NHS Reorganisation

John Healey Excerpts

Wednesday 17th November 2010 Commons Chamber

[John Healey (Wentworth and Dearne) (Lab)]

I beg to move,

That this House believes that the Government is pursuing a reform agenda in health that represents an ideological gamble with successful services and has failed to honour the pledges made in the Coalition Agreement to provide real-terms increases each year to health funding; further believes that the Government is failing to honour its pledge in the Coalition Agreement by forcing the NHS in England through a high-cost, high-risk internal reorganisation as set out in the health White Paper; is concerned that the combination of a real cut to funding for NHS healthcare and the £3 billion reorganisation planned by the Secretary of State for Health will put the NHS under great pressure and that services to patients will suffer; supports the aims of increasing clinician involvement and improving patient care, but is concerned that the Government’s plans will lead to a less consistent, reliable and responsive health service for patients which is also more inefficient, secretive and fragmented; and calls on the Secretary of State for Health to listen to the warnings from patients’ groups, health professionals and NHS experts and to rethink and put the White Paper reforms on hold, so that in this period of financial constraint the efforts of all in the NHS can be dedicated to improving patient care and making sound efficiency savings that are reused for frontline NHS services.

The motion is set in similar terms to the motion standing in the name of my right hon. Friend the Member for Leigh (Andy Burnham), the shadow Education Secretary, which we will debate a little later. That is because in both health and education we are seeing many of the same broken funding promises, much of the same free market ideology, many of the same problems of big changes forced through without considering or caring about the consequences, and many of the same risks that the poorest and most vulnerable will lose out and that comprehensive, consistent public services will be broken up. Beyond the spending cuts, we are starting to see the pattern of what public service reform means in Tory terms.

The Prime Minister told Britain before the election:

“We are the only party committed to protecting NHS spending.”

In his coalition agreement with the Deputy Prime Minister, he went further, saying:

“We will guarantee that health spending increases in real terms in each year of…Parliament”.

The Government whom the Prime Minister leads are now breaking the promises that he made to the British people. The Secretary of State has been caught out double-counting £1 billion in the spending review as both money for the NHS and money to paper over the cracks in social care. Let me quote from a Library research paper, which confirms:

“Including the (social care) funding is critical to the description of the settlement as a ‘real terms increase’; without it, funding for the NHS falls by £500 million—0.54% in real terms.”

There we have it—the facts in the figures. There is no real-terms rise in NHS funding, but a real-terms cut over this Parliament by this Government—[Interruption.]

The Secretary of State says “Nonsense” from a sedentary position. If he wants to deny the figures in the Green Book, deny the report in the Library research paper, and take issue with the Nuffield Trust, who all say the same, he should do so. He should by all means take credit for funding social care, but he should not double-count the credit by including it for both NHS funding and social care funding.

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

I do indeed deny that. It is very simple. The total NHS budget will rise in real terms. Resource funding will rise by 1.3% in real terms over four years. Even if the money to be transferred to local authorities were taken out, that is an increase in resource funding for the NHS in real terms.

The right hon. Gentleman must consider that if a health service buys rehabilitation for patients returning home after being in hospital so that they do not need another emergency hospital admission, or puts telehealth in someone’s home so that their independence at home is maintained, that is health spending. It is the normal approach of the NHS to providing preventive services.

[John Healey]

There is a good case for more funding in social care, but the truth is, as Age UK says, that in this Parliament it will be cut by an average of 7% in real terms. Social care may help the health service, but if money is spent on social care, it is not spent on NHS services, and it cannot be double-counted as NHS funding. When that is taken into account, and when the Secretary of State stops fiddling the figures, we see that the country and the NHS will get a real-terms cut, not a real-terms rise during this Parliament.

[Mr Lansley]

I have a simple question for the right hon. Gentleman. Is he in favour of the budget that we announced for the NHS, and does he wish to spend more or less?

[John Healey]

My right hon. Friend the shadow Chancellor said in response to the Chancellor’s spending review:

“We support moves to ring-fence the”

NHS

“budget”.—[Official Report, 20 October 2010; Vol. 516, c. 968.]

People saw Labour’s big investment in the NHS bring big improvements—50,000 extra doctors, 98,000 more nurses, deaths from cancer and heart disease at an all-time recorded low, the number of patients waiting more than six months for operations in hospital down from more than 250,000 in 1997 to just 28 in February this year, and more than nine in 10 patients rating their experience of hospital care as good, very good or excellent.

[Mr John Baron (Basildon and Billericay) (Con)]

How does the right hon. Gentleman account for the fact that the UK is still floundering in the lower divisions of the international cancer league on survival rates?

[John Healey]

We still have a lot further to go. There have been big improvements in international comparisons, but we must go further. It beggars belief that the Government have decided not to press ahead with plans to give patients a guarantee of, for example, receiving test results within one week, especially as hon. Members on both sides of the House recognise the importance of early diagnosis for cancer, and the cancer specialist, Mike Richards, said that this contribution to early diagnosis could save 10,000 lives a year.

Instead of building on those great gains, I fear that the NHS will again go backwards under this Tory-led Government. It is already showing signs of strain. The number of patients waiting more than 13 weeks for diagnostic tests has trebled since last year, 27,000 front-line staff jobs are being cut, and two thirds of maternity wards are so short-staffed that the Royal College of Midwives says that mothers and babies cannot be properly cared for.

This is not what people expected when they heard the Prime Minister say that he would protect NHS funding. In fairness, a proper, long-term perspective is needed on NHS financing. Year-on-year funding just below or even 0.1% above inflation is way short of the 4% average increase that the NHS has had over its 60 years. During the last Labour decade, it averaged 7% in real terms.

There are, and have been for many years, built-in pressures on the NHS: the cost of staff, drugs and equipment rises by about 1.5% above general inflation, and the demands of our growing and ageing population adds £1 billion to the bill each year just to deliver the same services.

[Sarah Newton (Truro and Falmouth) (Con)]

It is interesting that the right hon. Gentleman omitted from his list any mention of the escalating costs of administration in the NHS. Does he agree with us that what is really important is to reduce the cost of administration?

[John Healey]

The hon. Lady is right, and there is plenty of scope to do that. We recognised that, and we had plans to take out many of the managerial costs. I will come to that later, but it is hard to understand how creating three or even four times as many GP consortiums doing the same job as primary care trusts is likely to reduce rather than increase bureaucracy in the NHS. My right hon. Friend the Member for Leigh says that in Wigan there is one PCT, but it is set to have six GP consortiums. The same job will be done six times over in the same area. How is that a cut, or an improvement in the bureaucratic overheads and costs of the NHS?

In the spending review, the NHS is set for the biggest efficiency squeeze ever. On 12 October, the NHS chief executive, David Nicholson, told the Health Committee:

“It is huge. You don’t need me to tell you that it has never been done before in the NHS context and we don’t think, when you look at health systems across the world, that anyone has quite done it on this scale before.”

Money is tight, and something must happen, but that can be done by building on Labour’s big improvements in the NHS over the last decade. It will be tough, but I will back the Government, as long as all savings are reused for better front-line services to patients.

[Mr Lansley]

Before the right hon. Gentleman continues, may I remind him that the “it” that Sir David Nicholson was talking about was the achievement of between £15 billion and £20 billion of efficiency savings, which is a substantial improvement in productivity that is expected over the next four years? That is in complete contrast with a Labour Government who had declining productivity over the whole of the last decade. The efficiency savings of £15 billion to £20 billion that Sir David was talking about were set out by the last Labour Government in late 2009. We are continuing with that, but we will make it happen, and Labour did not.

[John Healey]

I have read David Nicholson’s transcripts, and he was indeed talking about £15 billion to £20 billion of efficiency savings, which were not achieved, as the Secretary of State said, but planned. That is a big test for the NHS, and it will be more difficult because of his plans for reorganisation, which I will come to.

[Andrew George (St Ives) (LD)]

As I was at the evidence session, I can confirm that Sir David Nicholson was clearly talking about the challenging £15 billion to £20 billion savings, which I would have thought the whole House approved of and agreed should be achieved. But the right hon. Gentleman was right to say that Sir David was also talking about their being achieved in the context of the proposed changes in the White Paper.

[John Healey]

Of course Sir David was talking about the two together, because the Select Committee was understandably probing both matters. In the quote that I gave, he was talking about the significant efficiency savings required of the health service at this time of an unprecedented financial squeeze. Many would say that that is the toughest financial test in the NHS’s history.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will the right hon. Gentleman give way?

[John Healey]

Of course I will give way to the Chairman of the Health Committee.

[Mr Dorrell]

The right hon. Gentleman is right to say that Sir David was talking about the £15 billion to £20 billion efficiency challenge, and as my right hon. Friend the Secretary of State said, that programme has its roots in the time of the last Government. Will the right hon. Gentleman confirm that his party still supports the QIPP challenge—quality, improvement, productivity, prevention—that was first articulated when his right hon. Friend the Member for Leigh (Andy Burnham) was Secretary of State?

[John Healey]

If the right hon. Gentleman reads the official record, he will see I have just said that I will back plans to get the efficiency savings out of the NHS. They are needed and they have to happen, and I will back them as long as all the savings are reused for front-line services to patients.

Faced with the toughest test in its history, the least NHS patients and staff can expect is that the Government keep their funding promise. At this time of all times, the last thing the NHS needs is a big internal reorganisation. The Prime Minister ruled out such a reorganisation before the election, saying:

“With the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS”.

The right hon. Gentleman, now the Secretary of State, ruled it out, saying that the NHS

“needs no more top-down reorganisations”.

The coalition agreement was clear and reassuring on this point. In it, the Prime Minister and the Deputy Prime Minister pledged:

“We will stop the top-down reorganisations of the NHS that have got in the way of patient care”.

That was before the Secretary of State’s White Paper plans, which the head of the King’s Fund has called

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

Promise made in May, broken in July. Promise made by the Prime Minister, broken by the Secretary of State.

There is a story doing the rounds in the media of a journalist being briefed by No. 10, early on the morning of the publication of the White Paper, and told

“there’s nothing much new in it.”

When did the Secretary of State tell the Prime Minister that he was breaking his promise? When did he tell the Prime Minister that he was not only breaking the Government’s promise but forcing the NHS through the biggest reorganisation in its history, with a £3 billion bill attached, at a time when all efforts should be dedicated to achieving sound efficiencies and improving care for patients? This is high cost and high risk; it is untested and unnecessary.

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

The Public Accounts Committee has identified that improving integration and co-ordination of services for the 580,000 people who suffer from rheumatoid arthritis would deliver efficiency savings on the annual £560 million bill faced by the NHS each year for this care. The National Rheumatoid Arthritis Society believes, however, that the new commissioning responsibilities outlined in the White Paper

“risk increasing fragmentation in services”

and reducing savings overall. Does my right hon. Friend agree?

[John Healey]

In a way it does not matter whether I agree; it matters much more that the National Rheumatoid Arthritis Society and many other patients groups are deeply concerned about this.

It is not just patients groups but professional bodies and NHS experts who are worried. Even the GPs are not convinced, and they are meant to be the winners in all this. They are meant to be the ones planning, buying and managing the rest of the NHS’s services. A King’s Fund survey carried out last month found that fewer than one in four GPs believe that the plans will improve patient care, and only one in five believe that the NHS will be able to maintain the focus on efficiency at the same time.

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

In my constituency, we have been holding one-to-one dialogues with GPs, particularly about the White Paper, and I can tell the right hon. Gentleman with total confidence that well over 65% of the GPs I have met—it is only 65% because I have not managed to meet all of them—have endorsed the removal of the PCTs, from which they felt remote and disjointed and from which they felt they were getting poor value for money.

[John Healey]

If two thirds of the GPs the hon. Gentleman met are in favour, one third are obviously not convinced, but they will be forced to do this anyway. That is part of the problem, and I will come to that in a moment.

It is no wonder that the head of the NHS Confederation, the body that is there for those who run the NHS, told the Health Committee last month that

“there is a very, very significant risk associated with the project”.

Even the Secretary of State’s right-wing supporters in the Civitas think-tank tell him that he is wrong. They have said:

“The NHS is facing the most difficult…time in its history. Now is not the time for ripping up internal structures yet again on scant evidence”.

[Mr David Evennett (Bexleyheath and Crayford) (Con)]

I have been listening to the right hon. Gentleman with great interest. I know his moderate views on many things, but he misrepresented what my hon. Friend the Member for Enfield North (Nick de Bois) said about the numbers of GPs. Now that targets and top-down management—the centrepiece of the last Labour Government’s policies—are being discarded even by those on the right hon. Gentleman’s own Front Bench, does he not agree that giving significant freedoms to front-line professionals is a better way forward?

[John Healey]

Yes, of course; we had been doing that for some years before the election and we had plans to do it after the election, but the fact is that we did not win the election, and the Secretary of State is in power now. He is making the decisions and he is the one who is entrusted with the future of our NHS. He is the one who needs to answer to the House for his plans.

The problem with broken promises is worse than I have already suggested. The coalition agreement promised:

“The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs.”

The Secretary of State’s plans will do precisely the opposite. He is abolishing the PCTs, not building on the best of what they do.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

There is a great deal of talk about reducing bureaucracy and administration, but PCT staff work on issues such as NHS treatment for people with learning disabilities. Ministers have talked about that role continuing, but will those staff not be really worried about their futures now? They will be looking around, and if they see another job, they are not going to wait two years; they are going to jump now, and the PCTs will lose that expertise. It will drain away and the PCTs will be unable to carry out all those important residual functions.

[John Healey]

This is precisely why those who understand the health service, including those who run it, say that it is going to be so hard, at a time when the NHS has never faced such a tough financial challenge, to see through the biggest reorganisation in its history at breakneck speed.

Whether on funding, reorganisation or the role of the PCTs, the Secretary of State is doing precisely the opposite of what was set out in the coalition agreement. He is running a rogue Department with a freelance policy franchise, in isolation from his Government colleagues. He claimed on the “Today” programme yesterday that he had been saying all this for four years before the election. So when did he tell people, and when did he tell the Prime Minister, that GPs will be given £80 billion of taxpayers’ money—twice the budget of the Ministry of Defence—to spend? When did he tell people that, in place of 150 primary care trusts, there could be up to three times as many GP consortiums doing the same job? When did he tell people that GP consortiums will make decisions in secret and file accounts to the Government only at the end of the year?

When did the Secretary of State tell people, and the Prime Minister, that nurses, hospital consultants, midwives, physiotherapists and other NHS professionals will all be cut out of care commissioning decisions completely? And when did he tell the Prime Minister that hospitals will be allowed to go bust before being broken up, if a buyer can be found for them? When did he tell people that NHS patients will wait longer, while hospitals profit from no limit on their use of NHS beds and NHS staff for private patients? When did he tell people that lowest price will beat best care, because GPs will be forced to use any willing provider? When did he tell people that essential NHS services will be protected only by a competition regulator, similar to those for gas, water and electricity? And when did he say that he was creating a national health service that opens the door for big private health care companies to move in?

[Mr Lansley]

I am grateful to the right hon. Gentleman, who is generous in giving way. It is never an ideal thing to quote yourself, but let me risk doing so:

“We have been clear about the need for improvement in the NHS: responsive to patient choice; where budgets are in the hands of GPs; where hospitals are set free; where professionals are released from targets and bureaucracy; where the independent sector has a right to supply to the NHS; where competition delivers efficiency; and where patients have the assurance that NHS standards of care are based on the founding principle of the NHS—free at the point of use and not based on the ability to pay.”

I said that in a letter to The Daily Telegraph on 10 March 2006—four years ago.

[John Healey]

The real question is why the right hon. Gentleman, if he had these plans, did not tell the Prime Minister and the Deputy Prime Minister when they were writing the coalition agreement what he wanted to do on funding, on reorganisation and on the role of primary care trusts. Why did he allow his Government to make these pledges to the British public in May and then break their promises two months later in the White Paper? Whatever the boss of Tribal health care says about the private health care companies, he described the White Paper as

“the denationalisation of healthcare services”.

He went on to say that

“this white paper could result in the biggest transfer of employment out of the public sector since the significant reforms seen in the 1980s.”

This is not what people expected when they heard the Prime Minister tell the Conservative conference last month that the NHS would be protected.

[Andrew George]

It is incontrovertible that the White Paper contradicts the coalition agreement in respect of top-down reorganisation, but I think we would accept the right hon. Gentleman’s criticisms of top-down manipulation of local services a great deal more if he were prepared to accept that the previous Government failed in their attempt to reorganise through independent treatment centres or alternative providers of medical services which were massively expensive and did not necessarily provide better services on the ground. Will the right hon. Gentleman at least acknowledge that the previous Government failed in that regard?

[John Healey]

The treatment centres, which the hon. Gentleman mentions, helped contribute to bringing waiting times down to 18 weeks and helped to say to the British public, “Whatever treatment you need in hospital, you will not have to wait more than 18 weeks for it.” That was a consistent universal promise that we were able to make to patients as a guarantee for the future. That has now been ripped up, and we can see the result as waiting times and waiting lists lengthen. As I said at the start of my speech, my fear is that during this period of Tory leadership, we will see the NHS going backwards.

As for the hon. Member for St Ives (Andrew George), I understand his problem. He is a Liberal Democrat and I have to say that this health policy bears very little of the Liberal Democrat imprint. The one part of the Liberal health manifesto that they managed to get into the coalition agreement was this:

“We will ensure there is a stronger voice for patients locally through… elected individuals on the boards of their local primary care trust”.

Within two months, of course, that was not even worth the coalition agreement paper it was written on.

[Helen Jones (Warrington North) (Lab)]

Does my right hon. Friend agree that there is something else that the Government are not telling us—namely, the huge cost of getting rid of primary care trusts and strategic health authorities in respect of redundancy and getting out of broken contracts? Does he, like me, speculate that many of the people affected will end up working for GP consortiums or private health care firms—a huge cost to the public purse that delivers not one iota of front-line care?

[John Healey]

Quite so. Estimates of the cost of the reorganisation are up to £3 billion, but we have not had any cost announcements from this Government, who will not tell us how much is going to be spent on reorganisation rather than on patient care. At a time when finances are tight, this is precisely the wrong prescription for the NHS over the next few years.

It is no wonder that GPs have grave doubts—they trained as family doctors, not as accountants or procurement managers, and they are committed to treating patients, not doing deals over contracts. However, they will be forced to commission services, whether they like it or not; they will make rationing decisions, not just referral decisions for their patients; and they will have to take on the deficits or inbuilt funding shortfalls in their PCT areas. GPs spend an average of eight or nine minutes with each patient. If they plan, negotiate, manage and monitor commissioning contracts in future, they will have no time left to see patients. If they continue to be family doctors, commissioning will be done for them, not by them; it will be done in their name by many of the same PCT managers who presently do the job or by commercial companies that have already started hard-selling their services to GPs. The other day I picked up “The Essential Guide to GP Commissioning” helpfully published by United Health—one of the biggest US-based health care companies in the world.

[Dr Sarah Wollaston (Totnes) (Con)]

Does the right hon. Gentleman realise that not all GPs will have to be involved with commissioning? Does he welcome the efforts of the Royal College of General Practitioners to introduce real clinical leadership and tuition for those GPs interested in taking up commissioning, helping them to provide this service?

[John Healey]

It is a very good thing that the Royal College of General Practitioners is trying to bring the skills of many GPs up to speed because this is a big job for which GPs are not trained and not equipped, and which many do not want to do.

[David Tredinnick (Bosworth) (Con)]

Does the right hon. Gentleman recall that we had GP fundholders during the previous Conservative Government, and the doctors managed the budgets all right and increased choice for patients?

[John Healey]

The GP fundholding experiment took place in a completely different context—within an NHS that still had an area-based plan and still had bodies accountable through the Secretary of State to Parliament. In the end, however, it did not work and we stopped it.

[Andrew Percy (Brigg and Goole) (Con)]

Will the right hon. Gentleman accept that there is some kind of ideological disagreement going on in his own mind, given that the last Labour Government did exactly the same thing to head teachers by bringing alternative providers into schools and giving them control over budgets and what services to deliver? Our proposals for GPs are exactly the same—aiming to put in charge the professionals who deliver services and have contact with the people who use them.

[John Healey]

I thought the hon. Gentleman was in his place at the start of the debate. In that case, he will have heard me say that one reason for having an Opposition day debate on both health and education is that we see many of the same ideological fingerprints over the plans for education and for health. These are Tory ideological fingerprints, and I hope that this will become clearer as the debate progresses.

Let us make no mistake: if these changes go ahead, patients will rightly question whether GPs’ decisions are about the best treatment for them or about the best interest of the GP budget and consortium business. The public will find “commercial in confidence” stamped over many of the most important decisions taken about our NHS services. Members of Parliament wanting to hold Ministers to account in future when hospitals go bust, there are no contracted services for constituents or there is a serious failure in the system will be told, “It’s nothing to do with me”.

[Dr John Pugh (Southport) (LD)]

Was the right hon. Gentleman perfectly happy about the situation under the last Government? When anyone complained in this Chamber about anything happening in their local health economy, they were told rather piously by a Minister that it was a matter for local decision making by a quango that was completely unelected and beyond their control. In what sense were the PCTs in any sense accountable?

--- Later in debate ---

[John Healey]

Part of the problem is that there is so little detail in the White Paper that we simply cannot see how the bodies taking big decisions about taxpayers’ money will be accountable to the public. I lost count of the number of times during the last Government when Health Ministers came to this House and to Westminster Hall and had meetings with Members in order to respond to and sort out the problems that their constituents were experiencing with NHS services.

What the Secretary of State says he wants from the White Paper plan is to put patients first, to improve health care outcomes, to cut bureaucracy and to improve efficiency. These are “motherhood and apple pie” aims. We can support his aims, but we cannot support the action he is taking or the breakneck speed with which he is forcing these changes on the NHS. He wants shadow GP consortiums to be in place by April, and he will remove primary care trusts entirely two years after that. What he is doing is rushed and reckless. Almost every respondent to the White Paper has warned of the risks and said, “Slow down.”

[Rosie Cooper (West Lancashire) (Lab)]

Is my right hon. Friend aware that yesterday the Health Committee was told by health service organisations that some London PCTs would close by March 2011? Is anything happening in that regard? We know that there was a suggestion that PCTs would close in 2012, but we heard for the first time yesterday that they might close in 2011.

[John Healey]

I am very concerned if those plans are being speeded up rather than slowed down, because that would be entirely contrary to the view that has been consistently expressed by patients groups, experts in the NHS and professional bodies in response to the consultation on the White Paper. “Too far, too fast,” says the King’s Fund. According to the NHS Confederation:

“It will be exceptionally difficult to deliver major structural change and make £20 billion of efficiency savings at the same time.”

The Alzheimer’s Society says:

“The pace of structural change has the potential to undermine the progress made in services for people with dementia and their families, unless handled carefully”.

Almost every other group representing patients says the same. Even the chief executive of the NHS has written to the Secretary of State saying:

“Implementing the White Paper will require us to strike the right balance between developing early momentum for change and allowing enough time to properly test the new arrangements. Getting this balance right will be critical to maintaining quality and safety”.

[Mr Steve Brine (Winchester) (Con)]

I know that the right hon. Gentleman does not have a policy of his own, but the motion seems to be saying, “It’s all become a bit difficult, so let’s just put it off.” Until when exactly does he propose to put these changes off? Will they be made in the current Parliament, in the next Parliament, or 10 years down the line?

[John Healey]

The hon. Gentleman is new to the House, but he and his party are in government now. One of the frustrations for me and for other Labour Members is that his party is making the decisions, and is responsible for the future of the health service. Our plans would be different, but this is what the Government are planning.

The Secretary of State has received the responses that I have quoted. He has been advised to listen, to slow down, and not to risk the future of the NHS in his consultation. However, he is not listening. I hope that the Prime Minister is listening, for the sake of the NHS, its patients and staff, and for the sake of us all.

Here is a “thought for the day” for the Prime Minister. The Tories worked hard to be trusted by the public with the NHS before the election. The Government’s reckless big-bang reorganisation at a time of tough financial pressures in the NHS will wreck their reputation, but that is the Prime Minister’s problem. My problem is that he is set to wreck the great NHS gains made for patients over the last decade, and to wreck the founding principle of our NHS: that it should be available equally to all, free at the point of need, and properly funded through general taxation. We on the Labour side of the House will not allow him to do that.

I commend the motion to the House.

[Several hon. Members]

rose—

--- Later in debate ---

[John Healey]

If the Secretary of State—who, I concede, has a six-and-a-half-year head start on me in this job—really cared about NHS patients, really cared about NHS staff and really cared about NHS services, he would not be putting the NHS through the biggest reorganisation in its history, especially at this time. As I said earlier, it is patients groups and bodies representing NHS staff who are saying, “Slow down—think again.” I urge the Secretary of State to do that today, and to rethink.

[Mr Lansley]

The right hon. Gentleman has just taken to heart the old saying that the job of the Opposition is to oppose. That is all he is doing: he is simply opposing. Nothing in his motion states positively what should be done, whether that is supporting NHS staff or listening to patients and giving them the shared decision making opportunity that is so essential. While opposing the reforms that we in the coalition Government are introducing, he seems to have ignored the simple fact that those reforms, in truth, represent the coherent consistent working out, in practice, of policies that were initiated, but never properly implemented, by the Government of whom he was a member. They are not revolutionary, as he has called them.

--- Later in debate ---

[Mr Lansley]

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

I was talking about the principles of the White Paper.

[John Healey]

Will the Secretary of State give way?

[Mr Lansley]

In a moment; the right hon. Gentleman must allow me to make some progress.

I was talking about the principles of the White Paper. They are very clear. First, patients should be at the heart of the new national service, with a simple principle of “No decision about me without me” transforming the relationship between citizen and service.

Secondly, we will focus on outcomes, not processes. We will focus on outcomes that capture the entirety of patient care, and quality standards and indicators that genuinely reflect what a high-quality service should actually deliver. We will orientate the NHS towards focusing on what really matters to patients, not narrow processes. Thirdly, we will empower clinicians, freeing them from bureaucracy and centralised top-down controls, so that change is genuinely driven from the grass roots, rather than driven, top-down, from above.

The right hon. Gentleman’s speech did not appear to recognise that central principle at all when he talked about people in the NHS Confederation and the managers who run the NHS. Clinicians are already the people who actually do the commissioning: general practitioners make the referrals and write the prescriptions, and consultants in hospitals make referrals from one consultant to another. In effect, cost and commissioning in the NHS is already controlled by clinicians, but they are divorced from the processes of combining the management of patient care with the management of resources. Whether in this country or in others around the world, it is perfectly clear that that divide is what breaks health care systems. What makes health care systems more effective is bringing together the management of patient care with the management of commissioning and resources on behalf of patients.

[John Healey]

I wanted to intervene to discuss what my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) said about Great Ormond Street hospital. I have the official record of what was said at Health questions, to which the Secretary of State referred. He said that the proposal would have

“the overall effect of reducing Great Ormond Street’s total income by less than 2%.”—[Official Report, 2 November 2010; Vol. 517, c. 754.]

How does he reconcile that with the trust’s figures, which say that the reduction will not be less than 2%, but will be more than 5.5%? Would he like, therefore, to correct the official record now? Will he also publish the figures so that this House and Members who represent these areas can make up their own minds about whether those big stealth cuts to the hospitals that treat many of our most critically ill kids are a good idea?

[Mr Lansley]

No, I will not do those things, because what I said was accurate. The specialist children’s hospitals and ourselves are engaged in a constructive process of discussion about the future of the tariff for those hospitals and the top-up. Until a proposal is made there is no purpose in informing the House. We will inform the House as soon as we are in a position to say what the tariff for next year looks like.

--- Later in debate ---

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

This has been a revealing debate. Labour has come to the House today to make the case for the status quo—the case for standing still. Labour is here defending a failed status quo. We have heard Labour Members presenting to the House a number of extraordinary claims and grotesque caricatures of the Government’s plans. They want to defend a failed status quo in which the NHS has been spending at European levels but has been so tied up in red tape that it has not delivered European levels of quality health care.

For 13 years, Labour tested to destruction the idea that the NHS was best run from Whitehall. The record speaks for itself. My hon. Friend the Member for Basildon and Billericay (Mr Baron) talked about cancer survival rates, and it is nothing short of a scandal that cancer survival rates in this country lag so far behind the best in Europe. If the status quo is right, as Labour Members seem to be arguing, why are a staggering 23% of cancer patients diagnosed only when they turn up as emergencies? Why is that an acceptable outcome?

[John Healey]

The hon. Gentleman is right, of course; there is still more to do to improve health and to improve the NHS, but can I just check something? Did I hear him right? Did he say that the NHS had failed?

[Paul Burstow]

No, I said that the Opposition had failed and that they were defending a failed status quo. Let me give the House an example of a failed status quo. If the NHS were performing at the level of the best in Europe, 10,000 more lives could be saved every year. This is what our focus on outcomes is all about. It is what patient-reported outcomes are all about, too.

We all agree that elderly patients should be treated with dignity and compassion, yet for far too many, that is not what happens in practice. Just last week, a report on patient deaths found that 61% of older people received “inadequate” care in their final days. After 13 years of a Labour Government, the NHS is in the bottom third in Europe in dealing with dementia—way behind Ireland, Spain and Portugal.