(10 years, 5 months ago)
Commons ChamberMy hon. Friend will know, not least from the many occasions on which I have quite properly received representations from hon. Members, that it is important to Members of this House that they can advise and support their constituents on many issues arising from asylum and immigration and that they can do so effectively through their contact with the Home Office and its associated agencies. I will, if I may, ask my hon. Friend the Minister for Security and Immigration to respond directly to my hon. Friend on the subject of the cost of the asylum immigration hotline. If he is happy to do so, he might like to have a direct conversation about how we can best represent our constituents in a way that serves their interests.
Will the Leader of the House find adequate time for discussion of the outstanding reports from the Standards Committee that await debate and of the report from its predecessor, the Committee on Standards and Privileges, on the proposed revision to the guide to the rules relating to the conduct of Members? That report was published in December 2012, yet we are still waiting for time for a debate in the House.
I am grateful to the right hon. Gentleman for his question, which allows me to say that I had hoped that we might have resolved those issues before now. We have not and I hope that we will soon. We and other stakeholders across the House need to establish consensus not only on that important issue but on how we might take forward the issues that the right hon. Gentleman and his Committee are considering as regards a more general revision of the code of conduct. I hope that in our conversations and my representations to his Committee we might be able to strengthen the work of the Standards Committee and give greater reassurance to the public and our constituents about the independence and robustness of the processes we have in place.
(10 years, 5 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
I am grateful to my hon. Friend, who expresses that point very straightforwardly and well. I think the House will know that if at any point the lay members of the Standards Committee were to present an opinion to the House which had the effect of dissenting from the decisions of the Committee as a whole, the House would take that very seriously indeed.
The Select Committee on Standards adjudicates on individual cases but also has a duty under Standing Order No. 149 to consider any matters relating to the conduct of Members. On 22 March, before any of the current controversy arose, the Committee received a thoughtful paper from lay members on their impressions of their first year on the Committee from January 2013 to January 2014, which was also sent to you, Mr Speaker, and was placed in the Committee’s programme for future discussion. The Committee has already decided to examine the current system for consideration of complaints about Members of Parliament, to consider improvements as required. We will be drawing up detailed terms of reference over the next few weeks, drawing on the lay members’ reflections. The lay members will continue to play a leading role in this work.
The Committee has reported the lay members’ paper to the House and it is available on our website. As the lay members say, it is a matter of regret that the Committee on Standards and Privileges’ recommendations on standards issues have not yet come before the House but the Committee is determined to lead on these issues in the interests of maintaining the integrity of this House.
The Committee does not think it is appropriate to keep a running commentary on its decisions in individual cases, but at our meeting today the Committee authorised me to say that it continues to believe that its individual adjudications are impartial, fair and non-partisan. It is extremely important that those who express opinions on these cases both within the House and outside it should have read closely the careful reasons and evidence-based conclusions set out in each report. The Committee will continue to work closely and co-operatively with the commissioner to reach objective, fair and non-partisan adjudications.
I am grateful to the right hon. Gentleman, the Chair of the Standards Committee. What he illustrates is, as I said at the conclusion of my response to the urgent question, that this is a matter for this House, and the House does look to the Standards Committee, not least to advise the House on how our system of regulation of Members’ conduct can be as robust as possible. I hope that, in consultation with the Standards Committee and in discussion among the parties, we can ensure that any views that come forward, not least from the lay members, are reflected in changes if necessary.
(11 years, 1 month ago)
Commons ChamberOh, the hon. Gentleman said “please”! Okay, but I will give way to the Chairman of the Standards Committee.
The Standards Committee met this morning and has agreed a report on the implications of this Bill for Members of Parliament, and we are making strong recommendations that paragraph 2 of schedule 1 should be removed and that there should be a sub-paragraph in paragraph 6 stating that any payments we get from IPSA cannot be interpreted as money for lobbying. I hope the Leader of the House will take this into account and make sure the requisite amendments are made before the Bill leaves this House at the end of next week.
My colleagues will, of course, take what the Standards Committee has said very much into account, and I think that illustrates, contrary to what the hon. Member for Brighton, Pavilion said, why the Bill has not been badly drafted. This is not the first time this has happened. It happens with every piece of legislation in my experience. Sometimes we have to have belt, braces and a piece of string to make sure everybody is absolutely convinced that we are doing what we intend to do.
(12 years, 2 months ago)
Commons ChamberMy hon. Friend makes an important point. We want people who move from England to Wales or from Wales to England to have continuity of care, so I will make it clear to my counterpart in Wales that I am entirely open to discussions about that. Given that it is a devolved matter, it is better in a sense if the initiative for those discussions comes from Wales, because I do not want to be interpreted as trying to impose any solution on Wales, but if the Welsh Government look for such discussions I will be open to them.
In response to the White Paper, the NHS Confederation has said that people are
“staying in hospital longer…because the right services are not in place to allow them to go home when they are medically fit to do so.”
Given that it is estimated that delayed discharges from our hospitals cost some £18 million a month, what action are the Government taking to get rid of that waste of public money?
The total number of delayed discharges is broadly the same as it was last year and, I believe, from memory, the year before—I will correct the record if not. Some 29% of the delays in discharge from hospital are due to the inability to access social care. Most of them arise because people are awaiting further assessment or treatment in the NHS. We have all the details of delayed discharges and are working actively to reduce them.
(12 years, 3 months ago)
Commons ChamberI am grateful to my hon. Friend. There are many ways in which we can improve the control that patients can exercise, including greater opportunities for patients to exercise choice. In my announcement today, that includes the opportunity for patients to choose alternative providers of NHS care if, for example, the standard of 18 weeks that the constitution sets is not met. I might say that, at the last election, 209,000 patients were waiting for treatment beyond 18 weeks. That number has been brought down to 160,000.
My hon. Friend makes an important point about the exercise of control on the part of patients, who have an opportunity to access clinically appropriate care through the NHS. We will make sure that that is available and, as he knows, in relation to homeopathic treatments, for example, we have maintained clinicians’ ability across the service to make such treatments available through the NHS when they think that it is appropriate to do so.
I have not been able to read the annual report in the last few minutes, but may I ask the Secretary of State for Health whether it gives any information on the benefits of high-street pharmacy companies taking over the running of hospital pharmacies?
No, the annual report makes no reference to that. It refers—I hope, for the first time—in detail to the performance of the NHS over the past year. If the right hon. Gentleman wishes to raise any issues about that, I shall be glad to respond to him separately.
(12 years, 7 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
I am grateful to my right hon. Friend and thank him for his positive remarks about my noble Friend Earl Howe. I attach to that my appreciation to Baroness Northover for the work she has been doing in another place and to the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), who is responsible for care services, who has been heavily engaged in discussing some of the amendments. I recall that nearly a year ago there was a clear expression of interest from the Liberal Democrats, as a party, on how they felt the Bill should be improved. I was pleased that we were able to bring forward changes that reflected virtually all those. Indeed, they are reflected directly in what my right hon. Friend the Deputy Prime Minister said in his letter yesterday.
If the competition in the Bill is just an extension of what the previous Government did by introducing independent sector treatment centres and everything else, why are more than 90 clauses writing into the law of the land that competition policy should run the NHS, not the NHS, as has been the case in the past?
I would not characterise this as an extension of the independent sector treatment centres programme. That is precisely what we do not need to do with the private sector. Under the Labour Government, the private sector was paid 11% more than the NHS, which was wrong, and in another place there is a legislative provision that will prevent discrimination in favour of the private sector. The Bill will carry forward exactly the principles and rules of co-operation and competition, as reflected in the panel set up under the previous Government. As NHS Future Forum set out, the reason for having that in the Bill, with Monitor exercising those responsibilities, is so that there will be a health sector regulator, rather than that being done without health expertise by the Office of Fair Trading.
(12 years, 8 months ago)
Commons ChamberI am grateful to my hon. Friend. He rightly highlights an area where we are clear that innovation can be considerably supported, and not only by the academic health science centres, which were established under the last Government. As the life sciences strategy set out in early September made clear, we want to create academic health science networks across the NHS so that higher education, industry and the NHS can work together to bring about the greatest possible innovation to the benefit of patients.
The current pharmaceutical price regulation scheme is able to recognise the fact that pharmaceutical companies based here and developing drugs here should be paid a little bit more for their drugs by the NHS on the basis of their worth for the general economy. Will the Secretary of State tell us whether his proposals for value-based prices will affect that?
The right hon. Gentleman will be aware that the existing PPRS does not in any sense directly fund innovation in the United Kingdom. Although it takes account of expenditure on innovation, it cannot identify that expenditure in the United Kingdom as a beneficiary through pharmaceutical pricing. As the right hon. Gentleman knows, we are continuing to discuss with the industry the shape of value-based pricing from January 2014, the purpose being to ensure that we fund the value associated with new medicines: the therapeutic value to patients, the innovative value—which will highlight the UK as a base for research and development—and the societal value.
(12 years, 10 months ago)
Commons ChamberI am grateful to my hon. Friend and heartily welcome his support for the opportunities in regenerative medicine. I was fortunate enough to meet at the UK Stroke Forum last Thursday, among those exhibiting, a company that is based in England but undertaking trials and research activity in Scotland and is looking precisely at how it can use foetal-derived stem cells for regenerative purposes. The right hon. Member for Leigh (Andy Burnham) talked about Pfizer. In my constituency, it has been one of the companies leading the development of new regenerative medicine techniques. That is clearly one of the areas that this country has tremendous potential in developing. The technology innovation centre for regenerative medicine was announced in the “Plan for Growth” published alongside the Budget earlier this year, and I hope that it will be one of the areas in which we will see those developments.
The Health Committee, in its report on the electronic patient record, published in September 2007, stated that the highly detailed data captured had “outstanding” prospects for new and improved research, but it also asked that the best balance be found between
“the opportunity to improve access for research purposes with the ongoing need to safeguard patient privacy”.
Do the Government believe they can get that right, so that we can go ahead and use the enormous amount of data that we have in this country to improve health care for patients not just here, but throughout the world?
I am glad that the right hon. Gentleman is here and able to ask that question, because he was the Chair of the Health Committee in September 2007, when it stated that the secondary use of data in the NHS was “vital” for the development of the NHS, including for research use. I hope that he is one of those who recognise that what we are setting out in the life sciences strategy—in particular, with the clinical practice research datalink—will enable precisely all those secondary uses for research to be developed.
(12 years, 11 months ago)
Commons ChamberI am confident that we will make the progress that we seek. If we are not ready in any location, we will not be able to proceed with that procurement, but the PCTs will act on the basis of an evaluation of four pilots. To that extent, the character of what they are procuring through the 111 system will be well defined through piloting.
What progress has been made since the launch of the Secretary of State’s tobacco control plan last March in changing the behaviour of people who smoke in cars in the presence of children?
(13 years, 3 months ago)
Commons ChamberThe 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?
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.
(13 years, 5 months ago)
Commons ChamberYes. 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.
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?
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.
(13 years, 6 months ago)
Commons ChamberI 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.
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?
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.
(13 years, 8 months ago)
Commons ChamberI 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.
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.
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.
(13 years, 8 months ago)
Commons ChamberCan the Secretary of State tell us why the midwives association was not written to until 16 December?
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.
(13 years, 10 months ago)
Commons ChamberYes, 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.
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?
(13 years, 10 months ago)
Commons ChamberThe 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.
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.
(13 years, 10 months ago)
Commons ChamberNot 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.
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?
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—
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—
(13 years, 11 months ago)
Commons ChamberMy hon. Friend will be aware that we in the Department and across government have invited Will Hutton to examine pay differentials in public services, and we have talked to him about precisely that. In my hon. Friend’s area, the earnings of a qualified member of ambulance staff would be about £37,000 on average, which of course is only about a sixth of the highest pay of an NHS manager.
Past reorganisations of the national health service have taken years to embed and affected performance negatively, and history suggests that, given the scale of the reorganisations in the White Paper, they will be no exception. Can the Secretary of State tell us how much the administrative costs of the changes will be?
Perhaps I can remind the right hon. Gentleman that the major part of the reorganisation is to eliminate strategic health authorities and primary care trusts, to focus resources on the front line, to get them into the hands of those who are responsible for delivering care and, in the process, to deliver £1.9 billion a year of savings on administration costs.
(14 years ago)
Commons ChamberYes I will gladly do that. I have had the privilege and pleasure of visiting the specialist allergy service at my local hospital, Addenbrooke’s, one of a small number across the country. I think it was the House of Lords Select Committee that produced an excellent report on allergy services, and I hope that this is one of those areas where clinical relationships between GPs and hospital specialists will enable both community and specialist services to be improved to meet this need.
Given that 50% of health inequalities are created by tobacco use, will the Secretary of State give us an assurance that the targeted smoking cessation programmes in the national health service will survive?
We are going to improve the effectiveness of our public health services. As the right hon. Gentleman will know from past debates, I entirely recognise the extreme importance of reducing tobacco use. After the introduction of legislation on smoking in public places, there was a reduction in prevalence, but at the moment there is no continuing further reduction, especially among manual workers and young people; we need to achieve that reduction, and we will continue to look at measures to do that. We will say more about the issue in our public health White Paper.