Health and Social Care Bill
Nigel Evans Excerpts(12 years, 7 months ago)
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Grahame M. Morris
On a point of order, Mr Deputy Speaker. I wonder whether I might seek your advice in relation to a declaration of interest. The hon. Member for Boston and Skegness (Mark Simmonds) has made two interventions on the private patient cap and has made a declaration of interest. He is a director of Circle, a private health care company. Is it your ruling that every Member must make such a declaration if they speak during the course of this debate?
Mr Deputy Speaker (Mr Nigel Evans)
It is up to each individual Member to make whichever declaration of interest they wish during a debate, but ultimately it is up then to the Member and the Commissioner if the Member wished to take that further.
Andy Burnham
The amendment gives us no protection at all, and it gives us no protection from the NHS cross-subsidising private care. There is nothing in the Bill which says, “The whole costs of the provision of that care have to be reimbursed to the national health service”, as the Financial Times has again demonstrated, and that is why we object to what is happening. We are going back to the old days of the NHS, whereby patients are told, “You can go private or you can go to the back of the queue and wait longer.” That is the choice which we removed from the NHS during our 13 years in government, and we will not accept any return of it.
Paul Burstow
I beg to move, That this House agrees with Lords amendment 11.
Mr Deputy Speaker (Mr Nigel Evans)
With this we will consider Lords amendments 12, 43 to 53, 61, 62, 168 to 241, 243 to 245, 247, 249 to 251, 253 to 286, 288 to 291, 327, 333, 334 and 366 to 374.
Liz Kendall
On a point of order, Mr Deputy Speaker. Is it in order for the Minister who moved these particularly important amendments, which will abolish a statutory organisation, HealthWatch, to be absent from the debate? If it is in order, is it not a huge discourtesy to Members on both sides of the House?
Mr Deputy Speaker (Mr Nigel Evans)
I thank the hon. Lady for her point of order. It is in order for the Minister not to be here at this moment in time, and it is up to each Member’s judgment as to what to make of that.
Andrew George
It is a pleasure to follow the right hon. Member for Wentworth and Dearne (John Healey), who has taken us round a number of issues, particularly in relation to the public’s ability to scrutinise, through the proposed healthwatch organisations, the effective delivery of commissioning in their areas.
As my right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes) suggested, there is a desperate need for provision within our procedures whereby important Bills such as this, which have been significantly altered in another place, can be reviewed on Third Reading. Our earlier debate about the still unpublished transitional risk register was, in a sense, a proxy for that lack of a Third Reading debate.
This debate has placed public health and the role of HealthWatch, particularly local healthwatch, in the context of local health services being placed at risk. We have already discussed how clinical commissioning groups may be fundamentally conflicted. In my contribution to that debate, I posed questions about the conflicts that intrinsically exist within those organisations. I believe that HealthWatch should be there to provide scrutiny of those conflicts. Throughout the debates on the Bill, fundamental concerns have been expressed about the fragmentation of local health services. We need a strong and independent-minded local healthwatch in all our areas to be watching for that and looking out for opportunities to maintain the integration of local services.
I fear that one of the effects of such a major reorganisation of the health service nationally and locally will be to make it more difficult to deliver the £20 billion efficiency gain that the previous Government proposed and that the coalition Government intend should be delivered. That issue needs to be considered at national level, with HealthWatch, and at local level. I believe that we need an independent body that is capable of ensuring that efficiency gains are being achieved at local level and that keeps an eye on the commissioning and delivery of local health services.
The Royal College of Nursing has said today that there is a need to look carefully at staffing levels in front-line health services, including in acute hospitals. There is a debate about whether that should be mandatory. That has long been a concern of mine when looking at the delivery of local health services and it is identified by people when they visit hospitals. There are staff-to-patient ratios that, in my view, are barely tenable and barely safe. Qualified nurses are struggling to provide the support and care that patients require, simply because the staffing ratios are inadequate. The same ratios may have been adequate in the past when the throughput of patients and the acute status of patients were lower, but with the current turnaround of patients and their acute status, it is no surprise that the RCN’s survey has identified the need to review staffing levels in our wards.
NHS Risk Register
Nigel Evans Excerpts(12 years, 8 months ago)
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Mr Lansley
On a point of order, Mr Deputy Speaker. For the purposes of accuracy, I understand the right hon. Gentleman to have said that 105% more patients waited longer than a year for their treatment in December 2011 compared with December 2010, when he should know that the figure—[Interruption.]
Mr Lansley
Thank you, Mr Deputy Speaker. For the purposes of accuracy, the figures published by my Department for December 2010 were 14,671, and for December 2011 were 9,190, a reduction of almost 5,000.
Mr Deputy Speaker
That is not a point of order for the Chair, Mr Lansley. As—[Interruption.] Order. As you well know, that is a point of debate.
Andy Burnham
Even though it was not a point of order, Mr Deputy Speaker, let me just answer it. I was comparing December 2010 with December 2011. That is a different time frame from the one that the Secretary of State quoted, which involved a time frame since the election. The Government inherited an NHS in which those waiting times were going down, and that is why he quoted those figures. On his watch, they are going back up, and it is a disgrace that he does not have the courage to admit it.
The fact is, as I said a moment ago, that warnings have been coming from the NHS, and I want the House to listen carefully to this information. The right hon. Gentleman has not been listening. The Government will not publish the transition risk register, but we have a pretty good understanding of what is in it from the local and regional risk registers that have been made public in line with Government policy as expressed on the Treasury website. So what do they say about waiting times?
Let us take the risk register from NHS Bradford and Airedale. Its assessment warns of
“a risk of poor patient access and assessment within four hours at Leeds Teaching Hospital due to significant staffing pressures resulting in potential patient safety issues and delay”.
The likelihood of that happening is considered 4, likely to happen, and the consequences are rated 4, major, giving an overall risk register rating of 16, which is extreme.
Julian Smith
Last week, I met Airedale NHS Foundation Trust, to which the right hon. Gentleman referred earlier. To clarify, neither the chief executive nor the chairman raised any of the points that he has raised. Not only that, but the local GP commissioning consortia are perfectly happy and are asking me and other local MPs to push ahead with the Bill. Why is the right hon. Gentleman such a scaremongering buffoon?
Mr Deputy Speaker (Mr Nigel Evans)
Order. I ask the hon. Gentleman to withdraw that description.
Andy Burnham
I do not know why the hon. Gentleman thinks that such an intervention is appropriate. Why did he not ask the chairman and chief executive about this matter? Why does it take me to go and research the risk register—[Interruption.] Listen to the answer. Why does it take me to research the risk register in his constituency and to tell him about the risks to the NHS in his constituency, which he clearly does not know about? I suggest that he goes away from this Chamber right now and searches online, where he will find that risk register. Perhaps he will learn something about his constituency.
We are told that the market will decide. Last week, the Government received a specific warning from more than 150 members of the Royal College of Paediatrics and Child Health that the market-based approach envisaged in the Bill will have
“an extremely damaging effect on the health care of children”.
They went on to say:
“Care will become more fragmented, and families and clinicians will struggle to organise services for these children. Children with chronic disease and disability will particularly suffer, since most have more than one condition and need a range of different clinicians.”
They stated that:
“The Bill is misrepresented by the UK Government as being necessary”
and that it will
“harm those who are most vulnerable.”
Those are not my words, but those of clinicians. [Interruption.] If the hon. Member for Suffolk Coastal (Dr Coffey) wants to dismiss them, that is up to her, but she would do well to listen to them.
Warnings do not come any more serious than the one that I have just read out. It shows why the Government will not publish the risk register: they know that the case for their Bill would be demolished in an instant. People watching this debate will ask how it is possible to proceed when experts make such warnings and when NHS bodies warn of fatalities. To press on regardless would be utterly irresponsible and unforgivable. That is what the Prime Minister said today that he plans to do.
The truth is that the Government are not listening, as we have seen throughout this debate. The Prime Minister is surrounding himself with people who say what he wants to hear, while closing the door of No.10 Downing street in the faces of those who do not. He will not listen to the doctors and nurses with whom he was once so keen to have his photograph taken. It could not be clearer: he is putting his political pride and the need for the Government to save face before the best interests of the national health service. He is gambling with patients, with public safety and with this country’s best-loved institution. The Prime Minister asked people to trust him with the NHS, but we have learned today that he is running unforgivable risks with it. What his Government are doing is wrong and they need to be stopped.
I call on Members across the House to put the NHS first tonight. Vote with us for the publication of the risk register so that the public can see what this reorganisation will do to their NHS. They deserve the full truth and tonight this House can give it to them and correct the Government who have got things so badly wrong. I say to people outside who are watching this debate, join this fight to save the NHS for future generations. The NHS matters too much to too many people for it to be treated in this way. People have not voted for what is happening. [Interruption.] Not a single Government Member who is shouting at me now can look their constituents in the eye and say, “I told you that I was going to bring forward the biggest ever top-down reorganisation.” The more people who join this fight, the stronger our voice will become.
We promised this Government the fight of their life for betraying that trust and that is what we will give them. Tonight, this House has an opportunity to speak for the millions of people who care about the NHS and are worried about what is happening to it. I implore this House to take that opportunity and I commend the motion to the House.
Mr Deputy Speaker (Mr Nigel Evans)
Before I call the Secretary of State for Health, I say to the House that in my time as Deputy Speaker, this is easily and by some margin the worst-tempered debate that I have chaired. I ask Members on both sides of the House to lower the temperature so that we can have a decent and full debate.
Mr Deputy Speaker (Mr Nigel Evans)
Order. Will Members please resume their seats? I am introducing a seven-minute limit, with the usual injury time for up to two interventions. Clearly there is a lot of interest in this debate, and if Members do not use up their full seven minutes, I am sure it will be greatly appreciated by Members towards the end of the list of speakers.
Richard Graham
On a point of order, Mr Deputy Speaker. As the business of the day is specifically focused on the publication of the NHS risk register, is it in order to describe the register as a secondary issue?
Mr Deputy Speaker (Mr Nigel Evans)
May I advise all Members that they should not resort to a device such as this, as it is an argument in continuation of the debate. Many Back Benchers want to get into the debate, so Members should not misuse points of order. That was not a point of order for the Chair.
Alan Johnson
Thank you, Mr Deputy Speaker.
I believe I heard the Secretary of State say that he did not really want to talk about the risk register, and neither do I, but I think it is important to the Government’s basic problem and the threat to the national health service.
Three important and interlinked reforms can be summed up in five words: “better outcomes for lower costs”. Does the private sector have a role? Of course it does.
Let me say a word about the introduction of independent treatment centres, which seem to have been used by some in this debate to suggest that this Bill simply carries forward policies pursued by the Labour Government. ITCs were introduced to deal with the perennial problem in the NHS—long waiting lists. We should remember that in the late 1990s about one in 25 people on the cardiac waiting list died before they were operated on. Rudolf Klein, in his seminal history of the NHS, said that ever since it was created, there has been a tail of around 600,000 people on waiting lists. He said that the captain shouted his order from the bridge and the crew carried on regardless.
In 1995, after 16 years in power, the Government before the last one decided to reduce the guaranteed in-patient waiting time under the citizens charter from two years to 18 months. That was the best they could do after being so long in power. For us, it was an absolute priority. Let me say to Members of all parties that independent treatment centres transformed behaviour in the NHS. Suddenly, it became possible for surgeons to operate on Fridays and on Saturday mornings as hospitals reacted to the threat of competition.
Alan Johnson
I shall not be taking an intervention from the hon. Gentleman.
When it comes to integrating social care with health, people want an adult social care system that resembles the NHS, not an NHS that resembles the current adult social care system. The very real fears about the Bill, particularly in respect of commissioning, were highlighted recently by the Health Committee. If the necessary economies are to be made, the provision of health and social care must be planned together, and, despite its title, the Bill is hindering that process. Yes, it includes the word “integration”, at a late stage, but the word just sits there doing nothing more than suggest that this is the spirit that the Bill will introduce, and it is not.
The one sensible decision made by the Health Secretary was the one to retain the services of Sir David Nicholson as chief executive of the NHS. The goal of achieving efficiency savings of 4% a year to reinvest in patient services is a noble one, but its achievement will be particularly difficult for the acute sector. What seems to be happening at present is that hospitals are cutting services to save money. What needs to happen, and what the Nicholson challenge envisaged, is the transformation of services to eliminate waste by, for instance, reducing readmissions and bringing care much closer to the patient. Of the £80 billion spent by PCTs in 2009-10, nearly half went to hospitals, the most expensive form of care, while primary care received only a quarter.
When I asked the distinguished colorectal surgeon Ara Darzi to lead 2,000 clinicians in moving the NHS to the next stage of its development by focusing remorselessly on quality, he produced a report that was radical in its concept if a little boring in its detail. Government Members could do with a bit of “dull and boring” on the NHS at the moment. The proposals required no reorganisation and very little legislation.
At that time, the Conservative party was promising a bare-knuckle fight to defend the district general hospital, and siding with the British Medical Association to stop patients accessing GP surgeries later in the day and on Saturday mornings. If the Nicholson challenge is to work, it must be accepted that the vision of the district general hospital as all-singing, all-dancing, and capable of providing all clinical procedures must change. There is no political leadership on that, there is no leadership from the Government—
Manufacturing
Nigel Evans Excerpts(12 years, 11 months ago)
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Mr Deputy Speaker (Mr Nigel Evans)
I remind the House that there is a five-minute limit on Back-Bench contributions, but not for the first two speakers, or for the Minister and the shadow Minister.
Mr Deputy Speaker (Mr Nigel Evans)
Order. As we are approaching the festive season, I will play an early Father Christmas and set the time limit at 10 minutes.
National Health Service
Nigel Evans Excerpts(13 years ago)
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Rosie Cooper (West Lancashire) (Lab)
I congratulate my right hon. Friend the Member for Leigh (Andy Burnham) on his appointment as shadow Secretary of State for Health, a brief to which he brings valuable experience. We are going to need every bit of that experience, given what the current Secretary of State is doing to bring the NHS to its knees.
I strongly disagree with my colleague on the Health Committee, the hon. Member for Kingswood (Chris Skidmore). This is not their NHS. This is not your or my NHS. It belongs to the people, all of us. We all have an incredible stake in the NHS. The Secretary of State and the Government play with it, with their reputation and with patients’ needs at their peril. I believe your policy will fundamentally damage the NHS—
Mr Deputy Speaker (Mr Nigel Evans)
Order. May I remind the House not to use the word “you”? Members speak through the Chair and should use the third person, please.
Rosie Cooper
Forgive me. I have a great propensity to do that. I believe passionately in the NHS and I take this all very personally. I apologise.
The Government’s policy will fundamentally damage the health service in terms of both the quality of care available to patients and the founding principles of the NHS. The more we debate Government health policy, the less the Secretary of State seems to be listening, whether to Opposition Members, medical professionals, patients, patient groups or constituents.
I might go further and say that I now believe the Secretary of State occupies a parallel universe—a universe where everyone wholeheartedly supports his policy and believes him when he says that there is real-terms growth in NHS spending, a universe where waiting times are not increasing, people are not being refused treatments, bed-blocking is not happening because of pressure on the social care system, a universe where he never discussed the issue of re-banding of nurses with the Royal College of Nursing.
Unfortunately, while the Secretary of State, ably supported by the Prime Minister, is off in that parallel universe, which we shall call delusional, the rest of us are left facing the terrifying reality of what the Government’s policy means to our constituents and to the national health service. We must disregard the rhetoric and the myth-making of the Conservative party as it seeks to demonstrate that it has changed when it comes to the NHS. Sadly for the health service, the Conservatives have not changed at all.
I have spoken repeatedly about the Prime Minister’s clear promises to the British people—one was that there would be no more pointless top-down reorganisation. He even said:
“When your family relies on the NHS all the time—day after day, night after night—you know how precious it is”.
How quickly those words were forgotten. Michael Portillo comments on the BBC’s “This Week” spoke volumes. He could not have made it clearer that the Government meant to misrepresent their position and mislead their voters. He said:
“They did not believe they could win if they told you what they were going to do.”
My fear is that their broken promises are leading us headlong into a broken NHS.
There is much I could say about how disgracefully the Government started to change NHS structures without the consent of the people or the House. Because of those broken promises, a failure to secure a clear mandate for the reforms from the British public, and an abject failure to secure support from the clinicians and the medical profession, we are left in the present mess. I hear time and again that the doctors, the nurses and the professionals are all behind the Government. Where are they? They are shouting loud and clear, “We’re not with you.”
Rosie Cooper
I will not.
The point is that even if the Secretary of State was not aware of the re-banding, as he claims, that speaks volumes about how out of touch he is with the hard-working staff he is supposed to represent. Perhaps he would like to remove himself from his parallel universe—
Stephen Pound
It has been said—not by me, but by some—that the NHS has almost become the national religion. They say that as Christianity has faded, as it has in some places—not in my constituency, and certainly not in my home—the NHS has become more important. The NHS is the perfect example of what Galbraith called the “gift relationship”, when we look out for one another. We should not constantly look for the bottom line, but instead look to be our brothers’ keepers. That is the principle—
Mr Barron
On a point of order, Mr Deputy Speaker. As you know, I took part in this debate and I asked the Minister a question and requested him to answer it in his winding-up speech. Yet he will not even acknowledge that I spoke in the debate. Is there anything you can do, Mr Deputy Speaker, to help Back Benchers keep the Executive in check?
Mr Deputy Speaker (Mr Nigel Evans)
Absolutely nothing. I am sure, however, that the Minister will have heard the point.
Mr Burns
Did I hear the right hon. Gentleman’s point, Mr Deputy Speaker? I heard it about three times in Committee and I heard it on Report; I replied each time, as well as writing to the right hon. Gentleman. He does not like the answer, so there is no point in taking the intervention again.
As I was saying, in Yorkshire and the Humber the ambulance service gives PCTs—[Interruption.] I know I have already said it, but there was so much disruption and noise that Labour Members did not hear it. In Yorkshire and the Humber, the ambulance service gives PCTs a monthly list of their top 10 most frequent callers so that they can talk to them and help them in future, saving money and staff time that can be concentrated elsewhere.
Mr Burns
Just as Labour Members are wrong about NHS funding, they are also wrong about the Bill. [Interruption.] The Bill focuses on the most important thing for patients—the outcome of the treatment they need either to cure them or to stabilise their long-term conditions. Doctors, nurses and other health care professionals—[Interruption.]
Mr Deputy Speaker (Mr Nigel Evans)
Order. I am finding it difficult to hear the Minister. [Interruption.] Order. He has made it quite clear that he is not giving way.
Health and Social Care (Re-committed) Bill
Nigel Evans Excerpts(13 years, 1 month ago)
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Mr Deputy Speaker (Mr Nigel Evans)
Order. As Members will see, we have only a very short time before I put the Question, so could they please be very pithy and short in their contributions in order to get as many Members in as possible?
Dr Wollaston
I will not, because so many Members are waiting to speak.
There has been real scaremongering about, in particular, the difference between the duty to provide and the duty to secure provision, but I believe that the wording simply reflects the reality. The key issue is the line between the ability to step in if things go wrong, and the very real need for politicians to step back and let clinicians and patients take control.
I shall cut my speech short because I have been asked to be brief, but let me end by saying that, for three clear reasons, I would not be supporting the Bill if I thought that it would lead to the privatisation of the NHS. [Hon. Members: “Have you read it?”] I assure Members that I have read it in great detail.
Let me give those three clear reasons. First, clinicians will be in charge of commissioning. Secondly, the public will be able to see what clinicians are doing. Thirdly, neither clinicians nor the public will allow privatisation to happen. They do not want it to happen, and neither do Members of this House.
PCTs and foundation trusts did not meet in public, but they will do so in future, and it is the public and patients who will ensure that the NHS is safe in the hands of the Conservatives and the Liberal Democrats.
Nicky Morgan
In yesterday’s debate the right hon. Member for Holborn and St Pancras (Frank Dobson) said of the NHS that he believed that in most parts of the country and most of the time it does a good job for people, but I want to see it doing an excellent job for people in all parts of the country all the time, and that is what this Bill will achieve. Having served on the Bill Committee, it is a great sadness to me that that message, and the fact that patients will be at the heart of the NHS, has been lost in the months of scaremongering—a word used by the last speaker—and wrangling by those who have campaigned against it and have obscured all such messages. That has been totally unfair to the patients who rely on the NHS.
I briefly want to make two points. First, Members who served on the Committee will know of my passion for getting the right treatment for mental health patients, and at a meeting of the all-party group on mental health yesterday the Bill was described by GPs as a great opportunity: an opportunity for the integration of primary and secondary care—something they have not had before, and that will now be achieved.
Secondly, as my hon. Friend the Member for Totnes (Dr Wollaston) said, the Bill puts clinicians at the heart of commissioning. When the Bill was recommitted, my researcher said to me, “This Bill is a gift that keeps on giving.” Now it is time for this present to be handed over to the other place, but it needs to reach the statute book and we need to implement it on the ground. I have heard nothing from the Opposition in the past eight months to convince me that this Bill should not receive its Third Reading and get on to the statute book, and I urge all hon. Members to support it.
Mr Deputy Speaker (Mr Nigel Evans)
I am grateful for that short speech. I ask for another short speech from Kevin Barron.
Health and Social Care (Re-committed) Bill
Nigel Evans Excerpts(13 years, 1 month ago)
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Rosie Cooper
The Minister keeps saying no, but the reality is that, as I told the Secretary of State, you may very well be fooling yourselves, but you are not fooling the public, and the Bill was wrong. That was followed by a pause, and when you admitted that you had got various bits of it wrong, you then said—
Mr Deputy Speaker (Mr Nigel Evans)
Order. The hon. Lady must desist from using the word “you”, as it refers to the Chair.
Rosie Cooper
I apologise, Mr Deputy Speaker. Each time I said “you”, I meant the Secretary of State.
The Secretary of State simply threw the Bill at the British public after the Prime Minister had promised that this would not happen. I have been very clear in the speeches I have made so far on the Bill that the only people the Secretary of State is fooling are those in the Tory party. He has made changes to the Bill, but we are now beginning the great mix-up and going back to exactly where we were.
The hon. Member for Boston and Skegness (Mark Simmonds) said that Labour did not want progress and good value, and that the coalition programme was all about ensuring that the NHS survived and getting a good return for the taxpayer. Let me tell him that I am absolutely passionate about the NHS. I expect value for money, cutting-edge treatment, efficiency and the best possible care for everyone in this country. The lives of every taxpayer and every family depend on the care they get from the NHS. Second rate will not do for me at all.
However, I do not believe that throwing a grenade into the NHS systems will achieve that. Even breaking big promises will not achieve that, because that will break the trust. I suggest to the Conservative party that the Great British public gave tentative support during the general election and will now withdraw that support rapidly as the Bill progresses. The Conservatives expect the public to believe that the party that promised no top-down reorganisation and then broke that promise can be trusted when it says that there will be no privatisation of the NHS, yet evidence comes to light via freedom of information requests that that is not the case.
What are patients out there actually experiencing? Again, Conservative Members can fool themselves. When they went to accident and emergency units they saw that the four-hour waiting time was being exceeded, so they abolished it. It is already taking longer to treat fewer people, which does not strike me as particularly efficient or good value for money. It took 13 years of a Labour Government to rebuild the NHS after what the previous Conservative Government did to it. Labour reduced waiting lists from two years to 18 weeks. It has taken the coalition Government less than a year to wreck it all again. Broken promises are leading us to an NHS that is broken again.
Let us look at what is currently happening in the NHS. There are two different processes at work: financial efficiency gains and structural reform. The idea was to ask the system to make efficiency gains of 4% each year for four years. On top of that there is the reorganisation, which a Conservative Member has likened to tossing a grenade into the system. We have had muddle, pause, fog and are now effectively back to where we were some time ago.
The reforms do not address the financial challenges, especially the Nicholson challenge. This is costly—making people redundant, throwing organisations into disarray and telling people, “You don’t have a future, you might have a future,” “Let’s have a cluster, let’s not have a cluster,” “Where are you going to work?”, “It’s all going to disappear by 2013,” “There are no PCTs—well, they’re there really, but clusters will do the work,” “No, we don’t have strategic health authorities—well, okay, we’ll keep four of them.” The Marx brothers would be proud of the stops, turns, U-turns, pauses and muddle that there have been. But the bottom line is that the great British public have to watch those antics and are worried about their health service.
Rosie Cooper
How much? I will give way if the Minister tells me exactly how much it is all going to cost. I shall happily sit down; there you go. [Interruption.]
Mr Deputy Speaker (Mr Nigel Evans)
Order. This is not a conversation but a debate. I do not think that the Minister indicated that he wished to intervene.
Rosie Cooper
Thank you, Mr Deputy Speaker. You will forgive me; my lip reading was obviously slightly wrong. He looked as if he was trying to tell me something, and I hoped that it might be the answer.
In all such situations I always say, “Follow the money.” What is actually going to happen? If this is costing a lot of money—there is a lot of muddle—it has to be really clear that the driver of the reforms cannot be, as the Secretary of State has previously said, the idea that the NHS is unaffordable; we seem to be able to afford a lot of other things. If the reason is not financial efficiency, it has to be purely ideological.
I understand that 85% of respondents to the NHS Confederation survey were very clear: the hardest job that they could have is to deliver both NHS changes and savings simultaneously. That makes it harder for them to deliver objectives for improving efficiency and quality—but that is what I am told that Government Members are all about; the Bill is supposed to improve efficiency and quality.
Who is going to deliver the health care? The Royal College of Nursing suggests that 27,000 front-line jobs, equivalent to nine Alder Hey children’s hospitals, will disappear. I asked the NHS Confederation whether we would see hospital closures, and it is clear that we will; we are seeing that in various reports. The Bill is three times longer than the Act that created the NHS, and it leaves more questions than answers. I say to the Government that if they believe that the great British public will be fooled by any of this, they are sadly wrong.
I do not normally make personal statements about anybody, but Roy Lilley, a former NHS professional, writes a blog in which he refers to the Secretary of State as “LaLa”; I am sure the Secretary of State has seen it. I have been hearing “La la” all afternoon. This is just nonsense. Just because the Secretary of State or the Tory party says that the world is square, that does not mean that it is. They are insulting the public if they think that they will go along with them.
Monitor makes decisions about the future sustainability of individual services and the patterns of local health services under the failure regime. It is unclear how those decisions would be made, and how and to whom Monitor is accountable. Technically it is an independent body and it should be responsible to Parliament and the Secretary of State, but perhaps the Secretary of State will clarify that.
As the economic regulator, Monitor is given a whole series of powers that ultimately focus on enforcing competition in the NHS. There are still fundamental gaps in how that organisation will be held to account. There is a lack of clarity about how health services can engage with and influence the work of Monitor. Having been chair of a foundation trust hospital, albeit only for a month—because I stood for Parliament and had to resign—I can say that Monitor was a law unto itself. And before the Health Committee, Monitor likened the NHS to utility companies, which does not give me any confidence whatever.
I want to talk about Monitor not consulting commissioners on changes to enhance tariff. Private providers can apply to Monitor for an enhanced tariff to preserve the services that they, as private businesses, are providing to the NHS.
Congenital Cardiac Services for Children
Nigel Evans Excerpts(13 years, 4 months ago)
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Mr Deputy Speaker (Mr Nigel Evans)
Order. As hon. Members can see, this is a popular debate. There is, therefore, a six-minute limit on contributions.
Mr Deputy Speaker (Mr Nigel Evans)
Order. To accommodate more Members, I am reducing the time limit to five minutes. I hope that both Front Benchers will take into account the popularity of the debate and the need to get Back Benchers in when they make their contributions.
Mr Andrew Turner (Isle of Wight) (Con)
I shall confine my speech to issues that uniquely affect my constituents. The Safe and Sustainable consultation is fundamentally flawed. Three of the four options envisage the closure of the Southampton centre. Those options are based on wrong assumptions and inaccurate data. Let me set out the background. The consultation document states:
“All options must be able to meet the minimum requirement to collect a child by ambulance…within three hours of being contacted by the referring unit”.
It then examined “detailed access mapping” using train and road journeys—that is important—and considered how existing networks were affected. More options that did not meet the “three hours” criteria were ruled out. Bristol is included in “all viable options” because south-west Cornwall and south Wales are more than three hours away from either Southampton or Birmingham.
Unfortunately, nobody in that expert team seems to have noticed that people cannot travel by train or road from the Isle of Wight. There is a clue in the name: it is an island, separated from the mainland by the Solent. I have said before that the ferries provide lifeline services for my constituents, but in this case that is literal. The error in the data was that because we must cross the Solent by ferry, the island is more than three hours away from either Bristol or London.
In May, that was pointed out to Mr Jeremy Glyde, the programme director of the Safe and Sustainable review. A statement issued on 3 June said that the team
“based retrieval times between the island and the mainland on travel by air. This was an oversight”
because the policy is
“to retrieve children from the Isle of Wight by road and ferry”.
That is very odd, because the consultation document explicitly states:
“Air travel has not been considered because it cannot always be relied upon”.
The statement goes on to say that
“an ambulance must reach the referring hospital within 3 hours, or within 4 hours in ‘remote areas’”.
The conclusion was that
“it is sensible to measure retrieval times to the Isle of Wight against the threshold for ‘remote areas’.”
On remote areas, the consultation document states:
“Removing surgery from some centres could have a disproportionate impact on children in some remote areas because ambulances would not be able to reach the child in three hours or less”—
meaning three hours or less from Southampton in my case.
On 3 June, Mr Glyde did not say why the Isle of Wight suddenly became a “remote area” when previously it was not. I am sure it did not move without me or any of the other 130,000 residents noticing. I asked Mr Glyde to point me to the guidelines that determine when an area is designated as “remote”. He told me that it was a “subjective interpretation” and that the review board recognised that the island,
“by its very nature, is remote from the mainland”.
Of course, that is accurate, but the board should have noticed earlier. After starting the consultation and working on it for years, it suddenly struck the board that there are
“unique factors around retrieval times by ferry”.
My Glyde was very helpful. He explained:
“We have been able to generate potential scenarios that could enable the ambulance to meet the standards”.
They did so not by using the “three hours” standard set out in the consultation, but by deciding that the “four hours” will apply to the newly remote Isle of Wight. It may be possible to generate scenarios in which an ambulance from Bristol or London can get to the island in four hours. I can generate some scenarios in which I become Prime Minister. Neither possibility can be entirely ruled out, but they do not reflect what is likely to happen in real life—[Hon. Members: “No!”]
Putting aside my political future, let us examine some realities. The AA route planner shows that it takes two hours to get to the other side of the Isle of Wight, and an hour at least—
Mr Deputy Speaker (Mr Nigel Evans)
Order. Just to inform the House of the procedure, I will now call the Minister. The recommendation from the Backbench Business Committee is that he speaks for about 15 minutes. However, I should remind the House that if he takes persistent interventions, that will extend the time that he spends on his feet, which will deny other Back Benchers the opportunity of speaking. The shadow Minister will be speaking towards the end of the debate.
Mr Deputy Speaker (Mr Nigel Evans)
Order. I am sure that hon. Members will show time discipline, so that we can get as many of them in as we possibly can.
Mr Deputy Speaker (Mr Nigel Evans)
Order. If hon. Members speak for just under four minutes, everyone will get in.
Damian Hinds (East Hampshire) (Con)
The review document is called “Safe and Sustainable”, and that is absolutely the right title for it. It is worth repeating what has been said by every speaker today, and by the clinical leadership of the review: this is about saving lives, not about saving money. We must bear in mind the link between scale and quality and between quality and safety. The “scale” factor applies to the number of procedures per surgeon per year and to the number of surgeons per unit. The challenge was summed up best by the statement from the Royal College of Surgeons, to which the right hon. Member for Oxford East (Mr Smith) referred, that although the country has the right number of surgeons carrying out these complex operations, they are too thinly spread. Change is clearly needed.
Coincidentally, in the last three weeks my family has had occasion to rely on the paediatric intensive care units and surgery at Southampton General hospital, in the constituency of the hon. Member for Southampton, Test (Dr Whitehead), where we benefited from outstanding care. This was not heart surgery, but the experience gave me plenty of cause to reflect on the value of not just convenience and location but, above all, quality of care. In such circumstances, families will do what they have to do, although it may be very difficult, and they will find a way of securing care of the highest quality. The experience also taught me something about the interconnection between services.
All the criteria set out in the review document have a role to play, but in my view the most important criterion of all must be quality, and I do not think that that comes across as much as it should in the review. How can it, given that the centre that is ranked second out of the 11 in the country for quality appears in only one of the four options? The question also arises, in the context of Southampton General hospital, of whether—given the role of scale and quality—sufficient consideration has been given to the most recent trends since the suspension of paediatric cardiac surgery at the John Radcliffe hospital.
Other factors have also not been given sufficient weight. First, there is the requirement for co-location of paediatric surgery with other essential services for children. Secondly, there is the impact on paediatric intensive care units, paediatric intensive care retrieval, and the other networks mentioned by the right hon. Member for Oxford East. Thirdly, there are the implications for services that provide longer-lasting care for people with cardiac conditions from birth to adulthood.
Our objective must not be to stall or jam the process, because there is a need to reduce the number of centres. We must avoid the politician’s tendency to say that of course we agree with the general principles of the review, except in the particular circumstances that apply to our own constituency. I hope I have not done that, but I do think that Southampton has a particularly strong case based on the excellence of its clinical record. I strongly support the drive for us not to be restricted only to the four options in the review, considering the additional evidence that has come to light during its course.
Andrew Percy (Brigg and Goole) (Con)
Outrageous, Mr Deputy Speaker! But obviously accepted.
I associate myself with many of the comments of my fellow Yorkshire and the Humber MPs, particularly my near neighbour the hon. Member for Scunthorpe (Nic Dakin). I want to mention a couple of issues raised by our local health trust, which is opposing anything other than option D very strongly. Indeed, North Lincolnshire council’s scrutiny committee met to discuss the matter on Tuesday and similarly supports that option, which would help to maintain the Leeds unit. That is not simply because it is our local centre. My constituents have to travel a considerable distance to get to Leeds, as it is not exactly next door. It is okay for some of us, but it is quite some distance for my constituents over in Brigg, in particular.
My constituents accept the regionalisation of health services when it is of proven benefit. That is so in the case of adult cardiac services, which are currently provided in Hull, and the same applies to children’s cardiac services. However, if we are to go down the route of regionalisation and big centres, it seems sensible to put services where the population is rather than try to move the population to where the clinicians are.
I wish to quote a couple of points that my local health trust has made. It has stated:
“Leeds has the largest population centre and therefore it is most sensible to ask fewer patients to travel the least distance”.
As I said earlier, the conclusion of the North Lincolnshire and Goole Hospitals NHS Foundation Trust was that it believed babies, children and families in North Lincolnshire would largely be disadvantaged in their access by the proposed changes.
I am aware of the very short time available, so I cannot say most of what I would have liked to say, but my final point is that under the proposals we could end up in the rather odd situation that some of my constituents could be served by one centre and others by another. Given that they are all in the same health trust area, that could mean different services being provided to different constituents.
Mr Deputy Speaker (Mr Nigel Evans)
To speak for 10 minutes, I call the shadow Minister, Liz Kendall.
Health and Social Care Bill (Programme) (No. 2)
Nigel Evans Excerpts(13 years, 4 months ago)
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David Wright (Telford) (Lab)
On a point of order, Mr Deputy Speaker. Will you find out from the parliamentary authorities whether the monitors are working throughout the parliamentary estate? Only one Liberal Democrat Back Bencher is present, and, given that the Liberal Democrats have laid claim to significant alterations to the Bill, it is very important that they are in the Chamber.
Mr Burns
I beg to move,
That the following provisions shall apply to the Health and Social Care Bill for the purpose of supplementing the Order of 31 January 2011 (Health and Social Care Bill (Programme)):
Re-committal
1. The Bill shall be re-committed to the Public Bill Committee to which it previously stood committed in respect of the following Clauses and Schedules—
(a) in Part 1, Clauses 1 to 6, 9 to 11, 19 to 24, 28 and 29 and Schedules 1 to 3;
(b) in Part 3, Clauses 55, 56, 58, 59, 63 to 75, 100, 101, 112 to 117 and 147 and Schedules 8 and 9;
(c) in Part 4, Clauses 149, 156, 165, 166 and 176;
(d) in Part 5, Clauses 178 to 180 and 189 to 193 and Schedule 15;
(e) in Part 8, Clause 242;
(f) in Part 9, Clause 265;
(g) in Part 11, Clauses 285 and 286;
(h) in Part 12, Clauses 295, 297 and 298.
2. Proceedings in the Public Bill Committee on re-committal shall (so far as not previously concluded) be brought to a conclusion on Thursday 14 July 2011.
3. The Public Bill Committee shall have leave to sit twice on the first day it meets.
Let me say at the outset that, because of the number of Members who wish to speak in the debate, I will take only a small number of interventions and will respond to them briefly.
The vital importance of our national health service cannot be overstated, nor can the Government’s determination to do all in our power to make it as good as it can be for the patients who depend on it by putting patients at the centre of care and putting outcomes first—outcomes such as survival rates, speed of recovery, and the ability to lead a full and independent life. The Health and Social Care Bill represents a bold evolutionary programme of essential modernisation: a programme—[Interruption.]
Mr Deputy Speaker
Order. I know that passions are running high, but it is important that we hear the Minister.
Mr Deputy Speaker
Hold on. Keep calm. I am absolutely certain that the Minister is about to move on to the programme motion.
Mr Burns
If Opposition Members were more interested in listening than in trying to be disruptive, they would discover that after setting the scene I will deal precisely with the recommittal and our reasons for proposing it.
We will replace that culture with a bottom-up culture of clinical leadership and patient choice and an unfaltering focus on improving health outcomes.
While there has always been widespread agreement on the principles of modernisation—a fact that even the shadow Secretary of State now accepts—there have been concerns in some quarters that the Bill could support those principles better.
Kevin Brennan (Cardiff West) (Lab)
On a point of order, Mr Deputy Speaker. Some of us wish to talk about the programme motion that we are supposed to be debating, and indeed to intervene on the Minister if he will give way, as he said that he would at the outset. Can the Minister be persuaded to discuss the motion that is before the House?
Mr Deputy Speaker
Several Members wish to participate in this very short debate. It will last for only an hour, and we are already well into that hour. Will the Minister now refer directly to the programme motion?
Mr Burns
Absolutely, Mr Deputy Speaker.
Given our commitment to, and the paramount importance of, the NHS, we decided to take the unprecedented step of pausing at an appropriate point in the legislative process. The independent Future Forum produced its report. We shall be able to make some changes to our plans that will not require legislation, but a number of changes will need to be scrutinised again by a Committee. All our proposed changes will be subject to further detailed parliamentary scrutiny through a further Committee stage and on Report. We propose—
Mr Deputy Speaker (Mr Nigel Evans)
That is just an extension of the debate. I reiterate that we have only one hour to debate this programme motion, so may we make progress? May I also ask Members to calm down, because I am finding it difficult to listen to the Minister?
Mr Burns
Thank you, Mr Deputy Speaker, and you can rest assured that I am doing my bit. If only Opposition Members would listen, they would get the plot.
As the changes we are making are substantial and significant, we have decided to recommit relevant parts of the Bill to Committee. I can tell the House that we expect to make around 160 amendments to the Bill, which we will table in good time. We will also go further and publish briefing notes to help explain the amendments to parliamentarians and those who follow our proceedings outside.
Ian Lucas (Wrexham) (Lab)
On a point of order, Mr Deputy Speaker. I tabled a named day question to the Minister, of which he is aware, in which he made it very clear that the changes to the Bill that he says relate to the recommendations of the Future Forum were in fact—
Mr Deputy Speaker (Mr Nigel Evans)
Order. Please resume your seat. That is not a matter for the Chair; it is an extension of the debate. Yet again I reiterate that we are now 13 minutes into a one-hour debate and we have yet to hear from the shadow Minister and a number of Back Benchers who wish to participate, so, please, could we restrain bogus points of order—that is No. 1 —and could we also have more quiet?
Mr Burns
As I was saying, although the pause may have ended, we will never stop listening. [Laughter.] That is why a team of top health experts will continue to provide independent advice to the Government. [Interruption.] It is extraordinary, Mr Deputy Speaker, that hon. Members giggle and scream hysterically when they do not like what they hear. What they will not accept is that we did listen through the independent forum—we listened, we strengthened the Bill and they do not like it that more people and more organisations outside the House now believe that the plans that my right hon. Friend the Secretary of State introduced have been strengthened and will meet the needs of a modernised health service. That is the problem. That is why they are behaving in that way.
Of course, we need to give right hon. and hon. Members ample opportunity to examine the amendments in detail, but unnecessary delays will only cause harm for patients and add to the pressure on hospitals and commissioners as they make their modernisation plans. They will prevent clinicians on the ground from making the changes they believe will help to improve and save people’s lives. That is why we can have proper scrutiny through the recommittal of the parts of the Bill we are changing, as outlined in the motion, and I urge my hon. Friends and the House to accept it.
Mr Deputy Speaker (Mr Nigel Evans)
Order. Many Members wish to participate and there is only half an hour left, so long speeches would not be appropriate, to be fair to Back Benchers.
NHS Reorganisation
Nigel Evans Excerpts(13 years, 7 months ago)
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Owen Smith (Pontypridd) (Lab)
On a point of order, Mr Deputy Speaker. You were not in the Chair at the conclusion of the Opposition day debate, but the Minister of State, the hon. Member for Sutton and Cheam (Paul Burstow), used barely half his allotted time in winding up, as he was clearly short of arguments to defend his position on the important subject under discussion. That left many of us who have plenty to say on the subject short of time to speak. Will you work through the usual channels, Mr Deputy Speaker, to make sure that in future either Ministers use all their time or Back Benchers are given more time to speak?
Mr Deputy Speaker (Mr Nigel Evans)
How long the Minister wishes to speak for is not a matter for the Chair. The Minister spoke, the debate came to an end, and a vote was taken.
Children's Heart Surgery (Leeds)
Nigel Evans Excerpts(13 years, 8 months ago)
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Mr Burns
The hon. Gentleman is a very experienced parliamentarian, and I do not say this in any rude way, but he was not present when his right hon. Friend the Member for Leeds Central spoke. That is not a criticism, but I shall make to the hon. Gentleman the same point that I made to his right hon. Friend: the consultation process and review is being carried out not by Ministers and politicians, but by the JCPCT. As we are engaged in the consultation process, it would be inappropriate and wrong of me to pontificate from this Dispatch Box on the merits or demerits of one case or another. I hope that the hon. Gentleman will accept that that is meant to be a helpful reply, even if it is not the answer that he was seeking. [Interruption.] Fair enough. I am not criticising; I just want him to understand the position that I am in, because I do not want—[Interruption.]
Mr Deputy Speaker (Mr Nigel Evans)
Order. We cannot have chit-chat across the Chamber in this way.
Mr Burns
Thank you, Mr Deputy Speaker. [Interruption.] The hon. Gentleman is indeed being nice to me, and I appreciate it.
As I was saying, smaller surgical units often struggle to recruit and retain new surgeons. They also find it difficult to provide a safe service around the clock.
Under the auspices of the review, an expert group has developed a comprehensive set of service standards, taking into account the contributions of parents and professionals. The standards cover the whole of children’s heart services. They also reference other relevant professional standards and guidance, including the co-location of other clinical services that are interdependent with children's heart surgical services, the need for larger surgical teams to be able to provide a 24/7 emergency service, and the development of clinical networks of providers to ensure a coherent service for children and their families. I think that in some ways that picks up on the point made by my hon. Friend the Member for Pudsey. The current centres have been visited and assessed against these standards by an independent expert panel.
I would like to go into a little more detail on a few of these standards to clarify areas which cause particular concern. On the standard on the number of procedures and surgeons, I can assure my hon. Friends and Opposition Members that there is convincing evidence from this country and overseas that larger centres, seeing more cases, are better able to consolidate their expertise and deliver better clinical outcomes. The recommendation on the number of procedures—between 400 and 500 a year—is based on the level of activity needed to provide good-quality care around the clock while enabling ongoing training and mentoring of new surgeons. This recommendation is based on the outcome of international research on minimum numbers of procedures in surgical centres. It has strong professional support in this country, including from the steering group of professional experts that was convened under the auspices of this review. In addition, there is a consensus among professional associations on minimum staffing levels that four surgeons in each centre should avoid the risk of surgeons not being able to maintain and develop their skills.
At this point, I would like to pay tribute to the commitment and dedication by talented NHS staff delivering congenital cardiac services. We have a responsibility to ensure they are supported as well as possible, and that includes ensuring that they do not risk burn-out if left to practise alone. Transforming a service from one that is “adequate” to one that is “optimal” requires sufficient volume, expertise and experience to develop what Sir Bruce Keogh calls “accomplished teams”.
Co-location, which I mentioned earlier, refers to the proximity of other critical services to the children’s heart surgery service. In this context, these services include specialised paediatric surgery; paediatric critical care; paediatric ear, nose and throat; and paediatric anaesthesia. The accepted definition of “co-location”—services either on the same hospital site or on a neighbouring hospital site—and which services should be co-located was set out in the 2008 publication, “Commissioning safe and sustainable specialised paediatric services: a framework of critical inter-dependencies”. This guidance is endorsed by the relevant professional associations, including the Royal College of Paediatrics and Child Health, the Royal College of Surgeons and the Royal College of Physicians. I can assure hon. Members that the safe and sustainable review has correctly applied the accepted definition of “co-location”, as set out in the guidance, as meaning either on the same hospital site or on a neighbouring hospital site.