Health and Social Care Bill

John Bercow Excerpts

Tuesday 20th March 2012 Commons Chamber

[Several hon. Members]

rose—

[Mr Speaker]

Order. The Secretary of State has indicated that he wishes to speak later in the debate—[Interruption.] Order. That is his absolute prerogative. In view of the level of interest in the debate, it will be helpful for the House to know at this point that a five-minute limit on Back-Bench speeches is to be imposed immediately. I call Dr Daniel Poulter.

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

indicated dissent.

[Mr Speaker]

He was in, on the list and at the top. If he does not wish to speak, so be it.

--- Later in debate ---

[Tony Baldry]

No.

All I am saying to my hon. Friend is that this is a debate about the relationship between civil servants and Ministers, a relationship that has worked very well and very effectively in this country.

Here we have heads of the civil service advising Parliament that this move, which the Opposition would seek to force upon us, is not in the best interests of the relationship between civil servants and Ministers and is not in the best interests of the good running of government.

[Mr Speaker]

Do I take it that the hon. Gentleman has concluded his speech?

[Tony Baldry]

I have, Mr Speaker, and I hope that I have made my point.

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[Grahame M. Morris]

Absolutely; I completely agree with my right hon. Friend. These are huge structural changes to a beloved organisation, and it is in the public interest that we know precisely what is in the transition risk register.

A little while ago, I tabled early-day motion 2659, which called on the Health Secretary

“to respect the ruling by the Information Commissioner and to publish the risk register associated with the Health and Social Care Bill reforms in advance of Report Stage in the House of Lords”,

so that we could have proper scrutiny in the Lords and in the House of Commons. We have not seen what is in the transition risk register, but we are aware of the existence of other risk registers. While the Health Secretary has been fighting tooth and nail to prevent the publication of the transition risk register and, in the process, hiding the risks to the NHS in England, other NHS bodies and clinical groups have been compiling their own risk registers into the impact of the Health and Social Care Bill.

One such body is the Faculty of Public Health, the body for specialists in public health, which is a joint faculty of the three Royal Colleges of Physicians of the United Kingdom. I am grateful to Professor Clare Bambra, from the north-east, and Professor John Ashton, from the north-west, for providing this information. In a letter to The Independent, Professor Lindsey Davies, the president of the Faculty of Public Health, outlined his concerns about the pressure that clinicians were now under from their employers for criticising the Government’s plans to reform the NHS. He wrote:

“Public health professionals have the right and duty to speak out on issues which they perceive as threatening the health of the population they serve”.

The bunker mentality of the Health Secretary, and his determination to silence clinical and public opposition, have astounded the country as a whole.

In response to the Department of Health’s refusal to publish its own strategic risk assessment of the impact of the Bill, the Faculty of Public Health has undertaken its own study, in which it has highlighted a number of significant risks, not least the potential for a postcode lottery. It states:

“Clinical Commissioning Group flexibility to determine services will lead to an increase in geographical variation in service provision.”

It identifies the possibility of costs being pushed up, and states that the

“development of more overt market mechanisms, and the greater role for the independent sector in the provision of healthcare is likely to increase the overall cost of providing healthcare.”

It also raises concerns about issues of quality as a consequence of the reforms. If the transition risk register indicates that, we should know about it.

The delaying tactics employed by the Secretary of State are, to my mind, holding Parliament in contempt. He should publish and employ no further delaying tactics. Reports that Tory-Lib Dem Cabinet members banged their Cabinet table in delight and glee at the prospect of the health Bill finally being rammed through and becoming law at the end of today leave a very sour taste in the mouth. I urge all Members to support this motion and get the risk register published.

[Mr Speaker]

I inform the House that there is a slight discrepancy between the clock time shown on the annunciator screen and that shown on the digital display panels on either side of the Chamber. For the avoidance of doubt, this debate began at 3.44 pm and has to end at or before 5.14 pm. For the purposes of deciding when we reach the end time, the Chair will use the time on the Chamber digital display panels. I hope that that is helpful. Given the level of interest in the debate, the time limit for Back Benchers will be reduced to three minutes with immediate effect.

Health and Social Care Bill

John Bercow Excerpts

Tuesday 20th March 2012 Commons Chamber

Consideration of Lords amendments

[Mr Speaker]

I must draw the House’s attention to the fact that financial privilege is involved in Lords amendments 7, 21, 35, 132 to 141, 181, 189, 192, 198, 243, 244, 253, 265, 288, 290, 291, 319, 320 and 366. If the House agrees to any of these amendments, I shall ensure that the appropriate entry is made in the Journal.

Clause 1

Secretary of State’s duty to promote comprehensive health service

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

I beg to move, That this House agrees with Lords amendment 1.

[Mr Speaker]

With this we will consider the following:

Lords amendments 2 to 10 and 13 to 30.

Lords amendment 31, and amendment (a) thereto.

Lords amendments 32 to 42, 54 to 60, 74, 242, 246, 248, 252, 287, 292 to 294, 299 to 326, 328 to 332 and 335 to 342.

[Mr Burns]

The aim of this Bill is to secure a national health service that achieves results that are among the best in the world. Through it, the Government reaffirm their commitment to the values and principles of the NHS: a comprehensive service, available to all, free at the point of use and based on need, not ability to pay. However, we have always been prepared to listen and make changes to improve the Bill, and we have continued to do so in another place. The Lords amendments in this group fall within five main areas.

First, we recognised that concerns had been expressed about the Secretary of State’s accountability for the health service. Although it was never our intention in any way to undermine that responsibility, we have worked with Members of another place and the House of Lords Constitution Committee to agree Lords amendments 2 to 5, 17, 18, 24, 39, 40, 74, 246, 287 and 292. Those amendments put beyond doubt ministerial accountability to Parliament for the health service. In addition, they amend the autonomy duties on the Secretary of State and the NHS Commissioning Board, to make it explicit that the interests of the health service must always take priority. They also amend the intervention powers of the Secretary of State and the board, to clarify that they can intervene if they think a body is significantly failing to exercise its functions consistently with the interests of the health service. Finally, a new provision will make it explicit that the Secretary of State must have regard to the NHS constitution in exercising his functions in relation to the health service.

Although clinical commissioning groups will have autonomy in their individual decisions, Lords amendment 9 clarifies that CCGs must commission services consistently with the discharge by the Secretary of State and the board of their duty to promote a comprehensive health service, and with the objectives and requirements in the board’s mandate.

The Government also tabled amendments in response to the recommendations of the House of Lords Select Committee on Delegated Powers and Regulatory Reform, all of which we have accepted. Amendments 15 and 16 ensure that the requirements set out in the mandate, and any revisions to those requirements, must now be given effect by regulations.

Commissioning will be led by GPs, who know patients best. However, with that responsibility must come accountability. Therefore, further to the amendments made in the House requiring CCGs to have governing bodies, the other place has strengthened requirements in relation to CCGs’ management of conflicts of interest. We recognised how important it is to ensure the highest standards of probity in CCGs and accepted amendments 31, 300, 301 and 302, which were tabled by the noble Baroness Barker, and which require CCGs to make arrangements to ensure that members and employees of CCGs, members of the governing body, and members of their committees and sub-committees, declare their interests in publicly accessible registers.

The amendments also require CCGs to make arrangements for managing conflicts of interest and potential conflicts of interest in such a way as to ensure that they do not, and do not appear to, affect the integrity of the board’s decision-making processes. The board must issue statutory guidance on conflicts of interest, to which CCGs must have regard.

Taken together, those amendments provide certainty that there will be clear and transparent lines of accountability in the reformed NHS. However, I cannot support Opposition amendment (a) to Lords amendment 31. The Bill is clear that CCGs must manage conflicts of interest in a way that secures maximum transparency and probity. In most cases, that would mean that a conflicted individual withdraws from the decision-making process, but that might not always be possible, for instance when a CCG is commissioning for local community-based alternatives to hospital services, and determines that the most effective and appropriate way to secure them is to get them from all local GP providers within its geographic area. In that event, it would not be possible for every GP to withdraw from the decision-making process. We cannot, therefore, agree to a blanket ban.

--- Later in debate ---

[Mr Speaker]

Order. [Hon. Members: “More!”] Whatever the views of Members, there is no time for more.

--- Later in debate ---

Remaining Lords amendments agreed to, with Commons financial privileges waived in respect of Lords amendments 181, 189, 192, 198, 243, 244, 253, 265, 288, 290, 291 and 366.

[Mr Speaker]

We come now to the petition. Before I call the hon. Member for Hayes and Harlington (John McDonnell), may I ask Members who are leaving the Chamber to do so quickly and quietly—

[Jeremy Corbyn (Islington North) (Lab)]

Stay for the petition.

--- Later in debate ---

[Mr Speaker]

If Members wish to stay, they should stay. If they wish to leave, perhaps they can do so quickly and quietly, affording the hon. Member for Hayes and Harlington the courtesy that they would want to be extended to them in similar circumstances.

Health and Social Care Bill

John Bercow Excerpts

Tuesday 13th March 2012 Commons Chamber

[Mr Speaker]

We come now to the main business and to the Opposition motion in the name of the Leader of the Opposition. It might be helpful if I inform the House that I have selected the amendment in the name of Mr Andrew George.

Just before I call the shadow Secretary of State to move the motion, may I remind the House that in the light of the extensive interest in this debate I have imposed a five-minute limit on individual Back Benchers’ contributions? There is no formal limit on contributions from the Front Benchers, but I feel sure that the shadow Secretary of State and Secretary of State will tailor their contributions in order to facilitate their Back-Bench colleagues’ participation.

Health and Social Care Bill

John Bercow Excerpts

Tuesday 28th February 2012 Commons Chamber

[The Secretary of State for Health (Mr Andrew Lansley)]

I am glad to have this opportunity again to set out the purposes of the Health and Social Care Bill. It will give patients more information and choice, so that they can share in decision-making about their care. It empowers front-line doctors and nurses to lead the delivery of care for their patients. It cuts out two tiers of bureaucracy and strengthens the voice of patients and the role of local government in integrating services and strengthening public health.

The values of the Bill are simple: putting patients first, trusting doctors and nurses, focusing on results for patients and maintaining the founding values of the NHS. We are constantly looking to reinforce those values, strengthening the NHS to meet the challenges it faces. We know change is essential; we will not let the NHS down by blocking change. Throughout the development and progress of this Bill, we have engaged extensively with NHS staff, the public, and parliamentarians.

The Health and Social Care Bill is the most scrutinised public Bill in living memory—[Interruption.] With over 200 hours of debate between the two Chambers and 35 days in Committee, we have ensured that Members and peers have had every opportunity to examine, understand and amend the Bill to—[Interruption.]

[Mr Speaker]

Order. I granted this question because I want Members to have the chance to scrutinise the Government of the day, but courtesy dictates that the Secretary of State’s statement must be heard.

[Mr Lansley]

Thank you, Mr Speaker.

We have made this legislation better and stronger. We have made significant changes to the Bill, including in response to the NHS Future Forum’s work and we have been open to any further changes that would improve or clarify the Bill. For example, so far in the Lords, the Government have accepted amendments tabled by a number of Cross-Bench, Liberal Democrat and Labour peers.

Yesterday, my right hon. Friend the Deputy Prime Minister and Baroness Williams wrote to their Liberal Democrat colleagues explaining their support for the Bill, with those changes and some further amendments they wish to see. They said, for example, how we must

“rule out beyond doubt any threat of a US-style market in the NHS”.

I wholeheartedly agree. The Bill is about quality, not competition on price. It will not permit any NHS organisation to be taken over by the private sector. It will put patients’ interests first. The Bill does not permit any extension of charging, and care will be free, based on need. Where the doctors and nurses on the ground know that competition is in the best interests of their patients—where it is based entirely on the quality of the care and treatment provided and not in any way on the price of that care and treatment—then competition can play an important role in driving up standards throughout the NHS.

We will not see a market free-for-all or a “US-style” insurance system in this country. I believe in the national health service. I am a passionate supporter of our NHS, and that is why I understand the passionate debate it arouses. It is also why I resent those Opposition Members who seek to misrepresent the NHS, its current achievements and its future needs. We—and I do mean all of us on the Government Benches—are using the debates in the Lords further to reassure all those who care about the NHS. I am grateful for this chance to reassure all my hon. Friends regarding the positive and beneficial effects of debate in the other place and about the work we are all doing to secure a positive future for the NHS.

--- Later in debate ---

[Several hon. Members]

rose—

[Mr Speaker]

Order. If I am to accommodate anywhere near the level of interest in this important matter, I shall require brevity—to be led, as so often, by Mr John Redwood.

[Mr John Redwood (Wokingham) (Con)]

Am I right to tell my constituents that the purpose of this reform is to give more choice of care to patients, and to give more power to GPs to deliver better free treatment?

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[Several hon. Members]

rose—

[Mr Speaker]

Order. May I say to the hon. Member for Colne Valley (Jason McCartney) who is chuntering inanely from a sedentary position, to no obvious benefit or purpose, that the Chair is perfectly capable of adjudicating upon what is and is not in order and that it does not behove an hon. Member to seek to intervene in such matters? These proceedings have thus far been entirely orderly. That is the beginning and the end of the matter.

[Mr Peter Bone (Wellingborough) (Con)]

There is an old political saying that the Liberal Democrats say one thing at one end of their constituency and another thing at the other end. Will the Secretary of State lay that rumour absolutely to rest—that they are not saying one thing at this end of Parliament and another thing at the other end?

--- Later in debate ---

[Mr Lansley]

My hon. Friend is absolutely right, and I share his deep resentment at the way in which Opposition Members misrepresent and distort what is in the legislation and then, when people write to us concerned about what is in the legislation, accuse us of not listening to them. Opposition Members should read what is in the Bill, find out that it achieves the purposes that my hon. Friend describes and not distort it.

[Mr Speaker]

Order. I simply say to the Secretary of State that to refer to somebody “distorting” something is perfectly in order, but I know that he would not want to use an unparliamentary term and talk about anything being “misrepresented”. I think he is accusing a Member of being erroneous. I think that is what he has in mind.

[Mr Lansley]

You are absolutely right, Mr Speaker. They are very erroneous.

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[Mr Lansley]

We have already made it very clear in another place that the legislation will ensure that foundation trusts should have the freedom to increase their private income, not least in relation to international work. However, their principal legal purpose is for the benefit of NHS patients, and so they already have to make sure that they reflect that in their annual reports and in their annual plans. As the letter indicates, we are, with my hon. Friends in another place, working on a further corporate governance mechanism to ensure that foundation trusts reflect their principal legal purpose in all that they do. [Interruption.]

[Mr Speaker]

Order. I want to hear the questions and the answers. Members are a little overexcited and they need to calm down just a tad. A good example of such calm will now, I am sure, be provided by Mr John Hemming.

[John Hemming (Birmingham, Yardley) (LD)]

Under Labour, local democratic accountability in the NHS was reduced by the abolition, without consultation, of the community health councils. The letter refers to the creation of the health and wellbeing boards, which will increase local democratic accountability for the health service. Will the Secretary of State explain how that will ensure that local services in the health service better fit local health needs?

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[Several hon. Members]

rose—

[Mr Speaker]

Order. I would like to accommodate a few more questions, but from now on I really do require single-sentence questions without preamble and comparably pithy replies.

[Jane Ellison (Battersea) (Con)]

My constituency has considerable health inequalities, so I very much welcome the fact that tackling health inequalities is at the heart of the Bill. Does the Secretary of State share my surprise that the Opposition do not similarly welcome that?

--- Later in debate ---

[Mr Lansley]

I agree with my hon. Friend, but fortunately this urgent question has given me another opportunity to remind everybody in this House and beyond that this Government’s purpose is to empower patients, get front-line doctors and nurses in charge in the NHS, cut our tiers of bureaucracy and improve the quality of care for patients.

[Mr Speaker]

I thank colleagues for their succinctness, which enabled 53 Back Benchers to question the Secretary of State in 42 minutes of exclusively Back-Bench time. I am indebted to the House.

Under the terms of Standing Order No. 24, I now call Mr William Cash to make an application for leave to propose a debate on a specific and important matter. As I am sure the hon. Gentleman will know, he has three minutes in which to make such an application.

NHS Risk Register

John Bercow Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Mr Speaker]

In view of the extensive interest in this debate, I have imposed a seven-minute limit on Back-Bench contributions. That limit is based on the premise of reasonable self-discipline being shown in terms of the length of the opening Front-Bench speeches.

--- Later in debate ---

[Harriett Baldwin (West Worcestershire) (Con)]

Has the right hon. Gentleman read the article in The Times today by Stephen Bubb, which says:

“When in government . . . Labour’s Shadow Health Secretary spoke of his vision for a preventive, people-centred NHS that would allow the maximum freedom for local innovation… And yet, to judge by the reaction that”

the Secretary of State’s

“Bill has provoked, one would think that a centralised, bureaucratic and too often inefficient NHS is politically sacred and permanently untouchable”?

[Interruption.] Is that the impression that the shadow Secretary of State is trying to create?

[Mr Speaker]

Order. I remind the House that there is a lot to get through, many Members wish to contribute, and interventions in any event should be brief.

[Andy Burnham]

I have never believed in a free market in the NHS. I did not believe it then and I do not believe it now. That is why I oppose the Bill that the hon. Lady supports.

I was saying, before I was rudely interrupted, that we say it is dangerous to reorganise the NHS at this time. On the day the White Paper was published, I stood opposite the Secretary of State and described his plans as

“a huge gamble with a national health service that is working well for patients.”—[Official Report, 12 July 2010; Vol. 513, c. 663.]

He never has explained why this successful NHS needs to be turned upside down. From day one we have asked the Government to be up front about the precise nature and scale of the risks that they are taking. Their failure to provide a full assessment of those risks to inform the House’s consideration of their Bill led my predecessor, my right hon. Friend the Member for Wentworth and Dearne (John Healey), to initiate a freedom of information request for the transition risk register. I wish to point out that my right hon. Friend did not request the full departmental risk register, which was subject to a similar request in August 2009 at the height of the swine flu pandemic.

Let me now directly answer the question that the hon. Member for Weaver Vale (Graham Evans) asked. There are three crucial differences between that situation and the subject of today’s debate. The first important difference—[Interruption.] The hon. Gentleman would do well to listen, as the Prime Minister got his facts wrong at Prime Minister’s Question Time.

The first important difference is that the debate relates to a different document. This debate is about the transition risk register, not the strategic risk register held by the Department. They are different things. The transition risk register relates solely to the reorganisation and the effects that the reorganisation could have. That brings me to my second reason why the situation is different. I did not initiate the biggest ever top-down reorganisation of the NHS. It is the policy of the hon. Gentleman’s Government to do that. We on the Labour Benches who care about the NHS have a right to know what damage that reorganisation might cause. The Government are not just launching the biggest ever reorganisation; they are doing it at a time of the biggest ever financial challenge in the history of the NHS.

The third reason—

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[Several hon. Members]

rose—

[Mr Speaker]

Order. May I make it clear to Back Benchers that the shadow Secretary of State is clearly not giving way at present, and that in the circumstances they should exercise some self-restraint?

[Andy Burnham]

They do not want to listen because it does not suit their argument. This was meant to be their whole reason today, and we heard it from the Prime Minister earlier, but now they do not want to hear the reasons.

The third reason this situation is different from the one in August 2009 is that at that time there was not a precise ruling from the Information Commissioner, but there is a clear ruling from the commissioner in this case. Those are three important differences. Let me remind the House of that ruling. It stated:

“The Commissioner finds that there is very strong public interest in disclosure of the information, given the significant change to the structure of the health service the government’s policies on the modernisation will bring.”

That is where one of the Government’s key arguments for withholding the register falls apart. The Minister in another place has repeatedly defended the Government’s action by saying that they had published a full impact assessment for the Bill—[Interruption.] “It’s true”, says the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns). Let me answer that point. Having had sight of the impact assessment and the transition risk register, the commissioner said that

“disclosure would go somewhat further in helping the public to better understand the risks associated with the modernisation of the NHS than any information that has previously been published.”

In other words, the impact assessment that the Secretary of State has published is not good enough and the public deserve to know the full truth about his reorganisation.

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[Andy Burnham]

I quoted from the policy, but the Secretary of State is not publishing the risk register—

[Mr Speaker]

Order. I am sorry to have to interrupt, but I must say to the hon. Member for Broxtowe (Anna Soubry), who no doubt is an immensely brilliant individual, that in her capacity as Parliamentary Private Secretary to the Minister of State, at this stage in her career her role is to fetch and carry notes and nod in the right places, not to conduct a running commentary on the debate. I trust that she will now exercise a self-denying ordinance for the remainder of the debate.

[Andy Burnham]

As I was saying, the Government clearly are not following the statement of policy set out on the Treasury website, but the strange thing, as the House will hear shortly, is that NHS bodies across the country at local and regional level are following the policy closely. As I understand it, the Treasury’s theory is that the more widely the risks are understood and shared, the greater the ability to mitigate them. Indeed, I recall the Minister stating in a press release as recently as last October, the month before the commissioner’s ruling, that an open and transparent NHS would be a safer NHS. Two simple questions follow: why is the Department for Health not following stated Government policy and what it said in October was its own policy; and is the Department in breach of Government policy, or has it secured an exemption from it? I hope that the Health Secretary will shed light on this point today, because at present it does not look too good.

Let me turn to the Government’s other reasons for fighting publication. First, it is claimed that disclosure would

“jeopardise the success of the policy”

That is a moot point. The Information Commissioner said that it is a strange defence, given the Government’s other statements on openness and scrutiny building more robust plans. Secondly, it is claimed that it could have a chilling effect and that officials would be less frank in future. Given that risk assessment is a core part of all public servants’ responsibilities, not an optional activity, that claim was not accepted by the commissioner. Thirdly, it is claimed that the names of junior officials could be disclosed, but the commissioner has said that he was satisfied that the register would identify only senior civil service or senior NHS officials.

Fourthly, it is claimed that disclosure would set a difficult precedent and could lead to the publication in future of information relating to national security. The weakness of this argument, as the commissioner pointed out, is that a precedent has already been set, and it was set by the Labour party when we were last in government. A comparable risk register linked to the specific implications of a particular policy—the Heathrow third runway—was released by the previous Government in March 2009 following a ruling by the Information Commissioner on a request from the current Transport Secretary. Why are this Government not following the clear precedent set by the previous Government? That is the answer to the hon. Member for Weaver Vale. In truth, these four reasons seem to me to be the desperate defences of a desperate Government who have something to hide and a desperate Secretary of State.

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[Steve McCabe]

Off the top of my head. I can check the figure, because the Secretary of State wants to be accurate, but I think it is 36%—since he became Secretary of State. It is going up, and he must know that, because he was quite happy to cite other figures earlier.

The money should be spent on reducing waiting times; it should not be withheld by the SHAs to cover the cost of the reorganisation. The Minister of State says that that is not happening, but his own operating framework shows perfectly well that that is exactly what the money is being withheld for. It is spelt out in black and white in his own documents, and that is what is wrong at the moment.

The public feel that waiting times are rising, they have difficulty accessing GPs and they are worried about the confusion surrounding the measure. As my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) said earlier, in some parts of the country it is already destabilising the NHS, but what we have today is the Government dismissing all those arguments while hiding behind a cloak, saying, “Everything’s going to be okay, but we’re not going to tell you the facts of the matter.” It is disgraceful, and the Secretary of State knows perfectly well that during the years that he spent in opposition he would never have tolerated such behaviour. His behaviour since taking office has been to undermine the NHS and to waste every bit of political capital that the Tory party accumulated during its years in opposition.

That is what is fundamentally wrong with the measure. It does not matter how many times people try to deal with the minutiae of the risk register; the reality is that the report is there and the information is there. There is only one person hiding it, and he is sitting opposite me on the Government Front Bench at the moment. That is what the public know. This is no longer an argument confined to what happens in this Chamber; it has gone way beyond that. It has got to the stage where the Secretary of State’s credibility is on the line, and I am afraid that it has been lost.

[Mr Speaker]

We are grateful to the hon. Gentleman. The winding-up speeches will begin at 6.38 pm.

Oral Answers to Questions

John Bercow Excerpts

Tuesday 21st February 2012 Commons Chamber

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

Has the Minister seen an article today by the respected journalist Polly Toynbee—[Laughter.] Respected by the Prime Minister—[Hon. Members: “Stop laughing.”] I am not laughing at all—

[Mr Speaker]

Order. I want to hear the views of Polly Toynbee, as enunciated by Dame Joan.

[Dame Joan Ruddock]

On a very serious issue, a waiting list clerk of 17 years has just resigned because she was asked to adopt a range of devious methods to make sure that people coming up to the 18-week target for treatment were taken off lists. Does the Minister understand that patients will not always know whether they have had proper treatment, and that it will be far too late to refer them to an ombudsman at some later date?

[Anne Milton]

I thank the right hon. Lady for her question. I am devastated to say that I have not seen the article to which she refers, but I am sure that I will. The Department has made it very clear to the NHS that clinical priority is and remains the main determinant of when patients should be treated. When I was in opposition I made various visits to various hospitals and saw them fiddling around at the edges, with admin staff forced to do things that they did not want to do, in order to tick boxes for the previous Government.

[Mr Speaker]

Right. Can we now speed up a bit? We have a lot to get through, and I should like to accommodate the interests of colleagues, so everybody needs to tighten up.

[Jo Swinson (East Dunbartonshire) (LD)]

7. What assessment he has made of the effectiveness of NHS allergy services.

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[Mr Burns]

I suspect that the hon. Lady does not get out and about much to meet doctors who are beginning to commission care for their patients. If she did, she would know that the mantra she is repeating from organisations that are not representative of doctors in this country—[Interruption.]

[Mr Speaker]

Order. The Minister of State is such an emollient fellow that I cannot imagine why people are getting so worked up, but they are getting very worked up, and they must calm themselves. We are only on Tuesday; we have got some time to go. Let us hear the Minister.

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[Anne Milton]

My hon. Friend echoes many of the comments that I have heard as I have gone around the country. Without the Bill, we cannot strip out primary care trusts and strategic health authorities, which will save £4.5 billion over this Parliament. I cannot see anybody going out on a march to save PCTs and SHAs. The public want the outcomes and the quality of care that they deserve, which they were denied under the previous Government.

[Mr Speaker]

I remind Members on both sides of the House—Back and Front Benchers alike—that topical questions and answers must be brief.

[Nic Dakin (Scunthorpe) (Lab)]

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

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[Andy Burnham]

It is, it would seem, the Secretary of State’s new top-down bullying policy, and it is happening right across the NHS. How does he reconcile that with what he used to say about whistleblowing? I remind him of what he once said:

“The first lines of defence against bad practice are the doctors and nurses”,

who

“have a responsibility to their patients to raise concerns if they see risks to patient safety. And when they do, they should be reassured that the Government stands full square behind them.”

Full square behind them so that he can plunge the knife straight into their backs! The truth about his mismanagement of the NHS is coming out: staff bullied into silence, professionals frozen out, crucial information in the risk register—

[Mr Speaker]

Order. We get the gist.

[Mr Lansley]

When the right hon. Gentleman has no argument, he resorts to abuse.

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[Several hon. Members]

rose—

[Mr Speaker]

Order. I am sorry to disappoint colleagues but, as usual, Health questions have been heavily oversubscribed. The House is in high spirits, and it is only Tuesday afternoon.

Breast Implants

John Bercow Excerpts

Wednesday 11th January 2012 Commons Chamber

[Several hon. Members]

rose—

[Mr Speaker]

Order. Before I call Margot James, let me wish the hon. Member for Rhondda (Chris Bryant) a very happy birthday.

[Margot James (Stourbridge) (Con)]

I commend the Black Country Partnership NHS Foundation Trust on conducting 517 breast implant operations in the decade before 2008 without the use of a single PIP implant.

What this furore has revealed to me is the existence of a growing private sector offering a vast array of cosmetic surgery that extends well beyond breast implants. I fear that the need for tighter regulation of the industry will prove widespread, and I therefore welcome the Government’s commitment to a review. Does my right hon. Friend expect to be able to charge the private sector for the costs of any additional regulation that the review group may deem necessary?

Oral Answers to Questions

John Bercow Excerpts

Tuesday 10th January 2012 Commons Chamber

[Mr Speaker]

Order. I was doing my best to listen attentively—it is very difficult to hear clearly when there is so much noise. If there is to be a reference to another right hon. or hon. Member, advance notice of it should be provided. These courtesies must be observed. They are there for a good reason.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I remind my hon. Friend that smoking kills over 80,000 people a year in the UK. We have published our tobacco control plan, are implementing the display ban and hope to consult soon on the future of plain packaging. The important thing to remember about improving public health is that it is not a party political issue. I cannot comment on the specifics of the case he mentions, but this is a matter that interests everyone across the House.

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[Mr Lansley]

I do indeed agree with the Prime Minister, but I would not characterise what he said in the way that the hon. Gentleman does. I was very interested to see a number of letters in The Times just this morning that highlighted that in the past, under patient and public involvement forums and community health councils, there was a direct public interest in seeing what happened in hospitals and in inspection. Through the Health and Social Care Bill and the establishment of HealthWatch, we will enable the public—representatives of patients—to be involved directly in assessing the quality of the environment in which patients are looked after. They will not supervise nurses. Nurses will be responsible for the experience and care of patients, but the public have a right to be participants in inspection—

[Mr Speaker]

Order. I am grateful to the Secretary of State.

[Andrew George (St Ives) (LD)]

When the Government introduced the Health and Social Care Bill a year ago, they did so with the claim that the NHS fails in comparison with its European counterparts with regard to patient outcomes. Now we know that that is not the case, will the Government withdraw the Bill?

Mental Health Unit (Burton)

John Bercow Excerpts

Monday 19th December 2011 Commons Chamber

[Paul Burstow]

I will certainly give some further consideration to that. I am not sure that I am in a position to give my hon. Friend the undertaking he wants tonight, but if new issues arise it is in the public interest to make sure they are properly understood. My hon. Friend has rehearsed a number of the key issues this evening, and although he is right that consideration is being given to extending the consultation period, that is not for quite as long, as he suggested. I believe the PCT has decided to extend it by three to four weeks. It must do that, as the public and my hon. Friend must have confidence in the process. I am sure that he will understand that in responding tonight what I cannot, will not and must not do is come down on one side or the other on the options being canvassed in the consultation or express a preference as to its outcome. As he will know, there are clear requirements in law in respect of significant service changes that ultimately allow for reference to the Secretary of State, and I must avoid fettering the discretion the Secretary of State might in due course have to exercise.

Staffordshire Local Involvement Network—the LINk—is overseeing this consultation, and it has facilitated sessions after the presentations at public meetings. It has not involved anyone from either the PCT or South Staffordshire and Shropshire Healthcare NHS Foundation Trust. The LINk will also oversee the analysis of the consultation, to ensure its results are presented objectively. There is an independent element, therefore. I hope that goes some way towards reassuring my hon. Friends who have spoken tonight.

Travel has been mentioned in passing, and it is an important issue. When PCTs and service providers consult on service reconfigurations of this sort they must properly consider travel times, distances and journeys. I am pleased to note that, certainly in terms of the environmental impact assessment, those matters have been brought into play, although I await to see from the outcome of the consultation whether they have been sufficiently brought into play.

The local NHS would say that the consultation is about the future direction of in-patient services in the area and further strengthening community services. We must remember that this consultation is not only relevant to mental health in-patient services in Burton, but that it covers Tamworth and Stafford as well.

Although the concerns raised tonight have rightly focused on the Margaret Stanhope Centre, the important wider issue of improving community mental health services must be kept in mind. That is why I come back to the concern about the impact of reducing the number of beds available in the area. There is a dispute between the NHS locally and my hon. Friend about whether that will retard local services’ ability to meet legitimate needs, or whether more investment in community services will meet those needs.

This has been an important debate because it has allowed my hon. Friend to set out clearly and cogently his concerns. The consultation is not yet concluded and there will now be some additional weeks in which further views can be gathered. Clearly, the campaign being run by the Burton Mail, with the support of many of my hon. Friend’s constituents, will be a factor that the PCT will need to take into account when making its decisions. I am sure that the health overview and scrutiny committee will also want to be satisfied when it draws its conclusions about whether the results of the consultation are safe and sound, and whether it supports a model that does posit the notion that there are many mental health circumstances where the mental health needs are better and more appropriately met in the community, although there is also a need to ensure that there is always a robust in-patient response where that is necessary.

With that, may I take the opportunity to wish you and others in this Chamber the compliments of the season, Mr Speaker? I thank my hon. Friend for raising these matters and I will come back to him on any details that I have not addressed this evening.

[Mr Speaker]

I thank the Minister for his good wishes, and they are warmly reciprocated.

Question put and agreed to.

Life Sciences

John Bercow Excerpts

Monday 5th December 2011 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

May I thank the right hon. Gentleman for his statement and start by setting out two points of common ground with the Government? First, we too have pride in Britain’s life sciences industry and its strength. We agree that the industry needs Government support and focus if its potential to contribute to the country’s industrial future is to be maximised. Secondly, we agree that there are huge potential benefits to British patients from closer collaboration between the NHS and the industry. We all want patients to have the quickest possible access to the latest life-saving and life-enhancing treatments.

It was for those two principal reasons that Labour, when in government, prioritised the life sciences sector and established the Office for Life Sciences. In Lord Drayson, we created a life sciences Minister who was a contact point for the industry—someone of huge experience and with real personal commitment to the industry. One of our criticisms of this Government is that they have allowed the momentum that Labour had established in promoting the industry to fall away. Progress has stalled because of the Government’s failure to understand that economic growth needs a proper partnership between the public and private sector and because of the combined effect of a number of their policies. Such policies include: damaging 15% real-terms cuts to the science budget; the loss of the regional developments agencies, many of which were heavily involved in this area; cuts to regional investment; and the destabilising effect of the unnecessary reorganisation of the NHS, particularly the disintegration of the strategic health authorities, which played a role in promoting research. The unexpected closure of Pfizer earlier this year exposed a Government asleep at the wheel and was a wake-up call, and now we see a Government playing catch-up.

Although we welcome their belated recognition of the importance of the sector, there are sensitive issues involved and Ministers need to tread carefully so as not to undermine public trust. What they are fond of calling red tape are, to others, essential safeguards. Some areas will always need proper regulation and the use of patient data is most certainly one of them. As we have heard from patients groups today, some have been caused real anxiety by this media-briefed statement from the Government and the lack of accompanying detail.

Ministers need to be aware that people with terminal illnesses and long-term conditions will react differently from others to a statement of this kind, so for them we seek direct assurances today from the Secretary of State that he failed to give in his statement. Will all patients have the ability to opt out of the sharing of their data, even in anonymised form? Surely that fundamental principle of consent should form the bedrock of any new system, and that control of data should be possible in today’s information age. If the Secretary of State cannot give that assurance, why not? How can he justify that?

Did patients’ representatives walk away from the Department of Health working group on these important matters and, if so, why? One representative said on the radio this morning that the whole process “stinks”. Does the Secretary of State not accept that he and his Department will need to do better than this to uphold public confidence in the process or risk undermining trust in the whole principle? What safeguards will there be to ensure that patient data are stored securely? Does he not need to articulate a more positive statement of patients’ rights in this important area, rather than the loose opt-out he proposes in the NHS constitution?

Is it the case that the anonymity of data cannot always be guaranteed? If so, what are those circumstances and, again, why not? Even within anonymised datasets, particularly dealing with small numbers of very specific conditions, it is possible to identify individual patients. What steps are being taken to guard against those risks? Will the Secretary of State give a categorical assurance that data cannot be used for purposes other than research—passed on to third parties or used by the same company to target people for other products and services?

Today’s announcement also needs to be considered in the context of the Government’s reorganisation of the NHS. Does not a more market-based health system with a greater number of private providers create much greater challenges for the control of data? I had many dealings with senior figures in the pharmaceutical industry in my time as a Minister. They were clear that it was the national structure of the NHS, and the ability to collaborate and share information across a whole health system, that was a huge attraction to the industry and a competitive strength for this country.

Does not the Secretary of State’s Health and Social Care Bill risk turning the NHS into a competitive market, where collaboration is discouraged in an any-qualified-provider free-for-all? So how can he guarantee that that competitive strength will be there in the future and will continue to be used by the pharmaceutical industry? Although he will not admit it today, were not many of the measures he has announced, particularly the expansion of telecare, made possible by the steps that we took to invest and modernise NHS IT?

More broadly, this announcement raises questions about the Government’s policy on the involvement of the private sector in the NHS. The Government need to set out what, if any, limit they see on the involvement of the private sector in the NHS. The Prime Minister has said that he wants the NHS to be a fantastic business. Let me quote from a recent leaked document on NHS commissioning, “Towards Service Excellence”. It says:

“The NHS sector . . . needs to make the transition from statutory function to freestanding enterprise.”

It is no wonder that, on the back of these worrying words, the British Medical Association has adopted a position of outright opposition to the Secretary of State’s Bill. Our worry is that, in their desperation to develop a credible industrial strategy, Ministers seem ready to put large chunks of the NHS up for sale.

Patient data are not the Secretary of State’s to give away. The NHS is not his to sell. The truth is that the Government are running huge risks with patient confidentiality and patient safety by opening up the NHS to the private sector and reorganising at a time of financial stress, but we do not yet know the full scale of those risks.

[Mr Speaker]

Order. I am pretty sure that the shadow Secretary of State is on his last sentence, which is almost certainly a short one.

[Andy Burnham]

It is.

The great irony is this: while Ministers are happy to offer up other people’s data, they continue to withhold the NHS risk register, which shows the risk they are running with our NHS. Is that not why people are increasingly asking what the Secretary of State has to hide?

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[Mr Skinner]

Yes, but in a free health service, not a privatised health service, which it will be—

[Mr Speaker]

Order. The hon. Gentleman has made his point.

May I say gently to the Secretary of State that we are enjoying the full product of his lucubrations, but I think just a snapshot will do. We can get by with that. [Interruption.] The Minister of State, the right hon. Member for Chelmsford (Mr Burns), can look it up in his dictionary later. That is fine.

[Mike Crockart (Edinburgh West) (LD)]

Key to the strategy announced today is the ability to translate primary research into early adoption and commercial outcomes. Does the Secretary of State agree that Edinburgh’s BioQuarter is uniquely placed to do that, as it already shares a campus with the state-of-the-art royal infirmary of Edinburgh and is hopefully soon to be joined by the excellent sick children’s hospital, providing a base for the commercialisation of the innovative work being carried out by Edinburgh’s universities?