via the ever-magnificent Hansard.
Click here for details of 'PM Cameron - Mr Lansley's "as one" or assassin?', the new issue of subscription-based Health Policy Intelligence.
The Secretary of State was asked—
PFI Debt (NHS Hospitals)
1. Chris Kelly (Dudley South) (Con):
What steps he is taking to address levels of PFI debt in NHS hospitals; and if he will make a statement.
9. Oliver Colvile (Plymouth, Sutton and Devonport) (Con):
What steps he is taking to address levels of PFI debt in NHS hospitals; and if he will make a statement.
The Secretary of State for Health (Mr Andrew Lansley):
The previous Government left 102 hospital projects with £67 billion of PFI debts. We have worked closely with NHS organisations for which PFI affordability is an issue to identify solutions for them, which have included joint working with the Treasury to reduce the costs of PFI contracts. Despite that, some trusts have unaffordable PFI obligations. On 3 February I announced how each of them could access ongoing Government support to help meet those costs.
Chris Kelly: I thank my right hon. Friend for that answer. Russells Hall hospital was expanded in 2003, but still has £1.8 billion of PFI debt attached to it—debt which will not be paid off until 2042. What steps is he taking to help reduce the PFI costs for hospitals such as mine that have not been completely crippled by Labour’s PFI and therefore do not qualify for central support, but none the less have high levels of debt?
Mr Lansley: I am grateful to my hon. Friend, who illustrates the precise issue with what Labour left. Labour talked of building new hospitals but left this enormous mortgage, in effect, of £67 billion. He refers to Russells Hall hospital, which, like others, is having its contracts reviewed for potential savings following the Treasury-led pilot exercise that I described, which was undertaken at Queen’s hospital, Romford.
Oliver Colvile: Given that the PFI process has been proven to have flaws in delivering value for money for taxpayers, what effect does my right hon. Friend feel that that will have on new commissioning boards?
Mr Lansley: My hon. Friend will know from the very good work being done by the developing clinical commissioning groups in Plymouth that they have a responsibility to use their budgets to deliver the best care for the population they serve. It is not their responsibility to manage the finances of their hospitals or other providers; that is the responsibility of the strategic health authorities for NHS trusts and of Monitor for foundation trusts. In the future, it will be made very clear that the providers of health care services will be regulated for their sustainability, viability and continuity of services but will not pass those costs on to the clinical commissioning groups. The clinical commissioning groups should understand that it is their responsibility to ensure that patients get access to good care.
Grahame M. Morris (Easington) (Lab): The Secretary of State will recall that he cancelled the new hospital planned for my area shortly after the general election. Will he advise the House how many hospitals the Government are building that use models other than PFI?
Mr Lansley: The hon. Gentleman will recall that his foundation trust was looking to receive more than £400 million in capital grant from the Department, which went completely contrary to the foundation trust model introduced under the previous Government. I pay credit to North Tees and Hartlepool trust, which is developing a better and more practical solution than that which it pursued before the election—many of the projects planned before the election were unviable. The hon. Gentleman will know that projects are going ahead, and last November, together with the Treasury, we published a comprehensive call for reform of PFI. We achieve public-private partnerships and use private sector expertise and innovation, but on a value-for-money basis.
Valerie Vaz (Walsall South) (Lab): John Appleby of the King’s Fund says that PFI represents less than 1% of the total annual turnover of £115 billion. Does the Secretary of State agree?
Mr Lansley: I gave the hon. Lady the figure: £67 billion of debt. Seven NHS trusts and foundation trusts are clearly unviable because of the debt that was left them by the Labour Government.
John Pugh (Southport) (LD): Is the Secretary of State confident that subsidising hospitals burdened with PFI will not be deemed anti-competitive under forthcoming legislation, or state aid under EU legislation? Has he taken appropriate legal advice?
Mr Lansley: I always act on advice, and I am absolutely clear that the support we have set out for NHS trusts and foundation trusts will not fall foul of anti-competitive procedures.
2. David Wright (Telford) (Lab):
What recent assessment he has made of the potential risks of NHS reorganisation.
The Minister of State, Department of Health (Mr Simon Burns): The Department monitors risks associated with the implementation of the health and social care reform programme on an ongoing basis.
David Wright: “An open, transparent NHS is a safer NHS”: not my words, but those of the Secretary of State for Health. Is it not amazing that Ministers do not want to release documentation relating to the reorganisation of the NHS? Is it not an absolute scandal that they will not publish the documentation? Is it not the fact that the reorganisation of the NHS is looking a bit like the Norwegian blue? Should it not shuffle off the perch?
Mr Burns: No, the hon. Gentleman is wrong. As he, or certainly the right hon. Member for Leigh (Andy Burnham), will know, the risk register is an ongoing document—discussions between Ministers and civil servants on the formulation, implementation and transition of policies—and it would be wrong, in my opinion, for it to be published. That is why my right hon. Friend the Secretary of State appealed to the tribunal following the decision of the Information Commissioner, in line with the precedent adopted by Secretaries of State in the Labour Government in both the Department of Health and the Treasury.
David T. C. Davies (Monmouth) (Con): Does the Minister agree that the risk of not reorganising would be the longer waiting lists, longer waits for ambulances and lower access to life-prolonging drugs that we currently see in socialist-dominated Wales under the Assembly?
Mr Burns: My hon. Friend is absolutely right, and of course he speaks from the authority of living in a country that has a Labour Administration, where we see spending cut, waiting times and lists rising, and utter chaos in the quality of care for patients.
Hywel Williams (Arfon) (PC): The Minister will know that large numbers of people from Wales, particularly north Wales, access treatment in England. What assessment has he made of the risks to such treatment if the legislation goes through?
Mr Burns: If the hon. Gentleman is trying to tease out of me what is in the risk register, I am afraid he will be unsuccessful, but if it is of any reassurance I can tell him that for people living close to the border there have been arrangements between Wales and the English NHS and they will continue. Those people will benefit if treated in England, because waiting times are falling in this country, unlike Wales where they are increasing.
Mr Jamie Reed (Copeland) (Lab): What a pleasure it is to see the Secretary of State here today; he managed to make his way in.
I am afraid I have to describe the Minister of State’s answer as codswallop. Let me give him an example of one risk to the NHS that we already know about. The number of NHS nurses has fallen by 3,500 since the general election, and that figure could be at least 6,000 by the end of this Parliament. The Bill is damaging front-line services in the NHS right now. Why does the Minister not put patients before his, the Secretary of State’s and the Prime Minister’s pride, drop this unwanted Bill, and use some of the money it would save to protect those 6,000 nursing posts?
Mr Burns: I have to say that, unfortunately, notwithstanding what the hon. Gentleman thought was a rather clever way of describing my answers, his figures are factually incorrect. As Jim Callaghan once said, an inaccuracy can be halfway round the world before truth gets its boots on. The facts are these: there are 896—[Interruption.] If the hon. Gentleman would listen to the answer he asked for, he might learn something and stop making misrepresentations. There are 86 more midwives working in the NHS—[Hon. Members: “86?”]—896, which is an increase of 4%. There are 4,175 more doctors working in the NHS: an increase of 4%. There are 15,104 fewer administrators working in the NHS—a decrease of 7.4%—and 5,833 fewer managers. There are more doctors. There are more midwives. There are fewer administrators.
Private Health Care
3. Jessica Morden (Newport East) (Lab):
What recent assessment he has made of the future of private health care.
6. Teresa Pearce (Erith and Thamesmead) (Lab):
What assessment he has made of the future of private health care.
13. Mr Russell Brown (Dumfries and Galloway) (Lab):
What assessment he has made of the involvement of the private health care sector in the NHS.
The Minister of State, Department of Health (Mr Simon Burns): The Department has made no assessment of the future of private health care. This is not the role of the Department of Health. The private sector has always provided services to the NHS and the Department monitors trends where it does so—for example, the number of NHS patients choosing a private provider under patient choice.
Jessica Morden: Given that the Prime Minister said there would be no top-down reorganisation of the NHS, the coalition agreement ruled it out and nobody voted for it, what exactly is the Secretary of State’s mandate for turning the NHS into a “fantastic business”, as the Prime Minister has said?
Mr Burns: I am extremely sorry if the hon. Lady really believes the mantra that she has just spewed out. If she had read pages 45 and 46 of our manifesto, she would have seen that it says that we would introduce clinical commissioning groups, take away political micro-management from Whitehall, free up the NHS and cut bureaucracy, as we are doing, which will save £4.5 billion to reinvest in the health service. Our coalition colleagues, the Liberal Democrats, had in their manifesto the abolition of SHAs. So I have to tell the hon. Lady that she is wrong. The test of what is going on and what is a success is the fact that if one meets GPs around the country, they support commissioning for their patients.
Teresa Pearce: On the BBC’s “Newsnight”, the Minister of State stated that the Health and Social Care Bill would turn the NHS into a “genuine market”. How does this belief fit in with the NHS founding principle that access should be based on need, not market forces?
Mr Burns: I am sorry—the hon. Lady has obviously not listened properly to me. It has been my guiding principle and my core belief from the day I entered politics that we should have a national health service free at the point of use for all those eligible to use it. In no shape or form does the Bill, or any actions by this Government, compromise that core belief of mine.
Mr Brown: The Minister is aware that funding for the health service in Wales and Scotland is through the Barnett formula. For every pound saved by the Government—in other words, for every pound less spent per person in England—there is a knock-on consequence for the budgets in Wales and Scotland. What assessment has he made of the fact that he will be funding NHS provision from private patient fees, rather than the public purse?
Mr Burns: As the hon. Gentleman knows better than I do, the running of the NHS in Scotland and Wales is a matter for the devolved authorities. I speak for the English NHS, and I can tell him that that we have guaranteed that the budget of the NHS in England will be a protected one for this Parliament in which there will be real-terms increases, albeit more modest than in the past. But we have seen in Wales in particular a fall of just over 8% in funding. That is the decision of a Labour Welsh Government. The moneys that are saved in the health service in England through cutting out bureaucracy and through greater effectiveness in delivering care will be totally reinvested—100%—in the NHS in England.
Sir Paul Beresford (Mole Valley) (Con): I may have an interest—a remote one—in this question. I expect my right hon. Friend would agree that every patient who chooses to have private health care rather than national health service care, for whatever reason, is one less case on the national health cost and care bases. Does my right hon. Friend agree that it may be appropriate for the Treasury to do a cost-benefit analysis so as to consider a tax encouragement for individuals, especially those over 65, to take out private health insurance?
Mr Burns: I do not want to disappoint my hon. Friend, but I am afraid I do not agree with that. What the Government have to concentrate on is giving the maximum amount of resources within the protected budget to the provision of health care in this country, to ensure, enhance and improve the quality of care for patients in England. That is the priority, not providing tax relief in any shape or form for people who use their choice for private health care.
Margot James (Stourbridge) (Con): Professionals working in the NHS told the Health and Social Care Bill Committee that income from private patients was important to the development and improvement of NHS services. What steps will my right hon. Friend take to ensure that that income benefits NHS patients?
Mr Burns: I am grateful to my hon. Friend for her question, because it might clarify some of the misinformation being bandied around on the Opposition Benches. Any money generated by private patients or by the private sector within the NHS must be spent on NHS patients, so it will benefit NHS patients and the NHS, and that is to be welcomed.
Andrew Bridgen (North West Leicestershire) (Con): Does my right hon. Friend agree that collaboration between the NHS and the independent sector can deliver real benefits for both patients and the taxpayer?
Mr Burns: My hon. Friend is absolutely right, because we need to drive up the quality of care. What we are doing with the Health and Social Care Bill is closing a loophole so that there can be no favouritism towards the private sector, so the travesty introduced under the previous Government, including the right hon. Member for Leigh (Andy Burnham), where independent treatment centres had an advantage that put the NHS at a disadvantage in providing care, and were paid more than the NHS, will stop, because it is unacceptable.
Mr Kevin Barron (Rother Valley) (Lab): Part 3 of the Health and Social Care Bill will introduce competition policy to the NHS by law for the first time in its history. Does the Minister think that that is likely to lead to more private care in this country or less?
Mr Burns: I am sorry, but the right hon. Gentleman, who always asks this question, is wrong. We have not introduced competition into the NHS; it was there under the previous Administration.
Andy Burnham (Leigh) (Lab)
Mr Burns: It is a bit rich for the former Secretary of State to bleat about that. What I want is the finest health care for patients so that they are treated more effectively and quickly and their long-term conditions are managed in a way that enhances the patient experience.
4. Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con): What steps he is taking to address underperforming hospital management teams.
The Secretary of State for Health (Mr Andrew Lansley): The performance of hospital management teams is the responsibility of their boards. Those are accountable to strategic health authorities for NHS trusts, and foundation trusts are accountable to their governors to ensure that they comply with Monitor’s framework. As part of our work to strengthen NHS trusts so that they can reach foundation trust status, we have published guidance on strengthening trust boards, their clinical leadership and management. We are further strengthening accountability through quality accounts and open reporting so that the public can see the absolute and relative performance of all NHS service providers.
Dr Poulter: I thank my right hon. Friend for that answer. It is absolutely right that managers take responsibility for the decisions that they take at a local level on behalf of patients and are held accountable for them. A doctor or nurse who fails in their duty can be struck off, so there is clear accountability, but there appears to be no clear accountability or traceability for the decisions of hospital managers. Who will hold those people properly to account when they have failed?
Mr Lansley: My hon. Friend knows that the management of trusts should be accountable directly to their boards. As I said, the management of foundation trusts are accountable, through their boards, to their governors. An important point that arose in relation to Mid Staffordshire NHS Foundation Trust is that we should ensure—we are looking at how to fulfil this—that there is also a code of practice to which managers are held accountable. He knows, as I do, that management must be accountable through their boards.
Rosie Cooper (West Lancashire) (Lab): The Secretary of State has part-begun to answer this question, as he recently threatened to sack NHS boards that do not meet their financial and waiting time targets. The question is this: why is he abolishing those powers in the Health and Social Care Bill? Is he really saying that governors of foundation trust hospitals have the power and wherewithal to sack a board?
Mr Lansley: The hon. Lady should know that we intend to enhance the powers of foundation trust governors, but I am simply taking what was her Government’s policy before the election—that all NHS trusts should become foundation trusts, with the freedoms that go with that, and the responsibilities and accountability. We are putting that into place where her Government failed.
5. Penny Mordaunt (Portsmouth North) (Con):
What recourse patients have when denied facilities to which they are entitled under the NHS constitution.
The Parliamentary Under-Secretary of State for Health (Anne Milton): The patient may complain either to the local organisation that provides the service or to the primary care trust. If it proves impossible to resolve the complaint locally, the complainant has the right to ask the health service ombudsman to look into their case. They have the right also to make a claim for judicial review if they think that they have been directly affected by an unlawful act or decision of an NHS body.
Penny Mordaunt: In the short time that I have been a Member, I have had to challenge my local trust over its policies on cancer drugs, metabolic surgery, IVF and a raft of other issues in order to get my constituents the treatment that their doctors say they need. When will all NHS patients in Portsmouth and elsewhere be able to have treatment based on clinical need?
Anne Milton: My hon. Friend’s constituents are fortunate to have such a vigilant MP who has taken up their individual cases. Patients have the right to expect local decisions on the funding of drugs and treatments to be made rationally, following proper consideration of the evidence. I suggest that she, like many other Government Members, will not be going out to march to preserve the PCTs, which often make flawed decisions.
Dame Joan Ruddock (Lewisham, Deptford) (Lab): Has the Minister seen an article today by the respected journalist Polly Toynbee—[Laughter.] Respected by the Prime Minister—[Hon. Members: “Stop laughing.”] I am not laughing at all—
Mr Speaker: Order. I want to hear the views of Polly Toynbee, as enunciated by Dame Joan.
Dame Joan Ruddock: On a very serious issue, a waiting list clerk of 17 years has just resigned because she was asked to adopt a range of devious methods to make sure that people coming up to the 18-week target for treatment were taken off lists. Does the Minister understand that patients will not always know whether they have had proper treatment, and that it will be far too late to refer them to an ombudsman at some later date?
Anne Milton:I thank the right hon. Lady for her question. I am devastated to say that I have not seen the article to which she refers, but I am sure that I will. The Department has made it very clear to the NHS that clinical priority is and remains the main determinant of when patients should be treated. When I was in opposition I made various visits to various hospitals and saw them fiddling around at the edges, with admin staff forced to do things that they did not want to do, in order to tick boxes for the previous Government.
Mr Speaker: Right. Can we now speed up a bit? We have a lot to get through, and I should like to accommodate the interests of colleagues, so everybody needs to tighten up.
NHS Allergy Services
7. Jo Swinson (East Dunbartonshire) (LD): What assessment he has made of the effectiveness of NHS allergy services.
The Minister of State, Department of Health (Paul Burstow): A number of reports have highlighted variations in NHS allergy services and a lack of integration throughout primary, secondary and tertiary care. The Department has funded the NHS in north-west England to pilot an integrated model of care, and the results of that work have been widely disseminated. The Government expect NHS commissioners to commission services to meet the health needs of their local population and to deliver improving outcomes for patients.
Jo Swinson: I thank the Minister for that reply. He mentions the recent north-west allergy pilot, and its report contains a number of recommendations, including improved education for commissioners about the impact of allergy on primary care, and the allocation of additional specialists allergy training posts. How does he intend to act on those recommendations in order to improve services for millions of allergy sufferers?
Paul Burstow: I am grateful to my hon. Friend, who I know campaigns on these issues and has a parliamentary reception on them later this week. She is absolutely right that we need to ensure that there are improvements in the area, and that is why I can confirm today that discussions are under way with clinical leaders on the potential development of a tariff to cover allergy services and the steps necessary to make that possible. On training places, I can confirm also that the joint working group, on which the Department, strategic health authorities, NHS Employers, postgraduate medical deans and professional organisations sit, does look at those issues and make recommendations about additional places.
Derek Twigg (Halton) (Lab): What services is the Secretary of State setting up for professionals who have become allergic to his Health and Social Care Bill and to him?
Paul Burstow: That was a pretty limp attempt. One of the most striking things about this Question Time is how many Opposition Members are yet again suffering from another health problem—memory lapses. When it comes to the Labour party’s record in government, £12 billion was wasted on a computer system that did not work, with which 60,000 nurses could have been recruited and employed for a decade.
8. Iain Stewart (Milton Keynes South) (Con):
What progress he has made in improving outcomes for NHS patients.
The Secretary of State for Health (Mr Andrew Lansley): Last December, we published data against 30 indicators in the new NHS outcomes framework, which has been supported enthusiastically by patients, by professionals and internationally. The data show that for 25 of the new measures, the NHS improved or maintained performance, including MRSA infections being down by half and C. difficile infections being down by 40% since 2008-09. I expect continuing improvement over the coming years, as the focus on outcomes drives change and improvement.
Iain Stewart: Campaigns such as “Be Clear on Cancer” are invaluable in ensuring the early detection and treatment of serious conditions. Will the Secretary of State do what he can to ensure that there is proper co-operation between charities and local hospitals about the timing of such campaigns, to ensure that the spike in referrals that follows is dealt with as efficiently as possible?
Mr Lansley: I will indeed ensure that that happens. We work closely with the cancer charities. We are working with them as we roll out the campaign that was piloted in the east of England to encourage the awareness of symptoms and the earlier diagnosis of bowel cancer. I hope that we will ensure that the services, such as endoscopy services, are available to support that.
Mr Ben Bradshaw (Exeter) (Lab): Is the Secretary of State aware of this week’s report from the distinguished health academic at Exeter university, Dr Mike Williams, which states that his NHS upheaval is putting patient safety at risk and making a Mid Staffordshire-style hospital scandal more likely? Given that, will he assure the House that he will publish the findings of the Mid Staffordshire public inquiry in time to inform the final outcome of the Health and Social Care Bill, if it ever gets through this place?
Mr Lansley: The right hon. Gentleman should know that the timing of the publication of Robert Francis’s public inquiry is a matter for the inquiry, not for me. It is pretty rich for him, who came to this Dispatch Box to disclaim all responsibility for what happened at Stafford hospital, to accuse us of being responsible for something like that. Something like that will not happen because our plans focus on quality for patients, which he failed to do.
Mr Adrian Sanders (Torbay) (LD): The Secretary of State will be aware of the report today that more than 1.3 million diabetes patients have not been offered vital tests. Does that not re-emphasise the need for a plan post-2013, when the national service framework for diabetes comes to an end?
Mr Lansley: Yes, indeed. I share my hon. Friend’s view about the importance of this publication. For the first time, we are publishing the data so that we are absolutely transparent about performance in this and other areas. It is wrong that there are primary care trusts that are failing to meet the nine standards of care that are set out. That is why we published the atlas of variation. By focusing on that variation and through the commissioners’ responsibility to meet the standards, not least in the publication of the quality standards, we will deliver improving standards across the country.
Andrew Gwynne (Denton and Reddish) (Lab): But the Secretary of State must surely be aware that, for seven weeks running since the new year, the NHS has missed its target for 95% of patients to be seen within four hours at A and E. That is precisely what Labour warned would happen when this Government downgraded the waiting times standard. Is it not clear that he has lost control over waiting times while he focuses on the largest top-down reorganisation in the NHS’s history? That is why he is losing public trust on the NHS. He should focus on what matters to people and drop the Health and Social Care Bill.
Mr Lansley: Let me tell the hon. Gentleman that the average time that in-patients waited for treatment at the time of the last election was 8.4—[Interruption.] The hon. Gentleman asked a question and I am telling him the answer. The average time was 8.4 weeks. That has gone down to 7.7 weeks. For out-patients, the average waiting time was 4.3 weeks at the time of the election. That has gone down to 3.8 weeks. The number of patients waiting for more than 18 weeks at the time of the election was—
Andy Burnham (Leigh) (Lab): A and E.
Mr Lansley: I made it very clear after the election that, on clinical advice, we would relax the 98% target to 95%. Patients are being seen within four hours in A and E far more consistently in England than in Wales, where there is a Labour Government. Let me remind the hon. Member for Denton and Reddish (Andrew Gwynne) that we have more than halved the number of patients who wait more than a year for treatment since the election.
10. Dan Jarvis (Barnsley Central) (Lab):
What progress he has made on tackling inequalities in cancer care.
The Minister of State, Department of Health (Paul Burstow): Through the national cancer equality initiative, we are working in partnership with patients, professionals, academics and the voluntary sector to take forward a range of projects, such as working with Macmillan Cancer Support and Age UK to tackle the under-treatment of older people, our launching of the “Cancer does not discriminate” campaign with black and minority ethnic groups and our funding of work to target lesbian and bisexual women with cervical screening.
Dan Jarvis: I am sure the Secretary of State and the Minister will acknowledge that cancer mortality rates are higher in my constituency than in his. Can he therefore justify to my constituents why Barnsley primary care trust is being forced to spend £17 million not on addressing issues surrounding the inequality of cancer care but on delivering an undemocratic, unwanted and unnecessary top-down reorganisation of our NHS?
Paul Burstow: I say two things to the hon. Gentleman: first, that the reforms will actually release resources from back-office costs and put them back into the front line, which I hope all hon. Members want to happen; and, secondly, that when it comes to our cancer strategy, we committed additional resources in the spending review to invest in cancer services. If he wants to raise specific issues with me, I will be only too happy to address them.
Mr John Baron (Basildon and Billericay) (Con): The Minister will fully understand the importance of early diagnosis in cancer outcomes and tackling cancer inequalities. May I therefore urge the Government to include the one-year outcome measure in the commissioning outcome framework, so that we can measure the performance of clinical commissioning groups?
Paul Burstow: My hon. Friend, who chairs the all-party group on cancer, has been pursuing that issue vigorously. We certainly need to ensure that we use both proxy and other performance indicators on cancer outcomes, and I will want to continue examining whether that indicator is the most appropriate one to tell us what we need to know about improvements in cancer outcomes performance.
Liz Kendall (Leicester West) (Lab): The hon. Member for Basildon and Billericay (Mr Baron) is right that early diagnosis is crucial for treating cancer, and it is often very worrying for people to wait for their test results. Under the current Government, waiting times for diagnostic tests have soared. Will the Minister confirm that the number of patients waiting more than six weeks for their test has more than doubled since May 2010, the number waiting more than 13 weeks has more than trebled and the average wait is up, too, by 28%? It is a simple question, so will he give us a simple answer—yes or no?
Paul Burstow: It was a somewhat longer question than that, so I hope the hon. Lady will let me go a little further than a yes or no. I tell her that at the end of December 2011 only 1.4% of patients were waiting six weeks or longer for one of the 15 key diagnostic tests, and that just five NHS trusts are responsible for about 30% of all waits of six weeks or longer. We are working specifically with those five trusts to bear down on those waits and ensure that people do not have to wait so long. Of course she is right to make her point about waits, which is why the Government are focused on the issue and have sent in the additional support needed to ensure that trusts deal with it.
Health and Social Care Bill
11. Andrew George (St Ives) (LD):
If he will withdraw the Health and Social Care Bill.
The Minister of State, Department of Health (Mr Simon Burns): No, Sir.
Andrew George: I respect the Minister, but massive opposition to the Bill is mounting at the same time as its meagre support is ebbing away. Any more rational process would have resulted in the dignified withdrawal of the Bill long ago. Is there anything that would persuade the Secretary of State—frankly, he should be answering this question—to change his mind?
Mr Burns: The straightforward answer is no, because everyone, including the right hon. Member for Leigh (Andy Burnham), accepts that the NHS has to evolve to keep up and meet its challenges. What matters to patients is not who delivers their care but the quality of the care that they receive, their experience of that care and the dignity and respect with which they are treated at all times. Cutting bureaucracy by a third to reinvest £4.5 billion in front-line services between now and 2015 is the way forward. Frankly, if one goes and talks to doctors around the country, one finds that they wish that Labour’s party political squabbling would stop so that they can get on with implementing the modernisation programme.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): The Minister talks about party politics. Is he not aware that not a day goes past without an organisation representing doctors and nurses coming out against his Bill? Most recently, the Royal College of Physicians is having to hold an extraordinary general meeting because of pressure from its members. The Royal College of Paediatrics and Child Health is consulting its members. Why should anyone in this House support a Bill to which the men and women who work in the health service are so opposed and which even Tory Cabinet Ministers are briefing against?
Mr Burns: I suspect that the hon. Lady does not get out and about much to meet doctors who are beginning to commission care for their patients. If she did, she would know that the mantra she is repeating from organisations that are not representative of doctors in this country—[Interruption.]
Mr Speaker: Order. The Minister of State is such an emollient fellow that I cannot imagine why people are getting so worked up, but they are getting very worked up, and they must calm themselves. We are only on Tuesday; we have got some time to go. Let us hear the Minister.
Mr Burns: Very briefly, Mr Speaker, I can say to the hon. Lady that a number of the organisations that she mentions are trade unions that do not represent the views of GPs up and down the country who are actually engaged in implementing the modernisation by commissioning care for their patients.
12. Lorely Burt (Solihull) (LD):
What steps he is taking to improve the standard of dementia care in hospitals.
The Minister of State, Department of Health (Paul Burstow): As many as four out of 10 people in hospital have dementia, and people with dementia stay longer in hospital. We know that there is much room for improvement. That is why we have set a new national goal for hospitals actively to identify people with dementia.
Lorely Burt: According to the Royal College of Psychiatrists’ report on dementia care in hospitals, only one in three staff said that they felt that their training and development in dementia was sufficient. What action is the Minister taking better to equip staff to be able to take care of dementia patients in future?
Paul Burstow: I am grateful to my hon. Friend. Training is certainly one of the issues highlighted by the audit. We are taking a number of steps. We are working with the Royal College of Nursing, which has developed an online dementia information resource; we have been working with Skills for Care and Skills for Health to provide a series of training workshops for staff; we have been working with Oxford Deanery to trial a new approach to dementia education and training for GPs; and we are funding another audit to make sure that we keep track of the improvements that we expect to see across the NHS.
Jim Shannon (Strangford) (DUP): What discussions has the Minister had with universities such as Queen’s university in Belfast with regard to new treatments and medication for those suffering from dementia, and when will those advances filter through to patients?
Paul Burstow: I have not had such conversations with the university to which the hon. Gentleman refers. However, this Government, right from their first Budget, have indicated their commitment to prioritising research into dementia—both the basic research that gives us the targets for detailed research and the translational research. We have put in place all the building blocks that will allow this country not only to maintain its pre-eminence but to accelerate the pace of research.
14. Chris Skidmore (Kingswood) (Con):
What progress he has made on reducing the costs of PFI schemes in the NHS.
The Secretary of State for Health (Mr Andrew Lansley): We have made a lot of progress. All PFI schemes are having their contracts reviewed for potential savings following a Treasury-led pilot exercise. We are providing seven of the worst affected PFI schemes with access to a £1.5 billion support fund, and we are working with 16 other trusts to address long-term sustainability. As I said, in November last year the Treasury announced plans for a complete reform of the current PFI model, using public-private partnerships, private sector expertise and innovation, but at a value-for-money price for the taxpayer.
Chris Skidmore: I thank the Secretary of State for that answer. The new Southmead hospital in Bristol will cost over £400 million, to be funded by PFI, yet it will take over 30 years, at £37 million per year, to pay that off. That cannot be good value for money for the taxpayer or for the NHS. What more can the Government do to ensure that these contracts can be renegotiated in future?
Mr Lansley: My hon. Friend will be aware of the difficulties involved in the contracts that we inherited; that is true for PFI, as well as for the NHS IT contracts and many others. We have to try to use PFI contracts more cost-effectively; on average, the Treasury exercise demonstrated a 5% saving on their costs. Beyond that, we have to ensure that from now on the NHS delivers a much more value-for-money approach to using private sector expertise, including proper transfer of risk.
Nick Smith (Blaenau Gwent) (Lab): PFI enabled the building of many new hospitals and brought benefits to millions of patients. However, the Public Accounts Committee has found that lengthy procurement timetables led to increased costs. What will the Department do to sharpen its capital funding procurement model to get a good deal for the taxpayer?
Mr Lansley: That is a sensible question, and precisely why we are pursuing, as we said in November last year, a new approach to public-private partnership that does not entail the extreme costs, delays and burdens that past PFI projects have left. We are working with projects—for example, one at Alder Hey in Liverpool—to ensure that they demonstrate enhanced value for money compared with past PFI projects.
Health and Social Care Bill
15. Mr Stephen Hepburn (Jarrow) (Lab):
What recent representations he has received from health care professionals on the Health and Social Care Bill.
The Parliamentary Under-Secretary of State for Health (Anne Milton): The Government have received a wide range of representations throughout the passage of the Health and Social Care Bill, including from health care professionals, the public and voluntary bodies, and the trade unions.
Mr Hepburn: The vast majority of people, whether they work for or use the health service, see the Bill for exactly what it is: a Tory plan to privatise the national health service. When will the Minister listen to people, stop trying to pull the wool over their eyes—it is not working—and scrap this tawdry Bill?
Anne Milton: The only bit of the hon. Gentleman’s supplementary question that I recognise is a diatribe from the Labour party that perpetuates a myth about the Bill and fails to understand that the Bill is about the public of this country. This is about the people—patients—getting the health care that they need and deserve.
Dr Thérèse Coffey (Suffolk Coastal) (Con): May I pass on the representation of a health care professional in my constituency—one of the general practitioners involved in the commissioning group—who said that he felt the Health and Social Care Bill had been written for GPs, and that it was perfect for improving care in our community?
Anne Milton: My hon. Friend echoes many of the comments that I have heard as I have gone around the country. Without the Bill, we cannot strip out primary care trusts and strategic authorities, which will save £4.5 billion over this Parliament. I cannot see anybody going out on a march to save PCTs and SHAs. The public want the outcomes and the quality of care that they deserve, which they were denied under the previous Government.
Mr Speaker: I remind Members on both sides of the House—Back and Front Benchers alike—that topical questions and answers must be brief.
T1. Nic Dakin (Scunthorpe) (Lab): If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Andrew Lansley): My responsibility is to lead the NHS in delivering improved outcomes in England; to lead a public health service that improves the health of the nation and reduces health inequalities; and to lead the reform of adult social care to support and protect vulnerable people.
Nic Dakin: If the argument is that doctors are the best people to commission health and manage finances, why not listen to doctors themselves, who universally reject the Government’s plans? Why not listen to the royal colleges and patients groups and drop the Bill?
Mr Lansley: The hon. Gentleman just does not know what is happening around the country. All over the country doctors taking clinical leadership in foundation trusts and NHS trusts, and GPs and their nursing and medical colleagues taking responsibility in the new clinical commissioning groups, are demonstrating that they can improve the quality of care for the patients they serve. They hear what is said by the hon. Gentleman and some of his colleagues and think they are completely out of touch with the world in which they live.
T5. Annette Brooke (Mid Dorset and North Poole) (LD): I appreciate that the Government have allocated additional funding for social care, but what more will and can they do in the short term not only to address the current crisis in funding and ensure that funding is used creatively and efficiently locally, but to cater for those with lower-level needs through preventive measures and early intervention?
The Minister of State, Department of Health (Paul Burstow): My hon. Friend is right about the need to invest in early intervention and prevention. In addition to the £7.2 billion that we will invest this Parliament, this January we announced an extra £120 million for the remainder of the year to support care services. Furthermore, we are funding, jointly with the Local Government Association, work to support councils in delivering improved productivity and sharing best practice to ensure that they deliver improvements to services, and not just cuts.
Andy Burnham (Leigh) (Lab): The Secretary of State said that he would listen to doctors and nurses but yesterday shut the door of No. 10 Downing Street in their faces. But now things take a sinister turn. Let me quote from a letter from an NHS director received last week by a respected clinician of many years’ standing:
“I understand that you are a signatory to a letter which highlights your personal concerns about the Health Bill. It is inappropriate for individuals to raise their personal concerns about the proposed Government reforms. You are therefore required to attend a meeting with the Chief Executive to explain and account for the actions you have recently taken.”
Will he confirm that it is now his policy to threaten NHS staff with disciplinary action if they speak out against his reorganisation?
Mr Lansley: No, it is not my policy. I do not know the letter to which the right hon. Gentleman refers, and if he had shown it to me beforehand I could have investigated it. Yesterday, I and the Prime Minister met doctors and medical professionals and they discussed precisely how to improve services for patients. I went to Queen’s hospital in Romford and met nurses, midwives and doctors working to make the trust one in which their public can have confidence and, in due course, a foundation trust. All these things—foundation trusts, clinical commissioning, patient choice—used to be things that he believed in. They are now things that we are achieving but which he has rejected.
Andy Burnham: It is, it would seem, the Secretary of State’s new top-down bullying policy, and it is happening right across the NHS. How does he reconcile that with what he used to say about whistleblowing? I remind him of what he once said: “The first lines of defence against bad practice are the doctors and nurses”, who “have a responsibility to their patients to raise concerns if they see risks to patient safety. And when they do, they should be reassured that the Government stands full square behind them.”
Full square behind them so that he can plunge the knife straight into their backs! The truth about his mismanagement of the NHS is coming out: staff bullied into silence, professionals frozen out, crucial information in the risk register—
Mr Speaker: Order. We get the gist.
Mr Lansley: When the right hon. Gentleman has no argument, he resorts to abuse.
T6  Ben Gummer (Ipswich) (Con):
Dentists in Ipswich are increasingly concerned about having to put right work done by dentists from outside the UK who have received temporary registration from the General Dental Council, causing yet more cost to the NHS and trouble for those receiving care. How will Ministers measure the quality of those receiving temporary registration?
Paul Burstow: The hon. Gentleman raises an important issue that we are discussing with the GDC. The council’s work on revalidation will ensure that the work of those supervising foreign dentists and, where appropriate, foreign dentists themselves is properly covered.
T2. Mrs Mary Glindon (North Tyneside) (Lab):
Given that managed clinical networks for neuromuscular conditions can help to reduce the number of unplanned hospital admissions for patients with life-shortening illnesses and save the NHS money, will the Secretary of State commit to establishing such networks with funding from the NHS Commissioning Board?
Mr Lansley: As we have set out clearly, we want to promote clinical networks more widely, not just in relation to cancer and stroke, as has been the case in the past. I shall write to the hon. Lady about whether it would be appropriate for neuromuscular conditions and whether it is embraced in any plans that the NHS Commissioning Board and commissioning groups have in place already.
T7. Mr Philip Hollobone (Kettering) (Con): Northamptonshire residents are rightly concerned that in the county in the last four months of 2011 the East Midlands ambulance service reached fewer than 69% of category A calls within eight minutes. The target is 75%. What hope can my right hon. Friend offer to local residents that this poor performance will rapidly improve?
The Minister of State, Department of Health (Mr Simon Burns): I hope that I can give some reassurance to my hon. Friend by telling him that East Midlands ambulance service is working with commissioners, hospital trusts, community health services and social care services in taking measures to address its response time performance. NHS Milton Keynes and NHS Northamptonshire have received £1.7 million in additional funding, and NHS Midlands and East advices me that some of that has been used to fund further measures to help improve EMAS response times, including through the provision of additional ambulance crews and the deployment of hospital-ambulance liaison officers in each accident and emergency department to improve handover and turnaround times.
T3. Mrs Madeleine Moon (Bridgend) (Lab): The Secretary of State says he acts on advice. May I advise him to read the horrendous report from Mencap that details the death of 74 people with learning disabilities due to a lack of basic care and a lack of understanding of the health care needs of people with learning disabilities? Will he follow the advice of Mencap and ensure that the undergraduate and postgraduate training of doctors and nurses includes intensive training in the needs of people with learning disabilities, so that there will be no further unnecessary deaths of people with learning disabilities due to neglect in NHS hospitals?
Mr Lansley: I am grateful for the hon. Lady’s question, and I am glad to say that I had a useful meeting with Mark Goldring of Mencap. I have read his report and, in response to what the hon. Lady has said, I would be glad to write to her and put a copy in the Library.
T8. Karl McCartney (Lincoln) (Con): Is my right hon. Friend as concerned as I am that the employment tribunal of the former United Lincolnshire Hospitals Trust chief executive Gary Walker ended in secrecy? Does he agree that the NHS should stop using public money to impose gagging orders to suppress information that is not only in the public interest, but that impacts on patient safety?
Mr Lansley: My hon. Friend will know that it is the policy of the NHS not to use compensation agreements in order to suppress information that is in the public interest, and I will certainly write to him about the case that he raises.
T4. Kerry McCarthy (Bristol East) (Lab): Before the election, the Conservative party and the then shadow Health Secretary received substantial donations from the chairman of the private health company Care UK and his wife. Does he agree with the then Liberal Democrat health spokesman, the hon. Member for North Norfolk (Norman Lamb)—who has now been promoted to Minister—when he said:“This is a staggering conflict of interest which completely undermines the Tories’ claim that the NHS would be safe in their hands”?
Mr Lansley: If not abuse, then smear. I never received any money personally from the chief executive of Care UK. The Conservative party solicited and received donations that were declared in the normal way. They had no influence, and we would never permit any such influence over our party’s policies.
T9. Simon Wright (Norwich South) (LD): I recently met Norwich and District Carers Forum to hear about the work that it is undertaking, together with GP surgeries in Norfolk, to help identify carers in the county. What recent steps have Ministers taken to help identify and support carers in Norwich and elsewhere?
Paul Burstow: I am grateful for my hon. Friend’s question, and I know that a lot of work is being done across the county of Norfolk between the NHS and social care. Nationally, the Government are working with the Royal College of General Practitioners, Carers UK, the Princess Royal Trust for Carers and Crossroads Care to recruit GP carers champions and volunteer carers ambassadors, and make them aware of the need not just to identify carers, but to ensure that they take the necessary action to assess and provide appropriate support, so that carers get a break from their caring responsibilities and have the opportunity both to stay in work, if that is what they want to do, and to have a life, not just a caring responsibility.
Mr David Winnick (Walsall North) (Lab): If I was concerned only with the politics of the situation, I would be urging the Secretary of State to carry on with the Health and Social Care Bill, in view of the political fallout. However, does he realise that the strength of opposition throughout country—certainly among the medical profession, as well as the public—is based on the fact that they believe that the national health service will be seriously undermined if the measure goes through? Why is he not willing to listen to the voices of people who are so concerned that the institution—which we all believe is so necessary—will be threatened and damaged as a result of his measure?
Mr Lansley: The hon. Gentleman should go back to last year and recall that not only did we consult on the White Paper, but—following the listening exercise last year with dozens of independent health professionals, who conducted hundreds of meetings with thousands of professionals across the service, who made a substantial series of recommendations, and with the Future Forum clear that the principles of the Bill were supported, just as many organisations continue to say that they support them—we took on board and accepted those recommendations. That is why the Bill, which is in another place, was supported by a majority in this House and was supported by a majority there.
Steve Brine (Winchester) (Con): There has been much talk today about improving outcomes of patient care—when we move beyond the politics—so will the Secretary of State commend the excellent hyper-acute stroke service that he saw with me in Winchester just a few weeks ago? As he knows, the service rightly enjoys the support of the emerging care commissioning group. Indeed, he also met those in the group and saw how positive they are about the changes.
Mr Lansley: Yes, and I am grateful to my hon. Friend for the invitation that he extended to me to visit Winchester, which is now forming part of the Hampshire Hospitals NHS Foundation Trust and looking to do so very successfully. I share with him the optimism derived from a meeting with the members of the West Hampshire clinical commissioning group. They, like others across the country, are demonstrating how they will use the responsibilities that they will be given to improve care for patients.
Mr Dennis Skinner (Bolsover) (Lab): As the House will know, I have been a regular customer of the NHS over the last 12 years, and it hurts me to think of what is happening, after all the wonderful treatment that I had for cancer, as well as a bypass and a hip replacement. I am still here to tell the story because of the treatment by those nurses and doctors. Please stop this savage attack on the NHS, and drop this dreadful Bill.
Mr Lansley: The hon. Gentleman clearly has no idea of what is actually in the Bill or the modernisation process. It is only about simple things. It is about giving patients information and choice. It is about empowering doctors and nurses and health professionals, and it is about strengthening the ability of the NHS to improve care in the future. That is all that it is about, and it cuts the cost of bureaucracy in so doing. It will enable us and the NHS to do the things that his Government supported in the past—he might not have supported them, but his friends did—including commissioning by clinicians, patient choice and using the best qualified provider. Those are the things that his Government used to believe in, and they are the things that we are doing. There is no privatisation, no charging and no break-up of the NHS. There is only supporting the NHS.
Nicky Morgan (Loughborough) (Con): Ministers will be aware of the Centre for Mental Health’s report last week, which showed that physical health outcomes are linked to mental health outcomes, and that both need to be treated at the same time. Can the Minister update the House on the Department’s progress on implementing its mental health strategy?
Paul Burstow: I can indeed. We will shortly be publishing a more detailed implementation plan showing the role that the NHS Commissioning Board, the clinical commissioning groups and others will play, alongside the voluntary sector, in delivering the strategy. More importantly, we are also doing work on long-term conditions that will begin, for the first time, to join up the way in which we commission physical and mental health services. We have to do that in order to deliver better outcomes for people.
Simon Danczuk (Rochdale) (Lab): Every week in my surgery, I hear more and more residents complaining about having to wait too long for an operation, if they can get on to the waiting list at all. This top-down reorganisation is clearly exacerbating the problem. Why do not the Government just drop the Bill?
Mr Lansley: The hon. Gentleman is going to have to explain why the NHS’s performance is improving, and why it is better than it was at the election. We have cut mixed-sex accommodation, more people have access to NHS dentistry and hospital infections are at a record low. He talks about waiting times. The number of people waiting over a year for treatment has halved since the last election. The total number of people waiting beyond 18 weeks is lower than it was at the election, and the average wait for patients is lower than it was at the election. I am afraid that the premise of his question is completely wrong.
Ian Swales (Redcar) (LD): Following the closure of a specialist ME clinic in Bolton, will the Minister review the narrow NICE guidelines on the treatment of ME, so that patients can get the outcomes that work for them, and so that the doctors providing such treatment are not placed at risk of losing their licence?
Mr Lansley: My recollection is that NICE itself is undertaking a review of the guidelines relating to the commissioning and provision of services for ME. I will check to ensure that that is the case, and if I am wrong I will of course correct the record. I will write to the hon. Gentleman in any case. It is not for Ministers to write NICE guidelines; that is a matter for NICE to deal with independently.
Several hon. Members rose—
Mr Speaker: Order. I am sorry to disappoint colleagues but, as usual, Health questions have been heavily oversubscribed. The House is in high spirits, and it is only Tuesday afternoon.
via the ever-magnificent Hansard.