Southern Cross Healthcare

Stephen Dorrell Excerpts

Thursday 16th June 2011 Commons Chamber

[Paul Burstow]

The hon. Gentleman asks a number of questions, some of which are for Ministers and others of which are for the landlords. He asked about NHP Ltd, and he is right to identify the fact that it is the largest landlord. He also asked about bank lending; obviously, the lenders have a key part to play in a solvent restructuring of the business, and that is why they were at the meeting yesterday. He mentioned HMRC, which, as an autonomous Government body responsible for making these decisions, is considering those matters at the moment.

The hon. Gentleman asks about the financial problems and the seeds of the problems. I urge him, in looking at the history of this, to look back several years to the restructuring of the company and the business model that was established and that caused the problem, and to ask himself who were in government at that time.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my hon. Friend agree that the Government have just one priority in this set of circumstances, and that is to secure the interests of residents? Will he assure the House that he will send a clear message into the system that there will be zero tolerance of any slippage in the quality conditions that are imposed on the providers of care to residents, and that he will continue to keep his eyes firmly focused on the day-by-day quality of care that is delivered to residents?

NHS Future Forum

Stephen Dorrell Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

Well, I was hoping that, having got past the abuse, the right hon. Gentleman would tell us whether he agreed with the NHS Future Forum, but he did not even mention it. He welcomed the listening and engagement exercise that we announced—he said it was the right thing and that it would be good government to do it—but then when an independent group of experts reports and makes recommendations, he ignores it and says he will oppose the Bill regardless. He did not listen to what people in the NHS were saying. I think it was shameful how he dismissed everything that has happened over the past year as though it did not matter at all—a year in which the coalition Government said we would increase resources to the NHS. We have done that and are committing to investing an extra £11.5 billion in the NHS over the next four years. That is money that, as we will continue to remind the British public, the Labour party told us we should not give to the NHS.

In the past year, the coalition Government and the NHS across the country have implemented a cancer drugs fund from which 2,500 more patients have benefited, and in the past four months, we have cut the number of breaches of the single-sex rule by three quarters, and the number of hospital infections by 22% and C. difficile infections by 15%. Some 750,000 more people are accessing dentistry, and waiting times for people going into hospital are down compared with March 2010. We said that we would reduce management costs, and we will do so, and we have taken 3,800 managers out of the NHS since the election, while the number of doctors has gone up. Six months ago, the right hon. Gentleman said that he supported the reform principles in the Bill. All he said today was sheer opportunism, but it will come back to haunt him, because the NHS will benefit from the changes we are proposing today. It will take greater ownership of its own service; patients will be empowered; and clinicians across the service will be empowered and will deliver better outcomes for patients, and when that happens, we will be able to say, “The Labour party would have denied the NHS the resources and the freedom and responsibility to deliver those better outcomes.”

[Mr Stephen Dorrell (Charnwood) (Con)]

Is not the key challenge facing the national health service today the need to reverse a decade of declining productivity bequeathed to us by the Labour party? Does my right hon. Friend agree that his statement today provides the basis for us to do that based on the evolution of effective commissioning engaging the entire clinical community, which will address the fragmentation of service and progress the integration of service around the needs of individual patients?

[Mr Lansley]

Yes, I agree with my right hon. Friend. It is precisely that process of engaging clinicians, who will come together to design services around the needs of patients in a way that delivers not just improving productivity, but improving quality of services for patients, that is at the heart of the shift from primary care trusts and strategic health authorities. Let’s face it: the Labour party spent a decade presiding over declining productivity, while the costs of bureaucracy and management in the NHS doubled. We will empower people in the NHS to deliver improving services and reduce bureaucracy. [Interruption.]

Winterbourne View Care Home

Stephen Dorrell Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

Of course, we need to ensure a full and thorough inquiry into all these matters, which is being undertaken in the serious case review, which will be chaired independently, and in the work of the CQC. That will go on as the Department brings together all the different reviews and that is why we are very pleased that Mark Goldring will take part in the process.

The hon. Lady suggests that there was confusion last week, but the confusion was only that which she sought to spread. We were very clear from the outset that we wanted to examine all the results from all the different inquiries, and that is what we are doing. We are not ruling out any further inquiries, but we want to ensure that the processes that are in hand are concluded and that we make judgments with the full facts available.

[Mr Stephen Dorrell (Charnwood) (Con)]

May I welcome my hon. Friend’s announcements to the House this afternoon? Does he agree that although there has quite properly been a lot of focus on the CQC—Dame Jo Williams accepts that there have been quite clear failures in its supervision of the home—there are also some difficult questions to be answered, particularly by the commissioners of the care? What were they doing paying for care that clearly was not to the required standard? Equally importantly, there are some important questions for the professional regulatory bodies to answer. Did no doctor ever go into the home? If they did, what conclusions did they draw? Where were the nursing regulators in this case?

[Paul Burstow]

My right hon. Friend poses a number of questions that are at the heart of the various current inquiries. He is right to say that to focus solely on the CQC is to miss the point, as the primary responsibility rests with the provider organisation to recruit, train and supervise the right staff in the first place. He is also absolutely right to ask about the role of the commissioners and the professional regulators. Those are the issues that we are looking at and will examine, and I will come back to the House with answers in due course.

Oral Answers to Questions

Stephen Dorrell Excerpts

Tuesday 7th June 2011 Commons Chamber

[Mr Lansley]

I can tell the right hon. Gentleman that in contrast to the last Labour Government it is our intention to increase the front-line staffing of the NHS relative to the staffing of the administration in the NHS. That is why, since the general election, there are 3,800 fewer managers in the NHS and 2,500 more doctors.

[Mr Stephen Dorrell (Charnwood) (Con)]

Can my right hon. Friend confirm that it is a key priority of the Government to reverse a decade of declining productivity in the health service in order to ensure that the resources that are committed by the Government deliver improved access and improved quality of patient care?

[Mr Lansley]

Yes, I can. My right hon. Friend is absolutely right about that. Over the last year in hospitals in particular we saw what was approaching a 15% reduction in productivity. That is why we are proceeding with ensuring that across the NHS we recognise not only that there are increasing demands on the NHS, which is why we are increasing the NHS budget by £ll.5 billion over four years, but that that money must be used increasingly effectively to deliver efficiency savings in excess of 4% each year so that we can improve the quality of services for patients.

Future of the NHS

Stephen Dorrell Excerpts

Monday 9th May 2011 Commons Chamber

[John Healey]

It is in the impact assessment; I suggest that the right hon. Gentleman take a good look at it.

[Mr Stephen Dorrell (Charnwood) (Con)]

The right hon. Gentleman has just implied that the Government were proposing to introduce, for the first time, private sector expertise into the commissioning process of the health service. Will he correct that statement to the House by confirming that under the world-class commissioning programme, the previous Government explored exactly that proposal?

[John Healey]

No. What I am referring to is the provision in the Bill to allow the job of commissioning to be outsourced to private companies. That has never been done before. It is there in the Bill and it is a big risk for the future.

The Prime Minister made the NHS his most personal pledge before the election.

--- Later in debate ---

[Mr Stephen Dorrell (Charnwood) (Con)]

I do not agree with everything that the hon. Member for Barnsley Central (Dan Jarvis) has just said, but I congratulate him on a thoughtful speech and wish to pick up on two points with which I entirely agree. The first was his moving tribute to the NHS staff who provided the care for his late wife. The second point, which is of immediate concern to us, was his recognition that the health service, like all human institutions, must embrace the need for change.

The question before the House this afternoon is how we can ensure that the need for change that the health service faces can be embraced and made a force for good. I open my remarks on that point by agreeing with the shadow Health Secretary, who said only a few short months ago, on 20 January —his words have already been quoted to him—that

“these plans are consistent, coherent and comprehensive. I would expect nothing less from Andrew Lansley”

Nor would I. I agree that that is a fair description of my right hon. Friend the Secretary of State’s proposals. I particularly congratulate my right hon. Friend, and the Government at large, on the fact that, despite that being a fair description of their proposals, they are now engaged in a listening exercise, the purpose of which is to improve a set of proposals that were described by the shadow Health Secretary in the terms I have already quoted.

I particularly welcome the fact that my right hon. Friend and the Prime Minister have made it clear that this will be a listening exercise on the policy substance, not just a process of balancing political forces in order to cobble together a compromise. If we are to be true to our commitment to the health service, as my right hon. Friend is, we need to ensure that we focus on the problems it faces and put in place structures that will deliver solutions.

[Mary Macleod (Brentford and Isleworth) (Con)]

Does my right hon. Friend agree that the Prime Minister has not broken any promises on the NHS, as the shadow Health Secretary has suggested, and that the Government are investing in the NHS and there is no question of privatising it?

[Mr Dorrell]

I entirely agree with my hon. Friend. The Prime Minister and the Secretary of State made clear during the listening exercise their determination to ensure that proposals are brought forward that improve the capacity of the structures of the health service to deliver the objectives my hon. Friend has just articulated.

[Emma Reynolds (Wolverhampton North East) (Lab)]

Will the right hon. Gentleman give way?

[Mr Dorrell]

I will give way once more and will then have to make progress, because I have very limited time.

[Emma Reynolds]

Does the right hon. Gentleman agree that it would have been possible to make the current structures work better? The coalition agreement states, on page 24:

“We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust”.

It is possible better to democratise the PCTs and give greater clinician involvement in them, so does he support some of the calls from the professionals to keep the cluster PCTs?

[Mr Dorrell]

I want to make my speech in my own way. The hon. Lady asked at the beginning of her intervention whether I agree that it would have been possible to introduce quite a lot of this without the need for a long Bill. She does not need to put that question to me, because the Health Secretary made the same point during the last health questions. We are seeking in the Bill to provide a holistic basis—a structure for the health service going forward, and that is an objective, starting from where we are, that it seems entirely reasonable to embrace.

I was seeking to identify the problem that my right hon. Friend’s measures must be designed to tackle, because as he and the Prime Minister have said repeatedly, no change is not an option. That should not be a matter of party political debate because the definition of the core problem facing the health service can be found in the NHS annual report for 2008-09, which was published 12 full months before the general election. I quote from it a single sentence:

“We should also plan on the assumption that we will need to release unprecedented levels of efficiency savings between 2011 and 2014—between £15 billion and £20 billion across the service over those three years.”

That is what we on the Health Committee referred to as the Nicholson challenge, because it was first articulated in the chief executive’s report a full 12 months before the election. That is the challenge that my right hon. Friend has to address, because it is the inescapable challenge in front of the national health service.

In point of fact, my right hon. Friend has made the challenge rather easier than it was in the days of the previous Labour Government, because there is a commitment to real-terms growth in the health budget throughout this Parliament, and because he has given the health service four years to respond to the Nicholson challenge, whereas the original articulation was focused on the three years ending in 2014.

But the substance of the need to deliver unprecedented efficiency gains out of the health service is the constant between the previous Government and the current Government. The articulation of it in the chief executive’s report was “£15 billion to £20 billion”; I have always preferred to articulate it as, “4% efficiency gain, four years running”.

That is what the health service has to deliver against the background of it never having delivered 4% efficiency in a single year, and of no health care system anywhere in the world having delivered a 4% efficiency gain, four years running. So, Sir David Nicholson, 12 months before the general election, was 100% right to say, “This is an unprecedented challenge,” and the challenge was embraced by the previous and current Governments.

[Grahame M. Morris]

Will the right hon. Gentleman give way?

[Mr Dorrell]

Will the hon. Gentleman forgive me? I want to cover what I regard as important ground.

I have expressed the challenge as an efficiency target, but the same target can be looked at differently, and it is important for the House to understand that this is a matter not just of dry health economics, but of the way in which the health service delivers clinical care, because so often in such debates we imagine that the normal health service patient is a normally healthy person who goes to see the GP and is referred for an elective acute procedure. It is as well to remember, however, that such patients constitute 11% of NHS expenditure, and sometimes I wish that we would devote the same attention to the remaining 89%, because that includes emergency patients, with 75% being expenditure on patients with long-term complex conditions, most of whose care would be better delivered by integrated services in the community.

The challenge that we ought to address when we think about the future of the health service involves not just another discussion about bureaucratic structures, but how we deliver the change in the service’s clinical model to ensure that it delivers efficient and high-quality care to the patients who present for care, rather than to the patients as so often described in the policy pamphlets.

That is why it is so important that the structures that emerge from this listening exercise achieve more radical integration than we have yet achieved in the health service—of primary care, community care and social care. It is why the GPs have to be engaged in the process. Once again, that is not a matter of party political debate; the point is made in all the world-class commissioning documents that I do not have time to quote.

My message for the House is that this is an intensely depressing debate, because it is as if the past 20 years never happened. The reality, when we look through the torrent of rhetoric, is that this policy is not a great break from the past; it is a desire on the part of my right hon. Friend to take ideas that were expressed and pushed through by Labour Ministers between 1997 and 2010, and to seek to make them effective in the context of the challenge that I have defined.

Oral Answers to Questions

Stephen Dorrell Excerpts

Tuesday 26th April 2011 Commons Chamber

[Mr Lansley]

I think I made it clear to the right hon. Gentleman in the House on 4 April that we were looking to pause, to listen, to reflect and to improve the Bill, and we are taking the opportunity to do so now, before Report and Third Reading.

[Mr Stephen Dorrell (Charnwood) (Con)]

Can my right hon. Friend confirm that in the listening exercise it is his intention, in addition to listening to representatives of local authorities and the public, to ensure that we fully take account of the views of representatives of the full range of clinical opinion within the health service—nurses, hospital doctors and community-based clinicians as well as GPs?

[Mr Lansley]

Yes. My right hon. Friend will know that we have done that in the past, and we continue to do so. Just as early implementers of health and wellbeing boards have an important voice in how local authorities will strengthen public accountability and democratic accountability, we also now have an opportunity that we did not have in the consultation last year for the new pathfinder consortia, as they come together—88% of the country is already represented by them—to have their voices heard. I hope that the public generally will exercise this opportunity too. I know that groups representative of patients are doing so and very much want to get involved in these discussions.

NHS Reform

Stephen Dorrell Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

We heard from the Leader of the Opposition earlier that the NHS needed to change, but once again we have heard nothing from Labour Members about how it needs to change. It is not unusual to hear nothing from them. They say that we need to tackle the deficit, but they will not say how. They say that we must change the NHS, but they will not say how.

Interestingly, in January the right hon. Member for Wentworth and Dearne (John Healey) said that he agreed with the aims of the Bill. He said that he supported a

“greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes”.

At the last election, his manifesto said that he wanted all NHS trusts to become foundation trusts. It said that he wanted patients to have access to every provider, be it private sector, voluntary sector or NHS-owned. Now we do not know what the Labour party’s policy is at all, but what I do know is that the Government will give leadership to the NHS, and that we will give the NHS a strategy enabling it to deliver improving results in future.

The right hon. Gentleman clearly wrote his response to the statement before reading it. In fact, we have made it clear that we will listen to what is said about precisely the issues on which people in the NHS and people who depend on the NHS are united. They know which issues are really important. They know that we must be clear about accountability, and that there must be transparency. Clinicians throughout the health service want to work together, and want the structure of the service to help them to work together so that they can deliver more holistic and joined-up services to patients. We want that, and they want that. We will back up our strategy with detail, but from the right hon. Gentleman we heard no strategy, no detail, and no answers whatsoever.

We are clear about the principles that we are pursuing through the reform and modernisation of the national health service. We are listening, and we are engaging with those principles. We are listening to the people in the health service who have come together to implement those principles, so that we can help them to do so effectively. Labour Members have not even listened to those who threw them out at the last election, because they are still wedded to the past and to a failed, top-down, centralised, bureaucratic approach.

[Mr Stephen Dorrell (Charnwood) (Con)]

All who genuinely wish the NHS well and consider it to be an important part of our national heritage will welcome my right hon. Friend’s commitment to ensuring that clinical practice delivered by the NHS is kept up to date with the best available medical practice, and responds effectively to the wishes of patients. Will he continue to develop effective commissioning as the best way of delivering that, building on 20 years of commitment to the principle of commissioning under Governments of all political complexions since 1990?

[Mr Lansley]

I am grateful to my right hon. Friend. He knows and I know—and past Secretaries of State, with the exception of the right hon. Member for Holborn and St Pancras (Frank Dobson) also knew—that in order to deliver the best possible care in the NHS, we needed to engage clinical leadership more effectively. That is what these reforms are about. The modernisation of the NHS is about better and stronger clinical leadership delivering better commissioning of care and thereby helping to deliver better provision of care, and about allying that with democratic accountability at a local level. Neither of those things has happened sufficiently in the past, but both are at the heart of our Bill.

NHS Reorganisation

Stephen Dorrell Excerpts

Wednesday 16th March 2011 Commons Chamber

[Mr Stephen Dorrell (Charnwood) (Con)]

I serve on the Select Committee on Health with the hon. Member for West Lancashire (Rosie Cooper), which I enjoy doing. If I may say so, her speech was uncharacteristically partisan, but I guess that that is the nature of debate on the Floor of the House.

The motion moved by the right hon. Member for Wentworth and Dearne (John Healey), the shadow Health Secretary, has a clear, simple message: “Frank was right.” For 20 years, every Health Secretary—starting with my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) and including me and my right hon. Friend the current Health Secretary—with the exception only of the right hon. Member for Holborn and St Pancras (Frank Dobson), has espoused the principles that underlie the Health and Social Care Bill.

The motion is an apologia from the Labour party to the right hon. Member for Holborn and St Pancras, for whom I feel rather sorry. He was roundly rubbished by his party in opposition, and now he is being canonised. As in the Roman Catholic Church, it is better that you are dead if you are to be a saint in the Labour party. I did not agree with him when he was in office, and nor do I agree with him now.

As my right hon. Friend the Secretary of State said, the truth is that the principles in the Bill are principles that every Labour Health Secretary, with the exception of the right hon. Gentleman, sought to carry out in office. Let us go through them. GP-led commissioning was one of the first principles that Labour espoused in 1997. My right hon. Friend rightly refers to practice-based commissioning, but that was actually the previous Government’s second attempt to introduce GP-led commissioning, which happened after the first attempt—primary care groups—had failed. The previous Government tried twice to apply the principle that they espoused; my right hon. Friend is trying once again.

[Tom Blenkinsop]

The Bill gives primacy to Monitor, which makes economic decisions. It does not give primacy to quality under the Care Quality Commission. Primacy will go to Monitor, which will make economic decisions on what health treatment people receive.

[Mr Dorrell]

I understand the point, and it is part of the argument that the Labour party has started to make about how, since Christmas, it has suddenly discovered that the Health and Social Care Bill and the policy that it implements—a policy based on commissioners having choices in the interests of taxpayers and patients—require commissioners to have those very choices if the policy is to be effective. As my right hon. Friend the Secretary of State said, the principle of competition for commissioners’ budgets, as funded by the taxpayer, was set out by the last Government in their policy of December 2007. Hon. Members should look at the text—it is there in the record.

The last Government were right. The right hon. Member for Wentworth and Dearne seeks to set up an Aunt Sally when he says that there is something wrong with European principles of competition law when applied to health care. Let us be clear: if we are spending £100 billion of taxpayers’ money on securing high-quality health care on the principle of equitable access, what is wrong with insisting on the principle that we should not allow monopolists to restrict the choices available for using that budget to deliver high-quality care for patients? That is the principle, and that is why I am in favour of competition law applying to the provision of health care in response to a tax-funded budget.

[Nadhim Zahawi]

Does my right hon. Friend agree that this is political opportunism of the worst kind?

[Mr Dorrell]

It is, but it is not even political opportunism that applies to a popular principle. Surely opportunism is normally motivated by some popular principle, yet defending the interests of a monopolist does not seem to me to be a very popular principle.

[Grahame M. Morris]

Will the right hon. Gentleman give way?

[Mr Dorrell]

I will give way to the hon. Gentleman, who is another member of the Health Committee.

[Grahame M. Morris]

I am doubly honoured, because the right hon. Gentleman has afforded me a courtesy that the Secretary of State would not. The concept of having greater clinical engagement—not just for GPs, but for doctors in secondary care—enjoys broad support across the parties. However, the framework laid out in the Health and Social Care Bill opens the service up to privatisation.

[Mr Dorrell]

I thought that the hon. Gentleman was going to make the point that he has made in the Select Committee—a point with which I agree—that the purpose of GP-led commissioning is to engage the entire clinical community, not just GPs, in the commissioning process. That is a principle that my right hon. Friend the Secretary of State agrees with. It is also a principle that Sir David Nicholson has made clear will be part of the principles that will be expected to be applied in GP-led commissioning consortia.

Before the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) led me down the road of competition policy, I was going through the principles that are consistent across the health policies implemented by all Health Secretaries since 1990, with the single exception of the right hon. Member for Holborn and St Pancras.

[Mr Brine]

Will my right hon. Friend give way on that point?

--- Later in debate ---

[Mr Dorrell]

If my hon. Friend will forgive me, I will not.

There are two other important principles, one of which was espoused by the hon. Member for Leicester West (Liz Kendall) when she worked for Patricia Hewitt. That is the principle that all NHS providers should be foundation trusts, in order to provide a level playing field, and to ensure that commissioners have a fair choice and that we deliver good value, high-quality care for patients. Finally, there is the principle of “any willing provider”, where the Labour party provided us not only with a policy, but with a slogan and an election commitment to implement that policy. Now Labour wishes to desert both the policy and the slogan in its election manifesto.

This debate makes me feel as though the last 20 years never happened. It could have happened at any time between 1990 and 1997; and in fact it did—many, many times. What has happened since is that Labour in government picked up those principles and sought to put them into effect. Now, less than 12 months after the general election, it has reverted to type. It is as though nothing happened in the past 20 years. We have heard industrial quantities of nonsense this afternoon, and I hope that the House will reject the Opposition’s motion.

--- Later in debate ---

[Andrew George]

I am prepared to talk to anyone who wants to engage constructively in improving the Bill to ensure that it achieves its stated intentions, because I do not think that it will, given the nature of the reorganisation proposed in it. The reason I will not be joining the hon. Lady and her colleagues in the Lobby to support the motion is that it is tactically wrong at this stage to engage in such antics. This issue is a great deal too important to be turned into a party political playground game.

I am pleased that the Secretary of State said today that he is prepared to listen and engage. We need to explore every opportunity to engage in constructive dialogue with him, involving all the stakeholders I mentioned, and, indeed, those in the Labour party who want so to engage, to find a way through and to ensure that the genuine concerns about the impact of the Bill are properly scrutinised. Yes, they are being scrutinised in the Bill Committee, but before we get to Report stage in this House, it is important that we create a coalition of the bodies that share these concerns. Rather than inviting them to go out on to Parliament square and wave their placards and so on, it would make a lot of sense to encourage them to engage in greater constructive dialogue than we have succeeded in achieving so far.

[Mr Dorrell]

Does my hon. Friend agree that the case he is making is reinforced by the fact that our right hon. Friend the Secretary of State has already moved two amendments to the Bill dealing with the cherry-picking issue and—this was mentioned by the Prime Minister today—price competition. The amendments have been tabled to ensure that the Bill addresses concerns expressed by the hon. Gentleman and some of his hon. Friends.

Oral Answers to Questions

Stephen Dorrell Excerpts

Tuesday 8th March 2011 Commons Chamber

[Mr Burns]

I can categorically give that assurance to the hon. Gentleman, because there is no two-track system. Where the private sector may provide care, it is to help to raise standards. I imagine he would agree with that, because he fought the general election on this manifesto commitment:

“Patients requiring elective care will have the right…to choose from any provider who meets NHS standards of quality at”

the NHS level.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will my right hon. Friend tell the House how many representations the Government have received arguing the case in favour of the PCTs in the structure that we inherited at last year’s general election? If, as I suspect, the answer to that question is not very many, is that not because there was a shared commitment between this Government and the previous Government to introduce genuine clinical engagement to the commissioning process?

[Mr Burns]

I am grateful to my right hon. Friend for that question. I can go a little further and say that, to the best of my knowledge, we received no representations to keep the PCTs. He is right when he talks about what the previous Government were seeking to do, and we want commissioning to go to the local level—to GP commissioners, who have the best knowledge of the needs of their patients. The fact that we have so many pathfinders shows that GPs are signing up voluntarily, with enthusiasm, to take part in the scheme.

Health and Social Care Bill

Stephen Dorrell Excerpts

Monday 31st January 2011 Commons Chamber

[John Healey]

The point made by my right hon. Friend the Member for South Shields is based on page 42 onwards of the Health Secretary’s impact assessment of the Bill, which mentions a premium for private providers of £14 per £100. The Bill allows the system to pay a premium and a bung to private sector providers.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will the right hon. Gentleman now answer the question put to him by my right hon. Friend the Health Secretary? Does he agree or disagree with the maximum price tariff principle that was set out in December 2009 by the previous Labour Health Secretary?

[John Healey]

We operated an NHS with a set tariff, not a maximum tariff. In government, we operated an NHS in which price could not be the factor that drove decisions about what services patients received and by whom they were provided. My right hon. Friend the Member for South Shields is absolutely right to point out that the Bill will introduce price competition and the flexing of the price so that there is no longer a set tariff for treatments and patients but a maximum price that can be undercut by providers coming into the field. The Government will not talk about that.

The Prime Minister is not helping the Health Secretary, because the changes the Bill makes were not in his election manifesto, not on his election posters and not in his election speeches. I have the Conservative manifesto here. There is no mention of axing all limits on NHS hospitals treating private patients, so that NHS patients lose out; no talk or mention of undercutting on price, so that established NHS services are hit as new private companies cherry-pick easier patients and services; no mention of guaranteeing only selective hospital services, so that others can be closed and lost to local people without public consultation; and no mention of putting a new market regulator at the heart of the NHS with the principal job of promoting and enforcing competition. There is no mention in the Conservative manifesto of the biggest reorganisation of the NHS since it was set up more than 60 years ago. They did not tell people about their plans before the election and they promised not to introduce such measures in the coalition agreement after the election. There is no mandate from the election or the coalition agreement for this fundamental and far-reaching reorganisation. That is not a debating point, but a point of democratic principle.

--- Later in debate ---

[Mr Stephen Dorrell (Charnwood) (Con)]

I rise to support the Bill. The shadow Secretary of State started by saying that my right hon. Friend the Secretary of State struggled to explain his reasons for introducing the Bill, but I think that the shadow Secretary of State struggled to explain why he opposes it. He struggled from the moment that my hon. Friend the Member for Grantham and Stamford (Nick Boles) intervened to draw his attention to the fact that the Bill represents an evolution of policy that has been consistently developed by every Secretary of State since 1990, with a single exception in the form of the right hon. Member for Holborn and St Pancras (Frank Dobson), who sits on the Labour Back Benches. The question that the shadow Secretary of State has to answer is this.

[John Healey]

rose—

[Mr Dorrell]

Let me pose the question and I shall be delighted to give way. Which of the key themes does the right hon. Gentleman oppose? Is it the practice-based commissioning or the “any willing provider” model? Is it the introduction of private sector expertise into commissioning, which was first articulated in the world class commissioning programme, or is it the principle of the maximum tariff? Let me help him by quoting from the operating framework of 2009, to which my right hon. Friend the Secretary of State referred. It states:

“After 2010/11, we shall move to a position where national tariffs represent the maximum price payable to a commissioner, as opposed to the mandated price for a particular activity.”

With which of those four key policies does the right hon. Gentleman disagree?

[John Healey]

The right hon. Gentleman started by saying that the policies are an evolution. If that is the case, why did he say:

“I thought we were looking to develop existing institutions rather than starting again, and that appeared to be confirmed in the coalition agreement.”

[Mr Dorrell]

indicated assent.

[John Healey]

The right hon. Gentleman, who is nodding, went on:

“Then in July that approach was changed. That came as a surprise.”

[Mr Dorrell]

Indeed it did. I offered the right hon. Gentleman four consistent themes of policy. He accurately quoted my comments about a specific element of bureaucracy. One of the questions that the Select Committee addressed was why, since all these broad themes are so broadly supported, we went down the road of replacing the PCTs with the consortia. That is a question that the Select Committee said in its report had not been adequately explained, but that is a relatively minor question of bureaucratic presentation when compared with the broad themes of policy that were articulated in the debate by my hon. Friend the Member for Grantham and Stamford. Which of these key policies does Labour now wish to dissent from?

[Hugh Bayley]

rose—

[Mr Dorrell]

I give way to the hon. Gentleman, an expert on health policy from the Back Benches, who may able to answer the question that the shadow Secretary of State wishes to avoid.

[Hugh Bayley]

I wonder whether the Select Committee agrees that private contractors, where they are engaged, should be required to publish the same information about cost, quality and outcomes as NHS providers, to ensure a level playing field and real, true comparison.

[Mr Dorrell]

I have been here long enough not to presume to speak on behalf of a Select Committee on a question that the Select Committee has not addressed, but I think there would be broad support across the House for the principle that where the private sector provides a service to a public sector commissioner, the private sector provider should be accountable to that commissioner on precisely the same terms as the public sector provider. As my hon. Friend the Member for St Ives (Andrew George) mentioned in his intervention on the shadow Health Secretary, one of the problems about the independent sector treatment centre programme was exactly the point that the hon. Gentleman makes—the accountability expected of a private sector provider was different from the accountability expected of a public sector provider.

Therefore, I agree with the hon. Gentleman and hope that he can persuade his right hon. and hon. Friends on the Front Bench to endorse the principle of common accountability for public and private sector providers providing a service to a public sector commissioner. I see my right hon. and hon. Friends on the Government Front Bench endorsing the principle. I hope that I am not misrepresenting the way that they are reacting to the hon. Gentleman’s question.

This is a consistent set of themes. Why is it consistent? I want to move the debate on. The House of Commons loves debating structures in the national health service. The inference from what I have said so far might be that that means it is all business as usual—that what has gone on, with the exception of the period when the right hon. Member for Holborn and St Pancras was in charge, is a seamless development of policy since 1990.

However, the truth is that during the lifetime of this Parliament the national health service faces a genuinely unprecedented challenge, first articulated not by my right hon. Friend the Secretary of State in the present Government, but by the chief executive of the health service before the general election in May 2009, when he drew attention to the fact that demand for health care should be expected to continue to rise at roughly 4% per annum, as it has done throughout the recent history of the national health service. However, because of the budget deficit, we will not see the health budget continue to rise to absorb that rise in demand, in the way it has over the past decade.

Therefore, during the lifetime of this Parliament, we will have to see, in the national health service, a 4% efficiency gain four years running—something that not merely our health care system, but no other health care system in the world, has ever delivered. The Select Committee has referred to that as the Nicholson challenge, reflecting the fact that it was first articulated by the chief executive and endorsed by the previous Government. Again, this is a case of a shared agenda across the House of Commons.

Given the Budget deficit, the only way we can continue to meet the demand for high-quality health care, which we all want to see, is by delivering an unprecedented efficiency gain in the NHS for four years running. That is why I support the Bill. I support it because to my mind it is inconceivable that we can deliver such an efficiency gain without delivering more effectively than we have done yet on the ideas, which have been endorsed over the past 20 years, about greater clinical engagement in NHS commissioning, which I have been talking about. Commissioning cannot be successful if it is something that is done to doctors by managers; it must engage the whole clinical community. We must address the democratic deficit, because we cannot bring change on the scale that we need to deliver the efficiency gain without engaging local communities.

Finally, the NHS must also be a national service that is accountable through the commissioning consortia, the commissioning board and the Secretary of State to this House, because it is ultimately the taxpayers who pay for it. Those are the principles that were set out by the Health Committee, and it is those that we will seek to review as the Bill goes through Parliament.

--- Later in debate ---

[Hugh Bayley (York Central) (Lab)]

The Government White Paper said some sensible things: it promised to increase NHS spending in real terms, to improve patient choice, to devolve decision making, to reduce management costs and to hold doctors to account for their clinical outcomes. Indeed, the objectives are very similar to many of those of the former Labour Government. The problem, however, is that the Bill will undermine many of those good aspirations.

Health spending is, as we know, falling because the amount by which the Government increased the NHS budget is lower than the rate of inflation. [Interruption.] For my health authority, it is 0.3% lower than the rate of inflation. Patient choice will remain limited to where GPs choose to commission services. Centralising many services under the NHS commissioning board—a new layer of bureaucracy—means that NHS dentistry, community pharmacy, optometry services, regional and sub-regional specialties and, indeed, some more complicated local services will be commissioned at national level by that board rather than at local level by a primary care trust, as in the past, or by a commissioning consortium in future.

I am sure that the Government will try to reduce NHS management costs. Every Government since the creation of the NHS have sought to do so, but this Government need to explain how creating 500 or 600 commissioning consortia—each with the skills to commission services—will cost less than the 150 PCTs that currently do the job. They are likely to lose economies of scale and the decisions taken could well lead to the fragmentation of some services such as dermatology or pathology. Such services are currently commissioned by a PCT for the whole PCT area, but in future could be commissioned in three or four different ways by different consortia. Small, less well resourced GP commissioning consortia will, I believe, be less effective than PCTs and strategic health authorities in controlling the costs of powerful hospital foundation trusts.

The Government are right to stress the importance of measuring clinical effectiveness and outcomes, but that makes it extraordinary that they have put primary care in the driving seat. We know a lot about the work of hospital doctors from the hospital episode statistics, but there are no national data on GP consultation rates or the thresholds they employ before they intervene with treatment or on GP outcomes, yet GPs are being put in charge of demanding this from everybody else.

Running through the Bill is the idea that transparency and accountability will drive up performance, so here are some questions to the Minister, which I hope he will address in his concluding speech. The Bill is designed to reduce health inequalities, yet there are enormous inequalities in GP services. Some GPs are very good; others less so. There are differences in their prescribing and referral rates, so how are the Government going to measure GPs’ clinical performance? How will a GP commissioning consortium hold erring GP practices to account? What sanctions will be employed?

How will patients hold their GPs to account for their commissioning decisions? We are, of course, familiar with GPs being sued for bad clinical decisions, which is why they take out medical insurance and have to pay increasingly more for it each year. Will patients sue their GPs for bad commissioning decisions? How will the consortia hold hospitals to account?

How much will the GP commissioning consortia receive in management allowance per patient, because the Government’s success in making administrative savings will depend on that? What sanctions will be imposed on a GP commissioning consortium to ensure that it commissions effectively and uses a good evidence base for its decisions?

The Government tell us that PCT deficits will be written off before the consortia take over, but what help will the commissioning consortia get in areas such as mine where there has been a difficult structural deficit—brought into balance by the previous Labour Government, but out of balance once again under the new Administration—to stop them falling into deficit? What will happen if they do go into deficit? Will their budgets and the services they provide to patients be cut as a result?

[Mr Dorrell]

The hon. Gentleman is making a thoughtful speech and asking, if I may say so, some very good questions, with all of which I agree. There is an implication behind his speech, however, which is that if all those questions can be answered, as I hope and believe they can, he will support the Government’s policy. Is that implication correct?

[Hugh Bayley]

If I were convinced that they could be answered, I would indeed support the Government, but unfortunately I am far from convinced that it is the case.

Let us take another issue. The Government are providing a lesser increase in funding to the NHS this year, which amounts to a cut in real terms when the rate of inflation is taken into account. They think they will get away with this because the NHS staff wage bill is being frozen for a two-year period. What thought have they given to the wage bounce that will inevitably come in two years’ time? There will be enormous wage pressure on the NHS budget; are the Government intending to increase it significantly at that time?

[Mr Dorrell]

I am anxious to provide the hon. Gentleman with extra minutes so that he can tell us whether he approves, in principle, of the idea of practice-based commissioning, which was originally introduced by the previous Government?