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“The NHS is now in better shape than in 2002 to deliver improved quality and increased productivity”.
I will swap Wanless quotes all day.
The hon. Gentleman also raised an important point of substance on productivity, which I mentioned in my statement. I said how difficult this issue was and that we have made modest gains over the past year. As he well knows, the difficulty is that people can examine two calculations. One can show that productivity has declined by 7 per cent. since 2002 and the other can show that it has increased by 8 per cent. The problem is how one defines quality of care when examining productivity. GPs now spend four minutes more with each patient than they did in the early ’90s. The onus must be on spending more time and personalising care. The National Audit Office and others have found it almost impossible to define how one puts quality into productivity considerations. That is the dilemma. It is not that NHS staff are not working hard and doing their best: it is about how we reflect that in the statistics.
The hon. Gentleman also talks about the 4 per cent. real-terms increase. This is an amazing continuation of record investment in the NHS. It is a 4 per cent. increase on forecast spend in this year. He promises to match it, and he also suggests that the Conservatives will go further on social care. That will just add to their black hole problem. Incidentally, the most recent document that I have read on their policies in this area contained just one sentence on social care.
We are saying that the 2006 Wanless report was a very important contribution. We need to move forward on it now, because Wanless made some important points, not least of which concerned the need for a partnership to cope with social care. He was examining how we provide proper social care in 2026.
Our self-regard increases all the time as the Opposition nick our policies, but let us get this straight. They have now signed up to the NHS funded by the taxpayer. The patient passport, which was their policy, has gone. They have signed up to the idea of the NHS 60 years after we created it, having opposed it bitterly when it was introduced. They have signed up to the 10 core principles of the NHS plan, which we introduced in 2000 and they opposed. They have just come round to signing up to the spending commitments that we agreed in 2004. Accusing us of nicking their policies is rather rich coming from a party that has decided at last that it cares about the NHS. The public will see through that.
Mr. Kevin Barron (Rother Valley) (Lab): I welcome my right hon. Friend’s statement and its implications, particularly the £250 million access fund to open up another 100 GP practices in areas where there are great health inequalities. That is not rocket science, yet for 60 years areas of the country have had high ill-health indices and high levels of health inequalities, but have not had the high levels of activity in the national health service that there should have been. Patient-GP ratios are a simple measure showing where we should be working. In some areas those ratios are far too high. I welcome the Government’s revolutionary initiative. To say that it is not new is nonsense—it is new, and it is welcomed by those who represent areas such as mine.
Mr. Speaker: Order. The right hon. Member for Rother Valley (Mr. Barron) did not ask a question. So far there have not been many questions. Perhaps we can have questions from now on.
Alan Johnson: One thing that cannot be denied is the enormous contribution that my right hon. Friend has made over a number of years. He will remember the Black report, which was commissioned under a Thatcher Government to look at health inequalities. It was published on a bank holiday Monday, 260 copies were produced and it disappeared without trace. The Conservatives did nothing about health inequalities, apart from worsen the situation.
My right hon. Friend is right. The Opposition say that there is nothing of substance in the statement. However, we have announced £170 million to be spent on psychological therapy services, £270 million on health care-acquired infections, £250 million on access, part of which is for the crucial 25 per cent. of PCTs with the least provision, and £100 million on innovation. That is not bad for a seven-minute statement.
Norman Lamb (North Norfolk) (LD): I thank the Secretary of State for early sight of the statement. In his response to the hon. Member for South Cambridgeshire (Mr. Lansley), he referred to the fact that he had delivered the interim report exactly three months after he had promised to do so, which was before the summer recess. That must be the first time ever that a Government report has been published on time. I congratulate the right hon. Gentleman on his impeccable timing.
I start by acknowledging the good things in the report. We warmly welcome the extra investment in psychological therapies, which is long overdue. There are many people languishing on incapacity benefit who could be helped back to work but who are not getting the help that they need. I also welcome the announcement on screening for hospital-acquired infections—a necessary change. I hope the Secretary of State agrees that there should be a zero tolerance of low hygiene standards, following the Dutch example, which nails down the standards expected in hospitals.
I welcome the greater flexibility in accessing GPs and the focus on securing more access to GPs in the most deprived communities. The fact that people in those communities have poorer access to primary care is
wholly unacceptable. If the proposal starts to address that, it is a good thing. The statement refers to local accountability. For a long time the Government have used the rhetoric of local accountability, but what does it mean? Will there be any substance to the assertion that it is important to listen to local communities and that they should have a say, rather than just staff having a say, important as that is? Innovation and spreading best practice are clearly good things. Is it right, though, to set up another quango to deliver them? Is that necessarily the best way of achieving the aim? How will it sit alongside the National Institute for Health and Clinical Excellence, which already does work in this area?
The statement gives little attention to care for elderly people— [Interruption.] The Secretary of State laughs, but this is an important issue. Is not Niall Dickson of the King’s Fund right that the failure to support frail and vulnerable older people is one of the unrecognised scandals of our time? Although I welcome the tentative step towards some sort of resolution, is not the issue far more urgent than the Government acknowledge? The royal commission in 1999 recommended free personal care. The Liberal Democrats forced such a provision through in Scotland, and we want people in the rest of the UK to benefit in the way that people in Scotland already do. [Interruption.] The Tories scoff, but it is a question of priorities. They prefer to give tax cuts of £300,000 to millionaires. We think that people who lose everything when a loved one develops dementia are a greater priority. Does the Secretary of State acknowledge that the Joseph Rowntree Foundation found that in Scotland there is more care as a result of the introduction of free personal care, more innovation in services and public support for the policy in Scotland some years after it was introduced? Is not the truth that the funding of social care—care for the elderly—continues to lag scandalously behind other funding?
The pre-Budget report highlights the fact that there is a 4 per cent. increase in NHS funding, which is absolutely necessary, but just a 1 per cent. increase for social care provided by local authorities. What is the justification for care for the elderly having such a low priority in the overall funding settlement? In the Department’s budget for social care initiatives, why do we have to wait until 2010-11 before the bulk of the extra funding comes through, with very little extra funding next year or the year after? Is not the reality that social care continues to be cut and that yesterday’s statement will do nothing to change that?
Is it right that there should have been a 25 per cent. drop in households receiving domiciliary care in the past 10 years? The criteria tightened massively so that only the most urgent cases receive support, and charges were massively increased for people needing care in their own home. Is that not unacceptable treatment of elderly people? Why will we have to wait an interminable length of time before any reforms come in? Will the review include respite care? When I spoke to carers last week, they made it clear that their top priority was gaining access to respite care, which is unavailable to many people in many parts of the country.
What is the timing of the review? When will concrete proposals be introduced and will the review be given priority? Is there any real hope of reform, given that
public finances are much tighter? Why, when yesterday’s statement perpetuated the funding crisis for elderly care, should we have any confidence that the Government are genuinely committed to badly needed reform?
Alan Johnson: I thank the hon. Gentleman for congratulating us on probably the only report delivered on time. We should proceed on that basis in future.
On the question of how we develop the psychotherapy proposals, we are running trials, and we will extend the pilots to inform the way in which we introduce the measures. The aim is to provide a groundbreaking network right across the country, which will be set up during the comprehensive spending review period.
In a balanced contribution, the hon. Gentleman’s other positive point—I will address his criticisms in a moment—concerned the introduction of pre-screening across the health service. In the Netherlands, the incidence of MRSA was reduced to 1 per cent. over a long period, and one of the biggest factors was the introduction of pre-screening everywhere. As the hon. Member for South Cambridgeshire mentioned, many hospitals pre-screen for elective surgery, but the introduction of pre-screening for emergency care requires isolation facilities. Reducing the length of the testing process, which is between 24 and 48 hours, is important. New technologies will allow us to do that and open up a new war against MRSA.
The hon. Gentleman made an important point about local accountability. If politicians are removed from the process of reconfiguration, it will be clinically led. I have removed myself, so if a case is passed to me, I will pass it to the independent reconfiguration panel, which is clinically led. If that is to become a permanent arrangement, which is what Lord Darzi is considering, we need proper local accountability in the system. The hon. Gentleman is right that we should listen to local communities, and that will be a big part of Lord Darzi’s final piece of work heading towards the report next year.
On innovation, a quango will not be involved. I understand the point about the other initiatives and NICE, but the organisations involved have welcomed the setting up of the innovation council, because, as I said in my statement, a lot is happening on development. There is no overarching view, which is what the innovation council will bring. The Wellcome Trust is enthusiastic, and I think that the scheme has achieved widespread buy-in. I assure the hon. Gentleman that there is no danger of duplication.
The hon. Gentleman made a long contribution, and I am trying to respond to the issues he raised. In his criticisms, he stated that we should go down the Scottish route and provide free care for the elderly, but that is not what the Wanless report states. The hon. Gentleman is sitting close to the hon. Member for Romsey (Sandra Gidley), who is a Front-Bench health spokesperson and who said in the House that she regretted the fact that her party’s manifesto had misled people to believe that care could be free. There is a disagreement not only between the hon. Gentleman and Wanless, but between the hon. Gentleman and the person who is two seats away from him.
Mr. Lansley: Hardly a surprise.
Alan Johnson: Wanless did not go for a soft option. The Scottish route would be a soft option.
Mr. David Kidney (Stafford) (Lab): It is unaffordable.
Alan Johnson: It is not only unaffordable. In Scotland, the cap on payments is £214 a week, and the average cost of health care is £217 more than that. The majority of people in Scotland pay for health care for the elderly, which is why Wanless examined an affordable and sustainable solution.
I have detained the House far too long. The hon. Gentleman has raised some important points, which we will debate at length at some stage. However, he should have welcomed the whole statement rather than some of it.
Mr. Bob Laxton (Derby, North) (Lab): May I tell my right hon. Friend how much I welcome the visionary decision to put £170 million of new money into psychological services? Mental health trusts in Derby city and Derbyshire serve patients who in some cases have waited two years to access those services. Where will we get the clinicians, psychiatrists and therapists? Furtherthermore, there are serious organisational deficiencies around the country in how services are provided, not least in Derbyshire.
Alan Johnson: My hon. Friend is right about the urgent need to introduce such services. We made that manifesto commitment in 2005 and examined some pilots. We must secure the resources and tackle the organisational problems that my hon. Friend rightly raised. We do not intend to wait for the end of the three-year period, and we will immediately start to recruit extra staff and set up centres across the country to allow us to deal with the 900,000 people who are just offered drugs, when many of them would find therapy far more effective.
Sir Nicholas Winterton (Macclesfield) (Con): During the recess, I became involved in the case of an elderly, retired farmer living in a rural area who was terminally ill—he was on both morphine and oxygen. I was incensed that the local PCT would not provide continuing health care—free care at home—for my terminally ill constituent. Social services found it extremely difficult to provide any form of care at home, and the family had to carry an unfair burden. Must not the Government and the national health service address such cases? That man, who was dying, deserved free care so that he could die with dignity.
Alan Johnson:
If the hon. Gentleman writes to me about that case, I will look into it. We issued new guidance on 1 October, because, as he rightly pointed out, the issue is important. This is a dreadful American phrase, but the NHS was not particularly good at “end-of-life issues”—indeed, there was an element of postcode lottery. The hospices were set up to counter the fact that the NHS was not concentrating on that issue as much as it should have done, but the situation is changing. One of Lord Darzi’s clinical review groups is considering that issue, and Lord Darzi will report on it next year. The guidance that we issued on 1 October
was meant to address some of the points raised by the hon. Gentleman. The case that he described may have occurred in the recess before 1 October, but I want to look into it, because I agree that it is unacceptable.
Joan Walley (Stoke-on-Trent, North) (Lab): May I tell my right hon. Friend how much I welcome the statement and everything that it does to tackle health inequalities, particularly in areas such as Stoke-on-Trent? Last week, I visited North Staffordshire Carers Association, and I am sure that it will welcome the extra £190 million that will be available nationally. The real issue, which Opposition Members have raised, concerns social care and the Green Paper. Will my right hon. Friend hold urgent talks with the Alzheimer’s Society on how we can ensure that the radical rethink will enable all the people who need extra social care to be treated with dignity?
Alan Johnson: My hon. Friend is right to raise that important issue. In the spring, we will publish our new deal for carers. I recently attended a reception in Bournemouth, where all the charity organisations and voluntary groups were enormously excited about the level of consultation on the new strategy. We have a new approach to dementia, which we need to tackle more intensively. Along with many other mental health problems, it is an important issue, but it has not been at the top of the agenda—in some cases, it was not even considered important, although it is the single biggest cause of ill health in this country.
Dr. Richard Taylor (Wyre Forest) (Ind): Will the Secretary of State accept that more deaths result from preventable venous thrombosis in hospitalised patients than from MRSA? Does he support measures to make risk assessment mandatory, which would result in wider prevention?
Alan Johnson: Lord Darzi is considering that specific issue. Indeed, I believe that he recently spoke to the hon. Gentleman.
Alan Johnson: If Lord Darzi has not done so, he will be in touch soon, because he wants to talk to all the members of the Health Committee. We have an enormous amount in common on that issue—whether we can proceed as quickly as the hon. Gentleman would like is another thing—and I think that that conversation should take place.
Lynne Jones (Birmingham, Selly Oak) (Lab):
It is great news that the Government are investing much more in psychological therapies, which is surely an example of spending to save. However, if we are not going the full hog and adopting the recommendations of the royal commission, why are we waiting to implement the reforms on social care recommended by Wanless? I know that that would cost money, but yesterday the Government found money to help the winners in the lottery of life—those who will not develop dementia or other conditions that require long-term care and who have assets in excess of £350,000. Does my right hon. Friend agree that a Labour Government should give priority to the losers
in the lottery of life who develop such conditions, end up having to sell their homes and have no inheritance tax for the Government to take?
Alan Johnson: Wanless was considering a vision for social care in 2026. His report came out in 2006. We need to appraise it, and achieve close integration between Government Departments before we can begin the debate with a Green Paper. That does not mean that nothing will happen on social care between now and the publication of the Green Paper—and the debate on it. For a start, there has been a 39 per cent. real-terms increase in the money invested in social care since 1997. Secondly, a concentration on individual budgets and individualisation is being led by authorities around the country. Recently, I was in Barnsley, where terrific things are being done. The settlement will allow us to move that forward.
The situation is much like that relating to pensions a few years ago. We need cross-party consensus, because we are looking towards 2026. It does not have to be done this way, but we need a Turner report on social care that can cross boundaries that have never been crossed before. The NHS has never provided social care free of charge; it did not do so under Nye Bevan, and it does not do so now.
Angela Browning (Tiverton and Honiton) (Con): Will the Secretary of State reflect on the false economy of removing fundamental services across health and social care and on its consequences? This week, a report from Age Concern about the consequences of the removal of chiropody services on the frail elderly was published. If people cannot cut their own toenails—a pretty basic thing—and have no one to do it for them, they may fall over trying to do it themselves, which can be life threatening. They become less mobile. I hope that the Secretary of State will take account of that sort of thing, at that very basic level, as he seeks to improve services.
Alan Johnson: As always, the hon. Lady makes a sensible and pertinent point. Incidentally, Help the Aged has welcomed our commitment to a Green Paper and is part of the consensus on the need to discuss Wanless seriously, as grown-up politicians, and find agreement. The very point that she raised is why the issue is so important, because we now find in some areas that only those in need of the most desperate care are provided with help. People with serious needs, such as the elderly person mentioned by the hon. Lady, find that their services have been cut, and we need to address that. As Wanless pointed out, the cost of doing so effectively for everyone—given an ageing population, demographic change and all the other things that we know about—would take up the whole pot of public money. We will have to find a solution that is different from the one found in Scotland.
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