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I want to say a few words about professionals working in the health service. One is often left with the impression that they do such good work despite what happens in Whitehall rather than because of any direction from there. In the past week, I have been overwhelmed by watching the work of a consultant professor at University College hospital in London
who is developing pioneering photodynamic therapy to cure people of cancer without the need for an operation. I talked to a consultant who is developing a cure for multiple sclerosis. When one hears from these people about the remarkable work that they are doing, one is left humbled by the quality of people within the health service. That is just the specialists, but it goes the whole way through the system, from the lowliest cleaner to the most specialist consultant. The dedication and quality of care is immense.
However, as the Secretary of State wonderfully declared recently, those working in the NHS are “not happy bunnies”. That is because they are utterly sick of the endless incompetence, contradictory reform and reorganisation from Whitehall. The psychologist from Sheffield who I mentioned earlier told me that morale in her section is being undermined because she and her colleagues face a change of employer. They are going to carry on doing exactly the same job, but once again their employer will change. I talked to health visitor in Sedgefield who was on her fifth employer and had been doing exactly the same job since 1987. There are ludicrous changes and reorganisations from the centre, as we saw with the junior hospital doctors debacle.
Then there are payments to administrators. In Health questions, the Secretary of State was very honest in response to a question about what is happening with pay-offs to administrators who leave the health service. I want to refer to the case of a guy called Peter Reading, who was chief executive of a hospital trust in Leicester. He was earning £180,000 a year. There was a pathway project to build new hospitals in Leicester, which collapsed. This guy was widely respected, but it appears that he was forced out of his job with no notice, probably by the strategic health authority. He got a £700,000 pay-off. The new temporary chief executive will earn £100,000 in three months—that is, on my reckoning, £400,000 a year. What is going on in Labour’s health service? This is ridiculous, is it not? How can one possibly justify such pay-offs to people who are often in their early 50s and doing very good work but for one reason or another, following a decision by the powers above—usually the SHA doing the Secretary of State’s bidding in the region—have to go, so there is another change and another enormous pay-off?
I end by referring briefly to the Bills in the Queen’s Speech. The health and social care Bill will be welcomed by the Liberal Democrats. It is positive and will break the regulatory divide between health and social care, which is a good thing. while bringing in mental health care as well. I am struck by the fact that the organisational divide between health and social care will remain in place. That divide is damaging patient care, and we must integrate those services much better than we do at the moment. The new service must be properly and adequately resourced, and we have to ensure that mental health is prioritised—it must not be allowed to sink as part of a larger service—and that it has real powers to drive up health and social care standards. The regulation of human embryology was also a welcome inclusion in the Bill. That will be the subject of joyous debate because it involves many
controversial issues, many of which are conscience issues that will divide the House on the basis of a free vote.
We will support the Conservatives’ amendment, but on the basis that our vision of a reformed legislative structure for the NHS is very different from what the Conservatives have in mind. Our vision is of local democratic accountability and local control, which this Government have so far failed to provide, and which is certainly not on offer from the Conservative party.
Mr. Deputy Speaker (Sir Alan Haselhurst): I must remind the House that Mr. Speaker has placed a 10-minute limit on Back-Bench speeches, which operates from now.
6.31 pm
Mr. Andrew Smith (Oxford, East) (Lab): I would like to concentrate my remarks on the education and skills Bill, and in particular the fulfilment of the historic commitment to education and training for all young people up to the age of 18. I have three general points. First, the commitment to the educational and skills needs of everyone in this age range is greatly to be welcomed, as the TUC, CBI, the British Chambers of Commerce and many others have already said. However, we have to think through its implementation carefully—and I believe that we are. We all know that the process will not work if it just conscripts uninterested or hostile 16 and 17-year-olds into occasional attendance at schools or colleges that they do not want to be in, where a minority would have the opportunity to sabotage other people’s education as well as their own.
Secondly, the reform will work only if it is enabling and engages those who so far have not done well at school and do not like it. It must give, and be seen to give, a range of good opportunities. As the Secretary of State said, it must not be seen as mandatory school attendance up to 18. As it applies most of all to those who might not otherwise have chosen to stay on at school, it must be good at guiding them towards options that they feel really offer them something, and at persuading them that they have the chance to make something of themselves.
Thirdly, that process must be part and parcel of raising aspirations and standards, as we are seeking to do throughout mandatory education, not simply as an add-on or an alternative. If the problem is that there are too many 16-year-olds without basic numeracy, literacy or social skills for employment, the best solution is still to have a more effective focus in getting the basics right in the early years, not simply adding another year or two of remedial education.
Mike Penning (Hemel Hempstead) (Con): Absolutely right.
Mr. Smith:
The hon. Gentleman says that that is absolutely right. The difference is that I see the investment and attention that we are giving to the early years as a platform for opportunity for all 16 to 18-year-olds, whereas Opposition Members would deny them that. We must make sure that the goal of achieving five A to C grades at GCSE does not detract from efforts to ensure that those who do not achieve at that grade come away with a basic qualification in
literacy, numeracy and communication that employers recognise and that young people can be confident will meet basic requirements for some of the jobs on offer. We have to pay closer attention to that matter.
Mr. Graham Stuart: The right hon. Gentleman repeated the mantra, which no doubt might have some political resonance and use, but does he accept that Members in my party are not committed to excellence only for the few? All of us, throughout this House, want an education system that helps everybody, and indeed, that helps most of all the vulnerable and those with least, who are failed by the system. That is common throughout the House, and parroting the weak remarks of the Secretary of State does not do the right hon. Gentleman any justice.
Mr. Smith: If the hon. Gentleman and his colleagues wish to will the ends and say that they want to achieve those ends, let them embrace the means. That is precisely what the Bill is about.
John Bercow (Buckingham) (Con): Will the right hon. Gentleman give way?
Mr. Smith: I am sorry, but as the hon. Gentleman knows, time is very limited and I have to press on.
Meeting the goal of providing appropriate education and training for 16 to 18-year-olds not presently in education and training will, as we know, be a huge challenge. It puts a big responsibility on all providers and employers, as well as the Government, to make sure that we get it right. It is crucial that the 14-to-19 partnerships to plan delivery of entitlement to diplomas work well. I must commend the guidance the Government have put out on the gateway to diplomas, which is commendable.
I stress the importance of young people getting accurate advice about the opportunities available to them. The issue of which courses and qualifications actually enable them to do a job is important. For example, at the moment, someone completing a hairdressing course at a college of further education would get a licence to practise, whereas someone doing a hairdressing course at school will not. Once over 18, such a school leaver would have to pay to complete the vocational course, which clearly disadvantages those from poorer backgrounds. It is very important that young people and their parents know where they stand on that sort of choice.
Advice on education, skills and careers needs to be independent. We need to make sure that the advice suits the interests of the young person, rather than those of the organisation through which it is provided. We also need to make more and better use of providers with a track record of working successfully with young people at risk of exclusion from the education system. I have seen at first hand the good work done in a range of secondary schools in my own constituency by Skill Force, which provides project-based personal development and basic skills courses. Teachers have told me that Skill Force instructors have been able to re-engage pupils with whom they were struggling. From talking with some of the young people concerned and reading their own self-evaluation in their workbooks, it is clear that they appreciated and
benefited from the approach, which is based on breaking down longer-term goals into discrete projects, so that the young person can see, almost day to day, the progress that they are making.
Skill Force was able to expand its activities to cover some 200 secondary schools through central funding from the Ministry of Defence and the Department for Children, Schools and Families, as well as funds raised externally. They have accepted the phasing out of central funding in favour of payments from schools themselves, but have asked if that could be done more gradually. I and my hon. Friend the Member for Stockton, South (Ms Taylor) have been to see the Secretary of State about that, and I was pleased to learn yesterday that he was able to provide Skill Force with some additional transitional funding, which is welcome. However, that raises the more general issue of the mechanism for funding plurality of provision within the system, especially where schools are both purchasers and providers.
Ms Dari Taylor: Would my right hon. Friend stress, before he leaves the matter of Skill Force, what many in the teaching profession have said? When such projects are established in their schools, they are able to teach for the first time, and they find a serious improvement in the relationship that they have with students. Secondly, the youngsters end up with significantly improved examination results. It is a win-win.
Mr. Smith: It certainly is, and my hon. Friend is quite right. Not only do young people benefit from the Skill Force approach, but it subsequently enables them to re-engage with mainstream education and their teachers.
My point is that there is a lot to be said for shifting the responsibility for such funding across to local education authorities so that they can mobilise resources to engage young people who might otherwise drift out of the system. Making the LEA the broker in such a way would also help the involvement of external providers by cutting down to a more manageable level the number of separate relationships they have to establish and maintain. It would also better align provision with consequences in so far as the LEAs would ultimately have to pick up the pieces when young people drop out.
Many of the additional young people whom we will expect to stay in education and training will be attracted by courses at colleges of further education because of college links with employers and expertise in vocational courses. It is important that the role of colleges is fully recognised. The point about funding was mentioned earlier. Of 16 and 17-year-olds presently in full-time education and training, 38 per cent. are at maintained schools, 9 per cent. are at independent schools, 14 per cent. are in sixth form colleges and 39 per cent. are at further education and other tertiary colleges. If resources are to follow the student rather than the other way round, it is important that further progress is made to eliminate the funding gap between schools and colleges, which will still be around 12 per cent. per student next year, and to tackle disparities, such as the fact that colleges are not funded for each additional student they take on whereas schools are.
Let us do all we can to ensure that employers large and small play their full part through apprenticeships and effective training. The TUC, in its submission on the Queen’s Speech, makes a powerful case for apprenticeship targets to be included in sector skills agreements. I hope that that is something that the Government will consider favourably.
For many young people in the age range who are not presently in education and training, employment with accredited qualifications will be a more attractive way forward than staying in the classroom, but some will need a lot of help and support to make it a reality. Let us make sure that they get it. This is one of those epoch-making reforms which, done well, will strengthen opportunity, social cohesion and competitiveness. Whatever the Opposition Front-Bench team say now, I do not believe that they would reverse the change if they got the chance. They ought to join us now in making it a success.
6.42 pm
Mr. Kenneth Clarke (Rushcliffe) (Con): I am pleased that the Secretary of State for Health is speaking second, even if it is a result of the Government not understanding what the other parties were arranging for the debate. It gives me a chance to address him, as he will be winding up the debate, and ask him some fundamental questions about health. I want to invite him to try to reassure me that his commitment to reform and improving the health service remains unabated and that we are likely to see some more practical progress in the near future.
It has become a truism to say that the Queen’s Speech revealed no signs of that vision for which the Prime Minister apparently delayed going to the country for an election. I waited to see whether it gave any signs of the now old and discredited Blair Government being abandoned and new policies being produced by the “new Government”, led by this Prime Minister. It gave us few clues. The only change of policy that I noticed in this area is that we are now to give every expectant mother £150 to buy vegetables and fruit, which does not seem to me to go to the heart of the health care of the nation. There are more substantial issues, in particular how far the health service will be further reformed and whether the Government are committed to going in the direction of reform on which there was a wide measure of agreement.
I regret that the Secretary of State for Children, Schools and Families wound up his contribution with a quarter of an hour of knockabout nonsense in his description of our education policy. In health, that is scarcely possible because everybody knows that for the past few years, in principle, there has been a remarkable degree of connection between the Government and the Opposition, despite all the controversy that health reform caused in the past. Both sides are committed to a free national health service paid for out of taxpayers’ money and so on. We have always agreed that a combination of more resources and reform at the same time are required if the vision of the health service is to succeed. We are agreed on the purchaser-provider division, and that choice and competition are the way
to drive up standards in the health service. At least that was the position of the Blair Government: money would follow the patient, with payment by results, and the services being purchased with taxpayers’ money would come from a wider range of providers, including voluntary and private sector providers as well as state-owned ones.
When I listened to most of the previous Secretaries of State for Health under the Blair Government, after the first one, I always found that when they spoke in principle, they made speeches that I could have made. The principles that I have just described were those of the third-term Thatcher Government, of the Major Government and of the Blair Government after about 1999. What went wrong was the competence in delivery, about which I frequently complained. I agree with my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) that the whole thing was buried by an over-centralised approach, a plethora of constant initiatives, an over-concentration on nationally determined targets and so on, and constant structural upheaval. As the hon. Member for North Norfolk (Norman Lamb) rightly said, that upheaval means that many people working for the NHS have found that they are working for the umpteenth employer in the past few years and have had to reapply several times for their own job when it has been readvertised by some new organisation.
Are the “new Government” as committed to reform as their predecessor?
The Secretary of State for Health (Alan Johnson): Yes.
Mr. Clarke: The Prime Minister has constantly let it be understood that he was far less committed than Tony Blair to all this reform of the health service. He regarded it as what we used to describe as the internal market, and thought that there was a limit to what the market could achieve. The Queen’s Speech gives no clue about that. The Secretary of State is comparatively new, because we keep changing Secretaries of State for Health. His predecessor found herself, near the end, in a constant mist. She made little progress in reform and spent her entire time firefighting incident after incident and presiding over debacles such as the junior doctors appointments farce.
Is the Secretary of State now committed to reform? He nodded and said yes earlier. He will have to reassure me that he does not mean just trying to keep out of trouble with his foot taken off the accelerator and a touch on the brake. The NHS will require more. In my opinion, the NHS has never needed reform to be implemented effectively more than it does at the moment.
The background is a great financial crisis. I shall not go into the cause of the present crisis, but it finally came to a head with those ridiculous pay settlements and new contracts, which laid down levels of provision for payments that the NHS could not afford. That has produced a fantastic mess, with deficits all over the place. My NHS trust is allegedly “borrowing” almost £10 million, which it will have to repay with interest next year to get itself out of deficit. Primary care trusts with surpluses find that they are “lending” money to the NHS trust to get it out of trouble, so that those that are run well and have surpluses they thought they
could use to redesign their services do not have the money at the moment. The growth in funding in the NHS will slow down. The days when everything was buried with money and a 7 per cent. real-terms increase each year could smooth out a lot of the problems are over, and so the need for properly implemented reform has never been greater. I do not quite see where we are going.
I want to concentrate on the key and most difficult issue in reform towards the model that the Queen’s Speech defined as a patient-led service. That is the euphemism for reform in the direction that I have described. The most difficult thing on the way is the purchasing, or so-called commissioning, of services. Patients should have a choice, and I agree with the Liberal spokesman on that. Actually, Liberal Democrats are wrong to dismiss the professionals. None of us has clinical expertise. The patient exercises choice with the advice of his family doctor, usually a GP, who should be in a position to satisfy that choice. I have no idea where we are getting to on commissioning. No subject in the service has surrounded me in more of a mist of incomprehensibility. When I was Secretary of State, I laid down the plans for GP fundholding, to which we were committed. By the time the new Government came to office, half of all GPs in the country were in fundholding practices. The system was becoming popular and the Government made a big mistake by scrapping it. There is no point in going back over that; but then they changed their mind, did not abolish the purchaser-provider divide and revived the scheme under the name of practice-based budgeting, which we are now meant to have.
The Government corrected some of the errors that we made. I approve of the national tariff. I will not argue too much about whether practice-based budgeting is exactly the same thing as GP fundholding, but it is the same principle. We are to back to purchasing and commissioning. Most GPs share my hope that they will be given much more control over how taxpayers’ money is used for their patients and much more ability to redesign their local services and improve them in directions that they can see are desirable.
Mr. Charles Walker (Broxbourne) (Con): Does my right hon. and learned Friend agree that GPs are probably in the best position to know what the unique needs of their patients are?
Mr. Clarke: I do. The best general practices in this country are among the best features of the NHS. I would argue that there is a wide variation in quality, but the best family doctors are in the best position to have a big influence on the development of the service and are greatly trusted by their patients. The best of the younger ones are mad keen to get on with things. I am always pleasantly surprised by the entrepreneurial spirit and the desire to improve things that one finds among the best GPs. That is why 96 per cent. have signed up to the idea of GP practice-based budgeting.
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