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Mr. John Gummer (Suffolk, Coastal) (Con): Before my hon. Friend allows the hon. Member for High Peak to get away with his comment, does he agree that before 1997 people in my constituency could at least get a national health service dentist? Those over the age of 80 were not sent back from the hospital several times in order to get the waiting list time started again, people could access a proper health service, because local hospitals such as the Bartlet hospital had not been
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closed, and, although I have some of the oldest constituents in the country, we did not receive one of the lowest payments per head. The Government have given a second-rate health service to areas such as mine that they do not think are worth supporting.

Mr. Lansley: Another thing that people did not find before 1997 was their local hospital’s maternity services disappearing and being transferred 15 miles up the road, as has happened in Welwyn, which I visited on Saturday. People in Banbury, where I also visited, did not find their maternity services being transferred to the John Radcliffe hospital 10 years ago. Likewise with A and E services. Right across London, people might well wonder what kind of NHS they have when, after 10 years and three times the amount of money, they cannot visit their local hospital safely, because although it advertises that it has an A and E department, it does not have the necessary back-up to make it one.

Lord Darzi, who is on— [ Interruption. ] The Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo), mentions Tomlinson from a sedentary position—I have a quotation from when she opposed the Tomlinson report—yet she and her colleagues propose a reconfiguration in London that seems to be based on the proposition that A and E departments will be available in local hospitals that have high dependency level 2 care, not intensive care. However, the Academy of Medical Royal Colleges has said in terms that for an A and E service to be provided, it is essential that it should be backed up by level 3 intensive care. And these Ministers have the temerity to come to the House and tell us that the reconfigurations are locally determined and based on clinical criteria. They are not; they are being dictated by the Government.

The latest evidence came out only last week, in the Health Service Journal, that the Government are proposing to try to fix the NHS tariff, so that they can force specialist services into centralised, larger hospitals by undermining the viability of specialists in district general hospitals.

The Minister of State, Department of Health (Dawn Primarolo) indicated assent.

Mr. Lansley: Frankly it is an outrage, and the right hon. Lady, having been a Minister for four months, could at least have visited the hospital concerned before she starts to lecture the House about what is going on, because she has not done so yet.

David Tredinnick (Bosworth) (Con): I am concerned that my hon. Friend might have forgotten the fact that people throughout the country are too frightened to go into hospital now because of the MRSA problems.

Mr. Lansley: I am grateful to my hon. Friend. I have not forgotten about that—far from it. Indeed, the Government’s central argument for their promised health and social care Bill is that it will strengthen infection control, but the code of practice should have been stronger and it should have been enforced. Indeed, we were here legislating for that more than 18 months ago and arguing about what needed to be done
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even before that. The Secretary of State can talk about the importance of screening now, but we were arguing that screening before admission was necessary four years ago. The chief medical officer said, in “Winning Ways” in December 2003, that screening before admission was a necessary part of the process of infection control, but Ministers did not implement that proposal. They talk about accountability, but there is no accountability on the part of Ministers for their failure to deliver infection control.

Years ago, the National Audit Office demonstrated that there were insufficient isolation facilities in the NHS. Now, Ministers talk about isolation but cannot provide it. We have known for years that bed occupancy rates are too high. For nearly two years, the Department of Health has been in possession of a report quantifying the increases in MRSA as a result of bed occupancy rates rising to above 90 per cent., but what have Ministers done? They actually reduced the number of beds in the NHS by 6,000 in the last year for which figures were available, so that we are now way below the figure that obtained in 2000, when the NHS plan—which, according to Ministers, is the basis on which they are working—said that there was to be an increase of 2,100 in the number of general and acute beds.

The health and social care Bill will simply bring together the Healthcare Commission, the Commission for Social Care Inspection—CSCI—and the Mental Health Act Commission. In principle, that is fine. Indeed, Opposition colleagues argued for that arrangement way back in 2003 when those bodies were first established. In implementing it now, however, it is important that we do not lose sight of the role of CSCI in respect of social care, which must be protected. It is also important not to lose sight of the responsibility of the Mental Health Act Commission, which must be carried into the new body in order to follow up on the Mental Health Act 2007, which we passed earlier this year.

Where in the Government’s legislative programme is the wider regulatory review that was always promised? Frankly, we have done the work over the past two years to determine what is needed to give the NHS a sustainable, long-term structure that will give professionals in the service greater autonomy while ensuring that that devolved power is subject to enhanced accountability. We have put those measures into a Bill, which we have published ourselves and which we will introduce in this Session. It sets out for the first time a constitution for the national health service which will incorporate the principles of the NHS, devolve responsibility through the NHS board closer to patients, make services increasingly accountable to patients through patient choice, empower providers to come into the system by creating an independent regulator in Monitor to work right across the health care sector, ensure genuine competition in health care matters, give the national institute its own statutory responsibilities for the first time, and for the first time create a national patient voice. A review undertaken by the Department of Health in late 2005 said that it was necessary to create that voice, but Ministers have signally failed to do so.

Let me make exactly the same offer to the Secretary of State now that I have already made to him privately. In the past, we supported the Government when they were doing the right thing on education and schools,
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giving greater freedom, through legislation, to those running schools. If the Secretary of State will work with us now, we will use our legislation to give far greater freedom and accountability to patients through the national health service, but the Government will have to be prepared to get away from their ideological fixations and to get into thinking about how this can be achieved more effectively.

We hear the Government’s promises time and again, but those promises seem to turn to nothing in their hands. We see one incompetent failure after another. We have just been listening to a further failure of the Home Office. Unfortunately, we know from the capability reviews that the Department of Health is second only to the Home Office in that regard, thanks to its failings in supporting the national health service. We need that incompetence to end, but I am afraid that that will happen only when we have an election.

Let us look at what we have ahead of us. The Government’s handling of the training scheme for junior doctors was described by the Royal College of Physicians as the worst event to impact on the medical profession for decades. We are not out of the woods. [ Interruption. ] Ministers think that it is funny, but they are responsible, and it has left a demoralised generation of junior doctors, thousands of whom cannot pursue their training.

Thousands of junior doctors are thinking about next year, and when the Secretary of State speaks, he can tell us what he is going to do. The consequence of thousands of junior doctors not having run-through training posts, in addition to those coming out of the foundation programme, and of the Department of Health losing its court case last week, which means that it will not be able to discriminate against those on the highly skilled migrant programme who are already here, is that the Department believes that there will be a 3:1 competition ratio for applications for training posts in the coming year. By any measure, the impact on junior doctors looking for training posts in the coming year will be worse than it was in the year just gone. What is the Secretary of State going to do about that?

The disasters in the DOH have led to a loss of confidence. Government Members like to talk about how much has been spent in the national health service over the past year, but consider the DOH’s evidence to the doctors and dentists pay review body, which states the real-terms increase in 2006-07 in NHS expenditure: on revenue, the increase was 2.8 per cent. in real terms, which is lower than the long-run average and lower than the average under the last Conservative Government. That is simply a consequence of gross financial mismanagement in the preceding two years, which led directly to the reduction in provision in the national health service last year. When the Prime Minister gets up and says, “Look what a big increase there has been this year in comparison with last,” it is in part because last year’s expenditure was artificially depressed by the impact of previous deficits.

The Government have wasted money time and again, and we cannot be sure that they have finished. The capital building programme went £4 billion over cost; the Paddington health basin scheme was abandoned after £15 million had been spent; and necessary changes to St. Mary’s Paddington simply did not happen. The NHS IT scheme is more than two years
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off, but the Minister came to the House and told us that that was fine because we do not have to pay most of the bills. If I were a director of a public company and said to the board of directors, “The IT and computerisation scheme that is integral to the improvement of services in our company is not going to be delivered, but that is okay because we are not going to pay the bills just yet,” I would be shot or sacked. The NHS was promised the delivery of benefits, be it electronic patient records or the electronic transfer of prescriptions, but once again there has been a failure.

I love the Department’s evidence this month to the doctors and dentists pay review body, which includes this epic understatement:

The Department did not get it, and that is true of GP contracts and its management across the NHS. This Government’s epitaph will be: “We intended to get more from our taxes, and we expected to get more in return.” They did not get it. [ Laughter. ] I was never a copywriter; I do policy and management, and it would be better if more Ministers did, too.

The Government say that they want to respond to rising aspirations. Ten years ago, they raised expectations, but they did not deliver, which is also true today. They have tested to destruction the idea that the Government can spend and legislate their way out of trouble. What is needed is a vision of patients who are empowered to demand high standards through choice and competition to secure the service that they have the right to expect. We need empowered professionals in public services who can provide the education, health care and other care that is their professional purpose and passion—if there is passion in all this, then it involves the people who work in our public services and what they want to be able to achieve. We want empowered families and communities who take control of their local services and take responsibility for bringing up young people, including young people’s education and health.

The Conservative party has indeed set out such a vision—not least at our party conference—and we have presented the policies to back it up. We have even done the necessary work to put the framework in place. What we want is more autonomy for professionals delivering our public services; professionals more responsive to the people they serve and more accountable for the outcomes they achieve; and services more focused on high standards. We will meet the aspirations of the electorate after the next election. I commend the amendment to the House.

5.15 pm

The Secretary of State for Children, Schools and Families (Ed Balls): Last week’s Queen’s Speech set out our programme to respond to the rising aspirations of the British people and to build a Britain in which everyone can rise as fast as their talents and hard work will take them. In the areas of health and education—the twin subjects of today’s debate—we will legislate to make the NHS more focused around the needs of individual patients, as we back British science. We will help all children—including the most vulnerable in our society—to get the best possible start in life and we will extend educational opportunity to all young people in
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order to ensure that they get the qualifications and skills that they need to succeed. My right hon. Friend the Secretary of State for Health will now legislate to bring the regulation of assisted reproduction and embryo research up to date and he will ensure the safety and quality of health services by introducing a new integrated regulator, the care quality commission, with new enforcement powers. A health pregnancy grant will also be introduced for every expectant mother.

As my right hon. Friend the Secretary of State has said, we have made real progress since 1997 through unprecedented NHS investment and reform. We have had 1 million more operations each year, built 100 new hospitals and reduced mortality rates, particularly for cancer and heart disease. But we still face new challenges—to take advantage of new technologies, to tackle rising obesity, particularly among children and young people, and to meet the rightly rising expectations of patients about what a 21st century health service should provide.

Mr. Graham Stuart (Beverley and Holderness) (Con): Does the Secretary of State accept that there is a sexual health epidemic in this country at the moment?

Ed Balls: I do not accept that there is such an epidemic, but it is important to do all we can to ensure that young people get the advice and support they need both in schools and outside them. My right hon. Friend the Health Secretary will respond to that later, as I am sure he will to those issues raised by the hon. Member for South Cambridgeshire (Mr. Lansley) that he understood.

Mr. David Laws (Yeovil) (LD): May I take the Secretary of State back to his home turf and ask him what deficiencies in the academies programme caused him to ask the Downing street Policy Unit to review this whole area?

Ed Balls: I am happy to answer that question. There are no deficiencies in the academies programme that led to any review. As the hon. Gentleman will know, the Prime Minister’s delivery unit conducts regular reviews across all Government programmes. In my September meeting with that unit, I asked it to look at the academies programme to ensure that it was delivering our objectives. It has delivered a faster rise in standards in academies where the catchment areas and pupil intakes have more free school meal pupils than the average school. Because of the scale of the resources that we are spending on this programme, it is right to ensure that we deliver value for money. That is what the review will do. I made it clear yesterday, as I did in my July statement, that we are taking forward, indeed accelerating, the academies programme. That is what we will do; I make no apology at all for looking into it in detail.

Mr. Laws: Is the Secretary of State really telling us that he asked the Downing street Policy Unit to look into the programme without having any concerns at all about it and without believing that it has any deficiencies? If he expects us to believe that, it would seem to be a quite extraordinary waste of time.

Ed Balls: The hon. Gentleman is quite wrong because I have not asked the Prime Minister’s Policy Unit to look into it at all—

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Mr. Laws: The delivery unit.

Ed Balls: The delivery unit looks across all Government spending, Department by Department. I have a six-monthly meeting with the delivery unit and I asked it to look into all aspects of my programmes. If it can make proposals to help us strengthen the academies programme even further, that is all well and good. In July, I announced reforms, including the abolition of the £2 million entry fee to get more universities into the academies programme. We are taking forward and accelerating that programme, as I said yesterday in topical questions. The continual charge that we are slowing down or trying to undermine the academies programme is quite wrong—I said that yesterday and say it again today.

Last Friday, my right hon. Friend the Secretary of State for Innovation, Universities and Skills published the Sale of Students Loans Bill. This week, my right hon. Friend the Minister for Children, Young People and Families will publish the children and young persons Bill to improve the life chances and provide greater stability, more support and a bigger voice for all children in care. In this debate, I want to set out more details of our education and skills Bill, which I will introduce with my right hon. Friend the Secretary of State for Innovation, Universities and Skills. That Bill will deliver world-class skills for all and raise the education leaving age to 17 by 2013 and to 18 by 2015.

Let me pay tribute to my right hon. Friend the Secretary of State for Health for his work and leadership on this issue in his previous job. He published the Green Paper on children in care and highlighted the fact that while the achievement of children in care has risen in the past 10 years, they are still five times less likely to get five or more good GCSEs than the average, and are nine times more likely to be excluded from school. That was not all that I inherited from him: he also published a Green Paper on raising the education leaving age. He set out how, despite rising participation rates, UK staying-on rates at 16 still lag behind those of international competitors, and how a young person’s background is still a key factor in whether they progress into post-16 education and training.

That is why the Queen’s Speech introduces the biggest reform in educational participation for more than 50 years. Let me tell the hon. Member for South Cambridgeshire that it was not introduced first in 1999; in fact, the first proposal in the House to raise the education participation age to 18 was in the Fisher Act of 1918. That Act introduced compulsory education to 14, but it also contained a provision to raise the education leaving age to 18, which was dropped in the years after the first world war because of the Geddes axe.

What was visionary 90 years ago, however, is essential today, both economically and morally. As the Leitch report demonstrated, the demand for higher-level skills is increasing, and the supply of jobs for lower-skilled workers is decreasing. Other countries are making fast progress in developing their own skilled work force, and we need to do more to avoid lagging behind.

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