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Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.

Madam Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.


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Mr. Gummer: On a point of order, Madam Deputy Speaker. We are about to debate a motion tabled by my right hon. and hon. Friends that states:

I therefore found it surprising that one of the signatories of the amendment is the Secretary of State for Health, who will benefit from the decision, one way or another. That would not be —[ Interruption. ]

Madam Deputy Speaker: Order. I must be able to hear the point of order.

Mr. Gummer: That would not be a matter of importance were it not for the fact that the Secretary of State for Health has personally made a number of statements about the wonders of the national health service, including the fact that is the best service that we have had, and she is being paid for it. I think that it is an unusual circumstance.

Madam Deputy Speaker: The right hon. Gentleman knows the procedure. He is an experienced and senior Member of Parliament, and he knows what the process and the procedures of the House are. It is not unusual for that to happen. We must now proceed.

Mr. Gummer: Further to that point of order, Madam Deputy Speaker.

Madam Deputy Speaker: Is the right hon. Gentleman going to pursue the same point of order that he has just raised?

Mr. Gummer: No, Madam Deputy Speaker. You kindly suggested that I have been in the House a long time, but at no point during that period have I ever known any circumstances in which the person under criticism signed the contrary measure. It is a new element, and I seek your advice on the matter.

Madam Deputy Speaker: I remind not only the right hon. Gentleman who raised the point of order but, indeed, all other hon. Members that it is up to each individual Member to judge whether they have a relevant interest that should be declared in any way. That is the norm for the House.

Alan Duncan (Rutland and Melton) (Con): On a point of order, Madam Deputy Speaker. In the statement on the energy White Paper this afternoon, the Secretary of State for Trade and Industry trumpeted his policy on carbon capture and experiments to achieve it. While he was on his feet, I understand that BP announced that it has withdrawn from what is probably the only carbon capture experiment. Do you have the power, Madam Deputy Speaker, to ask the Secretary of State to come back and explain the apparent contradiction in what he told the House of Commons this afternoon?

Madam Deputy Speaker: I must inform the hon. Gentleman that that is not, in fact, a point of order for the Chair, but his remarks are now on the record.

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Secretary of State for Health

Madam Deputy Speaker (Sylvia Heal): We now come to the second debate on the Opposition motions. I must inform the House that Mr. Speaker has selected the amendment in the name of the Prime Minister.

4.18 pm

Mr. Andrew Lansley (South Cambridgeshire) (Con): I beg to move,

The purpose of the motion is to force the resignation of the Secretary of State. I am sorry that it has come to that. Members on both sides of the House will know that we have frequently used the time available to the official Opposition to raise a series of NHS and health-related issues. We have done so on health care-acquired infections, mental health, the NHS work force and planning, and the management of the health service, always on the basis of motions that are constructive and designed to support the national health service. However, NHS staff have reached the end of the line with the Secretary of State. Serial incompetence and a chronic failure to listen to those staff mean that she has no credibility left to resolve the imminent problems facing the national health service. It is not simply that she and the rest of the Government are paralysed by the non-election campaign of the right hon. Member for Kirkcaldy and Cowdenbeath (Mr. Brown). The fact is that even were she to remain as Secretary of State after a change in prime ministership, she cannot command the necessary confidence and support across the national health service.

Many Members will recall the matters that we have raised before. Let me reiterate the many serial failures for which the Secretary of State has been responsible over the past two years. In 2005, there was the botched reorganisation of primary care trusts, which led within months to the resignation of Nigel Crisp, now Lord Crisp, as chief executive of the NHS. Under this Secretary of State, we saw the NHS plunge into its largest ever deficit. Since May 2005, the number of staff— [ Interruption . ] Labour Members are always telling us—the Prime Minister did it again at Prime Minister’s questions today—how many additional staff have been recruited by the Labour Government. Of course, those include 107,000 administrators. When the Prime Minister says, “There have been 250,000 extra staff”, funnily enough he never goes on to say, “of whom 107,000 are administrators.”

We are focusing on the record of the Secretary of State. Since May 2005, the number of staff working in the national health service has fallen. Payment by results and the tariff—a critical element of NHS reform—collapsed in February 2006, weeks before the start of the financial year in which the NHS plunged into its largest ever deficit. In payment by results and the tariff, we have a system that is necessary but is not being delivered successfully. [ Interruption . ] The Minister for the Cabinet Office says, “Ah!” as though it is some kind of mystery. “Money follows the patient” was a policy advocated by the last Conservative Government; it took years for the Labour Government
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to get round to recognising it, exactly as happened with GP fundholding and market mechanisms inside the NHS.

Tom Levitt (High Peak) (Lab) rose—

Mr. Lansley: The Labour Government do not understand that it took years to get back to a range of policies that were pioneered by the last Conservative Government. Of course we need “money follows the patient” and the tariff, but it is still true, all across the NHS—as the Secretary of State will have discovered today at the Royal College of Midwives conference—that the tariff does not support choice, does not support the range of services being provided across the NHS, and discriminates, for example, between normal births conducted in a midwife-led unit and those conducted in a consultant-led unit.

Tom Levitt rose—

Mr. Lansley: We need payment by results and the tariff to be delivered quickly, but what have we had under the Secretary of State? A chronic failure, a collapse in early 2006— [ Interruption . ]

Madam Deputy Speaker: Order. It is clear that the hon. Gentleman is not prepared to give way.

Mr. Lansley: I am sorry, Madam Deputy Speaker. I had not even noticed the hon. Member for High Peak (Tom Levitt), but as I have stopped I will give way to him.

Tom Levitt: I am grateful to the hon. Gentleman. Of course, the Tory Government were no stranger to deficits. Is it not the case that the deficit that he is talking about was smaller, as a proportion of the NHS budget, than many of those that the Tories had—and now it has gone?

Mr. Lansley: The hon. Gentleman does not seem to understand that last year a deficit of more than £1 billion within the NHS masked a deficit in excess of £2 billion within the Department of Health as a whole. That scale of increase has never happened before. The hon. Gentleman and other Labour Members probably often sit there wondering why, in the year just gone, their primary care trusts have had so much of their money top-sliced in order to deal with that deficit. Why did that happen if the deficit is so modest? Why £1.5 billion out of PCT budgets? Why £350 million out of education and training budgets? Why hundreds of millions extra out of the central budgets of the Department of Health? It is all because in the previous year there was not only a gross deficit of £1.3 billion within NHS trusts but an unprecedented scale of overspending within the Department.

Mr. Henry Bellingham (North-West Norfolk) (Con): Is my hon. Friend aware that the new Norfolk and Norwich PCT started its operations with a massive £50 million deficit? Surely if the Government set up a new organisation going back to where we were 10 years ago, they should at least allow it to start without a deficit.

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Mr. Lansley: I understand my hon. Friend’s point. Indeed, the same can be said of Cambridgeshire primary care trust, which is, like his, in the east of England. We have the largest deficit proportionately anywhere in the NHS. Of course, there must be a transitional process of trying to deal with those deficits, otherwise the consequences to patients will be unacceptable. Ministers are only now beginning to realise the scale of the deficits.

Although Ministers are always telling the public about the unprecedented amounts of additional money that are provided to the NHS, the consequence of last year’s deficits recurring this year is no growth in resources on the front line of the NHS. That means that, far from growth in services and resources in the past two years, people in the NHS have experienced cuts and reductions.

Mr. John Gummer (Suffolk, Coastal) (Con): Does my hon. Friend realise that the Great Yarmouth and Waveney primary care trust—which was created on the basis that there was previously no deficit—has entered into its existence with a special deficit, which the NHS central organisation invented, insisting that the PCT take on board a large sum of money because others have a deficit? Instead of starting deficit free, after working for five years to achieve that, it has to pay back money that it never owed.

Mr. Lansley: My right hon. Friend makes an important point. When Ministers consider the consequences of dealing with deficits, they claim that they have done away with the old system, which they describe as opaque. They say that everything is more transparent now. Conservative Members, who actually speak to members of primary care trusts and others about their financial position, know that the system is anything but transparent. Ministers are still in the business of shifting the money around the NHS to cover up the deficits and, indeed, the consequences.

Ministers try to cover up the consequences of deficits in places where accident and emergency departments—for example, in Surrey, Sussex, Worthing and Enfield—are threatened with closure, not because of genuine clinical cases for change, which the Secretary of State promulgates, but because of financially driven cuts and the consequences of the European working time directive. The Secretary of State has told us more than once that she wished that that directive had been amended. The Secretary of State for Work and Pensions, who is present, promised in 2004 that it would be amended to tackle its worst aspects. He told us that services to patients in the NHS would not suffer as a consequence of the implementation of the directive. Yet maternity units in Manchester and A and E departments in the south of England are being shut precisely because of the failure in December 2006 to amend the working time directive, as the Government had promised.

What about the NHS IT programme? It began before the current Secretary of State was in charge but the implementation remains disastrous.

Andrew Miller (Ellesmere Port and Neston) (Lab): Unfortunately, no Conservative Member who is present today attended a meeting that I had the honour
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to chair last night to discuss the NHS IT programme. Let me pass on two figures from that. This week, the picture archiving and communications system stored 6,200,000 images, making a total of 237 million images stored on the system. The hon. Gentleman calls that a failure—he should get his facts right and learn a little bit about IT.

Mr. Lansley: Oh dear. The hon. Gentleman knows perfectly well that digital imaging and the transfer of digital images happened before the NHS IT programme got going.

Andrew Miller rose—

Mr. Lansley: I shall not give way to the hon. Gentleman again. [Interruption.] Five years ago, Addenbrooke’s hospital told me that it was doing that already, but its problem was that it had to go at the same pace— [Interruption.]

Madam Deputy Speaker: Order. The House must come to order.

Andrew Miller rose—

Mr. Lansley: I shall give way to the hon. Gentleman shortly, but let me tell him something else if he is interested in the IT programme. He will remember that, 10 days ago, the Chancellor of the Exchequer said that we had to deliver the electronic transfer of prescriptions. By the end of 2005, 50 per cent. of prescriptions were supposed to be delivered electronically. By now, the figure should have approached 100 per cent. Yet the last quarter for which figures are available shows that 4 per cent. of prescriptions were transferred electronically. Actually, it is worse than that: about 4,500,000 prescriptions were issued electronically, but only just over 1 per cent. of those issued could be dispensed electronically because bar codes had not been fitted to them and pharmacists did not have access to the necessary equipment.

Andrew Miller rose—

Mr. Lansley: I will give way again to the hon. Gentleman if he will explain why the Secretary of State has not delivered what the Chancellor is calling for.

Andrew Miller: Had the hon. Gentleman attended the meeting last night, he would have seen that more than 8,000 practices are now involved in the choose and book system. [Interruption.] The hon. Gentleman might like to put himself in my position as a patient. I have seen the system working. The IT system is working, and contractors are delivering up and down the country. He is doing a disservice not only to the best IT programme in the world, but to the 350,000 people working in the NHS.

Madam Deputy Speaker: Order. The hon. Gentleman knows that interventions must be brief.

Mr. Lansley: It is always a help if interventions are accurate. The hon. Gentleman mentions choose and book, which is a classic example: it is two years late;
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GPs have not been listened to with regard to its implementation; and the target was for 90 per cent. of appointments to be made through choose and book by now, but the latest figure is 38 per cent., and half of those were done on the telephone, not online. His intervention is therefore rubbish.

Let us deal quickly with the implementation of contracts. The consultants contract did not deliver productivity and went over budget. The GP contract did not deliver the access that the Chancellor of the Exchequer now apparently wants. As for cutting GPs out of out-of-hours care, the cost was a quarter of a billion pounds more than estimated, and it has turned into a shambles. The dental contract, which was described by the British Dental Association as a shambles, has reduced and limited access to NHS dentistry.

On public health, the Secretary of State has been attacked by the chief medical officer over public health budgets being raided to deal with deficits. After the publication of the White Paper, prior to the Secretary of State taking up her position, it took two years to agree a definition of childhood obesity, and the Government have now resorted simply to measuring children. No actions or interventions are to follow.

Meg Hillier (Hackney, South and Shoreditch) (Lab/Co-op): It is instructive about the pace of change in the health service that, in 1997, people were waiting two years even to get an operation. They might be waiting now, but only for improvements in what is already a damned sight better service than we had 10 years ago.

Mr. Lansley: If we look at the hospital episode statistics, I acknowledge that the proportion of patients waiting less than six months for operations increased from 84 per cent. in 1997 to 90 per cent. in 2006. Given that NHS budgets have tripled, however, that is not exactly a triumph.

The flu vaccine implementation has been delayed twice in each of the past two years, and the Government have now missed the World Health Organisation’s target for delivering flu vaccine to over-65-year-olds. When the Secretary of State took up her position, she said that hospital-acquired infections would be her priority. What has she done about it? We have seen a dramatic increase in the number of deaths associated with MRSA and clostridium difficile, and horrendous outbreaks of C. difficile in a number of hospitals across the country, including in her constituency.

We have also seen the Secretary of State in the humiliating position of having to admit, in early December, that whereas Ministers said that 99 per cent. of patients were admitted to single-sex accommodation, some people might still be getting admitted to mixed-sex wards. She asked for a report from health authorities across the country. It took her six months to admit, because the Healthcare Commission survey was going to present it anyway, that 22 per cent. of patients admitted to hospital were first admitted to mixed-sex wards. That was a complete failure on something that, as her Prime Minister said in 1996, cannot be beyond the wit of Government to achieve.

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