Commission on the Funding of Care and Support
Lord Lansley Excerpts(13 years, 9 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I have today placed in the Library the terms of reference for the Commission on the Funding of Care and Support. Copies are available to hon. Members in the Vote Office.
I am also pleased to announce to the House that Andrew Dilnot will be chairing the commission. There will be two additional Commissioners, Dame Jo Williams and Lord Norman Warner. The commission will also draw on the expertise of two expert independent panels, one comprising academics and the other experts drawn from the financial services industry.
Urgent reform of the social care system is needed and the Government have made clear their commitment and determination to reach a fair and enduring settlement for the system for generations to come. We want a sustainable adult social care system that gives people the support and freedom to lead the life they choose, with dignity.
This announcement follows on from the commitment set out in the coalition agreement to—
“establish a commission on long-term care, to report within a year. The commission will consider a range of ideas, including both a voluntary insurance scheme to protect the assets of those who go into residential care, and a partnership scheme as proposed by Derek Wanless”.
It is my intention to publish a White Paper next year, which will bring together the conclusions of the commission, with the work being led by the Law Commission on creating a single modern statute for social care, and the Government’s vision for social care. This will be followed with legislation to establish a sustainable legal and financial framework for adult social care in this Parliament.
NHS White Paper Consultation
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 the first of five supporting documents to the NHS White Paper, “Equity and Excellence: Liberating the NHS”, which was published on 12 July. “Transparency in outcomes: a framework for the NHS”, has been placed in the Library and copies are available to hon. Members from the Vote Office. The document is also available electronically at: www.dh.gov.uk/liberatingtheNHS.
The publication of this document marks the start of a full public consultation on the development of an NHS outcomes framework and fulfils a key commitment made in the White Paper to develop this in partnership with patients, the public and all those working or with an interest in the NHS.
The White Paper set out the coalition Government’s ambition for the NHS to provide among the best outcomes in the world, delivered by empowered and engaged healthcare professionals liberated from central control and political interference.
“Transparency in outcomes: a framework for the NHS” puts forward proposals for a framework that is designed to refocus the efforts and accountabilities running throughout the NHS on improving the health outcomes achieved for patients.
The NHS outcomes framework will include a focused set of national outcomes goals and supporting measures which patients, the public and Parliament will be able to use to judge the overall performance of the NHS. The framework will also provide a mechanism by which the Secretary of State for Health can hold the proposed NHS Commissioning Board to account for the outcomes it is securing for patients through its role in allocating resources and overseeing the commissioning process that, in future, will be led locally by general practitioner consortia.
The consultation document puts forward proposals for a framework structured around five broad outcome domains and seeks views on this structure, the core principles that should underpin the development of the framework as well as the more specific outcome measures that should be included under each domain. The proposed outcome domains are:
Domain 1: Preventing people from dying prematurely.
Domain 2: Enhancing the quality of life for people with long-term conditions.
Domain 3: Helping people to recover from episodes of ill health or following injury.
Domain 4: Ensuring people have a positive experience of care.
Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm.
The consultation period will close on 11 October 2010.
Overseas Doctors (Out-of-hours Services)
Lord Lansley Excerpts(13 years, 9 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I have today laid before Parliament the Government’s response to the House of Commons Health Committee’s report “The use of overseas doctors in providing out-of-hours services: Fifth Report of Session 2009-10” which was published on 8 April 2010.
This Government are committed to ensuring that foreign healthcare professionals are not allowed to work in the national health service unless they have proven their competence and language skills, and we are working with the General Medical Council and others to explore a number of options to put a stop to foreign doctors slipping through the net.
In particular, we plan to explore how the proposed NHS Commissioning Board could oversee a more effective system for undertaking checks on language knowledge of primary care practitioners to address the historic lack of consistency in the application of checks by primary care trusts.
The Government also share the concerns raised by the Committee that since 2004 there have been serious failures in out-of-hours services, both on the part of the Government of the day to secure good value for money from the 2004 reforms and on the part of some primary care trusts to monitor the quality of out-of-hours services effectively since then. This situation has been compounded by a lack of clarity on responsibility between commissioners and providers and little or no integration of out-of-hours care with urgent care.
The Government are committed to providing universal access to high-quality urgent care services 24 hours a day, seven days a week, including out-of-hours services. Our vision for urgent care will be to replace the ad hoc unco-ordinated system that has developed in England over the last 13 years.
We will help the public to better understand what urgent care services are available to them by improving information to support choice and accountability and introducing a new single telephone number to provide consistent clinical assessment at point of contact and direct patients to the right service, first time. The proposed new NHS Commissioning Board will also have a role in ensuring that those commissioning out-of-hours services ensure that contracts with out-of-hours providers detail rigorous standards in respect of the recruitment, induction and training that doctors should receive and that there is more effective contract monitoring.
Health Select Committee Report on Social Care
Lord Lansley Excerpts(13 years, 10 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I have today laid before Parliament the Government’s response to the Health Select Committee’s report on social care (Cm7884).
We know that urgent reform of the social care system is needed and we are grateful to the Health Select Committee for its report on social care. This is an important contribution to the debate on how to deliver a care and support system which provides much more control to individuals and their carers, reduces the insecurity they and their families face and ensures that people are treated with dignity and respect.
We have made clear our commitment and determination to move on from more than a decade of indecision on how to fund social care, and to reach a fair and enduring settlement for the system for generations to come. We want a sustainable adult social care system that gives people the support and freedom to lead the life they chose, with dignity.
The coalition agreement sets out our commitment to:
“establish a commission on long-term care, to report within a year. The commission will consider a range of ideas, including both a voluntary insurance scheme to protect the assets of those who go into residential care, and a partnership scheme as proposed by Derek Wanless”.
We recognise that how we should fund care and support is a key question for society to face—and one that will inevitably involve difficult choices and difficult trade-offs. But it is a question we can no longer avoid. We are grateful to the Health Select Committee for its interest in this area and will be recommending that the soon to be established Commission on the Funding of Care and Support consider its report, alongside other contributions to the debate.
We will also take decisive steps to accelerate the pace of reform so that older people and disabled people get the care they need and have more choice and control over how their needs are met. Transformation of services should be a key part of how local authorities continue to deliver services effectively and efficiently during a period of fiscal consolidation. As we take critical steps to reduce the deficit, the right response is for the pace of transformation to increase—maximising the performance and penetration of services such as re-ablement, intermediate care and telecare.
Later this year, we will publish a vision for adult social care, including the key next steps on personalisation.
In addition, as a key component of a lasting settlement for the social care system, we will reform the law underpinning adult social care by creating a single modern statute, helping disabled people, older people and carers to understand whether services can or should be provided. We will be working with the Law Commission as they consider their proposals on this work.
We will bring together the conclusions of the Law Commission and the Commission on the Funding of Care and Support, with our vision, into a White Paper in 2011, with legislation following to establish a sustainable legal and financial framework for adult social care in this Parliament.
As a coalition Government, established with the aim of working together in the national interest, we have an unprecedented political opportunity to deliver reform. Care and support is a good example of where we need pragmatic, sustainable proposals to build a new and lasting settlement.
Health Select Committee Report on Commissioning
Lord Lansley Excerpts(13 years, 10 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
We are today laying before Parliament the Government’s response (Cm 7877) to the Health Select Committee report on commissioning, which was published on 30 March 2010.
The range of the Health Select Committee’s inquiry and their report recognise the scale and complexity of the challenge we face. Commissioning is a crucial process in the NHS. It ensures that the health and care services provided effectively meet the needs of the population. It is a complex process with responsibilities ranging from assessing population needs, prioritising health outcomes, procuring products and services to managing service providers.
Since the Health Select Committee’s inquiry, there has been a change of administration following a general election in May 2010. The Command Paper published today therefore sets out the present coalition Government’s response to the Health Select Committee’s fourth report of the session 2009-10.
The White Paper, “Equity and Excellence: Liberating the NHS”, published on 12 July 2010, sets out our proposals for transforming the quality of commissioning by devolving decision making to local consortia of GP practices supported by an independent NHS Commissioning Board.
The weaknesses in commissioning identified by the Health Select Committee are symptomatic of a system that did not emphasise the importance of clinical involvement in decisions about how the precious resources of the NHS should be spent. We have set out in the White Paper a clear sense of direction, with new rigour and the commitment to put commissioning decisions in the hands of those who are closest to patients themselves—GP practices and other primary care professionals.
Today’s publication is in the Library and copies are available to hon. Members from the Vote Office.
NHS White Paper
Lord Lansley Excerpts(13 years, 10 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
With permission, Mr Speaker, I would like to make a statement on the future of the national health service.
The NHS is one of our great institutions, and a symbol of our society’s solidarity and compassion. It is admired around the world for the comprehensive care it provides and for the quality, skill and dedication of its staff. I begin today by paying tribute to the staff of the NHS and the commitment they daily show to patients in their care.
This Government will always adhere to the core principles of the NHS: a comprehensive service for all, free at the point of use, based on need, not ability to pay. That principle of equity will be maintained, but we need the NHS also consistently to provide excellent care.
The NHS today faces great challenges: it must respond to the demands of an increasing and ageing population, advances in medical technology and rising expectations; it remains stifled by a culture of top-down bureaucracy, which blocks the creativity and innovation of its staff; and it does not deliver outcomes in line with the best health services internationally—many of our survival rates for disease are worse than those of our neighbours. The NHS must be equipped to meet those challenges. We believe it can do much better for patients, so today I am publishing the White Paper, “Equity and Excellence: Liberating the NHS”, so that we can put patients right at the heart of decisions made about their care, put clinicians in the driving seat on decisions about services, and focus the NHS on delivering health outcomes that are comparable with, or even better than, those of our international neighbours.
For too long, processes have come before outcomes, as NHS staff have had to contend with 100 targets and over 260,000 separate data returns to the Department each year. We will remove unjustified targets and the bureaucracy that sustains them. In their place, we will introduce an outcomes framework setting out what the service should achieve, leaving the professionals to develop how.
We should have clear ambitions, and our approach will be set out shortly in a further consultation document. For example, our aims could be: to achieve one and five-year cancer survival rates above the European average; to minimise avoidable hospital-acquired infections; and to increase the proportion of stroke victims who are able to go home and live independently—in short, care that is effective, safe and meets patients’ expectations.
The outcomes framework will be supported by clinically established quality standards, and the NHS will be geared across the board towards meeting them. We will do that by rewarding commissioners for delivering care in line with quality standards; strengthening the regulatory regime so that patients can be assured that services are safe; and reforming the payment system in the NHS, so that it is a driver not just for activity, but also for quality, efficiency and integrated care.
Patients will be at the heart of the new NHS. Our guiding principle will be “no decision about me, without me.” We will bring NHS resources and NHS decision making as close to the patient as possible. We will extend “personal budgets”, giving patients with long-term conditions real choices about their care. We will introduce real, local democratic accountability to health care for the first time in almost 40 years by giving local authorities the power to agree local strategies to bring the NHS, public health and social care together. Local authorities will also be given control over local health improvement budgets. This will give an unprecedented opportunity to link health and social care services together for patients. We will give general practices, working together in local consortiums, the responsibility for commissioning NHS services, so that they are able to respond to the wishes and needs of their patients. This principle is vital, bringing together the management of care with the management of resources. With commissioning support, GPs collectively will lead a bottom-up design of services.
In addition, we will introduce more say for patients at every stage of their care, extending the right to choose far beyond a choice of hospital. Patients will have choice over treatment options, where clinically appropriate, and the consultant-led team by whom they are treated. They will have the right to choose their GP practice, and they will have much greater access to information, including the power to control their patient record. We must ensure also that patients’ voices are heard, so we will establish HealthWatch nationally and locally, based on local involvement networks, to champion the needs of patients and the public at every level of the system.
To achieve these improvements in outcomes, we need to liberate the NHS from the old command-and-control regime, so all NHS trusts will become foundation trusts, freed from the constraints of top-down control, with power increasingly placed in the hands of their employees; and we will allow any willing provider to deliver services to NHS patients—provided that they can deliver the high-quality standards of care we expect from them. Our aim is to create the largest social enterprise sector in the world, but it is not a free-for-all. Monitor will become a stronger economic regulator to ensure that the services being provided are efficient and effective, and that every area of the country has the NHS services it needs to provide a comprehensive service to all. The Care Quality Commission will safeguard standards of safety and quality. An independent and accountable NHS Commissioning Board will be established to drive quality improvements through national guidance and standards, in order to inform GP-led commissioning. The board will allocate resources according to the needs of local areas, and lead specialised commissioning.
In the coming weeks, detailed consultation documents will enable people to comment on the implementation of this strategy, leading to the publication of a health Bill later this year. I recognise that the scale of today’s reforms is challenging, but they are designed to build on the best of what the NHS is already doing. Clinicians are already working to facilitate patient choice, giving patients the information they need to make effective decisions. GP consortiums are already established in some areas of the country and are ready to go. Local authorities in some areas are already working closely with local clinicians to co-ordinate health and social care and improve public health. Payment by results already gives us a starting framework for building a payment system that really drives performance. Foundation trusts are already using the freedoms they have to innovate. We will build on this progress, not dismantle it.
With this White Paper we are shifting power decisively towards patients and clinicians. We will seek out and support clinical leadership. That means simplifying the NHS landscape and taking a further, radical look at the whole range of public bodies. We will reduce the Department of Health’s NHS functions, delivering efficiency savings in administration. We will rebalance the NHS, reducing management costs by 45% over the next four years and abolishing quangos that do not need to exist, particularly if they do not meet the Government’s three tests for public bodies. We will also shift more than £1 billion from back-office to the front line. Form must follow function. As we empower the front line, so we must disempower the bureaucracy. Therefore, after a transitional period we will phase out the top-down management hierarchy, including both strategic health authorities and primary care trusts.
Later in the summer, we will be publishing a report setting out how we see the future of NHS-related quangos. I can say now that this will mean a reduction of at least a third in the number of such bodies. This is part of a wider drive across government to increase the accountability of public bodies and reduce their number and cost. The dismantling of this bureaucracy will help the NHS realise up to £20 billion of efficiency savings by 2014, all of which will be reinvested in patient care. Today’s reforms set out a long-term vision for an NHS that is led by patients and professionals, not by politicians. It sets out a vision for an NHS empowered to deliver health outcomes as good as any in the world. I commend this statement to the House.
Andy Burnham (Leigh) (Lab)
I thank the right hon. Gentleman for his statement and for giving me advance sight of it, although in keeping with the style of this Government, it would appear that this House was the last to find out, behind every media outlet in the land.
Last month, the Commonwealth Fund gave its verdict on Labour’s NHS, saying that it was top on efficiency and second overall on quality compared with other developed health care systems. Today, we have further evidence of progress, with figures from Cancer Research UK showing that long-term cancer survival rates have doubled. This progress was hard won; it took 10 years of painstaking work piecing together a detailed jigsaw. The right hon. Gentleman, with this White Paper, has today picked it up and thrown the pieces up in the air. It is a huge gamble with a national health service that is working well for patients.
The right hon. Gentleman’s spin operation bills this as
“the biggest revolution in the NHS since its foundation 60 years ago”.
That is something of a surprise, given the ink was barely dry on a coalition agreement that said:
“We will stop the top-down reorganisations of the NHS that have got in the way of patient care.”
What has happened since the publication of the coalition agreement to justify a U-turn of such epic proportions? Manifesto commitments have been casually dropped but this must be the first time that that agreement has been so spectacularly ripped up.
This reorganisation is the last thing that the NHS needs right now; it needs stability, not upheaval. All its energy must be focused on the financial challenge ahead. It needs confident, motivated staff, but the 1.3 million people who work for the NHS will not be comforted by this White Paper and they will be alarmed that their systems of national pay bargaining are being torn up. We support a strong say for clinicians and GPs in improving quality. That was the direction that Lord Darzi set out, after broad consultation. We introduced practice-based commissioning within a framework of public accountability and population-wide commissioning supported by primary care trusts. What we do not support is the wiping away of oversight and public accountability, and the handing over of £80 billion of public money to GPs, whether they are ready or not. Michael Dixon, chair of the NHS Alliance, says that only about 5% of GPs are ready to take over commissioning. Sir David Nicholson, chief executive of the NHS, has judged that even the best GP practice-based commissioners are “only about a three” out of 10 in terms of the quality of their commissioning. So what sound evidence does the right hon. Gentleman have that 100% of GPs are ready, willing and able to commission services for the entire population?
The right hon. Gentleman’s statement talked of rewarding commissioners who hit outcomes. Does he mean yet more money for GPs? How much will all GPs be paid for taking on this role? How many jobs does he expect to be lost in the NHS and how much money has he put aside for redundancy costs? What guarantees can he give the House that people will not simply be paid off by the NHS to be re-employed by a GP practice?
How does the right hon. Gentleman think loyal primary care trust staff felt when they read this quote—I apologise, in advance, for the language, Mr Speaker—from
“a senior Department of Health source”,
which was anonymously briefed to the Health Service Journal? It reads:
“PCTs are screwed. If you’ve got shares in PCTs I think you should sell”.
That is no way to treat loyal public servants, who have served the NHS and are now worried about their future. On page 10, the right hon. Gentleman says that the reforms are vital to deal with the financial situation, but is it not the case that there has never been an NHS reorganisation that did not cost money and divert resources in the short term? Is not the handing of the public budget to independent contractors tantamount to the privatisation of the commissioning function in the NHS? Will there be any restrictions at all on the use of the private sector by GPs?
Added to this, the right hon. Gentleman is bringing a series of market reforms into hospitals. He tells us that the first role of Monitor will be to promote competition and talks of any willing provider and freedoms for foundation trusts. Is not that the green light to let market forces rip right through the system with no checks or balances? Are not the hearts of NHS staff sinking as they read the White Paper?
On bureaucracy, we will support the Government where sensible reductions can be made, but what he calls pointless bureaucracy, we call essential regulation. What are his plans for the Food Standards Agency and are the reports correct that he has waived his right to regulate in return for funding for Change4Life? Can he explain how 500 or more GP consortiums, all of whom will need administration and management, can be less bureaucratic than 152 primary care trusts?
Lastly, where are the public accountability and the accountability to this House? How will GPs be held to account for the £80 billion of public money for which they will be responsible and how will the new NHS commissioning board—the biggest quango in the world—be accountable to this House and to Members of Parliament?
In conclusion, this White Paper represents a roll of the dice that puts the NHS at risk—a giant political experiment with no consultation, no piloting and no evidence. It is the right hon. Gentleman at his confused and muddled worst, but the sadness is that he is taking an £80 billion gamble with the great success story that is our national health service today. At a stroke, he is removing public accountability and opening the door to unchecked privatisation. He is demoralising NHS staff at just the time we need them at their motivated best. For patients, it opens the door to a new era of postcode prescribing where services vary from street to street. It turns order into chaos, and we will oppose it.
Mr Lansley
I am just astonished that the shadow Secretary of State seems to have gone to the barricades for the primary care trusts. The primary care trusts and strategic health authorities are organisations that, under his watch as Secretary of State—for about a year—increased their management costs by 23%. In the year for which he was in charge, they spent £261 million on management consultants. Before the election, when it had a majority of Labour Members, the Select Committee on Health said that PCT commissioning was weak and that it was not delivering what was intended. He set up a programme called world class commissioning—it never worked. Central to delivering better commissioning in the health service is ensuring that those people who incur the expenditure—the general practitioners, on behalf of their patients—and who decide about the referral of patients are the same people who, through the commissioning process, determine the shape of the services in their area. It is more accountable.
How often have all of us, on both sides of the House, asked Labour Ministers about what primary care trusts are doing locally in terms of service change only to be told, “It’s nothing to do with us; it’s all happening locally”? We are going to be very clear about the accountability. One thing that the coalition programme has enabled us to do, as two parties bringing our programmes together, is to strengthen the accountability to local authorities. Local authorities, through their strategies that mesh NHS services, public health and social care, will ensure that major service changes and the design of services reflect the interconnection between those things. Those who have complaints and problems will be able to have them addressed through HealthWatch and through their local authority. We will be able, through local authorities, to ensure that the commissioning support to GP commissioning consortiums can be more effective.
The shadow Secretary of State talked about the Commonwealth Fund. I do not know whether he has even read the Commonwealth Fund report, but it said that the UK health care system was the second worst on hospital-acquired infections, that the UK delivers the poorest level of patient-centred care and that, on outcomes, we performed the second worst overall on mortality amenable to health care.
The right hon. Gentleman stood up and said that cancer mortality rates have improved. They have—since the 1970s, and all over the world. However, the issue is where we stand in relation to the rest of the world. If we were to meet the European average on cancer survivals, 5,000 more people would live each year rather than die. If we were to do the best in Europe, 10,000 more would live each year. For stroke, the figure is 9,000. We have to measure ourselves on the outcomes relative to the other health systems that are comparable to ours.
Nine years ago, the right hon. Gentleman’s Prime Minister, Tony Blair, said that we must spend as much as Europe. Through this White Paper and the reforms that we will bring in, we are determined to achieve results for patients that are at least as good as those in the rest of Europe. It is not just about inputs and spending, but about the results we achieve. The right hon. Gentleman, on behalf of his party, has just abandoned the reforms that his Prime Minister, Tony Blair, put forward. In 2006, Tony Blair said that we must have patient choice, practice-based commissioning, the independent sector and foundation trusts—reforms that Labour failed to deliver and, indeed, undermined. We, as a coalition Government, are now determined to put those reforms in place to deliver results for patients.
Mr Stephen Dorrell (Charnwood) (Con)
I congratulate my right hon. Friend on setting out a clear vision for the NHS that is committed to high-quality outcomes for patients and good value for money for the taxpayer. Does he agree that the delivery of that objective depends critically on effective commissioning? Does he recall that the last Labour Government said that engaging GPs with the commissioning process was the key to success? Does he recall that the White Paper setting out the plan for practice-based commissioning said that GP commissioning was not a new idea to the NHS? Indeed, it is not. He is to be congratulated on holding out the prospect that, at last, this idea can be made good and made powerful in the interests of patients.
Mr Lansley
I am grateful to my right hon. Friend for his comments. In his capacity as the Chairman of the Select Committee on Health, we will be responding to him very shortly regarding the Select Committee’s report from before the election on commissioning in the NHS. What he has just said is absolutely right; we have to be able—this is a central task in commissioning—to bring together the responsibility for the management of patient care with the responsibility for the commissioning of services. The current situation is akin to a shopping trolley being pushed to the checkout while the primary care trust is standing there with a credit card, bleating about whether things should be taken out of the trolley. We have to ensure that the design of services follows the best clinical leadership in terms of the services that are required for patients. He and I very much agree on precisely that objective.
Caroline Flint (Don Valley) (Lab)
Thank you, Mr Speaker. Is it not already the case, in PCTs, that it is clinical directors, who are professionally trained as doctors, who lead in terms of providing services in conjunction with GPs at a local level? Can the Secretary of State assure the House that his proposals will make the system any better? I do not think so.
Mr Lansley
I am sorry, but when the right hon. Lady was a Minister, she should have talked to more GPs. Overwhelmingly, they would have told her that they do not feel that the PCTs listen to them. They feel that the PCTs tell them what to do and get in the way. We are going to empower GPs to deliver services for their patients.
David Tredinnick (Bosworth) (Con)
I, too, congratulate my right hon. Friend on his statement. If he is going to get more choice for patients in treatment options, he will have to expand integrated health care so that herbal medicine, acupuncture, back treatments and homeopathy are more widely available across the country. Will he look at the American model of the consortium of 44 academies that has been considering integrated health care? Can he reassure me that his NHS commissioning board will not block options for integrated health care across the country?
Mr Lansley
The job of the NHS commissioning board will be to inform GP-led commissioning through scientific evidence, clinical evidence and guidelines, but it will be for GPs themselves, managing their budgets, to enable patients to exercise greater choice. The working out of what that choice looks like should not be dictated by politicians, but should be determined by patients and their clinical advisers.
Miss Anne Begg (Aberdeen South) (Lab)
The Secretary of State has not answered the question of my right hon. Friend the Member for Leigh (Andy Burnham) about the future of the Food Standards Agency. The Scottish arm of the FSA is based in Aberdeen, and I wonder whether the Secretary of State has had any discussions with the Scottish Government about its future. If not, is this yet another example of the new relationship that is meant to be in place between Scotland and the rest of the UK?
Mr Lansley
The shadow Secretary of State will have had the chance to see that there is nothing in today’s White Paper about the FSA—no such proposal.
Mr Lansley
I have not been briefing anything to anybody. [Interruption.] I have not. It is very straightforward. The FSA, along with other bodies associated with our public health responsibilities, will be the subject of a public health White Paper in the autumn. There is no proposal.
Andrew George (St Ives) (LD)
In seeking to reassure the House that this is not the top-down reorganisation that the coalition agreement derided, would my right hon. colleague reassure my constituents, who are quite excited by the idea of more patient and local authority involvement in local decision making, that where the primary care trusts in which they are going to be appointed will be abolished, there will be more GP commissioning groups than PCTs at the end of the process?
Mr Lansley
Yes, I am grateful to the hon. Gentleman. The number of GP-commissioning consortiums will be determined not least by GPs themselves, deciding what makes sense in their locality. He and his Cornish colleagues have often been frustrated by the way in which a top-down bureaucracy has sought to dictate to the people of Cornwall, often in specific localities, at a considerable distance from their hospital services, what services should be provided locally in places such as Hayle and Penzance. He and his constituents can be really comforted by the thought that their clinical advisers and general practitioners in local consortiums can in future make those decisions about their services.
Hazel Blears (Salford and Eccles) (Lab)
Despite the tremendous improvements that have been made in Salford and Eccles over the past few years in tackling cancer and heart disease, significant inequalities remain that require substantial resources. Will the Secretary of State confirm that in shifting commissioning powers to GPs and allowing the NHS commissioning board to allocate resources, the funding formula will still properly reflect the needs and deprivation factors in areas such as mine and right across the country?
Mr Lansley
The White Paper makes it clear that the NHS commissioning board will be required to allocate resources across the NHS in England on the basis, as far as possible, of seeking to secure equivalent access to NHS services. That will clearly be relative to the prospective burden of disease. In tackling health inequalities, the right hon. Lady will know that we need separately to allocate resources to local health improvement plans, which will be led through local authorities, and which will enable them to create local public health strategies to secure improvements in health outcomes and to reduce health inequalities.
Nadine Dorries (Mid Bedfordshire) (Con)
May I congratulate the Secretary of State on what is a truly exciting White Paper? Will he confirm that in addition to GPs having responsibility for commissioning, there will be the opportunity for them to become actively involved in the provision of care and deciding what care is allocated to which patients?
Mr Lansley
Yes, my hon. Friend understands that GPs are often providers beyond their primary medical services responsibilities. One of the difficulties with fundholding was that there was an opportunity for that conflict of interest to arise and not be properly resolved, so we have made it clear that, in the commissioning framework that we will publish, we will set out consultation proposals on how we ensure that that conflict of interest is not allowed to arise. Where GPs wish to be providers, we do not constrain them, but how that contract is arrived at is transparent and open.
Mr Nick Raynsford (Greenwich and Woolwich) (Lab)
How can the Secretary of State, with a straight face, say that he opposes the culture of top-down bureaucracy and decisions being taken by politicians, when he himself, in the past six weeks, has stopped the implementation of a clinically led and agreed programme for improving health care provision in south-east London, which was going ahead until he stopped it? Does he now accept that his words carry very little force for those of us who know what his actions indicate?
Mr Lansley
No is the answer. I set out on 21 May criteria on listening to patients and understanding what patient choice will be in future; on engaging the public, including local authorities, which are now following through on that accountability; on following the clinical evidence of what can best deliver outcomes; and on ensuring that GPs, as we have made clear, must be supportive and engaged. If any proposal in London is made at local level, such as the one the right hon. Gentleman refers to in Oxleas, that satisfies those criteria, which are bottom-up and locally led, there is no difficulty in its proceeding.
Mr Steve Brine (Winchester) (Con)
I congratulate the Secretary of State on his statement, which many people outside the House will recognise is a breath of fresh air for our NHS, unlike the flagging leadership bid we heard earlier—the second this afternoon—from the Opposition.
Will the Secretary of State confirm that the new consortiums of GPs can regain responsibility for out-of-hours care, the provision of which is a great worry for many of the people I represent across Winchester and Chandler’s Ford?
Mr Lansley
Yes. The commissioning responsibility will include urgent and out-of-hours care. I commend to my hon. Friend what the White Paper says about how we can deliver improvements in efficiency and effectiveness in terms of urgent care, 24 hours a day, seven days a week.
Mr Dennis Skinner (Bolsover) (Lab)
Speaking as someone with a successful outcome, twice, under the national health service in recent times, could the Secretary of State explain to me why these private elements within the NHS—that is, the GP practices—which are getting another £80 billion to spend are not going to be watched over by the primary care trusts or, seemingly, anybody else? Who is going to watch them spend that money—the private sector?
Mr Lansley
I am astonished that Labour Members are still attacking general practice. I thought that shadow Ministers—former Ministers—had had enough of doing that. [Interruption.] I will answer the hon. Gentleman. GP practices will be accountable to patients who exercise choice; accountable to their local authority, through which a strategy is established; and accountable to Parliament and to Ministers through the NHS commissioning board with which they will have their contract.
Jacob Rees-Mogg (North East Somerset) (Con)
In welcoming this statement, I wonder whether the Secretary of State will be able to put in place any interim measures for people such as a constituent of mine who have been prescribed life-prolonging cancer drugs such as Lapatinib but are being denied them.
Mr Lansley
I am pleased to be able to tell my hon. Friend that as part of the coalition programme we have said that we will implement a cancer drugs fund from April 2011. Indeed, my ministerial colleagues—not least the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Mr Burstow)—and I are looking urgently at what we can do in the meantime to try to ensure that we no longer continue with a situation where patients do not have access to cancer drugs that are routinely available in other countries.
Mr David Lammy (Tottenham) (Lab)
Most people will recognise that GPs are at the cornerstone of the NHS, but also that since 1948 they have been independent practitioners running for-profit businesses. What safeguards has the Secretary of State put in place, and what is he doing about conflicts of interest? He said nothing about that in his statement. Is not what is proposed like asking pharmaceutical companies to be in charge of the NHS drugs bill?
Mr Lansley
I must not be unkind to the right hon. Gentleman, because he has not yet had a chance to read the White Paper—
Mr Lansley
That is my statement. When the right hon. Gentleman reads the White Paper, it will become obvious to him that, yes, we are looking to GPs to take responsibility for commissioning, but, unlike the problems that arose with fundholding, there will not be an opportunity for GPs to generate surpluses on their commissioning budget, and so money in their pocket. It will not work like that: there will be a clear separation between the commissioning budget and their personal budget. We will focus on the thing that really matters, which is GPs taking a commissioning responsibility in designing services.
Nicholas Soames (Mid Sussex) (Con)
I welcome the Secretary of State’s bold and imaginative statement on a White Paper that I am sure will be broadly welcomed in the NHS, not least because it will give people within the NHS the opportunity to give true vent to their creativity. Does he agree, however, that he is setting very demanding targets and challenges; and what time line does he envisage before this is finally implemented?
Mr Lansley
I am grateful to my hon. Friend. I will not go through the White Paper in detail now, but within it he will find that we look towards some GP commissioning consortiums taking an early adopter place from 2011-12, with consortiums generally taking, as it were, a shadow responsibility but not a legal responsibility in 2012-13, and then taking full responsibility, subject to the passage of the legislation to establish that, from April 2013 onwards—the point at which we anticipate that primary care trusts will be abolished.
Liz Kendall (Leicester West) (Lab)
The Minister will know that about 80% of patient contact with the NHS is in primary care. Will GP commissioning groups be allowed to commission GP and other primary care services from themselves, and if so, how will they be held to account for that decision?
Mr Lansley
No, the NHS commissioning board will contract for the primary medical services provided by GPs themselves. GPs will commission for the additional services, including all the community and hospital services. There will be a combination of individual practices taking a responsibility, rewarded through their quality and outcomes framework for the service that they provide to their patients individually, and a general commissioning responsibility for those practices together with others in a local consortium.
Ben Gummer (Ipswich) (Con)
Could the Secretary of State confirm what will happen to those trusts that have not yet achieved foundation trust status and those that are in the middle of applying for it?
Mr Lansley
I am grateful for that question, because what is important is that we have coherent reform in relation to both commissioners and providers. That means that by 2013-14, we should not only have energised the commissioning process and patient choice but set free the hospital providers. My objective, set out in the White Paper, is that by that time all NHS trusts should become foundation trusts. We will need to put in place measures to support them to do that.
Mr Geoffrey Robinson (Coventry North West) (Lab)
Is the Secretary of State aware that those of us who listened to his speeches in opposition were much encouraged, but that with this first statement he has totally disillusioned everybody who believed that he was going to avoid the faults of the past? He has now introduced the biggest top-down, ill thought-through reorganisation that there has ever been in the NHS, and it has about as much chance of success as any previously introduced.
Mr Lansley
I would encourage the hon. Gentleman to go and talk to GPs in Warwickshire whom I have talked to, and to talk to those at Walsgrave about the freedoms that they want to enjoy.
I wish to make it absolutely clear to the hon. Gentleman that there is great consistency between what we said in opposition and what I am announcing today, but that there are some major improvements. Frankly, they have come about because of the conversations that I have had with my colleagues from the Liberal Democrat party. Not least, those conversations have enabled us to focus on the fact that instead of leaving what was a diminishing, residual role for primary care trusts, which withered on the vine, it is better and stronger for us to create a strategic responsibility for local authorities on public health and on joining up health and social care. That will allow us to remove the bureaucracy associated with PCTs, and it is more coherent and stronger than the proposals that we had in opposition.
Dr Sarah Wollaston (Totnes) (Con)
My right hon. Friend recognises how toxic many targets were in the NHS, but they were not all bad. There were some that ensured that standards were maintained—for example the two-week wait for cancer referrals. How will he ensure that standards are maintained when targets are abolished?
Mr Lansley
I am grateful to my hon. Friend, who is absolutely right. That is why, as I said in my statement, not only will we be clear about what we are trying to achieve—for example, where cancer is concerned, one and five-year survival rates at least as good as the European average and hopefully as good as any in Europe—but we will require the NHS to look towards clinically led, evidence-based quality standards that enable those working in the NHS to be clear about what constitutes quality. That will enable us to deliver those outcomes.
Glenda Jackson (Hampstead and Kilburn) (Lab)
Some of the greatest health inequalities occur in areas of the greatest deprivation, which are not infrequently areas that are not attractive to GPs. We also have in London a very large number of people who have never registered, and will never register, with a GP. They tend to use accident and emergency departments. How will their medical needs be presented to this top-down body, the NHS commissioning agent, when there can be no input from GPs? If I read the Secretary of State’s statement correctly, GPs’ recommendations will be disregarded by the NHS commissioning board.
Mr Lansley
I do not recognise the hon. Lady’s latter point. Some 7% of the population in London are not registered with a GP, which is one reason why commissioning consortiums of GPs will take responsibility for their locality, not just their registered patient population.
In relation to hospitals such as the Royal Free, one reason why the hon. Lady, I and other Members were campaigning against her Government before the election was that we recognised that we cannot shut down accident and emergency departments when patients are coming in the door by the tens of thousands because there is no alternative provision. The best way to design services in the community that better meet the needs of patients is through general practitioners designing them around the needs of their patients.
Mr John Baron (Basildon and Billericay) (Con)
I very much welcome the White Paper’s increased focus on improving outcomes, and particularly my right hon. Friend’s comments about the introduction of one-year and five-year cancer survival rates, for which the all-party group on cancer has been pushing. How does he envisage GP commissioning of cancer services improving with the White Paper, given that part of the problem is that a typical GP will see only eight new cancer presentations a year?
Mr Lansley
I pay tribute to my hon. Friend’s work. He will have noted that I deliberately said both one-year and five-year cancer survival rates—he made an important point about that. Clearly, there are many specialist commissioning services, which will become the NHS commissioning board’s responsibility. To that extent, GPs should not be expected to commission specialised services—they have little experience of that. However, GPs as commissioning consortiums, like primary care trusts at the moment, are capable of having a relationship with their cancer networks to establish the services that they need for their patients. Indeed, that applies more to GPs because many of the patients and those who work in cancer services to whom I speak are critical of the lack of awareness on the part of PCT commissioners of the available services. Those who work in cancer services do not believe that PCT commissioners understand the service that they provide. Not every GP understands every aspect of cancer care, but they are much better placed to work with cancer specialists to design the services.
Mr Michael Meacher (Oldham West and Royton) (Lab)
Given the transfer of £70 billion of NHS funds from PCTs to 500 GP consortiums, the vast majority of which have neither the expertise nor the inclination for such a huge administrative task and will have to buy in specialists from the private sector to do it for them, is not it clear that the real motive behind the reforms is to enable US multinational corporations, such as UnitedHealth, or UK corporations, such as BUPA or Virgin, to parcel out health care to the private sector on a vast scale?
Dr Julian Lewis (New Forest East) (Con)
I congratulate my right hon. Friend on his firm grasp of the subject and on taking an axe to the forest of bureaucracy. As he proposes to phase out the strategic health authorities, may I nominate the South Central strategic health authority—he knows what is coming—because that would ensure that it was no longer able to waste hundreds of thousands of pounds of our money on fighting a hopeless legal case to impose fluoridation on a population, three quarters of whom have indicated that they do not want it?
Mr Lansley
Yes, I am indeed aware of precisely what my hon. Friend says and will certainly take it into account.
Jeremy Corbyn (Islington North) (Lab)
The Secretary of State has been asked by many Members about the accountability of GPs, and he has not answered. Some £80 billion is to be pumped through GPs, who will then buy in services. Who manages them? Who monitors them? Who checks on what they are doing? Will we get value for money or, as my right hon. Friend the Member for Oldham West and Royton (Mr Meacher) said, will the system in reality be administered by private health companies, just as GPs are private contractors in the NHS?
Mr Lansley
At the risk of repetition, let me say that GPs will be accountable to patients, who will exercise more control and choice. They will be accountable to the NHS commissioning board, which will hold their contracts, for financial control and for their performance, through the quality and outcomes framework. They will be accountable to their local authority for their strategy and for the co-ordination of public health services and social care.
Jason McCartney (Colne Valley) (Con)
Thousands of patients in my constituency are desperate for specialist maternity care to be returned to Huddersfield royal infirmary, which was downgraded under the previous Government. Does the White Paper make the return of consultant-led maternity services to Huddersfield more likely?
Mr Lansley
The White Paper will enable GPs in an area, plus their local public and their local authority, to make decisions about the shape of services rather than its being done by ministerial diktat.
Alex Cunningham (Stockton North) (Lab)
The Secretary of State referred to delivering for the patient. Will he guarantee that patients such as those who need a new knee or a new hip can expect their treatment in 18 weeks, or is it more likely to be 18 months under today’s proposals, as it was under the previous Tory Government?
Mr Lansley
Ah! That was one of the Opposition Whips’ handout questions, wasn’t it? I will tell the hon. Gentleman that actually, patients are more likely to get their treatment more quickly. Let me give him an example. Patients with rheumatoid arthritis need rapid treatment, but they were losing out and suffering as a consequence of the 18-week target, because hospitals were hitting 18 weeks, but not providing the care needed by those patients in the light of their conditions. We must focus on what is in the best interests of patients, not on what is in the best interests of political grandstanding.
Bob Blackman (Harrow East) (Con)
The Secretary of State’s announcement will be warmly welcomed in my constituency. On Friday, I went to see a group practice of 12 GPs who are totally frustrated by the local PCT. They are concerned that when the reforms are introduced, they will also be frustrated by the GP consortiums. Will my right hon. Friend give me some assurances on how the GP consortiums will be formed? What will happen if some GPs disagree with how a consortium is set up?
Mr Lansley
I can tell my hon. Friend that I am looking to GPs in a locality to create GP commissioning consortiums that represent an area. They must decide on the geography of that and make proposals. It will not be possible for GPs simply to say, “This is nothing to do with us,” because in future, we must expect GPs, who are senior professionals in public service and paid appropriately, to be responsible not only for the care of the individual patient in front of them, but collectively for the quality of care provided to their population at large.
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)
Prior to 1997, there was no cancer strategy and cancer was not a priority. The Secretary of State is absolutely right to make reaching European levels of one and five-year survival rates one of his priorities and an aspiration, but he knows very well that the one thing that is holding us back is the problem of early diagnosis. Precisely how does he think his abolition of targets and his woolly assurances will ensure early diagnosis? I will wager him that under his proposals, we will fall backwards rather than make progress.
Mr Lansley
Let me tell the hon. Lady that only just over 40% of those who were diagnosed with cancer actually came through the two-week wait process at all. She is right that it is very important that patients’ signs and symptoms should be identified at an earlier point and that they should have earlier diagnosis. Whom does she imagine is best placed to identify signs and symptoms and to take action on them other than patients and the GPs who are responsible for their care? [Interruption.] If Opposition Members stop interrupting from a sedentary position, I can continue. Actually, patients need—[Interruption.] The shadow Secretary of State should understand this, having held responsibility for it. For early diagnosis, awareness of signs and symptoms on the part of patients is critical. Only 30% of members of the public had any idea what cancer signs and symptoms were beyond the presence of a lump or swelling. We need to change such things and the responses of GPs to those early signs and symptoms.
Mr Speaker
Order. Members really should not chunter, witter or otherwise heckle from a sedentary position, because they thereby reduce their chances of getting in, or of their colleagues getting in.
Margot James (Stourbridge) (Con)
Older people and people with long-term medical conditions have not been well served by the division between health and social care, which has lasted many years. I congratulate the Secretary of State on his plan to give local authorities control over local health improvement budgets. Can he say any more about how those reforms will break down the barriers between health and social care?
Mr Lansley
I am grateful for my hon. Friend’s question. There is an unprecedented opportunity for local authorities and the NHS to create a much more integrated and effective strategy for health and social care working together. That is partly about focusing on outcomes, partly about listening to patients, and partly about extending personal budgets for patients, so that they themselves can break down such barriers. However, critically, it is also about local authorities exercising the responsibility that we will give them, plus their existing powers in relation to well-being right across their areas, to seal that working together, to deliver better public health and better integration between their social care responsibility and NHS commissioning plans.
Tony Lloyd (Manchester Central) (Lab)
Without any shame, the Secretary of State is introducing an internal market in the health service. In that context, how will he guarantee that GPs will not look for cheaper medicine rather than better medicine?
Mr Lansley
Because patients will have increased choice—[Hon. Members: “How?”] Because patients will make their choices on the quality of service they receive, because the service will be free to them.
Dr John Pugh (Southport) (LD)
The coalition agreement pledges to introduce true local democratic accountability through citizens actually being elected on to a health board. What can the Secretary of State do to persuade me—because he has not so far—that we will have local citizens, not doctors, making any decisions about the shape and configuration of local NHS services other than in public health, and will any of them be consulted about his structural changes or allowed to do things differently locally?
Mr Lansley
Yes. I feel very strongly that we have deliberately set out to improve local democratic accountability and we have found an effective mechanism for doing so. Local authorities will themselves have statutory powers to agree local strategies that encompass not only local health improvement, but the commissioning plans and the social care commissioning strategies locally. If a major service change is contemplated as a consequence, the commissioning consortiums will not be able to proceed without the agreement of the local authority through its joint strategic assessment. The White Paper makes it clear that if they do not agree, the local authority will continue to have the capacity to send the proposals to the independent reconfiguration panel and, if necessary, to the Secretary of State.
Austin Mitchell (Great Grimsby) (Lab)
May I tell the Secretary of State that north-east Lincolnshire has developed an effective care trust plus, which worked with the local authority to link care and health in exactly the way that he proposes, but the effect of his proposals on that trust will be to deprive it of most of its functions and cause it to issue redundancy notices to most of its staff. Has he heard of the old adage, “If it ain’t broke, don’t fix it”?
Mr Lansley
It is broke, and we are fixing it. We are fixing it because primary care trusts have not succeeded in delivering the outcomes that we are looking for, and they have consumed an enormous amount of money. I remind the hon. Gentleman that in the last year, at a time when we knew that there was a financial crisis facing the public sector and that the NHS would have to deliver more for less, the strategic health authorities and primary care trusts increased their management costs—not their spending on patients—by 23% in one year. It was outrageous.
Jeremy Lefroy (Stafford) (Con)
I thank my right hon. Friend for his statement. As he will know, concerns were expressed about the role played by Monitor in the authorisation of the Mid-Staffordshire NHS Foundation Trust. Does he have any plans to beef up Monitor’s role and ensure that it plays a better role in the future in the authorisation of trusts?
Mr Lansley
Yes, and hon. Members will see in the White Paper the way in which we can strengthen the role of Monitor. It is not just about the authorisation processes for foundation trusts, but a continuing responsibility for the quality and standard of care being provided in all our trusts, NHS trusts or foundation trusts. It is important to focus on quality, on what constitutes quality and on ensuring sufficient incentives to support quality. In addition, I hope that some of the lessons that will be learnt from the inquiry being conducted by Robert Francis QC will inform how we can put a better system in place.
Paul Flynn (Newport West) (Lab)
How much will be created in additional bureaucracy and new costs by dumping on GPs tasks for which they are not trained?
Mr Lansley
The hon. Gentleman has not talked to GPs across England who are keen to take on this responsibility. In the process, we will reduce the costs of bureaucracy in the NHS by more than £1 billion a year.
Nick de Bois (Enfield North) (Con)
Does the Secretary of State agree that where moratoriums are in place, practising GPs should be encouraged to seize the opportunity to determine the future of hospital accident and emergency departments, as with Chase Farm hospital in my constituency?
Mr Lansley
Yes, I very much agree. As he knows, his local GPs, patient representative groups and the local authority are already demonstrating how they can come together to devise the right solutions for the people of Enfield and the district around Chase Farm.
Valerie Vaz (Walsall South) (Lab)
The Secretary of State talks about choice in the NHS, but could he confirm that GPs will be given the choice to join a consortium?
Mr Lansley
GP practices will all have to be members of a consortium, otherwise it will not be possible for them collectively to commission emergency and urgent care, and they will need to do that.
Clive Efford (Eltham) (Lab)
The Secretary of State seems to misunderstand one thing. When patients go in to be treated by a GP, they expect to get the best possible treatment available. The Secretary of State said in an earlier answer that he would expect patients to have the knowledge of drugs to be able to determine whether a GP was supplying cheaper or better drugs. What local accountability will there be of GPs, what resources will be put into HealthWatch networks, what resources will be left available for local health improvement budgets, and what teeth will local authorities have to impose local health plans?
Mr Speaker
Order. That was four questions, to which one answer will suffice.
Mr Lansley
The answer is that I said no such thing as what the hon. Gentleman suggested, and the record will show that.
Harriett Baldwin (West Worcestershire) (Con)
I welcome the fact that my right hon. Friend has said that an extra £20 billion will be going into patient care by 2014. Can he clarify how much more that is under our Budget, compared with Labour’s Budget, which would have cut the NHS budget?
Mr Lansley
My hon. Friend is right. It appears that the Labour party’s policy is to cut the NHS. Our policy is to do something that Labour never achieved: deliver greater efficiency and greater productivity in the NHS, not least through the reforms that I have announced. Every penny saved will be a penny reinvested to the benefit of patient care.
Meg Munn (Sheffield, Heeley) (Lab/Co-op)
Sheffield is one of the areas that already has GP consortiums. They have been developing their relationships with the primary care trust and are now starting to make progress. What guarantee can the Secretary of State give to my constituents that today’s unwanted change will not set back that process and not cause significant problems with the progress that has already been made?
Mr Lansley
It is not an unwanted change. All over the country, GPs themselves have resisted the concept that they do what the primary care trust tells them to do, when they are better placed to design services on behalf of their patients. They can, and I know that the GP commissioning consortiums in many places will want to take on board the key teams in primary care trusts that they think would help them deliver commissioning. However, GP commissioning consortiums will not be required to do so, although they will be required to deliver better outcomes for their patients.
Charlotte Leslie (Bristol North West) (Con)
If hon. Members speak to GPs and professionals, who do not just sit here and talk about the NHS, but actually run it, day by day, they will find that it is not change or the White Paper that has caused demoralisation, but the machine-gun fire of targets and the monolith of management. The reason why that has caused so much demoralisation among the work force is that target box-ticking is so often different from the provision of quality care, as we have tragically seen in Staffordshire. Can my right hon. Friend reassure me that his reforms will mean that box-ticking is replaced by quality of care?
Mr Lansley
My hon. Friend is absolutely right and expresses her point superbly. The process is going to be about quality, not tick-box targets, and it is going to enable the front-line staff of the NHS to have not only access to the resources that they need, but the power to use them more effectively.
Fiona Mactaggart (Slough) (Lab)
Who will have the legal responsibility for delivering the Secretary of State’s welcome promise of a health care service free at the point of delivery? If we have expensive patients who are not being well treated by the GPs, what resource do we have, as Members of Parliament representing the interests of those patients?
Mr Lansley
The hon. Lady will see, in the White Paper and the subsequent legislation, the continuation of the existing legal framework, which does not allow additional charges to be levied inside the NHS.
Derek Twigg (Halton) (Lab)
It is interesting that the Secretary of State said in the statement, “We will allow any willing provider to deliver services to NHS patients”. Does he rule out any area of services in the NHS where private providers will be able to provide services?
Mr Lansley
I am adopting an any-willing-provider policy that was the policy of the hon. Gentleman’s Government, until the shadow Secretary of State abandoned it in September 2009 at the behest of the trade unions. I am adopting a policy designed to achieve the best possible care for patients by giving them access to all those who will deliver NHS services within NHS prices.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
Is my right hon. Friend aware that Hartismere hospital in my constituency was closed by Suffolk PCT, while at the same time, the PCT was able to afford to spend £500,000 on opening a new car park for managers? Does he agree that community hospitals such as Hartismere are still a valuable part of health care and that the White Paper might see a return to valuing them once again?
Mr Lansley
I am grateful to my hon. Friend for that question. I did in fact visit Hartismere hospital with his predecessor, and I entirely sympathise with his point. At that time, the primary care trust in his part of Suffolk was regarded as “initiative central”. It had to pursue every initiative from the Department of Health, and the money just went out the door. Those initiatives lasted just a year or two and then disappeared. That is not the basis on which to design the national health service. GPs are an excellent basis for this work because they are committed to their areas, and to the patients they look after, in the long term.
Alan Keen (Feltham and Heston) (Lab/Co-op)
If the Secretary of State is correct in saying that we need clinicians and GPs to have more influence and even control over the commissioning process, will he explain why he does not simply legislate for them to take over the current trusts? That would achieve his aim immediately, and if any inefficiencies appeared and changes to the management commissioning structure were needed—whether in the present PCTs or following reorganisation—they could take place after a period of time. Instead, these slash and burn proposals are going to cost millions of pounds and cause a lot of disruption.
Mr Lansley
The simple answer is because GP commissioners want to create their own commissioning consortiums according to their own needs and local circumstances. They do not want to be saddled with the legislative structures and costs that currently bedevil primary care trusts.
Rachel Reeves (Leeds West) (Lab)
In my constituency, a local charity called Healthy Living Network Leeds is commissioned by the PCT to provide health services in the most deprived areas, including among the Traveller community. What guarantee can the Secretary of State give to my constituents that those community-based health services will continue, and that they will be overseen to ensure that those treatments continue in the most deprived areas?
Mr Lansley
The answer is that GP commissioning consortiums will have a responsibility that goes beyond their registered patient population, and that when they set out their commissioning plans, those plans will have to be agreed by the local authority. In the hon. Lady’s case, Leeds city council will have a responsibility to ensure, through its health improvement plan and through NHS commissioning, that the needs of groups such as Travellers are properly met.
Sajid Javid (Bromsgrove) (Con)
My right hon. Friend will know that community hospitals, including The Princess of Wales community hospital in my constituency, have been under threat because of the policies of the previous Government. Does he agree that these new initiatives will make it more likely that local communities will take back control of their health care?
Mr Lansley
Yes, exactly. Last Thursday I was in Cumbria, and that is exactly what has happened there. The GP commissioners have collectively taken over responsibility for the Cockermouth community hospital. Instead of its being run down, as was intended, they have built it up as a base from which they are providing services for their area.
Andrew Gwynne (Denton and Reddish) (Lab)
Given that not all primary care trusts are coterminous with local authority areas, how will the public health aspect of the reorganisation be dealt with in areas such as Tameside and Glossop? It will not be as simple as just moving functions across to a single local authority in an area where a single health economy is greater than just one district.
Mr Lansley
As I am proposing to abolish primary care trusts, the problem of a lack of coterminosity will no longer apply. Health improvement plans, led by local authorities, will be set out on a basis consistent with many of the other services that make a significant contribution to delivering the kind of health and well-being that we are looking for.
Emma Reynolds (Wolverhampton North East) (Lab)
Wolverhampton primary care trust, working closely with GPs, has been at the forefront of driving improvements throughout Wolverhampton. For example, there has been a reduction in teenage pregnancies and in infant mortality. What evidence does the Secretary of State have that GP-led consortiums will be better placed than primary care trusts to carry forward further improvements in those areas, which affect the poorest communities in my constituency?
Mr Lansley
There is good evidence that physician-led commissioning of services for patients is very effective. Precedents in this country and across the world have shown that. The hon. Lady mentioned teenage pregnancy and infant mortality, and this is principally about the relationship between NHS services and wider public health services. Given such responsibility, I am sure that the local authority will be able to deliver local health improvement strategies that will impact on those factors more effectively than has been possible with the NHS doing it solely using NHS services and resources.
Chris Leslie (Nottingham East) (Lab/Co-op)
If the Secretary of State is going to force GPs to spend all this extra time on bureaucracy and managing the NHS, does it not mean that they will have less time to spend with their patients? Is that the reason why he scrapped patients’ right to see a GP within 48 hours?
Mr Lansley
Many GPs will find that they spend much less time trying to negotiate services for their patients through a PCT and NHS bureaucracy that get in the way. Of course GPs are operating collectively in a commissioning consortium, and I am not going to turn them into individual managers. Some GPs will be leaders—I am looking for clinical leadership—but they will also look for commissioning support. They can derive that from existing primary care trust teams if they think they are doing a good job; they can do it via local authorities or from independent sector providers of commissioning services as well.
Joan Walley (Stoke-on-Trent North) (Lab)
Does the Secretary of State not realise that there are greater health inequalities in some parts of the country, as in Stoke-on-Trent? Can he explain how this new arrangement of GP-led commissioning is going to deal with those health inequalities? Is it all going to be rolled out at one and the same time, or will there be pilot projects as part of a rolled-out programme? How is he going to ensure that health inequalities are dealt with, when local authorities in Stoke-on-Trent have to make £70 million of cuts over the next three years? How is it all going to be provided for?
Mr Lansley
It would be a good idea if Labour Members at least acknowledged that over the last 13 years health inequalities have widened in this country. We have not achieved health outcomes here that are at least as good as the European average, and in some respects regarding some diseases we are among the worst in Europe. We are going to turn this around. In order to do so, we are going to work not only with national strategies but with local strategies that are geared towards identifying those health inequalities and that expressly set out to reduce inequalities by looking beyond the NHS. Local authorities, the NHS, social care, the community and the voluntary sector will work together to make it happen.
Alison Seabeck (Plymouth, Moor View) (Lab)
The right hon. Gentleman talks about empowering GPs—some willingly and some unwillingly, I suspect. Some of them will need upskilling and training in order to understand the new process. What assessment has he made of the time GPs will need to devote to their training, and that of their staff, and of how much it will cost—or will GPs themselves be expected to pay for it?
Mr Lansley
I wonder whether the hon. Lady has met doctors in Devon. I have been to their local medical committee conference and discussed these issues with them. They are keen to go. If there was any difficulty, it was that at least one Plymouth GP had very high referral rates. I do not think he had ever checked those rates with his colleagues. It was interesting to hear them talk to one another. It became perfectly obvious that peer review—that sense of working collectively to manage services in an area—is going to hold GPs to account very effectively within consortiums as well. [Interruption.] The hon. Lady and all her colleagues completely underestimate the capacity of general practitioners, who are responsible for the overwhelming majority of patient contact in the NHS, not only to take on the responsibility of deciding whether they should incur the expenditure for the referrals they make but to have a say in designing those services.
Quality Accounts
Lord Lansley Excerpts(13 years, 10 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
This Government’s ambition is for health outcomes—and our national health service—to be as good as any in the world. To achieve this, the NHS will need to focus on providing high-quality care, led by empowered clinicians, with the patient at the centre of the service. The NHS, free of bureaucratic interference and the tick-box culture, will make quality improvement the central principle along the entire care pathway, integrated with a reformed social care service.
A quality account is an annual report to the public from providers of NHS healthcare services about the quality of their services. It allows clinicians to demonstrate their commitment to continuous, evidence-based quality improvement. By making boards and leaders of healthcare organisations visibly accountable for service quality, in the same way that they are responsible for finances, quality accounts put what matters to patients at the heart of the NHS.
Quality accounts require boards and leaders of healthcare organisations to review quality across all of the healthcare services they offer, and to identify objectives for continuous quality improvement that meet the needs of the public they serve. They are therefore a tool to empower providers and patients to produce the best possible outcomes of care.
The first quality accounts—for providers of acute national health services—have now been published. They are available from the providers themselves, and from the www.nhs.uk website.
We want staff, patients and the wider public to read their local providers’ quality accounts, and then make their views known to the boards and leaders of those providers. The public’s input to their local quality accounts has demonstrated a great willingness to get involved—which provides a clear spur for boards of provider organisations to focus their attention on improving patient care.
This is a step towards focusing the NHS on continuous quality improvement, and allowing patients to see the information they need to make an informed judgment about that commitment to quality improvement. More needs to be done to standardise our definition, measurement and reporting of service quality—along lines that clinicians will recognise as evidence-based and be accountable for. We need to drive up the range and quality of information published, to enable patients to exercise choice. Quality accounts help with this transformation.
For the future, quality accounts will evolve to reflect the Government’s aim of developing a new culture of leadership and responsibility across the NHS. Following a formal evaluation over the summer, we will consult on how the potential of quality accounts can be better realised, including by:
relating the content to emerging outcome measures and quality standards;
building in third party assurance through external audit; and
extending quality accounts to primary and community care providers, following the evaluation of the pilots in the North-East and East Midlands strategic health authorities.
Proposals will be consulted on in the autumn, with updated regulations and guidance to follow later in the year.
H1N1 Pandemic
Lord Lansley Excerpts(13 years, 10 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I have today placed a copy of the report of the independently chaired review of the United Kingdom response to the 2009 H1N1 (“swine flu”) pandemic in the Library of the House. Copies are available to hon. Members from the Vote Office. The review was jointly commissioned, and the chair appointed, by all four of the UK Health Ministers in March 2010. Dame Deirdre Hine chaired the review.
The four UK Health Ministers set up this independent review with a remit to review the appropriateness and effectiveness of the UK strategy for responding domestically to the swine flu pandemic, and make recommendations for any future influenza pandemic. The review was not asked to comment on operational matters.
I would like to thank Dame Deirdre Hine and her team for their work and I welcome her report and recommendations. I will take these into account, alongside financial and operation considerations, and other research evidence, when reviewing our future pandemic plans in the national framework for responding to an influenza pandemic.
I would like to express the Government’s thanks to everyone who has assisted and advised on the response to the swine flu pandemic.
Oral Answers to Questions
Lord Lansley Excerpts(13 years, 10 months ago)
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Lilian Greenwood (Nottingham South) (Lab)
1. What steps he is taking to improve rates of early detection of cancer.
The Secretary of State for Health (Mr Andrew Lansley)
Late detection of cancer is one of several reasons why our cancer survival rates are below the European average. That is why we will focus on improving those outcomes and achieving better awareness of the signs and symptoms of cancer. These aims will be part of our future cancer strategy.
Lilian Greenwood
Over half the men who receive a testing kit under the national bowel cancer screening programme throw it away. What action is the Secretary of State taking to improve the take-up of screening, particularly by men, and what provision has he made within the NHS budget for the extra costs of increased take-up?
Mr Lansley
I am grateful to the hon. Lady for that question, and I have had the privilege of twice visiting the national bowel cancer screening programme at St Cross hospital in Rugby—it looks after people in parts of the midlands and the north-west—and indeed, I have visited the Preston royal infirmary, which deals with bowel cancer screening follow-up. As I said in my first reply, one of the things we aim to do is to increase awareness of the signs and symptoms of cancer. It is unfortunate that, as a recent study established, only 30% of the public had real awareness of what the symptoms of cancer would be, beyond a lump or a swelling. We have very high rates of bowel cancer, so it will be part of our future cancer strategy to increase awareness of those symptoms and to encourage men in particular to follow up on them.
Mr John Baron (Basildon and Billericay) (Con)
The recent inquiry of the all-party parliamentary cancer group into cancer and equalities heard expert evidence to suggest that if people can survive the first year of cancer, their chances of surviving for five years are almost identical to the chances in the rest of Europe. Does the Secretary of State therefore believe that a one-year survival indicator is a good idea both for encouraging early diagnosis and for matching the survival rates of the best in Europe?
Mr Lansley
My hon. Friend makes an extremely good point. When we set out proposals for an outcomes framework, I hope that he and others will respond, because that is one of the ways in which we can best identify how late detection of cancer is leading to very poor levels of survival to one year. I hope that we can think about that as one of the quality indicators that we shall establish.
Diana R. Johnson (Kingston upon Hull North) (Lab)
I welcome the Secretary of State to his new position and wish him well in his role. I understand that he is keeping the two-week target for seeing a cancer specialist, but abandoning the work that the Labour Government did on the one-week target for access to diagnostic testing. Professor Mike Richards stated in the annual cancer reform strategy that improving GP access to diagnostic tests is essential to the drive for early diagnosis of cancer. Can the Secretary of State spell out some of his current thinking on what the alternative would be if we no longer have the one-week target?
Mr Lansley
Let me make it clear to the hon. Lady and the House that only 40% of those diagnosed with cancer had actually gone through the two-week wait. Establishing a better awareness of symptoms and earlier presentation across the board is, as we have been discussing, important to achieve. I am afraid that the hon. Lady is wrong: I have not said that we are abandoning any of the cancer waiting-time targets at the moment, but that we have to be clear about what generally constitutes quality. For example, seeing a cancer specialist without having had prior diagnosis is often pointless, whereas getting early diagnosis is often a serious indicator of quality.
Derek Twigg (Halton) (Lab)
2. What assessment he has made of the effects on NHS waiting times of NHS targets in the last 10 years.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
4. What steps he plans to take to implement the Government’s proposals to end the target culture in the NHS.
The Secretary of State for Health (Mr Andrew Lansley)
On Monday 21 June I published a revision to the NHS operating framework in which I removed the central management of three process targets that had no clinical justification. We will carry on focusing on quality and outcomes, getting rid of top-down process targets.
Dr Poulter
Does my right hon. Friend agree that meeting targets does not necessarily mean improving health care, and that the last Government were far too focused on the process of health care, rather than on improving the patient experience?
Mr Lansley
My hon. Friend is absolutely right. I was here just a few weeks ago, announcing a public inquiry into the events at Stafford general hospital. Of course, in that hospital the adherence to ticking the box on the four-hour target was one of the things that contributed to the most appalling care of patients. We have to focus on delivering proper care for patients—the right treatment at the right time in the right place—and delivering the best outcomes for them. We will focus on that—on quality—not on top-down process targets.
Chris Leslie (Nottingham East) (Lab/Co-op)
Is it really true that the coalition Government are going to scrap the right for people to see their GP within 48 hours? If so, will the Secretary of State publicise that, so people know that the right has been reduced? If it is true, is he not just axing public service quality under the pretence of dealing with so-called bureaucracy?
Mr Lansley
It is astonishing—the Labour Government spent money trying to achieve the GP access target, and the hon. Gentleman might at least have recognised that the latest data, published two or three weeks ago, show that public satisfaction with access to their GPs, and the things that the Labour Government had been paying for, had actually gone down. A consequence of the 48-hour access target was that patients were unable to access their GPs more than 48 hours in advance. Is it not reasonable to expect GPs to be able to manage their own services in order to deliver better patient experience and outcomes across the board? I think we can reasonably expect that.
Nadine Dorries (Mid Bedfordshire) (Con)
It has been reported today that historically speaking, as a result of targets, an obstetrician in a hospital could herself have a caesarean section but then have to refuse one to a patient, because of the pressures that targets put on the local NHS trust. Can the Secretary of State give us an assurance that any woman in the NHS who needs a caesarean section will have one, and that no targets will be imposed?
Mr Lansley
My hon. Friend is referring to World Health Organisation targets, which have not in themselves been applied within the NHS, and it certainly would not be my intention to impose such targets. I agree with the implication of her question, which is that a woman who needs a caesarean section should have access to one. I am also well aware that when a woman does not require a caesarean section we should seek, through a process of discussion and providing information, to avoid that wherever possible. Birth should be considered a normal event, rather than being subject to excessive medicalisation.
Mrs Madeleine Moon (Bridgend) (Lab)
5. What his most recent assessment is of the adequacy of the level of support provided for people with low vision.
Mr Dominic Raab (Esher and Walton) (Con)
11. What steps his Department is taking to increase participation by local people in NHS decision making.
The Secretary of State for Health (Mr Andrew Lansley)
I have stopped top-down reconfigurations where the NHS has not listened to local people. Our coalition agreement is clear that we will give patients more control over their own health care, and give patients and the public a stronger voice in the design of local health and care services.
Mr Raab
NHS managers have justified cuts in community hospitals in Walton, Cobham, Molesey and other parts of the country on efficiency grounds, but in 2009, because of targets, almost 1 million patients were discharged and then readmitted within 30 days, at a cost of £1.6 billion. What plans has the Secretary of State to strengthen local democratic control over community hospitals and the vital services that they provide?
Mr Lansley
My hon. Friend has raised an important issue. Let me make two points. First, we need to strengthen not only the local public and patient voice but the voices of GPs who are involved in commissioning, so that they can act on behalf of their patient population in commissioning the services, and design of services, that they need. Secondly, as I have made clear in the revision of the operating framework, we must look at results. When someone goes into hospital for treatment, we must consider not just their treatment in the hospital, but their subsequent rehabilitation and re-ablement. I believe that that will allow greater use of intermediate care beds in the way that my hon. Friend has described.
Hazel Blears (Salford and Eccles) (Lab)
I thank the Secretary of State for agreeing to meet me—together with representatives of my local primary care trusts, local mums and midwives—to discuss maternity services in Salford. In the light of his new criteria for reconfigurations, will he confirm that he is prepared to reconsider the decision to close Salford’s maternity services, and to recognise the views of thousands of people throughout Salford and Eccles, including me, who opposed it at the time?
Mr Lansley
The right hon. Lady knows that we will meet to discuss the issue. However, as I said when I was in Greater Manchester, it is not for me to reconsider the application of the new criteria from 21 May. That is for local people to reconsider. It is for GPs, the public, local authorities and, indeed, PCTs in Salford and district to start thinking about what they consider to be viable and successful future services for mothers-to-be.
Mr Edward Timpson (Crewe and Nantwich) (Con)
In helping local people to become more involved in NHS decision making, will my right hon. Friend agree to consider my Ambulance Response Times (Local Reporting) Bill, which received its Second Reading during the last Parliament? The Bill requires all ambulance trusts to publish local as well as regional response times and patient outcomes so that—as is already the case in Crewe and Nantwich—they have access to those details and can deliver better response times, with the help of local initiatives such as Community First Responders.
Paul Goggins (Wythenshawe and Sale East) (Lab)
12. What his policy is on maximum waiting times in accident and emergency departments; and if he will make a statement.
The Secretary of State for Health (Mr Andrew Lansley)
From April 2011, the accident and emergency four-hour waiting time standard will be replaced by a set of clinical quality standards, developed with clinicians, which will support quality care without the damaging distortion of the four-hour tick-box target. On the basis of clinical advice, I have immediately reduced the threshold for meeting the four-hour standard from 98% to 95%.
Paul Goggins
I am sure that the Secretary of State will want to join me in congratulating the staff at Wythenshawe hospital in my constituency. Last year 85,000 patients were seen in the accident and emergency department, 98% of them within four hours. Can the Secretary of State explain to my constituents why he has decided that this year 4,500 of those patients will not need to be seen within that time?
Mr Lansley
As I told the right hon. Gentleman, I made that decision on the basis of clinical advice. It was clear that the 98% standard was distorting clinical care for patients. There is no benefit for patients if, for the purpose of meeting a four-hour target, they are discharged inappropriately, transferred to wards when they have not been thoroughly looked after in the accident and emergency department, or indeed put in an observation ward for 48 hours, which is under the scrutiny of the accident and emergency department but ticks the box. None of that helps patients. I will focus on what is actually in the best interests of patients, and delivers the right outcomes for them.
Philip Davies (Shipley) (Con)
17. What recent representations he has received on the appropriateness of the remit of the National Institute for Health and Clinical Excellence; and if he will make a statement.
The Secretary of State for Health (Mr Andrew Lansley)
Since 7 May, the Department has received about 120 representations from hon. Members, noble Lords and members of the public on a range of issues concerning the National Institute for Health and Clinical Excellence, including its remit.
Philip Davies
May I urge the Secretary of State to get NICE to go back to what most people think it is for, which is monitoring the cost-effectiveness and clinical effectiveness of drugs? Many people do not think that it does a particularly good job on that, anyway, but it is currently indulging in empire building, with its ridiculous drivel in recent weeks about smoking breath tests for pregnant women, compulsory sex education for five-year-olds and subsidies for food companies to make healthier food. Surely it ought to go back to what it should be doing, and do it better, rather than empire building, as it is doing.
Mr Lansley
In 2005 the previous Government charged NICE with producing public health guidance as part of its work. As I establish a more integrated and effective public health service, I shall consider how the advice of NICE fits into that strategic framework.
Mike Gapes (Ilford South) (Lab/Co-op)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Andrew Lansley)
My responsibility is to lead the NHS in delivering improving health outcomes in England; to lead a public health service that improves the nation’s health and reduces health inequalities; and to lead the reform of adult social care that supports and protects vulnerable people.
Mike Gapes
When the new Secretary of State intervened to stop the reorganisation of health services in London, he said that there would be no forced closures. Can he give me an unambiguous and categorical assurance that he will not allow the closure of the accident and emergency department, the children’s surgery or the maternity services at King George hospital in Ilford? Yes or no?
Mr Lansley
The hon. Gentleman’s question seems rather churlish, given that he wanted to stop the top-down configuration that NHS London imposed so that people in his area—GPs, the local authority, local people and patients—could have an opportunity themselves to decide how services might best be designed for local people. That is the pledge that I have made. Those criteria will enable that process to be led locally, rather than imposed and forced on people.
Lorraine Fullbrook (South Ribble) (Con)
T4. St Catherine’s hospice is used by many of my constituents, and they will be pleased to be able to go ahead with the hospice’s planned improvements, which will be funded through the capital grants programme. Does the Secretary of State agree, however, that the excellent work of such hospices goes far beyond the hospice building? What will his Department do to ensure that hospices play a greater role in providing services to the local community?
Mr Lansley
I am very grateful to my hon. Friend, who will know that I entirely understand and applaud the work of St Catherine’s hospice, because we have visited it together. She makes a very important point, because those whom I know in the hospice movement want to think not just about the service that they provide in their buildings, but about an holistic service for patients’ families and for those who require palliative care. I might just say that on Saturday I made it clear that up to £30 million will be available in this financial year to support children’s hospices, specifically, in extending their work so that they can provide a service in the community for children with life-limiting illnesses.
Andy Burnham (Leigh) (Lab)
The right hon. Gentleman will remember our exchanges at the election hustings, where there was a real difference between us: we said that we would protect the NHS budget in real terms, and I stand by that commitment; the right hon. Gentleman said that he would increase the NHS budget. After last week’s Budget, however, we now know the price of that commitment: 25% cuts to social care will mean vulnerable people either left without the support that they need or facing higher charges to pay for care, and huge pressure on carers. It means also that the NHS itself stops working, because it cannot discharge people from hospital when there is no support in the community. That unbalanced approach to public spending is dangerous and will decimate services on which the NHS depends. Is it not time to drop a pledge that had more to do with votes and nothing to do with people’s lives?
Mr Lansley
So there we have it, Secretary of State. [Hon. Members: “Secretary of State?”] I meant “Mr Speaker”—you are far more elevated than a Secretary of State, Mr Speaker.
The shadow Secretary of State’s belief is that the NHS budget should be cut. I fail to see how that could help social care. We are going to look much more positively at how we can join up the work of the NHS and social care. What my colleagues and I have announced on 30-day support for patients leaving hospital, including rehabilitation and re-ablement, will do precisely that, relieving some of the pressures on social care by seeing the NHS as a more holistic service for patients.
Dr Julian Huppert (Cambridge) (LD)
T5. Does the Secretary of State accept the conclusions of the Science and Technology Committee’s report “Evidence Check 2: Homeopathy”? Earlier, the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton) gave a commitment to an evidence-based approach and today the British Medical Association passed a motion about homeopathy. Given the financial constraints in which we all share, can the Secretary of State defend spending millions of pounds of NHS money on methods that simply do not work?
Toby Perkins (Chesterfield) (Lab)
T2. My right hon. Friend the shadow Secretary of State referred to the Commonwealth Fund report, which said that Britain’s NHS was the most efficient. Does that not make it clear that after 13 years of a Labour Government, the NHS is not just so much better for patients, but efficient? To say that it is not is an insult to the people who have worked so hard to make it great.
Mr Lansley
I have looked at the reports of the Commonwealth Fund for a number of years; it regards the NHS as efficient because it spends relatively little in comparison with other health economies. In this country, we need to recognise that the NHS does not spend very much in comparison with other countries but it could spend it more efficiently. There has been declining productivity for 10 years. [Interruption.] The shadow Secretary of State needs to recognise that NHS management costs went up by 63% while nursing costs went up by just 27%. My colleagues and I are committed to halving NHS management costs and to reducing the costs of the NHS, through efficiency, by £20 billion. Every penny of that will be reinvested in meeting the rising demand for the NHS and the improvements in quality that we require.
Duncan Hames (Chippenham) (LD)
T7. What encouragement is the Secretary of State giving to primary care trusts to restore minor injury services to towns such as Melksham in my constituency? It saw its minor injuries unit close under the last Government.
Jim Shannon (Strangford) (DUP)
One of the concerns of a great many of us recently has been the availability of cancer care drugs. [Interruption.] Right across—right across, Mr Speaker, the whole United Kingdom, and Northern Ireland in particular, a great many people have not been able to access cancer care drugs and have had to endure sickness and illness without them. Can the Secretary of State assure the House today that cancer care drugs will be made available and that those who are ill and suffering from cancer can rest easy?
Mr Lansley
We have been very clear that it is a scandal that we have some of the finest cancer research anywhere in the world and some of the best cancer medicines have been developed in this country, yet in the past in this country NHS patients have often been the last to have access to those drugs. That is why at the election we made it clear that we will introduce from April next year a cancer drugs fund, the purpose of which will be to ensure that patients get access through the NHS to the cancer medicines that they need, on clinical recommendation and advice, and that they are not unduly delayed in getting that access.
Julian Sturdy (York Outer) (Con)
T9. I am sure that the Secretary of State will remember visiting my constituency earlier in the year and listening to constituents’ concerns about the withdrawal of spinal injections on the NHS. Given that the PCT’s decision is set to become another example of the postcode lottery in the health service, will his Department consider the ongoing debate about spinal injections in York and support the attempts of my constituents as they seek to shape local health services around their specific needs?
Vernon Coaker (Gedling) (Lab)
T3. Does the Minister agree that it is crucial for patients to have information if we are to make a reality of choice within the NHS? In that respect, does he agree that if we are to give people a real choice as regards the choose and book system that GPs operate, there is a need to ensure that patients have the information about the success rates of different hospitals, and different surgeons, as regards operations?
Mr Lansley
I agree with the hon. Gentleman—it is just that that did not happen under a Labour Government in the way that it should have done. For example, the national quality registers in Sweden have 69 areas of clinical practice for which such comparative data are published. I have made it clear that one of our priorities is that we focus on outcomes and on giving patients real empowerment. To do that, information for patients on outcomes will be absolutely critical.
Dr John Pugh (Southport) (LD)
T10. I have here a letter from my local PCT indicating that the clinical review of the safety of a proposed children’s walk-in centre in Southport is to be conducted by Dr Sheila Shribman and the Minister’s Department. Will the Minister arrange to meet me and relevant officials to ensure that the Department is properly aware of the background to this vital access issue and that we have a clinical network suitable for patients, as well as for practitioners?
Mrs Mary Glindon (North Tyneside) (Lab)
T6. Every year in the north-east, 300 children are born with congenital heart disease. These very sick children receive expert treatment locally in the world-class cardiothoracic unit at Newcastle’s Freeman hospital. Can the Minister assure my constituents, who value this vital local service, that the findings of Sir Ian Kennedy’s review of children’s heart surgery centres will be implemented without financial constraint?
Mr Lansley
I should tell the hon. Lady that it is premature to make any commitment about the review, because we now need to have proper engagement with local people, patients and those who are responsible to focus on how we can make absolutely certain that the outcomes that we achieve for children requiring cardiac surgery are as good as we can possibly make them.
Robert Halfon (Harlow) (Con)
Will the Minister review the problem of highly priced patient lines and introduce competition so that patients in Harlow and elsewhere no longer pay extortionate prices to watch TV or make phone calls?
Mr Nick Raynsford (Greenwich and Woolwich) (Lab)
The Secretary of State has halted the reconfiguration of services in south-east London, which was clinically led, the subject of detailed public consultation and approved by the reconfiguration panel. The outcome is to leave my PCT and hospital trust acutely troubled about their ability to deliver the improved health services that were promised under “A picture of health” and to meet their financial targets. What does that say about the Government’s commitment to evidence-based policy making?
Mr Lansley
What we have done in London is to give those who would be most affected by decisions to reconfigure services the opportunity, where decisions have not already been made, to have a local say. That includes patients, the public and GP commissioners. The delay, in so far as there is any delay, need not be great if those proposals are fully subscribed to by local people and by their GPs as commissioners.
David Tredinnick (Bosworth) (Con)
Would my right hon. Friend accept that there is widespread anecdotal evidence of the effectiveness of homeopathic medicines? There are 500 doctors in this country who use them, and nobody is obliged to have them if they do not want them. Will he therefore heavily discount the illiberal views of our hon. Friend the Member for Cambridge (Dr Huppert)?
Alex Cunningham (Stockton North) (Lab)
The North Tees and Hartlepool NHS Foundation Trust believes that its strategy for one hospital to replace the North Tees and Hartlepool university hospitals is the right strategy, despite the project being dropped by the Government. Does the Minister accept that the trust’s strategy to provide a new hospital and health facilities closer to communities to meet their health needs is correct, that the trust should be encouraged to press ahead with alternative funding models that could still deliver the new hospital, and that its members and the public at large can expect Government support to realise that strategy?
Mr Lansley
What I would look for is for the foundation trust to meet the criteria that I published on 21 May in relation to any reconfiguration of services that it proposes for its area. As a foundation trust, I would also expect that, having secured the freedoms associated with that status, it should not ask the Department of Health to meet the whole capital cost of whatever it proposes.
NHS Operating Framework
Lord Lansley Excerpts(13 years, 10 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
Today I am publishing a document setting out the revisions to the NHS operating framework for 2010-11. The document has been placed in the Library and copies are available to hon. Members from the Vote Office.
In now moving towards a health service which puts patients at the heart of decision making, which focuses on quality and outcomes not processes, and with more devolved responsibilities, this short document sets out a number of areas subject to immediate change.
The Department will cease to centrally performance-manage the previous Government’s targets on 18-week waiting times and access to primary care. More clinically relevant accident and emergency indicators will be developed for 2011-12. Locally led plans should deliver improvements in median waiting times and access.
The coalition Government are committed to stopping top-down reorganisations of the NHS that have got in the way of patient care. To that end, a moratorium is in place for future and ongoing reconfiguration proposals. All current and future reconfiguration proposals will need to meet four new tests as I set out in the document; and can go forward, if and when they do so.
I shall set out that primary care trusts (PCTs) should accelerate the process to transform community services with clear deadlines.
I have asked each strategic health authority (SHA) region to now go further, faster, to release all possible resources to meet demand and quality challenges. The overall ceiling for management costs in PCTs and SHAs will now be set at two thirds of the 2008-09 management costs (£1,509 million), the ceiling will therefore be £1,006 million. In aggregate, PCTs and SHAs will need to save at least £222 million in 2010-11 and a further £350 million by the end of 2011-12.
I am asking NHS organisations to ensure that they demonstrate similar discipline to central Government on consultancy, marketing and information, communications and technology spend, recruitment, and centralised procurement for goods and services.
The number of best practice tariffs shall be expanded where payment is linked to best practice care, as well as expanding the list of never events so that no payment is made for services, which compromise patient safety.
I announced on 8 June 2010 my intention to make hospitals responsible for patients 30 days after discharge, one of the key health commitments in the coalition agreement. If a patient is re-admitted during that time, the hospital will not receive any further payment for the additional treatment. Making hospitals responsible for a patient’s ongoing care after discharge will create more joined-up working between hospitals and community services and may be supported by the developments in re-ablement and post-discharge support. This will improve quality and performance and shift the focus to the outcome for the patient.
These are the only changes I am making in-year. The remainder of the NHS operating framework 2010-11, which was published on 16 December 2009, still stands and I expect the NHS to play its role when partnership approaches are needed to secure better outcomes.