Health and Social Care Bill
Joan Ruddock Excerpts(12 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Tony Baldry
I will give way to the right hon. Lady in a moment.
Lord Wilson made it clear in his comments:
“Every day in government, Ministers consider policy issues and depend on the Civil Service for advice. Anyone who has been a Minister understands the private space in which civil servants give their best advice.” —[Official Report, House of Lords, 19 March 2012; Vol. 736, c. 643.]
It seems to me that this debate is really very much about a matter of principle: the relationship between civil servants and Ministers.
I understand the Opposition wishing to make some political points, but many of them, including the right hon. Lady to whom I am about to give way, have recently been Ministers, so I am sure they understand that point, and it does not behove the House, in its desire to make a political point, to seek to undermine a long-standing relationship between Ministers and officials.
Dame Joan Ruddock
Why therefore has the strategic health authority in London felt able to publish its risk register? There are 18 areas of risk, and those that were red are, after mitigation factors, still red, so we learn something very important. That is why we should have the risk register under discussion published.
Tony Baldry
I understand that point, but they are very different registers. The register to which the right hon. Lady refers is meant to be publicised. The two are of an entirely different nature, and that point has been explained to the House by my right hon. and hon. Friends on the Treasury Bench on a number of occasions.
We are discussing departmental risk registers and the advice that civil servants give to Ministers. All I am saying is that right hon. and hon. colleagues, before they vote, should at least take care to consider the advice of former heads of the civil service on the effect that publication would have on the relationship between civil servants and Ministers.
Dr Wollaston
I am not trying to trivialise the issue; believe me, I understand how vital the NHS is to all our constituents and to patients. My view is that the transition risk register has been elevated to a status far out of proportion to what it merits. I completely understand the points made by Lord Wilson and Lord Armstrong—very experienced civil servants who tell us that they would feel constrained in giving full and frank advice. However, we have seen how any detail can be taken out of all proportion in this House; we are all partly responsible for that. As I said, some of the shroud waving over this Bill has been disgraceful, and I know of patients who have been genuinely frightened by it. I would be prepared to see the risk register published, but I accept the point of my right hon. Friend the Member for Charnwood (Mr Dorrell) that it has to be done on the basis of a clear understanding.
Mr Lansley
The right hon. Gentleman knows perfectly well that in the debate on 22 February we made it clear that we felt that our appeal to the tribunal was justified, and indeed it was, because we won at appeal on the question of the publication of the strategic risk register. The Government’s objection and my objection to the publication of the risk register is precisely that risk registers are not written for publication. They are written in that safe space within which officials give advice to Ministers.
Mr Lansley
No.
Risk registers do not represent a balanced view. They are not a prediction of the future. They set out a worst-case scenario to challenge decision making. My hon. Friend the Member for Totnes (Dr Wollaston) captured the understanding of what a risk register is very well. The point is that we have looked precisely at the balanced view in the impact assessment, which captures where the risks and the benefits of the Bill lie. However, publication of the risk register, as my right hon. Friend the Member for Charnwood (Mr Dorrell) made perfectly clear, would prejudice the frankness and integrity of the decision-making processes of government and the Government are opposed to their publication.
As I mentioned, we won on appeal in relation to the strategic risk register, but not on the transition risk register. In the absence of the reasons for those decisions by the tribunal, and given the nature of the overlap between the strategic risk register and the transition risk register, I cannot comment further on that, or indeed on what our response will be to the tribunal’s decisions.
Health and Social Care Bill
Joan Ruddock Excerpts(12 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Lansley
We know that it is necessary for us to reform in order to deliver the improvements that the NHS needs, as well as the sustainability that it needs. We are not even speculating about this; we can demonstrate that it is happening. This is in contrast to what the right hon. Member for Leigh said. He said that he was not scaremongering, then he got up and did just that. He scaremongered all over again. He went to a completely different set of data on the four-hour A and E provision, for example. He went to the faulty monitoring data, which are completely different from the ones that we have always used in the past—namely, the hospital episodes statistics data, which demonstrate that we are continuing to meet the 95% target.
When we look across the range of NHS performance measures, we can see that we have improved performance while maintaining financial control. The monitoring data from the NHS make that absolutely clear, and that is in contrast to what happened when the right hon. Gentleman was a Minister in the Department, when Labour increased the NHS budget and lost financial control. That happened when the hon. Member for Leicester West (Liz Kendall) was a special adviser in the Department. Now, we have financial control across the NHS and we have the NHS in financial surplus.
Let me return to the Labour manifesto—[Interruption.] Labour Members do not like to hear this. It stated:
“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs.”
Yes—choice and any qualified provider are in the Labour manifesto. We are doing what Labour said should be done in its manifesto—and it is now opposing it.
Let us find out what it is that the right hon. Member for Leigh opposes in the Bill. I did not find that out in his speech; I heard generalised distortions, but I genuinely want to know. Let us take some examples. Is it the Secretary of State’s duty in clause 1 to promote a comprehensive health service free of charge, as now? No, he cannot possibly be against that. Is it that the Bill incorporates for the first time a duty on the Secretary of State to act to secure continuous improvement in quality—not just access to an NHS service, but putting quality at the heart of the NHS? Is he against that? No, surely not. Anyway, that approach began with Ara Darzi, and we have strengthened it.
Mr Lansley
The short answer to that is no. If one wishes to arrive at a place where the clinical commissioning groups have responsibility for budgets and proper accountability—including democratic accountability for what they do—legislation is required to get there. That is why we are putting legislation in place to make it happen.
Mr Dorrell
The right hon. Gentleman knows that there is room for more than one view about the extent to which there is a need to rewrite the full statutory basis of the Bill, but that is not the issue now. The question is how, if we went down his route, had a summit and talked for another 12 months about what the institutional structure of the health service should be, that would serve the policy objective that he seeks to espouse, of greater clinical engagement in commissioning. How would it serve the policy objective of which he says he is in favour, of engaging local authorities and the wider political community in decisions that shape the future of the health service?
One issue that the right hon. Gentleman did not mention in his speech is the shift of public health out of the relatively narrow interpretation that is implicit when it is located in the national health service. Instead, public health can properly be understood as being part of the wider range of local government. Those changes do not justify some of the more ambitious rhetoric being used in support of the Bill but they certainly do not come close to justifying the rhetoric being used against it. If half the things being said about the Bill by Opposition Members were true, I and most of my right hon. and hon. Friends, and certainly my right hon. Friend the Secretary of State, would not support it.
Dame Joan Ruddock
In answer to a recent parliamentary question I asked about waiting lists, Ministers told me that they had no information on waiting lists for private patients. How does the right hon. Gentleman think it will be possible for NHS patients to believe that their waiting times are consistent with their need for treatment when there are no figures to indicate what happens in the private sector?
Mr Dorrell
One of the effects of the Bill will be to integrate the private sector more fully in the delivery of public sector services in order to meet better standards for the national health service patient whose services are commissioned by the NHS commissioner. I should have thought the right hon. Lady would welcome the fact that there was greater opportunity for the national health service patient to enjoy the benefits that have previously been available on too exclusive a basis to the private sector patient. With a proper, open-minded commissioner, those benefits ought to be available, as the Blairite doctrine advocated when the Labour party believed in it, to all patients, including, pre-eminently, the vast majority of patients who rely on the national health service.
It is claimed by the Bill’s opponents that it is in favour of privatisation, but as my right hon. Friend the Secretary of State says, there is not a single provision in it that promotes privatisation. It is said to be a Bill that promotes fragmentation. The service already suffers too much fragmentation. The Bill writes into the law an obligation to deliver integrated, more collaborative, joined-up services. That addresses the problem that has been identified, which is attributed by its opponents to the Bill. It is said to be a Bill that promotes unbridled competition. That is absurd.
It is not only the shadow Secretary of State, the right hon. Member for Leigh, who can be quoted from the past. The hon. Member for Leicester West (Liz Kendall), who is seated alongside him, has said some very useful positive things in the past. I quote from the hon. Lady in 2010:
“I’ve always believed that there needs to be some competition and challenge in the system. . . I am also a strong champion of giving patients more voice and a greater say, not only over which hospital they go to but all aspects of their treatment and care.”
I am sure the hon. Lady was speaking on behalf of those on her Front Bench. The whole Labour party used to believe in that. We believe in that. That is what the Bill provides. It builds on the policy that the right hon. Gentleman used to believe in and used to advocate. He should have the courage of those convictions.
NHS Risk Register
Joan Ruddock Excerpts(12 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
I should like to tell the hon. Member for Finchley and Golders Green (Mike Freer) that it is hard to take seriously all the points that he made, as the strategic health authority in London has published a risk register. I want to devote my contribution to that issue.
That risk register lists 18 areas of risk. It describes the risks to the improvement programmes agreed by the strategic health authority, including London’s contribution to the Government’s £20 billion efficiency savings, and to the public health transition programme, in which some mitigating actions would be beyond the direct control of NHS London. It goes on to list the risks involved in the transition to the reorganisation that the Government plan for the NHS. It makes devastating reading. I shall highlight a few of the 18 risk areas. On the risk to the efficiency savings and improvement plans, it says that they
“may not be realised in full or are delayed, thereby undermining significant improvements in the health of Londoners.”
On the public health transition, which involves NHS public health staff dispersing into local government, it says:
“The consequence of this risk would be a negative impact on the leadership and structure of the public health workforce, and thereby delivery of public health services.”
On the abolition of primary care trusts next year, it says that the result
“may be poor, both in securing the best health outcomes for London’s population and in maximising value for money.”
In all cases, I am quoting directly from the reports.
Sajid Javid
We have heard from two former Labour Health Secretaries, both of whom refused to release the risk register. Does the right hon. Lady think that they made the right decision?
Dame Joan Ruddock
The decision that was made was about strategic health risks, and reference was made to things such as nuclear war, climate change and pandemics. We are talking about the transition, and we want to see a risk register on that. As my right hon. Friend the Member for Leigh (Andy Burnham) said, the London risk register goes on to describe risks to the safeguarding of children and maternity services as creating possible harm to patients. On patient safety and clinical quality, it concludes that the risks are such that the consequence
“could be poor or unsafe care for patients and loss of public confidence in healthcare in London.”
I understand the argument made by Members from all parts of the House that the point of a risk register is to enable mitigation measures to be applied to those risks. That is exactly what the London document does, but in half the risk areas the original red risk is still red after the mitigation measures are proposed. In all areas, the risks after mitigation are still amber. That is an extraordinarily serious matter of which we have to take account when we look at how the planned reorganisation will affect the health of Londoners and of my constituents.
How is it possible, I ask the Secretary of State, for staff already under pressure to deliver more with less, to carry on doing their job against the change programme that their strategic managers believe poses such risks? With so many issues raised by the London risk register, is it any wonder that the British Medical Association, the Chartered Society of Physiotherapy, the Royal College of Midwives and the Royal College of Nursing have all called on the Government to publish their risk register, which, as my right hon. Friend the Member for Leigh pointed out, relates specifically to the transition required by the Health and Social Care Bill and, presumably, the very changes already under way that are forcing people to wait longer and most definitely undermining confidence in the service?
In Lewisham alone, nearly £21,000 has been spent reorganising the PCT, and now the number of those patients waiting more than 18 weeks has gone up by 73%. How can that be the improvement of which the Secretary of State speaks? Even more worrying for my constituents are the difficulties faced at Guy’s and St Thomas’ foundation trust, where the latest available figures showed that over 20% of patients urgently referred by their GPs and subsequently treated for cancer in those hospitals waited more than two months for hospital admission. I tell the Secretary of State that if I had a diagnosis of cancer, I would be terrified of waiting more than two months to begin my treatment.
I do not blame the Guy’s and St Thomas’ foundation trust, where I myself have had excellent treatment in both hospitals, but I do blame this Government. I blame them for this top-down reorganisation that is already under way at a time of straitened financial circumstances.
I could not end without paying tribute to two of my constituents—Jos Bell and Dr Brian Fisher—who have mounted a superb local campaign, with thousands and thousands of people signing their petition. In 2010, the NHS was shown by the World Health Organisation to be the most efficient health service, and one of the best health services in the world. Patient satisfaction in that year was at its highest ever rating. We now face rising waiting lists; a fragmented service; a focus on finance, profit and private patients; and poorer health outcomes for those of us who cannot pay or who refuse to pay for private health insurance. The Secretary of State, I suggest, faces two challenges: he should either publish that risk register and let us make our own decisions or, frankly, he should just drop the Bill.
Oral Answers to Questions
Joan Ruddock Excerpts(12 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
Has the Minister seen an article today by the respected journalist Polly Toynbee—[Laughter.] Respected by the Prime Minister—[Hon. Members: “Stop laughing.”] I am not laughing at all—
Mr Speaker
Order. I want to hear the views of Polly Toynbee, as enunciated by Dame Joan.
Dame Joan Ruddock
On a very serious issue, a waiting list clerk of 17 years has just resigned because she was asked to adopt a range of devious methods to make sure that people coming up to the 18-week target for treatment were taken off lists. Does the Minister understand that patients will not always know whether they have had proper treatment, and that it will be far too late to refer them to an ombudsman at some later date?
Anne Milton
I thank the right hon. Lady for her question. I am devastated to say that I have not seen the article to which she refers, but I am sure that I will. The Department has made it very clear to the NHS that clinical priority is and remains the main determinant of when patients should be treated. When I was in opposition I made various visits to various hospitals and saw them fiddling around at the edges, with admin staff forced to do things that they did not want to do, in order to tick boxes for the previous Government.
NHS (Private Sector)
Joan Ruddock Excerpts(12 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Lansley
Let me explain to the hon. Gentleman. The average time that patients waited for in-patient elective procedures in the NHS according to the latest data was 8.4 weeks, which is exactly the same as at the time of the last general election. For out-patients it was 3.9 weeks, compared to 4.3 weeks at the election. For diagnostic tests, despite the fact that the NHS has performed 440,000 more diagnostic tests, the average waiting time is 1.8 weeks, the same as at the election. Long waits? The hon. Gentleman did not say that according to the latest data published the number of patients waiting more than a year for their treatment went down 40%, compared with what we inherited from the Government at the time of the last election.
The motion is all about Labour’s going back to the past. I am staggered. It is almost like revisiting Barbara Castle’s antipathy towards the private sector, or that of the right hon. Member for Holborn and St Pancras (Frank Dobson), the only former Labour Secretary of State now, even including himself, that the right hon. Member for Leigh seems to agree with.
I will ask the House to reject the motion, but in a way I am asking the House to reject those sentiments all over again, because we have been here before with this debate. Far from the House not having had an opportunity to consider issues including the private income cap, I remember having exactly this debate on Report. We were very clear about that. We discussed it when the White Paper was published, we discussed it when the Bill was debated on Second Reading, when it was in Committee and on Report, and it has been debated again in another place. I hope to use this opportunity to trample on some of the myths that the right hon. Member for Leigh and his friends are propagating about the Bill.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
I have received information from inside King’s College Hospital NHS Foundation Trust that priority is being given to private cancer patients in both diagnosis and treatment. Will the Secretary of State either confirm or deny that that is a fact?
Mr Lansley
If the right hon. Lady has any such evidence, she should give it to me. Let me explain that at the moment any individual member of NHS staff would be acting contrary to the NHS staff code of conduct if they saw a conflict between private sector and NHS activity and gave priority to private patients to the detriment of NHS patients. Technically speaking, under the legislation we inherited it is not explicitly unlawful for a foundation trust to do that but, as I explained to the right hon. Member for Leigh, a whole series of specific safeguards relating to the relationship between private and NHS activities was introduced into the Bill in another place. It makes it clear that the principal purpose of a foundation trust is to benefit NHS patients and NHS services. To do anything that is to the detriment of NHS patients will be unlawful. There are specific safeguards stating that foundation trusts cannot cross-subsidise between NHS activities and services and private services. If the right hon. Lady has information of a particular instance, she might as well give it to me.
Dame Joan Ruddock
I am grateful to the Secretary of State for giving way again. Does he not understand that a person who has this information is terrified of putting it into the public domain—[Interruption.] I am sorry, but he is wrong. We are talking about someone’s job and livelihood. I simply asked him whether this is correct or not. Does he know?
Mr Lansley
I have no knowledge of what the right hon. Lady describes. Let me remind her that those working in the NHS have a responsibility to disclose anything that that they think is to the detriment of their patients’ interests, and under legislation on public interest disclosure they have protection. I announced just before Christmas that in the latest contract for an enhanced advice line there should be a whistleblower advice line.
Oral Answers to Questions
Joan Ruddock Excerpts(12 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Anne Milton
I am certainly happy to meet my hon. Friend. I should point out that the Royal College of Obstetricians and Gynaecologists is updating its guidelines and that NICE is also developing guidance. The issue is complex, however, and even testing is not 100% effective. Women who produce a positive result during pregnancy might be negative during labour and, more importantly, those who are negative during pregnancy might be positive during labour. It is important that we get the most up-to-date evidence and ensure that we reduce the tragic consequences of this infection.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
I welcome the Minister’s statement, but may I urge her to consider carefully the kind of testing, as the false negatives and positives to which she refers come with the current testing and there are better tests? About 340 babies are affected every year of which one in 10 dies and one in five is permanently disabled. This is a very serious matter and I hope she will do all she can to deal with it.
Anne Milton
I will certainly do all I can to deal with it. As the right hon. Lady says, the consequences are tragic but this is a complex area that has changed quite rapidly. I think the US is now at a similar level of infection to us, but what remains a challenge is ensuring that we have an effective test that does not produce false positive or, more seriously, false negative results and that we have effective treatment that works in 100% of cases.
National Health Service
Joan Ruddock Excerpts(13 years ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Andy Burnham
Frankly, it is disgraceful that primary care trusts were allowed to disintegrate before Parliament had given its consent to those changes, leaving the NHS in limbo in most communities represented in the House. I have said that the Government have put the NHS in the danger zone, and I mean it. There is no capacity on the ground to help the NHS through these difficult times. It has lost the grip it would have needed to take us through the financial challenge, and I lay that charge directly at the Secretary of State’s door.
Andy Burnham
I will give way in a moment.
I mentioned that the Prime Minister is out of touch, and that he promised to recruit 3,000 more midwives and then handed out redundancy notices to them. However, if the Prime Minister is out of touch, I worry that the Secretary of State is in outright denial. On 11 October, when my hon. Friend the Member for West Lancashire (Rosie Cooper) asked him about the practice of hospitals re-grading or down-banding nursing posts to cut their costs, he replied:
“I am not aware—my colleagues may be—of…trusts…seeking to manage their costs by the downgrading of existing staff. If you are aware of that, then, by all means, tell us, but I was not aware.”
The very next day, that version of events was directly contradicted by Janet Davies of the Royal College of Nursing, who said that
“the Royal College of Nursing has raised the issue of downbanding with the Secretary of State on a number of occasions, alongside other concerns such as recruitment freezes and redundancies in the NHS…Our members’ survey released earlier this month also revealed that 7% of nurses expect to be downbanded in the next 12 months”.
If the Secretary of State would like to correct the evidence that he gave to the Select Committee on Health and confirm that he was aware of the practice of down-banding, he can be my guest right now.
Joan Ruddock
I am grateful to my right hon. Friend for giving way, because like the hon. Member for Banbury (Tony Baldry), I missed the opportunity to intervene when efficiency savings were being discussed. Does my right hon. Friend agree that the key to this problem is proper discussion with the experts within the health service—with the nurses, doctors and all the people who administer our fantastic service? They are the ones who can give us ideas for efficiency savings. The hallmark of the Government is their failure to listen to the professionals.
Andy Burnham
My right hon. Friend makes an important point. When we were in government, we said that there had to be a clinical case for change, if changes to hospital services were to be made. I mentioned Greater Manchester a moment ago. There was a clinical case to support those reforms. The experts, to which she rightly pointed, said that about 50 babies’ lives would be saved every year by specialising care in fewer locations. In such circumstances, politicians have a moral obligation to listen to those experts and to make changes, no matter how politically difficult they are. That is why I say that it was sheer opportunism of the worst kind for the Government, when in opposition, to say that they would have a moratorium on any changes and to tour those marginal constituencies promising to overturn decisions, when in fact they had no intention of doing so. I put it to the House that the people of Bury, Burnley and Enfield have now clearly discovered what opportunism there is from those on the Conservative Front Bench.
Mr Lansley
The second reason the House should reject the motion is that it fails to pay tribute to the hard-working staff of the NHS. I participated in many debates such as this when I was shadow Secretary of State and I thought that they provided an incredibly good opportunity for Members to raise issues relating to their own constituencies. I hope that that happens in this debate, as it is important. Every one of us has in our constituencies thousands of committed and hard-working NHS staff who want to know that we recognise it. I do not see any of that in the motion.
Mr Lansley
No, as I need to conclude my speech. [Interruption.] I am sure what the hon. Lady says is true.
The NHS in Wales is not cutting its budget because everything is going well. Labour Members are fond of citing waiting times, but the latest figures on waiting times show that in England 90.4% of admitted patients and 97.3% of non-admitted patients were referred to treatment within 18 weeks, whereas the figures for Wales are 67.6% and only 74% respectively.
Let me tell the House about infection rates. In 2007, the clostridium difficile mortality rates in England and Wales were similar—in fact, the rate was slightly higher in England. However, in the latest year for which figures are available there were 23.4 deaths per million for men and 23.5 deaths per million for women in England, whereas the figures for Wales were 54.9 deaths per million for men and 59.5 deaths per million for women, so the level in Wales is more than twice that in England. In four years, the gap has widened to the point where Wales has double the number of deaths from C. diff infections relative to England. Less money, less innovation and less good care is what has been happening in Wales under a Labour Government.
I must make it clear that we are going to put patients at the heart of the NHS. We are going to focus on the NHS delivering excellent care every time. Labour focused on the targets and the averages, and never got to the place of really caring about the specifics. A patient about to go into hospital for knee replacement surgery does not want to know about the national figure; they want to know about their hospital, their ward and what will happen to them. The same is true for mixed-sex accommodation. Labour turned a blind eye to variation in performance. We are going to open it up to clinical and public scrutiny, so that we can reward and celebrate achievement and excellence across the service, and shine a light on poor performance.
Joan Ruddock
Two weeks ago, I had an operation in Guy’s hospital. Because of possible complications, I had to ask my consultant directly, “Would you advise me to go ahead or not?” He advised me to do so, and I had complete trust in him. He was not thinking about whether he had to fulfil a quota, whether there was competitiveness in his hospital or his department, or whether a private patient would be preferred in the bed that I was to occupy. He was someone I could trust. In the health service that the Secretary of State proposes in his Bill, I could never have that confidence. I ask him please to abandon this Bill.
Mr Lansley
The right hon. Lady is simply wrong. There is nothing in the legislation that will do anything other than support clinicians to exercise their judgments in order to deliver the best care for their patients. It was under her Government, when people were told to pursue 18-week targets, that managers were literally walking in to speak to consultants who were about to do waiting lists and surgery lists and telling them that, because of the 18-week target, they had to treat a certain patient rather than another whose interests would mean that they would be seen first. So I will not take any lectures about that. We are going to put clinicians at the heart of delivering care and put patients at the heart of the service that is delivered.
The Labour motion does not reflect reality. It is based on a misleading set of interpretations and representations. Labour Members have a very short memory, but I am afraid that they have left us a shocking legacy. The motion contains no appreciation of the challenges the NHS faces, no appreciation of the care the NHS has provided to patients day in, day out over the past year, and no vision of how the NHS can be better in the future. Modernisation of the NHS will deliver an NHS that we can rely on for future generations, that is based on need, not ability to pay, and that is able to deliver the best outcomes for patients. I urge the House to reject the motion.
Joan Ruddock
My hon. Friend heard the Secretary of State’s responses to my questions. I know that my hon. Friend served on the Committee considering the Health and Social Care Bill. Will he confirm that competitiveness is still at the heart of that Bill and that the cap on private patients in the NHS is being removed from hospitals?
Grahame M. Morris
I am grateful for that intervention from my right hon. Friend and I should like to place on record, because the Secretary of State did not take the opportunity to do so, that the cap on private patient work, which had been set at 5%, is to be raised by the Bill. That must have a detrimental impact on the NHS in general, and on non-private patients, as resources are directed to the private sector and private patients.
Chris Skidmore
We are spending £1 billion more than we should on procurement because of the lack of consistency across the NHS, delivered principally by the previous Government. That is one area in which we could make vital savings. The NHS needs to change. Your boss, the Leader of the Opposition, said:
“To protect the NHS is to change it”
and we need to do so. The reforms that we are bringing in are essential if we are to deliver savings and also to ensure that the NHS survives when our ageing population means there will be twice as many 85-year-olds by 2030.
We need to reform the NHS and we do so in the spirit of what Tony Blair and new Labour put forward. Julian Le Grand, Tony Blair’s key adviser, said that the reforms were
“evolutionary, not revolutionary: a logical, sensible extension of those put in place by Tony Blair”.
When I asked him in the Health Committee whether this is what Blair would have done, he said: “Absolutely. Blair ‘would have tried’ to get these reforms through, but I imagine the left of his party may have prevented him from doing so.”
Joan Ruddock
How does the hon. Gentleman square his enthusiasm for all these reforms with the Prime Minister’s statement that there would be no top-down reforms of the NHS?
Chris Skidmore
We are introducing these reforms principally so that we put power back in the hands of GPs and, above all, patients. We are making these reforms because we have to. The status quo cannot remain—[Interruption.] If the right hon. Lady wants the NHS to continue as it is, fine. If the NHS is to be free at the point of delivery, it needs clinician-led commissioning. That is what we are going to achieve.
NHS Future Forum
Joan Ruddock Excerpts(13 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Lansley
My hon. Friend is absolutely right. We will legislate to stop precisely that distortion and that favouritism to the private sector. The private sector must know that it will have to provide additional services to the NHS on the basis of quality, not on the basis of any preferential system, as under the previous Government.
Joan Ruddock (Lewisham, Deptford) (Lab)
I remember that under the previous Conservative Government people died while on waiting lists. [Hon. Members: “Oh!”] It is a fact. I was a Member of Parliament at the time and it happened. Labour’s targets transformed that. The Secretary of State has been forced today to retake responsibility for the delivery of the NHS. He has talked about what has been happening. Will he make a specific promise today about the future waiting lists under his jurisdiction?
Mr Lansley
I will make clear to the right hon. Lady, as the Prime Minister has made clear, that we will not let waiting times rise. We will continue to maintain downward pressure, but it is very important that we do not treat waiting times in the NHS as the only measure of performance. It is more than that: it is the quality of care that is provided, not just the access to care.
NHS Reform
Joan Ruddock Excerpts(13 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Lansley
Yes, my hon. Friend is absolutely right. Locally, he can see how that is happening as GP leaders—including Dr Howard Stoate, whom Members will fondly remember, as the chair of the clinical cabinet in Bexley—are coming together to look at issues that the previous Government never dealt with, including those relating to the South London Healthcare NHS Trust and to Queen Mary’s hospital in Sidcup. They are coming forward with proposals to improve services for local people, and I applaud that kind of clinical leadership.
Joan Ruddock (Lewisham, Deptford) (Lab)
Before the general election, the right hon. Member for Witney (Mr Cameron) promised an extra 3,000 midwives. Has the Secretary of State noted the alarming rise in preventable maternal mortality? Would the Secretary of State not do better to deliver on his Prime Minister’s promises and abandon his reckless reorganisation?
Mr Lansley
The right hon. Lady must know that we continue to have a record number of midwives in training, and that the number of midwives in the health service has continued to increase since the election. In the financial year that is just starting, the number of commissions for training will continue to be at a record level.
NHS Reorganisation
Joan Ruddock Excerpts(13 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Lansley
In a moment.
Only yesterday, the Public Accounts Committee said that over the past 10 years the productivity of NHS hospitals had been in almost continuous decline, and that taxpayers were getting less for every pound invested in the NHS: Labour, leaving us to sort out the mess. The truth of the matter is that the NHS needs to change to meet the rising demand for and cost of health care.
The changes that the NHS needs are simple: more investment, less waste, power to front-line doctors, nurses and health professionals, and to put patients first.
Mr Lansley
No. I will give way to the right hon. Member for Lewisham, Deptford (Joan Ruddock) first.
Joan Ruddock
The right hon. Gentleman speaks of the respect that patients have for their GPs, and that is certainly the case in my area, where GPs do an incredibly difficult and demanding job. How does he think, therefore, patients and the doctors themselves regard the pressure being put on them to become managers, to adopt skills that they do not have, and being forced to do it, when they say to me that the plans are untested, potentially divisive and will take them away from their patients? Those things are actually happening. Does he think that it is ethical to pay GPs £300,000 to cut services to patients?
Mr Lansley
The Royal College of General Practitioners has said that it believes that there should be more clinician-led commissioning, and yesterday the British Medical Association reasserted its view that general practice-led commissioning is the right way forward. The Labour Government set up practice-based commissioning but, as the shadow Health Minister, the hon. Member for Leicester West (Liz Kendall), said, GPs were not given the power, responsibility and opportunity to do it. I am afraid that the right hon. Member for Lewisham, Deptford is speaking against the evidence and the experience of GPs all over the country.