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The hon. Gentleman said that morale had reached rock bottom. I doubt whether it has reached as low a level as it reached during the 1980s, but I accept that morale is low. He cannot make up his mind whether he wants things to be top-down or locally decided. He
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quotes the example of A and E reconfiguration in Sussex. That is a local, clinically-driven decision happening in that area. It is absolutely right that we should allow those proposals to go on. Incidentally, nine out of 10 reconfiguration proposals are decided and agreed locally, and do not even get referred to me for decision by the overview and scrutiny committee.

We are not saying that the statement solves all the problems in the NHS. Of course there are problems in relation to junior doctors and problems to be tackled in a whole range of areas, but I hope that when Members on the Opposition Benches have had time to reflect, they will agree about using a team of highly respected clinicians who work in the NHS day in and day out. Incidentally, Professor Sir Ara Darzi will continue with his practice for two days a week, even while he is a Minister. It is right that he is a Minister, because if we handed the review to someone outside the NHS, and then outside Government when the review was delivered, that would be far less powerful than having someone conducting the review and being in government to ensure that the review is implemented.

The Conservative party has crossed the Rubicon. You have crossed the Rubicon in relation to getting rid of the patient passport. You have crossed the Rubicon in making the NHS a priority—

Mr. Speaker: Order. The Minister should be careful when he uses the term “you”, because some people might think that he is talking about me.

Alan Johnson: I apologise, Mr. Speaker. I should say that the Rubicon has been crossed. Core principle No. 7 of the NHS core principles, which the hon. Gentleman’s party has now signed up to, says:

We remain committed to that. It is a big change for the Conservative party to follow us across the Rubicon, and the hon. Member for South Cambridgeshire (Mr. Lansley) has left some Members behind on the other side. Sitting behind him is the hon. Member for Wellingborough (Mr. Bone), from the Cornerstone group, who still has to cross those perilous waters. Now we can decide together how we will take the NHS on to its next stage.

Mr. Kevin Barron (Rother Valley) (Lab): I thank my right hon. Friend for his statement. I am sure that the Health Committee, of which I am a member, will want to look in some detail at what has been placed in the Library. My right hon. Friend said that society cannot stand still. Does not most of what was said from the Opposition Front Bench disprove that theory? Most of the time the Conservatives do want to stand still and not to move on. If the review is to look at targeting, will he make sure that targets set—whether at local or national level—in order to get rid of health inequalities are not removed, but are improved, so that we can address health inequalities in a serious way and have a national health service that deals with that matter better than it has in the past?

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Alan Johnson: My right hon. Friend is right, particularly when he describes the conservatism of Members on the Opposition Benches, which is hardly surprising. We needed to be top-down and to set targets to transform the situation in the NHS, particularly in relation to waiting lists. My right hon. Friend has a long and proud record of standing tall for the NHS and of arguing for the necessary changes. The point that I made both yesterday and today is that the NHS needed to be, in effect, in intensive care. It is now on the road to recovery. We need a different approach, and we need that to be formulated into a new constitution for the NHS that can make it fit for the 21st century.

Norman Lamb (North Norfolk) (LD): I thank the Secretary of State for the advance copy of his statement. As an aside, the new Government, under the new Prime Minister, have said that they want to strengthen Parliament. May I suggest that providing copies of statements a little earlier than traditionally happens would be a sensible reform? That would mean that there could be a much more informed debate, rather than Members trying to come up with an intelligent response in the 35 minutes before the statement is made. I would be grateful if that could be considered.

The statement is surely something of an admission of failure, given that after 10 years of the Government’s stewardship of the NHS, they are still searching a strategic direction. It comes after the Cabinet Office’s review of the Department, which was pretty scathing about the leadership offered and the lack of strategic direction. Nevertheless, I give it a cautious welcome, provided that the Government are prepared to examine fundamentally the serious weaknesses in their stewardship of the NHS, primarily the far too great centralisation of the way in which the service is run. I welcome the fact that consideration will be given to a constitution, because that approach seems entirely sensible.

I am worried that it appears that the process will be entirely led by clinicians and health professionals. Will it involve patient representatives, other groups with a direct interest and the public? I appreciate that the public will be consulted, but will only clinicians and health professionals make all the decisions and recommendations?

There are some fundamental weaknesses regarding the four areas that the review will examine. I was amazed that no reference was made to health inequalities and fairness. I raised that point during yesterday’s debate. Health inequalities have increased under the Government in recent years, not reduced, despite the Government target on cutting such inequalities. Will the Secretary of State reassure me that even though there was no reference to health inequalities in the statement or the terms of reference, the review will examine them as a central issue?

The proposals are pretty thin on the question of productivity. More and more people tell me that despite the enormous record investment, which we supported, money could be used much more effectively to achieve outcomes for patients who need help. Will there be a central look at how to improve productivity in the NHS?

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There has been a series of contradictory reforms over the past 10 years. Structural changes have subsequently been reversed, so I welcome the fact that there will be no more such changes. However, will the review address something that the former Secretary of State recognised in a speech that she made just before she stood down: the local democratic deficit in the NHS? She said that there was a need to strengthen local accountability. Yesterday, the Prime Minister said that he would look to devolve power genuinely. How seriously will the review address providing genuine democratic accountability locally in the NHS?

The Secretary of State said that existing problems needed addressing, but he referred to only one: hospital-acquired infections. He said that he would commit additional resources to tackling that problem, but how much extra will he provide for the strategy? Will this not be, again, too much of a top-down approach, and will it sufficiently engage staff? The Department was supposed to be producing a guidance note on the use of antibiotics, which is critical to tackling hospital-acquired infections, but so far that has not appeared.

Finally, a number of existing problems need to be addressed, especially regarding out-of-hours care and access to NHS dentistry. Will the review examine those problems, too?

Alan Johnson: I am very grateful for the hon. Gentleman’s positive comments. I will consider whether, as part of this great new world in which we are living, we can give out statements much earlier. This statement was not finalised until 11 o’clock, but he makes a fair point. I hope that hon. Members accept that there was nothing about the statement in this morning’s newspapers or on the “Today” programme. We tried hard to ensure that the statement was heard by Parliament first.

The hon. Gentleman asks whether this is an admission of failure, but that is not the case at all. The Government have to be big enough to recognise the problems in the NHS, which have not been caused by a failure in investment, resolve, additional staffing, or reducing waiting lists. Staff feel bemused and dazed by the fact that many changes have taken place over a short time, so it is important that we tackle that. The hon. Gentleman referred to the speech made by my right hon. Friend the Member for Leicester, West (Ms Hewitt) to the London School of Economics the week before last. That bears reading because she was pointing in that direction. Indeed, she mentioned the important point raised by the hon. Gentleman about the democratic deficit.

The hon. Gentleman raised many important issues, but let me pick out one: health inequalities. The matter is crucial to the Government, although it was virtually ignored before when there was no focus on health inequalities. Although elements of the Darzi review will relate to the issue, it is too important for us to wait for that review, so I assure him that we will crack on with that as an absolute priority.

Let me make a point about the role of the patient. I said in my statement that the patient is crucial. The first part of the review will involve Professor Darzi’s team of clinicians listening to patients as well as staff. Patients
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are as important as any other group because their buy-in and commitment to the NHS really matter to its health in the future.

Several hon. Members rose

Mr. Deputy Speaker (Sir Alan Haselhurst): Order. If this is not stating the obvious, may I just say to the House that the opening exchanges have been very extended? Protecting Back Benchers is the job of the Chair, but equally, I hope that Back Benchers will help the Chair to get as many people in as possible. I ask that questions be brief and that answers be concise.

Dr. Brian Iddon (Bolton, South-East) (Lab): I welcome my right hon. Friend to his new post. Despite increased funding and better facilities, a recent report showed that the health of people in my constituency was still well below the average of those living in other constituencies. Will my right hon. Friend not lose sight of the fact that our party has a commitment to moving the outriders with well below funding up to the average for the rest of the country?

Alan Johnson: I recognise the problem that my hon. Friend raises, which also affects the city that I represent. I assure him that that is one of the major priorities that we must tackle, but it can be addressed only with a bottom-up, rather than top-down, approach. That is the reason why we must ensure that local health authorities are able to tackle the problems in their areas. The problems in Kingston upon Hull will be different from those in Kingston upon Thames, while those in Bolton will be different from those in Bradford. That is an essential reason why we must have a bottom-up process.

Mr. Malcolm Moss (North-East Cambridgeshire) (Con): In the light of fact that the Secretary of State said in his statement that he wanted more “patient control, choice and local accountability”, what encouragement can he give to patients who are fighting to retain services at their local community hospitals, such as Doddington hospital in my constituency? Are those words about patient choice as empty as his predecessor’s?

Alan Johnson: The important point about any reconfiguration involving community hospitals is that there should be local dialogue with the patient voice included in the locally driven process. I remind the hon. Gentleman that we put £750 million of capital into community hospitals. Some closures have been agreed by local health service professionals, but every time that that has happened, there has been an insistence that a new service be provided. Sometimes that service is much closer to patients’ homes and is a community resource. The health service that we inherited 10 years ago, let alone that of 60 years ago, cannot ossify and be set in aspic. It is important that such changes happen, but the patient voice is absolutely crucial when there is any change.

Mr. Neil Gerrard (Walthamstow) (Lab): My right hon. Friend said that he would ask the independent reconfiguration panel to consider any decisions about hospital changes that are referred to him while the
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review is under way. Will he look into some of the reviews that are now under way? The “fit for the future” review has major implications for hospitals in north-east London, but I do not believe that it has been carried out in the transparent and accountable way that he suggests is needed, or that front-line staff have had serious involvement with patients. It seems highly unlikely that any recommendations arising from the review will fit the criteria that he says he wants to apply.

Alan Johnson: The important thing is that if there has not been transparency in the procedures locally, that is a reason for the overview and scrutiny committee to refer the decision to the Secretary of State, and it is one of the things that the independent reconfiguration panel will consider; specifically, it will look at whether there has been a proper consultation, and what that means for patient care, so I think that I can reassure my hon. Friend. I want clinicians, not politicians or bureaucrats, to make decisions, on the basis of what is best for patient care.

Miss Julie Kirkbride (Bromsgrove) (Con): The Worcestershire Hospitals Acute NHS Trust will shortly come forward with proposals, which we expect will include the axing of maternity and paediatric services at the Alexandra hospital, which serves my constituents and those of the Home Secretary. Bearing in mind that the cuts are very unpopular locally and could lead to future questions about the hospital’s accident and emergency unit, and bearing in mind that the cuts are motivated by the fact that the Alexandra is an NHS hospital, and the Worcestershire Royal hospital is a private finance initiative hospital that cannot be touched, may I take it from the Secretary of State’s statement that if such changes are proposed in the near future, they will be put on hold while the review is undertaken?

Alan Johnson: No, sadly not. I always like to say something encouraging to the hon. Lady, but I cannot say that we will put the measures on hold. Indeed, it would be betraying the patient if we put all change on hold, because many of the changes taking place across the country are necessary. There must be a process of local consideration, and I am not going to stop that consideration taking place. If the case is referred to me by the overview and scrutiny committee, I promise the hon. Lady that I will refer it on to the clinicians on the independent reconfiguration panel.

Hugh Bayley (City of York) (Lab): The Secretary of State is absolutely right to stress the importance of making the NHS and its doctors more accountable to the patients whom they serve. He will be aware that performance, in terms of both clinical outcomes and productivity, varies enormously from one doctor to another. Will he ask Professor Darzi to talk seriously to the royal colleges about how to address those inconsistencies of performance, and how to publish information in a way that the public will understand, so that the public have a say on the quality of care that they receive from the doctors whom they visit in the NHS?

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Alan Johnson: As Professor Darzi is a member of almost all of the organisations that my hon. Friend mentions, I am sure that he will talk to them about the issue. Indeed, the issue of the disparity between services in different parts of the country is a major part of the review.

Mrs. Nadine Dorries (Mid-Bedfordshire) (Con): The Secretary of State said that he would double the size of infection improvement teams, so that all trusts could have access to an infection control nurse or doctor. According to his predecessor, that was already happening. If the Secretary of State wants to know how to keep wards clean and how to stem MRSA increases, he should look no further than the Royal Marsden hospital, which was mentioned by his predecessor when she was at the Dispatch Box. At the Royal Marsden, no nurse is allowed to travel home in uniform, and all uniforms are laundered on site. Stopping MRSA and keeping wards clean is not brain surgery; I suggest that there be no review, and that he look at the Royal Marsden instead.

Alan Johnson: Even I would not get brain surgery mixed up with the measures that the hon. Lady mentions. I am pleased by her remarks about my predecessor, who did indeed say the things that the hon. Lady said she did, and who put in place the improvement teams. We are now doubling the number of those teams. I am happy to praise the Royal Marsden, and indeed Kingston hospital, which I visited on Saturday, which has had tremendous success in tackling MRSA. We need to ensure that that success is replicated elsewhere.

Mrs. Joan Humble (Blackpool, North and Fleetwood) (Lab): I welcome today’s statement, which will build on the improvements that I have seen to the local health community in Blackpool. My right hon. Friend will recall last year’s White Paper, “Our health, our care, our say”, which mentioned the importance of social care services working with health services to deliver the Government’s public health agenda. Will he take this opportunity to reconfirm the central role played by such services, so that patients can be considered as a whole and get the services that they need?

Alan Johnson: I can give my hon. Friend the assurance that she seeks. Social care will not be a specific part of the Darzi review, as Darzi is looking at the national health service, but he will talk to social care providers to get a feel for their concerns. I will discuss the matter with the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), who is responsible for social care, because I understand the issues relating to social care, the need to ensure that we keep our partnership with local authorities, and the need to improve the quality of social care.

John Bercow (Buckingham) (Con): Given that the lifetime cost of untreated communication disorders is estimated by the educational charity I CAN to be no less than £26 billion, how, in practical terms, does the Secretary of State intend to work with the Secretary of State for Children, Schools and Families to ensure that all children with such conditions get the help that they
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need, and do not suffer the irretrievable damage, for themselves and the country, that will otherwise result?

Alan Johnson: The hon. Gentleman has consistently and eloquently raised the issue. He raised it with me when I was in the Department for Education and Skills and, if it is not revealing any secrets to say so, he sent me a note saying that the issue is equally important to the Department of Health. I invite him to come and speak to me so that we can have a discussion on the subject, and on how best we can integrate the work of the two Departments on speech and language therapy, because I recognise the importance of the issue.

Helen Jones (Warrington, North) (Lab): My right hon. Friend rightly referred to the need to value NHS staff, but the NHS contains a large number of staff who are not doctors or nurses. I seek an assurance from him that our valuable support staff will be involved in the process. Will he seriously consider implementing the recommendations of the Fryer report on widening participation in learning, so that support staff get the training that they need and are valued for the contribution that they make to the NHS?

Alan Johnson: Yes. My speech did not leave out ancillary staff such as hospital porters—I made the point that everyone who works in the NHS will be involved in the exercise. The group that my hon. Friend mentions is particularly important, as is the training element to which she referred. That is why the social partnership forum action plan, which was launched in April with the support of all the unions, the education sector, the Department of Health and the strategic health authorities, has been well received, but we need to build on it. I understand the issue that my hon. Friend raises.

Dr. Richard Taylor (Wyre Forest) (Ind): I welcome the promise of stability and of consistent use of the independent reconfiguration panel for all contested reconfigurations. In view of the transition from patient forums to local involvement networks—LINks—how will the Darzi review select the patients and members of the public to whom it will talk?

Alan Johnson: That level of detail is being worked out by Professor Darzi and his team across the country. I will ensure that the hon. Gentleman’s point is raised, so that we do not fall between two stools. It is important that we hear the patient’s voice, and that it is accurately recorded. I am sure that on future occasions the hon. Gentleman will have opportunities to question me on how that is going.

Mr. John Grogan (Selby) (Lab): Has my right hon. Friend any news of the proposed second wave of independent sector treatment centres, six of which have been cancelled, according to this morning’s edition of the Financial Times?

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