Oral Answers to Questions
Derek Twigg Excerpts(12 years, 2 months ago)
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Paul Burstow
I am grateful to my hon. Friend, who I know campaigns on these issues and has a parliamentary reception on them later this week. She is absolutely right that we need to ensure that there are improvements in the area, and that is why I can confirm today that discussions are under way with clinical leaders on the potential development of a tariff to cover allergy services and the steps necessary to make that possible. On training places, I can confirm also that the joint working group, on which the Department, strategic health authorities, NHS Employers, postgraduate medical deans and professional organisations sit, does look at those issues and make recommendations about additional places.
Derek Twigg (Halton) (Lab)
What services is the Secretary of State setting up for professionals who have become allergic to his Health and Social Care Bill and to him?
Paul Burstow
That was a pretty limp attempt. One of the most striking things about this Question Time is how many Opposition Members are yet again suffering from another health problem—memory lapses. When it comes to the Labour party’s record in government, £12 billion was wasted on a computer system that did not work, with which 60,000 nurses could have been recruited and employed for a decade.
Vascular Services (Warrington)
Derek Twigg Excerpts(12 years, 5 months ago)
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Helen Jones (Warrington North) (Lab)
I am very grateful to have the opportunity to discuss vascular services in Warrington, and in particular the decision not to locate a vascular centre there. The review of vascular services conducted by the NHS in Cheshire and Merseyside was fatally flawed. It has no proper evidence base. It failed to engage clinicians in Warrington and Halton and it demonstrated a singular lack of transparency. It failed to adopt the open and transparent procedures used elsewhere and instead held only two meetings—one for staff and one for the public—to cover the two counties. The survey it carried out was on the internet, thus excluding many of the people in the centre of Warrington and in Halton who do not have internet access. The conclusions it drew from that survey were rather bizarre. Although people said that they valued safety first, it does not mean that the position adopted by Cheshire and Merseyside NHS makes things safer. Anyone who follows that flawed logic should not be conducting a review of services in the first place.
We have been left with a decision that will damage service at Warrington and Halton Hospitals NHS Foundation Trust and dismantle the partnership working that has been built up with St Helen’s and Knowsley NHS Trust over the years. It has left unanswered some serious questions about co-dependent services and about possible increased risk and mortality elsewhere. This is a shabby little stitch-up that cannot go unchallenged. If the Minister wants to champion local decision making, it is his duty to ensure that those decisions are properly based on evidence and are reached through due process. That has not been the case here.
This review started by looking at “evac” procedure. It then mutated into a review of vascular services as a whole. It is never a good sign when that sort of slippage occurs. The review then decided that any centre must carry out a minimum of 50 open aortic aneurysm repairs and 100 carotid endarterectomies. Where is the evidence for these figures? The Royal College of Surgeons has never recommended them and many other centres operate using different minima. The suspicion is that the figures were chosen to bolster the case for two centres rather than three, yet Great Manchester will have three, as will Cumbria and Lancaster. Unless the Minister is prepared to argue that centres operating on different minima are unsafe—I do not believe that he is prepared to argue that—there is no evidence base for these figures.
Derek Twigg (Halton) (Lab)
I congratulate my hon. Friend on securing this debate and on making an excellent speech. She said that the Minister will probably argue that this is a matter for local decision making but she has shown that there is no clear evidence base, so one would hope that the Minister would ensure that the matter is reconsidered.
Helen Jones
My hon. Friend is right. I want to come to some of the other evidence and how the review was carried out. The decision was eventually taken that one centre would be located in Liverpool and one at the Countess of Chester hospital. Originally, the review panel allowed both Liverpool and Chester to take away their submissions and rewrite them from June until October, but it did not allow the same leeway to Warrington and Halton NHS trust. After protests from overview and scrutiny committees, it allowed them only seven days. That is not a fair process.
It is also clear that the review panel originally had reservations about locating a centre at Chester in partnership with Wirral university hospital. It said that
“there were a number of outstanding questions about how the proposed arterial centre would work clinically”.
However, when we asked how those clinical problems have been resolved, answer comes there none.
There were other questions about the skills base, co-dependent services and possible increased mortality rates elsewhere, which it is clear from the impact assessment carried out for Warrington have not been resolved. We were left with the decision to base a centre at Chester—a decision that, I understand, was queried even by its partner at Wirral university hospital NHS trust—that has been designated the south Mersey centre. I have to tell the Minister that I was born and bred in Chester, and it is not on the Mersey but on the Dee, and it is difficult to get to it from elsewhere in the region.
The result of this decision is that centres are concentrated in a relatively small area—one in Liverpool, one in Chester and a satellite one in the centre of the Wirral. There is nothing in the review for those who live in north or east Cheshire, and as a result emergency patients from the Warrington area will now have to travel 30 miles by emergency ambulance instead of the maximum eight miles as before. Those who wish to travel by public transport will, because of the different combinations of buses and trains, be facing a journey of three to four hours. That is important because car ownership in Halton and the centre of Warrington is lower than the national average—people are reliant on public transport.
The questions about access, which were deemed to be important, have not been resolved but there are other troubling issues. It seems that the review—based, after all, on flawed evidence—will form the basis for decisions on other specialties. For example, the review stated that it was highly desirable, if not essential, that hyper-acute stroke units be located with vascular centres. That indicates that Warrington’s chances of getting these services in the future are limited. However, the review also undermines existing stroke services in Warrington—services that are highly rated and delivered in partnership with St Helens and Knowsley trust. If a vascular surgeon is not to be on site, those stroke services will be undermined.
The same is true of trauma care. The review thought it desirable that in the future trauma centres be co-located with arterial centres. That would seem to be pre-judging where those services will be located in future.
As things stand, Warrington often deals with serious cases because it is at the centre of a motorway network. Many will need a vascular surgeon, as well as other specialties. The response from the review was that patients could be stabilised by a general surgeon and that a vascular surgeon would be on site within 30 minutes. Frankly, anyone who knows Warrington’s traffic will know that that is absolute nonsense. The North West Ambulance Service gave evidence to the impact assessment panel about gridlock in Warrington. If the service cannot guarantee that it can get an emergency ambulance through, there is little chance of getting a surgeon through. Indeed, I have done the journey from Chester to Warrington many times, because I still have relatives there. It is not possible to do it in 30 minutes at peak time—one has to get through the traffic in Chester, go along a congested motorway and then get through the traffic in Warrington. Where on earth have those figures come from and how have they been validated?
The suspicion is that the review has been carried out in a cavalier manner in order to fit a predetermined outcome. Indeed, there are also concerns arising from the impact assessment, because the points put by clinicians in Warrington appear to have been accepted, yet nothing has been done about them. For instance, the review panel received evidence that the vascular services in Warrington were well developed and had worked over 10 years in partnership with St Helens and Knowsley trust. The panel accepted that it was desirable to maintain that partnership and that disrupting it was contrary to practice elsewhere in the NHS. The panel said that it hoped that the partnership would be maintained. However, the clinicians in the St Helens and Knowsley trust had already given the panel evidence showing that it could not be maintained if the recommendations of the review were accepted, because transfer times and transport difficulties would mean having to partner with Liverpool.
Similarly, the North West Ambulance Service gave evidence showing that it could not guarantee ambulance response times in Warrington if it had to transfer patients from Warrington to Chester. The service’s figures were accepted by the impact assessment panel, which then said that it was drawing the matter to the attention of commissioners as a cost not yet planned for. Where will the extra money come from to fund extra ambulance services in Warrington, given that the NHS is already expected to take cuts of £20 billion? If the Minister wants to get up and promise us extra money for Warrington ambulance services, we would be very pleased to hear from him, but I do not think he can.
Similarly, the ambulance service drew attention to the fact that Warrington is uniquely prone to gridlock, because if an accident happens on the motorway system, it can gridlock the whole town. The response from the panel was that gridlock was “challenging”. Not being able to get an emergency ambulance through is not challenging; it is life-threatening. Indeed, it is really quite arrogant to dismiss the concerns of those responsible for transferring patients in that way.
However, worse was to come. The clinicians from Warrington and Halton—who, at this stage in the process, were now being consulted for the first time—gave evidence about the impact of removing vascular services on other specialities. In particular, they were concerned about the problems of ensuring support for vascular injury in other surgical procedures and invasive specialities. The panel then said that the volume of patients needing to be transferred could become “unmanageable”. It also said that the number of patients whose services would be disrupted might be greater than the small number who would see an improvement. All that was asked of the review panel was that it should publish its evidence at the same time as its implementation plan. Frankly, that is the wrong way round: if the evidence is not there, there should not be an implementation plan to start with.
Derek Twigg
My hon. Friend is most generous in giving way again. I am sure that she will discuss this further, but the areas covered by the two hospitals—Whiston, Warrington and Halton; and Knowsley, St Helens and the centre of Warrington—are some of the most deprived boroughs in the country, and yet the services are being transferred to one of the most affluent parts of the north-west. Does she not think that an odd way to deal with populations that suffer the most ill health?
Helen Jones
I agree. One thing that the review appears not to have looked at properly is the incidence of these sorts of vascular illnesses and where the centres should be located to deal with them.
Another interesting issue is that clinicians told the panel that more and more patients would need to be transferred over time as a result of not having vascular services on site. In fact, one clinician on the panel expressed the view that the
“lives at risk in these situations, equalled, or outweighed those saved by the anticipated improvements.”
I have to ask what sort of service improvement it is that can put more lives at risk. Evidence was also given about the difficulty of maintaining cancer services without support from vascular surgeons—Warrington is a centre for renal cancer—about the difficulty of maintaining limbs compromised by diabetes without having those surgeons on site and about the waste of resources, with Warrington having invested in new facilities. It has the most modern vascular lab in the region and the only fully compliant one. That will go to waste if vascular services are transferred, and we will spend millions elsewhere in providing new services on another site.
In short, what we have is a proposal that breaks an existing working partnership—one that has provided highly rated services—that could harm co-dependent services, that could impact on ambulance transfer times in a way that puts other patients in Warrington at risk and that wastes services. In the end, it will seriously damage services at Warrington hospital. In fact, I am told that a consultant interventional radiologist who had already been appointed has now declined to come because of this decision. Yet an implementation plan is going ahead even before we have begun the consultation. That is no consultation at all.
I ask the Minister to look at this seriously. I will support changes in services where they can be shown to improve patient care. I cannot support them where there is no evidence that they will improve patient care and there is a lot of evidence that they will damage patient care in other specialties. The ultimate responsibility, I say to the Minister, is his. I have agreed with Mrs Thatcher on only one thing—when she said:
“Advisers advise, and Ministers decide.”
He has to look very seriously at what has been going on here and he needs to act before other services in Warrington are damaged.
Mr Burns
If my hon. Friend means by “piecemeal” that the decision is dealing only with a certain part of the country, then that is indeed the case. However, the review was carried out in the context of a wider geographical area in and around Merseyside, and in that respect it is achieving its aim of finding the most relevant service for the local communities. That is why the recommendation was to have two arterial centres located there.
The hon. Member for Warrington North raised the issue of population, as she believes, I think, that there should be a third centre. The following point is based on advice from both the Vascular Society of Great Britain and Ireland and the local clinical advisory group. The population in the area under discussion in respect of this decision on services is 1.2 million, whereas the figures that would be required to have a third centre are 1.4 million for the vascular networks and 1.6 million for abdominal aortic aneurysm screening programmes. Therefore, the population currently under discussion is too small to warrant an extra centre. I hope she will accept that.
Mr Burns
No, as there is not sufficient time.
On the proposals for consultation, I have been assured by NHS North West and the PCT cluster boards that an implementation steering group will ensure that the recommendations made in the impact assessment are taken forward. The final proposals will be subject to formal public consultation in 2012.
I appreciate that the hon. Lady and her constituents have concerns about the proposals for vascular services. However, I should stress that these proposals have been developed by the NHS in Cheshire and Merseyside based on advice by clinicians made in the light of best practice recommendations by the Vascular Society of Great Britain and Ireland. I therefore encourage her to take the opportunity to discuss the proposals with the Cheshire and Warrington and Wirral PCT cluster boards while they are being prepared for formal consultation, which will take place next year, as I mentioned earlier.
Question put and agreed to.
Private Finance Initiative Hospitals
Derek Twigg Excerpts(13 years ago)
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Derek Twigg (Halton) (Lab)
It is a pleasure to speak under your chairmanship, Mr Meale. I congratulate my hon. Friend the Member for St Helens North (Mr Watts) on securing this very important debate and my right hon. Friend the Member for Knowsley (Mr Howarth) on the contribution that he made. As you will have picked up, we are constituency next-door neighbours, but there are wider issues that we need to discuss and that I intend to raise with the Minister.
Derek Twigg
I will say more about the St Helens and Knowsley Teaching Hospitals NHS Trust a little later, but I have a lifelong relationship with the Whiston hospital, which is used by many thousands of my constituents. As I said, my right hon. Friend the Member for Knowsley, my hon. Friend the Member for St Helens North and I work very closely on issues relating to it, as neighbouring MPs.
I congratulate the hospital on delivering the PFI six months ahead of time and to an excellent standard. The chief executive, the board and the staff have done an outstanding job. The many medical staff, support staff and ancillary staff do an amazing job, and the hospital has the highest reputation, but I will talk specifically about the hospital in more detail later.
It is important to understand the use of PFIs, what was required and what was achieved. In 1997, after 18 years of Conservative disinvestment in the NHS, the service was in crisis: 1 million people were on waiting lists, hospitals were in disrepair, staff felt undervalued and buildings had been neglected. As my hon. Friends will confirm, people regularly complained to us in 1997 and thereafter—my right hon. Friend will say that they were complaining before then—about waiting more than two years to have an operation or even to be seen by a specialist in some instances. It is important to make that point.
The Labour Government made a firm commitment to improve, support and protect the NHS. In government, we did what was necessary to turn it from an organisation that was struggling for survival into the world-class and world-leading service it is today. It is important to make that point about the improvements made under the previous Labour Government, which included achieving the lowest waiting times, the highest public satisfaction, a two-week turnaround to see a specialist, a massive decrease in the number of those dying early from heart disease and cancer, and improved facilities. In the context of PFI, investment in the NHS is important.
As my hon. Friend said, 114 new hospitals were built over Labour’s 13 years in government to replace the existing ageing and neglected infrastructure. In 1997, half the NHS estate dated from before 1948; in 2010, that figure was down to about 20%. That rapid modernisation was unprecedented, but vital to the regeneration of the NHS, and PFIs played an important part in making that possible. They made possible the move from the previous workhouse-style provision of health care to a modern, technically advanced health care system for the 21st century. [Interruption.] The Minister tuts, but an old workhouse building was still being used on the Whiston site at the time. In fact, back in the 19th century, one of my distant relatives died in that building when it was still a workhouse, so it was a workhouse and it was used for health care. Now, we have a modern hospital to replace it. It is important to make that contrast, as my hon. Friend did.
Graham Stringer (Blackley and Broughton) (Lab)
Even with the massive investment and improvement under the previous Labour Government, my local hospital is still 60% a Victorian workhouse, and we need more. [Laughter.] The Minister laughs, but I mean that we need more investment, not more workhouses. Does the shadow Minister agree that although PFI was incredibly valuable in bringing that expansion about, it had two fundamental flaws? In a pragmatic way, it relied on the private sector being more efficient than the public sector to recover the higher borrowing costs, but that has not happened in many cases, because of the strict configuration of the contracts. Secondly, when the private sector is involved—I am not totally against that—we have the secrecy that my hon. Friend the Member for St Helens North (Mr Watts) mentioned. There are commercial interests, which is bad when public money is being used for the public good, because we cannot find out what is going on.
Derek Twigg
I totally understand my hon. Friend’s concerns. As regards his local hospital, he will realise that I never said that every hospital was modernised and improved. The issue now is how they will be modernised and improved under this Government, and I will return to that because we need to know from the Minister today what the Secretary of State’s and the Prime Minister’s plans are for modernising our NHS estate. The massive improvement under the previous Labour Government was unprecedented, but my hon. Friend is right that there were concerns. Not everybody supported PFIs, and there were issues, which I will come to later. My hon. Friend raises an important point.
It should be remembered that PFIs were also used under the previous Conservative Government. As noted in the Public Accounts Committee report entitled “PFI in Housing and Hospitals”, which was published on 18 January,
“PFI has delivered many new hospitals and homes which might otherwise not have been delivered”.
It is also important to note that the report’s summary says that hospitals are mostly
“receiving the services expected at the point contracts were signed and are generally being well managed.”
Again, I accept there were some problems, but the Public Accounts Committee recognised that they were generally well managed. Labour not only invested in the NHS, we invested in protecting its future. The contracted maintenance of buildings under the PFI agreements will ensure that the standard of NHS buildings will be as high in 30 years as it is today. The present generation is only the custodian of the NHS. Future generations are its owners, and PFI agreements will ensure that they are served by the same exceptional standard of facilities as today. That is an important point.
The system is not perfect, but at least it guarantees the maintenance of the buildings over a 30 to 35 year contract period. We all know that, with financial pressures, funding was cut for maintenance. Rather than being a one-off, that became a regular occurrence. That is why we found hospitals in the state they were in 1997—for which we, too, had some responsibility, as we had been in government for various periods before then. The fact was that there was massive under-investment, which was exacerbated by the Thatcher Government.
Under Labour, PFIs gave private sector partners responsibility for the completion of large infrastructure projects. A crucial point—of importance to my hon. Friend the Member for Blackley and Broughton (Graham Stringer)—is that accountability for services and the satisfactory completion of such projects remained in the public sector. That meant that the Government were still accountable to the people and Parliament for improving services to patients.
The PFI arrangement is a tool; it is a method that can be used badly or well. It would be disingenuous, as I said to my hon. Friend, to suggest that we were all in favour of PFIs when we were in government. It is important to be frank and honest and acknowledge that. There are strong views opposed to PFIs—it would be wrong to suggest otherwise with regard to some schemes. What we can be sure of is that, under Labour, the PFIs formed part of a carefully managed NHS in which the private sector could play a limited role. Sadly, under the Government’s current reforms, that will no longer be the case. The Government continue to rush through their NHS reorganisation; despite the so-called pause, work is still going on, without sufficient evidence or consultation on its true effect. Pressure has been relentlessly piled on to the NHS and foundation trusts, with insufficient consideration for the future. Through these costly, unwise and unwarranted reforms, spending cuts and efficiency savings, the Government are showing once again that they cannot be trusted on the NHS.
My hon. Friend the Member for St Helens North and my right hon. Friend the Member for Knowsley highlighted the issues surrounding the St Helens and Knowsley Teaching Hospitals NHS Trust, with which they have had a long association. However, it is important to repeat some of the things they said. This trust has a strong track record of high performance, achieving three stars and consecutive double excellent ratings from the Care Quality Commission. That high standard of care has been maintained: in 2010, it was the only acute trust in the country to perform above the national average in every indicator of quality of services and care in the CQC assessment. Therefore, I believe it could be described as the nation’s top-performing hospital. In addition, the trust achieved the maximum overall score in the auditors’ local evaluation for the use of its resources, for the fourth year running, acknowledging the trust’s excellent financial management.
Therefore, the trust performs to an excellent standard, not only in services and hygiene, but in financial management. The benefits of the PFI scheme for the hospital have been tremendous—more than 80% of the accommodation is new build on two sites, to which my right hon. and hon. Friends have referred; there has been capital investment of £350 million, with a 35-year concessionary period; radiology imaging equipment through a managed equipment services has been provided by GE Medical Systems; and hard and soft facilities management services, including catering, domestic estates, grounds, gardens and so on, have been provided. An important point for the Minister is that there is also 50% single room provision, with en suite facilities, as per Department of Health guidance. That is important in meeting both what we wanted and what the Government have said in respect of single-sex wards.
In 2009, the Secretary of State for Health, who was then the shadow Secretary of State, said this in an interview on Mumsnet about the pledge regarding single-sex rooms:
“This pledge will be delivered as part of our plans to provide 45,000 more single rooms in the NHS.”
Funnily enough, that pledge was dropped, and we have heard no more about it. I am interested to know, in the context of any PFI plans or hospital building programmes that the Minister has to comment on, whether there are plans to increase the number of single rooms, which is an important part of improvements in the NHS. I look forward to hearing any details that the Minister might give us.
My hon. Friend the Member for St Helens North, backed up by my right hon. Friend the Member for Knowsley, made some important points about secret documents. One has now been put into the public domain, though not officially, but we have not been able to see the other one. The Minister must answer who suggested as an option that a private sector provider could be brought in to manage this specific trust, and perhaps other trusts. Who suggested that that was the case? I understand that the trust board rejected that option and would only deal with it if directed to do so by the NHS, whether that involved the strategic health authority or the Department. I understand that that was the case. Will the Minister clarify that important point? I understand that one reason why the trust board would not accept the option of voluntarily considering a private sector provider coming to run it was a concern for patient safety. The cuts it was being asked to make to get to foundation trust status were too great and, in its opinion, were threatening patient safety. Will the Minister tell us whether that was the case?
What part of the NHS would suggest that option for a hospital that has achieved a double excellent rating, that has excellent financial management, that has been well run for years, that has a brilliant chief executive and management board, that has a committed staff and that has the support of the community? What person in their right mind would suggest a private sector provider? How could a private sector provider run it better than a double excellent rating?
Mr Simon Burns
I want to deal with this in detail when I come to my contribution. The hon. Gentleman said, “What man in his right mind would consider the private sector being used in the NHS for the management of an NHS hospital?”
Mr Burns
I am talking about the generality. I can answer the generality and will come to the specifics in my speech. The gentleman concerned, who accepted the principle in a generality, was the right hon. Member for Leigh (Andy Burnham), who was Secretary of State for Health before the election.
Derek Twigg
I am not sure that that is worthy of a reply. I am being specific. The Minister may remember—and the hon. Member for Broxtowe (Anna Soubry) sitting behind him will—that when the Health and Social Care Public Bill Committee discussed foundation trusts and insolvency, I made the point that it does not always follow that a hospital that gets into financial difficulties is badly run. That is the issue that the proposals in the Bill do not take into account. What was the logic behind the proposal for this specific hospital to have a private provider brought in to help manage it? That is a different point from the one that the Minister took.
I also want to make the point that the Government are placing NHS trusts under intense pressure through the policy of forcing foundation status within three years, coupled with the costs of reorganisation and the efficiency savings that trusts have been asked to find. That is leaving many NHS trusts in peril as they struggle to meet foundation trust status, or become foundation trusts with financial difficulties from day one. The Minister knows a number of hospitals are in financial difficulty. I do not know whether he has yet decided to put that list in the public domain.
The dangers are clear. St George’s hospital in Tooting, London, recently decided that it was too risky to push ahead with the Government’s preferred timetable for NHS trusts to become foundation trusts. Speaking after announcing a two-year delay to the plan to become a foundation trust, the board of the hospital said:
“The board recognises that if we put the organisation under pressure to become an FT during 2011-12 then this could impact on the quality and safety of the patient care that we provide.”
I wonder whether parallels can be drawn with the St Helens and Knowsley trust, as the board is not prepared to take the risk. Put simply, existing pressures on NHS trusts are too great to risk a massive reorganisation. Hospitals realise that, and so should the Government. It is important to understand that the pressures are great, and what is being asked behind the scenes at particular foundation trusts is important.
Now more than ever, the dangers of an FT or NHS trust experiencing financial difficulties are growing. Under the Tory-led Government’s plans for the NHS, a struggling FT will be faced with two options. One is insolvency in line with commercial insolvency procedures, and the other is the sort of takeover dictated by clause 113 of the Health and Social Care Bill, which the Committee discussed in some detail, or a takeover on unknown terms. The Minister refused to be drawn on giving an example of what hospitals might be in difficulty and what sort of takeover might be considered. I do not know whether he has changed his mind since then, because an example would help us with the detail of our deliberations.
Although the debate on PFIs and their appropriate use will continue, it is important to be clear on one issue. During our time in government, we supported the NHS. We undertook no step that would have endangered its position as a world class public health care system. In comparison, this Government’s policy on health care has been in turmoil from the very beginning. It is hated by the public and despised by the professionals, and we believe that that is dangerous for the NHS.
We need to know what plans the Government, the Secretary of State and the Prime Minister have for capital investment in the NHS. What will hospitals and NHS facilities have to do if they require large capital investment? Is it the case, as reported in the Financial Times last year, that the Secretary of State has ruled that they should no longer have access to public sector cash for big capital projects? Is that the Government’s current policy? Alternatively, will the Minister confirm that future investment in NHS capital projects will be determined solely by the market, as part of the Government’s plans to place the market at the centre of the NHS?
The Minister will expect me to remind him that he was forthright—it is not what the Secretary of State would have wished—in identifying the extent to which EU competition law will increasingly apply to the NHS. Just as importantly, we need to understand where the Government are going on PFI. Much has been said about what they are considering, but when will they publish their plans?
I remind the Minister that he is now in government. Whatever matters he raises this afternoon, he must realise that he needs to supply the answers to these difficult questions. There is great uncertainty within the NHS, which is not helped by the lack of policy detail on which course the Government intend to pursue. It is a crucial question for NHS services, and the answers need to be heard.
The Government should make no mistake about it that their massive reorganisation proposals are putting the future of the NHS as we know it in peril. They are causing massive uncertainty and distracting the professionals, and, as the Health and Social Care Bill impact assessment shows, it could have an impact on the safety and care of patients. The fact remains that opposition to the Health and Social Care Bill, which has been led by the Labour party, and the increasing rejection of the Government’s plans by medical professionals, health experts and patients groups alike have forced the Government to take this humiliating pause. If it is to be more than a simple political ruse to get through the local elections tomorrow, real and significant changes will need to be made to the Bill, including the crucial deletion of part 3, which has severe implications on the issues that we have been discussing today.
Labour left the NHS with record levels of public satisfaction, record low waiting lists and world class hospitals such as those at St Helens and Whiston. It is becoming increasingly clear that the NHS is moving backwards because of this Government’s cuts and broken promises. I have no doubt that that will inform the choice that people will make tomorrow at the ballot box.
Mr Alan Meale (in the Chair)
I call the Minister to reply. As an ex-Whip, you will be aware that you have extra time—11 minutes will be added to our debate because of the Division.
Mr Burns
I do not share the hon. Gentleman’s blinkered view of what went on in the health service prior to May 1997. I am probably of a more generous spirit, in that I am prepared to pay tribute to the achievements of the last Labour Government, although it would be more difficult to discover those of the Wilson-Callaghan Government and before that the Wilson Government because of the chronic economic situation.
Unfortunately, the hon. Gentleman is not as generous of spirit; he seems to think that everything changed in May 1979 and did not improve again until May 1997, despite the fact that for every year between those dates we saw a real-terms increase in health spending. Indeed, health spending went up from just under £9 billion a year in 1979 to more than £39 billion in 1996-97, which at the time was an incredibly large sum, although due to inflation and other factors, it now seems far more modest. However, I am prepared to be more open-spirited and to acknowledge achievement when justified, but also to criticise when justified.
Derek Twigg
No one suggested that everything was renewed and changed under the previous Labour Government, but there was record investment and an unprecedented hospital building programme. How many hospitals did the Thatcher and Major Governments build?
Mr Burns
This is the point. Perhaps the hon. Gentleman is taking a punt on something with which he is not very familiar, but if he had been in the House in the mid-1990s, he would know beyond doubt that there were record levels of investment in the NHS. Even he said, looking at the report in front of him, that the Major Government used PFI, and there was considerable investment in infrastructure. He would probably argue—with some justification because one can always argue this—that there should have been more investment, but there was more. I shall give one example, but—
Mr Burns
I will. There are so many examples of old and dilapidated buildings or buildings that were past their sell-by dates that the Thatcher and the Major Governments knocked down and replaced through new investment. One example was the moving of the European-renowned burns and plastic surgery facility on a Billericay site in Essex, which wanted to expand to maintain its position at the forefront of providing highly specialist services and was moved to Broomfield. I remember a particularly happy day in February 1997 when, as a junior Health Minister, I accompanied the then Prime Minister to open it.
May I now get back to the point I was making to the hon. Member for St Helens North? However reasonable the hon. Member for Halton is trying to be, his hon. Friend was not quite so generous, suggesting that everything was appalling prior to 1997 and everything was magnificent after it. The hon. Member for Blackley and Broughton rather unfortunately brought the speech of the hon. Member for Halton to a bit of a halt by highlighting some of the perceived criticisms of the PFI system under the Blair and Brown Governments, but the hon. Member for Halton very neatly sidestepped the issue. He did not want his story of good news on investment in hospital buildings to be punctured, and neatly avoided it.
Mr Burns
To pick up the point made by the hon. Member for Blackley and Broughton, until October last year, I, too, for the 13 years of the previous Labour Government had a hospital in my constituency that was an old, Victorian workhouse, with ancillary wards that were improved Nissen huts. We could go round the country and find many buildings that needed improvement.
I am sure that Labour Members will accept that even the NHS is restricted in that it cannot have unlimited funding, there will be priorities for improvements and reinvestment, and not everything will be done all the time. The process is ongoing. To answer another point before I focus on St Helens, the hon. Member for Halton asked about what is happening to the capital spending settlement and programme. As I am sure he is aware, as an outcome of the spending review, the Government have a capital spending settlement up to 2014-15, and capital will continue to be used to provide investment for NHS development, as well as PFI.
Mr Burns
The hon. Gentleman wants me to list some more new hospitals. There is the Chelsea and Westminster hospital on Fulham road, which was a flagship hospital for the centre of London initiated by Baroness Bottomley, I believe. I could continue round the country, but I will not because my time is limited. I think that the hon. Member for St Helens North would prefer it if I spent more time discussing his local PFI project, because there is a lot to be said to clear his mind and reassure him, if only he has the open ears to listen; an open mind would help as well.
As the Government confirmed at the end of last year, where they can be clearly shown to represent good value for money, we remain committed to public-private partnerships, including those delivered via PFI. Such arrangements will continue to play an important role in delivering future NHS infrastructure. However, the Government also believe that not only have too many PFI schemes been undertaken, but some were too ambitious in their scope. The Treasury has now reviewed the value for money guidance for new schemes and looked at how operational schemes can be run more efficiently. We are clear that the focus should now be on releasing efficiencies at the many existing PFI schemes.
In January, the Treasury published new draft guidance, “Making Savings in Operational PFI Contracts”, which will help Departments and local authorities to identify opportunities to reduce the cost of operational PFI contracts. As part of that initiative, my noble Friend Lord Sassoon, the commercial secretary, launched four pilot projects to test the ideas raised in the Treasury’s draft guidance. The focus of the pilots is to find efficiency gains and savings within the PFI contract itself, allowing the quality of care for patients to remain the priority. The pilots should end by the end of this month. The lessons learned will be used to finalise the Treasury guidance and to improve other relevant PFI contracts, including the one at Whiston hospital. One essential element is that all NHS trusts will retain any savings made to reinvest in improving patient care.
The other important aspect of operational PFI schemes and their cost to local health economies is their effect on NHS trusts seeking NHS foundation trust status. The coalition Government have set a clear commitment for all remaining NHS trusts to achieve foundation trust status by April 2014. That policy will finally realise the ambition of the previous Labour Government. It is about ensuring high quality and sustainable NHS services by giving trusts the freedom to serve their patients to the very best of their ability, unhindered by top-down bureaucratic control.
An issue facing some NHS trusts in their move towards attaining FT status is the affordability of their PFI schemes, as hon. Members are aware from examples in their constituencies. We are tendering for an independent review to establish where PFI schemes may, in some organisations, be the root cause of problems that prevent them from becoming foundation trusts. St Helen’s and Knowsley NHS Trust is one such organisation, and will be considered as part of the scheme. In addition to the independent assessment, the Department and the NHS are developing solutions in a systematic and comprehensive way to manage the PFI schemes in the very small number of trusts where a local or regional solution cannot be found.
When the current management of St Helens and Knowsley NHS Trust signed their PFI agreement in 2006, with the agreement of the then Secretary of State for Health, Patricia Hewitt, and other Ministers, local PCTs agreed to make up the shortfall between the revenue generated by the hospital through the national tariff and other means and the cost of the unitary payment—the annual PFI charge, which was some £20.3 million. Unfortunately, that decision built a deep lack of sustainability into the trust’s finances—a lack of sustainability that the trust, the strategic health authority and the Department are now working extremely hard to rectify. To that end, the trust’s board and the strategic health authority, NHS North West, are developing a tripartite formal agreement, or TFA, to be agreed with the Department of Health, which will support the work to achieve foundation trust status.
Every trust is required to produce a TFA, setting out how it plans to progress to FT status by 2014, the challenges that it faces and how it plans to overcome them. In the case of the St Helens and Knowsley trust, the TFA is still in draft form and is very much a work in progress. Beyond what was leaked to the Liverpool Echo and to the hon. Member for St Helens North, I have not seen the draft and while discussions are ongoing it would be inappropriate for me to do so and I will not see it. Therefore, it would also be inappropriate at this stage to publish the documents.
Mr Burns
Because it was a first draft document, drawn up between officials in the Department of Health, the SHA and the trust, and I do not think that at that stage it was appropriate for me to see it. Also, I suppose that if one is being totally candid, which often gets me into trouble when the hon. Member for Halton or particularly the hon. Member for Leicester West (Liz Kendall) are around, it does make it slightly easier for me because I can say, “In all honesty, I have not seen it.”
I will now make some progress, because I think that what I am about to say may answer some of the questions put by the hon. Member for St Helens North and it may well help the right hon. Member for Knowsley, too. If it does not and I have time to do so, I will give way then.
The TFA process should be completed soon, with the final approved version hopefully being published some time in June or July. I can confirm—if the hon. Member for St Helens North would like to listen to me, because I think that he will find what I am about to say particularly interesting, as he has expressed a degree of confusion about the issue—is that one of the options under review is not, I repeat not, to somehow “privatise” the NHS. As I said to the hon. Gentleman during Health questions last week, this Government will never privatise the NHS and we have no intention of doing so at the St Helens and Knowsley trust.
Perhaps it would be a help if I took a moment to explain the process through which the trust, like all trusts in a similar position, is progressing towards becoming an FT. First, the trust, along with local health authorities, will attempt to find a local solution to whatever financial issues there may be. If a simple local solution cannot be found from within its own resources, then a more radical solution may be necessary, such as merging with another trust and examining whether services need to be reconfigured. On that point, it may be of some consolation to Opposition Members that the benefits of a merger with another trust are that it reduces the percentage of the unitary payment of the PFI in relation to income, which helps with the financial situation, and for other FTs in a merger it increases the income base and economies of scale become possible, which again potentially helps with the finances of a trust.
If the problems cannot be resolved in that way, we would work to a national solution, which is being developed by the Department and which will be agreed with the Treasury. If there is no foreseeable solution, a final option would be to consider tendering the management of the trust. Under that option, management teams from within the NHS, from a social enterprise or from the private sector would put forward their ideas on how to find a way forward for the trust.
Mr Burns
May I just continue, because this is rather important?
While that option is a very long way down the line of potential solutions, it is only what is currently being done at Hinchingbrooke hospital in Huntingdon, in the constituency of the Under-Secretary of State for Justice, my hon. Friend the Member for Huntingdon (Mr Djanogly). The decision on that hospital was taken by the previous Labour Government, when the right hon. Member for Leigh (Andy Burnham) was the Secretary of State for Health. So it is not a new option dreamt up by the present Government since coming into office. We are simply taking an option that is already on the table and that was there when we came into power, which the previous Secretary of State for Health—a Labour Secretary of State for Health—was prepared to accept.
Mr Burns
Just one minute. I must say that at the time, during the discussions about what should happen to Hinchingbrooke hospital and about the use of the option that the right hon. Member for Leigh agreed to, nobody said that that was privatising the hospital, because it was not. If—and it is a big if—that solution were to be considered the right way to solve the problems at the St Helens and Knowsley trust, that would not be privatisation either.
Derek Twigg
With respect to the right hon. Gentleman, we are not comparing like with like.
Derek Twigg
We have a double-excellent hospital at St Helens and Knowsley; it has excellent financial management and excellent services. It meets all the standards. I put the question back to the Minister. On that basis, why is the Department—whether we call it the SHA or not, it is part of the Department and it has responsibility to the Secretary of State—
Derek Twigg
Well, I understand the SHA discussed this as an option with the hospital. I want the Minister to ask my question. Did the hospital voluntarily reject the third option of a private sector provider coming in to manage or run the hospital? Did it refuse that option and also say that it would not accept the cuts being asked of it by the SHA as that would put patient safety at risk? Is that correct or not? If he does not know, will he find out?
Mr Burns
That the trust rejected consideration, or the possible consideration, of that option, because—[Interruption.] What I want to do is to put it in context. As I said in my comments earlier, that is very much a last possible solution if the other solutions are not able to be worked out.
Derek Twigg
I understand that the SHA, not the hospital trust, suggested as a third option having the private provider, on the basis that the hospital—I understand that it was approved by the board—would not accept what was on offer because of the cuts that it would have to make and it was concerned about patient safety. It therefore would not accept voluntarily an option to have a private sector provider come in. The question is whether that option was proposed by the SHA and whether the trust, because of concerns about patient safety, rejected it on that basis, on a voluntary basis. I make that point very clearly.
Oral Answers to Questions
Derek Twigg Excerpts(13 years ago)
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Mr Speaker
I thought that the hon. Gentleman wanted to come in on this question. That is what I have been told, but never mind: we will wait to hear his dulcet tones in due course.
Mr Speaker
I apologise to the hon. Member for Kingston upon Hull North (Diana Johnson). The change of mind on the part of the Opposition Front Bench fazed me, for which I apologise. The hon. Member for Halton (Derek Twigg) wants his opportunity to ask a question, and he should have it.
Derek Twigg
Thank you, Mr Speaker. I think there was some confusion between questions 13 and 16.
We obviously want to see important improvements to the Bill, including the deletion of part 3, which drives competition to the heart of the NHS, and of clause 150, which removes the private patients’ income cap. I also want to ask the Secretary of State a specific question. On 16 March, during the Bill’s passage through the House, the Prime Minister said to the Leader of the Opposition:
“Perhaps he would like to…support our anti-cherry-picking amendment.”—[Official Report, 16 March 2011; Vol. 525, c. 292.]
Will the Secretary of State tell us whether it is still the Government’s policy to table such an amendment in this House, or whether they intend to do so at a later stage?
Mr Lansley
As I said earlier, when we have completed this process of listening and reflecting, we will table amendments to the Bill. I will tell the House about them then, just as I told them on 4 April that we were going to go through this process. Let me make it clear that we are intending not to allow cherry-picking. We intend to make it absolutely clear to the private sector or anybody else that they must not be able to compete with the NHS on uneven terms because, actually, that is what the last Labour Government did. Under that Government, we ended up with £250 million being spent on operations in private hospitals that never took place because of the poor nature of the private sector provision that they put in place. We are not introducing competition into the NHS through this Bill. Why does the hon. Gentleman suppose that the last Labour Government set up the competition and co-operation panel, if not—
Oral Answers to Questions
Derek Twigg Excerpts(13 years, 2 months ago)
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Paul Burstow
Again, I suspect that the hon. Gentleman is trying to re-run the Second Reading of, in this case, the Health and Social Care Bill, but in fact this Government are committed to seeing improvements across the board. That is why in the NHS outcomes framework we do not just talk about cancer, we identify other areas as well. If hon. Members table the questions, I am certainly happy to answer them.
Derek Twigg (Halton) (Lab)
The Secretary of State is fond of making unfavourable comparisons between European and UK health outcomes, but recent research shows that we are doing much better than the picture he portrays. Independent research has borne that out. Concerns have also been raised about the impact of his NHS reorganisation on cancer networks. Sarah Woolnough of Cancer Research UK says:
“One of our concerns is to ensure that we do not lose the expertise that we have been developing.”––[Official Report, Health and Social Care Public Bill Committee, 10 February 2011; c. 116, Q227.]
Under this Government, however, patients are already waiting longer than six weeks for diagnostic tests, many of which are for cancer. In fact, the numbers have doubled, and that is according to the Department’s own figures. Can I ask the Minister why?
Paul Burstow
On the hon. Gentleman’s last point, the first thing to say is that average waiting times have gone down, but beyond that, he is right to identify the need to achieve earlier diagnosis. That is one of the reasons performance in this country on cancer survival has not been as good in comparison with other European countries. That is why, in the outcomes strategy that we published in January, we made it clear that we would put in an extra £450 million over the next four years to fund the additional diagnostic procedures directly available to GPs so that they can make those tests available to their patients.
Health and Social Care Bill
Derek Twigg Excerpts(13 years, 3 months ago)
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Derek Twigg (Halton) (Lab)
This has been a fascinating debate with some interesting and excellent speeches. Some 17 Labour Members and a similar number on the Government Benches have given a variety of speeches, some showing great knowledge and some not so much. I particularly congratulate my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) on her excellent maiden speech, in which she demonstrated her great knowledge of the health service and her background in it. I am sure that she will make many more such speeches and be a great success in this House.
I would like to thank the NHS staff for all the work they do every day in our health service. That includes those at PCTs; one might sometimes think that they were ogres, given how PCTs are described by some Government Members. They work very hard, and they, too, have to deliver the changes that will take place as a result of this Bill.
The Secretary of State is pushing ahead with the Bill despite criticism from all sides. Patient groups, professional bodies and health experts have attacked the plans as high cost, high risk, a danger to the commissioning of key health services, and a distraction from the need to find efficiencies. The heads of the British Medical Association, the Royal College of Nursing, the Royal College of Midwives and the Chartered Society of Physiotherapy, as well as union leaders, have described the reforms as extremely risky and potentially disastrous. The more they see, the more they become concerned. The clear message that we have been getting is that the proposals have come at the wrong time, they are ill conceived, and a lack of attention has been paid to stakeholders’ concerns.
The Secretary of State has ignored the massive improvements that took place under the Labour Government. One would think that he was talking about a different health service, because we had record numbers of doctors and nurses and record low waiting times. I wonder whether the Minister will confirm, as the Prime Minister and the Secretary of State have not done so, that there will be no increase in waiting times during the life of this Parliament. There have been record levels of patient satisfaction, with 71% agreeing that Britain’s national health service is one of the best in the world—the highest figure on record. That is also evidenced by the satisfaction levels recently recorded across user groups, with, for instance, 91% of GPs and 90% of out-patients satisfied. The argument that the NHS is in crisis and is not dealing with patients’ concerns does not stand up. It is important to look at some of the other improvements that have taken place. In June 2010, 90% of admitted patients and 98% of non-admitted patients were being seen within 18 weeks. The coalition has scrapped the targets that delivered those improvements to patient care.
Several Members referred to international comparisons. Let me take the example of the Commonwealth Fund, which ranked the UK first for efficiency and effective care in a study of seven top health care systems. In its 2010 international survey, it found that 92% of people were confident that they would receive the most effective treatment when sick—the No. 1 figure among comparable nations.
A lot has been said about cancer mortality. From 1997 to 2008, cancer mortality rates in all regions of England decreased by between 17.5% and 23%. Even more pronounced improvements have been observed in mortality from circulatory diseases: between 1995-97 and 2006-08, the mortality rate for England fell by 47%.
There are many uncertainties and unanswered questions about the Bill. There are concerns about who will be involved in commissioning and whether it will include other clinicians such as hospital doctors, physios and, importantly, nurses. How do nurses fit into the structural regime? In an article in today’s edition of The Times, the Prime Minister says:
“Nurses too will continue to play a vital role. GP consortia will have a statutory duty to work with nurses and other healthcare professionals, ensuring they have a real voice in shaping better care for patients”.
The Royal College of Nursing says that it was interested to see this, because it does not believe that the Bill goes far enough for it to be possible to claim that that is a statutory duty. Perhaps the Minister will respond to that, too. The only provision that the RCN believes relates to that matter is new section 14O in clause 22, which states that commissioning consortia must obtain appropriate advice. It does not believe that the Bill goes far enough in ensuring that commissioning consortia have relevant multi-disciplinary expertise to commission appropriate care.
I should like to turn to Monitor and competition—an aspect that has not been much mentioned. An ideological commitment to competition on price and to a massively increased role for the private sector is at the heart of the Conservatives’ proposals, despite their attempts to hide it. On 17 January, in a 700-word article in The Times, the Secretary of State did not mention the word “competition” once, but the Government have had to reveal where the true thrust of this legislation lies. Of course, he did not mention it much in his speech today, either. The Prime Minister told the House that
“what we want is a level playing field for other organisations to come into the NHS.”—[Official Report, 19 January 2011; Vol. 521, c. 831.]
When we appeared together on “Newsnight” a couple of weeks ago, the Minister of State, Department of Health, the hon. Member for Chelmsford (Mr Burns) said:
“It is going to be a genuine market. It is going to be genuine competition.”
The Government have hidden the great bulk of the ideological market and competition changes from public view. There is the introduction of competition on price. Monitor will have the power to direct consortia to put the provision of services out to tender, irrespective of what the GP consortia say. The Minister wants to deny that, but it is what we read in the Bill. Monitor will be driving this, not the GP consortia. Government Members should be reading that part very carefully. NHS resources, such as beds and staff, will be used without limit to treat private patients as the cap on private patients in hospitals is lifted. That means that private patients may jump the queue while NHS patients are waiting for treatment. Services or whole hospitals may be forced to close as the most profitable patients are cherry-picked by private providers.
Robert Flello
Does my hon. Friend recognise the effect when a local MP sets up a big campaign? In my constituency, I may well be doing that with the Sutherland centre, which is under threat. The local MP will have no influence or power at all because of Monitor’s role.
Derek Twigg
The issue of accountability for this House—what we can and cannot do—is important and I will come on to it if I have time.
I turn to the Liberal Democrats. The hon. Members for Burnley (Gordon Birtwistle) and for Manchester, Withington (Mr Leech) suggested that the Bill will protect hospitals and wards from closure. I am afraid that it will not. They need to read the Bill again. Monitor will be driving a lot of this, and they need to be clear about what the Bill actually does. They should join the hon. Member for St Ives (Andrew George), who is taking the interesting stance of not voting for the Bill tonight. He understands it better than other Government Members.
Concerns over fragmentation and obstacles to integrated working have been raised by numerous bodies in the health service and by those who work in the health service. The Commonwealth Fund states that the UK has the best co-ordination between health care providers and professionals, with the lowest percentage of patients having experienced co-ordination problems in their care. Only 10% of patients have received conflicting information. The more privatised, competition-driven systems in Australia and the US experience greater co-ordination problems.
The King’s Fund brief for this debate states:
“The Bill signals a significant shift towards a more competitive market for health care. While we support increased competition in areas where it demonstrates benefits to patients, the Bill appears to move towards promoting competition at the expense of collaboration and integration.”
That is from one of the most respected think-tanks.
One cannot underestimate the huge powers that will be given to Monitor. It will expose the NHS to a rigorous competition regime, with services going out to tender. The explanatory notes state that Monitor will become the
“economic regulator for all NHS-funded health services”,
with the power to
“do anything it needs to in order to exercise its functions.”
In other words, the NHS will become like a utility.
Of course, the Government are full of broken promises. The Prime Minister said that there would be real-terms increases in NHS spending, but there are not. He said that there would be no cuts, but there are. He said that there would be no top-down reorganisations, but we have a top-down reorganisation. David Nicholson said that
“no one could come up with a scale of change like the one we are embarking on at the moment. Someone said to me ‘it is the only change management system you can actually see from space’—it is that large.”
This is a massive change. There are other issues, such as the cuts in staff that are taking place and the vacancies that are not being filled. We are being told about that by people who work in the health service. That is the true nature of the health service under the Conservatives and the coalition.
We are in favour of improving the quality of care, driving up standards, greater clinical involvement and giving a greater say to patients. We are therefore not anti-reform, but we are against this reckless, top-down reorganisation with a cost of £3 billion, which was hidden away during the general election campaign. It is reckless, it is not in our best interests and many believe that it will be the end of the NHS as we know it.
Oral Answers to Questions
Derek Twigg Excerpts(13 years, 3 months ago)
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Mr Burns
I am grateful to my hon. Friend in view of the considerable interest he takes and work he does in this field of health care. Let me reassure him that we have guaranteed the funding for next year, so it can work itself out to a successful conclusion thereafter through the cancer networks in the commissioning plans.
Derek Twigg (Halton) (Lab)
Under Labour, hospital waiting times were at a record low and satisfaction with the NHS in its current form was at a record high. Over the last few months, however—no matter how much the Secretary of State does not like it—we have seen more and more operations cancelled or postponed at our hospitals. A number of nurses in my constituency have written to tell me that they are short staffed. One of them pointed out that
“those who have left are not being replaced”.
Is that not the true picture of what is going on in the NHS at the moment? If the Minister is confident in his Secretary of State’s plans for the NHS, will he guarantee that under those plans, hospital waiting times will not rise—or is he going to duck the question like the Prime Minister did last week?
Mr Burns
Under these reforms, by concentrating on raising quality and outcomes, we will give improved quality health care for patients. What I can guarantee is that under these reforms, when implemented, people will not only get improved quality treatment but will see times based on clinical decisions rather than being distorted by political processes.
Oral Answers to Questions
Derek Twigg Excerpts(13 years, 5 months ago)
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Mr Lansley
I think that the reforms will have a positive impact on performance right across the NHS, because they will enable patients who want to exercise choice to see the quality and standard of services, including waiting times. Unlike in the past, they will be able to see waiting times for individual hospitals, rather than just a single target. They will be able to make choices based on information about the quality of services.
Derek Twigg (Halton) (Lab)
If the reforms are so good, why have they been criticised by the chairman of the Royal College of General Practitioners, Dr Clare Gerada? She said:
“I think it is the end of the NHS as we currently know it, which is a national, unified health service”.
The British Medical Association has expressed concerns about competition, and we hear in this morning’s edition of The Independent from an unnamed “ally” of the Secretary of State that
“There is no wobble. No 10 and the Treasury are fully behind the principle of the reforms”—
obviously a very brave ally. Why has the Prime Minister asked the Cabinet Office Minister who is in charge of Government policy to review the plans? Is it because the Secretary of State is the only one who believes in them?
Mr Lansley
The hon. Gentleman should not believe all that he reads in the newspapers. The curious thing is that the Minister with responsibility for Government policy is engaged with Government policy. That is a good and positive thing. The hon. Gentleman referred to the Royal College of General Practitioners and to Dr Gerada. In response to the White Paper, the RCGP said:
“General Practice is the central plank in our world-class healthcare system. The College thoroughly agrees that it makes a great deal of sense to give GPs, with their unique patient-centred perspective, a central role in commissioning and directing healthcare services.”
Dr Gerada said:
“I fully support placing clinicians at the centre of commissioning decisions”.
Health (CSR)
Derek Twigg Excerpts(13 years, 6 months ago)
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Derek Twigg (Halton) (Lab)
I thank my hon. Friend the Member for Easington (Grahame M. Morris) for securing this very interesting debate and his excellent speech. Such debates are important to our more detailed examination of Government policy. This is the first opportunity I have had to welcome the Minister to his obviously well-deserved promotion. He is a stalwart supporter of the coalition Government and I am sure that his efforts had a lot to do with the coalition coming together. I look forward to hearing his speech.
It is interesting that not a single member of the coalition has stood behind the Minister to support his policy. That might indicate that the Secretary of State and his Department are somewhat isolated because there is a great deal of worry about what is happening. All the speeches have been very important. Of course, they have all been Labour speeches.
Derek Twigg
No, not all old Labour at all. There has been a mix of Labour: young, old, new—some a bit younger than others. My hon. Friend the Member for Easington made some very important points about this being the worst settlement since the 1950s, and he raised the point about rising to the challenge of the financial settlements and the impact on social care. We heard many important points from my right hon. Friend the Member for Rother Valley (Mr Barron) who, along with my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson), is probably the most experienced person in the Chamber, given his knowledge of the health service and his involvement in it over the years. One of those points was what the Nuffield Trust said about this being a real-terms cut, once the £1 billion that is being transferred from the NHS is taken out—I shall come back to that later. My right hon. Friend also made an important point about how the Government have used a Health Committee report to support their policies. His point was very clear, and he also raised the important issue of commissioning for GPs.
My hon. Friend the Member for Newport West (Paul Flynn) made a very important point about NICE and drugs companies with reference to funding and influence. My hon. Friend the Member for West Lancashire (Rosie Cooper) has great experience in the health service. She is a near neighbour, and our areas successfully share the excellent women’s hospital in Liverpool. She made a number of powerful and important points about the reorganisation and cost pressures, and their effects on patient care. She also talked about Ministers not listening—[Interruption.] I know that the Minister has listened to what has been said in the Chamber, but Ministers’ listening will also be an important aspect of the reorganisation.
My right hon. Friend the Member for Tottenham (Mr Lammy) made a powerful speech. I think he said that because he had believed what was in the Conservative and Liberal Democrat manifestos, he was somewhat disappointed—[Interruption.] Perhaps I got that wrong, but he made the point that what was said before the election and in the manifestos is not now being delivered.
Frank Dobson
Does my hon. Friend agree that if my right hon. Friend the Member for Tottenham (Mr Lammy) were a coalition Member and he believed everything that was in the Tory and Liberal Democrat manifestos, he would be unique?
Derek Twigg
I always carry a copy of the coalition’s programme for government—it is a fascinating read and, I must say, comforting at times.
My right hon. Friend the Member for Tottenham made some important points about mortality, the different life expectancy rates in his constituency, and the impact of the 28% cut on local government services, to which I shall return later in my speech.
Mr Simon Burns
I advise the shadow Minister to take the analysis of the right hon. Member for Tottenham (Mr Lammy) of the impact of the so-called figures that he used with a pinch of salt, because he also said that when he was as a Health Minister in 2001, he remembered the PCTs beginning to bed down. That was rather confusing, because of course the PCTs were not established until 2002.
Derek Twigg
The hon. Gentleman should have listened much more carefully to what my right hon. Friend the Member for Tottenham said. He made a lot of good points, including one about GPs being put under pressure by the reorganisation due to the fact that some of them do not have the skills that it will require. That was a very powerful point, because many GPs are either opposed to or very uncertain about the Government’s proposed reorganisation.
My hon. Friend the Member for Gateshead (Ian Mearns) made a very impassioned speech about his own experience, his local health service, of which he has great knowledge, and the consequences of the Government’s actions for A and E and maternity units. He also made an important point about the great uncertainty in the health service as a result of the reorganisation—not just financially, but in all aspects of the service.
It is worth reiterating that we have had some successes in the health service, although many of them were achieved in recent years by the Labour Government rather than during the Conservatives’ 18 years in government. Back in 1997, I was regularly contacted by constituents who had to wait between 18 months and two years to have an operation. We have now got that time down to 18 weeks or fewer, and two to three weeks for cataracts. I set out that information because the Government will be measured on such things, although I am not sure whether they will be “outcomes”, “horizons” or “milestones”. A million more operations have been carried out each year since 1997, and there is now rapid access to chest complaint clinics. A large part of the NHS estate dates from before 1948, but we now have more than 100 new hospital building schemes and more than 90 NHS walk-in centres.
We have not achieved those gains for patients without sustained, deliberate and targeted investment. The combination of reform and investment that Labour undertook when in it was power has brought about tangible results for patients: heart disease deaths are down by more than a quarter; cancer mortality rates are down by more than a tenth; and breast cancer and male lung cancer death rates have been cut faster than anywhere else in the world. Under the cancer target, patients now see a cancer specialist within two weeks, which saves many lives. We made real investment and real change, and real people’s lives were made better. Let us see how the coalition intends to honour some of Labour’s guarantees. It has scrapped the right to cancer test results within one week of referral.
Derek Twigg
As I said, that was one of our guarantees, and the Government have not taken forward those guarantees. They have gone against what we said, which was welcomed by many patients and organisations. Free prescriptions for vulnerable patients with long-term conditions have been scrapped and, in this Parliament, some 8,000 new psychological therapists have been scrapped.
Mr Burns
The shadow Minister is a reasonable and intelligent individual, so he knows that we did not scrap that target because it was never in place. All that happened was that the previous Prime Minister, at his party conference just over a year ago, made public an aspiration that was totally unfunded and totally untried against any clinical guarantee for quality.
Derek Twigg
The Minister should realise that he cannot meet what we proposed. I notice that he intervenes on that point, but not to congratulate us on the many improvements that we made in the NHS over the years. I look forward to hearing what he says about those improvements in his speech.
Returning to mental health, the Department of Health website says:
“Policy around mental health is developing…Mental health policy cannot be devised and implemented by any single government department or the NHS alone – it requires collaboration across central government, local government and the independent sector.”
We knew that already, did we not? However, the coalition has cut those 8,000 therapists. Of course the financial climate is difficult, and whomever was in government would have difficult choices and decisions to make, but the Prime Minister and the coalition have, again, broken their promises on health, which I want to explore, particularly with reference to the CSR.
For all the coalition’s boasts of ring-fencing the total NHS budget, the negligible 0.1% increase in NHS spending over the CSR period is low by historical standards, as we have heard. The King’s Fund has been cited, but let me give another quote from it:
“the NHS has averaged real terms increases of 4% a year since it was established and 7% since the turn of the century. The only similar period of near-zero real terms growth was in the early 1950s”—
I think that the Minister agrees. Spending in the NHS has increased from 6.6% of gross domestic product in 1996-97 to 8.7% in 2009-10.
The Minister might be interested to hear that the Royal College of Midwives has said:
“there are fears that a funding increase of 0.1% a year could be swallowed up by a rise in drugs, an ageing population, the cost of reorganisations and inflation.”
While we are on the subject of midwives, will the coalition deliver on the pre-election pledge to increase substantially the number of midwives, or will that be another broken promise?
Perhaps the Minister will want to respond to my next point. The CSR also announced that £1 billion will be transferred from the NHS budget to local councils for spending on social care. He will argue that that is designed to improve working relationships between the NHS and local social services departments, to improve health and to reduce costs on the NHS, such as by helping older people to stay healthy and independent in their homes. Of course, that is a good thing. However, the Government cannot have it both ways and double count. This is a real-terms change in NHS funding over the next four years. When we consider the net funding for social care support, there is a reduction of 0.5%, which is a real-terms cut.
Derek Twigg
The Nuffield Trust actually supports that point of view. This is a broken promise. Will the Minister confirm that not all the additional money for social services announced in the CSR is ring-fenced?
Mr Burns
I want to respond to the point that the shadow Minister made about the Nuffield Trust. He said that we were giving £1 billion to local authorities for social care, but we are not giving—[Interruption] I think that he did say that, but if he did not, we will wait for my speech.
Derek Twigg
Let me make it clear that £1 billion is being taken out of the NHS budget. Is that correct?
Derek Twigg
I am asking the Minister to intervene. Has £1 billion been taken out of the NHS budget for social care?
Mr Burns
I will be careful because of the context in which the shadow Minister is trying to put the matter. We have made no secret of what we have done. Because of the lack of funding for social care and the demand for it, which we inherited, we have decided that we will use £1 billion out of the capital budget on social care and, at the same time, local authorities, through the revenue support grant, will provide another £1 billion. There will be £2 billion of extra money: £1 billion from the health service, which the health service will spend, and £1 billion through the RSG.
Derek Twigg
I am not sure about that, although I am always happy for the Minister to intervene. Will he confirm, just for the record, that £1 billion has been taken out of the NHS budget?
Derek Twigg
I will carry on and we will take this up later during the Minister’s speech.
Will the Minister make clear whether the money has been ring-fenced? What what will be the impact on local services of the 28% cut in councils’ budgets over the next four years, which was announced as part of the CSR? We must not forget the increase in VAT to 20% from January, which several of my colleagues mentioned, which will do little to enhance the NHS’s spending power. It is little wonder that the King’s Fund feels it necessary to warn:
“slashing budgets and cutting services should not be the answer to the financial challenge facing the NHS.”
I cannot allow the Government to get away with another disastrous decision for the NHS and it will be interesting to see what the Minister has to say about this.
The NHS has accumulated £1.8 billion of capital and £3.7 billion of revenue underspend. It would normally be allowed to keep that money to reinvest in patient care or to help deal with future overspends, but the CSR has abolished end-of-year flexibility. Perhaps the Minister would like to deny that or tell me that we have got it wrong.
What estimate has the Minister made of the number of job losses and redundancies in the NHS that will occur as a result of the CSR? What will be the impact on waiting times in the spending review period? What is his estimate of the number of nurses who will be employed in the NHS at the end of the spending period? What measures has he implemented to deal with winter pressures? How many specialist nursing posts will be left vacant at the end of this financial year? I have many other questions. We do not have time to go into them now, but I shall be tabling a lot of written questions for the Minister to answer.
We now move on to another broken promise in the context of the CSR, which has been the subject of a fair bit of comment. An ideologically inspired, top-down reorganisation of the NHS has been proposed. It has been put forward in defiance of the coalition agreement. The approach is untested and threatens the viability of the NHS. I remind hon. and right hon. Members that the coalition agreement says:
“we will stop top-down reorganisations of the NHS”—
another broken promise. Here is a straight question for the Minister: why, as many believe, did his party hide their plans for such a massive reorganisation from the public? Why did it make no mention of the scale of the proposed changes in its manifesto or election campaign? This is the biggest reorganisation in NHS history. The King’s Fund estimates the actual cost at some £3 billion, and that is at a time when the NHS can ill afford it. The British Medical Association has stated:
“these proposals risk undermining the stability and long-term future of the NHS”.
What is the Minister’s latest estimate of the financial cost of the reorganisation, and will he publish the rationale underpinning the assumption for those costs?
The coalition talks about reducing waste, but the 45% cuts in strategic health authorities and primary care trust management will save just £850 million of the £15 billion to £20 billion of efficiencies that are required. I could not agree more with the words of my right hon. Friend the Member for Wentworth and Dearne (John Healey):
“This reorganisation is untested and unnecessary. It is high cost and high risk. At this time when finances are tight, all efforts should be bent to making sound efficiencies and improve patient care. We are in favour of giving clinicians greater responsibility and patients a greater say in their healthcare. NHS experts, professional bodies and patient groups say ‘slow down’, because this big reorganisation is a big risk for the NHS.”
Trade unions such as Unison, the RCN and Unite, who represent many who work in the NHS, have raised genuine concerns, but we do not believe that the Secretary of State is listening to what is being said.
As part of these changes, there is danger of fragmentation, of more of a postcode lottery and of doctors’ time being diverted from their main role of looking after their patients. We need to know the extent and nature of future private sector involvement in running the health service. How and to whom will organisations be accountable? How can we deal with current overspends in organisations, which my right hon. Friend the Member for Tottenham mentioned?
Will the Secretary of State and the Chancellor listen to the appeal of patient groups, Royal Colleges practitioners and other health staff, or is he bent on setting his face against the view from the coal face—from the same professionals whom his party’s manifesto says we should trust to deliver services?
I want to mention another important issue: the proposed stealth cuts to the funding of specialist children’s hospitals, which will affect the hospitals that treat some of the most severely ill children in the country. The Prime Minister promised that the health budget would be “protected”. In an interview with Andrew Marr on 2 May 2010, he said that he
“would not accept cuts to the NHS”.
It is unarguable that specialist children’s services are the front line, so even that is not being protected. This is another promise broken by the Prime Minister.
The Secretary of State is not being straight on this matter. During oral questions on 2 November, he told my right hon. Friend the Member for Holborn and St Pancras that the hospital that my right hon. Friend asked about would face a 2% cut under the proposed tariff changes. That is bad enough, but it is contradicted by the trust’s own assessment of those changes, which suggests that they will bring about much larger cuts. Will the Minister set out—I ask him this carefully—what the situation is and how much funding the hospitals will lose?
I will give a couple of examples of the figures that we have received from the hospitals involved. Great Ormond Street hospital, which is in the constituency of my right hon. Friend the Member for Holborn and St Pancras, will face a cut of £16.3 million. In Birmingham, the cut will be £12.8 million, and at Alder Hey hospital, on the doorstep of my constituency, it will be £12.9 million. Will the Minister confirm what the funding cuts will be and how much those hospitals will lose? What figures have the hospitals provided to the Department in their assessments of the cuts? Will he make public any assessment that has been sent to his officials about the impact of the tariff changes?
I do not feel that Liberal Democrat or Conservative Members have realised the true extent of what the coalition Government are doing to the health service and the impact that it will have on their constituencies. Perhaps they are not in the Chamber because they find the measures difficult to support. As the impact of the health cuts becomes clearer, I believe that hon. Members will become more worried and will seek answers to the broken promises of the Prime Minister and the Secretary of State.
There have been broken promises on NHS funding to protect front-line services, and broken promises about structural change. Hon. Members might ask why the Secretary of State is forcing the NHS into a major reorganisation that costs valuable time and resources at a time that the King’s Fund and the NHS Confederation have called the biggest financial challenge of its life. I assure the Minister and the Secretary of State that we will hold the coalition Government to account for what they have said and what they will do.
Mr Burns
I will briefly answer that now; I was going to come to it later. The figure that has been bandied around by shadow Ministers, Labour Back Benchers and so on is £3 billion. The Department does not recognise that figure. We recognise the figure that the previous Secretary of State for Health, the right hon. Member for Leigh, put in this year’s Budget, which is 1.7%. He put that in specifically for reorganisational purposes under a Labour Government. That is the only figure—[Interruption.] That is the only figure that we recognise.
Derek Twigg
The Minister is using a figure that was in the Budget for reorganisation. I assume that that reorganisation is not the reorganisation that his Government are proposing, so have he, the Department and his officials made any assessment of the cost of their reorganisation? That cannot in any way be linked to a figure that was laid down by the previous Government; it is bizarre if it is. If they have made such an assessment, what is the rationale for it and will he publish it?
Mr Burns
I am saying that the previous Secretary of State had built in to this year’s Budget a £1.7 billion figure for reorganisational purposes and we recognise that amount of money as money that can or could be used for reorganisational purposes. On the question of the full figures, we will publish in due course our response to the consultation process on the White Paper and the documents that flowed from that White Paper. Also, we will respond on any decisions that we have taken emanating from that consultation process. We will also publish the Bill, which will flesh out more of the details where details need fleshing out.
As a number of hon. Members mentioned, there are parts of the Bill where we are not prescriptive and we are not dictating, down to the last dotting of an i and crossing of a t, what has to happen. That will be down to local decisions. That will then put us in a position—
Mr Burns
The hon. Member for Newport West (Paul Flynn) probably is not aware, because this is a new form of debate following the setting up of the Backbench Business Committee, that I am not winding up the debate, even if I am speaking last. I am making a speech on the Government’s position on the subject that we are debating, and I will certainly—on occasions, where appropriate—refer to and answer hon. Members’ questions, although I have to say to the hon. Gentleman that I probably will not answer any of his questions because he was not taking part in the same debate that is on shown on the annunciator. He was having a general roam-about on NICE and pharmaceuticals, rather than speaking on the spending review and health.
Mr Burns
No, it is not. It is a fact, and the hon. Gentleman knows it.
As I said before the intervention and the point of order, just as important as reducing the deficit is protecting and improving the nation’s health. That is why I am proud that we have kept our pledge to protect the NHS budget. More than that, it will receive an increase of 0.4% over the next four years. In this difficult financial climate, that demonstrates the Government’s determination to provide the best care and the best outcomes for patients.
This year, the NHS budget is £103.8 billion. That will rise to £114.4 billion by 2014-15. No matter how anyone looks at that, it is obvious that it is a real-terms increase. A number of people who have sent in briefings for this debate and who have commented on the spending review have echoed the view that I have just outlined. It is a self-evident fact that it is a real-terms increase, however much Opposition Members prefer to say that it is not. The facts do not bear out that criticism.
Mr Burns
The shadow Minister must be patient; I will come to social care.
The Department’s capital budget will be sufficient to ensure that key schemes that have already been agreed are continued and that the NHS estate is properly maintained. The NHS capital budget will pay for, among other things, publicly funded projects at North Cumbria University Hospitals NHS Trust, Pennine Acute Hospitals NHS Trust, and Epsom and St Helier University Hospitals NHS Trust.
Notwithstanding the real-terms increase in funding, we always knew that the NHS was facing challenging times. That is self-evident and we have never sought to hide behind it; everyone recognises it. As a number of hon. Members said, that challenge is due to an ageing population, expensive treatments, and health care and social care costs rising substantially every year. That is why the NHS and social care need to do more with their resources and make every penny count. In health, we are asking the NHS to secure, as a number of hon. Members said, up to £20 billion of efficiency savings over the next four years through the QIPP—quality, innovation, productivity and prevention—programme.
In addition, every penny of those savings will be reinvested in front-line services, enabling us to meet the costs of increased demand for care. The savings will come from cutting administration costs across the system by a third, as well as from other efficiencies throughout the NHS. Frequently, better care can save money. It is cheaper, as well as better for people, to get the right care first time, rather than the inappropriate or insufficiently relevant care that is involved when people have to go back to be provided with extra care—an expensive way to provide care and not an experience that patients should have.
Mr Burns
On the issue of social care, it is accepted by all parties that we need to be more efficient. There have been historic problems in the funding of social care and we found that, given the mounting pressures and the economic situation when we came to power, there was a serious problem that needed to be addressed so as to provide support in the forthcoming year and thereafter for some of the most frail and vulnerable members of society.
We believe, as I am sure the hon. Member for Halton does, that re-ablement services can restore someone’s independence. They have a crucial role to play, where appropriate. Around half of those who go through re-ablement require no immediate care package afterwards. The NHS is investing £70 million this year, £150 million in 2011-12 and £300 million a year for the rest of this Parliament in better re-ablement services. That will have a significant impact on improving the lives of many people.
Telecare, too, can help keep people safe and feeling more confident in their own homes, reducing their reliance on formal home care services. These are not isolated cases. There are similar remarkable stories across the country.
Re-ablement can make a real difference, provided that the authorities act seamlessly and quickly to ensure the equipment and anything else needed to assist someone to return home, avoiding a stay in a hospital, care home or any other non-domestic environment.
Derek Twigg
We will pursue the issue about specialist children’s hospitals, but I will now concentrate on the issue of the £1 billion that the NHS has set aside for, or put into, social care. No one argues that putting more money into social care is not a good thing, but we want to ensure that there is no double counting. The Minister confirms that £1 billion has been set aside, but will some of that money, or all of it, be used to fund the social care side of those services provided by local authorities?
Mr Burns
If I may, I shall start on that point in my own way, as I want to give the setting for the whole social care thing. I know that the hon. Gentleman and the right hon. Member for Wentworth and Dearne (John Healey) have shown considerable interest in the matter.
The shadow Minister accepts that the NHS does not stand alone. It is only one part of this country’s care system; another essential service is social care, which helps hundreds of thousands of people to live as independently as possible. As I said earlier, when the Government were elected, we found a huge hole in funding for social care. That affects some of the most frail and vulnerable, and we believe that it is imperative to do something immediately to make up some of the shortfall. As the shadow Minister will know, the Department of Health has always funded social care—not all of it, but part of it—and local authorities have funded the other part. In some areas, there is a means test under the National Assistance Act 1948, so there are possibly three funding streams. I hope that I carry the shadow Minister with me.
To redress the funding gap in social care, the NHS will transfer up to £1 billion from the health capital budget to the health revenue budget by 2014-15. That will be spent by the health service on measures that support social care as well as health. That will include a specific allocation for re-ablement services to help people regain confidence and independence following discharge from hospital. We believe that this will help hundreds of thousands of people to live as independently as possible. To the person who uses both services, it makes no sense that health and care should be separate. I hope that I have given the shadow Minister sufficient explanation.
Mr Burns
If I carry on for another minute, the hon. Gentleman may not need to intervene.
As well as the extra £1 billion that the Department of Health is making available for NHS social care, additional grant funding—again, rising to £1 billion by 2014-15—will be made available for social care through the revenue support grant. By 2014-15, the total additional funding for social care will amount to £2 billion, half from the NHS and half in grant funding. That will be allocated in addition to the Department’s existing social care grants, which will rise in line with inflation. In total, therefore, grant funding from the Department of Health for social care will reach £2.4 billion by 2014-15. I hope that that explains the situation for the shadow Minister.
Derek Twigg
I want to be clear about it, so I put the question again. How much of the £1 billion that is being taken from the NHS budget will be spent on services that council and local authority social services provide?
Mr Burns
The £1 billion will come from the NHS capital fund and be transferred to the NHS resources fund. It will then be spent by the NHS on re-ablement and other sorts of help and care for which the NHS is responsible. The NHS is responsible for the social care element of the assistance required by those in need. [Interruption.] So that the shadow Minister understands, on top of that, £1 billion will be coming from local government through the RSG.
Oral Answers to Questions
Derek Twigg Excerpts(13 years, 6 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Lansley
Yes, I am grateful to my hon. Friend. Indeed, we will take account of precisely the point that he makes when we consult on how responsible officers in primary care will be established in future following primary care trusts. It is important to recognise that revalidation should be a process very like the normal appraisal of staff. However, when it comes to investigation of fitness to practise, it will be important for there to be proper independence.
Derek Twigg (Halton) (Lab)
This is a very important issue affecting patient safety. The Secretary of State will know that the British Medical Association has raised significant concerns about the revalidation proposals, referring specifically to the implications of the reorganisation. Does he recall criticising NHS reorganisations and their cost in his conference speech on 5 October 2009? Why, then, has he embarked on a reorganisation that will cost an estimated £3 billion at a time when the NHS will also face deep cuts because of his broken promises over funding?
Mr Lansley
May I welcome the hon. Gentleman to his new responsibilities?
We are doing this because it is absolutely essential for the NHS to use resources better to deliver improving outcomes for patients. A combination of the ability for general practice-led consortiums to combine the management of care for patients with the management of resources is instrumental to achieving that. It will deliver substantial reductions in management costs. We will achieve a £1.9 billion-a-year reduction in management costs by 2015.