Northwick Park Hospital

Simon Burns Excerpts

Tuesday 22nd June 2010 Westminster Hall

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

I begin by congratulating the hon. Member for Harrow West (Mr Thomas) on securing the debate. I wish also to pay tribute to the NHS staff, not only at Northwick Park hospital but across north-west London, who do so much, day in, day out, to look after patients and, it turns out, the hon. Gentleman and his family. The staff consistently deliver first-class care, benefiting his and other hon. Members’ constituents throughout north-west London.

Before I get on to the hon. Gentleman’s specific points—I shall seek to deal with all the issues he raised—I wish to set out the general financial situation. All decisions around NHS funding need to be seen in the context of reducing the deficit. Despite the massive debt acquired from the previous Government, and the measures to rectify our situation, which are to be set out later today by my right hon. Friend the Chancellor of the Exchequer, the NHS budget is protected. More than that, it will receive real-terms increases in each year of this Parliament. That underlines the Government’s commitment to the national health service.

However, the NHS still faces a huge challenge to improve patient outcomes and meet the increasing demand for services and new medicines within a tight financial settlement. North West London Hospitals NHS Trust, which runs Northwick Park hospital, is still dealing with long-standing financial difficulties. Two years ago, the trust was almost £24 million in debt. Since then, NHS London has been gradually helping the trust to return to economic stability one step at a time. I know that clinical staff and managers are working hard to ensure that cost savings do not come at the expense of patient care. Savings can be and have been made by providing more effective and efficient care for patients, and by reducing the burden of back-office costs. Notable examples of cost savings by 2010-11 include: recruiting permanent staff to replace, and reduce reliance on, higher-cost agency staff; a 10% reduction across all corporate areas, such as finance, human resources and information technology; and improving procurement, principally through bulk buying and working in collaboration with the London procurement programme.

As well as savings, there are new investment proposals on the table, as the hon. Gentleman said. They aim to address the essential and immediate needs of the hospital, and to improve the fabric of the hospital and the facilities on offer to patients. If approved, the programme will complement other investments in recent years, including: the £4.1-million new hyper-acute stroke centre, which he mentioned; the £6.7 million for three dedicated elderly care wards; and a £4.3-million bowel cancer screening hub based at Northwick Park—one of six such hubs across London.

The total value of the proposed programme is £65 million, with most of the money coming from the existing budget. A business case for the additional £23 million needed—a point that the hon. Member for Brent North (Barry Gardiner) raised—was submitted to NHS London for approval on 7 June. After careful consideration, the hospital trust was asked to improve the bid. NHS London received the strengthened business case last Friday, and we hope that it will be ready for consideration by the Capital Management Group on 25 June, a little later this week. If the business case is approved, my Department will then thoroughly consider the loan application from NHS London. Let me be clear: my officials will need to see a sound and credible recovery plan before they can agree to the investment.

I am afraid that I cannot give a specific time when a final decision will be reached, but we are acutely aware of the urgency of the issue, and we will reach a conclusion as quickly as we possibly can. I hope that that reassures both the hon. Member for Harrow West and the hon. Member for Brent North.

[Mr Thomas]

Can the Minister give a guarantee that he will write to the three hon. Members present—there is one behind him—to let us know the outcome of that bid, ideally in advance of any public notice?

[Mr Burns]

I can categorically give the hon. Gentleman an assurance that at the appropriate time, before the announcement, I will make sure that my office contacts all three hon. Gentlemen present to ensure that they have advance notice of it.

On the question of foundation status, the hon. Member for Harrow West raised the possibility of North West London Hospitals NHS Trust attaining foundation status. The Government strongly support all trusts that aspire to that aim. Foundation-trust status enables the local NHS to develop stronger connections with communities, so that health care better reflects patient needs. It also creates the conditions for improving performance, which can only benefit patient care. More than half of all eligible NHS trusts are now foundation trusts, but we want to go further. We want to reduce Government control over the health service and set trusts free to innovate and take decisions based on what is right for their local populations. That includes North West London Hospitals NHS Trust.

The trust serves its population well and delivers good-quality care, as the hon. Member for Harrow West mentioned, but to step up to this new challenge, the trust needs to establish a solid financial foundation and needs to gain the support of GPs and commissioners. Bearing that in mind, I understand that the trust is likely to apply to become a foundation trust in 2012, and I wish it well in its application.

[Barry Gardiner]

I am grateful to the Minister for giving way; he has been most generous. He talked about building the confidence of local commissioning GPs. My understanding is that under his Department’s new arrangements, the ring-holder for the GP commissioning groups set up under the auspices of Brent primary care trust—I am sure the same applies in Harrow also—will no longer be the primary care trust. How does he propose that those groups of private businesses avoid the risk of being providers of services that they commission? Who will hold the ring, as the PCTs used to do?

[Mr Burns]

The hon. Gentleman is tempting me to go down a path that it would be unwise to go down at this stage. The reason I say that, and why I will not be tempted, is that as he is probably aware, my right hon. Friend the Secretary of State and my ministerial colleagues are doing a considerable amount of work putting together and fleshing out our vision for the NHS, not only for the next five years but thereafter—a vision that puts patients at the heart of the NHS and that is driven by the needs and improved care standards of patients. It would be inappropriate and wrong of me to succumb to temptation and to start to unveil, in this august debate, what my right hon. Friend the Secretary of State will announce in due course. The only good news that I can give the hon. Gentleman is that he will not have long to wait before all these mysteries are explained to him, and I am confident that he will be reassured and pleased by what my right hon. Friend the Secretary of State has to say.

[Bob Blackman (Harrow East) (Con)]

One of the key issues for Northwick Park hospital is how it deals with both Brent and Harrow primary care trusts. Both are in desperate financial straits, as I think hon. Members would agree. My concern is how that will be manipulated for Northwick Park and St Mark’s hospital trust in the future.

[Mr Burns]

My hon. Friend raises an interesting point. It is true, as I hope I have explained, that there have been challenges for the North West London Hospitals NHS Trust with regard to its finances in recent years. However, as I explained—I will go into more detail on this later—measures are being put in place to seek to minimise the problems. I can assure my hon. Friend that when it comes to dealing with PCTs, trusts and the finances, I do not recognise the word “manipulate” as being in the lexicon. Everything is done to ensure that the maximum amount of money is made available to PCTs and trusts, to ensure that we protect front-line services, and to provide the best health care possible for my hon. Friend’s constituents and those of all hon. Members throughout the country.

[Barry Gardiner]

I wish to correct any suggestion that Brent PCT is in any way financially embarrassed. [Interruption.] My hon. Friend the Member for Harrow West (Mr Thomas) wishes to correct any such suggestion for Harrow as well. Three years ago, Brent PCT was running a deficit of more than £20 million. It took the necessary measures, and that deficit has now been turned into a surplus of £12 million.

[Mr Burns]

I appreciate what the hon. Gentleman says. I am sure that my hon. Friend the Parliamentary Secretary, Cabinet Office, will have taken that on board, and the record will certainly reflect the accurate assessment that the hon. Member for Brent North makes of the situation. However, it is fair to say, particularly in the case of the constituency of the hon. Member for Harrow West, that there has been a problem with the finances. As I said earlier, the requests for a loan and for money that are being considered reflect a need to bring finances into better alignment without affecting front-line services. I am hopeful—probably a bit more than that—that, with the actions that have been taken and the proposals that are awaiting decisions, there will be positive movement.

I come to the point raised by the hon. Member for Harrow West about new hospital build. He mentioned his desire to see completely new build at Northwick Park. As he knows, plans were put forward in 2004 to build a brand new £305-million hospital for his constituents. In 2005, at an early stage of the business case and planning application processes, the plans for the scheme were put on hold by the trust and the local PCTs due to concerns about their affordability. After more than a year on hold, the proposals were formally cancelled by the Department in the summer of 2008. That is standard procedure for schemes that are not progressing and that have been put on hold for a specified period of time. I am afraid that those limitations remain. While the trust is working hard to achieve financial stability, I regret to say that it is still a long way from realistically being able to afford such a large building project.

The hon. Gentleman also raised the issue of designating Northwick Park hospital a major acute centre within the context of the north-west London sector review. The proposals, which I understand are still at a very early stage of development, would need to pass the Secretary of State’s four tests. They would need the support of GP commissioners; the support of the local community; to be evidence-based; and to develop patient choice. That relates to the decision that the Secretary of State took a few weeks ago to strengthen the criteria for considering any reconfiguration by placing more emphasis on gaining support following full consultations with GPs, clinicians and local stakeholders. I am sure that the hon. Gentleman, being a reasonable man, would accept that that is a sensible improvement, with regard to seeking to reconfigure health patterns throughout the country and to ensure that the local community and the clinicians and GPs who deliver the services have more say and influence over what happens.

The hon. Gentleman requested a commitment from me, but there is not a lot that I can tell him at present, because the proposals are at such an early stage. What I can tell him—I hope this will go some way towards reassuring him—is that all proposals, when put together as a final package for consideration, will be fully considered in the context of the Secretary of State’s criteria, and a decision will be taken at the appropriate time.

[Mr Thomas]

I should acknowledge the presence at this debate of the hon. Member for Ruislip, Northwood and Pinner (Mr Hurd), who represents the fourth constituency with a strong interest in Northwick Park hospital. I am indeed a reasonable man, and the Minister has a reputation for being a reasonable man, so will he meet with those of us who are interested in the future of Northwick Park within a minimum of 12 months to review some of the issues that we have discussed today, and particularly the affordability or otherwise of any significant rebuilding of the hospital?

[Mr Burns]

I am grateful to the hon. Gentleman. He is a knowledgeable man who knows that flattery usually gets one everywhere. I cannot resist flattery. It would be a considerable pleasure to meet him and any of his or my hon. Friends. If he would be kind enough to get in touch with my office, a meeting will be arranged in the not-too-distant future.

In conclusion, the Government have made a clear commitment to protecting the NHS and to ensuring real-terms increases in funding. There remains, however, a responsibility on all parts of the NHS to be innovative, to become more efficient, and to reinvest the savings that they make to improve quality of care for patients. North West London NHS Trust shares that responsibility, and must continue to rise to the challenge. We will consider all the proposals that we receive very carefully and will reach a decision as quickly as we can. Moreover, we will work with the trust to achieve ongoing improvements for the constituents of the hon. Members for Harrow West and for Brent North, and those of my hon. Friends the Members for Ruislip, Northwood and Pinner (Mr Hurd) and for Harrow East (Bob Blackman). I hope that we will be able to consider the issue further when I meet the hon. Member for Harrow West.

Health Funding

Simon Burns Excerpts

Tuesday 22nd June 2010 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Weir. I congratulate the hon. Member for St Ives (Andrew George) on securing today’s debate. From my reading in preparation for the debate, I know that this is an issue that he has taken up over many years during his time in Parliament and that he is a very committed campaigner for health funding for his local area and the wider area of Cornwall. I welcome the Minister of State, Department of Health, the hon. Member for Chelmsford (Mr Burns), to his role and wish him well in his new position.

It has been very interesting to hear the contributions of the two Members who have also spoken in the debate today, the hon. Member for Truro and Falmouth (Sarah Newton) and my hon. Friend the Member for Hartlepool (Mr Wright). As my hon. Friend said, I want to congratulate the hon. Member for Truro and Falmouth on her maiden speech, if that is how it is going to be seen. Like the hon. Member for St Ives, she is making a very strong case for her constituents and ensuring that there is an advocate for them in this House who stands up for the real health funding that is required for people in her constituency.

It was also very interesting to hear what the hon. Member for St Ives said about some of the different criteria that have been used to allocate funding and about some of the tensions that exist when one looks at some of those criteria. I hope that I shall have an opportunity to say a few words about those tensions shortly.

My hon. Friend the Member for Hartlepool made some very pertinent points about the need to get to the target for health funding for primary care trusts. I noted that he said that his constituency was 4.3% below the funding target. As a result, I had a quick look to see where my primary care trust was in terms of being on target. It is actually 6% below target, so we are just above the group of PCTs that the hon. Member for St Ives referred to, which are 6.2% below the funding target.

It was also very pertinent to raise the issue of access to health services, and of course there is a funding implication to that issue. If we want to have services out in the community, there is a need to look at how funding is allocated and at the issues related to health inequalities. It is not acceptable that there are still parts of this country where the mortality rates show that men in particular will live for fewer years than men born in the south of England. I know that in the north there are real concerns about that issue.

Very importantly, there is also the issue of hospitals and capital funding. I know that that is mainly about PCTs’ revenue funding, but we need to keep an eye on what happens to capital funding. Of course, the hospital at Hartlepool that my hon. Friend the Member for Hartlepool mentioned has been in the planning for a very long time and there has been a huge investment in it, through the PCT and other people and other organisations in that area ensuring that it was really going to deliver for local people.

Therefore, I am particularly concerned about the cancellation of that hospital, especially in the light of the reassurances that were given by the new coalition Government that the cuts that they would make this year would not to be to front-line services and that, as I understood it, they would protect hospital builds. So it would be very helpful if the Minister could say a little more about his view of how the cancellation of the Hartlepool hospital fits in with the agreement not to cancel front-line services.

The main thrust of the debate is the funding of health services in Cornwall, and I have looked with interest at what the hon. Member for St Ives has said about it previously. Today I also had a quick look at his website, where he trails the debate and says that he is looking to secure an additional £56 million of funding for his area. He also says:

“The Conservatives created a system of endemic underfunding. Now they are in Coalition they can put this right.”

The press cuttings prepared by the Library for the debate also include an article from The West Briton of 10 May, in which he says:

“The coalition is already starting to deliver many outcomes which Cornwall has craved.”

I admire his positive view of what the new Government will deliver for him and his constituents and I very much hope that he is correct.

What the coalition Government have said so far about the NHS is quite limited. Section 22 of the coalition agreement sets out their priorities for the NHS, and the first bullet point says:

“We will guarantee that health spending increases in real terms in each year of the Parliament”.

Paragraph 21 of the revision to the operating framework for the NHS in England for 2010-11, which was published just yesterday, reiterates that commitment, and I have just heard the Chancellor of the Exchequer make it clear in the Budget debate on the Floor of the House that the commitment remains.

Of course, that is just the headline, and we do not actually know what it will mean for services in the NHS in England in the coming years. Obviously, the Minister will be working hard on the comprehensive spending review over the summer months. He will be looking at how he can make sure that his Department secures all the resources that it needs to ensure that the view of the hon. Member for St Ives that he will get his £56 million comes to fruition. The written reply to a question that the hon. Gentleman tabled to the Minister contained a commitment just to increase spending

“in real terms in each year of the Parliament.”—[Official Report, 7 June 2010; Vol. 511, c. 47W.]

We really need to have the detail. I accept that it is very early days for the Minister, who has been in office a few weeks, and that the coalition Government are still trying to sort out their policies on NHS funding.

The hon. Member for St Ives made a clear and effective case for raising the funding for his constituency and primary care trust. There have been many written questions and debates on the issue, and I pay tribute to everybody who has been involved in the campaign to get additional resources into the primary care trust and into Cornwall. I also pay tribute to the staff, who are working hard day in, day out with the resources that they have.

Funding is obviously a key issue. The hon. Gentleman has given us quite a detailed canter through the historic reasons why we are where we are on funding, which was very interesting, but many of the views about why there is underfunding in certain constituencies and areas point to the 1970s as the time when allocations perhaps did not work in quite the way that they should have. That is the view that comes out of the debates and explanations about the current funding criteria.

At this point, it is worth reflecting on how the NHS has changed over the years. Patients now want access to high-tech, specialist services with the best nursing and clinical advice. There is also a tension around the fact that people want services much closer to home—in their local GP surgeries or at home if at all possible.

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

I was just reflecting on what the hon. Lady said before she got to this section of her speech. I must gently remind her that her party was in power for 13 years and introduced the funding formula that the hon. Member for St Ives (Andrew George) is complaining about. Having put that on the record, I beg to ask why the last Labour Government did nothing in those 13 years to remove the problem facing Cornwall and the Isles of Scilly.

[Diana R. Johnson]

I am grateful that the Minister intervened on me, because I am coming to that. I recognise, as the hon. Member for St Ives probably does, that where we are today might not be perfect, but the previous Labour Government made huge strides in terms of putting money into his area and others that were underfunded. The statistics show that there have been significant improvements since 2003-04, when some PCTs were 22% below target; now the figure is 6.2%, so there has been movement. I am not saying that everything done under the Labour Government was done as fully as we would have liked, but it would be interesting to hear what plans the Minister has to target the pace of change and how soon he feels we will reach the target level for all PCTs. We have to recognise, as I am sure the hon. Member for St Ives does, that taking money from other areas of the country in one fell swoop is not the best way to have a stable national health service.

[Diana R. Johnson]

We can probably agree that history is history. We are where we are today, and we need to make sure that we move forward as quickly as possible to get to the point that we all want to be at—an NHS that is funded fairly across England and that addresses some of the issues that the hon. Gentleman raised about rural constituencies and rural areas.

I want to address the rural nature of the hon. Gentleman’s constituency, the primary care trust and the patients that it serves. The issue of islands and peninsulas is also quite unusual, and few primary care trusts have to deal with it, so there needs to be some recognition of that. Clearly, the influx of people during the summer months must swell the demands on the national health service; all that must be recognised and factored in. There is also the issue of poverty. There can be pockets of poverty in rural areas; they are not just in urban areas, although we recognise that there might be different solutions to poverty in different parts of the country.

Let me reiterate that 80% of NHS spending is at primary care trust level, which means that the best solutions for an area can be put forward, debated and agreed at that level. I want to remove the myth that seems to exist that everyone is being told that certain areas have to do things in a certain way. That is wrong. Primary care trusts have much more capacity to design local services to meet their area’s needs. I understand that the new coalition Government will introduce directly elected representatives into primary care trusts to increase the level of local involvement and accountability. I hope that I have that correct, because the Minister is looking at me as if I do not.

[Mr Burns]

No, I am not doing anything.

[Diana R. Johnson]

I just wanted to make sure, because that was not a Conservative manifesto policy. As I understand it, such engagement and increased accountability in the NHS was one of the Liberal Democrat policies; but it is part of the coalition agreement.

[Mr Burns]

May I just reassure the shadow Minister that I am just listening intently to what she has to say.

[Diana R. Johnson]

I am delighted to hear it.

I now want to move on to the matter of health spending. I recognise that the hon. Member for St Ives would like more money for his constituency, but I think he recognises that since 1997 the relevant spending on St. Ives, and on Cornwall, has increased. This year the allocation for all PCTs is £164 billion. As I said, 80% of the entire NHS budget is now in the hands of PCTs—the highest proportion ever. That means that local decision making is possible. The PCT for Cornwall and the Isles of Scilly is this year receiving £856.2 million and its budget has increased by 12.4%, but we recognise that it is still 6.2% away from the target.

I am grateful that the hon. Member for St Ives has recognised the work of the independent Advisory Committee on Resource Allocation, which is made up of GPs, academics and health service managers, to develop a new funding formula to determine each PCT’s allocation. That has built on previous formulae to meet the objectives of providing equal access for equal need, and a reduction in health inequalities. Of course, a huge debate has raged about the tensions between the criteria used for allocating resources. For instance, there has been a debate about age versus deprivation, and the Conservative party in opposition would often argue that it was not deprivation but age that should be given more weight. The Conservatives also criticised the weighting of health inequalities in trying to remove those inequalities.

I hope that we now recognise that a series of criteria must be considered. Since last year a new formula has been introduced. We can clearly see how far the PCTs’ actual allocation is from their target allocation. The previous Government’s commitment was to move towards the target, while recognising that that would have to be done over a period of time, ensuring that it did not cause major problems to the smooth running of the NHS throughout the country.

When I looked again at the figures I found that the PCT that was the furthest over its target was Richmond and Twickenham; it was 23.4% over the target. I thought that it would make an interesting example to consider, as the relevant MPs are the Secretary of State for Business, Innovation and Skills, who is a member of the Liberal Democrats, and the hon. Member for Richmond Park (Zac Goldsmith), who is a member of the Conservative party. I can just imagine the tension and debate in that case about chopping the funding allocation for that PCT. Perhaps it would add some strains to the tensions within the coalition.

--- Later in debate ---

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

I congratulate my colleague, the hon. Member for St Ives (Andrew George), on securing this debate on NHS funding allocations. I also congratulate the shadow Minister, the hon. Member for Kingston upon Hull North (Diana R. Johnson), on her appointment to the Health Front Bench. In Government she was a Minister with other responsibilities, and a Whip, and I assure her that she will find serving as a shadow Health Minister tremendously rewarding, because of the important role of such matters in our lives and those of our constituents. I also congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on her almost but not quite maiden speech.

I pay tribute to the NHS in Cornwall, which provides an excellent level of care to the constituents of my hon. Friend and those of my honourable colleague; he has long campaigned on how best to distribute resources and has argued that PCTs should be moved to their target allocations. Before I respond in detail to his points, perhaps I might set out the general principles of the system of funding allocation; that may help the hon. Member for Kingston upon Hull North.

The Government believe in an NHS that is free to all, irrespective of need or ability to pay; in which professionals are freed from the shackles of centralised targets and empowered to take responsibility for their patients; where better access to services is matched by improved quality and greater efficiency; and which provides value for money and health outcomes that are second to none. That is our vision for the national health service, and the coalition’s programme for government sets out how we will achieve it.

First, the Government will increase spending on the NHS in real terms for each year of this Parliament, as the shadow Minister acknowledged. It is a commitment that reflects a deeper belief: that the NHS must be protected and properly resourced to continue its vital work. We must focus our resources where they are needed most. That means stopping the flow of resources from the front line to the back office, giving front-line staff the responsibility and resources to improve outcomes for patients, and entrusting local professionals—and local people—with the means to improve local health. By committing to cut the costs of health bureaucracy by a third, we will release resources that can be reinvested in front-line services; by giving GPs the power to commission services based on need, we will push decisions about health care provision close to patients; and by giving local communities more responsibility for public health, we will create a more flexible national health system—one that is responsive to local demand for health services, and is able to react to changing health needs and to direct funds towards emerging priorities.

Secondly, we will establish an independent NHS board to allocate resources and provide commissioning guidelines. The board will ensure access to health services that are designed around the needs of the patient, not the needs of the bureaucracy. It will set standards based on clinical evidence, not political micro-management. The aim is to achieve the best outcomes for patients, instead of simply ticking boxes and meeting targets.

[Mr Iain Wright]

I congratulate the Minister on securing his post. I know that he is passionate about health, and I wish him all the best as a Minister in the Department of Health. He mentioned the establishment of an independent NHS board whose focus will be on clinical standards as opposed to political micro-management. Bearing in mind health services north of the Tees, a clinically led, independent reconfiguration panel recommended that a new hospital should be built. Is that not something that the Government should be doing?

[Mr Burns]

I have to congratulate the hon. Gentleman. I remember that as a Minister he was extremely helpful, within the confines and straitjacket of his remit. He was tenacious both in that job and this afternoon, and is using his skills to try to tease out an answer beyond the one that was given to him in my letter to him last Thursday explaining why that capital project was cancelled as part of the public spending review. However, to be helpful, and if he would like it, I will repeat basically what the letter said. Facts are facts, and I am afraid that the situation has not changed since I wrote to him.

When this Government came into power in May, we were faced with the largest deficit and debt that any Government had ever inherited from an outgoing Government. The debt is a financial problem that must be addressed urgently. Therefore, the incoming Government announced a review of spending commitments that were made by the previous Government after 1 January 2010—that is, in the run-up to the general election. As a result of the review, which has been carried out over the past seven weeks or so, an announcement was made on 17 June in which the coalition Government announced the go-ahead of four major hospital programmes, ranging from the Pennines to Liverpool and to St Helier in south-west London. Unfortunately, the North Tees and Hartlepool project did not get permission to go ahead. I am afraid that that is the answer. It is because of the economic situation and debt in which we find ourselves.

[Mr Wright]

The Minister is gracious in giving way a second time. On that basis, and given what the Prime Minister said about NHS funding increasing in real terms despite the financial problems that we find ourselves in, capital spends will be provided elsewhere in the country, but seemingly not in my constituency. Are my constituents’ health outcomes not to be thought of because of financial considerations?

[Mr Burns]

The hon. Gentleman knows the answer to that question. That is not why the hospital was not given the go-ahead last week. I can appreciate his frustration. As a constituency MP myself, I too would be frustrated, but the hon. Gentleman, who is a generous man, must not try to reinterpret the decision for other reasons. Sadly, the decision was taken simply because of the urgent need of this Government to take decisions to start curbing the ballooning debt problem, which needs to be addressed. That is the reason, I am afraid. It has nothing to do with our commitment to reducing health inequalities and spending more money on providing health care and services for people throughout the country.

I hope that the hon. Gentleman is satisfied with that. If he is not, and if it would be of any help to him, I would be more than happy to meet with him and, if he wants to bring them along, his colleagues from the Hartlepool area and the surrounding constituencies. They can discuss the matter with me—my door is always open. I would be more than happy to do that, if we can arrange a meeting, and if he thinks that it would be helpful.

Let me return to Cornwall and the general position on health funding allocations. I was saying, before discussing Hartlepool again, that we will establish an independent NHS board.

[Andrew George]

On that point, I would be grateful if the Minister would clarify whether the board will replace the Advisory Committee on Resource Allocation.

[Mr Burns]

I can reassure my hon. colleague that it will not. It will be something completely different. It will be a stand-alone body that will be the driving engine of the NHS, in its required field.

By strengthening the link between investment and outcomes, the board will enable the NHS to deliver improved quality, higher productivity and better value for money. I am sure that my hon. colleague will appreciate that I cannot yet discuss the precise functions of the board, nor its composition, but our proposals underline our central belief that resources should be allocated according to need, without ministerial interference.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Perhaps the Minister can touch on another hospital situation. I understand that the Secretary of State visited Bury on Friday and overrode a clinically reached decision on maternity units. He said that, in his judgment, Fairfield General hospital’s maternity unit could remain open, against a clinical decision made in the “Making things better” reorganisation in Greater Manchester.

[Mr Burns]

I hope that the hon. Lady is aware of the announcement that my right hon. Friend the Secretary of State made shortly after he assumed his current position, in which he laid down new criteria for determining the reconfiguration of hospital services. Prior to the general election, when he was the shadow Secretary of State for Health, he made it a priority that, in particular, maternity units and accident and emergency units would be looked at far more closely than they had been looked at. That is why, on assuming office, he strengthened the criteria for carrying out consultations on proposed reconfigurations, and brought in four new criteria that will apply to any future reconfigurations, and current ones that are still in the process. They will have to abide by the new strengthened criteria, which include ensuring that the wishes and views of GPs, clinicians, local stakeholders and the general public are taken into account. Decisions that affect local communities and people will have the input of local people, rather than simply being imposed on communities which, for a variety of reasons, do not want what is being proposed.

[Barbara Keeley]

Those of us in Greater Manchester who are affected by the decision and the new process that the Minister is outlining are struggling to understand how to square the clinicians’ recommendation, which was based on things such as the number of doctors available, doctor training and the experience that has to be gained in maternity to deliver a safe service—a clinically led decision was made in that case—and the community’s wish and desire always to keep maternity and A and E units. It is hard for local people to understand how such things can be squared. Most constituency MPs understand that no one ever wants to lose an A and E or maternity unit. Does that really mean that clinically led decisions, such as those in Hartlepool and Manchester, will be overridden if local people do not want them?

[Mr Burns]

No, it does not mean that. What I said when explaining the criteria that the Secretary of State has laid down is that it will strengthen the consultation process leading to decisions, but obviously there will be a number of processes thereafter. The different processes of assimilation before a final decision must ensure that the Secretary of State’s criteria for greater input of clinicians’, GPs’ and local communities’ wishes are taken into account. In the past, reconfigurations have too often left the impression among local communities that they have not been consulted or listened to, and that decisions have been made by managers or others based only on their narrow point of view without taking account of other people’s views.

[Barbara Keeley]

Will the Minister give way?

[Mr Burns]

No. I have been generous, and I want to make progress.

That is the principle for the criteria, but it will not mean automatically that there will never be any changes because there is a block. We are strengthening the process to take account of local wishes and needs. There is a balance to be struck, which will emerge during the reconfiguration process.

[Mr Andrew Turner (Isle of Wight) (Con)]

Is my hon. Friend aware that we have a unique arrangement for health, and that a single organisation is responsible for both commissioning and delivery—the local hospital? That works for the Isle of Wight, and it has turned round a deficit of £3 million and broken even in the past three years. Can he assure me that the forthcoming White Paper will allow the success of the island’s health services to continue?

[Mr Burns]

I am grateful to my hon. Friend for that intervention. I assure him that the White Paper will be aimed completely at improving and enhancing the provision of health care throughout the country—not just on the Isle of Wight, but on the mainland from Cornwall and the south-west up to Hadrian’s wall in the north. That will be based on a principle of putting patients first and at the heart of health care provision so that they drive the national health service and so that it is there for them and their needs, rather than the needs of management bureaucracy or of politicians micro-managing the system from Whitehall down the road. However much affection and respect I have for my hon. Friend, I cannot be tempted to outline in detail now the White Paper’s contents, but I assure him that when it is published he will share my enthusiasm for the way in which the Secretary of State will unveil his vision for the national health service, not simply for the next five years, but thereafter. I trust that that satisfies my hon. Friend, if not the hon. Member for Worsley and Eccles South (Barbara Keeley).

My honourable colleague the Member for St Ives mentioned the current pace of change, and particularly the distance from target measurements used to assess relative progress towards target allocations. His constituency is in Cornwall and Isles of Scilly primary care trust. It received an allocation of £808 million in 2009-10, which increased to £856 million in 2010-11—an increase, as he knows, of 12.4% above the national average of 11.3%. However, under the formula established by the previous Government, and as many contributors to the debate have noted, that is still 6.2% or some £56.3 million below its target allocation for 2010-11.

I hope that my honourable colleague will appreciate that until the spending review is complete, I cannot comment on specific time scales or the future plans for NHS allocations, nor on the financial standing of specific local health services. I trust that he will be reassured that his partners in Government share a common assessment of both the problems facing the NHS and the solutions available to us.

During the spending review, we will examine rigorously all areas of health spending to identify where we can make savings—for example, by maximising the NHS’s buying power, renegotiating contracts and improving financial accountability throughout the system. The picture that I have painted is of an NHS in which decisions on resource allocation centrally are made by an independent NHS board. But although I cannot give the hon. Member for St Ives the commitment and promise that he wants now, the matter will be examined as part of the spending review between now and the autumn. When our reforms become reality, the NHS board will be responsible for the allocation of spending and will consider a whole range of areas.

[Andrew George]

I want to raise a point for clarification. The Minister described the role of the NHS board and made it clear that it will be remote from political micro-management. He also said that he cannot give me or the PCTs that are a long way below their targets any answer until after the spending review. Will the decision on the pace of change towards achieving targets be made by the spending review, or will that decision be made ultimately by the independent NHS board? If he cannot say which of the two, or which combination of the two, when will I and other hon. Members receive a clear answer on what will happen and who will make the decision on the speed of change?

[Mr Burns]

I believe that I can help my honourable colleague. The ultimate decisions will be made by the NHS board when it is established, but he will appreciate that primary legislation will be required and that that will take time. In the meantime, the allocation of funding for health care throughout the country will be done initially following the spending review, but when the board is established on a statutory basis and operating, it will take over that function. I hope that has cleared up the matter for my honourable colleague.

[Diana R. Johnson]

I am wondering about the time scale for the board’s establishment. When will the Minister be in a position to provide some dates for when it will come into existence?

[Mr Burns]

That is a reasonable question, and I shall be reasonable in my response. The date will be determined partly by Parliament because primary legislation will be required, as outlined in the Queen’s Speech last month. Speaking as an ex-Whip rather than a Minister for Health, I anticipate that the legislation will make progress through Parliament this Session and receive Royal Assent in July next year, or perhaps September, depending on whether there is a spillover in September or October next year, which I do not know at the moment. That is my guess as an ex-Whip for the timetable for the primary legislation. We will then have to wait to see at what point after that it will be up and running, but my guess is that it will be as soon as is feasible.

[Andrew George]

Given the state of flux and the uncertainty of the spending review, which will be followed by the creation of the independent NHS board, there will be a vacuum because decisions have yet to be made in this two-stage process. Will the Minister agree to meet colleagues from Cornwall and me to discuss the progress of that review, either at the time of the review itself or immediately afterwards? We would find that very helpful, because we know that the NHS budget in Cornwall is under tremendous pressure at the moment.

[Mr Burns]

I reassure my honourable colleague that there is not a state of flux. There is a state of potential change, yes, because there is a new Government with an important vision for the future of the health service. That is a difference, but there is not a state of flux because there is stability there. I am not criticising him, but I wanted to reassure him, so that he did not get the impression that there was a state of flux, with the connotations that that has. There is no state of flux. We have a vision, which will be unveiled shortly, but we have things in place to make sure that the system is running properly.

The other thing I would like to repeat—it is so important that it does not matter if it is repeated again, because the issue has featured frequently during today’s debate—is that the Department of Health budget is, of course, protected, which means that in every year of this Parliament, it will increase in real terms. There will be pressures on the Department of Health budget but, under the coalition agreement and the commitment that my party gave prior to the general election, which has been upheld by the coalition agreement, there will be a real-terms increase in that budget. That gives a degree of stability to the health service because it knows that, in every year of this Parliament, it will receive that money.

I thank my honourable colleague for his earnest and informed contribution to today’s debate. As a constituency MP myself, I respect and appreciate the tremendous battle that he has fought over a number of years for Cornwall. I am thrilled to see that my hon. Friend the Member for Truro and Falmouth is also joining in fighting for her constituents to ensure that they, too, get the best health care possible. That is something that all hon. Members want and fight for on behalf of their constituents.

At its most basic level, allocation is a question of measuring need and distributing resources accordingly. To the outsider—and some insiders—funding allocation is a dense and sometimes opaque subject. As the former health editor of The Times wrote,

“only the brave or foolhardy venture into some areas of NHS management. Resource allocation is certainly one”.

I can safely say that my honourable colleague falls into the former category. I trust that he is reassured that although it is too early to comment on specific funding allocations, the coalition’s programme for government shows that we share the same basic belief in the importance of both independence and local decision making when it comes to setting funding levels for the NHS.

[Mr Mike Weir (in the Chair)]

As the Minister is not present for the next debate, I suspend the sitting until 4 pm.

Horton General Hospital

Simon Burns Excerpts

Wednesday 16th June 2010 Commons Chamber

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

I congratulate my hon. Friend the Member for Banbury (Tony Baldry) on securing this debate on the future of Horton general hospital. I know that he has campaigned vigorously in support of the hospital for several years, and I am sure that his constituents appreciate both his hard work and his dedication to protect good local health services in his constituency. I also pay tribute to the NHS staff across the whole of Oxfordshire, who provide such first-class care for his constituents.

As my hon. Friend will know, the Secretary of State has visited his constituency a number of times, and has seen for himself the excellent work carried out daily at Horton general hospital. I would be delighted to accept my hon. Friend’s offer to visit Horton myself, so that I, too, can benefit from knowledge of the experience that his constituents enjoy.

[Steve Baker (Wycombe) (Con)]

I, too, congratulate my hon. Friend the Member for Banbury (Tony Baldry) on securing this debate, and I note the Minister’s diligent concern for Horton hospital. Will he consider the case of Wycombe hospital, which is somewhat further down the route upon which the Horton had embarked, and our local services?

[Mr Burns]

I am grateful to my hon. Friend for drawing that to my attention. Given the constraints of time in this debate, if he were to be kind enough to write or to come and see me, I would be more than happy to discuss the situation with him.

My hon. Friend the Member for Banbury referred to the decision made by the board of Oxford Radcliffe Hospitals NHS Trust on Monday this week to maintain 24-hour paediatric services and a full obstetrics service at Horton general hospital. That is good news, and thanks in no small part to the strong opposition mounted by local GPs, clinicians and the public to the trust’s original plans that were proposed in 2007. In addition, my hon. Friend and my right hon. Friend the Prime Minister—in his constituency role—my former hon. Friends Tim Boswell and John Maples, and my new hon. Friends the Members for Stratford-on-Avon (Nadhim Zahawi) and for South Northamptonshire (Andrea Leadsom), should be congratulated on the determined way in which they have fought for their constituents in seeking to stop the original proposals, which would have meant paediatric in-patient services moving from the Horton to the John Radcliffe hospital in Oxford, with the problems that that would cause for their constituents.

Following the rejection of the original plans in 2008 by the independent reconfiguration board, Oxfordshire PCT set up the better healthcare programme to develop proposals on how safe, long-term services at Horton might be delivered. It established a community partnership forum to ensure wide engagement with the local community, which included representation from local GPs, patients, the public, Horton general hospital staff, councillors and Members of the House. I am aware that my hon. Friend the Member for Banbury played a long and active role in those deliberations.

I am pleased to note that local engagement has been such a key part of the better healthcare programme. I understand that the community partnership forum has been involved throughout, and that frequent briefings were held with GPs and the practice-based commissioning consortia. Clinical staff at Horton general and John Radcliffe hospitals have also been involved, to ensure wide clinical engagement.

The model of care that emerged from the better healthcare programme was for consultant-delivered paediatrics and obstetrics services to remain at Horton general. That will mean less reliance on middle-grade doctors, and result in Horton continuing to provide local, high-quality paediatric and maternity services. The Oxfordshire health overview and scrutiny committee agreed with that model.

In March, the proposals developed to implement that model were presented to a clinical review panel. The panel consisted of local GPs, representatives from the Royal College of Obstetricians and Gynaecologists, the Royal College of Paediatrics and Child Health, the Royal College of Anaesthetists, Cherwell district council and a PCT board member. Although I understand that the panel had some concerns, it concluded that the proposals were clinically safe and deliverable. Now that the PCT and trust boards have decided to go ahead with these proposals, the next step is for the trust to develop an implementation plan. That will involve recruiting the required number of additional consultants.

I am pleased that Oxfordshire PCT and South Central SHA have both assured me that the better healthcare programme has passed the four tests set out by the Secretary of State, which have been a strong feature of the way the programme has been organised. As my hon. Friend will appreciate, the four tests to which I refer are the new tests that the Secretary of State has laid down to ensure that when reconfiguration proposals are made, local GPs and clinicians—and local communities—are fully consulted before any decisions are made, so that they can have a say in the health care that they need.

My hon. Friend asked a number of questions that I will seek to answer now as far as I can. He asked about the timetable for the transition to GP commissioning and the future role of primary care trusts. As he knows, we have only been in government a matter of weeks and a tremendous amount of work needs to be done to begin to realise our vision for an NHS based on putting patients first so that quality of care is the priority in the service. In that context, we will set out our vision for the national health service shortly. Until we do, I am not in a position to respond in detail to those two specific questions.

My hon. Friend asked about the independent NHS Board. The board will set outcome objectives, allocate resources and provide commissioning guidelines free from political interference. Again, I beg my hon. Friend’s patience as we will set out further details of the NHS Board shortly. I am sure that he appreciates that I cannot go into detail at this stage and while we are putting together our proposals to bring before the House and the nation.

My hon. Friend also raised the idea of an initiative to bring together an alliance of general hospitals to help provide the best integrated primary, community and hospital care. Like him, I believe that it is vital to have first-class integrated health and community services, and I assure him that we are looking at how we might best achieve that.

I applaud the determination that my hon. Friend, and my other hon. Friends—I am pleased to see them in their places tonight—have shown in their championing of local services in Banbury and in other areas affected by these proposals. His constituents, like those of all hon. Members, deserve good local health services that have the full support of local GPs, clinicians and the local community and provide the highest standards of quality and care. By seeking the support of GPs and local people for any changes made, by basing any changes on clear evidence, and by ensuring that all changes improve patient choice, the enhanced services in Oxfordshire will inevitably lead to better care for my hon. Friends’ constituents, not only in that area but in those parts of south Northamptonshire and Warwickshire that form part of this hospital area.

In conclusion, I am pleased that the plans that have finally been devised through local involvement and commitment have solved a potential problem. It shows that, by consulting with local stakeholders and the local community, one can achieve the sort of configuration that meets the needs of local people as well as the needs of a local national health service. In particular, I congratulate my hon. Friend on his tremendous work and the leadership that he has provided in ensuring that the local community, working together, achieved the successful outcome determined last Monday. I wish him and the local health service in Banbury and the surrounding area every success in ensuring that these proposals work, and work well, for the benefit of the local community.

Question put and agreed to.

Wirral University Teaching Hospital NHS Foundation Trust (Fraud)

Simon Burns Excerpts

Wednesday 9th June 2010 Commons Chamber

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

I add my congratulations on your elevation, Madam Deputy Speaker. It is warmly welcomed by me and I imagine by many right hon. and hon. Members.

I congratulate the right hon. Member for Birkenhead (Mr Field) on securing the debate on detecting and dealing with fraud in Wirral NHS foundation trust. I know from the research that I have done that he has had a long-standing interest in the case. In certain areas I can appreciate his frustration as a constituency MP seeking to represent the interests of his constituents and to get to the bottom of a problem. Fraud in the NHS is totally unacceptable, but before I move to the specifics of the case that he has raised, I would like to explain the processes and institutions involved in the detection, investigation and prosecution of fraud in the NHS, although I promise to keep it brief.

Fraud and corruption in the NHS is dealt with by the NHS counter-fraud service. Since the NHS anti-fraud initiative began in 1998, counter-fraud service investigations have led to 551 successful prosecutions, with a 96% conviction rate, 773 civil and disciplinary sanctions and the recovery of more than £59 million in cash. Under “Secretary of State Directions”, all NHS bodies nominate a local counter-fraud specialist, who reports to their director of finance and works with counter-fraud service staff.

Because of their independent status, foundation trusts are not, however, bound by Secretary of State directions. Clause 43 and schedule 13 of the standard NHS commissioning contract, under which foundation trusts operate, regulate anti-fraud requirements and mirror those in Secretary of State directions. Local counter-fraud specialist staff investigate allegations or suspicion of fraud. Where fraud is suspected, all appropriate disciplinary, civil and criminal sanctions are sought.

Through a quality assurance programme, the counter-fraud service works to ensure that all NHS organisations apply the highest standards to their anti-fraud work. A self-assessment process, managed by the counter-fraud service, helps NHS organisations identify and improve any areas of weakness. The assessment rated trusts on a scale of 1 to 4, with level 1 indicating that adequate performance had not been met and level 4 demonstrating that the organisation was performing strongly. In 2009, Wirral University Teaching Hospital NHS Foundation Trust achieved a level 2 rating, indicating that its performance was “adequate”. The counter-fraud service is continuing to work with the trust to improve its performance and to ensure that it meets the highest possible standards.

I understand that the right hon. Gentleman has been concerned about this particular case of alleged fraud since 2007, when a constituent anonymously alleged that fraud was being committed by a general practitioner. The allegation was that the GP was using NHS blood service facilities at Arrowe Park hospital for his private patients but not declaring them as such. The case was first referred to the primary care trust by the pathology laboratory manager in January 2005. Following some initial inquiries, the PCT referred it to the trust local counter-fraud specialist in January 2006. The trust began its investigation in March 2006.

I understand that the right hon. Gentleman wrote to the trust’s chief executive in March 2007, asking what actions had been taken to investigate such a serious allegation of fraud. The trust explained that an investigation had taken place. The trust’s local counter-fraud service was provided via a contract with Deloitte. This is common practice among NHS trusts.

In the report into the case, published in October 2007, the investigation found that while there had been inaccuracies in the documentation, there was insufficient evidence that the GP had intended to defraud the hospital. The GP accepted that he had made mistakes, but refuted any suggestion that he had intended to deceive or mislead the trust. The investigation report concluded that there was insufficient evidence on which to charge and prosecute the GP concerned. The investigation reached this decision partly because of a lack of clear instructions to GPs on how to complete referral forms, and partly because of the potential ambiguities on the forms themselves, such as a lack of a declaration on the form.

I understand that the GP repaid the money to the trust for the work done and that the trust chief executive wrote to the right hon. Gentleman to explain the outcome of the investigation. Separately, between December 2007 and February 2008, the Mersey internal audit agency investigated concerns over the use of NHS services on behalf of private patients. The review found no evidence of fraud.

I know that the right hon. Gentleman has met representatives of the trust and the counter-fraud service to discuss his concern that the investigation was not sufficiently robust. It is vital that hon. Members and the public have full confidence in the ability of the NHS to identify and root out any examples of fraud. So that I may satisfy myself and the right hon. Gentleman—I hope—that the original investigation was indeed sufficiently robust, I will ask the departmental sponsor at the Department of Health in Whitehall for the NHS counter-fraud service to work with the managing director of that service to review this case and report to me directly on their findings. I will then write to the right hon. Gentleman on the matter.

The second issue concerns the right hon. Gentleman’s requests for information on the investigation. I understand that on 30 November 2007 the trust offered him a copy of the investigation report subject to a confidentiality agreement, which he rejected. While accepting the good intentions of the trust, this offer was, to my mind, a mistake. While the trust’s intention was to be as helpful as possible, it was required to protect the GP under the provisions of the Data Protection Act 1998 and the Freedom of Information Act 2000.

I have noted the right hon. Gentleman’s observations about the workings of that legislation vis-à-vis the work of Members of this House in pursuing their constituency duties, and I will certainly give him a commitment that I will pass on his concerns to my relevant ministerial colleague, so that this can be looked at. I make no other promise or commitment on that, but I do give an assurance that it will be passed on to be considered, without any ties as to what the ultimate decision might be.

In January 2008, the right hon. Gentleman submitted a freedom of information request to the trust, asking for information on the investigation. Legal advice was sought by the trust. It was advised that it was legally required not to comply with the right hon. Gentleman’s request, as the release of the information in question would have been considered personal and in breach of the legislation that I have just mentioned. However, it was felt appropriate to disclose limited information from the investigation report that dealt with improving trust practices, such as the weaknesses in procedures that had been identified.

I understand that the right hon. Gentleman then sought the assistance of the Information Commissioner’s Office on this matter. The commissioner upheld the trust’s decision not to provide the GP’s sensitive personal data, and advised the trust that it should not take any further steps in relation to the request. Finally, the right hon. Gentleman appealed to the Information Tribunal, which also found that the trust had acted properly on the matter.

I understand that, at that point, the right hon. Gentleman agreed to the trust’s original proposal to sign a confidentiality agreement, so that he could see the original report. However, following the decision of the Information Commissioner’s Office, the trust was legally unable to disclose that information. As I said, I feel that it had been a mistake to make that offer to the right hon. Gentleman.

I wholeheartedly share the right hon. Gentleman’s concern about any possibility of fraud in the NHS. If there is ever any suspicion of fraud, it must not only be investigated thoroughly, but be seen to be investigated thoroughly. That is why I have asked the responsible Department of Health official, in conjunction with the NHS counter-fraud service, to review this case and the investigations that took place. I hope that that will clearly demonstrate to the right hon. Gentleman that the Government and I take issues of fraud in the NHS very seriously indeed. When it is committed, it must be rooted out. Equally, when an innocent party is accused, they must have every opportunity to clear their name. When the review is complete, I will write to the right hon. Gentleman with its findings. I hope that he will be satisfied with that approach to what has been a long, complex and sometimes perplexing problem.

Question put and agreed to.

Royal Liverpool University Hospital

Simon Burns Excerpts

Wednesday 9th June 2010 Westminster Hall

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

I begin by congratulating the hon. Member for Liverpool, Riverside (Mrs Ellman) on securing this debate on the future of the Royal Liverpool and Broadgreen University Hospitals NHS Trust. I know of her long-standing support for the rebuilding of the Royal Liverpool hospital and it is apparent, just from looking at the number of Labour Members from Liverpool who are here today, that they are showing their interest in and concern about the provision of health care services in their constituencies and in the broader area of Liverpool and the Wirral.

I also pay tribute to the NHS staff across the whole of Liverpool, who do such an incredible job of caring for hon. Members’ constituents throughout the city and the surrounding area. Those members of staff do a fantastic job, day in and day out, with little recognition or thanks from people. I want to place on record my gratitude for their tremendous work and that of NHS staff in the rest of the country.

Before I come to the specifics about the Royal Liverpool hospital, I would like to set out the Government’s approach to the reconfiguration of local NHS services mentioned by the hon. Lady as part of her argument. I believe passionately that local decision making is essential to improving outcomes for patients and driving up quality. This Government will do more than just talk about pushing power to the local level; we will actually do it.

My right hon. Friend the Secretary of State has identified four crucial tests that all reconfigurations must pass. First, they must have the support of GP commissioners. Secondly, arrangements for engaging patients and the public, including local authorities, must be further strengthened. Thirdly, there must be greater clarity about the clinical evidence base underpinning any proposals. Fourthly, any proposals must take into account the need to develop and support patient choice. To be clear, that means that forced hospital closures that do not have the support of GPs, local clinicians, patients and the local community should not occur.

[Mrs Ellman]

I am interested to hear the Minister’s enunciation of Government policy, but does he agree that in this instance we are discussing the much-needed replacement of an existing hospital that is required by practitioners and the local authority?

[Mr Burns]

The hon. Lady can rest assured that I will come to that in due course, during the latter part of my speech. In light of some of her comments, particularly about cancer services, I wanted to show the setting for reconfiguration in so far as it might affect that site and other parts of Liverpool’s health care provision.

Where local NHS organisations have already started to consider changing services, they will need to consider again whether their plans meet the criteria before continuing. It will be an opportunity for patients, local GPs and clinicians, and local councils to play a far greater role in how services are shaped and to ensure that the changes will lead to the best outcomes for patients.

The hon. Lady mentioned in an intervention the rebuilding of the Royal Liverpool. That will be reviewed in the light of the Secretary of State’s four tests. As she said in her speech, it is widely recognised that the hospital has a number of issues. Most significantly, the fabric of the building is deteriorating due to a serious case of concrete rot. The building’s condition contributes to high maintenance costs and a significantly poorer patient experience. The building is also inflexible, making it increasingly difficult for the trust to deliver modern, high-quality services.

[Maria Eagle]

I welcome the hon. Gentleman to his role. He is a reasonable man, and I am happy to see him in this job. Can he give all the Liverpool MPs here today some time scale within which the Government will take the decision on the review? We would be grateful for an approximate date.

[Mr Burns]

I thank the hon. Lady for her kind comments, which are greatly appreciated. I return the compliment by saying that when our roles were reversed, I found her an extremely helpful and sympathetic Minister when I brought problems to her concerning Chelmsford prison. She has anticipated me in her direct question. I assure her—I am choosing my words carefully, as she will discover—that I will answer her question later in my speech.

The programme to address the issues within the trust has been ongoing for some time, as all hon. Members present will know and appreciate. For the benefit of those hon. Members not present who will read the report of the debate, I shall set out the timeline of events.

Due to the sorry state of the buildings and the high cost of refurbishment, the trust decided fully to rebuild the Royal Liverpool and Broadgreen University Hospitals NHS Trust while refurbishing the site at Broadgreen. In July 2004, the Department of Health agreed the project’s strategic business case, enabling work to start on the outline business case and the process of obtaining planning permission from Liverpool city council. In March 2008, planning permission was granted. In September 2009, the strategic health authority, NHS North West, approved the outline business case. Then, in March this year, the project was approved by the Department of Health and the Treasury. On 14 April, an advertisement to tender for the project was placed in the Official Journal of the European Union. That is the scheme’s current position.

However, it is important to understand the changed context within which we now find ourselves. The most urgent task facing the Government is to tackle our record debt. As part of that, the Treasury is reviewing every significant spending decision made between 1 January 2010 and the general election on 6 May. As the hon. Member for Liverpool, Riverside herself said, the final approvals were given on 29 March—two weeks to the day before the general election was announced. As a result, the project has been included in the Treasury review of public spending commitments made by the previous Government.

I hasten to add, as delicately as I can, that we, as a nation, face tremendous difficulties due to the staggering debt left to this Government. My right hon. Friends have rightly decided that we must get to grips with the economic situation that we inherited, and the primary problem that we face in the immediate future is the debt.

[Mrs Ellman]

We all understand the problems of debt, but, as the Minister himself said, the replacement of this particular hospital has a long history. It has been scrutinised many times at many different levels—locally, regionally and nationally. It is a majority private finance initiative scheme funded mainly by the private sector. Is he suggesting either that the scrutiny has not been proper or that the hospital is not needed to meet the health needs of the people of Liverpool?

[Mr Burns]

I am not quite sure how the hon. Lady could reach either of those conclusions, and I can tell her with all clarity that my answer to both questions is no. I do not think either of those things—that is, that proper scrutiny has not been carried out or that changes to the existing system are not needed. I can reassure her on those points, but the problem is that the final decision was taken after 1 January—very close to the calling of the general election. Because the review commences from 1 January, the project falls within its scope and must be reviewed, in these changed circumstances, to help to meet our pressing economic problems and deal with the debt that we have inherited. The project received Treasury approval only in March. As a result, it is caught up in the review, as are many other projects.

The issue comes down to the simple fact that this country faces crippling debts. A huge amount of work is involved in the Treasury review. As I hope hon. Members will appreciate, I cannot give an exact timetable for the decision, but to be as helpful as I can and, I hope, live up to the kind words of the hon. Member for Garston and Halewood, I anticipate a decision being taken by the spending review in the autumn. I appreciate that that might be frustrating for hon. Members and their constituents, but it is the best I can do. I hope that that answer moves towards their concept of helpfulness. I am afraid that, until then, I cannot comment further on the future of the development. If hon. Members were in the position in which my Government and I find ourselves, I am sure that they would do the same.

Like the hon. Member for Liverpool, Riverside, I and everyone in the country share a vision of and want a high-quality NHS—accountable to patients, led by GPs and controlled locally. As a party, we were elected on a platform of real-terms increases in the NHS budget for every year of this five-year Parliament. It is a protected budget, so there will be no cuts, but there will be real-terms increases year after year, as long as this Parliament remains, which I anticipate will be five years. In that respect, there is stability and commitment, and an understanding of the financial commitments to the NHS. That, I hope, will give some stability to the overall decision-making process and the decisions that the NHS will have to take beyond simple capital projects.

[Steve Rotheram (Liverpool, Walton) (Lab)]

Does the Minister agree that our city and its citizens deserve not only a new hospital built on the Royal Liverpool site, but the state-of-the-art facilities outlined by my hon. Friend the Member for Liverpool, Riverside (Mrs Ellman)? Does he also agree that the jobs created during the construction phase, similar to those that the Prime Minister spoke of in the Chamber this afternoon, would boost the local economy at a time of economic uncertainty? From what the Minister has said, the project appears to meet the Chancellor’s tests under the Treasury review because it is primarily financed under the private finance initiative.

--- Later in debate ---

[Mr Burns]

The hon. Gentleman makes a valid point, but everything has to be taken in the context of the changed circumstances—a change of Government and our overriding need to get the debt and the deficit under control. The context for that and the engine driving it is the review of all public spending commitments across the board. We are talking about not simply the health service, but commitments made across Government since 1 January. I cannot anticipate the outcome of any review, and I am sure that hon. Members would not expect me to. I can tell them that decisions will be taken by the spending review in the autumn, and I hope that hon. Members consider that helpful.

[Maria Eagle]

The Minister is being extremely generous in giving way and I am grateful. I understand the position that he is in—believe me. He gave an endpoint to the deliberative process, but the time scale he suggested might put the development at risk. Uncertainty can create difficulties with the funding arrangements for a PFI project, such that it is no longer workable or cannot be put together properly if the delay is too extensive because the private sector needs to raise money through the markets and in other ways.

Will the Minister undertake to do the usual thing that Ministers do, which is talk behind the scenes to his Treasury colleagues, as he will have to do anyway? Will he ensure, as far as he can, that the project is at the front rather than the back of the queue? The delay he indicated—through to the spending review in the autumn—could put the viability of the scheme at risk, whether or not the Government reaffirm the commitment made by the previous Government. For that reason, I urge him to do us a favour and discuss with the Treasury behind the scenes, as Ministers do, the urgent need to deal with this scheme as soon as possible.

[Mr Burns]

I respect the hon. Lady’s ingenuity and I can see where she is hoping I will go. I do not want to disappoint, but I understand the situation and all I can do is reiterate that the project will be reviewed, as a lot of other projects across Government will be reviewed, in line with the Treasury guidelines for the review of projects from 1 January.

A decision will be taken by or at the time of the spending review in the autumn. I cannot go further than that. However frustrating it is for the hon. Lady, I know that in her heart of hearts she understands what I am saying. If the roles were reversed, she would probably say the same thing. It would be wrong and irresponsible, and potentially misleading, to go any further.

[Stephen Twigg (Liverpool, West Derby) (Lab/Co-op)]

rose—

[Mr Burns]

I give way to the hon. Gentleman, who has not had a chance to intervene.

[Stephen Twigg]

I am grateful to the Minister for giving way and I join in the congratulations to him on his well deserved appointment to the Department of Health. I understand that he cannot go further on timing, but can he tell us more about the nature of the review? Is it likely that his Department will say that certain projects will go ahead as planned and others will not, or will it ask projects to look again at the cost, to achieve more projects at the lowest cost to the taxpayer?

[Mr Burns]

I thank the hon. Gentleman for his kind and gracious comments, which I greatly appreciate. I also pay tribute to his experience in coming at the question from a different angle. I do not want to, but I am afraid that I must disappoint him. I will not go down the route he suggests because it could be open to misinterpretation. I can only repeat what will happen: all spending projects from 1 January are being reviewed. Decisions will be taken by the time of the spending review.

I return to the reconfiguration of cancer treatments in the area, which the hon. Member for Liverpool, Riverside raised, to give her a brief explanation of the current position, because that will put it in context and, I hope, be of help to her. Local health organisations in Cheshire and Merseyside are working together to ensure better cancer facilities for the local population. However, I am advised that the primary care trusts plan to review the first facility at the University Hospitals Aintree site before committing to further facilities at the Royal Liverpool. As the hon. Lady will appreciate, that is a local decision and it would not be appropriate for Ministers, at this stage, to compromise the processes, intervene or comment. There are local procedures to be gone through before final decisions are taken.

I welcome the opportunity to discuss the future of Liverpool Royal University hospital and fully appreciate how important it is to all hon. Members present and their constituents. We will have to wait until the spending review is concluded in the autumn for a decision. In the nicest possible way, I urge hon. Members, however difficult it is, to be patient and wait. If I were a constituency MP in Liverpool, I would be in the same position as them.

Question put and agreed to.

Review of Prescription Charges

Simon Burns Excerpts

Thursday 27th May 2010 Written Statements

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

In 2008 Professor Ian Gilmore, president of the Royal College of Physicians, was asked to lead a review on how a prescription charge exemption for people with long-term conditions should be implemented, including how it would be phased in. He reported in November 2009.

I wish to thank Professor Ian Gilmore for his work on the report, which we are publishing today. He has undertaken a thorough analysis of the issues and has considered carefully the views of patient representative groups, charities and other interested parties.



Any decisions on future changes to the system of prescription charges and exemptions would need to be taken in the context of the next spending review, which is due to report in the autumn.

Professor Gilmore’s report has been placed in the Library and copies are available for hon. Members in the Vote Office.