1. What recent progress he has made in introducing GP commissioning consortia. (35632)

3. What recent progress he has made in introducing GP commissioning consortia. (35634)

6. What recent progress he has made in introducing GP commissioning consortia. (35637)

8. What recent progress he has made in introducing GP commissioning consortia. (35639)

11. What recent progress he has made in introducing GP commissioning consortia. (35642)

Last week, I announced the second wave of GP-led pathfinder consortia. There are now 141 groups of GP practices piloting the future GP commissioning arrangements. Those groups are made up of more than 4,000 GP practices, with over half the population starting to benefit from services that better meet their needs and improve outcomes for patients. The Health and Social Care Bill, which had its First Reading last week, sets out the legislative framework that supports our reforms.

Consortia in Milton Keynes have been given £1 per patient as a transition fund. That money is most welcome. It will rise to £2 per head next year. The problem, however, is that the fund is proving hard to access because of the bureaucratic nature of the local primary care trust. Will the Secretary of State look into that and ensure that the money is accessible?

I entirely understand my hon. Friend’s point. The PCT’s role is to support the development of consortia, not inhibit it. The operating framework that was published last month sets out the range of support that PCTs should be offering emerging consortia. Milton Keynes PCT has confirmed that it will actively support Premier MK, one of two consortia in the area, with its application to become a pathfinder, and that it is actively working with another consortium in the Milton Keynes area.

Pathfinder consortia will play a crucial role in improving the NHS, so it is imperative that any problems are sorted out as quickly as possible. How does my right hon. Friend propose to help any pathfinder consortium that finds itself in the unfortunate position of failing to deliver the results expected of it?

My hon. Friend makes an important point. He will recall that before the election, the Select Committee on Health severely criticised the way in which primary care trusts were going about commissioning. We are looking to consortia because they are clinically led and responsive to patients in designing far better clinical services, and they will have considerable support in doing so. Over the next two years, we will enable them to develop support arrangements, whether through existing primary care trust teams, local authorities, the NHS commissioning board, or a range of voluntary and independent sector organisations.

Will the Secretary of State outline the role that charities and voluntary organisations will play under GP commissioning to ensure that the needs and views of patients are at the heart of services?

To give my hon. Friend one example, last Friday I spoke to the Motor Neurone Disease Association, which has developed a commissioning support organisation with the Multiple Sclerosis Society and Parkinson’s UK. The voluntary sector can therefore be involved directly in helping GP consortia to commission for those critical diseases more effectively. My hon. Friend might have seen what Sir Stephen Bubb, the chief executive of the Association of Chief Executives of Voluntary Organisations, said last week:

“These reforms could herald a new and dynamic relationship between local GPs and charities that both deliver good services and act as a powerful voice for patients.”

My constituents in Hendon are eager to see the improvements in health services that I believe GP commissioning will bring about. Will my right hon. Friend give examples of where GPs have had the freedoms and responsibilities that we can expect in Hendon?

My hon. Friend might like to speak to general practitioners in Redbridge in London who, as a pathfinder consortium, have been pioneering GP-led commissioning for 18 months. They have redesigned care for patients with diabetes and coronary artery disease, and are shifting care in ophthalmology and dermatology to primary care settings. They are demonstrating how this form of locally and clinically-led commissioning is more responsive to patients and more effective.

As we shift from PCTs commissioning services to GP consortia doing so, can my right hon. Friend confirm that the important work done by pharmacies, such as providing anti-smoking clinics and the supervised consumption of drug substitutes, will not be left out in the cold?

My hon. Friend enables me to say that I and my colleagues entirely understand and endorse the stronger role that pharmacies can play, including by assisting with the provision of services such as minor ailments services and medicines use reviews, which will be commissioned through arrangements led by the NHS commissioning board. In addition, the services that he describes, such as stop smoking services, will be commissioned as part of the public health efforts, which will be led by local authorities through their local health improvement plans.

Will the Secretary of State comment on the apparent conflict between, on the one hand, a general practitioner being an advocate for their patient and taking purely clinical decisions and, on the other hand, GPs having to allocate resources in the new system? Will that conflict not lead to a breakdown of trust in the relationship between the GP and their patients?

I am afraid the hon. Lady sees a conflict where, to GPs, there is none. It is their responsibility—[Interruption.] No, their first duty is always to their patients, whose best interests they must secure. When she has an opportunity to look at the Health and Social Care Bill, which we published last week, she will see that it makes very clear the duty to improve quality and continuously to improve standards. We all know that we have to achieve that with finite resources, but we will do that much better when we let clinical leaders influence directly how those resources are used rather than letting a management bureaucracy tell them how to do it.

Can the Secretary of State explain why, at a time when front-line NHS staff in my constituency and elsewhere across the country are in fear of their jobs, it is proposed that the NHS commissioning board will be able to make bonus payments to a GP consortium if, to quote the Bill,

“it considers that the consortium has performed well”,

and that a GP consortium may

“distribute any payments received by it…among its members”?

Is that not the worst kind of excess? We do not want to see it in our banking system, and we certainly do not want to see it in our NHS.

I am glad to have the opportunity to welcome the hon. Lady to the Opposition Benches and wish her well in representing Oldham East and Saddleworth. I am sorry that she did not take the opportunity to welcome in particular the Government’s commitment to the new women and children’s unit at the Royal Oldham hospital.

For years, general practices have been remunerated partly through a quality and outcomes framework. The principle is that if they deliver better outcomes for patients, they should have a corresponding benefit from doing so. In the same way, if the commissioning consortia deliver improving outcomes for patients, that should be recognised in their overall reward.

The Secretary of State talks a lot about GPs using £80 billion of public money to commission services, but if they are to carry on being family doctors, the planning, negotiating, managing and monitoring of hundreds of commissioning contracts will be done not by GPs but in their name, either by the people who do it now in primary care trusts or by the big health companies that are already hard-selling the service to new GP consortia. Is he not deliberately disguising the true purpose of his changes, which is to open up all parts of the NHS to big private health care companies?

On the contrary, the purposes of the Bill are very clear to see—for example, the duty to improve quality and raise standards throughout the health service. I hope that the shadow Secretary of State will acknowledge that putting clinical leadership at the heart of the system is essential. I entirely understand that leadership is not the same thing as management, as do general practitioners. The Prime Minister and I will meet the first wave of pathfinder consortia tomorrow, and we will support them in taking clinical leadership in designing services for patients and bringing to bear the best management support in doing so.

Why will the right hon. Gentleman not be straight with the public? I have with me the White Paper—57 pages and only three references to the market, all of them to the social market. He talks about GP commissioning, but not about the hard-line political ideology that underlines these changes. The Bill puts no limit on the use of NHS beds and staff to treat private patients, it puts no limits on big private health care companies undercutting and undermining local hospitals, and it puts at the heart of the new system an economic regulator charged not with improving services but with guaranteeing and enforcing competition. Is this NHS reorganisation not like an iceberg, with the substantial ideological bulk being kept out of the public’s sight?

The shadow Secretary of State cannot actually criticise what we put forward in the White Paper or the Bill and is resorting to inventing something else and attacking that. Let me tell him that the one thing we will not do with the private sector is rig the market so that private companies get contracts and guaranteed money whether or not they treat patients. We are not going to give them 11% more money than the NHS would get for doing the same work. We will give NHS organisations a proper chance to deliver services for patients.

Whatever the Secretary of State claims about his reorganisation, a King’s Fund survey showed that more than three quarters of doctors do not believe that it will improve patient care, and even his Department’s impact assessment on the Health and Social Care Bill says that the reorganisation risks distracting staff and making them less focused on patient care.

Will the Health Secretary now confirm that the number of patients waiting more than six weeks for their cancer test has already doubled under this Government, and that routine operations are being cancelled? Will he finally listen to the Royal College of Nursing and the British Medical Association, which have told him that his plans are

“extremely risky and potentially disastrous”

for the NHS and patient care?

I find it astonishing that the hon. Lady should attack the NHS because some elective operations have been cancelled. We have been through a flu outbreak and very severe weather, and that is what happens as a consequence. She should not try to make a political point out of it.

It is also astonishing that the hon. Lady gets up and says that she does not agree with our policy. On 3 December, she is quoted in GP news as saying that

“it is ‘absolutely right’ that GPs are ‘better involved’ in commissioning services.”

She supported it. The truth is that before the election the Labour Government instituted practice-based commissioning, introduced foundation trusts, started payment by results and said that patient choice was right. The shadow Secretary of State said just last week that

“these plans”—

our plans—

“are consistent, coherent and comprehensive”,

and indeed they are.

Cumbria’s current health commissioners—the PCT—chose to scrap the heart unit at Westmorland general hospital, despite medical, clinical and public opposition. Will the Secretary of State confirm that new GP fundholding arrangements allows the possibility of returning services that are clinically supportable, such as a heart unit at Westmorland general?

I know, not least from visiting that hospital, how strongly people in my hon. Friend’s area feel about their access to services locally. I am pleased to say that he will see in the Bill that one of the duties of the NHS commissioning board is to reduce inequalities in access to health services, and GPs can do precisely that.

The Secretary of State knows fine well that the British public knew nothing at the general election of his plans dramatically to dismantle and privatise the NHS. Will he give them a say now and have a referendum on the issue?

Since we have no plan either to dismantle or to privatise the NHS, it is no surprise that people were not told of any such plan. Before the election and in the Conservative manifesto, people were told of our determination to cut bureaucracy and get money to front-line care. They were told of the determination of both parties in the coalition to get decision making close to the front line, to enhance accountability, including democratic accountability, and to give greater responsibility to clinicians to lead the development of services.

2. What steps he plans to take to increase cancer survival rates. (35633)

10. What assessment he has made of the effects on survival rates of his Department’s cancer strategy. (35641)

We published “Improving Outcomes: A Strategy for Cancer” on 12 January, which sets out a range of actions to improve cancer outcomes, including diagnosing cancer earlier, helping people to live healthier lives to reduce preventable cancers, screening more people, introducing new screening programmes, and ensuring that all patients have access to the best possible treatment, care and support. Through those approaches, we aim to save at least an additional 5,000 lives every year by 2014-15.

May I raise the case of my constituent, Suzanne Lloyd, who was diagnosed with breast cancer a decade ago? She was told that she had two years to live, but has successfully battled cancer for the last decade. The problem is that she has also been battling health chiefs to give her the drugs that she needs to extend her life. Will the Minister tell the House about measures to increase longevity through greater drug access?

Just last year the national clinical director published a report on the extent and causes of international variations in drug usage, which revealed that the UK tends to lag behind other countries in its use of newer cancer drugs. That is one reason why we have introduced the interim cancer drugs fund of £50 million in this current year and will introduce the full fund of £200 million from this April. That will help my hon. Friend’s constituent.

What steps is my hon. Friend taking to ensure that all GP consortia will have access to the expertise they need to commission cancer services effectively?

The national cancer director will work with pathfinder GP consortia on commissioning cancer services, and that work will be fed into a cancer commissioning support pack that will be developed to support GP commissioners in discharging their functions effectively. Cancer networks will also be well placed to support GP consortia in that activity.

We all agree that properly evaluated, appropriately prescribed drugs make a big difference to survival, which is why patients welcome what was described as the additional special fund, of which Ministers made mention this afternoon, of £200 million for the coming two years. Why is it, therefore, that the budget for Sheffield has been top-sliced for next year to the tune of £1.5 million to pay towards this £200 million, which was supposed to be additional—to add to and not subtract from—what was available through GP commissioning?

The NHS has real-terms increases in its resources, and those resources are going into the programme that we outlined in our outcome strategy. Three quarters of a billion pounds will be going into that programme to deliver improvements in cancer services and the £200 million, being extra, will go into improving cancer services. That is the commitment that the Government have made and that is the investment that we will make.

Is the Minister listening when Macmillan warns that the proposed changes to the NHS risk us losing expertise in the cancer networks? If that happens, Macmillan says that

“cancer treatment will get worse…some treatments could even collapse in parts of the country…more patients could die earlier”.

As the Minister in charge of cancer services, should not he be on the side of cancer patients, not backing his boss’s reckless reforms?

The last comment was pretty cheap, and no Government Member has suggested that the future of the cancer networks is in doubt. Indeed, in the coming financial year, the funding is secure. As we move to the new arrangements, it will be for the NHS commissioning board to decide the appropriate arrangements for commissioning in the future. We are clear that the expertise of those groups could, should and will continue to be used to support commissioning in the future.

4. What steps he is taking to improve co-ordination of social care and health care for the benefit of patients. (35635)

We have set out in the White Paper “Equity and Excellence: Liberating the NHS” and the Health and Social Care Bill how we will deliver the coalition programme for Government commitment to promote greater integrated working. This includes local authorities taking the lead role in the future in joining up local NHS services, social care and health improvement via council-led health and well-being boards.

Can my hon. Friend assure me that there will be a joined-up approach when addressing patients’ interests and complaints when they straddle social care? Perhaps a single point of contact for a complaint would be a good step forward from what we have now.

My hon. Friend is right to draw attention to the need to integrate not only the way in which we deliver and plan services, but the way in which we manage complaints. That is why the Government have included in the Bill our proposals for the establishment of local healthwatch and healthwatch England. Local healthwatch will have the ability to deal with complaints and also have the capacity to refer concerns about services to the Care Quality Commission so that it can take the necessary steps to investigate. In that way, we will deliver a more integrated system for dealing with such complaints.

Is the Minister aware that most of us are in favour of much better co-ordination of these services, but we worry about the backdrop of the reforms? In Yorkshire, some doctors are saying, “Come on, guys, this is a bonanza and we will all be California-style millionaires under these reforms.” What sort of a backdrop is that for health care reforms and better co-ordination of services?

The backdrop that the hon. Gentleman has just painted is a rather thin one. In fact, it does not exist at all. The Government set out in the Bill we published last week that there will be clear responsibilities on GP commissioning consortia, working in partnership with their colleagues in local government, to commission services in ways that will improve quality of life for people in his constituency, my constituency and the constituencies of all hon. Members.

Does my hon. Friend agree that improved co-ordination between health and social care is fundamental to the delivery of the efficiency challenge faced by the health service and social services? Does he further agree that the £1 billion provided by the health service to reinforce that relationship is an important step taken by the Government to reinforce that interface? Can he assure the House that, as we move into the new world, the existing arrangements for good practice across that interface will be preserved?

Order. I know that three questions will attract one answer from the Minister.

The answer to all those questions is yes. The right hon. Gentleman is right to draw attention to the additional money going into social care via the NHS. It is intended to kick-start the collaborative working that was often so absent under the previous Administration.

The care that someone gets can be defined as either “social care” or “health care”, and that can determine the benefits to which an individual is entitled. With that in mind, what conversations has the Minister had with the Minister with responsibility for disabled people about the Government’s proposal to withdraw mobility disability living allowance from those staying in residential care?

I and the Minister responsible for disability issues in the Department for Work and Pensions meet regularly. In fact, a further meeting on this and other matters is coming up shortly.

5. What recent steps he has taken to reduce levels of alcohol misuse among young people. (35636)

The public health White Paper, “Healthy Lives, Healthy People”, sets out how society can harness the efforts of individuals, families, local and national Government, and the private, voluntary and community sectors to take better care of our children’s health and development.

I thank the Minister for that reply. Hon. Members will be aware of the recent publicity given to vodka eye-balling, which is a dangerous practice. Members of the ArcAngel volunteer team in my constituency are going into schools seeking to alert young people to this and other dangers of binge drinking and excessive alcohol abuse. What support can the Minister offer to ensure that we can eradicate, in particular, the dangerous practice of vodka eye-balling?

I thank my hon. Friend for her question, particularly in highlighting this extraordinary practice. I have to say, it was news to me. I congratulate the efforts of that local organisation on highlighting this sort of issue with school children. There is no doubt that vodka eye-balling can cause damage to the surface of the eye, ulceration and scarring. Although it has got some publicity, however, a lot of young people are likely to be drunk in the first place when they do it, so the effects are probably overestimated.

Did the Minister hear the report on Radio 4 this morning that in the past decade there has been a 50% increase in the number of young people in their 30s being admitted to hospital with alcohol-related liver disease? Does she think that we ought to be looking at how alcohol is promoted and advertised around young people?

I thank the right hon. Gentleman for his question. I heard the report, and I think that it made particular reference to the worrying trend among young women as well. There is no doubt that our public health White Paper is timely. We need to do something about this. It is important to remember that no one tool will fix this problem; we need to take a wide variety of measures and alter, in particular, young people’s relationship with alcohol. However, we will not do that until we get a proper strategy out there.

Do Ministers clearly understand that the price of alcohol is a relevant consideration? Will they look at whether we can get relatively cheaper prices for soft and sports drinks? They are a viable alternative for many young people, but the price is often double that for alcohol.

I thank the right hon. Gentleman for his question. There is no doubt that price is one of the tools to which I referred. However, we need to take a huge number of actions. Reforming the Licensing Act 2003 via the Police Reform and Social Responsibility Bill will bring in a number of measures—for instance, doubling the fines for under-age alcohol sales to £20,000 and giving councils and the police the power to shut permanently shops or bars that persistently sell alcohol to children. That is one other way. Also, the Bill will make local health bosses responsible authorities for licensing decisions. That is an important shift and demonstrates the fact that this is everybody’s problem—no one public body can cure this on its own.

7. What recent representations he has received on his plans for the internal reorganisation of the NHS; and if he will make a statement. (35638)

17. What recent representations he has received on his plans for the internal reorganisation of the NHS; and if he will make a statement. (35648)

The Government received more than 6,000 responses to the NHS White Paper consultations. As a result, we have strengthened both our approach to implementation and our proposals in the Health and Social Care Bill, which was introduced in Parliament last week.

The Government have embarked on a reorganisation of our health service that involves altering the commissioning process, handing responsibility to those with less experience of contracting, and at the same time unleashing the market, allowing a whole load of new providers in. What risks does the Minister see might be associated with that approach?

The risk is that if we do not go ahead with these reforms, which are crucial to raising standards and improving outcomes, patient care, survival rates and treatment, we will be doing a grave disservice to the people of this country.

Last week, north-east regional board members of the British Medical Association made it abundantly clear to me and other north-east colleagues that they have serious concerns about the Government’s plans and that they risk patient care. How is it that the Minister is right and they are wrong?

Because I am afraid that the hon. Lady has not read the whole document, in this case from the BMA, or those from other organisations. What many say, including the BMA, on many of the proposals is that they are supportive of them, but naturally the hon. Lady and others cherry-pick those parts that suit their arguments.

The Minister will be only too aware of the worries of my constituents in Newark about the future of the hospital. Will he assure me that the internal reorganisation of the NHS will run in parallel with and improve the delivery of the Newark health care review, rather than the contrary?

Yes, and let me reassure my hon. Friend—because last summer I had the pleasure of joining him to visit what is an excellent hospital for the people of Newark—that under our reforms, given the commissioning powers of the GP consortia in the area, they will be able to help strengthen and tailor the health care that the hospital delivers, ensuring that it meets the needs of the people of Newark.

How does my hon. Friend envisage the commissioning of ambulance services under the new GP commissioning regime?

Ambulance services will be commissioned through the GP consortia at the local level. What I envisage—this is not prescriptive from the Department of Health, but what I think will develop—is that, just as ambulance services are currently commissioned for geographical areas in England through one PCT, the consortia will appoint lead consortia to commission the services for that area.

Does the Minister agree with the representations of the Select Committee on Health, chaired by the hon. Member for Charnwood (Mr Dorrell), when it said that it was

“surprised by the change of approach between the Coalition Programme”

in May

“and the White Paper”

in July? The Committee continued:

“The White Paper proposes a disruptive reorganisation of the institutional structure of the NHS which was subject to little prior discussion and not foreshadowed in the Coalition Programme.”

If he cannot convince his hon. Friend the Member for Charnwood, how is he going to convince the rest of us?

Let me begin by congratulating my, in fact, right hon. Friend the Member for Charnwood on the report that his Committee produced. The Government will give a full response to it in due course, as is usual. What I would tell the hon. Lady is that what happened in the Bill and the White Paper was what we and our coalition colleagues, the Liberal Democrats, had outlined in our election manifestos, which—[Interruption.] Hon. Members may say that, but I suggest that they look at pages 45 to 47 of the Conservative manifesto, which probably very few of them have bothered to do. GP commissioning, along with “any willing provider” et al, are there, and if one looks at the Liberal Democrat one—[Interruption.]

Order. The Minister’s answer must be heard.

I am extremely grateful, Mr Speaker.

If we look at the Liberal Democrat manifesto, we can see that it also contains proposals for the abolition of strategic health authorities. The hon. Member for Hackney North and Stoke Newington (Ms Abbott) has alluded to the abolition of PCTs, and the reason for their abolition is that, when we have given the commissioning to GP consortia and the public health responsibilities to local authorities, there will be no job for the PCTs to do. Why keep them? There will be £5 billion savings during this Parliament that can be reinvested in front-line services.

9. What assessment he has made of the effectiveness of video link medical consultations in prisons. (35640)

The Department has made no assessment. PCTs and prison partnerships may consider using telemedicine as an alternative to hospital appointments for offenders, after considering any security issues and the benefits for improved health care. Decisions about treatments for offenders, including video link consultations, are made by local commissioners.

Red Embedded Design, an SME technology company in my constituency, is working in partnership with Airedale NHS Foundation Trust to enable video link medical consultations to take place in prisons. May I suggest that the Minister look closely at this scheme, which has been rolled out in a number of prisons? He will see the cost benefits and the lack of risk of absconding involved. Will he encourage other PCTs around the country to introduce the system in their prisons?

As part of a wider programme, a demonstrator project looking at telemedicine and telecare, we are looking at a possible roll-out of such approaches. In regard to the specific case of the Airedale NHS Foundation Trust, I would be only too happy to look further at the details and the benefits that have arisen.

Telemedicine is obviously a help, but nothing beats talking to a real human being about our medical problems. Would the ministerial team consider copying the Conservative-Liberal Government in Sweden, who have banned from all public agencies, including health agencies, automatic answering machines—the kind that tell us to “Press 1”, “Press 2” or “Press 3”? Instead, people calling those agencies have to speak to a real live Swede in Sweden. Would not that be a good step forward for our health service?

The right hon. Gentleman has found a cunning way of getting in a point that does not directly relate to the question. He makes a very fair point, however. It is important that people should feel confident that, when they pick up the phone and make a call, they can speak to a person. Telemedicine can provide that route as well, through allowing people to get a diagnosis and treatment, as well as access to the appropriate support at the right time.

12. If he will take steps to increase the availability of the BCG vaccine for children. (35643)

I should point out to the hon. Gentleman that there are no problems with the availability of the BCG vaccine. I am also aware that he takes a personal interest in this subject because of his local experience. I am confident that those most at risk of contracting tuberculosis are being offered the BCG vaccination as part of a targeted national programme.

Does the Minister not think that it is time to widen that targeted national programme? Tuberculosis is an airborne infection, and it covers a broader area than the areas that are being focused on at the moment. Would not the widening of the programme improve protection?

Yes, I would just like to point out to the hon. Gentleman that TB has changed from being a disease of the whole population to one that affects high-risk groups. In fact, the Joint Committee on Immunisation and Vaccination looked at this in 2005 and reaffirmed it in 2009. We are confident that this targeted approach is the best way of addressing the problem.

13. What assessment he has made of the likely effects on waiting times of his proposed reorganisation of the NHS. (35644)

The proposed changes will focus the NHS on quality and the results that matter to patients—such as how successful their treatment was—and not just on bureaucratic processes such as waiting time targets. Waiting times are important to patients, along with the quality of their experience and outcomes, which will drive improvements in the future.

Well, what a revelation! I think that the Minister will find that the public do care about waiting times. Will he confirm that waiting times are already going up, that more people are already waiting more than 18 weeks—the maximum that we achieved when we were in government—and that the performance of accident and emergency departments has deteriorated since he watered down our A and E targets?

I think that the right hon. Gentleman either did not hear my earlier remarks or had penned his question prior to hearing them. What I said was that waiting times are important to patients—and if he looks at the record tomorrow, he will see that. May I also explain to him that the average median time for the latest month available—November—shows patients completing a referral to treatment pathway in about 8.3 weeks? The right hon. Gentleman’s comments on A and E are just factually wrong and somewhat cheap.

There are concerns that some of the expertise of cancer networks might be lost because of the funding gap between the end of the Government’s funding for the networks and the transition to full GP commissioning. Will the Government consider bridging this gap, at least until GP consortia are fully up and running—and therefore better able to make informed decisions about the commissioning of cancer network services?

I am grateful to my hon. Friend in view of the considerable interest he takes and work he does in this field of health care. Let me reassure him that we have guaranteed the funding for next year, so it can work itself out to a successful conclusion thereafter through the cancer networks in the commissioning plans.

Under Labour, hospital waiting times were at a record low and satisfaction with the NHS in its current form was at a record high. Over the last few months, however—no matter how much the Secretary of State does not like it—we have seen more and more operations cancelled or postponed at our hospitals. A number of nurses in my constituency have written to tell me that they are short staffed. One of them pointed out that

“those who have left are not being replaced”.

Is that not the true picture of what is going on in the NHS at the moment? If the Minister is confident in his Secretary of State’s plans for the NHS, will he guarantee that under those plans, hospital waiting times will not rise—or is he going to duck the question like the Prime Minister did last week?

Under these reforms, by concentrating on raising quality and outcomes, we will give improved quality health care for patients. What I can guarantee is that under these reforms, when implemented, people will not only get improved quality treatment but will see times based on clinical decisions rather than being distorted by political processes.

14. What recent discussions he has had with primary care trusts on their policies on halting elective treatments in cases where such treatment has been demonstrated to be effective. (35645)

Strategic health authorities have recently been reminded of the statutory commissioning responsibilities of their primary care trusts in this area, and the need to base commissioning decisions on clinical evidence and discussions with local GP commissioners, secondary care clinicians and providers.

What is the Minister’s response to the trusts that have been saving money by halting procedures such as hip and knee replacements, hernias and hysterectomies, which have proved to be clinically effective? My constituent, John Deas, has just lost the care of the nurse practitioner who has managed his prostate cancer over some years and has been referred to a GP who will not see him. As the president of the Royal College of Surgeons said that the immediate need to

“save money by going for the soft targets of elective surgery will leave a lot of people with unpleasant symptoms and build up future health problems. Medically that makes no sense.”

Does it make any sense governmentally?

I am sorry to hear about the example that the hon. Lady mentioned; if she would like to write to me with the details, I would be more than happy to look into it. PCTs have a continuing responsibility to provide clinical treatment for their patients. Obviously, once the PCTs cease to exist, that will happen through the GP consortia and the national commissioning board. There is also a legal right in the NHS constitution for patients to be treated when they need to be.

A number of patient groups across the country are concerned about the future of in vitro fertilisation treatments, particularly when many PCTs downgraded it and put it on a par with things like tattoo removal and cosmetic surgery. Will the Minister confirm that, in future, IVF treatments will fall under the remit of the NHS commissioning board?

Let me reassure my hon. Friend on IVF. PCT commissioners should have regard to the National Institute for Health and Clinical Excellence guidelines for fertility treatment, including to the recommendation that up to three cycles of IVF treatment are offered to eligible couples. To reinforce this, in November last year, the NHS operations board reminded PCTs, through the SHAs, of that responsibility. Indeed, Mr David Flory of the Department of Health has in the last month or so written to PCTs to remind them of their responsibilities.

15. What recent estimate he has made of the monetary value of medical aids issued to patients by hospitals and not returned in the latest period for which figures are available. (35646)

As my hon. Friend knows, NHS patients are provided with NHS aids free of charge and requested to return them when they are no longer required. Obviously the cost of recovery must be weighed against the cost of the items being lent, but it is the responsibility of the local NHS to monitor the position and arrange for the recovery of medical aids when that is safe and cost-effective.

For many years the experience of my constituents, and indeed my own family, has been that hospitals often provide patients with, for example, crutches, without ever asking for them back. I accept that this is a matter for the management of local hospitals, but does my hon. Friend agree that the Department has an interest in ensuring value for taxpayers’ money, and that the medical aids involved could be used by other patients who need them?

I agree. One always hopes that people will act responsibly, and that they or their families will return medical aids. My hon. Friend may know that Bedford hospital has organised a scheme for the collection of aids, and that a number of voluntary organisations are also involved. However, the cost of collection and decontamination or cleansing is sometimes greater than the cost of the equipment itself. Crutches, for instance, cost between £11 and £20. Such is life today.

T1. If he will make a statement on his departmental responsibilities. (35657)

My responsibility is to lead the national health service in delivering improved health outcomes in England, to lead a public health service which improves the health of the nation and reduces health inequalities, and to lead the reform of adult social care which supports and protects vulnerable people.

Cheshire East council is working closely with local health care partners in my constituency to tackle the growing challenge of alcohol abuse, which not only causes serious illness and injury but costs our local primary care trust £34 million a year. Does my right hon. Friend agree that that is the right way in which to tackle this growing problem, and will a member of his ministerial team meet me, along with representatives of the council, to help secure the best possible outcomes in Macclesfield?

Of course we will support the efforts of my hon. Friend and his local council to tackle alcohol abuse. He will have heard what was said earlier by the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), which I entirely endorse.

Local authorities and their communities should have a greater say in what happens in their areas. We will enable them to do so, through the Health and Social Care Bill, the establishment of local health improvement plans, and—as my hon. Friend the Under-Secretary said—the alcohol strategy that we will introduce following the public health White Paper later in the year.

T3. Does the Secretary of State envisage a time when GP consortia may be purchased by foreign companies, and operated and administered thousands of miles away across the globe? (35659)

No, I do not. I am glad that the hon. Gentleman has asked that question, because I think that there is a world of difference between the question of the exercising of clinical leadership by general practices as members of a consortium in an area and the question of from whom they derive management support. I believe that many will derive it from existing PCT teams, the voluntary sector and local authorities. Sometimes the independent sector will be involved, but it is a question of the consortium choosing where to go rather than being taken over.

T2. Some care homes that have received critical reports from the Care Quality Commission are reopening under the same management but with different names. The CQC’s practice is to remove earlier poor reports from its website, leaving potential customers in the dark about the poor record of those homes. Will the Minister remind the CQC of its responsibility to highlight poor practice in care homes, and request that it change its practice? (35658)

I will certainly ensure that the CQC understands that that is a matter of concern. When it discharges home owners and deregisters them, after receiving an application for a fresh registration, it conducts a thorough appraisal and assessment of their fitness to provide the service. The new owner of a home may well have done a great deal of work in improving the quality of training given to staff, but I agree that it ought to be possible for people to look at the CQC’s website and see reports on the quality of the previous provider so that they can assess that as well.

T5. A year ago, writing in The Sun, the Prime Minister made a firm and passionate pledge to increase the number of midwives by 3,000. Last week, the chief executive of the NHS told the Public Accounts Committee that the NHS is now short by 4,500 midwives. Will the Secretary of State tell the House when he intends to implement plans to honour the Prime Minister’s pledge—or can we take it that it is just another Conservative broken promise on the NHS? (35661)

Well, I do not wish to embarrass the chief executive of the NHS, but actually, he told me he made an error—he was referring to health visitors, not midwives, when he was talking to the Public Accounts Committee. We are short of health visitors precisely because, through the life of the last Government, the number was continuously going down, and we are going to recruit more. Actually, we share the last Labour Government’s commitment to increase the number of midwives, not least because of the increase in the number of births, and to do so in pace with that. As a consequence, in conversations that the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), and I have had with the Royal College of Midwives, we have made it clear that we will do all we possibly can. We already have more midwives in training than at any other time in our history.

T4. As Ministers are aware, GPs in north Cumbria are supportive of GP commissioning and are already working hard for its success. However, given the rural nature of the area, what support will be given to the local hospitals to ensure that they can provide secondary health care within the new regime, when they have to accommodate the additional costs of providing health care in a rural environment? (35660)

Yes, I entirely endorse what my hon. Friend says about GPs in Cumbria. They are indeed very forward-looking and show that, even under the last Government, practice-based commissioning was demonstrating its benefits, and we are building on that. I mentioned earlier the duty in the Health and Social Care Bill on the NHS commissioning board to reduce inequalities in access to health care. That will be important for rural areas. The pricing arrangements, led by the commissioning board and Monitor, must also take into account varying costs associated with the delivery of care in different localities.

T8. If the Government will not even trust GPs with the responsibility of ordering flu vaccine, how on earth can they trust them with commissioning the care and treatment of cancer victims? (35664)

Of course, it was the last Government who agreed the arrangements with GPs. It was the last Government who, in 2007, undertook a flu review when central procurement of flu vaccine was recommended, but did nothing about it. The public health responsibility is distinct from the commissioning responsibility for health care of patients. We will look at, and we have still to make a decision about, how we procure flu vaccine in future years. We may do it through central procurement or through continuing GP procurement; but either way, we will make sure that we improve on the system we inherited.

T6. Can the Minister tell us how much money is spent each year on disposable surgical instruments, and whether any thought has been given to greater use of properly sterilised reusable instruments? (35662)

The straightforward answer to my hon. Friend’s question is, £18 million per annum. The decision to use single-use instruments as opposed to reusable ones is based on many complex clinical factors. For this reason, these decisions are left for the determination of local trusts on the basis of safety, quality and value for money.

T9. May I ask the Secretary of State directly about leaked documents seen by The Northern Echo? They show that a £53 million NHS contract to provide health care services to the prison service in the north-east was awarded to a private company, Care UK, even though the NHS provider was marked higher on quality, delivery and risk. Care UK beat the NHS provider only on price. Is this confirmation of the Minister of State’s remarks on Newsnight, that this Bill will create a full market and full competition? (35665)

The hon. Gentleman is asking about arrangements that we have inherited from his Government; they are from before the election and are nothing to do with the White Paper or the Bill. The contract to which he refers was let by the North East Offender Health Commissioning Unit. This was its procurement decision and it states that a competitive, robust and transparent process was followed. This was not a decision taken or influenced by the Department of Health.

T7. In support of national obesity fortnight, which is currently running, I wish to raise awareness of this serious condition, which causes numerous deaths and other serious health conditions. Redditch has high levels of obesity compared with the average in England. NHS Worcestershire is doing a fantastic job, but what more can the Government do to ensure that the NHS will not be overly burdened with increasing obesity problems? (35663)

I thank my hon. Friend for raising this issue, and I know that her local council is running a number of schemes. As she knows, we have published a White Paper on public health, “Healthy Lives, Healthy People”. In the spring, we will publish a document on reducing obesity, and we will set out how this will be tackled in the new public health systems and in the NHS. It is important to remember that at this time of year a number of people go on diets and try to lose weight and get fit, and I urge them all to carry on, including Members of this House.

Does the Minister accept that during times of illness people often experience associated problems, for example, difficulties with employment and housing, and personal problems, with which they can be helped by the information available through StartHere? Will he ensure that his Department and others treat StartHere as essential to the provision of high-level public service?

I am very grateful to the right hon. Gentleman for that question because, as he is aware from meetings that we have had, we have been supporting StartHere through NHS Choices. We are now reviewing the benefits of this joint working, and that will help us to understand potential contributions to savings to improve the information flow to those who may be excluded from the use of the internet. He may be interested to learn that I have today written to Ms Hamilton-Fairley, outlining where we are at the moment. I am anxious to resolve this as soon as possible, once the review has been completed.

T10. What does the Minister think is the likelihood of the pathfinder consortia examining commissioning arrangements for neurological conditions? This is particularly important, because conditions such as Parkinson’s are not familiar to many general practitioners, and commissioning arrangements for these complex conditions are tricky, so they need specialist knowledge. They need to be getting expert support and advice, including from patients and third sector groups. (35666)

The hon. Gentleman makes some important points about how the new system provides the opportunity to access a range of new resources to develop the way in which commissioning is provided for people with neurological conditions. Not the least of these are the way in which the Neurological Alliance is working to provide a new structure for its way of operating at the local level to offer commissioning support and, from the Department, how the neurological commissioning support group will be able to work with early implementers of the health and well-being boards and pathfinder GP consortia to provide them with the necessary support to develop their capability in this area.

The Minister of State referred earlier to Labour Members cherry-picking quotes, but I do not believe that Laurence Buckman, chair of the British Medical Association’s GP committee, was mincing his words when today he described the Government’s reorganisation plans as “fatally flawed”, warning that they

“would see the poor, elderly, infirm and terminally ill in large parts of the country losing out”.

Why does the Secretary of State believe that he knows better than Dr Buckman?

I do not recall the BMA ever agreeing with the previous Government. Let me provide one quote to the hon. Lady:

“The general aims of reform are sound—greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes—and are common ground between patients, health professions and political parties.”

The shadow Secretary of State said that last week.

The NHS Litigation Authority has presented NHS Wiltshire with a bill for more than £3.5 million in clinical negligence scheme payments this year. Nationally, among closed claims, legal fees made up more than a third of costs last year. How does the Minister propose to switch this expenditure away from lawyers and towards front-line health services?

I wish, first, to say two things, but there may be further to add. First, my right hon. and learned Friend the Secretary of State for Justice is working on the implementation of the Jackson review. That, in itself, will help considerably in reducing the extent to which these costs are consumed in legal fees, rather than proper compensation for clinical negligence. As we made clear in response to Lord Young’s report, we will also pursue the question of whether we can have a fact-finding phase following up a claim against the national health service, so as to mitigate what is otherwise considerable additional cost on conditional fee arrangements and getting expert witnesses.

Why is it that the Secretary of State does not compliment the Labour Government on providing £110 billion, starting with £33 billion in 1997? Is it not a fact that waiting times have fallen as a result of the nurses, the doctors and that money? Is he frightened to utter the words because in 2001 every single Tory MP marched through the Lobby not to give the money to the national health service?

Let me remind the hon. Gentleman that at the general election we just fought we were the party that was committed to increased resources for the national health service. We are the coalition Government who, over this Parliament, will increase resources for the national health service by £10.7 billion, even in the face of the deficit we inherited from Labour. The hon. Gentleman’s party’s response was to tell us that we should cut the NHS, and we are not going to do it.

Will my right hon. Friend the Secretary of State please explain why it is taking so long for him to come to the House about the regulation of herbal medicine? He has to do that before April to comply with European legislation. What is the hold-up?

I thank my hon. Friend for his question and I know that he has a keen interest in this subject. I share his frustration that the previous Government spent a long time not doing anything about it. The Medicines and Healthcare products Regulatory Agency has identified the possibility of creating a national regulatory scheme, allowing authorised herbal practitioners to continue to commission unlicensed manufactured herbal medicines after 30 April. We are in discussions with the devolved Administrations, the Health Professions Council and the Complementary and Natural Healthcare Council about the feasibility of a statutory register. As I say, I share my hon. Friend’s frustration but we will make proposals shortly.

Specialists in the field state that the figures that point to a more than 50% rise in young drinkers ending up in hospital are a gross underestimate of the serious problem. What further steps can the Department and the Government take to address this important problem?

As the hon. Gentleman will recall from earlier exchanges, it is absolutely right that we must have a series of measures to tackle alcohol abuse. Price is part of it, as is the enforcement of legislation. Community alcohol partnerships have been very promising. We must have better alcohol education, and I spoke at the first annual conference of Drinkaware yesterday, encouraging it in the work that it does. We must understand that we have to change people’s behaviour and that the damage that can be done is intense. As a consequence of chronic alcohol abuse, large numbers of people are coming in and out of intensive care units, presenting an enormous burden to the health service as well as doing great damage to themselves.

The College of Emergency Medicine recently stated that if a hospital A and E unit is to be downgraded to an urgent care centre, the nearest A and E unit should be no more than 12 miles away. Will the Secretary of State revisit the cases of A and E units that were recently downgraded by the previous Government to urgent care centres when the nearest A and E unit is more than 12 miles away?

Yes. My hon. Friend makes a very important point. I promise I will discuss with John Heyworth of the College of Emergency Medicine precisely the point that my hon. Friend has raised. The College of Emergency Medicine says that it does not recognise what an urgent care centre is. From its point of view, hospitals should either have an emergency department or an A and E or they should not. If they do not, it is very important to be clear that they do not. I feel that we need to be much clearer about the nature of the service provided in A and E departments and the distinction between that and the service provided in minor injury or minor illness centres.

Do not the reorganisation plans for the NHS, coupled with cuts to local authority budgets, mean that public health projects in this country will effectively be binned?

No, they will not. We are making very clear our determination to ring-fence public health budgets so that prevention does not suffer, as it did under the hon. Gentleman’s Government. In 2005-06, the first things to disappear as a consequence of financial pressures were the public health budgets and public health staffing. We will not allow that to happen.

I welcome the Government’s commitment to ending mixed-sex wards, but does the Secretary of State agree that it is both unnecessary and extreme to extend that policy to children’s wards and to enforce it with the threat of fines?

I entirely understand my hon. Friend’s point, and the rules we have set out for the NHS are very clear. We are also clear that we will ensure, through the NHS, that people have access to the privacy and dignity they have a right to expect, contrary to what the hon. Member for Leicester West (Liz Kendall) has said. She said that as long as they get the treatment through the NHS, it does not matter whether they are in mixed-sex accommodation, but that is not our policy. It does matter, and we will enforce it.