Future of the NHS

Lord Lansley Excerpts

Monday 9th May 2011 Commons Chamber

[John Healey]

No. What I am referring to is the provision in the Bill to allow the job of commissioning to be outsourced to private companies. That has never been done before. It is there in the Bill and it is a big risk for the future.

The Prime Minister made the NHS his most personal pledge before the election.

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

Will the right hon. Gentleman just be clear to the House and get it accurate? The Bill sets out that commissioning consortia are statutory bodies covering the whole of the country in the public sector. Therefore, if they use private sector commissioning expertise—which the Bill does not require them to do—that is not commissioning responsibility. In the two years leading up to the election, primary care trusts increased their use of management consultancy by 80%, so they did use the private sector, whereas commissioning consortia do not have to.

[John Healey]

The point about the Health Secretary’s legislation is that it allows consortia to outsource in whole the job of, not the responsibility for, commissioning. He made the point that the consortia are public bodies, but they meet none of the standards of public governance. They can meet in private. As the right hon. Member for Charnwood (Mr Dorrell) has said, that serious job should be done by properly constituted and governed public authorities, but that is a loophole in the Bill.

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

The right hon. Member for Wentworth and Dearne (John Healey) has not only presented a weak motion to the House but managed to make a weak speech in support of it. The motion is completely silent about the problems that the NHS faced when we came to office. It is completely ignorant of the challenges that the NHS faces, and completely devoid of any recognition of the ongoing efforts of NHS staff to offer the very best standards of patient care, day in and day out. I am happy to make it clear, however, that I support the staff of the NHS every day, as we all must. I am not interested in a motion that ignores that; I am interested in supporting NHS staff to deliver the best possible care for patients.

This debate is supposed to be about the future of the NHS, but the right hon. Gentleman had nothing to say about its future. He wanted to talk only about politics and the Health and Social Care Bill. What happens in the NHS every day is not the same as the content of the Bill, important though that is; it is about quality of care and the outcomes that are being achieved for patients. I will ask the House to reject the motion, because I intend to use the debate to be positive and to show how we will give the NHS a stronger future.

[Toby Perkins (Chesterfield) (Lab)]

I am glad to hear that the Secretary of State supports the staff of the NHS, but is it not the truth that the staff of the NHS do not support him?

[Mr Lansley]

That is complete nonsense. This is not about me: it is about what the staff of the NHS want. They want the ability to be able to deliver care for patients without being told what to do by the top-down bureaucracy and targets of the Labour Government. They want the ability to deliver the care that patients need, to join up health and social care and to integrate the pathways of care. Our Bill is about giving them the structure that will allow them to do that. They want every penny that we as taxpayers provide to the NHS to get into the hands of front-line staff, and for the absolute minimum to go in waste and inefficiency. That is what they want, and that is not about me, it is about them.

A stronger NHS will require change, so that it no longer spends £5 billion a year on bureaucracy.

[Mr Watts]

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[Mr Lansley]

Perhaps the hon. Gentleman will explain why all that money was being spent on bureaucracy.

[Mr Watts]

Given that today and on previous occasions the Secretary of State has claimed that the Government are not trying to privatise our hospitals, will he publish all the documents that have passed between his Department and my NHS trust, because they will demonstrate that that is exactly what he intends to do? He intends to try to privatise my hospital.

[Mr Lansley]

The hon. Gentleman will know, because the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns) has told him in the past, that when NHS trusts are moving to foundation trust status, there will be an agreement, but it is not about privatisation. When the hon. Gentleman’s party was in government, it said that the only way Hinchingbrooke NHS trust could turn its management around was for it to be prepared to look for the best possible management. That is the extent of what we are talking about, and it was done under his Government.

This will require change. We are not going to spend £5 billion on bureaucracy. We are not going to let the number of managers double in future as it did under Labour, and we are not going to let the number of managers increase six times as fast as the number of nurses. Since the general election, we have 3,500 fewer managers and, as a consequence, 2,500 more doctors and 200 more nurses.

[Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)]

On 19 March, the interim chief executive of Monitor said that under this Bill, doctors talking to providers about health care would be the same as Marks & Spencer talking to their suppliers about which brand of washing powder to buy. Is that the Health Secretary’s vision for the future of the national health service?

[Mr Lansley]

No, not at all, and I do not believe that Monitor believes that either. The hon. Lady can see that the proposal in the Bill is clear. It was the Labour Government who established Monitor as a regulator and who introduced competition into the NHS. The Labour Government did all those things, but Monitor’s job is not to impose competition rules but to deliver what is in the best interest of patients.

[Mr Graham Stuart (Beverley and Holderness) (Con)]

The shadow Secretary of State is a decent man and an experienced Minister. The reason his speech was so weak is that he had no conviction because he has been forced by the union paymasters of the Labour party and of the shadow Leader of the Opposition to deliver the sort of speech previously given by the far left who inhabit the Benches way over there. My right hon. Friend should not listen to those voices; he should press ahead and make a difference for patients, not politicians.

[Mr Lansley]

I agree with my hon. Friend that the shadow Health Secretary is a decent man, and at the turn of the year he quite decently expressed his support for the Bill’s principles and his understanding that it was consistent, coherent and comprehensive. It makes one wonder what happened to him in the interim. Did the trade unions—the paymasters of the Labour party—get to him and tell him that they did not like the idea that patients should be able to get the care they need or the idea that we should get resources into the front line rather than into the vested interests of the NHS?

What we are going to do is put patient care at the heart of our reforms. We are not going to let hospital productivity continue to decline as it did over the last decade. Under Labour, we saw a 15% decline in productivity, yet we heard nothing from the shadow Health Secretary about that. It is this Government who are taking action to improve hospital performance by changing the way hospitals are paid to reward excellence—for example, by not paying for unnecessary readmissions of patients who are discharged too soon.

[Jesse Norman (Hereford and South Herefordshire) (Con)]

Hereford hospital is labouring under a very expensive private finance initiative contract. Does my right hon. Friend not think it a tragedy that the last Government cast good sense and good economics away, forcing so many hospitals into PFI?

[Mr Lansley]

My hon. Friend makes an important point—that it was under the Labour Government that many of these projects were undertaken, and they are leaving an enormous bill in the NHS for future taxpayers and future NHS organisations to meet. A contract is a contract, as the right hon. Gentleman and the House will understand, and we inherited contracts from the Labour Government, many of which were very bad contracts, such as the ones on IT that we have had to renegotiate. Frankly, it is due to my right hon. and hon. Friends in the Treasury and ourselves at the Department of Health that people have been put into the Queen’s hospital in Romford to look at how we can resolve some of these PFI problems and reduce those costs. We need to increase productivity in the NHS and cut out much of the waste in it.

It is us who will usher a new era of transparency into the NHS, shedding light on those areas that the previous Administration sought to cover up. Before the election, how often were patients having to go into mixed-sex accommodation when the rules on single-sex accommodation were breached? We did not know, because when Labour Members were in government they would not tell us. Since we started publishing the data in December, the number of patients put into mixed-sex accommodation without justification has halved.

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

The Secretary of State talks of service to patients. Does he accept that the amount of time for which patients must wait for treatment is extremely important to them? Does he also accept that the number of people waiting more than four hours to be treated in accident and emergency departments is at its highest for six years, and that the number of people waiting more than 18 weeks for non-urgent operations is at its highest for three years?

The Secretary of State attacks our targets, describing them as “top-down bureaucracy”. Does he not accept that they are actually a guarantee that people who cannot afford to go private and pay will not have to wait in pain, but will be treated within a reasonable time frame?

[Mr Lansley]

I do not accept the right hon. Gentleman’s premise. Waiting times in the NHS are stable. We had a conversation about that during the last session of Health questions, but perhaps the right hon. Gentleman was not in the Chamber and did not hear it. The average waiting time is nine weeks. The operational standard requires 90% of admitted patients to be seen within 18 weeks—that is in the NHS constitution—and it has been maintained, although the figure was 89.9% in February after a winter during which critical care beds were full because of flu.

The right hon. Member for Wentworth and Dearne talked of four-hour waits in A and E as if the fact that a patient had been discharged within four hours were the only issue. He should go and talk to the families of patients who, in the past, were discharged from the emergency department at Stafford general hospital and left to die.

What matters is how long it is before a patient is seen by a qualified professional, and how long it is before that patient is treated. What about those who leave without being seen? What about those who are not given the care that they need, and have to return to the emergency department? Those are the things that matter to patients, and those are the things that are now part of the accident and emergency quality indicators which, this April, we said that we would publish for the first time. It is we who are focusing on services for patients. Labour Members had 13 years to look at what really mattered to patients and at the real quality of what was delivered to patients, but they did not do it, and we are going to do it.

[Nadhim Zahawi]

Pausing and listening and getting the detail right are about grown-up politics. Opportunism and flip-flopping are about the Opposition.

[Mr Lansley]

My hon. Friend is absolutely right.

[Several hon. Members]

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[Mr Lansley]

I give way to my hon. Friend the Member for Gainsborough (Mr Leigh), the former Chairman of the Public Accounts Committee.

[Mr Edward Leigh (Gainsborough) (Con)]

Sadly, despite massive increases in funding over 15 years, there has been an undoubted catastrophic decline in NHS productivity. Does my right hon. Friend accept that many of us on the Government Benches feel that if we are to save the NHS there is no alternative to more co-operation with the private sector, and that he should stick to his guns?

[Mr Lansley]

My right hon. Friend made that point when he chaired the Public Accounts Committee, and it should silence Labour Members, because the Public Accounts Committee has said exactly the same thing since the election under the chairmanship of the right hon. Member for Barking (Margaret Hodge)—that productivity in the NHS declined consistently under Labour.

Let me make clear that if we are going to make—[Interruption.]

[Mr Speaker]

Order. The House is in a very excitable state. The issues are of the highest importance and they provoke strong feelings, but the debate must be conducted in an orderly way, and the Secretary of State is entitled to a decent hearing.

[Mr Lansley]

Thank you, Mr Speaker.

I remember Labour’s scaremongering during the election about cancer waits, for example, but in 13 years in government they never actually looked at cancer survival rates. They never looked at the results for patients. It took this Government to publish the first outcomes strategy for cancer, which made clear that what matters to patients—

[Several hon. Members]

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[Mr Lansley]

I will give way in a moment. That strategy made it clear that what matters to patients is not only how quickly they see a consultant, but whether they survive.

[Mr Bradshaw]

If things were so terrible under the Labour Government, why was public satisfaction with the NHS at record levels when we left office, and why were waiting times at record lows? Both are now going in the wrong direction. Will the Secretary of State please tell us—we have not yet received an answer to this question—what will happen in those areas now that GP consortia are to be voluntary? He has already abolished the primary care trusts, so who will be responsible?

[Mr Lansley]

It was also a period during which complaints to the NHS reached their highest ever levels. If we ask the public who they think are best placed to design the services patients need, we will find that the answer is their general practitioners, hospital doctors and nurses, not politicians on either the Government or the Opposition Benches. This is about doctors and nurses being in charge, not politicians.

It took this Government to focus on cancer outcomes. It took this Government to provide the drugs patients need through the cancer drugs fund. Under Labour, patients went without new cancer medicines that patients in every other European country were getting access to. It is this Government who are investing in more diagnostic equipment, and more screening and early diagnosis, so that we get better outcomes.

[Angela Smith (Penistone and Stocksbridge) (Lab)]

I must say that I admire the consistency with which the Secretary of State defends his proposed legislation. However, will he tell us what he plans to concede, given the threatened veto by the Deputy Prime Minister and the Liberal Democrats?

[Mr Lansley]

I do not want to correct the hon. Lady, but everything I have been saying up until now has been about defending the NHS and defending our focus on delivering better results by giving the NHS greater front-line devolved responsibility. That is not a matter of debate and disagreement between the coalition parties; we are all in favour of that. The point is this: how can the Bill best support the principles on which we are agreed? I thought the right hon. Member for Wentworth and Dearne and the Labour party were agreed on those principles; that seemed to come out from his interview last week. Indeed, at the end of his speech today I was not quite sure whether or not he agreed with us.

[Mr Baron]

Given that our cancer outcomes are well below the European average, the need for NHS reform is well established. However, as my right hon. Friend the Secretary of State will know from my having raised the issue with him previously, the entire cancer community will breathe a sigh of relief if the guaranteed funding for cancer networks can be extended to 2014 when the transition period for GP commissioning comes to an end, as we would risk losing a lot of expertise if we were to end it in 2012. Will he address that point?

[Mr Lansley]

The support for cancer networks will continue during the course of this year and the start of next year, but when the NHS commissioning board takes responsibility for commissioning, including the relationship with consortia, it will need to decide how to manage its commissioning responsibilities. However, as I have told my hon. Friend in the House previously, it is now looking—we will look at this over the coming months—at how it can use networks as a basis for having precisely the kind of commissioning structures we want, and it is my expectation that that would include cancer networks that are not only helpful for providers, but that tie together commissioners and providers in understanding the future strategy for cancer.

[Charlie Elphicke]

Will my right hon. Friend give way?

[Mr Lansley]

If my hon. Friend will forgive me, I will give way again a little later, but first I want to make a couple of further points.

The House knows of my commitment to the NHS; Opposition Members know of that, too. They know that I have not spent seven and a half years as shadow Secretary and Secretary of State to see the NHS undermined, fragmented or privatised. They know that that was never my intention; it is not my intention. Before the last election, we were absolutely clear that we would protect the NHS, but we are doing more than just protecting it; we are strengthening it. We are enabling clinicians to lead a more integrated, responsive, accountable NHS—not fragmented, not privatised, not based on access to insurance, and not compromising quality for price—and, equally, an NHS that is not run by a top-down, unaccountable bureaucracy, but that is locally led and locally accountable.

As the right hon. Member for Wentworth and Dearne admitted, this is a comprehensive, consistent and coherent vision, and it is an evolution of the better policies of the last 20 years. It was the last Labour Government who introduced patient choice; we will extend it and give patients the information they need to make it work. It was the last Labour Government who introduced practice-based commissioning; we will make it real, with health professionals designing integrated pathways of care with decision-making responsibilities. It was the last Labour Government who introduced foundation trusts; we will deliver on their broken promise to take all NHS trusts to foundation status. It was the last Labour Government who introduced payment by results, but left it half baked, distorting services and hindering joined-up care; we will change it so that it genuinely supports the best care for patients. Of course, it was the last Labour Government who brought the independent sector and competition into the NHS, but we will not follow their lead by giving the independent and private sector providers the opportunity to cherry-pick services and by giving them financial advantages over NHS providers.

[Gordon Birtwistle (Burnley) (LD)]

Will the Secretary of State confirm that the meeting patients needs programme put forward by the previous Government, which closed down many accident and emergency units and many children’s wards, will not happen again under this new regime? Will he confirm that that is because local people and local GPs will be consulted first, as opposed to having the programme driven through with no support and no consultation, as under the previous Government?

[Mr Lansley]

I completely understand and agree with my hon. Friend. I thought it was outrageous for the shadow Secretary of State to say, “Oh, they promised a moratorium and now some closures are taking place.” Why? Because we were left what were, in effect, faits accomplis by the previous Government and it was impossible to change them. [Interruption.] My hon. Friend the Member for Maidstone and The Weald (Mrs Grant) would feel the same as my hon. Friend the Member for Burnley (Gordon Birtwistle).

[Andrew George]

I can confirm that we agree on the issue of principle and that I am not questioning the Secretary of State’s personal commitment. The issue remains one mentioned in the motion: the extent to which the policy in the Health and Social Care Bill is not just another top-down reorganisation of the sort that the coalition Government said they would stop and the extent to which the policy being driven through Parliament, on which a listening exercise is taking place, delivers what is in the coalition agreement. The debate is about the extent to which the Bill reflects the coalition programme agreement.

[Mr Lansley]

My hon. Friend will know that the coalition agreement supports, in essence, all the principles of the Bill, with the exception of the specific consequence of the abolition of the strategic health authorities and primary care trusts. As with the whole of the Bill and its related measures, that proposal was the subject of collective agreement and it flows directly from the belief, shared not least by him and his Liberal Democrat colleagues, that we need much stronger local democratic accountability in the NHS. We are constructing health and wellbeing boards as an integral part of local authorities, and he will know that the overwhelming majority of local authorities which have volunteered to be early implementers of that approach believe precisely that democratic accountability is an essential part of the future of the NHS.

[Several hon. Members]

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[Mr Lansley]

Let me just make some progress. We need this modernisation for the NHS because of the challenges it faces in the future. We need to deliver £20 billion of efficiencies over the next four years. I remind the House that that requirement was set out originally under a Labour Government in 2009 without the merest hint of irony—I say that given that they created the inefficiencies in the first place. Today, I can give the House some figures that the Labour party would wish that people did not know. If Labour’s spending plans for the NHS at the last election had been implemented over this spending review period, the NHS budget would have been cut by £30 billion compared with what we have put into the NHS over the spending review period. So let the right hon. Member for Wentworth and Dearne get up now and explain: how was the NHS going to deal with £20 billion of efficiencies while he was cutting £30 billion out of it, instead of it getting the extra £11.5 billion it is getting from taxpayers through this coalition Government?

[John Healey]

After 20 minutes of the Health Secretary’s speech, the hon. Member for St Ives (Andrew George) finally brought him to his own plans and he was clearly very uncomfortable. What does he say when the Prime Minister wonders how he got the Government into such a mess over his plans? What does he think of the chair of Monitor’s observation that the approach being taken is a combination of

“previously unannounced policies, a complete failure to build the necessary political and professional consensus and an apparent disdain for the detailed planning of implementation”?

That was said by one of the Government’s allies.

[Mr Lansley]

I suppose the one thing the right hon. Gentleman has learned about being in opposition is that it is best for a party to try to forget everything that it did in government, because it will not be held to account for it. He has also recognised that the best thing is to have no ideas of his own. He does not even seem to know whether he agrees with our ideas or opposes them. We do not have any answers from him. The right hon. Gentleman’s quotation was from the former, not current, chair of Monitor, who knows perfectly well that these measures were in our respective manifestos and were brought together in the coalition agreement. They have a mandate. From my point of view, this is not just about the electoral mandate but about how we can deliver the best care for patients and see through principles that I thought the right hon. Gentleman’s party, as well as ours, believed were right.

Let me make it clear that the challenges in the NHS are about more than just clearing up Labour’s mess. We must recognise that there are now more pensioners than children under 16, alcohol-related admissions to hospital have doubled and emergency admissions have risen by 12% in just four years. Obesity in this country has doubled in the last 25 years. Under Labour, the demand for health care was rising while productivity was falling. The only way that Labour could cover those risks was by massively increasing the budget and that is no longer an option. Mounting pressure on the NHS is inevitable and the status quo, as Labour recognises, is not an option. The NHS needs modernisation.

[Nadine Dorries (Mid Bedfordshire) (Con)]

Will the Secretary of State give us an update on the tally of the number of GPs who have signed up to the new consortia to support the NHS reforms?

[Mr Lansley]

Yes, I will. Some 220 pathfinder consortia have come forward, representing the equivalent of 45 million patients across England—that is, 90% of the population. They are not obliged to do so. They have volunteered to come forward to demonstrate that they can deliver better services for patients.

[Several hon. Members]

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[Mr Lansley]

Let me explain—[Interruption.]

[Mr Speaker]

Order. I am going to try to be helpful to the hon. Member for Easington (Grahame M. Morris). When a Minister gives no indication of giving way, a Member must not simply stay on his or her feet. The situation is clear: the Secretary of State is not giving way at the moment. Once again, I appeal for the restoration of some sort of calm. The Secretary of State should be heard with a degree of civility—[Interruption.] Order. I ask Members to reflect on how our proceedings are regarded by members of the public whose support we sought not that long ago.

[Mr Lansley]

Thank you, Mr Speaker.

The principles we are pursuing are simply stated as

“a greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes”.

The right hon. Member for Wentworth and Dearne will no doubt recognise those words, because they are his own from January, when he said that he supported the general aims of our reform.

We are already delivering on our vision. We are extending patient choice and involving patients more in decisions about their care. We are cutting back Labour’s waste and reducing the bureaucracy that stifles and undermines doctors and nurses. We are putting clinicians at the heart of commissioning, with almost 90% of the country now covered by new pathfinder consortia.

We are driving down hospital-acquired infections, sustaining and improving the performance of the NHS, stopping Labour’s arbitrary box-ticking and focusing on the outcomes that matter. We have a world-leading framework for the results that matter to patients: reducing avoidable mortality; enhancing recovery after treatment; improving quality of life for those with chronic conditions; maximising safety and cutting the number of infections; and continually improving patients’ experience of their health care. Those are the outcomes for which we and the NHS will be accountable.

Let me be clear: there will be substantive changes to the Bill to deliver improvements for patients. There is only one issue for me, however: will it deliver better care for patients? That is why we will pursue NHS modernisation and why we will stick to our principles. It is why we are listening to improve the Bill. That is what the coalition Government are committed to. Today, led by the NHS future forum, we are engaging with the health service and beyond to ensure that the legislation delivers on those principles.

Unlike the Labour party, which has retreated to its union-dominated, regressive past, we will not retreat. We will be progressive with those principles. Just last week, the right hon. Gentleman called for a return to Labour’s top-down targets and for GPs to be stripped of all their financial responsibility. He has called for the NHS to be run by a bureaucracy, not by doctors and nurses. Critics of the Bill must answer this question: if they do not want patients, doctors and nurses to be in charge of the NHS, then who do they want to be in charge?

The right hon. Gentleman has turned his back on two decades of NHS modernisation. We will never accept the Labour party’s prescriptive, top-down bureaucracy or its waste. We did not accept Labour’s plan, which would have meant taking £30 billion out of the NHS in England over this Parliament and we will not follow the route that the Labour party in Wales has taken, where it is cutting the NHS. Instead, we are increasing the NHS budget over this Parliament by £11.5 billion. We will equip the NHS to deliver better and improving services by using more resources more effectively. We will empower patients with information and with choice. We will empower doctors and nurses to shape services for their patients. We will bring together the NHS, public health and social care in a combined local strategy. We will make the NHS genuinely locally led, while meeting national standards. We will focus relentlessly on the quality and outcomes we achieve for patients. We will protect the NHS and strengthen it. We will do that not by living in the past, but by modernising for the future. We want a modern service that is true to its core values. The Labour party’s motion offers no future for the NHS. We on the Government side will give the NHS a stronger future, and I urge the House to reject the Labour party’s motion.

[Several hon. Members]

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