EU Working Time Directive (NHS)

Chris Skidmore Excerpts

Thursday 26th April 2012 Westminster Hall

[Chris Skidmore (Kingswood) (Con)]

As a member of the Select Committee on Health, I am very interested in this debate. I have learned a lot from the engaging contributions of all hon. Members who have spoken.

I want first to acknowledge the hard work of my hon. Friend the Member for Bristol North West (Charlotte Leslie), and not only for this debate. I want to put on the record the fact that she has campaigned on the matter for nearly two years. She has brought it up in recess Adjournment debates, Health questions, Prime Minister’s questions, and a ten-minute rule Bill—the NHS Acute Medical and Surgical Services (Working Time Directive) Bill. She has not let the issue go, and I think it is important to put that on the record because, without all her work over the past two years, we would not have achieved this Back-Bench debate today, which is extremely important, and the final Backbench Business Committee debate of the Session—and very apt it is too.

Following my hon. Friend’s two-year campaign, the exact financial cost and burden on the NHS caused by the directive is becoming clear. On 18 March, The Sunday Telegraph published a freedom of information request about the cost, and some of the figures have been read out, but I want to read out a few more to place them on the record. Of the hospital trusts that provided figures, 80% admitted spending more than £1,000 per shift on medical cover as a result of the EU working time directive. In total, £2 billion has been spent on that since 2009, which is roughly equivalent to the wages of 48,000 nurses or 33,000 junior doctors.

We have talked about inequalities. It is worrying that some trusts are clearly suffering more than others, and some are in extreme financial difficulties. Yet North Cumbria University Hospitals Trust spent £20,000 on hiring a surgeon for one single week. Mid Staffordshire NHS Foundation Trust—my hon. Friend the Member for Stafford (Jeremy Lefroy) referred to this—spent £5,667 for a doctor for just one 24-hour shift in a casualty unit. The Christie NHS Foundation Trust in Manchester spent £11,000 on six days’ cover for a haematology consultant. Scunthorpe general hospital offered £100 an hour for one month’s work in a temporary post. Princess Alexandra Hospital NHS Trust in Essex paid more than £2,000 for a locum doctor to work a 12.5 hour shift last October.

I could go on, but I want to come back to that £2 billion in two years, and to relate it to the Nicholson challenge, which is a cross-party issue, of saving £20 billion to reinvest back into front-line services. The challenge was set in 2009 by the previous Government to take place over three years. As a result of the comprehensive spending review, that has now been extended to four years. No MP can claim that that is a cut by one Government or another, although some MPs have tried to. It is a cross-party approach, and we in the Chamber are responsible and understand that if the NHS is to remain free at the point of use, regardless of ability to pay, we need to make savings and to reinvest them into front-line care.

The coalition Government have already done a fantastic job in making savings of about £7.5 billion on the way to the £20 billion figure. But the reality is that, if this £1 billion a year cost to the EU working time directive remains, that will be a £4 billion cost over the period of the comprehensive spending review. Therefore an extra £4 billion will need to be found in efficiency savings. We are moving from a 20% efficiency gain, therefore, to almost a 25% one. [Interruption.] It appears that the Minister disagrees, but it is just a back-of-an-envelope calculation.

[Charlotte Leslie]

My hon. Friend is contextualising this debate in an important way, in respect of wider finances and the Nicholson review. Reverting to the question of evidence, does he agree that simple figures, such as these, on the cost of a directive that has been introduced are also evidence? The first-hand reports of clinicians on the ground are perhaps more reliable than the evidence gathered from sources that might not always be willing to tell the truth about the situation, for fear of not meeting compliance targets.

[Chris Skidmore]

Absolutely. On the figures I mentioned, only 34 hospital trusts responded to the requests for information, so the data were incomplete. Only 83 out of 164 responded with any data at all.

[Debbie Abrahams]

Is that not the point? This is about ensuring that we have quality data to inform policy development. It may not be working as it should be—I will accept that—but we cannot use incomplete, poor data to propose solutions. We need to ensure that we have quality data to inform that process. What if I made a statement now and that was regarded as evidence? Surely we are not going to base policy on just one person or on poor data.

[Chris Skidmore]

I agree. I am sure that all hon. Members would echo such a call. We should have complete data. The complete data, if we had them, would show that the situation is far worse and that, instead of the £1 billion a year cost, the hidden cost is, according to the data that I have, perhaps £2 billion. We do not know.

My hon. Friend the Member for Bristol North West, almost like a Cassandra, warned that this would be a problem back in 2010, and started the campaign with no data at all. Two years down the line, we find what she said to be true, in respect of data from individual trusts. We will know more, probably, by the end of this year and there will be more stories in the Sunday papers and it will become an ever bigger issue. That is why it is so important to have this debate now, because when the public and patients who use the NHS ask, “What were you doing about this, as MPs?”, we can say, “We’ve had this debate. Okay, it’s not come up with all the solutions just yet”—we are interested to hear what the Minister says about possible solutions—“but we are on the case.” That is important, because an avalanche of cases will come forward in the near future. It is important to recognise that.

There is a challenge from Nicholson and we need to make those savings. The problem is that this matter is standing in the way of the Nicholson challenge being effectively delivered. Either we have to push harder to gain those efficiency savings—the problem now is that we have inefficiencies of the worst kind and are essentially having to make more efficiencies elsewhere to reinvest in front-line care—or the money will not be reinvested back into front-line care. Working time directive costs are classed as front-line care, when clearly they are not, so money is being removed that could be spent on nurses or on alternative equipment for the NHS that would have benefited patients.

[Mr Simon Burns]

My hon. Friend might find it helpful to know—he is talking about the Nicholson challenge and asking, “What were we doing during this”—and might take some comfort from the fact that, since May 2010, the cost of locums has fallen by 11%.

[Chris Skidmore]

I appreciate that information. I only have pre-coalition data from 2007-08 and 2009-10, although they are not inaccurate. It is interesting to note that, before the coalition came in, the cost of locums was rising enormously, from £384 million to £758 million. The coalition’s inheritance was enormous. It is good to hear that there has been an 11% saving, which is roughly £75 million.

[Mr Burns]

Let me give my hon. Friend the precise figures on the savings. The number of people employed as locums by the NHS has fallen by 11% since May 2010, and the number of doctors in the NHS has increased by about 4,000.

--- Later in debate ---

[Chris Skidmore]

I welcome those figures. The coalition Government clearly recognise that front-line care is in danger of becoming atomised. We want continuity of care and front-line doctors, and we want full-time doctors and nurses rather than locums. Over the past couple of years—I am not blaming any one Government in particular—we have seen a sort of fragmentation and atomisation so that we now have 50 agencies delivering locum services, one of which has a turnover of £100 million a year. We need to look at that issue. The working time directive has been blamed for the rise of locum doctors, and it is good to hear that the coalition Government are making strides to change that, and we must recognise that in this debate.

The issue of training has been raised, as well as the fact that 400,000 hours of surgical time are lost every month—that is 4.8 million hours every year. My hon. Friend the Member for Hastings and Rye (Amber Rudd) was very informative about the impact that that will have on surgery as a craft, and I appreciate that. Professionalism is an issue, and the clock on, clock off attitude is not what any of us wants to see in the NHS. We want professionals to be in charge of their services in the NHS, and such an attitude clearly puts them out of charge.

On the timeline, the Secretary of State for Health claimed that the “Time for Training” report by Sir John Temple reinforced his,

“determination to support efforts to resolve these difficulties and be ready to work constructively with the European Commission and other member states on radical, creative approaches to gain additional flexibilities.”—[Official Report, 9 June 2010; Vol. 511, c. 14WS.]

The Prime Minister responded on the Floor of the House to a question from my hon. Friend the Member for Bristol North West:

“My hon. Friend raises an important issue about the working time directive and its effect on the NHS. Nobody wants to go back to the time when junior doctors were working 80 or 90 hours a week, but I think we all see in our constituencies that the working time directive has sometimes had a bad effect on the NHS…The Health and Business Secretaries are committed to revising the directive at EU level to give the NHS the flexibility it needs to deliver the best and safest service to patients. We will work urgently to bring that about.”—[Official Report, 18 January 2012; Vol. 538, c. 745-6]

My hon. Friend, and others, have spoken about other countries such as Spain, the Netherlands, Ireland and Portugal, which all somehow manage to get around the directive. I was interested to read my hon. Friend’s article in The Times where she wrote about what happens in the Netherlands and stated that Dutch trainee doctors are categorised as autonomous workers because they earn more than three times the national minimum wage. Being classified as working for themselves exempts them from the directive. There is a similar situation in Ireland where training has been exempted from the definition so that work done by trainee doctors falls outside the directive.

We must either look at the EU angle—many Members have raised the issue of the European Union—or at what the British Government can do within the NHS. GPs are self-employed. Can we not think radically and ask to what extent doctors working in hospitals could also be classed as self-employed so that we can get round the regulations? That is worth thinking about, although I am not sure what the consequences would be.

[Mr Burns]

I really do not want to be a clever clogs. My hon. Friend has accurately described what happens in the Netherlands, but even with the opt-out, weekly hours in that country are limited, in that case to 60 hours.

[Chris Skidmore]

Sixty hours would be a start—65 is what most people seem to be calling for. It is about getting a balance. We do not want to go back to the 80, 90 or 100-hour working week, but nor do we want to face the consequences of the 48 or 56-hour working week. There is a balance to be struck, and I would be very interested to hear what the Minister thinks can be done. This debate is obviously an interesting one because it can go down a European direction, which I know a Health Minister cannot say very much about today. However I would be interested to hear what he has to say about the NHS in his capacity as a Health Minister.

[Ian Paisley]

There is also the issue of bean counting. We must be very careful, because this debate is about delivering something to the patient and ensuring that the team around the patient, including the doctors, co-ordinate their work to meet the needs of the patient. If we get into very strict bean counting—whether we are talking about 48 hours, 60 hours or whatever—and do not recognise that this is about a patient-centred service, we will keep having more and more of these problems that we have discussed. That is the critical issue, and why we need the flexibility.

[Chris Skidmore]

I entirely agree with the hon. Gentleman. Patient-led care is where we must get to. That is why we are all here; that is what the Health and Social Care Act 2012 will deliver. I am sure that we will all be working further to ensure that the patient is placed at the heart of the NHS.

Oral Answers to Questions

Chris Skidmore Excerpts

Tuesday 27th March 2012 Commons Chamber

[Paul Burstow]

Of course, I will be only too pleased to have that meeting.

[Chris Skidmore (Kingswood) (Con)]

Is the Minister aware of the publication today of the industrial action review by the London ambulance service, which details that on 30 November, the day of the public service strikes, in the afternoon and the evening, requests for front-line staff to return to front-line ambulances were made by the London ambulance service. However, of the three unions to strike, only Unison responded to say that it would not ask staff to return to work. Three hours later, after three repeated requests for help, a patient who had been unable to get an ambulance had died. The report has called—

[Mr Speaker]

Order. The hon. Gentleman should resume his seat. I do not wish to be unkind, but topical questions are about short questions, and that was not. I am very sorry. The Minister may give a brief reply if he wishes.

Health and Social Care Bill

Chris Skidmore Excerpts

Tuesday 20th March 2012 Commons Chamber

[Liz Kendall]

I absolutely concur with my right hon. Friend. For the record in this House, I pay tribute to our colleagues in the Lords for their achievements and their efforts in securing some of the protections for the NHS that we are debating today.

There was absolutely no mention of education and training in the original Bill, despite the fact that the Bill abolishes strategic health authorities, which play a vital role in education and training—for example, by hosting deaneries. Labour Members raised this issue in the first Commons Committee stage. We also tabled an amendment on Report to place a duty on the Secretary of State to ensure a comprehensive education and training system for all professions in the NHS, which would have included continuing professional development. Labour Members in the other place then tabled amendments to address the issue. I should note, again for the record, that it was Labour and Cross-Bench Lords, not Liberal Democrat Lords, who argued for those important amendments and who forced the Government to introduce substantive new clauses placing duties in respect of education and training on the Secretary of State, the NHS Commissioning Board and clinical commissioning groups.

However, the critical issue that I want to focus on is how to deal with conflicts of interest in clinical commissioning groups. Clinical commissioning groups will be responsible for spending around £65 billion of taxpayers’ money. They will be made up of a majority of GPs—professionals who run businesses that are largely, and in many cases wholly, dependent on the NHS for their income. Clinical commissioning groups will commission NHS services, some of which will be provided by GPs who are members of the group, or—as is increasingly envisaged by the Government—by companies in which GP members may have a financial interest. The public must have confidence that clinical commissioning groups are making decisions based on patients’ and taxpayers’ best interests, not the financial interests of GPs.

[Chris Skidmore (Kingswood) (Con)]

rose—

[Liz Kendall]

I will finish this point.

However, under the Bill, clinical commissioning groups—the newest bodies in the NHS, and with the least experience—will have the weakest corporate governance of any public body in the country. They are required to have only two lay members. However, there has been no reassurance in this House or another place that those members will be independently appointed. The Government have not even given a reassurance that the chairs of clinical commissioning groups will be lay members. The Government have also failed, at every faltering stage of this Bill, to ensure robust protections against actual or perceived conflicts of interest in clinical commissioning groups.

[Chris Skidmore]

Will the hon. Lady give way?

[Liz Kendall]

No, I am going to proceed.

Let me remind hon. Members that the Bill started out without any requirement for GP consortia—as they were then called—even to have a board to govern their work, let alone any measures to deal with potential conflicts of interest. On 3 March last year, in the first Commons Committee stage, Labour Members called for effective corporate governance and robust measures to deal with conflicts of interests in clinical commissioning groups.

Health and Social Care Bill

Chris Skidmore Excerpts

Tuesday 13th March 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move,

That this House notes the e-petition signed by 170,000 people calling on the Government to drop the Health and Social Care Bill; and declines to support the Bill in its current form.

I do so on behalf of the 170,000 people who have signed the e-petition calling on the Government to drop the Health and Social Care Bill.

The petition was initiated by Dr Kailash Chand, a distinguished general practitioner in the north-west of many years’ standing, and I pay tribute to him today. He has united patients who depend on the NHS and professionals who have devoted their lives to it in this simple but sincere call on the Government: “Drop the Bill”. Today, their voice will be heard in this House, as it is entitled to be. We will not let them be silenced, even though attempts were made to stop this debate taking place.

That takes us—

[Chris Skidmore (Kingswood) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

No. I have been listening to the strictures from the Chair, and I want to get into my speech so that Back-Bench colleagues have a chance to contribute.

That takes us straight to the heart of the predicament in which we find ourselves. There is huge concern in the country about the Bill, but the Government and Parliament—

--- Later in debate ---

[Chris Skidmore (Kingswood) (Con)]

It is an honour to speak in this debate.

I thought that I should set out the context of our discussion. Members on both sides of the House have talked about demand, in particular, and it is important to look at that question. Most importantly, we must admit that the NHS needs to adapt under new pressures. In 2001 the NHS treated 12 million patients. Today that figure is 17 million, so in other words the number of people accessing the NHS has risen over the past decade from 101 per minute to 124 per minute, resulting in the cost of drugs and prescriptions rising by more than 65%.

[Mr Anderson]

Will the hon. Gentleman give way?

[Chris Skidmore]

No, I will not. The right hon. Member for Leigh (Andy Burnham) did not give way to me, I am afraid, so I am not feeling too charitable.

Despite the coalition Government’s added investment of £12.5 billion over the course of this Parliament, demand will only rise further, with 1.6 million people turning 65 in the course of this Parliament and many living into their 80s and beyond. The number of 85-year-olds will double by 2030. The NHS is facing a perfect storm—an ageing population combined with a rise in chronic conditions, including an increase in diabetes, which will take up as much as 25% of the health budget. That is why we are reforming the NHS. Just as this Government are committed to dealing with the deficit so that future generations will not be burdened with debt racked up yesterday, we must be committed to reforming the NHS so that future generations can enjoy an NHS that is free at the point of delivery regardless of the ability to pay. I am sure that that is what everyone in this House is committed to.

By placing GPs rather than management in control of patient treatment, we will not only drive up standards of care, allowing patients access to more treatments under any the qualified provider scheme, but ensure that recurrent cost savings are made to be reinvested in the NHS to cope with the rising demand. Above all, this is an evolutionary measure. My right hon. Friend the Member for Charnwood (Mr Dorrell) touched on the Blairite doctrine. It was a pleasure that we had Professor Julian Le Grand come to the Health Committee, where he said that if Tony Blair were still Prime Minister and he were advising him, he would have urged him to undertake this measure. It is great to see the right hon. Member for South Shields (David Miliband) in his seat. It would have been fascinating to see what would have happened if he had become leader of the Labour party. I am sure that we would not have seen the rank tribalism that we have seen from those on his Benches today.

[Andy Burnham]

We are supporting the amendment.

[Chris Skidmore]

I am talking about the right hon. Member for South Shields, not the hon. Member for St Ives (Andrew George).

Professor Julian Le Grand stated on 28 February:

“With respect to the NHS bill, it is important that even those who generally prefer to rely upon their intuitions should avoid muddying the waters by accusing the bill of doing things that it does not, like privatising the NHS; and that all those involved should acknowledge the peer-reviewed evidence demonstrating that its provisions with respect to public competition…are likely to improve patient care.”

More hours have been given to debating this Bill than any other during this Session. Despite Labour’s message, which seems to be opposition for opposition’s sake, we are gradually learning what its policy will be for the next general election. It is interesting that at a rally in Manchester last week, the right hon. Member for Leigh stated, in front of his union faithful,

“And I will make you a promise today—if I am the health secretary after the next general election I will repeal this bill.”

According to the Opposition, this is the greatest reorganisation in history. Yet the Bill will save £4.5 billion straight away and then £1.5 billion recurrently, year on year, thereafter.

[Mr Burrowes]

All our constituents will be listening intently to the debate and will hear that following the health inequalities that have grown under the previous Government, the Opposition will oppose and repeal legislation that imposes a duty to tackle those inequalities. What will they think of that?

[Chris Skidmore]

We have already heard one Labour Member say that she welcomes the new measures on health inequalities, so it is a shame that the legislation could be repealed in its entirety.

Last week, Labour Members committed themselves to re-establishing primary care trusts and strategic health authorities—to reconstituting the NHS as if time had stood still, with middle-level management holding the reins. It is remarkable that Labour is not the party of the NHS patient but has become the party of the PCT, the SHA and, above all, the NHS manager.

[Grahame M. Morris]

On the hon. Gentleman’s point about efficiency, costs and so on, I draw his attention to an article in The Guardian today which says that the cost of replacing with a locum GPs who are away on clinical commissioning duties is £123,000 a year, while one clinical commissioning group has reported that 15 local doctors are each spending two days a week away from their surgeries. How is that an efficient use of resources?

[Chris Skidmore]

We are reinvesting the billions of pounds saved on managers into front-line care, and that is why we have already seen over 5,000 new doctors working on front-line services this year. I understand where the hon. Gentleman is coming from in terms of the political spectrum, but I believe that he is referring to a TUC press release that The Guardian published in full.

In a previous debate, the right hon. Member for Leigh said that he would put a cap on private practice in “single figures”. That would take the NHS backwards from its current position, and it is an arbitrary cap based on ideology, not on what is in the best interests of NHS patients. Nor is it in the interests of some of our best-loved hospitals. Dr Jane Collins, the chief executive of Great Ormond Street hospital, has said:

“The lifting of the private patient cap would allow us as a Foundation Trust to treat more patients, but also, through re-investment, to help more NHS patients.”

So Labour has set its face against Great Ormond Street hospital: well done!

We need a constructive debate about what needs to be done for patients in the 21st century. The right hon. Member for Leigh should stop using the shroud-waving language that he used today in stating:

“Time is running out for the NHS.”

In December last year, he said that there were 72 hours to save the NHS. What happened? He should beware, above all, of becoming the boy who cried wolf. I believe that this Bill will improve the NHS. I sincerely urge him to base his argument not on intuition but on facts, and, for the sake of patients, not to turn his back on reform that he once believed in and should go back to believing in.

Adult Social Care

Chris Skidmore Excerpts

Thursday 8th March 2012 Commons Chamber

[Chris Skidmore (Kingswood) (Con)]

I start, like others, by congratulating my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing this debate, bringing out the urgent need to tackle the issue of the future of social care, and ensuring that we face up to the responsibilities of looking after the elderly of today and tomorrow. We have heard humble messages from the Minister and the shadow Secretary of State about their willingness to work together. The spirit of cross-party agreement is encouraging.

As the right hon. Member for Leigh (Andy Burnham) said, these issues go right back to Beveridge in 1942, when the average life expectancy was 69 and social care was not an issue to be considered within the realms of the state. The right hon. Gentleman mentioned the “sixth giant”, and he is right that we need to revisit Beveridge for the 21st century and perhaps to look again at what Beveridge considered to be most important—the contributory principle. The contributory principle for social care will be all-important when we look at how to deliver social care reform.

As we know, reform is desperately needed. The arguments over the funding of our social care system are well practised, but let us rehearse some of the statistics, which are becoming more familiar with every debate we hold. The number of those aged over 85 will double by 2030, and during the course of this Parliament alone, more than 1.4 million people will turn 65—one in 10 of whom will have a long-term care need that will cost more than £100,000. We should also make it clear that this problem is not unique to the UK. Germany and Japan have recently taken radical action to reform their systems. However, the UK has a specific problem that makes finding a solution to the ever-growing problem of social care particularly difficult: most people simply do not understand the system. They do not understand that social care and the associated costs of getting older are not free, as the Minister stated, and nor have they ever been.

That point was made in the Dilnot report, and it cannot be stressed enough. I wish to highlight two of Dilnot’s recommendations. First, he states:

“To encourage people to plan ahead for their later life we recommend that the Government invests in an awareness campaign.”

Secondly:

“The Government should develop a major new information and advice strategy to help when care needs arise.”

The acknowledgement that more needs to be done to inform the public is welcome. In reality, until one is forced to interact with the system, there is a serious lack of information compounded by an assessment procedure that is often unrealistically complicated. For many elderly people, part of the shock that comes from being forced to sell their house to pay for care is the unexpected nature of that situation. In some respects, we are facing a problem of responsibility and of planning ahead. Although people are now accustomed to the idea of preparing for their old age with regard to pension provision, there remains an aversion to preparing for the eventuality of future frailty and ill health. Few of us wish to admit that we will grow old and frail and need help and support, before it is too late.

The solution to the funding crisis brought on by an ageing population will inevitably require individuals to pay more, and from an earlier age. Whatever we do to change the current system, it is absolutely essential that a much clearer picture of the relationship between contribution and entitlement—precisely as Beveridge set out—is at the heart of that.

Reform requires realism. Even if the Dilnot proposals are implemented in their entirety, they will not provide the full solution. Whatever cap on care costs is set, domiciliary care costs and annual living costs are not taken into account. A new system that is able to lever more private funding into the system will ensure that we can provide the best deal for the elderly, but it will require an understanding that we need to grow an insurance market to maturity that is then sustainable in the longer term. That will not happen overnight. This is a process that will take between 10 and 20 years.

The current Government have taken the first important steps to reforming the system. As hundreds of billions of pounds are being talked about in respect of the current euro crisis, it is easy to forget that the Government’s decision to give an additional £2 billion a year to social care in the 2010 comprehensive spending review was the greatest ever increase in social care funding, and will lead to a vast increase in resources. We are investing more than ever before in carers and respite care, recognising the huge contribution that they make to our country, selfless in their service to their partners, parents, families and relatives.

In addition, a greater focus on personalisation and individual budgets, combined with an increased use of resources such as tele-health, will put more control over care into the hands of individuals, ultimately allowing new providers to provide more tailored services, thereby driving down costs at the same time as improving quality. Placing the person at the heart of their care has the potential to transform social care services, which for too long have been led by inefficient monopolies.

The Prime Minister’s recent call for greater integration of health and social care is equally welcome. I am a member of the Health Committee, and we called for that in our recent report. If we fail to address the social care problem, the NHS will end up picking up the tab. Every unplanned hospital bed admission for the elderly is a mark of the failure of social care to prevent that from happening in the first place. We know that if we can reduce demand for hospital beds by just 10%, that could free up £1 billion that could then be redirected into community-based care services. We must recognise that hospital is not always the best place for care to take place and redirect resources to reflect that.

In preparing for the Committee’s social care report, we visited Torbay, and I was particularly struck by the experience of integrated care there. Torbay’s primary care trust and adult social services have been combined into Torbay Care Trust, following which five integrated health and social care teams were established. They seek to be proactive in managing patients and to work in partnership with GPs. In Torbay, a team was also introduced that was specifically charged with monitoring patients in hospital and discharging patients where there is pressure on beds—again, the team is working closely with clinical professionals. That has helped to cut out unnecessary lengthy hospital stays and delayed transfers of care. As a result, Torbay now has the lowest use of hospital bed days in the south-west region, as well as the best performance on the length of stay. The chief executive of the NHS, Sir David Nicholson, has said:

“I have seen the future and the future is Torbay”.

He did so because it is the elderly who will benefit most from integrated care. Complex long-term conditions complicated by age can be properly managed only with a collaborative approach.

[John Pugh (Southport) (LD)]

Torbay has, for some time, been a model of good practice and the fact that this good practice has not spread much further than the confines of Torbay is something of an enigma. Would the hon. Gentleman care to comment on that?

[Chris Skidmore]

Torbay was one of the sites for the pilots set up in alliance with Kaiser Permanente, which came over in 2003. Interestingly, it is instructive that one of the problems the NHS faces as an institution is that, although it creates fantastic pilots and the NHS innovation centre is working hard on rolling them out across a wider area, that process encounters significant delays. Good models of care should be spread out far more widely and far faster.

What most elderly people want from their health care system is simplicity. They do not want to be moved around constantly from pillar to post, waiting for specialists to see them; they do not want to see a host of different medical professionals, each of whom is unfamiliar with their case; and they do not want to languish in hospital beds when they could be more comfortable at home. The most important change must be a cultural one. There may have been a tendency in the past for health care to be reactive, responding to medical crises as they arise, but the future must be very different. To paraphrase John F. Kennedy, we do these things not because they are easy but because they are hard. We know that we face a challenge that will define the landscape of health and care for the decades to come—it is a challenge that all in this House cannot be willing to postpone.

Health and Social Care Bill

Chris Skidmore Excerpts

Tuesday 28th February 2012 Commons Chamber

[Mr Lansley]

I think I made that perfectly clear not only in the course of the initial consultation on the White Paper, but then through the NHS Future Forum. Many thousands of NHS staff contributed their views to the NHS Future Forum, which made many recommendations and we accepted them all.

[Chris Skidmore (Kingswood) (Con)]

Is it not the case that the text of the letter merely reflects the Government’s amendments on Lords Report? The Opposition really should have done their homework, because it has been on the website since 1 February. They are four weeks out of date.

[Mr Lansley]

My hon. Friend is right up to a point. On Report in the other House, amendments reflecting the debate in Committee will be tabled. They might not all be Government amendments, but I am looking forward to constructive amendments. As I have said, if amendments from Liberal Democrat or indeed Labour peers are constructive and will help to improve the Bill, we will accept them.

NHS Risk Register

Chris Skidmore Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Chris Skidmore (Kingswood) (Con)]

It is a pleasure to follow two of my fellow Health Committee members. The Chairman of the Committee wrote to the Secretary of State on 16 November 2011 to ask for the Government’s reasons for not publishing the risk register. In response, the Secretary of State wrote:

“It is important to understand that the risk register sets out all of the potential risks identified by the Department of Health for the entire range of areas for which it is responsible. These include financial risks, policy risks and sensitive contractual risks. It is a means by which the Department focuses on risks and acts to mitigate them. If the Department were to release risk registers in the future, there is a genuine possibility that the most significant risks will no longer be recorded, and no solution or mitigating action will therefore be identified. Any action that could deter staff from articulating and addressing business risk to their senior management and ministers carries with it the potential for highly damaging consequences.”

That is remarkably similarly to an answer given in Hansard on 23 March 2007 by the right hon. Member for Leigh (Andy Burnham) in response to a parliamentary question tabled by my hon. Friend the Member for South Holland and The Deepings (Mr Hayes). The right hon. Gentleman stated that the Department’s risk register dealt with

“emerging risks to the Department’s programme and the national health service, and what can be done to control and mitigate these risks. It also informs discussions between the Department and top management in the NHS about addressing key issues in policy, resourcing and service management. Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers. We therefore cannot agree to place a copy of the current version of the register in the Library.”—[Official Report, 23 March 2007; Vol. 458, c. 1191W.]

We had a similar example on 31 July 2008, when the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) responded to a freedom of information request by stating:

“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.”

The Department of Health also refused a freedom of information request for copies of any presentations given by the director of public health concerned with the risk of not delivering on targets to reduce health inequalities, so it is not only risk registers that the Department has previously refused to reveal.

Members have talked today about the risk register in apocalyptic terms, as though it were a document that should remain within the confines of MI5 or MI6. The Health Minister, Earl Howe, has revealed details of the broad issues that are covered by this risk register. I should like to read them out, so as to set the debate properly in context. They include:

“how best to manage the parliamentary passage of the Bill and the potential impact of Royal Assent being delayed on the transition in the NHS; how to co-ordinate planning so that changes happen in a co-ordinated fashion while maintaining financial control; how to ensure that the NHS takes appropriate steps during organisational change to maintain and improve quality; how to ensure that lines of accountability are clear in the new system and that different bodies work together effectively, including the risk of replicating what we already have; how to minimise disruption for staff and maintain morale during transition; how best to ensure financial control during transition, to minimise the costs of moving to a new system, and to ensure that the new system delivers future efficiencies; how to ensure that future commissioning plans are robust, and to maximise the capability of the future NHS Commissioning Board; how stakeholders should be engaged in developing and implementing the reforms; and finally, how to properly resource the teams responsible for implementing the changes”.—[Official Report, House of Lords, 28 November 2011; Vol. 733, c. 16.]

[John Healey]

The hon. Gentleman is right to draw the House’s attention to that fact, but does he accept that that is information that has not been published elsewhere and that the Secretary of State’s argument that the impact assessments that have been published are sufficient therefore simply will not wash?

[Chris Skidmore]

It is interesting that the right hon. Gentleman raises that point, because Earl Howe was mentioning the transition risk register, which is continually updated. That is an important point, because the appeal to the Information Commissioner to release the risk register was made on 29 November 2010, in the autumn when the register was live. The Information Commissioner made his ruling based on the fact that there was an issue of public interest at the time of the request. If the risk register is released today, it will be the risk register from autumn 2010 rather than that from February 2012. That is the moment when the wheels come off the bandwagon. The Opposition are asking the Information Commissioner to release the risk register from autumn 2010, not the risk register from February 2012. The risk register that would be released is that from the time of the White Paper, before the changes were made and before the listening exercise. It is complete nonsense. If the document was released, it would be out of date, inaccurate and would scaremonger among the population.

[John Healey]

So the hon. Gentleman agrees with Lord Henley, the Minister in the House of Lords, who told the House in January that if the Government lose the appeal next month they will publish not only the risk register from November 2010 but the updated risk registers, too?

[Chris Skidmore]

The Government do not have to publish the updated registers on the basis of the Information Commissioner’s verdict, which was on the autumn 2010 register. That is the Information Commissioner’s advice that is referred to in the motion. The Opposition are asking for an out-of-date document—we might as well give up and go home.

[Rosie Cooper (West Lancashire) (Lab)]

Is the hon. Gentleman aware of the comments made by David Nicholson, the chief executive of the NHS Commissioning Board, who said:

“I’ll not sit here and tell you that the risks have not gone up. They have”?

[Chris Skidmore]

I am, as I have the parliamentary Labour party brief—I can see that that is on the back of it.

[Mr Robert Buckland (South Swindon) (Con)]

My hon. Friend’s point about the Information Commissioner’s decision is vital, because the public interest test is the test applied at the time of the request. That makes the decision interesting but, frankly, historical rather than relevant to the issues raised by Members today.

[Chris Skidmore]

Absolutely. We are debating whether we should release a register that is no longer relevant and that was written in autumn 2010, at the time of the request on 29 November. The topic is completely irrelevant, as the debate has moved on. We ought to be talking about reform and why we need it. We have wasted six hours of parliamentary time today discussing an out-of-date risk register.

[Margot James (Stourbridge) (Con)]

Does my hon. Friend envisage that some of the amendments and changes to the Bill that the Government have introduced since that time would deliberately have taken account of some of those risks and that the situation would therefore have moved on?

[Chris Skidmore]

Yes, the situation has moved on. We have had the listening exercise under Steve Field and various Select Committee on Health reports. The name of the commissioning bodies, which were called consortia, has changed. Nurses have been added and we have opened things up so it is not just about GP commissioning.

[Yasmin Qureshi (Bolton South East) (Lab)]

If the register is as irrelevant as the hon. Gentleman says, why not publish it?

[Chris Skidmore]

The Opposition are asking—[Interruption.] The shadow Secretary of State has already said that risk registers should not be published because they are confidential documents that must be used by policy makers. The Opposition are asking for a risk register that is out of date when what we should have been discussing today was reform of the NHS and how we can deal with an ageing population at the same time as dealing with a rise in chronic diseases.

I thought that it was striking that the shadow Secretary of State said at the end of his remarks that he would put the NHS first, without any mention of the patients. That is what these reforms are here for. They are allowing patients to be put in the driving seat and to sit down with their doctor, to understand what treatments they need and to have a choice of treatment through the opening up of providers. We could have had that debate—we could have spent six hours discussing that instead of this irrelevant document that you want to have a look at, which is out of date and from November 2010 when it is now February 2012. You are two years out of date, you are out of time and you are out of touch. I urge everyone to vote down the motion, simply because it falls outside the point.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I remind the hon. Gentleman that I am not out of touch, and I am sure that he was not suggesting that I was. Others might think so, but I want to reassure him that I am not.

Oral Answers to Questions

Chris Skidmore Excerpts

Tuesday 21st February 2012 Commons Chamber

[Paul Burstow]

I have not had such conversations with the university to which the hon. Gentleman refers. However, this Government, right from their first Budget, have indicated their commitment to prioritising research into dementia—both the basic research that gives us the targets for detailed research and the translational research. We have put in place all the building blocks that will allow this country not only to maintain its pre-eminence but to accelerate the pace of research.

[Chris Skidmore (Kingswood) (Con)]

14. What progress he has made on reducing the costs of PFI schemes in the NHS.

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

We have made a lot of progress. All PFI schemes are having their contracts reviewed for potential savings following a Treasury-led pilot exercise. We are providing seven of the worst affected PFI schemes with access to a £1.5 billion support fund, and we are working with 16 other trusts to address long-term sustainability. As I said, in November last year the Treasury announced plans for a complete reform of the current PFI model, using public-private partnerships, private sector expertise and innovation, but at a value-for-money price for the taxpayer.

[Chris Skidmore]

I thank the Secretary of State for that answer. The new Southmead hospital in Bristol will cost over £400 million, to be funded by PFI, yet it will take over 30 years, at £37 million per year, to pay that off. That cannot be good value for money for the taxpayer or for the NHS. What more can the Government do to ensure that these contracts can be renegotiated in future?

[Mr Lansley]

My hon. Friend will be aware of the difficulties involved in the contracts that we inherited; that is true for PFI, as well as for the NHS IT contracts and many others. We have to try to use PFI contracts more cost-effectively; on average, the Treasury exercise demonstrated a 5% saving on their costs. Beyond that, we have to ensure that from now on the NHS delivers a much more value-for-money approach to using private sector expertise, including proper transfer of risk.

Melanoma

Chris Skidmore Excerpts

Wednesday 18th January 2012 Westminster Hall

[Pauline Latham]

Yes, I would like that to happen. Looking tanned does not mean that someone is healthy. In fact, tanning increases the risk of malignant melanomas, which are rapid killers, and I would like councils to have the strength to say, “No.”

It may be expensive to prescribe the drug, but it is the first advance in treatment for a long time, and if used, may offer the opportunity of more trials to refine it, which could lead to its becoming even more effective. For young people with melanomas, it is a lifeline, even if they only survive for a relatively short time. Let us not forget the possibility that agencies, such as social services, and welfare benefits can cost the country huge sums if the remaining parent has to give up their career to look after a young family. Patients with this aggressive disease are expected to have a median overall survival time of six to nine months, but in trials, 46% of patients taking ipilimumab were still alive after a year, and in some cases, patients can live even longer.

At the stakeholder’s meeting on 8 November, we heard from a patient called Ian. He seemed well, spoke eloquently and raised many important points on access to treatment, which I urge hon. Members to read in the report that we submitted to NICE—I am happy to provide a copy. Sadly, before 21 December 2011, Ian became very unwell and was ultimately bedridden. The short time between Ian attending the meeting in November and his death a week ago demonstrates the aggressive nature of advanced melanomas.

Lack of access to the drug is still a major concern to all melanoma patients and, of course, to their families and friends. It is very distressing for them to know that there is a drug on the market that has been proven to prolong the lives of sufferers, if even for only a few months or years, yet they cannot access it through the normal channels. I acknowledge that ipilimumab is available in some parts of England through the cancer drugs fund, but it is not available in all areas, and the fund does not even exist in Wales—yet another example of inequality from the cancer drugs fund and another illustration of a postcode lottery.

[Chris Skidmore (Kingswood) (Con)]

On my hon. Friend’s point about a postcode lottery and regional variation, I think that she will be interested in figures that I recently obtained through a parliamentary question. They break down the number of registrations of newly diagnosed cases of melanoma—skin cancer—by local authority and region. I would happily give her a copy. In my region of Avon, Somerset and Wiltshire, there has been an explosion of newly diagnosed cases of skin cancer, from 254 in 1999 to 455 in 2008—an increase of 79%. The huge variation across the country shows that this is not just about the future, but that we have a problem now that we must urgently tackle.

[Pauline Latham]

Yes, I agree. I thank my hon. Friend for raising that point, because although we are talking about a big increase by 2030, he is right that melanomas are affecting more and more people, particularly the young, and they are usually a death sentence.

What will happen to those patients in areas covered by the cancer drugs fund who can access ipilimumab through the fund when funding ends in 2014? That further illustrates why it is imperative that NICE recommends ipilimumab, so that it is available across England and Wales to all patients who could benefit from it. The Minister knows that my concerns about access to treatments for other cancers—for example, Avastin as second-line treatment for bowel cancer via the cancer drugs fund—are well versed through parliamentary questions and speeches in the Chamber. I remain equally determined to ensure the availability to cancer patients of other life-prolonging drugs, such as ipilimumab.

Alongside Factor 50 and Skcin, I urge in the strongest possible terms that the Department of Health, the manufacturers and NICE work together, so that ipilimumab is available to appropriate patients across England and Wales. There are huge concerns that, without a positive decision on ipilimumab, patients will lose out on a lifeline to have those extra months or even years with their loved ones.

NHS (Private Sector)

Chris Skidmore Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

My argument would be that if those decisions are to be made, the people who make them should be accountable to the hon. Gentleman and the House, whereas the Bill that his right hon. Friend the Secretary of State is introducing proposes to push those things away. There will be an independent commissioning board that GPs and clinical commissioning groups will not be able to overturn; it will make the decisions. That is a completely unacceptable state of affairs.

Before the last election, we proposed a modest loosening of the private patient cap in response to pressure in another place when we were debating the Health Act 2009, but compared with our modest reforms, the Government’s plans are off the scale. Instead of private sector activity at the margins, the Health and Social Care Bill places market forces at the heart of the system. The private sector will not support the NHS, but will replace large chunks of the service in commissioning and provision.

[Chris Skidmore (Kingswood) (Con)]

I should be interested to learn—as I am sure would the whole House—the right hon. Gentleman’s definition of modest loosening. In the four years between 2006 and 2010, the amount of money going to the private sector rose from £2 billion to about £12.2 billion. Does the right hon. Gentleman simply oppose the 49% cap or will he pledge to reverse it if he returns to government? What exactly would the cap be? Would it be 30% or 12%? Please let us know.

[Andy Burnham]

May I refer the hon. Gentleman to the motion? Its request to the Government is not unreasonable; it asks them “to revise significantly downwards” the cap they have proposed.

--- Later in debate ---

[Mr David Anderson (Blaydon) (Lab)]

The NHS is rightly the most valued institution in this country. It has an impeccable track record of continuing improvement and innovation going back more than 60 years. The staff on the front line and those in the support services who are disparaged by Conservative Members as somehow irrelevant to the success of the service have never been frightened to face up to the challenges of change. They are, however, sick and tired of the constant demands of know-it-all politicians on all sides for endless reorganisations, restructuring and re-profiling. That is why they were so disappointed after the Prime Minister had told them that there would be no more top-down impositions from on high; they and the British public were, quite simply, misled.

The fears around privatisation are a reflection of yet another change to the structure of the NHS, and it is a very unwelcome one. The Secretary of State tried to rubbish the trade unions tonight. He did not mention all the other professional bodies in the NHS that are opposed to the changes. The only people who seem to be in favour of them are those in the Tory party, and their friends in the Liberal Democrats. None of the people who are delivering the services want the changes to happen. That includes the GPs that the hon. Member for Crawley (Henry Smith) was talking about. They might well be doing good work in Crawley, but the key is that they do not want to have to do it in that way. The general public are also worried about the changes.

The Secretary of State said that we should not look back, but if we do not learn the mistakes of history, we will repeat them. We need to look at the situation that prevailed a long time ago. The working people in this country in the first half of the last century were desperate for a health care system. People came back from the devastation of world war one to a worldwide influenza epidemic. They were living in desperate conditions and working in massively unsafe workplaces. They were bringing up families whose lives were blighted and shortened by the diseases of poverty: tuberculosis, rickets, malnutrition and pneumonia. Their conditions of life at home and at work had changed little since the days of Dickens, yet we saw yet another world war where money that could not be found to build a decent society in peacetime was miraculously produced to kill millions in wartime.

At the end of that war, the men and women of this country were determined not to continue with that and were not going to put their faith in a Government and a private sector-driven economy that had failed them so badly. They turned instead to a Government who, despite the biggest debt crisis ever, determined that the health and well-being of this country’s people was paramount. That is why Labour built millions of homes for people, why swathes of industries that had been disgracefully run down by the private sector owners were nationalised, and why we, the Labour party, built the NHS to ensure that never again would the quality of a person’s health care depend on the depth of their wallets.

People quite rightly felt bitter about the way they had been treated for decades. That was perhaps best summed up by Nye Bevan, who set up the NHS, when on 4 July 1948, two days before the NHS came into being, he said:

“no amount of cajolery and no attempts at ethical or social seduction can eradicate from my heart a deep burning hatred for the Tory party that inflicted those bitter experiences on me.”

As expected, the Opposition did not like that, and Mr Churchill labelled Mr Bevan “the Minister for Disease”. Equally as expected, Nye Bevan was having none of it. Speaking from the platform of the Durham miners’ gala, he reminded people of the reality of life under Tory rule when he said—

[Chris Skidmore]

Will the hon. Gentleman give way?

[Mr Anderson]

Go on, then.

[Chris Skidmore]

The hon. Gentleman is quoting history, so I wonder whether he would agree that Nye Bevan could be seen as the pioneer of private sector involvement within the NHS, given that he accepted that more than 4,000 pay beds should be part of the NHS in order to ensure bags of investment in facilities?

[Mr Anderson]

Of course, the reality is as envisaged by my right hon. Friend the shadow Secretary of State, who has accepted that there is a role for the private sector within the health service, but the debate is about how big it should be and how much control there should be of the health sector. [Interruption.] May I carry on?

As I was saying, Nye Bevan responded to Churchill’s criticism by saying:

“Who should be called the Minister for Disease? I am keeping mothers and children alive when he half starved them to death.”

That is the legacy with which the Conservative party is lumbered. It is the burden round the neck of Conservative Members when the people of this country get worried about private involvement in health care. I have no doubt that Conservative Members will not agree with me, but it was right and proper when my right hon. Friend the Member for Leigh (Andy Burnham) drew an analogy between this privatisation and that of the utilities. We should look at the results of those privatisations: unfettered and uncontrolled expansion, with our energy supplies now controlled by foreign companies; huge, uncontrolled price increases; millions of people in fuel poverty; no control over the security of supply; a national grid not fit for purpose; and an incoherent strategy to face up to the challenge of climate change. Those are all the result of giving away our vital services to the highest bidder. People are quite right to say, “Why would it be any different in health?”

The people of this country do not want the NHS to become a copycat version of the American model—a model that costs twice as much as ours to run, yet leaves 20% of the population out in the cold when they are ill. Our NHS has a tremendous track record, dealing with millions of people every week. Our life expectancy levels have risen rapidly, especially over the period when the previous Government reversed the years of underfunding that were the trademark of the last Tory Government. Public satisfaction rates were at record levels when we left office 18 months ago.

This present Government have broken their promise to the British people. They have lied to the staff who work magnificently to deliver our NHS. They are intent on breaking up the NHS and replacing it with a system based once again on a programme that puts profits before patients. If Conservative Members really believe in privatisation, they should ask the people what they want. The people have woken up to the reality of the Conservative party; they realise that once again the NHS is not safe in Tory hands—even though they are wearing the yellow gloves provided by the Liberal Democrats. Patients, as the figures clearly show, want no further privatisation of our NHS.