Oral Answers to Questions
John Healey Excerpts(13 years, 1 month ago)
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Mr Lansley
Yes, I can. My right hon. Friend is absolutely right about that. Over the last year in hospitals in particular we saw what was approaching a 15% reduction in productivity. That is why we are proceeding with ensuring that across the NHS we recognise not only that there are increasing demands on the NHS, which is why we are increasing the NHS budget by £ll.5 billion over four years, but that that money must be used increasingly effectively to deliver efficiency savings in excess of 4% each year so that we can improve the quality of services for patients.
John Healey (Wentworth and Dearne) (Lab)
The Secretary of State spoke in glowing terms of the last year, but the last year has been a catalogue of confusion, incompetence and broken promises. So will he now accept that the Government’s massive mishandled NHS reorganisation is piling extra pressure on NHS services, with nearly £2 billion promised for patient care being wasted on the internal changes? Will he admit that it is patients who will suffer as front-line NHS staff lose their jobs, treatments are cut back and waiting times start to rise again under the Tories?
Mr Lansley
The right hon. Gentleman asked about performance last year. I told him what the financial performance was. Let me also make it clear that, for example, for hospital in-patients, referral to treatment waiting time has gone down from 8.4 weeks in May 2010 to 7.9 weeks in the latest figures in March, and for out-patients the figure has gone down from 4.3 weeks in May 2010 to 3.7 weeks in the latest figures, so waiting times have improved. We have established the cancer drugs fund, with more than 2,500 patients benefiting from that. We have published and driven down the number of breaches of the single sex accommodation rules: a 77% reduction in those breaches, which Labour never achieved. In the last year we have reduced the number of MRSA infections in hospitals by 22% and C. difficile infections by 15%. I applaud the NHS—
Mr Speaker
Order. I think we have got the thrust of it and are most grateful.
John Healey
The Secretary of State mentioned a lot of things, but I notice that he did not mention the Prime Minister’s five new guarantees. [Interruption.] The Secretary of State shakes his head as if they do not matter, but perhaps he was not consulted on them. People have seen the Prime Minister make and then break promises on the NHS before, but this time he is breaking his pledges as he is making them. The King’s Fund says that waiting times are going up and the Nuffield Trust says that health funding is being cut in real terms. Privatisation, the break-up of integrated care and the removal of national standards at the heart of the health service are exactly what his health Bill is designed to do. Is that not why MORI shows public concern about the NHS rising rapidly and why people are right to conclude that they cannot trust the Tories on the NHS?
Mr Lansley
My right hon. Friend the Prime Minister has made it very clear that we will not let waiting times rise and that we will improve performance in the NHS right across the board, which was what I was illustrating. I remind the right hon. Gentleman again that waiting times in hospitals are down from 8.4 weeks to 7.9 weeks for in-patients and from 4.3 weeks to 3.7 weeks for out-patients. That is what we are committed to. Chris Ham of the Kings Fund was on the “Today” programme this morning and said on waiting times, “There hasn’t been a great deal of change since the election.” What has changed since the election is that we are improving performance, driving down the number of breaches of the single-sex rules, increasing access to dentistry, cutting the number of managers and increasing the number of doctors. Those are the things we are doing in the NHS, and it is to the benefit of patients that we do.
Future of the NHS
John Healey Excerpts(13 years, 2 months ago)
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John Healey (Wentworth and Dearne) (Lab)
I beg to move,
That this House notes the growing concerns over the Government’s handling of the NHS and the effect its policies are having on hospitals and patient care; and calls on the Government to uphold the Coalition Agreement promise to stop the top-down reorganisations of the NHS which have got in the way of patient care, to use the present pause in the progress of the Health and Social Care Bill to make fundamental changes, including dropping the damaging and unjustified market-based approach, and to concentrate efforts instead on achieving sound efficiencies, better clinical quality and improved integration of services.
We have called this debate after the Prime Minister was forced to order an unprecedented pause in his health legislation last month. He was forced to do so because of the growing criticism, confusion and crisis of confidence over the Government’s NHS reorganisation. It was unprecedented because he told his Health Secretary to stop what he was doing while 45 others on the NHS Future Forum work out what he should be doing. It looks as though the Prime Minister is listening to anybody and everybody on the NHS except the Health Secretary.
We have called this debate after the Deputy Prime Minister’s flagship policy was sunk in the AV referendum last week. He is now trying to find a replacement, and claims that changes to the Health and Social Care Bill are his new No. 1 priority. The Deputy Prime Minister and his party are up to their necks in the Tory NHS plans. He and the Prime Minister co-signed the foreword to the White Paper last summer, and he signed off the NHS legislation in Cabinet before Christmas. He and his Lib Dem MPs have backed the Bill at every stage in Parliament. In Committee, his Lib Dem Health Minister led the rejection of Labour’s amendments—the amendments that he now says he wants to make.
Now that the Lib Dems are making many of the arguments that Labour has been making since early autumn, people may ask what the Deputy Prime Minister has been doing for the past year, when he changed his mind and why. People may suspect that the deal he is stitching together has more to do with saving his party than safeguarding the NHS.
Sajid Javid (Bromsgrove) (Con)
Will the right hon. Gentleman tell the House whether he still believes that the Government’s plans are “consistent, coherent and comprehensive”? If not, when did he change his mind?
John Healey
Indeed, they are comprehensive, consistent and coherent, and they are wrong.
Charlie Elphicke (Dover) (Con)
I thank the right hon. Gentleman for being so generous in taking interventions. He has told the House that the plans are wrong. However, in January 2010, he said to the King’s Fund:
“The general aims of reform are sound”.
It seems to me that he has changed his mind.
John Healey
There is nothing wrong with the general aims of the changes, but what the Government are doing is different from what they are saying. In one third of the legislation, they are not setting up GP consortia or reducing bureaucracy in the NHS, but setting up the NHS as a full-blown market. That is the wrong prescription for our NHS, and it is patients who will suffer.
Christopher Pincher (Tamworth) (Con)
The right hon. Gentleman seems to be suffering from amnesia, which, by the way, is treatable on the NHS. On 30 November, he said that he supported our proposals to move public health functions from primary care trusts to local authorities. If he does not believe in reorganisation any more, how does he intend to achieve that move?
John Healey
In principle, that is a good move. The Opposition, including those of us on the Front Bench, have said that it makes sense in principle to give local authorities a lead responsibility on public health; after all, they are responsible for things that affect public health such as housing, employment and a good environment. The Government’s failure is that local authorities are not getting the powers or resources to do the job properly. The provisions in the Bill will fragment the NHS and make it harder, not easier, for them to do that job.
Mr Dave Watts (St Helens North) (Lab)
Can my right hon. Friend explain why the Secretary of State says in public that the change is not about the privatisation of our hospitals, when in fact that is exactly what his officials are doing behind closed doors?
John Healey
My hon. Friend has been pressing that point with his local hospital, because it is quite clear that the hospital’s managers were forced to look at privatising it and having its management run by a private company. I fear that under the provisions of the Health and Social Care Bill, more hospitals will be driven to the brink and will have to face the prospect of insolvency or a takeover by the private sector companies that are lining up to make the most of the Government’s plans for the NHS.
Grahame M. Morris (Easington) (Lab)
On the transfer of responsibility for public health, can my right hon. Friend explain how withdrawing the funding for the public health observatories, which have informed health policy, will help improve public health?
John Healey
My hon. Friend gives good service on the Health Committee and follows the details of the matter more closely than most in the House. He has an important point, because the quality of health services for patients is inevitably affected by the deep and fast cuts in other areas. People in local authorities are experiencing difficulty in continuing to provide good social care, which is causing problems for the people who depend on that care and for the NHS.
Mr Stewart Jackson (Peterborough) (Con)
Does the right hon. Gentleman regret the policy of rigging the market in favour of independent sector treatment centres in the last Parliament, which some Conservative Members opposed? Does he agree with that policy?
John Healey
The independent sector treatment centres played a part in clearing the backlog and improving waiting lists. They introduced the extra capacity that allowed the Labour Government, through a combination of investment and reform, to achieve the highest levels of patient satisfaction with the NHS ever and the lowest waiting times ever.
Mr Kevan Jones (North Durham) (Lab)
My right hon. Friend will have seen the nauseating, sanctimonious and preaching sermons of the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) after the election results on Thursday. Does he understand why the right hon. Member for Wokingham (Mr Redwood) and others are concerned that the Liberal Democrats are going to scotch a policy that they have been signed up to from day one?
John Healey
My hon. Friend is absolutely right, and he makes the point that I have begun to make to the House. The Liberal Democrats have been up to their necks in this for the past year, and welcome though their late conversion is, the House is entitled to ask exactly why the Deputy Prime Minister now believes that radical changes to the Health and Social Care Bill are required.
John Healey
I am going to carry on and make a little progress.
If the Deputy Prime Minister is not going to sell out the principles of the NHS like he has the principles of his party, he must toughen the tests for the Bill and help stop the market free-for-all in the Government’s plans. If he and his party mean what they say, they can start today by backing us and backing the motion. It calls on the Government to drop
“the damaging and unjustified market-based approach”,
exactly as the Liberal Democrat spring conference did, and to
“uphold the Coalition Agreement promise to stop the top-down reorganisations of the NHS which have got in the way of patient care”.
There is no mandate for this, the biggest reorganisation in NHS history, either from the general election or from the coalition agreement.
Andrew George (St Ives) (LD)
If the right hon. Gentleman is concerned about consistency, he will know that since the publication of the White Paper last year, my concerns about the proposal have been well established. The motion, however, castigates top-down reorganisation. Will he apologise for the previous Government engaging in substantial top-down reorganisations time and time again, including the introduction of the independent sector treatment centres, which lost millions and millions of pounds of taxpayers’ money?
John Healey
Some of the reorganisations in the 13 years of our Government played an important part in the reform and the great gains that patients saw in the NHS. However, it is also the case—and we learn from this—that reorganisations often take longer, save less, cost more and have less impact on improving care for patients than envisaged at the outset. We learned that lesson towards the end of our 13 years, which is why we had a period of important stability in the NHS, but it is a lesson that the Conservatives have failed to learn—extraordinarily so, as we all thought that they had learned it, because NHS reorganisation is exactly what the Prime Minister promised not to do before the election.
The Prime Minister’s broken promise on NHS reorganisation is part of the reason for the growing doubt and distrust about whether he is making the right decisions for the right reasons on the NHS. He promised to give the NHS a real rise in funding, but the Budget this year confirmed a £1 billion shortfall in England. He promised to protect front-line services, but nursing posts are already going, and the Royal College of Nursing expects 40,000 NHS jobs to go in the next four years. The Prime Minister promised a moratorium on hospital A and E, and maternity service closures, but some are now going ahead, and more will follow—without public consultation—under the Health and Social Care Bill plans.
Miss Anne McIntosh (Thirsk and Malton) (Con)
I am following the shadow Minister extremely closely. The last Government opened a treatment centre in my old constituency, Vale of York. I am having great difficulty understanding what we are proposing to do, following what Labour did in York.
John Healey
Let me help the hon. Lady. For the first time, all parts of the NHS, including the commissioning job, will be opened up to private companies and subject to competition. As I have said, independent sector treatment centres played a part in our being able to clear long waiting lists and restore the quality of service to the NHS, as well as in supplementing the mainstream NHS, not substituting for it, which is what will happen under her party’s Bill.
The Minister of State, Department of Health (Mr Simon Burns)
Just for the sake of balance, will the right hon. Gentleman confirm that such treatment centres were also prime cherry-pickers and that between 2003 and 2009, the private sector was paid £250 million for not carrying out a single operation?
John Healey
The right hon. Gentleman will know from his current position that the premium that we paid in the first wave of treatment centres was stopped in the second wave. He will also know that by the end of our period in government we had stopped the independent treatment centres programme; and he ought to know that built into his Bill’s impact assessment is what it calculates to be a 14% premium, paid to providers under his proposals.
John Healey
It is in the impact assessment; I suggest that the right hon. Gentleman take a good look at it.
Mr Stephen Dorrell (Charnwood) (Con)
The right hon. Gentleman has just implied that the Government were proposing to introduce, for the first time, private sector expertise into the commissioning process of the health service. Will he correct that statement to the House by confirming that under the world-class commissioning programme, the previous Government explored exactly that proposal?
John Healey
No. What I am referring to is the provision in the Bill to allow the job of commissioning to be outsourced to private companies. That has never been done before. It is there in the Bill and it is a big risk for the future.
The Prime Minister made the NHS his most personal pledge before the election.
The Secretary of State for Health (Mr Andrew Lansley)
Will the right hon. Gentleman just be clear to the House and get it accurate? The Bill sets out that commissioning consortia are statutory bodies covering the whole of the country in the public sector. Therefore, if they use private sector commissioning expertise—which the Bill does not require them to do—that is not commissioning responsibility. In the two years leading up to the election, primary care trusts increased their use of management consultancy by 80%, so they did use the private sector, whereas commissioning consortia do not have to.
John Healey
The point about the Health Secretary’s legislation is that it allows consortia to outsource in whole the job of, not the responsibility for, commissioning. He made the point that the consortia are public bodies, but they meet none of the standards of public governance. They can meet in private. As the right hon. Member for Charnwood (Mr Dorrell) has said, that serious job should be done by properly constituted and governed public authorities, but that is a loophole in the Bill.
Clive Efford (Eltham) (Lab)
Like my right hon. Friend, I heard the Prime Minister and Deputy Prime Minister over the weekend say that there will be changes to the Bill. However, every Government Member who has intervened has defended the position in the Bill. Will we see changes as a result of pausing, listening and reflecting, or not? Will the Liberal Democrats have a spine tonight and vote with the Opposition to get changes to the Bill?
John Healey
My hon. Friend puts the position and the challenge, especially to the Lib Dems, very clearly. The challenge to Conservative Members is this: they must recognise that the Prime Minister made the NHS his most personal pledge before the election. People wanted to believe him, but in just one year the NHS has become his biggest broken promise. My hon. Friend mentions the pause. In our Opposition motion in March, we urged the Government to
“pause the progress of the legislation in order to re-think their plans”.—[Official Report, 16 March 2011; Vol. 525, c. 374.]
The Health Secretary dismissed that, but he has now been told to do so by the Prime Minister.
However, many of the signs point to the Prime Minister’s “pause to listen” being a sham. Just one week after the announcement, and in fact on the day that the Health Secretary received that historic vote of no confidence at the Royal College of Nursing, the NHS chief executive wrote to NHS managers to tell them that
“we need to continue to take reasonable steps to prepare for implementation and maintain momentum on the ground”.
The House is used to pre-legislative scrutiny, but not pre-legislative implementation.
Mr Ben Bradshaw (Exeter) (Lab)
My right hon. Friend is absolutely right. Do we not face the worst of both worlds? The Government appear to be saying that GP consortia should be voluntary rather than compulsory, but primary care trusts are being abolished, and in some cases have been already. If that pause is serious, the Government need to stop that dismantling of the NHS and go back to the drawing board.
John Healey
My right hon. Friend is absolutely right, and he draws on his experience as a former Health Minister. While implementation continues apace, there is a so-called pause in the legislation. His point is exactly the one made by the all-party, Tory-led Health Committee in a recent report. If the Prime Minister wants to prove to NHS patients and staff that his pause is not just spin, he must shelve the Bill and make radical changes to his NHS reorganisation plans.
Mr John Baron (Basildon and Billericay) (Con)
The shadow Secretary of State speaks as if no reform is needed. However, given that our cancer survival rates are well below the European average and that that costs thousands of lives in this country, does he accept that reform of how the NHS treats cancer patients is necessary?
John Healey
The hon. Gentleman has great expertise in, and commitment to, cancer care. He is right that our survival rates continue to lag behind those of parts of Europe, but I am sure he is aware that the rate of fall in deaths from cancer has accelerated in the past decade. On that basis, and with continued investment and reform, we have a chance of catching up to European levels. However, the reforms proposed in the Bill, as many cancer charities and those who represent patients testify, raise the concern that the great gains made by the cancer networks in integrating and co-ordinating services for cancer patients and sufferers will be put at risk.
John Healey
I am going to make progress now.
The NHS chief executive described the NHS reorganisation as
“enormous—beyond anything anybody from the public or private sector has witnessed”.
He is right. At this time of tight finances, the Government are piling on extra pressure and putting the NHS at risk with this reorganisation. The Health Committee warned in January that the NHS efficiency challenge was
“already a high-risk strategy and the White Paper increased the level of risk considerably”.
Now nearly £2 billion that was promised for patient care is being held back to cover the cost of reorganisation, and hospitals are being forced to cut back on costs by one third over the next five years, as all are forced into foundation status by 2014.
I was in Wigan this morning, where the chief executive of the hospital trust told me that the hospital must make £14 million in cost savings this year and similar amounts the following year. He described that as an almost impossible task. More importantly, however, it puts at risk the strategy for better services and better value for money, and the strategy for more integration of hospital and community services. He said of the Government’s plans that the sheer distraction of reorganisation and insistence on competition will scupper our chance of doing that.
The pressures of this high-risk reorganisation are one the reasons that, just one year into this Government, patients are starting to see the NHS go backwards again under the Tories, with waiting times rising, operations delayed, services cut back and front-line jobs lost. This is not just a problem with the timing or pace of change, however, and nor is it a problem of presentation. In fact, the closer people look at the plans, the more concerned they become, which is why there is growing criticism of the Tory plans for the NHS from doctors, nurses, patients’ groups, NHS experts, the Health Select Committee, peers in all parts of the House of Lords and now even the Lib Dem leader. The closer people look, the more fundamental and far-reaching they see these changes to be.
Today, the Royal College of General Practitioners warned the Prime Minister that his health Bill undermines our comprehensive health care system and will cause “irreparable damage” to the core values of the NHS. So far Ministers have branded such criticisms as scaremongering, but people in the NHS are already starting to see this happen. The Government’s first act was to remove national waiting time standards—the patients’ guarantee that they would be seen and treated quickly—which the Health Secretary described as “clinically unjustified targets”, but the patients do not see it that way, and nor do the surgeons. The president of the British Orthopaedic Association described the delays now being faced by patients as “devastating and cruel”.
The NHS Bill takes the break-up of our NHS still further. National Institute for Health and Clinical Excellence decisions on what drugs or treatments patients should have on the NHS become optional for commissioning consortia, and for the first time since 1948 the Secretary of State will not be responsible for delivering a national health service or for defining its scope. In future, the power to decide what health services will be provided free at the point of need—as now—and what further services will be charged for will rest with the new commissioning consortia. That was the basis of the concern expressed today by the Royal College of General Practitioners. These consortia will be able to meet and take decisions in private, and to outsource commissioning to private companies; but they will not even need to have a GP on their board—in fact, they will not need to have a board at all.
Nadhim Zahawi (Stratford-on-Avon) (Con)
The right hon. Gentleman mentioned the Royal College of General Practitioners. What does he think it makes of his policy, revealed in Pulse, to strip GPs of all financial responsibility?
John Healey
When the hon. Gentleman reads his next edition of Pulse, he will see my correction of that report, and note that the first five paragraphs were all reported and contained no quotes from me. He ought to know that after a survey by the British Medical Association found that more than half of doctors believed that they would spend less time with their patients as a result of these changes, the chairman of the BMA council, Dr Hamish Meldrum, said:
“This survey shows that the government can no longer claim widespread support among doctors as justification for these flawed policies.”
It is not the five clauses that set up the GP consortia that cause the most concern. It is the 85 clauses that set up the NHS as a full-scale market, and it is part 3 of the Bill, which opens up all areas of the NHS to private health companies; removes requirements for proper openness, scrutiny and accountability to the public and to Parliament; allows NHS hospitals to go bust and face a commercial insolvency scheme; places the judgment of the new competition regulator—just like those for gas and electricity—at the heart of decisions about the future of the NHS; and, for the first time, makes the NHS subject to the full force of UK and European competition law. That means that, in the long term, we will see clinical planning in the NHS being replaced by market competition, service integration being replaced by corporate cherry-picking, public accountability being replaced by commercial confidentiality and the public ethos at the very heart of our NHS being replaced by the profit motive.
I agree with the Deputy Prime Minister that no Bill is better than a bad one, but I say to him that this is a bad Bill. That is why we have opposed it from the outset, and that is why we say that it must be shelved in its current form and that radical changes must be made. For us, for the NHS and for NHS patients, this is the test of the Prime Minister’s promise to protect the NHS. I commend the motion to the House. [Interruption.]
Mr Speaker
Order. The Prime Minister’s Parliamentary Private Secretary should be setting a good example to others. I call the Secretary of State for Health.
Mr Lansley
Let me just make some progress. We need this modernisation for the NHS because of the challenges it faces in the future. We need to deliver £20 billion of efficiencies over the next four years. I remind the House that that requirement was set out originally under a Labour Government in 2009 without the merest hint of irony—I say that given that they created the inefficiencies in the first place. Today, I can give the House some figures that the Labour party would wish that people did not know. If Labour’s spending plans for the NHS at the last election had been implemented over this spending review period, the NHS budget would have been cut by £30 billion compared with what we have put into the NHS over the spending review period. So let the right hon. Member for Wentworth and Dearne get up now and explain: how was the NHS going to deal with £20 billion of efficiencies while he was cutting £30 billion out of it, instead of it getting the extra £11.5 billion it is getting from taxpayers through this coalition Government?
John Healey
After 20 minutes of the Health Secretary’s speech, the hon. Member for St Ives (Andrew George) finally brought him to his own plans and he was clearly very uncomfortable. What does he say when the Prime Minister wonders how he got the Government into such a mess over his plans? What does he think of the chair of Monitor’s observation that the approach being taken is a combination of
“previously unannounced policies, a complete failure to build the necessary political and professional consensus and an apparent disdain for the detailed planning of implementation”?
That was said by one of the Government’s allies.
Mr Lansley
I suppose the one thing the right hon. Gentleman has learned about being in opposition is that it is best for a party to try to forget everything that it did in government, because it will not be held to account for it. He has also recognised that the best thing is to have no ideas of his own. He does not even seem to know whether he agrees with our ideas or opposes them. We do not have any answers from him. The right hon. Gentleman’s quotation was from the former, not current, chair of Monitor, who knows perfectly well that these measures were in our respective manifestos and were brought together in the coalition agreement. They have a mandate. From my point of view, this is not just about the electoral mandate but about how we can deliver the best care for patients and see through principles that I thought the right hon. Gentleman’s party, as well as ours, believed were right.
Let me make it clear that the challenges in the NHS are about more than just clearing up Labour’s mess. We must recognise that there are now more pensioners than children under 16, alcohol-related admissions to hospital have doubled and emergency admissions have risen by 12% in just four years. Obesity in this country has doubled in the last 25 years. Under Labour, the demand for health care was rising while productivity was falling. The only way that Labour could cover those risks was by massively increasing the budget and that is no longer an option. Mounting pressure on the NHS is inevitable and the status quo, as Labour recognises, is not an option. The NHS needs modernisation.
Oral Answers to Questions
John Healey Excerpts(13 years, 2 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Lansley
Yes, I can tell my hon. Friend that the response to dementia is a key priority for this coalition Government. I think we have already demonstrated it in our commitment to dementia research. We need to improve both earlier diagnosis of dementia and the possibilities for treatment. We have demonstrated our commitment to improving standards in dementia care, both in hospitals and in care homes, and, indeed, in the further work we have done on reducing the use of anti-psychotic medicines.
John Healey (Wentworth and Dearne) (Lab)
How does the Health Secretary square the Prime Minister’s promise to pause in his changes to the NHS with the NHS chief executive saying a week later:
“I want to stress very firmly that we need…to maintain momentum on the ground.”
With the Government’s health Bill, are we not seeing both rushed pre-legislative implementation and confused post-legislative policy making? If the Prime Minister really gets cold feet about his NHS changes, let me ask the Health Secretary for a fourth time whether the Government will guarantee the extra time needed for this House to examine the changes fully?
Mr Lansley
Let me be clear about the right hon. Gentleman’s point. Both things are entirely compatible because there are 220 GP-led consortia that have come together as pathfinders to demonstrate how they can improve commissioning and the service to their patients; 90% of local authorities have come together in health and wellbeing boards; while at the same time, we have to deliver the challenge of improving productivity, quality and efficiency. All of that requires us, on the ground, to continue the momentum of improvement for patients. At the same time, we are listening not least to all those clinicians and members of the public who want to be sure that the Bill will provide them with the opportunities for involvement and the safeguards they are looking for in the NHS in the future.
John Healey
The Health Secretary ducked for the fourth time this afternoon the question of whether he will do right by this House in allowing sufficient time for proper scrutiny of any changes to the Bill that come forward. While he is listening, will he consider the risks he is running with the NHS? The Prime Minister promised a real rise in NHS funding, yet this year more than nine out of 10 hospitals are faced with cutting costs by more than 4%; one in seven by more than 8%; while nearly £2 billion for patient care is being held back to cover the costs of the internal NHS reorganisation. Will he admit that this reorganisation is now piling extra pressure on NHS funding and services so that patients are seeing waiting times rise, operations cancelled and front-line staff jobs cut as the NHS starts to go backwards again under the Tories?
Mr Lansley
I find the hon. Gentleman’s cheek astonishing. It was his party which, before the election, announced its intention of making up to £20 billion of efficiency savings, it was his party which told us after the election that the NHS should be cut, and it is his party which is actually cutting the NHS in Wales. It is the coalition Government who have made decisions that will give the NHS £2.9 billion—a 3% cash increase—and, because of the way in which we are tackling the costs of management, will put more people on the front line. Following the election, there are 3,500 fewer managers and 2,500 more doctors and nurses.
NHS Reform
John Healey Excerpts(13 years, 3 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Lansley
MRSA is at its lowest level since records began. We have helped more than 2,000 patients have access to new cancer drugs that would previously have been denied to them. All that is a testament to the excellent work of NHS staff up and down the country, and we thank them for their efforts to achieve these results for their patients. The coalition Government are increasing NHS funding by £11.5 billion over this Parliament, but the service cannot afford to waste any money. We can sustain and build on those improvements only by modernising the service to be ever more efficient and effective with taxpayers’ money.
The Bill is a once-in-a-generation opportunity to set the NHS on a sustainable course, building on the commitment and skills of the people who work for it. Our purpose is simple: to provide the best health care service anywhere in the world. I commend this statement to the House.
John Healey (Wentworth and Dearne) (Lab)
I thank the Secretary of State for Health for a copy of his statement shortly before he made it this afternoon. So Mr Speaker, in the middle of confusion, chaos and incompetence, the Prime Minister has pushed the Health Secretary out of the bunker to try and tell people what exactly and what on earth they are doing with the NHS. Why is the Health Secretary here and not the Prime Minister? After all, we have been told that the Prime Minister has taken charge and it was he who made his most personal pledge to protect the NHS and to stop top-down reorganisations that have got in the way of patient care. It is the Prime Minister who is now breaking his promises on the NHS.
Will the Health Secretary tell us why the Tories did not tell people before the election about the biggest reorganisation in NHS history? Why did they not tell the Lib Dems about the reorganisation before the coalition agreement was signed? Whatever the Government say or do now, there is no mandate—either from the election or the coalition agreement—for this reckless and ideological upheaval in the health service. In truth, the Health Secretary is here only because there is a growing crisis of confidence over the far-reaching changes that the Government are making to the NHS.
There is confusion at the heart of Government, with briefings and counter-briefings on all sides, and patients starting to see the NHS go backwards again under the Tories—with waiting times rising, front-line nursing staff cut and services cut back. Yet the Health Secretary has done nothing to restore public confidence in the Government’s handling of the NHS and nothing to convince people to back the Tories’ reorganisation plans. Everything he said today the Government were told about in the consultation—and they ignored it. Everything he said today the Government were told in Committee—and they rejected it.
This is not just a problem with the pace of change; simply doing the wrong thing more slowly is not the answer. It is not just a problem with presentation. In fact, the more people see the plans, the more concerned they become about them. That is why there is growing criticism of the Tories’ plans for the NHS—from doctors, nurses, patients’ groups, NHS experts, the Health Select Committee, the Lib Dems and peers of all parties in the House of Lords. I have to hand it to the Health Secretary: it takes a special talent to unite opposition from Norman Tebbit and MC NxtGen. That is why Labour has been saying that the reorganisation requires a root-and-branch rethink and that the legislation requires radical surgery.
There are fundamental flaws in what the Government are doing, not just in what they are saying. The test is whether the Prime Minister will now deal with these fundamental flaws. Will he radically safeguard commissioning to draw on the full range of NHS expertise, to prevent conflicts of interests, bonus payments to GPs and to guarantee that important decisions are taken in public not in private? Will he radically strengthen local accountability to the public and to patients? Will he delete the one third of the Bill that breaks up the NHS and makes it into a full-blown market ruled by the forces of market regulation and EU competition law? Will this be just a public relations exercise or will real changes be made in the NHS plans—or has the Prime Minister not yet told the Health Secretary? This is no way to run a Bill; this is no way to run a Government; this is no way to run the NHS.
Mr Lansley
We heard from the Leader of the Opposition earlier that the NHS needed to change, but once again we have heard nothing from Labour Members about how it needs to change. It is not unusual to hear nothing from them. They say that we need to tackle the deficit, but they will not say how. They say that we must change the NHS, but they will not say how.
Interestingly, in January the right hon. Member for Wentworth and Dearne (John Healey) said that he agreed with the aims of the Bill. He said that he supported a
“greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes”.
At the last election, his manifesto said that he wanted all NHS trusts to become foundation trusts. It said that he wanted patients to have access to every provider, be it private sector, voluntary sector or NHS-owned. Now we do not know what the Labour party’s policy is at all, but what I do know is that the Government will give leadership to the NHS, and that we will give the NHS a strategy enabling it to deliver improving results in future.
The right hon. Gentleman clearly wrote his response to the statement before reading it. In fact, we have made it clear that we will listen to what is said about precisely the issues on which people in the NHS and people who depend on the NHS are united. They know which issues are really important. They know that we must be clear about accountability, and that there must be transparency. Clinicians throughout the health service want to work together, and want the structure of the service to help them to work together so that they can deliver more holistic and joined-up services to patients. We want that, and they want that. We will back up our strategy with detail, but from the right hon. Gentleman we heard no strategy, no detail, and no answers whatsoever.
We are clear about the principles that we are pursuing through the reform and modernisation of the national health service. We are listening, and we are engaging with those principles. We are listening to the people in the health service who have come together to implement those principles, so that we can help them to do so effectively. Labour Members have not even listened to those who threw them out at the last election, because they are still wedded to the past and to a failed, top-down, centralised, bureaucratic approach.
NHS Reorganisation
John Healey Excerpts(13 years, 4 months ago)
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John Healey (Wentworth and Dearne) (Lab)
I beg to move,
That this House supports the founding principles of the National Health Service (NHS); therefore welcomes the improvements patients have seen in the NHS and supports steps further to ensure the NHS is genuinely centred on patients and carers, achieves quality and outcomes that are among the best in the world, refuses to tolerate unsafe care, involves clinicians in decision-making and enables healthcare providers to innovate, improves transparency and accountability, is more efficient and gives citizens greater say; recognises however that all of those policies and aspirations can be achieved without adopting the damaging and unjustified market-based reorganisation that is proposed, and already being implemented, by the Government; notes the strength of concerns being raised by independent experts, patient groups and professional bodies about the Government’s NHS reorganisation; further notes the similar concerns expressed by the Liberal Democrat Party spring conference; and therefore urges the Government to halt the implementation of the reorganisation and pause the progress of the legislation in order to re-think their plans and honour the Prime Minister’s promise to protect the NHS.
We have called this debate because of the growing crisis of confidence in the Government’s handling of the health service and the Conservatives’ NHS reorganisation, and a growing lack of confidence among independent experts, professional bodies and patients groups. Only one in four of the public back giving profit-making companies free access to the NHS, two thirds of doctors think the reorganisation will lead to worse, not better, patient services, and nearly nine in 10 believe it will lead to the fragmentation of services. When the Prime Minister misquotes me at Prime Minister’s Question Time in support of his plans, we know he is desperate and increasingly isolated.
John Healey
I will give way shortly.
Yesterday the British Medical Association delivered a comprehensive vote of no confidence in the Government’s plans. Dr Hamish Meldrum, the BMA chair, said they were
“driven by ideology rather than evidence, enshrined in ill-thought-through legislation and implemented in a rush during a major economic downturn.”
On Saturday the Lib Dems did the same. Baroness Williams called the plans “lousy” and a “stealth privatisation”. I heard that very good speech for myself at the conference in Sheffield, and I hope that today the House will hear speeches by the hon. Members for Southport (John Pugh) and for St Ives (Andrew George) similar to those that they made to their party conference on Saturday. I must also say to the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), that I hope that when he winds up this debate we do not hear the same flat and feeble apology that he gave for the Government’s plans when he opened the conference debate. He was totally rejected by his party, which told him and his parliamentary colleagues that the Health and Social Care Bill must be amended.
John Healey
I will give way in a moment.
The test for the Prime Minister is whether the Government’s proposals are always under review, as the Health Secretary said on Sunday, or whether this is not about significant changes to the policy, but about reassuring people as the Bill goes through the House, as people in the Department said on behalf of the Health Secretary on Monday.
Mark Pritchard (The Wrekin) (Con)
Does the right hon. Gentleman not accept that with an annual budget of £100 billion and rising, there is room for efficiency savings and reform? Why has he set his face against fundamental reform, which even the public accept needs to take place?
John Healey
Nobody can doubt our commitment to the NHS, and to both investment and reform, during our 13 years in office—often in the face of opposition from trade unions. Of course there is room for efficiencies, and there are ways to get much better value for money out of the NHS but, as the Select Committee on Health has said, the reforms will make it harder, not easier, to meet that challenge.
Rehman Chishti (Gillingham and Rainham) (Con)
Has the shadow Health Secretary seen the consultation responses to the White Paper, which show widespread support for the reforms?
John Healey
The hon. Gentleman needs to read some of the material for himself, rather than just reading the briefings provided by his Whips and his Front-Bench team. Some of the 52 organisations that this Government and the Health Secretary claim supported the Bill have written to me saying that far from supporting the principles of the Bill, they have “grave concerns” about the White Paper; that was said by the Patients Association. The Chartered Society of Physiotherapy has said:
“We have been very clear that we have grave concerns about the scope and speed of the structural changes proposed”.
Diabetes UK, Cancer Research UK, the Royal College of Speech and Language Therapists and others do not take kindly to being misrepresented by Ministers as supporting this Bill when they have such grave concerns.
Mr David Evennett (Bexleyheath and Crayford) (Con)
I always thought that the right hon. Gentleman was a reformer at heart, but he obviously is not, given what he is saying today. Why did productivity in our hospitals decline by 15% during the 13 years of the Labour Government, while bureaucracy increased?
John Healey
One of the problems—we all know this, and the new Government will be faced with it in exactly the same way—is exactly how to measure productivity in the NHS. Given the complexity of what is provided for patients—and the requirement to put together packages of care to help people recover from serious illness and live independently is so complex—it is hard to do that. The NHS just is not like a commercial business, which is what this Government want to turn it into.
Henry Smith (Crawley) (Con)
Let us consider something more quantifiable. Is the right hon. Gentleman in favour of more or less bureaucracy in the NHS?
John Healey
Let me send the hon. Gentleman a copy of the Labour manifesto, because we set out exactly how we could make significant savings from the bureaucracy.
John Healey
I am just responding to the hon. Gentleman’s colleague, so I ask him to be patient. We set out exactly how we could reduce the costs and some of the bureaucracy. Perhaps the hon. Member for Crawley (Henry Smith) could ask his Front-Bench colleagues how bureaucracy will be cut when the function currently carried out by 150 primary care trusts in England will be carried out instead by more than double that number of general practitioner consortia.
Grahame M. Morris (Easington) (Lab)
Perhaps the Secretary of State, too, would share his thoughts about how money will be saved on bureaucracy when expenditure on Monitor, which will take on a new economic regulator role under clause 52 of the Health and Social Care Bill, will increase from £21 million a year under Labour to as much as £140 million a year—£500 million over the course of a Parliament. How is that saving money on bureaucracy?
John Healey
My hon. Friend does a great job in ensuring that this Government are held to account on the NHS through the Health Committee. He rightly says that Monitor’s budget is currently about £20 million and the impact assessment calculates that that could increase to as much as nearly £140 million—although Monitor’s core operating costs are not that entire total, the figure will be at least three times as high as it is now. That is not a decrease in bureaucracy and operating costs, it is an increase. Hon. Members would do well to read some of the documents, rather than the briefings they have been given by their Front Benchers.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
My hon. Friend the Member for Easington (Grahame M. Morris) has told us that Monitor’s budget will increase by the amount that he said, but does my right hon. Friend agree that it will continue to increase exponentially, because the Government are opening up the NHS to European competition law, and that competition will grow exponentially year on year?
John Healey
This is such a big and fundamental change to the NHS that £140 million is the best guess. Clearly, as the competition role of Monitor increases and the competition legislation it has to deal with becomes stronger, those costs could increase. We simply do not know, because this is a leap in the dark for the NHS.
Simon Hughes (Bermondsey and Old Southwark) (LD)
Having listened to the debate at our party conference on Saturday, the right hon. Gentleman will know that there were strong views that the Bill needed to be further improved and strengthened, but he will also know that there was no call for it to be pulled or paused. He will also remember that when his party and my party joined together to form the NHS, the doctors were not always on the side of the enlightened.
John Healey
The Liberal Democrats are quick to try to claim credit for other people’s successes, and quick to try to duck responsibility for some of the difficult challenges they face. However, the right hon. Gentleman is right—it was the BMA that called yesterday for the Bill to be withdrawn. Our motion calls not for it to be withdrawn but for a pause in its passage through Parliament to give the Government a chance to rethink, exactly as was requested by speaker after speaker at his conference in Sheffield on Saturday, and all but a handful of the members who voted at it.
John Healey
I am going to make some progress. We are all conscious of your encouragement to do that, Madam Deputy Speaker.
Some say that the Prime Minister and the Health Secretary are failing to get the message across, but from the start they have told only half the story. The Tories did not tell people about their plans for reorganisation and market competition at the heart of the NHS before the election, and they did not tell the Lib Dems about them before they signed the coalition agreement pledging that there would be no NHS reorganisation. There is no mandate from the election or the coalition agreement for this fundamental reorganisation and far-reaching legislation. They will not be straight with people about their plans. This is not just about communication; it is about judgment. In the face of widespread warnings, they are forcing through at breakneck speed the biggest reorganisation in the NHS’s history.
Nadhim Zahawi (Stratford-on-Avon) (Con)
The right hon. Gentleman wisely started by saying that there is room for reform. The right hon. Member for Edinburgh South West (Mr Darling) had plans in his Budget for a 20% cut in the NHS. Will the shadow Secretary tell us which bit of the NHS he would cut to deliver that 20%?
John Healey
There is someone else who needs a copy of the Labour manifesto. He almost used his six minutes’ allocation to make that intervention.
John Healey
I am going to move on. If that is the best the Conservatives can do, I am going to move on.
The truth is that the more people see of the plans, the less they like them. The closer they look the more concerned they become, because they start to see far-reaching changes at the very heart of this reorganisation and legislation. These are the wrong reforms for the wrong reasons at the wrong time. As our motion says, and as the Lib Dem conference motion said, most people would agree on the declared and desirable objectives—indeed, that is the direction in which the Labour Government were heading—but those aims could be better achieved without this huge internal reorganisation and, as the Lib Dem conference motion stated,
“without adopting the damaging and unjustified market-based approach that is proposed.”
Steve McCabe (Birmingham, Selly Oak) (Lab)
Does my right hon. Friend agree that there is room for reform, but not room to risk the GP-patient relationship? Dr Gerada and the Manchester business school have both highlighted that there is a risk that bonuses and profits could be put above diagnoses and treatment.
John Healey
My hon. Friend is right: this reorganisation and legislation leave no part of the NHS untouched. One big concern is that when GPs are making both rationing and referral decisions at the same time, patients will start to ask whether their GP is making a judgment about their treatment in their best interests or in the best interests of his or her budget and consortia business. That can hit at the trust at the heart of the patient-doctor relationship.
Sajid Javid (Bromsgrove) (Con)
I thank the right hon. Gentleman for giving way so generously. He has mentioned the Labour manifesto twice, and I just happen to have a copy of it. It says that Labour will support a
“role for the independent sector”,
encourage any willing provider, make all hospitals foundation trusts and give them the
“freedom to…increase their private services”.
On that basis, will he explain why he and the leader of the Labour party, who I believe to have been the author of that manifesto, are reneging on that position?
John Healey
We were doing what the manifesto said before the election. [Interruption.] We were doing it where the private sector and competition could add capacity to clear waiting lists, or do something new that the NHS was not doing. We did it in circumstances that were carefully planned, properly managed and always publicly accountable. If the hon. Gentleman is going to swallow the guff from those on his Front Bench that this is somehow an evolution of Labour’s policy, he will have to ask the Health Secretary why he needs legislation that is more than three times longer than the Act that set up the NHS in the first place.
Why do we say what we do in the motion before the House? In truth, this is a Tory reorganisation, and the legislation has been mis-sold. It is not just about getting GPs to lead commissioning or looking to cut layers of management; it is setting up the NHS as a full-scale market driven by the power of the competition regulator and the force of competition law. The reorganisation and legislation is designed to break up the NHS, open up all areas of the NHS to private health companies, remove requirements for proper openness, scrutiny and accountability to the public and to Parliament, and make the NHS subject to both UK and European competition law. The Tories are driving the free market political ideology through the heart of the NHS.
The Secretary of State for Health (Mr Andrew Lansley)
On precisely that point about scrutiny and accountability, we have been talking about independent sector providers. Under Labour, if scrutiny committees in local authorities wanted to investigate the activities of independent sector providers they could not do so. Under our legislation, they will be allowed to do so. Wherever NHS money—the public pound—goes, scrutiny will be able to follow. That is a change for the better.
John Healey
That is simply not true. The people who will make the big decisions about £80 billion of spending—the GP consortia—will not need to meet in public or to publish minutes of their meetings. They will not be subject to scrutiny by this House or proper public accountability.
Let me turn now to the question of subjecting the NHS to UK and European competition law. The Prime Minister clearly did not know about that at Prime Minister’s questions today—he clearly did not know that a third of his legislation sets up this new free market NHS. Perhaps the Health Secretary has only told him half the story about the legislation—
John Healey
Shall I finish what I have to say? Then I will give way. If the Health Secretary has not told the Prime Minister, he certainly has not told the public or this House, so let me spell it out—[Interruption.] The Health Secretary says that I have made it up, but why not wait for me to explain to the House, and then he can say whether what I am about to explain to the House is in my words or his?
Clause 52 of the Health and Social Care Bill, entitled “General duties”, sets up the new competition regulator, Monitor, and says:
“The main duty of Monitor in exercising its functions is to protect and promote the interests of people who use health care services—
(a) by promoting competition where appropriate, and
(b) through regulation where necessary.”
The new regulator is given legal competition powers, as well as functions under the Competition Act 1998 and the Enterprise Act 2002, and there are provisions on reviews by the Competition Commission and co-operation with the Office of Fair Trading.
John Healey
The Secretary of State can speak in a minute; I will finish this point. The regulator can investigate complaints about competition, force services to be put out to competitive tender, remove licences and fine the commissioner or provider up to 10% of their turnover. Helpfully, the Government’s new chair of Monitor confirms that. In The Times last month, he said:
“We did it in gas, we did it in power, we did it in telecoms, we’ve done it in rail, we’ve done it in water, so there’s actually 20 years of experience in taking monopolistic, monolithic markets and providers and exposing them to economic regulation”.
Mr Lansley
It is dead simple: the Health and Social Care Bill does not extend the application of EU competition law, or the application of domestic competition law. The powers given to Monitor as a sector regulator are the same as those now available to the Office of Fair Trading. The Bill does not change the scope of competition law at all.
John Healey
The right hon. Gentleman was involved, so he knows better than anyone else that the Tories are now setting out to do to the public services, including the NHS, what they did to the public utilities in the 1980s.
John Healey
Let me finish. The Government’s explanatory memorandum is helpful on the issue of EU law. It says, about chapters 1 and 2 of the Bill—the one third of the legislation that sets up the new competition system—that
“The Chapter 1 and Chapter 2 prohibitions are modelled on Articles 101 and 102 of the Treaty on the Functioning of the European Union which prohibit agreements that prevent, restrict or distort competition, and abuse of a dominant market position.
Monitor would have concurrent powers with the OFT to conduct investigations where it had reasonable grounds for suspecting that either of these two prohibitions—under either UK or EU law—had been infringed in the provision of health services in England.”
That means that a competition challenge in the NHS can be taken all the way to the European Court.
Helpfully, under pressure in Committee yesterday, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), confirmed that
“As NHS providers develop and begin to compete actively with other NHS providers and with private and voluntary providers, UK and EU competition laws will increasingly become applicable.”––[Official Report, Health and Social Care Public Bill Committee, 15 March 2011; c. 718.]
As GP consortia will be corporate bodies, not public sector bodies, and as hospitals will be competing with each other, will have no limit on treating private patients, and will have no support from the wider NHS if they run into financial problems, they will be bodies to which the EU competition rules and legislation apply. That means that the NHS will be tied up in the red tape of market regulation and competition law, and we risk decisions about who provides our health care services being taken not in England by GPs or Ministers, but in Brussels by the European Commission, and in Luxembourg by the European Court.
Margot James (Stourbridge) (Con)
The right hon. Gentleman has already acknowledged that competition and markets were a hallmark of the Labour Government; they took them far further than the previous Conservative Government ever did. Of 475 acute care sites providing elective care, 175 are independent sector providers. The Bill proposes making the competition fair and putting it on a level playing field. No longer will we allow the private sector to be as favoured as it was under the Labour Government.
John Healey
This is a debate. People in the country and in the NHS are worried not about what we did in government—they saw the massive improvements under Labour—but about the application of competition law, domestic and European, in full force to the NHS for the first time. The hon. Lady is serving on the Public Bill Committee. She will have the chance to get her head around that, as she clearly has not done so yet.
Owen Smith (Pontypridd) (Lab)
My right hon. Friend has anticipated the point that I was going to make. As we heard clearly in Committee yesterday—the Secretary of State ought to read the Official Report—his Minister, the right hon. Member for Chelmsford (Mr Burns), let the cat out of the bag. Hitherto the NHS has been insulated from European competition law. As there are more entrants to the market, competition law will have to apply—competition red in tooth and claw—followed by the break-up of the NHS.
John Healey
My hon. Friend is right. We have misinformation and confusion. If the Health Secretary disagrees with his Health Minister, I suggest that they have a word about it after the debate.
In the end, perhaps Nye Bevan was right. When Clement Attlee suggested that the NHS opening should be celebrated as a national institution supported by the whole nation, he said, “The Conservatives voted against the National Health Act, not only on second but the third reading. . . I don’t see why we should forget this.”
It is time for the Health Secretary to tell us why he is spending £2 billion on an NHS reorganisation when front-line staff and services are being cut. How many hospitals will be forced to close because of these reforms? Why is he handing such powers over our NHS to new national quangos, competition lawyers and the EU? Why is there no democratic voice in commissioning? Why is he allowing profit to be made in commissioning essential health services? Why is he removing any limit on private patients paying to jump the queue for treatment in NHS hospitals?
John Healey
It is time the Health Secretary told us who is fully in support of the NHS reorganisation and the legislation. NHS staff, dedicated to the part that they play in our NHS, will strive to keep things going whatever the pressures, but patients are starting to see operations cancelled, waiting times rise, hospital services at risk, front-line staff jobs cut and services cut. This is not what people expected when the Prime Minister said that he would “protect the NHS”. Instead, they are seeing the Prime Minister’s NHS promises to “protect front-line services”, to “give the NHS a real rise in funding”, and to “stop top-down reorganisations that get in the way of patient care” all broken. The NHS was the Prime Minister’s most personal pledge. It is now becoming his biggest broken promise.
Now is the time to listen to the chorus of criticism and concern, and to recognise the growing crisis of confidence in the Government’s handling of the health service. Now is the time to call a time out, pause the passage of the Bill in Parliament, and think again. I commend the motion to the House.
Mr Lansley
I want to make progress. I have given way several times.
The right hon. Member for Wentworth and Dearne (John Healey) said that we planned to get rid of regional system management in the NHS, but that was Labour’s policy when it introduced NHS foundation trusts. Through introducing health and well-being boards in local authorities, we will have a genuine, system-wide view that looks at the NHS, public health and social care. He complains about the commercial insolvency regime, but Labour introduced that under the legislation that set up the foundation trusts eight years ago. He said that our plans introduce EU competition law. No. EU competition law already exists and the Bill does nothing to change that—it does not extend the application of competition law. [Interruption.] No, it does not. In Committee, the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), explained the current position, which the Bill does not change.
The right hon. Member for Wentworth and Dearne and other Labour Members talk about price competition. We have clarified the Bill to ensure that the competition is on quality. What happened under Labour? The private sector was paid 11% more than the NHS. Under Labour, private sector providers were paid £250 million for operations that they did not perform. Under Labour, NHS hospitals were barred from tendering to provide the capacity that Labour offered to the independent sector. Labour Members favoured the private sector. A Liberal Democrat manifesto commitment stated that we would not in future allow the private sector to be given advantages and the NHS to be shut out. We will implement that.
I want to know a bit, because although the right hon. Member for Wentworth and Dearne said that it was the Opposition’s job to ask questions today, I have done many Opposition day debates on health when I was asked many times what our policy was, and I answered those questions. Is it Labour’s policy to extend the use of voluntary sector providers in the NHS? That was in the Labour party’s manifesto. Indeed, Labour said that it wanted to use the independent private sector, too. Is it still the policy? No answer. We do not know. Is it Labour’s policy to make every trust an NHS foundation trust? Again, it was in the Labour party manifesto. Is it still the Labour party’s policy—yes or no? No answer. Again, we do not know. Is it Labour’s policy to promote competition in the NHS, as quoted from the Labour party manifesto in the debate? The right hon. Gentleman has just made a speech opposing that. Does he wish to intervene?
John Healey
I am grateful to the Secretary of State for giving way. We had the NHS as the preferred provider and were ready to use other providers when they could help, and we did so. The great improvements in the NHS happened because we were prepared to put in the investment and to make the reforms. The Secretary of State talks about policies. The problem with what he is doing to the NHS—the reorganisation, the legislation and the ideological change at the heart of it—is that he did not tell the people about it before the election and he did not tell the Lib Dems about it before they signed the coalition agreement. This top-down reorganisation is exactly what he promised not to do.
Mr Lansley
The right hon. Gentleman was not satisfied with his first speech, so he had to have a go at a second one. He did not answer any of my questions. The Labour party said in its manifesto that it would use the private and voluntary sectors alongside NHS providers. The reason for that was simple: having the NHS as the preferred provider meant that the patient could be let down time after time before another quality provider could be permitted. We are going to allow competition on quality, but the quality has to be there. Patients will get the best possible service from whoever is best placed to provide that care.
Our changes are being seen across the country already.
Oral Answers to Questions
John Healey Excerpts(13 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Lansley
As the Minister of State, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), has set out in previous answers, our cancer outcome strategy commits more than £450 million a year over the spending review period to achieving earlier diagnosis of cancer, including access for GPs in the community to diagnostic tests such as non-obstetric ultrasound. At the heart of the strategy is the need to improve awareness and early diagnosis of all cancers, and we are working with the prostate cancer advisory group to help men who do not have symptoms to make decisions about whether to have a prostate-specific antigen test.
John Healey (Wentworth and Dearne) (Lab)
The Prime Minister promised to protect the NHS. What does the Health Secretary say to the people who are not getting the hip, knee and cataract operations that they need, and to the patients who are now having to wait longer for tests and treatment?
Mr Lansley
I will say three things. First, we did protect the NHS, contrary to the recommendations of the Opposition, who said that we should cut the NHS budget. Next year, primary care trusts across England will receive an average increase of 3% in cash. I went to Wales at the weekend, to Cardiff. The people of Wales are seeing a Labour-led Assembly Government cutting their NHS budget in real terms. That was what the Opposition recommended we should do, and we are not doing it.
Secondly, the number of hip and knee replacement operations went up in 2010 compared with 2009—the Patients Association figures were wrong about that. Thirdly, waiting times are stable, as we have set out, and the latest figures show that the average waiting time for diagnostic tests has gone down.
John Healey
The Secretary of State is a man in denial. What does he say to the chief executive of the Patients Association, who has said:
“It is a disgrace that patients are being denied access to surgical procedures that they would have had if they had needed them a year ago”?
What the Government are doing on the NHS is making things worse, not better. The Secretary of State is axing Labour’s patient guarantee on waiting times, he is breaking the promise of a real rise in NHS funding, he is wasting £2 billion on the Government’s top-down reorganisation and he is forcing market competition into all parts of the NHS. Does he not see that the NHS is rapidly becoming the Prime Minister’s biggest broken promise?
Mr Lansley
I can tell the right hon. Gentleman and the House exactly what we are doing. We are increasing the budget for the NHS by £10.7 billion over the next four years, contrary to what the Opposition told us they would do and what a Labour-led Assembly Government in Wales are doing. They are cutting the NHS budget in real terms.
Let me take one example. The number of hip operations in the first half of this financial year was 41,863, whereas in the previous period it was 39,114, and waiting times are stable, so the right hon. Gentleman’s assertion simply is not true. We are delivering an improving quality of care.
Let me give the right hon. Gentleman another example. As the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), said, not only are waiting times stable but infections are going down, with a reduction of 29% in C. diff rates and 35% in MRSA rates in our hospitals. Safer, higher-quality care—
Health and Social Care Bill
John Healey Excerpts(13 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
John Healey (Wentworth and Dearne) (Lab)
The Health Secretary is a man who is struggling to sell his plans. The more people learn about them, the less they like them. The more those in the NHS see, the more worried they become and the less they find to support. Only one in four of the public back him in wanting profit-making companies to be given free access to the NHS. Most GPs neither like nor want these changes, and three out of four doctors do not believe that they will improve services to patients.
Today, for the second week running, the Prime Minister is talking about the NHS changes. He is like a football club chairman stepping in to back a beleaguered manager because everyone else is losing faith in the manager’s judgment. Mind you, the Prime Minister does not always help the Health Secretary, because his words do not ring true with people. Last week, the Prime Minister called the NHS “second rate”. People know that it can be better, but they are proud of the NHS. They have seen big improvements during the last Labour decade, and they know that waiting lists are at their lowest ever and that patient satisfaction is at its highest ever. Those facts are backed up by international comparisons from the Commonwealth Fund, which said last year that Britain’s NHS is one of the very best in the world, and second to none on best value for money.
Nick Boles (Grantham and Stamford) (Con)
The Labour Government introduced foundation hospitals, private sector provision in the NHS, patient choice and payment by results—four things on which we are now building. They also introduced GP commissioning through pathfinders. Which elements of the Blair reforms to the health service is the right hon. Gentleman not repudiating today?
John Healey
It is true that we encouraged many of the GP commissioning models that the Health Secretary now champions, but that process was always within a planned and managed system, and it was never implemented at the expense of other clinicians or patients being in charge. We used private providers when they could add something to the NHS and help it to raise its game, and when they could add capacity so that we could clear waiting lists. Of course there is a role for them in the future, but that is not the question at the heart of the Bill. I will come back to the hon. Gentleman’s question later, however. People saw big improvements in the NHS under Labour, but they now realise that many of those gains might be at risk as a result of the decisions that this Government are taking.
David Miliband (South Shields) (Lab)
Does my right hon. Friend agree that the most significant change in the Bill was not mentioned by the Secretary of State? It is that the Bill introduces price competition into a market that, up to now, has allowed competition only on quality. The London School of Economics, citing academic evidence, states clearly that
“most international evidence suggests that, whereas hospital competition with fixed prices can improve quality, simultaneous price and quality competition can actually make things worse”.
John Healey
Characteristically, my right hon. Friend is absolutely right. These changes to the NHS and the Bill—[Interruption.]
John Healey
I shall answer my right hon. Friend the Member for South Shields (David Miliband), then I will give way.
My right hon. Friend is absolutely right. The Government will talk about some changes, but not about others. The changes are like an iceberg, with big, substantial, ideological changes hidden from public sight.
Mr Lansley
The edifice of an argument from the right hon. Member for South Shields (David Miliband), which is repeated by others, is based on one fact: in December 2009, the operating framework said that commissioners in the NHS could set a maximum price and not just a fixed price. That was December 2009. The right hon. Gentleman and the shadow Health Secretary were in the Government who put that measure into the operating framework. This Government did not put it in; the previous one did.
John Healey
The point made by my right hon. Friend the Member for South Shields is based on page 42 onwards of the Health Secretary’s impact assessment of the Bill, which mentions a premium for private providers of £14 per £100. The Bill allows the system to pay a premium and a bung to private sector providers.
Mr Stephen Dorrell (Charnwood) (Con)
Will the right hon. Gentleman now answer the question put to him by my right hon. Friend the Health Secretary? Does he agree or disagree with the maximum price tariff principle that was set out in December 2009 by the previous Labour Health Secretary?
John Healey
We operated an NHS with a set tariff, not a maximum tariff. In government, we operated an NHS in which price could not be the factor that drove decisions about what services patients received and by whom they were provided. My right hon. Friend the Member for South Shields is absolutely right to point out that the Bill will introduce price competition and the flexing of the price so that there is no longer a set tariff for treatments and patients but a maximum price that can be undercut by providers coming into the field. The Government will not talk about that.
The Prime Minister is not helping the Health Secretary, because the changes the Bill makes were not in his election manifesto, not on his election posters and not in his election speeches. I have the Conservative manifesto here. There is no mention of axing all limits on NHS hospitals treating private patients, so that NHS patients lose out; no talk or mention of undercutting on price, so that established NHS services are hit as new private companies cherry-pick easier patients and services; no mention of guaranteeing only selective hospital services, so that others can be closed and lost to local people without public consultation; and no mention of putting a new market regulator at the heart of the NHS with the principal job of promoting and enforcing competition. There is no mention in the Conservative manifesto of the biggest reorganisation of the NHS since it was set up more than 60 years ago. They did not tell people about their plans before the election and they promised not to introduce such measures in the coalition agreement after the election. There is no mandate from the election or the coalition agreement for this fundamental and far-reaching reorganisation. That is not a debating point, but a point of democratic principle.
Gordon Birtwistle (Burnley) (LD)
I do not remember in the 2005 Labour party manifesto the “Meeting Patients’ Needs” programme that closed the A and E unit and the children’s ward in Burnley. Do not start getting on to us about what we are and are not closing. The right hon. Gentleman closed those things. Does he agree that what he did was a disgrace to the people of Burnley?
John Healey
May I urge the hon. Gentleman to look very closely at the Bill and beyond what he hears the Health Secretary say when he talks about it? I urge him instead to look at how local hospitals could be undercut by private health companies, and at how GPs could be forced to put out work to those companies. That will undermine local hospitals such as the one in Burnley and lead to hospital closures driven not by proper planning and the development of better services in the community, but by hospitals being driven to the point of bankruptcy and closure.
Dan Byles (North Warwickshire) (Con)
The right hon. Gentleman does not seem to understand how the health service operated under his Labour Government. My constituents in Warwickshire have been suffering because NHS Warwickshire, under the rules we inherited from his Government, set up a fixed-price, below-tariff contract with one of the trusts in its area that has led to patients being drained from the George Eliot hospital trust in my area and the area of my hon. Friend the Member for Nuneaton (Mr Jones) to Warwick. It was Labour’s rules that allowed it to undercut the hospital in my constituency.
John Healey
If the hon. Gentleman was worried about the past, he should be a good deal more worried about the future, and, a bit like the Health Secretary, he should spend a lot less time talking about the Labour Government and what we did to the health service and more time talking about the plans and big changes to come.
Geraint Davies
Does my right hon. Friend accept that the core difficulty with the Bill is that it is not about patient choice but about a movement towards general practitioner choice and GP consortia choice? They want to maximise not medical outcomes but profitability. That is what this is about, and the reason is the same as what was said about flexible pricing.
John Healey
My hon. Friend is right. For the first time in the NHS we are facing, first, the potential for profit at the point of commissioning and, secondly, commissioning—in other words, decisions about rationing as well as referral—being made at the individual patient level, not at the collective area level, and we are looking at them being made by bodies and individuals who are not publicly accountable, including to the House.
Mr Lammy
My right hon. Friend is right to press the case about private providers. Is he surprised that the Secretary of State, in response to my question earlier, did not confirm to the House that the wife of John Nash, the chairman of Care UK, funded his office in November 2009 to the tune of £21,000? Does he think that the Secretary of State should put that on the record?
John Healey
I am surprised that the Health Secretary was asked a direct question and did not answer. I would simply encourage my right hon. Friend to keep asking the questions that he feels are important for the future.
Mr Andy Slaughter (Hammersmith) (Lab)
Mr Nash’s wife also bankrolled my opponent at the last election—for all the good it did him. However, something else was not in the Tory party manifesto, and that was cuts in the health service. I have in my hand a letter from the chief executive of my primary care trust that simply states that
“healthcare in North West London will face a £1bn shortfall in funding by 2014/15, given these upward pressures.”
Is that not something else that the Tory party did not tell the truth about, and something on which it is not following the Labour Government?
John Healey
My hon. Friend won his seat at the last election because he helped to expose the truth about the Conservative plans for housing—a truth that it denied but which has now come true. He is absolutely right. The truth about what is happening in the health service now is that patients are starting to see the signs of strain and services being cut, and that is not what they expected when they heard the Prime Minister, before the election and afterwards, promising to protect the NHS.
Andrew Bridgen (North West Leicestershire) (Con)
I thank the right hon. Gentleman for giving way. In my first two weeks as an MP, I paid a visit to the local PCT in Leicester, and in a meeting with the chief executive I asked how the PCT would cope with the immediate 35% cuts in management imposed by the coalition Government. The answer truly shocked me: I was told, “It will be no problem at all, because we have already increased our management by 50% in the past year.” Will the right hon. Gentleman accept that under the previous Government’s watch, the PCTs became the bloated bureaucracies that now need reforming?
John Healey
The problem for PCTs, and the managers and staff who work in them, is that they are being asked to do several things at the same time: to make unprecedented efficiencies at a time when the NHS is being put through its tightest financial squeeze in history; to axe its own jobs; and to guide the reorganisation and ensure that it can take place. That is a tough challenge for anyone. I am sure that the hon. Gentleman will keep on his local PCT’s case.
Andrew George
I am grateful to the shadow Secretary of State for giving way. I would accept his criticisms more openly—I think—were he prepared to acknowledge that the previous Labour Government set up independent treatment centres and rigged the market to hand over 15% of all elective operations in an area such as mine to an independent company that they more or less set up themselves, and which undermined the local acute trust and services with changes that patients had not asked for. That was forced on the PCT and not something for which it asked. It was a rigged market. Would he like to apologise to the House for the practices of the previous Labour Government?
John Healey
I am more interested in what we will be facing in future. I am more interested in the claim by the Health Secretary that there will not be, as he describes it, a rigged market in future, but a level playing field for all providers. However, my hon. Friend—[Interruption.] Well, we will see. The hon. Gentleman is a member of the Select Committee on Health, and he follows such matters closely. I urge him to read page 42 onwards of the impact assessment, because there he will see the preparations for being able to pay for the sort of thing that he criticises in the health service.
As the hon. Gentleman gives me this opportunity, let me say to him and his Lib Dem colleagues that what we are facing is clearly Conservative health policy, not coalition health policy, and certainly not Lib Dem health policy. The main evidence of any influence of Lib Dem ideas on health policy in the coalition agreement was the commitment to
“ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust”.
The Bill abolishes PCTs. The Lib Dem policy priority before the election was to ensure that local people had more control over their health services. The Bill places sweeping powers in the hands of a new national quango—the national commissioning board—and a new national economic regulator, which is charged with enforcing competition, to open up all parts of the NHS to private health companies. The Lib Dems’ principal concern was to strengthen local and public accountability of health services, but the Bill seriously restricts openness, scrutiny and accountability to both the public and Parliament. It will lead to an NHS in which “commercial in confidence” is stamped on many of the most important decisions that are taken. I therefore say to the hon. Gentleman and his Lib Dem colleagues: this is not your policy, but it is being done in your name. The public will hold you—
Mr Deputy Speaker (Mr Nigel Evans)
Order. I know that this debate is attracting a lot of emotion and generating a lot of heat, but will Members please try to speak through the Chair? I have been accused by both sides of doing many things in this debate, and I have not done any of them.
John Healey
I accept that correction, Mr Deputy Speaker. Let me put it in these terms. The policy is not Liberal Democrat policy, but it is being done in their name, and the public will hold the Liberal Democrats responsible if they allow the Tories to do this to our NHS.
Jeremy Corbyn (Islington North) (Lab)
Is my right hon. Friend aware that, in the rush to establish a GP commissioning system, PCTs are being merged, and that large numbers of highly skilled staff are disappearing quickly, as is the ability of PCTs to administer anything, and all this before the Bill has even received a Second Reading? Does he not think that the Secretary of State is culpable in the rapid disintegration and disorganisation of local NHS facilities all over the country?
John Healey
That is one of the things that worries experts and those in the health service the most. It is also one of the things that the right hon. Member for Charnwood (Mr Dorrell) and his Health Committee were most concerned about. [Interruption.] The right hon. Gentleman is nodding. “Disruptive” was one term that the Committee used for the changes.
Mr Dennis Skinner (Bolsover) (Lab)
Why on earth should the health service be changed? We had 13 years. We dragged the health service from the depths of degradation and hoisted it to the pinnacles of achievement. There was £33 billion in 1997; we increased that to £110 billion. All those miners in my constituency and that of my right hon. Friend who wanted those knees or hips replaced—they have all been done, after waiting not for five years, but for a few months. That is what I call achievement, and that is what the people in Bolsover and elsewhere know. That is why the health service was safe in our hands and why, they assume, this one on the Government Front Bench is now going to privatise it.
John Healey
Well, my hon. Friend is right in this respect: people will come to see clearly that they cannot trust the Tories with the NHS; they will come to see clearly what these changes really mean for their services; and they will come to see clearly what the future of the NHS holds.
John Pugh (Southport) (LD)
I cannot follow the previous contribution, but the right hon. Gentleman has mentioned democratic accountability, so will he accept that in 10 years of Labour government, nothing was done about democratic accountability in the NHS? We simply had rule by quangos.
John Healey
No, I do not accept that, but I will tell the hon. Gentleman that the measures in this Bill will undermine many of his principal concerns and policy priorities about opening up the NHS to the public and to Parliament. I hope that he will take a close look at what the Health Secretary really plans.
Alex Cunningham (Stockton North) (Lab)
I hope that my right hon. Friend will agree that the NHS is supposed to be about people and their health, so does he also agree that putting different parts of the health service in competition with one another will lead to fragmented and disjointed pathways of care and undermine innovation and the sharing of best practice, as well as increasing administrative and other costs with public funding being wasted on transaction costs?
John Healey
My hon. Friend is right—and the chief executive of the Patients Association, Katherine Murphy has said just that. Many patient groups are making the same arguments and issuing the same warnings.
My serious concern is that this Government have told only half the story from the start. The Health Secretary and the Prime Minister are happy to talk about GP commissioning and happy to talk about cutting management—the organisational changes—but they downplay or deny the deep ideological changes at the heart of these plans. The Health Secretary mentioned the new economic regulator, Monitor, in just one line in a speech lasting more than 40 minutes. The Prime Minister said last week in his speech on public services that these reforms
“are not about theory or ideology”.
The Prime Minister writes in The Times today, just as the Health Secretary did last week, both of them producing 700 words about their health plans, yet they made not a single mention of competition.
We will explain and expose the truth throughout this debate and the Bill’s passage through Parliament because these changes will break up the NHS; they will open up all areas of the NHS to price-cutting competition from private health companies; and they will take away from all parts of the NHS the requirement for proper openness, scrutiny and accountability to the public and to Parliament. These Government changes are driving free market political ideology into the heart of the NHS, and that is why doctors are now saying:
“As it stands, the UK Government’s new Bill spells the end of the NHS.”
John Healey
The public are being told that the reorganisation is “patient centred”, but patients are being sold a false promise on the NHS. The changes in the Bill come in only in 2013, but patients are already seeing the consequences of the Government’s handling of the health service. The Government have scrapped Labour’s waiting time targets, which were, of course, the patients’ guarantee of being seen and treated promptly. They are breaking the Prime Minister’s promise of a real increase in NHS funding, so Scotland is being short-changed next year by £70 million and Wales is being short-changed next year by £40 million. England, if we take out the double counting of cash to be spent on social care rather than on NHS services, faces a shortfall next year of £1.2 billion on the Prime Minister’s promise.
With this Bill, the Government are now breaking their promise to stop top-down internal reorganisations and they are putting extra unnecessary pressure on the NHS. Patients are starting to see waiting times rise; they are starting to see discharges from hospital delayed; they are starting to see wards mothballed and staff posts cut. That is not what people expected when the Prime Minister promised to protect the NHS. The Prime Minister’s most personal pledge to the public is becoming his biggest broken promise.
Nick de Bois
Will the right hon. Gentleman try to understand—[Interruption.] Perhaps he will. Members suggest that this is ideological. I do not see how it is ideological not to repeat the gross error of 2008-09 when, under the right hon. Gentleman’s watch, managers were recruited at five times the rate of nurses working on the front line—which is not ideological either, and does not serve patients.
John Healey
This is ideological. It is about driving politics into the heart of the NHS, and in some respects breaking what has been a 60-year consensus. Parties on all sides have tried to make decisions about the best interests of patients and better services, and not about their own political ideologies. That has changed today, with this Bill.
John Healey
I want to make a bit of progress before I give way again.
The public are being told that this reorganisation is patient-centred, but most patients’ GPs will not, in practice, be doing what the Government claim they will be doing. GPs spend an average of only about eight minutes with each patient. If they continue as family doctors, the commissioning will not be done by them; it will be done in their name by the managers in the primary care trust who carry out that function now, or by private health companies that are already hard-selling their services to GP consortia. Those consortia are being sold a false promise as well. Because expanded open-ended choice of treatment means funding unused capacity in the system, it is highly unlikely to happen at a time when NHS finances are under pressure.
Despite the boast about putting patients at the heart of everything that the NHS does, there is no place for patients on the bodies that will make the most important decisions on the NHS. There is no place for them on GP consortia, no place for them on the national commissioning board, and no place for them on the regulator, Monitor.
John Healey
The hon. Gentleman has already heard some of my hon. Friends mention the analysis of Dr John Appleby, published in the British Medical Journal online last week. He took to task those who had made the sweeping assertion that somehow Britain’s health service lags behind those of the rest of Europe. It is an argument that the Prime Minister advances. It is an argument for change, he says, because we are still a long way from European standards of care.
Let me read something to the House. We have been told that
“if you have heart surgery in England, you now have a greater chance of survival than almost any other European country – over the last five years, death rates have halved and are now 25 per cent lower than the European average.”
Those are not my words, or even those of Dr John Appleby. They are the words of the Health Secretary, published on ConservativeHome last week.
The Prime Minister argues that this is somehow an evolution and not a revolution. The Bill, however, is more than three times as long as the legislation that set up the NHS in 1948. The NHS chief executive told the Select Committee on Health:
“The scale of change is enormous—beyond anything that anybody from the public or private sector has witnessed”.
The Health Secretary argues that the Bill is somehow an extension of Labour policies. That is wrong, and it disguises again the fundamental changes to the NHS in the Government’s plan. Make no mistake, Mr Deputy Speaker: this is a revolution, not an evolution.
Jesse Norman (Hereford and South Herefordshire) (Con)
I note that the right hon. Gentleman failed to answer the question about the rate of increase in the number of managers. When I last checked, the NHS had 1.3 million employees, of whom almost exactly half were administrators and half were on the front line. Is he really willing to defend such an extraordinary level of overstaffing in management?
John Healey
Oh dear, the hon. Gentleman really has to get a better briefing from his Whips than that.
Clive Efford
Will my right hon. Friend confirm that in order to shoehorn private enterprise into the NHS, the regulations are being written to add a 14% premium into the tariff for private sector companies that will be tendering for work?
John Healey
My hon. Friend may be right. I have not seen the regulations, but that is certainly in the impact assessment, so he is on to an important point.
Government Members and the Health Secretary have spent a long time talking about Labour’s plans, policies and record, but the debate at the heart of this Bill is not about whether competition, choice or the private sector has a part to play in the NHS—they have and they do. The debate at the heart of this Bill is about whether full-blown competition, based on price and ruled by competition law, is the right basis for our NHS. That is why Labour Members oppose this Bill. We want the NHS run on the basis of what is best for patients, not what is best for the market. We want the NHS to be driven by the ethos of public service, not by the economics of forced competition. We will defend to the end a health service that is there for all, fair for all and free to all who need it when they need it.
If the stated aims for the reform were all the Government wanted—we have heard the Health Secretary say that he wants a greater role for doctors in commissioning, more involvement of patients, less bureaucracy and greater priority put on to improving health outcomes—he should do what the GPs say: turn the primary care trust boards over to doctors and patients, so that they can run this and do the job. But there is no correlation between the aims that the Health Secretary sets out and the actions he is taking. There is no connection between his aims and his actions. He is pursuing his actions because his aims are not sufficient. His actions would not achieve the full-scale switch to forced market competition, which is the true purpose of the changes.
Meanwhile, the biggest challenges and changes for the NHS will be made harder, not easier, by the reorganisation. Such challenges include making £20 billion of efficiency savings and improving patient services; ensuring better integration of social care and health care, of primary care and hospital care, and of public health and community health; and providing more services in closer reach of patients in the community rather than in hospital. But the Government will not listen to the warnings from the NHS experts, the NHS professional bodies, patient groups or even the Select Committee on Health.
Mr Anderson
In a disparaging comment earlier, the Secretary of State said that the voices of concern were the voices of the trade unions. They are led by people who were health professionals and they represent 1.3 million professionals. Surely somebody in this place should listen to what they say and not to Government Members, who have a biased reason for doing this.
John Healey
My hon. Friend is right. The more that NHS staff see of the changes and the consequences of this Government’s handling of the NHS, the more concerned they are about the changes and the more they are starting to see the NHS go backwards. But the Government will not listen to these warnings that are coming from all sides. They are in denial about the risks: the risk that patients will see services get worse, not better; the risk that up to £3 billion will be wasted on internal reorganisation; the risk that innovation and improvements in care that come from greater collaboration will be blocked by the Office of Fair Trading, competition courts and the new market regulator; and the risk that the Bill will create the monster of a full-blown market in health care which GPs will not control and nor will Ministers or Parliament.
If patients have been sold a false prospectus, that is true of GPs too. GPs are being told that they will call the shots on deciding who provides care for their patients, but they are being set up by the Government. They are likely to find their hands tied by Monitor and the Office of Fair Trading and by the courts enforcing competition law. They are likely to find their decisions challenged by private companies if they do not accept “any willing provider”, especially one that offers to undercut on price. The chair of the Royal College of General Practitioners recently issued a warning to her colleagues. She said:
“I understood these reforms were about putting GPs at the centre of planning healthcare for their patients, not about making sweeping cuts, which will include shutting hospitals, making enormous redundancies, closing services”.
Because the reorganisation will force doctors to make rationing decisions as well as referral decisions for their patients, they will make treatment decisions with one eye on their patient and the other on their budget and their consortium’s bottom line.
The Government say they are devolving power to front-line services, putting clinicians in control, making the NHS more accountable and improving the integration and quality of services, but in the Bill they are making the forces of competition and centralisation far stronger than those of devolution, democratic accountability or the development of quality in patient services. We will explain and expose the gap between what Ministers are saying and what they are doing in every debate at every stage of this legislation.
Patients and staff are already seeing signs of strain in the NHS. They are starting to ask, “What on earth are the Government doing with the NHS? Why don’t they listen to the warnings? Why is the Prime Minister breaking the very personal promise he made to protect the NHS?” The Bill puts competition first and patients second. That is why we will oppose the Bill tonight and expose this truth in the months ahead. These are the wrong reforms for the wrong reasons at the wrong time.
Mr Stephen Dorrell (Charnwood) (Con)
I rise to support the Bill. The shadow Secretary of State started by saying that my right hon. Friend the Secretary of State struggled to explain his reasons for introducing the Bill, but I think that the shadow Secretary of State struggled to explain why he opposes it. He struggled from the moment that my hon. Friend the Member for Grantham and Stamford (Nick Boles) intervened to draw his attention to the fact that the Bill represents an evolution of policy that has been consistently developed by every Secretary of State since 1990, with a single exception in the form of the right hon. Member for Holborn and St Pancras (Frank Dobson), who sits on the Labour Back Benches. The question that the shadow Secretary of State has to answer is this.
Mr Dorrell
Let me pose the question and I shall be delighted to give way. Which of the key themes does the right hon. Gentleman oppose? Is it the practice-based commissioning or the “any willing provider” model? Is it the introduction of private sector expertise into commissioning, which was first articulated in the world class commissioning programme, or is it the principle of the maximum tariff? Let me help him by quoting from the operating framework of 2009, to which my right hon. Friend the Secretary of State referred. It states:
“After 2010/11, we shall move to a position where national tariffs represent the maximum price payable to a commissioner, as opposed to the mandated price for a particular activity.”
With which of those four key policies does the right hon. Gentleman disagree?
John Healey
The right hon. Gentleman started by saying that the policies are an evolution. If that is the case, why did he say:
“I thought we were looking to develop existing institutions rather than starting again, and that appeared to be confirmed in the coalition agreement.”
John Healey
The right hon. Gentleman, who is nodding, went on:
“Then in July that approach was changed. That came as a surprise.”
Mr Dorrell
Indeed it did. I offered the right hon. Gentleman four consistent themes of policy. He accurately quoted my comments about a specific element of bureaucracy. One of the questions that the Select Committee addressed was why, since all these broad themes are so broadly supported, we went down the road of replacing the PCTs with the consortia. That is a question that the Select Committee said in its report had not been adequately explained, but that is a relatively minor question of bureaucratic presentation when compared with the broad themes of policy that were articulated in the debate by my hon. Friend the Member for Grantham and Stamford. Which of these key policies does Labour now wish to dissent from?
Oral Answers to Questions
John Healey Excerpts(13 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Lansley
I am glad to have the opportunity to welcome the hon. Lady to the Opposition Benches and wish her well in representing Oldham East and Saddleworth. I am sorry that she did not take the opportunity to welcome in particular the Government’s commitment to the new women and children’s unit at the Royal Oldham hospital.
For years, general practices have been remunerated partly through a quality and outcomes framework. The principle is that if they deliver better outcomes for patients, they should have a corresponding benefit from doing so. In the same way, if the commissioning consortia deliver improving outcomes for patients, that should be recognised in their overall reward.
John Healey (Wentworth and Dearne) (Lab)
The Secretary of State talks a lot about GPs using £80 billion of public money to commission services, but if they are to carry on being family doctors, the planning, negotiating, managing and monitoring of hundreds of commissioning contracts will be done not by GPs but in their name, either by the people who do it now in primary care trusts or by the big health companies that are already hard-selling the service to new GP consortia. Is he not deliberately disguising the true purpose of his changes, which is to open up all parts of the NHS to big private health care companies?
Mr Lansley
On the contrary, the purposes of the Bill are very clear to see—for example, the duty to improve quality and raise standards throughout the health service. I hope that the shadow Secretary of State will acknowledge that putting clinical leadership at the heart of the system is essential. I entirely understand that leadership is not the same thing as management, as do general practitioners. The Prime Minister and I will meet the first wave of pathfinder consortia tomorrow, and we will support them in taking clinical leadership in designing services for patients and bringing to bear the best management support in doing so.
John Healey
Why will the right hon. Gentleman not be straight with the public? I have with me the White Paper—57 pages and only three references to the market, all of them to the social market. He talks about GP commissioning, but not about the hard-line political ideology that underlines these changes. The Bill puts no limit on the use of NHS beds and staff to treat private patients, it puts no limits on big private health care companies undercutting and undermining local hospitals, and it puts at the heart of the new system an economic regulator charged not with improving services but with guaranteeing and enforcing competition. Is this NHS reorganisation not like an iceberg, with the substantial ideological bulk being kept out of the public’s sight?
Mr Lansley
The shadow Secretary of State cannot actually criticise what we put forward in the White Paper or the Bill and is resorting to inventing something else and attacking that. Let me tell him that the one thing we will not do with the private sector is rig the market so that private companies get contracts and guaranteed money whether or not they treat patients. We are not going to give them 11% more money than the NHS would get for doing the same work. We will give NHS organisations a proper chance to deliver services for patients.
Swine Flu
John Healey Excerpts(13 years, 6 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
John Healey (Wentworth and Dearne) (Lab) (Urgent Question)
Thank you, Mr Speaker, for allowing this urgent question to ask the Secretary of State for Health if he will make a statement on the Government’s preparations for and response to the current flu outbreak.
The Secretary of State for Health (Mr Andrew Lansley)
Every winter, flu causes illness and distress to many people. It causes serious illness in some cases and, unfortunately, some deaths. I know that each death is a tragedy that will cause distress to family and friends.
The NHS is again well prepared to respond to the pressures that winter brings—it has responded excellently this year. I thank in particular general practitioners, who each year work tirelessly to look after the health of their patients—especially this winter when the weather, as well as flu and other viruses, has presented challenges.
The rate of GP consultations for influenza-like illness is currently 98 per 100,000 people, down from 124 per 100,000. Those figures are lower than the numbers recorded during the pandemic in 2009-10 and below epidemic levels, which are defined as 200 per 100,000 people. The most recent data showed that 783 people were in critical care in England with influenza-like illness.
Where necessary, local NHS organisations have increased their critical care capacity, in part by—regrettably—delaying routine operations that require critical care back-up. That is a normal local NHS operational process; critical care capacity is always able to be flexible according to local need. We have also increased the number of extracorporeal membrane oxygenation beds, for patients with the most severe disease, from five to 22. A seasonal flu vaccine is again available this year. Our surveillance data show that the vaccine is a good match to the strains of flu that are circulating.
GPs in England order seasonal flu vaccine direct from the manufacturers, according to their needs. Vaccine supply is determined in the early part of the year, for autumn delivery. We recently became aware of reports of flu vaccine supply shortages in some areas in England. We are working with the NHS locally to ensure available supplies of surplus vaccine are moved to where they are needed. In addition, the H1N1 monovalent vaccine is now available to GPs for patients who are eligible for the seasonal flu vaccine.
The Government continue to take expert advice from the Joint Committee on Vaccination and Immunisation. Last year, the JCVI advised for the first time that, in addition to usual risk groups, healthy pregnant women should be vaccinated with seasonal flu vaccine. It did not recommend that children under the age of five outside the at-risk groups should be vaccinated. On 30 December, the JCVI assured me that this advice remains appropriate.
The number of deaths in the UK this winter from flu, verified by the Health Protection Agency, currently is 50. The number of deaths from seasonal flu varies each year, with over 10,000 deaths from seasonal flu estimated in the winter of 2008-09.
Antiviral medicines can also help clinical at-risk groups who have been exposed to flu-like illness. We notified clinicians that the use of antiviral medicines in these groups was justified and, at their discretion, with other patients. We have given access to the national antiviral stockpile to support that.
We are making publicly available for the first time a range of winter performance information, published on the Winterwatch section of the Department’s website. I wrote to all Members last week to inform them of the NHS response to flu, and updated them further in a written statement published this morning.
John Healey
I thank the Health Secretary for that statement, but the truth is that he has been slow to act at every stage of this outbreak, and that is putting great pressure on the NHS across the country. It is working flat-out in our local hospital in Rotherham. We have had to open extra beds, and since last Tuesday have cancelled all non-urgent surgery. Four of the 50 patients in the UK who have so far died linked to this flu have been in Rotherham, and two were constituents.
The Health Secretary talks about seasonal flu, but we knew this would not be like normal winter flu because we knew swine flu would be dominant, so the central question for the Health Secretary is why he made less preparation for a flu outbreak that was expected to be more serious. Why did he axe the annual autumn advertising campaign to help boost take-up of the flu jab and help the public understand who is at risk and what treatment is available? We know it works, and this was a serious misjudgment.
Why was the Government’s first circular to midwives, urging them to help get pregnant women to take up the flu jab, not sent out until 16 December? Why has there been no move to offer vaccines through antenatal clinics, and why are the Government not publishing details of the numbers of pregnant women who are seriously ill or who have died, as they are with other groups that are most at risk?
With proper planning and preparation, we should not have seen GPs and pharmacies running out of the vaccine in some areas last week, nor should we have seen parents confused about the treatment available for their young children. I hope last week’s figures mean we may be over the worst, but, with 783 people in critical care and a long winter still ahead, what steps will the Health Secretary take if the numbers of ill people continue to rise? Can he now, today, give the House the reassurance he has failed so far to give the public, which is that he really has got a grip on this situation? Finally, when all the bodies he is relying on to sort out this situation will be abolished under his internal organisation, what assurance can he give the public that this will be any better handled in the future?
Mr Lansley
I share the right hon. Gentleman’s deep sadness at the deaths in Rotherham and join him in expressing clearly my condolences to the families of his and other Members’ constituents who have died. Regrettably, there will, I fear, be further deaths from flu—that is in the nature of the winter flu season—but I have to explain to him that we are in the midst of a seasonal flu outbreak that has not reached epidemic levels. Neither is it a pandemic, which is clearly a different situation in which a novel virus, to which there is not acquired immunity, is in circulation.
The right hon. Gentleman asked some specific questions. First, on having to cancel operations, I have made it clear that that is, unfortunately, a consequence: if the NHS’s critical care capacity is under pressure, it cannot admit large numbers of patients for elective operations that might require critical care back-up. The seasonal winter flu outbreak has led to an increase in the number of patients with flu in critical care beds, although they still constitute only about one fifth of the total number of critical care beds, and I pay tribute to hospitals across the country that have increased their critical care capacity, particularly in intensive care, to deal with the situation.
We are also providing assistance to the NHS. I am sorry that the right hon. Gentleman did not refer to my important announcement last Tuesday that, because we made savings in the Department of Health’s central budgets, on things such as management consultancy costs and the IT scheme, we have been able to issue this financial year—in other words, starting now—an additional £162 million to primary care trusts throughout England. They will be able to use that money directly with their local authorities to facilitate the discharge of patients. There are currently about 2,500 patients in hospital who could be discharged if the appropriate arrangements were in place. That will accelerate the relationship with social care that we are looking for.
It is pretty rich for the right hon. Gentleman and the Labour party to say that there should not have been any shortages. The number of vaccines supplied to the United Kingdom was determined before the Government took office. It was determined under the previous Administration, in the early part of last year, not by this Administration. Furthermore, it was equally not just presumptuous but unhelpful for him, during the Christmas period, to talk inaccurately about whether children under the age of five should be vaccinated. He knows perfectly well that like his predecessors we take advice from the Joint Committee on Vaccination and Immunisation. With the chief medical officer, we asked the committee to look at the issue again, and it met on 30 December and reiterated its advice that young children should not be vaccinated. So for him to stimulate press reports suggesting that parents should have their children vaccinated, when the expert advice was not that that should be done, was deeply unhelpful.
The right hon. Gentleman’s final point was about the organisations. It is clear to me that, by abolishing the Health Protection Agency and bringing its responsibilities inside the Department of Health under the new Public Health England, we will have a more integrated and more effective system for responding to seasonal flu in future years.
Oral Answers to Questions
John Healey Excerpts(13 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
John Healey (Wentworth and Dearne) (Lab)
May I welcome the Secretary of State’s sensible rethink and change of mind on the funding of specialist children’s hospitals after Labour Members raised concerns during the previous Health questions? During those questions he also got his NHS funding figures in a twist, so what has he got to say about the updated inflation forecasts on page 83 of last week’s Office for Budget Responsibility report? They show that for the next four years the inflation increase will be bigger than the cash increase in the NHS—in other words, the NHS will get a real cut in funding, not a real increase. Does he accept the OBR figures? Does he accept that they are hard proof that the Government are breaking their promise to protect NHS funding?
Mr Lansley
Let me tell the right hon. Gentleman that it is not a change on specialist children’s hospitals. The previous Government initiated a study by York university, which reported. I made it clear, when we discussed it last, that we were examining the results of that together with the specialist children’s hospitals. We have reached what I regard, as I hope they do, as a very acceptable outcome.
The spending review gave a real-terms increase in NHS funding. That was the commitment we gave and it was set out in the spending review, and it remains true that revenue funding for the NHS continues to rise in real terms.
John Healey
Perhaps I should have asked the Secretary of State whether he has even seen the OBR report. Let me try to help him. The OBR’s inflation figures mean that the NHS will not get the 0.4% real increase that he bragged about and that was stated in the spending review; the NHS will get a 0.25% decrease—a cut—in funding, as has been confirmed today for me by the House of Commons Library. No wonder the Prime Minister is rattled and is asking what on earth the Health Secretary is doing with the NHS. Does the Health Secretary accept that this confirms that the coalition’s pledge to guarantee that health spending rises
“in real terms in each year of the Parliament”
is being broken? How does he explain that to the Prime Minister and how does he explain it to the public?
Mr Lansley
No, I do not accept that for a minute. At the spending review we set out what met our commitment. I am very clear that, as I just told the right hon. Gentleman, revenue funding for the NHS will increase in real terms. It will do so because we did not listen to the advice of the Labour party in the run-up to the spending review, which was to cut the NHS budget. We did not do that and we were committed at the spending review to an increase in real terms. The gross domestic product deflator will move from time to time, but the commitment that we set out was clear and will continue.