(11 years, 4 months ago)
Commons ChamberYes, I do take this opportunity to join my hon. Friend in congratulating Rugby borough council on its award from the FSB. The point he raises is very important, and that is why we are taking forward recommendations in Lord Young’s report to simplify and standardise bidding, payment and advertising of contracts, and to reduce complexity costs and inconsistency when trying to sell to more than one local authority. That will include the abolition of unnecessary bureaucracy such as prequalification questionnaires for small tenders. We hope to ensure greater access for SMEs to all the procurement that is available across the public sector.
Following yesterday’s performance by the Prime Minister—and bearing in mind that when we return in September for three days of the second week we will discuss not any of the issues around lack of growth in our economy, but how our politics is done—can we have any confidence at all that he and this Government will take seriously the real concerns about the way the Conservative party is funded? My right hon. Friend the Member for Doncaster North (Edward Miliband) made it clear that the Labour party is going to deal with its issues; when are this Government going to deal with their issues around party funding?
I am quite interested that the hon. Gentleman says he wants to talk about issues relating to funding in September. I have just announced business relating to transparency of lobbying, non-party campaigning and trade union administration. That will be at the forefront of business here. The point he makes is that he does not want to talk about growth in the economy, and his right hon. Friend the Leader of the Opposition did not raise issues relating to growth in the economy and employment. Why? Because we are seeing growth: we are seeing increases in employment and we are seeing unemployment coming down because we are seeing a healing economy, one that is in complete contrast to the earlier 7.2% reduction in gross domestic product, a consequence of the bust that happened under the last Government.
(11 years, 9 months ago)
Commons ChamberI will carry on for a moment, if I may.
Some argue that the boundaries review may spend further money this year and then not be approved—that argument was adduced in the Lords. One might equally say that several millions have been spent and the process should be completed. Either way, the amendments in lieu, if passed today, would settle that question. They would bring the review into effect without any further political interference, which, given the independent character of the review, has merit in any case.
I will, and then I will give way to my hon. Friend the Member for Crawley (Henry Smith).
I am grateful to the Leader of the House. It is undoubtedly true that the question could be settled one way or another today. However, given that the Liberal Democrats are clear that they will not support him, is not the most sensible thing for the House to finish this and not waste any more money on it, rather than continue with the process when it has already been made clear that what was a very political initial manoeuvre is now doomed to fail?
I am rather disappointed that the hon. Gentleman thinks that my modest rhetoric might have no impact on my hon. Friends on the Liberal Democrat Benches. Surely that is the whole point of this debate and, in particular, of my colleagues and I tabling the amendments in lieu—precisely because it would be in the interests of this House to settle the matter today. It would be in the interests of this House, not least in its relationship with their lordships, to say, “We have settled it today. The boundaries review should be completed, as we legislated for it to happen, and there should be no more interference by either House, for any reason or any party.” There is an independent review; it should be completed. Before we come to the amendments in lieu, however, we first have to decide whether the Lords were right to amend the Bill as they did.
(12 years, 10 months ago)
Commons ChamberI hope I did not say what the hon. Gentleman ascribes to me. Some 3,000 women, we think, had PIP implants, and of course, that is only a fraction of the number having breast reconstruction surgery. I think I can offer him reassurance. The MHRA withdrew authorisation in March 2010, and given that there was only one distributor of these implants in this country—Cloverleaf—they will not have been distributed for use after that date.
A constituent in Chesterfield contacted me who is at her wits’ end. She has been in considerable pain since having a PIP implant fitted, and has been told by the private provider that she will have to pay £3,600 to have it replaced. What more can the Secretary of State do to ensure that her private provider follows the example of the other eight providers that are doing this free of charge? Let us put some pressure on these companies to make sure that all of them do the same as the NHS and replace the products they have fitted.
I think I have made it clear that not only the Government but, helpfully, the professional associations are looking to give no reason why private providers should not match that standard of care, especially if the implanting surgeons are willing to offer replacement surgery free of surgical charge themselves. It would be very helpful if the hon. Gentleman and other Members gave us details of such cases on behalf of their constituents. Clearly, his constituent will have had that implant before March 2010. The adverse incident centre has had 478 reports of ruptures over the whole period, which extends back many years. One of the things we want to understand as part of our review is why, if there were ruptures and, more to the point, adverse health effects associated with these implants, they were not disclosed to the adverse incident centre. As yet, we have not seen a range of health effects over a period of time that, in themselves, distinguish these implants from other, normal implants.
(13 years, 2 months ago)
Commons ChamberI am grateful to the Secretary of State for giving way. Does he think that the British Medical Association, too, is misrepresenting the position when it says that even after Report stage there will still be too much emphasis on using market forces to shape health services? Is the BMA misrepresenting the truth as well, or is it just the Labour party?
I was interested to read this morning a letter whose lead signatory was Hamish Meldrum, the chairman of the BMA council, whom I know well. It was curious because his objection to the Bill, which he wants to be amended, was about the introduction and extension of the role of “any qualified provider”. However, that extension is not in the Bill. It is not occasioned by the Bill; it is a consequence of the way in which commissioners—[Interruption.] No, it does not. If there were no Bill, it would be open to strategic health authorities and primary care trusts to extend “any qualified provider” and patient choice in the NHS to whatever extent they wished. The Bill does not make that happen.
The point is that under the legislation there is a stronger safeguarding process, because the commissioners—
I will finish answering the hon. Gentleman before letting him intervene again.
The safeguard structure will be stronger, because commissioners must ensure, for example, that they meet their duty of continuous improvement of quality, their duty of safety and their duty of integration of services and other duties, including a duty to promote patient choice—but of course they have to balance those duties. Whether they extend “any qualified provider” is a matter of judgment. If they took the view that the extension of patient choice would be inimical to the integration of services and the improvement of quality, they would not go ahead with it. The hon. Gentleman and his colleagues should recall that they have put in an NHS constitutional right for patients to exercise choice, so if the commissioners think it is possible to promote choice and improve quality by extending the any qualified provider remit, they can do it, but the Bill is not what enables it. It is therefore curious that the Bill should be attacked on that basis.
I am grateful to the right hon. Gentleman for giving way a second time. That was a very long answer to a short question, but I understand the Secretary of State to be saying that the BMA is wrong and the Labour party is wrong. Everyone I meet in the health service tells me that it is the Secretary of State who has got it wrong. He has come back here once again, confirming that he is not listening to what people are saying to him. He thinks the BMA is misleading people, but is it possible that he is the one who has got it wrong?
I will give the hon. Gentleman a shorter answer this time: he does not talk to enough people in the NHS.
Let me return to the important point that I was about to make. I was saying that criticism of the Bill has typically developed to the point of literally misrepresenting the facts in order to attack the Bill, as was the case with 38 Degrees. I am indebted to my hon. and learned Friend the Member for Sleaford and North Hykeham (Stephen Phillips) for sharing with me a letter that he prepared for the better information of his constituents. He looked at the legal opinion obtained by 38 Degrees and concluded that it did not support the views that those behind the 38 Degrees website evidently wished it did.
For example, 38 Degrees claims that the Bill removes the Secretary of State’s duty to provide a comprehensive health service. However, its own legal advice makes it clear that the Secretary of State has never had a duty to provide a comprehensive health service—only a duty to “promote” a comprehensive health service, which is exactly reproduced in clause 1.
Clause 1 also makes it clear that the Secretary of State must secure the provision of that service. The “duty to provide” certain services to which 38 Degrees refers is a duty that I, as Secretary of State, currently delegate to primary care trusts. In future, the Bill will—in exactly the same way—pass that duty of the Secretary of State to the NHS commissioning board and to clinical commissioning groups. In other words, the situation will be legally unchanged. The Secretary of State has a duty, and discharges it through organisations to which he or she delegates that power. Strictly speaking, they have more direct statutory duties, but the duty to provide will not change.
38 Degrees also claims that the Bill opens up the NHS to competition law, but its own legal advice—which it obviously did not like—made it clear that there would be no change between the present competition regime and that which would operate if and when the Bill became law.
I am very grateful to my hon. and learned Friend, whose forensic analysis accords with our own view. The provision, under the Bill, of a comprehensive NHS is watertight, and it is equally clear that the Bill does not change the extent of the application of competition law and EU procurement rules. The 38 Degrees campaign should be seen for the distorting and misleading political propaganda that it is.
(13 years, 6 months ago)
Commons ChamberI am glad to hear that the Secretary of State supports the staff of the NHS, but is it not the truth that the staff of the NHS do not support him?
That is complete nonsense. This is not about me: it is about what the staff of the NHS want. They want the ability to be able to deliver care for patients without being told what to do by the top-down bureaucracy and targets of the Labour Government. They want the ability to deliver the care that patients need, to join up health and social care and to integrate the pathways of care. Our Bill is about giving them the structure that will allow them to do that. They want every penny that we as taxpayers provide to the NHS to get into the hands of front-line staff, and for the absolute minimum to go in waste and inefficiency. That is what they want, and that is not about me, it is about them.
A stronger NHS will require change, so that it no longer spends £5 billion a year on bureaucracy.
(13 years, 7 months ago)
Commons ChamberI am grateful to my hon. Friend. We are not only developing communication with GPs in pathfinder consortia, but, more importantly, creating a learning network among GPs in pathfinder consortia, so that these groups across the country will not only learn from each other, but, we hope, arrive at a set of views that help us to design a service that supports them.
The Secretary of State, who tells us how much he studies the NHS, must know that the King’s Fund tells us that under the Labour Government, Britain’s NHS was the most efficient in the entire world. On that basis, a broad coalition of people, including health experts and the Liberal Democrats, is telling him that this policy is wrong. He apparently came here today to tell us why he is right and all those people are wrong. Is this a genuine consultation, or is it just a pause to get through the local elections before he does what he wants to do anyway?
The hon. Gentleman is wrong on almost every count. We have seen a decade of declining productivity in the NHS. The Office for National Statistics and the National Audit Office set that out recently. We have seen an NHS that, despite record increases in funding, which are welcome, is still not meeting the best European cancer survival rates, as was made clear by the NAO. We need to improve the NHS. The Government are not discounting anybody’s views on how we can best achieve that. In the spirit of continuous improvement in the NHS, there is a spirit of continuously listening about how to make that happen.
(13 years, 10 months ago)
Commons ChamberI take this issue seriously, even if the right hon. Gentleman does not. As it happens, I fall into one of the at-risk groups, because I had a stroke in 1992, so I have had the flu jab. I would not ask members of my ministerial team who are not in the at-risk groups to have the vaccination, because it is not recommended.
The biggest tragedy is that the Secretary of State has learned no lessons whatsoever from what has happened. As a result, it is likely that the same mistakes will be made in the future. His answers about the advertising campaign are completely unconvincing. Will he explain why he cancelled the advertising campaign, which GPs were demanding at the time, to increase the take-up of vaccinations?
I cancelled no campaign; I proceeded only with the awareness campaign on respiratory and hand hygiene. An advertising campaign aimed at the general population would not have been effective, and I was advised that there was no evidence that it would be effective. We knew who the at-risk groups were, and it was possible to reach them directly rather than engaging in wider advertising.
(13 years, 11 months ago)
Commons ChamberI agree with my hon. Friend, who is obviously an advocate for his constituents to the Welsh Assembly Government. These are matters for the devolved Administrations and they must decide how to allocate their resources. In this instance we have shared with the devolved Administrations the consultation on the cancer drugs fund, which will start next April, although the policy proposed will apply in England alone.
2. What recent representations he has received on the effect of the abolition of primary care trusts on the co-ordination of preventive health care.
My hon. Friend will know that all that has not yet come to me, so I will not prejudge this issue. However, I have made it clear, not least in a letter I recently sent to Baroness Margaret Wall, who is the chair of the Barnet and Chase Farm Hospitals NHS Trust, that I expect us to examine not only the Barnet, Enfield and Haringey proposals, but any other proposals that the trust might put forward about the level of acute services provided through Chase Farm.
T9. The Secretary of State seemed to suggest, in his answer to the shadow Secretary of State, that his definition of a real-terms increase includes changes in inflation. If he does not accept the Office for Budget Responsibility verdict that the increase in inflation means a real-terms cut in 2012, which definition of inflation is he using?
What I said to the shadow Secretary of State was entirely accurate.
(14 years ago)
Commons ChamberMy right hon. Friend makes an excellent point, and I invite the shadow Secretary of State to respond to it in due course. We will ensure that the NHS uses resources more efficiently to meet increasing demand and costs in the NHS. Savings of that order are required, and the NHS is on track to make them.
I would like to return to the subject raised by my hon. Friend the Member for North East Derbyshire (Natascha Engel) about the national hereditary breast cancer helpline. The Minister’s response was inept. She said that a national service will be funded by tons of different GP commissioning groups. That just will not happen. She said nice words about Wendy Watson, but her Government’s policies will see the end of that helpline unless she intervenes. Will she please ensure national funding for a national service?
(14 years, 4 months ago)
Commons ChamberT2. My right hon. Friend the shadow Secretary of State referred to the Commonwealth Fund report, which said that Britain’s NHS was the most efficient. Does that not make it clear that after 13 years of a Labour Government, the NHS is not just so much better for patients, but efficient? To say that it is not is an insult to the people who have worked so hard to make it great.
I have looked at the reports of the Commonwealth Fund for a number of years; it regards the NHS as efficient because it spends relatively little in comparison with other health economies. In this country, we need to recognise that the NHS does not spend very much in comparison with other countries but it could spend it more efficiently. There has been declining productivity for 10 years. [Interruption.] The shadow Secretary of State needs to recognise that NHS management costs went up by 63% while nursing costs went up by just 27%. My colleagues and I are committed to halving NHS management costs and to reducing the costs of the NHS, through efficiency, by £20 billion. Every penny of that will be reinvested in meeting the rising demand for the NHS and the improvements in quality that we require.