Oral Answers to Questions

Debate between Lord Lansley and Duncan Hames

Tuesday 17th July 2012 Commons Chamber

[Mr Lansley]

If a member of staff is professionally qualified, they will be counted against the number of managers part of the overall work force census. It remains true, as we have said, that since the election we have reduced the number of managers in the NHS by more than 6,000 and increased the number of clinical staff by more than 4,000.

[Duncan Hames (Chippenham) (LD)]

T7. Last year’s National Audit Office report highlighted inconsistencies in the care of patients with neurological conditions such as Parkinson’s, which neurology networks could address. When will the Government publish their review, announced last September, of clinical networks in the national health service, and will it offer any hope for Parkinson’s patients?

Health and Social Care Bill

Debate between Lord Lansley and Duncan Hames

Tuesday 20th March 2012 Commons Chamber

[Mr Lansley]

No.

Risk registers do not represent a balanced view. They are not a prediction of the future. They set out a worst-case scenario to challenge decision making. My hon. Friend the Member for Totnes (Dr Wollaston) captured the understanding of what a risk register is very well. The point is that we have looked precisely at the balanced view in the impact assessment, which captures where the risks and the benefits of the Bill lie. However, publication of the risk register, as my right hon. Friend the Member for Charnwood (Mr Dorrell) made perfectly clear, would prejudice the frankness and integrity of the decision-making processes of government and the Government are opposed to their publication.

As I mentioned, we won on appeal in relation to the strategic risk register, but not on the transition risk register. In the absence of the reasons for those decisions by the tribunal, and given the nature of the overlap between the strategic risk register and the transition risk register, I cannot comment further on that, or indeed on what our response will be to the tribunal’s decisions.

[Duncan Hames (Chippenham) (LD)]

The Secretary of State consistently makes the distinction between policy development issues and operational matters in respect of risk registers and other plans that have been published. Once this Bill has become law and the NHS becomes engaged in the operational matter of implementing his reforms to the health service, will he then encourage NHS trusts to publish, in due course, the risk mitigation plans that they might have, in order to reassure the communities they serve?

[Mr Lansley]

As the House has noted, risk registers designed for publication form part of the papers prepared for the boards of trusts. Of course, the legislation further strengthens the openness of foundation trust boards, for example, in respect of meeting in public and publishing their documents. But, as my right hon. Friend the Member for Charnwood rightly pointed out, there is an enormous difference between the frank expression of officials’ worse-case scenarios to Ministers in order to challenge decision making—as I say, it was anticipated that that was not intended for publication—and the preparation of risk registers by NHS bodies and trusts, which are designed for publication. Indeed, the national risk register is also designed for publication on that basis. As I said, those in the House of Lords yesterday agreed, by a substantial majority when voting on an amendment, that not only had the consideration of the Bill received unprecedented scrutiny, but that they also had the information they required.

Thirdly, let me just remind the House that the right hon. Member for Leigh, as a Minister, refused to publish the Department’s risk register. He said:

“Whilst we are conscious that there will be public interest in the contents of the Strategic Risk Register being made freely available, we have also taken into account the public interest in preserving the ability of officials to engage in the discussions of policy options and risks without apprehension that suggested courses of action may be held up to public or media scrutiny before they have been fully developed or evaluated. We also take into account the fact that ministers and their officials need space in which to develop their thinking and explore options, and that this disclosure may deter them from being as candid in the future, which will lead to poorer quality advice and poorer decision-making. Having regard to all these factors, we have determined that the balance of public interest strongly favours withholding the information.”

I could not have put it better myself, because that is precisely the point. He talks about the difference between the strategic risk register and the transition risk register, but the one requested was a risk register at the point at which policy was being formulated, and there is a substantial overlap between the strategic risk register and the transition risk register.

The right hon. Gentleman did one thing when he was a Minister and he argues the opposite now. The same thing seems to be happening in so many other fields. When he was a Minister he said that he was in favour of clinical commissioning, and practice-based commissioning was in the Labour manifesto in 2005. In 2006, he said that his ambition was to introduce

“practice-based commissioning. That change will put power in the hands of local GPs to drive improvements in their area”.—[Official Report, 16 May 2006; Vol. 446, c. 861.]

Now he wants to block a Bill whose purpose is to give clinicians—doctors and nurses across the NHS—the power to commission and design services in their area. We just do not know the position. Once more, we heard nothing positive from him about what Labour would offer the health service; all we heard was a denigration of the performance of the NHS and a determination to block the Bill. We are still hearing from him about what Labour Members are opposed to; we just do not hear about anything he is in favour of.

The curious thing is that last Tuesday, on an Opposition day debate, I said, “We are hearing from Labour Members and Labour activists all over the country about their opposition to £20 billion of cuts.” Hon. Members will remember, because this happened only a week ago, that the right hon. Gentleman was shouting at me from the Labour Front Bench, “No, no, no. We are in favour of that.” I said to him, “Look, it is in the manifesto”, because Labour’s manifesto said that

“we will deliver up to £20 billion of efficiencies in the frontline NHS”.

Yesterday, the right hon. Gentleman turned up with his hon. Friends at the Department of Health to deliver a petition from Wigan and Leigh. It said:

“We the undersigned are opposed to the Government’s Health and Social Care Bill and £20 billion of ‘unmandated’ cuts in NHS funding”.

He sat there last Tuesday saying, “No, we are in favour of £20 billion of efficiencies”, yet he is wandering all around the country with his hon. Friends saying, “No, it is £20 billion of cuts.” Frankly, Mr Speaker, if I recall correctly, that is what you would have me describe as an erroneous view.

The NHS across the country is a service that not only will use reform positively but is using reform positively now. We are seeing the reforms being implemented. On 1 April, clinical commissioning groups will take responsibility for more than £60 billion-worth of delegated responsibility for commissioning. I am tired of hearing the right hon. Gentleman denigrate NHS performance when what we have, since the election, is the lowest ever number of patients being admitted to mixed-sex wards, with numbers down 95%; the lowest ever number of patients waiting more than six months for treatment, with numbers down from 100,000-plus to 70,000; the lowest ever number of patients waiting more than a year for treatment, with numbers down from more than 18,000 to below 6,000; and the lowest ever number of patients waiting more than 18 weeks from referral to treatment. In May 2010, that figure was 209,000 but the latest figure is down to 182,000. Also, fewer people than ever are acquiring infections in hospital, with methicillin-resistant Staphylococcus aureus down 36% and clostridium difficile down 25%.

I have searched in vain for a point to this debate. I think that the only point was so that the right hon. Gentleman and his friends could put out a press release about having 24 hours to save the NHS—I think I have heard that one before. The Labour party is never knowingly over-clichéd. Only the Daily Mirror bothered to notice the press release, putting it on page 6; if it had really thought that this was about saving the NHS, it might at least have put in on page 1. No, the truth is that this is political opportunism dressed up as principle. This is a debate for no purpose and the only effect of this one and a half hour debate is to delay the consideration by this House of the amendments made in another place. Given the full and constructive character of the debate in the Lords over 25 days, I think it is a disservice to the other place that this House’s time has been wasted on having this debate. The Labour party has shown that it is interested not in what is in the Bill, but only in the political opportunity of opposing it. We are interested not only in what is in the Bill but in the opportunity it presents—not for the sake of the Opposition’s politics but for the NHS to improve and strengthen in the future.

Health and Social Care Bill

Debate between Lord Lansley and Duncan Hames

Tuesday 13th March 2012 Commons Chamber

[Mr Lansley]

No.

In the space of under two years, my right hon. and hon. Friends at the Department and I have delivered a reduction approaching £2 billion in the cost of the NHS IT programme. That will enable us to empower services right across the country to be better users and deliver better IT systems.

[Duncan Hames (Chippenham) (LD)]

Further to the list of changes to the Bill that the Health Secretary has outlined, will he confirm that it no longer imposes reviews by the Competition Commission on the NHS, therefore ensuring that it is not treated in the same way as any private industry would be?

[Mr Lansley]

That is indeed true, and my hon. Friend will also be aware—the Future Forum was clear about this—that the NHS benefits from the transfer of competition powers. The Bill does not create any new competition powers in the NHS; it transfers the exercise of competition powers from the Office of Fair Trading to Monitor, as a sector-specific regulator, as we agreed in the coalition agreement. That is what the Bill does, and that is a better protection for the NHS compared with what would otherwise be the application of competition rules, and before—[Interruption.] Labour Members mutter, but it has become apparent over recent weeks that in 2006, when the right hon. Member for Leigh was a Health Minister, it was their Government who received legal advice that demonstrated that their changes had introduced the application of EU competition rules into the NHS.

Health and Social Care Bill

Debate between Lord Lansley and Duncan Hames

Tuesday 28th February 2012 Commons Chamber

[Mr Lansley]

The Government’s position is that there has been very constructive debate in Committee in the Lords, and I look forward to that being reflected in equally constructive debates on Report.

[Duncan Hames (Chippenham) (LD)]

Liberal Democrats hate Labour’s health reforms, which result in hospitals being paid for operations whether they happen or not. Does the Secretary of State consider that the NHS, for which he remains responsible, would be in better health had Labour’s reforms been subjected to the parliamentary scrutiny that his have?

[Mr Lansley]

My hon. Friend makes an extremely good point. Many of the issues that have been the subject of some of the most heated debate on the Bill have been raised because Labour never addressed them. He is absolutely right that one result will be that in future, it will no longer be possible for £250 million to be paid to the private sector for operations that never take place.

NHS Risk Register

Debate between Lord Lansley and Duncan Hames

Wednesday 22nd February 2012 Commons Chamber

[Mr Lansley]

I will give way in a moment.

Fourthly, the publication of the risk register would distort rather than enhance public debate. We should remember that a risk register does not express the risks of not pursuing the policy—[Interruption.] Hon. Members should think about it. A risk register does not include the risks of not pursuing a policy and ignores the benefits of a policy—it presents only one side of the cost-benefit equation and is deliberately negative. Effectively, it is a “devil’s advocate” document, not a balanced one.

What is the balanced document associated the Bill? The impact assessment. I have with me a summary of the impact assessment, but there are hundreds more pages. We incorporate all relevant information in the impact assessment because it not only captures the same risks, but puts them alongside the benefits, costs and impacts, including the impact of not taking action.

The impact assessment is the proper evidential and informative basis for parliamentary and public debate. If any hon. Member is in any doubt about the public interest served by not releasing the risk register, I remind them of the advice received by the House nearly five years ago from the shadow Secretary of State. The argument that he put was precisely the argument that we are now putting.

[Duncan Hames (Chippenham) (LD)]

When pressed earlier, the shadow Secretary of State seemed to recognise some of the issues. He said that the publication of any document should be considered on its merits. May I invite the Secretary of State to stand by a simple principle and ensure that his Department always honours the full terms of the Freedom of Information Act?

[Mr Lansley]

We will, of course, fully abide by the terms of the Act. As my hon. Friend knows, and as the Information Commissioner himself said, we are proceeding precisely in line with the provisions of the Act.

Oral Answers to Questions

Debate between Lord Lansley and Duncan Hames

Tuesday 10th January 2012 Commons Chamber

[Mr Lansley]

I am grateful to the hon. Gentleman, and he is absolutely right about that, of course. He will also be aware that Cancer Research UK highlighted not only the progress that had been made, but the variation in progress on different cancers. Harking back to the earlier point about innovation, we must focus on how some of these innovations will enable us to deliver improved survival rates for specific cancers, and I announced last month that we would be funding additional scanner facilities in this country—proton beam therapy scanning interventions—in order to enable some of the most difficult cancers, such as brain cancers in children, to be treated in this country effectively.

[Duncan Hames (Chippenham) (LD)]

A cancer patient in my constituency faces an avoidable further round of chemotherapy having waited for the strategic health authority to make an individual funding request decision on the drug Plerixafor, which is not included in the cancer drugs fund. Will the Minister consider broadening the scope of the cancer drugs fund to include such drugs that are critical in cancer patients’ care, in addition to their other uses?

[Mr Lansley]

I should be grateful if my hon. Friend would write to me about that. The cancer drugs fund is focused on an identified lack of access to cancer medicines, but if a drug is of particular benefit to a cancer patient, such as in the instance he describes, it should be possible for SHA panels to include it within the scope of the fund.

Life Sciences

Debate between Lord Lansley and Duncan Hames

Monday 5th December 2011 Commons Chamber

[Mr Lansley]

The answer to that question varies depending on which conditions one is talking about. When one looks at the OECD “Health at a Glance” data that was published on 23 November, one sees how relatively poor are our mortality outcomes in relation to respiratory and chronic obstructive pulmonary diseases. By contrast, we are slightly better than average in relation to diabetes. However, I have seen for myself how well patients with COPD can manage their conditions at home. For example, they can see their blood oxygen levels day-by-day and have supplies of medicines at home, including steroids. They can therefore anticipate and deal with any exacerbations of their condition so that they do not end up in an ambulance going to hospital late at night.

[Duncan Hames (Chippenham) (LD)]

From earlier access to potentially life-saving medicines through to releasing the power of information in the NHS, there is much to welcome in this statement. Given the importance of techniques such as pseudonymisation, how satisfied is the Secretary of State with the priority afforded to developing the informatics capability of NHS staff?

[Mr Lansley]

My hon. Friend makes an important point, to which I fear I do not have time to respond fully. One thing that I hope we can do as a consequence of abandoning the previous Government’s failed NHS IT structure is empower many individual hospital trusts and general practices once more to develop their own informatics expertise, which will stretch beyond IT infrastructure to the positive uses of data and information for the benefit of patients.

NHS Future Forum

Debate between Lord Lansley and Duncan Hames

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

I have a mission for the hon. Gentleman— he should head to Wales. In England, this coalition Government have committed to increasing the NHS budget in real terms in the life of this Parliament. The King’s Fund reported the other week that in Wales, a Labour Government intend to reduce the NHS budget in real terms by over 8%.

[Duncan Hames (Chippenham) (LD)]

I believe that the very act of listening to patients and the public will have done a lot to improve these proposals—as, I suspect, once the dust has settled, it will have done for the Health Secretary’s reputation, too. Given the requirement for greater local accountability in these proposals, will the right hon. Gentleman make the same recommendation to local clinical commissioners in the changes they are yet to make for health services in their areas?

[Mr Lansley]

I am grateful to my hon. Friend for his kind remarks, but I have to tell him that I am not looking to achieve anything in terms of reputation; I just want a positive outcome for the NHS. I have said before that this is not about me; it is about achieving for the NHS the opportunity to deliver better services for patients. That is all I am interested in.

The proposals on public and patient involvement illustrate what we needed to do—and will now do in response to the Future Forum—as many people wanted to see set out in detail in the legislation how patient and public involvement would work in the respective NHS bodies. The legislation had set out the fact that these bodies existed, but the detail was not prescribed. There is always a balance to be struck in legislation between the degree of prescription and the degree of freedom. Clearly, through engagement with the NHS, we have approval for putting much more of the detail into the Bill, now that it is clear that it will engage patients and the public.

Oral Answers to Questions

Debate between Lord Lansley and Duncan Hames

Tuesday 7th June 2011 Commons Chamber

[Mr Lansley]

No, not at all. We were very clear—indeed, I was clear to the House on 4 April when I announced the pause to listen, to reflect on and improve the Bill—that it was specifically related to achieving in the legislation the necessary support for the many changes happening across the NHS. It cannot be right, however, that people across the NHS who are engaging in delivering improved care, redesigning clinical pathways—or designing clinical services to deliver the best outcomes for patients—should be told to stop making those positive changes. They are engaging with those positive changes and we are not preventing them from doing so.

[Duncan Hames (Chippenham) (LD)]

T2. I am wearing neither sandals nor flip-flops, Mr Speaker. Given that local GPs typically charge £500 a day, what action is the Minister taking to ensure that GP consortium board members do not cost the NHS as much as £25,000 each a year for just one day’s work a week?

[Mr Lansley]

Among the intentions that we have made clear from the outset is our intention to reduce the running costs of management in the NHS. We propose to cut administration costs by a third in real terms, including the running costs of the commissioning consortia when they are established. There will be a constantly tight envelope for running costs, which means that whoever is working for a commissioning consortium, it must deliver value for money.

Oral Answers to Questions

Debate between Lord Lansley and Duncan Hames

Tuesday 26th April 2011 Commons Chamber

[Duncan Hames (Chippenham) (LD)]

Professional autonomy need not come at the expense of transparency in the provision of public services. Given that the Department for Education was able to extend the Freedom of Information Act to academy schools, does the Minister agree that it would be healthy for the Act to apply also to GP consortia in the NHS?

[Mr Lansley]

I am grateful to my hon. Friend for that. The Health and Social Care Bill establishes the commissioning consortia as public statutory bodies and, as such, that Act will apply to them.

NHS Reform

Debate between Lord Lansley and Duncan Hames

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

I do not think I dismiss anybody; I might not agree with people, but I do not dismiss them. If I recall correctly, I did not agree with the hon. Gentleman’s suggestion because he misunderstood the fact that the consortia are separate statutory bodies, not private bodies, and separate from GP practices, which are individual contractors to the NHS. The confusion between those two things meant that his point was not valid.

[Duncan Hames (Chippenham) (LD)]

My constituents, who have watched primary care trusts halve the number of community hospital medical beds in Wiltshire, know that NHS reform is needed to make decision makers accountable, so how does the Secretary of State propose to strengthen the public and patient voices on the boards of the GP consortia that will replace them?

Oral Answers to Questions

Debate between Lord Lansley and Duncan Hames

Tuesday 25th January 2011 Commons Chamber

[Mr Lansley]

I do not recall the BMA ever agreeing with the previous Government. Let me provide one quote to the hon. Lady:

“The general aims of reform are sound—greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes—and are common ground between patients, health professions and political parties.”

The shadow Secretary of State said that last week.

[Duncan Hames (Chippenham) (LD)]

The NHS Litigation Authority has presented NHS Wiltshire with a bill for more than £3.5 million in clinical negligence scheme payments this year. Nationally, among closed claims, legal fees made up more than a third of costs last year. How does the Minister propose to switch this expenditure away from lawyers and towards front-line health services?

[Mr Lansley]

I wish, first, to say two things, but there may be further to add. First, my right hon. and learned Friend the Secretary of State for Justice is working on the implementation of the Jackson review. That, in itself, will help considerably in reducing the extent to which these costs are consumed in legal fees, rather than proper compensation for clinical negligence. As we made clear in response to Lord Young’s report, we will also pursue the question of whether we can have a fact-finding phase following up a claim against the national health service, so as to mitigate what is otherwise considerable additional cost on conditional fee arrangements and getting expert witnesses.

Contaminated Blood

Debate between Lord Lansley and Duncan Hames

Monday 10th January 2011 Commons Chamber

[Duncan Hames (Chippenham) (LD)]

I thank the Secretary of State for bringing the Government’s deliberations on the issue to this conclusion. Will he reassure the House that those experiencing the symptoms of advanced liver disease who received contaminated blood will not in all cases be required to have a liver biopsy in order to demonstrate and establish their eligibility for these payments?

[Mr Lansley]

No, they will not. From our point of view, eligibility will simply be based on a diagnosis of their condition.

Oral Answers to Questions

Debate between Lord Lansley and Duncan Hames

Tuesday 7th December 2010 Commons Chamber

[Mr Lansley]

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

[Duncan Hames (Chippenham) (LD)]

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

[Mr Lansley]

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

Oral Answers to Questions

Debate between Lord Lansley and Duncan Hames

Tuesday 29th June 2010 Commons Chamber

[Mr Lansley]

I have looked at the reports of the Commonwealth Fund for a number of years; it regards the NHS as efficient because it spends relatively little in comparison with other health economies. In this country, we need to recognise that the NHS does not spend very much in comparison with other countries but it could spend it more efficiently. There has been declining productivity for 10 years. [Interruption.] The shadow Secretary of State needs to recognise that NHS management costs went up by 63% while nursing costs went up by just 27%. My colleagues and I are committed to halving NHS management costs and to reducing the costs of the NHS, through efficiency, by £20 billion. Every penny of that will be reinvested in meeting the rising demand for the NHS and the improvements in quality that we require.

[Duncan Hames (Chippenham) (LD)]

T7. What encouragement is the Secretary of State giving to primary care trusts to restore minor injury services to towns such as Melksham in my constituency? It saw its minor injuries unit close under the last Government.