Oral Answers to Questions

Lord Lansley Excerpts

Tuesday 12th June 2012 Commons Chamber

[Nadhim Zahawi (Stratford-on-Avon) (Con)]

17. What progress clinical commissioning groups have made in improving care for patients.

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

This year, developing CCGs have delegated responsibility for more than £30 billion of local commissioning. Clinical leadership is using NHS resources more effectively, as part of improvements in care. In particular, we are seeing many improvements in community-based services—for example, a pulmonary exercise programme in Durham; a community spinal service in Reading; and a new musculoskeletal service in the Vale of York CCG.

[Claire Perry]

I thank the Secretary of State for that reply. During the Easter recess, I helped to organise a number of health question times in my constituency, where we brought together the commissioning groups, doctors, people from acute hospitals and hundreds of interested constituents to talk about how we would improve local health care. The good news was that doctors and clinicians—

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[Claire Perry]

Will the Secretary of State help by telling me how we can communicate out this example so that other MPs can repeat this valuable exercise?

[Mr Lansley]

I am very grateful to my hon. Friend for demonstrating how these new developing relationships that CCGs and local authorities are creating with NHS providers and care providers are delivering improvements in care for the constituents we all represent. I urge other hon. Members to follow her example in stimulating exactly those relationships.

[Nadhim Zahawi]

The CCG covering my constituency is interested in improving patient care by looking at new methods of contracting and management, but it has been told that it must use a clinical support service set up by the primary care trust, staffed by ex-PCT staff and most likely based in Birmingham, rather than south Warwickshire, at a cost of £4 million a year. Could the Secretary of State—

[Nadhim Zahawi]

I apologise, Mr Speaker. Will the Secretary of State confirm that there is no need for the CCG to use such an organisation and that it is free to form its own commissioning structure without incurring redundancy and wind-up costs from the PCT?

[Mr Lansley]

Yes, I can confirm that CCGs have the freedom to decide which commissioning activities they will do themselves and which they choose to secure from external organisations, thus enabling them to carry out their functions effectively. They can, if they wish, develop their own organisations and staff or contract with other organisations, and they are not required to contract with the commissioning support services hosted by the NHS Commissioning Board.

[Derek Twigg (Halton) (Lab)]

In order for the CCGs to be able to carry out and improve their services, they need appropriate funding. Will the Secretary of State therefore tell me why the Halton CCG has had less funding than it was promised originally?

[Mr Lansley]

If the hon. Gentleman is talking about the management budget for CCGs, I can tell him that we set out clearly that it would be up to £25 per head across England, and that is indeed the sum that will be made available.

[Keith Vaz (Leicester East) (Lab)]

Has the Secretary of State seen the letter to The Times this morning from six diabetes experts? What steps are the local groups taking to do more to prevent diabetes?

[Mr Lansley]

Yes, I read that letter this morning. Today, elsewhere in the House, the permanent secretary to my Department and the chief executive of the NHS will give evidence to the Public Accounts Committee on precisely that issue. In the context of doing so, they will demonstrate how we have continued over the past two years to achieve a substantial year-on-year increase in the number of patients with diabetes who are accessing best-practice services.

[Mr Stephen Dorrell (Charnwood) (Con)]

I welcome the successful development of clinical commissioning groups, but does my right hon. Friend agree that their success in refashioning care throughout the whole of the health and social care system will depend on close relationships not just in the health service but across into social care and the world of social housing, too?

[Mr Lansley]

I do believe that and the legislation requires it of clinical commissioning groups and health and wellbeing boards. The relationship being built up between clinical leadership in the NHS and democratic leadership through health and wellbeing boards is an instrumental part of delivering that integrated care.

[Andy Burnham (Leigh) (Lab)]

The year 2011 saw the biggest ever fall in public satisfaction with the national health service. It was also the right hon. Gentleman’s first full year in office. Does he think that those two facts are in any way related?

[Mr Lansley]

No, I do not. The right hon. Gentleman might also care to note that the same survey demonstrated a lower level of satisfaction with the NHS in Wales than in England, but let us leave that to one side.

That survey of 1,000 people asked whether they were satisfied with the way in which the NHS was being run. I was not satisfied. We were in the midst of reform, and we are changing how the NHS is run. Government Members were demonstrating to the public that improvement is necessary and possible in the NHS and that we should not be satisfied with the situation. What is more interesting is that a survey of 70,000 people that we published today demonstrates that 92% of the public—an unprecedentedly high level—who received care from the NHS said that it was good, very good or excellent.

[Andy Burnham]

How out of touch can he get, Mr Speaker? I would have suggested some work shadowing on the NHS front line to get him back in touch, but I forgot that he cannot go into a hospital without a police escort these days. Let me tell him why satisfaction with A and E is down: he lowered the target and missed it repeatedly, leaving nearly a quarter of a million people waiting longer than four hours. Today we have found out why his waiting list statistics do not match people’s real experience: managers are changing clinical criteria and removing people from lists. If he wants to regain people’s trust, why not start today by ordering an immediate inquiry and ending this unacceptable practice of waiting list recategorisation?

[Mr Lansley]

I spend more time in hospitals than the right hon. Gentleman has hot dinners, I suspect—[Interruption.] The weekend before last, I spent two days in hospitals and I did not require any policemen to be there.

Let me make it clear. In A and E, we have 96.6% of patients being seen, treated and discharged within four hours. More to the point, the latest data on A and E show that the average time spent there came down from 57 minutes to 49. On the question of referral to treatment, we inherited more than 209,000 patients across the NHS who were waiting beyond 18 weeks for their treatment. According to the latest data, that figure went down by nearly 50,000. We are delivering for patients better and improving care. I wish the right hon. Gentleman would get on his feet—perhaps he will do it now—thank the NHS and congratulate it on the improving care, rather than trying to find the one thing wrong with it—

[Mr Speaker]

Order. I do not want to be unkind, but every month the Secretary of State’s answers are too long. Perhaps he can make this the first month in which he is rather more economical.

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[Shabana Mahmood (Birmingham, Ladywood) (Lab)]

16. What recent representations he has received on regional pay variation in the NHS.

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

I have not received any such representations. The Government’s evidence to the NHS Pay Review Body shows that market-facing pay has the potential to enable NHS organisations better to achieve their need to recruit and retain staff within the “Agenda for Change” framework for pay. The pay review body will take evidence from all parties and make its recommendations in July.

[Robert Flello]

It can often be harder to work on the NHS front line in more deprived parts of our country, so would the Secretary of State like to join me on a busy Friday night in A and E in Stoke-on-Trent, where he can explain to the staff why their work is worth less than that of someone working in a more affluent part of the country?

[Mr Lansley]

I had the privilege and pleasure of visiting the University hospital of North Staffordshire about eight weeks ago. I very much enjoyed being there, meeting the staff, who I thought were doing a terrific job, and talking in particular to a substantial number of nurses. We did talk about that issue, and implicitly the hon. Gentleman is criticising the existing “Agenda for Change” framework, because there are high-cost areas in some parts of the country. The proposals and my evidence to the NHS pay review body do not recommend cutting anybody’s pay; they suggest that within the “Agenda for Change” framework we should extend high-cost areas.

[Shabana Mahmood]

Will the Secretary of State confirm that highly paid senior managers working in the new bodies established by the NHS reorganisation will be exempt from his plans for regional pay variation? Does he think that that is fair?

[Mr Lansley]

Yes, I do—in the same way as, for example, we are not including doctors and dentists in the same market-facing proposals. The reason why is that they do not work in what are essentially local labour markets; rather, they work in national labour markets.

[John Pugh (Southport) (LD)]

The most recent available statistics show that 50% of public sector jobs outside London were vacant for more than eight weeks, compared with 13% in the private sector. How will lower regional pay improve that situation?

[Mr Lansley]

I simply reiterate to my hon. Friend the point that I have already made. We are not proposing to cut anybody’s pay; we are proposing to give NHS organisations a greater mechanism through the “Agenda for Change” framework so that they can secure the recruitment and retention of staff. That is precisely the issue. Whatever their needs may be in terms of the recruitment and retention of staff, their pay should be better able to adjust to that.

[Ms Margaret Ritchie (South Down) (SDLP)]

Given the extent of social deprivation and the fact that £450 billion will be taken out of the pockets of people in Northern Ireland, particularly those on low incomes, will the Secretary of State confirm that there are no plans to introduce regional pay into the national health service in Northern Ireland during this parliamentary term or in future, as this would have a detrimental impact on the economy?

[Mr Lansley]

Clearly, that is a matter for the devolved Administration in Northern Ireland, not for me.

[Andrew George (St Ives) (LD)]

If, as the Secretary of State says, it is not his intention to see pay cut, does he hope that as a result of this measure lower-paid health workers in poor regions will be paid more?

[Mr Lansley]

At the risk of repetition, let me say that in any part of the country NHS organisations, like organisations in other fields, should have the ability to set pay levels that reflect to a greater extent local labour market conditions and their need to recruit and retain staff. My hon. Friend will recall that a number of south-west trusts are looking at going down the path of setting their own pay arrangements. It was in fact the previous Administration who in 2004, under the “Agenda for Change” pay framework, gave trusts and foundation trusts precisely the freedoms that they are proposing to use, so I cannot understand how Labour Members can possibly object to those freedoms now.

[Mr Jamie Reed (Copeland) (Lab)]

The Secretary of State may wish to call this market-facing pay, but he has rather let the cat out of the bag with his previous answers. In fact, he has proposed lower pay for NHS staff in poor areas—a move that would create a deeply divided, two-tier NHS and undermine the NHS in the communities that need it most. We know that the Secretary of State does not take advice from medical professionals, but will he perhaps take some from one of his own Back-Bench colleagues, the hon. Member for Hexham (Guy Opperman), who said that

“someone working in the NHS in a deprived part of the North East probably deserves more pay, certainly not less, than a nurse in leafy Surrey”?

Will the Secretary of State commit today, yes or no, to withdraw these disastrous proposals?

[Mr Lansley]

If I may say so, I think that the hon. Gentleman wrote his question before he had listened to my earlier answer. I am not proposing to reduce anybody’s pay. It is very simple. The NHS Pay Review Body will have the opportunity to make recommendations. I gave evidence to it on the basis that we should retain a national framework for pay through the “Agenda for Change” framework. However, it is transparently the case that the “Agenda for Change” framework has not thus far enabled NHS organisations, as they say themselves, to adopt a pay structure locally which better reflects the market in which they are employing.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

8. What steps he is taking to improve the sustainability of NHS trusts.

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

We are working directly with all NHS trusts to enable them to achieve foundation trust status—for the great majority, by April 2014. Achieving foundation trust status means that NHS trusts have achieved high and sustainable levels of clinical quality and financial governance.

[Andrew Jones]

It is possible that North Yorkshire and York primary care trust will this year declare a deficit based on inherited debt from the merger of PCTs several years ago. I am concerned that the new clinical commissioning groups might have to pick up that deficit. Will my right hon. Friend look at all the options to ensure that clinical commissioning groups can be given the best possible start by having a clear balance sheet?

[Mr Lansley]

No primary care trust should plan for a deficit in 2012-13. Primary care trusts carrying legacy debt into 2012-13 must clear it in accordance with the 2012-13 NHS operating framework. As at the end of 2011-12, the primary care trust my hon. Friend mentions had legacy debt that has been managed and absorbed locally by the strategic health authority. As at the end of 2011-12, the PCT is not forecasting any legacy debt.

[Nicholas Soames (Mid Sussex) (Con)]

No-shows and people failing to keep appointments in out-patient departments are costing Brighton and Sussex University Hospitals NHS Trust nearly £6 million a year. Does my right hon. Friend agree that this is extremely selfish, and would he propose sanctions on those who fail to show up for their appointments?

[Mr Lansley]

I am grateful to my right hon. Friend. I have no proposals for sanctions, but I commend to him and his trust the many mechanisms that are available, which they may know about, such as sending text messages to mobile phones. I have seen them in practice, and they do stimulate patients to attend their appointments and so reduce what has been an unacceptable level of non-attendance.

[Andrew Selous (South West Bedfordshire) (Con)]

9. What recent progress the NHS has made in improving outcomes for orthopaedic patients.

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

Substantial progress has been made through innovative approaches and improved risk management, leading to increased survival after fragility fracture, improved trauma care and better governance of hip implants. The latest results to December 2011 show improvements in patient reported outcomes for both hip and knee replacements.

[Andrew Selous]

Does my right hon. Friend share my concern about the significant increase in hip and knee revisions over the past five years or so? Does he support Professor Tim Briggs’ proposals to deal with that in his report, “Getting it right first time”, which is supported by all the professional associations and which NHS London is looking to adopt?

[Mr Lansley]

An increased number of hip and knee revisions is one of the consequences of an ageing population. I welcome Tim Briggs’ report, “Getting it right first time”. His recommendations are sensible. I am pleased to note that it has the support of the British Orthopaedic Association, as well as clinicians in London. It will help us build on the progress that is being made, to which I referred. The latest figures show that the proportion of hip fracture patients who receive all elements of the best practice tariff has risen from 24% in 2010 to 37% in 2011, and to 55% in 2012. That achievement has attracted international interest and is undoubtedly saving lives.

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

10. What improvements in public health outcomes he anticipates by the end of the decade.

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

The responsibility deal has brought together 392 partners, a doubling in number since its launch a year ago. Working together, we have removed artificial trans fats in foods, reduced salt content, put calories on high street menus, improved alcohol labelling, set out ambitious future plans for calorie and alcohol reduction, promoted enhanced physical activity and strengthened employers’ support for health in the workplace. Transparent monitoring and evaluation are vital, and our partners’ assessment of the delivery of their pledges will be published on our website. We are making up to £l million available to fund an independent evaluation of the responsibility deal.

[Nick Smith]

The Mayor of London supports a ban on the sale of mega-sized sugary soft drinks at entertainment venues, which will help fight obesity. Will the Government consider such a measure as part of their nationwide responsibility deal?

[Mr Lansley]

As I said to the hon. Gentleman, as part of the responsibility deal we are considering an ambitious programme of removing 5 billion calories a day from the diet in England. A range of programmes, such as behaviour change programmes and the reduction of saturated fats and sugars in foods by the industry, will make that happen. All those issues will be considered as part of how we can deliver that ambitious programme.

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

22. I congratulate the Secretary of State on yet another initiative that has helped to ensure that patients in England have a better standard of health service than their counterparts in Wales. What is his message to Welsh Members of Parliament who call on him to stop various reforms and expect him to impose the second-class standards of health service that we see in Wales thanks to the Welsh Assembly?

[Mr Speaker]

With reference purely, of course, to the public health responsibility deal.

[Mr Lansley]

Yes indeed. There are serious public health challenges to be faced up to in Wales, and it would be much better if the Labour Government in Wales, instead of cutting the budget by 6.5% as they are planning to do, increased it in real terms as the coalition Government are doing in England.

[Nadine Dorries (Mid Bedfordshire) (Con)]

13. What improvements in health inequalities he anticipates by the end of the decade.

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[Mark Lancaster (Milton Keynes North) (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 NHS in delivering improved health outcomes in England, to lead a public health service that 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.

[Mark Lancaster]

The strategic health authority has ruled out the locally preferred option for the transformation of community health services in Milton Keynes. Given the Government’s commitment to localism and their preferred approach to the integration of services, will the Secretary of State look at this matter again?

[Mr Lansley]

It is for the primary care trust to appraise the options and decide which is best for local people. The SHA has a role in providing assurance in that process, but I would urge both the PCT and the SHA to ensure that they meet the test that we are looking for, which is that any decision must be in the best clinical interests of patients and must meet the views of clinical commissioners in the future and, indeed, those of the public, not least as expressed through the local authority. I would urge the PCT and the SHA to make progress on that, and, if it would be of any assistance to my hon. Friend, I would be glad if he were able to meet me, the PCT and the local authority to help to resolve the issue.

[Liz Kendall (Leicester West) (Lab)]

In their 2010 NHS White Paper, the Government promised legislation on a new legal and financial framework for social care. However, last month’s Queen’s Speech included only a draft Bill, on social care law alone. We cannot tackle the care crisis without tackling the funding crisis, so will the Secretary of State now agree to Labour’s call for legislation on a new system for funding social care in this Parliament? Yes or no?

[Mr Lansley]

The hon. Lady will know very well that last year we made it clear that we intended to publish both a White Paper on the reform of social care law and, alongside it, a progress report on the reform of the funding of adult care. We still intend to do both those things, and to do so soon.

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[Paul Blomfield (Sheffield Central) (Lab)]

T2. Speaking on 24 April, the Secretary of State indicated that the NHS distribution formula should no longer take account of deprivation. That would have cost Sheffield £73 million a year and benefited Surrey by £400 million. His ministerial colleague, the Minister of State, the right hon. Member for Chelmsford (Mr Burns), seems to have denied that that is the case. Will the Secretary of State therefore confirm that this is the Government’s latest U-turn?

[Mr Lansley]

No, I will do no such thing, because the premise of the hon. Gentleman’s question is completely wrong. I never said any such thing. What I made perfectly clear is that, as has been the case in the past, age will continue to be the principal determinant of health need, and therefore, by extension, that age will be the largest factor in determining the allocation of resources to the NHS. That was true under the last Government; it will continue to be true under this one.

[Dr Sarah Wollaston (Totnes) (Con)]

T5. On 21 June, conscientious, hard-working doctors will be putting their patients before the British Medical Association’s ill-judged call for industrial action. Can the Secretary of State confirm to the House, however, how many surgeries, operations and clinics will be needlessly cancelled, and how much all this will cost the NHS?

[Mr Lansley]

I entirely understand my hon. Friend’s concern, and I applaud the way in which she has expressed it. The BMA’s proposed action could result in up to 30,000 operations being cancelled, as many as 58,000 diagnostic tests being postponed, and more than 200,000 out-patient appointments being rescheduled. I do not think that the House will understand why the BMA would risk patient safety in that way, when it knows perfectly well that its action will have no benefit and that we cannot now go beyond the basis for pension reform that has been agreed with the majority of the NHS trade unions, especially in circumstances in which doctors will continue to receive an extremely generous pension worth up to £68,000 a year at the end of their working lives. I think that the right hon. Member for Leigh (Andy Burnham) and I share the view that this is not a justified position for the NHS to take. The pension is intended to be a generous one. Through the negotiations with the BMA and the other trade unions, we arrived at a very generous pension scheme.

[Bill Esterson (Sefton Central) (Lab)]

T3. Thanks to the staff at St Thomas’ hospital in London, and at Aintree in Liverpool, I have had excellent health care myself in the past three weeks, but, in order to build the morale of staff across the NHS, will the Secretary of State instruct all NHS trusts not to cut anyone’s pay?

[Mr Lansley]

I am glad that the hon. Gentleman has had excellent care; he might like to tell those on his own Front Bench about it, as they are constantly denigrating the NHS. I will simply reiterate what he will have heard me say previously, which is that I have made no proposals to cut anybody’s pay in the NHS.

[Julian Smith (Skipton and Ripon) (Con)]

T6. What progress has been made in discussions with primary care trusts on the transfer of assets to NHS Property Services Ltd?

[Heidi Alexander (Lewisham East) (Lab)]

T7. We have learned today that public satisfaction with the NHS has fallen dramatically. We also know that satisfaction with GP services has fallen for the second consecutive year, and that satisfaction with accident and emergency services is going down by 7% each year. The Prime Minister promised that the NHS would be his priority. Is it not about time that this Government lived up to that promise?

[Mr Lansley]

We have learned no such thing. Indeed, we published on the Department’s website today a survey that asked people who had been looked after by the NHS how well they thought their care had been provided to them. It showed that 92% of the patients said their care had been good, very good or excellent. In my view, that survey of 70,000 patients who had received care from the NHS completely trumps a survey that asked 1,000 people what they might have thought about the NHS in relation to the media activity that took place last year.

[David Mowat (Warrington South) (Con)]

T8. The Cheshire and Merseyside treatment centre has been closed for just over a year, since the private sector contract let by the last Government expired. Can the Minister confirm that the centre is now going to be brought back into the NHS as a fully fledged part of the Warrington and Halton hospitals trust, and will he give me an indication of the time scale involved?

[Rosie Cooper (West Lancashire) (Lab)]

In written responses to questions about clinical commissioning groups, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) incessantly replies—most recently on 18 April—that CCGs do not yet exist, so how can he offer assurances, as he has done today, that any real progress is being made by the CCGs, when they are currently being supported by PCTs? And will he explain his “now you see them, now you don’t” response?

[Mr Lansley]

I will tell the hon. Lady how we can talk about the progress made by CCGs—because we actually go and talk to them. I recall visiting the Blue Coat school in Merseyside a few weeks ago and speaking to the leaders of clinical commissioning groups—from Liverpool, Lancashire, Manchester, Warrington, Knowsley and St Helens—and many of them had 100% delegated responsibility for budgets this year. They explained to me the opportunities they were taking to improve the care of their patients by using that responsibility.

[Mr Douglas Carswell (Clacton) (Con)]

T9. Clacton was promised a new renal unit several years ago. While they are waiting, local people have had to travel long distances for treatment. I am due to meet the commissioning authority to discuss the endless delay. If it fails to make progress soon-ish, could I meet the relevant Minister and his officials to work out what we can do to prod the commissioning authority into getting a move on?

[Mr Lansley]

My hon. Friend will be aware—and, I am sure, will understand and support—the devolution of commissioning responsibilities locally. He is right to pursue the matter in the way he proposes. Over a number of years, including under the previous Administration, efforts were made to secure additional access to dialysis. For a long period, we in this country had lesser access to dialysis than in other countries—particularly when people were not only working but likely to be on holiday. I welcome the point my hon. Friend is pursuing and, when he has had his conversation locally, perhaps he would like to tell me the outcome.

[Diana Johnson (Kingston upon Hull North) (Lab)]

The Government blocked Labour’s plans to introduce public health as one of the licensing conditions. I wonder whether, in the spirit of localism, this power should now be given to health and wellbeing boards.

[Iain Stewart (Milton Keynes South) (Con)]

May I emphasise to my right hon. Friend the strength of local feeling in Milton Keynes that we should retain our integrated community health service, which has worked incredibly well and provides a good role model for elsewhere in the country?

[Mr Lansley]

I am grateful to my hon. Friend. The four tests for service change that we have set out—I think rightly—are not just about the tests that must be met before changes can be introduced; they also involve the same considerations that should drive the design of services. If local commissioners, the local authority and local people are supportive of a particular form of organisation, including community services, I would hope that that would provide the basis on which the design of services would proceed.

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

Last evening, I attended the launch of UKCK—a group of charities coming together to raise funds to purchase advanced radiotherapy equipment. Will the Minister explain why, despite his previous assurances, regions like the north-east are having to turn to charities to raise funds to buy this potentially life-saving equipment?

[Greg Mulholland (Leeds North West) (LD)]

In an Adjournment debate last year on the safe and sustainable review, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) confirmed the minimum number of operations at 400 a year, saying that it was based on the level of activity needed to provide good quality care around the clock. Does he share my astonishment that the chairman of the joint committee of PCTs has said that he can give no assurance that that will be included in the final review? Does that not undermine this unhappy process?

[Mr Lansley]

My hon. Friend will be aware, as other Members are, that this is an independent review conducted by the joint committee of primary care trusts. On that basis, I will not comment directly on anything said in that context. I simply reiterate what was made clear in last year’s debate that the joint committee will not conduct its review solely on the basis of the options set out in its original consultation.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Regarding the answer given to my hon. Friend the Member for Leicester West (Liz Kendall), the Government did not promise to give us a progress report on funding, but to legislate in this Session to reform social care funding. Social care is now widely seen as being in crisis. When will the Secretary of State commit to acting urgently—because urgency is needed now—to tackle this crisis?

[Mr Lansley]

I must correct the hon. Lady. We did not say that we would legislate in the current Session. What we made clear was that we would publish a White Paper—which we will do—and that we would publish a progress report on funding reform. We were also clear—as we still are—about the fact that, as part of the coalition programme, we would act urgently, and we will continue to do so.

[Mr Speaker]

Last but not least, I call Anne McIntosh.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

The Department of Health is to be asked to sign off the business case for the transfer of services from Lambert Memorial community hospital to the new extra care housing scheme—sometimes called an extra sheltered accommodation scheme—in updated community facilities. Will the Secretary of State give me a personal assurance that there will be no sign-off until the future of Thirsk’s community hospital is guaranteed for its current purposes?

[Mr Lansley]

I cannot give my hon. Friend that assurance, not least because such decisions are led locally by local organisations. However, if the tests for service change were not met and the local authority referred the matter to me, I would of course take advice through the independent reconfiguration panel, and consider it in the light of that advice.