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11 Oct 2006 : Column 306

Mr. Lansley: If the Labour party would vacate the Government Benches and give us the opportunity to take up the responsibilities of government, we would ensure that NHS resources are used more effectively to deliver services for patients, that the staff the NHS recruit are front-line staff who deliver those services for patients, that accessible services—which are demanded by patients and GPs—can be commissioned by GPs on their patients’ behalf, and that the threat that is the consequence of the Government’s policies is lifted. Unfortunately, I cannot promise that, because the Government are not going to disappear tomorrow and the hon. Member for Tooting (Mr. Khan) is asking me about jobs that are under threat now. I cannot promise that I can restore those jobs—of course I cannot. But I can promise that we will have policies that never lead, through gross mismanagement, to the problems that we face today and for which the current Government are responsible.

Let me tell the House how many jobs we are talking about: 20,000. I heard what the Prime Minister said; he had the effrontery to stand up at the Dispatch Box at Prime Minister’s questions and say that there is no such threat of 20,000 job losses. He might like to look at some information I have, namely, that 64 NHS trusts have announced up to 20,000 posts that will be cut in the hospital sector alone. If the Prime Minister tries to deny that, let me refer him to the NHS Confederation, which is in no mood simply to support my party on this matter. It wants to minimise the effect of what might happen and it has issued a briefing. Labour Members seem to be reading only from the Labour Whip crib sheet, when what they should be doing is reading the briefings they have been receiving from organisations that know something about this matter. [Interruption.]

Mr. Speaker: Order. Ms. McIsaac, I have already asked for some calmness in the Chamber and you are not helping me. You are not being as helpful as you usually are in such situations.

Mike Penning (Hemel Hempstead) (Con): There is a lot of laughter on the Labour Benches, but there is not much laughter in my constituency, where 750 doctors, nurses and key medical workers are being sacked by this Government.

Mr. Lansley: I understand exactly what my hon. Friend says. When the casualties of the Buncefield oil depot incident—happily, there were very few—were taken to an accident and emergency department, it was the one at my hon. Friend’s Hemel Hempstead hospital, and that accident and emergency department could have shut under this Government. Labour Members might like to explain why such things are happening. Indeed, they might like to explain—

Geraldine Smith (Morecambe and Lunesdale) (Lab): Will the hon. Gentleman give way?

Mr. Lansley: I will in a moment, but to my hon. Friend the Member for Christchurch (Mr. Chope).

Labour Members might like to explain why the Prime Minister gets up and issues a denial in this, when the NHS Confederation says:

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In fact, what the NHS Confederation is saying is worse than I thought because it is talking about an overall reduction of 20,000, whereas I am talking only about an announced 20,000 posts to be cut in the hospital sector. One might have imagined that there would be at least some compensating increase in posts in the community sector, but that is not, apparently, the experience of the NHS Confederation.

Mr. Christopher Chope (Christchurch) (Con): I am grateful to my hon. Friend for giving way. He is making some excellent points— [Laughter.]

Mr. Speaker: Order.

Mr. Chope: When I attend the Conservative NHS action day stalls in Christchurch on Saturday, I know that I am likely to be asked what our policy is in response to the National Institute for Health and Clinical Excellence decision to deprive those in the early stages of Alzheimer’s of much needed medication. Can my hon. Friend assure me that we will overrule that decision by NICE when we get into government?

Mr. Lansley: I am happy to be able to agree with my hon. Friend’s first sentiment, but on Alzheimer’s drugs I cannot give him the assurance for which he asks. [Interruption.]

Mr. Speaker: Order, this behaviour certainly will not help the debate. Those who are listening to our proceedings will wonder why we are behaving in this way in a debate on such an important issue. I know that there is some excitement around, but things are getting to a stage where we are having a bawling or shouting match. Labour Members should understand that the Secretary of State’s turn to speak will come, and I will seek the same courtesies for her as I seek for the spokesman for the Opposition. I know that the Speaker should not intervene for so long, but the Chamber is getting far too noisy—and perhaps one Member will be disciplined if we continue in this way.

Mr. Lansley: Thank you very much, Mr. Speaker.

I was endeavouring to explain something to my hon. Friend the Member for Christchurch, with which he may or may not agree. NICE has to do an exhaustive job of trying to assess whether it is in the interests of the NHS that a treatment be provided because it is both clinically effective and cost-effective. That process has been extremely useful because it has increasingly exposed what is cost-effective and clinically effective about Alzheimer’s drugs. They are effective for patients, especially for those with moderate and severe Alzheimer’s—dementia. However, in respect of mild dementia, they are not regarded as sufficiently effective to be a treatment that should be recommended on the NHS. Frankly, it is my opinion that in an independent national health service such decisions must be made independently and we must ensure that there is a correct statutory framework. On this matter, one
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important issue remains in my mind. Because of the nature of the regulations prescribed by the Government, the benefits that NICE can take into account apply only to the national health service and to publicly funded social care. The benefits to carers and their families beyond that point cannot be taken into account. We must look into that—and that might, of course, have a bearing on the outcome of any appraisal undertaken by NICE.

Mr. Jonathan Djanogly (Huntingdon) (Con): As my hon. Friend knows, hundreds of jobs have gone at Hinchingbrooke hospital, with hundreds more likely to go, and the hospital is now subject to a closure threat. It seems to me that the strategic health authority’s review is in fact cover for a slash-and-burn policy conducted by this Government. What does my hon. Friend have to say about that?

Mr. Lansley: To some extent, my hon. Friend and I share that hospital. Patients from my constituency go to Hinchingbrooke hospital. That anticipates something that I was going to say. It is disgraceful that “reviews”—in inverted commas—should be taking place that are in fact driven by finance. The implication— [Interruption.] Members might like to listen to this point. The implication of that for staff working at Hinchingbrooke is that the maternity unit has to be closed because it is not safe, but that is not true as it has one of the finest patient safety records in the country. That is financially driven.

Frankly, I do not think that the strategic health authority should be the body doing that. We are supposed to be moving—this is what the Government say—towards a structure in the health service that is increasingly geared towards the decisions of local commissioners such as primary care trusts, practices through practice-based commissioning, and patient choice. However, on the contrary, we have a strategic health authority that has just been established and that has inherited a financial problem—many of my colleagues right across the east of England are in the same position. Because of a £233 million deficit, it will decide which hospitals stay open and which are shut. That is a disgrace. In a year or two services will be shut down by the strategic health authority, but in subsequent years we will have to re-establish them because they are required to meet the needs of patients.

Mr. Kevin Barron (Rother Valley) (Lab): May I ask the hon. Gentleman about a news story that I read on the Conservative party website? Does he agree with the Leader of the Opposition when he says that

Mr. Lansley: Absolutely, and that is exactly why my right hon. Friend and I explained on Monday how we could take politicians out of the day-to-day management of the NHS. However, as we heard from the Prime Minister at lunchtime, he is so keen on having the NHS as a political football that he is not prepared to allow it greater independence. I am sure that when the time comes, the Chairman of the Health Committee will want to ask the Secretary of State what the NHS political football game looked like on 3 July, when she sat down with the chairman of the Labour
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party, Ministers and political advisers, including Labour party staff, in order to debate their “heat maps” and to decide where in the country hospitals were to be shut. Frankly, that is not acceptable. It is the Government who are indulging in that political football game, not us.

Several hon. Members rose—

Mr. Lansley: I will carry on for a minute. I have taken an intervention and I have yet to get on to the issues that we really need to reach.

We need to understand that all the deficits are having major consequences for staff. As I said, we might have imagined that, at the same time as jobs in hospitals were being cut, they were being created in the community. Members will recall that back in January, a White Paper was published the purpose of which was to state that precisely that shift of patients would happen. Well, what do we find? The work force census showed that in the last year for which figures were available, there were 485 fewer health visitors, 760 fewer district nurses, and even 36 fewer midwives. Yet the Government seem to think that those people are somehow magically going to increase in number and be available to provide services.

The Prime Minister made a speech on this issue last month. The action plan for social exclusion says that all additional health visitors and community midwives will be upskilled in order to undertake early interventions with families. Health visitors in my constituency used to visit every family, but that service disappeared about seven years ago. There simply is not the number of health visitors to enable that to happen.

Mr. Graham Stuart (Beverley and Holderness) (Con): I am grateful to my hon. Friend for giving way. Is he aware that in the first six months of this year—in other words, almost from the moment that the Secretary of State sat down after presenting the White Paper in this House—10 community hospitals across England were closed under this Administration, with devastating effect? That is the exact reversal of the Government policy set out in that White Paper—a vision that many Conservative Members shared, but which has not been delivered on the ground. It is that sense of betrayal—the difference between the words and the reality—that is so undermining confidence in this Government.

Mr. Lansley: I entirely agree with my hon. Friend. Let me give an example. If the Government were serious about supporting community hospitals, they would have taken the technical step that would have helped: unbundling the tariff to enable patients to be discharged from acute hospitals and transferred to community hospitals, with the money going with them. The Government keep talking about it and saying that it will happen, but they have not done it.

Several hon. Members rose—

Mr. Lansley: I give way to the hon. Member for Dartford (Dr. Stoate).

Dr. Howard Stoate (Dartford) (Lab): I am most grateful to the hon. Gentleman for giving way. I cannot
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help thinking that we might be losing the focus of this debate. Surely what matters in the health service is patient outcomes and patient care. As I still work as a GP, I can point to the fact that it now takes only two weeks to see a cancer consultant and to the fact that waiting lists are falling and GPs are providing much more care in their own practices, thereby significantly reducing the need to refer people to secondary care. Those are significant improvements in patient care, which surely is the purpose of the health service.

Mr. Lansley: I am grateful to the hon. Gentleman. Patient care does indeed matter tremendously, and in pursuit of that, patients in his practice will no doubt find things improving when he returns to full-time work in the NHS after the next election.

Gregory Barker (Bexhill and Battle) (Con): Will my hon. Friend give way?

Mr. Lansley: May I just answer the hon. Member for Dartford (Dr. Stoate), because there is an important point here? In their amendment to this motion, the Government say that

and the Prime Minister said at Prime Minister’s questions that deaths from coronary heart disease had fallen since 1997. Indeed they have, but as it happens they have not fallen faster than ever before. In the seven years before 1997, the death rate for circulatory diseases and the cancer death rate fell slightly faster than in the seven years since that date. The right hon. Member for Rother Valley (Mr. Barron), the Chairman of the Health Committee, made a point earlier about the use of the health service as a political football. Well, a good starting point would be to tell the whole truth about what is going on.

Yesterday, the Government —[Interruption.] Let me finish this point. Yesterday, the Government published health profiles across England and said that cardio-vascular disease death rates have been falling since the mid-1990s. They have not—in fact, they had been falling for at least a decade before that. Let us be honest about what is going on. There is a long-term secular reduction in both coronary heart disease and cancer death rates, which is very much to be welcomed. That has not happened simply as the consequence of the 1997 election, or of additional money. It has happened in virtually every developed country across the world, so let us be honest about these things.

Several hon. Members rose—

Mr. Lansley: I give way to my hon. Friend the Member for Epsom and Ewell (Chris Grayling).

Chris Grayling (Epsom and Ewell) (Con): I am very grateful to my hon. Friend. In my view, Labour Members simply do not understand the reality of what is going on. Two weeks ago, there were thousands of people on the streets of Epsom protesting against the loss of services at our local hospital. We now face the loss of services not only there but in Guildford—ironically, given the Secretary of State’s clumsy party political intervention at St. Helier before last year’s
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local elections—and we are losing community services and district nurses. The podiatry service is now being provided by Age Concern, and it looks as though we are going to lose sexual health advice for teenagers. What is going wrong? Labour Members seem not to understand the reality of our health service today.

Mr. Lansley: Frankly, the quality of management at the top of the health service is what is going wrong, and that stems from Ministers. I hope that the Secretary of State will have the grace to apologise for trying, for political reasons, to steer a capital project to St. Helier, rather than to where the evidence pointed to. She had to backtrack on that in August.

Several hon. Members rose—

Mr. Lansley: I am going to carry on because, as the hon. Member for Dartford rightly said, we have got to get to the points that really matter. There are a lot of NHS staff out there who want to know what the Government are actually going to do now about these problems. There are junior doctors worrying about whether they will find training places. I am glad that the Government said that they are going to find between 22,000 and 23,000 places in August 2007; indeed, I raised precisely that issue with the Secretary of State back in January. Of course, and as I recall from last year’s flu statistics, she has always had problems understanding what is England and what is the United Kingdom. In this instance, she has gone for 22,000 to 23,000 training posts in the UK, in order to meet a demand for 22,000 such posts in England, so the figures do not quite add up.

Chris Bryant (Rhondda) (Lab): Will the hon. Gentleman give way?

Mr. Lansley: No; I am carrying on for a bit.

I do hope that the Secretary of State will also make it clear that, wherever possible, such posts will be run-through training posts that give the junior doctors concerned greater assurance that they can qualify and get their certificate of completion of specialist training in due course.

It is not only doctors who have problems. As the Royal College of Nursing made clear in its surveys, many nurses are leaving college unsure that they will find jobs; indeed, many do not find jobs. In some cases, half or more of the graduate output do not find jobs. Some 100,000 nurses are due to retire in the next five years, and over the next three years there will be a 20 per cent. reduction in the number of nursing training places. What are the prospects for nurses? I met a nurse in my surgery just last Friday, who said:

I also received a copy of the following letter from a lady, who writes:

Let us consider physiotherapists. How many Members present met members of the Chartered Society of Physiotherapy when they came here in July? Well, I met the students from the Royal London: 99 students completed the course, but only one has a job.

A lady writes to me:

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