Health Care (London)

Anne Main Excerpts

Wednesday 8th January 2014 Westminster Hall

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

I am most grateful to my hon. Friend for giving way, and I congratulate her on her brilliant speech, which hon. Members understand from our experiences.

If clause 118 of the Care Bill goes through, every hospital and potential patient in the country will be faced with a situation in which no regard is given to clinical standards or clinical needs. The service will be based entirely upon accountancy. That is what the challenge was in Lewisham hospital. That was what was overturned. The people who knew about it—the consultants, the patients and the commissioning groups—all utterly opposed the trust special administrator proposals. We were right and we won the case. With the new powers, however, all that would be set aside and no one would be heard.

[Mrs Anne Main (in the Chair)]

Order. Before I call Ms Buck, I ask that interventions be brief. There will be time to make contributions later. This is a well attended debate and many Members have asked to speak.

[Ms Buck]

My right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) is completely correct. Lewisham hospital brilliantly exemplifies the argument.

Secondly, there must be effective partnership working between hospitals, primary care providers and local authorities in the delivery of services. It was the failure even to inform partners that elective surgery had already moved from St Mary’s hospital to Charing Cross hospital that prompted my debate some weeks ago, to which the Minister replied, and which subsequently prompted an apology for the breakdown in communication. That was not only a matter of leaving someone off an e-mail circulation list, but a complete unwillingness to collaborate even within the national health service, let alone with outside bodies such as the local council, which is responsible for social care delivery.

Furthermore, those three boroughs—Kensington, Westminster and Hammersmith—are part of a pilot scheme to demonstrate integration, yet what happened in the relationship between the Imperial College trust and those local authorities could not have been further from integration—it was like something written for a comedy sketch.

Even worse, fundamental confusion remains about how north-west London hospitals are to be configured with Hammersmith—my hon. Friend the Member for Hammersmith (Mr Slaughter) is in his place and I am sure will comment—which has a different spin on its hospital provision from Westminster, even though they are joined in a tri-borough arrangement. Even after the Secretary of State has blessed the restructuring of west London hospitals, just weeks before Imperial concludes its outline business case, we cannot even have a clear agreement on the status of Charing Cross hospital or, by extension, of St Mary’s. That goes to the very heart of whether we can have confidence in the new structure of the national health service.

Thirdly, everyone needs to keep focused on the key issues, and that takes me to the devastating impact of the Government’s ill-considered reforms on the strategic management of London’s health service. The service should be focused like a laser on delivering the vision set out by Lord Darzi, but instead it has been fragmented, diverted and injected with rules on competition when integration should be the key objective.

The King’s Fund report of only some months ago, “Leading health care in London”, stated that the recent NHS reorganisation and the abolition of strategic health authorities and primary care trusts have resulted in an “absence” of health care system leadership in London. The report states:

“The NHS reforms have created a much larger number of organisations in London and their purposes are not always well aligned; the risks of incoherence and inconsistency are high…Reorganising the NHS in London in such a fundamental way has made a challenging situation much more difficult”.

That is so significant that the country’s top emergency doctor has said that the current A and E crisis could have been averted two years ago had the Government heeded warnings of a looming collapse in casualty ward staffing.

The president of the College of Emergency Medicine has said that Ministers and health chiefs were “tied in knots” by the challenges of implementing the coalition’s health reforms from 2011 onwards, leading them to ignore the first warnings from the college of imminent crisis—that the NHS was failing to recruit enough A and E doctors. Therefore, London, which possibly has the most complex challenges and the greatest need for integrated strategic leadership, actually has the least such leadership. Had leading health care managers and professionals been able to concentrate on dealing with such tasks, we might have had some opportunity to build public confidence, carry people with us and make the changes. In fact, the exact reverse has happened.

Finally, we need community and social care and other support services that minimise unnecessary admissions, especially for chronic conditions, and facilitate early discharge. Again, we can all agree on the principle. There are some excellent specific examples of integrated practice and of people working hard to deliver it, but there are also some harsh truths of individual experiences and the funding of social care.

The reality is illustrated in letters from my constituents in response to the moving of elective surgery from St Mary’s. One letter states:

“When I had my mastectomy I was sent to Charing Cross Hosp. After the operation I went home by bus and underground holding my drainage…bottle…from my operated breast. In the same way I travelled after my cardiac arrest on my second lumpectomy due to anaphylactic shock!”

That is only one hazard of putting patients with no family far from where they live. A second letter states:

“They took my City of Westminster Taxi card from me and so I have to pay for taxis to take me to St Marys Hospital and…Charing Cross. I pay £6.50 there and the same coming home (£26 one way to Charing Cross). I cannot walk far”—

—she is unable to use public transport—

“as I get out of breath. I am 84 this year”,

diabetic and

“have had one breast removed with cancer.”

Another constituent told me:

“I have lost my…home help”—

due to the cuts in social care—

“If I’m ill, I wait for it to go away.”

London as a whole faces a £1.14 billion shortfall in social care funding as a consequence of the pressures on adult social care and of the extra costs likely to arise because of the cap—in principle, that is a good thing, but obviously revenue is necessary to fund social care costs. That situation is London-wide and has been set out clearly in a London Councils report. My local authority also set the situation out clearly in a report to the health and wellbeing board, which states:

“As a result of reductions in local government funding Adult Social Care…has to deliver substantial savings in 2013/14”—

£4.4 million in Hammersmith and Fulham, £2.1 million in Kensington and Chelsea, and £2.9 million in Westminster. The report continues:

“These are very large savings; the cumulative effects are much bigger than any other savings programme delivered in the local authorities in the past.”

That is on top of £8 million in cuts to the adult social care budget already coming into effect since 2011. The report states:

“Amongst big reductions to back office and support functions, the savings programmes also include reductions in the use of packages and placements, the greatest area of spend for ASC.”

Rather sweetly, it adds:

“Some of the savings projects may be difficult to deliver or may take longer than anticipated.”

It continues:

“Funding growth for packages and placements arises mainly in the Learning Disabilities, Mental Health and the Young Disabled care groups where client numbers are growing, but also in Older People, as people live longer and are supported in the community.”

There is an important point. There is an integration care fund, which is shifting money from the NHS into social care, but, as Westminster council’s report on the pressures on social care funding states, that funding will mainly be used for purposes that include:

“To sustain services, otherwise at risk from savings plans”.

We are in an extraordinary position. There is a transformation fund designed to put in place the services that would allow us to make changes in hospital care, with which in principle we agree—we would argue in some specific cases—but that funding is simply going to fill the gaps caused by the cuts in social care, which are the result of cuts to local authority budgets. In London, as we know, there has been a 25% cut in local authority funding, with a further 10% cut as a result of the Chancellor’s autumn statement. Much of that new money is simply sustaining services that would otherwise be at risk from savings.

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[Mark Field]

Other hon. Members want to speak so, if the hon. Lady will forgive me, I will finish with a request to the Minister. I would welcome an indication from the Government of when we can expect more clarity on how future public health allocations will be determined. I would also appreciate confirmation that the formula consulted on in June 2012 will not be used to determine public health funding allocation in future.

[Mrs Anne Main (in the Chair)]

I will call the Minister and shadow Opposition spokesman at 20 minutes to the hour. About five hon. Members want to speak. That means, bearing in mind time for interventions, about seven minutes for speeches. That is just a suggestion.

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[Mrs Anne Main (in the Chair)]

Order. Four speakers have risen to speak, all from the Opposition, so hopefully they will be mindful of their colleagues.

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[Several hon. Members]

rose—

[Mrs Anne Main (in the Chair)]

Order. I shall call Mr Gwynne at 20 minutes to four. I now call Mr Sharma.

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[Glenda Jackson]

rose—

[Mrs Anne Main (in the Chair)]

Order. I call Ms Glenda Jackson—you have one and a half minutes.

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[Jane Ellison]

Forgive me, but I really will not have a chance to respond to any of the points made if I give way. I will catch up with the hon. Lady afterwards if there are points that she specifically wants to discuss.

All the reconfigurations must focus on delivering modern health care, better patient outcomes and services as close to home as possible, but, most importantly, they must focus on saving lives and improving quality of life. Those service changes are best led by clinicians, with all of us getting involved and engaging with the process, as we must do. That is what we all want for our constituents, and there are different ways to achieve that.

Change is inevitable, as most, but not all, hon. Members have acknowledged. We have debated questions such as the changes to stroke services in London, which many campaigners predicted would have dire and dreadful outcomes. In fact, the opposite has been true, and London clinicians believe that hundreds of our constituents’ lives have been saved by the concentration of excellence in certain centres. We must be realistic about the fact that reconfiguration can bring great health benefits, as long as it meets the important tests set out by the Secretary of State, and is clinically led.

The health service has to respond to growing demand. Much of the debate has focused on the long-term challenges to the health service in London and across the country. The Government are trying to respond to those huge long-term pressures. We are looking at GP opening hours and at access. That could not be a bigger issue in London, which has a highly diverse and highly mobile population in a 24-hour city. People need to be able to access health care at a time that suits their work patterns and lifestyle, and we are pushing for changes to contracts in that area. There will be named GPs for over-75s. We are looking at the integration of social care and public health. We know that there are big challenges around that, but a big project is under way to try to tackle it.

Ring-fenced public health budgets will empower local authorities to do the very thing that many hon. Members have drawn our attention to, which is to look at the needs of local communities and respond to them at the most local level. We do not want to take a “Whitehall knows best” approach; we want to tell local authorities, “We have ring-fenced your local public health budget so that you can look at the needs of your local population and work with health and wellbeing boards and clinical commissioning groups to devise services that help people to live longer and healthier lives without the need to resort to acute services.”

There has not been much recognition of the need for the changes made to public health budgets, but of all the measures raised in the debate, those changes have some of the most exciting potential to tackle the challenges that we face.

I have touched on health and wellbeing boards. The challenge around Newham GPs would be ideal for discussion at a health and wellbeing board, where all the key people are present. It is a big challenge, and one of the first questions I asked as a Health Minister is why we struggled so badly to get GPs in our most deprived areas. There are varying answers to that, but it is a problem across the country.

The health and wellbeing board is exactly the right forum for discussion because the right people are around the table. Tackling health inequality is now built into statute through the Health and Social Care Act 2012, which must be given due attention in all parts of the health service. The Darzi-led London Health Commission will be interesting. I spoke to Lord Darzi about it just before Christmas to improve my understanding of its objectives. As a Minister with responsibility for public health and as a London MP, I will be looking closely at the commission’s outcomes and I will be keen to work with people on that. It is a big opportunity.

To touch on the point raised by my hon. Friend the Member for Cities of London and Westminster (Mark Field), the formula does not currently reflect non-resident population or the homeless, but that is something that the Advisory Committee on Resource Allocation and NHS England continue to consider. I will ensure that I draw my hon. Friend’s concerns to their attention and that those are fed into the ongoing process of looking at formulas.

For the first time, the formulas for CCG patients and public health allocations take into account health inequalities, and they look at GP populations rather than census-based populations. The formulas are also designed to be more locally sensitive. As the hon. Member for Westminster North and I know particularly well, in a city such as London areas that appear to be quite affluent can contain pockets of tremendous deprivation. The new formula allows for that by enabling consideration of sub-areas and the real health inequalities that they suffer. I hope that hon. Members feel some reassurance about that. We keep the matter under close watch.

Several detailed concerns were raised by the hon. Member for Lewisham East (Heidi Alexander) about Lewisham, the south London reconfiguration, maternity services and accommodation. The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne) referred to clause 118. I will ensure that I draw his concerns to the attention of the Minister who is leading on that Bill. No doubt that point will be responded to when the Bill is brought before the House. The Court of Appeal overturned the decision to make service change in Lewisham, and we respect that. The Secretary of State has put that on the record.

Several points were raised about the north-west London reconfiguration. That was debated in this Chamber on 15 October, after which a letter was sent by the local NHS to the hon. Member for Westminster North. If other hon. Members have not seen that letter and would find it helpful to, I am happy to put it in the Library. I note the ongoing concerns expressed by the hon. Member for Hammersmith (Mr Slaughter) about the reconfiguration, and I will relay to the Secretary of State the detailed points that he has made and his desire for a meeting.

Other hon. Members have made comments about the same reconfiguration. For all the criticism of the plans and the analysis, I note that the shadow Minister did not commit his party to changing any of the reconfigurations or to changing NHS funding levels. If I may say so, his speech was long on analysis and short on commitment.

I conclude by saying that the issues raised today are important to all of us as London MPs. There are some big long-term challenges and the Government are trying to respond to them in the best interests of all our constituents.

[Mrs Anne Main (in the Chair)]

Before we commence the debate on Scotch whisky excise duty, I should say that we are expecting a vote—hence my glances at the Annunciator screen. Should that happen, I will call for the sitting to be suspended until the vote has taken place.

Health and Social Care

Anne Main Excerpts

Monday 13th May 2013 Commons Chamber

[Mr Leigh]

That is an interesting argument. I have appended my name to the important amendment to the Queen’s Speech, and we should have a serious debate on the issue. This is not Conservative Members of Parliament obsessing about Europe; this is a real issue for people. It is no longer a dry as dust issue.

In Boston, a seat with a 12,000 Conservative majority, UKIP won nearly every council seat two weeks ago. Unlike my hon. Friend the Member for Stone (Mr Cash), the people there are not particularly worried about all the details of European legislation, but they are worried about immigration. I echo what my hon. Friend the Member for Broxbourne (Mr Walker) said in his very measured speech: people in Lincolnshire are not closet racists. They welcome Polish, Lithuanian and Latvian people, but they want their public services to be supported, when, on the coast of Lincolnshire, public services are overwhelmed. Since 2004, 1.1 million have arrived in this country from eastern Europe, and we have to address that issue.

[Mrs Anne Main (St Albans) (Con)]

Will my hon. Friend give way?

[Mr Leigh]

I am sorry; I have only a short time left.

Speaking personally as a comfortable, middle-class person living in the hinterland of the beautiful Lincolnshire wolds—where, incidentally, we held all the seats we were defending—and in a comfortable part of London, I have no angst about Poles. They are hard working, and I think that most of them will go back. Their religion is estimable, and I have no complaint whatever against them. But we should listen to the people who are worried about public services, and this is therefore a European issue.

I personally believe that we should listen to those people and that we should have a referendum. I would also say to my right hon. Friend the Member for Mid Sussex (Nicholas Soames) that I believe that the Prime Minister is absolutely a man of honour and a gentleman, and there is no doubt in my mind that if he is still Prime Minister in 2017 we will have that referendum. The trouble is that ordinary people—if I may use that expression—do not think like us. They do not think in terms of four-year Parliaments; they think about now. The question they ask is, “If this is such an important issue, why can’t we have a referendum in the next two years?”

There should at least be a mandate referendum that we can put to the British people, asking whether we should have a new relationship with Europe based on political co-operation and economic free trade. If we fail to listen to the people, we will create a sense of alienation and, despite all our success in driving through the Government’s central economic policies and tackling the deficit—the reason that the coalition was created and what we are really about—that would eat away at the support for the coalition. A sense of alienation is created when people are worried about their public services.

People are worried about other issues as well. In the middle of my constituency, the Government are erecting wind turbines more than 150 metres high—taller than the highest point in the Lincolnshire wolds—that are being paid for by ordinary people living in terraced houses in Gainsborough. They are paying £100 a year, and the money is going straight into the pockets of rich farmers, all in the name of dealing with global warming—if indeed there is global warming, if indeed carbon emissions are causing it and if indeed wind farms will make any difference. That all adds to people’s sense of alienation.

People also worry about the budget for international development. I am personally in favour of spending money on international development, but we have a commitment to spend 0.7% of our gross national product, for which there is no scientific basis. As we reduce the number of staff in the Department for International Development, we are loading more burdens on the remaining staff to hand out more money. That is simply not good economics. It is not a good way to run a Department.

I do not believe we should ring-fence the budget of any Department. We should spend wisely and carefully on the right things at the right time. Whether we are talking about same-sex marriage, about the EU referendum or about the DFID budget, we must recognise that people are feeling a sense of alienation, and that good, strong Conservative voters do not feel that their Government are representing them all the time. Let us also put the focus on the Labour party, but let us concentrate on the core issue of getting rid of the deficit. Let us make that the successful mission of this Parliament.

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[Mr Kevin Barron (Rother Valley) (Lab)]

I have to say to the hon. Member for Mid Bedfordshire (Nadine Dorries): welcome back to the Conservative party. I heard what she has been saying today from the Conservatives about 20 years ago. It led to their spending 13 years in opposition, and I hope it has the same result in a couple of years’ time. I look forward to that.

This debate seems to be more about what is not in the Queen’s Speech than what is, but immigration and access to the national health service are addressed, and the tone of this debate has been quite distasteful. We know that, from time to time, some of our constituents go to work in other European economic area countries; they pay their taxes and social insurance contributions there, and as a consequence they are allowed to obtain health care in those countries. Immigrants are not coming to this country to use our national health service, and they do not use it for free: they pay, as they should.

We need be very careful when we talk about people moving around Europe. Tens of thousands of our fellow citizens have gone to live in Spain, Portugal and France, not to work but to retire. If they return to this country en bloc, consider the impact on the health service, social care and care for the elderly. We need to have a rational debate on this issue.

[Mrs Main]

In the last Parliament, I was privileged to serve on the Communities and Local Government Committee. We produced a report on community cohesion and integration under the right hon. Gentleman’s Government. It said that the pace of change, the resources and facilities were all wrong, and many of the communities we visited said that. He needs to show a little humility when talking about immigration and numbers, because his own Government condemned the situation in that report.

[Mr Barron]

It was not a Government report but a Select Committee report, and I do not remember it, quite frankly.

Community cohesion is important and has been important in this country for centuries—not just since we joined the European economic area or the EU expanded to 27 countries, with people having the right to come and work here, as indeed we have the right to go out and work in other EEA countries. A lot of this debate is distasteful and is not the truth. In a recent by-election, a political party that is not represented here and I hope will not be was saying that, as of January next year, probably nearly half the population of Bulgaria will come and work in this country. That is nonsense, and neither Back Benchers nor Front Benchers should have a knee-jerk reaction to that type of debate. We should have sensible debates about what immigration does or does not do in this country.

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[Sir Gerald Howarth]

My hon. Friend is absolutely right. I was going to tell the right hon. Gentleman that some 1% of the Romanian population of working age, which is 150,000 people, have indicated that they wish to come to this country, as have 4% of the 4.9 million Bulgarians of working age, which is another 200,000 people. That is another 350,000 people. We cannot go on building houses and cities. As MigrationWatch has said, we will need eight cities the size of Birmingham if we are going to accommodate all the people who wish to come to this country.

I welcome the fact that the Opposition have at long last recognised that this is a serious issue. They have not a snowball’s chance in hell of being re-elected unless they are prepared to recognise the concerns of the British people. Under Labour’s stewardship, there was a deliberate act of policy: Andrew Neather, a speech writer at No. 10, said immigration was being positively encouraged by the Labour Government in order to

“rub the Right’s nose in diversity.”

They knowingly inflicted this on the country—it was not done by accident—and they left this Government with the most awful backlog of cases to deal with, which is unfair to those who ought to be allowed to stay in the UK and to those in our country whose lives are affected by the presence here of people who should have been deported.

[Mrs Main]

The Select Committee report “Community Cohesion and Migration”, which Labour Members seem to have forgotten about, stressed that second and third-generation immigrants were as resentful as the native British population, because the necessary resources were never provided by the Government, who encouraged so much immigration so fast and without preparation.

[Sir Gerald Howarth]

My hon. Friend is absolutely right. Immigration is imposing burdens on our services, such as the health service and social services. I am seeing that in my own constituency. We now have some 10,000 Nepalese, mostly elderly, who have come to the United Kingdom as a result of the politicians’ caving in to the campaign run by an actress called Joanna Lumley. That has resulted in a fundamental change to the nature of Aldershot that has deeply upset my constituents, who are entitled to express a view without being told that they are racist. They do not like seeing their locality changed—[Interruption] I wish the right hon. Member for Rother Valley would shut up—because of something on which they were not asked for their opinion. When they do express an opinion, they are dismissed as being racist.

The projection that the United Kingdom’s population is likely to reach 70 million in the next 15 years means, as I said, that we will need to build eight large cities outside the capital during that time—in other words, one home every seven minutes, day and night, just to house new immigrants unless the Government are able to continue their progress in tackling immigration. The 2011 census revealed a mass exodus of white British from the city of London—a fall of 600,000 between 2001 and 2011. Almost half the population of Ealing and Hammersmith were born outside the United Kingdom. These are fundamental changes to the nature of our country. The people of Britain are entitled to express a view on the composition of their country. Last week there was a story in the Evening Standard about Harris Primary Academy Philip Lane in Haringey, where 59% of the 463 children are on free school meals, 79% have English as a second language, and Somali and Turkish are the most prevalent languages. What are we doing to our country? We have to take sterner action, and I recommend that to the Government.

Let me turn briefly to Europe, which the right hon. Member for Leigh dismissed as irrelevant and not a great issue that should be addressed, although he had no answer to the challenge by my hon. Friend the Member for Gainsborough. This issue is not going to go away, and it is of great concern to people in this country. Our European partners are determined to create a united states of Europe, which is not what the people of Britain want. The Prime Minister is entirely right to seek to renegotiate. He is also right to have a referendum. Like my right hon. Friend the Member for Mid Sussex (Nicholas Soames), I profoundly believe that he will deliver that referendum after the next election. The trouble is that people are uncertain about whether we are committed to that. The way to deliver it is a new Act of Parliament during this Parliament to determine that there will be a referendum during the next Parliament.

Antibiotics (Intensive Farms)

Anne Main Excerpts

Wednesday 9th January 2013 Westminster Hall

[Zac Goldsmith]

The difficulty is that it is very hard to measure antibiotic use in extensive farming of the sort that my hon. Friend describes, whereas in organic farming there is quite clear regulation—self-regulation, in effect—which enables that comparison to be made. He is probably right, but I cannot authenticate what he says, because the data simply do not exist.

The second BPC quote that I read out cannot be true. The BPC must be aware of DEFRA’s statement last year that as many ESBLs were found in chickens in the first half of last year than in the entire previous year, so what it has said to me in its briefing simply is not true.

The BPC also says:

“Antibiotics may only be used on a farm if they have been prescribed by a veterinary surgeon”.

But it knows that producers often go straight to the feed mill, which will write out the prescription, send it to the vet’s at the eleventh hour and put pressure on them to sign it immediately. We know that because a number of vets have complained to the Veterinary Medicines Directorate about just that.

Finally, the BPC says:

“Scientific evidence increasingly recognises that the problem of antibiotic resistance in humans comes largely from the use of antibiotics in human medicine.”

That is true, as I have already acknowledged, but for certain bacteria—salmonella, campylobacter and E. coli—the farm use probably accounts for more than half the problem. It certainly accounts for a very significant chunk of the problem. With MRSA, it is probably accounting at the moment for only a few per cent. of cases, but if it is allowed to get established in UK livestock, that situation could very easily change, and dramatically.

The briefing adds, approvingly, that the use of growth-promoting antibiotics was banned 10 years ago in this country. It is probably worth pointing out that that ban came into force only in 2006 and was vigorously opposed by the BPC at the time. Perhaps for that reason, the British Government of the time, initially at least, was the only EU member state Government to oppose the ban. That is another example, I would suggest, of the industry calling the shots on this issue.

I must acknowledge that, 12 months ago, the BPC agreed to introduce a voluntary ban on the use of cephalosporins in poultry production and to stop giving fluoroquinolones to day-old chicks. That does not go nearly far enough, but it is an important step forward and demonstrates an acknowledgment by the BPC, albeit a reluctant one, of the problem.

There is no excuse to delay. The warning has been there since 1945, when, on accepting his part of the Nobel prize in medicine for the discovery and isolation of penicillin, Alexander Fleming said that

“there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”

If we continue to ignore this risk for fear of upsetting vested interests, we will be complicit in robbing future generations of one of the great discoveries of our species and propelling us—apologies for repeating myself—into a truly frightening, post-antibiotic age. It is surely time for the Government to act.

[Mrs Anne Main (in the Chair)]

For clarification to those participating in the debate, it will finish at 5.10 pm.

National Health Service

Anne Main Excerpts

Monday 16th July 2012 Commons Chamber

[Andy Burnham]

My hon. Friend makes his point powerfully. With some reconfigurations there is a clinical case supporting change, such as the changes I introduced in London before the last election to improve stroke services. We reduced the number of centres from 12 to eight. That was a difficult decision for many London Members at the time, but it was the right thing to do because lives are being saved. However, there is a world of difference between those changes and the crude, cost-driven reconfigurations in the NHS that those on the Government Benches said they would not allow.

I spent my weekend reading a very entertaining book entitled “Never Again? The story of the Health and Social Care Act 2012: A study in coalition government and policy making”. It is a very interesting book and offers a new, detailed account, by Nick Timmins, of the Government’s NHS reorganisation—or, as it says on the blurb, the inside story of a “car crash”. I particularly enjoyed the quotation from the Minister of State—I gather that he has not read it, but there he is, up in lights at the very beginning of the book. He made this comment about the then Bill, which the author thought worthy of special attention:

“You cannot encapsulate in one or two sentences the main thrust of this.”

He should know that better than anybody, as he toured more media studios than anybody, and used more sentences than anyone, in a vain attempt to sell the technocratic and dense plans that made sense to his boss and nobody else.

[Mrs Anne Main (St Albans) (Con)]

Given that the biggest strain on most health authorities is staff pay, does the right hon. Gentleman regret the fact that Labour doubled the remuneration of GPs, allowing them to opt out and thus putting huge stresses on many health care authorities, which then had to buy in additional services? Does Labour not regret allowing doctors to be paid more for doing less?

[Andy Burnham]

I am interested in the argument that the hon. Lady is beginning to develop, which is that she wants to deliver pay cuts to NHS staff across her constituency. Presumably she wants the same as people in the south-west are getting. Is that what she is calling for? It is an interesting argument, and I would be interested to hear her expand on it later.

Health and Social Care Bill

Anne Main Excerpts

Tuesday 13th March 2012 Commons Chamber

[Mr Lansley]

I am afraid that the hon. Gentleman is completely wrong. The private income cap for foundation trusts was debated fully in Committee in this House, and it has been debated again in another place. The reason for the so-called 49% was simply that Members in another House said that they wanted to be absolutely clear that the principal legal purpose of foundation trusts is to provide services to the NHS, and therefore that, by definition, a foundation trust could not have more of its activity securing private income than NHS income, hence the 49%. But in truth, the safeguards that are built in make it absolutely clear that, whatever the circumstances and whatever their private income might be—from overseas activities or overseas patients coming to this country—foundation trusts must always demonstrate that they are benefiting NHS patients. That is why, I remind the House again, the foundation trust with the highest private income—27%—is the Royal Marsden, which delivers consistently excellent care for NHS patients.

[Mrs Anne Main (St Albans) (Con)]

Does my right hon. Friend share my absolute astonishment at Labour Members’ collective amnesia when it comes to the 13 years of mixed-sex wards and rising levels of MRSA and C. difficile that they presided over, along with a failed patient record system that has cost billions?

[Mr Lansley]

My hon. Friend is absolutely right, and I will come to some of those points. However, I might just say that, in the space of the last few days, we have had an opportunity to demonstrate that Labour signed up to an enormous, centralised, top-down NHS IT scheme that was never going to deliver, was failing to deliver and was costing billions.

Health and Social Care Bill

Anne Main Excerpts

Tuesday 28th February 2012 Commons Chamber

[Mr Lansley]

I can give the right hon. Gentleman the same reassurance that the Minister of State gave.

[Mrs Anne Main (St Albans) (Con)]

Will my right hon. Friend confirm that the previous Government were, in 2006, given the advice that it was neither possible nor desirable to ensure that competition was not allowed in the NHS because it is subject to EU competition rules?

[Mr Lansley]

I am glad that my hon. Friend has made that important point. People such as the former Chair of the Select Committee on Health, the right hon. Member for Rother Valley (Mr Barron), who is no longer in his place, are fond of asking why we are introducing competition into the NHS. We are not. The Bill does not introduce competition to or extend competition within the NHS. The legal advice disclosed in one of today’s national newspapers makes it clear that the previous Labour Government introduced the reach of competition law into the NHS by introducing the elective choice programme in 2006.

HIV

Anne Main Excerpts

Tuesday 29th November 2011 Westminster Hall

On resuming—

[Mrs Anne Main (in the Chair)]

I remind hon. Members that there are 16 minutes of this interesting debate left. Members who make interventions should do so briefly.

Reform of Social Care

Anne Main Excerpts

Monday 4th July 2011 Commons Chamber

[Mr Lansley]

On the hon. Gentleman’s point about local government, he should remember that the overwhelming majority of the residents in Southern Cross care homes are funded by local authorities, and that is precisely why we are working with local authorities to ensure that those residents’ interests will be protected. I recognise the problems that we have seen with Southern Cross, although I do not know of any other companies in a similar position. None the less, it is one of the reasons why we seek the powers in the Health and Social Care Bill to regulate social care provision in the same way as health care provision.

[Mrs Anne Main (St Albans) (Con)]

If we are to see elderly and disabled people needing more carers, my right hon. Friend will need to work with the Secretary of State for Education to enhance the status of those who work in the care industry, because we will need far more people willing to work in it and with the skills, qualifications and commitment needed to give the enhanced care that people would like to receive.

[Mr Lansley]

I am grateful to my hon. Friend. During the engagement that we are undertaking, one of the areas that we should certainly pursue is the work force development strategy in relation to care and support—and we will do that.

NHS Reorganisation

Anne Main Excerpts

Wednesday 16th March 2011 Commons Chamber

[Mr Lansley]

No, I will not give way—Labour Members might like to hear this.

Our cuts in bureaucracy have led to 2,000 fewer managers since the general election and 2,500 more doctors. We are already shifting resources to the front line. More than 5,000 surgeries across the country are now part of the pathfinder groups taking responsibility for front-line services. Some 25,000 front-line NHS staff are taking the opportunity to come together in social enterprises. All this is the modernisation that Labour now opposes. It is the modernisation that is delivering the results that matter, and will matter in future even more as we get to the outcomes that people really care about—whether they live, whether they recover, whether their treatment is successful, whether they have successful lives at home with long-term conditions.

At the same time, waiting times are stable and hospital infections are down, with C. diff down by a fifth and MRSA down by more than a quarter. The number of patients who are in mixed-sex accommodation when they should not be has also come down.

[Mrs Anne Main (St Albans) (Con)]

Does my right hon. Friend agree that we should totally dissociate ourselves from the disgraceful remarks implying that our reforms will somehow encourage GPs to make choices that are not best for their patients?

--- Later in debate ---

[Rosie Cooper]

No, I have very little time now.

I believe that what Michael Portillo said on the BBC’s “This Week” programme was an accurate reflection of how the Government have sought to mislead the people of this country. When asked by Andrew Neil why the Government had not told us about the plans for the NHS prior to the general election, he responded:

“Because they didn’t believe they could win the election if they told you what they were going to do. People are so wedded to the NHS. It’s the nearest we have to a national religion—a sacred cow.”

He could not have been more clear: the Government intended to misrepresent their position and to mislead voters.

As I have said previously, this Conservative Government have been prepared to play to the gallery while playing Russian roulette with the future of people’s health services. That is still the case, but the gallery is now empty. They are on their own and have no mandate—

[Mrs Main]

On a point of order, Mr Deputy Speaker. On two occasions the hon. Lady has accused the Government of misleading the public. I cannot believe that that is the case, and I am sure she would like to withdraw those remarks.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. That is not a point of order, because the accusation was not against individual Members.

Public Health White Paper

Anne Main Excerpts

Tuesday 30th November 2010 Commons Chamber

[Mr Lansley]

I understand the hon. Lady’s point. Sir Michael Marmot has generously welcomed the White Paper’s proposals and its thrust. He made a specific proposal about a specific standard of living related to health—effectively a basic income proposal. That is not the Government’s proposal, but we intend to act on the other five domains in his report, the effect of which, among other things, will be to ensure that the welfare to work programme—the most ambitious and comprehensive programme ever initiated by any Government in this country to take people off benefits into work—will support people not only through better disability benefit assessments, which will help in health assessments, but by ensuring that people in work are healthier because they are less likely to be poverty and more likely to be free of the distress associated with unemployment.

[Mrs Anne Main (St Albans) (Con)]

In St Albans we are lucky that people live for quite a long time, but often elderly care packages are not put in place to allow elderly care patients to come out of hospital and into adult social care services. Will the proposals in the White Paper to give local government more control help to ease this problem?

[Mr Lansley]

As my hon. Friend may know, we are acting already. Through the spending review we have made very clear the NHS commitment to support local authorities in the delivery of adult social care responsibility, particularly through the integration of health and social care. That includes £70 million this year for re-ablement, £150 million in the next financial year for more re-ablement activity and nearly £650 million in the next financial year in direct support from the NHS for preventive and other activities to support social care. That will make a big difference to her constituents.