House of Commons
Tuesday 17 July 2012
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
The Secretary of State was asked—
Clinically Led Commissioning
Clinical leadership in the design of services for patients will deliver better outcomes and improve patient experience of care. In the last year, for example, NHS Dorset clinical commissioning group has worked to improve outcomes in cardiology, dermatology and muscular-skeletal services, and NHS Nene CCG has admitted more than 3,000 patients on to a proactive care scheme, which I have had the privilege of seeing for myself, to identify and reduce the risks of people needing an emergency admission. That is one reason why the number of emergency admissions to hospital in the NHS fell by 1%.
The Secretary of State will be aware of Chester’s location on the border with Wales and of the issues with cross-border health care commissioning. In order to ensure that there will be no financial shortfall for the West Cheshire CCG in relation to the treatment of patients who are registered with general practitioners in Wales but who receive treatment in England, will he confirm that the cross-border commissioning funding protocol between England and Wales will be fully implemented?
I would be grateful if my hon. Friend could convey my best wishes to the Countess of Chester hospital, which I visited just before Christmas, and my appreciation of the work of the West Cheshire CCG. I can confirm that discussions between officials in the Welsh Government, my Department and the NHS Commissioning Board are under way to extend and renew the protocol for cross-border commissioning for 2013-14 and beyond.
If the Secretary of State believes that the reconfiguration of hospitals is clinically rather than finance led, will he ensure that NHS North West London publishes full risk assessments of its decision to close four accident and emergency departments and replace them with urgent care centres?
As the hon. Gentleman will—I hope—be fully aware, the view of Ministers is clear: any reconfiguration of services must be driven not by cost but by a need to improve clinical outcomes for patients; must be in line with the commissioning intentions of the local commissioning group; must be on the basis of strong patient and public engagement; and must protect the choice available to current and prospective patients. To that extent, I hope that all the necessary information to support those four tests is in the public domain.
GP commissioners in Bromley have opened a consultation on the future of services currently provided at the Orpington hospital site. Will the Secretary of State ensure that the administrator recently appointed to South London Healthcare trust takes account of the consultation’s findings when drawing up his proposals for how best to put SLHT on a sustainable clinical and financial footing?
I hope that my hon. Friend is aware that when I appointed the trust special administrator and set a timetable for his work, I specifically added 30 days on an exceptional basis to the timetable for the production of his first report, one of the exceptional reasons being that an accelerated consultation should take place locally on the future of Orpington hospital.
The right hon. Gentleman needs to listen carefully to what I am about to say. Yesterday, he promised action to stop the restricting of cataract operations for financial reasons, if given evidence. How about this example? NHS Sussex has imposed severe restrictions that contradict the Department’s own guidance, “Action on Cataracts”, and this has seen the number of operations in Sussex fall from 5,646 in 2010 to 4,215 in 2011. Does the Secretary of State consider that fair to older people, and will he now take the action his Department has promised?
I have made it clear to the right hon. Gentleman many times, as has the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), that it is not acceptable and we will not allow NHS commissioners to impose blanket bans. I will gladly take note of and investigate that example, but I have to say that the right hon. Gentleman wrote to me with a document that purported to contain a series of examples from across the country, most of which turned out to be fictional. I shall respond in writing about NHS Sussex and put a copy in the Library of the House, but, as I have made clear, we, unlike our predecessors, will not accept any blanket ban on treatment. Any treatment must be clinically determined in the interests of patients.
Well, the right hon. Gentleman is accepting it, and he continues to dispute my evidence, but what does he say to the president of the Royal College of Ophthalmologists, who said yesterday of cataract restrictions:
“They are arbitrary and are a response to financial pressures, not clinical needs”?
The reason for the Government’s denial is that the financial pressures are greater than they care to admit. The figures released by the Treasury yesterday confirmed that he and the Government have now cut the NHS budget for two years running, but they also reveal something else: another real-terms cut planned for 2013-14. Do not their flagship promises on NHS spending now lie in shreds, and will this Prime Minister not be for ever remembered as the man who cut the NHS, not the deficit?
It is staggering, isn’t it? In 2010-11, the NHS budget was set by the right hon. Gentleman, not by us. The final accounts for 2011-12 will not be published until the autumn. I wish he would just get up at the Dispatch Box and admit that over the course of this Parliament the coalition Government will increase the NHS budget in England by 1.8% in real terms, which is £12.5 billion in cash, whereas the Wales Audit Office has said that a Labour Government in Wales will cut the NHS budget over the same period by 10% in real terms.
The draft Care and Support Bill contains clauses that support our commitment to introduce a universal deferred payments scheme and a national eligibility threshold. We have set out our intention to base a new funding model on the principles of the Dilnot commission model and we will take a decision in the next spending review.
Last week the Secretary of State dismissed the concerns of Labour MPs about councils being hard pressed to find funds to implement any of the proposals. The Local Government Association stated that there was no money. Will the Minister now commit to legislation in this Parliament to sort out the funding of social care at local level?
It does not need legislation to sort out the amount of money that goes into social services; it does need legislation, however, to put in place a universal deferred payments scheme. We have made it clear that we will fully fund the commitment that we have already announced and we will work with the Local Government Association and others on its detailed design and implementation.
The verdict of the Care and Support Alliance on the delay in introducing legislation to reform social care funding is this:
“Each day of delay condemns greater numbers of older and disabled people to the risk of isolation and neglect,”
trapping people in hospital and pushing many more carers to “breaking point”. Just when will the Government realise the damage done by delaying the decision to do anything about funding social care?
In fact, in October 2010 this Government took an important decision about the funding of social care: to invest an extra £7.2 billion. I wish Opposition Members would stop running local authorities down and support the ones that are doing the right thing and ensuring that they spend the money the Government have provided to them on social care, rather than cutting those services. That is what I am doing; I hope that the hon. Lady will as well. I just wish that she had prefaced her comments by apologising for 13 years of Labour failure on social care.
I welcome my hon. Friend’s statement today and the announcements last week about the future structure and the commitment to introduce legislation later in this Parliament in line with the draft Bill. Will he confirm that it is the Government’s intention to pursue the cross-party talks on funding options for the Dilnot package, and that if solutions can be found, they can be included in the legislation that is introduced?
Notwithstanding some of the perhaps intemperate exchanges we have in this place, my colleagues and I are still determined, if those on the Opposition Front Bench are, to engage in talks on how we reform the funding system. Indeed, the debate we had in the Chamber last night confirmed that both sides of the House wish to support the principles of the Dilnot reforms, so I hope that we can have such talks and that they can be reflected in the Bill.
I welcome the Government’s commitment to support the provision of free and fully integrated end-of-life care. While the palliative care funding pilots are progressing, can lessons be learnt quickly in my borough of Enfield where, sadly, most people are dying in hospital rather than, as is their choice, at home or with the support of local hospices?
My hon. Friend is absolutely right. Just last week we published the world’s first ever survey of bereaved people’s experiences of the end-of-life care received by loved ones. It revealed quite stark variations from one part of the country to another, and will prove a valuable tool in driving up performance of areas that are not doing well by families in end-of-life care. As for the White Paper, we have said clearly that we are committed to doubling funding for the pilots to ensure that we have the data to take decisions about the introduction of free personal care when it comes to end of life.
Opposition Members are genuine in our desire to reach cross-party consensus on the funding of social care. Will the Minister demonstrate his Government’s seriousness by agreeing to include Treasury Ministers directly in the cross-party talks, as Labour has offered to do from the start?
Talks that start with lots of preconditions are not going to be very good talks to start with. The Government always retain the responsibility for making decisions about taxation and spending priorities. We set out our position last week on the Dilnot Commission, and we now have a clear basis for talks, as those on both sides of the House seem to agree on the principles of Dilnot as the basis for reform.
At the beginning of this month, I laid my first annual report before the House setting out the achievements of the health service in 2011-12. The report showed that the NHS had continued to maintain or improve all the key performance standards while delivering unprecedented efficiency savings and a strong financial out-turn. That is a testament to the achievements of all NHS staff.
I thank my right hon. Friend for that answer. Will he confirm that the numbers of people waiting over 18 weeks, over 26 weeks and over 52 weeks for treatment are now at their lowest-ever levels—lower than when Labour was in office? Will he also confirm that that gives the lie to Labour’s claims that waiting lists are increasing?
Yes; I am grateful to my hon. Friend. When we came into office, something like 209,000 people had waited over 18 weeks. We have reduced that figure to 160,000. The number waiting over a year was nearly 19,000, and we have brought that down to below 5,000. I remind Opposition Members that in Wales the target for the number waiting more than 26 weeks has not been met—the figure stands at 6%, whereas in England it is 2.2%.
I am grateful to the hon. Gentleman for that question, because it allows me to confirm that the annual report states that the NHS has met all the cancer waiting time standards, and that we in England have provided for 12,500 patients to have access, through the cancer drugs fund, to cancer drugs that they would not otherwise have been able to have. It is a matter of regret that a similar cancer drugs fund is not available for exceptional treatments in Wales.
If I may, I will write to my hon. Friend in order to convey the precise figure. From my recollection, I believe that the bulk of the £5.8 billion efficiency savings—£2.8 billion—was in the acute sector. As most of the acute sector’s costs are pay costs, the pay freeze will have contributed a significant part of that.
Will the Secretary of State accept that some of those so-called efficiency savings are totally counter-productive? Despite Ministers’ claims to be saving money on agency staff, is not the truth that hospitals’ attempts to improve their efficiency have backfired, with jobs being cut and agency staff being hired at rates as high as £1,600 a day?
No, I will not accept any such thing. We are aiming to reduce agency staffing costs in the NHS under QIPP—the quality, innovation, productivity and prevention programme—by £300 million, and we have already made a reduction of more than £120 million. Since the election, in complete contrast to the situation beforehand, we have reduced the number of administrative staff in the NHS by 15,000, including a reduction of more than 6,000 managers. We have also increased the number of clinical staff by 4,000 since the election.
The White Paper introduces new measures to help us to deliver better quality services and to improve the care that people experience, including through greater transparency, with new provider quality profiles and new care audits. It also clarifies what quality in care and support means, by setting out principles, standards, roles and responsibilities for driving up the quality of care. The White Paper makes it clear that we will rule out crude commissioning by the minute, which turns care workers into clock-watchers, and that we will work with commissioners, care providers and people who use services and carers in order to bring to an end commissioning practices that undermine people’s dignity and choice.
I recently visited Ashton Lodge residential home in Dunstable, and I was delighted to hear from the residents how kind the staff were. Occasionally, however, I get letters from constituents detailing simply unacceptable levels of care for their family in residential homes. How can we involve local communities more so they take a role in ensuring that all residential homes have consistently high standards of care?
I am grateful for that question. Indeed, one of the issues set out in the White Paper is the collaboration by the Department of Health and others with leaders in the care sector to make sure that care homes become much more embedded as part of their local communities and much more genuinely open to their local communities—working with local schools and working with HealthWatch, which will have powers of entry to work with those care homes as well. By turning the spotlight on in a benign way, making sure that all care homes are more open to their public, I think we can significantly improve quality.
Indeed we do. We identify in the White Paper the fact that there has been a postcode lottery for many years when it comes to access to primary care in our care home sector. The White Paper sets out how to ensure that we begin to eradicate that postcode lottery. By establishing a national commissioning board to commission primary care, we can ensure greater consistency in the future.
I am grateful to the hon. Lady for her question. Indeed, officials in my Department are in close contact with officials in all the devolved Administrations to make sure that we share best practice across the nations so that we drive up the quality of care for all.
Only last week, the Secretary of State said about care:
“The…number of delayed discharges is broadly the same as it was last year and, I believe, from memory, the year before—I will correct the record if not.”—[Official Report, 11 July 2012; Vol. 548, c. 322.]
Figures published by his own Department show the number of delayed days is up by 18% in the last year and 29% since August 2010. Are Ministers completely out of touch with reality, or would the Minister now like to correct the record?
Of course what the hon. Gentleman omits to mention in seeking to give an impression is this: the implication is that social services are not coping with delayed discharges and are the principal cause of them, but the figures do not bear that proposition out. [Interruption.] Indeed, the extra investment the Government are making in reablement services means that discharges in this area are being assisted and improving—[Interruption.]
Order. The question has been asked, and the Minister is giving his answer. Members may like it or dislike it, but they have a duty to listen to it with courtesy. While I am about it, let me emphasise that there is far too much sedentary noise coming from both Front-Bench teams. I think that the Minister has finished his answer; we are grateful to him.
5. What assessment he has made of the availability of insulin pumps for young diabetics. (117281)
We are currently undertaking a national audit to give us a clear picture of provision of pump services in England. This will be published shortly. The rapid response survey for 2010-11 suggests that half of all those eligible for a pump in England already have one, or have funding agreed—a significant improvement on the initial survey in 2010.
I thank the Minister for that reply. I am sure he will be aware that Nicola Sturgeon, the Health Minister in the devolved Administration at Edinburgh, announced earlier this year that all the under-18s requiring an insulin pump would get one. My constituent 13-year-old Fiona Clark has been told by Yorkhill hospital in Glasgow that she will have to wait an unspecified time to receive the pump her doctors say she needs. Given that the National Institute for Health and Clinical Excellence estimates the standard benchmark rate for the uptake of insulin pump therapy for type 1 diabetes in England is 12.4%, will the Minister offer his Department’s assistance to help those in Scotland to get above the current paltry 3.1% uptake?
I am extremely grateful to the hon. Gentleman, but as he will appreciate as a Scottish Member of Parliament, this is a devolved responsibility for the Scottish Government. On the specific issue—[Interruption.] If the right hon. Member for Leigh (Andy Burnham) would shut up, it would be helpful. It would probably be useful if the hon. Gentleman raised the specific issue with the Scottish Government, but on the general principle let me say that we are determined, certainly in England, to do all we can through education, the workings of the NHS and the operating framework to ensure that the number of people receiving pumps increases, as it already has in the last two years.
Nursery Milk Scheme
In 2009-10, the number of portions funded was 218 million. In 2010-11 it was 262 million, and in 2011-12 it was 271 million. Of course, children do not necessarily attend nursery five days a week, so the number of portions does not equate to the number of children, so, say, 1 million children attending full- time or 2 million attending 2.5 days a week.
In Hull the nursery milk scheme has never been more needed, at a time when poverty is increasing and food banks are expanding. Will the Minister guarantee that no child who currently receives nursery school milk will lose out after the results of the consultation have been published?
As the hon. Lady will know, we are consulting on a range of options to modernise the operation of the scheme. The cost rose to £53 million in 2010-11, and is due to rise to about £67 million in 2012-13. Given those massive increases, we need to look at the scheme’s operation to ensure that we are getting good value for money.
10. Does the Minister accept that the cost may well have risen because more children are receiving free milk? Because the consultation is being launched during the school holidays, it will be extremely difficult for schools to respond. If this is a genuine consultation which aims to ensure that milk reaches the children who need it, will the Minister consider extending the deadline into September and October? (117287)
The consultation has been running for some time now, and I should have thought that local authorities in particular would have had plenty of time in which to respond. Given that 8,962 settings are paying more than 90p for a pint, which is an outrageous amount, it is extremely important for us to hear from everyone. If the hon. Lady feels that there has been any problem with responses to the consultation and would like to drop me a line, I shall be happy to respond.
The Health and Social Care Act 2012 established the first legal duties to reduce health inequalities for national health service commissioners and for the Secretary of State. Both the NHS and public health outcomes frameworks will have a strong focus on reducing inequalities in access to health services, and on inequalities in the health outcomes of the population as a whole.
As I think my hon. Friend will know from recently published data, some of the pilot work involving general practices demonstrated that it was possible to increase substantially the number of patients diagnosed with dementia. I believe that during the pilot period there was an increase of two thirds, more than 60%, in the number diagnosed. As part of the Prime Minister’s dementia challenge, we are using quality incentives in the NHS to identify and refer patients who are admitted to hospital with potential dementia in order to improve their diagnosis and treatment. We hope that that and other measures will identify more of those whose dementia is at an early stage, and will also assist their treatment.
One of the key elements in the tackling of inequality is funding. The funds allocated to the clinical commissioning groups was set out in the operating framework, which related to GPs’ patient lists. It has now been changed to take account of data from the Office for National Statistics. Will the Secretary of State assure me that deprived areas will not lose out on the funds allocated to CCGs—not the per-head funds, but the funds allocated to CCGs as a result of the change?
As I am sure the hon. Gentleman knows, we will publish the allocations for 2013-14 later this year. However, we are ensuring, I think rightly, that the allocations to clinical commissioning groups for NHS services reflect the population, because they have a responsibility for the whole population. Some parts of the country, particularly London, have substantial unregistered populations, which often include the groups who are most at risk.
Does my right hon. Friend agree that one of his important initiatives that could reduce health inequalities is the development of personal care budgets, which give real power and choices to patients, and also have the potential to reduce hospital admissions and costs?
Yes, since the election we have pushed forward with offering access to a personal care budget to those who are in receipt of care and support. At the time of the last election, about 168,000 people were exercising that right. The figure now is over 432,000, and we are extending the scheme so that, for example, people in receipt of continuing health care through the NHS will not lose the opportunity for personal care when the NHS takes over that responsibility; instead, that will continue as a personal budget under the NHS.
Does the Secretary of State think any of the steps he set out in his original answer will lead to a repeat of the shock rise in the number of cancelled operations in the local hospitals serving my constituents, the figures for which were recently set out in a written answer to me by his Minister of State, the right hon. Member for Chelmsford (Mr Burns)?
The number of cancelled operations rises at certain times during the winter, and it did so during last winter. We are clear about the necessity of ensuring that patients do not have cancelled operations if we can avoid that, and, in particular, that those whose operations are cancelled have access to treatment rapidly thereafter. The key is to make sure, as we have done, that patients have timely access to treatment under the referral to treatment times guidelines, and as the hon. Gentleman will be aware, the average waiting time for treatment in the NHS has fallen since the election, as has the number of people waiting a long time for treatment. That is the strongest measure for ensuring all patients get timely to access to care.
Wythenshawe Hospital A and E
The Department does not collect data on accident and emergency attendances at hospital level. These data are only available at trust level. In the 12 months up to 8 July 2012, there were 108,393 accident and emergency attendances at University Hospital of South Manchester NHS Foundation Trust.
I am grateful to the Minister for that reply, and I am sure he will want to join me in thanking the staff at Wythenshawe A and E department, particularly given that that colossal number of 108,000 attendances has taken place in a unit originally designed for 70,000 patients. However, if the A and E department at Trafford general hospital is closed, as is currently proposed, that would lead to a still greater increase in the number of patients at Wythenshawe A and E. Given that, is it not essential that the £11.5 million that will be required for extra facilities at Wythenshawe should be made available?
I hope the right hon. Gentleman is not disappointed, but I cannot add anything to the answer I gave in the debate we had last week when he asked that specific question. I can assure him, however, that local commissioners have assessed the impact of the proposed changes at the Trafford and other hospitals, including Wythenshawe. The plans are still at an early stage and are yet to go to public consultation, and I have been informed that local commissioners will continue to review the impact of these changes on the other hospitals, including Wythenshawe. I urge the right hon. Gentleman, other Members whose constituencies are in the area and their constituents to contribute fully to the consultation process.
The Minister knows that the proposal is, first, to reduce services at the Trafford to urgent care provision and then, within not less than two to three years, to a minor injuries unit. What processes will be put in place to ensure that the most stringent criteria are applied in respect of investment in Wythenshawe and the other hospitals, as well as in Trafford community services and improved services to patients, before any such further move is contemplated?
As the hon. Lady will be aware from the debate we had last week, these proposals are subject to the consultation process and to consideration of the results. Commissioners fully recognise the need to minimise the impact the changes will have on neighbouring A and E departments and other services. The Trafford and South Manchester clinical commissioning groups are working on developing further integrated care services, and on developing community care services as an alternative to hospital care, as well as on ensuring that the final decisions meet the needs of the local health economy by providing first-class quality care for the people of that area.
Of course, it is not just Wythenshawe A and E that is facing difficulties. All Members throughout the House are grateful for the work our medical professionals do in extremely trying circumstances, but the truth is that the Government’s chaotic reorganisation has resulted in longer waits in accident and emergency. The Minister of State said last night that A and E departments were meeting the target, but figures published by his Department last week show that the Government have failed to meet the 95% target across major type 1 A and E units. If he cannot get his own figures right, he cannot expect to command the trust of patients or medical professionals. Will he now take this opportunity to show some respect for this House, for the public and for patients in general, and correct the record?
Order. May I just explain that the Minister did not widen the parameters of the exchange and therefore they should not be widened, so he is perfectly within his rights, if he wishes, to focus his reply on Wythenshawe. I hope he is not going to be too disappointed. We’ll give it a go.
I am most grateful.
Of course, the hon. Gentleman is playing with the figures. As he knows from previous discussions, he is talking about the SITREP—situation report—figures, which do not form the basis of the figures the Government use. [Interruption.] If he will keep quiet for a minute and listen, I will reiterate the point I made last night. Regarding A and E waits of under four hours and the percentile of 95, we are at 96%, which means we are within and above the level set down by the Government’s figures.
Health Allocation Formula
The independent Advisory Committee on Resource Allocation is reviewing the allocation of resources for the NHS through clinical commissioning groups, and for local authorities in relation to their future public health responsibilities. ACRA’s interim recommendations on the preferred distribution of public health resources were published on 14 June. The NHS formula will be published in due course. The draft mandate for the NHS Commissioning Board makes it clear that it should provide resources to secure equal access for equal need.
I thank the Secretary of State for that answer. It is becoming increasingly clear that ageing is a key driver of health care costs, yet the ACRA formula currently does not properly take that into account, to the detriment of towns such as Warrington. Can he confirm that under the new formula, ageing will be more prominent?
Yes. As my hon. Friend will know, under the existing formula, age was the single biggest factor, but what is important is that the formula accurately reflects the factors that will give rise to need for health care, so that the allocation of resources can respond directly to that need. Ensuring separately that there is an allocation to local authorities for public health, which will be measured in relation to mortality below the age of 75 in particular, will enable those resources separately to be focused on, for example, areas of greatest deprivation which give rise to the poorest health outcomes.
I am interested to hear the Secretary of State say that he understands there is a link between deprivation and health inequality, in light of the new funding arrangements that seem to indicate that councils in the north-east will receive £17 per head less for public health, whereas councils in wealthier parts of the country will receive £8 per head more.
The hon. Lady knows perfectly well that I have said many times that deprivation can give rise to inequalities in health outcomes. In particular, we are improving substantially the framework for reducing those health inequalities, because we are giving local authorities specific, dedicated resources. Let me make it clear to her that under the public health allocation formula that I outlined just a few weeks ago, no part of the country will see any reduction in its public health resources from the baseline established.
Residential Care (Funding)
Local authorities choose how best to use their funding; however, the levels of residential care provision are not determined solely by local council social care budgets. The supply of care home places is governed principally by demand from both public commissioners, such as local councils and the NHS, and private purchasers of services.
Nine out of 10 residential home providers say that low council fees are creating a two-tier system, as new investment is directed at wealthier areas where there are more people who can self-fund, and 82% of those providers say that self-funders are being charged more to cross-subsidise local authority-funded residents. This clearly is not fair, so what is the Minister going to do to rectify the situation?
We know from the most recent survey published by Laing and Buisson that there has been a 1.4% increase in the fees paid this year, compared with no increase last year. We also know that there is a surplus of places, which accounts for about 10% of the total number of bed places available in care homes up and down the country. So there is actually space, and it is entirely appropriate for local authorities to negotiate appropriate prices to provide good-quality care from one locality to another.
Following the census announcement yesterday that there are elderly hot spots, including North Yorkshire, will this is be a good opportunity for the Minister and the Government to review health and social care funding to reflect a growing elderly population in sparsely populated, isolated rural areas such as North Yorkshire?
My hon. Friend is absolutely right to highlight those issues and the emerging findings from the survey. It is important to say that data will be a key consideration in how the next spending review is shaped, along with the priorities that the Government will give to different demographic pressures as a result.
Children's Heart Services
I have received representations about the review of children’s heart services via letters, parliamentary questions and e-mails from hon. Members, via letters and e-mails from organisations and the public, and via meetings. My right hon. Friend the Secretary of State has received two overview scrutiny committee referrals, one from the Yorkshire and Humber joint health and overview scrutiny committee and one from the royal borough of Kensington and Chelsea.
The assurance I can give the hon. Gentleman is that we certainly believe so, but these are matters for the joint committee of primary care trusts, which carried out this review. As he will appreciate, it is totally independent from the Department of Health, and rightly so.
I am very grateful to my hon. Friend; this is the hors d’oeuvre before the main meal later today. Ultimately, if any overview and scrutiny committees of relevant local authorities do not agree with the final decisions, they have a right to write to my right hon. Friend the Secretary of State asking him to refer the matter, with their concerns, to the Independent Reconfiguration Panel. If it is asked to look into the matter, it will then come to a conclusion, of which it will inform my right hon. Friend and he will then take a decision.
The Scottish Government have decided that although the Yorkhill unit is currently unsafe, it can be made safe in the context of three surgeons doing 300 operations, whereas the “Safe and Sustainable” review, which is increasingly discredited, is demanding 400 to 500 operations. Why is it one rule for children in Scotland and another for children in Yorkshire?
I have to tell the hon. Gentleman that the decisions that the Scottish Government and the Scottish Health Department might take with regard to Glasgow is a matter for them. The fact is that we recognise what is commonly accepted among the international community: that the safest way of providing that surgery is by carrying out about 400 operations a year.
14. What steps his Department is taking to ensure that confidentiality agreements do not discourage NHS whistleblowers from coming forward. (117293)
The Department wrote to the NHS trusts most recently in January 2012 reminding them that compromise agreements should not prevent information from being disclosed in the public interest. It also said that they should satisfy themselves that their organisational policies are in line with previously issued guidance.
I am grateful to my hon. Friend for that answer. She will be aware of the case of my constituent Mr Gary Walker, the former chief executive of United Lincolnshire Hospitals NHS Trust, who has been prevented by a confidentiality agreement from raising his concerns about the effect on patient safety of the previous Government’s targets. I want to hear Mr Walker’s concerns and my constituents are entitled to hear them. I hope that my right hon. Friend the Secretary of State will look into this matter and give a categorical assurance that the concerns that Mr Walker has told us about will come into the public domain.
I thank my hon. and learned Friend for his supplementary question. I cannot comment on the individual details of the case, but I appreciate his concern that NHS staff could be prevented from speaking out by confidentiality agreements. Confidentiality and compromise agreements are allowed in contracts, but the Public Interest Disclosure Act 1998 provides that any clause in that contract or compromise agreement between employer and employee is void in so far as it acts to stop the employee making a protected disclosure.
Given the proliferation of new bodies being created to deliver NHS services, including a number of private sector organisations, can the Minister be confident that the NHS constitution protects whistleblowers working for private companies but delivering NHS public services?
I assure the hon. Lady that all must have regard to the NHS constitution. In fact, we issued guidance to NHS organisations that all contracts of employment should cover whistleblowing rights. In September 2010, we amended terms and conditions of service and guidance to the NHS on supporting and taking action on concerns raised by staff. The changes made to the NHS constitution make very clear the rights and responsibilities of NHS staff and their employers in respect of whistleblowing. As I have pointed out, all those providing services on behalf of the NHS must have due regard to the NHS constitution.
My responsibility is to lead the NHS in delivering improved health outcomes in England, to lead a public health service that 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.
I thank the Secretary of State for that answer. Two of my local dentists have been closed as a result of an Office of Fair Trading investigation. Although that is totally understandable and nothing to do with the NHS, will the Secretary of State confirm to my constituents that they will have access to NHS-funded dentists? There happen to be more NHS-funded dentists in this country now than there were under the previous Government.
I think I can give my hon. Friend that reassurance. We are committed to increasing access to NHS dentistry, and over 1.1 million more patients have been seen by an NHS dentist since May 2010 than before the election. Nationally, there are more dentists. In 2010-11, there were 22,799 compared with 22,003 in the preceding year, before the election. NHS Kent and Medway has confirmed that it will have six dentists in place from 1 September 2012 who will temporarily provide the treatment that she is looking for, and it has started tendering processes to commission permanent NHS dental services in her area.
T2. The Minister will be aware of the 500% increase in the use of antidepressants over the past 20 years. I welcome the announcement of the hundreds of millions that will be spent on talking therapies over the next few years, but will the Minister tell us specifically what funding has been allocated for mindfulness, which is the best known treatment for repeat episode depression? (117303)
I am grateful to the hon. Gentleman for that question. He has been a doughty campaigner and pursuer of this issue and I can tell him that a number of improving access to psychological therapies—IAPT—services are developing and using mindfulness-based approaches. Indeed, as the hon. Gentleman said, NICE recommends them for the treatment of recurrent depression. A number of randomised controlled trials are going on to see how it might be applied to other long-term health conditions. There is baseline allocated funding but there is no specific earmarked funding for this particular project other than in the context of the IAPT programme, in which we have invested £400 million.
T6. Yesterday’s figures showed a 17% increase in the population of Milton Keynes over the past 10 years, the highest outside London or Manchester, and an unexpected increase of some 4,000 over the estimate in the past 12 months. May I seek the Secretary of State’s reassurance that that will be reflected in future health care budgets for the city? (117307)
As my hon. Friend will, I hope, have understood from previous exchanges, the focus on the delivery of care to the resident population in an area covered by a clinical commissioning group will mean that we try, as far as possible, to align resources with the needs of a whole population rather than with just the practice-registered population.
T3. The Government often talk about reducing the number of managers in the health service to defend the front line, but following my recent meeting with my local representative from the Royal College of Nursing, can the Secretary of State confirm that under the Government’s definition a ward sister at band 7, who has a hugely important front-line role, is actually considered a manager? (117304)
If a member of staff is professionally qualified, they will be counted against the number of managers part of the overall work force census. It remains true, as we have said, that since the election we have reduced the number of managers in the NHS by more than 6,000 and increased the number of clinical staff by more than 4,000.
T7. Last year’s National Audit Office report highlighted inconsistencies in the care of patients with neurological conditions such as Parkinson’s, which neurology networks could address. When will the Government publish their review, announced last September, of clinical networks in the national health service, and will it offer any hope for Parkinson’s patients? (117308)
I am grateful to my hon. Friend for asking that question. The NHS Commissioning Board is currently conducting a review of the effectiveness of clinical networks, and the scope for expanding them. It includes examining the case for neurological clinical networks, and a report should be published very soon.
T4. In yesterday’s debate, when talking about the south-west consortium, the Minister of State, the right hon. Member for Chelmsford (Mr Burns) emphasised the need for negotiations and agreement with staff. Does the Secretary of State not think it was shocking that staff found out only through a series of freedom of information requests that the consortium existed, and can he tell me when the Department of Health first found out about the consortium? (117305)
I will gladly write to the hon. Lady about when we were first aware of the consortium. I think it was several weeks ago; indeed, the document referred to prominently in the press on Sunday had been on websites for some weeks, so there is nothing new about that. We knew about it. I reiterate the point that I and my right hon. Friend made yesterday: even though under a Labour Government, in the 2006 legislation, powers were given to trusts to take their own decisions on the employment of staff, they must do so in negotiation with the staff side. We would expect that. From my point of view, the South West Pay Consortium is rightly looking to maximise flexibility, but I have made it clear to the pay review body that we believe that the flexibility it needs can be delivered through negotiations and “Agenda for Change”. It will not and should not require the reduction of pay for staff.
T9. The clinician-led “Better Services Better Value” review has condemned the accident and emergency unit, and the maternity and children’s wards at St Helier hospital, because it expects out-of-hospital services to be expanded instead. Will the Secretary of State meet me to discuss local concerns that the £5 million allocated to provide the out-of-hospital services will be totally inadequate to the task? (117310)
I am grateful to the right hon. Gentleman for that question. As he knows, any proposals for service changes will be subject to the Secretary of State’s four tests and a full three-month public consultation across south-west London, which I am sure the right hon. Gentleman and his constituents will take part in. My right hon. Friend the Secretary of State will be more than happy to meet him to discuss the matter further.
T8. In the north-east region, there is one neuromuscular care adviser providing dedicated specialist care and support for more than 3,000 people with muscular dystrophy and associated conditions. Will the Minister give assurances that care advisers will continue to be funded and commissioned at specialist NHS Commissioning Board level so that they can carry on supporting community teams across the country? (117309)
T10. I commend the Government for their plans to improve the care and support system, especially for an ageing population. How will the changes make a real difference to carers, particularly those supporting people with Alzheimer’s and dementia? Is there more we can do to support them? (117311)
I am grateful to the hon. Lady for her question. She is right: we have to do as much as we possibly can to recognise and support family carers. In the White Paper, we have set out a number of steps, not least investment of £400 million to fund more breaks for carers. We are working with the Royal College of General Practitioners to make sure that they are more aware of carers and can identify more carers. We are doing work to make sure we have earlier, quicker diagnosis in more areas of dementia so that people get the support they need. Most important of all, we are making sure that hospitals, as part of the services they provide for people with dementia, actually deliver on NICE guidance on supporting family members. Finally, the Government are legislating, for the first time ever, on support for the needs of carers.
I have the benefit of a review undertaken by Sir John Bell and his colleagues, which I accepted wholeheartedly. In particular, I immediately agreed with the recommendations, and we are implementing and funding recommendations for the establishment of centres across the NHS for genetic testing to support stratified medicine for cancer patients.
Further to the Secretary of State’s welcome response to the hon. Member for Bristol East (Kerry McCarthy), and his comments yesterday on the issue of the south-west consortium in relation to pay reductions, will he apply the same attitude to pay and conditions, particularly backward or downward regradings and other detrimental changes to terms and conditions?
As my hon. Friend knows, trusts and NHS employers are responsible for the terms and conditions of their staff, and for ensuring, as “Agenda for Change” intends to, that staff who effectively have the same knowledge and competences have the same pay banding, wherever they happen to be across the country. That is the objective of “Agenda for Change”. As I said yesterday, and will continue to say, “Agenda for Change” can be improved—we made that clear to the pay review body—but we think it is possible, if the staff side works with us, to enhance “Agenda for Change” and increase its flexibilities, so that NHS employers can recruit, retain and motivate their staff, with local flexibility, in a national pay framework.
I am sure that the hon. Gentleman is very familiar with the alcohol strategy and has read it in detail. It is one of the things that we need to do. Brief interventions, specialised treatment, the NHS alcohol check and, of course, changes to licensing will all make a difference. As I say, the alcohol strategy, a cross-Government document, is out. We will respond further in due course.
Last week, the Royal Cornwall Hospitals NHS Trust cleared an important milestone towards becoming a foundation trust. An historical debt remains, largely as a result of punitive accounting measures under Gordon Brown. Will my right hon. Friend the Secretary of State do everything that he can to ensure that when the Royal Cornwall becomes a foundation trust, it is debt-free?
My hon. Friend will, I am sure, know that an application for foundation trust status from the Royal Cornwall Hospitals NHS Trust is currently being considered by my Department. The trust is being assessed on whether it meets the quality, service, performance, business strategy, finance and governance standards required if a trust is to be an FT. Once the trust has demonstrated that it has met those standards in all other regards, the Department will ensure that any outstanding liquidity issues are resolved in time for the trust to be authorised as an FT. The process of assessing FT applications will ensure that any remaining debt carried by the trust when it becomes a foundation trust is affordable within the trust’s forward plans.
The chair of the South London Healthcare NHS Trust has written to the Secretary of State to correct inaccurate information given out by the Department of Health regarding the trust’s performance. [Interruption.] Instead of barracking me, would the Secretary of State—[Interruption.] Instead of shouting at me now, it is a shame that the Secretary of State did not meet the local MPs when he had the opportunity. Will he distance himself from the false information put out by unattributable sources in his Department, which will undermine the performance of the hospital and shows little respect for the health service workers who are working to improve services?
Order. There is, frankly, too much noise on both sides of the House. It does not suit the Minister now for the hon. Member for Eltham (Clive Efford) to shout from a sedentary position, and I absolutely understand, similarly, that it does not suit Opposition Members when the right hon. Gentleman and his colleagues chunter from a sedentary position. Let us have a truce, and the right hon. Gentleman can be a statesman—we look forward to it.
As ever. I do not share the hon. Gentleman’s analysis of the interpretation of what has happened with regard to the trust’s performance. There has been an historic problem with its performance, but I pay tribute to the staff, who have made tremendous efforts to improve performance, and have achieved some improvement. The trouble is that it is not sustainable not to put the trust on a sustainable financial footing. The hon. Gentleman said that he would like a meeting with me or my right hon. Friend the Secretary of State. [Interruption.] As he will know, if he keeps quiet for a minute, I have written to him offering a meeting with my right hon. Friend, on 24 July; I hope that the hon. Gentleman can attend.
Cases of blood poisoning from E. coli have increased by nearly 400% in the past 20 years, and E. coli resistance to antibiotics is almost certainly linked to record levels of antibiotic usage on factory farms. By over-using antibiotics we risk ruining for future generations one of the great discoveries of our species. Will the Department put pressure on the Department for Environment, Food and Rural Affairs finally to take that issue seriously?
I understand the issues. Indeed, I was interested to see analysis some years ago of the extent of antibiotic resistance in hospitals in the Netherlands. Resistance was clearly much more prevalent in parts of Friesland where there was much greater antibiotic usage in farming. I therefore completely understand, and my colleagues in DEFRA understand this too. Just as we are looking for the responsible and appropriate prescribing of antibiotics in the health service, my colleagues feel strongly about the proper use of antibiotics in farming.
When the national advisory council of the Thalidomide Trust recently met Government representatives, no funding undertakings were available on the replacement of the health support grant for sufferers. When can we expect a meaningful commitment in that regard, and is the Department liaising with its devolved counterparts?
Yes, we are liaising with the devolved Administrations. Yes, we had a productive meeting with the trust and the council, which confirmed that they will shortly submit to us the second-year evaluation of the pilot programme. I undertook to look at that carefully and enter into further discussions with a view to reaching a conclusion and making further announcements this autumn.
Ministers may recall the concern of patients and carers in the New Forest area about the decision to close a third of acute adult mental health beds in Hampshire. Are Ministers aware of a similar trend in other parts of the country, and if they are, as they should be, what do they think about it?
My hon. Friend has raised that issue in different forms on many occasions, and feels strongly about it. The decision to reconfigure services in his constituency was made locally, and the Hampshire overview and scrutiny committee decided not to write to my right hon. Friend the Secretary of State asking him to refer it to the Independent Reconfiguration Panel, because it presumably believes that it is the right way forward to continue to provide first-class quality care for patients.
Does the Secretary of State agree that commissioners in Cumbria must bear their share of responsibility for the deep-seated problems in the Morecambe Bay health trust, which have taken far too long to address. Will he join me in urging those commissioners to protect services such as Barrow’s maternity unit in their forthcoming review?
As we have seen in a number of instances over the years in the NHS, all those responsible should always be aware that, although the responsibility for quality may be, in the first instance, for the board of a trust, it is also the responsibility of those who commission the services. As the hon. Gentleman will be aware, one of the key considerations for the future in the development of services is for the NHS to respond to the commissioning intentions of local commissioners. Clearly, the matter that he raised will be determined locally as regards what commissioners require in terms of services from Morecambe Bay trust.
Defence Equipment and Support
Before I call Alison Seabeck to ask the urgent question, it may be for the convenience of the House if I make it clear from the outset that I intend to conclude supplementary questioning no later than half an hour after the start of the UQ. Brevity by all concerned should enable all those who wish to contribute to do so.
A key element in the transformation process under way in the Ministry of Defence is that of its equipment and support activities through the matériel strategy. Reforming the acquisition system to drive better value from the defence budget is a core element of the process. This will require changes to Defence Equipment and Support to ensure that the organisation has the structures, management and skills it needs to provide the right equipment to our armed forces at the right time and at the right cost. Change is essential to tackle the legacy problems in defence acquisition that have historically led to cost and schedule overruns and have resisted previous attempts at reform.
The current system does not help or support DE&S properly, and it is not delivering value for money for the taxpayer. Bernard Gray’s analysis reveals the following root causes: first, an historically overheated equipment programme in which far more projects were planned than could be paid for; secondly, a weak interface between DE&S and the wider Ministry of Defence, with poor discipline and change control between those setting requirements for equipment and those delivering the programmes; and, thirdly, insufficient levels of business capability at DE&S for the scale and complexity of the portfolio it is asked to deliver. The result of these combined issues has been significant additional costs in the defence budget in the order of hundreds of millions of pounds each year.
Earlier this year, MOD officials were asked to focus their efforts on considering the comparative benefits that could be derived from changing DE&S into an Executive non-departmental public body with a strategic partner from the private sector or a Government-owned, contractor-operated entity. The work done to date suggests that the strategic case for the GOCO option is stronger than that for the ENDPB option. Further value-for-money work is under way to confirm this assessment. In the meantime, as resources and commercial appetite constrain our ability to pursue these two options simultaneously to the next stage, we have decided that the Department should focus its effort on further developing and testing the GOCO option.
The work to determine value for money between the options will take place over the next few months. In parallel, we will begin to develop a commercial strategy, engaging with industry to hone our requirement. This work will support decisions later this year on whether to proceed with the GOCO option and whether to launch a competition for a private sector management company to run the organisation. Provided that the further work demonstrates that the value-for-money case for GOCO over ENDPB is conclusive, this will be followed by an investment appraisal that will test the GOCO against a public sector comparator. Ultimately, this would be followed by a decision on whether to proceed.
Let me be clear that there is massive consensus across this House that defence procurement must be tackled to ensure that some of the issues that plagued successive Governments are not repeated. We understand the budgetary challenges faced by the MOD and agree that procurement reform is essential to ensure financial sustainability.
It was therefore a huge surprise when yesterday the Secretary of State revealed in Defence questions that a decision had been made on the future of DE&S, but that no oral statement was planned and, indeed, that it was to be slipped out on the last day of Parliament. It was a bigger surprise, therefore, to read in the written statement that in their third year of government, no decision has yet been made by Ministers. The delay is as worrying as it is inexplicable. With the Gray review, the previous Government began the process of reform. It is now unclear when it will be completed. Will the Minister comment on the timing and confirm that primary legislation will be required for a GOCO?
The Government prefer the Government-owned, contractor-operated model, but it is unclear why. Will the Minister explain precisely why a GOCO is preferable to an NDPB? Are his Treasury colleagues content that the GOCO model offers value for money? Will he make a commitment to publish the full reasoning for the rejection of other models?
We fear that privatisation could weaken the public accountability and transparency of multi-billion-pound defence decision making. How would a GOCO be held publicly accountable? Who would be responsible for ensuring that contracts were delivered to time and to cost? We have seen recently with G4S that outsourcing does not guarantee efficiency or effectiveness, and can increase risk. Indeed, even with the London Organising Committee of the Olympic Games and Paralympic Games model, problems have arisen because Ministers have been distanced from the decision-making process and the lines of responsibility have been blurred. Such issues would be unacceptable when dealing with our armed forces.
Will the Minister say what will happen to existing contracts under the GOCO model? Crucially, those include the nuclear deterrent. Finally, what will the military’s role be in procurement under these plans? What guarantee can he give to the 20,000 people who are employed by DE&S that their jobs are not under threat?
The future of DE&S is not only about tens of thousands of highly skilled jobs in our defence industry, but, crucially, about the security of our nation. Getting it wrong would put lives at risk. It is vital that Parliament has a full opportunity to scrutinise these decisions.
May I correct the hon. Lady’s first proposition? It is clear that no decision has been made. A study is being carried out, which involves value-for-money work. If, when that appraisal is completed, we take this option forward, that is the point at which the decision will be made. Only when the model had been worked up and thoroughly tested would we finally take the decision to go ahead. Of course, we would come back to the House at that point.
The hon. Lady suggested that we had slipped this announcement out. I would say that the contrary is true. If the House had not been about to go into several weeks of recess, we would not necessarily have made a statement yet. We have done so to give the House the greatest possible transparency about what is going on and to send the clearest possible signal to the potential commercial partners that we are serious about this matter and are taking it forward. I stress that the decision about timings will be taken towards the end of this year. The commercial partner would be sought in a competition during the course of next year and a decision on whether to go ahead would be taken early in 2014.
The hon. Lady asked whether this model would include the nuclear component of defence. I remind her that the Atomic Weapons Establishment at Aldermaston is a Government-owned, contractor-operated organisation, and that it works extremely well. The last Labour Government and previous Governments have made extensive use of the private sector in providing critical elements of our defence and other public services. I see no reason to believe that it would be any less capable of doing so in this area.
The GOCO option has looked better in the early explorations because if we stuck with an ENDPB, the work force and the management would remain in the public sector, and the greatest possible private sector involvement would be the use of a consultant. If we go for the GOCO option, the entity will have all the freedoms of a private sector operator: it will recruit people on private sector terms and conditions, and will have an incentive to make the thing work in a way that an ENDPB would not.
Does my hon. Friend agree that this is a matter of such crucial importance that it is important that it should not become a party political plaything, and if it can be done in such a way as to attract the support of all sides of the House, the benefits that will flow from these changes will come sooner and they will flow much more copiously, and we will reach the sunlit uplands of wonderful defence procurement?
I strongly agree with my right hon. Friend. It is worth recalling that the previous Government asked Bernard Gray, a former Labour special adviser at the Ministry of Defence, to conduct his study of defence procurement. He came forward with a compelling and, to some extent, damning report. Central among his recommendations was the proposition that there should be a GOCO to run DE&S in the future.
We have now recruited Bernard Gray to be the Chief of Defence Matériel and given him the opportunity to go into further depth, and it has become increasingly clear that he was absolutely right. Of course these issues will have to be debated, and I have explained that the timelines are still quite long. No decisions have yet been taken, and proper value-for-money studies will continue.
To answer a question that the hon. Member for Plymouth, Moor View (Alison Seabeck) asked, those studies will be made available for everybody to have a look at. This does not need to be a political football, and I hope it does not become one.
As far as I am concerned, the proposals will have no impact on that. The specific contracts to provide particular services and products will be unaffected by the changes. They will enable us to secure better value for money in future when we make further contracts on a variety of defence procurement issues.
Urgent operational requirement contracts have played an important part in recent years, but unlike with planned procurement the through-life costs are often not included in the initial costs. How will the through-life costs be accommodated in an overheated defence budget?
Decisions on whether any of the procurements that we made under the UOR process should be brought into the core defence programme will have to be taken individually in respect of each procurement. Some will be brought into the core programme, and at that point a full analysis of through-life costs will have to be made. Others, despite having performed well in theatre, will not be brought into the long-term defence programme. The type of scrutiny that my hon. Friend seeks will take place at that point.
Can the Minister explain in a practical way how a complex and expensive equipment programme such as the future carriers would have been better carried out under the new arrangements? For example, somewhere along the line the idea that the carriers should be easily convertible to take catapults was left out of the design. Would that situation be improved by the new arrangements?
It is probably common ground throughout the House that defence procurement has not been an exemplar of success for a good many years. One reason for that is that despite the good work of good people working for DE&S, they do not have available to them the full range of skill sets that they need to negotiate on equal terms with some of the more complex providers. Granting DE&S the private sector freedoms I have described will enable it to take on board the necessary skill sets to ensure that in future negotiations and future project management there is a better match between those securing value for the taxpayer and good products for the armed forces and the private sector providers of complex programmes. That will be a marked improvement on how things have been in the past.
It is certainly true that a lot of our procurement is done in a cohort with our allies, and as time goes forward I expect that to be increasingly the case. Having a Government defence equipment and support body with the freedom to operate in a quasi-private sector model will give us the best possible latitude to deal with a variety of allies that have differing models of defence arrangements.
One of our allies is Australia. I urge the Minister to look to that country, where a Government-owned contractor-operated organisation seems to work successfully. Will he give me a guarantee that this Government, unlike the previous one, who gave away submarine engine orders to Germany, will ensure that contracts are let to British industry?
Of course, competition laws dictate the ability of any Government to grant contracts to onshore suppliers. Our first and foremost consideration is to equip the armed forces with what they need. Our second consideration is to ensure value for the taxpayer. If, having ticked both those boxes, it is possible to ensure a healthy and thriving defence industry in the UK, so much the better. We like to give contracts to British suppliers when possible, but there are competition laws and our hands are tied.
The Minister proposes a procurement model that allows the Government to buy off the shelf from any company, whether or not it is British. He will be aware that BAE lost the Typhoon contract and that a French company has preferred-bidder status. If we are not prepared to give preferred-bidder status to British companies, why should other countries do so?
Clearly, it would be foolish not to consider buying things off the shelf that meet the requirements of the British armed forces. However, I repeat that clear competition laws determine the circumstances in which we can award preferred-bidder status. In many cases, we are unable to do so.
My hon. Friend makes a good point. Even under the proposed model, we will continue to have quite a lot of military personnel inside DE&S, which it needs to give it insight into the user requirement. I agree with my hon. Friend that short rotations have not served DE&S well. It would be to the benefit of both the individuals and the organisation if postings were for longer periods.
We need to make the best use of the defence budget and give our armed forces the tools they need to do the job, but we must also protect sovereign capability and have a strategy on where we invest our research and development budgets. Does the Minister agree that deciding how we organise those two things is too important to be left to dogma?
I agree with my hon. Friend that we need to maintain sovereign capabilities. I referred a moment ago to competition law, but when there are specific exemptions that enable us to protect national sovereignty for reasons of national security, we will take them. She is right on the research and technology budgets. They will remain an important part of our work. We cannot leave it entirely to the private sector to undertake primary research. It is necessary for the state to stimulate it.
The Minister may know that I was present on 2 July at the royal opening of the new £75 million BAE System munitions factory in my constituency. It was built thanks to the innovative, 15-year munitions acquisition supply solution contract signed by the MOD back in 2008, and sustains more than 200 jobs. What will happen with such long-term contracts, which are so important to my constituency?
Nobody would suggest that everything that occurred under previous systems was not good. Clearly, there are exemplars—some contracts worked well. I am sure the facility in the hon. Lady’s constituency will be a great success and that it will support employment for many years to come, but the fact that we will have a more private sector-rooted procurement body will not have any negative impact on such contracts.
The shadow Minister spoke of the budgetary challenges facing all Governments, but was quick to gloss over her legacy—the budget was taken away from the MOD by Labour and given to the Treasury. Does the Minister share my surprise at Labour Members questioning the new avenues of efficiency when, if they looked at the National Audit Office major projects report 2010, they would see that the majority of major projects overran, including the A400M, the Astute and the Typhoon?
There have undoubtedly been serious problems with the procurement side of the defence business for a very long time. The deficit in defence from two years ago was in very substantial part caused by the overheating of the procurement budget, but we have taken dramatic steps in the past couple of years to get the defence budget back into balance. The Treasury can see the progress we have made, but the steps we are proposing today will not be taken unless it is satisfied by the work on value for money that is currently taking place.
As the Minister has acknowledged, there have been long-standing problems in defence procurement. The Public Accounts Committee has taken a keen interest in the matter. Will he outline exactly what steps he is taking to ensure that the establishment of the GOCO model is well worked up, so that we do not have some of the problems that we have had with other procurement bodies in the past?
The hon. Lady makes a good point—that is why I was at pains to spell out at the outset that the process has some considerable way to go. Only when the work on value for money is completed will a decision be taken on whether we are going ahead in principle. At that stage, we will work the model up in detail and look for a competition with private sector partners. At the end of all of that, there will be a final testing, which must satisfy the Treasury, among others. That will be the point at which a decision to go forward will be taken. There is a long route to go.
Does the Minister agree that a key indicator of the success of either of the two models that he has described will be the attitude towards small and medium-sized enterprises in defence tendering in instruments such as pre-qualification questionnaires, which are generally unhelpful to SMEs?
My hon. Friend makes good points on the difficulties that SMEs believe they currently have in some of our big procurement projects. Since the move to the MOD contracting directly with prime contractors, which then handle subsidiary contracting, it would be true to say that the MOD has rather lost the skill set of managing SMEs. By the time the reforms are complete, I hope that a GOCO of the sort I have described will reinvest in those skill sets and that we will be better able to manage SMEs directly.
There will be very little difference. The fact of the matter, however, is that the project management undertaken on behalf of the MOD by DE&S will—I say this with considerable confidence—be better, because there will be a higher level of skills in DE&S. It will bring in a variety of new commercial skill sets of which it is currently short. That will secure better value for money and more efficient delivery of the contract.
I thank the Minister for his openness with the House at this early stage in his considerations. Will he commit to write to Members of the House who represent the DE&S work force as the project progresses, particularly in relation to the protections available to them under TUPE regulations?
My hon. Friend makes a good point, and I have been at pains to stress that despite DE&S lacking some of the skills it needs going forward the work done by those who work for it is of a high quality and is much appreciated by the MOD. We are consulting the work force and the trade unions as we take these steps forward, and as part of the ongoing consultation we will be happy to talk to Members representing constituencies where the majority of DE&S staff are based.
I sincerely believe that SMEs in Britain will benefit because, at the moment, they get all their work through prime contractors, and it is a common complaint of SMEs that they do badly out of prime contractors. If we rebuild the skills inside DE&S so that it can manage the supply contracts from SMEs directly—in some instances—they will benefit. That is certainly what SMEs are telling us.
Points of Order
On a point of order, Mr Speaker. Yesterday, and again this morning, Health Ministers made a series of inaccurate statements. What powers exist under Standing Orders for you to ask them to return to the House and correct inaccurate figures on NHS budgets, delayed discharges and accident and emergency waiting times?
The short answer to the hon. Gentleman’s attempted point of order is that answers to questions are the responsibility of Ministers. Similarly, in the event of an inaccuracy known to the Minister, it is the Minister’s responsibility to correct the record. The hon. Gentleman is a determined and persistent chap, and I feel sure that he will pursue the path of righteousness to his satisfaction. If he remains dissatisfied, no doubt we shall hear from him again.
On a point of order, Mr Speaker. In response to a question on 11 July, the Health Secretary told me that local government was being given sufficient funding to cope with provisions in the new social care White Paper, but on the same day the Local Government Association released a statement saying:
“there won’t be enough money to provide these services to anyone other than the most needy, or those who can afford to pay for all of their own care.”
In the interests of accuracy, will the Secretary of State correct the record?
I am sorry to disappoint the hon. Lady, but in material terms my reply does not differ in content from that which I just offered the hon. Member for Copeland (Mr Reed). It is, at least in part, a matter of interpretation. I said that the hon. Gentleman was a persistent chap, but she is a persistent woman, and I feel sure that she will pursue this matter in a way she judges fit.
I shall now call the hon. Member for Wellingborough (Mr Bone) to make an application for leave to propose a debate on a specific and important matter that should have urgent consideration under the terms of Standing Order No. 24. The hon. Gentleman has three minutes in which to make such an application.
Application for emergency debate (Standing Order No. 24 )
I seek leave to move the Adjournment of the House to discuss a specific and important matter that I believe should have urgent consideration—the loss of up to 600 jobs in my constituency owing to the announcement today of the closure of Her Majesty’s Prison Wellingborough.
It is with great regret that I move this motion at all. At 9.30 today, I was doing a live broadcast on BBC Radio 5 Live when it was announced as breaking news that Wellingborough prison was to be closed. I was not told in advance and have only just received an e-mail from the Under-Secretary of State for Justice, my hon. Friend the Member for Reigate (Mr Blunt), who has responsibility for prisons, outlining the plans to shut the prison. I hasten to add that this came after I learned about it through the media first.
That is in total contrast to how the right hon. Member for Blackburn (Mr Straw) handled the situation when Wellingborough prison was put into the market testing programme. On that occasion, the then Justice Secretary rang me at 6 am on the day of the announcement to ensure that I was fully briefed before the public statement. Clearly, the coalition Government believe in making announcements to the media before telling the local constituency MP.
What is most disturbing about the matter is the number of jobs that will be lost in my constituency. Up to 600 people might lose their employment, whether they are employed directly through the prison or indirectly through local businesses. The independent monitoring board annual report states that the prison improved from a level 2 to a level 3 prison. Wellingborough prison has moved from 123rd out of 130 in the prison rankings to 93 owing to the hard work and commitment of its governor and staff. It has also become far more cost effective, with 5% efficiency savings in 2011-12 and further planned efficiency savings of 3% projected for 2012-13.
This is a good, improving prison that is now being closed without any consultation or appeal process. Closure would have significant ramifications for my constituents. The prison management and officers have done everything they were asked to do and more. The reason given for its closure is that we have too much space in our prisons. This comes after years and years of being told that they are overcrowded and that we need more spaces—the previous Government allowed prisoners out early because there were not enough spaces.
There seems to be no consistency within the Ministry of Justice. With Britain’s increasing population, surely to have spaces left in prisons would be a sensible precaution, not least in case we have a repeat of last year’s riots. Hundreds of people losing their jobs in my constituency for a short-term, dubious economic saving is plain wrong. This is the wrong prison being closed for the wrong reasons at the wrong time.
I am grateful to the hon. Gentleman for his application under Standing Order No. 24. I understand his extreme disappointment at the decision and the alleged handling of the matter and of him. That said, having listened carefully to his application, I must nevertheless conclude that the matter does not, on this occasion, meet the criteria under Standing Order No. 24. Agreeing to the application would, of course, cause the subsequent debates to be significantly delayed. I recognise that my decision will disappoint him, but knowing him, as I do, to be an extraordinarily assiduous parliamentarian, I feel sure that it will not be long before he returns to the matter. I suspect that Justice Ministers are also keenly aware of that fact.
Cosmetic Surgery (Minimum Standards)
Motion for leave to bring in a Bill (Standing Order No. 23)
I beg to move,
That leave be given to bring in a Bill to establish minimum standards for the practice of cosmetic surgery, including non-surgical procedures; and for connected purposes.
The Bill would establish the regulation of cosmetic surgery. I, too, am persistent, Mr Speaker. I first introduced a ten-minute rule Bill on the regulation of cosmetic surgery in 1994. Unfortunately, despite calls from a wide range of organisations, not much has changed since. As a result, thousands of women have continued to face the horrific consequences of unregulated cosmetic surgery. That ten-minute rule Bill generated huge publicity and hundreds of letters, and the issue of breast implants has received even more attention of late following the PIP implant scandal in 2010.
At some time in our lives, most of us have wanted to change something about ourselves. Huge pressure is put on women in particular, but increasingly on men too, to change their looks. Private sector clinics offer a multitude of cosmetic procedures to achieve the perfect shape or a wrinkle-free face. Too thin, too fat, never just right—that is the message. Cosmetic surgery, including breast implants, continues to be a growing industry. In 2011, members of the British Association of Aesthetic Plastic Surgeons conducted almost 45,000 surgical procedures, more than 10,000 of which were breast enlargements for women. Between 2002 and 2011, the number of boob jobs rose by 324%, and it continues to rise, as do the numbers of facelifts, tummy tucks and nose jobs.
Members of the British Association of Aesthetic Plastic Surgeons also operated on more than 4,000 men, with nose jobs and man-boob jobs the two most popular procedures. That represents a 219% increase in cosmetic surgery for men since 2002, and does not include procedures carried out by people who are not members of the association, those undertaken abroad or those not yet classified as cosmetic procedures. Many people face exploitation by private sector clinics and even cowboy surgeons if they are unable to receive treatment through the NHS. Most cases of botched surgery or mistakes are then rectified by the NHS, as we have seen with the removal of PIP implants.
Regulation is needed in a number of areas to reduce the risks to patients. In 1998, the then Government accepted the recommendation of an independent review body on silicone breast implants to establish a national breast implant registry. I was part of that process and took part in several meetings at the Department of Health, but the register was abandoned in 2006. I propose that we now need a register for all types of implants used in all areas of the body, including breasts, cheeks, pecs and buttocks. That would allow better monitoring of outcomes and problems as they occur, which would have been useful in the recent PIP cases.
Many clinics gain much of their business from advertising in national newspapers and women’s magazines. They ask, “Is cosmetic surgery only for the rich and famous?” The answer they give is: “Not any more—it’s a lifestyle choice!” Some offer significant discounts, and there are even special deals on websites. Private clinics are now advertising on Twitter. One even suggested that women add a boob job to their Christmas present list. Misleading images and claims are used, despite tighter guidelines from the Advertising Standards Authority. Therefore, a ban on cosmetic surgery advertising should be introduced, as happened in France in 2005 and as the British Association of Aesthetic Plastic Surgeons has called for. If cosmetic surgery is considered a form of medical procedure—which it undoubtedly is—it should not be advertised, as is the case with prescription medicines.
A further concern is non-surgical cosmetic procedures. Injected fillers such as Botox currently need only a CE mark—as do fridges—and are therefore heavily marketed in the UK, while the Food and Drug Administration in the USA categorises them as medical device implants requiring approval. [Interruption.] I would be grateful if those on the Government Front Bench listened to the point I am making, because it is a scandal that Ministers have done nothing about the situation.
The medical profession has always been controlled and regulated by strict ethics, but the voluntary codes of practice have been breached by some operators to make quick, easy money. An independent review found that 70% of clinics in the private cosmetic sector are effectively unregulated and that fewer than half of all operating theatres were properly equipped in 2010. We also need compulsory registration of all those who practise aesthetic medicine and use lasers. Facilities should be licensed and regulated by an independent body, such as the Care Quality Commission. Similarly, only doctors or nurses qualified to do so should be able to advise patients about cosmetic surgery. At the moment, initial consultations can be undertaken by a hard-sell receptionist, and doctors in private practice who lack specific experience can offer treatment which they are simply not qualified to give.
Somebody wrote to me about her experience of liposculpture in a ground-floor office in Harley street. She said:
“I think the operating table was a dental chair. They asked me to turn over on to my stomach, but the chair was the wrong shape and it was very difficult. At some stage during the operation I woke up. I was in tremendous pain and began screaming. They were still taking fat from my legs. The doctor told me afterwards that he had to continue with me awake or my legs would have been uneven.”
It turned out subsequently that the “cosmetic surgeon” was a general practitioner. He had performed a surgical operation without any surgical training and had administered a general anaesthetic without an anaesthetist. Such incidents are far too common. I read last week about a children’s writer. She has been left with blurred vision from botched laser eye surgery at a private clinic. After a five-year battle, she has finally received £250,000 in compensation, but has permanent scarring. In the Daily Mail only last week there was a piece headed, “Plastic surgeons offer buy one get one free on breast enlargements and nose jobs”.
Given all the issues and the lack of regulation in cosmetic surgery, it seems imperative to establish an official regulator of cosmetic surgery—OfCos, as proposed by the British Association of Aesthetic Plastic Surgeons—to ensure registration and regulation of all cosmetic surgeons and practitioners in the UK. Or perhaps we should consider a cosmetic surgery licensing body that has a different type of structure and operates as a financial guarantee system, like ATOL—air travel organisers licensing—which provides financial protection for flights and air holiday packages.
The problem has been swept under the carpet for far too long. It is now almost 20 years since I first stood here and called for greater regulation of private cosmetic surgery. The current system of self-regulation by the private surgeons and clinics is clearly not working. As the previous president of the British Association of Aesthetic Plastic Surgeons said in 2009:
“In no other area of medicine is there such an unregulated mess…Imagine a ‘2-for-1’ advert for general surgery? That way lies madness!”
This is a complex subject, but too many people are suffering and being disfigured at the hands of cowboys who have been given free rein to abuse the British public’s trust in the voluntary system of medical ethics. The responsibility clearly lies with the Government to take action as soon as possible to stop any more innocent people being subjected to butchery at the hands of some greedy, unscrupulous, and incompetent people, and to introduce the kind of regulation for cosmetic surgery that is long overdue.
Question put and agreed to.
That Ann Clwyd, Dr Sarah Wollaston, Fiona Mactaggart, Valerie Vaz, Dr Daniel Poulter, Barbara Keeley and Sheila Gilmore present the Bill.
Ann Clwyd accordingly presented the Bill.
Bill read the First time; to be read a Second time on Friday 2 November 2012, and to be printed (Bill 60).
Prime Minister’s Adviser on Ministers’ Interests
Before I call the hon. Member for Harwich and North Essex (Mr Jenkin) to move the motion, I should explain to the House that this is not a vehicle for the utterance of ad hominem attacks on individual right hon. or hon. Members. For the purpose of such attacks or criticism, a substantive motion relating to an individual right hon. or hon. Member would be necessary. The issue here is the principle and the proposal that the hon. Gentleman wishes to put before the House.
I beg to move,
That this House calls on the Government to implement the recommendation made by the Public Administration Select Committee in paragraph 44 of its Twenty-second Report of Session 2010-12, The Prime Minister’s Adviser on Ministers’ Interests: independent or not?, that the Independent Adviser on Ministers’ Interests ‘should be empowered to instigate his own investigations’; and notes that this motion has been agreed by the Public Administration Select Committee.
I am extremely grateful to the Backbench Business Committee for giving the House this brief opportunity to express an opinion on this question today. The Public Administration Select Committee motion is supported by no less than 18 Select Committee Chairmen. The issue turns on a simple question of principle, which is whether or not the Prime Minister’s adviser on Ministers’ interests should be able to decide for him or herself to investigate a potential breach of the ministerial code. All the credible advice that we have received suggests that such a decision should be a matter for the adviser and not for the Prime Minister.
The Public Administration Select Committee—PASC—has advocated that course of action since the first adviser, Sir John Bourn, was appointed by Tony Blair in March 2006. The ministerial code sets out the circumstances in which the adviser—always referred to as the “independent adviser”—is requested to investigate alleged breaches of the code. Under the present arrangements, the question of whether or not to investigate is therefore in the hands of the Prime Minister of the day, on the advice of the Cabinet Secretary.
In 2006, in paragraph 17 of PASC’s report entitled “The Ministerial Code: the case for independent investigation”, the Committee warned:
“It is hard to see how the Independent Adviser can command public confidence if the Prime Minister can decide that prima facie breaches of the Code will not be investigated. Put simply, there is no point in having an investigator in post if he is not given discretion to investigate very public allegations that the Code has been breached.”
Paragraph 20 of the report points out:
“The decision to instigate an investigation still lies with the Prime Minister. The Prime Minister is clearly not an impartial figure when it comes to deciding whether or not to instigate an investigation. If the regulatory system is to have credibility, that decision must be taken out of political hands.”
In paragraph 34 of the report, the Committee therefore concluded:
“Until the changes we outline have taken place, it is inappropriate to refer to the new investigator as an Independent Adviser.”
The previous Government refused to accept PASC’s recommendation because they believed that
“it must ultimately be for the Prime Minister to account to Parliament for his decisions and actions in relation to the appointment of his Ministers”.
I have to say that that rather missed the point. The Committee was not suggesting that the Prime Minister should cease to make decisions about who to appoint or to dismiss as Ministers, or that he should cease to account to Parliament for those decisions. It merely suggested that he should be supported by truly independent advice.
PASC’s most recent report on the subject, entitled “The Prime Minister’s adviser on Ministers’ interests: independent or not?” was published this year. In it, we concluded that, because our previous recommendations had not been implemented,
“the title of ‘independent adviser’ is a misnomer.”
Paragraph 44 of that report also reiterated PASC’s central recommendation
“that the independent adviser should be empowered to instigate his own investigations. The Prime Minister could do this on his own initiative, without any need for legislation, but placing the post on a statutory footing would be preferable.”
The disadvantages of the present arrangements have been manifest in recent months. Sir Philip Mawer, the previous incumbent, expressed his frustration to the Committee that he was given no role in the investigation of the conduct of my right hon. Friend the Member for North Somerset (Dr Fox) in respect of Adam Werritty, and suggested that there needed to be a willingness to engage the adviser earlier in the process of investigating potential breaches of the ministerial code. In that case, the Cabinet Secretary conducted the investigation instead of the adviser. Why? We were told that the adviser would have taken too long. However, PASC has established that Sir Philip’s successor, Sir Alex Allan, will conduct swift preliminary inquiries if asked to do so, so that he can play his proper role. The problem of public perception was all the more acute in the case of the Secretary of State for Culture, Olympics, Media and Sport and the conduct of his special adviser, Adam Smith.
The problem with the present system is that as soon as the question of a serious potential breach of the code and a possible referral to the Prime Minister’s adviser arises, the Prime Minister is damned if he does, and damned if he does not. Referral is seen either as condemnation of the Minister’s conduct or as an attempt to protect the Minister from a full investigation. The same damage is done to the reputation of the Minister in question who, if innocent, would doubtless prefer the clean bill of health given by an independent investigation. In the more recent case, we finished up with one of the most unpleasant and acrimonious debates in the House of Commons that I have ever witnessed. The office of the independent adviser was set up to improve public confidence in the conduct of Government, but that episode does not vindicate it as a success.
Changing the procedure would avoid all that. It would make the adviser more genuinely independent, and it would help to remove the public suspicion that ministerial conduct can be protected from proper investigation. Short preliminary investigations, unimpeded by political considerations, would speed up the whole process.
I pay tribute to my hon. Friend for his chairing of the Committee and for the contribution that he is making today. I strongly support what he is saying. Can he offer the House any guidance on how we can best protect against potential witch hunts by those in the media who simply want to make life difficult for a Minister and get an investigation under way?
I submit that that would be a question of the robustness of the adviser. The process would operate in a similar way to that of the Parliamentary Commissioner for Standards, in that if the adviser felt that there was a serious case to answer, he would pursue it. If he thought that it was based on hearsay or tittle-tattle, he would dismiss it. Obviously, the moment at which he announced an investigation would be a threshold moment, but we have experience of that with the Parliamentary Commissioner for Standards, who operates in that manner.
I support what the hon. Gentleman is saying. In response to the hon. Member for Vale of Glamorgan (Alun Cairns), I think that media witch hunts would be less likely if the new arrangements were to be adopted, because the media would be less suspicious that anything untoward was happening.
The hon. Gentleman also serves on the Committee, and I am grateful to him for his participation. He makes his point extremely well. Witch hunts start when there is a suspicion that the Prime Minister is seeking to protect a Minister from an investigation. That is when the media—and, indeed, Her Majesty’s official Opposition—tend to jump on the bandwagon.
I want to express my full support for the motion and for the Committee’s report. There are certain questions that many people will ask, and they need to be put on public record. To whom should the independent adviser be directly accountable, and who should appoint him if we are to ensure the maximum degree of genuine independence?
The hon. Gentleman raises a salient point. The manner of the adviser’s appointment was mentioned in the report, although I am not going to address it directly today. In 2003, before the post was established, the Committee on Standards in Public Life originally recommended that the appointment should be made through the public appointments process and overseen by the Commissioner for Public Appointments. That has not happened. It did not happen with the appointment of Sir Alex Allan, and we have been highly critical of that fact. We believe that there should be an open public appointments process for this role, as there is for any other significant public appointment.
My hon. Friend seems to be making an unanswerable case. Will he explain to the House the present position if a Minister chooses to refer him or herself to the independent adviser? Would that position change if his proposals were adopted?
I imagine that any Minister who pressed the Prime Minister for referral should be granted one; however, it might be granted or it might not be—it is a matter for the Prime Minister. That is that. I do not know what a Minister who wanted to be referred would do if the Prime Minister refused that; I think he would just have to lump it.
It is a privilege to serve under my hon. Friend’s chairmanship on the Public Administration Select Committee. Will he confirm that, although the report recommends that the Prime Minister’s adviser should be independent in making the decision, he will nevertheless operate under a clear set of guidelines to help him make that decision?
I think the guidelines are the ministerial code, and it should be for the adviser to determine his own process, but it is perfectly reasonable for the Government and the Prime Minister to insist that the adviser has a quick process to establish prima facie cases and decide whether they are worthy of further investigation rather than go into the full process straight away. I can understand the Prime Minister being reluctant to refer cases to Sir Philip Mawer, who had established a very long, tortuous and indisputably fair process, but not one that could be quick under the pressure of political events as required.
We held a hearing with the new adviser on Minister’s interests, but we were anxious—at least, I was anxious—to make it clear that it was not a pre-appointment hearing. Personally, I have absolutely no doubt of Sir Alex Allan’s bona fides and integrity. Unfortunately, we expressed the view that the manner of his appointment undermined the idea that he is actually an independent adviser, although he is certainly an adviser. He has a day job, too, in that he advises Ministers on their respective private interests and potential conflicts of interests, and ensures that there is a register of Ministers’ interests. That is his main job, and I have no doubt that he does it extremely efficiently. As I say, however, the manner of his appointment does not lead the public to believe that he is truly independent.
Does the hon. Gentleman have any plans to persuade his Committee to do further work in this area, perhaps in line with Sir Philip Mawer’s suggestions for trying to establish ground rules for assessing whether Ministers should be suspended as and when an investigation is taking place—a suggestion made in answer to an earlier question from the hon. Member for Vale of Glamorgan (Alun Cairns)?
We are certainly minded to conduct a further inquiry into the ministerial code at some stage. At the moment, we are waiting for the Government to respond to our latest report on the Prime Minister’s adviser.
To reiterate, the Parliamentary Commissioner for Standards has the power to instigate his own investigations. Who would suggest now that he should not? His office would command little public support and therefore provide little protection for the reputation of this House and its Members. Other systems in countries such as Canada allow political ethics regulators to instigate their own inquiries into ministerial conduct. How can the Prime Minister—any Prime Minister—be objective or, perhaps more importantly, be seen to be objective when he has to make judgments about close colleagues that could have far-reaching political consequences? I appreciate the fact that Government insiders, including my right hon. Friend the Prime Minister, see this as a potentially huge change, but those who are outside government and not imbued by being in government see this as a very obvious change to make.
Today, on the last day of term, not many colleagues are here, but I nevertheless intend to press this matter to a vote. I challenge Ministers not to resist, and I challenge Labour Members, too, to show how they now embrace what they resisted when they were in office. I have no doubt where public sentiment lies, so let us not delay any longer to bring about what should have been implemented years ago, for this issue will return again and again. PASC will return to it, too, until this recommendation is accepted.