Oral Answers to Questions

Lord Lansley Excerpts

Tuesday 25th January 2011 Commons Chamber

[Christopher Pincher (Tamworth) (Con)]

11. What recent progress he has made in introducing GP commissioning consortia.

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

Last week, I announced the second wave of GP-led pathfinder consortia. There are now 141 groups of GP practices piloting the future GP commissioning arrangements. Those groups are made up of more than 4,000 GP practices, with over half the population starting to benefit from services that better meet their needs and improve outcomes for patients. The Health and Social Care Bill, which had its First Reading last week, sets out the legislative framework that supports our reforms.

[Mark Lancaster]

Consortia in Milton Keynes have been given £1 per patient as a transition fund. That money is most welcome. It will rise to £2 per head next year. The problem, however, is that the fund is proving hard to access because of the bureaucratic nature of the local primary care trust. Will the Secretary of State look into that and ensure that the money is accessible?

[Mr Lansley]

I entirely understand my hon. Friend’s point. The PCT’s role is to support the development of consortia, not inhibit it. The operating framework that was published last month sets out the range of support that PCTs should be offering emerging consortia. Milton Keynes PCT has confirmed that it will actively support Premier MK, one of two consortia in the area, with its application to become a pathfinder, and that it is actively working with another consortium in the Milton Keynes area.

[Stephen Mosley]

Pathfinder consortia will play a crucial role in improving the NHS, so it is imperative that any problems are sorted out as quickly as possible. How does my right hon. Friend propose to help any pathfinder consortium that finds itself in the unfortunate position of failing to deliver the results expected of it?

[Mr Lansley]

My hon. Friend makes an important point. He will recall that before the election, the Select Committee on Health severely criticised the way in which primary care trusts were going about commissioning. We are looking to consortia because they are clinically led and responsive to patients in designing far better clinical services, and they will have considerable support in doing so. Over the next two years, we will enable them to develop support arrangements, whether through existing primary care trust teams, local authorities, the NHS commissioning board, or a range of voluntary and independent sector organisations.

[Nick de Bois]

Will the Secretary of State outline the role that charities and voluntary organisations will play under GP commissioning to ensure that the needs and views of patients are at the heart of services?

[Mr Lansley]

To give my hon. Friend one example, last Friday I spoke to the Motor Neurone Disease Association, which has developed a commissioning support organisation with the Multiple Sclerosis Society and Parkinson’s UK. The voluntary sector can therefore be involved directly in helping GP consortia to commission for those critical diseases more effectively. My hon. Friend might have seen what Sir Stephen Bubb, the chief executive of the Association of Chief Executives of Voluntary Organisations, said last week:

“These reforms could herald a new and dynamic relationship between local GPs and charities that both deliver good services and act as a powerful voice for patients.”

[Mr Offord]

My constituents in Hendon are eager to see the improvements in health services that I believe GP commissioning will bring about. Will my right hon. Friend give examples of where GPs have had the freedoms and responsibilities that we can expect in Hendon?

[Mr Lansley]

My hon. Friend might like to speak to general practitioners in Redbridge in London who, as a pathfinder consortium, have been pioneering GP-led commissioning for 18 months. They have redesigned care for patients with diabetes and coronary artery disease, and are shifting care in ophthalmology and dermatology to primary care settings. They are demonstrating how this form of locally and clinically-led commissioning is more responsive to patients and more effective.

[Christopher Pincher]

As we shift from PCTs commissioning services to GP consortia doing so, can my right hon. Friend confirm that the important work done by pharmacies, such as providing anti-smoking clinics and the supervised consumption of drug substitutes, will not be left out in the cold?

[Mr Lansley]

My hon. Friend enables me to say that I and my colleagues entirely understand and endorse the stronger role that pharmacies can play, including by assisting with the provision of services such as minor ailments services and medicines use reviews, which will be commissioned through arrangements led by the NHS commissioning board. In addition, the services that he describes, such as stop smoking services, will be commissioned as part of the public health efforts, which will be led by local authorities through their local health improvement plans.

[Emma Reynolds (Wolverhampton North East) (Lab)]

Will the Secretary of State comment on the apparent conflict between, on the one hand, a general practitioner being an advocate for their patient and taking purely clinical decisions and, on the other hand, GPs having to allocate resources in the new system? Will that conflict not lead to a breakdown of trust in the relationship between the GP and their patients?

[Mr Lansley]

I am afraid the hon. Lady sees a conflict where, to GPs, there is none. It is their responsibility—[Interruption.] No, their first duty is always to their patients, whose best interests they must secure. When she has an opportunity to look at the Health and Social Care Bill, which we published last week, she will see that it makes very clear the duty to improve quality and continuously to improve standards. We all know that we have to achieve that with finite resources, but we will do that much better when we let clinical leaders influence directly how those resources are used rather than letting a management bureaucracy tell them how to do it.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Can the Secretary of State explain why, at a time when front-line NHS staff in my constituency and elsewhere across the country are in fear of their jobs, it is proposed that the NHS commissioning board will be able to make bonus payments to a GP consortium if, to quote the Bill,

“it considers that the consortium has performed well”,

and that a GP consortium may

“distribute any payments received by it…among its members”?

Is that not the worst kind of excess? We do not want to see it in our banking system, and we certainly do not want to see it in our NHS.

[Mr Lansley]

I am glad to have the opportunity to welcome the hon. Lady to the Opposition Benches and wish her well in representing Oldham East and Saddleworth. I am sorry that she did not take the opportunity to welcome in particular the Government’s commitment to the new women and children’s unit at the Royal Oldham hospital.

For years, general practices have been remunerated partly through a quality and outcomes framework. The principle is that if they deliver better outcomes for patients, they should have a corresponding benefit from doing so. In the same way, if the commissioning consortia deliver improving outcomes for patients, that should be recognised in their overall reward.

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

The Secretary of State talks a lot about GPs using £80 billion of public money to commission services, but if they are to carry on being family doctors, the planning, negotiating, managing and monitoring of hundreds of commissioning contracts will be done not by GPs but in their name, either by the people who do it now in primary care trusts or by the big health companies that are already hard-selling the service to new GP consortia. Is he not deliberately disguising the true purpose of his changes, which is to open up all parts of the NHS to big private health care companies?

[Mr Lansley]

On the contrary, the purposes of the Bill are very clear to see—for example, the duty to improve quality and raise standards throughout the health service. I hope that the shadow Secretary of State will acknowledge that putting clinical leadership at the heart of the system is essential. I entirely understand that leadership is not the same thing as management, as do general practitioners. The Prime Minister and I will meet the first wave of pathfinder consortia tomorrow, and we will support them in taking clinical leadership in designing services for patients and bringing to bear the best management support in doing so.

[John Healey]

Why will the right hon. Gentleman not be straight with the public? I have with me the White Paper—57 pages and only three references to the market, all of them to the social market. He talks about GP commissioning, but not about the hard-line political ideology that underlines these changes. The Bill puts no limit on the use of NHS beds and staff to treat private patients, it puts no limits on big private health care companies undercutting and undermining local hospitals, and it puts at the heart of the new system an economic regulator charged not with improving services but with guaranteeing and enforcing competition. Is this NHS reorganisation not like an iceberg, with the substantial ideological bulk being kept out of the public’s sight?

[Mr Lansley]

The shadow Secretary of State cannot actually criticise what we put forward in the White Paper or the Bill and is resorting to inventing something else and attacking that. Let me tell him that the one thing we will not do with the private sector is rig the market so that private companies get contracts and guaranteed money whether or not they treat patients. We are not going to give them 11% more money than the NHS would get for doing the same work. We will give NHS organisations a proper chance to deliver services for patients.

[Liz Kendall (Leicester West) (Lab)]

Whatever the Secretary of State claims about his reorganisation, a King’s Fund survey showed that more than three quarters of doctors do not believe that it will improve patient care, and even his Department’s impact assessment on the Health and Social Care Bill says that the reorganisation risks distracting staff and making them less focused on patient care.

Will the Health Secretary now confirm that the number of patients waiting more than six weeks for their cancer test has already doubled under this Government, and that routine operations are being cancelled? Will he finally listen to the Royal College of Nursing and the British Medical Association, which have told him that his plans are

“extremely risky and potentially disastrous”

for the NHS and patient care?

[Mr Lansley]

I find it astonishing that the hon. Lady should attack the NHS because some elective operations have been cancelled. We have been through a flu outbreak and very severe weather, and that is what happens as a consequence. She should not try to make a political point out of it.

It is also astonishing that the hon. Lady gets up and says that she does not agree with our policy. On 3 December, she is quoted in GP news as saying that

“it is ‘absolutely right’ that GPs are ‘better involved’ in commissioning services.”

She supported it. The truth is that before the election the Labour Government instituted practice-based commissioning, introduced foundation trusts, started payment by results and said that patient choice was right. The shadow Secretary of State said just last week that

“these plans”—

our plans—

“are consistent, coherent and comprehensive”,

and indeed they are.

[Tim Farron (Westmorland and Lonsdale) (LD)]

Cumbria’s current health commissioners—the PCT—chose to scrap the heart unit at Westmorland general hospital, despite medical, clinical and public opposition. Will the Secretary of State confirm that new GP fundholding arrangements allows the possibility of returning services that are clinically supportable, such as a heart unit at Westmorland general?

[Mr Lansley]

I know, not least from visiting that hospital, how strongly people in my hon. Friend’s area feel about their access to services locally. I am pleased to say that he will see in the Bill that one of the duties of the NHS commissioning board is to reduce inequalities in access to health services, and GPs can do precisely that.

[Mr Stephen Hepburn (Jarrow) (Lab)]

The Secretary of State knows fine well that the British public knew nothing at the general election of his plans dramatically to dismantle and privatise the NHS. Will he give them a say now and have a referendum on the issue?

[Mr Lansley]

Since we have no plan either to dismantle or to privatise the NHS, it is no surprise that people were not told of any such plan. Before the election and in the Conservative manifesto, people were told of our determination to cut bureaucracy and get money to front-line care. They were told of the determination of both parties in the coalition to get decision making close to the front line, to enhance accountability, including democratic accountability, and to give greater responsibility to clinicians to lead the development of services.

[Charlie Elphicke (Dover) (Con)]

2. What steps he plans to take to increase cancer survival rates.

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[David Rutley (Macclesfield) (Con)]

T1. If he will make a statement on his departmental responsibilities.

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

My responsibility is to lead the national health service in delivering improved health outcomes in England, to lead a public health service which improves the health of the nation and reduces health inequalities, and to lead the reform of adult social care which supports and protects vulnerable people.

[David Rutley]

Cheshire East council is working closely with local health care partners in my constituency to tackle the growing challenge of alcohol abuse, which not only causes serious illness and injury but costs our local primary care trust £34 million a year. Does my right hon. Friend agree that that is the right way in which to tackle this growing problem, and will a member of his ministerial team meet me, along with representatives of the council, to help secure the best possible outcomes in Macclesfield?

[Mr Lansley]

Of course we will support the efforts of my hon. Friend and his local council to tackle alcohol abuse. He will have heard what was said earlier by the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), which I entirely endorse.

Local authorities and their communities should have a greater say in what happens in their areas. We will enable them to do so, through the Health and Social Care Bill, the establishment of local health improvement plans, and—as my hon. Friend the Under-Secretary said—the alcohol strategy that we will introduce following the public health White Paper later in the year.

[Ian Lavery (Wansbeck) (Lab)]

T3. Does the Secretary of State envisage a time when GP consortia may be purchased by foreign companies, and operated and administered thousands of miles away across the globe?

[Mr Lansley]

No, I do not. I am glad that the hon. Gentleman has asked that question, because I think that there is a world of difference between the question of the exercising of clinical leadership by general practices as members of a consortium in an area and the question of from whom they derive management support. I believe that many will derive it from existing PCT teams, the voluntary sector and local authorities. Sometimes the independent sector will be involved, but it is a question of the consortium choosing where to go rather than being taken over.

[Margot James (Stourbridge) (Con)]

T2. Some care homes that have received critical reports from the Care Quality Commission are reopening under the same management but with different names. The CQC’s practice is to remove earlier poor reports from its website, leaving potential customers in the dark about the poor record of those homes. Will the Minister remind the CQC of its responsibility to highlight poor practice in care homes, and request that it change its practice?

[Paul Blomfield (Sheffield Central) (Lab)]

T5. A year ago, writing in The Sun, the Prime Minister made a firm and passionate pledge to increase the number of midwives by 3,000. Last week, the chief executive of the NHS told the Public Accounts Committee that the NHS is now short by 4,500 midwives. Will the Secretary of State tell the House when he intends to implement plans to honour the Prime Minister’s pledge—or can we take it that it is just another Conservative broken promise on the NHS?

[Mr Lansley]

Well, I do not wish to embarrass the chief executive of the NHS, but actually, he told me he made an error—he was referring to health visitors, not midwives, when he was talking to the Public Accounts Committee. We are short of health visitors precisely because, through the life of the last Government, the number was continuously going down, and we are going to recruit more. Actually, we share the last Labour Government’s commitment to increase the number of midwives, not least because of the increase in the number of births, and to do so in pace with that. As a consequence, in conversations that the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), and I have had with the Royal College of Midwives, we have made it clear that we will do all we possibly can. We already have more midwives in training than at any other time in our history.

[John Stevenson (Carlisle) (Con)]

T4. As Ministers are aware, GPs in north Cumbria are supportive of GP commissioning and are already working hard for its success. However, given the rural nature of the area, what support will be given to the local hospitals to ensure that they can provide secondary health care within the new regime, when they have to accommodate the additional costs of providing health care in a rural environment?

[Mr Lansley]

Yes, I entirely endorse what my hon. Friend says about GPs in Cumbria. They are indeed very forward-looking and show that, even under the last Government, practice-based commissioning was demonstrating its benefits, and we are building on that. I mentioned earlier the duty in the Health and Social Care Bill on the NHS commissioning board to reduce inequalities in access to health care. That will be important for rural areas. The pricing arrangements, led by the commissioning board and Monitor, must also take into account varying costs associated with the delivery of care in different localities.

[Mr Tom Harris (Glasgow South) (Lab)]

T8. If the Government will not even trust GPs with the responsibility of ordering flu vaccine, how on earth can they trust them with commissioning the care and treatment of cancer victims?

[Mr Lansley]

Of course, it was the last Government who agreed the arrangements with GPs. It was the last Government who, in 2007, undertook a flu review when central procurement of flu vaccine was recommended, but did nothing about it. The public health responsibility is distinct from the commissioning responsibility for health care of patients. We will look at, and we have still to make a decision about, how we procure flu vaccine in future years. We may do it through central procurement or through continuing GP procurement; but either way, we will make sure that we improve on the system we inherited.

[David T. C. Davies (Monmouth) (Con)]

T6. Can the Minister tell us how much money is spent each year on disposable surgical instruments, and whether any thought has been given to greater use of properly sterilised reusable instruments?

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[Grahame M. Morris (Easington) (Lab)]

T9. May I ask the Secretary of State directly about leaked documents seen by The Northern Echo? They show that a £53 million NHS contract to provide health care services to the prison service in the north-east was awarded to a private company, Care UK, even though the NHS provider was marked higher on quality, delivery and risk. Care UK beat the NHS provider only on price. Is this confirmation of the Minister of State’s remarks on Newsnight, that this Bill will create a full market and full competition?

[Mr Lansley]

The hon. Gentleman is asking about arrangements that we have inherited from his Government; they are from before the election and are nothing to do with the White Paper or the Bill. The contract to which he refers was let by the North East Offender Health Commissioning Unit. This was its procurement decision and it states that a competitive, robust and transparent process was followed. This was not a decision taken or influenced by the Department of Health.

[Karen Lumley (Redditch) (Con)]

T7. In support of national obesity fortnight, which is currently running, I wish to raise awareness of this serious condition, which causes numerous deaths and other serious health conditions. Redditch has high levels of obesity compared with the average in England. NHS Worcestershire is doing a fantastic job, but what more can the Government do to ensure that the NHS will not be overly burdened with increasing obesity problems?

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[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

The Minister of State referred earlier to Labour Members cherry-picking quotes, but I do not believe that Laurence Buckman, chair of the British Medical Association’s GP committee, was mincing his words when today he described the Government’s reorganisation plans as “fatally flawed”, warning that they

“would see the poor, elderly, infirm and terminally ill in large parts of the country losing out”.

Why does the Secretary of State believe that he knows better than Dr Buckman?

[Mr Lansley]

I do not recall the BMA ever agreeing with the previous Government. Let me provide one quote to the hon. Lady:

“The general aims of reform are sound—greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes—and are common ground between patients, health professions and political parties.”

The shadow Secretary of State said that last week.

[Duncan Hames (Chippenham) (LD)]

The NHS Litigation Authority has presented NHS Wiltshire with a bill for more than £3.5 million in clinical negligence scheme payments this year. Nationally, among closed claims, legal fees made up more than a third of costs last year. How does the Minister propose to switch this expenditure away from lawyers and towards front-line health services?

[Mr Lansley]

I wish, first, to say two things, but there may be further to add. First, my right hon. and learned Friend the Secretary of State for Justice is working on the implementation of the Jackson review. That, in itself, will help considerably in reducing the extent to which these costs are consumed in legal fees, rather than proper compensation for clinical negligence. As we made clear in response to Lord Young’s report, we will also pursue the question of whether we can have a fact-finding phase following up a claim against the national health service, so as to mitigate what is otherwise considerable additional cost on conditional fee arrangements and getting expert witnesses.

[Mr Dennis Skinner (Bolsover) (Lab)]

Why is it that the Secretary of State does not compliment the Labour Government on providing £110 billion, starting with £33 billion in 1997? Is it not a fact that waiting times have fallen as a result of the nurses, the doctors and that money? Is he frightened to utter the words because in 2001 every single Tory MP marched through the Lobby not to give the money to the national health service?

[Mr Lansley]

Let me remind the hon. Gentleman that at the general election we just fought we were the party that was committed to increased resources for the national health service. We are the coalition Government who, over this Parliament, will increase resources for the national health service by £10.7 billion, even in the face of the deficit we inherited from Labour. The hon. Gentleman’s party’s response was to tell us that we should cut the NHS, and we are not going to do it.

[David Tredinnick (Bosworth) (Con)]

Will my right hon. Friend the Secretary of State please explain why it is taking so long for him to come to the House about the regulation of herbal medicine? He has to do that before April to comply with European legislation. What is the hold-up?

[Dr William McCrea (South Antrim) (DUP)]

Specialists in the field state that the figures that point to a more than 50% rise in young drinkers ending up in hospital are a gross underestimate of the serious problem. What further steps can the Department and the Government take to address this important problem?

[Mr Lansley]

As the hon. Gentleman will recall from earlier exchanges, it is absolutely right that we must have a series of measures to tackle alcohol abuse. Price is part of it, as is the enforcement of legislation. Community alcohol partnerships have been very promising. We must have better alcohol education, and I spoke at the first annual conference of Drinkaware yesterday, encouraging it in the work that it does. We must understand that we have to change people’s behaviour and that the damage that can be done is intense. As a consequence of chronic alcohol abuse, large numbers of people are coming in and out of intensive care units, presenting an enormous burden to the health service as well as doing great damage to themselves.

[Gordon Birtwistle (Burnley) (LD)]

The College of Emergency Medicine recently stated that if a hospital A and E unit is to be downgraded to an urgent care centre, the nearest A and E unit should be no more than 12 miles away. Will the Secretary of State revisit the cases of A and E units that were recently downgraded by the previous Government to urgent care centres when the nearest A and E unit is more than 12 miles away?

[Mr Lansley]

Yes. My hon. Friend makes a very important point. I promise I will discuss with John Heyworth of the College of Emergency Medicine precisely the point that my hon. Friend has raised. The College of Emergency Medicine says that it does not recognise what an urgent care centre is. From its point of view, hospitals should either have an emergency department or an A and E or they should not. If they do not, it is very important to be clear that they do not. I feel that we need to be much clearer about the nature of the service provided in A and E departments and the distinction between that and the service provided in minor injury or minor illness centres.

[David Wright (Telford) (Lab)]

Do not the reorganisation plans for the NHS, coupled with cuts to local authority budgets, mean that public health projects in this country will effectively be binned?

[Mr Lansley]

No, they will not. We are making very clear our determination to ring-fence public health budgets so that prevention does not suffer, as it did under the hon. Gentleman’s Government. In 2005-06, the first things to disappear as a consequence of financial pressures were the public health budgets and public health staffing. We will not allow that to happen.

[Zac Goldsmith (Richmond Park) (Con)]

I welcome the Government’s commitment to ending mixed-sex wards, but does the Secretary of State agree that it is both unnecessary and extreme to extend that policy to children’s wards and to enforce it with the threat of fines?

[Mr Lansley]

I entirely understand my hon. Friend’s point, and the rules we have set out for the NHS are very clear. We are also clear that we will ensure, through the NHS, that people have access to the privacy and dignity they have a right to expect, contrary to what the hon. Member for Leicester West (Liz Kendall) has said. She said that as long as they get the treatment through the NHS, it does not matter whether they are in mixed-sex accommodation, but that is not our policy. It does matter, and we will enforce it.