NHS White Paper

Stephen Dorrell Excerpts

Monday 12th July 2010 Commons Chamber

[Mr Lansley]

I am just astonished that the shadow Secretary of State seems to have gone to the barricades for the primary care trusts. The primary care trusts and strategic health authorities are organisations that, under his watch as Secretary of State—for about a year—increased their management costs by 23%. In the year for which he was in charge, they spent £261 million on management consultants. Before the election, when it had a majority of Labour Members, the Select Committee on Health said that PCT commissioning was weak and that it was not delivering what was intended. He set up a programme called world class commissioning—it never worked. Central to delivering better commissioning in the health service is ensuring that those people who incur the expenditure—the general practitioners, on behalf of their patients—and who decide about the referral of patients are the same people who, through the commissioning process, determine the shape of the services in their area. It is more accountable.

How often have all of us, on both sides of the House, asked Labour Ministers about what primary care trusts are doing locally in terms of service change only to be told, “It’s nothing to do with us; it’s all happening locally”? We are going to be very clear about the accountability. One thing that the coalition programme has enabled us to do, as two parties bringing our programmes together, is to strengthen the accountability to local authorities. Local authorities, through their strategies that mesh NHS services, public health and social care, will ensure that major service changes and the design of services reflect the interconnection between those things. Those who have complaints and problems will be able to have them addressed through HealthWatch and through their local authority. We will be able, through local authorities, to ensure that the commissioning support to GP commissioning consortiums can be more effective.

The shadow Secretary of State talked about the Commonwealth Fund. I do not know whether he has even read the Commonwealth Fund report, but it said that the UK health care system was the second worst on hospital-acquired infections, that the UK delivers the poorest level of patient-centred care and that, on outcomes, we performed the second worst overall on mortality amenable to health care.

The right hon. Gentleman stood up and said that cancer mortality rates have improved. They have—since the 1970s, and all over the world. However, the issue is where we stand in relation to the rest of the world. If we were to meet the European average on cancer survivals, 5,000 more people would live each year rather than die. If we were to do the best in Europe, 10,000 more would live each year. For stroke, the figure is 9,000. We have to measure ourselves on the outcomes relative to the other health systems that are comparable to ours.

Nine years ago, the right hon. Gentleman’s Prime Minister, Tony Blair, said that we must spend as much as Europe. Through this White Paper and the reforms that we will bring in, we are determined to achieve results for patients that are at least as good as those in the rest of Europe. It is not just about inputs and spending, but about the results we achieve. The right hon. Gentleman, on behalf of his party, has just abandoned the reforms that his Prime Minister, Tony Blair, put forward. In 2006, Tony Blair said that we must have patient choice, practice-based commissioning, the independent sector and foundation trusts—reforms that Labour failed to deliver and, indeed, undermined. We, as a coalition Government, are now determined to put those reforms in place to deliver results for patients.

[Mr Stephen Dorrell (Charnwood) (Con)]

I congratulate my right hon. Friend on setting out a clear vision for the NHS that is committed to high-quality outcomes for patients and good value for money for the taxpayer. Does he agree that the delivery of that objective depends critically on effective commissioning? Does he recall that the last Labour Government said that engaging GPs with the commissioning process was the key to success? Does he recall that the White Paper setting out the plan for practice-based commissioning said that GP commissioning was not a new idea to the NHS? Indeed, it is not. He is to be congratulated on holding out the prospect that, at last, this idea can be made good and made powerful in the interests of patients.

[Mr Lansley]

I am grateful to my right hon. Friend for his comments. In his capacity as the Chairman of the Select Committee on Health, we will be responding to him very shortly regarding the Select Committee’s report from before the election on commissioning in the NHS. What he has just said is absolutely right; we have to be able—this is a central task in commissioning—to bring together the responsibility for the management of patient care with the responsibility for the commissioning of services. The current situation is akin to a shopping trolley being pushed to the checkout while the primary care trust is standing there with a credit card, bleating about whether things should be taken out of the trolley. We have to ensure that the design of services follows the best clinical leadership in terms of the services that are required for patients. He and I very much agree on precisely that objective.