National Health Service
Debate between Lord Lansley and Chris Leslie(13 years ago)
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Mr Lansley
Does the hon. Lady act as parliamentary private secretary to the shadow Secretary of State? Ah, she does. Well, she has the merit of consistency. I am reminded that in June 2006, when for a short period she was chair—I think—of Rochdale primary care trust, she resigned. She said that she resigned because the radical changes happening under the then Labour Government in 2006 would
“destroy the NHS as we know it.”
The hon. Lady has the merit of being consistent: she is against every Government and every change. She does not think that any steps will make the NHS into what it ought to be. I will not take any lectures from her, therefore.
I was explaining to the hon. Lady and the House what has been achieved. We have stripped out pointless bureaucracy. The number of managers more than doubled under Labour, but we have cut their number by more than 5,000, and we have increased the number of doctors in the NHS by more than 1,500. The Bill includes measures to abolish primary care trusts and strategic health authorities, but in the meantime we have clustered PCTs and SHAs together.
We are reducing the cost of bureaucracy in the NHS not only because it is necessary to do so. The transfer to clinically led commissioning in the NHS, for which there is a very good case of course, also involves reducing such costs. As the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), has frequently made clear, as part of the transfer process we will deliver £4.5 billion in savings in administration costs this year across the national health service. The transition itself involves costs of course, but they will be recovered by the end of 2012-13, and by the end of the Parliament we will have gone on to save more than £4.5 billion in total.
Chris Leslie (Nottingham East) (Lab/Co-op)
Will the Secretary of State give way?
Mr Lansley
No.
Productivity fell in every single year that Labour was in charge of the NHS. However, according to the Audit Commission, in the last year—2010-11—we saved £4.3 billion. As the deputy chief executive of the NHS has reported, PCTs are intending to save a further £5.9 billion in 2011-12. Contrary to what the right hon. Member for Leigh repeatedly said, the NHS is not failing to deliver on the quality, innovation, productivity and prevention challenge; it is on target to meet that challenge. The modernisation that is at the heart of the Bill and the White Paper is not about frustrating the NHS in that endeavour; it is about enabling it to meet the QIPP challenge.
Last summer, I announced that we would be measuring mixed-sex accommodation and then driving down the extent to which patients were put in such accommodation when they should not have been. The right hon. Gentleman said at the time:
“This hollow announcement is an attempt by Mr Lansley to claim credit for something Labour has done”.
That is absolutely wrong. The evidence showed that almost 150,000 patients a year were being placed in mixed-sex accommodation in breach of the rules. We ensured that figures were published for the very first time. The first set of results was published in December, and it showed that in that month alone there were well over 11,000 such patients. Since then, there has been a 91% reduction in the number of patients put into mixed-sex accommodation. The right hon. Gentleman was prepared to see issues of care, service and standards in the NHS covered up. We are determined to shine a light on where the NHS can, and should, improve its performance; we are determined to enable the NHS to do so and to challenge it wherever it is not doing so.
Mr Lansley
I will give way to the hon. Gentleman shortly.
If the public want to know how the NHS in England would have fared under Labour since the last general election, they should look across the border at what has happened in Wales—I am not sure whether any Members representing Welsh constituencies are present. We are protecting the NHS and increasing its budget in real terms. However, I have brought along to the Chamber a report by the Auditor General for Wales that was published just a few days ago, on 14 October 2011. If I could, I would enter it in evidence, but I can at least hold it up in order to show Members a series of bar charts. They demonstrate that in England there is real-terms growth in the NHS, in Northern Ireland there is small real-terms growth that is unevenly distributed across the years, in Scotland there is tiny real-terms growth, and in Wales there is a large downward curve, which shows the reduction in real-terms spending on the NHS in Wales. Wales is the only part of the UK that is run by Labour, and there are real-terms cuts in the NHS budget there.
Chris Leslie
The right hon. Gentleman must know that “real terms” means taking account of inflation. For the record, can he tell the House what the retail prices index was for the last month for which figures are available? That will give us a sense of what “real terms” ought to mean in this context.
Mr Lansley
The hon. Gentleman is a shadow Treasury Minister, so he must know that the expression “real terms” has consistently been used in relation to the GDP deflator, which is independently estimated by the Office for Budget Responsibility. That is the basis on which we do these calculations, so the Wales Audit Office will have calculated the real-terms changes in budgets in each of the countries of the United Kingdom on that basis. John Appleby from the King’s Fund has estimated an 8.3% real-terms cut in the NHS budget in Labour Wales.
Health and Social Care (Re-committed) Bill
Debate between Lord Lansley and Chris Leslie(13 years, 2 months ago)
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Mr Lansley
Our plans for modernising the NHS are focused not only on improving the quality of care of patients today, but on ensuring that the NHS is fit to face the challenges of tomorrow—to ensure that the NHS is always there, always improving and always based on the needs of patients, not their ability to pay. Parts 3 and 4 of the Bill are an integral part of achieving that aim. They take forward our commitment to protecting patients’ interests, by establishing a comprehensive system of regulation in part 3, and to promoting high quality services, by supporting all NHS trusts to become foundation trusts in part 4.
The regulatory framework that we inherited from the previous Government simply did not do enough to protect patients. It lacked a way to protect patients’ interests in relation to all types of provider. The previous Government set up two regulators—Monitor for foundation trusts and the Care Quality Commission—but forgot, or neglected, to create an explicit link between the two. They also left independent providers outside much of that regulatory oversight. We have proposed the development of Monitor as a health sector-specific regulator, establishing equivalent safeguards to protect patients’ interests in relation to all types of provider.
By contrast, let us look at Labour’s proposed amendment—amendment 10, in this group—which would delete all of part 3. That would leave the NHS in a position in which inconsistent regulation as between NHS trusts and foundation trusts undermined accountability and performance, in which independent providers were not regulated effectively, in which the Labour Government’s preferential treatment of independent sector providers could carry on, and in which politicians would continue to second-guess regulatory decisions, creating a double jeopardy for providers. On the Government side of the House, however, we recognise the needs of the NHS. We recognise the fact that patients’ interests must be protected, irrespective of the type of organisation providing their NHS services, in a clear, consistent, transparent framework.
These parts of the Bill have been scrutinised in the Bill’s two Committee stages and by the NHS Future Forum. I should like once again to thank Professor Steve Field and the members of the NHS Future Forum for their work in making recommendations on how to improve our plans. We then took those recommendations forward in the recommittal stage. As a result of the listening exercise, we made changes to introduce stronger safeguards, to ensure that fears of a market free-for-all could not happen. Monitor’s core duty has been changed to make it clear that it is there to protect and promote patients’ interests, and that it will not be required to promote competition as if that were an end in itself.
Chris Leslie (Nottingham East) (Lab/Co-op)
Do not the right hon. Gentleman’s changes to the Bill still emphasise far too much the supposed read-across with competition law, treating health provision as though it were simply another utility? With regard to mergers and changes, for example, the Office of Fair Trading will be the arbiter on competition duties. Why has he chosen the OFT as arbiter in such cases?
Mr Lansley
I am not sure that the hon. Gentleman has followed this closely enough. We do not do any of those things. We are very clear that, through the Bill, we are creating, in Monitor, a health sector-specific regulator that will be able to exercise competition powers in a way that is entirely sensitive to the duties that it has for sustaining high-quality NHS services. As I will explain later, there will be a role for the OFT. Indeed, it has a role now. Labour Members should know that the application of competition law inside the NHS at the moment is exactly the same as it will be after the Bill. However, instead of it being done through the OFT as principal competition authority, it will—with the exception of mergers, which I will talk about later—be done through the concurrent powers of Monitor. The NHS Future Forum helpfully discussed these matters at length with people throughout the country, and concluded that it would be in the interests of the NHS for the legislation to create concurrent competition jurisdiction for Monitor, thereby ensuring that the application of competition rules—which is not changed in its extent by this legislation—is achieved in a health-specific context.
Oral Answers to Questions
Debate between Lord Lansley and Chris Leslie(13 years, 4 months ago)
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Mr Lansley
Yes, I can indeed do that. We are committed to real-terms increases in the NHS budget in England. According to an analysis by the King’s Fund, the Welsh Assembly Government—a Labour-led Welsh Government —are going to reduce the NHS budget by 8.3% in real terms by 2013-14 in comparison with 2010-11. That might be one reason why it is already the case that in Wales, 26.4% of patients in April 2011 waited more than 18 weeks for treatment.
Chris Leslie (Nottingham East) (Lab/Co-op)
Will the Secretary of State confirm that his definition of a real-terms increase is based on a 2.9% figure? Will he also confirm that the retail price index actually stands at 5%, so any claim that he is increasing the NHS budget in real terms is a complete and total con?
Mr Lansley
I think that it has been conventional over many years for the calculation of real terms in public accounting to use the GDP deflator. Given that it includes the prices of investment goods, Government services and exports and subtracts the price of UK imports, it gives a more appropriate overall measure of inflation.
Oral Answers to Questions
Debate between Lord Lansley and Chris Leslie(13 years, 8 months ago)
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Mr Lansley
In the first instance, I am not sure how the hon. Lady can argue that there is a difficulty with ring-fencing public health budgets, as they are not and will not be formally in the hands of local authorities until 2013-14. Clearly, there are no such practical issues at the moment. Further, she should have reflected the simple fact that we are already working between the NHS and local authorities to deliver much greater co-ordination in health, public health and social care. For example, this financial year, because we made savings in the Department of Health’s budget, we were able to provide, through primary care trusts, £162 million extra for the purpose of delivering improvements in social care in local authorities. Local authorities are having to deal with substantial reductions in their formula grant and some reductions in their spending power, but the NHS and social care are getting a substantial increase in support, both from the formula grant of my right hon. Friend the Secretary of State for Communities and Local Government and specifically through the NHS.
Chris Leslie (Nottingham East) (Lab/Co-op)
2. What steps he plans to take to reduce cancer mortality rates in deprived communities.
Swine Flu
Debate between Lord Lansley and Chris Leslie(13 years, 10 months ago)
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Mr Lansley
No, absolutely not. I was simply pointing out to Opposition Members that the principle that applied in 2009, which was that the point at which flu was circulating in the community was the point at which the “catch it, bin it, kill it” campaign was initiated, was precisely the same principle that I applied this year.
May I say in response to the hon. Member for Liverpool, Wavertree (Luciana Berger) that the supplies of vaccine provided to primary care trusts or GPs’ surgeries from the national stockpile of swine flu vaccine will be provided free?
Chris Leslie (Nottingham East) (Lab/Co-op)
To be absolutely clear on that answer, does the Secretary of State have any regrets whatsoever about not proceeding with the flu publicity campaign?
Mr Lansley
No. I have made it perfectly clear that the principle we applied is exactly the same and was based on the medical advice given to me, which was to pursue an awareness campaign on respiratory and hand hygiene at the point at which flu was circulating in the community. That is what I was asked and that is the decision I took.
NHS White Paper
Debate between Lord Lansley and Chris Leslie(14 years, 4 months ago)
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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.
Oral Answers to Questions
Debate between Lord Lansley and Chris Leslie(14 years, 4 months ago)
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Mr Lansley
My hon. Friend is absolutely right. I was here just a few weeks ago, announcing a public inquiry into the events at Stafford general hospital. Of course, in that hospital the adherence to ticking the box on the four-hour target was one of the things that contributed to the most appalling care of patients. We have to focus on delivering proper care for patients—the right treatment at the right time in the right place—and delivering the best outcomes for them. We will focus on that—on quality—not on top-down process targets.
Chris Leslie (Nottingham East) (Lab/Co-op)
Is it really true that the coalition Government are going to scrap the right for people to see their GP within 48 hours? If so, will the Secretary of State publicise that, so people know that the right has been reduced? If it is true, is he not just axing public service quality under the pretence of dealing with so-called bureaucracy?
Mr Lansley
It is astonishing—the Labour Government spent money trying to achieve the GP access target, and the hon. Gentleman might at least have recognised that the latest data, published two or three weeks ago, show that public satisfaction with access to their GPs, and the things that the Labour Government had been paying for, had actually gone down. A consequence of the 48-hour access target was that patients were unable to access their GPs more than 48 hours in advance. Is it not reasonable to expect GPs to be able to manage their own services in order to deliver better patient experience and outcomes across the board? I think we can reasonably expect that.