Diabetes

Rosie Cooper Excerpts

Wednesday 9th January 2013 Westminster Hall

[Rosie Cooper (West Lancashire) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Crausby, for this debate.

I congratulate the hon. Member for Torbay (Mr Sanders) on securing the debate on such an important issue, which affects a growing proportion of our population. Indeed, having listened to the contributions that have already been made, it is very clear that there are many facets of diabetes that could be covered during this debate, but I think that we will all probably concentrate on amputation. I will spend a few minutes focusing on the importance of podiatry services, which can reduce preventable amputations for those with diabetes.

Currently, 4% of the population live with diabetes, and a fifth of those people will develop a foot ulcer at some point. At any one time, there are 61,000 diabetics in England who have foot ulcers. A foot ulcer may not sound like a very serious condition, but for a diabetic the consequences of foot ulcers can be severe, and even fatal if the appropriate treatment is not given. Statistics for England alone show that, of those diabetics with foot ulcers, 6,000 people—that is 10% of the total number—had leg, toe or foot amputations in 2009-10. Based on current trends, that figure is projected to rise to 7,000 people by 2014-15. An amputation is devastating. If any individual loses a limb, it will have a far-reaching impact on their life. For many diabetics, an amputation can increase the likelihood of premature death.

Let me put those figures for diabetes in context. The five-year survival rate for those with breast cancer is just over 80%, but for those with a diabetic foot ulcer the five-year survival rate falls to just under 60%. For those people who have a lower limb amputation, their survival rate worsens after five years. The consequences are even more horrific when we consider that 80% of those amputations are preventable. In 2012, that is simply incredible. We are not doing everything we can to rectify that and to ensure that people have the information and services that will help them protect their limbs.

It is scandalous that with our 21st-century health care we are allowing people to go through the completely unnecessary, torturous and miserable experience of amputation. Prevention is supposed to be the watchword of the modern national health service; through prevention, people can enjoy a better quality of life and the NHS can save itself millions.

It is therefore hard to understand why better prevention is not deployed with diabetes and amputations. Why is more effective use of podiatry services not a priority for the health service? At a time when the number of diabetics is growing, and with it the costs of treatment, podiatry could be a means of improving a diabetic’s quality of life and saving the NHS money. Amputations cost the NHS considerable sums, which are estimated to be in the region of £600 million to £700 million each year.

Results from pilot projects can demonstrate the positive impact of investing in good podiatry services. A multidisciplinary foot care team for in-patients with diabetes in Southampton led to a reduction in the length of in-patient stays from 50 days to 18 days. Not only were patient outcomes improved but annual savings to the NHS of £900,000 were generated from an investment of £180,000. That savings ratio of £5 saved for every £1 invested was bettered in another example. In James Cook hospital in Middlesbrough, a multidisciplinary foot care team generated annual savings of some £250,000 at a cost of £30,000, which is a ratio of £8 saved for every £1 invested. Those figures show how it would be not only the Government and the NHS that reaped great rewards from a small investment, but diabetics and those who need podiatry care. Based on the pilot evidence, logic would suggest that even in these straitened times we should be investing in podiatry services, because that could save even more money and improve health.

There is evidence, however, that the opposite is happening and that services are not improving. The danger of the new arrangements is that important issues fall between the cracks, are left to local decision making and do not get the prioritisation they deserve. More than half of hospitals do not have a multidisciplinary foot care team. In fact, 31% of hospitals do not even have an in-patient podiatry service, according to data from the national diabetes in-patient audit in 2011. That reflects a worsening service, because in 2010 only 27% of sites had no provision. The amount of provision has dropped, and nearly a third of hospitals no longer have that service.

There is also evidence that there is a problem with GPs having no incentive to refer their patients on to a foot protection team for education or follow-up. Why is that? Why is this woeful situation tolerated? If more referrals were made, we would see a beneficial reduction in ulcer and amputation rates.

[John Pugh]

Will the hon. Lady explain why a GP would need an incentive to do what is clinically desirable in the first place?

[Rosie Cooper]

I absolutely share that concern, which is why I cannot understand the current view that doctors do only what they get paid for and if there is no money attached to something, it may not be the first thing they do. As I pointed out in Westminster Hall yesterday, when we had a debate on the Liverpool care pathway, financial rewards to clinicians should not be the driver of what happens or the pathways that are followed. That is good clinical practice. Surely to goodness, if a referral to podiatry is required, that is what should happen. It could also be said that if the services are not there or are being reduced, the GP has less incentive to refer, knowing that it will take so long to get an appointment.

The College of Podiatry is

“fearful that public expenditure constraints mean that rather than being prioritised through the QIPP”—

quality, innovation, productivity and prevention—

“agenda, current podiatric services are at best, being frozen and in some cases being reduced, with patient services including the diabetic foot service deteriorating as a consequence”.

That has massive implications for the NHS budget and for the patients themselves. During a debate in the other place on 29 November 2012, the Under-Secretary of State, Earl Howe, accepted that

“rapid access to multidisciplinary foot care teams can lead to faster healing, fewer amputations and improved survival. Savings to the NHS can substantially exceed the cost of the team.”—[Official Report, House of Lords, 29 November 2012; Vol. 741, c. 336.]

My question for the Minister is whether the NHS, which is in the throes of a reorganisation and being more localised through clinical commissioning groups, as well as being put under increasing financial pressure, will move towards or away from having more multi- disciplinary foot care teams, given that fewer than half of hospitals currently have such a team. Investment in more podiatry services would result in improved foot screening, appropriate follow-up services, enhanced care when required, better outcomes—including fewer amputations—reduced length of stay in hospitals, increased quality adjusted life years and reduced morbidity. We would all win; we would have a healthier nation and significant financial savings.

Liverpool Care Pathway

Rosie Cooper Excerpts

Tuesday 8th January 2013 Westminster Hall

[Rosie Cooper (West Lancashire) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Weir. I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on securing this essential and timely debate.

As hon. Members and the Minister will know, opinions on this end-of-life care framework tend to be polarised, but I believe that fundamental questions need to be answered about how the Liverpool care pathway has fallen into such disrepute, when it was developed to help doctors and nurses provide quality end-of-life care for the dying. That involves palliative care options for patients in the final hours or days of life, not a procedure that some members of the public now regard as a way prematurely to kill off the terminally ill or senior citizens.

The hon. Member for Montgomeryshire has outlined the process in which the Liverpool care pathway should work, involving significant communication if possible with the patient, but certainly with their next of kin and family. I share his support for the framework when it operates properly and allows the dying to die with dignity and free of pain. Why are there so many stories in the press of distressed families complaining that they did not know that a relative had been put on the pathway? The huge problem lies in the human application of the rules, not necessarily in the rules themselves. One in three families of those dying say that they never received the leaflet explaining the LCP process that they should have been given. Why is it not mandatory to evidence in the notes discussions with the patient or the family about the Liverpool care pathway?

Some would say that the difference between a multidisciplinary team decision, taken with the family’s knowledge and consent, and a decision taken in isolation could be seen as murder or at least manslaughter. The stark reality of the Liverpool care pathway is that 57,000 patients a year are dying without being told that efforts to keep them alive have been stopped. In some respects, there are parallels with the cases of Mid Staffordshire NHS Foundation Trust and University Hospitals of Morecambe Bay NHS Foundation Trust, which were supposed to be operating the same system as that in every other NHS trust in the country and yet somehow ended up abjectly failing their patients, so that people died unnecessarily. The sheer scale of the failure to inform people, or their relatives, that they are on the pathway opens up the practice to attack.

People talk about back-door euthanasia and some say that it is tantamount to assisted death, except that in 57,000 cases people were not aware that they were being assisted. That has to be added to the cocktail of the timing and the context of where we are now. The NHS is saving £20 billion over four years. There are service pressures—the lack of available beds and severe cuts in social services budgets that result in bed blocking, together with the demands of an aging society—but, frighteningly, as we have become aware via the press, at the same time hospital trusts receive financial incentives for achieving certain performance targets in putting people on the Liverpool care pathway.

Let me be clear—not for one second am I suggesting that those factors are part of the decision-making process; I use them merely to highlight the fundamental problem of the pathway and the perception that exists in the wider public, especially among the elderly.

Why do hospital trusts require any financial incentive to follow the Liverpool care pathway? For me, that question goes to the very heart of our national health service and our absolute understanding of what the medical profession stands for in people’s eyes. We believe that it is the role of the NHS and medical professionals to take every conceivable step to preserve life until the options are exhausted. The Department of Health has proposed to enshrine in the NHS constitution, as a patient right, an entitlement to be informed of any consideration about placing a patient on the Liverpool care pathway. Why can that not be made a legal requirement, so that everybody knows—and we are sure that everybody knows—and can be assured that taking such a decision is right?

[Robert Flello (Stoke-on-Trent South) (Lab)]

I add my congratulations to the hon. Member for Montgomeryshire (Glyn Davies) on securing this important debate. To go back to the hon. Lady’s point about the financial incentives for hospitals, it appals me, too. Surely, if patients or their families are not consulted, the Liverpool care pathway is not being followed, so any payment by the Department of Health to a hospital for having supposedly had someone supported by the pathway is money paid wrongfully, deceitfully and possibly unlawfully. Does she therefore agree that the Department should tell hospitals that have failed to consult family and friends or the patients themselves that the Department wants back some of that money?

[Rosie Cooper]

That takes me back to my earlier point that we should document the conversations with families, so that that would be the tick box for payments. I am running out of time, so I shall move on quickly.

Will the Minister elucidate how the NHS constitution requirement will make a difference? Procedures are already in place, yet 50% of patients on the pathway were not informed, or their families were not consulted. It is time that the soundbite, “No decision about me without me” became a principle and a value, rather than the vacuous phrase that it currently is. There is no politics in that—it is really important; it is the core of everything.

Through Lord Alton of Liverpool, I am aware that Liverpool medical school requires all its students to undertake one month’s training in the care pathway, working in a hospice during their fourth year. Such good practice should surely be a core component nationwide, and in the light of a recent study, there is perhaps an argument for making it mandatory across the country. That kind of training needs to be given to those already qualified and working on our wards—not just doctors, but nurses and all members of the multidisciplinary team who are called on to make decisions. If there have to be financial incentives, they should follow the training to ensure that all those who care for the terminally ill and dying are properly equipped with the skills that they need, in what for all concerned are traumatic and often complex situations. Good training costs money and must be externally validated, and I invite the Minister to respond specifically about that need.

I see merits in a system that manages end-of-life care effectively—it is a measure of our humanity that we seek ways to ease suffering—but my concerns about the application of the Liverpool care pathway remain. There is far too little reassurance in the system, which has allowed the pathway to move from an end-of-life care system to one that is held up as hastening death. We can talk about the theory of how the LCP should be followed, but the fact remains that, in practice, it is not always implemented as intended. It should never be seen as a conveyor belt to the cemetery. Some 80,000 patients are supported by—not put on—the Liverpool care pathway, and many receive the finest care, but many is not good enough. It is said that about 1% of cases go badly wrong, but just one case—never mind 1% of cases—is one too many. Those who founded the pathway did so because of their respect for the dignity of patients; those who implement it need to understand and share that view or face the legal consequences and their own consciences.

--- Later in debate ---

[Liz Kendall]

I absolutely agree. The issue we face is less about the pathway itself and absolutely about how it is implemented in practice. The pathway document states on its very first page that the pathway is only as good as the teams who use it.

There has clearly been an issue about taking a pathway that was developed by experts in one part of the country over several years, with regular training and audit, and trying to implement it across the wider NHS. Individual patients and families—as we have heard—and also the national audit of the Liverpool care pathway, suggest that there are genuine problems with communication. Too many patients and families are not properly informed about what the pathway is and how it works, and they are not effectively involved and their consent not sought at every stage and on all the necessary decisions. One incident in which patients and families are not fully and sensitively involved is one too many. It is not acceptable, and it directly contradicts the very essence of the Liverpool care pathway and its key principles and values.

[Rosie Cooper]

Will my hon. Friend give way?

[Liz Kendall]

If my hon. Friend does not mind, I will not give way as I do not have much time.

I welcome the fact that the issues are now being looked into. I understand that three separate reviews are being undertaken. The national end-of-life care programme is doing a short, snapshot review of complaints about the use of the Liverpool care pathway, the Dying Matters coalition is working with families whose loved ones have been on the pathway, to see what worked well and what did not, and the Association for Palliative Medicine and a range of other national organisations are talking to clinicians, to get their opinions regarding integrated care pathways in the last days of life, of which the Liverpool care pathway is one.

In November, the Minister said he would appoint an independent chair to co-ordinate the work of the different reviews, so I ask him: has a chair now been appointed? Will the chair, the Department of Health or any other organisations consider any additional issues, alongside the work that is under way? For example, will the way in which the Liverpool care pathway is paid for be reviewed? It is important that hospitals receive proper payment for the care they give and for any associated training, but any evidence that patients are being put on a pathway for financial reasons is a serious matter and is totally unacceptable.

Will there also be a review of the education and training in end-of-life care for new and existing staff, in particular training in how to discuss difficult, complex and emotional issues with patients and their families? One of the real challenges is that the process of death and dying is so uncertain. A patient’s prognosis is not always clear; the situation changes. Doctors are used to treating and curing, giving clear evidence, treatment and advice—or they are trained to do so—but it is not always possible.

I want to finish on a broader point, which is important for us in this House. The difficulty that NHS and care staff, the media, families and the public have in discussing end-of-life care reflects wider society’s lack of familiarity with death and dying, which was not the case 100 years ago. Age, cause and place of death are generally very different now from what they were at the beginning of the last century, when a far greater proportion of deaths occurred in childhood or early adult life, often from acute infections, with most people dying at home. Now, more than two thirds of the 500,000 deaths a year are among people aged over 75, most of them following a long-term illness such as heart disease, cancer, stroke, chronic respiratory disease or dementia, and most are in hospitals and care homes.

Many people do not, therefore, experience the death of a loved one until they are well into mid-life. We do not see dying people and dead bodies—not for real. We see them on television and in computer games but not in real life, and we do not talk openly in society about death. I know that in all our families it is difficult to discuss death, but in the century of the ageing society, with chronic conditions as the major cause of death and disease, that must change.

As the hon. Member for Banbury (Sir Tony Baldry) said, death comes to us all, and we should strive for as good a death as possible. That will, of course, mean different things to different people—I would like to go quickly, and I hope that the people I love go quickly, too, and do not have a long, slow death.

[Rosie Cooper]

We will not be bumped off.

[Liz Kendall]

Indeed, or have a premature death. For many of us, a good death means being treated as an individual with dignity and respect, without pain and suffering wherever possible, and in a familiar environment surrounded by the people we love. We need a full and frank debate about these difficult issues, handled calmly and sensitively and based on evidence and fact rather than on myths and misconceptions. Dying matters, not just to the NHS and the wider care system but to us all, and for that reason I am grateful to the hon. Member for Montgomeryshire for securing the debate.

[The Minister of State, Department of Health (Norman Lamb)]

I do not have a Parliamentary Private Secretary sitting behind me, and I am most grateful therefore to you, Mr Weir, for your assistance with some Members’ constituencies.

I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on securing the debate, and on the sober, serious and rational tone he deployed in his contribution. The whole debate, in fact, has been exemplary in that regard. I suspect that all of us in this room are after the same thing; it is how we secure it that matters so much. I have just over 11 minutes, which is not really enough to do justice to every contribution, so as soon as I possibly can, I will write to all the Members who have taken part, to update them.

I take the Liverpool care pathway extremely seriously. It has been much discussed recently: many hon. Members and members of the public have written to the Department of Health expressing their concerns, and there have been numerous parliamentary questions, too, all of which stems from a lot of media interest over the past few months. Several stories have appeared discussing the ways in which the LCP is used and what it is for. In particular, there have been a number of reports in the media alleging that patients are being placed on the LCP secretly, with no consultation with them or their relatives. It has been suggested that the LCP routinely involves medical staff withdrawing treatment, including food and fluids, from patients. Perhaps most seriously, the LCP has been accused of being a way to kill patients to save the NHS money. There have been suggestions that the Department of Health bribes hospitals with extra money for every patient placed on the pathway.

Those accusations paint a misleading picture of the purpose of the Liverpool care pathway, yet I take seriously the concerns raised by the families of patients who have experienced extremely poor end-of-life care. I am horrified by some of the stories that people have told me about the withdrawal of food and fluids from sick relatives in hospital and about the failure to inform loved ones that the patient has been placed on the pathway.

The hon. Member for Congleton (Fiona Bruce) spoke movingly of her experience, and I am pleased that she came to the round table that I held to discuss those concerns. As the hon. Member for Gainsborough (Mr Leigh) made clear, the concerns are legitimate and should be taken seriously, not dismissed because of exaggerated reporting. What happens on the front line and how we translate theory into practice are so important.

I agree with my hon. Friend the Member for Southport (John Pugh). I dislike the jargon: what on earth does “Liverpool care pathway” mean to patients and their families? We must use language that ordinary people understand, particularly at a most traumatic time for all involved. That is one thing we need to address.

One aspect of care that receives almost universal praise, as the hon. Members for Banbury (Sir Tony Baldry) and for Hackney South and Shoreditch (Meg Hillier) have made clear, is the hospice movement, which grew from Dame Cicely Saunders’s belief that, however ill, people matter at the end of their life and should never be abandoned. That is why the Marie Curie Palliative Care Institute Liverpool, led by Professor John Ellershaw, developed the Liverpool care pathway in the late 1990s. The pathway was designed to transfer the principles of hospice care—the shadow Minister, the hon. Member for Leicester West (Liz Kendall), made this point—so that terminally ill patients always get the best treatment, even if they do not receive specialist palliative care.

The Liverpool care pathway is not a treatment but a framework for managing treatments, which is important to understand. As the hon. Member for Montgomeryshire made clear, the LCP, when used correctly, is one way to ensure that the last hours or days of a patient’s life are as comfortable as possible. The guidance for using the LCP makes it clear that the aim is to support, not replace, clinical judgment. Sometimes there are questions about clinical judgment, but not about the pathway itself.

The Liverpool care pathway guidance sets out the following objectives and considerations for taking care of patients: determining whether any further medications and tests would be helpful; ensuring that the patient is as comfortable as possible—surely we all agree with that; helping the patient to take on food and drink for as long as possible, which means not denying them food and drink, as we sometimes hear; and taking care of the patient’s spiritual and religious needs, which is of acute importance to many people. The guidance reminds clinicians that unnecessary treatment or tests may cause harm rather than good.

The guidance states that regular review is acutely important. If their condition improves, the patient should be taken off the pathway. The 5% figure to which the hon. Member for Gainsborough referred is of concern and should be considered; it is essential that the medical team discusses the pathway with the patient, their family or their carers. Those people need to be fully involved in decisions about end-of-life care, even though those discussions may be very difficult. Obviously, those conversations need to happen as quickly as possible.

The Liverpool care pathway can work as intended only if each patient is fully consulted, unless that is not possible. Even then, the family must be fully involved. Through his interventions, the hon. Member for Stoke-on-Trent South (Robert Flello) made that point strongly. The opening section of the information sheet that comes with the pathway cites the absolute importance of discussion with the family. Staff must talk to the patient and their family as much as they need and want, to explain what is happening and why. That is non-negotiable. Any failure to do so is completely unacceptable.

The hon. Member for West Lancashire (Rosie Cooper) mentioned documentation, which is best practice and should always happen so that everyone can see what has been discussed. She also mentioned the constitution, and we are considering how we can give it greater traction. There is a sense that everyone agrees with the constitution, but what value is it? How can we make the constitution provide real power to patients in the NHS?

I agree with the shadow Minister’s concerns about translating across the whole system something that has been designed by experts. Such translation can be problematic and needs further attention.

[Rosie Cooper]

rose—

[Norman Lamb]

I am conscious that time is tight. I will write to the hon. Lady. If she wants to raise issues with me later, I will be happy to address them, but I need to respond to the debate.

From what people have said, it is clear that there are too many cases where patients have been put on the pathway without proper explanation, without the involvement of their family and sometimes without any notification, which is totally unacceptable. Yet again, we see how right Dame Cicely Saunders was when she said:

“How people die remains in the memory of those who live on”.

The impact is profound. My wife works for Cruse Bereavement Care, which does magnificent work helping people who have suffered bereavement. We have a duty to give such people the best possible experience as they lose a loved one.

On 26 November, I hosted a round-table meeting with patients, families and professionals—both supporters and critics of the pathway were represented—and at that meeting I announced that we will appoint an independent chair to consider how the LCP is used and experienced and to examine the accusations made in the press. We expect to announce the chair of that review very soon, and we expect that the chair will want to identify a small panel of independent experts from a range of backgrounds, including representatives from faith groups, which is important. I reassure hon. Members that the review will be independent.

The Liverpool care pathway is internationally recognised as good practice, and it is widely supported by organisations involved in end-of-life care. If people do not feel that they have received the best care or, worse, if patients cease to trust the pathway, that is a problem that needs to be addressed.

Training is fundamental, as the hon. Members for Hackney South and Shoreditch and for Congleton and the shadow Minister said, and it will be considered as part of the review. The review will systematically examine the experience of the Liverpool care pathway by patients, families and health professionals, and it will seek evidence to support or refute the accusations and to see where improvements might be needed. The review will hear directly from families. There will be a session dedicated to families so that they can tell the panel about their experiences.

The review will also consider the role of financial incentives in the use of the LCP. Like my hon. Friend the Member for Southport, the hon. Member for West Lancashire and others, I have concerns about the use of financial incentives. The review will report both to the Department of Health and to the NHS Commissioning Board by the summer.

Everyone wants their loved ones’ final hours to be as pain-free and dignified as possible. Used as intended, the Liverpool care pathway can help achieve that. The pathway prioritises comfort, dignity and appropriate care, but all that is undermined if the public distrust the pathway and if clinicians do not apply it properly. We do not dismiss people’s concerns, which I take extremely seriously. Instead, we have to ensure that care in the last few days and hours of life is always of the highest standard. Reinforcing the absolute importance of involving patients and their families in discussions on their care and treatment is essential.

Mobile Technology (Health Care)

Rosie Cooper Excerpts

Wednesday 21st November 2012 Westminster Hall

[Rosie Cooper (West Lancashire) (Lab)]

It is a great pleasure to serve under your chairmanship for the second time today, Mr Havard. I welcome the Minister to his place. We were occupants of neighbouring offices in this House, but I tend not to see him quite so much now, with his promotion to the Government ranks.

In every aspect of our lives, technology is driving innovation, improvement and increased efficiency. Health care is no different, where the use of mobile communications technology is becoming increasingly important. We are reaching a point where mobile technology can take an increasingly strategic role in meeting today’s health care demands. That is because a number of critical factors are converging, including several extremely demanding health care challenges that, taken together, require new approaches and solutions; the remarkable computing power now available on portable devices such as tablets and smart phones; and the development of specific mobile technology-based health-care focused solutions that can improve quality, efficiency and a patient’s experience of their care. I shall cover each of those in turn.

Our health service faces unprecedented challenges that go way beyond the £20 billion cuts to national health service spending, and most health care systems across the world face similar situations. We are, as a population, living longer. That is undoubtedly a good thing, but it brings with it demands. Older people with multiple and complex health care needs constitute the majority of interactions with the NHS, and their care consumes the majority of health care expenditure, to the extent that health care costs are growing faster than gross domestic product. New drugs, diagnostics and treatments mean that we can treat conditions that years ago were simply considered beyond the reach of modern medicine. They are welcome developments, but they inevitably involve significant financial cost.

A less welcome reason for increasing health costs relates to the increase in long-term and chronic diseases. Over recent years, we have seen the rise in the prevalence of obesity, type 2 diabetes and other conditions that have a significant lifestyle-related component. They contribute directly to health care requirements and lead to secondary complications. For example, the single most significant risk factor to the development of dementia is cardiovascular health. The NHS needs to address all those challenges while delivering an unprecedented 4% year-on-year compound efficiency savings. The Minister, as a former member of the Select Committee on Health, on which I still sit, will be aware that the Committee has correctly pointed out that such a level of savings has not been achieved by any other health care system.

I think we can accept that the face of health care and the challenges it faces are changing. How can mobile communications technology help deal with the challenges? It is worth reflecting that the power of today’s mobile communications technology—they are long words, but we would just call them tablet computers and smart phones—is comparable to some of the faster supercomputers of just a decade or so ago. I was interested in what is termed “always on” connectivity, which means that one can always be reached if devices are switched on, through secure wi-fi, 3G and the emerging 4G technology. Such devices can connect instantly with extremely powerful networks. That means that working practices established 10 or more years ago can be radically transformed. Through harnessing the power and capabilities of mobile communications technology, the health service can better support its health care professionals. Technology can reduce the time spent on administration and give professionals much more needed time to care.

Specifically, modern mobile communications technology can help patients and the public make healthier decisions, enabling individuals to manage their conditions more effectively and therefore to live independently. It can also help health care professionals collect information more effectively, which leads to improved efficiency, patient safety and care quality. I will draw on a few examples that relate to those areas. Mobile technology can help patients take more control of their health by encouraging healthier lifestyle choices; by giving patients more control and information to manage their conditions effectively; and by supporting more comprehensive remote monitoring.

I think the Minister is aware that there is already extensive clinical evidence that shows that patients who take an active role in their care do better. For example, a study in Toronto showed that diabetic patients who monitored their blood pressure using smart phones experienced a 25% drop in cardiovascular mortality. The Government have committed to giving patients the right to book general practitioner appointments, order repeat prescriptions and talk to GP practices online. That represents just the tip of the iceberg. The effect on the population’s health would be much stronger if patients were encouraged to monitor their care with support from their health care professionals.

Much closer to home, Leicestershire’s nutrition and dietetic services and the university of Chester in the UK have pioneered a secure smart phone solution to enhance the approach to adult weight management services. Achieving sustainable weight loss is hard, yet their service, known as LEAP—lifestyle, eating and activity programmes—weight management groups, based on national guidance, has achieved just that. They have found that the key to long-term weight loss is to provide follow-up support. After finishing the initial programme, patients take part in a three-month follow-up programme, focusing on self-monitoring with encouragement from staff via text messages. I understand that they are not alone in doing that kind of thing; the all-party group of which I was formerly chair, Slimming World, does something similar. To ensure patient confidentiality and data security, a BlackBerry smart phone is used with an application that converts text messages to e-mail and vice versa. That creates an accurate record of patient-practitioner dialogue. The results include statistically significant weight loss compared with a control group and an improved quality of life.

Those two simple examples show that by supporting individuals to use smart phones and tablets already at their disposal, people can take more control of their lives and make healthier decisions. There is scope for the NHS to become more proactive in encouraging such approaches without incurring significant cost.

[Bill Esterson (Sefton Central) (Lab)]

I congratulate my hon. Friend on securing this important debate. She is making a point about the importance of technology in preventing health care problems. As she will know, the preventive public health role is being transferred to local government. Does she agree that it is vital for the technology to have the funding needed when the preventive role is transferred, and that it is not left to local government, given the scale of the cuts that local government has suffered?

[Rosie Cooper]

A serious point is being made here: public health is being transferred to local government, and the funds that go with it need to be spent on public health and preventive means. I am worried that councils might use some of the money to do work to which they are already committed. So, yes, they do need support, and we need to ensure that the money they get is spent correctly and wisely. Mobile technology can help to improve public health.

One of the perennial challenges of modern health care is to keep accurate, comprehensive records without detracting from the care-giving process, which is quite difficult. Too often the supposed solutions feel burdensome. As a result, clinicians can sometimes be difficult to engage—in fact, there is a view that sometimes clinicians rarely engage—and the accuracy and completeness of records suffers as a result.

We can show that there are tried and tested solutions developed by and in partnership with NHS organisations that have been shown to work. For example, digital pen-and-paper technology, supported by mobile connectivity, can be used to complete patient records. In turn, that can improve patient safety, care quality and efficiency. That technology is pioneered by Portsmouth Hospitals NHS Trust and allows mums-to-be to keep their paper records as normal, and because the records are made using a mobile-enabled digital pen and paper, the maternity department instantly receives an easily accessible electronic copy of the expectant mum’s paper records. That happens while the midwife is still with the expectant mum in her home. As well as improving safety when mums arrive at the hospital without their notes, the technology’s deployment has brought about real efficiency by halving the time that midwives spend on administration.

As well as solutions that can help health care professionals in the community, we need to recognise that most acute hospitals are large complex buildings that, all too sadly, often span several sites. There is strong evidence that the accuracy of patient records and the quality of clinical decision making may be improved if clinicians record information themselves and have access to it when they are with their patients, rather than leaving the process to administrators who are removed from the care. Realistically, that can be achieved only by making it easier for clinicians to record and access information wherever they are.

I am told that organisations such as University Hospitals Birmingham NHS Foundation Trust are making real progress in mobilising information so that clinicians have real-time, secure access to patient records. The foundation trust is using tablet devices and smartphones to achieve such improvements. As the NHS looks to implement new solutions, we need to encourage people to focus on secure approaches that patients and clinicians trust, which means designing privacy into the entire system, with security measures built into mobile devices. We also need reliable connectivity, which is fundamental for effective mobile working. Even in areas with the most advanced mobile infrastructures, bandwidth can sometimes be limited, so it is essential to choose hardware that can switch seamlessly between different mobile protocols and wi-fi connections. Such functionality would minimise bandwidth-related costs. We need to focus on approaches that complement patient-clinician interactions and that make the most of existing technology. Mobile solutions that can be rapidly deployed and that integrate with existing infrastructure would ensure investments that have already been made can be enhanced rather than discarded.

As the former chair of Liverpool Women’s hospital, I know there are now solutions to some of the problems in enabling midwives to spend the maximum amount of time out on the front line. Such improvements are a godsend and enable our professionals to deal with patients efficiently and effectively. I am aware of the Government’s plan to introduce a fund for technology to improve midwifery and nursing care, and I very much welcome that. As the plans for the fund are developed, it is essential to learn from those trusts that have already pioneered new approaches. I ask the Minister, therefore, to meet me and some of the professionals who have been involved in developing the examples I have cited so that he can hear about their experiences. That might help future implementation. The truth is that mobile communication technology will be a core strand in the 21st-century health service. We very much need it, and working together we can deliver for all the people who depend on the health service to deliver their care.

Oral Answers to Questions

Rosie Cooper Excerpts

Tuesday 12th June 2012 Commons Chamber

[Mr Simon Burns]

I am grateful to my hon. Friend for giving me the opportunity to explain that the NHS trust and the PCT have made plans for the building to be used by the Warrington and Halton Hospitals NHS Foundation Trust for orthopaedic out-patients and surgery. Those plans should enable clinicians to provide the NHS services needed by local people in much-improved buildings, and I understand that services will be recommenced from those buildings in weeks.

[Rosie Cooper (West Lancashire) (Lab)]

In written responses to questions about clinical commissioning groups, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) incessantly replies—most recently on 18 April—that CCGs do not yet exist, so how can he offer assurances, as he has done today, that any real progress is being made by the CCGs, when they are currently being supported by PCTs? And will he explain his “now you see them, now you don’t” response?

[Mr Lansley]

I will tell the hon. Lady how we can talk about the progress made by CCGs—because we actually go and talk to them. I recall visiting the Blue Coat school in Merseyside a few weeks ago and speaking to the leaders of clinical commissioning groups—from Liverpool, Lancashire, Manchester, Warrington, Knowsley and St Helens—and many of them had 100% delegated responsibility for budgets this year. They explained to me the opportunities they were taking to improve the care of their patients by using that responsibility.

Oral Answers to Questions

Rosie Cooper Excerpts

Tuesday 27th March 2012 Commons Chamber

[The Minister of State, Department of Health (Mr Simon Burns)]

I am extremely grateful to my hon. Friend for that question. As he will be aware from his time on the Bill Committee this Government have for the first time in the 64 years of the NHS put into legislation a duty to reduce health inequalities. That will be done through the NHS Commissioning Board and clinical commissioning groups, each being under a duty to have regard to the need to reduce inequalities in access to and the outcomes of health care. The Secretary of State will also have a wider duty to have regard to the need to reduce inequalities relating to the health service. That will include his duties for both the NHS and public health. It is a great step forward and I am surprised that the previous Government did not think of doing it during their 13 years.

[Rosie Cooper (West Lancashire) (Lab)]

T4. At a time of major upheaval in the national health service, the people of west Lancashire and other areas of Lancashire are being failed by the chief executive of the Lancashire primary care trust cluster. Living in Yorkshire and working from Lancaster, Janet Soo-Chung has failed to meet with me or other colleagues, including my hon. Friend the Member for Chorley (Mr Hoyle). Can the Secretary of State assure me that the necessary time and development is being invested in health services in west Lancashire to ensure that authorisation takes place in a timely way without conditions and that the health services provided to my constituents are good?

[Mr Lansley]

I will, of course, ask Janet if she will meet the hon. Lady and her colleagues, but I think the hon. Lady might have noted that the NHS is performing magnificently. The quarter document published just this morning gives details of 14 performance measures across the NHS, in five of which performance has been maintained and in nine of which there has been improvement, so there has been no deterioration in performance. When the hon. Lady gets to her feet she should say to the NHS, “Well done for improving performance.”

NHS Risk Register

Rosie Cooper Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Chris Skidmore]

The Government do not have to publish the updated registers on the basis of the Information Commissioner’s verdict, which was on the autumn 2010 register. That is the Information Commissioner’s advice that is referred to in the motion. The Opposition are asking for an out-of-date document—we might as well give up and go home.

[Rosie Cooper (West Lancashire) (Lab)]

Is the hon. Gentleman aware of the comments made by David Nicholson, the chief executive of the NHS Commissioning Board, who said:

“I’ll not sit here and tell you that the risks have not gone up. They have”?

[Chris Skidmore]

I am, as I have the parliamentary Labour party brief—I can see that that is on the back of it.

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

I congratulate my right hon. Friend the Member for Leigh (Andy Burnham) on his persistence with these Opposition day health debates. I am sure that he shares with me a deep-seated hope that the Secretary of State will soon see the light, publish the risk register and drop the Bill.

“The public can be forgiven for being bewildered by the latest round of plans to reform the National Health Service in England. The set of proposals is large, many are highly technical, why they are needed is not clear and the protests from key respected groups are loud.”

Those are the words of Jennifer Dixon of the Nuffield Trust in her most recent paper for The Political Quarterly, and I am sure that many in the Chamber will agree wholeheartedly with them; I certainly do. They are an incisive analysis of the state of play with regard to the Health and Social Care Bill and the planned NHS reforms. The short opening paragraph of the paper begins to explain why it is essential that the Department of Health publish the transition risk register, as ordered by the Information Commissioner.

As each day passes, there are ever more reasons why the British people need to be able to see for themselves the risks associated with the Bill and how the Department of Health proposes to mitigate them. This is about a broader, more fundamental and more important issue than publication in itself. Many people are fearful about what the Secretary of State’s plans really mean for them and their families, and for the health service that so many people rely on. I cannot understand what is in the risk register that the Government are so frightened of revealing to the people who are actually paying for this.

The message of what the public think is loud and clear: they simply do not believe and do not trust the Government, the Prime Minister or the Health Secretary. A ComRes poll says that 69% of respondents do not trust the Government to get it right on health, while YouGov says that six out of 10 people think that the Prime Minister has failed to deliver.

[Gloria De Piero]

Perhaps one of the reasons why there is such a lack of trust is what is going on in our own constituencies. In my constituency of Ashfield, waiting times have gone up and the NHS walk-in centre has closed. That is the reality of what is happening on the ground.

[Rosie Cooper]

I am dreadfully sorry that my hon. Friend is able to say such a sad thing, and Government Members do not hear any of it.

People have listened to what the Secretary of State has said and they are telling the Government clearly that they think that their proposals are complex, muddled and expensive, and that they do not trust what they have been told. I wonder why they have such difficulty in accepting the Secretary of State’s words of reassurance, but perhaps there is a clue in the track record of the Government, the Prime Minister and the Secretary of State in making promises. They promised no top-down reorganisation and then did it anyway with no mandate, no mention of huge reform having been made by the coalition Government. We have a so-called Government of openness and transparency who will not publish the transition risk register despite being ordered to do so by the Information Commissioner. So much for “No decision about me without me”; these decisions seem to be about us without us—all of us. The Government say that there will be no cuts to front-line services, whereas we have just heard about cuts to front-line staff and the down-banding of members of staff. They say that waiting times will not increase, but they have increased. Yet the Government still press on.

This reminds me of a story about a man who is stranded as flood waters rise. The water is getting higher and higher, and he prays to God to save him. He refuses help from a neighbour in a rowing boat, from someone in a speedboat, and even from someone in a helicopter, saying, “No, thank you—I have faith that God will save me.” Of course, he is washed away. Standing before his maker, he says, “I had faith that you would rescue me,” and is told, “I sent you two boats and a helicopter. What more did you want?” In this case, the Secretary of State has been sent the Royal College of General Practitioners, the Royal College of Midwives, the Royal College of Nursing, the British Medical Association, the physiotherapists and other professions allied to medicine—need I go on? Those are just a few of the signals to the Secretary of State that he has got it wrong.

If the Secretary of State continues with the Bill, before long he will be meeting the Prime Minister on the day of a reshuffle, but by that time the people in the NHS will have suffered hugely for these silly mistakes. The risk register is so potentially damaging that the Department of Health refuses to publish it, thereby spending taxpayers’ money on preventing taxpayers from knowing what it is doing with their money. That is absolutely ridiculous. It is imperative that the transition risk register be published.

The Government have been the architect of their own problems by breaking their promises, failing to demonstrate the need for such extensive reform of the NHS, and not listening to the people who use the service and the people on the front line who deliver the service—the very patients and staff whom the Government keep telling us that we forget about, and who are at the core of this matter.

When the Secretary of State assumed responsibility for the NHS there had been a sustained period of increased funding, lower waiting times had been achieved, the quality of care had improved significantly, and there were some of the highest levels of public satisfaction in the history of the NHS. In a little under two years, that situation is being reversed. I would put it to the Secretary of State, if he were here, that surely even he can see that now is the time to be honest and up front with the people of this country. It is time for the Government to take another deep breath, publish the risk register and put their trust in the people.

Oral Answers to Questions

Rosie Cooper Excerpts

Tuesday 21st February 2012 Commons Chamber

[Mr Lansley]

My hon. Friend knows that the management of trusts should be accountable directly to their boards. As I said, the management of foundation trusts are accountable, through their boards, to their governors. An important point that arose in relation to Mid Staffordshire NHS Foundation Trust is that we should ensure—we are looking at how to fulfil this—that there is also a code of practice to which managers are held accountable. He knows, as I do, that management must be accountable through their boards.

[Rosie Cooper (West Lancashire) (Lab)]

The Secretary of State has part-begun to answer this question, as he recently threatened to sack NHS boards that do not meet their financial and waiting time targets. The question is this: why is he abolishing those powers in the Health and Social Care Bill? Is he really saying that governors of foundation trust hospitals have the power and wherewithal to sack a board?

[Mr Lansley]

The hon. Lady should know that we intend to enhance the powers of foundation trust governors, but I am simply taking what was her Government’s policy before the election—that all NHS trusts should become foundation trusts, with the freedoms that go with that, and the responsibilities and accountability. We are putting that into place where her Government failed.

NHS (Private Sector)

Rosie Cooper Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

It did not, and I would expect a Minister not to make misleading statements like that in a debate of this kind. It did not propose the removal of the cap: it said that more freedom would be given to NHS hospitals with a modest loosening of the cap. That was my policy as Health Secretary. We did not propose removal of the private patient cap.

[Rosie Cooper (West Lancashire) (Lab)]

Does my right hon. Friend know whether the private operations will be charged at tariff? Is there a limit on the charge hospitals can make? Will it be at tariff or at a premium on tariff? Would that not be a way of increasing the amount of resources coming in? Less work would be done on the NHS.

[Andy Burnham]

My hon. Friend raises an important issue. We have not had those safeguards; there has been no explanation from the Government of any safeguards that will be introduced under this liberal measure. This evening, we need to probe exactly what they have in mind. During the pause, they said that they would restrict any competition on price in the NHS, yet they are bringing forward a measure that would allow NHS facilities to be used for the treatment of private patients with no guarantee that the private sector would not try to undercut NHS tariffs. Those are precisely the questions that the Government have to answer.

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

There is no escaping the fact that the role of the private sector in the national health service is one of the most contentious issues to arise when discussing or debating the health service. Some people would suggest that there was no appreciable difference between the policies of the Labour Opposition and the Conservative Government, especially on the use of private companies to deliver services.

I believe that there is a huge chasm of difference, which has been borne out by this debate. It comes down to this: what we saw under previous Labour Governments was the private sector being used to add grit to the system. It operated in the system with strict limitations, and it was deployed, for example, to drive down waiting times from 18 months to 18 weeks. In tandem with targets, the private sector offered a means of improving the efficiency and effectiveness of the NHS, delivering choice and quality to patients. That is where our policies and those of the Government diverge.

It is clear that the intention of the Conservative-led Government is completely different. The NHS is under siege from the Government, who regard the private sector as a means to undermine and weaken the NHS. For all the rhetoric of the Prime Minister and the Health Secretary about their love of the NHS, I would assert that their actions have shown only that they do not fundamentally believe in the principles, values and ethos of the NHS. Those actions attack its very purpose and everything that people hold dear in that world-revered service.

The Government are pushing ahead with their Bill in the face of widespread opposition. Along with the majority of health professionals and the British public, I believe that the Bill should be stopped. Let me make it clear: nothing that I have heard from Health Ministers is reassuring for anyone who has fought to save the NHS. When the Government talk about a regulated market for the NHS people are, and should be, filled with fear.

There will be an increasing role for the private sector, and organisations can be both providers and commissioners. Any A-level business student could explain that that leads to a conflict of interest, and it contradicts and inhibits the notion of introducing genuine competition in the NHS, if that was the intention. I think that the Health Secretary may be mixing up words beginning with “c”. Instead of “competition”, I believe that the word he has been looking for is “cartel”. However it is dressed up, there is one thing I am certain of: allowing such a situation to develop is not in patients’ best interests. There are many questions that need answering. With the private income cap set at 49%, what guarantees are there that hospitals will be able to deliver choice and meet waiting times? What assurance can the Secretary of State give the House that private providers will not cherry-pick the best income-generation services, leaving cost-intensive services such as—

[Julie Elliott (Sunderland Central) (Lab)]

Does my hon. Friend agree that removing the cap will do nothing to help the problem of health inequalities and that it will in fact exacerbate the problem?

[Rosie Cooper]

National health services should be provided on the basis of need, not the ability to pay, so I agree.

I was saying that cost-intensive services such as accident and emergency services may well be threatened. How will the overall capacity of the health care market be managed effectively? How would the Government ensure that the proposal did not impact on the ability of hospitals to deliver urgent care?

We have had to proceed very quickly, but there are some major issues to consider. In conclusion, I urge Members to support the motion for the simple reason that it shines a light on how, once again, the Government are developing policy based on ideology and not on what is best for patients. The people’s trust was hard won and the Government have broken that trust yet again. It is another example of ill conceived, poorly developed, incomprehensible policy that we have come to expect from the Government, which leaves Members, the medical profession and our constituents with more questions than answers. A commentator said that the NHS was on the verge of a nervous breakdown. I believe that the way to save it is to kill the Bill.

National Health Service

Rosie Cooper Excerpts

Wednesday 26th October 2011 Commons Chamber

[Andy Burnham]

If that is the case, I respectfully ask the Health Secretary why he has not responded to a letter from my hon. Friend the Member for West Lancashire—

[Rosie Cooper (West Lancashire) (Lab)]

indicated assent.

[Andy Burnham]

My hon. Friend is nodding. Why has the Secretary of State not responded to the letter that my hon. Friend sent to him several weeks ago pointing out the discrepancy between his evidence and the statements from the RCN? If he wants to adopt a pious tone in the House, he needs to reply to his letters on time and put his facts on the record.

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

I would like to inform both my right hon. Friend and the Secretary of State that I did, in fact, write to you but have received no reply. In my letter, which I shall ensure gets to you again, I asked you to publish the minutes of that meeting. It was very clear. One or other of you have made a severe error.

[Mr Speaker]

Order. We must preserve the proper parliamentary terms. Nobody has written to me and I have not made a severe error. We will leave it at that.

--- Later in debate ---

[Mr Lansley]

I entirely agree with my right hon. Friend. That is not only the case in hospitals, where people can sometimes ask, “Under whose care is my husband?” It is also especially true in community care. I hope that there will be more integrated services in the community, but although there may be a range of providers, there must be an integrated service with a clear line of accountability.

[Rosie Cooper]

Will the Secretary of State give way?

[Mr Lansley]

No, as I need to conclude my speech. [Interruption.] I am sure what the hon. Lady says is true.

The NHS in Wales is not cutting its budget because everything is going well. Labour Members are fond of citing waiting times, but the latest figures on waiting times show that in England 90.4% of admitted patients and 97.3% of non-admitted patients were referred to treatment within 18 weeks, whereas the figures for Wales are 67.6% and only 74% respectively.

Let me tell the House about infection rates. In 2007, the clostridium difficile mortality rates in England and Wales were similar—in fact, the rate was slightly higher in England. However, in the latest year for which figures are available there were 23.4 deaths per million for men and 23.5 deaths per million for women in England, whereas the figures for Wales were 54.9 deaths per million for men and 59.5 deaths per million for women, so the level in Wales is more than twice that in England. In four years, the gap has widened to the point where Wales has double the number of deaths from C. diff infections relative to England. Less money, less innovation and less good care is what has been happening in Wales under a Labour Government.

I must make it clear that we are going to put patients at the heart of the NHS. We are going to focus on the NHS delivering excellent care every time. Labour focused on the targets and the averages, and never got to the place of really caring about the specifics. A patient about to go into hospital for knee replacement surgery does not want to know about the national figure; they want to know about their hospital, their ward and what will happen to them. The same is true for mixed-sex accommodation. Labour turned a blind eye to variation in performance. We are going to open it up to clinical and public scrutiny, so that we can reward and celebrate achievement and excellence across the service, and shine a light on poor performance.

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

I congratulate my right hon. Friend the Member for Leigh (Andy Burnham) on his appointment as shadow Secretary of State for Health, a brief to which he brings valuable experience. We are going to need every bit of that experience, given what the current Secretary of State is doing to bring the NHS to its knees.

I strongly disagree with my colleague on the Health Committee, the hon. Member for Kingswood (Chris Skidmore). This is not their NHS. This is not your or my NHS. It belongs to the people, all of us. We all have an incredible stake in the NHS. The Secretary of State and the Government play with it, with their reputation and with patients’ needs at their peril. I believe your policy will fundamentally damage the NHS—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. May I remind the House not to use the word “you”? Members speak through the Chair and should use the third person, please.

[Rosie Cooper]

Forgive me. I have a great propensity to do that. I believe passionately in the NHS and I take this all very personally. I apologise.

The Government’s policy will fundamentally damage the health service in terms of both the quality of care available to patients and the founding principles of the NHS. The more we debate Government health policy, the less the Secretary of State seems to be listening, whether to Opposition Members, medical professionals, patients, patient groups or constituents.

I might go further and say that I now believe the Secretary of State occupies a parallel universe—a universe where everyone wholeheartedly supports his policy and believes him when he says that there is real-terms growth in NHS spending, a universe where waiting times are not increasing, people are not being refused treatments, bed-blocking is not happening because of pressure on the social care system, a universe where he never discussed the issue of re-banding of nurses with the Royal College of Nursing.

Unfortunately, while the Secretary of State, ably supported by the Prime Minister, is off in that parallel universe, which we shall call delusional, the rest of us are left facing the terrifying reality of what the Government’s policy means to our constituents and to the national health service. We must disregard the rhetoric and the myth-making of the Conservative party as it seeks to demonstrate that it has changed when it comes to the NHS. Sadly for the health service, the Conservatives have not changed at all.

I have spoken repeatedly about the Prime Minister’s clear promises to the British people—one was that there would be no more pointless top-down reorganisation. He even said:

“When your family relies on the NHS all the time—day after day, night after night—you know how precious it is”.

How quickly those words were forgotten. Michael Portillo comments on the BBC’s “This Week” spoke volumes. He could not have made it clearer that the Government meant to misrepresent their position and mislead their voters. He said:

“They did not believe they could win if they told you what they were going to do.”

My fear is that their broken promises are leading us headlong into a broken NHS.

There is much I could say about how disgracefully the Government started to change NHS structures without the consent of the people or the House. Because of those broken promises, a failure to secure a clear mandate for the reforms from the British public, and an abject failure to secure support from the clinicians and the medical profession, we are left in the present mess. I hear time and again that the doctors, the nurses and the professionals are all behind the Government. Where are they? They are shouting loud and clear, “We’re not with you.”

[Henry Smith]

Will the hon. Lady give way?

[Rosie Cooper]

I fell for that last time and did not get to the end of what I had to say.

I will not go on about the rest of the problems that I see with the Bill—the financial challenge, the fact that we are open to European competition regulation, or the fact that the chair of the NHS Commissioning Board believes the Bill is unintelligible. I believe the Bill has been driven forward as an ideological exercise, rather than by an ideological desire to improve the quality of health care available.

[Barbara Keeley]

Will my hon. Friend give way?

[Rosie Cooper]

Forgive me; I need to get to the end of my speech.

My right hon. Friend the Member for Leigh dealt with the finances and the myth of real-terms growth in the NHS budget. My local trust is being asked to go beyond the 4% savings compounded over the next four years and will be expected to achieve 6% or £8.5 million in this financial year. On top of that, Monitor expects trusts to make a 1% profit. People who have given evidence to the Select Committee have said it is clear that there will need to be hospital closures in order to release money back into the wider health service. We are told that this is all part of managing demand and redesigning pathways—two horrible phrases that appear to be back in vogue.

I want to deal quickly with the re-banding of nurses to reduce budgets, which the Health Secretary appears to have little understanding of. I am sorry he is no longer in his place. He clearly told the Health Committee that he was unaware that re-banding was taking place. His problem is that Janet Davies from the Royal College of Nursing told the Committee that, although the RCN does not release conversations, that issue was clearly discussed. I really worry about that. Does he have a twin he is sending into meetings on his behalf? Does he simply not listen? It would not be the first time. Or is the truth even worse, and should he be described in terms that Mr Speaker would call unparliamentary? The Secretary of State said earlier that he stood by his answers to the Committee. He has also claimed that he did not receive a letter from me, but I can confirm that he received it at 11.57 on 13 October, and I have confirmation from his office.

[Mr Simon Burns]

Will the hon. Lady give way?

[Rosie Cooper]

I will not.

The point is that even if the Secretary of State was not aware of the re-banding, as he claims, that speaks volumes about how out of touch he is with the hard-working staff he is supposed to represent. Perhaps he would like to remove himself from his parallel universe—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I call John Pugh.

--- Later in debate ---

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is always a pleasure to follow the right hon. Member for Rother Valley (Mr Barron). He would be surprised if I agreed with everything he said, but he made some good points in the first half of his speech.

Today’s debate has been a wasted opportunity for the Opposition, because nothing positive has come out of it—nothing about how we will better look after patients or how we will address very real needs in all our constituencies. There has been a lot of mud-slinging but very little talk about what will benefit patients and how we will deliver a patient-centred NHS.

That is to the detriment of the Opposition and to the way in which they have addressed the motion. It is disingenuous of Opposition Members to attack the Prime Minister and the Secretary of State for Health, and to try to give the impression that my right hon. Friends do not care about the NHS. All politicians and, I believe, everyone in the country care about the NHS, but we have slightly different views about how the service should be run.

I have a great deal of time for the hon. Member for West Lancashire (Rosie Cooper) and I like her very much on a personal level, but some of her points were wrong. In particular, it was wrong to bring the Prime Minister’s personal experience into the debate. He had a difficult family circumstance, and of course someone with that background will understand the NHS very well.

[Rosie Cooper]

rose—

[Dr Poulter]

The hon. Lady did not make her point very well, and she did not allow me to intervene on her. I am sure that the Minister will address the points that she made about the letter.

Health and Social Care (Re-committed) Bill

Rosie Cooper Excerpts

Wednesday 7th September 2011 Commons Chamber

[Paul Burstow]

The power to establish NHS trusts is contained in previous legislation. The Bill provides for, in due course, the repeal of the provision to establish NHS trusts. As we indicated in our response to the NHS Future Forum, that will not take place for several years to come. Regardless of that, however, the Secretary of State will retain the power to establish special health authorities that can exercise a provider function.

[Rosie Cooper (West Lancashire) (Lab)]

The Minister just said that the Secretary of State will have the power directly to remove the management of hospitals or provider organisations. Will that apply both to NHS and private providers? Will the Secretary of State’s reach go that far?

[Paul Burstow]

We discussed yesterday at some length the role of Monitor and its powers through the licensing regime, which will apply not just to NHS public sector providers but to private and voluntary sector providers. The powers there are extensive and I recommend that the hon. Lady should look at the debate we had yesterday.

Another issue that comes up is the duty of autonomy. Amendment 1197, which was tabled by my hon. Friend the Member for St Ives—not all of Cornwall—(Andrew George), seeks to remove clause 4, entitled “The Secretary of State’s duty as to promoting autonomy”. This clause was highlighted by the legal team advising 38 Degrees about the changes to the role and functions of the Secretary of State. The specific purpose of the autonomy duty is to free front-line professionals to focus on improving outcomes for patients rather than looking up to Whitehall. It does not undermine the overarching duty to promote a comprehensive health service, nor enable Ministers to abdicate responsibility for the NHS.

It is our view that the legal opinion published by 38 Degrees overstates the effect of clause 4. The opinion suggests that the court will expect the Secretary of State to demonstrate that any steps he took that interfered with the autonomy were “really needed”, or “essential”, and that no other course of action could be followed. This is not the Government’s intention and we do not believe that that is the effect of the clause. It would be sufficient for the Secretary of State to demonstrate that he had reasonable grounds for concluding that a course of action was the most effective way to act in the interests of the health service and fulfil a duty imposed on him by, for example, clause 1 or a new section 1A in the Bill.

--- Later in debate ---

[Rosie Cooper]

Great play keeps being made about consultation. I do not hear any play being made about the right to be heard or a right of veto, or whatever. CCGs can ask the health and wellbeing boards what they think; health and wellbeing boards might make a recommendation, but there is no obligation for anyone to listen.

[Paul Burstow]

The hon. Lady is completely wrong when she says that there is no obligation. There are clear duties in the Bill for health and wellbeing boards’ views, and their preparation of joint strategies on health and well-being and joint strategic needs assessments, to be legally binding documents, in the sense that CCGs must have regard to them. They are not pieces of paper that can be just tossed aside and dismissed. They are very important documents in the emerging system.

--- Later in debate ---

[Owen Smith]

As the Minister has just confirmed by omission, there will be no power to direct and therefore no power to deliver absolutely a comprehensive, universal health service as we have come to expect and understand it. Those are the key differences. [Interruption.] The Minister can shake his head, but that is an accurate interpretation of what has happened.

[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.

[Owen Smith]

I am grateful to my hon. Friend for that intervention. As she will know, the Government have no mandate for any of these things—they were not in the manifesto, the election or the coalition agreement. There is a mandate, but not one to effect these sorts of changes. That is another disgrace given how large the changes are.

I am going to move off this issue, but I will conclude by reading back to the Government their own words, which make it absolutely clear what they are doing in getting rid of direction. Paragraph 66 of the explanatory notes states:

“Currently, the Secretary of State is directly responsible for providing or securing the provision of all health services as set out in the NHS Act, a function which is largely delegated to Strategic Health Authorities and Primary Care Trusts…However, the new commissioning structure proposed by the Bill means that this would no longer be the case.”

The explanatory notes also state that

“functions in relation to the health service are conferred directly on the organisations responsible for exercising them”.

Effectively, the Secretary of State will move on and his focus will shift to public health.

--- Later in debate ---

[Rosie Cooper]

I fear that for all the listening, the work of the Future Forum, the concerns voiced by health professionals and our constituents who rely on the health service, and the two days of debate in this place, we have ended up on Third Reading with something that is not substantively different from the original idea. Although it is three times longer than the National Health Service 1946 Act, which created the NHS, the Bill before us leaves us with more questions than answers. I suspect that that will remain the case for some time, as the Government have indicated that more amendments will be tabled.

It is astonishing that we have progressed from a Bill that was never meant to be, because the Conservative party had promised no top-down changes to the NHS, to the Conservatives’ having a supposedly well-thought-out plan—which required a pause because of the sheer scale of the public’s and medical professions’ opposition—and then to the Bill that we have today, which needs more amendments. Sadly, the changes are not substantive enough. The Minister told us yesterday that 715 of the 1,000 amendments were intended merely to change the words “commissioning consortia” to “clinical commissioning groups”. I believe that the public, clinicians and those of us who could see right through the Bill were looking for something more substantive when the Government stopped to pause and promised to listen to people’s concerns.

The Health and Social Care Bill that we now have is still as confused and muddled as on the day it was first brought before the House. I expect that Ministers hoped to confuse and bore people into submission. Disgracefully, the Government began to change the NHS structures without the consent of the people even before they produced the Bill, and they continue to do so even though it has not passed through this House or proceeded to the other place—where it is to be hoped that it will receive the thorough and tough consideration that we should have had the time to give it here.

What we have is a Bill that is high on autonomy and low on accountability. It is supposed to be built on the principles of efficiency, reducing bureaucracy and cutting out waste, yet I do not believe it achieves any of them. In fact, in practice it does the opposite. The Bill will leave us with an organisational malaise, as the number of bodies and organisations significantly increases, with the relationship between them all being complex and incoherent and severely lacking in detail and accountability. The Bill leaves us with a financial challenge that has never been achieved in any health economy anywhere in the world at the same time as removing great swathes of the people with the experience and skills to deliver this outcome. The Secretary of State said that he admired NHS employees. If that is so, why have his policies led to so many of them losing their jobs?

The Bill will leave the NHS open to European competition regulation, all of which will be overseen by an economic regulator enforcing competition who appears to think the system can be based on an outdated and failing regulatory model like that of the utilities sector, and whose accountability to Parliament and the Secretary of State is unclear. Ultimately, I believe the Bill has been driven forward as an ideological exercise, rather than through a desire to improve the quality of health care available to the people of this country. The Government could have achieved the changes they said they wanted without all this structural mayhem, such as by reducing the number of primary care trusts, changing the make-up of the boards and putting clinicians firmly in the driving seat, but perhaps that was not macho enough.

This evening, the Government are in serious danger of consigning to the bin 13 years of progress, in which patients were being treated within four hours in accident and emergency and were guaranteed an operation with 18 weeks. Tonight, I genuinely fear that the Bill before us will be the equivalent not of throwing a grenade into the NHS, but of pushing the button on the nuclear option: a completely disproportionate response to the challenges facing the NHS.

In my speech on Report, I referred to the former NHS employee Roy Lilley and his blog. Today, he takes a quote from Mary Anne Evans, otherwise known as the novelist George Eliot:

“It is never too late to be who you might have been.”

I therefore urge the Liberal Democrat Members of this House to consider whether they genuinely believe this Bill will deliver a better, more caring and more patient-led NHS.

Earlier in the debate there were suggestions of scaremongering, so let me be clear: I am not scared; I am terrified—terrified that this Conservative Government will kill off the NHS, a system of health care that is envied throughout the world and that is being threatened for the sake of ideology. I am not scaremongering when I say that if this Government destroy the NHS, they will never be forgiven.