Branded Medicines (NHS)

Lord Lansley Excerpts

Thursday 4th December 2014 Commons Chamber

[Mr Andrew Lansley (South Cambridgeshire) (Con)]

I beg to move,

That this House has considered availability and pricing of branded medicines on the NHS.

I am most grateful to the Backbench Business Committee for providing this opportunity to raise an issue of continuing importance to Members and their constituents. The debate will be short, but I am sure that we will be able to put it on the record that there are areas of concern. The two Front-Bench teams will, I am sure, be keen not only to respond now but to take some of these matters forward in the future as the Minister and his colleagues have sought to do over the past couple of years.

Colleagues from the previous debate must not feel that they have trespassed too much on to our debate. Listening to the contributions, it was amply clear that it was important for Members to be able to represent their constituencies. I know that all colleagues are very happy that they had the chance to do that.

Let me set the scene. Over the many years that I have been engaged with health matters, one of the most persistent sources of frustration has occurred when our constituents have not been able to access the medicines that they need through the national health service. That can happen because of a lack of data, and the National Institute for Health and Care Excellence will not appraise such a drug at that point because it determines that it is not cost-effective and is not therefore approved for NHS use, or because local commissioning decisions are incorporated in a local formulary.

Since its inception, NICE has created a more consistent national basis for decisions on access to medicines, but the application of what is essentially an arbitrary cost-effectiveness threshold still means that patients can be denied access to some new drugs. That has been exacerbated by the chronic slowness of uptake of some new medicines across the NHS, because of a clinical conservatism—new drug treatments are viewed as an extra cost rather than an opportunity to improve outcomes—or a general bureaucratic lack of responsiveness to patients.

That is deeply ironic as the UK is among the leading countries for drug discovery. We may represent only 3% of the international pharmaceuticals market, but we have been responsible in this country for 10% of new drug development, including such major innovations as monoclonal antibodies, which were first invented in my own constituency at the Laboratory of Molecular Biology.

As a coalition Government, we commit resources to world-leading research. Ministers have rightly sought both early access to new medicines and continuing support for research and innovation, but we continue to face institutional and cultural resistance. One of my objectives over recent years was to tackle that issue. I wanted to assure patients that, through the NHS, they could access the best and latest medicines and treatments. We wanted the NHS to adopt new innovation and technologies and to move away from a system in which the drug companies set a price that NICE and the NHS appraise and reject, leaving patients unable to access the medicines that their clinicians believe are best for them.

Instead, we should have a system that puts the patient at the heart of the service. If a clinician believes that a medicine is the right one for their patient, they should be able to prescribe it and the NHS and the pharmaceutical company should settle on a fair price, reflecting the value of that drug and a fair return to the costs involved in drug development.

[Bill Wiggin (North Herefordshire) (Con)]

One of the things my right hon. Friend will know probably better than anyone from his role as Secretary of State for Health and something that is not well understood by my constituents is that the NHS is one of the most exciting clients for anybody selling drugs and has the most efficient buy-in capability. Why does that not seem to come across to our patients and constituents, and what about medicines that used to work but now are not available? Will he cover that in his speech?

[Mr Lansley]

On the latter point, no, but drugs that move beyond patent become generically available to the NHS. On the former point, my hon. Friend is absolutely right. I often found this issue frustrating. The best way for drug companies to get their new medicines adopted internationally is to introduce them successfully into the NHS. As we move to a more systematic patient record system, the introduction of new treatments and medicines through the NHS will provide the strongest possible database of outcomes anywhere in the world, because of the character and scale of the NHS. So he makes a really important point.

The principle behind securing patient access to new medicines lay behind the proposal for a value-based structure of drug pricing. It was my intention that come the introduction of the new pharmaceutical price regulation scheme, which was to be negotiated for January 2014, a transition to a new price-setting mechanism would also be in place. As the House will recall, in the interim, we introduced the cancer drugs fund because patients in the UK had significantly worse access to new cancer medicines than patients in other countries. That contributed to our poor relative cancer survival rates, and we were determined that it should stop and that the lack of access to new cancer medicines should be tackled while a longer-term solution was developed.

In 2010, therefore, we introduced the CDF to meet that specific need over a defined period and within a defined budget. The achievement of the CDF has been vital. More than 60,000 patients have accessed the cancer drugs they need through the CDF over the past four years. I am immensely proud of that fact. However, the fund is not, and was never intended to be, a permanent solution. Over time, more cancer drugs will be introduced, and if we carry on like this, an increasing number will not be available other than through the fund. Some drugs, such as cetuximab, Avastin and abiraterone, have already been substantially provided through the CDF. If this continues, while other drugs are added, it will greatly increase the cost.

I welcome the Government’s commitment to the CDF through to 2016—it is needed while the pricing of drugs to the NHS is tackled—but that extension cannot continue indefinitely. I therefore call on the Government to reinvigorate the drive to a value-based assessment of new drug pricing and to incorporate that into the PPRS, so that while the Government and the NHS have control of the budget, the NHS can make all licensed new medicines available through the NHS. In addition, it would incentivise innovation in the pharmaceutical industry and result in a fair return to industry on the cost of drug discovery.

The CDF has been necessary and successful, but it was intended only as a bridge to a better scheme across the whole NHS. It cannot bear the weight that will fall on it if we do not reform the system for the pricing of medicines more generally. If we can see our way to that reform, the prospect of de-listing new or existing medicines to the CDF can be deferred. However, reform of drug pricing has not been progressed as it should have been, or as we hoped it would be.

The new PPRS did not incorporate a value-based assessment of the pricing of medicines payable by the NHS. It gave the Treasury a good deal, securing a real-terms reduction in the drugs budget, but a reduction via a rebate is not transparent to the NHS. Drug companies setting their own price for new medicines will continue to set prices that conflict with NICE cost-effectiveness thresholds.

Members might have noted that, yesterday, Roche won an appeal against NICE’s final appraisal of Kadcyla, a drug used to treat HER2-positive breast cancer. Roche won on the basis that NICE should have taken account of the PPRS but did not do so. It argued that as a budget control mechanism, the PPRS, through its rebate, could be argued to offset the relatively high cost of a medicine on introduction. Roche won the appeal, but I have to say that the NICE appraisal might none the less remain unchanged.

The rebate is not predictable; nor is it attributable to any particular drug. It goes to the Treasury, not to the NHS. So, in practice, any NHS purchaser of a high-cost medicine must fully absorb the cost, and the opportunity cost, that paying a high price implies. This case highlights the theoretical link between a NICE appraisal and the PPRS, and it demonstrates how the PPRS does not in practical terms serve to resolve the dilemma of how to introduce high-cost medicines in the NHS.

The PPRS deal showed how much the pharmaceutical industry in this country was willing to offer for a guaranteed rate of return and the ability to set prices at introduction here in the UK, which can then act as a reference price for a quarter of the drugs market across the globe. The current PPRS of course benefits the shareholders and the boards of the big pharmaceutical companies, which are able to maintain high prices throughout a quarter of the world on the back of high prices in the UK, even for those drugs that offer limited clinical benefit. The other beneficiaries are those in the Government who are able to plan spending on drugs a little bit better than they were before. The losers, unquestionably, are patients, who continue to be denied access to the drugs that their doctors think they need.

This is not the kind of price regulation we should have in future. Price should reflect the value of new medicines. A new drug that offers little or no benefit relative to the best available alternative for treatment should secure only a small price differential. New drugs that tackle unmet need or substantially reduce the burden of disease should enjoy a correspondingly substantial price premium. By such a means, we would incentivise innovation and drug development, particularly in relation to major unmet targets. We could also build a premium into pricing in areas in which drug development was most needed, such as early-stage dementia, new antibiotics or the treatment for some cancers, such as pancreatic and ovarian cancer.

The benefits of a value-based pricing system were set out in an OECD study six years ago. But the study recognised—as, subsequently, did we—that the principle had yet to be given practical effect. A year ago, the Minister responsible, Earl Howe, said that value-based assessment would be taken forward and that it would be brought in late this year. That is not happening. NICE was given the task of developing value-based assessment last year, but in September this year, it appeared to have put that on the back burner. That is just not good enough.

Without value-based assessment, NICE will continue to apply an arbitrary threshold to a measurement of the benefits of drugs which takes into account only the quality-adjusted life year gain—the QALY—and end-of-life addition, not the broader societal benefits or the need to promote drugs targeted at key areas of therapeutic need and to promote innovation.

We must look to the value beyond the QALY. We must ask NICE to design a clearer methodology for value, but not just through add-ons to its existing methodology. It should recognise the burden of disease in extending life and the importance of greater clinical and patient engagement. In developing realistic pricing, it could draw on the real-world mature outcomes data for drug use that the cancer drugs fund has given us. It must also draw on the work done by charities and by Sanofi to examine ways in which patient engagement with NICE could be supported. Qualitative judgment of innovation and patient benefits must form a part of this broader assessment, as well as the quantitative data relating to the QALY.

I congratulate Ministers for pushing the NHS to promote innovation. We had our report in December 2011 and more recently Ministers have launched the early access to medicine scheme. The Under-Secretary of State for Health, my hon. Friend the Member for Mid Norfolk (George Freeman), has been right not only to support that and the Medical Innovation Bill but to launch a review of how innovation processes can be enhanced in the NHS.

How perverse would it be if, at the same time, licensed and effective medicines were not approved or available through the NHS? In recent months, a number of drugs have not been approved by NICE, such as Kadcyla, Alimta for lung cancer and abiraterone for prostate cancer prior to chemotherapy. Several of those cases demonstrate the problem of paying for new personalised medicines, but we cannot see the difficult process of introducing new drugs being made even worse by the de-listing of drugs by the cancer drugs fund.

I hope that in response to the debate Ministers will tell NICE to reinvigorate and make progress on the work on value-based assessment, while developing a new methodology in the way that I have described. The Government should work with industry to develop the pharmaceutical price regulation scheme, so that pharmaceutical companies can, within the overall framework, continue to set the price of their medicines at introduction but accept that the NHS should receive a rebate if, and to the extent that, a value-based assessment shows a lower price. That would lead to drug-specific rebates that could then be incorporated within the overall rebate for budget control purposes. In my view, such a system must be in place by 2016, so that the cancer drugs fund can be maintained between now and then and can be the bridge that it was intended to be, while having a realistic time-limited remit.

Only by pushing forward with such measures can we expect in future to offer doctors in the NHS the assurance that they can access the medicines and treatments they think best for their patients and give patients the confidence that the NHS, as a comprehensive free service, is able and willing to provide whatever treatment is in their best interests. I am grateful for the time and attention of the House.

Ebola

Lord Lansley Excerpts

Monday 13th October 2014 Commons Chamber

[Mr Hunt]

The Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), has been in touch with Jim Wells in the Northern Ireland Assembly and she will take up that issue. The broader point that the hon. Member for North Antrim (Ian Paisley) makes is that there are many points of entry into the UK, and it is important for us to recognise that our screening and monitoring process will not catch absolutely everyone who comes from the affected regions. That is why we need to have other plans in place, such as the 111 service, and to have encouragement at every border entry point for people to self-present so that we can protect them better, should they develop symptoms.

[Mr Andrew Lansley (South Cambridgeshire) (Con)]

I welcome the Secretary of State’s statement to the House, and I am also grateful to the shadow Secretary of State for what he said. All Members share the Secretary of State’s admiration for the staff of the NHS and Public Health England who are assisting in the front-line treatment and care of those in west Africa. In that context, he is right to try to tackle the virus in west Africa, but this is not just about the availability of much better treatment facilities; it is also about working in the community in short order to try to stem the continuing transmission of the disease. Work has clearly been done on that; will he tell us how we might scale it up?

[Mr Hunt]

My right hon. Friend makes an important point. I discussed this with United States Secretary Burwell today. The US is piloting a programme in Liberia, and we are doing the same thing in Sierra Leone. We are both providing the same response, which is to tackle the disease at source. We know that, if we can get 70% of the people who develop Ebola symptoms into treatment and care, we will contain the disease. At the moment, the disease is replicating at a rate of 1.7, which means that every 10 people infected are going on to infect another 17 people. That is why the virus is spreading so fast, and we can halt it only if we get people into treatment very rapidly. Community treatment centres are therefore an important part of the Department for International Development’s strategy to help to contain the virus, and that is why we are supporting the development of 700 beds in Sierra Leone.

Regulatory Reform

Lord Lansley Excerpts

Tuesday 9th September 2014 Commons Chamber

[Mr Andrew Lansley (South Cambridgeshire) (Con)]

I did not intend to say much about the regulatory reform order but I am prompted to do so to ask some questions and to respond to one or two points. I will not rise to the bait of the shadow Minister, the hon. Member for Leicester West (Liz Kendall), other than to say that I thought it deeply ironic that, in railing against the Health and Social Care Act 2012, she instanced for most of her speech the views of Healthwatch England, a body representing patients that was created under that Act. It remedies one of the greatest failings of the last Labour Government, who demolished successive efforts to give patients a genuine voice.

I was grateful to my hon. Friend the Member for Stafford (Jeremy Lefroy) for instancing the Act’s requirements on CCGs in relation to patient involvement. “No decision about me without me” is at the heart of the principles of reform. They are set out in the primary legislation. This reform order does not in any way reduce the statutory requirements on CCGs, which must ensure that any joint arrangements they enter into match up to the requirements under the Act.

Under the Act, the essence of CCGs, compared with primary care trusts, is that they are independent statutory bodies. I will not follow the hon. Member for Blackley and Broughton (Graham Stringer) and discuss the process of the regulatory reform order, but he is right: it is not theoretical; it is practical. There is a practical reason why we are in a better place, with CCGs enjoying statutory authority compared with PCTs. Although they were statutory bodies, they did not have the authority that exists presently under statute to deliver and commission services in the interests of the population they serve, without interference or instruction by others. Therefore, as the Minister rightly says, if they wish to enter into these commissioning arrangements, they do so on a voluntary basis. My view is that in the relatively short intervening period under the Act, they have probably underestimated their capacity as statutory bodies to enter into arrangements voluntarily, exercising their statutory authorities as long as they do not improperly delegate their responsibility.

That takes us back to the practical issue. I remember that in 2006, also in Manchester, as it happens—some Members will recall this very well—there was the reorganisation of maternity and children’s services across the city. I suspect that what is being complained of in relation to Healthier Together is exactly the same kind of complaint as was made against that consultation, which had its deficiencies, of which I complained.

Leaving aside whether the consultation was good, bad or indifferent, the point is it did arrive at a position. I can remember talking to the chief executive of the primary care trust in Salford and also, separately, to the chief executive of Salford Royal, and they were told that, as a consequence of the configuration, although the primary care trust wished to commission maternity services and paediatric intensive care services from Salford Royal and the hospital wished to provide them, they were not allowed to do so because the Joint Committee of Primary Care Trusts was preventing them from doing so. In fact, as they were, in effect, in a hierarchy under the strategic health authority, under past legislation they could have been required—forced—to go down that route, and were forced to do so.

That, in my view, is not the position now, and it still will not be the position under these proposals because they are voluntary. If a CCG takes the view that it is in the best interests of its population to deliver some service, it must take a decision consistent with that view. If that means it enters into a voluntary arrangement to deliver that, that is to be supported. If it takes the view that it has to depart from any such arrangement in order to secure the best interests of its population, it must go down that path as well. It would be wrong, under this order or otherwise, for it not to do what is in the best interests of the population it serves.

Finally I have a question, which in this respect is an important one following on from what the shadow Minister asked. In commissioning—quite often when commissioning, for example, out-of-hospital and community services—it is right that one may well need to co-ordinate across CCG services and NHS England’s responsibility for the commissioning of primary care services or, indeed, other services such as dental care and pharmacy services. That being the case, however, it is also important to commission across social care services and some public health aspects of local authorities’ responsibilities. With local authorities having their own statutory authority, and CCGs likewise, it is perfectly possible for them to enter into joint commissioning arrangements, and they do so. I hope the Minister will be able to reassure me that not only are local authorities and the geography of health and wellbeing boards and scrutiny to be respected in terms of the way in which CCGs enter into these kinds of voluntary arrangements, but also that where they enter into joint commissioning arrangements they are able to do so in ways that can mesh together NHS England, CCGs, as necessary, and local authorities.

I urge that at the heart of this is a recognition that CCGs now have statutory authority. That is what is different. They are accountable to their local community, and must set out a commissioning plan and agree it with their health and wellbeing boards. If they try to enter into an arrangement which is contrary to the best interests of their population, as set out in that commissioning plan or by agreement with the health and wellbeing boards, clearly it would be deficient and it should not be able to be pursued.

Business of the House

Lord Lansley Excerpts

Thursday 6th September 2012 Commons Chamber

[Ms Angela Eagle (Wallasey) (Lab)]

Will the Leader of the House please give us the business for next week?

[The Leader of the House of Commons (Mr Andrew Lansley)]

The business for next week will be:

Monday 10 September—Consideration in Committee of the European Union (Approval of Treaty Amendment Decision) Bill [Lords] (day 1).

Tuesday 11 September—Opposition Day (6th allotted day). There will be a debate on tuition fees, followed by a debate on a subject to be announced. Both debates will arise on an Opposition motion.

Wednesday 12 September—Remaining stages of the Defamation Bill, followed by a motion relating to the appointment of a new Parliamentary Commissioner for Standards.

Thursday 13 September—A debate on a motion relating to oil markets, followed by a debate on tax avoidance and evasion. The subjects for these debates have been nominated by the Backbench Business Committee.

Friday 14 September—Private Members’ Bills

The provisional business for the week commencing 17 September will include:

Monday 17 September—Second Reading of the Infrastructure (Financial Assistance) Bill.

Tuesday 18 September—Motion on the conference recess adjournment, the format of which has been specified by the Backbench Business Committee.

I should also like to inform the House that the business in Westminster Hall for 13 September will be:

Thursday 13 September—Debate on the dairy industry.

May I say how privileged I am to be appointed Leader of the House? I pay tribute to my predecessor, my right hon. Friend the Member for North West Hampshire (Sir George Young), and to the former Deputy Leader of the House, the hon. Member for Somerton and Frome (Mr Heath), who takes on important new Government responsibilities. Throughout the House, my predecessor was held in the greatest respect and affection, and continues to be. He saw through important reforms, and I can hope to do no better than to emulate him in how he demonstrated that he understood the importance of being not only Leader of the House but a leader for the House, speaking for the House and representing it in government and beyond, and balancing that with the important responsibility of representing the Government within the House. I look forward to these new responsibilities.

[Ms Eagle]

I welcome the new Leader of the House and join him in paying a warm tribute to his distinguished predecessor. The right hon. Member for North West Hampshire (Sir George Young) has given long and distinguished service both in government and to the House. Over the years, he has surprised political pundits with his Lazarus-style tendencies, and perhaps even this time he is merely on a sabbatical and will be back. I also welcome the new Deputy Leader of the House of Commons, and pay tribute to his predecessor, the hon. Member for Somerton and Frome (Mr Heath).

I also welcome the Chief Whip to his new and extremely challenging job. One of the first things he will have to do is console his colleagues who have been sacked in the reshuffle—and not given knighthoods. If it is any help, I can tell them that, in my experience, being sacked from government does not necessarily mean the end of a Member’s ministerial career. I returned to government in a subsequent reshuffle—under a new Prime Minister.

Over the summer, the Olympics and Paralympics have shown the best of our country, and I salute the tremendous achievements of all our athletes and those who volunteered during the games, who contributed to making it such an inspirational summer. I pay particular tribute to those at the London Organising Committee of the Olympic Games and Paralympic Games and my right hon. Friend the Member for Dulwich and West Norwood (Dame Tessa Jowell), who did so much to bring the games to this country and make them a success. Also, in the spirit of cross-party unity and wanting, as always, to be helpful, may I single out the part played by the Mayor of London? No one has asked him whether he is a man or a mouse.

Speaking of the Prime Minister, after his disastrous summer, it is hardly a surprise that we have had yet another Government relaunch. After the reshuffle, we have a new right-wing Justice Secretary, an Environment Secretary who is a climate change sceptic and an Equalities Minister who has voted against almost every piece of equality legislation. So now we know: at the end of the rose garden, turn right. Given her record, can the Leader of the House arrange for an urgent statement from the new Equalities Minister, so she can inform the House of her unique approach to her brief?

The new Secretary of State for Health said before the election that a Conservative Government would “crowd-source” ideas, because Conservatives believe in collective wisdom. Will the Leader of the House commend the Chancellor for going to the Olympics stadium the other night to do his own little experiment with crowd-sourcing, and can he tell us what the Chancellor will be doing with the answer he got?

What the British people want is not yet another Government relaunch, but a real plan for jobs and growth, because the Chancellor’s economic policies have failed spectacularly. We now have an economy in the longest double-dip recession since the second world war. Growth forecasts have been cut and borrowing is up by a quarter. The Prime Minister has been on “Daybreak” this morning making announcements that should have been made to this House. When will he learn that cosy chats on the “Daybreak” sofa are no substitutes for a statement to this House? We should not have to rely on urgent questions.

The Deputy Prime Minister said in an interview with The Guardian over the recess that, given the economic situation, it was right to increase taxes on the very wealthy. The next day the Chancellor rubbished the idea. After the reshuffle, does the new roving Economic Minister, the right hon. and learned Member for Rushcliffe (Mr Clarke), have the casting vote? With the excitement of the Olympics, I thought I must have forgotten about the Liberal Democrats joining us in the Lobby to vote against a Budget that gave a huge tax cut to millionaires, but according to Hansard the Liberal Democrats voted for it. After the Deputy Prime Minister’s disastrous performance at the Dispatch Box this week, the new Leader of the House might find it difficult to coax him back to the Chamber any time soon, but can he try to get us an urgent statement? The impression at the moment is that the Deputy Prime Minister is saying one thing in public and voting the opposite way in this House.

I look forward very much to working with the Leader of the House. I hope that he can set out his views soon on the proposed House business committee. In the meantime, will he put all our minds at rest, on this first occasion at the Dispatch Box, and rule out a top-down reorganisation of the House of Commons?

[Mr Lansley]

I am grateful to the hon. Lady for her welcome. I am also grateful for her very warm tribute to my predecessor. I know that the House will very much appreciate the intention that he should be further honoured, as a Companion of Honour. It is a rare honour, but one that reflects the regard in which we all hold him.

The hon. Lady is quite right: I recall at the last business questions before the recess that the House was looking forward to the Olympics and Paralympics. In truth, I think all our expectations have been wonderfully exceeded. It has been a most inspirational event, and not only inspirational for a generation, as it was intended to be, but a fabulous showcase for what this country can achieve. We, the Government and the people of this country will be able to depend on that reputation across the world in years to come.

The hon. Lady asked a number of questions and made a number of points. Let me tell her that the changes in the Government are all about ensuring that we take forward our reforms and our focus on growth. All of us, as the Prime Minister absolutely said, recognise the difficulties that we encountered when we came into government. We know—and have known for two and a half years—how difficult they are. In a sense, they have been added to by the problems in the eurozone and the international economic situation. We are not alone in the problems we have to face, so we are focused on growth, and that will be true, as the Prime Minister has rightly said, in every Department—whether in the Department for Education, in developing the skills, the qualifications and the standards that are required; in the Foreign Office, which has been focused on delivering trade and investment, and business relationships across the world; or in the Department for Communities and Local Government, in using the powers that the Localism Act 2011 gave to local authorities and the new planning arrangements to deliver increased growth and build jobs. That is what it will mean in all those Departments. The difference between the Government and the Opposition is that the Labour Government were responsible for the mess that the country was in in 2010, whereas this Government are focused on getting the country out of that mess.

[Margot James (Stourbridge) (Con)]

Millions of law-abiding citizens will be outraged that Mr and Mrs Ferrie spent three days in custody after defending themselves against burglars, one of whom turned out to be a violent career criminal out of prison early on licence. May we have a statement from the Home Secretary on the urgent need to include common sense in the training of police officers, and may we have a debate about the rights of householders to defend themselves and their property?

--- Later in debate ---

[Mr Lansley]

I completely understand how strongly my hon. Friend feels about that, and I think many Members of the House feel the same. I hope she sees that there is an opportunity for her on the 18th of this month to raise that issue at Justice questions. I am sure that Ministers will feel as strongly as she does on this.

[Natascha Engel (North East Derbyshire) (Lab)]

Before I welcome the new Leader of the House to his new role, I too would like to put on record my thanks to his predecessor, the right hon. Member for North West Hampshire (Sir George Young). Without his help and good advice, the Backbench Business Committee would not be what it is today, and the Back Benches are a more interesting and more powerful place as a result of his time in office.

I am sure that the Backbench Business Committee will continue to enjoy a good and strong working relationship with the Office of the Leader of the House, and I look forward to working closely with him. May I take this opportunity to say to the House that the closing date for submitting subjects for the mini-recess Adjournment debate on the final Tuesday is Wednesday 12 September?

[Mr Lansley]

I am grateful for the hon. Lady’s kind words. I was pleased that in my first announcements on the business of the House I was able to include not only the pre-recess Adjournment debate but a day for the Backbench Business Committee which is not a Thursday. I want to follow what my predecessor achieved in improving the opportunities for debates for Back-Bench Members and in bringing a sense to this House of being a forum for the nation on issues of importance. I hope that we will continue to do that.

[Jake Berry (Rossendale and Darwen) (Con)]

For more than 100 years the Bacup and Britannia Coco-nutters have been dancing the boundaries of Bacup on Easter weekend. May we have a statement about the cost of road closure orders, as the Coco-nutters face the prospect of not being able to dance this Easter because it will cost £1,000 to close the road? It is endangering our morris dancing tradition.

[Mr Lansley]

I am grateful to my hon. Friend for giving me an early opportunity to understand the encyclopaedic nature of business questions. The limits of my knowledge I have always been aware of, and it does not extend to morris dancing. I will draw the point that he raises on behalf of his constituents to the attention of my colleagues at the Department for Communities and Local Government, and ask them to respond to it.

[Mr Ben Bradshaw (Exeter) (Lab)]

May we have a clear statement from the Government on their policy on regional pay? In May the Deputy Prime Minister said:

“There is going to be no regional pay system. That is not going to happen.”

Yet 20 health trusts in south-west England have announced that they intend to abandon the NHS’s national “Agenda for Change” pay structure and adopt just such a regional pay system. This is causing great concern and anger among thousands of NHS workers and their families across the south-west.

--- Later in debate ---

[Mr Lansley]

I am grateful to the right hon. Gentleman for the opportunity further to reiterate—we have discussed it in the past—that we were not proposing regional pay. I made it clear in my previous role as Secretary of State for Health that we were proposing pay that was more reflective of local labour market circumstances, marketplace and pay. That is capable of being achieved through the “Agenda for Change” framework, and to that extent it is consistent with national frameworks for pay. The consortium of trusts has made it clear that its frustration is borne of the lack of progress in the national pay frameworks.

[Mr Ian Liddell-Grainger (Bridgwater and West Somerset) (Con)]

The Leader of the House will be fully aware that the 2nd Battalion the Royal Regiment of Fusiliers is due to be cut. That decision is wrong on many levels. It is a fully recruited, highly motivated regiment, in whose 6th Battalion I served. May we please have time in this Chamber to discuss what is blatantly a wrong decision and to put forward the reasons why the 2nd Battalion the Fusiliers should be kept as a line regiment doing the phenomenal job that it has been doing and wants to continue to do for this country?

[Mr Lansley]

I completely understand the strength of feeling that my hon. Friend expresses. He will have heard, as I did, the Prime Minister’s response to a question from my hon. Friend the Member for Basildon and Billericay (Mr Baron) yesterday. The Prime Minister explained how the reshaping and the changing character of the armed forces were being developed under the Army 2020 arrangements. He was willing to arrange a meeting to discuss that matter, and I simply reiterate that.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I welcome the new Leader of the House to his post. We will miss the old Leader of the House, who was essentially a great parliamentarian. He was full of wit and wisdom, and he will be a hard act to follow, but I am sure that the right hon. Member for South Cambridgeshire (Mr Lansley) will have a good go at it.

May I raise an important question as the Member of Parliament for Huddersfield? It relates to Pakistan and extradition. Criminals and suspected criminals who flee to Pakistan are almost impossible to track. Ten years ago, eight members of the Chishti family were killed in an arson attack, including the mother, the older children and tiny babies. Three of the gang that did it were arrested, tried and convicted, but one of the prime suspects, Shahid Mohammed, fled to Pakistan. People in Pakistan know where he is. What can we do to track him down, bring him back to face justice and give comfort to the Chishti family?

[Mr Lansley]

The hon. Gentleman raises an issue that is clearly of great importance to his constituents. I do not know the answer to his question, but I will gladly raise it with my Foreign and Commonwealth Office colleagues and ask them to respond to him.

[Dr Julian Lewis (New Forest East) (Con)]

May I say to my former chief at the Conservative research department what a pleasure it is to see one of the most decent people in political life now occupying one of the most distinguished positions in Parliament? In return for that, may we have a statement from a member of the new Defence ministerial team on the situation of Commonwealth soldiers who would normally be in a good position to apply for citizenship at the end of their service, but who are being prevented by the UK Border Agency, on very questionable grounds such as minor military disciplinary infractions? We owe those soldiers a debt of honour, and they should not be discriminated against in that way.

[Mr Lansley]

I am grateful to my hon. Friend, and I will raise that issue. I know that people feel strongly that service personnel who serve this country should be treated with the greatest respect and honoured as a consequence. My colleagues at the Ministry of Defence will want to reply to him on that matter.

[Mr John Spellar (Warley) (Lab)]

May I also welcome the Leader of the House to his new position? I should like to take him back to his previous incarnation as Health Secretary. Is he as shocked as I was to find out how much typing work is now being outsourced abroad by hospitals? My freedom of information request has revealed that West Middlesex outsourced 230,000 letters in one year, that Whittington outsourced 90,000, that Epsom outsourced 11,000 in a quarter, and that Kingston outsourced 17,000 in a pilot. Medical secretaries are being laid off as a result. May we have a debate so that the Secretary of State for Health can justify taking away British jobs from British workers?

[Mr Lansley]

I will of course raise that issue with the Department of Health on the right hon. Gentleman’s behalf, but he might also like to raise it himself in the pre-recess Adjournment debate, which will give Members the opportunity to mention issues of that kind. I was interested to see, in my own constituency a few years ago, that Addenbrooke’s—a major hospital—had outsourced activities of that kind, but that it brought them back to this country as a consequence of seeing the quality of service that could be delivered here.

[Dr Matthew Offord (Hendon) (Con)]

In July this year, the Prime Minister said that he fully supported the right of people to wear religious symbols at work. That position was supported by the Attorney-General and the Equalities Minister. Will a Minister therefore come to the Dispatch Box to explain why lawyers acting on behalf of the Government are contradicting the Prime Minister in bringing a case against Shirley Chaplin for wearing a crucifix at work?

[Hon. Members]

Hear, hear!

[Mr Lansley]

I think that that response to my hon. Friend’s question demonstrates the fact that we feel strongly about this matter. People should be able to wear crosses and to reflect their faith and beliefs. The law allows for that, and employers are generally good at being reasonable in accommodating people’s religious beliefs. We believe that the law as it stands strikes the right balance between the rights of employees and employers. We also believe that it is better for the UK to look after its own laws, rather than being forced into a change by a European court. We believe that UK law strikes the right balance, and losing that case would place extra restrictions on how employers treat their work forces. We are not seeking that.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

I congratulate the Leader of the House on his new position. May I also express my disappointment that the Government reshuffle did not deliver a Minister for Teesside? I say that because figures from the Office for National Statistics have today shown that South Teesside has moved from 14th to second in the country for its number of households with no work. May we have a statement on why the number of workless households in Teesside has increased so desperately in the past year?

[Mr Lansley]

I am surprised that the hon. Gentleman did not put that in the context of the overall reduction in the number of households with nobody in work, which I believe is very much to be applauded.

[Philip Davies (Shipley) (Con)]

May we have a debate on the appointment of judges, and on how to make them more reflective of public opinion? A great deal of concern has been expressed about lily-livered judges by many people, not least me, and yesterday we heard a judge saying that it took a huge amount of courage to burgle a house, and refusing to send a persistent burglar to prison. How can we ensure that idiots like that do not remain in the judiciary, and that the people who are appointed to the judiciary do not reflect the views of that individual?

[Mr Lansley]

I am conscious that, in my new privileged position, I stand at a constitutional juxtaposition between the legislature and the Executive. One of the last things I would want to do, on my first occasion at the Dispatch Box, would be to trespass on the relationship between the legislature, the Executive and the judiciary, and in particular on the independence of the judiciary, so I will avoid commenting on that. However, my hon. Friend’s observations are on the record.

[Alex Cunningham (Stockton North) (Lab)]

Yesterday, 500 Teessiders, many of them from my constituency, lost their jobs with Direct Line, which is part of the state-owned RBS Group, not long after apparently having been cajoled into signing new contracts. That means that their redundancy payments will be considerably less; they will lose thousands of pounds as well as their jobs. I am sure that the Leader of the House will agree that such actions are abhorrent, and that the managers must be held to account. Does he know whether the Business Secretary plans to make a statement on the decisions of this state-owned business, and would the Leader of the House allow a debate on the issue?

[Mr Lansley]

I share the hon. Gentleman’s view, as I am sure all Members do, that the prospect of losing one’s job can be difficult and that we should all sympathise and do everything we can to help. Indeed, the Government will do everything they can to help, and Governments have done a great deal in the north-east. For example, the Deputy Prime Minister and the Chancellor were there recently to see how new investment was going to the north-east as a result of the enterprise zones. I confess that I was in the House only for the latter part of Business, Innovation and Skills questions, so I do not know whether the hon. Gentleman was able to raise this matter then. That would have been a good opportunity to do so.

[Mike Crockart (Edinburgh West) (LD)]

Six hundred and fifty million silent calls were made in the UK last year, many of them to vulnerable older people. Forty-five million spam texts are sent in Europe every single year, 92% of which are estimated to be fraudulent, and 3 million UK adults will be scammed out of £800 each this year by fraudulent marketing calls. May we therefore have an urgent debate on the effectiveness of the powers of the Information Commissioner’s Office, as it is now clear that we have an industry in crisis and a country under siege?

[Mr Lansley]

I am interested to hear what the hon. Gentleman has to say. I think that all Members and people outside the House will, almost without exception, have been the recipients of such nuisance calls, which can be very distressing, particularly for older and vulnerable people. He will know that this is exactly the sort of issue that it is helpful to raise, for example, in the pre-recess Adjournment debate, not least because that will focus the mind of the Information Commissioner. In any case, I will make sure that the issue, which touches on the responsibilities of Ofcom and the ICO, is raised with the Department for Culture, Media and Sport.

[Paul Flynn (Newport West) (Lab)]

When can we debate the apparent ambition of the Prime Minister to rival the work of King James I and David Lloyd George in degrading the honours system? A Select Committee has already criticised the Prime Minister for setting up in March this year, without the knowledge or consent of Parliament, a new Committee dominated by the Whips, which exists to give honours to MPs. The distribution of consolation prizes to sacked Ministers is likely to bring the honours system into further disrepute and ridicule.

[Mr Lansley]

I do not welcome what the hon. Gentleman says. In this House as elsewhere, we should honour public service. This is a mechanism for honouring public service, and I see absolutely no reason why this Members of this House should be debarred from having access to that kind of honour.

[Jason McCartney (Colne Valley) (Con)]

For the first time in ages, all the shop premises in Holmfirth, a market town in my constituency, are actually let, which is really good news. I know that the Government have been doing their bit to support our town centres with their high street strategy, but could we have a debate on the many “shop local” campaigns, which are working hard to support our local shop centres and businesses and our local producers?

[Mr Lansley]

I am pleased to hear what my hon. Friend has to say, and I welcome what he said about Holmfirth high street. Indeed, we have accepted and implemented virtually all Mary Portas’s review recommendations. I hope that the pilots will show how we can extend some of the lessons further to invigorate high streets across the country—something that, as my hon. Friend illustrates, can be achieved.

[Valerie Vaz (Walsall South) (Lab)]

I welcome the Leader of the House to his new position and place on record my thanks to the right hon. Member for North West Hampshire (Sir George Young) for the helpful and courteous way in which he dealt with Back Benchers. I hope that that will continue.

Can we have an urgent debate on the Sunday trading laws, given that the announcements outside this House are at variance with the undertakings given inside it? If there is any consultation, will the Leader of the House ensure that retail staff, the unions, the Churches and the Association of Convenience Stores are included?

[Mr Lansley]

I am grateful to the hon. Lady for her kind words about my predecessor. I do hope to emulate in many respects the way in which he fulfilled his responsibilities so wonderfully. As to Sunday trading legislation, however, I do not accept the premise of her question. I do not think there is any variance between what the Government said when we introduced the legislation about the extension of Sunday trading hours during the summer and what has been said subsequently.

[Mr David Nuttall (Bury North) (Con)]

In welcoming my right hon. Friend to his new position as Leader of the House, I would like to reiterate and add my voice to the calls for a debate on the proposal to disband the 2nd Battalion the Royal Regiment of Fusiliers? In particular, we should consider how that decision will affect recruitment opportunities in my Bury North constituency, which has a long and proud history of providing new recruits to the Fusiliers.

[Mr Lansley]

I am grateful to my hon. Friend, who reiterates on behalf of his constituency a point that is particularly important to it as a location for recruitment. My colleagues in the Ministry of Defence are, through Army 2020, setting about the process of changing not the size but the shape of the armed services, particularly the Army. In that context, they are looking for something that is sustainable, not least because the Army recruits from across the country. I have already mentioned the opportunity for Members to talk to Ministers about this, but in addition, I hope that Members will recognise that this is the sort of issue that is worth raising in the pre-recess Adjournment debate on Tuesday week.

[Kelvin Hopkins (Luton North) (Lab)]

It was reported yesterday that 50,000 more patients suffering from alcohol problems had been admitted to A and E, bringing the national annual total to a staggering 1.2 million. Again, according to experts, cheap alcohol is to blame. Will the Leader of the House press his Government colleagues to bring forward comprehensive measures to deal with Britain’s growing and serious alcohol problems, including a minimum price for alcohol?

[Mr Lansley]

The hon. Gentleman will no doubt be aware of the alcohol strategy that the Government published several months ago. In itself, that reflected a comprehensive strategy to address the severity of the problem he describes. In that context, data were published only last week on alcohol-related admissions to hospital showing that the previous rates of increase in those hospital admissions under the last Government were considerably greater than those under this Government last year.

[Bob Stewart (Beckenham) (Con)]

I was in the House a lot yesterday, and have been here a lot during the week, but I cannot recall any tribute being given to our armed forces for how they rescued the security of the Olympics. I may be wrong, but I would like to place on record everyone’s thanks to our armed forces. When watching the Olympics on my big television, I often noticed the red and white hackle of the Royal Regiment of Fusiliers. These soldiers were brought in quickly in an emergency to sort out a problem. I reiterate what colleagues and friends on both sides of the House have said: we need to debate what is happening to English regiments, which may well be needed quickly in the future. I would very much like to have a debate on the 2nd Battalion the Royal Regiment of Fusiliers and on my own old regiment, the 2nd Battalion the Mercian Regiment, called the Staffordshire Regiment.

[Mr Lansley]

I am grateful to my hon. Friend. I will not reiterate my earlier points, as the importance of his points is recognised, as are the opportunities to debate the matter before the House rises for the pre-conference recess. I entirely share his view about the fabulous job done at the Olympics by members of our armed services, as I noted from my experience of visiting the Olympic park on one occasion. It is not just that they provided security, but that they did so in such a friendly, welcoming and engaging way.

[Wayne David (Caerphilly) (Lab)]

Can we have a debate on multiple and double jobbing? I am thinking particularly of the large number of Conservative MPs who now have more than one job in government. For example, the hon. Member for Preseli Pembrokeshire (Stephen Crabb) is not only a Wales Office Minister, but a senior Government Whip. Leaving aside the convention that senior Whips do not normally speak in the Chamber, how do we know which job has his priority?

[Mr Lansley]

I am absolutely clear that there is no conflict between having a responsibility as part of the Government’s business management and having responsibilities on policy and administration. I understand that there is no conflict, because I have such a role: I have responsibilities to this House and I have responsibilities in government, and I see them as equally important.

[Several hon. Members]

rose—

[Robert Halfon (Harlow) (Con)]

Can we have a debate on intellectual insanity? The Labour-supporting Institute for Public Policy Research is now arguing that motorists are not suffering enough from high petrol taxes, and is calling for more taxes. Is that not surprising, given that high petrol taxes hit the poorest Britons twice as hard as the rich?

[Mr Lansley]

I am interested by what my hon. Friend has said. I seem to recall that, according to Einstein, one of the definitions of that kind of insanity was “to keep doing the same thing while expecting a different result”. I am afraid that that is what we see from the Labour party day by day.

[Chris Bryant (Rhondda) (Lab)]

I, too, pay tribute to the former Leader of the House. I think it is a bit of a shame that he has not been given a knighthood. I know that he is already a baronet, but I thought he could prove that at the age of 70 it was still possible to do “twice a knight”.

Let me now ask a question of real importance. Given that the Government have a massive hole in their programme for the autumn because we lost the House of Lords reform Bill, which was carried by a three-to-one majority, can the Leader of the House do something on behalf of all the Back Benchers in the House, and ensure that the days that would have been allocated to that Bill—10 days, perhaps—can be allocated to Back-Bench business, particularly private Members’ Bills, so that some of the good ideas on the Back Benches can inform the Government?

[Mr Lansley]

I must confess that I am slightly staggered that the hon. Gentleman now seeks to make a virtue of the fact that he and his party voted by a substantial majority for the principle of House of Lords reform, and then effectively sought to obstruct any progress. My definition of opposition is not obstruction. It may be his definition, but it is not mine.

[Henry Smith (Crawley) (Con)]

I warmly welcome my right hon. Friend to his position. Will he consider arranging a debate on over-zealous health and safety regulation? Apparently my local authority, Crawley borough council, has been told to remove all park benches that are under trees.

[Mr Lansley]

I hope my hon. Friend will not be surprised to learn that we in the Government have been working actively over the last two and a half years to ensure that common sense is at the heart of the way in which we apply health and safety regulations. It must be evidence-based, common-sense and proportionate. Measures have been taken, but I will certainly draw my hon. Friend’s comments to the attention of my colleagues in the Department for Business, Innovation and Skills so that they can continue the process.

[Helen Jones (Warrington North) (Lab)]

This week, in Westminster Hall, Members held a debate on the shambles that is Atos. When will the Secretary of State for Work and Pensions come to the House to make a statement on what is going on in that organisation? In my constituency I have seen a woman undergoing chemotherapy passed as fit for work, and a veteran who was classed as being more than 40% disabled for the purpose of industrial injuries benefit lose his disability living allowance following an Atos report which referred to him as a woman throughout. When are we going to get some answers in relation to what this organisation is inflicting on disabled people?

[Mr Lansley]

In terms of business, the hon. Lady is right. The House had an opportunity to debate Atos Healthcare, and I think that she may have received replies from the then Minister of State, my right hon. Friend the Member for Epsom and Ewell (Chris Grayling). I personally know that the work done as a consequence of the Harrington reviews, and what we announced in July about the recording of tribunal judges’ reasons for overturning decisions on appeal, will enable us continuously to improve the process.

[Mr John Baron (Basildon and Billericay) (Con)]

I welcome the Leader of the House to his new post. May I ask him to consider one further fact relating to the 2nd Battalion the Royal Regiment of Fusiliers? It is the only infantry battalion that is being axed for political rather than military reasons, in order to save the more poorly recruited Scottish battalions ahead of the referendum. In fact, no Scottish battalions are being axed. I am married to a Scot and I believe in the Union, but discriminating against the English is not the way for us to achieve our goal.

[Mr Lansley]

My hon. Friend had an opportunity to raise that with the Prime Minister at Prime Minister’s Question Time, and I hope that he will take the opportunity that the Prime Minister gave him to make his points at a meeting. However, I do not recognise his description of the way in which decisions were made. They were made on the basis of an assessment of how the armed services could be sustainable for the future, and could secure representation and maintain recruitment throughout the United Kingdom.

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

It is good to see that the Leader of the House is still in the Cabinet, and especially good to know that he will not be steering any legislation through the House in his new position. He will know that the number of university applications from young people in Britain has dropped by nearly 10% for this year, as a direct result of the disastrous decision to raise tuition fees to £9,000. Why will the Government not find time for a debate on the subject—in Government time—rather than leaving it to the Opposition?

[Mr Lansley]

When the Opposition have wished to present an issue for debate and have chosen the issue of tuition fees, I have announced it as a consequence.

I am grateful to the right hon. Gentleman for his reference to legislation. I wonder whether he meant by it the piece of legislation which, shortly after its introduction, he described as “consistent, coherent and comprehensive”.

[Sir Tony Baldry (Banbury) (Con)]

It is clear from what the Prime Minister said yesterday at Prime Minister’s Question Time, and will be clear from the statement that we shall hear shortly, that a considerable number of initiatives are being taken throughout Whitehall to promote growth and jobs. Indeed, it is sometimes quite difficult to keep up with what is being done. Could the Leader of the House arrange for a quarterly statement to be deposited in the Vote Office, in which every Whitehall Department reports to the House on the initiatives that it is taking to promote growth and the progress of those initiatives?

[Mr Lansley]

I will of course reflect on my hon. Friend’s suggestion. However, although he says that it is difficult to keep up, the connection between the things that are being done is often very straightforward. For example, our announcement in July of funding for lending that would allow increased access to mortgages at more affordable rates will be followed up by my right hon. Friend the Secretary of State for Communities and Local Government in his statement shortly. While we wish to create more demand for new housing, we also wish to ensure that some sites that have not been developed can be developed in future.

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

For the second time in 12 months, the Department for Work and Pensions is planning to close the Old Swan jobcentre. Unemployment in the Old Swan ward has risen by 3% in the last month. Will the Leader of the House find time for the employment Minister to make a statement to the House explaining why he is making it more difficult for my constituents to find jobs?

[Mr Lansley]

The hon. Lady will have an opportunity to raise that issue during questions to the Secretary of State for Work and Pensions next Monday.

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

I, too, welcome the new Leader of the House, who I am sure will do an excellent job. May I take him back to his old brief for a moment, and ask for a debate about the gross distortions in health care funding that we inherited from the last Government? For instance, in Dorset, which I believe has the largest elderly population in the country, £4,000 is being spent on each cancer patient, while in Tower Hamlets, which contains very few elderly people, the figure is £13,000. We have a grossly distorted inheritance from Labour. In the name of deprivation, Labour distorted health funding and cheated people of the health care that they deserve.

[Mr Lansley]

A consultation is taking place on the mandate of the NHS Commissioning Board. It will deal with, among other topics, the board’s responsibility to allocate NHS resources on the basis of equal access for equal need. If my hon. Friend wishes to make his points again, the board will be able to take them into account when it receives recommendations from the Advisory Committee on Resource Allocation.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

I welcome the members of the new team. They will be as surprised as I was to hear what happened to a constituent of mine, a victim of domestic violence. Her screams and the breaking of a window from the inside attracted the attention of the police, but it is she who is now subject to antisocial behaviour powers. Will the Leader of the House please ask the new Home Office team to come to the House and engage in a debate about the way in which domestic violence victims are supported—or not—by police forces around the country?

[Mr Lansley]

I am surprised, and like the hon. Lady, I am obviously disappointed. I will of course ask whether my colleagues in the Home Office can respond to her on the issue.

[Rehman Chishti (Gillingham and Rainham) (Con)]

When I spoke recently to Bishop Michael Nazir-Ali, I was informed that there was persecution of Christian and minority communities in 130 out of 190 countries. May we have an urgent debate on tackling this growing problem?

--- Later in debate ---

[Mr Lansley]

My hon. Friend makes an important point. This matter has exercised Foreign Office Ministers. They have made substantial representations in a number of countries about such situations. I will gladly raise the matter with Foreign Office Ministers and ask them to respond to him.

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

I welcome the new Leader of the House to his post. Will he explain why only sacked male Ministers received honours, while none of the women who were sacked received honours, despite their having been more senior Ministers?

[Mr Lansley]

Matters relating to honours are matters for the Prime Minister.

[Steve Brine (Winchester) (Con)]

I welcome the new Leader of the House to his post. I know he will do well for the House, as he did day in, day out for the health service in the last two-and-a-half years in government.

My right hon. Friend was present for the end of Department for Business, Innovation and Skills questions, and he will have heard the representations made about the Post Office. May we have a statement from the new Minister with responsibility for the Post Office about the Driver and Vehicle Licensing Agency contract? The Government say they support post offices and making them viable front-office businesses. We need to put our money where our mouth is, so we are not at the mercy of a Europe-wide tendering process. Kings Worthy post office and its customers have made many representations to me over the summer, and this decision could very well close the business.

[Mr Lansley]

I did, indeed, hear the answer rightly given by the new Department for Business, Innovation and Skills Minister. I should put this matter in context. The post office local model is an excellent model, and we are seeing substantial take-up, which is in many instances reviving post office services. The Government are absolutely clear that we will not entertain a process of post office closures, which is what happened under the last Government. On the specific point, this contract process is currently live and it would not be proper for Ministers to comment or interfere during the course of that.

[Kevin Brennan (Cardiff West) (Lab)]

I welcome the new Leader of the House and his deputy to their posts, and as the right hon. Member for East Yorkshire (Mr Knight) is on the Treasury Bench, may I also congratulate him on his appointment to his new post of Vice-Chamberlain of Her Majesty’s Household, prompting the headline “MP4 drummer joins Queen”? May we have the debate on the honours system that has just been suggested, because is not giving honours to losers in a reshuffle to console them an example of the “all shall have prizes” culture that the Prime Minister claims to denigrate?

[Mr Lansley]

I will give the hon. Gentleman the prize of best joke of the day, if I may. I merely reiterate the point I made earlier: in this House, people give public service. It is not simply a job; it is much more than that. People do far beyond what I think people in most jobs would expect to do. They give of themselves and their time, and their families and their lives, especially when they are in government, as many Opposition Members will know from their past experiences. Being in government is an onerous and demanding task. For example, my parliamentary neighbour, my right hon. Friend the Member for South East Cambridgeshire (Mr Paice), has had Front-Bench responsibilities for over 22 years. That is a dramatic contribution to public service, and I think it is right that it is properly recognised.

[Andrew Stephenson (Pendle) (Con)]

Has the Leader of the House had time to see early-day motion 337, standing in my name, welcoming the success of Pendle borough council in promoting tourism over the summer?

[That this House welcomes the success of Pendle Borough Council in promoting tourism; notes that 2012 is the 400th anniversary of the Pendle Witch trials and the 100th anniversary of the sinking of the Titanic, whose Bandmaster Wallace Hartley came from Pendle; commends the opening of the Titanic in Lancashire Museum to remember the many Lancastrians caught up in the tragedy; further notes that over the summer events will include the Trawden Agricultural Show and Barrowford Show, the Trawden Garden Festival, the Pendle Cycle Festival, including the Colne Grand Prix Cycle Race, the Pendle Pedal and the Tour of Pendle; further notes that the highlight of the summer for music lovers has to be the Great British Rhythm and Blues Festival in Colne, spanning four days and featuring some of the greatest names in blues, and that the event was named the Best British Blues Festival in the British Blues Awards 2011; further notes that September brings the annual Pendle Walking Festival, which is now the largest in the UK; believes that promoting tourism is vital for economic development across the north of England; and encourages hon. Members to visit Pendle during 2012.]

I hope that my right hon. Friend agrees that the tourism sector is vital in the north of England. May we therefore have a debate on this vital sector of the economy?

[Mr Lansley]

I will perhaps now become more familiar with early-day motions than I have been in the recent past. I will certainly pay attention to the one that my hon. Friend mentions, and he might like to reiterate his important point about tourism at the soon-forthcoming Department for Culture, Media and Sport questions.

[Nick Smith (Blaenau Gwent) (Lab)]

The “rockets and feathers” strategies employed by oil companies are crucifying motorists in Blaenau Gwent, so I welcome the Office of Fair Trading plans to investigate petrol pricing. May we have a debate on how to help our road hauliers and logistics industries to get our economy moving again?

[Mr Lansley]

I, too, take an interest in this issue, and welcome the OFT call for evidence. I note that the Backbench Business Committee has selected the oil market as a subject for debate, and it would probably be entirely in order for the issues the hon. Gentleman has just raised to be discussed in the course of that debate.

[Andrew Bridgen (North West Leicestershire) (Con)]

May we urgently have a debate about the effectiveness of the Government’s bursary scheme for 16 to 19-year-olds? The latest figures show that the proportion of 16-year-olds classed as NEETs—not in education, employment or training—has fallen year-on-year in the second quarter of 2012. Given that this is the first cohort to be affected by the transition from education maintenance allowance to the bursary scheme, does this not show that, despite the hysterical reaction of the Opposition, the scrapping of EMA has not had a negative impact on the number of NEETs, and that the money is now being better spent and better targeted?

[Mr Lansley]

My hon. Friend makes important points. The coalition Government have put £180 million into the 16-to-19 bursary fund this year, to enable the most financially disadvantaged young people to participate in education. The most vulnerable young people receive, as a standard amount, £1,200 more than they would have received under EMA.

[John Cryer (Leyton and Wanstead) (Lab)]

May I welcome the dear Leader to his new Front-Bench post? I suspect he will be a very effective Leader of the House—probably more effective than the Prime Minister would strictly want. Is there any sign of a Bill to create a register of lobbyists, which we have been promised for over two years? The Prime Minister said this would be the next big scandal in British politics and he has been proved right. When will a Bill be on the statute book?

[Mr Lansley]

I am grateful to the hon. Gentleman. I never expected to be called “Leader”; to be called “dear Leader” was beyond my expectations.

At yesterday’s Cabinet Office questions, the Minister of State, Cabinet Office, my right hon. Friend the Member for West Dorset (Mr Letwin), explained the current situation and noted that there have been many responses to the consultation on this matter. They are being seriously considered and he will make a statement in due course.

[Alun Cairns (Vale of Glamorgan) (Con)]

I congratulate the Leader of the House on his appointment. From his previous post, he will be acutely aware of the different approaches to cancer care across the UK. Sadly, my constituents in Wales have less money spent on drugs, longer waiting times and higher mortality rates than those in other parts of the UK. May we have a debate on cancer treatment and the merits of the various approaches, so we can at least show that Wales is getting a worse deal on cancer drugs?

[Mr Lansley]

I understand, and greatly sympathise with, my hon. Friend’s point, and I will ask my colleagues at the Department of Health to respond to him. The coalition Government should be especially proud of tackling directly the issue of access to new cancer medicines. As a consequence of the Cancer Drugs Fund, more than 12,500 people with cancer have received access to the latest medicines over the last two-and-a-half years who would not have done so under the arrangements the last Government left us.

Oral Answers to Questions

Lord Lansley Excerpts

Tuesday 17th July 2012 Commons Chamber

[Stephen Mosley (City of Chester) (Con)]

1. What assessment he has made of the effect on patients of clinically led commissioning.

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

Clinical leadership in the design of services for patients will deliver better outcomes and improve patient experience of care. In the last year, for example, NHS Dorset clinical commissioning group has worked to improve outcomes in cardiology, dermatology and muscular-skeletal services, and NHS Nene CCG has admitted more than 3,000 patients on to a proactive care scheme, which I have had the privilege of seeing for myself, to identify and reduce the risks of people needing an emergency admission. That is one reason why the number of emergency admissions to hospital in the NHS fell by 1%.

[Stephen Mosley]

The Secretary of State will be aware of Chester’s location on the border with Wales and of the issues with cross-border health care commissioning. In order to ensure that there will be no financial shortfall for the West Cheshire CCG in relation to the treatment of patients who are registered with general practitioners in Wales but who receive treatment in England, will he confirm that the cross-border commissioning funding protocol between England and Wales will be fully implemented?

[Mr Lansley]

I would be grateful if my hon. Friend could convey my best wishes to the Countess of Chester hospital, which I visited just before Christmas, and my appreciation of the work of the West Cheshire CCG. I can confirm that discussions between officials in the Welsh Government, my Department and the NHS Commissioning Board are under way to extend and renew the protocol for cross-border commissioning for 2013-14 and beyond.

[Mr Andy Slaughter (Hammersmith) (Lab)]

If the Secretary of State believes that the reconfiguration of hospitals is clinically rather than finance led, will he ensure that NHS North West London publishes full risk assessments of its decision to close four accident and emergency departments and replace them with urgent care centres?

[Mr Lansley]

As the hon. Gentleman will—I hope—be fully aware, the view of Ministers is clear: any reconfiguration of services must be driven not by cost but by a need to improve clinical outcomes for patients; must be in line with the commissioning intentions of the local commissioning group; must be on the basis of strong patient and public engagement; and must protect the choice available to current and prospective patients. To that extent, I hope that all the necessary information to support those four tests is in the public domain.

[Joseph Johnson (Orpington) (Con)]

GP commissioners in Bromley have opened a consultation on the future of services currently provided at the Orpington hospital site. Will the Secretary of State ensure that the administrator recently appointed to South London Healthcare trust takes account of the consultation’s findings when drawing up his proposals for how best to put SLHT on a sustainable clinical and financial footing?

[Mr Lansley]

I hope that my hon. Friend is aware that when I appointed the trust special administrator and set a timetable for his work, I specifically added 30 days on an exceptional basis to the timetable for the production of his first report, one of the exceptional reasons being that an accelerated consultation should take place locally on the future of Orpington hospital.

[Andy Burnham (Leigh) (Lab)]

I shall give the Secretary of State one last chance on rationing.

[Andy Burnham]

The right hon. Gentleman needs to listen carefully to what I am about to say. Yesterday, he promised action to stop the restricting of cataract operations for financial reasons, if given evidence. How about this example? NHS Sussex has imposed severe restrictions that contradict the Department’s own guidance, “Action on Cataracts”, and this has seen the number of operations in Sussex fall from 5,646 in 2010 to 4,215 in 2011. Does the Secretary of State consider that fair to older people, and will he now take the action his Department has promised?

[Mr Lansley]

I have made it clear to the right hon. Gentleman many times, as has the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), that it is not acceptable and we will not allow NHS commissioners to impose blanket bans. I will gladly take note of and investigate that example, but I have to say that the right hon. Gentleman wrote to me with a document that purported to contain a series of examples from across the country, most of which turned out to be fictional. I shall respond in writing about NHS Sussex and put a copy in the Library of the House, but, as I have made clear, we, unlike our predecessors, will not accept any blanket ban on treatment. Any treatment must be clinically determined in the interests of patients.

[Andy Burnham]

Well, the right hon. Gentleman is accepting it, and he continues to dispute my evidence, but what does he say to the president of the Royal College of Ophthalmologists, who said yesterday of cataract restrictions:

“They are arbitrary and are a response to financial pressures, not clinical needs”?

The reason for the Government’s denial is that the financial pressures are greater than they care to admit. The figures released by the Treasury yesterday confirmed that he and the Government have now cut the NHS budget for two years running, but they also reveal something else: another real-terms cut planned for 2013-14. Do not their flagship promises on NHS spending now lie in shreds, and will this Prime Minister not be for ever remembered as the man who cut the NHS, not the deficit?

[Mr Lansley]

It is staggering, isn’t it? In 2010-11, the NHS budget was set by the right hon. Gentleman, not by us. The final accounts for 2011-12 will not be published until the autumn. I wish he would just get up at the Dispatch Box and admit that over the course of this Parliament the coalition Government will increase the NHS budget in England by 1.8% in real terms, which is £12.5 billion in cash, whereas the Wales Audit Office has said that a Labour Government in Wales will cut the NHS budget over the same period by 10% in real terms.

[Mrs Mary Glindon (North Tyneside) (Lab)]

2. What steps he is taking to bring forward legislative proposals on the funding of social care.

--- Later in debate ---

[Chris Kelly (Dudley South) (Con)]

3. What assessment he has made of the performance of the NHS in 2011-12; and if he will make a statement.

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

At the beginning of this month, I laid my first annual report before the House setting out the achievements of the health service in 2011-12. The report showed that the NHS had continued to maintain or improve all the key performance standards while delivering unprecedented efficiency savings and a strong financial out-turn. That is a testament to the achievements of all NHS staff.

[Chris Kelly]

I thank my right hon. Friend for that answer. Will he confirm that the numbers of people waiting over 18 weeks, over 26 weeks and over 52 weeks for treatment are now at their lowest-ever levels—lower than when Labour was in office? Will he also confirm that that gives the lie to Labour’s claims that waiting lists are increasing?

[Mr Lansley]

Yes; I am grateful to my hon. Friend. When we came into office, something like 209,000 people had waited over 18 weeks. We have reduced that figure to 160,000. The number waiting over a year was nearly 19,000, and we have brought that down to below 5,000. I remind Opposition Members that in Wales the target for the number waiting more than 26 weeks has not been met—the figure stands at 6%, whereas in England it is 2.2%.

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

In regard to improving cancer outcomes, will the Secretary of State consider using some of the underspend in the cancer drugs fund to allow improved access to advanced radiotherapy?

[Mr Lansley]

I am grateful to the hon. Gentleman for that question, because it allows me to confirm that the annual report states that the NHS has met all the cancer waiting time standards, and that we in England have provided for 12,500 patients to have access, through the cancer drugs fund, to cancer drugs that they would not otherwise have been able to have. It is a matter of regret that a similar cancer drugs fund is not available for exceptional treatments in Wales.

[John Pugh (Southport) (LD)]

What part or percentage of the £5.8 billion efficiency savings can be attributed to the salary freeze alone?

[Mr Lansley]

If I may, I will write to my hon. Friend in order to convey the precise figure. From my recollection, I believe that the bulk of the £5.8 billion efficiency savings—£2.8 billion—was in the acute sector. As most of the acute sector’s costs are pay costs, the pay freeze will have contributed a significant part of that.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Will the Secretary of State accept that some of those so-called efficiency savings are totally counter-productive? Despite Ministers’ claims to be saving money on agency staff, is not the truth that hospitals’ attempts to improve their efficiency have backfired, with jobs being cut and agency staff being hired at rates as high as £1,600 a day?

[Mr Lansley]

No, I will not accept any such thing. We are aiming to reduce agency staffing costs in the NHS under QIPP—the quality, innovation, productivity and prevention programme—by £300 million, and we have already made a reduction of more than £120 million. Since the election, in complete contrast to the situation beforehand, we have reduced the number of administrative staff in the NHS by 15,000, including a reduction of more than 6,000 managers. We have also increased the number of clinical staff by 4,000 since the election.

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

4. What steps he is taking to improve the quality of care provided in residential and nursing homes.

--- Later in debate ---

[Mark Menzies (Fylde) (Con)]

7. What steps he is taking to reduce health inequalities.

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

The Health and Social Care Act 2012 established the first legal duties to reduce health inequalities for national health service commissioners and for the Secretary of State. Both the NHS and public health outcomes frameworks will have a strong focus on reducing inequalities in access to health services, and on inequalities in the health outcomes of the population as a whole.

[Mark Menzies]

My right hon. Friend will be aware of the inequalities in diagnoses of dementia around the country. What steps has he taken to reduce that variation in diagnosis rates?

[Mr Lansley]

As I think my hon. Friend will know from recently published data, some of the pilot work involving general practices demonstrated that it was possible to increase substantially the number of patients diagnosed with dementia. I believe that during the pilot period there was an increase of two thirds, more than 60%, in the number diagnosed. As part of the Prime Minister’s dementia challenge, we are using quality incentives in the NHS to identify and refer patients who are admitted to hospital with potential dementia in order to improve their diagnosis and treatment. We hope that that and other measures will identify more of those whose dementia is at an early stage, and will also assist their treatment.

[Derek Twigg (Halton) (Lab)]

One of the key elements in the tackling of inequality is funding. The funds allocated to the clinical commissioning groups was set out in the operating framework, which related to GPs’ patient lists. It has now been changed to take account of data from the Office for National Statistics. Will the Secretary of State assure me that deprived areas will not lose out on the funds allocated to CCGs—not the per-head funds, but the funds allocated to CCGs as a result of the change?

[Mr Lansley]

As I am sure the hon. Gentleman knows, we will publish the allocations for 2013-14 later this year. However, we are ensuring, I think rightly, that the allocations to clinical commissioning groups for NHS services reflect the population, because they have a responsibility for the whole population. Some parts of the country, particularly London, have substantial unregistered populations, which often include the groups who are most at risk.

[David Tredinnick (Bosworth) (Con)]

Does my right hon. Friend agree that one of his important initiatives that could reduce health inequalities is the development of personal care budgets, which give real power and choices to patients, and also have the potential to reduce hospital admissions and costs?

[Mr Lansley]

Yes, since the election we have pushed forward with offering access to a personal care budget to those who are in receipt of care and support. At the time of the last election, about 168,000 people were exercising that right. The figure now is over 432,000, and we are extending the scheme so that, for example, people in receipt of continuing health care through the NHS will not lose the opportunity for personal care when the NHS takes over that responsibility; instead, that will continue as a personal budget under the NHS.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

Does the Secretary of State think any of the steps he set out in his original answer will lead to a repeat of the shock rise in the number of cancelled operations in the local hospitals serving my constituents, the figures for which were recently set out in a written answer to me by his Minister of State, the right hon. Member for Chelmsford (Mr Burns)?

[Mr Lansley]

The number of cancelled operations rises at certain times during the winter, and it did so during last winter. We are clear about the necessity of ensuring that patients do not have cancelled operations if we can avoid that, and, in particular, that those whose operations are cancelled have access to treatment rapidly thereafter. The key is to make sure, as we have done, that patients have timely access to treatment under the referral to treatment times guidelines, and as the hon. Gentleman will be aware, the average waiting time for treatment in the NHS has fallen since the election, as has the number of people waiting a long time for treatment. That is the strongest measure for ensuring all patients get timely to access to care.

[Paul Goggins (Wythenshawe and Sale East) (Lab)]

8. How many patients attended the accident and emergency department at Wythenshawe hospital in the last 12 months for which figures are available.

--- Later in debate ---

[David Mowat (Warrington South) (Con)]

11. What plans he has to review the health allocation formula.

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

The independent Advisory Committee on Resource Allocation is reviewing the allocation of resources for the NHS through clinical commissioning groups, and for local authorities in relation to their future public health responsibilities. ACRA’s interim recommendations on the preferred distribution of public health resources were published on 14 June. The NHS formula will be published in due course. The draft mandate for the NHS Commissioning Board makes it clear that it should provide resources to secure equal access for equal need.

[David Mowat]

I thank the Secretary of State for that answer. It is becoming increasingly clear that ageing is a key driver of health care costs, yet the ACRA formula currently does not properly take that into account, to the detriment of towns such as Warrington. Can he confirm that under the new formula, ageing will be more prominent?

[Mr Lansley]

Yes. As my hon. Friend will know, under the existing formula, age was the single biggest factor, but what is important is that the formula accurately reflects the factors that will give rise to need for health care, so that the allocation of resources can respond directly to that need. Ensuring separately that there is an allocation to local authorities for public health, which will be measured in relation to mortality below the age of 75 in particular, will enable those resources separately to be focused on, for example, areas of greatest deprivation which give rise to the poorest health outcomes.

[Jenny Chapman (Darlington) (Lab)]

I am interested to hear the Secretary of State say that he understands there is a link between deprivation and health inequality, in light of the new funding arrangements that seem to indicate that councils in the north-east will receive £17 per head less for public health, whereas councils in wealthier parts of the country will receive £8 per head more.

[Mr Lansley]

The hon. Lady knows perfectly well that I have said many times that deprivation can give rise to inequalities in health outcomes. In particular, we are improving substantially the framework for reducing those health inequalities, because we are giving local authorities specific, dedicated resources. Let me make it clear to her that under the public health allocation formula that I outlined just a few weeks ago, no part of the country will see any reduction in its public health resources from the baseline established.

[Julie Hilling (Bolton West) (Lab)]

12. What assessment he has made of the effect on residential care providers of reductions in local authorities’ budgets.

--- Later in debate ---

[Laura Sandys (South Thanet) (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.

[Laura Sandys]

I thank the Secretary of State for that answer. Two of my local dentists have been closed as a result of an Office of Fair Trading investigation. Although that is totally understandable and nothing to do with the NHS, will the Secretary of State confirm to my constituents that they will have access to NHS-funded dentists? There happen to be more NHS-funded dentists in this country now than there were under the previous Government.

[Mr Lansley]

I think I can give my hon. Friend that reassurance. We are committed to increasing access to NHS dentistry, and over 1.1 million more patients have been seen by an NHS dentist since May 2010 than before the election. Nationally, there are more dentists. In 2010-11, there were 22,799 compared with 22,003 in the preceding year, before the election. NHS Kent and Medway has confirmed that it will have six dentists in place from 1 September 2012 who will temporarily provide the treatment that she is looking for, and it has started tendering processes to commission permanent NHS dental services in her area.

[Chris Ruane (Vale of Clwyd) (Lab)]

T2. The Minister will be aware of the 500% increase in the use of antidepressants over the past 20 years. I welcome the announcement of the hundreds of millions that will be spent on talking therapies over the next few years, but will the Minister tell us specifically what funding has been allocated for mindfulness, which is the best known treatment for repeat episode depression?

[Mark Lancaster (Milton Keynes North) (Con)]

T6. Yesterday’s figures showed a 17% increase in the population of Milton Keynes over the past 10 years, the highest outside London or Manchester, and an unexpected increase of some 4,000 over the estimate in the past 12 months. May I seek the Secretary of State’s reassurance that that will be reflected in future health care budgets for the city?

[Mr Lansley]

As my hon. Friend will, I hope, have understood from previous exchanges, the focus on the delivery of care to the resident population in an area covered by a clinical commissioning group will mean that we try, as far as possible, to align resources with the needs of a whole population rather than with just the practice-registered population.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

T3. The Government often talk about reducing the number of managers in the health service to defend the front line, but following my recent meeting with my local representative from the Royal College of Nursing, can the Secretary of State confirm that under the Government’s definition a ward sister at band 7, who has a hugely important front-line role, is actually considered a manager?

[Mr Lansley]

If a member of staff is professionally qualified, they will be counted against the number of managers part of the overall work force census. It remains true, as we have said, that since the election we have reduced the number of managers in the NHS by more than 6,000 and increased the number of clinical staff by more than 4,000.

[Duncan Hames (Chippenham) (LD)]

T7. Last year’s National Audit Office report highlighted inconsistencies in the care of patients with neurological conditions such as Parkinson’s, which neurology networks could address. When will the Government publish their review, announced last September, of clinical networks in the national health service, and will it offer any hope for Parkinson’s patients?

[Kerry McCarthy (Bristol East) (Lab)]

T4. In yesterday’s debate, when talking about the south-west consortium, the Minister of State, the right hon. Member for Chelmsford (Mr Burns) emphasised the need for negotiations and agreement with staff. Does the Secretary of State not think it was shocking that staff found out only through a series of freedom of information requests that the consortium existed, and can he tell me when the Department of Health first found out about the consortium?

[Mr Lansley]

I will gladly write to the hon. Lady about when we were first aware of the consortium. I think it was several weeks ago; indeed, the document referred to prominently in the press on Sunday had been on websites for some weeks, so there is nothing new about that. We knew about it. I reiterate the point that I and my right hon. Friend made yesterday: even though under a Labour Government, in the 2006 legislation, powers were given to trusts to take their own decisions on the employment of staff, they must do so in negotiation with the staff side. We would expect that. From my point of view, the South West Pay Consortium is rightly looking to maximise flexibility, but I have made it clear to the pay review body that we believe that the flexibility it needs can be delivered through negotiations and “Agenda for Change”. It will not and should not require the reduction of pay for staff.

[Tom Brake (Carshalton and Wallington) (LD)]

T9. The clinician-led “Better Services Better Value” review has condemned the accident and emergency unit, and the maternity and children’s wards at St Helier hospital, because it expects out-of-hospital services to be expanded instead. Will the Secretary of State meet me to discuss local concerns that the £5 million allocated to provide the out-of-hospital services will be totally inadequate to the task?

--- Later in debate ---

[Andrew Miller (Ellesmere Port and Neston) (Lab)]

What assessment has the Secretary of State made of the views of clinicians, and scientists from academia, industry and the third sector, on the impact of change on the development of stratified medicines?

[Mr Lansley]

I have the benefit of a review undertaken by Sir John Bell and his colleagues, which I accepted wholeheartedly. In particular, I immediately agreed with the recommendations, and we are implementing and funding recommendations for the establishment of centres across the NHS for genetic testing to support stratified medicine for cancer patients.

[Andrew George (St Ives) (LD)]

Further to the Secretary of State’s welcome response to the hon. Member for Bristol East (Kerry McCarthy), and his comments yesterday on the issue of the south-west consortium in relation to pay reductions, will he apply the same attitude to pay and conditions, particularly backward or downward regradings and other detrimental changes to terms and conditions?

[Mr Lansley]

As my hon. Friend knows, trusts and NHS employers are responsible for the terms and conditions of their staff, and for ensuring, as “Agenda for Change” intends to, that staff who effectively have the same knowledge and competences have the same pay banding, wherever they happen to be across the country. That is the objective of “Agenda for Change”. As I said yesterday, and will continue to say, “Agenda for Change” can be improved—we made that clear to the pay review body—but we think it is possible, if the staff side works with us, to enhance “Agenda for Change” and increase its flexibilities, so that NHS employers can recruit, retain and motivate their staff, with local flexibility, in a national pay framework.

[Nick Smith (Blaenau Gwent) (Lab)]

Given that every year, 1.2 million admissions to accident and emergency units are alcohol-fuelled, when will the Government help the NHS and legislate for a minimum alcohol unit price?

--- Later in debate ---

[Mr Speaker]

I think the hon. Lady was referring to the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown). For future reference, we do not refer to Members of the House by name.

[Mr Lansley]

My hon. Friend will, I am sure, know that an application for foundation trust status from the Royal Cornwall Hospitals NHS Trust is currently being considered by my Department. The trust is being assessed on whether it meets the quality, service, performance, business strategy, finance and governance standards required if a trust is to be an FT. Once the trust has demonstrated that it has met those standards in all other regards, the Department will ensure that any outstanding liquidity issues are resolved in time for the trust to be authorised as an FT. The process of assessing FT applications will ensure that any remaining debt carried by the trust when it becomes a foundation trust is affordable within the trust’s forward plans.

[Clive Efford (Eltham) (Lab)]

The chair of the South London Healthcare NHS Trust has written to the Secretary of State to correct inaccurate information given out by the Department of Health regarding the trust’s performance. [Interruption.] Instead of barracking me, would the Secretary of State—[Interruption.] Instead of shouting at me now, it is a shame that the Secretary of State did not meet the local MPs when he had the opportunity. Will he distance himself from the false information put out by unattributable sources in his Department, which will undermine the performance of the hospital and shows little respect for the health service workers who are working to improve services?

--- Later in debate ---

[Zac Goldsmith (Richmond Park) (Con)]

Cases of blood poisoning from E. coli have increased by nearly 400% in the past 20 years, and E. coli resistance to antibiotics is almost certainly linked to record levels of antibiotic usage on factory farms. By over-using antibiotics we risk ruining for future generations one of the great discoveries of our species. Will the Department put pressure on the Department for Environment, Food and Rural Affairs finally to take that issue seriously?

[Mr Lansley]

I understand the issues. Indeed, I was interested to see analysis some years ago of the extent of antibiotic resistance in hospitals in the Netherlands. Resistance was clearly much more prevalent in parts of Friesland where there was much greater antibiotic usage in farming. I therefore completely understand, and my colleagues in DEFRA understand this too. Just as we are looking for the responsible and appropriate prescribing of antibiotics in the health service, my colleagues feel strongly about the proper use of antibiotics in farming.

[Mark Durkan (Foyle) (SDLP)]

When the national advisory council of the Thalidomide Trust recently met Government representatives, no funding undertakings were available on the replacement of the health support grant for sufferers. When can we expect a meaningful commitment in that regard, and is the Department liaising with its devolved counterparts?

--- Later in debate ---

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

Does the Secretary of State agree that commissioners in Cumbria must bear their share of responsibility for the deep-seated problems in the Morecambe Bay health trust, which have taken far too long to address. Will he join me in urging those commissioners to protect services such as Barrow’s maternity unit in their forthcoming review?

[Mr Lansley]

As we have seen in a number of instances over the years in the NHS, all those responsible should always be aware that, although the responsibility for quality may be, in the first instance, for the board of a trust, it is also the responsibility of those who commission the services. As the hon. Gentleman will be aware, one of the key considerations for the future in the development of services is for the NHS to respond to the commissioning intentions of local commissioners. Clearly, the matter that he raised will be determined locally as regards what commissioners require in terms of services from Morecambe Bay trust.

[Several hon. Members]

rose—

Sector Regulation - Consultation and Implementation

Lord Lansley Excerpts

Monday 16th July 2012 Written Statements

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

Today I have published “Sector regulation: update on plans for consultation and implementation”.

Following Royal Assent of the Health and Social Care Act 2012, the Department of Health and Monitor are working on proposals on matters relating to implementation of the Act’s provisions on sector regulation. A number of consultation documents will be published over the next year, setting out these proposals and asking for views.

Today’s document describes what the various consultation documents will cover and sets out the expected timing of the consultations. It is designed to ensure that all those with an interest are aware of and able to read and respond to the consultations. The document also sets the consultations in context by recapping the aims and key components of the health and care modernisation programme as a whole, and of sector regulation in particular.

“Sector regulation: update on plans for consultation and implementation” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

National Health Service

Lord Lansley Excerpts

Monday 16th July 2012 Commons Chamber

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

I was rather disappointed by the speech of the hon. Member for Denton and Reddish (Andrew Gwynne). Like the motion, the hon. Gentleman failed to say anything about NHS staff, or to reflect the admiration and respect we have for them. The motion and his speech were just another occasion for Labour to use the NHS as a political football, fuelled by nothing but distortions, inaccuracies and myths.

I always welcome such debates, because they give hon. Members an opportunity to raise constituency issues. Many did—I will respond to the points they made—but the right hon. Member for Leigh (Andy Burnham), the shadow Secretary of State, did not. When the Conservative Opposition raised debates on the NHS before the election, as we often did, we had an alternative policy to express and arguments to put forward. Like the motion, his speech was empty of argument and of fact, and he and the Labour party are empty of policy.

The right hon. Gentleman told us only that he wants to abolish the Health and Social Care Act 2012. If that happened, there would be no clinical commissioning in the NHS. In fact, nobody would be responsible for commissioning. He would abolish local authorities’ responsibilities for public health in their area, which they are embracing and acting on. He would abolish health and wellbeing boards, which are integrating health and social care more effectively. He would abolish the duties in the legislation for NHS bodies to act to reduce health inequalities, which rose under a Labour Government.

Let me address some of the points—

[Grahame M. Morris]

Will the Secretary of State give way?

[Mr Lansley]

No. I will address the points made in hon. Members’ speeches, including the hon. Gentleman’s. He was the first Back-Bencher to speak in the debate. He talked about more support for radiotherapy. He must recognise that we committed to £150 million additional support for radiotherapy in the cancer outcomes strategy. That will be available. He mentioned CyberKnife, which is a brand name for stereotactic beam therapy. That form of therapy is available in the NHS and will continue to be available. He neglected to mention that I announced during the past few months new plans for the establishment of two major centres for proton beam therapy in this country, which will mean that patients no longer have to go abroad to access it.

[Grahame M. Morris]

Will the Secretary of State give way?

[Mr Lansley]

No.

My right hon. Friend the Member for Charnwood (Mr Dorrell) made an important point on the Nicholson challenge, which a number of Opposition Members mentioned. At least one or two of them had the good grace to recognise that David Nicholson’s proposals were set out in May 2009, under, and endorsed by, a Labour Government. Labour Members now want nothing to do with the consequences of meeting that financial challenge. They fail to recognise, as my right hon. Friend said, that the challenge was against the background of an expectation that a Labour Government would not increase the NHS budget, and that the challenge would have to be achieved within three years. The Conservative Government have increased the budget for the NHS. Over the course of this Parliament, it will go up by £12.5 billion, which represents a 1.8% increase in real terms. The right hon. Member for Leigh and his party were against that.

No Opposition Member recognised in the debate the simple fact that, in the first year of this Parliament, £4.3 billion of efficiency savings were achieved, and performance improved, across the NHS. That was not even in the time frame for the Nicholson challenge. We have now had one year of the challenge. The target was £5.9 billion of efficiency savings, and we achieved, across the NHS, £5.8 billion. Things are on track, which completely refutes the shadow Secretary of State’s argument that we cannot have reform and deliver on the financial challenge at the same time. Actually, we can do both, and in addition improve performance in the NHS.

The right hon. Member for Greenwich and Woolwich (Mr Raynsford) completely contradicted the hon. Member for Eltham (Clive Efford) on the South London Healthcare NHS trust. The latter said he was against changes at Queen Mary’s, Sidcup, but the former said that I did not get on with the changes soon enough. The hon. Member for Denton and Reddish complains from the Opposition Front Bench that I did not have a moratorium, but the right hon. Member for Greenwich and Woolwich complains because I did have one.

Let me be clear about this: I did introduce a moratorium, and the four tests. Reconfigurations that meet the four tests should go ahead, because they will improve clinical outcomes for patients, meet the needs of the people of that area, deliver on the intentions of local commissioners, and be in line with the views of the local public. If they meet the four tests, they should go ahead; if they do not, as my hon. Friend the Member for Redditch (Karen Lumley) made clear in respect of Worcestershire, they should not go ahead. That much is clear.

My hon. Friend the Member for Pudsey (Stuart Andrew) made good points on how clinical commissioning is bringing improvements in musculoskeletal services. He also rightly made it clear, as the right hon. Member for Leigh did not, that Wales does not meet anything like the same standards as England and is cutting its NHS budget by 8.4%. We are increasing resources for the NHS in England and improving it. It is expected that, by the end of this Parliament, expenditure per head for the NHS in Wales will be below that of England. That is what we get from a Labour Government.

Let me reiterate to the hon. Member for Ealing, Southall (Mr Sharma) and my hon. Friend the Member for Ealing Central and Acton (Angie Bray) a point I made a moment ago. The hon. Member for Ealing, Southall should admit that the plans being looked at in north-west London are entirely the same ones considered under a Labour Government before the election. I will insist that the plans are subjected to the four tests I have described. If they meet those four tests, they can go ahead; if not, they will not. I advise him to continue making speeches in the House, but also to ask the general practitioners and clinical commissioners in Ealing what they think is in the best interests of their patients—his constituents. That is a good basis to start with.

My hon. Friend the Member for St Ives (Andrew George), the right hon. Member for Holborn and St Pancras (Frank Dobson), and a number of other hon. Members, asked about the south-west pay consortium. When I went to the NHS pay review body just a couple of months or so ago, I made it very clear that the Government believe we should do everything we can to support NHS employers to have the flexibilities in the pay framework that are necessary for them to recruit, retain and motivate staff.

[Frank Dobson]

Meaning: pay staff less in the south-west.

[Mr Lansley]

The right hon. Gentleman should not interrupt from a sedentary position. I am answering the question. Members are interested in this. When I went to the pay review body, I made it clear that, in my view, we could achieve that through negotiations on the “Agenda for Change”. That continues to be my view, and the south-west pay consortium makes it clear in its documentation that it supports such a negotiation. It is right to pursue such a negotiation nationally and for local pay flexibilities to be used in the national pay framework. That is what most NHS employers do, with the exception of Southend.

I have made it clear, as the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns) has, that we are not proposing any reductions in pay as a consequence. I do not believe they are necessary or desirable in achieving the efficiency challenge.

[Andy Burnham]

I have a simple question for the Secretary of State. Is he therefore overruling the south-west consortium?

[Mr Lansley]

No, because the south-west consortium has made no such proposal. Its document is clear: it wants the “Agenda for Change” national pay framework to give it the necessary flexibilities. My view is that we should do that, and I hope that the Opposition, along with the trade unions and the staff side, will support it. As a consequence, no proposal for the reduction of pay or the dismissal and re-engagement of staff is, in my view, desirable or necessary. Indeed, when I went to the pay review body, I made the point that I did not believe reduction of pay in the NHS to be necessary.

Let me conclude. There was a lot that those of us in the Chamber did not hear from Opposition Members. Much of it was in the annual report that I published just two weeks ago—waiting times below what they were at the time of the last election; the number of people waiting beyond 18 weeks cut by 50,000; the number waiting beyond a year reduced by nearly two thirds; infection rates in hospitals at their lowest ever level; cancer waiting times met; ambulance trusts all meeting the category A8 standard; 95.8% of patients seen, treated and discharged from A and E within four hours; 92% of in-patients and 95% of out-patients saying that their care was good, very good or excellent; and patients across the NHS saying that they support the NHS and believe the care they received to have been excellent. On that basis, the House should reject the motion as unfair in its characterisation of the NHS and wrong in its denigration of the NHS.

Question put.

South London Healthcare NHS Trust

Lord Lansley Excerpts

Thursday 12th July 2012 Written Statements

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

I wish to inform the House that I have made an order to appoint a trust special administrator to South London Healthcare NHS Trust. The order will be laid in the House shortly with a report setting out the basis of my decision, in accordance with chapter 5A of the National Health Service Act 2006, as introduced by the Health Act 2009.

My decision is based on the recommendation of the NHS chief executive and the responses to my recent statutory consultation with the trust board, the strategic health authority and local NHS commissioners on the proposal to place the trust in the trust special administrator’s regime. In accordance with the legislation, I have decided it is in the interests of the health service and, in particular, of the patients the trust serves to put South London Healthcare NHS Trust in the trust special administrator’s regime.

I have appointed Matthew Kershaw as the trust special administrator. Mr Kershaw’s role will take effect on Monday 16 July and I will issue him with terms of appointment. From this point, Mr Kershaw will assume full control of South London Healthcare NHS Trust, replacing the functions of the trust board and assuming the role of the accountable officer. He will be responsible for maintaining services for patients as well as developing recommendations to secure a sustainable future for services provided by the trust for me to consider. At this point, and pending the outcome of the regime, the chair and directors are suspended from their board duties in accordance with the legislation. However, some of the executive and non-executive directors will support the trust special administrator in the work he leads during the regime. How this is organised is a decision for the trust special administrator.

My key objective for all NHS providers is to ensure they deliver high-quality services to patients that are clinically and financially sustainable for the long term. The purpose of the trust special administrator’s regime is to ensure that services provided by any NHS trust subject to the regime meet that objective.

The regime, included by the last Government in the Health Act 2009, offers a time-limited and transparent framework to provide a rapid resolution to problems within a significantly challenged NHS trust and its health economy. This is to ensure long-term sustainability and the protection of access to quality services for local patients. In addition to maintaining the provision of services during the period of the regime, the duty of a trust special administrator appointed to an NHS trust is to develop and consult locally on a draft report, making recommendations to me in a final report about what should happen to the organisation and the services it provides. The objective is that high-quality, sustainable services are delivered to the local health economy. I must make a final decision based on the recommendations made in the trust special administrator’s final report, publishing that decision and the reasons for it in Parliament.

The trust special administrator’s regime is not a day-to-day performance management tool for the NHS or a back-door approach to reconfiguration. The purpose is to deliver a rapid and robust process when the widest range of other solutions to improve and maintain sustainability have been tried, implemented and not delivered the results required. It is for this reason that Parliament agreed to set challenging milestones for any appointed trust special administrator and for the Secretary of State to make a final decision about an organisation within a usual maximum period of 120 working days from the date the order is made.

I am using my powers to extend by order the overall time frame by 30 working days. For South London Healthcare NHS Trust, it means I will make a final decision on the fixture of the organisation within 145 working days from 16 July 2012 and, therefore, by 4 February 2013 at the latest. The issues affecting South London Healthcare NHS Trust are particularly complex; they are long standing and are built on a history of trust mergers, changes in commissioning arrangements and affect a range of providers within the trust’s area. This is also the first time the regime has been used. Therefore, the trust special administrator in this case is starting, effectively, with a blank canvas and will be unable to draw on learning and processes developed by previous trust special administrators.

Furthermore, the future of services at Orpington are about to be consulted upon, following a public health driven and commissioner-led needs assessment. Extending the time period in which a draft report would be produced by the trust special administrator by 30 working days would allow him to take into account responses to that consultation, so far as they are relevant, as he develops his own recommendations in the draft report, assuming that consultation goes ahead. It is crucial that the first use of the regime is robust and has the greatest possible chance of success. I believe that the particular complexities and issues that affect South London Healthcare NHS Trust, coupled with this being the first ever use of the regime, and the opportunity to take into account responses to the planned consultation on Orpington, mean that this is an exceptional case which warrants an extension to the time frame in the interests of the health economy and, most importantly, the patients of south-east London.

Despite recent improvements in quality of services and access times, there is a long-standing history of underperformance, particularly around financial management and some key access targets, within the area now served by South London Healthcare NHS Trust. There has been a consistent inability by the trust to deliver high-quality services whilst balancing income with expenditure over the last seven years. A number of solutions have been implemented to attempt to resolve the worsening problems and ensure the NHS in this area can provide consistent quality services to patients and the public within the designated budget. These systemic, long-standing challenges mean that South London Healthcare NHS Trust has historically underperformed against key quality, performance and finance requirements outlined in the national NHS performance management framework. The trust has also failed to make progress towards a viable foundation trust application. In 2011-12, it incurred the largest financial deficit of any of the 248 NHS provider organisations in England, at over £65 million. The deficit equates to an average weekly overspend of £1.3 million of taxpayers’ money on top of an average allocated weekly income of £8.4 million.

For South London Healthcare NHS Trust, the regime will be used because of the particular nature and scale of the financial and performance challenges, the complex interrelationship, the failure to make the scale of change required in the trust and with its partners and the absence of any viable, alternative strategy to ensure long-term clinical and financial sustainability.

The trust special administrator, working with clinicians, staff, commissioners, patients and the public, and other stakeholders, must now prepare recommendations for a sustainable solution for South London Healthcare NHS Trust as part of the south-east London health economy. The scale of the challenge means that Mr Kershaw will be expected to engage with, and consider the implications of any recommendations he makes with regard to the South London Healthcare NHS Trust on, other providers. Whilst it is not possible to speculate on the effect any decision may have pending the outcome of the regime, providers in the south London health economy could be affected and will be engaged throughout the process.

The trust special administrator will also constitute a clinical advisory panel, comprising prominent clinical leaders, to support and advise him in developing his recommendations. This will provide further reassurance that the TSA’s proposals are based on strong clinical evidence and are in the interests of local patients.

In accordance with my statutory duty, I have published guidance for trust special administrators appointed to NHS trusts, to which they must have regard in undertaking their legal duties. This can be found at: www.dh.gov.uk/health/2012/07/statutory-guidance-tsa/

A copy has been placed in the Library.

Abortion Providers (Inspections)

Lord Lansley Excerpts

Thursday 12th July 2012 Written Statements

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

Following reports of potential breaches of the Abortion Act 1967, in March 2012 the Care Quality Commission (CQC) undertook a series of unannounced inspections of all abortion providers. The focus of these inspections was whether abortion certificates (Form HSA1) had been signed by doctors before a woman had been seen in the clinic. The law requires two doctors to certify that at least one (and the same) ground for abortion exists in relation to a specific woman.

At the end of the inspection process, the CQC set up a national quality assurance panel to review findings, judgments and action. The CQC have today published 249 inspection reports on their website, www.cqc.org.uk. Inspectors seized evidence from around a fifth of providers where issues of consistency and completeness of HSA1 forms were identified. Clear evidence of pre-signing was identified in a total of 14 providers and the CQC have required compliance actions be taken by all of these providers to ensure that their practices meet the standards set in law by a set date.

Investigations by the police, General Medical Council, and Nursing and Midwifery Council continue and further referrals may result from the publication of the CQC reports. We await the outcome of these investigations.

In the meantime, my officials will work with a number of bodies including the CQC and the Royal College of Obstetricians and Gynaecologists to address the findings from these inspections.

Care and Support

Lord Lansley Excerpts

Wednesday 11th July 2012 Commons Chamber

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

With permission, Mr Deputy Speaker, I would like to make a statement on the future of care and support for adults in England.

The coalition programme said that reform is needed urgently. We inherited a system that too often let people down and was unfair; a system that was complex and confusing, and which responded to a crisis, but too rarely prevented it. For many years, people have called for a system fitted around the needs of care users, not the preferences of the service; one that puts people at the heart of the service and delivers high-quality care with dignity and respect.

We knew two years ago that we had to offer urgent support to social care. In the spending review 2010, we provided an additional £7.2 billion for social care over the course of this Parliament, including nearly £3 billion from the NHS to deliver more integrated care. This gives the current system resource backing, but not reform. We need also to build a better service for the long term.

The White Paper I am publishing today represents the greatest transformation of the system since 1948. The practical effect will be to give service users, their carers and their families more peace of mind. Services will be organised around each individual's care and support needs, their goals and aspirations. Intervention will be earlier, promoting independence and well-being.

The White Paper will support people to remain active in their own communities, connected to their families, friends and support networks. We will invest an additional £200 million over five years in the development of specialised housing for older and disabled people, so that people can stay independent in their own homes for as long as possible. The role of carers is critical, so we will transform how the system views and treats carers. We will extend rights for carers to have an assessment and for the first time provide a clear entitlement to the support they need to maintain their own health and well-being.

The measures in the White Paper will make it easier for people to understand how care and support services work, and what their entitlements and responsibilities are. To give people greater consistency of access, we will introduce a national minimum eligibility threshold, as the Dilnot commission suggested. We will require councils to start supporting people as soon as they move into a new area, so that it is easier for people to choose to move home, to be nearer, for example, to their relatives. Local authorities will be under a duty to ensure continuity of care, and that care users are able to take their assessments with them if they move area.

We will establish a single website to provide clear and reliable information about all care and support services for self-funders and local authority supported users and carers. As well as these improvements to national information, we will invest £32.5 million to ensure that there is better local information about the range of local care and support services available in each area.

We want people to be confident that the care and support they receive is delivered by a compassionate and caring work force. We will place dignity and respect for care users at the heart of a new code of conduct and minimum training standards for care workers. Alongside the new minimum standards, we will train more care workers, with 50,000 more apprenticeships by 2017.

A key requirement is for people to be confident that they will be treated with dignity and respect, and that providers deliver high-quality care at all times. We will rule out the crude practice known as “contracting by the minute” that can so undermine people’s dignity and choice. We should contract for quality and service, not by the clock. We will call on local HealthWatch organisations to make active use of their new power of entry, allowing them to visit care services in their local area, and to make recommendations to the providers and to local authority commissioners.

People should also be entitled to expect that services will be maintained if a provider fails. Working with local government and the care sector, we successfully handled the consequences of the Southern Cross crisis, but we also learned lessons, so we will consult on how we can anticipate and act to ensure continuity of care if a provider goes out of business. Care itself, not the provider of care, is the most important factor.

A key theme of the White Paper is that those receiving care and support know what is best for them. It is right that they must be in control of their care and support. We will make sure everyone is entitled to a personal budget, so they can be in control of their own care. We will offer all who want it a personal budget, and by 2015 support that with a legal right to request this as a direct payment. To make it easier for people to get the care they want, we will ensure that they have better access to independent advice. We will make it easier for people to see whether a care provider is good or not so that they can make real choices through an online “quality profile” for each provider. We will work with a range of organisations to develop comparison websites so that people can give feedback and compare the quality of care for themselves.

Integrated care is important for everyone, regardless of age or the reason they need care and support, but getting integration right is particularly important for those moving from one service to another. That is why we will transfer an additional £100 million in 2013-14 and £200 million in 2014-15, beyond previous plans, from the NHS to support social care services that benefit people’s health and well-being and promote better integrated care.

The White Paper will help people get better joined-up care at key points in their lives. We will legislate to give adult social care services a power to assess young people under the age of 18, and we will ensure protection so that no young person goes without care while waiting for adult support to start. We want people to receive the best possible care at the end of their lives, including a choice over where they die. The palliative care funding review recommended that all health and social care should be funded by the state once someone reaches the end of life and is entered on the end-of-life care locality register. We think that there is much merit in this and will be using the eight palliative care funding pilot sites to collect the data and experience we need to assess the proposal.

Alongside the White Paper, I am today publishing the draft Care and Support Bill. Many of the White Paper reforms need new legislation to make them work, but the draft Bill is also a major reform in its own right. The law for adult social care is complex and outdated. All those involved know how it has made the system harder to work in. The draft Bill sets out a single, modern statute for adult care and support. It brings together and simplifies provisions from at least a dozen Acts of Parliament, reflecting the recommendations of the Law Commission. It builds the law around people’s well-being and needs and outcomes—clear principles, clearly set out in law.

I am also today publishing a progress report on funding reform. In July 2010 I asked Andrew Dilnot to review the funding of the system of care and support in England. I can confirm today the Government’s support for the principles of the Dilnot commission’s report as the right basis for any new funding model: financial protection through capped costs and an extended means test. As Andrew Dilnot himself has said, that would enable people to plan and prepare so that they are not so vulnerable to the arbitrary impact of catastrophic care costs.

The progress report sets out a detailed analysis of the funding model, giving us a better basis for making decisions on how these changes can be funded. Of course, any proposal that includes extra public spending needs to be considered alongside other spending priorities, including the demographic pressures on social care services. The right and necessary time to do that is at the next spending review. Our talks with the Labour party were constructive, but no plan for funding Dilnot was agreed or, indeed, proposed by either side. A decision at the next spending review will allow time for continuing discussions with stakeholders and between the parties, and we can undertake open engagement on detailed implementation issues and options. These discussions will include the level of the cap, whether a voluntary or opt-in approach is a viable option in addition to the universal options and whether legislative provision is required.

However, as the report makes clear, we are also taking definitive steps now by accepting a number of the Dilnot commission’s recommendations. Most notably, we will introduce a universal deferred payments scheme. This will mean that no one will be forced to sell their home in their lifetime to pay for care. Provisions for this are included in the draft Bill.

The White Paper, the draft Care and Support Bill and the progress report on funding together set out our commitment to a modern system of care and support, one designed around the needs of individual people, one with dignity and respect at its heart, and one that brings care and support into the 21st century. These reforms are also the product of immensely helpful reviews by the Law Commission and the Dilnot commission and a positive and wide-ranging engagement with the care sector and the public, which is helping us to design the kind of care services and support that we would all like to see for ourselves and our families. We are determined to secure these reforms to achieve in this Parliament that which our predecessors failed to achieve in over 13 years. I intend to continue and develop an open and co-operative approach in developing these reforms. I commend this statement to the House.

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[Mr Lansley]

I am grateful to the right hon. Gentleman for welcoming the announcements about access to universal deferred payments, national eligibility criteria, and the work that we are undertaking on promoting free care at end of life. I am surprised, however, that his final remarks seemed to be completely contrary to what he said at the outset. Let me be very clear: the White Paper is the product of the priorities of the people with whom we have engaged throughout the “Caring for our future” process. It directly reflects the priorities of the care and support sector, and I would therefore be surprised if anybody in the sector failed to recognise that and to support it. It is focused on delivering quality and promoting the work force. For the first time, it gives access to legal rights for carers in terms of support. It is very clear about the issue of personal budgets, where there has been a dramatic expansion over the past two years.

Let me deal with the right hon. Gentleman’s specific questions. Since we came into office, we have continually recognised the need for support for social care and for the funding of local authorities for this purpose. That is why we made provision for £7.2 billion of additional support, £3 billion of which comes from within the NHS. As he will see from page 64 of the White Paper, the £300 million of additional resources that it announces more than meets the cost of the White Paper to local government. We are continuing to support social care within the NHS. The latest figures from the Association of Directors of Adult Social Services suggest that only about 13% of total savings took the form of reductions in any service for care users, with the rest relating to efficiency savings redirected into the service that is being provided.

It is simply not the case that we are adopting a pick-and-mix approach to the commission of Andrew Dilnot and his colleagues. We are proceeding with some of its recommendations—for example, on eligibility criteria and deferred payments—and supporting the principles for a new funding model based on the capped cost and extension of the means test. The right hon. Gentleman said that we have to be able to pay for it; yes, indeed we do. That is why we will continue to engage with him and his colleagues and with the wider sector. It is very important that we take people with us on this.

It cuts no ice for the right hon. Gentleman to say that after 13 years of a Labour Government he published a White Paper days before the announcement of the last general election. If he wants to go back to the proposal that he made at that time, which was to impose a tax in order to pay for this and to means-test access to disability benefits, then let him say so, but that is not the basis on which we are proceeding. Andrew Dilnot considered those proposals and did not recommend them. We need a proposal that garners wider consensus and support than was evident for the right hon. Gentleman’s White Paper. I am determined to try to secure that, and we will continue to engage with the sector to make it happen.

[Several hon. Members]

rose—

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[Mr Stephen Dorrell (Charnwood) (Con)]

I welcome the package of measures that my right hon. Friend has announced, which represent important progress towards the delivery of many objectives that are, as we have heard, shared across the House. May I ask him two specific questions? First, he has published a welcome draft Bill showing that many of these aspirations can be brought into effect. Do the Government expect to be able to provide time to make that draft Bill law in the next Session of Parliament? Secondly, in the context of that Bill, does he hope that the continuing cross-party talks may yet provide the basis for answering the funding question that has bedevilled those talks for so long?

[Mr Lansley]

I am grateful to my right hon. Friend. It was neglectful of me not to mention that the White Paper and the announcement that I have made also drew on the recommendations and work of the Health Committee, and I am pleased to have been able to respond to its report as well.

First, matters relating to the legislative programme for the next Session will be announced in the normal way in the Gracious Speech. Secondly, I am determined that we will not only, I hope, have continuing cross-party talks but that they will be conducted, as I think that the shadow Secretary of State himself would wish, with the sector in a more open, public debate. If we were able to arrive at a position whereby, notwithstanding the fact that funding decisions might be made in the spending review, there was scope to put in place legislative provisions that allowed that to happen and could be agreed in time for the introduction of the draft Care and Support Bill, then we would look to make that happen. However, that is conditional at this stage.

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

The Secretary of State seems to forget two things. First, his Government did not implement the Personal Care at Home Act 2010, which would have made a difference to people. Secondly, they did not ask Dilnot to consider where the money was coming from, so he can hardly be blamed for not putting forward suggestions. The Secretary of State has committed to a few of Dilnot’s principles but ignored the fact that he advised the closure of the current funding gap in social care. Will he back Labour’s call for the Treasury to use £700 million of this year’s health underspend to close that funding gap, which is the cause of the crisis in social care?

[Mr Lansley]

First, it is ironic that the shadow Secretary of State said that local authorities would be aghast if they were asked to do extra things without resources given that we are providing those resources and that the Personal Care at Home Act was completely unfunded, which is why local government was desperate for us not to proceed with it. Andrew Dilnot and his colleagues are very clear, as are we, that there are, as I said in my statement, baseline funding pressures on local authorities in relation to social care. That will be addressed in the next spending review, as it was necessarily addressed in the previous spending review in direct response to recommendations that Andrew Dilnot gave us in 2010.

[John Pugh (Southport) (LD)]

I welcome the statement, which contains many good things, but without financial clarity we risk offering an unsustainable solution to an unsustainable problem. What can coalition Back Benchers do to get the Treasury to go further and faster?

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[Mr Lansley]

The statement I have made is a Government statement. We are working closely with our colleagues across Government to secure these proposals. I know that my hon. Friend understands these things very well. He will know that if there are significant public expenditure implications beyond the current spending review period, they must be dealt with in the context of a spending review. All Government Members are committed to deficit reduction. Understanding where, within those constraints, our priorities lie is the essence of a spending review.

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

This is a much more important issue than Lords reform. It is important to millions of people in this country and I am happy to have the opportunity to discuss it. There is clearly a huge shortfall and a crisis of funding in social care. The Secretary of State is not hoodwinking anybody by suggesting anything other than that. What has changed since he walked away from the cross-party talks led by my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown)? The Secretary of State dressed up the proposal made before the general election as a “death tax”, yet he has come back with a proposal that is broadly similar.

[Mr Lansley]

I am not attempting to hoodwink anybody. I have made the point very clearly that in this financial year the Association of Directors of Adult Social Services is making total savings of £891 million, of which only 13%, some £113 million, is being achieved through reductions in services. We are investing in and supporting such services. In 2012-13, £930 million of extra funding will go to local authorities through formula grant to support social care. The NHS is transferring £622 million and we are doubling last year’s figure so that £300 million will be available through the NHS for re-ablement. Those are major additions to the support for care.

On the other point that the hon. Gentleman made, even the right hon. Member for Leigh did not try to return to the debate that we had before the election, and rightly so. The right hon. Gentleman eschewed party political point scoring; the hon. Member for Easington (Grahame M. Morris) did not. I think he should have done.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I warmly welcome the statement. There is clear commitment in a number of good areas, including improving the portability of services, providing greater support for carers, improving respite care and having more joined-up working between the NHS and adult social services, which will save social services and the NHS money, and improve the care that is delivered to patients. Does the Secretary of State agree that when local government commissions services, it should do so with a view to improving the quality of care and moving away from the care-by-the-minute mentality to which many local care providers seem to adhere?

[Mr Lansley]

My hon. Friend is absolutely right in all respects. I know that local government will welcome the philosophy of commissioning for quality, rather than commissioning simply on the basis of watching the clock. That will also be welcomed by older people who are in receipt of care.

[Mr Dave Watts (St Helens North) (Lab)]

It is clear that the Secretary of State is moving on from causing chaos in the NHS to causing it in the care service. Given the crisis in the budgets of social services, will he set up an independent body to look at how much money local authorities require to provide high-quality social care?

[Mr Lansley]

I am sorry, but the hon. Gentleman simply demonstrates his ignorance of what is in the White Paper. Those who work in social care, those who represent care users, care recipients and carers want the changes in legislation and in support to focus on looking after people. That is absolutely our agenda. We know that there are funding needs. That is why, in the spending review, we have provided the sums that I have set out. That will enable local authorities to maintain their eligibility to care. This year, only six authorities have reduced their level of eligibility to care from moderate to substantial.

[David Tredinnick (Bosworth) (Con)]

My right hon. Friend’s statement will be widely welcomed, especially the loans aspect and the emphasis on personal care budgets. Will he confirm that his Department’s trials are showing that personal care budgets are very effective in empowering patients, reducing costs and bringing in a wider range of services and greater patient choice?

[Mr Lansley]

My hon. Friend is absolutely right. A study published in the latter part of last year demonstrated exactly what he has set out. There has been a major increase in access to personal budgets. When we came to office, about 168,000 people had access to a personal budget. The latest figures show that we have reached 432,000 people. We are aiming for everyone who wants it to have access to a personal budget by April 2013. The draft Bill that we have published today would give legal backing to that and to access to direct payments.

[Kate Green (Stretford and Urmston) (Lab)]

On 5 December last year, the Minister with responsibility for disabled people said in a written ministerial statement that a consultation on the independent living fund would be published in conjunction with a White Paper on social care this year. Will the Secretary of State say how a consultation on a review of the independent living fund will be meshed with the proposals in the White Paper? Will he assure me that there will be a coherent approach in Government to deal with the ILF in the context of the proposals that he is announcing today?

[Mr Lansley]

I am grateful to the hon. Lady, because she gives me the opportunity to say that my colleagues at the Department for Work and Pensions will publish a document shortly. That will enable her and other hon. Members to see the relationship between the two documents.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome my right hon. Friend’s statement, and in particular the recognition of the role of housing in helping people to live independently in their own homes. Will he elaborate further on how the £200 million extra may be spent by local councils? Does he support the recommendation of the Health Committee that we have a single commissioner for health, social care and housing?

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[Mr Lansley]

The £200 million over a period of five years that I have announced today will be able to be leveraged, with the involvement of private sector investment and social landlords, to provide an opportunity for several thousand additional places in specialist housing for older people and those with disabilities. We are talking about the kind of extra-care homes that give people the sense that they are moving into their own home, but with care available. That will be available in people’s own communities to a greater extent if we can increase the supply.

[Derek Twigg (Halton) (Lab)]

The Secretary of State says that he can give no commitments past the spending review in 2015. However, he said that by 2017—two years after that—we will have 50,000 more care workers. There is a big question over how that money will be found. He makes a big point of saying he has given local authorities all these extra resources to deal with the extra tasks that they will have. In the discussions on that, have local authorities said they are satisfied that he is providing enough money for them to carry out those extra tasks?

[Mr Lansley]

I know that the hon. Gentleman will not have had a chance to look in detail at the White Paper, but it makes it clear that the costs in the spending review period are more than adequately met by the additional resources. [Interruption.] The hon. Gentleman and his colleagues are confusing two different things. The White Paper looks at specific additional tasks—for example, in the provision of independent information and advice, including local information about access to care services. That is more than fully funded. The figure he mentioned referred not to the number of care workers but to the number of care apprenticeships that are being developed with the sector.

[Sir Tony Baldry (Banbury) (Con)]

As co-chair of the all-party parliamentary group on carers, I welcome the new rights for carers that are proposed in the White Paper. However, a couple of things follow from that. First, GPs, social workers and others have a responsibility to do everything possible to identify carers, because unless people identify themselves as carers, they will not be able to access those rights. Secondly, we should support carers by developing training programmes for them, so that those who find themselves in that position are empowered to undertake their caring role.

[Mr Lansley]

I am grateful for the work of my hon. Friend and the all-party group. This is an important moment. If the House approves the draft Bill, the rights and entitlements of carers to assessment and support will be set out in law for the first time, in the same way as we have done for those for whom they care. He makes an important point. The draft mandate for the NHS that I published last week gives specific attention to the need to identify and support carers. I hope that these proposals will also enable the NHS and social care to join together in support of carers.

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

May I return to the point that my hon. Friend the Member for Halton (Derek Twigg) made? Have local authorities confirmed that they are satisfied that the funding that has been made available will cover the new duties they have to undertake?

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[Mr Lansley]

We have consulted not only the Local Government Association but my colleagues at the Department for Communities and Local Government, and I can assure the hon. Lady that that is indeed the case.

[Sarah Newton (Truro and Falmouth) (Con)]

There is much to be welcomed in today’s announcement. After so many years, people all over the country will be pleased that so much progress has been made, particularly for carers and in improving the quality of care and professional standing of paid-for carers. Will the Secretary of State confirm what I think I heard him say—that if the Opposition were to redouble their efforts and the whole country were to engage in the debate that today’s announcement will trigger, the mechanisms to solve the bigger problem of how the funding can be provided could be included in the forthcoming Bill within the next 12 months?

[Mr Lansley]

Yes, and I am grateful to my hon. Friend. I will not reiterate what I said in response to the Chair of the Health Committee, but I hope that as we make progress we will be able to see what legislative provisions are required and make them available at the earliest opportunity. She makes an important point, because we must not lose sight of the opportunity to improve quality. There are certain things that require resources, such as access to quality profiles of care providers so that people can make proper assessments of the quality of service that they will receive, increasingly using their personal budgets or direct payments. There is dramatic potential in that. Starting today, quality profiles of 12,000 care providers will be made available.

[Jack Dromey (Birmingham, Erdington) (Lab)]

A delayed solution to the growing crisis in social care is no solution. In Birmingham, there are none more noble than those who care and none who deserve our support more than those in need of care. Does the Secretary of State not recognise that in failing to act now he is both surrendering a historic opportunity for a new settlement based on Dilnot and letting down the most vulnerable in our country?

[Mr Lansley]

I know it is difficult for hon. Members when documents are published alongside a statement and they have not had an opportunity to read them, but when the hon. Gentleman does so he will know that what he has just said was utter nonsense.

[Glyn Davies (Montgomeryshire) (Con)]

I, too, greatly welcome today’s statement and congratulate my right hon. Friend on taking forward this important policy. Health and social care is devolved to the Welsh Government, but it is inevitable that statements, decisions and policy changes in England have a major effect on Wales as well, because some of the services provided to people in Wales are over the border in England. As well as cross-party talks, may we have cross-border talks to ensure that the system works well in Wales?

[Mr Lansley]

My hon. Friend makes an important point. We want people who move from England to Wales or from Wales to England to have continuity of care, so I will make it clear to my counterpart in Wales that I am entirely open to discussions about that. Given that it is a devolved matter, it is better in a sense if the initiative for those discussions comes from Wales, because I do not want to be interpreted as trying to impose any solution on Wales, but if the Welsh Government look for such discussions I will be open to them.

[Mr Kevin Barron (Rother Valley) (Lab)]

In response to the White Paper, the NHS Confederation has said that people are

“staying in hospital longer…because the right services are not in place to allow them to go home when they are medically fit to do so.”

Given that it is estimated that delayed discharges from our hospitals cost some £18 million a month, what action are the Government taking to get rid of that waste of public money?

[Mr Lansley]

The total number of delayed discharges is broadly the same as it was last year and, I believe, from memory, the year before—I will correct the record if not. Some 29% of the delays in discharge from hospital are due to the inability to access social care. Most of them arise because people are awaiting further assessment or treatment in the NHS. We have all the details of delayed discharges and are working actively to reduce them.

[Margot James (Stourbridge) (Con)]

I very much welcome many of the measures that my right hon. Friend has announced, particularly on the improvement that he wishes to see in the dignity and respect accorded to those in our care homes and NHS hospitals, especially older people. Will he say a little more about the minimum standards for staff working in the care sector, and about the qualifications that people who apply for care apprenticeships might require to provide the right quality of care?

[Mr Lansley]

Yes, I am glad to do so. Through the work that we are doing with Skills for Health and Skills for Care, we will set out more clearly the training requirements for those undertaking care work and care assistance in the NHS. In addition, we set out in the White Paper that there should be a code of conduct, and I hope that across the service the philosophy of commissioning for quality, not simply commissioning or contracting by the minute, will help push us towards improvements in the dignity and respect with which care users are treated.

[Hazel Blears (Salford and Eccles) (Lab)]

There are 800,000 people in this country with dementia, a devastating condition for themselves and their families. Many of them rely on the support of community-based services, which means that they are not admitted to residential care and may have a crisis that results in hospital admission. It is a false economy not to support community services. If the Secretary of State were really in touch, he would know that there are massive cuts across the country in exactly those services. Will he go back to the Chancellor now and say, “We need some money now to deal with the crisis”? Otherwise, the integration that he talks about in the White Paper will not happen and the crisis in local authority care will continue.

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[Mr Lansley]

I am sorry that the right hon. Lady does not seem to recognise that in addition to what I have announced today, about three months ago the Prime Minister launched the dementia challenge. It provides resources in the NHS, through the commissioning for quality incentive, for the identification of patients with dementia and for follow-up assessments and support. It is doubling research into dementia and supporting a programme for the creation of dementia-friendly communities. As part of that dementia challenge, local authorities and the health service will work actively together to make communities far more dementia-friendly and more effective in treating dementia.

[Matthew Hancock (West Suffolk) (Con)]

Like carers and many vulnerable people across the country, I warmly welcome the White Paper and the progress that is being made. People are keen to see a continued political consensus, which existed, and on which the Opposition were to be congratulated, until about half an hour ago. May I urge the Secretary of State to do everything he can to ensure that that consensus continues? Will he also set out a bit more about what the national minimum eligibility threshold will mean, so that people across the country know what they are entitled to?

[Mr Lansley]

On the latter point, my hon. Friend will be aware that the national eligibility threshold that we are legislating for will come into effect in 2015. We will of course make it clear before that at what level it will be set. I cannot provide that information at the moment, not least because we have reservations about the overall effectiveness of the classification of need under the fair access to care services system in the intervening period. If we can improve the eligibility framework, we will set out to do so.

I say to the right hon. Member for Leigh and his colleagues that I am very happy to continue to talk. I know that he did not want us to proceed on a unilateral basis from the progress report, but in truth what we published did not represent our making decisions unilaterally but instead reflected the point that we had reached. I am happy for further talks to take us beyond that point.

[Tony Lloyd (Manchester Central) (Lab)]

If we are to offer people the dignity and respect that the Secretary of State has talked about and prevent the type of abuse that both shocks the nation and frightens care users and their families, although training is very important, so is monitoring. Will he guarantee that the money necessary for monitoring will be available to HealthWatch, the Care Quality Commission and similar agencies? At the moment, people do not believe that those agencies are requested to monitor them properly.

[Mr Lansley]

The hon. Gentleman will know that we are making resources available for HealthWatch. It also has additional powers and a remit that extends in a way that the remit of LINks never did. There is therefore a patient and care users’ voice, and a much more effective power to enter, view and report. The link of HealthWatch England to the Care Quality Commission is important. We have increased the resources of the latter. I am sure that when he sees its annual report, he will appreciate the steps it is taking to extend its inspection more reliably on an unannounced basis, including into domiciliary care provision.

[Tracey Crouch (Chatham and Aylesford) (Con)]

I have a great deal of respect for the Secretary of State, but I agree with the chief executive of the Alzheimer’s Society, who has said:

“Every day without a funding decision is another day where people…with dementia…face huge costs for…substandard care.”

Will the Secretary of State therefore take this opportunity to assure the House that any new system of funding will end the current dementia tax, under which those with dementia are penalised as a result of their condition with some of the highest social care costs?

[Mr Lansley]

In this instance, I completely understand where the Alzheimer’s Society is coming from. We all want to achieve what Andrew Dilnot made very clear in presenting his report. Any of us or any members of our families could be subject to catastrophic care costs as a consequence of a diagnosis of dementia and several years’ need for care. We want people to be able to plan and prepare, and to protect themselves against that. From the Government’s point of view, and as I have said today, the Dilnot commission’s report is the basis for a funding model for that, but it must be paid for. As with anything else, we are not going to start promising things that we do not know we can pay for. We therefore have a job of work to do, and I am determined that we will do it as speedily as we can.

[Glenda Jackson (Hampstead and Kilburn) (Lab)]

The Secretary of State referred to deferred payments. In the time before the individual dies, who will pay for that care? Is there any estimate of how much the care will cost? It seems to be an extremely bad deal for the individual if they must also carry the interest rates of that loan. Will it be administered by local authorities? Who will fund that local authority?

[Mr Lansley]

From the care user’s point of view, it will be funded by local authorities. Central Government will back that up.

[Laura Sandys (South Thanet) (Con)]

The residents of Thanet will be reassured by the paper, particular when it comes to caring by the minute, which shows so little respect and dignity for the elderly. However, I urge the Secretary of State to look at the culture of social care, in which funds go more to crisis management than to prevention. I urge him to understand that we could introduce many new measures that will keep people healthy as they get older rather than ambulance-chase after a crisis.

[Mr Lansley]

I agree with my hon. Friend. That is why we want the focus to be on maintaining well-being and independence. More specialist housing will help with that. The doubling this year compared with last year of resources from the NHS to support re-ablement—when people are discharged from hospital after, for example, a fall and a hip fracture—will directly enable people to be more independent. A lot of the resources that the NHS is putting in with social care is directed towards that kind of preventive work rather than to crisis response. I hope we can do more of that in future.

[Mark Durkan (Foyle) (SDLP)]

Without underestimating the inherent challenges, may I welcome the statement and commend the approach of the shadow Secretary of State? The draft care and support Bill makes provision in respect of the portability of care packages between local authorities in England, but it does not yet provide for the “passportability” of care packages to Northern Ireland and Scotland. Historical migration factors mean that many Irish people are lonely and in remote care settings in England who would much rather be in a care setting in which they can enjoy the support and contact of their families—their families want them there too. When will that finally be addressed?

[Mr Lansley]

As I told my hon. Friend the Member for Montgomeryshire (Glyn Davies), I completely understand the problem. I will be entirely open to representations from, and discussions with, the Wales and Northern Ireland Administrations on the scope for achieving continuity of care for those who move between different parts of the UK. There are differing systems, but we can at least try to ensure that we build continuity of care around the needs of the individual care user rather than constantly being obsessed with the characteristics of our own systems.

[Fiona Bruce (Congleton) (Con)]

As the Member of Parliament who represents the area with the highest elderly population in the north-west of England per head, I welcome the statement and the importance that the Government place on care and support, which is the most challenging issue authorities such as Cheshire East council will face over the next few years. The Secretary of State is right to talk about working with local authorities, but how will this work on greater support for carers include greater support for, and, importantly, dialogue with, community and voluntary organisations, such as Crossroads Care Cheshire East, which does excellent work and provides real added value? It tells me that it could do so much more if it was given such support.

[Mr Lansley]

I am grateful to my hon. Friend. I know how important the work of Crossroads Care is in my constituency and others. The “Caring for our future” engagement over a number of months was a major contributory process to the White Paper. I believe we have accurately reflected in the White Paper the priorities set out then. This is not the end of the process. We have important and positive messages to take forward, and further work to do, not least on funding. I hope we can do that equally in close co-operation with the Care and Support Alliance and its members.

[Alison McGovern (Wirral South) (Lab)]

Given the scale of the care crisis in Wirral, I have listened to my constituents at a number of public meetings. They tell me that their priority is for loved ones to live at home with dignity, but local authority cuts make that harder, and—I am sorry—the NHS reorganisation is just a distraction. Contracting by the minute, which the Secretary of State mentioned, is far from the only problem. How will he tackle other problems in the care industry, such as older people being disrespectfully told what time to go to bed and get up?

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[Mr Lansley]

As I said in the statement, we absolutely intend for care services to be responsive to the needs of patients, and to their goals, aspirations and wishes. That is not only a cultural shift, but a financial one—the availability of personal budgets and direct payments for everybody in the social care system will give patients the financial levers to make that cultural shift happen. However, the situation in the Wirral she describes is not how it was described to me when I was there in April. I was told that the health and wellbeing board brings together social care, public health and the NHS so that they are far more effective in the delivery of services locally.

[Mr David Nuttall (Bury North) (Con)]

I thank my right hon. Friend for making progress on this problem, which is a worry for so many of my constituents. They will welcome the proposals, but does he agree that the proposals for paying for care fees by way of a one-off insurance premium, which are contained in the Conservative party manifesto, would have been far better in promoting personal responsibility?

[Mr Lansley]

My hon. Friend will see in the progress report that we need to discuss both the universal options for paying for the Dilnot model of care and voluntary, opt-in systems. The latter could have a character not dissimilar to that he describes.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

I welcome many measures in the paper, including on the transition from being a child needing care to becoming an adult needing care, and on allowing people to choose where they want to end their life in palliative care. I represent a coastal constituency. Many people retire to the coast to enjoy the benefits of the sea air. Will he assure me that Suffolk county council will not be penalised by the fact that, in bringing families together, they will not take on extra care burdens for which they had not planned?

[Mr Lansley]

I completely understand my hon. Friend’s point. We very much reflect the need for care and health care in the allocation of resources to local authorities through the formula grant, and the allocation of resources to the NHS through the NHS resource allocation.

[Bill Esterson (Sefton Central) (Lab)]

Councils have faced a £1 billion cut in their funding for care of the disabled and elderly since the right hon. Gentleman’s Government came to power. Without the cash, the White Paper will be meaningless. How confident can he and everybody else in the country be that the Treasury will cough up, given the track record so far of a £1 billion cut to councils?

[Mr Lansley]

I am sorry, but I simply do not recognise the figures that the hon. Gentleman is using. The Association of Directors of Adult Social Services has suggested—these are not my figures—that this year the service reduction in adult social care budgets on a monetary basis was £113 million and last year it was £226 million. The great majority of the figures he is quoting are actually not cuts at all; rather, they are service efficiencies, which are being reinvested for the benefit of maintaining eligibility.

[Sheila Gilmore (Edinburgh East) (Lab)]

My constituent who has been campaigning on portability of care packages outwith England will be extremely disappointed, because he was given to understand in correspondence from the Secretary of State that this would be covered in the White Paper and it clearly has not been. While we are thinking about Scotland, does the Secretary of State accept that the problem will not be solved even by shifting some of the costs of care from the individual to the state? We have had free personal care in Scotland for some years, but it has not resolved the problems because no additional money was put into the system.

[Mr Lansley]

I will not attempt—not least because of time—to give an analysis of the difficulties that have been experienced in Scotland. From my point of view, I had understood that what we have set out to do in the White Paper is very much to ensure continuity of care, so that when people move—certainly in England, for which I am responsible—local authorities have a duty to ensure continuity of support. If we can make it so that this happens across the United Kingdom, I am absolutely open to having the discussions necessary to do so.

[Heidi Alexander (Lewisham East) (Lab)]

The Health Secretary has spoken about the catastrophic costs that face some older adults suffering from dementia. My nan was one of those people. She had to sell her home and spent more than £100,000 on her care costs. Under the loan scheme proposed by the Government today, would somebody like my nan not just end up paying more for the costs of their care? Can the Health Secretary also clarify whether the interest payments would eat into the small amount of money that people like my nan can pass on to their families?

--- Later in debate ---

[Mr Lansley]

We are very clear—I hope I have been clear—that the adoption of a universal deferred payment scheme gives people an opportunity. We are not talking about something that people are required to do; rather, they can choose to do it. One of the things that has most distressed some of those who go into residential care settings is that, as a consequence, they are required to sell their homes—they are forced to do it. What we have announced gives people an opportunity for that not to happen, but as the White Paper and the progress report make clear, we would like to proceed on the basis of a funding model, based on the Dilnot commission, that enables people also to have a cap on their care costs. If we can do that, the combination of the two will be an effective solution.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

Without a cap on costs, which is what the Dilnot commission proposed for universal deferred schemes, will this measure not potentially leave some families with massive debts to pay when their loved ones die, far in excess of the £35,000 cap that the commission proposed?

[Mr Lansley]

I am sorry that the hon. Gentleman has read out the Whips’ question, but he did not listen to the last answer. We are both implementing the universal deferred payment scheme and proposing in the draft Bill that we should legislate for that. We are, as I have made clear, supporting the principle of Dilnot that we should implement a capped-cost model with an extended means test, but we have to demonstrate, as we know, that it needs to be paid for, and if those decisions involve public expenditure, they must necessarily be held for the spending review.