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20 Feb 2007 : Column 20WH—continued
10.45 am
The Minister of State, Department of Health (Andy Burnham): This has indeed been a good debate, even if it has taken place in somewhat chilly surroundings, as the hon. Member for East Worthing and Shoreham (Tim Loughton) said. That made me pine for the sun-baked days of my childhood that were spent in many of the constituencies represented here today.
I congratulate the hon. Member for Truro and St. Austell (Matthew Taylor) on securing this debate on the provision of out-of-hours health care in Cornwall by Serco. I note that he is joined by three of his four colleagues from Cornwall: the hon. Members for South-East Cornwall (Mr. Breed), for Falmouth and Camborne (Julia Goldsworthy) and for St. Ives (Andrew George). That shows the strength of feeling on the issues that the hon. Member for Truro and St. Austell has put before the House today. I say quite straightforwardly, without any sense of party politics, that he and his colleagues have raised, quite properly, concerns that they should raise as MPs about the quality of health care in their locality.
I am sure that the comments that the hon. Gentleman has made today will have been heard not only in this place but in his county, by those to whom the remarks relate. I shall go on to address some of the specific points that he raised, but I want to say first that he has properly raised issues, and I think that we would all be united in saying that we want improvements to result from the process that he has begun.
I want to clear up one thing at the beginning. I think that the hon. Gentleman’s description of my response to his referral of this matter to the Department was a little unfair. He wrote to Dr. Colin Barrett of Kernow Urgent Care Services on 11 January to outline some of his concerns, including the concern about accountability and the response to the concerns that he has raised, quite properly, as an MP. I wrote back to the hon. Gentleman less than a month later. I shall quote from my letter:
“Dear Matthew...I am concerned you are not getting a response from the out-of-hours provider in your area to the questions you have raised.”
I was quite explicit about the fact that I was concerned about that point. I did not simply bat it away to the primary care trust, asking him to take it there. I asked
the trust to investigate the matter, and I copied into the correspondence Sir Ian Carruthers, chief executive of the South West strategic health authority.
I just want to assure the hon. Gentleman that there was not a dismissive response to his letter. We took the proper action, which was to refer it to the bodies in the region that have the responsibility for ensuring that the quality standards are achieved. That brings us to one issue that has cropped up a few times in the debate, which is that of accountability. I agree with the points that hon. Members have made. The question was asked: who is accountable? The PCT is accountable. In contracting with any provider, the PCT does not offshore its responsibility—its accountability—for the service. The process that is under way is the right and proper one.
Let me address some of the context on out-of-hours services before addressing the specific concerns raised about Cornwall. It is important to put in context the changes that we have brought about today. Under the old primary care contracts, GPs traditionally had a 24-hour responsibility for their patients. Although responsible for care, most GPs did not provide their own out-of-hours services, as was the case in the constituency of the hon. Gentleman, I believe. Instead, they delegated responsibility to independent GP co-operatives or commercial providers. Indeed, at the beginning of 2004, only 5 per cent. of GPs provided out-of-hours services themselves.
By early 2000, it had become clear that the old model for out-of-hours arrangements was not sustainable. There were rising numbers of complaints about the quality of service and there was evidence that the quality of care was inconsistent across the country. That prompted the health service commissioner to raise with the Department concerns about the provision of out-of-hours services. There was also concern about the impact that the responsibility of providing such services had on the recruitment and retention of GPs. We all know about low morale among GPs and how it is linked to the requirement to provide out-of-hours services.
Those two factors prompted the Department to commission the Carson review. The October 2000 report, “Raising Standards for Patients: New Partnerships in Out-of-Hours Care” made 22 recommendations, all of which were fully accepted by the Department. The review identified a future model of out-of-hours care in which PCTs would develop an integrated network of urgent care provision. Under the new primary care contract from April 2004, GP practices have been able to transfer responsibility for providing out-of-hours services to their primary care trust by opting out and handing to the PCT a sum reflecting the cost of providing the service—on average, about £6,000 per GP. That transfer of responsibility is improving GPs’ lives and having a positive effect on their recruitment and retention. That is certainly true in my constituency, where we have traditionally had a low number of GPs per 100,000 population.
PCTs now have a legal responsibility to ensure that patients are well cared for when GPs’ surgeries are closed. They are also responsible for performance managing providers’ delivery of out-of-hours services. We have put quality requirements in place that set out the standard of service that we expect to be provided
across the country. I shall return to that important point when I address the concerns raised by the hon. Gentleman.
The quality requirements set out the minimum standards that a high-quality, safe out-of-hours service should achieve. They include performance targets for answering the telephone calls of patients who access the service as a first point of contact and for face-to-face consultations. The requirements stipulate that patients will be guaranteed a GP consultation, including a home visit if there is clinical need for one, and that they will be treated by the clinician who is best equipped to meet their needs and in the most appropriate location. They also stipulate that service providers should be regularly audited to ensure that patients receive high-quality care.
Before I relate all that to the concerns that have been raised, it is important to note that the changes have improved out-of-hours services across the country. The hon. Member for Southport (Dr. Pugh) mentioned the National Audit Office report, which confirmed that patient experiences of out-of-hours services are generally positive. Some eight out of 10 patients are satisfied with the service, and six out of 10 rate it as excellent or good. Crucially, the NAO found no evidence of risk to patient safety as a result of the change to the GMS contract, but—there is a but—we accept that some PCTs need to improve their performance and those of their service providers to comply with the quality requirements.
Since the NAO published its report, we have introduced a series of steps to help PCTs and their contracting teams to improve their commissioning of out-of-hours services. I was asked whether I accept that responsibility and I do. We take it extremely seriously that such things can be improved.
Dr. Pugh: The Minister talks of performance targets, but with those targets must come penalties. What penalties are there for providers who significantly miss their performance targets again and again? Do matters have to wait until the end of the contract, when it is to be renegotiated, or do penalties fall on providers during the contract period?
Andy Burnham: Of course, the ultimate penalty is to cancel the contract. As the commissioner, the PCT has that ultimate sanction.
Andrew George: Will the Minister give way?
Andy Burnham: I am keen to cover all the points that colleagues have made. I shall give way if the hon. Gentleman is brief, but I want to respond to all of those points.
Andrew George: My point is essential to what we are asking the Minister to do today. In what context may a PCT choose to terminate a contract early, and what would be the cost or penalty to the PCT, particularly in the example that has been given?
Andy Burnham: I shall answer that as I wrap up and answer the questions about the contract in Cornwall. It is important that I address the specifics.
The out-of-hours contract for Cornwall and the Isles of Scilly went out to tender in line with the Audit
Commission’s recommendation in its review of out-of-hours services. Although it acknowledged the good service provided by KernowDoc, it was concerned that Cornwall’s PCT, which is responsible for commissioning the service, could not be sure that the service gave good value for money to the people of the county.
I make this point to the hon. Member for Southport because he used the phrase “on the cheap” several times. I take exception to that because this is not about providing a cut-price service; it is about paying the right price for the service. He knows that this Government have given more money to all of the PCTs that are represented in the Chamber. That is beyond dispute. It is absolutely right that those PCTs are critical and challenging about the money that they spend on every aspect of health care, because securing contracts at a lower cost gives them money to reinvest in the health service in Cornwall. That money does not come back to the Department. That is why things are done that way: it is called best value. It is important that the hon. Gentleman makes a distinction on that point.
The hon. Member for East Worthing and Shoreham asked about the tendering exercise. Five providers were shortlisted, each of which was scrutinised by the PCT. Reports were submitted to a selection panel, which met each of them. After more than 15 hours of discussion, the panel finally chose Serco Health as its preferred provider. I acknowledge that there have been problems with the contract and I accept many of the criticisms made by the hon. Member for Truro and St. Austell, but I believe that the figures that he quoted indicate that performance improved in the autumn of 2006, and that confidence has improved. However, the PCT’s concerns about the variable nature of performance were renewed over the Christmas period.
The PCT has employed intensive performance management on this contract, which has been escalated in stages each month from May 2006. The managing
director of Serco Health was asked to visit in August 2006, and was advised that it was imperative that he took decisive action to address the PCT’s concerns about the non-delivery of agreed actions. A series of actions resulted from that intervention and led to an improvement in the service.
Confidence had grown, but the serious deterioration in performance during the Christmas period resulted in a further escalation in the performance management of the contract. The PCT last met the director of operations on 1 February and required a formal rectification plan to be submitted by 8 February. I hope that hon. Members will accept that that is an appropriate way to deal with the issues that they have raised—I accept that they were properly raised—within the parameters of the contract. The PCT will meet the director of operations to monitor progress against that plan.
Matthew Taylor: Will the Minister promise to take a personal interest in ensuring that the situation is rapidly turned around?
Andy Burnham: I give the hon. Gentleman that commitment, because these are extremely important concerns. I am pleased that those concerns are not replicated across the country and that there is a good standard of out-of-hours service everywhere. I do not say that the Department and Ministers have no responsibility to ensure that proper arrangements are in place, but it is the responsibility of the PCT, as the commissioner for health services in Cornwall, to put things right. I am satisfied that it is taking the correct steps to bring about the improvement that he and his constituents want, as do I.
I assure the hon. Gentleman that we will monitor progress against basic standards. The crucial question is—
Ann Winterton (in the Chair): Order. We now move on to the next debate.
Housing and Social Cohesion (Yorkshire)
11 am
Jon Trickett (Hemsworth) (Lab): I am grateful to you, Lady Winterton, and the House authorities for allowing me to introduce this important debate. I am pleased to speak in the first hour-and-a-half debate that I have secured in 11 years in the House. I am glad that it will take place under your firm but fair chairmanship and that colleagues from Yorkshire are present.
I was wondering how the previous speaker’s last sentence was going to finish, because he had just reached the crucial question. The crucial question in this debate is how the housing market works. There has been much debate about how public service provision ought best to be made. There has been a particular focus on the marketisation or even the privatisation of public services. There is no doubt that there is a place for the market in the distribution of goods and services, because it is an efficient means of distributing services. However, from time to time the market produces inequity, and, in something such as housing, inequity can lead to a breakdown in social cohesion. I want to reflect on how the housing market has worked over the past few years and to suggest that housing is not a good example of a public service that can rely exclusively on the market as a means of distributing public services.
I begin by reflecting on a sentence in a speech made by the Prime Minister last year. He said:
“The USP of New Labour is aspiration and compassion reconciled.”
The USP refers to the unique selling proposition. It is fair to say that the Prime Minister and this Administration have located much of their effort around aspiration. As I shall illustrate, the housing market has enabled many families and others to achieve their aspirations. My right hon. Friend combines aspiration with compassion, which suggests that he is disturbed or worried about the possibility that aspiration alone, or marketisation alone, can lead to social exclusion. That probably explains the latter part of his comment, whereby aspiration is reconciled with compassion.
During this Labour Government’s time in power, families, households and individuals who have owned their houses have done remarkably well. Owning one’s own house has been a route for many not only to security and happiness, but to prosperity and a generally benign life. Let us consider what has happened to house prices since 1996, when the Tories had engineered a most catastrophic collapse in the housing market—we all remember the negative equity and the other problems that the country then faced. House prices across the nation as a whole have increased by 187 per cent. on average. That has contributed to a sense of well-being and to a realisation of many families’ aspirations.
Yorkshire and the Humber has outperformed the nation in the housing market, because the value of houses in the area has doubled. My constituency forms part of the Wakefield area, which has four MPs. Wakefield’s house prices have increased from an average of £58,000 in 2000—imagine that—to today’s
heady heights of just under £140,000. In this decade alone, a number of factors, doubtless including the wise stewardship of the economy and a surfeit of demand over supply because of changes in the household structure, have resulted in an increase of about 250 per cent. in the value of the average house in Wakefield. That is a remarkable achievement, and it doubtless explains the benign attitude of many people to new Labour. We should celebrate it, because we all want a home-owning democracy.
The housing market is, to some extent, dysfunctional in places. In those areas, there is both a breakdown in social cohesion and the exclusion of large numbers of people. When I was discussing the possibility of securing this debate, someone told me that we can compare the housing market to a ladder that people can ascend. That is a valuable metaphor, but let us consider it further. The housing ladder, both in my constituency and more generally, has some rungs missing, and some people now find it too hard to mount the bottom rung. The Abbey recently estimated that 17 million of our fellow citizens feel excluded from home ownership.
I received some remarkable figures from my local authority in Wakefield on the amount of money that the average constituent in Hemsworth earns as a percentage of the average cost of a mortgage needed by first-time buyers—people attempting to get on to the bottom rung of the housing market—to buy a starter home. The figures for Yorkshire and the Humber are broadly the same as those for the nation. In the first quarter of 2000, the average monthly mortgage payment as a proportion of the average monthly take-home pay was less than 70 per cent. Obviously, many households would have more than one earner, but let us consider the figures as an indication of how difficult it now is to get on to the first rung of the ladder.
Mr. Paul Truswell (Pudsey) (Lab): I congratulate my hon. Friend on securing the debate. Is part of the problem with the ladder analogy the fact that we always talk about the first rung being the first rung of ownership? There are several rungs beneath that, such as the need for social housing. They allow people to get into a home—to rent it, if not to buy it.
Jon Trickett: I am grateful to my hon. Friend for making an important point. He has been a long-time acquaintance and colleague of mine. Sitting alongside him is another Leeds Member of Parliament, my hon. Friend the Member for Leeds, North-East (Mr. Hamilton). They have both spent their lives committed to the development of steady progress in the housing market in Leeds.
I shall come on to the extreme difficulties faced by the 30 per cent. of the population that does not have access to the bottom rung of the ladder—if a ladder is an appropriate analogy. I was about to compare the 60 per cent. or so of average income that the first-time buyer spent on mortgage payments in 2000 to the current situation. Extraordinarily, the average first-time buyer will now need 111 per cent. of their monthly income to pay the cost of an average mortgage for a starter home in Yorkshire and Humberside. I need not say that the mathematics simply do not work.
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