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NHS Next Stage Review

Volume 462: debated on Wednesday 4 July 2007

With permission, Mr. Speaker, I wish to make a statement about the NHS. Next year marks the 60th anniversary of the creation of the national health service. If the welfare state represented the crowning achievement of Attlee’s post-war Labour Government, the NHS was the jewel in that crown—one of the great civilising influences of the 20th century.

After the carnage of the second world war and the poverty and deprivation that went before, the advent of the NHS heralded a new era of equity, with medical care available for all—the weak, the sick and the vulnerable, as well as the wealthy and privileged. Nye Bevan said that the NHS made society

“more wholesome, more serene and spiritually healthier”.

That is as true today as it was in 1948. However, great change has occurred in the intervening 59 years, presenting new challenges for that cherished institution.

We are living longer, partly thanks to the NHS and partly owing to incredible scientific advances, with groundbreaking research emerging every day, bringing new cures but also extra costs. We are more discerning as consumers: we have gone from the old ration-book culture to a new iPod age, in which we increasingly expect choice and convenience. And we are more prosperous, with a range of goods and devices—at one level improving our quality of life, but also leading to an increase in lifestyle diseases, such as obesity and diabetes.

Society cannot stand still in the face of scientific and social change, and neither can the NHS. We have trebled spending to £90 billion a year, so there are now 80,000 more nurses and 36,000 more doctors. That unprecedented investment has been matched by new ways of working, from practice-based commissioning to NHS Direct and foundation hospitals.

On most objective measures, the NHS is performing better than ever, with more than 1 million extra operations taking place every year. Waiting lists are down, while satisfaction levels are up. Ninety two per cent of patients describe the treatment that they receive as “good”, “very good” or “excellent”. Only a few weeks ago, a global study by the Commonwealth Fund ranked the NHS first in a comparison with five other developed countries, including the US, Canada and Germany.

Yet, subjectively and anecdotally, there has been confusion and frustration in the NHS. The public are rightly concerned to know that their taxes are being wisely spent to build a health service that will meet their needs. Doctors, clinicians and nurses complain that they are fed up with too many top-down instructions, and they are weary of restructuring. They want a stronger focus on outcomes and patients, and less emphasis on structures and processes. That lack of confidence matters, because of the impact that it has on the operational capacity of the service. If the morale and good will of the profession is dissipated, our capacity for bringing about improvement for patients diminishes.

Restoring the NHS was one of the Government’s top priorities and, following almost two decades of neglect, a huge amount of reform in a short period of time was unavoidable. That was, as it were, the “emergency room” approach and, in the early stages it brought about substantial achievements. However, we now need to forge a new partnership with the profession.

Having addressed the funding shortfall, and put the necessary reforms in place, we will give the NHS the sustained period of organisational and financial stability that it requires. I can announce today that there will be no further centrally dictated, top-down restructuring to primary care trusts and strategic health authorities for the foreseeable future.

But we need to do more to make sure that the NHS keeps up with the changing demands and expectations of patients. New drugs, new medical technologies and better clinical practices provide huge opportunities, while lifestyle diseases and an ageing population present major challenges. To set us on the path to the next stage of the transformation of the NHS, my right hon. Friend the Prime Minister and I have asked Professor Sir Ara Darzi, one of the world’s leading surgeons, to carry out a wide-ranging review of the NHS. This is a once-in-a-generation opportunity to ensure that a properly resourced NHS is clinically led, patient-centred and locally accountable.

The review, the first of its kind, will directly engage patients, NHS staff and the public on four critical challenges. First, we want to work with NHS staff to ensure that clinical decision making is at the heart of the future of the NHS and of the pattern of service delivery. Secondly, we want to improve patient care, including providing high-quality, joined-up services for those suffering long-term or life-threatening conditions, so that patients are treated with dignity in safe, clean environments.

Thirdly, our aim is to ensure that more accessible and convenient care is integrated across primary and secondary providers, reflecting best value for money and offering services in the most appropriate settings for patients. Fourthly, we will establish a vision for the next decade of the health service that is based less on central direction and more on patient control, choice and local accountability, and which ensures that services are responsive to patients and local communities. The terms of reference for the review have been placed in the House of Commons Library, and I have written today to all NHS staff to explain the importance of this new approach.

Professor Darzi will complete an initial assessment in three months’ time to inform the comprehensive spending review. He will produce his full report in the new year, setting out a new vision for a 21st-century NHS, coinciding with the 60th anniversary celebrations.

I know that the review will not succeed if it is controlled from above: the best of the NHS sits not at the top of the organisation but in the millions of complex and diverse relationships that exist across the country between dedicated, devoted professionals and their patients. The success of the review will depend on gaining access to those relationships and stimulating a range of lively, local, provocative debates. The scale of our discussions with staff, patients and the public will be unprecedented, harnessing Professor Darzi's wide experience of building engagement as part of his work in London and elsewhere.

Patients must have the chance to shape the kind of NHS they want, to say how they wish to access services as they manage increasingly complex lives, juggling competing demands. They should have the chance to say how they feel about services delivered through pharmacies, the internet and other new technologies. We must respond by ensuring that they have more convenient services, open when they need them, making it easier to book timely appointments. Patients should also have the chance to say how we can make services more personal to them, particularly in long-term care.

Although it is right that we look forward, we must also deal with the problems at hand. A major immediate concern for patients is the cleanliness of hospitals. Last year, NHS staff successfully brought about a reduction in MRSA bloodstream infections as well as stemming the increase in C. difficile reports. Today, I am providing funding for each director of nursing in every strategic health authority to work with front-line nurses to ensure that they get the support they need to provide clean, safe wards. I am also doubling the size of the infection improvement teams, so that all trusts struggling to meet the MRSA target can have access to doctors and nurses who are experts in infection control, to help them get back on track.

Public services cannot be transformed by going against the grain of public service, or without support from the professionals who know the NHS best. As Secretary of State, I am determined to establish a new, closer, more robust social partnership between patients, practitioners and policy makers, based on trust, honesty and respect. That is why Professor Darzi is leading the review, supported by a team of leading clinicians across the country. He will engage directly with front-line staff, not just the great and the good of the health world, but those working in every primary care trust and hospital trust up and down the country.

As part of the review, we must look at how we make decisions on the shape and location of hospital services. The way we do so must be transparent, open and accountable. People need to know that decisions are being made for the right reasons by clinicians, and are based on the best available medical evidence. While the review is under way I will, as a matter of course, ask the independent reconfiguration panel—our expert clinical group—for advice on any decisions made at local level that have been referred to me by overview and scrutiny committees. I will make sure that any changes made are made on the basis of clinical need and patient care.

At the end of the review, we will consider the case for a new NHS constitution, with respect for the needs of patients and the judgment of professionals at its heart, ensuring that power is devolved to those who know the service best. That will ensure that the service is genuinely led by the needs of patients, providing value to the taxpayer as we move to the next stage of improvement. It will protect the enduring, cherished principles of universal health care, free at the point of need, which lay behind the establishment of the NHS, and ensure that this precious institution continues into the 21st century in ruder health than ever. I commend the statement to the House.

I thank the Secretary of State for advance notice of his statement. But is that it? The NHS an immediate priority for the Prime Minister? And what is the immediate priority? An 11-month review. If the Secretary of State really thinks we shall leave him alone for a year while he finds out what is going on in the NHS, he has another think coming.

It is 4 July today: I thought that it would be NHS independence day, but it did not turn out to be. I was disappointed by what I heard, and—notwithstanding a letter from the Secretary of State—NHS staff, along with the public, will be disappointed.

For a start, we need to know what on earth is going on. A fortnight ago, the NHS chief executive said in his report:

“in the autumn we will set out a clear, strategic direction for the NHS going forward”.

That report is now so much chip paper. The Secretary of State has started with the same self-congratulatory material as we got from his predecessor. He cited the Commonwealth Fund report. I hope that he has read it; yesterday, this incoming Secretary of State did not seem to have read much.

The Commonwealth Fund report compares Britain with only one other European country. On page 9, it says that the UK is worst on hospital-acquired infections; contrary to the Secretary of State’s self-congratulatory statement, levels of C. difficile have not been stemmed, but are continuing to rise. On page 15, the report places the UK worst on access to out-of-hours GP services and worst for waiting times. On page 21, it states that the UK has the highest mortality rates after adjusting for factors unrelated to health care—[Interruption.]

Perhaps the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw) has read it, if the Secretary of State has not. He says that the UK comes out best overall. Does he know why? The report puts into the equation what it regards as an efficiency measure, which it calculates on the basis of how much is spent. It adjusts the whole table on the basis of the fact that we spend less in the United Kingdom than Germany, Canada, Australia or New Zealand. Spending less is the main reason why the Secretary of State and his Ministers think that UK health care is best.

The only thing that the Secretary of State seems genuinely to have understood is that morale in the NHS is at rock bottom. In a recent Health Service Journal survey, NHS staff were asked whether morale was good or poor: 4 per cent. said that it was good, 0 per cent. said that it was excellent and 66 per cent. said that morale was poor or very poor. What on earth have we heard in the Secretary of State’s statement that would change any of that? We know what has to happen. We have published a White Paper that sets out direction and leadership. If the Secretary of State would only look at that, he would find things that clearly need to be done.

First, the core principles of the NHS need to be entrenched in statute. We are prepared to do that; apparently, the Secretary of State’s predecessors were prepared to as well, although with the exception of the principle that public funds for health care should be devoted solely to NHS patients. We subscribe to that principle. Will the Secretary of State now say that he will do the same?

Secondly, we need no more pointless organisational upheaval. My right hon. Friend the Member for Witney (Mr. Cameron) has been saying that for a year, and finally Ministers have accepted it, so we can put that one down. Thirdly, the Government need to set the resources and objectives, but not to interfere in the day-to-day decisions of the national health service. In a recent poll, 67 per cent. of NHS staff and 71 per cent. of the public agreed with that proposition. Where is that today? If there were such an acknowledgement by the Secretary of State, he would scrap targets immediately.

Fourthly, we need to take decisions close to patients. I am astonished that the incoming Secretary of State said nothing today about the centrality of the family doctor service and primary care, having a primary care-led service and strengthening commissioning. Fifthly, we need independent regulation of health care providers; even his predecessor acknowledged that we needed independent regulation. We need not a review but legislation in the next parliamentary Session to achieve those things.

I have mentioned five long-term reforms, of which the Secretary of State has acknowledged only one. The NHS desperately needs leadership and direction. Reform in the NHS is confused and incoherent, and on its own admission, the Department of Health has no vision of where the NHS is going. We set out a blueprint. Come on, Secretary of State, steal our clothes! We need to show the NHS that politicians can work together for the long term to give it the framework that it really needs. Only if there is that long-term framework can we deal with the real challenges of demography, technology, productivity and improving public health outcomes.

The Secretary of State said that he was dealing with immediate issues, but he mentioned only one, with something that should have been done years ago. Will he abolish the top-down centralised targets that stop NHS professionals doing their jobs and distort clinical priorities? Will he make the allocation of NHS resources fair and independent? We have asked for that, the Health Committee has asked for it, and two weeks ago his predecessor said that she thought it was the right thing to do.

Will the Secretary of State stop major service reconfigurations? He is apparently going to put a brake on them and use the independent reconfiguration panel. When he goes to his new colleague, Sir Ara Darzi, and mentions that he is going to do that, Sir Ara Darzi will be amused, because in Hartlepool he was used by Ministers to bring forward proposals on reconfiguration, which were promptly overturned by the independent reconfiguration panel. That is not much of a recommendation for the policy-making skills of Sir Ara Darzi.

Will the Secretary of State tell the House how it can be right, in terms of clinical need and patient care, for accident and emergency departments in Surrey and Sussex that treat up to 300,000 people to be shut down, while in Bishop Auckland hospital in Durham, which serves the former Prime Minister’s constituency, an accident and emergency department that treats 125,000 people is apparently absolutely fine?

Will the Secretary of State create additional training posts and assure well-qualified UK-based junior doctors that they will have an opportunity for specialty training? How can an incoming Secretary of State for Health not recognise that the crisis in junior doctor training is an immediate issue to be tackled? If the Secretary of State is so keen on a review, will he today initiate the independent review that we have called for on NHS IT—one that really listens to the people working in the NHS?

Five long-term reforms are required. There are five urgent issues. What have we got? Two. Two out of 10: those are the Secretary of State’s marks so far. We would give the NHS the priority that it really needs by taking the action required. Where is the immediate priority that the Prime Minister promised? Where is the autonomy and accountability that the NHS is calling out for? Where is the leadership and the direction that the NHS so badly needs? The NHS is there for us. Why will not the Government trust NHS staff to deliver?

I am tempted to ask—to echo the hon. Gentleman’s predictable response—“Is that it?”. It is a shame, because he thinks about these things, and he sent me a letter about having a dialogue on resolving these issues. His response will not be shared by NHS staff. NHS staff right across the country will be pleased that we are initiating the biggest consultation exercise we have ever had—a genuine dialogue about how we move to the next phase of the NHS. The hon. Gentleman said that we were asking Members on the Opposition Benches to sit silent for a year—but as I said in my statement, we are asking Ara Darzi to report first in October. The second part of the report will be next year, but certainly not 12 months away.

The hon. Gentleman said that he thought this was going to be NHS independence day. I take issue with him about the Conservative party’s policy on independence for the NHS. It is a fundamental central plank—

That was yesterday. I have had time to read it overnight, and I am deeply unimpressed. There is some tinkering around with detail that I would be pleased to talk to the hon. Gentleman about—particularly in the context of GP practitioners, which is an important issue—but the central plank of Conservative party policy is that we ought to hand the NHS over to some kind of 1960s public corporation, and it should be run completely independently by that huge quango. That will not work. I cannot think of a worse recipe for addressing the problems that we have in the NHS, which are about the work force believing that their views have been completely ignored in the context of the issues that have led to change, and that they are being talked down to by Whitehall, rather than their having a role in deciding the issues, based on clinical need, and patient care being an absolute priority.

The hon. Gentleman said that morale had reached rock bottom. I doubt whether it has reached as low a level as it reached during the 1980s, but I accept that morale is low. He cannot make up his mind whether he wants things to be top-down or locally decided. He quotes the example of A and E reconfiguration in Sussex. That is a local, clinically-driven decision happening in that area. It is absolutely right that we should allow those proposals to go on. Incidentally, nine out of 10 reconfiguration proposals are decided and agreed locally, and do not even get referred to me for decision by the overview and scrutiny committee.

We are not saying that the statement solves all the problems in the NHS. Of course there are problems in relation to junior doctors and problems to be tackled in a whole range of areas, but I hope that when Members on the Opposition Benches have had time to reflect, they will agree about using a team of highly respected clinicians who work in the NHS day in and day out. Incidentally, Professor Sir Ara Darzi will continue with his practice for two days a week, even while he is a Minister. It is right that he is a Minister, because if we handed the review to someone outside the NHS, and then outside Government when the review was delivered, that would be far less powerful than having someone conducting the review and being in government to ensure that the review is implemented.

The Conservative party has crossed the Rubicon. You have crossed the Rubicon in relation to getting rid of the patient passport. You have crossed the Rubicon in making the NHS a priority—

Order. The Minister should be careful when he uses the term “you”, because some people might think that he is talking about me.

I apologise, Mr. Speaker. I should say that the Rubicon has been crossed. Core principle No. 7 of the NHS core principles, which the hon. Gentleman’s party has now signed up to, says:

“Public funds for healthcare will be devoted solely to NHS patients”.

We remain committed to that. It is a big change for the Conservative party to follow us across the Rubicon, and the hon. Member for South Cambridgeshire (Mr. Lansley) has left some Members behind on the other side. Sitting behind him is the hon. Member for Wellingborough (Mr. Bone), from the Cornerstone group, who still has to cross those perilous waters. Now we can decide together how we will take the NHS on to its next stage.

I thank my right hon. Friend for his statement. I am sure that the Health Committee, of which I am a member, will want to look in some detail at what has been placed in the Library. My right hon. Friend said that society cannot stand still. Does not most of what was said from the Opposition Front Bench disprove that theory? Most of the time the Conservatives do want to stand still and not to move on. If the review is to look at targeting, will he make sure that targets set—whether at local or national level—in order to get rid of health inequalities are not removed, but are improved, so that we can address health inequalities in a serious way and have a national health service that deals with that matter better than it has in the past?

My right hon. Friend is right, particularly when he describes the conservatism of Members on the Opposition Benches, which is hardly surprising. We needed to be top-down and to set targets to transform the situation in the NHS, particularly in relation to waiting lists. My right hon. Friend has a long and proud record of standing tall for the NHS and of arguing for the necessary changes. The point that I made both yesterday and today is that the NHS needed to be, in effect, in intensive care. It is now on the road to recovery. We need a different approach, and we need that to be formulated into a new constitution for the NHS that can make it fit for the 21st century.

I thank the Secretary of State for the advance copy of his statement. As an aside, the new Government, under the new Prime Minister, have said that they want to strengthen Parliament. May I suggest that providing copies of statements a little earlier than traditionally happens would be a sensible reform? That would mean that there could be a much more informed debate, rather than Members trying to come up with an intelligent response in the 35 minutes before the statement is made. I would be grateful if that could be considered.

The statement is surely something of an admission of failure, given that after 10 years of the Government’s stewardship of the NHS, they are still searching a strategic direction. It comes after the Cabinet Office’s review of the Department, which was pretty scathing about the leadership offered and the lack of strategic direction. Nevertheless, I give it a cautious welcome, provided that the Government are prepared to examine fundamentally the serious weaknesses in their stewardship of the NHS, primarily the far too great centralisation of the way in which the service is run. I welcome the fact that consideration will be given to a constitution, because that approach seems entirely sensible.

I am worried that it appears that the process will be entirely led by clinicians and health professionals. Will it involve patient representatives, other groups with a direct interest and the public? I appreciate that the public will be consulted, but will only clinicians and health professionals make all the decisions and recommendations?

There are some fundamental weaknesses regarding the four areas that the review will examine. I was amazed that no reference was made to health inequalities and fairness. I raised that point during yesterday’s debate. Health inequalities have increased under the Government in recent years, not reduced, despite the Government target on cutting such inequalities. Will the Secretary of State reassure me that even though there was no reference to health inequalities in the statement or the terms of reference, the review will examine them as a central issue?

The proposals are pretty thin on the question of productivity. More and more people tell me that despite the enormous record investment, which we supported, money could be used much more effectively to achieve outcomes for patients who need help. Will there be a central look at how to improve productivity in the NHS?

There has been a series of contradictory reforms over the past 10 years. Structural changes have subsequently been reversed, so I welcome the fact that there will be no more such changes. However, will the review address something that the former Secretary of State recognised in a speech that she made just before she stood down: the local democratic deficit in the NHS? She said that there was a need to strengthen local accountability. Yesterday, the Prime Minister said that he would look to devolve power genuinely. How seriously will the review address providing genuine democratic accountability locally in the NHS?

The Secretary of State said that existing problems needed addressing, but he referred to only one: hospital-acquired infections. He said that he would commit additional resources to tackling that problem, but how much extra will he provide for the strategy? Will this not be, again, too much of a top-down approach, and will it sufficiently engage staff? The Department was supposed to be producing a guidance note on the use of antibiotics, which is critical to tackling hospital-acquired infections, but so far that has not appeared.

Finally, a number of existing problems need to be addressed, especially regarding out-of-hours care and access to NHS dentistry. Will the review examine those problems, too?

I am very grateful for the hon. Gentleman’s positive comments. I will consider whether, as part of this great new world in which we are living, we can give out statements much earlier. This statement was not finalised until 11 o’clock, but he makes a fair point. I hope that hon. Members accept that there was nothing about the statement in this morning’s newspapers or on the “Today” programme. We tried hard to ensure that the statement was heard by Parliament first.

The hon. Gentleman asks whether this is an admission of failure, but that is not the case at all. The Government have to be big enough to recognise the problems in the NHS, which have not been caused by a failure in investment, resolve, additional staffing, or reducing waiting lists. Staff feel bemused and dazed by the fact that many changes have taken place over a short time, so it is important that we tackle that. The hon. Gentleman referred to the speech made by my right hon. Friend the Member for Leicester, West (Ms Hewitt) to the London School of Economics the week before last. That bears reading because she was pointing in that direction. Indeed, she mentioned the important point raised by the hon. Gentleman about the democratic deficit.

The hon. Gentleman raised many important issues, but let me pick out one: health inequalities. The matter is crucial to the Government, although it was virtually ignored before when there was no focus on health inequalities. Although elements of the Darzi review will relate to the issue, it is too important for us to wait for that review, so I assure him that we will crack on with that as an absolute priority.

Let me make a point about the role of the patient. I said in my statement that the patient is crucial. The first part of the review will involve Professor Darzi’s team of clinicians listening to patients as well as staff. Patients are as important as any other group because their buy-in and commitment to the NHS really matter to its health in the future.

Order. If this is not stating the obvious, may I just say to the House that the opening exchanges have been very extended? Protecting Back Benchers is the job of the Chair, but equally, I hope that Back Benchers will help the Chair to get as many people in as possible. I ask that questions be brief and that answers be concise.

I welcome my right hon. Friend to his new post. Despite increased funding and better facilities, a recent report showed that the health of people in my constituency was still well below the average of those living in other constituencies. Will my right hon. Friend not lose sight of the fact that our party has a commitment to moving the outriders with well below funding up to the average for the rest of the country?

I recognise the problem that my hon. Friend raises, which also affects the city that I represent. I assure him that that is one of the major priorities that we must tackle, but it can be addressed only with a bottom-up, rather than top-down, approach. That is the reason why we must ensure that local health authorities are able to tackle the problems in their areas. The problems in Kingston upon Hull will be different from those in Kingston upon Thames, while those in Bolton will be different from those in Bradford. That is an essential reason why we must have a bottom-up process.

In the light of fact that the Secretary of State said in his statement that he wanted more “patient control, choice and local accountability”, what encouragement can he give to patients who are fighting to retain services at their local community hospitals, such as Doddington hospital in my constituency? Are those words about patient choice as empty as his predecessor’s?

The important point about any reconfiguration involving community hospitals is that there should be local dialogue with the patient voice included in the locally driven process. I remind the hon. Gentleman that we put £750 million of capital into community hospitals. Some closures have been agreed by local health service professionals, but every time that that has happened, there has been an insistence that a new service be provided. Sometimes that service is much closer to patients’ homes and is a community resource. The health service that we inherited 10 years ago, let alone that of 60 years ago, cannot ossify and be set in aspic. It is important that such changes happen, but the patient voice is absolutely crucial when there is any change.

My right hon. Friend said that he would ask the independent reconfiguration panel to consider any decisions about hospital changes that are referred to him while the review is under way. Will he look into some of the reviews that are now under way? The “fit for the future” review has major implications for hospitals in north-east London, but I do not believe that it has been carried out in the transparent and accountable way that he suggests is needed, or that front-line staff have had serious involvement with patients. It seems highly unlikely that any recommendations arising from the review will fit the criteria that he says he wants to apply.

The important thing is that if there has not been transparency in the procedures locally, that is a reason for the overview and scrutiny committee to refer the decision to the Secretary of State, and it is one of the things that the independent reconfiguration panel will consider; specifically, it will look at whether there has been a proper consultation, and what that means for patient care, so I think that I can reassure my hon. Friend. I want clinicians, not politicians or bureaucrats, to make decisions, on the basis of what is best for patient care.

The Worcestershire Hospitals Acute NHS Trust will shortly come forward with proposals, which we expect will include the axing of maternity and paediatric services at the Alexandra hospital, which serves my constituents and those of the Home Secretary. Bearing in mind that the cuts are very unpopular locally and could lead to future questions about the hospital’s accident and emergency unit, and bearing in mind that the cuts are motivated by the fact that the Alexandra is an NHS hospital, and the Worcestershire Royal hospital is a private finance initiative hospital that cannot be touched, may I take it from the Secretary of State’s statement that if such changes are proposed in the near future, they will be put on hold while the review is undertaken?

No, sadly not. I always like to say something encouraging to the hon. Lady, but I cannot say that we will put the measures on hold. Indeed, it would be betraying the patient if we put all change on hold, because many of the changes taking place across the country are necessary. There must be a process of local consideration, and I am not going to stop that consideration taking place. If the case is referred to me by the overview and scrutiny committee, I promise the hon. Lady that I will refer it on to the clinicians on the independent reconfiguration panel.

The Secretary of State is absolutely right to stress the importance of making the NHS and its doctors more accountable to the patients whom they serve. He will be aware that performance, in terms of both clinical outcomes and productivity, varies enormously from one doctor to another. Will he ask Professor Darzi to talk seriously to the royal colleges about how to address those inconsistencies of performance, and how to publish information in a way that the public will understand, so that the public have a say on the quality of care that they receive from the doctors whom they visit in the NHS?

As Professor Darzi is a member of almost all of the organisations that my hon. Friend mentions, I am sure that he will talk to them about the issue. Indeed, the issue of the disparity between services in different parts of the country is a major part of the review.

The Secretary of State said that he would double the size of infection improvement teams, so that all trusts could have access to an infection control nurse or doctor. According to his predecessor, that was already happening. If the Secretary of State wants to know how to keep wards clean and how to stem MRSA increases, he should look no further than the Royal Marsden hospital, which was mentioned by his predecessor when she was at the Dispatch Box. At the Royal Marsden, no nurse is allowed to travel home in uniform, and all uniforms are laundered on site. Stopping MRSA and keeping wards clean is not brain surgery; I suggest that there be no review, and that he look at the Royal Marsden instead.

Even I would not get brain surgery mixed up with the measures that the hon. Lady mentions. I am pleased by her remarks about my predecessor, who did indeed say the things that the hon. Lady said she did, and who put in place the improvement teams. We are now doubling the number of those teams. I am happy to praise the Royal Marsden, and indeed Kingston hospital, which I visited on Saturday, which has had tremendous success in tackling MRSA. We need to ensure that that success is replicated elsewhere.

I welcome today’s statement, which will build on the improvements that I have seen to the local health community in Blackpool. My right hon. Friend will recall last year’s White Paper, “Our health, our care, our say”, which mentioned the importance of social care services working with health services to deliver the Government’s public health agenda. Will he take this opportunity to reconfirm the central role played by such services, so that patients can be considered as a whole and get the services that they need?

I can give my hon. Friend the assurance that she seeks. Social care will not be a specific part of the Darzi review, as Darzi is looking at the national health service, but he will talk to social care providers to get a feel for their concerns. I will discuss the matter with the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), who is responsible for social care, because I understand the issues relating to social care, the need to ensure that we keep our partnership with local authorities, and the need to improve the quality of social care.

Given that the lifetime cost of untreated communication disorders is estimated by the educational charity I CAN to be no less than £26 billion, how, in practical terms, does the Secretary of State intend to work with the Secretary of State for Children, Schools and Families to ensure that all children with such conditions get the help that they need, and do not suffer the irretrievable damage, for themselves and the country, that will otherwise result?

The hon. Gentleman has consistently and eloquently raised the issue. He raised it with me when I was in the Department for Education and Skills and, if it is not revealing any secrets to say so, he sent me a note saying that the issue is equally important to the Department of Health. I invite him to come and speak to me so that we can have a discussion on the subject, and on how best we can integrate the work of the two Departments on speech and language therapy, because I recognise the importance of the issue.

My right hon. Friend rightly referred to the need to value NHS staff, but the NHS contains a large number of staff who are not doctors or nurses. I seek an assurance from him that our valuable support staff will be involved in the process. Will he seriously consider implementing the recommendations of the Fryer report on widening participation in learning, so that support staff get the training that they need and are valued for the contribution that they make to the NHS?

Yes. My speech did not leave out ancillary staff such as hospital porters—I made the point that everyone who works in the NHS will be involved in the exercise. The group that my hon. Friend mentions is particularly important, as is the training element to which she referred. That is why the social partnership forum action plan, which was launched in April with the support of all the unions, the education sector, the Department of Health and the strategic health authorities, has been well received, but we need to build on it. I understand the issue that my hon. Friend raises.

I welcome the promise of stability and of consistent use of the independent reconfiguration panel for all contested reconfigurations. In view of the transition from patient forums to local involvement networks—LINks—how will the Darzi review select the patients and members of the public to whom it will talk?

That level of detail is being worked out by Professor Darzi and his team across the country. I will ensure that the hon. Gentleman’s point is raised, so that we do not fall between two stools. It is important that we hear the patient’s voice, and that it is accurately recorded. I am sure that on future occasions the hon. Gentleman will have opportunities to question me on how that is going.

Has my right hon. Friend any news of the proposed second wave of independent sector treatment centres, six of which have been cancelled, according to this morning’s edition of the Financial Times?

Well, hon. Members should not believe everything that they read in the Financial Times. All that I can say to my hon. Friend is that every single ISTC proposal has to be cleared, not just by my Department but by Her Majesty’s Treasury, on the basis of whether it is cost-effective, and whether it provides capacity that does not exist. The whole point is to get more MRI scanners and more cardiothoracic centres, and to bear down on the issues so that we attain that precious objective of patients waiting only 18 weeks from referral to treatment. We cannot put that on hold, and that is why the Financial Times story is inaccurate, but we can ensure that at every stage we get value for money and add to capacity. That is the whole point of using the independent sector.

Following on from that question, may I ask the Secretary of State what the Government’s general view on the second wave of independent sector treatment centre contracts is? In particular, will he say when he is likely to sign a contract for Cirencester hospital, which I gather is on his desk or his Minister’s desk? I am sure he would agree that prolonged uncertainty does nothing for the morale of the staff and the clinicians in that hospital.

I have not had a chance to look at that, but now that the hon. Gentleman has raised it, I will look specifically at his scheme.

I welcome the Secretary of State’s statement and the fact that he is in listening mode. I will bring him many of the local issues that I wish to discuss, such as GP referrals and GP out of hours services at walk-in centres. It is important that the review is not just hospital led. Does my right hon. Friend agree that public health, especially challenging lifestyles, will be the most important thing that we do? Obesity is reckoned to cost the country £8 billion a year. Will he work across Departments, as he has done in his other roles, to ensure physical activity, sport and so on play a crucial role in developing and delivering many of the lifestyle changes that are needed to reduce health inequalities?

My hon. Friend is right. I can give him the assurance that public health will be a central part of what we are examining. We are some way off our public service agreement target on obesity. As I mentioned in my statement, these are the new problems that we are dealing with. Lifestyle changes have brought about a whole set of new problems that did not exist back in 1948. Malnutrition, rather than obesity, was the problem then. We need to tackle that and face up to the challenges presented by demographic and lifestyle changes. That is one of the basic reasons for the review.

This morning the National Audit Office published a strong and critical report on the diagnosis and treatment of dementia in the United Kingdom, comparing us unfavourably with the rest of Europe. Given that the second of the review’s objectives is dealing with long-term debilitating illnesses, may I ask the Secretary of State whether, in the first three months, he will be able to use the review to come up with a strategy to respond to the NAO’s criticisms?

I am not sure whether I can set a time scale, but that was an extremely important report. We need to study it carefully and work with the Alzheimer’s Society to see how we can resolve the problems. The review is crucial. The right hon. Gentleman will have a chance to see the terms of reference in the House of Commons Library, but as I mentioned, Professor Darzi will look particularly at the new challenges of an ageing population.

I welcome my right hon. Friend’s desire to go deeper than the professors. In Newcastle, at the university of Northumbria we have an expanded group of physiotherapy graduates with no jobs to go to, and a huge need to raise the quality of physical activity and deal with avoidable pain and discomfort. The north-east health authority, which is responsible for planning and training, has a surplus of £60 million. Will my right hon. Friend knock heads together and get that sorted out?

I will look at that problem. It needs local partnerships to tackle those issues in their locality. Once again I say that that is why we need a bottom-up national health service, rather than a top-down one. I am willing to discuss with my hon. Friend the specific matters that he raised, should he wish to come and see me.

May I congratulate the Secretary of State on his promotion, but say to him that I am astonished that Professor Darzi is working only two days a week on the project? I thought that it was urgent. Surely he should be doing more. May I alert the right hon. Gentleman to a potential problem at his Department of which he may not be aware? There are two important reports on the regulation of Chinese medicine and herbs by Professor Pitillo and the late Lord Chan. He must act on them because European legislation is round the corner, and it would be very much in the mode of Aneurin Bevan, who had a homeopathic doctor and wanted a fully integrated health service.

Well, well, if it was good enough for Nye, it is good enough for me. I will look into that, but may I clarify the fact that Professor Darzi is working two days a week for the NHS? He is an esteemed surgeon, and he does that free of charge, incidentally. It is important that he carries on his practice. I know that the Opposition will not appreciate this. I heard their comments from a sedentary position about his being a Minister, but I think it is right that he is a Minister and that he continues to practise. That gives him a special focus. He is already hugely esteemed and highly valued in the profession, but taking away one or other of those aspects would not make his role any easier and, indeed, would diminish it.

In relation to the shape and location of hospital services, may I tell my right hon. Friend that our most pressing need in Northampton is for a new acute hospital? Will he ensure that when the proposals for that are drawn up, they will be expedited through the Department and given financial support—I see our new Chief Secretary to the Treasury on the Front Bench—so that my constituents in a growing town can have the quality of hospital that they deserve for the 21st century?

The Chief Secretary to the Treasury knows a thing or two about those aspects of the national health service. I can assure my hon. Friend that we will expedite the matter and make whatever decisions need to be made very quickly.

The Secretary of State spoke about a more robust partnership between patients and policy makers based on trust, honesty and respect. With reference to rationing, which means that some effective treatments are not available on the NHS, will he be the first Minister to accept that rationing is taking place and that that needs to be done transparently and rationally, as the National Institute for Health and Clinical Excellence seeks to do?

I do not know whether I would be the first Secretary of State to accept that that is the case, but I do. That is the reality of how the system works. We set up NICE to take those decisions out of the hands of politicians, and NICE is now world respected. In many countries there are attempts to replicate it. The hon. Gentleman makes an important point.

I welcome my right hon. Friend’s resolve to tackle health inequalities. He will be aware that my primary care trust is underfunded by some £11 million compared with what its funding should be, according to the Department’s formula. May I press him to give an assurance that in the next comprehensive spending review he will make substantial progress towards eradicating funding inequalities so that primary care trusts have the resources to tackle those inequalities?

I thank my hon. Friend for those remarks. The report by Professor Darzi and in particular his extensive consultation right across the national health service, including on issues such as funding and inequalities in funding, will form a major part of our decision on the CSR. In that respect, I can give my hon. Friend the assurance that he requires.

Whatever the Secretary of State’s intentions, my constituents will be worried by yet another review of the NHS, just as they will be worried by the absence from his statement of any reference to the story in the Financial Times that the previous Chancellor of the Exchequer, in his last act, cut by a third the NHS capital budget. Will the right hon. Gentleman reassure my constituents that neither the review nor that policy change will have any bearing on the approval of the new Pembury PFI hospital in my constituency announced by the current Chief Secretary three months ago? Can he reassure us that that will be unaffected by his statement and that policy change?

I can give the hon. Gentleman the reassurance that he seeks. I take the opportunity to say, while the Chief Secretary is on the Bench, that the Chief Secretary wrote to the Financial Times about the story about £2 billion of funding being taken out and made it clear that all we were doing was looking at how much money was spent that year in the NHS. The extra money is still available to be spent this year.

I warmly welcome my right hon. Friend to his new position and in particular the powerful way in which he spoke of the need to address health inequalities. Does he agree that health visitors are some of the most important people in our health service as they are able to reach out to some of the poorest families and most disadvantaged groups in our communities, and that the value that they bring to the health service by addressing those inequalities from an early age is of primary importance?

I agree with my hon. Friend about the importance of health visitors and health visiting, which is why we have recently had a review and are considering its recommendations, and I am sure that my hon. Friend, as always, will be following this with great interest.

How will the Secretary of State’s statement help my constituent, Mrs. Ruby Waterer, a 79-year-old, who went to hospital with an eye complaint only to be told that she would go blind if she did not have three injections? When Mrs. Waterer asked when she could have those, she was told that she could not have them on the NHS, but that she could go down the road a couple of miles and have them done privately for £3,300. That is not the Government’s intention, so how will the Secretary of State help Mrs. Waterer?

Various comments are being made by my hon. Friends about the hon. Gentleman raising this matter yesterday and his article—

I doubt if I can answer it today, but, with respect, I care more about the hon. Gentleman’s constituent than I do about him. It sounds to me as if she has an issue that we need to tackle, and if he writes to me about it, I will look into it.

I welcome the review, but it is surprising that so far we have not touched on carers, particularly of people with dementia, which has been mentioned. Those carers are the experts, with whom the NHS must deal. Can my right hon. Friend assure me that in this important review, carers will be listened to, particularly the expert carers, such as those handling dementia?

My hon. Friend raises an important point. Alongside the Darzi review is a comprehensive review of carers that was announced recently by the Prime Minister. We are looking to see what extra help we can give to carers, having already done a lot in respect of pensions and the right to request flexible working, but we need to take a series of other measures, because carers save the Government a lot of money, which can be spent elsewhere in the health service. We are probably the first Government to recognise their importance, and we will ensure that the review is completed speedily.

To what extent will some of the long-term financial pressures within the NHS be examined in the review, in particular the affordability of PFI-funded hospitals, when Professor Darzi may well come up with models of care that direct patients away from those hospitals, and therefore direct some of the income for those hospitals away from them, challenging their ability to pay the underlying PFI costs that are already entrenched within the system?

We will have to deal with Professor Darzi’s recommendations when they come up, but we could never have embarked on this huge programme of rebuilding hospitals without PFI. When we came into Government, most of the NHS estate was built before the NHS was created. Now only a fifth of it was there before 1948, and that is because of the biggest hospital building programme ever in this country, and probably one of the biggest in the world. PFI was necessary to ensure that we did that.