NHS Reorganisation Debate
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Lord Lansley
Main Page: Lord Lansley (Conservative - Life peer)Department Debates - View all Lord Lansley's debates with the Department of Health and Social Care
(13 years, 9 months ago)
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John Healey
We were doing what the manifesto said before the election. [Interruption.] We were doing it where the private sector and competition could add capacity to clear waiting lists, or do something new that the NHS was not doing. We did it in circumstances that were carefully planned, properly managed and always publicly accountable. If the hon. Gentleman is going to swallow the guff from those on his Front Bench that this is somehow an evolution of Labour’s policy, he will have to ask the Health Secretary why he needs legislation that is more than three times longer than the Act that set up the NHS in the first place.
Why do we say what we do in the motion before the House? In truth, this is a Tory reorganisation, and the legislation has been mis-sold. It is not just about getting GPs to lead commissioning or looking to cut layers of management; it is setting up the NHS as a full-scale market driven by the power of the competition regulator and the force of competition law. The reorganisation and legislation is designed to break up the NHS, open up all areas of the NHS to private health companies, remove requirements for proper openness, scrutiny and accountability to the public and to Parliament, and make the NHS subject to both UK and European competition law. The Tories are driving the free market political ideology through the heart of the NHS.
The Secretary of State for Health (Mr Andrew Lansley)
On precisely that point about scrutiny and accountability, we have been talking about independent sector providers. Under Labour, if scrutiny committees in local authorities wanted to investigate the activities of independent sector providers they could not do so. Under our legislation, they will be allowed to do so. Wherever NHS money—the public pound—goes, scrutiny will be able to follow. That is a change for the better.
John Healey
That is simply not true. The people who will make the big decisions about £80 billion of spending—the GP consortia—will not need to meet in public or to publish minutes of their meetings. They will not be subject to scrutiny by this House or proper public accountability.
Let me turn now to the question of subjecting the NHS to UK and European competition law. The Prime Minister clearly did not know about that at Prime Minister’s questions today—he clearly did not know that a third of his legislation sets up this new free market NHS. Perhaps the Health Secretary has only told him half the story about the legislation—
John Healey
Shall I finish what I have to say? Then I will give way. If the Health Secretary has not told the Prime Minister, he certainly has not told the public or this House, so let me spell it out—[Interruption.] The Health Secretary says that I have made it up, but why not wait for me to explain to the House, and then he can say whether what I am about to explain to the House is in my words or his?
Clause 52 of the Health and Social Care Bill, entitled “General duties”, sets up the new competition regulator, Monitor, and says:
“The main duty of Monitor in exercising its functions is to protect and promote the interests of people who use health care services—
(a) by promoting competition where appropriate, and
(b) through regulation where necessary.”
The new regulator is given legal competition powers, as well as functions under the Competition Act 1998 and the Enterprise Act 2002, and there are provisions on reviews by the Competition Commission and co-operation with the Office of Fair Trading.
John Healey
The Secretary of State can speak in a minute; I will finish this point. The regulator can investigate complaints about competition, force services to be put out to competitive tender, remove licences and fine the commissioner or provider up to 10% of their turnover. Helpfully, the Government’s new chair of Monitor confirms that. In The Times last month, he said:
“We did it in gas, we did it in power, we did it in telecoms, we’ve done it in rail, we’ve done it in water, so there’s actually 20 years of experience in taking monopolistic, monolithic markets and providers and exposing them to economic regulation”.
Mr Lansley
It is dead simple: the Health and Social Care Bill does not extend the application of EU competition law, or the application of domestic competition law. The powers given to Monitor as a sector regulator are the same as those now available to the Office of Fair Trading. The Bill does not change the scope of competition law at all.
John Healey
The right hon. Gentleman was involved, so he knows better than anyone else that the Tories are now setting out to do to the public services, including the NHS, what they did to the public utilities in the 1980s.
The Secretary of State for Health (Mr Andrew Lansley)
The Labour motion is interesting. I will ask the House to reject it, but it is an interesting motion. The first half of it accepts the principles of our reforms—it even does so in the same terms in which we have expressed them—but in the second half it goes on to say, “Not yet. Don’t make us do it yet.” Labour Members are turning their backs on the change that we need in the national health service and even on the policies they pursued in government.
But it is time for change. The public agree—65% of adults in England think that fundamental changes are needed in the national health service. The need to improve results for patients demands it. The need to empower clinical leadership demands it. The need to cut bureaucracy and invest in front-line care for patients demands it. As a coalition Government, we do not shirk our responsibilities. We have been absolutely clear that the NHS will remain free at the point of need, paid for from general taxation and based entirely on need and not on the ability to pay.
Those values are not, and never will be, threatened by this Government. The Health and Social Care Bill will not undermine any of the rights in the NHS constitution. It is for those same reasons that we, in a coalition Government, are protecting the NHS in the life of this Parliament by increasing NHS funding by £10.7 billion.
Clive Efford (Eltham) (Lab)
Will the Secretary of State distance himself from the comments of Dr Charles Alessi, a GP alleged to have been one of the architects of GP commissioning in this Bill and one of the people invited to No. 10, who is of the opinion that too many people in his area are receiving treatment for macular degeneration? Is that not rationing services and nothing whatsoever to do with providing them on the basis of clinical need?
Mr Lansley
All GPs and their colleagues who were part of the first wave of pathfinders were invited to No. 10—there were far more than we ever expected—and Charles Alessi was one of them. It is a complete illustration. I do not know what Charles said or why he said it, but he is the doctor, not me. Frankly, I think that it is clinical leaders in the NHS who are responsible for what they say, not me.
Nadhim Zahawi
Does my right hon. Friend agree that the way in which the Opposition are conducting themselves, when they proposed a 20% cut to the NHS, is scaremongering among our constituents and entirely irresponsible?
Mr Lansley
My hon. Friend makes an extremely good point, and he made it to the shadow Secretary of State, who did not answer it.
Mr Lansley
No.
The fact is terribly clear that before the election the Labour Government said that in three years the NHS would have to save between £15 billion and £20 billion. The Labour party never said in government that that money, if saved in the NHS, would be reinvested in the NHS. The other point is that when we came to the spending review, in which we agreed £10.7 billion extra for the NHS over the life of this Parliament, the shadow Secretary of State’s friends, who were then responsible, said that we should cut the NHS. We do not need to speculate about what they said they would do, because we can look at the example of Wales. The Labour-led Welsh Assembly Government are proposing to cut the NHS budget in Wales by 5%, while we are increasing it. We know exactly what Labour would do if they were in charge of the NHS: they would cut it. We have not cut it and are going to protect it.
Simon Hughes
I share absolutely my right hon. Friend’s view that the protection of the budget and the commitment to the principles of the NHS, which he has just enunciated, are really valuable and that Labour’s record in forcing privatisation undermines its whole argument. He knows that there are concerns. Having come back from the debate in my party, I ask him straightforwardly whether he will take on board the concerns expressed and look at ways to strengthen and further improve the Bill as it passes though this House and the House of Lords.
Mr Lansley
My right hon. Friend was busy in Sheffield over the weekend, but he might have heard me say on Sunday that where there are legitimate concerns, founded in reality rather than myth, about how we will secure the NHS and its modernisation for the future, we will listen. We have listened and changed the policy before the Bill was introduced. We have already amended the Bill during the course of its passage so far and will always look to clarify and improve it as it proceeds.
Mr Lansley
I will give way to the hon. Gentleman, and perhaps he can explain why the Labour party leading the Welsh Assembly Government will cut the NHS by 5% while we are going to increase the budget by £10.7 billion.
Michael Dugher
I might be new to Parliament, but we ask the questions and he is supposed to answer them. The Secretary of State knows full well that patient groups, health charities, doctors and nurses oppose the Bill—even that shower opposite opposed it at their conference. Is it not just arrogance on the part of the Government—
Madam Deputy Speaker
Order. It was not an opportunity to ask another question, either.
Mr Lansley
The hon. Gentleman has now learned that, if one is trying to pray somebody in aid, it is best not to insult them at the same time.
We have made it clear that we need to protect the NHS now and for future generations through modernisation. Under the Labour party—
Mr Lansley
Ah! Now we really do have somebody who can explain why in Wales the Labour party is cutting the NHS budget while we are increasing it. Come on!
Owen Smith
That is happening as a result of the very difficult decisions being taken in Wales, having seen the Welsh Assembly budget cut by £1.8 billion by the right hon. Gentleman’s Government. What we are not doing in Wales, however, is effectively privatising the NHS, exposing it to competition law or stuffing the mouths of private companies with public gold.
Mr Lansley
Let us remember that, when we decided to support the NHS here, through the Barnett formula by extension, money was provided to the devolved Administrations, but the hon. Gentleman confirms that a Labour-led Welsh Assembly Government chose not to invest in the NHS, while we in England chose to do so. I urge Welsh voters to remember that when they come to the elections in May.
Under the trade union thumb, Labour is turning its back on modernisation in the NHS, but the NHS cannot be preserved for the future and protected by neglect; it is not something that sits in a static format. It has to change to improve. When the number of managers in the NHS doubled under Labour, when results for patients in many conditions remain way below those achieved in other countries, and when the number of patients placed in mixed-sex accommodation runs into the thousands every month, the NHS needs to change.
Brandon Lewis (Great Yarmouth) (Con)
Does my right hon. Friend agree that some GPs are seeing the potential benefits to their local areas of improving the service for patients, and will he join me in congratulating GPs, such as those in Great Yarmouth, who are moving forward, several years ahead of schedule, with the pathfinder projects?
Mr Lansley
Yes. My hon. Friend will know that we have already arrived at the point where 177 GP groups, representing 35 million patients all over England, have volunteered as pathfinders to show how they can demonstrate such work. [Interruption.] Labour MPs who are insulting general practitioners might like just to remember—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Come on; we want to see the debate continue. A lot of Members want to speak and to intervene, but we cannot have so many of them on their feet at once.
Mr Lansley
I remember that if we ask the public whom they trust in public service, we find that general practitioners are at the top of the list. Members of Parliament and politicians are pretty near to the bottom of the list, so the public might take it pretty amiss that Labour politicians are insulting general practitioners by thinking that they are in it for the money. They are not; they are in it for the patients.
Kate Green (Stretford and Urmston) (Lab)
Will the right hon. Gentleman give way?
Joan Ruddock (Lewisham, Deptford) (Lab)
Will the right hon. Gentleman give way?
Mr Lansley
In a moment.
Only yesterday, the Public Accounts Committee said that over the past 10 years the productivity of NHS hospitals had been in almost continuous decline, and that taxpayers were getting less for every pound invested in the NHS: Labour, leaving us to sort out the mess. The truth of the matter is that the NHS needs to change to meet the rising demand for and cost of health care.
The changes that the NHS needs are simple: more investment, less waste, power to front-line doctors, nurses and health professionals, and to put patients first.
Mr Nick Raynsford (Greenwich and Woolwich) (Lab)
Will the right hon. Gentleman give way?
Mr Lansley
No. I will give way to the right hon. Member for Lewisham, Deptford (Joan Ruddock) first.
Joan Ruddock
The right hon. Gentleman speaks of the respect that patients have for their GPs, and that is certainly the case in my area, where GPs do an incredibly difficult and demanding job. How does he think, therefore, patients and the doctors themselves regard the pressure being put on them to become managers, to adopt skills that they do not have, and being forced to do it, when they say to me that the plans are untested, potentially divisive and will take them away from their patients? Those things are actually happening. Does he think that it is ethical to pay GPs £300,000 to cut services to patients?
Mr Lansley
The Royal College of General Practitioners has said that it believes that there should be more clinician-led commissioning, and yesterday the British Medical Association reasserted its view that general practice-led commissioning is the right way forward. The Labour Government set up practice-based commissioning but, as the shadow Health Minister, the hon. Member for Leicester West (Liz Kendall), said, GPs were not given the power, responsibility and opportunity to do it. I am afraid that the right hon. Member for Lewisham, Deptford is speaking against the evidence and the experience of GPs all over the country.
Andrew Bridgen (North West Leicestershire) (Con)
Does my right hon. Friend agree that the words of the shadow Secretary of State in this debate seem to contrast somewhat with his words back in January, when he said that
“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”?
Why does my right hon. Friend think he has changed his mind?
Mr Lansley
Yes, that is one possibility. Another is that Labour Members are paid for by the trade unions.
Our changes are driving real improvement. Our investment means that more than 1,300 patients are now getting the life-extending cancer drugs they need; that is investment in cancer drugs that the Labour party opposed.
Mr John Baron (Basildon and Billericay) (Con)
My right hon. Friend is absolutely right to make no apology about the need for reform when cancer outcomes in this country remain well below the European average. The all-party group on cancer and, most recently, the Public Accounts Committee have made the case for recording staging data, which provide an insight into early diagnosis. Will he assure the House that, under these reforms, the importance of this issue will be pursued by the Government?
Mr Lansley
Yes. I am grateful to my hon. Friend and pay tribute to his work in this area, which is much respected. He is absolutely right—we will be doing that. Indeed, we can see the benefit already. A few weeks ago, I launched the bowel cancer awareness campaign in the east of England. The reason we were able to start that awareness campaign in that region is that we had good staging data arising out of the cancer networks in the area, which means that we will be able to make valid comparisons between the past and the future in terms of the stage at which patients are presenting for diagnosis of cancer.
Mr Lansley
No, I have given way to the hon. Gentleman before. [Interruption.] He only gets one shot.
Let me make it very clear. Our cuts in bureaucracy—
Mr Lansley
No, I will not give way—Labour Members might like to hear this.
Our cuts in bureaucracy have led to 2,000 fewer managers since the general election and 2,500 more doctors. We are already shifting resources to the front line. More than 5,000 surgeries across the country are now part of the pathfinder groups taking responsibility for front-line services. Some 25,000 front-line NHS staff are taking the opportunity to come together in social enterprises. All this is the modernisation that Labour now opposes. It is the modernisation that is delivering the results that matter, and will matter in future even more as we get to the outcomes that people really care about—whether they live, whether they recover, whether their treatment is successful, whether they have successful lives at home with long-term conditions.
At the same time, waiting times are stable and hospital infections are down, with C. diff down by a fifth and MRSA down by more than a quarter. The number of patients who are in mixed-sex accommodation when they should not be has also come down.
Mrs Anne Main (St Albans) (Con)
Does my right hon. Friend agree that we should totally dissociate ourselves from the disgraceful remarks implying that our reforms will somehow encourage GPs to make choices that are not best for their patients?
Mr Lansley
My hon. Friend makes a very important point. I caution Labour Members not to put political opportunism in place of the relationships that they should have in future with GPs, doctors and nurses and local foundation trusts in their constituencies. They are not speaking for their constituencies—they are just speaking for the trade unions.
The coalition Government are listening to patient groups, professional bodies and independent experts. We have had eight separate substantial consultations on our proposals, and we have changed policy as a result. For example, we have amended the Health and Social Care Bill on an important point, which greatly concerned the BMA, and clarified that the measure supports competition on quality, not price. At the point when a patient exercises choice or a GP undertakes a referral, the price of providers will be the same. By extension, competition must be on the basis of quality. That is important.
Malcolm Wicks (Croydon North) (Lab)
Given the removal of the limit on private patients who can go to an NHS hospital, my constituents will be concerned that, in conditions of scarcity, clinical need for a bed will be trumped by the weight of a wallet. Will the Secretary of State reassure my constituents that money will not trump the needs of patients?
Mr Lansley
Yes. I can entirely reassure the right hon. Gentleman’s constituents because the Bill makes it clear that even if private patient income is available to foundation trusts, it must support the principal purpose, which is provision of services to patients through the NHS. If the right hon. Gentleman wants an example, he might like to go along the road into the constituency of the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), and meet people from the Royal Marsden, which is a foundation trust that attracts, from memory—I may not be entirely up to date—approximately 25% of income from private patients. It has consistently recorded the highest scores of excellence for its quality of service to patients.
Mr Lansley
I want to make progress. I have given way several times.
The right hon. Member for Wentworth and Dearne (John Healey) said that we planned to get rid of regional system management in the NHS, but that was Labour’s policy when it introduced NHS foundation trusts. Through introducing health and well-being boards in local authorities, we will have a genuine, system-wide view that looks at the NHS, public health and social care. He complains about the commercial insolvency regime, but Labour introduced that under the legislation that set up the foundation trusts eight years ago. He said that our plans introduce EU competition law. No. EU competition law already exists and the Bill does nothing to change that—it does not extend the application of competition law. [Interruption.] No, it does not. In Committee, the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), explained the current position, which the Bill does not change.
The right hon. Member for Wentworth and Dearne and other Labour Members talk about price competition. We have clarified the Bill to ensure that the competition is on quality. What happened under Labour? The private sector was paid 11% more than the NHS. Under Labour, private sector providers were paid £250 million for operations that they did not perform. Under Labour, NHS hospitals were barred from tendering to provide the capacity that Labour offered to the independent sector. Labour Members favoured the private sector. A Liberal Democrat manifesto commitment stated that we would not in future allow the private sector to be given advantages and the NHS to be shut out. We will implement that.
I want to know a bit, because although the right hon. Member for Wentworth and Dearne said that it was the Opposition’s job to ask questions today, I have done many Opposition day debates on health when I was asked many times what our policy was, and I answered those questions. Is it Labour’s policy to extend the use of voluntary sector providers in the NHS? That was in the Labour party’s manifesto. Indeed, Labour said that it wanted to use the independent private sector, too. Is it still the policy? No answer. We do not know. Is it Labour’s policy to make every trust an NHS foundation trust? Again, it was in the Labour party manifesto. Is it still the Labour party’s policy—yes or no? No answer. Again, we do not know. Is it Labour’s policy to promote competition in the NHS, as quoted from the Labour party manifesto in the debate? The right hon. Gentleman has just made a speech opposing that. Does he wish to intervene?
John Healey
I am grateful to the Secretary of State for giving way. We had the NHS as the preferred provider and were ready to use other providers when they could help, and we did so. The great improvements in the NHS happened because we were prepared to put in the investment and to make the reforms. The Secretary of State talks about policies. The problem with what he is doing to the NHS—the reorganisation, the legislation and the ideological change at the heart of it—is that he did not tell the people about it before the election and he did not tell the Lib Dems about it before they signed the coalition agreement. This top-down reorganisation is exactly what he promised not to do.
Mr Lansley
The right hon. Gentleman was not satisfied with his first speech, so he had to have a go at a second one. He did not answer any of my questions. The Labour party said in its manifesto that it would use the private and voluntary sectors alongside NHS providers. The reason for that was simple: having the NHS as the preferred provider meant that the patient could be let down time after time before another quality provider could be permitted. We are going to allow competition on quality, but the quality has to be there. Patients will get the best possible service from whoever is best placed to provide that care.
Our changes are being seen across the country already.
Mr Edward Leigh (Gainsborough) (Con)
This party political ding-dong is great fun, but what worries me is that we have an ageing population, there are rightly more and more expensive techniques, and the taxpayer cannot put any more money in. Who is going to save the NHS if there is no co-operation with the private sector?
Mr Lansley
Over many years as Chair of the Public Accounts Committee, my hon. Friend challenged the failure of the previous Government to secure the improvement and value for money that is necessary patients. I make no bones about it: I think that if we give NHS organisations freedom and opportunity through foundation trust status, they will be competitive. I do not think that we will see a big expansion in the number of private sector providers, because the NHS has the enterprise and innovation to succeed. However, we have to make sure that they are open to that test. We test whether voluntary and independent sector providers meet the right quality, and we must expose the NHS to that test.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The Secretary of State has decided that he is not going to give way. That is his decision. He has given way already. We need to have a little less noise so that we can hear the Secretary of State.
Mr Lansley
Thank you, Mr Deputy Speaker. I have to conclude to ensure that we do not trample on Members’ time.
We will hold the NHS to account for what it achieves, but not tell it how to achieve it. We want continuous improvements in outcomes and more personalised care. We are going to change accountability in the NHS. In the past, the only question in accident and emergency was whether people were seen within four hours. We will ask whether a patient was seen by the right person, whether the quality of care they received was appropriate, and whether they recovered. From April, we will know those things for the first time. On mental health, we will ask whether we are helping people with serious mental health problems to live longer, and whether we are helping them to get a job. We will ensure that we find out those things and that we know which services provide the right care.
Beyond the NHS, we will make changes that increase accountability. As of today, 134 local authorities with social care responsibilities—almost 90% of such local authorities in England—have signed up to be early implementers of health and well-being boards. Those are the bodies that will finally tear down the walls between the NHS, public health and social care; and they will strengthen local accountability to the public and patients. Local authorities will finally have the powers that they need to scrutinise all NHS-funded providers of care, be they public, voluntary or private sector providers.
The coalition Government were elected to protect the NHS and that is what we are doing. We are protecting the NHS in this Parliament through increased investment, and protecting it for future generations through modernisation. We need an NHS in which every system, process and incentive encourages excellence in health care and weeds out poor performance. Labour now opposes that. It has turned its back on the NHS. It wants to drag the NHS back into politics; I want the NHS to be freed from political interference so that it can deliver the best possible care and results for patients. This Government will always support the NHS. We have a simple aim: to create an NHS that is up there with the best in the world. Our modernisation plans will do just that.
Debbie Abrahams
No, I am sorry, I am going to make progress so that everyone gets a chance to speak.
The Government have also said that the NHS commissioning board will ensure that NHS delivery is free from political control, but I am not so sure about that. The Bill contains a variety of contradictions, particularly in relation to the Secretary of State’s appointments to the various quangos. Another of the founding principles under threat from this Government is that treatment should be based on clinical need and not the ability to pay. We heard the Secretary of State say that that would be protected, but the Government’s reorganisation of the NHS will result in opening up that fundamental principle. The NHS commissioning board and the GP consortia will have the power to generate income, perhaps by charging for non-designated services. What constitutes designated and non-designated services has yet to be defined, however. My hon. Friend the Member for Leicester West (Liz Kendall) tried to get some elucidation on that, but none was forthcoming.
Debbie Abrahams
No, I am sorry, I want to make some progress—[Hon. Members: “Give way!”]