Health and Social Care Bill

Debate between Andrew George and Simon Burns

Tuesday 20th March 2012 Commons Chamber

[Mr Burns]

The aim of this Bill is to secure a national health service that achieves results that are among the best in the world. Through it, the Government reaffirm their commitment to the values and principles of the NHS: a comprehensive service, available to all, free at the point of use and based on need, not ability to pay. However, we have always been prepared to listen and make changes to improve the Bill, and we have continued to do so in another place. The Lords amendments in this group fall within five main areas.

First, we recognised that concerns had been expressed about the Secretary of State’s accountability for the health service. Although it was never our intention in any way to undermine that responsibility, we have worked with Members of another place and the House of Lords Constitution Committee to agree Lords amendments 2 to 5, 17, 18, 24, 39, 40, 74, 246, 287 and 292. Those amendments put beyond doubt ministerial accountability to Parliament for the health service. In addition, they amend the autonomy duties on the Secretary of State and the NHS Commissioning Board, to make it explicit that the interests of the health service must always take priority. They also amend the intervention powers of the Secretary of State and the board, to clarify that they can intervene if they think a body is significantly failing to exercise its functions consistently with the interests of the health service. Finally, a new provision will make it explicit that the Secretary of State must have regard to the NHS constitution in exercising his functions in relation to the health service.

Although clinical commissioning groups will have autonomy in their individual decisions, Lords amendment 9 clarifies that CCGs must commission services consistently with the discharge by the Secretary of State and the board of their duty to promote a comprehensive health service, and with the objectives and requirements in the board’s mandate.

The Government also tabled amendments in response to the recommendations of the House of Lords Select Committee on Delegated Powers and Regulatory Reform, all of which we have accepted. Amendments 15 and 16 ensure that the requirements set out in the mandate, and any revisions to those requirements, must now be given effect by regulations.

Commissioning will be led by GPs, who know patients best. However, with that responsibility must come accountability. Therefore, further to the amendments made in the House requiring CCGs to have governing bodies, the other place has strengthened requirements in relation to CCGs’ management of conflicts of interest. We recognised how important it is to ensure the highest standards of probity in CCGs and accepted amendments 31, 300, 301 and 302, which were tabled by the noble Baroness Barker, and which require CCGs to make arrangements to ensure that members and employees of CCGs, members of the governing body, and members of their committees and sub-committees, declare their interests in publicly accessible registers.

The amendments also require CCGs to make arrangements for managing conflicts of interest and potential conflicts of interest in such a way as to ensure that they do not, and do not appear to, affect the integrity of the board’s decision-making processes. The board must issue statutory guidance on conflicts of interest, to which CCGs must have regard.

Taken together, those amendments provide certainty that there will be clear and transparent lines of accountability in the reformed NHS. However, I cannot support Opposition amendment (a) to Lords amendment 31. The Bill is clear that CCGs must manage conflicts of interest in a way that secures maximum transparency and probity. In most cases, that would mean that a conflicted individual withdraws from the decision-making process, but that might not always be possible, for instance when a CCG is commissioning for local community-based alternatives to hospital services, and determines that the most effective and appropriate way to secure them is to get them from all local GP providers within its geographic area. In that event, it would not be possible for every GP to withdraw from the decision-making process. We cannot, therefore, agree to a blanket ban.

[Andrew George (St Ives) (LD)]

Will the Minister clarify something in view of what he has just said about the conflict that all members of the board and the CCG will have with regard to decisions on the provision of new services? Does he share my fear that the structure of CCGs results in bodies that will continue to be conflicted? Does that continuing conflict not undermine that important structure within the health service?

[Mr Burns]

I appreciate the hon. Gentleman’s intervention, but I am afraid I do not share that view. I hope that what I shall go on to say will help to give him additional reassurance on that.

There will be additional safeguards in the Bill to ensure that those processes are transparent, including the regulations that Monitor will enforce on procurement practices and its accompanying guidance. In addition, the board must publish guidance for CCGs on their duties in relation to the management of conflicts of interest. Of course, the CCGs' commissioning intentions will have been set out in its commissioning plan, which is subject to consultation with both the public and the health and wellbeing boards.

The second area in which the other place has strengthened the Bill relates to the duties placed on commissioners to ensure a patient-focused NHS. It has always been the Government’s intention to put in place reforms that support the simple principle, “No decision about me without me.” To achieve that, commissioners will for the first time have a duty in relation to patient involvement in decisions. The House strengthened those duties following the listening exercise, and they were further improved by amendments 19, 32 and 33 in the other place, to make it explicit that the duty means promoting the involvement of patients in decisions relating to their own care or treatment.

Another core principle of the White Paper was the need to eliminate discrimination and reduce inequalities in care. The Bill will for the first time in the history of the NHS place specific duties on the Secretary of State and commissioners to have regard to the need to reduce health inequalities.

To reinforce that further, the other place agreed amendments 22, 23, 36, 37, 38 and 60. These ensure that the Secretary of State, the board and CCGs will be better held to account for the exercise of these duties through their annual reports, the board’s business plan and, in the case of CCGs, their commissioning plans and annual performance assessment by the board. However, improvements in quality, outcomes, and reduced inequalities will not happen unless we better integrate services for patients. That is why we placed duties on commissioners, again for the first time, to promote integration in new sections 13M and 14Y, and made clear, following the listening exercise, that competition will not take priority over integration.

Oral Answers to Questions

Debate between Andrew George and Simon Burns

Tuesday 21st February 2012 Commons Chamber

[Andrew George (St Ives) (LD)]

11. If he will withdraw the Health and Social Care Bill.

[The Minister of State, Department of Health (Mr Simon Burns)]

No, Sir.

[Andrew George]

I respect the Minister, but massive opposition to the Bill is mounting at the same time as its meagre support is ebbing away. Any more rational process would have resulted in the dignified withdrawal of the Bill long ago. Is there anything that would persuade the Secretary of State—frankly, he should be answering this question—to change his mind?

[Mr Burns]

The straightforward answer is no, because everyone, including the right hon. Member for Leigh (Andy Burnham), accepts that the NHS has to evolve to keep up and meet its challenges. What matters to patients is not who delivers their care but the quality of the care that they receive, their experience of that care and the dignity and respect with which they are treated at all times. Cutting bureaucracy by a third to reinvest £4.5 billion in front-line services between now and 2015 is the way forward. Frankly, if one goes and talks to doctors around the country, one finds that they wish that Labour’s party political squabbling would stop so that they can get on with implementing the modernisation programme.

Hinchingbrooke Hospital

Debate between Andrew George and Simon Burns

Thursday 10th November 2011 Commons Chamber

[Mr Burns]

I can assure the hon. Gentleman, because of the way in which the agreements have been framed, that there is an incentive and a pressure on Circle to seek to deliver on reducing and—we hope—eliminating over the 10 years the £39 million historical deficit. On the question of who has what size of a deficit, I must tell him that my concern is to remove that shackle from the neck of Hinchingbrooke hospital.

[Andrew George (St Ives) (LD)]

Notwithstanding the inconsistency of the Opposition’s position, will the Minister clarify whether this marks clearly the termination of public NHS trusts as preferred providers of public NHS services?

[Mr Burns]

It was all going so well up until now, Mr Speaker. The hon. Gentleman, who has shown a keen interest in the progress of the Health and Social Care Bill, will know that we are concentrating on any willing provider—based on quality care, not price—rather than preferred bidder.

Health and Social Care (Re-committed) Bill

Debate between Andrew George and Simon Burns

Tuesday 6th September 2011 Commons Chamber

[Mr Simon Burns]

I am grateful to my hon. Friend the Member for Cornwall—I mean the hon. Member for St Ives (Andrew George)—for moving the new clauses and amendment, especially for the constructive and reasonable way in which he did so. He raised several issues and, if I understand him correctly, he sees the amendment as a probing amendment that also puts across several of his concerns about this issue. I hope to deal with the main thrust of his concern in my contribution.

I am also grateful to the hon. Member for Islington South and Finsbury (Emily Thornberry) for her contribution. Her amendment and indeed her comments were more controversial and I have far more disagreement with several of the contentious things that she said, although she will be unaware that I am saying that because she is not listening. She might argue that she is not missing much.

I shall start with a fact. It may have got lost in the telling, but I assume that the hon. Lady realises that there is no cap at the moment for NHS trusts. There is only a cap for foundation trusts. She has not seen the difficulties that she forecasts in NHS trusts, and I hope—although I am not confident of success—that I will convince her that her fears are unfounded.

The Government believe that keeping the cap would damage the NHS and patients’ interests. Removing it would allow foundation trusts to earn more income to improve NHS services, and I will address the safeguards that will be in place to ensure that the armageddon that the hon. Lady predicted will not happen and that my hon. Friend’s concerns are needless.

Removing the cap will enable foundation trusts to earn more money to improve NHS services, and those trusts are telling us that they must be freed from what is an unfair, arbitrary, unnecessary and blunt legal instrument. I do not want to go too far down memory lane, but I must remind the House that there was no intellectual case for bringing in the cap in the first place. It was introduced in 2002-03 in the relevant legislation as a sop to old Labour. The right hon. Member for Holborn and St Pancras (Frank Dobson) says that he has moved on, but he still has the Neanderthal tendencies of old Labour—[Interruption.] Before the Opposition Whip says anything, I should point out that the right hon. Gentleman takes that as a compliment. I am being very nice to him and probably enhancing his street cred. He would not thank the Whip for diminishing that.

The point is that the cap was not brought in after some coherent intellectual argument about protecting the NHS or preventing private patients from overrunning the NHS. It was brought in because the then Health Secretary, Alan Milburn, and the then Prime Minister, Tony Blair, were having considerable problems with some of their Back Benchers on this issue. To avoid a defeat on the Floor of the House, they brought in the cap as a sop to those Back Benchers to buy them off. But it was not introduced consistently for both NHS trusts and foundation trusts—just for the latter.

The cap is arbitrary and unfair. Several NHS trusts that are not subject to the private patient income cap have private incomes well in excess of many foundation trusts. Last year, four of the top 10 private income earners were NHS trusts—that is, without a cap. A few FTs have high private incomes simply because they did a few years ago. The cap locks FTs into keeping private income below 2002-03 levels and means that last year about 75% of FTs were severely restricted by caps of 1.5% or less. Meanwhile, patients at the Royal Marsden benefit from its cap being 31%, and it has consistently been rated as higher performing by the Care Quality Commission.

[Andrew George]

The Minister is making an interesting point. Will he elaborate further on the proportions of the private work to which he refers? Is that private work for private patients or private work for research, innovation and training, which are important functions of hospitals but are often lost in the debate?

[Mr Burns]

The hon. Gentleman raises an important point, but the simple answer is that it is a combination of both.

The cap is unnecessary. I remind Opposition Members that the original proposal was not to have one. To suggest that NHS patients would be disadvantaged if the cap was removed, as the hon. Member for Islington South and Finsbury did, is pure and simple scaremongering. Existing and new safeguards will protect them. NHS commissioners will remain responsible for securing timely and high-quality care for NHS patients. The Bill will make FTs more accountable and transparent to their public and staff, allowing us to require separate accounts for NHS and private income and giving communities and governors greater powers to hold FTs to account in performing their main duty, which is to care for NHS patients.

Oral Answers to Questions

Debate between Andrew George and Simon Burns

Tuesday 8th March 2011 Commons Chamber

[Mr Burns]

Unlike the hon. Gentleman, my right hon. Friend the Secretary of State actually understands the situation. It is not true that doctors see patients for only eight minutes; GPs see their patients for the length of time that they feel they should see them. The concept that GPs will have their time taken away from looking after patients to do commissioning is not right, because GPs will employ commissioners with expertise to work with them and do the commissioning for them, so that they can get on with looking after their patients.

[Andrew George (St Ives) (LD)]

With regard to the admin load of GPs, the Government correctly want to have better integration of health and social care. Why, therefore, are they creating GP consortia that are less coterminous with local authority boundaries than the existing primary care trusts? How will that help to deliver a better integrated health and social care system?

[Mr Burns]

I hope that I can reassure my hon. Friend in so far as that is not automatically or necessarily the case. The geographical area of a consortium will be determined by what is most appropriate in the local area.

NHS (Cornwall)

Debate between Andrew George and Simon Burns

Monday 12th July 2010 Commons Chamber

[Andrew George]

I am grateful to the Minister for his response. As he says, things have moved on in a few weeks on the commitment directly to elect PCT boards, but a vacuum has been left, and not just in Cornwall, because we must make sure that finances are adequate for future need and because the local community cannot be represented through the GP commissioning boards. It needs a role in the shaping of services.

[Mr Burns]

I am extremely grateful to my hon. colleague. As he reads the White Paper in conjunction with other documents that will flow from it in the next few weeks, he will come to understand that all the pieces are in place to deal with the concerns that he has expressed. We as a Government are committed to providing a strong local voice for patients through democratic participation. As he and my hon. Friends will appreciate, the nub of the White Paper announced today for Cornwall and for the rest of England is about putting patients at the heart of our reforms, so that their desires and health care needs drive the reformed NHS. No longer will the NHS be told from the top what has to be done throughout our local communities, both in Cornwall and elsewhere. It will be driven by a bottom-up, rather than a top-down, process. To meet that objective, PCT commissioning functions will be phased out and transferred to the NHS commissioning board.

My hon. Friend the Member for Truro and Falmouth asked about the time scale for these reforms. The time scale for phasing is between now and 2013. We propose to replace PCTs with an enhanced role for elected councillors and local authorities to boost local democratic engagement in the NHS. Given the way in which the whole system is to be held accountable, they will increase their responsibilities from their existing role in the public health sphere.

I now turn to my hon. Friend’s point about information. If we are going to create a national health service that is driven by patients, for patients, they must have the information that qualifies them to make the decisions and the choices that are all part of our vision for a patient-led NHS. I can give her this commitment: information across the whole of the health sector will be made available to all patients and members of the public so that they will be able to access it and then make a judgment based on their health requirements as to their choices of consultants and hospitals. That informed decision making can be provided only by enhanced information for those people. I can assure her that that information will be made available so that they can make those decisions and choices.

My hon. Friend mentioned whistleblowing. As she will know, my right hon. Friend the Secretary of State is a strong supporter of holding the NHS to account when it fails or could do better to ensure that we have the finest health service that does not concentrate on processes, as it has for too long, but is driven by outcomes, which is the important thing that matters the most to our constituents. My right hon. Friend has already stated that he is going to strengthen and protect the position of whistleblowers, to use the old-fashioned phrase—I am not convinced it is the best one, but it is certainly the most obvious—so that people who see things that are wrong or things being done that should not be done have the protection and the confidence to be able to draw them to the attention of the authorities so that we can right the wrongs and make the improvements without those individuals fearing for their jobs, future careers and commitment to the NHS. I hope that my hon. Friend is reassured by that.

My hon. Friend mentioned the inspection and regulation regime and the Care Quality Commission. Let me tell her, although she will certainly know the basic principles, that the role of the CQC as the regulator of all health care providers will be strengthened by a clear focus on essential levels of safety and quality. All providers of regulated health care and adult social care will be registered against essential levels of safety and quality, and the CQC has the power to take action against providers that do not meet these standards. The CQC will carry out targeted inspections of providers against the essential standards.

As my hon. Friend will be aware from the White Paper, GP consortiums will commission the majority of health services in place of PCTs, and the NHS commissioning board will authorise consortiums and hold them to account for their performance. The CQC will no longer have a role in assessing commissioning. On the involvement of patient and clinical experience of services in the regulation and inspection regime, instead of focusing on the measurement of processes or targets, the CQC now places the experiences of the people who use health and social care services at the very heart of its work.

The CQC actively seeks the views of people who use health and social care services when making assessments of the quality and safety of that care. When inspecting a care provider, it asks to see evidence of outcomes and evidence that patients experience effective, safe and appropriate care. Rather than looking at policies, it speaks to people experiencing care, to their families and to staff to find out what the quality of care is like in practice. The CQC also actively seeks the views of clinicians, who play a crucial role in improving the quality of care. When there is a problem, it works with them to work out the best way to solve it and to improve care. Clinicians’ expertise in service delivery and design is invaluable, as I am sure my hon. Friend will agree.

In addition, the CQC works in partnership with a range of professional regulators, such as the General Medical Council and the Nursing and Midwifery Council, to ensure that its assessments of a provider are informed by their views on clinical best practice. Integration with HealthWatch, as announced in today’s White Paper, will give patients in Cornwall and throughout the country a greater public voice, providing a greater connection between their views and the actions of the regulator.

I reassure my hon. Friend, my colleague the hon. Member for St Ives and all other hon. Members from the great county of Cornwall that we are determined to improve and enhance the quality of care in the county and throughout the whole country. We want to ensure that the improvements are experienced by patients, because patients are at the heart of the new NHS that we envisage. Only by taking into account what they want and their patient experience within the NHS can we make the improvements necessary to ensure that we have a great NHS not just for the next five years but thereafter.

Question put and agreed to.

Health Funding

Debate between Andrew George and Simon Burns

Tuesday 22nd June 2010 Westminster Hall

[Mr Burns]

The hon. Gentleman knows the answer to that question. That is not why the hospital was not given the go-ahead last week. I can appreciate his frustration. As a constituency MP myself, I too would be frustrated, but the hon. Gentleman, who is a generous man, must not try to reinterpret the decision for other reasons. Sadly, the decision was taken simply because of the urgent need of this Government to take decisions to start curbing the ballooning debt problem, which needs to be addressed. That is the reason, I am afraid. It has nothing to do with our commitment to reducing health inequalities and spending more money on providing health care and services for people throughout the country.

I hope that the hon. Gentleman is satisfied with that. If he is not, and if it would be of any help to him, I would be more than happy to meet with him and, if he wants to bring them along, his colleagues from the Hartlepool area and the surrounding constituencies. They can discuss the matter with me—my door is always open. I would be more than happy to do that, if we can arrange a meeting, and if he thinks that it would be helpful.

Let me return to Cornwall and the general position on health funding allocations. I was saying, before discussing Hartlepool again, that we will establish an independent NHS board.

[Andrew George]

On that point, I would be grateful if the Minister would clarify whether the board will replace the Advisory Committee on Resource Allocation.

[Mr Burns]

I can reassure my hon. colleague that it will not. It will be something completely different. It will be a stand-alone body that will be the driving engine of the NHS, in its required field.

By strengthening the link between investment and outcomes, the board will enable the NHS to deliver improved quality, higher productivity and better value for money. I am sure that my hon. colleague will appreciate that I cannot yet discuss the precise functions of the board, nor its composition, but our proposals underline our central belief that resources should be allocated according to need, without ministerial interference.

--- Later in debate ---

[Mr Burns]

I am grateful to my hon. Friend for that intervention. I assure him that the White Paper will be aimed completely at improving and enhancing the provision of health care throughout the country—not just on the Isle of Wight, but on the mainland from Cornwall and the south-west up to Hadrian’s wall in the north. That will be based on a principle of putting patients first and at the heart of health care provision so that they drive the national health service and so that it is there for them and their needs, rather than the needs of management bureaucracy or of politicians micro-managing the system from Whitehall down the road. However much affection and respect I have for my hon. Friend, I cannot be tempted to outline in detail now the White Paper’s contents, but I assure him that when it is published he will share my enthusiasm for the way in which the Secretary of State will unveil his vision for the national health service, not simply for the next five years, but thereafter. I trust that that satisfies my hon. Friend, if not the hon. Member for Worsley and Eccles South (Barbara Keeley).

My honourable colleague the Member for St Ives mentioned the current pace of change, and particularly the distance from target measurements used to assess relative progress towards target allocations. His constituency is in Cornwall and Isles of Scilly primary care trust. It received an allocation of £808 million in 2009-10, which increased to £856 million in 2010-11—an increase, as he knows, of 12.4% above the national average of 11.3%. However, under the formula established by the previous Government, and as many contributors to the debate have noted, that is still 6.2% or some £56.3 million below its target allocation for 2010-11.

I hope that my honourable colleague will appreciate that until the spending review is complete, I cannot comment on specific time scales or the future plans for NHS allocations, nor on the financial standing of specific local health services. I trust that he will be reassured that his partners in Government share a common assessment of both the problems facing the NHS and the solutions available to us.

During the spending review, we will examine rigorously all areas of health spending to identify where we can make savings—for example, by maximising the NHS’s buying power, renegotiating contracts and improving financial accountability throughout the system. The picture that I have painted is of an NHS in which decisions on resource allocation centrally are made by an independent NHS board. But although I cannot give the hon. Member for St Ives the commitment and promise that he wants now, the matter will be examined as part of the spending review between now and the autumn. When our reforms become reality, the NHS board will be responsible for the allocation of spending and will consider a whole range of areas.

[Andrew George]

I want to raise a point for clarification. The Minister described the role of the NHS board and made it clear that it will be remote from political micro-management. He also said that he cannot give me or the PCTs that are a long way below their targets any answer until after the spending review. Will the decision on the pace of change towards achieving targets be made by the spending review, or will that decision be made ultimately by the independent NHS board? If he cannot say which of the two, or which combination of the two, when will I and other hon. Members receive a clear answer on what will happen and who will make the decision on the speed of change?

[Mr Burns]

I believe that I can help my honourable colleague. The ultimate decisions will be made by the NHS board when it is established, but he will appreciate that primary legislation will be required and that that will take time. In the meantime, the allocation of funding for health care throughout the country will be done initially following the spending review, but when the board is established on a statutory basis and operating, it will take over that function. I hope that has cleared up the matter for my honourable colleague.

[Mr Burns]

That is a reasonable question, and I shall be reasonable in my response. The date will be determined partly by Parliament because primary legislation will be required, as outlined in the Queen’s Speech last month. Speaking as an ex-Whip rather than a Minister for Health, I anticipate that the legislation will make progress through Parliament this Session and receive Royal Assent in July next year, or perhaps September, depending on whether there is a spillover in September or October next year, which I do not know at the moment. That is my guess as an ex-Whip for the timetable for the primary legislation. We will then have to wait to see at what point after that it will be up and running, but my guess is that it will be as soon as is feasible.

[Andrew George]

Given the state of flux and the uncertainty of the spending review, which will be followed by the creation of the independent NHS board, there will be a vacuum because decisions have yet to be made in this two-stage process. Will the Minister agree to meet colleagues from Cornwall and me to discuss the progress of that review, either at the time of the review itself or immediately afterwards? We would find that very helpful, because we know that the NHS budget in Cornwall is under tremendous pressure at the moment.

[Mr Burns]

I reassure my honourable colleague that there is not a state of flux. There is a state of potential change, yes, because there is a new Government with an important vision for the future of the health service. That is a difference, but there is not a state of flux because there is stability there. I am not criticising him, but I wanted to reassure him, so that he did not get the impression that there was a state of flux, with the connotations that that has. There is no state of flux. We have a vision, which will be unveiled shortly, but we have things in place to make sure that the system is running properly.

The other thing I would like to repeat—it is so important that it does not matter if it is repeated again, because the issue has featured frequently during today’s debate—is that the Department of Health budget is, of course, protected, which means that in every year of this Parliament, it will increase in real terms. There will be pressures on the Department of Health budget but, under the coalition agreement and the commitment that my party gave prior to the general election, which has been upheld by the coalition agreement, there will be a real-terms increase in that budget. That gives a degree of stability to the health service because it knows that, in every year of this Parliament, it will receive that money.

I thank my honourable colleague for his earnest and informed contribution to today’s debate. As a constituency MP myself, I respect and appreciate the tremendous battle that he has fought over a number of years for Cornwall. I am thrilled to see that my hon. Friend the Member for Truro and Falmouth is also joining in fighting for her constituents to ensure that they, too, get the best health care possible. That is something that all hon. Members want and fight for on behalf of their constituents.

At its most basic level, allocation is a question of measuring need and distributing resources accordingly. To the outsider—and some insiders—funding allocation is a dense and sometimes opaque subject. As the former health editor of The Times wrote,

“only the brave or foolhardy venture into some areas of NHS management. Resource allocation is certainly one”.

I can safely say that my honourable colleague falls into the former category. I trust that he is reassured that although it is too early to comment on specific funding allocations, the coalition’s programme for government shows that we share the same basic belief in the importance of both independence and local decision making when it comes to setting funding levels for the NHS.