NHS Reorganisation
Lord Lansley Excerpts(13 years, 8 months ago)
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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.
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.
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.
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—
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.
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.
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—
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.
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
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?
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.
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.
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.
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 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 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—
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.
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”—
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(13 years, 8 months ago)
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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(13 years, 8 months ago)
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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.
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.
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.
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.
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.
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?
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 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?
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(13 years, 9 months ago)
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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(13 years, 9 months ago)
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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(13 years, 9 months ago)
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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.
Oral Answers to Questions
Lord Lansley Excerpts(13 years, 10 months ago)
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Neil Carmichael (Stroud) (Con)
1. What steps he is taking to work with clinicians and patient groups in the design of the cancer drugs fund.
The Secretary of State for Health (Mr Andrew Lansley)
We are committed to ensuring that the cancer drugs fund, which is to be introduced in April next year, will enable NHS patients to have greater access to new cancer drugs. We will soon consult the public and clinicians on our plans for this. From 1 October this year, as an interim measure, regional panels led by expert clinicians will respond to requests to fund cancer drugs that have not been funded locally.
Neil Carmichael
I am delighted with the answer from the Secretary of State. Some people are concerned about the possibility of a postcode lottery. Has the Department thought about that, and what actions does it plan to avoid the fund being subject to that?
Mr Lansley
I am grateful to my hon. Friend. Many people are concerned about their experience of a postcode lottery and access to new cancer drugs. Indeed, there is not just a postcode lottery but an international lottery, with patients in this country not getting access through the NHS to new cancer drugs while patients in other countries do get access to those drugs in the same clinical circumstances. That is why we will not only establish the cancer drugs fund next year, but, this year, we have found £50 million by making savings on management and marketing costs to enable new cancer drugs to be made available, at a regional level across England, where they are not funded locally.
Valerie Vaz (Walsall South) (Lab)
Has the Secretary of State had any discussions with the National Institute for Health and Clinical Excellence about the fund, and is it cash-limited?
Mr Lansley
Yes, I did have discussions with NICE. The interim measure this year is indeed cash-limited—£50 million is available between October and the end of March.
Anne Marie Morris (Newton Abbot) (Con)
Will the Secretary of State consider seriously the situation with regard to Avastin—a drug that particularly relates to bowel cancer? I have a constituent who is dying of that complaint, and their primary care trust has refused treatment under current NICE guidance. NICE is currently reviewing the situation. I would be grateful if the Secretary of State will say that he will support positive findings.
Mr Lansley
My colleagues and I are very well aware of the issues relating to Avastin, and I am grateful to my hon. Friend for her question. In terms of the interim measure that starts on 1 October, patients should go through all the normal procedures of seeking treatment through their hospital with the consent of their PCT. However, if that fails, a regional panel of expert clinicians will be able to look at their circumstances, with a special fund to enable patients to have access to cancer drugs which previously they would not have received.
Diana R. Johnson (Kingston upon Hull North) (Lab)
Of course we support efforts to ensure that those with rarer cancers get access to the drugs that they need, but there are serious concerns about the cancer drugs fund. Professor Alan Maynard says that
“this will run a coach and horses through the work done by NICE”.
The Lancet has called the fund a product of political opportunism and intellectual incoherence leading to the potential for a postcode lottery between strategic health authorities. Where does this leave NICE—an organisation that the Secretary of State said that he wants to strengthen?
Mr Lansley
It in no way undermines the role of NICE, which continues to play a very important role in giving advice to the NHS on the relative clinical effectiveness and cost-effectiveness of drugs. However, there are many circumstances at the moment whereby patients are not getting access to medicines. NICE, through its thresholds, is setting limitations on access to new cancer medicines. The hon. Lady should know, because the research was commissioned under her Government, that we need to look at international variations in drug use across health economies. Her Government did not publish that information; we have published it. It demonstrates that in this country we have relatively poor access to new cancer medicines, often before the point at which NICE has undertaken a full cost-effectiveness appraisal. We are going to ensure that patients in this country do not lose out as a consequence of those delays.
David Tredinnick (Bosworth) (Con)
When considering the drugs fund, will the Secretary of State bear it in mind that many patients who have had chemotherapy find relief from using herbal medicine and acupuncture? When will he come forward with proposals to interface with next year’s European directive so that herbal and acupuncture practitioners can conform to the law?
Mr Speaker
I know that the Secretary of State’s response will relate to the cancer drugs fund.
Mr Jim Cunningham (Coventry South) (Lab)
3. What estimate he has made of the number of redundancies which would result from the abolition of strategic health authorities and primary care trusts?
The Secretary of State for Health (Mr Andrew Lansley)
Our White Paper set out proposals for greater devolution to clinical leadership in the NHS and an enhanced role for local authorities in setting health strategies and improving public health. That means that we will abolish primary care trusts and strategic health authorities. General practice-led consortiums will make decisions about their requirements for management support, as will the new NHS commissioning board and local authorities. However, the requirement to cut management costs and protect the front line will mean reduced numbers of administrative posts. The extent of that will depend on local plans, and we will publish an impact assessment in due course.
Mr Cunningham
The coalition agreement stated that PCTs would be a strong voice for the public. How will the Government achieve that if they are going to abolish them?
Mr Lansley
We set out clearly in the White Paper how we will increase accountability to the public, including by establishing Health Watch. Before the election, the hon. Gentleman’s party’s Government demolished the patient representative voice in community health councils and patients’ forums and created nothing effective in its place. Health Watch will be an effective voice for patients, and democratic accountability through local authorities will be far stronger because Health Watch will enable NHS services, public health services and social care to be joined together through co-ordination in a local authority’s health and well-being partnership.
Mark Pawsey (Rugby) (Con)
On the question of redundancies, the hon. Member for Coventry South (Mr Cunningham) and I represent adjacent constituencies covered by the same NHS trust, in which there is currently a review of urgent care provision at the hospital of St Cross in my constituency. Candidates for the Labour leadership recently visited the area, and one spoke to the Rugby Advertiser about his concern that the review was an example of the
“economic masochism being unveiled across the country by the Tories who continue to show no compassion for the vulnerable.”
Does the Secretary of State share my outrage at the choice of language by the likely Leader of the Opposition, and will he confirm that since this Government have committed themselves to real-terms increases in NHS funding, any reforms considered for Rugby will have nothing to do with the amount of funding for the local NHS?
Mr Lansley
I am grateful to my hon. Friend. We visited St Cross hospital together, so he knows the importance that we both attach to the service that is provided there for his constituents locally, but that happens in the context of the resources that we provide to enable the NHS to do its job. The Government have made an historic commitment to increase resources for the NHS in real terms each year, notwithstanding the appalling financial circumstances that we inherited from the Labour party.
The policy of the right hon. Member for Leigh (Andy Burnham) is to cut the NHS budget. Under those circumstances and under the policies of the Labour party, the number of redundancies in the NHS would proliferate.
Andy Burnham (Leigh) (Lab)
The right hon. Gentleman is planning the biggest reorganisation in the history of the NHS, and yet he is unable to give basic information on it, such as how many people may lose their jobs, to my hon. Friend the Member for Coventry South (Mr Cunningham). Tens of thousands of people who work for primary care trusts and strategic health authorities are at risk of losing their jobs, so it is no wonder that after a just a few short weeks in his job, the Secretary of State has brought morale in the NHS to rock bottom.
In his letter to the NHS, the NHS chief executive says that £1.7 billion should be set aside to pay for the Secretary of State’s reorganisation. Others have said that the cost of his reform could be up to £3 billion. At a time when the NHS needs every penny to maintain standards of patient care, it is scandalous for money to be diverted in that way. He may be ignoring the human cost, but can he tell the House today his latest estimate from the Department of how much his ideological reorganisation will cost?
Mr Lansley
I do wish the right hon. Gentleman would at least remember what he was responsible for before the election. He said that the NHS in this financial year should set aside 2%—£1.7 billion—for the cost of reorganisation. I have not changed that figure by one penny. However, I have taken his policies, which led to a proliferation in management costs—an 80% increase in the cost of management consultants in the NHS in two years and a doubling of management costs in PCTs and SHAs in eight years—and reversed them. We are cutting management costs in the NHS this year by more than £220 million and by up to £1 billion over four years. I make no apology for that, because if we are to protect front-line services and improve health outcomes, that is exactly what we need to do.
Andy Burnham
Let us first get some facts straight. I asked PCTs to set aside money to invest in patient care, changing patient pathways and better services. I did not say that a Labour Government would cut the NHS budget; I said that we would maintain it in real terms, not increase it, as the Secretary of State proposes. The effect of his increase will mean severe cuts to councils, which need to provide care support to older people to get people out of hospital.
However, the Secretary of State would not today tell us what his proposals would cost. Is it not the case that the plans were not in the Conservative or Liberal Democrat manifestos, and that there is no democratic mandate for the break-up of the NHS? Given that there is now a chorus of protest at his plans, will he step back, listen to patients and staff and consult on those reforms before taking them forward further?
Mr Lansley
I and my colleagues are engaging right across the country with patients, the public, local authorities, PCTs and general practitioners, and we are meeting enthusiasm for our proposals. Why? Because we are focusing on delivering improving outcomes for patients, and doing so in the context of an historic commitment by this coalition Government to increase resources for the NHS in real terms each year. The right hon. Gentleman’s policy would be to cut the NHS budget.
Andy Burnham
The Secretary of State thinks he can behave any way he likes with the NHS, the most beloved institution in this country, but we will not let him—we will give him a fight every inch of the way. The latest example of his high-handed and arrogant behaviour came on the eve of a bank holiday weekend, when he casually let slip that NHS Direct would be scrapped. NHS Direct is a valued service that receives 27,000 calls every day and saves millions of pounds for the NHS, and that has more than 3,000 staff working for it. Will he today apologise for making that statement in such an outrageous manner? Will he listen to the 14,000 people who signed a petition to save NHS Direct, and going forward, stop acting in such a cavalier manner with our NHS?
Mr Speaker
Order. A question should be a question—it should not really be three questions.
Mr Lansley
Once again, the right hon. Gentleman should remember what he did before the election. A press release from his Department on 18 December 2009, when he was Secretary of State, said that he would establish a new 111 national number for non-emergency health care, and that this could become the single number to access non-emergency care services, including NHS Direct. I did not announce anything: I simply said that we were going to get on with that—he never did.
Mr Peter Bone (Wellingborough) (Con)
4. What plans he has for the future of the national capitation formula.
Gordon Birtwistle (Burnley) (LD)
14. What steps his Department takes to ensure that local NHS trusts observe its guidelines on reconfigurations involving transfer of facilities from one hospital to another.
The Secretary of State for Health (Mr Andrew Lansley)
Commissioners should ensure that current and future reconfigurations demonstrate evidence of compliance with the four criteria that I announced in May. That should be a rigorous process, involving GPs and other local clinicians, local authorities, patients and the public, as set out in guidance. For current schemes, the local assessment should be concluded by 31 October this year.
Gordon Birtwistle
Is my right hon. Friend aware that East Lancashire Hospitals NHS Trust is breaching his guidelines by transferring a children’s ward from Burnley to Blackburn without the approval of local GPs and the local council or the support of the local population? Will he please intervene?
Mr Lansley
My hon. Friend and I have had a conversation in Burnley about emergency and children’s services at Burnley hospital. I was not aware of the position that he has just described, but I will ensure that any reconfigurations that have taken place in the past and are still being reviewed, or that are currently being proposed or acted on, comply with the criteria that I set out in May, and I will write to him.
Anna Soubry (Broxtowe) (Con)
15. What mechanisms are in place to assess the effectiveness of assertive outreach teams in providing support for people with severe mental illness; and if he will make a statement.
Caroline Flint (Don Valley) (Lab)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Andrew Lansley)
My responsibility is to lead the national health service in delivering improved heath outcomes in England, to lead a public health service that improves the health of the nation and reduces health inequalities, and to lead the reform of adult social care that supports and protects vulnerable people.
Caroline Flint
In recent years more research and evidence has demonstrated that the trans fats present in our food are a major heath hazard. That is how the National Institute for Health and Clinical Excellence has described them, and the World Health Organisation has described them as toxic, but many people do not even know they are in our foods because they are not listed on the front of our food packaging. Is the Secretary of State prepared to consider banning trans fats in our food, as is happening in other countries around the world, or at the very least consider making sure they are labelled on the products we buy so that we can make an informed choice?
Mr Lansley
The right hon. Lady will know that we have made progress in this country in reducing the amount of trans fats in foods. My personal view is that we should seek to eliminate them, rather than have them in foods and have them labelled. It is important that we have front-of-pack food labelling that identifies the extent to which there are saturated fats, and I am looking forward to making greater progress in getting a more consistent front-of-pack food labelling than we have achieved in the past.
Tony Baldry (Banbury) (Con)
T2. GPs and GP practice managers in my constituency are keen to get on with GP commissioning because they see that that can lead to better outcomes for local people but, unsurprisingly, they have a number of detailed questions as to how GP commissioning will work. Who will best answer those questions, and when will that happen?
Mr Lansley
My ministerial colleagues, and many other leadership colleagues across the NHS, are engaged in meeting staff and potential commissioners, and existing commissioners and patients and public across the country. I had a meeting of that kind in Hampshire just last week, which illustrated precisely the point my hon. Friend makes: people came from general practices across Hampshire, and they fully endorse the principle of this change and they just want to get on with it. They did not want to wait for the full transition, and they now wanted to go through some of the detailed questions. We issued a consultation document following the White Paper, which was focused on general practice commissioning. I urge my hon. Friend’s constituents and others to respond to that before 11 October, which will enable us then to proceed to set out the full details of how general practice-led commissioning will work.
Mary Creagh (Wakefield) (Lab)
The Secretary of State had a difficult summer, with his plans to scrap free milk for the under-fives being attacked across the spectrum and eventually vetoed by the Prime Minister, but he met the new chair of Unilever, Amanda Sourry, on 21 July. On the following day, Ms Sourry wrote him a letter, some of which is blanked out. She wrote that
“with a clear signal from you, I would be happy to engage with retailers and manufacturers to find resolution on front-of-pack labelling”.
The Department has tried to black out that sentence, perhaps because it shows an unhealthy closeness between the Secretary of State and Unilever. Does the Secretary of State have an opinion on how food should be labelled, and, if so, will he tell the House what it is? Will he tell the House what other areas of food policy he plans to subcontract out to multinational food giants?
Mr Lansley
I hardly know where to begin due to the absurdity of some of the assertions in that question. How does the hon. Lady imagine that we are going to make progress on front-of-pack food labelling, on which her Government never made sufficient progress—there is no consistency on front-of-pack food labelling? This Government and this Parliament have no unilateral power to mandate what front-of-pack food labelling should look like and we have to achieve consensus in Europe and consensus in this country. We must do that with the manufacturers, the retailers, the charities and the health experts. That is precisely why our public health commission, when we were in opposition, brought together all those people around a table for the first time. I intend to create a realistic and effective partnership to deliver improving public health in this country, where her Government failed.
Mr Philip Hollobone (Kettering) (Con)
T5. Kettering general is a wonderful hospital but recently its paperwork has got out of control. Some 30 occasional chaplaincy visitors from the local Catholic Church, many of whom are retired, have recently had to complete Criminal Records Bureau checks, employer references and an intrusive personal health questionnaire. Does the Minister agree that if we are to create the big society that the Prime Minister would like us to create, such bureaucracy must be minimised?
Keith Vaz (Leicester East) (Lab)
T3. Some 1,800 patients in the Belgrave area of my constituency have been left without their local surgery because it has closed. Will the Minister assure me that despite the scrapping of the primary care trust, the new Belgrave health centre will be built? If he cannot tell me now, it would be very helpful if he could write to me.
Mr Lansley
I am grateful to the right hon. Gentleman, but in the absence of notice of that question, I fear that I shall have to tell him that I shall certainly look into that and write to him.
Miss Anne McIntosh (Thirsk and Malton) (Con)
T6. The Minister of State wrote to me on 25 August to say that all future service changes must be led by clinicians and patients. How can it be that, although all the clinicians and patients oppose the downgrading and possible closure of the Ryedale ward of Malton hospital, that can proceed? Will he please use his good offices to block any such change?
Gloria De Piero (Ashfield) (Lab)
T4. When the Government say that the NHS budget will be ring-fenced, people might assume that whatever cash a hospital gets in this financial year will be matched next financial year. So could the Health Secretary explain why the King’s Mill hospital in my constituency has been told to expect its budget to treat patients next year to fall by 8.2% or £14.9 million?
Mr Lansley
The answer to the hon. Lady’s question is probably because that is what the Labour Government’s spending intentions implied. All over the country primary care trusts are telling their hospitals that they can expect a zero increase in tariff and a reduction in activity, and hence a reduction in budget. I am making it clear that we are intending an historic commitment by this coalition Government to increase the resources for the NHS in real terms. That does not mean an increase in real terms for every part of the NHS all the time. It does mean, however, that resources will be realised through efficiency savings and that increase to enable us to improve the service we provide through the NHS and to meet rising demand.
Mr John Baron (Basildon and Billericay) (Con)
T8. Is any flexibility available to allow the interim cancer drug fund to review earlier and more speedily adverse National Institute for Health and Clinical Excellence decisions—because in certain cases, as we know with Avastin for late-stage bowel cancer, a few months, or even a few weeks, can make a big difference to patients.
Mr Lansley
My hon. Friend will be aware that we have proceeded as rapidly as we possibly can in finding savings this year, so that from 1 October the regional panels of expert clinicians can look at individual cases. It is not a matter of their reviewing NICE decisions; it is a matter of their looking at individual cases that cannot be funded under existing guidance or local decisions, but being able to apply clinical criteria to individual cases using an additional fund.
Emma Reynolds (Wolverhampton North East) (Lab)
T7. Wolverhampton is the 28th most deprived local authority area in the country, resulting in major health inequalities. Can the Secretary of State reassure me that in future funding allocations, levels of deprivation will be taken into account?
Mr Lansley
Yes and more than that. I could make it clear that in the future, we will be moving—not for next year necessarily, but in years beyond, as we will make clear in the public health White Paper—to an explicit allocation of public health resources taking account of relative health outcomes and health inequalities, and those funds will be used to deliver improving public health. At the moment the formula to the NHS may take account of relative deprivation as measured by, for example, access to income support, but the money does not get spent on reducing those health inequalities and on an effective public health strategy. That is why we shall be very clear about separate, ring-fenced, public health resources used, together with local authorities, to deliver an effective public health strategy locally.
Andrew Selous (South West Bedfordshire) (Con)
Leighton Buzzard is one of the larger towns in the country not to have a community hospital. What reassurance can my hon. Friend give me that the wishes of local GPs will be respected in deciding what services the proposed community hospital will have?
John Mann (Bassetlaw) (Lab)
Some 36,000 of my constituents, who voted by ballot, and every single GP in both local authorities, all believe that Bassetlaw accident and emergency department should remain a full 24-hour service. Can the Secretary of State conceive of any reason why that might not be the case during this Parliament?
Mr Lansley
The hon. Gentleman will be reassured to recognise that one of the commitments of the coalition Government in our programme was to stop the forced closure of accident and emergency departments. I am sure he will take comfort from the commitment of this Government, and from our commitment to increasing resources for the NHS in real terms each year, to enable the services that his constituents and others’ require to continue to be provided and improved.
Jo Swinson (East Dunbartonshire) (LD)
Information in a parliamentary answer given on 19 July showed that the cost to the NHS of emergency admissions in cases of anaphylaxis has risen by 45% in four years. Will the Minister look at how allergy support services could be enhanced in primary care to reverse the rising trend in emergency cases and in doing so save money and, crucially, lives?
Mr Lansley
Yes I will gladly do that. I have had the privilege and pleasure of visiting the specialist allergy service at my local hospital, Addenbrooke’s, one of a small number across the country. I think it was the House of Lords Select Committee that produced an excellent report on allergy services, and I hope that this is one of those areas where clinical relationships between GPs and hospital specialists will enable both community and specialist services to be improved to meet this need.
Mr Kevin Barron (Rother Valley) (Lab)
Given that 50% of health inequalities are created by tobacco use, will the Secretary of State give us an assurance that the targeted smoking cessation programmes in the national health service will survive?
Mr Lansley
We are going to improve the effectiveness of our public health services. As the right hon. Gentleman will know from past debates, I entirely recognise the extreme importance of reducing tobacco use. After the introduction of legislation on smoking in public places, there was a reduction in prevalence, but at the moment there is no continuing further reduction, especially among manual workers and young people; we need to achieve that reduction, and we will continue to look at measures to do that. We will say more about the issue in our public health White Paper.
Mr Steve Brine (Winchester) (Con)
Many of my constituents, and indeed many practitioners, have grave concerns about the pending closure of Winchester ambulance station. Will the Minister assure the House that no changes to static ambulance bases will take place until local consortiums, when they are formed, are happy that a suitable alternative is in place?
Mr Lansley
I am aware of the matter. The right hon. Gentleman will be perfectly well aware of my view: we want to involve general practitioners much more in commissioning out-of-hours services. I will undertake to look at what is proposed by the primary care trusts in north London and see whether it is consistent with the development that we are looking for in the White Paper.
Mrs Helen Grant (Maidstone and The Weald) (Con)
If local GPs fail to support reconfiguration plans en masse—if, say, 97% fail to do so—what would be the Secretary of State’s response?
Mr Lansley
As I said in response to a previous question, one of the four criteria that I set out on 21 May was that reconfigurations must have the support of local general practitioners as the future commissioners of services. To that extent, a reconfiguration that did not have the support of local general practices would not be able to meet that test.
Ian Paisley (North Antrim) (DUP)
What discussions, if any, has the Secretary of State had with the Minister for Health, Social Services and Public Safety in Northern Ireland about making Avastin and other specialist cancer drugs available on the same terms and conditions under which they are available to people who suffer from cancer here on the mainland? Will those drugs be made available in Northern Ireland under the same terms and conditions?
Mr Lansley
I have had very helpful and productive conversations with the Health Minister in Northern Ireland, but I have to say that they did not include that particular subject. Of course, decisions on the availability of medicines in Northern Ireland are a devolved matter, but I should be perfectly happy to take account of those issues when we next talk.
Dr Sarah Wollaston (Totnes) (Con)
One year on from the implementation of the European working time directive, there is evidence that patient care is suffering. Handovers have been inadequate in some cases, and junior doctors’ training time has been reduced. Will my right hon. Friend reassure me that he will take action to allow some acute specialities to opt out of the European working time directive?
Mr Lansley
Yes. I am very clear that, together with my right hon. Friend the Secretary of State for Business, Innovation and Skills, we need to take the European working time directive back to the European Union. We need to discuss it again. We need to go to the European Union with the intention of maintaining the opt-out and of giving ourselves, not least in the health context, the flexibility that we lack, so that junior doctors, in particular, have the capacity to undertake the training that they need. It is not that we want to go back to the past, when there were excessive hours—100-hour weeks and so on—but we want junior doctors to be confident that they will get the training that they require in the period allocated for training.
Cancer Drugs
Lord Lansley Excerpts(13 years, 12 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
In 2008, Professor Sir Mike Richards, National Cancer Director, was asked to lead a review of the extent and causes of international variations in drug usage and provide a report. Professor Richard’ report has been in the Library of the House and copies are available to hon. Members from the Vote Office.
I would like to thank Professor Richards and his advisory group for their work on the report. They have undertaken a thorough review, which represents the most comprehensive analysis yet of the extent and potential causes of international variations in medicines usage.
The report explores the extent and causes of international variations in drug usage across 14 countries, including the United Kingdom, for a range of conditions and diseases. The report indicates that there are wide international variations in usage of most of the drugs included in the study. Although a few countries emerge as generally high or low users, there does not appear to be a uniform pattern across disease areas.
As with most of the countries studied, usage levels in the UK appear mixed when looking across the range of conditions. It does however show high levels of use in some important areas, for example of lipid-regulating drugs which are helping to prevent many deaths from cardiovascular disease.
One of the more concerning findings in the report relates to our usage of newer cancer drugs, which lags behind that of most of the countries studied. The findings in this report make it even more important that Government do everything it can to remove barriers to doctors prescribing the cancer drugs they think will help their NHS patients. In the medium term our plans to introduce value-based medicines pricing in 2014, on expiry of the current pharmaceutical price regulation scheme, will allow Government to take the initiative on access to new medicines. We will make new medicines available to NHS patients at a price that represents their value, rather than being restricted to recommending against the use of a new drug in the NHS due to the price its manufacturer sets.
However, we also need to act to improve access to these drugs in the meantime. As an interim measure, the coalition agreement set out our plans to establish a cancer drugs fund from April 2011, subject to the spending review outcome. The need for this fund is clearly supported by Professor Richards’ findings, and we will be consulting on our plans for the fund later in the year. But the report underlines the need for action now to help NHS patients access the cancer drugs their doctors think will benefit them.
I am therefore announcing today additional funding of £50 million for this financial year to support improved access to cancer drugs. This funding, which has been found from a review of Department of Health central budgets, will be made available through clinically-led regional panels from October 2010.
This Government are committed to ensuring that cancer patients no longer have to worry about whether they will be able to get the cancer drugs their doctors recommend from the NHS.
NHS White Paper (Supporting Information)
Lord Lansley Excerpts(13 years, 12 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
Today I am publishing two further supporting documents to the national health service White Paper, “Equity and Excellence: Liberating the NHS” (Cm 7881) which was published on 12 July.
The first document, “Regulating Healthcare Providers”, provides further detail on the principles of the policies set out in the White Paper, and seeks views from the public and external partners on some of the questions arising out of them.
The White Paper set out a vision for a national health service centred around the needs of patients, focusing consistently on improving quality of care. One of the fundamental features of the proposals is to free providers from political interference and to establish a stable, transparent regulatory environment.
“Regulating Healthcare Providers” therefore sets out proposals to free providers from central Government controls and to develop Monitor, the current regulator for foundation trusts, as an independent economic regulator for health and adult social care.
Under our proposals, all remaining NHS trusts will become or be part of a foundation trust, free from the state’s operational control and not subject to the Secretary of State’s direction. We will create an environment where staff and organisations enjoy greater freedom and clearer incentives to flourish. All providers should be able to compete on a fair playing field, so that they succeed or fail according to the quality of care for patients and the value they offer the taxpayer.
Monitor will be responsible for regulating all providers to promote efficient, financially sustainable service provision. It will operate independently of Government so that providers have confidence in a stable, rules-based system—without the risk of political interference—to make long-term investments in services. Monitor will have powers to license providers of NHS services and core functions to regulate prices for NHS services, where needed, to promote competition, and to support service continuity.
The document seeks views on a number of questions by 11 October.
Today, I am also publishing the report of the Department’s review of its arm’s-length bodies.
The publication, sets out our proposals for arm's-length bodies in the health and social care sector. These proposals form part of the cross-Government strategy to increase accountability and transparency, and to reduce the number and cost of quangos.
The Government’s proposed reforms of the NHS, set out in “Equity and Excellence: Liberating the NHS”, will establish more autonomous institutions, with greater freedoms, clear duties and transparency in their responsibilities to patients. Power will be devolved to the front-line. Liberating the NHS will fundamentally change the role of the Department and those bodies accountable to it. Changes to the arm’s-length body sector must reflect these wider reforms.
There is also an economic imperative for change. The Government have guaranteed that spending on health will increase in real terms in every year of this Parliament and are committed to increasing the proportion of resource available for front-line services, to meet the current financial challenges and the future costs of demographic and technological change. This means that we need to make significant cuts in the costs of health bureaucracy. Over the next four years, the Government will reduce NHS administrative costs by more than 45%, freeing up resources for front-line care.
The review has assessed arm’s-length bodies in light of both the current financial challenges and the strategy for the NHS set out in “Equity and excellence: Liberating the NHS”. Only those functions which need to be carried out a national level to support the Department’s clear objectives should remain in the sector. Functions that are better delivered by other parts of the system should be devolved to the right level, and organisations that carry out these functions should be abolished. Shifting functions from public bodies back into the Department, or to those who are closer to local needs and are independent of the state, will ensure more direct accountability to local people, Parliament and Ministers.
By ensuring that functions are delivered in the right place, the sector will be streamlined to cut costs and remove duplication and unnecessary burdens on the front line. The review will achieve a significant reduction in the number and cost of public bodies.
The Department will impose tight governance and accountability over the cost and scope of its remaining arm’s-length bodies. In future, arm’s-length bodies’ independence will be exercised within the confines of clear and agreed functions. This is in line with the Government’s wider commitment to increase transparency and accountability.
The report details the proposals for each of the Department’s bodies. Where changes require primary legislation, these will be enacted through legislation which will be introduced in this Parliament.
Proposals for the General Social Care Council (GSCC), the regulatory body for social workers, are included in the report. My predecessor issued a written ministerial statement on 4 November 2009, Official Report, column 41WS about the publication of the Council for Healthcare Regulatory Excellence’s (CHRE) report and recommendations on the General Social Care Council (GSCC) function relating to conduct. As part of its response to CHRE’s report the previous Administration announced that the GSCC would report on its progress to Ministers at the end of March. This report has now been received and is published today.
While the GSCC has made good progress over preceding months, the reality is that the costs of maintaining an independent regulator for social workers are prohibitive and we therefore propose to transfer the function of regulating social workers to the Health Professions Council, which will accordingly be renamed to reflect its remit.
These publications will be of interest to anyone working in the health and social care sector, to taxpayers, and to people who use health and social care services.
Copies of today’s publications have been placed in the Library and copies are available to hon. Members from the Vote Office.
“Regulating Healthcare Providers” can be viewed at:
www.dh.gov.uk/en/Consultations/Liveconsultations/DH_117782
The report of the arm’s length bodies review can be viewed at:
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117691
NHS White Paper Consultation
Lord Lansley Excerpts(14 years ago)
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The Secretary of State for Health (Mr Andrew Lansley)
Today I am publishing two further supporting documents to the national health service White Paper, “Equity and Excellence: Liberating the NHS”, which was published on 12 July. The documents have been placed in the Library, and copies are available to hon. Members in the Vote office. The documents are also available at: www.dh.gov.uk/liberatingtheNHS.
The documents, “Commissioning for Patients” and “Local Democratic Legitimacy in Health” provide further detail on the principles of the policies set out in the White Paper, and seek views from the public and external partners on some of the questions arising out of them.
One of the central features of the proposals in the White Paper is to devolve commissioning responsibilities and budgets as far as possible to those who are best placed to act as patients’ advocates and support them in their healthcare choices. “Commissioning for Patients” sets out my intended arrangements for general practitioner (GP) commissioning and the role of the NHS Commissioning Board.
Through our world-renowned system of general practice, GPs and other primary care, professionals are already supporting patients in managing their health, promoting continuity and co-ordination of care, and making referrals to more specialist services. In empowering GP practices to come together in wider groupings, or “consortia”, to commission care on their patients’ behalf and manage NHS resources, we are building on these foundations. We are also empowering primary care clinicians to work more effectively alongside the full range of other health and care professionals and, where appropriate, to work collaboratively to combine their commissioning power and influence. The NHS Commissioning Board will provide overall leadership on commissioning for quality improvement. It will have a duty to ensure comprehensive coverage of consortia and hold them to account for the outcomes they achieve and for their financial performance.
“Local Democratic Legitimacy in Health” is a joint publication between my Department and the Department for Communities and Local Government. It sets out proposals to increase local democratic legitimacy in a way that is consistent with national accountability for a national health service. Local authorities will become responsible for local public health improvement functions. They will have a new role in shaping NHS commissioning activities and a new role promoting integration. Local authorities will lead in assessing the needs of their populations and co-ordinate local strategies to address these needs. This will promote integration and partnership across the NHS, social care, public health and wider services such as housing and disability services. Local HealthWatch organisations, acting as independent consumer champions, will also be funded by and accountable to local authorities. To reinforce local accountability, local authorities will be responsible for ensuring that local HealthWatch are operating effectively, and for putting in place better arrangements if they are not.
The document also outlines how local authorities may choose to work with their partners to implement the arrangements and how the new public and patient involvement and local authority health improvement functions will be taken forward.
Both documents seek views on a number of questions by 11 October.