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If I may digress for a personal moment, my two hon. Friends reminded me in their speeches that 12 and a half years ago, shortly after I came here, my old politics teacher at Brentwood school in Essex retired. He visited Parliament for tea, and there were four of us who gave it to him: two Labour Members-the right hon. Member for Blackburn (Mr. Straw) and the hon. Member for Leeds, North-East (Mr. Hamilton)-along with myself and our former hon. Friend Howard Flight, the then Member for Arundel. Our teacher had taught us all
politics and inspired two Labour Members and two Conservative Members, which struck me as an admirable illustration of his capacity as a teacher. There were no Liberal Democrats, I hasten to add, as he was clearly a man whose inspiration to the art of politics obviously had all the right effects.
My hon. Friend the Member for Ribble Valley (Mr. Evans) echoed the point that was made by the hon. Member for Huddersfield about young people getting a bad press. He also touched on an important health issue. The National Institute for Health and Clinical Excellence has said in a decision-I hasten to add that it is a provisional decision-that it does not propose to recommend sorafenib as a drug for primary liver cancer, which is a very serious disease. Only about 5 per cent. of those diagnosed with primary liver cancer are alive five years after diagnosis. There has been an increase in the number of people with primary liver cancer of about three and a half times in the past 30 years, so the issue is important. Even though it may have limited effects, sorafenib is recognised as the only drug of its kind available for treatment, as most patients at that stage will be beyond surgery.
If the Government are talking about guarantees, as they are in the context of patients' rights in the NHS, we have to find a means by which patients recognise that they have guaranteed access in the NHS to the treatment that they need when they need it. With sorafenib, of course it is unacceptable for pharmaceutical companies to have limitless opportunities to produce new drugs and simply ask the NHS to pay any sum of money. That is why I have made it clear that it will be our intention, the electorate permitting, to move to a system of value-based pricing in the NHS, so that the reimbursement price to pharmaceutical manufacturers should reflect the value of that medicine-the therapeutic value, the innovative value and, where appropriate, the wider value to society.
On that basis, the question should never be, "Should this drug be available on the national health service?" if it is licensed and effective; rather, that drug should be available for patients, and clinicians should have access to it. Then the argument will be between us and the pharmaceutical companies about what the appropriate reimbursement is. However, if we all genuinely believe that patients must come first, we must ensure that they have access to the medicines that they need, so I am grateful to my hon. Friend the Member for Ribble Valley for making that point.
Mr. Evans: I listened to a patient speaking on the television this afternoon about the treatment that he receives. He gave the example of Norway, which is another country where the drug is made available. Does my hon. Friend agree that patients in this country who need that cancer drug will find it rather bizarre that it seems to be available in so many other European countries, yet not here?
Mr. Lansley:
My hon. Friend makes an important point. I remember talking to a consultant oncologist-working in bowel cancer, as it happened-who said that she was embarrassed at international meetings that her colleagues across the world had routine access to cetuximab to treat bowel cancer. She worked at one of the regional centres of excellence in this country, but every time she wanted to prescribe cetuximab for a patient, she had to
go through the long and bureaucratic process of explaining why it was exceptionally justified in the case of that patient.
Ministers asked Professor Mike Richards to undertake a report, which they then brought here and which the Secretary of State's predecessor said would mean that patients would get the drugs that they needed. That has not happened and we need a further reform to make it happen.
As I said, my hon. Friend the Member for Bexleyheath and Crayford talked about education, but he also mentioned Queen Mary's hospital at Sidcup. Having visited with him and talked subsequently to managers of the new trust formed in south-east London, I hope that additional services will be based at Queen Mary's in future. Looking at the population, there is obviously an opportunity for access to cancer services, for example, based at Queen Mary's. I hope that we can look to a positive future for hospital services based in Sidcup.
My hon. Friend the Member for Wycombe (Mr. Goodman) and I have often discussed maternity services. I share entirely his view that the NHS seems to be in constant revolution as an organisation. Organisational upheaval and reform do not seem to correlate well. The organisational upheaval over the past decade seems to have impeded reform rather than furthered it. It is therefore important for us, as my hon. Friend says, to give people structural stability while ensuring that the dynamic process of reform happens. One touchstone of that will be, as he has stressed in his own constituency, the need for patients and local clinicians to be able to make decisions about where services can best be provided. He has been an effective advocate on behalf of his constituents. For that and for all the other reasons that he demonstrated in his speech, we will certainly miss him after the election in this place.
The hon. Member for Mid-Dorset and North Poole (Annette Brooke) talked about the problems of child abuse and the number of children contacting ChildLine, and I note the extent to which children are now subjected to online bullying-cyberbullying. The other day, at Netherhall school in my constituency, I met a group of young people who I thought were doing an excellent job as cybermentors, in the school and online, to people who feel themselves victims of cyberbullying, helping them to deal with it effectively. That is just one more good example of the importance of recognising that there are many impressive young people doing very good things, which we should celebrate.
My hon. Friend the Member for Beverley and Holderness (Mr. Stuart) talked about home education, making some important points that tell us something broader about the nature of the relationship between the state and public services. Sometimes we have to trust people more. We have to trust that the decisions that parents make about their children and that patients make about their health care will sometimes, individually and in aggregate, be better than those made by a bureaucracy. I echo the point made by my hon. Friend the Member for Poole (Mr. Syms) when he said that decisions made in Dorset were better than decisions made in Whitehall.
The hon. Member for Bolsover (Mr. Skinner) made the only other contribution from a Labour Back Bencher. I have counted 11 Back-Bench contributions, two from
the Government Benches and nine from this side of the House. I am afraid that that is a telling and damning indictment of the Labour party's commitment to its own Government's legislative programme. It is the weak legislative programme of a tired Government clearly incapable of being supported by a tired Labour party that has run out of time, ideas and steam.
However, it turns out that one person who never runs out of steam is the hon. Member for Bolsover. His killer sudoku seems to be working. I must say to him that his point about the impact of an ageing population on demand for health care services was right. On that basis, my right hon. Friends the Member for Witney (Mr. Cameron) and the shadow Chancellor and I have made it clear that we are committed to real-terms increases for the national health service in the life of the next Parliament. I must tell the hon. Gentleman that that commitment has not been matched by his own Prime Minister or those on his own Front Bench.
My hon. Friend the Member for Ilford, North (Mr. Scott) talked about a meeting that he held last night in relation to the accident and emergency department at the King George hospital. He said, rightly, that we need to ensure-if necessary by imposing a moratorium after the general election, if the electorate permit us-that the proposals are not based on the impact of the European working time directive or a response to the failures of management. As my hon. Friend knows, there have been sequential failures in management of the health service in parts of north-east London, including his area. Rather, decisions about the configuration of services, particularly the commissioning decisions of local general practitioners, should respond to the needs and wishes of local people. There is no way that we should allow bureaucratic organisations to pre-empt access or service decisions made by local commissioners on behalf of local people under the sort of devolved decision making in the health service that we hope to introduce.
Mr. Scott: I do not wish to be cynical, but could the proposed cuts possibly be based on the fact that there is a £110 million deficit in the trust, which I believe is the worst in the country?
Mr. Lansley: It may well be. One of the worst reasons for denying people access to health care services is as a result of the failures of management that have allowed deficits of that kind to build up. If it is the consequence of inequalities of access under the funding formula, we need a more independent and transparent process, as my hon. Friend the Member for Wycombe rightly said, by which resources for the NHS are distributed across the country on the basis of a fair assessment of the prospective burden of disease in each area rather than on the Government's distorted funding formula.
We have talked a little about the NHS during our debate, but of course the Gracious Address does not actually refer to it. Health care is not mentioned in it. Arguably, then, on the basis of the Queen's Speech, this debate should not be about the health service. I think I know, however, why there was no mention of the NHS in the Queen's Speech; it is because the Government have no ideas about what to do in the NHS. Their reform programme has completely stopped. Three years ago, Tony Blair, who was then Prime Minister-
Michael Gove: Where is he now?
Mr. Lansley: Where is he now? I do not know. Perhaps he is somewhere in a corridor outside the Council of Ministers in Brussels-who knows? Three years ago, Tony Blair as Prime Minister said that there were drivers of reform in the national health service and that practice-based commissioning was going to be one of them. It stalled. The national clinical director for primary care at the Department of Health said the other day that practice-based commissioning was a "corpse" that was "not for resuscitation" and was
"certainly not seen as a major vehicle for change".
Payment by results, instead of payment by activity, is an absolutely instrumental process in trying to deliver the services we need in the NHS. It needs to be introduced and it needs to be reformed. It has stalled. Progress has not been made to the extent that it should have been. The Government literally took their feet off the accelerator on payment by results simply because they did not realise that it was bound to have an impact on the distribution of resources between hospitals. What they should have done is to move faster to a much more effective payment-by-results system that accurately reflected the costs of different procedures.
Payment choice is supposed to have been offered by April 2008, yet the latest patient choice survey shows that still fewer than half of patients feel that they have been offered any choice, while foundation trusts were supposed to be another driver of reform. Last year there were 28 new foundation trusts and there were 28 in the previous year; this year, there have been eight so far. The Health Bill of the last Session before prorogation showed the Government moving towards trying to de-authorise foundation trusts rather than to authorise more of them.
On the independent sector, the NHS should be open to new providers, which is also important, as my hon. Friend the Member for Surrey Heath made clear, in the schools context. The Government have gone into reverse. Instead of having a policy of any willing provider who will meet NHS standards within NHS prices, which is the policy that we have consistently argued for and I thought that the Government had accepted, the Secretary of State writes a letter to the general secretary of the Trades Union Congress announcing a U-turn, saying that the NHS is going to be a preferred provider. Frankly, he was saying, social enterprises and the independent sector can go hang. The right hon. Member for Darlington (Mr. Milburn), who is not in his place, described this as "a deeply retrograde step". He said:
"If we are going to drive efficiency, productivity and quality on the scale required, the last thing you do is renew a monopoly and say your existing provider is your preferred one."
So the former Secretary of State, who launched the NHS plan that the Government were supposed to be pursuing, himself says that the Government have abandoned the process.
The only thing that the Government did not include in the Queen's Speech-although they had previously suggested that it would be included-was the idea that their targets should be turned into guarantees. The guarantees to which they have referred do not seem to be the kind of guarantees described by the Secretary of State for Education; they are narrow-process guarantees.
The NHS equivalent of the education guarantee would be "All patients should have access to good-quality treatment when they need it, where they need it, and from the person from whom they wish to receive it." That is the sort of guarantee that we are seeking, but it is not the guarantee being offered by the Government. The Government's narrow-process target suggests that if a patient receives treatment within 18 weeks that is good enough, but there are many patients for whom it is not good enough. There are many patients whose maximum waiting time should relate to their condition and circumstances. Just as education should be built around the individual needs of children, health care treatment should be built around and assessed according to individuals' health care needs.
Because of the way in which the Government's target approach works, hospital clinicians often find that the bureaucracy has ordained that patients who have been referred should not see a consultant for eight weeks, and that a decision can be made after that. The consultant will suddenly find that a referral has been made without his or her knowledge, and that it relates to a patient who should have been seen on a more urgent basis. The problem is that patients are treated as if they were on a production line rather than on the basis of their clinical priorities. Identifying clinical priorities is central to providing patients with good-quality treatment in the future, although, in the case of many patients, that does not preclude the provision of quality indicators demonstrating the standard of treatment that should be provided. What I am saying-we have been saying it for a very long time-is only exactly what the Secretary of State himself said in January 2007. He said then:
"Overall, from 2009, there should be fewer national targets...Targets and priorities should be set locally wherever possible, within national service frameworks and national standards such as those set by NICE."
We are looking for quality indicators set by NICE-the National Institute for Health and Clinical Excellence-making it clear what should be the basis of a contract between the commissioners and the providers of health care services. When the Government talk about legally enforceable rights, what they mean is that, through the contracts, patients should have access to the rights to treatment that are specified in the contract between commissioner and provider. That is exactly what we are talking about, and that is the kind of guarantee that we should be talking about. What we need in future is for patients to know what are their entitlements to treatment, and to know that those entitlements are reflected in the commissioning undertaken by their GPs on their behalf. The Government's "legal entitlement" is no such thing. What they are describing is simply an expression of a wish in the NHS constitution-a wish that, if it is to become a reality, must be turned into the contracts made between commissioners and providers.
As I have said, the Government talk of guarantees, but where is their guarantee of access to the medicines that patients need at the point at which they need them? Where is their guarantee that patients will have access to a "zero tolerance of infection" environment in hospitals? We may talk of waiting times, but there is clear evidence that patients also want-perhaps want even more-to know that they are entering an environment in which they are much less likely to acquire an infection. The Government have not offered that guarantee, and, in
fact, the number of MRSA infections acquired by people in hospital is now three times higher than it was in 1997.
Where is the Government's guarantee of access to choice in maternity services or in end-of-life care? Where is the guarantee of access to local accident and emergency services to which my hon. Friend the Member for Ilford, North referred? If the Government are talking about guarantees and access, why are those kinds of access completely left out? If we then go down the path of making sure patients have such access, and we focus on the degree of quality that needs to be built into decisions on the purchasing of health care, we can concentrate on the outcomes. We can then move beyond the narrow targets that have been the obsession of this Government and that have distorted clinical priorities-and that in places such as Stafford have led, frankly, to the death of many patients who were discharged from accident and emergency departments on to wards to languish and to die. We can then also start to make up the difference between where we are and where we need to be in respect of so many of our key, great public services, including education and health.
There remains a persistent and unacceptable gap between the quality of outcomes achieved in this country and those achieved in some of the leading countries elsewhere in the world. In respect of health, since 1997, despite increasing spending threefold-as the hon. Member for Bolsover said-our ranking among European countries on deaths from disease has slipped from ninth to 10th. More people die in this country from diseases that are amenable to health care than the average for Europe. We have fallen behind other countries in our deaths from cancer rates, too. Deaths from lung disease-such as mesothelioma, which the hon. Gentleman talked about-are 75 per cent. higher in this country than the European average. People in the United Kingdom are twice as likely to die prematurely from a heart attack than in the best performing country in Europe, which is France. That is where we need to be. We must have the ambition to have the best outcomes in Europe-not just to spend as much as other countries in Europe, but to have outcomes that are at least as good as any in Europe.
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