NHS Future Forum

John Bercow Excerpts

Tuesday 14th June 2011 Commons Chamber

[The Secretary of State for Health (Mr Andrew Lansley)]

With permission, Mr Speaker, and further to the written ministerial statement I laid in the House earlier today, I wish to make a statement on the Government’s response to the NHS Future Forum.

We established the independent Future Forum on 6 April, under the chairmanship of Professor Steve Field, to look again at our proposals on the modernisation of the NHS. Yesterday it published its report and recommendations. I would like to thank Professor Field and his 44 senior colleagues from across health and social care who have worked so hard these past eight weeks. I would also like to thank more than 8,000 members of the public, health professionals and representatives from some 250 stakeholder organisations who attended some 250 events across the country—and also the tens of thousands who wrote to us with their views. I want also, if I may, to thank the many officials in my Department who supported this unprecedented engagement across the country.

Two months ago, I said to the House that we would pause, listen, reflect and improve our plans. Our commitment to engage and improve the Bill has been genuine and has been rewarded with an independent, expert and immensely valuable report and recommendations from the Future Forum. I can tell the House that we will ask the forum to continue its work, including looking at the implementation of proposals in areas including education and training and public health.

In his report, Professor Field set out clearly that the NHS must change if it is to respond to challenges and realise the opportunities of more preventive, personalised, integrated and effective care. The forum said that the principles of NHS modernisation were supported: to put patients at the heart of care, to focus on quality and outcomes for patients, and to give clinicians a central role in commissioning health services.

The forum set out to make proposals for improving the Bill and its implementation, to provide reassurance and safeguards, and to recommend changes where needed. As Professor Field put it, it did this not to resist change, but to embrace it, guided by the values of the NHS and a relentless focus on the provision of high-quality care and improved outcomes for patients.

We accept the NHS Future Forum’s core recommendations. We will make significant changes to implement those recommendations and, in some cases, offer further specific assurances that have been sought. There are many proposed changes and we will publish a more detailed response shortly. However, I would now like to tell the House some of the main changes that we will make.

The Bill will make it clear that the Secretary of State has a duty to promote a comprehensive health service, as in the National Health Service Act 1946, and is accountable for securing its provision and for the oversight of the national bodies charged with doing so. We will also place duties on the Secretary of State to maintain a system for professional education and training within the health service, and to promote research.

One of the most vital areas of modernisation to get right is the commissioning of local services. For commissioning to be effective, the process of designing services must draw on a wide range of people, including clinicians, patients and patient groups, carers and charities. We will amend the Bill so that the governing body of every clinical commissioning group will have at least two lay members, one focusing on public and patient involvement and the other overseeing key elements of governance, such as audit, remuneration and managing conflicts of interest. Although we should not centrally prescribe the make-up of the governing body, it will have to include at least one registered nurse and one secondary care specialist doctor. To avoid any potential conflict of interest, neither should be employed by a local health provider. The governing bodies will meet in public and publish their minutes. The clinical commissioning groups will also have to publish details of all their contracts with health service providers.

To support commissioning, the independent NHS commissioning board will host “clinical senates”, which will provide expert advice on the shape and fit of health care across wider areas of the country. Existing clinical networks will be developed and will advise on how specific services, such as those for cancer, stroke or mental health, can be better designed to provide integrated and effective care.

Building on that multi-professional involvement, clinical commissioning groups will have a duty to promote integrated health and social care with regard to the needs of their users. To encourage greater integration between social care and public health, the boundaries of clinical commissioning groups should not normally cross those of local authorities. If they do, clinical commissioning groups will need to demonstrate to the NHS commissioning board a clear rationale for doing so in terms of benefit to patients.

I have always said that I want there to be “no decision about me, without me” for patients when it comes to their care. The same—[Interruption.]

[Mr Speaker]

Order. Let us hear the Secretary of State’s statement with some courtesy.

[Mr Lansley]

Thank you very much, Mr Speaker.

We will further clarify the duties on the NHS commissioning board and clinical commissioning groups to involve patients, carers and the public. Commissioning groups will have to consult the public on their annual commissioning plans and involve them in any changes that would affect patient services.

One of the main ways in which patients will influence the NHS is through the exercise of informed choice. We will amend the Bill to strengthen and emphasise the commissioners’ duty to promote patient choice. The choice of any qualified provider will be limited to areas where there is a national or local tariff, ensuring that competition is based solely on quality. The tariff development, alongside a best-value approach to tendered services, will safeguard against cherry-picking.

Monitor’s core duty will be to protect and promote the interests of patients. We will remove its duty to promote competition as though that were an end in itself. Instead, it will be under a duty to support services integrated around the needs of patients and the continuous improvement of quality.

It will have a power to tackle specific abuses and restrictions of competition that act against patients’ interests. Competition will be a means by which NHS commissioners are able to improve the quality of services for patients.

We will keep the existing competition rules introduced by the last Government—the so-styled “Principles and rules for co-operation and competition”—and give them a firmer statutory underpinning. The co-operation and competition panel, which oversees the rules, will transfer to Monitor and retain its distinct identity. We will also amend the Bill to make it illegal for the Secretary of State or the regulator to encourage the growth of one type of provider over another. There must be a level playing field.

We will strengthen the role of health and wellbeing boards in local councils, ensuring that they are involved throughout the commissioning process and that local health service plans are aligned with local health and wellbeing strategies.

In a number of areas, we will make the timetable for change more flexible to ensure that no one is forced to take on new responsibilities before they are ready, while enabling those who are ready to make faster progress. If any of the remaining NHS trusts cannot meet foundation trust criteria by 2014, we will support them to achieve that subsequently. However, all NHS trusts will be required to become foundation trusts as soon as clinically feasible, with an agreed deadline for each trust.

We will ensure a safe and robust transition for the education and training system. It is vital that change is introduced carefully and without creating instability, and we will take the time to get it right, as the Future Forum has recommended. During the transition, we will retain postgraduate deaneries and give them a clear home within the NHS family.

The extension of “any qualified provider” will be phased carefully to reflect and support the availability of choice for patients. Strategic health authorities and primary care trusts will cease to exist in April 2013. By that date, all GP practices will be members of either a fully or partly authorised clinical commissioning group, or one in shadow form. There will be no two-tier NHS.

However, individual clinical commissioning groups will not be authorised to take over any part of the commissioning budget until they are ready to do so. Individual GPs need not take managerial responsibility in a commissioning group if they do not want to, and April 2013 will not be a “drop dead” date for the new commissioners. Where a clinical commissioning group is not able to take on some or all aspects of commissioning, the local arms of the NHS commissioning board will commission on its behalf. Those groups that are keen to press on will not in any way be prevented from becoming fully authorised as soon as they are ready.

I told the House on 4 April that we would secure proper scrutiny for any changes that we made to the Bill. In order to do that without trespassing on the House’s time to review the Bill as a whole on Report, we will ask the House to recommit the relevant parts of the Bill to a Public Bill Committee shortly.

Through the recommendations of the NHS Future Forum and our response, we have demonstrated our willingness to listen and to improve our plans; to make big changes, and not to abandon the principles of reform, which the forum itself said were supported across the service. However, we are clear that the NHS is too important, and modernisation too vital, for us not to be sure of getting the legislation right. The service can adapt and improve as we modernise and change, but the legislation cannot be continuously changed. On the contrary, it must be an enduring structure and statement, so it must reflect our commitment to the NHS constitution and values and incorporate the safeguards and accountabilities that we require. It must protect and enhance patients’ rights and services, and it must be crystal clear about the duties and priorities that we will expect of all NHS bodies and local government in the future.

Professor Field’s report says that it is time for the pause to end. Strengthened by the forum’s report and recommendations, we will now ask the House to re-engage with delivering the changes and modernisation that the NHS needs. I commend this statement to the House.

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[Several hon. Members]

rose—[Interruption.]

[Mr Speaker]

Order. The Opposition Front-Bench team should not be yelling at the Secretary of State when he is answering. [Interruption.] Order. On both sides of the House, right hon. and hon. Members, whatever the passions they feel, need to simmer down just a little. A fine example of that calm and stoicism can now be provided by the right hon. Member for Holborn and St Pancras (Frank Dobson).

[Frank Dobson (Holborn and St Pancras) (Lab)]

Does the Secretary of State recognise that forcing the national health service to start implementing his changes before the law had been changed has resulted in vast expense to the NHS, in chaos to services and in the diversion of NHS staff from the treatment of patients? Does he also recognise that just cobbling together a few amendments to the Bill will not make things better but worse? Will he not recognise—[Interruption.]

[Mr Speaker]

Order. I ask the right hon. Gentleman to finish his sentence. We must press on.

[Frank Dobson]

Does the Secretary of State—[Interruption.]

[Mr Speaker]

Order. I will have the question finished. I do not require any help from any Member.

[Frank Dobson]

Does the Secretary of State not recognise that pretending to produce a collaborative silk purse from a competitive pig’s ear will not work?

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[Several hon. Members]

rose—

[Mr Speaker]

Order. I want to say two things. First, questions and answers must focus on the policy of the Government. That is the parliamentary position, and Members know it. Secondly—[Interruption.] Order. Secondly, I want to accommodate the level of interest in this statement, but Members must help me to help them, by being brief.

[Mr Ben Bradshaw (Exeter) (Lab)]

In fact, the last Labour Government left record low waiting times and record levels of public satisfaction with the NHS. I welcome the fact that Professor Steve Field has said what many of us in the Opposition have been saying for at least a year. How much has this year’s shambles cost the NHS, and how much has it damaged patient care?

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[Several hon. Members]

rose—

[Mr Speaker]

Order. May I remind the House that Members who came into the Chamber after the Secretary of State began his statement should not expect to be called?

[Mr Kevin Barron (Rother Valley) (Lab)]

The Secretary of State must know that the biggest threat to the stability of the national health service is the introduction of competition law into clinical services. Will the clause that says that the mergers of NHS trusts will be a matter for the Office of Fair Trading and the Competition Commission be removed from the Bill?

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

What can we conclude from the fact that the Prime Minister is not here with us this afternoon to support the Secretary of State, but is involved in a PR stunt at Guy’s and St Thomas’ NHS Foundation Trust? It was once said on the other side of the Atlantic that you could put lipstick on a pig, but at the end of the day it was still a pig. Is that not true of the Bill?

[Mr Speaker]

Order. We are starting to get involved in issues perhaps not of order, but certainly of taste.

[Mr Lansley]

If you will forgive me, Mr Speaker, I do not think that I will favour that question with an answer.

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[Gavin Barwell (Croydon Central) (Con)]

I welcome the revised proposals, in particular the focus on competition not as an end in itself but on informed—[Interruption.]

[Mr Speaker]

Order. I apologise for having to interrupt the hon. Gentleman. Whatever feelings the hon. Member for Blyth Valley (Mr Campbell) entertains in relation to the Liberal Democrats, who seem unlikely to feature on his Christmas card list, I urge him to exercise what modicum of self-restraint he can muster in the circumstances.

[Gavin Barwell]

Thank you, Mr Speaker.

I welcome the focus not on competition as an end in itself, but on informed patient choice to improve patient care. Can my right hon. Friend confirm that, unlike the Opposition, the Government believe that NHS patients in my constituency deserve the best that the public, private and voluntary sectors can offer them?

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[Mr Lansley]

rose—

[Mr Speaker]

Order. I remind the House of the wise stipulation in “Erskine May” that moderation and good humour are the defining features of parliamentary language.

[Mr Lansley]

In that spirit I thank the hon. Gentleman for the generosity of his remarks and encourage him likewise to apologise for the performance of a Labour Government in Wales who are cutting the NHS budget by 5% and seeing the performance of health care in the NHS in Wales deteriorate considerably relative to that in England.

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[Mr Lansley]

I have made it very clear that the impact assessment set out that we expect the total cost of the reorganisation—these figures will be revised because of the changes—to be about £1.4 billion, but that it will deliver recurring savings of £1.7 billion a year, leading to something approaching a £5 billion net saving in administration costs over the life of this Parliament.

[Mr Speaker]

I am grateful to the Secretary of State. All 65 Back-Benchers who stayed in the Chamber and sought to catch my eye were successful in doing so. I hope that the House’s inquisitorial appetite has been satisfied on this matter, at any rate for today. I was going to come to the ten-minute rule motion, but not before we have entertained a point of order from the hon. Member for Rhondda (Chris Bryant)—nothing new there.