Health

Norman Lamb Excerpts

Monday 9th June 2014 Commons Chamber

[Gordon Birtwistle]

I am delighted to hear that, and I would like Wiltshire to become a standard that everyone else copies. I would hope that my constituency and the rest of Lancashire copies that. There are great companies—I know a few good companies that really care about the customer. These elderly people are customers: if Tesco treated people like some of those carers, they would shop somewhere else. Unfortunately, elderly people cannot go anywhere else, because a contract has been organised, and they have to use it. I urge the Minister to consider those suggestions and look at ways of improving the service that we deliver to our old people. I would be very happy if he did so, and I am sure that he would be too.

[The Minister of State, Department of Health (Norman Lamb)]

I completely agree with what my hon. Friend is trying to achieve. I hope that he is reassured that the Government have effectively introduced compulsory minimum training for all care assistants for the first time. I think he will welcome that.

[Gordon Birtwistle]

I do welcome it, and I am delighted to have heard that. I just hope that we make it a major condition of all Government and local authority contracts that all companies deliver that service to our elderly people. We will all become elderly—I am catching up very quickly—so who knows how soon it will be before someone comes to my house to say, “Gordon, it’s bedtime. It’s 8 o’clock—it’s toilet time.” That’s the worst thing I think I have ever heard—someone coming in and saying that it is toilet time. An old man said to me: “I do not want to go to the toilet, but I am told that it is time to go to the toilet.” It is just not acceptable to do that to an elderly man. I am delighted to hear what the Minister said, and I hope that we ensure that it continues in future so that we really respect and care for the people who have put us where we are today.

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[Dr Sarah Wollaston (Totnes) (Con)]

May I start by paying tribute to my predecessor, Anthony Steen, for his tireless work in bringing in a modern slavery Bill?

Today, however, is for talking about health, which is a great passion for me in this place and outside it. The NHS touches people’s lives 1 million times every 36 hours, which is a staggering figure. I believe that the NHS is worth every penny of the nearly £110 billion that we spent on it in the last financial year. I am very proud that this Government have protected the health budget, but that does not of course mean that there are not enormous financial pressures. We are now in the fifth year of effectively near-flat funding, and the issues set out by the hon. Member for Ilford South (Mike Gapes) are part of those pressures. We know that whichever Government were in power, there would have been serious challenges.

If the NHS is to be sustainable, we need to listen to the new chief executive of NHS England, Simon Stevens, who has called on all staff members to think like a patient and act like a taxpayer—we must do that to get every ounce of value out of our NHS—and to address issues of patient safety and of how we keep people out of hospital in the first place and get on with implementing the measures. The nature of the challenge has been set out in exhaustive detail; now we need to get on with the measures that have been put in place to help to prevent hospital admissions, to treat people at the right time in the right place, and to integrate health and social care. I want us to look carefully at the better care fund and the plans for getting best value out of it, and at the issues of patient safety that were mentioned earlier.

Given the absence of much legislation in the Gracious Speech, there is one regret that I want to point out: the absence of the Law Commission’s draft Bill on the regulation of health and social care. I hope that in summing up this debate, the Minister will give some reassurance that he can use secondary legislation to bring forward at least some of the measures in that draft Bill. It covers issues that touch 1 million people across 32 professions that are covered by nine regulatory bodies. Unless we clarify the language so that there is a common language in respect of patient safety across all those regulators, it will be difficult to implement some of the core messages from Francis and to act quickly in response to emerging threats to protect the public.

Every year for three years, the Health Committee has called on the Government to allow the General Medical Council to appeal panel decisions that clearly have not protected the public. Likewise, the Nursing and Midwifery Council would like powers to reopen cases in which it has been judged there is “no case to answer” if serious new evidence emerges. Alongside that, the General Pharmaceutical Council would like to implement transparency and to be able to take enforcement action. Those are all simple measures that I hope the Minister will mention in summing up. I also want the unacceptable level of delays to be addressed.

[Norman Lamb]

I want to give a quick confirmation that we will do what we can through secondary legislation to do what the hon. Lady requests.

[Dr Wollaston]

I am very pleased to hear that.

There will not be an absence of debates on health in this place. Two Bills will probably come here from the Lords in this Session: the Medical Innovation Bill and the Assisted Dying Bill. I will briefly put some of my concerns about the Medical Innovation Bill on the record while there is time for it to be amended. I have no doubt that it was introduced with the best of intentions to bring forward innovative treatments. However, I fear that it will have the reverse effect: it could undermine research and open the door to the exploitation of people when they are at their most vulnerable.

Currently, clinical negligence law provides redress for patients who have been harmed as a result of treatments that would not be supported by anybody of medical opinion. There is insufficient evidence that doctors are not introducing new treatments or are put off from doing so because of the fear of litigation. The NHS Litigation Authority has made it clear that doctors are protected from medical litigation in that respect. However, the briefing note for the Saatchi Bill talks about a doctor being able to use a novel treatment if he is “instinctively impressed” by it. In other words, doctors will be able to use an anecdotal base for treatments, rather than a clear evidence base. There are dangers in going down that route.

There have been some amendments to the Bill. Lord Saatchi has accepted that a doctor should have to consult colleagues and their medical team, but not that they should consider a body of opinion or consult ethics committees. I fear that we could be turning the clock back. We should rightly be proud of the advances that we are making in the field of medical research. We should rightly be proud of the push towards greater transparency, particularly in respect of open data and drug trials. However, I fear that if we allow people to access innovative treatments that have no evidence base, we will open the door to the purveyors of snake oil, rather than those who want to allow patients to enter controlled trials to establish a clear medical evidence base.

We should not underestimate the extent to which the purveyors of snake oil are out there. I put on the record my congratulations to Westminster city council and its trading standards department on fighting two successful prosecutions under the Cancer Act 1939 against two individuals, Errol Denton and Stephen Ferguson, for peddling so-called nutritional microscopy to people who were at their most vulnerable—cancer patients and patients with HIV—and telling them that it was an alternative to evidence-based treatments.

We must therefore be careful in how we move forward with such legislation. We should take more notice of the concerns of the Medical Research Council, the Wellcome Trust and the Academy of Medical Royal Colleges, who feel not only that the Bill is unnecessary, but that it could turn the clock back on evidence-based medicine. I hope that the Government will look at the concerns that have been expressed about the Bill in its current form.

Finally, Lord Falconer’s Assisted Dying Bill would enable competent adults who were terminally ill to have assistance to end their lives, but it would require the involvement of a medical practitioner. Although the Bill comes under the responsibility of the Ministry of Justice, it would have profound implications for end-of-life care and medical practice. It would fundamentally change the relationship between doctors and patients. There is a risk that the right to die would slide into a duty to die. I have seen how often patients who are towards the end of their lives fear being a burden on their families, and they often go through periods of profound depression. I do not feel that this Bill is the way forward.

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[The Minister of State, Department of Health (Norman Lamb)]

I thank all right hon. and hon. Members who have contributed to today’s debate. It has been a wide-ranging debate stretching well beyond the NHS, as the shadow Minister said. I think that we all enjoyed the alternative Queen’s Speech from the hon. Member for Blyth Valley (Mr Campbell). His Front-Bench colleagues looked horrified, but it was the authentic voice of Labour.

[Mr Ronnie Campbell]

There were some good policies in there.

[Norman Lamb]

Well, let us just make sure that Opposition Front Benchers listen to the hon. Gentleman.

We can be justifiably proud, it seems to me, of the action we have taken in health and care over the course of this Parliament. The hon. Member for Scunthorpe (Nic Dakin) made a speech that faded away from agreement, but at the very start he made the point that we should all pay tribute to a really remarkable work force in the NHS—1.3 million people doing incredible work. We want to free those people up as much as possible to do the very best they can.

[Andy Burnham]

Would not the best way to pay tribute to those thousands of staff in the NHS be to honour the 1% pay increase that the Chancellor promised them?

[Norman Lamb]

That is equivalent to about 6,000 nurses a year. The right hon. Gentleman has to demonstrate how that would be paid for. The fact is that there is an average wage increase of 3% as a result of annual pay increments under Agenda for Change. We have ensured that at least everyone will get a 1% increase. If he is arguing for something different, he has to say where the money would come from to pay for it and how he would cope with 6,000 fewer nurses, which would be the result of his action.

For the first time, it is this Government who have made decisive moves to join up the care and health system and focus more on preventing ill health. Contrary to the shadow Secretary of State’s claims, the better care fund has been widely welcomed, and it has initiated action across the country to join up a very fragmented system. We have sent out the signal that we encourage innovation and change, driven by clinicians from the bottom up, not from the top down. Brilliant pioneers across the country are ending this fragmented system that has interrupted patient care for so long and failed patients. Those pioneers are combating loneliness, which my hon. Friend the Member for Burnley (Gordon Birtwistle) spoke passionately about. It is so far removed from the caricature offered by the shadow Secretary of State and the tired old refrain about privatisation. It was, after all, a Labour Government who mortgaged the future of the NHS to the tune of billions of pounds with their private finance initiative programme, giving massive windfall profits to private consortiums—a scandal of historic proportions. Yet Labour Members continue to argue that the Government are privatising—an argument that is based on thin air, not substance.

[Tom Blenkinsop]

Will the Minister tell the House at what point the provisions of the Competition Act 1998 were introduced into the Bill that became the Health and Social Care Act 2012? I think it was this Government who did that. In the Public Bill Committee, I commented on the fact that they were exposing the NHS and undermining the category B status of the European competition regulations by putting the Competition Act at the very heart of the Bill.

[Norman Lamb]

I am sorry to disappoint the hon. Gentleman, but it was under the Labour Government that it was made clear that competition law applied to the health care system. Indeed, the Labour Government’s guidelines on the NHS replicated exactly the regulations under section 75 of the Competition Act that this Government have introduced. Time and again, we hear false claims by Labour Members.

This Government have developed a new health and care system that is totally patient-centred, led by health professionals, and focused on delivering world-class health outcomes. The difficult decisions that we have made on public finances have meant that we have been able to protect the NHS budget. The shadow Minister spoke as though the Government have had to face no financial challenge at all. She knows that across Europe, Governments have slashed pay for health workers and introduced co-payments. We have done none of that. We have protected the budget for the NHS, and we are proud of doing so; Labour did not commit to that in its manifesto at the last election. The truth is that the NHS is doing extremely well under a great deal of pressure.

This Government have laid solid foundations to transform our NHS to help it to meet the challenges of an ageing population, drive up standards, and focus absolutely on compassionate care. My hon. Friend the Member for Mid Worcestershire (Sir Peter Luff) spoke movingly about his experience of the importance of compassionate care. We have introduced tough, robust inspections overseen by new chief inspectors of hospitals, of social care, and of general practice. We have introduced ratings of hospitals, care homes and GP practices so that people know how good their local services are. We have introduced, for the first time, fundamental standards and the ability to prosecute—to hold to account organisations and directors who seriously fail patients. We have introduced a fit and proper person test for directors; for the first time, compulsory training for health and care assistants; and—I am particularly proud of this—a statutory duty of candour to ensure that there is openness when things go wrong in the NHS or the care system.

[Geraint Davies]

Given the Minister’s focus on accountability and transparency, why will he not support the regulation of psychotherapists and counsellors? My private Member’s Bill would have protected 1 million people. He or I could set up shop as psychotherapists tomorrow and see these vulnerable people who are currently at risk. Why will he not protect them?

[Norman Lamb]

The Government are not convinced by the argument for statutory regulation. The hon. Gentleman and I have had this debate many times, and I am happy to continue to discuss the matter with him.

In the wake of Francis, the Government are clear that poor or unsafe care will not be tolerated. There will be consequences for those who fail patients.

Opposition Members have criticised the lack of health legislation in the Gracious Speech, yet, as several of my hon. Friends, including the Members for Witham (Priti Patel) and for Rochford and Southend East (James Duddridge), have noted, people are not out there on the streets demanding a new NHS Act of Parliament; they want safe, good, compassionate care.

The Government remain committed to legislating on professional regulation when parliamentary time allows.

[Mr Jamie Reed (Copeland) (Lab)]

Will the Minister give way?

[Norman Lamb]

Let me complete this point.

This is a complex area and we should not rush to legislate. We will keep making progress to respond to the scandal of Mid Staffordshire for the remainder of this Parliament. We are working closely with the regulators to ensure that key provisions, such as a faster fitness to practise test for nurses and midwives and English-language checks for all health care professionals, are in place during this Parliament.

The shadow Secretary of State quoted selected statistics on access to a GP, yet 86% of patients are satisfied with their GP practice. The Government have introduced a £50 million challenge fund, which will support more than 1,000 practices to develop innovative and flexible services. That will include Skype and e-mail consultations, as well as extended hours, and will benefit more than 7 million people.

The right hon. Member for Cynon Valley (Ann Clwyd) again spoke extraordinarily passionately, giving a voice to those who feel they have no voice in our system. We should all express our gratitude to her for her continued campaigning on this critical issue, which demonstrates that we still have a long way to go if we are to ensure that we have a system of which we can all be genuinely proud. Like the right hon. Lady, I hope that one day the flood of letters on poor care will stop. We are doing what we can through the actions we are taking and we are grateful to her for the enormously valuable work she did on the complaints system. I hope the Labour Administration in Wales will do the same, especially after she eloquently highlighted the problems there in a recent BBC documentary.

[Barbara Keeley]

Will the Minister give way?

[Norman Lamb]

I have given way quite a lot; I need to make some progress.

The right hon. Member for Newcastle upon Tyne East (Mr Brown) asked about allocations. It is right that the allocation of funding is no longer a political football but in the hands of experts. NHS England is seeking to make progress on reducing inequalities.

The hon. Member for Blyth Valley talked about charging in the NHS. Access to NHS services is based on clinical need, not on an individual’s ability to pay. That is fundamental to the NHS, and for as long as this coalition Government are in power the NHS will remain free.

We heard from Members on both sides of the House —my hon. Friend the Member for Bracknell (Dr Lee) and the hon. Member for Westminster North (Ms Buck)—that health care needs to change so that care is provided more locally. The better care fund establishes a £3.8 billion pooled fund, to help people to stay healthy and independent.

[Barbara Keeley]

It is not new money.

[Norman Lamb]

Of course it is not new money—this is a different way of working. We have never claimed that it is new money; this is to ensure that we use the money more effectively. Indeed, the hon. Lady’s Front-Bench colleagues have made the argument that by pooling the health and social care budgets, we can achieve more with the money available.

[Barbara Keeley]

Will the Minister give way?

[Norman Lamb]

No, I will not; I have given way many times. The fund is the largest financial incentive by any Government to promote integrated care, and it would be better if Opposition Members applauded the initiative rather than constantly criticising it.

At the start of this Parliament, this Government had five priorities for health and social care. We have delivered on all of them. Through the Care Act 2014, we have delivered the most profound change to the care and support system for a generation. After a decade of inaction under the previous Labour Government, we have introduced, for the first time, a cap on care costs and extended means-tested support. No one will have to sell their home during their lifetime to pay for care.

Under the leadership of Public Health England, we have created a new public health service, giving public health the priority it deserves in local government alongside other local services. As my hon. Friend the Member for Newbury (Richard Benyon) outlined, it is vital that we prevent ill health in the first place, as opposed to repairing the damage once it is done.

We are transforming health and care so that services are integrated around the needs of patients and users. We have revolutionised NHS accountability and seen a successful transition to a new health and care system. Finally, by focusing on outcomes rather than top-down diktat, we can identify what works and where we need to give additional support to help the system do more.

[Mr Jamie Reed]

I always enjoy the hon. Gentleman’s emollient Dr Jekyll, in contrast to the Secretary of State’s Mr Hyde. Will he be following the Crosby diktat and keeping his head down and his mouth shut about the Government’s record on the NHS between now and the general election, or will the Liberal Democrats be doing something rather different?

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[Norman Lamb]

I am very happy to speak for myself, and I will do so in due course. I am sure that the Secretary of State is enormously grateful to the hon. Gentleman for his description of him.

In the final session of this Parliament, the Government will continue to ensure that the new health and care system works with both integrity and purpose, delivering safe and compassionate care to patients, their families and friends.

Ordered, That the debate be now adjourned.— (Mr Gyimah.)

Debate to be resumed tomorrow.