Oral Answers to Questions

John Cryer Excerpts

Tuesday 21st October 2014 Commons Chamber

[Dr Poulter]

As my hon. Friend will be aware, when commissioning services, it is important that regard is given not only to competition because, under the 2012 Act, we have ensured that there must be regard to delivering an integrated and joined-up approach for local services. That is an issue for local commissioners to decide in the best interests of the patients they look after.

[John Cryer (Leyton and Wanstead) (Lab)]

Are not certain CCGs starting to merge decision-making processes, meaning that some important strategic decisions are removed even further from local communities and there is therefore a complete lack of accountability?

[Dr Poulter]

For some more specialist services, collaboration between various parts of the local NHS will always be needed. That is about good health care commissioning and ensuring that services are joined up in a collaborative way. Whereas day-to-day, bread-and-butter services will be commissioned by a local CCG, for more specialist services, clinical commissioners will of course need to work together to ensure that local centres of excellence are commissioned.

Wanstead Hospital

John Cryer Excerpts

Thursday 4th September 2014 Commons Chamber

[John Cryer (Leyton and Wanstead) (Lab)]

I wish to thank Mr Speaker for granting this debate on the closure of Wanstead hospital in Redbridge in north-east London in my constituency.

Wanstead hospital has not existed as a full general hospital since it closed in 1986. It is where my hon. Friend the Member for Ilford South (Mike Gapes) was born 62 years ago—it is his birthday today, so I wanted to mention it. Hon. Members will have noticed all the bunting hung outside to celebrate that event, and he is happy for me to point it out. What remains of Wanstead hospital are two intermediate care wards called Heronwood and Galleon. The care is usually provided to elderly people who have perhaps been ill or in hospital and are not well enough to go home, and they need intermediate care before they can return to their homes.

This issue affects not only the London borough of Redbridge but three London boroughs: Redbridge, Barking and Dagenham, and Havering. It stretches from the boundary of Redbridge in the west to the boundary between Havering and Essex in the east—a huge swathe of north-east London. The plan is to take the three boroughs, cut all the intermediate care beds—there are currently 104—and reduce them to 40 beds located at King George hospital in Ilford. Apart from anything else, that is six miles from Wanstead so it is a long way for people in my constituency, many of whom are elderly, to travel. The facility in Dagenham at Grays Court is being closed, and the biggest facility is Wanstead hospital, which has 48 intermediate care beds over the two wards. We have already lost 35 beds in St George’s hospital—not to be confused with King George hospital—which is in Hornchurch in Havering and is an old RAF hospital. Those beds were lost last year and the plan is now to concentrate all the intermediate care beds in one place in Ilford at King George hospital.

The ongoing consultation has been produced and launched by an obscure and unaccountable group led by chief officer Conor Burke and the chairman, Dr Mehta. This group is not a clinical commissioning group; it has an overall strategic planning role above the CCG. Conor Burke and Dr Mehta are accountable to a small board that is made up of representatives of the three CCGs from those boroughs—hardly a shining example of democratic accountability.

It is basically a deeply flawed consultation. I was told by Conor Burke and Dr Mehta on 13 June that they might possibly be engaging in a consultation that would lead eventually to the closure of what remains of Wanstead hospital and those two wards. They did not volunteer that information; they said that there might possibly be a consultation only because I asked what the future held for Wanstead hospital. They said not that it was closing at that point, but that there might be a consultation. I asked three times for an assurance—which I received—that I would be informed as soon as the decision to consult on the future of Wanstead and the other facilities was made. I was not told about that decision. I found out about it only on 18 July when I received a letter with a consultation document stating that the consultation was already under way. If they treat elected representatives like that, God knows how they treat members of the public. It calls their track record into question.

The consultation document has not been made widely available, and I receive e-mail after e-mail saying that it is difficult to get hold of it or access it online. It is not in the libraries, GP surgeries or community centres—at least not the ones that I or anybody I know frequent. The document sets out a series of options, and then states, “This is the option we want.” It is clearly pushing respondents in a particular direction. That is not a clear, fair or neutral consultation. They are saying, “We’ll set out a few options for you, but this is the one we want, and if you respond, we want you to support this option.” That is clearly what the consultation document says, as anyone will see, if they can actually get hold of it. Only a couple of hours ago, I received an e-mail from a constituent I know quite well who told me about her difficulty—she is an articulate, intelligent person—getting hold of the consultation document and then responding online.

Another great difficulty, and a point that has met with another rebuff, was the request to extend the consultation deadline. The consultation started in July and will end on 1 October, but there has been call after call to extend it until 31 October, because most of the current consultation period falls in the holidays and most people do not know it is happening. I have met scores of people in Wanstead and elsewhere, even people who have used the facilities, who do not know the consultation is up and running. One of the richest ironies of the process is that the newly elected health scrutiny committee on Redbridge council—all people elected on 22 May—clearly requested an extension to 31 October, but so far the health tsars in north-east London have said it is not necessary.

The plan put forward by the senior health managers was to create two teams. The community treatment team, which provides care in people’s own homes—I have nothing against that, but I think we need the intermediate care beds as well—is not available after 10 pm, and the intensive rehabilitation team stops at 8 pm. It is promised that the CTT will respond to any call within two hours, but if someone needs help at 3 o’clock in the morning, when both teams are off duty, they will need to call the out-of-hours service or the emergency services, which I think is inadequate for a lot of people in need of intermediate care.

Both teams are up and running and seem to have done a good job. The reaction from the public who have received their care has been very positive—I cannot dispute that. However, we now see a proposal to introduce massive changes to intermediate care across a huge swathe of north-east London, including three of the biggest London boroughs—Havering is the second-biggest and Redbridge is one of the biggest—based on very little evidence. There have been intermediate care beds at King George for only a year, and the beds lost at St George’s in Hornchurch were cut only last year, in 2013, yet we now face a huge cut in bed numbers and their concentration in a facility that has been run for only a year, with two relatively new community-based teams, both based at King George hospital. The system is just not tried and tested. In my view and that of most of the people I represent—in my experience—we are not in a position to say the system will work, yet those beds will be lost, and once beds are lost, they are rarely got back.

The health tsars tell me that the beds are not being used. I dispute that. For one thing, last winter, which was very mild, 75 out of the 104 intermediate care beds were used. That is a relatively low number, but, as I say, it was a mild winter. If this or next winter is very cold and harsh and intermediate care beds are needed, we will only have 40 located at King George, rather than what we used to have, which was three far more accessible facilities across the three boroughs. I am being told stories off the record—nobody has gone on the record—by NHS staff and constituents that people are being turned away from Wanstead hospital and sent to King George in Ilford in order, I can only imagine, to massage the figures. I am also told by doctors and nurses who work for the health service that it is quite difficult to get into Wanstead hospital. Again, that will bring down the bed occupancy figures, adding grist to the mill of the senior health managers who are keen on getting bed occupancy down, so that they have a perfect justification for closing Grays Court and Wanstead hospitals and putting 40 beds in the King George hospital.

The Minister will be acutely aware, I imagine, of the difficulties experienced by local hospitals, by which I mean general hospitals. Queen’s hospital in Romford has faced enormous difficulties, as I am sure she will be aware. Capacity at Queen’s was forced down because the Care Quality Commission felt that the hospital was not capable of dealing with the relevant number of people—particularly in maternity, but in other areas, too. Whipps Cross hospital in my constituency has also had significant problems, receiving a series of very critical reports from the CQC.

King George hospital, where the intermediate beds are planned to be located, has been under threat of closure for years. It is only because of the stalwart efforts of my hon. Friend the Member for Ilford South and others in campaigning to keep the hospital open that it is still there. It could close at some point in the future. Against that background, with all those problems in the acute trusts across north-east London, it seems to me that taking out all the intermediate care beds with huge cuts and putting in 40 beds in Ilford at the King George is, at best, a foolhardy decision.

Let me make one more point about the consultation—the lack of accountability. The whole process, in my view, has been deeply flawed. Perhaps the greatest talking point among my constituents is the pig-headed refusal to extend the deadline to the consultation until the end of October, which seems a fairly modest sort of request. The demand for it was overwhelming and the scrutiny committee elected on 22 May called for the extension, yet the senior health managers in north-east London seem absolutely determined to refuse that relatively modest request.

Why are these senior managers so unwilling to respond to public opinion? It is because they do not have to respond to public opinion. The two people responsible for this exercise were not elected. I am not saying that there was a glorious era when everybody running the NHS was elected—such an era never existed—but these two people were certainly not elected and they are not particularly accountable. If they are at all, it is to a fairly obscure board, indirectly appointed. That has resulted in a process that provides a pretty disgraceful example of sweeping aside the wishes of local people, local councillors and locally elected representatives, and saying, “We know best. If only all these daft people would leave us alone and let us get on with it, we can make all the decisions and run the health service efficiently.”

I do not say this as a party political point, but I do not think the national health service was set up for the convenience of well paid senior managers whose wages are paid by the taxpayers I represent. The NHS was set up by Nye Bevan after the second world war in order to provide care for everybody. In future, we should move to a position whereby the people who use the NHS and run it at the sharp end should be far more involved in decisions about how to provide care that will always be free at the point of need. There has to be a change. This exercise has brought home to me just how unaccountable so many senior NHS managers are. If they are unaccountable, they will not care what the people who use the facilities for which they are responsible think. Their lack of accountability has to change in the long term.

[Madam Deputy Speaker (Dame Dawn Primarolo)]

I call the Minister.

Oral Answers to Questions

John Cryer Excerpts

Tuesday 25th February 2014 Commons Chamber

[Jane Ellison]

We anticipate that we will be able to share the data collected with all appropriate Government Departments and partner organisations. On local education campaigns, I see no reason why requests to access the data would not be approved. We want to build a proper national picture of what is going on with FGM so that we can do all we can both to care for victims and to stamp out this abuse.

[John Cryer (Leyton and Wanstead) (Lab)]

On the issue of widening education, could the Minister encourage her colleagues at the Department for Education to write to schools to raise awareness of this abhorrent practice?

[Jane Ellison]

Fahma Mohamed, the brilliant young woman who has led the campaign on this, will meet the Education Secretary today and there is a lot of work under way across all Government Departments. There was recently a cross-Government declaration on the things that are going on to stamp out FGM and to care for its victims. The hon. Gentleman’s question is a matter for the Department for Education, but I assure him that the Government as a whole are hugely committed to wiping out FGM within a generation and to caring for its victims.

Oral Answers to Questions

John Cryer Excerpts

Tuesday 14th January 2014 Commons Chamber

[Mr Hunt]

I absolutely join my hon. Friend in congratulating Herefordshire Housing. One of the key things about people with dementia is that relatively small adjustments to their homes can make it possible for them to live at home healthily and happily for much longer under the care of a husband, wife or partner without having to go into residential care. Those are precious years that we should treasure and do everything we can to facilitate, so I am delighted that that is happening, and he will be pleased to know that, thanks to the Government’s initiative, it is happening all over the country.

[John Cryer (Leyton and Wanstead) (Lab)]

Figures from the House of Commons Library show that £1.8 billion has been cut from social care budgets since 2010. Does not that imply that delayed discharge among older people will be driven upwards because the finances are just not there to look after them?

[Mr Hunt]

I think the figures the hon. Gentleman is talking about are efficiencies and not actual cuts. [Laughter.] Well, Members should look at the figures carefully. If they are the figures from the Association of Directors of Adult Social Services, that is what they will find. If the hon. Gentleman looks more specifically at the figures related to delayed discharges, he will find that, year on year, the number attributable to the social care system went down by 50,000 bed days in the last year.

Oral Answers to Questions

John Cryer Excerpts

Tuesday 26th November 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

My hon. Friend may know that specialist NHS stoma nurses offer a range of support and advice to help patients adapt to life with a colostomy, and this advice can cover colostomy irrigation, if appropriate. This is supplemented with patient literature on colostomy, which is widely available in the NHS.

[John Cryer (Leyton and Wanstead) (Lab)]

Further to question 15, I understand that responsibility for walk-in centres has been devolved. Why does that necessarily prevent central Government from collecting those figures centrally? It is pretty staggering that a Minister should turn up and say, “Well, the decisions are made locally so we just don’t bother finding out.”

[Dr Poulter]

That is a question that the hon. Gentleman had much better address to his own Front Bench, who made the decisions to devolve these responsibilities locally. When it comes to commissioning health services, we believe it is down to doctors and nurses, who are now leading clinical commissioning on the front line, to determine which services are appropriate in local areas. There were clearly concerns about the way that urgent care centres had previously been commissioned. That is why so many of them are now being relocated and co-located in accident and emergency departments.

Oral Answers to Questions

John Cryer Excerpts

Tuesday 16th July 2013 Commons Chamber

[John Cryer (Leyton and Wanstead) (Lab)]

Further to the question from the hon. Member for Bristol North West (Charlotte Leslie), Ministers often—quite rightly—mention the importance of whistleblowers, so why have the Government weakened protection for whistleblowers through the Enterprise and Regulatory Reform Act 2013?

[Mr Jeremy Hunt]

We are strengthening protection for whistleblowers and are going much further by creating a culture of openness and transparency in the NHS, where people are not bullied if they speak out about poor care.

Oral Answers to Questions

John Cryer Excerpts

Tuesday 16th April 2013 Commons Chamber

[Dr Poulter]

Of course, I would be very happy to meet my hon. Friend to discuss this matter further. He can be reassured that I have regular discussions on these matters with representatives from the nursing profession, both in my clinical work and, more specifically, in my ministerial roles.

[John Cryer (Leyton and Wanstead) (Lab)]

The Secretary of State said earlier that 1 million extra people are attending A and Es annually, but a few minutes later he said that the figure was 4 million. Which one is it?

[Mr Hunt]

It is an additional 4 million since the disastrous changes to the GP contract and an additional 1 million since the last election.

Business of the House

John Cryer Excerpts

Thursday 6th September 2012 Commons Chamber

[Mr Lansley]

My hon. Friend makes important points. The coalition Government have put £180 million into the 16-to-19 bursary fund this year, to enable the most financially disadvantaged young people to participate in education. The most vulnerable young people receive, as a standard amount, £1,200 more than they would have received under EMA.

[John Cryer (Leyton and Wanstead) (Lab)]

May I welcome the dear Leader to his new Front-Bench post? I suspect he will be a very effective Leader of the House—probably more effective than the Prime Minister would strictly want. Is there any sign of a Bill to create a register of lobbyists, which we have been promised for over two years? The Prime Minister said this would be the next big scandal in British politics and he has been proved right. When will a Bill be on the statute book?

[Mr Lansley]

I am grateful to the hon. Gentleman. I never expected to be called “Leader”; to be called “dear Leader” was beyond my expectations.

At yesterday’s Cabinet Office questions, the Minister of State, Cabinet Office, my right hon. Friend the Member for West Dorset (Mr Letwin), explained the current situation and noted that there have been many responses to the consultation on this matter. They are being seriously considered and he will make a statement in due course.

Cigarette Packaging

John Cryer Excerpts

Tuesday 17th April 2012 Commons Chamber

[Anne Milton]

I shall say something about the illicit trade shortly, because it is an important issue. However, it should not be confused with the separate issue of plain packaging, which is also important and on which we are to consult.

In March last year, we published “Healthy lives, healthy people: a tobacco control plan for England”, which described how our programme of tobacco control would be delivered over the next five years within the framework of the new public health system. The tobacco control plan included a commitment to consult on options to reduce the promotional impact of tobacco packaging, including standardised packaging. There is strong, consistent evidence that the advertising and promotion of tobacco can influence young people in particular, from the first puff to full addiction.

I am pleased to say that yesterday we published a UK-wide consultation document, with the agreement of the devolved Administrations. The consultation will consider what measures could be taken to restrict or prohibit the use of logos, colours, brand images or promotional information on packaging other than brand and product names displayed in a standard colour and font style. At this stage, we have an open mind about the introduction of standardised packaging of tobacco products. We hope that the consultation will help us to establish whether there is evidence that it would have an additional public health benefit, over and above the existing tobacco control initiatives.

[John Cryer (Leyton and Wanstead) (Lab)]

I do not approach this issue with particularly strong views in either direction, but it occurs to me that if I were a counterfeiter, I would probably welcome the introduction of plain packaging. I know that that is a bit of a euphemism, but for want of a better term, I would welcome it, because I would find it easier to copy than other packaging.

It also concerns me that in the illicit trade some really nasty substances go into the cigarettes. Tobacco is bad enough, but the other substances that are added are even worse.

[Anne Milton]

I will come on to deal specifically with that point. Like the hon. Member for Coventry North West, I am sure that this will not be the last debate we have on this issue. It will be important to dispel some of the myths, and this week Cancer Research UK has put out a good piece of information that does so.

As I say, the Government have an open mind, and it is important that we hear everyone’s views. We will keep that open mind until the consultation closes. The consultation has four aims: to reduce the appeal of tobacco products to consumers; to increase the effectiveness of the health warnings; to reduce the ability of tobacco packaging to mislead consumers about the harmful effects of smoking; and to have a positive effect on smoking-related attitudes, beliefs, intentions and behaviours, particularly among young people and children. The consultation will be open from 16 April to 10 July, and I encourage all hon. Members, and any other person, business or organisation with an interest, to respond to it.

NHS (Public Satisfaction)

John Cryer Excerpts

Wednesday 30th March 2011 Westminster Hall

[John Cryer (Leyton and Wanstead) (Lab)]

I would like to thank the Speaker’s Office for selecting the subject of public satisfaction with the NHS for debate. I will focus on three pieces of research, and on the Government’s attempts to prevent information getting into the public domain, to prevent scrutiny of policy and to cut funding for future sources of information, all while failing to inform Parliament. The three surveys are “Public Perceptions of the NHS and Social Care” by Ipsos MORI from March 2010, the general lifestyle survey by the Office for National Statistics, and the British social attitudes survey by the National Centre for Social Research.

The first survey, “Public Perceptions of the NHS and Social Care” by Ipsos MORI, has been carried out every six months since 2000. It recently emerged that the latest results, from last year, were being withheld from the public domain. Ministers were accused of burying good news because the information clearly shows increasing levels of public satisfaction. On 22 March 2011, the Secretary of State was questioned about that by the Select Committee on Health, and particularly by my hon. Friend the Member for Walsall South (Valerie Vaz). The Secretary of State’s defence was that as previous surveys had not been released, he would not release the information from March 2010. The reality is that the previous data were only ever released following questions by the Opposition. From March 2007, the then Opposition stopped asking for the information, and we can only assume that that was because the level of public satisfaction was increasing, and it did not exactly serve their purpose to draw that information into the public domain.

[Mr Andrew Love (Edmonton) (Lab/Co-op)]

I want to emphasise what my hon. Friend says. I can recount a conversation I had with a local general practitioner, who told me that in the 1980s, a constituent of mine in need of a hip replacement came to see him. He could not get her a place anywhere within the health service. My constituency is deprived, and it was impossible for her or her family to get treatment privately, so she had to suffer in silence. That would not happen nowadays. My GP, who represents my constituents, told me that that has not happened to him since the early 1990s. Is that not the evidence we need to show that the health service has improved significantly in recent years?

[John Cryer]

I agree with my hon. Friend. I have had exactly the same experience. We were both elected in 1997, and when I became an MP, I regularly had people come to see me with orthopaedic problems who had been waiting for operations for two to two and a half years. Some of them were in serious pain and unable to work. In the past few years, the complaints I have been hearing are that people have not had an operation for four or six months. It is a completely different world.

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

May I put the hon. Gentleman out of his misery before we start the debate on a false premise? He is absolutely right: the previous Government did not publish the 2008, 2009 and 2010 surveys, to which he refers. It may be of interest to him to know that the 2010 report was published following a written answer by the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow) in December 2010, and placed in the Library.

[John Cryer]

If the Minister will calm down a bit, I will come to that. After the Secretary of State appeared before the Health Committee, it emerged that data until 2010 had been placed in the Library, and the results until December 2009 are on the Ipsos MORI website. I was granted this debate on 24 March and the data were released the following day, Friday 25 March, on the Department of Health website. Previously, the data had not been on the Department’s website. It might be a coincidence, but it struck me that that was a fairly good time to bury good news: it was the day before 500,000 people tramped through central London on the TUC march in opposition to the cuts. The fact that the data were not initially released is unsurprising, given that polling showed a 72% satisfaction rating. Ipsos MORI concluded in the report:

“This level of satisfaction has now been recorded for over a year…suggesting that there has been a…positive shift in the public’s perceptions of the NHS. Pride in the NHS also continues to climb and is at its highest recorded level”.

Pride in the NHS is at its highest ever recorded level—an interesting statistic. We might hear a comment from the Minister about that.

[Mr Love]

The report has some very good news about public attitudes to the NHS. Why would Government, who are in control of the NHS, not want to publish such a report?

[John Cryer]

I will leave that to the Minister to answer, because I have not finished my comments about the suppression of statistics.

My story does not end with the original survey on public perceptions of the NHS. The second of the three surveys is the general lifestyle survey, carried out every year by the ONS on behalf of Government Departments, but that has had its funding withdrawn by the NHS information centre, for reasons best known to the Government. However, Sir Michael Scholar, head of the UK Statistics Authority, has warned that the decision may break the Government’s rules on consultation. I should point out that the general lifestyle survey provides statistics on public health and does not involve NHS satisfaction rates. It produces figures, information and statistics for testing Government policy and holding Governments to account; it is important that the information be available for holding Ministers to account. If the decision to withhold funding for the general lifestyle survey stands, the information will not be available to us in future.

The Department of Health also intends to withdraw funding for health and NHS satisfaction questions in the British social attitudes survey. The survey will be familiar to many Members. It is carried out annually by the NCSR, which is a pretty respected body, both nationally and internationally. The withdrawal of funding was not announced to the House of Commons, but was leaked over the weekend to Health Policy Insight, which published an interesting editorial that condemned the decision to withdraw funding in fairly colourful language.

The British social attitudes survey charts how NHS satisfaction started at 55% in 1983, which was the year the first survey was published. That plummeted to 35% by the time the Conservative Government left office in 1997. The latest satisfaction rate is 64%, which, according to John Appleby from the King’s Fund, is the highest level of satisfaction since the survey began in 1983, and part of a continuous upward trend since 2002. He said:

“The NHS must have been doing something right to earn this extra satisfaction”.

There is also an interesting quote from the director of the Nuffield Trust, Jennifer Dixon:

“I suspect that public satisfaction will decline because the pressurised financial climate will result in staff unrest, cuts, and the spectre of rationing but also because of the relaxation of some of the process targets that the public hold dear, such as waiting times.”

She continued:

“To overload reform on top of that is the problem and to do both at the same time is very risky.”

I emphasise “very risky”.

The reason for killing off such research is fairly clear. The aim is to obscure the results of Government policies so that they cannot be exposed to the proper scrutiny that we all want, and to prevent comparisons with the records of previous Governments—Labour and Tory. If the information is not available, the records of previous Governments cannot be compared with the record of this Government.

There are a number of questions that I should like the Minister to answer. Will the “Public Perceptions of the NHS and Social Care” survey by Ipsos MORI continue to be funded and to be reported on? If it is not to be continued, will the research be replaced? The research is very detailed and heavyweight. I can provide it to the Minister, although I assume he already has it. I do not intend to imply that Ministers intend to cut funding for that research, but because of other decisions, we start to wonder whether that might be the conclusion.

The Government have decided, apparently without telling Parliament, to axe funding for two other crucial pieces of independent research: the British social attitudes survey, which I mentioned, and the general lifestyle survey, conducted by the ONS, which I also mentioned. Ministers have sneaked out the information that funding is to be cut in a fairly underhand way. Many Labour Members suspect that it is being done so that we cannot draw comparisons with previous Governments. The information will not be available to allow us to say, “Government policies were working but funding has been cut, which is having an effect on public perceptions and services.”

Public perception is crucial. My impression and that of piles of research is that public perceptions are improving and are at an all-time high, but that does not satisfy Ministers, who are engaging in the biggest reorganisation of the NHS since Nye Bevan created it in 1947. If information is in the public domain showing that the public are very happy with the NHS, particularly acute and GP treatments, it does not serve the purposes of a Government who are committed to the wholesale reorganisation of one of the most beloved institutions of British society. I look forward to what the Minister has to say.

[Several hon. Members]

rose—

--- Later in debate ---

[Tony Baldry]

I have not missed the point at all. The point being made by the hon. Member for Leyton and Wanstead is that nine out of 10 people are satisfied with their GPs, so somehow all is well with the NHS and nothing need change. If my hon. Friend the Member for Southport (John Pugh) had read the report of the Public Accounts Committee, chaired by the former Labour Minister of State, the right hon. Member for Barking (Margaret Hodge), he would know that it concludes that although the previous Government increased the amount of money going into the NHS that did not lead to greater outputs. The report makes sobering reading, and I am concerned that more parliamentary colleagues have not read it and that it has not received the attention in the House that it deserves.

[John Cryer]

The point effectively made by the hon. Member for Southport (John Pugh) is that satisfaction rates are not remaining level but climbing markedly. The British social attitudes survey shows that in 1983 satisfaction stood at 55% and plummeted to 35% in 1997. It is now up to 64%. According to Ipsos MORI, 90% of outpatients, 88% of inpatients and 81% of accident and emergency patients are satisfied—the highest levels ever recorded.

[Tony Baldry]

The hon. Gentleman, again, makes his own point in his own way. He says, and I understand him, that members of the public are satisfied with the NHS so nothing need change. I am not sure whether he has read the unanimous PAC report that was published only weeks ago, but I remind Members that it says:

“The level of hospital activity has not kept pace with the increased resources as hospitals focused on meeting national targets, but not on improving productivity, and productivity has actually fallen over the last decade…Though the increased money going into the NHS has helped to reduce waiting times, improve facilities, and deliver higher quality care, the Department promised at the same time to improve productivity. It failed and, in future, the Department needs to have a more explicit focus on improving hospital productivity if it is to deliver its ambitious savings targets without healthcare services suffering.”

[Tony Baldry]

I am sorry to hear the apologia of Opposition Members, who are confronted with concerns about what is happening in the NHS. I commend to the hon. Gentleman the National Audit Office report published on 17 December 2010, “Management of NHS hospital productivity”. The NAO has no difficulty in measuring NHS productivity, and neither does the PAC. Before Opposition Members jump up, they should remember that the Labour party left the NHS with a huge, unpaid overdraft of £60 billion. It is a staggering fact that of the £65 billion of hospital building works carried out in the 13 years of the Labour Government, only £5 billion was paid for. Despite a number of very generous private finance initiative projects, the NHS still has an overdraft and must pay for £60 billion of hospital building works. The previous Government, while they may have put more money into the NHS, saw no improvement in outcomes and have left the NHS with a substantial overdraft.

As the Chair of the Health Committee, my right hon. Friend the Member for Charnwood (Mr Dorrell), has observed, even if, as intended, the Government manage to ensure that spending on the NHS is ring-fenced and runs ahead of inflation, the NHS, in the next few years, has to become substantially more efficient in how it uses its assets, and treats and looks after patients—hence the need for reforms. Let us be clear. The reforms are about cutting bureaucracy and improving patient care and have been proposed by the coalition Government to improve the NHS and to ensure that we maintain public satisfaction and support for the NHS. We need to ensure that the Health and Social Care Bill, which is going through Parliament, delivers those reforms in the best possible way.

I have no doubt that Ministers will give proper attention to the report next week of the Health Committee and that, in due course, the Government will have regard to any constructive suggestions from the other place to ensure that the Bill is as clear and effective as possible. In any health system, however, difficult decisions have to be made about how one best utilises finite resources. However much money as a country we commit to the NHS, that money will be finite. Choices will have to be made about how that money is best spent: at one end of the spectrum, about whether and in what circumstances people get treated for varicose veins; and at the other end of the spectrum about when, and how often, major and significant, complex and expensive invasive surgery takes place. It seems to me that it makes extremely good sense for those decisions to be made in a collegiate manner, on behalf of their patients, by GPs. It seems to me to make very good sense to allow GPs, individually and collegiately, to make value judgments about the quality of services being provided by individual hospital providers for their patients.

As the hon. Member for Leyton and Wanstead made clear when introducing this debate, patients trust their GPs and I see no reason why we should not, collectively, trust GPs to commission the best available services in the NHS. Critics of the reforms have sought to present them as something that they are not. However, as the Prime Minister has made clear on a number of occasions:

“we have ruled out price competition in the NHS.”

He went gone on to make it clear that

“we must avoid cherry-picking by the private sector in the NHS.”—[Official Report, 16 March 2011; Vol. 525, c. 292.]

[John Cryer]

Will the hon. Gentleman give way?

[Tony Baldry]

I am happy to give way to the hon. Gentleman, but I would just make the observation that I suspect that quite a number of his colleagues wish to contribute to the debate, and that every time I allow an intervention it probably reduces the time that they have.

[John Cryer]

I am very grateful to the hon. Gentleman, both for giving way and for his valuable advice that I will hold dear to my heart.

May I just point out that, although the exposure to EU competition laws—he is referring indirectly to that—is not in the Bill, primary care trusts are officially regarded as state enterprises? As state enterprises, they are not exposed to EU competition law. The new consortia that will replace them, because they are not state enterprises, will be exposed to EU competition law, and will therefore expose the NHS, generally, to EU competition law. Does he support that?

[Tony Baldry]

Again, that is a slightly bizarre argument from the hon. Gentleman. There has been much talk about competition in the NHS, which is surprising as the Labour party appeared to be in favour of competition in its own election manifesto. The coalition Government have made it clear that the only competition that will exist in the NHS is competition on quality, not price. The Secretary of State could not have made that clearer in the House when he said:

“At the point when a patient exercises choice or a GP undertakes a referral, the price of providers will be the same. By extension, competition must be on the basis of quality.”—[Official Report, 16 March 2011; Vol. 525, c. 387.]

To deal with another misrepresentation, EU competition law already exists and the health reform proposals do nothing to change that. They do not, in any way, extend competition law. The Bill makes it absolutely clear that any competition can only be on quality, not on price. In any event, I find it strange that the Labour party and others suddenly seem to be coming forward to express concerns about the private sector in the NHS, when it was the previous Labour Government who, for example, in Banbury set up a privately run, privately managed, privately owned independent treatment centre and a privately managed, privately owned independent Darzi GP centre. The previous Labour Government, bizarrely, gave the private sector—because their contracting was so poor—some £250 million for operations that were never carried out. However, given that they have left the NHS with an overdraft of £60 billion, I suppose that they would consider £250 million thrown away on operations that were never actually carried out as, possibly by their standards, small change.

We have to realise, with an ageing population, more extensive treatments and new drugs becoming available, that we have to tackle bureaucracy in the NHS. We need to reform the NHS to make sure that it is as efficient and as effective as possible. We are ensuring that patients have choice—choice based on quality and from whom they receive care. There is simply no issue on this, in that the Labour Party said in its manifesto at the general election, and I am sure that the hon. Member for Leyton and Wanstead has read it:

“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality”.

We have made it absolutely clear, under the coalition Government, that the NHS will remain free at the point of need, paid for from general taxation, and be based entirely on need, not on the ability to pay. Those are fundamental principles of the NHS. They have been fundamental principles of the NHS ever since it came into being, and the coalition parties are, I am sure, determined not to undermine, in any way, any of the rights in the NHS constitution. Indeed, the coalition Government are seeking to protect the NHS, throughout the duration of the Parliament, by increasing NHS funding by £10.7 billion. A substantial number of GP groups, all over England, have volunteered as pathfinders to demonstrate how GP commissioning can work. GPs throughout Oxfordshire are coming together to form a suitable GP consortium.

Let me tell the House what is being said by those in my constituency who are involved in the GP consortium. Local GP Dr Judith Wright, who is co-ordinating the north Oxfordshire GPs, has said:

“Andrew Lansley’s proposals will give power to local GPs to decide how that budget should be spent to meet local health needs. Priorities will be decided by doctors through a process informed by patients, local authorities, public health and secondary care”.

Dr Wright went on to observe:

“I believe that GPs are best placed to be able to meet this challenge. Collectively they know the health needs of their local population. They can act as a catalyst for change. They will have a role in deciding the destination of local services and the route to get there.”

Andrew McHugh, who is the practice manager at Horsefair surgery in Banbury, observed:

“The health budget is a finite resource. Andrew Lansley’s proposals will give power to local GPs to decide how that budget is spent in order to meet local health needs. Priorities will be decided by doctors through a process informed by democratically accountable public and patient involvement. We need to be looking for innovative ways of spending the health budget wisely.”

In a recent issue of Prospect magazine, Ali Parsa pointed out that, as a nation:

“We used to spend 3 per cent of our GDP on healthcare in the 1980s…6 per cent in the 1990s, 9 per cent now and on our way to 12 per cent.”

In the current financial climate, that is unsustainable. Business as usual is not an option. We need to review what treatments are provided to ensure they are clinically effective and cost-effective—in other words, evidence-based practice. I think that Dr Judith Wright and Andrew McHugh’s comments are extremely balanced and sensible.