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House of Commons Hansard
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14 June 2011
Volume 529

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

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

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

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

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

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

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

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

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

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

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

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

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Thank you very much, Mr Speaker.

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

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

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

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

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

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

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

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

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

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

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

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

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

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I thank the Secretary of State for an advance copy of his statement, although I learned more from the Prime Minister’s press conference than from the statement.

Humiliating! The Health Secretary has had health policy taken out of his hands. He spent the last nine months telling anyone who criticised the Government’s health plans that they were wrong, and that they did not understand. Today, he admits that he is wrong. How can he argue for this latest blueprint for the biggest reorganisation in NHS history with any credibility or integrity? The man who messed up so badly last year is telling us how he will mess up next year too.

Why no apology to NHS patients and staff for the wasted year of chaos, confusion and incompetence? Why no apology for breaking the coalition agreement to stop top-down reorganisations? Why no apology for patients, who are already beginning to see the NHS go backwards again because of this reorganisation? More than one in 10 people now waits 18 weeks for operations, three times the number of patients wait more than six weeks for tests, and casualty waits are at a six-year high.

This is the first Prime Minister who has been forced to ask 45 experts for a report on how to protect the NHS from his own Government’s policies. Now he is reorganising his reorganisation. The Future Forum report yesterday was a demolition job on the Government’s misjudgments and mishandling of the health service. Why is he wasting £800 million on redundancy payments when some of the same people will be re-hired to do the same job? Why is he holding back £2 billion promised for patient care when it could fund 55,000 nurses? Why is he ploughing on with the Health and Social Care Bill when what he announced today could largely be done without legislation, and certainly without the risk and cost of the biggest reorganisation in NHS history?

This is a political fix, not a proper plan for improving care for patients, or for a better or more efficient NHS that can meet the big challenges that it must face for the future. Make no mistake, today’s plans will mean that the NHS is mired in more complex bureaucracy, more confusion and more wasted cost in the years to come. In the battle of spin, with all parts of the divided Government claiming a win, the big losers will be NHS patients. The Opposition and the public will judge the Government on what they do, not on what they say.

I lost track of the bureaucracy that the Health Secretary announced in his statement. Will he admit that this reorganisation creates five new national quangos, set to spend tens of billions of pounds? Will he admit that this reorganisation replaces one local body—the primary care trust—with at least five others, all of which will play a part in commissioning? Will he admit that the plans still cut hospitals loose from the NHS, with no limits on treating private patients while NHS patients wait longer, and no support from the NHS if they run into financial trouble? Will he admit that hospitals will no longer have the protection as a public service from the full force of competition law?

What was a very bad Bill will still be a bad Bill. This House should be allowed to do its proper democratic job, as the only elected House, and scrutinise in full in Committee the whole Bill. At its heart, the Bill will still be the Tory long-term plan to see the NHS set up as a full-scale market, and the NHS broken up as a national public service, so that patients increasingly see the services on which they depend subject to the lottery of where they live.

The public have rumbled the Prime Minister. They know that they cannot trust him with the NHS. Fewer than one in four now trusts him to keep his NHS promises, and more than half believe that the Conservative party’s plans for the NHS are just a way to privatise the health service. Today, the Government have recycled their plans for the NHS when they should have been scrapped. People are right to conclude that they cannot trust the Tories with our NHS.

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Well, I was hoping that, having got past the abuse, the right hon. Gentleman would tell us whether he agreed with the NHS Future Forum, but he did not even mention it. He welcomed the listening and engagement exercise that we announced—he said it was the right thing and that it would be good government to do it—but then when an independent group of experts reports and makes recommendations, he ignores it and says he will oppose the Bill regardless. He did not listen to what people in the NHS were saying. I think it was shameful how he dismissed everything that has happened over the past year as though it did not matter at all—a year in which the coalition Government said we would increase resources to the NHS. We have done that and are committing to investing an extra £11.5 billion in the NHS over the next four years. That is money that, as we will continue to remind the British public, the Labour party told us we should not give to the NHS.

In the past year, the coalition Government and the NHS across the country have implemented a cancer drugs fund from which 2,500 more patients have benefited, and in the past four months, we have cut the number of breaches of the single-sex rule by three quarters, and the number of hospital infections by 22% and C. difficile infections by 15%. Some 750,000 more people are accessing dentistry, and waiting times for people going into hospital are down compared with March 2010. We said that we would reduce management costs, and we will do so, and we have taken 3,800 managers out of the NHS since the election, while the number of doctors has gone up. Six months ago, the right hon. Gentleman said that he supported the reform principles in the Bill. All he said today was sheer opportunism, but it will come back to haunt him, because the NHS will benefit from the changes we are proposing today. It will take greater ownership of its own service; patients will be empowered; and clinicians across the service will be empowered and will deliver better outcomes for patients, and when that happens, we will be able to say, “The Labour party would have denied the NHS the resources and the freedom and responsibility to deliver those better outcomes.”

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Is not the key challenge facing the national health service today the need to reverse a decade of declining productivity bequeathed to us by the Labour party? Does my right hon. Friend agree that his statement today provides the basis for us to do that based on the evolution of effective commissioning engaging the entire clinical community, which will address the fragmentation of service and progress the integration of service around the needs of individual patients?

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Yes, I agree with my right hon. Friend. It is precisely that process of engaging clinicians, who will come together to design services around the needs of patients in a way that delivers not just improving productivity, but improving quality of services for patients, that is at the heart of the shift from primary care trusts and strategic health authorities. Let’s face it: the Labour party spent a decade presiding over declining productivity, while the costs of bureaucracy and management in the NHS doubled. We will empower people in the NHS to deliver improving services and reduce bureaucracy. [Interruption.]

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rose[Interruption.]

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

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

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

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Does the Secretary of State—[Interruption.]

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

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

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It is slightly confusing, because the right hon. Gentleman’s right hon. Friend on the Opposition Front Bench, the Member for Wentworth and Dearne (John Healey), was just telling us—erroneously—that we could have done this without legislation anyway, but now the right hon. Gentleman is accusing us of proceeding without legislation. It is not true: we are doing things in the NHS by way of changes that are absolutely essential in any case. I have to tell him and the House that sustaining the structure that we inherited from the Labour party, with all the strategic health authorities and all the primary care trusts—this vast bureaucracy— could never have happened. We had to take out administration costs in the service, and empower clinicians and patients, and we are doing it now regardless of whether the legislation has made progress.

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I welcome the statement and the change. I have a list here. The Government’s response has satisfied 70% of the demands for change on that list, but it is seemingly not enough—nor can it be enough—because ironically, it is the list of amendments tabled by the Labour party in Committee. Why does the Secretary of State think that it is so hard to build consensus? Given that in many cases the amendments are ones that Labour has asked for, why is the Labour party being so pointlessly churlish?

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I am grateful to my hon. Friend. There are many things that are beyond many of us to understand. One of them is the Labour party and the way it approaches policy. As he and the House will know, the fact is that the Labour party has no policy; it simply had opposition for opposition’s sake.

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rose

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

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

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It has not damaged patient care. The right hon. Gentleman should not denigrate the NHS. In May 2010, at the last election, patients waiting to be admitted to hospital waited 8.4 weeks for their treatment; on the latest figures, that went down to 7.9 weeks. Out-patient waiting times for May 2010 were 4.3 weeks on average; that went down to 3.7 weeks, and that in the midst of rising demand on the NHS and continuously improving performance.

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This is clear evidence of a listening Government. Does the Secretary of State agree that what the NHS now needs is consensus across all political parties, and for everybody to put their money where their mouth is and support the NHS and these changes as we move forward?

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I am grateful to my hon. Friend, who makes a very good point. The Future Forum made the point that what people across the NHS want now is the certainty of knowing what the policy is and to move forward to make that happen.

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In view of the NHS Future Forum’s comments about the

“importance and relevance of the NHS Constitution”

in guiding its work, does the Secretary of State accept that the seven principles set out in the constitution were more effective in protecting the NHS from a hostile Government than the Prime Minister’s five pledges?

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No, I do not accept that. The Prime Minister’s commitments are absolutely what the public and the people working in the NHS expect and wish to see. They are vital, and they would not have been true under a Labour Government. For example, a Labour Government would not have increased resources for the NHS. The only part of the United Kingdom where there is now a Labour Government is Wales, where resources for the NHS are being cut this year by 5% in real terms compared with last year. When I went to north Wales in the middle of the recess, I saw on the front page of the Liverpool Daily Post that the number of patients waiting more than 36 weeks for their operations had risen from 16 to 989.

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I welcome the proposals, but will the Secretary of State give details of the safeguards against cherry-picking of the kind that, if unchecked, could fatally undermine rural district hospitals such as the West Suffolk hospital in my constituency?

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Yes; we have to ensure that commissioners are increasingly able to use a tariff involving an established national or local price to determine the service that they commission, and that that does not allow the private sector—or anyone else, for that matter—to cherry-pick services by undercutting on price. We also need to ensure that that price reflects the cost of the treatment for the conditions involved, including complex conditions. This is why we have committed to carry out work, not least with the Royal Colleges, to identify where we need to develop tariffs in order to ensure that that happens.

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I welcome the statement, not least because it pays tribute to the future of the NHS commission. What is the Secretary of State’s thinking on the forward planning for the commission?

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If I may, I will interpret the hon. Lady’s question in relation to the NHS Future Forum. I freely acknowledge that I wish that we had instituted the Future Forum after the publication of the White Paper last year. Although we had a full, formal consultation process at the time, to which 6,000 people replied, the character of the engagement that has been achieved over the past two months has been superlative. As we make further progress on the development of education and training proposals, for example, I want to ask the NHS Future Forum to continue that process of engagement in that and other areas across the service.

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I have a great deal of time for most GPs—in particular for the one sitting in front of me, my hon. Friend the Member for Totnes (Dr Wollaston)—but what part of the Bill would allow communities to rid themselves of underperforming GP practices?

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That would need to be initiated by the NHS commissioning board. Under the legislation, the board would respond to the health and wellbeing board in the local authority in question, or to the local clinical commissioning group. In my hon. Friend’s area of Hertfordshire, the health and wellbeing board will provide a new and powerful means by which the voice of the public can be expressed to challenge all the poor performance that occurs in the service.

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rose

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

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

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The right hon. Gentleman should be aware that the Future Forum has recommended that the powers to be held by the Office of Fair Trading or the Competition Commission should be exercised by Monitor. That is because it believes it to be in the interest of the NHS for them to be exercised by a health service-specific regulator that is sympathetic to and has an understanding of NHS interests.

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Primary care trusts and strategic health authorities are part of a top-down management structure that has led to waste and bureaucracy and tolerates poorer patient outcomes. Will my right hon. Friend confirm that they will be abolished, and that the £5 billion that that will save over this Parliament will be ploughed back into front-line medical services?

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Yes, I am grateful to my hon. Friend; I can do that. It is essential to move to a world where we reduce administration costs, relieve bureaucracy in the service and free those providing services by offering them the resources to deliver improving care without the burden of bureaucracy, cost and waste inflicted by a Labour Government in the past.

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Does not the Secretary of State understand that when the Labour Government were in power, they increased spending from £33 billion to £111 billion in one decade, and that we are now witnessing, at a cost of £2 billion, a new Frankenstein monster all to pacify these tin-pot Liberals? Judas only got 30 pieces of silver.

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I have a mission for the hon. Gentleman— he should head to Wales. In England, this coalition Government have committed to increasing the NHS budget in real terms in the life of this Parliament. The King’s Fund reported the other week that in Wales, a Labour Government intend to reduce the NHS budget in real terms by over 8%.

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I believe that the very act of listening to patients and the public will have done a lot to improve these proposals—as, I suspect, once the dust has settled, it will have done for the Health Secretary’s reputation, too. Given the requirement for greater local accountability in these proposals, will the right hon. Gentleman make the same recommendation to local clinical commissioners in the changes they are yet to make for health services in their areas?

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I am grateful to my hon. Friend for his kind remarks, but I have to tell him that I am not looking to achieve anything in terms of reputation; I just want a positive outcome for the NHS. I have said before that this is not about me; it is about achieving for the NHS the opportunity to deliver better services for patients. That is all I am interested in.

The proposals on public and patient involvement illustrate what we needed to do—and will now do in response to the Future Forum—as many people wanted to see set out in detail in the legislation how patient and public involvement would work in the respective NHS bodies. The legislation had set out the fact that these bodies existed, but the detail was not prescribed. There is always a balance to be struck in legislation between the degree of prescription and the degree of freedom. Clearly, through engagement with the NHS, we have approval for putting much more of the detail into the Bill, now that it is clear that it will engage patients and the public.

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Along with the vast majority of the public, I welcome most of the changes announced today. I always welcome U-turns when they bring about the right thing. I am very concerned, however, that the bureaucracy that will be around after all these changes have gone through could be worse than what we have at the moment. I would genuinely like to be reassured on that point.

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I am grateful to the hon. Lady for her support for the majority of the recommendations. The bureaucracy will reduce in the NHS as a consequence of the changes for one very simple reason—because we are shifting the ownership of commissioning and the responsibility for the design and delivery of services from what is essentially a distant managerial organisation into one that is locked into the clinical decision making of doctors and nurses across the service. Let us be clear: this is about delivering benefit to patients by empowering the doctors and nurses who care for them. That in itself will cut the bureaucracy.

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Can the Secretary of State confirm that the Government have no plans to decrease the budget for the NHS—unlike the plans of the Labour party to slash it by £30 billion?

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Yes, my hon. Friend makes an important point. If we had listened to the Labour party last year, we would have cut the NHS and would not have increased the resources going into it. The £20 billion efficiency savings required to respond to demand and cost would have been £30 billion, which would have put an unsupportable degree of pressure on the NHS. As it is, we are giving the NHS not only resources but the opportunity to deliver improving care.

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After the White Paper was published in July last year, 6,000 representations were received from health professionals and from the Select Committee on Health asking the Secretary of State to think again about breaking up the NHS, so this “listening exercise” has been a waste of public money. Either the Secretary of State was wrong then, or he is wrong now. Which is it?

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I am afraid I have to say that that was all nonsense. As the hon. Lady knows, we responded positively to the consultation last year and made changes then. However, as the details of the Bill have been emerging, people have been trying to work out how they will make it all work in the future. They have been saying, “We want to set out in the legislation precisely how it will work.” There is no better way of making that process effective than talking to people in the NHS, engaging with them, listening to them, and then implementing the changes.

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I am sure the Secretary of State agrees that the single biggest challenge facing health care in the United Kingdom is the economic and human challenge of looking after an ageing population. Does he also agree that the key to that is better integration of health care services—better integration of hospital services with community and social services—and that these reforms are a good way of going about that?

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I agree very much with that. The Future Forum’s report, particularly the part that deals with clinical advice and leadership, has given us a robust structure for engagement with the range of professions that are capable of delivering that kind of integrated, joined-up and more effective care.

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Can the Secretary of State reassure us that no services or hospitals will be taken over by the private sector?

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There are no plans in the legislation or, indeed, in the Future Forum’s recommendations that would lead to that. In particular, as the hon. Lady will see in the detail published with the written ministerial statement this morning, we have proposed that Monitor should have no power to allow the private sector access to NHS facilities for reasons of competition and to take them away from NHS providers.

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We have a Prime Minister who loves the NHS, a Secretary of State who is the most experienced Member in the House when it comes to the NHS, and a coalition Government who have done something that the Labour Government never did. They listened, and they were willing to improve their Bill. This is a great day for democracy. I congratulate the Secretary of State on that, and on referring the Bill back to a Committee—and if he is looking for volunteers for the Committee, I am available.

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I am grateful to my hon. Friend. It is because I believe in the NHS and the people who work in the NHS that I think it right to listen to and engage with those people, and to give them much greater control of the service that they provide for patients.

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

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

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

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Will the Secretary of State expand on the support that organisations such as the Spinal Injuries Association can expect through specialised commissioning?

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I believe that as a result of our proposals the NHS commissioning board will be able to provide more consistency in much specialised commissioning, and I hope that that will apply to people with spinal injuries. I am well acquainted with the work of the Spinal Injuries Association: I think that it has done terrific work, and we have already worked closely with it in trying to ensure that we improve commissioning and services for those with spinal injuries.

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It is utterly disgraceful that Liberal Democrats and Tories are scrapping with each other to claim credit for the alleged listening exercise. Will the Secretary of State now apologise to my colleagues and me for not listening to us when the Bill was in Committee?

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Yes, in relation to the changes we are now bringing forward, I do indeed give credit to some of my colleagues—very much so—but I also give credit to the Prime Minister and the Deputy Prime Minister for the time and trouble they have taken; they have spent a great deal of time listening, and engaging with people across the health service. We give credit, too, to the NHS Future Forum and the thousands of people across the NHS who have now made their contribution to the NHS’s future, and I think they will be very disappointed to hear Opposition Members just wanting to denigrate that, and to make political capital out of it, rather than supporting the NHS in its future objectives.

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GPs collectively throughout Oxfordshire told the Field commission that they wanted to get on with GP commissioning, and that they were wholeheartedly committed to it because they believed they could be catalysts for change and better design NHS services for local people. When are GPs in Oxfordshire going to be able to get on with GP commissioning?

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I can assure my hon. Friend that I know his local GPs, and that they want to work with their professional colleagues across their area and to get on with that now. We will continue to be able to delegate commissioning responsibilities to all commissioning groups who are ready to do that; if they show that they are ready, we can give them the capacity to do it through existing NHS structures.

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This is not a U-turn; it is a body-swerve around the Liberals. The Secretary of State has spent the last year telling us that cherry-picking for profit in the NHS will not be possible under his Bill, yet today’s report has told us that he must take action to prevent such cherry-picking. Does the Secretary of State understand that this is now an issue of trust, and that nobody trusts him on the NHS—made in Britain by Labour, stolen by the Tories, and given away to his fat cat friends?

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I will not attempt to compete with the hon. Gentleman on any driving analogies, but we have been clear that we will not countenance cherry-picking against NHS providers. The Future Forum has made recommendations on that, but they are not all to do with the Bill: for example, the processes I described of using a tariff lie outside the scope of the Bill. The Future Forum is making recommendations, and we are responding positively to them.

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Does my right hon. Friend agree that the discourtesy and mock anger from Opposition Members demonstrate why it is so important to take politics out of the day-to-day running of the NHS, so that we avoid this sort of political football nonsense every time we try to implement sensible reforms of this vital public service?

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My hon. Friend is absolutely right, and that may be why Opposition Front-Bench Members have not told us whether they agree with the Future Forum. The truth is that they know they have to agree with it, because it makes good sense, but they are also trying not to let their political opportunity drift away from them. People will be deeply disappointed, and in some cases angry, that they cannot abandon trying to turn the NHS into a political football.

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Will the new, revised GP consortia still be allowed to outsource commissioning, either in whole or in part, to private health care firms, many of them probably American, which would create a major conflict of interest?

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The clinical commissioning groups will be statutory bodies, and will therefore not be able to delegate the responsibility for such commissioning to any other organisation, including a private sector organisation.

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My constituents will be reassured to hear the Secretary of State say that it remains the duty of the Secretary of State to deliver a comprehensive health service, but was that duty ever at risk?

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It was always clear that we would retain section 1(1) of the 1946 Act, which states that the Secretary of State will have a continuing duty to promote a comprehensive health service in England. What has been asked of us is that the Secretary of State should have not only that duty but a duty to secure the provision of that health service and an oversight responsibility in relation to the national bodies charged with providing it, and we will respond positively to that request.

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This is a sorry tale of the Government going too far, too fast. What we have now is in danger of being a dog’s breakfast and the worst of all possible worlds. How much has this top-down reorganisation cost the UK taxpayer so far?

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The listening exercise has to date—on 14 June—cost £36,640.97. The process of modernisation in the NHS is saving hundreds of millions of pounds every month. We know that we have to not only increase resources to the NHS but deliver continuously improving productivity and efficiency in the NHS. The Labour party always ignored that and failed on that; we will not fail on that.

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Today’s proposals are clearly winning the support of the health professionals and of political colleagues, but to win the support of the public and the patients I hope the Secretary of State will be able to give one further assurance that these plans will give greater local democratic accountability for the NHS than ever before and will therefore mean no enforced local privatisation of services, which happened under the previous Labour Government.

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Yes, I can give my right hon. Friend that assurance. He will know that in our response to the Future Forum we will strengthen the role of health and wellbeing boards, deliver more integrated care and ensure that the local health and wellbeing strategy is a central document in determining the shape of commissioning in the NHS, social care and public health. The powers, including those for service reconfiguration in an area, will be maintained so that they must continue to meet the four tests I set out last year. The public voice will therefore be at the forefront of the response to any changes in the local service.

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Given that the Secretary of State is about to waste £2 billion on this reorganisation—money that would be better spent on patient care—will he give us an assessment of how many A and E departments will close over the next two years?

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That is pretty rich. When I became Secretary of State, I found that all over the country there were threats to accident and emergency departments and to maternity departments generated under a Labour Government. Let me tell the hon. Lady that this is about delivering continuously improving care and cutting costs. We set out very clearly that although there are costs involved in reorganisation, they will be recouped severalfold over the course of this Parliament, saving in total some £5 billion in reduced administration costs.

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My right hon. Friend will be aware that tens of thousands of families throughout my constituency are deeply concerned about the reduction of services at Fairfield hospital in Bury. Will any of the changes that my right hon. Friend has outlined enable that process to be reversed?

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My hon. Friend and I have visited Fairfield hospital on a number of occasions and I have every sympathy with him and his constituents. He inherited as a Member of Parliament, as I did as Secretary of State, very advanced plans for changes to services at the hospital. What will now come to the forefront is the ability of the local authorities, through the health and wellbeing board and the clinical commissioning group, to bring clinical staff and the public together to say that in his area, north of Manchester, they can take greater ownership of the design of services to meet local needs.

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I am sure that I am not the only Member who noticed that the title given to the urgent question required only one consonant to be added for us to use it for the ministerial statement: “Wasted Review”—[Interruption.] Wasted review—was that the sound of a large penny dropping? Given that the Minister is constantly dodging questions about the cost of the review, will he tell us how many nurses and doctors could have been put in post using the money the review cost?

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The latest figures on the changes in staffing in the NHS since the general election have shown a reduction of 3,800 managers, an increase of 2,500 in the number of doctors and no reduction in the number of nurses.

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In Dover and Deal, we have dynamic GPs, many of whom want to get involved in commissioning, but not every GP wants to do so. Will the Secretary of State confirm that no individual GP will be forced to be involved in the work of the commissioning group and that that was always the case under his reforms?

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My hon. Friend makes a good point. Many GPs across the country understand that clinically led commissioning is the right thing to do, but they do not personally want to be involved in that process. There are, however, leaders who do, and leaders across the country have already come forward through pathfinder consortia and will be a basis on which we can create much greater clinical leadership across the service. The Future Forum was very clear that leadership from within the service, from doctors, nurses and other health professionals, will be instrumental in improving care in the future.

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Everyone knows that the Conservatives opposed the introduction of the national health service and that they brought it to its knees when they were last in power. Now they are trying to undermine it by wrapping it up in bureaucracy. With waiting lists increasing, what assurances can the Secretary of State give the House that they will not increase further as a result of the measures he is bringing forward in the Bill?

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I do not think that the hon. Gentleman listened to or heard the Prime Minister when he made absolutely clear our commitment to keeping waiting times low. Not only did the Prime Minister make that commitment, but it is in the constitution. In practice, the opportunity for patients increasingly to see the performance of the hospitals to which they can choose to go will help to drive increases in performance. As I told the House in response to an earlier question, waiting times are now lower for in-patients and out-patients than at the time of the last election. I am also old enough to remember that in June 1944, Winston Churchill, as the leader of a coalition Government, went to the Royal College of Physicians and set out an ambition for a national health service that would give everybody in the country access to the highest quality health care, free for all, regardless of means.

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The Cure the NHS group, founded by Julie Bailey in Stafford, has rightly stressed the importance of a culture of caring and zero harm to patients—something that my right hon. Friend has always emphasised. How does he think the recommendations of Professor Field’s report will help with embedding such a culture across the NHS?

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As my hon. Friend knows, much can contribute to that change of culture, not least making safety one of the central domains for measuring outcomes in the NHS. In addition, it must be personal to each member of staff in the NHS that they have that responsibility. We have too often seen cases in which people have been professionally responsible but have not acted in line with that responsibility. A central part of what we need to do is not about organisations and structures but about creating that sense of personal responsibility in professionals across the service to look after their patients and those for whom they care and to blow the whistle if there is harm or abuse; and we must protect and secure that whistleblowing when it happens.

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The Secretary of State promised to reduce bureaucracy, but he has now spent more than £760 million on a botched reorganisation that gives us commissioning consortia, senates, a whole host of national quangos and PCTs being abolished to transfer their staff somewhere else. Is it not time he accepted that this is a botched reorganisation and withdrew the Bill?

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Most of that was pure invention, including all the numbers. We are going to save money with these changes to the NHS. We are going to transfer resources from bureaucracy, management and administration into front-line care. Through clinical commissioning groups we are going to empower staff in the NHS, and abolishing two tiers of management in the NHS will save us, in total, a third in real terms out of administration costs.

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Will the Secretary of State confirm that despite the existence of clinical senates the primary driving role in commissioning will remain with GPs, who know their patients best and know which services they require?

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My hon. Friend makes an important point. General practice—not just general practitioners but general practice—has a central role for patients because there is a long-term relationship with patients and an understanding of the whole population and the health of a whole area. However, GPs recognise that in order to get the right services for patients, they have to design services alongside the range of professionals whose job it is to deliver them.

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Let us be clear: this is just a dog’s dinner and these amendments have proved it. What we have here is a slow-privatisation-of-the-NHS Bill that is backed by the Rag, Tag and Bobtail party—the Liberal Democrats. This is the beginning of the privatisation of the health service and it is time it stopped.

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This Bill and our proposals were never to support privatisation; they are not to support privatisation and they will not be to support privatisation. The hon. Gentleman should have attacked the Labour Government who gave the private sector £250 million for operations it never carried out; they paid it 11% more than they would have paid the NHS for that. They tried to push the NHS out of the provision of services when it could have provided them and competed. The Labour Government did that, and we shall legislate to make it illegal for a Secretary of State or any regulator to engage in that kind of preferential treatment for the private sector in future.

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

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

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Thank you, Mr Speaker.

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

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I understand. What my hon. Friend says is absolutely clear. We know that informed choice for patients is a serious contributory factor in improving outcomes for patients. When there is informed choice, of necessity we must have a diversity of providers to support it. There is no doubt that to that extent competition is an essential part of delivering improving care in the future, but it is not an end in itself. It should not be elevated to that point, over and above delivering the integrated services that best give patients the care they need.

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My constituent Rosie Edwards suffers from a rare congenital heart condition, known as Fallot’s tetralogy. Fortunately, for all her life, both as a child and now as an adult, she has had to have all her treatment at the Royal Brompton hospital in London. Unfortunately, the Government are proposing that that paediatric cardiac service is terminated—[Hon. Members: “Not true.”] It is completely true. There is no provision in the suggestions that have been brought forward for the service to continue. My constituents are asking whether, if reorganisation will cost a lot of money, it would not be better to spend that money on protecting those services.

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I am sorry the hon. Gentleman tried to characterise that as he did. The joint committee of primary care trusts is conducting a consultation. The Government are not doing it; I am not doing it; the committee is doing it, and the consultation closes on 1 July. People across the country are quite properly making representations to the consultation, including on the Royal Brompton and other units. The committee has not made recommendations to me; it will come to its conclusions after that consultation, which has absolutely nothing to do with the structure of the proposals I am referring to today.

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My constituents will not be interested in hard left, old school scaremongering. They simply want to know whether the Bill will put local health services under a greater degree of local control.

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My hon. Friend will know that many of us in the House were deeply frustrated in the past that Ministers would say at the Dispatch Box that primary care trusts were responsible for local decisions, and then nobody found locally that the PCT was in any practical sense accountable to them or the population they represented. In future, there will be proper accountability: clinical accountability through the commissioning groups and democratic accountability through local authorities.

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Will the Secretary of State apologise to the people of this country for a botched process that will lead to nothing but chaos and confusion in the NHS?

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I think the hon. Lady should read the NHS Future Forum report where she will find that right across the service there is support for the principles we set out, and agreement that change is necessary. I do not know where she imagines that change will come from if not by going through a process of the kind we have engaged in.

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Public health continues to be an important priority, particularly in Cheshire East which, surprisingly, is ranked 15th in the league table for hazardous drinking. Can my right hon. Friend tell the House what remit he is giving the Future Forum in this important area?

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I am grateful to my hon. Friend. The Future Forum has made recommendations in relation to public health. One of them, which I announced today, is that we want to combine the direct integrated work on health protection and response to emergencies through Public Health England with continuing independence for expert advice, so I am proposing that Public Health England should be established as an executive agency. What is critical is that we create through the legislation a greater opportunity for local authorities to lead health improvement plans locally, so issues such as alcohol abuse and problem drinking will need not only national leadership, which we will give, but local leadership, which the Bill will empower.

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Accountability is not at all clear. The Secretary of State said that clinical accountability will be in one place and democratic accountability in another. We are replacing one organisation—the PCT—with five. My constituents will just want to know where the accountability lies for important local NHS decisions. That has not become clear from the statement so far.

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I repeat: from the public’s point of view, we know that what they wanted was genuine accountability, in the sense that the doctors, nurses and other health professionals who care for them should be able directly to design and influence the shape of services locally to meet their needs, but they also want a patient voice and a public voice. That has not existed in the past; we will enable it to happen. They will come together at the health and wellbeing board, where they will establish a strategy for their area.

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In the commendable listening exercise, was it not clear that there is now broad support for the principles of reform? Is it not better that we now take that forward, rather than being opposed to reform and opposed to the resources for the NHS, as the Opposition are?

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I am grateful to my hon. Friend. That is indeed the message that came through to us from the NHS Future Forum and its extensive engagement with the NHS and beyond. I will not go down the path urged on us by the Opposition, which for the NHS seems to be spend less, do nothing and let the crisis happen when it will.

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The Secretary of State is still talking about the Bill as if it is a way of promoting localism and local accountability, but is it not still the fact that most of the extension of locality commissioning that that would involve could happen without the Bill? I refer the Secretary of State to the role of the national commissioning board. What is that, if not a massive and bureaucratic centralisation of power?

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With respect, the hon. Gentleman misses the point entirely. Without the legislation we could not transfer out of the hands of a managerial top-down bureaucracy into the hands of clinicians and local people, but he is right—it is not just the localisation of decision making. There is also in the NHS a nationally funded service with an expectation of national standards, and many services that require high levels of national consistency in commissioning. There is a job for the national commissioning board, which we will establish. That in itself will inject a considerable level of consistency in standards and quality, and considerable efficiency in commissioning some services.

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I congratulate the Secretary of State on his reforms. I know how hard he has worked and conducted consultation across the political spectrum. That should be respected by the Opposition. The reforms empower our medical practitioners—doctors and nurses—and in doing so, as I am sure he would agree, will stop the litigation culture that has galloped away over the past 13 years under the previous Government.

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I understand the point that my hon. Friend is making. We need—not least in a further emphasis on safety and some of the other measures that we as a Government, including my colleagues at the Ministry of Justice, have said we would bring forward—to try to offset a rising tide of litigation and cost associated with clinical negligence cases in the NHS. My hon. Friend is kind to me about working hard. I never imagined I would not do so, but if I have worked hard over the past eight weeks, it is nothing compared to the leaders of the NHS Future Forum who, in the space of just eight weeks, produced excellent work which will be of enduring significance.

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Last year, the NHS in Wirral tried to respond quickly to the Secretary of State’s top-down reorganisation and has since spent months in uncertainty and stress. Will the Secretary of State apologise now to staff and patients on the Wirral for all the unnecessary problems he has caused them and all the money he has wasted?

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I met many of the previous practice-based commissioning groups in the Wirral and south Merseyside, who came together to tell me how enthusiastic they were about the possibilities for designing clinical services more effectively in future. They are doing that. They want to get on with it and the Future Forum is right: we need to give them the opportunity to get on with that now.

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What assurance can the Secretary of State give that his plans will abolish the rigged market introduced by the previous Government that ended up giving £250 million to the private sector for delivering nothing?

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My hon. Friend is absolutely right. We will legislate to stop precisely that distortion and that favouritism to the private sector. The private sector must know that it will have to provide additional services to the NHS on the basis of quality, not on the basis of any preferential system, as under the previous Government.

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I remember that under the previous Conservative Government people died while on waiting lists. [Hon. Members: “Oh!”] It is a fact. I was a Member of Parliament at the time and it happened. Labour’s targets transformed that. The Secretary of State has been forced today to retake responsibility for the delivery of the NHS. He has talked about what has been happening. Will he make a specific promise today about the future waiting lists under his jurisdiction?

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I will make clear to the right hon. Lady, as the Prime Minister has made clear, that we will not let waiting times rise. We will continue to maintain downward pressure, but it is very important that we do not treat waiting times in the NHS as the only measure of performance. It is more than that: it is the quality of care that is provided, not just the access to care.

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I am very sorry to say that the Secretary of State demonstrated a creative interpretation of the coalition agreement when he launched his policy last July. What can he say to the House to reassure us that he will not make the same creative interpretation of the Future Forum’s recommendations, particularly in relation to the risk of the marketisation of health services?

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The hon. Gentleman will know that when I came forward with the White Paper last year, or the Command Paper in December, or the Bill, we did so collectively as a Government, and I can assure him and all my colleagues that we will continue collectively to agree on the basis on which we take all these issues forward.

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Some say that the reason the Secretary of State went too far, too fast and has now come up with a fix that is too little, too late is that he has a bit of a tendency to be pig-headed and cloth-eared when people disagree with him. I do not agree with those who say that, but could he now find the humility and courage at least to say sorry for the mess he has made?

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rose—

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

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

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My constituency has borders with Gloucestershire, Herefordshire and Shropshire. The NHS Future Forum has recommended that commissioning group boundaries should not normally cross local authority boundaries, but will my right hon. Friend confirm that my local commissioning consortia can work with doctors in other areas?

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The Future Forum is perfectly clear that there is a benefit associated with integrating health and social care if clinical commissioning groups do not normally cross local authority boundaries. But it is clear, and we are clear, that they should be able to make a case to do so if they think it appropriate. We have the benefit of being able to look at the pathfinder consortia, of which there are 220 and I think that 16 cross local authority boundaries, so it is already the exception rather than the rule.

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Will the NHS be the preferred provider of choice for health care services for my constituents?

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No, I have said that we will legislate to ensure a level playing field, so her constituents should have access to whichever provider their clinical commissioning group views as best able to deliver quality care.

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The Government are incorporating the co-operation and competition panel into Monitor to advise the NHS on competition rules. Given that the Opposition seem to be engaged in collective amnesia this afternoon, will my right hon. Friend remind the House which party first established the CCP and the concept of competition in the NHS?

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My hon. Friend makes an interesting point, because, as the Future Forum report acknowledges, the Bill does not extend the application of competition rules in the NHS, which were introduced under the Labour Government. The co-operation and competition panel was established under the Labour Government in 2009. The rules that we will maintain as a process of evolution, rather than revolution, are the ones that were consulted on in January 2009 and most recently published by a Labour Government in March 2010. To that extent, and despite all the hot air from the Labour party on competition in the NHS, we are adopting an evolutionary approach and starting precisely from the situation that applied under the Labour Government.

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In his earlier answer to my right hon. Friend the Member for Oldham West and Royton (Mr Meacher), the Secretary of State, if I understood him correctly, said that commissioning consortia would have to do the commissioning themselves and could not franchise it out to private providers. Will he confirm that that is the case and that he has powers to limit the number of private patients who can be taken into NHS facilities under the regulations he is proposing in the Bill?

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I reiterate that the clinical commissioning groups will be statutory bodies with a statutory responsibility for commissioning, so it would not be legal for them to delegate that to another body that was not subject to the same obligations. As far as access to private patients is concerned, we have made it clear—I do not believe that the Future Forum makes any recommendations on this—that foundation trusts, which often have arbitrary rules relating to limits on their income from private patients, should have that cap lifted, but we propose to put additional safeguards in place to make it clear that, if they do so, not only must that income be separately accounted for so that there is no subsidisation from NHS facilities, but the trusts must demonstrate how that will support their continuing primary purpose of providing services to the NHS in England.

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Having very much supported the listening exercise, I know that for many of us the most important aspect of these reforms has always been the new focus on outcomes, as illustrated by the inclusion of the one and five-year cancer survival rates in the outcomes framework. Will the Secretary of State assure me that the Future Forum’s suggestions will in no way detract from that new focus on the quality of care?

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I can give my hon. Friend that assurance. Indeed, I can go further and say that one of the reasons the Future Forum has made no recommendations on the outcomes framework is that it found enthusiasm across the NHS for focusing on quality and outcomes and nothing but approval for the framework. Of course, the Labour party ignores the fact that, as stated in the White Paper we published last year, that is one of the central aspects of what we are setting out to do. He is right that the focus on outcomes, which enables people to see how this country performs in health, relative to other countries, and continuous improvement in health outcomes, rather than just a small number of focused targets, is instrumental in continuous improvement.

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The Secretary of State is aware of the situation faced by Trafford acute trust. Will he reassure my constituents that there is no prospect of Trafford General hospital being either broken up or taken over by a private company?

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The hon. Lady will have a further opportunity to discuss that shortly. She will know that the NHS trust in Trafford is examining whether it might merge with one of two possible foundation trusts and whether it might change its corporate configuration, as it were, but entirely within the NHS.

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Last Friday, I met two members of the local Labour party in my constituency who presented me with an apparently independent petition on the NHS reforms. At that meeting, they told me that it was a fact that our reforms would lead to the removal of a comprehensive health service; we now know that that is a load of old nonsense. They also told me that it was a fact that these changes would open up the NHS to European Union competition law in a way that it is not at the moment. Is that a fact, or is it just shameless scaremongering?

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It is entirely scaremongering. My hon. Friend might like to look at what the Future Forum report says in relation to choice and competition, which sets out very clearly that the extent to which EU competition rules apply in the NHS will not change as a consequence of this Bill.

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So far, £768 million has been wasted on this failed reorganisation. In my region, Freeman hospital’s cardiac unit for children is under threat, South Tees Hospitals trust has had £20 million removed by the Government, and the Government are proposing a national commissioning board that sits in private, is unelected, produces no minutes, remunerates itself and sets its own sub-committees. Where is the front-line quality of care for people?

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I am afraid that that is a further repetition of invention by Labour Members, who appear to have been given one or two figures of their own. It is complete nonsense. In the impact assessment associated with the Bill, which we will now revise to reflect these changes, we explained that there was an estimated £1.4 billion total cost of reorganisation, but that that would lead to a £1.7 billion recurring annual benefit in savings, which would accumulate to more than £5 billion over the course of the Parliament.

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Building on the question from my hon. Friend the Member for West Worcestershire (Harriett Baldwin), HealthEast pathfinder consortium in my constituency crosses two district councils—in fact, it crosses two counties—and it might be appropriate for GPs from a third council area to join it. Will my right hon. Friend assure me that no barriers will be put in the way of what should be effective care for patients rather than simply political boundary lines?

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As I have said, we will expect, and the Future Forum says, that commissioning groups should not normally cross local authority boundaries—in this respect, boundaries for social authorities—but they should be able to make a case for doing so based on benefit to patients. The one thing I would urge is that they are very clear with their local authorities about how they can secure the continuing integration of health and social care at a local level.

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Is not the reason the Secretary of State has so much support from the right wing of his party that they know that this will lead to privatisation of large parts of the NHS, as he confirmed in his answer on preferred suppliers?

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I hope that my colleagues would support me in saying that I have support from colleagues right across the coalition, because the coalition Government are supporting the NHS in enabling it to deliver improving services. That is what it is all about.

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It is appropriate that I am last, because I come at this from a different direction from everybody else. Given that no extra cash is available—we know that—how will the watering down of Monitor’s duty to promote core competition help to deliver the efficiency gains that are the future of the NHS? How will the Secretary of State now achieve that?

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I say three things to my hon. Friend. First, let us be clear that there is £11.5 billion of additional cash available to the NHS over the course of this Parliament—but we have to use it better and deliver greater quality and effectiveness. The job of the commissioners and Monitor together is to deliver that—partly through tariff development in ensuring that they get those efficiencies by the price that they set, based on benchmark-to-best practice prices, but also through using their commissioning strength to design services. We all know that if we simply said every year to the NHS, “You must save money by cutting the price of what is paid to you”, its response would be to cut services, cut staffing or cut quality. In fact, achieving greater quality and effectiveness is about the redesign of clinical services—the transfer of services into the community and keeping people well at home rather than through emergency admissions to hospital. It is about clinical leadership and clinical redesign, and that is what these proposals will bring to the forefront.

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Given the Secretary of State’s manifest interest in Wales, I invite him to come to Wales to meet some Welsh patients with me to find out at first hand which party they trust to safeguard the heritage of the NHS—Labour or the Tories. I suspect that the answer would be revealing for him. How much Welsh taxpayers’ money has been wasted on this needless reorganisation of the NHS?

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The hon. Gentleman must know that the money available to the NHS in Wales is available to the NHS in Wales, and that it is separate from England. The Labour Welsh Assembly Government have made their own decisions about the priority that they attach to the national health service in Wales, and the result is, as the King’s Fund says, that they plan to reduce its budget by 8.3% in real terms. We are going to increase the NHS budget in real terms. The result can be seen in waiting times, which we were talking about. In England, the proportion of patients admitted to hospital who are seen within 18 weeks, according to the latest data, is 89.6%. He might like to reflect on the fact that the figure for Wales is 64.5%.

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Although it has been difficult to hear during this debate, I would like to address my comments to the statement made by the Secretary of State.

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Question.

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Question, sorry. [Interruption.] Let us get to the point and stop playing around. The Secretary of State said in the statement that consortia will now have one nurse and one secondary care doctor and that:

“To avoid any potential conflict of interest, neither should be employed by a local health provider.”

How will the Secretary of State apply that rule to GPs? Would not the Secretary of State and his reforms be best described as like Schrodinger’s cat—in a state of uncertainty and both alive and dead at the same time?

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The hon. Lady misses the point. If GPs were providers as well as providing primary medical services, they would be unable to make decisions about those responsibilities because of a conflict of interest. Of course, as primary medical services providers in their area, they are not commissioned by the clinical commissioning groups—if the hon. Lady is listening to the answer at all—because the commissioning of primary medical services is undertaken by the NHS commissioning board, not by the local groups.

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Will the Secretary of State accept that he would not be in the position he is in today had there been proper pre-legislative scrutiny of this Bill? Will he recommend to his Cabinet colleagues that that process is used for all future legislation? It is a case of more haste, less speed.

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We as a coalition Government are engaging in more pre-legislative scrutiny than any of our predecessors. In this instance, I do not accept the hon. Lady’s proposition. What has been done by the NHS Future Forum could not conceivably have been achieved in pre-legislative scrutiny, because it was essentially about engaging people across the service in how we will implement principles that are widely supported across the service. It is very much of the here and now, rather than something that could have been done in advance.

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I ask the Secretary of State to answer a straightforward question with a straightforward answer. How much money has so far been outlaid on this NHS reorganisation?

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

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