Business of the House

Debate between Lord Lansley and John Healey

Thursday 9th May 2013 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend. I think that many people across the country would agree with him.

Notwithstanding what I read in the newspapers this morning, in my experience it is often general practitioners who say that the situation is absurd. I recall a GP speaking to me—forgive me, Mr Speaker, if I tell a little story—about the American and Japanese students who registered at her practice. After a while, they would go to see her when they were leaving and say, “Shall I talk to the receptionist about payment?” She had to say, “There is no payment.” They looked at her as if we were mad because at home they would have paid and they had insurance and were willing to pay. However, because of the structure of the legislation, the national health service said, “You are ordinarily resident here so it is free. End of story.” That is absurd. The students did not expect it and we should not have got into that position. We need to deal with that. The issue is not always abuse. This is a system that should be tightened up.

I anticipate that the measures to which my hon. Friend refers will be part of an immigration Bill later in the Session.

[John Healey (Wentworth and Dearne) (Lab)]

It is humiliating for the Leader of the House to have to defend such a light legislative programme and a coalition Government who have all but run out of road on which they can agree to travel together. He will know that for more than a year I have highlighted a problem for the Nursing and Midwifery Council, which does not have the same powers as other professional regulators to review and revise its disciplinary decisions. Given that there is so little legislation before the House this year, will he help find time for a small but important legal change to deal with that problem?

Business of the House

Debate between Lord Lansley and John Healey

Thursday 6th September 2012 Commons Chamber

[Mr Lansley]

My hon. Friend had an opportunity to raise that with the Prime Minister at Prime Minister’s Question Time, and I hope that he will take the opportunity that the Prime Minister gave him to make his points at a meeting. However, I do not recognise his description of the way in which decisions were made. They were made on the basis of an assessment of how the armed services could be sustainable for the future, and could secure representation and maintain recruitment throughout the United Kingdom.

[John Healey (Wentworth and Dearne) (Lab)]

It is good to see that the Leader of the House is still in the Cabinet, and especially good to know that he will not be steering any legislation through the House in his new position. He will know that the number of university applications from young people in Britain has dropped by nearly 10% for this year, as a direct result of the disastrous decision to raise tuition fees to £9,000. Why will the Government not find time for a debate on the subject—in Government time—rather than leaving it to the Opposition?

[Mr Lansley]

When the Opposition have wished to present an issue for debate and have chosen the issue of tuition fees, I have announced it as a consequence.

I am grateful to the right hon. Gentleman for his reference to legislation. I wonder whether he meant by it the piece of legislation which, shortly after its introduction, he described as “consistent, coherent and comprehensive”.

NHS Annual Report and Care Objectives

Debate between Lord Lansley and John Healey

Wednesday 4th July 2012 Commons Chamber

[Mr Lansley]

My hon. Friend makes an excellent point—in fact, an excellent series of points. On his behalf I am glad to send to the Minister for Health and Social Services in the Labour Government in Wales a copy of the annual report for England, perhaps inviting her to publish a similar report in Wales. As the NAO said, and, indeed, as the Wales Audit Office said, only 60% or, on the latest data, only 68% of patients in Wales waiting for treatment accessed it within 18 weeks—the right under the NHS constitution—whereas in the NHS in England, the figure is 92%.

[John Healey (Wentworth and Dearne) (Lab)]

NHS staff and patients simply do not have the same rosy view of the NHS as the Secretary of State. When a Government-commissioned survey asked people last summer what they thought of the NHS, why had satisfaction with the NHS plummeted from 70% to 55% in just a year under the Secretary of State?

[Mr Lansley]

The right hon. Gentleman makes an interesting point, because MORI conducted an independent survey last December after the survey conducted on behalf of the King’s Fund. The survey said that 70% of people were satisfied with the running of the NHS; 77% agreed that their local NHS provided a good service; and 73% agreed that England had one of the best national health services in the world—the highest level ever recorded in that survey.

Health Transition Risk Register

Debate between Lord Lansley and John Healey

Thursday 10th May 2012 Commons Chamber

[Mr Lansley]

I am grateful to my right hon. Friend. This case is seen and was judged by me and my colleagues on its particular circumstances; as I made clear, it is an exceptional case. One of the arguments that underlay our decision was necessarily the one about the principle that we were assessing. That principle is very clear: the Freedom of Information Act envisages that there should be an exemption for the formulation and development of policy, and that under those circumstances the public interest in the proper development of policy could outweigh the public interest in disclosure.

In this case, we are very clear—and my colleagues have been very clear—that the risk register, when it was produced, was at that time instrumental to the formulation and development of policy and that therefore the public interest did not require its disclosure.

[John Healey (Wentworth and Dearne) (Lab)]

On Tuesday, the Health Secretary said that the veto was justified because the NHS risk register case is exceptional. On Wednesday, Earl Howe, the Health Minister, said:

“This isn’t just about the NHS. The Cabinet collectively took a decision that this was a matter that extended across Government.”

On Tuesday, the Health Secretary said that he was blocking publication, but on Wednesday, the same Health Minister said:

“We have every intention of publishing the risk register”.

This is a conspiracy and a cock-up. Is it not typical of this Government—too incompetent even to organise a decent cover-up?

Oral Answers to Questions

Debate between Lord Lansley and John Healey

Tuesday 27th March 2012 Commons Chamber

[Mr Lansley]

I will of course accept representations from my hon. Friend and, indeed, from anyone else. Pilot schemes are under way in County Durham and Darlington and in Nottingham, Lincolnshire and Luton. The system is also live in Derbyshire, the Isle of Wight, Cumbria, parts of Lancashire and parts of London. An evaluation will be published shortly by the university of Sheffield, but an interim evaluation suggested that 93% of patients were pleased with the service that they had received, and, most important, 84% felt that it had delivered them to the right place first time.

[John Healey (Wentworth and Dearne) (Lab)]

Will the Secretary of State confirm the provision in regulation, reinforced by his new guidance, that no GPs should use 0844 numbers for their surgeries? Some patients are having to pay over the odds to contact their GPs.

[Mr Lansley]

We have made it very clear that GPs should not be using 0844 numbers for that purpose and charging patients for them. One of the benefits of NHS 111 is that it will be a free service for patients, and will give them an opportunity to gain access to integrated urgent care wherever they are in the country. That is why we want to roll it out as soon as we can.

Health and Social Care Bill

Debate between Lord Lansley and John Healey

Tuesday 20th March 2012 Commons Chamber

[John Healey]

The right hon. Gentleman argues that one of the principal reasons why the Government have not accepted the decision to disclose the risk register is that information about risks has been disclosed to the public already. The Information Commissioner considered that. Will the right hon. Gentleman recognise that, in his legal decision, the Information Commissioner said that he did not accept the argument that the Government advanced, and that he considers that

“disclosure would go somewhat further in helping the public to better understand the risks associated with the modernisation of the NHS than any information that has previously been published”?

[Mr Lansley]

The right hon. Gentleman knows perfectly well that in the debate on 22 February we made it clear that we felt that our appeal to the tribunal was justified, and indeed it was, because we won at appeal on the question of the publication of the strategic risk register. The Government’s objection and my objection to the publication of the risk register is precisely that risk registers are not written for publication. They are written in that safe space within which officials give advice to Ministers.

Health and Social Care Bill

Debate between Lord Lansley and John Healey

Tuesday 28th February 2012 Commons Chamber

[Mr Lansley]

My hon. Friend is absolutely right, and I am sure that in that context he shares with me the appreciation of the benefit that will come from campaigns to promote the early awareness of cancer, such as, following piloting, the roll-out of the national campaign for the awareness of bowel cancer symptoms.

[John Healey (Wentworth and Dearne) (Lab)]

Is not this another attempted PR and political fix for a mismanaged health Bill that is again in chaos? Which of the changes set out in the Deputy Prime Minister’s letter was not agreed in government first?

[Mr Lansley]

Would that be the same Bill that the right hon. Gentleman described as “consistent, coherent and comprehensive”?

NHS Risk Register

Debate between Lord Lansley and John Healey

Wednesday 22nd February 2012 Commons Chamber

[Mr Lansley]

I will give way to the right hon. Member for Wentworth and Dearne (John Healey).

[John Healey (Wentworth and Dearne) (Lab)]

In January 2011, the Secretary of State's Department set up the audit and risk committee with a commitment to publish minutes of its meetings within three months. The last note of any meeting of that committee published on its website is from February 2011. Is that international leadership or the same cloak of secrecy that prevents him from publishing the transition risk register?

[Mr Lansley]

When the right hon. Gentleman was a Minister he and his colleagues never published such information, so I will not take any lessons on that. As a Treasury Minister, he refused to disclose a Treasury risk register.

Let me explain what risk registers are for, because an hon. Lady on the Opposition Benches keeps chuntering about them. A high-level risk register, such as those being considered by the tribunal on 5 and 6 March, is a continuously reviewed and updated document that enables officials, advisers and Ministers to identify and analyse the risks of, and to, particular policies. Risk registers present a snapshot of the possible risks involved at any one time. Their purpose is to record all risks, however outlandish or unlikely, both real and potential, and to record the mitigating actions that can ensure that such risks do not become reality.

For such a register to be effective and for it to serve the public interest, those charged with compiling it must be as forthright as possible in their views. The language of risk registers must be forceful and direct. That is essential for their operation, to enable Ministers and officials fully to appreciate those risks and to take the steps to mitigate them, or to redesign policy to avoid them.

It is important to note that such high-level risk registers are different to the risk registers of the organisations from which the shadow Secretary of State quoted, such as the risk registers of strategic health authorities. The latter concern operational matters and not matters of developing and designing policy, and they are written with publication in mind—they are intended to be published. By contrast, there are very clear reasons why Departments—under not just this Government, but previous ones—do not publish their high-level risk registers while they are still active and while policy development is ongoing.

Oral Answers to Questions

Debate between Lord Lansley and John Healey

Tuesday 10th January 2012 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend, who clearly understands that NICE is responsible for the methods it uses in the development of its guidance and that it is undertaking a review of its appraisal methods. I expect that that will be published for consultation this year. NICE should issue final guidance only after careful consideration of the evidence and public consultation with stakeholders, including patient and professional groups.

[John Healey (Wentworth and Dearne) (Lab)]

It is sometimes hard to follow the Secretary of State as he can get lost in his own jargon. Just to be clear: if NICE says that a drug should be available to patients on the NHS wherever they live and whatever their clinical commissioning group, will they get it? Can he give that guarantee today?

Oral Answers to Questions

Debate between Lord Lansley and John Healey

Tuesday 22nd November 2011 Commons Chamber

[Mr Lansley]

I would like to take this opportunity not least to commend the work that the chief medical officer has done this year in encouraging health care workers to have their seasonal flu jab. The latest figures are that 29% have done so, compared with 11% at the same point last year. We heard earlier from my hon. Friend the Member for Kettering (Mr Hollobone) how well Kettering has done, and there are hospitals that are demonstrating that a higher level is entirely achievable. I urge staff across the NHS to have their flu vaccination. It is the ethical thing to do, not least to provide protection to their patients.

[John Healey (Wentworth and Dearne) (Lab)]

One of the things that makes the problem of winter pressures much greater is the NHS coping with the biggest reorganisation ever. The public have a right to know the risks that the Government’s policies are placing on our NHS. The Information Commissioner agrees and has judged that the Secretary of State must now release the risk assessments and register for his NHS reorganisation. Will he now obey the law and end his 12-month cover-up?

[Mr Lansley]

I have been very clear and published all the cost-benefit and risk information relating to the modernisation of the NHS, and the impact assessment was published when the legislation was presented to the House of Lords.

Oral Answers to Questions

Debate between Lord Lansley and John Healey

Tuesday 12th July 2011 Commons Chamber

[Mr Lansley]

Yes, I do indeed welcome that. We all know that last year, this year and in future years, increases in the NHS budget in real terms will not be the kind of real-terms increases we saw in the past, but they will be real-terms increases. What we are already seeing in the NHS—we saw it last year—is that with a 2.2% increase in cash spending, there is none the less an ability to sustain, and in many respects improve, performance.

[John Healey (Wentworth and Dearne) (Lab)]

In spite of the spin, the truth is that the Prime Minister’s personal promise to give the NHS a real rise in funding is being broken. It is not just how much that counts; it is how well the money is spent. Today it is one year to the very day since the Health Secretary launched the Government’s plans to “liberate” the NHS. He told the House:

“we will phase out the top-down management hierarchy”—[Official Report, 12 July 2010; Vol. 513, c. 663.]

He said that he would reduce “the number and cost” of NHS-related quangos, so why is he setting up the new national commissioning board, set to employ 3,500 people, when even its chief executive says that it

“could become the greatest quango in the sky we have seen”.

Why is the right hon. Gentleman setting up more than 500 public bodies in the NHS when 161 do the job now, and why are the Government wasting precious NHS funding on the biggest reorganisation in history, when it could and should be spent on patient care?

[Mr Lansley]

Since the election we have reduced the number of managers in the NHS by more than 4,000 and increased the number of doctors by more than 2,000. The NHS commissioning board—I did not hear from the right hon. Gentleman whether he supports it—is part of our strategy to give the NHS not only local clinical leadership but national leadership through it. The functions covered by the board are currently undertaken by something approaching 8,000 staff; the number delivering those functions in future will go down to 3,500 staff, so the reduction in administration will be dramatic.

[John Healey]

We had plans to reduce bureaucracy, which were published, and we also said that the Government should keep Labour’s waiting time guarantees for patients, which the Health Secretary told the House a year ago today were “unjustified” targets, which he would remove. The Prime Minister has now promised to keep waiting times low, but after one wasted year of NHS reorganisation by the right hon. Gentleman’s Government, an extra 25,000 patients a month are waiting more than four hours in accident and emergency departments, an extra 12,000 patients a month are waiting more than six weeks for tests, and an extra 2,300 patients a month are waiting more than 18 weeks to get into hospital for the treatment they need. The NHS deputy chief executive has called the rise in long waiting times this year “unacceptable”. Does the Health Secretary agree?

[Mr Lansley]

As we said in the NHS constitution, we do not intend patients to be waiting for more than 18 weeks. [Hon. Members: “They are!”] The April figures show that we met the operational standard, which is that more than 90% of admitted patients and more than 95% of non-admitted patients should be treated within 18 weeks. The right hon. Gentleman’s analysis of waiting times did not include the fact that the average time for which patients waited for treatment in April was 7.7 weeks, down from 8.4 weeks in May 2010. The average time for which patients wait is being reduced.

Reform of Social Care

Debate between Lord Lansley and John Healey

Monday 4th July 2011 Commons Chamber

[The Secretary of State for Health (Mr Andrew Lansley)]

With permission, I wish to make a statement on the reform of social care.

The coalition Government have from the outset recognised that reform of the care and support system is needed to provide people with more choice and control and to reduce the insecurity faced by individuals, carers and their families. By 2026, the number of people over 85 years old is projected to double. Age is the principal determinant of need for health and for care services. It is further estimated that in 20 years’ time, 1.7 million more people will have a potential care need than do today.

People often do not think about how they might meet the costs of care in later life. They assume that social care will be provided free for all at the point of need, but since the establishment of the welfare state that has never been the case. Currently, people with more than £23,250 in assets, often including their home, face meeting the whole cost of care themselves.

The cost of care can vary considerably and it is hard for people to predict what costs they may face. The average 65-year-old today will face lifetime care costs of £35,000, but as the Commission on Funding of Care and Support notes, costs are widely distributed: one in four will have no care costs, but one in four will face care costs of more than £50,000 and for one in 10 it will be more than £100,000. The lack of understanding of how the system works and uncertainty about costs means that it is difficult for people to prepare to meet potential care costs, and there are currently few financial products available to help them. This means that paying for care can come as a shock to many families and have a severe impact on their financial security.

Change is essential. That is why we took immediate action last July by establishing the Commission on Funding of Care and Support, which was tasked with making recommendations on how to achieve an affordable and sustainable funding system for care and support for all adults in England. In response to its initial advice, we allocated an additional £2 billion a year by 2014-15 in the spending review to support the delivery of social care as a bridge to reform. This represents a total of £7.2 billion of extra support for social care over the next four years, including an unprecedented transfer of funds from the NHS to support social care services that will also benefit health.

Since then we have taken forward wider reform. Last November we published our vision for adult social care, setting out our commitment to a more responsive and personalised care and support system that empowers individuals and communities, including the objective that all those who wish it should have access to a personal social care budget by 2013. In May, after three years of work, the Law Commission published its report on how to deliver a modernised statute for adult social care. Making sense of the current confused tangle of legislation to deliver a social care statute will allow individuals, carers, families and local authorities to understand more clearly when care and support will be provided.

Andrew Dilnot’s report comes at the same time as the final report from the palliative care funding review, which I received last week. Tom Hughes-Hallett and Sir Alan Craft have made an excellent start in looking at this complex and challenging issue. We want to see integrated, responsive and high-quality health and care services for those at the end of life. We will now consider the review team’s proposals in detail before consulting stakeholders on the way forward later this summer. We will also consider how best to undertake substantial piloting, as recommended in the report, in order to gather information on how best to deliver palliative care services.

We are also responding to events at Southern Cross, which have caused concern to residents in Southern Cross care homes and their families. We welcome the fact that Southern Cross, the landlords and the lenders are working hard to come up with a plan to stabilise the ownership and operation of the care homes. We have also made it clear that we will take action to ensure proper oversight of the market in social care. That is why we are seeking powers through the Health and Social Care Bill to extend to social care the financial regulatory regime that we are putting in place in the NHS, if we decide that that is needed as part of wider reform.

A central component of those wider reforms will be the long-term funding of care and support. Over the past 12 months Andrew Dilnot, who chairs the Commission on Funding of Care and Support, together with the noble Lord Warner and Dame Jo Williams, has engaged extensively with many different stakeholders. They have brought fresh insight and impetus to this most challenging area of public policy. We welcome the commission’s excellent work and its final report. I would like to thank Andrew Dilnot, Lord Warner and Jo Williams for their work, which has made an immensely valuable contribution to meeting the long-term challenge of an ageing population.

The report argues that people are unable to protect themselves against the risk of high care costs, leaving them fearful and uncertain about the future. The commission’s central proposal, therefore, is a cap on the care costs that people face over their lifetime of between £25,000 and £50,000—it recommends £35,000. Under the commission’s proposals, people who cannot afford to make their personal contribution would continue to receive means-tested support, but it proposes that the threshold for receiving state help for residential care costs would rise from £23,250 to £100,000. People would make some contribution to their general living costs in residential care, but the commission suggests that this should be limited to between £7,000 and £10,000.

The commission also proposes the following standardised, national eligibility for care, which would increase consistency across the country; universal access to a deferred payments scheme for means-tested contributions; improvements in information and advice; improved assessments for carers and better alignment between social care and the wider care and support system; and considering changing the means test in domiciliary care to include housing assets. The commission makes recommendations about how as a society we can organise and fund social care. We will consider the recommendations as a priority.

The commission recognises that implementing its reforms would have significant costs. In the current public spending environment, the Government will have to consider the recommendations carefully against other funding priorities and calls on our constrained resources. The commission’s recommendations present a range of options, including on the level of a cap and the contribution that people make to living costs in residential care, which could help us to manage the system and its costs. We intend to engage with stakeholders on those issues, including on the trade-offs involved.

Reform in this area will have to meet a number of tests, including whether the proposals would promote closer integration of health and social care and increased personalisation, choice and quality; support greater prevention and early intervention; whether a viable insurance market and a more diverse and responsive care market would be established as a result of the proposals; what is the level of consensus that additional resources should be targeted on a capped costs scheme for social care; and what a fair and appropriate method of financing the additional costs would be.

The Government have set out a broad agenda for reform in social care. We want to see care that is personalised; that offers people choice in how their care needs are met; that supports carers; that is supported by a diverse and flourishing market of providers; that has a skilled work force who provide care and support with compassion and imagination; and that offers people the assurances they expect of high-quality care and protection against poor standards and abuse. Andrew Dilnot’s report was never intended to address all those issues, but it forms a vital part of that wider agenda.

To take the matter forward, we will work with stakeholders in the autumn, using Andrew Dilnot’s report as the basis for engagement and as a key part of the broader picture. That engagement will look at the fundamental issues for reform in social care, such as improving quality, developing and assuring the care market, integration with the NHS and wider services, and personalisation. We want to hear stakeholders’ views on the priorities for action from the commission’s report and on how we should assess the proposals, including in relation to other priorities for improvement in the system. As the right hon. Member for Wentworth and Dearne (John Healey) and I have discussed, the Government will engage directly with the official Opposition to seek consensus on the future of long-term care funding.

We will set out our response to the Law Commission and the Dilnot commission in the spring. There will be full proposals for the reform of adult social care in a White Paper and a progress report on funding reform. It remains our intention to legislate to this effect at the earliest opportunity. The care of the elderly and of vulnerable adults is a key priority for reform under this Government, and I commend this statement to the House.

[John Healey (Wentworth and Dearne) (Lab)]

I thank the Health Secretary for the copy of his statement, and for making it to the House himself.

We welcomed the Hughes-Hallett report last week and we welcome the Dilnot report on social care today. The Dilnot report sets out important recommendations on capping the catastrophic costs of care; lifting the wealth threshold for state help; immediate free support for children with care needs on becoming adults; universal disability benefits continuing as now; a standard national needs test; and better information and advice, led by local councils.

The important elements in the Dilnot report are similar to the plans that we set out in government in the care White Paper in March last year. Our concern was and is to protect the one in 10 people who have to pay more than £100,000 for the cost of their care in older age; our concern was and is to protect hard-working people on modest incomes, who are more likely to care for their relatives and a lot less likely to get any help in doing so; and our concern was and is to protect people from the lottery of where they live, rather than what they need, determining their assessment for care and the level of support.

It should be a cause for celebration and pride that one in five of us in this country who are alive today will live to 100, and that our children are likely to spend a third of their lives in retirement. Instead, too many of us approach our older age in fear—fear that we will need care that will not be there; fear that our savings will be wiped out by the open-ended costs of care; fear that we cannot protect our families from that risk; and fear of becoming a burden or being left alone.

Today’s report from Andrew Dilnot is a starting point, but it is what the Government do with it now that counts. My right hon. Friend the Leader of the Opposition has made a big offer to the Prime Minister to put politics aside and work to see a better, fairer and lasting system of support for our older and disabled people in England. Labour is willing to talk to and work with the Government and all other parties to do so, because we know that any new system of care must give all of us long-term confidence about what will be on offer for us and our families as we plan and prepare for older age.

That requires the Prime Minister to give the lead, because discussing and agreeing an affordable, sustainable system and how we pay for it involves important parts of Government beyond the Health Secretary. It requires the Prime Minister to give a guarantee that the Government will not kick Dilnot’s recommendations into the long grass, because as Dilnot says, the system needs “urgent and lasting reform”. If the Government are serious, we are serious; and if they are serious, we need to hear more. Dilnot recommends a White Paper by December this year, so why are the Government already saying that it will be spring before publication?

Any solution is a solution only if it is available and affordable to everyone, so what assurance can the Government give that the voluntary insurance protection will be an option for all? Dilnot states that the current system is

“under extreme strain, and people are experiencing tightening eligibility and reduced care packages.”

Do the Government accept his conclusion that additional public funding for the means-tested system is urgently required?

The corporate crisis at Southern Cross is causing extreme anxiety for many people living in its homes. Do the Government accept that there is a case for regulating business standards as well as care standards, to give people greater confidence in their care?

The Secretary of State said that he would engage directly with me. I thank him, but this is a big challenge not just for him but for the Chancellor and the Prime Minister. Will the Government accept that cross-party talks are required across Government? This is a once-in-a-generation chance, and the House and the public will need to hear from the Prime Minister himself to believe that his Government are determined, as we are, to build a better, fairer and lasting system of care in our country.

[Mr Lansley]

I am grateful to the right hon. Gentleman for the welcome that he gives to the report by Andrew Dilnot and his colleagues, and indeed to the report that Tom Hughes-Hallett and Alan Craft produced on palliative care. They are both immensely valuable.

The right hon. Gentleman rightly says that it is important for us to move beyond many of the suggestions that have been made in the past. One of the essential purposes of the Dilnot commission was to seek something that was affordable and sustainable, that met tests of choice, fairness, value for money and ease of understanding, and that would be sustainable for the longer term. Dilnot has responded immensely well to the issues that we put to him, but that is part of a broader process of reform. In that sense we have not waited for Dilnot, because we have made progress on the wider aspects of reform. Now we have to ensure that we bring them together in a way that is coherent and works to deliver long-term, sustainable reform across the whole social care sphere.

The right hon. Gentleman rightly points to the fact that we inherited a fragile system in which there had already been a substantial tightening of eligibility and loss of care and support, with increasing levels of unmet need. That was precisely why, in an interim report last year, Andrew Dilnot and his colleagues asked us to make additional resources available in the spending review. I set out in my statement precisely how we have done so.

The concerns in relation to Southern Cross are particular to that company, and the Minister of State, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), has made clear to the House how we are interacting with those who are involved with the company. We are making it very clear to the public—I reiterate it today—that we are prepared to act to secure the interests of individuals if there were any threat to their position in care homes. We are working with the Association of Directors of Adult Social Services and local authorities to ensure that those contingencies are in place. What I said today in the statement, and which people have not previously recognised, is that as early as last year we set out in the Health and Social Care Bill that we were prepared for regulatory powers to be available to ensure the future viability of social care providers, as we intend to do in relation to health care providers.

Let me may make one final point. I believe that my statement makes it absolutely clear that we will engage on the basis of the Commission on Funding of Care and Support, and that we will do so on a timetable that will work and that gives stakeholders and the public, and indeed the Government and the Opposition, an opportunity to come forward with a consensus. I discussed that timetable with Andrew Dilnot, and he is clear that he supports it. It will lead to a White Paper in the spring and an associated progress report on funding reform. I am clear that that assures stakeholders that we will take this forward as a priority.

NHS Future Forum

Debate between Lord Lansley and John Healey

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

Thank you very much, Mr Speaker.

We will further clarify the duties on the NHS commissioning board and clinical commissioning groups to involve patients, carers and the public. Commissioning groups will have to consult the public on their annual commissioning plans and involve them in any changes that would affect patient services.

One of the main ways in which patients will influence the NHS is through the exercise of informed choice. We will amend the Bill to strengthen and emphasise the commissioners’ duty to promote patient choice. The choice of any qualified provider will be limited to areas where there is a national or local tariff, ensuring that competition is based solely on quality. The tariff development, alongside a best-value approach to tendered services, will safeguard against cherry-picking.

Monitor’s core duty will be to protect and promote the interests of patients. We will remove its duty to promote competition as though that were an end in itself. Instead, it will be under a duty to support services integrated around the needs of patients and the continuous improvement of quality.

It will have a power to tackle specific abuses and restrictions of competition that act against patients’ interests. Competition will be a means by which NHS commissioners are able to improve the quality of services for patients.

We will keep the existing competition rules introduced by the last Government—the so-styled “Principles and rules for co-operation and competition”—and give them a firmer statutory underpinning. The co-operation and competition panel, which oversees the rules, will transfer to Monitor and retain its distinct identity. We will also amend the Bill to make it illegal for the Secretary of State or the regulator to encourage the growth of one type of provider over another. There must be a level playing field.

We will strengthen the role of health and wellbeing boards in local councils, ensuring that they are involved throughout the commissioning process and that local health service plans are aligned with local health and wellbeing strategies.

In a number of areas, we will make the timetable for change more flexible to ensure that no one is forced to take on new responsibilities before they are ready, while enabling those who are ready to make faster progress. If any of the remaining NHS trusts cannot meet foundation trust criteria by 2014, we will support them to achieve that subsequently. However, all NHS trusts will be required to become foundation trusts as soon as clinically feasible, with an agreed deadline for each trust.

We will ensure a safe and robust transition for the education and training system. It is vital that change is introduced carefully and without creating instability, and we will take the time to get it right, as the Future Forum has recommended. During the transition, we will retain postgraduate deaneries and give them a clear home within the NHS family.

The extension of “any qualified provider” will be phased carefully to reflect and support the availability of choice for patients. Strategic health authorities and primary care trusts will cease to exist in April 2013. By that date, all GP practices will be members of either a fully or partly authorised clinical commissioning group, or one in shadow form. There will be no two-tier NHS.

However, individual clinical commissioning groups will not be authorised to take over any part of the commissioning budget until they are ready to do so. Individual GPs need not take managerial responsibility in a commissioning group if they do not want to, and April 2013 will not be a “drop dead” date for the new commissioners. Where a clinical commissioning group is not able to take on some or all aspects of commissioning, the local arms of the NHS commissioning board will commission on its behalf. Those groups that are keen to press on will not in any way be prevented from becoming fully authorised as soon as they are ready.

I told the House on 4 April that we would secure proper scrutiny for any changes that we made to the Bill. In order to do that without trespassing on the House’s time to review the Bill as a whole on Report, we will ask the House to recommit the relevant parts of the Bill to a Public Bill Committee shortly.

Through the recommendations of the NHS Future Forum and our response, we have demonstrated our willingness to listen and to improve our plans; to make big changes, and not to abandon the principles of reform, which the forum itself said were supported across the service. However, we are clear that the NHS is too important, and modernisation too vital, for us not to be sure of getting the legislation right. The service can adapt and improve as we modernise and change, but the legislation cannot be continuously changed. On the contrary, it must be an enduring structure and statement, so it must reflect our commitment to the NHS constitution and values and incorporate the safeguards and accountabilities that we require. It must protect and enhance patients’ rights and services, and it must be crystal clear about the duties and priorities that we will expect of all NHS bodies and local government in the future.

Professor Field’s report says that it is time for the pause to end. Strengthened by the forum’s report and recommendations, we will now ask the House to re-engage with delivering the changes and modernisation that the NHS needs. I commend this statement to the House.

[John Healey (Wentworth and Dearne) (Lab)]

I thank the Secretary of State for an advance copy of his statement, although I learned more from the Prime Minister’s press conference than from the statement.

Humiliating! The Health Secretary has had health policy taken out of his hands. He spent the last nine months telling anyone who criticised the Government’s health plans that they were wrong, and that they did not understand. Today, he admits that he is wrong. How can he argue for this latest blueprint for the biggest reorganisation in NHS history with any credibility or integrity? The man who messed up so badly last year is telling us how he will mess up next year too.

Why no apology to NHS patients and staff for the wasted year of chaos, confusion and incompetence? Why no apology for breaking the coalition agreement to stop top-down reorganisations? Why no apology for patients, who are already beginning to see the NHS go backwards again because of this reorganisation? More than one in 10 people now waits 18 weeks for operations, three times the number of patients wait more than six weeks for tests, and casualty waits are at a six-year high.

This is the first Prime Minister who has been forced to ask 45 experts for a report on how to protect the NHS from his own Government’s policies. Now he is reorganising his reorganisation. The Future Forum report yesterday was a demolition job on the Government’s misjudgments and mishandling of the health service. Why is he wasting £800 million on redundancy payments when some of the same people will be re-hired to do the same job? Why is he holding back £2 billion promised for patient care when it could fund 55,000 nurses? Why is he ploughing on with the Health and Social Care Bill when what he announced today could largely be done without legislation, and certainly without the risk and cost of the biggest reorganisation in NHS history?

This is a political fix, not a proper plan for improving care for patients, or for a better or more efficient NHS that can meet the big challenges that it must face for the future. Make no mistake, today’s plans will mean that the NHS is mired in more complex bureaucracy, more confusion and more wasted cost in the years to come. In the battle of spin, with all parts of the divided Government claiming a win, the big losers will be NHS patients. The Opposition and the public will judge the Government on what they do, not on what they say.

I lost track of the bureaucracy that the Health Secretary announced in his statement. Will he admit that this reorganisation creates five new national quangos, set to spend tens of billions of pounds? Will he admit that this reorganisation replaces one local body—the primary care trust—with at least five others, all of which will play a part in commissioning? Will he admit that the plans still cut hospitals loose from the NHS, with no limits on treating private patients while NHS patients wait longer, and no support from the NHS if they run into financial trouble? Will he admit that hospitals will no longer have the protection as a public service from the full force of competition law?

What was a very bad Bill will still be a bad Bill. This House should be allowed to do its proper democratic job, as the only elected House, and scrutinise in full in Committee the whole Bill. At its heart, the Bill will still be the Tory long-term plan to see the NHS set up as a full-scale market, and the NHS broken up as a national public service, so that patients increasingly see the services on which they depend subject to the lottery of where they live.

The public have rumbled the Prime Minister. They know that they cannot trust him with the NHS. Fewer than one in four now trusts him to keep his NHS promises, and more than half believe that the Conservative party’s plans for the NHS are just a way to privatise the health service. Today, the Government have recycled their plans for the NHS when they should have been scrapped. People are right to conclude that they cannot trust the Tories with our NHS.

[Mr Lansley]

Well, I was hoping that, having got past the abuse, the right hon. Gentleman would tell us whether he agreed with the NHS Future Forum, but he did not even mention it. He welcomed the listening and engagement exercise that we announced—he said it was the right thing and that it would be good government to do it—but then when an independent group of experts reports and makes recommendations, he ignores it and says he will oppose the Bill regardless. He did not listen to what people in the NHS were saying. I think it was shameful how he dismissed everything that has happened over the past year as though it did not matter at all—a year in which the coalition Government said we would increase resources to the NHS. We have done that and are committing to investing an extra £11.5 billion in the NHS over the next four years. That is money that, as we will continue to remind the British public, the Labour party told us we should not give to the NHS.

In the past year, the coalition Government and the NHS across the country have implemented a cancer drugs fund from which 2,500 more patients have benefited, and in the past four months, we have cut the number of breaches of the single-sex rule by three quarters, and the number of hospital infections by 22% and C. difficile infections by 15%. Some 750,000 more people are accessing dentistry, and waiting times for people going into hospital are down compared with March 2010. We said that we would reduce management costs, and we will do so, and we have taken 3,800 managers out of the NHS since the election, while the number of doctors has gone up. Six months ago, the right hon. Gentleman said that he supported the reform principles in the Bill. All he said today was sheer opportunism, but it will come back to haunt him, because the NHS will benefit from the changes we are proposing today. It will take greater ownership of its own service; patients will be empowered; and clinicians across the service will be empowered and will deliver better outcomes for patients, and when that happens, we will be able to say, “The Labour party would have denied the NHS the resources and the freedom and responsibility to deliver those better outcomes.”

Oral Answers to Questions

Debate between Lord Lansley and John Healey

Tuesday 7th June 2011 Commons Chamber

[Mr Lansley]

Yes, I can. My right hon. Friend is absolutely right about that. Over the last year in hospitals in particular we saw what was approaching a 15% reduction in productivity. That is why we are proceeding with ensuring that across the NHS we recognise not only that there are increasing demands on the NHS, which is why we are increasing the NHS budget by £ll.5 billion over four years, but that that money must be used increasingly effectively to deliver efficiency savings in excess of 4% each year so that we can improve the quality of services for patients.

[John Healey (Wentworth and Dearne) (Lab)]

The Secretary of State spoke in glowing terms of the last year, but the last year has been a catalogue of confusion, incompetence and broken promises. So will he now accept that the Government’s massive mishandled NHS reorganisation is piling extra pressure on NHS services, with nearly £2 billion promised for patient care being wasted on the internal changes? Will he admit that it is patients who will suffer as front-line NHS staff lose their jobs, treatments are cut back and waiting times start to rise again under the Tories?

[Mr Lansley]

The right hon. Gentleman asked about performance last year. I told him what the financial performance was. Let me also make it clear that, for example, for hospital in-patients, referral to treatment waiting time has gone down from 8.4 weeks in May 2010 to 7.9 weeks in the latest figures in March, and for out-patients the figure has gone down from 4.3 weeks in May 2010 to 3.7 weeks in the latest figures, so waiting times have improved. We have established the cancer drugs fund, with more than 2,500 patients benefiting from that. We have published and driven down the number of breaches of the single sex accommodation rules: a 77% reduction in those breaches, which Labour never achieved. In the last year we have reduced the number of MRSA infections in hospitals by 22% and C. difficile infections by 15%. I applaud the NHS—

[Mr Speaker]

Order. I think we have got the thrust of it and are most grateful.

[John Healey]

The Secretary of State mentioned a lot of things, but I notice that he did not mention the Prime Minister’s five new guarantees. [Interruption.] The Secretary of State shakes his head as if they do not matter, but perhaps he was not consulted on them. People have seen the Prime Minister make and then break promises on the NHS before, but this time he is breaking his pledges as he is making them. The King’s Fund says that waiting times are going up and the Nuffield Trust says that health funding is being cut in real terms. Privatisation, the break-up of integrated care and the removal of national standards at the heart of the health service are exactly what his health Bill is designed to do. Is that not why MORI shows public concern about the NHS rising rapidly and why people are right to conclude that they cannot trust the Tories on the NHS?

[Mr Lansley]

My right hon. Friend the Prime Minister has made it very clear that we will not let waiting times rise and that we will improve performance in the NHS right across the board, which was what I was illustrating. I remind the right hon. Gentleman again that waiting times in hospitals are down from 8.4 weeks to 7.9 weeks for in-patients and from 4.3 weeks to 3.7 weeks for out-patients. That is what we are committed to. Chris Ham of the Kings Fund was on the “Today” programme this morning and said on waiting times, “There hasn’t been a great deal of change since the election.” What has changed since the election is that we are improving performance, driving down the number of breaches of the single-sex rules, increasing access to dentistry, cutting the number of managers and increasing the number of doctors. Those are the things we are doing in the NHS, and it is to the benefit of patients that we do.

Future of the NHS

Debate between Lord Lansley and John Healey

Monday 9th May 2011 Commons Chamber

[John Healey]

No. What I am referring to is the provision in the Bill to allow the job of commissioning to be outsourced to private companies. That has never been done before. It is there in the Bill and it is a big risk for the future.

The Prime Minister made the NHS his most personal pledge before the election.

[The Secretary of State for Health (Mr Andrew Lansley)]

Will the right hon. Gentleman just be clear to the House and get it accurate? The Bill sets out that commissioning consortia are statutory bodies covering the whole of the country in the public sector. Therefore, if they use private sector commissioning expertise—which the Bill does not require them to do—that is not commissioning responsibility. In the two years leading up to the election, primary care trusts increased their use of management consultancy by 80%, so they did use the private sector, whereas commissioning consortia do not have to.

[John Healey]

The point about the Health Secretary’s legislation is that it allows consortia to outsource in whole the job of, not the responsibility for, commissioning. He made the point that the consortia are public bodies, but they meet none of the standards of public governance. They can meet in private. As the right hon. Member for Charnwood (Mr Dorrell) has said, that serious job should be done by properly constituted and governed public authorities, but that is a loophole in the Bill.

--- Later in debate ---

[Mr Lansley]

Let me just make some progress. We need this modernisation for the NHS because of the challenges it faces in the future. We need to deliver £20 billion of efficiencies over the next four years. I remind the House that that requirement was set out originally under a Labour Government in 2009 without the merest hint of irony—I say that given that they created the inefficiencies in the first place. Today, I can give the House some figures that the Labour party would wish that people did not know. If Labour’s spending plans for the NHS at the last election had been implemented over this spending review period, the NHS budget would have been cut by £30 billion compared with what we have put into the NHS over the spending review period. So let the right hon. Member for Wentworth and Dearne get up now and explain: how was the NHS going to deal with £20 billion of efficiencies while he was cutting £30 billion out of it, instead of it getting the extra £11.5 billion it is getting from taxpayers through this coalition Government?

[John Healey]

After 20 minutes of the Health Secretary’s speech, the hon. Member for St Ives (Andrew George) finally brought him to his own plans and he was clearly very uncomfortable. What does he say when the Prime Minister wonders how he got the Government into such a mess over his plans? What does he think of the chair of Monitor’s observation that the approach being taken is a combination of

“previously unannounced policies, a complete failure to build the necessary political and professional consensus and an apparent disdain for the detailed planning of implementation”?

That was said by one of the Government’s allies.

[Mr Lansley]

I suppose the one thing the right hon. Gentleman has learned about being in opposition is that it is best for a party to try to forget everything that it did in government, because it will not be held to account for it. He has also recognised that the best thing is to have no ideas of his own. He does not even seem to know whether he agrees with our ideas or opposes them. We do not have any answers from him. The right hon. Gentleman’s quotation was from the former, not current, chair of Monitor, who knows perfectly well that these measures were in our respective manifestos and were brought together in the coalition agreement. They have a mandate. From my point of view, this is not just about the electoral mandate but about how we can deliver the best care for patients and see through principles that I thought the right hon. Gentleman’s party, as well as ours, believed were right.

Let me make it clear that the challenges in the NHS are about more than just clearing up Labour’s mess. We must recognise that there are now more pensioners than children under 16, alcohol-related admissions to hospital have doubled and emergency admissions have risen by 12% in just four years. Obesity in this country has doubled in the last 25 years. Under Labour, the demand for health care was rising while productivity was falling. The only way that Labour could cover those risks was by massively increasing the budget and that is no longer an option. Mounting pressure on the NHS is inevitable and the status quo, as Labour recognises, is not an option. The NHS needs modernisation.

Oral Answers to Questions

Debate between Lord Lansley and John Healey

Tuesday 26th April 2011 Commons Chamber

[Mr Lansley]

Yes, I can tell my hon. Friend that the response to dementia is a key priority for this coalition Government. I think we have already demonstrated it in our commitment to dementia research. We need to improve both earlier diagnosis of dementia and the possibilities for treatment. We have demonstrated our commitment to improving standards in dementia care, both in hospitals and in care homes, and, indeed, in the further work we have done on reducing the use of anti-psychotic medicines.

[John Healey (Wentworth and Dearne) (Lab)]

How does the Health Secretary square the Prime Minister’s promise to pause in his changes to the NHS with the NHS chief executive saying a week later:

“I want to stress very firmly that we need…to maintain momentum on the ground.”

With the Government’s health Bill, are we not seeing both rushed pre-legislative implementation and confused post-legislative policy making? If the Prime Minister really gets cold feet about his NHS changes, let me ask the Health Secretary for a fourth time whether the Government will guarantee the extra time needed for this House to examine the changes fully?

[Mr Lansley]

Let me be clear about the right hon. Gentleman’s point. Both things are entirely compatible because there are 220 GP-led consortia that have come together as pathfinders to demonstrate how they can improve commissioning and the service to their patients; 90% of local authorities have come together in health and wellbeing boards; while at the same time, we have to deliver the challenge of improving productivity, quality and efficiency. All of that requires us, on the ground, to continue the momentum of improvement for patients. At the same time, we are listening not least to all those clinicians and members of the public who want to be sure that the Bill will provide them with the opportunities for involvement and the safeguards they are looking for in the NHS in the future.

[John Healey]

The Health Secretary ducked for the fourth time this afternoon the question of whether he will do right by this House in allowing sufficient time for proper scrutiny of any changes to the Bill that come forward. While he is listening, will he consider the risks he is running with the NHS? The Prime Minister promised a real rise in NHS funding, yet this year more than nine out of 10 hospitals are faced with cutting costs by more than 4%; one in seven by more than 8%; while nearly £2 billion for patient care is being held back to cover the costs of the internal NHS reorganisation. Will he admit that this reorganisation is now piling extra pressure on NHS funding and services so that patients are seeing waiting times rise, operations cancelled and front-line staff jobs cut as the NHS starts to go backwards again under the Tories?

[Mr Lansley]

I find the hon. Gentleman’s cheek astonishing. It was his party which, before the election, announced its intention of making up to £20 billion of efficiency savings, it was his party which told us after the election that the NHS should be cut, and it is his party which is actually cutting the NHS in Wales. It is the coalition Government who have made decisions that will give the NHS £2.9 billion—a 3% cash increase—and, because of the way in which we are tackling the costs of management, will put more people on the front line. Following the election, there are 3,500 fewer managers and 2,500 more doctors and nurses.

NHS Reform

Debate between Lord Lansley and John Healey

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

MRSA is at its lowest level since records began. We have helped more than 2,000 patients have access to new cancer drugs that would previously have been denied to them. All that is a testament to the excellent work of NHS staff up and down the country, and we thank them for their efforts to achieve these results for their patients. The coalition Government are increasing NHS funding by £11.5 billion over this Parliament, but the service cannot afford to waste any money. We can sustain and build on those improvements only by modernising the service to be ever more efficient and effective with taxpayers’ money.

The Bill is a once-in-a-generation opportunity to set the NHS on a sustainable course, building on the commitment and skills of the people who work for it. Our purpose is simple: to provide the best health care service anywhere in the world. I commend this statement to the House.

[John Healey (Wentworth and Dearne) (Lab)]

I thank the Secretary of State for Health for a copy of his statement shortly before he made it this afternoon. So Mr Speaker, in the middle of confusion, chaos and incompetence, the Prime Minister has pushed the Health Secretary out of the bunker to try and tell people what exactly and what on earth they are doing with the NHS. Why is the Health Secretary here and not the Prime Minister? After all, we have been told that the Prime Minister has taken charge and it was he who made his most personal pledge to protect the NHS and to stop top-down reorganisations that have got in the way of patient care. It is the Prime Minister who is now breaking his promises on the NHS.

Will the Health Secretary tell us why the Tories did not tell people before the election about the biggest reorganisation in NHS history? Why did they not tell the Lib Dems about the reorganisation before the coalition agreement was signed? Whatever the Government say or do now, there is no mandate—either from the election or the coalition agreement—for this reckless and ideological upheaval in the health service. In truth, the Health Secretary is here only because there is a growing crisis of confidence over the far-reaching changes that the Government are making to the NHS.

There is confusion at the heart of Government, with briefings and counter-briefings on all sides, and patients starting to see the NHS go backwards again under the Tories—with waiting times rising, front-line nursing staff cut and services cut back. Yet the Health Secretary has done nothing to restore public confidence in the Government’s handling of the NHS and nothing to convince people to back the Tories’ reorganisation plans. Everything he said today the Government were told about in the consultation—and they ignored it. Everything he said today the Government were told in Committee—and they rejected it.

This is not just a problem with the pace of change; simply doing the wrong thing more slowly is not the answer. It is not just a problem with presentation. In fact, the more people see the plans, the more concerned they become about them. That is why there is growing criticism of the Tories’ plans for the NHS—from doctors, nurses, patients’ groups, NHS experts, the Health Select Committee, the Lib Dems and peers of all parties in the House of Lords. I have to hand it to the Health Secretary: it takes a special talent to unite opposition from Norman Tebbit and MC NxtGen. That is why Labour has been saying that the reorganisation requires a root-and-branch rethink and that the legislation requires radical surgery.

There are fundamental flaws in what the Government are doing, not just in what they are saying. The test is whether the Prime Minister will now deal with these fundamental flaws. Will he radically safeguard commissioning to draw on the full range of NHS expertise, to prevent conflicts of interests, bonus payments to GPs and to guarantee that important decisions are taken in public not in private? Will he radically strengthen local accountability to the public and to patients? Will he delete the one third of the Bill that breaks up the NHS and makes it into a full-blown market ruled by the forces of market regulation and EU competition law? Will this be just a public relations exercise or will real changes be made in the NHS plans—or has the Prime Minister not yet told the Health Secretary? This is no way to run a Bill; this is no way to run a Government; this is no way to run the NHS.

[Mr Lansley]

We heard from the Leader of the Opposition earlier that the NHS needed to change, but once again we have heard nothing from Labour Members about how it needs to change. It is not unusual to hear nothing from them. They say that we need to tackle the deficit, but they will not say how. They say that we must change the NHS, but they will not say how.

Interestingly, in January the right hon. Member for Wentworth and Dearne (John Healey) said that he agreed with the aims of the Bill. He said that he supported a

“greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes”.

At the last election, his manifesto said that he wanted all NHS trusts to become foundation trusts. It said that he wanted patients to have access to every provider, be it private sector, voluntary sector or NHS-owned. Now we do not know what the Labour party’s policy is at all, but what I do know is that the Government will give leadership to the NHS, and that we will give the NHS a strategy enabling it to deliver improving results in future.

The right hon. Gentleman clearly wrote his response to the statement before reading it. In fact, we have made it clear that we will listen to what is said about precisely the issues on which people in the NHS and people who depend on the NHS are united. They know which issues are really important. They know that we must be clear about accountability, and that there must be transparency. Clinicians throughout the health service want to work together, and want the structure of the service to help them to work together so that they can deliver more holistic and joined-up services to patients. We want that, and they want that. We will back up our strategy with detail, but from the right hon. Gentleman we heard no strategy, no detail, and no answers whatsoever.

We are clear about the principles that we are pursuing through the reform and modernisation of the national health service. We are listening, and we are engaging with those principles. We are listening to the people in the health service who have come together to implement those principles, so that we can help them to do so effectively. Labour Members have not even listened to those who threw them out at the last election, because they are still wedded to the past and to a failed, top-down, centralised, bureaucratic approach.

NHS Reorganisation

Debate between Lord Lansley and John Healey

Wednesday 16th March 2011 Commons Chamber

[John Healey]

We were doing what the manifesto said before the election. [Interruption.] We were doing it where the private sector and competition could add capacity to clear waiting lists, or do something new that the NHS was not doing. We did it in circumstances that were carefully planned, properly managed and always publicly accountable. If the hon. Gentleman is going to swallow the guff from those on his Front Bench that this is somehow an evolution of Labour’s policy, he will have to ask the Health Secretary why he needs legislation that is more than three times longer than the Act that set up the NHS in the first place.

Why do we say what we do in the motion before the House? In truth, this is a Tory reorganisation, and the legislation has been mis-sold. It is not just about getting GPs to lead commissioning or looking to cut layers of management; it is setting up the NHS as a full-scale market driven by the power of the competition regulator and the force of competition law. The reorganisation and legislation is designed to break up the NHS, open up all areas of the NHS to private health companies, remove requirements for proper openness, scrutiny and accountability to the public and to Parliament, and make the NHS subject to both UK and European competition law. The Tories are driving the free market political ideology through the heart of the NHS.

[The Secretary of State for Health (Mr Andrew Lansley)]

On precisely that point about scrutiny and accountability, we have been talking about independent sector providers. Under Labour, if scrutiny committees in local authorities wanted to investigate the activities of independent sector providers they could not do so. Under our legislation, they will be allowed to do so. Wherever NHS money—the public pound—goes, scrutiny will be able to follow. That is a change for the better.

--- Later in debate ---

[John Healey]

That is simply not true. The people who will make the big decisions about £80 billion of spending—the GP consortia—will not need to meet in public or to publish minutes of their meetings. They will not be subject to scrutiny by this House or proper public accountability.

Let me turn now to the question of subjecting the NHS to UK and European competition law. The Prime Minister clearly did not know about that at Prime Minister’s questions today—he clearly did not know that a third of his legislation sets up this new free market NHS. Perhaps the Health Secretary has only told him half the story about the legislation—

[Mr Lansley]

Will the right hon. Gentleman give way?

[John Healey]

Shall I finish what I have to say? Then I will give way. If the Health Secretary has not told the Prime Minister, he certainly has not told the public or this House, so let me spell it out—[Interruption.] The Health Secretary says that I have made it up, but why not wait for me to explain to the House, and then he can say whether what I am about to explain to the House is in my words or his?

Clause 52 of the Health and Social Care Bill, entitled “General duties”, sets up the new competition regulator, Monitor, and says:

“The main duty of Monitor in exercising its functions is to protect and promote the interests of people who use health care services—

(a) by promoting competition where appropriate, and

(b) through regulation where necessary.”

The new regulator is given legal competition powers, as well as functions under the Competition Act 1998 and the Enterprise Act 2002, and there are provisions on reviews by the Competition Commission and co-operation with the Office of Fair Trading.

[Mr Lansley]

Will the right hon. Gentleman give way?

[John Healey]

The Secretary of State can speak in a minute; I will finish this point. The regulator can investigate complaints about competition, force services to be put out to competitive tender, remove licences and fine the commissioner or provider up to 10% of their turnover. Helpfully, the Government’s new chair of Monitor confirms that. In The Times last month, he said:

“We did it in gas, we did it in power, we did it in telecoms, we’ve done it in rail, we’ve done it in water, so there’s actually 20 years of experience in taking monopolistic, monolithic markets and providers and exposing them to economic regulation”.

[Mr Lansley]

It is dead simple: the Health and Social Care Bill does not extend the application of EU competition law, or the application of domestic competition law. The powers given to Monitor as a sector regulator are the same as those now available to the Office of Fair Trading. The Bill does not change the scope of competition law at all.

[John Healey]

The right hon. Gentleman was involved, so he knows better than anyone else that the Tories are now setting out to do to the public services, including the NHS, what they did to the public utilities in the 1980s.

--- Later in debate ---

[Mr Lansley]

I want to make progress. I have given way several times.

The right hon. Member for Wentworth and Dearne (John Healey) said that we planned to get rid of regional system management in the NHS, but that was Labour’s policy when it introduced NHS foundation trusts. Through introducing health and well-being boards in local authorities, we will have a genuine, system-wide view that looks at the NHS, public health and social care. He complains about the commercial insolvency regime, but Labour introduced that under the legislation that set up the foundation trusts eight years ago. He said that our plans introduce EU competition law. No. EU competition law already exists and the Bill does nothing to change that—it does not extend the application of competition law. [Interruption.] No, it does not. In Committee, the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), explained the current position, which the Bill does not change.

The right hon. Member for Wentworth and Dearne and other Labour Members talk about price competition. We have clarified the Bill to ensure that the competition is on quality. What happened under Labour? The private sector was paid 11% more than the NHS. Under Labour, private sector providers were paid £250 million for operations that they did not perform. Under Labour, NHS hospitals were barred from tendering to provide the capacity that Labour offered to the independent sector. Labour Members favoured the private sector. A Liberal Democrat manifesto commitment stated that we would not in future allow the private sector to be given advantages and the NHS to be shut out. We will implement that.

I want to know a bit, because although the right hon. Member for Wentworth and Dearne said that it was the Opposition’s job to ask questions today, I have done many Opposition day debates on health when I was asked many times what our policy was, and I answered those questions. Is it Labour’s policy to extend the use of voluntary sector providers in the NHS? That was in the Labour party’s manifesto. Indeed, Labour said that it wanted to use the independent private sector, too. Is it still the policy? No answer. We do not know. Is it Labour’s policy to make every trust an NHS foundation trust? Again, it was in the Labour party manifesto. Is it still the Labour party’s policy—yes or no? No answer. Again, we do not know. Is it Labour’s policy to promote competition in the NHS, as quoted from the Labour party manifesto in the debate? The right hon. Gentleman has just made a speech opposing that. Does he wish to intervene?

[John Healey]

I am grateful to the Secretary of State for giving way. We had the NHS as the preferred provider and were ready to use other providers when they could help, and we did so. The great improvements in the NHS happened because we were prepared to put in the investment and to make the reforms. The Secretary of State talks about policies. The problem with what he is doing to the NHS—the reorganisation, the legislation and the ideological change at the heart of it—is that he did not tell the people about it before the election and he did not tell the Lib Dems about it before they signed the coalition agreement. This top-down reorganisation is exactly what he promised not to do.

[Mr Lansley]

The right hon. Gentleman was not satisfied with his first speech, so he had to have a go at a second one. He did not answer any of my questions. The Labour party said in its manifesto that it would use the private and voluntary sectors alongside NHS providers. The reason for that was simple: having the NHS as the preferred provider meant that the patient could be let down time after time before another quality provider could be permitted. We are going to allow competition on quality, but the quality has to be there. Patients will get the best possible service from whoever is best placed to provide that care.

Our changes are being seen across the country already.

Oral Answers to Questions

Debate between Lord Lansley and John Healey

Tuesday 8th March 2011 Commons Chamber

[Mr Lansley]

As the Minister of State, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), has set out in previous answers, our cancer outcome strategy commits more than £450 million a year over the spending review period to achieving earlier diagnosis of cancer, including access for GPs in the community to diagnostic tests such as non-obstetric ultrasound. At the heart of the strategy is the need to improve awareness and early diagnosis of all cancers, and we are working with the prostate cancer advisory group to help men who do not have symptoms to make decisions about whether to have a prostate-specific antigen test.

[John Healey (Wentworth and Dearne) (Lab)]

The Prime Minister promised to protect the NHS. What does the Health Secretary say to the people who are not getting the hip, knee and cataract operations that they need, and to the patients who are now having to wait longer for tests and treatment?

[Mr Lansley]

I will say three things. First, we did protect the NHS, contrary to the recommendations of the Opposition, who said that we should cut the NHS budget. Next year, primary care trusts across England will receive an average increase of 3% in cash. I went to Wales at the weekend, to Cardiff. The people of Wales are seeing a Labour-led Assembly Government cutting their NHS budget in real terms. That was what the Opposition recommended we should do, and we are not doing it.

Secondly, the number of hip and knee replacement operations went up in 2010 compared with 2009—the Patients Association figures were wrong about that. Thirdly, waiting times are stable, as we have set out, and the latest figures show that the average waiting time for diagnostic tests has gone down.

[John Healey]

The Secretary of State is a man in denial. What does he say to the chief executive of the Patients Association, who has said:

“It is a disgrace that patients are being denied access to surgical procedures that they would have had if they had needed them a year ago”?

What the Government are doing on the NHS is making things worse, not better. The Secretary of State is axing Labour’s patient guarantee on waiting times, he is breaking the promise of a real rise in NHS funding, he is wasting £2 billion on the Government’s top-down reorganisation and he is forcing market competition into all parts of the NHS. Does he not see that the NHS is rapidly becoming the Prime Minister’s biggest broken promise?

[Mr Lansley]

I can tell the right hon. Gentleman and the House exactly what we are doing. We are increasing the budget for the NHS by £10.7 billion over the next four years, contrary to what the Opposition told us they would do and what a Labour-led Assembly Government in Wales are doing. They are cutting the NHS budget in real terms.

Let me take one example. The number of hip operations in the first half of this financial year was 41,863, whereas in the previous period it was 39,114, and waiting times are stable, so the right hon. Gentleman’s assertion simply is not true. We are delivering an improving quality of care.

Let me give the right hon. Gentleman another example. As the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), said, not only are waiting times stable but infections are going down, with a reduction of 29% in C. diff rates and 35% in MRSA rates in our hospitals. Safer, higher-quality care—

Health and Social Care Bill

Debate between Lord Lansley and John Healey

Monday 31st January 2011 Commons Chamber

[John Healey]

Characteristically, my right hon. Friend is absolutely right. These changes to the NHS and the Bill—[Interruption.]

[Mr Lansley]

Will the right hon. Gentleman give way?

[John Healey]

I shall answer my right hon. Friend the Member for South Shields (David Miliband), then I will give way.

My right hon. Friend is absolutely right. The Government will talk about some changes, but not about others. The changes are like an iceberg, with big, substantial, ideological changes hidden from public sight.

[Mr Lansley]

The edifice of an argument from the right hon. Member for South Shields (David Miliband), which is repeated by others, is based on one fact: in December 2009, the operating framework said that commissioners in the NHS could set a maximum price and not just a fixed price. That was December 2009. The right hon. Gentleman and the shadow Health Secretary were in the Government who put that measure into the operating framework. This Government did not put it in; the previous one did.

[John Healey]

The point made by my right hon. Friend the Member for South Shields is based on page 42 onwards of the Health Secretary’s impact assessment of the Bill, which mentions a premium for private providers of £14 per £100. The Bill allows the system to pay a premium and a bung to private sector providers.

Oral Answers to Questions

Debate between Lord Lansley and John Healey

Tuesday 25th January 2011 Commons Chamber

[Mr Lansley]

I am glad to have the opportunity to welcome the hon. Lady to the Opposition Benches and wish her well in representing Oldham East and Saddleworth. I am sorry that she did not take the opportunity to welcome in particular the Government’s commitment to the new women and children’s unit at the Royal Oldham hospital.

For years, general practices have been remunerated partly through a quality and outcomes framework. The principle is that if they deliver better outcomes for patients, they should have a corresponding benefit from doing so. In the same way, if the commissioning consortia deliver improving outcomes for patients, that should be recognised in their overall reward.

[John Healey (Wentworth and Dearne) (Lab)]

The Secretary of State talks a lot about GPs using £80 billion of public money to commission services, but if they are to carry on being family doctors, the planning, negotiating, managing and monitoring of hundreds of commissioning contracts will be done not by GPs but in their name, either by the people who do it now in primary care trusts or by the big health companies that are already hard-selling the service to new GP consortia. Is he not deliberately disguising the true purpose of his changes, which is to open up all parts of the NHS to big private health care companies?

[Mr Lansley]

On the contrary, the purposes of the Bill are very clear to see—for example, the duty to improve quality and raise standards throughout the health service. I hope that the shadow Secretary of State will acknowledge that putting clinical leadership at the heart of the system is essential. I entirely understand that leadership is not the same thing as management, as do general practitioners. The Prime Minister and I will meet the first wave of pathfinder consortia tomorrow, and we will support them in taking clinical leadership in designing services for patients and bringing to bear the best management support in doing so.

[John Healey]

Why will the right hon. Gentleman not be straight with the public? I have with me the White Paper—57 pages and only three references to the market, all of them to the social market. He talks about GP commissioning, but not about the hard-line political ideology that underlines these changes. The Bill puts no limit on the use of NHS beds and staff to treat private patients, it puts no limits on big private health care companies undercutting and undermining local hospitals, and it puts at the heart of the new system an economic regulator charged not with improving services but with guaranteeing and enforcing competition. Is this NHS reorganisation not like an iceberg, with the substantial ideological bulk being kept out of the public’s sight?

[Mr Lansley]

The shadow Secretary of State cannot actually criticise what we put forward in the White Paper or the Bill and is resorting to inventing something else and attacking that. Let me tell him that the one thing we will not do with the private sector is rig the market so that private companies get contracts and guaranteed money whether or not they treat patients. We are not going to give them 11% more money than the NHS would get for doing the same work. We will give NHS organisations a proper chance to deliver services for patients.

Swine Flu

Debate between Lord Lansley and John Healey

Monday 10th January 2011 Commons Chamber

[John Healey (Wentworth and Dearne) (Lab) (Urgent Question)]

Thank you, Mr Speaker, for allowing this urgent question to ask the Secretary of State for Health if he will make a statement on the Government’s preparations for and response to the current flu outbreak.

[The Secretary of State for Health (Mr Andrew Lansley)]

Every winter, flu causes illness and distress to many people. It causes serious illness in some cases and, unfortunately, some deaths. I know that each death is a tragedy that will cause distress to family and friends.

The NHS is again well prepared to respond to the pressures that winter brings—it has responded excellently this year. I thank in particular general practitioners, who each year work tirelessly to look after the health of their patients—especially this winter when the weather, as well as flu and other viruses, has presented challenges.

The rate of GP consultations for influenza-like illness is currently 98 per 100,000 people, down from 124 per 100,000. Those figures are lower than the numbers recorded during the pandemic in 2009-10 and below epidemic levels, which are defined as 200 per 100,000 people. The most recent data showed that 783 people were in critical care in England with influenza-like illness.

Where necessary, local NHS organisations have increased their critical care capacity, in part by—regrettably—delaying routine operations that require critical care back-up. That is a normal local NHS operational process; critical care capacity is always able to be flexible according to local need. We have also increased the number of extracorporeal membrane oxygenation beds, for patients with the most severe disease, from five to 22. A seasonal flu vaccine is again available this year. Our surveillance data show that the vaccine is a good match to the strains of flu that are circulating.

GPs in England order seasonal flu vaccine direct from the manufacturers, according to their needs. Vaccine supply is determined in the early part of the year, for autumn delivery. We recently became aware of reports of flu vaccine supply shortages in some areas in England. We are working with the NHS locally to ensure available supplies of surplus vaccine are moved to where they are needed. In addition, the H1N1 monovalent vaccine is now available to GPs for patients who are eligible for the seasonal flu vaccine.

The Government continue to take expert advice from the Joint Committee on Vaccination and Immunisation. Last year, the JCVI advised for the first time that, in addition to usual risk groups, healthy pregnant women should be vaccinated with seasonal flu vaccine. It did not recommend that children under the age of five outside the at-risk groups should be vaccinated. On 30 December, the JCVI assured me that this advice remains appropriate.

The number of deaths in the UK this winter from flu, verified by the Health Protection Agency, currently is 50. The number of deaths from seasonal flu varies each year, with over 10,000 deaths from seasonal flu estimated in the winter of 2008-09.

Antiviral medicines can also help clinical at-risk groups who have been exposed to flu-like illness. We notified clinicians that the use of antiviral medicines in these groups was justified and, at their discretion, with other patients. We have given access to the national antiviral stockpile to support that.

We are making publicly available for the first time a range of winter performance information, published on the Winterwatch section of the Department’s website. I wrote to all Members last week to inform them of the NHS response to flu, and updated them further in a written statement published this morning.

[John Healey]

I thank the Health Secretary for that statement, but the truth is that he has been slow to act at every stage of this outbreak, and that is putting great pressure on the NHS across the country. It is working flat-out in our local hospital in Rotherham. We have had to open extra beds, and since last Tuesday have cancelled all non-urgent surgery. Four of the 50 patients in the UK who have so far died linked to this flu have been in Rotherham, and two were constituents.

The Health Secretary talks about seasonal flu, but we knew this would not be like normal winter flu because we knew swine flu would be dominant, so the central question for the Health Secretary is why he made less preparation for a flu outbreak that was expected to be more serious. Why did he axe the annual autumn advertising campaign to help boost take-up of the flu jab and help the public understand who is at risk and what treatment is available? We know it works, and this was a serious misjudgment.

Why was the Government’s first circular to midwives, urging them to help get pregnant women to take up the flu jab, not sent out until 16 December? Why has there been no move to offer vaccines through antenatal clinics, and why are the Government not publishing details of the numbers of pregnant women who are seriously ill or who have died, as they are with other groups that are most at risk?

With proper planning and preparation, we should not have seen GPs and pharmacies running out of the vaccine in some areas last week, nor should we have seen parents confused about the treatment available for their young children. I hope last week’s figures mean we may be over the worst, but, with 783 people in critical care and a long winter still ahead, what steps will the Health Secretary take if the numbers of ill people continue to rise? Can he now, today, give the House the reassurance he has failed so far to give the public, which is that he really has got a grip on this situation? Finally, when all the bodies he is relying on to sort out this situation will be abolished under his internal organisation, what assurance can he give the public that this will be any better handled in the future?

[Mr Lansley]

I share the right hon. Gentleman’s deep sadness at the deaths in Rotherham and join him in expressing clearly my condolences to the families of his and other Members’ constituents who have died. Regrettably, there will, I fear, be further deaths from flu—that is in the nature of the winter flu season—but I have to explain to him that we are in the midst of a seasonal flu outbreak that has not reached epidemic levels. Neither is it a pandemic, which is clearly a different situation in which a novel virus, to which there is not acquired immunity, is in circulation.

The right hon. Gentleman asked some specific questions. First, on having to cancel operations, I have made it clear that that is, unfortunately, a consequence: if the NHS’s critical care capacity is under pressure, it cannot admit large numbers of patients for elective operations that might require critical care back-up. The seasonal winter flu outbreak has led to an increase in the number of patients with flu in critical care beds, although they still constitute only about one fifth of the total number of critical care beds, and I pay tribute to hospitals across the country that have increased their critical care capacity, particularly in intensive care, to deal with the situation.

We are also providing assistance to the NHS. I am sorry that the right hon. Gentleman did not refer to my important announcement last Tuesday that, because we made savings in the Department of Health’s central budgets, on things such as management consultancy costs and the IT scheme, we have been able to issue this financial year—in other words, starting now—an additional £162 million to primary care trusts throughout England. They will be able to use that money directly with their local authorities to facilitate the discharge of patients. There are currently about 2,500 patients in hospital who could be discharged if the appropriate arrangements were in place. That will accelerate the relationship with social care that we are looking for.

It is pretty rich for the right hon. Gentleman and the Labour party to say that there should not have been any shortages. The number of vaccines supplied to the United Kingdom was determined before the Government took office. It was determined under the previous Administration, in the early part of last year, not by this Administration. Furthermore, it was equally not just presumptuous but unhelpful for him, during the Christmas period, to talk inaccurately about whether children under the age of five should be vaccinated. He knows perfectly well that like his predecessors we take advice from the Joint Committee on Vaccination and Immunisation. With the chief medical officer, we asked the committee to look at the issue again, and it met on 30 December and reiterated its advice that young children should not be vaccinated. So for him to stimulate press reports suggesting that parents should have their children vaccinated, when the expert advice was not that that should be done, was deeply unhelpful.

The right hon. Gentleman’s final point was about the organisations. It is clear to me that, by abolishing the Health Protection Agency and bringing its responsibilities inside the Department of Health under the new Public Health England, we will have a more integrated and more effective system for responding to seasonal flu in future years.

Oral Answers to Questions

Debate between Lord Lansley and John Healey

Tuesday 7th December 2010 Commons Chamber

[John Healey (Wentworth and Dearne) (Lab)]

May I welcome the Secretary of State’s sensible rethink and change of mind on the funding of specialist children’s hospitals after Labour Members raised concerns during the previous Health questions? During those questions he also got his NHS funding figures in a twist, so what has he got to say about the updated inflation forecasts on page 83 of last week’s Office for Budget Responsibility report? They show that for the next four years the inflation increase will be bigger than the cash increase in the NHS—in other words, the NHS will get a real cut in funding, not a real increase. Does he accept the OBR figures? Does he accept that they are hard proof that the Government are breaking their promise to protect NHS funding?

[Mr Lansley]

Let me tell the right hon. Gentleman that it is not a change on specialist children’s hospitals. The previous Government initiated a study by York university, which reported. I made it clear, when we discussed it last, that we were examining the results of that together with the specialist children’s hospitals. We have reached what I regard, as I hope they do, as a very acceptable outcome.

The spending review gave a real-terms increase in NHS funding. That was the commitment we gave and it was set out in the spending review, and it remains true that revenue funding for the NHS continues to rise in real terms.

[John Healey]

Perhaps I should have asked the Secretary of State whether he has even seen the OBR report. Let me try to help him. The OBR’s inflation figures mean that the NHS will not get the 0.4% real increase that he bragged about and that was stated in the spending review; the NHS will get a 0.25% decrease—a cut—in funding, as has been confirmed today for me by the House of Commons Library. No wonder the Prime Minister is rattled and is asking what on earth the Health Secretary is doing with the NHS. Does the Health Secretary accept that this confirms that the coalition’s pledge to guarantee that health spending rises

“in real terms in each year of the Parliament”

is being broken? How does he explain that to the Prime Minister and how does he explain it to the public?

[Mr Lansley]

No, I do not accept that for a minute. At the spending review we set out what met our commitment. I am very clear that, as I just told the right hon. Gentleman, revenue funding for the NHS will increase in real terms. It will do so because we did not listen to the advice of the Labour party in the run-up to the spending review, which was to cut the NHS budget. We did not do that and we were committed at the spending review to an increase in real terms. The gross domestic product deflator will move from time to time, but the commitment that we set out was clear and will continue.

Public Health White Paper

Debate between Lord Lansley and John Healey

Tuesday 30th November 2010 Commons Chamber

[The Secretary of State for Health (Mr Andrew Lansley)]

With permission, Mr Speaker, I would like to make a statement on public health. Today, the Government have published a public health White Paper with two clear aims: first, to protect and improve the health of the nation; and secondly, to reduce health inequalities by improving the health of the poorest fastest.

The need for this White Paper is beyond question. Britain currently has among the highest rates of obesity and sexually transmitted infections in Europe. Smoking still claims 80,000 lives a year. Alcohol-related admissions to hospital have doubled in the last seven years. In recent years, inequalities in health have widened, rather than narrowed.

Professor Sir Michael Marmot’s review to my Department said that

“dramatic health inequalities are still a dominant feature of health...across all regions.”

There is a seven-year gap in life expectancy between the richest and poorest neighbourhoods, but a gap of nearly 17 years for disability-free life expectancy. About a third of all cases of circulatory disease, half of all cases of vascular dementia and many cancers could be avoided by reducing smoking, improving diet and increasing physical activity.

We need to do better, and we will not make progress if public health continues to be seen just in terms of NHS provision and state interventions. Two thirds of our potential impact on life expectancy depends on issues outside health care. Factors such as employment, education, environment and equality are all determinants of health. They are, as Michael Marmot put it,

“the causes of the causes”—

the underlying factors leading to poorer health. Unhealthy behaviours, such as drinking too much, smoking or taking drugs, are part of a complex chain of individual circumstances and social causes, typically rooted in poor aspiration, adverse peer pressure and low self-esteem.

The human cost of poor health is obvious, and so too is the financial one. Alcohol abuse costs an extra £2.7 billion and obesity an extra £4.2 billion each year to the NHS alone. Although there are things we can do to help, we cannot resolve all the difficult issues from Whitehall. Hence the White Paper has one clear message above all others: it is time for politicians to stop telling people to make healthy choices, and start helping them to do it. There will be a profound shift in tone, attitude and outlook. Rather than nannying people, we will nudge them by working with industry to make healthy lifestyles easier; rather than lecturing people about their habits, we will give them the support they need to make their own choices; and rather than dictating policies from the centre, we will support leadership from communities, by giving local authorities more power to develop the right approaches for their communities.

The White Paper is a genuine cross-Government strategy. Through the Cabinet Sub-Committee on Public Health, we will put good health and well-being at the heart of all our policies. To do so, we will recognise that we need to provide support at key times in people’s lives. We will not only measure general well-being; we will seek to achieve it. For instance, because we know a mother’s health is key to a child’s health and development, we are investing in 4,200 more health visitors working with Sure Start children’s centres to give families the support they need; because we know those who are unemployed for long periods are more likely to be admitted to hospital and more likely to die prematurely, we are transforming the welfare system, ending the benefits trap and making sure that work always pays, through a single universal credit; and because we know more people would cycle to work or school more often if there were safer routes for them to use, the Government are investing £560 million in sustainable transport.

Subject to parliamentary approval, there will be a new dedicated public health service—Public Health England—which will provide the resources, the ideas, the evidence and the funding to support local strategies. Public Health England will bring together, within the Department of Health, expertise from a range of public health bodies, including the Health Protection Agency, the National Treatment Agency for Substance Misuse and the chief medical officer’s department. It will work with industry and other Government Departments to shape the wider environment as it affects our health. It will also develop health protection plans and screening programmes to protect people from health risks.

The foundations of good health are rooted in the community, often at a neighbourhood level, so we must strengthen and renew local leadership to ensure that these efforts reach deeply into communities and match their unique circumstances. Under the White Paper, the lead responsibility for improving health will pass to local government for the first time in 40 years. We intend to give local authorities new powers to plan, co-ordinate and deliver local strategies with the NHS and other partners, and to embed the foundations of good health in ways that fit local circumstances. Directors of public health will provide strong and consistent leadership within local councils. We also intend to establish the new local statutory health and well-being boards as a way of bringing together the NHS and local government.

Whereas before, public health budgets were constantly raided by other parts of the NHS, we will prioritise public health spending through a new ring-fenced budget. We will look to the highest standards of evidence and evaluation to ensure this money is spent wisely. The new outcomes framework for public health, on which we will consult shortly, will provide consistent measures to judge progress on key elements across all parts of the system—national and local. The framework will emphasise the need to reduce health inequalities, and will be supported by a new health premium, incentivising councils that demonstrate progress in improving the health of their populations and so reducing health inequalities.

We have learned over the last decade that state interventions alone cannot achieve success. We need a new sense of collective endeavour—a partnership between communities, businesses and individuals that transforms not only the way we deliver public health, but the way we think about it. Through the public health responsibility deal, the Government will work with industry to help people make informed decisions about their diet and lifestyle, to improve the environment for health, and to make healthy choices easier. Through greater use of voluntary and community organisations, we will reach out to families and individuals, and develop new ways to target the foundations of good health. Reflecting the framework in the ladder of interventions developed by the Nuffield Council on Bioethics, we will adopt voluntary and less intrusive approaches, so that we can make more progress more quickly and resort to regulation only where we cannot make progress in partnership.

This is a time when the NHS and social care are under intense pressure from an ageing population and higher costs—a time when we must therefore put as much emphasis on preventing illness as we do on treating it. In the past, public health has been a fragmented and forgotten branch of the health service. This White Paper will make it a central part of everything that we do, and we will bring forward legislation in the new year to enact these changes. By empowering local authorities, strengthening our knowledge of what works, and establishing the right incentives to drive better outcomes, this White Paper will deliver the strategy and support needed to reduce health inequalities and improve the nation’s health. I commend this statement to the House.

[John Healey (Wentworth and Dearne) (Lab)]

I thank the Secretary of State for advance sight of his oral statement. I am sure that the House will also thank him for the advance copies of the White Paper, which were available before he made his statement.

On Sunday the Health Secretary promised a White Paper that would

“take a radical new approach to public health”.

Today he has published the White Paper, and it falls far short of his hype. He has had six years in opposition and six months in government to prepare for this White Paper, but it will disappoint many of those who are most committed to better public health in this country and most concerned that we still have a great deal further to go. For the most part, this White Paper is not new. It is not clear how it will help to improve public health, and it is not a guarantee that the big gains made in the last decade—in cancer screening, healthy food in schools, stopping smoking and free flu vaccines, as well as the big cut in deaths from heart disease—will be continued.

However, in the spirit of responsible opposition, let me tell the Health Secretary that we can offer general support for his aims, which are very similar to those that we set out in our White Paper in 2004. I can promise him close scrutiny of his actions and those of his Government, because as the White Paper says, good public health depends on much more than what the NHS does. As he said in his statement, education, employment, environment and equality are the causes of the causes of poor health. However, the Government’s wider policies, which will lead to higher unemployment, poorer housing, greater poverty and an end to the Sport for All programme in schools, will do more damage to public health than his White Paper will do good, and more to increase health inequalities than his plan will do to reduce them.

So what did the Health Secretary say to the Chancellor about policies that will see a third of a million public sector staff on the dole? How hard has he argued against the Education Secretary’s plan to axe the school sports partnerships, which have seen three times as many children playing competitive sport than six years ago, and nine out of 10 children playing more than two hours of sport each week? Why is it that everyone else in the Government is set to make announcements affecting public health—on alcohol taxation or pricing, for example —except the Health Secretary? Far from being, as he said, a genuine cross-Government strategy, the White Paper—like his last one, on NHS reform—shows that this a Health Secretary working alone and operating largely in isolation from the rest of Government.

There is nothing new in “nudge”, except the soundbite and how hard the Secretary of State is pushing it. We set out the importance of individual decisions and incentives, alongside the need for support services and Government action, in our White Paper on public health in 2004. The test for the Health Secretary is whether the Government will act when they can and when they are needed, especially to protect children. The legislation is in place to end point-of-sale displays of cigarettes. The evidence is there and the experts are clear. Cancer Research UK says that

“we need to put tobacco out of sight and out of mind to protect all young people. The Government has the opportunity to act with conviction and reduce the devastating impact that tobacco has on so many lives.”

Will the Secretary of State do that: yes or no?

There is little new in this White Paper, and little is clear about how its plans will improve health and reduce health inequalities. It is 96 pages long but short on detail. We welcome in principle the lead responsibility for improving health being passed to local government, but can the Secretary of State guarantee the powers and the funds that it will need to do the job? Will he confirm that public health outcomes will also be part of the operating frameworks for the NHS and social care, because it would be a disaster if the NHS were now to decide that public health was not its job?

We are concerned about the Secretary of State’s responsibility deals. What exactly does he mean by that? What influence will industry have over future health policy? What does he say to the Liverpool health expert and Tory adviser, Professor Simon Capewell, who said that health experts on the public health commission

“were outnumbered and outvoted by people from Tesco, Diageo, and other food and drink manufacturers—and the Commission went with what the industry wanted…which is a scandal”?

What does he say when one of his own advisers offers that view?

We welcome the health inclusion board and the new national public health service, although we thought that this Government were committed to cutting, not creating, quangos. But is not the fact that the inclusion board will tackle the health needs of groups such as homeless people, drug users, alcoholics and sex workers an admission that GPs on their own do not know, and will not commission, what they need for the future?

Is not this one of the first in a series of bodges that will be needed to make the Secretary of State’s massive reorganisation plans for the NHS actually work? Whatever he says, we and the public will judge him on what he does. Will he ensure that his £3 billion internal reorganisation of the NHS does not damage public health? Will he take tough decisions about Government action on tobacco? Will he make and win the big arguments in government about the damage to health that comes from no work, poor housing and bad education? In government, it is deeds that count, not words.

NHS Reorganisation

Debate between Lord Lansley and John Healey

Wednesday 17th November 2010 Commons Chamber

[John Healey (Wentworth and Dearne) (Lab)]

I beg to move,

That this House believes that the Government is pursuing a reform agenda in health that represents an ideological gamble with successful services and has failed to honour the pledges made in the Coalition Agreement to provide real-terms increases each year to health funding; further believes that the Government is failing to honour its pledge in the Coalition Agreement by forcing the NHS in England through a high-cost, high-risk internal reorganisation as set out in the health White Paper; is concerned that the combination of a real cut to funding for NHS healthcare and the £3 billion reorganisation planned by the Secretary of State for Health will put the NHS under great pressure and that services to patients will suffer; supports the aims of increasing clinician involvement and improving patient care, but is concerned that the Government’s plans will lead to a less consistent, reliable and responsive health service for patients which is also more inefficient, secretive and fragmented; and calls on the Secretary of State for Health to listen to the warnings from patients’ groups, health professionals and NHS experts and to rethink and put the White Paper reforms on hold, so that in this period of financial constraint the efforts of all in the NHS can be dedicated to improving patient care and making sound efficiency savings that are reused for frontline NHS services.

The motion is set in similar terms to the motion standing in the name of my right hon. Friend the Member for Leigh (Andy Burnham), the shadow Education Secretary, which we will debate a little later. That is because in both health and education we are seeing many of the same broken funding promises, much of the same free market ideology, many of the same problems of big changes forced through without considering or caring about the consequences, and many of the same risks that the poorest and most vulnerable will lose out and that comprehensive, consistent public services will be broken up. Beyond the spending cuts, we are starting to see the pattern of what public service reform means in Tory terms.

The Prime Minister told Britain before the election:

“We are the only party committed to protecting NHS spending.”

In his coalition agreement with the Deputy Prime Minister, he went further, saying:

“We will guarantee that health spending increases in real terms in each year of…Parliament”.

The Government whom the Prime Minister leads are now breaking the promises that he made to the British people. The Secretary of State has been caught out double-counting £1 billion in the spending review as both money for the NHS and money to paper over the cracks in social care. Let me quote from a Library research paper, which confirms:

“Including the (social care) funding is critical to the description of the settlement as a ‘real terms increase’; without it, funding for the NHS falls by £500 million—0.54% in real terms.”

There we have it—the facts in the figures. There is no real-terms rise in NHS funding, but a real-terms cut over this Parliament by this Government—[Interruption.]

The Secretary of State says “Nonsense” from a sedentary position. If he wants to deny the figures in the Green Book, deny the report in the Library research paper, and take issue with the Nuffield Trust, who all say the same, he should do so. He should by all means take credit for funding social care, but he should not double-count the credit by including it for both NHS funding and social care funding.

[The Secretary of State for Health (Mr Andrew Lansley)]

I do indeed deny that. It is very simple. The total NHS budget will rise in real terms. Resource funding will rise by 1.3% in real terms over four years. Even if the money to be transferred to local authorities were taken out, that is an increase in resource funding for the NHS in real terms.

The right hon. Gentleman must consider that if a health service buys rehabilitation for patients returning home after being in hospital so that they do not need another emergency hospital admission, or puts telehealth in someone’s home so that their independence at home is maintained, that is health spending. It is the normal approach of the NHS to providing preventive services.

[John Healey]

There is a good case for more funding in social care, but the truth is, as Age UK says, that in this Parliament it will be cut by an average of 7% in real terms. Social care may help the health service, but if money is spent on social care, it is not spent on NHS services, and it cannot be double-counted as NHS funding. When that is taken into account, and when the Secretary of State stops fiddling the figures, we see that the country and the NHS will get a real-terms cut, not a real-terms rise during this Parliament.

[Mr Lansley]

I have a simple question for the right hon. Gentleman. Is he in favour of the budget that we announced for the NHS, and does he wish to spend more or less?

[John Healey]

My right hon. Friend the shadow Chancellor said in response to the Chancellor’s spending review:

“We support moves to ring-fence the”

NHS

“budget”.—[Official Report, 20 October 2010; Vol. 516, c. 968.]

People saw Labour’s big investment in the NHS bring big improvements—50,000 extra doctors, 98,000 more nurses, deaths from cancer and heart disease at an all-time recorded low, the number of patients waiting more than six months for operations in hospital down from more than 250,000 in 1997 to just 28 in February this year, and more than nine in 10 patients rating their experience of hospital care as good, very good or excellent.

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[John Healey]

The hon. Lady is right, and there is plenty of scope to do that. We recognised that, and we had plans to take out many of the managerial costs. I will come to that later, but it is hard to understand how creating three or even four times as many GP consortiums doing the same job as primary care trusts is likely to reduce rather than increase bureaucracy in the NHS. My right hon. Friend the Member for Leigh says that in Wigan there is one PCT, but it is set to have six GP consortiums. The same job will be done six times over in the same area. How is that a cut, or an improvement in the bureaucratic overheads and costs of the NHS?

In the spending review, the NHS is set for the biggest efficiency squeeze ever. On 12 October, the NHS chief executive, David Nicholson, told the Health Committee:

“It is huge. You don’t need me to tell you that it has never been done before in the NHS context and we don’t think, when you look at health systems across the world, that anyone has quite done it on this scale before.”

Money is tight, and something must happen, but that can be done by building on Labour’s big improvements in the NHS over the last decade. It will be tough, but I will back the Government, as long as all savings are reused for better front-line services to patients.

[Mr Lansley]

Before the right hon. Gentleman continues, may I remind him that the “it” that Sir David Nicholson was talking about was the achievement of between £15 billion and £20 billion of efficiency savings, which is a substantial improvement in productivity that is expected over the next four years? That is in complete contrast with a Labour Government who had declining productivity over the whole of the last decade. The efficiency savings of £15 billion to £20 billion that Sir David was talking about were set out by the last Labour Government in late 2009. We are continuing with that, but we will make it happen, and Labour did not.

[John Healey]

I have read David Nicholson’s transcripts, and he was indeed talking about £15 billion to £20 billion of efficiency savings, which were not achieved, as the Secretary of State said, but planned. That is a big test for the NHS, and it will be more difficult because of his plans for reorganisation, which I will come to.

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[John Healey]

This is precisely why those who understand the health service, including those who run it, say that it is going to be so hard, at a time when the NHS has never faced such a tough financial challenge, to see through the biggest reorganisation in its history at breakneck speed.

Whether on funding, reorganisation or the role of the PCTs, the Secretary of State is doing precisely the opposite of what was set out in the coalition agreement. He is running a rogue Department with a freelance policy franchise, in isolation from his Government colleagues. He claimed on the “Today” programme yesterday that he had been saying all this for four years before the election. So when did he tell people, and when did he tell the Prime Minister, that GPs will be given £80 billion of taxpayers’ money—twice the budget of the Ministry of Defence—to spend? When did he tell people that, in place of 150 primary care trusts, there could be up to three times as many GP consortiums doing the same job? When did he tell people that GP consortiums will make decisions in secret and file accounts to the Government only at the end of the year?

When did the Secretary of State tell people, and the Prime Minister, that nurses, hospital consultants, midwives, physiotherapists and other NHS professionals will all be cut out of care commissioning decisions completely? And when did he tell the Prime Minister that hospitals will be allowed to go bust before being broken up, if a buyer can be found for them? When did he tell people that NHS patients will wait longer, while hospitals profit from no limit on their use of NHS beds and NHS staff for private patients? When did he tell people that lowest price will beat best care, because GPs will be forced to use any willing provider? When did he tell people that essential NHS services will be protected only by a competition regulator, similar to those for gas, water and electricity? And when did he say that he was creating a national health service that opens the door for big private health care companies to move in?

[Mr Lansley]

I am grateful to the right hon. Gentleman, who is generous in giving way. It is never an ideal thing to quote yourself, but let me risk doing so:

“We have been clear about the need for improvement in the NHS: responsive to patient choice; where budgets are in the hands of GPs; where hospitals are set free; where professionals are released from targets and bureaucracy; where the independent sector has a right to supply to the NHS; where competition delivers efficiency; and where patients have the assurance that NHS standards of care are based on the founding principle of the NHS—free at the point of use and not based on the ability to pay.”

I said that in a letter to The Daily Telegraph on 10 March 2006—four years ago.

[John Healey]

The real question is why the right hon. Gentleman, if he had these plans, did not tell the Prime Minister and the Deputy Prime Minister when they were writing the coalition agreement what he wanted to do on funding, on reorganisation and on the role of primary care trusts. Why did he allow his Government to make these pledges to the British public in May and then break their promises two months later in the White Paper? Whatever the boss of Tribal health care says about the private health care companies, he described the White Paper as

“the denationalisation of healthcare services”.

He went on to say that

“this white paper could result in the biggest transfer of employment out of the public sector since the significant reforms seen in the 1980s.”

This is not what people expected when they heard the Prime Minister tell the Conservative conference last month that the NHS would be protected.

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[John Healey]

If the Secretary of State—who, I concede, has a six-and-a-half-year head start on me in this job—really cared about NHS patients, really cared about NHS staff and really cared about NHS services, he would not be putting the NHS through the biggest reorganisation in its history, especially at this time. As I said earlier, it is patients groups and bodies representing NHS staff who are saying, “Slow down—think again.” I urge the Secretary of State to do that today, and to rethink.

[Mr Lansley]

The right hon. Gentleman has just taken to heart the old saying that the job of the Opposition is to oppose. That is all he is doing: he is simply opposing. Nothing in his motion states positively what should be done, whether that is supporting NHS staff or listening to patients and giving them the shared decision making opportunity that is so essential. While opposing the reforms that we in the coalition Government are introducing, he seems to have ignored the simple fact that those reforms, in truth, represent the coherent consistent working out, in practice, of policies that were initiated, but never properly implemented, by the Government of whom he was a member. They are not revolutionary, as he has called them.

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[Mr Lansley]

I explained to the right hon. Gentleman at Health questions just a fortnight ago that we are in discussions with the specialist children’s hospitals. They are very clear that they are engaging constructively with the Department, with the intention that the payments through the tariff should accurately reflect the costs incurred in providing specialist services. That is the current situation, and no decision has yet been made.

I was talking about the principles of the White Paper.

[John Healey]

Will the Secretary of State give way?

[Mr Lansley]

In a moment; the right hon. Gentleman must allow me to make some progress.

I was talking about the principles of the White Paper. They are very clear. First, patients should be at the heart of the new national service, with a simple principle of “No decision about me without me” transforming the relationship between citizen and service.

Secondly, we will focus on outcomes, not processes. We will focus on outcomes that capture the entirety of patient care, and quality standards and indicators that genuinely reflect what a high-quality service should actually deliver. We will orientate the NHS towards focusing on what really matters to patients, not narrow processes. Thirdly, we will empower clinicians, freeing them from bureaucracy and centralised top-down controls, so that change is genuinely driven from the grass roots, rather than driven, top-down, from above.

The right hon. Gentleman’s speech did not appear to recognise that central principle at all when he talked about people in the NHS Confederation and the managers who run the NHS. Clinicians are already the people who actually do the commissioning: general practitioners make the referrals and write the prescriptions, and consultants in hospitals make referrals from one consultant to another. In effect, cost and commissioning in the NHS is already controlled by clinicians, but they are divorced from the processes of combining the management of patient care with the management of resources. Whether in this country or in others around the world, it is perfectly clear that that divide is what breaks health care systems. What makes health care systems more effective is bringing together the management of patient care with the management of commissioning and resources on behalf of patients.

[John Healey]

I wanted to intervene to discuss what my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) said about Great Ormond Street hospital. I have the official record of what was said at Health questions, to which the Secretary of State referred. He said that the proposal would have

“the overall effect of reducing Great Ormond Street’s total income by less than 2%.”—[Official Report, 2 November 2010; Vol. 517, c. 754.]

How does he reconcile that with the trust’s figures, which say that the reduction will not be less than 2%, but will be more than 5.5%? Would he like, therefore, to correct the official record now? Will he also publish the figures so that this House and Members who represent these areas can make up their own minds about whether those big stealth cuts to the hospitals that treat many of our most critically ill kids are a good idea?

[Mr Lansley]

No, I will not do those things, because what I said was accurate. The specialist children’s hospitals and ourselves are engaged in a constructive process of discussion about the future of the tariff for those hospitals and the top-up. Until a proposal is made there is no purpose in informing the House. We will inform the House as soon as we are in a position to say what the tariff for next year looks like.

Oral Answers to Questions

Debate between Lord Lansley and John Healey

Tuesday 2nd November 2010 Commons Chamber

[Mr Lansley]

The right hon. Gentleman must realise that if we had listened to the Labour party in the comprehensive spending review, we would have cut the NHS budget, but we did not. We resisted the Labour party’s proposal, and resources for the NHS will increase in real terms, but there is then the matter of how those resources should be deployed to best effect. The application of the proposal—we have still to agree with children’s hospitals on how it will be applied—would have the overall effect of reducing Great Ormond Street’s total income by less than 2%.

[John Healey (Wentworth and Dearne) (Lab)]

The Secretary of State’s answer simply will not do. He is in government now, not us. He is making decisions to make deep cuts to our specialist children’s hospitals. He is trying to keep the NHS out of the public spotlight, and we will make sure that the public know what his plans for the NHS are.

I have the Secretary of State’s letter. He has not answered my questions and I ask him again to tell the House why, before today, no Minister has made any statement in public or in the House about these big stealth cuts to our children’s hospitals, and how much each one of the 35 specialist children’s hospitals will lose next year in funding to treat some of the most critically ill children in our country.

[Mr Lansley]

I welcome the right hon. Gentleman to his place. I hope he enjoys being shadow Secretary of State as much as I did, and that he enjoys an even longer tenure. I explained to his right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) the impact on Great Ormond Street. I do not discount its importance to the hospital, and it is being discussed today with specialist children’s hospitals by a group chaired by the national clinical director, but it represents less than 2% of Great Ormond Street’s total income. This is about specialist top-ups to the tariff where the new tariff has been introduced, which in itself makes differences to the income and the accuracy of costs of services provided by those hospitals. It was all set up by the previous Government. They started the review. They published it on 16 December 2009. It was not our doing; it was their doing.

[John Healey]

I thank the right hon. Gentleman for his welcome to me in my job. I have no intention of being in the job for six years, as he was before he came into government. We will have won an election before the end of that period.

Big stealth cuts to our children’s hospitals are not what the public expected to see when they heard the Prime Minister promise to protect the NHS budget. Will the Secretary of State admit that he is double-counting £1 billion a year in the spending review as both money for the NHS and money to paper over the cracks in social care? Will he accept the new House of Commons Library research report, which confirms:

“Including the (social care) funding is critical to the description of the settlement as a ‘real terms increase’; without it, funding for the NHS falls by £500 million—0.54% in real terms.”

When did the Secretary of State tell the Prime Minister that the Government are breaking his promise to protect the NHS budget?

[Mr Lansley]

I am afraid the right hon. Gentleman is wrong about that. Even if we did not treat up to £1 billion to support social care through the NHS as NHS money—we should treat it as NHS money, but even if we did not—there would still be an increase in the resources available to the NHS in real terms each year. It is NHS money. The right hon. Gentleman must accept that this year we are spending £70 million on reablement, which has the effect of mitigating need in social care and reducing emergency readmissions to hospital. We will provide NHS money, which in itself supports health gain and social care support.