NHS Risk Register
Debate between Lord Lansley and Emily Thornberry(12 years, 9 months ago)
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Mr Lansley
My hon. Friend is safely in Dover, a long way from Wales, when he says these things, but I go to Wales and he is absolutely right. It is staggering. The right hon. Member for Leigh and his colleagues can stand there and say, “Oh, well, you know, it’s only”—what is it?—“8% of patients who are not being seen within 18 weeks.” In Wales it is 32% of patients who are not being seen—
Mr Lansley
If the hon. Lady wants more, I will give her more. In this country—in England—we are increasing the NHS budget, despite the fact that her right hon. Friend the Member for Leigh said it would be irresponsible of us to do so. We are increasing the NHS budget in this Parliament in real terms each year. In Wales—
Mr Lansley
Perhaps the hon. Lady ought to talk to her friends from Wales, because she is deriding Wales. The Wales Audit Office said that the Labour Government there were going to cut the NHS budget in Wales by over 6% in the course of this Parliament. The Wales Audit Office said that on present trends, by 2014-15—before the next election—expenditure on the NHS would be lower in Wales, under Labour, than in any other part of the United Kingdom. Come the next election, it will be Labour that has to defend its neglect of the NHS in Wales, while we in the coalition Government will be able, together, to defend and promote our stewardship of the NHS, including resources for the NHS.
Health and Social Care (Re-committed) Bill
Debate between Lord Lansley and Emily Thornberry(13 years, 2 months ago)
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Mr Lansley
My hon. Friend is right in relation to the independent treatment centre contracts. They were constructed in a way that effectively removed most of the financial risk from the operators. For other private sector operators in the NHS that is not necessarily true. For example, most of us would recognise that private sector providers are instrumental to continued access to many NHS diagnostic services. There are providers who could fail and at the moment no regulatory structure is in place for that.
Let us continue down the path of the implications of the removal of part 3, which the Labour party proposes. Part 3 includes clause 60. I am sure that Opposition Members are familiar with clause 60, their having served in Committee for so long. It is the means by which, if the hon. Member for Islington South and Finsbury (Emily Thornberry) recalls, we can consider the application of Monitor’s functions to adult social care. So precisely when we are legislating to be able to consider whether the implications of an issue such as that at Southern Cross are such that there should be an additional prudential regulatory regime, the Labour party would take away that opportunity.
Emily Thornberry (Islington South and Finsbury) (Lab)
Does the Secretary of State agree that it is unfortunate that the Government have not had an opportunity to table detailed amendments on how they would deal with situations such as Southern Cross? To table an amendment that simply says, “At some stage in the future, the Government may be able to do something about a failing organisation such as Southern Cross”, is not necessarily adequate. Although there will be a White Paper on social care next spring, we understand that there are unlikely to be any further details until that point.
Mr Lansley
I am confused. I understood that the hon. Lady was a member of the Bill Committees. [Hon. Members: “She was.”] She does not seem to have learned what is going on in the Bill. Clause 60 was not an amendment; it was in the Bill from the outset. It was not introduced as a result of what happened at Southern Cross. We had anticipated the need to address the extent to which Monitor’s functions in relation to the health sector—
Mr Lansley
No. I will answer her question. The functions that it exercises in relation to health care include assessing viability and taking action if access to services or the interests of patients or care users are threatened. The Government can consider that by virtue of clause 60. It was not an amendment. So the idea that the measure could not be scrutinised is absurd. It has been in the Bill through all the 100 hours in Committee. If the hon. Lady never said anything about it, that is her own fault and as the shadow care services Minister she should have been more on the ball.
Mr Lansley
No. She can sit down.
Let me come to the other Opposition amendments. Amendment 10 would delete all of part 3, which would be absurd. Some of the other Opposition amendments are equally absurd. Amendment 28 envisages that part 3 would remain in place, but that Monitor would license providers of NHS services. However, it then takes away any means of enforcement. Perhaps the Labour party has forgotten that in government if you create obligations it is rather helpful to create a means by which they can be enforced.
Opposition amendment 44 would take the Bill down a slippery slope by trying to prescribe the range of factors that Monitor should reflect in setting prices for NHS services. Such a list could never be exhaustive and would inevitably suggest that some factors were more important than others. It would undermine our ability to hold Monitor to account for setting prices that promote patients’ interests. We must focus Monitor on its duties to promote the quality, efficiency and effectiveness of NHS services, not on trying to prescribe in legislation how it goes about it.
Labour Members have tabled amendments to part 4 that indicate that they either do not understand the Bill, or have abandoned their previous, repeated commitment to supporting all NHS trusts in becoming foundation trusts. They gave that commitment back in 2003, when they passed the necessary legislation, and repeated it in about 2006, when they said that trusts should all be foundation trusts by 2008. The Labour party manifesto from last year—2010—said:
“All hospitals will become Foundation Trusts, with successful FTs given the support and incentives to take over those that are under performing”.
Compare our programme for such hospitals as those in Trafford and Carlisle. The manifesto continued:
“Failing hospitals will have their management replaced. Foundation Trusts will be given the freedom”—
additional freedoms—
“to expand their provision into primary and community care, and to increase their private services”.
We will debate that later today, but I should complete the quote, or I might be accused of being selective:
“where these are consistent with NHS values, and provided they generate surpluses that are invested directly into the NHS.”
That is exactly what we are proposing.
The Labour party appears utterly confused. Does it support foundation trusts or not? The NHS Future Forum said that all NHS trusts should continue to work towards achieving FT status by 2014. It was right: achieving FT status is about demonstrating clinical and financial stability, and we think that all NHS providers should be expected to do that, in the interests of NHS patients and staff. If we maintained the NHS trust legislative model in statute, we would risk losing the change in mindset and the momentum that is being demonstrated by prospective foundation trusts.
Our consequential amendments 219, 220 and 367 to 370 will simply remove references to NHS trusts when they no longer exist—and not, of course, until then. For the hon. Member for Pontypridd, I add that our amendments 185 to 188 make it clear that—sadly for those in Wales—a foundation trust cannot merge with or acquire a Welsh NHS trust.
The Opposition want to take the retrograde step of de-authorising foundation trusts, retaining NHS trusts under the Secretary of State’s direct control, and having them dependent on the layers of bureaucracy that go with that. There would be all the regulatory requirements for foundation trusts and independent providers, and all the bureaucracy that has accompanied NHS trusts and strategic health authorities. That would undermine the FT regulatory regime and the objective of all NHS trusts becoming FTs. Opposition Members who voted in favour of the original legislation establishing foundation trusts in 2003 can have no credibility in supporting Labour now, because the very purpose of that legislation was to give hospitals greater autonomy.
Other Opposition amendments would simply result in duplication and reduced coherence in the Bill. For example, amendments 1166 and 19 seek to retain controls on goods and services, and borrowing and property, but that would duplicate Monitor’s powers through the licensing regime. Deleting clause 166, as the Opposition propose would undermine our intention of increasing transparency in the public financing of foundation trusts. I am looking for the hon. Member for Slough (Fiona Mactaggart); this would have been her moment. Through our amendments, we can show how we can maintain support for FTs, if necessary, in a transparent fashion, including through a requirement, which the Labour party apparently wants to delete, on the Secretary of State to publish an annual report showing what form of financial support has been given to foundation trusts.
I turn to the amendments tabled by my Liberal Democrat friends below the Gangway, who expressed their intention of improving NHS services and ensuring sustainable access for patients. We all share those aims, but I believe that we have in place alternative approaches to meeting those aims. The hon. Member for St Ives tabled a series of amendments emphasising the need to secure sustainability in the provision of NHS services. Securing sustainable access to meet patients’ needs is fundamental to good commissioning. We would expect the board to ensure that there was sufficient competency over issues when it authorised clinical commissioning groups to take on their new responsibilities, and when holding them to account for doing that job.
As the Government have said many times, our focus is on outcomes, including ensuring that patients have access to the services that they need when they need them. That the outcomes must be sustainable is obviously implied, but that is not necessarily the same as saying that commissioners must ensure the sustainability of particular providers or particular services, as amendments 1205 and 1209 suggest when referring to the sustainability of “existing NHS services”. In some cases it will not be in the interests of patients to maintain the status quo—for example, where those services may be unable to improve in line with new standards of clinical best practice, or where there is clear evidence that centralising specialist services on fewer sites would improve health outcomes, as we have seen in examples relating to cardiac, stroke and trauma services. So although I agree with the intention behind these amendments regarding the role of commissioners, I must urge the hon. Member for St Ives not to press them.
I addressed earlier the hon. Gentleman’s amendments about integration and collaboration. On integration, we agree with the conclusion of the NHS Future Forum that integrating services around the needs of patients and giving patients greater choice over who provides those services are not mutually exclusive. As the NHS Future Forum made clear, this is a false dichotomy. As the NHS Future Forum’s report stated:
“If commissioners want to commission integrated care they will only succeed in doing this by creating a new market in integrated care services and stopping the current commissioning of episodic services from different NHS organisations.”
As the hon. Member for St Ives will recognise, his amendments 1207 and 1208 are based upon that dichotomy, so I ask him to withdraw them.
Oral Answers to Questions
Debate between Lord Lansley and Emily Thornberry(13 years, 8 months ago)
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Emily Thornberry (Islington South and Finsbury) (Lab)
Some Government Members have supported the Government’s proposals for GP consortia because they believe that hospitals in their constituencies will be protected from closure, but yesterday’s leaked letter from the Foundation Trust Network to the Department of Health proves them wrong. It warns that financial stress is threatening the organisational survival of some foundation trusts. Now that they know that their hospitals are in danger, will the Secretary of State tell us all which faceless bureaucrats will be closing our hospitals and what extra powers, if any, local communities will have to stop them?
Mr Lansley
That will be the leak that took place when the head of the Foundation Trust Network gave it to the BBC.
The hon. Lady might not be very experienced in these matters, but she will know that at this time of year, in anticipation of the new financial year, hospitals tell their local primary care trusts how much money they would like to have, but that is not the same as the amount of money available in the whole system. That is part of the contract negotiations. She should also know that the necessity to deliver efficiency savings and redesign clinical services will mean that hospitals need to deliver 4% efficiency gains year on year, right across the NHS.
Oral Answers to Questions
Debate between Lord Lansley and Emily Thornberry(14 years ago)
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Mr Lansley
My hon. Friend will know that these decisions were made locally. Indeed, we support local decision making. We will ensure that such decisions are taken not only in the health service but alongside local authorities as part of their public health function. It is important that one is clear that a young person is competent to make such decisions. Subject to that, however, we are always clear that patients have a right to access health care on their own cognisance if they are competent to do so.
Emily Thornberry (Islington South and Finsbury) (Lab)
Does the Secretary of State accept that good preventative care walks hand in hand with good social care? Does he further accept that even if all efficiencies were made and every single pound of the so-called additional £2 billion for social care was to be spent, there will, as the Local Government Association and the Association of Directors of Adult Social Services warn, nevertheless be a shortfall of at least another £2 billion before the end of the comprehensive spending review? In those circumstances, why does the Treasury’s own document say:
“In social care, the Spending Review has provided additional funding needed to maintain current levels of care”?
Who is the public to trust and what are they to make of it?
Mr Lansley
First, may I welcome the hon. Lady to her position in the shadow health team? I do not accept her proposition. We are very clear about the nature of the efficiencies that can be made in social care, and we have established an efficiency group that is advising on how that can be done. In addition, in the spending review the Chancellor was able to announce that the Secretary of State for Communities and Local Government has made £1 billion extra available, and we have made £1 billion available through the NHS. On that basis, there is no need for local authorities to have to reduce eligibility to social care.