Oral Answers to Questions

Simon Burns Excerpts

Tuesday 18th October 2011 Commons Chamber

[Steve Baker (Wycombe) (Con)]

3. What representations he has received on the reorganisation of urgent care in the past six months.

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

A search of the Department of Health’s database revealed that 131 items of correspondence, and five parliamentary questions relating to the reorganisation of urgent care were received in the past six months. In addition, I have received three requests to meet MPs on this subject.

[Steve Baker]

Wycombe hospital is currently going through a consultation on a change to urgent care services, and it is doing so in the context of the betrayal felt after “Shaping Health Services” in 2004, which removed our accident and emergency department. I would like to escape this cycle through mutuality. What is the Government’s position on mutuality? Will the Minister join my call for directly owned community health services?

[Mr Burns]

The Government have supported the right to request, which has enabled 45 staff-led social enterprises to be established. This policy has supported approximately 25,000 staff into social enterprises, with contracts of roughly £900 million. NHS staff have been assisted by a wide-ranging programme of support from the Department.

[Mr Ben Bradshaw (Exeter) (Lab)]

Has not the Government’s so-called moratorium on the reconfiguration of services put back improvements to urgent care by several years? The Minister inherited perfectly coherent plans for every region in England under the auspices of Lord Darzi’s next-stage review. How many lives have been lost and how much money has been wasted by the tearing up of those plans?

[Mr Burns]

I am afraid that the right hon. Gentleman is wrong. It is not holding back the national health service; it is moving it forward with things such as the establishment of the 111 service and the reconfiguration proposals, which are based on the four tests that my right hon. Friend the Secretary of State introduced in May last year. That not only links reconfiguration to the needs of the local health economy but takes into account the wishes and needs of the local community and medical staff.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my right hon. Friend agree that the improved delivery of urgent care right across the health service is one of the great challenges facing the new commissioning structure and one of the great opportunities to deliver more integrated services that deliver better value and better quality to patients?

[Mr Burns]

I am extremely grateful to my right hon. Friend; speaking with the authority of the Chair of the Health Committee, he is absolutely right. It is the way forward to drive improvements in service, raise standards and ensure that there is high-class, quality care at an urgent care level and across the acute sector.

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

4. What assessment he has made of the potential effects of NHS reorganisation on the protection and improvement of public health.

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[Lorely Burt (Solihull) (LD)]

5. What steps he is taking to reduce the burden on NHS hospitals of (a) PFI repayments and (b) debt.

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

A study conducted by the Treasury has identified savings opportunities of up to 5% on annual payments in NHS PFI schemes. The Cabinet’s Efficiency and Reform Group is rolling out a programme of work to secure savings of up to £1.5 billion across the 495 PFI contracts in the public sector in England.

[Lorely Burt]

Contrary to the earlier complacent comments of the Opposition spokesman, some national health trusts are paying up to 20% of their revenue to PFI contracts. What steps can we take to ensure that the payments are reduced and that the same terrible financial situation never happens again?

[Mr Burns]

I am grateful to the hon. Lady. I, too, recognise the small number of organisations that are reporting financial challenges. The Department is continuing to work with strategic health authorities to ensure that those organisations have robust plans in place for financial recovery, while ensuring the quality of services for patients.

[John Healey (Wentworth and Dearne) (Lab)]

On the subject of financial pressures on hospitals, does the Minister recall the circular to hospitals from Monitor that was smuggled out on the eve of the royal wedding, which raised the requirement for efficiency cutbacks on hospitals from 4% to 6.5%, which is more than £1 billion in this year alone? Will he admit that the service cutbacks that we are seeing in many hospitals around the country are deeper, as that circular confirms, directly because of the Government’s policies?

[Mr Burns]

No, I do not recognise that, because the figure that the right hon. Gentleman has used is an upper calculation, not an actual figure. I say to him that we are making efficiency savings, and that trusts should be cutting not front-line services but inefficiency, waste and excessive management, and reinvesting every single penny in front-line services.

[Helen Jones (Warrington North) (Lab)]

6. What steps he is taking to ensure that patients receive accurate and unbiased information on treatment options.

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[Chris Skidmore (Kingswood) (Con)]

9. What progress he has made on reducing the number of foreign nationals using NHS services without payment.

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

We have updated and simplified regulations and guidance on identifying and charging visitors who must pay. Immigration rules now before Parliament will allow the UK Borders Agency to refuse entry to visitors with an unpaid debt to the NHS, and we are now reviewing this area more fundamentally to identify further improvements.

[Chris Skidmore]

I thank the Minister for that answer. On 19 July, I spoke in the House about foreign nationals using the NHS without payment and, having entered a freedom of information request to each foundation trust and PCT, I now have a more accurate picture of the sums involved. It suggests that some £15 million has been completely written off. Will the Minister meet me to discuss the findings and what possible solutions might be found to tackle this important issue?

[Mr Burns]

I share my hon. Friend’s concerns about this important issue and challenge for the NHS. I would be more than happy to see the results of his FOI request, and I or a colleague would also be happy to meet him to discuss the matter further.

[Keith Vaz (Leicester East) (Lab)]

There is a relatively painless way to deal with this. At the time that the visa is applied for, the person should sign an undertaking that they will pay the costs of NHS treatment. Will the Minister talk to the Minister for Immigration to see whether it is possible to introduce such a requirement?

[Mr Burns]

I am grateful to the right hon. Gentleman. We are looking at a range of options and I am more than happy to pass on his suggestions to my hon. Friend for them to be considered.

[Mark Pawsey (Rugby) (Con)]

10. What representations he has received on the need for effective and clear distinction in uniforms worn by fully trained nurses and other workers in the care sector.

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[Alec Shelbrooke (Elmet and Rothwell) (Con)]

12. What steps he is taking to assist patients to access a greater range of NHS services.

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

The NHS constitution gives patients the right to make choices about their care. The Government are committed to empowering patients. Our goal is for patients to have more choice of treatment.

[Alec Shelbrooke]

What steps is my hon. Friend taking to ensure that my constituents requiring cardiac services will have access to the care that they need in Leeds?

[Mr Burns]

My hon. Friend raises an important and controversial issue, as he will have heard when listening to my right hon. Friend the Secretary of State earlier and the debates that he has attended in the House on this subject. We are determined that proper facilities will be made available, based not on money but on the high quality of care, particularly for children. An independent review is being carried out by the joint committee of primary care trusts, which is expected to announce its recommendations later this year.

[Jim Shannon (Strangford) (DUP)]

Has the Minister considered exchanging expertise with the regions of Scotland, Northern Ireland and Wales? That exchange could take place without any charge.

[Mr Burns]

The hon. Gentleman raises a valid point. The NHS in England has regular contact and discussions with the NHS in other parts of the United Kingdom, and will continue to do so because both the UK and the devolved authorities can learn a considerable amount from sharing views and practice.

[Hazel Blears (Salford and Eccles) (Lab)]

13. What recent estimate he has made of the number of midwives working in the NHS.

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[John Mann (Bassetlaw) (Lab)]

T7. I have noticed a growing creeping privatisation of cleaning contracts in the NHS this year. Does this signify a return to the old Tory days of longer waiting lists and dirty hospitals?

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

The hon. Gentleman seems to be somewhat confused. This is not about privatisation in a derogatory sense, as he is trying to suggest. For many years, including the 13 years of the Labour Government, hospital cleaning services in NHS hospitals were put out to tender, and many private companies provided the service. That is simply continuing.

[Chris Skidmore (Kingswood) (Con)]

T9. I am a long-standing supporter of independent sector treatment centres and of the need for commissioners to be able to bring in private and voluntary sector providers, as well as alternative NHS provision where existing services fail to improve—[Interruption.] I see that some Labour Members, including the hon. Member for Leicester West (Liz Kendall), disagree, but does at least the Secretary of State agree—

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[Andrew Bridgen (North West Leicestershire) (Con)]

I welcome the policy review of the entitlement of foreign nationals to free NHS care, but will my right hon. Friend assure the House that it will examine the options relating to charges for GP as well as hospital services?

[Mr Burns]

My hon. Friend has asked an extremely reasonable question, and I can give him the assurance that he seeks.

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

PCTs in Staffordshire are pre-empting legislation by merging and reorganising now, which has led to plans to close the high street practice in Newcastle-under-Lyme simply because it is run by salaried GPs. Is that really NHS policy? If not, what will the Secretary of State do to help 5,000 patients rescue a much-needed surgery?

Innovation (NHS)

Simon Burns Excerpts

Wednesday 12th October 2011 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Rosindell. I congratulate my hon. Friend the Member for Salisbury (John Glen) on securing this debate on what is widely recognised as an important issue for the NHS because of the crucial role that innovation plays in the present and will play in the future. Given his ideas, views and thoughts, he might seek to arrange a meeting, if he has not already done so, with my noble Friend the Earl Howe, who is the Health Minister with responsibility for innovation.

I shall respond by first setting out the Government’s approach to innovation, before looking at the specific issues that have been raised by my hon. Friend. As we all know, and as he has reiterated, we face a significant challenge. Without real change, the cost of health care will grow faster than the rest of the economy. Moreover, the quality of care in vital areas such as cancer will lag behind other countries, and the gap between the best and the worst NHS care will continue to grow. More of the same simply will not do. We cannot afford it and patients do not deserve it. We need, in other words, to innovate, as my hon. Friend has said.

Fortunately, there is a vast reservoir of innovation to tap within the NHS. It has a long history of innovation, invention and research by great people and great institutions. Ian Donald, for instance, pioneered the use of ultrasound in the 1950s. Sir Peter Mansfield’s work led to the MRI scanner in the 1970s. The Sanger Institute developed the first working draft of the human genome in 2000. We continue to lead the way in cutting-edge research, as the recently announced first European trial of embryonic stem cell research at Moorfields eye hospital demonstrates.

The creative spark that kick starts the long and difficult journey from initial idea to widely adopted treatment is a precious and delicate thing. We need to do all we can to encourage that creativity within the NHS—to grow and propagate the ideas that clinicians and others have for the benefit of their patients. While we continue to achieve great things, we must always strive for more.

Innovation does not happen when power is centralised and people are told what to do, so the single biggest thing that we are doing to encourage innovation is to devolve power to clinical professionals, trusting their professional judgment and their desire to do their best for their patients.

Our modernisation of the NHS will encourage innovation in three main ways. First, it will place the patient at the centre of decision-making about their own care—informed, empowered and able to choose the best possible appropriate care—so that providers will have to innovate to stand out. Secondly, it will have a resolute focus on improving health outcomes—publishing the data and rewarding excellence—so that hospitals and others will have a powerful incentive to innovate and improve. Thirdly, it will place power in the hands of local clinicians, thereby getting rid of the huge and wasteful bureaucracy that can strangle and frustrate innovation, and let the knowledge and expertise of clinicians drive innovation locally.

That will lead to a more personalised NHS, with services tailored to patients’ needs; a more integrated NHS, with solutions that tackle inequalities, improve access and deliver care closer to home; and a better quality NHS, with every provider encouraged, rewarded and incentivised to constantly improve outcomes for patients.

There is also a wider economic imperative for innovation. The health care sector, including pharmaceuticals, medical technology, research, equipment and services, directly or indirectly employs hundreds of thousands of highly skilled people in companies, from small and medium-sized enterprises to global giants, generating billions of pounds in revenues, all helping to drive future economic growth. Innovation in health care applies to everyone—scientists, nurses, doctors and managers. In fact, it applies to all those working to deliver better health, better care and better value. We must ensure that innovation is not simply the preserve of elite minds at the top of august institutions, because it is not just about the latest drugs or high-tech pieces of equipment. The spirit of innovation should be part and parcel of every part and every level of the NHS.

One of my favourite examples of innovation in action is a jug—a health care assistant in Milton Keynes decided that patients whose fluid intake needed close attention should each have a bright red water jug. That particular innovation gave ward staff a clear visual reminder of those patients’ specific needs, helped them to better care for patients, avoided the need for drips, reduced the risk of infection, cut patients’ stays in hospital and consequently cut the cost of their care. That is all because of a bright red jug and one very bright idea from a health care assistant.

We have also made a strong and ongoing commitment to innovation through research. The Government’s plan for growth cements our commitment to health care and the life sciences as a force for growth in the economy. The Government’s National Institute for Health Research aims to support outstanding individuals, working in world-class facilities and conducting leading-edge research focused on the needs of patients and the public. We have recently announced a record £800 million in additional NIHR funding for experimental medicine and translational health research. We will also streamline regulation and improve the cost-effectiveness of clinical trials, speeding up the process of translating research into better lives for patients, their families and their carers.

However, no matter how extraordinary the innovation or how miraculous the invention, it is worthless if it is not used, as my hon. Friend the Member for Salisbury said. Any innovation that is not widely adopted is a tragic waste. Like many large organisations, the NHS’s uptake and spread of innovation has often been slow. We need to raise our game, as my hon. Friend alluded to. We need to do more to recognise the contribution that innovators and innovative organisations make and to encourage adoption and diffusion across the NHS on a scale never seen before.

[Mr Andrew Smith]

In that context, can the Minister say what future he sees for the work presently being undertaken by the regional NHS hubs, especially in the area to which I alluded earlier where there might not be an immediate commercial return?

[Mr Burns]

I am grateful to the right hon. Gentleman for that intervention. I will certainly come to that matter during my comments and before we finish the debate.

A substantial amount of work is already under way, including the £60 million that has been invested in regional innovation funds, which support front-line staff to develop and spread new ideas and validate the notion that it is good to challenge the way things have always been done. The funds are massively over-subscribed and have to date given money to more than 300 projects. Further work includes the innovative technology adoption procurement programme, which aims to encourage the NHS-wide adoption of high-impact innovative medical technologies, and the innovation challenge prizes, which reward the ideas that tackle some of our big health and social care challenges, improving productivity and the quality of health care. The first innovation challenge prizes—ranging from £35,000 to £100,000—were awarded in March. Winning entries helped to reduce waste and increase the benefits of medicines, helped people with kidney failure to lead a more independent lifestyle and helped in the early diagnosis of cancer. An expert panel is going through this year’s round of applications and I very much look forward to seeing the results later in the autumn.

There is also much of value in the innovation hubs, to which the right hon. Gentleman referred. Identifying, developing and commercialising new ideas within the NHS is a must, and we need to adopt a systematic approach to that. We also need to ensure that all parts of the innovation pipeline—invention, adoption and diffusion—are more efficient and effective. The NHS chief executive’s innovation review will consider that and how we can achieve better value for money.

As announced in “The Plan for Growth,” NHS Global is being developed to help NHS organisations to compete in the global market. NHS Global seeks to build and grow the NHS brand and reputation overseas, enabling the NHS to compete in the international health care market and to exploit the commercial value of its technologies, products and knowledge. In doing so, NHS Global acts as another mechanism to support great ideas generated in the NHS being widely accepted across the world.

In the case of the company mentioned by my hon. Friend the Member for Salisbury—Odstock Medical Ltd—if it has not done so already, I suggest that it contacts the NIHR’s invention for innovation scheme. i4i supports product development and the guided progression of innovative medical product prototypes, and I strongly advise the company to get in touch with it if it has not done so.

The Health and Social Care Bill, now passing through the House of Lords, will place a legal duty on the NHS commissioning board and on clinical commissioning groups to promote innovation and research. Soon the NHS chief executive, Sir David Nicholson, will set out achievable, high-impact recommendations that will inform the strategic approach to innovation that is so important within a modernised NHS. We will open up NHS procurement to small and medium-sized enterprises, simplify the process and challenge them to come up with solutions to problems within the NHS. We have committed £10 million to the small business research initiative.

Innovation can never be mandated and it should never be restricted to a particular group. Innovation in health and social care will come from a wide variety of partners—for example, NHS staff and patients, private companies, the voluntary sector and academia. They all have a crucial role to play in pushing forward the boundaries in developing and dreaming up innovative products and services to meet the ever-increasing demands of a modernised NHS.

Innovation is not easy. It takes more than just a good idea to innovate; it takes courage to speak out against how things have always been. Innovators have to hold and develop an idea often in the face of opposition and keep pushing forward until it begins to bear fruit. I fully appreciate that the process of innovation can be a very frustrating time. We must encourage people, so that they do not become frustrated and give up. They should be able to pursue dreams and ideas that will bring a greater improvement to the general provision of health care and the NHS.

Let us imagine a world without antibiotics, without insulin, without cancer screening. Then let us imagine a world with a cure for cancer or where we can reverse dementia and end heart disease. Without innovation none of that would be, or could be, possible. Innovation is essential for the future of our NHS and for the future of the UK economy. I assure hon. Members that the Government will do everything in their power to continue to promote innovation, so that it can flourish and develop along the lines that we would wish.

Report on Complaints and Litigation (Government Response)

Simon Burns Excerpts

Thursday 15th September 2011 Written Statements

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

We have today laid before Parliament “Government Response to the House of Commons Health Committee Sixth Report of the Session 2010-12: Complaints and Litigation” (Cm 8120).

The starting point for this Committee’s inquiry has been that sometimes patient experience of the NHS falls below the high standards expected, and when this happens patients should have access to a responsive and effective complaints and if necessary litigation systems.



The majority of people using health and social care services in England are satisfied with the care and treatment received. However, there are times where things go wrong. In these circumstances, it is important that people are able to make a complaint and to have it investigated and dealt with effectively.

Complaints are important and need to be taken seriously. When something has gone wrong it needs to be put right quickly, and organisations need to work closely with people to find the most appropriate resolution to a complaint. Organisations also need to make sure they learn from every aspect of a complaint so that the same thing does not happen again. The more successful organisations take the views of their customers, including views expressed in complaints, seriously.

A small proportion of complaints made about care relate to negligent harm. In these circumstances, it is correct that complainants are able to obtain proportionate compensation in a timely manner for the harm they have suffered.

The Government’s civil justice reforms will develop a system that is proportionate, encourages personal responsibility in resolving disputes, and with streamlined procedures to provide timely access to justice. This will improve outcomes for patients seeking compensation, and allow limited NHS resources to be diverted away from legal expenses and back to patient care.

The Government welcome the Committee’s acceptance that the current complaints arrangements provide the potential for delivering better outcomes for complainants and improvements in service delivery. However, the Government accept that there is more to do, and we will work with the NHS better to ensure lessons learned from the local investigations of complaints feed into service improvements. Good practice does exist in the NHS, and it needs to be shared more widely.

The NHS reforms the Government have proposed, offer an opportunity to drive improvement, and to improve patients’ experiences of the NHS, and they will put patients, carers and local communities at the heart of the NHS. In addition the Government’s transparency agenda, along with the wider information sharing agenda instigated by the health service ombudsman, the Department of Health and regulatory bodies should help to ensure that in future, information in respect of complaints will be more widely available to the public to inform choice and to highlight areas of healthcare provision that need improvement.

Coeliac Disease

Simon Burns Excerpts

Wednesday 7th September 2011 Westminster Hall

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

I congratulate my hon. Friend the Member for Ochil and South Perthshire (Gordon Banks) on securing the debate. I also thank Coeliac UK for its work in campaigning and research, and the information that it gives to many thousands of individuals who are diagnosed with coeliac disease.

I have two interests to declare. I am the chair of the all-party coeliac disease group and, as my hon. Friend the Member for Ochil and South Perthshire said, I was diagnosed with coeliac disease nearly 10 years ago. I want to reiterate a point that my hon. Friend made, which is that what we are discussing is not the latest fashionable diet, or a lifestyle choice: it is a medical condition. Sometimes it seems from media coverage, and media understanding of the gluten-free diet, that people have a choice whether to eat foodstuffs containing gluten. We do not have that choice, because of the serious health conditions that my hon. Friend has already mentioned. It is important to ensure awareness and wider understanding, including among GPs.

It is worth reflecting on how people are diagnosed. I was diagnosed 10 years ago, at the age of 37. Did I know I was intolerant to gluten? No, I did not. It was only following a serious stomach operation that the consultant who treated me did tests and biopsies, and said, “You do realise that you are suffering from coeliac disease.” Had I heard of coeliac disease? No, I had not. As with all such things, people learn quickly. I have heard stories from talking to many members of Coeliac UK regional groups—and I thank the volunteers who run local groups for providing information. More often than not, the people I have talked to received mistaken diagnoses. Awareness among consultants, as well as GPs, is an issue.

One may ask what the average age of a coeliac is, but there is not one. I have met parents whose children became ill soon after they began eating food, by two and three years old. My 71-year-old mother was diagnosed only last year, and that was only because I asked her to insist that her doctor tested her for it. Interestingly, many of the complaints and health issues that she has had over many years were explained by coeliac disease, and the diagnosis has changed the way she feels. Awareness is important, therefore, not just in the wider population, but among GPs, to ensure that they ask the questions to find out whether a patient’s symptoms are down to coeliac disease—and the symptoms can be quite varied, as my hon. Friend the Member for Ochil and South Perthshire said.

I do not think that matters have been helped in the past few months by press coverage of prescription charges. Some of the debate is ill-informed. Earlier in the year a headline in The Sun ran: “NHS pays £32.27 for a loaf of bread”. As my hon. Friend has mentioned, if the story had been looked into, it would have been found that the sum was paid not for one loaf of bread, but for a number of products. However, there are underlying issues, which can be remedied by some of my hon. Friend’s suggestions. Nevertheless, the entire tenor of the article was that people are somehow getting free food on the NHS—not just loaves of bread but biscuits, cakes and things like that, which is not the case. Gluten-free products are a very expensive part of the household budget, certainly for families with more than one person affected. I do not get products on prescription, but purchase them. My hon. Friend the Member for Aberdeen South (Dame Anne Begg) is right; the range of products available now is far wider than when I was diagnosed. As for the idea that people are getting foods free, as has been said, they are not: if they receive them on prescription they will pay for that anyway. Many people do not choose to take anything in that way.

The reaction to the publicity, and the pressure on NHS budgets to secure value for money, which we would all support, has been a knee-jerk reaction to go the other way and reduce the number of products that people can get. That is not acceptable for low-income families and those who rely on gluten-free products on prescription. My hon. Friend the Member for Ochil and South Perthshire talked about a cost of about £400 a year, but in some cases it could be more, depending on how many affected people there are in a family. It has been recognised that the condition is not a fad or lifestyle choice, but a disease that needs treatment; and proper management can save the NHS money. People will not present at GPs’ surgeries with undiagnosed conditions. They can live perfectly well with the condition if it is properly managed; and my hon. Friend might agree that in some cases that improves health, because the diet is quite healthy—including, in my case, not being able to drink beer.

There has been a knee-jerk reaction from some PCTs. Is it acceptable that arrangements with suppliers are costing the NHS money? No—and I think that the Cumbrian and Northamptonshire examples are a way forward. If we encourage PCTs to adopt the approach of having prescriptions managed by the pharmacist, not only will the NHS save a lot of money, but that will be better for people who suffer from coeliac disease than going to the doctor for a prescription. I have talked to my GP about it, and doctors do not really review what is on the prescription. They just keep signing it. At least if the process happens in the pharmacy, the pharmacist, who knows the people involved, may review the quantity or type of products that the individual wants. I think that it would reduce the possibility of people getting the same prescription repeatedly, whether they need it or not. The pharmacist would be able to manage things. If someone has a prescription for eight loaves, but does not need them, why keep paying for them?

The examples and pilots in Cumbria and Northamptonshire show that not only can costs be driven down, but the service to the patient can be improved. There is an easy win there, and Coeliac UK and pharmacists are quite keen on the idea, and so are GPs, because it would cut the person hours taken up in writing the prescriptions. The pilots provide good instances of how GPs’ time is freed up. I urge the Government to look seriously at that, and consider how such best practice can be moved across. Quite rightly, when there are lurid headlines about people paying £32 for gluten-free bread, on top of the actual costs, that is not acceptable. If we can do something to reduce that problem, it would be good. We need to see more positive and constructive articles. To be fair, the Daily Mail in its health section has carried quite a few good articles about coeliac disease, explaining its symptoms, and promoting the suitable food that is available.

Some quick wins are available for the Government and the NHS, if they are allowed to take them on board. As chair of the all-party group, I would like the Minister to attend a meeting if that could be fitted into his diary commitments, and to meet the members of the group and others from around the country.

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

I am grateful to the hon. Gentleman, and it would be extremely useful to attend such a meeting. However, he may wish to invite the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), who is the lead Minister on this medical condition.

[Mr Jones]

I am disappointed about that, because I was looking forward to the right hon. Gentleman’s attendance. He is a good friend, but I will obviously leave it to the Department to decide who is the best person to come, and we will certainly issue that invitation in the next few days.

I want to pick up some of the issues that my hon. Friend the Member for Ochil and South Perthshire raised, including the products that are available. My hon. Friend the Member for Aberdeen South was right when she said that products have changed remarkably in the last 10 years from bread like cardboard that was hardly edible without a pint of water to some very good products on the market now. It is interesting that on the commercial side, large bread manufacturers such as Warburtons are producing gluten-free bread, so it obviously sees a market. I have tried its bread, and it is very good. Likewise, the invention of products such as Genius bread has completely changed the type of bread that is available, and the technology for producing it.

The supermarkets have also changed. Asda, Tesco and Sainsbury’s in particular have done two things. First, they have shelving dedicated to gluten-free products, which is important. Secondly, labelling has changed, which is important for people who suffer from coeliac disease, because it is amazing how many products contain gluten. Some flavours of crisps contain gluten, but others from the same producer do not. Correct labelling is important for all products so that people may buy with confidence, and see that the products that they are buying are gluten-free. It is important that the supermarkets recognise that there is a large and growing market for such products, so anything we can do to encourage better labelling of food content is important.

My hon. Friend referred to eating out, which can be difficult, although some restaurants recognise the problem of gluten in certain foods. However, the bane of my life is organisations that provide food on airlines and National Express, on which I sometimes travel. The people serving the food have no understanding of what a gluten-free diet is, and offer everything from sandwiches to sausages. When asked whether those foods contain gluten, they look blank.

The other reaction, which one gets from British Airways and which is amazing, is that whenever one asks for a gluten-free meal it thinks that that means vegetarian. I am not sure why, but it seems to think that one can eat what everyone else eats, but without the sauce. It seems to think that coeliacs are vegetarians, and my usual response is to ask whether I look like a vegetarian. There should be a campaign to persuade airlines and train companies that provide meals to ensure that their staff know what a gluten-free diet is. They could also be more imaginative about what they provide, because it is often inedible.

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

May I say what a pleasure it is to serve under your chairmanship again, Dr McCrea? I will begin with some congratulations and an apology. The congratulations go to the hon. Member for Ochil and South Perthshire (Gordon Banks) on securing this debate and on raising the issues faced by people living with coeliac disease. It was genuinely fascinating to listen to him speak about a long-term condition that, as was mentioned by other hon. Members, is unknown to a vast majority of people in this country. To hear at first hand about the day-to-day living of someone with that long-term condition was extremely interesting and illuminating.

The question of illumination is where I get to my apology. I must apologise to the hon. Gentleman because I am afraid he got the monkey rather than the organ grinder this afternoon. As he will know, the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), is the lead Minister in the Department for issues such as coeliac disease and other long-term conditions. As the hon. Gentleman will understand, deliberations on the Health and Social Care Bill are reaching their concluding hours on the Floor of the House of Commons as the legislation approaches Report and Third Reading. The Minister of State’s debate on Report clashed with this debate in Westminster Hall, so I am an inadequate stand-in for him. I assure hon. Members, however, that I will draw his attention to a number of points that have been raised this afternoon, and I know that he will be interested to read the debate tomorrow. If there are other issues that he needs to answer, I will make sure that he does so. In the time available, I will try to respond to as many points raised by hon. Members as I can. If time does not allow all those points to be answered, I will ensure that they receive a letter to clarify any outstanding issues.

For those hon. Members who are not aware of coeliac disease—I know that there are none in the Chamber today, but I am sure that there will be some MPs who follow health issues assiduously in Hansard but who are not as knowledgeable as those present in the debate—let me say that the disease is a common condition that affects approximately one in every 100 people in the UK. Rather surprisingly, women are two to three times more likely to develop the condition than men, although there seems to be no apparent reason for why that should be the case. Cases of coeliac disease have been diagnosed in people of all ages, as the hon. Member for North Durham (Mr Jones) mentioned when illustrating one of his points. It is therefore crucial that information, education and support are available for individuals as well as the other people involved in their lives, such as parents, teachers, carers, employers and others.

There is only one clear path to get properly diagnosed—again, early diagnosis was another theme that was echoed by all three hon. Members who took part in the debate. That is an extremely important issue. The points that hon. Members raised in making the case for early diagnosis are unanswerable. It is crucial. However, as they will know, getting a proper diagnosis requires a blood test and endoscopy with biopsy. We of course welcome any new tools that can help to get more people diagnosed. However, it must be recognised that pinprick self-testing kits do not replace a medical diagnosis. Indeed, for a definitive diagnosis, it is important that people have not already taken gluten out of their diet as a result of self-diagnosis, because that can lead to the diagnostic tests being inconclusive, with all the unfortunate results that that has.

Anyone experiencing symptoms of coeliac disease should seek the advice of their doctor to get a proper diagnosis and professional dietary advice on how to manage their condition. We must ensure that people living with coeliac disease get the best clinical advice and support available, that they are involved in decisions about their care and that they are fully supported to make informed choices.

The hon. Member for Ochil and South Perthshire said, “Why not use the QOF?” With regard to the testing of people and of members of their family to see whether they may have the disease, we believe that it is up to people to raise any concerns that they have as a result of a family member having the disease, and that is likely to result in a test for coeliac disease for those people.

I think that the hon. Gentleman specifically asked—I hope that I have got this right—when or if there would be NICE guidelines. On that issue, I have what I hope is some rather good news for him. There are already NICE guidelines on diagnosis and recognition. They were published on 27 May 2009. The reason that the guidelines were drawn up is that they were part of a determined campaign in the NHS and, to be fair, by the Government of the day to improve recognition of the disease and to increase the number of people diagnosed with it.

[Gordon Banks]

I am well aware of what the Minister is referring to; indeed, I alluded to it in my contribution. What I am saying is that there is now an opportunity through the QOF framework to make coeliac disease one of the 150 measurable outcomes for GPs to be measured against.

[Mr Burns]

I am grateful to the hon. Gentleman. He makes a perfectly reasonable point. I will certainly ensure that his comments are drawn to the attention of NICE, because of course it will be NICE, working with the Department of Health, that draws up the list of conditions. That is apart from the standards that it is already working on. As the hon. Gentleman said, between 150 and 180 are being considered. I will ensure that his comments are drawn to NICE’s attention.

[Gordon Banks]

With regard to the points that the Minister has made, which I did allude to, those are not mandatory, enforceable measurements. That is why we need something more.

--- Later in debate ---

[Mr Burns]

I am grateful and I will ensure that the hon. Gentleman’s recommendation and the points associated with that are drawn to the attention of the relevant bodies, so that they can be considered as NICE considers its programme for the standards.

The question of managing coeliac disease in the NHS featured in a number of contributions today. The NHS is best placed to determine and manage its services locally, supported by clinical guidelines and close community and partnership working. The NICE guidelines on recognition and diagnosis of the condition are supported by prescribing guidelines for professionals on prescribing gluten-free foods, developed in association with the British Dietetic Association, the Primary Care Society for Gastroenterology and Coeliac UK.

The NHS also has to ensure that the resources that it has available are used to greatest effect. That is another theme that I think was developed by all three hon. Members who took part in the debate. Some of the comments concentrated on the question of prescriptions. One area in which spending needs to be more effective in order to meet rising demand for services is prescribing, as hon. Members said. A range of programmes is in place to try to reduce the money spent on prescribing drugs, and the review of gluten-free food prescribing is part of that process.

Discussions are taking place throughout the country on that matter. In the south-east—the hon. Member for Ochil and South Perthshire referred to this—a review was conducted of gluten-free prescribing policies across the region. That was led by medicines management leads, who are pharmacists, from the different counties. They made recommendations that caused concern to some patients. However, as a result of their subsequent discussions with patients and, indeed, the role played by Coeliac UK, a number of changes are to be made to their original proposals. I will add that GPs are not prevented from such prescribing if specific patients are considered to have a special clinical need. I hope that that reassures the hon. Gentleman.

It is a matter for doctors’ clinical judgment which products they prescribe for their individual patients. They are not prevented from such prescribing if patients are considered to have a special clinical need. We fully expect GPs and other health professionals who prescribe gluten-free products to assess the dietary requirements of individual patients, taking into account not only their nutritional requirements but their lifestyle and other needs. We expect the provision of food items to be based on individual needs, not on a preconceived idea of what someone ought to receive.

We believe that patients stand to benefit from the modernisation of commissioning, as that will enable GPs to focus resources to meet the local needs of their population and enable local people to be involved in shaping services that are crucial to them. It will be for consortia to determine how they organise themselves to commission services for patients affected by coeliac disease. The new arrangements in the NHS are designed to ensure that GPs are in the driving seat on commissioning services for their local population.

[Gordon Banks]

In my contribution, I spent a considerable amount of time talking about pharmacy-led prescribing. The Minister has gone around the houses on that; he has not really addressed it directly. In the last two and a half minutes of the debate, could he deal with it in a little more detail?

[Mr Burns]

I am planning to come to that, but first I want to deal with another issue that the hon. Gentleman raised—food labelling. I will then move on to prescribing. If I run out of time, I will ensure, as I promised, that I write to him.

Food labelling is crucial to patients’ quality of life, and improvements have needed to be made. The coalition Government want to see health and social care provided in a way that achieves better outcomes and delivers personalised services, focused around individuals, not organisations, and ending up with care and support that is of a higher quality and safer than ever before.

For people living with coeliac disease, having the right information about the gluten content of food is crucial. That has certainly emerged in the course of this debate. Prescribed foods represent a small proportion of an individual’s diet. People with coeliac disease buy most of their food from high street shops, like everyone else. It is therefore important that food labelling is comprehensive and reliable. It has got better in recent years, particularly in supermarkets, which the hon. Member for North Durham mentioned, and in some restaurants—although there is a long way to go—as more and more people become aware of the condition. Indeed, a wide selection of gluten-free foods is now available at supermarkets. That was not the case 10 years ago.

New labelling requirements introduced in January 2009 for full implementation on 1 January next year are designed to reduce confusion and to help people with coeliac disease to make safer choices about the food that they eat. The legislation sets out new low limits for gluten in foods making “gluten-free” and “very low gluten” claims, so that consumers can understand how much gluten there is in the foods that they buy. The Government are working with industry, health professionals and Coeliac UK to provide advice for consumers on what the new legislation means for them.

As I am running out of time and sadly have not been able to cover all the points, I give hon. Members a categorical assurance that they will receive a letter answering in detail the outstanding points that they have validly raised during an extremely interesting and high-quality debate.

Health and Social Care Bill (Programme) (No. 3)

Simon Burns Excerpts

Tuesday 6th September 2011 Commons Chamber

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

I beg to move,

That the Order of 31 January 2011 (Health and Social Care Bill (Programme)) as supplemented by the Order of 21 June 2011 (Health and Social Care Bill (Programme) (No. 2)) be varied as follows:

1. Paragraphs 5 and 6 of the Order shall be omitted.

2. Proceedings on Consideration shall be taken on the days shown in the first column of the following Table and in the order so shown.

3. Each part of the proceedings shall (so far as not previously concluded) be brought to a conclusion at the time specified in relation to it in the second column of the Table.

TABLE

[Frank Dobson (Holborn and St Pancras) (Lab)]

Is it not treating the people who work in the national health service with contempt to expect the House to consider more than 1,000 amendments and new clauses in two days? Is that not a disgrace?

[Mr Burns]

The right hon. Gentleman’s hyperbole does not match the facts. He mentioned 715 amendments —[Interruption.] Yes, but the right hon. Gentleman mentioned 715 amendments dealing with one issue within the more than 1,000 amendments. May I point out to him that 715 amendments are all technical amendments? They change the name of GP consortia to clinical commissioning groups, following the recommendations made by the Future Forum and others working in the health service, which I would have thought would be welcomed by the Opposition Front Bench team at least. That number bloats and distorts the total number. The other significant number of amendments—121—deal with the continuity of services, which is an issue that the Opposition Front-Bench team implored us to bring before the House, rather than allowing it to be dealt with another place. That is why we have done so.

If we are going to be somewhat churlish, let me point out that 100 amendments were tabled by the official Opposition, of which 41 have been selected, and the vast majority of those amendments have been dealt with in Committee in great detail. So in that respect we will be going over well covered ground.

I do not intend to speak for long as I do not wish to detain the House. There is work to be done. This Government have allowed four two-day Report stages in this Session alone. Let me remind the House of one of those rare Government Bills that was granted a two-day Report stage under the previous Government—the Planning Bill in June 2008, with which I know the right hon. Member for Wentworth and Dearne (John Healey) is extremely familiar and probably very fond of. For that Bill the Government of the day thought that two days were appropriate—an interesting judgment, given that they were tabling 29 new clauses and seven new schedules on Report. Indeed, by the end of Report, the Planning Bill had grown by 25%. That compares with the nine new clauses that the Government have tabled on Report for the Health and Social Care (Re-committed) Bill. So that those on the Opposition Benches get the message, that is nine new clauses under this Government, as opposed to 29 new clauses in the right hon. Gentleman’s Bill.

Let us give the Opposition the benefit of the doubt. They might have forgotten what the right hon. Gentleman said when the Planning Bill was, unusually, allowed two days on Report, so let me remind them:

“My reasons for moving this motion were straightforward… It is true that the Bill is wide-ranging and important, which is why we have, unusually, provided two full days for the Report stage… we have departed from the usual by giving two days to this consideration.”—[Official Report, 2 June 2008; Vol. 476, c. 507.]

He established the fact that it is highly unusual. The Health and Social Care Bill has had far more time in Committee than previous Bills, and we are giving an extra day to allow hon. Members the opportunity to contribute to debates, although I must warn my hon. Friends that some of the debates will be a repetition, particularly for those who served on the Committee. It is for those reasons that I urge the House to support the motion.

[Liz Kendall (Leicester West) (Lab)]

We oppose this programme motion because it fails to give hon. Members enough time to scrutinise one of the most important Bills of this Parliament and, indeed, of the 63 years of the NHS. It is one of the largest Bills of recent times and the largest ever in the history of the NHS, with 420 pages and more than 300 clauses. It is also one of the most controversial. It will force the NHS through a massive reorganisation, which is already happening even though the Bill has not been passed, when it should be focused on meeting the biggest financial challenge of its life and improving patient care. It also seeks to make fundamental changes to the way our NHS is run, driving competition into every part of the system whether or not it is in patients’ best interests.

Labour has led the arguments against the Bill since the autumn, helping to create the widespread opposition that has already forced the Government to pause and amend their plans. However, the Government, far from what the Minister said, refused to give the second Bill Committee enough time to scrutinise properly the changes after their so-called listening exercise. [Interruption.] The Minister tuts from a sedentary position, as is his wont, but 42 Government amendments and two new clauses were not debated in the second Committee due to a lack of time. They have not even bothered to publish the explanatory notes and impact assessment for the post-pause Bill, so the two days on Report that the programme motion proposes would have been insufficient in any case.

Then, on Thursday, three days before this debate, more than 1,000 new Government amendments were tabled, 363 of which are significant. They include a completely new set of proposals on whether local NHS services and, indeed, entire hospitals will be allowed to fail—proposals that could affect every constituency in England. It is a gross discourtesy to this House, not to mention to patients and NHS staff, to produce such important proposals and give such little time for scrutiny. I am sure that Members of the other place will take that into consideration in their deliberations on the Bill.

We are now faced with hundreds of significant new amendments and a series of fundamental questions about the post-pause Bill, and yet we have only two days for debate. Who will have the final say, and who is accountable for vital decisions about the future of local services? What will the Government’s health care market mean for expensive local services that do not make money, such as accident and emergency services and geriatric care, if hospitals lose services that do make money, such as hip and knee operations? How will NHS patients be protected if the private patient cap is abolished and hospitals are forced to take on more patients who pay in order to balance their books? What will be the true cost to taxpayers of the extra red tape and bureaucracy created by the Bill?

The Government’s failure to give the House sufficient time for scrutiny and provide proper answers about their Bill means that many NHS staff and patients remain deeply concerned. Unfortunately, that seems to have passed the Prime Minister by. Two weeks ago, he claimed:

“the whole…profession is on board for what is now being done.”

I wonder whether “the whole profession” includes the British Medical Association, which says—

[Mr Burns]

indicated dissent.

[Liz Kendall]

The Minister groans. If he thinks that the body representing doctors in this country is worthy of that response, that is a disgrace. The BMA says that the Bill is still

“an unacceptably high risk to the NHS, threatening its ability to operate effectively and equitably now and in the future”.

It calls for the Bill’s withdrawal

“or at the very least further, significant amendment”.

Health and Social Care (Re-committed) Bill

Simon Burns Excerpts

Tuesday 6th September 2011 Commons Chamber

[Mr Dorrell]

Ministers can correct me, but my understanding is that, under the obligation being introduced, they “must” meet in public. I have no authority to speak for the Government, but I believe that that is what the Government intend. For myself, as a patient of a trust or other NHS provider, whether in the public or private sector, my interest lies in ensuring that the information about my—

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

Will my right hon. Friend give way?

[Mr Dorrell]

Of course.

[Mr Burns]

I am grateful to my right hon. Friend for giving way and allowing me to clarify the point. Let me reassure him that, yes, such meetings must be held in public.

[Mr Dorrell]

I am grateful to my right hon. Friend, who answers the hon. Member for Worsley and Eccles South (Barbara Keeley) with very much more authority than is at my disposal.

I want to make one final point and it is a direct response to the hon. Member for Oldham East and Saddleworth (Debbie Abrahams). Of all the misrepresentations about the intentions of this Bill that we have listened to since the White Paper was published over a year ago, the most persistent is that this is somehow a Bill—a ramp—for the privatisation of the health service.

I was first a Health Minister more than 21 years ago. Throughout that period I have listened to speeches directed first at my right hon. and learned Friend the current Justice Secretary, when he was Health Secretary, and subsequently at all his Labour and Tory successors, including me, although probably excluding the right hon. Member for Holborn and St Pancras (Frank Dobson). All their legislative and other proposals to introduce more flexible and patient and standards-oriented structures in the health service were opposed by somebody or other on the grounds that they were going to privatise the health service. If that was the purpose of those policy initiatives, the one thing that they all have in common is that they have been singularly unsuccessful. If it is the policy purpose of this Bill to privatise the health service—which I do not for one moment believe it is—it will, I am sure, be as unsuccessful as all the other measures that went before it.

--- Later in debate ---

[Grahame M. Morris]

That point was raised during the Secretary of State’s earlier remarks. [Interruption.] Well, it came in response to a freedom of information request. I thought that his response was illuminating, as he assured us that that would not involve the transfer of NHS real estate, although he did not rule out the possibility that private sector providers would take over the running of these things. The report that I saw said that they would take responsibility for the management and staff, and he gave no rebuttal of that report.

[Mr Simon Burns]

rose—

[Grahame M. Morris]

I will give the Minister an opportunity to do that, if he so wishes.

[Mr Burns]

There is an air of déjà vu to this debate now, although I am delighted to be taking part in a debate with the hon. Gentleman yet again. May I point out that the only example of what he is saying relates to Hinchingbrooke hospital? What happened there was started by the previous Labour Government—his Government.

[Grahame M. Morris]

I do not wish to labour the point, but the report in The Guardian said that freedom of information requests to the Department of Health indicated that discussions were taking place between officials in respect of the transfer of between 10 and 20 NHS units—[Interruption.] I am simply reporting what I have read in the paper.

[Mr Burns]

May I say to the hon. Gentleman that that report is unadulterated claptrap? The trouble is that it was a misunderstanding of the contents of the e-mails. [Laughter.] The right hon. Member for Holborn and St Pancras (Frank Dobson) may think that that is funny, but the e-mails were not about these bodies taking over NHS hospitals; the e-mails were about discussing what their views are on hospitals that are struggling. The e-mails were part of an information-gathering mechanism to find out how policy in the NHS could be improved to deal, within the NHS, with hospitals that might be struggling as part of the foundation trust pipeline.

[Grahame M. Morris]

I do not find this at all funny. I would find it really worrying if this report is an indication of what is in store. It is rather ironic that the Secretary of State quoted from the Labour party manifesto. Perhaps it might be instructive if I were to quote from the Conservative party manifesto. It said that the Conservatives would

“defend the NHS from Labour’s cuts and reorganisations”.

If this Bill is not the biggest reorganisation that we have ever seen—[Interruption.] Well, it is, even though the Conservatives said that they would not proceed with any such huge reorganisation.

--- Later in debate ---

As for a number of the new clauses and the changes to the failure regime that we are dealing with, in the recommitted Public Bill Committee we tried on numerous occasions to tease out from those on the Government Front Bench precisely what they had in mind. I was shocked when I saw that there were 1,000 amendments. Admittedly, the Minister said that 715 are so-called technical amendments—

[Mr Simon Burns]

Changing the name.

[Grahame M. Morris]

Absolutely. At this late stage in the process, however, these are huge and significant changes.

--- Later in debate ---

[Rosie Cooper]

Members of the public listening to Government Members this afternoon might wonder whether we were having this debate in a parallel universe, because they have heard the Prime Minister promise that there would be no top-down reorganisation of the NHS, and what did we get? We got the biggest reorganisation in the history of the NHS. The Prime Minister said only recently that everyone was on board and behind the Bill, and yet we find that clinicians, professionals and the public are far from being on board. The Government talk about the protection of services, but the public will have read only yesterday that the Government are meeting McKinsey about the possible transfer, albeit a slow transfer, of up to 20 hospitals.

[Mr Simon Burns]

indicated dissent.

--- Later in debate ---

[Rosie Cooper]

I can categorically say that we have asked the questions over and again and we do not get any answers.

[Mr Burns]

The impact assessment.

[Rosie Cooper]

How much? I will give way if the Minister tells me exactly how much it is all going to cost. I shall happily sit down; there you go. [Interruption.]

--- Later in debate ---

[Mr Simon Burns]

I am grateful to my hon. Friend the Member for Cornwall—I mean the hon. Member for St Ives (Andrew George)—for moving the new clauses and amendment, especially for the constructive and reasonable way in which he did so. He raised several issues and, if I understand him correctly, he sees the amendment as a probing amendment that also puts across several of his concerns about this issue. I hope to deal with the main thrust of his concern in my contribution.

I am also grateful to the hon. Member for Islington South and Finsbury (Emily Thornberry) for her contribution. Her amendment and indeed her comments were more controversial and I have far more disagreement with several of the contentious things that she said, although she will be unaware that I am saying that because she is not listening. She might argue that she is not missing much.

I shall start with a fact. It may have got lost in the telling, but I assume that the hon. Lady realises that there is no cap at the moment for NHS trusts. There is only a cap for foundation trusts. She has not seen the difficulties that she forecasts in NHS trusts, and I hope—although I am not confident of success—that I will convince her that her fears are unfounded.

The Government believe that keeping the cap would damage the NHS and patients’ interests. Removing it would allow foundation trusts to earn more income to improve NHS services, and I will address the safeguards that will be in place to ensure that the armageddon that the hon. Lady predicted will not happen and that my hon. Friend’s concerns are needless.

Removing the cap will enable foundation trusts to earn more money to improve NHS services, and those trusts are telling us that they must be freed from what is an unfair, arbitrary, unnecessary and blunt legal instrument. I do not want to go too far down memory lane, but I must remind the House that there was no intellectual case for bringing in the cap in the first place. It was introduced in 2002-03 in the relevant legislation as a sop to old Labour. The right hon. Member for Holborn and St Pancras (Frank Dobson) says that he has moved on, but he still has the Neanderthal tendencies of old Labour—[Interruption.] Before the Opposition Whip says anything, I should point out that the right hon. Gentleman takes that as a compliment. I am being very nice to him and probably enhancing his street cred. He would not thank the Whip for diminishing that.

The point is that the cap was not brought in after some coherent intellectual argument about protecting the NHS or preventing private patients from overrunning the NHS. It was brought in because the then Health Secretary, Alan Milburn, and the then Prime Minister, Tony Blair, were having considerable problems with some of their Back Benchers on this issue. To avoid a defeat on the Floor of the House, they brought in the cap as a sop to those Back Benchers to buy them off. But it was not introduced consistently for both NHS trusts and foundation trusts—just for the latter.

The cap is arbitrary and unfair. Several NHS trusts that are not subject to the private patient income cap have private incomes well in excess of many foundation trusts. Last year, four of the top 10 private income earners were NHS trusts—that is, without a cap. A few FTs have high private incomes simply because they did a few years ago. The cap locks FTs into keeping private income below 2002-03 levels and means that last year about 75% of FTs were severely restricted by caps of 1.5% or less. Meanwhile, patients at the Royal Marsden benefit from its cap being 31%, and it has consistently been rated as higher performing by the Care Quality Commission.

[Andrew George]

The Minister is making an interesting point. Will he elaborate further on the proportions of the private work to which he refers? Is that private work for private patients or private work for research, innovation and training, which are important functions of hospitals but are often lost in the debate?

[Mr Burns]

The hon. Gentleman raises an important point, but the simple answer is that it is a combination of both.

The cap is unnecessary. I remind Opposition Members that the original proposal was not to have one. To suggest that NHS patients would be disadvantaged if the cap was removed, as the hon. Member for Islington South and Finsbury did, is pure and simple scaremongering. Existing and new safeguards will protect them. NHS commissioners will remain responsible for securing timely and high-quality care for NHS patients. The Bill will make FTs more accountable and transparent to their public and staff, allowing us to require separate accounts for NHS and private income and giving communities and governors greater powers to hold FTs to account in performing their main duty, which is to care for NHS patients.

[Chris Leslie]

Will the Minister give way?

[Mr Burns]

No, because others want to speak.

I can assure the House that FTs will retain their principal legal purpose—to serve the NHS. This means that the majority of their income will continue to come from the NHS. With no shareholders, any profit they make will have to be ploughed back into the FT, and so will support that purpose of caring for NHS patients. The vast majority of FTs have little, if any, potential to increase private income, never mind the desire to do so. For them, NHS activity will remain the overwhelming majority of the work they do, if not all of their work. It is extremely unlikely that even the most entrepreneurial FTs with international reputations would seek to test the boundaries. Their commissioners, public and NHS staff governors would hold them to account in fulfilling their duties and serving their NHS patients.

For these FTs, however, the cap is a blunt instrument that harms NHS patients. FTs tell us that there is potential to bring extra non-NHS income into the NHS, for example, by developing the NHS’s intellectual property, from innovations such as joint ventures and by using NHS knowledge abroad. Additional demand and income can help organisations to bring in leading-edge technology faster, including in the important area of cancer treatment. I hope that that goes some way to helping my hon. Friend the Member for St Ives. Opposition amendment 1165 would harm the NHS, and new clauses 19 and 22 would stop FTs providing private health care altogether. Many of the other protections proposed would be almost as damaging and reduce income.

We want to ensure that safeguards are appropriate, not harmful. For example, a prohibition on FTs offering privately the same services that they offer on the NHS would rule out most of their current private health care. It could even create perverse incentives to stop providing some services for some NHS patients. We are confident that private income benefits NHS patients. On reflection, we are proposing to explore whether and how to amend the Bill to ensure that FTs explain how their non-NHS income is benefiting NHS patients. We will also ensure that governors of FTs can hold boards to account for how they meet their purpose and use that income. I believe that that is an important move forward.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

Will the Minister give way?

[Mr Burns]

I hope that the right hon. Gentleman will forgive me, but I will not give way, because other hon. Members wish to speak and the debate finishes in 20 minutes.

To my mind, the private patient cap and the proposed new restrictions are both unnecessary and damaging. Indeed, I know that this will drive some Opposition Members potty, but the former Labour Minister responsible for the cap, Lord Warner, repented his sins in the other place, describing it as

“wrong and detrimental to the NHS.”—[Official Report, House of Lords, 12 May 2009; Vol. 710, c. 936.]

I urge Opposition Members not to repeat that mistake and to heed Lord Warner’s advice. I appreciate that the Opposition Benches are not full of champions of Lord Warner—particularly not at that end of the Chamber from which we heard the earlier comments about him—but he is a respected former Labour Health Minister and I would suggest that he knows what he is talking about.

Let me deal briefly with two final points that were made by the hon. Members for Islington South and Finsbury and for St Ives about the safeguards that are in place to offer protection and ensure that NHS patients would not lose out with the removal of the cap. First, the NHS commissioning board and clinical commissioning groups would be responsible for ensuring that NHS patients are offered prompt and high-quality care, and that good use is made of NHS resources, whoever provides care, through robust contracting arrangements. NHS patients will also maintain their right in the NHS constitution to start treatment within 18 weeks of referral. Secondly, as foundation trusts do not have shareholders and cannot distribute surpluses externally, and as their principal legal purpose will remain to serve the NHS, all proceeds from non-NHS work would be reinvested in the organisation, ultimately adding to the level and quality of the NHS service.

The Bill will make FTs more accountable and transparent to their public and NHS staff. Our commitment that FTs will produce separate accounts for their NHS and NHS private-funded services—as well as Monitor’s use of its regulatory powers to ensure a level playing field between providers—will also help to avoid any risk of NHS resources cross-subsidising private care, thereby protecting NHS money. I believe that those five safeguards will protect NHS patients and the NHS, and will not lead to the situation that the hon. Member for Islington South and Finsbury described in her speech.

[Emily Thornberry]

I do not mean in any way to suggest that the right hon. Gentleman does not believe what he has just said, but what if he is wrong? It is all very well for him to say, “We’re going to lift the private patient cap—we have these safeguards and I believe they’re sufficient to ensure that NHS patients won’t suffer,” and he may be right. However, the difficulty is that he may be wrong, so why are we taking this risk at a time like this? What is the point? What is the benefit?

[Mr Burns]

I do not think that this will come as a surprise to the hon. Lady, but I do not think that I am wrong, and I say that for the following reasons. First, there has never been a cap on NHS trusts, and the problems that she has speculated about during this debate have never occurred where there is not a cap. Secondly, the reasons that I have outlined would suggest to me that there will not be a problem, particularly as the one hospital that I singled out—the Royal Marsden—has an income cap of 30.7%. Nobody is suggesting that NHS patients are suffering as a result of that, and that is where a substantial income comes from non-NHS work. Finally, the five safeguards that I have highlighted will be powerful measures to ensure that what she describes will not happen.

For those reasons, I would be grateful if my hon. Friend the Member for St Ives did not press his new clause to a vote. I would also hope that, on reflection and having made her points, the hon. Member for Islington South and Finsbury will resist the temptation to press her amendment to a Division. I fear, however, that she is not going to heed my advice, and she will regret it.

[Several hon. Members]

rose—

Hospital Finances

Simon Burns Excerpts

Tuesday 19th July 2011 Westminster Hall

[John Pugh (Southport) (LD)]

I could not help thinking on my way here, as I passed the scrum of photographers and reporters, “There are an awful lot of people. They can’t all be coming for the debate on hospital finances, however important it might be.” I apologise in advance to the Members present, who I know debated such themes extensively in the Committee that considered the Health and Social Care Bill. I can only say that I did not anticipate that today would turn out as it has. I wanted to flag up an important issue that I think will dominate next year’s headlines and to put some of my thoughts and concerns on record. I will not suggest that we could all go off quietly, have a cup of tea and discuss it in a genteel way, but if the Minister and the Opposition spokesman give adequate responses, we might curtail this debate before an hour and a half.

When I arrived in this place in 2001, one of the first people whom I met was another new MP, Dr Richard Taylor, a distinguished Member who had just won the Wyre Forest constituency somewhat unexpectedly. David Lock, an unfortunate colleague of yours, Mr Betts, had lost half his votes in the election simply by virtue of his stance on hospital reconfiguration. Since then, an axiom in this place has gone something like this: “If you back hospital changes and any sort of configuration, you lose; if you oppose hospital changes and any sort of configuration, you ordinarily win.” I certainly sat through many debates, somewhat better attended than this, on hospital configuration in many parts of England when I was part of the Liberal Democrat health team, and generally speaking, that has been the invariable subtext to the debate.

Offstage, away from the Commons arena, many groups were set up during the previous Parliament to defend their local hospitals in a variety of ways. An all-party group was set up on community hospitals, and another, of which I was a founding member, was set up on small hospitals. It is recognised that reconfiguration and change in the acute sector is ordinarily political dynamite. Understandably, this and previous Governments have wanted to keep the issue at arm’s length.

One way to do so is to suggest that it is all a matter of local decision making, although somehow it always comes back to the Secretary of State’s desk. Another way is to refer such matters to a reconfiguration panel, a device set up expressly to keep things off the Secretary of State’s desk. A third way is to claim that whatever change is in the offing is the result of extensive work by consultants—McKinsey is often involved. I have never found them particularly helpful myself, as ordinarily they suggest that hospitals solve their financial problems by simply doing less, meaning closing wards and so on. However the technique favoured by most Governments hitherto has been deferral: putting off the agony in the expectation that some other Secretary of State will have to pick up the ball and run with it. The current Secretary of State is a veteran of many hospital configuration debates, having been a health spokesman for his party for a long time.

That is the background to the issue. However, I suggest that the landscape is changing dramatically. First, there is a widely accepted view that more services should be delivered in the community, and, presumably, that fewer services should be delivered in the acute hospital sector. Many of the effects of the “any willing provider” policy and patient choice are already working their way through the system, leading to an increase in the deficit on the acute hospital side. Since the 2010 Budget, there is clearly a need across the health sector to find substantial savings, amounting in national terms to £20 billion.

Added to that is the chronic effect of private finance initiatives, which appear to be crippling many in the hospital sector. An investigation conducted by The Daily Telegraph found, for example, that one fifth of hospital trusts with active PFIs have closed casualty departments, while during the same period only 4% of hospitals without PFIs closed or proposed to close casualty departments. We can clearly see from the cases of some individual hospitals—I shall not name them here—that severe problems have been brought about chiefly, if not exclusively, by long-standing PFI debts. The Daily Telegraph investigation—we do not need to believe The Daily Telegraph, but this is what it says—found that

“Some PFI hospitals—built and run by private firms and effectively rented back to the state—will end up costing taxpayers more than 10 times their capital value.”

Much of that cost, of course, is picked up by the acute sector.

In addition, constant deferral has sometimes made problems more acute, which is particularly true in London. Further grief is generated, to some extent, by adjustments, not uninfluenced by the Department of Health, to the tariff for many acute services. Not long ago, primary care trusts were strapped for cash and acute hospitals were okay; to some extent, intervention in the tariff has changed that, and the acute sector could do absolutely nothing except remonstrate.

Some trusts are in serious trouble, and their problems cannot be eternally deferred. The problems of the South London Healthcare NHS Trust, for example, are critical. The other day—I am sure that the Minister will be familiar with this issue—I picked up a brochure distributed around Merseyside saying, “Save Whiston and St Helens hospital”. He might be surprised to know that it says that

“local politicians have been informed by Ministers in the Department of Health that plans are in place to privatise”

Whiston and St Helens hospitals.

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

As the hon. Gentleman is not an MP for that area, I will explain a bit of the background. One or two hon. Members are scaremongering among the local population. Despite repeated assurances from me and others, they will not accept that there is no intention, in any shape or form, to privatise Whiston or any other hospital.

[John Pugh]

To be fair to the Minister, I was using that case as an illustration not of what is afoot but of how such things become inflamed and distorted and how emotion tends to dominate, rather than facts.

[Mr Burns]

I certainly accept that, but will he join me in saying that hon. Members have a responsibility to be accurate about the true situation? Some hon. Members are prepared to put grubby party politics ahead of accuracy in their public accusations.

--- Later in debate ---

[Owen Smith (Pontypridd) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate the hon. Member for Southport (John Pugh) on securing the debate, albeit at an hour and on a day when there is a little competition for the attention of the House and perhaps of the media, too. Maybe the media are watching, but I have my doubts.

I will start on a note of agreement with the hon. Gentleman, and, I am sure, the Minister, on the need to make savings in the NHS. There was widespread agreement before and after the general election that the NHS needs to make significant savings of £15 billion or maybe £20 billion in the spending period, which is vital. Equally, the NHS needs to find ways to achieve those efficiencies to achieve productivities that will allow those savings to be sustained over a longer period. There is also widespread agreement that there is a massive challenge in achieving those savings, and addressing perennial problems that have persisted in the NHS under successive Administrations.

Some trusts, as the hon. Gentleman has said, are consistently in the red and have been for a while. They seem to have persistent and perhaps insurmountable problems with their finances. There has been an evolving but still too opaque process of dealing with that, with bail-outs or loans from the SHA or the PCT to trusts that have struggled. Despite the efforts of successive Governments, and particularly the previous Labour Government, there remains too much variability in the quality of service offered and prices paid across the NHS. I also agree with the hon. Gentleman that there have been persistent political obstacles in the way of achieving the reconfiguration of services, which we all recognise may be required to deliver some of the proposed savings.

Since the Government came to office more than a year ago, they have been right to try—rhetorically, at least—to address those issues and to spell out some of the challenges and potential solutions. First, we all agree that there needs to be greater transparency on accounting, on design decisions about services and, in particular, on reconfigurations of acute services. Secondly, there has been widespread agreement over a long period that clinicians need to take greater responsibility for redesigns and, as the Government would put it, to be at the heart of decision making in ways that force them to take account of issues and be responsible about engaging in the ongoing debate. Finally, there is agreement that we need a more effective means of dealing with failing trusts, so that we have a failure regime that allows whichever party is in government to reconfigure vital services in a way that protects them.

The Government want to do all those things, and they are right to want to do them, while increasing quality at the same time, but the problem is that their prescription for achieving them is entirely inappropriate. It is the wrong prescription for the NHS, and it will not achieve what the Government want; in fact, it will compound the problem. The past year has been a wasted year, in which many of the decisions that the Government say they want to take and that they want the NHS to take have been put off. The health service has had to deal with the chaos of having to wait and wonder what the future will hold for individuals and institutions across the NHS, as the Government’s shambolic Health and Social Care Bill passes slowly and tardily through the Commons.

The principal reason why the Government have introduced the Bill is that they still have an entirely misguided belief that competition in the NHS between providers will result in a more efficient allocation of resources, drive productivity and lead to innovation in the NHS, which is not the case. The planning that the hon. Gentleman has mentioned is vital in the NHS, and that is particularly true of planning that militates against injudicious decisions being taken by parts of the NHS that are more autonomous than they were previously.

Ultimately, the chaos we have seen over the past year has been worse than not allowing the NHS to take the necessary financial decisions and steps towards reconfiguration to achieve better financial outcomes. Worse still, it is compromising patient care. The quality agenda that the Government profess to support and pursue above all else, even in respect of competition, is not letting the NHS improve as quickly as it has done in the past. The Minister is looking quizzical, but I would point to the fact that the figures for 18-week waiting times, for four-hour waits at A and E and for the time people wait to receive vital diagnostic tests are all increasing.

[Mr Simon Burns]

indicated dissent.

[Owen Smith]

Yes, they are. The Minister says they are not, and if he wants to intervene, I would love to hear what he has to say.

[Mr Burns]

I know that the hon. Gentleman does not want to misinterpret the facts, and even he will have to accept, if he looks at the facts, that the median waiting time remains stable. Even someone he loves to quote—Chris Ham of the King’s Fund—has acknowledged that in recent weeks.

[Owen Smith]

The King’s Fund explicitly said that, for the months from February through to March, numbers for the 18-week wait were at a three-year high. The Minister talks about median waiting times, but we need to talk about overall waiting times. He cannot disagree with the fact that the figures for the other waiting times that I have mentioned—the waiting times for diagnostic testing and for four-hour waits in A and E—are at their highest levels since their inception. That is where we are, and I fear that is where we will be for a long period unless the NHS is allowed to concentrate on clinical targets, which are crucial to the quality of service that patients receive, rather than having to worry about future configuration and structure.

How has the vital question of savings been dealt with over the past year? The hon. Member for Southport has discussed the need to save between £15 billion and £20 billion, and service reconfiguration is one way to do that. We do not know exactly how we are doing on savings right now, because the Government have not told us where we are or whether we are on track to realise those savings. We know that trusts are being asked to make savings of about 4% a year, but we do not know how many actually are. We fear that we are behind the curve in achieving that figure, which Monitor’s report of September last year suggests that 63% of trusts are failing to do. The King’s Fund tracker, which came out only last week, said that half the managers it surveyed feared that they would not hit the 4% target, and an even greater proportion feared they would not hit the 6% target that they are setting for themselves.

[Mr Burns]

Will the hon. Gentleman accept—I am sure that he knows this—that the King’s Fund work was only a snapshot? It surveyed only 29 finance directors out of 165, and 27 of them made the comments that he has described. However, the latest quarterly NHS performance statistics, which are an actual look at what is going on across the NHS rather than a snapshot, show that 20 of the 21 indicators are being reached. Of those, 14 show improvements, whether that is on bowel and breast cancer screening or on times for admission for minor strokes. That gives a more accurate assessment of what is going on.

[Owen Smith]

Of course, the baseline for those outcomes is relatively new, because this is a new set of indicators. More importantly, however, the Minister will accept that I was talking specifically about financial data and whether services will hit their financial targets. I acknowledge that the King’s Fund tracker is but a snapshot and that, as the Minister has said, it uses only 29 NHS trusts. However, the Monitor survey of September last year, which I have mentioned, related to all 100-odd foundation trusts, and it found that 63% of them are behind the curve in achieving the 4% target. It is not, therefore, inexplicable or out of the realms of possibility that the King’s Fund survey might be entirely accurate, even though it is a snapshot. Of course, the Minister can clear this up for us right now by saying precisely how many foundation and non-foundation trusts are on target to meet the 4% target for productivity savings this year. He can clear that up for us, and we will have no further questions about it. He could publish a tracker to keep things clear for us.

After quality and savings, the third issue that I want to discuss is transparency, because the Government have persistently said that more transparency in the system will allow decisions to be taken in a better way and to be scrutinised, as well as allowing an improvement in productivity and quality. Other Opposition Members and I have pursued this issue during the seemingly endless sittings on the Health and Social Care Bill. I have said repeatedly that the fog around this issue has not got any thinner; in fact, it was approaching pea-soup status towards the end of our sittings.

We have no real idea how the Government will address the apparent shortcomings in the 17—or is it 20 or 25?—trusts that are currently in trouble and do not have the requisite stability to achieve foundation trust status. We do not know exactly what the Government are doing to bring them up to foundation trust status. Nor do we know precisely what will happen if one of them goes bust. We do not know what the failure regime is—

[Mr Burns]

You will.

[Owen Smith]

Well, as we said in Committee, we wait with bated breath to hear what the failure regime will look like. It is a crucial piece of the jigsaw if the Government are to be trusted with the NHS and if we are to know precisely what regime they will put in place to protect services that, as we have heard across the country, are considered vital for communities.

We do not have any idea, really, how many of the existing foundation trusts are overspent, and therefore in breach of their authorisation. The Minister could inform us about that. He could be a little more transparent about precisely what the situation is. I mentioned this earlier, but the Minister could clear up persistent concerns, in particular on the Labour side of the House, that the Government think that private sector management might be a means to improve the productivity, efficiency and, indeed, perhaps even the clinical quality, of some of the failing trusts. I do not think that that fear is wholly misplaced. We simply need to listen to the words of Matthew Kershaw, who is employed in the Department of Health to oversee that very process, and who told a Health Service Journal conference just the other day—it was reported only a week ago—that it was perfectly possible that we might look at means by which private sector companies might come in to run, through franchise, some failing trusts.

[Mr Burns]

The hon. Gentleman really takes the biscuit. He raises the possibility of private sector companies providing a manager or managers where the management in an NHS hospital are failing to help pull it round and return it to stability. He conveniently forgets that there is only one instance, to the best of my knowledge, where that is happening in the NHS, and it is—possibly, provided it is all finalised—at Hinchingbrooke hospital in Huntingdon. That was set in progress not by a Conservative Government, but by his party’s Government, under the right hon. Member for Leigh (Andy Burnham), prior to the general election. To complain about something that his own party’s Health Secretary did is somewhat rich.

[Owen Smith]

The difference, of course, is that that is one instance in a system where there is still strategic management, planning and control, both at the centre and in the regions. The difference under the new dispensation, as envisaged in the Health and Social Care Bill, will be that we shall have a fundamentally disaggregated, fragmented NHS with more autonomy and with the ability for more trusts to choose what to do. That runs the risk that the Secretary of State will have far less control over those private providers, if they are running franchises.

[Mr Burns]

The hon. Gentleman can wriggle as much as he likes. The fact is that he has been holed below the waterline. A Labour Government set up the only example in the health service in England of what he said, specifically, it was unacceptable to do. He could at least have the decency to come clean and accept it, and, if he feels so strongly now, he could apologise.

[Owen Smith]

I am not sure that I am the most celebrated politician being asked to apologise today. I do not need to apologise and do not feel that I am holed below the Plimsoll line, because clearly a very different future scenario is being painted as a result of the changes that the Minister and the Government are pushing through in the Bill. Our grave concern is that the local populace, politicians, and, indeed, Parliament, will have far less control over and insight into what different parts of the NHS will be doing after they are afforded that much greater autonomy. Of course, there will also, ultimately, be a far greater ingress of private companies into the NHS at many levels.

[Owen Smith]

I would love to be undefeatable in argument, but I am not sure whether that is true. However, I will add one thing before I move on. I did not say—this is the principal reason why I do not need to apologise to the Minister—that the idea of a private company coming in and running an NHS service should never be countenanced. I suggested that in the world envisaged in the Health and Social Care Bill, where there will be a significant increase at many levels in the number of private sector providers in the NHS, there is an immediate local concern, in addition to the far more substantive problems of competition law becoming the norm for organising the NHS and, crucially, dismantling it. The local concern is that there will be less control over a greater proportion of the NHS, once we have more private providers. That clear concern is widely felt across the House and outside it.

The hon. Member for Southport touched on how NHS bureaucracy allows tough decisions to be taken. He talked about politicians not being prepared to take tough decisions, and about the NHS’s own clinicians, bureaucrats and managers being unable to do so. That needs to be recognised, because there are difficulties with an organisation as big, and arguably as unwieldy, as the NHS, with so many different moving parts and so many different agendas in play. However, as to the labyrinthine bureaucracy that the Health and Social Care Bill will create, with the welter of new organisations—the national commissioning board at national and local levels, consortia, senates, clinical networks in addition to the ones that we currently have, health and wellbeing boards, HealthWatch, the Office of Fair Trading and the Competition Commission—it is beyond this simple politician to see how that much more complex architecture will facilitate easier decision making in the NHS about tough reconfigurations. I just cannot see how it will get easier with far more complex architecture.

I thought that the hon. Member for Southport talked interestingly about how, at a more aggregate level, one might imagine better ways to manage what he called the “dormant surplus estate” of the NHS, which is an interesting point. There are ways in which dormant bits of hospitals and dormant land could be better managed. I have grave concerns about the world that I envisage will pertain in several years, if the Bill unfortunately passes, in which different parts of the NHS will have much greater autonomy in making those decisions, and there will be a much greater risk that the motivation behind them will be financial as opposed to clinical. I find it impossible to believe that the likelihood of aggregated strategic decision making in respect of that estate will be improved by allowing the NHS to break up, as I fear it will. The National Audit Office report that the hon. Gentleman prayed in aid was not on precisely that territory, but it pointed to a risk that always attends autonomy—that it results in less strategic decision making, because decisions are made at a more micro level. That risk clearly attended foundation trusts, and it will get worse, not better, under the Bill.

Lastly, the Minister has talked about clinicians sitting at the heart of the decision-making process. Again, I use the analogy of a labyrinth in the NHS; I cannot see how in that new labyrinth clinicians will be at the heart of decision making. It is a labyrinth that would challenge Theseus, let alone the NHS. Those clinicians will be in the maze with many bureaucrats, some of them perhaps rebadged and shifted from primary care trusts and strategic health authorities into consortia, the NCB or the NCB’s regional arms, and some perhaps from BUPA, Assura Medical or one of the other bodies that will no doubt help to manage commissioning for consortia, and, potentially, for acute care.

In reality, the previous Government funded the NHS from a point where it was on its knees. They tripled the funding of the NHS, radically increased capital spending and raised some of the issues that the hon. Member for Southport has mentioned about the private finance initiative—we could have a long debate about that and how we should reconsider some of those capital projects.

[Mr Burns]

The hon. Gentleman just said that the previous Government tripled funding on the NHS. Will he share with the Chamber how much NHS funding was in financial year 1996-97?

[Owen Smith]

My recollection is that in 1996-97 NHS funding was around £39 billion, and it has now gone up to around £111 billion.

[Mr Burns]

How is that triple?

[Owen Smith]

Well, it is not far off. With the greatest respect, funding pretty much tripled—the figure might be £10 billion short, but it is pretty close.

[Mr Burns]

That is a lot of money.

[Owen Smith]

Okay, let us call it 2.8 times, as opposed to three times, but the increase was rather large. It was certainly reflective of the enormous need when the Labour Government came to power in 1997, following the chronic underfunding of the NHS presided over by the Government in which the right hon. Gentleman was a Minister. Some of the capital spending and its mechanisms, as I have said, need to be opened up and debated, so transparency ought to be a good thing in that case. That capital investment was undoubtedly required, because we needed new hospitals and investment, which were not provided by the previous Tory Government and which the Labour Government delivered.

In the latter years of the Labour Government, after the 2006 White Paper and, crucially, Lord Ara Darzi and his review, we started to look carefully and in a structured fashion, given the difficult nature of the task in hand, at how clinician-led reconfiguration of the NHS could come about and, notably, at greater integration between primary and secondary care and at delivering more of the services traditionally delivered in secondary and tertiary care in the primary care setting. That was the legacy that we left this Government, who have, with respect, blown it. They have wasted the past year, instead of moving on with that positive heritage. They have shifted into their misguided belief that competition in the health service, as for utilities, white goods or whatever other analogy they want to use, will drive more efficient decision making, innovation and better productivity. The Minister is wrong about that, and that will not happen. I am absolutely certain that that is the case.

In pursuing the illusion of competition, the Minister is running two risks in the reconfiguration and financial agenda that we are debating today. First, the increased short-term risk is of ill-considered cuts and reconfigurations in the NHS as a result of managers with their eye only half on the ball, and, as Sir David Nicholson has conceded, half their time spent wondering and worrying about their personal and professional future. There is a real risk that short-term decisions are being taken in that worrying, troubling atmosphere.

In the longer term, the far more profound risk is that the sort of competition that the Minister believes will drive greater efficiency and the disaggregation of the NHS will result in an NHS that delivers worse, more fragmented care, with more variability in the price paid for care, which is a licence for a postcode lottery. My grave concern is that the Government are prepared to countenance such a future and prepared to take such risks with the NHS.

--- Later in debate ---

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

May I also say what a pleasure it is to serve under your chairmanship this afternoon, Mr Betts?

I congratulate the hon. Member for Southport (John Pugh) on securing the debate and on his particularly interesting and thoughtful speech. I have some sympathy with him, but he is right: sadly, events elsewhere on the parliamentary estate are securing more attention. However, I hope to reassure him by saying that this debate had quality rather than quantity.

It is a particular pleasure to have the hon. Member for Pontypridd (Owen Smith) with us. We have got used to him, while in Committee on the Health and Social Care Bill, and he is beginning to invent—or rather, reinvent—himself as some sort of cheeky chappie, who talks the talk that is fed to him by his party elders. One has to admire him because, more or less, most of the time, he manages to stop that smile completely breaking out on his lips—he clearly does not believe a lot of what he is telling us, because it flies in the face of reality. If one needed an example taken to its typical extreme, it would have been his accusations about private managers helping to secure and turn around any NHS hospital, because the only example will probably be Hinchingbrooke, which was of course set on its way by the right hon. Member for Leigh (Andy Burnham). We have to admire the hon. Member for Pontypridd for bringing up an example as fraught with danger for him as that.

The subject of the debate is interesting and, as the hon. Member for Southport said on a number of occasions, difficult in many ways. Before engaging in it, however, I pay tribute to those doctors, nurses, ancillary staff and others who work day in, day out in hospitals up and down the country doing a fantastic job for patients. All too often, because the quality of their care for patients is seamless, it goes unnoticed, which is a reflection of the high standards that they set for themselves in providing that care.

We believe that we must have a sustainable national health service in this country—one that can evolve with the times and changing situations, whether medical or financial. The report this week from the independent Office for Budget Responsibility has underlined the importance of the Government’s commitment to long-term fiscal sustainability for the NHS. It also demonstrates the critical importance of responding to our ageing population. Consequently, health funding will need to rise in the coming years, and the Government are totally committed to its doing just that.

As hon. Members know, we gave a commitment in our election manifesto to provide a real-terms increase in funding in every year of the Parliament while we are in government—the lifetime of this Parliament. We have honoured that, and we will continue to do so in subsequent years. The only trouble is that because of the horrendous economic situation that we inherited from the last Government, the available money is far more restricted, because we must take some extremely tough decisions to sort out the mess that was left to us. That has meant that the real-terms increase in NHS funding has been modest, albeit a real-terms increase, and has presented a challenge to the NHS, as the hon. Members for Pontypridd and for Southport said.

[Owen Smith]

Will the Minister say how much less that amount of money will be as a result of the pause and listen exercise, and the increased cost resulting from the Health and Social Care Bill?

[Mr Burns]

The answer is no. It is not, “No, I will not give an answer”; it is no to the fundamental question. The hon. Gentleman is aware from previous discussions that the cost of the listening process and the Future Forum was modest, and the impact assessment for the Bill, which he studied, will be updated, as he well knows, when the Bill leaves this House and goes to another place. The current impact assessment shows that the one-off cost of the modernisation and improvement of the NHS is about £1.4 billion. By the end of this Parliament, the savings generated by that modernisation process and the changes will be about £5 billion, and £1.7 billion a year thereafter until the end of the decade, of which every penny will be reinvested in front-line services. There will be a subsequent impact assessment, probably in about six or seven weeks, subject to progress in this House, and if there are any changes or updating we will see them in that impact assessment, and there will be an updated figure.

[Owen Smith]

I look forward to it.

[Mr Burns]

The hon. Gentleman says he looks forward to it. Let us hope that he does when he sees the figures, because in my experience he rarely looks forward to anything that flies in the face of his arguments or is not helpful to his arguments, because he finds that disappointing. I hope that he will be disappointed when the new impact assessment comes out.

To return to my original point, the increase in real terms that we will make in every year of this Parliament will mean a £12.5 billion increase in funding for the health service over the lifetime of this Parliament.

The report from the Office for Budgetary Responsibility emphasises the importance of constantly increasing productivity within the NHS and other public services. As the hon. Gentleman knows, in every year of the last Government there was a fall of between 0.2% and 0.4% in productivity in the NHS, which is unacceptable, and ultimately would become unsustainable because we need to generate growth and productivity to drive improvements in patient care, outcomes and the overall performance of the NHS in providing patient care.

As the hon. Gentleman and the hon. Member for Southport said, we embraced and accepted the quality, innovation, productivity and prevention agenda challenge set out by the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), which involved savings of £20 billion over three years originally, but we have extended it to four years. By cutting out inefficiencies, and enhancing and improving best practice that can be shared within the NHS, we can make savings that can be ploughed back into patient care.

The extra £12.5 billion to finance the increase in the health service over the next few years will not alone be enough to meet the rising demand for health care and its increasing costs. We need to find savings of up to £20 billion during the lifetime of this Parliament that we can reinvest, and that is the crucial challenge facing the national health service. I am confident that it will meet that challenge over the next three to four years.

The overall strategic health authority and primary care trust surplus of £1.375 billion during the last financial year will act as a sound financial platform for the NHS. Every penny of that surplus should be used to help to improve health outcomes for patients, and to meet the challenges and demands as we move to the new, modernised NHS, subject to approval in this House and another place. The challenge for every NHS organisation is to improve the quality of care that it offers while ensuring that money spent on care is spent effectively and efficiently, because that is what matters to patients and to the public.

The hon. Member for Southport referred to the crucial move to community-based services, which is already happening, and will continue to happen where it is clinically appropriate. The hon. Gentleman spoke about the impact on hospitals of reducing hospital-based activities and delivering more services in the community. That is a crucial area, and a valid issue to raise. As I said, where it is clinically appropriately and when it can lead to demonstrable improvements in patient outcomes, more services should be provided in the community—for example, in GP practices or even in the home. All of us as constituency MPs and those of us with a particular interest in the NHS and health care know of examples and more and more practices where home and community settings are being used to meet the demands and needs of local populations, because the vast majority of people in this country would prefer, when it is clinically appropriate and feasible, to be treated in the community in their own homes instead of having to go to a perhaps inappropriate hospital setting for treatment. The QIPP long-term conditions workstream seeks to ensure that patients can be cared for effectively in their home or community, avoiding unplanned, unnecessary and expensive admissions. That is better for the patient, better for the NHS and better for taxpayers. It is also an opportunity for hospitals.

Increasingly, the best hospitals think of themselves no longer as just a physical place of bricks and mortar, but as providers of excellent health care. For example, Croydon Health Services NHS Trust provides both hospital and community services through a number of community and specialist clinics throughout the area. It is effectively becoming a health care trust instead of simply a hospital trust. That is the way for the future.

A considerable amount of the debate was spent on reconfiguration, and I would like briefly to address that. As society and medicine change, so must the NHS. The hon. Gentlemen said that tough decisions will have to be taken, and that people will have to be brave, honest and realistic in addressing the issues. I totally agree.

The NHS has always been responsive, whether to patients’ expectations or improving technologies. As lifestyles, society and medicine continue to change and evolve, the NHS must also change to meet those challenges. As technology and clinical practice get better and better, some services that were previously provided only in acute hospitals can now be safely provided in other places. A local health centre, a GP surgery or even the patient’s own home may, when appropriate, be the setting for health care and treatment that were previously not possible or feasible in such places. That shows how our health care is constantly evolving and improving.

[Owen Smith]

I hope the Minister will forgive me as I have asked this sort of question many times. Does he feel that in the world envisaged by the Health and Social Care Bill, where there is more competition between different providers in local health economies, it will be more difficult rather than easier for the sort of integration he speaks of to come about?

[Mr Burns]

In the light of the hon. Gentleman’s question, I will preface my reply by the words, “If he will forgive me.” We have had these conversations frequently—to be polite—during the course of the 42 sittings of the Health and Social Care Bill, and I fundamentally disagree with him. As we modernise the NHS, we are seeking through the Bill to put the patient at the centre of their experience, so that they are totally involved in their treatment and needs, are talked with rather than talked to, and can be part of the decision-making processes by which we are driving up the quality of patient care and improving outcomes. We will ensure those things through a comprehensive national health service, greater integration and far greater collaboration.

[Owen Smith]

rose—

[Mr Burns]

There is no point in my giving way to the hon. Gentleman; I have only 10 minutes left and whatever I say he will not accept publicly because it runs contrary to the mantra that he and his hon. Friends constantly spout as they seek to undermine the procedures that will ensure a first-class national health service to meet the demands of our citizens.

Returning to my original point, at the same time as one will see different settings for appropriate care, other services that need highly specialist care will be centralised at larger, regional centres of excellence where there is clear evidence of improved health outcomes. Reconfiguration is about modernising treatment and improving facilities to ensure that patients get the best treatment as close to home as possible, thereby both saving and improving lives. That is an essential part of a modernised NHS, but it should not be enforced from above.

There will be no more impositions of the kind that saw a GP-led health centre in every PCT, whether it was wanted or not. Instead, the reconfiguration of services will be locally driven, clinically led and will have public support. It will be change from the bottom up, not the top down. The reconfiguration of services should—and will—be a matter for the local NHS. There is no national blueprint for how health care should be organised locally, and services need to be tailored to meet the specific needs of the local population. Effective local engagement will ensure that services continually improve, based on feedback from local communities. In an NHS that is built around the patient, changes to services must begin and end with what patients and local communities need. Last May, my right hon. Friend the Secretary of State introduced four tests, and current and future reconfigurations must be along the lines of the four basic premises in those tests. Local plans must demonstrate: support from local GPs; strengthened public and patient engagement; a clear clinical evidence base; and support for patient choice. The tests make sure that any changes to health services will be true to the spirit of “No decision about me, without me.”

The hon. Member for Southport also raised the important issue of the private finance initiative. We have seen evidence from around the country of significant problems in a number of hospitals as a result of decisions taken by the previous Government to approve what were sometimes extremely expensive PFI schemes that became a drain on a trust’s annual income. As the Government confirmed at the end of last year, where PFI schemes can clearly be shown to represent good value for money, we remain committed to public-private partnerships, including those delivered by PFI, and they will play an important role in delivering future NHS infrastructure. We also believe, however, that there have been too many PFI schemes, and that some were too ambitious in scope. In addition, we have also had serious concerns about the value for money of some PFI contracts signed in the past.

The Treasury has reviewed value for money guidance for new schemes, and looked at how operational schemes can be run more efficiently. In January, the Treasury published new draft guidance, “Making savings in operational PFI contracts”, which will help Departments and local authorities to identify opportunities to reduce the cost of operational PFI contracts. As part of that savings initiative, my noble Friend Lord Sassoon, Commercial Secretary to the Treasury, launched four pilot projects to test the ideas in the Treasury’s draft guidance. One of those pilots was a hospital PFI scheme at Queen’s Hospital in Romford. The focus of the Romford pilot was to find efficiency gains and savings within the PFI contract, allowing the quality of care for patients to remain the top priority. Earlier today, Lord Sassoon announced the results of three of the four pilots, including that at Romford hospital. The Romford pilot showed that savings of 5% could be made to the revenue cost of the PFI scheme.

I welcome the Treasury’s findings, but we have yet to consider them in detail. I understand that the Treasury has now placed updated value for money guidance on its website. I hope that that will help trusts with operational PFI schemes, and trusts that are planning PFI schemes, to make significant savings. Every penny of those savings will be retained by the trust to be reinvested in improving patient care.

[Owen Smith]

rose—

[Mr Burns]

I will briefly give way for the last time.

[Owen Smith]

I have a basic factual question for the Minister. Will the results of that survey lead to an attempt to reopen or renegotiate any of those contracts?

[Mr Burns]

As I said to the hon. Gentleman a few moments ago, the pilot schemes and investigation published by my noble Friend Lord Sassoon show that there is potential within existing PFI schemes to make some savings—I cited the figure of up to 5%. We are going to study that report. It was published earlier today and we need time to look at it and see how those savings can be realised within the context of the existing PFI scheme, rather than by reopening it and starting again.

In conclusion, there are many challenges to the NHS, but those concerning finances will be assisted and helped by our commitment to a real-terms increase in funding. The hon. Member for Southport said that the reconfiguration programme must be driven by local demand and needs, and I agree with him. He raised the issue of access to facilities being part of those considerations, and it may console him that I am able to assure him that access will form part of any consideration. Local people will determine where their local services should be placed and, together with a number of other factors, the issue of access should be considered. Such decisions must be determined by what the local community needs and what meets its requirements in the provision of health care. In many ways, such decisions will be determined with the same checks and balances, and with the involvement under a modernised NHS of health and wellbeing boards, and in certain circumstances, the national commissioning board. Overview and scrutiny committees will have the opportunity to refer plans to the Secretary of State.

As the NHS is modernised, the changes outlined by the Secretary of State will begin to take effect and give clinicians and the local NHS greater control over decision-making processes, rather than having politicians micro-managing on a day-to-day basis from Richmond House. That will provide a future for the NHS that can meet the requirements of enhancing and improving patient care and, most importantly, improving outcomes for patients.

Care Quality Commission Registration

Simon Burns Excerpts

Monday 18th July 2011 Written Statements

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

I wish to inform the House that the Department is today publishing a consultation on proposed changes to the Care Quality Commission (Registration) Regulations 2009 and The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The proposals include changes that will improve the effectiveness of current regulatory arrangements for health and social care and reduce the burden on providers (including the providers of health care at the Olympic games).

The Government are committed to keeping regulatory systems under review and to ensuring that regulatory burdens are kept to a minimum, while ensuring that the systems are effective at protecting service users. In line with commitments given to the House, officials have carried out an initial review of the operation of the regulations governing the new registration system for health and adult social care providers operated by the Care Quality Commission. The first year of operating the system has highlighted a number of issues in the regulations that either do not function as initially intended, lack clarity or which impose an unjustified burden on providers. This consultation document sets out the issues identified, proposes how they might be addressed and seeks views on these. It also asks respondents to identify other issues that should be considered as part of a wider review to begin later this year. The proposals include changes to both the regulation of health care and adult social care services that, subject to consultation responses and the parliamentary process, could be made swiftly and that we plan to start to implement in 2012.

By keeping the regulations governing the registration system under constant review, we will ensure that legislative framework keeps pace with service developments, focuses regulatory requirements where they are most effective, and delivers a system that allows the Care Quality Commission to provide the assurance that services meet the safety and quality requirements that people who use services and their families expect.

“Consultation on proposed changes to regulations for Care Quality Commission registration” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Oral Answers to Questions

Simon Burns Excerpts

Tuesday 12th July 2011 Commons Chamber

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

We are not aware of any GP practices that offer services on a 24-hour basis.

[Simon Hughes]

Will the Minister confirm that the Government would have no objection, and would not put any barrier in the way, if Guy’s and St Thomas’ NHS Foundation Trust and the local Southwark services wished to set up a 24-hour service at Guy’s hospital, with the collaboration of the local community?

[Mr Burns]

As the right hon. Gentleman will know, the local NHS has responsibility for commissioning local primary care services, and in doing so it must take into account the results of the local population and their needs. If he is working with the hospitals and organisations that he has mentioned and he has some constructive ideas that they are going to consider, I too would be personally interested to hear from him about how they envisage doing things.

[Mr Ben Bradshaw (Exeter) (Lab)]

What has happened to the Labour Government’s guarantee that everybody should be entitled to see their GP within 24 hours, and also be able to book an appointment more than 48 hours ahead? Will the Minister publish a full performance table for GPs, so that the public can make an informed choice?

[Mr Burns]

As the right hon. Gentleman will know, the access measures concerning people being able to see their GP within a reasonable period of time are set out in the quality and outcomes framework. The evidence that I have seen certainly shows that our approach is generally working very well, although there are variations in different parts of the country, especially London, where I believe there is scope for improvement.

[Valerie Vaz (Walsall South) (Lab)]

5. What discussions he has had with the Chancellor of the Exchequer on the cost to the public purse of NHS reorganisation arising from the proposed changes to the Health and Social Care Bill.

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

The Treasury had sight of the impact assessment published alongside the Health and Social Care Bill, which estimated savings of about £5 billion by 2014-15, and £1.7 billion a year thereafter. A revised impact assessment will be published as the Bill progresses.

[Valerie Vaz]

I thank the Minister for his helpful answer. Given that there are to be new structures—the NHS commissioning board, the clinical senates, the local commissioning groups and Public Health England—will there be new money for them, or will the money come out of the allocated budget?

[Mr Burns]

I thank the hon. Lady for her helpful question. As she will appreciate, the money will come out of the existing allocations, but what she needs to understand is that as a result of this, and as a result of improving and cutting out wasteful inefficiencies and bureaucracy, we will actually be saving significant sums. Administration will be cut by a third, so that we can invest all the savings in front-line services.

[Gavin Williamson (South Staffordshire) (Con)]

Does my right hon. Friend agree that although there is a cost in making these changes, it will have been paid back within two years, and that £5 billion a year will be available to be invested in front-line services and making sure that people in South Staffordshire get the best possible from their health service?

[Mr Burns]

My hon. Friend makes an extremely important point, because not only are his figures correct, but thereafter until the end of the decade there will be savings of £1.7 billion a year, on current projections. Every single penny of that will be reinvested in front-line services for patients.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The Minister continues to insist that his reorganisation will result in savings that will be reinvested in patient care. Yet even before we have the impact assessment for the changes in the legislation, we know, as will Members across this House, that on a daily basis people are leaving primary care trusts with their redundancy money. That totals £800 million and upwards, and it has not been costed. We also know that the Royal College of General Practitioners has said that we will have gone from having 163 statutory organisations to having 521. Are not the costs of this misconceived car crash of a reorganisation spiralling out of control?

[Mr Burns]

The reality is that the hon. Lady does not understand, or will not accept, the figures published in the impact assessment. What she does not like is the fact that by the end of this Parliament there will be savings of about £5 billion, and thereafter of £1.7 billion until the end of the decade. That will all be reinvested in front-line services. The hon. Lady will not accept, and wishes to misrepresent to members of the public, the resulting benefits in improved and enhanced patient care.

[Mark Lancaster (Milton Keynes North) (Con)]

6. What steps he has taken to increase access to NHS dentistry since May 2010.

--- Later in debate ---

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

10. What steps his Department is taking to provide funding for healthcare infrastructure projects.

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

The Department’s capital budget for this spending review period will be higher in real terms than spending in 2010-11. Forecast capital spending in 2010-11 is £4.2 billion and the amount available in 2011-12 is £4.4 billion. By 2014-15, the total amount of capital made available since the start of the Parliament will be £22.1 billion.

[Dr Poulter]

Is the Minister as concerned as I am about the failure of Suffolk primary care trust to act to invest in proper buildings and infrastructure for the Gipping valley practice in Claydon in my constituency? That practice has been forced to treat patients out of a portakabin for 15 years now. Will he agree to meet me, and local doctors and patient groups, to see whether we can find a solution to the problem?

[Mr Burns]

I fully appreciate my hon. Friend’s concerns. As he will appreciate, the matter is primarily for the local NHS. If it is any consolation to him, I am advised that Suffolk PCT will continue to work with the GP practice on the issues, but I would be more than happy to see my hon. Friend to discuss the matter further.

--- Later in debate ---

[Alun Cairns (Vale of Glamorgan) (Con)]

13. What progress he has made in reducing the use of mixed-sex accommodation in the NHS.

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

In just six months, the number of reported breaches of mixed-sex accommodation guidance has fallen by 83%, from 11,802 in December 2010 to 2,011 in May 2011. Across England, the reported breach rate is now 1.4 per 1,000 finished consultant episodes, compared to 8.4 per 1,000 FCEs in December 2010.

[Alun Cairns]

A 93-year-old female patient from my constituency was placed in a cardiac ward opposite a mental health patient who also needed cardiac treatment. This male patient was much younger and was left in a near-naked state for much of the day. That caused so much distress to my constituent that she discharged herself early. What effort and focus can the Minister give to the NHS in Wales to ensure that such breaches and mixed-sex wards are ended?

[Mr Burns]

I am saddened to hear my hon. Friend’s account of what happened in a hospital in, I assume, his constituency. I can appreciate how distressing it is. As he will understand, that comes within the responsibility of the Welsh Administration as a devolved power. My advice to my hon. Friend is two things. I hope the Welsh Assembly will, first, follow the example of my right hon. Friend the Secretary of State and concentrate on reducing mixed-sex accommodation, and secondly, stop cutting funding for the health service so that it can afford to do that.

[Mr Mark Spencer (Sherwood) (Con)]

Can the Minister explain briefly how he has managed to make such rapid progress in 12 months, given that the previous Administration made no progress whatsoever?

[Mr Burns]

My hon. Friend has hit on an important issue. The answer is clarity of purpose and vision on the part of my right hon. Friend the Secretary of State not only to talk the talk, but to walk the walk and achieve dignity for patients in the NHS in England.

[Mr David Burrowes (Enfield, Southgate) (Con)]

14. What progress he has made in reducing rates of hospital-acquired infections.

--- Later in debate ---

[Nic Dakin (Scunthorpe) (Lab)]

16. What progress has been made on the review of children’s congenital heart services.

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

The consultation on the future of children’s congenital services ended on 1 July. The joint committee of primary care trusts, which is overseeing the consultation, is expected to make a decision later this year, based on an independent analysis of the consultation, reports from overview and scrutiny committees, and a health impact assessment.

[Nic Dakin]

I thank the Minister for his reply and his thoughtful response to the Back-Bench debate that took place in the Chamber. Will he ensure that if any further reconfiguration options have emerged from the consultation, they are properly considered and go out to further consultation before a decision is made?

[Mr Burns]

Yes, I can give the hon. Gentleman a categorical assurance on that.

[Greg Mulholland (Leeds North West) (LD)]

Further to the previous question, if there are further options in addition to the four already presented, I ask that the Government do not rule out looking at the matter again if it is shown that it is possible for Leeds and Newcastle to serve the north of England.

[Mr Burns]

As the hon. Gentleman will appreciate, I do not want to be drawn into that too far because this is an independent assessment by the joint committee of primary care trusts and I do not want to be seen to be interfering, but I can say that neither we nor the JCPCT have ever said categorically exactly how many centres there should be. It will be up to the JCPCT, as it considers the representations it receives, to decide how many there should be. If it decides to have more than four, it would not need the processes that he is suggesting because it has the power within its remit to increase the number if it thinks circumstances warrant it.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

18. What steps he is taking to improve cancer care for older people.

--- Later in debate ---

[Claire Perry (Devizes) (Con)]

T2. Under the previous Government, Savernake hospital in my constituency was redeveloped. As a result, taxpayers have got stuck with nearly £1 million a year in private finance initiative unitary charges and local services offered have been cut drastically. Will the Minister undertake to look at all hospitals labouring under uneconomic PFI burdens and meet me to discuss the Savernake hospital situation specifically?

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

I am grateful to my hon. Friend, because she has been campaigning on this issue for more than a year, and rightly so. Work is being done on the whole issue of PFI and the NHS to ensure value for money. Given her concerns, I would be more than happy to meet to discuss this particular case.

[John Healey (Wentworth and Dearne) (Lab)]

I want to say to the Health Secretary directly that it is a disgrace how he and his Ministers have ducked responsibility for reassuring more than 30,000 elderly and vulnerable residents whose homes may be at risk because of the financial crisis at Southern Cross. Today’s urgent question is the second time in a month that this House has had to drag Ministers to Parliament to explain what is going on. Southern Cross is set to close down completely by October. Will the Secretary of State give a commitment this afternoon to the residents of Southern Cross, their families and 40,000 staff that Ministers will in future show leadership and make public statements to this House?

--- Later in debate ---

[Mr Speaker]

Order. We must have short questions and short answers.

[Mr Simon Burns]

I appreciate that question, because I understand how important the issue is to the hon. Gentleman. We have had considerable discussions on this matter, which is currently being further discussed by the Department of Health and the Treasury. We hope to reach some decisions shortly, and he will be one of the first to know.

[Dr Julian Lewis (New Forest East) (Con)]

How can a consultation process on children’s heart units that includes the best unit in the country outside London, at Southampton general hospital, in only one out of four options and disregards the population of the Isle of Wight completely be anything other than fundamentally flawed?

[Mr Burns]

As my hon. Friend will know from the debate that we had in the House a few weeks ago, it would be inappropriate for me to comment, because I must in no way be seen to be prejudging the issue. The inquiry and consultation is independent. However, I can say to him that the inquiry is not fixed on determining only four sites if the results of its consultation suggest that there should be more. The decision rests with the inquiry.

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

The Secretary of State will be aware that there has been a tripling of prescriptions for drugs such as Ritalin, or to give it its generic name methylphenidate hydrochloride, in the past decade. He will also know that National Institute for Health and Clinical Excellence guidelines state that those drugs should not be prescribed to children under the age of six. Why cannot his Department give a breakdown showing how many of those prescriptions are going to children under the age of six? Will he heed the call from the Association of Educational Psychologists for a review of the growth of the prescription of those powerful psycho-stimulants to very young children?

Infant Mortality: Research

Simon Burns Excerpts

Wednesday 6th July 2011 Ministerial Corrections

The full answer given was as follows:

[Mr Simon Burns]

The Department funds research through both the National Institute for Health Research (NIHR) and the Policy Research Programme (PRP).

Estimated spend by the NIHR and PRP relating to maternal and foetal health is as follows.

[Mr Simon Burns]

The Department funds research through both the National Institute for Health Research (NIHR) and the Policy Research Programme (PRP).

Estimated spend by the NIHR and PRP relating to maternal and foetal health is as follows.