Managing Risk in the NHS

Frank Dobson Excerpts

Wednesday 17th July 2013 Commons Chamber

[Frank Dobson (Holborn and St Pancras) (Lab)]

I do not wish to get involved in great party turmoil on this matter, but it seems to me that a characteristic of any health care system is whether it is entirely devoted to managing risk. When people are ill or injured, their lives and health are at risk, and it is also possible that any treatment they may be offered will itself be risky.

The principal problem faced by doctors, nurses and midwives is that of uncertainty, and they want to give the right diagnosis. It is statistically true, for example, that the average GP will be confronted by 1.5 patients who are suffering from meningitis in a 35-year career, yet we expect them to make the right diagnosis. It is difficult. If the GP has made the right diagnosis—I am not necessarily talking just about meningitis—we expect them to come up with the right treatment, which involves another judgment and a great deal of uncertainty. Even if the diagnosis and choice of treatment are right, it may be that the treatment will, for one reason or another, go wrong.

Nevertheless, within the national health service, most people, most of the time and in most places, get very good treatment. Over the past 15 or 16 years, there has been a big reduction in mortality in hospitals, a big improvement in people’s recovery from treatment for a serious illness, and we have been catching up with some countries that had a better record than us. Despite all the criticism, general satisfaction with the national health service remains high. If people are asked what they think of the national health service, about 60% say it is pretty good. If they are asked how the NHS treated them or a member of their family, the percentage of those who are satisfied is usually in the high 80s or low 90s. Any political party or political leader would love that sort of satisfaction rating.

People working in the NHS have very demanding jobs and they need help in doing those jobs. The first thing we must do is try not to make their lives more difficult than they are already. We should ensure, for instance, that they are not in a decrepit hospital without enough beds and that the equipment they have is reliable.

[Mr Kevan Jones]

Does my right hon. Friend agree that one of the achievements of the previous Labour Government was the capital investment we put into hospitals? In 1997, for example, the hospital in my constituency was housed in the old workhouse, and we now have a brand-new hospital thanks to Labour. That has made a difference not just to patient care but to the working environment of the people we are asking to care for those patients.

[Frank Dobson]

That is certainly the case and applies to many parts of the country, including areas represented by Government Members.

I do not think any hospital has had more money spent on it than University College hospital in my constituency, the rebuilding of which, I freely admit, was authorised when I was Secretary of State. I understand that it is the hospital in this country from which one is least likely to come out dead. It is a good place that has modern and reliable equipment and is not, generally speaking, short of staff. It is quite clear that staff shortages in parts of the country have endangered the standard of care provided.

People’s pay and conditions are also important. The Cavendish report, produced only last week by a journalist for The Daily Telegraph, Ms Cavendish, stated that she regarded the pay and conditions of large numbers of people providing services outside hospitals to people who need them as disgraceful, shocking and a condemnation of our society. She is quite right.

One thing concerns me most, however. I remember when I first became Secretary of State for Health being telephoned by a very good friend who was then a professor in the medical school at Nottingham and said—I shall have to bowdlerise this—“For Lord’s sake, leave us alone. Do not reorganise; do not distract people from their usual jobs.” That is what too many Governments have done, including this one, but I do not want to go ranting on about it.

One thing I want to talk about is not mentioned very often. It became fashionable to say that the money must follow the patient and that we did not want to hand over big lumps of money to hospitals and other parts of the health service as that did not provide the right incentives. The only trouble is that as a result NHS transaction costs went up from 4p in the pound to what is estimated now to be between 12p to 15p in the pound. That is a lot of money—about £8 billion, £9 billion or £10 billion extra, just because of the new method of funding. If we want to release funds to help people who are being treated in the health service and who want to be treated there, to provide the buildings, equipment and staff, and to encourage the staff, we must think about the money being squandered on transaction costs. Unless we do something about that, it will only get worse under the new system.

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[Charlotte Leslie]

I absolutely agree with my hon. Friend. I would draw a distinction, however, as I think many members of staff in the NHS want, and wanted, nothing more than to put patients first. I was slightly surprised that only two Opposition Members mentioned patients and patient safety in their contributions yesterday. That was very upsetting.

[Frank Dobson]

In reference to the point the hon. Lady made to the previous intervention, does she agree with Professor Keogh—a most excellent man—that there is a strong correlation between the extent to which staff feel engaged and mortality rates, thus indicating that caring about staff is absolutely crucial if we are going to care about patients?

[Charlotte Leslie]

I absolutely agree, although there is a distinction to draw between managerial staff, who I think have been leant on heavily to make their hospital look good, and the ground-level staff, many of whom have been battling over the last decade to be able to put clinical priorities ahead of management and political priorities.

Accident and Emergency Waiting Times

Frank Dobson Excerpts

Wednesday 5th June 2013 Commons Chamber

[Frank Dobson (Holborn and St Pancras) (Lab)]

That is the most extraordinary speech I have heard from a Secretary of State for Health in all my years in this House. As a former Secretary of State, I know that Secretaries of State cannot be responsible for everything, but this is the first speech in which a Secretary of State has claimed he is not responsible for anything. He quoted the Francis report. One of its most significant features was that it said that we should impose a statutory duty of candour on people working in the national health service; if anything goes wrong, they are supposed to come clean and admit responsibility. I hope that there will be a clause in a Bill introducing the duty that says that this Secretary of State should have a duty of candour and admit the things that have gone wrong.

What have Ministers been doing for the past three years? The main thing they have been doing is dismantling the national health service. Staff have been distracted from their jobs, and money—£3 billion—has been diverted into that reorganisation. Some of that has been spent on redundancy for nurses who work in accident and emergency. The Government have been proudly saying, “We have hit our new target.” Well, they reduced it and made it easier to hit. The 111 line has referred more cases to A and E than NHS Direct did. There have been cuts in social care, which have two effects on A and E. First, it means that more elderly people go to A and E for treatment because they are not getting the attention that they were from social services. Secondly, it means that there will be delays in patients going home, both from A and E and from ordinary hospital beds, and that causes delay, too. Walk-in centres have closed, and the Government have given the surplus money back to the Treasury, yet they deny that any single one of their policies has had any effect on A and E services. They have had three years in power, and they are still blaming other people.

The Government claim that the increase resulted from the change to the GP contract. They know full well that that is not true; they know that it was because walk-in centres and minor injuries units were counted in the figures for the first time. If the Secretary of State expects people in the national health service to respect him and take any notice of him, not just regard him as the Catherine wheel of spin, he has to come clean. He is telling people that if they get things wrong in the health service they must come clean and be honest with the public. If he does not apply that to himself he will be a bit like the dad who has told people not to give their kids a leg up, but who turns out to have employed both his daughters: he did not apply to himself what he said everybody else should do. My right hon. Friend the Member for Leigh (Andy Burnham) was right: there was spare money, but under the new set-up can the Secretary of State get it into the hands of the health service, or did his predecessor throw away that power?

A and E Departments

Frank Dobson Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

As ever, my right hon. Friend speaks with great wisdom. When it comes to the frail elderly, the key is to have a system that heads off problems before they arrive so that people do not find that they end up having to be rushed into A and E in the middle of the night. That can often be the very worst place for someone with advanced dementia or any condition that makes them extremely fragile and vulnerable. We need to integrate systems properly, and that did not happen under the previous Government. One of the key work streams of the vulnerable older people’s plan will be to look at barriers to integration, particularly the barriers to joint commissioning of social care and health. We intend to make good progress on that front.

[Frank Dobson (Holborn and St Pancras) (Lab)]

Does the Secretary of State accept that when NHS Direct was operating, nurses had the professional competence to decide not to refer people to A and E, and to provide reassuring advice? They have been replaced by call handlers who, understandably, opt to send people to A and E because they have neither the professional competence nor the professional confidence to do anything else?

[Mr Hunt]

I agree that there have been teething problems with 111 and we are addressing those problems. [Hon. Members: “ Teething problems?”] There is laughter on the Opposition Benches. We are hitting our A and E targets at the moment, and 111 is available in more than 90% of the country. We are dealing with those teething issues, but I take on board the right hon. Gentleman’s point. The 111 service needs to be quicker at getting advice to people from a GP or a nurse. The fundamental issue with 111 is that giving the public an easy number to remember has highlighted how inaccessible GP out-of-hours services have become. We have to address that if we are to restore public confidence in 111.

Health and Social Care

Frank Dobson Excerpts

Monday 13th May 2013 Commons Chamber

[Frank Dobson (Holborn and St Pancras) (Lab)]

I will not follow the right hon. Member for Mid Sussex (Nicholas Soames) in referring to Europe, other than to say I regret the possibility that European competition law will in future apply to the national health service, which will no doubt be exploited by major American health corporations.

I will talk exclusively about the current destruction of NHS Direct, a successful, safe and popular service, and its replacement by 111—I hesitate to call it a service— that has proved to be a shambles in many parts of the country. I must declare an interest—a sort of proprietorial one—because I was Health Secretary when we decided to set up NHS Direct in 1998. We set it up in a sensible way, and it worked from the start. We established three pilot schemes. The service was gradually rolled out across the country, learning all the time from the experiences of the earlier services that were already working. It worked well from the start, and there is no excuse for Ministers in this Government who have introduced the 111 service as a mess. They have been calling summits and announcing reviews ever since it started going wrong. That is pathetic, because they are not in the Department of summits and reviews; they are in the Department of Health.

Those Ministers were not even doing anything new. They had the opportunity to build on NHS Direct, which was a successful example. In 2002, it was described as a remarkably successful service by the Public Accounts Committee, then chaired by the hon. Member for Gainsborough (Mr Leigh), and of which the current Chancellor of the Exchequer was a very active member. Reports by the Comptroller and Auditor General and the PAC commended the service, saying it had met all its deadlines and properly addressed all the risks, and that it had a practical approach and had learned lessons as it went along. It was also commended for the fact that its computer procurement had been well managed and had been delivered to cost, and that there had been satisfactory consultation and it was clinically safe.

It was praised, too, for reducing demand on other parts of the NHS. The main reason it was reducing demand was because it was predominantly staffed by nurses, who had the professional confidence and judgment simply to offer reassurance to some who got in touch. In the current service, however, there are many call handlers, who do not have that professional knowledge and confidence, and are therefore referring people to GP services or A and E and are arranging ambulances.

I commend the views of the PAC back in 2002. It was far sighted, because it said:

“Departments should consider what wider lessons they could learn from the successful introduction of this significant and innovative service on time.”

The Chancellor’s Government have clearly decided to ignore that recommendation. The PAC also noted:

“Short lines of communication between the Project Team and those implementing the service at local level enabled lessons to be learnt quickly as the projects progressed.”

Clearly the current Government did not learn that lesson either.

The current Chancellor himself said in one of his contributions to the Committee:

“My concern is that the Permanent Secretary…is going to start saying, we are great, we have this giant switchboard for the NHS, and your service is going to lose the focus of its original function”.

That perfectly describes what has happened with the abolition of NHS Direct and its replacement by the 111 service.

The 111 service does not have short lines of communication—indeed, I doubt whether it has any at all. It has also taken on innumerable new functions, and has been expected to carry them out at less cost than NHS Direct was operating at. The only way it could reduce costs was by getting rid of nurses, because they are more expensive than call handlers. Indeed, GP representatives have told me the current service has reversed the situation: whereas there used to be more nurses than call handlers, there are now more call handlers than nurses, and in one area there are 15 call handlers and one nurse.

The computers keep going down, there are massive delays, and a lot of the call handlers are giving the wrong advice, much of which is expensive for the NHS. The Government cannot say that they were not warned about this because they were warned by Members, even Government Members, as long ago as March, not this year but last year.

In bidding to get one of these contracts, people assumed, in good faith or bad faith, that they could provide as good a service as NHS Direct at half the cost. It is now clear that they cannot. Other parts of the NHS are bailing them out to try to keep the 111 service going. As my right hon. Friend the Member for Leigh (Andy Burnham) said, the question that arises is what the Secretary of State can do about it. The people running these services have bid for fixed-price contracts. If they now need to spend more, how is the money going to get to them so that they can do so? They are left with three alternatives: they can struggle on providing this very poor, unreliable service, they can go bust and there is no service, or the money is found from somewhere else in the NHS. However, under the crackpot system that the Government introduced when they changed the law, there is no machinery for putting extra money into these services so that they can do their job properly.

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[Paul Blomfield]

My understanding is that the majority of unions would support standardised packaging. I deeply regret the fact that the tobacco giants use some individual trade unionists as de facto lobbyists.

The Government surrendered to the tobacco giants. What message does that send to the country? This Government are prepared to see people die and, as the hon. Member for Mid Derbyshire (Pauline Latham) said, die horribly, and in their hundreds of thousands, to prop up the profits of the tobacco industry. There are no industries like the tobacco industry—the more cigarettes it sells, the more money it makes and the more people die.

Since science confirmed the link between smoking and lung cancer, the tobacco industry has opposed every single measure to reduce smoking. We all know that smoking is the largest preventable cause of cancer; it is responsible for four out of every 10 cancer deaths. According to Cancer Research UK, tobacco is responsible for 100,000 deaths in the UK every year. We have made huge strides with the measures that have already been taken against smoking, but as we have encouraged people to stop smoking, the tobacco giants have been building their market among young people. A report from Cancer Research UK in March showed that the number of children smoking had risen by 50,000 in just one year.

[Frank Dobson]

Let me demonstrate the absolutely vile morality—if I can combine those two words—of the tobacco industry. When it was discovered that nicotine was addictive, the industry increased the proportion of nicotine in cigarettes to make them more addictive. People like that should not be listened to; they should be shown the door.

[Paul Blomfield]

I agree with my right hon. Friend: the tobacco industry should not be listened to. However, it finds no end of ways to seek to defeat the arguments of public health lobbies against smoking, and indeed to encourage the wider use of cigarettes.

Shockingly, in the last year for which figures are available about 207,000 children aged between 11 and 15 started smoking. The vile way—to use my right hon. Friend’s word—in which the tobacco giants operate means that that is a direct result of the industry’s marketing strategies, which are as sophisticated as they are cynical. Flavoured cigarettes have been introduced, and not only menthol, but chocolate and fruit flavours. Some cigarettes are targeted at young women. Even the Daily Mail pointed out, in condemning that move, that those cigarettes seek to

“make smoking look elegant, sexy and classy”.

Alternatively, as British American Tobacco’s Hinesh Patel said, almost acknowledging the company’s strategy:

“We’ve taken a creative approach to respond to the female under-30 demand for a smaller, slimmer, less masculine cigarette…a contemporary product in a new accessible size.”

In that context, packaging is crucial. A Saatchi & Saatchi marketeer said this of British American Tobacco’s Vogue package:

“The cigarettes look like something found behind a glitzy counter at Selfridges....trying to capitalise on a woman’s desire to feel beautiful to sell their cigarettes.”

The Government public health Minister, the hon. Member for Broxtowe (Anna Soubry), is not present, but she has made her views on this subject clear. In April, she said before a House of Lords Select Committee:

“We know that the package itself plays an important part in the process of young people and their decision to buy a packet and to smoke cigarettes.”

All the experts back standardised packaging, and until a few days ago we thought the Government did, too. The public back that as well, with 63% in favour and only 16% against, according to recent polling. This Government are getting it wrong again. They are showing again that they are out of touch with people and they are on the wrong side of the argument, and I urge them to think again.

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[Jim Shannon]

I thank the hon. Gentleman for his intervention. I perceive and am of the opinion that companies saw such measures as a loss to their profit margin, and we would like to see what happened in Australia happen here.

The former Health Secretary, the right hon. Member for South Cambridgeshire (Mr Lansley),was quoted in the media saying that the Government did not work with tobacco companies as they wanted them to have “no business” in the UK. Has that changed? The current Health Secretary stated that one of his key priorities is to reduce premature mortality. His call to action on premature mortality commits to a decision on whether to proceed with standard packaging. He also stated:

“Just because something is not in the Queen’s Speech doesn’t mean that the Government cannot bring it forward in law.”

Even at this late stage, may we hear a commitment to bringing forth such a measure in law? If we do, that will be good news and we will welcome it.

Some 10 million adults smoke in the UK and more than 200,000 children start smoking at a very early age. More than 100,000 people die from cancer-related smoking diseases across the UK, which is more than from the next six causes of preventable death put together. The immensity of the number of deaths from smoking cannot be underestimated. Many Members have spoken about that, and I believe the fact we are all saying the same thing is something we should underline.

We cannot remove people’s choice to smoke—that is a decision to be made by any adult—but we can, and must, ensure that everyone knows they are doing harm to themselves and those around them. Evidence that standardised packaging helps smokers quit and prevents young people from taking up the habit and facing a lifetime of addiction is clear, and we should encourage more people to stop smoking and not to become addicted.

[Frank Dobson]

Does the hon. Gentleman agree that the argument sometimes put by defenders of the tobacco industry—usually paid defenders—is that people are exercising free choice? In fact, they are not exercising free choice because they are addicts who took up the addiction when tobacco companies persuaded them to smoke when they were teenagers.

[Jim Shannon]

I thank the right hon. Gentleman for that intervention and for clearly underlining the stand we are all taking on this issue. We hope that Ministers will respond positively. I believe that plain packaging is a major step in this informational and educational journey to end smoking, and I ask the Minister to commit today to begin that journey that has been planned for so long.

Another disappointment in last week’s speech was the lack of reference to the minimum pricing of alcohol, although there has been some indication that there may be a change of heart, which we hope will be the case. Last week I was sent a copy of a study containing numerous sources, and there are certainly some shocking statistics. Its findings, among other pertinent points, demonstrate that alcohol is 45% more affordable today than it was in 1980. Men and women can currently exceed the recommended low-risk daily drinking guidelines for £1. That is hard to believe in this day and age, but it is the truth. Data from Canadian provinces suggest that a 10% increase in the average minimum price would result in about an 8% reduction in consumption, a 9% reduction in hospital admissions, and—this is the big one, Mr Deputy Speaker—a 32% reduction in deaths caused wholly by alcohol, which is even higher than the figure suggested in the Government’s impact assessment.

Alcohol Health Alliance UK stated:

“The case for introducing minimum unit pricing is clearer than ever, yet despite committing to the principle of minimum unit pricing, it appears that the Government are going to drop the measure from their alcohol strategy.”

Perhaps Ministers will comment on that, but I sincerely hope it is not the case. Minimum pricing of alcohol is not to ensure that those on low incomes cannot have a drink, but to ensure that people of all incomes are aware how much they are drinking and conscious of the health implications of excessive or binge drinking. When it comes to minimum pricing for alcohol, we can all take note and take advantage of it.

Every year there are 1.5 million victims of alcohol-fuelled violence in the United Kingdom, and it is clear that community safety is threatened by the misuse of alcohol. Police superintendents have advised that alcohol is present in half of all crimes committed, and a 1990 study for the Home Office found that growth in beer consumption was the single most important factor in explaining the growth in crimes of violence against the person. The figures are clear. Statistics show that 37% of offenders had a current problem with alcohol; 37% had a problem with binge drinking; 47% have misused alcohol in the past; and 32% had violent behaviour related to their alcohol use. When we mix young people, who have not had time to develop their moral standards and ideals, with alcohol, we have a generation who are fuelled by the desire to live in the moment, with no thought of the consequences. Alcohol changes personalities, and young people are only learning who they are. Adding alcohol to the mix means that they will never have a good understanding of who they are. A minimum price for alcohol will lessen the number of young people who drink copious amounts of it. Hopefully, it will also mean a lessening of crimes that are aggravated or exacerbated by alcohol.

My third point is on diabetes, which is a ticking bomb in our society. We had a debate on it in Westminster Hall, when the right hon. Member for Leicester East (Keith Vaz) made the point about diabetes and obesity among children. The figures are overwhelming. The United Kingdom of Great Britain and Northern Ireland diabetes strategy ended in April, but perhaps the Minister can tonight commit to its continuation. I believe the strategy was working. Had it not had an effect, the figures would be much worse. Even given the strategy, the number of people living with types 1 and 2 diabetes has increased by 33% in Northern Ireland, 25% in England, 20% in Wales, and 18% in Scotland. The numbers are rising. A commitment to the continuation of the strategy would be helpful. The statistics are scary—3.7 million people in the UK are diagnosed with type 2 diabetes. However, we are talking not only about statistics, but about people’s lives. We need to prevent and control as well as we can.

I am aware that the health portfolio is not an easy one. Everybody needs something urgently. I understand the restrictions that apply, but does the Minister understand that the three issues that I and others have raised affect every corner of the United Kingdom of Great Britain and Northern Ireland? I believe we could have reform on those issues if the Government put their hand to the plough and disregard all but the health and safety of our population.

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[Norman Lamb]

I was coming on to pay tribute to the hon. Lady for the work she has done. I absolutely agree with her that we need to get this right. We have the juxtaposition of two Bills, dealing with children on the one hand and adult social care on the other. Earlier I made a commitment to meet the children’s Minister; I had an opportunity to speak to him briefly when he was in the Chamber earlier. I am also meeting the hon. Lady later this week. I am committed to doing everything I can to get this right, and to ensure that young carers are not let down.

The Care Bill also highlights the importance of preventing and reducing ill health and of putting people in control of their care and support. This will involve the right to personal budgets, taken as a direct payment if the individual wants it, and putting people in charge of their care and of how the money is spent. This will put carers on a par with those for whom they care for the first time. The hon. Lady has consistently argued her case, and I am determined that we should get this provision right. The hon. Member for Rotherham (Sarah Champion) also made some powerful points on the subject.

The Bill will also end the postcode lottery in eligibility for care support. My hon. Friend the Member for Totnes (Dr Wollaston), the hon. Member for Easington and others raised concerns about the level of the eligibility. That question will obviously have to wait until the spending review, but I point out that if we were to set it at moderate need, the cost attached would be about £1.2 billion. All hon. Members need to recognise that this is difficult, given the tough situation with public finances. We also need to do longer-term work on developing a more sophisticated way of assessing need and providing support before people reach crisis point.

The Bill will refocus attention on people rather than on services. It will bring in new measures based on the Francis inquiry, ushering in a new ratings system for hospitals and care homes, so that people will be able to judge standards for themselves. The hon. Member for Walsall South (Valerie Vaz) criticised the idea of appointing a chief inspector of hospitals, but I disagree with her. It will be really important to identify where poor care exists and to expose it so that improvements can be demanded without fear or favour. The chief inspector will be able to do just that. It will also be really important to celebrate great care, so that those people in the health and care system who are doing everything right can be applauded and recognised for the work they are doing.

[Frank Dobson]

Does the Minister accept that a generalised rating for a hospital is not going to be valuable because, within one hospital, some departments might be doing a brilliant job while others are not? It would be stupid if an overall rating persuaded people not to go to a particular hospital for treatment if the specialty they required was being practised brilliantly.

[Norman Lamb]

I disagree. We brought in Jennifer Dixon of the Nuffield Trust to advise on this matter. There will be ratings for specific services within hospitals to identify areas of great care, but the single rating will give the hospital the incentive to bring up to a proper standard those areas that are falling short, and that will be a good thing.

Accountability and Transparency in the NHS

Frank Dobson Excerpts

Thursday 14th March 2013 Commons Chamber

[Frank Dobson (Holborn and St Pancras) (Lab)]

I congratulate the hon. Member for Stafford (Jeremy Lefroy) on his thoughtful contribution to the debate. We all owe it to the people of Stafford and those round about, all of whom depend on Mid Staffs, to ask the Secretary of State to guarantee that nothing and no one is allowed to use the horrors that occurred as an excuse to close the hospital or to run it down. That would punish the local people, the potential patients, and the good staff at the hospital. I hope he is willing to make whatever organisational changes—extra cash, or new ways of financing parts of the health service—are necessary to make that guarantee to the people in that area.

I started off as Health Secretary fully in favour of transparency. My last job before I became an MP was working for the local government ombudsman. It was my view, and it remains my view, that the best way to deal with anything that has gone wrong is to stand up and say, “Sorry, I got it wrong.” However, there is a problem. We are asking people in the NHS to operate in two different worlds. If something goes wrong in the hospital, the GP’s surgery or the clinic, we say: confess straight away. That is one world—the official world. People then get in their car, drive out of the car park to go home and bump into another car. What happens? Their insurer says, “Whatever you do, don’t accept any responsibility.” We need to recognise the clash of different worlds that people live in.

When the excellent hon. Member for Aldridge-Brownhills (Sir Richard Shepherd) introduced the Public Interest Disclosure Act 1998 to protect whistleblowers, I made sure that the Labour Government supported it, and that the provisions covered the national health service. There were those who did not want it to cover the NHS. I am delighted to say that I anticipated that some might want to have disappearance clauses in contracts—gagging clauses—and issued a circular that prohibited them. Any health body that has inserted such a clause is breaking the terms of the circular that was sent out in my name in 1999.

I also established the Commission for Health Improvement. It was intended to monitor and improve standards, and it was the first time in the history of the national health service that such a body had been set up. At that time, there was no machinery in the NHS for identifying good or bad practice, or for promoting good practice more widely and eliminating poor practice. I also required all health boards and chief executives to be responsible for the quality of treatment and care. No such obligation had been placed on them before, and that was a step in the right direction.

The hon. Member for Stafford rightly said that if transparency is to be based on experience and on data, those data have to be fair. We cannot have a situation in which someone who performs regular, straightforward surgery is compared favourably with someone who treats people in desperate circumstances and therefore has a greater chance of the operation or treatment going wrong. Everyone in the medical profession has got something wrong, and some have done so quite a few times.

If we are to have transparency in the provision of services to NHS patients that are paid for by public money, that transparency must apply not only to the NHS providers but to any other franchised provider of services. I know from experience that, when our lot were selling off a GP practice in my constituency, we were told that we could not find out the terms of the contract because it was commercially confidential. If we had been able to see the contract, we might have spotted that it enabled the contractor to leg it if things got difficult, which is what it duly did.

However keen Government Members might be on involving the private sector—I freely admit that I am not, but they are—they must ensure that patients and others are not denied information on the ground of commercial confidentiality. I strongly support the idea of making whistleblowing a duty, and that duty of candour must apply to any private sector provider. We cannot have them hiding away behind their private profit-making efforts. We must also ensure that, when anything goes wrong, the Secretary of State will answer to the House of Commons. We do not want anyone coming along and saying, “It wasn’t me, guv, it was the commissioning board wot got it wrong.” We must make it absolutely certain that our national health service is responsible to us here.

My final point is that I am sick to death of what is happening at the Whittington hospital. In order to qualify for trust status, it is being told to reduce the ratio of nurses to patients, yet it is already one of the five safest hospitals in the country.

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[Steve Baker (Wycombe) (Con)]

My constituent Edward Maitland was a frail man who could not eat solid food following tongue surgery. He was admitted to Wycombe hospital from his warden-controlled accommodation suffering from dehydration, shortness of breath and weight loss, things from which he should have recovered. His son, a paramedic, clearly explained on his father’s admission that Mr Maitland could not eat solid food and he also provided liquids. About three weeks later Edward Maitland had died from aspiration pneumonia. At the post-mortem, Weetabix was found in his lungs.

Of course, the investigation was taken extremely seriously and the documentation is, up to a point, very professional. Under “root cause”, it states:

“The investigation found that there is no evidence to support robust communication between nursing and medical staff…No SBAR”—

situation, background, assessment and recommendations—

“documentation was used in EMC or in handover to Ward 6B this would have highlighted the patient’s nutritional needs.”

It proceeds to make some “recommendations”, but I want to highlight the “lessons learned”:

“To care for all patients with a holistic approach and the multi-disciplinary team must focus on all health concerns.

Better communications between all staff members, this should be ongoing and involve all the different professionals who may need to collaborate the care delivery plan. This collaboration and communication should involve the patient, family and the healthcare staff.”

Unfortunately, that is bread-and-butter, typical stuff—and managerial gibberish.

What I learned is that two words would have saved the life of Edward Maitland: “no solids”, written on the records at the end of his bed, on his wristband, and above his bed. The situation in his case is very simple. A man died who ought not to have died. He should not have died in these circumstances.

I have the hard task of saying, therefore, that I look to the courts, and the Francis report helps me. Recommendation 13 of the report, on fundamental standards, refers to:

“Fundamental standards of minimum quality and safety, where non-compliance should not be tolerated. Failures leading to death or serious harm should remain offences for which prosecutions can be brought against organisations.”

Elsewhere, the report discusses at some length—I do not have time to go into detail—a regulatory gap in relation to the Health and Safety Executive:

“It should be recognised that there are cases which are so serious that criminal sanction is required, even where the facts fall short of establishing a charge of individual or corporate manslaughter. The argument that the existence of a criminal sanction inhibits candour and cooperation is not persuasive. Such sanctions have not prevented improvements in other fields of activity.”

I took legal advice. I approached a retired circuit judge in my constituency, who in turn approached a firm of lawyers. I am most grateful for the guidance of Kate McMahon, of Edmonds Marshall McMahon, who has provided me with considerable free legal advice in relation to this case. The firm specialises in private criminal prosecutions. She has explained that, at least at the preliminary stage, there may be a corporate manslaughter case to answer, and liability for gross negligence manslaughter may well be attributable to one or more employees of the hospital.

I do not want people to be prosecuted unnecessarily, or to see taxpayers’ money wasted, but I do want accountability, and I believe that in the end the courts provide that crucial accountability. Edward Maitland’s son Gary now has this advice, and I have left it to him to decide whether to approach the police. I have briefed the police superintendent in Wycombe on the circumstances. I believe that the courts should be the ultimate way of sanctioning the NHS. Francis agrees, and I hope he will provide a policy in this area.

There should be more democratic control. I am delighted—

[Frank Dobson]

Does the hon. Gentleman not agree that one characteristic of involving lawyers is that there is a lot of money around, and it goes to them? Would it not be better spent trying to ensure that performance standards are enhanced, rather than employing lawyers to have a go at the people who got it wrong?

[Steve Baker]

Of course I would rather that the money was spent on standards and performance and not on prosecutions, because I would rather the problems did not occur. I do not wish to lecture the right hon. Gentleman, and I feel sure he did not quite mean it this way, but if we do not intend to apply the law of corporate and individual gross negligence manslaughter, let us repeal it, or amend it so that it does not apply to the NHS. I have to say to the right hon. Gentleman that it does apply to the NHS and that in certain cases, as Francis has said, things are so bad it should be applied.

I ask the Government to look at democratic control. I am delighted that the Secretary of State is reforming the Care Quality Commission, but how can we make sure that there is more direct accountability, perhaps to the health and well-being boards, and the overview and scrutiny committees? How can we give them the power to sanction or perhaps even, through due process, dismiss a board or a chief executive?

I think here of Paul Ryan, a man with vascular disease who had lost one leg already when he found himself sick. He had four days of GP visits and spent nine hours in accident and emergency on a Friday. He was then sent home, having had an MRI scan, after which he was expecting to lose his leg on the Monday. He was told to expect a phone call, but no phone call came. The Ryans eventually called 999 and were told that it was better to get a GP. The GP arrived and called an ambulance. It took two hours for that to arrive and Paul Ryan died in the ambulance with his wife on the way to hospital.

NHS Commissioning Board (Mandate)

Frank Dobson Excerpts

Tuesday 13th November 2012 Commons Chamber

[Mr Hunt]

I hope my right hon. Friend is right that there is agreement on the goals in the mandate, because they have been drawn up after extensive consultation with the people of this country and are important priorities, particularly as we grapple with an ageing society. I agree with him that it does not the help the NHS to descend to the rhetoric we heard from the right hon. Member for Leigh (Andy Burnham). There is a very important and legitimate debate about the right way to achieve shared goals. Government Members do not believe the right way is through performance management from the Department of Health and trying to echo out every part of the system. We believe the right way is to empower local GP-led groups to make changes on the ground. That is at the heart of the reforms.

[Frank Dobson (Holborn and St Pancras) (Lab)]

I can understand the Secretary of State’s desire to give operational freedom to people in each locality, and his desire, as he says in his document, to reduce the inequalities of treatment between one area and another, but how does he intend to reconcile those two objectives?

[Mr Hunt]

The approach the reforms take is this: when there are inequalities in treatment, and when one hospital is particularly good at certain operations and another hospital is not as good, the best way to drive up performance is to make that information available in a way that has never happened before. More than anything, peer review drives the NHS. A very important part of the programme will be to roll out plans similar to those we have rolled out for cardiothoracic surgery, for which a performance comparison by consultant team, not just by hospital, has led to a dramatic improvement in survival rates from heart operations. We need to roll that out across many other disciplines. We also need to be able to compare local GP-led group with local GP-led group, and local authority with local authority. That will be a far more effective way of driving change than the old top-down way. That was tried under different Governments many times and in many ways, but it was never as successful as it was meant to be.

National Health Service

Frank Dobson Excerpts

Monday 16th July 2012 Commons Chamber

[Andy Burnham]

My hon. Friend is absolutely right about the waste of money the Government have brought into the NHS through this reorganisation. The total is over £3 billion. That is simply unjustifiable at this time. Staff who had been working in primary care trusts are either being re-employed as consultants or are going into clinical commissioning groups. This is such a waste of money at a time when the NHS needed every penny to maintain standards of patient care.

I was talking about rationing, and let me focus on cataract surgery. GP magazine has found limits on cataract surgery in 66% of PCTs. The Royal National Institute of Blind People found that 58% of PCTs are using visual acuity thresholds to restrict surgery. This is the evidence, so the Secretary of State had better start listening. What has happened since those restrictions on cataract operations have been introduced? Unsurprisingly, the number of cataract operations in England fell by over 12,000 between 2010 and 2011. That is a direct result of the new restrictions. There is no less need, however. Thousands of older people need such procedures, but they are now being forced to live with very poor sight.

This is truly a false economy. Cataract surgery is one of the most cost-effective procedures carried out by the NHS. It helps people live independently and have a quality of life, and research has shown that in the last two years poor vision has been a factor in 270,000 falls by people aged 60 or over. This is the rationing by cost that Ministers have repeatedly denied is happening. So let me ask the Secretary of State again: does he agree with these restrictions on cataract surgery? If he does not, will he take immediate action to lift them?

[Frank Dobson (Holborn and St Pancras) (Lab)]

Will my right hon. Friend confirm that under the last Labour Government the number of cataract operations carried out by the NHS rose from 160,000 a year to 310,000 a year, as a result of the commitment of the staff? What will the staff in the south-west think about all this if they have their pay cut?

[Andy Burnham]

For staff who are trying to hold things together through the chaos the Government have brought about, what a kick in the teeth it must have been to read in the Sunday newspapers that unless they accept pay cuts, they will be made redundant. My right hon. Friend says the staff made those improvements, but so did he. As the incoming Secretary of State, he made improvements to waiting times for cataract surgery, which, if I remember rightly, were commonly about a year in the late-1990s. We brought those waiting times right down. Now what do we hear? We hear that under this crowd people with two cataracts are being told, “You can have one done, but not both.” That is what the NHS has been reduced to under this Government. The Secretary of State has promised action, and I have given him the evidence. He now must take action.

The second area on which the Government need to be challenged is privatisation. As the debate on the Bill drew to a close, the Secretary of State made this clear statement:

“The legislation is absolutely clear that it does not lead to privatisation, it does not promote privatisation, it does not permit privatisation and it does not allow any increase in charges in the NHS.”—[Official Report, 27 March 2012; Vol. 542, c. 1335.]

It is hard to know where to start, but how about the NHS walk-in centre in Sheffield, which is managed by a private company and has just started charging patients with whiplash injuries £25 for treatment, or the NHS hospitals now marketing private treatments for in vitro fertilisation, cancer screening or bone screening since the cap was lifted? How about the letter sent to all PCTs requiring them to identify three or more services for tendering under the “any qualified provider” measure in 2012-13? How about the 100 or so tenders for a range of services that have been offered to the private sector on this Secretary of State’s watch, with a total value of more than £4 billion? So let me ask the Minister and the Secretary of State today: will they now at least be honest about their true intentions for the level of private sector involvement in the NHS?

--- Later in debate ---

[Mr Dorrell]

The right hon. Gentleman shakes his head, but he said that he would repeal the Health and Social Care Act 2012, the result of which would be to commit the health service to precisely the kind of reorganisation—or re-disorganisation—that he accuses the Government of introducing.

The challenge for the Opposition is to show that they are willing to map a future for the health service, in much more constrained financial circumstances, that allows it to meet the demand for services that is going to be placed on it and to fulfil the aspirations that we all have for improved quality of service. That becomes increasingly difficult in the light of motions such as the one that the right hon. Gentleman has put down for the House to consider. He invites us to regret

“the increasing number of cost-driven reconfigurations of hospital services”

and

“growing private sector involvement in both the commissioning and provision of NHS services”.

Yet when he was Secretary of State and bore my right hon. Friend’s responsibilities for meeting this challenge, he made it clear that service reconfiguration was precisely how the health service needed to meet the challenges that it faced, and that the private sector had an important role—of course, not an exclusive role—in introducing the solutions to the challenge that Sir David Nicholson articulated in May 2009. The same approach was taken in the Labour party’s manifesto for the 2010 general election.

The challenge that the right hon. Gentleman has to address if he is to discharge his responsibilities as shadow Health Secretary is to move on from party political ding-dongs, of which we have had too many. [Interruption.] The right hon. Member for Holborn and St Pancras (Frank Dobson) is commenting from a sedentary position. I have always been aware that he, at least, does not agree with the commissioner-provider split that the shadow Health Secretary operated as Secretary of State and has always said that he is in favour of considering.

[Frank Dobson]

Would the right hon. Gentleman care to confirm for the House that in the last year when he was Secretary of State, NHS hospitals carried out 5.7 million operations and at the end of the Labour Government’s period in office it was carrying out 9.7 million operations?

[Mr Dorrell]

I am grateful to the right hon. Gentleman for drawing attention to the fact that throughout the history of the health service, under Governments of all political complexions, there has been a growth in the level of services, and improvement in the quality of services, provided to patients. It happened under the Tory Government of whom I was a member and under the Government of whom he was a member. Of course, that is delivered not by the politicians but by the doctors and nurses who work in the health service.

The challenge faced by the current generation of policy makers, including the shadow Health Secretary, is how to meet the rising demands and the requirement for improved quality in much more constrained financial circumstances than I or he faced as Secretaries of State. He signally failed to meet that challenge today.

--- Later in debate ---

[Frank Dobson (Holborn and St Pancras) (Lab)]

We all know that the massive top-down reorganisation of the national health service that the Government have pushed through had not a jot of public support, that no one voted for it and that it was not mentioned in the famous coalition agreement. Nevertheless, it was proceeded with.

We are now faced with something that was not in the election manifesto of either of the Government parties. Nor, I suspect, was it in any of the election literature of any of the MPs from those parties in the south-west. I do not think that any of them said, to use the phrase of the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), “We admire you people in the health service so much that we have decided that you will have to pay more for your pension and work longer, and that your pension will be smaller.” I do not think that any of the Lib Dem or Tory candidates in the south-west put in their leaflets, “We admire you people in the national health service so much that we intend to reduce your pay.” None of them said, “We admire you so much that we are going to reduce your entitlement to leave.” None of them has said, at a time when there is rightly increasing concern about the standard of care in hospitals at the weekend, “We intend to reduce or get rid of your overtime pay at weekends.” I would not wish to be admired by a Health Minister, because something nasty would clearly appear shortly afterwards.

People in the national health service are sick to death of this massive reorganisation, of thousands of their colleagues being made redundant, of people having to reapply for their own jobs, and of being expected to do their day job while falling into line with the preposterous ideas in the major health legislation that went through this House. On top of that, they are now being told that they cannot be paid what they used to be paid. Apparently, people in the south-west say, “Pay down here tends to be lower, so let’s reduce the higher pay of people in the public sector, such as those in the hospitals, to the miserable levels that the private sector pays people here.” It is not likely that giving people even lower pay, which is always associated with poor health, will improve the public health of people in the south-west, which the hon. Member for Totnes (Dr Wollaston), who is herself a GP in the south-west, has talked about.

What the Government have done is disgraceful and is in clear breach of their manifesto commitments. They are now attacking people in the national health service. I laud and admire people who work in the national health service. There may be some bad ’uns—there are bad ’uns everywhere—but most of them work very hard and brilliantly on our behalf, none more so than those at University College hospital in my constituency and at the Kentish Town health centre, which I was happy to be at recently with Alan Bennett for the ceremony to celebrate 125 years of the Wigg practice, which serves people brilliantly. Believe me: when I talk to people at those two institutions, the main people who are denigrated are the Tory Ministers who have wished all this upon them. I join in that denigration.

--- Later in debate ---

[Mr Lansley]

No.

My right hon. Friend the Member for Charnwood (Mr Dorrell) made an important point on the Nicholson challenge, which a number of Opposition Members mentioned. At least one or two of them had the good grace to recognise that David Nicholson’s proposals were set out in May 2009, under, and endorsed by, a Labour Government. Labour Members now want nothing to do with the consequences of meeting that financial challenge. They fail to recognise, as my right hon. Friend said, that the challenge was against the background of an expectation that a Labour Government would not increase the NHS budget, and that the challenge would have to be achieved within three years. The Conservative Government have increased the budget for the NHS. Over the course of this Parliament, it will go up by £12.5 billion, which represents a 1.8% increase in real terms. The right hon. Member for Leigh and his party were against that.

No Opposition Member recognised in the debate the simple fact that, in the first year of this Parliament, £4.3 billion of efficiency savings were achieved, and performance improved, across the NHS. That was not even in the time frame for the Nicholson challenge. We have now had one year of the challenge. The target was £5.9 billion of efficiency savings, and we achieved, across the NHS, £5.8 billion. Things are on track, which completely refutes the shadow Secretary of State’s argument that we cannot have reform and deliver on the financial challenge at the same time. Actually, we can do both, and in addition improve performance in the NHS.

The right hon. Member for Greenwich and Woolwich (Mr Raynsford) completely contradicted the hon. Member for Eltham (Clive Efford) on the South London Healthcare NHS trust. The latter said he was against changes at Queen Mary’s, Sidcup, but the former said that I did not get on with the changes soon enough. The hon. Member for Denton and Reddish complains from the Opposition Front Bench that I did not have a moratorium, but the right hon. Member for Greenwich and Woolwich complains because I did have one.

Let me be clear about this: I did introduce a moratorium, and the four tests. Reconfigurations that meet the four tests should go ahead, because they will improve clinical outcomes for patients, meet the needs of the people of that area, deliver on the intentions of local commissioners, and be in line with the views of the local public. If they meet the four tests, they should go ahead; if they do not, as my hon. Friend the Member for Redditch (Karen Lumley) made clear in respect of Worcestershire, they should not go ahead. That much is clear.

My hon. Friend the Member for Pudsey (Stuart Andrew) made good points on how clinical commissioning is bringing improvements in musculoskeletal services. He also rightly made it clear, as the right hon. Member for Leigh did not, that Wales does not meet anything like the same standards as England and is cutting its NHS budget by 8.4%. We are increasing resources for the NHS in England and improving it. It is expected that, by the end of this Parliament, expenditure per head for the NHS in Wales will be below that of England. That is what we get from a Labour Government.

Let me reiterate to the hon. Member for Ealing, Southall (Mr Sharma) and my hon. Friend the Member for Ealing Central and Acton (Angie Bray) a point I made a moment ago. The hon. Member for Ealing, Southall should admit that the plans being looked at in north-west London are entirely the same ones considered under a Labour Government before the election. I will insist that the plans are subjected to the four tests I have described. If they meet those four tests, they can go ahead; if not, they will not. I advise him to continue making speeches in the House, but also to ask the general practitioners and clinical commissioners in Ealing what they think is in the best interests of their patients—his constituents. That is a good basis to start with.

My hon. Friend the Member for St Ives (Andrew George), the right hon. Member for Holborn and St Pancras (Frank Dobson), and a number of other hon. Members, asked about the south-west pay consortium. When I went to the NHS pay review body just a couple of months or so ago, I made it very clear that the Government believe we should do everything we can to support NHS employers to have the flexibilities in the pay framework that are necessary for them to recruit, retain and motivate staff.

[Frank Dobson]

Meaning: pay staff less in the south-west.

[Mr Lansley]

The right hon. Gentleman should not interrupt from a sedentary position. I am answering the question. Members are interested in this. When I went to the pay review body, I made it clear that, in my view, we could achieve that through negotiations on the “Agenda for Change”. That continues to be my view, and the south-west pay consortium makes it clear in its documentation that it supports such a negotiation. It is right to pursue such a negotiation nationally and for local pay flexibilities to be used in the national pay framework. That is what most NHS employers do, with the exception of Southend.

I have made it clear, as the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns) has, that we are not proposing any reductions in pay as a consequence. I do not believe they are necessary or desirable in achieving the efficiency challenge.

Health and Social Care Bill

Frank Dobson Excerpts

Tuesday 20th March 2012 Commons Chamber

[Frank Dobson (Holborn and St Pancras) (Lab)]

The national health service is probably the most precious institution in this country. It is vital to millions of our fellow citizens—its hospitals treated nearly 10 million people last year—and so no one should take risks with it. The Prime Minister decided to take such risks, he told a private meeting of Conservatives, because the NHS was in an “invisible crisis”. Well, all I can say to the Prime Minister is that it is invisible because there is not one. The NHS is not in crisis; it is doing remarkably well, and it needs to continue to improve. The Prime Minister also said that he was willing to “take a hit” in this regard. No Labour Member cares very much whether he does or not: what we are bothered about is that we do not want the national health service to take a hit; we do not want its precious, hard-working staff to take a hit; and we do not want its patients to take a hit.

Government Members—or those in the majority party—call themselves conservatives, but actually they are a party of chancers. Real conservatives recognise that the outcome of change is unpredictable, that the process of change can be troublesome, and that there are often unexpected consequences of change, and they therefore need convincing that there is a good case for the change. Clearly, the Government have not made such a case.

[Mr David Evennett (Bexleyheath and Crayford) (Con)]

Will the right hon. Gentleman give way?

[Frank Dobson]

No.

The Government have not made such a case for change. They have not convinced the 1 million-odd people in the national health service that these changes are needed, and if they cannot convince the people on whom the service is going to depend, they are taking a real chance with its future.

The Prime Minister attributes his commitment to competition, including outside competition, to some of the most worthless and shallow research that has ever been conducted at the London School of Economics—and that puts it in a pretty extreme category. The researchers said that they identified that hospitals they claimed competed with one another had achieved a 7% improvement in the period for which patients awaiting an operation had to wait once they got into hospital. A 7% improvement is a period of less than an hour. Then, without any justification whatever, they generalised from the particular and said that the hospitals they claimed competed with one other were 7% more efficient right across the board. It is on that basis that the Prime Minister says that he wants to introduce competition into our national health service.

[Lilian Greenwood (Nottingham South) (Lab)]

rose—

[Andrew George (St Ives) (LD)]

Will the right hon. Gentleman give way?

[Frank Dobson]

No, I will not give way, even to the hon. Member for St Ives (Andrew George), who has made a very honourable contribution to these debates.

Across the board, we see the Government taking unjustified risks with our national health service. If they are not prepared to disclose to the rest of us what risks they have been advised they are bringing about, they are both cowardly and stupid. I do not think that the people of this country will ever forgive them for their reckless, chancy, dodgy, second-hand-car-salesman approach to the national health service.

Health and Social Care Bill

Frank Dobson Excerpts

Tuesday 28th February 2012 Commons Chamber

[Mr Lansley]

My right hon. Friend makes extremely good points. It is interesting that the right hon. Member for Leigh (Andy Burnham) appears to be trying to represent us as not agreeing about matters. He is chronically incapable of agreeing with himself. In June 2006 the then Prime Minister, Tony Blair, said that what the NHS needed in future was foundation trusts, practice-based commissioning, more involvement for the private sector and payment by results. The thing is that Labour in office did not achieve any of those things. It is only through the mechanism of the legislation that we are putting together that we are going to enable the NHS to achieve those things in a way that does not entail all the difficulties that Labour had, such as getting the private sector involvement with the NHS wrong. We are going to get those things right.

[Frank Dobson (Holborn and St Pancras) (Lab)]

Does the Secretary of State agree that the Salisbury convention requires the House of Lords not to reject a measure if it has an electoral mandate? As all the parties in the House were mandated not to totally reorganise the national health service, would it not be wholly proper for the Liberal Democrats in the Lords to have some guts, join with Labour and Cross Benchers and vote the whole measure down?

[Mr Lansley]

The right hon. Gentleman is completely wrong about that. Perhaps he was not here last Wednesday when we debated health matters. [Hon. Members: “He was.”] Well, then he did not listen. I set out very clearly how the Bill was responding to the manifesto mandate that we in our party had, and it was a manifesto mandate that the Liberal Democrats brought to the coalition Government, not least in relation to the role of local government, bringing greater democratic accountability, which is precisely how some of these things have been achieved. If the right hon. Gentleman is talking about a mandate in the Lords, he might like to tell his colleagues that at the last election his party was elected on the basis of supporting foundation trusts, for example, to be able to be free to increase their private income.

NHS Risk Register

Frank Dobson Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Mike Freer]

I will give way later. I want to make a little progress first.

I do not believe that the Opposition’s call for publication is remotely to do with transparency. If it were, they would themselves have published risk registers in the past. The right hon. Member for Leigh (Andy Burnham) said earlier that the present was not the same as the past, and that the past had not involved major reorganisations. Let me refresh his memory. In 2008 and 2009, in London, there was a major reorganisation of hyper-acute stroke units and a major reorganisation of major trauma centres. When the clinicians and the public opposed that action, what did NHS London do? It did not make the risk register public; it did not make details of all the risks fully available so that we could make an informed judgment, as the Opposition are trying to persuade us to do. It simply rewrote the consultation results, and what did it say? “The consultation results from the people of Barnet were inconvenient, and we are therefore inserting a new chapter so that we can ignore the clinicians and the patients.” That is the track record of the Labour party.

The Opposition may come to regret—

[Frank Dobson (Holborn and St Pancras) (Lab)]

Will the hon. Gentleman give way?

[Mike Freer]

I said earlier that I would give way to the hon. Member for Birmingham, Erdington (Jack Dromey).

--- Later in debate ---

[Frank Dobson (Holborn and St Pancras) (Lab)]

I think the Government will conclude that it is foolish of them not to publish the register, because everybody assumes that they must have something to hide—something to do with policy development.

In the absence of publication, we can only speculate on what the register contains. I should like to know, for instance, whether there is any reference to the risk that is being taken by inviting American health corporations to bid for services in this country. After all, all the leading American health corporations have, at one time or another, been indicted for defrauding patients, doctors or taxpayers. I asked the Secretary of State whether he would ensure that no contracts are given to any American corporation that has been indicted for fraud. He refused to ban them, so we can expect them to come in.

There is also the question of marketisation and of putting things out to tender. We have an example in my constituency. The Camden road practice was put out to tender in 2008 and the existing practice doctors put in a bid that met all the requirements. According even to the stuff that was published, they did better than the private sector bidder in respect of the requirements, but the private sector firm bid to provide the services at a lower cost to the NHS and got the contract.

When I asked for details of all the bids and considerations, I was told that they could not be disclosed because they were commercial and confidential. I warn all hon. Members who think they will get the details of what happens in their areas—we can safely bet that the words, “No you can’t have the information. It is commercial and confidential”, will come up time and again.

As it happens, a US company, UnitedHealth primary care, got the contract. I admit to having a touch of cynicism in my make-up and rather assumed it would do a rattling good job to demonstrate what a wonderful outfit it is, but it was not so. It did not even bother to act as a loss leader. It reduced the amount of time patients had with doctors and at one time suggested that patients could raise only one topic with their GP. Opening hours were changed. It closed a baby clinic, but because there was a great row, it reopened it. The PCT contemplated taking legal action to enforce compliance with the contract but was advised by its lawyers that the contract was not enforceable.

Last year, that triumphant outfit suddenly sold all its GP contracts, including the one at the Camden road practice, and said it would concentrate on offering support to GP commissioning boards because that is easier and more profitable than supplying a GP service. It sold the Camden road surgery contract to an outfit called The Practice plc. The contract was not put out to tender and nobody was consulted about the transaction—not the NHS or the staff, or least of all patients.

Patients—my constituents—were chattels in that transaction, but they might have been reassured when they saw the publicity for The Practice plc, which states:

“At The Practice we offer clinical services to NHS patients who need to be sure of the very highest standards. But it’s how we do what we do that makes the difference. We aim to deliver genuinely caring and thoughtful patient centered services, minimise waiting times and make the whole experience one to remember with satisfaction. From first referral through diagnosis to effective treatment we promise true professionalism…At The Practice, patients come first.”

Not any more they don’t. It has been announced that the practice in both centres is closing down because the lease has run out. The patients have been left bereft and bewildered. It is not a question of integrated care between primary care and social services. There will be no integrated care at the practice because people will be spread around half a dozen neighbouring practices. And why? It is because this commercial organisation, dedicated to profit and lining the pockets and handbags of its shareholders—the sacred shareholders, whose interests must always come first—has decided that it cannot find alternative premises. What is the risk of that happening when the Government spread this practice right across the country? Is the risk of that happening mentioned in this famous risk assessment? I doubt it very much.

A constituent of mine wrote to me:

“Before United Health took over…we had an excellent surgery with excellent…doctors. They knew their patients’ medical histories and the patients trusted them…. What are we left with? A Surgery which started to deteriorate almost as soon as the original doctors left/were forced to leave, one which continued to deteriorate… So much unnecessary disruption and upset… Totally ridiculous and unprofessional and with no sensitive consideration or understanding being afforded to patients.”

We hear a lot about patients from Government Members. They need to consider what will happen to their patients when this is all marketised.