Winterbourne View

Emma Reynolds Excerpts

Tuesday 30th October 2012 Commons Chamber

[Norman Lamb]

My hon. Friend raises an important point. One thing we are doing on the NHS Choices website is having quality indicators for every care home, nursing home and so on. That means that any individual looking for a care home for a loved one will be able to find out much more about the quality of the care that an organisation provides. In due course, the website will include user reviews, so that people who have experienced care in those homes will have their voices heard. That openness of information could have a transformational effect in driving up standards.

[Emma Reynolds (Wolverhampton North East) (Lab)]

It beggars belief that some of the vulnerable adults who were subjected to the most appalling and horrific abuse at Winterbourne View were moved to other providers where they were either abused—according to the “Panorama” allegations—or at risk of further abuse. Will the Minister reassure me that all local commissioners responsible for each of the former Winterbourne View residents have a proper plan in place to guarantee that they are now receiving safe and effective care?

[Norman Lamb]

I share the hon. Lady’s view on what has happened. We must make absolutely certain that every commissioner is held to account. My understanding is that proper arrangements are in place for all those individuals, but I will continue to monitor the situation to ensure that that remains the case. We must be alert to the interests of the 48 residents who were in Winterbourne View, but we must also focus our minds on the 1,500 people who are in settings of that sort—assessment to treatment centres—often for years. The interests of all those individuals are important.

Mental Health (Approval Functions) Bill

Emma Reynolds Excerpts

Tuesday 30th October 2012 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

I beg to move, That the Bill be now read a Second time.

The purpose of the Bill is simple, but urgent. The Secretary of State described to the House yesterday how the need for it arose and came to light, and I hope that hon. Members will bear with me if some of what I say today repeats what he said then. May I begin by reiterating my gratitude to Opposition Members for the highly constructive approach that they are taking to the issue, without which we would not be able to respond with the necessary speed?

Detaining a mentally ill person in hospital and treating them against their will is clearly a matter of the utmost seriousness, and it is treated as such by the law and by health and social care practitioners. The statutory framework is contained in the Mental Health Act 1983, which sets out that, for assessments and decisions under certain sections of the Act, including detention decisions under sections 2 and 3, three professionals are required to be involved: two doctors and an approved mental health professional, usually a social worker. One of the two doctors must be approved under section 12 of the Act. When strategic health authorities came into being in 2002, the Secretary of State at the time quite properly and lawfully delegated to them his function under the 1983 Act of approving the doctors able to be involved in making these decisions.

Early last week, the Department of Health learned that, in four out of the 10 SHAs—North East, Yorkshire and the Humber, West Midlands and East Midlands—the authorisation of doctors’ approval was further delegated by the SHAs to NHS mental health trusts over a period extending, in some cases, from 2002 to the present day. The issue was identified as a result of a single doctor querying an approval panel’s processes. I was informed later in the week, as soon as the extent of the issue became clear, and since then, the Secretary of State and I have been kept informed of, and involved in, the action being taken.

[Emma Reynolds (Wolverhampton North East) (Lab)]

This is an issue of great concern. Can the Minister reassure the House that the four areas that he has identified are the only areas in which this has happened, and that it has not taken place in other regions?

[Norman Lamb]

I can assure the hon. Lady on that point. All SHAs have undertaken an assessment of the position, and the position has been regularised for future cases in those four SHAs. Of course, individual patients may be moved to different parts of the country, but the problem relates to those four SHA areas.

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[Emma Reynolds (Wolverhampton North East) (Lab)]

I wish to make only a couple of points about this emergency legislation, which I support. The Government still have a number of questions to answer. First, further to the point made by my right hon. Friend the Member for Oxford East (Mr Smith), I should like to press the Secretary of State on legality. In the explanatory notes, the Government say:

“Although we believe that there are good arguments that detentions under the Mental Health Act were and are lawful, it is important that there should be no doubt about this.”

If legislation does not permit the authorisation and delegation of power to doctors under that measure, does that accord with the law? I am not lawyer. Many right hon. and hon. Members on both sides of the House served in that profession before first coming to Parliament, but I am not one of them. However, if the previous measure did not permit such a delegation of power, doctors acting without that permission were not proceeding according to the law. I should therefore welcome clarity on that point.

Secondly, with regard to what happens from now on—the Bill is retrospective in effect—the Government propose to abolish strategic health authorities. As far as I understand it, SHAs were named in the original legislation. What will effectively take their place when they are abolished and will further amendments need to be tabled by the Government?

NHS Risk Register

Emma Reynolds Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Mr Lansley]

My hon. Friend is absolutely right, and when he was Chair of the Public Accounts Committee he constantly told the last Government that they should do something to ensure rising productivity in the NHS. He was not alone in that.

[Emma Reynolds (Wolverhampton North East) (Lab)]

Will the Secretary of State give way?

[Mr Lansley]

I will in a moment. Perhaps the hon. Lady would like to explain the views of not only my hon. Friend the Member for Gainsborough (Mr Leigh) but his successor as Chair of the Public Accounts Committee, the right hon. Member for Barking (Margaret Hodge), who said:

“Over the last ten years, the productivity of NHS hospitals has been in almost continuous decline.”

[Interruption.] I hear Labour Front Benchers ask, “What about the risk register?” I will tell them what the risk to the NHS was before we came into government. It was that a Labour Government would carry on failing to increase productivity in the NHS. Productivity would have declined, and the NHS would have been unable to provide patients with the service and care that it should provide, because Labour wasted money on bureaucracy instead of spending it on patient care.

[Emma Reynolds]

I am proud of our record on the NHS, given that patient satisfaction with the NHS is at an all-time high. Does the Health Secretary agree with the analysis of Professor Black in his report in The Lancet that Tory Ministers’ claims that productivity declined between 2000 and 2009 is based on a myth?

[Mr Lansley]

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

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

Oral Answers to Questions

Emma Reynolds Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Lansley]

I do not know whether Hansard will record it, but the mirth with which that remark was met is an indication from Members that they know perfectly well, as the hon. Gentleman ought to know, that the previous Labour Government left a terrible legacy of unaffordable PFI projects that were poor value for money when they were introduced. He knows perfectly well the position his local trust has been put in. We are working through that, and out of the work that has been done to resolve that poor legacy, we identified 22 NHS trusts which said that their PFI was an impediment. We are working with all of them to resolve that.

[Emma Reynolds (Wolverhampton North East) (Lab)]

5. What plans he has to allocate resources to local authorities when they assume responsibility for public health.

[Fabian Hamilton (Leeds North East) (Lab)]

9. What plans he has to allocate resources to local authorities when they assume responsibility for public health.

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[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

For the first time, public health money will be ring-fenced and from April 2013 local authorities will receive that ring-fenced public health grant, targeted at areas with high population need and weighted for inequalities. In the preceding year—that is 2012-13—the shadow allocation will be published to allow local authorities to plan for the following year.

[Emma Reynolds]

As the Minister knows, public health problems are much more acute in areas of high deprivation. Wolverhampton primary care trust has been incredibly successful in reducing teenage pregnancies and increasing childhood nutrition. Will she reassure me in detail on exactly what weighting will be given to deprivation so that that good work in Wolverhampton can continue?

[Anne Milton]

We have commissioned advice from the independent Advisory Committee on Resource Allocation and recently completed a survey of current NHS spend on public health. As the hon. Lady says, allocation needs to be weighted for inequalities and we are particularly keen that the committee develops a formula that captures within-area deprivation, which has been an issue in the past. Otherwise, affluent areas with pockets of deprivation tend to be ignored. If we want to improve the health of the poorest fastest, we must consider the heath need and deprivation.

Reform of Social Care

Emma Reynolds Excerpts

Monday 4th July 2011 Commons Chamber

[Mr Lansley]

I entirely understand my hon. Friend’s point. In the course of the engagement during the latter part of this year, some of those issues will certainly come to the fore. My colleagues and I felt that it was better for us not to cherry-pick Andrew Dilnot’s report now, but rather for us to give people an opportunity to comment on the recommendations in full. That will, however, take place over the space of weeks rather than many months.

[Emma Reynolds (Wolverhampton North East) (Lab)]

I should remind Government Members that this issue has already been delayed because the Conservatives broke ranks before the election in order to score political points. However, there is now cross-party support for the recommendations, so why has the Secretary of State let the timetable slip from the autumn to next spring? Can he reassure the House and the country that there will be no further slippage in the timetable?

[Mr Lansley]

I am afraid that I do not accept the hon. Lady’s premise. I am not going to revisit the past, but the truth is that, since I became directly involved, I initiated cross-party discussions before the election on the reform of social care, and I did not leave those discussions. It was her former Prime Minister who effectively broke them down.

Southern Cross Healthcare

Emma Reynolds Excerpts

Thursday 16th June 2011 Commons Chamber

[Paul Burstow]

Such work is in hand and has been for some time.

[Emma Reynolds (Wolverhampton North East) (Lab)]

There is concern among Members on both sides of the House that 31,000 of the most vulnerable people in our country face having to move care home, with all the risks to their health that that involves. The Minister should not introduce a White Paper but sense the urgency of the matter. He should introduce regulations to ensure that the sector is more tightly regulated, and that such a situation does not happen again.

[Paul Burstow]

I understand the desire of all hon. Members for urgent action and a rapid resolution that secures the interests of residents, but I did not hear the hon. Lady suggest what those changes to regulation should be. When she cares to offer such suggestions, we can look at them.

Social Care Services

Emma Reynolds Excerpts

Tuesday 17th May 2011 Westminster Hall

[Emma Reynolds (Wolverhampton North East) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Brady.

I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing this debate on an incredibly important issue. It is a great cause for celebration that people now live longer, but it brings new challenges. Our society—and our Government—should be judged on how we look after our most vulnerable people, and I want to focus my contribution on the care of the group of people who tend to be the most vulnerable: the elderly.

My hon. Friend said that there is a large, sustained increase in the percentage of people needing long-term care, and the projection is that the figure will continue to rise. As has been pointed out, the standards of care in care homes vary greatly, not only across the country but within regions and sometimes within cities—there is even variation across my constituency of Wolverhampton North East. My grandma is in a great care home in neighbouring Staffordshire, which provides wonderful care, and I want to pay tribute to the care workers there, and to those across the country in good care homes. We know, however, that that is more the exception than the rule.

I am very concerned about the drop in the number of inspections of care homes by the Care Quality Commission. I echo the questions asked by my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) about how the Government can guarantee that care home standards across the country are at least good—not poor—and how they can stop those who seem to want to make a quick buck out of the industry and ensure that care home staff are given basic protection rights and paid properly.

I want to turn to the pressing issue of the financing of care, which the previous Labour Government tried to deal with perhaps a little too late. Thousands of people across the country have to sell their homes to fund long-term care, and the cross-party talks regrettably broke down before the general election, with the Conservatives preferring to score political points and publish posters about a “death tax” rather than engage seriously with this most important issue. However, I congratulate the Liberal Democrats, in particular their then health spokesperson, the hon. Member for North Norfolk (Norman Lamb), who stayed in the talks and was willing to reach some kind of consensus.

I know that the Minister will not want to answer some of my questions because the Government are awaiting the outcome of the Dilnot commission, but I urge him to consider the shortcomings of a voluntary contribution model. Experts in the insurance industry have pointed out that people are unlikely to take out insurance 30 years before they might need the care, and international evidence suggests that such a system is unworkable. France has the largest voluntary insurance market for long-term care but there is only a 15% take-up, so if the Government go for that option, which was in the Conservative manifesto—I am waiting to see what the coalition will do—it is almost as good as doing nothing. If we introduced the model and people did not take up the care, we might as well have done nothing at all.

My hon. Friend the Member for Stockton North said in his closing remarks that this is a matter for generations to come, and it is most pressing that we have a system that enables the Government to provide care for the elderly in the years to come. I said at the start of my speech that this is a great cause for celebration, but it brings a new challenge, and I urge the Minister to consider the value of making this a cross-party issue and ensuring cross-party consensus on the financing of long-term care for the elderly.

Future of the NHS

Emma Reynolds Excerpts

Monday 9th May 2011 Commons Chamber

[Mr Dorrell]

I entirely agree with my hon. Friend. The Prime Minister and the Secretary of State made clear during the listening exercise their determination to ensure that proposals are brought forward that improve the capacity of the structures of the health service to deliver the objectives my hon. Friend has just articulated.

[Emma Reynolds (Wolverhampton North East) (Lab)]

Will the right hon. Gentleman give way?

[Mr Dorrell]

I will give way once more and will then have to make progress, because I have very limited time.

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[Emma Reynolds]

Does the right hon. Gentleman agree that it would have been possible to make the current structures work better? The coalition agreement states, on page 24:

“We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust”.

It is possible better to democratise the PCTs and give greater clinician involvement in them, so does he support some of the calls from the professionals to keep the cluster PCTs?

[Mr Dorrell]

I want to make my speech in my own way. The hon. Lady asked at the beginning of her intervention whether I agree that it would have been possible to introduce quite a lot of this without the need for a long Bill. She does not need to put that question to me, because the Health Secretary made the same point during the last health questions. We are seeking in the Bill to provide a holistic basis—a structure for the health service going forward, and that is an objective, starting from where we are, that it seems entirely reasonable to embrace.

I was seeking to identify the problem that my right hon. Friend’s measures must be designed to tackle, because as he and the Prime Minister have said repeatedly, no change is not an option. That should not be a matter of party political debate because the definition of the core problem facing the health service can be found in the NHS annual report for 2008-09, which was published 12 full months before the general election. I quote from it a single sentence:

“We should also plan on the assumption that we will need to release unprecedented levels of efficiency savings between 2011 and 2014—between £15 billion and £20 billion across the service over those three years.”

That is what we on the Health Committee referred to as the Nicholson challenge, because it was first articulated in the chief executive’s report a full 12 months before the election. That is the challenge that my right hon. Friend has to address, because it is the inescapable challenge in front of the national health service.

In point of fact, my right hon. Friend has made the challenge rather easier than it was in the days of the previous Labour Government, because there is a commitment to real-terms growth in the health budget throughout this Parliament, and because he has given the health service four years to respond to the Nicholson challenge, whereas the original articulation was focused on the three years ending in 2014.

But the substance of the need to deliver unprecedented efficiency gains out of the health service is the constant between the previous Government and the current Government. The articulation of it in the chief executive’s report was “£15 billion to £20 billion”; I have always preferred to articulate it as, “4% efficiency gain, four years running”.

That is what the health service has to deliver against the background of it never having delivered 4% efficiency in a single year, and of no health care system anywhere in the world having delivered a 4% efficiency gain, four years running. So, Sir David Nicholson, 12 months before the general election, was 100% right to say, “This is an unprecedented challenge,” and the challenge was embraced by the previous and current Governments.

Health and Social Care Bill

Emma Reynolds Excerpts

Monday 31st January 2011 Commons Chamber

[Mr Lansley]

I am sorry, but 57 Members wish to speak, as you have rightly told us, Mr Speaker. I will give way as often as I can, but more than one intervention from each Member is excessive. [Interruption.] I have just quoted from the coalition agreement and our manifesto, so hon. Members have heard both.

Through the outcomes framework, which we published in December, we will stop the top-down, politically motivated targets that have led to real quality being sidelined. We will ensure that we focus on the outcomes that really matter and back them up for the first time with quality standards that are designed to drive up outcomes in all areas of care. Those standards have not been dreamt up in Whitehall, but are being developed by health professionals themselves. Similarly, doctors and other health professionals will not be told by us how to deliver those standards. The standards will indicate clearly what is expected, but it will be up to clinicians to decide how to achieve them. At every step, clinical leadership—that of doctors, nurses and other health professionals—will be right at the forefront. It will be an NHS organised from the bottom up, not from the top down.

The shift in power away from politicians and bureaucrats will be dramatic. The legislation none the less builds on what has gone before. It is not a revolution, but as the shadow Secretary of State said just a fortnight ago:

“The general aims of reform are sound—greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes—and are common ground between patients, health professions and political parties.”

[Emma Reynolds (Wolverhampton North East) (Lab)]

The right hon. Gentleman quoted the National Audit Office earlier. Does he agree with the statement in its report that his revolution in and upheaval of the NHS risk undermining the quality initiative—the so-called QIPP programme—that the previous Government introduced?

[Mr Lansley]

No, far from it—actually, quite the contrary. It is only by virtue of our ability to engage front-line clinicians more strongly in the management and design of care that we will deliver those quality, innovation, productivity and prevention ambitions; and it is only if we cut bureaucracy and the costs of bureaucracy that we will be able to get those resources on to the front line more effectively. I made it very clear, and the shadow Secretary of State endorsed the view, that there is consensus about the purposes of reform, but if Labour now voted against the Bill, although we do not know whether it will, it would abandon that consensus and, indeed, its own policies when in government.

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[Emma Reynolds (Wolverhampton North East) (Lab)]

There is much disquiet and concern among health professionals about the speed and scale of the reforms outlined in the Bill, with various respected organisations warning that they are a “significant risk” and “could be disastrous”.

It is important to see the Government’s plans in the context of the progress and the health legacy that this Tory-led Government inherited from Labour—patient satisfaction in the NHS at record levels, a world-class public service transformed by Labour, record numbers of doctors and nurses, and new hospitals. Contrary to some of the claims from the Government Benches about the statistics, survival rates for the most serious conditions are improving, and we will have the lowest mortality rates of any European country for heart disease by next year. The Government would do well to recognise this progress.

One of the Government’s central arguments is that massive restructuring is necessary to drive efficiencies in the NHS. I beg to differ. By overhauling the system, the Government are putting at risk the very drive for efficiencies that we support. According to the Royal Society of Physicians,

“Achieving both efficiency savings and reorganisation simultaneously will be an unprecedented challenge for both commissioners and providers”.

In government we recognised the efficiency challenges that we faced in the NHS. That is why in the last Labour Budget the Department of Health committed to £4.35 billion of savings over two years, with a further commitment to save £20 billion in the next five years. We demanded that primary care trusts reduce their management costs by 30% over a three-year period. The choice between doing nothing or modernising the NHS is a false choice, as I think the Government know.

Evidence from the previous reorganisation suggests that the disruption will extend well beyond the period of the reform. Even one of the Government’s Back Benchers, the hon. Member for Totnes (Dr Wollaston), a GP herself, has said:

“To my mind, it felt a bit like someone had tossed a grenade into the PCTs. These people have so much uncertainty about their position that they are haemorrhaging in a rather uncontrolled fashion.”

The transition process is not only disruptive, but will undermine efficiency and quality. This risk was recognised by the National Audit Office in its report, where it said that the previous government’s initiative, the so-called quality, innovation, productivity and prevention programme, is at risk because of the overhaul proposed by the present Government. What is more, their obsession with driving down costs using price competition carries a very real risk of decline in the quality of care, according to professional organisations such as the BMA, the Royal College of Nursing and the Royal College of Midwives.

[Mr Graham Stuart]

The hon. Lady is giving a powerful speech, making the case that every Government must look for efficiencies and suggesting that the previous Government did. One of the key failings under the previous Government, who did see improvements in the NHS with vast increases in expenditure, was on productivity. According to the National Audit Office, which the hon. Lady just mentioned, productivity, after improving in the 1990s before Labour came to power, fell during the Labour years, despite the massive investment of additional funds. Turning that around is the central challenge for this Government. What views does she have about how best that can be made to happen?

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[Emma Reynolds]

I have already said that we on the Labour Benches recognise the need to drive efficiencies and, as part of that, we recognise the need to increase productivity. We made massive strides in the 13 years that we were in power, and Government Members would do well to remember that.

The allocation of resources in the NHS is all about economics and the tension created by infinite demands and finite resources. Difficult questions that are at the heart of commissioning need to be answered at a macro level—questions such as how do we value the improvement or lengthening of one person’s life compared with another’s; and what is the cost of investing in one drug compared with another or with an existing treatment? These are not easy questions to answer, and clinicians are making decisions at a micro level.

Faced with a limited budget, clinicians will call for more resources to be allocated to their field. Oncologists will argue for a greater share of the budget to be spent on cancer treatment. Paediatricians will argue for more money for paediatrics. As well as prioritising primary care, GPs might well bid for more resources for treatment or minor surgery that their practice offers—a potential conflict of interests against which the Bill does not safeguard sufficiently.

GPs are trained to be advocates of their patients, and rightly so, treating them as individuals, not as a particular percentage of the population. Their training does not equip them with the tools to make the tough, unpopular decisions about the allocation of limited resources. Perhaps in his winding-up speech the Minister will tell the House what percentage of GPs he thinks have had to grapple with the complexities of the modified Portsmouth scoreboard or the quality-adjusted life years measure. Those are the instruments used day in, day out by people who make commissioning decisions.

As my right hon. Friend the Member for South Shields (David Miliband) said so eloquently, the choice is not between reform or no reform. We are not against reform or driving efficiencies, but we are against the ill-considered, costly, reckless reform contained in the Bill, which will undermine the drive for efficiency, jeopardise quality of care and fails to take into account the fact that GPs do not have the expertise or the training to make the macro-level decisions on the allocation of resources.

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[Nicky Morgan]

I entirely agree with my hon. Friend. It just shows that GPs, if they are given the responsibility, will step up to the plate and deliver what their patients need.

In the limited time available, I wish to focus on what the proposed changes will mean for mental health services. I speak as a member of the all-party group on mental health, and as someone with a family interest in mental health issues. The NHS in England spends more on mental health services than on any other disease category, including cancer and heart disease, and one in four people will experience mental ill health at some point in their lives. The public health strategy has so far not been mentioned in the debate. I entirely welcome the Government’s emphasis on public health and the emphasis on good mental health as well as good physical health. I recently spoke with Charnwood mental health forum, which is based in my constituency, whose members told me that prevention of mental health problems and supporting people who are perhaps heading down the road to depression and more serious conditions is incredibly important.

There are four keys areas that I want to mention in the time available. My first point, which has already been mentioned by the Opposition, is that we must ensure that GPs get proper support to commission effective mental health services and other specialised services. That support can come from the national commissioning board, third sector organisations and patients. That is why I think GPs will step up to the plate, because they will ask their patients and listen to them when designing and commissioning services.

A recent Rethink survey of GPs found that 31% of GPs did not feel equipped to commission mental health services, compared with 75% who felt that they could commission diabetes and asthma services. It also revealed that 42% of the GPs said that they had a lack of knowledge about specialist services for people with mental illness, and 23% said that they had a lack of knowledge about mental illness in the first place. I will cite a recent case study from my Loughborough constituency, in which I was told that one of my constituents was suffering from complex mental health conditions, but his GP appeared to have no knowledge of personality disorders and saw the problem as largely behavioural. The relationship between the constituent and the GP deteriorated and therefore the local Rethink carers group stepped in to help find another GP. With consortia, a GP in a different practice could have that specialisation, and the first GP, realising their limitations, could speak with that other practice and engage with carers groups, such as Charnwood mental health forum or Rethink to ensure that there are special services available for patients.

[Emma Reynolds]

Is the hon. Lady as concerned as I am that a recent survey by Rethink showed that 95% of GPs did not feel that they had sufficient expertise to commission mental health services?

[Nicky Morgan]

I was just talking about that, but the point that has been made is that GPs do not feel that they necessarily have the specialist skills to commission mental health services. That says not that the underlying plan set out in the Bill is wrong, but that GPs recognise their limitations. From the conversations that I have had with GPs, I think that they will know where to go to commission those services and they will get the support from the national commissioning board.

Oral Answers to Questions

Emma Reynolds Excerpts

Tuesday 25th January 2011 Commons Chamber

[Mr Lansley]

My hon. Friend enables me to say that I and my colleagues entirely understand and endorse the stronger role that pharmacies can play, including by assisting with the provision of services such as minor ailments services and medicines use reviews, which will be commissioned through arrangements led by the NHS commissioning board. In addition, the services that he describes, such as stop smoking services, will be commissioned as part of the public health efforts, which will be led by local authorities through their local health improvement plans.

[Emma Reynolds (Wolverhampton North East) (Lab)]

Will the Secretary of State comment on the apparent conflict between, on the one hand, a general practitioner being an advocate for their patient and taking purely clinical decisions and, on the other hand, GPs having to allocate resources in the new system? Will that conflict not lead to a breakdown of trust in the relationship between the GP and their patients?

[Mr Lansley]

I am afraid the hon. Lady sees a conflict where, to GPs, there is none. It is their responsibility—[Interruption.] No, their first duty is always to their patients, whose best interests they must secure. When she has an opportunity to look at the Health and Social Care Bill, which we published last week, she will see that it makes very clear the duty to improve quality and continuously to improve standards. We all know that we have to achieve that with finite resources, but we will do that much better when we let clinical leaders influence directly how those resources are used rather than letting a management bureaucracy tell them how to do it.