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I send my congratulations to Bolton PCT. Again, here there is a mix between what is done nationallyfor example, the smoke-free legislation that
we introduced a year ago, which was not an easy decision to makeand the action that takes place locally. In my hon. Friends constituency and mine, we see terrific initiatives to tackle deeply entrenched problems of health inequalities. I congratulate Bolton PCT and all the other PCTs across the country that are getting to grips with this issue.
Sir Patrick Cormack (South Staffordshire) (Con): What does the Secretary of States statement offer in the way of hope for a more human and humane service to the cancer patient in my constituency who received the most appallingly cold and bureaucratic letter telling him that he cannot have the drug? When he wants to see a doctor in the middle of the night, someone comes and, with satellite navigation, eventually finds their way to the house but has no knowledge of the patient and little knowledge of the language. What does the statement offer that man?
Alan Johnson: The hon. Gentleman touches on some of the issues. Irrespective of what else happens in the NHS, his constituent will feel let down by it. There will always be treatments that do not go through the NICE process or are still undergoing the appraisal process. In those circumstances, it is up to the PCT to make a decision. What we say in the constitution is that a patient now has a right to a proper explanation of why a treatment has been denied. They also have the right to ensure that they are treated with dignity, respect and compassion. Those things can be measured. The press were talking about the size of a nurses smile, but the Royal College of Nursing supports us on this because although safety and effectiveness can be measured, compassion and dignity are equally important to patients experience. We can measure those factors through patient surveys and ensure that the quality of care improves for everybody.
Clive Efford (Eltham) (Lab): I welcome the statement and the fact that my right hon. Friend has reiterated that future Secretaries of State will remain responsible for the framework and accountable for the future of the NHS. The Opposition seem to want to do away with national targets, but can he explain how we could set a national framework without targets? Does he ever envisage a day when a Secretary of State will come to the Dispatch Box and say, Its not my fault, mate: its all the local people taking decisions.? What is being proposed is a free-for-all in the NHS, which is where we were in 1997, when we had an internal market that did not provide a consistent service across the country, and passports that would have taken money out of the NHS to subsidise the private sector. It is only this Government who are protecting the NHS and only a national framework that will do so.
My hon. Friend is right. Waiting times were the major concern in every survey. Patients were dying on waiting lists of more than two years. I have quoted the best that the Conservatives could do after 16 years in governmentit was a disgrace. Getting hold of that situation and reducing waiting lists to an average of nine weeksand a maximum of 18 weeksfor all the diagnostic tests and so on by the end of this year will be a major achievement. Of course we need to ensure that the NHS is clinically led and locally driven, but that does not release me as Secretary of State, or us
as a Parliament, from our responsibility for ensuring that we have a national health service providing a uniform quality of care across the country.
Mr. Kenneth Clarke (Rushcliffe) (Con): Ever since the Labour Government were converted to the principles of reform, Ministersincluding the present Secretary of Statehave expressed support for patient choice and competition between providers. Can the Secretary of State reassure me that he is not moving away from that by now insisting on using the words empowerment and transparency, and adding a load of management consultancy jargon and the legalism of a constitution written by whoever prepared his statement for him today? If he wishes to make a reality of local patient-based services, why not just give GP practices more control over commissioning and implement practice-based budgeting? If he wants polyclinics to emerge, which they could with some benefit in London and parts of big cities where there is an obvious need for them, why does he need a centrally managed national plan to impose themand use resourcesin areas where there is not the slightest evidence of local demand or need?
Alan Johnson: For two reasons. First, for 60 years we have had the bizarre and perverse result that there are half as many GPs per head of population in the poorest areas. That is Dr. Julian Tudor Harts inverse care law, under which the people who need the care most are least likely to get it. We are not putting up with that any more. Putting new GP services in the 25 poorest communities in the country will tackle health inequalities, and it is essential that we do that [Interruption.] Opposition Members say that that would have happened anyway, but it did not happen in 60 years. Incidentally, on the second point, neither has there been a GP service that patients can access from 8 am to 8 pm, seven days a week, 365 days a year. Yes, I plead guilty to saying that we should provide the funding from the centre to ensure that that happens. It has not happened since 1948, because of either a lack of funding or professional opposition. The Anne of Green Gables idea that if we just hand over the money to the British Medical Association it will ensure that that change happens is, frankly, ludicrous.
My final point to the right hon. and learned Gentleman is that there is more than one word to use. We use the simple word choice, as I hope that he will see, over and over again in the constitution. Practice-based commissioning needs to be developed further, and that is part of the review, but the real issue of choice comes down to the patients. We are introducing, for the first time, an element of the tariff that will be based on quality. That is an important development to drive quality through the system.
Mary Creagh (Wakefield) (Lab): My right hon. Friends national vascular screening programme will be of great interest to my constituent, Kath Howitt, whose husband Glen died two years ago, very suddenly, at the tragically young age of 39 with undiagnosed high blood pressure. Will my right hon. Friend ensure that the tendering process for the new GP services will not be over-burdensome and will allow innovative social enterprises, such as Local Care Direct, which offers out-of-hours GP services in Wakefield, to increase their scale and reach? Will he ensure that the tendering process allows a level playing field and does not hinder such initiatives?
Alan Johnson: I am sorry to hear about my hon. Friends constituent. Of course, it is crucial to have this screening programme for everyonemen and women from the ages of 40 to 74, with a call and then a recall every three years. When we announced it, there was only one dissenting voicethe representative of the BMA, who said, We dont have the capacity. Now we are providing that capacity, not just for that condition but for abdominal aortic aneurysms, which are one of the biggest killers of men over 65. I can assure my hon. Friend that the services will be properly tendered and will allow social enterprises, pharmacies and others to compete, although the majority of the screening programmes will take place in GPs surgeries.
Dr. Richard Taylor (Wyre Forest) (Ind): May I welcome the emphasis on quality, and particularly on compassion and kindness? The debate in the House on 17 June on polyclinics cleared the air very well and told us exactly what GP-led health centres will have to provide. It also made it clear to me for the first time that existing GPs could bid for those services. It has come to my notice that the offers of bidding have closed in some PCTs before general practices have been aware of them. Is there any way by which the length of time can be extended so that GP practices can tender on a level playing field?
Alan Johnson: Ironically, it was the Opposition who gave us the opportunity to clarify the situation by going against the propaganda that they had been putting out. I am happy that the hon. Gentleman saw that clarification. Only one contract has been awarded, and that was awarded to a social enterprise. We expect the vast majority to go to GP consortiums and there is no way that those consortiums have anything other than a level playing field as regards bidding. If the hon. Gentleman has any details about where he believes that there has been a problem, and if he writes to me, I shall look into it and try to ensure that the proper procedures take place.
Lynne Jones (Birmingham, Selly Oak) (Lab): May I ask my right hon. Friend how greater choice and control over health care will be extended to groups that are sometimes very vulnerable, such as people with mental health conditions, and those for whom society has generally had less sympathy, such as people with gender dysphoria? On the subject of mental health wards, may I invite my right hon. Friend to join me and visit the brand new in-patient facilities that have recently opened in south Birmingham, of which we are very proud?
Alan Johnson: I will very gladly come and look at the new facility in south Birmingham. It is important to point out that we must ensure that mixed-sex accommodation is eliminated in mental, as well as physical, health facilities. On the issue of mental health, as I said earlier, there was a specific pathwayone of the pathways of care, as they are termed in medical circleson mental health. When my hon. Friend has had a chance to look at the report, she will see that the result, particularly in her area, is that there will be a complete focus on ensuring that if people are incapacitated to such a degree that they are not able fully to control their own destiny, they will have someone with theman advocateto make sure that the right decisions are made. As the World Health Organisation keeps saying, there is no physical health without mental health. In the report, mental health is as important as any other aspect of health.
Mr. Phil Willis (Harrogate and Knaresborough) (LD): I was a little concerned about the fact that the right hon. Gentleman did not mention the ambulance service at all in his statement. A week ago, one of my constituents called for an ambulance at 7 oclock; by 8 oclock, when an ambulance eventually arrivedall the ambulances were in York and Scunthorpe and were not availableshe was dead. What does the Secretary of State have to say to her family, and to others who do not get the care that they need simply because there is no ambulance available for them?
Alan Johnson: I very much hope and trust that that is an exception to the normal rule, and I will look into the circumstances of that case if the hon. Gentleman would like me to do so. Ambulance services and paramedics are a crucial part of the report. When he has had a chance to look at itI appreciate that we are talking about 10 SHA visions in every region of the country, and by an enabling report by my noble Friend Lord Darzihe will see that the issue is crucial to ensuring quality. Paramedics and ambulance staff are even more important now, particularly as regards stroke care, which we talked about earlier. Care for a stroke patient should start at the moment when the ambulance arrives, not when the patient gets to hospital.
Mr. Gordon Prentice (Pendle) (Lab): My friend told us that NHS staff will be able to leave the organisation and subsequently contract with it as members of a social enterprise. How many people does he think will take advantage of that offer in the next year or two, and what are the advantages of going down that road, both for the national health service and for groups of former employees?
Alan Johnson: I am not sure how many people will take up the offer. There are already three or four social enterprises across the country. When we went through the process, we found that lots of front-line clinicians, including midwives, nurses and physiotherapists, wanted to link together and set up their own organisationand sometimes to move into adult social care as wellto avoid the bureaucracy sometimes involved in different NHS organisations working together. What stopped them was the fact that they wanted to preserve their pensions. For instance, people providing sexual health services in my patch, Hull, told me just a couple of weeks ago how much more they could do if they could set up their own organisation.
Today, we are saying that PCTs that are being difficult on the issue will have to treat a request from staff seriously. If the change goes ahead, staff will retain their NHS pensions. In addition, for the first three years, the contract will not go out to tender; the people involved will be guaranteed a clear run. I believe that lots of providers across the country will be keen to take up the suggestion. The unions are very keen for us to go a step further and ensure pension portability everywhere. That is much more difficult. Ensuring that portability in social enterprises is easy; for the independent sector, it is very difficult.
Mr. James Arbuthnot (North-East Hampshire) (Con):
Forty per cent. of children who die of cancer die of a brain tumour, yet it takes longer to diagnose a brain tumour in this country than it does in many other
countries in Europe, or in the United States. How will the review help to push brain tumours up the national health services list of priorities ?
Alan Johnson: Once again, when the right hon. Gentleman has had a chance to look at the eight clinical pathways, one of which included the issues of paediatrics and childrens care, he will see that there are some really important developments. Strategic health authorities and local clinicians are saying, If we were empowered to do things differently, we could improve services and do what we need to do, not just nationally, but locally. There is a clear concentration on improving childrens health as part of that clinical pathway.
Tom Levitt (High Peak) (Lab): The modern equivalent of outright opposition to the NHS in 1948 is the professional cynicism that we hear today from the Opposition and, indeed, from some parts of the medical profession. Does my right hon. Friend not agree that some doctorssome, only a fewtalk as if healthier patients are a threat to their livelihood? Will he assure me that over the next few days and weeks he will spend his time not in defending the health service but in proselytising the advantages that it brings to patients, communities and the people who work in it?
Alan Johnson: I can proselytise for England, and will do so for the national health service, which is very precious. Yes, there are disputes, disagreements and so on with organisations and individuals but, basically, there is a huge buy-in to the next 60 years being even better than the past 60. I believe that we can work together with all organisations, whoever they represent, to make this vision work and improve patient care for everyone.
Damian Green (Ashford) (Con): The Secretary of State talked about GPs providing responsive, accessible, and high-quality services, so will he take this opportunity to remove the axe that he has placed over the level of service provided by rural GP practices in my constituency that run their own dispensaries, which he plans to close down if there is a pharmacy near by? One of them has written to me saying that that would involve making redundant two salaried doctors, cancelling all phlebotomy services and discontinuing ECGs, 24-hour blood pressure monitors and 24-hour heart monitors. If he is genuinely concerned about GP services, why is he continuing with this mad plan?
Alan Johnson: That is myth No. 380 from the Opposition. What we have announced in the pharmacy White Paper is a consultation to look at dispensing pharmacies, principally because we need to ensure that patients have a proper choice. All the things that the hon. Gentleman mentioned in Hansard are absolute, complete, undiluted poppycock. We are not proposing any such thing. [Interruption.] Poppycock is the mildest word I could find. People should not be frightened of a consultation that concentrates, not on vested interestsI know that Opposition Members are absolutely imprisoned by vested interestsbut on the good of the patient.
That this House acknowledges that the security of the UKs energy supply has become of increasing importance over the last five years; understands that with over eight GW of coal and a further seven GW of nuclear generating capacity coming offline in the next decade the UK faces a potentially serious energy gap by 2016; regrets that with only 2 per cent. of the UKs energy needs coming from renewable sources, the UK is one of the worst performers in Europe; notes that the Governments own Renewables Advisory Board has established that the UK is set to miss its EU renewables target for 2020 even with significant policy changes; further notes that, as an island nation, the UK has major potential as a source of wave and tidal energy; deplores the fact that the Marine Renewables Deployment Fund has not delivered monies to a single project since its creation in 2005; regrets that the Governments latest Energy Bill contains insufficient provisions for feed-in tariffs for microgeneration, the fast roll-out of smart meters or any serious help for the fuel poor; and urgently presses the Government to act now to secure the UKs energy supplies for the future.
At the heart of this debate is the need of the entire world to wean itself off its extreme dependency on oil. I say that as a former oil trader and as someone who has been steeped in the industry for more than 20 years. May I therefore declare my interest in the sector, and make reference to my declarations in the register, the annual printed version of which is due to be printed soon?
We have called this debate to discuss an issue on which our economic survival depends. The security of our energy supplies, whether for lighting our homes, fuelling our cars or powering our industry should always be one of highest priorities. But now, as we look ahead to the next 10, 20 or 50 years, there are uncertainties and complications that never existed for previous generations, including rapid growth in the demand for energy, and the threat of a drastic climate change caused by burning fossil fuels. So, when we talk about energy security, we must acknowledge that there are three dimensions: supply security, climate security and price security. The need to resolve those three problems has become extremely urgent, and so far, a chronic lack of decision making has seriously compromised our ability to act and to adapt as needed.
Our understanding of the issue has dramatically changed over the past 20 years. I remember working with an oil company that used to specialise in supplying heating oil in winter to the fuel poor. Its promotional gizmo comprised a small Perspex cube containing a small quantity of oil, and printed on the outside was its proud slogan, Thank you for making the world a warmer place. I do not know what the company would happily print there today, because the whole world seems to be heating up.
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