Public Health Grants to Local Authorities (2013-14) and (2014-15)

Jeremy Hunt Excerpts

Thursday 10th January 2013 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today I am announcing ring-fenced public health grants to local authorities for 2013-14 and 2014-15.

This Government have an ambitious vision to help people live longer, healthier and more fulfilling lives, and to improve the health of the most vulnerable fastest. From April 2013, upper tier and unitary local authorities will take on a new duty to improve their population’s health, funded by this ring-fenced budget. Local authorities are best placed to understand the needs of their communities, and to tackle the wider determinants of health at a local level, putting people’s health and well-being at the heart of everything they do—from adult social care to transport, housing, planning and environment. The public health grants will allow local authorities to transform the lives of the local people through commissioning a wide range of innovative services.

Despite difficult financial circumstances, I am pleased to announce that we have been able to provide an above inflation growth representing a major investment in health and the prevention of illness. We are investing £2.7 billion in 2013-14 and £2.8 billion in 2014-15. In each year every local authority will see real-terms growth. This is on top of an updated 2012-13 baseline that is now just over £2.5 billion, significantly above the estimate of £2.2 billion that we published in February last year.

Announcing allocations for the next two years will provide local authorities the certainty they need to extend and develop their planning, including for initiatives that may be better delivered across more than one year.

The allocation is built on the advice of the independent Advisory Committee on Resource Allocation (ACRA). ACRA’s interim recommendations went through an intensive engagement during the summer, generating some important changes that we believe will be welcomed by the public health and local government communities.

Full details of the public health grants to local authorities have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

South London Healthcare NHS Trust

Jeremy Hunt Excerpts

Tuesday 8th January 2013 Commons Chamber

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the trust special administrator’s report on South London Healthcare NHS Trust and the NHS in south-east London.

[The Secretary of State for Health (Mr Jeremy Hunt)]

I have today published the final report of the trust special administrator to South London Healthcare NHS Trust and laid it before Parliament. I received the report yesterday and must now consider it carefully. I am under a statutory duty to make a decision by 1 February on how best to secure a sustainable future for services provided by the trust.

The trust special administrator began his appointment on 16 July. He published his draft report on 29 October and undertook a consultation on his draft recommendations between 2 November and 13 December. More than 27,000 full consultation documents and 104,000 summary documents were distributed during the consultation and sent to 2,000 locations across south-east London, including hospital sites, GP surgeries, libraries and town halls. A dedicated website was established to support the consultation, the TSA team arranged or attended more than 100 events or meetings and the consultation generated more than 8,200 responses.

I understand the concerns of hon. Members and, indeed, the people living in areas affected by the proposals, especially in Lewisham. They have a right to expect the highest quality NHS care, and I have a duty to ensure that they receive it. However, they will understand that it would not be appropriate for me to give a view on the report’s recommendations only one day after receiving it.  To do so would be pre-emptive and would prejudice my duty to consider the recommendations with care and reach a decision that is in the best interests of the people of south-east London.

However, I have made it clear that any solution would need to satisfy the four tests outlined by the Prime Minister and my predecessor, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), with respect to any major reconfigurations: the changes must have support from GP commissioners; the public, patients and local authorities must have been genuinely engaged in the process; the recommendations must be underpinned by a clear clinical evidence base; and the changes must give patients a choice of good-quality providers.

The challenges facing South London Healthcare NHS Trust are complex and long standing, but to fail to address them is to penalise other parts of the NHS from which resources must be taken to finance the biggest deficit anywhere in the NHS. To date, it has not proved possible to ensure that South London Healthcare NHS Trust can secure a sustainable future for its services within its existing configuration and organisational form. In appointing a special administrator to the trust, the Government’s priority was to ensure that patients continue to receive high-quality, sustainable NHS services, and I will consider the special administrator’s report with that objective in mind.

[Dame Joan Ruddock]

I thank the Secretary of State for his reply. Neither I nor my hon. Friends the Members for Lewisham East (Heidi Alexander) and for Lewisham West and Penge (Jim Dowd) are opposed to change or to greater efficiencies, but we are opposed to the destruction of Lewisham hospital, which is a solvent, well-regarded trust that meets all its performance and financial standards.

There is a fundamental question at stake. My right hon. Friend the Member for Leigh (Andy Burnham) has made it clear that the powers associated with the failure regime under which the TSA acts were not intended to be used to encompass the services of other hospitals. Yet in order to tackle the huge financial deficit sustained by South London Healthcare Trust, the TSA proposes to close Lewisham hospital’s accident and emergency services, including the acclaimed children’s A and E, to end all medical and surgical emergency care and to demolish maternity services. He then proposes to sell off half the hospital’s land. That cannot be justified. Each year around 120,000 people use Lewisham A and E, more than 30,000 children use the children’s A and E and more than 4,000 babies are born in the hospital. There is no current capacity at any of the other hospitals in the area to provide for those patients.

These proposals amount to a major reconfiguration by the back door, and they are opposed by virtually all the health professionals in the area and by the people of Lewisham. Does the Secretary of State believe that a reconfiguration of services in south-east London is necessary? If he does, he needs to propose one with the relevant consideration for patient safety and health care standards and that meets his four tests. These proposals do none of that and must be rejected.

[Mr Hunt]

First, I want to recognise the right hon. Lady’s real concerns about the proposals that have been made. I also recognise that they reflect the concerns of many of her constituents and, indeed, many people in Lewisham. Her point about scope is one I replied to in my letter to the right hon. Member for Leigh (Andy Burnham) before Christmas. I have taken legal advice on that and been told that under the unsustainable provider regime, which the previous Government put into law, an administrator must initially look at a trust’s defined area, but if they conclude that the defined area is not in itself financially sustainable—they have a duty to come back with a financially sustainable solution—and if it is necessary and consequential, they need to look at a broader area. Of course there is interrelation between different parts of the south-east London health care economy. However, I will be getting fresh legal advice on that point, because I recognise that it is extremely important.

I welcome the fact that the right hon. Lady recognises that changes need to be made. I also hope that she understands that I have a duty to address this issue, which has affected hospitals in the South London Healthcare Trust area for many years. The deficit of the trust amounts to £207 million in the period since it was set up, and that is money that must be taken away from other parts of the NHS. I have a clear duty to address that issue. I will not comment on specific proposals today, but I will be very happy to meet her and her colleagues from Lewisham in order to hear from them directly about their concerns. Indeed, I will be meeting the trust special administrator on 10 January so that I can ask him any questions about his proposals before I make my decision, which must be within 20 working days.

[Bob Stewart (Beckenham) (Con)]

I remind my right hon. Friend that the Beckenham Beacon is not only modern, but extremely central. I stress the incredible value it could have in south London. I very much hope that the services currently provided there will increase, rather than decrease, at the end of this consultation.

[Mr Hunt]

I thank my hon. Friend for again speaking up for his constituents, as indeed I have done as a constituency MP on many occasions. I want to reassure him that the four tests we have outlined for any major changes to health care services would indeed apply to the Beckenham Beacon and that, were there to be any changes, we would need to be satisfied that they would have strong, local, clinical support, that his constituents had been properly consulted and that there was clear evidence that change would be beneficial.

[Andy Burnham (Leigh) (Lab)]

I apologise for missing the start of proceedings on this urgent question.

It has long been accepted that difficult decisions are needed to secure the sustainability of health services in south-east London. That is why recommendations from the review, “A Picture of Health”, were agreed under the previous Government. The trust special administrator has adopted many of those proposals, which we welcome.

However, the review presented today goes way beyond that and takes the NHS into new territory. It uses powers passed by the previous Government in a way that was never intended and, in so doing, sets a worrying precedent whereby normal processes of public consultation are short-circuited and back-door reconfigurations of hospital services are pushed through. The Health Act 2009, which I took through this House, states that

“the administrator must provide to the Secretary of State and publish a draft report stating the action which the administrator recommends the Secretary of State should take in relation to the trust.”

In making recommendations that have a major impact on another trust, is the Secretary of State not going beyond the powers this House has given to him? He has acknowledged that he needs to commission fresh legal advice, which suggests to me that the legality of the process is in doubt. Will he publish all the legal advice he has been given so far and give a commitment that any new legal advice he commissions will be made available?

As this is a financially driven process, the people of Lewisham have justifiable concerns about whether it is safe to close their A and E and downgrade the maternity services. Is the Secretary of State satisfied that a clinical case has been established behind these major changes? Given that all A and E departments in south London are currently overstretched and operating at full capacity, people will need to be convinced that these changes will not put lives at risk.

Finally, will the Secretary of State give a guarantee today to the people of Lewisham that, if he accepts the TSA’s recommendations, they will have the full consultation rights that come with any hospital reconfiguration, including the ability to challenge the clinical case and, if necessary, to refer it to the Independent Reconfiguration Panel? This process is attempting to rewrite the rules on making changes to hospital services, bypassing the intention of the House. It will send a shiver through any communities without a foundation trust, as it raises the prospect that their hospital will be able to be used as a pawn to solve problems in another.

People in Lewisham feel a huge sense of unfairness and I am sure that that will be shared by people across the House. The onus is on the Secretary of State to justify the changes and ensure that rules governing hospital changes are fair and respect the essential rights of all communities to be fully consulted and involved in any decision affecting their services.

[Mr Hunt]

We have followed to the letter the processes laid down in the law that the right hon. Gentleman’s Government passed. We followed the procedure extremely carefully. This is the first time that the procedure has been invoked, so we have taken extra legal advice to make sure that the processes followed strictly adhere to the letter of the law. I will continue to take legal advice, because I want to make sure that we absolutely follow the wishes of the House in how we carry out the procedure.

Unlike the right hon. Gentleman’s Government, we have introduced new safeguards for any major changes made to NHS services. Those safeguards did not exist when the right hon. Gentleman was Health Secretary. We have said that we will not accept any changes unless there is proper consultation of the local population, clear evidence and clear local clinical support. We made that commitment in the four tests, which did not exist under his Government.

I will not accept any of the changes that the special administrator proposes unless I am satisfied that all four tests have been met. They include proper local consultation, because I consider that to be extremely important.

[Gareth Johnson (Dartford) (Con)]

The report mentions an increase in elective surgery in Darent Valley hospital—my local hospital, which is just over the Kent border with south London. Although the hospital has enjoyed extra funding from the Government, it still has capacity issues. Will the Secretary of State ensure that the knock-on issues are taken into account before he makes any decision?

[Mr Hunt]

My hon. Friend makes a very important point. One of the most important things that I have to consider in the next 20 days is what he describes as the knock-on impact of all the proposed changes. I have a duty to find a solution that is financially and clinically sustainable for the South London Healthcare NHS Trust area. However, I need to consider the knock-on effects everywhere else, including in Lewisham and my hon. Friend’s constituency.

As well as legal advice, I will be seeking clinical advice and want to make sure that my officials agree with the financial considerations made in the report. I will consider all that advice in enormous detail before I come to any decisions.

[Heidi Alexander (Lewisham East) (Lab)]

I am grateful to the Secretary of State for agreeing to meet Members with Lewisham constituencies about this matter. Representatives of the Save Lewisham Hospital campaign, which is made up of local GPs, local hospital doctors and the public, are also very keen to meet the Secretary of State to put our case directly to him about why it is important to retain a full, admitting A and E and full maternity service at Lewisham. Will he agree to meet them?

[Mr Hunt]

I want to meet colleagues from the House but, as I am sure the hon. Lady will understand, I want to be careful not to restart the whole consultation process that has been happening in what I believe is a very thorough way in the past few months. However, one of the things that I will be considering very carefully—and I will listen to any points that the hon. Lady makes when I meet her—is whether the consultation has been done properly, as it needs to be done and as was intended by the legislation. I will not accept any changes unless I am satisfied on that point.

[Dame Tessa Jowell (Dulwich and West Norwood) (Lab)]

I welcome the Secretary of State’s apparently open-minded approach to the proposals, which have caused enormous clinical alarm in our hospitals as well as local concern.

Two particular issues affect my constituents and those of my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman) in relation to King’s College hospital. I ask the Secretary of State to take them seriously. First, should the proposed closures at Lewisham hospital go ahead, that will impact on the King’s College hospital paediatric A and E, which is already overstretched; the staff have enormous concern about their ability to meet any additional demand.

Secondly, will the Secretary of State agree that discussions currently under way to merge the managements of King’s College hospital with those of Guy’s and St Thomas’s should be suspended while the extensive reorganisation threatens the stability of a number of hospitals? If they were to go ahead in parallel, that would risk engulfing our hospitals with preoccupations about reorganisation rather than there being a focus from our world-class hospital staff in south London on treating the patients that we represent.

[Mr Hunt]

The right hon. Lady makes two important points. As she knows, I visited King’s College hospital just before Christmas and was incredibly impressed by what I saw. I visited the geriatric ward and was really impressed, and I am sure that the paediatric service is outstanding as well. It came across to me as an extremely well run hospital. I will, of course, make sure that I consider the impact of the changes proposed by the trust special administrator on King’s, just as I will consider the impact on all surrounding hospitals.

With respect to the merger proposals, because the legislation requires me to come to a decision within 20 working days, the right hon. Lady will find that I have to make and publish my decision quickly enough to ensure that any impact from the changes is properly considered by the people pursuing the possibility of a merger between King’s, Guy’s and Tommy’s.

[Mr Nick Raynsford (Greenwich and Woolwich) (Lab)]

The Secretary of State will understand that I have not been able to read the entire trust special administrator’s report in the hour or so I have had access to it. However, while I was reading the report, it became clear that a great deal of concern was expressed during the consultation about the implementation of the proposals. Indeed, the report highlights the fact that following previous reorganisations, costs have increased rather than reduced as a result of the very process of reorganisation.

Given those worries, will the Secretary of State agree to meet representatives from other boroughs, who are equally concerned? I remind him that he declined my request for a meeting on the trust special administrator’s draft report; I hope he will not decline to meet now that we have the full report. In particular, will he consider the implications for patient care and services of a major reorganisation, which can be disruptive and fail to deliver the savings envisaged?

[Mr Hunt]

I heed absolutely the right hon. Gentleman’s warning that reorganisations are not always the panacea that they are made out to be. We need to be absolutely clear that, if we accept the proposals, they will deliver a sustainable, robust and clinically sound outcome for the right hon. Gentleman’s and neighbouring constituents, as the trust special administrator believes they will. I shall be delighted if the right hon. Gentleman attends the meeting with other MPs affected by the proposal. I shall hear what he has to say further at that meeting.

[Clive Efford (Eltham) (Lab)]

The Secretary of State has to recognise the serious contradictions between the proposals in the trust special administrator’s report and the Conservative manifesto before the last general election. If he were to accept the proposals, particularly in relation to A and E, that would be a serious betrayal of promises made to the electorate. There are also the changes expected from the “A Picture of Health” proposals for Queen Mary’s hospital in Sidcup in relation to overnight elective surgery. How much is the Secretary of State bound by the specific promises made in the Conservative manifesto before the election when it comes to making a decision on the report?

[Mr Hunt]

We were concerned in the run-up to the last election at the pace and scale of many of the reconfigurations pursued by the last Government. That is why when we came into office we paused the reconfigurations and introduced the four tests—an additional safeguard to make sure that reconfigurations were not done without local clinical support.

We wanted to avoid what had happened so often, including in my own constituency—an alliance of Health Ministers and NHS managers riding roughshod over what local people wanted. We wanted to stop that, so we put in place new systems. I hope that the hon. Gentleman will be comforted by the robustness and thoroughness of the processes that we are now going through.

South London Healthcare Trust

Jeremy Hunt Excerpts

Tuesday 8th January 2013 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

I wish to inform the House that the trust special administrator appointed to South London Healthcare NHS Trust provided me with his final report on 7 January 2013. It makes recommendations to me in relation to securing a sustainable future for services provided by that organisation.

Details about the appointment of the administrator, Matthew Kershaw, were given in a written ministerial statement issued on 12 July 2012, Official Report, columns 47- 48WS.

The report was provided to me in accordance with chapter 5A of the National Health Service Act 2006, as introduced by the Health Act 2009, and has today been laid before Parliament and made publicly available at:

www.dh.gov.uk/health/2013/01/south-london-healthcare/

Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

I would like to thank Matthew Kershaw for the work he has carried out in producing his report. This is the first time the trust special administrator’s regime has been used since the last Government introduced the provisions which were enacted in the Health Act 2009. In accordance with the legislation, in addition to producing his recommendations on the future of the trust, Mr Kershaw has also been responsible for managing South London Healthcare NHS Trust and maintaining services for patients while the board is suspended pending the outcome of the regime. I do not underestimate the demands this has placed on him.

In triggering this regime, the Government’s priority was to ensure that patients continue to receive high-quality, sustainable NHS services. At the time Mr Kershaw was appointed last July, South London Healthcare NHS Trust was overspending by £1 million a week. In the last financial year, the trust had a deficit at over £65 million, the largest in the country. Left to itself, the trust’s very severe financial position would have continued in a downward spiral of continuing deficits and ultimately threaten the quality of care for patients across south-east London.

The challenges facing South London Healthcare NHS Trust are complex and long standing. To date, it has not proved possible to ensure that South London Healthcare NHS Trust is able to secure a sustainable future for its services within its existing configuration and organisational form. The Government’s priority is to ensure the delivery of a long-term, viable solution for services provided by the trust if it cannot be made sustainable. All responses to my predecessor’s statutory consultation on whether to trigger the regime, including from South London Healthcare NHS Trust itself, stated that a solution for the trust cannot be viewed in isolation from broader service provision within south-east London.

In accordance with my statutory duty, I will consider the trust special administrator’s recommendations carefully and make a final decision by 1 February that can secure sustainable services for the people of south-east London. In considering the recommendations, I will examine particularly:

whether the recommendations are likely to provide a sustainable long-term financial position which will secure high-quality services in the local area for the future; and

whether the recommendations have regard to the Government’s four key tests for local service reconfiguration. These are support from GP commissioners, strengthened public and patient engagement, clarity on the clinical evidence base and support for patient choice.

Ultimately, my priority is to ensure that all NHS hospitals live within their budgets and achieve the best quality care, best patient outcomes and best patient experience for all their NHS patients.

I will inform the House of my decision as soon as reasonably possible afterwards.

Health Allocations 2013-14

Jeremy Hunt Excerpts

Tuesday 18th December 2012 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today I am informing the House that the NHS Commissioning Board has announced the allocations to clinical commissioning groups (CCGs) for 2013-14 of £63.4 billion.

The board’s overriding objective is to improve outcomes for patients and to reduce health inequalities. Together with ensuring stability during transition, this has driven the decisions the board has taken in the approach to allocations for next year.

All CCGs will receive an identical increase of 2.3%, which will ensure that funding is stable in the first year of the new commissioning arrangements and supports a smooth transition. The board is also initiating a review of the approach to allocations, not just confined to CCG allocations, to give the best opportunity to improve outcomes for patients and tackle health inequalities.

Full details of the allocations have been placed in the Library and can be seen at: www.commissioning board. nhs.uk/files/2012/12/ccg-allocations-13-141.pdf. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

NHS Consultants and Junior Doctors' Contracts

Jeremy Hunt Excerpts

Monday 17th December 2012 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

I am responding on behalf of my right hon. Friend the Prime Minister to the report by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) “Review of compensation levels, incentives and Clinical Excellence and Distinction Awards schemes for NHS Consultants”. The report has been laid before Parliament today (Cm 8518). The report was to all four UK Health Departments. I am grateful to the chair and members of the DDRB for their report.

The recommendations in the report are wide ranging. As well as making recommendations on a new approach to national and local awards, it suggests the contract needs to recognise different stages in a consultant career by introducing a break point in the pay scale and a new principal consultant grade, that would cover up to 10% of the consultant work force at any one time.

The report sets out the case for change and the Government accept the key principles underlying the report. In particular, we agree that clinical excellence awards should recognise current not past excellence and that there is a compelling case for changes in the consultant contract. Local NHS organisations need to have a consultant contract that meets their needs and is fit for purpose for the future.

I recognise that there may be some concerns within the medical profession over the report. The Government are therefore committed to work with the profession on these recommendations with a view to reaching agreement with doctors’ representatives on how they should be implemented.

I am particularly mindful of the position of doctors who hold current pensionable and consolidated awards and on the impact of the DDRB’s proposals for national awards on the most senior doctors including clinical academics. It will be important to ensure that their reward packages remain competitive so that we continue to recruit and retain the most able consultants in the UK and provide appropriate incentives to encourage clinical excellence and innovation; not only in patient care but also in medical research and teaching.

The Government do not necessarily accept that consultants should be prohibited from holding awards simultaneously in the old and new schemes. This will depend on the final scheme design and should be considered as part of transition planning to ensure that all consultants retain appropriate incentives for continued excellence while avoiding paying twice for the same activities.

I am also prepared to consider the issue of pensionability of future awards as there is nothing inherent in a career average pension scheme that prohibits this. I therefore believe that longer-term national awards can remain pensionable. I would also be prepared to consider affordable proposals on pensionability of future local awards.

In advance of these discussions, we intend shortly to launch a specific consultation about discontinuing two anomalies in the current schemes.

We wish to work with the profession and employers to ensure that pay arrangements for doctors are affordable and sustainable in the long term. We will therefore also be seeking to agree changes to doctors’ contracts to better support seven-day working in the NHS. A move to seven-day working must be approached alongside better availability of community services and primary care. An NHS fit for the future needs to be delivering the same quality of service at the weekend as it does during the week and pay arrangements need to reflect this.

We are also today publishing a report commissioned from the NHS employers organisation by the four UK Health Departments on the junior doctors’ contract. The incentives in the current contract operate in a way that militates against the best quality training and restrict the service contribution made by doctors in training. We therefore wish to agree changes to ensure pay arrangements for juniors are also fit for purpose.

I am ambitious to see early progress on implementing these changes. I would wish to see a heads of agreement reached by the spring of 2013 on changes across both contracts with the intention of implementation beginning from April 2014. With the agreement of the devolved Administrations, this will be taken forward on a UK-wide basis, while respecting any differences arising from devolved responsibilities.

Copies of both reports are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. The report on the junior doctors’ contract has been placed in the Library.

“Liberating the NHS: No decision about me, without me”

Jeremy Hunt Excerpts

Thursday 13th December 2012 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today I am publishing “Liberating the NHS: No decision about me, without me”, Government response and the Department’s NHS choice frameworks for 2012-13 and 2013-14. The response document and the choice frameworks have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

The consultation document, “No decision about me, without me—Further consultation on proposals to secure shared decision-making”, published on 23 May 2012, set out proposals to provide patients with more opportunities to be involved in decisions about their care and to make choices. A small number of focused consultation questions were asked which sought views on whether the proposals were realistic and achievable and whether there were any issues that had not been recognised sufficiently. The consultation ran for 14 weeks from 23 May to 31 August 2012.

The majority of the 172 responses received to the consultation were broadly supportive of the proposals as a means for patients to become more involved in their care, in partnership with professionals.

Some respondents outlined concerns that greater choice did not equate to the wider adoption of shared decision-making. We agree with this principle and set out in the response document the clear importance of both proposals to increase patient involvement and patient choice.

Other themes were raised regarding the practical implementation of the proposals relating both to patient involvement and patient choice. The response document addresses the comments made by respondents and sets out how we are implementing the proposals to increase patient involvement and patient choice.

The Department’s NHS choice framework for NHS funded care and treatment in England will set out, for the first time, the choices that people can expect to be offered. This will raise awareness of these choices, including where people have legal rights to make choices, as well as setting out where they can find information to support these choices and what they can do if they are not given the choices they are entitled to.

NHS Funding

Jeremy Hunt Excerpts

Wednesday 12th December 2012 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

We have heard a lot of bluster and nonsense today. At its heart is an extremely uncomfortable truth for the Opposition: this Government are spending more on the NHS than Labour would have spent. That spend has moved away from consultancy and the back office to the front line, so the NHS is now performing better—I know that it is uncomfortable, but it is true—than it ever did under Labour. That means more treatment—[Interruption.] This might not be what Opposition Members want to hear, but they might as well listen. That means more treatment, more care and more lives saved. The previous Government talked the talk on the NHS, but it is this Government who have delivered an NHS of which we can be immensely proud.

[Grahame M. Morris (Easington) (Lab)]

Will the Secretary of State give way?

[Mr Hunt]

I will make a little progress before giving way.

[Lyn Brown (West Ham) (Lab)]

rose—

[Mr Hunt]

I said that I would make a little progress, if that is all right.

I must confess to being both surprised and delighted at this afternoon’s motion, because I would have thought that the last thing the right hon. Member for Leigh (Andy Burnham) would want to do was remind the nation of his opposition to our increasing the NHS budget. The motion is about spending, but we can spend only what is in our budget. What did he say about budget and spend during his failed bid for the leadership of his own party? [Interruption.] I think that right hon. and hon. Members on the Opposition Benches should listen to what those on their Front Bench are saying. He said:

“It is irresponsible to increase NHS spending in real terms”.

So let me ask him to clarify this to the House: does he stand by his comment that it is irresponsible to increase NHS spending?

[Andy Burnham]

Yes, I do. I said in my speech that the NHS should be protected in real terms at the front line. That is what the Secretary of State has not done. I cannot believe that he is contradicting the contents of the letter from Andrew Dilnot. He really needs to tread very carefully before he goes any further.

[Mr Hunt]

Let me say very gently to the right hon. Gentleman that he can hardly come to this House criticising us for an alleged cut in NHS spending if his own plans would have led not to higher but to lower NHS spending. We are increasing spending by £12.5 billion, and he thinks that that is irresponsible.

[Grahame M. Morris]

Will the Secretary of State at least acknowledge that the previous Labour Government increased resources in the NHS from £30 billion when we took office to over £100 billion when we left office in 2010?

[Mr Hunt]

I accept that. We wanted to increase spending even further, and the right hon. Member for Leigh said that that was irresponsible.

[Lyn Brown]

Will the right hon. Gentleman confirm just how many nurses’ jobs have been cut on this Government’s watch?

[Mr Hunt]

I will confirm for the hon. Lady that the nurse-to-bed ratio has gone up so that nurses are spending—[Interruption.] Perhaps the Opposition will want to hear about issues of care. The average bed is getting two hours of nursing care per week more than under Labour.

Let me give the right hon. Member for Leigh another chance to clarify Labour policy on health spending. In Wales, Labour has announced plans to cut the NHS budget by 8% in real terms despite an overall settlement protected by Barnett. Given that the motion condemns an alleged cut in NHS spending, will he, once and for all, condemn the choice that Labour made in Wales? If he does not want to do that, let me tell him what the British Medical Association says is happening in Wales. It talks of a “slash and burn” situation and “panic” on the wards. Would he want that to be repeated in England? If not, he should not sit idly by but have the courage to condemn the choice that Labour has made in Wales.

While we are on the subject of Wales, the right hon. Gentleman will know that NHS patients there are five times less likely to get certain cancer drugs than English NHS patients, but the Labour Welsh Health Minister has said it would be “irresponsible”—the same word that the right hon. Gentleman used—to introduce a cancer drugs fund in Wales. Does the right hon. Member for Leigh support what Labour is doing with regard to cancer drugs in Wales—yes or no?

[Andy Burnham]

indicated assent.

[Mr Hunt]

He does support it—well, there we are. So now we have it. Labour policy in Wales is to cut the NHS budget, and that is supported by Labour Front Benchers.

[Susan Elan Jones (Clwyd South) (Lab)]

Can the Secretary of State tell us whether that has anything to do with the cuts in capital spend from Westminster central Government? Does he have any comment to make on National Audit Office figures showing that spending on health in Wales is higher than that in England, or does that not fit with his fictitious version of events?

[Mr Hunt]

I gently remind the hon. Lady that this is about the choice made by the Labour Government in Wales. They had a choice. They could have protected the NHS budget—they had the money under Barnett to do that—but they chose not to do so, and that is supported by the right hon. Gentleman.

[Julian Smith]

Does it surprise my right hon. Friend that we heard nothing from Labour Members about productivity, innovation or the Derek Wanless report, which demonstrated that Labour’s health spending led to lower productivity rather than higher productivity?

[Mr Hunt]

It absolutely did. The key issue in this debate is the level of spending, and we will explain thoroughly why what the Opposition are saying is quite wrong. However, it is also about how the money is spent.

[Heidi Alexander (Lewisham East) (Lab)]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make a little progress, if I may.

The right hon. Member for Leigh rather helpfully spelled out the difference between his position and our position when he admitted in the New Statesman that we are spending more than he wanted to spend on the NHS. He said of the NHS budget:

“They’re not ring-fencing it. They’re increasing it.”

In respect of NHS spending, he said:

“Cameron’s been saying it every week in the Commons: ‘Oh, the shadow health secretary wants to spend less on health than us’…it is true, but that’s my point.”

It was a good point, because we are spending more and he would have spent less. So why on earth call an Alice in Wonderland Opposition day debate condemning levels of spending in the NHS when he has so clearly put it on the record that he wanted that spending to be less?

[Mr Graham Stuart (Beverley and Holderness) (Con)]

Does my right hon. Friend agree that it is disingenuous, should it be allowed by the Deputy Speaker to say that, of the shadow Secretary of State and Labour Members—

--- Later in debate ---

[Mr Deputy Speaker]

Order. I do not think we can have “hypocrisy” either, so we will have the Secretary of State instead.

[Mr Hunt]

The simple truth that Labour Front Benchers cannot understand is that spending is related to budgets, and they wanted the budgets to be lower than they currently are.

[Heidi Alexander]

The Secretary of State seems to be very keen to ask questions of our Front Benchers. Why will he not answer the question put to him by my hon. Friend the Member for West Ham (Lyn Brown)? How many nurses have lost their jobs on his watch? I do not want to be told about the nurses-to-beds ratio—answer the question.

[Mr Hunt]

It is because we have protected the NHS budget that the number of clinical staff in the NHS has gone up and not down. [Interruption.] Okay, let me explain this, because there is a very important point here. Unlike Labour Front Benchers, I do not want to micro-manage every hospital in the country and tell them exactly how many doctors and how many nurses they should have. I want them to put money on the front line, and the result is that the number of clinical staff—doctors, nurses, midwives and health visitors—has gone up and not down.

[Clive Efford]

rose—

[Mr Hunt]

I am going to make some progress.

Let me move on to the accusation that the right hon. Member for Leigh made. He says that, using 2009-10 as a base year, NHS spending went down in 2010-11.

[Mr Charles Walker (Broxbourne) (Con)]

Will my right hon. Friend give way?

[Mr Hunt]

I want to make a little progress and then I will give way.

[Mr Walker]

I have to chair a Committee shortly.

[Mr Hunt]

In that case, I will give way.

[Mr Deputy Speaker]

Order. I am sure that the hon. Member for Broxbourne (Mr Walker) is not going to walk out after his intervention and will stay a little longer.

[Mr Walker]

The meeting is in thirteen minutes.

My right hon. Friend knows that it is not just about funding but about good management. He cannot be responsible for management across the NHS, but in the East of England ambulance service there are question marks over the quality of its senior management. Will he find time to cast his eye over those senior managers?

[Mr Hunt]

I assure my hon. Friend that I am aware of the concerns that he raises, which are frequently raised with me by the Minister of State, my hon. Friend the Member for North Norfolk (Norman Lamb), who has a constituency in the east of England. I follow that situation carefully.

Let me now deal with the substance of the motion. I have always talked about spending going up from the first year of the comprehensive spending review—the first year when this Government had full control of the budget and were responsible for setting the spending plans. In 2011-12—[Interruption.] The shadow Secretary of State should listen to the facts. He tabled the motion, so he probably should hear the answer, although I know it is not what he wants. In 2011-12, spending went up by £2.5 billion in cash terms—0.1% in real terms—on 2010-11. This year, 2012-13, it will go up again, as it will in every year of the Parliament.

[Andy Burnham]

Would the Secretary of State care to remind the House of the commitment in the coalition agreement? Could he read that out for us?

[Mr Hunt]

I have just said that spending will go up in every year of the Parliament. Let me point out to the right hon. Gentleman that these are small real-terms increases, albeit ones that he bitterly opposed. That is why, given the uncertainties around GDP deflators, Andrew Dilnot’s letter says, in the sentence that the right hon. Gentleman did not want to read out, that

“it might also be fair to say real terms expenditure has changed little over this period.”

There it is, exposed for all to see: a bogus Labour motion trying to paint a picture of cuts to the NHS budget when even the head of the UK Statistics Authority says that the broad picture of NHS spending is that it has been protected in real terms—something that almost certainly would not have happened had Labour been in power.

[Andy Burnham]

I am struggling to believe what I am hearing. The Secretary of State is saying that Andrew Dilnot agreed with him that there had been real-terms increases in every year of this Parliament—[Interruption.] That is what he just said at the Dispatch Box. Let me quote Andrew Dilnot again, for the sake of accuracy. He said that

“we would conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10”.

How can the Secretary of State square what he has just told the House of Commons with what is in Andrew Dilnot’s letter? Is he saying that Andrew Dilnot is wrong?

[Mr Hunt]

Some politicians walk into the same trap not once but twice. Let me give the right hon. Gentleman the sentence that comes straight after that, which he did not want to quote. It says that

“it might also be fair to say that real-terms expenditure had changed little over this period.”

That is what Andrew Dilnot is saying, which is why the motion is so completely bogus.

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

I am no statistician, but my understanding of that English is that things have not changed much. However, the Secretary of State has consistently said that he and the Government have pledged to implement an increase. There is nothing in that letter to suggest that any increase has occurred.

[Mr Hunt]

The right hon. Lady’s party has been saying that spending has been cut, and it had the foolishness to call an Opposition day debate on the basis of a letter from Andrew Dilnot that states that, broadly speaking, spending has remained unchanged. That is why, at its heart, the motion is bogus.

The sad fact is that this is not the debate that the Opposition planned to have, two years into this Parliament. The right hon. Gentleman dreamed of coming to the House to remonstrate about an NHS that was on its knees and that was not delivering for the public. He wanted to argue about waiting times, but they have gone down, with fewer people waiting a long time for an operation than at any time under Labour. He wanted to argue about treatments, but there are more people getting new hips and knees and many other treatments than under Labour. [Interruption.] Opposition Members should listen to this. He wanted to argue about cancer, but 23,000 people are now getting drugs under the cancer drugs fund that Labour refused to set up.

Today, the right hon. Gentleman has tabled a motion criticising the decisions taken by the coalition and my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) on NHS spending in our first two years in office. This is also about how we spend the money, as many of my hon. Friends have said. What are the decisions that the right hon. Gentleman is criticising? They are precisely the decisions that mean that the NHS is now performing at record levels, and vastly better than at any time under Labour.

Let us look at those decisions. There was the decision to reduce the number of managers by 7,000 and transfer resources to the front line. There was also the decision to cancel Labour’s disastrous attempt to embrace the technology revolution that cost billions and set the NHS back by years. Then there was the decision to end the wasteful consultancy spend, which has now been cut by 39%. [Interruption.] The right hon. Gentleman needs to listen to this. There was the decision to stop the scandal of unsustainable private finance initiative projects that left the NHS with a £73 billion debt and £1.6 billion-worth of repayments every year. [Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Christmas is coming. Let us show a little bit more Christmas spirit towards each other. Members on both sides of the House want to hear the Secretary of State.

[Mr Hunt]

I could not agree with you more, Mr Deputy Speaker. I am trying to give the House some good news, but it is difficult for the Opposition to take it in.

There was also the decision, championed by both coalition parties, to transfer that money to the front line, so we now have more clinical staff, including 5,000 more doctors; better access to drugs, including £600 million invested in the cancer drugs fund; 500,000 more elective admissions every year than under Labour; over 3 million more out-patient appointments every year than under Labour; nearly 1 million more going through accident and emergency every year than under Labour; and 1.5 million more diagnostic tests every year than under Labour. On top of all that, we have 60,000 fewer people waiting longer than 18 weeks than under Labour; 90% fewer people waiting more than a year than under Labour; clostridium difficile down more than a third compared with under Labour; MRSA halved compared with under Labour; and the number of people facing the indignity of mixed-sex wards down by 98% compared with under Labour.

Of course the NHS faces huge challenges with an ageing population and increasing demand, but we are now facing up to those challenges with ambitious plans to tackle dementia, to reduce mortality rates for the big killer diseases to the lowest in Europe, to embrace the technology revolution—but getting it right this time—and to improve the quality of care which, in parts of the system, has been allowed to become shockingly poor for far too long. All those priorities were ignored by Labour in office and, even worse, they have been rejected by Labour today as a “meaningless list”. Those were Labour’s words. Well, tell that to the 157,000 people who die from cancer every year, or the 800,000 people who have dementia, or the people whose families suffer from the poor care that we read about every week in the newspapers.

None of the improvements to the NHS, and none of the ambitions for our NHS, would be possible without the extraordinary dedication of our doctors, nurses and front-line professionals, to whom I pay tribute today. But none of them would have been possible either if we had not increased the NHS budget and NHS front-line spend, contrary to what Labour intended and wanted. Labour’s plans would have meant less spending in real terms on the NHS, and vastly less spending on the NHS front line. No clever fiddling with baselines can obscure the harsh reality that Labour’s policy towards the NHS is a mass of contradictions that fools nobody—certainly not the brilliant doctors, nurses and professionals who have given their lives to saving and improving the lives of others. I urge the House to reject this ridiculous motion.

[Several hon. Members]

rose—

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

During this debate, Ministers and the few Government Members who have spoken have either denied that the Government have broken their promise to increase NHS spending or have claimed that it does not matter, as if the Prime Minister’s clear, direct and personal pledge to voters can easily be swept to one side. They—perhaps with the exception of the hon. Member for Southport (John Pugh)—have also skated over or ignored the waste, confusion and utter distraction of their back-room NHS upheaval.

In contrast, Opposition Members have talked about the harsh reality of the double whammy of cuts and reorganisation on their constituencies. My hon. Friend the Member for Lewisham East (Heidi Alexander), my right hon. Friends the Members for Lewisham, Deptford (Dame Joan Ruddock) and for Rother Valley (Mr Barron), my hon. Friends the Members for Corby (Andy Sawford), for Bolton West (Julie Hilling) and for Easington (Grahame M. Morris), and the hon. Member for Strangford (Jim Shannon) spoke powerfully about their concern that changes to local services are being driven by money alone, not by improving patient care. I also pay tribute to my right hon. Friend the Member for Cynon Valley (Ann Clwyd), who spoke with bravery and compassion about the unacceptable standards of care in parts of the country, which must be tackled.

Perhaps the most worrying example of the combination of cuts and reorganisation that the Government are forcing through involves what is happening to cancer networks. Those groups of local specialists were set up more than a decade ago under Labour’s 2000 cancer plan to help tackle one of Britain’s biggest killers. It is widely acknowledged that cancer networks have played a central role in improving mortality rates, cancer survival rates and equality of cancer care, and they have done that on small budgets with few staff, offering good value for taxpayers’ money. Crucially, the specialist local skills of cancer networks are vital to making even greater improvements that cancer patients need and deserve in the future.

Ministers have repeatedly promised to protect budgets for cancer networks. On 31 January last year, the then Health Secretary told the House that

“cancer networks funding is guaranteed during the course of 2011-12.”—[Official Report, 31 January 2011; Vol. 522, c. 612.]

On 27 November this year in a debate on the NHS mandate, the new Health Secretary told the House:

“Cancer networks are here to stay and their budget has been protected.”—[Official Report, 27 November 2012; Vol. 554, c. 127.]

Those promises have been broken.

In response to a freedom of information survey from Labour, cancer networks report budget cuts of 13% in 2011-12 alone—[Interruption.] The Secretary of State shakes his head but he can look through all the figures, including individual examples, if he wants to see those cuts. In total, budgets have been slashed by 26%—by a quarter—since the Government came to power.

The Government’s national cancer director, Professor Mike Richards, at least has the honesty to say that

“cancer networks will have a smaller proportion of the budget in future.”

I understand that the Health Minister in the House of Lords, Earl Howe, has also been forced by an urgent question to admit that less money will be available to cancer networks.

[Mr Jeremy Hunt]

Will the hon. Lady give way?

[Liz Kendall]

I will, of course, give way to the Secretary of State.

[Mr Hunt]

First, these networks are brilliant. They are a good thing and they have done a huge amount. The Government support them and we are expanding them. That is why instead of just having cancer, cardiac and stroke networks, we will also have networks for dementia and maternity. The budget for those networks is going up by 27%.

[Liz Kendall]

The budget for cancer networks has been cut by a quarter. The Secretary of State is not expanding those networks but merging them and diluting their specialist expertise, as I will show. The cuts and the Government’s NHS upheaval mean that cancer networks have lost one fifth of their staff, withdrawn or scaled back current work, and put future projects on hold—[Interruption.] The Secretary of State is still denying that so let me tell him what the networks actually say.

The Arden cancer network in Coventry and Warwickshire says that it has lost its vital chemotherapy nurse. The Peninsula cancer network in Devon and Cornwall says it has had to turn down £150,000 from Macmillan Cancer Support to fund a programme for cancer survivors because its future is so uncertain. Essex cancer network says that posts have been removed, its staff are in a redeployment pool, and that it will have

“no presence in Essex from April 1st next year.”

Instead of supporting those vital local experts, as well as specialists in heart and stroke networks, the Government are merging them into 12 generic clinical networks that cover bigger geographical regions and far more health conditions. No one is against sharing the skills and experience of cancer and cardiac networks. However, as Maggie Wilcox, a former palliative care nurse, breast cancer patient, president of Independent Cancer Patients’ Voice and the layperson on the recent review by the Department of Health into breast screening said,

“subsuming cancer networks into generic clinical networks could be disastrous for cancer patients…you cannot be both a specialist and a generalist.”

That is especially important in an area as complex and fast-developing as cancer. Staff will not be able to make the same depth or scale of improvements if they are forced to cover a large area and more conditions with fewer members of staff.

The Secretary of State ploughs on regardless, denying that there is a problem and telling BBC Radio 5 Live that it is too early to know what will happen. How utterly complacent and out of touch. Networks are already disappearing. Their staff have left or are looking for jobs because their future is in such disarray. With their reckless NHS reorganisation, the Government have wasted not just taxpayers’ money but the knowledge and expertise of specialist staff, and patients are paying the price.

[Mr Hunt]

With respect to the hon. Lady, we have increased the budget for strategic networks by 27%. What would have happened to that budget if we had a lower NHS budget, as her party’s Front Benchers have been arguing for?

[Liz Kendall]

I do not think the Secretary of State understands that in a really complex and fast-developing area such as cancer, we need to know about individual, specific issues and concerns. If there are fewer staff covering bigger areas and more health conditions, we will not get specialist expertise.

If the Secretary of State does not believe me, perhaps he would like to comment on what Dr Mick Peake, the clinical lead for NHS cancer improvement and the national cancer intelligence network, has said. He has stated:

“With the shift towards GPs commissioning, the need for this expert…clinical advice will become ever more crucial…I am worried that in the process of reorganisation of the networks…we will lose many expert and very committed individuals, and that this could impact on the quality of commissioning and cancer services in the future.”

What will be the impact on patients, who are what the network is supposed to be about? Let us take prevention. Who has championed prevention by increasing the uptake of screening programmes? Cancer networks. Who trains GPs to spot the signs of cancer so that patients get earlier diagnosis? Cancer networks. Who has helped patients get their tests and scans done in days, not months, and slashed waits for cancer specialists to two weeks? Who has helped hospitals compare their performance, use the best drugs and treatments and transform patient information and support, and who has been central to setting up the new national cancer outcomes database, which the Government rightly say will help reduce cancer variations and drive improvements in future? Cancer networks. So why is the Secretary of State diluting—[Interruption.] Oh, now he switches to talk about the cancer drugs fund, because he knows that by stripping away vital local expertise, he is putting care at risk.

When the Secretary of State tells Radio 5 Live that he does not know why Labour is flogging this issue, calls cancer networks a mere pilot and says that his upheaval will be in patients’ best interests, cancer specialists, patients and Opposition Members know that he is wrong. We know that he cannot sustain the progress on cancer and make even more improvements in future when he is ripping away the foundations of better cancer care. As Earl Howe has just told Members of the Lords, it is “perfectly correct” that the share of the pot that cancer networks will be able to get will be smaller next year than it is this year. I rest my case.

The Prime Minister said that he would increase spending on the NHS, but NHS spending is lower in real terms today than it was when Labour left office—broken promise No. 1. Health Ministers repeatedly claim that they have protected cancer network budgets—broken promise No. 2. No top-down NHS reorganisation, mental health a priority and social care budgets protected—broken promises three, four and five. The list goes on. The Prime Minister claims that his priority can be summed up in three letters—NHS. That very same organisation is responding with its own three letters—SOS. I commend the motion to the House.

UK Life Sciences

Jeremy Hunt Excerpts

Monday 10th December 2012 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today, the Prime Minister has announced the Government’s intention to pump-prime the sequencing of 100,000 whole genomes over the next three to five years. This work will initially focus on cancer and rare diseases which, together with infectious diseases, are already showing patient benefit.

The potential of the information contained in the human genome is recognised as one of the most important health care opportunities of modern times. This initiative will include funding for staff training and developing bioinformatics support to prepare the NHS to make the paradigm shift from sequencing individual genes to scanning whole genomes. It will change fundamentally the way we view disease, monitor its progression and use this knowledge to transform health care. It will help patients get targeted treatments for them as individuals. The NHS Commissioning Board will lead on a delivery framework and service design with an aim to have contracts in place by April 2014 at the latest.

The Department of Health is working closely with colleagues in the Department for Business, Innovation and Skills and the NHS Commissioning Board to ensure that clinicians, patients, researchers and the wider public are involved in promoting the adoption of genomic technology to provide better health care and help research and the wider economy. The Government will also put in place careful safeguards for the storage each patient’s genome sequence and the use of anonymised data for research, which will be overseen by the chief medical officer for England.

This new initiative will form part of the next phase of the “Strategy for UK Life Sciences”, launched 12 months ago by the Prime Minister, which declared our commitment to a sector we see as vital to the UK’s long-term economic prospects. This work will also complement “Innovation Health and Wealth, Accelerating Adoption and Diffusion in the NHS”, published by Sir David Nicholson, the NHS chief executive, which is updated today. The UK is well placed to play a world-leading role in this next phase of the biomedical revolution, thanks to its first-class science and research base and the unique position of the NHS as a single health care provider. We remain at the forefront of genetic science innovation, translating this into real benefits for NHS patients. The Government and the NHS Commissioning Board will ensure that NHS patients benefit and that there is a clear strategy to take advantage of opportunities in genomics.

In addition, the Minister for Universities and Science, my right hon. Friend the Member for Havant (Mr Willetts), Department of Business and Skills is today announcing that part of the science capital committed in the Chancellor’s recent “Autumn Statement 2012” will be for projects in the life sciences: in synthetic biology; regenerative medicine; and biologies.

NHS Pay Review Body/Senior Salaries Review Body

Jeremy Hunt Excerpts

Wednesday 5th December 2012 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

I am responding on behalf of my right hon. Friend the Prime Minister to the reports of the NHS Pay Review Body (NHS PRB) and the Senior Salaries Review Body (SSRB) on market facing pay for their respective remit groups, which have been laid before Parliament (CM 8501 and Cm 8507). I am grateful to the chairs and members of the review bodies for producing these reports.

The Chancellor of the Exchequer on 7 December 2011 and I on 23 December 2011 asked the NHS PRB to consider how to make pay more market facing in local areas for NHS Agenda for Change (AfC) staff. The remit was for England only.

The NHS PRB found that the AfC pay system already has more extensive market facing features than in many other pay systems in large, national employers, in both the public and private sectors, to respond effectively to local labour markets. Additional freedoms are also available to foundation trusts introduced in legislation by the previous Government.

The NHS PRB found that there was not the firm evidence which would be essential to justify further top-down investment in additional market-facing pay in the NHS at this time. They do not recommend the introduction of centrally designed pay zones this year. Instead, the NHS PRB recommended a fundamental review of high-cost area supplements (HCAS), appropriate use of local recruitment and retention premia and regular review of AfC, including its flexibilities, with any negotiations brought to a conclusion at a reasonable pace. The NHS PRB agreed that should any market-facing approaches emerge from these developments they should be introduced incrementally to take account of affordability.

The Government welcome and accept all of the recommendations of the NHS PRB, including a review of HCAS and will take this work forward in partnership with NHS trade unions and the NHS Employers organisation. The priority is to continue to develop the AfC system and ensure that national terms and conditions are fit for purpose and support the recruitment and retention of good quality staff in the most cost-effective and efficient way.

The Chancellor and I wrote in similar terms to the chair of the SSRB. However, the Department of Health’s evidence noted that from 1 April 2013, the only NHS staff within the remit of the SSRB will be those relatively few very senior managers (VSMs) employed by the Department’s special health authorities and executive non-departmental public bodies, together with a small number in ambulance trusts that have not yet become foundation trusts. All other NHS organisations are free to determine their own pay and terms and conditions for their VSMs.

The SSRB recommended that no additional locality pay measures be added to the new VSMs’ national pay framework as the evidence pointed clearly to the market for VSMs being national rather than local. They observed that the new pay framework already has some flexibility, with safeguards, which should enable the NHS to recruit and retain sufficient numbers of suitable VSMs.

The SSRB also recommended that all NHS VSMs should be assimilated into and paid according to the new pay framework, on the basis of job weight, once the current NHS reforms have been fully implemented. Our view is that, to avoid increasing pay and costs unnecessarily, the new framework should apply to all new appointments. Existing VSMs should normally remain on their existing terms and conditions unless adjustments are required to comply with equal pay legislation.

The Government welcome and accept the recommendations of the SSRB, apart from the recommendation to assimilate all VSMs on to the new pay framework.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 27th November 2012 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

1. How many (a) health visitors and (b) nurses there were in the NHS in May 2010 and the latest month for which figures are available.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The number of full-time equivalent qualified nurses and midwives employed in the national health service in England in May 2010 was 310,793, and in August 2012 it was 304,566. The number of full-time equivalent health visitors in May 2010 was 8,092 and in August 2012 it was 8,067, with an additional 226 health visitors employed by organisations not using the electronic staff record.

[Barbara Keeley]

I thank the Secretary of State for that answer. The recent Care Quality Commission report found that 10% of NHS hospitals did not meet the standard of treating people with respect and dignity, and underpinning that poor care were high vacancy rates and hospitals that have struggled to make sure they have enough qualified staff on duty at all times. That shows us the real impact of losing those thousands of nurses. So does he agree that it is urgent that this Government take action when understaffing in the NHS results in poor care?

[Mr Hunt]

I absolutely agree with the hon. Lady that nowhere in the NHS should allow low staff numbers to lead to poor care. What was interesting about the CQC report, which was a wake-up call for the whole NHS, was that institutions under financial pressure, as the whole NHS is, are delivering excellent care in some places and delivering care that is unsatisfactory and not good enough in other places. On her specific question about nurses and nurse numbers, it is important to recognise that across the NHS as a whole the nurse-to-bed ratio has increased. Every NHS bed is getting an extra two hours of care per week compared with the situation two years ago.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

Will the Secretary of State give an instruction, irrespective of the numbers, that we go back to traditional nursing methods, as now that we have an almost all-graduate nursing profession we seem to have lost touch with true, caring nursing?

[Mr Hunt]

I have some sympathy with what my hon. Friend is saying, although it is important to recognise, as we have this debate about nursing, that the vast majority of nurses in the NHS do an outstanding job and we are very lucky to have them giving their lives to the NHS. Next week, at the chief nursing officer’s conference, we are launching a new vision for nursing, which will put compassion and the patient at the heart of what nurses do. I hope that will address some of her concerns.

[Andy Burnham (Leigh) (Lab)]

Last week, official statistics revealed that 7,134 nursing jobs had been lost under the coalition—almost 1,000 of them in the last month on the Secretary of State’s watch. The very next day, the Care Quality Commission warned that 16% of hospitals in England are not meeting the CQC standard for adequate staffing levels. Is this not prima facie evidence that the NHS and patients are not safe in his hands? Will he urgently intervene to stop the job losses?

[Mr Hunt]

The reason why the CQC undertook its shocking investigation into the state of care in our country was that this Government introduced dignity and nutrition inspections, which never happened when the right hon. Gentleman was Secretary of State. He talked about numbers employed in the NHS, so let us look at them. Yes, there has been a 2% decline in the number of nurses, but there has been an increase in the nurse-to-bed ratio. There has been a 4% increase in the number of midwives, a 5% increase in the number of doctors and an increase of more than 50% in the number of health visitors—their number went down when he was in office. How much worse would those numbers have been if we had had the cut in NHS funding that he wanted?

[Mary Macleod (Brentford and Isleworth) (Con)]

2. What steps the Government are taking to raise awareness of and help those who have brain tumours.

--- Later in debate ---

[Graeme Morrice (Livingston) (Lab)]

4. How much the NHS spent on consultancy in (a) 2010-11 and (b) 2011-12.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The amount spent by strategic health authorities, primary care trusts and NHS trusts on consultancy services in the financial years 2010-11 and 2011-12 was £291 million and £278 million respectively—a 39% fall in expenditure, compared to the last year of the previous Administration.

[Graeme Morrice]

In 2010 the former Secretary of State said he was

“staggered by the scale of the expenditure on management consultants”.

However, in the past year alone foundation trusts have increased their spend on consultancy by 25% and NHS trusts have increased their spend by 13%. Is the new Secretary of State just as staggered?

[Mr Hunt]

With respect to the hon. Gentleman, a 39% fall in consultancy expenditure compared to the last year of the previous Administration is something that we are rather proud of. If he wants to know what the Health Secretary is directly responsible for, direct Department of Health expenditure on consultancy in the past year was £3 million. In the last year of the previous Government it was £108 million.

[Andrew Bridgen (North West Leicestershire) (Con)]

Has my right hon. Friend made any recent assessment of the total efficiency savings achieved in the NHS over the past two years under the Nicholson challenge?

[Mr Hunt]

We are making good progress on the Nicholson challenge. This year we expect to save £5.8 billion under that important programme to improve efficiency in the NHS so that we can treat more people.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The Secretary of State cannot have it both ways. Is he aware that in the past year alone Monitor spent more than £9 million on NHS transition costs, with a staggering £5.6 million of that being squandered on management consultants? Is this not a further sign of a Government with their priorities all wrong, wasting precious public money on management consultants to push through a reorganisation that nobody wanted, while they are handing out P45s to our nurses?

[Mr Hunt]

If the hon. Gentleman is shocked at consultancy spend in the NHS today, he will be even more shocked to know that it was nearly double when his party was in power.

[Mr William Bain (Glasgow North East) (Lab)]

5. What estimate he has made of the number of foundation trusts considering plans to opt out of NHS national pay agreements.

--- Later in debate ---

[Pauline Latham (Mid Derbyshire) (Con)]

6. What recent assessment he has made of the cancer drugs fund.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Since October 2010, more than 23,000 patients in England and more than 1,600 patients in NHS East Midlands have benefited from the additional £650 million funding for cancer drugs that this Government have committed to providing.

[Pauline Latham]

I thank my right hon. Friend for that answer, but I have previously raised in the House a constituency case where the NHS East Midlands cancer drugs fund would not pay for drugs that other CDFs would pay for, such as Avastin for second-line treatment of bowel cancer. Sadly, my constituent has since died because she could not get funding for the drugs she needed, having spent all her own money funding the treatment herself. Will my right hon. Friend meet me and my late constituent’s consultant, Dr Bessell, to discuss how we can end this postcode lottery?

[Mr Hunt]

Proud as we are of the cancer drugs fund, to hear such stories is extremely distressing, and our first thoughts are with the family of my hon. Friend’s constituent. We will of course look into the issue she raises, which is a cause of great concern. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), is a neighbouring MP and would be happy to meet her to discuss the matter.

[Liz Kendall (Leicester West) (Lab)]

The reality is that the Government are ripping away the foundations of better cancer care. The former Health Secretary made a clear promise from the Dispatch Box to protect cancer network funding, but the NHS South East London and greater midlands cancer networks both say that their budgets and staff have been slashed. The NHS medical director, Sir Bruce Keogh, says that cancer networks are an NHS success story, and Macmillan Cancer Support says it is nonsensical to cut their specialist expertise. Why do the Government not agree?

[Mr Hunt]

Cancer networks are here to stay and their budget has been protected. They are extremely important. The hon. Lady uses hyperbolic phrases such as “ripping away the foundations of better cancer care”, so perhaps she would like to talk to the 23,000 people who have benefited from the cancer drugs fund that her Government failed to introduce.

[George Freeman (Mid Norfolk) (Con)]

I congratulate my right hon. Friend on the cancer drugs fund and the ring-fencing of the budget for cancer, which delivers important benefits in research, not least by funding new treatments by new companies that would not otherwise be able to sell their product and by generating important evidence on health economics. As a Mo-bro, I am very aware that medicines are better than surgery. Will he give the House some reassurance that the Government plan to renew the cancer drugs fund?

[Mr Hunt]

We are committed to finding a way of ensuring that people who have benefited from the cancer drugs fund—23,000 to date—can continue to receive that kind of support. That is something we can do because we protected the NHS budget, unlike the Labour party, which wanted to cut it.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

7. What steps he is taking to ensure that primary care trusts do not ration access to NHS treatments and operations.

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[Simon Hughes (Bermondsey and Old Southwark) (LD)]

14. What the process is for deciding the future of health care provision in south-east London; and if he will make a statement.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The trust special administrator at South London Healthcare NHS Trust will be making recommendations to me on the future of the trust’s services. Those recommendations will inevitably impact on the services provided by other trusts in the south-east London health economy.

[Simon Hughes]

When the Secretary of State considers outer south-east London health arrangements, and problems that are not at all of his making, will he bear in mind that all five Members of Parliament for Southwark and Lambeth are clear that plans by King’s Health Partners for a super-trust across Lambeth, Southwark and beyond should be put on hold until we know the implications for inner south-east London of any changes that happen further out?

[Mr Hunt]

I will certainly bear in mind the right hon. Gentleman’s comments. The decision time scale for the South London Healthcare NHS Trust is very quick as prescribed in the National Health Service Act 2006. I must make a decision on that by 1 February, so the situation will soon become clear.

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

24. The trust special administrator’s report proposes the closure of the full A and E service at Lewisham hospital —which currently sees 115,000 people a year—and asserts that 30% of that department’s work can be transferred to the community. Will the Secretary of State provide evidence of how that can be done, especially considering a cash-strapped NHS and a local authority that is suffering from deep cuts by his Government?

[Mr Hunt]

I remind the right hon. Lady that the Government have not cut the NHS budget; we have protected the NHS budget. There is an ongoing consultation on the proposal that she mentions. It will finish on 13 December and I hope she will contribute to it. I will receive the recommendations of the trust special administrator at the beginning of January, and I will then make my decision.

[Clive Efford (Eltham) (Lab)]

The 2010 Conservative manifesto stated:

“We will stop the forced closure of A and E and maternity wards, so that people have better access to local services,”.

They then closed the accident and emergency department at Sidcup, having promised to save it, and they now plan to close the A and E at Lewisham hospital. Is that not a betrayal of people in south-east London and the NHS?

[Mr Hunt]

The hon. Gentleman should talk to the shadow Minister on the Opposition Front Bench, the hon. Member for Leicester West (Liz Kendall), who said yesterday that she would not automatically oppose all reconfigurations. The coalition Government have introduced four tests, which were not used by the previous Government. Those tests state that we will not impose closures of A and E and maternity units unless there is local clinical support, and evidence that it will benefit local people and improve patient choice. The tests exist to provide precisely the safeguards about which the hon. Gentleman is concerned.

[Chris Ruane (Vale of Clwyd) (Lab)]

15. What recent assessment he has made of the treatment of repeat episode depression by (a) drugs and (b) mindfulness-based intervention.

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[Jack Dromey (Birmingham, Erdington) (Lab)]

T1. If he will make a statement on his Departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

I am pleased to report an NHS performing at record levels. There are half a million more out-patient appointments every year since the last election, nearly 1 million more people go through A and E every year, and there are 1.5 million more diagnostic tests every year. To clarify a previous answer, the number of health visitors will go up by more than 50% during the course of this Parliament.

[Jack Dromey]

The Erdington walk-in centre is at the heart of our high street. It is much loved, much used and cost-effective, yet it is at risk of closure because of the combination of a £76 million reduction in expenditure by Birmingham primary care trusts and health service reorganisation. Thousands of local people have expressed their concern and elected a users committee. Will the Secretary of State meet the users of the centre and me?

[Mr Hunt]

I am happy to look into the issues the hon. Gentleman raises. The purpose of the reforms is to put more money on to the front line and into primary care, where we can save the most lives.

[Sir Tony Baldry (Banbury) (Con)]

T2. The new mandate for the NHS includes a very welcome objective for it to be a world leader in end-of-life care. Can we have an indicator in the commissioning outcomes framework on deaths in preferred places of care to ensure that new commissioning groups prioritise better end-of-life care, and to ensure that those who want to die peacefully at home have the best opportunity to do so?

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[Mr Aidan Burley (Cannock Chase) (Con)]

T4. Yesterday, I received a letter from the chief executive of Monitor, which asked me and the Asset Transfer Unit to undertake feasibility work to develop a professional business case for the local community to take ownership of Cannock Chase hospital. This would be done through its transfer to a community interest company, which would then take over running the hospital estate, securing the building for the people of Cannock Chase. Will the Secretary of State welcome these proposals, which would be the first of their kind in the UK, and work with us as we develop a plan for the local community to own its hospital?

[Mr Jeremy Hunt]

I congratulate my hon. Friend on his campaigning and hard work on this issue, which represents an interesting way forward for community hospitals. I wish him every success and I know that hon. Members in all parts of the House will watch carefully what happens in Cannock.

[Heidi Alexander (Lewisham East) (Lab)]

T5. I would like to press the Health Secretary further on the unsustainable providers regime, which has been enacted in the South London Healthcare NHS Trust. Given that the statutory guidance for that regime explicitly states that it is not to be used as a back-door route to service reconfiguration, why are Lewisham A and E and maternity services earmarked for closure? If that is not a service reconfiguration, can he tell me what is?

[Mr Hunt]

What this issue is addressing—it was legislation introduced by the hon. Lady’s Government in 2006—is a clearly unsustainable situation with South London Healthcare. The proposals have to look at making sure that there is sustainability throughout an entire local health economy. I have not made any decisions at all. I will wait for the proposals to come to me at the end of the year, and I will then make my decision in January.

[Andrew George (St Ives) (LD)]

T6. There is mounting evidence that clinical care failure is as much to do with inadequate staff levels as anything else. In view of that, do Ministers agree that it is worth looking at the merits of establishing mandatory registered nurse to patient ratios across secondary and tertiary care wards?

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[Mr Jeremy Hunt]

I will absolutely look into that issue. We are keen to ensure that people with rare diseases, including rare cancers, are not discriminated against because it is more expensive to do the research and get the drugs necessary to treat them.

[Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op)]

The Minister will be aware that the process of making Kalydeco available to people with cystic fibrosis in England is much further advanced than in Scotland, where the G551D gene is two to three times more prevalent—a point highlighted by the Daily Record yesterday in respect of seven-year-old Maisie Black from Burnside in my constituency. Will the Minister clarify that the roll-out in England will not be restricted, so that young children, who have the least accumulated lung damage and therefore most to benefit, do not lose out on the chance of benefiting from this transformational drug?

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[Mr Stewart Jackson (Peterborough) (Con)]

Last week it was a great pleasure to visit Age UK Peterborough, whose No. 1 priority is dementia care, which coincides with the NHS priorities that my right hon. Friend the Secretary of State outlined earlier this week. Will he put in place procedures to make available capital moneys for the construction of dementia care facilities locally?

[Mr Jeremy Hunt]

I can announce that we have already put in place such funds, because dementia is one of the biggest challenges we face across the entire health and social care system. We need more capital funds, but we also need massively to increase the shockingly low diagnosis rates. At the moment, only 42% of the 800,000 people with dementia are being diagnosed properly and therefore getting the treatment they need.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Is the Secretary of State worried about the high level of qualified managers leaving the NHS—fleeing the NHS—to go to other places or retire early when there are few people in clinical commissioning groups with any management experience at all?

[Mr Hunt]

There is always a role for excellent managers in the NHS, but this Government’s priority is front-line clinicians, which is why the number of doctors has increased by 5,000 since we have been in power and why administration costs have been cut, which will save the NHS £1.5 billion every year.

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[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

Is the Secretary of State disappointed by the low number of GPs who have come forward to take on accounting officer roles in clinical commissioning groups, and can he say why he thinks that is?

[Mr Jeremy Hunt]

I am actually very encouraged by the enthusiasm of the GPs who are running clinical commissioning groups up and down the country. They are going to transform services and, most of all, they are going to integrate services at a local level. That is something that has long been talked about but not delivered before in the NHS.

[Several hon. Members]

rose—