Oral Answers to Questions
Lord Lansley Excerpts(14 years, 3 months ago)
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Neil Carmichael (Stroud) (Con)
1. What steps he is taking to work with clinicians and patient groups in the design of the cancer drugs fund.
The Secretary of State for Health (Mr Andrew Lansley)
We are committed to ensuring that the cancer drugs fund, which is to be introduced in April next year, will enable NHS patients to have greater access to new cancer drugs. We will soon consult the public and clinicians on our plans for this. From 1 October this year, as an interim measure, regional panels led by expert clinicians will respond to requests to fund cancer drugs that have not been funded locally.
Neil Carmichael
I am delighted with the answer from the Secretary of State. Some people are concerned about the possibility of a postcode lottery. Has the Department thought about that, and what actions does it plan to avoid the fund being subject to that?
Mr Lansley
I am grateful to my hon. Friend. Many people are concerned about their experience of a postcode lottery and access to new cancer drugs. Indeed, there is not just a postcode lottery but an international lottery, with patients in this country not getting access through the NHS to new cancer drugs while patients in other countries do get access to those drugs in the same clinical circumstances. That is why we will not only establish the cancer drugs fund next year, but, this year, we have found £50 million by making savings on management and marketing costs to enable new cancer drugs to be made available, at a regional level across England, where they are not funded locally.
Valerie Vaz (Walsall South) (Lab)
Has the Secretary of State had any discussions with the National Institute for Health and Clinical Excellence about the fund, and is it cash-limited?
Mr Lansley
Yes, I did have discussions with NICE. The interim measure this year is indeed cash-limited—£50 million is available between October and the end of March.
Anne Marie Morris (Newton Abbot) (Con)
Will the Secretary of State consider seriously the situation with regard to Avastin—a drug that particularly relates to bowel cancer? I have a constituent who is dying of that complaint, and their primary care trust has refused treatment under current NICE guidance. NICE is currently reviewing the situation. I would be grateful if the Secretary of State will say that he will support positive findings.
Mr Lansley
My colleagues and I are very well aware of the issues relating to Avastin, and I am grateful to my hon. Friend for her question. In terms of the interim measure that starts on 1 October, patients should go through all the normal procedures of seeking treatment through their hospital with the consent of their PCT. However, if that fails, a regional panel of expert clinicians will be able to look at their circumstances, with a special fund to enable patients to have access to cancer drugs which previously they would not have received.
Diana R. Johnson (Kingston upon Hull North) (Lab)
Of course we support efforts to ensure that those with rarer cancers get access to the drugs that they need, but there are serious concerns about the cancer drugs fund. Professor Alan Maynard says that
“this will run a coach and horses through the work done by NICE”.
The Lancet has called the fund a product of political opportunism and intellectual incoherence leading to the potential for a postcode lottery between strategic health authorities. Where does this leave NICE—an organisation that the Secretary of State said that he wants to strengthen?
Mr Lansley
It in no way undermines the role of NICE, which continues to play a very important role in giving advice to the NHS on the relative clinical effectiveness and cost-effectiveness of drugs. However, there are many circumstances at the moment whereby patients are not getting access to medicines. NICE, through its thresholds, is setting limitations on access to new cancer medicines. The hon. Lady should know, because the research was commissioned under her Government, that we need to look at international variations in drug use across health economies. Her Government did not publish that information; we have published it. It demonstrates that in this country we have relatively poor access to new cancer medicines, often before the point at which NICE has undertaken a full cost-effectiveness appraisal. We are going to ensure that patients in this country do not lose out as a consequence of those delays.
David Tredinnick (Bosworth) (Con)
When considering the drugs fund, will the Secretary of State bear it in mind that many patients who have had chemotherapy find relief from using herbal medicine and acupuncture? When will he come forward with proposals to interface with next year’s European directive so that herbal and acupuncture practitioners can conform to the law?
Mr Speaker
I know that the Secretary of State’s response will relate to the cancer drugs fund.
Mr Jim Cunningham (Coventry South) (Lab)
3. What estimate he has made of the number of redundancies which would result from the abolition of strategic health authorities and primary care trusts?
The Secretary of State for Health (Mr Andrew Lansley)
Our White Paper set out proposals for greater devolution to clinical leadership in the NHS and an enhanced role for local authorities in setting health strategies and improving public health. That means that we will abolish primary care trusts and strategic health authorities. General practice-led consortiums will make decisions about their requirements for management support, as will the new NHS commissioning board and local authorities. However, the requirement to cut management costs and protect the front line will mean reduced numbers of administrative posts. The extent of that will depend on local plans, and we will publish an impact assessment in due course.
Mr Cunningham
The coalition agreement stated that PCTs would be a strong voice for the public. How will the Government achieve that if they are going to abolish them?
Mr Lansley
We set out clearly in the White Paper how we will increase accountability to the public, including by establishing Health Watch. Before the election, the hon. Gentleman’s party’s Government demolished the patient representative voice in community health councils and patients’ forums and created nothing effective in its place. Health Watch will be an effective voice for patients, and democratic accountability through local authorities will be far stronger because Health Watch will enable NHS services, public health services and social care to be joined together through co-ordination in a local authority’s health and well-being partnership.
Mark Pawsey (Rugby) (Con)
On the question of redundancies, the hon. Member for Coventry South (Mr Cunningham) and I represent adjacent constituencies covered by the same NHS trust, in which there is currently a review of urgent care provision at the hospital of St Cross in my constituency. Candidates for the Labour leadership recently visited the area, and one spoke to the Rugby Advertiser about his concern that the review was an example of the
“economic masochism being unveiled across the country by the Tories who continue to show no compassion for the vulnerable.”
Does the Secretary of State share my outrage at the choice of language by the likely Leader of the Opposition, and will he confirm that since this Government have committed themselves to real-terms increases in NHS funding, any reforms considered for Rugby will have nothing to do with the amount of funding for the local NHS?
Mr Lansley
I am grateful to my hon. Friend. We visited St Cross hospital together, so he knows the importance that we both attach to the service that is provided there for his constituents locally, but that happens in the context of the resources that we provide to enable the NHS to do its job. The Government have made an historic commitment to increase resources for the NHS in real terms each year, notwithstanding the appalling financial circumstances that we inherited from the Labour party.
The policy of the right hon. Member for Leigh (Andy Burnham) is to cut the NHS budget. Under those circumstances and under the policies of the Labour party, the number of redundancies in the NHS would proliferate.
Andy Burnham (Leigh) (Lab)
The right hon. Gentleman is planning the biggest reorganisation in the history of the NHS, and yet he is unable to give basic information on it, such as how many people may lose their jobs, to my hon. Friend the Member for Coventry South (Mr Cunningham). Tens of thousands of people who work for primary care trusts and strategic health authorities are at risk of losing their jobs, so it is no wonder that after a just a few short weeks in his job, the Secretary of State has brought morale in the NHS to rock bottom.
In his letter to the NHS, the NHS chief executive says that £1.7 billion should be set aside to pay for the Secretary of State’s reorganisation. Others have said that the cost of his reform could be up to £3 billion. At a time when the NHS needs every penny to maintain standards of patient care, it is scandalous for money to be diverted in that way. He may be ignoring the human cost, but can he tell the House today his latest estimate from the Department of how much his ideological reorganisation will cost?
Mr Lansley
I do wish the right hon. Gentleman would at least remember what he was responsible for before the election. He said that the NHS in this financial year should set aside 2%—£1.7 billion—for the cost of reorganisation. I have not changed that figure by one penny. However, I have taken his policies, which led to a proliferation in management costs—an 80% increase in the cost of management consultants in the NHS in two years and a doubling of management costs in PCTs and SHAs in eight years—and reversed them. We are cutting management costs in the NHS this year by more than £220 million and by up to £1 billion over four years. I make no apology for that, because if we are to protect front-line services and improve health outcomes, that is exactly what we need to do.
Andy Burnham
Let us first get some facts straight. I asked PCTs to set aside money to invest in patient care, changing patient pathways and better services. I did not say that a Labour Government would cut the NHS budget; I said that we would maintain it in real terms, not increase it, as the Secretary of State proposes. The effect of his increase will mean severe cuts to councils, which need to provide care support to older people to get people out of hospital.
However, the Secretary of State would not today tell us what his proposals would cost. Is it not the case that the plans were not in the Conservative or Liberal Democrat manifestos, and that there is no democratic mandate for the break-up of the NHS? Given that there is now a chorus of protest at his plans, will he step back, listen to patients and staff and consult on those reforms before taking them forward further?
Mr Lansley
I and my colleagues are engaging right across the country with patients, the public, local authorities, PCTs and general practitioners, and we are meeting enthusiasm for our proposals. Why? Because we are focusing on delivering improving outcomes for patients, and doing so in the context of an historic commitment by this coalition Government to increase resources for the NHS in real terms each year. The right hon. Gentleman’s policy would be to cut the NHS budget.
Andy Burnham
The Secretary of State thinks he can behave any way he likes with the NHS, the most beloved institution in this country, but we will not let him—we will give him a fight every inch of the way. The latest example of his high-handed and arrogant behaviour came on the eve of a bank holiday weekend, when he casually let slip that NHS Direct would be scrapped. NHS Direct is a valued service that receives 27,000 calls every day and saves millions of pounds for the NHS, and that has more than 3,000 staff working for it. Will he today apologise for making that statement in such an outrageous manner? Will he listen to the 14,000 people who signed a petition to save NHS Direct, and going forward, stop acting in such a cavalier manner with our NHS?
Mr Speaker
Order. A question should be a question—it should not really be three questions.
Mr Lansley
Once again, the right hon. Gentleman should remember what he did before the election. A press release from his Department on 18 December 2009, when he was Secretary of State, said that he would establish a new 111 national number for non-emergency health care, and that this could become the single number to access non-emergency care services, including NHS Direct. I did not announce anything: I simply said that we were going to get on with that—he never did.
Mr Peter Bone (Wellingborough) (Con)
4. What plans he has for the future of the national capitation formula.
Gordon Birtwistle (Burnley) (LD)
14. What steps his Department takes to ensure that local NHS trusts observe its guidelines on reconfigurations involving transfer of facilities from one hospital to another.
The Secretary of State for Health (Mr Andrew Lansley)
Commissioners should ensure that current and future reconfigurations demonstrate evidence of compliance with the four criteria that I announced in May. That should be a rigorous process, involving GPs and other local clinicians, local authorities, patients and the public, as set out in guidance. For current schemes, the local assessment should be concluded by 31 October this year.
Gordon Birtwistle
Is my right hon. Friend aware that East Lancashire Hospitals NHS Trust is breaching his guidelines by transferring a children’s ward from Burnley to Blackburn without the approval of local GPs and the local council or the support of the local population? Will he please intervene?
Mr Lansley
My hon. Friend and I have had a conversation in Burnley about emergency and children’s services at Burnley hospital. I was not aware of the position that he has just described, but I will ensure that any reconfigurations that have taken place in the past and are still being reviewed, or that are currently being proposed or acted on, comply with the criteria that I set out in May, and I will write to him.
Anna Soubry (Broxtowe) (Con)
15. What mechanisms are in place to assess the effectiveness of assertive outreach teams in providing support for people with severe mental illness; and if he will make a statement.
Caroline Flint (Don Valley) (Lab)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Andrew Lansley)
My responsibility is to lead the national health service in delivering improved heath outcomes in England, to lead a public health service that improves the health of the nation and reduces health inequalities, and to lead the reform of adult social care that supports and protects vulnerable people.
Caroline Flint
In recent years more research and evidence has demonstrated that the trans fats present in our food are a major heath hazard. That is how the National Institute for Health and Clinical Excellence has described them, and the World Health Organisation has described them as toxic, but many people do not even know they are in our foods because they are not listed on the front of our food packaging. Is the Secretary of State prepared to consider banning trans fats in our food, as is happening in other countries around the world, or at the very least consider making sure they are labelled on the products we buy so that we can make an informed choice?
Mr Lansley
The right hon. Lady will know that we have made progress in this country in reducing the amount of trans fats in foods. My personal view is that we should seek to eliminate them, rather than have them in foods and have them labelled. It is important that we have front-of-pack food labelling that identifies the extent to which there are saturated fats, and I am looking forward to making greater progress in getting a more consistent front-of-pack food labelling than we have achieved in the past.
Tony Baldry (Banbury) (Con)
T2. GPs and GP practice managers in my constituency are keen to get on with GP commissioning because they see that that can lead to better outcomes for local people but, unsurprisingly, they have a number of detailed questions as to how GP commissioning will work. Who will best answer those questions, and when will that happen?
Mr Lansley
My ministerial colleagues, and many other leadership colleagues across the NHS, are engaged in meeting staff and potential commissioners, and existing commissioners and patients and public across the country. I had a meeting of that kind in Hampshire just last week, which illustrated precisely the point my hon. Friend makes: people came from general practices across Hampshire, and they fully endorse the principle of this change and they just want to get on with it. They did not want to wait for the full transition, and they now wanted to go through some of the detailed questions. We issued a consultation document following the White Paper, which was focused on general practice commissioning. I urge my hon. Friend’s constituents and others to respond to that before 11 October, which will enable us then to proceed to set out the full details of how general practice-led commissioning will work.
Mary Creagh (Wakefield) (Lab)
The Secretary of State had a difficult summer, with his plans to scrap free milk for the under-fives being attacked across the spectrum and eventually vetoed by the Prime Minister, but he met the new chair of Unilever, Amanda Sourry, on 21 July. On the following day, Ms Sourry wrote him a letter, some of which is blanked out. She wrote that
“with a clear signal from you, I would be happy to engage with retailers and manufacturers to find resolution on front-of-pack labelling”.
The Department has tried to black out that sentence, perhaps because it shows an unhealthy closeness between the Secretary of State and Unilever. Does the Secretary of State have an opinion on how food should be labelled, and, if so, will he tell the House what it is? Will he tell the House what other areas of food policy he plans to subcontract out to multinational food giants?
Mr Lansley
I hardly know where to begin due to the absurdity of some of the assertions in that question. How does the hon. Lady imagine that we are going to make progress on front-of-pack food labelling, on which her Government never made sufficient progress—there is no consistency on front-of-pack food labelling? This Government and this Parliament have no unilateral power to mandate what front-of-pack food labelling should look like and we have to achieve consensus in Europe and consensus in this country. We must do that with the manufacturers, the retailers, the charities and the health experts. That is precisely why our public health commission, when we were in opposition, brought together all those people around a table for the first time. I intend to create a realistic and effective partnership to deliver improving public health in this country, where her Government failed.
Mr Philip Hollobone (Kettering) (Con)
T5. Kettering general is a wonderful hospital but recently its paperwork has got out of control. Some 30 occasional chaplaincy visitors from the local Catholic Church, many of whom are retired, have recently had to complete Criminal Records Bureau checks, employer references and an intrusive personal health questionnaire. Does the Minister agree that if we are to create the big society that the Prime Minister would like us to create, such bureaucracy must be minimised?
Keith Vaz (Leicester East) (Lab)
T3. Some 1,800 patients in the Belgrave area of my constituency have been left without their local surgery because it has closed. Will the Minister assure me that despite the scrapping of the primary care trust, the new Belgrave health centre will be built? If he cannot tell me now, it would be very helpful if he could write to me.
Mr Lansley
I am grateful to the right hon. Gentleman, but in the absence of notice of that question, I fear that I shall have to tell him that I shall certainly look into that and write to him.
Miss Anne McIntosh (Thirsk and Malton) (Con)
T6. The Minister of State wrote to me on 25 August to say that all future service changes must be led by clinicians and patients. How can it be that, although all the clinicians and patients oppose the downgrading and possible closure of the Ryedale ward of Malton hospital, that can proceed? Will he please use his good offices to block any such change?
Gloria De Piero (Ashfield) (Lab)
T4. When the Government say that the NHS budget will be ring-fenced, people might assume that whatever cash a hospital gets in this financial year will be matched next financial year. So could the Health Secretary explain why the King’s Mill hospital in my constituency has been told to expect its budget to treat patients next year to fall by 8.2% or £14.9 million?
Mr Lansley
The answer to the hon. Lady’s question is probably because that is what the Labour Government’s spending intentions implied. All over the country primary care trusts are telling their hospitals that they can expect a zero increase in tariff and a reduction in activity, and hence a reduction in budget. I am making it clear that we are intending an historic commitment by this coalition Government to increase the resources for the NHS in real terms. That does not mean an increase in real terms for every part of the NHS all the time. It does mean, however, that resources will be realised through efficiency savings and that increase to enable us to improve the service we provide through the NHS and to meet rising demand.
Mr John Baron (Basildon and Billericay) (Con)
T8. Is any flexibility available to allow the interim cancer drug fund to review earlier and more speedily adverse National Institute for Health and Clinical Excellence decisions—because in certain cases, as we know with Avastin for late-stage bowel cancer, a few months, or even a few weeks, can make a big difference to patients.
Mr Lansley
My hon. Friend will be aware that we have proceeded as rapidly as we possibly can in finding savings this year, so that from 1 October the regional panels of expert clinicians can look at individual cases. It is not a matter of their reviewing NICE decisions; it is a matter of their looking at individual cases that cannot be funded under existing guidance or local decisions, but being able to apply clinical criteria to individual cases using an additional fund.
Emma Reynolds (Wolverhampton North East) (Lab)
T7. Wolverhampton is the 28th most deprived local authority area in the country, resulting in major health inequalities. Can the Secretary of State reassure me that in future funding allocations, levels of deprivation will be taken into account?
Mr Lansley
Yes and more than that. I could make it clear that in the future, we will be moving—not for next year necessarily, but in years beyond, as we will make clear in the public health White Paper—to an explicit allocation of public health resources taking account of relative health outcomes and health inequalities, and those funds will be used to deliver improving public health. At the moment the formula to the NHS may take account of relative deprivation as measured by, for example, access to income support, but the money does not get spent on reducing those health inequalities and on an effective public health strategy. That is why we shall be very clear about separate, ring-fenced, public health resources used, together with local authorities, to deliver an effective public health strategy locally.
Andrew Selous (South West Bedfordshire) (Con)
Leighton Buzzard is one of the larger towns in the country not to have a community hospital. What reassurance can my hon. Friend give me that the wishes of local GPs will be respected in deciding what services the proposed community hospital will have?
John Mann (Bassetlaw) (Lab)
Some 36,000 of my constituents, who voted by ballot, and every single GP in both local authorities, all believe that Bassetlaw accident and emergency department should remain a full 24-hour service. Can the Secretary of State conceive of any reason why that might not be the case during this Parliament?
Mr Lansley
The hon. Gentleman will be reassured to recognise that one of the commitments of the coalition Government in our programme was to stop the forced closure of accident and emergency departments. I am sure he will take comfort from the commitment of this Government, and from our commitment to increasing resources for the NHS in real terms each year, to enable the services that his constituents and others’ require to continue to be provided and improved.
Jo Swinson (East Dunbartonshire) (LD)
Information in a parliamentary answer given on 19 July showed that the cost to the NHS of emergency admissions in cases of anaphylaxis has risen by 45% in four years. Will the Minister look at how allergy support services could be enhanced in primary care to reverse the rising trend in emergency cases and in doing so save money and, crucially, lives?
Mr Lansley
Yes I will gladly do that. I have had the privilege and pleasure of visiting the specialist allergy service at my local hospital, Addenbrooke’s, one of a small number across the country. I think it was the House of Lords Select Committee that produced an excellent report on allergy services, and I hope that this is one of those areas where clinical relationships between GPs and hospital specialists will enable both community and specialist services to be improved to meet this need.
Mr Kevin Barron (Rother Valley) (Lab)
Given that 50% of health inequalities are created by tobacco use, will the Secretary of State give us an assurance that the targeted smoking cessation programmes in the national health service will survive?
Mr Lansley
We are going to improve the effectiveness of our public health services. As the right hon. Gentleman will know from past debates, I entirely recognise the extreme importance of reducing tobacco use. After the introduction of legislation on smoking in public places, there was a reduction in prevalence, but at the moment there is no continuing further reduction, especially among manual workers and young people; we need to achieve that reduction, and we will continue to look at measures to do that. We will say more about the issue in our public health White Paper.
Mr Steve Brine (Winchester) (Con)
Many of my constituents, and indeed many practitioners, have grave concerns about the pending closure of Winchester ambulance station. Will the Minister assure the House that no changes to static ambulance bases will take place until local consortiums, when they are formed, are happy that a suitable alternative is in place?
Mr Lansley
I am aware of the matter. The right hon. Gentleman will be perfectly well aware of my view: we want to involve general practitioners much more in commissioning out-of-hours services. I will undertake to look at what is proposed by the primary care trusts in north London and see whether it is consistent with the development that we are looking for in the White Paper.
Mrs Helen Grant (Maidstone and The Weald) (Con)
If local GPs fail to support reconfiguration plans en masse—if, say, 97% fail to do so—what would be the Secretary of State’s response?
Mr Lansley
As I said in response to a previous question, one of the four criteria that I set out on 21 May was that reconfigurations must have the support of local general practitioners as the future commissioners of services. To that extent, a reconfiguration that did not have the support of local general practices would not be able to meet that test.
Ian Paisley (North Antrim) (DUP)
What discussions, if any, has the Secretary of State had with the Minister for Health, Social Services and Public Safety in Northern Ireland about making Avastin and other specialist cancer drugs available on the same terms and conditions under which they are available to people who suffer from cancer here on the mainland? Will those drugs be made available in Northern Ireland under the same terms and conditions?
Mr Lansley
I have had very helpful and productive conversations with the Health Minister in Northern Ireland, but I have to say that they did not include that particular subject. Of course, decisions on the availability of medicines in Northern Ireland are a devolved matter, but I should be perfectly happy to take account of those issues when we next talk.
Dr Sarah Wollaston (Totnes) (Con)
One year on from the implementation of the European working time directive, there is evidence that patient care is suffering. Handovers have been inadequate in some cases, and junior doctors’ training time has been reduced. Will my right hon. Friend reassure me that he will take action to allow some acute specialities to opt out of the European working time directive?
Mr Lansley
Yes. I am very clear that, together with my right hon. Friend the Secretary of State for Business, Innovation and Skills, we need to take the European working time directive back to the European Union. We need to discuss it again. We need to go to the European Union with the intention of maintaining the opt-out and of giving ourselves, not least in the health context, the flexibility that we lack, so that junior doctors, in particular, have the capacity to undertake the training that they need. It is not that we want to go back to the past, when there were excessive hours—100-hour weeks and so on—but we want junior doctors to be confident that they will get the training that they require in the period allocated for training.
Cancer Drugs
Lord Lansley Excerpts(14 years, 5 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
In 2008, Professor Sir Mike Richards, National Cancer Director, was asked to lead a review of the extent and causes of international variations in drug usage and provide a report. Professor Richard’ report has been in the Library of the House and copies are available to hon. Members from the Vote Office.
I would like to thank Professor Richards and his advisory group for their work on the report. They have undertaken a thorough review, which represents the most comprehensive analysis yet of the extent and potential causes of international variations in medicines usage.
The report explores the extent and causes of international variations in drug usage across 14 countries, including the United Kingdom, for a range of conditions and diseases. The report indicates that there are wide international variations in usage of most of the drugs included in the study. Although a few countries emerge as generally high or low users, there does not appear to be a uniform pattern across disease areas.
As with most of the countries studied, usage levels in the UK appear mixed when looking across the range of conditions. It does however show high levels of use in some important areas, for example of lipid-regulating drugs which are helping to prevent many deaths from cardiovascular disease.
One of the more concerning findings in the report relates to our usage of newer cancer drugs, which lags behind that of most of the countries studied. The findings in this report make it even more important that Government do everything it can to remove barriers to doctors prescribing the cancer drugs they think will help their NHS patients. In the medium term our plans to introduce value-based medicines pricing in 2014, on expiry of the current pharmaceutical price regulation scheme, will allow Government to take the initiative on access to new medicines. We will make new medicines available to NHS patients at a price that represents their value, rather than being restricted to recommending against the use of a new drug in the NHS due to the price its manufacturer sets.
However, we also need to act to improve access to these drugs in the meantime. As an interim measure, the coalition agreement set out our plans to establish a cancer drugs fund from April 2011, subject to the spending review outcome. The need for this fund is clearly supported by Professor Richards’ findings, and we will be consulting on our plans for the fund later in the year. But the report underlines the need for action now to help NHS patients access the cancer drugs their doctors think will benefit them.
I am therefore announcing today additional funding of £50 million for this financial year to support improved access to cancer drugs. This funding, which has been found from a review of Department of Health central budgets, will be made available through clinically-led regional panels from October 2010.
This Government are committed to ensuring that cancer patients no longer have to worry about whether they will be able to get the cancer drugs their doctors recommend from the NHS.
NHS White Paper (Supporting Information)
Lord Lansley Excerpts(14 years, 5 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
Today I am publishing two further supporting documents to the national health service White Paper, “Equity and Excellence: Liberating the NHS” (Cm 7881) which was published on 12 July.
The first document, “Regulating Healthcare Providers”, provides further detail on the principles of the policies set out in the White Paper, and seeks views from the public and external partners on some of the questions arising out of them.
The White Paper set out a vision for a national health service centred around the needs of patients, focusing consistently on improving quality of care. One of the fundamental features of the proposals is to free providers from political interference and to establish a stable, transparent regulatory environment.
“Regulating Healthcare Providers” therefore sets out proposals to free providers from central Government controls and to develop Monitor, the current regulator for foundation trusts, as an independent economic regulator for health and adult social care.
Under our proposals, all remaining NHS trusts will become or be part of a foundation trust, free from the state’s operational control and not subject to the Secretary of State’s direction. We will create an environment where staff and organisations enjoy greater freedom and clearer incentives to flourish. All providers should be able to compete on a fair playing field, so that they succeed or fail according to the quality of care for patients and the value they offer the taxpayer.
Monitor will be responsible for regulating all providers to promote efficient, financially sustainable service provision. It will operate independently of Government so that providers have confidence in a stable, rules-based system—without the risk of political interference—to make long-term investments in services. Monitor will have powers to license providers of NHS services and core functions to regulate prices for NHS services, where needed, to promote competition, and to support service continuity.
The document seeks views on a number of questions by 11 October.
Today, I am also publishing the report of the Department’s review of its arm’s-length bodies.
The publication, sets out our proposals for arm's-length bodies in the health and social care sector. These proposals form part of the cross-Government strategy to increase accountability and transparency, and to reduce the number and cost of quangos.
The Government’s proposed reforms of the NHS, set out in “Equity and Excellence: Liberating the NHS”, will establish more autonomous institutions, with greater freedoms, clear duties and transparency in their responsibilities to patients. Power will be devolved to the front-line. Liberating the NHS will fundamentally change the role of the Department and those bodies accountable to it. Changes to the arm’s-length body sector must reflect these wider reforms.
There is also an economic imperative for change. The Government have guaranteed that spending on health will increase in real terms in every year of this Parliament and are committed to increasing the proportion of resource available for front-line services, to meet the current financial challenges and the future costs of demographic and technological change. This means that we need to make significant cuts in the costs of health bureaucracy. Over the next four years, the Government will reduce NHS administrative costs by more than 45%, freeing up resources for front-line care.
The review has assessed arm’s-length bodies in light of both the current financial challenges and the strategy for the NHS set out in “Equity and excellence: Liberating the NHS”. Only those functions which need to be carried out a national level to support the Department’s clear objectives should remain in the sector. Functions that are better delivered by other parts of the system should be devolved to the right level, and organisations that carry out these functions should be abolished. Shifting functions from public bodies back into the Department, or to those who are closer to local needs and are independent of the state, will ensure more direct accountability to local people, Parliament and Ministers.
By ensuring that functions are delivered in the right place, the sector will be streamlined to cut costs and remove duplication and unnecessary burdens on the front line. The review will achieve a significant reduction in the number and cost of public bodies.
The Department will impose tight governance and accountability over the cost and scope of its remaining arm’s-length bodies. In future, arm’s-length bodies’ independence will be exercised within the confines of clear and agreed functions. This is in line with the Government’s wider commitment to increase transparency and accountability.
The report details the proposals for each of the Department’s bodies. Where changes require primary legislation, these will be enacted through legislation which will be introduced in this Parliament.
Proposals for the General Social Care Council (GSCC), the regulatory body for social workers, are included in the report. My predecessor issued a written ministerial statement on 4 November 2009, Official Report, column 41WS about the publication of the Council for Healthcare Regulatory Excellence’s (CHRE) report and recommendations on the General Social Care Council (GSCC) function relating to conduct. As part of its response to CHRE’s report the previous Administration announced that the GSCC would report on its progress to Ministers at the end of March. This report has now been received and is published today.
While the GSCC has made good progress over preceding months, the reality is that the costs of maintaining an independent regulator for social workers are prohibitive and we therefore propose to transfer the function of regulating social workers to the Health Professions Council, which will accordingly be renamed to reflect its remit.
These publications will be of interest to anyone working in the health and social care sector, to taxpayers, and to people who use health and social care services.
Copies of today’s publications have been placed in the Library and copies are available to hon. Members from the Vote Office.
“Regulating Healthcare Providers” can be viewed at:
www.dh.gov.uk/en/Consultations/Liveconsultations/DH_117782
The report of the arm’s length bodies review can be viewed at:
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117691
NHS White Paper Consultation
Lord Lansley Excerpts(14 years, 5 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
Today I am publishing two further supporting documents to the national health service White Paper, “Equity and Excellence: Liberating the NHS”, which was published on 12 July. The documents have been placed in the Library, and copies are available to hon. Members in the Vote office. The documents are also available at: www.dh.gov.uk/liberatingtheNHS.
The documents, “Commissioning for Patients” and “Local Democratic Legitimacy in Health” provide further detail on the principles of the policies set out in the White Paper, and seek views from the public and external partners on some of the questions arising out of them.
One of the central features of the proposals in the White Paper is to devolve commissioning responsibilities and budgets as far as possible to those who are best placed to act as patients’ advocates and support them in their healthcare choices. “Commissioning for Patients” sets out my intended arrangements for general practitioner (GP) commissioning and the role of the NHS Commissioning Board.
Through our world-renowned system of general practice, GPs and other primary care, professionals are already supporting patients in managing their health, promoting continuity and co-ordination of care, and making referrals to more specialist services. In empowering GP practices to come together in wider groupings, or “consortia”, to commission care on their patients’ behalf and manage NHS resources, we are building on these foundations. We are also empowering primary care clinicians to work more effectively alongside the full range of other health and care professionals and, where appropriate, to work collaboratively to combine their commissioning power and influence. The NHS Commissioning Board will provide overall leadership on commissioning for quality improvement. It will have a duty to ensure comprehensive coverage of consortia and hold them to account for the outcomes they achieve and for their financial performance.
“Local Democratic Legitimacy in Health” is a joint publication between my Department and the Department for Communities and Local Government. It sets out proposals to increase local democratic legitimacy in a way that is consistent with national accountability for a national health service. Local authorities will become responsible for local public health improvement functions. They will have a new role in shaping NHS commissioning activities and a new role promoting integration. Local authorities will lead in assessing the needs of their populations and co-ordinate local strategies to address these needs. This will promote integration and partnership across the NHS, social care, public health and wider services such as housing and disability services. Local HealthWatch organisations, acting as independent consumer champions, will also be funded by and accountable to local authorities. To reinforce local accountability, local authorities will be responsible for ensuring that local HealthWatch are operating effectively, and for putting in place better arrangements if they are not.
The document also outlines how local authorities may choose to work with their partners to implement the arrangements and how the new public and patient involvement and local authority health improvement functions will be taken forward.
Both documents seek views on a number of questions by 11 October.
Commission on the Funding of Care and Support
Lord Lansley Excerpts(14 years, 5 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(14 years, 5 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(14 years, 5 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I have today laid before Parliament the Government’s 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(14 years, 5 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I have today laid before Parliament the Government’s 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(14 years, 5 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(14 years, 5 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.