NHS (Private Sector)

Frank Dobson Excerpts

Monday 16th January 2012 Commons Chamber

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

I agree with a substantial number of the points made by the hon. Member for Southport (John Pugh). The Government claim that their proposals are just an incremental extension of the Labour Government’s involvement of the private sector, bringing private patients into NHS hospitals. In fact, they are nothing of the sort; they are dramatically different in nature and scale. To justify them, the Government grossly exaggerate the contribution the private sector has made.

I am sorry that the right hon. Member for Charnwood (Mr Dorrell) has left the Chamber, as in 1997 when I took over from him as Secretary of State for Health, the NHS was carrying out 5.7 million operations. By the time Labour left office, the figure was 9.7 million—4 million more than when he was in charge. Of those 9.7 million operations a year, 9.5 million were being carried out in NHS hospitals and the private sector was doing 200,000, or 2.1% of the total. So much for its massive contribution to improving the service for ordinary people.

The private sector cherry-picked operations and patients, yet now we have the proposition that things will be franchised out; it was to be to “any willing provider,” but now it is to “any qualified provider.” Recent events suggest that it will be to any willing profiteer—to people who are good at the sales pitch and say that they can keep costs down and are superior to the NHS. They will be the people who use the cheapest breast implants and when things go wrong expect the national health service to bail out the patients they have harmed. They are a bit like the bankers: they are in favour of competition and a free market, but when things go wrong, they say, “Will the taxpayer please bail us out?” That is what we are seeing.

We also see in the proposals that the NHS hospitals should in future be able to undertake up to half the work on private patients. The right hon. Member for Charnwood talked about increased revenue. This year sees the 200th anniversary of the birth of Charles Dickens. He had a character called Mr Micawber, and he would have noticed that it is not the revenue that counts, but the revenue against the cost of providing the service. If the cost of providing the service to private patients is greater than the revenue that comes in from private patients, we are running at a loss and the NHS is subsidising them.

I say that about the Royal Free hospital, which does a very good job in serving my constituency. It just so happens that I have its figures, because I asked for them. In the last year for which figures are available, the Royal Free hospital took in £17.3 million in revenue from private patients. According to the figures it gave me, the cost of providing those services was £15.6 million—an apparent gain of £1.7 million. However, it went on to say that “costs are estimated” and

“not all costs are split between private and NHS patients in this way”.

The costs are not clear. It might look as though the income is clear, but I then asked what the private patient debt is from those people.

[Lorely Burt (Solihull) (LD)]

Will the right hon. Gentleman give way?

[Frank Dobson]

No, I do not have time and others want to speak.

The answer is that, over the past five years, private patient debt has never been lower than £6.4 million, against an income of £17 million. They are not exactly subsidising NHS patients out of the private sector income at the Royal Free, because they do not have enough income to subsidise them.

I recall years ago, when I was shadow Health Minister, running a campaign on this issue. The Tory Government said that they would change the rules and introduce a system, backed up by the National Audit Office, as it is now called—then, it was the Comptroller and Auditor General’s office—that ensured that any private sector contribution produced a surplus. No such arrangements were put in place, and I challenge the Minister to identify what the position is with all those private patients in NHS hospitals. How many are running a surplus and how many are running at a loss?

[Several hon. Members]

rose—

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

To begin on a conciliatory note, I congratulate the hon. Member for Copeland (Mr Reed) on his first speech from the Front Bench as a junior shadow Health spokesman. I did not agree with a single word that he said, but I congratulate him on the way in which he spoke.

I have no idea what new year resolutions the Labour party has made, but perhaps I could suggest one: to get their facts right. Having listened to the endearing speech of the right hon. Member for Holborn and St Pancras (Frank Dobson), the same speech that I have heard on many occasions from the hon. Member for Easington (Grahame M. Morris), the slightly bizarre speech of the hon. Member for Blaydon (Mr Anderson) and the speech from the hon. Member for West Lancashire (Rosie Cooper), I have to say that they really have got it wrong. It is wrong to seek to misrepresent by repeating a fallacy.

I congratulate my right hon. Friend the Member for Charnwood (Mr Dorrell) on his lucid exposé of the contradictions in the arguments of the right hon. Member for Leigh (Andy Burnham). I thank my hon. Friends the Members for Central Suffolk and North Ipswich (Dr Poulter), for Crawley (Henry Smith) and for Battersea (Jane Ellison) for their thoughtful contributions. I listened carefully and with great interest to the speech by the hon. Member for Southport (John Pugh) but, to be honest and frank, I was not carried by the strength of his argument on the issues.

I fear that many of the contributions of Opposition Members that my hon. Friends and I have had to listen to have given a series of misrepresentations and misinformation. I remind them that for 36 years, just over half the 64 years of the national health service, it has been under the stewardship of the Conservative party. We have never sought to privatise the health service and we never will privatise the health service.

[Frank Dobson]

Will the Minister give way?

[Mr Burns]

Because of the time, I will give way to the right hon. Gentleman, but to no one thereafter.

[Frank Dobson]

The Minister suggested that I had used figures that were not factual. If they are not, he should know that they all came from parliamentary answers signed by him.

Health and Social Care (Re-committed) Bill

Frank Dobson Excerpts

Tuesday 6th September 2011 Commons Chamber

[Mr Lansley]

As we said in our response to the recommendations of the NHS Future Forum, we recognise the importance of integrating health and social care services—while concentrating on the needs of patients and their families—to the achievement of our aims. However, I do not believe that we would further those aims by changing Monitor’s name, as amendment 1225 suggests. Although I agree with the aims of my hon. Friend the Member for St Ives (Andrew George), we have an alternative approach.

Rather than making it explicit that the Secretary of State could impose requirements on commissioners in key areas through regulations, as my hon. Friend suggests in amendment 1209, the Bill proposes that commissioners should have clear statutory duties to reduce inequalities between patients, in relation to both access and outcomes. That is covered in clauses 20 and 23. Commissioners would also have to promote integration of services in carrying out those duties. That is covered in clause 20, which inserts new section 13M of the National Health Service Act 2006, and in clause 23, which inserts new section 14Y. Those clauses refer respectively to the NHS commissioning board and to clinical commissioning groups.

The Bill would also establish clear duties for Monitor to allow the integration of health care services and the integration of health care with other relevant services, including social care. We have already amended the Bill to make it clear that Monitor should not promote competition for competition’s sake: this is all about quality. However, integration can only ever be a means to that end, not an end in itself. Integration, like competition, is designed to secure continuous improvement in the quality of services and a reduction in inequalities, as clauses 20 and 23 make clear.

Although I understand the point that my hon. Friend is making, I ask him to not to press amendments 1225 to 1228 when we reach the appropriate moment.

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

The Secretary of State has pleaded the legal view of one of his Back Benchers in rebutting the case made by others about the impact of the changes in his duties. Will he tell us what advice he received from the Department’s lawyers or the Law Officers of the Crown?

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[Debbie Abrahams]

I would be happy to forward to the hon. Gentleman a British Medical Journal article that reproduced in full the concerns of health care professionals that were not included in that account. Unfortunately, there is an element of bias in how they have been reported.

[Frank Dobson]

Steve Field was a great asset to the Government when he was president of the Royal College of General Practitioners and overwhelmingly welcomed everything that they were proposing. That was probably why he was replaced by a new president who does not do that.

[Debbie Abrahams]

I thank my right hon. Friend.

When I raised these issues in the recent recommitted Bill Committee, the Minister suggested that I was scaremongering and, with the rest of those on the Government side, refused to accept any of our amendments—not a single one. Given what recent revelations are proving, perhaps he would like to withdraw some of his comments and concede that I have not been scaremongering.

I urge Liberal Democrat MPs who have felt compelled to support this Bill and their Front-Bench colleagues but whose conscience tells them that it is wrong to vote against the amendments and the Bill. This is not what they signed up to.

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[Mr Dorrell]

I am grateful to my right hon. Friend, who answers the hon. Member for Worsley and Eccles South (Barbara Keeley) with very much more authority than is at my disposal.

I want to make one final point and it is a direct response to the hon. Member for Oldham East and Saddleworth (Debbie Abrahams). Of all the misrepresentations about the intentions of this Bill that we have listened to since the White Paper was published over a year ago, the most persistent is that this is somehow a Bill—a ramp—for the privatisation of the health service.

I was first a Health Minister more than 21 years ago. Throughout that period I have listened to speeches directed first at my right hon. and learned Friend the current Justice Secretary, when he was Health Secretary, and subsequently at all his Labour and Tory successors, including me, although probably excluding the right hon. Member for Holborn and St Pancras (Frank Dobson). All their legislative and other proposals to introduce more flexible and patient and standards-oriented structures in the health service were opposed by somebody or other on the grounds that they were going to privatise the health service. If that was the purpose of those policy initiatives, the one thing that they all have in common is that they have been singularly unsuccessful. If it is the policy purpose of this Bill to privatise the health service—which I do not for one moment believe it is—it will, I am sure, be as unsuccessful as all the other measures that went before it.

[Frank Dobson]

I begin with a reminder. I was one of those Labour people who voted against the establishment of foundation trusts and the setting up of Monitor. In doing so, I was supported by those on the Conservative Front Bench, so I do not think that the Conservatives should claim any consistency in these matters.

My second point is that although one would never dream it was true from listening to Ministers or their supporters, it is quite clear that the national health service is now working very well and is more popular than ever; and yet we are told that it needs a radical overhaul. However, the popularity of the national health service at the time of the last general election probably explains why both the Conservative party and the Liberal Democrats promised that there would be no top-down reorganisation of it. However, if neither the Bill as originally produced nor the post-pausal Bill that we have now is top-down change, God knows how one would define it.

The whole purpose of this Bill is to shift us away from the basic collaborative approach to the provision of health care in this country and to substitute a large amount of competition, gradually involving more and more of the private sector and, I believe, privatisation. In order to put things in perspective, it is worth pointing out that when the right hon. Member for Charnwood (Mr Dorrell), ceased to be the Secretary of State for Health, the national health service was performing 5.7 million operations a year in its hospitals. When Labour left office, it was performing 9.7 million operations a year, an increase of 58%. That was the result of improved working practices developed by—

[Dr Poulter]

Will the right hon. Gentleman give way?

[Frank Dobson]

No, not for the minute.

That change was the result of improved working practices developed by the people working in the national health service, not the result of any structural changes. It was also partly the result of the biggest hospital building programme in history, as well as a lot more new and better equipment, newer GP surgeries, 78,000 extra nurses and 27,000 extra doctors. Those were among the reasons that the NHS became so much more popular. It is popular because, for most people in most parts of the country most of the time, it is already doing a very good job. However, that is now going into decline, because many people working in the NHS carrying out pre-legislative preparatory work on the proposed changes are having to divert their efforts into bringing about structural change. That is one of the reasons waiting lists and waiting times are going up—something that the Government deny is happening.

[Lyn Brown (West Ham) (Lab)]

Bearing in mind the lack of popularity of the proposals among our constituents, is my right hon. Friend as worried as I and my constituents are about the £850 million that is being spent on redundancies and the projected £2 billion of primary care trusts’ budgets that is being held back from patient care to cover the risks and costs associated with the reorganisation?

[Frank Dobson]

I entirely agree. Nobody could possibly claim that redundancy payments constitute money being spent on improving services for our constituents. That is just money down the drain as far as patient care is concerned.

The fundamental problem behind the proposals is that the Government are, in effect, proposing a further major fragmentation of the national health service. In the past, up to the point at which the previous Tory Government introduced an internal market, the spending on administration in the NHS amounted to 4% of the total. That was largely because great big slugs of money were transferred round the system, and I am prepared to accept that there might be some disadvantages in that arrangement. Since then, however, under that Government and the Labour Government, the system has changed to one in which the money follows the patient. That has led to the creation of all sorts of exceptionally expensive systems to bring about individualised transactions, which has resulted in the cost of administering the national health service rising to 12% of the total—an increase of 8%. The NHS is spending about £100 billion a year at the moment, so an extra £8 billion that should have been spent on patient services is now being spent on the administration of the semi-fragmented system. What is now being proposed will involve yet further fragmentation, and I shall explain why I believe we will end up spending yet more money, but not on patients.

[Chris Skidmore]

The right hon. Gentleman has mentioned the £8 billion being spent on administration in the NHS. I assume that he therefore welcomes the coalition Government’s decision to cut the administration budget by £5 billion by 2015. In his speech so far, however, he seems to be suggesting that the status quo is acceptable. I believe that it is unacceptable. Does he welcome the fact that we will be putting an extra £12.5 billion into the NHS?

[Frank Dobson]

If the hon. Gentleman—and, for that matter, the Secretary of State and the Chair of the Health Select Committee—had ever listened to what I say, they would know that I think that we need change. We need organic change, however, rather than structural change, because structural change generally costs more than it provides. If the hon. Gentleman thinks that introducing a system in which virtually every transaction will be a legally binding document, with herds of lawyers grasping their share of proceedings, will reduce the amount spent on administration, he obviously believes in Father Christmas and various other mythical figures.

[Barbara Keeley]

Before we get into any more claims of more being spent, I want to touch on two examples of cuts, caused by the cuts and efficiency savings, which I raised with the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow). The most deprived ward in my constituency is losing its NHS walk-in centre and all the people with long-term conditions are losing active case management. I raised those two cuts made by Salford PCT with the Minister in an Adjournment debate, to which I have received no answer. There is no answer. People in the most deprived wards with the greatest health inequalities are suffering from these cuts. I will not hear any more about more investment being made, because all I see as a constituency MP is less investment.

[Frank Dobson]

I agree entirely with my hon. Friend. A further point is that I doubt whether there is a single constituency anywhere in the United Kingdom of Great Britain and Northern Ireland that has seen more change in health provision than mine. There are not many places where a virtually trouble-free amalgamation of two major and famous teaching hospitals into one has taken place successfully. There are not very many places that have seen more small GP practices getting together in one location and improving their performance. Those things have always been done with my strong support, even when on some occasions, at least at the outset, the ideas were not popular with some local people. Therefore, I do not accept that I do not believe in change. I believe in sensible change, not stupid change, but stupid change is what we seem to be getting.

[Mr Stewart Jackson (Peterborough) (Con)]

I admire the right hon. Gentleman’s chutzpah, but I wonder whether he was missing in action during the last Parliament. Some of us were saying in 2008 that the imposition of independent sector treatment centres—Darzi centres—would have a direct impact on the budget of primary care trusts and would cause the development of structural deficits that would impact directly on poorer areas with smaller primary care facilities. Where was the right hon. Gentleman then, when it came to attacking his own Government on that specific issue?

[Frank Dobson]

I was attacking them! I am sorry if the hon. Gentleman did not notice, but I believe I was the first person to expose the fact that on average the private sector was paid 11% more per operation than the NHS was getting for the equivalent operation. I shall take no lessons from anybody when it comes to opposing some of the daft things that went on. I did oppose them and I am proud to have done so. What is being proposed now, however, goes far beyond that. As my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), who has a great deal of knowledge in these matters, has pointed out, there is scarcely any evidence from anywhere in the world to show that a competitive system delivers better health care than a collaborative system.

To ask the essentially collaborative health care system in this country to turn over to being competitive is a bit like asking the Meat and Livestock Commission to promote vegetarianism: it is simply not what people want to do; it is not their approach and nor should it be. It remains the case that Monitor is still rigged in favour of promoting competition. Let me point out—hopefully without putting my glasses on—that clause 58(3) states:

“Monitor must exercise its functions with a view to preventing anti-competitive behaviour in the provision of health care services for the purposes of the NHS which is against the interests of people who use such services.”

However, it does not say that “Monitor must exercise its functions with a view to preventing competitive behaviour in the provision of health care services which may be against the interests of the people who use such services”. Apparently, then, there is a basic, intrinsic and fundamental assumption that competition must be beneficial and non-competition must be harmful. If the Government say that Monitor is neutral, it should be given a neutrality in respect of competition and non-competition. As I think the hon. Member for Peterborough (Mr Jackson) would agree, the unfair competition of some of the independent treatment centres was harmful to and threatened the services provided by neighbouring NHS hospitals. There is clear evidence here of problems within the private sector.

I recall that, a few years ago, United Health—a subsidiary of the US United Health—took over three GP services in my constituency. It bid that it could provide the range of services for less than the local GPs, so it got the contracts. It has not complied with all the conditions that were set, but the primary care trust decided that it could not take it to court because it would be such a lengthy and expensive exercise and it feared that the PCT might not win. Not content with that, United Health recently announced that it was selling the franchise to another private outfit. It did not consult the staff. It did not consult any elected local representatives—neither me nor councillors. Above all, it never consulted the patients. These private sector outfits regard patients as part of the chattels that they can dispose of to maximum benefit and maximum profit.

That illustrates the fact that if we are to have contract-based provision of services, a huge amount of lawyer effort will be put into trying to draw up watertight contracts. What one lawyer thinks is a watertight contract, another lawyer will make a leaky contract by puncturing a hole in it, and we will go over to the system in the United States, where zillions of dollars are spent on court challenges or settlements with the providers of health care.

Furthermore, there is virtually no major American supplier of health care that has not been indicted for defrauding federal taxpayers, city taxpayers, state taxpayers, doctors or patients—and sometimes all five. I thus asked the Secretary of State whether he would rule out giving any NHS contracts to any organisation that had been indicted for defrauding people in another country. He gave me about a page-long answer, which could be summarised as, “No, he would not rule them out.”

We are thus talking about the possibility of European competition law being used to force our Secretary of State to allow people to give contracts to American companies whose greatest claim to fame is that they have defrauded innumerable Americans. I think that that is intolerable. I would have thought that all these anti-EU Conservatives found it rather embarrassing to think that European law was going to be used to allow fraudulent Americans to get contracts working in our national health service. All those things, however, will be possible under the system proposed by the Secretary of State.

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[Grahame M. Morris]

May I take up my right hon. Friend’s point about effective scrutiny and the assurances that Ministers have given the House? The knives prevented us from debating two of the Bill’s most significant clauses in terms of costs and implications, clauses 29 and 30, which deal with the abolition of strategic health authorities and primary care trusts. The redundancy costs will amount to more than £1,000 million.

[Frank Dobson]

I entirely agree with my hon. Friend. I think that nowadays those who call themselves members of the Conservative party only purport to be Conservatives. The basic Conservative approach in this world is, broadly speaking, not to make great changes without being absolutely certain that substantial benefits will result from them. A proper Conservative recognises the problems that arise during the process of change, and the unpredictability of things in human life. What we have now, certainly in relation in health and possibly in other spheres, is a Government who are going ahead with something which—good God!—cannot be regarded as well thought out, given that they have tabled 1,000 amendments on Report.

[Barbara Keeley]

I winder whether my right hon. Friend heard the Leader of the House say to the Hansard Society that

“it has simply become too easy for the Government to sideline Parliament; to push Bills through without adequate scrutiny; and to see the House more as a rubber-stamp than a proper check on executive authority.”

He also said that, in the Government’s view,

“a strong Parliament leads to a better Government.”

Does my right hon. Friend believe that the Bill, and the very shortened debate on its recommittal, constitute a good illustration of that?

[Frank Dobson]

In fairness, I think that given the accuracy of the present Government’s aim, if they tried to rubber-stamp something they would probably miss.

[Dan Byles]

In view of the speech that the right hon. Gentleman is making and his definition of a “proper Conservative”, I wonder whether he has just come out of the closet as a proper Conservative himself.

[Frank Dobson]

People have described me as old Labour, but I have moved on from that. I am now heritage Labour. Part of our heritage, however, is the national health service, and it is not the Tories’ heritage either. Those who play with the national health service—which is what I think the Government are doing, purely for ideological reasons—do us a disservice in two ways. They threaten the likely performance of the national health service and the people working in it, and they threaten the relationship between the British people and the national health service.

[Fiona O'Donnell]

Will my right hon. Friend give way?

[Frank Dobson]

No, I will not.

I believe that the national health service is popular for two reasons: because, in most parts of the country and for most of the time, it does a good job for people; and because people value the thought that it not only looks after them but looks after their families, looks after their neighbours, and looks after all of us. I believe that, in many ways, that is its most important function.

We live at a time when everyone is filled with growing concern about the divisive elements in our society, and the national health service, along with the feeling that people have for it as a collaborative organisation, is one of the few exceptions to that. The health service does not just bind the wounds of people in this country, but helps to bind us together. That, I believe, is why it is so dangerous that the Government are going against its basic principles, thus risking not only its performance, but its relationship with us and its binding function in our increasingly divided society.

[John Pugh (Southport) (LD)]

I wish to speak to my amendments 1219 and 1220, and against amendment 10. The House is right to be sceptical about the blessings of the internal market in health. It is right to be worried about price competition, which everyone thinks is a race to the bottom. It is right to be concerned about the reckless extension of “any willing provider”, and it is correct in fearing that health services will be increasingly exposed to competition law, including EU competition law. It should fear the huge transactional costs that will be incurred in the hardening of the commissioner-provider split. It should fear the threat to integration, and it should fear cherry-picking, particularly in a narrow tariff system based on payment by results. It should also fear the blurring of the difference between public and private hospitals, and the financial incentives given to the private sector under the banner of choice.

That is why I dislike the greater part of what Tony Blair did to the NHS. Those who are now Opposition Members voted for all that, and that is where we are now: it is the default position. As one Opposition Member said, Labour has put all the bricks in place. A few moments ago we witnessed the strange anomaly of the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) complaining about a feature of foundation trusts—their ability to borrow on the private market—which I consider to be a direct consequence of Labour legislation.

The choice for the House is not between Aneurin Bevan’s NHS and the Bill, but between Blair’s NHS and Secretary of State’s version. If I were to sum it up neatly, I would say that the Secretary of State’s version most closely resembled Blairism with clearer and more equitable rules. First, there is an overt sector regulator instead of the powerful covert regulating body, the Co-operation and Competition Panel, which has been making all the decisions that Monitor will make in a more overt way. Secondly, there is the outlawing of subsidy to the private sector, which is perfectly possible: the Secretary of State is not minded to take such action at present, but current legislation does not prohibit him from doing so. Thirdly, as Members must acknowledge, the Bill makes a clear attempt to forfend cherry-picking and protect clinical networks by safeguarding integrated provision. It is possible to have an argument about how well that is done, but there is certainly an explicit intention to do it—as, to be fair, there was in some of the activities of the CCP, although in that instance the constraints were somewhat weaker.

Fourthly, since the pause a clear attempt has been made to ensure that Monitor merely regulates, without performing a strategic role in promoting much except the interests of patients. It functions as a regulator and adjudicator on what it is intended to do, rather than occupying an unaccountable strategic role in promoting competition. Clearly much will depend on the mandate that it continues to be given and on its personnel: that will vary over time, and we should be watchful in that regard.

I recently had the benefit—as I think other Members have, too—of the legal advice of 38 Degrees, which is in danger of rapidly becoming the provisional wing of the “Evan Harris organisation.” I carefully read what Mr Roderick said, and I would like to share the details of his comments with the House. He says:

“contracting out services to the private sector is anything but a novel proposition in the NHS”

and

“the government has for some years rolled out the policy of Any Qualified Provider”.

Presumably, that is a reference to the previous Government, not the current one.

Mr Roderick also says:

“the application of procurement law is not by any means new to the NHS”.

Referring again to Labour party principles, he says:

“the current internal Principles and Rules for Cooperation and Competition”—

which were set up by Labour—

“seek to inject…promotion of choice and competition principles into the operation of the NHS”.

On the thorny subject of the definition of “undertaking”, which we debated ad nauseam in Committee, he has this to say:

“The NHS has already developed a structure whereby it is more likely than not that NHS Trusts are undertakings for the purposes of competition”.

Mr Roderick is often cited by Labour Members as representing independent legal advice, but that is what he says. He concludes by saying that Labour’s

“recent reforms…have done much to alter”

the basic

“landscape, even in the absence of legislative change.”

As we have both commissioning and a mixed economy—people are not saying that we ought not to have such an economy—there is a chance that there will be challenges from disappointed providers, and we must try to understand how that would go. In terms of EU law it does not matter how many providers there are out there, as even one will do, and it does not even have to be in the UK. The law can be applied in such circumstances. If these issues are to be taken up by providers who are disappointed in one context or another, it is better for that to be handled by a sector regulator such as Monitor than by the Office of Fair Trading, which would be the default situation.

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[Grahame M. Morris]

I am grateful for that information. I know that other hon. Members have spent a day with the health service and I am sure that Ministers take soundings, but I can honestly say that what the hon. Gentleman describes is the feedback I have received from talking to health professionals, patients and so on. I recognise that the Secretary of State has said on numerous occasions that a substantial body of GPs support this approach. When I tuned in to this morning’s “BBC Breakfast” I saw Professor Chris Ham of the King’s Fund being interviewed. He is an eminent and respected commentator on health service issues who has given evidence to the Public Bill Committee and the Health Committee. He gave his view that it was a small cohort of GPs who were signed up and committed to these reforms. I agree with his assessment.

These provisions deal with the role of Monitor, the relevant implications and changes to the failure regime. A “Panorama” documentary on the BBC featured Sir Gerry Robinson, who has some standing in the business community and for previous journalistic investigations into the NHS. The conclusion of his report was that he thought that these reforms could mean

“the end of the NHS.”

That is his conclusion. Even after meeting the Secretary of State he remained unconvinced of the value of the reforms.

The Secretary of State has failed to persuade the public and he has failed to persuade NHS staff of his approach. That has been illustrated by various surveys, through the British Medical Association, by personal contacts and in other ways. Even elements of the business community recognise the level of public opposition and concern. It seems that the principal backers are overseas US-style private health groups, whose interest is not philanthropic. They see the prospect of substantial profits and unprecedented access to billions of pounds soon to be available from NHS coffers. We hear Ministers and Government Members saying that the NHS was open to private sector providers under the previous Administration, and a very small figure—5% or so—was cited in the Public Bill Committee proceedings.

[Frank Dobson]

My hon. Friend may like to know that even in the final year of the Labour Government just 2.1% of operations were carried out by the private sector.

[Grahame M. Morris]

I am grateful that that information has been put on the record.

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[Grahame M. Morris]

This is the danger. Labour Members have attempted to highlight it, and people are increasingly aware of it.

[Frank Dobson]

Does my hon. Friend accept that if we want to look at how best to increase the number of people who are treated, the best thing to do is go to the people who do the treatment? When I was Health Secretary, the NHS was doing 160,000 cataract operations a year. Following discussions with the experts, some changes were made—no structural changes—and in the last year for which figures are available the NHS did 346,000 cataract operations a year. The private sector’s contribution averaged 6,000 a year.

[Grahame M. Morris]

I am grateful to my right hon. Friend for putting those important statistics on the record. Government Members often raised these issues in the Bill Committee so it is helpful to have that clarified with such precision.

I want to deal in more detail with health inequalities, if that is in order, Mr Deputy Speaker. While serving on the Bill Committee and as a member of the Health Select Committee, I have always tried to champion the cause of reducing health inequalities. In the Bill Committee, Opposition Members pushed for greater duties to reduce health inequalities to be placed on the new bodies being created by the Bill.

I am conscious that there has been some movement in this direction. New clause 6 is relevant to the special administration of services and makes references to health inequalities. I would be grateful if the Minister gave some clarification in respect of the point that I wish to make. I am delighted that the Government have recognised that a market system in health care will only worsen health inequalities. My rationale in making that statement is that at least new clause 6 says that services must be kept open where closure would adversely impact on or increase health inequalities. Opposition Members are not convinced that the safeguards are strong enough, that the safeguards could not be overturned or that inherent health inequalities that areas such as mine suffer from so terribly, largely reflecting socio-economic patterns in society, would not be exacerbated.

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[Dr Poulter]

I am going to make a little progress. Other speakers want to contribute, so I hope that the hon. Lady will forgive me for not taking her intervention.

The Bill focuses on integration and looks to improve the care particularly of our frail elderly. There is too much silo working in the health service—in primary care, in secondary care and in adult social services. The Bill seeks to integrate services through the role provided by Monitor in helping to provide an overarching view of value for the patient and through the setting up of health and wellbeing boards at local level. That is intended to provide better integration of adult social care with NHS care, which has not happened in all parts of the country.

The hon. Member for Easington made a very good speech in which he said that care was hugely variable throughout different parts of England. That is because in many areas we do not have properly joined-up thinking about how things are done. For example, hospitals are paid on payment by results, but there is no incentive necessarily to reduce admissions and to provide much more focused community care, which would be so important in improving the care of the frail elderly in their communities and in their homes. The Bill is starting to take the first steps towards that sort of joined-up thinking.

If Labour Members are concerned about this, the point was well made by Lord Warner in his recent comments as part of the Dilnot report. The right hon. Member for Holborn and St Pancras (Frank Dobson) laughs, but he served alongside Lord Warner in the previous Government.

[Frank Dobson]

rose—

[Dr Poulter]

The right hon. Gentleman did not give way to me, but I will give way to him in a moment and listen to what he has to say. He sat alongside Lord Warner as a member of the Government, and Lord Warner has said that the previous Government did not pay enough attention to how we are better to integrate services and provide adult social care in the context of the NHS and other services.

[Frank Dobson]

I am glad that when I was Secretary of State for Health, Norman Warner did not get anywhere the Department of Health. I can report, on behalf of my London colleagues, that when he became an arbiter of the future of health care in London he must have been about the most unpopular person who has ever had that job.

[Dr Poulter]

The right hon. Gentleman was a part of the party of Government at that time. Lord Warner was a leading member, and it is fair to point out that he has come forward with some good cross-party recommendations that we very much welcome. The recommendations point to the fact that the key challenge for the NHS is better integrating services and providing high-quality patient care, especially in elderly care and adult social care. That has not happened as effectively as it should have done in the last 10 years and we need to ensure that it does happen. That is why this Bill is a good thing.

Members on both sides of the House have generally welcomed the use of the private sector where it can add value to the NHS, especially for patients. That has to be a good thing, but we need to ensure—as the Bill does—that we do not have the cherry-picking that we saw in the past. We need to ensure that we have a health service that provides better value for money, better care and more integrated adult social care and health care for the frail elderly.

Health and Social Care Bill (Programme) (No. 3)

Frank Dobson Excerpts

Tuesday 6th September 2011 Commons Chamber

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

I beg to move,

That the Order of 31 January 2011 (Health and Social Care Bill (Programme)) as supplemented by the Order of 21 June 2011 (Health and Social Care Bill (Programme) (No. 2)) be varied as follows:

1. Paragraphs 5 and 6 of the Order shall be omitted.

2. Proceedings on Consideration shall be taken on the days shown in the first column of the following Table and in the order so shown.

3. Each part of the proceedings shall (so far as not previously concluded) be brought to a conclusion at the time specified in relation to it in the second column of the Table.

TABLE

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

Is it not treating the people who work in the national health service with contempt to expect the House to consider more than 1,000 amendments and new clauses in two days? Is that not a disgrace?

[Mr Burns]

The right hon. Gentleman’s hyperbole does not match the facts. He mentioned 715 amendments —[Interruption.] Yes, but the right hon. Gentleman mentioned 715 amendments dealing with one issue within the more than 1,000 amendments. May I point out to him that 715 amendments are all technical amendments? They change the name of GP consortia to clinical commissioning groups, following the recommendations made by the Future Forum and others working in the health service, which I would have thought would be welcomed by the Opposition Front Bench team at least. That number bloats and distorts the total number. The other significant number of amendments—121—deal with the continuity of services, which is an issue that the Opposition Front-Bench team implored us to bring before the House, rather than allowing it to be dealt with another place. That is why we have done so.

If we are going to be somewhat churlish, let me point out that 100 amendments were tabled by the official Opposition, of which 41 have been selected, and the vast majority of those amendments have been dealt with in Committee in great detail. So in that respect we will be going over well covered ground.

I do not intend to speak for long as I do not wish to detain the House. There is work to be done. This Government have allowed four two-day Report stages in this Session alone. Let me remind the House of one of those rare Government Bills that was granted a two-day Report stage under the previous Government—the Planning Bill in June 2008, with which I know the right hon. Member for Wentworth and Dearne (John Healey) is extremely familiar and probably very fond of. For that Bill the Government of the day thought that two days were appropriate—an interesting judgment, given that they were tabling 29 new clauses and seven new schedules on Report. Indeed, by the end of Report, the Planning Bill had grown by 25%. That compares with the nine new clauses that the Government have tabled on Report for the Health and Social Care (Re-committed) Bill. So that those on the Opposition Benches get the message, that is nine new clauses under this Government, as opposed to 29 new clauses in the right hon. Gentleman’s Bill.

Let us give the Opposition the benefit of the doubt. They might have forgotten what the right hon. Gentleman said when the Planning Bill was, unusually, allowed two days on Report, so let me remind them:

“My reasons for moving this motion were straightforward… It is true that the Bill is wide-ranging and important, which is why we have, unusually, provided two full days for the Report stage… we have departed from the usual by giving two days to this consideration.”—[Official Report, 2 June 2008; Vol. 476, c. 507.]

He established the fact that it is highly unusual. The Health and Social Care Bill has had far more time in Committee than previous Bills, and we are giving an extra day to allow hon. Members the opportunity to contribute to debates, although I must warn my hon. Friends that some of the debates will be a repetition, particularly for those who served on the Committee. It is for those reasons that I urge the House to support the motion.

Southern Cross Care Homes

Frank Dobson Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

My right hon. Friend is absolutely right to make that point, which allows me to make another point. The Health and Social Care Bill is currently before this House—Members are enjoying the Committee stage at this very moment—and it contains the very provisions that will allow us to put in place a regime, which currently does not exist, to ensure proper oversight and engagement with those issues from a central Government perspective. The previous Government did not leave such a regime in place, nor did they put in place the necessary tools to allow the Government to do everything that they might want to do and that the hon. Member for Islington South and Finsbury (Emily Thornberry) might like us to do.

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

Does the Minister accept that if any elderly people are moved out of their homes, there will be an increased incidence of death and a reduction in people’s mental and physical health? What measures is he taking to ensure that as few people as possible are moved from those homes?

[Paul Burstow]

The right hon. Gentleman is absolutely right: we are working hard with the landlords, lenders and others to ensure that those risks are minimised, because the trauma of a hasty care home move and a forced closure leads to exactly those consequences. The Association of Directors of Adult Social Services has published new guidance for its members to manage those difficult decisions and processes and to minimise that risk as far as humanly possible.

NHS Future Forum

Frank Dobson Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Speaker]

Order. The Opposition Front-Bench team should not be yelling at the Secretary of State when he is answering. [Interruption.] Order. On both sides of the House, right hon. and hon. Members, whatever the passions they feel, need to simmer down just a little. A fine example of that calm and stoicism can now be provided by the right hon. Member for Holborn and St Pancras (Frank Dobson).

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

Does the Secretary of State recognise that forcing the national health service to start implementing his changes before the law had been changed has resulted in vast expense to the NHS, in chaos to services and in the diversion of NHS staff from the treatment of patients? Does he also recognise that just cobbling together a few amendments to the Bill will not make things better but worse? Will he not recognise—[Interruption.]

[Mr Speaker]

Order. I ask the right hon. Gentleman to finish his sentence. We must press on.

[Frank Dobson]

Does the Secretary of State—[Interruption.]

[Mr Speaker]

Order. I will have the question finished. I do not require any help from any Member.

[Frank Dobson]

Does the Secretary of State not recognise that pretending to produce a collaborative silk purse from a competitive pig’s ear will not work?

Future of the NHS

Frank Dobson Excerpts

Monday 9th May 2011 Commons Chamber

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

The current situation is extraordinary: the Liberal Democrats originally denied our criticisms of the Bill, but they have now suddenly jumped on board, and all I can say is that they are very welcome.

Both Lib Dem and Tory Ministers have claimed that the NHS is a failure, and the Secretary of State said today that he had inherited Labour’s mess. Labour’s mess was to leave the national health service in the best situation it has ever been in: more successful than ever before and improving rapidly, with waiting lists and waiting times reduced to the lowest they have ever been, and with massive improvements in survival rates. From listening to Opposition Members, people would never imagine that when we came to power 5.9 million operations were being carried out in NHS hospitals, yet when the current Government came to power we—or, rather, the people working in the national health service—had increased that to 9.7 million, which is a rise of 64%. For instance, the number of cataract operations carried out each year had increased from 165,000 to 346,000.

There have been massive improvements, and I personally do not give a toss what the OECD says. The national health service is more cost-effective than practically any other system, and it achieved that by making many different sorts of local changes—not structural changes, but by people going about their professional business trying to do things better. The Labour Government facilitated that in a body that is essentially co-operative in its organisation, ethic and culture. That is because it is based on the pooling of costs: all of us pay in, and if we get ill we get treated without having to pay. That is not going to happen any longer, because under the Bill’s provisions both the commissioning bodies and the hospitals will be able to decide to charge for some of the services that are currently free. The new chief executive at the Whittington hospital has told us all that.

There is not just a pooling of cost and risk in terms of patients. There is a pooling of risk and cost across the national health service, so that these co-operative organisations share the costs of providing treatment and care. That will not prevail if they are forced to compete with the private sector because, as the hon. Member for Southport (John Pugh) pointed out, the first, and only, legal priority of private sector organisations is to look after the interests of their shareholders. They will therefore concentrate on creaming off the profitable work, leaving the national health service to try to provide the services that are too expensive for the private sector.

I did not support the bits of privatisation that the previous Labour Government introduced so, unlike the Tories, I have been consistent. UnitedHealth took over three GP practices in my area not that long ago and that American-based company has just sold those three franchises to another supplier without any consultation with local people, patients or staff. It regards its function as taking part in a commercial set-up and a commercial transaction, and that is what we face if this Bill goes through.

The problem is that the transaction costs—the bureaucratic costs—will actually rise. Before the previous Tory Government introduced the internal market, the money spent on NHS bureaucracy was just 4%, but that has increased to 12%. I am willing to bet any Member on the Government Benches that the level will go well above 12%, because once legal contracts are required, once the lawyers, accountants and God knows who else gets involved and has to be paid, and once we end up with court actions, the transaction costs will rise. That is why these proposals are a disaster.

Health and Social Care Bill

Frank Dobson Excerpts

Monday 31st January 2011 Commons Chamber

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

I make no apologies for the policies that were pursued while I was Secretary of State for Health, because I set about implementing every item in Labour’s election manifesto. I know that implementing promises in election manifestos has gone out of fashion on the Government Benches, but it has not gone out of fashion with me. Before I became Health Secretary, while I was Health Secretary and since, most doctors, nurses, midwives and others in the health service have said above all, “For God’s sake, leave us alone, stop diverting our attention into reorganisation and let us get on with the job of looking after patients and raising standards of treatment and care.” Presumably, that was why the Conservative manifesto and the coalition programme both stated:

“We will stop the top-down reorganisations of the NHS”.

They claim that their proposed reforms are not top-down, but I cannot think of anything more top-down than an Act of Parliament set out in 353 pages and 61,344 words, and yet it is still a broken promise.

The NHS, as we all know, is doing better than ever before: waiting lists have come down dramatically; waiting times have been massively reduced; and survival rates are dramatically improving. Most people, in most places, and most of the time, are getting a very good deal from the health service, which is why it is more popular than ever before.

[Mr Graham Stuart (Beverley and Holderness) (Con)]

Will the right hon. Gentleman give way?

[Frank Dobson]

No, I do not have time.

Those improvements have come about not as a result of any structural changes, but because the Labour Government put into the NHS more money than ever before, built more new hospitals than ever before, put in more new equipment and, above all, recruited record numbers of doctors and nurses. We also put more emphasis on standards and on trying to ensure that we spread best practice right across the health service.

I accept that we need more clinician involvement in decision making, but we do not need to go to GP commissioning to bring that about. All we need do is get more of them on primary care trusts with more influence there. Why is it just confined to GPs? There is no reference to greater involvement of hospital specialists and there is nothing in the 61,000-odd words about giving hospital doctors a bigger say, and they have some expertise in these matters. Many GPs, as we know, do not support the proposals, and many of them want to get on with just being doctors.

One great deception that is being promoted is saying to patients, “You and your GP will decide where you will get treated.” That is simply not true. Unless the consortium of which the GP is a compulsory member has a contract with a particular hospital, the patient will not be able to go there from their GP.

The NHS is essentially a co-operative organisation in principle and in practice, and now it will be forced to compete: every part of the health service competing with the other parts and the private sector on price. It is rather remarkable, considering all the Eurosceptics on the Government Benches, that the Government are going to force our NHS to comply with European competition rules set out in the Lisbon treaty—the Lisbon treaty that the Tories voted against. Who is most likely to benefit from those rules? The answer is American health corporations, almost all of which have been indicted in the United States for defrauding US taxpayers, doctors, patients and, sometimes, all three. I asked the Secretary of State whether he would rule out any of those outfits obtaining contracts, and I am afraid his answer was, “I can’t say.”

The next question is, how will we know what is going on? How will we and local TV, radio and newspapers know what is being decided? In the Bill, there is no serious obligation for hardly any of the decision-making bodies to hold their meetings in public; there is no obligation on declaration of interests; and there is no obligation on consultation. If anyone says, “Well, freedom of information will cope,” we know what the answer will be, “Commercial confidentiality; you can’t have it.” If we are to have a competitive system, almost everything will be commercial and, therefore, almost everything will be confidential.

These proposals will divert people in the NHS from their job of looking after people. The Government are privatising the NHS, they are fragmenting the NHS, they will cost us a fortune and do little or no good for anybody.

--- Later in debate ---

[David Miliband]

No, I have given way once and I want to make some progress. If I have time, I will come back to the hon. Gentleman.

All the matters that I have mentioned are to service a vision of health care as a regulated industry. The Secretary of State has engaged in a ding-dong about which operating framework is more important—the 2009 or the 2010 one. Two points, though, have not been contested. The first is that in 2011-12, for the first time, there will be competition according to price—page 54 of the operating framework says that. The second is that the academic evidence is absolutely clear that price competition results in lower prices, yes, but also in lower quality.

The hon. Member for St Ives (Andrew George) asked the Secretary of State, “What about my community hospitals?”, but of course the Secretary of State does not want to make decisions about community hospitals. His predecessor but six, eight or 10, Nye Bevan, said that he wanted a bedpan falling in Tredegar to be heard in the corridors of Whitehall. The Secretary of State does not want to hear bedpans falling; he wants to say that it is GPs who should be making decisions, or the commissioning board, or, in the ultimate irony that my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) pointed out, the European Court of Justice under European competition law. He pointed out the irony of the Lisbon treaty being critical, but at this very time the House is passing a Europe Bill that calls for referendums when any power is transferred to the EU, including on matters as puny as the appointments system for the Court of Auditors, never mind on a vital part of NHS provision.

[Frank Dobson]

Does my right hon. Friend agree that the hon. Member for St Ives (Andrew George) is perhaps being a little ungrateful? He might have mentioned that the NHS wanted to close all his community hospitals in Cornwall, and that the dreaded centralist top-down Dobson stopped it.

[David Miliband]

The benefits of memory are useful in politics, and perhaps my right hon. Friend’s intervention will help the hon. Member for St Ives to decide how to vote in the Lobby tonight.

Many people have asked why the Government are making these proposals at such breakneck speed. Surely it is not to solve a political problem on health. After all, the Conservative party spent the whole of the last Parliament doing everything possible to avoid any policy on health that might hint at radical change. That paid off, because in the last prime ministerial debates before the general election, not a single question on health was put to any of the party leaders. It would be massively in the interests of my party and all Labour Members if the next general election were dominated by debates on the health service. On that basis, we should be urging the Government to plough ahead and make the next general election a referendum on health. Frankly, however, the cost would be far too high, and the consequences would be far too great for the national health service.

The truth is that a radical Secretary of State would do something that too few of his predecessors have been willing to do—namely, to say, “On my watch, there will be no reorganisation of the national health service.” Such a Secretary of State would dedicate himself to implementing the reforms that are working today. It is not the case that the only choice is between no reform at all and the reforms now being offered. According to health experts, there is more reform going on in the English health service now than in other health system in Europe. Our Scottish and Welsh friends might benefit from some of the changes that are taking place in England, because those changes have made the English health service a fast-improving one in Europe.

There is always room for improvement in the national health service to strengthen commissioning, to link health authorities and local government, to get people out of hospitals and to align with social care. The Dilnot commission has just been appointed to review the funding of social care, but it will not report until July. At exactly the time when we are looking at the localisation of health provision, the Government have appointed someone to look at the nationalisation of social care provision and its funding. This is not a Health and Social Care Bill; it is a health without social care Bill.

“The real choice is not between stability and change, but between reforms that are well executed and deliver results for patients and reforms that are poorly planned and risk undermining the NHS”.

Those are not my words but those of the chief executive of the King’s Fund. The Hippocratic oath says that we should “Do no harm”. The Bill fails that test. It aims at irrevocable change and threatens real harm, and that is the reason to oppose it in the Lobby tonight.

[Mark Garnier (Wyre Forest) (Con)]

It is a great pleasure to follow the right hon. Member for South Shields (David Miliband). I am delighted to be able to speak in support of the Bill, because I believe that it responds to some of the issues that have been affecting my constituency for the past dozen or so years. I want to focus on two elements of it in the relatively limited time available to me.

The first concerns the influence of GPs. Like many hon. Members, I hold constituency surgeries, and barely a week goes by without one of my constituents coming to me with an issue about the national health service. Few of my constituents understand the inner machinations of the NHS, but the vast majority of their complaints are directed towards hospitals and treatments, and the way in which treatment is commissioned. For those with some knowledge of how the system works, it is clear that the problems lie with one of the three organisations that serve Worcestershire—the acute hospitals trust, the primary care trust and the mental health partnership—and the way in which they interface with each other. However, what my constituents never complain about is their GP—[Hon. Members: “What?”] Well, they do not. Most of the problems lie in the fact that the chain of delivery of services is too complicated. For a GP to commission services for their patient, their wishes must cross not one but two organisational interfaces, at the very least. That does not make any sense. Anyone designing a complex system tries to instil the highest possible level of simplicity so that opportunities for mistakes are kept at a minimum.

My local GPs, far from fearing change, have welcomed and embraced the new proposals set out in the White Paper. When I met them last September, they had already formed a shadow consortium serving my constituents. They are enthusiastic to take on the responsibilities of commissioning, and they were disappointed not to have been chosen as one of the initial pathfinder consortia. That has now been remedied with the second tranche, with the Wyre Forest consortium being chosen to act as pathfinder.

It is in the second aspect of the Bill that I have a specific interest. Hon. Members will be acutely aware of the issues surrounding Kidderminster hospital and the changes that affected it in the early years of the previous Government. What started as a removal of blue-light services from our hospital ended up as a downscaling from district general hospital to a mere treatment centre with a minor injuries unit, although I must say that the treatment centre is now well liked locally.

At the time, there was huge protest at this outrage. Public opinion was dead against the downscaling, with local residents marching in force against it, a human chain being formed around the hospital to protect it and finally, and most dramatically, an extraordinary result in the 2001 general election when the people of Wyre Forest demonstrated their anger in the strongest way possible by voting at the ballot box to save Kidderminster hospital. But still they were not listened to, and the hospital was downscaled.

Shortly after I was selected as the candidate in Wyre Forest in January 2004, I arranged the first of many visits from the then shadow Secretary of State for Health, now the Secretary of State. I wanted him to come to Kidderminster to hear at first hand how angry local residents were at not being listened to. He came on many occasions and listened to the staff, to patient groups, to doctors and to nurses. Indeed, he has come so often that he is now on first name terms with the two matrons at Kidderminster. [Hon. Members: “Ooh!”] He is a very popular fellow, I can tell you. He has also been to other hospitals facing closure and downscaling, and he seems to have listened to them as well, because the second key element in this Bill is the proposal for local health and wellbeing boards and the local democracy that they will bring.

[Frank Dobson]

At a press conference this morning, the hon. Gentleman’s predecessor, Dr Richard Taylor, made it perfectly clear that he was utterly opposed to all these proposals.

[Mark Garnier]

I am grateful to the right hon. Gentleman for bringing that up. If my predecessor were that upset about the proposals, it would have been good of him to get in touch with his Member of Parliament and voice his concerns to me directly. He has not done that. He is, however, a man for whom I have a great deal of respect, and his views are worth listening to, although I would not necessarily agree with him on this point.

When I look at the Bill, I ask myself a fundamental question. If these provisions had been in place after 1997, would Kidderminster hospital have been downscaled? I am confident that it would not.

These proposals clearly have the full and enthusiastic support of my local GPs, who are willing, ready and able to take on these new responsibilities. I and they believe that the Bill will result in a more responsive NHS that listens to local people in delivering local solutions to local problems. Finally, I can say to my constituents in Wyre Forest, who are still angry because they thought that they were ignored for a decade, that they are being listened to, that it was the Conservative Opposition who listened to their plight, and that it is their anger at being ignored and the response to that anger that lie at the heart of the Bill.

Public Health White Paper

Frank Dobson Excerpts

Tuesday 30th November 2010 Commons Chamber

[Mr Lansley]

I am grateful to my right hon. Friend for his comments. Derek Wanless said that we needed an “engaged” scenario back in 2002, but it simply did not happen. I know that many in public health feel that the transfer giving local government the lead responsibility on public health—which is radical and new—will, in many respects, bring public health back home. It allies the public health initiative and resources to the responsibilities of local government on economic development, the environment, planning, housing and education in precisely the ways that will influence the wider determinants of health.

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

I welcome the Secretary of State’s proposal to return public health to local authorities, from which a Tory Government took it away, but why did he not mention housing in his statement? It is widely accepted that homelessness, poor-quality housing, overcrowding and insecurity of tenure are major causes of both mental and physical ill health, and a major cause of inequalities in health.

[Mr Lansley]

I am grateful to the right hon. Gentleman for his support. In fact, I did mention housing. However, I have also established in the Department a health inclusion unit—derided by those on the Labour Front Bench as a quango, although it is not one—whose purpose will be to focus specifically on some of the most excluded communities, such as the homeless and Traveller groups. Life expectancy in some of those groups can be in the 40s, and the gap in life expectancy and the health inequalities are a scandal. I have appointed Professor Steve Field, formerly of the Royal College of General Practitioners, to lead it, and I think that he will do a fantastic job in ensuring that the NHS, as well as local authorities, reaches out to deliver the health improvement that is needed.

NHS Reorganisation

Frank Dobson Excerpts

Wednesday 17th November 2010 Commons Chamber

[Mr Lansley]

For England, the White Paper sets out very clearly that specialised commissioning, whether currently regional or national, will be undertaken through the NHS commissioning board, rather than by individual commissioning consortiums.

The point about the reform process is that if we change nothing, nothing will change. The Labour party is the party of no change: it is the party of stasis, inertia and inactivity. Labour says, “Do nothing, put the reforms on hold”—whatever that means. Our aim is a simple one. We cannot stand still. If we carry on as we are, resources will, as over the last decade, be consumed without delivering the improved outcomes for patients that are so essential. Delivering improved outcomes for patients is our objective, and the White Paper gives us a clear and consistent vision for achieving that, based on three guiding principles.

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

Will the right hon. Gentleman give way?

[Margot James (Stourbridge) (Con)]

Will my right hon. Friend give way?

--- Later in debate ---

[Mr Lansley]

I said I would give way to the right hon. Member for Holborn and St Pancras (Frank Dobson), if he still wishes to intervene.

[Frank Dobson]

The right hon. Gentleman said that he wanted to improve treatment. How does he think the treatment of sick children at Great Ormond Street hospital will be improved if it has to do without the £16 million that his Government are currently threatening to take away?

[Mr Lansley]

I explained to the right hon. Gentleman at Health questions just a fortnight ago that we are in discussions with the specialist children’s hospitals. They are very clear that they are engaging constructively with the Department, with the intention that the payments through the tariff should accurately reflect the costs incurred in providing specialist services. That is the current situation, and no decision has yet been made.

I was talking about the principles of the White Paper.

--- Later in debate ---

[Mr Lansley]

No.

Against all the advice from the Opposition, we protected the NHS budget in the spending review. It was a brave decision for a Government to take in such circumstances, but it underlined our commitment as a coalition to the NHS. It was a decision that went contrary to the advice and recommendations of the Opposition. For the right hon. Member for Wentworth and Dearne to try to attack the Government over “cuts”—he used that word—in the present circumstances is pure opportunism.

The right hon. Gentleman will not say whether he backs our NHS budget. He talked about what the shadow Chancellor is supposed to have said, but it was the shadow Chancellor who specifically said that he did not support our proposals to increase the NHS budget. Does the right hon. Member for Wentworth and Dearne support our cancer drugs fund or not? He did not say. Does he back our integration of health and social care and the resources that we will use through the NHS to support social care and local authorities? He has not said.

The right hon. Gentleman has not said whether the Opposition oppose or support our commitment to the NHS. How could he? The Leader of the Opposition said before the spending review that he would publish his alternative proposals, but he never did so. The Opposition were promised it, but it did not happen. Without a plan for the economy and for public services, the right hon. Member for Wentworth and Dearne can say nothing about the NHS.

Our commitment to the NHS is clear. We have made tough choices on public spending so that we can protect the NHS and ensure that the sick do not pay for Labour’s debt crisis—

[Frank Dobson]

Will the right hon. Gentleman give way?

[Mr Lansley]

I gave way to the right hon. Gentleman before.

The big gamble is not pressing ahead with reform; the gamble now would be to carry on as the last Government did, failing to implement the reforms that are necessary and desirable—and supported—across the service. The spending review and the White Paper give the health service a clear, practical, evidence-based framework for sustained improvement in the future. We will not go back to the days of top-down Whitehall micromanagement and bureaucracy. We will free the NHS to improve outcomes for all patients and to meet our vision of ensuring that health outcomes for the people of this country are among the best in the world. I urge the House to reject the Labour party’s motion.

--- Later in debate ---

[Frank Dobson]

If the hon. Gentleman is genuinely committed to getting away from top-down impositions, will he now formally abandon the top-down proposal to take £16 million away from the Great Ormond Street hospital for sick children?

[Paul Burstow]

I am grateful to the right hon. Gentleman for raising that issue, as I was coming on to deal with the comments of the hon. Member for Sheffield Central (Paul Blomfield). We are all here to say, rightly, that we want the best from our NHS—dedication from our staff of professionals and creativity from front-line staff. Both the right hon. Member for Holborn and St Pancras (Frank Dobson) and the hon. Member for Sheffield Central talked about that, but I remind the right hon. Gentleman that the review of top-up tariffs started under Labour. [Hon. Members: “So what?”] Yes, it was in the NHS operating framework under Labour. We will complete that review and we are engaged constructively with the foundation trusts, but I think the right hon. Gentleman should have a conversation with his own Front-Bench team before he attacks the Government Front-Bench team.

Our proposals build on reforms such as practice-based commissioning, patient choice, foundation trusts, tariffs and social enterprise, and they hold true to the founding principles of the NHS—that it is free at the point of delivery, and not based on ability to pay.

Freeing front-line staff from the tyranny of process targets is another issue. The hon. Member for Winchester (Mr Brine) was right to talk about the need to build on the knowledge of general practices and help them to shape services to fit local need and deliver quality outcomes.

The hon. Member for Stretford and Urmston (Kate Green) talked about health inequalities and how they had widened in her constituency under Labour. That is why the Government are forging new relationships between the NHS and local government, making common cause on public health so that we can see it not only as a matter of medical health but as part of a far wider attack on the determinants of ill health in the first place. That makes local government entirely the right place to start.

We must ensure that collaboration takes place. The right hon. Member for Charnwood (Mr Dorrell) talked about collaboration between health and social care becoming the norm rather than the exception, as it is today. We need to increase local accountability for health care decision making. Yes, we also need to empower patients and provide more choice and more control. Through HealthWatch, a champion for patients and service users, we should make sure that the seldom heard, too, are heard in decision making.

Health (CSR)

Frank Dobson Excerpts

Thursday 11th November 2010 Westminster Hall

[Mr Barron]

I had nothing to do with the interventions, Mr Gale, apart from giving way. There is no plan or plot. I thought I would seize the opportunity to talk about the commissioning report, because the current Health Committee is looking again at commissioning and the House has not had the opportunity to debate the report and the Government’s response, which came in July.

In relation to the latest intervention, at the last Health Question Time the Minister attempted to reply to what I said about major reorganisations in the health service. It is well known now that they take years to embed, are normally very expensive and usually have a negative effect on performance while they happen. That has happened under every major NHS reorganisation in the last 20 or 30 years. That is the truth of the matter. If the estimate of the increase in costs arising from the reorganisation is right, the CSR will have a significant impact on the NHS in the future.

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

Beside the financial impact of reorganisation, even more important is the fact that large numbers of clinicians and others working in the NHS are distracted from their day job of looking after patients to go to innumerable meetings and discussions. In some cases, they even have to reapply for their current jobs. That is all to do with the reorganisation, so it wastes staff time, as well as wasting money.

[Mr Barron]

I think that there is some evidence in relation to that. Having said that, the evidence that we should be concerned about is the evidence that has come out in surveys recently about what GPs think about the proposed reorganisation.

I have in front of me a press release from what is probably the strongest trade union that we have in the United Kingdom, which is the BMA. The BMA does not like to be called a trade union, but, indeed, that is what it is. Along with the Minister’s favourite organisation, the King’s Fund, the BMA conducted a survey of doctors. I will quote from the results of that survey:

“Asked if the reforms would improve patient care, 38 per cent of doctors who responded either said they did not know, or said they neither agreed nor disagreed. Less than a quarter believed patient care would be improved.”

Obviously surveys are surveys—we do not know what question was asked. In addition, I think that the number of doctors who responded to that survey was quite low. I would not lay great store in it, and the Minister probably has the figures from the survey in front of him. However, I want to point out what Dr Hamish Meldrum of the BMA said about the White Paper. He said that it had “many positive aspects” but added:

“Giving more power to clinicians has the potential to improve the quality and cost-effectiveness of patient care, but as this survey reflects, doctors believe that many of the proposals in the white paper would make joint working much harder.”

He continued:

“GP-led commissioning will only be successful if there is effective integration between different parts of the NHS, but some of the proposals in the white paper will accelerate competition and fragmentation.”

That comment takes me back to the question that I posed to the Minister about whether those local GP consortiums can include other people who work in the NHS, such as consultants, other people from the local hospital or providers of primary care services. Can such people sit on those consortiums or is it exclusively GPs who will do the commissioning?

I will not go into much detail, but I want to refer briefly to the comment that the coalition said that these proposed changes are not “top down”. I appreciate that this debate might not be the right forum in which to debate that issue much further, Mr Gale, but what is the national commissioning board going to do if not act in a “top-down” manner?

There is good evidence—I do not think it has been denied by the Department of Health—that if a local GP consortium were to fail, the national commissioning board would intervene. I want to know what is the difference in concept between the national commissioning board and Richmond house. We have had about 40 years of battles between the NHS at local level and central Government, over central Government trying to give direction to the NHS at local level. How will that change?

Before I sit down I have a nice easy question for the Minister. I have here a press release that went out on 21 October, and the heading reads:

“New support for GPs will cut the costs of commissioning”.

The press release continues:

“A new series of resources to support GP Consortia to design and commission services for patients was announced today by Health Secretary Andrew Lansley”.

It says that those resources

“will provide… a set of tools and templates to use when designing and buying services for their patients. The first of these support packs published today is for cardiac rehabilitation services”.

We are apparently saving money with GP commissioning, so I want the Minister to tell us what evidence he has that this new system will save money and cut the costs of commissioning? I ask that question because such evidence—evidence of how commissioning had cut costs—was one of the holy grails that the Health Committee could never find. It has been said in the debate, and it is well evidenced, that the changes in commissioning that we have had during the past few decades have done anything but cut costs. In fact, they have increased them.

I will finish by saying that the Health Committee’s report on commissioning that was published in March said that we need to look wholesale at the past 20 years of payment by results, because payment by results is not working no matter what shape it comes in. We said that quite clearly in the report.

I do not necessarily want to make radical changes to commissioning, but I do want things to be better for patients and the public, and I am not convinced that the outcome of the White Paper will be better treatment for patients and the public, nor am I convinced about the evidence that the CSR’s effect on health will be a better outcome for patients and the public. As I said, organisations such as the Nuffield Trust, which have great experience of our national health care system, are talking about a reduction of 0.5% in NHS spending. I fear that that will happen, and it is not what was in people’s manifestos before the general election. I want the Minister to tell us what he thinks about that.

[Paul Flynn (Newport West) (Lab)]

I am very grateful for the opportunity to speak in this debate and I congratulate my right hon. Friend the Member for Rother Valley (Mr Barron) and my hon. Friend the Member for Easington (Grahame M. Morris) on their very illuminating speeches.

I will not follow the lines that my right hon. and hon. Friends have taken. However, I note that the comprehensive spending review has been described as generous by some. If we want to see a generous settlement in next year’s spending, it is the settlement that has been given to the landowners and farmers of the country, especially when one recalls that the price of wheat has gone up by 47% and the price of lamb has gone up even more. Not only will the £3 billion that was given out in handouts to the farming industry be protected but it will probably be increased by 3%. Now, there is generosity from a Government.

When one considers what is behind this CSR, one is filled with a sense of despair; we have a new Government with new myths and new jargon, and we will have new errors too. An example of a piece of new jargon is that the National Institute for Health and Clinical Excellence is about to be emasculated and replaced by something called “value-based pricing”. It sounds attractive, but we know that it will not work because the pharmaceutical industry supports it and the pharmaceutical industry has a long record over the years of demonstrating that the only thing that it supports is increased prices and an increased share of the cake for itself. That is what has gone on.

At least with NICE, we had a modicum of control over the increases in the price of pharmaceutical products and the increasing share that the pharmaceutical industry had of the NHS; a share that the industry took away for itself, consequently depriving other parts of the NHS.

We know of examples of that practice by the pharmaceutical industry, mostly involving anti-cancer drugs. One drug was promoted as an answer to pancreatic cancer. One of my constituents was very much involved in this field, and I did some research myself to find out exactly what that drug offered. As far as The Sun, the Daily Mail and all the other tabloids were concerned, this was a miracle drug that had to be obtained for patients and it was only the “mean” Government who were not allowing patients to obtain it. Having gone into the details of what this drug achieved, I found that it cost £16,000 a year and that it increased life expectancy by 12 days, but it caused side effects in 10% of the patients who used it, including death. The other side effects were so dreadful and destroyed patients’ dignity to such an extent that their 12 days of extra life were of no value and would possibly even have been an increased burden to themselves and their loved ones. As is the case with many other drugs now, however, that drug was being pushed by the pharmaceutical company and its agents.

If we take away the power of NICE to make objective, scientific judgments, we will have the power of the tabloids and the lobbyists replacing it, and the patients associations will all join in behind them. We will have campaigns to persuade us; we will have patients on the television making appeals, patients who will be good-looking and who will arouse our sympathy. The pressure will then be on to alter the priorities of the health service to accord with the demands of the pharmaceutical industry. This is a surrender from a reliance on objective, science-based judgments to a reliance on the prejudice-rich decisions of the tabloid press and “big pharma”. Will the Minister guarantee that the price of drugs will go down?

[Frank Dobson]

Does my hon. Friend accept that the 150 drugs that are most commonly prescribed in this country are half the price that they are in the United States, where the pharmaceutical industry, roughly speaking, determines the price of drugs? We can guarantee that prices will start to go up under the new system.

[Mr Roger Gale (in the Chair)]

Order. There is a very interesting debate to be had on those issues, but the hon. Member for Newport West (Paul Flynn) has been in the House a long time, and the right hon. Member for Holborn and St Pancras (Frank Dobson), who has just intervened, has been Secretary of State for Health and both are aware that, while the subject may be interesting, it is not to do with the comprehensive spending review, which is the title of the debate.

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

Thank you for allowing me to contribute to this debate under your chairmanship, Mr Gale. I am a passionate advocate for the national health service. For more than 30 years, I have been directly involved in it. Through the health authority, I was chair of Liverpool Women’s hospital for 10 years; just before I became an MP, we took the hospital to foundation status. I am also currently a member of the Select Committee on Health.

I explain my background because I want the Minister to understand that I have witnessed at first hand the roller coaster that the NHS has been on—reorganisations, crises, investment, disinvestment and improvements—as it has sought to deal with a dramatically changing world and shifting demands and expectations. However, today the NHS faces perhaps its most far-reaching and fundamental challenge since its inception. I will lay out some of the challenges for the future of the NHS that will be driven directly by the Department of Health settlement in the comprehensive spending review.

The Chancellor’s announcement in the CSR that health would receive a real-terms increase of 0.1% revealed the tension and struggle that will define the future of the health service. It is not exaggerating to say that decisions in the CSR and subsequently in the Department of Health are life-and-death decisions. We cannot afford to play Russian roulette with the future of the people’s health services.

We must disregard the rhetoric and myth-making of the Conservatives as they seek to demonstrate that they have changed when it comes to the NHS. Sadly for the health service, I am not convinced that they have changed at all. Before the general election, the now Prime Minister pledged clearly to end the merry-go-round of organisational change and to protect NHS funding. Those two clear and definitive statements would have suggested to voters a period of stability and continuity for the NHS, even in these difficult and challenging economic times.

There was certainly no indication at that point of what the Secretary of State was about to unleash. We are only now starting to get to grips with the implications of the proposed changes. As a member of the Select Committee who has addressed Department of Health officials and the Secretary of State, I am not sure that the Department of Health is really in control of what is happening. As far as I can see, the current policy in the Department of Health is “Don’t ask for the detail; we haven’t made it up yet.” All the changes are being led by the Secretary of State.

Statements change from one minute to the next. We are told that primary care trusts and strategic health authorities will remain until 2013 to underpin the changes; then, today, Sir David Nicholson, chief executive of the national health service, warned the Secretary of State that his proposal to abolish all PCTs by 2013 could affect quality and safety. The whole thing is becoming a circus. The plans were described by one journalist as an accident waiting to happen, and by a doctor as a politically motivated reorganisation of the NHS. That is hardly critical acclaim.

The Secretary of State for Health said to the Conservative party conference that the Government had made

“An historic commitment to increase NHS resources in real terms each year”.

That is over-egging the pudding somewhat, given the 0.1% increase. The Government could not have done any less without failing to keep their commitment. It is the lowest settlement since the 1950s. That promise must be seen in context: in-year efficiency savings of £20 billion; £1 billion taken out of the NHS to make up half the £2 billion allocated to local authorities for social care, which is not ring-fenced; an increase of £200 million to £300 million in VAT costs after the coalition increases the VAT rate; a possible £800 million to £900 million in redundancy payments over the next two years; an anticipated budget shortfall of about £6 billion by 2015; a 17% cut in capital expenditure; a two-year freeze for those earning £21,000 or more, with the expectation of a catch-up in salaries post-2013. Hospitals face financial pressures because the Department of Health has frozen the tariff. Those are the downward pressures on the financial strength of the NHS, without even taking into account the long-term strategic pressures that will shape the nature of health services and increase the strain on the NHS. They will inevitably require a more substantial budgetary provision than 0.1% year on year.

The Minister knows that the NHS faces increasing demand for services, an ageing population, an increasing number of people with complex long-term illnesses, rising treatment costs and more and more expensive medical technology. On top of that comes the far-reaching organisational restructuring of the entire health service. Sir David Nicholson told the Health Committee that the productivity challenge was huge and had never been done on the same scale in the NHS or anywhere in the world, and it is expected to happen during the transition into the new world of NHS commissioning.

With your permission, Mr Gale, I will quote Nigel Edwards, chief executive of the NHS Confederation. I asked him:

“I just wonder whether you could address this in a few sentences: do you think that we can release these productivity gains, face the furore of the populace, who will not be happy with the comments you have made about hospitals closing, and GPs in consortia trying to manage this system and, in the interim of trying to get there, a lot of the PCTs and strategic health authorities––the good people––are jumping ship? So you are now facing a huge, dangerous area where you may not have the personnel to keep what we have got going. How are we going to get the consortia—the GPs who are commissioning services—facing the wrath of their people, when some of the services they are well used to are closing down? At the same time we are busy saving all this money, do you actually think we can do it?”

He responded:

“I was going to say I think you have encapsulated the problem extremely well…my personal view is there is a very, very significant risk associated with the project that you have just described.”

On top of that, we have heard warm words from the Secretary of State. In various speeches, he has said that the guiding principle will be:

“‘No decision about me, without me’”,

yet when we examine the detail—very little of which is available—the truth appears different.

[Frank Dobson]

My hon. Friend is right to deal with such global matters. Does she think that it is possible for the Secretary of State or the Minister to reconcile all that benign guff about the money being there with the Government’s proposal to take £16 million away from Great Ormond Street hospital for sick children in my constituency? It is the most famous of its kind in Britain, with world-renowned staff, and it now faces major cuts.

[Rosie Cooper]

I share my right hon. Friend’s view. Alder Hey, which is adjacent to my constituency and serves my constituents, will be similarly affected. We are taking a worrying direction.

On “No decision about me, without me”, the Secretary of State said to the Select Committee that

“the conclusion that we reached was that we could achieve democratic accountability more effectively by creating a stronger strategic relationship between the general practice-led consortia and the local authority.”

Many people might imagine that that would mean patients being at the heart of decision making and that consortia would operate with councillors, the public and non-executives on the board with a vote. However, that will not be the case. The scrutiny will come from well-being boards. The fact that they will not be at the table and will not have a vote means—as with the current local authority overview and scrutiny arrangements—they might as well not be there. In the Health Committee, I said that such a situation was like throwing snowballs at a moving truck—in other words, the decisions and views of the well-being boards would make little or no difference.

In reality, the Government are giving the NHS budget to GPs, many of whom just want to practise medicine, rather than get involved in this giant policy experiment. There will be no testing; it will just be a big bang. The Government will use the consortiums as a shield to deflect criticism, rather like the way they are currently using the Liberal Democrats. There are rumours that the Prime Minister is getting worried about all of this. I can only hope that that is true.

The warning signs of what this means for the national health service are already apparent. There was an 80% increase in bed blocking in hospitals between May and September. I expect that that situation will only get worse, especially when the cuts to local government budgets really start to bite. Hospitals are once again increasingly becoming the safety net when the funding for social care has been used up. If a local authority cannot afford to provide the necessary care, people will end up in hospital.

Questions were asked at the Health Committee about reserves held by NHS organisations and how they would be treated. Primary care trusts are beginning to refuse to provide certain treatments. We have also had announcements on the future role of the National Institute for Health and Clinical Excellence, which will no longer advise on drug treatment and is moving towards value-based pricing. Will the Secretary of State control the drug companies pricing policies or, as most people think, will the drug companies shortly be back in control? We will soon be back to postcode prescribing and, more worryingly, we are making the availability of drugs a political rather than a clinical decision.

When I hear Government statements about their commitment to the quality of health care and delivering outcomes, my thoughts return to the fight between myth and reality. The idea that front-line services will not be affected seems somewhat delusional. During questions at the meeting of the Health Committee on 26 October, it became apparent from a witness giving evidence that hospital closures would be necessary to release moneys back into the wider health service. We were told that that was part of “managing demand” and “redesigning care pathways.” I have heard those two phrases throughout my health service attachment and they are very much back in vogue at present.

The failure adequately to address the true budget requirements of the NHS will not deliver and continue the quality of care that patients expect and need. These are short-term measures that have long-term consequences. They are ill thought out and will have major ramifications for the people who rely on access to vital health services. For those people, such services are a lifeline. Nobody is pretending that nothing can be improved in the health service. However, does it have to be subject to untested reorganisation while we are trying to manage increasing demand in the current financial climate?

The Labour Government were rightly proud that they reduced waiting lists from 18 months to 18 weeks. It took 13 years of proper investment to turn the NHS around, and it is a service that we should rightly be proud of. My fear is that Conservative policies could destroy all that hard work within a matter of 13 months. I agree with the comments of my right hon. Friend the Member for Wentworth and Dearne (John Healey) about the “broken promises” of the coalition. My fear is that those broken promises will lead us headlong into a broken NHS—or is that the intention?

[Mr David Lammy (Tottenham) (Lab)]

I congratulate my hon. Friend the Member for Easington (Grahame M. Morris) on securing this Back-Bench debate today. I shall take the opportunity to talk about the effects of the spending review on health care locally. In concentrating on my constituency of Tottenham and on the London borough of Haringey, I hope to illustrate some of the real concerns of what would traditionally be classed as deprived and disadvantaged areas.

When one looks across the canvas of political issues, it must be the sincere hope of all hon. Members that health care should not be treated like a political football. People’s lives literally depend on health services. In the run-up to the general election, I was therefore pleased by the Conservative party’s undertakings on health care spend. Frankly, I was pleased at the absence of detailed policy on health in the Conservative manifesto. It felt to me as if we had perhaps arrived at a place in which health care could be a quiet zone for a few years. That is absolutely and clearly not the case. The coalition Government and the rapid plans they have brought forward will bring about the biggest change to health care in this country that we have seen since the war.

I am absolutely certain that such changes will have a detrimental effect on my constituents in Tottenham. It is important to remember that Tottenham is a constituency with the highest level of unemployment in London. It is a constituency that we like to say is the most diverse in not just London but the UK and possibly Europe. Mortality rates among many of the members and subsections—different groups—of the community are high. If someone caught, for example, the W3 bus at Northumberland park—just up by the Spurs stadium—and travelled across the constituency to the other side of Haringey, they would experience a life expectancy rise of about 10 years. That is the reality in this part of north London.

We have heard about the conclusions reached by the King’s Fund and by the Nuffield Trust. Those organisations have been in the business for many years; they are independent and they are clear that there will be a cut in funding to the NHS over this next period. However, the truth is that the Minister knows that when we talk about health care, it is absolutely the one policy area that does not sit on its own in some kind of silo; it is dependent on what is going on around it.

Much has been said about multidisciplinary working and agencies working together, but what is happening at the coal face in an area such as mine is that the local authority is calculating how to afford 28% cuts in local community services. What is actually happening is that the borough commander is calculating cuts to his front-line services and that, in an area that has experienced high levels of knife crime, youth services will be cut over this next period. Right across the board, the things that people rely on will be cut. Where will those challenges end up? They will end up in the local hospitals and in the GP surgeries at a time when the Government are proposing a fundamental restructuring of how we afford health care locally and are handing power down to GPs.

Not all the country is like a leafy part of Surrey. There are GPs—sometimes single-handed GPs—in communities such as mine who are struggling. We have GPs, as has been said, who simply do not have the practical skills needed to engage in GP commissioning on the scale proposed and over the time frame proposed. What will that mean for health care? I would like the Minister to say something on what will happen in communities such as mine, and in London more generally. We still do not know the size of the areas proposed, so I would like to hear something on that today.

I remind the Minister of a recent debate on housing benefit that focused on the health implications of the proposed changes. In the London borough of Haringey, we have already seen other local authorities begin to place people in our borough in reaction to those proposals. I have been advised by the lead member for children on the council that 27 additional children who are on the child protection register have been placed in the borough in the past two months. In remind the Minister that it is in my constituency that baby P lost his life. Those were profound challenges that found the health care system wanting in that borough and involved one of our greatest hospitals, Great Ormond Street, which, as we have heard, now faces a £16 million budget cut. This is a serious debate and we need some serious answers.

The biggest problem facing health care in my constituency is that Haringey PCT is forecasting a year-end deficit of £35 million, largely because of some of the problems I have outlined. If one includes the deficits faced by Enfield and Barnet, that amounts to a £110 million deficit in that part of north London. Which GPs does the Minister think will take on a £110 million deficit, and what does his Department propose to do about PCTs that have deficits of that level? Is he asking them to make in-year cuts to deal with it, or is he saying that the Department will pick up the deficit? It does not take a rocket scientist to work out that few GP commissioners will rush to take on a deficit on that scale in a constituency with the needs that I have outlined. I ask him to read his notes quickly, because we want an answer. What are his proposals for PCTs with such deficits?

What are the Minister’s plans for mental health? We have heard very little about mental health services and the relationships that they will be expected to have in the new arrangements, in the context of cuts beyond the borders of mental health in the local authority and in relation to social care.

The Minister might recall that my first ministerial job was in the Department of Health. I remember working with my colleague, John Hutton, the former Member for Barrow and Furness, as he negotiated the GP contract. Many Members will have their views on our former colleague, who has most recently been employed by the Minister’s party. They will also have their views on the contract and the success of those negotiations, which I was not privy to, because they were being led by the Minister at the time, who has now taken his seat in another place.

Historically, the arrangement we have in this country is that GPs are the for-profit element of the NHS; they run small businesses and have done since the war. We are obviously grateful for the oath they take and the undertaking to serve people in their local communities, but does it not seem bizarre to hand power to the element within the NHS that has historically always been its for-profit element? How will that save costs in practice? Will it not make things even harder than they are?

I started my time in the Department in 2001, just as PCTs were beginning to bed down and find their feet. For a community such as mine, the great benefit of having the chair, the non-executive directors and sometimes councillors come forward to be on the boards was that local people were in the driving seat. I do not claim that that ever got to where we would have liked it to be, but for the first time in London we began to see the leadership of PCTs reflecting the communities they served.

I also remember the situation we inherited at the Whittington hospital, the other hospital that serves the local community, with beds lined up in the corridors—a problem that we successfully dealt with over time. The Minister has previously made a commitment that the Whittington is safe under the new arrangements, but will he reiterate that for the record? Will he state for the record that North Middlesex University hospital, which has just seen a huge rebuild, is also safe and commit to the health strategy for Barnet, Enfield and Haringey, which sees that hospital really servicing the needs of that poor part of London?

This is a hugely important time for health care in London. It is a time when I want to be able to talk to people. I want to be able to find people to discuss the deficit and the existing health needs, but guess what? I cannot find them. I cannot find them because they are beginning to leave and because there are now proposals to amalgamate so that there is a pan-London relationship on all those issues. That is not local at all. It is disastrous, frankly, for people in my constituency, which has seen profound health care challenges over the last period that have got on to the national agenda as a result. I am looking forward to what the Minister has to say.

[Frank Dobson]

Before my right hon. Friend leaves the subject of the Whittington hospital, in which he was born, does he remember attending one of the rallies to save the A and E department? The current Secretary of State, then the shadow Secretary of State, promised at the time that the unit would not be closed. Is he confident that that still applies, because there are all sorts of rumours that its closure is once again being contemplated?

[Mr Lammy]

My right hon. Friend is right. I am grateful to him for that question and for his great expertise in health care matters. We are lucky that he is one of the MPs representing north London. I was at that rally, as was he, along with all the MPs from the wider north London area, because it was a cross-party issue. It was absolutely clear that the then shadow Secretary of State had promised a future for the Whittington hospital and had said that the A and E would remain.I hope that that is still the case because, if it were to go, the effect on health care outcomes for the people of north London and certainly my constituents would be profound. The Royal Free hospital in Hampstead is too far away to expect them to drive there in the event of an emergency.

I conclude on that basis. I am grateful to have been able to put on the record some of the health care issues in Tottenham and Haringey.

--- Later in debate ---

[Derek Twigg]

No, not all old Labour at all. There has been a mix of Labour: young, old, new—some a bit younger than others. My hon. Friend the Member for Easington made some very important points about this being the worst settlement since the 1950s, and he raised the point about rising to the challenge of the financial settlements and the impact on social care. We heard many important points from my right hon. Friend the Member for Rother Valley (Mr Barron) who, along with my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson), is probably the most experienced person in the Chamber, given his knowledge of the health service and his involvement in it over the years. One of those points was what the Nuffield Trust said about this being a real-terms cut, once the £1 billion that is being transferred from the NHS is taken out—I shall come back to that later. My right hon. Friend also made an important point about how the Government have used a Health Committee report to support their policies. His point was very clear, and he also raised the important issue of commissioning for GPs.

My hon. Friend the Member for Newport West (Paul Flynn) made a very important point about NICE and drugs companies with reference to funding and influence. My hon. Friend the Member for West Lancashire (Rosie Cooper) has great experience in the health service. She is a near neighbour, and our areas successfully share the excellent women’s hospital in Liverpool. She made a number of powerful and important points about the reorganisation and cost pressures, and their effects on patient care. She also talked about Ministers not listening—[Interruption.] I know that the Minister has listened to what has been said in the Chamber, but Ministers’ listening will also be an important aspect of the reorganisation.

My right hon. Friend the Member for Tottenham (Mr Lammy) made a powerful speech. I think he said that because he had believed what was in the Conservative and Liberal Democrat manifestos, he was somewhat disappointed—[Interruption.] Perhaps I got that wrong, but he made the point that what was said before the election and in the manifestos is not now being delivered.

[Frank Dobson]

Does my hon. Friend agree that if my right hon. Friend the Member for Tottenham (Mr Lammy) were a coalition Member and he believed everything that was in the Tory and Liberal Democrat manifestos, he would be unique?

[Derek Twigg]

I always carry a copy of the coalition’s programme for government—it is a fascinating read and, I must say, comforting at times.

My right hon. Friend the Member for Tottenham made some important points about mortality, the different life expectancy rates in his constituency, and the impact of the 28% cut on local government services, to which I shall return later in my speech.

--- Later in debate ---

[Mr Burns]

We will come to that point. Whenever there is a parliamentary briefing or statement for a debate that fits the prejudices that Labour Members want to project—their straitjacket—that is fine, but anything that does not conform to their prejudices or prejudged views, or to the facts, such as the comments from the King’s Fund on which I kept pressing the hon. Member for Easington, which confirmed its view that we had honoured our pledge and made a real-terms increase, they dismiss as fiction. I am afraid that I do not share the support offered by the right hon. Member for Rother Valley (Mr Barron) for the views in the Nuffield Trust document.

I will come on to social care spending, because I know that the shadow Minister, the hon. Member for Halton, made quite a lot of that. I will try, in a longer period than I would have in an intervention, to show that he is wrong and the Government are right.

[Frank Dobson]

Will the hon. Gentleman give way?

[Mr Burns]

I will, but then I must make progress.

[Frank Dobson]

What is the Government’s estimate of the money that will be consumed by the process of reorganisation during the process of reorganisation?

--- Later in debate ---

[Mr Burns]

No. That will then put us in a position to move forward on the implementation and funding the costs of those changes. I shall now move on to deal with the rest of the issue. This year, before we spend a single—

[Frank Dobson]

Will the Minister give way?

[Mr Burns]

No. I gave way to the right hon. Gentleman once and I said that I would then make progress, because the purpose of my speech is twofold: to outline our view on the subject—

--- Later in debate ---

[Mr Burns]

In the overall run of things, the hon. Lady makes a genuine point, but most of the cost cutting that I heard about during the speeches involved accusations of services being cut without the reasons for the status of what are, in many cases, reconfigurations being gone into. Also, until conclusions have been reached, there is no guarantee that those reconfigurations will happen. They might do so, but there is no automatic guarantee that, just because there is to be a reconfiguration, the end product will be what was first proposed.

Furthermore, I heard very little comment—indeed, I do not think that anyone passed comment, although I apologise if someone did—on the QIPP programme, which is so important and vital for raising standards, using innovation to improve quality of care and delivery. In that, we have examples across the country of the NHS finding changes that can make a big difference.

For example, Southend Hospital NHS Trust is saving £160,000 a year by mapping postcodes—patients who live near each other can be picked up together for their dialysis appointments. Oxford Radcliffe Hospitals NHS Trust is saving £1 million a year by implementing an electronic blood transfusion system, which cuts the staff time taken to deliver blood and reduces transfusion errors, thereby improving services for patients. Ten NHS trusts have been piloting a new pathway to improve care for patients, mainly elderly people who have suffered a fractured neck of femur. If that were rolled out across the country, it could save £75 million a year.

Those are just small examples of things that can be done where savings are made, the quality and appropriateness of care improve, and money can be ploughed back into front-line services, which is so important.

While we are talking about resources, I shall answer the important question asked by the right hon. Member for Holborn and St Pancras (Frank Dobson). He specifically mentioned Great Ormond Street hospital, but this applies across all the specialist children’s hospitals. The Department is having ongoing discussions with Great Ormond Street and the other relevant hospitals in England about potential—I emphasise “potential”—changes to the tariff for specialist children’s hospitals for 2011-12.

I can tell the right hon. Gentleman that no decisions have yet been taken and the discussions are continuing. On his specific question about how much less money is going to be given, there is no answer at the moment, because no decisions have been taken. The discussions will continue. I hope, for the time being, that he is reassured by that answer.

[Frank Dobson]

Can the Minister confirm that Great Ormond Street hospital was asked to do without £16 million during the course of those wondrous negotiations he is talking about?

[Mr Burns]

No, but I will confirm that discussions with the hospital are ongoing and, flowing from that, decisions will be reached in due course. At this point it would be inappropriate for me to interfere by giving any confirmation or denials of anything, because the situation does not arise in that context. Discussions are going on, and no decisions have been made. We will have to see once the discussions are concluded.

[Frank Dobson]

Will the Minister give way?

[Mr Burns]

I cannot see how much more I can say, because my answer seemed fairly conclusive.

--- Later in debate ---

[Mr Burns]

I will not give way because there is little more that I can add to what I have already said on the subject.

[Frank Dobson]

rose—

[Mr Burns]

I shall make progress, because I have made the situation plain.

[Frank Dobson]

rose—

[Mr Roger Gale (in the Chair)]

Order. The Minister has made it plain that he is not giving way.

[Frank Dobson]

On a point of order, Mr Gale, the Minister might be inadvertently misleading those present here today, on the basis of information available to me.

[Mr Roger Gale (in the Chair)]

That is not a point of order for the Chair, Mr Dobson.

[Mr Burns]

All I can tell the right hon. Gentleman is the situation as it is known to me: no decisions have been made and discussions are continuing. In due course, decisions will be reached, but as of now none has been made and the discussions continue.

[Frank Dobson]

Will the Minister give way?

[Mr Burns]

I honestly do not see what more I can say—my answer seems fairly conclusive, so I will make progress. If the right hon. Gentleman wants to have a quick word with me afterwards, I am more than happy to do so.

Moving on to social care, which a number of hon. Members and the shadow Minister have mentioned—

[Frank Dobson]

On a point of order, Mr Gale—as I understand it, the Department of Health has been briefing that it wants to take away only £4 million from Great Ormond Street.

[Mr Roger Gale (in the Chair)]

Order. That is not a point of order for the Chair. The right hon. Gentleman has been in the House long enough to know that.