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Let us see whether this ten-minute Bill causes the supermarkets to act and to make a commitment to act in the next few days. If they do not, not only will I be disappointed by the claimed intentions of supermarkets
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not being followed up with action, but I will also feel that the prognosis for the environment as a whole is grim indeed.

Question put (Standing Order No. 23) and agreed to.


That Clive Efford, Steve Webb, Norman Baker, Peter Bottomley, Andrew George, Mr. David Drew, Jim Dowd, Mr. Michael Meacher, Mr. Andrew Dismore, Ms Karen Buck, John Austin and Mrs. Ann Cryer present the Bill.

Clive Efford accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 30 April and to be printed (Bill 81).

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Opposition Day

[5th Allotted Day]

Health Care in London

Mr. Speaker: I inform the House that I have selected the amendment in the name of the Prime Minister. The House will also be conscious that I have imposed a limit of eight minutes on Back-Bench contributions both in this debate and in the second Opposition day debate.

3.49 pm

Mr. Andrew Lansley (South Cambridgeshire) (Con): I beg to move,

Members of the House, particularly the many with London constituencies, will be aware that for the past two years there has been a process called Healthcare for London, which has increasingly sought to prescribe to the health economies across London how they should design their services, which services should be provided and by whom, and, by implication therefore, where patients should go for their treatment. The purpose of the debate is to give the House, for what I think is the first time, the opportunity to express a view on how we want health care services in London to be provided in future. We want literally to fire a shot across the bows of those in the upper hierarchies of the NHS who want to determine these things without reference to the public whom they serve, to the general practitioners who refer patients, or to the patients themselves, who have a right to exercise choice. We also want to give the House an opportunity to set out how it wishes Healthcare for London to be improved in the years ahead.

My first point is at the heart of improving health outcomes. We need to focus on improving public health in London, which has some of the greatest health inequalities in the country. At ward level, between Tottenham and Kensington and Chelsea, for example, there is a disparity in life expectancy of 17 years. I know that such disparities exist in other parts of the country, but those are very pronounced. We feel the issue even more keenly when we see such relative wealth and poverty side by side in London, where nearly one in four children live in poverty.

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There are many specific health problems that are greater in London than anywhere else in the country. The level of sexually transmitted infections is higher in London than anywhere else, and the level of alcohol abuse and dependency is higher than in any other region in the country, as is the level of drug use and abuse. We know-not least because London is where many refugees, asylum seekers and, indeed, rough sleepers are found-that London has 40 per cent. of the total number of tuberculosis cases in the country and more than 50 per cent. of HIV cases. The importance of having an effective public health strategy must be at the heart of this issue.

I commend the Mayor of London for the health inequalities strategy that he published last October. I shall not dwell on that at length, although there is plenty of reason to do so, because time will not permit it. The document that I published with my right hon. Friend the Member for Witney (Mr. Cameron) in February was about focusing on public health, having a dedicated public health budget and having a health premium that is intended to support successful local strategies.

In the London context, I want to make it clear that if we were given the opportunity to do so by the electorate of London, we would equip the local NHS with individual London boroughs to pursue locally owned strategies to improve public health. We also intend that the NHS should co-operate, on a London basis, directly with the Mayor of London to pursue the health inequalities strategy. Given the particular characteristic of London as a city with city-wide government, we want that city-wide government to bear down on the particular public health challenges that I have mentioned and to exploit opportunities for promoting better health in London, and I know from my conversations with the Mayor that he is immensely keen to do that.

The Minister of State, Department of Health (Mr. Mike O'Brien): I share the hon. Gentleman's concern about health inequalities in London, and I am curious to know how much money he would transfer from Chelsea to Haringey, for example, to deal with those relative inequalities.

Mr. Lansley: As the Minister is in no position to tell us what the spending in individual primary care trusts will be beyond 2010-11, I shall not take any lectures from him on this. What we are clear about-this has never happened under a Labour Government-is having a direct focus on public health outcomes and a determination to use the resources of the NHS to reward successful strategies. It is understood as well in Kensington and Chelsea as it is in Haringey or Tottenham that the places with the worst current health outcomes should be where we focus our public health resources not only to improve everybody's health but to narrow those health inequalities.

Tom Brake (Carshalton and Wallington) (LD): Will the hon. Gentleman give way?

Mr. Lansley: In a second, as I want to make the point set out in our motion. We have previously given Ministers a chance to be clear about what implications and opportunities will arise for the NHS and London through the Olympics. Clearly, the games represent a very great opportunity in public health terms, and we have to
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make sure that the legacy will be realised. However, some very particular costs will arise in 2012 itself, and I think, from what he said two or three weeks ago, that the Minister has estimated them to be in the order of some £30 million.

When he replies, I hope that the Minister will tell us precisely what the costs are. What commitments on costs have been given to the London Organising Committee of the Olympic Games, and how does he intend them to be met in the NHS in London during 2012?

Tom Brake: I thank the hon. Gentleman for giving way. On the subject of implications, will he make it clear to the House whether there are any implications for the Better Healthcare Closer to Home programme, which affects residents in Sutton and Merton? The programme would provide a new hospital on the St. Helier site, and local care hospitals in the area. Will he confirm that the argument that he is deploying today about what should happen with the NHS in London will have no implications for that programme?

Mr. Lansley: I assure the hon. Gentleman that what I have said about public health will not impact directly on the availability of NHS services. I remind the House about the current level of spending on public health care in London through the Healthy Living programme. [ Interruption. ] The Minister might be interested in this, because 13 primary care trusts in London spend more on management than they do on public health under the Healthy Living programme.

Across London, the average spend on the Healthy Living programme is £38 a head, and average management costs are more than £30 a head. The total for management costs in London is £246 million a year, and that shows a rise of 22 per cent. in just the past three years. We want to cut those management costs by a third over the next four years. We will reinvest all the money, because we aim to protect the NHS budget and increase it in real terms every year. That means that we will be able to ensure that we have less bureaucracy and more promotion of public health.

Mr. David Burrowes (Enfield, Southgate) (Con): No areas of public health are more important than drug abuse and drug treatment. A great deal of public money has gone into them, targets have been set and a huge amount of management brought to bear, yet very little has been achieved in terms of outcomes or recovery from addictions. Is not that a prime example of Labour failure?

Mr. Lansley: Yes; my hon. Friend has made a very important point. We have to be focused on results. I am afraid that for too long parts of the country have said, "We have relatively poor outcomes, so we must have more money," yet the money has never been used to deliver proper results.

I make no pretence about the fact that it is a tough call. In straitened financial circumstances, we intend that the dedicated public health budget will rise in real terms, but we have to ensure that that will deliver results. As we made clear in our public health green paper, we believe that we stand a much better chance of achieving those results if we engage properly with local
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authorities and the NHS as a local strategy, with voluntary-sector bodies as deliverers. That approach will help charities and voluntary-sector organisations, when the results come through from the services that they provide, to believe that their funding will be locked in on a more permanent basis. That will be better than the constant flow of short-term initiatives that have so undermined them in the past.

Mr. Edward Davey (Kingston and Surbiton) (LD): Will the hon. Gentleman give way?

Mr. Lansley: No, as I want to make some points about the Healthcare for London programme.

In January, NHS London published an overall strategic plan, and we have begun to see some of the so-called "sector plans" for different areas of London. The plan for outer north-east London has been published and the one for north-west London has been leaked. In addition, people are speculating about what the implications might be for other places across London.

There are questions about the assumptions underlying the NHS London approach. It does not help that the text of the document published in January by NHS London is confusing and erroneous. The notes relating to the scenarios and the funding figures were transposed, they did not include the base case at all, and they were wrong. For example, there was a reference to 2.3 per cent. per annum funding growth in the next spending review period, which should have been minus 2.3 per cent. Essentially, NHS London is assuming that there will be unchanged real terms funding for the NHS all the way through to 2016-17. Alongside that, it assumes 3.5 per cent. cost inflation in the NHS. We need to challenge the assumption that costs can be accommodated in that way. NHS London also assumes 4 per cent. a year demand growth, which is not in line with the projections of national demand growth produced by the King's Fund and the Institute for Fiscal Studies.

We know what NHS London set out to do-make a set of assumptions, arrive at a big funding shortfall in 2017, and tell everyone that they must do the things that NHS London is calling for them to do-but let us leave that on one side.

Under any reasonable set of assumptions, we have to deliver efficiency savings and improving productivity in the NHS, including in London, in ways that have not been adopted in the past. Over the past 10 years, when funding for the NHS has more than doubled, how is it possible that in London there is still legacy debt of more than £500 million for the NHS trusts and a worrying number of financially challenged trusts, and very few of the changes that should have taken place in the NHS to redesign services and deliver care more appropriately and more effectively have happened? Perhaps the Minister will explain.

The moment when the financial pressures are assumed to begin is the moment when NHS London feels that it must start taking the management action necessary to respond to it. There has been a dereliction of duty. After a 20 per cent. increase in management costs and a £25 million management consultancy cost the year before last, many of the things that needed to be done have not been done.

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Robert Neill (Bromley and Chislehurst) (Con): My hon. Friend makes a powerful point. Is he aware that that concern is particularly reinforced in south-east London, where it seems that underlying assumptions based on a crisis-driven need to amalgamate three trusts into a huge super-trust are distorting the assumptions and the long-term planning, reinforced by the suggestion in documents seen by the South London Healthcare Trust, that the principal driver of this is to "right-size"-in other words, financially rectify-the enormous historic deficit that it inherited?

Mr. Lansley: My hon. Friend makes an important point. Experience suggests that merging three failing organisations does not make one big successful organisation. I hope I am proved wrong and that the South London Healthcare Trust succeeds in its objectives, but I am afraid that past evidence does not necessarily support that, and the trust has a massive debt.

The central issue is that NHS London is making extreme assumptions about the ability to transfer activity from within hospitals to a community context. Alongside that, it is assuming dramatic reductions in cost, which are not proven.

Mr. David Evennett (Bexleyheath and Crayford) (Con): My hon. Friend is making a powerful case. He has visited our area, south-east London, regularly to see at first hand the problems of health care that we had. The regrettable reorganisation that my hon. Friend the Member for Bromley and Chislehurst (Robert Neill) referred to is causing great concern locally about the provision and quality of health care that constituents will receive. There is failure in our area. What reassurance can my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) give our area about the future?

Mr. Lansley: I hope that I can give the reassurance that decisions will be made locally in relation to local needs, local patients' choice and GP referral decisions. My visit with my hon. Friend to his constituency, and the example of Queen Mary's hospital in Sidcup, begin to give the lie to the Government's amendment-in that none of the changes will happen unless and until new services have been developed. That is far from the case at the moment, and it is assumed that patients who are denied access to hospital services will simply be accommodated elsewhere in the community at a lower cost. The assumptions are literally heroic, stating that it will be possible for 55 per cent. of out-patient and 60 per cent. of accident and emergency attendances to take place in the community rather than in the hospital.

The Government cite the National Primary Care Research and Development Centre, which just over two years ago undertook a study on care closer to home, but that does not for a minute justify the 55 per cent. out-patients figure. All the examples are small-scale, and none systematically demonstrates a reduction in cost if one maintains quality, not least because good-quality community services often have to be delivered by the same hospital specialists-or certainly with them, and as a result of their training and co-operation. The Government cannot point to any evidence that supports their assumptions.

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Mrs. Theresa Villiers (Chipping Barnet) (Con): My constituents are hugely concerned about the future of Barnet hospital and Chase Farm hospital. Does my hon. Friend share their anger that the whole NHS London process has been so secretive, compounding fears that it is all about suiting the agenda of NHS managers, not patients?

Mr. Lansley: I entirely agree. My hon. Friend knows about this, because she, other hon. Friends and I have been to see the management of Barnet and Chase Farm Hospitals NHS Trust over five years to try to work out what they propose to do with Chase Farm hospital, and to argue the case for it. Time and again, in the private conversations that we have had, it was clear that options were not being presented. It was also perfectly clear that the management sought to prejudice the public consultation by tying up in advance the views of all the clinicians whom they employed. That is not satisfactory, either.

Richard Ottaway (Croydon, South) (Con): Does my hon. Friend agree that there is no better example of things not being done that ought to be done than the redevelopment of Purley War Memorial hospital, which is part of the Mayday Healthcare NHS Trust? In 2001 a pledge was given at the Government Dispatch Box to redevelop that hospital. Nine years later, nothing has happened and there are still no concrete plans for redevelopment. Can my hon. Friend assure me that a future Conservative Government will get behind the local authorities and deliver something for the people of south Croydon?

Mr. Lansley: I am glad that my hon. Friend has made that point, because I can give him that assurance. Indeed, I have made it very clear to the chief executive of the Mayday Healthcare NHS Trust that I shall support its action in seeking to develop Purley War Memorial hospital, and I am very pleased that Croydon council is getting behind the project, too, because the planning authority and the NHS trust must be willing to make it happen. That redevelopment is very important, because if the trust is to become a foundation trust that service needs to be provided and that project needs to go ahead.

Mr. Davey: I, too, deplore the secrecy of the process. Will the hon. Gentleman therefore join me, and his hon. Friends, in calling for the publication of many documents, including the McKinsey report that lies behind the process, and in my own area, the south-west London strategic plan, which contains many of the options that so concern people?

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