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Almost three years ago, my right hon. Friend the Member for Witney (Mr. Cameron) and I called for an NHS constitution to be established in primary legislation, and the Government are now following our lead, but do their plans have the necessary purpose? The Government’s plan is to construct an NHS constitution that, by their own admission, does not extend new legal rights to NHS services. That is astonishing; their consultation
states to the public that they are not setting out to create any new legal rights. All the rights or pledges could be provided under existing powers. Even the much-vaunted new legal right to choose can be, and indeed probably will be, established by a direction issued by the Secretary of State under existing legislation. NHS bodies can already be required by direction under existing legislation to comply with any of these rights or pledges, and certainly to have regard to them.
So what does the Government’s proposal—the centrepiece of the Queen’s Speech so far as health is concerned—achieve? It achieves this: the Prime Minister said he wanted a constitution, so he has to have one. I wonder whether Ministers are even aware of how meaningless their response to the prime ministerial commitment has become. However, I think the public and the people who work in the NHS do know. The consultation issued this summer on the NHS constitution resulted in 1,008 replies to the Department of Health, including just 178 from NHS staff. That is not even one response for each NHS hospital; not even one in 5,000 NHS staff could be bothered to reply.
No doubt Ministers think that silence betokens consent. I do not think so; I think silence means contempt—contempt for the Government, where NHS staff feel that responding to the Government is pointless because they do not listen. In a top-down culture, what price consultation? When gimmicks abound, why should NHS staff have given this particular Government proposal any more credence? We will see whether Ministers listen to consultation. Three weeks ago, another consultation on the pharmacy White Paper ended, with 80,000 responses received. If consultation means anything, the Secretary of State will say this afternoon that the Government will make no changes to the existing GP dispensing arrangements because he has listened to the results of that consultation. I challenge him to do so.
Dr. Ian Gibson (Norwich, North) (Lab): I would be grateful if the hon. Gentleman repeated what he has just said. Did he say that the lack of response indicated consent or contempt?
Mr. Lansley: What I said was that Ministers probably think that silence betokens consent, but in my view silence means contempt— [ Interruption. ] No, I have said it twice, and that is sufficient, even for the purpose of educating the Secretary of State for Children, Schools and Families.
I regret the lack of engagement with the idea of an NHS constitution. My third point is about substance, and there is an opportunity for substance there. We could have had legislation in prospect that would genuinely put the values of the NHS into primary legislation. We could have NHS bodies given greater freedom and autonomy, which the Prime Minister said—before he became Prime Minister—that he favoured. It turns out that he is not remotely interested in giving those freedoms to the NHS.
A constitution could do what constitutions are bound to do—define in statute for NHS bodies, often for the first time, their respective duties and responsibilities, both within the service and towards patients. A constitution could give patients choice, and a voice, after the Government have so disgracefully dismantled any effective statutory voice for patients at a national level. It could also
strengthen the link between inspection and complaints. The Government have just legislated—wrongly—to remove from the new Care Quality Commission responsibility for the consideration of second stage complaints and hand it to the Parliamentary and Health Service Ombudsman. How can the new Care Quality Commission acquire and use intelligence about what is happening in the NHS if it does not have a responsibility to investigate unresolved complaints?
The ombudsman will get £4.6 million, which is less than half the amount of money that is currently being spent by the Healthcare Commission—between £10 million and £11 million—on second stage complaints. The Government blithely assume that the number of second stage complaints going to the ombudsman will be about half the number that currently go to the Healthcare Commission, but there is no basis for that belief. It is at best naive and at worst dangerous. The system is at serious risk, and if that carries on, the NHS will not be the learning organisation that it should be. I urge the Government to reconsider.
The opportunity is there for a health Bill in this Session that could make a real difference. Typically, the Government have failed to take that opportunity. The Secretary of State is pursuing a “do nothing” strategy for the Department of Health—least said, soonest mended. We should not be surprised by that, because before he became Secretary of State he described his approach to his responsibilities. He said, “I just drift along.” At least that provides plenty of room for his Under-Secretary, Lord Darzi, to hog the limelight. It is a pity that Lord Darzi has not understood that he is just window dressing for a Government who are chronically incapable of delivering.
I shall give one example. Hon. Members will recall that in October 2007, in anticipation of a general election, Lord Darzi was prevailed on to publish rapidly his interim report. The headline proposal was the Health Innovation Council, which Lord Darzi was to chair. Many people were prevailed on to become members of the council. It was announced that it would spend £100 million on a new health innovation fund—half from the Wellcome Trust and half from the Government. The details of the fund were to be published early in 2008, bids would be sought by the second quarter of 2008 and innovation would, as a consequence, flow throughout the NHS. What happened? The council met, twice, for rather inconclusive discussions; no details of the fund have been published; no bids have been sought; no money has been offered; and nothing has happened. It has all just drifted, again.
Mr. Stewart Jackson (Peterborough) (Con): On the subject of platitudinous Labour soundbites, perhaps my hon. Friend recollects a vintage example of the genre—the 1999 pledge by the former Prime Minister, Tony Blair, that within the following two years everyone would once again be able to see an NHS dentist just by phoning NHS Direct. Does my hon. Friend share my concern that since then 1.2 million of our fellow countrymen and women have lost access to NHS dentistry, including many thousands in my constituency and his?
Mr. Lansley:
I am very concerned about that. The House will have an opportunity next Thursday to debate dentistry, but the Government should be ashamed of
the current position. As my hon. Friend rightly says, we were promised in 1999 that everyone would have access, but the consequence of the Government’s contract is that 1.2 million fewer people have access to dentistry.
The Government also promised that the change in charging for dentistry would be neutral, in the sense that the amount raised through charges would not increase as a proportion of dental expenditure. That did not happen either. The latest figures published by the Government suggest a 14 per cent. increase in dental charges in the latest year alone. That is about £65 million extra from dental charge income. Patients are paying more, fewer have access, and the dental contract is not delivering as it should.
Mr. Lee Scott (Ilford, North) (Con): Does my hon. Friend share my concerns about orthodontic provision? Children have to travel vast distances for such provision and wait up to two and a half years for those services.
Mr. Lansley: My hon. Friend is right. The great bulk of orthodontic work is provided privately, but work for children whose oral health would otherwise be prejudiced is done through the NHS. That is very difficult to access, and can often lead to the circumstances to which my hon. Friend refers. It is important that we ensure that children get good access. I was in a hospital recently and the staff told me about the rising numbers of children with dental caries presenting to hospitals as a consequence of an inability to access NHS dentistry. That will get worse. I do not know whether Ministers are aware of it, but from the coming year many primary care trusts will tell their dentists that they cannot have children-only contracts. So NHS dentistry will be taken away from children whose parents are not accessing NHS dentistry. That is a scandal, and I hope that Ministers will do something about it.
Mr. Kevin Barron (Rother Valley) (Lab): Does the hon. Gentleman think that it is right and proper that dentists should say to parents, “We’ll look after your children under the NHS if you take out private insurance with us”? Does he agree that those dentists should be ashamed of blackmailing individuals in that way?
Mr. Lansley: The right hon. Gentleman makes a different point. I am not asking dentists to tell parents that they should be private patients. The point that I am making is that dentists who offer NHS services should not take NHS access away from children if they are already registered with them. That is what will happen. If he is suggesting that we should see the number of children accessing NHS dentistry falling, with all the potential consequences for poor oral health, I would be surprised. That seems contrary to many of the things that I have heard him say in the past.
A central and joint responsibility for both Secretaries of State—and also at the centre of our concerns—is children’s health. The Department for Children, Schools and Families is pushing for a child health strategy to be published, but the Department of Health is letting that drift. That will not do. I hope that the Secretary of State for Health will now tell us when he will publish that child health strategy.
Drift will not do either when it comes to the protection of vulnerable children. The Secretary of State for Children, Schools and Families has responded to the latest tragic
events in Haringey by announcing a review by Herbert Laming and the establishment of a task force. The Select Committee was told yesterday by Ofsted that three children a week die from abuse or neglect, which is a compelling case for urgent action.
The joint area review of children’s services in Haringey illustrated one of the important points with painful clarity:
“the reliance on national and local performance indicators is too great and does not enable understanding of the quality and effectiveness of service provision on the ground.”
When we respond, as we must, to the tragic baby P case, I hope that Ministers recognise—and perhaps will use this afternoon to say—that constant structural change and a tick-box, top-down attitude will not do for protecting children. We have to move on from that.
Like other hon. Members present this afternoon, I remember when the then Secretary of State, the right hon. Member for Darlington (Mr. Milburn), responded in the House to Lord Laming’s report on the Victoria Climbié inquiry. He announced the creation of children’s trusts, even though Lord Laming had not recommended them. That is an example of the Government offering a structural solution that Lord Laming had not asked for. It did a disservice to Lord Laming’s report from six years ago to offer a structural response to the problem that he identified.
In his report, Lord Laming stated:
“I am convinced that it is not just structures that are the problem but the skills of the staff that work in them...The single most important change in the future must be the drawing of a clear line of accountability from top to bottom without doubt or ambiguity about who is responsible at every level for the welfare of vulnerable children”.
How can it be that, six years later, it took weeks of public pressure in the same borough of Haringey for such accountability to be brought to bear, for the facts to be exposed and for those at the most senior levels to accept responsibility? We must all take responsibility for the fact that things that Lord Laming asked for, and which were understood early in 2003, were clearly not being put into effect culturally in the social work profession and in those services with responsibility for children. It is important that we make sure that that accountability is in place now, and that we recognise the need for improvements in skills.
In 2006, in the absence of Government action in that respect, my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton), set up the Opposition’s own commission to look into how to improve the training, recruitment, status and perception of social workers. Its report was published in 2007, and I urge the Government to look at some of the examples that are available, including work done on this side of the House. Instead of starting again from year zero, with another task force and another report that will take a great deal of time to prepare, they should think about how we can do things.
I shall take one example from our report. It suggests that we should recognise that experienced social workers far too often go into hierarchies of management and are not retained on the front line. The report proposes that we should recognise the need for them to be retained in front-line care and that, to make that happen, we should create a structure of consultant social workers.
I urge the Government not to push every issue off to a new review or task force. We need to think—by all means on a cross-party basis—about the things that need to be done now that we know can make a difference in the short term.
The Secretary of State for Children, Schools and Families (Ed Balls): I am grateful to the hon. Gentleman for giving way. For the most part, we have proceeded in this matter in a cross-party way. I am pleased that he recognises the importance of Lord Laming’s original report, and that he welcomes the urgent progress report that I have asked Lord Laming to compile. Does the hon. Gentleman think that Lord Laming is the right man to do the progress report?
Mr. Lansley: I do. The right hon. Gentleman may or may not recall that I was vice-chair of the all-party parliamentary group on child health when Lord Laming produced his original report. I had my own debate on child health at the time and did not share some of the concerns expressed in that report. As I have said, that report concentrated on structures and did not focus enough on the importance of skills, leadership and accountability in the social work profession. It discussed those matters, but it has not been acted on sufficiently. I have no difficulty accepting that Lord Laming is capable of finding out why his earlier recommendations in that regard are not being implemented.
My point is that Lord Laming can produce a report, but that does not mean that the things that need to be done will get done. We have to be aware of what needs to be done, and producing reports is not the sole answer.
John Hemming (Birmingham, Yardley) (LD): I met Lord Laming on Monday to discuss the review that he is to undertake. Does the hon. Gentleman share my concern about the narrowness of its terms of reference?
Mr. Lansley: I confess that I have not read the terms of reference of Lord Laming’s review, so I shall leave that question to my hon. Friend the Member for Surrey Heath (Michael Gove), who may want to refer to it later.
I return now to the Government’s legislative intentions. The Secretary of State for Health announced this week that the Government are going to remove point-of-sale displays for tobacco products. I hold no brief for tobacco—I wish that no one were a smoker—but how can it be legal for a shop to sell cigarettes to adults but illegal for it to put such products on a shelf? What is the point of the Government constantly mandating increasingly alarming labels for cigarette packets—as the Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo), did recently—and then require them to be hidden? How can they say that their proposal is aimed at sales in shops of cigarettes to young people, when we legislated less than two years ago to make it illegal for shops to sell tobacco products to under-18s?
The day before yesterday, the Government claimed that removing displays of cigarettes can reduce smoking prevalence among young people by 10 per cent., but the evidence from other countries shows that similar bans have not had that effect. It is true that smoking prevalence rates among 15 to 19-year-olds in Canada declined after 2002, but that cannot be attributed to the removal of
tobacco displays. The provinces that removed tobacco displays achieved a success rate broadly equal to those that did not, so the ban apparently had no great effect. In Iceland, Government statistics show that the display ban had no impact on the number of 15 to 19-year-olds who smoke—in fact, the proportion rose from 14.4 per cent. to 15.2 per cent.
Many small businesses will be hit by the proposal, and it is simply not good enough to say to them that the Government have the best interests of public health at heart when the evidence to back that up is not there. The Norwegian Department of Health and Care Services said last year that
“there is yet no scientific study published that definitely shows the impact that a ban against public display would have on the number of people who smoke”.
Norman Lamb (North Norfolk) (LD): Is the hon. Gentleman aware of the recommendations from the World Health Organisation? It set out six priorities for action to tackle smoking, but none of them refers to the removal of tobacco displays in shops.
Mr. Lansley: Yes, I recall that report, which contained no such reference. If international example and guidance are important, we should listen to them.
No doubt we will have this debate when we discuss the health Bill, but Ministers have had an outing this week on the basis of evidence that has been reported in an uncritical fashion. It is rather important that we in this House base our arguments on the evidence.
Rob Marris: I am listening carefully to the hon. Gentleman. I have not yet made up my mind about the issue, but it strikes me that if a ban on display does not work, sales will not be adversely affected and corner shops will not suffer. If corner shops were to suffer as a result of a ban, the ban would be working in cutting tobacco sales. Which is it?
Mr. Lansley: No, it would raise the question why the ban does not work, because the percentage of illegal sales is already high. If one removes the point of display, there may be an impact not only on costs but on the proportion of sales going through small retailers rather than the illegal trade. I am surprised that the Government are not more concerned about protecting their income. If they want to do something about the issue, we have suggestions. There are things that can be done on enforcement against the illegal trade, which would at least mean that the price of cigarettes would have an impact on smokers, many of whom do not realise what the real cost of tobacco, including duty, would be if they had to pay it. There is much that we can do on nicotine patches, such as ensuring that the right strength of patch is available to help habitual users of tobacco.
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