Oral Answers to Questions

John Bercow Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Lansley]

I am sorry, but that was all completely synthetic anger on the hon. Gentleman’s part. The average time that patients have been waiting in the NHS for treatment continues to be between eight and nine weeks. It has been so ever since the last election. The operational standard under the previous Government and now for the 18-week waiting time is that at least 90% of patients who are admitted for treatment should be admitted and treated within 18 weeks, and 95% of outpatients. Both of those operational standards continue to be met. Last week I made it clear that whereas the previous Government abandoned people who went beyond 18 weeks—and there were 250,000 of them who went beyond 18 weeks—we will not abandon those forgotten patients. We will make sure that they, too, are brought into treatment as soon as possible.

[Mr Speaker]

I call Sajid Javid. Not here.

[Natascha Engel (North East Derbyshire) (Lab)]

8. What arrangements he has put in place to involve dental practitioners in the commissioning of dental services.

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[Mr Burns]

No, I do not think that the register should be published before then, in so far as we are still considering whether or how to move forward within the time scale that the Information Commissioner has given us—[Interruption.] Before the hon. Lady gets too pious, I must tell her—I do not say “remind her”, because in the previous Government she will have been too busy tweeting, as the tweeting tsar, to know what the Department of Health was doing—that in September 2009 the right hon. Member for Leigh (Andy Burnham) similarly blocked release of the Department of Health’s strategic risk register, using the non-disclosure provisions under section 36 of the Freedom of Information Act 2000, and that his predecessor, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), did the same on two occasions in 2008.

[Mr Speaker]

Order. It seems that the subject matter for an Adjournment debate is being provided.

[Duncan Hames (Chippenham) (LD)]

Two, or even three, wrongs do not make a right. Regarding an exemplary risk register, does the Minister consider that the mitigation plans for any risks identified there may serve to reassure Members of the other House, if it were to be published in advance of the conclusion of the Committee stage there?

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[Mr Lansley]

Yes, I am grateful to my hon. Friend. It is very important to me that NHS staff, and other public servants, are valued in their remuneration, including the pensions that they receive. That is precisely why I have myself engaged in discussion with the NHS trade unions and staff side and continue to be engaged directly in negotiations with them about that, on the basis of the conditional offer that the Chief Secretary to the Treasury announced to the House recently, which I think would be fair to NHS staff and to taxpayers. On that basis, I think it is completely irresponsible and unacceptable for some unions in the NHS—not the Royal College of Nursing or the British Medical Association—to intend to go on strike next week.

[Mr Speaker]

We are immensely grateful to the Secretary of State. He is testing the knee muscles of colleagues very considerably, and we are grateful to him for that, I am sure.

[Lilian Greenwood (Nottingham South) (Lab)]

Today’s report by Macmillan Cancer Support showed that over the past 40 years there has been virtually no improvement in life expectancy for those diagnosed with a brain tumour. Brain Tumour UK and experts such as my city’s own Professor David Walker are calling for action to improve diagnosis and treatment. What action is the Department taking to address their concerns?

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[Several hon. Members]

rose—

[Mr Speaker]

Order. I apologise for disappointing colleagues, but Health questions are invariably box office, and usually a sell-out at that. We must now move on.

Hinchingbrooke Hospital

John Bercow Excerpts

Thursday 10th November 2011 Commons Chamber

[Several hon. Members]

rose—

[Mr Speaker]

Order. The Minister of State is a resilient man. Considering that he was rendered speechless, his recovery has been both quick and complete. The House will be aware that the terms of this urgent question are narrow. I appreciate that Members may want to refer to other cases, but they must do so with reference to the specifics of the issue that has been aired from the Opposition Front Bench and by the Minister of State.

[Mr Robert Syms (Poole) (Con)]

Is not the key point that the deal will lead to better NHS services for people who live in the area of the hospital? The Minister has reassured us today that if it does not, there will be changes.

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[Mr Burns]

With regard to the hon. Gentleman, I have over the past few months been very restrained. In the light of his question, however, I shall now share with the House what was going on.

The hon. Gentleman is referring to the foundation trust status of his local hospital. A leaked document got into the public domain, but it was nothing to do with me or other Department of Health Ministers; it was an early draft of a tripartite formal agreement. What the hon. Gentleman did then—because he is an Opposition MP and he is entitled to do so—was to run a campaign in his area stating that the Tories were going to privatise his local hospital. I assured him from day one that that was utter rubbish, that there was no truth in it and that he should wait until the TFA was finally published. It was published recently, and of course there was no proposal in it to privatise the health service—[Interruption.]

[Mr Speaker]

Order.

[Mr Burns]

Can I tell you, Mr Speaker, as a final thing—[Interruption.]

[Mr Speaker]

Order. I want to hear the final bit.

[Mr Burns]

The cynicism of politicians is such that when that happened, so that no face was lost, the hon. Gentleman claimed that his campaign had been so successful that it had forced me to reverse my position.

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[Mr Burns]

The hon. Lady shakes her head, but of course she is a Member for the north-west, whereas I understand from the Under-Secretary of State for Justice, my hon. Friend the Member for Huntingdon (Mr Djanogly), who is the MP for Hinchingbrooke, that it does have an A and E. I will check and write to her immediately, and no doubt if I am right and she is wrong, she will in her charming way correct the record in due course.

[Mr Speaker]

I am grateful to the Minister and to colleagues, because everybody who wanted to question him had the chance to do so.

National Health Service

John Bercow Excerpts

Wednesday 26th October 2011 Commons Chamber

[Rosie Cooper (West Lancashire) (Lab)]

I would like to inform both my right hon. Friend and the Secretary of State that I did, in fact, write to you but have received no reply. In my letter, which I shall ensure gets to you again, I asked you to publish the minutes of that meeting. It was very clear. One or other of you have made a severe error.

[Mr Speaker]

Order. We must preserve the proper parliamentary terms. Nobody has written to me and I have not made a severe error. We will leave it at that.

[Andy Burnham]

It is clear that we will get to the bottom of this, because the Secretary of State has committed to publishing the minutes, and if he is suggesting that the RCN has been inaccurate, he needs to produce the evidence.

That takes me to the Prime Minister’s second personal promise on the NHS, which deals with hospital reconfiguration and the mythical moratorium.

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[Chris Skidmore]

On a point of order, Mr Speaker. Is it in order for the right hon. Gentleman to name my hon. Friend the Member for Bury North (Mr Nuttall) without telling him?

[Mr Speaker]

Yes, it is.

[Andy Burnham]

I point out to the hon. Gentleman, with his clever point of order, that I did contact the office of the hon. Member for Bury North and, indeed, the hon. Member for Enfield North (Nick de Bois).

[Mr Speaker]

Order. I am grateful to the right hon. Gentleman for that clarification, but perhaps this is an opportunity for me to make the position clear. I am not cavilling at the hon. Member for Kingswood (Chris Skidmore), but the position is basically this: if a Member is going to impugn the integrity or attack the record of an individual hon. Member, the Member who is the subject of the criticism should be notified in advance. The fact that someone simply intends to refer to another Member and something that may or may not have happened in his constituency during an election campaign, or at any other time, is not something of which prior notification is required.

[Andy Burnham]

After that rude interruption from the hon. Member for Kingswood (Chris Skidmore), I shall get back to my script.

Just days after the election, the Prime Minister went to Chase Farm hospital, with the Secretary of State, to announce the coalition’s new policy of the moratorium and the following commitment in the coalition agreement:

“We will stop the centrally dictated closure of A&E and maternity wards.”

I have with me the photograph from that very visit of the Secretary of State holding up a placard stating his opposition to any changes to the A and E at Chase Farm hospital. However, he has recently failed to prevent those changes to the A and E department and maternity unit at Chase Farm hospital, leaving the new hon. Member for Enfield North writing a desperate letter to the Prime Minister stating that his constituents had been utterly let down by them both. I do not know whether the Prime Minister or the Secretary of State have the decency to feel embarrassed today, hearing these cynical promises repeated in the House. The proposed moratorium and opposition to closures were purely political and designed to help the Conservatives win votes in marginal seats. That is a fact.

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15:59

Division 377

Ayes: 228

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Labour: 221
Democratic Unionist Party: 2
Independent: 2
Alliance: 1
Green Party: 1

Noes: 307

---

Conservative: 264
Liberal Democrat: 41
Democratic Unionist Party: 1

[Mr Speaker]

We come to the next matter to be debated on this Opposition day, namely the Government’s record on environmental protection and green growth.

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

On a point of order, Mr Speaker.

[Mr Speaker]

Who could neglect the hon. Member for Liverpool, Walton (Steve Rotheram)? We will deal with his point of order first.

[Steve Rotheram]

On a point of order, Mr Speaker. I should like some clarification from you because I do not know the answer to this question. When two of my constituents went through the Cromwell Green security check area, they were searched and photographed, obviously, but then a piece of paper they had with them—a pensions petition signed by the staff of Four Oaks primary school—was taken from them. When they asked why, they were told it was a security risk. Can you clarify what might have been meant by a piece of paper being a security risk? Were staff frightened that somebody might get a paper cut?

[Mr Speaker]

I am grateful to the hon. Gentleman for his point of order and for having given advance notice of his intention to raise it. I have a fertile imagination but it is stretched to the limits by an attempt to discover what on earth could be the problem here. The hon. Gentleman and others will know that some items are considered out of order for bringing into the House, but I cannot imagine why this would fall into that category. I think it only right to say that I will have a conversation and look into the matter. I know that the staff of the House always do their best, but my instant reaction is that I cannot imagine why it should have caused offence. Moreover, I cannot, off the top of my head, credit the idea that constituents of the hon. Gentleman’s coming to the House would cause offence.

Oral Answers to Questions

John Bercow Excerpts

Tuesday 18th October 2011 Commons Chamber

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

The reorganisation of NHS procurement has been described in a National Audit Office report as fragmented and poor value for money. The report shows—

[Mr Speaker]

Order. Is the hon. Gentleman inquiring about organ donation?

[Grahame M. Morris]

Sorry. I am referring to the next question.

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[David Tredinnick (Bosworth) (Con)]

Does my hon. Friend agree that many patients look to NHS Choices for accurate and unbiased information? Is he aware that its site on homeopathy is both biased and inaccurate? As the Department has had a long-standing review that has not reported, will he—

[Mr Speaker]

Order. I call the Minister.

[Paul Burstow]

If the hon. Gentleman would care to write to me setting out where he believes there are inaccuracies, we will examine them.

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[Mr Lansley]

I am grateful to my hon. Friend and completely understand what he is saying. In this financial year compared to the previous one, revenue available to Berkshire East PCT increased by £16.3 million. That is just one part of the £3.8 billion increase in revenue resources available to the NHS this year compared with last year.

Although I very much welcome the shadow Secretary of State to his new position, we will miss his predecessor. We welcome the new shadow Secretary of State not least because he might begin to explain to the NHS why he thought it was irresponsible to increase resources to the NHS in real terms by about £3.8 billion—

[Mr Speaker]

Order. I am grateful to the Secretary of State, but we have a lot to get through. He will resume his seat—and I know he will do so happily.

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[Anne Milton]

I always give my full support to midwives, but we must not forget that this is about teamwork as well. There has been an increase in the number of maternity support workers, who also play a critical role, as do the obstetricians and gynaecologists, all of whom have increased in numbers as well.

[Mr Speaker]

There is just time for Mr Andrew Rosindell.

[Andrew Rosindell (Romford) (Con)]

15. What progress he has made on reducing rates of hospital-acquired infections.

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[Mr Lansley]

I am sorry, but I think the hon. Lady should withdraw that. I have no connection with private health care companies, and if I did, I would have entered it in the register of Members’ interests.

[Mr Speaker]

I am grateful to the Secretary of State, who has put the position very explicitly on the record.

[Gordon Henderson (Sittingbourne and Sheppey) (Con)]

T2. The coalition agreement states:“Doctors and nurses need to be able to use their professional judgement about what is right for patients and we will support this by giving front-line staff more control of their working environment.” That being the case, can my right hon. Friend explain why, despite national clinical guidelines, GPs in my constituency face financial penalties if they do not meet targets for reducing the cost of the drugs that they prescribe?

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[Several hon. Members]

rose—

[Mr Speaker]

Order. I remind the House that there is intense interest, and therefore there is a premium on brevity from Back and Front Benchers alike.

[Jeremy Lefroy (Stafford) (Con)]

T4. Several of my constituents, including members of the Cure the NHS group, have raised concerns over the way in which “Do not attempt resuscitation” notices are used in hospitals. Will the Secretary of State tell the House what the NHS is doing to ensure that the national guidance is followed?

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[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

T5. In the evidence session on the Health and Social Care Bill, the Secretary of State told me that he was committed to reducing health inequalities. We also heard from the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton) on that subject a few moments ago. Will the right hon. Gentleman therefore explain why he made a political decision last December, against the advice of the Advisory Committee on Resource Allocation, to reduce the health inequalities component of primary care trusts’ target funding from 15% to 20%, in effect shifting funding from poor health areas such as my constituency to richer health areas such as his own? The Government are saying one thing—

[Mr Speaker]

Order. We have got the question.

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[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—

[Mr Speaker]

We are grateful.

[Mr Lansley]

I will not interrupt the hon. Member for Leicester West (Liz Kendall) who is replying from a sedentary position. I agree with my hon. Friend. What we heard under the Labour Government appears to be very much at odds and not at all in keeping with what we hear from the Labour Opposition now. Let me remind my hon. Friend that the South Gloucestershire primary care trust has received a cash increase of £10 million, or 3%, this year. Like every other part of England, it is receiving increases in resources this year that the shadow Health Secretary opposed.

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[Several hon. Members]

rose—

[Mr Speaker]

Order. As usual, demand has exceeded supply, and we must now move on.

Health and Social Care (Re-committed) Bill

John Bercow Excerpts

Wednesday 7th September 2011 Commons Chamber

[Nadine Dorries (Mid Bedfordshire) (Con)]

I beg to move amendment 1, page 6, line 8, at end insert—

‘(c) after paragraph (f) insert a new paragraph as follows—

“(g) independent information, advice and counselling services for women requesting termination of pregnancy to the extent that the clinical commissioning group considers they will choose to use them.”.’.

[Mr Speaker]

With this it will be convenient to discuss the following:

Amendment 2, page 6, line 8, at end insert—

‘(2A) After subsection (1) insert a new subsection as follows—

(1A) In this section, information, advice and counselling is independent where it is provided by either—

(i) a private body that does not itself provide for the termination of pregnancies; or

(ii) a statutory body.”.’.

Amendment 1221, in clause 14, page 9, line 37, at end insert—

‘( ) After paragraph 8 insert—

“Provision of independent information, advice and counselling services for women requesting a termination of pregnancy

8A (1) A local authority must make available to women requesting termination of pregnancy from any clinical commissioning group the option of receiving independent information, advice and counselling.

(2) In this paragraph, information, advice and counselling are independent where they are provided by either—

(a) a private body that does not itself refer, provide or have any financial interest in providing for the termination of pregnancies; or

(b) a statutory body.’.

Amendment 1252, page 9, line 37, at end insert—

‘( ) After paragraph 8 insert—

“Provision of advice relating to unplanned pregnancy

8A The Secretary of State must ensure that all organisations offering information or advice in relation to unplanned pregnancy choices must follow current evidence-based guidance produced by a professional medical organisation specified by the Secretary of State.”.’.

Amendment 1180, in clause 240, page 226, line 31, at end insert—

‘(1) Regulations must require NICE to make recommendations with regard to the care of women seeking an induced termination of pregnancy, including the option of receiving independent information, advice and counselling about the procedure, its potential health implications and alternatives, including adoption.

(2) The regulations must require health or social care bodies or any private body that provides for the termination of pregnancies to comply with the recommendations made by NICE under subsection (1).’.

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[Mark Pritchard]

Soubry, zip it! [Interruption.] Sorry, Mr Speaker.

[Mr Speaker]

Order. The hon. Gentleman should withdraw that remark.

[Mark Pritchard]

I withdraw it, Mr Speaker.

[Mr Speaker]

I am grateful to the hon. Gentleman. Let us try to maintain proceedings on an even keel. The hon. Gentleman has said that he is sorry, and that is fine.

[Nadine Dorries]

As I said, I do not want to look as if I am knocking abortion providers. As a nurse, I assisted with many terminations. I do not want to look as if I feel that there is no place for abortion provision. I am pro-choice and do not want to return to those other days.

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[Mr Umunna]

rose—

[Mr Speaker]

Order. It is important that the hon. Lady makes it clear to whom she is giving way.

[Nadine Dorries]

I give way to the hon. Member for Streatham (Mr Umunna).

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[Nadine Dorries]

I will not give way. The right hon. Gentleman may be interested to know—

[Mr Speaker]

Order. I apologise for interrupting the hon. Lady, but there is so much noise in the House that it is sometimes difficult to know whether somebody is seeking to intervene or standing for another purpose. Point of order, Mr Martin Horwood.

[Martin Horwood]

On a point of order, Mr Speaker. Is it in order for an hon. Member to accuse a former hon. Member of blackmail in the course of their speech? That is an accusation of a criminal offence.

[Mr Speaker]

I am grateful to the hon. Gentleman. My understanding at present is that there has been no breach of order. However, I would say to the hon. Member for Mid Bedfordshire (Nadine Dorries) and to the House that temperate language, moderation and good humour are the essential features referred to in “Erskine May”, and it is best if they inform our debates.

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[The Minister of State, Department of Health (Paul Burstow)]

I beg to move, That the clause be read a Second time.

[Mr Speaker]

With this it will be convenient to discuss the following:

New clause 10—Requirements as to transparency—

‘(1) Regulations may impose requirements on the National Health Service Commissioning Board and clinical commissioning groups for the purpose of ensuring that they are open and transparent in their decisions in commissioning health services for the purpose of the NHS.

(2) Regulations under this section may in particular impose requirements relating to—

(a) the imposition of minimum waiting times for patients,

(b) the imposition of clinical thresholds that a patient must reach before being eligible for treatment.

(3) The regulations may provide for the requirements imposed, or such of them as are prescribed, not to apply in relation to arrangements of a prescribed description.’.

New clause 11—Financial duties on clinical commissioning groups: administrative costs—

‘After section 223K of the National Health Service Act 2006 insert—

“223L Financial duties on clinical commissioning groups: administrative costs

(1) The Board must direct clinical commissioning groups to ensure that their expenditure on administrative costs does not exceed a prescribed percentage of their resource.

(2) The Board must ensure that the total national limit on clinical commissioning groups expenditure on administrative costs in any year from April 2014 does not exceed 55 per cent. of the total spent on administrative costs by primary care trusts in the financial year 2009-10.”’.

New clause 12—Secretary of State’s duty as to education and training—

‘After section 1F of the National Health Service Act 2006 insert—

“1G Secretary of State’s duty as to education and training

For the purposes of improving the quality of patient care, the Secretary of State has a duty to maintain a comprehensive, multi-professional education and training system for health professionals and to ensure the continued professional development of all staff delivering NHS services.”’.

New clause 13—Providers’ duty as to education and training—

‘For the purposes of improving the quality of patient care, all providers of services for the purposes of the health service have a duty to contribute towards the maintenance of a comprehensive, multi-professional education and training system for health professionals and to ensure the continued professional development of all their staff delivering health services.’.

New clause 14—Duties of clinical commissioning groups as to persons for whom they are responsible—

‘After section 3B of the National Health Service Act 2006 insert—

“3C Duties of clinical commissioning groups as to persons for whom they are responsible

(1) A clinical commissioning group has responsibility for persons who usually reside in the clinical commissioning group’s area.

(2) Regulations may provide that for the purposes of this section a clinical commissioning group also has responsibility (whether generally or in relation to a prescribed service or facility) for persons who—

(a) were provided with primary medical services by a person who is or was a member of the clinical commissioning group,

(b) have a prescribed connection with the clinical commissioning group’s area, or

(c) are provided with primary medical services by a member of the clinical commissioning group.

(3) The power conferred by section 3(1B)(b) must be exercised so as to provide that, in relation to the provision of services or facilities for emergency care, a clinical commissioning group has responsibility for every person present in its area.

(4) Regulations may provide that section 3(1A) does not apply—

(a) in relation to persons of a prescribed description (which may include a description framed by reference to the primary medical services with which the persons are provided);

(b) in prescribed circumstances.

(5) The duty in subsection (1) does not apply in relation to a service or facility if the Board has a duty to arrange for its provision.”.’.

New clause 16—Distribution of health service functions—

‘(1) The Secretary of State may direct the NHS Commissioning Board, or a clinical commissioning group, to exercise any of his functions relating to the health service which are specified in the directions.

(2) The functions which may be specified in directions include functions under enactments relating to mental health and care homes.’.

New clause 17—Secretary of State’s directions to health service bodies—

‘(1) The Secretary of State may give directions to any of the bodies mentioned in subsection (2) about its exercise of any functions.

(2) The bodies are—

(a) the NHS Commissioning Board; and

(b) clinical commissioning groups.

(3) Nothing in provisions made by or under this or any other Act affects the generality of subsection (1).’.

New clause 18—Care Quality Commission: duty as regards stability of existing NHS services—

‘The Care Quality Commission, in exercising its functions, must have regard to the need to avoid existing NHS services, including but not restricted to, emergency care, intensive care, chronic and complex care, teaching, training and research or case-load, becoming viable or unstable due to an unplanned reduction in income or caseload.’.

New clause 20—Clinical commissioning group commissioning work: public function—

‘The Secretary of State must issue directions to clinical commissioning groups which will ensure that commissioning work is predominantly retained as a function by staff directly employed by the clinical commissioning group.’.

New clause 23—Chief environmental health officer for England—

‘(1) The Secretary of State shall appoint a Chief Environmental Health Officer for England.

(2) The Chief Environmental Health Officer for England shall give advice to and report to the Chief Medical Officer for England on all such aspects of environmental and public health as are relevant to the public health functions referred to in section 2A of the National Health Service 2006 Act and the duties referred to in section 2B of that Act.

(3) The Secretary of State shall report to Parliament annually on the work of the Chief Environmental Health Officer for England.’.

Amendment 1222, in clause 1, page 2, line 2, leave out ‘promote’ and insert ‘provide or secure a’.

Amendment 1223, page 2, line 3, leave out from ‘must’ to ‘improvement’ in line 4 and insert ‘provide or secure a comprehensive Health Service designed to promote’.

Amendment 1239, page 2, line 4, after ‘improvement’, insert ‘and to ensure improvement’.

Amendment 1176, page 2, line 7, leave out subsection (2) and insert—

‘(2) The Secretary of State must for that purpose provide or secure the provision of services in accordance with this Act.’.

Amendment 1224, page 2, line 8, leave out ‘secure that services are provided’ and insert ‘provide or secure, either directly or indirectly, services’.

Amendment 48, page 2, Leave out lines 10 to 12 and insert—

‘(3) The services so provided must be free of charge.’.

Amendment 1174, page 2, line 10, after ‘services’, insert ‘so’.

Amendment 1175, page 2, line 10, leave out ‘as part of the health service in England’.

Amendment 1177, page 2, line 12, at end insert—

‘(4) For the purposes of this Act “the health service in England” is defined as those services provided under section 3 of this Act.’.

Amendment 1240, in clause 2, page 2, line 17, leave out ‘with a view to securing’ and insert ‘so as to ensure’.

Amendment 1241, page 2, line 23, leave out ‘with a view to securing’ and insert ‘so as to ensure’.

Amendment 1212, page 2, line 33, at end insert—

‘(5) In discharging the duty under subsection (1) the Secretary of State retains the power to create a new NHS trust or provider organisation.’.

Amendment 1169, in clause 3, page 2, line 38, leave out from ‘State’ to end of line 40 and insert ‘, so far as is consistent with the interests of the health service, must exercise the functions conferred by this Act so as to secure—

(a) that inequalities between the people of England with respect to the benefits that they can obtain from the Health service are reduced, and

(b) a continuous reduction of inequalities between the people of England with respect to the outcomes achieved for them.

‘(2) The Secretary of State must publish and lay before Parliament an annual report detailing the progress which has been achieved in discharging this duty, and the means by which the Secretary of State intends to fulfil this function in the following year.’.

Amendment 1183, page 2, line 38, leave out ‘have regard to the need to reduce’ and insert ‘act with a view to reducing’.

Amendment 1197, page 3, line 1, leave out Clause 4.

Amendment 1194, in clause 5, page 3, line 16, leave out ‘have regard to the need to’.

Amendment 1242, in clause 9, page 5, line 32, at end insert—

‘(h) promoting co-operation between each of the authority’s relevant partners.’.

Amendment 1243, page 5, line 35, at end insert—

‘(4A) For the purposes of this section each of the following is a relevant partner of a local authority—

(a) where the authority is a county council for an area for which there is also a district council, the district council;

(b) the police authority and the chief officer of police for a police area any part of which falls within the area of the local authority;

(c) a local probation board for an area any part of which falls within the area of the local authority;

(d) a youth offending team for an area any part of which falls within the area of the local authority;

(e) a clinical commissioning group for an area any part of which falls within the area of the local authority.

(4B) The relevant partners of a local authority must co-operate with the local authority in the making of arrangements under this section.’.

Amendment 5, page 5, line 43, leave out Clause 10.

Amendment 1178, in clause 11, page 7, line 15, leave out from ‘Subsections’ to ‘apply’ and insert ‘(1), (3) and (4) of section 3C’.

Government amendment 49.

Amendment 1172,  in clause 14, page 9, line 35, after ‘blood’, insert ‘, haematopoietic stem cells’.

Amendment 1173, page 9, line 37, after ‘tissue’, insert ‘, haematopoietic stem cell’.

Government amendments 50, 51 and 54.

Amendment 42, in clause 20, page 16, line 34, at end insert—

13DA Duty of the Board as to commissioning of services

In carrying out its duties in respect of the commissioning of services the Board must in the exercise of its functions have regard to the interdependency of services and the impact that the arrangements for the provision for one service may have on the financial and clinical sustainability of other services.’.

Amendment 1198, page 17, leave out lines 12 to 19.

Amendment 1184, page 17, line 21, leave out ‘have regard to the need to reduce’ and insert ‘act with a view to’.

Amendment 1185, page 17, line 23, leave out ‘reduce’ and insert ‘reducing’.

Amendment 1186, page 17, line 25, leave out ‘reduce’ and insert ‘reducing’.

Amendment 1187, page 17, line 36, leave out ‘act with a view to enabling’ and insert ‘have regard to the need to enable’.

Amendment 1188, page 18, line 4, after ‘functions’, insert ‘have regard to the need to’.

Amendment 1195, page 18, line 17, leave out ‘have regard to the need to’.

Government amendment 60.

Amendment 1203, page 19, line 28, at end insert—

13OA Duty as regards stability of existing NHS services

The Board must not exercise its functions, in particular in respect of section 13I (Duty as to patient choice) or 13K (Duty to promote innovation) in a way which could lead to existing NHS services, including but not restricted to, emergency care, intensive care, chronic and complex care, teaching, training and research, becoming unviable or unstable due to an unplanned reduction in income or case-load.’.

Amendment 46, page 22, line 12, at end insert—

‘(1A) The Secretary of State must publish guidance to the Board, to which the Board must have regard, about the exercise of its powers under subsection (1).’.

Amendment 1167, page 24, line 16, at end insert—

‘Duty to reduce bureaucracy

132ZA Duty to reduce bureaucracy

‘(1) The Board must exercise its powers so as to reduce administrative costs in the NHS.

(2) For that purpose the Board must exercise its duties under 14A and 14C to ensure that at no time there exist more clinical commissioning groups than there were primary care trusts on 1 April 2011.’.

Government amendments 67 and 68.

Amendment 1206, page 26, line 41, at end insert—

223E1 Financial duties of the Board: needs-based allotments

(1) The Board must make allotments to clinical commissioning groups based solely on the need of the population served by each commissioning group.

(2) The Secretary of State may give directions as to how the needs set within subsection (1) are determined.’.

Amendment 1218, in clause 22, page 27, line 17, at end insert ‘provided that the members of a clinical commissioning group cannot consist entirely or mainly of persons who are providers of primary medical services under section 83(2).’.

Amendment 1211, page 27, line 22, at end insert—

‘(c) shall be co-terminus with the social services local authority, unless it is notified by the relevant health and wellbeing board, and the local authority, that they approve an area which is not co-terminus.’.

Government amendments 70 and 71.

Amendment 43, in clause 23, page 34, line 20, at end insert—

14PA Duty of clinical commissioning groups as to commissioning of services

In carrying out its duties in respect of the commissioning of services each clinical commissioning group must in the exercise of its functions have regard to the interdependency of services and the impact that the arrangements for the provision for one service may have on the financial and clinical sustainability of other services.’.

Amendment 1189, page 35, line 2, leave out ‘have regard to the need to reduce’ and insert ‘act with a view to’.

Amendment 1190, page 35, line 3, leave out ‘reduce’ and insert ‘reducing’.

Amendment 1191, page 35, line 5, leave out ‘reduce’ and insert ‘reducing’.

Amendment 1192, page 35, line 22, leave out ‘act with a view to enabling’ and insert ‘have regard to the need to enable’.

Amendment 1193, page 35, line 36, after ‘functions’, insert ‘have regard to the need to’.

Amendment 1196, in clause 20, page 36, line 3, leave out ‘have regard to the need to’.

Amendment 1230, in clause 23, page 36, line 7, leave out from ‘consortium’ to ‘that’ in line 8 and insert ‘has a duty to secure’.

Amendment 1231, page 36, line 16, leave out from ‘consortium’ to ‘that’ in line 17 and insert ‘has a duty to secure’.

Amendment 37, page 36, line 36, at end insert—

14YA Duty as to conflicts of interest

(1) Each clinical commissioning group must exercise its functions so as to ensure that any conflicts of interest, and personal and prejudicial interests are dealt with.

(2) The Secretary of State must issue guidance on how conflicts of interest and personal and prejudicial interests should be dealt with by clinical commissioning groups as part of their decision making.’.

Amendment 1204, page 36, line 36, at end insert—

14YA Duty as regards stability of existing NHS services

Each clinical commissioning group must not exercise its functions, in respect of section 14U (Duty as to patient choice) or 14W (Duty to promote innovation) in a way which could lead to existing NHS services, including but not restricted to, emergency care, intensive care, chronic and complex care, teaching, training and research, becoming unviable or unstable due to an unplanned reduction in income or case-load.’.

Amendment 41, page 36, line 43, leave out from second ‘are’ to end of line 44 and insert ‘fully consulted—’.

Amendment 45, page 38, line 22, at end insert—

‘(1A) The Secretary of State must publish guidance to commissioning consortia about its exercise of powers under subsection (1), to which each commissioning consortia must have regard.’.

Amendment 1181, page 38, line 26, at end insert—

‘(3) For the avoidance of doubt it is hereby declared that nothing in this section authorises a clinical commissioning group—

(a) to disregard any enactment or rule of law, including but not limited to section 1(3), or to override any person’s contractual or proprietary rights; or

(b) to charge for anything the group does in the exercise of its powers under this section which relates to any accommodation, service or facility of a type to which section 3(1) applies; or

(c) to charge for anything in relation to the exercise of its functions under section 3 or 3A.

(4) A clinical commissioning group shall exercise the powers specified in section 7(2)(f) only after consulting (to the extent that it appears to it to be practical) any person who appears to it to have an interest through its own previous research in the ideas or intellectual property in question as to whether it should exercise them and, if so, as to any financial arrangements.

(5) A clinical commissioning group shall demonstrate in its annual report under section 14Z3 how the exercise of its power conferred by subsection (1) has not interfered to a significant extent with the performance by the group of its functions.

(6) Income raised by a clinical commissioning group as a result of the exercise of powers under this section shall be specified in its annual accounts, referred to in its annual report under section 14Z13, and paid annually to the Secretary of State.’.

Amendment 1250, page 41, line 38, at end insert—

‘(6A) If the opinion of a Health and Wellbeing Board given to the clinical commissioning group under subsection (5) is that the Health and Wellbeing Board does not consider that the draft takes proper account of each joint health and wellbeing strategy referred to in that subsection, and if the clinical commissioning group does not so consider it, the group shall inform the Health and Wellbeing Board, whereupon it may report to the Secretary of State that it does not consider that such a plan takes proper account of any such strategy and the Secretary of State may require the clinical commissioning group to carry out such further consultation with the Health and Wellbeing Board as he considers appropriate, or may make a final decision on the plan and require the Commissioning Board or the clinical commissioning group to take such action, or desist from taking such action, as he may direct.’.

Amendment 1171, page 42, line 23, at end insert—

‘(3) If in the Board’s opinion, having considered any opinion submitted to it by a Health and Wellbeing Board under 14Z12(1)(a), the plan published by the clinical commissioning group does not take proper account of each joint health and wellbeing strategy published by the Health and Wellbeing Board which relates to the period (or any part of the period) to which the plan relates, the Board must instruct the clinical commissioning group to revise its plans under 14Z10(1).’.

Amendment 1202, page 42, line 23, at end insert—

14Z12A Power of Referral of Commissioning plans to the Secretary of State

(1) If the Health and Well-being Board is of the opinion under section 14Z12(1) that a plan published by the CCG under section 14Z9(6) or 14Z10(2) and which is submitted to it in accordance with section 14Z9(6) and 14Z10(3) or 14Z11(4) or (8), does not take proper account of any relevant joint health and wellbeing strategy it may refer the matter to the Secretary of State for a decision.

(2) Regulations under this section may provide for the mechanism by which such referrals are made.’.

Amendment 38, page 43, line 9, at end insert—

‘(ab) section 14YA’.

Amendment 1199, in clause 24, page 49, line 35, leave out from beginning to end of line 37 on page 50.

Amendment 1213, page 50, line 27, at end insert ‘and must consult with local Health and Wellbeing Boards prior to any decision on this matter with a view to securing their agreement.’.

Amendment 1255, in clause 27, page 53, line 5, leave out ‘the Secretary of State’ and insert ‘Public Health England’.

Amendment 1256, page 53, line 6, leave out ‘an’ and insert ‘a suitably qualified’.

Amendment 1257, page 53, line 20, after ‘authority’, insert ‘, reporting to the Chief Executive of that authority,’.

Amendment 1253, page 53, line 21, at end insert ‘, and will be accountable to—

(a) the local authority, and

(b) the Secretary of State for Health.’.

Amendment 1258, page 53, line 21, at end insert—

‘(2A) The individual so appointed is to be employed by Public Health England, which shall have responsibility for their professional qualification and development.’.

Amendment 1259, page 53, line 30, after ‘authority’, insert ‘or Public Health England’.

Amendment 1254, page 53, line 42, leave out ‘consult’ and insert ‘obtain the agreement of’.

Amendment 1260, page 53, line 42, leave out ‘the Secretary of State’ and insert ‘Public Health England’.

Amendment 7, in clause 29, page 54, line 30, at end insert—

‘(3) This section comes into force on a date to be specified by order by the Secretary of State.

(4) The time specified in subsection (3) must be after such time as the Secretary of State is satisfied that the workforce education and training functions of strategic health authorities are being fulfilled by another body.’.

Amendment 1237, page 256, line 31, leave out Clause 299.

Amendment 1238, page 257, line 29, leave out Clause 300.

Amendment 47, in clause 304, page 261, line 19, at end insert—

‘(1A) Section 29 comes into force in accordance with sections 29(3) and (4).’.

Amendment 1245, in schedule 2, page 269, line 21, leave out from ‘consortium’ to end of line 24.

Amendment 1244, page 269, leave out lines 25 to 29 and insert—

‘(3) The arrangement must include provision for the functions of the clinical commissioning group to be exercised by, and only by, its employees on its behalf.’.

Amendment 1249, page 269, leave out line 29.

Amendment 1234, page 269, line 29, at end insert—

‘(4) Nothing in paragraph (3) shall authorise the inclusion of any provision for any of such functions to be exercised by—

(a) any of the clinical commissioning group’s members who hold or benefit from contracts to provide primary medical services under section 83(2); or

(b) individuals who have been employees of such members; or

(c) by a governing body, committee or sub-committee which consists entirely or mainly of such members.’.

Government amendments 292 to 299.

Amendment 1170, in schedule 4, page 278, leave out lines 35 and 36 and insert—

‘(a) omit “Strategic Health Authorities” and insert after “(a)”— “the National Health Service Commissioning Board”, and

(b) omit “Primary Care Trusts” and insert after “(b)” — “Clinical Commissioning Groups”.’.

Amendment 1247, page 281, line 10, at end insert—

‘(2A) Regulations made under this section must specify that—

(a) direct payments can not be made in respect of the whole or part of a course of private health care or in respect of insurance premiums which have the purpose of providing healthcare, and

(b) direct payments can only be made in respect of services which NICE has specified are services that can be provided by the health service, having particular regard to safety, efficacy and cost-effectiveness.’.

Amendment 1248, page 281, line 23, at end insert—

11A In section 12C (Direct payments pilot schemes) omit subsection (8).’.

Amendment 31, in schedule 23, page 417, leave out lines 18 to 21.

Amendment 32, page 418, line 34, leave out lines 5 to 8.

Health and Social Care (Re-committed) Bill

John Bercow Excerpts

Tuesday 6th September 2011 Commons Chamber

Consideration of Bill, as amended in the Public Bill Committee

[Mr Speaker]

Before the House embarks on the Bill, it may help if I deal with a matter that has been raised with me concerning the 715 virtually identical Government amendments changing the phrase “commissioning consortia” to “clinical commissioning groups”. These are the fourth group on today’s selection list. It has never been the practice of the House or its Committees to allow a single global amendment to make a series of identical or very similar amendments. The rule that any substantive change to the text of the Bill must be done by an amendment is designed for the protection of the rights of all Members and the integrity of the legislative process. I do understand that in this case it leads to a particularly bulky amendment paper. The fact that a practice is long-standing does not, in my view, mean that it is sacrosanct. Any hon. Member who wishes is of course free to ask the Procedure Committee to inquire into this matter. I hope that that is helpful.

I should also inform the House that amendment 781, which is printed on page 2985, should appear on page 3051, and amendments 945 and 946, which are printed on page 3138, should appear on page 3068. That has no material effect on today’s proceedings, but I know that the House will have wanted me to share those crucial nuggets of information with it.

[Sir Peter Bottomley (Worthing West) (Con)]

On a point of order, Mr Speaker. The House will have noted your comments about the repetitive amendments. Are we to take it that we have to go through quite a lengthy procedure in order just to be able to list the places where the words would be substituted? Is it not possible—is it not in your power or that of the Leader of the House—to make the change without having to go through weeks and weeks of Committees and other consideration? I do not necessarily need an answer now, but that is a consideration to which I would have thought a reforming Speaker might have found a solution.

[Mr Speaker]

I thought that I had found a very satisfactory way forward—one that should appease the hon. Gentleman and perhaps mollify him, putting him in a better frame of mind. There will be a grouping. If he is inquiring of me whether a separate Division will be required to give effect—

[Sir Peter Bottomley]

indicated dissent.

[Mr Speaker]

The hon. Gentleman is shaking his head from a sedentary position to indicate that that is not the burden of his proposition, in which case I am not sure what is. I can nevertheless assure him that no separate Division will be required. I think that at the end of our proceedings he will be in the good humour to which we know he is accustomed.

[Sir Peter Bottomley]

Further to that point of order, Mr Speaker. The point was the one that you have made, which is that the amendment has to be repeated, with different pages and lines. I suggest that an amendment might be tabled setting out a list of the pages and lines where it applied.

[Mr Speaker]

What I am saying is what I have already said, which is that there is no provision for a global amendment. An amendment is required to be made in each case. That does not entail a separate Division or what the hon. Gentleman in his first point of order described with some trepidation as a “lengthy procedure”. There will be no requirement for a lengthy procedure. Ministers seem sanguine; so am I—so, I think, should the House be. Perhaps we can now proceed to the business before us.

New Clause 2

Conditions relating to the continuation of the provision of services etc.

‘(1) The things which a licence holder may be required to do by a condition under section 104(1)(i)(i) include, in particular—

(a) providing information to the commissioners of services to which the condition applies and to such other persons as Monitor may direct,

(b) allowing Monitor to enter premises owned or controlled by the licence holder and to inspect the premises and anything on them, and

(c) co-operating with such persons as Monitor may appoint to assist in the management of the licence holder’s affairs, business and property.

(2) A commissioner of services to which a condition under section 104(1)(i), (j) or (k) applies must co-operate with persons appointed under subsection (1)(c) in their provision of the assistance that they have been appointed to provide.

(3) Where a licence includes a condition under section 104(1)(i), (j) or (k), Monitor must carry out an ongoing assessment of the risks to the continued provision of services to which the condition applies.

(4) Monitor must publish guidance—

(a) for commissioners of a service to which a condition under section 104(1)(i), (j) or (k) applies about the exercise of their functions in connection with the licence holders who provide the service, and

(b) for such licence holders about the conduct of their affairs, business and property at a time at which such a condition applies.

(5) A commissioner of services to which a condition under section 104(1)(i), (j), or (k) applies must have regard to guidance under subsection (4)(a).

(6) Monitor may revise guidance under subsection (4) and, if it does so, must publish the guidance as revised.

(7) Before publishing guidance under subsection (4) or (6), Monitor must obtain the approval of—

(a) the Secretary of State, and

(b) the National Health Service Commissioning Board.’. —(Mr Lansley.)

Brought up, and read the First time.

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

I beg to move, That the clause be read a Second time.

[Mr Speaker]

With this it will be convenient to discuss the following:

Government new clause 6—Objective of trust special administration.

Amendment 10, page 83, line 5, leave out part 3.

Amendment 1225, in clause 57, page 83, line 13, leave out ‘monitor’ and insert ‘Integrated Health Service Regulator (elsewhere referred to in this Bill as “Monitor”)’.

Amendment 1226, in clause 58, page 83, line 20, at end insert ‘and

(c) is sufficiently integrated so as to reduce any risk to patient care and to provide continuity of service.’.

Amendment 1207, page 83, line 23, after ‘preventing’, insert ‘competitive or, as the case may be,’.

Amendment 1227, in clause 59, page 84, line 42, at end insert ‘bearing in mind that it should be balanced with ensuring the protection of health service integration.’.

Amendment 1228, page 85, line 2, at end insert—

‘(3A) “Integration”, in relation to health services, means the provision or commissioning of health services in a manner to ensure the viability of the full range of health and social care facilities which a community might reasonably expect from the NHS, including the provision of complex and commercially less attractive and difficult to provide emergency and other acute services which require to be provided on a site or in a manner which benefits from its collaboration with other acute health specialities or services.’.

Government amendment 87.

Amendment 1205, in clause 61, page 86, line 14, at end insert—

‘(n) the need to avoid existing NHS services, including but not restricted to, emergency care, intensive care, chronic and complex care, teaching, training and research, becoming unviable or unstable due to an unplanned reduction in income or case-load.’.

Government amendment 90.

Amendment 1208, in clause 70, page 92, line 7, after ‘in’, insert ‘competitive or, as the case may be,’.

Amendment 1209, page 92, line 8, at end insert—

‘(d) protect and promote the integration of health services and health and social care services,

(e) improve the equality of access to NHS services and healthcare outcome,

(f) do not undermine the stability of existing NHS services, including but not restricted to, emergency care, intensive care, chronic and complex care, teaching, training and research.’.

Amendment 1229, page 92, line 8, at end insert—

‘(d) do not act in a manner which risks undermining the viability of maintaining essential or designated core health services or the essential integration between health services.’.

Amendment 1219, in clause 74, page 94, line 22, leave out subsections (1) to (3) and insert—

‘(1) Part 3 of the Enterprise Act 2002 (mergers) applies (in so far as it would not otherwise) where two or more enterprises have ceased to be distinct enterprises and specifically the activities of one or more NHS foundation trusts and the activities of one or more businesses have ceased to be distinct activities.’.

Amendment 1220, page 94, line 29, leave out ‘subsections (2) and (3)’ and insert ‘subsection (1)’.

Government amendments 91 to 107.

Amendment 28, page 117, line 22, leave out clause 110.

Government amendments 113 to 115.

Amendment 44, in clause 119, page 123, line 30, at end insert—

‘(10A) A description for the purposes of subsection (9)(b) may be framed by reference to—

(a) the level of workforce training undertaken by the provider, and

(b) the extent to which the provision of its service leads to consequential costs for other providers.’.

Government amendments 116 to 136.

Amendment 29, in clause 130, page 132, line 34, at end insert—

‘(5AA) Regulations under this section must ensure that where transfers of property or liabilities occur, they can only be transferred to another NHS body.’.

Government amendments 137 to 164.

Amendment 30, in clause 134, page 136, line 26, leave out ‘licence holder’ and insert ‘NHS body’.

Government amendments 165 to 180.

Amendment 19, page 156, line 38, leave out clause 166.

Government amendments 181 to 184.

Amendment 1166, page 159, line 2, leave out clause 167.

Government amendments 185 to 187.

Amendment 20, page 163, line 14, leave out clause 176.

Government amendments 188 to 217.

Amendment 8, page 168, line 6, leave out clause 182.

Government amendment 218.

Amendment 9, page 168, line 39, leave out clause 183.

Government amendments 219, 220 and 366 to 372.

[Mr Lansley]

Our plans for modernising the NHS are focused not only on improving the quality of care of patients today, but on ensuring that the NHS is fit to face the challenges of tomorrow—to ensure that the NHS is always there, always improving and always based on the needs of patients, not their ability to pay. Parts 3 and 4 of the Bill are an integral part of achieving that aim. They take forward our commitment to protecting patients’ interests, by establishing a comprehensive system of regulation in part 3, and to promoting high quality services, by supporting all NHS trusts to become foundation trusts in part 4.

The regulatory framework that we inherited from the previous Government simply did not do enough to protect patients. It lacked a way to protect patients’ interests in relation to all types of provider. The previous Government set up two regulators—Monitor for foundation trusts and the Care Quality Commission—but forgot, or neglected, to create an explicit link between the two. They also left independent providers outside much of that regulatory oversight. We have proposed the development of Monitor as a health sector-specific regulator, establishing equivalent safeguards to protect patients’ interests in relation to all types of provider.

By contrast, let us look at Labour’s proposed amendment—amendment 10, in this group—which would delete all of part 3. That would leave the NHS in a position in which inconsistent regulation as between NHS trusts and foundation trusts undermined accountability and performance, in which independent providers were not regulated effectively, in which the Labour Government’s preferential treatment of independent sector providers could carry on, and in which politicians would continue to second-guess regulatory decisions, creating a double jeopardy for providers. On the Government side of the House, however, we recognise the needs of the NHS. We recognise the fact that patients’ interests must be protected, irrespective of the type of organisation providing their NHS services, in a clear, consistent, transparent framework.

These parts of the Bill have been scrutinised in the Bill’s two Committee stages and by the NHS Future Forum. I should like once again to thank Professor Steve Field and the members of the NHS Future Forum for their work in making recommendations on how to improve our plans. We then took those recommendations forward in the recommittal stage. As a result of the listening exercise, we made changes to introduce stronger safeguards, to ensure that fears of a market free-for-all could not happen. Monitor’s core duty has been changed to make it clear that it is there to protect and promote patients’ interests, and that it will not be required to promote competition as if that were an end in itself.

--- Later in debate ---

[Several hon. Members]

rose—

[Mr Speaker]

Order. Four Members are seeking to catch my eye, and I should like to give the person who moved the new clause a couple of moments to speak. Members can do the arithmetic for themselves.

Oral Answers to Questions

John Bercow Excerpts

Tuesday 12th July 2011 Commons Chamber

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

Has the Secretary of State had an opportunity to pause, reflect and listen to the NHS foundation trusts, particularly North Tees and Hartlepool NHS Trust, which serves part of my area, given the uncertainties created by the Health and Social Care Bill and the difficulties that they are encountering in raising capital for new build and modernisation? In particular, will he indicate what consideration he has given to detailed safeguards?

[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.

Southern Cross Care Homes

John Bercow Excerpts

Tuesday 12th July 2011 Commons Chamber

[Several hon. Members]

rose—

[Mr Speaker]

Order. I thank the Minister for his statement, which was very informative, but he significantly exceeded his time. I will therefore allow the shadow Minister slightly more than her two minutes so that there is equity between the two sides. I emphasise for the future, however, that answers to urgent questions must be of the prescribed length, and the same goes for questions from now on.

[Emily Thornberry]

I thank the Minister for his response to my urgent question. Yesterday’s Southern Cross announcement that responsibility for managing 752 homes will pass back to the 80 landlords who own them has created a vacuum. I was interested to hear him say that that was part of a managed process, because it does not look like that—it has been a source of terrible uncertainty and great anxiety among residents and families. We have had so little information.

I am grateful for the information that the Minister has given today, but we need much more. Can the Government publish a list of all 80 landlords, or are the rumours correct that some of them have yet to be identified? Yesterday it was further announced that control of 250 of the homes would be handed back to the landlords immediately. We need to know which homes they are so that people living in them know who is running their home. Many of these landlords have little or no experience of running care homes. Does he have any information on the intentions of property companies such as London and Regional homes, which owns 90 former Southern Cross homes, or Prestbury, which owns 21?

I understand that the Association of Directors of Adult Social Services is doing its best to support its members, who will have a key role in ensuring that the operating companies can provide good quality care, and also that local authorities know how to perform financial stress tests to ensure that the new businesses have sound financial models, but what assistance is the Minister giving? Does he intend to provide additional resources to hard-pressed local authorities in order to help them? What advice can he give to local authorities if, for example, the new company is an offshore company? If the Department of Health does not have the expertise to assist ADASS, will he give that organisation access to officials from the Department for Business, Innovation and Skills, who might be able to provide that assistance?

Presumably, the new operators taking control of the homes will need to be registered with the Care Quality Commission—the Minister has assured us that that will happen—but given the staff shortages at the CQC will he assure us that the registrations will be completed quickly? The House has heard him guarantee that the new operators will honour the previous terms and conditions of the 44,000 employees, but how does that square with the announcement of 3,000 job losses? Does he know how many homes are likely to close and what the timetable is for such closures? What will happen to the 50 former Southern Cross homes owned by Lloyds properties, which is in administration? What about NHP, which owns 250 former Southern Cross homes and which is at a standstill with its bondholders? These problems must be addressed. We need a home-by-home plan from the landlords, and he must give us that plan. The buck stops with him. Will he now accept his responsibilities?

--- Later in debate ---

[Paul Burstow]

It really is not a question of financial assistance; it is about the co-ordination of the Association of Directors of Adult Social Services and the Department’s regional directors of social care, who are working with those colleagues at local authority level, and about making sure that they are co-ordinating their activity with the Care Quality Commission. All those things are happening, have been happening and will continue to happen to ensure that we do what the Government are committed to doing—ensuring continuity of care and that people can stay in the homes they are currently in with the knowledge that the Government really are committed to making sure that they have no doubt that they are not going to be thrown out on the streets as a consequence of this business’s restructuring.

[Mr Speaker]

I am grateful to the Minister of State and to colleagues.

Reform of Social Care

John Bercow Excerpts

Monday 4th July 2011 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

I welcome the Dilnot report’s many practical suggestions, which will be very important in Devon because it has the highest level of retired people—22%. With regard to the need for any new funding proposal to cover a range of different provision, given the change in relation to when people need to go into residential care, the contracting will need to be looked at carefully. Does the Secretary of State agree that if we are to have contracts, they need to be standardised? For example, the contracts that councils enter into with care homes are not standard, so although in theory they offer the same quality of care—

[Mr Speaker]

Order. I am extremely grateful to the hon. Lady, but I think that that is an excellent subject for her to pursue in an Adjournment debate, and I feel sure that she will.

[Mr Lansley]

There is the nub of a very good question there. If we develop greater national consistency in eligibility and in assessment, we might also start to engender greater consistency in quality, including the contracting that supports it.

--- Later in debate ---

[Mr Lansley]

I am grateful to my hon. Friend for asking that question, and I will, indeed, join her—and, I am sure, the whole House—in expressing our support for those who care for their relatives. It is absolutely vital work, and we should understand and support it. As my hon. Friend will know, my right hon. Friend the Secretary of State for Work and Pensions is currently reforming welfare, and he has made it clear that although carer’s allowance does not form part of universal credit, it is important for us to continue to understand how it should in future meet its aim of supporting carers.

[Mr Speaker]

I am grateful to the Secretary of State and all colleagues who participated.

Musculoskeletal Diseases

John Bercow Excerpts

Monday 4th July 2011 Commons Chamber

[Graham Stringer (Blackley and Broughton) (Lab)]

The genesis of this debate was four reports into musculoskeletal disorders from about two years ago. The first was from the National Audit Office, one was the King’s college report, there was another from the umbrella organisation, the Arthritis and Musculoskeletal Alliance, and the final one was the clinical advice from the National Institute for Health and Clinical Excellence. Those four reports led to an excellent debate in Westminster Hall on 19 January 2010 at column 1WH of the Official Report. I advise the Minister to take a look at that hour and a half debate in which many more points were made than—[Interruption.]

[Mr Speaker]

Order. I apologise for interrupting. There are Members behind the Chair making a frightful racket and it should not happen. They should leave the Chamber and show some courtesy to the Member who is developing his speech. I apologise to the hon. Gentleman who should now resume.

[Graham Stringer]

Thank you, Mr Speaker.

Many more points were made in that debate than it is possible to make in a half hour debate in this Chamber. What the then Government were essentially being asked was to take action to ensure better clinical outcomes for the money being spent on musculoskeletal disorders. The real ask from the community was for a clinical director or so-called tsar. In a sense, however, the most important ask is not that, but that there is an outcome strategy that improves the outcome for people suffering from musculoskeletal disorders. In many ways, in spite of those four reports and the debates that have taken place since, the situation nationally remains much the same. The statistics are worth going through in some detail. The amount of money spent on musculoskeletal disorders is large—£4.76 billion, which is the fourth-largest category spend within the NHS. That money is spent on 25% of the population as one in four people have a musculoskeletal disorder. That is 9.6 million adults and 12,000 children. Many people think that arthritis and rheumatism affect only older people, but that is not true. They can affect people of any age, as is perfectly illustrated by the fact that 12,000 children suffer from it. In terms of costs, the magnitude of the issue is that one visit in every four to a general practitioner concerns musculoskeletal disorders and 10.8 million working days are lost because of such disorders.

Those are the statistics. The problem is that there is no equality of outcome and no sense that when money is put into the system outcomes improve. About two years ago, partly in response to the reports, the previous Government put £600 million more into the system, but there was no noticeable improvement in outcomes. The NHS atlas of variation shows a threefold difference in spending in different parts of the country, but it does not relate to differences in incidence, prevalence or severity of the problem; nor does it necessarily relate to better outcomes. Although there is a threefold difference generally, the difference for rheumatoid arthritis is five times, for hip replacements 14 times, cemented hips 16 times and for uncemented hips it is 30 times. Clearly something unusual is happening in that area of the service and it requires examination.

Quite simply, current services do not ensure swift treatment of arthritis, which in many cases is vital. I shall give an example from one category of disorder: rheumatoid arthritis. People think it is the same as any other arthritis but it is not; it is an auto-immune disease and few people suffer from it. Many GPs see only one new case every year or so, which is surprising but true. Because GPs do not see such cases regularly, patients often have to visit their GP about three times before they receive treatment, but early treatment is vital. The time before treatment means not only pain but also that the rheumatoid arthritis is not cured. Since a third generation of drugs—the biologics—has been developed, the disease is curable in a large number of cases if treatment is given quickly enough. Even if the disease is not curable, what matters is getting the patient to a multidisciplinary team of physiotherapists, consultant surgeons, doctors and community nurses as quickly as possible.