NHS Commissioning Board (Mandate)

Henry Smith Excerpts

Tuesday 13th November 2012 Commons Chamber

[Mr Hunt]

I hope we can move beyond the debate about public good, private bad and private good, public bad that has dogged the NHS for many years. I believe there is a role for the independent sector and the voluntary sector. Of course, the primary role will be for the traditional NHS. However, when the private and voluntary sectors are used will not be a matter not for politicians or parties; but for local doctors on the ground. I think that in the vast majority of cases, they will want to use and contract with traditional NHS services, but it is important that they have the choice to do what is in the interests of the patients for whom they are responsible.

[Henry Smith (Crawley) (Con)]

For too many years in my Crawley constituency health decisions were made by people who were nowhere near that location. I am delighted that under this Government decisions are being returned to local clinicians and local people. We have seen results already—the local CCG has started a dementia pilot with money from the Department of Health. Will my right hon. Friend join me in congratulating that kind of vision, both in Crawley and elsewhere?

[Mr Hunt]

I am more than happy to do that, because when it comes to conditions such as dementia there is no one right solution, and doctors’ surgeries and hospitals will have different approaches in different parts of the country. We want everyone to take ownership of the problem. I hope that what is happening in Crawley will be noticed by other parts of the country, so that we can spread best practice everywhere. That is the point—we want to allow innovation to happen in a way that has never happened before.

Regional Pay (NHS)

Henry Smith Excerpts

Wednesday 7th November 2012 Commons Chamber

[Andy Burnham]

I know that many Members want to speak in the debate, so I shall give way once or twice, to ensure that there is time left for others to contribute.

[Henry Smith (Crawley) (Con)]

The right hon. Gentleman is right that it is a national health service that this country enjoys. Why, therefore, is a Labour Administration reducing funding to the health service in Wales?

[Andy Burnham]

I am here to talk about the NHS in England. I will come on to the Conservative Government’s record on funding the NHS in England, so I would not be so smug if I were the hon. Gentleman.

The drive to turn collaboration into competition depends on breaking national standards—breaking the “N” in NHS. The former Health Secretary’s request to the pay review body to consider the case for “market-facing pay” needs to be seen alongside his Health and Social Care Act 2012. Breaking national pay in the NHS is an essential step towards creating the free market in health that many in the Conservative party have long wanted, and which the Liberals now seem willing to let them have.

Business of the House

Henry Smith Excerpts

Thursday 6th September 2012 Commons Chamber

[Mr Lansley]

I must confess that I am slightly staggered that the hon. Gentleman now seeks to make a virtue of the fact that he and his party voted by a substantial majority for the principle of House of Lords reform, and then effectively sought to obstruct any progress. My definition of opposition is not obstruction. It may be his definition, but it is not mine.

[Henry Smith (Crawley) (Con)]

I warmly welcome my right hon. Friend to his position. Will he consider arranging a debate on over-zealous health and safety regulation? Apparently my local authority, Crawley borough council, has been told to remove all park benches that are under trees.

[Mr Lansley]

I hope my hon. Friend will not be surprised to learn that we in the Government have been working actively over the last two and a half years to ensure that common sense is at the heart of the way in which we apply health and safety regulations. It must be evidence-based, common-sense and proportionate. Measures have been taken, but I will certainly draw my hon. Friend’s comments to the attention of my colleagues in the Department for Business, Innovation and Skills so that they can continue the process.

National Health Service

Henry Smith Excerpts

Monday 16th July 2012 Commons Chamber

[Mr Burns]

I will give way to my hon. Friend the Member for Crawley (Henry Smith), then I will give way to the right hon. Member for Knowsley (Mr Howarth) and the hon. Member for Walsall South (Valerie Vaz), then I will stop giving way for a time to make progress.

[Henry Smith (Crawley) (Con)]

Earlier this year I was delighted to be able to open a new digital mammography unit at Crawley hospital, a hospital which under the previous Government saw its accident and emergency unit closed down. Does my right hon. Friend find it odd that the Opposition refuse to match the spending commitments on the NHS that this Government are delivering?

[Mr Burns]

My hon. Friend is right. As he would probably expect, I shall deal with that issue later in my speech. While I am responding to his intervention, let me say that not only was his hospital fortunate in having that fantastic equipment to look after his constituents, but I had the pleasure last week to be in his constituency to visit Elekta and Varian, which are world leaders in making equipment to help with radiotherapy.

Hospitals (Sussex)

Henry Smith Excerpts

Wednesday 20th June 2012 Westminster Hall

[Stephen Lloyd (Eastbourne) (LD)]

It is an honour to serve under your chairmanship, Mrs Brooke.

I am grateful that Mr Speaker has given me an opportunity to address an important local issue—the proposed reconfiguration of my local Sussex NHS trust, the East Sussex Hospitals NHS Trust. A number of reconfigurations have already taken place in Sussex, such as the transfer in March of in-patient elderly care and orthopaedics in the Western Sussex Hospitals NHS Trust from Southlands hospital to Worthing hospital. It appears that the latest direction of travel for Southlands is to become a day surgery and out-patients-only hospital, with which I expect few local residents would agree.

Let me give the Minister the details of the proposed changes to my local trust and hospital, Eastbourne district general hospital. Four or five years ago, the trust board wished to downgrade maternity at the DGH while maintaining consultant-led maternity at our sister hospital in the trust, Conquest hospital in Hastings. There was a substantial campaign against the proposals in which all parties were involved, and eventually the matter was referred to the Independent Reconfiguration Panel for consideration. It found against the proposals, and the trust-proposed strategy was sent to the then Secretary of State for a decision. I am glad to say that he backed the IRP and our campaign to retain consultant-led maternity on both sites.

As I am sure the Minister is aware, there was a number of reasons why the IRP found against the trust, but essentially the main reason was the poor road link between Hastings and Eastbourne, which would have meant a blue-light ambulance potentially taking upwards of 50 minutes to travel from hospital to hospital. From a patient safety perspective—for example, for a mother facing a complicated birth—that was considered far too long. Hon. Members can imagine my surprise to find out a few weeks ago that the new trust board is recommending a similar change—to be precise, that there should be a consultant-led maternity unit on one site and a midwifery-led unit on the other site. For the record, the road links between the DGH and the Conquest are even worse than they were five years ago, when the IRP found in our favour.

[Henry Smith (Crawley) (Con)]

I congratulate the hon. Gentleman on securing this debate. The story elsewhere in Sussex has been similar. A decade ago, we lost maternity services from Crawley hospital, which was a very retrograde step. Mothers now have to travel long distances and a difficult journey to East Surrey hospital for maternity services. The proximity argument is important.

[Stephen Lloyd]

I thank the hon. Gentleman for that important intervention, not least because he demonstrates that if the proposed downgrades go through, the backlog will be even worse. Patients coming from his constituency would have an even longer wait, which an expectant mum with a complicated birth cannot afford.

Along with maternity, the proposed clinical changes recommend significant further reductions to trauma and orthopaedics, general surgery, stroke, emergency care, acute medicine, cardiology, paediatrics and child health provision. I am no medical expert, but even I can see that if some of the proposals are carried through, they will lead to a substantial downgrade of core services at Eastbourne district general hospital. We are talking about a possible downgrading of a much loved hospital in one of the fastest growing towns in the south-east, where the fastest growing age group is the 25 to 45s. I am simply not prepared to stand idly by and allow that to happen. The people of Eastbourne and the surrounding area are not prepared to do so, and none of the local political parties is prepared to accept the proposals.

On that note, I am grateful to the Under-Secretary of State for Transport, my hon. Friend the Member for Lewes (Norman Baker), who is here supporting me in this debate, as he has done throughout the past few years. He was very heavily involved five years ago, when we won the last campaign. I also acknowledge the support I have received from the Minister of State, Department of Energy and Climate Change, the hon. Member for Wealden (Charles Hendry), the hon. Member for Hastings and Rye (Amber Rudd) and the Minister of State, Department of Energy and Climate Change, the hon. Member for Bexhill and Battle (Gregory Barker). They send their apologies for not being here, but they are very supportive of what we are trying to achieve. The local business community and the voluntary sector are also not prepared to stand by while our hospital’s core services face such a proposed downgrade. We will all fight the proposals vigorously and tenaciously. I cannot emphasise that strongly enough to the Minister.

Why are we so determined to fight? Let me flesh out just a little of what we believe the consequences will be if the proposed clinical strategy goes ahead. The first issue is travel distance. The travel time between Conquest and the DGH is 50 minutes. Even when the planned Bexhill-Hastings bypass is built, in however many years’ time, that journey time will be reduced by only five-and-a-half minutes. That is still way outside the guidance from the Royal College of Midwives on mothers giving birth safely. The IRP and the Secretary of State agreed with us on that five years or so ago.

Secondly, although I wholly accept that very specialised procedures—for instance, children’s cardiac surgery or even specialist oncology and cancer—are better in the fewer, larger specialist expert centres, the vast majority of Sussex patients also need good-quality local care for simple conditions. Why would the Department of Health encourage care closer to home and then sanction the massive movement of patients, which would be an inevitable consequence of some of the proposed changes?

Thirdly, there will continue to be two hospitals admitting medical emergencies, as there are too many patients to move them all into one giant hospital. The reality is that it is often difficult to make a diagnosis for elderly people, but the proposals mean that one unit will have a surgeon on call and one will not. An elderly person admitted to a hospital with no surgeon who proves to have a burst appendix or to be bleeding internally will have to travel from the DGH to Conquest. That simply cannot be safe.

Fourthly, both hospitals fix fractured bones, but under the proposed strategy, if someone has a fracture, they will have to travel. The number of elderly and frail patients with hip fractures having to travel will increase exponentially. It will take longer for them to get an operation, and the inherent delay will lead to worse outcomes. In addition, there is likely to be a longer waiting period to sort out social services, and the individual patient will have to be sent home from a greater distance. Surely that cannot be better for the patient. In fact, pretty much anyone with a broken arm, leg or hip that needs fixing will have to travel further. The service will not be better quality, Minister; it will just be slower.

Let us take a look at the nearby trusts that will, apparently, take up the slack. This is patently absurd. Brighton more often than not has huge waits, and Pembury is full, so that is no answer. In stroke care, elderly patients will be moved, making it doubly hard for their similarly-aged husbands and wives to visit. Is that good practice for the patient? I do not think so. There is more, but I am that sure the Minister gets my drift. If he does not, let me draw his attention to the contents of a very important letter that was leaked to me a couple of weeks ago—I am happy to share the contents of the letter with him afterwards.

The letter was sent to the trust board from the consultant advisory committee that represents the most senior clinicians at Eastbourne district general hospital, following a meeting that 63 consultants attended. I quote:

“The main body of Consultant Opinion expressed little or no confidence in significant elements of the strategy… Concerns repeatedly expressed (by the Consultants) were that proposals would not advance the desire for improved access and quality of care for patients in East Sussex”.

These are direct quotes. The letter continues:

“There was frustration that clinical input from the majority of CAC members into the strategy has not been taken into account. Furthermore, concern was expressed that although Management has described the strategy as clinically led, this has been by a few invited individuals and the majority Consultant opinion expressing concerns regarding many aspects of the strategy has not been adequately expressed… the clinical strategy as explained and understood by the CAC does not deliver clear benefits to patients and therefore cannot be supported in its current form”.

The CAC letter further states:

“our local population rightly expects key services should be maintained at both sites and that these include stroke care, orthopaedics and trauma, general surgery and other core services. The strong recommendation of the CAC was that both sites should be developed to improve quality of care, training issues and access for local patients”.

I shall conclude my speech, because I am very keen to listen to the Minister’s response. Time precludes me from going into detail about the cross-party “Save the DGH” campaign group, which has been working together for years. It succeeded five years ago and has come back together stronger than ever. Time precludes me from talking about the fantastic work that has been done by our chair, Liz Waike, the strong determination in my constituency to protect core services at the DGH, and the important support provided by our local paper, the Eastbourne Herald.

I also do not have enough time to talk about the details of the utter financial shambles. The trust has been under successive managements since it was merged with the Conquest more than 10 years ago. I am well aware that, like me, the Minister has a business background. The financial inefficiency of the trust for many years has been mind-blowing. I would be happy to give the right hon. Gentleman more details at another time.

Time precludes me from giving details of the severe morale challenges felt by community nurses, who face reductions while at the same time being told ad nauseum that they must keep people in the community, so as not to take up expensive hospital beds. Time precludes me from telling the Minister of the sheer frustration that my constituents and I feel as we have to fight a similar battle around maternity all over again, despite the IRP’s clear conclusions five years or so ago.

Time precludes me from presenting details of how, if necessary, we should seriously consider de-merging the trust and setting Eastbourne DGH up as a separate foundation trust. We have been doing this work for many months now, as we suspected that proposals to downgrade DGH core services from the current trust board were in the pipeline. I have even had a number of key people in the DGH campaign visit an equivalent sized trust in Yeovil in the west country. We came back from that visit with some very useful data and plans for if we were to de-merge.

As time is an issue, I will finish with a direct quote from our mutual friend and colleague, the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), who wrote in a letter that I received yesterday:

“The Government has said that, in future, all service changes must be led by clinicians and patients”.

The clinicians, as I have already reported, have profound concerns. I can assure the Minister of State that patients—former and future, from Eastbourne, Willingdon, Lewes and beyond—also have profound concerns about the proposed clinical strategy currently presented by East Sussex Hospitals NHS Trust managers.

I ask the Minister to take on board our concerns, to do what is necessary to address them, and to ensure that our hospital, Eastbourne DGH, is continues to perform as a fully functioning district general hospital for many years to come. Eastbourne is a growing town—in many ways, we are bucking the economic trend—and I am working closely with business and the council. We are rolling up our sleeves up in this difficult economic climate. I have already mentioned that the fastest-growing demographic in my constituency is the 25-to-45 age group. I need a proper hospital for Eastbourne. I need a district general hospital for the long term. I would welcome any comments that the Minister has to make.

Health and Social Care Bill

Henry Smith Excerpts

Tuesday 20th March 2012 Commons Chamber

[Henry Smith (Crawley) (Con)]

It is a great honour to take part once again in a debate on the Health and Social Care Bill. I first made a contribution to these debates in 2010 and, as the right hon. Member for Wentworth and Dearne (John Healey) said, since then there have been 14 months of detailed and careful consideration of the Bill’s provisions. That says a lot. There has been criticism both in this debate and previously that the Bill is ill-considered and has been rushed through, but given the consideration of it that there has been over such a long period, and with so much public involvement and comment, that is clearly not the case.

The right hon. Gentleman also said that our NHS is truly a precious institution for each and every one of us—our own family members as well as all our constituents—and I agree. People rely on the health service and hold it very dear, and it is therefore right for passionate feelings to be expressed about its future both in this Chamber and outside. I contend that because we have a changing demographic and magnificent advances in medical technology, the way our national health service is run cannot stay still.

[Helen Jones (Warrington North) (Lab)]

No one on the Opposition Benches has argued that the NHS does not need to continue to improve. That is not what we are discussing; we are discussing the risk register. Does the hon. Gentleman believe that the Government should abide by the tribunal’s decision, or does he believe they should continue to ignore that lawfully made decision?

[Henry Smith]

I think the biggest risk to the national health service is if we do not reform it and move it forward. It needs reform to stay relevant to the needs of all our constituents. I find the Opposition’s position strange—I would put it down to political opportunism, but I am happy to take another intervention if Opposition Members want to state their case—given what happened with the three requests made when the right hon. Member for Leigh (Andy Burnham) was Secretary of State and under his predecessor.

[Andy Burnham]

Does the hon. Gentleman understand the difference between a strategic risk register and a transition risk register?

[Henry Smith]

I believe I do understand the difference between the different types of risk register, but if we simply stand still and have inertia in our health service, it will become less relevant.

The right hon. Member for Holborn and St Pancras (Frank Dobson) accused members of my party of being chancers. I prefer to consider us as reformers, and only if we embrace reform will we be able to provide a better NHS.

[Fiona Mactaggart (Slough) (Lab)]

One reform that I imagine the hon. Gentleman will welcome is the Chancellor’s proposal, which we gather we will learn about tomorrow, that every taxpayer can find out where their taxes go. As the taxpayers have paid for the compiling of the risk register, why should they and we not be able to read it?

[Henry Smith]

I am a great supporter of transparency across all our public services, and the people of this country thirst for transparency about how their hard-earned money is spent.

The Health and Social Care Bill provides for the democratisation of the national health service. The experience of the NHS in my constituency over the past decade was the sad loss of the maternity department at Crawley hospital, followed four years later by the closure of its accident and emergency department. One reason why those two units and others were transferred from my constituents’ local hospital was that decisions about the national health service were made nowhere near where they took effect.

The Bill will allow local clinicians, in conjunction with their patients—and, I might add, with democratically elected local government—to have a much greater say in how the NHS is delivered and greater scrutiny of it. We will have a far more responsive health service. It has been almost decades since health decisions in Crawley were made by clinicians, patients and elected councillors. By repatriating many decisions, we will have a more transparent and responsive health service.

It was a great privilege to be able to open the new digital mammography unit at Crawley hospital a few weeks ago. That is a classic example of a health service that develops in line with technology and with the changing needs of our population. I am confident that the Bill will give local clinicians, patients and democratically elected local representatives the tools to provide a far safer and more relevant national health service to the people of my constituency and constituencies up and down the country.

In conclusion, after 14 months of careful consideration of the Bill, it is time we get on with the reform of the national health service, which goes hand in hand with the increased investment in it that the Government have guaranteed at least to the end of this Parliament. I might add that that is in stark contrast to what is happening in Wales, where Labour is in control of the NHS and where budgets have been cut. The people of Wales are feeling the result. I want to resist that happening to patients in England and therefore believe that it is time to get on and pass this legislation for the good of our NHS.

NHS Risk Register

Henry Smith Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Mr Lansley]

My hon. Friend makes an important point that I understand precisely. He has been a strong advocate on behalf of not only George Eliot hospital but the whole health service in his constituency. I appreciate that.

I shall give a practical example. When I was at the Stobart centre meeting hundreds of general practitioners from across the north-west, those from St Helens said, “We’re really worried about Whiston hospital”—a PFI approved by the previous Secretary of State—“and we can’t deliver the service that we want to for our patients, because all the money will be eaten up by the PFI project at Whiston.” That is precisely why we are tackling the risks that we inherited from Labour.

The NHS also faces risks from Labour’s failed approach to public health. Under Labour, public health budgets were raided and alcohol-related admissions to accident and emergency departments, and levels of obesity and sexually transmitted infections, all rose sharply. I was staggered to hear the Leader of the Opposition talking about fragmentation of sexual health services at the last election. The last Conservative Government—I hope that my coalition colleagues will forgive me for a moment, because I am talking about the Conservative Government before the Labour Government—acted on sexual health, not least in relation to HIV. As a consequence, not only were HIV rates among the lowest anywhere in Europe but sexual infection rates fell for a decade. After the 1997 election the Labour party failed on sexual health, and sexual infection rates rose for a decade. Labour’s position has no basis. We had some of the highest HIV rates at the end of the previous Government’s term. It is outrageous. The Opposition have completely wiped out their recognition of what went wrong under the Labour Government, including on sexual health matters. That is why we are dealing with those risks.

[Henry Smith (Crawley) (Con)]

rose—

[Mr Lansley]

I will mention one more risk, and then give way to my hon. Friend.

There is one more risk: Labour’s IT programme—not a small risk, but a risk of £7.4 billion-worth of contracts, and a risk not just of money not being spent properly or being wasted, but of the opportunity cost to the NHS of not getting high-quality IT in place. This morning I had the pleasure of launching a “Maps and apps” event, showing how we are promoting the use of the latest technologies across the NHS, not on the basis of the Government saying, “Here’s the single app that everybody must use in the NHS: it’s a centralised system,” but by allowing literally hundreds of people—enterprising people from across the NHS and beyond—to bring in new technology applications for the benefit of patients and clinicians across the service.

[Henry Smith]

I am grateful to my right hon. Friend for giving way. Going back to the Labour PFI burden that we have been left with, can he confirm a figure that I heard recently, which is that the burden on the NHS budget amounts to about £3,000 a minute?

--- Later in debate ---

[Henry Smith (Crawley) (Con)]

I am grateful to have the opportunity to take part in the debate. As I have said in the House before, every right hon. and hon. Member feels passionately about the NHS. We have legitimate disagreements about the best way forward for the national health service, but we all know that it is something that each and every one of our constituents, almost without exception, and each and every member of our families, cares about. We have all relied on our health service at one time or another. It is therefore understandable that debates about the future direction of the NHS should arouse the sort of passion articulated earlier today.

It is important in the debate to reiterate what my right hon. Friend the Secretary of State said, which has been repeated by other hon. Members—that as a result of the Health and Social Care Bill, the national health service will remain free, regardless of the ability to pay, and universally available to all citizens of this country. When we discuss improvements to the health service, it is outcomes that we need to focus on.

I believe that the biggest risk to the NHS—which, as the shadow Secretary of State has said, is one of this country’s most respected institutions—is allowing it to continue with inertia and carry on as it has done in the past. At best that is a sentimental and quaint way of looking at the future of our health service. At worst it is dishonest and dangerous for the future health care of each and every one of our constituents.

Certainly, the experience in my constituency shows that the health service desperately needs change, and that without it we risk the quality of care. In 2001 maternity services were removed from Crawley hospital, and in 2005 we lost our accident and emergency department. The risks that have been experienced since those events have increased immeasurably, but since we have started to move towards the provisions of the Health and Social Care Bill we have seen considerable improvements. Waiting times have reduced for my constituents. Local GPs and clinicians very much support the provisions of the Bill and have already joined together in a GP commissioning consortium. The elected local authorities, which are a welcome addition to local health debates, are engaged, which is great for improving future health care provision and ensuring the involvement not only of patients and clinicians but of elected councillors. Only last week I was delighted to open a new digital mammography unit at Crawley hospital and a new day unit being expanded there, so already there are improvements.

In my concluding remarks I want to talk about the inconsistency we have heard from the Labour party on the release of the risk register. As we have heard, the right hon. Member for Leigh (Andy Burnham), the former Health Secretary, and his predecessor in that job, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), rejected making the risk register available on a total of three occasions. The argument that things are now different is just nonsense; the only thing that is different is that Labour are now in opposition. They are using precious time in this place to call for the release of a risk register that, as my hon. Friend the Member for Kingswood (Chris Skidmore) has said, is now over a year old and no longer relevant, because we have moved on with—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. I call Hugh Bayley.

Midwife and Maternity Services

Henry Smith Excerpts

Tuesday 17th January 2012 Commons Chamber

[Henry Smith (Crawley) (Con)]

Thank you, Mr Speaker, for the opportunity to hold this debate on midwife and maternity services. It is particularly important because, as I speak, there is a baby boom in the UK. Last year, a baby was born every 40 seconds—the highest number in 20 years—and in certain areas of the country maternity units are under considerable pressure and midwives are working harder than ever. England has seen a 22% increase in the number of births, compared to Wales at 17%, Northern Ireland at 15%, and Scotland at 12%. The number of live births in England in 2010—the latest year for which figures are available—was well over two thirds of a million, representing an increase of 22% since 2001.

The Royal College of Midwives recently published its “State of Maternity Services” report, and I was pleased to be at its launch in Westminster Hall. The report looks at a number of indicators of the pressures on maternity care and the resources available to cope, and for the first time it does so for all four nations of the Union. The report finds that a significant increase in the number of births in each of the UK’s constituent parts and a trend towards older mothers are increasing the pressures on maternity services significantly. The extra work load placed on midwives by more older women giving birth has been exacerbated by an increased complexity in their work load.

The number of births to women aged 40 or over rose by more than 70% between 2001 and 2010—a level not seen since 1948. In England that has led to a substantial deficit in the work force needed to provide a safe level of care to women and their babies. Furthermore, the existing midwifery work force in England is ageing. We can therefore anticipate an even greater strain on services over the next 15 years, if the situation is not properly addressed. One region of England actually cut midwife numbers between 2001 and 2010. Between those years, the north-west experienced a 19% increase in the number of live births, but a reduced number of full-time equivalent midwives.

The only way to get large numbers of new midwives into the profession is through training student midwives, yet the record on student midwife numbers is patchy. In the 2005-06 academic year, for example, there was even a 16% cut in student midwife numbers, and it took five years for those numbers to climb back up to their 2004-05 level. With an ageing profession, a substantial and consistent rise in student midwife numbers is the only way of rectifying the enduring problem that there are too few midwives working in the NHS in England.

I very much welcome the increased number of midwives and trainee midwives introduced by the Government. That is fundamental. I also very much welcome the increase in NHS funding over each and every year of this Parliament, including the greater investment in maternity care as part of the solution. However, the financial limits resulting from the historically high debts that the previous Administration left us mean that innovative ways to address the work force shortages need to be considered.

I know that the Royal College of Midwives, for its part, is realistic about the financial challenges facing the NHS. The “State of Maternity Services” report recommends, for example, providing more midwife-led units and appropriately integrating maternity support workers as two ways to make better use of the limited financial resources available. The report also recommends at least maintaining, and in some regions increasing, the number of student midwives to ensure that more midwives are available to meet future needs.

Maternity services in England are approaching a critical point. London, along with many parts of the south and east, is particularly overstretched, with some maternity units currently having a midwife vacancy rate of over 20%. Maternity services in Scotland, Wales and Northern Ireland are in better shape. According to the Royal College of Midwives, an average ratio of one midwife to 28 births is a safe level. At the moment the figures for the UK are as follows: in England there is one midwife for every 33 births, in Wales there is one for every 30 births, in Northern Ireland one for every 28 births, and in Scotland one for every 26 births. There are clear variations in care across the UK that need to be addressed. It is clear that with adequate midwife numbers to match the birth rate, mothers and babies receive a higher standard of care.

The situation in England is a concern, but it is certainly not hopeless. The midwifery shortage can be solved; it is simply a matter of policy will and using resources innovatively. For example, giving expectant mothers real choice when deciding where to give birth could alleviate the shortage problem in England. In essence, a mother has three main choices when choosing the location of birth: a midwife-led unit, a consultant-led unit or at home. Most women choose a local hospital, usually for convenience and because of the perception of safety and security. Encouraging more births at midwife-led units, however, would help with NHS work force planning. Births at home or in midwife-led units require fewer interventions and are less demanding on midwife time. According to calculations, for every 10,000 births moved from a consultant-led to a midwife-led unit or to the home, the required midwifery work force would be reduced by the equivalent of 71 full-time midwives.

There are significant variations in home birth take-up, which suggests that the message of choice is not getting through to all mothers. For example, in Somerset 11.4% of births are at home. At the other end of the scale, however, in Wansbeck, just 0.1% of births are at home. By encouraging real choice we could enable mothers across the country to receive higher levels of care during and after their pregnancy.

Choice of location of birth—that is, of course, a specific coalition policy set out in the NHS White Paper—is far too important to be denied to mothers, particularly when it is readily available in other parts of the country. According to the Office for National Statistics the percentage of home births decreased to 2.5% in 2010 compared with 2.7% the previous year.

Research by Oxford University’s national perinatal epidemiology unit has given further weight to the evidence that suggests women at a low risk of complications should be given full and frank options when it comes to choosing where to give birth. The general secretary of the Royal College of Midwives, Professor Cathy Warwick, welcomed the research, saying:

“This ground-breaking research makes a very important contribution to the evidence base for women and health professionals about the safety of childbirth planned in different settings for women at a low risk of complications. The RCM hopes that its findings will be widely used and will help health professionals support women to make informed choices about their options when considering where to give birth. It should also influence the planning of high-quality maternity services across the UK.”

Maternity support workers who have been adequately trained, and are appropriately supervised and suitably deployed, can also provide a significant reduction of the pressure on midwife time.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this matter to the House. He will be aware that some 70% of midwives oversee the birth of a child without a doctor’s support. He has not mentioned that it can cost up to £45,000 to train a midwife. Some of our midwives, certainly some from Northern Ireland, are going to Australia to gain experience. Does the hon. Gentleman see some way of retaining midwives here in England, where, as he has said, there seems to be a shortage? Might there not be some way for the regions to help each other in this respect?

[Henry Smith]

The hon. Gentleman has raised an important point, which reinforces my view that there must be proper investment—the Government are already making a good start—to ensure that student midwives learn how to help mothers give birth in a safe environment so that in most cases there are no complications. It should be emphasised that consultant-led maternity units, although obviously vital, do not represent the full picture, and that midwife-led units play an important role in increasing capacity. Midwife training in each part of the United Kingdom should be at least maintained, and in some regions increased. It is necessary to maintain the numbers who begin training to ensure that an adequate supply emerges at the other end, and I repeat my commendation of the Government in that regard.

Let me end by referring to a matter related to my constituency. Yesterday evening, during the Opposition day debate on the NHS, I mentioned that 10 years ago, in 2001, the maternity unit at Crawley hospital had regrettably been closed and moved nearly 10 miles up the road to East Surrey hospital. The move has created extra pressure at that hospital, and mothers and their families have a more difficult journey to attend the unit at for check-ups and for births.

I am personally very grateful to East Surrey hospital. It is where my children were born. My daughter Georgia was born there in 2003, my son Isaac was born there in 2006, and I feel that it is important also to mention that my son Ethan was stillborn there in 2005. The care that the hospital provided for us was second to none. Nevertheless, I think it important for mothers and families to have access to midwife-led services that are closer to their communities. It is certainly one of my hopes and desires that we may be able to establish a midwife-led unit for Crawley—and, indeed, many more such units throughout the country.

NHS (Private Sector)

Henry Smith Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

Just hang on and listen. Nothing has been done to the Bill to bring together the Prime Minister’s and Deputy Prime Minister’s promises that there would be no privatisation. There has been no substantial change since the pause.

Let me come directly to whether the Bill represents a privatisation of the kind that we saw in the 1980s. In doing so, I shall refer to a report from the King’s Fund, which I recommend to the hon. Lady. The Government have failed to introduce measures that they promised, months after the pause, so it is still considered appropriate for a body as respected as the King’s Fund to make a fairly shocking comparison that, indeed, the Bill is similar to the privatisations of the Thatcher Government. The report says:

“The Government’s proposals draw heavily on the regulatory framework developed in telecoms and utilities regulators …Interestingly, Secretary of State for Health Andrew Lansley’s own ideas for the reform of the NHS, developed while in opposition, were born out of his experience of the privatisation and regulation of utilities in the mid-1980s when he was Principal Private Secretary to Norman Tebbit.”

There we—[Interruption.] Okay, there we have it. That is the view of the King’s Fund—this is a privatisation along the lines of those we saw in the 1980s.

To back up that point, the King’s Fund quotes from a speech that the Secretary of State gave in 2005 to the NHS Confederation. He said this of the 1980s privatisations:

“The combination of the introduction of competition with a strong independent regulator delivered immense consumer value and economic benefits.”

There are two problems with that statement. First, there are real questions about whether gas, electricity, water and rail customers feel that they have had immense value. Secondly, it is troubling that the Secretary of State for Health, of all people, considers the delivery of health care directly comparable to telecoms and utilities.

[Henry Smith (Crawley) (Con)]

Does the right hon. Gentleman recall saying in 2007 that he celebrated the role of the private sector in the NHS?

[Andy Burnham]

This is getting a little tedious. May I refer the hon. Gentleman to the motion, which indeed does the very same thing? It recognises the fact that there is

“an important role for the private sector”

in the delivery of good NHS care and celebrates the role that it played in helping us to deliver the lowest ever NHS waiting times. Before intervening in future debates, he might like to read the motion that the House is considering.

Let me quote the Secretary of State’s interesting 2005 speech to the NHS Confederation, which set out the essential ingredients that we now see in his Health and Social Care Bill. His plan was to

“maximise competition, transfer risk to the private sector…appoint a strong, pro-competitive regulator…set out clearly the standards which have to be met and how operators will be held accountable for them…be clear about how and by whom universal service obligations are to be met…ensure high quality information for customers”

and have

“more customers rather than fewer.”

That is, do not have a few monopolistic health authority purchasers. The Secretary of State is nodding in assent that that is, essentially, his Health and Social Care Bill. This is, of course, the basic framework that the House of Lords is considering, despite the Deputy Prime Minister’s claim to have rejected

“the free market dogma that can fragment the NHS.”

A phrase leaps out of that 2005 speech that, in the light of recent events, needs to be challenged. It is

“transfer risk to the private sector”.

While acceptable in theory, I wonder whether recent experience with the private cosmetic surgery industry has led the Secretary of State to reconsider whether and how, in the health context, that can be delivered in practice. In an NHS based on commercial contracts, would there not always be arguments about legal liability when things went wrong? Would it not be much harder to control quality and costs in such a way, rather than through the current planned and managed NHS system that we have?

--- Later in debate ---

[Mr Lansley]

There will not be any transfer of responsibility for services from the NHS to the private sector; the NHS will continue to be responsible. The balance in the NHS—[Interruption.] No, I shall answer the right hon. Gentleman’s point. He is trying to interpret “privatisation” as every service currently provided by an NHS provider being provided by an NHS provider in the future, but whether services are provided by the NHS or by a private enterprise, a social enterprise or a charity will be determined by patients choosing who is the best-quality provider. So that is not privatisation; the service remains free, and it remains an NHS service. It is guaranteed to patients in exactly the same way, and there is no presumption in the legislation—in fact, it excludes any presumption—in favour of a private sector provider as against an NHS provider.

The right hon. Gentleman is in absolutely no position to make any criticism of that, because he served in a Government who introduced independent sector treatment centres. They went through the process of giving the private sector contracts that were not available to the NHS, with an 11% higher price on average and a guarantee that they would be paid even if they did not necessarily provide the treatment. The net result was £297 million spent on operations that never took place, and the private sector walked away with that money, so he is in absolutely no position to make any criticism, because we are going to exclude such practices. The contracts that the Labour party gave to the private sector when he was a Minister are exactly the contracts that our legislation will exclude.

[Henry Smith]

Will the Secretary of State confirm that, under the previous Administration, private sector involvement in the NHS went up by 78%?

[Mr Lansley]

Interestingly, under the so-called extended choice network that the Labour Government introduced, the number of elective operations conducted in the private sector went from, I think, 16,000 in 2005-06 to 208,000 in 2009-10—an enormous increase. From the right hon. Gentleman’s point of view, it was marginal capacity that did not really matter, but the point is that patients said that they thought it provided good quality care. In a Care Quality Commission survey, some 96% of NHS patients using independent facilities said that the elective surgery they received was “excellent” or “very good”. The figure for NHS facilities was 79%. On the NHS Choices website, nine of the top 20 highest-rated NHS-funded providers were run by the independent sector; there were no independent-sector hospitals in the bottom 20. The general proposition is that the private sector is worse in the NHS, but there is no evidence to support that.

The right hon. Gentleman will recall that the Royal College of Surgeons conducted a study of the quality of care, and its general conclusion was that the quality of clinical care offered to NHS patients by private sector providers was as good as the care offered by the NHS. So what is his point? He used the private sector, patients used the private sector and patients were happy. What is his point?

--- Later in debate ---

[Henry Smith (Crawley) (Con)]

I am grateful to be called, Mr Deputy Speaker. I had three reasons for writing to Mr Speaker requesting to take part in this debate. The first is that I genuinely wanted to hear, in this Opposition day debate on the NHS, what the Opposition’s plans really are for the future of our health service. The second reason is that I want to describe the experience that my constituents went through, over 13 years of a Labour Administration. Finally, I want to talk about how already, in anticipation of the Health and Social Care Bill becoming law, clinicians in Crawley are working to deliver a better national health service.

I do not mind telling the House that I am forgoing an invitation to a dinner this evening, so great was my desire to hear exactly the official Opposition’s view on the NHS. What I have heard this evening is incredible—or, so that I am not misunderstood, not credible. It is amazing that a party that massively increased the PFI programme during its tenure, spending billions of pounds of taxpayers’ money in an inefficient way through the national health service, should come to the House this evening and try to claim that what we are trying to achieve in the Health and Social Care Bill will somehow privatise the national health service. Let us be quite clear: this Government are committed to providing a national health service that is available regardless of the ability to pay. The difference, I contend, between Government Members and Opposition Members is that they are ruled by some sort of centralist dogma that says that if the Department of Health has not willed it, it cannot happen, whereas the Government are trying to introduce a pragmatic approach, in which outcomes are far more important than the strict processes that a dogmatic system for delivering health care should produce.

I said that I wanted briefly to mention the experience of the NHS during what we are often led to believe were the golden years of the health service, under the previous Government. Those years were not so golden for my constituents, because in 2001—a decade ago—we regrettably saw the downgrading of maternity services at Crawley hospital. Crawley is a growing town; indeed, its motto is, “I grow and I rejoice”. However, there was not much rejoicing when its maternity services were taken away and transferred almost 10 miles up the road to East Surrey hospital, where there is now increased pressure on maternity services, as it is having to cope with the increased number of people from not only east Surrey, but the north-east of West Sussex.

To add insult to injury, in 2005 Crawley hospital saw its accident and emergency department closed. Again, it was moved miles up the road to East Surrey hospital, even though there is little public transport between that hospital and Crawley—a growing and ageing town, with increasing health needs and major transportation links, not least the nation’s second biggest airport, London Gatwick—and single-carriageway roads. At best, that is inconvenient for patients and for families wishing to visit them in hospital; at worst, it is potentially fatal. That is my constituents’ experience.

[Barbara Keeley]

The hon. Gentleman is making a defence of A and E and maternity services, but does he not recognise that, despite the promises made by the current Secretary of State during the election campaign, many hospitals have, for clinical reasons, done the very same thing? They include Salford Royal, which has lost its maternity services, and others in the north-west, even though the Secretary of State promised that that would not happen to them. Does the hon. Gentleman not see that those things are going on now?

[Henry Smith]

The principal reason behind the closure of the accident and emergency unit at my local hospital was the European working time directive, which had a massive impact across the national health service. The NHS as an institution will of course evolve, the better to serve patients up and down the country. That is absolutely right.

That brings me to the third point that I wanted to make: the opportunity that the Health and Social Care Bill will provide for greater localisation in decision making on the future of health care services. I am delighted that the clinicians and GPs in Crawley have already come together to form a GP commissioning body, which is very ably chaired by Dr Amit Bhargava. It is brimming with ideas for innovative ways in which patients can be provided with much better services. For the first time in many years, decisions about the future of health care in Crawley are being made by Crawley clinicians, in conjunction with their patients and in the light of their patients’ needs. The group is working in conjunction with the local authorities—West Sussex county council and Crawley borough council—which, incidentally, will be providing oversight of some of the private sector contracts in the national health service, as envisaged in the Bill. The provision of that democratic oversight for the first time will achieve a localisation of services that is more relevant to the needs of the local communities, as well as a far greater degree of oversight.

I reject the motion before us, and I welcome the Health and Social Care Bill. It will be better for patients and better for democratic oversight. Ultimately, we should be talking about, and delivering, better outcomes for health care in this country, not remaining wedded to an outdated dogma which does not deliver services as efficiently as it could and should deliver them.

Oral Answers to Questions

Henry Smith Excerpts

Tuesday 22nd November 2011 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I know that the right hon. Gentleman has campaigned hard on this issue. I can assure him that I recently met a group of MPs, and constituents of theirs who are suffering from hepatitis. As he knows, there is a wide spectrum of illness associated with chronic hepatitis C infection. We are aware that people could be suffering financial hardship as a result, and I would urge them to apply to the Caxton Foundation. The Department’s expert advisory group on hepatitis C will continue to keep the evidence under review.

[Henry Smith (Crawley) (Con)]

T7. In a number of surgeries in my constituency, and in many across the country, physicians’ assistants play a very important role in enhancing capacity. Can my hon. Friend say whether there are any plans in the Department of Health to allow physicians’ assistants to be able to prescribe medication?