Community Hospitals (North-East)

Lindsay Hoyle Excerpts

Wednesday 20th June 2012 Commons Chamber

[Tom Blenkinsop]

I am not surprised, to be honest. A couple of days ago, the Newcastle Journal reported that a freedom of information request had demonstrated that even after the NHS redundancies that we have seen, which I think cost approximately £60 million, a further 1,000 nurses are set to be cut in the north-east region.

The role of community hospitals is as important as ever. Despite the apparent importance of community hospitals, I fear for the future of hospitals such as those in Brotton and Guisborough in my constituency, the five other community hospitals of the South Tees Hospitals NHS Foundation Trust, and the trust’s district general hospital, the Friarage, which is at the heart of the Foreign Secretary’s constituency. All those hospitals are seeing a reduction in services as a consequence of the Government’s health reforms and austerity package—whether the reduction of minor injuries provision, the closure of the Chaloner ward at Guisborough hospital or the downgrading of maternity and paediatric services at the Friarage, which even the Secretary of State has branded “unacceptable”.

Ultimately, communities, patients and employees recognise that only so many services can be cut before the future of the hospitals themselves is brought into question. They are concerned that the Government are failing to do anything whatever to prevent those reductions in services. [Interruption.] I give way to the hon. Member for Redcar (Ian Swales).

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. May I suggest to the hon. Member for Redcar (Ian Swales) that if he wants to intervene, it is better if he actually stands up rather than waving his hand?

[Ian Swales]

Thank you for your advice, Mr Deputy Speaker.

I congratulate my neighbouring MP, the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop), on securing this important debate. My daughter was born in Guisborough hospital in his constituency, but that would no longer be possible as the maternity unit closed in 2006. The withdrawal of services from older community hospitals, and the failure to put services into new community hospitals such as Redcar, are top-down decisions. Does he support more locally based commissioning driven by clinicians?

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[Jim Shannon (Strangford) (DUP)]

Will the hon. Gentleman explain why some Members, when they are outside the House, support petitions to retain hospitals and community services, but in the House vote to stop them?

[Mr Deputy Speaker]

Order. I allowed the intervention, but I am not sure what the connection is between the north-east and Northern Ireland.

[Tom Blenkinsop]

The current Prime Minister, when he was Leader of the Opposition, identified Northern Ireland and the north-east as areas where the public service cuts should primarily take place. That is the similarity. Of course, the north-east leads all other regions in the United Kingdom on exports, so there was some smoke and mirrors in that argument. There are indeed a number of Members who are introducing petitions against the closure of health services, including a number who are in the Cabinet.

The centralisation process is well under way at Guisborough hospital, in my constituency, and that is just one example of what is happening across the north-east. The hospital has already been forced to operate a reduced service owing to staffing pressures, opening only from 9 am to 5 pm on weekdays and 8 am to 8 pm at weekends instead of the usual round-the-clock service. The Chaloner ward there is an eight-bed unit providing palliative, post-operative and respite care, with dedicated nursing care for a variety of medical conditions. There is also an out-patient suite and a minor injuries unit. Closing the Chaloner ward could eventually mean the end of the hospital. The maternity service has already been lost, and closing the ward would leave only a residual out-patient service and the Priory ward on the site. East Cleveland hospital, in the Brotton area of my constituency, offers even more limited services than Guisborough, and I have often spoken to constituents who have been forced to seek treatment elsewhere.

My main concern is that hospitals such as Guisborough and Brotton will become marginalised owing to a continuous reduction of funding from South Tees Hospitals NHS Foundation Trust, as more and more services are consolidated at James Cook university hospital. It takes nearly an hour to reach that hospital by bus from Guisborough, and even longer from the more rural parts of my constituency—and that is under the very generous assumption that such bus services will still be available.

It may be politically expedient for some to argue that such decisions are solely the responsibility of the relevant trust and are somehow detached from being the responsibility of central Government, but they are unfortunately a worrying national trend. No one trust can take the blame, and the scrutiny must instead be of the Government who force them into such a position. For example, I have read that in Sutton,

“a cloud has gathered over St Helier”

district general hospital, where accident and emergency services are under threat, to such an extent that the Minister of State, the hon. Member for Sutton and Cheam, has started a petition against the closure in his own constituency, despite the fact that it seems to be part of a broader pattern that is perhaps caused by his own Department’s policies.

Given all the campaigns that are emerging throughout the country to save services at local hospitals, I find myself asking why there seems to be such a decline in the provision of services. Despite the Government’s localism agenda, it appears that services are becoming more centralised to larger hospitals, leaving community hospitals with empty beds and abandoned wards.

Mental Health

Lindsay Hoyle Excerpts

Thursday 14th June 2012 Commons Chamber

[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Given that 19 Members wish to catch the eye of the Chair, it would be beneficial if each of them could aim to speak for about eight minutes. I hope that that will make it possible for everyone to contribute.

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[Sir Paul Beresford (Mole Valley) (Con)]

It was beginning to look like a Whips’ cabal in the Chamber. I was quite worried. A number of hon. Members, particularly the hon. Member for Strangford (Jim Shannon), who is busy disappearing from the Chamber, mentioned care for, and the mental health of, veterans—[Interruption.] I am making a plea to keep my small audience. To my delight, the shadow Secretary of State mentioned a famous organisation in that field: Combat Stress—[Interruption.] He is also leaving the Chamber the moment I mention him. He can read my speech in Hansard as he has obviously been urgently called away.

Combat Stress was supported by the previous Government as it is by this one. Combat Stress clients—ex-servicemen, or veterans—suffer from the appalling conditions of post-traumatic stress disorder, depression or anxiety, or all three. Anyone who has seen such individuals with such conditions will recognise that they are exceptionally debilitating. They destroy the normal life of victims and those around them.

Combat Stress has three centres—the main one is in my constituency—an outreach service throughout the nation and a liaison team. It has been making a difference for some considerable time. Some 83.5% of Combat Stress clients are ex-Army. Three per cent. are female. Most of the veterans contact the Combat Stress service themselves or through family referral, but only 3.6% are referred by general practitioners, 6.9% by community health teams, and 0.3% by a hospital service. I hope the Minister thinks about that.

To make access to those services more available, Combat Stress set up a 24-hour helpline in March last year. It may interest the House and the Minister to consider statistics from the helpline from March 2011 to January 2012. Combat Stress received 6,279 calls, including voicemails. A few people hung up—a tragic few calls were silent, which I think says a lot.

Of the callers who were contacted, 74% were male and 26% female. Army veterans made a total of 2,248 calls. The second largest group of callers were family, friends and carers of the victims, who themselves were therefore victims. Seventy-seven per cent. of callers called about themselves. Perhaps tragically—I hope the Minister makes a note of this—just 6% of callers were given the number and contact details by a health professional. The call centre seems to be catching on. In March, it received 286 calls, but that doubled to 604 the following January. The organisation is funded by the Government, and I plead with the Minister to keep the funding going. I am sure he will.

The average post-service delay is a staggering 13 years. The Minister should be aware that after such a delay an individual’s condition will have developed in complexity, meaning that their recovery treatment can last for years, whereas if treatment is early, it can last just weeks and months. Early diagnosis and referral can lead to faster and cheaper treatment, and greater success, and can mean that the potential side effects of alcoholism, drug problems, which have been mentioned—[Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Will the Minister wait while the hon. Gentleman is standing? The Minister was right in my line of vision, and it is not fair to the person speaking. This is the third time it has happened.

[Sir Paul Beresford]

As mentioned by several Members, the result can often be imprisonment, yet all these side effects could be avoided. On average, it takes veterans just over 13 years from service discharge to first approach Combat Stress. This is an ongoing issue for veterans.

Community outreach teams across the country now provide much support for veterans. They provide support and advice in veterans’ own homes and nearby community-based clinical care. Yesterday, we made much of the Falklands war, which ended 30 years ago today, on 14 June 1982. Of the 4,800 veterans Combat Stress is helping, 221 served in the Falklands war. The youngest is 46 and the oldest is 74, and on average the Falklands veterans have waited 15 years before going for help. Last year, 18 Falklands veterans contacted Combat Stress for the first time, and this year, to date, 10 have contacted it. But of course the case load is not just from the Falklands. Of the 4,800 ex-service men and women being treated, 589 served in Iraq and 228 served in Afghanistan. Between 1 April 2010 and 31 March 2011, Combat Stress received 1,443 new referrals.

Having set the scene, I shall touch on a few key points for the Minister to consider. First, all the UK Governments must acknowledge the ongoing need. Most of the Governments contribute considerably towards Combat Stress and its costs. Combat Stress estimates that in 2012, 960 service personnel will leave the armed forces with the likelihood of suffering from PTSD. I shall follow up a point made by the hon. Member for Strangford. We must persuade the MOD to look specifically at their decompressing veterans-to-be and, if there is any suspicion, to refer them to Combat Stress. It would make treatment by Combat Stress easier, because it would be given earlier, and all the pain and suffering of these men and women could be reduced to a tiny fraction of what it is for many of those in Combat Stress now.

That brings me to the crux of the problem, which has been touched on. Because mental illness is not a physical but a mental wound, a stigma is attached to it. A lot of Members have mentioned that. Combat Stress tells me that 81% of veterans with a mental illness feel ashamed or embarrassed, which often prevents them from seeking help—it certainly delays them seeking help—and sadly one in three veterans are too ashamed of their condition ever to tell their families about it. As a result, many of those families break up. Among the other side effects are crime, disorder and alcoholism. This is a mental health problem, then, that could and should be alleviated early.

Much has been done to raise the profile of the condition and the availability of help, so that those individuals do not feel that they are unique or, perhaps, weak. Much needs to be done to encourage them and their families to seek assistance. We need to put these valuable individuals back on their feet—and they are valuable: they have already performed valuable service, and there is still valuable service available if we can do that. Amazingly, there appears to be a considerable lack of understanding among GPs. Research conducted in September 2011 showed that only 5% of the veterans receiving help from Combat Stress had been referred by their GP. Perhaps those GPs failed to recognise the condition or were unaware of the existence of Combat Stress—or, more likely, both. I urge the Minister to ensure that the word is spread among our GPs. Combat Stress has done a clinical audit, and it would appear that approximately 80% of the veterans who come to it for clinical treatment tried to get help from their GPs or other specialist services first, and did not get it. Appallingly, that support and treatment was not forthcoming. It should be.

I hope that the Minister will consider joining me in a visit to Combat Stress, to see the value of the work first hand, to understand its difficulties and to help to build on the opportunity to prevent some of the tragedies that we see. We need to remember that for those veterans the physical war is over, but the battle is still raging in their heads.

Health and Social Care Bill

Lindsay Hoyle Excerpts

Tuesday 13th March 2012 Commons Chamber

[Bill Esterson (Sefton Central) (Lab)]

My right hon. Friend is, as ever, making the case for the NHS, not for the privatisation that the Tories and their Lib Dem friends are pursuing. We are talking about the future of the NHS, so let me quote Victoria Roberts, a student nurse from Merseyside, who starts her training in two weeks. She says:

“I am a student nurse due to start my training in 2 weeks. This is not the NHS I want to serve or work in, but rather will help only those who can pay the most.”

Does my right hon. Friend agree with that assessment of where the Tories are taking the NHS?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. We must have shorter interventions. A lot of people want to speak and we have got to get on with it.

[Andy Burnham]

I wish the Government would listen to voices such as the student nurse that my hon. Friend the Member for Sefton Central (Bill Esterson) quoted—people who want to dedicate their lives to the NHS. Frankly, their views are brushed aside by an arrogant Government.

It gets worse as the Bill enters a new crisis, with one of the coalition parties formally withdrawing permission from its peers to support the Bill. It is not at all clear what happens now—whether Lib Dem peers will defy the wishes of their party or their leader. Given the developments of the last few days, it is simply inconceivable that the Government can continue on their current course and present the discredited Bill here in seven days. The only responsible thing to do is listen to what Lib Dem Members are saying and support what the amendment tabled by the hon. Member for St Ives seeks to do. I will deal with that shortly.

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[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Front Benchers need to be a little calmer. A lot of Members want to be called, and we want to hear the Secretary of State.

[Mr Lansley]

Let me just say this to the hon. Member for Barnsley East (Michael Dugher), who is sitting on the Opposition Front Bench. There may be many things that we can debate in this House, including the policies, but I deeply resent any implication that I do not care about the national health service. I believe that I have demonstrated that I do; and his hon. Friends—and, to be fair, the right hon. Member for Leigh—have made that absolutely clear, time and again. Dr Clare Gerada, on behalf of the Royal College of General Practitioners, has said clearly that she recognises the Prime Minister’s and my passion and commitment and that of the Prime Minister to support the national health service.

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[Mr Lansley]

rose—

[Mr Deputy Speaker]

Order. Interventions must be curtailed.

[Mr Lansley]

There is absolutely nothing in the Bill that promotes or permits the transfer of NHS activities to the private sector. Of course, NHS trusts are technically able to do any amount of private activity at the moment, with no constraint. The Bill will make absolutely clear the safeguard that foundation trusts’ governors must consent if trusts are to increase their private income by more than 5% in the course of one year, and that they must always demonstrate in their annual plan and their annual reporting how that private activity supports their principal legal purpose, which is to provide services to NHS patients.

Labour sought to oppose the Bill in another place, but its motion was defeated by 134 votes. We have reached a stage at which the Labour party, and the right hon. Member for Leigh in particular, having embraced opposition —for which they are well suited—now oppose everything. They even oppose the policies on which Labour stood at the election. Labour’s manifesto stated that

“to safeguard the NHS in tougher fiscal times, we need sustained reform.”

The trade unions have got hold of the Labour party in opposition, and it is now against reform. Its manifesto also stated that

“we will deliver up to £20bn of efficiencies in the frontline NHS, ensuring that every pound is reinvested in frontline care”.

I remind Labour Members, who are all wandering around their constituencies telling the public that there are to be £20 billion of cuts to the NHS, that that £20 billion was in their manifesto. Now they are talking about it as if it were cuts; it is not. We are the ones who are doing it, and they are the ones who are now opposing it. They scare people by talking of cuts—[Interruption.] They do not like to hear this. Actually, this year, the NHS has an increased budget of £3 billion compared with last year, and in the financial year starting this April there will be another increase of £3 billion compared with this year. The Labour manifesto also stated:

“Foundation Trusts will be given the freedom to expand their provision into primary and community care, and to increase their private services”.

NHS Risk Register

Lindsay Hoyle Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Chris Skidmore]

The Opposition are asking—[Interruption.] The shadow Secretary of State has already said that risk registers should not be published because they are confidential documents that must be used by policy makers. The Opposition are asking for a risk register that is out of date when what we should have been discussing today was reform of the NHS and how we can deal with an ageing population at the same time as dealing with a rise in chronic diseases.

I thought that it was striking that the shadow Secretary of State said at the end of his remarks that he would put the NHS first, without any mention of the patients. That is what these reforms are here for. They are allowing patients to be put in the driving seat and to sit down with their doctor, to understand what treatments they need and to have a choice of treatment through the opening up of providers. We could have had that debate—we could have spent six hours discussing that instead of this irrelevant document that you want to have a look at, which is out of date and from November 2010 when it is now February 2012. You are two years out of date, you are out of time and you are out of touch. I urge everyone to vote down the motion, simply because it falls outside the point.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I remind the hon. Gentleman that I am not out of touch, and I am sure that he was not suggesting that I was. Others might think so, but I want to reassure him that I am not.

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[Rehman Chishti]

I am grateful to the shadow Secretary of State for that point, to which I shall return. In my view, the Secretary of State is absolutely right to use that discretion. The shadow Secretary of State knows the Department of Health well because he has been there, but I should point out to him that a spokesman for the Department of Health said:

“We have never previously published our risk registers as we consider them to be internal management documents. We believe that their publication would risk seriously damaging the quality of advice given to Ministers and any subsequent decision-making”.

I would say to the shadow Secretary of State—[Interruption.] He asked the question; I would be grateful if he listened to the answer. The reason why I say that the Secretary of State is within his powers and is right to do what he did is that never before have any Government or Secretary of State released that information. Being a sensible, considerate and fair man—which the Secretary of State is—he is right to challenge the decision, because that information has never been released before, as stated by the spokesmen for the Department of Health and made clear on page 2 of the information pack provided by the Library.

I also want to refer the shadow Secretary of State to another point. He has previously used the exemptions in section 36. Either we have exemptions or we do not, but the current exemptions, whether in section 36 or section 35, were put in place by the previous Government. If they did not want those exemptions—if they had said that everything should be in the public domain—they should have made that clear. I remind the Opposition of the saying “What’s good for the goose is good for the gander”. The fact is that you applied similar provisions, whether in section 35 or section 36, to withhold information. If you were able to do that in the public interest, then this Government, applying the same procedures and the same rules, can do so too. There is simply no point having legislation, in the form of the Freedom of Information Act, and now suddenly, when you are in opposition, you move the goalposts. In my view, that is totally and utterly unacceptable. It is also important to note that the Department of Health—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. May I gently remind the hon. Gentleman that I am not responsible? He keeps saying “you”, and I assure him that I will not and do not want to take responsibility for the NHS.

[Rehman Chishti]

I am grateful, Mr Deputy Speaker, and I am sorry to put the previous Government’s legacy on you.

Moving on, it is important to bear in mind the previous Secretary of State’s decisions in 2008, to which I referred earlier. However, it was not just him who acted in that way; the Secretary of State for Health before him, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), made similar decisions, under section 36 of the Act. In view of the procedure provided under the Freedom of Information Act and the similar decision taken by previous Labour Health Secretaries on public interest grounds, I feel that the Secretary of State is absolutely right to challenge the current Information Commissioner’s ruling.

On such an important issue, it is absolutely right to say that in the interest of fairness and transparency, the matter should be looked at by a higher authority. If a point of law is at stake, I would say that section 59 should be used to refer the matter to the High Court. The debate has touched on the excellent work going on—whether in respect of the cancer drugs fund or the reduction of viruses in hospitals—so I endorse the view of my constituent, Mr Thomas, sitting in the Public Gallery, who says that the Government are doing an excellent job.

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[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. A lot of Members still want to speak and time pressure is on. I shall have to reduce the limit to five minutes, and people will have to restrain themselves from making interventions. Those who continue to intervene must recognise that they might end up being dropped down the list accordingly.

NHS (Private Sector)

Lindsay Hoyle Excerpts

Monday 16th January 2012 Commons Chamber

[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. We have very limited time and I wish to get quite a lot of Back Benchers in, so I am going to start with a six-minute limit. I may have to reduce it, but I am going to try to ensure that we get everybody in.

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[John Pugh]

My fundamental point is that this is not evidence-led pragmatism. If we join up the policy dots, we see pure, simple, unalloyed faith in the market system to deliver health in this country. Time after time, in issue after issue, ideology trumps pragmatism and prudence.

The Labour motion is a potpourri of varied sentiments, some of which are true and some of which are confused, and some, given the history, that it is surprising the Opposition have the gall to table at all. However, we should be genuinely grateful to them because they have given us an opportunity—a platform—to name the beast, to define real choice and to cut to the quick.

Chris Mullin, in his excellent “Diaries”, describes a discussion with a fellow Member of this place, a Yorkshire MP, “a mild-mannered fellow”—I do not know who that would include—who in 2005, prophetically, said of the Labour party:

“We’re opening the door…Whatever safeguards we put in place, whatever assurances we give will be absolutely worthless once the Tories are in power…I think we will lose the next election. The Tories will come to some sort of understanding with the Lib Dems—”

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order.

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[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I will reduce the time limit to four minutes to try to get everybody in.

National Health Service

Lindsay Hoyle Excerpts

Wednesday 26th October 2011 Commons Chamber

[Mr Lansley]

I went with my colleagues; in fact, the Chief Secretary to the Treasury stood here at the Dispatch Box and reconfirmed support for that project, so I will not have any nonsense from the hon. Member for Copeland. [Interruption.] Withdraw that. I have not misled the House. The Chief Secretary to the Treasury came here and reconfirmed support for that project. I will not put up with being told from a sedentary position that I am misleading the House. I ask the hon. Gentleman to withdraw that accusation.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I am sure that it was not intentional, and I am sure that the hon. Member for Copeland (Mr Reed) would not wish to leave it on the record. [Hon. Members: “Withdraw. The hon. Gentleman has been asked to withdraw.”] Order. I do not need any advice. I am sure that it was not intentional, and that the hon. Member for Copeland would not wish to leave it on the record.

[Mr Jamie Reed (Copeland) (Lab)]

It was unintentional— [Interruption.]

[Mr Deputy Speaker]

Order. I think that we have established that it was not intentional. I call the Secretary of State.

[Mr Lansley]

Thank you, Mr Deputy Speaker. I will now give way to the hon. Member for West Ham (Lyn Brown).

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[Mr Lansley]

Next, the motion fails to offer any—[Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Three Members are trying to catch the Secretary of State’s eye. I am sure that he has noted that and that he will give way, but we cannot have three Members continuously on their feet.

[Mr Lansley]

Thank you, Mr Deputy Speaker.

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[Paul Farrelly]

I thank the Secretary of State. [Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. There are too many side comments coming from the Front Benches. Let us carry on with the debate. I am sure that the Secretary of State does not need any help.

[Paul Farrelly]

Staff of the High Street medical practice at Newcastle-under-Lyme are dedicated and hard working, yet that practice, which has 5,000 patients, is being forced to close. The Secretary of State has written me a letter, from which it is quite clear that closing directly run GP practices with salaried doctors is NHS policy. It is also clear that the closures are pre-empting proposed legislation to abolish PCTs, which is yet to go through Parliament. If the Secretary of State believed in a patient-focused NHS, surely he would be trying to save such practices, not encouraging their closure.

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[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Just before I call the next speaker, I suggest that we have an eight-minute limit. I want to get all the speakers in, as I do not want anyone to be disappointed.

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[Grahame M. Morris]

I shall not, if the hon. Gentleman does not mind, because I do not think I will get any injury time if I do so and I have rather a lot to get through.

I have mentioned the transfer of resources from the NHS budget to meet the growing costs of social care. We have also discovered, from evidence that was given to the Select Committee, that there has been an underspend of almost £2 billion—much of it from the capital budget, with some of it, presumably, being saved by cancelling the new hospital that was to serve my area. Meanwhile many NHS trusts are sitting on hundreds of millions of pounds of debt, and figures produced by the Department of Health show that six large NHS trusts in London are predicting year-end deficits of £170 million. The pressures on the system are enormous and will inevitably show through in reductions in services, having an impact on the front line.

The reductions in tariffs for operations and the further pressures in that area will also mean that foundation and NHS acute trusts will bear the brunt of financial pressures within the system. Again, that means that the buck and the spotlight of transparency are being passed away from the Secretary of State to the NHS Commissioning Board, although he might have to reconsider that after last night’s Lords amendments.

Another area of pressure in the NHS comes from the huge redundancy costs being incurred as a consequence of the premature closure of primary care trusts and strategic health authorities, which is estimated to cost the taxpayer more than £1 billion. The opening up of the NHS entirely to the private sector, and the prospect of the £103 billion NHS budget being taken out of the public sector and placed within the remit of shareholders in private health care companies, is anathema to the majority of the British public. The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) is cringing, but the majority of the British public are cringing at the thought of this proposal.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order.

Health and Social Care (Re-committed) Bill

Lindsay Hoyle Excerpts

Wednesday 7th September 2011 Commons Chamber

[Andrew George]

I am grateful to my hon. Friend for giving way and for his appreciation of the efforts I am making. I, too, appreciate his comments on the Government’s intentions. It has not been my argument at any stage to suggest that the Government’s intentions are dishonourable. He has mentioned the possibility of tabling amendments, but may I have some reassurance that this is a genuine and serious issue—that we need to have policy, but also, clearly, the restraint of the Secretary of State at the same time?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. We must have shorter interventions, as we have a lot to get through. Hon. Members should not take advantage of the Minister’s generosity in giving way.

[Paul Burstow]

I am grateful for your protection, Mr Deputy Speaker. I will take that as advice in relation to further interventions.

I have heard my hon. Friend’s comments and I think he needs to look again at what I have said. I have been very clear that we are listening and that, if necessary, we will offer clarifications or further amendments, and I am very happy, as is the Secretary of State, to carry on those discussions.

There are a number of amendments regarding other duties on the Secretary of State that I believe would not improve the drafting of the Bill. Amendments 1240, 1241, 1169 and 1183 seek to revise the duties of quality and inequality. I know that the amendments are well meant, but they would make the duties undeliverable. The Secretary of State cannot improve quality and reduce inequalities in isolation, and the duties have to reflect that. Amendment 1194 is unnecessary as the Bill already recognises the need to promote research and the use of research evidence, and creates, for the first time, responsibilities for taking a whole-system approach to achieving this. Amendments 1184 to 1193, 1195, 1196 and 1198 seek to change the extent of similar duties on the board and the clinical commissioning groups. Each of the board’s and clinical groups’ duties has been drafted to ensure that the duty is suitably strong, realistic and appropriate.

Let me address the role of the Secretary of State in relation to another issue that has been misunderstood—charging. I want to be very clear that nothing in the Bill enables the board or clinical commissioning groups to charge for services provided as part of the comprehensive health service. Services will remain free at the point of need, except where legislation specifically allows for charges to be made—for example, prescription charges and charges for dentistry. The Government have also committed not to introduce any new charges.

Amendment 48, tabled by the hon. Member for Brighton, Pavilion (Caroline Lucas), who is not in her place at the moment, would prevent charges from being imposed for any service provided by the NHS. It has always been possible for Ministers to provide for charges for certain health services. There are limited provisions for charging even in the original NHS legislation introduced by Nye Bevan and the Labour Government of 1946. Under the current system, there are extensive exemptions: about 60% of the English population do not pay prescription charges, but—it is an important but—NHS charging raises over £1 billion a year of revenue that is ploughed back into services for patients, and it does make an important contribution to the overall affordability of the NHS. Therefore, I cannot accept the amendment.

The hon. Member for Brighton, Pavilion also tabled several amendments on direct payments. The amendments are unnecessary and too restrictive. Amendment 1247 would restrict direct payments to being spent on services approved by the National Institute for Health and Clinical Excellence. The great opportunity of personal budgets is that they allow people in areas where less medicalised services are provided to have much greater control over aspects of their care—those community-based services that are so important in maintaining the quality of life for many people with long-term conditions.

Finally, amendment 1248 would remove the power to extend direct payments nationally following the pilots, which are continuing. The Health Act 2009 provided that direct payments could be extended with the active agreement of Parliament using the affirmative procedure, and that seems a perfectly reasonable way of having a parliamentary check over the outcomes of the pilots that will be reported to the House next year. Amendment 1247 would prevent direct payments from being used for private health care or health insurance. The amendment is unnecessary. NHS funds could never be used to pay people’s private health insurance premiums.

I shall now turn to education and training. We have already committed to introduce at a later stage in the Bill’s proceedings an explicit duty for the Secretary of State to maintain a system for professional education and training. Work is ongoing and an amendment will be tabled in the House of Lords. That will be more effective and more precise than the long-term measure of simply blocking the abolition of strategic health authorities, so amendments 7 and 47 will not do.

Our vision of a modern NHS has clinical commissioning at its very heart. We want clinicians, GPs, nurses and other health care professionals to have the autonomy to commission innovative new services, and to have the true responsibility that the previous Government denied them. That involves striking the right balance between freedoms for clinical commissioning groups and their essential responsibilities to other parts of the health care service.

We made many changes in response to the recommendations of the NHS Future Forum report. We always wanted clinical commissioning groups to have a robust set of governance arrangements, to involve a wide range of other professionals and to be transparent in how they conducted their business, and we have now further strengthened those parts of the Bill so that they are very much improved.

As I said at the start of my remarks, I should like to speak briefly to a number of amendments, as I am conscious that many other hon. Members wish to speak. First, I will address some amendments that are very similar, if not identical, to those that we had the opportunity to debate at least once, and possibly twice, during the first stage of the Committee and in the re-committed Committee.

Amendment 1181, which is like amendments 45 and 46, seeks to restrict clinical commissioning groups’ powers to raise additional income. As was explained in Committee, those amendments are unnecessary. The Secretary of State has already published guidance, which can be easily updated, specifically on the powers to generate income, which applies to current NHS bodies, including primary care trusts.

Amendments 37 and 38 are on conflicts of interest. We have listened to the concerns that were expressed in the listening exercise and made changes, so the Bill already requires clinical commissioning groups to make provision for dealing with conflicts of interest.

Amendments 31 and 32 would prevent any property currently held by PCTs or strategic health authorities from being transferred to any provider that is not a public authority. As we said in Committee, we have no intention of giving away NHS property to private companies. That will not be the case and, given the safeguards that are in place, it cannot happen.

Several amendments have sought to probe accountability within clinical commissioning groups. I repeat what we said in Committee. A clinical commissioning group is not able to delegate its statutory responsibilities for carrying out its functions. It cannot palm them off or pass them on to others. Amendment 1245 would limit representation on CCG committees and sub-committees, preventing those clinical commissioning groups from inviting other professionals and experts to participate—something that we were told during the listening exercise was widely welcomed and wanted.

Amendment 1249 restricts the use of sub-committees—an essential part of any organisation with a wide range of functions. Similarly, amendment 1234 would prevent GPs or their employees from working on behalf of a clinical commissioning group, which would be a severe constraint on those groups’ ability to function. Amendment 1244 would prevent a clinical commissioning group from delegating its functions to anyone other than its employees. That would make it very difficult for those groups to carry out their statutory functions effectively.

New clause 20, tabled by my hon. Friend the Member for St Ives, similarly would restrict the support that clinical commissioning groups can draw on. We want to allow those groups to access the best support and advice available—to be able to work with local authorities, third sector organisations and charities, research organisations and the independent sector. I mentioned in Committee several times, and it is worth repeating, that the support organisation established by the Neurological Alliance is proving of invaluable assistance to commissioners, and amendments such as new clause 20 would prevent it from doing the work it does for the clinical commissioning groups. I can follow the intention behind the amendments, but I hope my reassurances about the final responsibility—the statutory responsibility—for decision making in clinical commissioning groups resting with their members and the governing body are clear.

There is a raft of amendments dealing with the relationship between local authorities and commissioning groups. We want that to be a dynamic relationship, with constant dialogue and collaboration, which is precisely why the Bill proposes the establishment of health and wellbeing boards. Amendments 1202, 1171 and 1250 would introduce a new, centrally imposed procedural requirement on health and wellbeing boards and clinical commissioning groups. Clinical commissioning groups will have a duty to have regard to the relevant joint health and well-being strategy.

Where commissioning plans vary significantly from the joint strategy, the group will need to justify or consider amending its plans. Health and wellbeing boards also have the power to refer their views and concerns to the NHS commissioning board when they feel that the plans have not had proper regard to the joint health and well-being strategy. That indicates to the NHS commissioning board that the health and wellbeing board believes the CCG is actively failing to fulfil its duties. Anything further would undermine the important balance that needs to be struck in what is fundamentally a partnership relationship between two organisations that have separate sets of sovereignties and responsibilities.

The importance of that partnership approach highlights why it would be impossible to create an obligation on clinical commissioning groups to act alone to secure integration of services. How can one body decide to integrate with another against the wishes of the other? A duty cannot be imposed on one side unless the relationships exist that will allow that to take place. That can be achieved only by both parties working together, and for that reason amendments 1230 and 1231 do not contribute to that relationship’s working well.

Amendment 1211 seeks to make the clinical commissioning groups coterminous with local authorities. We have accepted the NHS Future Forum’s recommendation that the boundaries of local clinical commissioning groups should not normally cross those of local authorities, with any departure needing to be clearly justified as part of the establishment process set out in the Bill.

Amendment 1213 would prevent a clinical commissioning group that had received a reward under the quality premium from using that money without first securing the agreement of the local health and wellbeing boards. That would severely limit the CCG’s freedom to spend its quality payment as it saw fit. Health and wellbeing boards will shape commissioning priorities through the joint health and well-being strategy, by being consulted by the CCG on their commissioning plans. Under the duties set out in proposed new section 14Z14 of the National Health Service Act 2006, the NHS commissioning board must also consult each relevant health and wellbeing board in making its annual performance assessment of those CCGs.

--- Later in debate ---

[Rosie Cooper]

My hon. Friend has been talking about mandates. Will he explain under what mandate and how the Secretary of State is implementing all these structural changes? The House has not voted on them and the process started before the Bill came to the House. You are making structural changes, damaging the health service and making it impossible—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I am sure that the hon. Lady will not be using “you”.

[Rosie Cooper]

Forgive me. I am for ever doing that, and I must stop. In essence, I am saying that the Secretary of State and Ministers keep talking about mandates and what they will and will not do, yet they are disregarding everything because they are implementing the Bill before it has been sanctioned by the House or the other place.

Health and Social Care Bill (Programme) (No. 2)

Lindsay Hoyle Excerpts

Tuesday 21st June 2011 Commons Chamber

[Chris Bryant]

I will not give way. If he had allowed more—[Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. There is very little time as it is, and screaming at each other does not help.

[Chris Bryant]

If the Deputy Leader of the House had allowed more than an hour for debate today, I would give way to him, but I am not going to give way now. We have already heard from a Minister for 15 minutes.

It is a bizarre selection of clauses that the Committee will be allowed to discuss. For instance, it will not be allowed to discuss clause 239 on NICE’s charter, nor clause 240 on its functions, but it will be allowed to consider clause 242, on the failure of NICE to discharge its functions. There is absolutely no logic to what is being presented to us.

In addition, the programme motion does not allow enough time. The Prime Minister is profoundly confused about all this, because he said many times this morning that 10 days would be allowed. Indeed, he said:

“Ten days… I don’t want to sort of misquote the Monty Python sketch but when we were in opposition we used to dream of tens days to debate a government bill”.

Well, yes, we are dreaming of 10 days now. We would love to have 10 days, but there will not be 10 days; there will be 10 sittings.

--- Later in debate ---

[Andrew Percy]

We have discussed where these procedures come from and who is accountable for them, and that certainly cannot be laid at the door of this Government. Over the past few months, we have heard first that there has been too much delay, and now that there is not enough delay.

As we have heard, professionals in the health service and the public have been saying that they wanted to know where we were heading and that they needed some clarity. The Government wanted that brought to an end, and they have had their listening exercise. On that basis alone, although I do not like the idea of curtailing debate, I hope that we can get on with this so that we all know what the changes are going to be, and that we end up with an NHS that is on a stable footing for the long term and do not have any more reorganisation for a considerable time.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Grahame Morris with about four seconds.

NHS Reorganisation

Lindsay Hoyle Excerpts

Wednesday 16th March 2011 Commons Chamber

[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Come on; we want to see the debate continue. A lot of Members want to speak and to intervene, but we cannot have so many of them on their feet at once.

[Mr Lansley]

I remember that if we ask the public whom they trust in public service, we find that general practitioners are at the top of the list. Members of Parliament and politicians are pretty near to the bottom of the list, so the public might take it pretty amiss that Labour politicians are insulting general practitioners by thinking that they are in it for the money. They are not; they are in it for the patients.

--- Later in debate ---

[Mr Lansley]

No. We will hold the NHS to account—[Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. The Secretary of State has decided that he is not going to give way. That is his decision. He has given way already. We need to have a little less noise so that we can hear the Secretary of State.

[Mr Lansley]

Thank you, Mr Deputy Speaker. I have to conclude to ensure that we do not trample on Members’ time.

We will hold the NHS to account for what it achieves, but not tell it how to achieve it. We want continuous improvements in outcomes and more personalised care. We are going to change accountability in the NHS. In the past, the only question in accident and emergency was whether people were seen within four hours. We will ask whether a patient was seen by the right person, whether the quality of care they received was appropriate, and whether they recovered. From April, we will know those things for the first time. On mental health, we will ask whether we are helping people with serious mental health problems to live longer, and whether we are helping them to get a job. We will ensure that we find out those things and that we know which services provide the right care.

Beyond the NHS, we will make changes that increase accountability. As of today, 134 local authorities with social care responsibilities—almost 90% of such local authorities in England—have signed up to be early implementers of health and well-being boards. Those are the bodies that will finally tear down the walls between the NHS, public health and social care; and they will strengthen local accountability to the public and patients. Local authorities will finally have the powers that they need to scrutinise all NHS-funded providers of care, be they public, voluntary or private sector providers.

The coalition Government were elected to protect the NHS and that is what we are doing. We are protecting the NHS in this Parliament through increased investment, and protecting it for future generations through modernisation. We need an NHS in which every system, process and incentive encourages excellence in health care and weeds out poor performance. Labour now opposes that. It has turned its back on the NHS. It wants to drag the NHS back into politics; I want the NHS to be freed from political interference so that it can deliver the best possible care and results for patients. This Government will always support the NHS. We have a simple aim: to create an NHS that is up there with the best in the world. Our modernisation plans will do just that.

[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I remind Members that there is a six-minute limit.

--- Later in debate ---

[Rosie Cooper]

No, I was giving way to—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. The hon. Lady will have to sit down during the hon. Gentleman’s intervention.

[Graham Evans]

I am new to the House, but I seem to recall the right hon. Member for Leigh (Andy Burnham), who was then the Secretary of State for Health, saying that we should

“celebrate the role of the private sector in the NHS.”

What has changed for Labour Members? [Interruption.]

--- Later in debate ---

[Mrs Main]

On a point of order, Mr Deputy Speaker. On two occasions the hon. Lady has accused the Government of misleading the public. I cannot believe that that is the case, and I am sure she would like to withdraw those remarks.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. That is not a point of order, because the accusation was not against individual Members.

[Rosie Cooper]

Oh how the truth hurts! Michael Portillo could not have been more clear that the Government intended to misrepresent their position and to mislead voters.

I believe very clearly that you are playing Russian roulette with people’s futures, but the gallery is empty and you are on your own. I still believe that you have no mandate for these ill-advised reforms. You do not have that support, and it seems to me you do not have a clue—[Interruption.] It is impossible to make a speech with that noise.

I shall just recap. I do not believe that you have any mandate for these reforms. You do not have the support out there and it seems to me that you do not have a clue. For goodness’ sake, stop now before you kill the NHS.

[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. May I just remind Members that the Chair is not responsible? I would be pleased if we did not use the word “you”.

--- Later in debate ---

[Debbie Abrahams]

No, I am sorry, I want to make some progress—[Hon. Members: “Give way!”]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order.

[Debbie Abrahams]

Not only are the founding principles of the NHS in danger of being wiped out, but its culture—the reason that most of its employees work for the NHS—will go as well. The whole ethos of the NHS will change. It will now be driven by competition and consumer interests—[Interruption.]

[Mr Deputy Speaker]

Order.

[Debbie Abrahams]

My first question to the Secretary of State was about the proposal that the NHS commissioning board will be able to award bonuses to the GP consortia that it deems to be adopting innovative measures. The Bill states:

“The Board may make payments as prizes to promote innovation in the provision of health services.”

That means bonuses within the NHS based on innovation, which is anathema to the NHS and not what we want for it. This is indicative of the Bill as a whole. Central to the reforms are increasing competition across the NHS and opening it up to providers from the private and voluntary sectors. The Government claim that increasing competition drives down costs and improves quality, but there is evidence from across the world—in the US and Europe—that that is not the case. It does not improve quality at all in health care systems.

Although I am glad to see that the Government have reversed their position on price competition, as of yesterday they were still wedded to establishing Monitor as a powerful economic regulator with the duty to promote competition. As has been pointed out, our health services will be subject to EU competition law for the first time. By forcing these GP consortia to put any services out to competitive tender—even if they are working well and patients and the public are happy with them—the Bill encourages “any willing provider” to—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order.

--- Later in debate ---

[Grahame M. Morris]

We have heard about the layers of bureaucracy that the coalition Government propose to take away, but what does the hon. Gentleman have to say about the additional layers that they are imposing through the exponential growth of Monitor, which will be the economic regulator? They are increasing its budget from £21 million a year to as much as £140 million a year. How many more thousands of people will it employ? How many lawyers? It will cost £600 million over the course of a Parliament.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. We must have shorter interventions.

[Dr Poulter]

This is very much the point. Let us not forget that Monitor was introduced by the Labour party to regulate competition in foundations trusts, and the Government are looking at giving it a slightly increased role while also cutting £5 billion-worth of bureaucracy in the NHS, which has to be a good thing. I hope that the hon. Gentleman agrees that that £5 billion would be much better spent on patients rather than on management and paper trails.

The core of the issue is that Government Members would like GPs to be placed at the heart of the commissioning process. Giving power to doctors and health care professionals is undoubtedly a good thing because the best advocates for patients are undoubtedly doctors and other health care professionals rather than faceless NHS bureaucrats. I am delighted that my hon. Friend the Member for Ipswich (Ben Gummer) is sitting next to me because far too often in Suffolk damaging decisions to remove vital cardiac and cancer care services from Ipswich hospital have been taken by the strategic health authority and the primary care trust, against the advice of front-line professionals. Community hospitals in my constituency in Hartismere have been closed despite GP advice that we need to look after older people and the growing older population. Putting GPs and health care professionals in charge of the new system will bring better joined-up thinking between primary and secondary care, which does not happen at the moment because GPs are often hindered in what they are trying to do and are unable to communicate effectively with the hospital doctors and trusts they need to talk to because of PCTs intervening in the process. Bureaucrats are getting in the way of good medical decisions and the Bill will deal with that problem.

I am aware that others want to speak in this debate so I shall not speak for much longer. I think that all Government Members must oppose the motion. The hypocrisy of the Labour party in its dealings with health care and the NHS has been ably exposed by my right hon. Friends the Member for Charnwood (Mr Dorrell) and the Secretary of State. Government Members want to cut bureaucracy and put money into front-line patient care and helping patients. We believe that GPs and health care professionals are the best people to do that. We want a patient-centred NHS that is locally responsive to local health care needs and that will properly address the fact that we have an ageing population. We want joined-up thinking between adult social care and the NHS, which did not happen under the previous Government. For all those reasons, I commend the health care reforms to the House, and I beg the Conservative party to oppose the motion.

Health and Social Care Bill

Lindsay Hoyle Excerpts

Monday 31st January 2011 Commons Chamber

[Dr Wollaston]

I am confident that commissioners will consider the impact of those decisions across the health care spectrum, which is very important.

In the limited time I have left, I should like to ask the Secretary of State to consider how we will monitor the quality of primary care. Who will be responsible for performers’ lists, audit, and identifying poorly performing doctors? As I understand it, all GP contracts will be held with the NHS commissioning board. What powers will GPs within consortia have to deal with those whom they feel are underperforming if they have no control over their contracts? What will be done about the ongoing, disgraceful situation regarding doctors from the EU with poor English skills, over whom we have few powers to protect patients until there has been a problem?

Professionals are also concerned about the make-up of consortia. Will they have the flexibility to include consultants and other specialists—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Time is up.