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Mr. Andrew Lansley (South Cambridgeshire) (Con): I am grateful to the Secretary of State for giving me two-hour advance notice of the statement and a copy of the White Paper. I will not be so churlish as to say that it was more useful to read three days of briefing in the newspapers beforehand.
It is clear what Members on both sides of the House want to achieve: more accessible, high-quality health care available to all on the basis of need, not ability to pay and NHS staff and professionals who are increasingly enabled to deliver the care that they want to deliver in response to patient choice and patient voice. I welcome some of the Secretary of State's proposals in the White Paper. In 1996, before the 1997 election, the Conservative party was the first to legislate for direct payments. Today, under a Labour Government, only 2.25 per cent. of people eligible for direct payments have taken them up. The Secretary of State says that such payments should be more accessible and that she will legislate accordingly, which I welcome. She said that there should be more respite care. We all very much agree, but I hope she will be more specific about the entitlements to respite care that will be provided.
In the election, we all promised and intended to deliver increased resources for palliative care. The White Paper makes it clear that that will be delivered through end-of-life care networks, but the Secretary of
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State has not made it clear how much additional money that palliative care support represents. In particular, she did not say how much of that will go to support children's hospices which, at the moment, must survive with just 5 per cent. of their resources derived from statutory or Government sources. East Anglian Children's Hospices in my own area has recently had to make 25 staff redundant, so it would be very interested to hear the Secretary of State's answer.
I welcome the U-turn on community hospitals. On 15 November last year, my hon. Friends will recall an Opposition debate in which we pressed Ministers to review the closure of community hospitals. Indeed, our motion stated that we should not allow short-term measures to be taken for budgetary reasons, because that would prejudice the delivery of care in the community in the long term. The Secretary of State now says that she will do precisely what Government Members voted against on 15 November.
The statement comes just five days after the Secretary of State sent financial hit squads into 18 NHS trusts. The NHS Confederation threatened "painful decisions" and a £1 billion deficit across the NHS. That is not what we hear from the Secretary of State. Instead, we hear about the sunlit uplands of future health care with happy patients, doctors waiting in supermarkets for patients to drop by and hospitals that are empty for lack of patients. It is rather like "Yes, Minister"the NHS and hospitals would work perfectly if only patients did not keep turning up and wanting treatment. The Secretary of State must acknowledge reality before she embarks on a Patricia in Wonderland adventure.
Does the Secretary of State understand that primary care trusts have cut the precise services on which her White Paper plans depend? How can palliative care be improved if Macmillan nurses have been transferred to other duties for budgetary reasons? How can consultants offer out-patient clinics in the community or minor operations locally if 90 community hospitals are being closed? How can young people using mental health services be supported as the White Paper promises if those services are being cut, as is the case in my constituency? How can she criticise GPs for lack of access to their surgeries when it is just under two years since the Government contract removed Saturday morning surgeries? It is Government targets that have turned the GP appointment system into chaos.
The Secretary of State has not dared to tell the House what she is proposing to do to hospital services. Last Thursday, her Department published the document that I have in my hand. She did not tell us about it today and she did not make a statement last Thursday, but it makes it clear that, in 200607, NHS costs will rise by 6.5 per cent., but the tariff in hospitals will rise by 1.5 per cent. Labour Members should read that document before they read the White Paper. The squeeze on hospitals will continue next yearhospitals that have deficits this year will have larger deficits next year. The Secretary of State is planning a £4 billion shift from hospital care, but she has not told the House which wards and which hospitals will close, and perhaps she will address this point in her reply. NHS staff think it madness to engage with some of the additional proposals in the White Paper while the wards and hospitals that patients need are being closed.
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The Secretary of State is taking an immense gamble, because unless patients can be more effectively and comprehensively cared for in the community, the hospital sector will be under-resourced to handle rising demand, and it will be patients who suffer. At least she understands that she must adopt the previous Conservative Government's policies to make progress in community and primary care. Market mechanisms with increased private sector involvement, direct payments in social care and GP fundholding are essential if we are to have success after eight years of failure to reform the service.
The White Paper fails to spell out how the reforms will work. Will the Government legislate to allow direct payments to extend across health and social care, so that patients with long-term conditions can control the management of their care? Will GPs in practice-based commissioningnew Labour-speak for GP fundholdingbe given real budgets as Professor Julian Le Grand, the former health adviser at No. 10, has recommended? Will GP budget holders be able to use the savings that they generate to improve their patients' care or will such savings be siphoned off to meet PCT deficits? Will GPs be given the freedom to refer rather than being constrained by PCT decisions? Will the Government actually deliver real patient choice, given that their choose-and-book system is already 15 months late? Finally, will GPs be able to hold and negotiate contracts? If the answer to those questions is yes, then the Opposition will support the White Paper and the legislation to bring back fundholding.
I hope that the Secretary of State makes it clear that no more community hospitals will be shut. If the PCTs must review community hospitals, will she ensure that those PCTs that have deficits and that have nowhere else to go are supported to keep community hospitals open until additional resources are provided? In particular, will she introduce a split tariff to allow patients who are treated in a community hospital as part of a spell of hospital care to obtain part of the tariff for that treatment?
On health MOTs, more screening is, of course, requiredfor example, ultrasound screening for abdominal aortic aneurisms and bowel cancer screening have not been implemented, although they have been recommended and are needed. We are also 20 per cent. below the target level on diabetic retinopathy.
We need more opportunistic health screening. As the Secretary of State knows, the pharmacy contract permits pharmacies, which are visited by 90 per cent. of the public, to provide cholesterol tests, blood pressure tests, blood sugar level testing and body mass index assessments. Pharmacies can provide such services to GPs, who can follow up on people with certain risk factors. Where will the so-called life checks come from, and why should they take place at 11, 18 and 50? Why did the Secretary of State go down that route rather than the one being developed and piloted in the NHS today?
If the Government are confident that Tesco, Boots, companies such as United Healthcare and social enterprises want to provide primary health care, especially in areas that lack GP services, then we will support them. However, the market must be genuinely competitive, and community health services should not be so concentrated in one provider's hands as to represent a monopoly. Of course, there is no reason why
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PCTs should not continue to provide services, as long as they, too, are subject to competition. However, if they are providers of services, that undermines the case for them to become more distant strategic bodies instead of local providers that are more locally accountable. As the Select Committee on Health made clear, the whole process of PCT reorganisation has been a shambles. Even now, we do not know the future structure of commissioning, and the Government say that it will not be published for some months, yet that is the basis on which reorganisation should proceed. We should know the function of PCTs and then determine what their structure should be, not the other way round.
This White Paper should have been about commissioning. It should have set out how patients can have more choice, more control and a stronger voice. We have had the Government's sham consultations, and many of them, but where is the genuinely accountable patient and public involvement system for the NHS? That has not happened, and there are no proposals in the White Paper to do it. It should have explained how GPs can use real GP budgets to access the whole patient pathway; how we break down the barriers between health and social care, with individual budgets, including for those with long-term conditions; how we break down the barriers between primary care and hospitals instead of institutionalising, as the White Paper does, the idea that money can be shifted between hospitals and primary care rather than devoted to the needs of individual patients; and, most of all, how we can improve the effectiveness of public health and reduce the widening health inequalities in terms of life expectancy.
The Secretary of State said that the White Paper is about a primary care-led NHS. It is not, because GPs are at the heart of primary care, and this does not put them in the driving seatit puts primary care trusts in the driving seat. A PCT-led NHS is not what we should be looking for. We should have a patient-led NHS that does not try to manipulate from the top down, as the Government have done in the past and are proposing to do again. That approach has failed. There is much that we can applaud in the ideas behind the White Paper, but far too little to applaud in the mechanics of its implementation.
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