NHS Future Forum

Kevin Barron Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Speaker]

Order. May I remind the House that Members who came into the Chamber after the Secretary of State began his statement should not expect to be called?

[Mr Kevin Barron (Rother Valley) (Lab)]

The Secretary of State must know that the biggest threat to the stability of the national health service is the introduction of competition law into clinical services. Will the clause that says that the mergers of NHS trusts will be a matter for the Office of Fair Trading and the Competition Commission be removed from the Bill?

[Mr Lansley]

The right hon. Gentleman should be aware that the Future Forum has recommended that the powers to be held by the Office of Fair Trading or the Competition Commission should be exercised by Monitor. That is because it believes it to be in the interest of the NHS for them to be exercised by a health service-specific regulator that is sympathetic to and has an understanding of NHS interests.

Oral Answers to Questions

Kevin Barron Excerpts

Tuesday 7th June 2011 Commons Chamber

[Anne Milton]

We most certainly can do better than that. I agree with my hon. Friend that such problems are often a barrier, and that therapy can unlock so much more. I refer him to service redesigns that have happened, such as at the Cambridgeshire Community Services NHS Trust, which redesigned its clinical pathways with the result that the number of children waiting longer than 18 weeks from referral to treatment fell from 409 in May 2010 to eight at the end of January 2011. That is a fantastic improvement in the service. This is not all about money, but about the way in which services are designed.

[Mr Kevin Barron (Rother Valley) (Lab)]

The Minister will know that more than 60% of inmates in young offender institutions have speech and communication problems. Can we ensure that the Green Paper addresses this matter not just within the national health service, but in education and wider, so that we can begin to tackle this problem, which has lain dormant in this country for decades?

[Anne Milton]

The right hon. Gentleman is right that we are not talking just about children. A number of people have languished and failed to achieve their potential, particularly their educational potential, for the lack of speech and language therapies. I take this opportunity to commend the work of Jean Gross, the communication champion, in raising and highlighting these issues.

Oral Answers to Questions

Kevin Barron Excerpts

Tuesday 26th April 2011 Commons Chamber

[Mr Lansley]

Yes. I am grateful to my right hon. Friend, and I can give him that assurance. Indeed, one reason why it is important to pause and to listen now is not least that shadow health and wellbeing boards have been put forward by 90% of relevant local authorities in England, and it is an opportunity for them to be very clear about how we can improve patient and public accountability. I hope that they and others will take that opportunity. As my right hon. Friend knows, the Bill already substantially improves both the public and the patient voice in the NHS, and we have to ensure that we take every opportunity now further to improve it.

[Mr Kevin Barron (Rother Valley) (Lab)]

If the Government do come back with some major changes to the Bill, will those changes go out to public consultation, and will this House have the opportunity to oversee and to look in detail at any further proposals they may make?

[Mr Lansley]

I think I made it clear to the right hon. Gentleman in the House on 4 April that we were looking to pause, to listen, to reflect and to improve the Bill, and we are taking the opportunity to do so now, before Report and Third Reading.

NHS Reform

Kevin Barron Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend for his remarks. He and other Surrey Members will be aware of that primary care trust’s past failure to manage effectively within its budget. The GPs in Surrey are, like many others across the country, coming together and demonstrating that they can achieve much greater service improvement within NHS resources—and those resources will increase in future years.

[Mr Kevin Barron (Rother Valley) (Lab)]

Does the Secretary of State recognise that the reorganisation and introduction of competition under this Bill have created chaos inside the national health service? What message does he have for the 40% of people who work for Rotherham PCT who have now taken redundancy, and who are getting out because they know they are aboard a sinking ship?

[Mr Lansley]

As we have demonstrated, NHS performance is continuing to improve, and it will improve further with clinical leadership, but we can achieve that effectively only if we achieve a £1.9 billion a year reduction in administration costs in the NHS. We have started that process: since the election, we have reduced the number of managers in the NHS by 3,000 and increased the number of doctors by 2,500.

Health and Social Care Bill

Kevin Barron Excerpts

Monday 31st January 2011 Commons Chamber

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

I beg to move, That the Bill be now read a Second time.

The purpose of the Bill can be expressed in one sentence—to improve the health of the people of this country and the health of the poorest fastest. While the previous Government increased funding for the national health service to the European average, they did not act similarly to increase the quality of care. We spent more, but others spent better. In important areas, the NHS performs poorly compared with other countries. An expert study found that out of 19 OECD countries that were investigated, the UK had the fourth-worst death rate from conditions that are considered amenable to health care. If NHS outcomes were as good as the EU15 average, we would save 5,000 lives from cancer and 4,000 lives from stroke every year. We would also prevent 3,000 premature deaths from respiratory disease and 1,000 premature deaths from liver disease every year. This cannot go on: things have to change to protect the NHS and deliver better results for patients.

[Mr Kevin Barron (Rother Valley) (Lab)]

I do not dispute what the Secretary of State says about European comparators, but what does he say to Professor John Appleby, who said last Friday that all those markers, some of which are not direct comparisons, are getting nearer to European targets? Professor Appleby suggested that the disruption that is going to take place in the health service will not help us to do that.

[Mr Lansley]

I would say two things to Professor John Appleby. First, the latest data published in EUROCARE-4, which I know the right hon. Gentleman will have seen, are clear about the gap between cancer survival rates in this country and others, and in recent years that gap has not diminished as it should have. He can read in last week’s Lancet an authoritative study of cancer survival rates in this country and a number of others demonstrating that the gap remains very wide and that we have to close it. Secondly, the King’s Fund supports the aims of the Bill and Professor Appleby, as a representative of the King’s Fund, clearly understands, as we do, that if we are to deliver the change that is needed, we need the principles in the Bill.

People trust the NHS, and its values are protected and will remain so—paid for from general taxation, available to all, free at the point of delivery and based on need rather than the ability to pay. However, a system in which everyone is treated the same is not one that treats everyone as they should be treated. Our doctors and nurses often deliver great care, but the system does not engage and empower them as it should.

--- Later in debate ---

[Mr Kevin Barron (Rother Valley) (Lab)]

I shall move on quickly. We had seven hours and 45 minutes to debate the Bill, but the first hour and 15 minutes was taken up by Front Benchers. Given that the Government have not found time to debate the White Paper that they published in July, we should probably have had two days’ debate on a Bill as important as this. As the shadow Secretary of State said, it is far larger than the 1948 Bill that established the national health service.

I find it difficult to find any justification for such a major reorganisation of our NHS. We have had a decade of major investment and we have seen improving services and major satisfaction ratings given by patients. In November 2009, the then Leader of the Opposition, now Prime Minister, said that

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

He was supported by the now Secretary of State for Health, who said as shadow Secretary of State in July 2007 that the NHS needed no more top-down reorganisation. Indeed, even after the general election, the coalition agreement stated:

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

It went on to spell out the continuing role of PCTs in some detail, pledging:

“We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust…The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level”.

A few months later, we have this potential chaos thrown on to the national health service. Once again, people are looking at the NHS and trying to change its culture by reorganising it.

We have had 30 years of Governments of different political persuasions trying to change the culture of the national health service by reorganisation. Every time, there have been years-long delays in implementation, performance has been affected in a negative way and there have been costs—particularly on this occasion, when the NHS is being instructed to make efficiency savings.

I agree with the report on commissioning just published by the Health Committee. I am not too sure whether the Chair agrees with it himself; the right hon. Member for Charnwood (Mr Dorrell) spoke earlier. The report states:

“The Coalition Programme anticipated an evolution of existing institutions; the White Paper announced significant institutional upheaval. The Committee does not believe that this change of policy has yet been sufficiently explained given the costs and uncertainties generated by the process.”

The last 30 years should tell the House and the Government exactly that.

[Dan Byles]

Will the right hon. Gentleman not concede that the Bill does not represent any reorganisation of NHS bureaucracy, of which there were many under the previous Government? It represents the abolition of a whole tier of unnecessary bureaucracy.

[Mr Barron]

That is an interesting comment, but the Bill does not represent that. In my borough, the PCT—as was; it still is, although it is now Rotherham NHS—will become the GP commissioning consortium. Let us not get away from that. The idea that getting rid of the strategic health authorities or anything else is going to save massive amounts of money is palpable nonsense.

Does anybody think that top-down meddling is going to end because of this reorganisation? If the local GP consortium does not offer provision as it should, the national commissioning board will tell it what to do. If that is not top-down, I do not know what is. Those will be the people responsible for whether local residents, particularly those who need specialised commissioning, are going to get the services or not. The idea that those people are going to be responsible for NHS dentistry in my constituency is nonsense. There has now been a move away from midwifery, and that was going to be commissioned nationally. The changes are nonsense; they have been ill thought out.

[Mr Graham Stuart]

rose—

[Mr Barron]

I give way for the last time.

[Mr Stuart]

The Chair of the Health Committee also set out the central challenge, which was recognised by the previous Government: to make major savings, year on year, for the next four years, at a time when budgets will not be able to increase—or at least not by much. How does the right hon. Gentleman think that that issue could best be addressed? Suggesting, as he did at the beginning, that we could just carry on as we were would not be sustainable.

--- Later in debate ---

[Mr Barron]

I am not saying that savings should not be made. Indeed, the Select Committee in the last Parliament took evidence from the chief executive of the NHS on that particular point. The case that I make is about the type of reorganisation. Not only has nobody in the public sector ever been able to get 4% a year in savings, but nobody in the private sector has, in the time scale being predicted now. [Interruption.] The Secretary of State says that that is rubbish—it is not rubbish at all. He should go and talk to his advisers about what happens in the real world, as opposed to the world that has appeared since July last year.

I would like to say something in defence of managers. This Government have been bashing managers in the NHS every week they have been in office, and did so for many months before they got there. How do they think we got waiting lists for things such as new knee and hip joints down from years to months, and even weeks, in areas such as mine? I will tell them. It was not done by taking the surgeons out of theatres to do the administration, but by putting people in to do the administration so that the surgeons could spend more time in theatres seeing more patients. That is the real truth. The management -bashing that has been taking place of people inside the NHS might be popular on the ground, but let me say this to the Government: if they take those managers out and we go back to the waiting lists and waiting times of five or six years ago, they will see where popularity lies.

[Andrew George]

Will the right hon. Gentleman give way?

[Mr Barron]

No, I will not; I have given way twice. The hon. Gentleman can make his own speech.

The King’s Fund, which the Secretary of State mentioned, supports some parts of the Bill. Indeed, I support a lot of its aims, but I do not support the reorganisation and upheaval that it will create inside the NHS. That is why I will vote against it. The King’s Fund says:

“The Bill abolishes the Health Protection Agency, places a duty on the Secretary of State to promote public health, and transfers responsibility for public health to local authorities.”

I agree with that. However, the Bill does not give me any confidence that GP consortia will have responsibility for the health of the population they cover.

Anybody looking at the history of public health in this country should recognise that we cannot run it on the basis of just handing it over to local government. The issues are far wider than that. The Secretary of State shakes his head, but people should look at the answers to questions that I got a week or so ago about what has happened to smoking cessation since this Government took over. Rates of smoking cessation have plummeted because of the advertising and promotion that is permitted. About 50% of health inequalities are created by smoking. The Government have taken their foot off the accelerator on the main thing that we should be doing to address public health inequalities, and they will suffer at the polls because of it.

Oral Answers to Questions

Kevin Barron Excerpts

Tuesday 25th January 2011 Commons Chamber

[Anne Milton]

I thank my hon. Friend for her question, particularly in highlighting this extraordinary practice. I have to say, it was news to me. I congratulate the efforts of that local organisation on highlighting this sort of issue with school children. There is no doubt that vodka eye-balling can cause damage to the surface of the eye, ulceration and scarring. Although it has got some publicity, however, a lot of young people are likely to be drunk in the first place when they do it, so the effects are probably overestimated.

[Mr Kevin Barron (Rother Valley) (Lab)]

Did the Minister hear the report on Radio 4 this morning that in the past decade there has been a 50% increase in the number of young people in their 30s being admitted to hospital with alcohol-related liver disease? Does she think that we ought to be looking at how alcohol is promoted and advertised around young people?

[Anne Milton]

I thank the right hon. Gentleman for his question. I heard the report, and I think that it made particular reference to the worrying trend among young women as well. There is no doubt that our public health White Paper is timely. We need to do something about this. It is important to remember that no one tool will fix this problem; we need to take a wide variety of measures and alter, in particular, young people’s relationship with alcohol. However, we will not do that until we get a proper strategy out there.

Swine Flu

Kevin Barron Excerpts

Monday 10th January 2011 Commons Chamber

[Mr Kevin Barron (Rother Valley) (Lab)]

Can the Secretary of State tell us why the midwives association was not written to until 16 December?

[Mr Lansley]

We made it very clear that everyone in the at-risk groups was going to be contacted through their GP surgery, and it is the responsibility of GPs to have done that.

Oral Answers to Questions

Kevin Barron Excerpts

Tuesday 7th December 2010 Commons Chamber

[Mr Lansley]

Yes, I am indeed aware of that, not least because the Bourn Hall clinic, where Robert Edwards and Patrick Steptoe did their groundbreaking work, is in my constituency. As a former vice-chair of the all-party infertility group, I feel strongly that the reason the NICE guidance was written as it was, way back in 2004, was to recognise both the distress and the extent of the difficulties that couples face, and the need for them to be assured not only of good-quality investigation, but of good quality follow-up provision in fertility services throughout the NHS. I urge PCTs to have regard to the NICE guidance in their commissioning decisions.

[Mr Kevin Barron (Rother Valley) (Lab)]

If this unfair situation in the commissioning of infertility services continues, and if the reconfiguration goes ahead, would it be the responsibility of the national commissioning board to address it?

Public Health White Paper

Kevin Barron Excerpts

Tuesday 30th November 2010 Commons Chamber

[Mr Lansley]

The support for women seeking the termination of a pregnancy should include the fullest possible information about the nature of that procedure and its consequences. Consent should always be fully informed.

[Mr Kevin Barron (Rother Valley) (Lab)]

There is much merit in what the Secretary of State has announced. Will the new outcomes framework, which will provide consistent measures to judge progress on key elements, include smoking cessation figures? As he well knows, 50% of our health inequalities in this country are created by tobacco use.

NHS Reorganisation

Kevin Barron Excerpts

Wednesday 17th November 2010 Commons Chamber

[Mr Lansley]

Not only is it my choice, but it is a necessity. As you said earlier, Madam Deputy Speaker, 15 Members wish to speak in the debate, and they will be allowed only seven minutes. I shall therefore take less time than the shadow Secretary of State did.

The Labour Administration pursued practice-based commissioning. Labour Members now make up numbers about how many GP-led commissioning consortiums there will be, but under practice-based commissioning there are 909 practice-based commissioning consortiums. The Labour Government did not give them any power, but they established them and they all have costs associated with them; there are 152 primary care trusts. Bureaucracy and cost in the system is legion, and we have to take it out; we have to reduce the number of people.

Under the Labour Administration the number of managers and senior managers in the NHS doubled. Where was the corresponding improvement in outcomes? The number of nurses increased by only 27%. That shows the kind of distorted priorities that were at the heart of the previous Government. They said that all NHS trusts should be foundation trusts by December 2008, but they simply did not bring that about; we are going to make it happen. They set up the idea of a right to request for staff in PCTs in provider services to become social enterprises, but we are the ones who are now bringing that about. Yesterday, I was able to announce 32 more social enterprises in the NHS, where staff are taking responsibility and ownership of the service that they provide, representing 15,000 additional staff and more than £500 million of revenue. If the Labour party is now against all the reforms that used to be part of the process of delivering greater empowerment of staff and patients in the NHS, what is it in favour of? I simply cannot find out the answer to that question any more.

What does represent a radical departure from the past is the fact that we are pressing ahead with the reforms with purpose and pace. I make no apology for the fact that we are going to achieve the changes required in the NHS more rapidly than anything that the Labour party did in the past—because not to do so would prejudice the opportunity to deliver resources to the front line, choice for patients and clinical responsibility for leaders across the NHS.

[Mr Kevin Barron (Rother Valley) (Lab)]

On at least two occasions in the House since the general election, the right hon. Gentleman has cited the Health Committee report on commissioning that was published in March, and used my name, as that Committee’s then Chair, to suggest that the report supports his changes in commissioning in the White Paper. Will he confirm that it does not do that? Where is the evidence that the change in commissioning will save any money?

[Mr Lansley]

What is very clear from the Health Committee’s report before the election is that, as the right hon. Gentleman knows, it criticised in strong terms the weaknesses of PCT commissioning, and that position has only been reinforced since then. One such example is out-of-hours services, for which PCTs were supposed to be the commissioners but did not properly scrutinise the services being tendered, and did not monitor the contracts or the quality of the contracts. PCTs have too often been responsible for simple cost and volume commissioning. What we are concerned with, because we shall engage clinical leadership in the commissioning of services through the NHS, is being engaged in commissioning for quality. Patients will be able to exercise choice based on real information that tells them about the quality of the services being provided, not the cost and volume—

[Mr Barron]

rose—

[Mr Lansley]

I have already given way to the right hon. Gentleman, and I am now going to conclude rapidly.

Contrary to what the right hon. Member for Wentworth and Dearne said, we have heard organisations from right across the NHS supporting the principles of the White Paper. The British Medical Association says that it

“strongly supports greater clinical involvement in the design and management”

of the health service.

The Royal College of Nursing said:

“The principles on which the proposed reforms are based—placing patients at the heart of the NHS, focusing on clinical outcomes and empowering health professionals—are both welcome and supported by the RCN.”

The King’s Fund said that it

“strongly supports the aims of the White Paper”.

The National Association of Primary Care described the White Paper as

“a unique opportunity to raise the bar in the commissioning and delivery of care for patients.”

The chairman of the NHS Alliance said that it provides

“a unique opportunity for frontline GPs... to make a real difference to the health of their patients”

The Foundation Trust Network said:

“the vision for the NHS articulated in the White Paper is the right one—putting patients and carers at the centre”.

The right hon. Member for Wentworth and Dearne made a number of specific points. He said that the reforms were an ideological gamble. Well, if they are, they are based on an ideology once shared by the Labour party; and if there is an ideology, it is the belief that patients and clinicians in the health service know best. That is not a gamble at all; it is a certainty.

The right hon. Gentleman talked about reorganisation, but he did not say that the number of managers in primary care trusts rose all the way through to last year in the face of the impending crisis in finances over which the Labour Government presided. He did not tell us that last year primary care trusts spent £261 million on consultancy—an 80% increase in such expenditure in two years.

The right hon. Gentleman gave us the benefit of some of his figures—some of his dodgy numbers—so let me give him a real number. Our decisions to cut the cost of management and administration in the NHS will release £1.9 billion of savings a year by 2014-15. That money will be reinvested directly to support front-line care, so there will be not only a real increase in the resources available to the NHS, but a real change and increase in the resources that get to the front line, because we are cutting the costs of administration and back offices.

Let me make this clear—