Oral Answers to Questions
Nadhim Zahawi Excerpts(11 years, 11 months ago)
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Claire Perry (Devizes) (Con)
1. What progress clinical commissioning groups have made in improving care for patients.
Nadhim Zahawi (Stratford-on-Avon) (Con)
17. What progress clinical commissioning groups have made in improving care for patients.
The Secretary of State for Health (Mr Andrew Lansley)
This year, developing CCGs have delegated responsibility for more than £30 billion of local commissioning. Clinical leadership is using NHS resources more effectively, as part of improvements in care. In particular, we are seeing many improvements in community-based services—for example, a pulmonary exercise programme in Durham; a community spinal service in Reading; and a new musculoskeletal service in the Vale of York CCG.
Mr Lansley
I am very grateful to my hon. Friend for demonstrating how these new developing relationships that CCGs and local authorities are creating with NHS providers and care providers are delivering improvements in care for the constituents we all represent. I urge other hon. Members to follow her example in stimulating exactly those relationships.
Nadhim Zahawi
The CCG covering my constituency is interested in improving patient care by looking at new methods of contracting and management, but it has been told that it must use a clinical support service set up by the primary care trust, staffed by ex-PCT staff and most likely based in Birmingham, rather than south Warwickshire, at a cost of £4 million a year. Could the Secretary of State—
Mr Speaker
Order. Let us just have a question—not the preamble, but the question.
Nadhim Zahawi
I apologise, Mr Speaker. Will the Secretary of State confirm that there is no need for the CCG to use such an organisation and that it is free to form its own commissioning structure without incurring redundancy and wind-up costs from the PCT?
Mr Lansley
Yes, I can confirm that CCGs have the freedom to decide which commissioning activities they will do themselves and which they choose to secure from external organisations, thus enabling them to carry out their functions effectively. They can, if they wish, develop their own organisations and staff or contract with other organisations, and they are not required to contract with the commissioning support services hosted by the NHS Commissioning Board.
Future of the NHS
Nadhim Zahawi Excerpts(12 years, 12 months ago)
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John Healey
I am going to make progress now.
The NHS chief executive described the NHS reorganisation as
“enormous—beyond anything anybody from the public or private sector has witnessed”.
He is right. At this time of tight finances, the Government are piling on extra pressure and putting the NHS at risk with this reorganisation. The Health Committee warned in January that the NHS efficiency challenge was
“already a high-risk strategy and the White Paper increased the level of risk considerably”.
Now nearly £2 billion that was promised for patient care is being held back to cover the cost of reorganisation, and hospitals are being forced to cut back on costs by one third over the next five years, as all are forced into foundation status by 2014.
I was in Wigan this morning, where the chief executive of the hospital trust told me that the hospital must make £14 million in cost savings this year and similar amounts the following year. He described that as an almost impossible task. More importantly, however, it puts at risk the strategy for better services and better value for money, and the strategy for more integration of hospital and community services. He said of the Government’s plans that the sheer distraction of reorganisation and insistence on competition will scupper our chance of doing that.
The pressures of this high-risk reorganisation are one the reasons that, just one year into this Government, patients are starting to see the NHS go backwards again under the Tories, with waiting times rising, operations delayed, services cut back and front-line jobs lost. This is not just a problem with the timing or pace of change, however, and nor is it a problem of presentation. In fact, the closer people look at the plans, the more concerned they become, which is why there is growing criticism of the Tory plans for the NHS from doctors, nurses, patients’ groups, NHS experts, the Health Select Committee, peers in all parts of the House of Lords and now even the Lib Dem leader. The closer people look, the more fundamental and far-reaching they see these changes to be.
Today, the Royal College of General Practitioners warned the Prime Minister that his health Bill undermines our comprehensive health care system and will cause “irreparable damage” to the core values of the NHS. So far Ministers have branded such criticisms as scaremongering, but people in the NHS are already starting to see this happen. The Government’s first act was to remove national waiting time standards—the patients’ guarantee that they would be seen and treated quickly—which the Health Secretary described as “clinically unjustified targets”, but the patients do not see it that way, and nor do the surgeons. The president of the British Orthopaedic Association described the delays now being faced by patients as “devastating and cruel”.
The NHS Bill takes the break-up of our NHS still further. National Institute for Health and Clinical Excellence decisions on what drugs or treatments patients should have on the NHS become optional for commissioning consortia, and for the first time since 1948 the Secretary of State will not be responsible for delivering a national health service or for defining its scope. In future, the power to decide what health services will be provided free at the point of need—as now—and what further services will be charged for will rest with the new commissioning consortia. That was the basis of the concern expressed today by the Royal College of General Practitioners. These consortia will be able to meet and take decisions in private, and to outsource commissioning to private companies; but they will not even need to have a GP on their board—in fact, they will not need to have a board at all.
Nadhim Zahawi (Stratford-on-Avon) (Con)
The right hon. Gentleman mentioned the Royal College of General Practitioners. What does he think it makes of his policy, revealed in Pulse, to strip GPs of all financial responsibility?
John Healey
When the hon. Gentleman reads his next edition of Pulse, he will see my correction of that report, and note that the first five paragraphs were all reported and contained no quotes from me. He ought to know that after a survey by the British Medical Association found that more than half of doctors believed that they would spend less time with their patients as a result of these changes, the chairman of the BMA council, Dr Hamish Meldrum, said:
“This survey shows that the government can no longer claim widespread support among doctors as justification for these flawed policies.”
It is not the five clauses that set up the GP consortia that cause the most concern. It is the 85 clauses that set up the NHS as a full-scale market, and it is part 3 of the Bill, which opens up all areas of the NHS to private health companies; removes requirements for proper openness, scrutiny and accountability to the public and to Parliament; allows NHS hospitals to go bust and face a commercial insolvency scheme; places the judgment of the new competition regulator—just like those for gas and electricity—at the heart of decisions about the future of the NHS; and, for the first time, makes the NHS subject to the full force of UK and European competition law. That means that, in the long term, we will see clinical planning in the NHS being replaced by market competition, service integration being replaced by corporate cherry-picking, public accountability being replaced by commercial confidentiality and the public ethos at the very heart of our NHS being replaced by the profit motive.
I agree with the Deputy Prime Minister that no Bill is better than a bad one, but I say to him that this is a bad Bill. That is why we have opposed it from the outset, and that is why we say that it must be shelved in its current form and that radical changes must be made. For us, for the NHS and for NHS patients, this is the test of the Prime Minister’s promise to protect the NHS. I commend the motion to the House. [Interruption.]
Mr Lansley
I do not accept the right hon. Gentleman’s premise. Waiting times in the NHS are stable. We had a conversation about that during the last session of Health questions, but perhaps the right hon. Gentleman was not in the Chamber and did not hear it. The average waiting time is nine weeks. The operational standard requires 90% of admitted patients to be seen within 18 weeks—that is in the NHS constitution—and it has been maintained, although the figure was 89.9% in February after a winter during which critical care beds were full because of flu.
The right hon. Member for Wentworth and Dearne talked of four-hour waits in A and E as if the fact that a patient had been discharged within four hours were the only issue. He should go and talk to the families of patients who, in the past, were discharged from the emergency department at Stafford general hospital and left to die.
What matters is how long it is before a patient is seen by a qualified professional, and how long it is before that patient is treated. What about those who leave without being seen? What about those who are not given the care that they need, and have to return to the emergency department? Those are the things that matter to patients, and those are the things that are now part of the accident and emergency quality indicators which, this April, we said that we would publish for the first time. It is we who are focusing on services for patients. Labour Members had 13 years to look at what really mattered to patients and at the real quality of what was delivered to patients, but they did not do it, and we are going to do it.
Nadhim Zahawi
Pausing and listening and getting the detail right are about grown-up politics. Opportunism and flip-flopping are about the Opposition.
NHS Reform
Nadhim Zahawi Excerpts(13 years, 1 month ago)
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Mr Lansley
No, the hon. Gentleman misunderstands. I was very clear in my statement and in subsequent responses to questions. Right across the country, there are thousands of people who are developing the pathfinder consortia, taking NHS trusts through to foundation trust status, and building the health and well-being boards and new public health structures in local government. They should be confident in doing that, because the Government continue to be committed to achieving those changes. In the process of doing so, we will engage with them to ensure that the legislation specifically gives them the support that they need.
Nadhim Zahawi (Stratford-on-Avon) (Con)
I congratulate my right hon. Friend on engaging and listening. We have all received the 50 or so e-mail circulars from constituents who are concerned, but that does not reflect the evidence on the ground. GPs in Shipston in my constituency are absolutely passionate about the reforms and want to engage fully with them, as do 220 other groups—87% of the country. May I make a suggestion to the Secretary of State? Perhaps we should bring all those people who are passionate about this reform and want to take party politics out of it together with Labour Members on a platform so that we can take this forward without petty politics derailing a brilliant piece of legislation.
Mr Lansley
I am grateful to my hon. Friend. Labour Members sit and laugh about this, but they ought to realise that 1 million patients a day visit their local general practice surgery. GPs across the country who have come together to form pathfinder consortia—87% of the country—are doing it on the basis that they can improve services for patients. I suspect that they understand the needs of their local community and patients better than many Labour Members, who are not listening to their GPs locally.
NHS Reorganisation
Nadhim Zahawi Excerpts(13 years, 1 month ago)
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John Healey
I am going to make some progress. We are all conscious of your encouragement to do that, Madam Deputy Speaker.
Some say that the Prime Minister and the Health Secretary are failing to get the message across, but from the start they have told only half the story. The Tories did not tell people about their plans for reorganisation and market competition at the heart of the NHS before the election, and they did not tell the Lib Dems about them before they signed the coalition agreement pledging that there would be no NHS reorganisation. There is no mandate from the election or the coalition agreement for this fundamental reorganisation and far-reaching legislation. They will not be straight with people about their plans. This is not just about communication; it is about judgment. In the face of widespread warnings, they are forcing through at breakneck speed the biggest reorganisation in the NHS’s history.
Nadhim Zahawi (Stratford-on-Avon) (Con)
The right hon. Gentleman wisely started by saying that there is room for reform. The right hon. Member for Edinburgh South West (Mr Darling) had plans in his Budget for a 20% cut in the NHS. Will the shadow Secretary tell us which bit of the NHS he would cut to deliver that 20%?
John Healey
There is someone else who needs a copy of the Labour manifesto. He almost used his six minutes’ allocation to make that intervention.
Mr Lansley
All GPs and their colleagues who were part of the first wave of pathfinders were invited to No. 10—there were far more than we ever expected—and Charles Alessi was one of them. It is a complete illustration. I do not know what Charles said or why he said it, but he is the doctor, not me. Frankly, I think that it is clinical leaders in the NHS who are responsible for what they say, not me.
Nadhim Zahawi
Does my right hon. Friend agree that the way in which the Opposition are conducting themselves, when they proposed a 20% cut to the NHS, is scaremongering among our constituents and entirely irresponsible?
Mr Lansley
My hon. Friend makes an extremely good point, and he made it to the shadow Secretary of State, who did not answer it.
Mr Lansley
Yes, that is one possibility. Another is that Labour Members are paid for by the trade unions.
Our changes are driving real improvement. Our investment means that more than 1,300 patients are now getting the life-extending cancer drugs they need; that is investment in cancer drugs that the Labour party opposed.
Mr Dorrell
I understand the point, and it is part of the argument that the Labour party has started to make about how, since Christmas, it has suddenly discovered that the Health and Social Care Bill and the policy that it implements—a policy based on commissioners having choices in the interests of taxpayers and patients—require commissioners to have those very choices if the policy is to be effective. As my right hon. Friend the Secretary of State said, the principle of competition for commissioners’ budgets, as funded by the taxpayer, was set out by the last Government in their policy of December 2007. Hon. Members should look at the text—it is there in the record.
The last Government were right. The right hon. Member for Wentworth and Dearne seeks to set up an Aunt Sally when he says that there is something wrong with European principles of competition law when applied to health care. Let us be clear: if we are spending £100 billion of taxpayers’ money on securing high-quality health care on the principle of equitable access, what is wrong with insisting on the principle that we should not allow monopolists to restrict the choices available for using that budget to deliver high-quality care for patients? That is the principle, and that is why I am in favour of competition law applying to the provision of health care in response to a tax-funded budget.
Nadhim Zahawi
Does my right hon. Friend agree that this is political opportunism of the worst kind?
Mr Dorrell
It is, but it is not even political opportunism that applies to a popular principle. Surely opportunism is normally motivated by some popular principle, yet defending the interests of a monopolist does not seem to me to be a very popular principle.