lansley)]

I will ask the House to reject the motion.

As I listened to the speech of the right hon. Member for Wentworth and Dearne (John Healey) I was very disappointed, because it seemed to be all about primary care trusts rather than about patients, all about managers rather than about doctors and nurses, and all about processes rather than about outcomes. It was completely the opposite of what the White Paper sets out to do, which is to give patients control of health care and allow more shared decision making for patients.

The White Paper is all about focusing on improving health care outcomes, and about empowering the doctors and nurses who work in the health service and recognising the contribution that they make. I am really disappointed that the Opposition motion does not recognise fully, as it should, the role that should be played by patients and staff in the NHS. I advise the right hon. Gentleman, when he tables motions such as this, always to think more about the staff of the NHS and the patients whom they look after, and less about the managers and the processes.

I will give way to the right hon. Gentleman if he wishes, but let me tell him this. Fighting a campaign called “Save the primary care trusts” will cut no ice with the people of this country. Fighting a campaign to save our NHS is what we did in the last Parliament; we did it successfully, and now that we are in government, saving the NHS is exactly what we are going to do.

[John Healey]

If the Secretary of State—who, I concede, has a six-and-a-half-year head start on me in this job—really cared about NHS patients, really cared about NHS staff and really cared about NHS services, he would not be putting the NHS through the biggest reorganisation in its history, especially at this time. As I said earlier, it is patients groups and bodies representing NHS staff who are saying, “Slow down—think again.” I urge the Secretary of State to do that today, and to rethink.

[Mr Lansley]

The right hon. Gentleman has just taken to heart the old saying that the job of the Opposition is to oppose. That is all he is doing: he is simply opposing. Nothing in his motion states positively what should be done, whether that is supporting NHS staff or listening to patients and giving them the shared decision making opportunity that is so essential. While opposing the reforms that we in the coalition Government are introducing, he seems to have ignored the simple fact that those reforms, in truth, represent the coherent consistent working out, in practice, of policies that were initiated, but never properly implemented, by the Government of whom he was a member. They are not revolutionary, as he has called them.

[Andrew George]

As the right hon. Member for Wentworth and Dearne (John Healey) said earlier, the seventh point in the coalition agreement begins with the words:

“We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust…The remainder of the PCT’s board will be appointed by the relevant local authority or authorities”.

Was the Secretary of State consulted before those words were included in the agreement? If he was, what changed his mind between the drawing up of the agreement and the White Paper?

[Mr Lansley]

The answer to the first question is yes. The answer to the second question is that we in the coalition Government collectively took the sensible view that form must follow function. If we arrived at a point at which people were being elected to primary care trusts which themselves no longer had a substantive role to play, because public health was rightly being transferred to local authorities—

[Liz Kendall (Leicester West) (Lab)]

Did you know that at the time?

[Mr Lansley]

We did know that at the time. [Interruption.] I will not engage in a conversation with the hon. Lady when she is intervening from a sedentary position. I am replying to my hon. Friend the Member for St Ives (Andrew George).

If we arrived at that point—a point at which GP-led commissioning consortiums were rightly leading on the commissioning of health care services—we would then find ourselves suggesting the election of people to a body that did not exercise any substantive responsibilities.

We therefore made a collective decision not to implement the policy in that way. The principle that we were pursuing was the strengthening of local democratic legitimacy in relation to health care—and, for that matter, social care—and that is exactly what we are going to do. We are going to do it through the health and well-being boards, and through the local authorities that are directly responsible for the provision of health improvement plans in their areas, engaging directly with local GP consortiums in the strategic commissioning functions and increasingly integrating health and social care.

Let me return to the point that I was making to the right hon. Member for Wentworth and Dearne. He ought to recognise, but does not seem to understand, that when I was announcing our intentions in 2006, the Government of whom he was a member were saying that these were the reforms that they wished to pursue. Tony Blair made a speech in June 2006 in which he said that NHS reform should be based on patient choice, independent sector providers, general practice-led commissioning and foundation trusts, yet the right hon. Gentleman’s motion today has left all that out. All those things that the Labour Government once supported, he, in opposition, now opposes.

The right hon. Gentleman’s motion is notable for what it has left out: it has left out the call for patient information and choice; it has left out any reference to the need for improving health outcomes; and it has left out a recognition, which the House should always reiterate, of the commitment of health and social care staff to the patients they care for. Particularly tellingly, it has also left out any indication of whether Labour supports or opposes our health service spending plans.

The right hon. Member for Leigh (Andy Burnham) has left the Chamber, but before the spending review he said to us, “Don’t protect the NHS budget; cut the NHS budget and transfer it to social care.” We did not do that; we did not do what the Labour party suggested. Instead, we have both protected the NHS budget and supported social care.

Before the election, the Labour Administration said, “Cut NHS capital budgets by 50%,” but the real-terms reduction in NHS capital budgets will be just 17%. They said, “Protect the primary care trust budgets but cut central budgets; cut research and development in the NHS; cut education and training,” but we are not doing that. We are protecting the resource funding for the NHS, and it will increase in real terms.

[Several hon. Members]

rose—

[Mr Lansley]

I will give way to the hon. Member for Worsley and Eccles South (Barbara Keeley) first, and then to my hon. Friend the Member for Bexleyheath and Crayford (Mr Evennett).

[Barbara Keeley]

The Secretary of State talks about protecting social care, but he must be aware that at the same time cuts of 28% are being made to local council budgets, of which social services and social care account for the largest component. Even before the comprehensive spending review, six or seven councils were already saying their situation was moving from moderate to substantial, and for one council that has now risen from substantial to critical—and that is before the Government implement their cuts of 28%. There is no such protection in place, therefore. Instead, this radical NHS reorganisation is happening at the same time as those huge council budget cuts, and next year will be terrible. My right hon. Friend the Member for Leigh (Andy Burnham) was right to protect social care, as well as in the other things that he did with the NHS.

--- Later in debate ---

[Mr Lansley]

The hon. Lady is simply completely wrong. Local government budgets are not being cut by the figure she cites. The formula grant from central Government is having to be cut because of the debt we inherited from Labour, although she, like the rest of her party, is in denial about that, but that does not mean a cut—

[Barbara Keeley]

Will the Secretary of State give way?

[Mr Lansley]

No; I am addressing the point that the hon. Lady made. That cut in formula grant does not mean a corresponding cut in council tax, so that revenue is available to local authorities. In addition, the NHS is going to support social care activity in the ways I have described, such as through telehealth, re-ablement and equipment adaptations. We are transferring the learning disability transfer grant and other adult social care grants collectively representing £2.7 billion a year from the NHS to local authority funding, without reductions in those grants. I am afraid the hon. Lady is just simply wrong, therefore.

[Mr Evennett]

I congratulate my right hon. Friend on his determination to improve our national health service, and on the initiatives that he is proposing. However, does he agree that in enabling the NHS and social care services to work more closely together, it is vital to have integrated cost-effective services, and make sure that the patients get the best out of the system?

[Mr Lansley]

My hon. Friend is absolutely right. The Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), and I are very impressed that the local NHS and local authorities are, sometimes for the first time, sitting down together and discussing how they can use their resources. Even this year we managed to save £70 million from the budget that we inherited from the Labour party. That money can be invested in re-ablement, and in bringing local authorities and the NHS together to improve the service to people who are going home.

[Chris Bryant (Rhondda) (Lab)]

Will the Secretary of State give way?

[Mr Lansley]

I want to make a little progress first.

The Opposition motion reveals that they have no alternative vision. The Labour party today is empty of ideas, confused and incoherent. It did not have anything to offer the country at the general election, and it has nothing to offer today. I will deal with each of the points made by the right hon. Member for Wentworth and Dearne, but first I want to say something about what we are doing through the White Paper, and why we are doing it.

We should be proud of the fundamental values of the NHS: that it is free at the point of use, and that it is based on need and not on the ability to pay. Nothing that we do will ever undermine those principles; that is the coalition Government’s commitment. However, our pride in these values is no excuse for complacency. The demands facing the NHS over the coming decades are many: an increasing and ageing population; continued advances in medicine and technology; and rising expectations on the part of patients and the public. That is why, as we maintain equity in access to services, we will also pursue excellence in health care. We will do so because despite the great improvements in the NHS in the past—such as in cardiac surgery and cardiology, and, more recently, in stroke care and many cancer services—we have much more still to do.

Outcomes for patients in this country are too often poor in comparison with outcomes in other countries: someone in this country is twice as likely to die from a heart attack as someone in France; survival rates for cervical, colorectal and breast cancers in this country are among the worst in the OECD; and premature mortality rates from respiratory disease are worse than the EU-15 average. Simply putting more money into the system has not worked, which is why reform is needed.

[Chris Bryant]

I am grateful to the Secretary of State for giving way. He has argued the need for greater localism and for local health services to be more accountable to local people. However, pulmonary hypertension is one condition in which significant advances have been made in recent years. It affects a number of my constituents but it is a rare condition, and has to be managed not locally but on a country-wide—indeed, often a Wales and England and Scotland-wide—basis. How can the Secretary of State make sure that, with the pressure towards local services, proper account is also taken of conditions on which action can be delivered only on a national basis?

[Mr Lansley]

For England, the White Paper sets out very clearly that specialised commissioning, whether currently regional or national, will be undertaken through the NHS commissioning board, rather than by individual commissioning consortiums.

The point about the reform process is that if we change nothing, nothing will change. The Labour party is the party of no change: it is the party of stasis, inertia and inactivity. Labour says, “Do nothing, put the reforms on hold”—whatever that means. Our aim is a simple one. We cannot stand still. If we carry on as we are, resources will, as over the last decade, be consumed without delivering the improved outcomes for patients that are so essential. Delivering improved outcomes for patients is our objective, and the White Paper gives us a clear and consistent vision for achieving that, based on three guiding principles.

[Frank Dobson (Holborn and St Pancras) (Lab)]

Will the right hon. Gentleman give way?

[Margot James (Stourbridge) (Con)]

Will my right hon. Friend give way?

[Mr Lansley]

Of course. I will give way first to my hon. Friend.

[Margot James]

The Secretary of State was discussing the disappointing cancer survival rates. A National Cancer Intelligence Network survey was conducted earlier this week, and I was shocked to learn that it found that one in four cancers were diagnosed only when a patient was rushed to hospital experiencing symptoms. Does the Secretary of State think ring-fencing the public health budget and co-ordinating it better with local authorities will enable us to make a swifter impact in respect of the preventive aspects of cancer management, in order to reduce that figure?

--- Later in debate ---

[Mr Lansley]

Yes, I feel that it should. When the NHS last came under financial pressure in 2005-06, public health budgets were cut and public health staff were lost, but we are determined to address the worrying situation that my hon. Friend described. That is why we are committed to the implementation of a cancer signs and symptoms campaign. It will be launched in the new year, and its purpose is precisely to ensure that we tackle the lack of awareness of cancer symptoms, so that people will present to their GP earlier and we can bring them to diagnosis sooner.

[Several hon. Members]

rose—

[Mr Lansley]

I said I would give way to the right hon. Member for Holborn and St Pancras (Frank Dobson), if he still wishes to intervene.

[Frank Dobson]

The right hon. Gentleman said that he wanted to improve treatment. How does he think the treatment of sick children at Great Ormond Street hospital will be improved if it has to do without the £16 million that his Government are currently threatening to take away?

[Mr Lansley]

I explained to the right hon. Gentleman at Health questions just a fortnight ago that we are in discussions with the specialist children’s hospitals. They are very clear that they are engaging constructively with the Department, with the intention that the payments through the tariff should accurately reflect the costs incurred in providing specialist services. That is the current situation, and no decision has yet been made.

I was talking about the principles of the White Paper.

[John Healey]

Will the Secretary of State give way?

[Mr Lansley]

In a moment; the right hon. Gentleman must allow me to make some progress.

I was talking about the principles of the White Paper. They are very clear. First, patients should be at the heart of the new national service, with a simple principle of “No decision about me without me” transforming the relationship between citizen and service.

Secondly, we will focus on outcomes, not processes. We will focus on outcomes that capture the entirety of patient care, and quality standards and indicators that genuinely reflect what a high-quality service should actually deliver. We will orientate the NHS towards focusing on what really matters to patients, not narrow processes. Thirdly, we will empower clinicians, freeing them from bureaucracy and centralised top-down controls, so that change is genuinely driven from the grass roots, rather than driven, top-down, from above.

The right hon. Gentleman’s speech did not appear to recognise that central principle at all when he talked about people in the NHS Confederation and the managers who run the NHS. Clinicians are already the people who actually do the commissioning: general practitioners make the referrals and write the prescriptions, and consultants in hospitals make referrals from one consultant to another. In effect, cost and commissioning in the NHS is already controlled by clinicians, but they are divorced from the processes of combining the management of patient care with the management of resources. Whether in this country or in others around the world, it is perfectly clear that that divide is what breaks health care systems. What makes health care systems more effective is bringing together the management of patient care with the management of commissioning and resources on behalf of patients.

[John Healey]

I wanted to intervene to discuss what my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) said about Great Ormond Street hospital. I have the official record of what was said at Health questions, to which the Secretary of State referred. He said that the proposal would have

“the overall effect of reducing Great Ormond Street’s total income by less than 2%.”—[Official Report, 2 November 2010; Vol. 517, c. 754.]

How does he reconcile that with the trust’s figures, which say that the reduction will not be less than 2%, but will be more than 5.5%? Would he like, therefore, to correct the official record now? Will he also publish the figures so that this House and Members who represent these areas can make up their own minds about whether those big stealth cuts to the hospitals that treat many of our most critically ill kids are a good idea?

[Mr Lansley]

No, I will not do those things, because what I said was accurate. The specialist children’s hospitals and ourselves are engaged in a constructive process of discussion about the future of the tariff for those hospitals and the top-up. Until a proposal is made there is no purpose in informing the House. We will inform the House as soon as we are in a position to say what the tariff for next year looks like.

[Mr Baron]

I totally commend the Government for their focus on cancer reform and improving outcomes. I accept that this is in the melting pot at the moment, but does my right hon. Friend agree that it is important that the one-year and five-year cancer survival rate figures are presented not as a league table but as a performance table, to ensure that all primary care trusts and GP consortiums are tasked with improving performance, irrespective of how they compare with others?

[Mr Lansley]

Yes, my hon. Friend makes a good point. What we are looking for is not a league table at all, as health care should not be regarded in that way; we are looking for proper benchmarking to take place. We are going to benchmark this country’s performance against that of the best health care systems around the world—the Labour party never did that—and we are going to ensure that there is a culture of continuous improvement in the NHS in respect of both the one-year and the five-year cancer survival rates, which my hon. Friend rightly mentioned.

The reforms that I was talking about are not a radical departure from the past. The principles of the White Paper should be what the NHS has always been about, but it has been distracted too often by the bureaucratic processes that the Labour party was always supporting. Let me make it clear that many of the things that we are doing were championed by former Labour Ministers. When John Reid was Health Secretary he championed patient choice, and we know why. His view was, rightly, that in the NHS, in a bureaucratic system, the articulate middle classes get access to the best health care, and it is only through institutionalising and embedding patient choice—shared decision making for every patient—that we will ensure that the most disadvantaged in society get the right access to health care.

As for GP-led commissioning, the Labour party was supposed to have introduced practice-based commissioning.

[Rosie Cooper]

rose—

[Mr Lansley]

I am not giving way, so the hon. Lady must sit down. [Interruption.]

[Madam Deputy Speaker]

Order. The Secretary of State is indicating that he is not giving way, and that is his choice.

[Mr Lansley]

Not only is it my choice, but it is a necessity. As you said earlier, Madam Deputy Speaker, 15 Members wish to speak in the debate, and they will be allowed only seven minutes. I shall therefore take less time than the shadow Secretary of State did.

The Labour Administration pursued practice-based commissioning. Labour Members now make up numbers about how many GP-led commissioning consortiums there will be, but under practice-based commissioning there are 909 practice-based commissioning consortiums. The Labour Government did not give them any power, but they established them and they all have costs associated with them; there are 152 primary care trusts. Bureaucracy and cost in the system is legion, and we have to take it out; we have to reduce the number of people.

Under the Labour Administration the number of managers and senior managers in the NHS doubled. Where was the corresponding improvement in outcomes? The number of nurses increased by only 27%. That shows the kind of distorted priorities that were at the heart of the previous Government. They said that all NHS trusts should be foundation trusts by December 2008, but they simply did not bring that about; we are going to make it happen. They set up the idea of a right to request for staff in PCTs in provider services to become social enterprises, but we are the ones who are now bringing that about. Yesterday, I was able to announce 32 more social enterprises in the NHS, where staff are taking responsibility and ownership of the service that they provide, representing 15,000 additional staff and more than £500 million of revenue. If the Labour party is now against all the reforms that used to be part of the process of delivering greater empowerment of staff and patients in the NHS, what is it in favour of? I simply cannot find out the answer to that question any more.

What does represent a radical departure from the past is the fact that we are pressing ahead with the reforms with purpose and pace. I make no apology for the fact that we are going to achieve the changes required in the NHS more rapidly than anything that the Labour party did in the past—because not to do so would prejudice the opportunity to deliver resources to the front line, choice for patients and clinical responsibility for leaders across the NHS.

[Mr Kevin Barron (Rother Valley) (Lab)]

On at least two occasions in the House since the general election, the right hon. Gentleman has cited the Health Committee report on commissioning that was published in March, and used my name, as that Committee’s then Chair, to suggest that the report supports his changes in commissioning in the White Paper. Will he confirm that it does not do that? Where is the evidence that the change in commissioning will save any money?

[Mr Lansley]

What is very clear from the Health Committee’s report before the election is that, as the right hon. Gentleman knows, it criticised in strong terms the weaknesses of PCT commissioning, and that position has only been reinforced since then. One such example is out-of-hours services, for which PCTs were supposed to be the commissioners but did not properly scrutinise the services being tendered, and did not monitor the contracts or the quality of the contracts. PCTs have too often been responsible for simple cost and volume commissioning. What we are concerned with, because we shall engage clinical leadership in the commissioning of services through the NHS, is being engaged in commissioning for quality. Patients will be able to exercise choice based on real information that tells them about the quality of the services being provided, not the cost and volume—

[Mr Barron]

rose—

[Mr Lansley]

I have already given way to the right hon. Gentleman, and I am now going to conclude rapidly.

Contrary to what the right hon. Member for Wentworth and Dearne said, we have heard organisations from right across the NHS supporting the principles of the White Paper. The British Medical Association says that it

“strongly supports greater clinical involvement in the design and management”

of the health service.

The Royal College of Nursing said:

“The principles on which the proposed reforms are based—placing patients at the heart of the NHS, focusing on clinical outcomes and empowering health professionals—are both welcome and supported by the RCN.”

The King’s Fund said that it

“strongly supports the aims of the White Paper”.

The National Association of Primary Care described the White Paper as

“a unique opportunity to raise the bar in the commissioning and delivery of care for patients.”

The chairman of the NHS Alliance said that it provides

“a unique opportunity for frontline GPs... to make a real difference to the health of their patients”

The Foundation Trust Network said:

“the vision for the NHS articulated in the White Paper is the right one—putting patients and carers at the centre”.

The right hon. Member for Wentworth and Dearne made a number of specific points. He said that the reforms were an ideological gamble. Well, if they are, they are based on an ideology once shared by the Labour party; and if there is an ideology, it is the belief that patients and clinicians in the health service know best. That is not a gamble at all; it is a certainty.

The right hon. Gentleman talked about reorganisation, but he did not say that the number of managers in primary care trusts rose all the way through to last year in the face of the impending crisis in finances over which the Labour Government presided. He did not tell us that last year primary care trusts spent £261 million on consultancy—an 80% increase in such expenditure in two years.

The right hon. Gentleman gave us the benefit of some of his figures—some of his dodgy numbers—so let me give him a real number. Our decisions to cut the cost of management and administration in the NHS will release £1.9 billion of savings a year by 2014-15. That money will be reinvested directly to support front-line care, so there will be not only a real increase in the resources available to the NHS, but a real change and increase in the resources that get to the front line, because we are cutting the costs of administration and back offices.

Let me make this clear—

[Mr David Lammy (Tottenham) (Lab)]

Will the right hon. Gentleman give way?

[Mr Lansley]

No.

Against all the advice from the Opposition, we protected the NHS budget in the spending review. It was a brave decision for a Government to take in such circumstances, but it underlined our commitment as a coalition to the NHS. It was a decision that went contrary to the advice and recommendations of the Opposition. For the right hon. Member for Wentworth and Dearne to try to attack the Government over “cuts”—he used that word—in the present circumstances is pure opportunism.

The right hon. Gentleman will not say whether he backs our NHS budget. He talked about what the shadow Chancellor is supposed to have said, but it was the shadow Chancellor who specifically said that he did not support our proposals to increase the NHS budget. Does the right hon. Member for Wentworth and Dearne support our cancer drugs fund or not? He did not say. Does he back our integration of health and social care and the resources that we will use through the NHS to support social care and local authorities? He has not said.

The right hon. Gentleman has not said whether the Opposition oppose or support our commitment to the NHS. How could he? The Leader of the Opposition said before the spending review that he would publish his alternative proposals, but he never did so. The Opposition were promised it, but it did not happen. Without a plan for the economy and for public services, the right hon. Member for Wentworth and Dearne can say nothing about the NHS.

Our commitment to the NHS is clear. We have made tough choices on public spending so that we can protect the NHS and ensure that the sick do not pay for Labour’s debt crisis—

[Frank Dobson]

Will the right hon. Gentleman give way?

[Mr Lansley]

I gave way to the right hon. Gentleman before.

The big gamble is not pressing ahead with reform; the gamble now would be to carry on as the last Government did, failing to implement the reforms that are necessary and desirable—and supported—across the service. The spending review and the White Paper give the health service a clear, practical, evidence-based framework for sustained improvement in the future. We will not go back to the days of top-down Whitehall micromanagement and bureaucracy. We will free the NHS to improve outcomes for all patients and to meet our vision of ensuring that health outcomes for the people of this country are among the best in the world. I urge the House to reject the Labour party’s motion.

--- Later in debate ---

[Rosie Cooper]

Absolutely. I am sure the Secretary of State will give due cognisance to the comments being made, especially about putting resources right there on the front line, delivering for the very people who are paying the wages.

In his evidence to the Select Committee on 20 July, the Health Secretary set out five aims of the White Paper, and he went through them here today. I shall review some of those in the light of the dribbles of information that we have received, and see how they stand up. The first aim was creating a patient-led NHS. Let us start with the Secretary of State’s glib catch-phrase, “No decision about me without me”—

[Mr Lansley]

Glib?

[Rosie Cooper]

Yes, glib. Where is the substance? Will it make any difference if the GP consortiums do not agree with the Secretary of State? Will those consortiums meet in private or in public? Will he listen to those patient voices? Will he be able to hear them?

Right to Request Social Enterprise Scheme

Lord Lansley Excerpts

Tuesday 16th November 2010 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

I am announcing a third, and final, wave of 32 national health service organisations that will join the Department of Health’s “Right to Request” social enterprise scheme.

The “Right to Request” gives all primary and community care staff employed by primary care trusts (PCTs) the right to put a request to their PCT board to set up a social enterprise to deliver health and social care services. Each of these organisations has received the approval of their PCT and strategic health authority (SHA) to pursue plans to set up a social enterprise. With appropriate support, these projects should go on to become successful and financially viable social enterprises that strengthen the delivery of tailored health and social care services in the NHS.

This scheme empowers staff to harness their entrepreneurial skills and exercise leadership to improve services for local communities through social enterprise.

The projects include a wide range of primary and community care for children, families and vulnerable people, such as dental, physiotherapy, bereavement and podiatry services. The proposals range from single service lines to whole provider arms.

These latest projects join the existing group of 29 “Right to Request” projects, bringing the total number participating in the scheme to 61. This represents a major milestone in the delivery of the White Paper commitment to create a vibrant social enterprise sector, and a substantial move towards the transformation of community services.

The growth of social enterprise is a priority for the Government. Social enterprises play a vital role in delivering innovative services and creating capable and confident communities. I am committed to enabling these organisations to have a significant role in the running of health and social care services across the country.

A list of the third wave of projects has been placed in the Library.

Oral Answers to Questions

Lord Lansley Excerpts

Tuesday 2nd November 2010 Commons Chamber

[Chris Heaton-Harris (Daventry) (Con)]

3. What steps his Department is taking to increase the provision of preventative health care.

[The Secretary of State for Health (Mr Andrew Lansley)]

We are committed to protecting and improving the nation’s health and well-being. Since the election, we have already announced our commitment to preventative action on cancer, including improved bowel cancer screening and a campaign on signs and symptoms to promote early diagnosis; investment in a programme of reablement for those leaving hospital; and £70 million of investment this year to increase access to talking therapies.

[Chris Heaton-Harris]

Does my right hon. Friend agree that dedicated health spending focused on the poorest areas in most need is urgently required to narrow the health inequalities that, as a recent National Audit Office and Public Accounts Committee report show, actually widened under the Labour party?

[Mr Lansley]

I am grateful to my hon. Friend for that question, because it enables us to point out that over the period of the previous Labour Government health inequalities in this country widened—life expectancy, for example, widened by 7% for men and 12.5% for women between the richest and the poorest areas of this country. We are very clear. Our public health White Paper, which will be published shortly, will focus on how we can not only deliver a more effective public health strategy, improving health outcomes for all, but improve health outcomes for the poorest fastest.

[Fiona Mactaggart (Slough) (Lab)]

There is an area of the country where public health inequalities have not widened, and it is the borough of Slough. Will the Secretary of State come to Slough and look at the work of health advocates, who are ordinary citizens who help to engage people with their health and avoid some of the conditions that have led to early deaths in Slough?

[Mr Lansley]

The hon. Lady might not recall, but about five and a half years ago I visited Slough to meet the health trainers, particularly in the Asian community, who were going to help people. Their focus was on diabetes. It has been a very effective pilot and we will need to work—we will do so—with local authorities and the NHS. We should work together, using dedicated public health resources of precisely that kind, to identify the risk of diabetes and to tackle it at source.

[Mr Andrew Turner (Isle of Wight) (Con)]

On the Isle of Wight, the local NHS has decided that contraceptive pills may be given to girls as young as 13. Their parents and even their GPs are not involved. Nowhere else, I am told, shares that approach. Many of my constituents are horrified. What is the Secretary of State’s view?

[Mr Lansley]

My hon. Friend will know that these decisions were made locally. Indeed, we support local decision making. We will ensure that such decisions are taken not only in the health service but alongside local authorities as part of their public health function. It is important that one is clear that a young person is competent to make such decisions. Subject to that, however, we are always clear that patients have a right to access health care on their own cognisance if they are competent to do so.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Does the Secretary of State accept that good preventative care walks hand in hand with good social care? Does he further accept that even if all efficiencies were made and every single pound of the so-called additional £2 billion for social care was to be spent, there will, as the Local Government Association and the Association of Directors of Adult Social Services warn, nevertheless be a shortfall of at least another £2 billion before the end of the comprehensive spending review? In those circumstances, why does the Treasury’s own document say:

“In social care, the Spending Review has provided additional funding needed to maintain current levels of care”?

Who is the public to trust and what are they to make of it?

[Mr Lansley]

First, may I welcome the hon. Lady to her position in the shadow health team? I do not accept her proposition. We are very clear about the nature of the efficiencies that can be made in social care, and we have established an efficiency group that is advising on how that can be done. In addition, in the spending review the Chancellor was able to announce that the Secretary of State for Communities and Local Government has made £1 billion extra available, and we have made £1 billion available through the NHS. On that basis, there is no need for local authorities to have to reduce eligibility to social care.

[Alun Michael (Cardiff South and Penarth) (Lab/Co-op)]

4. What recent assessment he has made of the potential contribution of StartHere to his Department’s programmes to reduce the digital divide in respect of health services.

--- Later in debate ---

[Tony Lloyd (Manchester Central) (Lab)]

5. What plans he has for future funding of specialist children’s hospitals.

[The Secretary of State for Health (Mr Andrew Lansley)]

Specialist children's hospitals will continue to be funded through local commissioning and specialised commissioning based on payment by results and local contracting while also recognising the specific additional costs of specialist paediatric services.

[Tony Lloyd]

The Secretary of State will know that his Department has written to specialist children’s hospitals threatening to withdraw the top-up moneys that are recognised as important in treating the most critically ill children. That is outrageous and seems to run counter to the Government’s commitment not to cut funding. Will he go back to his Department and tell his officials that he will not go ahead with the reduction in top-up fees?

[Mr Lansley]

I am afraid that I have to correct the hon. Gentleman. We are not withdrawing specialist top-up payments; the Department has acted on the basis of a review conducted by the university of York which was initiated by the Opposition Front Bench team’s predecessors when they were in government. They set up a review on specialist top-ups which said that the payments should go down from 78% to 25%, not that they should be withdrawn completely. We are reviewing that outcome with the specialist children’s hospitals and a meeting is taking place today to consider whether the review’s conclusions were accurate and applicable.

[Gordon Birtwistle (Burnley) (LD)]

Does the Minister agree with me and the 1999 Shields report that children’s accident and emergency, paediatrics and maternity units should be kept together in one hospital? Will he postpone the move of the Burnley children’s ward to Blackburn until the new GP commissioners are installed and can make an informed decision?

[Mr Lansley]

Yes, I entirely understand my hon. Friend’s point and we have discussed this at Burnley. I feel strongly—indeed, I know—that we must continue to apply the tests that I have set out for such issues of configuration, including that they will deliver improving clinical outcomes, be safe for patients and, as he rightly says, reflect the commissioning intentions of local GPs representing local patients.

[Frank Dobson (Holborn and St Pancras) (Lab)]

How can it possibly be right that the world-renowned staff at Great Ormond Street hospital in my constituency face, under this proposition, a reduction of £16 million in the funding of that hospital? NHS funding is supposed to be ring-fenced, but from the point of view of people at Great Ormond Street, it seems to be rather more ringed than fenced.

[Mr Lansley]

The right hon. Gentleman must realise that if we had listened to the Labour party in the comprehensive spending review, we would have cut the NHS budget, but we did not. We resisted the Labour party’s proposal, and resources for the NHS will increase in real terms, but there is then the matter of how those resources should be deployed to best effect. The application of the proposal—we have still to agree with children’s hospitals on how it will be applied—would have the overall effect of reducing Great Ormond Street’s total income by less than 2%.

[John Healey (Wentworth and Dearne) (Lab)]

The Secretary of State’s answer simply will not do. He is in government now, not us. He is making decisions to make deep cuts to our specialist children’s hospitals. He is trying to keep the NHS out of the public spotlight, and we will make sure that the public know what his plans for the NHS are.

I have the Secretary of State’s letter. He has not answered my questions and I ask him again to tell the House why, before today, no Minister has made any statement in public or in the House about these big stealth cuts to our children’s hospitals, and how much each one of the 35 specialist children’s hospitals will lose next year in funding to treat some of the most critically ill children in our country.

[Mr Lansley]

I welcome the right hon. Gentleman to his place. I hope he enjoys being shadow Secretary of State as much as I did, and that he enjoys an even longer tenure. I explained to his right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) the impact on Great Ormond Street. I do not discount its importance to the hospital, and it is being discussed today with specialist children’s hospitals by a group chaired by the national clinical director, but it represents less than 2% of Great Ormond Street’s total income. This is about specialist top-ups to the tariff where the new tariff has been introduced, which in itself makes differences to the income and the accuracy of costs of services provided by those hospitals. It was all set up by the previous Government. They started the review. They published it on 16 December 2009. It was not our doing; it was their doing.

[John Healey]

I thank the right hon. Gentleman for his welcome to me in my job. I have no intention of being in the job for six years, as he was before he came into government. We will have won an election before the end of that period.

Big stealth cuts to our children’s hospitals are not what the public expected to see when they heard the Prime Minister promise to protect the NHS budget. Will the Secretary of State admit that he is double-counting £1 billion a year in the spending review as both money for the NHS and money to paper over the cracks in social care? Will he accept the new House of Commons Library research report, which confirms:

“Including the (social care) funding is critical to the description of the settlement as a ‘real terms increase’; without it, funding for the NHS falls by £500 million—0.54% in real terms.”

When did the Secretary of State tell the Prime Minister that the Government are breaking his promise to protect the NHS budget?

[Mr Lansley]

I am afraid the right hon. Gentleman is wrong about that. Even if we did not treat up to £1 billion to support social care through the NHS as NHS money—we should treat it as NHS money, but even if we did not—there would still be an increase in the resources available to the NHS in real terms each year. It is NHS money. The right hon. Gentleman must accept that this year we are spending £70 million on reablement, which has the effect of mitigating need in social care and reducing emergency readmissions to hospital. We will provide NHS money, which in itself supports health gain and social care support.

[Julian Sturdy (York Outer) (Con)]

6. What assessment he has made of the likely effect on cancer survival rates of the implementation of his proposed reforms of the NHS.

--- Later in debate ---

[Henry Smith (Crawley) (Con)]

8. What mechanisms he plans to put in place to provide for GP revalidation after the ending of primary care trusts.

[The Secretary of State for Health (Mr Andrew Lansley)]

The General Medical Council is responsible for the revalidation of doctors, rather than primary care trusts. In the current structures, subject to parliamentary approval, responsible officers in primary care trusts will make recommendations to the GMC on the fitness to practice of doctors in primary care. Before the dissolution of primary care trusts, we will consult on options for responsible officers in primary care.

[Henry Smith]

I am very grateful for that answer from my right hon. Friend. I welcome the commissioning role that GPs are to have. Does he believe, however, that there needs to be a distance between revalidation and local GP practices, and that that would best sit at a county or metropolitan borough level?

[Mr Lansley]

Yes, I am grateful to my hon. Friend. Indeed, we will take account of precisely the point that he makes when we consult on how responsible officers in primary care will be established in future following primary care trusts. It is important to recognise that revalidation should be a process very like the normal appraisal of staff. However, when it comes to investigation of fitness to practise, it will be important for there to be proper independence.

[Derek Twigg (Halton) (Lab)]

This is a very important issue affecting patient safety. The Secretary of State will know that the British Medical Association has raised significant concerns about the revalidation proposals, referring specifically to the implications of the reorganisation. Does he recall criticising NHS reorganisations and their cost in his conference speech on 5 October 2009? Why, then, has he embarked on a reorganisation that will cost an estimated £3 billion at a time when the NHS will also face deep cuts because of his broken promises over funding?

[Mr Lansley]

May I welcome the hon. Gentleman to his new responsibilities?

We are doing this because it is absolutely essential for the NHS to use resources better to deliver improving outcomes for patients. A combination of the ability for general practice-led consortiums to combine the management of care for patients with the management of resources is instrumental to achieving that. It will deliver substantial reductions in management costs. We will achieve a £1.9 billion-a-year reduction in management costs by 2015.

[Graham Evans (Weaver Vale) (Con)]

9. What progress he has made on increasing the provision of specialist neuromuscular care in (a) the north-west and (b) England.

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[Mr Dominic Raab (Esher and Walton) (Con)]

11. What steps he is taking to reduce administrative costs in the NHS.

[The Secretary of State for Health (Mr Andrew Lansley)]

We are cutting management costs in the NHS by 45%. We will cut total administrative costs as well, and in total that will save £1.9 billion a year by 2015.

[Mr Raab]

I thank the Secretary of State. I recently spent a morning in my constituency with local paramedics and was shocked to learn that the very best paramedic can earn just one tenth of that earned by the highest-paid NHS manager. What steps is my right hon. Friend taking to address those skewed priorities?

[Mr Lansley]

My hon. Friend will be aware that we in the Department and across government have invited Will Hutton to examine pay differentials in public services, and we have talked to him about precisely that. In my hon. Friend’s area, the earnings of a qualified member of ambulance staff would be about £37,000 on average, which of course is only about a sixth of the highest pay of an NHS manager.

[Mr Kevin Barron (Rother Valley) (Lab)]

Past reorganisations of the national health service have taken years to embed and affected performance negatively, and history suggests that, given the scale of the reorganisations in the White Paper, they will be no exception. Can the Secretary of State tell us how much the administrative costs of the changes will be?

[Mr Lansley]

Perhaps I can remind the right hon. Gentleman that the major part of the reorganisation is to eliminate strategic health authorities and primary care trusts, to focus resources on the front line, to get them into the hands of those who are responsible for delivering care and, in the process, to deliver £1.9 billion a year of savings on administration costs.

[Heather Wheeler (South Derbyshire) (Con)]

12. What steps he is taking to prioritise funding for dementia research from his Department’s research budget.

--- Later in debate ---

[Caroline Nokes (Romsey and Southampton North) (Con)]

14. What steps his Department is taking to increase the provision of preventative health care.

[The Secretary of State for Health (Mr Andrew Lansley)]

In addition to what I said in reply to Question 3, I can tell my hon. Friend that we will shortly be publishing a public health White Paper, which for the first time will not only demonstrate a commitment across Government to improving public health and reducing health inequalities, but introduce a strategy and implementation programme to achieve precisely that.

[Caroline Nokes]

I thank my right hon. Friend for that answer. Chronic obstructive pulmonary disease is responsible for 30,000 deaths a year, and it is the second largest cause of emergency hospital admissions in the UK. In response to the consultations that have been received from, among others, groups in my constituency, will the Secretary of State please tell me when the Government plan to publish the clinical strategy on COPD?

[Mr Lansley]

We need to continue our work with the British Lung Foundation, because that has been extremely helpful. We are in the process—through the consultation on the White Paper and other such consultations—of putting in place an outcomes framework, which will enable us to see how outcomes can be achieved for people with respiratory diseases. In the meantime, I hope that we will push forward with the commissioning guidelines, clinical guidelines and quality standards that will help to support some of the COPD initiatives that I have seen, including a successful community COPD service in Somerset.

[Mr David Lammy (Tottenham) (Lab)]

The Secretary of State will be aware that 6,000 women a year die from ovarian cancer. Will he welcome the National Institute for Health and Clinical Excellence guidelines that were published this year, and, in so doing, will he tell us why he has decided to neuter NICE? The independent assessment that it provides was established in 1999 to ensure that, where we have a finite pool of resources, money is spent properly. Are not the pharmaceutical companies now rubbing their hands in glee?

[Mr Lansley]

The right hon. Gentleman has it completely wrong. We are not neutralising NICE. On the contrary, we will focus NICE on what its real job always was and should be, which is to provide independent advice to the NHS about the relative clinical and cost-effectiveness of treatments so as to achieve the best outcomes. The point that he may be misunderstanding is that by 2014 we intend to ensure that we are no longer denying access to the new medicines that patients need, because we will have a new and more effective value-based pricing system of reimbursement to pharmaceutical companies.

[Penny Mordaunt (Portsmouth North) (Con)]

15. What advice his Department provides to NHS trusts seeking to renegotiate private finance initiative contracts.

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[Julie Elliott (Sunderland Central) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Andrew Lansley)]

My responsibility is to lead the NHS in delivering improved health outcomes in England, to lead a public health service that improves the health of the nation and reduces health inequalities, and to lead the reform of adult social care, which supports and protects vulnerable people.

[Julie Elliott]

In the light of the 0.5% real cut in the NHS after the social care switch, to which my right hon. Friend the Member for Wentworth and Dearne (John Healey) referred, may I ask when the Secretary of State decided to break his promise on a real-terms funding increase for the NHS? Does he accept that that is not what my constituents expected when they heard the Prime Minister promise real increases for the NHS?

[Mr Lansley]

The hon. Lady’s constituents expect the truth, which is that we are providing increased resources for the NHS in real terms, taking it from £104 billion to £114 billion. That is completely contrary to what we were advised to do by the Labour party, which said that we should cut the NHS budget. We did not do that; we increased it.

[Mr James Gray (North Wiltshire) (Con)]

T2. The all-party group on multiple sclerosis held an all-day seminar last week on the subject of drug pricing, during which it broadly welcomed the end of the risk-sharing scheme and looked forward to value-based pricing, which will be introduced shortly. That welcome is subject to two important conditions: first, that NICE clinical guidelines should be updated and continued; and secondly, that the NICE risk appraisal should be abandoned. Does the Secretary of State agree with me on those two conditions?

[Mr Lansley]

Yes; my hon. Friend is absolutely right. As we implement our plans for the value-based pricing of medicines from 2014, NICE’s role will change. It will focus on advising how best to use treatments and to develop quality standards for the NHS, rather than recommending whether patients should be able to access particular drugs. We want patients to have access to the medicines that their clinicians believe are best for them.

[David Miliband (South Shields) (Lab)]

I wonder whether the Secretary of State can provide some reassurance to residents of Cleadon Park estate in my constituency who are concerned about the consequences of primary care trust abolition for the PCT-owned, PCT-organised and PCT-financed health centre that brings together primary and secondary care, and local authority and community services. Is there not a real danger of the sort of expensive “anarchy” of which Professor Tony Travers of the London School of Economics has warned?

[Mr Lansley]

Happily, I can offer the right hon. Gentleman’s constituents great reassurance that not only will the relationship between community health care and specialist health care in hospitals be improved by general practice-led commissioning—because clinicians will speak to clinicians—but the services they rely on will be improved, because we will no longer spend so much money on PCT administration. He will know that in 10 years under his Government the number of managers in the NHS increased by more than 60%.

[Mr Marcus Jones (Nuneaton) (Con)]

T4. NHS Warwickshire is consulting on the future of Bramcote hospital, which serves my constituency and the wider north Warwickshire area. That could lead to the closure of the hospital which has provided valuable intermediate care to my constituents over many years. To close the hospital, NHS Warwickshire requires the Department of Health to meet substantial impairment costs. Can the Secretary of State assure my constituents that before any decision is made by the Department to pay any such costs, the views of the local GP consortiums and local people will be taken into account?

--- Later in debate ---

[Mrs Linda Riordan (Halifax) (Lab/Co-op)]

T8. Following the coalition Government’s announcement that the NHS budget was to be protected and, indeed, increased, can the Secretary of State tell me why a ward will be closed at Calderdale Royal hospital? Will he reverse that crazy decision immediately for the safety of my constituents?

[Mr Lansley]

I cannot tell the hon. Lady precisely why that proposal has been made, but I will investigate and write to her. Increasing resources overall for the NHS does not mean that everything will stay the same in every particular. There will be change, including the redirection of resources towards providing services in the community rather than in hospitals.

[Mike Freer (Finchley and Golders Green) (Con)]

T5. Occupational therapists are crucial in effective rehabilitation. Will the Minister advise me on what role he sees for occupational therapists in using the £70 million investment in reablement announced by the Government?

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

T9. Is it appropriate for my constituents in Huddersfield to be lectured about healthy living standards by a Minister who is out of condition, overweight and a chain smoker?

[Mr Lansley]

I take it that the hon. Gentleman is not referring to me in those respects, although I can probably claim one or two of those epithets. We are none of us looking to lecture anybody: we are trying to lead a public health strategy that enables everybody to make healthier choices and lead healthier lives.

[Mr Philip Hollobone (Kettering) (Con)]

T6. May I invite the Minister to congratulate my local newspaper, the Northamptonshire Evening Telegraph, on running a successful campaign to encourage people to sign up to become organ donors? Given the success of that campaign, perhaps the Department might like to encourage other local newspapers to do the same.

[Mr Ben Bradshaw (Exeter) (Lab)]

Since when has handing over the running of any service to a powerful producer interest been good for the consumer—that is, the public? In the absence of primary care trusts, who will do the difficult but important job of performance-managing underperforming GPs and, where necessary, weeding out incompetent ones?

[Mr Lansley]

The right hon. Gentleman was a member of a Government who said that they would introduce practice-based commissioning, but who then let primary care trusts override the general practice role in determining not only the proper care of patients, but how resources should best be used to make that happen. If he is defending primary care trusts, he is making a very sad choice, because in reality they know that they simply increased their management but did not succeed when it came to commissioning. The right hon. Member for Rother Valley (Mr Barron), the former Health Committee Chairman, produced a report showing that, and it is very clear that—

[Mr Speaker]

Order. I do not want to be unkind to the Secretary of State, but I am thirsting to hear the question from Mr David Burrowes.

[Mr Speaker]

We have got it.

[Mr Lansley]

I am grateful to my hon. Friend. He knows that the criteria that I set out, which were repeated earlier during questions, must be applied, not only to the strategies that were previously presented, but to potential new strategies that Barnet and Chase Farm hospitals might wish to present, in order to ensure that GP commissioning intentions, future patient choice and public views are properly reflected.

[Valerie Vaz (Walsall South) (Lab)]

Many of my constituents are being offered the swine flu vaccine in combination with the seasonal flu vaccine. Will the Secretary of State ensure that they have the choice to have those vaccines separately?

[Mr Lansley]

The hon. Lady will forgive me, but I do not propose to make that available, as it would be a great deal more expensive. Each year, and on an international basis, the World Health Organisation advises on what the seasonal flu vaccine should consist of, and it almost always consists of the three most likely strains combined together into one vaccine.

[Tim Farron (Westmorland and Lonsdale) (LD)]

Is the Secretary of State prepared to make a statement on the vital work of the co-ordination of organ donation at the hospital level, particularly given that under the current system there is no specified organ donation co-ordinator at the Westmorland general hospital in Kendal?

--- Later in debate ---

[Amber Rudd (Hastings and Rye) (Con)]

I know that the Secretary of State is aware of the high level of teenage pregnancies in this country, and particularly in Hastings in my constituency. What action are we going to take to support those young women? We all know of the negative health outcomes that come with those young pregnancies.

[Mr Lansley]

Yes, indeed I do. It is sad to report that we have the highest rate of teenage pregnancies in western Europe. At the heart of this is the fact that we must have community strategies that are geared not least to improving the self-confidence and self-esteem of young people, so that they are able to make better decisions. We must assist them in doing that, but I would also mention the importance of ensuring that we have long-acting reversible contraception available for young people.

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

Each year, around 7,000 more people in the UK are diagnosed with HIV, and more people than ever are living with the virus. How will the Government’s new public health White Paper address HIV prevention?

[Mr Lansley]

The hon. Gentleman will know that the White Paper is yet to be published, so I will not pre-empt it, but it will be important to ensuring that there is a clear strategy for improving sexual health services. He will share our view that we want to deal with the extent of undiagnosed HIV and the extent to which people coming into contact with health care services are not offered HIV tests.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

I recently met a group of Bournemouth and Poole college health and social care students whose research indicated that the average age for repeated sexual activity in the UK is now 16. With that and other information, they have set up a campaign to reduce the age for cervical screening to 20. What action will the Minister take?

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

Dr Clive Peedell, a consultant oncologist at James Cook university hospital in Middlesbrough, said that the coalition Government’s plans for the NHS

“are a roadmap to privatisation”.

That was his reaction to the King’s Fund report, which argues that the plans to make savings in direct NHS expenditure while dismantling local PCTs has the support of fewer than one in four doctors. What is the Secretary of State’s response to that overwhelming opposition from local doctors to the Government’s plans?

[Mr Lansley]

We will, of course, respond to the consultation in due course, but support for the principles of the White Paper was widespread and came from local government and the medical and nursing professions. The issues that we will address in the consultation were mainly about implementation of the principles, but support for the principles was widespread.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will my right hon. Friend confirm that the Government’s policy is to ensure that over the next four years we deliver efficiency gains from the health service, valued by the chief executive at between £15 billion and £20 billion? As that target was first set out by the Labour party when it was in government, will my right hon. Friend take an early opportunity to invite the new shadow Secretary of State to endorse that programme, and to support its specific execution as each change is introduced?

[Mr Lansley]

My right hon. Friend makes an excellent point, and I invite the shadow Secretary of State to respond to it in due course. We will ensure that the NHS uses resources more efficiently to meet increasing demand and costs in the NHS. Savings of that order are required, and the NHS is on track to make them.

[Toby Perkins (Chesterfield) (Lab)]

I would like to return to the subject raised by my hon. Friend the Member for North East Derbyshire (Natascha Engel) about the national hereditary breast cancer helpline. The Minister’s response was inept. She said that a national service will be funded by tons of different GP commissioning groups. That just will not happen. She said nice words about Wendy Watson, but her Government’s policies will see the end of that helpline unless she intervenes. Will she please ensure national funding for a national service?

NHS Organ Donor Register

Lord Lansley Excerpts

Tuesday 19th October 2010 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

I am today publishing the report of an independent review of the NHS organ donor register (ODR) by Professor Sir Gordon Duff. The review, announced on 11 April, was prompted by an error in the recording of the donation wishes of a number of registrants.

I am extremely grateful to Sir Gordon for establishing so clearly the circumstances surrounding this serious error, for his recommendations on how to ensure it does not happen again, and for his wider review of the ODR.

Organ donation relies on the generosity of people who are willing to donate organs after their death to help change or save the lives of others. If organ donation is to help the many people in need of a transplant, it is essential that people who join the ODR have confidence that their wishes are accurately recorded. It is extremely regrettable that as a result of this error donation decisions were influenced by incorrect information in 25 cases. NHS Blood and Transplant (NHSBT) has rightly apologised to the affected families. I would like to offer my condolences to the families concerned for their loss and to express gratitude to their late relative for agreeing to be a donor.

Sir Gordon’s review found that the error originated in 1999 when faulty data conversion software was used by UK Transplant (now part of NHSBT) to upload data on individuals’ organ donation wishes from the Driver and Vehicle Licensing Agency, when moving to a new computer system. These individuals had elected, when completing their driving licence application form, to donate some, but not all of their organs. In 25 cases the decision by the donor’s relatives to agree to the donation of a particular organ was made using inaccurate information about the donor’s wishes as a result of the error. Sir Gordon concluded that the error was avoidable if systematic data verification procedures had been in place in 1999.

The report provides a detailed explanation of how the error occurred, how it came to light, and why it was not uncovered sooner. It also outlines the remedial action taken by NHSBT and the actions taken to prevent a recurrence. Sir Gordon concludes that once the error was identified and brought to the attention of NHSBT’s senior managers it was handled efficiently and sensitively.

Sir Gordon has also concluded that the ODR is now expected to fulfil functions for which it was not originally designed. He believes that a new interactive ODR based on 21st century technology would help to reduce the scope for human error inherent in the current system. He recommends that a new ODR should be designed and commissioned as soon as resources allow. We will discuss this recommendation with NHSBT, once it has completed its planned scoping and costing of a future operating model.

Sir Gordon has made a number of other recommendations addressed to NHSBT which are designed to ensure that the register reflects more clearly the wishes of those registered, and that confidence in the system is maintained. We look to NHSBT to consider those recommendations carefully and to respond accordingly.

Sir Gordon’s report has been placed in the Library and copies are available for hon. Members in the Vote Office.

NHS White Paper

Lord Lansley Excerpts

Monday 18th October 2010 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

Today I am publishing two further consultation documents seeking views on proposals set out in the White Paper, “Equity and Excellence: Liberating the NHS” (Cm 7881). We are consulting on proposals for an information revolution and to give patients greater choice and control. The vision set out in the White Paper is of an NHS and social care system that puts patients and the public first and is more responsive to their needs and wishes—an NHS where patients, service users, carers and families have far more influence and choice in the system and where they have the information they need. “Liberating the NHS: Greater choice and control—A consultation on proposals” and “Liberating the NHS: An Information Revolution—A consultation on proposals” have been placed in the Library and copies are available to hon. Members from the Vote Office. The documents are also available electronically at www.dh.gov.uk/liberatingtheNHS.

“Liberating the NHS: Greater choice and control—A consultation on proposals” further develops the choice commitments set out in the White Paper to:

increase the current offer of choice of any provider significantly;

create a presumption that all patients will have choice and control over their care and treatment and that all patients will have a choice of any willing provider wherever relevant;

introduce choice of named consultant-led team for elective care by April 2011 where clinically appropriate;

extend maternity choice;

begin to introduce choice of treatment and provider in some mental health services from April 2011;

begin to introduce choice for diagnostic testing from 2011;

begin to introduce choice post-diagnosis from 2011;

introduce choice in care for long-term conditions as part of personalised planning;

move towards a national choice offer to support people’s preferences about end-of-life care; and

consult on choice of treatment.

The proposals envisage choice of treatment and health care provider becoming the reality in the vast majority of NHS-funded services by no later than 2013-14.

The second consultation “Liberating the NHS: An Information Revolution—A consultation on proposals” is about transforming the way information is collected, analysed, controlled and used in NHS and adult social care services. The information revolution is about moving:

away from information belonging to the system, to patients and service users being clearly in control;

away from patients and service users merely receiving care, to patients and service users being active participants in their care;

away from information based on administrative and technical needs, to information based on patient and service user consultation and good clinical and professional practice;

away from top-down information collection, to a focus on meeting the needs of individuals and local communities;

away from a culture in which information was held close and recorded in forms that were difficult to compare, to one characterised by openness, transparency and comparability;

away from the Government being the main provider of information about the quality of services to a range of organisations being able to offer service information to a variety of audiences; and

in relation to digital technologies, away from an approach where we expect every organisation to use the same system, to one where we connect and join up systems.

These consultations are opportunities to seek the views of patients, the wider public and the NHS, about the challenges that lie ahead, how we can successfully address them, and how we best take forward the choice and information commitments. Responses to the consultation will help us shape how greater choice and control and the information revolution are delivered.

The consultation period for both documents will close on 14 January 2011.

NHS Constitution (Whistleblowing)

Lord Lansley Excerpts

Tuesday 12th October 2010 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

On 9 June I made a statement to the House about the failings of the Mid Staffordshire NHS Foundation Trust, Official Report, column 333. I made clear my intention to hold a full public inquiry into how these failings have continued unchallenged and undetected for so long.

A culture of fear and secrecy had pervaded this trust, leaving its staff feeling unable to raise concerns. Therefore, I set out action needed prior to the publication of the inquiry’s findings in March 2011. Specifically, I made it clear that I intended to initiate work on whistleblowing, to improve conditions and procedures for those who wished to raise concerns.

Today, I am launching a public consultation on amendments to the NHS constitution and its handbook, which are concerned with making clear the rights and responsibilities of NHS staff and their employers in respect of whistleblowing.

The consultation proposes three key changes:

highlighting existing legal rights of all staff to raise concerns about safety, malpractice or other wrongdoing without suffering any detriment;

introduce an NHS pledge that employers will support all staff in raising such concerns, responding to and where necessary investigating the concerns raised; and

create an expectation that NHS staff will raise concerns about safety, malpractice or wrongdoing at work which may affect patients, the public, other staff or the organisation itself as early as possible.

Responses from all interested parties are welcome. The consultation and response form have been placed in the Library and copies are available to hon. Members in the Vote Office. The documents can also be found at: http://www.dh.gov.uk/en/Consultations/Liveconsultations/index.htm.

The consultation closes on 11 January 2011.

I am pleased to say that this consultation follows significant progress already made on whistleblowing since June. On 25 June 2010 new guidance was published for the NHS, developed through the social partnership forum (SPF) with expert support and advice from the independent whistleblowing charity Public Concern at Work.

Designed to support NHS organisations who are in the process of updating or creating whistleblowing policies and procedures, the guidance promotes best practice. It suggests simple steps to help NHS organisations ensure their whistleblowing arrangements are fit for purpose. The guidance can be found on the Department’s website at:

www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4050929.

In addition, the NHS Staff Council has negotiated changes to the terms and conditions of service handbook for NHS staff covered by Agenda for Change, to include a contractual right and duty to raise concerns in the public interest. A circular to NHS organisations informing them of these changes was published on 13 September 2010 with immediate effect. Both these are available on the NHS employers website at:

www.nhsemployers.org/PayAndContracts/Pay%20circulars/Agenda-for-Change/Pages/2010.aspx.