Congenital Cardiac Services for Children

Simon Burns Excerpts

Thursday 23rd June 2011 Commons Chamber

[Greg Hands (Chelsea and Fulham) (Con)]

I very much support the principle that lies behind the review—that we need larger, more sustainable centres with the same overall number of specialists throughout the country. That is why charity and campaign groups, such as the Children’s Heart Federation and Little Hearts Matter, back the change.

I recognise that people will have to travel further as a consequence, and that will sometimes be extremely difficult, for families in particular, but the choice is between people travelling further and getting the best outcome for their child, and people having a shorter distance to travel but perhaps compromising the outcomes that can be achieved. The clinical evidence is unambiguous: travelling further means that some children will live who would otherwise die. On that basis—the whole basis behind the review—we have to bite the bullet and make change.

I support the principle of fewer, larger units, but the experience of Royal Brompton hospital in my constituency has made me question the process that is being used to make individual decisions. As my hon. Friend the Member for Pudsey (Stuart Andrew) pointed out, the matter needs to be depoliticised from the outset. The review is taking place at arm’s length from the Government. Indeed, as the right hon. Member for Newcastle upon Tyne East (Mr Brown) said, it was set up under the previous Government and is being administered by a body called the joint committee of primary care trusts, which I assume is up for abolition.

Phase 1 of the assessment process involved ranking all the existing units on core standards, sustainability, facilities and so on. Great care was taken, and that makes the next phases all the more mystifying. Out of the 11 units ranked, the Royal Brompton came joint fourth, on 464 points. Of the 11 units assessed, only two had the maximum number of four surgeons—the Royal Brompton and Great Ormond Street. In terms of the number of procedures undertaken each year, the Royal Brompton came fourth highest of all. In each of the three objective criteria, the Royal Brompton was in the top four nationally. I therefore asked the joint committee of PCTs this question: why bother to rank all the units only then to stipulate that one of the top four has to close whatever else happens? That is the consequence of the decision arbitrarily to rule out keeping three centres open in London. One of the top four units in the country is to be axed, no matter its size and no matter its quality, due merely to its location. That flies in the face of the starting point of the review—that it was all about clinical outcomes, not geography.

The Royal Brompton has four specialist surgeons who perform 520 operations, including 453 children’s heart operations, per year. It has a fantastic safety record, with an aggregate mortality rate of 0.94 of 1%—less than half the national average of 2%. Why, then, when it is already a model example of what the review wants to create, does the consultation, in all the options available, decree that it must close? The joint committee of PCTs is claiming that it has an open mind, but in reality it is consulting on four options, all of which would shut the unit at the Royal Brompton.

The knock-on effects on services elsewhere in the trust would be considerable, especially on children with cystic fibrosis, of whom there are 300 in the country. The future of provision for those children would be extremely unclear. It is also unclear what capacity the remaining two hospitals in London would have to take on—

[The Minister of State, Department of Health (Mr Simon Burns)]

I will speak with great care because—my hon. Friend is as aware of this as I am—of the possible judicial review with regard to the Royal Brompton. I would like to say, though, as I think it may help him, that no decisions have yet been made. The consultation literature specifically asks consultees for their views on how many centres it is best to have in London—two or three. If they agree that two is optimal, they are asked to state which two they prefer, including the Royal Brompton. Even though it is not included in any of the pillars, people who are taking part in the consultation process can argue its case, and it will be considered because the JCPCT is taking a flexible approach to the consultation process.

[Greg Hands]

I welcome that intervention from the Minister. He is right that it is open to the consultation to consider it, as it says on the last page of the consultation document, but the document was contradictory on this point in the first place. On page 84, it says:

“London requires at least 2 centres due to the size of the population it covers”,

but in a footnote on page 93 it still imposes the arbitrary limit of two centres at most.

The joint committee has belatedly recognised a problem. Under pressure, it announced at the beginning of May that an expert panel would be established to review the wider impact on other services if cardiac paediatrics were to close. That was welcome, but it has continued to press ahead with the original consultation and names for the new panel were not proposed until this week. By the time the new panel reports in August, the consultation will have closed. What happens if its response reflects the serious concerns about a whole series of national services? Having consulted on options A, B, C and D, it can hardly go for an option E that no one was asked about. It would then probably have to re-consult.

I became the MP for the Royal Brompton in May last year, although, as the neighbouring MP previously, I have been very familiar with its work for many years. Its previous MP, my right hon. and learned Friend the Member for Kensington (Sir Malcolm Rifkind), also strongly supports its campaign to fight the proposal. I have visited the hospital three times in the past year. The proposal to end its cardiac paediatrics has been brought to the attention of parliamentary colleagues across all parties and across large parts of London, the south-east and East Anglia. A huge petition has been gathered, signed by more than 30,000 people, and tomorrow we are delivering it to No. 10. I have written at length and in detail to the Secretary of State on the matter, and he helpfully replied—I think this was confirmed by the Minister—that

“no decisions have yet been made”,

including on the number of units to be located in London. That is a cause for encouragement.

I repeat that I support the aims of the review, but the consultation has been badly flawed. Three units in London, perhaps restructured, should have been an option, and the knock-on effects of closing services should have been considered. The case must now be re-examined. The Royal Brompton is good enough, large enough and loved enough to survive.

--- Later in debate ---

[Pat Glass]

I am not going to give way, no matter how much the hon. Gentleman hassles me. I can see that that is what he plans to do.

Many local campaigns have been mounted, and they have been supported by local MPs fighting for their own units or fighting to delay decisions. I absolutely understand that, but the decisions have been put off before for many reasons, which I believe is to the detriment of patients.

The decision should not be made on a political basis. Few of us in the House are qualified to judge the quality, sustainability and deliverability of clinical outcomes in children’s heart provision. On 7 June, when I questioned the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), on the matter, he gave me a categorical assurance that decisions would be

“based on clinical outcomes, not political considerations.”—[Official Report, 7 June 2011; Vol. 529, c. 12.]

I hope that he will keep his nerve in the face of sustained political lobbying.

[The Minister of State, Department of Health (Mr Simon Burns)]

If it encourages or reassures the hon. Lady, I will give her that commitment again today.

[Pat Glass]

I thank the Minister.

The Children’s Heart Foundation has advised me that the closer we get to a decision, the more difficult the political battle will become. In a bid to save surgery facilities in their areas, some parents and clinicians are asking MPs to stall progress towards a decision. Parents have been told that some units will close, when in fact even if surgery is centred elsewhere, local units will continue to provide specialist medical treatment on a “hubs and spokes” model. I believe that parents have been misled on some matters.

These decisions are crucial to the future clinical outcomes and life chances of our children. The Minister has again today categorically assured me that they will be based on clinical outcomes only, and I thank him for that.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on securing this debate on the review of children’s heart surgery services. He has a strong record of campaigning on this issue and of bringing the concerns of his constituents to the attention of the House. I also congratulate him and the other hon. Members on the motion they tabled. The Government and I wholeheartedly support its contents, and I urge other hon. Members to do so as well.

I should also like to take this opportunity to pay tribute to the dedicated NHS staff who work in children’s heart services in my hon. Friend’s constituency and across the country. They do a tremendous job, for which we are all incredibly grateful, more often than not in complex and difficult circumstances.

I should like to confirm that the review is totally independent of the Government, and that it is clinically led. It is not driven by me, by other Ministers or by the Department of Health. It is therefore not appropriate for me to comment on the specific hospitals consulted during process. I do not wish to act, or to be seen to act, in a way that could influence or prejudice the process that is going on. As many hon. Members have said, this is a highly emotive issue, particularly for those whose children’s lives have been saved by the services under review. It is worth reminding ourselves why the review was conceived and planned and is now being carried out.

This is not a new issue. The provision of children’s heart surgery has been a cause for concern since the Bristol Royal infirmary inquiry in the late 1990s. Understandably, there has been considerable pressure from national parents groups and professionals to ensure that children receive the best treatment, and the sole purpose of the Safe and Sustainable review is to ensure that children with congenital heart problems receive the best possible care now and long into the future. To do that, we must be certain that the centres in which surgery takes place are as good as they can be.

[Mr David Davis (Haltemprice and Howden) (Con)]

The Minister will not be surprised to hear that my constituents, like all the others in Yorkshire, are in favour of Leeds, but I do not want to draw him on that. I would like him to help us in our argument by telling us what the clinical outcomes for Leeds are and how they compare with other centres. In particular, will he confirm that they are all safe?

[Mr Burns]

I am grateful to my right hon. Friend for that intervention. With regard to Leeds teaching hospital, he will know that this is a complex issue. There are 36 different surgical procedures listed on the central cardiac audit database, but the three most relevant ones in the context of his question are those that deal with atrioventricular septal defect, arterial switch and Fallot’s tetralogy. Over the past six years, 304 operations have taken place involving those three specialties. Sadly, the number of patients who died within 30 days was 12, and 18 died within one year. The results of surgery in all units are good, with no significant divergence. The issue, however, is the future. We need to prepare for units that can deal with these highly complex procedures and the intense technology needed, and provide the qualified doctors and nurses involved, in order to keep up with professional and public expectations of the high quality of care required. This is not so much about today’s figures as about how we meet the challenges of the future to provide the finest and safest possible care in this deeply complex area of medical treatment.

The consensus among professional associations is that there should be no fewer than four congenital surgeons in a centre, each performing between 100 and 125 procedures every year, for a centre to be optimally staffed. Over the past few years, the outcomes for the services have remained good, as the figures that I have just given to my right hon. Friend illustrate, but there have been several warning signs that the current arrangements are fragile. For many years, professionals and national children’s charities, including the Children’s Heart Federation and the British Heart Foundation, have urged the NHS to review services for children with congenital heart disease. They have consistently raised serious concerns about the risks posed by the unsustainable and sub-optimal nature of smaller surgical centres.

Many of the 150 types of operation undertaken by these dedicated teams are among the most complex, challenging and technically demanding areas of surgery. Success requires intricate surgery on hearts often no bigger than a walnut, coupled with finely balanced judgments drawn from a combination of advancing science, personal experience and compassion. It involves a range of highly trained individual team members—before, during and after the operation.

The risks posed by the complex nature of heart surgery include not just possible death after surgery, but lifelong complications such as brain damage and other disabilities. The judgments of any expert medical team caring for a particular child therefore have a direct and long-lasting impact not only the future of each vulnerable child, but on that of their families.

There is also the issue of recruitment. The fact is that smaller centres have problems with recruiting and retaining the very best surgeons. There is a risk that those working in smaller centres will find themselves working in isolation and in units that are not as up-to-date with techniques and clinical practice as the larger ones are.

[Greg Mulholland]

We all understand the premise of the review about the need to move to larger centres, but does the Minister not understand—I am not trying to draw him—the real concern when Leeds is performing 370 procedures a year and Newcastle, a smaller unit, performed only 255 last year, yet Newcastle is in all four options and Leeds only in one?

[Mr Burns]

I fully appreciate the hon. Gentleman’s point, but I hope that he will appreciate that he is now trying to draw me into a discussion on the merits of Leeds as against Newcastle. As I said earlier, it is inappropriate for me as a Minister to do that. However, it is a point that the hon. Gentleman, my hon. Friend the Member for Pudsey and others can make more than adequately to the joint committee, which will be able to determine the merits of the argument prior to reaching a decision. I urge the hon. Gentleman to understand how inappropriate it would be for me to go down the route of arguing the merits or demerits of one area or another.

Smaller centres struggle to train and mentor junior surgeons, making these units less attractive to the senior surgeons of tomorrow and making it difficult to provide a safe 24-hour service. We must ensure that our surgeons and their teams are well supported. They need opportunities to develop their experience as they become increasingly expert in these intricate and complex procedures. We must ensure that all the hospitals that provide heart surgery for children can also provide care within safe medical rotas.

No parent would wish the care of their child to be entrusted to a surgeon who, though an excellent doctor, is overly tired because they have had to work around the clock without any peer support. This means that to reduce the risk of surgery in sick children and to improve their long-term outcomes, we must focus our surgical expertise in larger centres. The need has become ever more pressing with the increasing complexity of treatment.

As hon. Members will know, the national review is known as the Safe and Sustainable review. Its aim is to ensure that children’s heart services deliver the very highest standard of care. The NHS must use its skills and resources collectively to gain the best outcomes for patients. As I stated at the beginning of my speech, in line with the Government’s entire approach to the NHS, this review is both independent and clinically led. May I reassure hon. Members that the objective of the review is not to close children’s heart centres? Far from it. While surgery may cease in some centres, they will continue to provide specialist, non-interventional services for their local population.

Indeed, the review proposes to extend local care further, supported by the professional associations that support the increased clinical expertise across England. This wider support is crucial. Surgery is usually a single, short episode in what is often a lifelong relationship with specialist congenital heart services. The aim is to improve those services as a whole and to ensure that as much non-surgical care as possible is delivered as close to the child’s home as possible through the development of local congenital heart networks. These will enable children to be safely and expertly cared for nearer to home in the longer term.

Given the complexity of the issues for consideration, the NHS has held a four-month, rather than the usual three-month, consultation. Hon. Members should be reassured that the consultation process has been impressive in its scope, inclusiveness and transparency.

[Julian Smith]

Will the Minister give way?

[Mr Burns]

I will, but it will be for the last time.

[Julian Smith]

I thank the Minister. Will he comment on the lack of translation of certain consultation documents, which has affected many communities, particularly in and around the Leeds area?

[Mr Burns]

I am grateful to my hon. Friend for raising that issue, and I will address it later in my speech.

No decision has yet been made about which centres should continue to undertake surgery. That decision will be made only after the responses to the consultation have been properly and fully considered. The chair of the joint committee of primary care trusts, Sir Neil McKay, has made it clear that it is a genuine consultation and that all viable proposals will be considered, and I agree with that. There has been no pre-determination of the number of centres that will be selected. Rather, the review remains flexible and open-minded as to the final number and is happy to listen to all options that would produce the excellent clinical outcomes for our children that we desire.

As I have said however, this review is being driven by a powerful clinical imperative. The trend in children’s heart care is towards increasingly complex surgery on ever-smaller babies. That requires surgical teams that are large enough to provide sufficient exposure to complex cases, so that surgeons and their teams can maintain and develop their specialist skills. Larger teams also provide the capacity to train and mentor the next generation of surgeons. In recent years, other countries have recognised the clinical necessity of larger surgical units and have reconfigured their services along the lines proposed by the Safe and Sustainable proposals. Here in the United Kingdom, there are successful precedents for centralisation. In the past 15 years, the congenital cardiac services in Cardiff and Edinburgh have ceased heart surgery on children, as they recognised that their centres were just too small to be sustainable.

I also want to reassure Members about the integrity of the process that was followed in developing the options for consultation. In the past, concerns have been put to me in this House about mistakes in the assessment process, particularly relating to the Leeds service, and Members have referred to that again today. I understand that since our last debate in February or March of this year the chair of the joint committee, Sir Neil McKay, has written to the chief executive of the trust in Leeds to explain why mistakes have not been made in relation to the Leeds centre.

Members, including my hon. Friend the Member for Skipton and Ripon (Julian Smith) in his recent intervention, have also raised the issue of documents not being made available in a sufficiently wide range of languages, thereby excluding those who speak those languages from the consultation process. The relevant documents have for several weeks been available in 10 different languages, including Urdu, Arabic, Farsi and Punjabi. [Interruption.] The hon. Member for Leicester West (Liz Kendall) shakes her head, but I assure her that they have been available for several weeks, although I accept that they were not available from the first day of the review. That may be the point the hon. Lady was seeking to make, and I agree with her if she thinks they should have been from the first day. We cannot change the fact that they were not available from then, however, but they have been available from, I believe, 20 May, and the consultation process runs until 1 July, which gives sufficient time for people who need to access the documents in those languages to do so and to be able to input their views.

I hope to be able to reassure my hon. Friend the Member for Isle of Wight (Mr Turner) on retrieval times and access times from the Isle of Wight, given its unique geographical situation. It is my understanding that the joint committee of primary care trusts has agreed that Southampton University Hospitals NHS Trust has provided evidence on this issue that requires further consideration and has invited the trust to develop a detailed case regarding retrievals from the Isle of Wight, which the committee will consider as part of the evidence to determine the optimum reconfiguration.

Several Members raised the issue of the inclusion of black and minority ethnic communities in the consultation process. There have been a number of workshops and focus groups, many of which have been aimed specifically at the BME communities. Almost 2,000 community groups and organisations that have an interest in BME issues have been contacted and invited to take part in the proceedings. Public meetings have been arranged, particularly in Leeds, specifically for the Asian population of Yorkshire in partnership with representatives of local BME groups. The Leeds meeting is on 29 June, there is a meeting planned for Bradford on 30 June and a further meeting is planned for Kirklees. I hope that hon. Members who represent parts of Yorkshire and the surrounding catchment areas will be assured by that.

To abide by your rules, Mr Deputy Speaker, I will now conclude by saying that I am confident about the consultation. Everyone will accept that all consultations of this nature can be difficult, when tough decisions have to be taken. The decisions have to be taken for the right reasons, based on clinical evidence about the best way to improve and enhance care and the quality of care for patients. That is particularly true in this case because more often than not the patients are very young children with very complex needs—that is what makes this issue so difficult.

Let me reiterate that no decisions have been taken or will be taken until the joint committee has had an opportunity to consider the independent analysis of the consultation responses, reports from any local overview and scrutiny committees and a health impact assessment. Throughout, it will remain open-minded and flexible as to the number of centres. The only important consideration will be the sustainability of clinical excellence at the centres chosen. I doubt whether this is the case, but if any hon. Members have not taken part in the consultation I urge them to do so. I also urge them to ensure that their constituents and organisations in their constituencies with an interest in this matter take part in the consultation if they have not already done so, so that the committee can have the widest range of views, information and opinion before reaching what will, in any circumstances, be difficult decisions.

Points of Order

Simon Burns Excerpts

Tuesday 21st June 2011 Commons Chamber

[Mr Speaker]

I am grateful to the hon. Lady for her point of order. I would simply say that no, I have had no indication on that matter. Of course, she and I came into the House together in 1997, and she will be as aware as I am that precisely who moves motions on the part of the Government is a matter for the Government. I think I know the Minister who is going to move the motion, and if he wants to respond he is perfectly welcome to do so. He is under no obligation, but he may.

[The Minister of State, Department of Health (Mr Simon Burns)]

Further to that point of order, Mr Speaker. It might help you and the hon. Member for Warrington North (Helen Jones) if I point out that the precedents for recommittals are not that common, but that if one looks at the previous recommittal, it was done in 2003, by the then Minister of State, one Mr Tony McNulty.

[Mr Speaker]

I am grateful to the Minister of State. I think that we will leave that as a no-score draw or a score draw, as the case may be. I am happy to take any further points of order, but if the House’s appetite has been satisfied, we will move on.

Bill Presented

Legal Aid, Sentencing and Punishment of Offenders Bill

Presentation and First Reading (Standing Order No. 57)

Mr Secretary Kenneth Clarke, supported by the Prime Minister, the Deputy Prime Minister, Mr Chancellor of the Exchequer, Mrs Secretary May, Mr Secretary Lansley, the Attorney-General and Mr Jonathan Djanogly, presented a Bill to make provision about legal aid; to make further provision about funding legal services; to make provision about costs and other amounts awarded in civil and criminal proceedings; to make provision about sentencing offenders, including provision about release on licence or otherwise; to make provision about bail and about remand otherwise than on bail; to make provision about the employment, payment and transfer of persons detained in prisons and other institutions; to make provision about penalty notices for disorderly behaviour and cautions; and to create new offences of threatening with a weapon in public or on school premises.

Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 205) with explanatory notes (Bill 205—EN).

Health and Social Care Bill (Programme) (No. 2)

Simon Burns Excerpts

Tuesday 21st June 2011 Commons Chamber

[The Minister of State, Department of Health (Mr Simon Burns)]

rose—

[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 Deputy Speaker (Mr Nigel Evans)]

Good try, but let us move on.

[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 Burns]

It is a programme that will end the culture of processed targets and diktats from politicians and of putting the convenience of institutions above the needs of patients.

[Mr Kevan Jones (North Durham) (Lab)]

On a point of order, Mr Deputy Speaker. I thought we were debating a programme motion, but the speech we are hearing seems to be a rehearsal of the Bill.

[Mr Burns]

rose—

[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—

[Several hon. Members]

rose—

[Mr Burns]

I was about to come on to what we propose to do, but I will give way to the hon. Member for Penistone and Stocksbridge (Angela Smith), and then I will make progress.

[Angela Smith (Penistone and Stocksbridge) (Lab)]

I thank the Minister for giving way.

It is not unprecedented for Bills to come back to the House having been changed by the Government, but previously the whole Bill has gone back to Committee. Why are the Government not doing that?

--- Later in debate ---

[Mr Burns]

The hon. Lady might not be too familiar with the past. Two previous Bills have been recommitted, both in 2003, and if she will wait I will put them in the context of what we are doing.

We propose to recommit 63 of the Bill’s clauses and to add a further five to the Bill. About 35 of those 63 clauses will need to be amended. The remainder will provide context and allow the Committee to have a sensible debate about the revisions. These clauses will cover the key areas of the Bill, including the role of the Secretary of State, clinical commissioning groups, the NHS commissioning board, the role of Monitor, foundation trusts, health and wellbeing boards and HealthWatch. We are demonstrably committed to subjecting the Bill to the full and proper scrutiny of Parliament. The Health and Social Care Bill spent a very long time in Committee, with 28 sittings over seven weeks, which, in fact, is the longest series of sittings of a Committee since we considered the modernisation of this Chamber and the House of Commons. Indeed, the hon. Member for Halton (Derek Twigg), who led for the Opposition in Committee, acknowledged at the time that the Committee had

“scrutinised every inch of the Bill.”––[Official Report, Health and Social Care Public Bill Committee, 31 March 2011; c. 1310.]

However—[Interruption.] However, as the changes we are making are—

[Several hon. Members]

rose—

[Mr Burns]

Earlier, Opposition Members complained that I was not discussing why the Bill was being recommitted, yet as I now go through, point by point, why we are doing that they do not seem interested in listening. As I have said, I will not accept interventions frequently, because the House wants to know what we are doing and why are doing it, and that is the right way to proceed.

[Several hon. Members]

rose—

[Mr Burns]

I will give way once more, to the hon. Member for St Helens North (Mr Watts), and then I will make progress.

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

I thank the Minister for giving way.

So far today, the Minister has used the precedent of 1983. Will he confirm that when a similar Bill came back in 1983, the whole Bill was recommitted to the House?

[Mr Burns]

The hon. Gentleman seems a little confused. He is talking about 1983, but if he had been listening he would know that I have already said that two Bills were recommitted in 2003. I also said that if Opposition Members wait, I will explain the context of those Bills vis-à-vis the current situation. I therefore urge them to show patience, as they will then learn something.

[Kevin Brennan]

On a point of order, Mr Deputy Speaker. In fact, the last Bill to be partially recommitted to a Committee was the Mineral Workings Bill in 1951, some 60 years ago, but the Minister is not referring to that.

--- Later in debate ---

[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.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

When?

[Mr Burns]

The hon. Lady, from a sedentary position, rather like a Greek chorus that ill-befits her, asks when. The answer is that we expect to table the amendments by 23 June, which, if it helps her, is in two days’ time. That is despite the fact that many previous Bills—[Interruption.] The hon. Member for Islington South and Finsbury (Emily Thornberry) should listen to this because it has some direct relevance that she will not like. We are doing this despite the fact that many previous Bills were not recommitted under the previous Government despite their having undergone significant change. For example, the Local Government and Public Involvement in Health Bill in 2007 had 54 new clauses and three new schedules added by Government amendment, but rather than returning it to Committee the previous Government added them on Report. The Planning Bill of 2007-08 had 29 new clauses and three new schedules added by Government amendment; again, rather than return that Bill to Committee, the previous Government added the clauses on Report. Indeed, a Bill has not been recommitted for eight years since the Planning and Compulsory Purchase Bill in 2003.

No fair-minded person can claim that we are not subjecting the Bill to the closest possible scrutiny. Our recommitting the Bill will give hon. Members additional time to examine parts of the Bill that the Government propose to change. Of course, hon. Members will have further opportunity to scrutinise the entire Bill on Report in the Commons and the Bill will receive full scrutiny in another place. We do not believe that it is necessary for the entire Bill to be recommitted—[Hon. Members: “Why not?”] If hon. Members will listen they will find out why not. We do not believe that it is necessary for the entire Bill to be recommitted in order for proper scrutiny to take place. Indeed, we feel very strongly that that would unnecessarily delay the progress of the Bill to the ultimate detriment of patients. It is now time to give greater clarity and direction to staff and patients. As Professor Steve Field said in the Future Forum report:

“It is time for the pause to end.”

Professor Field is not alone in the opinion that now is the time to move forward and to enable proper and thorough scrutiny of those parts of the Bill that will change but without delaying the Bill’s passage beyond what is absolutely necessary. The Academy of Medical Royal Colleges said in its response to the Future Forum report:

“We hope the Government will now accept the Future Forum’s recommendations in full and move swiftly to make the changes to the Bill and the proposals that are required”.

The King’s Fund has also emphasised the need to avoid unnecessary delay. It said:

“The ‘pause’ has served the NHS, its staff and patients well”—

[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.

--- Later in debate ---

[John Healey]

My hon. Friend is right. We know that the Prime Minister is a PR man. We know that he was forced to call the pause and that, when he did, he was looking for a PR solution. The answer that my hon. Friend flushed out of the Government stands that up clearly.

To return to the motion before the House and the question whether the Bill requires, as we argue, recommittal in full, parliamentary precedent demands this, proper parliamentary scrutiny demands this and, above all, our responsibility to NHS patients to try to get the legislation right demands this. The parliamentary precedent is clear, as my hon. Friend the Member for Cardiff West (Kevin Brennan) said. The House of Commons Library tells me that the last time a Bill was recommitted in part was 60 years ago. In response to a point of order, the Health Minister cited the Planning and Compulsory Purchase Bill of 2003 as a precedent. The Labour Government recommitted that Bill in full and gave Committee members the whole of the summer recess to examine the detailed amendments before the Committee sat again. Why are the Government not acting as they should and as Labour acted in government with that Bill?

The NHS, the legislation and the changes to the changes announced last week are all complex, and the House cannot do its proper job unless the Government’s changes to one clause can be considered alongside the consequences for other parts of the Bill and for the health service. How can the promised changes to Monitor’s role be considered without looking at all 29 clauses dealing with its licensing powers? The House cannot do its proper job unless all the areas that the Government say they will change are recommitted.

Why are the clauses on the failure and designation regime for hospitals, which the Government say they will change, not covered in the recommittal motion? The House cannot do its proper job, and organisations cannot give proper evidence to the Bill Committee, unless all the amendments are tabled in good time, so why will there be only two full working days between the tabling of amendments and the Committee sitting? The House cannot do its proper job unless the Bill Committee has sufficient time for scrutiny.

The 64 clauses in the recommittal motion took 45 hours of debate in Committee last time. The Government are now cutting that time in half. The Minister said that he expects 160 amendments in Committee. That allows less than 10 minutes for each amendment that the Government table, and that is before the Opposition table our own amendments and before taking into account the six schedules that are being recommitted.

[Mr Simon Burns]

As a former Minister, the right hon. Gentleman knows about taking legislation through Committee. Given that a number of the 160 amendments will be technical and drafting amendments, will he please tell the House how many minutes he needs for each technical and drafting amendment to be debated in Committee?

[John Healey]

The Minister, his colleagues and the Prime Minister have broken their word so often so far on the NHS that we cannot take at face value what the Minister says. We will wait to see and we will judge what he does when we see the detail of the amendments that he tables.

Registration of Primary Medical Care Providers

Simon Burns Excerpts

Friday 17th June 2011 Written Statements

[The Minister of State, Department of Health (Mr Simon Burns)]

I wish to inform the House of a proposal that the Department is today publishing to defer the registration of NHS GP practices with the Care Quality Commission (CQC) until April 2013.

CQC is the independent regulator of health and adult social care in England. All providers of a regulated activity are required to register with the CQC. In order to be registered and to remain registered, providers are required to comply with a set of registration requirements that establish the essential levels of safety and quality.

Where a registered provider fails to meet these registration requirements the CQC has a range of enforcement powers that it can use to bring about improvements. In the case of persistent and/or serious failings, the CQC has the power to stop providers operating.

The role of registration with CQC is central to the Government’s plans for the future delivery of health care and adult social care in England. It forms the foundation on which high-quality services can be built.

Since April 2010, the CQC has registered around 20,000 health and adult social care providers. This has been a major programme of work which the CQC has carried out well.

In April 2012, providers of primary medical care are due to enter the registration system. This covers providers of primary medical care services for the NHS including GP practices, out-of-hours primary care services and NHS walk-in centres. This final wave comprises registration of around 8,000 providers.

We have reconsidered the timing of the registration of primary medical services providers for the NHS and believe there are strong reasons to move the start date for the registration for most of these providers to April 2013.

Postponing the registration of most primary medical services providers for the NHS will afford the opportunity to ensure that, when it does go ahead, the CQC’s systems, tools and processes will have been refined in the light of the experience of the earlier registration rounds and piloting with primary medical services providers.

A pause will also allow for the further development of accreditation schemes for primary medical services providers to be used as evidence of their compliance with the registration requirements.

For these reasons, we are seeking views on a proposal that the registration of most primary medical services providers should be deferred until April 2013.

The Government have made a commitment to bring out-of-hours providers into registration at the earliest opportunity. I am therefore proposing that the registration of dedicated providers of out-of-hours care should go ahead as planned, in April 2012, together with registration of NHS walk-in centres which do not provide primary care to a list of registered patients.

I believe that phasing the registration of NHS providers of primary medical services will strike the right balance between protecting the safety of patients and making the registration process more streamlined for both providers and the CQC.

The consultation has been placed in the Library. Copies are available to hon. members from the Vote Office and to noble Lords from the Printed Paper Office.

NHS Future Forum

Simon Burns Excerpts

Tuesday 14th June 2011 Commons Chamber

[Rosie Cooper (West Lancashire) (Lab)]

Although it has been difficult to hear during this debate, I would like to address my comments to the statement made by the Secretary of State.

[The Minister of State, Department of Health (Mr Simon Burns)]

Question.

[Rosie Cooper]

Question, sorry. [Interruption.] Let us get to the point and stop playing around. The Secretary of State said in the statement that consortia will now have one nurse and one secondary care doctor and that:

“To avoid any potential conflict of interest, neither should be employed by a local health provider.”

How will the Secretary of State apply that rule to GPs? Would not the Secretary of State and his reforms be best described as like Schrodinger’s cat—in a state of uncertainty and both alive and dead at the same time?

Hospital Food

Simon Burns Excerpts

Tuesday 14th June 2011 Commons Chamber

[The Minister of State, Department of Health (Mr Simon Burns)]

I congratulate the hon. Member for Stoke-on-Trent North (Joan Walley) on securing this debate on hospital food. I hope she gets better swiftly. I have considerable sympathy with her as she was clearly suffering through no fault of her own, and I wish her a speedy recovery.

I know that food and nutrition is a subject dear to the hon. Lady’s heart, and that she has done a considerable amount of work in her constituency, bringing together schools, primary care trusts, the city council and others, Prue Leith not least among them, to see what can be done locally to improve the diet of her constituents. I pay tribute also to the many NHS staff who have worked so hard to push nutritional care up the agenda, and who continue to make it their priority.

Good food—nutritionally balanced, clinically appropriate meals that taste good— are right up there with good hygiene and good clinical care when it comes to a patient’s experience of the NHS. They are all things that we should be able to take for granted while being cared for by the NHS. Good food contributes directly to recovery from illness and it adds structure to a day that can be all too long and featureless. Although I agree with much of what the hon. Lady said, there are some details on which we may not have such close proximity of views.

As the hon. Lady mentioned in the course of her comments, we will shortly publish the Government buying standards for food. Developed by DEFRA and the Department of Health, they will support and encourage public bodies to provide a healthy balanced diet for public sector workers. They will also help to reduce the environmental impact of food and catering in the public sector. However, as the hon. Lady said, within the NHS, these standards will be voluntary, not mandatory. Government buying standards are already promoted through the NHS operating framework for 2011-12 and through the Boorman review of health and well-being on the NHS, now being implemented by NHS Employers. We will promote the Government buying standards through training and materials developed to help NHS organisations to procure more sustainably.

The Government believe in giving far greater responsibility and control locally to NHS providers. NHS trusts must be allowed to determine their own procurement policy. Hospitals need to find out the wants and needs of their local population and then work out how to meet them efficiently. Government’s role is to set the direction and the policy, but it is for local experts to deliver the food locally. This is not to say that the NHS is on its own. There are a number of resources available, including guidance on reducing food waste, sustainable procurement and developing menus and food services.

No health care catering manager need feel unsupported. If hospitals wish to increase the proportion of locally-sourced food, there is guidance to help them do that. If they have a problem with food waste, there are resources that can help them to tackle it. This is the way we should tackle problems—with assistance and support, not restrictive legislation and diktat. It is wrong for Government to meddle in the detail and to attempt to micro-manage the NHS from on high. Our job is to create the right environment, to set standards and to lead, and that is what we are doing.

[Joan Walley]

Is not there a contradiction in having minimum standards in schools but not having minimum standards that would apply in the same way to patients in hospitals?

[Mr Burns]

No, I do not think so, for the reasons that I have already given and because of our ethos that the modernised NHS should respond through local decision-making rather than top-down diktat from Whitehall or Westminster. However, as I have outlined, we are prepared to, and we have and we will, provide the guidance to enable local deliverers to seek advice and take decisions based on the best needs of their patients.

We should also bear in mind that the food needs of patients are already regulated and checked by the Care Quality Commission, through the choice of suitable food, the food and nutrition to meet reasonable needs and the support to enable patients to eat and drink—a subject that I will come on to because I feel very much, as the hon. Lady did, that that is an essential part of the care of patients in a hospital setting.

I share the hon. Lady’s concerns about poor standards of nutritional care. In too many cases, food has slipped off the menu of some NHS providers, and that is not good enough. Of course, proper nutritional care is a multidisciplinary affair. There are many links in the chain from field to fork. Food must be well sourced and properly cooked by well-trained catering staff, delivered efficiently by the porters, and properly presented on the ward. The chain is a long one, and if any single link breaks, the good work that went before it is undone. Of course, the best food is of no value if it is not eaten, and many people, particularly older patients, will need help, and they must have it. Stories of food left out of reach, or taken away before a patient has had the chance to eat it are shocking and, sadly, too common, as are stories of those unable to feed themselves left without the assistance they require.

The latest in-patient survey found that less than two thirds—64%—of patients always got the help they needed to eat. But that sadly meant that 36% did not always get the help, which, frankly, is unacceptable. That is something that hospitals must concentrate on to ensure that we quickly and dramatically raise those figures. In a civilised society, in this day and age, that is unacceptable as part of patient care, particularly for elderly people.

That is why we asked the CQC to inspect 100 hospitals, focusing on issues of dignity and nutrition. The CQC has begun to publish reports on individual hospitals, and we expect a final report in September. In most cases so far, the care was every bit as good as one would expect. There were many examples of high-quality nursing and of people enjoying healthy, nutritious meals. Indeed, in a number of cases, the quality of food was actually complimented. But the inspections also identified a number of hospitals that were failing to provide the nutritional care their patients need. In one damning example, a doctor was forced to prescribe water on a patient's medicine chart to ensure they got enough to drink. That, again, is unacceptable, and something that one would find hard to believe if it had not shown up in the inspection. Where there are deficiencies, the CQC has demanded that improvements are made. Progress against these demands will be followed up and, like everyone in this House, I expect such follow-up to be rigorous and complete.

The CQC's inspection programme is just one example of how we are shining a light on all aspects of the performance of NHS providers—in this case on hospital food. There are also the annual patient environment action team inspections, the CQC's in-patient survey and patient feedback through NHS Choices, along with any local surveys that trusts choose to undertake. This information is crucial if patients are to make informed choices about their care and if pressure is to be brought to bear upon providers to improve.

Improving the patient experience of care is vital to drive up standards. Providers need to listen to patients’ complaints and suggestions and to change and improve in response. This will be one of the main ways in which the NHS will improve in coming years. Our information revolution will mean that patients are better placed to understand and influence the NHS, and we expect to see standards increase as performance becomes more transparent.

When it comes to hospital food, people know what they want. They expect good-quality, wholesome meals that are attractively served, arrive on time and taste good. They want to receive the food they ordered, not what is left over. They want to be able to eat it in comfort, they want sufficient fluids to drink, and they want the help they need when they need it. That is hardly asking the earth, so we owe it to them to be clear about what they can expect in their local hospital, however good or bad it may be.

I understand the hon. Lady’s concerns about hospitals that are built without kitchens. However, there are many ways to provide food in hospitals. Excellent meals can be delivered ready-made, either chilled or frozen, and poor-quality food is not an inevitable consequence of being made off-site. Although the quality of the food at the University Hospital of North Staffordshire has been rated as among the poorest 20% in the country, that is not simply because it is not made in a hospital kitchen. Other hospitals, such as those in Papworth Hospital NHS Foundation Trust and Dorset County Hospital NHS Foundation Trust, also have meals brought in and maintain in-patient survey scores that are among the highest in the country. In fact, for a small hospital, delivered meals can combine a wider choice of food and more accommodating meal times, with economies of scale and greater flexibility.

Delivered meals can also help hospitals to meet high sustainability standards, because although on-site kitchens might at first seem more likely to be sustainable, that is not necessarily the case. Larger off-site kitchens are often more efficient because, by utilising economies of scale, they can reduce the amount of energy they use. What is important is the quality of the finished product and whether it meets the specific needs of patients, not where or by whom the food is produced or prepared. If the best solution for a particular hospital is to do that on site, that is what should happen. However, the service should be contracted out if that is in the best interests of the individual hospital and its patients. We should reject any knee-jerk reaction that says doing it in one way will automatically be a disaster, or vice versa. With food, as with all aspects of NHS care, it is the outcomes that are important to patients, not the process. We need to remember that whoever provides the food, the trust management retains the responsibility for its quality. If the provider does not meet the standards that the trust has set, it must take action.

Of course, efficiency and value for money are also important. We have to find ways of producing excellent food at manageable cost. For some hospitals, that will certainly mean looking at delivered meals. This is sensible and prudent management, but it need not and should not mean poor quality. As long ago as 2002, the Audit Commission found no relationship between the amount of money spent on meals and their quality, and the Department of Health’s more recent internal analysis backs this up. Across the country there are trusts that provide great meals at low cost, which is precisely what all providers should aspire to. The Queen Victoria hospital NHS foundation trust is in the top 10% of NHS organisations rated by patients for having good food, but in the lowest 5% for production costs.

As ever, improving patient experience is central to the Government’s vision of the NHS. Good food is not only a vital element of that experience, but vital for improving clinical outcomes. However, I do not accept that the answer to these problems is to impose ever more controls that would prove expensive to administer, undermine local accountability and stifle the innovation and flexibility that hospitals need to tailor improvements to their specific local needs and constraints. Where food services are not as good as they should be, we should highlight the fact in order to improve care for patients. I do not pretend that making improvements will be easy or fast. Although there is much to do, I am confident that we now have the right approach and that the real winners in all of this will be patients.

Question put and agreed to.

Information Technology (NHS)

Simon Burns Excerpts

Tuesday 14th June 2011 Westminster Hall

[The Minister of State, Department of Health (Mr Simon Burns)]

It is a pleasure to take part in this debate under your chairmanship, Mrs Brooke.

I congratulate my hon. Friend the Member for South Norfolk (Mr Bacon) on securing this debate. His forensic analysis of what has happened over the past decade or so made it clear that he has a justifiable reputation as a leading expert in the House on the subject, and it is due to his tenacity that things are done and things are found out, and that we can be kept on our toes through the legislature holding the Executive to account. In a mood of bonhomie, I also congratulate the hon. Member for Leicester West (Liz Kendall) on her tribute to my hon. Friend. That was particularly magnanimous of her because, for the vast majority of his 40-minute speech, he was criticising her Government’s performance in creating the situation we are in, and for the mistakes and problems that have flowed from the decisions taken at the beginning of the century.

I agree that IT is crucial to a modernised NHS. We need to be able to record, store and exchange information if we are to realise our ambition of having health outcomes that are consistently among the best in the world. The previous Government’s centrally driven, top-down vision of NHS IT began in 2002, and the original title was “Delivering 21st century IT support for the NHS.” Sadly, however, the vision took an approach that was more akin to the early post-war years of the 20th century. It was clear to us, even before we took office, that the approach made little sense, and that to deliver a modern health service we needed a more flexible and locally driven approach—a view shared, ironically, throughout the NHS.

Last September, I announced that we should no longer talk about a “national programme for IT”:

“Improving IT is essential to delivering a patient-centred NHS. But the nationally imposed system is neither necessary nor appropriate to deliver this. We will allow hospitals to use and develop the IT they already have”.

So, rather than the old “replace all” strategy of the previous Government, we favour a strategy of “connect all.” It makes no sense to rip out and replace systems that trusts already successfully use, and we have, therefore, put local NHS organisations in control of introducing new systems. Rather than a single national programme, we should view the strategy as a series of related projects, categorised under national infrastructure, national applications and local services.

It is clear that, over the years, the scope of the national programme expanded, but it is now vital that we focus our investment and energies on the things that will make a difference to the quality of care. We asked clinicians what they wanted from NHS IT systems and they came up with five things that they believed were critical to them and their ability to carry out their duties. They were: a patient administration system that integrates with other systems and provides sophisticated reports; order communications and diagnostic reporting; letters with coding for patient discharge, clinics, and accident and emergency; scheduling for beds, tests and theatres, and e-prescribing. In addition, we are focusing suppliers on key departmental systems, such as those needed to support maternity, child health and accident and emergency, which, taken together, will make a significant difference to the experience of patients and the working practices of clinicians and managers.

At the same time as changing the approach and scope of the programme, we have closely examined its costs. There is little we can now do about the money that has already been spent, but we have been able to reduce the cost forecast from 31 March 2010 by £1.3 billion— about 18%. The savings will come from the companies supplying services, from reduced local costs and from our internal overheads in managing the programme. Suppliers will reduce their costs by £670 million, local costs will reduce by £200 million and we expect to save £400 million on our internal central costs. That is a 25% saving of the total internal budget, and 40% of the amount that the previous Government expected to be spent from the end of March 2010 to the end of the programme.

We have asked local service providers—the companies delivering the contracts—to change their scope and their delivery model and to reduce their costs. We have reached agreement with BT but still have some way to go before we come to an agreement with CSC. We will absolutely maintain the principle that suppliers will get paid only when they deliver working systems. We are pushing harder for faster results, and have made it clear to suppliers that we will not tolerate further delays. It is important to state that every single penny saved will be reinvested in improving patient care.

When it comes to NHS IT, there are, I am afraid, no easy choices. Several Members have mentioned that we have just carried out another major projects review, the outcome of which we expect to know in two to three weeks’ time. Until we have had the opportunity to consider the review’s conclusions, we will not be making any decisions on future investment.

It should not be said, however, that nothing has been achieved over the past decade, as many essential elements have already been delivered. Regarding national infrastructure, there is the spine, which is the core service that connects all other systems at both national and local level and handles, among other things, more than 11 million daily queries made on the personal demographics service.

N3, the secure network that links all NHS organisations to each other, to outside data centres and to the internet, has almost 50,000 connections. The NHS internal e-mail service handles 2 million e-mails every day.

As for national applications, every day, choose and book processes about 30,000 appointments, the electronic prescription service sends about 660,000 prescription messages and about 2,000 records are transferred electronically using the GP2GP system. On the summary care record, as a result of the two reviews that I commissioned last summer, we now have agreement on the core data to be held and the approach to roll-out. More than 30 million patients have been contacted about the summary care record.

Systems implemented by the programme are making a difference to patients’ experiences and to clinical efficiency, safety and effectiveness. For example, at Morecambe Bay, infection prevention is now fully electronic, using the Lorenzo system. In St Barts, clinicians are alerted to all patients carrying MRSA through the Millennium system. The Royal Free hospital has also used Millennium to create safety procedure information, including for endoscopy data and bleeding guidelines.

Although progress in delivering local systems has been slower than anticipated, BT has delivered community and mental health systems to all trusts in London and the south that requested them, and the Cerner Millennium system to just over half the London trusts that require it. CSC has delivered to 83 acute trusts in the north, midlands and east of England using upgraded interim systems. It has also delivered iSoft’s Lorenzo e-patient record system to 10 trusts and completed delivery of 137 prison health IT systems across the country.

The NHS needs local systems to be fully integrated with the core components supplied by the programme. The interoperability toolkit will help. It is a core part of the “connect all” strategy, enabling trusts to exploit their existing systems fully. There is a great deal of interest in the approach; 78 suppliers and 71 health organisations attended the last forum on the toolkit. It is already being used to good effect at Newham hospital to deliver a patient check-in kiosk, and at Liverpool Broadgreen hospital to provide a consolidated view of patient information across multiple care settings.

All but 14 of the more than 8,000 GP practices in England have a system supplied by either the national programme or the GP systems of choice scheme, which has allowed us to maintain several small and medium suppliers in the market. In the south, we have used the additional supply capability and capacity framework for community and mental health to bring together 10 trusts to leverage their combined buying power while increasing their choice.

Security must always be at the front of our minds when we consider NHS IT systems. Great care is taken to ensure that systems are secure, and we carry out regular tests to ensure that they cannot be penetrated inappropriately. My hon. Friend will have heard late last week about the hacking of the SHINE sexual health website run by the East London NHS Foundation Trust. The website was an information-only site that carried no patient data and a local service that was not connected to any data held nationally. The issue was dealt with promptly, and the trust urgently reviewed its local security arrangements and is satisfied that no further breaches are possible. We also operate a rigorous process of role-based access controls to ensure that only the clinicians treating a patient have access to sensitive clinical data.

Because NHS systems are so critical, they need to be far more robust and stable than those outside the programme. We invest a great deal of money in ensuring that if systems go down, each and every component can be automatically recovered. Should a whole system fail, it can be recovered and made available for clinicians to use within two hours. Of course, such a level of disaster recovery does not come cheaply, which helps explain differences in price between some systems in the programme and similar systems procured by some trusts outside the programme. Systems bought locally will need to meet the technical and data standards laid down by the national commissioning board in order to participate in the networked environment.

I turn to the points raised by the hon. Member for Leicester West and my hon. Friend the Member for Thurrock (Jackie Doyle-Price). The hon. Member for Leicester West asked about the role of the NHS Future Forum. There were no specific responses about NHS technology systems, but it is clear that information flows are essential to link interventions and outcomes. However, as she said, we concentrated on the information revolution through the document that flowed from the White Paper last summer. As she also said, a consultation was held. We have been considering the responses, and we will publish them in due course. At the moment, I cannot give her a definite time.

The reason for the delay—I hope that she will appreciate this—is that during the eight to nine weeks of the listening pause on NHS modernisation, a decision was taken not to publish the responses to the information revolution consultation, if only to help the hon. Lady, so that she could not accuse us of not pausing sufficiently to listen to people and of carrying on regardless of what was going on in the listening exercise. I hope that she will give us credit for holding a genuine listening exercise and appreciate why we did not publish during that period. It was not least to forestall her criticism of us for doing so.

The hon. Lady also asked about the transitional vehicle. As she will appreciate, it is required to manage the existing arrangements and support local systems. It will not determine what needs to be done; the shape, scale and timeline have still to be determined exactly. We are working on it as part of the response to the pause, and we will determine in due course how it will operate to provide that support and move forward under the auspices of the national commissioning board.

My hon. Friend the Member for Thurrock asked about ensuring value for money and checking everything. I can give her assurances on that, because it is crucial. There is little point continuing to talk about the past, partly because we were not responsible and would not have done things as the last Government did them. We are where we are. We must learn from our mistakes and move forward. I hope that my hon. Friend will accept from my comments that we have grasped the nettle, accepted that the approach was wrong and learned from our mistakes, and that we will continue to learn and to seek to ensure that we have the information system critical to a modernised NHS and improved and enhanced patient care and patient experience, while minimising the problems that have haunted this episode ever since its introduction a decade ago.

I hope that my hon. Friends and the hon. Member for Leicester West will accept that we are moving forward, learning lessons from the past and seeking to ensure that we have a system that meets the requirements of a modernised NHS and, above all, is fit for purpose and does what the NHS needs it to do.

Oral Answers to Questions

Simon Burns Excerpts

Tuesday 7th June 2011 Commons Chamber

[Pat Glass (North West Durham) (Lab)]

12. What recent assessment he has made of the ability of all NHS hospital trusts to become foundation trusts by 2014.

[The Minister of State, Department of Health (Mr Simon Burns)]

The Department is currently in the process of working with strategic health authorities to establish timetables for every NHS trust to achieve foundation trust status by April 2014, and to agree the actions that are required to achieve that. That work is ongoing, and once plans are finalised, they will be published locally.

[Pat Glass]

The Minister will have to make some difficult decisions very soon about specialist children’s heart provision. In my part of the world, the choice will be between the NHS trusts in Newcastle and Leeds. Can he confirm that those decisions will be based on clinical outcomes, not political expediency?

[Mr Burns]

I can give the hon. Lady a categorical assurance that they will be based on clinical outcomes, not political considerations. I hope she will accept that it would be inappropriate for me to say anything further at this point in the proceedings, because we are in the middle of a consultation process at arm’s length from Ministers.

[Mr Stewart Jackson (Peterborough) (Con)]

Over the past 12 months, the Peterborough and Stamford Hospitals Foundation Trust has spent thousands of pounds of public money in connection with a vacant site—the former Peterborough district hospital site— and has yet to take it to market, despite having a £38 million deficit this year. Will my right hon. Friend ask Monitor to ensure that trusts make use of, and dispose of, valuable public assets in a timely way, in the best interests of both the taxpayer and the local health economy?

[Mr Burns]

I hope that I can reassure my hon. Friend by giving him a straightforward yes in answer to that question.

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

Will the Minister look urgently at what is happening in Trafford? The Trafford Healthcare NHS Trust has decided not to seek foundation status and is looking to transfer its acute services to another local provider. One difficulty with that is the projected funding shortfall of £55 million. Will he take a close interest in that, and seek to resolve the current uncertainty?

[Mr Burns]

I am grateful to the right hon. Gentleman for that question. I am aware of that situation and of the problems at that hospital. My understanding is that the strategic health authority is working hard with the trust to seek a solution. That work will continue until a viable solution is found.

[Nick de Bois (Enfield North) (Con)]

13. What recent assessment he has made of progress by GP pathfinder consortia in delivering improvements in NHS services.

--- Later in debate ---

[Lilian Greenwood (Nottingham South) (Lab)]

18. What assessment he has made of the potential role of (a) competition and (b) co-operation and collaboration in the NHS.

[The Minister of State, Department of Health (Mr Simon Burns)]

Co-operation and competition both have important roles to play in improving services for patients. We want to see better integration of services to improve quality and increase choice for patients. Following the listening exercise, we are awaiting the report on the best way forward.

[Lilian Greenwood]

The Deputy Prime Minister says that he wants Monitor to promote co-operation and collaboration, while the Secretary of State says that competition can lead to a far greater degree of integration. It is good that the Deputy Prime Minister has finally caught up with the views of the public and health professionals—but which of those fundamentally contradictory views will end up in the Bill?

[Mr Burns]

First, we all want co-operation and competition based on quality. We have had a listening event, and we are awaiting the recommendations of the forum set up under Professor Steve Field. Until we see that report, we cannot comment. I can tell the hon. Lady, however, that we do not want the kind of system of competition in the health service that leads to an independent sector treatment centre in Nottingham being paid 18% more than the NHS for the services provided, and getting £5.6 million for not doing a single operation.

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

Does my right hon. Friend agree that a key focus for improving collaboration in the NHS must be to break down the silo working that occurs between adult social services and the NHS? That will be particularly pertinent in improving elderly care services and mental health care services, and in providing a community focus for that care.

[Mr Burns]

Yes—and it is always refreshing to get a question from someone who has had experience of working in the NHS and actually knows what he is talking about. My hon. Friend is absolutely right; greater integration of services is crucial if we are to break down the barriers and get improved, high-quality care for all patients.

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

I was interested to hear the Minister’s earlier answer to my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) about the situation in Trafford. Will he confirm that he will encourage a collaborative approach, involving the strategic health authority, the primary care trust, the existing foundation trust and the potential bidding foundation trust, to secure the best possible clinical and financial outcome for patients?

[Mr Burns]

Yes, I can tell the hon. Lady that it will be up to the SHA, the trust and officials at the Department—[Interruption.] The SHA is the strategic health authority in the north-west. It is for them to work together to produce a tripartite formal agreement—when agreed, it will be published for the local community to see—as the best way forward to seek solutions and to help trusts achieve foundation trust status. It is in their interest and the interest of patients to bring about improved, high-quality patient care.

[Henry Smith (Crawley) (Con)]

19. What steps he is taking to improve mental health services.

--- Later in debate ---

[Mr David Ruffley (Bury St Edmunds) (Con)]

The Labour Government paid independent sector treatment centres 11% more, on average, than they were prepared to pay NHS hospitals. Will the Secretary of State confirm that such a practice forms no part of his health reforms?

[The Minister of State, Department of Health (Mr Simon Burns)]

I share my hon. Friend’s concerns, and those of his constituents, about the appalling situation whereby not only were ISTCs paid more than the NHS, but they were paid considerable sums for doing no work at all. It was a sham and a waste of money that could have been spent on front-line services, and I can give him the categorical assurance that it will not happen under this Government, or under my right hon. Friend the Secretary of State.

Stillbirth

Simon Burns Excerpts

Wednesday 18th May 2011 Westminster Hall

[The Minister of State, Department of Health (Mr Simon Burns)]

It is a pleasure to serve under your chairmanship, Mr Crausby.

I congratulate my hon. Friend the Member for Daventry (Chris Heaton-Harris) on securing this important debate and on the sensitive way in which he commented on a deeply distressing set of circumstances that, sadly, affect far too many families in this country. My hon. Friend has an active interest in this area, with his support both for his constituents who have suffered the tragedy of stillbirth and for the I Have Rights Too campaign, to which he alluded.

My hon. Friend asked for help from Department officials in an individual case. If he is kind enough to contact me with further details, I will be more than happy to ask my officials to look into what could be done to help. I cannot prejudge what might happen—there are too many unknown quantities—but he has my assurance that we will see whether there is anything we can do to help. I would certainly like to provide help if that is humanly possible.

For most people, having a baby is the most profound and important event of their lives. It is a time to make plans and look forward to a future with all the joys that having a child can bring. To lose a baby, at birth or shortly afterwards, is devastating for parents and the wider family. Anyone who has been fortunate enough not to have undergone such a tragic circumstance cannot fully appreciate the depth of devastation and despair of such a family; nothing could be worse in family life.

It is important for parents who have lost a baby to receive immediate and ongoing support and information at a time that is appropriate for their needs. Parents might find it helpful to talk to their GP or community midwife who, as well as providing support, can provide advice on the bereavement and counselling services available locally, such as those provided by specialist bereavement-support midwives.

To support the NHS in the provision of such services, in 2008 the Royal College of Obstetricians and Gynaecologists published “Standards for Maternity Care”, which sets out clear standards for the levels of care that should be provided to help patients and families whose baby is stillborn or dies shortly after birth. Comprehensive guidelines for professionals, on “Pregnancy Loss and the Death of a Baby” have been developed by Sands—the Stillbirth and Neonatal Death Charity. For parents, the pregnancy care planner on the NHS Choices website provides information on stillbirth, to complement information provided locally, and signposts other sources of help, including Sands, which I hope individuals find helpful at what is a difficult time.

Forms and certificates are often greatly valued by parents as a way to acknowledge and commemorate the life of their baby. The Births and Deaths Registration Act 1953, as amended, provides for the registration of babies born dead after 24 weeks’ gestation, which is the legal age of viability. A certificate of registration and a certificate for burial or cremation are issued.

Parliament supported a change to the stillbirth definition from “after 28 weeks” to “after 24 weeks” in 1992, given a clear consensus in the medical profession at that time that the age at which a foetus is considered viable should be changed. The medical certificate of stillbirth records the name of the mother and details such as the weight, the estimated duration of pregnancy and when the child died—before labour or during labour—as well as the cause of death and whether a post-mortem has been or might be carried out.

Some parents find it deeply distressing that they cannot legally register the birth of a baby born before 24 weeks, as my hon. Friend mentioned; the definition involves a baby born before 24 weeks who did not breathe or show any signs of life. However, it is important to recognise that some parents would be distressed at the possibility of having to do so. When a baby is born dead before 24 weeks’ gestation, hospitals may issue a local certificate to commemorate the baby’s birth.

The devastating effect of any stillbirth cannot be overestimated, and we recognise the distress that parents might face when having to deal with the further impact of a post-mortem examination. The Human Tissue Act 2004, which applies in England, Wales and Northern Ireland, established the Human Tissue Authority to regulate the removal, storage, use and disposal of any body parts, organs and tissue. Consent is the fundamental principle underpinning the Act.

The HTA has issued codes of practice that provide practical guidance and lay down expected standards in relation to activities within its remit, such as the carrying out of a post-mortem examination. The code on post-mortem examination recognises the particular difficulties involved when pregnancy loss or stillbirth has occurred, and emphasises the need for sensitive communication and the provision of further advice and guidance for parents when necessary. That is especially important when the pathology results have implications for future pregnancies.

The funeral arrangements for a stillborn child are a matter for the parents, or for the relevant health or local authority if the parents are unable to meet the costs. Individual local authorities decide what burial facilities to offer, but public graves for the interment of stillborn and young babies remain in some areas. In many cases, sections of the cemeteries may be set aside for the burial of babies, and that can provide some comfort for bereaved parents. Whatever arrangements are made, we expect them to be provided with dignity and sensitivity.

I turn to the UK’s record. My hon. Friend made a number of valid points. He alluded to a recent series on stillbirth in The Lancet, which ranked the UK stillbirth rate 33rd worldwide, below many other high-income countries. Since 1999, there has been a small reduction in the stillbirth rate for England—from 5.3 per 1,000 total births, to 5.2 in 2009. However, over the past 50 years the rate has declined significantly; for example, in 1960 the figure for England and Wales was 19.8.

Historically, there has been a step in the right direction, but I fully understand the validity of my hon. Friend’s point: even if the rate has declined in the past 10 years, the difference is marginal, suggesting that considerable work has still to be done to bring the rate down further and to minimise the number of occasions on which families have such a traumatic experience. The Government want to improve health outcomes, which is a key focus of our NHS reforms. We have made the reduction of perinatal mortality, including stillbirth, an improvement area under domain 1 of the NHS outcomes framework for 2011-12.

What can be done to reduce the risk of stillbirth? First, every unexpected death of a baby should be investigated. The National Patient Safety Agency has published a pro forma for the review of intrapartum-related perinatal deaths, for use by health professionals, and it may also be used for the review of all perinatal deaths. The aim is to find any avoidable factors, to identify any lessons to be learned, and then to develop and disseminate an action plan to deal with issues arising from the information. Secondly, it is imperative that we continue to drive forward improvements in maternity and new-born services, so that all women and their children have access to safe, high-quality and locally led care.

In recent years, there have been encouraging improvements in antenatal care. The Care Quality Commission’s survey of women’s experiences of maternity services was published in December 2010, and found that 92% of women rated their maternity care as good or better. We should be proud of that, but more can be done and needs to be done to improve care during pregnancy, labour, birth and the postnatal period. It is important that women access maternity services at an early stage; we believe that that is one of the most fundamental characteristics of high-quality maternity care. We therefore included the maternity 12-week early access indicator as one of the measures for quality in the NHS operating framework for 2011-12.

Encouraging early access to maternity services will enable women who can be identified as being at increased risk of stillbirth to receive additional support and monitoring. The National Institute for Health and Clinical Excellence will develop new quality standards on antenatal care, the management and care of women in labour and delivery, and postnatal care. Based on the best available evidence, the standards will play a key role in the Government’s vision of an NHS focused on improving outcomes for patients.

We believe that there should be more accountability within the NHS, and the outcomes framework will be used to hold the NHS to account for the outcomes that it delivers through commissioning health services from 2012-13. We also believe that the availability of a full range of services, as close to home as possible, is fundamental to safe, high-quality maternity care. To help to achieve that, we have made extending choice in maternity services a key priority for the NHS. Maternity provider networks will help to make safe, informed choice throughout pregnancy and in childbirth a reality, and will facilitate movement between the different services.

I am pleased to announce that my hon. Friend the Under-Secretary for Public Health plans to host a meeting on stillbirth later this year. It will consider the issues in more detail and consider what more can be done to help reduce the number of stillborn babies and provide an opportunity for all pregnant women to receive accurate and timely advice on risk factors and simple measures to reduce risk—for example, stopping smoking.

Pregnancy is a vital time for health promotion. Parents are motivated to do the best for their children, so they are particularly receptive to information and advice. That means that maternity services, when delivered well and with a holistic approach, can help to tackle some of the biggest public health issues facing us as a nation, to do with nutrition, physical activity and health inequalities—not just for infants and children, but for all of us.

My hon. Friend asked about research in the Department and the NHS, and I shall briefly address that issue. First, the Department of Health continues to invest in research in this important area. The Department’s National Institute for Health Research in Cambridge has an ongoing programme to look at women’s health. A major focus of that research is understanding the factors linked to stillbirth, and to use that information to improve the clinical care of pregnant women. I hope that that goes some way to reassure my hon. Friend that research is ongoing and that we take the issue extremely seriously because of the implications and level of the problem in this country, given its high income and standard of living compared with other nations around the world. We can do better, and we must do better.

I want to speak about another issue that my hon. Friend did not raise specifically, but I hope that he will find it useful in the context of this debate. Financial support is of great importance to families who may have a financial problem when they suffer the devastation of a stillbirth or early birth. Information on financial support is made available through the “Money made clear” leaflet on

“Late miscarriage, stillbirth and neonatal death: financial help available”.

It collates the information that parents may need from a range of cross-Government organisations and the voluntary sector. The leaflet contains information on whether, following late miscarriage, stillbirth or neonatal death, parents are eligible to receive free prescriptions and dental treatment, Healthy Start free vitamins and vouchers, statutory maternity pay, maternity allowance, statutory paternity pay, child benefit, the child trust fund and child tax credit.

That document is easily accessible in its format, so people do not have to be referred from pillar to post to find information and answers to questions that may be relevant to them, or uppermost in their minds when seeking a solution. It is worth putting that on the record so that people have an opportunity, when it is applicable or when they are suffering difficult financial circumstances, to be able easily to ascertain where and what they may do to access help at what is always a difficult time.

I conclude by thanking my hon. Friend for calling this debate. The issue is important simply because of the utter devastation, despair and misery that it causes to far too many families in this country. We take it extremely seriously, as I hope my hon. Friend recognises from the activities and actions that I have outlined and that the Department of Health and the NHS are pursuing. We continue to give the matter the highest priority, because we must do more to help families who face such a devastating and terrible loss.

Future of the NHS

Simon Burns Excerpts

Monday 9th May 2011 Commons Chamber

[John Healey]

Let me help the hon. Lady. For the first time, all parts of the NHS, including the commissioning job, will be opened up to private companies and subject to competition. As I have said, independent sector treatment centres played a part in our being able to clear long waiting lists and restore the quality of service to the NHS, as well as in supplementing the mainstream NHS, not substituting for it, which is what will happen under her party’s Bill.

[The Minister of State, Department of Health (Mr Simon Burns)]

Just for the sake of balance, will the right hon. Gentleman confirm that such treatment centres were also prime cherry-pickers and that between 2003 and 2009, the private sector was paid £250 million for not carrying out a single operation?

[John Healey]

The right hon. Gentleman will know from his current position that the premium that we paid in the first wave of treatment centres was stopped in the second wave. He will also know that by the end of our period in government we had stopped the independent treatment centres programme; and he ought to know that built into his Bill’s impact assessment is what it calculates to be a 14% premium, paid to providers under his proposals.

[Mr Burns]

indicated dissent.

[John Healey]

It is in the impact assessment; I suggest that the right hon. Gentleman take a good look at it.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

At the instigation of the Opposition, we have spent the past three hours debating the future of the national health service, and yet in not one single speech from their Members did we hear any mention of what they would do for the future of the NHS. We heard from the right hon. Member for Holborn and St Pancras (Frank Dobson), who is always a joy to listen to. He objected to the Blair/Brown health service reforms and to our proposals to improve the NHS, apparently without fully understanding them. We heard speeches from the hon. Members for Pontypridd (Owen Smith) and for Easington (Grahame M. Morris) that were simply a continuation of what we had to listen to for eight long weeks in the Bill Committee.

We had a sensible and reasonable speech by my right hon. Friend the Member for Charnwood (Mr Dorrell). My hon. Friend the Member for Totnes (Dr Wollaston) made an interesting speech and was right—absolutely right—to encourage the greater integration and seamless provision of social care and health care, because that is so important.

We had an excellent speech from my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), which was based on his experiences of having worked in the national health service, and we had a good speech by my hon. Friend the Member for Stafford (Jeremy Lefroy), who raised a number of questions. Time does not permit me to answer them all, but I remind him that, because of my right hon. Friend the Secretary of State, the Care Quality Commission started an unannounced investigation of nursing in hospitals to look specifically at dignity, respect and safety.

During this debate there have been times when the facts seem to have been obscured, so it is time that we had a reality check: our population is ageing—in 20 years’ time 2.5 million people will be over the age of 85; the cost of new medicines has almost doubled in the past 10 years, from £6.7 billion to £11.9 billion, rising last year alone by £600 million; and new surgical procedures are breathtakingly effective but expensive.

Those are the pressures facing the NHS at a time of economic turmoil inflicted on this country by the previous Labour Government. As a result, there are real challenges that the NHS must meet, so it does no one any good to scream “privatisation” as soon as we start exploring the best ways to safeguard the health of our children and of our children’s children. It is scaremongering of the lowest order, because this Government will never privatise the NHS. We have been, and we always will be, committed to an NHS free at the point of use for all eligible to use it.

In fact, when the Labour party was in government, it introduced private companies into the NHS on a scale that would have produced howls of outrage if we had done the same, but it was not privatisation then and it is not privatisation now. The previous Labour Government gave £4.7 billion to private companies in 2009-10 alone, and, unbelievably, to add insult to injury, £250 million of that money was given to private providers as payment for operations that never even happened.

We want to see a much fairer relationship, one that does not undermine the NHS but means increased choice for patients and better outcomes. That means saving thousands of lives every single year from conditions such as heart disease, respiratory disease and cancer. It means people with long-term conditions having their quality of life revolutionised with the seamless provision of care; the care that people receive being as good it possibly can be, based not on percentages or pie charts but on people’s real experiences; and the relationship between patients and doctors being humanised rather than seen as a means to an end—a relationship of equals based on trust, transparency and the best available treatment from the best available provider.

Every sensible-thinking person in the House knows that patient care can be improved if the NHS becomes more efficient. Efficient treatment is faster, cheaper and more effective. The previous Government knew that as well. We are carrying on their plans for £20 billion of efficiencies, plans that the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) brought in, whereby every penny saved will be reinvested in patient care.

To those who say that the plans are happening too fast, let me remind them that this coalition Government are giving the NHS an extra year to find those efficiencies, over and above what the Opposition would have allowed. On top of that, we are protecting front-line spending and, in fact, increasing the NHS budget overall in real terms.

We also want to see the quality of our clinical care improve so that a patient’s care will be among the best in the world, whatever they are being treated for. But these are not just pretty words and noble intentions; we are making real changes and patients can already see a real difference.

We are removing layers of unnecessary management so that clinicians have the freedom to look after in-patients rather than inboxes, and there are examples of improvements in care throughout the country. To look at just one, Oxford’s John Radcliffe hospital has invested in an electronic blood transfusion system that cuts the time taken by staff to deliver blood and reduces transfusion errors to improve services for patients. That saves the NHS £1 million every year to reinvest in patient care, because it is more efficient. That is the reality of efficiency, and it goes hand-in-hand with innovative, forward-thinking care.

Underpinning all our plans is the philosophy that a more integrated NHS is a better NHS—ending stop-start care and making sure that, from the point of diagnosis, every patient has seamless care that spans health care, social care, mental health care and, of course, a reliable support network afterwards so that patients can just concentrate on getting better.

We want GPs and other health care professionals, social care providers and local councils to come together to provide seamless services, whereby, for the patient, the lines drawn between those organisations fade to nothing. Giving autonomy to clinicians, in the form of consortia, will allow that to happen, and I hope that that reassures my hon. Friend the Member for Totnes.

Let us ask Dr Howard Stoate, who some Members might remember was Labour MP for Dartford until last May. [Interruption.] I know that the hon. Member for Islington South and Finsbury (Emily Thornberry) does not like this, but she will have to listen to it once again, because he is leading pathfinder consortia in Bexley. GPs such as Dr Stoate take a broader, more responsible view of care, working with others throughout the country and across primary, community and secondary care to manage, treat and refer their patients.

They are all in an ideal position to design services in collaboration with all the different strands of the NHS and, of course, with those beyond the NHS as well. Patients, who will have their own personal care budgets to spend how they like, will be involved every step of the way.

As I have said before, everyone knows that the NHS has to change. The noble Lord Warner, a Labour Health Minister for more than three years under the previous Government understands that point. [Interruption.] I am disappointed that the hon. Member for Leicester West (Liz Kendall) laughs, because at the time she thought that he was a valued Minister in the Department of Health. That point about change is in his book—a thoroughly good book, by the way, which I suggest she reads if she has not already done so. He says that reform is essential, because failure cannot be allowed to carry on taking taxpayers’ money and providing a sub-standard service to the public.

Reforming an organisation the size of the NHS is a big challenge, but it is also a big opportunity. What we propose is not simply to tread water or to be satisfied with the NHS just scraping by; we want to see it improve for the benefit of patients in every way.

There is no reason why we have to put up with care that is anything less than world-class, and our plans revolve around that happening: cutting down inefficiency; empowering clinicians; giving them—

[Mr Alan Campbell (Tynemouth) (Lab)]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Main Question accordingly put.