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4.54 pm

The Secretary of State for Health (Andy Burnham): I beg to move, That the Bill be now read a Second time.

As first days in a new job go, there must have been easier ones than this, but it is very good to be back and to be supported by an excellent new or nearly new team, in time to bring to the House a Bill that I can modestly claim to have had some hand in creating.

First, let me summarise what I think the Bill does. Building on last year’s 60th anniversary celebrations, it begins a new era in the national health service, in which quality becomes the focus of everything that the NHS does; the drive for quality is predominantly locally and staff led rather than dropped from on high; patients have more rights, choice and control over their care; prevention and health promotion truly come to the fore; and further reform can take place against the knowledge that NHS principles and values are secure and that the NHS will endure as the preferred British model throughout the century.

We build on a position of strength, banking the huge progress that the NHS has made in the past decade, but setting out a new direction for continued improvement in the next. By way of context, let me remind the House of some of the key developments of recent years.

In the past 12 years, the NHS estate has been transformed, with 100 new hospitals. NHS finances are secure, with more than a £1.7 billion surplus and only six trusts in deficit. Hospital-acquired infections are being tackled, with MRSA rates down 65 per cent. on 2003 figures. We now have the shortest waits in the history of the NHS, moving from the scandal of 18-month waits for operations to the landmark pledge that all patients are now seen in 18 weeks. On average, patients now wait only eight weeks for treatment and are seen by a specialist in two weeks if cancer is suspected.

Public satisfaction with the NHS is at a record high. The Care Quality Commission’s adult in-patient survey found that 93 per cent. of patients rated their overall care as good or better. That is conclusive proof that the NHS is Labour’s great achievement, and its revival in the past decade is arguably the Government’s greatest success story, which I intend to tell with pride and energy every day that I do the job.

Dr. Howard Stoate (Dartford) (Lab): May I be the first to congratulate my right hon. Friend on his new post? I am sure that he will do a splendid job, building on the amazing work that has already happened in the health service. Far from 18 weeks being the target, many people in my area are seen well before that. When I, as a practising GP, see somebody with suspected cancer, I can often get them seen in a few days. That was unthinkable five years ago. I therefore congratulate my right hon. Friend and the whole team on such a remarkable achievement.

Andy Burnham: I always bow to the wisdom of my hon. Friend. When I occupied the Minister of State position in the Department, I often talked about the 18-week commitment as the end of waiting lists. Conservative Members greeted that with derision, but that has happened, and my hon. Friend knows that better than anybody.

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That success and the others that I listed are due in no small part to the skill of my right hon. Friend the Member for Kingston upon Hull, West and Hessle (Alan Johnson), who—to paraphrase the hon. Member for South Cambridgeshire (Mr. Lansley)—is the postman who delivered. The Bill takes forward my right hon. Friend’s excellent work and that of my noble Friend Lord Darzi of Denham, providing the legal framework for the reforms proposed in the NHS next stage review, which was published almost a year ago.

Mr. Philip Dunne (Ludlow) (Con): May I be the first Conservative Member to congratulate the Secretary of State on his elevation? While revering his predecessor and his work in the Department, will he kindly undertake, as one of his first steps, a review of his predecessor’s decision in the past month to scrap the community hospital redevelopment fund building programme of some £500 million? It was announced to our strategic health authority, at great cost to the plans for redeveloping Ludlow community hospital.

Andy Burnham: I am sure that my right hon. Friend will be grateful for the hon. Gentleman’s reverence—I will be doing well if I get close to such praise. Obviously, I have not had time to examine that particular decision. I give the hon. Gentleman a commitment that I will do so and write to him.

The first chapter of the Bill relates to the NHS constitution and provides for further improving quality and giving patients greater say about their care. The Bill places a duty on all providers of NHS services to have regard to the first ever NHS constitution. It will also require the Secretary of State to review the constitution every 10 years and to report on its impact every three years.

The constitution is a landmark document. It sets out the rights and responsibilities of patients and staff, bringing together existing legal rights with commitments to deliver the standards of service that patients can expect from the national health service. However, the constitution is far more than a piece of paper. It provides three concrete legal rights for patients: first, the right to recommended vaccines under a national immunisation programme; secondly, the right to all National Institute for Health and Clinical Excellence-recommended drugs and treatments; and thirdly, the right to make choices about NHS care and the right to the information needed to make those choices.

The constitution belongs to every one of us. It reflects what people, patients and staff say they want to see in a 21st-century health service, and it commits the NHS to delivering on that promise, now and in the future. By placing a legal duty on all providers of NHS services to have regard to the constitution, we are reaffirming the right of patients to access the best possible treatment, while ensuring that the fundamental principles of the NHS are protected for future generations.

The proposal for an NHS constitution was the central recommendation of a report that I published for the then Secretary of State for Health, following a period of shadowing work at every level of the system. It is a pleasure to see the constitution as the centrepiece of the Bill, and I was encouraged by the wide welcome that it received when the Bill was in another place.

To improve the focus on quality, the Bill will place a legal duty on all NHS providers to provide annual quality accounts, in the same way that they are required
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to publish financial accounts. That information will be in the public domain, so that patients will have clear information on the quality of care provided by local health services. Lord Darzi’s definition of quality includes patient experience. The quality accounts will therefore cover not only the quality of clinical care, but whether patients feel that they have been treated with dignity and respect.

As Lord Darzi has pointed out, the NHS is good at invention, but it can be slow to adopt new technologies and treatments, and the spread of new ideas is variable. We are taking several measures to foster a more innovative culture in the NHS. NHS Evidence provides all the clinical and non-clinical evidence on new treatments and best practice in one place, through one easily accessible portal. The £220 million strategic health authority regional innovation funds will help front-line staff to develop, grow and spread new ideas, delivering genuine improvements in the quality of care that people receive. The Bill will provide further support for innovation by enabling the Secretary of State to make payments, as prizes, to promote innovation in health services. Innovation prizes will reward those front-line staff who have excelled and will encourage others to do likewise.

In order to give patients more choice and control over the care that they receive, the Bill brings forward measures that will enable the NHS to pilot direct payments, as part of a wider programme of piloting personal health budgets. Personal health budgets could work in many ways. The NHS is already setting up pilots where the personal budget is not physically held by the patient—rather, there is a notional amount—or where it is held by a third party on the patient’s behalf. However, where it makes sense, we also want to allow the option of direct cash payments to patients. The Bill provides powers for that, building on the experience of direct payments in social care, which have transformed the lives of many people over the past decade.

Bob Spink (Castle Point) (Ind): I congratulate the Secretary of State on his new post. Help the Aged, the British Medical Association and others have expressed concern about direct payments, which are to be piloted as part of the new personal health budget initiative. Will direct payments in any way remove patients’ human rights, and what happens to any underspend from them? Does it stay with the patient or does the patient pay it back to the NHS? There are genuine concerns about direct payments, so can we have a lot more meat on this bone?

Andy Burnham: I would say quite the reverse. The introduction of payments could help patients to secure their fundamental rights, particularly those that I mentioned earlier, as set out in the NHS constitution. I hear what the hon. Gentleman is saying, however, and there is a need to proceed cautiously. I looked at the issue when I was Minister of State in the Department, and I felt that although the idea had merit, there was a need to proceed cautiously. However, that is exactly what the Department is doing, with a programme of 70 pilots beginning next year. So we will listen carefully and work cautiously. The Minister of State, Department of Health, my hon. Friend the Member for Corby (Phil Hope) has done such good work in social care to unlock the benefits for patients of having more control over their care, and we now feel that there is merit in proceeding in this direction,
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especially when we can bring the two budgets together for people with particularly complex health and social care needs.

We are not being prescriptive nationally about how and where personal health budgets or direct payments should be used. Many of the primary care trusts that have applied to join the pilot programme believe that the arrangements could have the greatest impact for people with long-term conditions or mental health needs, but a range of innovative ideas is under consideration. However, we have set out a clear policy framework and guiding principles for how all types of personal budget will operate. Any budget should be spent on goods and services agreed in a care plan on which it is appropriate for the NHS to spend money, and there should be high quality advice and support to help people to manage their budgets properly. In the case of direct payments, the Bill and subsequent regulations will provide explicit safeguards. There will also be a robust evaluation to assess how personal budgets and direct payments can best improve the quality of care for patients.

Dr. Stoate: While my right hon. Friend is on the subject of direct payments, will he clarify what would happen if a patient decided to spend their budget on a clinically ineffective regime that did not deliver the goods? Might not that result in a fall-back on the NHS, which would have to pick up the pieces or repair the damage caused by ineffective or harmful treatments?

Andy Burnham: My hon. Friend raises a reasonable point, but as I said a moment ago, authorisation for direct payments will be given only for services that NHS money is normally used for, and they will form part of a care plan that will have been signed off by a clinician or a health service manager. Actually, there must be a role for the GP in this— [ Laughter. ] My hon. Friend is always looking for work. Perhaps GPs will be able to play a guiding role in helping people to explore options that might not be readily available through mainstream care. Obviously, we shall want to tease out all these points and, as I said to the hon. Member for Castle Point (Bob Spink) a moment ago, we shall proceed cautiously in order to pick up precisely the kind of concern that my hon. Friend has just raised.

Mr. Kevin Barron (Rother Valley) (Lab): I also congratulate my right hon. Friend on his appointment at the Department of Health. He talked about the evaluation of the personal budget pilots. Will the outcomes of the evaluation be published before anything is rolled out across the NHS?

Andy Burnham: I am grateful to the Chairman of the Select Committee for his kind congratulations. This is an issue on which I have not yet taken a firm view. I have seen the list of pilot projects; I believe that they exist in every SHA region and in many primary care trust areas. I hear what my right hon. Friend says and I believe that there should be careful analysis of what the pilots tell us before there is any rush in this direction. It is also important to acknowledge at this point that different issues arise in respect of health care and of social care. Health care can often involve more specialised or complex services that might require a critical mass of patients to support their continuation, for example.
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These are precisely the kind of issues that the pilots will test, and I give him a commitment that we will proceed with caution and, wherever possible, publish information as we go along.

In the case of direct payments, the Bill and subsequent regulations will provide explicit safeguards. There will also be evaluation. The Bill will ensure that direct payments could be extended more widely only in the light of evaluation and with the active approval of Parliament. I hope that that will give my right hon. Friend further reassurance; Parliament would have to endorse any further development of direct payments.

The second part of the Bill establishes a new regime for NHS providers that have been performing badly despite interventions by primary care trusts, the strategic health authority or the appropriate regulatory body. The vast majority of trusts perform well, but in the rare instances where that is not the case, there must be transparent processes in place to deal with poor performance.

The Bill outlines the following measures, which would be taken only as a last resort and when other measures have failed. In such circumstances, the trust board would be immediately suspended and the Secretary of State would appoint an independent trust specialist administrator to review and consult patients, public and staff on the organisation’s future. Recommendations would be made to the Secretary of State, who would report to Parliament the final decision about the organisation’s future. These measures will provide protection against the possibility of allowing NHS providers that have consistently failed patients to continue indefinitely.

Mr. Peter Bone (Wellingborough) (Con): I congratulate the right hon. Gentleman on becoming Secretary of State for Health. Will he explain who would trigger the occurrence that he described? If, for instance, people disagreed fervently with a decision about a foundation hospital, who would trigger the decision about how to proceed? Would it have to be the Government or could the public be involved in it?

Andy Burnham: In the legal context, Monitor, as the authorising body of foundation trusts, would be responsible. The public could, of course, be involved and one hopes that a foundation trust would have developed better mechanisms for public engagement and consultation. Any information that came through that route would inform any decision that Monitor reached. As I say, Monitor is the decision maker in this context.

The administrator would review and consult patients and staff on the organisation’s future and then make recommendations to the Secretary of State. We believe these measures will provide protection against the possibility of NHS providers continuing indefinitely.

The National Health Service Act 2006 placed restrictions on the amount of income foundations trusts can earn from private patients. The private patient cap is automatically set at the proportion of private patient work a trust did in 2002-03. It was introduced because of the understandable concern that foundation trusts might expand private patient activity at the expense of the NHS. These concerns are still relevant today. Private care must not be delivered on NHS premises to the detriment of NHS patients, but the implementation of the cap has raised complex issues for some foundation trusts, which need to be resolved.

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An amendment was tabled in the other place to give the Secretary of State the right to grant exceptions to the rule that limits the amount of income a foundation trust can generate from private work, but I do not believe that this is the right solution. Striking the right balance between protecting NHS services for NHS patients and allowing foundation trusts the flexibility they need to operate in the interests of patients is a complex issue. There is no quick fix to implement, particularly without widespread consultation with the NHS.

Mrs. Jacqui Lait (Beckenham) (Con): I add my congratulations to the right hon. Gentleman, and I hope that he enjoys his tenure until the end of this Parliament. He refers to the income that foundation trusts can receive from treating private patients. I have received some briefing material from the Foundation Trust Network, one of whose chairmen is my constituent. The briefing points out that there are some perverse impacts on foundation trusts stemming from the cap on private patient income, which effectively limits some of the Government’s own proposals for the health service. I do not want to get into a Committee stage debate, but will the Secretary of State provide an indication of what scope there will be to ensure that the cap no longer creates such perverse incentives?

Andy Burnham: I am grateful for the hon. Lady’s congratulations. I have some aspirations to stay beyond the next general election—who knows; we will see. She raises a very fair point and it is also fair to say that my predecessor had acknowledged that although we did not want to accept what we saw as a quick fix from the other place, we nevertheless believe that there is a case to review the operation of the cap and how it affects foundation trusts. We appreciate that many trusts are in very different positions in view of their case mix, and we would like to work with the Foundation Trust Network to explore those issues as part of the review. As I say, we are committed to looking again at the cap’s operation, but we think it would be better done through a wider process of consultation with the NHS rather than by simply accepting the amendment from the other place.

Mr. Andrew Lansley (South Cambridgeshire) (Con): I join others in welcoming the Secretary of State to his new position. I shall say a bit more about that in a short while.

As a Back Bencher, the Secretary of State contributed to the debate on the private income cap during the Report stage of the Bill that became the Health and Social Care (Community Health and Standards) Act 2003. He therefore knows about this issue. He must be aware that the way in which the cap is biting on foundation trusts that are also mental health trusts, which have had virtually no private income, is preventing them from supplying services to, for example, the private companies that are acting as employment providers under the new deal. It is having potentially significant perverse effects.

I hope that the Secretary of State has noted that his noble Friend Lord Warner, who moved the relevant clause back in 2003, said in another place on 12 May this year:

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