High Speed Rail (London - West Midlands) Bill (Fifth sitting)
Debate between Simon Burns and David Anderson(8 years, 9 months ago)
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Sir Simon Burns
The hon. Gentleman nods his head in a negative way, but he is wrong. The investment of £38 billion in CP5 is not 100% taxpayers’ money. As I said, part of it is rent accrued from the rail operators, which pay to use the track.
Since privatisation, there has been a will and determination to invest, as well as the actual delivery of investment, to bring our railways up to scratch. The process is time-consuming, sadly, because of the problems arising from the earlier lack of investment. The other sad thing for rail users is that a lot of the investment that is badly needed to improve journey times and the reliability of the service is not seen immediately by them. New rolling stock is immediately seen by commuters and travellers, obviously, and they benefit from it, but when we improve and upgrade the track or the overhead cables on that part of the railway that is being electrified, users do not see the outcome of the investment in the same way. However, such investment is still critical to improving the performance of our railways. I am confident that that will continue.
The hon. Member for Middlesbrough mentioned the east coast main line. I would be the first to accept that it was a well-run part of the network, but it was run under Directly Operated Railways because the last Labour Government rightly withdrew the franchise from the franchisee because there was dissatisfaction with the way it was operating the line. DOR is an emergency mechanism that was introduced in the legislation on privatising the railways because there is a legal requirement for the railways to provide a service all the time. To avoid a hiatus if there is a problem with the franchise, DOR will, for a fixed period of time only, step in to ensure continuity of service.
The hon. Gentleman kept talking about a state-run service. I suppose that DOR could, by definition, be called state-run, but it was not meant to run the line for ever. Even the Labour Transport Secretary who took the action made it plain at the time that there was not going to be a never-ending provision of service by DOR.
Mr David Anderson (Blaydon) (Lab)
I accept what the right hon. Gentleman says about the background, but DOR ran the line successfully. The Labour party recognises that and has learned from that experience. We now say that it is something that should be used in the future, which is why we opposed the refranchising last year.
Sir Simon Burns
I am sadly well aware of the Labour party’s proposals for that provider to continue to provide the service. Frankly, I have every confidence that the conglomerate, which includes Virgin, that has taken it over will provide a first-class service. Based on passenger satisfaction, Virgin does so on the west coast main line. I am sure that the hon. Gentleman remembers the fiasco of the refranchising of the west coast main line in the summer and early autumn of 2012. The passengers—for want of a better expression, it was people power—were amazed that Virgin’s franchise was not renewed. Ultimately, because of the problems that emerged, Virgin continued to run it, and I have every confidence that it will run a first-class service on the east coast main line.
Let me give the Committee an example of the way that franchisers can innovate to respond to the needs of local people. I am sure Committee members are aware—if they are not, the Minister will be more than aware—that there has never been a direct service between Scarborough and London in the lifetime of the railways. Why should Scarborough, where there is a demand for such a service, be so deprived? Virgin is responding to the marketplace and the wishes of customers, and from 2018 it will run a direct service from Scarborough to London. That is how franchisers can respond to changing circumstances and demands.
Similarly, Opposition Members will be aware that High Speed 1 is currently run by a private company. The hon. Member for Middlesbrough looks perplexed and is consulting his colleagues, but I chose my words very carefully: High Speed 1 is currently operated by a private operator. I see no reason why it should be returned to the public sector. I fundamentally do not believe that politicians and Governments are best equipped to run services and industries such as the railways. Our experience of their doing so was poor. Notwithstanding the problems and the need to improve our infrastructure, on balance, investment has been provided and work is being carried out to improve our rail services to make them into a first-class service in the private sector. I believe that that is where they should remain.
It would be a mistake if High Speed 2 were to be shackled before the first train had run on the tracks by being run, in effect, by the Government as a nationalised industry. If there is a Division on this contentious issue, I urge my colleagues to reject this opportunistic new clause. It is very much in keeping with the new politics of the Corbynista regime which, as in many other areas, is totally divorced from the best interests of the British people.
Mr Anderson
It is a great pleasure to be here, Mr Chope. I hope to see you at the weekend in the Orkney islands, with any luck. I would like to clarify a few points raised by the right hon. Member for Chelmsford. For the record, he praised Virgin’s role on west coast. Virgin is the brand name of the east coast main line at the moment, but Virgin has only 10% of the franchise. The other 90% is owned by Stagecoach, which they are trying to keep a very closely held secret because of Stagecoach’s horrendous record when it comes to transport in this country.
The right hon. Gentleman said that British Rail in various guises had failed. Nobody doubts that. No one on the Opposition Benches is saying that it was a success, but what has to be understood is that of the 46 years that it was in public ownership, 32 of those years were under a Tory Government. One of the main reasons why the trains were never improved was that we as a nation inherited very poor quality stock and a poor system of stations, and the truth is that Governments chose to dip in and dip out of supporting the railways, as the right hon. Gentleman rightly said. He is right that they were not run very well. However, I would argue that whatever the successes or failures of the past 20 years of privatisation have been, people have learned lessons. The east coast main line is an example of how people took some of the good of what they had learned from privatisation and put it into service on the east coast, which became the best service in the whole of Britain.
The right hon. Gentleman misquoted when he said that neither Blair nor Brown supported reprivatisation. What he meant was that they did not support renationalisation, and that is actually correct. They were opposed to going backwards, quite apart from the fact that they thought it would be a diversion of money that could be spent elsewhere on putting right a lot of things that failed under 18 years of Tory government. They chose not to do it, and they did not want to do it. The truth about Railtrack is that the Government were forced to do it, and I will tell the Committee why. On 19 September 1997 the Southall rail crash took place. A friend of mine was in that crash. He was given the last rites twice, but thankfully he survived. On 5 October 1999 the Paddington rail crash occurred. Another friend of mine was involved and, sadly, he was one of 31 people who died. On 17 September 2000 the Hatfield rail crash took place, and on 10 May 2002 the Potters Bar rail crash occurred. A common theme through all of them was the failure of Railtrack to maintain the tracks properly.
I work with people who worked with me in the coal mines in the ’70 and ’80s. They went on to be contractors and subcontractors repairing rails. They told me some nightmare stories of the work they were involved in. We used to have railways underground. I was a mechanic looking after trains underground, so I have some experience of how to look after railways properly. Some of the things they were telling me were nightmares. There used to be a standard in this country that every length of rail had to be changed once every 40 years, regardless of its condition. That was the maximum length of time a rail could be left in place. One thing which happened almost immediately after privatisation was that that was changed to rails being replaced once every 80 years. That was the mental attitude of the people to whom we gave away our railway system, and who we allowed to run our trains. Is it any wonder that things went wrong? Railtrack had to be brought back into public ownership to protect the travelling public from the shortcomings that were clearly occurring.
The east coast franchise went first to GNER, which ran it for some time. It was a reasonable service, but its parent company, Sea Containers, was going belly-up. Overnight, GNER pulled out of the franchise. Who had to come in? The Government had to step in. As the right hon. Gentleman said, it was right and proper to pick up the pieces and keep it running. They kept it running and it was franchised out again to National Express, but the National Express experience was appalling. They ran the trains the same way as they ran the buses. The hygiene, punctuality—every part went backwards, and again the public sector had to walk in. When National Express walked away—they were not thrown out; they walked away because they were failing—Directly Operated Railways became the most successful train line in the country.
Railways
Debate between Simon Burns and David Anderson(11 years, 8 months ago)
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Mr Burns
It is fascinating to hear that from one of Lord Adonis’s colleagues. I suspect that the hon. Gentleman—there seems to be a problem with Luton today—meant that in a derogatory way, but I thought that Lord Adonis was not a Tory, but the last Labour Secretary of State for Transport. I also thought that he was working with the present leader of the Labour party on formulating Labour’s policies.
Mr Burns
No, I am going to make progress—[Interruption.] I do not want to be disrespectful to the hon. Gentleman, but I have listened to many of his interventions and it is not often that they can be put in the category of making progress—they usually hark back to an era that most of us do not remember.
Mr Burns
I will make progress in my way, not the hon. Gentleman’s.
The subject of franchising has aroused considerable interest among Labour Members, so let me briefly set out something that I have said before. Since privatisation, rail numbers have doubled and passenger satisfaction is at an all-time high. Recent European research has shown that the countries with the greatest growth in rail travel are those with the most liberalised markets.
As with the proposals I have already discussed, we will need to ensure that we continue to engage on the detail, including by ensuring that any changes to public passenger transport services regulation are compatible with the specific needs of our network and give us the flexibility to deliver a sustainable franchise programme. I know that the Transport Committee’s report is concerned that our arrangements for letting train franchises should not be challenged, and I assure hon. Members that the Government share that view and are looking closely at the issue.
On transport plans, we are concerned that the requirements are over-prescriptive and will therefore impose a significant regulatory burden.
In relation to the channel tunnel, the focus of the Commission’s proposal is on achieving effective competition and further market opening for domestic passenger services, thereby increasing the quantity and improving the quality of passenger services. It is still too early to assess whether this will lead to more cross-border rail services through the channel tunnel.
I will summarise our initial findings on the impacts of the package on the UK. The package may present significant market opportunities for UK firms wishing to expand their operations into the EU. However, the benefits for domestic rail transport are less obvious. We cannot see how a substantial proportion of the additional demand and cost savings identified by the European Commission in its impact assessment will translate to the domestic rail sector in the UK. This is because significant parts of the Commission proposal, including the competitive tendering aspects of the package, are already in place, and because in the UK we already have the benefits of vertical separation which avoids discrimination.
I remain concerned about the Commission moving powers from national safety authorities to the European Railway Agency. The Government will need to be convinced that these powers are necessary, given the high level of co-operation already achieved between national safety authorities. We also do not want anything that interferes with the current UK rail structure or adds bureaucracy and costs, or any proposals that are not compatible with our plans for rail reform.
Rare Disease Strategy
Debate between Simon Burns and David Anderson(12 years, 7 months ago)
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The Minister of State, Department of Health (Mr Simon Burns)
May I begin by congratulating my hon. Friend the Member for Crewe and Nantwich (Mr Timpson) on securing this debate on what is a most important topic for a great number of people, and on the sensitive way in which he outlined his concerns, particularly those that affect his family? May I also congratulate him on running the London marathon an hour and a half quicker than the shadow Chancellor?
As we have heard, anybody, at any stage in life, can be affected by a rare disease, which can range from manageable conditions that do not affect daily living to debilitating conditions that have a significant impact on one’s quality and length of life. The Government are committed to providing the best quality of care to people with rare conditions, and the importance that we attach to services for people with rare conditions is clearly demonstrated in the reforms we set out in the Health and Social Care Act 2012. Through the Act, specialised services, which are currently provided at both national and regional level through a range of NHS organisations, will be brought together under one roof. From April 2013, the new NHS Commissioning Board will directly commission services for people with rare diseases on a national basis.
My hon. Friend asks for an explanation of how the NHS Commissioning Board will operate to ensure cluster-type service delivery in respect of rare diseases. Moving to a national standard system of commissioning but maintaining a regional focus gives the geographical and speciality oversight that he describes. National specifications will lead to services being defined once for England, allowing clear planning to take place across the country.
Mr David Anderson (Blaydon) (Lab)
I congratulate the hon. Member for Crewe and Nantwich (Mr Timpson) on a fine speech. As the chair of the all-party parliamentary group on muscular dystrophy, may I ask the Minister about two connected points in respect of what he has just said? There has been a great development within neuro-muscular services and work by the House and the Department. Will the Minister meet the all-party group and the muscular dystrophy campaign to discuss the progress of the national neuro-muscular work plan? Will he also give us an assurance on the positive advantages in the south-west region—he mentioned regional development—and confirm whether there will be strategic clinical networks for neuro-muscular services across the country?
Mr Burns
I am grateful to the hon. Gentleman. I recognise the tremendous work he does in this area of health care and congratulate him on his efforts. With regard to a meeting, I will pass on his comments to my noble Friend the Earl Howe, who has responsibility for this area of health care. On the hon. Gentleman’s second point, I am more than happy to give him the assurances he seeks.
The proposed operating model for specialised commissioning links national service knowledge and expertise with local contract knowledge of providers and pathways of care, cementing the new system together in the interests of patients. The benefits to patients with rare conditions are clear: a single national commissioning policy and better planning and co-ordination will result in improved consistency across the country.
My hon. Friend asked me to set out the Government’s thinking on the suggestion from the former chief medical officer for a national clinical director for rare diseases. I can assure him that there will be a director within the NHS Commissioning Board with lead responsibility for specialised services for people with rare conditions. The board will also consider the most suitable form of clinical advice covering the domains of the NHS outcomes framework. Rare diseases come under domain 2: long-term conditions.
Our commitment to people with rare conditions is demonstrated through our recently published, “A UK Plan for Rare Diseases”. The consultation was launched on 29 February—Rare Disease day—and was produced jointly by the four nations of the United Kingdom. The consultation will continue until 25 May and is an important step on the way to producing the final plan. I urge everyone with an interest in this area of health care to contribute to the consultation process.
This will be the first time that the UK has developed a plan to tackle rare diseases, and the consultation represents collaboration across the four nations of the UK. It brings together a number of recommendations designed to improve the co-ordination of care and to lead to better outcomes for people with rare diseases. We suggest that improvements can be made through earlier diagnosis, better co-ordination of services, stronger research and better engagement with patients and their families. Many of these recommendations will be of direct benefit to patients and can help the NHS to be more efficient and co-ordinated and to save money.
Earlier diagnosis through clear care pathways to expert centres can prevent disability, and in some cases save lives, by allowing an earlier start for effective treatment. It will also save money by avoiding more intensive or emergency treatment. More co-ordinated care saves patients’ time, money and stress by avoiding multiple visits to various clinics. As many rare diseases are of genetic origin, we must also embrace advances in genetics and genomic medicine and ensure that the NHS is ready to support and take full advantage of these developments.
My hon. Friend has already mentioned that people with rare diseases need to be able to access orphan medicines. Our priority is to give NHS patients better access to the innovative and effective drugs that their doctors recommend for them, including those designated as “orphan drugs”. The new system of value-based pricing will bring the price the NHS pays for drugs more in line with the value it delivers. Notwithstanding this, we know that there may be instances where an individual medicine should not be assessed under value-based pricing. We will keep the situation under review. If, as we begin to implement value-based pricing, it becomes clear that some treatments would be better dealt with through separate arrangements, we will explore alternative options.
The consultation document sets out a coherent approach to tackling rare diseases. It recognises existing developments while setting out a number of further developments, such as on better information for patients to help them manage their condition. My hon. Friend asked for reassurance that we are putting steps in place in preparation for the introduction of the international classification of diseases—ICD-11. I can assure him that the NHS is moving towards widespread use of systematized nomenclature of medicine clinical terms—Snomed CT—in preparation for the introduction of ICD-11.
The consultation will inform the final UK plan for rare diseases. We hope that the final plan will offer a framework for managing rare diseases wherever they occur. Each nation of the UK will then take forward implementation of the plan in accordance with its own priorities and patterns of service. In England, much of the implementation of the final plan will be for the new NHS Commissioning Board to take forward, in close dialogue with Public Health England.
As my hon. Friend will appreciate from my comments in this relatively short but important debate, he has raised an extremely important issue that all too often is forgotten in the mainstream of the NHS, where people concentrate on more acute services, rather than this highly specialised area. My hon. Friend the Member for Stourbridge (Margot James) mentioned a particular illness or condition. May assure her that following her intervention, I will ask my noble Friend the Earl Howe to write to her about the issue she raised?
In conclusion, the development of the first ever UK plan is an important signal of our continuing commitment to providing good quality services to people with rare conditions. The consultation is aimed at a wide audience, including not just clinicians and NHS specialised commissioners, but patients, their carers and families, support groups, specialist organisations, researchers, academics and colleagues from across social care. I call on all hon. Members to encourage their constituents with an interest in rare diseases to take part in this important consultation.
Question put and agreed to.
NHS (Public Satisfaction)
Debate between Simon Burns and David Anderson(13 years, 8 months ago)
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The Minister of State, Department of Health (Mr Simon Burns)
As others have said today, Mr Bayley, it is a pleasure to serve under your chairmanship.
We have had an interesting debate. Some speeches were a continuation of what has been said in the Health and Social Care Bill Committee, and they bordered on fantasy. Other speeches were extremely informative. The speech of my hon. Friend the Member for Banbury (Tony Baldry) was in the latter category, and my hon. Friend the Member for Southport (John Pugh) made a reflective and interesting speech. I listened with extreme interest, as I always do, to the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke), who made a typically thoughtful speech about an area of health and social care on which he is an acknowledged expert. I listened to the hon. Member for Easington (Grahame M. Morris), as I often do these days, and to the hon. Members for Birmingham, Erdington (Jack Dromey) and for Blaydon (Mr Anderson). It was rather like a curate’s egg—parts of it, depending on which hon. Member was speaking, were all right, and other parts slightly broached on to fantasy island.
I congratulate the hon. Member for Leyton and Wanstead (John Cryer) on securing this important debate. He may be surprised to hear that I am in considerable agreement with him on certain areas. I wish to clear up a number of his questions about the surveys. In an intervention on the hon. Gentleman, I alluded to the Ipsos MORI survey. There is something slightly ironic about claiming that we refused to publish it because of its content, given that the previous Government failed to publish similar surveys in 2007, 2008, 2009 and 2010. To say that they did not publish it because the Opposition did not table parliamentary questions asking for it to be published shows breathtaking gall.
The fact is that we published the March 2010 survey following a written answer in December from the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), who is responsible for social care. It was placed in the Library, but it was not placed on the Department of Health website, for which I offer an apology. Some Members referred to the comments of my right hon. Friend the Secretary of State. Those statements were made in good faith but he was given the wrong advice. That is unfortunate, but he made that statement some three months after the results of the survey had been published.
The hon. Member for Leyton and Wanstead asked whether we will continue with the survey. I can tell him that a further survey has been done. It has not been completed, in so far as it has not yet been given to the Department, but that will happen in due course. What happens in future remains to be seen, as no decision has been taken on future exercises. The hon. Gentleman also mentioned the general life-style survey. Again, no decision has been taken. In light of that information, it is incorrect to say that we will not allow it to proceed.
On the question of the British social attitudes survey, things are a little more complex. The hon. Gentleman will be aware that the Department of Health is not the only Department involved; it is a cross-Government survey, and the Department of Health has some interest in it, but not exclusively so. Again, that is being considered, so I cannot give a definitive answer as to what will happen.
Many hon. Members, including the hon. Member for Leyton and Wanstead, pointed out that the last survey published by Ipsos MORI said that public satisfaction with the NHS was relatively high. That is self-evident, and I suspect that all hon. Members, as constituency MPs, will be aware of that from their constituents, their correspondence and just talking to people. As we heard, the most recent research puts overall satisfaction rates at 72%.
If we were discussing the future of any other public service, perhaps the debate would end there. However, we are not here today to discuss other public services, such as local bus services or rubbish collections, vital as they are. We are here to discuss the national health service, which for the public is literally a matter of life and death, and they have a high regard for it. People expect the NHS to be there when they are at their most vulnerable, or when their family members are in greatest need.
One cannot quantify what the NHS means to the people of this country with a smattering of national statistics, however comforting they might seem. The public have never been over-inclined to set great store by the pronouncements of politicians about the brilliance of the NHS, however familiar such pronouncements might be. However, people do not live their lives through the monochrome of MORI’s painstaking statistical analyses. They do not judge the NHS on the numbers. They judge the NHS on their experience of it; it is the NHS staff that they meet, and what they say and do, that ultimately informs their opinion.
The fact that satisfaction rates are relatively high is without doubt a tribute to the fact that those staff treat thousands of patients every day. I am sure that Members on both sides of the Chamber are united in their admiration for the work of staff across the board, and we should congratulate them on doing it day in, day out, when looking after our constituents, ourselves and our families. They do a fantastic job. We should never forget that we owe them a debt of honour and gratitude.
Mr Burns
No. If the hon. Gentleman will forgive me, I do not have much time.
We should not kid ourselves that that is the whole story. Although some may be only too content with the fact that three quarters of people are happy with the NHS, I am not. High levels of public satisfaction are a genuine compliment to the work of NHS staff, but they do not undermine the case for modernisation or imply that the NHS is perfect or should never change. There is plenty of room for improvement, building on the high satisfaction rates that we already enjoy, as shown by the various surveys mentioned today.
The House will know that although the money going into the NHS has dramatically increased over the last decade, which I welcome, productivity has not. In fact, it has fallen by 0.2% every year since 1997. In hospitals, it has fallen further—by 1.4% a year between 1997 and 2008. However, such statistics can sound quite abstract. We should think about what they actually mean for patients.
Some of the targets and incentives in the current system are simply perverse; far from promoting good-quality care, they encourage poor care. Take maternity services. With antenatal care, the more visits or scans providers can record, the more they are paid. It is in the financial interests of the hospital to provide care on a purely reactive basis, dealing with problems as they arise, rather than preventing them from happening.
The result is poorer health outcomes for the mother and child and a bigger bill for the taxpayer. No midwife or doctor would ever organise the system in such a way. No doctor or nurse working in acute care would design a system in which a hospital would be paid for a mistake rather than be penalised for it. For example, would they pay if a patient were discharged from hospital only to be bounced back into A and E a week or so later because they were not properly treated? No health professional would choose to work in an environment in which they and their colleagues are rewarded not for how well they treat patients, but for how well they process them through the health system.
Hon. Members claim that there is no rationale for our reforms, but they are wrong. I do not claim that the NHS is failing; there is much that is good about it, and much of what it does is internationally acclaimed. None the less, if hon. Members were honest they would accept that there is room for improvement, as was shown by the Ipsos MORI poll.
I do not think that it is right that pensioners over the age of 75 in the primary care trust that serves the constituency of the hon. Member for Leyton and Wanstead are almost twice as likely to be admitted to hospital in an emergency than those over the age of 75 in Devon or Cornwall. I do not think that it is right that, in some parts of the country, people are more than five times more likely to die of heart disease.
In its current form, the NHS cannot hope to cope with the rising demand from our ageing population and the relentless rise in the cost of drugs and treatment. Our health system is no longer battling with infectious disease. The typical patient is not a young man with TB or polio, as it might have been in the 1940s, but someone who is over 75 with probably two, if not more, long-term conditions and social care needs, too. It is a very different problem that requires a very different kind of health service.
Even more importantly, as a nation, we should be aspiring to be as healthy and to live as long as our European neighbours. A recent OECD report found that, if the NHS were to perform as well as the best-performing health systems, we could increase life expectancy by three years. The argument for change could not be clearer.
The ultimate objective of modernisation is to ensure that the quality of care that people receive is on a par with the best available anywhere in the world. To do that, we need to make fundamental changes to the NHS. For example, we need to ensure that it is the GP and not a manager or civil servant in Whitehall who determines the needs and requirements of their patients. A radical extension of patient choice would allow patients to choose not only where they are treated, but which consultant-led team will treat them. Patients could choose their GP and even, where appropriate, their treatment.
There should be greater accountability and transparency in the NHS to give patients the information that they need to make choices and to drive up quality. As the Society for Cardiothoracic Surgery said only last week, publicly reporting on the performance of hospitals and surgeons treating patients with heart disease can improve mortality rates by 50%.
There should also be more independence and freedom for clinicians, so that if local health and social care professionals think that they can deliver better services to support stroke patients, they can set up a social enterprise that will do that. We will give genuine freedom to foundation trusts, so that they can strive to provide the best possible outcomes for patients.
In conclusion, there have been a lot of disingenuous statements about privatisation of the health service and the quality of care. If hon. Members are prepared to listen, I will assure them that we have no intention of privatising the health service. We just want to improve patient care.