Regional Pay (NHS)

Andrew George Excerpts

Wednesday 7th November 2012 Westminster Hall

[Mr Bradshaw]

The tariff is a separate issue, but that was an interesting intervention, because, for the first time, we had a Conservative MP actually speaking out in favour of regional pay in the NHS. That is not Government policy, and in all the correspondence that I have had from Ministers, they have denied that it is. At least the hon. Gentleman is one of the few MPs in the south-west who has the courage to be honest and to say that he supports it. He is almost alone; I have not spoken to a single other Conservative or Liberal Democrat Member of Parliament who supports this policy. I hope, as I said earlier, that those who do not support it will have the courage of their convictions, stand up for the west country for once and vote for the Labour motion in the main Chamber later.

As I was saying, there will be an exodus of staff to other regions and to hospitals in our region that are not part of the cartel. Between May 2010 and 2012, the south-west suffered the biggest reduction—3.54%—in qualified nurses of any region in England, and the situation is set to get worse. However, the impact will be felt not just on the health service. The south-west of England already has the biggest gap of any region in England between housing costs and wages. A reduction in public sector pay in our region of just 1%—of course, the reductions that we are talking about are much bigger—would suck £140 million out of the south-west economy, at a time when we need more, not less, demand in our economy.

I acknowledge, as do the unions and staff organisations, that there may be a case for changes to Agenda for Change. The NHS—this is partly a response to the point made by the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile)—is, after all, having to cope with the huge costs of the Government’s disastrous reorganisation of the health service, combined with its tightest-ever funding. However, the answer is to deal with these issues in national talks, in the usual way, and not to allow these parallel plans to proceed, threatening to derail national discussions and making a sensible agreement at national level less likely.

[Andrew George (St Ives) (LD)]

I would be grateful if the right hon. Gentleman clarified whether he supported the previous Government’s introduction of regional pay in the Courts Service or the freedoms that they gave foundation trusts, which enabled this very cartel to be established?

[Mr Bradshaw]

I am afraid the hon. Gentleman is wrong: the FT legislation allows FTs to pay wages that are as good as, or better than, those under Agenda for Change, so the claim often made by Liberal Democrats, who feel very uncomfortable being part of a Government who support regional pay in the NHS, is wrong. The FT legislation is quite clear: FT hospitals must pay rates as good as or higher than those under Agenda for Change. The hon. Gentleman’s point is completely irrelevant to our discussion.

In their answers to me so far, the current Health Secretary and his predecessor have tried to hide behind the very flexibility argument that the hon. Gentleman has just made—that flexibilities already exist in Agenda for Change—and they have declined to intervene. Yes, there are flexibilities in Agenda for Change to allow for local market conditions, but that is not what we are talking about. What we have here is an explicit—those involved have made it explicit—walking away from Agenda for Change, with the wholesale adoption of a regional and regionally negotiated pay structure, which, incidentally, takes no account of the different market conditions in, say, Cornwall and Wiltshire.

I know, as a former health Minister, that all it would take is a simple word from the Minister here today, and this madness could be stopped. Will she undertake to Members to intervene and make it clear to the 20 trusts involved that the Government do not support regional pay and that they should rejoin the national pay negotiation process under Agenda for Change? If she will not do that, she needs to explain why—and, please, no flannel about the NHS trusts being autonomous. She has been a Parliamentary Private Secretary and then a Minister for long enough to know that all she needs to do is speak to Sir David Nicholson, the chief executive of the NHS, or to the estimable chief executive of the southern region, Sir Ian Carruthers, and they would stop what is happening. If she will not intervene, she also needs to explain why she is prepared to continue to inflict damage on south-west NHS staff morale and destabilise the national pay negotiations.

If what is happening was thought up in the Department as a clever ruse to get the national talks kick-started, or to try to wring more concessions out of the staff side, it has backfired disastrously. There is a sensible way through, which the Minister has the power to achieve: to agree changes to Agenda for Change at the national level. The alternative is continuing uncertainty, long-term damage to staff morale and a wholly irresponsible risk to patient safety and the quality of care in the south-west of England.

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[Andrew George]

It is my understanding that the cartel is not entirely engaging with the unions in the way that the unions believe it should. What powers do the Government have to intervene in the activities of the cartel, within the powers and guidance that were conveyed to them by the previous Government in the regulations?

[Anna Soubry]

I hope to answer those points in my speech, in the time available to me. If I do not, I will of course write to the hon. Gentleman and answer those questions in full.

I want to talk about the financial situation in the national health service. We have already guaranteed the NHS preferential funding for the current spending review, ensuring real-terms growth every year and additional cash of more than £12 billion per annum by 2014, going into 2015. We are driving up £20 billion of quality, innovation, productivity and prevention savings, stripping out bureaucracy, cutting management costs by up to one third and shifting resources to front-line services. To be blunt, we cannot spend more on public expenditure without putting our national financial reputation at risk. We must demonstrate that we have the commitment to ensure that our economy is sustainable.

The south-west consortium faces a stern choice. It can either continue to ignore the problem, and hope that it will go away, or it can face the challenge, share it with its staff and their representatives, and work in partnership to achieve the best outcome for everyone concerned, especially patients. I used to be a shop steward and a member of the National Union of Journalists. I understand and value the role of good partnership working with staff and trade unions. I believe that the south-west consortium is taking a mature approach. It published two discussion documents in August, setting out the scale of the financial and service challenge that it faces. It has not made any decisions. It has produced a paper, setting out a wide range of options for changes to terms and conditions, and how they might help. It has included options affecting all staff, including doctors, so that every opportunity is considered, no stone is left unturned, and there are no sacred cows. I believe that that is a responsible approach.

The consortium reaffirmed its commitment to national terms and conditions and agreed not to put any proposal to its boards until December, allowing reasonable time for the conclusion of national negotiations on a possible agreement to make Agenda for Change changes sustainable. I believe that that, too, is responsible.

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[Anna Soubry]

I agree with my hon. Friend. Monolithic structures would not be welcome. What is welcome is when trusts take a responsible view to ensure that they act in the best interests of their employees and that they have a financially sustainable system. That is in the interests of everyone—staff and patients.

[Andrew George]

Following my intervention on the right hon. Member for Exeter, he responded that the only flexibility is to exceed existing pay and conditions, not to go below them. Is that also the Minister’s understanding?

[Anna Soubry]

My understanding is that foundation trusts—the hospitals—have powers and a great deal of autonomy. That was the system set up and backed throughout by the previous Government, and it continues today. NHS employers are better placed to decide how best to reward and motivate their staff for the benefit of patients. They are better placed to assess whether national terms are fit for purpose or sustainable in the light of local competition, and to assess the options and risks of any recruitment or retention problems that might follow from introducing local pay. Such decisions should not be, in my view, made by Ministers.

Some Members have expressed concern that it is not fair to pay different rates for the same job in different areas, as it could undermine recruitment or morale. I understand and appreciate the arguments advanced by many people and the concerns raised by those on both sides of the House. However, if that was the case, one might have thought that the Labour Government should not have included high-cost area supplements or recruitment and retention premiums when they introduced Agenda for Change in 2004, and that they should not have abolished the right of the Secretary of State to direct foundation trusts in 2003. The Labour party gave those powers to employers, and I make it quite clear that they were right to do so. We now have to trust employers to exercise their judgment wisely and to use the skills and expertise of their non-executive directors to consider what is in the best interests of their patients. We have to recognise that they know what rates of pay are fair and necessary in their local communities.

The Opposition need to allow the system that they created to work, without the political interference and micro-management that typified their term in office. If they want to do something useful, they should encourage the trade unions—those that fund many of their Members of Parliament—to ensure a swift and successful conclusion to national negotiations. That will secure the Agenda for Change as a sustainable option for employers and staff alike. Above all, it will put patients first and foremost.

Regional Pay (NHS)

Andrew George Excerpts

Wednesday 7th November 2012 Commons Chamber

[Andy Burnham]

No, I will make some progress.

Breaking national pay is what the Government want to do, and that springs from an entirely different philosophy from the one that forged the NHS in the first place. The Government are rejecting the “one NHS” approach, whereby hospitals collaborate and the unpredictable pressures of any health service are balanced across the system. Instead, they have a vision of hospitals as stand-alone small businesses, on their own in the marketplace, with no bail-outs and free to earn up to 49% of their income from the treatment of private patients, but—as we are seeing in south-east London—finding little mercy in a private-sector-style administration process if the sums do not add up. That is a very different vision of the NHS, and it is not one to which the British people have ever given their consent in a general election.

[Andrew George (St Ives) (LD)]

I will join the right hon. Gentleman in the Lobbies on one reasonable condition: he acknowledges that the last Labour Government did not just introduce regional pay in the Courts Service, but introduced flexibilities for foundation trusts which, through employment law, could result in detriment to NHS employees. If he acknowledges that and apologises for his introductory remarks, I will certainly join him in the Lobbies.

[Andy Burnham]

I partly welcome what the hon. Gentleman has said. I have already acknowledged the flexibilities, and mentioned that only one trust in England ever sought to make use of them, because it wanted to add to the national floor that we had introduced. The flexibilities were there and I support them, but we left office with a national pay system in place. I look forward to his support later this afternoon.

We have a new Secretary of State, but those who expect a change of direction look set to be disappointed. In his first major interview, he described his mission thus:

“I would like to be the person who safeguards Andrew Lansley’s legacy”.

That must qualify as the shortest suicide note in political history. We have Lansley-lite—more of the same—but, in fact, it may be worse.

Looking at the Secretary of State’s past speeches, I could find nothing that conveyed any passion, belief or commitment to the NHS. On the contrary, I was worried when I read that he tried to remove Danny Boyle’s NHS tribute from the opening ceremony of the Olympic games. He is also one of the co-authors of a right-wing pamphlet entitled “Direct Democracy”. He may remember that pamphlet. It said:

“Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of health care in Britain.”

Is that still the Secretary of State’s view? He has gone quiet now, has he not?

You will understand, Mr. Speaker, why NHS supporters get nervous about the intentions of this Secretary of State, but today he has a chance to calm those nerves. He can come to the Dispatch Box and send the clearest of messages to NHS trusts seeking to break from national pay. What he will learn about his job is that, if he says something with sufficient force, the NHS will respond.

The developing pay crisis in the NHS is the Secretary of State’s first real test, but so far he is failing it. As we reveal today, on his watch, the 20 NHS trusts that were threatening to break away in the south-west have become 32 NHS trusts across England. That is creating real worry for thousands of NHS staff and uncertainty for businesses, which have raised their concerns with the Chancellor. But what do we get from the Government today? A “do nothing” amendment expressing no view on the south-west issue, and inviting Government Members to sit on the fence and wait for the conclusions of the pay review body’s review. That will not do.

As the Government do nothing, national pay is being unpicked and the NHS is fragmenting before our eyes, but perhaps that is all part of the plan—it is nothing to do with them; it is all due to a local decision. The idea is to hide behind a review while national pay slowly and conveniently unravels, region by region, trust by trust. Staff facing the threat of a pay cut deserve some straight answers, but rather than getting a straight answer to the question “Does the Secretary of State support regional pay in the NHS or not?”, they are hearing contradictory statements from this shambolic Government. Not for the first time, the coalition is not speaking with one voice. I understand that the Liberal Democrat conference passed a motion opposing regional pay and that the Deputy Prime Minister was captured on film voting for it—although, as we know, being photographed making pledges does not make him more likely to keep them.

The Deputy Prime Minister has also made the following unambiguous statement:

“There is going to be no regional pay system. That is not going to happen.”

The trouble is that it is happening, under the Deputy Prime Minister’s nose and by the back door. Twenty NHS trusts in the south-west are openly defying the authority of the Deputy Prime Minister. Some 88,000 NHS staff are being affected by a unilateral drive to set a new going rate of NHS pay in the regions, which would be up to 15% lower than national “Agenda for Change” rates. The trusts are proposing to end overtime payments for night, weekend and bank holiday working, and to reduce holiday leave. They are also proposing to force staff to work longer shifts, and to cut sick pay rates drastically. That is no idle threat. The silence from Ministers is clearly emboldening them. Despite concerns raised here and elsewhere, they have built a fighting fund, set up a website, and appointed lawyers to make all this happen.

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[Mr Geoffrey Cox (Torridge and West Devon) (Con)]

It is never pleasant not to be in complete concurrence and happy harmony with one’s own Front Bench, but I hope the Minister will not ignore the fact that, despite voicing concern about the Government’s position, I strongly deplore the Labour party’s behaviour in taking a position that can only be described as cynically opportunistic. It is simply untenable for the right hon. Member for Leigh (Andy Burnham) to contend that he can, like Pontius Pilot, take his hands off the situation and wash them clean of what is going on in the NHS in the south-west today.

It is precisely the implementation of the freedoms granted under the right hon. Gentleman’s stewardship that these consortia are operating. He is in exactly the same position as the householder who opens the door to the burglar, and then complains when he walks in and burgles the property. He opened the door with his changes. It was his policy that introduced flexibilities, and to suggest that he was blind to the probability that trusts would exploit it by introducing differentials in pay up and down the length of the country is not merely naive but wilful irresponsibility and will be judged by people listening to this debate. The people in the low-wage areas I have the honour and privilege to represent will not be fooled by the Labour party’s position.

On the other hand, it is perfectly fair to say that the introduction of regional pay in the NHS would be a retrograde and wrong step. The fact is that low-wage areas, such as those I represent, are already suffering: 26% of families and homes in Torridge are on the edge of poverty. Only two constituencies in Cornwall, an area that receives special help in the form of objective 1 money from the EU, are in a worse position than those in Torridge and West Devon.

[Andrew George]

I represent one of those constituencies. In view of the hon. and learned Gentleman’s comments about the right hon. Member for Leigh (Andy Burnham) and his criticism of regional pay—a stand I entirely agree with—would he acknowledge that the Conservatives voted in favour of the legislation that brought in foundation trusts and flexibilities, and does he regret that? I recognise, of course, that he was not in the House at the time.

[Mr Cox]

I do not believe that any party can take its hands off and claim to be not responsible for measures that allowed trusts to exploit the ability to drive down pay by forming such consortia. The Labour party cannot disavow responsibility, and neither, if it voted for it, can the Conservative party.

I want to say something about regional pay. I hope and I am sure that the Minister is listening. I have already written to my right hon. Friend the Secretary of State. In areas such as Torridge and West Devon—areas that depend on public sector pay to create the spending and buying power that puts at least some life into its economy—the concept that pay could be even lower than it is now is unconscionable and inconceivable to those of us who represent them. I hope that the Government will think again in this review. I am comforted by the Secretary of State’s words when he says that they are committed to national pay scales. I hope that those words can be counted on.

I, for one, could not support a measure that introduced regional pay as formal NHS policy, unless I was satisfied that there were sufficient safeguards for the low-wage areas I represent. People often associate rural areas such as Torridge and West Devon with prosperity, but that is a grossly inaccurate caricature. In Torridge, 26% of households are on the edge of poverty, wages are in the bottom 5% of all areas in the country, and West Devon is not far behind. It is simply inconceivable for me, as its representative, to agree to a proposition that would further depress incomes in those areas.

Having said that, it is clear that the NHS has to do something about the pay bill, which is 70% of its budget, and the only appropriate way of dealing with it is for the unions and all parties, including all political parties, to tackle it at a national level. I am disturbed that those national negotiations are apparently not taking place. I hope that the right hon. Member for Leigh will encourage the unions to take part in those discussions, because we all have to accept that there is a major national problem with the burden of the NHS pay bill.

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[Andrew George (St Ives) (LD)]

It is a pleasure to follow the hon. Member for Worsley and Eccles South (Barbara Keeley), a fellow member of the Health Committee. I endorse her comments. She, like many others, has emphasised the reason it is so important that the House rejects the concept of regional pay and urges unions and employers to accelerate the process in order to reach a speedy conclusion on national pay bargaining. This is a serious issue, and it deserves a serious response from all parties in the House. It should not become a subject to be kicked around the playground of an Opposition Day debate in an opportunistic manner, as has so often happened—before the election as well as after it, to be fair. A matter as serious as this should not be debated in that way.

I intervened on the right hon. Member for Leigh (Andy Burnham) to ask whether he would acknowledge that we are where we are today because of the freedoms the previous Government created for the cartel in the south-west, or in any other part of the country. We are aware that other trusts are looking closely at what is happening with that cartel. The previous Government should be applauded for introducing the “Agenda for Change” and attempting to introduce a rigorous and effective method for agreeing pay and conditions at national level, but they also legislated to introduce foundation trusts and the new freedoms that went with them. The Liberal Democrats opposed that legislation at the time.

[Andy Burnham]

rose—

[Andrew George]

I was going to go on to talk about employment law, but I am happy to give way to the right hon. Gentleman.

[Andy Burnham]

This subject has featured a lot in today’s debate. I would encourage the hon. Gentleman to go back to the speeches made by Ministers when that legislation was being introduced. They were clearly saying that there could be occasions when flexibility would be needed at the margins to deal with a particular short-term pressure or problem. Such an arrangement was used once, in respect of Southend, to put pay up. It is important to understand that there was no suggestion that pay could be reduced across the board in a co-ordinated, orchestrated move to undercut the national pay system that was being brought in at the same time. That argument has been put today, but it simply does not hold water.

[Andrew George]

That might have been the stated intention, but the effect is being seen through the cartel’s actions. What is happening is not the result of any coalition Government legislation; it is the result of an opportunity having been made available under employment law. This is not within the parameters of “Agenda for Change”. It is a result of the freedom given to foundation trusts to step outside those agreements and to use employment law to seize the opportunity of certain flexibilities, to the detriment of the employees in their pay. That might not have been the intention behind the legislation, but it has been the effect of it, whether the previous Government appreciated that or not.

If the right hon. Gentleman is really so concerned about this, and given the fact that he can now see the effects of his legislation being played out by the cartel in the south-west, perhaps the shadow Minister, the hon. Member for Copeland (Mr Reed), will acknowledge, in summing up the debate, that that was not the intention behind the legislation. Will he, having noted what is now going on as a result of that legislation, commit to rescinding that element of it if Labour were to come to power, to put right the weaknesses of it? If so, we would know that Labour Members were genuine and sincere in their intent, and that they acknowledged that weakness, which they had not anticipated at the time but which is now being exploited.

I strongly support my hon. Friend the Member for Southport (John Pugh) and congratulate him on his characteristic breathtakingly brilliant contribution to the debate. He was most entertaining, and there was disappointment across the whole House when he resumed his seat without having used all the time available to him. He made many insightful comments about the situation we are in today, and the weaknesses of it.

I also thank my hon. Friend the Member for North Cornwall (Dan Rogerson) for pointing out the significant weaknesses in the legislation and the impact they are likely to have on NHS staff. I am pleased to see my hon. Friend the Member for St Austell and Newquay (Stephen Gilbert) in the Chamber today. We are all aware that the Royal Cornwall Hospitals Trust’s involvement in the cartel is creating deep concern across Cornwall. The hon. Member for Truro and Falmouth (Sarah Newton) made a telling intervention earlier when she said that Cornwall has some of the highest costs of living in the country, while perpetually being at the bottom of the earnings league table, pretty much since records began.

One of the drivers behind the problem is the cherry-picking in the NHS. The private sector is already offering the easiest procedures. A private provider in Cornwall carries out the easiest procedures for the fittest patients with low anaesthetic risk and those who are the least likely to suffer complications following orthopaedic procedures. It is now extending its services into areas such as cardiology, hernias, haemorrhoids and endoscopy. If any complications occur, it will simply pass the patient across to the Royal Cornwall Hospitals Trust to deal with any difficulties or emergencies. It therefore has no need to invest in all the facilities necessary to provide the kind of wrap-around service that we want the NHS to provide. The fact that such private sector companies are able to vary wages, terms and conditions for their staff is undermining the NHS. The foundation trusts are having to compete with those companies, and that is one of the pressures that is driving their agenda. All parties need to recognise that fact, and Ministers need to acknowledge that this continued cherry-picking by the private sector is fundamentally undermining the capacity and ability of the NHS to respond adequately.

We must also ask why we are in this situation in the south-west. In regard to resource allocation, only two years ago Cornwall was getting £56 million a year less than the Government said that it needed to provide the necessary services. If there is a significant gap between the funding actually provided for the local health community and the amount that the Government say is the target funding, it is no wonder that local trusts find themselves having to make extremely challenging decisions.

I urge the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), when he winds up the debate, to acknowledge that resource allocation still needs to be addressed. Members of Parliament from across the south-west and I have arranged to hold a meeting with him on this matter, and I hope that it will take place soon so that we can have an opportunity properly to address the issues.

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[Andrew George]

If the hon. Gentleman really believes that, and the motion does say that the Government should intervene, is he aware that his Government gave foundation trusts such freedoms that in fact the Government cannot intervene?

[Mr Bradshaw]

Of course they can.

[Andrew George]

They cannot.

[Mr Anderson]

Clearly, there are issues about foundation trusts, but the Government can do what they want—or they can as long as the Liberal Democrats help them. Tonight, however, the Liberal Democrats have a chance of stopping the Government doing what they want, by doing what their party wants, and what the people they represent want—by throwing out the proposal, and voting on the clear principle that national pay bargaining should happen in the national health service, and nothing should be done to undermine it, including supporting the amendment.

Oral Answers to Questions

Andrew George Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Mr Jeremy Hunt]

It will be a totally impartial and very thorough review. This is an extremely important decision, and that is why I asked the Independent Reconfiguration Panel to take the time that it needs to do the review properly; that is the least that the hon. Gentleman’s constituents would want.

[Andrew George (St Ives) (LD)]

In order to get the Health and Social Care Act 2012 through this House, the Government gave explicit assurances that private companies could not cherry-pick the easiest procedures and patients, yet a recent letter from David Flory, the deputy chief executive of the NHS, back-pedals on the Government’s position, and shows that the Government are dependent purely on guidance. What can the Government do to put a bit of backbone back into that important policy?

Oral Answers to Questions

Andrew George Excerpts

Tuesday 17th July 2012 Commons Chamber

[Mr Lansley]

I have the benefit of a review undertaken by Sir John Bell and his colleagues, which I accepted wholeheartedly. In particular, I immediately agreed with the recommendations, and we are implementing and funding recommendations for the establishment of centres across the NHS for genetic testing to support stratified medicine for cancer patients.

[Andrew George (St Ives) (LD)]

Further to the Secretary of State’s welcome response to the hon. Member for Bristol East (Kerry McCarthy), and his comments yesterday on the issue of the south-west consortium in relation to pay reductions, will he apply the same attitude to pay and conditions, particularly backward or downward regradings and other detrimental changes to terms and conditions?

National Health Service

Andrew George Excerpts

Monday 16th July 2012 Commons Chamber

[Andy Burnham]

At the heart of the defective legislation that the Government rammed through the House of Commons is an unresolved conflict of interest, in which commissioners can also be providers who can remove services from hospitals and then provide them themselves. Under pressure in the other place, the Government came up with a requirement for a statement of such interests, but without introducing any mechanism for enforcement to ensure that decisions in the NHS are being made for the right reasons. I fear that that conflict of interest will return to haunt the Government.

[Andrew George (St Ives) (LD)]

The right hon. Gentleman knows that I share his critique of the Health and Social Care Act 2012. He mentioned the fact that civil servants had given him warnings and cautioned him about the consequences of his decisions during his time in office. Was he warned about the changes in regulations that have resulted in the decision of the south-west consortium to suggest changes to the terms and conditions and pay of staff in that area? That was a direct result of regulations brought in by his Government.

[Andy Burnham]

No, it was not. Agenda for Change was one of the proudest achievements of our Government, and we always staunchly defended national pay arrangements. The hon. Gentleman talks about warnings, but I have just read out the explicit warning that was given to the current Secretary of State that this was the wrong time to reorganise the NHS. It was unforgivable to proceed in those circumstances. This was the single most reckless gamble ever taken with the NHS, and patients and staff are already proving to be the biggest losers.

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[Andrew George (St Ives) (LD)]

It is a pleasure to follow the hon. Member for Ealing, Southall (Mr Sharma), a fellow member of the Health Committee. He makes a strong case on behalf of his constituents, and one hopes that any reconfiguration will be evidence-based and, above all, based on clinical governance and clinical safety.

This is an important debate—indeed, we cannot debate the future of the NHS enough, because it concerns many Members and their constituents. It draws passion and a great deal of interest, because it affects everyone’s lives. I therefore congratulate the Opposition on giving us the opportunity to debate it this evening.

I apologise to the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), for not having heard his speech. I had to attend an urgent meeting with a Minister to discuss the closure of a Remploy factory in my constituency. My hon. Friend the Member for Southport (John Pugh) gave me a précis of the Minister’s wise remarks as best he could—without, of course, being able to convey fully his panache and oratorical dexterity. I understand that the Minister made a number of important remarks about one issue that I want to discuss, as a Member representing west Cornwall and the Isles of Scilly, which, apart from being the centre of the world, are in the far south-west. That issue is pay and conditions for staff. As I understand it, he emphasised the point that no such independent review of pay, conditions and the salaries of staff in such an area can proceed without the full involvement and support of the unions, and their engagement in the final decisions.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

It is absolutely right that the trade unions should be involved, because this is an enormous issue, particularly for staff morale in the south-west. Does the hon. Gentleman not share my concern that thus far the consortium has shown no great desire to undertake that consultation in the south-west? That really has to change.

[Andrew George]

The hon. Lady makes an important point. Lezli Boswell, the chief executive of the Royal Cornwall Hospitals Trust, wrote to me on behalf of the consortium about concerns that have been raised, including by the unions, saying that once the national pay review has concluded under “Agenda for Change” it would then be appropriate, if it is at all appropriate, for any further local discussions to proceed. Without union involvement in the work of the consortium, I agree with the hon. Lady that the proposal is irrelevant and potentially disruptive and dangerous, given its impact on staff morale throughout the NHS in the south-west. My hon. Friends will be listening closely to this debate, and to the concerns that have been raised by many Members and, indeed, by staff across the south-west about the consequences for staff morale and the impact on NHS services. I certainly hope that the Secretary of State will address those issues when he concludes the debate.

A key issue is one that dare not speak its name—it affected staff morale under the previous Government as well—but it is the increasing pressure on front-line NHS staff. The staffing levels at the coal face have never been sufficient to provide a safe staff to patient ratio. Many people have been critical of nursing and care standards in the NHS, but they often overlook staffing ratios.

I have also expressed concerns about the out-of-hours service in Cornwall—I know that we will not have time to discuss that—and the Care Quality Commission will produce a report as a result of those concerns, which were also voiced by the hon. Member for Truro and Falmouth (Sarah Newton).

On pay for staff in the south-west, the chief executive of the Royal Cornwall Hospitals Trust said to me in a letter:

“In recent years NHS organisations have largely exhausted other avenues of potential cost-saving (including reducing reliance on bank or agency staff and implementing service improvement initiatives). Monitor…has also estimated that NHS organisations with a turnover of around £200m will need to produce savings of around £9m a year for each year until 2016/17 to remain in financial health.”

She goes on to say that the consortium, which consists of 20 organisations in the south-west,

“is looking at how pay costs may be reduced, whilst maintaining a transparent and fair system that is better able to reward high performance, incentivise the workforce and support the continued delivery of high quality healthcare.”

Does the Secretary of State agree with that, and how does he intend that that should proceed? How will he protect staff and staff morale, because the consequences will, I fear, derail national negotiations on “Agenda for Change” and drive down pay and morale, particularly in an area of very low wages? I hope that he is listening.

[Barry Gardiner (Brent North) (Lab)]

rose—

Adult Social Care

Andrew George Excerpts

Monday 16th July 2012 Commons Chamber

[Paul Burstow]

I will come on to give a specific figure in a moment, so the right hon. Gentleman will have to be patient.

I wanted to pick up again on the point about the White Paper ruling out crude contracting by the minute—a culture of clock-watching which has been allowed to grow up for years in too many places and which is not good for dignity, respect or quality. Under the Labour Government there were years and years of delay and dither when it came to addressing the quality of care workers and health care assistants. This Government are putting in place a code of conduct and national minimum training standards, and will double the number of people able to access apprenticeships in the care sector to 100,000.

[Andrew George (St Ives) (LD)]

I am grateful to my hon. Friend for his remarks. I hope I am not taking him back too far, but given that he is talking about the integration of services, particularly among authorities, and implying the portability of assessments for those with care packages, will he comment on the extent to which the Local Government Association has approved and supported the proposals in the Government’s White Paper?

[Paul Burstow]

On the proposals for portability of assessment and guaranteed continuity of care, the LGA is certainly aware and has been engaged in the consultations that we undertook last year as part of our preparations for the White Paper. It did not, of course, negotiate line by line the text of the White Paper, but it has the opportunity, as does everyone else, to participate now in the scrutiny of the draft Bill that we introduced. I hope the LGA will do so. We wish to engage with the LGA on these issues.

Integration is an important part of these reforms. Too often, people feel bounced around the system. What we do for the first time in the White Paper is set out a number of important steps towards more integration of the two existing systems.

NHS Annual Report and Care Objectives

Andrew George Excerpts

Wednesday 4th July 2012 Commons Chamber

[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.

[Andrew George (St Ives) (LD)]

I am pleased and reassured by the comments from the Secretary of State on outcomes, which he said were among the best in the world. In view of that, would he perhaps reconsider whether it is wise to press ahead with such disruptive and damaging reforms?

[Mr Lansley]

One reason why the NHS continues to deliver such significant improvements in performance is that through the transition, we are increasing clinical leadership, which will make an important, positive difference, and can already be shown to have done so. For example, we are managing patients more effectively in the community, and reducing reliance on acute admission to hospital. The number of emergency admissions to hospital in the year just ended went down, which is a strong basis on which to develop services in future, and that is happening not least because of leadership in the primary care community. I hope that my hon. Friend from Cornwall, along with other Members, supports the assumption of clinical leadership through clinical commissioning groups by those clinicians.

Oral Answers to Questions

Andrew George Excerpts

Tuesday 12th June 2012 Commons Chamber

[Mr Lansley]

Clearly, that is a matter for the devolved Administration in Northern Ireland, not for me.

[Andrew George (St Ives) (LD)]

If, as the Secretary of State says, it is not his intention to see pay cut, does he hope that as a result of this measure lower-paid health workers in poor regions will be paid more?

[Mr Lansley]

At the risk of repetition, let me say that in any part of the country NHS organisations, like organisations in other fields, should have the ability to set pay levels that reflect to a greater extent local labour market conditions and their need to recruit and retain staff. My hon. Friend will recall that a number of south-west trusts are looking at going down the path of setting their own pay arrangements. It was in fact the previous Administration who in 2004, under the “Agenda for Change” pay framework, gave trusts and foundation trusts precisely the freedoms that they are proposing to use, so I cannot understand how Labour Members can possibly object to those freedoms now.

Oral Answers to Questions

Andrew George Excerpts

Tuesday 27th March 2012 Commons Chamber

[Paul Burstow]

The Government are committed to extending the range of NICE approved therapies when it comes to access to talking therapies. Certainly, we will look very carefully at how we extend it in the area he has suggested. I will write to him in further detail about this.

[Andrew George (St Ives) (LD)]

What reassurance can the Secretary of State give to Members of Parliament representing areas that have received an allocation from the formula which has been significantly below their target, given the change in arrangements to clinical commissioning groups in future?

[Mr Lansley]

My hon. Friend will be aware that the distance from target on the existing formula for Cornwall in particular has narrowed and is only just over 2%. For the future, I hope that he and all hon. Members will take considerable reassurance from the fact that not only will the formula continue to be the subject of independent advice, but new statutory provisions will set out that it should be intended to reflect the prospective burden of disease in each area, so it should be matched as closely as possible to the need for services in each area.

Health and Social Care Bill

Andrew George Excerpts

Tuesday 20th March 2012 Commons Chamber

[Lilian Greenwood (Nottingham South) (Lab)]

rose—

[Andrew George (St Ives) (LD)]

Will the right hon. Gentleman give way?

[Frank Dobson]

No, I will not give way, even to the hon. Member for St Ives (Andrew George), who has made a very honourable contribution to these debates.

Across the board, we see the Government taking unjustified risks with our national health service. If they are not prepared to disclose to the rest of us what risks they have been advised they are bringing about, they are both cowardly and stupid. I do not think that the people of this country will ever forgive them for their reckless, chancy, dodgy, second-hand-car-salesman approach to the national health service.

--- Later in debate ---

[Mr Dorrell]

It is an interesting debate whether a risk register about a transition related to a policy is advice about policy or advice about management. The issue is that there is doubt. If the Government surrender this line without arguing the case to its conclusion, there is space for doubt about whether these risk registers will remain confidential or whether they will be published. The important principle is certainty.

[Andrew George]

Will my right hon. Friend give way?

[Mr Dorrell]

I will give way to my hon. Friend in a moment.

The important principle—it is always an important principle in the law—is certainty: the certainty that people can be clear whether the advice or the register that is being given to a Minister will remain confidential or whether it will be published. My concern is that this motion is seeking to move that line retrospectively, in a way that two distinguished former heads of the home civil service clearly believe would prejudice the space that the right hon. Member for Wentworth and Dearne said was important.

--- Later in debate ---

[Andrew George]

My right hon. Friend has argued the case on behalf of retired senior civil servants and Government Front Benchers. However, as the Chair of the Select Committee on Health, and therefore as someone who is deeply interested in effective scrutiny, does he not agree that if the Committee, of which I am a member, wishes properly to understand the potential impact of fragmentation, the conflicted nature of clinical commissioning groups, and so on, we need to find a way of getting behind the declaratory reassurances from the Front Bench?

[Mr Dorrell]

Of course I agree with the proposition in the way that my hon. Friend puts it. However, the proposition before the House is a rather more precise one: that a register drawn up in the expectation that it would remain private should retrospectively be put into the public space. The proposition that I am advancing to the House is that that is an area where we should proceed with care. We should embrace the principle that when advice is given to Ministers, it should be clear to those giving it whether it is being given confidentially or whether it will later be given over for publication. That is the simple principle that I wanted to set out.