Oral Answers to Questions
Grahame Morris Excerpts(12 years, 4 months ago)
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Mr Lansley
I am grateful to my hon. Friend. The four tests for service change that we have set out—I think rightly—are not just about the tests that must be met before changes can be introduced; they also involve the same considerations that should drive the design of services. If local commissioners, the local authority and local people are supportive of a particular form of organisation, including community services, I would hope that that would provide the basis on which the design of services would proceed.
Grahame M. Morris (Easington) (Lab)
Last evening, I attended the launch of UKCK—a group of charities coming together to raise funds to purchase advanced radiotherapy equipment. Will the Minister explain why, despite his previous assurances, regions like the north-east are having to turn to charities to raise funds to buy this potentially life-saving equipment?
The Minister of State, Department of Health (Paul Burstow)
If the hon. Gentleman would like to supply me with the details of regions that are having to do that, I will certainly write to him on the matter. What we are doing is making an extra £750 million available to the NHS during this spending period to support the investment in radiotherapy services. I will certainly come back to the hon. Gentleman on his particular point.
Oral Answers to Questions
Grahame Morris Excerpts(12 years, 7 months ago)
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The Minister of State, Department of Health (Paul Burstow)
I am grateful to my hon. Friend for his question, and he is absolutely right to identify the priority that this Government are now placing on dealing with the harm caused by alcohol, not least because of the 1.2 million alcohol-related hospital admissions. The strategy outlined by the Home Secretary last week is about education and raising awareness; enforcement; and treatment—making sure that the treatment services are more widely spread. It is also about recognising that this is a cross-government responsibility, not the responsibility of any one Department. That is why the proposals to use a national minimum unit pricing policy will tackle cheap booze and the binge culture.
Grahame M. Morris (Easington) (Lab)
T3. We now know that the Conservatives have received more than £8 million in donations from private health care companies since 2001. This goes beyond simply cash for access to a much more sinister issue of cash for policy influence. Ministers have said that they do not expect any increase in private sector provision in the NHS, but how will this be measured in years to come?
Mr Lansley
Nobody buys influence over the policy of the Conservative party or the coalition Government. That is in complete contrast to the situation with the right hon. Member for Leigh (Andy Burnham) and his friends on the Opposition Front Bench, who are the wholly owned subsidiaries of the trade unions.
Health and Social Care Bill
Grahame Morris Excerpts(12 years, 7 months ago)
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Grahame M. Morris (Easington) (Lab)
I have got out of my sick bed to be here today, because this is a vital debate, and I am grateful for the opportunity to participate in it. I often feel that these debates are a bit like the siege of Stalingrad: we are rolling back the forces of oppression. I content myself, with my cough and sore throat, that at least the red army was victorious on that occasion.
In response to the point that the hon. Member for Banbury (Tony Baldry) and the right hon. Member for Charnwood (Mr Dorrell), who chairs the Health Committee, made about the ruling by the Information Commissioner, I think we should reflect on the fact that it was indeed a ruling. It was not advice that he was giving. Mr Christopher Graham has some expertise in this field, and although the detailed reasons have not been published, the arguments that were made by my right hon. Friend the Member for Wentworth and Dearne (John Healey) and the co-applicants from the Evening Standard—that it was in the public interest to publish the risk register—were obviously accepted.
If I may, I would like to remind the House of what the Information Commissioner said, which was upheld on appeal. Mr Graham said:
“Disclosure would significantly aid public understanding of risks related to the proposed reforms and it would also inform participation in the debate about the reforms”.
Earlier on, Government Members were shouting “Frit!” at Labour Members. I really did not understand what that meant—I am just a simple working-class lad from Easington—but I now understand that it means “You’re afraid”. However, if the Government have complete confidence in the direction of their reforms, surely it is they who are afraid, because they should have the confidence to publish the document.
Jim Dowd (Lewisham West and Penge) (Lab)
It is beyond doubt that the Information Commissioner considered all these matters before reaching his decision. Does my hon. Friend agree that, if the risk assessment had supported the Government’s case, the Government would have got it out like a shot? That they have not done so exposes the fact that they are playing fast and loose with one of the nation’s most treasured institutions, and that they are trying to hide that.
Grahame M. Morris
Absolutely; good point, well made. If the Government had nothing to hide and were not concerned, they would have published the contents of the risk register. We have had a flavour of the contents of the other risk registers that have been compiled at strategic and other levels, and I believe that the Government are concerned about them.
We know that the Bill will increase the risks to the national health service. Indeed, the chief executive of the NHS, Sir David Nicholson, told the Health Select Committee, of which I am a member:
“I’ll not sit here and tell you that the risks have not gone up. They have. The risks of delivering the totality of the productivity savings,”—
that is, the Nicholson challenge; the £20 billion—
“the efficiency savings that we need over the next four years have gone up because of the big changes that are going on in the NHS as whole.”
It is clear that local and national risk registers, as well as the strategic risk registers to which we have had access, have highlighted serious concerns with patient safety, increased costs, the break-up of care pathways—which we have seen on Health Select Committee visits—as well as competition harming integration, about which the Committee was very concerned, and the specific risks during the transition stage.
John Healey
Will my hon. Friend also confirm that, in that session on 23 November 2010, Sir David Nicholson stated that the scale of the proposed change was enormous, and that it was beyond anything that anyone in the public or private sector had witnessed? That is why the risks involved in the reorganisation are so great, as is the imperative for the House and the public to know about them.
Grahame M. Morris
Absolutely; I completely agree with my right hon. Friend. These are huge structural changes to a beloved organisation, and it is in the public interest that we know precisely what is in the transition risk register.
A little while ago, I tabled early-day motion 2659, which called on the Health Secretary
“to respect the ruling by the Information Commissioner and to publish the risk register associated with the Health and Social Care Bill reforms in advance of Report Stage in the House of Lords”,
so that we could have proper scrutiny in the Lords and in the House of Commons. We have not seen what is in the transition risk register, but we are aware of the existence of other risk registers. While the Health Secretary has been fighting tooth and nail to prevent the publication of the transition risk register and, in the process, hiding the risks to the NHS in England, other NHS bodies and clinical groups have been compiling their own risk registers into the impact of the Health and Social Care Bill.
One such body is the Faculty of Public Health, the body for specialists in public health, which is a joint faculty of the three Royal Colleges of Physicians of the United Kingdom. I am grateful to Professor Clare Bambra, from the north-east, and Professor John Ashton, from the north-west, for providing this information. In a letter to The Independent, Professor Lindsey Davies, the president of the Faculty of Public Health, outlined his concerns about the pressure that clinicians were now under from their employers for criticising the Government’s plans to reform the NHS. He wrote:
“Public health professionals have the right and duty to speak out on issues which they perceive as threatening the health of the population they serve”.
The bunker mentality of the Health Secretary, and his determination to silence clinical and public opposition, have astounded the country as a whole.
In response to the Department of Health’s refusal to publish its own strategic risk assessment of the impact of the Bill, the Faculty of Public Health has undertaken its own study, in which it has highlighted a number of significant risks, not least the potential for a postcode lottery. It states:
“Clinical Commissioning Group flexibility to determine services will lead to an increase in geographical variation in service provision.”
It identifies the possibility of costs being pushed up, and states that the
“development of more overt market mechanisms, and the greater role for the independent sector in the provision of healthcare is likely to increase the overall cost of providing healthcare.”
It also raises concerns about issues of quality as a consequence of the reforms. If the transition risk register indicates that, we should know about it.
The delaying tactics employed by the Secretary of State are, to my mind, holding Parliament in contempt. He should publish and employ no further delaying tactics. Reports that Tory-Lib Dem Cabinet members banged their Cabinet table in delight and glee at the prospect of the health Bill finally being rammed through and becoming law at the end of today leave a very sour taste in the mouth. I urge all Members to support this motion and get the risk register published.
Mr Speaker
I inform the House that there is a slight discrepancy between the clock time shown on the annunciator screen and that shown on the digital display panels on either side of the Chamber. For the avoidance of doubt, this debate began at 3.44 pm and has to end at or before 5.14 pm. For the purposes of deciding when we reach the end time, the Chair will use the time on the Chamber digital display panels. I hope that that is helpful. Given the level of interest in the debate, the time limit for Back Benchers will be reduced to three minutes with immediate effect.
Dr Wollaston
There we go—a deliberate misrepresentation. After I made those comments, I wrote to senior colleagues and told them that what I had said was completely different. I was deliberately misquoted on that statement and have been consistently misquoted by Labour Members. They should go back and look at the original.
I feel that it would be reasonable to present all the risks, but it would be crucial for Members of all parties to recognise that we are talking about a lasting change. We would also need to see a change in how risks are extrapolated out of all proportion to what they represent and an end to the deliberate frightening of patients into believing that they will have to pay for health care, which has been a consistent feature of how this Bill has been misrepresented by Labour Members.
Grahame M. Morris
In the context of her medicinal anecdote, does the hon. Lady not accept that members of the public at least have the right to read the little inserts in books of pills before they take them? Should we not have the same right to read the risk register?
Health and Social Care Bill
Grahame Morris Excerpts(12 years, 7 months ago)
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Grahame M. Morris (Easington) (Lab)
I want to make a few points on Lords amendment 2, which deals with the Secretary of State’s duties. This has been the subject of one of the most fundamental debates during the course of the Bill. The Lords still have grave concerns about whether the Secretary of State does indeed have a duty to
“provide or secure the effective provision”
of health services in England. In addition, concern remains over exactly what the Secretary of State will remain accountable to the House for.
In Committee, the Lords agreed not to amend clause 1, or clause 4, in regard to the duty to promote a comprehensive health service and the Health Secretary's accountability to Parliament. Instead, they preferred to engage in negotiations with the Minister with a view to bringing back proposals before the Report stage. The Lords Constitution Committee also proposed amendments on ministerial accountability for the NHS. The Committee’s concern was that, even after the months of debate here and in the other place and the amendments that had already been tabled, the Bill still posed an undue risk to maintaining adequate ministerial and legal accountability for the NHS. Given the number of amendments that had been tabled, it was a remarkable achievement still to have such uncertainty.
The wording of amendments remained an issue, and on 2 February 2012, the Government tabled 137 amendments to the Bill covering a range of areas, including changes to clarify the responsibility of the Secretary of State for the health service. There were two key amendments: one sought to ensure that the Secretary of State
“retains ministerial responsibility to Parliament for the provision of the health service in England”.
The other sought to place the duty to promote a comprehensive health service and to exercise functions to secure the provision of services above that of promoting autonomy.
Jim Shannon (Strangford) (DUP)
The hon. Member used the term “comprehensive health service”. Does he feel that the changes to the NHS will deliver a comprehensive health service, or does he feel that what we will see is some people being able to access services while others are not? Is that not the sort of health care service that he would be against and to which the people of this country would object?
Grahame M. Morris
I am grateful for that intervention and I share the hon. Gentleman’s concern that this amendment, which deals with the Secretary of State’s powers, and, indeed, the whole thrust of the Bill, are likely to lead to a fragmented service, when what we all want to see is co-operation and integration. I am concerned about the direction of travel in that respect.
The point about autonomy is relevant, because Lords amendment 2 reiterates that
“The Secretary of State retains ministerial responsibility to Parliament for the provision of”
health services. Lords amendments 4 and 17 would further amend clauses 4 and 20 in order to downgrade the duty to promote autonomy even more, through the idea that the Secretary of State must only
“have regard to the desirability of securing”
autonomy instead. When it comes to ministerial accountability for the Secretary of State, we have a yearly mandate to the NHS Commissioning Board, which will remove the Secretary of State—and therefore Parliament—from being involved in or interfering in the running of the NHS. In that case, I ask the Minister: what would be the point of Health questions? As private health care interests take over the provision of health services, they will not be subjected to freedom of information requests or other forms of accountability to which NHS providers are subjected.
Grahame M. Morris
I will in a moment, but I want to pose a few questions first. The Secretary of State clearly cannot answer for private companies that are exempt from FOI requests. He cannot answer for GP commissioning groups, which are essentially independent contractors and private bodies. Surely, it is clear that the Secretary of State is handing over a big chunk of the NHS budget to private GP commissioning groups, cutting himself and Parliament out of the loop. I therefore believe that it is a fantasy to say that the Secretary of State will remain accountable.
Mr Burns
There is almost—no, there is—an air of déjà vu to this part of the hon. Gentleman’s speech, as there always is. We discussed this in Committee, and I am a bit frustrated that he cannot quite get it. The fact is that at the moment there is virtually no transparency and no real accountability as to what a Secretary of State does with regard to the provision of health services. The fact is that the mandate will be published; it can be debated in this House either on a motion from the Government or from the Opposition; there will still be Question Time at which hon. Members will be able to ask questions; there will still be an opportunity for Adjournment debates, urgent questions and statements. There will be accountability.
Grahame M. Morris
Well, as Aneurin Bevan said, “You give your version of the truth, and I will give mine.” In my assessment, yes, there will certainly be a mandate, but this House’s power to scrutinise and hold Ministers to account will be severely diminished under the new arrangements. Writing down that the Secretary of State has the duty
“to exercise functions to secure the provision of services”
is thus rather perverse—one might even say ridiculous—when the rest of the Bill hands over those duties to other bodies, often private bodies outside the NHS such as the clinical commissioning groups. Indeed, the National Commissioning Board—the world’s biggest quango—will also secure provision through clinical commissioning groups, which will not be done through the Secretary of State. [Interruption.] I think the Minister is being extremely disrespectful, Madam Deputy Speaker, in the way he is gesticulating when I am trying to make my points.
In effect, the Secretary of State’s only duty seems to be to pass over the money or the resource and write one letter a year—this mandate—to the National Commissioning Board.
On the issue of the duty to promote a comprehensive health service and secure the provision of services as opposed to any duty to promote autonomy, this surely remains a conundrum, as they are virtually mutually exclusive. How the Secretary of State thought that those two competing principles could sit side by side or that he could balance the two is beyond me. This is the problem with the Bill as a whole. No matter how much tweaking is done to clauses 2, 4 or 20 by these amendments, we cannot escape this dilemma. That brings me back to my key point that this Bill’s driving ideological purpose remains to commercialise and privatise each and every service in the NHS.
Finally, let me return to the definition of autonomy—[Interruption.]—for the information of Conservative Members, who are shouting across the Chamber. According to the dictionary, autonomy means
“the condition of being autonomous; self-government or the right of self-government; independence”.
What we are talking about here is being autonomous or independent of the Secretary of State. My contention is that only central planning can deliver a comprehensive service. Otherwise, we will have postcode lotteries—identified in the risk registers we have discussed, such as the one from the Faculty of Public Health—and unprofitable services being cut back. Once the private sector is too big to control, what then?
Grahame M. Morris
I have concluded my remarks, so perhaps the Minister can address those points in his summing up.
Dr Poulter
I shall make some brief remarks, but I first want to welcome the renewed focus on integrated care, as outlined by the Minister this afternoon. He clearly outlined the importance of mental health services and clarified that the primary duty in commissioning will be to ensure that there is integrated care.
We all know the importance of dealing with the biggest challenge facing the NHS, which is how we are going to look after our ageing population. How are we going to improve the care for the increasing numbers of people living longer, which is a good thing but poses a big financial challenge for the NHS as well as a big human challenge in how to look after them? How are we going to address the challenge of looking after people living at home with diabetes, heart disease and dementia?
This Bill goes a long way towards meeting those challenges, and I believe that the renewed focus on integration is key and vital. It is only by different services and different parts of the NHS working together effectively—with primary care working effectively with hospitals, as well as with social services—that we are going to meet the big financial and human challenge of improving the care of older people. That is why I am reassured—I hope that my Liberal Democrat colleagues will also be reassured—by this renewed focus on integration, which is at the heart of the debate and at the heart of the way in which we will make our NHS meet future challenges.
Let me deal briefly with the Opposition amendment 31, which deals with what they believe is an inherent conflict between people involved in delivering care—health care providers or GPs—and others when it comes to involvement in the clinical commissioning groups. The amendment ignores the fact that, at present, good commissioning involves a partnership with primary care trusts that were set up by Labour when they were in government. GPs who are engaged in the provision of health care in local communities are involved in PCTs and involved in the Government arrangements for PCTs, working in partnership with local managers. So, if it was good enough to have that inherent partnership in the current structures set up by the previous Government, I do not see why, when we all believe that clinical leadership is a good thing in the NHS, a conflict of interest should suddenly be created under the Bill. That does not make sense; it is not intellectually coherent. For that reason, we must oppose the amendment.
We have before us more reassuring amendments to promote integrated care, to focus it on more joined-up thinking between the primary and secondary care sector, and to ensure that we do not have to deal with patients with mental health problems only when they get to the point of crisis. The focus on integrated care will mean that they are better supported in their communities. Opposition amendment 13 is, as I have explained, inconsistent with how they managed the NHS when they were in government.
Paul Burstow
Thank you, Madam Deputy Speaker.
Part 3 is a key element of the Bill. As the Government have made clear, commissioners will decide whether, when and how to use competition to deliver services for patients. Where they decide to do so, part 3 will ensure that competition is regulated effectively and in the patient’s best interests. Under the Bill, Monitor will, in future, regulate all providers of NHS services, so that all patients are protected, irrespective of who supplies their treatment and care.
In the earlier debate, my hon. Friend the Member for Southport (John Pugh) asked about the applicability of competition law to the function of commissioning. I draw his attention to European case law, which makes it clear that commissioning is not subject to competition law. It is the function that matters when it comes to determining whether this is applicable—
Paul Burstow
I am responding to my hon. Friend and, if the hon. Gentleman does not mind, I am going to carry on doing so.
In addition, the Office of Fair Trading has published guidance that is consistent with the view that the Department has expressed on this matter. I will write to my hon. Friend with the detailed case law, so that I can quote the case reference for him.
Claims have also been made that part 3 does something else. Specifically, it has been suggested that it introduces competition and competition law into the NHS, as if that were the case for the first time. Part 3 does not do that, nor does anything else in the Bill. The NHS will, as a result of the Bill, be better insulated against the inappropriate application of competition law, particularly as it develops more integrated services, which are now embedded throughout this legislation. Without Part 3, the NHS would continue to be exposed to price competition and the preferential treatment of private providers introduced by the previous Labour Government. Indeed, Labour’s 2006 procurement regulations assume that public authorities will be securing services from a market—that will not always be appropriate in the NHS—and so, under the existing regulations from the 2006 legislation, commissioners are placed at greater risk of legal challenge whenever they decide to secure services without competition.
Grahame M. Morris
I wish to seek a point of clarification on the Minister’s reference to what Earl Howe said about the Bill providing
“insulation against inappropriate application of competition law”.—[Official Report, House of Lords, 6 March 2012; Vol. 735, c. 1689-90.]
Concerns were raised in the Minister’s own party about American-style private health care interests being able to use these mechanisms to provide health care services. Will he give an example of how this “insulation” would protect an NHS trust from being taken over by a north American private health care company?
Paul Burstow
That shows a fundamental flaw in the hon. Gentleman’s argument and in his understanding of what the Bill actually does. I commend to him the contribution made by Earl Howe, the Minister in the other place, on 6 March 2012, when he set out in great detail—this can be found in column 1689—all the aspects relevant to how this Bill protects the NHS, creating insulation for it against the application of competition law under the current framework, as provided by the 2006 legislation, which does not offer those protections. It certainly does not give commissioners the ability to exercise their discretion over whether, when and if to use competition. In those circumstances, the measures give for the first time, because of the sector-specific regulator, the ability to decide which services will be exempt from competition altogether—something that does not exist as a result of Labour’s legislation. That is one reason why so many hon. Members in this House are concerned about the impact of competition—because they are seeing the NHS being exposed to competition under the 2006 Act. This Bill will sort those defects out.
Paul Burstow
What I heard the hon. Gentleman set out was a rehearsal of the interrelationship that exists between the NHS Commissioning Board and Monitor, particularly in the area of setting NHS tariffs and prices. For the first time, as a result of this legislation, there will be greater transparency and requirements about consultation in the design of those tariffs. At the moment, that process is obscured within the bowels of the Department of Health without accountability or public scrutiny. For the first time, this Bill puts that on a footing that ensures that transparency. As a result, it will produce much better tariff design for the future.
On Monitor’s role as the regulator of foundation trusts, it is important to be clear about this important part of the legislation. Foundation trusts will remain the principal providers of NHS services. The Government do not expect that to change. Monitor must therefore be able to continue operating a compliance regime transparently to assess and manage the risks, intervening proactively to address problems where necessary. The Bill is designed to reflect this and for Monitor to protect patients’ interests by regulating foundation trusts so that they continue to be able to provide NHS services in line with their principal purpose. Where Monitor identifies significant risk to a foundation trust’s continued ability to provide NHS services, the Bill provides Monitor with powers to intervene proactively to ensure that the risk is addressed. The Government agreed amendments in the House of Lords to clarify that further. In particular, the amendments clarify that Monitor’s powers to direct foundation trusts to do, or not to do, things to maintain essential standards of governance, or to ensure their continued ability to provide NHS services, will not be transitional powers. We accept that that previously was not as clear as it needed to be and we have made it clear.
We think that the Bill has been improved as a result of the amendments that were made in the House of Lords in that regard. Under clause 94 in the latest version of the Bill, Monitor’s enduring powers will include the power to set and enforce requirements specifically on foundation trusts to ensure that they are well governed. Monitor does that now and those requirements will need to be differentiated for foundation trusts to reflect their unique role and legal status as public benefit corporations financed by the taxpayer with a principal purpose defined in statute as being
“to provide goods and services for the purposes”
of the NHS. Monitor will also have enduring powers to set and enforce requirements on foundation trusts to ensure that they remain financially viable and to protect NHS assets. These measures deal with one of the concerns that has often been rehearsed about the privatisation of the NHS. The Bill does not provide that opportunity, but it provides for the protection of NHS assets. Those are necessary conditions of a foundation trust’s continuing ability to provide NHS services; they are not transitional issues.
Grahame M. Morris
I would appreciate the Minister’s clarification about reports that have been made available as a result of freedom of information requests indicating that senior officials of Monitor have been meeting on a regular basis with representatives of the private health care consultancy, McKinsey. Is the Minister aware of the nature of those discussions and do they have any relevance to the assurances that have been given at the Dispatch Box that there is no conspiracy to privatise the health service?
Paul Burstow
Absolutely not; the reports to which the hon. Gentleman refers, which had a substantial exposé in The Mail on Sunday, really do not bear as close an examination as he would like of them. We know that the relationship that existed in terms of contracting McKinsey to provide services was one that the previous Government engaged in far more freely than the current Administration. The amounts that this Government have contracted and the nature of the relationships that this Government have are far smaller.
Paul Burstow
My hon. Friend’s point seems to have upset some hon. Members, but it was entirely—
Paul Burstow
Let me at least do my hon. Friend the courtesy of answering his point before taking another intervention.
It is absolutely right to make the point about the use of those resources. Indeed, that has been one of the benefits of the system, as we have seen in the performance that some of the trusts that have had historically high caps have delivered in NHS services. However, it is worth noting that it is not just in relation to foundation trusts that there have been concerns about caps, because NHS trusts have never had caps, and it has been entirely possible for NHS trusts to increase their income without any of the constraints or controls that foundation trusts have found themselves under. The Labour party, in crafting its manifesto, seemed to have understood that, but it has now decided to run away from that in order to paint a picture about privatisation that is not part of this legislation.
Andy Burnham
The hon. Gentleman should make a speech if he wants to make interventions of that length. We had a cap to protect the interests of private patients; he is getting rid of the cap, and he is going to have to explain to patients in his constituency, if waiting lists start getting longer, why that is happening. It is as simple as that. We had systems regulation, he is removing that with the Bill and we are moving to a more unregulated market, which is not what we want to see.
Grahame M. Morris
On a point of order, Mr Deputy Speaker. I wonder whether I might seek your advice in relation to a declaration of interest. The hon. Member for Boston and Skegness (Mark Simmonds) has made two interventions on the private patient cap and has made a declaration of interest. He is a director of Circle, a private health care company. Is it your ruling that every Member must make such a declaration if they speak during the course of this debate?
Mr Deputy Speaker (Mr Nigel Evans)
It is up to each individual Member to make whichever declaration of interest they wish during a debate, but ultimately it is up then to the Member and the Commissioner if the Member wished to take that further.
Simon Hughes
I do not think that I have any more support or encouragement for the private sector in the NHS than the right hon. Gentleman does. May I therefore get him to accept that what Lords amendment 148 does is to limit in relation to each hospital an increase to—
Simon Hughes
No, to 5% of its current figure—not 5% in total, but a 5% proportion. That is what the amendment says, and that gives Guy’s hospital, St Thomas’s hospital and King’s College hospital and patients the reassurance that I think they need. The right hon. Gentleman should read the amendment.
Paul Burstow
I am grateful to my hon. Friend for the opportunity to do just that. First and foremost, I want to be absolutely clear that local authorities are under a statutory duty to ensure that local healthwatch arrangements are put in place. The Lords amendments do not change that one iota, and they do not in any way weaken the statutory functions conferred upon local healthwatch organisations. Nor do they enable local authorities in some way to limit, restrict or censor what local healthwatch organisations can do. Indeed, we tabled amendments to ensure there are better safeguards in relation to how local authorities carry out their role. The Secretary of State will be able to publish guidance relating to potential conflicts of interest between a local authority and its local healthwatch organisation, to which both sides must have regard. We have provided for HealthWatch England to make recommendations in that respect, but to be absolutely clear, local healthwatch has a statutory basis. All that has changed is that we want to enable local decisions about whether it is a social enterprise, a voluntary organisation or another format.
Grahame M. Morris
Will the Minister clarify that point and the issue raised earlier by the right hon. Member for Bermondsey and Old Southwark (Simon Hughes)? One Lords amendment allows a local authority to commission a community interest company, charity or other form of social enterprise that meets the prescribed criteria to be the local healthwatch for its area, and allows local healthwatch to make arrangements with others to carry out its functions—it effectively allows local healthwatch to delegate its functions to a community interest company. How does that address the concerns raised by the right hon. Gentleman? How would an individual constituent have their interests represented through a local healthwatch if it is no longer a statutory body?
Paul Burstow
The point is that the body will discharge a number of statutory functions. The models that the hon. Gentleman describes—community interest companies and other forms of mutual or social enterprise—are exactly the sort of organisations that are likely to engage more effectively with community interests and bring in a wider range of them. That is why we want that flexibility in the organisational form, against a set of criteria to safeguard the interests of the public. The public can tailor those organisational forms to meet the needs of their local community. That corporate envelope does not guarantee anything; the legislation still provides a statutory basis.
Andrew George
Earlier, I asked a question about the rationale behind the last-minute change from having independent bodies to the situation now, under which, as a result of both a proposal we are debating this evening and an amendment tabled in the Lords, we are allowing local authorities to commission community interest companies or others to provide the healthwatch function in their areas. That ties the local healthwatch into the local authority. I believe we should devolve and localise, and empower local communities as far as possible, but this change does not achieve that. Instead, it empowers the local authority. If there is a genuine intention to ensure that we have integrated health and social care, then there is a problem here. If the local authority provides both the social care and the local scrutiny, I fear we may not have effective scrutiny of the work of the local authority in this regard.
Liberal Democrats in the Lords have done excellent work in advancing a large number of amendments to improve the Bill, and I am perplexed that the proposal before us tonight appears, in effect, to backpedal from that progress made in other areas. That is why I hope the Minister will reassure us on the rationale for this proposal, and assure us that the new body will be genuinely independent and genuinely effective. I shall therefore reserve judgment on the question of which way to vote tonight.
Grahame M. Morris
Although the HealthWatch issue is important, in the brief time available to me I want to talk about Lords amendments 249 to 283, dealing with the health and social care information centre and patient confidentiality. The amendments raise several issues about who would have access on a mandatory basis to the information provided by the centre as well as changes in the terminology used to refer to the persons who would be able to make such requests. There are important issues here about patient confidentiality and protections to ensure that the right checks and balances are in place. I am sure Ministers will be well aware of the arguments made in Committee about the issue, and I wish to seek some assurances and express some concerns. Perhaps the Minister may be able to address some of them.
One issue that was raised in Committee was the power of the Secretary of State to direct the information centre as he wishes. The Opposition think it is a good thing that the Secretary of State should discharge certain powers, particularly when failures happen, and be held to account for them by the House. Naturally, we support the view that people should have greater access to, and control over, their health and social care needs and the care that they receive. I am sure the whole House can subscribe to that idea. However, the opportunity to access health and social care records has to be tempered by protections for patient confidentiality and, equally importantly, protections to prevent the misuse of information by private bodies.
The Opposition have raised the issues of access to patient information and privatisation, and expressed concerns that sensitive information may find its way to organisations that will use it for commercial reasons. In Committee, my right hon. Friend the Member for Rother Valley (Mr Barron) spoke about the value to patients of anonymised data, which enable them to make relevant choices. It is not a huge leap of faith to imagine that those same data would be commercially valuable to pharmaceutical companies and commercial interests. I am concerned to hear from the Minister that adequate safeguards are in place in the Lords amendments.
Fiona O'Donnell
It is valuable to the debate that my hon. Friend is highlighting his concerns about confidentiality. Does he agree that a theme running through the Bill is that it will undermine the confidence that patients can have in the people who deliver services to them?
Grahame M. Morris
I do agree. Indeed, Professor Steve Field, whom the Government appointed to head up the listening exercise, agreed. He stated:
“Better information systems and the development of more integrated electronic care records will be a major enabling factor.”
Without better information sharing with patients, and between professionals across organisations, it will be quite difficult to provide better co-ordinated and integrated care, which we all want to see. As you will be aware, Mr Speaker, I represent a former coal mining area. One of the slogans on the miners’ banners in Durham is, “Knowledge is Power”. That is a true sentiment that can be applied equally to health policy.
The buck should stop with the Secretary of State. In Committee, we considered the possibility of failure in NHS organisations, and Ministers reassured us that the issue would be effectively addressed in amendments. I would like some reassurance this evening that Ministers can foresee patients gaining greater access to their records, and I would like some detail of how that might be achieved. In view of the current cuts to the service—[Interruption.] Not the new centre that has not been set up, the existing NHS Information Centre. In view of that, is the Minister setting out any red lines for accomplishing the ambitious targets that he has set out in the Bill?
A House of Commons Library briefing note defines the role of the health and social care information centre as a special health authority. It states that the NHS Information Centre will be
“a non-departmental public body. In its role collecting data to support central bodies in discharging their statutory functions, it will have powers to require data to be provided to it when it is working on behalf of the Secretary of State or the NHS Commissioning Board”.
The Minister said that he had not cut funding, but there have been cuts to funding this year to the NHS Information Centre, which is separate from the new body that is being set up by the Bill.
Chi Onwurah
I congratulate my hon. Friend on the important points he is making, particularly his last point on public health. He and I represent constituencies in the north of England that suffer from great health inequalities. Does he agree that knowing and understanding those health inequalities is an essential part of being able to address them?
Grahame M. Morris
I agree with my hon. Friend and am grateful for her intervention. Those points were exercised in a recent debate in Westminster Hall. The basic point that I seek to make—I will finish on this—is that in order to plan effective health interventions, we need an effective and reliable evidence base. I would like assurances from the Minister that the necessary funding will be in place to ensure that that is delivered as a consequence of that measure in the Bill.
Stephen Pound (Ealing North) (Lab)
May I trespass upon your good nature, Mr Speaker, to endeavour to speak on behalf of the House to praise my hon. Friend the Member for Easington (Grahame M. Morris), who is not well, but who has risen from his sick bed to join us today because this subject is of such importance?
Those of us who stood at the Bar in the other place listening to the debate—[Interruption.] Not that bar. Those of us who stood at the Bar of the other place listening to the debate on the Bill cannot help but to have been massively impressed by the breadth and depth of expertise that was displayed. We had past presidents of royal colleges and consultants, and people from every aspect of our glorious national health service, giving their expertise, passion and analysis.
I come from a slightly different perspective. I spent more than 10 years working in the national health service—this is specifically in relation to the issue of health and wellbeing boards, in case you are worried, Mr Speaker—before community health councils were established in 1974, when, frankly, the NHS was not run for patients, people or the local community, and when there was little or no consultation with democratically elected local authorities, let alone with special interest groups or people representing areas that were ill served by the NHS. Community health councils had not only statutory powers, but a budget. They enabled the voice of the people to be heard in wards, corridors and A and E departments throughout the national health service.
We have heard tonight an extraordinary, agonising attempt on the part of the junior section of the coalition to justify what had been for years their principled support of a public voice within the NHS. The Liberal Democrats say that they will scrutinise the measure having voted to destroy that for which they have stood for so long. It is like somebody setting fire to a house and saying that they will time how long the fire engine takes to get there—and then criticising it. It ill becomes Members to draw attention to the shortcomings of other Members, but one speaker reminded me of those people in Spain who, on Good Friday, flagellate themselves up and down mountains trying to display their agonies. All the time, the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) tries to show us that he is not enjoying this—he is in agony but that agony will not deter him, I fear, from voting against the amendments.
Health and Social Care Bill
Grahame Morris Excerpts(12 years, 7 months ago)
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Mr Lansley
Let us try this one. For the first time the Bill introduces in clause 3 a duty that embeds the need to act to reduce inequalities firmly within the health system. After 13 years of widening health inequalities under Labour, surely he cannot be against that—or is he? No. Well, what about clinically led commissioning, with doctors and nurses who are responsible for our care given the leadership role in designing services? We heard earlier about one CCG, but 75 leaders of clinical commissioning groups wrote to The Times a fortnight ago. Let me quote them, because it is instructive of what is happening. They said:
“Since the…Bill was announced, we have personally seen more collaboration, enthusiasm and accepted responsibility from our GP colleagues, engaged patients and other NHS leaders than through previous ‘NHS re-organisations’”.
They continued:
“Putting clinicians in control of commissioning has allowed us to concentrate on outcomes through improving quality, innovation and prevention”—
precisely the things that the NHS needs for the future.
Now the right hon. Gentleman says, “Oh, yes, we can do GP commissioning”, but let us recall that in 2005, practice-based commissioning was in the Labour manifesto, and that in 2006, he said he was in favour of it. He said that he was
“introducing practice-based commissioning. That change will put power in the hands of local GPs to drive improvements in their area”—[Official Report, 16 May 2006; Vol. 446, c. 861.]
Chris Skidmore
We have already heard one Labour Member say that she welcomes the new measures on health inequalities, so it is a shame that the legislation could be repealed in its entirety.
Last week, Labour Members committed themselves to re-establishing primary care trusts and strategic health authorities—to reconstituting the NHS as if time had stood still, with middle-level management holding the reins. It is remarkable that Labour is not the party of the NHS patient but has become the party of the PCT, the SHA and, above all, the NHS manager.
Grahame M. Morris
On the hon. Gentleman’s point about efficiency, costs and so on, I draw his attention to an article in The Guardian today which says that the cost of replacing with a locum GPs who are away on clinical commissioning duties is £123,000 a year, while one clinical commissioning group has reported that 15 local doctors are each spending two days a week away from their surgeries. How is that an efficient use of resources?
Chris Skidmore
We are reinvesting the billions of pounds saved on managers into front-line care, and that is why we have already seen over 5,000 new doctors working on front-line services this year. I understand where the hon. Gentleman is coming from in terms of the political spectrum, but I believe that he is referring to a TUC press release that The Guardian published in full.
In a previous debate, the right hon. Member for Leigh said that he would put a cap on private practice in “single figures”. That would take the NHS backwards from its current position, and it is an arbitrary cap based on ideology, not on what is in the best interests of NHS patients. Nor is it in the interests of some of our best-loved hospitals. Dr Jane Collins, the chief executive of Great Ormond Street hospital, has said:
“The lifting of the private patient cap would allow us as a Foundation Trust to treat more patients, but also, through re-investment, to help more NHS patients.”
So Labour has set its face against Great Ormond Street hospital: well done!
We need a constructive debate about what needs to be done for patients in the 21st century. The right hon. Member for Leigh should stop using the shroud-waving language that he used today in stating:
“Time is running out for the NHS.”
In December last year, he said that there were 72 hours to save the NHS. What happened? He should beware, above all, of becoming the boy who cried wolf. I believe that this Bill will improve the NHS. I sincerely urge him to base his argument not on intuition but on facts, and, for the sake of patients, not to turn his back on reform that he once believed in and should go back to believing in.
Nicky Morgan
Thank you, Madam Deputy Speaker. After many, many weeks on the Health and Social Care Bill Committee, there is no danger of the hon. Gentleman agreeing with any of the points that I make, but that will not stop me making them.
My hon. Friend the Member for South West Bedfordshire (Andrew Selous) talked about mental health. Those who spent time on the Public Bill Committee will know that I am particularly involved and interested in mental health, and I hope that we will have a debate on mental health in the Chamber soon, but what has struck me in discussions of the Bill is that mental health service users want to be involved in decisions about the commissioning of their services. They have that opportunity in the Bill through the health and wellbeing board, HealthWatch, the clinical commissioning groups, the involvement of the voluntary sector, and, as hon. Members have said, the integration of health and social care services. The Secretary of State talked about shared decision making. It is incredibly important that that is allowed to flourish under the Bill.
My next point—a damning and depressing one for a Member of Parliament to make—is the misinformation that has been perpetuated about the Bill. Tonight, we heard the shadow Secretary of State say that time is running out for the NHS. An hon. Member said that the shadow Secretary of State spoke in December of our having 72 hours to save the NHS, and another said that their constituents are worried about the services that will be on offer. All that is scaremongering, and it is unfair on those who do not have the time, capacity or inclination to read the Bill. We need to talk about the reality.
Grahame M. Morris
On the charges of scaremongering, is the hon. Lady aware that the George Eliot hospital in Nuneaton is engaged in conversations with two private sector providers—Serco and Circle—on taking over that provision? In my 30-odd years involved in the NHS, I have never known that to happen.
Nicky Morgan
I thank the hon. Gentleman for his point and the measured way in which he made it. That is welcome in the debate on the Bill. As a midlands MPs, I am aware of what is happening in Nuneaton, but it is not my constituency so I will refrain from saying too much. I will say only that the hospital management have asked in other providers because they are concerned and want to ensure the best possible care. Is that not what we want?
Nicky Morgan
That could be the voluntary sector or the community sector. They are all private. If someone has a physio appointment, it could be with a private provider. At the end of the day, we want the best care for patients and constituents. That is what we all want.
Grahame M. Morris (Easington) (Lab)
I want to pay tribute to all the hard-working individuals who work in the national health service, and to Dr Éoin Clarke and Dr Clive Peedell, who have been supportive of the coalition, for highlighting the dangers of the Health and Social Care Bill. I suspect that this will be my final opportunity to speak up on the Bill. I understand that there are only about seven days before its Third Reading debate in the House of Lords. It terrifies me that the Bill, which I have studied intently during its 40 Committee sittings, is going to become law. The Secretary of State is introducing a new health system. It is a system that no one voted for, and it will be unrecognisable in comparison with the NHS that cared for an entire population from the cradle to the grave.
Jim Shannon
Does the hon. Gentleman share the concerns of many Members on the Opposition Benches—and, I suspect, many people outside the House—that the Government will create a two-tier health system consisting of those who can afford to pay and those who cannot? Does not that fly in the face of what the NHS was originally set up to do?
Grahame M. Morris
That is precisely our fear, and I hope to develop that argument in a moment.
The national health service was established in 1948, against the background of the devastation following a world war. Men and women with a vision for a better, fairer society set in law the guiding principles and values of our NHS. Let us not forget that, during the post-war period, this country faced a bigger deficit as a proportion of our national wealth than we are facing today.
Grahame M. Morris
I am afraid not, as I have very little time.
Those people knew that the value of money would be worthless if it did nothing for ordinary people. Nye Bevan stated:
“No longer will wealth be an advantage, nor poverty a disadvantage. Healthcare will be provided free of charge, based upon clinical need and not on ability to pay”.
In contrast, this Government seem to see any money spent by public sector providers as somehow wasteful unless it is trickled through their friends in the private sector who can turn a profit. I am concerned that their whole philosophy is antagonistic towards the public sector. I was outside the Lib Dem conference on Saturday, lobbying the delegates. I hope that Lib Dem MPs will support the motion tonight.
Grahame M. Morris
No, I will not.
The Health Secretary’s problem is that no one voted for these reforms. He has no mandate, and 24 organisations are ranged against them. He has cited Clare Gerada of the Royal College of General Practitioners as his new ally, but nothing could be further from the truth. She has said that, just because the GPs are being forced to man the lifeboats, it does not mean that they agree with sinking the ship. They really have no alternative.
It has been suggested that Labour left the NHS in a dreadful state. Let us not forget that when the Labour Government were elected in 1997 only 34% of those surveyed in the British social attitudes survey said that they were satisfied with the NHS. That was the lowest level since the survey was started under the Tories in 1983. By 2009, however, public satisfaction in the NHS had more than doubled, to 64%. So, from that starting-point of cutting bureaucracy, decentralising powers and increasing clinical commissioning, we now seem to have an end-point, which is becoming clearer. It seems to be the NHS ripped asunder by competition and private provision.
This Bill is about establishing competition and entry-points for the private sector at every level of the NHS. In essence, it is a Trojan horse for privatisation. [Interruption.] People are saying that this is not true, so let us look at clause 163, as amended by the Lords, whereby for NHS hospitals and foundation trusts, up to 49% of their treatments can be set aside for private fee-paying patients. That must surely put NHS patients at the back of the queue.
In conclusion, Labour Members are keen to form a coalition with progressive Members who recognise the damage that these so-called reforms are likely to do to our health service. We fervently oppose the reforms as set out in the Bill. What we should be doing is talking about how to create a national care service, which would be the next and logical step for the NHS. On behalf of everyone in this country, my party, the Labour party, created the NHS and is now fighting to save it. We are building a coalition so to do. We will fight for the values, principles and future of the NHS well beyond the passage of this Bill.
Health and Social Care Bill
Grahame Morris Excerpts(12 years, 8 months ago)
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Grahame M. Morris (Easington) (Lab)
There is clearly no mandate, either in this House or in the other place, for these huge changes and massive top-down reorganisation. Some 162,000 people have signed an e-petition calling on the Government to drop the Bill, so may I remind the Secretary of State that his own party’s election manifesto stated that
“any petition that secures 100,000 signatures will be eligible for formal debate”?
Does he not think that it is time for us to have a full debate about the issue, to find out who is in favour and who is against and to drop the Bill?
Mr Lansley
The hon. Gentleman, himself, was present at 40 sittings in Committee, during which his hon. Friend the Member for Halton (Derek Twigg), the shadow spokesman, said that the Bill had been thoroughly scrutinised. We have debated it; in another place they continue to debate it very fully and very constructively; and I believe that that will deliver us the right Bill for the NHS.
NHS Risk Register
Grahame Morris Excerpts(12 years, 8 months ago)
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Mr Lansley
I am sorry, but unlike the shadow Secretary of State I have taken a lot of interventions. I will take more before I finish, but I need to say one or two things without trespassing too much on Back Benchers’ time.
The shadow Secretary of State does not really have anything of substance to talk about, so he wants to talk about the risk register. Let me tell him about our approach to transparency. We are international leaders in openness and transparency in government. Across government, we publish business plans, departmental staffing and salaries, full details of departmental contracts and summaries of departmental board meetings. We are legislating for foundation trust boards to meet in public, which the Labour Government never did; they resisted it. We are opening up the workings of government in ways that Labour rejected outright.
We have set our sights higher than that. In the NHS, we have opened up more information about services than was ever done under the last Government, shining a light on poor performance and promoting better performance. The NHS atlas of variation has been published for the first time, exposing the variation in outcomes for patients in different parts of the country. That was covered up by Labour, which would have said, “Oh, no, that’s the postcode lottery, we mustn’t publish that information.” We have set it out, because that is the route to improving performance.
I remember the shadow Secretary of State’s predecessors as Health Secretary going on the “Today” programme and saying, “Oh, no, nobody’s in mixed-sex accommodation any more. We’ve eliminated all that.” Well, we have published data on that for the first time, showing that 12,000 patients a month were being put into mixed-sex accommodation. Now, because we published those data and acted, that figure has come down by 95% since December 2010. The previous Government covered that information up; we are publishing and dealing with it.
Mr Lansley
I bow to my hon. Friend on the procedures under the Freedom of Information Act. We have made it very clear that we are proceeding as the Act provides, as the Information Commissioner himself set out. I want to make it clear to the House that there is no information that it would be proper for the other place to have access to when considering the legislation, that it does not already have access to. The tribunal will be an opportunity not for politicians but for the likes of Lord O’Donnell, the former head of the home civil service, to set out clearly the process by which the free and frank expression of advice to Ministers in policy development needs to be protected under the Act.
I will tell the House about some of the risks that the NHS faced. It faced risks relating to the £67 billion private finance initiative repayment bill left to us by the right hon. Gentleman. He talks about hospitals being under threat, but we have had to offer exceptional financial support to seven hospitals to help them to back up their PFIs. Members might be interested to know that when I announced that decision on 3 February—just a fortnight or so ago—the shadow Secretary of State, who puts his view of these things on Twitter, wrote:
“I didn’t sign them off.”
He did not even use 140 characters. He managed it in even fewer. He said he didn’t sign them off—but oh yes, he did. What about Whiston hospital in St Helens and Knowsley? He signed that off. It is a pathetic attempt to escape responsibility for leaving the NHS in debt. [Interruption.] Oh, he is blaming his junior Minister now. It had nothing to do with him! When he refused to release the departmental risk register back in 2009, did he do that, or is he going to blame one of his junior Ministers? I have such excellent Ministers that I will never have to blame them for anything, but frankly I would never attempt to do so, and I hope they know that.
Mr Lansley
No.
The NHS faced the serious risk under Labour of declining productivity, as has been so powerfully illustrated. Labour turned a blind eye to inefficiency. The reason why we have to plug a £20 billion productivity black hole in the NHS is that Labour let productivity fall year on year before the election. We are pushing productivity up, and already efficiency gains of £7 billion have been delivered.
Mr Lansley
No.
I asked, “How much money has the Department of Health spent on contracts with McKinsey since the election?” The answer is £390,000. Well, I know McKinsey well enough from the past to know that we do not get an awful lot of advice for £390,000.
Grahame M. Morris (Easington) (Lab)
May I start by placing on the record my appreciation for all the staff who work in the national health service? I also want to make a declaration, unashamedly, that I love the NHS and will campaign tooth and nail to prevent any fragmentation, privatisation or postcode lottery or any diminution in the service to patients.
I tabled early-day motion 2659 calling on the Health Secretary
“to respect the ruling by the Information Commissioner and to publish the risk register associated with the Health and Social Care Bill reforms in advance of Report Stage in the House of Lords”
so as to inform that debate. The motion we are debating in today’s important debate echoes the wording in my early-day motion, which almost 100 people have signed, including 15 Lib Dem MPs at the last count. I hope they will back up their signature with their vote in the Lobby today. Many Members on both sides of the House have received letters about this issue and there has been an e-petition from 38 Degrees, which has had tremendous support in very few days. In case Government Members need any encouragement, let me refer to a poll from this week showing that 70% of Lib Dem supporters trust NHS professionals more than the Prime Minister and the Health Secretary on the Health and Social Care Bill.
Grahame M. Morris
Most of the health care professionals—indeed 90%; the ones who were not invited to the summit—oppose the changes in one form or other. Also, 80% of Lib Dem voters want the risk register published—an even bigger percentage than that of Labour voters.
Ian Lavery (Wansbeck) (Lab)
Does my hon. Friend agree with the Secretary of State about the huge support for the Government from GPs over these reforms?
Grahame M. Morris
A number of Members on the Government Benches have referred, in Health questions and at other times, to the huge support among clinicians and GPs in their area, but Clare Gerada, the chair of the Royal College of General Practitioners, has said that just because GPs are compelled to man the lifeboats does not mean they agree with the sinking of the ship. That sums things up.
Hon. Members on the Government Benches should be particularly concerned by some recent polling figures. According to a poll by ICM, the over-65s—the category of people who are most likely to use the NHS and most likely to vote—want to drop the Bill by a margin of 56% to 29%, or two to one, which is the largest such margin. Sadly, not one Conservative Member, as far as I am aware, has had the courage to sign the early-day motion or to call publicly on the Health Secretary to publish the risk assessment. I know that, privately at least, some of the more thoughtful Conservative Members have been advising the Secretary of State to publish, but he seems to be flatly ignoring them. The risk register contains an objective list of the Department’s view of the risks, an estimation of the likelihood of each specific risk occurring and an estimation of its severity if it did occur. To be clear, what the Health Secretary is determined to conceal are the severe and likely risks of his own reckless attack on the NHS.
The Prime Minister must also be held to account for his broken promises on the NHS, for allowing his Health Secretary to put the NHS at risk and for standing by him while he tries to cover up the mess that is the Health and Social Care Bill. I remind the House that the coalition agreement that was signed by the Government parties stated:
“The Government believes that we need to throw open the doors of public bodies, to enable the public to hold politicians and public bodies to account.”
How does that statement square with this decision? Where is the accountability now? No one in the country voted for these health reforms, the Health and Social Care Bill has no mandate and we in the House will be asked to vote on reforms in the knowledge that the Department of Health and the Health Secretary are complicit in hiding the associated risks.
Charlotte Leslie (Bristol North West) (Con)
Will the hon. Gentleman give way?
Grahame M. Morris
I am only going to give way twice, so I shall give way to the hon. Lady.
Charlotte Leslie
That is very kind; I thank the hon. Gentleman. Does he agree that if we want to debate the health reforms, this is not the place to do it because we are talking about the risk register? Also, does he agree that all this is slightly disingenuous because Governments do not publish risk registers for good reasons, in that it would be far more risky for patients, whom we should all be considering, if Government Departments could not have frank and open discussions? The risks we should really be looking at are those to patients.
Grahame M. Morris
I thank the hon. Lady for her intervention, but if she had been present for the whole debate, she would know that we have covered much of that in discussing the nature of a fundamental change—the biggest ever shake-up—in the national health service since it was established. We are not calling for the nationalisation of the railways or the abolition of the House of Lords. We are simply calling for the risk register to be published, in the interests of openness and transparency, to identify the risks associated with the changes proposed by the Government.
The changes are a matter of the most serious consequence. If the Health Secretary is suppressing a report that shows that the reforms could put patients at risk and worsen the functioning of the NHS—if that is in the report, which I do not know, as I have not seen the strategic risk register, at least the national one—he would be guilty of the biggest political cover-up in a generation.
As my right hon. Friend the Member for Leigh (Andy Burnham) mentioned, in his ruling back in November the Information Commissioner, Christopher Graham, said of the Secretary of State’s reasoning:
“Disclosure would significantly aid public understanding of risks related to the proposed reforms and it would also inform participation in the debate about the reforms.”
But almost three months on, we as parliamentarians are still being kept in the dark. We were told that releasing the risk register would jeopardise the success of the policy, but the Information Commissioner refuted that and said it would only enhance the quality of the debate and allow for greater scrutiny of the policy.
We were then told by Ministers that they had published the relevant risks associated with the reforms in the impact assessment. If that was the case, why would the Information Commissioner rule that they should be published to inform debate and why would the Health Secretary fight tooth and nail to prevent that?
Finally, we were told that publication would risk the frankness of future risk registers, another point that the Information Commissioner specifically ruled out. Before the general election, the Conservatives promised to “unleash an information revolution” in the NHS, yet in government they are giving us the biggest cover-up in the history of the NHS. The Prime Minister once described his priorities in three letters: NHS. So we should not be shocked by the professional and public outcry of “OMG!” since he has broken his promise of
“no more top-down reorganisation”
and deployed WMD—weapons of mass deception—to conceal the true nature of his reforms.
Opposition Members know the dangers for the future of the NHS with up to 49% of work carried out in NHS hospitals being done by the private sector, and every service provided by the NHS, whether it be radiotherapy or speech therapy, put out for competitive tender, making it vulnerable to private sector takeover. It is no wonder we are debating the threat to the NHS when so many pre-election promises have been broken.
I conclude by offering some advice to the Health Secretary. I leave him with this thought: history is littered with examples of people who have fallen from grace, not for their crimes, but for the cover-up. He should end his terrible attack on the NHS and have the courage to be open about his plans to fragment and privatise our beloved national health service.
Oral Answers to Questions
Grahame Morris Excerpts(12 years, 8 months ago)
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Mr Lansley
My hon. Friend will know from the very good work being done by the developing clinical commissioning groups in Plymouth that they have a responsibility to use their budgets to deliver the best care for the population they serve. It is not their responsibility to manage the finances of their hospitals or other providers; that is the responsibility of the strategic health authorities for NHS trusts and of Monitor for foundation trusts. In the future, it will be made very clear that the providers of health care services will be regulated for their sustainability, viability and continuity of services but will not pass those costs on to the clinical commissioning groups. The clinical commissioning groups should understand that it is their responsibility to ensure that patients get access to good care.
Grahame M. Morris (Easington) (Lab)
The Secretary of State will recall that he cancelled the new hospital planned for my area shortly after the general election. Will he advise the House how many hospitals the Government are building that use models other than PFI?
Mr Lansley
The hon. Gentleman will recall that his foundation trust was looking to receive more than £400 million in capital grant from the Department, which went completely contrary to the foundation trust model introduced under the previous Government. I pay credit to North Tees and Hartlepool NHS Foundation Trust, which is developing a better and more practical solution than that which it pursued before the election—many of the projects planned before the election were unviable. The hon. Gentleman will know that projects are going ahead, and last November, together with the Treasury, we published a comprehensive call for reform of PFI. We achieve public-private partnerships and use private sector expertise and innovation, but on a value-for-money basis.
Stereotactic Body Radiotherapy
Grahame Morris Excerpts(12 years, 9 months ago)
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Grahame M. Morris (Easington) (Lab)
I pay tribute to and congratulate the hon. Member for Wells (Tessa Munt) on securing this important debate. I want to put on the record the appreciation of myself and the whole House for the work that she has done in this important area.
Last August, the Department of Health released the first ever England-wide analysis of patient access to radiotherapy treatment. For those of us who represent constituencies outside London and the south-east, the results were shocking. The disparity in treatment levels for cancer patients living in and around London, compared with the rest of the country, is nothing short of disgraceful. Access to advanced radiotherapy should not be a postcode lottery. The data on each of England’s 28 cancer networks show that the further someone moves away from London, the smaller their chance is of receiving radiotherapy. North-west London tops the list, with radiotherapy provision at 94%, whereas the north-east—my region—came last, at 27%. In fact, the bottom five networks were all north of the River Trent.
Jim Shannon (Strangford) (DUP)
The benefits of SBRT are well proven in many cases and clear in numerous cases. Does the hon. Gentleman agree that it should be available more extensively across the whole of the NHS, and that it is time for the Minister to work alongside the devolved Administrations to ensure that the treatment is available for patients in Northern Ireland, as well as other parts of the United Kingdom?
Grahame M. Morris
Absolutely. I thank the hon. Gentleman for that intervention, and I agree completely. All 28 cancer networks should have equal access to this advanced radiotherapy.
In practical terms, cancer patients in the Minister’s London constituency are three times more likely to receive the radiotherapy treatment that they need than those residing in northern England and twice as likely as those living in the south-west of England. Believe it or not, however, when the general radiotherapy dataset is analysed further—by that I mean looking at radiotherapy centres offering conventional radiotherapy and those offering the more effective SBRT—the picture is far worse.
The conventional method of radiotherapy delivery is unable to distinguish between healthy and unhealthy tissue, so the treatment is delivered in short doses—often every day for four or five weeks—to avoid too much damage to the healthy tissue. As the hon. Member for Wells said, SBRT uses small, multiple and highly focused beams of energy to deliver radiation directly to the tumour, ensuring that a minimal dose is received by the surrounding healthy tissue. Consequently, there are little or no treatment-related side effects. SBRT allows the patient to be treated over five days, as opposed to five weeks, as with conventional radiotherapy. Because of its accuracy, SBRT can be used to treat tumours that might be surgically inaccessible or in close proximity to critical organs of the body, such as the heart.
When we look at the postcode lottery that the dataset report presents, we should also ask where SBRT is available and where it is not. The Minister must understand how important the comparison is. For cancer patients in my constituency, the difference between having access to SBRT and having access to conventional radiotherapy—for prostate cancer, for example—is a 50-mile car journey every day for five weeks and the treatment lasting just five days, with a rapid return to normal life. As well as the benefits to the individual, the cost savings to the NHS of using SBRT compared with conventional radiotherapy are obvious for all to see.
Like the hon. Lady, I, too, was approached, just before Christmas, by a constituent whose cancer needed SBRT. His tumour could be treated only using the accuracy of the robotic CyberKnife system, but there are only three CyberKnife systems in the NHS, and they are all in London. However, thanks to the incredible co-operation of my constituents’ clinicians and the clinicians from St Bartholomew’s hospital in London, as well as the understanding of County Durham PCT—the commissioners, who, in a timely fashion, agreed funding —he starts his treatment here in London in two weeks. My constituent is very happy that he is set to receive the treatment in an NHS hospital, but is it not a scandal that he has to travel more than 260 miles to do so? What is equally scandalous is that the reason why there are only three CyberKnife systems in NHS hospitals is that those hospitals needed to raise the money to purchase them from charitable donations. I have since learned that in Birmingham, as well as in Newcastle, in my region, the Bear appeal is seeking to raise the money for a CyberKnife system from charitable sources.
What an indictment of the NHS under this coalition government! The NHS should not have to go begging for charitable funds to buy the latest life-saving equipment, especially when we know that the Department of Health is currently holding back £300 million in capital allocations, in Whitehall coffers. This resource is for capital equipment, but is not given to the hospitals in regions like the north-east where it is most needed. If the Minister is serious about reducing health inequalities in the north-east, and, indeed, in the south-west, we should have this equipment and not be left to linger at the bottom of the radiotherapy dataset, which the Minister himself said is the benchmark for future provision. I ask the Minister to make a commitment to investing some of this £300 million in the capital equipment needed to reduce these disparities in the provision of radiotherapy in general and SBRT in particular.
The Minister of State, Department of Health (Paul Burstow)
We have had a good debate so far, and I congratulate my hon. Friend the Member for Wells (Tessa Munt) on securing it and on providing an opportunity for us to draw attention to radiotherapy services in the NHS. I want to try to answer as many questions as I can. I understand that my hon. Friend will meet Department officials to discuss some of her concerns further. I hope that if any issues are not covered, they can be explored further there.
Radiotherapy is an extremely important form of treatment for cancer, which often does not get the attention it deserves. This debate has, I think, helped in that regard. It is more targeted than chemotherapy and less invasive than surgery, with new, faster and more precise technologies reducing side-effects and improving outcomes for patients. Radiotherapy is a significant component in the treatment of 40% of patients cured of cancer and for 16% of cures overall. It is also extremely cost-effective in comparison to other curative cancer treatments. Spending is at around £325 million a year—just 5% of the total spend on cancer.
For these reasons, I very much welcome the opportunity presented by this debate to correct a number of inaccuracies that have appeared in the press on this subject. Claims have been made that patients are being denied life-saving treatments because of the lack of access to CyberKnife. Those claims are both inaccurate and alarming, and I think they must cause great anxiety to patients. The truth is that CyberKnife is not a form of treatment, but a brand name of a particular type of equipment that delivers stereotactic body radiotherapy or SBRT. It is not the only technology available, as I shall explain further in a moment.
My hon. Friend talked about the figures, and I repeat the fact that one in four radiotherapy centres currently has equipment—not CyberKnife in every case—that is capable of providing SBRT. I understand, and this bears out my hon. Friend’s figures—
Paul Burstow
No. Many points have been put to me, and to be fair, I now need to respond to them.
Currently, eight centres are active in providing these services, but I recognise and appreciate the work my hon. Friend has done, and we will certainly need to review carefully the information she has presented tonight.
CyberKnife can deliver only SBRT and cannot deliver conventional radiotherapy. Large, expensive radiotherapy delivery systems such as these are purchased by public tender. After vigorous and rigorous evaluation of the many different systems available to deliver this treatment, many hospitals around the country have chosen systems provided by other manufacturers, as they enable them to provide flexible, accurate and cost-effective radiotherapy and radio-surgery services. The promotion of CyberKnife over other alternatives does a disservice to other manufacturers that are successful in providing equipment to trusts, and distorts the nature of the debate.
Let me be clear: timely access to high-quality radiotherapy for cancer patients in this country should improve cancer outcomes and survival. That is why we have made a commitment to expand radiotherapy capacity by investing about £150 million more over the next four years. That will increase the utilisation of existing equipment, support additional services and ensure that all high-priority patients with a need for proton-beam therapy get access to it abroad.
Significant progress has been made in improving radiotherapy services since the publication of the National Radiotherapy Advisory Group report in 2007. The collection of the radiotherapy dataset, which the hon. Member for Easington (Grahame M. Morris) talked about, has enabled us to establish more accurately than ever before the measure of the number of patients being treated with radiotherapy, and to identify and address unacceptable and inexplicable variations around the country. Almost all patients referred for radiotherapy treatment receive that treatment within the waiting time standards. This improvement in waiting times, compared with historical waiting times, saves lives each year. New modelling tools have been developed that allow local services to model the needs of their populations and to predict demand and ensure that they have capacity to treat all patients who will benefit from the treatment without unnecessary delay as demand changes over the years.
However, there can be absolutely no room for complacency, and we realise that more work needs to be done to identify why the variations that the hon. Member for Easington has talked about in terms of referral rates in some parts of the country have existed. The dataset shows that some variations in access rates between cancer networks persist, and there is currently lower uptake in certain parts of the north that cannot be explained by variations in cancer incidence. That new dataset allows local commissioners to examine their referral practices in detail, and I understand that networks in the north-east are looking at capacity and travel times to start to address the concerns that the hon. Gentleman has brought to the House tonight.
Access to advanced radiotherapy techniques needs to be improved, particularly intensity modulated radiotherapy. Experts estimate that around a third of all treatments given with the intention of cure should be delivered by IMRT. Some centres are already delivering at that rate, but many are far below it. All centres have equipment that is capable of delivering that technique and a national training programme has been rolled out. We now need to ensure that IMRT, as well as image guided radiotherapy, is offered to all patients who might benefit.
As we have heard, radiotherapy treatment involves the delivery of a dose of radiation to a cancer tumour. That dose is delivered to each patient in fractions or treatments and the number of fractions delivered varies with the type of cancer. The ultimate goal in radiotherapy is to deliver the treatment to the tumour with pinpoint accuracy, thus sparing surrounding tissue and requiring as few fractions, or treatments, as possible—in other words, to treat and cure more cancers with shorter courses of radiotherapy and fewer side effects. For that reason, radiotherapy is continuously evolving with innovations and the development of new techniques and technologies that move us increasingly closer to that goal, but those new developments need to be evaluated in clinical studies.
It is a challenge for providers and commissioners to keep up with the evolving nature of radiotherapy treatment and to ensure the evaluation and adoption of new techniques. The royal colleges and other professional bodies provide guidance to their members to assist the continuous update of clinical practice. Commissioners in turn need to ensure that they are aware of sources of updated guidance. The radiotherapy community in this country can be rightly proud of its ability to deliver clinical studies and explore the use of delivering radiotherapy in fewer fractions. Indeed, the role of the Royal College of Radiologists and the National Radiotherapy Implementation Group in producing such guidance is absolutely crucial.
Let me come back to stereotactic body radiotherapy, which is an important example of specialist radiotherapy technique. It allows radiotherapy to be given to smaller target areas in higher doses with fewer treatments. Its greatest potential is in its possible use as an alternative to surgery and, because of its precision, to treat and potentially cure cancers that would otherwise be untreatable. However, as has been mentioned, it is regarded as a novel technique and it provides a very high dose of radiation per treatment. With conventional radiotherapy, a patient might receive their dose over 20 to 25 visits, but with SBRT that dose is delivered in five or six. More treatments need to be delivered within clinical studies so that clinicians can carefully follow up in both the short and long term to confirm the efficacy of the treatment and study any side effects. Side effects have been mentioned in the context of drugs, but we need to be conscious that there can also be side effects from radiotherapy and not be so anxious to expose people to risks if we are not confident. We should apply the standards of clinical trials to this area. It would be wrong for this Government to promote any form of treatment before the evidence has been collected. Evidence is about more than just making speeches in the House—it is also about looking at the clinical evidence.
All new techniques, including advanced radiotherapy, need to be justified on the grounds of cost and clinical effectiveness. Last year, the National Radiotherapy Implementation Group, published guidance, which has been mentioned, on the use of SBRT, including a clinical evidence review, and concluded that there is a substantial evidence base for the clinical effectiveness of SBRT in early stage lung cancer for patients who are unsuitable for surgery.
There are about 1,000 patients in the country who would benefit from that sort of procedure. There are ongoing clinical trials examining the use of the technique for other cancers, but they have yet to confirm its benefits for those cancers. For that reason, the national radiotherapy implementation group recommended that any patient receiving SBRT should receive it in a clinical study to enable the evidence to grow, and at specialised centres treating high volumes of patients with the necessary quality assurance safeguards in place. The implementation of the recommendations cannot be rushed, and the welfare of patients should be paramount in the introduction and use of novel techniques. Staff must therefore be thoroughly trained in this technique.
My hon. Friend asked me to consider a number of issues. I will certainly undertake to examine the tariff programme to establish what more can be done to expedite it, but I should point out that it is no small task to introduce new tariffs in the NHS. In 2012-13 we are mandating the use of the necessary resource groups and currencies in regard to contracting for external beam radiotherapy, and that is an essential first step. I hope that when my hon. Friend has a chance to sit down with officials, they will be able to talk in more detail about the work that is being undertaken to make progress with the implementation of tariffs.
It is possible that there will be a significant increase in demand for this treatment in the coming decades, but many tumours will continue to be treated better with conventional radiotherapy, and in particular with intensity-modulated and image-guided radiotherapy techniques.
Health Inequalities (North-East)
Grahame Morris Excerpts(12 years, 9 months ago)
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Ian Swales (Redcar) (LD)
It is a pleasure to speak under your chairmanship, Mrs Riordan. I congratulate the hon. Member for Newcastle upon Tyne Central (Chi Onwurah) on securing the debate. I agree with her that the issue of health inequalities is of great importance to all MPs and particularly those of us who represent constituencies in the north-east. Having been born in Leeds, I was delighted to emigrate to the north-east in my early 20s.
First, I would like to refer to the July 2010 National Audit Office report, which was specifically about “Tackling inequalities in life expectancy in areas with the worst health and deprivation”, and to the subsequent hearing of the Public Accounts Committee and the report that it produced in November 2010. That report was in effect a catalogue of action by the previous Government and bears detailed reading. It said that the Department of Health had been
“exceptionally slow to tackle health inequalities…we find it unacceptable that it took it until 2006—nine years after it announced the importance of tackling health”—
Grahame M. Morris (Easington) (Lab)
Will the hon. Gentleman accept that tackling health inequalities effectively requires a broad range of actions, including tackling things such as educational under-achievement, the need for warm homes, and child poverty, which go across a broad range of Departments, not just the Department of Health?
Ian Swales
I absolutely agree with that and will go on to say more about it. The Department of Health has an important role in being the umbrella Department for monitoring action in this area, however. The report went on to say that the Department recognised its failings, admitting that it had been
“slow to put in place the key mechanisms to deliver the target it had used for other national priorities”
and
“slow to mobilise the NHS to take effective action.”
However, I agree with the hon. Gentleman that there is much more to this than simply the NHS.
There certainly has not been a shortage of reports on this subject. The Department of Health issued 15 major publications on the issue, starting in 1998 and rising to a crescendo in 2010. In fact, 2007 was the only year in which the previous Government did not issue a publication.
Grahame M. Morris (Easington) (Lab)
It is a pleasure to serve under your chairmanship for the first time, Mrs Riordan. I congratulate my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah) on securing this debate. The number of Opposition Members who are present today is a testament to the issue’s importance. I wish we had a little longer to speak, because I will have to truncate my remarks.
I served on the Committee that considered the Health and Social Care Bill, and I am a member of the Health Committee. As someone who has worked in the health service for more than a dozen years, I can say that the subject is very close to my heart. I am grateful to a number of organisations for their work, including the Association of North-East Councils, the National Education Association, the Campaign for Warm Homes, Durham county council, the North East Public Health Observatory and Health Works, which won a national award last week for its innovative and pioneering work in tackling health inequalities at the very heart of my constituency, and I thank that organisation for the information that it provided to Members for this debate.
The NHS reforms contained in the Health and Social Care Bill are only one aspect—a very important aspect—of how Government policies will increase health inequalities. We must make it clear that there is no consensus on this matter. There is clear blue water between the views of the Opposition, who think that resources should be applied to the areas of greatest need to address real and fundamental problems, and the attitude of Government Members. Across every Department, coalition policies will exacerbate socio-economic inequalities and, ultimately, health inequalities, as indicated by Professor Sir Michael Marmot in his report. I wanted to mention some figures in my region, but I do not have enough time.
Chronic obstructive pulmonary disease, or COPD, is particularly prevalent in the north-east. It is often associated with heavy industry, coal mining and the like. Last year, my own primary care trust received a national award for its innovative approach to tackling this public health issue within our community. COPD costs the NHS an estimated £491 million every year.
Mortality rates in the north-east are higher than in the rest of England, accounting for 6% of all deaths in England, and the inequality gap appears to be increasing, which is a real concern.
I want to focus on two significant issues in the limited time that I have: first, inequalities in access to health service, which is a key factor that influences health outcomes; and secondly, the broader problem of health inequalities produced by deep-seated differences of social class.
As we have heard, in 1979 the Government’s chief scientific adviser, Sir Douglas Black, produced a report on the extent of health inequalities in the UK, and he acknowledged that the NHS could do much more to address those inequalities, alongside other improvements across the Government. As I mentioned earlier, those improvements include ones to child benefit, maternity allowances and pre-school education, as well as an expansion in child care and better housing. All those changes would address health inequalities.
Those findings by Sir Douglas Black were subsequently reinforced by further research and reports by Professor Peter Townsend and Sir Derek Wanless and more recently by Professor Sir Michael Marmot, all of whom I have had the pleasure to meet in one forum or another before and after I was elected to serve in the House.
There is a stark danger—a clear and present danger—of a downturn in the progress that has been made in addressing health inequalities because of decisions being made by the Government, both in the Department of Health and elsewhere, and severe cuts to services for the most vulnerable. That makes it all the more important that the NHS focuses on tackling health inequalities. Let us make no mistake: under Labour, good progress was made to address health inequalities, but a great deal more needs to be done.
I have served on the Health and Social Care Bill Committee for a year now, as well as on the Select Committee on Health, and I would argue that that Bill changes the fundamental aspects of our NHS. The NHS has been fragmented, with privately led commissioning, the reintroduction of a postcode lottery, an unco-ordinated health system and greater competition. That fragmentation risks entrenching the inequality of access to health services and health outcomes. Fragmentation is the antithesis of a co-ordinated approach. We need more co-ordination, more integration and a more focused approach.
Stephen Thornton, chief executive of the Health Foundation, talked about health inequalities when he was one of the expert witnesses who gave evidence to the Health and Social Care Bill Committee. He said:
“a duty needs to be placed on the national commissioning board and the consortia”—
the commissioning groups—
“to embed shared decision making in all care and treatment”.––[Official Report, Health and Social Care Public Bill Committee, 8 February 2011; c. 19.]
Only by reinforcing the duty on the commissioners themselves to reduce health inequalities is there any chance of achieving that goal.
The cuts that are falling across every Department are clearly hitting the poorest hardest. The Association of North East Councils has shown that the north-east will be worst affected by those cuts between now and 2013. Child poverty is rising in my constituency. Currently, one child in three in my constituency is living in poverty, but in the Eden Hill ward in Peterlee 48% of children are in poverty, and in Deneside in Seaham, which is next to where I live, the figure is 40%. Those figures should concern not only the local MP but the national Government.
Recently, the TUC produced figures after the unemployment figures were released that show that, on average, 7.5 jobseekers are chasing every vacancy, but in the constituency of my hon. Friend the Member for Hartlepool (Mr Wright) the figure is as high as 24 jobseekers chasing every vacancy. Youth unemployment is rocketing, and the coalition Government seem to have no intention of reducing health inequalities.
Ian Lavery (Wansbeck) (Lab)
I will make a very brief intervention. My hon. Friend has just mentioned statistics about child poverty, unemployment and jobseeker’s allowance applications, and earlier in the debate other colleagues talked about the inequalities in the north-east regarding the situation within the NHS. Those statistics and that situation are wholly unacceptable. The Prime Minister said before the election that he would attack the north-east first and then Northern Ireland second. That is happening. With the Welfare Reform Bill, there will be a continued attack on the north-east. Does my hon. Friend agree that that does not bode well for the future of the people in the north-east and that things can only get worse?
Grahame M. Morris
I am grateful to my hon. Friend for that intervention, and I agree with him. I was shocked to attend a meeting in my constituency last Friday about the contingency plans that are being put in place for emergency feeding centres after 2013. Those centres are the soup kitchens that we have not seen since the 1930s or the miners’ strike in 1984.
My final point is that the Labour Government produced the first ever targets to reduce health inequalities in the population, and the poorest were healthier when we left Government than they had been when we took office in 1997. My plea to the Minister is this: raise the standards and be a champion for public health and not an apologist.
Mrs Linda Riordan (in the Chair)
Order. I remind Members that I will call the Front-Bench spokespersons from 10.40 am onwards.