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There is a lack of practical action when there are things that ought to and can be done to help people facing the risk of unemployment. The Secretary of State for Health knows that rolling out cognitive behaviour therapies, which the Government are committed to do, can and should be achieved across the country, rather than only in certain areas. In 2004, Lord Layard told the Government that we needed 10,000 more cognitive behaviour therapists. The Government are committed to 3,600 but only over the next three years and only in
one in seven primary care trusts. Given the current unemployment risks, it must be right for such therapists to be available throughout the country.
We know that the impact of such therapy can be substantial; it can double the rate at which people who lose their employment get back to work. The evidence suggests that an increase of 1 per cent. in unemployment would lead to a 7 per cent. increase in demand for mental health services. We know where the biggest short-term demand for health services will be, but we do not have a strategy to respond to it.
Norman Lamb: Does the hon. Gentleman agree with the Liberal Democrat view that there should be an entitlement within a defined period to access treatment such as CBT, which has been approved by the National Institute for Health and Clinical Excellence as an effective treatment, especially as all the evidence suggests that early access to such treatments has a disproportionate impact on individuals suffering from anxiety or depression?
Mr. Lansley: No, I do not propose to go down that path, which involves simply reintroducing more targets. We need to ensure that capacity is available rather than simply setting targets.
The Government have, of course, set plenty of targets, and I shall remind them of one. In 1997, Labour told us that their plan for the NHS was
“rooting out unnecessary administrative cost”.
In 2006, Members will recall—because there was so much argument about it—that the Government proposed to halve the number of primary care trusts from 303 to 152. They told us that it would save the taxpayer £250 million by reducing management costs. What happened? In 2005-06, the management costs of PCTs were £1.09 billion. By 2007-08—only two years later—after reorganisation, the amount rose to £1.178 billion. The costs are not £250 million down, but £88 million up; an extra £333 million has gone into administration, which is not available for the front-line care that Ministers said that it would be used for. It is unbelievable. That is only one example, but there are many others.
Ministers constantly tell us about the importance of the front line, but the resources do not reach it, which is the experience of people right across the NHS. They are constantly told that they have resources, but they do not see the situation in the same way.
Rob Marris: Will the hon. Gentleman give way?
Mr. Lansley: No, I gave way to the hon. Gentleman earlier, and I want to finish my speech, because time does not permit me to go on too long.
Two years ago, my right hon. Friend the Member for Witney (Mr. Cameron) and I said that the Government and the NHS should focus on outcomes, not targets. This summer, Lord Darzi’s report endorsed the emphasis on outcomes, but it did not actually get rid of the targets. On Monday, the Secretary of State published the new operating framework and it is still littered with targets. We know what dominates the thinking of NHS managers—the so-called must-do targets, not the outcomes that in reality matter most for patients.
The Conservatives will focus on what we need to achieve the outcomes for the people whom we are here to serve, not on how people in services go about achieving them. Of course, performance management has to follow evidence of effectiveness and benchmarked performance,
but objective measures such as standardised mortality rates should be mixed with more subjective ones, such as patient experience and self-reported outcomes. All those things should also be benchmarked against the best in the world.
When evidence was published by the Healthcare Commission of the scale of adverse events and harm resulting to patients, it was entirely typical of the Government that their response was, “Well that’s all right, it’s about the same level as elsewhere in the world.” Ministers seem to be prepared to use international benchmarking only when it justifies the level of error in the NHS. They do not use international benchmarking for infections and admit that our MRSA rates are much higher than best practice or that our rates of clostridium difficile can be four times the average for other hospital systems. They do not use international benchmarks to admit that our cancer survival rate is a quarter worse than the best in Europe, that our stroke mortality is a third worse than Germany’s or that deaths from lung disease in the UK are two thirds worse than the European average. The NHS should be focused on those issues. That is what is most important, not whether every PCT sets up a Darzi centre.
The Government talk about world-class commissioning. We need world-class services, but we will not get them with a one-size, top-down bureaucratic approach. We will get them through innovation, professionalism, responsiveness to patients and the rigorous application of evidence-based care. Treat the staff of the NHS like drones, and they will behave like drones; trust them like professionals, and they will respond.
The Government have de-professionalised the NHS, which is why they have seen declining productivity year on year. That is why, despite their targets, performance has fallen short. Patient choice has diminished—fewer patients say that they have experienced access to choice—and practice-based commissioning has stalled. Patient experience measures have deteriorated, and the foundation trust programme has not met its 2008 targets. Health inequalities have widened— [ Interruption. ] The Minister of State says that I do not like targets. What is the point of targets if they do not deliver? What was the point of saying that every hospital should be a foundation trust by 2008, when only about half of them are?
The Minister of State may like to recall that back in 2006, Tony Blair described his four drivers for health reform—patient choice, foundation hospitals, independent sector treatment centres and practice-based commissioning. All four have stalled or disappeared from the reform process. The Blairite reforms have gone. What do we have in their place—world-class commissioning? It does not feel world-class yet.
We will not have world-class NHS services unless the Government recognise what is really needed—to trust NHS professionals, to make the service more accountable to patients, with less to top-down bureaucracy, to reinvigorate our public health service and to focus at every level on patient outcomes. We are committed to reforms that would make a real difference to patients and NHS staff. For the Government it is all Darzi or drift; it is about money spent and money wasted; it is all inputs and not enough outputs.
The Queen’s Speech is all short-term gimmicks and does not include the long-term reform that our great public services so badly need. The Government have run out of steam—they are out of ideas and out of time. I agree with my right hon. Friend the Member for Witney: bring on the election. I commend the amendment to the House.
1.49 pm
The Secretary of State for Health (Alan Johnson): I welcome this opportunity to debate the measures in Her Majesty’s Gracious Speech. The proposals on health set out how we will expand patient choice, enhance quality, protect the health of young people and safeguard the values and principles of the NHS for future generations. The proposals on education will provide new powers to improve standards in schools, provide greater opportunities for young people and improve the local organisation of children’s services to make them more responsive and accountable. The child poverty Bill will enshrine in legislation our intention to eradicate child poverty by 2020.
Eleven years ago, the NHS was on its knees, after nearly two decades of neglect and underinvestment. In schools, only 35 per cent. of pupils achieved five or more good GCSEs, including English and maths, and the Conservative Government were preparing to introduce nursery vouchers for early-years provision that was scant and inadequate. Now, we see improved standards, nursery places for all three and four-year-olds, new schools and hospitals, reductions in mortality rates from the three big killers—heart disease, stroke and cancer—and the best ever A-level and GCSE results.
By far the most damaging legacy of the previous Government was long waiting times, which delayed important surgery for many months and even years. By the end of 2008, no patient will need to wait more than 18 weeks from the time that they are referred by their GP for treatment, and the average wait will be no more than eight weeks. It is worth reflecting on the way that that enormous achievement by NHS staff has changed a mindset that became entrenched in the Conservative years. Only recently, a clinician at St. Thomas’s was telling me about how, in 1994, her chief consultant took his medical team out to dinner to celebrate the fact that they had reduced the waiting times for hip replacements from five years to three years. The chief medical officer tells of elderly patients in the 1980s seeking to bequeath in their wills their places on the waiting lists to family members, having waited years for a cataract operation. That was the reality of life in the NHS under the Conservative party.
Norman Lamb: I agree that substantial progress has been made on access to treatment, particularly in acute hospitals, but what about mental health? Does the Secretary of State agree that we need to tackle the outrageous waiting times in mental health care as well? People frequently wait more than a year for access to cognitive behaviour therapy. If they have the money, they can pay to go privately. If they have not got the money, they just wait. That must be tackled.
Alan Johnson:
That will be tackled. The hon. Gentleman is right to say that there are unacceptable waiting times in mental health care, but I will come on to mental
health in a minute. The leader of the Liberal Democrats described mental health as being in crisis in this country two weeks before the World Health Organisation said that we had the best mental health services in Europe. I will come on to mental health, because I believe that a chunk of time needs to be devoted to it.
Apart from waiting times, there has also been dramatic progress on tackling health care acquired infections. In September, we announced that we had achieved and exceeded our ambitions of reducing MRSA cases by half—achieving a 57 per cent. reduction in three years. In October, we announced that clostridium difficile cases had fallen by 38 per cent. among the over-65s. We have seen dramatic improvements in primary care. GPs see patients for longer—the length of consultations has gone up by 50 per cent.—and the number of consultations per year has risen from around 221 million in 1997 to nearly 300 million this year. Following the agreement reached with the British Medical Association earlier this year, which Opposition Members opposed, 65 per cent. of GP surgeries are now offering additional weekend and evening appointments—again, meeting and then exceeding our ambition, which was to have half of all surgeries opening for longer by the end of the year.
Mr. Edward Leigh (Gainsborough) (Con): Will the Secretary of State forgive me if I do not make a party political point and refer to the future, rather than the past? I am very proud of the fact that we are doing a lot of work with the National Audit Office in trying to raise up the agenda the Department of Health’s work on dementia, stroke and end-of-life care. I wonder whether he will say a word about his priorities now that he will address that problem. He has mentioned, of course, his efforts on cancer and heart disease, but dementia, stroke and end-of-life care are very important as well.
Alan Johnson: The hon. Gentleman is, of course, absolutely right. We published our stroke strategy a year ago, in December 2007, and everyone involved, including the non-governmental organisations and the Stroke Association, is very pleased with the progress that has been made. The hon. Gentleman is quite right to mention dementia. It is an important issue, and only a couple of weeks ago, I mentioned in a speech that cancer had a stigma 20 years ago—people did not talk about cancer in polite society—and that that was now the case with dementia. Of course, no one made jokes about cancer, but people make light-hearted references to dementia, which has to stop.
Our dementia strategy, which will be published shortly, will concentrate on raising awareness, removing the stigma and ensuring a better quality of care and much earlier diagnosis. A dementia sufferer usually goes to a GP about seven or eight times before dementia is diagnosed, so a lot needs to be done there as well. We published our strategy on end-of-life care four months ago. Once again, it entails working with the voluntary sector and NGOs to develop the ability to convince people that, if they choose to die at home, support services are available to them and their families to ensure that they will be okay. That is the biggest single reason why families are sometimes reluctant to allow their loved ones to come home.
Angela Browning (Tiverton and Honiton) (Con):
Following the NAO reports on dementia and stroke, the Government adopted the strategies that the Secretary
of State has discussed, and I am very pleased that they did so. When I have visited stroke units, I have found some excellent work going on. However, a physiotherapist told me that, once the person is discharged, so long as they can get around indoors, they then get virtually nothing at all—they go from very good support to nothing. Stroke victims need continuity of care when they go home. Is the right hon. Gentleman making plans to ensure that that support is provided?
Alan Johnson: The hon. Lady is absolutely right. That is why the strategy focuses on prevention, on what is done immediately someone has a stroke—thrombolysis and so on—and on a better quality of care. As important as all that is, however, as Macmillan has been saying for many years, aftercare back in the community is crucial. It is one of the three central features of the stroke strategy, and we intend to ensure that every aspect of that strategy is implemented.
Jeremy Wright (Rugby and Kenilworth) (Con): May I return the Secretary of State to dementia? He said that the national dementia strategy will be published shortly. As he knows, there are three elements to the welcome work that the Government are doing on dementia: first, there is the national strategy; secondly, there is the research summit; and thirdly, there is the review of anti-psychotic medication. The timetable has slipped quite significantly in relation to all those elements, and he will recognise the concern of all those involved that the urgency originally expressed by the former Minister with responsibility for care services, the present Under-Secretary of State for International Development, the hon. Member for Bury, South (Mr. Lewis) does not appear to have been persisted with, which is a matter of extreme concern. Will the Secretary of State assist us by saying exactly when each of those elements will be available?
Alan Johnson: I believe that the Minister of State, Department of Health, my hon. Friend the Member for Corby (Phil Hope) had a meeting yesterday with the all-party group that the hon. Gentleman chairs. The dementia strategy should be published very shortly—not before Christmas, but very soon in the new year—but getting a day in the grid is the problem. I believe that the review of anti-psychotic treatment will be ready by about the spring—it is on a slightly longer time scale. I am sorry, but I have forgotten the hon. Gentleman’s third point.
Jeremy Wright: The Government indicated that the research summit would be held this summer, but that did not happen. I take the opportunity to thank the current Minister with responsibility for care services for coming to the meeting. He explained that all those things will be available shortly, but I simply wonder whether we could have a little more specificity.
Alan Johnson: The hon. Gentleman is seeking a definition of “shortly”. The research conference will take place at about the same time as we publish the dementia strategy, so it should take place very early in the new year. I am not trying to be difficult, but the way in which this works is that we have to get our slot in the system, and I hope that we will get a date very soon.
Only two weeks ago, I opened the first GP-led health centre, in Bradford; the second opened on Tuesday, in
Corby. We were rather disappointed: we expected the Opposition Front-Bench team to be outside with placards, protesting vigorously, along with the BMA, but there was not a single protest. All we had was the local community, absolutely delighted to have that fabulous facility in their community. The centres provide access to primary care services from 8 am to 8 pm every day of the year, including Christmas day. The next year will see 152 such centres open, many of them offering additional services such as podiatry, physiotherapy or speech and language therapy. In addition, many will be able to perform minor operations and offer specialist services to patients with asthma or diabetes who would otherwise have had to go to hospital for treatment.
We are also funding 112 additional GP practices to provide much needed services for under-doctored areas, which, for the most part, have suffered from a chronic shortage of GPs since the NHS began. That is a vital step in tackling health inequalities. There is a clear correlation between limited access to primary care services and poor health.
Mr. David Chaytor (Bury, North) (Lab): On that very point, my right hon. Friend knows that I have invited him to my constituency to open the new Moorgate medical centre. The centre is now open and patients are benefiting from it. It is of enormous value to my constituents, who welcome the investment that paid for it. May I repeat my invitation to him to perform the official opening function in a few weeks’ time?
Alan Johnson: I am pleased to hear that. I think my hon. Friend is duty bound to inform the local population that the Conservative party opposes GP-led health centres, saying that they will lead to 1,117 GP practices closing. Have any closed or are any likely to close in his constituency? I expect that experience to be repeated throughout the country.
Mr. Lansley: I suggest that the Secretary of State should indeed go to Bury. As well as seeing the centre that the hon. Member for Bury, North (Mr. Chaytor) mentions, the right hon. Gentleman could take the opportunity to go to Fairfield hospital and shut the maternity services there at the same time.
Alan Johnson: Once again, the Opposition use that tactic. They said in a press release issued in summer 2007 that 29 hospitals were going to close; immediately, 15 of those hospitals pointed out how wrong they were. A hospital that they said was going to lose its accident and emergency department did not even have an A and E department. Then, the Opposition moved to arguing that 1,117 GP practices would close if GP-led health centres opened, because, they said, each centre would have 20 GPs. In fact, the most each centre will have is five. They were wrong on every count.
Mr. Chaytor: Will my right hon. Friend give way?
Alan Johnson: Now, the Opposition are mixing up two separate issues: the reconfiguration of maternity services—which I am sure my hon. Friend will mention when I give way to him—and GP-led health centres.
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