Health and Social Care Bill

Mark Simmonds Excerpts

Tuesday 20th March 2012 Commons Chamber

[Mark Simmonds (Boston and Skegness) (Con)]

Will the Minister confirm that most of the foundation trusts that are interested in raising and removing the cap want to invest the money that they would generate from private income to improve services for NHS patients? [Interruption.]

[Paul Burstow]

That is exactly the point; those moneys have to be reinvested—[Interruption.]

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[Mark Simmonds]

I draw the House’s attention to the Register of Members’ Financial Interests. Does the shadow Secretary—[Interruption.] Does the shadow Secretary of State—[Interruption.] Does the shadow Secretary of State object to NHS foundation trusts raising money through private income—therefore and thereby spending it on NHS patients?

NHS Risk Register

Mark Simmonds Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Mark Simmonds (Boston and Skegness) (Con)]

I draw the attention of the House to the Register of Members’ Financial Interests. The only thing on which I agreed with the hon. Member for Easington (Grahame M. Morris) was the commitment that he has, I have and all Members on the Government Benches have to the national health service and its future as a taxpayer-funded service, with access based on need, not on ability to pay. I think I speak for everybody on the Government Benches when I say that I would not vote for any Bill that privatised the national health service. The Health and Social Care Bill is not about that.

I can also confirm that my personal experience of using the national health service recently, both at Pilgrim hospital in my constituency in Boston and at Peterborough hospital—which, as the Secretary of State said, is highly indebted because of the previous Government’s PFI scheme—was first class and excellent.

[Mel Stride (Central Devon) (Con)]

Does my hon. Friend agree that the Labour party’s suggestion that we are privatising the health service is not only utterly disingenuous, but extremely cruel and frightening for elderly and vulnerable individuals, of whom there are many in my constituency, who are perturbed by what is being said, which is untrue?

[Mark Simmonds]

I am grateful to my hon. Friend for that intervention. He is absolutely right. Certainly, some of the communicating that both Government parties need to do will be myth-busting on what is being portrayed as the future of the NHS and its services. They will be improved and enhanced, as will patient outcomes and services, as a direct result of the reforms that we hope to implement though the Health and Social Care Bill. They will not go backwards, as Opposition Members suggest.

Two distinctions can be drawn between the Government and Opposition sides of the House on this matter. First, we on the Government side are committed to increasing resources and investment in the NHS—in contrast to the Labour party. We can see that distinction in the enhancement of services in England and the deceleration and paucity of services in Wales. Secondly, Government Members understand the necessity of reform, whereas Labour Members do not. I accept that there are some exceptions, such as the previous Health Secretary, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), who I think understands the importance of reform. Maintaining the status quo in the NHS is the greatest risk; it is not an option.

I think that today’s debate is a red herring and a cloak. My hon. Friend the Member for Kingswood (Chris Skidmore) completely destroyed the argument about the necessity of publishing the risk register, because it is no longer relevant. I am sure that the ministerial team would have been looking at that risk register and changing policies in order to mitigate and negate the initial impact of the risks recorded in it. Every former Government Minister who has spoken from the Labour Benches today, whether in a speech or an intervention, has form in refusing to put risk registers in the public domain when they had a chance to do so in office, and they know very well that risk registers can be misleading. Even the Information Commissioner, in his judgment, said that safe space was required.

[Hugh Bayley]

The hon. Gentleman said a few moments ago that he believed that increased competition, with private providers competing against NHS providers within the NHS, would improve outcomes. Does he therefore agree that there should be a common standard by which all care providers paid for with NHS money report on the cost and outcome of procedures? If so, why is that not in the Health and Social Care Bill?

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[Mark Simmonds]

I am grateful to the hon. Gentleman for his intervention. That is not exactly what I said, but I will get to the nub of what he is talking about. I do think that comparable information is needed to inform patient choice, and not just on cost, but on outcomes and patient satisfaction and experience, so that it is on a comparable level—

[Hugh Bayley]

Why is it not in the Bill?

[Mark Simmonds]

I am sure that the information centre in Leeds is working on that as we speak, because I know that it is important to the ministerial team.

[Charlotte Leslie]

Will my hon. Friend give way?

[Mark Simmonds]

I will not give way, because I have done so twice already.

Finally, it was made clear in an earlier intervention that the shadow Secretary of State, were he ever to be Health Secretary again, would not by necessity publish all risk registers, so it is nonsensical to suggest that this out-of-date risk register either informs debate or is necessary for discussing the future reforms of the NHS. Of course, that is not really what this debate is about. It is a cloak to try to put obstacles in the way of what I believe is necessary reform. We know why reform is necessary: a growing and ageing population; increasing levels of co-morbidities and long-term conditions; rising health care costs; and the impact of lifestyle choices. However, listening to the shadow Secretary of State, one would think that the NHS was falling apart. It absolutely is not. It is performing very well at the moment. We are reducing in-patient and out-patient waiting times. The backlog of patients waiting more than 18 weeks is going down, and the number of patients waiting more than a year is half what it was in May 2010.

[Gloria De Piero (Ashfield) (Lab)]

Will the hon. Gentleman give way?

[Mark Simmonds]

I will not, because I have done so twice already.

I could go on with the achievements that the national health service has delivered since the election, but while progress is being made we need to put in place the policy architecture that will enable the national health service to deliver improved patient outcomes, satisfaction and experience and to continue as a free taxpayer-funded service.

So what are these reforms that get Opposition Members so excited? First:

“Patients…will have the right…to choose from any provider.”

Interestingly enough, that was in the 2010 Labour party manifesto. Secondly:

“All hospitals will become Foundation Trusts”.

Interestingly enough, that was in the 2010 Labour party manifesto. Thirdly, there is the plan to

“support an active role for the independent sector”

in providing services. That too was in the 2010 Labour party manifesto. Fourthly,

“Foundation Trusts…given the freedom to expand…their private services”.

That was in the Labour party 2010 manifesto, as was the proposal to ensure that family doctors have more power over their budgets.

Who was the man in charge of putting that in the Labour party manifesto? It was the current shadow Secretary of State, which just shows how far the Labour party has moved to the left since the May 2010 election. If there is one thing that he and his supporters behind him need to understand, it is that general elections are won from the centre ground, not from the extremes of either left or right.

In the time remaining to me, I shall mention two key areas and bust some myths. The first area is competition and choice, which have always been part of the national health service. The original 1948 NHS leaflet stated that patients must choose their own GP. We should be discussing the benefits that choice can bring to patients, and how we can facilitate innovation and better patient outcomes. The evidence is clear: competition based on choice and quality, not on price for elective care, drives and improves not just efficiency and shorter hospital stays, but better management and, most importantly, patient care and outcomes.

The second area, which both the shadow Secretary of State and the Secretary of State mentioned, is integration, and it is absolutely key if we are to improve patient pathways and outcomes. Care is currently fragmented, and the state monopoly is under little pressure to deliver integrated care or new models of care. The national health service to date has been poor at integrating services, and the Secretary of State and his team need to be careful to ensure that the health service understands that the merger of organisations is not the same as integration, which is about integrating care pathways, and must not be used as an excuse to protect poor providers and weak management, or to block clinically led reconfiguration.

The successful integration of patient care, and in particular of chronic disease management, will, however, dramatically improve quality and outcomes. The Secretary of State also needs to address the issue of funding flows, moving them away from episodic care to year-of-care funding to enable integration to take place properly.

In conclusion, the national health service deserves our wholehearted support, but if it is to survive as a taxpayer-funded service free at the point of use, it must evolve and reform.

National Health Service

Mark Simmonds Excerpts

Wednesday 26th October 2011 Commons Chamber

[Andy Burnham]

The hon. Gentleman goes right to the heart of my speech today. We made those difficult decisions to get the NHS ready for the future. We grasped the nettle and took services out of hospitals and moved them into the community, because that is what has to happen if we are to have an NHS that is sustainable for the future. He stood on an election manifesto that promised the opposite. It was a dishonest pledge, and I will come to it in a moment.

I said a moment ago that it was irresponsible to promise real-terms increases. I say that because I completed a spending review of the NHS in March 2010 and knew the figures inside out. I had also been in detailed discussions with the Treasury on the funding of adult social care, in preparation for a White Paper. The implication of what the Conservatives featured on an election poster—cutting the deficit on an accelerated timetable while giving the NHS real-terms increases—could mean only one thing: unpalatable cuts to other public services, particularly adult social care, on which the NHS relies.

Despite that, the election pledge was carried over into the coalition agreement, which could not be clearer. It states:

“We will guarantee that health spending increases in real terms in each year of the Parliament”.

A year ago, at the time of the comprehensive spending review, the official figures claimed that that had been delivered, with a 0.1% settlement—essentially the same as Labour promised at the election.

[Mark Simmonds (Boston and Skegness) (Con)]

Does the right hon. Gentleman recall that before the general election, when he was Secretary of State, he said in the now infamous King’s Fund speech that the state should always be the preferred provider, irrespective of the quality of care that it provided to patients? Does he stand by that statement today, or is he now trying to drive a patient-centric health service rather than putting political ideology above patient care?

[Andy Burnham]

I think I should refer the hon. Gentleman back to the King’s Fund speech, because I did not say the NHS should be the preferred provider regardless of the quality of care it provided. I believe that the public NHS should have the first chance to change, and that was the preferred provider policy. We did not want to pull the rug from under the public NHS with a policy of “any willing provider”. If the NHS needed to change, we wanted to tell it, “You have to rise to the challenge, and you have a chance to do so. If you cannot, other providers will get a chance to come in.” That was the preferred provider policy, and I would be grateful if he did not misrepresent it.

As I said, a year ago the Government provided a 0.1% increase—or that was the headline, but the fine print began to emerge and their case began to fall apart from day one. It soon became clear that for the years 2011-12 to 2014-15, that figure included an annual £1 billion transfer to local government, ostensibly for social care but not ring-fenced, so councils would be free to spend it as they saw fit. The health funding settlement therefore already went below a real-terms increase. That transfer turned the apparently minuscule real-terms increase into a real-terms cut.

That still leaves 2010-11. When the coalition came into government, it immediately required primary care trusts to cut spending by increasing waiting times and restricting access to treatment, to generate an underspend in 2010-11.

Health and Social Care (Re-committed) Bill

Mark Simmonds Excerpts

Tuesday 6th September 2011 Commons Chamber

[Mr Lansley]

It would apply in any circumstances where it was necessary in order to secure continued access to essential services for patients, so a methodology would be in place. As I have described, the intention is to have a regime through which, although specific mechanisms will be applied to foundation trusts and to other providers—of course, the overwhelming majority of activity is in the hands of foundation trusts—the principles of intervention will be the same between the two sets of providers. We want to arrive, wherever possible, at a consistent application of failure rules. Why? Our concern is to make sure that we deal with this, which has not been the case in the past. Under Labour’s regime, if a private sector or independent sector provider failed financially, there was no appropriate mechanism for intervention and continuity of services.

[Mark Simmonds (Boston and Skegness) (Con)]

Will my right hon. Friend confirm that the additional funding he is describing will not be used to bail out, in the traditional way, inefficient and ineffective health providers, but will be used to ensure that services continue to be provided, particularly in rural areas, where the cost base may, necessarily, be more than it is in the metropolitan cities?

[Mr Lansley]

Yes, I understand that and I think that my hon. Friend makes entirely the right point. This is not about a bail-out; the commissioning board and Monitor will need to agree the methodology, because neither side will wish to undermine the integrity of the regulatory structure and the price structure that Monitor is responsible for, nor will the NHS commissioning board and commissioners want to pay any more for services than is necessary to secure continued access. None the less, continuing access to quality services for patients is the essential principle, and so there will be circumstances, particularly where it has become evident that in the absence of this there would be an unacceptable deterioration in or failure of services, in which it is necessary for the methodology to add to the tariff price.

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[Debbie Abrahams]

As we have shown, we are not opposed to private sector involvement in the UK’s health system. What is important is that it should add value and capacity. The Government’s proposals are a completely different ball game.

[Mark Simmonds]

Will the hon. Lady give way?

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The third point that was highlighted by the Future Forum—once again, it was accepted by the Government in these amendments—is the need to ensure that not only will there be continuing oversight of the achievement of those standards by foundation trusts, but Monitor will have the power to intervene if a threat emerges to the achievement of those standards by a foundation trust. Patients can be confident not only that there will be oversight, but that Monitor—on behalf of the taxpayer and of patients—has the capacity to intervene to ensure that action is taken if management in post at a foundation trust is not delivering the standards required.

[Mark Simmonds]

As always, my right hon. Friend is making an extremely powerful speech. Does he accept the need for Monitor to ensure that foundation trusts not only continue to meet basic standards but continue to improve those standards year on year, and thereby improve patient outcomes?

[Mr Dorrell]

I absolutely agree with my hon. Friend. One of the further important clarifications in their position is the stress that the Government have placed—rightly—on the importance of the link between Monitor and the Care Quality Commission to ensure that standards in foundation trusts are not just about the achievement of financial targets, but are about standards of care quality delivered to patients. The link between the two regulators—one of quality and the other of financial standards—is an important part of the regulatory structure that the Government are introducing.

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[Grahame M. Morris]

The picture is incredibly variable. We should consider many of the policies that the Government are pursuing, not least that on public health observatories, which collect the evidence on which many public health interventions are based. The sustained cuts to their budgets—there is a cut of 30% this year, and 30% next year—are exacerbating the situation. Some PCTs are performing well in this regard, and some are not performing as well. If there are measures that can strengthen our performance, they ought to be welcomed.

We have in the past mentioned some of the public health issues. As far back as 1977, the Department of Health and Social Security’s chief scientific adviser, Sir Douglas Black, commissioned a report on the extent of health inequalities in the UK. The Black report, published in 1980, brought about a sea change in how Governments would respond to health inequalities and reduce their worst effects, particularly for the lower social classes. It is generally acknowledged in more recent reports by Professor Sir Michael Marmot that the NHS can only do so much to address the situation. There are general issues that must be addressed through a whole plethora of Government policies—child benefit, improvements in maternity allowances, more pre-school education, an expansion of child care, and better housing. I mention that in relation to the amendments that we are discussing to highlight the stark danger of a reversal in relation to health inequalities, which are not only influenced by decisions of the Health Secretary, but greatly influenced by decisions taken across Government.

I shall draw my remarks to a conclusion. I am sure that Government Members will be relieved to hear that. [Interruption.] Well, I could go on for longer if they want; I have another six pages. I draw the House’s attention to the real concerns that the general public, the medical profession, staff who work in the service and patients have about particular details—about the new and expanded role of Monitor, and about the implications for the new NHS. It will not necessarily be Monitor that decides the future of failing services; in the end, that will be decided in the courts. Finally, in parts 3 and 4, we are dealing with some of the most contentious issues in the Bill, and I urge Members to consider the issues very carefully and to think about what is at stake, before deciding how to vote on the amendments.

[Mark Simmonds]

I draw the House’s attention to the Register of Members’ Financial Interests.

I congratulate the hon. Member for Easington (Grahame M. Morris) on a thoughtful, balanced and considered contribution, albeit somewhat lengthy. Some of the key points that he made are worthy of comment. He is absolutely right to highlight the importance of the issue of health inequalities, and it is absolutely right to make sure that the House understands that the Secretary of State and his Ministers are absolutely determined to narrow those inequalities; that is why the Secretary of State has ensured that that is in the Bill.

The hon. Member for Easington is also right to point out that health inequalities are determined not just by health policy. A whole range of factors influence health inequalities, and the best synthesis and summary that I have seen—if he has not read it, he should—is in a report by Professor Marmot.

[Grahame M. Morris]

indicated assent.

[Mark Simmonds]

The hon. Gentleman has read it, which is very good; I see him nodding his head. He also asked a key question about the Government’s motivation for bringing forward the Bill.

[Grahame M. Morris]

rose—

[Mark Simmonds]

I shall finish this point, and then I will happily give way to the hon. Gentleman, because he was extremely generous in giving way. Let me summarise the Government’s motivation in five areas. The first is to improve patient care; the second is to drive up the quality of services; the third is to improve patient outcomes; the fourth is to ensure better value for taxpayers’ money; and the fifth, and perhaps most important, is to ensure that our much-loved national health service has a successful future as a service that is free at the point of need, and a service that is based on requirement, not ability to pay. There should be continued equity of access and, even more importantly, excellence for all.

With the honourable exception of the hon. Gentleman’s contribution, all the contributions from Labour Members, including those on the Front Bench, have completely misrepresented the Bill. There is a degree of complacency creeping into the Labour party. The view that it puts forward—that there is nothing wrong with the national health service, and that it is a perfect, utopian service—is clearly not correct. Its view that no reform or innovation is required is not correct. Its view that no productivity improvements can be made is clearly not correct. The view that there is no problem with patient outcomes across a whole range of clinical indicators compared with the outcomes in our developed-world comparators is clearly not correct. The Labour party’s view that there is no need to reduce the cost of administration and get more resources to front-line patient care is clearly not correct; nor is it correct that there is no need for greater clinical involvement in commissioning and for greater patient choice. The Labour party’s position is purely political. It is not clinical and it does not have the best interests of patients at heart. I urge the Secretary of State and his ministerial team to reject the amendments tabled by Labour.

[Valerie Vaz (Walsall South) (Lab)]

Does the hon. Gentleman recall these words—“NHS” and “no top-down reorganisation”, said by one David Cameron, leader of the Conservative party?

[Mark Simmonds]

I do remember that. The changes outlined in both the original Bill and the amendments that have been tabled as a result of the considered and very professional work of Professor Field and his team demonstrate the desire of the coalition Government to make sure that the national health service survives for future generations as a taxpayer-funded service free at the point of need. All the changes set out in the Bill are determined by that.

The hon. Member for Leicester West (Liz Kendall), who spoke for Labour in the programme motion debate, should be wary of praying in aid the BMA. Not only did it object back in the 1940s to the setting up of the national health service, but just prior to the last election, it said that the Labour party was the enemy of the national health service. We need to engage with all the clinical groups within the national health service to ensure that we deliver the best possible patient outcomes for the amount of resources that we can put in.

I am slightly surprised at the repetitive nature of the debate. I have been told by my hon. Friends who sat on the Bill Committee that many of the points that were made in Committee have been made again today. The Government amendments that we are discussing are a direct result of the forum chaired by Professor Steve Field. I thought it unedifying of the right hon. Member for Holborn and St Pancras (Frank Dobson) to try to undermine Professor Field, who does excellent work in a very socio-economically deprived part of Birmingham. If the right hon. Gentleman has not visited Professor Field and seen the excellent work that he does, I suggest he does so.

[Several hon. Members]

rose—

[Mark Simmonds]

I give way first to the hon. Member for Worsley and Eccles South (Barbara Keeley).

[Barbara Keeley]

The speech of my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) is one of the best I have heard in the Chamber, as I think Opposition Members would agree. People outside the Chamber are saying that too.

On repetitiveness in the points that are being made, Report stage allows Members who did not serve on the Committee to say the things that they want to say. It is our chance right across the House to comment on the Bill, so that is not a valid criticism of what is going on in the debate.

[Mark Simmonds]

I hope the hon. Member for Easington has a better intervention to make.

[Grahame M. Morris]

Can we agree on one thing—that opinions should be evidence-based? I was amazed that when Professor Steve Field was asked whether the Future Forum had taken independent legal advice on the contentious issue of whether European competition law would apply as a result of the reforms—the matter was raised in the Bill Committee or the Select Committee—he said no, he had not taken independent legal advice. That was a major omission.

[Mark Simmonds]

I will not get into the nuances and the legal battles that other hon. Members have raised. Professor Steve Field and his team did an excellent job thoroughly and comprehensively in a relatively short time. To be fair to the Secretary of State and his team, they looked carefully at the suggested changes and have incorporated some of them in the clauses before us. I agree with many of them, and I highlighted some of these points on Second Reading—a greater emphasis on integration, wider engagement with a broader range of clinical commissioning teams, and greater protection for services which, in financial or quality terms, may not be providing the service that patients expect. All those have been changed in the Bill.

Almost all the Members on the Government Benches would not support the Bill if it was about privatisation of the national health service. It is not. It tries to ensure that the national health service has a future, and that the organisation that is in the best position to provide a particular service in a particular geographical locality has the ability to do so. That is not just the private sector; it is the voluntary sector, the charitable sector, the not-for-profit sector and the social enterprise sector. The mantra coming from the Opposition seems to dictate that those organisations should not be allowed to provide health care—that unless health care is provided by the state, it should not be allowed. That clearly is wrong. What is important is not the delivery mechanism, but patient outcomes and the quality of service provided.

I shall deal specifically with new clause 2 and amendments 100 to 104, 106 and the subsequent related amendments. They ensure that equity of access continues, irrespective of whether the provider is in a good financial state or not. My right hon. Friend the Member for Charnwood (Mr Dorrell) put his finger on exactly the right point, as he so often does. What matters is continuity of service, but not necessarily from the same provider.

The national health service has always changed in that way. It has always reconfigured services to make sure that the patient receives care of the best possible quality. New clause 2 puts in place an essential mechanism to ensure continued access for patients to NHS services. It is right that the Government are putting in place safeguards to protect patients and taxpayers, but the clause does more than that. It also enables commissioners to replace services with higher quality and better value options. Among the major failures of the last decade in which Labour was in charge of the national health service was not only the decline in productivity, but the fact that there was insufficient decommissioning of poor services and insufficient replacement and improvement of poor-quality service provision. Nowhere is that more marked than in Tunbridge Wells and Stafford.

The primary purpose is to enable Monitor to support commissioners to access services and place conditions on a licence holder. Some of those conditions are set out in the Bill. All hon. Members know that there is considerable variation in performance of organisations within the national health service. Providers who are providing excellent services should be allowed to thrive, innovate and drive the quality of clinical care. Those that are under-performing will require challenging, and support where necessary. Ultimately, if they cannot respond to that support and that challenge, they should be replaced by an alternative provider. That should apply both to the independent sector and to state sector provision. It is not acceptable that, purely because a service is provided by the state, it should be allowed to continue as a substandard service.

Some of the key changes in the new clauses and amendments allow that to happen. They make sure that funding is much more transparent. The existing framework has allowed hidden bail-outs to take place, which all too often have hidden poor management, poor service provision, and the need for clinically appropriate and evidence-driven reorganisation. All too often that has not happened, to the detriment of patient care.

I was pleased to see that the Secretary of State had allowed a safety valve in this part of the Bill, which would enable tariffs to be topped up, particularly for the provision of services in rural areas, such as my constituency in Lincolnshire. This must not be seen as an opportunity for the Department of Health to support and subsidise inefficient management and service provision. All too often there are inefficient cost bases and money could be transferred instead to front-line patient care.

I would be grateful if the Minister, when winding up, confirmed some specific points relating to new clause 2 and the subsequent amendments. Will he confirm that the new system will ensure that innovation is not inhibited—that providers and clinicians will have to configure services not only to satisfy patients, but to improve the quality and productivity of services, which, as we all know, have been very poor in the past decade or so? Will he confirm that the structure set out in the new clauses will enable Monitor to intervene early to ensure that the service provided is safe and provides good-quality, patient-centric services?

Will the Minister also confirm that the proposals build on the system set out in the Health Act 2009, which is in line with the Secretary of State’s consistent assertion that the Bill is about evolution, not revolution? Ministers must not allow the importance of integrated services, vital though they are, to be an excuse to maintain poor-quality providers. In the interests of patients, underperforming incumbents must be challenged and continued innovation must be facilitated and incentivised.

If the Minister has time when winding up, I would like him to address the point that I made to my right hon. Friend the Member for Charnwood, which is that the new clauses seem to ensure that Monitor will maintain minimum-based standards, particularly as they relate to acute foundation hospital trusts. We need commissioners, the Care Quality Commission and Monitor to work together to ensure that there is continuing improvement in patient care and continuing determination and drive to make sure that services are better the next year than they were the previous year. It is unclear from the amendments who will be responsible for co-ordinating that effort to drive up standards continually.

I have two final questions. What will happen if Monitor has to step in to provide advice, shore up a service or provide an alternative service provider, but the commissioners cannot agree on who should be the subsequent service provider? Who will resolve disputes between two commissioning consortia? Will it be the NHS commissioning board, Monitor or the Department of Health? Where a provider delivers a service to more than one commissioner, and one of the commissioning groups has access to an alternative provider already in existence but not another, who decides who will provide the service that has failed?

I will draw my remarks to a close. I am, as I believe are most Government Members, an avid supporter of the national health service. I defer to no other group more than I do to those who work tirelessly in the NHS to provide the excellent care that, more often than not, is delivered, and not only in the state service but across the range of NHS providers. However, if we are to continue the NHS, free at the point of delivery and based on need, not ability to pay, it must reform and change. We cannot allow it to stand still. I believe that these clauses and amendments provide an essential framework to ensure continuity of access to service, value for money for taxpayers and better quality patient care.

[Rosie Cooper]

Members of the public listening to Government Members this afternoon might wonder whether we were having this debate in a parallel universe, because they have heard the Prime Minister promise that there would be no top-down reorganisation of the NHS, and what did we get? We got the biggest reorganisation in the history of the NHS. The Prime Minister said only recently that everyone was on board and behind the Bill, and yet we find that clinicians, professionals and the public are far from being on board. The Government talk about the protection of services, but the public will have read only yesterday that the Government are meeting McKinsey about the possible transfer, albeit a slow transfer, of up to 20 hospitals.

NHS Reorganisation

Mark Simmonds Excerpts

Wednesday 16th March 2011 Commons Chamber

[Mark Simmonds (Boston and Skegness) (Con)]

It is a pleasure to follow the hon. Member for Sheffield Central (Paul Blomfield), who I thought was going to give a thoughtful speech. The only comment on which I agreed with him was his congratulations to the hard-working, committed staff in the NHS. I am sure that all hon. Members would agree with that.

I have been disappointed by the debate, but perhaps not surprised. Labour Members’ opposition to the reforms proposed in the Health and Social Care Bill and the evidence presented in support of their motion are based on inaccuracies, incorrect assertions and assumptions, and myths about the destruction and privatisation of the national health service. The plans were clearly laid out in the Conservative and Liberal Democrat manifestos. Two thirds of the country is already covered by GP consortia, many of which are keen to crack on with the reforms so that they can improve the care that they are delivering for their patients.

All Government Members are totally committed to the ethos of the national health service. We are totally committed to a free, taxpayer-funded national health service. Most importantly of all, we are totally committed to continual improvement of patient care. The Health and Social Care Bill will achieve all those things, for the reasons set out by my hon. Friends—ageing populations, increasing costs of drugs and technology, and the increasing level of co-morbidities.

In all the debates about the future of the national health service, no Member of the House should forget the most important factor—the user of the service. Some people on the Opposition Benches seem to have forgotten the patient. The Bill moves patient care in exactly the right direction. The reforms are about high-quality care and value for money for the taxpayers. They transfer resources to front-line patient care by reducing bureaucracy and administration. They are about driving up the quality of patient care and improving patient experience and outcomes.

I have no wish to repeat the Second Reading debate on the Bill, but it is wrong to suggest that everything in the national health service is perfect, and that improvements cannot be made through reform. Putting clinicians in a position to lead commissioning and allowing patients to be involved in the decision-making process will drive improvements. Providing easily accessible patient-centric information to inform choice and raise quality standards will drive improvements in patient care.

[Nicky Morgan (Loughborough) (Con)]

My hon. Friend is making a powerful argument. Does he agree that it is rather tragic—nay, even worse—that we have heard Opposition Members having a go at the motives of both GPs and those who work in hospitals? Opposition Members think that they are driven by money, not by the quality of patient care and outcomes.

[Mark Simmonds]

I thank my hon. Friend for the point that she has forcefully made. A few—not all—on the Opposition Benches believe that GPs are in it for the money. No GP I have ever met, or with whom I have discussed patient care, is interested in money. They are there to improve the lives of the patients for whom they are responsible.

If we are to engage seriously with improving patient care, we must allow any willing provider to provide services, and allow the provider that is best for optimising patient outcomes in a regulated way to drive up standards. As my hon. Friend the Member for York Outer (Julian Sturdy) said, it is perplexing to hear the arguments that Labour Members have been coming out with today, and ever since Christmas. Is it right that substandard and mediocre services should be allowed to continue purely because they are provided by the state, even when the patient can get better care elsewhere at the same cost? That has to be wrong. What is important is the quality of patient care that is free at the point of delivery, not the delivery mechanism.

The shadow Secretary of State’s position is completely untenable. He must be squirming inside, because he is an intelligent man and a reformer. The Labour party introduced foundation trusts, payment by results, patient choice and private sector provision in the delivery of patient care, and it twice introduced GP commissioning. As recently as 2010, the Labour party manifesto stated:

“We will support an active role for the independent sector”—

that is in the Bill;

“Patients requiring elective care will have the right, in law, to choose from any provider”—

that is in the Bill;

“All hospitals will become Foundation Trusts”—

that is in the Bill;

“Foundation Trusts will be given the freedom to expand their…private services—.

that is in the Bill. Labour also claimed that it would

“ensure that family doctors have more power over their budgets.”

That is in the Bill. The Labour party should support the Bill, not castigate it on the basis of false promises.

The Government are absolutely right to push the Bill, which is on exactly the right lines. We need more investment in the NHS, less waste and more powers for doctors and nurses to be involved in commissioning and clinical decisions. We need to focus on results, create accountability and transparency, and facilitate innovation. The Bill preserves the best of the NHS—equality of access—and creates the architecture to drive and deliver excellence for all.

Health and Social Care Bill

Mark Simmonds Excerpts

Monday 31st January 2011 Commons Chamber

[Mark Simmonds (Boston and Skegness) (Con)]

It is always a pleasure to follow the right hon. Member for Rother Valley (Mr Barron). Although I did not agree with much of his speech, I strongly agree with his last point about the importance of keeping the foot on the accelerator to try to narrow health inequalities. That is right at the top of the priorities of Health Ministers. This is a very important and complex Bill. We all want to see high-quality care and value for the taxpayer in the provision of health care. I think it is fair to say that there has never been a better-informed, more knowledgeable and better-prepared incoming Secretary of State than we have at the moment.

The opening speeches by my right hon. Friend and by the shadow Secretary of State stood in stark contrast to one another. I feel rather sorry for the shadow Secretary of State. He is clearly an intelligent man, but he is cornered by the supplicatory role that his leader is playing to the trade union movement. I am sure that the shadow Secretary of State agrees with the Government’s introduction of independent treatment centres. I am sure that he also agrees with the previous Government’s introduction of the independent sector into provision and into commissioning, “any willing provider”, practice-based commissioning, payment by results—although it was payment by activity then—and national tariff ceilings within quality standard frameworks. However, he could not say so because he is cornered.

Listening to some Labour Members, one would think that there were no improvements to be made—that the national health service was a utopian structure prior to the last general election. Let me point to 10 things that I sketched out this morning: too much money spent on administration and bureaucracy and not enough on front-line patient care; too little patient-centric information to inform decision making; too little innovation; too little clinical input into decision making; too much inertia and hostility to reform, as we have seen today; too much process-driven target culture distorting clinical decision making; falling productivity; poor outcomes across a range of clinical indicators; too often, weak commissioning of servicing; and widening health inequalities in the past 10 years, in addition to the scandals that occurred in Staffordshire and Kent. That is hardly a situation that makes the status quo desirable.

[Mr Lee Scott (Ilford North) (Con)]

At the risk of being accused of management-bashing, may I point out that somebody in my own trust who worked up a deficit in excess of £100 million was rewarded with a large pay-off when he left the NHS? Can that possibly be right?

[Mark Simmonds]

My hon. Friend is absolutely right. I remember him fighting tirelessly and vociferously to try to prevent those in the health service and the then Health Secretary from allowing that to happen.

Another thing that Labour Members have to understand is that we must move the NHS towards being a service that is centred on the patient, not one where the patient revolves around the system. To enable that to happen, we must measure and improve outcomes on a continuing basis, and we must do it with patient-centric information that will enhance patient choice, not only about the choice of the provider and the location of their treatment, but about the treatment that they receive for their ailment. This Bill deals with all the failings that were present when the Labour party was in charge.

There are three or four areas where the detail still needs to be discussed, and I want to make some suggestions. There must be an opportunity for integrated care and for improved patient pathways. I would very much like acute clinicians, pharmacists and others who deliver patient care to be involved in GP consortia and the commissioning process. Some of the more forward-thinking consortia are already involving acute clinicians, and this needs to be implemented across the board. We need to find a non-prescriptive architecture to enable consortia to work together to collaborate where appropriate, not only in the all-important area of cancer, as appropriately highlighted by my hon. Friend the Member for Basildon and Billericay (Mr Baron), but in acute stroke services. This has been done successfully, and it must continue to be done.

Performance management is absolutely critical. The Bill seems to make no specific mention of out-of-hours care. My right hon. Friend the Secretary of State will remember only too clearly the terrible case of Mr Gray, who was killed by Dr Ubani, the out-of-hours doctor who flew in from Germany and prescribed him the wrong dose of a drug. That was a performance management failure. The SHA failed to monitor the PCT, which was failing to monitor the provider. We must ensure that GPs are involved in driving improvements in out-of-hours care as well as in-hours care.

We need to look at GPs’ contracts. It is rather perplexing that a PMS—personal medical services—contract could be held by a national commissioning board. Who will be in charge of revalidation, training and performance lists? We must move GPs’ quality and outcomes framework towards one that is outcome-based rather than process-based.

[Mr Graham Stuart]

Like my hon. Friend, I will support the Bill. Does he hope, as I do, that the Government will look very carefully at any conflicts of interest? As we rightly give the power down to clinicians, we need to ensure that they always take decisions in the interests of the patient and not for their own financial gain.

[Mark Simmonds]

I entirely agree with my hon. Friend. My understanding is that the NHS commissioning board will have a significant monitoring role to ensure that GPs commission services not automatically from themselves but from providers who provide the best outcomes for the patients they are trying to look after.

I would like to make one final point to the ministerial team. Information is the key that will drive improvements in the NHS, and that information must be comparable, easily accessible and easily understandable in order to inform patients’ decision making processes. It should not just be on the internet. We should not just wait for patients to access information—we have to find ways of taking it to them, particularly those living in socio-economically deprived areas.

The Bill is a significant step in the right direction. It preserves the best of the national health service—equality of access—while creating opportunities to improve the provision of health care in the UK, so that it can become among the best in the world, rather than lag behind. Excellence for all should be the goal.

--- Later in debate ---

[David Miliband]

I am happy to wager the hon. Gentleman that the costs will turn out to be more like double those estimated and the savings more like half.

The Bill is myopic, or “deluded”, to use the word of the British Medical Journal, in three key areas, which I wish to mention. First, it assumes that all GPs are ready now to take on hard budgets in the commissioning framework. It took the previous Tory Government six years to get 56% to be GP fundholders. Secondly, it will deepen the divide between primary and secondary care. The hon. Member for Central Suffolk and North Ipswich raised that matter, which is vital. We all know that in our constituencies, collaboration between primary and secondary care is key, especially for chronic conditions. The Bill will make the divide worse, because collaboration will be deemed anti-competitive.

Thirdly, the Bill has absolutely nothing to say about quality control of GPs. In fact, it will remove the local drivers for improvement that I have seen in my constituency. The hon. Member for Basildon and Billericay (Mr Baron) mentioned cancer survival rates, and the Appleby research shows that we in this country have made more progress over the past 30 years than any other country in Europe, and will overtake France in 2012. It also shows that the extent to which we are behind can be explained by late diagnosis in the first year of cancer, which is the responsibility of GPs. They should focus on improving their cancer treatment, not commissioning care.

[Mark Simmonds]

Will the right hon. Gentleman give way?

[David Miliband]

No, I have given way once and I want to make some progress. If I have time, I will come back to the hon. Gentleman.

All the matters that I have mentioned are to service a vision of health care as a regulated industry. The Secretary of State has engaged in a ding-dong about which operating framework is more important—the 2009 or the 2010 one. Two points, though, have not been contested. The first is that in 2011-12, for the first time, there will be competition according to price—page 54 of the operating framework says that. The second is that the academic evidence is absolutely clear that price competition results in lower prices, yes, but also in lower quality.

The hon. Member for St Ives (Andrew George) asked the Secretary of State, “What about my community hospitals?”, but of course the Secretary of State does not want to make decisions about community hospitals. His predecessor but six, eight or 10, Nye Bevan, said that he wanted a bedpan falling in Tredegar to be heard in the corridors of Whitehall. The Secretary of State does not want to hear bedpans falling; he wants to say that it is GPs who should be making decisions, or the commissioning board, or, in the ultimate irony that my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) pointed out, the European Court of Justice under European competition law. He pointed out the irony of the Lisbon treaty being critical, but at this very time the House is passing a Europe Bill that calls for referendums when any power is transferred to the EU, including on matters as puny as the appointments system for the Court of Auditors, never mind on a vital part of NHS provision.