Regional Pay (NHS)

John Pugh Excerpts

Wednesday 7th November 2012 Commons Chamber

[Chris Skidmore]

The debate is not so much about regional pay because, as my hon. Friend says, there are local considerations to be taken into account; it is about what is the right pay. The right pay is not about lowering pay in poor areas, but about having the right pay in all areas. The right pay is the market rate for an individual, a professional with an individual mix of skills, expertise and experience. One of the problems with the national pay structure is that if trusts want to pay someone more, perhaps an expert, they will be prevented from doing so, which I think is wrong.

[John Pugh (Southport) (LD)]

The hon. Gentleman objected to the use of the word “cartel”. In what sense is it inappropriate in this context?

[Chris Skidmore]

I believe that “cartel” is a rather offensive word to use in this context, because it has connotations that are inappropriate for health care professionals who are doing their best to ensure that the NHS survives in the long term. That is the crux of the debate. Let us look at staffing costs. The Labour Government made a significant investment in the NHS over 13 years. It would be churlish to deny that, but it would also be churlish to deny the fact that a huge proportion of those costs were soaked up in pay.

--- Later in debate ---

[John Pugh (Southport) (LD)]

The submission made by 25 of my colleagues to the regional pay consortium—copies are still available, if people want them—has an excellent conclusion:

“Richard Disney, an expert on regional pay at Nottingham University, has said, ‘everyone thinks it’”—

regional pay—

“‘makes sense until they try to work it out.’ The Government is no different.”

Let us be brutal: this debate is not just about regional pay, but about a set of hospitals that are desperate to save money in any way they can by cutting their wage bill and that are stupid enough to think that how they treat their staff and human capital simply does not matter. This debate is not even just about getting the Government to intervene; it is also about exposing differences between the coalition parties and about the coalition trying, to an extent, to paper over the cracks, which is what the amendment endeavours to do.

We all know that the Secretary of State does not want to intervene and that he will wait, quite legitimately, for the pay reviews to report. He cannot do that much anyway, because the guys on the Opposition Benches created independent foundation trusts—they were conned into agreeing to them in 2003, I think—which has resulted in the current situation.

To be fair, some people believe that regional pay will revive economies in the regions, that pumping extra money into areas with high housing costs will not drive up house prices still further, that it will not reduce demand in the regions and that it is a great way of ensuring that everyone gets good quality public services. They are the sort of people who believe that it will allow us to create not only more private sector jobs, but more public sector jobs. That view was expressed by the hon. Member for Norwich North (Miss Smith) when we last debated this issue.

[Ian Mearns]

Would the hon. Gentleman care to speculate on how the quality of front-line care for our patients will improve by threatening tens of thousands of hospital workers and NHS front-line staff with a further reduction in their living standards?

[John Pugh]

Some proponents of regional pay argue that teachers would work harder, nurses would be more caring and skills shortages would disappear, and that we would not squander useless time on endless boundary, demarcation and wage disputes. Bizarrely, however, those same people usually believe that this principle and its effects are applicable only to lower paid jobs, not to the top jobs. In other words, the proposal applies only to the plebs.

A prejudiced northerner such as me might be tempted to call those people, “southerners,” but the truth is that they are only a tiny subset of southerners who are upwardly mobile, found in think-tanks, male and disproportionately London-based. Their arguments will change, but no evidence to the contrary will satisfy them, because they have a Tea party-like faith and simple creed that public services should and can be run as simple markets, that people respond only to financial incentives and, most preposterously of all, that nothing worthwhile is lost by turning our great public services into markets full of acquisitive agents. That is not so much market ideology as a form of market idolatry: an unreasoning faith in the omnipotence of idealised markets of the kind that we find only in economics textbooks. Regional pay—and market-facing pay—is part of that faith, and the principle of equal pay for equal work is not part of it. In all honesty, we have to say that we have such people in our midst, some of whom are in positions of power and influence, but equally we have many colleagues around us who have a better grip on reality and the complexities of life and who question such crackpot ideas as regional pay and where they might take us.

I pity the Minister, who is probably aware—I looked this up—that house prices, wages and the cost of living in his Suffolk constituency are very similar to those in many parts of the south-west. He certainly will not welcome telling hordes of his constituents that they are a tad overpaid.

[Yasmin Qureshi]

The hon. Gentleman said that as somebody from the north of the country he accepts that there is already a north-south divide in pay. Does he agree that regional pay would make that even worse?

[John Pugh]

Absolutely.

I was enlarging on the fact that the Minister has to keep peace between sectors of the coalition, and I do not envy him that role. To be fair, many Members from the majority party are also finding this issue uncomfortably irrelevant.

So what can the Minister do, and what can we do? I have a suggestion. The south-west trust was set up by Labour as an independent providers foundation trust with, frankly, pathetic levels of public accountability. Trusts were set up to operate within a market competing with other NHS providers and private providers, and they do not in law have to consider themselves as part of the wider NHS—as part of national bargaining or “Agenda for Change”. Apparently the trusts in the consortium do not to want to so consider themselves and want to ignore national agreements. If they see themselves as independent free agents in competition with other free independent agents, then surely they cannot all form a cartel with a huge share of the health market and conspire collectively to keep wages, and so their costs, down. That is not a free market—it is market abuse. It is not even fair trading. It is the sort of thing that in the United States would lead to a class action as wage fixing.

That is why my colleagues and I are referring this issue to Monitor and the Office of Fair Trading for investigation. This misguided lot in the south-west cannot be allowed to be freebooters when it suits them and freeloaders on the NHS when asked to play by market rules. If the Government are a bit schizophrenic on this issue, the south-west consortium appears to be even more so.

[Mr Bradshaw]

The hon. Gentleman mentions referring this to Monitor and the OFT. Does he accept from me, as a former health Minister, that all it would take is a word from the Minister to say “Stop it”, and it would stop?

[John Pugh]

I do not think that that is the case, or that the right hon. Gentleman thinks so, but he ruined my punchline, which goes like this: if the South West consortium is even more schizophrenic than the Government on this, it must be made to come to its senses.

[Dr Sarah Wollaston (Totnes) (Con)]

I ask the hon. Gentleman please to withdraw his comment about this being a schizophrenic response. It is really unfortunate when people use the term “schizophrenic” to refer to very important decisions, because it minimises the impact of schizophrenia on sufferers. May I ask him to rephrase his comment?

[John Pugh]

I cannot take it off the record, but I do take the point that the hon. Lady has made.

Induced Abortion

John Pugh Excerpts

Wednesday 31st October 2012 Westminster Hall

[John Pugh (Southport) (LD)]

Such debates in this place—I have attended a few—are deeply polarised, and often quite unpleasant, between those who assert the right to life and those who equally emphatically assert the right to choose, which is strange because both rights are then usually qualified by those who uphold them. I think all hon. Members would agree that there are circumstances where either right can be overridden and I know no one who does not believe this. The dividing issue between hon. Members in this Chamber is the limits of abortion, and such a debate is necessarily about how much or how little abortion is permissible. To be honest, those who argue for limits often favour much less abortion, or rare abortion, and constrained choice for the woman. That by itself is not an argument against discussing the limits rationally.

We are not helped much by the fact that two sorts of argument are given for abortion in law: one is about the preferences or the good of the woman, where her mental health, usually, and sometimes her physical health is the issue; the other is about the hypothetical preferences of the foetus, in cases of severe abnormality, where gross deformity or suffering is in prospect. There are, therefore, two different sorts of abortion, and it is not obvious to me that the same limits should apply to both types. A problem in discussing the current limits is that the cases that would immediately be affected by a small reduction would disproportionately fall into the latter category—deformity and so on. Such cases are rare and untypical, and that slightly skews our debate. It is a mistake, in this debate, to confound the two types of abortion.

Much, perhaps most, current debate has been centred on the viability of the foetus at certain stages—its ability to survive with or without medical assistance outside the womb. Of course, that varies depending upon the quality of that medical assistance, which we would all agree has improved enormously. On my way here, I read a story in Metro of a baby who survived being born below the abortion limit and was looking happily out of the pages of the paper. This kind of evidence is often cited as new scientific evidence about what we can achieve. We may achieve still more in future.

Some argue that we should not think simply of the survival of the foetus, but of its ability to thrive, lead a quality life, have full use of mental faculties and so on. It is legitimate to say that mortality and impairment is high among babies born prematurely.

[Nadine Dorries]

On the important matter of viability, the hon. Gentleman will be aware that, post-20 weeks, the method of aborting a baby is to administer a lethal injection into the baby’s heart via the mother’s abdomen, to ensure that the baby is delivered dead, not alive. That is why that procedure was invented, created and introduced. That in itself is an argument for viability below 24 weeks, because if there was no chance of viability below 24 weeks, there would be no need to introduce a lethal injection procedure.

[John Pugh]

I accept that point, but we must be aware that there is an argument that the abortion limit should be set at a point where a statistically significant number of foetuses can be shown not just to have survived, but to have thrived. That position is somewhat arbitrary. I see no obvious reason why obstetrics should not continue to improve and the issue continue to haunt us.

I find all this talk about survivability somewhat confusing, because at no stage is the human infant capable of independent survival. Some societies, and indeed some philosophers, have argued that a severely deformed infant born at full term, incapable naturally of living without abnormal intervention and presenting all those features that would have justified abortion should be allowed to perish or may be killed. I do not accept that view, but I recognise that it has been put.

What scientific evidence shows about survival prospects strikes me as relevant but not crucially so. Survivability is only relevant because it stands proxy for something else. No one argues that a baby that can survive and show all the signs of conscious, individual life was not conscious from the moment of its birth and capable of wilful behaviour, having feelings, sentience and so on. Equally, it is hard to argue that were they in the womb that would not also be exactly the case. To kill such a baby, or a baby of such an age, while it is in the womb is thus, logically, to kill a sentient, conscious, wilful and, indeed, innocent human being, and one needs a good reason to justify that type of behaviour. The paramount wishes of the mother simply do not seem to be a good enough reason.

Where consciousness can be presumed, or to put it more strongly, where complete unconsciousness cannot be assumed, the rights of the child in my view would ordinarily trump the rights of the mother. A precautionary principle should kick in, but it clearly does not do so within the existing framework. That is why it is important that we have this debate.

I accept that there is a different argument to be had about the destruction in the womb of human life that we would all agree not to be conscious, and that falls back upon religious views about respect for individual human life, including the potentially, but not actually, conscious. The mediaeval Church made that distinction. But the argument that we must take sentience seriously rests upon our ordinary moral intuitions about the value of individual existence. The debate simply will not go away until we align the law with our basic moral intuitions. I applaud those, including the Secretary of State for Culture, Media and Sport, who simply alerted us to this fact and indicated that we really must have this debate.

--- Later in debate ---

[John Pugh]

Why are we discussing now matters that we could have discussed in 2008? The hon. Lady is relatively new to the House. She will be aware that whenever the issue has been raised formally in the House, the lid has been put on it pretty quickly, so there has not been a thorough and exhaustive debate that might help matters.

[Julie Elliott]

I thank the hon. Gentleman for his intervention.

MPs must act with responsibility, and always consider the impact on our constituents and the wider population of issues that we bring to the House. We must not scaremonger, or involve issues of guilt, which has happened in some contributions today. I am wholly opposed to that.

I return to what I said at the beginning—why have this debate now? I cannot see any medical or logical reason for it now because no new evidence has come forward since it was last discussed in 2008. If there was new evidence, I would be happy to have the debate. My mind is not closed to changing the limit ever, and if medical evidence suggests strongly that survival rates may be lower than at 24 weeks, that would be the time to consider the issue, not now.

Mental Health (Approval Functions) Bill

John Pugh Excerpts

Tuesday 30th October 2012 Commons Chamber

[Norman Lamb]

We are talking about the approval function. Subsection (2) mentions

“practitioners approved to give medical recommendations”,

so it clearly deals with practitioners who have already been authorised, but by the wrong body.

[John Pugh (Southport) (LD)]

I am genuinely trying to understand this point and ensure that the Bill is as foolproof as possible. As I understand the Government’s case, the clinical need of people with mental health problems—the Bill clearly would not apply to people who did not have mental health problems—is trumping the absence of proper process, so the Bill is not an abuse of human rights.

The difficulty that I have with that argument—perhaps I ought not to have it, and maybe I am being particularly thick—is that the clinical need in question was established through a process that is acknowledged as formerly having been flawed. The clinical need is apparent only when a case has been heard and processed. The concept of clinical need here is certainly—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. May I say to the hon. Gentleman that this is an intervention, and interventions are supposed to be brief? I know that this is a complex point, but interventions are becoming speeches within the Minister’s speech. If the hon. Gentleman could make his point succinctly now, it would help all of us.

[John Pugh]

My point is that the definition of clinical need ought to be good enough for a psychiatrist, but I am not convinced that in this context it is good enough for a lawyer.

[Norman Lamb]

All that is being regularised is the power to approve a doctor, not whether a doctor is clinically sound. Any patient who challenges a judgment to section them either now or in the past will retain all their rights in law. We have acted on the advice of both lawyers and clinicians to ensure that we deal with the problem that has emerged in a way that respects patients’ clinical interests and considers them with the utmost seriousness. To go through a full reauthorisation process in every case could be incredibly damaging to individuals in potentially vulnerable situations. The Bill is based on the best clinical and legal advice that we have received on how to deal with the problem.

Mental Health (Approval Functions) Bill

John Pugh Excerpts

Tuesday 30th October 2012 Commons Chamber

[John Pugh (Southport) (LD)]

Yesterday I expressed bewilderment about how we have ended up in this situation, given the high profile given in this place to the issue of legal detention, particularly during the passage of the Mental Health Act 2007, on whose Bill Committee I served. Yesterday, the hon. Member for Broxbourne (Mr Walker) said that this issue has not been taken seriously during the past decade, but it has been in the House of Commons—it has been taken very seriously and has been debated at extraordinary length. I now see the Government’s problems over the issue and recognise the gravity of the situation. I understand the need for a rapid solution and the absence of any real viable alternative. However, I am not yet convinced that this retrospective legislation offers an unproblematic or wholly sufficient solution.

Let me explain why that is and underline my concerns. Let us suppose this were not an issue of mental health, and somebody was judicially processed and forcibly detained via a flawed process. Let us suppose that they were arrested by an officer who was competent but not properly authorised to arrest or that such a person were sentenced by a judge who was skilled but not properly appointed. Irrespective of the person’s actual guilt or the reasonableness of the evidence, they would be released, after an application had been made, on a technicality. That is how the law would work for those who do not have mental health issues to address. If we apply different principles for those who have mental health issues, we discriminate, and it could be argued that we might be doing so unfairly. Ironically, this week, we are beginning the Committee stage of a Bill to outlaw unfair discrimination.

If we add to that the fact that the job of determining who assesses cases was delegated to organisations such as care trusts, which are also providers of patient care and are paid for providing it, we see a legal challenge under human rights law starting to take shape. Mersey Care NHS Trust owns and runs Ashworth, and although I do not think it is one of the offending trusts in this case, it would have been a relevant example here. A consoling thought—the consoling thought—is that we believe that no one has been improperly detained or is being improperly detained, and nothing would have changed if authorisation had been done differently. However, it is not possible to be sure about that.

These cases are often genuinely difficult. I have met psychopaths who appear, on the surface of it and when encountered, to be very normal. Equally, when anyone is incarcerated it can be difficult to prove their normality. A classic pseudo-patient experiment was carried out by David Rosenhan in 1973, when mentally well researchers were admitted to an institution under false diagnoses in order to observe life and treatment there, and to conduct research. At the end of each day they wrote down their observations, and the nurses retired to their rooms and wrote down in their case notes, “Patients exhibit strange writing behaviour”. If this place was assumed to be an asylum, I often wonder what exactly would disabuse people of that perception.

Closer to home, I conducted an evening class many years ago at Park Lane hospital, which was the predecessor institution of Ashworth hospital. I encountered there a very articulate and seemingly responsible young man who appeared ready for discharge. Years later, I saw the same individual on a TV programme about Park Lane hospital applying for a discharge, arguing on camera with his psychiatrist for release and asserting his sanity. His willingness to argue and his insistence was taken by the psychiatrist as an indication of his lack of insight. Until he agreed with his psychiatrist that he was still sick he would get no joy—that is a kind of inverse Catch-22. There are those with less cause who genuinely think that they should not be detained, and they have lawyers and access to the courts. They will contest this legislation and we cannot be entirely sure what the result will be, especially as we are forced in this case to act in haste.

We have to go ahead with the measure, but it may not be sufficient for our purposes. We may have to consider judicially reviewing all flawed cases to ensure that there is a sustainable basis for continued detention. I would genuinely prefer to believe that in this case I am wrong.

--- Later in debate ---

[Mr Hunt]

My hon. Friend is absolutely right. The key point is that those patients are free to challenge any element of the clinical decisions made as part of that very thorough process. This proposed law is about the technical irregularity only, and it is precisely because of the legal risks associated with that irregularity that we think it is necessary, in the interests of those 5,000 people, to enact this Bill.

[John Pugh]

I totally accept the point that the clinical need trumps the patient’s right to due process, but if the clinical need is questioned by the patient themselves it becomes more arguable, does it not?

[Mr Hunt]

If the patient wishes to challenge their clinical assessment, they are free to do so and the Bill will not affect that in any way. It is important that that point is understood. In fact, the Bill is very narrowly defined for that precise reason, and I think that is why the Attorney-General felt comfortable saying that it complied with the ECHR.

In conclusion, we have had a constructive debate on this very important and sensitive issue, but there are broader lessons to be learned about the importance, more generally, of mental health issues, and I and my colleagues in the ministerial team will take those very seriously as we progress. I am grateful to all hon. and right hon. Members present for their contributions to this debate.

Question put and agreed to.

Bill accordingly read a Second time; to stand committed to a Committee of the whole House (Order, this day).

Winterbourne View

John Pugh Excerpts

Tuesday 30th October 2012 Commons Chamber

[Norman Lamb]

I share the hon. Lady’s view on what has happened. We must make absolutely certain that every commissioner is held to account. My understanding is that proper arrangements are in place for all those individuals, but I will continue to monitor the situation to ensure that that remains the case. We must be alert to the interests of the 48 residents who were in Winterbourne View, but we must also focus our minds on the 1,500 people who are in settings of that sort—assessment to treatment centres—often for years. The interests of all those individuals are important.

[John Pugh (Southport) (LD)]

To put it bluntly, after all this, is the Minister still confident in the CQC and does he believe that it is fit for purpose?

[Norman Lamb]

I tend to the view that we have had too many changes of regulator over a number of years, and that continuity would be a good thing. An assessment of the CQC earlier this year indicated that it was on the right track. I have met the new chief executive and am reassured by the plans he has in place. It is seductive to believe always that it is an attractive proposition to abolish an organisation and set up a new one, but is there any more chance that a new organisation will be better? Let us therefore make the CQC work properly.

Mental Health Act 1983

John Pugh Excerpts

Monday 29th October 2012 Commons Chamber

[Mr Hunt]

I am grateful to my hon. Friend for saying that, but I think that we should extend our gratitude to the Opposition on this occasion. It is possible to move with speed only when there is cross-party co-operation, and I think that everyone has recognised the seriousness of the situation.

[John Pugh (Southport) (LD)]

Given the huge, overwhelming concentration on the subject of detention during the passage of the National Health Service Act 2006, which revised the Mental Health Act 1983, why was this departure from the law not brought to Members’ attention, or, indeed, to light? Someone in the Department of Health must be answerable, surely.

[Mr Hunt]

The truth is that no one in the Department of Health knew that this irregularity was happening. I do not think that anyone in the system knew that it was happening, until the issue arose in Yorkshire and Humberside when a particular decision was challenged. However, the hon. Gentleman is right: there is an important question mark over why it was possible for the irregularity to continue for so long without being noticed. I think that we need to listen to what Dr Harris says about why he believes that it was possible for it to continue for so long, and to act on his advice.

Oral Answers to Questions

John Pugh Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Dr Poulter]

I remind the hon. Lady that it was the previous Government who set up the current national pay framework in 2004, and that framework has been amended 20 times to support employers over that period. The previous Government gave foundation trusts the freedom to amend those pay terms and conditions. Regional pay does exist in the NHS. On the basis of what she has said, does the hon. Lady wish to remove the London weighting for those workers who live in London? I am sure she would not want to do that because we recognise that it is more expensive to live in certain parts of the country, and workers should be rewarded for that.

[John Pugh (Southport) (LD)]

The Lib Dem conference rejected regional pay entirely, but not the London weighting, and 25 honourable colleagues endorsed a submission to the pay review body. With that in mind, is it not odd that the south-west consortium remains part of national pay bargaining?

[Dr Poulter]

My hon. Friend makes a good point and it is important that we support national pay bargaining where we can. There is an agreement in principle, endorsed by NHS employers, that national pay bargaining is supported throughout the NHS. It was supported throughout the NHS under the previous Government, who set up the “Agenda for Change”, and during their tenure, that agenda remained fit for purpose. Twenty changes during the previous Government’s tenure benefited employees in the NHS, and rightly so. The current Government believe that we must continue to ensure that the system is fit for purpose.

Community Hospitals

John Pugh Excerpts

Thursday 6th September 2012 Commons Chamber

[John Pugh (Southport) (LD)]

It is an honour to follow the hon. Member for Bracknell (Dr Lee), who made an excellent speech. I also congratulate the hon. Member for Totnes (Dr Wollaston) on having initiated this important debate, and welcome the Minister, who has secured a deserved promotion. I think that we have all appreciated her analytical contributions to debates on health and on other matters.

I have only one simple point to make, which is better than my normal average. The fact is that community hospitals are in a slightly ambiguous category. Some are innovative, valued, highly rated and essential, while others are historical legacies of a previous age—expensive to run, limited in range, and out on a limb. Some areas depend on them, and some areas, such as mine, have absolutely none. I was a founder member of the all-party parliamentary group on small hospitals simply because my constituency contained a small acute general hospital. Dr Taylor was, of course, elected on an issue involving the closure of hospitals, which has been a shock to the whole political system ever since.

What a community hospital offers, what it consists of, how it is staffed and the services that it offers vary from one community to another, but what is universally the case is that, negatively or positively, we are now deciding what we will do about such hospitals and evaluating their place in the new system. There are three forces working against them. First, there are the perceived and evidenced benefits of specialisation—mentioned by the hon. Member for Bracknell—and the concentration of hospital services across many surgical and medical fields, leading to bigger and more expensively resourced general hospitals. Secondly, there is the encouragement given to GPs to provide more and more services in a primary care setting: tests, dermatology and the like. Thirdly, there is the encouragement given to non-NHS providers to offer clinical services at NHS prices. Given the additional fact that the last Government cut the umbilical cord which, in many instances, joined community hospitals to PCTs and effectively guaranteed their funding, the problem is clear.

The result of all that is that each community hospital has had to establish its own niche within an increasingly tightly regulated and exacting health economy. The range of services they provide varies: recuperative services, palliative services, minor injuries services, clinical and diagnostic services, blood tests, and—very importantly—the provision of satellite services for bigger players. It can look as if they are searching for a role, but their absence, closure or downgrading has the capacity to seriously unnerve communities and their MPs.

Hard-headed health economists and medics regard this as emotional populism; they see people getting upset about the survival of their community hospital as, in effect, a costly attachment to buildings. However, they misunderstand the public—and, to some extent, the rural—psyche. People have reasonable and rational expectations concerning the clinical quality of services, and the NHS tries to state them, define them and meet them. People also have reasonable, but generally unstated, expectations about access to services, and the NHS often dodges them, declines to state them, or shuffles off responsibility to the Department for Transport. People will travel to the ends of the earth for life-saving specialist care, but they see no reason in the modern age to travel 10 miles for a simple blood test or the triaging of bumps and falls.

We have to accept that acute care will increasingly take place only in ever-larger city hospitals, but there will be hassle for everybody, including relatives, if prolonged recuperation or chronic diseases are treated in the same place. It is true that over time GPs will do more and send fewer patients to hospital, but no GP will ever provide 24/7 open access. Very few GPs are now on call, and they do not offer the full raft of community hospital services.

If community hospitals are to have a long-term future, we have to be clear about access, access standards, what the reasonable standards of access are and what each citizen can reasonably expect from the NHS—a subject on which I had an Adjournment debate a few months ago. If that is not done, the future of community hospitals will be left to market forces to play out, which is not a game I see community hospitals winning.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Let me begin by congratulating my hon. Friend the Member for Totnes (Dr Wollaston) on securing the debate, and congratulating not just those who added their names to her motion but all who have spoken in what has been a very interesting and, indeed, passionate debate. In fact it has not really been a debate, because there has been an outbreak of agreement, certainly on the Government Benches, as so many speakers have spoken with such passion about the community hospitals in their constituencies.

I should also say thank you to all who have congratulated me on my appointment, and have said some rather kind things. I am sure that normal service will soon be resumed. Sadly, my right hon. Friend the Member for Chelmsford (Mr Burns), the former Minister with responsibility for health services, has now departed from that post and gone to another place, as it were—to another Department. We all miss him and thank him for his great service and his commitment to the national health service. He explained to the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) during a debate in June about community hospitals in the north-east that this Government support improvements in community hospitals across the country. That is because we know that community hospitals make it easier for people to get care and treatment closer to where they live. They allow large hospitals to discharge patients safely into more appropriate care. They free hospital beds for people who need them. Community hospitals allow many patients to avoid travelling to large hospitals—and many of those large, acute hospitals are in cities, with all the attendant problems of transport, parking and so forth.

Our community hospitals provide a wide range of vital services, including minor injury clinics and intensive rehabilitation, on patients’ doorsteps. They can also help save the local NHS money by moving services out of acute hospitals and closer to the people who use them. People are often rightly very protective of their community hospitals, as we have heard from many Members this afternoon. They deliver essential services, and provide employment for people who live nearby and spaces for community groups. It is therefore understandable that community hospitals are fiercely defended and inspire such loyalty.

If I am to retain responsibility for community hospitals, I shall be a busy Minister. I shall be going up to the north-east to Middlesbrough and Cleveland, to South East Cornwall, Bracknell, Newton Abbot, Cannock Chase, West Worcestershire, South Dorset, Penrith and The Border, Halesowen and Rowley Regis, Hexham, North Dorset, Wells, Tiverton and Honiton, including Seaton, and Denton and Reddish—although not to Southport as it does not have a community hospital. I am grateful for all those invitations, and if I can, I certainly will accept them.

My hon. Friend the Member for Totnes delivered a speech that was, as ever, thoughtful, inspiring and well-informed, and she asked a number of questions of me. If I do not answer all the points she raised, I hope she will forgive me, and she will certainly get a letter from me answering all of them. Let me state at the outset, however, that she has made a very powerful case in relation to the Community Hospitals Association and its database. Funding for that database was stopped. I cannot promise that it will be restored, but I can say this: I have asked my officials to look at that decision again with great care.

I anticipate that we will not have a vote on this motion, and it is of interest that the two Opposition Members present will abstain if there is a vote, because we have rightly heard a cacophony of voices from the Government Benches in support of community hospitals.

My hon. Friend asked about tariffs, as did the hon. Member for Denton and Reddish (Andrew Gwynne). It may be of some assistance, especially to my hon. Friend the Member for Penrith and The Border (Rory Stewart), for me to state that work is under way in the Department, looking at a payment system for patients suffering from long-term conditions. That includes services delivered in community settings. I trust that provides some hope. From 2013 and into 2014, tariff settings will be decided by Monitor and the NHS Commissioning Board. My hon. Friend the Member for Totnes made a powerful point about the potential importance of tariffs in ensuring the future of our community hospitals.

A good point was made about the decline in the number of GPs in some areas. I hope my hon. Friend will take comfort from the fact that my information is that there is a 50% target in respect of medical trainees going into general practice—I do not much like targets, but this could be a good one—and a taskforce has been set up to try to achieve that.

The future of community hospitals will, I hope, be secure in many of our communities, but it has to be said that many of the concerns Members have raised relate to local decisions, and it would not be right for me, as the Minister, to interfere in any of those decisions. My door is always open and I am always happy to meet hon. Members and any of their constituents. I may not be able to help in Cannock Chase, in Rowley, where there is difficulty, in Wells or in some other places, but I am happy to provide such support, assistance or advice as I am able to give.

Hon. Members have rightly discussed the future of the estate. I am conscious of the time, Madam Deputy Speaker, so I hope you will forgive me if I read out this part of my speech. It is important that hon. Members know and understand that the Health and Social Care Act 2012 required new ownership arrangements for current PCT estates. That means that providers such as community foundation trusts, NHS trusts and NHS foundation trusts will be able to take over those parts of the PCT estate that are used for clinical services. That includes the community hospital estate, but—this is an important but—we have put safeguards in place so that providers cannot just sell off newly acquired land and make a quick profit. Estates must be offered back to the Secretary of State for Health if, for example, the provider fails to keep the service delivery contract associated with the property or if the property becomes vacant. In addition, where any former estate becomes surplus to NHS requirements 50% of any financial gain made by the provider must be paid back to the Secretary of State and will go straight to front-line NHS services.

A Department of Health-owned limited company called NHS Property Services Ltd, to which reference has been made, will take on the remaining estate, as announced in January this year. Its key objective will be to provide clean, safe and cost-effective buildings for use by community and primary care services. I would like to assure every hon. Member, and every member of the public, that any community hospital building taken on by this company will be well looked after. Local clinicians will decide how those estates are used; whether new buildings are built or existing ones are closed will be up to them, as will all decisions about local patient services. As I have said, it is right that these decisions are taken locally. In reality, patients and the public will not notice any difference, at least in the short term. In the longer term, they will see that the NHS estate is managed more efficiently, by people who know what they are doing; that money will go to improve properties and front-line services.

NHS Property Services Ltd will own and manage buildings that are needed by the NHS. However, it will also be able to release savings from its properties that are declared surplus to NHS requirements. That money will be used further to improve property provision in the NHS. All PCT properties will transfer to either NHS providers or NHS Property Services Ltd on 31 March 2013. Until the provisional lists of property transfers have been finalised later in the year, I cannot confirm whether any particular community hospital will transfer to either an NHS provider or NHS Property Services. In the latter case, the community hospital services provider will become a tenant of NHS Property Services, in the same way that it is currently a tenant of the PCT.

[John Pugh]

Should the tenant, be it a community hospital or whatever else, seek to expand and should it need further facilities, is there a dialogue it will be able to have with the company to get it to extend the premises?

[Anna Soubry]

I am grateful for that question, but I shall be blunt and say that I do not know the answer. I will make inquiries and I will certainly make sure that the hon. Gentleman gets a full report in response.

Under the statutory provisions, while a building is needed to deliver NHS services, no NHS organisation will be allowed to sell it off, so there is no question of useful NHS property being sold to or transferred to organisations outside the NHS. At the same time, this means that a league of friends—a number of hon. Members have spoken with great fondness and admiration in support of leagues of friends, and I am sure that they will relay this to their local league of friends and their community hospitals—is unable to own the freehold of an operational NHS property. A league of friends is able to bid to become an owner of a community hospital only when it is declared surplus to NHS and public sector requirements. Current Government policy is that surplus property should normally be sold by auction or competitive tender. In such cases, the hospital league of friends would be given the opportunity to bid for the property along with all other interested parties. A league of friends could form a social enterprise to compete to provide services from a community hospital but, even then, as a social enterprise rather than an NHS body it could not take ownership of the assets of the community hospital. That might disappoint some, but I hope that in many ways it will give people comfort for the future and go some way towards addressing many of the points raised by my hon. Friend the Member for Totnes.

In conclusion, the Government have taken steps to secure the assets of community hospitals and ensure they are used for the benefit of their community. Those decisions will be made by people qualified to do so. That is the best thing for the hospitals and it is certainly the best thing for the communities that they serve. It is quite clear why so many people speak out so strongly and forcefully about community hospitals; it is because of the great work that they do. On behalf of the Government, I want to pay tribute to everybody who works in community hospitals and all the organisations that support them. I thank everybody who has contributed to the debate, which has been a very good exposition of the fine qualities of our community hospitals and, in particular, the organisations, such as the leagues of friends, that do so much to make them the great hospitals that they invariably are.

Oral Answers to Questions

John Pugh Excerpts

Tuesday 17th July 2012 Commons Chamber

[Mr Lansley]

I am grateful to the hon. Gentleman for that question, because it allows me to confirm that the annual report states that the NHS has met all the cancer waiting time standards, and that we in England have provided for 12,500 patients to have access, through the cancer drugs fund, to cancer drugs that they would not otherwise have been able to have. It is a matter of regret that a similar cancer drugs fund is not available for exceptional treatments in Wales.

[John Pugh (Southport) (LD)]

What part or percentage of the £5.8 billion efficiency savings can be attributed to the salary freeze alone?

[Mr Lansley]

If I may, I will write to my hon. Friend in order to convey the precise figure. From my recollection, I believe that the bulk of the £5.8 billion efficiency savings—£2.8 billion—was in the acute sector. As most of the acute sector’s costs are pay costs, the pay freeze will have contributed a significant part of that.

National Health Service

John Pugh Excerpts

Monday 16th July 2012 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

We have had a good debate, albeit one slightly curtailed by statements. We have heard 10 speeches from Back-Bench Members and I would especially like to commend my right hon. Friends the Members for Greenwich and Woolwich (Mr Raynsford) and for Holborn and St Pancras (Frank Dobson) and my hon. Friends the Members for Easington (Grahame M. Morris), for Ealing, Southall (Mr Sharma), for Brent North (Barry Gardiner) and for Stockton North (Alex Cunningham) for their contributions. I also rightly want to pay tribute to the many thousands who work in our national health service, doing a tremendous job in often challenging and difficult circumstances.

As we have heard in the debate today, there are growing problems in the national health service. We know that two thirds of NHS acute trusts—65%—are reported to have fallen behind on their efficiency targets. As we have heard from right hon. and hon. Members, we are starting to see temporary ward and accident and emergency closures, while a quarter of walk-in centres are closing across England. Despite the “Through the Looking Glass” world of Ministers—one where the Secretary of State for Health closes a debate—we now have growing rationing across the national health service, with treatments—including cataracts, hip and knee replacements—being restricted or stopped altogether by one primary care trust or another.

[John Pugh (Southport) (LD)]

Does the hon. Gentleman not acknowledge that the real weakness of this debate, as specified by the Select Committee Chairman, is that the Labour party has at no point spelled out how it would meet the £20 billion Nicholson challenge? Will he tell us?

[Andrew Gwynne]

We set out the Nicholson challenge, but I notice that the hon. Gentleman does not defend the decisions being taken by his Government to restrict or stop these treatments.

It is becoming increasingly clear that there is a gap between Ministers’ statements on the NHS and people’s real experience of it on the ground. In opening, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) incorrectly said that GP referrals have gone down. Figures published by the Department of Health on 13 July 2012 show that GP referrals are up by 1.9% year on year. Those are statistics from the Minister’s own Department’s. He is out of touch. Furthermore, the Minister said that NHS Hull is not restricting procedures on ganglia, but a freedom of information request we received says:

“NHS Hull will not routinely commission excision of ganglia”.

That was in April 2012, and it is a fact, again showing that Ministers are out of touch. The Secretary of State claimed that there is no such evidence of treatments being restricted or decommissioned.