National Health Service
Nigel Evans Excerpts(13 years, 1 month ago)
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Rosie Cooper (West Lancashire) (Lab)
I congratulate my right hon. Friend the Member for Leigh (Andy Burnham) on his appointment as shadow Secretary of State for Health, a brief to which he brings valuable experience. We are going to need every bit of that experience, given what the current Secretary of State is doing to bring the NHS to its knees.
I strongly disagree with my colleague on the Health Committee, the hon. Member for Kingswood (Chris Skidmore). This is not their NHS. This is not your or my NHS. It belongs to the people, all of us. We all have an incredible stake in the NHS. The Secretary of State and the Government play with it, with their reputation and with patients’ needs at their peril. I believe your policy will fundamentally damage the NHS—
Mr Deputy Speaker (Mr Nigel Evans)
Order. May I remind the House not to use the word “you”? Members speak through the Chair and should use the third person, please.
Rosie Cooper
Forgive me. I have a great propensity to do that. I believe passionately in the NHS and I take this all very personally. I apologise.
The Government’s policy will fundamentally damage the health service in terms of both the quality of care available to patients and the founding principles of the NHS. The more we debate Government health policy, the less the Secretary of State seems to be listening, whether to Opposition Members, medical professionals, patients, patient groups or constituents.
I might go further and say that I now believe the Secretary of State occupies a parallel universe—a universe where everyone wholeheartedly supports his policy and believes him when he says that there is real-terms growth in NHS spending, a universe where waiting times are not increasing, people are not being refused treatments, bed-blocking is not happening because of pressure on the social care system, a universe where he never discussed the issue of re-banding of nurses with the Royal College of Nursing.
Unfortunately, while the Secretary of State, ably supported by the Prime Minister, is off in that parallel universe, which we shall call delusional, the rest of us are left facing the terrifying reality of what the Government’s policy means to our constituents and to the national health service. We must disregard the rhetoric and the myth-making of the Conservative party as it seeks to demonstrate that it has changed when it comes to the NHS. Sadly for the health service, the Conservatives have not changed at all.
I have spoken repeatedly about the Prime Minister’s clear promises to the British people—one was that there would be no more pointless top-down reorganisation. He even said:
“When your family relies on the NHS all the time—day after day, night after night—you know how precious it is”.
How quickly those words were forgotten. Michael Portillo comments on the BBC’s “This Week” spoke volumes. He could not have made it clearer that the Government meant to misrepresent their position and mislead their voters. He said:
“They did not believe they could win if they told you what they were going to do.”
My fear is that their broken promises are leading us headlong into a broken NHS.
There is much I could say about how disgracefully the Government started to change NHS structures without the consent of the people or the House. Because of those broken promises, a failure to secure a clear mandate for the reforms from the British public, and an abject failure to secure support from the clinicians and the medical profession, we are left in the present mess. I hear time and again that the doctors, the nurses and the professionals are all behind the Government. Where are they? They are shouting loud and clear, “We’re not with you.”
Rosie Cooper
I will not.
The point is that even if the Secretary of State was not aware of the re-banding, as he claims, that speaks volumes about how out of touch he is with the hard-working staff he is supposed to represent. Perhaps he would like to remove himself from his parallel universe—
Stephen Pound
It has been said—not by me, but by some—that the NHS has almost become the national religion. They say that as Christianity has faded, as it has in some places—not in my constituency, and certainly not in my home—the NHS has become more important. The NHS is the perfect example of what Galbraith called the “gift relationship”, when we look out for one another. We should not constantly look for the bottom line, but instead look to be our brothers’ keepers. That is the principle—
Mr Barron
On a point of order, Mr Deputy Speaker. As you know, I took part in this debate and I asked the Minister a question and requested him to answer it in his winding-up speech. Yet he will not even acknowledge that I spoke in the debate. Is there anything you can do, Mr Deputy Speaker, to help Back Benchers keep the Executive in check?
Mr Deputy Speaker (Mr Nigel Evans)
Absolutely nothing. I am sure, however, that the Minister will have heard the point.
Mr Burns
Did I hear the right hon. Gentleman’s point, Mr Deputy Speaker? I heard it about three times in Committee and I heard it on Report; I replied each time, as well as writing to the right hon. Gentleman. He does not like the answer, so there is no point in taking the intervention again.
As I was saying, in Yorkshire and the Humber the ambulance service gives PCTs—[Interruption.] I know I have already said it, but there was so much disruption and noise that Labour Members did not hear it. In Yorkshire and the Humber, the ambulance service gives PCTs a monthly list of their top 10 most frequent callers so that they can talk to them and help them in future, saving money and staff time that can be concentrated elsewhere.
Mr Burns
Just as Labour Members are wrong about NHS funding, they are also wrong about the Bill. [Interruption.] The Bill focuses on the most important thing for patients—the outcome of the treatment they need either to cure them or to stabilise their long-term conditions. Doctors, nurses and other health care professionals—[Interruption.]
Mr Deputy Speaker (Mr Nigel Evans)
Order. I am finding it difficult to hear the Minister. [Interruption.] Order. He has made it quite clear that he is not giving way.
Health and Social Care (Re-committed) Bill
Nigel Evans Excerpts(13 years, 2 months ago)
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Mr Deputy Speaker (Mr Nigel Evans)
Order. As Members will see, we have only a very short time before I put the Question, so could they please be very pithy and short in their contributions in order to get as many Members in as possible?
Dr Wollaston
I will not, because so many Members are waiting to speak.
There has been real scaremongering about, in particular, the difference between the duty to provide and the duty to secure provision, but I believe that the wording simply reflects the reality. The key issue is the line between the ability to step in if things go wrong, and the very real need for politicians to step back and let clinicians and patients take control.
I shall cut my speech short because I have been asked to be brief, but let me end by saying that, for three clear reasons, I would not be supporting the Bill if I thought that it would lead to the privatisation of the NHS. [Hon. Members: “Have you read it?”] I assure Members that I have read it in great detail.
Let me give those three clear reasons. First, clinicians will be in charge of commissioning. Secondly, the public will be able to see what clinicians are doing. Thirdly, neither clinicians nor the public will allow privatisation to happen. They do not want it to happen, and neither do Members of this House.
PCTs and foundation trusts did not meet in public, but they will do so in future, and it is the public and patients who will ensure that the NHS is safe in the hands of the Conservatives and the Liberal Democrats.
Nicky Morgan
In yesterday’s debate the right hon. Member for Holborn and St Pancras (Frank Dobson) said of the NHS that he believed that in most parts of the country and most of the time it does a good job for people, but I want to see it doing an excellent job for people in all parts of the country all the time, and that is what this Bill will achieve. Having served on the Bill Committee, it is a great sadness to me that that message, and the fact that patients will be at the heart of the NHS, has been lost in the months of scaremongering—a word used by the last speaker—and wrangling by those who have campaigned against it and have obscured all such messages. That has been totally unfair to the patients who rely on the NHS.
I briefly want to make two points. First, Members who served on the Committee will know of my passion for getting the right treatment for mental health patients, and at a meeting of the all-party group on mental health yesterday the Bill was described by GPs as a great opportunity: an opportunity for the integration of primary and secondary care—something they have not had before, and that will now be achieved.
Secondly, as my hon. Friend the Member for Totnes (Dr Wollaston) said, the Bill puts clinicians at the heart of commissioning. When the Bill was recommitted, my researcher said to me, “This Bill is a gift that keeps on giving.” Now it is time for this present to be handed over to the other place, but it needs to reach the statute book and we need to implement it on the ground. I have heard nothing from the Opposition in the past eight months to convince me that this Bill should not receive its Third Reading and get on to the statute book, and I urge all hon. Members to support it.
Mr Deputy Speaker (Mr Nigel Evans)
I am grateful for that short speech. I ask for another short speech from Kevin Barron.
Health and Social Care (Re-committed) Bill
Nigel Evans Excerpts(13 years, 2 months ago)
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Rosie Cooper
The Minister keeps saying no, but the reality is that, as I told the Secretary of State, you may very well be fooling yourselves, but you are not fooling the public, and the Bill was wrong. That was followed by a pause, and when you admitted that you had got various bits of it wrong, you then said—
Mr Deputy Speaker (Mr Nigel Evans)
Order. The hon. Lady must desist from using the word “you”, as it refers to the Chair.
Rosie Cooper
I apologise, Mr Deputy Speaker. Each time I said “you”, I meant the Secretary of State.
The Secretary of State simply threw the Bill at the British public after the Prime Minister had promised that this would not happen. I have been very clear in the speeches I have made so far on the Bill that the only people the Secretary of State is fooling are those in the Tory party. He has made changes to the Bill, but we are now beginning the great mix-up and going back to exactly where we were.
The hon. Member for Boston and Skegness (Mark Simmonds) said that Labour did not want progress and good value, and that the coalition programme was all about ensuring that the NHS survived and getting a good return for the taxpayer. Let me tell him that I am absolutely passionate about the NHS. I expect value for money, cutting-edge treatment, efficiency and the best possible care for everyone in this country. The lives of every taxpayer and every family depend on the care they get from the NHS. Second rate will not do for me at all.
However, I do not believe that throwing a grenade into the NHS systems will achieve that. Even breaking big promises will not achieve that, because that will break the trust. I suggest to the Conservative party that the Great British public gave tentative support during the general election and will now withdraw that support rapidly as the Bill progresses. The Conservatives expect the public to believe that the party that promised no top-down reorganisation and then broke that promise can be trusted when it says that there will be no privatisation of the NHS, yet evidence comes to light via freedom of information requests that that is not the case.
What are patients out there actually experiencing? Again, Conservative Members can fool themselves. When they went to accident and emergency units they saw that the four-hour waiting time was being exceeded, so they abolished it. It is already taking longer to treat fewer people, which does not strike me as particularly efficient or good value for money. It took 13 years of a Labour Government to rebuild the NHS after what the previous Conservative Government did to it. Labour reduced waiting lists from two years to 18 weeks. It has taken the coalition Government less than a year to wreck it all again. Broken promises are leading us to an NHS that is broken again.
Let us look at what is currently happening in the NHS. There are two different processes at work: financial efficiency gains and structural reform. The idea was to ask the system to make efficiency gains of 4% each year for four years. On top of that there is the reorganisation, which a Conservative Member has likened to tossing a grenade into the system. We have had muddle, pause, fog and are now effectively back to where we were some time ago.
The reforms do not address the financial challenges, especially the Nicholson challenge. This is costly—making people redundant, throwing organisations into disarray and telling people, “You don’t have a future, you might have a future,” “Let’s have a cluster, let’s not have a cluster,” “Where are you going to work?”, “It’s all going to disappear by 2013,” “There are no PCTs—well, they’re there really, but clusters will do the work,” “No, we don’t have strategic health authorities—well, okay, we’ll keep four of them.” The Marx brothers would be proud of the stops, turns, U-turns, pauses and muddle that there have been. But the bottom line is that the great British public have to watch those antics and are worried about their health service.
Rosie Cooper
How much? I will give way if the Minister tells me exactly how much it is all going to cost. I shall happily sit down; there you go. [Interruption.]
Mr Deputy Speaker (Mr Nigel Evans)
Order. This is not a conversation but a debate. I do not think that the Minister indicated that he wished to intervene.
Rosie Cooper
Thank you, Mr Deputy Speaker. You will forgive me; my lip reading was obviously slightly wrong. He looked as if he was trying to tell me something, and I hoped that it might be the answer.
In all such situations I always say, “Follow the money.” What is actually going to happen? If this is costing a lot of money—there is a lot of muddle—it has to be really clear that the driver of the reforms cannot be, as the Secretary of State has previously said, the idea that the NHS is unaffordable; we seem to be able to afford a lot of other things. If the reason is not financial efficiency, it has to be purely ideological.
I understand that 85% of respondents to the NHS Confederation survey were very clear: the hardest job that they could have is to deliver both NHS changes and savings simultaneously. That makes it harder for them to deliver objectives for improving efficiency and quality—but that is what I am told that Government Members are all about; the Bill is supposed to improve efficiency and quality.
Who is going to deliver the health care? The Royal College of Nursing suggests that 27,000 front-line jobs, equivalent to nine Alder Hey children’s hospitals, will disappear. I asked the NHS Confederation whether we would see hospital closures, and it is clear that we will; we are seeing that in various reports. The Bill is three times longer than the Act that created the NHS, and it leaves more questions than answers. I say to the Government that if they believe that the great British public will be fooled by any of this, they are sadly wrong.
I do not normally make personal statements about anybody, but Roy Lilley, a former NHS professional, writes a blog in which he refers to the Secretary of State as “LaLa”; I am sure the Secretary of State has seen it. I have been hearing “La la” all afternoon. This is just nonsense. Just because the Secretary of State or the Tory party says that the world is square, that does not mean that it is. They are insulting the public if they think that they will go along with them.
Monitor makes decisions about the future sustainability of individual services and the patterns of local health services under the failure regime. It is unclear how those decisions would be made, and how and to whom Monitor is accountable. Technically it is an independent body and it should be responsible to Parliament and the Secretary of State, but perhaps the Secretary of State will clarify that.
As the economic regulator, Monitor is given a whole series of powers that ultimately focus on enforcing competition in the NHS. There are still fundamental gaps in how that organisation will be held to account. There is a lack of clarity about how health services can engage with and influence the work of Monitor. Having been chair of a foundation trust hospital, albeit only for a month—because I stood for Parliament and had to resign—I can say that Monitor was a law unto itself. And before the Health Committee, Monitor likened the NHS to utility companies, which does not give me any confidence whatever.
I want to talk about Monitor not consulting commissioners on changes to enhance tariff. Private providers can apply to Monitor for an enhanced tariff to preserve the services that they, as private businesses, are providing to the NHS.
Congenital Cardiac Services for Children
Nigel Evans Excerpts(13 years, 5 months ago)
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Mr Deputy Speaker (Mr Nigel Evans)
Order. As hon. Members can see, this is a popular debate. There is, therefore, a six-minute limit on contributions.
Mr Deputy Speaker (Mr Nigel Evans)
Order. To accommodate more Members, I am reducing the time limit to five minutes. I hope that both Front Benchers will take into account the popularity of the debate and the need to get Back Benchers in when they make their contributions.
Mr Andrew Turner (Isle of Wight) (Con)
I shall confine my speech to issues that uniquely affect my constituents. The Safe and Sustainable consultation is fundamentally flawed. Three of the four options envisage the closure of the Southampton centre. Those options are based on wrong assumptions and inaccurate data. Let me set out the background. The consultation document states:
“All options must be able to meet the minimum requirement to collect a child by ambulance…within three hours of being contacted by the referring unit”.
It then examined “detailed access mapping” using train and road journeys—that is important—and considered how existing networks were affected. More options that did not meet the “three hours” criteria were ruled out. Bristol is included in “all viable options” because south-west Cornwall and south Wales are more than three hours away from either Southampton or Birmingham.
Unfortunately, nobody in that expert team seems to have noticed that people cannot travel by train or road from the Isle of Wight. There is a clue in the name: it is an island, separated from the mainland by the Solent. I have said before that the ferries provide lifeline services for my constituents, but in this case that is literal. The error in the data was that because we must cross the Solent by ferry, the island is more than three hours away from either Bristol or London.
In May, that was pointed out to Mr Jeremy Glyde, the programme director of the Safe and Sustainable review. A statement issued on 3 June said that the team
“based retrieval times between the island and the mainland on travel by air. This was an oversight”
because the policy is
“to retrieve children from the Isle of Wight by road and ferry”.
That is very odd, because the consultation document explicitly states:
“Air travel has not been considered because it cannot always be relied upon”.
The statement goes on to say that
“an ambulance must reach the referring hospital within 3 hours, or within 4 hours in ‘remote areas’”.
The conclusion was that
“it is sensible to measure retrieval times to the Isle of Wight against the threshold for ‘remote areas’.”
On remote areas, the consultation document states:
“Removing surgery from some centres could have a disproportionate impact on children in some remote areas because ambulances would not be able to reach the child in three hours or less”—
meaning three hours or less from Southampton in my case.
On 3 June, Mr Glyde did not say why the Isle of Wight suddenly became a “remote area” when previously it was not. I am sure it did not move without me or any of the other 130,000 residents noticing. I asked Mr Glyde to point me to the guidelines that determine when an area is designated as “remote”. He told me that it was a “subjective interpretation” and that the review board recognised that the island,
“by its very nature, is remote from the mainland”.
Of course, that is accurate, but the board should have noticed earlier. After starting the consultation and working on it for years, it suddenly struck the board that there are
“unique factors around retrieval times by ferry”.
My Glyde was very helpful. He explained:
“We have been able to generate potential scenarios that could enable the ambulance to meet the standards”.
They did so not by using the “three hours” standard set out in the consultation, but by deciding that the “four hours” will apply to the newly remote Isle of Wight. It may be possible to generate scenarios in which an ambulance from Bristol or London can get to the island in four hours. I can generate some scenarios in which I become Prime Minister. Neither possibility can be entirely ruled out, but they do not reflect what is likely to happen in real life—[Hon. Members: “No!”]
Putting aside my political future, let us examine some realities. The AA route planner shows that it takes two hours to get to the other side of the Isle of Wight, and an hour at least—
Mr Deputy Speaker (Mr Nigel Evans)
Order. Just to inform the House of the procedure, I will now call the Minister. The recommendation from the Backbench Business Committee is that he speaks for about 15 minutes. However, I should remind the House that if he takes persistent interventions, that will extend the time that he spends on his feet, which will deny other Back Benchers the opportunity of speaking. The shadow Minister will be speaking towards the end of the debate.
Mr Deputy Speaker (Mr Nigel Evans)
Order. I am sure that hon. Members will show time discipline, so that we can get as many of them in as we possibly can.
Mr Deputy Speaker (Mr Nigel Evans)
Order. If hon. Members speak for just under four minutes, everyone will get in.
Damian Hinds (East Hampshire) (Con)
The review document is called “Safe and Sustainable”, and that is absolutely the right title for it. It is worth repeating what has been said by every speaker today, and by the clinical leadership of the review: this is about saving lives, not about saving money. We must bear in mind the link between scale and quality and between quality and safety. The “scale” factor applies to the number of procedures per surgeon per year and to the number of surgeons per unit. The challenge was summed up best by the statement from the Royal College of Surgeons, to which the right hon. Member for Oxford East (Mr Smith) referred, that although the country has the right number of surgeons carrying out these complex operations, they are too thinly spread. Change is clearly needed.
Coincidentally, in the last three weeks my family has had occasion to rely on the paediatric intensive care units and surgery at Southampton General hospital, in the constituency of the hon. Member for Southampton, Test (Dr Whitehead), where we benefited from outstanding care. This was not heart surgery, but the experience gave me plenty of cause to reflect on the value of not just convenience and location but, above all, quality of care. In such circumstances, families will do what they have to do, although it may be very difficult, and they will find a way of securing care of the highest quality. The experience also taught me something about the interconnection between services.
All the criteria set out in the review document have a role to play, but in my view the most important criterion of all must be quality, and I do not think that that comes across as much as it should in the review. How can it, given that the centre that is ranked second out of the 11 in the country for quality appears in only one of the four options? The question also arises, in the context of Southampton General hospital, of whether—given the role of scale and quality—sufficient consideration has been given to the most recent trends since the suspension of paediatric cardiac surgery at the John Radcliffe hospital.
Other factors have also not been given sufficient weight. First, there is the requirement for co-location of paediatric surgery with other essential services for children. Secondly, there is the impact on paediatric intensive care units, paediatric intensive care retrieval, and the other networks mentioned by the right hon. Member for Oxford East. Thirdly, there are the implications for services that provide longer-lasting care for people with cardiac conditions from birth to adulthood.
Our objective must not be to stall or jam the process, because there is a need to reduce the number of centres. We must avoid the politician’s tendency to say that of course we agree with the general principles of the review, except in the particular circumstances that apply to our own constituency. I hope I have not done that, but I do think that Southampton has a particularly strong case based on the excellence of its clinical record. I strongly support the drive for us not to be restricted only to the four options in the review, considering the additional evidence that has come to light during its course.
Andrew Percy (Brigg and Goole) (Con)
Outrageous, Mr Deputy Speaker! But obviously accepted.
I associate myself with many of the comments of my fellow Yorkshire and the Humber MPs, particularly my near neighbour the hon. Member for Scunthorpe (Nic Dakin). I want to mention a couple of issues raised by our local health trust, which is opposing anything other than option D very strongly. Indeed, North Lincolnshire council’s scrutiny committee met to discuss the matter on Tuesday and similarly supports that option, which would help to maintain the Leeds unit. That is not simply because it is our local centre. My constituents have to travel a considerable distance to get to Leeds, as it is not exactly next door. It is okay for some of us, but it is quite some distance for my constituents over in Brigg, in particular.
My constituents accept the regionalisation of health services when it is of proven benefit. That is so in the case of adult cardiac services, which are currently provided in Hull, and the same applies to children’s cardiac services. However, if we are to go down the route of regionalisation and big centres, it seems sensible to put services where the population is rather than try to move the population to where the clinicians are.
I wish to quote a couple of points that my local health trust has made. It has stated:
“Leeds has the largest population centre and therefore it is most sensible to ask fewer patients to travel the least distance”.
As I said earlier, the conclusion of the North Lincolnshire and Goole Hospitals NHS Foundation Trust was that it believed babies, children and families in North Lincolnshire would largely be disadvantaged in their access by the proposed changes.
I am aware of the very short time available, so I cannot say most of what I would have liked to say, but my final point is that under the proposals we could end up in the rather odd situation that some of my constituents could be served by one centre and others by another. Given that they are all in the same health trust area, that could mean different services being provided to different constituents.
Mr Deputy Speaker (Mr Nigel Evans)
To speak for 10 minutes, I call the shadow Minister, Liz Kendall.
Health and Social Care Bill (Programme) (No. 2)
Nigel Evans Excerpts(13 years, 5 months ago)
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David Wright (Telford) (Lab)
On a point of order, Mr Deputy Speaker. Will you find out from the parliamentary authorities whether the monitors are working throughout the parliamentary estate? Only one Liberal Democrat Back Bencher is present, and, given that the Liberal Democrats have laid claim to significant alterations to the Bill, it is very important that they are in the Chamber.
Mr Burns
I beg to move,
That the following provisions shall apply to the Health and Social Care Bill for the purpose of supplementing the Order of 31 January 2011 (Health and Social Care Bill (Programme)):
Re-committal
1. The Bill shall be re-committed to the Public Bill Committee to which it previously stood committed in respect of the following Clauses and Schedules—
(a) in Part 1, Clauses 1 to 6, 9 to 11, 19 to 24, 28 and 29 and Schedules 1 to 3;
(b) in Part 3, Clauses 55, 56, 58, 59, 63 to 75, 100, 101, 112 to 117 and 147 and Schedules 8 and 9;
(c) in Part 4, Clauses 149, 156, 165, 166 and 176;
(d) in Part 5, Clauses 178 to 180 and 189 to 193 and Schedule 15;
(e) in Part 8, Clause 242;
(f) in Part 9, Clause 265;
(g) in Part 11, Clauses 285 and 286;
(h) in Part 12, Clauses 295, 297 and 298.
2. Proceedings in the Public Bill Committee on re-committal shall (so far as not previously concluded) be brought to a conclusion on Thursday 14 July 2011.
3. The Public Bill Committee shall have leave to sit twice on the first day it meets.
Let me say at the outset that, because of the number of Members who wish to speak in the debate, I will take only a small number of interventions and will respond to them briefly.
The vital importance of our national health service cannot be overstated, nor can the Government’s determination to do all in our power to make it as good as it can be for the patients who depend on it by putting patients at the centre of care and putting outcomes first—outcomes such as survival rates, speed of recovery, and the ability to lead a full and independent life. The Health and Social Care Bill represents a bold evolutionary programme of essential modernisation: a programme—[Interruption.]
Mr Deputy Speaker
Order. I know that passions are running high, but it is important that we hear the Minister.
Mr Deputy Speaker
Hold on. Keep calm. I am absolutely certain that the Minister is about to move on to the programme motion.
Mr Burns
If Opposition Members were more interested in listening than in trying to be disruptive, they would discover that after setting the scene I will deal precisely with the recommittal and our reasons for proposing it.
We will replace that culture with a bottom-up culture of clinical leadership and patient choice and an unfaltering focus on improving health outcomes.
While there has always been widespread agreement on the principles of modernisation—a fact that even the shadow Secretary of State now accepts—there have been concerns in some quarters that the Bill could support those principles better.
Kevin Brennan (Cardiff West) (Lab)
On a point of order, Mr Deputy Speaker. Some of us wish to talk about the programme motion that we are supposed to be debating, and indeed to intervene on the Minister if he will give way, as he said that he would at the outset. Can the Minister be persuaded to discuss the motion that is before the House?
Mr Deputy Speaker
Several Members wish to participate in this very short debate. It will last for only an hour, and we are already well into that hour. Will the Minister now refer directly to the programme motion?
Mr Burns
Absolutely, Mr Deputy Speaker.
Given our commitment to, and the paramount importance of, the NHS, we decided to take the unprecedented step of pausing at an appropriate point in the legislative process. The independent Future Forum produced its report. We shall be able to make some changes to our plans that will not require legislation, but a number of changes will need to be scrutinised again by a Committee. All our proposed changes will be subject to further detailed parliamentary scrutiny through a further Committee stage and on Report. We propose—
Mr Deputy Speaker (Mr Nigel Evans)
That is just an extension of the debate. I reiterate that we have only one hour to debate this programme motion, so may we make progress? May I also ask Members to calm down, because I am finding it difficult to listen to the Minister?
Mr Burns
Thank you, Mr Deputy Speaker, and you can rest assured that I am doing my bit. If only Opposition Members would listen, they would get the plot.
As the changes we are making are substantial and significant, we have decided to recommit relevant parts of the Bill to Committee. I can tell the House that we expect to make around 160 amendments to the Bill, which we will table in good time. We will also go further and publish briefing notes to help explain the amendments to parliamentarians and those who follow our proceedings outside.
Ian Lucas (Wrexham) (Lab)
On a point of order, Mr Deputy Speaker. I tabled a named day question to the Minister, of which he is aware, in which he made it very clear that the changes to the Bill that he says relate to the recommendations of the Future Forum were in fact—
Mr Deputy Speaker (Mr Nigel Evans)
Order. Please resume your seat. That is not a matter for the Chair; it is an extension of the debate. Yet again I reiterate that we are now 13 minutes into a one-hour debate and we have yet to hear from the shadow Minister and a number of Back Benchers who wish to participate, so, please, could we restrain bogus points of order—that is No. 1 —and could we also have more quiet?
Mr Burns
As I was saying, although the pause may have ended, we will never stop listening. [Laughter.] That is why a team of top health experts will continue to provide independent advice to the Government. [Interruption.] It is extraordinary, Mr Deputy Speaker, that hon. Members giggle and scream hysterically when they do not like what they hear. What they will not accept is that we did listen through the independent forum—we listened, we strengthened the Bill and they do not like it that more people and more organisations outside the House now believe that the plans that my right hon. Friend the Secretary of State introduced have been strengthened and will meet the needs of a modernised health service. That is the problem. That is why they are behaving in that way.
Of course, we need to give right hon. and hon. Members ample opportunity to examine the amendments in detail, but unnecessary delays will only cause harm for patients and add to the pressure on hospitals and commissioners as they make their modernisation plans. They will prevent clinicians on the ground from making the changes they believe will help to improve and save people’s lives. That is why we can have proper scrutiny through the recommittal of the parts of the Bill we are changing, as outlined in the motion, and I urge my hon. Friends and the House to accept it.
Mr Deputy Speaker (Mr Nigel Evans)
Order. Many Members wish to participate and there is only half an hour left, so long speeches would not be appropriate, to be fair to Back Benchers.
NHS Reorganisation
Nigel Evans Excerpts(13 years, 8 months ago)
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Owen Smith (Pontypridd) (Lab)
On a point of order, Mr Deputy Speaker. You were not in the Chair at the conclusion of the Opposition day debate, but the Minister of State, the hon. Member for Sutton and Cheam (Paul Burstow), used barely half his allotted time in winding up, as he was clearly short of arguments to defend his position on the important subject under discussion. That left many of us who have plenty to say on the subject short of time to speak. Will you work through the usual channels, Mr Deputy Speaker, to make sure that in future either Ministers use all their time or Back Benchers are given more time to speak?
Mr Deputy Speaker (Mr Nigel Evans)
How long the Minister wishes to speak for is not a matter for the Chair. The Minister spoke, the debate came to an end, and a vote was taken.
Children's Heart Surgery (Leeds)
Nigel Evans Excerpts(13 years, 8 months ago)
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Mr Burns
The hon. Gentleman is a very experienced parliamentarian, and I do not say this in any rude way, but he was not present when his right hon. Friend the Member for Leeds Central spoke. That is not a criticism, but I shall make to the hon. Gentleman the same point that I made to his right hon. Friend: the consultation process and review is being carried out not by Ministers and politicians, but by the JCPCT. As we are engaged in the consultation process, it would be inappropriate and wrong of me to pontificate from this Dispatch Box on the merits or demerits of one case or another. I hope that the hon. Gentleman will accept that that is meant to be a helpful reply, even if it is not the answer that he was seeking. [Interruption.] Fair enough. I am not criticising; I just want him to understand the position that I am in, because I do not want—[Interruption.]
Mr Deputy Speaker (Mr Nigel Evans)
Order. We cannot have chit-chat across the Chamber in this way.
Mr Burns
Thank you, Mr Deputy Speaker. [Interruption.] The hon. Gentleman is indeed being nice to me, and I appreciate it.
As I was saying, smaller surgical units often struggle to recruit and retain new surgeons. They also find it difficult to provide a safe service around the clock.
Under the auspices of the review, an expert group has developed a comprehensive set of service standards, taking into account the contributions of parents and professionals. The standards cover the whole of children’s heart services. They also reference other relevant professional standards and guidance, including the co-location of other clinical services that are interdependent with children's heart surgical services, the need for larger surgical teams to be able to provide a 24/7 emergency service, and the development of clinical networks of providers to ensure a coherent service for children and their families. I think that in some ways that picks up on the point made by my hon. Friend the Member for Pudsey. The current centres have been visited and assessed against these standards by an independent expert panel.
I would like to go into a little more detail on a few of these standards to clarify areas which cause particular concern. On the standard on the number of procedures and surgeons, I can assure my hon. Friends and Opposition Members that there is convincing evidence from this country and overseas that larger centres, seeing more cases, are better able to consolidate their expertise and deliver better clinical outcomes. The recommendation on the number of procedures—between 400 and 500 a year—is based on the level of activity needed to provide good-quality care around the clock while enabling ongoing training and mentoring of new surgeons. This recommendation is based on the outcome of international research on minimum numbers of procedures in surgical centres. It has strong professional support in this country, including from the steering group of professional experts that was convened under the auspices of this review. In addition, there is a consensus among professional associations on minimum staffing levels that four surgeons in each centre should avoid the risk of surgeons not being able to maintain and develop their skills.
At this point, I would like to pay tribute to the commitment and dedication by talented NHS staff delivering congenital cardiac services. We have a responsibility to ensure they are supported as well as possible, and that includes ensuring that they do not risk burn-out if left to practise alone. Transforming a service from one that is “adequate” to one that is “optimal” requires sufficient volume, expertise and experience to develop what Sir Bruce Keogh calls “accomplished teams”.
Co-location, which I mentioned earlier, refers to the proximity of other critical services to the children’s heart surgery service. In this context, these services include specialised paediatric surgery; paediatric critical care; paediatric ear, nose and throat; and paediatric anaesthesia. The accepted definition of “co-location”—services either on the same hospital site or on a neighbouring hospital site—and which services should be co-located was set out in the 2008 publication, “Commissioning safe and sustainable specialised paediatric services: a framework of critical inter-dependencies”. This guidance is endorsed by the relevant professional associations, including the Royal College of Paediatrics and Child Health, the Royal College of Surgeons and the Royal College of Physicians. I can assure hon. Members that the safe and sustainable review has correctly applied the accepted definition of “co-location”, as set out in the guidance, as meaning either on the same hospital site or on a neighbouring hospital site.
Health and Social Care Bill
Nigel Evans Excerpts(13 years, 9 months ago)
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John Healey
I am more interested in what we will be facing in future. I am more interested in the claim by the Health Secretary that there will not be, as he describes it, a rigged market in future, but a level playing field for all providers. However, my hon. Friend—[Interruption.] Well, we will see. The hon. Gentleman is a member of the Select Committee on Health, and he follows such matters closely. I urge him to read page 42 onwards of the impact assessment, because there he will see the preparations for being able to pay for the sort of thing that he criticises in the health service.
As the hon. Gentleman gives me this opportunity, let me say to him and his Lib Dem colleagues that what we are facing is clearly Conservative health policy, not coalition health policy, and certainly not Lib Dem health policy. The main evidence of any influence of Lib Dem ideas on health policy in the coalition agreement was the commitment to
“ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust”.
The Bill abolishes PCTs. The Lib Dem policy priority before the election was to ensure that local people had more control over their health services. The Bill places sweeping powers in the hands of a new national quango—the national commissioning board—and a new national economic regulator, which is charged with enforcing competition, to open up all parts of the NHS to private health companies. The Lib Dems’ principal concern was to strengthen local and public accountability of health services, but the Bill seriously restricts openness, scrutiny and accountability to both the public and Parliament. It will lead to an NHS in which “commercial in confidence” is stamped on many of the most important decisions that are taken. I therefore say to the hon. Gentleman and his Lib Dem colleagues: this is not your policy, but it is being done in your name. The public will hold you—
Mr Deputy Speaker (Mr Nigel Evans)
Order. I know that this debate is attracting a lot of emotion and generating a lot of heat, but will Members please try to speak through the Chair? I have been accused by both sides of doing many things in this debate, and I have not done any of them.
John Healey
I accept that correction, Mr Deputy Speaker. Let me put it in these terms. The policy is not Liberal Democrat policy, but it is being done in their name, and the public will hold the Liberal Democrats responsible if they allow the Tories to do this to our NHS.
Mr Deputy Speaker (Mr Nigel Evans)
Order. Because of the popularity of this debate, a six-minute limit on speeches has been introduced, with the usual injury time on two interventions. It is up to you whether you take the full six minutes and whether you take interventions, but, clearly, the more interventions there are and the longer you speak, the fewer people will get in.