Oral Answers to Questions
Kevin Barron Excerpts(14 years, 1 month ago)
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Mr Lansley
I am grateful to my hon. Friend. He rightly highlights an area where we are clear that innovation can be considerably supported, and not only by the academic health science centres, which were established under the last Government. As the life sciences strategy set out in early September made clear, we want to create academic health science networks across the NHS so that higher education, industry and the NHS can work together to bring about the greatest possible innovation to the benefit of patients.
Mr Kevin Barron (Rother Valley) (Lab)
The current pharmaceutical price regulation scheme is able to recognise the fact that pharmaceutical companies based here and developing drugs here should be paid a little bit more for their drugs by the NHS on the basis of their worth for the general economy. Will the Secretary of State tell us whether his proposals for value-based prices will affect that?
Mr Lansley
The right hon. Gentleman will be aware that the existing PPRS does not in any sense directly fund innovation in the United Kingdom. Although it takes account of expenditure on innovation, it cannot identify that expenditure in the United Kingdom as a beneficiary through pharmaceutical pricing. As the right hon. Gentleman knows, we are continuing to discuss with the industry the shape of value-based pricing from January 2014, the purpose being to ensure that we fund the value associated with new medicines: the therapeutic value to patients, the innovative value—which will highlight the UK as a base for research and development—and the societal value.
Life Sciences
Kevin Barron Excerpts(14 years, 2 months ago)
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Mr Lansley
I am grateful to my hon. Friend and heartily welcome his support for the opportunities in regenerative medicine. I was fortunate enough to meet at the UK Stroke Forum last Thursday, among those exhibiting, a company that is based in England but undertaking trials and research activity in Scotland and is looking precisely at how it can use foetal-derived stem cells for regenerative purposes. The right hon. Member for Leigh (Andy Burnham) talked about Pfizer. In my constituency, it has been one of the companies leading the development of new regenerative medicine techniques. That is clearly one of the areas that this country has tremendous potential in developing. The technology innovation centre for regenerative medicine was announced in the “Plan for Growth” published alongside the Budget earlier this year, and I hope that it will be one of the areas in which we will see those developments.
Mr Kevin Barron (Rother Valley) (Lab)
The Health Committee, in its report on the electronic patient record, published in September 2007, stated that the highly detailed data captured had “outstanding” prospects for new and improved research, but it also asked that the best balance be found between
“the opportunity to improve access for research purposes with the ongoing need to safeguard patient privacy”.
Do the Government believe they can get that right, so that we can go ahead and use the enormous amount of data that we have in this country to improve health care for patients not just here, but throughout the world?
Mr Lansley
I am glad that the right hon. Gentleman is here and able to ask that question, because he was the Chair of the Health Committee in September 2007, when it stated that the secondary use of data in the NHS was “vital” for the development of the NHS, including for research use. I hope that he is one of those who recognise that what we are setting out in the life sciences strategy—in particular, with the clinical practice research datalink—will enable precisely all those secondary uses for research to be developed.
National Health Service
Kevin Barron Excerpts(14 years, 3 months ago)
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Andy Burnham
Let me first acknowledge the hon. Gentleman’s courage in standing up and voting against the Health and Social Care Bill. I just wish that more of his Liberal Democrat colleagues had similar conviction and principle, and could stand up to the Government on a Bill that he knows—and which, in their heart of hearts, many of them know—will seriously damage the NHS.
The hon. Gentleman also asked me about the introduction of private sector capacity. I will not apologise for that, because that additional capacity was brought in to bring down NHS waiting lists, something that benefited his constituents. By bringing in that extra capacity we brought down NHS waiting lists to an all-time low and delivered the 18-week target. I am not going to apologise for that. The reason the NHS commands such strong support in the country today is that people’s experience of it improved in those years. I mentioned the preferred provider policy a moment ago. I believe that the private sector has a role to play in delivering world-class care to patients, and I am happy to put that on record.
Mr Kevin Barron (Rother Valley) (Lab)
At the heart of the current Bill are the 98 clauses that introduce competition law into the national health service—something that the last Government did not pass even one clause to do. Is not the ideology lying at the heart of the Bill what will wreck our national health service?
Andy Burnham
My right hon. Friend makes an incredibly important point. Make no mistake: if the Bill passes, the NHS will never be the same again. The Bill will unpick the fabric of a public national health care system—a planned system—and turn it into a free-for-all, as he says. Indeed, it is unbelievable to see a letter in The Guardian today from senior Liberal Democrats—many of whom made the same argument a few weeks ago as my right hon. Friend—now saying that, because of a few tweaks to the Secretary of State’s powers, the time has come to abandon all their concerns about the provisions. That is a ridiculous statement to make. If they still have concerns about competition and privatisation, they should have the courage of their convictions and stand up against the Bill, instead of writing sanctimonious letters to The Guardian.
Grip has been lost; the NHS is drifting. However, the Government cannot say that they were not warned. Sir David Nicholson, the chief executive of the NHS, told the Public Accounts Committee that the reorganisation had increased the scale of the financial challenge:
“I’ll not sit here and tell you that the risks have not gone up. They have. The risks of delivering the totality of…the efficiency savings that we need over the next four years have gone up because of the big changes that are going on in the NHS as a whole.”
This has been a lost year in the NHS—a crucial year, when it needed to face up to the financial challenge—but things are not getting better. We face months of further uncertainty, as the Secretary of State battles on with his complicated and unwanted Bill. Four-hundred and ninety pages, 70-page letters to peers, amendments made on the hoof: it is a total mess. The NHS deserves better than this. Even the man the Secretary of State brought in to run his new NHS Commissioning Board describes his Bill as “completely unintelligible,” and went on to say:
“It is going to be messy as we go through a very complex transitional programme.”
And this from the Secretary of State’s friends.
The harsh truth is that the Secretary of State has comprehensively failed to build the consensus he needs behind his Bill. GPs do not want it; nurses do not want it; midwives do not want it; patients do not want it. I say to the Prime Minister and the Health Secretary today: stop digging in. Drop this Bill. If they do, my offer still stands, as our motion makes clear. We will work with the Secretary of State to reform NHS commissioning, giving GPs and other clinicians a bigger role. That can be achieved without legislation and a major structural upheaval of the entire NHS. It can be done through existing legal structures, giving immediate stability and saving millions.
We make our offer again today, as it is time for all politicians to put the NHS first. It is slipping backwards, and the warning signs are there for all to see. Waiting lists and waiting times are getting longer, with a 48% rise in the last year in the numbers of patients waiting more than 18 weeks. When patients are waiting longer, it is unforgivable that £2 billion to £3 billion has been set aside to pay for the costs of reorganisation. It is also unforgivable that £850 million is being spent on making people redundant who will end up being re-employed elsewhere in the system, in the new clinical commissioning groups.
We are witnessing a return to the bad old days of waiting longer or paying to go private. This is just a glimpse of the future. If the Bill passes, the NHS will never be the same again. We have all seen the adverts on television for the health lottery. Is this the right hon. Gentleman’s early marketing and his new brand name for our NHS?
Mr Kevin Barron (Rother Valley) (Lab)
I support the motion on the Order Paper this afternoon, and I am very sorry that the hon. Member for Kingswood (Chris Skidmore) has left his seat, because he was coming out with a load of reasons why the NHS is in the mess it is in now, saying that it was to do with the previous Labour Government. He mentioned Adrian Mole, but I would have advised him not to use such arguments when, in the same breath, he was talking about the money that was spent on the NHS IT programme. It was nowhere near the £12 billion that he mentioned. People would be wise to look at the IT system, because it was ambitious in terms of creating a national database, and given my experience on the Health Committee that looked at the issue in the previous Parliament, I must say that if we want to make the national health service efficient, we will do so with IT. Currently, there are few programmes that manage people with long-term conditions, yet they consume between 75% and 80% of the moneys spent on the NHS, so batting arguments around on that basis, as the current Government did in opposition in relation to IT will not make health care better or the national health service more efficient for people in this country.
Members have mentioned three issues with the coalition agreement. I am going to leave the one on finance as it stands, because there is an argument about the Treasury figures. We will see in the next year or two, if the next election is in 2015, exactly where the issue goes, and then we will be able to comment a little more than we are able to at the moment.
On moratoriums, I saw a very embarrassed Secretary of State at the Dispatch Box today, and I am going to be consistent, because when I was Chair of the Health Committee and sitting on the Government Benches, I criticised on two occasions then Government Front Benchers for such stunts. I did not criticise Health Ministers, but I did make one criticism in a closed place, after a Secretary of State—not for Health, but a Scottish Member who no longer sits in the House—stood on the picket line against the closure of a hospital in Scotland near his constituency.
Another criticism I made was of a Member—who is still in the House but, again, not a Health Minister—who was against changes to health care in Greater Manchester. I was asked by the media—I think it was the BBC—and I said that, if the issue is being looked at locally and it is recommended that such reconfiguration will improve patient services, it should go ahead and politicians should not speak out against it. I then received the quickest response I have ever had on any issue from No 10 Downing street, but I stick to what I said then: the matter had been looked at locally.
I listened to the Secretary of State—I am sorry he is not in his place now—when he talked about stopping top-down decision making and letting local commissioners have a look at the clinical evidence and safety aspects, but the independent review panel has been looking at those matters for years. The interference of people at the top has been the real issue.
Politicians have to get away from the idea that they must defend the national health service in its current configuration at all costs. That will not improve it—[Interruption.] The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) laughs, but I am talking to him, and to the Secretary of State who stood holding up placards saying things would not happen which have happened. We should not do that. My right hon. Friend the Member for Leigh (Andy Burnham) has the image of that in his hand, but this is a lesson for all people in politics.
When the Health Committee in the previous Parliament looked at NHS deficits, it found that many years ago the major problem with deficits was in the east of England, because many small parts of the NHS were spread around marginal seats that had been fought for one way or another over the previous 20 or 30 years. That level of political interference does nothing for patient care. I am being even-handed in saying that, and I genuinely believe it.
I am going to move on from moratoriums. Ministers put well their arguments on those issues when they were in opposition, but now, given the decisions they are having to take in government, they are having to eat humble pie. It serves them right, as it served the last lot right.
I want to go on to the coalition agreement’s statement that there will be no top-down reorganisation in the national health service, because this current reorganisation is the worst, the biggest and the most savage. It has been defended again today on the basis, as the hon. Member for Southport (John Pugh) said, that GPs are going to be in charge, but they are going to get about £80 billion, and they are small, private, independent contractors, so the idea that there will not be any conflict of interest in some of the work that is going to take place is nonsense. It will be a matter for the courts.
I was also amazed when the hon. Gentleman said that we have competition now inside the national health service, because we do not in clinical services, and he will have to explain why there are 97 clauses in the Health and Social Care Bill which put competition law in clinical services on to the statue book of this land. Can somebody find me one country in the European Union which has competition law in clinical services? I have found none.
I sat on the Public Bill Committee for six months, and, on Third Reading, I asked the Minister who will make the winding-up speech today—I will ask him again, because I have to sit down in a couple of minutes—what the Competition Commission and the Office of Fair Trading had got to do with the merger of national health service trusts. That provision is written into the Bill, and it was not changed when the future forum looked at it; indeed, of the 97 clauses, only seven were changed. The Minister has not answered that question, and I asked Professor Steve Field when he went back to the Public Bill Committee what that had to do with the merger of NHS trusts.
I ask the Minister to answer this question when he winds up the debate. What have the Office of Fair Trading and the Competition Commission got to do with the merger of national health service trusts? I await the answer. I am fed up of asking the question.
The Secretary of State says, “We’re abolishing PCTs,” and indeed we are, but what PCTs do will be taken over by not one body but five different ones: clinical commissioning groups, health and wellbeing boards, clinical senates, the NHS Commissioning Board and local authorities—and that is how we get rid of bureaucracy! That is what the Secretary of State said at the Dispatch Box just a while ago, but five different organisations—some of them new—are going to be involved.
This is the biggest mistake that any Government have made with the NHS since it was brought in 60 years ago, and this Government would be well advised to take the Bill away and get on with serving the nation’s health care needs, not bringing in this competition law, which will be the end of the NHS as we know it.
Mr Burns
In Yorkshire and the Humber, the ambulance service gives PCTs a monthly list of their top 10 most frequent callers. These people are then given intensive personalised help, including the use of modern telemedicine to monitor their vital signs. The result is better care for patients as well as—
Mr Barron
On a point of order, Mr Deputy Speaker. As you know, I took part in this debate and I asked the Minister a question and requested him to answer it in his winding-up speech. Yet he will not even acknowledge that I spoke in the debate. Is there anything you can do, Mr Deputy Speaker, to help Back Benchers keep the Executive in check?
Mr Deputy Speaker (Mr Nigel Evans)
Absolutely nothing. I am sure, however, that the Minister will have heard the point.
Mr Burns
Did I hear the right hon. Gentleman’s point, Mr Deputy Speaker? I heard it about three times in Committee and I heard it on Report; I replied each time, as well as writing to the right hon. Gentleman. He does not like the answer, so there is no point in taking the intervention again.
As I was saying, in Yorkshire and the Humber the ambulance service gives PCTs—[Interruption.] I know I have already said it, but there was so much disruption and noise that Labour Members did not hear it. In Yorkshire and the Humber, the ambulance service gives PCTs a monthly list of their top 10 most frequent callers so that they can talk to them and help them in future, saving money and staff time that can be concentrated elsewhere.
Oral Answers to Questions
Kevin Barron Excerpts(14 years, 3 months ago)
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Mr Lansley
I am confident that we will make the progress that we seek. If we are not ready in any location, we will not be able to proceed with that procurement, but the PCTs will act on the basis of an evaluation of four pilots. To that extent, the character of what they are procuring through the 111 system will be well defined through piloting.
Mr Kevin Barron (Rother Valley) (Lab)
What progress has been made since the launch of the Secretary of State’s tobacco control plan last March in changing the behaviour of people who smoke in cars in the presence of children?
The Parliamentary Under-Secretary of State for Health (Anne Milton)
The right hon. Gentleman has a long-standing interest in this subject. We are working on a number of areas, but I think that the extension of public health duties to local authorities will open up many opportunities to persuade parents to think carefully about where they smoke, whether it is in cars or in their own homes.
Health and Social Care (Re-committed) Bill
Kevin Barron Excerpts(14 years, 5 months ago)
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Ms Abbott
I am afraid that we are an hour into an hour-and-a-half debate, and I am anxious to allow time for other Members to speak.
The case that the amendment is intended to make is that tens of thousands of women every year are either not getting counselling that they request, or are getting counselling that is so poor that only new legislation can remedy the situation. I might say, after many years in the House, that in matters of this kind, if legislation is the answer we have almost certainly asked the wrong question.
The amendment is the opposite of evidence-based policy making. We know that the British Medical Association advises its members:
“A decision to terminate a pregnancy is never an easy one. In making these decisions, patients and doctors should ensure that the decision is supported by appropriate information and counselling about the options and implications.”
We know that the Royal College of Obstetricians and Gynaecologists guidance on abortion states:
“Women should be given counselling according to their need—including post-abortion if she needs it. All women should be offered standalone counselling. The counselling should include: implications counselling (aims to enable the person concerned to understand the…course of action…); support counselling (aims to give emotional support in times of particular stress) and therapeutic counselling (aims to help people with the consequences of their decision and to help them resolve problems which may arise as a result)”.
We know that Department of Health regulations state:
“Counselling must be offered to women who request or appear to need help in deciding on the management of the pregnancy or who are having difficulty in coping emotionally”.
We also know that all the clinics that have been discussed in the debate are inspected and regulated.
Yet the proposers of the amendment are asking us to believe, on the basis of purely anecdotal evidence, that tens of thousands of doctors, nurses and charity workers involved in the 190,000 abortions a year are wilfully ignoring both the law and the guidance of the British Medical Association and the Royal Colleges. They go further than that, arguing that tens of thousands of doctors, nurses and charity workers are merely in it for the money. They imply that those men and women are involved in some sort of grotesque piecework. It is almost as though they were paid per abortion. The proposers of the amendment, I might add, also seem to be arguing that thousands of women do not actually know what they are doing. It tells us something about the validity of their claims that they are obliged to smear tens of thousands of doctors and nurses to make any kind of case. No wonder that a journalist for The Sunday Times—no friend of the liberal left, but one who happens to have served as a lay member of the Royal College of Obstetricians and Gynaecologists—last weekend described the amendments as a “senseless and sinister bid” to cut abortions.
Mr Kevin Barron (Rother Valley) (Lab)
I agree with my hon. Friend. Any evidence that we have heard has been anecdotal—we have heard of a 16-year-old’s journey and of e-mails that hon. Members have seen but that I have not. However, my hon. Friend makes a real point. The conclusion of the consultation might be that a termination takes place, but this is the only procedure in this country that requires the informed consent of two doctors. Government Members besmirch doctors by saying that such things happen daily, but that is not true. From my nine years on the General Medical Council, I recognise that we have good ethical guidelines for doctors. Nothing is done without the informed consent of two medical practitioners.
Owen Smith
The very simple question to be asked is “Why the delay?” Why could the Minister not have introduced it earlier? We have known about the problem for eight months and more. The Secretary of State, who has been keen on changes such as this for a long time, must have given some thought to what he was going to do about staff training and work force planning in the NHS.
Mr Barron
It was clear from the day of its publication that the Bill, which abolishes the structure that had kept education and training in place, would create chaos in the national health service. Here we are, hundreds of amendments later, with a resubmitted Bill. Our debate on the outcome has been crammed into two days, which is wholly unsatisfactory, and the Government still cannot tell us what will replace the structure that has been in place for so many years. That is a nonsense.
I listened to the Minister’s speech earlier. He was telling people—people outside, including professionals who want this kind of professional development on a continuing basis—to have faith in what might happen at some stage. I have to say that I have little faith in what the Government have done with the Bill from the very beginning.
Owen Smith
I entirely agree, and my faith is diminishing by the minute. I do not understand why the Government cannot simply concede that they have signally failed to deal with this crucial aspect of the Bill. It took them months to produce the revised failure regime. They managed to drag that out in time for Report, but they have not produced the impact assessment, they have not produced any figures showing how much this will cost the public purse, although we know that the amount is rising—I should love the Minister to tell us by how much—and they have not produced a solution to the crucial problem of staff training and work force planning. That is a disgrace. They could have and should have done it by now.
New clause 13 would place a further duty on providers, related to what is in the earlier new clause. It would oblige them to make provision for training and work force planning for their own staff, thus filling another gaping hole in the Bill. As the Minister might say if he intervened on me, Monitor may well have powers, under the pricing clauses, to pay less under the tariff to providers who do not engage in training, but nothing in the Bill compels new entrants—especially private providers—to give their staff any training, or to deal with any costs that the NHS has traditionally had to bear for the education of the work force.
We all know that in the incredibly fast-moving and innovative world of health care, keeping staff up to date is absolutely crucial. That is why—I hate to say it—despite the news that we are to have an amendment ín the Lords, we will attempt to press amendment 7 to a vote. It proposes the retention of SHAs until and unless we know precisely what the Government will put in their place in respect of training and administration.
NHS staff is another group that is profoundly concerned by the shambles, chaos and confusion that Ministers have overseen. Under the Bill, they are described as assets and will be transferred lock, stock and barrel between new providers. The new providers may be a private company—such as Helios, Bupa, UnitedHealth, or whoever else decides it is interested in running the NHS in future—and the staff may be transferred to the new providers. The Minister shrugs, suggesting that that is a misrepresentation, so I challenge him to intervene on me and state what he seemed to imply earlier: that what I have just said is not the case.
Schedule 23 makes that explicit, however. It provides for the transfer of NHS staff and other assets. It allows such so-called assets to be passed in future from NHS entities to the new CCGs. That can happen to any
“person who provides services as part of the health service in England and consents to the transfer”.
Under schedule 23, any NHS member of staff—or a building or intellectual property—can, so long as they agree, be transferred to anybody else who is licensed to provide services to the NHS. I find that extraordinary, but not quite as extraordinary as the next provision, which refers to NHS bodies being able to transfer all such assets—what a delightful way to refer to people—to a “qualifying company”, whatever that means. I will be delighted if the Minister tells us what the term “qualifying company” in schedule 23 means.
Mr Barron
I have been a Member of this House for 28 years and I have been active in different parts of health policy for many years, and I have never seen any Bill—not just any health Bill—come to this House so ill-prepared to be put on to the statute book. I served during the two stages of the Public Bill Committee. Largely, I asked questions where I wanted explanations, but I got very few answers. As was said earlier today, part 3 remains in this Bill and its 97 clauses bring in economic regulation. Only nine of those clauses have been amended since the Future Forum met and said that we were in deep trouble with this.
What did the Future Forum ask for? It recommended that Monitor’s powers should
“promote choice, collaboration and integration.”
Monitor’s powers have changed somewhat, but the major change that occurred during the second part of the Committee stage was that the Government took away Monitor’s power to promote competition and gave it a new power to prevent anti-competitive behaviour. Perhaps, at some stage, somebody will be able to tell me what that means. Perhaps somebody will also be able to tell me the answer to something I asked in the first sitting of the Public Bill Committee: what do the Competition Commission and the Office of Fair Trading have to do with the mergers of two NHS trusts? The relevant Minister said at the time that that was a good question, but I have not heard it answered since.
I must say, with all due respect, that no Labour Member argued that the NHS is perfect, nor would I do so. But this Bill is a dog’s dinner. The national health service and the nation do not deserve it, and I will vote against it tonight.
NHS Future Forum
Kevin Barron Excerpts(14 years, 8 months ago)
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Mr Speaker
Order. May I remind the House that Members who came into the Chamber after the Secretary of State began his statement should not expect to be called?
Mr Kevin Barron (Rother Valley) (Lab)
The Secretary of State must know that the biggest threat to the stability of the national health service is the introduction of competition law into clinical services. Will the clause that says that the mergers of NHS trusts will be a matter for the Office of Fair Trading and the Competition Commission be removed from the Bill?
Mr Lansley
The right hon. Gentleman should be aware that the Future Forum has recommended that the powers to be held by the Office of Fair Trading or the Competition Commission should be exercised by Monitor. That is because it believes it to be in the interest of the NHS for them to be exercised by a health service-specific regulator that is sympathetic to and has an understanding of NHS interests.
Oral Answers to Questions
Kevin Barron Excerpts(14 years, 8 months ago)
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Anne Milton
We most certainly can do better than that. I agree with my hon. Friend that such problems are often a barrier, and that therapy can unlock so much more. I refer him to service redesigns that have happened, such as at the Cambridgeshire Community Services NHS Trust, which redesigned its clinical pathways with the result that the number of children waiting longer than 18 weeks from referral to treatment fell from 409 in May 2010 to eight at the end of January 2011. That is a fantastic improvement in the service. This is not all about money, but about the way in which services are designed.
Mr Kevin Barron (Rother Valley) (Lab)
The Minister will know that more than 60% of inmates in young offender institutions have speech and communication problems. Can we ensure that the Green Paper addresses this matter not just within the national health service, but in education and wider, so that we can begin to tackle this problem, which has lain dormant in this country for decades?
Anne Milton
The right hon. Gentleman is right that we are not talking just about children. A number of people have languished and failed to achieve their potential, particularly their educational potential, for the lack of speech and language therapies. I take this opportunity to commend the work of Jean Gross, the communication champion, in raising and highlighting these issues.
Oral Answers to Questions
Kevin Barron Excerpts(14 years, 9 months ago)
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Mr Lansley
Yes. I am grateful to my right hon. Friend, and I can give him that assurance. Indeed, one reason why it is important to pause and to listen now is not least that shadow health and wellbeing boards have been put forward by 90% of relevant local authorities in England, and it is an opportunity for them to be very clear about how we can improve patient and public accountability. I hope that they and others will take that opportunity. As my right hon. Friend knows, the Bill already substantially improves both the public and the patient voice in the NHS, and we have to ensure that we take every opportunity now further to improve it.
Mr Kevin Barron (Rother Valley) (Lab)
If the Government do come back with some major changes to the Bill, will those changes go out to public consultation, and will this House have the opportunity to oversee and to look in detail at any further proposals they may make?
Mr Lansley
I think I made it clear to the right hon. Gentleman in the House on 4 April that we were looking to pause, to listen, to reflect and to improve the Bill, and we are taking the opportunity to do so now, before Report and Third Reading.
NHS Reform
Kevin Barron Excerpts(14 years, 10 months ago)
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Mr Lansley
I am grateful to my hon. Friend for his remarks. He and other Surrey Members will be aware of that primary care trust’s past failure to manage effectively within its budget. The GPs in Surrey are, like many others across the country, coming together and demonstrating that they can achieve much greater service improvement within NHS resources—and those resources will increase in future years.
Mr Kevin Barron (Rother Valley) (Lab)
Does the Secretary of State recognise that the reorganisation and introduction of competition under this Bill have created chaos inside the national health service? What message does he have for the 40% of people who work for Rotherham PCT who have now taken redundancy, and who are getting out because they know they are aboard a sinking ship?
Mr Lansley
As we have demonstrated, NHS performance is continuing to improve, and it will improve further with clinical leadership, but we can achieve that effectively only if we achieve a £1.9 billion a year reduction in administration costs in the NHS. We have started that process: since the election, we have reduced the number of managers in the NHS by 3,000 and increased the number of doctors by 2,500.
Health and Social Care Bill
Kevin Barron Excerpts(15 years ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I beg to move, That the Bill be now read a Second time.
The purpose of the Bill can be expressed in one sentence—to improve the health of the people of this country and the health of the poorest fastest. While the previous Government increased funding for the national health service to the European average, they did not act similarly to increase the quality of care. We spent more, but others spent better. In important areas, the NHS performs poorly compared with other countries. An expert study found that out of 19 OECD countries that were investigated, the UK had the fourth-worst death rate from conditions that are considered amenable to health care. If NHS outcomes were as good as the EU15 average, we would save 5,000 lives from cancer and 4,000 lives from stroke every year. We would also prevent 3,000 premature deaths from respiratory disease and 1,000 premature deaths from liver disease every year. This cannot go on: things have to change to protect the NHS and deliver better results for patients.
Mr Kevin Barron (Rother Valley) (Lab)
I do not dispute what the Secretary of State says about European comparators, but what does he say to Professor John Appleby, who said last Friday that all those markers, some of which are not direct comparisons, are getting nearer to European targets? Professor Appleby suggested that the disruption that is going to take place in the health service will not help us to do that.
Mr Lansley
I would say two things to Professor John Appleby. First, the latest data published in EUROCARE-4, which I know the right hon. Gentleman will have seen, are clear about the gap between cancer survival rates in this country and others, and in recent years that gap has not diminished as it should have. He can read in last week’s Lancet an authoritative study of cancer survival rates in this country and a number of others demonstrating that the gap remains very wide and that we have to close it. Secondly, the King’s Fund supports the aims of the Bill and Professor Appleby, as a representative of the King’s Fund, clearly understands, as we do, that if we are to deliver the change that is needed, we need the principles in the Bill.
People trust the NHS, and its values are protected and will remain so—paid for from general taxation, available to all, free at the point of delivery and based on need rather than the ability to pay. However, a system in which everyone is treated the same is not one that treats everyone as they should be treated. Our doctors and nurses often deliver great care, but the system does not engage and empower them as it should.
Mr Kevin Barron (Rother Valley) (Lab)
I shall move on quickly. We had seven hours and 45 minutes to debate the Bill, but the first hour and 15 minutes was taken up by Front Benchers. Given that the Government have not found time to debate the White Paper that they published in July, we should probably have had two days’ debate on a Bill as important as this. As the shadow Secretary of State said, it is far larger than the 1948 Bill that established the national health service.
I find it difficult to find any justification for such a major reorganisation of our NHS. We have had a decade of major investment and we have seen improving services and major satisfaction ratings given by patients. In November 2009, the then Leader of the Opposition, now Prime Minister, said that
“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.”
He was supported by the now Secretary of State for Health, who said as shadow Secretary of State in July 2007 that the NHS needed no more top-down reorganisation. Indeed, even after the general election, the coalition agreement stated:
“We will stop the top-down reorganisations of the NHS that have got in the way of patient care.”
It went on to spell out the continuing role of PCTs in some detail, pledging:
“We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust…The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level”.
A few months later, we have this potential chaos thrown on to the national health service. Once again, people are looking at the NHS and trying to change its culture by reorganising it.
We have had 30 years of Governments of different political persuasions trying to change the culture of the national health service by reorganisation. Every time, there have been years-long delays in implementation, performance has been affected in a negative way and there have been costs—particularly on this occasion, when the NHS is being instructed to make efficiency savings.
I agree with the report on commissioning just published by the Health Committee. I am not too sure whether the Chair agrees with it himself; the right hon. Member for Charnwood (Mr Dorrell) spoke earlier. The report states:
“The Coalition Programme anticipated an evolution of existing institutions; the White Paper announced significant institutional upheaval. The Committee does not believe that this change of policy has yet been sufficiently explained given the costs and uncertainties generated by the process.”
The last 30 years should tell the House and the Government exactly that.
Mr Barron
That is an interesting comment, but the Bill does not represent that. In my borough, the PCT—as was; it still is, although it is now Rotherham NHS—will become the GP commissioning consortium. Let us not get away from that. The idea that getting rid of the strategic health authorities or anything else is going to save massive amounts of money is palpable nonsense.
Does anybody think that top-down meddling is going to end because of this reorganisation? If the local GP consortium does not offer provision as it should, the national commissioning board will tell it what to do. If that is not top-down, I do not know what is. Those will be the people responsible for whether local residents, particularly those who need specialised commissioning, are going to get the services or not. The idea that those people are going to be responsible for NHS dentistry in my constituency is nonsense. There has now been a move away from midwifery, and that was going to be commissioned nationally. The changes are nonsense; they have been ill thought out.
Mr Stuart
The Chair of the Health Committee also set out the central challenge, which was recognised by the previous Government: to make major savings, year on year, for the next four years, at a time when budgets will not be able to increase—or at least not by much. How does the right hon. Gentleman think that that issue could best be addressed? Suggesting, as he did at the beginning, that we could just carry on as we were would not be sustainable.
Mr Barron
I am not saying that savings should not be made. Indeed, the Select Committee in the last Parliament took evidence from the chief executive of the NHS on that particular point. The case that I make is about the type of reorganisation. Not only has nobody in the public sector ever been able to get 4% a year in savings, but nobody in the private sector has, in the time scale being predicted now. [Interruption.] The Secretary of State says that that is rubbish—it is not rubbish at all. He should go and talk to his advisers about what happens in the real world, as opposed to the world that has appeared since July last year.
I would like to say something in defence of managers. This Government have been bashing managers in the NHS every week they have been in office, and did so for many months before they got there. How do they think we got waiting lists for things such as new knee and hip joints down from years to months, and even weeks, in areas such as mine? I will tell them. It was not done by taking the surgeons out of theatres to do the administration, but by putting people in to do the administration so that the surgeons could spend more time in theatres seeing more patients. That is the real truth. The management -bashing that has been taking place of people inside the NHS might be popular on the ground, but let me say this to the Government: if they take those managers out and we go back to the waiting lists and waiting times of five or six years ago, they will see where popularity lies.
Mr Barron
No, I will not; I have given way twice. The hon. Gentleman can make his own speech.
The King’s Fund, which the Secretary of State mentioned, supports some parts of the Bill. Indeed, I support a lot of its aims, but I do not support the reorganisation and upheaval that it will create inside the NHS. That is why I will vote against it. The King’s Fund says:
“The Bill abolishes the Health Protection Agency, places a duty on the Secretary of State to promote public health, and transfers responsibility for public health to local authorities.”
I agree with that. However, the Bill does not give me any confidence that GP consortia will have responsibility for the health of the population they cover.
Anybody looking at the history of public health in this country should recognise that we cannot run it on the basis of just handing it over to local government. The issues are far wider than that. The Secretary of State shakes his head, but people should look at the answers to questions that I got a week or so ago about what has happened to smoking cessation since this Government took over. Rates of smoking cessation have plummeted because of the advertising and promotion that is permitted. About 50% of health inequalities are created by smoking. The Government have taken their foot off the accelerator on the main thing that we should be doing to address public health inequalities, and they will suffer at the polls because of it.