NHS (Private Sector)

Stephen Dorrell Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

I agree that the cap varied according to historical levels of private sector activity within the different trusts. The hon. Gentleman is absolutely right about that, but he must agree that it was clearly defined in respect of every individual NHS hospital. They had a clear number and local people were able to hold them to account for that number. Where hospitals had large numbers, the cap froze their level of activity at the level when the cap was introduced.

[Mr Stephen Dorrell (Charnwood) (Con)]

Just to be clear, could the right hon. Gentleman explain why it is in the interests of NHS patients in a particular hospital for that hospital’s capacity to generate additional revenue from the private sector to be limited by a cap?

[Andy Burnham]

I will explain that very clearly. I am sure the right hon. Gentleman will have read the impact assessment to the Bill, which warns of the risk of lengthening NHS waiting lists if existing capacity is made available to private patients. It says that if additional capacity is provided, there might be no effect on NHS waiting lists. That is why this is dangerous, because all the progress that Labour made on reducing long NHS waits would be put at risk by the careless and cavalier policy of simply abandoning the principle of the cap, which has stood us in good stead.

[Mr Dorrell]

rose—

[Mr Simon Burns]

rose—

[Andy Burnham]

I shall give way to the Chairman of the Select Committee on Health once more and then to the Minister.

[Mr Dorrell]

I apologise to my right hon. Friend on the Front Bench. Could the right hon. Gentleman explain more clearly than he has so far why a hospital should reduce capacity at the same time as it is increasing revenue?

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[Mr Stephen Dorrell (Charnwood) (Con)]

It is a pleasure to follow the hon. Member for Easington (Grahame M. Morris). He and I are both members of the Health Committee and, surprisingly perhaps, we more often find ourselves in agreement about the objectives that we are trying to deliver than is obvious from the nature of the debates across the Floor of the House.

I shall focus my remarks on the speech by the shadow Health Secretary. I have some quite good news for him—he was a far better Secretary of State than he himself appears now to believe. As Secretary of State, he did not allow himself to fall victim to the kind of prejudices that have been ventilated this evening. Tonight, he fell into the old trap of eliding two concepts and pretending that they are the same. The two concepts are, on the one hand, privatising the health service, and on the other, involving the private sector in the improvement of care available to patients. As Secretary of State, he was well able to distinguish between those two concepts and pursued policies of involving the private and voluntary sector when there were opportunities to improve care for patients. He now prefers to forget the fact that during his time as a Minister we not only heard plans for involving the private sector in improving the care delivered to patients but saw an open-minded attempt to bring in the private sector to improve the process of commissioning in the health service. That was what world-class commissioning was designed to deliver. We are now asked to turn our mind away from all those ideas.

I, like my right hon. Friend the Secretary of State, am in favour of tax-funded care for patients. I am in favour of equitable access to high-quality care, like my right hon. Friend the Secretary of State and like the shadow Health Secretary. I am also, however, in favour of plural provision, looking for the best solution for patients and the best value for taxpayers. In that respect, I am, as the shadow Health Secretary used to be but apparently no longer is, a straightforward Blairite. This was the breakthrough that Tony Blair taught the Labour party that it now appears to have forgotten. It was Tony Blair who advocated the introduction of private hospitals into the delivery of care and Tony Blair who stressed the importance of the third sector in finding new ways of improving care for patients, yet it is now my right hon. Friend the Secretary of State who has to pick up the Blairite torch that has been so unceremoniously dropped by the shadow Health Secretary.

It is worth reflecting, is it not, on whether this Blairite consensus is the inevitable consequence of the principle of commissioning—

[Andy Burnham]

Will the right hon. Gentleman give way?

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[Mr Dorrell]

I would be delighted to.

[Andy Burnham]

If the policy that the Secretary of State is pursuing is a continuation of our policy in government, why do the Government need many hundreds of pages of legislation and a new Bill?

[Mr Dorrell]

The right hon. Gentleman is in danger of creating another consensus. Indeed, there is a debate about whether the Bill moves things forward as far as the rhetoric suggests. I am on the record many times saying that the claims made for the Bill by, if I am honest, both the Government and the Opposition spokesmen are grossly overstated. It introduces greater engagement by clinicians in commissioning and greater engagement by local authorities in commissioning through the health and wellbeing boards, and those are good things. I agree, however, with the tone of the right hon. Gentleman’s last intervention: the new world is not quite as far removed from the old as he sometimes likes to suggest and as he suggested in his speech.

Let us focus for a second on what it means to have commissioners in the health service. When the shadow Secretary of State has more time one day, I would like to hear him talk us through the process, which he would, on occasion at least, advocate, of turning down a good idea that is brought to a commissioner to improve care for patients and good value for taxpayers because that idea comes from the private sector. I hold no brief for the private or public sector in the delivery of care; I hold a brief for tax-funded equitable access to higher quality care from whomsoever provides that care. That is what I mean when I say that I am a straightforward Blairite and I look forward to welcoming the shadow Health Secretary back into the fold.

Breast Implants

Stephen Dorrell Excerpts

Wednesday 11th January 2012 Commons Chamber

[Mr Lansley]

It may be called devolution. I respect the devolved Administrations and always inform them of what I am doing, where it is relevant to them. We do not recognise the advice that Wales received. Sir Bruce Keogh’s expert group, which included some of the foremost experts in plastic surgery, made clear recommendations last week for patients in England and concluded that there was no significant increased clinical risk in cases where implants are not replaced.

If the shadow Secretary of State commends what the Welsh Government have done—[Interruption.] Perhaps he did not, but if he or anyone were to commend it, they would need to recognise that it runs the risk of letting the private providers off the hook. I am very clear that they should provide an equivalent standard of care. As the right hon. Gentleman made clear, there are limitations on what can be done. I do not have powers and I did not inherit powers to control what the private providers do in the private sector. I have to tell the right hon. Gentleman, however, that I have reflected on the Health and Social Care Bill, which is a positive legislative step forward. Just as it allows Monitor as a health and social care sector regulator, on which we are consulting, to look at the prudential regulation of private providers in social care, so it would allow us to consider the role of Monitor as a health sector regulator in licensing private providers of private health care. It is thus a positive not a negative step forward. There is no comparison, as the right hon. Gentleman will recognise, between the role of the private sector providing private care and the private sector in the NHS, which is subject to the same duties and obligations as an NHS provider. The Bill does not lead to an increase in private sector provision, but in so far as there are private sector providers, they will be properly regulated in the NHS.

On the role of private providers, they may be insured and there may be warranties relating to these implants. We do not have data on this aspect, but I am clear that these providers have legal and, indeed, moral obligations. I particularly commend a letter issued this morning by the leaders of the profession—the two principal professional associations—to their surgical colleagues. Having talked about the standard of care in the NHS, the letter went on to say:

“Those working in the private sector are urged to support in similar fashion. We would hope that implanting surgeons would honour requests for replacement surgery free of surgical charge”.

The private providers that have not made this offer to the women for whom they are responsible can see that their surgical associates are willing to carry this out free of surgical charge, so I see no reason why they should not now step up and deliver the standard of care that women have a right to expect.

[Mr Stephen Dorrell (Charnwood) (Con)]

May I welcome my right hon. Friend’s statement and the prompt action he has taken over the last few weeks to address this issue? Does he agree that the first priority when these concerns came to light was to ensure that the women who have had these implants had clear, authoritative advice based on the evidence of the right way to treat them, and that the process he established under Sir Bruce Keogh has provided and will continue to provide exactly that authoritative evidence-based advice? Does he further agree that there are some longer-term policy issues around the regulation of this industry that need to be addressed, but in a more considered way and not tied up in the emotions of this immediate concern?

[Mr Lansley]

I am grateful to my right hon. Friend and agree with all his points. I would add that when the French Government informed us of their prospective announcement—I spoke to the French Health Minister the day before it—we gave the best advice to date, based on the MHRA’s knowledge of the toxicology tests and its discussions with the French regulator. What we have to do is to establish the extent to which surveillance of these implants over a number of years should have led to any different conclusion. It remains true, however, that there is no evidence of long-term health effects that would give rise—and would have given rise at that time—to a different recommendation from the one that we made.

Oral Answers to Questions

Stephen Dorrell Excerpts

Tuesday 10th January 2012 Commons Chamber

[Mr Burns]

Throughout the consultation process there have been comments and responses to proposals across the whole of the health area, including on children’s health and well-being. Obviously, I cannot comment on a report that will not be published until later this week, but I or one of my ministerial colleagues would be more than happy to meet the Children’s Society once the report has been published if the society thinks that a meeting to discuss the report’s contents would be worth while.

[Mr Stephen Dorrell (Charnwood) (Con)]

Against the background of the recommendation of the NHS Future Forum that a key priority for the future is greater integration between health care and social care—a priority that was explicitly endorsed last week by the Prime Minister—does my right hon. Friend agree that the key opportunity in the Bill, through the health and wellbeing boards, is to drive that agenda, which has been much talked about for many, many years now, and actually to start to deliver on that rhetoric?

[Mr Burns]

My right hon. Friend is absolutely right; of course, when he was Secretary of State he did a considerable amount of work to lay the ground rules for the move towards greater integration, because that is the way forward. My right hon. Friend makes a very valid point: it is the way forward and we fully recognise that. We are deeply committed to achieving that aim, and that is why my right hon. Friend the Secretary of State has added an extra £150 million to the existing £300 million, to facilitate progress towards it.

Oral Answers to Questions

Stephen Dorrell Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Anne Milton]

I am sure that the hon. Gentleman would not want us to rush this. It is extremely important that for the first time we will have a public health outcomes framework. There was no such framework under the previous Government, so it is important that we get it right. It will be an important signal to local authorities about what we expect them to achieve—with, as I have said, a focus on improving the health of the poorest fastest.

[Mr Stephen Dorrell (Charnwood) (Con)]

As we transfer public health responsibilities to local Government—something that has been very broadly welcomed—is it not important that in addition to a clear definition of the funds that are going to be transferred, subject to a ring fence, we also have a clear definition of the responsibilities that local authorities will be expected to discharge in the new world? When can we expect that definition to be put into the public arena?

[Anne Milton]

My right hon. Friend is absolutely right. Conditions will be attached to the ring-fenced money to determine how it can be spent, but any expenditure will need to refer to promoting or protecting public health. I hesitate to use the word “shortly”, which the previous Government used on many occasions, but it will be published along with the outcomes framework. It is important that we get it right.

Oral Answers to Questions

Stephen Dorrell Excerpts

Tuesday 18th October 2011 Commons Chamber

[Mr Burns]

I am afraid that the right hon. Gentleman is wrong. It is not holding back the national health service; it is moving it forward with things such as the establishment of the 111 service and the reconfiguration proposals, which are based on the four tests that my right hon. Friend the Secretary of State introduced in May last year. That not only links reconfiguration to the needs of the local health economy but takes into account the wishes and needs of the local community and medical staff.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my right hon. Friend agree that the improved delivery of urgent care right across the health service is one of the great challenges facing the new commissioning structure and one of the great opportunities to deliver more integrated services that deliver better value and better quality to patients?

[Mr Burns]

I am extremely grateful to my right hon. Friend; speaking with the authority of the Chair of the Health Committee, he is absolutely right. It is the way forward to drive improvements in service, raise standards and ensure that there is high-class, quality care at an urgent care level and across the acute sector.

Health and Social Care (Re-committed) Bill

Stephen Dorrell Excerpts

Wednesday 7th September 2011 Commons Chamber

[Paul Burstow]

I am sure that as people read the transcript of the debate they will wonder why that intervention came at this point, other than to make a cheap party point. It is one that many Members of the House will know has set the tone for much of the Labour party’s contribution to debate on the Bill.

I was about to discuss an important issue, which is how we improve the health of our nation through our public health services. Returning to amendments 1253 to 1260 and the role of director of public health, we are having discussions about how best to ensure that the director of public health has an appropriate status within the local authority. There is concern about who directors report to and are accountable to. We intend to return to that matter once the consultations are concluded to make that absolutely clear, and to address those concerns.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will my hon. Friend repeat the statements that were made in a Select Committee hearing about the status of directors of public health? Is it the Government’s view that, at the very least, they should encourage—and preferably make mandatory—the status of a director of public health as a senior officer of the local authority, not reporting through any other senior officer of the authority?

[Paul Burstow]

My right hon. Friend is right to remind the House of the clarifying statement that was made before his Select Committee. That is what we want to encourage. We are listening to the results of the consultation exercise at the moment. Such people should be officers who report to the council and to the chief executive. Those are the issues that we are considering, and we will return to the matter.

Amendment 1254 would require the local authority to obtain the agreement of the Secretary of State before dismissing its director of public health. Our view is that as the local authority is the employer, it is not appropriate for the Secretary of State to intervene directly. The Bill already requires local authorities to consult the Secretary of State before dismissing a director of public health, so there is a safeguard already built into the legislation.

Amendment 1256 would require the director of public health to be suitably qualified. It is important to be clear that, as the Bill sets out, the director of public health must be jointly appointed by the Secretary of State, who can ensure that only appropriately qualified individuals are appointed. The amendment is therefore unnecessary.

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[Mr Stephen Dorrell (Charnwood) (Con)]

Like my hon. Friend the Member for Totnes (Dr Wollaston), I would vote against the Bill if I thought that it was going to promote the privatisation of the NHS. One thing that this Bill has in common with every health Bill I have debated in 21 years is that its opponents claim that it is about privatisation, but it is about nothing of the kind.

As the Secretary of State made clear, this is a different Bill, in some important respects, from the Bill that was first presented. First, the Bill introduces a statutory duty to promote the integration of health and social care—Labour Ministers talked about that but never delivered it. Secondly, the Bill introduces new safeguards against cherry-picking by private sector providers—Labour Members say they were against cherry-picking but they never introduced such safeguards. Thirdly, the Bill introduces new safeguards in respect of the continuity of essential services provided by private providers, who were introduced by Labour into the delivery of health and social care—such safeguards were never provided by Labour. Fourthly, the Bill makes real a commitment to the introduction of the clinical leadership of commissioning—Labour talked about that in office but never in reality delivered it. So this is a Bill that has been changed and improved as it has gone through the parliamentary process.

Let us not belittle the extent to which the Bill actually builds upon the same policies that were pursued by Labour in government: a policy of the extension of commissioning to act on behalf of the patient and the taxpayer; a policy to promote the development of foundation trusts as the best way of delivering care. This Bill takes 20 years of consistent development of policy and converts the words of Labour Ministers into reality. That is why I support its Third Reading tonight.

Health and Social Care (Re-committed) Bill

Stephen Dorrell Excerpts

Tuesday 6th September 2011 Commons Chamber

[Debbie Abrahams]

I thank my right hon. Friend.

When I raised these issues in the recent recommitted Bill Committee, the Minister suggested that I was scaremongering and, with the rest of those on the Government side, refused to accept any of our amendments—not a single one. Given what recent revelations are proving, perhaps he would like to withdraw some of his comments and concede that I have not been scaremongering.

I urge Liberal Democrat MPs who have felt compelled to support this Bill and their Front-Bench colleagues but whose conscience tells them that it is wrong to vote against the amendments and the Bill. This is not what they signed up to.

[Mr Stephen Dorrell (Charnwood) (Con)]

I welcome the amendments that the Government have tabled for consideration. I also welcome the very detailed way in which my right hon. Friend the Secretary of State introduced what is, as I am sure he will acknowledge, a substantial group of amendments. He emphasised that their purpose is to give effect to the undertaking that the Government gave when they set up the NHS Future Forum to ensure that the findings of that forum are reflected in the legislation, and that the Bill, when it reaches the statute book, is built on the work of Professor Field and his colleagues.

One purpose of the amendments is to respond to many of the points that have been made, throughout the passage of the Bill, about the role of Monitor. I completely agree with my right hon. Friend that many of those observations about the supposed role of Monitor have been based on a misunderstanding, whether deliberate or otherwise, of the intention behind the Bill when it was first introduced. Whether the misunderstanding was deliberate or accidental, the Government are responding to virtually all those points in order to make it clear that, in the context of the Bill, the central purpose of Monitor is not to be a blind economic regulator based on the assumption that the health service is simply another utility. Various loose words have been used that bear that construction—but never by Ministers, and the implications of those observations have never been accepted by Ministers. As I have understood it—this is why I have supported the Bill throughout its passage—the Government’s intention has always been to ensure that the new NHS envisaged by the Bill gives effect to the basic commitment on which the Government were elected to ensure that the health service secures equitable access to high-quality health care for all patients regardless of their ability to pay.

[Fiona O’Donnell]

The right hon. Gentleman referred to a misunderstanding of the original Bill. The Secretary of State said that that arose because he was a poor communicator. Do so many organisations still oppose the amended Bill because he is still a bad communicator or because it is still a bad Bill?

[Mr Dorrell]

In considering these amendments, it is important to refer to the individual functions of Monitor envisaged in the amended Bill and test them against the assertions that have been made, throughout the passage of the Bill, about what Monitor is there for. We must also test them against the Future Forum’s recommendations about how the role of Monitor should be clarified in order to remove these misunderstandings.

First—I warmly welcome this—it is made clear in the Bill as amended and the supporting documentation from the Department that although the Government intend to continue, as did their predecessor, to encourage the conversion of NHS trusts to foundation trusts, there will be no reduction in the standards required to qualify for the status of foundation trust. The registration principles established by Monitor, which are broadly welcomed throughout the health service, are intended to justify the independence that comes with foundation trust status. Those standards will continue as a gold standard under the new NHS, and achieving them, rather than meeting some artificial deadline, is the key determinant of whether a trust achieves foundation trust status. I welcome the fact that the Government have made that clear. It responds to a specific recommendation by the Future Forum, and it is exactly right.

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[Mark Simmonds]

As always, my right hon. Friend is making an extremely powerful speech. Does he accept the need for Monitor to ensure that foundation trusts not only continue to meet basic standards but continue to improve those standards year on year, and thereby improve patient outcomes?

[Mr Dorrell]

I absolutely agree with my hon. Friend. One of the further important clarifications in their position is the stress that the Government have placed—rightly—on the importance of the link between Monitor and the Care Quality Commission to ensure that standards in foundation trusts are not just about the achievement of financial targets, but are about standards of care quality delivered to patients. The link between the two regulators—one of quality and the other of financial standards—is an important part of the regulatory structure that the Government are introducing.

[Andrew George]

I entirely endorse the point that my right hon. Friend makes about the need to uphold standards and the role of Monitor in that respect. However, with regard to the Secretary of State’s response to me about the sustainability of essential services—acute emergency trauma centres—does he agree that Monitor must safeguard those services and not allow them to be eroded by the competitive environment in which they will operate?

[Mr Dorrell]

I agree that the sustainability of essential services—or, in the Government’s wording, the continuity of essential services—is a key role of Monitor. If I may interpret what my right hon. Friend the Secretary of State said, the patient’s interest is continuity of service, but not necessarily from the same provider for ever more. There has to be a commitment to sustain the service, and if there is to be a change of provider, the service has to be sustained through the change of provider, but the service does not necessarily have to be sustained by the same provider. Nor has there ever been such sustained service. There are not many people who rely on the service once provided by the Westminster hospital, as it is now a block of flats. I believe, however, that the service delivered to patients in this part of London is better as a consequence of the change that resulted from that decision.

[Grahame M. Morris]

As always, the Chairman of the Health Select Committee, is making a powerful contribution. He has really hit the nail on the head. The fundamental point, as evidenced in the Bill, is not that the provider could change—that has happened in the past, as he said, although the provider has always been a public sector provider, either in an NHS trust or an NHS foundation trust—but that, under the Bill, the provider could well be a private sector provider.

[Mr Dorrell]

I am grateful to the hon. Gentleman, who is a member of the Select Committee, because he provides me with a link to my next point—I was beginning to wonder how I was going to get on to it.

The health service has not always provided services from a public sector provider. Until this Bill and the powers it gives to Monitor, regulatory bodies in the public sector had not had the opportunity to inquire into the sustainability of services provided by private sector providers. My right hon. Friend the Secretary of State made the point that the role of Monitor under the Bill is to ensure first—if I may repeat myself—that foundation trusts are of a high quality when they are launched; secondly, that they are accountable for retaining their high standards; thirdly, that we intervene early if they start to go off the rails; and, fourthly, that if they get into serious difficulty, we have the capacity, through Monitor, to continue to deliver continuity of service to those who rely on public health provision, whether from an NHS foundation trust or, as a result of the Bill, for the first time from the private sector. I regard that as a significant step forward in the delivery of continuity of care for NHS patients, whether provided, as the vast majority still will be, by public sector institutions or by some of the independent sector treatment centres introduced by the previous Government.

[Rosie Cooper]

Does the right hon. Gentleman think that standards can be maintained, and be seen to be maintained, in foundation hospitals if they are allowed to do what they are currently doing, which is not to disclose all information relating to, for instance, complaints procedures or whatever? Furthermore, does he not think that board meetings should be held in public?

[Mr Dorrell]

My understanding is that the Government have clarified that foundation trust board meetings should be held in public and that, in future, it will be a requirement of licensing by Monitor. On the much broader point, I absolutely agree—the hon. Lady, who is another member of the Select Committee, knows that I agree—that providers of care to NHS patients, whether public or private, ought to have an obligation to provide information on the outcomes that they achieve and certainly on any complaints and other processes initiated by patients about the care they receive. That was one of the strong recommendations that the Select Committee made following its work on complaints. I think that that obligation ought to rest on all providers of care to NHS patients, whether they are foundation trusts or any other form of provider.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Will the right hon. Gentleman provide some clarification? I think that he said “should” and not “must”. For other functions, particularly relating to local government, the Government seem to be into dropping standards and codes of conduct—that is certainly the case in local councils—but surely trusts “must” have meetings in public, not “should”.

[Mr Dorrell]

Ministers can correct me, but my understanding is that, under the obligation being introduced, they “must” meet in public. I have no authority to speak for the Government, but I believe that that is what the Government intend. For myself, as a patient of a trust or other NHS provider, whether in the public or private sector, my interest lies in ensuring that the information about my—

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

Will my right hon. Friend give way?

[Mr Dorrell]

Of course.

[Mr Burns]

I am grateful to my right hon. Friend for giving way and allowing me to clarify the point. Let me reassure him that, yes, such meetings must be held in public.

[Mr Dorrell]

I am grateful to my right hon. Friend, who answers the hon. Member for Worsley and Eccles South (Barbara Keeley) with very much more authority than is at my disposal.

I want to make one final point and it is a direct response to the hon. Member for Oldham East and Saddleworth (Debbie Abrahams). Of all the misrepresentations about the intentions of this Bill that we have listened to since the White Paper was published over a year ago, the most persistent is that this is somehow a Bill—a ramp—for the privatisation of the health service.

I was first a Health Minister more than 21 years ago. Throughout that period I have listened to speeches directed first at my right hon. and learned Friend the current Justice Secretary, when he was Health Secretary, and subsequently at all his Labour and Tory successors, including me, although probably excluding the right hon. Member for Holborn and St Pancras (Frank Dobson). All their legislative and other proposals to introduce more flexible and patient and standards-oriented structures in the health service were opposed by somebody or other on the grounds that they were going to privatise the health service. If that was the purpose of those policy initiatives, the one thing that they all have in common is that they have been singularly unsuccessful. If it is the policy purpose of this Bill to privatise the health service—which I do not for one moment believe it is—it will, I am sure, be as unsuccessful as all the other measures that went before it.

[Frank Dobson]

I begin with a reminder. I was one of those Labour people who voted against the establishment of foundation trusts and the setting up of Monitor. In doing so, I was supported by those on the Conservative Front Bench, so I do not think that the Conservatives should claim any consistency in these matters.

My second point is that although one would never dream it was true from listening to Ministers or their supporters, it is quite clear that the national health service is now working very well and is more popular than ever; and yet we are told that it needs a radical overhaul. However, the popularity of the national health service at the time of the last general election probably explains why both the Conservative party and the Liberal Democrats promised that there would be no top-down reorganisation of it. However, if neither the Bill as originally produced nor the post-pausal Bill that we have now is top-down change, God knows how one would define it.

The whole purpose of this Bill is to shift us away from the basic collaborative approach to the provision of health care in this country and to substitute a large amount of competition, gradually involving more and more of the private sector and, I believe, privatisation. In order to put things in perspective, it is worth pointing out that when the right hon. Member for Charnwood (Mr Dorrell), ceased to be the Secretary of State for Health, the national health service was performing 5.7 million operations a year in its hospitals. When Labour left office, it was performing 9.7 million operations a year, an increase of 58%. That was the result of improved working practices developed by—

Southern Cross Care Homes

Stephen Dorrell Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

My slightly-longer-than-it-should-have-been answer to the hon. Lady’s question was an attempt to set out as much detail as was possible about the steps being taken to achieve a consensual, solvent restructuring of the business so that the homes can continue to operate. That is what my answer was all about. She asked about the role of the CQC, which, as I said to her, has been working for some months with the landlords to ensure a smooth process of re-registration as new operators are identified to take on the running of individual homes. I also said in response to her initial question that every home will be transferred. There is a plan in place that will lead to all homes being transferred over the next four months. She asked about engagement with BIS. Of course, as part of the ongoing work, the Department of Health is engaging with BIS to ensure that we have the very best advice in dealing with these issues. The Government have been—and remain—fully engaged with the process.

[Mr Stephen Dorrell (Charnwood) (Con)]

For the avoidance of doubt, will my hon. Friend confirm that the Government’s policy since the beginning of this saga has been motivated by a single and paramount concern—to secure the continued and orderly delivery of care to the right standards to the residents of these homes—and that, in that respect, this Government are operating unchanged precisely the policy operated by their predecessors?

[Paul Burstow]

My right hon. Friend is absolutely right to make that point, which allows me to make another point. The Health and Social Care Bill is currently before this House—Members are enjoying the Committee stage at this very moment—and it contains the very provisions that will allow us to put in place a regime, which currently does not exist, to ensure proper oversight and engagement with those issues from a central Government perspective. The previous Government did not leave such a regime in place, nor did they put in place the necessary tools to allow the Government to do everything that they might want to do and that the hon. Member for Islington South and Finsbury (Emily Thornberry) might like us to do.

Oral Answers to Questions

Stephen Dorrell Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

We will return to that important matter later, with the urgent question. However, we must examine the position of Southern Cross and the business model that underpinned it very carefully, in order to understand how such a model was agreed to under the arrangements for regulating care providers that existed before the establishment of the Care Quality Commission.

[Mr Stephen Dorrell (Charnwood) (Con)]

It is now more than a decade since Sir Derek Wanless first identified a funding gap in long-term care for the elderly. I welcome the Dilnot report, but will the Government act quickly to establish a partnership arrangement enabling private money contributed through insurance to be added to some public money, so that that funding gap can be filled?

[Paul Burstow]

The answer to the first part of the right hon. Gentleman’s question is that the Government are already committed, through the spending review, to the provision of an additional £7.2 billion for social care over the next four years, which will involve an unprecedented transfer of resources from the NHS to social care. As for the second part of his question, the Dilnot report makes many recommendations, and the Government will work through them and present their conclusions next year.

Congenital Cardiac Services for Children

Stephen Dorrell Excerpts

Thursday 23rd June 2011 Commons Chamber

[Mr Stephen Dorrell (Charnwood) (Con)]

Like the right hon. Member for Oxford East (Mr Smith), I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on introducing the motion, which is of huge importance to my constituents and to the national health service. In contributing to the debate, I wear two hats. First, I represent the village of Glenfield. Glenfield hospital is actually in the neighbouring constituency of the Opposition spokesman, the hon. Member for Leicester West (Liz Kendall), but it takes its name from the village in my constituency. Secondly, I am Chair of the Health Committee. The Committee has not approached the subject specifically, because we have been looking at a number of other matters, but we have so far published two reports on commissioning, which is precisely at the heart of today’s debate.

In a sense, I personify the conflict that every Member feels between the constituency interest and the national interest, and in this case I do so in a particularly dramatic form, as one of the surgical units involved is closely associated with my constituency. My first point is that that conflict exists for all Members. We are of course here to represent our constituents’ interests, but I argue that we are here first and foremost as Members of a national Parliament and should seek, as my hon. Friend the Member for Pudsey recognises, the right answer for all NHS patients, not simply for a particular local interest.

[Chris Bryant (Rhondda) (Lab)]

I wish to make a very small point because the right hon. Gentleman used the word “national”. Many of the services we are considering are also used by Welsh and Scottish constituents, so it is important to ensure that there is that communication between the different elements.

[Mr Dorrell]

I agree with the hon. Gentleman’s point.

My hon. Friend the Member for Pudsey said that this is not a political issue, by which he meant that it is not a party political issue. That is exactly right, but issues can be political without being party political. It is important that the House, in approaching the subject, makes it clear that the issue should ultimately be resolved according to clinical standards, not as a form of political bartering, whether party political or through the general representation of local interests.

I am in the happy situation, personifying, as I do, the conflict between local and national interests, that the specialist group has recommended a solution that accords with my constituents’ views, but I think that in approaching the subject it is important to be clear about the ladder of interest: we should approach this from the point of view of national standards for the service delivery. We of course should represent the views of our constituents, but we should be clear that the national view should come first.

Writing in The Times today, Sir Bruce Keogh, the medical director of the NHS, states:

“Intellectually, the case for change is compelling and widely accepted. Sadly, the realpolitik is that the closer we get to a solution, the more personal, professional and political interests conspire to perpetuate mediocrity and inhibit the pursuit of excellence…For too long this has been filed in the ‘too difficult’ box. Time is running out.”

Those words should ring loud in our ears as we debate the subject this afternoon.

We should recognise that the whole issue of child heart surgery has form in the history of the national health service. It is now over a decade since Sir Ian Kennedy published his review of circumstances that illustrate what can go tragically wrong when things are allowed to drift on and when real issues are not addressed. Although I am of course here as a Member representing my constituents’ interests, I think that the key priority for the House this afternoon is to support the principle that this issue must be decided in the interests of the children who are the patients and who will become the adult patients, and in a way that satisfies the key driver of the pursuit of excellence in clinical standards.

I welcome the fact that the previous Government set up the review to ensure that we addressed the issues that had been left to drift on for too long since the Bristol heart review a decade ago, and I wholeheartedly endorse the view, expressed by Sir Bruce in today’s Times, that the time to act is now.

As a local MP, I wonder what the effect is on Leicester of this drive to a decision. I have already referred to the fact that I am not in an uncomfortable position, because on page 93 the review states:

“Option 2”—

which became option A—

“is viable as it is consistently the highest scoring potential option.”

The review’s recommendation is that the process go ahead based on option A, and that is convenient from the point of view of the person arguing the case that I do, but I conclude that if anyone wants to argue for an alternative outcome, it behoves them, particularly in view of the history of this issue in the national health service, to present a coherent, whole argument for how their solution represents a better solution for the patients of those services, while reflecting, of course, the local interest of the people we are elected to represent.

--- Later in debate ---

[Mr Dorrell]

I think that the hon. Gentleman slightly misrepresented what I said. I did not say, “You must accept it”, or “Take it or leave it”. I said that those who wished to argue for a different approach must argue for the whole approach, and not for a sectional interest.

[Mr Mudie]

I entirely accept that, and I did not intend to suggest that the right hon. Gentleman had said anything different. My point is that, while the clinical case for a rationalisation is unarguable, equality of access is as important a consideration as any. Excellent treatment must not be available to only a certain number of people.

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a real privilege to take part in today’s debate, and to follow the thoughtful, moving and at times passionate speeches of Members of all parties. I thank the Backbench Business Committee, and I particularly thank the hon. Member for Pudsey (Stuart Andrew) for securing the debate.

Like the right hon. Member for Charnwood (Mr Dorrell), I wear two hats today. As the Member for Leicester West, home of Glenfield hospital’s superb congenital heart centre, I know how important the review of children’s heart surgery is for my constituents, as it is for those of each of the hon. Members who have spoken. As the Opposition spokesperson, however, I am also well aware of my national responsibility, and that of the House, to ensure that every child gets the very best quality of care.

I want to start by making the case for change, as did other Members including my hon. Friends the Members for Liverpool, West Derby (Stephen Twigg) and for North West Durham (Pat Glass), my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) and my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell), who made brave and courageous speeches.

Following the devastating findings of the Bristol Royal infirmary inquiry almost 10 years ago, clinicians and professional bodies have been clear that children’s heart services need to change to ensure that every child gets the best standard of care now, and crucially also in the future. They include the Royal College of Surgeons, the Royal College of Nursing, the Royal College of Paediatrics and Child Health, the Society for Cardiothoracic Surgery, the British Congenital Cardiac Association, the Paediatric Intensive Care Society and many others.

The reason why services need to change is that children’s heart surgery is becoming ever more sophisticated. Technological advances mean that care is increasingly specialised and capable of saving more lives and improving outcomes for very sick children. However, services in England have grown up in an ad hoc manner. As my right hon. Friend the Member for Oxford East (Mr Smith) said, surgeons are too thinly spread. Care needs to be better planned to pool expertise in specialist centres so that all children get excellent quality care. I therefore welcome the Safe and Sustainable review, which was initiated by the previous Government. The challenge, as the House has rightly demonstrated today, is to ensure that the right aims, objectives and criteria drive the review, and, crucially, that they have the right weighting and that the right balance is struck.

Of course, improving the quality of care must be our primary concern. The review rightly calls for fewer, larger surgical centres to provide 24/7 consultant cover, and seeks to ensure that surgeons treat a sufficient number of patients with a sufficient variety of problems to ensure that they have the best possible skills.

The review also recommends the development of congenital heart networks, so that care is better co-ordinated at all stages of a child’s life, and that assessments and ongoing care can be provided closer to where patients live. However, as several hon. Members have said, the review cannot look at children’s heart surgery services in isolation; it must also fully consider the knock-on effect on other specialties at the hospitals in question.

As my hon. Friend the Member for Leicester South (Jon Ashworth) and the hon. Member for Loughborough (Nicky Morgan) rightly said, the work of Glenfield children’s heart surgery centre is closely linked with its extra corporeal membrane oxygenation service. ECMO helps patients with reduced heart or lung functions to have complex surgery that they might not otherwise survive. Glenfield is the country’s leading specialist ECMO centre, and trains and supports other services nationally and internationally. There is real concern at the possibility that that service will be moved to another hospital, because of the time that it would take to build up expertise elsewhere. Not only does it take up to 18 months to train new specialist nurses, but it takes many years to develop equivalent experience.

Ensuring high quality care is not just about surgery standards or links with other specialisms. The wider help and support that families get from doctors and nurses are vital. I was genuinely moved when hon. Members spoke of their conversations with parents and staff in their centres. Time and again, parents emphasise the communication skills of staff, and their ability to explain diagnoses and procedures simply and clearly, at what is often a frightening and worrying time.

Parents at Glenfield tell me that staff are like members of their families—they can ring day or night if they have any concerns. Such familiarity and trust is crucial, and it links to the issue of providing ongoing help and support, which many hon. Members mentioned. When children who have had heart surgery grow up, they have to deal with difficult issues such as whether they can have children. Many families are understandably concerned about having to build new relationships with a different team of doctors and nurses if their local centre closes. It is vital that the review look closely at the links between child and adult congenital heart services, but it has probably paid insufficient attention to that so far. I hope and believe that that will change before the review concludes.

As well as stressing the importance of the quality of clinical care, many hon. Members stressed the importance of ensuring fair access to services. We heard passionate speeches about that from my hon. Friends the Members for Leeds East (Mr Mudie) and for Scunthorpe (Nic Dakin). Accessibility matters, because time is of the essence when seriously ill children need to get to heart surgery centres in life-or-death situations, as the hon. Members for Meon Valley (George Hollingbery) and for Isle of Wight (Mr Turner) rightly said.

However, travel times also matter to families who need ongoing care and support. My hon. Friend the Member for North West Durham rightly said that many parents would travel to the ends of the earth for their children, but as the hon. Members for Leeds North West (Greg Mulholland) and for Oxford West and Abingdon (Nicola Blackwood) said, making families travel further than they already travel would make such a difficult time even harder for them, especially if they must also hold down a job or care for other children.

The difficult balance between specialising services in some areas but ensuring fair access is the crucial issue for the review.

[Mr Dorrell]

The hon. Lady is making an important point about access being one of the quality characteristics that need to be taken into account in making these decisions. However, does she agree that the Safe and Sustainable work programme has taken that into account? It was one of the key factors it took into account in making its recommendations and drawing its conclusions on the relative merits of these units.

[Liz Kendall]

The right hon. Gentleman makes an important point, but hon. Members have said that they feel the issue was given insufficient weighting. At the Leicester consultation, one parent said to me, “If we’d known that all the services were safe”, as the review has said, “we might have placed more importance on the issue.”

The affordability issue has not been mentioned. Hon. Members will, I am sure, be as one in saying that the review must be driven by the need to improve the quality of care, not by reducing costs. However, it is important to recognise, particularly in these financially constrained times, that significant costs are associated with all the current, and likely future, options in the review. That needs to be taken into account.

In conclusion, changing how we provide any hospital service is difficult, but when changes are necessary to improve patient care, as I believe they are for children’s congenital heart services, the House must have the courage to make them happen. Hon. Members have rightly raised a range of concerns on behalf of their constituents, but I am sure we would all agree that the final decision must be made by clinicians on the basis of evidence, not on political considerations. I hope that the joint committee will seriously consider the points raised in this debate and then make final recommendations in patients’ best interests.