Transparency of Lobbying, Non-Party Campaigning and Trade Union Administration Bill

Debate between Andrew George and Lord Lansley

Wednesday 22nd January 2014 Commons Chamber

[Mr Lansley]

That is absolutely right. I am sure my right hon. Friend will recall—it has been interesting to have these conversations—that if charities comply with the guidance, called CC9, issued by the Charity Commission, we can be pretty confident, except in very limited circumstances, that they will not fall to be regulated under election law. It could happen if, for example, a charity pursued its purpose in a run-up to an election, received various pledges from various candidates or parties in relation to its objectives and then chose to issue details to the public. That could be held to be seeking to influence electoral outcomes. Frankly, however, our discussions have increasingly demonstrated a mature approach on the part of the charities, many of which have recognised that the Bill was not really about exempting charities and that only in very limited circumstances would charities fall to be regulated. Many charities completely understood and agreed that it was right for those who wished to influence election outcomes to do so openly and transparently. That is what the Bill is all about.

[Andrew George]

The Leader of the House implies that, in accepting all but three of the amendments to part 2, the Government are being generous, yet many of the amendments are, of course, Government amendments. Does the right hon. Gentleman not think that, as well as the charitable sector demonstrating its maturity, the Government might have learned some lessons from this particular process? What are those lessons, and does he not accept that he could have done things better?

[Mr Lansley]

I am sorry, but I think that, in this respect, my hon. Friend has not understood how these issues have often worked. I shall not go through all the amendments in detail, but many of those that he says are coming back to us as Government amendments were tabled as Government amendments on Report in recognition of the character of the preceding debate and consultation in Committee. Members of the House of Lords often raised issues in Committee. My noble Friends Lord Wallace of Tankerness, Lord Wallace of Saltaire and Lord Gardiner did magnificent work in determining where it was appropriate for the Government to make amendments in recognition of the concerns expressed. [Interruption.] I do not think that Opposition Members should sneer at the idea of the Government tabling amendments in the other place in order to bring them back here to meet the concerns, which is nothing other than a proper process of scrutiny.

There are a lot of amendments in the group, so let me set out the Government view of the main ones, starting with those with which we disagree. It is important for Members to understand where the burden of the debate lies.

Lords amendment 108 seeks to exclude staff costs associated with any member of staff of a third party from the calculation of controlled expenditure for transport, press conferences, organised media events, public rallies and public events. When Parliament passed the Political Parties, Elections and Referendums Act 2000, it believed that the inclusion of staff costs was an important element of ensuring a transparent regulatory regime. As Labour Members will recall from their time in government, that Act included staff costs in the calculation of controlled expenditure for non-party campaigners. The decision was taken on the basis that where a third party undertakes other activities besides political campaigning and enters into political campaigning, its spending for those purposes should be fully transparent.

Transparency of Lobbying, Non-Party Campaigning and Trade Union Administration Bill

Debate between Andrew George and Lord Lansley

Tuesday 3rd September 2013 Commons Chamber

[Mr Lansley]

I am not giving way now. This is an important debate to which I know that colleagues want to contribute, and I want to commence by giving them the chance to hear precisely what the Bill does.

We have heard repeated calls from the Opposition and others saying that the register should be expanded to include so-called “in-house” lobbyists, but what is not clear is what problem such an expansion would solve. As I said to the hon. Member for Rhondda, when a lobbyist from Shell or the WWF, to give typical examples, comes to meet Ministers it is quite clear whose interest they are representing, and these meetings are already publicly disclosed—the public can see that they happen. That is unlike what happens with any such meetings with shadow Ministers, as the Opposition have not committed to publish their shadow ministerial diaries.

In a debate some 10 weeks ago, I asked the hon. Member for Hemsworth (Jon Trickett), who is on the Opposition Front Bench, to consider whether Opposition Front Benchers might like to agree now to publish their diaries as part of this process of openness, but I am afraid that they have not agreed to do so. While I am referring to the Opposition, I must say that I am bemused by their suggestions that we should create an unworkable bureaucracy with spiralling administrative costs without a policy rationale. There is some confused thinking there, and they are attempting to jump on a bandwagon without having considered the implications of their policies—policies that were so important to them that the Labour party did not even respond to the public consultation on our proposals last year.

I am therefore proud that the coalition has introduced a Bill to put in place this register, which is a practical step in an area that the Labour party simply put in the “too difficult” box when in government; it failed to do anything in its 13 years in office. Our proposal addresses a specific problem. It is designed to capture professional consultant lobbyists, and that will include multidisciplinary firms that run consultant lobbying operations—a point important to the hon. Member for Huddersfield, who is no longer in his place. There are exclusions, however, for those operating in a representative capacity, such as the vast majority of trade associations and charities.

I believe that the great majority of those in our Parliament and our political system behave well. But, human nature being what it is, the minority tempted to do otherwise need to know that they cannot engage in sustained, concealed efforts to peddle influence. Their activity will be brought into the open and they must expect to be held to account for their behaviour. Sunlight is the best disinfectant.

Let me turn now to the second part of the Bill.

[Andrew George (St Ives) (LD)]

My right hon. Friend said that the previous Government had put this issue in the “too difficult to do” box. A lot of those who, like me, were working in the charitable sector before we came into Parliament understand the distinction between being non-party political as a charity and being able to engage robustly in policy debate. However, if this is in the “too difficult” box—or certainly in the “difficult to do” box—and the Electoral Commission has issued a briefing indicating that it is creating regulatory uncertainty, would the Leader of the House agree that the programme for the Bill’s consideration is far too short? Would he agree that the programme motion needs to be rewritten and that this House needs to be given a great deal more time to consider these difficult things—as he says they are too difficult to do in many senses—and to clarify these issues to reassure the charitable and community sector?

[Mr Lansley]

I am not sure that I agree with the premise of what my hon. Friend says, which was that this is that difficult. Clearly, as I said before, my conversations with the National Council for Voluntary Organisations show that there are existing uncertainties for third parties as to what constitutes expenditure for electoral purposes. The legislation does not clear up those difficulties because it substantively repeats the existing test, so it is important for the Electoral Commission to provide guidance to support it. However, we intend to allocate substantial time for the Bill to be considered.

Business of the House

Debate between Andrew George and Lord Lansley

Thursday 21st March 2013 Commons Chamber

[Mr Lansley]

I will, of course, ask the Transport Secretary, as the hon. Lady asks. I know that Network Rail and the train companies are undertaking quite a programme of improvement. I can say that because I know that the awful circumstances at Cambridge station will benefit from a substantial programme of rebuilding very soon. I will seek a reply for the hon. Lady.

[Andrew George (St Ives) (LD)]

May I seek the advice of my right hon. Friend in respect of the NHS competition regulations, which were laid before the House? The first version has not been revoked. As a result, the second version of the regulations, SI 500, as I understand it, even if it were successful, would not stop the implementation of the previously laid and defective competition regulations. I would be grateful for his advice on that.

[Mr Lansley]

If I am wrong about this I will correct it, but my understanding is that when the second draft of those regulations was laid, it included the revocation of the first draft.

[Andrew George]

indicated dissent.

[Mr Lansley]

I have read it. It does include that, so I know that to be the case. Since those regulations are subject to a negative resolution, they will come into force unless they are negatived. The original regulations will therefore not come into force, and the subsequent clarified regulations will.

Oral Answers to Questions

Debate between Andrew George and Lord Lansley

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?

NHS Annual Report and Care Objectives

Debate between Andrew George and Lord Lansley

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

Debate between Andrew George and Lord Lansley

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

Debate between Andrew George and Lord Lansley

Tuesday 27th March 2012 Commons Chamber

[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

Debate between Andrew George and Lord Lansley

Tuesday 20th March 2012 Commons Chamber

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

In commenting on the level of nursing staff, will the hon. Gentleman observe that since the election, there has been a 5% improvement in the ratio of nurses to occupied beds in general and acute wards?

[Andrew George]

I am not in a position to doubt that figure. The question is whether the ratio is sufficient to ensure that there is safe staffing in our hospitals now, as the RCN identified after a recent survey. I understand the argument advanced by Ministers that it comes down to the management and the management of paperwork within hospitals, and is not just about staff-to-patient ratios. I do not want to have a debate just about staff -to-patient ratios, but that issue has been raised today and I believe that it resonates with people out there in the country, who can see that nurses in particular are struggling to provide adequate services within their hospitals. Those ratios have an effect on the level of care that nurses can provide, as has been found by a variety of reports. The problem is not down to the callousness of the nurses or untrained care assistants who provide the services—where that exists, it should clearly be rooted out of the service—but to whether staff resources are sufficient to maintain safe services on our hospital wards. I think the RCN is right to raise that issue.

That concern is relevant to ensuring that we have adequate local healthwatch services because it shows that we need independent scrutiny of the health service by a body that is not in the pocket of anyone, including the local authority, but that is able to scrutinise hospitals and speak out about staffing levels in its area. We cannot be dependent on the RCN reporting such matters to the Department and on there being top-down diktats that impose mandatory staffing levels that apply in all circumstances. Rather, there should be a local healthwatch that looks at the guidance and recommendations of the professional bodies and ensures that the services in its local hospitals are adequate to provide safe nursing and hospital care. That is why it is important to ensure that the local healthwatch bodies are, as far as is possible, independent of any external influences, whether from the Department, the NHS Commissioning Board, clinical commissioning groups or the local authority. That is where I shall take my arguments.

NHS Risk Register

Debate between Andrew George and Lord Lansley

Wednesday 22nd February 2012 Commons Chamber

[Mr Lansley]

I have just quoted what the Labour Chair of the Public Accounts Committee said on the basis of advice from the National Audit Office, which is precisely in line with data published by the Office for National Statistics. I think I will rest on that.

I want to make it absolutely clear that I appreciate what NHS staff do and the fact that they are delivering improving outcomes. We published 30 indicators of NHS outcomes just two months ago, and 25 of them showed that performance had been maintained or improved. They had not all gone up, but that is why we are focusing on those outcomes, and not just waiting times. However, the average time for which in-patients waited for treatment was 7.7 weeks in December 2011, down from 8.4 weeks at the last election. For out-patient treatment, the average is down from 4.3 weeks at the election to 3.8 weeks now.

[Andrew George (St Ives) (LD)]

rose—

[Mr Lansley]

I know that my hon. Friend will join me in appreciating the success of the NHS in improving waiting times.

[Andrew George]

I do indeed welcome that news, and I do not question what the Secretary of State says about it. However, I am curious about the fact that on one hand the shadow Secretary of State says that it is all going terribly badly but opposes reform of the NHS, and on the other the Secretary of State says that outcomes have never been better but is pressing on with the Bill. Why is he doing so?

[Mr Lansley]

The curious thing, as I know my hon. Friend will appreciate, is that even the Leader of the Opposition says that reform is needed in the NHS because of the challenges that it faces. Of course we can debate what the nature of the reform should be, but the idea that we can simply stand still and that nothing in the NHS needs to change is not the view of NHS staff, patients, the Labour party or the Government. We therefore have to consider what the nature of that reform needs to be, and I believe in patient choice and empowering doctors and nurses on the front line to deliver care. I believe in cutting bureaucracy and removing whole tiers of management to enable that to happen, and in common with my Liberal Democrat friends and colleagues I believe in strengthening democratic local accountability in the NHS and strengthening public health services through local government operations.

The worst possible thing for me to do would be to say, “We need to reform the NHS because it is doing so badly.” I do not believe that, but I do believe we have to root out poor performance. I was shocked to hear the shadow Secretary of State and the right hon. Member for Exeter (Mr Bradshaw), who has disappeared, talking about Stafford hospital. They were the ones who never appreciated the risk of what was happening there. They know that they went through reorganisations without ever addressing the risk. The dreadful things there happened on their watch, so they might at the very least have come here and apologised. The right hon. Member for Exeter came to the Dispatch Box when he was a Minister and said, “Oh, it’s nothing to do with me, it’s all to do with the management of the hospital.”

I believe in foundation trust hospitals, which apparently the Labour party now does not. [Interruption.] The shadow Secretary of State is trying to have it both ways. He is trying to say that he is in favour of foundation trust hospitals, but that if they get into difficulties the best thing is for them to be run by the Secretary of State. He might talk to the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), who was the Secretary of State when, in the Maidstone and Tunbridge Wells NHS Trust, dozens, perhaps hundreds of patients died of clostridium difficile infection at the Kent and Sussex hospital. That was an NHS trust, not a foundation trust. The Department of Health and the Secretary of State have no God-given ability to run hospitals directly and do so better than they can be run by the doctors, nurses and managers in charge. The point is that there must be proper accountability, and through HealthWatch, local government and the responsibilities of Monitor we will have a proper accountability structure in the Bill.

NHS (Private Sector)

Debate between Andrew George and Lord Lansley

Monday 16th January 2012 Commons Chamber

[Mr Lansley]

When the right hon. Gentleman finds that his argument is not working, he resorts to abuse. It is very simple: the Bill is not about privatisation. Patients will have access to NHS-funded services; the commissioners of those services will be NHS commissioners who are accountable to the NHS through statutory bodies, and they will not be able to transfer that responsibility to the private sector. Provision will be determined by the choices that patients and their doctors and nurses make about who is the best-qualified provider, and that choice will be made on quality, not on any other basis.

On the simple fact that we are looking to use competition within a tariff system, studies from Imperial college and the university of Bristol have recently shown that when it is introduced quality increases. Indeed, research from the university of York’s centre for health economics suggests that, if anything, the use of such competition has tended to support a reduction in the inequalities of access and care, rather than to lead to greater inequalities.

Let me provide some examples, bearing in mind the path that the Labour party is looking to go down. The Eastbourne Wound Healing Centre, a social enterprise set up by a nurse and an occupational therapist, specialises in wound healing. Patients who go to their clinic often have wounds that have not healed over three years, but more than eight out of every 10 of them have those wounds healed in just six weeks. Should we prevent patients being seen there because it is not actually owned by the NHS?

The City Health Care Partnership in Hull provides palliative care at home for patients and does not put profit before patients. One carer said that

“this clinic is so different, the focus is about how the illness is affecting you and what can be done to support you through it.”

Should we stop it doing that?

Another example is Inclusion Healthcare, a social enterprise in Leicester, which the hon. Member for Leicester West might know. It provides specialist health care to the homeless. Jane Gray, its director of nursing and development, stated:

“We’re providing a better service than we did in the NHS. We’re able to innovate and shape our services without constraint.”

Should we shut it down? Would that reduce inequalities? No, it would make them worse.

[Andrew George (St Ives) (LD)]

I endorse entirely the Secretary of State’s criticism of the previous Government’s bias towards the private sector. I would be grateful if he clarified an issue in respect of the integration of health services. Does he agree that, particularly at the secondary and tertiary level, the question is not so much about privatisation because if the NHS was to lose its preferred provider status, the gradual loss of many aspects of secondary and tertiary services in, for example, an acute general hospital might undermine the viability of the hospital?

[Mr Lansley]

The position is very clear, as the hon. Gentleman should know from the debates that we have had. Continuity of access to services through the NHS is one of the central responsibilities of commissioners and of Monitor. If there is any threat to the continuity of those services, they can step in and take measures to ensure that the services continue, including by agreeing funding beyond the tariff to make that happen. If the extension of any qualified provider could lead directly to the loss of access to essential services for patients, the commissioners and Monitor do not have to go down that path. They can make those judgments.

I caution the hon. Member for St Ives (Andrew George) about hanging his hat on the NHS as preferred provider. Before the last election, the right hon. Member for Leigh said that the NHS should be the preferred provider. His philosophy said that the NHS should be allowed to get it wrong twice before the private sector gets a look in. From the patient’s point of view it is, of course, a very cheerful thought that they will be surrendered to the policy of NHS as preferred provider.

Curiously, in March 2010, before the election and at the same time as he said that his policy was the NHS as preferred provider, the right hon. Gentleman published the “Principles and rules for cooperation and competition”, which he seems to be very fond of and which we are maintaining. That document stated:

“Commissioners must commission services from providers who are best placed to deliver the needs of their patients.”

It also stated:

“Commissioners and providers must not take any actions which restrict choice against patients’ and taxpayers’ interests.”

The reason that the right hon. Gentleman published that document was that he knew that the policy of NHS as preferred provider was already going to be the subject of a legal challenge and that it would not survive that challenge. That is why he restated exactly the principles of co-operation and competition that we intend to incorporate directly and without amendment into the way in which Monitor does its job.

Breast Implants

Debate between Andrew George and Lord Lansley

Wednesday 11th January 2012 Commons Chamber

[Mr Lansley]

I am afraid that absence of evidence does not mean evidence of absence. We can be very clear, on expert advice, that there are no specific safety concerns that routinely require the removal of these implants, nor identification of any increased long-term health risks, in precisely the way I have described. I cannot go further and provide, on advice, absolute assurance, and the expert group was clear about that. That is why the French Health Minister, whom I was talking to last week, and I were clear that we should undertake additional toxicology tests on implants when they are explanted, in cases where they were implanted over a period of time, to begin to understand the extent to which they had adulterated filler material and what was in it.

[Andrew George (St Ives) (LD)]

I commend my right hon. Friend’s initiative. However, he said the following, which may have been sloppy wording: “those who have had reconstructive surgery following a mastectomy, will have received PIP implants through the NHS.” Of course, the majority will not have done so, and I have confirmed with surgeons in Cornwall that PIP implants have never been used in the NHS in Cornwall. Given that the Medicines and Healthcare products Regulatory Agency issued advice to stop using PIP implants in the UK in March 2010, can the Secretary of State confirm that this advice was acted on, no doubt within the NHS but across private clinics as well?

[Mr Lansley]

I hope I did not say what the hon. Gentleman ascribes to me. Some 3,000 women, we think, had PIP implants, and of course, that is only a fraction of the number having breast reconstruction surgery. I think I can offer him reassurance. The MHRA withdrew authorisation in March 2010, and given that there was only one distributor of these implants in this country—Cloverleaf—they will not have been distributed for use after that date.

Oral Answers to Questions

Debate between Andrew George and Lord Lansley

Tuesday 10th January 2012 Commons Chamber

[Andrew George (St Ives) (LD)]

When the Government introduced the Health and Social Care Bill a year ago, they did so with the claim that the NHS fails in comparison with its European counterparts with regard to patient outcomes. Now we know that that is not the case, will the Government withdraw the Bill?

[Mr Lansley]

I do not agree with that characterisation of why we instituted the Health and Social Care Bill or of the current situation. For example, the OECD published in October its latest assessment of health in a number of countries. In too many respects—for example, in relation to serious respiratory disease—we have very poor outcomes relative to other countries. What we are setting out to do in any case is to deliver continuously improving outcomes and to get among the best in the world. In too many respects we are not yet among the best in the world.

Health and Social Care (Re-committed) Bill

Debate between Andrew George and Lord Lansley

Tuesday 6th September 2011 Commons Chamber

[Mr Lansley]

I will give the hon. Gentleman a shorter answer this time: he does not talk to enough people in the NHS.

Let me return to the important point that I was about to make. I was saying that criticism of the Bill has typically developed to the point of literally misrepresenting the facts in order to attack the Bill, as was the case with 38 Degrees. I am indebted to my hon. and learned Friend the Member for Sleaford and North Hykeham (Stephen Phillips) for sharing with me a letter that he prepared for the better information of his constituents. He looked at the legal opinion obtained by 38 Degrees and concluded that it did not support the views that those behind the 38 Degrees website evidently wished it did.

For example, 38 Degrees claims that the Bill removes the Secretary of State’s duty to provide a comprehensive health service. However, its own legal advice makes it clear that the Secretary of State has never had a duty to provide a comprehensive health service—only a duty to “promote” a comprehensive health service, which is exactly reproduced in clause 1.

Clause 1 also makes it clear that the Secretary of State must secure the provision of that service. The “duty to provide” certain services to which 38 Degrees refers is a duty that I, as Secretary of State, currently delegate to primary care trusts. In future, the Bill will—in exactly the same way—pass that duty of the Secretary of State to the NHS commissioning board and to clinical commissioning groups. In other words, the situation will be legally unchanged. The Secretary of State has a duty, and discharges it through organisations to which he or she delegates that power. Strictly speaking, they have more direct statutory duties, but the duty to provide will not change.

38 Degrees also claims that the Bill opens up the NHS to competition law, but its own legal advice—which it obviously did not like—made it clear that there would be no change between the present competition regime and that which would operate if and when the Bill became law.

I am very grateful to my hon. and learned Friend, whose forensic analysis accords with our own view. The provision, under the Bill, of a comprehensive NHS is watertight, and it is equally clear that the Bill does not change the extent of the application of competition law and EU procurement rules. The 38 Degrees campaign should be seen for the distorting and misleading political propaganda that it is.

[Andrew George (St Ives) (LD)]

I entirely endorse the Secretary of State’s point about the biased way in which the last Government advanced the private sector, but may I make a point about the changes that have resulted from the listening exercise? The Secretary of State has sought to reassure the House about Monitor’s role of integration and promoting collaboration. Would he be prepared to respond to, and perhaps even accept, amendments that I have tabled—for example, amendment 1226—which propose, I think reasonably and in a balanced way, that promoting the importance and the role of integration should be among the principal duties?

[Mr Lansley]

As we said in our response to the recommendations of the NHS Future Forum, we recognise the importance of integrating health and social care services—while concentrating on the needs of patients and their families—to the achievement of our aims. However, I do not believe that we would further those aims by changing Monitor’s name, as amendment 1225 suggests. Although I agree with the aims of my hon. Friend the Member for St Ives (Andrew George), we have an alternative approach.

Rather than making it explicit that the Secretary of State could impose requirements on commissioners in key areas through regulations, as my hon. Friend suggests in amendment 1209, the Bill proposes that commissioners should have clear statutory duties to reduce inequalities between patients, in relation to both access and outcomes. That is covered in clauses 20 and 23. Commissioners would also have to promote integration of services in carrying out those duties. That is covered in clause 20, which inserts new section 13M of the National Health Service Act 2006, and in clause 23, which inserts new section 14Y. Those clauses refer respectively to the NHS commissioning board and to clinical commissioning groups.

The Bill would also establish clear duties for Monitor to allow the integration of health care services and the integration of health care with other relevant services, including social care. We have already amended the Bill to make it clear that Monitor should not promote competition for competition’s sake: this is all about quality. However, integration can only ever be a means to that end, not an end in itself. Integration, like competition, is designed to secure continuous improvement in the quality of services and a reduction in inequalities, as clauses 20 and 23 make clear.

Although I understand the point that my hon. Friend is making, I ask him to not to press amendments 1225 to 1228 when we reach the appropriate moment.

--- Later in debate ---

[Mr Lansley]

No. She can sit down.

Let me come to the other Opposition amendments. Amendment 10 would delete all of part 3, which would be absurd. Some of the other Opposition amendments are equally absurd. Amendment 28 envisages that part 3 would remain in place, but that Monitor would license providers of NHS services. However, it then takes away any means of enforcement. Perhaps the Labour party has forgotten that in government if you create obligations it is rather helpful to create a means by which they can be enforced.

Opposition amendment 44 would take the Bill down a slippery slope by trying to prescribe the range of factors that Monitor should reflect in setting prices for NHS services. Such a list could never be exhaustive and would inevitably suggest that some factors were more important than others. It would undermine our ability to hold Monitor to account for setting prices that promote patients’ interests. We must focus Monitor on its duties to promote the quality, efficiency and effectiveness of NHS services, not on trying to prescribe in legislation how it goes about it.

Labour Members have tabled amendments to part 4 that indicate that they either do not understand the Bill, or have abandoned their previous, repeated commitment to supporting all NHS trusts in becoming foundation trusts. They gave that commitment back in 2003, when they passed the necessary legislation, and repeated it in about 2006, when they said that trusts should all be foundation trusts by 2008. The Labour party manifesto from last year—2010—said:

“All hospitals will become Foundation Trusts, with successful FTs given the support and incentives to take over those that are under performing”.

Compare our programme for such hospitals as those in Trafford and Carlisle. The manifesto continued:

“Failing hospitals will have their management replaced. Foundation Trusts will be given the freedom”—

additional freedoms—

“to expand their provision into primary and community care, and to increase their private services”.

We will debate that later today, but I should complete the quote, or I might be accused of being selective:

“where these are consistent with NHS values, and provided they generate surpluses that are invested directly into the NHS.”

That is exactly what we are proposing.

The Labour party appears utterly confused. Does it support foundation trusts or not? The NHS Future Forum said that all NHS trusts should continue to work towards achieving FT status by 2014. It was right: achieving FT status is about demonstrating clinical and financial stability, and we think that all NHS providers should be expected to do that, in the interests of NHS patients and staff. If we maintained the NHS trust legislative model in statute, we would risk losing the change in mindset and the momentum that is being demonstrated by prospective foundation trusts.

Our consequential amendments 219, 220 and 367 to 370 will simply remove references to NHS trusts when they no longer exist—and not, of course, until then. For the hon. Member for Pontypridd, I add that our amendments 185 to 188 make it clear that—sadly for those in Wales—a foundation trust cannot merge with or acquire a Welsh NHS trust.

The Opposition want to take the retrograde step of de-authorising foundation trusts, retaining NHS trusts under the Secretary of State’s direct control, and having them dependent on the layers of bureaucracy that go with that. There would be all the regulatory requirements for foundation trusts and independent providers, and all the bureaucracy that has accompanied NHS trusts and strategic health authorities. That would undermine the FT regulatory regime and the objective of all NHS trusts becoming FTs. Opposition Members who voted in favour of the original legislation establishing foundation trusts in 2003 can have no credibility in supporting Labour now, because the very purpose of that legislation was to give hospitals greater autonomy.

Other Opposition amendments would simply result in duplication and reduced coherence in the Bill. For example, amendments 1166 and 19 seek to retain controls on goods and services, and borrowing and property, but that would duplicate Monitor’s powers through the licensing regime. Deleting clause 166, as the Opposition propose would undermine our intention of increasing transparency in the public financing of foundation trusts. I am looking for the hon. Member for Slough (Fiona Mactaggart); this would have been her moment. Through our amendments, we can show how we can maintain support for FTs, if necessary, in a transparent fashion, including through a requirement, which the Labour party apparently wants to delete, on the Secretary of State to publish an annual report showing what form of financial support has been given to foundation trusts.

I turn to the amendments tabled by my Liberal Democrat friends below the Gangway, who expressed their intention of improving NHS services and ensuring sustainable access for patients. We all share those aims, but I believe that we have in place alternative approaches to meeting those aims. The hon. Member for St Ives tabled a series of amendments emphasising the need to secure sustainability in the provision of NHS services. Securing sustainable access to meet patients’ needs is fundamental to good commissioning. We would expect the board to ensure that there was sufficient competency over issues when it authorised clinical commissioning groups to take on their new responsibilities, and when holding them to account for doing that job.

As the Government have said many times, our focus is on outcomes, including ensuring that patients have access to the services that they need when they need them. That the outcomes must be sustainable is obviously implied, but that is not necessarily the same as saying that commissioners must ensure the sustainability of particular providers or particular services, as amendments 1205 and 1209 suggest when referring to the sustainability of “existing NHS services”. In some cases it will not be in the interests of patients to maintain the status quo—for example, where those services may be unable to improve in line with new standards of clinical best practice, or where there is clear evidence that centralising specialist services on fewer sites would improve health outcomes, as we have seen in examples relating to cardiac, stroke and trauma services. So although I agree with the intention behind these amendments regarding the role of commissioners, I must urge the hon. Member for St Ives not to press them.

I addressed earlier the hon. Gentleman’s amendments about integration and collaboration. On integration, we agree with the conclusion of the NHS Future Forum that integrating services around the needs of patients and giving patients greater choice over who provides those services are not mutually exclusive. As the NHS Future Forum made clear, this is a false dichotomy. As the NHS Future Forum’s report stated:

“If commissioners want to commission integrated care they will only succeed in doing this by creating a new market in integrated care services and stopping the current commissioning of episodic services from different NHS organisations.”

As the hon. Member for St Ives will recognise, his amendments 1207 and 1208 are based upon that dichotomy, so I ask him to withdraw them.

[Andrew George]

Will the Secretary of State give way?

[Mr Lansley]

No. I do not want to intrude on the time of other Members.

Amendments 1219 and 1220 tabled by my hon. Friend the Member for Southport (John Pugh) would apply the Enterprise Act 2002 to mergers of the activities of foundation trusts with businesses, but would exclude from these arrangements mergers between foundation trusts. I have given careful thought to this proposal, but I am not convinced that it would address two of the problems of the existing regime.

There is currently legal uncertainty as to when and where the 2002 Act would apply to mergers of foundation trusts. As a result, under the current arrangements for the review of mergers involving foundation trusts by the Co-operation and Competition Panel, there is always a potential risk of duplication—or worse still, double jeopardy. The risk arising from a separate regime for foundation trusts would be increased where a trust’s activities extended beyond Monitor’s remit—for example, where a foundation trust provided social care or supplied goods. Consolidating oversight of foundation trust mergers under the Enterprise Act, as proposed by the Bill, would avoid the risk of double jeopardy and eliminate the uncertainty of the current approach.

Mergers are a specialist area. Hence, we think it is right to maintain existing responsibilities and expertise within the Office of Fair Trading and the Competition Commission, rather than resource a further body to consider potential mergers in health care. It may reassure my hon. Friend if I say that the OFT and the Competition Commission would consult Monitor to ensure that they had a full understanding of the health care issues involved.

Oral Answers to Questions

Debate between Andrew George and Lord Lansley

Tuesday 12th July 2011 Commons Chamber

[Andrew George (St Ives) (LD)]

It is acknowledged that the rising rates of norovirus are worse where there is a shortage of acute hospital beds. How does the Secretary of State square the understandable desire to get on top of hospital-acquired infections with his zeal to reduce acute hospital beds?

[Mr Lansley]

I am grateful to the hon. Gentleman. He will understand that each hospital trust or acute trust must be responsible for ensuring that there is not an excessive length of stay for patients and that it has the ability to isolate patients if necessary. Norovirus is one circumstance in which trusts often have to open additional capacity. In my experience of hospitals, that is precisely what is generally done. There is an ability to open new capacity if necessary when norovirus strikes.

NHS Future Forum

Debate between Andrew George and Lord Lansley

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

I will make clear to the right hon. Lady, as the Prime Minister has made clear, that we will not let waiting times rise. We will continue to maintain downward pressure, but it is very important that we do not treat waiting times in the NHS as the only measure of performance. It is more than that: it is the quality of care that is provided, not just the access to care.

[Andrew George (St Ives) (LD)]

I am very sorry to say that the Secretary of State demonstrated a creative interpretation of the coalition agreement when he launched his policy last July. What can he say to the House to reassure us that he will not make the same creative interpretation of the Future Forum’s recommendations, particularly in relation to the risk of the marketisation of health services?

[Mr Lansley]

The hon. Gentleman will know that when I came forward with the White Paper last year, or the Command Paper in December, or the Bill, we did so collectively as a Government, and I can assure him and all my colleagues that we will continue collectively to agree on the basis on which we take all these issues forward.

Future of the NHS

Debate between Andrew George and Lord Lansley

Monday 9th May 2011 Commons Chamber

[Mr Lansley]

I completely understand and agree with my hon. Friend. I thought it was outrageous for the shadow Secretary of State to say, “Oh, they promised a moratorium and now some closures are taking place.” Why? Because we were left what were, in effect, faits accomplis by the previous Government and it was impossible to change them. [Interruption.] My hon. Friend the Member for Maidstone and The Weald (Mrs Grant) would feel the same as my hon. Friend the Member for Burnley (Gordon Birtwistle).

[Andrew George]

I can confirm that we agree on the issue of principle and that I am not questioning the Secretary of State’s personal commitment. The issue remains one mentioned in the motion: the extent to which the policy in the Health and Social Care Bill is not just another top-down reorganisation of the sort that the coalition Government said they would stop and the extent to which the policy being driven through Parliament, on which a listening exercise is taking place, delivers what is in the coalition agreement. The debate is about the extent to which the Bill reflects the coalition programme agreement.

[Mr Lansley]

My hon. Friend will know that the coalition agreement supports, in essence, all the principles of the Bill, with the exception of the specific consequence of the abolition of the strategic health authorities and primary care trusts. As with the whole of the Bill and its related measures, that proposal was the subject of collective agreement and it flows directly from the belief, shared not least by him and his Liberal Democrat colleagues, that we need much stronger local democratic accountability in the NHS. We are constructing health and wellbeing boards as an integral part of local authorities, and he will know that the overwhelming majority of local authorities which have volunteered to be early implementers of that approach believe precisely that democratic accountability is an essential part of the future of the NHS.

Health and Social Care Bill

Debate between Andrew George and Lord Lansley

Monday 31st January 2011 Commons Chamber

[Mr Lansley]

No. I am going to make some progress.

The Labour party, when in government, pioneered patient choice; Labour said, “We must have patient choice.” I remember John Reid, when he was a Member, saying that the articulate and the well-off negotiated their way through the health service, and that he wanted to give choice to everybody in the health service. He was right. The social attitudes survey in 2009 found that more than 95% of people felt that they should have more choice, but that fewer than half of patients actually experienced it. The Labour party started down the road of extending choice; we will complete that journey.

[Andrew George (St Ives) (LD)]

On patient choice in health service design, is the Secretary of State aware that in Cornwall the primary care trust has engaged in the transfer of community hospitals and services without adequate public consultation and at breakneck speed? If “no decision about me, without me” is to apply to service design and patient involvement, is he prepared to intervene to ensure that the public are involved in such important decisions?

[Mr Lansley]

I am grateful to my hon. Friend for that point. I have not previously been asked to comment on the matter, nor have I received information about it, but from my visits to Cornwall I entirely endorse his view about the importance of community hospitals in accessing services. He will see that, in the Bill, a specific duty is placed on the commissioning board and each commissioning consortium to reduce inequalities in access to health care. He will see also that, through the Bill, we will strengthen accountability where major service change takes place, because it will require not only the agreement of the commissioning consortium, representing as it were the professional view, but the endorsement of the health and wellbeing board, which includes direct, local, democratic accountability. Points have been made about what was in manifestos, but the Liberal Democrat manifesto was very clear about the need for democratic accountability in health service commissioning—and so there will be.

Let me return to the point, because the previous Government also went down the route of practice-based commissioning. It was their policy, but, as the shadow Health Minister, the hon. Member for Leicester West (Liz Kendall) said, many GPs felt that

“they didn’t always get the power, responsibility and resources they might have wanted.”

Well, now they will, and we will give it to them.

On our definition of quality, Opposition Members say “quality matters”. It does, and it was under the Labour Government that Ara Darzi pioneered the thought that quality must be at the heart and an organising principle of the health service. It is we now who are going to make that happen. We are publishing quality standards. We are putting into this legislation a duty to improve quality that extends to all the organisations that commission and provide NHS services.

NHS Reorganisation

Debate between Andrew George and Lord Lansley

Wednesday 17th November 2010 Commons Chamber

[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.

[Andrew George]

As the right hon. Member for Wentworth and Dearne (John Healey) said earlier, the seventh point in the coalition agreement begins with the words:

“We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust…The remainder of the PCT’s board will be appointed by the relevant local authority or authorities”.

Was the Secretary of State consulted before those words were included in the agreement? If he was, what changed his mind between the drawing up of the agreement and the White Paper?

[Mr Lansley]

The answer to the first question is yes. The answer to the second question is that we in the coalition Government collectively took the sensible view that form must follow function. If we arrived at a point at which people were being elected to primary care trusts which themselves no longer had a substantive role to play, because public health was rightly being transferred to local authorities—

NHS White Paper

Debate between Andrew George and Lord Lansley

Monday 12th July 2010 Commons Chamber

[Mr Lansley]

I have not been briefing anything to anybody. [Interruption.] I have not. It is very straightforward. The FSA, along with other bodies associated with our public health responsibilities, will be the subject of a public health White Paper in the autumn. There is no proposal.

[Andrew George (St Ives) (LD)]

In seeking to reassure the House that this is not the top-down reorganisation that the coalition agreement derided, would my right hon. colleague reassure my constituents, who are quite excited by the idea of more patient and local authority involvement in local decision making, that where the primary care trusts in which they are going to be appointed will be abolished, there will be more GP commissioning groups than PCTs at the end of the process?

[Mr Lansley]

Yes, I am grateful to the hon. Gentleman. The number of GP-commissioning consortiums will be determined not least by GPs themselves, deciding what makes sense in their locality. He and his Cornish colleagues have often been frustrated by the way in which a top-down bureaucracy has sought to dictate to the people of Cornwall, often in specific localities, at a considerable distance from their hospital services, what services should be provided locally in places such as Hayle and Penzance. He and his constituents can be really comforted by the thought that their clinical advisers and general practitioners in local consortiums can in future make those decisions about their services.