Oral Answers to Questions

Stephen Dorrell Excerpts

Tuesday 25th January 2011 Commons Chamber

[Paul Burstow]

The backdrop that the hon. Gentleman has just painted is a rather thin one. In fact, it does not exist at all. The Government set out in the Bill we published last week that there will be clear responsibilities on GP commissioning consortia, working in partnership with their colleagues in local government, to commission services in ways that will improve quality of life for people in his constituency, my constituency and the constituencies of all hon. Members.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my hon. Friend agree that improved co-ordination between health and social care is fundamental to the delivery of the efficiency challenge faced by the health service and social services? Does he further agree that the £1 billion provided by the health service to reinforce that relationship is an important step taken by the Government to reinforce that interface? Can he assure the House that, as we move into the new world, the existing arrangements for good practice across that interface will be preserved?

[Mr Speaker]

Order. I know that three questions will attract one answer from the Minister.

Oral Answers to Questions

Stephen Dorrell Excerpts

Tuesday 7th December 2010 Commons Chamber

[Mr Lansley]

The hon. Gentleman should not believe all that he reads in the newspapers. The curious thing is that the Minister with responsibility for Government policy is engaged with Government policy. That is a good and positive thing. The hon. Gentleman referred to the Royal College of General Practitioners and to Dr Gerada. In response to the White Paper, the RCGP said:

“General Practice is the central plank in our world-class healthcare system. The College thoroughly agrees that it makes a great deal of sense to give GPs, with their unique patient-centred perspective, a central role in commissioning and directing healthcare services.”

Dr Gerada said:

“I fully support placing clinicians at the centre of commissioning decisions”.

[Mr Stephen Dorrell (Charnwood) (Con)]

I very much welcome the steps that my right hon. Friend is taking to encourage the early emergence of pathfinder consortiums, so that the shape of the new commissioning structure is made clear as quickly as possible. Given the nature of the quality, innovation, productivity and prevention challenge—QIPP—that the health service faces, does he agree that the process must be carried forward as quickly as possible so that the new framework is clear for all concerned as quickly as possible?

[Mr Lansley]

Yes, I do. I was delighted by the response of general practice to the emerging consortiums, because one of the central reasons it wants to make progress quickly is to shape clinical service redesign, which is at the heart of delivering the efficiency savings that will enable us all to improve outcomes.

Public Health White Paper

Stephen Dorrell Excerpts

Tuesday 30th November 2010 Commons Chamber

[Mr Speaker]

Order. There is much interest in this subject but real pressure on time, with two heavily subscribed Opposition day debates to follow. What we need are short questions and short answers.

[Mr Stephen Dorrell (Charnwood) (Con)]

I congratulate my right hon. Friend the Secretary of State on a White Paper that redeems his pre-election pledge to raise public health to a higher level of priority than was accorded to it not merely by the last Labour Government, but by the Conservative Government in which I held my right hon. Friend’s responsibilities. I congratulate him on delivering the first step towards that commitment, and particularly on the transfer of public health responsibility to local government. The White Paper proposals will fulfil the promise to make public health a cross-Government responsibility, and will deliver what has been described as the “fully engaged scenario”. That is the only way in which we can deliver our broader public health objectives.

[Mr Lansley]

I am grateful to my right hon. Friend for his comments. Derek Wanless said that we needed an “engaged” scenario back in 2002, but it simply did not happen. I know that many in public health feel that the transfer giving local government the lead responsibility on public health—which is radical and new—will, in many respects, bring public health back home. It allies the public health initiative and resources to the responsibilities of local government on economic development, the environment, planning, housing and education in precisely the ways that will influence the wider determinants of health.

NHS Reorganisation

Stephen Dorrell Excerpts

Wednesday 17th November 2010 Commons Chamber

[John Healey]

Of course Sir David was talking about the two together, because the Select Committee was understandably probing both matters. In the quote that I gave, he was talking about the significant efficiency savings required of the health service at this time of an unprecedented financial squeeze. Many would say that that is the toughest financial test in the NHS’s history.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will the right hon. Gentleman give way?

[John Healey]

Of course I will give way to the Chairman of the Health Committee.

[Mr Dorrell]

The right hon. Gentleman is right to say that Sir David was talking about the £15 billion to £20 billion efficiency challenge, and as my right hon. Friend the Secretary of State said, that programme has its roots in the time of the last Government. Will the right hon. Gentleman confirm that his party still supports the QIPP challenge—quality, improvement, productivity, prevention—that was first articulated when his right hon. Friend the Member for Leigh (Andy Burnham) was Secretary of State?

[John Healey]

If the right hon. Gentleman reads the official record, he will see I have just said that I will back plans to get the efficiency savings out of the NHS. They are needed and they have to happen, and I will back them as long as all the savings are reused for front-line services to patients.

Faced with the toughest test in its history, the least NHS patients and staff can expect is that the Government keep their funding promise. At this time of all times, the last thing the NHS needs is a big internal reorganisation. The Prime Minister ruled out such a reorganisation before the election, saying:

“With the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS”.

The right hon. Gentleman, now the Secretary of State, ruled it out, saying that the NHS

“needs no more top-down reorganisations”.

The coalition agreement was clear and reassuring on this point. In it, the Prime Minister and the Deputy Prime Minister pledged:

“We will stop the top-down reorganisations of the NHS that have got in the way of patient care”.

That was before the Secretary of State’s White Paper plans, which the head of the King’s Fund has called

“the biggest organisational upheaval in the health service, probably since its inception”.

Promise made in May, broken in July. Promise made by the Prime Minister, broken by the Secretary of State.

There is a story doing the rounds in the media of a journalist being briefed by No. 10, early on the morning of the publication of the White Paper, and told

“there’s nothing much new in it.”

When did the Secretary of State tell the Prime Minister that he was breaking his promise? When did he tell the Prime Minister that he was not only breaking the Government’s promise but forcing the NHS through the biggest reorganisation in its history, with a £3 billion bill attached, at a time when all efforts should be dedicated to achieving sound efficiencies and improving care for patients? This is high cost and high risk; it is untested and unnecessary.

--- Later in debate ---

[Mr Stephen Dorrell (Charnwood) (Con)]

In the brief time available, I do not want to follow the hon. Member for Sheffield Central (Paul Blomfield) in a detailed discussion of children’s hospitals, but I congratulate him on the first part of his speech, because he reminded us of what we are here to talk about—the delivery of high-quality care to patients, often in circumstances of extreme distress to them and their families.

I welcome the fact that the debate is taking place, but it is important for us not to imply that there is a choice to be made by politicians in 2010 about whether the health service faces the need for fundamental reform. The truth is that the health service, by which I mean the pattern of delivery of health care to patients, needs fundamental reform, as has been acknowledged since at least 2009. The shadow Secretary of State was good enough to confirm in his contribution that he recognises the need for that fundamental reform, which was set out by Sir David Nicholson in the £15 billion to £20 billion efficiency challenge. The purpose of the Nicholson challenge is to reconcile continuing rises in demand for health care, which we must assume will continue their long-term trends, with the inevitable fact that health budgets are more constrained, and will be more constrained in the years ahead, than during the period of the Labour Government. That was recognised before the general election, which is why the Nicholson challenge was articulated.

[Diana Johnson (Kingston upon Hull North) (Lab)]

But does the right hon. Gentleman agree that instead of taking such a big gamble with the NHS at this stage, it would be better to pilot some of the initiatives and changes to see whether they actually deliver better health outcomes?

[Mr Dorrell]

I shall come to the White Paper later, but I want to focus on what I regard as the key, unavoidable reforms that have to be delivered during this Parliament. I do not think the hon. Lady will find them controversial. They are the continued development of improvements in the delivery of primary care; the priority need to address unnecessary admissions to hospital, which have been identified by the National Audit Office as running at 30% of non-emergency hospital admissions; the need to address the requirement the health service faces to use its most expensive resource, clinicians’ time, more effectively; the need to improve links between social care and health-care, because if they do not work effectively there is no way we can deliver the aspirations we all share for high quality care delivered by the national health service; and the need to deliver better patient, user and local community involvement in the design and delivery of health care.

All those things are the challenges the health service faces over the lifetime of this Parliament. They are not a matter of political choice; they were articulated by Sir David Nicholson during the previous Government. They were endorsed by the previous Secretary of State and this afternoon they have been endorsed again by the shadow Secretary of State. It is simplest to summarise them by describing them in total as the need to deliver a 4% efficiency gain through the entire national health service system for four years running.

A few weeks ago, when Sir David Nicholson was before the Health Committee, which I have the privilege to chair, we asked him to set that challenge in context and he described it—as the shadow Secretary of State was right to say—as the most substantial challenge not just anywhere in the public service, but anywhere in the economy. The challenge has no precedent in any advanced health care system in the world. The challenge is huge: a 4% efficiency gain throughout the NHS, four years running. We are looking to deliver a wholly unprecedented efficiency gain. Against that background, what is the importance of the White Paper?

I ask the House to consider for a moment the counterfactual. Is it possible to deliver that kind of efficiency gain in the health service without effective empowered commissioning driving change? If effective empowered commissioners will not do it, who on earth will? Secondly, is it possible to imagine effective empowered commissioning that does not engage the clinical community in the process more effectively than we have yet done?

[Simon Danczuk (Rochdale) (Lab)]

If there is a requirement for more clinical involvement—for GPs to be more involved in commissioning—why do the Government not simply put GPs on the boards of primary care trusts? That would be a simpler, easier solution and would not cost as much. Is it not the case that the Government would rather open up commissioning to the private sector? Is that not the reality of their proposals?

--- Later in debate ---

[Mr Dorrell]

I cannot summarise the Government’s proposals in the White Paper in three minutes, but one of their key drivers is to deliver far greater clinical engagement in the commissioning process than was achieved in the lifetime of the previous Government, in my time as Secretary of State or at any time in the 20-year history of health service commissioning. We want to achieve a step change in the engagement of the clinical community in the commissioning process. As long as commissioning is something that is done to clinicians by managers, it will fail. It has to engage the clinical community on both sides of the argument. That, as I understand the Secretary of State’s White Paper, is one of his core objectives, and if it is, it has my full-hearted support.

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

In advancing that idea, does the right hon. Gentleman accept that the power to commission is being given to clinicians only in primary care, and that clinicians who work in a hospital setting are not being empowered or involved in the commissioning process at all?

[Mr Dorrell]

The hon. Gentleman is a fellow member of the Select Committee and I know from our discussions that the principle of clinical engagement in commissioning is broadly supported in the Committee. It is fair to say that none of us would support the view—I suspect the Secretary of State would not either—that clinical engagement means only GP engagement. We should see the GP as the catalyst for broader clinical engagement in the commissioning process if we are to deliver our objectives.

To deliver the Nicholson challenge, we must have strong commissioning, with clinical engagement, and we have to remove unnecessary processes that do not add value. We cannot afford to waste money on them. We must have greater local accountability for the commissioning process in order to embrace public support for change on this unprecedented scale.

[Dr Pugh]

rose—

[Mr Dorrell]

I have only 40 seconds left for my speech, so if my hon. Friend will forgive me I should like to conclude.

My key message is that as we look at the lifetime of this Parliament, I do not see the White Paper as the linchpin of reform, but as a key tool in the delivery of the reforms that are neatly encapsulated in what I have described as the Nicholson challenge.

Oral Answers to Questions

Stephen Dorrell Excerpts

Tuesday 2nd November 2010 Commons Chamber

[Mr Burns]

May I explain to the hon. Lady that, no, councillors will not be on the GP consortiums? They will have a full and active role to play on the health and well-being boards, so that they can take a full part in determining the local needs of the local health economy. That is the right venue for them.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my hon. Friend agree that as those commissioning consortiums are established, it will be important to ensure that they are subject to proper financial assurance, in the same way as Monitor applies such principles to foundation trusts? Can he assure the House that that will be one of the responsibilities of the NHS commissioning board?

[Mr Burns]

There is not altogether the same comparison to be made with Monitor and foundation trusts, but I certainly understand and take on board the general principle behind my right hon. Friend’s question. I think that it is important that there is accountability.

--- Later in debate ---

[Mr Lansley]

We will, of course, respond to the consultation in due course, but support for the principles of the White Paper was widespread and came from local government and the medical and nursing professions. The issues that we will address in the consultation were mainly about implementation of the principles, but support for the principles was widespread.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will my right hon. Friend confirm that the Government’s policy is to ensure that over the next four years we deliver efficiency gains from the health service, valued by the chief executive at between £15 billion and £20 billion? As that target was first set out by the Labour party when it was in government, will my right hon. Friend take an early opportunity to invite the new shadow Secretary of State to endorse that programme, and to support its specific execution as each change is introduced?

Contaminated Blood and Blood Products

Stephen Dorrell Excerpts

Thursday 14th October 2010 Commons Chamber

[Mr Stephen Dorrell (Charnwood) (Con)]

I congratulate the hon. Member for Coventry North West (Mr Robinson) on bringing this important, sensitive and emotive issue before the House. I congratulate him also on the tone—until perhaps the last couple of minutes of his speech—in which he moved the motion. He was absolutely right that this is not a question of the coalition defending its record; it is a question of the hon. Gentleman bringing a substantive proposition before the House for it to decide on.

In those circumstances,I would suggest to the hon. Gentleman and the House that it is more than usually important that Members who vote on the motion understand precisely what its implications are. He had a lot to say—all of which I agree with—about the human tragedy, the system failure and the slow response of successive Governments over 25 years. That is not in dispute. Sadly, however, I shall not be supporting the hon. Gentleman in the Lobby, because of the part of the motion that says that this House

“regrets the past refusal to accept the principal recommendation of the Independent Public Inquiry…relating to compensation for the victims and set out in paragraph 6(h)…of the”

inquiry report.

What the hon. Gentleman describes as the “principal recommendation” of the report is at the heart of the motion. The House must therefore understand precisely what that recommendation says, which is:

“We suggest that payments should be at least the equivalent of those payable under the Scheme which applies at any time in Ireland.”

Let us be clear what has actually happened in the evolution of policy on this subject. The previous Government accepted many of the other recommendations in the Archer report, but they explicitly refused to accept the recommendation that the compensation payments should be aligned with at least the level payable in Ireland. We are advised by the Government that payments at such a level would cost the Treasury about £3 billion. There is no controversy around the history of these matters or the emotion involved, or about how we got to where we are, but the House is being asked to accept that we should commit the Government to spending £3 billion on aligning our compensation payments with those currently payable in Ireland.

[Mr Robinson]

We set out the motion in those terms because that was very much what the victims wanted. However, the Government had the opportunity to respond with a constructive amendment, rather than a wrecking amendment that has no substance and takes not a single step towards our aims, even in relation to the Skipton Fund. We cannot accept that. We wanted a good amendment that we could vote for and unite around, so that the motion could have stood, as amended, in a progressive way that would have allowed us to step forward. Because the Government did not give us such an amendment, however, we are back where we were. We could not, in all honesty, let the victims down, which is why I was forced to move the motion as it stands.

[Mr Dorrell]

I understand the hon. Gentleman’s point. It is not for me to comment on the way in which the negotiations between him and the Government proceeded, but unfortunately, that is not the question on which the House is being asked to decide. I return to the proposition that today is different from normal political days in the House, because the House is being asked to make a decision. It is being asked to decide whether the Government should be committed to align compensation payments with those currently payable in Ireland, and I do not agree with that proposition. I shall vote against it—albeit with a heavy heart, because I accept much of what the hon. Gentleman has said about the context and the history of these matters. The motion is not about the context and the history, however; it is about what happens next. In the week before the comprehensive spending review, it would not be sensible to agree to the commitment of £3 billion to align our arrangements with those in Ireland.

[Alun Michael (Cardiff South and Penarth) (Lab/Co-op)]

Does the right hon. Gentleman, with all his ministerial experience, accept that the House—individual Back Benchers and Ministers—is being asked to consider the human impact and the ways in which that can be alleviated? Individuals and families have been devastated by the impact of contaminated blood—not only the medical impact but the social impact and the undermining of family confidence. Can we focus on that in coming to a decision in the debate?

[Mr Dorrell]

I absolutely agree with a huge amount of what the right hon. Gentleman says. That is why I believe that the proposal made by my hon. Friend the Minister offers a sensible way forward. I said earlier that I agreed with much of what the hon. Member for Coventry North West said, until he got to the last couple of minutes of his speech, when the Minister asked him whether he was prepared to sign up to the terms of reference of what the Government propose to do if, as I hope, the House rejects his motion. The Government are proposing to set up not a committee to think about this matter in the abstract, but a specific inquiry to report before the end of the year. The inquiry will review

“the level of ex gratia payments made to those affected by hepatitis C”

and—this will answer the point raised earlier—take into account the comparison with ex-gratia payments made in the UK to those infected with HIV. It will also review

“the mechanisms by which all ex-gratia payments are made”,

which was a specific recommendation in the Archer report. It will consider the provision for insurance—which has also been widely discussed in this context—and the issue of prescription charging, which Archer also recommended. It will also review the provision of and access to

“nursing and other care services in the community”

for those affected.

I assume that Government are not asking the House to reject the motion and simply carry on as though nothing had happened; I certainly will not do so. We all accept the context, but I would ask the House to consider carefully whether, instead of committing £3 billion to aligning our payments with those of Ireland, a better proposal would be to set up the review that the Minister recommends in her written statement, with the terms of reference that I have just outlined, in order better to meet the pressures that the hon. Member for Coventry North West rightly says are a human tragedy to which the House should respond.

--- Later in debate ---

[Owen Smith]

I, too, would very much like that point to be addressed. I was going to ask the Minister how the £3 billion figure was calculated. The Haemophilia Society has today suggested that the figure has been calculated erroneously on the basis of a typographical error in the Archer report and that the number has been extrapolated from a false figure that Archer published regarding the volumes that were given in Ireland. So, I, too, would welcome the Minister’s clarification on that hugely important point.

[Mr Dorrell]

I entirely agree with the hon. Gentleman and other hon. Members that the number of pounds we are talking about is, to put it mildly, salient. However, is it not also relevant that the House is being asked to sign up not to a specific sum but to the principle that the compensation payable in this country should be at least aligned with that payable in the Republic of Ireland? Whatever the number, the House should not sign up to the dubious principle that whatever is paid in Ireland we will pay here.

Oral Answers to Questions

Stephen Dorrell Excerpts

Tuesday 7th September 2010 Commons Chamber

[Mr Burns]

May I reassure the hon. Gentleman’s constituents that they will be just as pleased with the responses that they receive from a 111 line, where professional advice and help will be given to people who need to contact it about their health needs? May I also reassure his constituents on the question of four-hour targets? The target that was introduced caused distortions; it was a political target. We are relying on clinical decisions and activity to ensure that people are seen as quickly and relevantly as possible.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my hon. Friend agree that in addition to the proper funding of A and E departments, it is also important to take steps to manage the demand on those departments? In particular in urban areas, that means that commissioners should accept the responsibility to look for improvements in the delivery of primary care so that patients have more easy access to less urgent care in the primary care context, thus reducing the demand on A and E departments.

NHS White Paper

Stephen Dorrell Excerpts

Monday 12th July 2010 Commons Chamber

[Mr Lansley]

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

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

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

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

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

[Mr Stephen Dorrell (Charnwood) (Con)]

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

[Mr Lansley]

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

Oral Answers to Questions

Stephen Dorrell Excerpts

Tuesday 29th June 2010 Commons Chamber

[Mr Burns]

I am sorry, but the hon. Gentleman, for whom I have considerable respect, is just plain wrong. There have been a number of representations over the last seven weeks or so. In addition, as my right hon. Friend the Secretary of State and his shadow team went round the country over the past five years, they were constantly told by GPs and clinicians from hospital to hospital that politically motivated targets were distorting clinical decisions and patient care.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my hon. Friend agree that by far the most important way of improving the service delivered by the NHS is to focus on the three key indicators of clinical outcomes, patient experience and value for money? Can he assure the House that the Government will pursue those, particularly against the background of increasingly scarce resources, in order to deliver the objective we all have: a better-quality NHS?

[Mr Burns]

I am extremely grateful to my right hon. Friend, who is absolutely right, and I can give him the categorical assurances he is seeking, but I would also like to add one more: we need information to empower patients, because if patients are going to be at the heart of the NHS they must have the information to take the decisions that are important to their health care.

Mid Staffordshire NHS Foundation Trust

Stephen Dorrell Excerpts

Wednesday 9th June 2010 Commons Chamber

[Mr Lansley]

Yes; my hon. Friend is absolutely right. That is why I have made it clear that that is the first priority for our Department in how we are going to improve the NHS. As a nurse, my hon. Friend will know that what she describes is absolutely how many people across the NHS want to conduct their professional relationships. They have been so frustrated, demoralised and demotivated by not being able to deliver care in the way that they wish—focusing on the needs and expectations of patients.

[Mr Stephen Dorrell (Charnwood) (Con)]

Is not the important issue that the terrible events in Mid Staffordshire are not purely a local issue, terrible though they are for Mid Staffordshire? It is vital that lessons are learned for application right across the NHS. What were the commissioners doing? Where were the regulators? What price professional accountability? Why was all that allowed to happen over so long? Perhaps the most difficult question of all is this: why was it not the first time that this had happened in the NHS?

[Mr Lansley]

My right hon. Friend is absolutely right. That is why we have to move from all those questions to some serious answers—so that we can have the reform that the NHS so badly needs. I know and he knows that this is about not just a different set of structures, but a change of culture and a focus in the NHS on patients and results for patients to the exclusion of other bureaucratic impositions. There is such immense bureaucracy—PCTs, SHAs and regulators—that everything should have worked perfectly, but it did not. Why? Because in all of that, the underlying pressures in the service were not focused on results for patients. We have to drive towards that conclusion.