National Health Service

Henry Smith Excerpts

Wednesday 26th October 2011 Commons Chamber

[Andy Burnham]

Ministers are shaking their heads, but I will read them the Treasury figures published in July this year, and let them tell me then that what I have just said is not true. The public expenditure statistical analyses from this year provide official confirmation of what I have just said. They show that in 2009-10 health spending was £102,751 million. That was in the last year of the Labour Government. In 2010-11, health spending was £101,985 million. There we have it in black and white—the first real-terms cut in health spending for 14 years. In fact, it is the first real-terms cut since the last year of the last Tory Government in 1996-97.

[Henry Smith (Crawley) (Con)]

I am interested to hear how the right hon. Gentleman is trying to manipulate those figures. How does he reconcile what he is saying with what his party’s Administration is doing in Wales, where the health service has been cut and hospital infections and waiting times have risen?

[Andy Burnham]

The hon. Gentleman uses the word “manipulate”. May I say that I take great exception to that? I have read out the Treasury statistical analysis from this July. If he is telling me that I have misrepresented it, let him stand up again now and say so. If not, he should hold his peace. I remind him that his party’s Government delivered a much deeper cut to Wales than to Scotland or Northern Ireland. The Labour Administration are now dealing with the consequences of that.

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[Andy Burnham]

For the avoidance of doubt, let me address directly what my hon. Friend has said. A moment ago I mentioned a photograph of the Secretary of State on a visit to Chase Farm hospital just days after the election, when he announced his so-called moratorium—although no one has yet seen any evidence of it. He is holding up a placard in that photograph that says, “HANDS OFF! Chase Farm A & E”, underneath which are the words: “I oppose any cutbacks to our A & E,” and on the bottom we can see his signature. How on earth he can square that with the letter that he recently exchanged with his hon. Friend the Member for Enfield North, I do not know. I do not know how the Secretary of State can reconcile those two things in his mind or how he could look anyone in Enfield North in the eye, having promised them that he would save their accident and emergency department. It is quite scandalous. People across the country are discovering that the Prime Minister’s moratorium is utterly meaningless, as A and Es restrict opening hours and maternity wards close.

We now come to the third of the Prime Minister’s broken promises, on NHS reorganisation. Again, the coalition agreement could not have been clearer:

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

I have never understood how those in the coalition could possibly sign up to those words, when only weeks later they would bring forward a White Paper heralding the mother of all reorganisations, the biggest since 1948. I can see the cynical politics behind the Prime Minister’s first two pledges, but on this pledge at least he was right. A reorganisation is precisely the last thing that the NHS needs right now. I am clear: the abandonment of that pledge is the Prime Minister’s biggest mistake in office. If he ploughs on, he will ultimately pay a heavy price for it, because it is a catastrophic error of judgment to combine the biggest ever financial challenge in the NHS with the biggest ever reorganisation.

As Health Secretary, I was told by officials that rising to the financial challenge would require every ounce of our energy and focus. The NHS would need stability. Instead, this Government have picked up the pieces of the jigsaw and thrown them up in the air, distracting the service at the very moment it needed maximum focus. Grip has been lost; the NHS is drifting.

[Henry Smith]

Does the right hon. Gentleman not agree, however, that our NHS needs greater efficiency and localism, and that this requires reorganisation?

[Andy Burnham]

I said just a moment ago that I was the one who put my name to the Nicholson challenge, because that money was going to help the NHS respond to the new demands placed on it at this difficult time, so the hon. Gentleman need not lecture me about efficiency. He needs to tell me how placing a moratorium on change in the NHS helps it to respond and deliver those efficiencies. That is the contradiction of his position, and he stood for election on that policy, as did others.

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[Grahame M. Morris]

If the hon. Gentleman does not mind, I will continue my introduction and give way in a moment.

I wish to recognise the contribution of the NHS staff, who are the source of great pride. They have done such a great job, and continue to do so, even in difficult circumstances, in delivering the very high levels of patient satisfaction reported in the recent surveys.

In November 2010, the Backbench Business Committee selected my application for a debate on the impact of the comprehensive spending review on the Department of Health, the NHS and public health. So many of the issues that have been raised are implanted in my mind, not least the loss of the funding for a new hospital that would have served many of my constituents in the south of Easington. I am concerned about the particular reference that has been made to that and I would be grateful if the Secretary of State or the Minister would deal with that in their closing remarks. A value-for-money assessment was made by both the Department of Health and the Treasury and it was found that the best way to take forward that proposal was with public funding, rather than through the private finance initiative route. The disingenuous position repeated by those on the Government Benches, including the charges laid against the Labour Opposition about our support for PFI, has been compounded. I remind right hon. and hon. Members on the Government Benches that in the case of the new hospital planned for my area we were directed to the PFI route, despite the criticism that has come from the Secretary of State and other Members on the Government Benches.

I am pleased that the motion focuses on the failed personal pledges of both the Prime Minister and the Secretary of State. A key promise was made to increase real-terms expenditure on the NHS, but it is another broken promise. It is probably the most fundamental one, as the NHS is such a beloved institution of the whole British public. Before the election, the Conservatives promised to protect the NHS and give it a real-terms budget increase year on year. The coalition document promised a 0.4% real-terms budget increase for the NHS over the spending review period.

I am sure that we all saw the expensive billboards before the election, to which my right hon. Friend the Member for Leigh (Andy Burnham) referred. They showed the Prime Minister, then Leader of the Opposition, saying:

“I’ll cut the deficit, not the NHS.”

That was not really about rebranding the NHS; it was more an exercise in conning the British public. Whereas Labour gave a guarantee to protect the front line of the NHS, the Health Secretary, then the shadow Health Secretary, saw a cynical opportunity to give a guarantee on spending. We now know from the Treasury’s own figures that that guarantee was false: it is a promise that has been broken. It was a guarantee that went against all the Tory mantra. We are constantly told by the Conservative party that public service delivery is not about how much we spend but about how we spend it—in fact, we heard that today from the Prime Minister in relation to police numbers. However, the Tory promise was never about protecting the NHS; it was about protecting the Tory brand.

Even the Tories’ biggest backers realise that the promise to increase funding on the NHS was a con. The Secretary of State cited James Purnell a little earlier, so perhaps I might cite Fraser Nelson, who is not a well-known socialist—he writes for The Spectator and is a right-wing commentator. He says:

“It has become clear now that there was a cynical competition to dupe the British public into believing that if they voted Tory at the General Election, the NHS would be safe.”

After 13 years of unprecedented rises in the NHS budget under Labour, and efficiency measures such as those on procurement—

[Henry Smith]

The hon. Gentleman is talking about the 13 years under the previous Labour Government. I do not know what happened in his constituency, but my constituency lost accident and emergency provision, and we lost maternity provision. That was the direct consequence of Labour’s Department of Health.

[Grahame M. Morris]

I think we saw an unprecedented period of growth with the building of new hospitals and new facilities. I have some sympathy with the hon. Member for Enfield North (Nick de Bois) and what he is going through with the Chase Farm downgrading, because in my area the Hartlepool accident and emergency facility is also being downgraded to an urgent treatment centre. That is a cause of consternation among the public.

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[Rosie Cooper]

Forgive me. I have a great propensity to do that. I believe passionately in the NHS and I take this all very personally. I apologise.

The Government’s policy will fundamentally damage the health service in terms of both the quality of care available to patients and the founding principles of the NHS. The more we debate Government health policy, the less the Secretary of State seems to be listening, whether to Opposition Members, medical professionals, patients, patient groups or constituents.

I might go further and say that I now believe the Secretary of State occupies a parallel universe—a universe where everyone wholeheartedly supports his policy and believes him when he says that there is real-terms growth in NHS spending, a universe where waiting times are not increasing, people are not being refused treatments, bed-blocking is not happening because of pressure on the social care system, a universe where he never discussed the issue of re-banding of nurses with the Royal College of Nursing.

Unfortunately, while the Secretary of State, ably supported by the Prime Minister, is off in that parallel universe, which we shall call delusional, the rest of us are left facing the terrifying reality of what the Government’s policy means to our constituents and to the national health service. We must disregard the rhetoric and the myth-making of the Conservative party as it seeks to demonstrate that it has changed when it comes to the NHS. Sadly for the health service, the Conservatives have not changed at all.

I have spoken repeatedly about the Prime Minister’s clear promises to the British people—one was that there would be no more pointless top-down reorganisation. He even said:

“When your family relies on the NHS all the time—day after day, night after night—you know how precious it is”.

How quickly those words were forgotten. Michael Portillo comments on the BBC’s “This Week” spoke volumes. He could not have made it clearer that the Government meant to misrepresent their position and mislead their voters. He said:

“They did not believe they could win if they told you what they were going to do.”

My fear is that their broken promises are leading us headlong into a broken NHS.

There is much I could say about how disgracefully the Government started to change NHS structures without the consent of the people or the House. Because of those broken promises, a failure to secure a clear mandate for the reforms from the British public, and an abject failure to secure support from the clinicians and the medical profession, we are left in the present mess. I hear time and again that the doctors, the nurses and the professionals are all behind the Government. Where are they? They are shouting loud and clear, “We’re not with you.”

[Henry Smith]

Will the hon. Lady give way?

[Rosie Cooper]

I fell for that last time and did not get to the end of what I had to say.

I will not go on about the rest of the problems that I see with the Bill—the financial challenge, the fact that we are open to European competition regulation, or the fact that the chair of the NHS Commissioning Board believes the Bill is unintelligible. I believe the Bill has been driven forward as an ideological exercise, rather than by an ideological desire to improve the quality of health care available.

Oral Answers to Questions

Henry Smith Excerpts

Tuesday 12th July 2011 Commons Chamber

[Mr Lansley]

I think that it has been conventional over many years for the calculation of real terms in public accounting to use the GDP deflator. Given that it includes the prices of investment goods, Government services and exports and subtracts the price of UK imports, it gives a more appropriate overall measure of inflation.

[Henry Smith (Crawley) (Con)]

Does my right hon. Friend welcome the increase in the NHS West Sussex budget of £35 million this year, which, coupled with the provisions of the Health and Social Care Bill, means that we will have far greater patient choice in our local area?

[Mr Lansley]

Yes, I do indeed welcome that. We all know that last year, this year and in future years, increases in the NHS budget in real terms will not be the kind of real-terms increases we saw in the past, but they will be real-terms increases. What we are already seeing in the NHS—we saw it last year—is that with a 2.2% increase in cash spending, there is none the less an ability to sustain, and in many respects improve, performance.

Oral Answers to Questions

Henry Smith Excerpts

Tuesday 7th June 2011 Commons Chamber

[Mr Burns]

Yes, I can tell the hon. Lady that it will be up to the SHA, the trust and officials at the Department—[Interruption.] The SHA is the strategic health authority in the north-west. It is for them to work together to produce a tripartite formal agreement—when agreed, it will be published for the local community to see—as the best way forward to seek solutions and to help trusts achieve foundation trust status. It is in their interest and the interest of patients to bring about improved, high-quality patient care.

[Henry Smith (Crawley) (Con)]

19. What steps he is taking to improve mental health services.

[The Minister of State, Department of Health (Paul Burstow)]

May I refer the hon. Gentleman to the answer that I gave to the hon. Member for Loughborough (Nicky Morgan)?

[Henry Smith]

I am grateful for the Minister’s answer to that earlier question. Will he explain more fully exactly how services for those with eating disorders can be enhanced, particularly in the Sussex Partnership NHS Foundation Trust area?

[Paul Burstow]

Yes, the National Institute for Health and Clinical Excellence will update its guidance on eating disorders later this year. The plans already set out in the Health and Social Care Bill mean that eating disorders will be subject to specialised commissioning in future by the NHS Commissioning Board. We believe that, because of the consolidated expertise in matching needs, this will help to drive up standards and enhance quality and consistency across the country. In the hon. Gentleman’s own patch, the assessment service run by Sussex Partnership NHS Foundation Trust is certainly an impressive one.

NHS Reorganisation

Henry Smith Excerpts

Wednesday 16th March 2011 Commons Chamber

[John Healey]

One of the problems—we all know this, and the new Government will be faced with it in exactly the same way—is exactly how to measure productivity in the NHS. Given the complexity of what is provided for patients—and the requirement to put together packages of care to help people recover from serious illness and live independently is so complex—it is hard to do that. The NHS just is not like a commercial business, which is what this Government want to turn it into.

[Henry Smith (Crawley) (Con)]

Let us consider something more quantifiable. Is the right hon. Gentleman in favour of more or less bureaucracy in the NHS?

[John Healey]

Let me send the hon. Gentleman a copy of the Labour manifesto, because we set out exactly how we could make significant savings from the bureaucracy.

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[Angela Smith (Penistone and Stocksbridge) (Lab)]

Thank you, Mr Speaker, for giving me the opportunity to take part in this important debate. Health is undoubtedly one of the most important areas of public policy, and one that the British people care about deeply. We on the Opposition Benches are very proud of our record on the NHS. It was Labour who created the NHS in 1947, and Labour who saved it from Tory destruction in 1997. Under the Labour Government there was significant real growth in the resources going into health care. NHS expenditure increased by more than two thirds over 13 years, with real-terms growth averaging around 5.5% per annum. Those high rates of investment led to improvements in hospital waiting times, life expectancy and health outcomes.

It is all too easy to forget what the NHS was like under the previous Tory Government. People waited for years for treatment such as hip replacements, and it was common for patients to spend hours in the cold corridors of old hospitals built in the 19th century while waiting for beds to become available. We changed that by building new hospitals and employing more doctors and nurses.

[Henry Smith]

Will the hon. Lady give way?

[Angela Smith]

I will give way once and no more, because I want other Members to have an opportunity to speak.

[Henry Smith]

I am interested to hear the tale of life in the NHS before the Labour Government and now, because under Labour my constituents lost hospital provision, including accident and emergency and maternity services. That was the Labour experience in Crawley.

[Angela Smith]

All I will say to the hon. Gentleman is that I worked in the NHS as one of the so-called bureaucrats in the Tory ’80s, and I remember having a patient crying to me over the phone, begging me to admit him so that he could have his eye taken out, because the Tory NHS was not providing the beds or the theatre space for such operations. We changed that by investing in the NHS so that life chances for many people could be improved. There is no doubt that there are people alive today who would not be so had that investment not been made.

Before the election, the Tories promised to protect the NHS with real-terms increases in spending. Let us get one thing straight: the 0.1% per annum increase that the coalition Government said they would provide does not equate to real increases in spending, because since then inflation rates have gone through the roof. There is no real-terms increase in spending, so one has to ask why the Government want to divert a further £2 billion from tight budgets into a top-down, ideologically driven reorganisation, especially when the coalition agreement specifically stated that the Government would not do that.

Furthermore, it is a reorganisation that no one wants—and that includes the Lib Dems, as we saw with last week’s vote in the great city of Sheffield. Just this week the BMA voted against the proposals, and many other health professionals think that they are dangerous and ill thought through. Without the support of anybody, it seems, the Government are intent on forcing through

“the biggest…upheaval in the health service, probably since its inception.”

Those are not my words but the words of Chris Ham, the chief executive of the King’s Fund.

I have a fundamental disagreement with the Secretary of State’s view that competition and free markets will drive innovation in the NHS, and that profit will motivate performance. I do agree, however, with my hon. Friend the Member for Kingston Upon Hull (East) (Karl Turner), when he says that the introduction of these reforms risks removing the N from NHS. No longer will we have a national service; instead, the system will be fragmented and the postcode lottery of service will become more and more prevalent.

The notion of “any willing provider” means that many NHS hospitals will be at a disadvantage compared with private providers, which will not have to provide a comprehensive service for complex problems. “Fine,” some might say, “if that brings costs down”—but what happens when hospitals and other treatment centres become insolvent and have to close down, leaving many areas of the country without adequate health care provision? Handing over £80 billion to GPs to commission services not only risks the important relationship between patient and doctor; it is extremely risky in itself, because of the lack of accountability.

If the plans are passed unaltered, GPs, through the quality premium bonus, will have a financial incentive to keep costs down and not to refer patients for diagnostic tests or treatment. As we found the last time the Tories tried to undertake such a scheme, they could also become unwilling to take on costly patients with chronic conditions. Those who need the most help could find it more and more difficult to get the treatment that they require.

Of deeper concern is the opaque nature of the consortiums. They will have to produce annual financial reports only for the national commissioning board, and they will not have to publish them. At the same time, every council in the country will have to publish every invoice over £500.

These health reforms have no mandate with the British people. They were in neither of the coalition parties’ manifestos, and even if NHS funding were not being cut, they would still run the clear risk of destabilising the service, because they hand over £80 billion of taxpayers’ money to private institutions, with insufficient safeguards in terms of accountability. The reforms are simply wrong. To allow any willing provider to deliver services risks the destruction of the NHS and a return to the dark days of the 1930s, when we had a two-tier system, with the state providing a minimum service and those who could afford to going private. That, too, would be plainly wrong, and something that the British people have consistently said they would not want.

It was pleasing to see the Lib Dem grass-roots vote against the policy last week, so I say to Lib Dem Members, “The ball is in your court. You can be on the right side of this argument, and your party can be on the right side of the British people, if you go through the Lobby tonight with us. The choice is yours. Flex your muscles and demonstrate that you are prepared to force the Government to revisit their plans by voting with Members on this side of the Chamber tonight.”

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[Helen Jones (Warrington North) (Lab)]

In the devastation that followed the second world war, this country had the courage and the vision to realise the dream of a health service available to all in times of need. If the Government’s plans go ahead, that dream will die. [Interruption.] Yes, it will. It is not simply that the reorganisation represents a broken promise, which it does, or that it is costly, although it is, but that it strikes at the very foundations of the NHS. Indeed, if it goes ahead, there will no longer be a national health service, but a vast postcode lottery, with treatment depending on where people live.

[Henry Smith]

Will the hon. Lady give way?

[Helen Jones]

I am sorry—I have not got time. [Interruption.] Other Members are waiting to speak and I will not give way.

The market, not the patient will be king. That is being done under the cloak of localism—the Government’s current buzz word. Remove the cloak and we will see the realities: an NHS driven by the market, run by a vast, unelected and unaccountable bureaucracy, with accountability to Parliament greatly reduced.

The Government plan to give all commissioning to GPs. They conveniently ignore the fact that if GPs wanted to be managers, they would have taken MBAs rather than medical degrees. They will bring in other companies—mostly private—to do the managing.

Hospice Care

Henry Smith Excerpts

Wednesday 2nd February 2011 Commons Chamber

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is a pleasure to have secured this debate on palliative care and the hospice movement, particularly at a time when the coalition Government are taking the Health and Social Care Bill through the House. It is a great opportunity to talk about this important area of medicine and care, particularly because I do not think that it is always given as much attention as it deserves.

Palliative and hospice care is something that all Members are aware of, because we all have constituents who are suffering with terminal or progressive illness and we all want them to die with the most dignity that can be provided, in the most comfortable and supportive surroundings, and we all want to ensure that their families are looked after holistically. That is why hospices are so valuable to all of us and to all our constituents.

Notably, the previous Government and the new coalition Government have paid a lot of attention to cancer care, but the hospice movement is about not just cancer but a raft of progressive and terminal illnesses, such as heart disease, lung disease, chronic obstructive pulmonary disease and motor neurone disease. The movement is not just for older people, either; it looks after younger people and, indeed, children with terminal illnesses.

[Henry Smith (Crawley) (Con)]

I am grateful to my hon. Friend for securing this important Adjournment debate. Last Friday I visited the Chestnut Tree House children’s hospice, which serves my constituents and those throughout Sussex, and its concern is that hospice at home and section 64 funding should not be lost in the health reforms. Does he agree that that is important?

[Dr Poulter]

My hon. Friend is absolutely right. He talks about a children’s hospice, but hospice care, and the valuable service that it provides to people with terminal and progressive illnesses, is particularly pertinent to adults. It is also important to children, however, because there is nothing more distressing than a very sick child whom we know is going to die.

I shall explain why we need to invest in hospices and palliative care. The UK population is ageing significantly, and we will have to look after a lot more people with more than one terminal and progressive illness. By 2033, the number of people aged 85 and over is projected to more than double to 3.3 million, and it is predicted that 8.7 million people will be 75 years or older. There is an ever-increasing strain on the palliative services that help to support people with co-morbidities, or several illnesses, and we need to recognise that and invest properly in those services. It is often through the hospice movement that such people are properly looked after and their families properly supported during the terminal illness.

Hospice charities have many concerns, because in the past the top level of government paid insufficient attention to the role that hospices play in easing the burden on the NHS, as well as in providing a vital service for local communities. We are of course in a time of economic belt-tightening, but given the Government’s investment in the big society, there is a unique case for supporting hospices and the valuable services that they provide, alongside their role as a provider of NHS services and a key provider of support for families in the community.

Health and Social Care Bill

Henry Smith Excerpts

Monday 31st January 2011 Commons Chamber

[Henry Smith (Crawley) (Con)]

Before I begin my remarks on the Bill, may I say how well the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) made her maiden speech? I suspect that we disagree quite fundamentally on the future of the NHS, but one thing that is true of her and of all right hon. and hon. Members is that we want the very best health care for our constituents; we just disagree on the path that we take to get there.

A fortnight ago, I was privileged to speak on Second Reading of the Localism Bill. The hon. Lady spoke of the desire to be radical, but the Localism Bill is a radical measure that proposes to give power over the future of communities back to the people. The Health and Social Care Bill is very much in concert with the Localism Bill—and legislation on policing that is yet to be introduced—in giving authority, choice and power over the important services that people receive back to them.

Right hon. and hon. Members know that when we engage our electorates, they always—rightly and understandably—express certain priorities such as the future of our communities and law and order. Consistently, people are concerned about the future of health care. Health care is one of those great levellers. It matters not what one’s background is: we are all equally adversely affected when we do not have the right sort of health care available locally. The measures outlined in the Bill go a long way to giving back to people control over that most important public service, on which all of us and our families without exception rely.

I have spoken on many occasions to local GPs in my constituency. They are enthusiastic about their GP consortium pathfinder status. Already, they are brimming with ideas on how they can improve the patient experience in my constituency, which is broadly to be welcomed. Indeed, I have been heartened by the fact that many of my local GPs are enthusiastic about the democratic accountability that the Bill allows. My local GP pathfinder consortium wishes to be a health and wellbeing partnership pilot, working with Crawley borough council—the immediate local authority—and West Sussex county council.

[Dr Poulter]

I had the pleasure of working at my hon. Friend’s local hospital at Crawley. When I was there, I saw the downgrading of that hospital by the PCT—it lost more and more services. What discussions has he had with his local GPs on how they will improve and enhance services at the local community hospital and generally?

[Henry Smith]

My hon. Friend is indeed legendary at Crawley hospital, and it is great to take part in this debate with him. Unlike him, I do not have a health background. My wife used to work in the NHS, but my background is as a local elected representative of my community and as a patient, and as someone whose family has had experience of the NHS.

I am afraid that I shared the bitter experience of many in Crawley during the 13 years in which the Labour party was in government. On 1 May 1997, when Labour took office, Crawley had an A and E department and a maternity unit. I am sorry to say that in 2001, Crawley hospital lost the maternity unit. At the time of a rather joyous occasion for my family, it was saddening that my children could not be born in our local hospital.

[Hugh Bayley]

The hon. Gentleman champions localism, but has he picked up that maternity services will be taken away from GP consortia under the Bill? Is that a good thing?

[Henry Smith]

I dispute that reading of the Bill. Maternity was taken away from my local community in 2001 and is now 10 miles up the road, in another county, and accessible only by single-carriageway roads, which is at best inconvenient, and at worst dangerous for patients.

The sorry tale goes on. In 2005, under Labour, Crawley hospital lost its A and E unit to East Surrey hospital—10 miles up the road, in another county—which has been seriously detrimental to my constituents, and something that they and I very much regret.

I was struck by many of the comments of my hon. Friend the Member for Wyre Forest (Mark Garnier), because he mentioned things very similar to our experiences in Crawley—and listening to other right hon. and hon. Members, there seem to have been similar experiences across the country as well. I can speak only from my local experience, but there was an eerie resonance in the sort of downgrading of services under the Labour Government.

[Geraint Davies]

Does the hon. Gentleman accept that what his community, like other communities, will face is a local monopoly—the GP consortia—that will focus on the most profitable lines of treatment, rather than on the best treatment? Surely this is not the right direction.

[Henry Smith]

I do not see how multiple providers is a definition of a monopoly. However, I must make progress in the short time left to me.

My constituents are pleased that for the first time in many years health decisions will be made in Crawley, rather than, as has happened up until now, on the south coast, in east Surrey or up in Whitehall, and that more decisions will be made by local people.

[Rosie Cooper]

Will the hon. Gentleman give way?

[Henry Smith]

I am sorry, but I have not got enough time.

I will support the measures in the Bill, as should all right hon. and hon. Members. However, I would like briefly to ask for clarification on two points from those on the Treasury Bench. First, hospices are greatly valued in our local area—on Friday, I was privileged to visit the Chestnut Tree House children’s hospital, which serves my constituency—so some clarity over future support for hospices would be greatly appreciated. Secondly, I would also like an assurance that the merry-go-round of failing managers in our acute sector will be addressed. I regret to say that on new year’s eve, at East Surrey hospital—the acute hospital for my constituency— 14 ambulances were queuing to get into accident and emergency. That is not good enough. It is another area of the sector that needs to be reformed.

Forgive me, Mr Speaker, because in the seven seconds I have left, I would like to report that there is well-being in Crawley today, because they are due to play at Old Trafford in about three weeks’ time.

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[Nick de Bois (Enfield North) (Con)]

I am very grateful for this opportunity to contribute to the debate. It is a great relief to note that we are now having a debate, having passed the stage where people, such as the previous Government, believed that pouring in more money improved outcomes. We are now debating reform, and we should welcome its scale, so that we can head towards what patients want—improved outcomes.

Whatever the good intentions of the previous Government, there is no question but that, unfortunately, their measures led to reduced productivity, a massive increase in bureaucracy and a distortion of clinical priorities, which meant that, on the outcomes that we seek, patients were not satisfied. I have been more concerned about health outcomes and the fact that patients were becoming remote from the thing that mattered to them most. That is what the NHS is about. Whom do patients trust? Do they trust a remote primary care trust or their local doctor? There really is no contest, so I welcome these reforms, because they will give commissioning powers to GPs and bring their patients closer to the decisions about their future.

I do not recognise the picture painted by Opposition Members who say that GPs do not welcome the proposals. Already more than half the country is working under the pathfinder shadow consortia, and in Enfield we are already rushing to sign up. We have agreed our consortium, which I warmly welcome. It is keen to seize the opportunity.

Let us turn to local accountability, which goes hand in hand with local commissioning-based services. In the past, it has proved impossible to have genuine local accountability as the NHS processes ultimately all led directly to Whitehall and the Secretary of State. I agree with the Nuffield Trust that the widening involvement of independent providers, the use of social enterprises and community services, and the increase in foundation trusts mean that local accountability mechanisms should indeed be robust.

The right hon. Member for Croydon North (Malcolm Wicks), who, sadly, is not in his place, and the hon. Member for West Lancashire (Rosie Cooper) expressed concerns that the mechanisms would not be robust, but I refer them to clause 170, on independent advocacy services, and to clause 175, which emphasises the scrutiny role of the local health authorities, not to mention the local representation of councillors. [Interruption.] The hon. Member for Leicester West (Liz Kendall) says, “One” from a sedentary position, but I shall not take lectures from a member of a party whose Government carried out no consultation as they tried to reconfigure services in Enfield against the wishes of the public. I shall turn to that now.

It makes no sense that the people who want to hold the health care community to account for their local services should have to go to an intransigent bureaucracy and ultimately up to the Secretary of State. That process is removed from where the local decision making takes place. As I said, in my constituency we are reaching a critical stage now in the future configuration of our acute hospital services. The decision prompted by the previous Government, to downgrade and rip out our vital A and E service and axe the consultant-led maternity services that see 3,000 births a year, is being relentlessly pursued by those same bureaucrats and officials from the health services, despite the fact that the decision will cost lives.

In ignoring the wishes of thousands who took to the streets and the view of the majority of Enfield GPs, those same PCT officials, even at this late hour, are effectively trying to bully the residents into accepting the changes without the consent or consultation of the people. No such arrogance would have been evident if this Bill had been in place. Local people would have been engaged in a genuine process of change because such a proposal would have had to have been agreed by the local health and wellbeing board. As the Secretary of State said yesterday morning, any possible future changes would have to be agreed in the health and wellbeing board of the local authority, which is publicly open and accountable. Gone is the “Whitehall knows best” attitude, to be replaced with local accountability, local engagement and local decision making.

Had the Bill been in place as law, I do not believe that we would have reached the 11th hour for this critical decision in Enfield. The four tests that the Secretary of State rightly requires would have kicked the issue into touch long ago because of genuine local accountability. The local authority, local GPs and, above all, local residents have spoken with one voice. I am grateful that we have a Secretary of State who believes in local accountability and decision making. In future, the voice that was ignored by the Labour party will be enshrined in this legislation. For years, we have suffered from a lack of local accountability in the health service.

[Henry Smith]

Had the Bill been law 10 years ago, Crawley hospital would not have lost accident and emergency and maternity services. It seems that my hon. Friend thinks the same about hospital services in his constituency.

[Mr Speaker]

Order. The hon. Member for Enfield North (Nick de Bois) is being generous in giving way, but I remind him that the Front-Bench winding-up speeches begin at 9.39 pm.

Swine Flu

Henry Smith Excerpts

Monday 10th January 2011 Commons Chamber

[Mr Lansley]

I announced just after Christmas the “catch it, bin it, kill it” campaign. I had not—[Interruption.] Let me explain to Opposition Members. In 2009, the campaign took place in November. Why? It was because the spread of flu took place in late October, early November. Therefore, it occurred at the point at which there was a substantial spread of the influenza in the community. That is precisely what we did this year.

[Henry Smith (Crawley) (Con)]

As an asthma sufferer, I am pleased to report that just this morning I had the benefit of the flu jab and it was professionally and painlessly administered. However, constituents have come to me concerned about, in one case, a child who has had the respiratory syncytial virus, or RSV and, in another case, an adult who has had pneumonia, who have been denied the flu vaccine. Will he examine how the guidance to GP practices can be amended to include such groups?

[Mr Lansley]

I will of course write to my hon. Friend about the nature of the advice provided by the joint committee, but we follow and have followed at each stage the advice given to us by that independent expert committee, the Joint Committee on Vaccination and Immunisation. I will certainly write to him to explain how it has determined the at-risk groups for these purposes.

Oral Answers to Questions

Henry Smith Excerpts

Tuesday 7th December 2010 Commons Chamber

[Paul Burstow]

Of course the money will be accountable to Parliament, as it is now. The hon. Lady’s comments reflect an interesting campaign that the Labour party has dreamed up, which is very much to ally itself with the interests of primary care trusts rather than those of patients and ensuring that we improve public services. This Government’s proposals will improve the way in which services are commissioned, deliver better outcomes for patients up and down the country, and deliver the integration across health and social care that the previous Government failed to deliver.

[Henry Smith (Crawley) (Con)]

3. What recent progress he has made on the introduction of GP-led commissioning consortiums.

[Mark Lancaster (Milton Keynes North) (Con)]

13. What recent progress he has made on the introduction of GP-led commissioning consortiums.

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

On 21 October, I invited general practice-led commissioning consortiums to put themselves forward as pathfinders, and I have been absolutely delighted by the response. The pathfinder consortiums will be announced shortly. They have formed in response to the needs of local communities, and there is, sensibly, variation around the country to take account of those differing needs. Some consortiums map on to local authority boundaries; others organise themselves around catchments for hospitals or smaller populations. This bottom-up, locally determined approach is exactly in line with what we envisaged in the policy framework.

[Henry Smith]

Under the previous Government, Crawley hospital saw the removal of services such as accident and emergency and maternity. Can my right hon. Friend explain how, under the new GP-led consortiums, doctors will have the freedom and the flexibility to be able to refer their patients to local services if they so choose, as well as to new services?

[Mr Lansley]

That is exactly what our reforms will allow. We are putting not only the freedom to refer in the hands of general practices but choice in the hands of patients, and allying that to the power on the part of commissioners to commission services that meet the needs of their local community. That is precisely the change that will empower front-line clinicians and patients.

Oral Answers to Questions

Henry Smith Excerpts

Tuesday 2nd November 2010 Commons Chamber

[Mr Burns]

May I begin by congratulating the hon. Lady on her elevation to this position? I know that in the past she has worked at the Department of Health, so her experience will no doubt help her Front-Bench colleagues who do not share such a background. However, she is factually wrong, although no doubt she will not be wrong in the future, because we have never said that there will be 500 consortiums. It will up to local decision making to determine how many consortiums there will be. The hon. Lady can believe what she reads in the newspapers, but if I were her I would wait to see what actually happens.

[Henry Smith (Crawley) (Con)]

8. What mechanisms he plans to put in place to provide for GP revalidation after the ending of primary care trusts.

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

The General Medical Council is responsible for the revalidation of doctors, rather than primary care trusts. In the current structures, subject to parliamentary approval, responsible officers in primary care trusts will make recommendations to the GMC on the fitness to practice of doctors in primary care. Before the dissolution of primary care trusts, we will consult on options for responsible officers in primary care.

[Henry Smith]

I am very grateful for that answer from my right hon. Friend. I welcome the commissioning role that GPs are to have. Does he believe, however, that there needs to be a distance between revalidation and local GP practices, and that that would best sit at a county or metropolitan borough level?