Departmental Expenditure Limits

Simon Burns Excerpts

Tuesday 23rd November 2010 Written Statements

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

Subject to the necessary supplementary estimates, the Department of Health’s element of the departmental expenditure limit (DEL) will increase by £20,860,000 from £106,260,372,000 to £106,281,232,000 the Administration Cost Limit has increased by £4,201,000 from £211,079,000 to £215,280,000. The Food Standards Agency DEL decreases by £16,059,000 from £130,989,000 to £114,930,000. The Administration Cost Limit will reduce by £5,389,000 from £56,299,000 to £50,910,000. The overall DEL including the Food Standards Agency will increase by £4,801,000 from £106,391,361,000 to £106,396,162,000. The impact on resource and capital are set out in the following table:

Health (CSR)

Simon Burns Excerpts

Thursday 11th November 2010 Westminster Hall

[Grahame M. Morris (Easington) (Lab)]

It is a pleasure to serve under your chairmanship for the first time, Mr Gale.

I thank the Backbench Business Committee for allocating this slot. I sought the debate to allow right hon. and hon. Members the opportunity to examine the real impact of the Chancellor’s comprehensive spending review on the Department of Health, the national health service and, indeed, public health.

The coalition Government have set out a 0.4% real-terms budget increase over the spending review period. Although the numbers suggest that the Government are providing the NHS with a modest increase in its budget, the decisions they are making will mean cuts to services, staffing, capital spend, medicines and care. In truth, it is the worst settlement for the NHS in its 62-year history.

During the course of the debate, I want to challenge the Government’s claim that they have met their coalition agreement pledge to guarantee that health spending increases in real terms in each year of the Parliament. Right hon. and hon. Members should note that £1 billion a year is being taken from the existing NHS budget to meet some of the growing costs of social care.

Not only is the coalition failing to rise to the task of dealing with the growing crisis in social care but, by transferring responsibility for social care to local government, it is trying to rob Peter to pay Paul, and then pretending that Peter still has money. Both the Nuffield Trust and the House of Commons Library have confirmed that due to the transfer of money from the health budget to social care, there will actually be a cut in the health budget. The latest House of Commons Library research report confirms:

“Including the (social care) funding is critical to the description of the settlement as a ‘real terms increase’; without it, funding for the NHS falls by £500 million—0.54% in real terms.”

For social care, there are storm clouds on the horizon. Even with the additional money taken from the health budget, there will be a shortfall of at least £2 billion—as set out by the Local Government Association—to maintain current standards by the end of the spending review period. It seems like another broken promise to say that the coalition will provide sufficient resources to maintain current levels of social care.

On top of that, the Government are removing the ring fence from the personal social services grant and merging the social care budget into the local government formula grant. The NHS Confederation has noted that with councils facing a 26% cut in their funding from central Government, money for social care might not get to those who need it. In short, this means that there is no guarantee that the money will be used as intended, thus creating a postcode lottery in care and a Government who are washing their hands of their responsibility to provide dignity to the most vulnerable in our society.

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

Just to put the hon. Gentleman out of his misery, as he has prayed in aid the King’s Fund, would he care to comment on—and does he agree with—its briefing for the debate? It says:

“In the context of significant cuts to other Whitehall budgets, the settlements for health and social care are generous. The government has met its pledge to protect the NHS budget and has prioritised additional funding for social care.”

[Grahame M. Morris]

We have crossed swords before over an interpretation of figures. Later in my speech—

[Mr Burns]

It is the King’s Fund.

[Grahame M. Morris]

I intend to come to the King’s Fund in a moment. I suspect that the Minister is quoting rather selectively from its brief.

[Mr Burns]

To help the hon. Gentleman, and because I would like an answer to the question, may I say that I am not quoting selectively? I suspect that he, too, has the briefing. The quotation is at the top of page 4. It is the first and only paragraph of the conclusions, so it cannot be out of context.

[Grahame M. Morris]

I intend to come to the King’s Fund in a moment.

[Mr Burns]

Answer that.

[Grahame M. Morris]

I will answer in a moment, if the hon. Gentleman gives me the opportunity.

I am also quoting figures from a recent House of Commons Library note—perhaps the Minister has a copy as well. It seems quite clear to me that, in terms of departmental expenditure limits and certainly in terms of capital, we are looking at a 17.9% reduction over the lifetime of the Parliament. Indeed, the Minister and I, and other colleagues from the north-east, have raised issues about NHS capital funding in the past—I want to mention those later in my speech. I am conscious that other hon. Members want to make contributions, so I shall press on for the moment and hopefully I can respond to the Minister in a little more detail in a moment or two.

To highlight some of the anecdotal evidence, at a recent meeting of the Community Practitioners and Health Visitors Association, which is part of the union Unite, front-line workers gave their feedback on the impact of cuts already in the pipeline. They expressed concern that a reduction in the number of practitioners was eroding the service to the public, that specialist staff were already being made redundant, that vacancies were being frozen, that case loads were getting bigger and that patients had to wait longer. They further pointed to a reduction in vital health promotion work, which has been highlighted before, and the fact that health visitors were now working significantly over their paid hours in chaotic circumstances.

--- Later in debate ---

[Grahame M. Morris]

My hon. Friend makes a valid point. The White Paper “Equity and Excellence: Liberating the NHS” certainly seems to be setting out in that direction.

Certain projects, and particularly one in my area, have suffered as a result of the departmental expenditure limits that I mentioned earlier, which will result in a decrease of 17.9% over the four-year life of the Parliament. A new hospital in the north-east of England at Wynyard was to have served the southern part of my constituency of Easington, as well as the constituents of Stockton North and Stockton South, and those in parts of Sedgefield and Hartlepool, but it was an early casualty of the cuts.

In the longer term, the coalition partners seem to want not a capital budget, but to pursue a roll-out of private finance initiative hospitals. They want to place every privately built hospital into competition in the private sector so that they can be commissioned by GPs controlling the entire health budget in the private sector. The direction of travel for the health policies of the present Government is clear, but it is my belief that the duty of the Government should be to protect essential public services such as the NHS from the distorting effects of the market.

We need to learn lessons from recent history. It is ironic that my party’s efforts in government to incorporate market conditions in health showed that that could drive costs up rather than bring about efficiencies. Such an example was recently cited in the media. The Coventry University hospital was built under a PFI scheme. As we all know, PFI allows private companies to build public sector infrastructure, but although it gives the benefit of delayed costs to the public purse, those companies are entitled to levy huge interest rates, fees and services charges in the longer term. Treasury figures show that when the contract for Coventry University hospital is paid off in 2041, the estimated cost to the taxpayer will be £3.3 billion. If the state had built the hospital, the cost would have been a fraction of that sum. Indeed, the hospital at Wynyard was costed at £464 million—that is an incredible difference. Market discipline and privatisation do not automatically produce value for the public purse.

[Mr Simon Burns]

Will the hon. Gentleman confirm that that PFI scheme took place under a Labour Government and was approved by a Labour Treasury?

[Grahame M. Morris]

The Minister is right, but I was making the point that important lessons from history need to be learned. We are reacting to evidence that PFI does not necessarily provide value for money. Each case has to be considered on its merits.

Given the real-terms cut to health spending, an agenda of wholesale management reorganisation and the effective privatisation of the NHS budget, the impact of the comprehensive spending review and the Department of Health White Paper will not only alter the principles on which the NHS was founded, but squeeze health provision, increase costs, allow hospitals to go bust if they are failed by the markets, and create a postcode lottery of health services. There is widespread opposition to elements in the White Paper among health care professionals, including from the British Medical Association, which is not noted as radical left-wing organisation. The BMA states that it has

“opposed the increased commercialisation and competition imposed on the NHS in recent years and there is little evidence of any benefits to patients. It brings with it additional costs as well as disincentives for collaboration and co-operation.”

Staff costs account for more than half of NHS expenditure. Future decisions on pay will have a great impact on the health budget. The Royal College of Nursing has already highlighted short-sighted cuts by NHS trusts to their work force and services. The RCN is aware that about 10,000 nursing posts have been earmarked for removal in anticipation of cuts to front-line services. What consideration has the Minister given to the pressure to increase staff pay in coming years? By 2013-14, GPs will have had their pay frozen for four years; consultants for three years; and NHS staff earning more than £21,000 for two years.

[Grahame M. Morris]

I do indeed. My hon. Friend makes an important point. Another is the impact on the NHS budget of the VAT increase that is to be implemented on 1 January 2011.

Kieran Walshe, professor of health policy and management at Manchester business school, has criticised the coalition Government’s approach of making change without evidence. The implementation of the massive reorganisation that is set out in the White Paper will need at least another £3 billion in addition to the sums already identified, such as for wage costs, inflation, and the increase in VAT. That is at least another £3 billion from the NHS coffers, and the plans were still being altered after the coalition agreement was published. The decision to abolish primary care trusts seems more like a last-minute whim of the Secretary of State than a well-thought, evidence-based approach to health service reorganisation.

Professor Walshe said:

“the transitional costs of large scale NHS reorganisations are huge…projected savings from abolishing or downsizing organisations are rarely realised.”

Those of us who have been involved with local government will appreciate how true that is. He continued:

“Closing down or merging organisations produces a round of expensive redundancies, early retirements, and redeployment, while new organisations find new premises and appoint lots of new staff.”

I echo the concerns of Mencap—I am grateful for its briefing—which states

“As the government have still been unclear about the transitional and ongoing costs for moving to the new commissioning arrangements, this settlement may not be sufficient to deliver against needs.”

In contrast, the Secretary of State still believes that he can save money by carrying out the biggest reorganisation in the history of the NHS. Indeed, on 2 November, he said:

“We are cutting management costs in the NHS by 45%. We will cut total administrative costs as well, and in total that will save £1.9 billion a year by 2015.”—[Official Report, 2 November 2010; Vol. 517, c. 759.]

Will the Minister tell us what account has been taken of the unknown costs of the reorganisation?

Professor Chris Ham is the chief executive of the King’s Fund—the Minister’s favourite organisation. He questions why the Government would

“embark upon such a fundamental reorganisation as the NHS faces up to the biggest financial challenge in its history.”

Is it not the case that Ministers should be honest with the public? The impact of the spending review will mean deep cuts to vital services in the NHS. When the Health Secretary delivered his White Paper to the House, he said:

“The dismantling of this bureaucracy will help the NHS realise up to £20 billion of efficiency savings by 2014, all of which will be reinvested in patient care.-—[Official Report, 12 July 2010; Vol. 513, c. 663.]

Coalition Minsters are trying to give the impression that health provision has somehow been protected by a real-terms increase in the health budget, but that myth is starting to unravel. The coalition Government have admitted that current levels of health care will not be maintained. They are undertaking a massive reorganisation and all the evidence suggests that the projected savings will not be realised.

Edward Macalister-Smith, the chief executive of NHS Buckinghamshire, said:

“the amount of money that is available from administrative savings, management savings and the financial back office, is a very small proportion. Most of the money is spent on clinical care. If you want to reduce your spending, make your spending more efficient, that is, I am afraid, where you have to concentrate.”

It is simply not possible to achieve the sort of savings that the Government have outlined. The settlement for the NHS will come no way near maintaining current health care levels. Some £1 billion is being taken to plug the hole in social care. Many more billions are being wasted on a wholesale reorganisation, and the coalition seems to have agreed to take a gamble with the £80 billion NHS commissioning budget.

According to research carried out by the King’s Fund, the VAT rise to 20% from January next year will cost the NHS an additional £250 million a year. Furthermore, additional pressures will be placed on the NHS, thanks to the massive cuts that are being levied on local government budgets. There are also serious concerns that cuts to local government will lead to a shortage of hospital beds as the elderly and vulnerable are left without local care, thus placing even greater pressures on the NHS. The 26% cut in central Government funding for local authorities will pile on the pressure for the NHS. Nigel Edwards, the head of the NHS Confederation, has warned that the pressure on beds could mean that hospitals will be unable to admit patients “who badly need care”.

It is wrong for Ministers to pretend that their reorganisation will improve service delivery or that it is possible to save £20 billion through efficiencies alone. They should be honest about what they are doing to our national health service. The Government are not keeping the promises that they made to patients and staff to protect NHS health care funding.

[Mr Simon Burns]

I would hate the hon. Gentleman to escape from his earlier promise. He said that he would comment on the quote I cited, which, I repeat, has not been taken out of context. Let me remind him what it:

“In the context of significant cuts to other Whitehall budgets, the settlements for health and social care are generous. The government has met its pledge to protect the NHS budget and has prioritised funding for social care.”

Does not the hon. Gentleman agree with that element of the King’s Fund briefing; he seems to agree with anything that suits his argument?

[Grahame M. Morris]

Yet again, the Minister is quoting one specific element of the evidence. The King’s Fund evidence is quite extensive. It is logged on the Health Committee’s website and is open for the public to see. Many commentators and respected organisations take a view that runs counter to that expressed by the Minister.

I shall conclude because I know that other hon. Members wish to speak. Political and NHS leaders need to be realistic about the implications of the financial situation for patients, the public and staff. There are no pain-free options for the NHS. It is time that Ministers were honest about the future of the NHS. There is no doubt that over the spending review period, the NHS will have its spending power reduced. It is time for the Government to be honest with the public about the decisions they have made.

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[Ian Mearns (Gateshead) (Lab)]

Thank you for your indulgence, Mr Gale, in allowing me to speak this afternoon. I apologise; I was in the main Chamber earlier for the debate on policy for growth. I also thank my hon. Friend the Member for Easington (Grahame M. Morris) for securing the debate. To look at us, one would not believe that we are often mistaken for each other. I do not see how that comes about, but I understand that it does—it is something to do with the accent, I believe.

Despite pledges that the NHS would be ring-fenced from Government cuts, according to press reports, dozens of accident and emergency and maternity units have been earmarked for closure or merger. Let me highlight a few: Newark hospital in Nottinghamshire will have its A and E services downgraded, and emergency admissions will stop being taken from April 2011. At the Queen Elizabeth II hospital in Welwyn Garden City, A and E services will be downgraded and the consultant-led maternity unit could be closed. There will also be a downgrading of A and E services at Rochdale infirmary. The Conservative’s election manifesto promised a moratorium on the forced closure of A and E units and maternity wards, so what happened to that pledge?

The situation proves that the settlement provided for health by the comprehensive spending review is not sufficient to meet the pledges made by the coalition parties. As my hon. Friend said earlier, the Prime Minister’s promise in January, and the coalition agreement pledge to

“guarantee that health spending increases in real terms in each year of the Parliament”,

will not be met.

[Mr Simon Burns]

Rubbish.

[Ian Mearns]

The settlement agreed by the coalition will leave the NHS unable to meet growing cost pressures, and that will reduce its purchasing power each and every year. The Government seem to be in denial—that has just been shown by the Minister’s sedentary comment.

Kieran Walshe, professor of health policy and management at Manchester business school, who has already been cited in the debate, puts the figure for reorganisation at up to £3 billion, but there is nothing to say that it will not cost significantly more. We do not yet see where the money will come from.

One of the last reorganisations under the Labour Government involved reducing the number of primary care trusts from 303 to 150. In oral evidence to the Health Committee, Sir David Nicholson, the chief executive of the NHS, stated that it generated

“significant management cost savings and gains at that time. If you look at productivity in the NHS in 2006-07, by 2007-08 you see productivity improved.”

If streamlining and reducing commissioning bodies has saved significant amounts in the past and created efficiencies, why does it appear that the Government now want to create more commissioning bodies? Some say that up to 500 general practice consortiums would be required, but it could be more than that.

The GP involvement in the process is questionable. My local experience in Gateshead as deputy leader of the council with the adult social care portfolio was that it was often difficult to engage GPs in the process of partnership working—they are very busy people. In addition, it takes time for any organisation to become an effective negotiator in commissioning relationships with acute care providers, and to develop health provision plans and purchasing capacity. Why is the coalition placing those additional pressures on the NHS at a time when it is cutting its spending power?

Press reports—the Minister refers to these as rubbish—give fairly extensive lists of hospitals facing A and E closures, maternity closures and cutbacks. Let me quote an example:

“Despite pledges that the NHS would be ring-fenced from government cuts, dozens of A&E and maternity units have been earmarked for closure or mergers.”

Those are the words of not some revolutionary incitement periodical, but The Sunday Telegraph. I do not think that many of the people on yesterday’s demonstration about the proposed hikes to tuition fees were hawking The Sunday Telegraph as some kind of revolutionary organ with which they could incite the crowd to further action.

The Sunday Telegraph refers to:

“More than 30 maternity and casualty units facing the axe”,

and provides us with a significant list of examples from all over the country. It also tells us that, as a result of the spending review, the NHS faces a bed-blocking crisis. It states that the permanent closures and downgrading of services agreed since May affect many hospitals.

[Mr Burns]

Give us some.

[Ian Mearns]

There is a long list. However, according to The Sunday Telegraph:

“Maternity units in Tiverton, Okehampton and Honiton, Devon: plan to downgrade services so they will not offer any midwife care overnight. Solihull Hospital: maternity unit was shut as a temporary measure just before the election. It re-opened in July as a midwife-led unit. Proposals to make the closure permanent due to be published within weeks”—

I could go on. For Hartlepool, in my region, we are told that there is a “proposal to close A&E” and that that will be

“replaced with minor injuries unit, and direct admissions for emergency medical cases.”

Of course, that comes on the back of the announcement a couple of months ago of the cancellation of the replacement North Tees hospital.

[Mr Burns]

I would hate the hon. Gentleman to mislead the Chamber. He can quote examples, but given that he is the Member for Gateshead, I would assume that he is familiar with this. Surely he knows that Hartlepool has withdrawn the application to close the A and E.

--- Later in debate ---

[Mr Simon Burns]

Old Labour.

[Derek Twigg]

No, not all old Labour at all. There has been a mix of Labour: young, old, new—some a bit younger than others. My hon. Friend the Member for Easington made some very important points about this being the worst settlement since the 1950s, and he raised the point about rising to the challenge of the financial settlements and the impact on social care. We heard many important points from my right hon. Friend the Member for Rother Valley (Mr Barron) who, along with my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson), is probably the most experienced person in the Chamber, given his knowledge of the health service and his involvement in it over the years. One of those points was what the Nuffield Trust said about this being a real-terms cut, once the £1 billion that is being transferred from the NHS is taken out—I shall come back to that later. My right hon. Friend also made an important point about how the Government have used a Health Committee report to support their policies. His point was very clear, and he also raised the important issue of commissioning for GPs.

My hon. Friend the Member for Newport West (Paul Flynn) made a very important point about NICE and drugs companies with reference to funding and influence. My hon. Friend the Member for West Lancashire (Rosie Cooper) has great experience in the health service. She is a near neighbour, and our areas successfully share the excellent women’s hospital in Liverpool. She made a number of powerful and important points about the reorganisation and cost pressures, and their effects on patient care. She also talked about Ministers not listening—[Interruption.] I know that the Minister has listened to what has been said in the Chamber, but Ministers’ listening will also be an important aspect of the reorganisation.

My right hon. Friend the Member for Tottenham (Mr Lammy) made a powerful speech. I think he said that because he had believed what was in the Conservative and Liberal Democrat manifestos, he was somewhat disappointed—[Interruption.] Perhaps I got that wrong, but he made the point that what was said before the election and in the manifestos is not now being delivered.

[Derek Twigg]

I always carry a copy of the coalition’s programme for government—it is a fascinating read and, I must say, comforting at times.

My right hon. Friend the Member for Tottenham made some important points about mortality, the different life expectancy rates in his constituency, and the impact of the 28% cut on local government services, to which I shall return later in my speech.

[Mr Simon Burns]

I advise the shadow Minister to take the analysis of the right hon. Member for Tottenham (Mr Lammy) of the impact of the so-called figures that he used with a pinch of salt, because he also said that when he was as a Health Minister in 2001, he remembered the PCTs beginning to bed down. That was rather confusing, because of course the PCTs were not established until 2002.

[Derek Twigg]

The hon. Gentleman should have listened much more carefully to what my right hon. Friend the Member for Tottenham said. He made a lot of good points, including one about GPs being put under pressure by the reorganisation due to the fact that some of them do not have the skills that it will require. That was a very powerful point, because many GPs are either opposed to or very uncertain about the Government’s proposed reorganisation.

My hon. Friend the Member for Gateshead (Ian Mearns) made a very impassioned speech about his own experience, his local health service, of which he has great knowledge, and the consequences of the Government’s actions for A and E and maternity units. He also made an important point about the great uncertainty in the health service as a result of the reorganisation—not just financially, but in all aspects of the service.

It is worth reiterating that we have had some successes in the health service, although many of them were achieved in recent years by the Labour Government rather than during the Conservatives’ 18 years in government. Back in 1997, I was regularly contacted by constituents who had to wait between 18 months and two years to have an operation. We have now got that time down to 18 weeks or fewer, and two to three weeks for cataracts. I set out that information because the Government will be measured on such things, although I am not sure whether they will be “outcomes”, “horizons” or “milestones”. A million more operations have been carried out each year since 1997, and there is now rapid access to chest complaint clinics. A large part of the NHS estate dates from before 1948, but we now have more than 100 new hospital building schemes and more than 90 NHS walk-in centres.

We have not achieved those gains for patients without sustained, deliberate and targeted investment. The combination of reform and investment that Labour undertook when in it was power has brought about tangible results for patients: heart disease deaths are down by more than a quarter; cancer mortality rates are down by more than a tenth; and breast cancer and male lung cancer death rates have been cut faster than anywhere else in the world. Under the cancer target, patients now see a cancer specialist within two weeks, which saves many lives. We made real investment and real change, and real people’s lives were made better. Let us see how the coalition intends to honour some of Labour’s guarantees. It has scrapped the right to cancer test results within one week of referral.

[Mr Burns]

Will the hon. Gentleman please explain in rational terms how something that was never in place can be scrapped?

[Derek Twigg]

As I said, that was one of our guarantees, and the Government have not taken forward those guarantees. They have gone against what we said, which was welcomed by many patients and organisations. Free prescriptions for vulnerable patients with long-term conditions have been scrapped and, in this Parliament, some 8,000 new psychological therapists have been scrapped.

--- Later in debate ---

[Mr Burns]

The shadow Minister is a reasonable and intelligent individual, so he knows that we did not scrap that target because it was never in place. All that happened was that the previous Prime Minister, at his party conference just over a year ago, made public an aspiration that was totally unfunded and totally untried against any clinical guarantee for quality.

[Derek Twigg]

The Minister should realise that he cannot meet what we proposed. I notice that he intervenes on that point, but not to congratulate us on the many improvements that we made in the NHS over the years. I look forward to hearing what he says about those improvements in his speech.

Returning to mental health, the Department of Health website says:

“Policy around mental health is developing…Mental health policy cannot be devised and implemented by any single government department or the NHS alone – it requires collaboration across central government, local government and the independent sector.”

We knew that already, did we not? However, the coalition has cut those 8,000 therapists. Of course the financial climate is difficult, and whomever was in government would have difficult choices and decisions to make, but the Prime Minister and the coalition have, again, broken their promises on health, which I want to explore, particularly with reference to the CSR.

For all the coalition’s boasts of ring-fencing the total NHS budget, the negligible 0.1% increase in NHS spending over the CSR period is low by historical standards, as we have heard. The King’s Fund has been cited, but let me give another quote from it:

“the NHS has averaged real terms increases of 4% a year since it was established and 7% since the turn of the century. The only similar period of near-zero real terms growth was in the early 1950s”—

I think that the Minister agrees. Spending in the NHS has increased from 6.6% of gross domestic product in 1996-97 to 8.7% in 2009-10.

The Minister might be interested to hear that the Royal College of Midwives has said:

“there are fears that a funding increase of 0.1% a year could be swallowed up by a rise in drugs, an ageing population, the cost of reorganisations and inflation.”

While we are on the subject of midwives, will the coalition deliver on the pre-election pledge to increase substantially the number of midwives, or will that be another broken promise?

Perhaps the Minister will want to respond to my next point. The CSR also announced that £1 billion will be transferred from the NHS budget to local councils for spending on social care. He will argue that that is designed to improve working relationships between the NHS and local social services departments, to improve health and to reduce costs on the NHS, such as by helping older people to stay healthy and independent in their homes. Of course, that is a good thing. However, the Government cannot have it both ways and double count. This is a real-terms change in NHS funding over the next four years. When we consider the net funding for social care support, there is a reduction of 0.5%, which is a real-terms cut.

[Mr Simon Burns]

indicated dissent.

[Derek Twigg]

The Nuffield Trust actually supports that point of view. This is a broken promise. Will the Minister confirm that not all the additional money for social services announced in the CSR is ring-fenced?

[Mr Burns]

I want to respond to the point that the shadow Minister made about the Nuffield Trust. He said that we were giving £1 billion to local authorities for social care, but we are not giving—[Interruption] I think that he did say that, but if he did not, we will wait for my speech.

[Derek Twigg]

Let me make it clear that £1 billion is being taken out of the NHS budget. Is that correct?

[Mr Burns]

Carry on.

[Derek Twigg]

Therefore that is a real-terms cut of 0.5%.

[Mr Burns]

indicated dissent.

[Derek Twigg]

I am asking the Minister to intervene. Has £1 billion been taken out of the NHS budget for social care?

[Mr Burns]

I will be careful because of the context in which the shadow Minister is trying to put the matter. We have made no secret of what we have done. Because of the lack of funding for social care and the demand for it, which we inherited, we have decided that we will use £1 billion out of the capital budget on social care and, at the same time, local authorities, through the revenue support grant, will provide another £1 billion. There will be £2 billion of extra money: £1 billion from the health service, which the health service will spend, and £1 billion through the RSG.

[Derek Twigg]

I am not sure about that, although I am always happy for the Minister to intervene. Will he confirm, just for the record, that £1 billion has been taken out of the NHS budget?

[Mr Burns]

indicated dissent.

[Derek Twigg]

I will carry on and we will take this up later during the Minister’s speech.

Will the Minister make clear whether the money has been ring-fenced? What what will be the impact on local services of the 28% cut in councils’ budgets over the next four years, which was announced as part of the CSR? We must not forget the increase in VAT to 20% from January, which several of my colleagues mentioned, which will do little to enhance the NHS’s spending power. It is little wonder that the King’s Fund feels it necessary to warn:

“slashing budgets and cutting services should not be the answer to the financial challenge facing the NHS.”

I cannot allow the Government to get away with another disastrous decision for the NHS and it will be interesting to see what the Minister has to say about this.

The NHS has accumulated £1.8 billion of capital and £3.7 billion of revenue underspend. It would normally be allowed to keep that money to reinvest in patient care or to help deal with future overspends, but the CSR has abolished end-of-year flexibility. Perhaps the Minister would like to deny that or tell me that we have got it wrong.

What estimate has the Minister made of the number of job losses and redundancies in the NHS that will occur as a result of the CSR? What will be the impact on waiting times in the spending review period? What is his estimate of the number of nurses who will be employed in the NHS at the end of the spending period? What measures has he implemented to deal with winter pressures? How many specialist nursing posts will be left vacant at the end of this financial year? I have many other questions. We do not have time to go into them now, but I shall be tabling a lot of written questions for the Minister to answer.

We now move on to another broken promise in the context of the CSR, which has been the subject of a fair bit of comment. An ideologically inspired, top-down reorganisation of the NHS has been proposed. It has been put forward in defiance of the coalition agreement. The approach is untested and threatens the viability of the NHS. I remind hon. and right hon. Members that the coalition agreement says:

“we will stop top-down reorganisations of the NHS”—

another broken promise. Here is a straight question for the Minister: why, as many believe, did his party hide their plans for such a massive reorganisation from the public? Why did it make no mention of the scale of the proposed changes in its manifesto or election campaign? This is the biggest reorganisation in NHS history. The King’s Fund estimates the actual cost at some £3 billion, and that is at a time when the NHS can ill afford it. The British Medical Association has stated:

“these proposals risk undermining the stability and long-term future of the NHS”.

What is the Minister’s latest estimate of the financial cost of the reorganisation, and will he publish the rationale underpinning the assumption for those costs?

The coalition talks about reducing waste, but the 45% cuts in strategic health authorities and primary care trust management will save just £850 million of the £15 billion to £20 billion of efficiencies that are required. I could not agree more with the words of my right hon. Friend the Member for Wentworth and Dearne (John Healey):

“This reorganisation is untested and unnecessary. It is high cost and high risk. At this time when finances are tight, all efforts should be bent to making sound efficiencies and improve patient care. We are in favour of giving clinicians greater responsibility and patients a greater say in their healthcare. NHS experts, professional bodies and patient groups say ‘slow down’, because this big reorganisation is a big risk for the NHS.”

Trade unions such as Unison, the RCN and Unite, who represent many who work in the NHS, have raised genuine concerns, but we do not believe that the Secretary of State is listening to what is being said.

As part of these changes, there is danger of fragmentation, of more of a postcode lottery and of doctors’ time being diverted from their main role of looking after their patients. We need to know the extent and nature of future private sector involvement in running the health service. How and to whom will organisations be accountable? How can we deal with current overspends in organisations, which my right hon. Friend the Member for Tottenham mentioned?

Will the Secretary of State and the Chancellor listen to the appeal of patient groups, Royal Colleges practitioners and other health staff, or is he bent on setting his face against the view from the coal face—from the same professionals whom his party’s manifesto says we should trust to deliver services?

I want to mention another important issue: the proposed stealth cuts to the funding of specialist children’s hospitals, which will affect the hospitals that treat some of the most severely ill children in the country. The Prime Minister promised that the health budget would be “protected”. In an interview with Andrew Marr on 2 May 2010, he said that he

“would not accept cuts to the NHS”.

It is unarguable that specialist children’s services are the front line, so even that is not being protected. This is another promise broken by the Prime Minister.

The Secretary of State is not being straight on this matter. During oral questions on 2 November, he told my right hon. Friend the Member for Holborn and St Pancras that the hospital that my right hon. Friend asked about would face a 2% cut under the proposed tariff changes. That is bad enough, but it is contradicted by the trust’s own assessment of those changes, which suggests that they will bring about much larger cuts. Will the Minister set out—I ask him this carefully—what the situation is and how much funding the hospitals will lose?

I will give a couple of examples of the figures that we have received from the hospitals involved. Great Ormond Street hospital, which is in the constituency of my right hon. Friend the Member for Holborn and St Pancras, will face a cut of £16.3 million. In Birmingham, the cut will be £12.8 million, and at Alder Hey hospital, on the doorstep of my constituency, it will be £12.9 million. Will the Minister confirm what the funding cuts will be and how much those hospitals will lose? What figures have the hospitals provided to the Department in their assessments of the cuts? Will he make public any assessment that has been sent to his officials about the impact of the tariff changes?

I do not feel that Liberal Democrat or Conservative Members have realised the true extent of what the coalition Government are doing to the health service and the impact that it will have on their constituencies. Perhaps they are not in the Chamber because they find the measures difficult to support. As the impact of the health cuts becomes clearer, I believe that hon. Members will become more worried and will seek answers to the broken promises of the Prime Minister and the Secretary of State.

There have been broken promises on NHS funding to protect front-line services, and broken promises about structural change. Hon. Members might ask why the Secretary of State is forcing the NHS into a major reorganisation that costs valuable time and resources at a time that the King’s Fund and the NHS Confederation have called the biggest financial challenge of its life. I assure the Minister and the Secretary of State that we will hold the coalition Government to account for what they have said and what they will do.

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

I begin by thanking the Backbench Business Committee for and congratulating the hon. Member for Easington (Grahame M. Morris) on this interesting debate. In passing, let me say what a difference six months makes. Six and a half months ago, all the Labour Members who are sitting on the opposite side of the Chamber were in government. Some of the examples of reconfigurations and decisions taken on the health service happened under the last Labour Government, although some hon. Members seemed oblivious to that as they criticised what is happening.

[Grahame M. Morris]

Will the Minister give way?

[Mr Burns]

One moment; let me make a start. We have taken difficult decisions and, as I will explain, we have honoured our election pledge on a real-terms increase, albeit a modest one, as a number of hon. Members, including the hon. Member for West Lancashire (Rosie Cooper), pointed out. However, no hon. Member tried to explain why that increase had to be so modest, which amazed me. The reason was, quite simply, our inheritance of the most horrendous debt and deficit problems, left to us by the previous Government. That would have tied the hands of any party, including those of the Labour party had it won the election. Rest assured, if the previous Government had been re-elected, they would have been making serious cuts.

Having listened to a number of speeches, it is slightly ironic that some hon. Members present seem to be oblivious to the fact that one of the Labour leadership candidates during the recent campaign, the former Secretary of State for Health, the right hon. Member for Leigh (Andy Burnham), criticised us for honouring our pledge of a real-terms increase in NHS funding. He said that it was a disgrace that we were keeping to that pledge and that, in the overall spending programme, we should not be honouring our pledge of a real-terms increase in health spending. I find that a bizarre proposition from a former Labour Secretary of State for Health, but that was his view and his decision. Judging by the faces of some Labour Members, they seem oblivious to the fact that the right hon. Gentleman criticised us about that. That somewhat undercuts the arguments that I have heard today from those who say that we have broken our promise and not kept to a real-terms increase. They will have to make their mind up one way or another.

[Grahame M. Morris]

rose—

[Mr Burns]

Because I have such affection for the hon. Gentleman, I shall give way to him.

[Grahame M. Morris]

The Minister has just destroyed my reputation. My point is about the cost of the reorganisation at what is a difficult time for the economy. Why embark on an expensive major restructuring of the health service? It does not make any sense. Previous reorganisations were expensive and time consuming. Surely, if we learn anything from evidence, it is that now is not the time to do this. Another top-down reorganisation is the last thing we need.

[Mr Burns]

I am grateful to the hon. Gentleman for that intervention, and I am sure that his reputation will survive my praise of him. I shall, in my own way, come to the point that he raises.

Before I begin to explain why we have not broken our election pledge, let me congratulate the hon. Member for Halton (Derek Twigg). He is a dedicated and decent man who was always an exemplary Minister when he was in government. I am delighted to see him back on his party’s Front Bench, albeit in a shadow ministerial post, and I wish him well in his endeavours. I trust that he will be doing the job for many years to come and that the same fate will not befall him as sadly befell him when he left the previous Government: ironically—I grieve as much as he does about this—his place was taken by someone who was ostensibly a Tory, who was, for some bizarre reason, embraced with both arms by previous Prime Minister. It is great to see the hon. Gentleman back, and I look forward to many debates over the coming years as our careers continue.

This debate goes to the heart of two of the coalition Government’s main priorities: bringing the public finances back on to a sustainable footing and ensuring the future health of the nation. Our manifesto commitment, reiterated in the coalition agreement, was to increase spending on the NHS in real terms for every year of this Parliament. Notwithstanding the comments of some hon. Members, I am tremendously proud of the fact that we have kept the faith and honoured that pledge. Before anybody jumps up to try to intervene, let me remind them that I am proud of keeping that pledge.

The right hon. Member for Leigh, the former Secretary of State in the outgoing Labour Government, has criticised my party for keeping that pledge because he thought it was wrong. It would be difficult for any Labour Member to claim that we have broken the pledge, because, by definition, if we have broken the pledge, the right hon. Gentleman is factually incorrect in his criticism of us. It is a bit of a dilemma for Labour Members.

[Mr Barron]

rose—

[Mr Burns]

I give way to the former Chair of the Health Committee.

[Mr Barron]

What does the Minister say when the Nuffield Trust states that the Government have broken the pledge by reducing spending by 0.5%?

[Mr Burns]

We will come to that point. Whenever there is a parliamentary briefing or statement for a debate that fits the prejudices that Labour Members want to project—their straitjacket—that is fine, but anything that does not conform to their prejudices or prejudged views, or to the facts, such as the comments from the King’s Fund on which I kept pressing the hon. Member for Easington, which confirmed its view that we had honoured our pledge and made a real-terms increase, they dismiss as fiction. I am afraid that I do not share the support offered by the right hon. Member for Rother Valley (Mr Barron) for the views in the Nuffield Trust document.

I will come on to social care spending, because I know that the shadow Minister, the hon. Member for Halton, made quite a lot of that. I will try, in a longer period than I would have in an intervention, to show that he is wrong and the Government are right.

[Frank Dobson]

Will the hon. Gentleman give way?

[Mr Burns]

I will, but then I must make progress.

[Frank Dobson]

What is the Government’s estimate of the money that will be consumed by the process of reorganisation during the process of reorganisation?

--- Later in debate ---

[Mr Burns]

I will briefly answer that now; I was going to come to it later. The figure that has been bandied around by shadow Ministers, Labour Back Benchers and so on is £3 billion. The Department does not recognise that figure. We recognise the figure that the previous Secretary of State for Health, the right hon. Member for Leigh, put in this year’s Budget, which is 1.7%. He put that in specifically for reorganisational purposes under a Labour Government. That is the only figure—[Interruption.] That is the only figure that we recognise.

[Derek Twigg]

Will the Minister give way?

[Mr Burns]

Once, then I will make progress.

[Derek Twigg]

The Minister is using a figure that was in the Budget for reorganisation. I assume that that reorganisation is not the reorganisation that his Government are proposing, so have he, the Department and his officials made any assessment of the cost of their reorganisation? That cannot in any way be linked to a figure that was laid down by the previous Government; it is bizarre if it is. If they have made such an assessment, what is the rationale for it and will he publish it?

[Mr Burns]

I am saying that the previous Secretary of State had built in to this year’s Budget a £1.7 billion figure for reorganisational purposes and we recognise that amount of money as money that can or could be used for reorganisational purposes. On the question of the full figures, we will publish in due course our response to the consultation process on the White Paper and the documents that flowed from that White Paper. Also, we will respond on any decisions that we have taken emanating from that consultation process. We will also publish the Bill, which will flesh out more of the details where details need fleshing out.

As a number of hon. Members mentioned, there are parts of the Bill where we are not prescriptive and we are not dictating, down to the last dotting of an i and crossing of a t, what has to happen. That will be down to local decisions. That will then put us in a position—

[Derek Twigg]

Will the Minister give way?

[Mr Burns]

No. That will then put us in a position to move forward on the implementation and funding the costs of those changes. I shall now move on to deal with the rest of the issue. This year, before we spend a single—

[Frank Dobson]

Will the Minister give way?

[Mr Burns]

No. I gave way to the right hon. Gentleman once and I said that I would then make progress, because the purpose of my speech is twofold: to outline our view on the subject—

[Mr Lammy]

What are you scared of?

[Mr Burns]

I am not scared of anything. The purpose of my speech is to outline the Government’s view on the subject, rather than simply, as in an Adjournment debate, answering every single point from hon. Members who have contributed. I will not fall into the trap of being sidetracked into answering, as in an Adjournment debate, all the points that have been raised. I will certainly deal with those that I can deal with in the time available, but I shall primarily give the Government’s view on the topic before us, so I beg some indulgence from hon. Members as they listen and learn why we have kept our pledge.

I shall start again. This year, before we spend a single penny on health, education, defence or anything else, we shall have to pay £43 billion simply to service the interest on our debts. That is £120 million a day and more than £83,000 a minute. Those who are mathematicians will realise that during this three-hour debate that will have cost us £15 million. The colossal debt racked up by the previous Government is crippling the country. That is why, through my right hon. Friend the Chancellor, we have had to act decisively to lay the foundations for setting the economy back on track. The country simply could not continue to sustain such debt and payment of debt interest.

When the Chancellor stood at the Dispatch Box last month to deliver the spending review, he set a course for sustainable finances. He set out our plans to turn the country round, so that by the end of this Parliament our national debt will be falling, instead of rising, as a proportion of national income. To achieve that, over the next four years we need to reduce public spending by £81 billion. Difficult decisions have had to be taken, and more lie ahead, but the result will be a strong economy, more jobs and sustainable public services. As I have said, just as important as reducing the deficit is protecting and improving the nation’s health.

[Paul Flynn]

On a point of order, Mr Gale. There is a tradition in this place that Ministers making the winding-up speech reply to the debate. This Minister has been speaking for 14 minutes and has not mentioned a single point made in the debate.

[Mr Roger Gale (in the Chair)]

The hon. Gentleman has been in the House long enough to know that the Minister is responsible for his own speech and his own remarks.

[Mr Burns]

The hon. Member for Newport West (Paul Flynn) probably is not aware, because this is a new form of debate following the setting up of the Backbench Business Committee, that I am not winding up the debate, even if I am speaking last. I am making a speech on the Government’s position on the subject that we are debating, and I will certainly—on occasions, where appropriate—refer to and answer hon. Members’ questions, although I have to say to the hon. Gentleman that I probably will not answer any of his questions because he was not taking part in the same debate that is on shown on the annunciator. He was having a general roam-about on NICE and pharmaceuticals, rather than speaking on the spending review and health.

[Derek Twigg]

That is very unkind.

[Mr Burns]

No, it is not. It is a fact, and the hon. Gentleman knows it.

As I said before the intervention and the point of order, just as important as reducing the deficit is protecting and improving the nation’s health. That is why I am proud that we have kept our pledge to protect the NHS budget. More than that, it will receive an increase of 0.4% over the next four years. In this difficult financial climate, that demonstrates the Government’s determination to provide the best care and the best outcomes for patients.

This year, the NHS budget is £103.8 billion. That will rise to £114.4 billion by 2014-15. No matter how anyone looks at that, it is obvious that it is a real-terms increase. A number of people who have sent in briefings for this debate and who have commented on the spending review have echoed the view that I have just outlined. It is a self-evident fact that it is a real-terms increase, however much Opposition Members prefer to say that it is not. The facts do not bear out that criticism.

[Derek Twigg]

What about social care?

[Mr Burns]

The shadow Minister must be patient; I will come to social care.

The Department’s capital budget will be sufficient to ensure that key schemes that have already been agreed are continued and that the NHS estate is properly maintained. The NHS capital budget will pay for, among other things, publicly funded projects at North Cumbria University Hospitals NHS Trust, Pennine Acute Hospitals NHS Trust, and Epsom and St Helier University Hospitals NHS Trust.

Notwithstanding the real-terms increase in funding, we always knew that the NHS was facing challenging times. That is self-evident and we have never sought to hide behind it; everyone recognises it. As a number of hon. Members said, that challenge is due to an ageing population, expensive treatments, and health care and social care costs rising substantially every year. That is why the NHS and social care need to do more with their resources and make every penny count. In health, we are asking the NHS to secure, as a number of hon. Members said, up to £20 billion of efficiency savings over the next four years through the QIPP—quality, innovation, productivity and prevention—programme.

In addition, every penny of those savings will be reinvested in front-line services, enabling us to meet the costs of increased demand for care. The savings will come from cutting administration costs across the system by a third, as well as from other efficiencies throughout the NHS. Frequently, better care can save money. It is cheaper, as well as better for people, to get the right care first time, rather than the inappropriate or insufficiently relevant care that is involved when people have to go back to be provided with extra care—an expensive way to provide care and not an experience that patients should have.

[Rosie Cooper]

I appreciate what the Minister is saying, but does he not agree that radical change to or redesign of a system often requires investment to get those costs out at the end? We are hearing about lots of cost cutting, but there are no obvious signs of a process or pathway where investment is taking place to get those gains out.

[Mr Burns]

In the overall run of things, the hon. Lady makes a genuine point, but most of the cost cutting that I heard about during the speeches involved accusations of services being cut without the reasons for the status of what are, in many cases, reconfigurations being gone into. Also, until conclusions have been reached, there is no guarantee that those reconfigurations will happen. They might do so, but there is no automatic guarantee that, just because there is to be a reconfiguration, the end product will be what was first proposed.

Furthermore, I heard very little comment—indeed, I do not think that anyone passed comment, although I apologise if someone did—on the QIPP programme, which is so important and vital for raising standards, using innovation to improve quality of care and delivery. In that, we have examples across the country of the NHS finding changes that can make a big difference.

For example, Southend Hospital NHS Trust is saving £160,000 a year by mapping postcodes—patients who live near each other can be picked up together for their dialysis appointments. Oxford Radcliffe Hospitals NHS Trust is saving £1 million a year by implementing an electronic blood transfusion system, which cuts the staff time taken to deliver blood and reduces transfusion errors, thereby improving services for patients. Ten NHS trusts have been piloting a new pathway to improve care for patients, mainly elderly people who have suffered a fractured neck of femur. If that were rolled out across the country, it could save £75 million a year.

Those are just small examples of things that can be done where savings are made, the quality and appropriateness of care improve, and money can be ploughed back into front-line services, which is so important.

While we are talking about resources, I shall answer the important question asked by the right hon. Member for Holborn and St Pancras (Frank Dobson). He specifically mentioned Great Ormond Street hospital, but this applies across all the specialist children’s hospitals. The Department is having ongoing discussions with Great Ormond Street and the other relevant hospitals in England about potential—I emphasise “potential”—changes to the tariff for specialist children’s hospitals for 2011-12.

I can tell the right hon. Gentleman that no decisions have yet been taken and the discussions are continuing. On his specific question about how much less money is going to be given, there is no answer at the moment, because no decisions have been taken. The discussions will continue. I hope, for the time being, that he is reassured by that answer.

[Frank Dobson]

Can the Minister confirm that Great Ormond Street hospital was asked to do without £16 million during the course of those wondrous negotiations he is talking about?

[Mr Burns]

No, but I will confirm that discussions with the hospital are ongoing and, flowing from that, decisions will be reached in due course. At this point it would be inappropriate for me to interfere by giving any confirmation or denials of anything, because the situation does not arise in that context. Discussions are going on, and no decisions have been made. We will have to see once the discussions are concluded.

[Frank Dobson]

Will the Minister give way?

[Mr Burns]

I cannot see how much more I can say, because my answer seemed fairly conclusive.

[Derek Twigg]

rose—

[Mr Burns]

Does the hon. Gentleman want to intervene about social care, which I want to move on to?

[Derek Twigg]

No, it is on the specific point that has just been made.

--- Later in debate ---

[Mr Burns]

I can say nothing further than what I said to the right hon. Member for Holborn and St Pancras, so I shall make progress. There is nothing further to say—I have answered the question. [Interruption.]

[Mr Roger Gale (in the Chair)]

Order. We cannot have such discussions going on across the Chamber. Either the Minister will give way or he will not.

[Mr Burns]

I will not give way because there is little more that I can add to what I have already said on the subject.

[Frank Dobson]

rose—

[Mr Burns]

I shall make progress, because I have made the situation plain.

[Frank Dobson]

rose—

--- Later in debate ---

[Mr Roger Gale (in the Chair)]

That is not a point of order for the Chair, Mr Dobson.

[Mr Burns]

All I can tell the right hon. Gentleman is the situation as it is known to me: no decisions have been made and discussions are continuing. In due course, decisions will be reached, but as of now none has been made and the discussions continue.

[Frank Dobson]

Will the Minister give way?

[Mr Burns]

I honestly do not see what more I can say—my answer seems fairly conclusive, so I will make progress. If the right hon. Gentleman wants to have a quick word with me afterwards, I am more than happy to do so.

Moving on to social care, which a number of hon. Members and the shadow Minister have mentioned—

[Frank Dobson]

On a point of order, Mr Gale—as I understand it, the Department of Health has been briefing that it wants to take away only £4 million from Great Ormond Street.

[Mr Roger Gale (in the Chair)]

Order. That is not a point of order for the Chair. The right hon. Gentleman has been in the House long enough to know that.

[Mr Burns]

On the issue of social care, it is accepted by all parties that we need to be more efficient. There have been historic problems in the funding of social care and we found that, given the mounting pressures and the economic situation when we came to power, there was a serious problem that needed to be addressed so as to provide support in the forthcoming year and thereafter for some of the most frail and vulnerable members of society.

We believe, as I am sure the hon. Member for Halton does, that re-ablement services can restore someone’s independence. They have a crucial role to play, where appropriate. Around half of those who go through re-ablement require no immediate care package afterwards. The NHS is investing £70 million this year, £150 million in 2011-12 and £300 million a year for the rest of this Parliament in better re-ablement services. That will have a significant impact on improving the lives of many people.

Telecare, too, can help keep people safe and feeling more confident in their own homes, reducing their reliance on formal home care services. These are not isolated cases. There are similar remarkable stories across the country.

Re-ablement can make a real difference, provided that the authorities act seamlessly and quickly to ensure the equipment and anything else needed to assist someone to return home, avoiding a stay in a hospital, care home or any other non-domestic environment.

[Derek Twigg]

We will pursue the issue about specialist children’s hospitals, but I will now concentrate on the issue of the £1 billion that the NHS has set aside for, or put into, social care. No one argues that putting more money into social care is not a good thing, but we want to ensure that there is no double counting. The Minister confirms that £1 billion has been set aside, but will some of that money, or all of it, be used to fund the social care side of those services provided by local authorities?

[Mr Burns]

If I may, I shall start on that point in my own way, as I want to give the setting for the whole social care thing. I know that the hon. Gentleman and the right hon. Member for Wentworth and Dearne (John Healey) have shown considerable interest in the matter.

The shadow Minister accepts that the NHS does not stand alone. It is only one part of this country’s care system; another essential service is social care, which helps hundreds of thousands of people to live as independently as possible. As I said earlier, when the Government were elected, we found a huge hole in funding for social care. That affects some of the most frail and vulnerable, and we believe that it is imperative to do something immediately to make up some of the shortfall. As the shadow Minister will know, the Department of Health has always funded social care—not all of it, but part of it—and local authorities have funded the other part. In some areas, there is a means test under the National Assistance Act 1948, so there are possibly three funding streams. I hope that I carry the shadow Minister with me.

To redress the funding gap in social care, the NHS will transfer up to £1 billion from the health capital budget to the health revenue budget by 2014-15. That will be spent by the health service on measures that support social care as well as health. That will include a specific allocation for re-ablement services to help people regain confidence and independence following discharge from hospital. We believe that this will help hundreds of thousands of people to live as independently as possible. To the person who uses both services, it makes no sense that health and care should be separate. I hope that I have given the shadow Minister sufficient explanation.

[Derek Twigg]

rose—

[Mr Burns]

If I carry on for another minute, the hon. Gentleman may not need to intervene.

As well as the extra £1 billion that the Department of Health is making available for NHS social care, additional grant funding—again, rising to £1 billion by 2014-15—will be made available for social care through the revenue support grant. By 2014-15, the total additional funding for social care will amount to £2 billion, half from the NHS and half in grant funding. That will be allocated in addition to the Department’s existing social care grants, which will rise in line with inflation. In total, therefore, grant funding from the Department of Health for social care will reach £2.4 billion by 2014-15. I hope that that explains the situation for the shadow Minister.

[Derek Twigg]

I want to be clear about it, so I put the question again. How much of the £1 billion that is being taken from the NHS budget will be spent on services that council and local authority social services provide?

[Mr Burns]

The £1 billion will come from the NHS capital fund and be transferred to the NHS resources fund. It will then be spent by the NHS on re-ablement and other sorts of help and care for which the NHS is responsible. The NHS is responsible for the social care element of the assistance required by those in need. [Interruption.] So that the shadow Minister understands, on top of that, £1 billion will be coming from local government through the RSG.

[Derek Twigg]

It is in here.

[Mr Burns]

The shadow Minister says that it is in the document, as if it has suddenly occurred to him, but I am going through it slowly so that he gets it. Some of the letters that we have received are not quite right.

[Grahame M. Morris]

It is an important point, and an issue that the Select Committee has considered. Evidence presented to the Committee shows that, over the lifetime of this Parliament and beyond, the gap between funding and demand will grow. There will be an ongoing problem of underfunding in social care. I would not like the Minister to give the impression that this demographic time bomb can be resolved by this single measure.

[Mr Burns]

The hon. Gentleman is right. I do not claim that the demographic time bomb will be resolved by this measure. The trouble with personal social care is an historic one; Governments have always been playing catch-up. That is beyond dispute. I am saying that we recognised the growing pressures, and we believed that we had to act. That is why we have done so. It will reduce the problem, but the hon. Gentleman is right that it will not solve it, as more work has to be done. No doubt, it will be done, as we catch up with the past. I hope that I have reassured the hon. Gentleman. I now wish to make progress.

We believe that funding social care is important not only in its own right but for the sake of the hundreds of thousands of people who rely on it—and because the NHS cannot function without social care. Without it, people have to stay in hospital beds for longer, inappropriately blocking beds that other patients could use. It is important that we invest the money to ensure that there are no delayed discharges, and that we can provide an appropriate setting for those who are discharged.

[Rosie Cooper]

I thank the Minister for giving way. I am trying to be helpful. My hon. Friend the Member for Easington (Grahame M. Morris) is right. The Select Committee suggested that there was a £3 billion or £3.5 billion gap. Evidence to the Committee clearly showed that local authorities believed that if they invested a pound, the saving and the benefit was likely to be seen in the health service through exactly what the Minister mentioned—beds not being blocked and so on. This might help my hon. Friend the Member for Halton (Derek Twigg), the shadow Minister; I suggested in Committee that the element of funding that lies currently with local authorities should be transferred to the NHS. We would not then have such a gap. The local authorities resisted, but the core of the problem that both Front Benches are outlining is that the £1 billion that the councils have is not ring-fenced and will be spent on whatever provisions are desperately needed. The money that the Minister says is for the NHS will be spent only on NHS re-ablement and other stuff that is absolutely within the NHS, but the local authorities do not believe that. They think that it will be dropped on their toes at any minute, and that they can spend it.

[Mr Burns]

I fully understand the issue that the hon. Lady raised about whether we merge the NHS part of social care in local government into the NHS, or vice versa. That has been an ongoing debate for many years. The hon. Lady may find it difficult to believe, but 13 years ago I was the Minister with responsibility for social care. The argument was raging then. I have no doubt that it will continue to rage for some time to come. I, too, have heard the worries that the money that comes through the RSG will not be spent on social care. From the discussions that the NHS has had with local authorities, I have been led to believe that that will not be such a problem. Given that there is a problem with social care and a need to provide support, there will be a determination and a positive attitude to ensure that the money is appropriately spent on what it is designed for and that it will, with the money from the NHS, make a significant difference to a very serious and sensitive problem that we, as a society, have to address.

In conclusion, the spending review is the necessary consequence of this Government’s facing up to the financial responsibilities and problems that we inherited when we came to power. If we are to secure a future of growth, prosperity and jobs and if we are to fulfil our commitment to increase funding for the NHS in real terms for every year of this Parliament, then we must place our public finances on a stable, sustainable footing.

We will not ask the sick, the disabled or the elderly to pay the price of the previous Government’s economic mismanagement. We are increasing the health budget in real terms and reforming the service, not only to make the most of every penny but to put power in the hands of those who know best how to improve services. I am talking not about the Ministers and civil servants in Whitehall but about the NHS staff and patients on the ground.

[Mr Roger Gale (in the Chair)]

Mr Morris has indicated that he wishes to make a few closing remarks with the consent of the Members present. I am perfectly prepared to facilitate that, but the hon. Gentleman must understand that these are closing remarks, and that he is not actually responding to the entire debate all over again.

Clostridium Difficile

Simon Burns Excerpts

Tuesday 9th November 2010 Commons Chamber

[Mr Burrowes]

I am grateful to my hon. Friend. He makes the case for that proposal very well. Indeed, there are several innovative developments, not only in the hospital setting but in trying to look at prevention. Prebiotics is another area that is worth considering. I ask the Minister to look at supporting the centre I mentioned and at how we can support research in this field.

A C. diff infection exacts a great cost from the patient who suffers from it and the family who witness it. It is also financially expensive. In 2008, the Department of Health released a report called “Clean, safe care: reducing infections and saving lives”, which noted that treating one patient with a C. diff infection cost the NHS more than £4,000 per patient. By this estimation, and considering the number of infections reported last year, C. diff cost taxpayers close to £1 billion in the past 12 months.

It is true that C. diff has received a far more coherent and concerted response from the NHS in the past three years than it had previously. It is equally clear that this focus has had a positive effect on the quality of care and on survival rates in our hospitals. Last year the infection was noted on fewer than 4,000 death certificates and was considered to be responsible for deaths in 1,712 cases. That is less than half the rate in 2007, when more people died as a result of C. diff than as a result of road accidents. However, as the Secretary of State for Health has said:

“There is no tolerable level of preventable infections.”

I am grateful to his Department for making it clear that a zero-tolerance approach to health care-associated infections is a priority for the Government. During the week beginning 26 September, 190 new cases of infection were reported by hospitals in England and Wales—an average of 27 cases a day, or more than one every hour. There is no room at all for complacency.

One problem of which we need to be aware is the number of incidents of recurring C. diff symptoms in patients. I am greatly concerned that hospitals are releasing those who have suffered with the symptoms of the infection too early, which leads to many having to return to hospital with the same problem. I am glad that the Department has recently made it clear that hospitals are responsible for the care of a patient for up to 30 days after they have been discharged.

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

indicated assent.

[Mr Burrowes]

I am glad that the Minister fully shares my concern. It is good to know that hospitals cannot expect any additional payment for treating those who have suffered a recurrence during those 30 days. However, I ask him whether there could be any sanctions on trusts that sadly fail to reduce the rate of infection.

Along with the Department of Health, my constituent Graziella has produced a leaflet, which my hon. Friend the Minister helpfully distributed just before the debate. It is called “C. difficile—now you are going home”, and it sets out the best ways for patients to protect against the infection spreading. It is intended to be given to patients so that they can be aware of the risks and know how to prevent other vulnerable people from catching the infection. However, although both Graziella and I would like to see this leaflet distributed by every hospital and GP, there is no requirement that that happen. Many patients return home without the information in that fantastic leaflet about how best to protect themselves and others. Will the Minister consider requiring—or, in the more localising language that Conservative Members prefer, incentivising—hospitals to provide the leaflet or similar information to all patients leaving their charge who have had the infection?

Although improvements have been made in acute trust hospitals such as my local North Middlesex university hospital, it is important that we do not lose sight of the need to pay attention to what is happening in our primary care trusts. In fact, in every month of last year, PCTs reported far more cases of C. diff than acute trusts. Enfield PCT, which is by no means extraordinary in this regard, reported 144 cases in patients aged over two in just the past year.

--- Later in debate ---

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

I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on securing this debate on C. difficile. He has shown a strong interest in this issue for a very long period. Let me make it clear that the NHS should aim for a zero-tolerance approach to all health care-associated infections. I hope that what I say in my speech tonight will reassure my hon. Friend that we as a Government regard C. difficile as a priority and we will use all the levers at our disposal to support further significant progress in reducing this problem in our hospitals, care homes and other health facilities.

For most of the last decade, we saw unchecked increases in the number of MRSA and C. difficile infections, causing misery for thousands of patients and their families. However, in more recent years, the NHS has improved its infection prevention and control practices, which has led to a significant reduction in both C. difficile and MRSA bloodstream infections. I should like to take this opportunity to congratulate all NHS staff who were involved in turning the tide for their hard work in achieving that. From a high of around 56,000 infections in 2006, C. difficile infection has fallen to just over 25,000 in 2009-10. From almost 8,000 infections in 2004, numbers of MRSA have also fallen substantially to fewer than 2,000 in 2009-10. However, despite the progress that we have made, we can go further.

[Julian Smith (Skipton and Ripon) (Con)]

Will my hon. Friend give way?

[Mr Burns]

I would be grateful if my hon. Friend allowed me not to, because I have very little time in which to say a lot in answer to the questions from my hon. Friend the Member for Enfield, Southgate.

Despite the progress made, we can go a lot further to reduce infections, particularly of C. difficile. The previous Government’s approach was to introduce a rather crude national target for reducing infection rates that placed no specific obligation on individual organisations to improve their prevention and control systems or to reduce their own infection rates. We therefore find ourselves in a situation where, despite significant reductions at a national level, many organisations have made little or no improvement on their position years ago. The job of controlling C. difficile infections in the NHS is far from complete, and the NHS, in both secondary and primary care, must continue to prioritise reducing these infections. We will expose those poor-performing organisations that were able to ride on the coat tails of others, and force them to put their house in order.

My hon. Friend asked about monitoring care homes. I can assure him that, as part of our commitment to a whole-health economy approach to infection prevention and control, last month the adult social care sector became subject to the code of practice on the prevention and control of infections. Adherence to the code is a statutory requirement, and we expect to see improvements in infection prevention and control practice in the social care sector as a result of its introduction, in the same way as has happened in hospital settings. In addition, we have strengthened Care Quality Commission powers to ensure that, where required, appropriate action can be taken to address poor practice. Care homes should report single cases of suspected C. difficile to the resident’s general practitioner, and a suspected outbreak should be reported to the local health protection unit. I am confident that this additional strengthening of the measures will go some way to help reduce the problem in care homes.

The Government expect the NHS and social care organisations to take a zero tolerance approach to health care-associated infections, as I said at the beginning of my remarks. When patients have the relevant information, they can be the most powerful agents for change. In line with this, one of the first things we did was to publish weekly MRSA and C. difficile infection numbers by hospital, and the data are now available within weeks rather than months, giving a far more accurate picture of what is happening at a particular hospital. Patients can now clearly see and take account of this when choosing where to have their treatment.

My hon. Friend asked about making more information available. I can reassure him that one of the key parts of the White Paper on health reform in the NHS is on empowering patients by providing even more information relevant to them from independent sources. That means it will be reliable and accurate. It will also be provided in a way that is easily understandable, so that patients can see the areas of health care—in whatever shape or form—that are of particular interest to them. I would encourage anyone to respond to the consultation on the information revolution document that my right hon. Friend the Secretary of State published recently, so that we can consider all views on how to get this right and empower patients with information.

We also made it clear in the coalition agreement that we will use quality outcome measures, including HCAIs, to drive improvements in the areas that really matter to patients. In the near future, I want all organisations to be operating at the level of the best today. The challenge, therefore, will be greatest for those who have so far made the least progress. We have also decided to extend mandatory surveillance beyond MRSA and C. difficile, to provide a fuller picture of HCAIs within the NHS, which the previous Government resisted. As my right hon. Friend the Secretary of State announced last month, we will extend mandatory surveillance to include MSSA—meticillin-sensitive staphylococcus aureus—with infections such as E. coli to follow in due course, based on expert advice.

I know that my hon. Friend the Member for Enfield, Southgate has a strong interest in the different settings where C. difficile infections occur. For some years, such infections were essentially seen as a hospital problem, with hospitals being the focus for both central and local efforts to tackle them. However, that focus is not sufficient, as he mentioned. An unfortunate outcome of the previous focus on hospital-acquired C. difficile infections is a lack of awareness of the risks in primary care. Although we have seen substantial decreases in C. difficile infections in acute trusts, those occurring in primary care trusts—referred to as community-associated infections—have decreased at a far slower rate.

The origin of community-associated cases is not clear and needs further investigation. A significant proportion may be due to previous contact with previous health care facilities. In other cases there may have been no known links to health care, while others may be associated with antibiotic treatment in the community by GPs. GPs have a vital role to play in reducing the inappropriate use of broad spectrum antibiotics—those that attack a wide range of bacteria, but which can increase the risk of contracting C. difficile. GPs need to consider C. difficile when prescribing antibiotics, particularly to at-risk groups such as those who have recently been discharged from hospital or the elderly, as my hon. Friend rightly mentioned. Because such antibiotics can increase the risk of contracting C. difficile, prudent antibiotic prescribing is key. Although only a small number of C. difficile infections emanate from general practice, this is not an excuse to do nothing—not when the impact on individuals can be so great.

We will increase GPs’ awareness of the impact of antibiotic prescribing on contracting C. difficile infections and increasing antibiotic resistance. As part of that, we will use antibiotic awareness day on 18 November to focus attention on the need to reduce the unnecessary use of antibiotics. As my hon. Friend showed in his speech, we have produced leaflets and other materials that GPs, pharmacists and other professionals can use to raise the issue with patients and the public. Those materials make it clear that everyone has a role in improving prescribing and patient outcomes. To improve the evidence base, we are considering how to improve the monitoring of community associated cases. That links into our concern about the large number of readmissions to hospital within 30 days of discharge, which my hon. Friend also mentioned. The action that my right hon. Friend the Secretary of State took in the summer to alleviate the problem will, I believe, go a long way towards helping to find a solution to it.

Let me now turn to some of the questions that my hon. Friends have asked in this debate. I am grateful to my hon. Friends the Members for Watford (Richard Harrington) and for Enfield North (Nick de Bois) for drawing to my attention the equipment, which came from America, that is currently being tested in Northwick Park hospital. As they may be aware, the Department has established a mechanism, known as the rapid review panel, by which new products can be evaluated for their effectiveness against infections. As they said, the equipment is currently being tested at Northwick Park hospital. We await with interest the results of those tests, to see whether the equipment would be useful in the constant battle against such infections.

My hon. Friend the Member for Enfield, Southgate also asked what more the Government could do to ensure that GPs are fully briefed on C. difficile and respond to such knowledge efficiently and consistently. As I mentioned with social care, the forthcoming application of the code of practice to primary care will give a significant boost to improving GPs’ awareness and knowledge of infection prevention and control. We will publish the code shortly, and although primary care will not be subject to the requirements of the legislation until April 2012, the registration process with the Care Quality Commission will start much earlier, with all the benefits that this will secure, through increased focus and awareness. I trust that that will go some way towards reassuring my hon. Friend.

My hon. Friend also spoke about requiring hospitals to provide information to patients leaving their care. As he said, Graziella, with the Department of Health, has produced a leaflet on C. difficile, which he has seen. The best way to protect patients against the infection spreading is to provide them with information. The intention is to give the document to patients so that they are aware of the risks, and know how to prevent other vulnerable people from catching the infection. However, although both she and I would like the leaflet to be distributed by every hospital and GP, there is no requirement for that, and many patients are sent home without the information that they need to protect themselves.

We believe, as does my hon. Friend, that it is important for patients to have access to information. I certainly expect hospitals to provide that information to all relevant patients on their discharge. It is important to ensure that such leaflets are available for the NHS to use, and copies are available on the Department’s Clean, Safe Care website, but we must be careful not to be prescriptive on decisions about patients’ care that are best made at local level. I trust that many practitioners and hospitals at local level will recognise the importance of the leaflets and ensure that patients have them drawn to their attention.

Time is running out, and on the questions to which I have not had the opportunity of replying I will write to my hon. Friend so that he receives answers. I say again that we treat the matter seriously, and in the short time remaining I shall answer the final question about careful monitoring of patients in the community. Guidance, entitled “Clostridium difficile infection: how to deal with the problem”, has been published by the Department of Health and the Health Protection Agency, and provides evidence-based advice on how to treat C. difficile. We will take the opportunity in the forthcoming publication of the code to reiterate the value of that to GPs in their decision making, and I hope that my hon. Friend will find that reassuring and helpful.

When patients enter a health care setting, they expect to be taken care of and to be made better, not to contract a potentially fatal infection. I hope that I have reassured my hon. Friend that the Government share his deep concern and are determined to see significant progress in reducing C. difficile infections further.

Question put and agreed to.

Oral Answers to Questions

Simon Burns Excerpts

Tuesday 2nd November 2010 Commons Chamber

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

Access to information is a key pillar of our plans to empower patients and service users. We want to open up access to trusted health and care information to everyone, including through digital channels. Independent organisations have an important role to play in helping to ensure that health and care information reaches everyone. StartHere is a good example of how such organisations can help. I am very keen to see StartHere’s response to our consultation, “An Information Revolution”.

[Alun Michael]

I welcome the Minister’s positive response. Does he agree with me and, by the way, with Citizens Advice and the Royal British Legion that StartHere has the unique benefit of starting from the point of view of the person who needs information? It therefore increases efficiency and has the potential to save the health service money. Will he meet me to discuss how to realise those potential benefits?

[Mr Burns]

I am grateful to the right hon. Gentleman for those comments. I pay tribute to him because he has been a champion of StartHere ever since its existence. He and I agree that it is crucial that information is provided to empower patients and citizens, not all of whom have access to websites and the internet. I am more than happy to meet him to discuss this further.

[Tony Lloyd (Manchester Central) (Lab)]

5. What plans he has for future funding of specialist children’s hospitals.

--- Later in debate ---

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

7. What mechanisms he plans to introduce for public access to financial information about general practices under his Department’s proposals for GP commissioning.

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

Under our proposals, commissioning budgets will be held by GP-led consortiums, which will be established as statutory bodies, rather than by individual GP practices. The commissioning budgets will be distinct from the income that GP practices earn under their contracts for providing primary medical care. GP consortiums will have to make their accounts available to the public.

[Sir Alan Beith]

I welcome the Minister’s reply. As GP practices have always been treated as private partnerships and are not open to financial scrutiny or freedom of information requests, it is important that £80 billion of public spending is, in the way he describes, subject to scrutiny, including by this House.

[Mr Burns]

May I reassure the right hon. Gentleman that the NHS commissioning board will not allocate commissioning budgets directly to GP practices? Neither will they be included in either partnership or individual GP accounts. As is the situation now, those GP accounts will remain entirely separate. Our proposals set out clear lines of accountability in respect of commissioning resources. Each GP consortium must prepare a set of annual accounts, which the NHS commissioning board will include in its consolidated account. I hope that that reassures the right hon. Gentleman.

[Rosie Cooper (West Lancashire) (Lab)]

Will the Minister confirm that patients and councillors will sit on consortium boards, and that the boards will meet in public, so that there will be real transparency and accountability at the point of decision making, and accountability will not be sidelined to health and well-being boards?

[Mr Burns]

May I explain to the hon. Lady that, no, councillors will not be on the GP consortiums? They will have a full and active role to play on the health and well-being boards, so that they can take a full part in determining the local needs of the local health economy. That is the right venue for them.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my hon. Friend agree that as those commissioning consortiums are established, it will be important to ensure that they are subject to proper financial assurance, in the same way as Monitor applies such principles to foundation trusts? Can he assure the House that that will be one of the responsibilities of the NHS commissioning board?

[Mr Burns]

There is not altogether the same comparison to be made with Monitor and foundation trusts, but I certainly understand and take on board the general principle behind my right hon. Friend’s question. I think that it is important that there is accountability.

[Liz Kendall (Leicester West) (Lab)]

The Government want to create about 500 new GP commissioning groups and scrap 150 primary care trusts, which the King’s Fund says will cost £3 billion. Yet, last year the current Prime Minister promised that

“there will be no more of the tiresome, meddlesome, top-down re-structures… The disruption is terrible, the demoralisation worse—and the waste of money inexcusable.”

Can the Minister tell us when the right hon. Member for Witney (Mr Cameron) changed his mind?

[Mr Burns]

May I begin by congratulating the hon. Lady on her elevation to this position? I know that in the past she has worked at the Department of Health, so her experience will no doubt help her Front-Bench colleagues who do not share such a background. However, she is factually wrong, although no doubt she will not be wrong in the future, because we have never said that there will be 500 consortiums. It will up to local decision making to determine how many consortiums there will be. The hon. Lady can believe what she reads in the newspapers, but if I were her I would wait to see what actually happens.

[Henry Smith (Crawley) (Con)]

8. What mechanisms he plans to put in place to provide for GP revalidation after the ending of primary care trusts.

--- Later in debate ---

[Penny Mordaunt (Portsmouth North) (Con)]

15. What advice his Department provides to NHS trusts seeking to renegotiate private finance initiative contracts.

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

This Department and the Treasury provide guidance and advice to NHS schemes to maximise the savings and best value for money they can achieve when making variations to their PFI contracts for additional services or facilities, conducting market testing exercises for support services or when assessing refinancing requests from their private sector partners.

[Penny Mordaunt]

What can the Government do to assist the Queen Alexandra hospital in Portsmouth, which is under serious financial pressure because of its PFI contract, a £37 million deficit and, thanks to false planning assumptions, not enough patients to make a super hospital sustainable?

[Mr Burns]

May I pay tribute to my hon. Friend for her assiduous work in her constituency? She represents her constituents and looks after their interests regarding the provision of the highest quality health care. From conversations that I have had with her, I fully appreciate her concerns about the financial situation. I understand that South Central strategic health authority is working closely with the trust as it implements a cost-improvement programme to achieve financial balance.

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

16. How many diagnostic tests for cancer he expects to be carried out by the NHS in each of the next four years.

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

The Department collects waiting times and activity data on 15 key diagnostic tests, but these data do not include the reason for a diagnostic test, such as suspected cancer. The NHS carries out more than 40 million diagnostic tests per year. The cancer reform strategy review is looking at the scope to improve survival rates by increased use of some diagnostic tests.

[Angela Smith]

I thank the Minister for that answer, although it was not quite as precise as I would have liked. How will those numbers be impacted by the Government’s decision to abandon the one-week guarantee for cancer tests and their decision not to performance-manage the abandonment of the 18-week diagnostic target?

[Mr Burns]

I say in the politest way possible to the hon. Lady that we cannot abandon a target that has never been imposed in the first place. May I remind her that, as a sop to the Labour party conference more than a year ago, the former Prime Minister merely announced an aspiration? He never provided any funding or said where the funding should go, and he never provided any clinical evidence for the viability of the proposal. Saying that the Government have abandoned a target when it never existed is sheer poppycock.

[Mr John Baron (Basildon and Billericay) (Con)]

The all-party cancer group’s report last year found that those with rarer cancers got a bit of a raw deal from the NHS when it came to access to treatment and drugs. How will the new cancer fund put right that wrong?

[Mr Burns]

I am sure that my hon. Friend, through the tremendous work done by him and his colleagues on the all-party group, will appreciate that my right hon. Friend the Secretary of State’s initiative—providing £50 million for the rest of this year and £200 million from next year for the cancer fund—is an important step forward in helping those who suffer from cancer. I am sure that my hon. Friend will also welcome the fact that work is ongoing on refining, following the review, the cancer reform strategy, and we are looking at the scope for improving survival rates by the increased use of diagnostic tests and at improving care across the board, so that we raise our standards to the highest in Europe rather than being the poor relation.

[Julie Elliott (Sunderland Central) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

--- Later in debate ---

[Mr Marcus Jones (Nuneaton) (Con)]

T4. NHS Warwickshire is consulting on the future of Bramcote hospital, which serves my constituency and the wider north Warwickshire area. That could lead to the closure of the hospital which has provided valuable intermediate care to my constituents over many years. To close the hospital, NHS Warwickshire requires the Department of Health to meet substantial impairment costs. Can the Secretary of State assure my constituents that before any decision is made by the Department to pay any such costs, the views of the local GP consortiums and local people will be taken into account?

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

As my hon. Friend says, NHS Warwickshire is consulting on the future of intermediate care at Bramcote hospital. I hope that he will engage with that consultation and that the views of local people will be taken fully into account by NHS Warwickshire in deciding the way forward. As he knows, the Secretary of State has set out various tests and NHS Warwickshire’s decision must have the support of the GP commissioners; must strengthen public-patient engagement; and must be based on sound clinical evidence. I hope that my hon. Friend is reassured that those tests will be fully taken into account as part of the consultation process.

[Mr Speaker]

The House is obliged to the Minister.

--- Later in debate ---

[Alex Cunningham (Stockton North) (Lab)]

How can the Minister justify the already increasing delay in people having cancer diagnostic tests?

[Mr Simon Burns]

I am not sure whether the hon. Gentleman was here earlier, but we explained in great detail about the target that never existed. The latest figures show that the median time has gone from 1.7 weeks to 1.9 weeks, but that is because those figures were for the period between June and August—the holiday time—when many people changed their bookings or appointments to fit in with the school holidays or their own holidays. The figures for September are already on course to get us back to the median for that time of the year.

[Amber Rudd (Hastings and Rye) (Con)]

I know that the Secretary of State is aware of the high level of teenage pregnancies in this country, and particularly in Hastings in my constituency. What action are we going to take to support those young women? We all know of the negative health outcomes that come with those young pregnancies.

Health Services (North-east London)

Simon Burns Excerpts

Thursday 21st October 2010 Commons Chamber

[Mike Gapes (Ilford South) (Lab/Co-op)]

It is a great pleasure to begin the Adjournment debate so early in the day. I rushed back to get here in time, and I am delighted that my constituency neighbour, the hon. Member for Ilford North (Mr Scott) is here, because the future of the NHS in outer north-east London is vital to both of us as constituency MPs, and to residents not only of the London borough of Redbridge, but residents of Barking and Dagenham, who all use the facilities at King George hospital, Ilford, which is in my constituency.

Those who follow Hansard closely may have a feeling that this is a case of déjà vu yet again. I introduced a debate in Westminster Hall in December 2006 on the future of King George hospital and a debate in the Chamber in November 2009 on the same subject, and I am here again today. Why is that? We had a consultation process—the misnamed Fit for the Future proposals—launched in 2006, with supposed options that would have led to the scrapping of the accident and emergency department and all elective work at King George hospital. Then we had an independent review by Professor George Alberti that said that the proposals would be clinically unsound. The people behind the proposals, including Heather O’Meara, the then chief executive of the Redbridge primary care trust, were forced to go back to the drawing board, and we thought that we had seen those proposals off. But in 2008-09, they came back. In autumn 2009, we discovered that the new proposals would lead to the loss not—this time—of all the elective work, but of the accident and emergency department, all children’s surgery and all births at King George hospital.

The consultation on the original proposals was launched at a board meeting of the outer London primary care trusts held at Upton Park football ground—as a West Ham United season ticket holder, I feel very uncomfortable about this—in November 2009. Many glossy documents were published, and the whole exercise cost £800,000. One of those documents was called “Health for North-East London: Delivering high quality hospital health service for the people of north-east London”. It said that it was a consultation document launched in November 2009 until—or so we were originally told—15 March 2010. That was subsequently extended to 22 March.

The document gave people all kinds of boxes to tick and options for the future. However, in the summary, on page 39 it had a list of improvements or reductions in services, with only two red crosses, which meant a reduction in services. One was

“A & E, acute inpatient care for adults and children, complex planned surgery.”

There will be a reduction in services because it is proposed to get rid of the services at King George hospital in the London borough of Redbridge. The other was maternity and birthing services. It was proposed that women could have their antenatal care in Ilford and their postnatal care in Ilford, but they could not actually give birth there.

I had some doubts about the whole consultation exercise, including the questions being asked and the selection of the subjects, and I refer hon. Members to the debate that I introduced in November 2009 for the details.

We went through the consultation exercise—I still believe, as I said at the time, that it was as free and fair as a rigged Afghan election—and people sent back their responses. I worked closely with my right hon. Friend the Member for Barking (Margaret Hodge) and my friend, the hon. Member for Ilford North, on a cross-party basis, and we went to see the then Health Minister, Mike O’Brien. He was an excellent Minister and is a sad loss to this House. He agreed to come and visit King George hospital with us at the end of the consultation. He said that he understood the deep concern and recognised that tens of thousands of people had signed petitions against these proposals because they had serious concerns about the implications for the future. He agreed to refer the matter to the independent reconfiguration panel of the NHS. Over the next few weeks, the panel looked into the matter, but decided that it was not appropriate for it to intervene. The panel said that the consultation conclusions should be reported and that the process should continue.

Fair enough, but in July the results of the consultation were revealed to us at a meeting, again at the West Ham United football ground. There were a number of different documents, one of which was a great big analysis by Ipsos MORI of all the boxes that had been ticked, all the replies that had been received and all the different statements that had been sent in by clinicians, individuals, local authorities, LINks—local involvement networks—and various other organisations. In summary, despite the rigged nature of the consultation and the fact that those responsible did not take into account the petitions that I and others had organised—they simply said that petitions had been received, but did not add the figures into the equation—the proposals for maternity and accident and emergency were rejected by the public, by a two-to-one majority among all the respondents in all the boroughs concerned. Indeed, if we add the petitions, the figure is 90% against the proposals.

I went along to the meeting, I sat there, and I had my say, eventually. We were told that no decisions would be taken at that meeting, that people would go away over the summer and work up proposals, and that there would be further consultation with “stakeholders”—obviously we are not talking about vegetarians, but I do not quite know about the term “stakeholders”.

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

It is a new Labour term.

[Mike Gapes]

It may be a new Labour term, but it is still being used by the current Government, so if the Minister can do something to stop that, I would be grateful.

There was a report back to “stakeholders” in September. I shall come to that in a moment, but let me first give a flavour of the responses that were received as a result of the whole exercise. For instance, the responses from the local authorities have been listed. The London borough of Redbridge sent in a clear response, which was a resolution adopted unanimously by the council that said:

“having taken account of the need to provide a wide range of health services in Redbridge which are able to meet the needs of our growing and diverse population, we express our strong opposition to the Health for North East London ONEL proposals to downgrade services at King George Hospital which would include (a) closure of the Accident and Emergency department (b) the ending of critical care support and acute surgical and medical treatment; (c) the ending of Children’s surgery and (d) the ending of maternity delivery in the Borough”.

That was the unanimous Redbridge position, supported by all parties and councillors among the 63 members of Redbridge council.

Barking and Dagenham council took a similar position, writing in its covering letter that it was “concerned about the proposals”. In particular, it was concerned that Queen’s hospital in Romford, which is the larger of the two hospitals in the Barking, Havering and Redbridge trust, would not be able to cope with the increased pressures, including the increased pressures on A and E, and maternity services. Interestingly, Waltham Forest council, which, in a previous incarnation in 2006, had come out in favour of the Fit for the Future proposals, said in 2010 that it would not comment on the A and E position. However, the council was critical that concerns about mental health had been neglected, saying that alternative services were needed. Waltham Forest council also said that Health for North East London needed to

“spell out what will be involved in reducing the number of A & Es from six to five especially in terms of impact on the remaining A & E departments”,

adding that the proposals were not clear. Newham council said that it was not convinced by the proposals either:

“We also note the significant changes to service provision at King George’s hospital. It will be necessary to closely monitor any resulting impact on our local Newham Hospital… Our expectation is that any increase in activity will be matched by appropriate resource levels.”

That was a conditional position. Tower Hamlets did not want to comment on the proposal either. Among the borough councils—these are representative bodies, the people who represent the community—there was either a clear opposition or at least indifference or ambivalence.

What about other organisations? I have already mentioned the Newham trust. It said something very important in its documents:

“experience with the Gateway Surgical centre supports the model of locating elective care in a separate building but on the same site as acute provision, allowing easier access for staff.”

The whole thrust of the proposals is to separate the two out, whereby the elective and the acute are in different places, yet this has been questioned even by one of the hospitals that could benefit by receiving the transferred patients.

The position adopted by other organisations is also significant. The Ipsos MORI documents make it clear that very strong views were expressed. The essence of my debate is captured by an important sentence, which states:

“The views opposing the reduction… from six to five hospitals providing accident and emergency, critical care and maternity services…came from organisations representing the public (elected local authorities and patient representative groups such as LINks)”.

It continues:

“It should also be noted that some opposition was also expressed from representative groups associated with NHS staff, notably some Local Medical Committees.”

Who, then, is in favour of these proposals? Not a lot of people, it seems. Within the local community in Redbridge, it is very hard to find anybody in favour of the proposals. Perhaps some people in other boroughs might be found, but it is certainly true that in Redbridge it is very hard to find anybody of any authority or any representative political role who is prepared to speak out.

--- Later in debate ---

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

I congratulate the hon. Member for Ilford South (Mike Gapes) on securing this debate. I know from previous debates he has secured on this subject how strongly he feels about it—and rightly so—as a constituency Member of Parliament. I also congratulate my hon. Friend the Member for Ilford North (Mr Scott) on his contribution. He has worked for a long time with the hon. Member for Ilford South in representing the interests of their constituents. I know that the quality of service provided by the local NHS is very important to both hon. Members and their constituents, and I assure them that I share their commitment to achieving the best possible health care for the people of north-east London. I also praise the hard work and dedication shown by NHS staff in north-east London. Their jobs are not always easy, but they always strive to provide the best possible care for patients.

Today, the NHS has some of the best people and facilities in the world, but when it comes to what is really important—outcomes for patients—we lag behind many other countries. The Government’s ambition is clear: for health outcomes in this country to be among the best in the world. Just over three months ago, we published the White Paper “Liberating the NHS”, showing how we will achieve the real gains. We will liberate clinicians from top-down targets and endless micro-management by politicians and civil servants. It is an ambitious plan for reform focused on three key aims: the first is to put patients first. Patients should feel that no decision is made about them without them. Secondly, we want to focus on outcomes, not inputs or processes, and to build a culture of evidence and evaluation, to ensure that health care uses innovation and evidence to provide quality care and is accountable for improving outcomes. Thirdly, to deliver the best care, we must empower NHS staff, whose responsibility it is to give that care. Decision making must take place close to patients, so that clinical decision making can be better combined with the use of resources. GPs already influence the commissioning of decisions by the way in which they manage and refer patients, and by deciding which medicines to prescribe and which treatments. They decide what is best for their patients based on the options available and on their clinical judgment of what would be best for them.

We are asking GPs to take the next natural step by giving the responsibility for designing, commissioning and paying for local services to groups of GP practices. This will ensure that decisions are clinically led, involving all other health care professionals, hospital consultants, nurses and social care workers in order to design services that put patients first and are focused on improving clinical outcomes.

GP commissioning also opens up the potential for working closely with local authorities to commission services jointly—even for the pooling of budgets to tackle local priorities jointly. For example, by working closely with local authority and social care providers, far more can be done to help older people or those with a disability to live independently, reducing their reliance on the NHS by avoiding things such as hospital admissions.

My right hon. Friend the Member for Chingford and Woodford Green (Mr Duncan Smith) recently opened the Macmillan information and support centre at Whipps Cross hospital in north-east London. The centre is available free to anyone affected by cancer and offers confidential advice and support. Such partnerships between the NHS and the third sector take exactly the kind of innovative and exciting approach to health care that we are actively encouraging.

Before addressing the specific concerns of the hon. Gentleman and my hon. Friend, I should set out the wider context of local health care reform. Thanks to the NHS, most of us will enjoy better health and longer lives than our parents and our grandparents. That is a tremendous achievement, as I am sure both hon. Members recognise, but, as the NHS effects great change on the health of this country, so the changing nature of the population must transform the NHS.

An ageing population is just one of the many challenges to which the NHS must adapt over time. Every day, new medicines and treatments are developed to meet our changing lifestyles and expectations. We know that change can sometimes be unsettling, but we also understand that the NHS needs to evolve—to move with the times. All we ask is for the NHS to make collective, informed and local decisions that improve outcomes for patients.

On 15 December a joint committee of primary care trusts will make some important decisions about the future of King George hospital and about health services in north-east London more generally. I am confident that those decisions will be made by those best qualified to make them, based on a solid foundation of clinical evidence and local engagement.

[Mike Gapes]

rose—

[Mr Burns]

I thought that the hon. Gentleman might want to intervene at this point.

[Mike Gapes]

How are the views of elected local authorities, of elected Members of Parliament and of the community, as expressed even in that dubious consultation exercise, to be taken fully into consideration against an NHS management bureaucracy who seem determined to carry on regardless? Is 15 December the date of the final decision? Is there no other way in which we the public can have our say?

[Mr Burns]

I am grateful to the hon. Gentleman for that intervention, because I fully understand how strongly he feels about the issue—what he recognises, from his constituents’ point of view, as a potential problem—and how important it is to get the matter right. I shall not duck the question, but will the hon. Gentleman bear with me a little so that I can put it in context? I shall then respond to his intervention and answer his specific question about whether 15 December is the end of the road, or whether any other avenues might be open to him and to my hon. Friend the Member for Ilford North.

If the hon. Gentleman will allow me, I will describe how we reached this point. Back in February 2009, as he mentioned, the NHS in north-east London began to think about how it could better use its resources to provide safe, modern health care. The NHS in north-east London as a whole faces considerable challenges. Health outcomes and key health indicators are poor: people in the area have lower than average life expectancy and higher rates of infant death. The NHS recognised that it needed to improve services to meet those challenges head-on. For example, it found that long-term conditions could be managed better: instead of being admitted unnecessarily to hospital, patients could be treated in the community, closer to their homes.

One of the solutions suggested was to turn two of the existing hospital sites—the Royal London and Queen’s—into major acute hospitals and for them to become centres of excellence. Doctors can achieve that level of quality only if they see high numbers of complex cases, and patients can receive the best care only when surrounded by expert clinicians. To reach that critical mass of doctors and patients, specialist services would be consolidated into the two major acute hospitals, not spread thinly across each hospital in the region. The Royal London and Queen’s would be supported by three local hospitals, all with accident and emergency departments. The final site—King George hospital, which has been the main focus of this debate—would also play a vital role, taking a lead in providing primary, community and urgent care.

King George hospital would receive enhanced children’s services. An urgent care centre at the hospital would operate around the clock, the task being to manage as many patients as possible outside A and E services. Access and continuity of care for minor injuries and illnesses would be significantly improved. I know that there has been concern about rumours that the local NHS is planning to close King George hospital. I can categorically reassure the hon. Gentleman and my hon. Friend that that rumour is not true. Among the substantial number of services proposed to stay or to be moved to King George hospital was a recommendation that the hospital become a centre of excellence for planned surgery.

Barking, Havering and Redbridge University Hospitals NHS Trust has proposed the transfer of all breast surgery from Queen’s to King George. That will mean that some women who currently have treatment at King George but then have to be transferred to Queen’s for surgery will have the whole procedure carried out under one roof, which I am sure the hon. Gentleman and my hon. Friend will agree is an infinitely preferable and superior sequence of treatment to the present one. Those women will not have to go through the trauma and inconvenience of having to be moved to another hospital site for their surgery. In addition, local clinicians have identified a further 20,000 procedures a year that they believe would benefit from being provided solely at King George hospital.

Of the proposals made in north-east London, I know the hon. Member for Ilford South is most concerned about the potential loss of maternity and A and E services from King George hospital. I hope to be able to reassure him that, whatever the outcome of the meeting in December, nationally this Government remain committed to maternity and A and E services. When somebody walks through the doors of an A and E department, an urgent care centre or a walk-in centre, what sorts of service should they expect? To which facility should they go in the first place for the most appropriate care for the condition from which they are suffering? Part of the anger that we often see when the local NHS suggests replacing A and E with other, more appropriate services is due to a certain degree of confusion about what those services provide. The Government are committed to clarifying that, and work is already under way to standardise which services can be expected in various facilities. As well as improving A and E services, we want to improve urgent care radically. We are committed to providing universal access to high-quality urgent care 24 hours a day, 365 days a year. Whatever the need, place or time, patients should be able to find the care they need. That is what part of our reforms in A and E will achieve.

The Government are also determined to drive forward improvements in maternity and newborn services so that women and their partners have access to local services and so that children have the best start in life. The safety of mother and baby is paramount. It is fundamental to safe, high-quality maternity care that a full range of services must be available to all women, whatever their medical and social circumstances. Services must be as near to home as possible, depending on the complexity of needs, with facilities and expertise available to provide optimum care.

[Mike Gapes]

I know that the Government are committed to improving the quality of care, as the previous Government were, but I have a large number of young families in my constituency and they will be forced to go several miles for the births of their children at Queen’s hospital rather than going to a hospital in the community where they live, as people in Ilford have done for 80-odd years. Is there a national policy that births can be allowed only at sites with a coterminous accident and emergency department, or could the proposals be reconsidered? One of the arguments in the relevant documents is that maternity services have to be moved because the A and E is being moved. Is that national policy?

[Mr Burns]

It is not national policy that if there is an A and E department there automatically has to be a maternity facility by its side. If one strips out the whole area of safety and quality of care, which is vital, one realises that the guiding rule is that maternity services are provided where they are relevant to the local community’s needs. It is about having the best siting relevant to the community’s needs. Clearly, however, there cannot, for a variety of reasons, be a maternity ward in every hospital in the country. Where they are sited will be determined by need and by the wishes of local communities. Once the reforms are in place, it will also be up to commissioners to decide where to site maternity units.

[Mike Gapes]

The Minister has heard me quote the Royal College of Obstetricians and Gynaecologists, which takes the strong view that there should be maternity facilities and births at both the Queen’s and King George hospitals. I feel very strongly about this. There is clearly a difference of opinion between the people in NHS London, who are driving the change, and the people who deal with obstetrics and gynaecology—the experts—about what is necessary. Leaving aside the democratic arguments, the views of the people in the specialist royal college have not been taken into account.

[Mr Burns]

As with any proposals for reconfiguration anywhere, a range of views will be fed in, including those of the relevant royal colleges, GPs, clinicians, members of the public and other interested parties, and will be considered as part of the consultation process before a decision is made. I am going to come to the whole issue of consultations, on which the hon. Gentleman rightly has strong views, because I want to clarify the situation and, as I said earlier, I want to give him some answers about the options that might be open to him after 15 December.

In pursuit of true local backing for the proposals in the hon. Gentleman’s area, the local NHS has already started a debate about them. To date, it has talked through the issues with GPs, councillors, medical committees, national bodies and local patient representatives. I was going to say that perhaps he will recognise this from his own experience, as I am assured that the NHS has made every effort to keep him informed and to listen to his concerns. However, having listened to what he and my hon. Friend the Member for Ilford North said, it would seem that that is partly the case and there may have been certain slip-ups: for example, posting a letter the day after a meeting was held. I cannot confirm or deny that because I am not party to the information, but my hon. Friend has put it on the record, and if it did indeed happen that is somewhat unfortunate.

The hon. Member for Ilford South submitted a petition on behalf of his constituents, and the local NHS has confirmed that that will be taken into account. However, it asks different questions from those in the official consultation, which slightly skews the point that he made about it. I understand that one of the questions was: “Do you support the closing of King George hospital?” I suspect that in the case of the vast majority of people signing it, the answer would be no, they do not support it. The trouble is that there is not, never has been and will not be a proposal to close the hospital. I hope that he therefore understands that the question is not relevant to the consultation on the reconfiguration of services.

[Mike Gapes]

I do not know what advice the Minister has had from his officials. I do not want to get into a long textual discussion, but he should get the full wording of the petition that I submitted. I have to admit that there were several petitions from different organisations and individuals, but mine referred specifically to A and E, maternity and children’s services. It may have been headed “Save King George hospital”, “I support Mike Gapes’s campaign”, or whatever, but the wording specifically referred to those issues.

[Mr Burns]

I agree that we do not need to get into to-ing and fro-ing about what exactly was written. My point was that some of the questions—I am not saying all of them—on some of the petitions were not directly relevant to what was being consulted on. Having said that, it has been recognised that they will be considered as part of the consultation process.

[Mr Scott]

My own petition did not say anything like “Lee Scott’s petition”; it talked purely about the proposals to close A and E and maternity services, and made no reference to anything else. I therefore trust that those 8,000 names will also be taken into account.

[Mr Burns]

I have no doubt that they will, as part of the ongoing consultation and evaluation of responses to the consultation process.

Before 15 December, the London strategic health authority will assess north-east London’s readiness against the four tests that my right hon. Friend the Secretary of State introduced in May this year to ensure more local engagement in the proposed reconfigurations of services throughout the country. In certain previous consultations, there was a long-held view that although lip service was paid to local people and medical practitioners—clinicians and GPs—the views of the local community did not matter because, in effect, a decision had been taken at the launch and things would end up in exactly the same state at the end of the process.

To give greater credence and importance to local views, my right hon. Friend the Secretary of State announced his changes to the criteria that had to be conformed with for reconfigurations to take place, to empower people to take part in the discussions and to ensure that their views would be fully considered before decisions were taken. To achieve that, he has said that reconfigurations and consultation processes that are already in progress will have to be checked against the revised and strengthened criteria to ensure that they have been carried out under the new format. I can assure the hon. Member for Ilford South that that will happen prior to the meeting on 15 December.

[Mike Gapes]

Will the Minister clarify who will do that? Will it be the person in the London NHS who is behind the proposals, or will it be somebody independent of the proposals?

[Mr Burns]

It will be done by the national health service in London. People could be tempted to shout “Foul” if they do not agree with the decision, but that does not mean to say that it necessarily is a foul. In the case of a straightforward matter such as checking whether the consultation process has taken place under the new guidelines, we have to accept the professionalism of the people carrying out the job, and trust that they will do it properly. If it emerged that the guidelines had not been abided by in any way—I hasten to add that I make this point illustratively, and I am not saying that it will—the hon. Gentleman would be extremely happy. If it were found that they had been abided by, he would need to have an open mind, and not automatically say that things had not been done properly.

While the discussion in north-east London continues, the clinical working groups have already made changes to their previous recommendations. If the hon. Gentleman will allow me, I will give him some examples. From talking to parents it was obvious that many were anxious about the prospect of travelling long distances to get treatment for their children. Clinicians needed to find a way to reduce the chance of that happening, and now it is proposed that only children needing specialist or high-dependency care will be transported to specialist centres. That means that more children will be treated locally than was originally anticipated, but they will still have access to specialist care when they need it.

Women told the NHS that they wanted more midwife-led care. As a direct result, a study has been commissioned, working with local mothers and mothers-to-be, to find out what choice really means to them. Clinicians are working up plans for midwifery-led units across the region as we speak.

Some residents expressed concern about having no A and E at King George hospital. Doctors are still convinced that clinically, any small increases in travel time will be more than compensated for by having better, safer, faster care, but they have recommended changes to the original proposals for urgent care at the hospital. Now, as well as the 24/7 urgent care centre originally proposed, a 24/7 short stay assessment unit is being recommended. It would be staffed by a team of skilled clinicians with expertise in assessment and treatment as well as in emergency medicine. The service would offer facilities for longer periods of observation, assessment and treatment, including access to a range of tests not currently available in primary care and specialist advice from hospital clinicians. Staff would work closely with community health and social care services, including mental health services, so that as many patients as possible could be cared for in the community without recourse to a hospital admission.

The NHS in north-east London is also working closely with Transport for London to ensure a good bus service between Queen’s hospital and King George hospital. I am sure that the hon. Gentleman agrees that that is vital to help many of his constituents who may need to use such a service.

I believe that discussions with the local community have already made a positive impact. The local NHS is now truly listening to GPs and consequently changing its plans. That reflects the improvements that my right hon. Friend the Secretary of State introduced to engage local communities with reconfigurations.

[Mike Gapes]

Will the Minister address my point about consulting GPs? How will their views be taken into consideration?

[Mr Burns]

I am grateful to the hon. Gentleman for reminding me of that. My understanding is that the “health for north east London” programme team is prioritising engagement with GP practices whose patients would be most affected by the reconfiguration proposals, and GPs who are currently likely to be leaders in the commissioning consortiums that will flow from the NHS reforms.

[Mike Gapes]

rose—

[Mr Burns]

I will give way for the last time.

[Mike Gapes]

We are considering an important point. The letter from the Minister, the May proposals and the Prime Minister’s remarks yesterday place great emphasis on GPs’ views and wishes. Yet what we were told on Friday has made me very worried. Which GPs are we talking about—the lead person in a commissioning consortium, single-handed practitioners joining together and outvoting a group of GPs in a health centre, or what? There is no provision for a ballot. What is the process? People can get whatever result they want if they skew the process. My fear is that the process will be discredited unless it is seen to have democratic legitimacy. I suspect that we will have a big problem, because the views of certain GPs will be taken into account and those of others will not.

[Mr Burns]

I will confirm what I said before the hon. Gentleman’s intervention. The consultation will prioritise engagement with GP practices whose patients would be most affected by the reconfiguration. If the hon. Gentleman is saying that there should be a ballot of GPs, I do not agree. There should be engagement, discussion and GPs contributing to any reconfiguration proposals by meeting people who undertake the consultation process to make known their views and their preferences—the pros and cons that they envisage—but I do not think that a ballot is either feasible or necessary. To take his idea to its logical conclusion, why restrict a ballot to GPs? Why not have a ballot of social workers or community nurses? That sort of engagement is unnecessary when there are other perfectly satisfactory forms of engaging.

If the hon. Gentleman supported what was happening, he would be happy with the procedures.

[Mike Gapes]

No.

[Mr Burns]

I think that he would. Let me point out gently and tactfully that my right hon. Friend the Secretary of State expressly introduced criteria for the engagement of GPs, clinicians and other interested parties because of their concern that they did not have enough ownership of consultation processes. I have to say that until 6 May, for 13 years, we were not the Government—and that it was we who looked at the position afresh and recognised the concerns throughout the country about reconfigurations. By introducing his criteria, my right hon. Friend the Secretary of State responded to the concerns of local communities that their views were not being properly considered. This Government, in a very short time—within two and a half weeks, I think—took decisive action to give greater power and ownership to those groups to contribute to consultation processes.

On local scrutiny, which featured significantly in the hon. Gentleman’s speech, I fully recognise that there are considerable public concerns about the proposals for north-east London. In the light of those, the Redbridge overview and scrutiny committee referred the case to the previous Health Secretary, the right hon. Member for Leigh (Andy Burnham), in January 2010. He asked the independent reconfiguration panel for advice. In its response, the panel concluded that a full review was unnecessary. In July 2010 my right hon. Friend the current Health Secretary accepted the panel’s recommendation that due process by way of public consultation and formal engagement should be allowed to continue—a process that has not yet come to an end, as the hon. Gentleman knows.

However, as I said, we are determined that local voices will be properly heard, and we expect any concerns to be taken extremely seriously. I shall lay out again for the hon. Gentleman the critical tests that have been applied in the consultation process in the past two or three months, and that will be applied until the consultation’s conclusion. First, the proposals should have the support of GP commissioners; secondly, arrangements for public-patient engagement, including local authorities, should be further strengthened; thirdly, there should be greater clarity about clinical evidence underpinning any proposals; and fourthly, any proposals should take into account the need to develop and support patient choice.

Given the complexity and scale of the challenge in London, the Secretary of State, as the hon. Gentleman knows, called a halt to existing clinical strategies and asked the NHS to look at its plans afresh. That means that north-east London now has an opportunity—it has had one for some time—to have a frank and open discussion with GPs, clinicians, councils and patients on how their health services can change for the better. I believe that if that process is managed well, any changes made will lead to better health care for people across north-east London, including the hon. Gentleman’s constituents.

As was said in the debate, the question of whether those four criteria are fully met will be considered prior to the meeting on 15 December. Providing it is seen that those criteria have been met, the meeting will go ahead, and a decision will be taken. What happens if the decision is not popular with a number of people? I suspect, from what the hon. Gentleman said, that it will not be. Unless I misheard him, he said that the overview and scrutiny committee would have no opportunity to look at the proposal, reach a decision on it and write to the Health Secretary if necessary. I am not quite sure why he said that.

[Mike Gapes]

My understanding of what we were told at the meeting on Friday is that the decision on 15 December will be the final decision, subject only to the Secretary of State, and that there was no intermediate process. If that is inaccurate, I would be delighted, but that was my impression from what we were told on Friday. The hon. Member for Ilford North (Mr Scott) will confirm that.

[Mr Burns]

I am interested to hear what the hon. Gentleman was told on Friday, and I hope that I will be able to delight him. My understanding is that after the meeting on 15 December, the OSC can look at the decision that has been made. If it is not convinced that it is the right decision, it can contact the Secretary of State. That is a step forward from what the hon. Gentleman was told at his meeting on Friday. We cannot anticipate the decision to be taken on 15 December, because that would be irresponsible, but I have confirmed that he will have some further opportunity—if warranted by the OSC’s decision, because we cannot prejudge that either—to have the decision revisited.

As I have said, we must not prejudge the outcome of the meeting of the joint PCTs on 15 December, when local NHS leaders will gather to make a decision that will dictate the future of health services in north-east London. I believe—even if I do not altogether carry the hon. Gentleman with me—that that decision will, rightly, be made locally. I understand that these issues arouse strong feelings: they involve difficult decisions about how resources should be used to achieve the best care for patients, which must always be the priority for, and guiding force behind, any reconfiguration or provision of health care.

Similarly, the NHS must continue to develop its plans for the future, and it must do so by giving local people and GPs a far greater say. Obviously, we will have to wait to hear the judgment on how the consultation has been carried out in relation to the four criteria laid down by the Secretary of State, but we need to create an NHS run by empowered professionals free of the shackles of central Government. The NHS has received massive investment, but it is drowning in bureaucracy. We will cut the red tape and sweep it away, letting NHS professionals organise themselves locally. It is a measure of the importance that we afford the NHS and the future health of this nation that its budget will be protected, as was confirmed in the announcement of the comprehensive spending review by my right hon. Friend the Chancellor yesterday.

The hon. Gentleman must await the decision on 15 December. I am convinced that what will be done throughout the health service, especially in the case of difficult reconfigurations, will have as its guiding priority the desire to get the highest-quality health care for all our constituents.

Question put and agreed to.

Generic Medicines

Simon Burns Excerpts

Thursday 14th October 2010 Written Statements

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

I am today publishing the Government’s response to the consultation on the proposals to implement generic substitution of medicines in primary care. Alongside it a report of the analysis of responses is also published.

The pharmaceutical price regulation scheme 2009 committed to the introduction of generic substitution in primary care in the national health service, subject to discussion with affected parties. Further to discussions with, and views expressed by, stakeholders during 2009, the Department undertook a public consultation on proposals to implement generic substitution in primary care between 5 January and 30 March 2010, consulting on three options, including non-implementation.

In total, 423 organisations and individuals submitted written responses. In addition, 107 delegates attended Department of Health listening events, and their comments were recorded as part of the consultation.

Greenstreet Berman, an independent social research company, was appointed to analyse the responses on behalf of the Department following a competitive tender process run by the Central Office of Information.

The analysis of responses showed no clear consensus with regards to a preferred option going forward. Three key points were apparent:

there was a strongly held perception by respondents that generic substitution posed a threat to patient safety. If the proposals were to be implemented, these concerns would arise in the front-line delivery of NHS services, impacting on the work load of health care professionals;

the position on the cost-effectiveness of generic substitution implementation is inconclusive. There is a strong sense that the effort involved in implementing a formal generic substitution scheme was simply too great for the potential gain; and

other, less nationally prescriptive mechanisms for further supporting the use of generic medicines can be explored.



The coalition Government intend to stand by the 2009 PPRS agreement, which expires at the end of 2013. However, in the light of the public consultation findings, the Department will not be progressing any further the implementation of generic substitution. Instead, the Department will be looking at further ways to support the use of generic medicines in a way that is acceptable to patients, recognising that there are still some savings that can potentially be delivered in this area.

Further details can be found at: http://www.dh.gov.uk/en/Consultations/Responsestoconsultations/DH_120431

Copies of both the Government response to the consultation and the analysis of responses report have been placed in the Library and copies are available for hon. Members from the Vote office.

Synathon BV v. Licensing Authority of the Department of Health

Simon Burns Excerpts

Wednesday 13th October 2010 Written Statements

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

In 2001 and 2002, the Medicines Control Agency (a forerunner to the Medicines and Healthcare products Regulatory Agency) refused to accept certain marketing authorisation applications from Synthon. Synthon challenged the decision by way of judicial review.

In 2008 the European Court of Justice issued a judgment in relation to C-452/06 Synthon v. Licensing Authority of the Department of Health following a decision grant by the then Licensing Authority (the Medicines Control Agency) to refuse to grant a marketing authorisation for Synthon’s paroxetine mesylate product.

The Court’s judgment was that the United Kingdom should pay compensation for Synthon’s consequential lost profits.

Following a mediation held on 23 and 24 September 2010 the Department of Health has agreed to pay Synthon €33.25 million inclusive of legal costs in full and final settlement of their claim.

NHS Parking

Simon Burns Excerpts

Thursday 16th September 2010 Written Statements

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

I am today publishing the Government’s response to the recent public consultation on car parking at national health service hospitals issued by the previous Administration before the election.

That consultation set out proposals to introduce mandatory free parking for many inpatients and outpatients. Those proposals would cost the NHS in excess of £100 million. The impact assessment states that it would lead to a net disbenefit to patients valued at almost £200 million. This negative impact arises from substantial health benefits forgone from not investing this income in health-care, offset by lower financial benefits to favoured car park users. The impact also does not include environmental costs associated with the policy, which would also clearly be adverse. At a time when the NHS needs to make every penny of its budget count the Government cannot support such a proposal.

Moreover, the Government have embarked on a very clear strategy for the NHS that reduces central control and intervention in operational decisions, giving NHS managers the autonomy to make decisions that reflect the needs of their local community. Telling the NHS how to run their car parks would be inconsistent with this principle.

However, our strategy also puts patients at the centre of decision making, and supports patients to be able to make informed choices. It is clear from the consultation feedback that the parking policies and practices in some trusts fall short of these standards. Patients undergoing extended outpatient treatment, and long-stay inpatients, should not be further disadvantaged, and nor should their health needs be possibly compromised by high cumulative parking costs. A fair scale of concessionary rates should be offered, and all eligible patients should be fully informed and helped to take advantage of them. These standards are fundamental to patient-centred care and informed choice.

Through our announcement today we are:

ensuring that the NHS is made aware of patients’ concerns;

asking trusts to work with local groups to examine their current policies and practices and ensure that they are genuinely fair;

emphasising the importance of promoting these fully to eligible patients, prior to and during their treatment; and

asking the NHS confederation, who already provide best practice guidance on parking policy, to engage further with parking providers and patient advocate groups to respond to the concerns identified through the consultation.

Local autonomy requires local accountability. It is for trust boards to ensure that their policy is fair and patient-centred, and has the support of its local community. The challenge now is for the NHS collectively and locally, to take action to deliver the fair access that their patients expect.

The Government’s response and a summary of the responses to the consultation have been placed in the Library. Copies of the Government’s response are also available to hon. Members in the Vote Office.

Accident and Emergency Services

Simon Burns Excerpts

Tuesday 14th September 2010 Westminster Hall

[Diana R. Johnson (Kingston upon Hull North) (Lab)]

It is a delight to serve under your chairwomanship, Ms Clark. I congratulate the hon. Member for Southport (Dr Pugh) on securing this important debate. I know that he has particular interests in health concerns not only in his constituency but around the country. He set the scene very clearly at the outset and described why we need good A and E facilities in this country. However, I was concerned when he talked about hitting himself on the head with an iron bar. I hope that had nothing to do with his frustrations with some of the health policies of the coalition Government.

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

That happened when your party was in government.

[Diana R. Johnson]

Let me refer to the three points that were pertinent to this debate.

First, the hon. Member for Southport spoke about a patchwork system that reflected the haphazard way in which emergency services are provided. The White Paper “Equity and excellence: Liberating the NHS” says it plans to develop

“a coherent 24/7 urgent care service in every area of England that makes sense to patients when they have to make choices about their care.”

My hon. Friend the Member for Hartlepool (Mr Wright) raised the issue of local communities understanding where they can best access care. The hon. Member for Newton Abbot (Anne Marie Morris) mentioned the standardisation of services around the country. I will come back to that point later, because I have great concerns about the rest of the White Paper, which is much more about localism and ways to provide service. Such a thrust might be a problem for the particular aim that the White Paper sets out around emergency care.

Secondly, the hon. Member for Southport mentioned the need for baseline standards around waiting times, access and so on. I am again concerned with the thrust of the White Paper and that we may not have that baseline standard around the country. We have already seen the reduction in the waiting-time target in A and E from 98% to 95%, and I understand that it will be removed completely in the future.

Thirdly, the hon. Member for Southport raised the issue of democratic accountability. I have to say that I raised an eyebrow at that point because it was clear that the Liberal Democrat party had got one of its manifesto promises in the coalition agreement, which was to have directly elected members of the PCT, but just a few weeks later, the White Paper basically ripped up that section of the coalition agreement. As I understand it, democratic accountability is now to be through the scrutiny function of local authorities. Although I know that local authorities can carry out such scrutiny very well—we heard from my hon. Friend the Member for Hartlepool about the excellent scrutiny that has taken place in Hartlepool—I am concerned about how they will do it now that their budgets are being cut. To scrutinise health services will require further resources, not least because local authority members will need to be trained up. There is a difference between being able to scrutinise effectively the emptying of bins and so on and being able to scrutinise the very difficult, complicated and technical clinical health services.

[Mr Burns]

I am staggered by the shadow Minister. She is a very reasonable person and I understand that she has a job to do because she is now a shadow Minister in opposition. However, I was surprised that she did not mention, let alone give any credit to, the concept of the health and wellbeing committees, because they will play a crucial role. And there is another thing that surprises me. Presumably, she was perfectly happy when local authorities took on a greater role in public health, so why should they not do so under the proposals in the White Paper?

[Diana R. Johnson]

I am a great supporter of local government and served as a local authority councillor for eight years, so I understand clearly the important role that a local authority can play in a community. However, I am saying to the Minister that effective scrutiny and the effective ability to look at what is often quite complicated work would demand a rethink about the resources that we put into local government scrutiny. If we look back over the years during which there have been scrutiny panels in local government, we find that there is a concern about the capacity of local government to scrutinise services effectively that are outside their own remit.

[Mr Charles Walker in the Chair]

I want to move on, because I want to pay tribute to my hon. Friend the Member for Hartlepool, who, as ever, is a strong advocate for health services in his locality. Importantly, he also raised the issue of NHS Direct. Over the summer, there was a lot of confusion because of the unfortunate way that announcements were made about the future of NHS Direct. So it was important that that issue was raised in the debate, because I think there is genuine concern in the community about it.

The hon. Member for Newton Abbot raised the issues of minor injuries units and the need for appropriate networks of care. The hon. Member for Burnley (Gordon Birtwistle) gave a very full history of what had happened in his community. He discussed the problem of trying to define the difference between “urgent care” and “A and E services.” However, I noted that the Secretary of State for Health has made it clear that the naming of facilities is very much an issue for the locality in which a facility is situated, so the local area needs to determine what title best fits the services that a facility provides.

The hon. Member for Burnley also raised a number of points that I wish to discuss briefly regarding the confusion that exists at the moment about reconfiguration and the current Government’s position on that issue.

I think there is genuine agreement that all changes in health services should be clinically driven and, of course, locally led. My right hon. Friend the Member for Leigh (Andy Burnham) made it clear when he was Secretary of State for Health that tough decisions would have to be made about moving services out of hospitals and into communities, where they would be closer to people’s homes, and about centralising specialist care where it made sense in terms of protecting patients’ safety. The hon. Member for Southport referred to the great deal of research on patient safety that is available and he and my hon. Friend the Member for Hartlepool said that more consideration needs to be given to the transport links that are so vital if communities are to be able to access health care facilities.

I do not wish to take very long to make my comments, because I want the Minister to respond to the particular constituency issues that have been raised today. I just want to raise more general issues regarding the concerns that exist about the Secretary of State’s announcements on reconfiguration.

Before the election, the Secretary of State made great play of touring the country and promising that A and E services would not be closed; he said that such closures would not happen under his watch. Two weeks after the election, he made an announcement at Chase Farm hospital that there would be a moratorium on service changes. The revision to the NHS operating framework 2010-11 was published on 21 June and it states:

“A moratorium is in place for future and ongoing reconfiguration proposals.”

However, several local areas have pressed ahead and made decisions to downgrade A and E services and other facilities, including the downgrading of a maternity unit in Kent, which local GPs are opposed to, and the downgrading of a maternity unit at Chase Farm hospital, where before the election the Secretary of State had said that the plans for the north central London review would be scrapped. Now it appears that those plans are being brought forward again.

Ministers in the coalition Government have made it clear that it is not their approach to intervene in health care services and reconfigurations. Curiously, however, despite the Government’s saying that strategic health authorities should not take decisions relating to service changes, on 29 July David Nicholson, the chief executive of the NHS, wrote to strategic health authorities, asking them to

“undertake an assessment of which proposals have successfully demonstrated the test and should proceed, which require further work and which, if any, should be halted. This initial assessment should have been completed by 31 October 2010.”

I just want to refer to the “test” mentioned in that letter. As I understand it from what the Secretary of State has said, it involves commissioners—the commissioners being GPs—having to reconsider whether or not they support the proposal that is being put forward. It also includes strengthening arrangements for public and patient engagement with local authorities; that is particularly referred to in the “test”. There must also be greater clarity in the clinical evidence for any reconfiguration and the need to develop and support patient choice must also be taken into account. As I understand it, that is the “test” that the coalition Government are putting forward, which has to be gone through, step by step, for any reconfiguration.

However, when we refer back to the statement on the moratorium, that is all rather confusing and contradictory.

[Mr Burns]

May I help the shadow Minister by reading to her what the Secretary of State announced in May would be the guiding principles for new and current reconfigurations? He said that

“reconfigurations must have the support of GP commissioners; demonstrate strong public and patient engagement; be based on sound clinical evidence, and consider patient choice.”

I hope that helps to clear up her confusion, although I expect it will not.

[Diana R. Johnson]

I am grateful to the Minister for going through that list of criteria again. However, I think that the hon. Member for Burnley will remain confused, because in his contribution to the debate he made it very clear that local GPs overwhelmingly opposed the proposal that was being put forward in Burnley but that the primary care trust was pushing ahead with the proposal. That does not quite fit with the “test” that the coalition Government have put forward.

--- Later in debate ---

[Mr Burns]

The shadow Minister does not want to “intrude on private grief” and I appreciate that. I want to help her to stop digging. If she waits until I make my response to the debate and address the point made by the hon. Member for Burnley, my response might help to clarify her mind.

[Diana R. Johnson]

As always, I am very interested to hear what the Minister has to say. However, there are three specific points that I would like him to address. First, is there currently a moratorium on reconfiguration proposals, and if there is, why are local areas able to take decisions to downgrade A and E Departments?

[Mr Burns]

Do you want me to answer that?

[Diana R. Johnson]

I am very happy to let the Minister respond in full in a few moments. I am reaching the end of my comments.

Secondly, does the assessment of proposals that SHAs have been asked to carry out apply to existing schemes? Thirdly, if it is not for Ministers to intervene in service changes, why did they promise to halt closures of A and E departments and maternity departments before the general election?

I also want to say, Mr Walker, that I am delighted to serve under your chairmanship today. I am not sure if this is your first opportunity to be in the Chair in a Westminster Hall debate, but it is certainly a pleasure to see you in the Chair today.

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

What an unexpected pleasure it is to serve under your chairmanship, Mr Walker. It is a first for me, and I hope that there will be many such occasions in future. I congratulate the hon. Member for Southport (Dr Pugh) on securing this important debate. I will start by dealing with some general aspects, and will then discuss some of the specific issues raised by hon. Members and the Minister.

[Diana R. Johnson]

The shadow Minister.

[Mr Burns]

Sorry, the shadow Minister. I was trying to make the hon. Lady relive old glory days.

[Mr Iain Wright]

Happy days.

[Mr Burns]

Obviously they were not happy for the country, or the hon. Lady would not be a shadow Minister now. But there we are; that is life. I pay tribute to the many members of NHS staff in the constituency of the hon. Member for Southport for all the hard work that they do to provide dedicated, committed health care to his constituents and those of other hon. Members in the neighbourhood who are served by the facilities there.

This Government were elected on a platform of reform of the national health service. Our White Paper, to which the shadow Minister alluded, sets out our plans. More than any other Government in the history of the NHS, we will devolve real power to patients, GP commissioners and all clinicians working on the front line. As the NHS becomes increasingly locally led, it will become locally accountable to local authorities and health watch groups. As the White Paper unfolds and reforms are implemented, subject to current consultations, I hope that that commitment will give some reassurance to all those hon. Members who mentioned democratic accountability. Local authorities and health and well-being committees will have a significant role, in terms of democratic accountability, in a way that primary care trusts and strategic health authorities did not.

[Diana R. Johnson]

I would be interested to know what the Government’s rationale was for removing the section in the coalition agreement that said that PCT boards would be elected. Why was that in the coalition agreement if it was to be ripped up five weeks later, and if the White Paper was to get rid of PCT boards?

[Mr Burns]

As the hon. Lady will be aware, this is a coalition Government. That means merging the best practice that each party to the coalition has to offer. That is why we have adopted from the Liberal Democrat manifesto the policy of abolishing SHAs. When we unveiled our proposed reforms, which concentrate commissioning with GP commissioners and GP consortiums, because GPs are at the forefront and are closest to patients, it became clear that if we were to have proper democratic accountability with local authority involvement, the role of PCTs would be diminished to the point where it would have been a waste of resources to keep them, as their functions would be performed by other groups, such as GP consortiums and local authorities. It is a question of merging best practice to get the best solutions and provide the best health care for all our constituents.

[Dr Pugh]

Will the Minister give way?

[Mr Burns]

I will, but I am relatively short of time if I am to deal with all hon. Members’ questions.

[Dr Pugh]

It should be said that the previous Government shied away from every chance to give a decisive voice on the construction of health services to anybody who held elected office. I promoted a private Member’s Bill that endeavoured to introduce a different form of democratic accountability, but the test of the White Paper will be whether people with a democratic mandate have a voice in deciding health services.

[Mr Burns]

I am grateful for that intervention. The hon. Gentleman makes a valid point.

As we do away with politically motivated, top-down-process targets, we will focus all the NHS’s resources on what doctors and patients most want: improving health outcomes. Accident and emergency and urgent care services will be reshaped to reflect those changes in the coming years. I will outline some of our plans.

For many years, accident and emergency services have been operating under the rigid law of the four-hour wait target. How long someone waits in A and E before receiving treatment is important, of course. Not only does it affect the patient’s overall experience of care, but timely treatment generally means better and more effective treatment. However, the problem with the four-hour wait target, an incredibly blunt instrument by itself, was that it became the be-all and end-all of performance management. Such a narrow focus led to the distortion of clinical priorities. I am sure that we are all familiar with tales of hospitals admitting patients unnecessarily, solely in order to meet the target. There have even been persistent allegations that some hospitals have failed to record figures properly, undermining confidence in the whole system. I am sure that hon. Members will agree that that will not do.

From next April, we will introduce a range of more meaningful performance indicators balancing timeliness of treatment with other measures of quality, including clinical outcomes and patient experience. I trust that the shadow Minister will reflect on that. She is looking a little puzzled, because that is at variance with the shock-horror statement about targets and A and E that she made in her contribution.

[Diana R. Johnson]

Just so that we are all clear, is the Minister saying that there will still be a waiting time target for patients in A and E?

[Mr Burns]

No, that is not what I said. I am sure that you were listening carefully, Mr Walker, but for the benefit of the shadow Minister, I will repeat what I said, so that there can be no misunderstanding whatever. From next April, we will introduce a range of more meaningful performance indicators balancing timeliness of treatment with other measures of quality, including clinical outcomes and patient experience. Those performance indicators are currently being drawn up by the profession and will enable doctors and nurses on the ground to deploy their greatest asset: their own professional judgment. Based on clinical advice, the Secretary of State has already reduced the threshold for meeting the four-hour target from 98% to 95%, as the shadow Minister said. The move has been widely welcomed within the medical profession.

The shadow Minister will understand that the issue is about locally led, clinically led services. The same goes for the configuration of those services. It is vital that the NHS continues to modernise and improve for patients’ benefit, but it is also vital that when that means reconfiguring local services, reconfiguration is based on sound clinical evidence, has the support of GPs, clinicians and the local community and considers patient choice. The days are over when a select group of people could meet behind closed doors to decide the future of local health services. In future, change will be led from the ground up, not from the top down.

Where local NHS organisations have already started to consider changing services, we have asked them to go back and ensure that the proposals meet the new criteria and, if they do not, to take steps to ensure that they do so before they proceed. We have asked commissioners to complete any such reviews by 31 October. However, we do not intend to ask the NHS to reopen previously concluded processes or to halt work that has passed the point of no return—that is, projects where contracts have been signed or building work has started.

The hon. Member for Southport discussed the lack of clear definitions for various services. When somebody walks through the doors of an A and E department, a walk-in centre or an emergency care centre, what exactly should they expect? What ailments or injuries are most appropriate for each setting? It is not only an issue of general confusion; it is also a matter of safety. If someone presents at a place describing itself as an accident and emergency department, but it does not have the same facilities as most A and Es, that patient could face delay and unnecessary risk.

As part of the quality, innovation, productivity and prevention programme, work on standardising urgent and emergency care is under way. Its aim is to clarify what services can be expected in various facilities. By using criteria based on clinical evidence, it should be possible to standardise those terms across the country. That is currently being done in three pilot areas: east Lancashire, Manchester and Salisbury. The conclusions should be published by the end of the year, alongside the operating framework. However, it will not state which types of service should be provided in particular areas. That decision will be made locally.

The hon. Member for Southport specifically raised the issue of children’s services in his constituency. I understand that services were reconfigured across Southport and Ormskirk hospitals in 2005. As a result of that reorganisation, emergency surgeries, including adult accident and emergency, were centralised in Southport. All children’s services, including A and E, were concentrated in Ormskirk, as the hon. Gentleman said.

I know that the hon. Gentleman has been vigorously campaigning for the development of a children’s walk-in centre for Southport for some time. Sefton primary care trust commissioned two national experts in paediatric emergency medicine to conduct an independent clinical review of that proposal. On 8 September this year, I understand that the hon. Gentleman met Mike Farrar, the chief executive of the North West strategic health authority, to raise some serious issues about the content of the report that he was shown in advance—issues such as his belief that the report mixes up issues of clinical safety with those of affordability.

The SHA has suggested that the PCT receive that report as a preliminary report, and that further work should be conducted to address the hon. Gentleman’s concerns. The final report should be completed by December. I understand that my right hon. Friend the Secretary of State fully endorsed such an approach when he met the hon. Gentleman yesterday. Although that will add a further three months to an already drawn-out process, I hope that it will provide a far stronger platform for moving forward. Such an approach will also underline the Government’s determination that decisions about local services should be taken locally and include the views of GPs and the wider community.

On the question of children’s A and E services, one important aspect of high-quality care is ensuring that a particular institution receives a sufficient volume of cases to be safe. Patients are best seen by professionals who have access to the right equipment and support services, the right specialist skills and frequent opportunities to exercise those skills. Mercifully, serious illnesses and injuries are relatively rare but, when they occur, it may be better for a patient to travel slightly further to a specialist centre where the appropriate skills are concentrated. That is why regional trauma and stroke centres have been set up and are proving such a success. Similarly, children are best seen by specialist paediatricians in a child-friendly environment. Of course, that is and remains a matter for local decision making, based on local demand for urgent care for children.

I shall turn briefly to the points raised by the hon. Member for Hartlepool (Mr Wright), who mentioned a number of issues concerning the provision of health care in the Hartlepool area. As he rightly said, we have had a number of debates on health care, and I am starting to feel extremely familiar with his constituency’s issues, although sadly I have not yet visited it. First, on the issue of NHS 111—which was, of course, inevitably picked up by the hon. Member for Kingston upon Hull North (Diana R. Johnson)—as I am sure the hon. Member for Hartlepool knows, NHS 111 is being piloted in four areas this year. We will evaluate the experiences and knowledge we gain from those pilots and roll out nationally the 111 number to replace the NHS Direct number. He will appreciate that a 111 number is more easily identifiable in everyone’s mind than the far longer 0845 number that NHS Direct uses. We will wait and see what happens on that matter.

The situation that the hon. Member for Kingston upon Hull North outlined was not quite accurate. There has been no confusion. Ironically, what my right hon. Friend the Secretary of State is doing in piloting a 111 number is simply reflecting and implementing a manifesto commitment made by the hon. Lady’s party at the last election. There are times when political parties share views and think that an idea should be experimented with. I am running out of time for my speech, but I reassure her that there is no confusion.

The hon. Member for Hartlepool also mentioned the issue of A and E and ambulance services. As he will be aware, ambulance calls are put into the category of A, B or C. Any cover from Hartlepool would be imaged under that system, and who should use what type of ambulance or transport would depend on the category that their condition, illness or injury falls into. At this stage, I believe—I shall choose my words fairly carefully, so that the hon. Gentleman does not immediately intervene and contradict me—that the A and E at Hartlepool has not yet closed. If he will allow me, I shall look into the matter a little further, because I would like to know for my own education and knowledge exactly what is going on there. If he thinks it would be helpful, I will write to him after I have looked into the matter. I hasten to add that I do so simply for my own education and knowledge, because decisions must be taken locally.

My hon. Friend the Member for Newton Abbot (Anne Marie Morris) raised some extremely important issues, not least those relating to mental health. She also mentioned a crucial matter that not only causes problems in the health sector, but gives rise to antisocial behaviour and law and order considerations: that of alcohol and alcohol-related admissions to A and E or minor injury units. I reassure her that considerable work on that is being done across Government, including in the Department of Health, because we are as concerned as she is to come up with solutions to alleviate and reduce that pressing problem, which affects all our towns and villages, particularly on a Friday and Saturday night. On the question that my hon. Friend raised about opening hours and the availability of some minor injury units at Newton Abbott, Teignmouth and Dawlish, I will make sure that her comments are drawn to the attention of the South West SHA, so that it is aware of her concerns.

The hon. Member for Burnley (Gordon Birtwistle) was courteous enough to give me advance warning of the issues that were of particular concern to him. I understand and appreciate the points he raised. I know that he has written to me and if a response has not yet been received, one will shortly be sent to him from the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton). I must emphasise that it is not for me to reconsider the application of the new criteria with regard to the proposed reconfigurations in the hon. Gentleman’s area. That is for local people to consider. It is for GPs, the public, local authorities and local PCTs to reassess what they consider to be a viable and successful future for the services provided in Burnley and Blackburn.

The Department of Health has asked the local NHS to look at how ongoing schemes meet the new criteria, as laid down by my right hon. Friend the Secretary of State, including meeting patients’ needs. NHS North West has advised us that that work will be concluded in October 2010, and that it will be able to advise on the process and the progress of that review then.

As the hon. Member for Burnley outlined, he has done considerable work. I encourage him to share his and his constituents’ concerns again and again with NHS North West or the PCT, as is appropriate. He needs to ensure that the strong body of public feeling and opinion within his community and constituency is brought home to the relevant authorities that are considering the matter and recommending decisions on what should happen, so that they can fulfil the criteria that my right hon. Friend the Secretary of State has set out.

In conclusion, this has been an extremely helpful and useful debate. A number of very important issues have been raised by hon. Members across the divide, and by the shadow Minister, the hon. Member for Kingston upon Hull North. I know that there are a number of things that she will never accept, not least in the vision unveiled in the White Paper. However, as with all other areas of health care, on A and E—urgent care—I reassure her that the overriding principle of this coalition Government is to judge patients’ quality of care by raised outcomes, rather than through process targets. That will ensure that we can give the finest health care to all our patients.

National Programme for IT

Simon Burns Excerpts

Thursday 9th September 2010 Written Statements

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

The National Programme for IT is being reconfigured to reflect the changes described in the White Paper “Equity and Excellence: Liberating the NHS” and the outcome of the cross-Government review of ICT projects initiated in May.

A departmental review of the National Programme for IT has concluded that we deliver best value for taxpayers by retaining a national infrastructure and applications whilst devolving leadership of IT development to NHS organisations on the principle of connected systems and interoperability with a plural system of suppliers.

The programme has delivered a national infrastructure for the NHS, and a number of successful national applications such as choose and book, the picture archiving and communications (digital imaging) system, and the electronic prescription service should now be integrated with the running of current health services.

The remaining work of the programme largely involves local systems and services, and the Government believe these should now be driven by local NHS organisations. Localised decision making and responsibility will create fresh ways of ensuring that clinicians and patients are involved in planning and delivering front line care and driving change. This reflects the coalition Government’s commitment to ending top-down government.

The new approach to implementation will be modular, allowing NHS organisations to introduce smaller, more manageable change, in line with their business requirements and capacity. NHS services will be the customers of a more plural IT supplier base, embodying the core assumption of connecting all systems together rather than replacing all systems.

This approach will also address the delays, particularly in the acute sector, that resulted from the national programme’s previous focus on complete system replacement. It will allow NHS trusts to retain existing systems that meet modern standards, and move forward in a way that best fits their own circumstances.

An appropriate structure for health informatics is a key element of the organisational design work currently underway following the publication of “Equity and Excellence: Liberating the NHS”. The direction of travel being announced today for IT services very much reflects the key theme of the White Paper, of bringing decisions closer to the front line. It follows that the national programme will no longer be run as a centralised programme. Some elements will need to continue to be nationally managed and it is expected that new structures will be fully in place by April 2012.

Existing contracts will be honoured and it is vital that their value be maximised. However, by moving IT systems closer to the frontline, it is expected to make additional savings of £700 million, on top of the £600 million announced by the previous Administration in December 2009. These savings will mean that the total cost of the programme will be reduced significantly from the original forecast of £12.7 billion for combined central and local spending to £11.4 billion.

A separate review of the summary care record is currently underway, incorporating two elements: what content the summary electronic record should hold and make available for sharing across the health system; and whether the processes by which patients are able to withhold their consent are as clear and simple as possible. This review is expected to report by the end of September.