Points of Order
John Bercow Excerpts(13 years, 6 months ago)
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Hilary Benn (Leeds Central) (Lab)
On a point of order, Mr Speaker. We have today, for the second week in a row, had a written statement, followed by a prime ministerial press conference, followed by an oral statement. Last week it was on the Health and Social Care Bill, today it was on sentencing and legal aid. It is pretty unusual to have two statements on the same subject on the same day, but do you share my concern that it is discourteous to the House, because it means that the media have a chance to question Ministers on policy—the Prime Minister in the last two cases—before Members of this House get the chance to ask questions? As such, it is not in keeping with the spirit of our rules.
Mr Speaker
I thank the right hon. Gentleman for his point of order and for notice of it. I have made clear my view that important announcements of policy should be made first to this House, with the opportunity of questioning Ministers. Although I understand the pressures of the 24/7 news agenda, that remains my firm view. I am therefore uneasy at sequences of events in which a written ministerial statement is followed, or even preceded, by briefing outside the House, with the opportunity to question Ministers in the House by means of an urgent question or following an oral statement coming only some time later.
The House will recall that, on 20 July last year, it asked the Procedure Committee to consider whether the rules of the House should be changed. The Committee reported in February, and the Government’s reply was published a month ago. There are thus matters awaiting resolution by the House itself. In the meantime, the right hon. Gentleman may be assured that I will remain vigilant in the House’s interests, and will be ready to use my powers to permit questioning or debate if I see fit to do so, and indeed for such period as I see fit. I hope that is helpful.
Mr Peter Bone (Wellingborough) (Con)
Further to that point of order, Mr Speaker. I wish to show that there are concerns on both sides of the House, and to tell the shadow Leader of the House that I did not think he went far enough. Last night on Sky News, Jon Craig reported not only the detail of the statement but the media schedule. The policy was also reported in this morning’s newspaper. That clearly cannot be in order under current practices.
Mr Speaker
I note what the hon. Gentleman has said, and I think that the House will have noted it as well. I do not think I need to add to what he has said, but I am nevertheless grateful to him.
Helen Jones (Warrington North) (Lab)
On a point of order, Mr Speaker. We shall shortly be considering a very important motion on the recommittal of the Health and Social Care Bill, and I understand that the Secretary of State for Health is not going to be here to move it and be questioned on it. Have you had any communication from the Secretary of State about his presence or otherwise, or has he simply resigned or gone out looking for another job before he is pushed?
Mr Speaker
I am grateful to the hon. Lady for her point of order. I would simply say that no, I have had no indication on that matter. Of course, she and I came into the House together in 1997, and she will be as aware as I am that precisely who moves motions on the part of the Government is a matter for the Government. I think I know the Minister who is going to move the motion, and if he wants to respond he is perfectly welcome to do so. He is under no obligation, but he may.
The Minister of State, Department of Health (Mr Simon Burns)
Further to that point of order, Mr Speaker. It might help you and the hon. Member for Warrington North (Helen Jones) if I point out that the precedents for recommittals are not that common, but that if one looks at the previous recommittal, it was done in 2003, by the then Minister of State, one Mr Tony McNulty.
Mr Speaker
I am grateful to the Minister of State. I think that we will leave that as a no-score draw or a score draw, as the case may be. I am happy to take any further points of order, but if the House’s appetite has been satisfied, we will move on.
Bill Presented
Legal Aid, Sentencing and Punishment of Offenders Bill
Presentation and First Reading (Standing Order No. 57)
Mr Secretary Kenneth Clarke, supported by the Prime Minister, the Deputy Prime Minister, Mr Chancellor of the Exchequer, Mrs Secretary May, Mr Secretary Lansley, the Attorney-General and Mr Jonathan Djanogly, presented a Bill to make provision about legal aid; to make further provision about funding legal services; to make provision about costs and other amounts awarded in civil and criminal proceedings; to make provision about sentencing offenders, including provision about release on licence or otherwise; to make provision about bail and about remand otherwise than on bail; to make provision about the employment, payment and transfer of persons detained in prisons and other institutions; to make provision about penalty notices for disorderly behaviour and cautions; and to create new offences of threatening with a weapon in public or on school premises.
Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 205) with explanatory notes (Bill 205—EN).
Southern Cross Healthcare
John Bercow Excerpts(13 years, 6 months ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Mr Speaker
Order. By my reckoning the hon. Lady posed three questions, but I know that there will be an immaculate and beautifully tailored single reply from the Minister.
Paul Burstow
Thank you very much, Mr Speaker.
I can assure the hon. Lady that, first and foremost, clear arrangements are in place to deal with a catastrophic failure, which I think is now increasingly unlikely. More importantly, we need to ensure that we learn lessons from past care home closures and take them into account in future. However, we can also be clear that the underlying viability of this business is very strong indeed. We need care homes, and that is why we now have a route towards a solvent restructuring of the business.
Mr Speaker
Order. I will of course ask the Minister to provide a brief reply, as I know he will be happy to do, but we must focus on the very specific question of Southern Cross. This is not a general debate, whatever the temptations experienced by the hon. Gentleman.
Paul Burstow
In the spirit in which the question was asked, if the hon. Gentleman were to write to me I would be only too happy to consider his request.
Mr Speaker
Order. I am keen to accommodate remaining colleagues, but may I remind them of the merits of brevity?
Ian Lavery (Wansbeck) (Lab)
Thank you, Mr Speaker.
Residents in the six Southern Cross care homes in my constituency will be horrified by the Minister’s opening remarks. He said that this is a commercial problem to be dealt with by the commercial sector, which is absolutely outrageous and will frighten the wits out of each of those 31,000 residents. This is a society problem, and it should be dealt with by the Government. What small crumbs or words of comfort can he give to people in my constituency? When will we stop abusing elderly people and using them as marketplace commodities?
NHS Future Forum
John Bercow Excerpts(13 years, 6 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
With permission, Mr Speaker, and further to the written ministerial statement I laid in the House earlier today, I wish to make a statement on the Government’s response to the NHS Future Forum.
We established the independent Future Forum on 6 April, under the chairmanship of Professor Steve Field, to look again at our proposals on the modernisation of the NHS. Yesterday it published its report and recommendations. I would like to thank Professor Field and his 44 senior colleagues from across health and social care who have worked so hard these past eight weeks. I would also like to thank more than 8,000 members of the public, health professionals and representatives from some 250 stakeholder organisations who attended some 250 events across the country—and also the tens of thousands who wrote to us with their views. I want also, if I may, to thank the many officials in my Department who supported this unprecedented engagement across the country.
Two months ago, I said to the House that we would pause, listen, reflect and improve our plans. Our commitment to engage and improve the Bill has been genuine and has been rewarded with an independent, expert and immensely valuable report and recommendations from the Future Forum. I can tell the House that we will ask the forum to continue its work, including looking at the implementation of proposals in areas including education and training and public health.
In his report, Professor Field set out clearly that the NHS must change if it is to respond to challenges and realise the opportunities of more preventive, personalised, integrated and effective care. The forum said that the principles of NHS modernisation were supported: to put patients at the heart of care, to focus on quality and outcomes for patients, and to give clinicians a central role in commissioning health services.
The forum set out to make proposals for improving the Bill and its implementation, to provide reassurance and safeguards, and to recommend changes where needed. As Professor Field put it, it did this not to resist change, but to embrace it, guided by the values of the NHS and a relentless focus on the provision of high-quality care and improved outcomes for patients.
We accept the NHS Future Forum’s core recommendations. We will make significant changes to implement those recommendations and, in some cases, offer further specific assurances that have been sought. There are many proposed changes and we will publish a more detailed response shortly. However, I would now like to tell the House some of the main changes that we will make.
The Bill will make it clear that the Secretary of State has a duty to promote a comprehensive health service, as in the National Health Service Act 1946, and is accountable for securing its provision and for the oversight of the national bodies charged with doing so. We will also place duties on the Secretary of State to maintain a system for professional education and training within the health service, and to promote research.
One of the most vital areas of modernisation to get right is the commissioning of local services. For commissioning to be effective, the process of designing services must draw on a wide range of people, including clinicians, patients and patient groups, carers and charities. We will amend the Bill so that the governing body of every clinical commissioning group will have at least two lay members, one focusing on public and patient involvement and the other overseeing key elements of governance, such as audit, remuneration and managing conflicts of interest. Although we should not centrally prescribe the make-up of the governing body, it will have to include at least one registered nurse and one secondary care specialist doctor. To avoid any potential conflict of interest, neither should be employed by a local health provider. The governing bodies will meet in public and publish their minutes. The clinical commissioning groups will also have to publish details of all their contracts with health service providers.
To support commissioning, the independent NHS commissioning board will host “clinical senates”, which will provide expert advice on the shape and fit of health care across wider areas of the country. Existing clinical networks will be developed and will advise on how specific services, such as those for cancer, stroke or mental health, can be better designed to provide integrated and effective care.
Building on that multi-professional involvement, clinical commissioning groups will have a duty to promote integrated health and social care with regard to the needs of their users. To encourage greater integration between social care and public health, the boundaries of clinical commissioning groups should not normally cross those of local authorities. If they do, clinical commissioning groups will need to demonstrate to the NHS commissioning board a clear rationale for doing so in terms of benefit to patients.
I have always said that I want there to be “no decision about me, without me” for patients when it comes to their care. The same—[Interruption.]
Mr Lansley
Thank you very much, Mr Speaker.
We will further clarify the duties on the NHS commissioning board and clinical commissioning groups to involve patients, carers and the public. Commissioning groups will have to consult the public on their annual commissioning plans and involve them in any changes that would affect patient services.
One of the main ways in which patients will influence the NHS is through the exercise of informed choice. We will amend the Bill to strengthen and emphasise the commissioners’ duty to promote patient choice. The choice of any qualified provider will be limited to areas where there is a national or local tariff, ensuring that competition is based solely on quality. The tariff development, alongside a best-value approach to tendered services, will safeguard against cherry-picking.
Monitor’s core duty will be to protect and promote the interests of patients. We will remove its duty to promote competition as though that were an end in itself. Instead, it will be under a duty to support services integrated around the needs of patients and the continuous improvement of quality.
It will have a power to tackle specific abuses and restrictions of competition that act against patients’ interests. Competition will be a means by which NHS commissioners are able to improve the quality of services for patients.
We will keep the existing competition rules introduced by the last Government—the so-styled “Principles and rules for co-operation and competition”—and give them a firmer statutory underpinning. The co-operation and competition panel, which oversees the rules, will transfer to Monitor and retain its distinct identity. We will also amend the Bill to make it illegal for the Secretary of State or the regulator to encourage the growth of one type of provider over another. There must be a level playing field.
We will strengthen the role of health and wellbeing boards in local councils, ensuring that they are involved throughout the commissioning process and that local health service plans are aligned with local health and wellbeing strategies.
In a number of areas, we will make the timetable for change more flexible to ensure that no one is forced to take on new responsibilities before they are ready, while enabling those who are ready to make faster progress. If any of the remaining NHS trusts cannot meet foundation trust criteria by 2014, we will support them to achieve that subsequently. However, all NHS trusts will be required to become foundation trusts as soon as clinically feasible, with an agreed deadline for each trust.
We will ensure a safe and robust transition for the education and training system. It is vital that change is introduced carefully and without creating instability, and we will take the time to get it right, as the Future Forum has recommended. During the transition, we will retain postgraduate deaneries and give them a clear home within the NHS family.
The extension of “any qualified provider” will be phased carefully to reflect and support the availability of choice for patients. Strategic health authorities and primary care trusts will cease to exist in April 2013. By that date, all GP practices will be members of either a fully or partly authorised clinical commissioning group, or one in shadow form. There will be no two-tier NHS.
However, individual clinical commissioning groups will not be authorised to take over any part of the commissioning budget until they are ready to do so. Individual GPs need not take managerial responsibility in a commissioning group if they do not want to, and April 2013 will not be a “drop dead” date for the new commissioners. Where a clinical commissioning group is not able to take on some or all aspects of commissioning, the local arms of the NHS commissioning board will commission on its behalf. Those groups that are keen to press on will not in any way be prevented from becoming fully authorised as soon as they are ready.
I told the House on 4 April that we would secure proper scrutiny for any changes that we made to the Bill. In order to do that without trespassing on the House’s time to review the Bill as a whole on Report, we will ask the House to recommit the relevant parts of the Bill to a Public Bill Committee shortly.
Through the recommendations of the NHS Future Forum and our response, we have demonstrated our willingness to listen and to improve our plans; to make big changes, and not to abandon the principles of reform, which the forum itself said were supported across the service. However, we are clear that the NHS is too important, and modernisation too vital, for us not to be sure of getting the legislation right. The service can adapt and improve as we modernise and change, but the legislation cannot be continuously changed. On the contrary, it must be an enduring structure and statement, so it must reflect our commitment to the NHS constitution and values and incorporate the safeguards and accountabilities that we require. It must protect and enhance patients’ rights and services, and it must be crystal clear about the duties and priorities that we will expect of all NHS bodies and local government in the future.
Professor Field’s report says that it is time for the pause to end. Strengthened by the forum’s report and recommendations, we will now ask the House to re-engage with delivering the changes and modernisation that the NHS needs. I commend this statement to the House.
Mr Speaker
Order. The Opposition Front-Bench team should not be yelling at the Secretary of State when he is answering. [Interruption.] Order. On both sides of the House, right hon. and hon. Members, whatever the passions they feel, need to simmer down just a little. A fine example of that calm and stoicism can now be provided by the right hon. Member for Holborn and St Pancras (Frank Dobson).
Frank Dobson (Holborn and St Pancras) (Lab)
Does the Secretary of State recognise that forcing the national health service to start implementing his changes before the law had been changed has resulted in vast expense to the NHS, in chaos to services and in the diversion of NHS staff from the treatment of patients? Does he also recognise that just cobbling together a few amendments to the Bill will not make things better but worse? Will he not recognise—[Interruption.]
Mr Speaker
Order. I ask the right hon. Gentleman to finish his sentence. We must press on.
Mr Speaker
Order. I will have the question finished. I do not require any help from any Member.
Frank Dobson
Does the Secretary of State not recognise that pretending to produce a collaborative silk purse from a competitive pig’s ear will not work?
Mr Speaker
Order. I want to say two things. First, questions and answers must focus on the policy of the Government. That is the parliamentary position, and Members know it. Secondly—[Interruption.] Order. Secondly, I want to accommodate the level of interest in this statement, but Members must help me to help them, by being brief.
Mr Ben Bradshaw (Exeter) (Lab)
In fact, the last Labour Government left record low waiting times and record levels of public satisfaction with the NHS. I welcome the fact that Professor Steve Field has said what many of us in the Opposition have been saying for at least a year. How much has this year’s shambles cost the NHS, and how much has it damaged patient care?
Mr Speaker
Order. May I remind the House that Members who came into the Chamber after the Secretary of State began his statement should not expect to be called?
Mr Kevin Barron (Rother Valley) (Lab)
The Secretary of State must know that the biggest threat to the stability of the national health service is the introduction of competition law into clinical services. Will the clause that says that the mergers of NHS trusts will be a matter for the Office of Fair Trading and the Competition Commission be removed from the Bill?
Grahame M. Morris (Easington) (Lab)
What can we conclude from the fact that the Prime Minister is not here with us this afternoon to support the Secretary of State, but is involved in a PR stunt at Guy’s and St Thomas’ NHS Foundation Trust? It was once said on the other side of the Atlantic that you could put lipstick on a pig, but at the end of the day it was still a pig. Is that not true of the Bill?
Mr Speaker
Order. We are starting to get involved in issues perhaps not of order, but certainly of taste.
Mr Lansley
If you will forgive me, Mr Speaker, I do not think that I will favour that question with an answer.
Gavin Barwell (Croydon Central) (Con)
I welcome the revised proposals, in particular the focus on competition not as an end in itself but on informed—[Interruption.]
Mr Speaker
Order. I apologise for having to interrupt the hon. Gentleman. Whatever feelings the hon. Member for Blyth Valley (Mr Campbell) entertains in relation to the Liberal Democrats, who seem unlikely to feature on his Christmas card list, I urge him to exercise what modicum of self-restraint he can muster in the circumstances.
Gavin Barwell
Thank you, Mr Speaker.
I welcome the focus not on competition as an end in itself, but on informed patient choice to improve patient care. Can my right hon. Friend confirm that, unlike the Opposition, the Government believe that NHS patients in my constituency deserve the best that the public, private and voluntary sectors can offer them?
Mr Speaker
Order. I remind the House of the wise stipulation in “Erskine May” that moderation and good humour are the defining features of parliamentary language.
Mr Lansley
In that spirit I thank the hon. Gentleman for the generosity of his remarks and encourage him likewise to apologise for the performance of a Labour Government in Wales who are cutting the NHS budget by 5% and seeing the performance of health care in the NHS in Wales deteriorate considerably relative to that in England.
Mr Lansley
I have made it very clear that the impact assessment set out that we expect the total cost of the reorganisation—these figures will be revised because of the changes—to be about £1.4 billion, but that it will deliver recurring savings of £1.7 billion a year, leading to something approaching a £5 billion net saving in administration costs over the life of this Parliament.
Mr Speaker
I am grateful to the Secretary of State. All 65 Back-Benchers who stayed in the Chamber and sought to catch my eye were successful in doing so. I hope that the House’s inquisitorial appetite has been satisfied on this matter, at any rate for today. I was going to come to the ten-minute rule motion, but not before we have entertained a point of order from the hon. Member for Rhondda (Chris Bryant)—nothing new there.
Oral Answers to Questions
John Bercow Excerpts(13 years, 6 months ago)
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Mr Lansley
The right hon. Gentleman asked about performance last year. I told him what the financial performance was. Let me also make it clear that, for example, for hospital in-patients, referral to treatment waiting time has gone down from 8.4 weeks in May 2010 to 7.9 weeks in the latest figures in March, and for out-patients the figure has gone down from 4.3 weeks in May 2010 to 3.7 weeks in the latest figures, so waiting times have improved. We have established the cancer drugs fund, with more than 2,500 patients benefiting from that. We have published and driven down the number of breaches of the single sex accommodation rules: a 77% reduction in those breaches, which Labour never achieved. In the last year we have reduced the number of MRSA infections in hospitals by 22% and C. difficile infections by 15%. I applaud the NHS—
John Healey
The Secretary of State mentioned a lot of things, but I notice that he did not mention the Prime Minister’s five new guarantees. [Interruption.] The Secretary of State shakes his head as if they do not matter, but perhaps he was not consulted on them. People have seen the Prime Minister make and then break promises on the NHS before, but this time he is breaking his pledges as he is making them. The King’s Fund says that waiting times are going up and the Nuffield Trust says that health funding is being cut in real terms. Privatisation, the break-up of integrated care and the removal of national standards at the heart of the health service are exactly what his health Bill is designed to do. Is that not why MORI shows public concern about the NHS rising rapidly and why people are right to conclude that they cannot trust the Tories on the NHS?
Mr Speaker
Order. The Minister will want to focus on GP commissioning of integrated cancer services.
Paul Burstow
I am grateful for that advice, Mr Speaker. The hon. Lady’s remark was one that she might have made from the Back Benches when the Labour party was in power, but which it never listened to when in government. On GP commissioning consortia, we believe that it is important that consortia have access to the right expertise to be able to commission effectively both clinicians from other parts of the health economy and other expertise from the voluntary sector. That should be possible and we think that it is how we can improve commissioning in the NHS.
Karl MᶜCartney
I thank the Secretary of State for that answer. Will my right hon. Friend reassure me, and my Lincoln constituents, that whatever the outcome of the Government’s consultation, our NHS still requires some measure of reform—and that if a provider is qualified to deliver NHS standards at NHS costs, and if patients, with the support of their doctor, want to be treated there, this Government should do nothing to stand in their way, regardless of any political posturing by our flip-flopping coalition partners? [Hon. Members: “ Ooh!”] And further to—
Mr Speaker
Order. I apologise for having to interrupt the hon. Gentleman, but topical questions must not be statements or essays; they must be very brief questions. I think we have got the thrust of his question, and we are grateful to him.
Mr Lansley
Through the listening exercise and in response to the report of the NHS Future Forum, which we hope to see shortly, we hope to be able further to strengthen the principles of the Bill and its implementation of the White Paper, so that patients can share in decisions about their care and access the services that give them the best quality. That includes, in many instances, patients having access to a choice of providers as well.
Care Services (Older People)
John Bercow Excerpts(13 years, 6 months ago)
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Mr Speaker
Order. Before the hon. Member for Eastbourne (Stephen Lloyd) begins his speech, may I appeal to Members who are leaving the Chamber to do so quickly and quietly?
Stephen Lloyd
Thank you, Mr Speaker.
As an officer in the all-party parliamentary group for ageing and older people and an active member of the all-party parliamentary group on dementia, and as the Member of Parliament representing Eastbourne and Willingdon, an area that contains nearly 25,000 people over the age of 65, I called for this debate because the current system of care for older people is in crisis. The recent awful and shocking exposé by the “Panorama” programme is a desperate indictment of the worst in care provision, but it would be a naive mistake to believe that there are no other examples of bad practice out there. The growing age profile means that any Government will face difficult challenges for many years to come, and despite the growing demand, care provision has faced years of austerity with almost no net spending increase.
There are currently 291,000 people in residential and nursing homes in the United Kingdom, along with 6 million carers who allow people to live in their own homes. That means that an extremely large proportion of the United Kingdom’s population is directly affected by care service provision. Those who work in social care, or who care for someone on a voluntary basis, are the backbone of our society. They are the unsung heroes whose voices often go unheard, not least because they are simply too preoccupied with the enormousness of the task in hand.
A number of my colleagues who are present this evening will probably focus on several areas of care that affect older people, but I will focus mainly on dementia and on care service provision for dementia sufferers. I look forward to hearing the Minister’s response.
Future of the NHS
John Bercow Excerpts(13 years, 7 months ago)
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John Healey
When the hon. Gentleman reads his next edition of Pulse, he will see my correction of that report, and note that the first five paragraphs were all reported and contained no quotes from me. He ought to know that after a survey by the British Medical Association found that more than half of doctors believed that they would spend less time with their patients as a result of these changes, the chairman of the BMA council, Dr Hamish Meldrum, said:
“This survey shows that the government can no longer claim widespread support among doctors as justification for these flawed policies.”
It is not the five clauses that set up the GP consortia that cause the most concern. It is the 85 clauses that set up the NHS as a full-scale market, and it is part 3 of the Bill, which opens up all areas of the NHS to private health companies; removes requirements for proper openness, scrutiny and accountability to the public and to Parliament; allows NHS hospitals to go bust and face a commercial insolvency scheme; places the judgment of the new competition regulator—just like those for gas and electricity—at the heart of decisions about the future of the NHS; and, for the first time, makes the NHS subject to the full force of UK and European competition law. That means that, in the long term, we will see clinical planning in the NHS being replaced by market competition, service integration being replaced by corporate cherry-picking, public accountability being replaced by commercial confidentiality and the public ethos at the very heart of our NHS being replaced by the profit motive.
I agree with the Deputy Prime Minister that no Bill is better than a bad one, but I say to him that this is a bad Bill. That is why we have opposed it from the outset, and that is why we say that it must be shelved in its current form and that radical changes must be made. For us, for the NHS and for NHS patients, this is the test of the Prime Minister’s promise to protect the NHS. I commend the motion to the House. [Interruption.]
Mr Speaker
Order. The Prime Minister’s Parliamentary Private Secretary should be setting a good example to others. I call the Secretary of State for Health.
Mr Lansley
My right hon. Friend made that point when he chaired the Public Accounts Committee, and it should silence Labour Members, because the Public Accounts Committee has said exactly the same thing since the election under the chairmanship of the right hon. Member for Barking (Margaret Hodge)—that productivity in the NHS declined consistently under Labour.
Let me make clear that if we are going to make—[Interruption.]
Mr Speaker
Order. The House is in a very excitable state. The issues are of the highest importance and they provoke strong feelings, but the debate must be conducted in an orderly way, and the Secretary of State is entitled to a decent hearing.
Mr Lansley
Thank you, Mr Speaker.
I remember Labour’s scaremongering during the election about cancer waits, for example, but in 13 years in government they never actually looked at cancer survival rates. They never looked at the results for patients. It took this Government to publish the first outcomes strategy for cancer, which made clear that what matters to patients—
Mr Speaker
Order. I am going to try to be helpful to the hon. Member for Easington (Grahame M. Morris). When a Minister gives no indication of giving way, a Member must not simply stay on his or her feet. The situation is clear: the Secretary of State is not giving way at the moment. Once again, I appeal for the restoration of some sort of calm. The Secretary of State should be heard with a degree of civility—[Interruption.] Order. I ask Members to reflect on how our proceedings are regarded by members of the public whose support we sought not that long ago.
Mr Lansley
Thank you, Mr Speaker.
The principles we are pursuing are simply stated as
“a greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes”.
The right hon. Member for Wentworth and Dearne will no doubt recognise those words, because they are his own from January, when he said that he supported the general aims of our reform.
We are already delivering on our vision. We are extending patient choice and involving patients more in decisions about their care. We are cutting back Labour’s waste and reducing the bureaucracy that stifles and undermines doctors and nurses. We are putting clinicians at the heart of commissioning, with almost 90% of the country now covered by new pathfinder consortia.
We are driving down hospital-acquired infections, sustaining and improving the performance of the NHS, stopping Labour’s arbitrary box-ticking and focusing on the outcomes that matter. We have a world-leading framework for the results that matter to patients: reducing avoidable mortality; enhancing recovery after treatment; improving quality of life for those with chronic conditions; maximising safety and cutting the number of infections; and continually improving patients’ experience of their health care. Those are the outcomes for which we and the NHS will be accountable.
Let me be clear: there will be substantive changes to the Bill to deliver improvements for patients. There is only one issue for me, however: will it deliver better care for patients? That is why we will pursue NHS modernisation and why we will stick to our principles. It is why we are listening to improve the Bill. That is what the coalition Government are committed to. Today, led by the NHS future forum, we are engaging with the health service and beyond to ensure that the legislation delivers on those principles.
Unlike the Labour party, which has retreated to its union-dominated, regressive past, we will not retreat. We will be progressive with those principles. Just last week, the right hon. Gentleman called for a return to Labour’s top-down targets and for GPs to be stripped of all their financial responsibility. He has called for the NHS to be run by a bureaucracy, not by doctors and nurses. Critics of the Bill must answer this question: if they do not want patients, doctors and nurses to be in charge of the NHS, then who do they want to be in charge?
The right hon. Gentleman has turned his back on two decades of NHS modernisation. We will never accept the Labour party’s prescriptive, top-down bureaucracy or its waste. We did not accept Labour’s plan, which would have meant taking £30 billion out of the NHS in England over this Parliament and we will not follow the route that the Labour party in Wales has taken, where it is cutting the NHS. Instead, we are increasing the NHS budget over this Parliament by £11.5 billion. We will equip the NHS to deliver better and improving services by using more resources more effectively. We will empower patients with information and with choice. We will empower doctors and nurses to shape services for their patients. We will bring together the NHS, public health and social care in a combined local strategy. We will make the NHS genuinely locally led, while meeting national standards. We will focus relentlessly on the quality and outcomes we achieve for patients. We will protect the NHS and strengthen it. We will do that not by living in the past, but by modernising for the future. We want a modern service that is true to its core values. The Labour party’s motion offers no future for the NHS. We on the Government side will give the NHS a stronger future, and I urge the House to reject the Labour party’s motion.
Mr Speaker
Order. There is extensive interest in speaking in this debate, as a result of which I have imposed a seven-minute limit on each Back-Bench contribution.
Oral Answers to Questions
John Bercow Excerpts(13 years, 7 months ago)
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Richard Drax (South Dorset) (Con)
Will the Minister confirm whether funds will be held by the consortia or the GPs in the practices, because there is confusion among GPs in my constituency of South Dorset on that point?
Mr Speaker
With reference to the discussions that have been held with the Welsh Assembly Government.
Anne Milton
I am grateful, Mr Speaker. I was going to make that point. Although Dorset is a long way from Wales, I assure the hon. Gentleman that GPs will not have the money in their personal bank accounts.
Liz Kendall (Leicester West) (Lab)
Last year, the Prime Minister made a very clear pledge to protect front-line NHS services. Will the Secretary of State confirm that in the run-up to next year’s Olympics, which will bring around 1 million extra people to the capital, the London ambulance service is cutting 560 front-line staff? Will the Secretary of State also confirm that nationally, A and E waits of more than four hours are up 65%, that the number of patients waiting more than six weeks for their cancer test has doubled, and that more patients are waiting for longer than 18 weeks than at any time in the last two years? Will he now admit that the Prime Minister’s pledge to protect front-line care is unravelling even faster than the Secretary of State’s chaotic Health and Social Care Bill?
Mr Speaker
There were three questions there, but I know that the Secretary of State will provide a characteristically succinct reply.
Mr Lansley
Thank you, Mr Speaker. None of those questions reminded the House that the Labour party wanted to cut the budget of the NHS, nor that in Wales, a Labour-led Welsh Assembly Government are cutting the NHS budget in real terms—there is no increase at all.
Let me tell the hon. Lady that waiting times in the NHS are, on average, nine weeks for patients who are admitted and three and a half weeks for those who are not admitted. That is broadly stable.
The hon. Lady will know that the chief executive of the London ambulance service, Peter Bradley, has made it clear that the ambulance service, like the NHS, needs to maintain front-line services while continually improving efficiency. That will happen in the ambulance service and it will happen right across the NHS.
Mr Burns
I should like to reassure my hon. Friend. As he will know, we do not propose to introduce price competition into the NHS; rather, we propose to introduce competition based on quality. His clinicians are correct that the price will be the same. However, they must remember that we are going to stop the practice of the last Government, who, with independent sector treatment centres, paid the private sector over 11% more per operation than they were prepared to pay the national health service.
Mr Speaker
I thought that the hon. Gentleman wanted to come in on this question. That is what I have been told, but never mind: we will wait to hear his dulcet tones in due course.
Helen Goodman (Bishop Auckland) (Lab)
15. Whether he has made an assessment of the effectiveness of the 111 non-emergency number; and if he will make a statement.
Mr Lansley
As my hon. Friend knows, we intend health and wellbeing boards to bring together HealthWatch, plus councillors, commissioning bodies and providers, as part of the process of local representation, so that we can link up NHS commissioning with public health and social care, to see how they collectively meet the joint strategic needs assessment led by the local authority.
Mr Speaker
I apologise to the hon. Member for Kingston upon Hull North (Diana Johnson). The change of mind on the part of the Opposition Front Bench fazed me, for which I apologise. The hon. Member for Halton (Derek Twigg) wants his opportunity to ask a question, and he should have it.
Derek Twigg
Thank you, Mr Speaker. I think there was some confusion between questions 13 and 16.
We obviously want to see important improvements to the Bill, including the deletion of part 3, which drives competition to the heart of the NHS, and of clause 150, which removes the private patients’ income cap. I also want to ask the Secretary of State a specific question. On 16 March, during the Bill’s passage through the House, the Prime Minister said to the Leader of the Opposition:
“Perhaps he would like to…support our anti-cherry-picking amendment.”—[Official Report, 16 March 2011; Vol. 525, c. 292.]
Will the Secretary of State tell us whether it is still the Government’s policy to table such an amendment in this House, or whether they intend to do so at a later stage?
Mr Lansley
As I said earlier, when we have completed this process of listening and reflecting, we will table amendments to the Bill. I will tell the House about them then, just as I told them on 4 April that we were going to go through this process. Let me make it clear that we are intending not to allow cherry-picking. We intend to make it absolutely clear to the private sector or anybody else that they must not be able to compete with the NHS on uneven terms because, actually, that is what the last Labour Government did. Under that Government, we ended up with £250 million being spent on operations in private hospitals that never took place because of the poor nature of the private sector provision that they put in place. We are not introducing competition into the NHS through this Bill. Why does the hon. Gentleman suppose that the last Labour Government set up the competition and co-operation panel, if not—
Diana Johnson (Kingston upon Hull North) (Lab)
17. How much funding he plans to allocate to local authorities in order to perform their new public health duties in each of the next three years.
Mr Speaker
Order. I am sorry to disappoint colleagues but as is so often the case, demand has exceeded supply and we must now move on.
NHS Reform
John Bercow Excerpts(13 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Andrew Lansley)
With permission, Mr Speaker, I should like to make a statement about NHS modernisation. Modernisation of the national health service is necessary, is in patients’ interests and is the right thing to do to secure the NHS for future generations. The Health and Social Care Bill is one part of a broader vision of health and health services in this country being among the best in the world; world-leading measurement of the results we achieve for patients; patients always experiencing “No decision about me without me”; a service where national standards and funding secure a high-quality, comprehensive service available to all, based on need and not the ability to pay; and where the power to deliver is in the hands of local doctors, nurses, health professionals and local communities.
The House will know that the Bill completed its Committee stage last Thursday. I was also able to announce last week that a further 43 GP-led commissioning consortia had successfully applied to be pathfinder commissioning groups. We now have a total of 220 groups representing 87% of the country; that is 45 million patients whose GP surgeries are committed to showing how they can further improve services for their patients. In addition, 90% of relevant local authorities have come forward to be early implementers of health and well-being boards, bringing democratic leadership to health, public health and social care at local level.
That progress is very encouraging. Our desire is to move forward with the support of doctors, nurses and others who work in the NHS and make a difference to the lives of so many of us, day in and day out. However, we recognise that the speed of progress has brought with it some substantive concerns, expressed in various quarters. Some of those concerns are misplaced or based on misrepresentations, but we recognise that some of them are genuine. We want to continue to listen to, engage with and learn from experts, patients and front-line staff within the NHS and beyond and to respond accordingly. I can therefore tell the House that we propose to take the opportunity of a natural break in the passage of the Bill to pause, listen and engage with all those who want the NHS to succeed, and subsequently to bring forward amendments to improve the plans further in the normal way. We have, of course, listened and improved the plans already. We strengthened the overview and scrutiny process of local authorities in response to consultation, and we made amendments in Committee to make it absolutely clear that competition will be on the basis of quality, not price. Patients will choose and GPs will refer on the basis of comparisons of quality, not price.
Let me indicate some areas where I anticipate that we will be able to make improvements, in order to build and sustain support for the modernisation that we recognise is crucial. Choice, competition and the involvement of the private sector should only ever be a means to improve services for patients, not ends in themselves. Some services, such as accident and emergency or major trauma services, will clearly never be based on competition. People want to know that private companies cannot cherry-pick NHS activity, undermining existing NHS providers, and that competition must be fair. Under Labour, the private sector got a preferential deal, with £250 million paid for operations that never happened. We have to stop that. People want to know that GP commissioning groups cannot have a conflict of interest, are transparent in their decisions, and are accountable not only nationally, but locally, through the democratic input of health and well-being boards. We, too, want that to be the case. People want to know that the patient’s voice is genuinely influential, through HealthWatch and in commissioning. Doctors and nurses in the service have been clear: they want the changes to support truly integrated services, breaking down the institutional barriers that have held back modernisation in the past.
As I told the House on 16 March, we are committed to listening, and we will take every opportunity to improve the Bill. The principles of the Bill are that patients should always share in decisions about their care; that front-line staff should lead the design of local services; that patients should have access to whichever services offer the best quality; that all NHS trusts should gain the freedoms of foundation trust status; that we should take out day-to-day political interference, through the establishment of a national NHS commissioning board and through strong independent regulation for safety, quality and effectiveness; that the public’s and patients’ voices must be strengthened; and that local government should be in the lead in public health strategy. Those are the principles of a world-class NHS which command widespread professional and public backing. All those principles will be pursued through the Bill, and our commitment as a coalition Government to them is undiminished.
We support and are encouraged by all those across England who are leading the changes nationally and locally. We want them to know that they can be confident in taking this work forward. Our objective is to listen to them and support them, as we take the Bill through. No change is not an option. With an ageing and increasing population, new technologies and rising costs, we have to adapt and improve. Innovation and clinical leadership will be key. We want to reverse a decade of declining productivity. We have to make productive care and preventive services the norm, and we must continue to cut the costs of administration, quangos and bureaucracy. The House knows my commitment to the national health service and my passion for it to succeed. To protect the NHS for the future must mean change—not in the values of the NHS, but through bringing forward and empowering leadership in the NHS to secure the quality of services on which we all depend.
Change is never easy, but the NHS is well placed to respond. I can tell the House today that the NHS is in a healthy financial position. Waiting times remain at historically low levels, as promised under the NHS constitution. Patients with symptoms of cancer now see a specialist more quickly than ever before. MRSA is at—[Interruption.]
Mr Lansley
MRSA is at its lowest level since records began. We have helped more than 2,000 patients have access to new cancer drugs that would previously have been denied to them. All that is a testament to the excellent work of NHS staff up and down the country, and we thank them for their efforts to achieve these results for their patients. The coalition Government are increasing NHS funding by £11.5 billion over this Parliament, but the service cannot afford to waste any money. We can sustain and build on those improvements only by modernising the service to be ever more efficient and effective with taxpayers’ money.
The Bill is a once-in-a-generation opportunity to set the NHS on a sustainable course, building on the commitment and skills of the people who work for it. Our purpose is simple: to provide the best health care service anywhere in the world. I commend this statement to the House.
Mr Lansley
I am sorry that the right hon. Gentleman should denigrate what staff in the NHS have achieved over the past year. He will not have read the deputy chief executive’s report on NHS activity, which shows improvements in breast screening rates, improvements in bowel screening rates—[Interruption.]
Mr Speaker
Order. I apologise for interrupting the Secretary of State. I recognise that this subject inflames passions and that there are very strongly held views about it, but there is too much noise on both sides of the Chamber. I gently say to the hon. Members for Middlesbrough South and East Cleveland (Tom Blenkinsop) and for Kingston upon Hull East (Karl Turner) that they should cease to yell at the Secretary of State from a sedentary position. It is very unseemly.
Mr Lansley
Thank you, Mr Speaker. I shall not go through a long list, but many services in the NHS have improved and continue to improve. Our objective is very clear: it is to support that improvement, including improvement in waiting times. For example, last year the median wait in January for non-admitted patients was 4.8 weeks, whereas last year it was 4.9 weeks. For diagnostic tests, the average wait this year is 1.6 weeks, exactly the same as last year. Meanwhile, many other factors are continuing to improve as well.
Oral Answers to Questions
John Bercow Excerpts(13 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Speaker
I am grateful to the Minister of State. My sense is that the hon. Member for Copeland (Mr Reed) is seeking a meeting. The Minister is perfectly at liberty to say more if he wishes, or if he does not think it is worth it, he does not have to do so.
Mr Speaker
Wise owl is the kindest description that the hon. Gentleman has ever offered of me. I shall take it that he means it. It’s the best I’ll get.
Mr Marcus Jones (Nuneaton) (Con)
5. What recent progress he has made on the introduction of GP commissioning consortia.
Mr Lansley
I can tell the right hon. Gentleman and the House exactly what we are doing. We are increasing the budget for the NHS by £10.7 billion over the next four years, contrary to what the Opposition told us they would do and what a Labour-led Assembly Government in Wales are doing. They are cutting the NHS budget in real terms.
Let me take one example. The number of hip operations in the first half of this financial year was 41,863, whereas in the previous period it was 39,114, and waiting times are stable, so the right hon. Gentleman’s assertion simply is not true. We are delivering an improving quality of care.
Let me give the right hon. Gentleman another example. As the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), said, not only are waiting times stable but infections are going down, with a reduction of 29% in C. diff rates and 35% in MRSA rates in our hospitals. Safer, higher-quality care—
Mr Speaker
Order. I am very grateful, but from now on we do need briefer answers—[Interruption.] No, we need briefer answers, because I want to accommodate Back-Bench Members. It is about them that I am concerned.
Philip Davies (Shipley) (Con)
T2. I believe that the introduction of plain packaging for cigarettes would be gesture politics of the worst kind, that it would have no basis in evidence and that it would simply be a triumph for the nanny state—and an absurd one at that. Given that, does the Secretary of State believe that I am still a Conservative, and if so, is he?
Health and Social Care Bill
John Bercow Excerpts(13 years, 10 months ago)
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Angie Bray (Ealing Central and Acton) (Con)
My right hon. Friend will be aware that there has recently been an excellent reorganisation of stroke treatment in London, with a number of hospitals earmarked as emergency centres, all of which, crucially, are within 30 minutes of every Londoner. Once patients have been through the emergency procedures and are stabilised, they are returned to local stroke centres, which are also earmarked as part of the whole programme. Can he reassure me that that kind of regional organisation of hospitals, which has delivered good results, will not suffer through some of the proposed reforms?
Mr Speaker
Order. I remind Members that interventions should be short. There are 57 Members seeking to speak in the debate, so interventions must be pithy.
Mr Lansley
Thank you, Mr Speaker. I can give my hon. Friend the Member for Ealing Central and Acton (Angie Bray) precisely that reassurance. I was with NHS London at the beginning of last week, and it is clear that GP commissioning groups are coming together with providers to develop those kinds of commissioning plans, going beyond trauma and stroke care, which has already happened in London, to look, for example, at the integration of diabetes care between primary care and hospital services.
Under the Bill, patients will come first and will be involved in every decision about when, where, by whom, and even how, they are treated—“there must be no decision about me, without me.” The 2002 Wanless report called for patient engagement, but that did not happen. Now it will. Because patients cannot be empowered without transparent information, an information revolution will give them more detailed information than ever before, showing them and their doctors the consultants who deliver the best care, giving them control over their own care records and enabling everyone to access the care they need at the right place and at the right time. Patients and their doctors and nurses will be able to see clearly which health care provider offers the best outcomes and to make their decisions accordingly.
Henry Smith
Had the Bill been law 10 years ago, Crawley hospital would not have lost accident and emergency and maternity services. It seems that my hon. Friend thinks the same about hospital services in his constituency.
Mr Speaker
Order. The hon. Member for Enfield North (Nick de Bois) is being generous in giving way, but I remind him that the Front-Bench winding-up speeches begin at 9.39 pm.
Nick de Bois
Thank you, Mr Speaker.
For years, we have suffered from a lack of local accountability in the health service. The Bill delivers that accountability. For the health service, the Bill is evolutionary, building on the successes and correcting the failures of the past, and leading to improved outcomes. This revolutionary Bill decentralises power to local people.