Helen Jones (Warrington North) (Lab): On a point of order, Mr Speaker.
Mr Speaker: Order. It would not be a point of order, now, I am afraid.
1. Philip Davies (Shipley) (Con): For what reasons he has ended the Building Schools for the Future programme for Ilkley and Bingley grammar schools. 
The Secretary of State for Education (Michael Gove): As I set out in my statement last week, the Building Schools for the Future programme has been over-bureaucratic and inefficient. I therefore decided that where financial close had not been reached, future projects provided under BSF could not go ahead. Ilkley and Bingley grammar school projects have not reached financial close, and BSF plans for those two schools have therefore stopped. However, we will continue to invest in schools capital projects.
Philip Davies (Shipley) (Con): In the catchment areas for both Ilkley and Bingley grammar schools, there has been excessive house building, so there is no longer sufficient capacity on their existing sites to meet local demand. Can my right hon. Friend ensure that those schools that need new build to increase capacity to meet local demand will still receive capital expenditure?
Michael Gove: I very much take the point made by my hon. Friend. One of the defects of the BSF scheme was that, in many parts of the country where there was real need as a result of a growing population, the money was not there to provide new school places. As a result of our capital review, we will ensure that where there is additional population pressure and additional basic need, particularly in primary schools, which BSF did not cover, we will provide the support that is necessary. I look forward to working with my hon. Friend to help the parents and teachers in those two great schools.
Ed Balls (Morley and Outwood) (Lab/Co-op):
For parents, children and teachers in Ilkley and Bingley, the initial shock of learning that their new school building has been cancelled will have turned to outrage at the
seemingly arbitrary and chaotic way in which the Secretary of State has made and announced his decisions. The right hon. Gentleman must now know that there is widespread anger in all parts of the House. Following weekend reports that he was advised by his officials not to publish a list of schools at all, I wrote to him yesterday to request answers in advance of today's oral questions. I have received a reply that does not answer any of my questions: it merely attaches a new list-list No. 5-containing 20 additional cancelled schools compared with a week ago.
I shall ask the right hon. Gentleman for a straight answer to a specific question. Did he at any point receive written or oral advice from departmental officials or Partnerships for Schools urging him not to publish a list of schools until after he had consulted local authorities, to make sure that his criteria were sound and his facts were right?
Michael Gove: The right hon. Gentleman says that there was anger across the House. There was-at the way in which the BSF project had been run by the right hon. Gentleman. There was justifiable anger at the way in which a project that was originally supposed to cost £45 billion ended up costing £55 billion, and it was shared by those who were shocked that under the previous Government, one individual received £1.35 million in consultancy fees-money that should have gone to the front line. From the moment that I took office, everyone involved in this process said to me, "Make sure that you ensure that this faltering and failing project ends." That is what I have done. I inherited a mess from the right hon. Gentleman, and we are clearing it up.
Mr Speaker: Order. Both the Secretary of State and the shadow Secretary of State have had their say, and I know that we will now want to return to Ilkley and Bingley.
Ed Balls: The right hon. Gentleman cannot give a straight answer to a straight question. The people of Bingley and Ilkley will not be satisfied by that answer, and nor are we. Interestingly, his letter today says very clearly that his fifth list has been validated by local authorities-presumably a clear admission that the information should have been validated before the list was published in the first place, including by Bradford authority, in which the schools of Bingley and Ilkley are situated.
Let me ask the right hon. Gentleman another straight question. Is it not the case that he was advised of the risk of legal challenge from private contractors, but that he personally decided to ignore that advice and take that risk with taxpayers' money? That is a very simple question. We all know that he is on shaky ground, and that he is fast losing the confidence of pupils, parents and teachers. If he had any sense, he would end this shambles, withdraw these error-strewn lists, and let our communities have new schools.
I am grateful to the right hon. Gentleman for once again stretching so far the geographical definition of Bingley and Ilkley. Let me point out that under him the cost of setting up the procurement vehicle for Building Schools for the Future was £10 million, before a single brick was laid. The taxpayers of Bingley and Ilkley have
re-elected a Conservative MP because they are disgusted with the waste and squander of the right hon. Gentleman. There is a dividing line between this side of the House and that side of the House: when mistakes are made, we apologise and we take responsibility. The right hon. Gentleman has never apologised for a single mistake in his life; that is why he is on that side of the House and we are on this side of the House clearing up his mess.
Mr Speaker: Order. I want to help the House. I appreciate the enormous interest in the subject of BSF in Ilkley and Bingley-conceivably also elsewhere-and there will be opportunities, if Members look, to raise these matters later.
3. Julian Smith (Skipton and Ripon) (Con): How many expressions of interest in academy status have been received from schools in (a) Skipton and Ripon constituency and (b) North Yorkshire. 
The Minister of State, Department for Education (Mr Nick Gibb): So far five expressions of interest in academy status have been received from schools in Skipton and Ripon. Fifteen expressions of interest have been received from schools in North Yorkshire.
Julian Smith: Does the Minister agree that schools with foundation trust status should be given credit for the work they have already done in moving along the path to independence, and can their path to academy status therefore be made slightly easier?
Mr Gibb: May I welcome my hon. Friend to the House and congratulate him on his election? I understand his point. Trust status was a useful form of independence, which is why it surprises me that Labour Members are so critical of our moves to boost the academies programme and to give more schools the independence and the trust in professionals that is inherent in the trust school system. Our concern about the trust school basis is that it did not give sufficient freedoms to schools; we want to ensure that schools have those extra freedoms.
Tristram Hunt (Stoke-on-Trent Central) (Lab) rose-
Toby Perkins (Chesterfield) (Lab) rose-
Mr Speaker: Order. May I gently say to Members that Stoke-on-Trent and Chesterfield are a considerable distance from Skipton and Ripon and, more widely, North Yorkshire? This is what we call a closed question, I am afraid.
4. Esther McVey (Wirral West) (Con): What steps his Department is taking through the education system to assist children from poor families. 
The Minister of State, Department for Education (Sarah Teather):
We have made a clear commitment to narrowing attainment gaps between children from disadvantaged backgrounds and their peers through our recently announced pupil premium. This will help
us to give more support to the children who are most disadvantaged and who need it most, and to their schools. We will announce more details of our proposals in due course.
Esther McVey: I would like to push the Secretary of State for greater details on the pupil premium and on where the extra funds will be allocated.
Sarah Teather: I thank my hon. Friend for promoting me, but it is a little premature.
We will be announcing more information about the pupil premium in due course. However, to quote the Prime Minister, it will involve a "substantial" extra sum from outside the education budget. We are determined, in particular, to tackle the pockets of deprivation that have not been dealt with by other forms of deprivation funding, ensuring that the funding follows the students and that schools then have the freedom to decide how best to spend the money.
Mr Tom Watson (West Bromwich East) (Lab): Sandwell is home to some of the poorest families in the country. Last week, officials confirmed that school cuts in the borough were made because the outline business case for their wave 5 bid was not signed off until after 1 January. Can the Minister confirm that no school that retained funding missed that deadline? Does she think that the criteria used for the funding is fair given that children in Labour-controlled Sandwell lose £140 million of support while those in the neighbouring borough, Conservative Wolverhampton, gain £360 million?
Sarah Teather: I appreciate the particular difficulties with Sandwell. However, I remind the hon. Gentleman that BSF was set up by his Government, and it is because of the slowness and inefficiency of BSF that schools in Sandwell were so late in getting anything from the bid at all.
Mr Graham Stuart (Beverley and Holderness) (Con): Children from poorer areas of Hull have rightly had additional funds come to their local authority to help with their education. However, when those children travelled across the border to be educated in East Riding, the money that was given to support their education in Hull did not follow them. Ministers in the previous Administration, despite repeated representations, refused to make that change. Will the pupil premium follow the child wherever they go to school?
Sarah Teather: The hon. Gentleman makes a very good point. It is precisely for that reason that we need a funding system that follows the student and reflects their individual needs. We see widely varying levels of deprivation funding from one area to another.
Helen Jones (Warrington North) (Lab): Does the hon. Lady believe that cancelling new schools in the most deprived areas of my constituency will assist poor children with their education? Did she have any discussions with Warrington borough council about deprivation in the borough before cancelling those building projects?
Simply because some projects under BSF have been cancelled does not mean that schools will not be rebuilt or renovated in the future. That is precisely the reason why the capital review is happening-to ensure that we have enough money to rebuild and
renovate schools in the future. Unfortunately, BSF is such an inefficient way of doing that that there would not have been any money left.
5. Laura Sandys (South Thanet) (Con): What progress has been made on the Munro review of child protection; and if he will make a statement. 
The Parliamentary Under-Secretary of State for Education (Tim Loughton): Professor Munro's review, which was launched on 10 June, appointed a top-level reference group to advise her. It met for the first time on 6 July. Professor Munro has issued a call for evidence with a 30 July deadline. We have asked her to report in three stages, the final report being in April 2011. The review has come about because the system of child protection in our country is still not working as it should be, despite the immense dedication and hard work of front-line professionals.
Laura Sandys: Does the Secretary of State agree with me and many children's charities that out-of-area placements for children taken into care should be considered only in extreme circumstances?
Tim Loughton: I, too, am grateful for the promotion.
I know that my hon. Friend has already established her credentials in this matter. She will be pleased to know that as part of the care planning guidance that came out of the Children and Young Persons Act 2008, which we supported, a new sufficiency duty will come into effect from next April, which should lead to a significant drop in the number of children placed far away from their original homes. I know that that is a particular problem in her constituency, as it is in mine and those of other hon. Members with seaside constituencies in particular.
Cathy Jamieson (Kilmarnock and Loudoun) (Lab/Co-op): Would the Minister be concerned if, as a result of the review of the role of the Children's Commissioner that I understand has been announced, more children who are in care because of abuse were put at risk because no one was there to stand up for their interests? Will he confirm that there will be no dismantling of the office of the Children's Commissioner prior to the completion of the review that he has referred to and the implementation of its recommendations?
Tim Loughton: The hon. Lady makes a point about the review of the role of the Children's Commissioner and her office, which is quite separate from the Eileen Munro review. I share her concerns about the rights of children in care, and she will be aware that the children's rights director has a direct role in that matter, which he has carried out with enormous respect over recent years, ensuring that the concerns and voices of children in care are heard loud and clear.
6. Mary Creagh (Wakefield) (Lab):
Pursuant to the written ministerial statement of 5 July 2010, Official Report, columns 1-2WS, on public spending control,
how much of the £1 billion of reductions in his Department's expenditure in 2010-11 will take effect in (a) Wakefield constituency and (b) West Yorkshire. 
The Secretary of State for Education (Michael Gove): The budgets that will be affected were published on the Department's website on Monday 5 July. We will shortly write to all local authorities setting out the impact on their allocations.
Mary Creagh: I thank the right hon. Gentleman for that reply, but the promises of rebuilding and repairing schools ring a little hollow in the light of the £1 billion cut to the schools capital programme that he is making in-year. Given that almost a third of the financial year has passed and he has not yet written to Wakefield or any other West Yorkshire authority with the details of how much will be cut from their reparation programmes, is his cut not in effect more like £1.3 billion or £1.5 billion, as the cuts will have to be made in-year?
Michael Gove: I am grateful to the hon. Lady for her question, but I refer her to a letter from the permanent secretary of my Department to the right hon. Member for Morley and Outwood (Ed Balls). He pointed out last week that, last year, the Treasury wrote to clarify its expectations of the use of end-year flexibility capital. The Treasury wanted to limit its use, but the Department refused to acknowledge it. The Treasury said clearly to the right hon. Gentleman that he was playing fast and loose with that capital stream. The issue had not been resolved by the time of the election, and instead of the dysfunctional relationship between the right hon. Gentleman and the Treasury, we now have a proper relationship involving a coalition Government who are clearing up the mess that we inherited from the hon. Lady's Government.
Mr Iain Wright (Hartlepool) (Lab): Why was not a single word about that further £1 billion cut in education mentioned in the Secretary of State's oral statement to the House last week? Will he confirm that the additional cuts in education, at the expense of hundreds of thousands of pupils in Wakefield, West Yorkshire and elsewhere, are being made so that he can open free market schools for the benefit of mere hundreds of pupils?
Michael Gove: I am grateful to the hon. Gentleman, but he made two mistakes in his question. First, in my statement to the House last week, I explicitly mentioned that the right hon. Member for Morley and Outwood had abused end-year flexibility. That is why he was kind enough to write to me, and why the permanent secretary was kind enough to write to put the record straight and to explain that the Treasury was in dispute with the right hon. Gentleman-not for the first, nor, I suspect, the last time. The hon. Gentleman's other mistake is over the fact that the reduction in the-to my mind-unwarranted exploitation of end-year flexibility has been to restore sanity to the public finances after the mess that the right hon. Gentleman created. The capital allocation for our free schools is just £50 million, and it comes from a lower priority set of IT programmes. The permanent secretary makes it clear in his letter that the previous Government left us in a mess, which we are trying to resolve.
7. Amber Rudd (Hastings and Rye) (Con): What assessment he has made of the educational achievement of pupils in receipt of free school meals in (a) Hastings and (b) England. 
The Minister of State, Department for Education (Sarah Teather): Information is published on an annual basis on the performance of all pupils, including those eligible for free school meals, and it can be accessed on the Department's website. We have made a clear commitment to narrowing attainment gaps between children from disadvantaged backgrounds and their peers through the pupil premium. We will announce more details of our proposals in due course.
Amber Rudd: I thank the Minister for that answer. Will she confirm that the children who are eligible for free school meals will qualify for the pupil premium? Those who have high numbers of children on free school meals in our constituencies, as I do in Hastings, are looking forward to having that advantage to help our children do well.
Sarah Teather: We are looking at the best measure to ensure that we can target extra money at students. It is a question of ensuring that we have a system that is attached to the child, the child's background and the particular school. We will be able to say more about that shortly. However, we are clear that extra money will follow the student.
Emma Reynolds (Wolverhampton North East) (Lab): Thanks to the previous Labour Government, a further 8,000 pupils in Wolverhampton now benefit from free school meals. As somebody who benefited from free school meals, I know that there is a link between nutrition and the ability of pupils from lower income families to do better at school. Does the Minister acknowledge that link, and will she extend the pilot scheme in Wolverhampton and roll it out throughout the country?
Sarah Teather: I recognise the link, and I agree with the hon. Lady. However, we are in difficult financial circumstances and unfortunately we were unable to extend free school meals simply because it was an unfunded pledge. However, I recognise the hon. Lady's point, which was well made.
Chris Skidmore (Kingswood) (Con): After 13 years of the previous Government, only 75 free school meals pupils gained three As at A-level. That is a disgrace. What do the Government propose to do about it?
Sarah Teather: I agree with my hon. Friend that it is a scandal that, after 13 years of a Labour Government, the greatest predictor of achievement at school is still parents' income. That is precisely why the coalition is so committed to introducing a pupil premium and investing in early years. It is also why the Prime Minister appointed the right hon. Member for Birkenhead (Mr Field) to conduct a review of life chances.
Diana R. Johnson (Kingston upon Hull North) (Lab):
The publication last week of figures showing, contrary to claims by the Health Secretary, the biggest increase
in the take-up of school meals, proves that Labour's policy on school food worked. The work of people such as Jamie Oliver was also successful. Does the Minister wish to reconsider the coalition's reversal of those successful policies, as the Government let the junk food industry call the tune and snatch free healthy school meals from the poorest half million children in England?
Sarah Teather: I think that Jamie Oliver did the nation a great service in raising the issue of standards in school food, but the next stage is for the Government to take forward, particularly on take-up. I was pleased that take-up of school meals has increased, but there is a lot more work to do.
8. Margot James (Stourbridge) (Con): What his most recent assessment is of the level of discipline in schools. 
The Minister of State, Department for Education (Mr Nick Gibb): The latest Ofsted reports tell us that in 95% of primary schools and 80% of secondary schools inspected in 2008-09 pupils' behaviour was good or outstanding, but that means that behaviour in one out of five secondary schools is still no better than satisfactory. To address this, I announced to the House on 7 July a series of measures that will give head teachers and teachers the powers they need to ensure discipline in the classroom and to promote good behaviour.
Margot James: I thank my hon. Friend for his answer. Two teachers from a primary school came to my surgery in despair over school discipline. They and others have advised me that schools are deterred from excluding pupils because they believe that doing so would have a negative impact on their Ofsted score and budgets. Does he agree that discipline and a head teacher's ability to exclude pupils is being undermined by that and other aspects of schools policy that prevailed under the previous Government?
Mr Gibb: I thank my hon. Friend for that question. I welcome her to the House and congratulate her on her election. She is right: head teacher authority must be absolute in the classroom and we will remove deterrents that may prevent schools from properly exercising their powers to exclude pupils. The vast majority of head teachers intervene early to prevent exclusions becoming necessary, but when they are necessary we need to be sure that any deterrent is removed.
9. Mr Marcus Jones (Nuneaton) (Con): How many expressions of interest in academy status his Department has received from schools in (a) Nuneaton constituency, (b) Warwickshire and (c) England. 
The Secretary of State for Education (Michael Gove): So far, 15 expressions of interest have been received from schools in Warwickshire, including one from an outstanding school in Nuneaton. A total of 1,836 expressions of interest have been received from schools in England.
Mr Jones: I thank my right hon. Friend for his reply. Several schools in my constituency may wish to become academies. However, after 13 years of the previous Government, they are carrying a tremendous amount of debt, which seems to prevent them from doing so. Will he consider what he can do to make it easier for such schools to become academies?
Michael Gove: I sympathise with my hon. Friend, who was so handsomely elected at the last general election-a fact that reflects how angry people in Nuneaton and across Warwickshire were at the scandalous way in which education was underfunded and managed by the previous Government. Let me assure him that I look forward to working with him and the local authority to ensure that the many outstanding schools and teachers in Warwickshire have the chance to enjoy the benefits of academies.
Vernon Coaker (Gedling) (Lab): We know that the Secretary of State has had one or two problems with lists of schools in recent days. Is he aware that he has listed a number of schools almost as if they have applied to become academies, when all they have done is request information from his Department? Is he also aware of the comments of people such as Mark Lacey, head teacher of Parson Street primary in Bedminster, who said:
"We responded out of a desire to receive the information in order to keep up with what is happening-not because we want to become an Academy"?
Is that not another inaccurate list that the Secretary of State should now withdraw, just like the inaccurate remark he made earlier? As he will know, the letter from the permanent secretary actually corrected his mistakes, not the mistakes of my right hon. Friend the Member for Morley and Outwood (Ed Balls).
Michael Gove: I am grateful for that "two for the price of one" question from the shadow Minister. The letter from the permanent secretary actually did correct the errors of the right hon. Member for Morley and Outwood. On the question of lists, as I said in my earlier answer, there were 1,836 expressions of interest. As the hon. Gentleman should know, being a former teacher, it is vitally important for people to listen in class before they put their hands up.
10. Charlotte Leslie (Bristol North West) (Con): What assessment he has made of the effectiveness of local education partnerships; and if he will make a statement. 
The Secretary of State for Education (Michael Gove): As I set out in my statement to the House last week, local education partnerships are part of an over-bureaucratic and inefficient procurement model. The capital review that I announced last week will consider alternatives to ensure that, at last, capital spending achieves value for money, raises standards, and actually helps the most disadvantaged.
I have raised concerns about the local education partnership in my constituency in relation to the project with Elmlea school. Essentially, money has been snatched from children and schools to line the pockets of contractors and consultants. I am sure that
Opposition Members will share my concern about that. Will my right hon. Friend promise to stop this terrible reverse Robin Hood approach to public spending?
Michael Gove: I could not agree more with my hon. Friend. There is a dividing line between this side of the House and that one. As far as the Opposition are concerned, a Building Schools for the Future programme that enriches consultants and ensures that one man can earn £1.35 million is defensible, whereas we believe that that money should be going to the front line to ensure that the most dilapidated schools are repaired as quickly as possible. It is the contrast between a Government who wasted money like there was no tomorrow and a Government here at last who are building a better tomorrow for all our children.
Fiona Mactaggart (Slough) (Lab): In that capital spending programme, will money be reserved for areas such as Slough, which has a rapidly growing school population and insufficient secondary school places to educate the children?
Michael Gove: I sympathise with the hon. Lady and she is right. One of the reasons why we had to halt the Building Schools for the Future programme was that far too much money was being wasted inefficiently on secondary schools when that money is needed to ensure that children who arrive at primary school in Slough, the south-east and across the country receive the classrooms that they need. Our first priority is ensuring that every child who needs it has a good school place, instead of ensuring that money goes to consultants, architects and the others in receipt of the cash that was being funnelled to them by the right hon. Member for Morley and Outwood (Ed Balls).
Mr John Redwood (Wokingham) (Con): Does the Secretary of State accept that many of us, and many people outside, would love these quangos that cannot count and cannot provide accurate lists to be abolished, saving the money on salaries to spend on bricks and mortar?
Michael Gove: My right hon. Friend, as ever, is a redoubtable scourge of waste, and it is always a pleasure to hear him as he turns his eye to yet another non-departmental public body.
Ed Balls (Morley and Outwood) (Lab/Co-op): The letter from the Secretary of State, which was published at 2.35-the fifth list-refers to local education partnerships. It will be no surprise to the House to learn that already, within 25 minutes, the first mistake in this list has been found. The right hon. Gentleman referred earlier to past mistakes and the SATS fiasco. In that case, there was an independent inquiry. If he would like to establish an independent inquiry now into the BSF shambles, he would not find it easy to repeat his failure to answer questions in this House. Is not the truth that he should withdraw this list, apologise to local education partnerships and stop treating children and this House with such total contempt?
I am grateful once more to the right hon. Gentleman for his question. I would welcome an inquiry into just what went wrong with Building Schools
for the Future and Partnerships for Schools under the previous Government. The Chairman of the Public Accounts Committee pointed out in February 2009 that the estimates of progress for which the right hon. Gentleman's Government were responsible were fanciful, but steps were not taken to ensure that we were moving in the right direction. The list that we have issued today is one that has been verified by Partnerships for Schools and by the Department for Education. The most important thing that we need to ensure is that the waste that characterised the previous Government does not characterise this one. That is why we have taken steps to ensure that in future the public money that should be going to the front line is protected. The mess that the right hon. Gentleman and his team created is being cleared up by this Government-these two parties-who are at last acting in the public interest.
11. Tracey Crouch (Chatham and Aylesford) (Con): How many expressions of interest in academy status his Department has received from schools in the Kent and Medway local authority area. 
The Minister of State, Department for Education (Mr Nick Gibb): Ninety-five expressions of interest in academy status have been received from schools in Kent, and nine expressions of interest have been received from schools in Medway.
Tracey Crouch: I thank the Minister for his reply, and I am sure that he will be reassured to hear that many of the head teachers I have spoken to are genuinely very enthusiastic about the programme. The Minister will be aware that many of the schools in Kent and Medway that have expressed an interest are grammar schools. Can he assure the House that if they were to become academies they would retain their selective status?
Mr Gibb: I am happy to give my hon. Friend that assurance.
12. Damian Hinds (East Hampshire) (Con): What steps he is taking to reform early-years provision. 
The Minister of State, Department for Education (Sarah Teather): Last week, the Government asked Dame Clare Tickell, chief executive of Action for Children, to carry out an independent review of the early years foundation stage to consider how the framework could be less bureaucratic and more focused on young children's learning and development. The review will formally start in September this year, and will report in spring 2011. It is our intention to undertake a full consultation before any changes are implemented. A statement has been placed in the House outlining further details of the scope of the review.
Damian Hinds: We all want to see the very highest standards promoted in pre-schooling, but does the Minister agree that the over-prescriptive, box-ticking approach favoured by the previous Government is likely only to stifle the sector and reduce parental choice?
Sarah Teather: Indeed. This is a question of building on some of the good things about the foundation stage, but ensuring that we can reduce the burden on the sector, and particularly on the smaller providers. In fact, I was in a nursery school in Brent on Friday, and the head teacher said to me that she was grateful that we had begun a review of the foundation stage, because although there were many good things about it, the assessment is bureaucratic and she was hoping for something rather better.
Mr Gerry Sutcliffe (Bradford South) (Lab): Can the Minister explain why my constituents in Bradford should trust what this coalition Government say on education? We have lost Building Schools for the Future and the free school meals pilot, and we have an education authority that needs to be developed because of the failure of the private sector. Can the Minister tell us that Sure Start in particular will remain a key part of early years provision?
Sarah Teather: The current review of the foundation stage is independent, and we have asked Dame Clare Tickell-who I am sure would command respect right across the House-to conduct it.
13. Guy Opperman (Hexham) (Con): What recent representations he has received on funding for schools in Hexham constituency; and if he will make a statement. 
The Parliamentary Under-Secretary of State for Education (Tim Loughton): We have received just one representation on the subject of school funding from a school in Hexham. We will bring forward our proposals for school funding in due course.
Guy Opperman: Schools in the Hexham constituency in rural Northumberland all complain of a funding shortfall that was dramatic under the previous Government. What assurances will the Minister give me and the teachers in that particular school that this imbalance will be changed?
Tim Loughton: I am only too well aware of many of the discrepancies in the system that prevailed for far too many years under the previous Government. I am aware that Hexham middle school in my hon. Friend's constituency has raised concerns about problems in tackling rural deprivation and sparsity of population that have not been dealt with in the past. That is one area that we will be looking at, and the pupil premium will be a priority in ensuring that we recognise deprivation and have effective measures to deal with it.
14. Mr Barry Sheerman (Huddersfield) (Lab/Co-op): What steps he is taking to ensure availability of continuing professional development for teachers. 
Mr Speaker: Minister-any Minister.
The Parliamentary Under-Secretary of State for Education (Tim Loughton): I am sorry, Mr Speaker- [ Interruption. ]
Mr Speaker: Order. I do not need to be advised by the Government Whip on the Front Bench. The hon. Member for Rochford and Southend East (James Duddridge) should remain quiet. We are on Question 14 and we have a Minister at the Box; I require no advice from the hon. Gentleman whatever.
Tim Loughton: Thank you, Mr Speaker. I was expecting some interest in Hexham from the Opposition, but clearly there is none.
I agree with the hon. Member for Huddersfield (Mr Sheerman) that the quality of teachers and professional development is important. International evidence shows that teachers learn from observing good teachers, and this happens best in schools. That is why the Government are committed to encouraging schools to demonstrate a strong culture of continuing professional development, with teachers leading their own development and that of others, and sharing effective practice within and between schools. That is why we are currently reviewing our policies and existing activities to ensure that they focus on that vision.
Mr Sheerman: Is the hon. Gentleman aware that teachers are finding it much more difficult to get out of the classroom to go to good CPD sessions, particularly in places such as the science learning centres in York and elsewhere, because of the way in which the "rarely cover" provision is being interpreted as part of the work force agreement? Not only is CPD suffering; so are kids' visits to out-of-school facilities.
Tim Loughton: The hon. Gentleman makes a good point. I am aware of the limiting factors of "rarely cover", which is an area that we will look at in our assessment of the problems facing teachers in getting continuing professional development. Having to pay supply teachers can be an obstacle to getting CPD, which is why this Government want to free up school pay and conditions and give greater powers back to heads to ensure that they can devise the best methods for ensuring that their teachers get the best continuous professional development and training.
15. Stephen Gilbert (St Austell and Newquay) (LD): What assessment he has made of the educational achievement of pupils in receipt of free school meals in St Austell and Newquay constituency. 
The Minister of State, Department for Education (Sarah Teather): Information is published on an annual basis on the performance of all pupils, including those eligible for free school meals, and these can be accessed on the Department's website. We have made a clear commitment to narrowing attainment gaps between children from disadvantaged backgrounds and their peers through the pupil premium, and we will announce more details on these proposals in due course.
Children across the country who are in receipt of free school meals are only half as likely as their peers to get good GCSE results. Does the Minister
agree with me that only the pupil premium proposed by this Government will address the educational inequality left by the previous Government?
Sarah Teather: I absolutely agree. The scandal of educational inequality left by the previous Government is testament to their legacy, and I am very sad that they have not been willing to support the pupil premium. I hope that, with their change of leader, they will consider a U-turn on this policy.
Glenda Jackson (Hampstead and Kilburn) (Lab) rose-
Mr Speaker: Order. It is always a pleasure to hear the hon. Lady, but I must observe in passing that Hampstead and Kilburn are some considerable distance from St Austell and Newquay.
16. Hywel Williams (Arfon) (PC): What recent discussions he has had with Welsh Assembly Government Ministers on teachers' pay in Wales. 
The Secretary of State for Education (Michael Gove): I met the Minister for Children, Education and Lifelong Learning in the Welsh Executive, Mr Leighton Andrews, on 28 June, as part of a schedule of meetings since taking up my post. I look forward to having an ongoing discussion with him and his colleagues on this and other important issues.
Hywel Williams: I thank the Secretary of State for that answer. What consideration is he giving to introducing regional variation in teachers' pay outside London?
Michael Gove: As I am sure the hon. Gentleman knows, teachers' pay and conditions are set by the School Teachers Review Body, which governs England and Wales. I will have ongoing discussions with the Welsh Assembly Government, and it is important that we ensure that teachers have certainty in the future. It is my understanding that the current arrangements are working in the interests of teaching unions and teachers across England and Wales, but I would be very happy to receive any representations from the hon. Gentleman to ensure that the recruitment and retention of teachers in his constituency-in a very beautiful part of north-west Wales-are made as easy as possible.
17. Barry Gardiner (Brent North) (Lab): What recent representations he has received on the provisions of the Academies Bill; and if he will make a statement. 
The Secretary of State for Education (Michael Gove): Many schools have told us that they welcome the opportunity to acquire academy freedoms through our Bill. Officials and Ministers have had positive meetings so far with teaching unions, the Special Education Consortium, the Church of England and the Catholic Education Service. Alongside these representations, we have also had approaches from individual peers and MPs, which have been dealt with through correspondence and meetings with Ministers.
Barry Gardiner: Why does the Secretary of State continue to call these schools academies? Under the old system, academies were a means of getting extra money from outside the system to children from poor and disadvantaged backgrounds who were not doing well. Under the new system, academies are taking money from within the system away from poor and disadvantaged children and giving it to schools that are already doing very well. Why does he continue to call them academies?
Michael Gove: I know that the hon. Gentleman served with distinction as a Minister in Tony Blair's Government, and was then defenestrated when the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown) took over. He should be aware that Tony Blair made it clear, when he was Prime Minister, that academy freedoms should be extended to all schools. In that respect, we are simply carrying on the good work that was begun under the Prime Minister who was wise enough to have the hon. Gentleman on his Front Bench, rather than following the disastrous course that was taken by Gordon Brown and the right hon. Member for Morley and Outwood (Ed Balls).
Dr John Pugh (Southport) (LD): I have here a press cutting in which a local head teacher in my constituency complains about his school appearing on the Department's database as "interested in academy status", when all that he had actually done was to ask for details of a sketchy scheme. He now says that the chances of his school wanting academy status are minimal and that people are "playing politics" with this. How could such things happen? Could it be that the demand for academy status is being overstated? Also, will the Secretary of State correct the database?
Mr Speaker: Order. One question will probably suffice; one answer certainly will.
Michael Gove: I have consistently made it clear that all those who have expressed interest have only ever expressed interest. I am delighted that so many have done so, but as I am sure my hon. Friend knows, our legislation is permissive, and it will be for schools to decide, rather than Ministers or bureaucrats. That will be a welcome change from the dirigiste methods that so scarred education under the right hon. Member for Morley and Outwood.
18. Lilian Greenwood (Nottingham South) (Lab): What plans he has for support for children with special educational needs. 
The Minister of State, Department for Education (Sarah Teather): I will launch a Green Paper in the autumn to look at a wide range of issues for children with special educational needs and disabilities. Before then I will be looking at the results of the Ofsted review of special educational needs expected later this summer, along with the many other reviews of policy in recent years. I will also be listening to the views of parents, teachers and organisations with an interest in this area.
Does the Minister agree that children in Nottinghamshire with the most profound special needs deserve to be taught in first-class facilities? Is it not therefore fortunate that the previous Government
were committed to investing in their education and that they built the wonderful new Oak Field school under Building Schools for the Future?
Sarah Teather: As I said in an earlier answer, simply because some projects have been stopped under Building Schools for the Future does not mean that schools will not be rebuilt or renovated in the future. This Government are absolutely committed to renovating school buildings, which is why we have had to have a review of capital-to ensure that there is still money for children to be able to learn in decent facilities.
Patrick Mercer (Newark) (Con): This morning, I met all the head teachers in my constituency, the most vocal of whom was the head teacher of the Orchard special educational needs school. When it rains heavily, the children in this school have to stop being taught in order to hold buckets under the leaking roof. I ask the Secretary of State, or one of his Ministers, to visit the Orchard school and others in my constituency to find out exactly what the situation is.
Sarah Teather: One of the Ministers will come and visit the Orchard school.
T1.  Christopher Pincher (Tamworth) (Con): If he will make a statement on his departmental responsibilities.
The Secretary of State for Education (Michael Gove): As I pointed out earlier, because of the dysfunctional system we inherited, it has been difficult to establish the absolute truth about the number of schools affected by the rules-based announcement I made last week. Today, an hour and a half before the House met for questions, I distributed to the right hon. Member for Morley and Outwood (Ed Balls) and others the latest updated list of the schools affected. This list has been verified by Building Schools for the Future and by my Department, which has contacted every local authority affected. I am looking forward to hearing from the individual local authorities in due course.
May I also take the opportunity to correct the record on one further matter? In last week's statement, I referred to six schools built under BSF that had suffered from design or construction flaws. On Thursday evening, I was told that three of the schools I mentioned-Carr Manor, Lawnswood and Primrose high-were, in fact, built under a predecessor private finance initiative scheme that sought to renovate the school estate in Leeds. Some of the renovation was financed through BSF; the schools themselves were not procured through BSF, but instead through that predecessor programme. The other schools I referred to in last week's statement were procured through BSF.
We have also issued a written ministerial statement today, pointing out that we are going to review the Office of the Children's Commissioner. As I am sure the whole House will appreciate, this is very much a season for ensuring that we get value for money from our quangos.
Will my right hon. Friend confirm that fewer than 100 schools have been rebuilt under Building Schools for the Future, none of which, incidentally, are in Tamworth, where we have been waiting more
than three years for this labyrinthine process to happen, but not a brick has been laid? Will he confirm that this is yet another example of the former Government failing to keep their promises?
Michael Gove: I sympathise hugely with my hon. Friend. Only 97 schools were built under Building Schools for the Future during the period when the previous Government were in charge. Now we know that under this coalition Government, 706 schools will benefit from BSF and more than half of those will be new builds. Where the previous Government failed, this Government are succeeding.
T5.  Stephen Twigg (Liverpool, West Derby) (Lab/Co-op): On Friday, I visited Holly Lodge school-one of six in my constituency affected by last week's announcement. For Liverpool, investment in our schools is crucial to our economic future. Will the Secretary of State undertake to visit Liverpool between now and the end of September to meet schools, the business community, my colleagues and the local council to discuss this crucial issue for the future of our city?
Michael Gove: I am very grateful to the hon. Gentleman, who was a distinguished schools Minister, for that question. I know how hard he works for his constituents and, indeed, for every parent, child and teacher in Liverpool. I am aware that the consequences of the regrettable decision we had to take last week will be felt particularly hard in Liverpool, so either I or a member of my ministerial team will commit to come to Liverpool to talk to him and those affected-by the end of the year, I hope, but certainly as soon as possible.
T2.  Damian Collins (Folkestone and Hythe) (Con): Under the previous Government, 186 special schools closed. On Thursday, I will attend the annual prize-giving at Highview special school in my constituency-one that you, Mr Speaker, have visited. May I take the Secretary of State's message of support for special education under the new Government as meaning that the school will have a sustainable future and the support it needs?
Michael Gove: I am grateful to my hon. Friend for his question. It is a tragedy that the ideologically driven closure of special schools under the last Government meant that so many children with special educational needs did not receive the education they deserved. That ideologically driven closure will end under this Government, and under the Minister of State, Department for Education, my hon. Friend the Member for Brent Central (Sarah Teather) we will review support for children with special educational needs. Their care should always be our first concern.
T9.  Chris Bryant (Rhondda) (Lab):
The Secretary of State will know that one problem in many of the poorest constituencies in the land is the high level of teenage pregnancy in this country-five times higher than in the Netherlands. Before Government Members start blaming Labour-or, for that matter, me personally-let me tell them that the figures rose dramatically under the Conservative Government and then did not fall sufficiently under a Labour
Government. The Secretary of State fought hard in the previous Parliament to ensure that we did not have good compulsory sex and relationship education, for every child, in all schools in the land. Will he reverse the argument that he advanced then, because in countries with low levels of teenage pregnancy, the existence of such education is the big difference?
Michael Gove: The hon. Gentleman is a former vicar of the Church of England; he has been accused of many sins, but contributing to teenage pregnancy has never been one of them, to my knowledge. May I say that I entirely appreciate the importance of proper sex and relationships education? My dispute with the previous Government was simply over a question of individual liberty. I felt it important that parents had the right to withdraw their children from sex and relationships education if they thought it inappropriate. I agree, however, that it is vital that all children have high-quality sex and relationships education, in order to ensure that they make the right decisions later in life.
T3.  Mr David Burrowes (Enfield, Southgate) (Con): Further to my right hon. Friend's answer to the question from my hon. Friend the Member for Shipley (Philip Davies), is he aware of the situation in Enfield, where increasing housing, migration and birth rates are putting acute pressure on primary and secondary school places? Will he ensure that future capital funding focuses more on increasing capacity and less on increasing bureaucracy, as happened under the previous Government?
Michael Gove: My hon. Friend makes a very good point. One of the demographic changes to which the previous Government did not pay sufficient heed was the increase in the number of pupils arriving at primary schools, particularly in London and the south-east. That growth in basic need is our first priority.
T10.  Mr Gordon Marsden (Blackpool South) (Lab): The Secretary of State has already spoken of his great concern about special schools. Has he done any cumulative assessment of the impact on special schools of his BSF cuts last week? The programme for all three such schools in Blackpool-Woodlands, Park and Highfurlong-will be affected and stopped, because they were co-operating with other secondary schools. What assurance will he give the House that he will consider the cumulative impact on special schools, and what assurance will he give me that he will look at the problems in Blackpool in particular?
Michael Gove: I am very sensitive to the problems in Blackpool. I had the opportunity to visit one of the schools that the hon. Gentleman mentions-Highfurlong-with my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard). I appreciate the problems on that site and want to do everything possible to ensure that our capital review guarantees that children attending special schools get the money that they need for the facilities that are crucial to their education, as quickly and efficiently as possible.
T4.  Amber Rudd (Hastings and Rye) (Con):
Is my right hon. Friend aware that, under the overly cumbersome Building Schools for the Future, it took
on average 13 months from first meeting to first construction of a site? What can be done under this Government to ensure that that does not happen again?
Michael Gove: My hon. Friend makes a critically accurate point. As a result of the massive bureaucracy that used to exist under the Building Schools for the Future scheme, people in dilapidated classrooms were denied the resource that they needed, as it was going into the pockets of bureaucrats rather than into bricks and mortar for those most in need.
Jack Dromey (Birmingham, Erdington) (Lab): The Secretary of State will be aware that in his announcement to Parliament last week, a special needs school in my constituency of Birmingham, Erdington was listed under two separate titles, "Stopped" and "Unaffected". Hopes were raised, confusion was then caused, and hopes have been shattered. Will the Secretary of State come to my constituency to meet the head of Queensbury school, which, along with its sister school Kingsbury, has a remarkable vision for a world-class centre of excellence catering for the children of Birmingham with special needs?
Michael Gove: I am grateful to the hon. Gentleman for his question and for showing me the great courtesy of calling me before the weekend to explain precisely the question that he would ask. We will have the opportunity to meet one on one later this week to discuss the precise circumstances of the school that he mentions. I or one of my ministerial team will certainly join him in a visit to that school, to provide the head, teachers and parents with all the information that they need to ensure that in future we do everything possible to help to support them and the great work that they do.
T6.  Conor Burns (Bournemouth West) (Con): I thank my right hon. Friend for visiting St Michael's primary school in Bournemouth with me last week. If the head teacher of St Michael's, Mr Bob Kennedy-or, indeed, any other head teacher-were to ask him what excuse could be given for spending £60 million of local authority Building Schools for the Future money on consultants rather than the front line, what on earth would he say in reply?
Michael Gove: It was a pleasure to meet my hon. Friend and the teachers who were doing such outstanding work at St Michael's. It was a fantastic school, and a pleasure to visit.
If a head teacher were to ask me why the last Government spent so much money on consultants rather than on teachers, for once I would be dumbstruck.
Stella Creasy (Walthamstow) (Lab/Co-op): I recognise that there are many pressing issues in Ministers' diaries, but may I beg the Secretary of State to take seriously the request by Willowfield school in Walthamstow to host a meeting for him, for parents from the Walthamstow area, and for parents affected by the decision to stop all the wave 1 school projects in Walthamstow, including those involving William Morris school and Holy Family college? There could then be a discussion about how we can meet our urgent need for school places in the locality, given that all those buildings have been condemned as not fit for purpose-a bit like the present Government.
Michael Gove: I am grateful to the hon. Lady for asking a very good question with a nice scorpion sting in the tail. I appreciate that in some parts of the country, because of the way in which Building Schools for the Future was run, the decision that we had to make bites more sharply. Waltham Forest is one of them, Somerset another, and Liverpool a third. For that reason, I will ensure that one of my Ministers or officials contacts the hon. Lady very quickly to see what we can do to alleviate this necessary blow.
T7.  David Mowat (Warrington South) (Con): Given that last week's announcement on BSF has had an impact on several schools in Warrington-including Penketh high school, where the need is great-will the Secretary of State tell us when his capital review is likely to report, and what criteria will be used in the review to prioritise schools? Is he willing to meet me and Warrington educationalists to discuss their needs?
Michael Gove: My hon. Friend was good enough to lobby me several weeks ago about the fate of the school that he mentioned, and schools in Warrington overall. He was, as ever, articulate and powerful on behalf of his constituents. I recognise that his constituents have been let down by the fact that Building Schools for the Future spent so much money on bureaucracy, and not enough on bricks and mortar. The purpose of our capital review is to ensure that money reaches the front line more quickly, and that the dysfunctional system that was established under the last Government-which they took no steps to reform or abolish-is transformed. I believe that there will be an interim report in a few months' time and a final report by the end of the calendar year, both of which will transform school buildings for the future.
Tristram Hunt (Stoke-on-Trent Central) (Lab): Is the Secretary of State aware that figures from his department show that academy schools are, on average, teaching one third less GCSEs in history and geography than schools in the maintained sector, and are often inflating their grades through the use of GCSE equivalents? If that is to be the model for the future, what steps is the Secretary of State taking to ensure that academic subjects are protected in academies?
Michael Gove: Like the hon. Gentleman, I am committed to academic excellence, so I should point out that he should have said "fewer", not "less". However, he has made a good point. I am worried about the use of so-called equivalent qualifications instead of academic GCSEs. When I raised the issue from the Opposition Benches, the then Secretary of State said that I was talking achievements down, but I am glad to note that we can now form a coalition for excellence across the Dispatch Box.
Andrea Leadsom (South Northamptonshire) (Con): Does my right hon. Friend agree that it is regrettable that five secondary schools in my constituency which are in dire need of expenditure on the framework of their buildings have received absolutely nothing under the Building Schools for the Future programme, simply because in theory they are in a reasonable area where children are, in theory, receiving a good education?
Michael Gove: I am grateful to my hon. Friend for her question, which points to one of the many weaknesses in the Building Schools for the Future programme. Because its operation was area-based, some schools which were not dilapidated and which occupied serviceable buildings-not ideal, but serviceable-received large sums of money, while in many other parts of the country children suffered poor education in dilapidated buildings that were not prioritised for investment. That has to change.
Julie Hilling (Bolton West) (Lab): Will the Secretary of State or a member of his team undertake to meet the pupils of Westhoughton high school, who will be making an educational visit to Parliament this Thursday, to explain to them why they have wasted the last two years designing and developing their programme for their new school and why they will now have to spend the rest of their school career in a crumbling school?
The hon. Lady is an impassioned advocate for Bolton West, but I have to tell her-and she can tell this to the children and parents concerned-that the reason why this process took so long is because of
the bureaucracy her Government put in place. The reason why those children are losing out is because of the decisions made by the right hon. Member for Morley and Outwood, and if she is angry, as I am, that children's destinies have been compromised, that anger-that righteous anger-should be directed at the right hon. Gentleman, the person who presided over this debacle in the first place.
Graham Evans (Weaver Vale) (Con): Free schools have the potential to make a massive positive impact on the education of children in my constituency, Cheshire and the north-west as a whole. When does the Secretary of State anticipate that the first free schools will be able to open and begin their vital work?
Mr Speaker: Order. I am grateful to the Secretary of State for that pithy reply, but I am afraid that demand has exceeded supply and we must now move on to the statement.
The Secretary of State for Health (Mr Andrew Lansley): With permission, Mr Speaker, I would like to make a statement on the future of the national health service.
The NHS is one of our great institutions, and a symbol of our society's solidarity and compassion. It is admired around the world for the comprehensive care it provides and for the quality, skill and dedication of its staff. I begin today by paying tribute to the staff of the NHS and the commitment they daily show to patients in their care.
This Government will always adhere to the core principles of the NHS: a comprehensive service for all, free at the point of use, based on need, not ability to pay. That principle of equity will be maintained, but we need the NHS also consistently to provide excellent care.
The NHS today faces great challenges: it must respond to the demands of an increasing and ageing population, advances in medical technology and rising expectations; it remains stifled by a culture of top-down bureaucracy, which blocks the creativity and innovation of its staff; and it does not deliver outcomes in line with the best health services internationally-many of our survival rates for disease are worse than those of our neighbours. The NHS must be equipped to meet those challenges. We believe it can do much better for patients, so today I am publishing the White Paper, "Equity and Excellence: Liberating the NHS", so that we can put patients right at the heart of decisions made about their care, put clinicians in the driving seat on decisions about services, and focus the NHS on delivering health outcomes that are comparable with, or even better than, those of our international neighbours.
For too long, processes have come before outcomes, as NHS staff have had to contend with 100 targets and over 260,000 separate data returns to the Department each year. We will remove unjustified targets and the bureaucracy that sustains them. In their place, we will introduce an outcomes framework setting out what the service should achieve, leaving the professionals to develop how.
We should have clear ambitions, and our approach will be set out shortly in a further consultation document. For example, our aims could be: to achieve one and five-year cancer survival rates above the European average; to minimise avoidable hospital-acquired infections; and to increase the proportion of stroke victims who are able to go home and live independently-in short, care that is effective, safe and meets patients' expectations.
The outcomes framework will be supported by clinically established quality standards, and the NHS will be geared across the board towards meeting them. We will do that by rewarding commissioners for delivering care in line with quality standards; strengthening the regulatory regime so that patients can be assured that services are safe; and reforming the payment system in the NHS, so that it is a driver not just for activity, but also for quality, efficiency and integrated care.
Patients will be at the heart of the new NHS. Our guiding principle will be "no decision about me, without me." We will bring NHS resources and NHS decision making as close to the patient as possible. We will extend "personal budgets", giving patients with long-term
conditions real choices about their care. We will introduce real, local democratic accountability to health care for the first time in almost 40 years by giving local authorities the power to agree local strategies to bring the NHS, public health and social care together. Local authorities will also be given control over local health improvement budgets. This will give an unprecedented opportunity to link health and social care services together for patients. We will give general practices, working together in local consortiums, the responsibility for commissioning NHS services, so that they are able to respond to the wishes and needs of their patients. This principle is vital, bringing together the management of care with the management of resources. With commissioning support, GPs collectively will lead a bottom-up design of services.
In addition, we will introduce more say for patients at every stage of their care, extending the right to choose far beyond a choice of hospital. Patients will have choice over treatment options, where clinically appropriate, and the consultant-led team by whom they are treated. They will have the right to choose their GP practice, and they will have much greater access to information, including the power to control their patient record. We must ensure also that patients' voices are heard, so we will establish HealthWatch nationally and locally, based on local involvement networks, to champion the needs of patients and the public at every level of the system.
To achieve these improvements in outcomes, we need to liberate the NHS from the old command-and-control regime, so all NHS trusts will become foundation trusts, freed from the constraints of top-down control, with power increasingly placed in the hands of their employees; and we will allow any willing provider to deliver services to NHS patients-provided that they can deliver the high-quality standards of care we expect from them. Our aim is to create the largest social enterprise sector in the world, but it is not a free-for-all. Monitor will become a stronger economic regulator to ensure that the services being provided are efficient and effective, and that every area of the country has the NHS services it needs to provide a comprehensive service to all. The Care Quality Commission will safeguard standards of safety and quality. An independent and accountable NHS Commissioning Board will be established to drive quality improvements through national guidance and standards, in order to inform GP-led commissioning. The board will allocate resources according to the needs of local areas, and lead specialised commissioning.
In the coming weeks, detailed consultation documents will enable people to comment on the implementation of this strategy, leading to the publication of a health Bill later this year. I recognise that the scale of today's reforms is challenging, but they are designed to build on the best of what the NHS is already doing. Clinicians are already working to facilitate patient choice, giving patients the information they need to make effective decisions. GP consortiums are already established in some areas of the country and are ready to go. Local authorities in some areas are already working closely with local clinicians to co-ordinate health and social care and improve public health. Payment by results already gives us a starting framework for building a payment system that really drives performance. Foundation trusts are already using the freedoms they have to innovate. We will build on this progress, not dismantle it.
With this White Paper we are shifting power decisively towards patients and clinicians. We will seek out and support clinical leadership. That means simplifying the NHS landscape and taking a further, radical look at the whole range of public bodies. We will reduce the Department of Health's NHS functions, delivering efficiency savings in administration. We will rebalance the NHS, reducing management costs by 45% over the next four years and abolishing quangos that do not need to exist, particularly if they do not meet the Government's three tests for public bodies. We will also shift more than £1 billion from back-office to the front line. Form must follow function. As we empower the front line, so we must disempower the bureaucracy. Therefore, after a transitional period we will phase out the top-down management hierarchy, including both strategic health authorities and primary care trusts.
Later in the summer, we will be publishing a report setting out how we see the future of NHS-related quangos. I can say now that this will mean a reduction of at least a third in the number of such bodies. This is part of a wider drive across government to increase the accountability of public bodies and reduce their number and cost. The dismantling of this bureaucracy will help the NHS realise up to £20 billion of efficiency savings by 2014, all of which will be reinvested in patient care. Today's reforms set out a long-term vision for an NHS that is led by patients and professionals, not by politicians. It sets out a vision for an NHS empowered to deliver health outcomes as good as any in the world. I commend this statement to the House.
Andy Burnham (Leigh) (Lab): I thank the right hon. Gentleman for his statement and for giving me advance sight of it, although in keeping with the style of this Government, it would appear that this House was the last to find out, behind every media outlet in the land.
Last month, the Commonwealth Fund gave its verdict on Labour's NHS, saying that it was top on efficiency and second overall on quality compared with other developed health care systems. Today, we have further evidence of progress, with figures from Cancer Research UK showing that long-term cancer survival rates have doubled. This progress was hard won; it took 10 years of painstaking work piecing together a detailed jigsaw. The right hon. Gentleman, with this White Paper, has today picked it up and thrown the pieces up in the air. It is a huge gamble with a national health service that is working well for patients.
The right hon. Gentleman's spin operation bills this as
"the biggest revolution in the NHS since its foundation 60 years ago".
That is something of a surprise, given the ink was barely dry on a coalition agreement that said:
"We will stop the top-down reorganisations of the NHS that have got in the way of patient care."
What has happened since the publication of the coalition agreement to justify a U-turn of such epic proportions? Manifesto commitments have been casually dropped but this must be the first time that that agreement has been so spectacularly ripped up.
This reorganisation is the last thing that the NHS needs right now; it needs stability, not upheaval. All its energy must be focused on the financial challenge ahead. It needs confident, motivated staff, but the 1.3 million
people who work for the NHS will not be comforted by this White Paper and they will be alarmed that their systems of national pay bargaining are being torn up. We support a strong say for clinicians and GPs in improving quality. That was the direction that Lord Darzi set out, after broad consultation. We introduced practice-based commissioning within a framework of public accountability and population-wide commissioning supported by primary care trusts. What we do not support is the wiping away of oversight and public accountability, and the handing over of £80 billion of public money to GPs, whether they are ready or not. Michael Dixon, chair of the NHS Alliance, says that only about 5% of GPs are ready to take over commissioning. Sir David Nicholson, chief executive of the NHS, has judged that even the best GP practice-based commissioners are "only about a three" out of 10 in terms of the quality of their commissioning. So what sound evidence does the right hon. Gentleman have that 100% of GPs are ready, willing and able to commission services for the entire population?
The right hon. Gentleman's statement talked of rewarding commissioners who hit outcomes. Does he mean yet more money for GPs? How much will all GPs be paid for taking on this role? How many jobs does he expect to be lost in the NHS and how much money has he put aside for redundancy costs? What guarantees can he give the House that people will not simply be paid off by the NHS to be re-employed by a GP practice?
How does the right hon. Gentleman think loyal primary care trust staff felt when they read this quote-I apologise, in advance, for the language, Mr Speaker-from
"a senior Department of Health source",
which was anonymously briefed to the Health Service Journal ? It reads:
"PCTs are screwed. If you've got shares in PCTs I think you should sell".
That is no way to treat loyal public servants, who have served the NHS and are now worried about their future. On page 10, the right hon. Gentleman says that the reforms are vital to deal with the financial situation, but is it not the case that there has never been an NHS reorganisation that did not cost money and divert resources in the short term? Is not the handing of the public budget to independent contractors tantamount to the privatisation of the commissioning function in the NHS? Will there be any restrictions at all on the use of the private sector by GPs?
Added to this, the right hon. Gentleman is bringing a series of market reforms into hospitals. He tells us that the first role of Monitor will be to promote competition and talks of any willing provider and freedoms for foundation trusts. Is not that the green light to let market forces rip right through the system with no checks or balances? Are not the hearts of NHS staff sinking as they read the White Paper?
On bureaucracy, we will support the Government where sensible reductions can be made, but what he calls pointless bureaucracy, we call essential regulation. What are his plans for the Food Standards Agency and are the reports correct that he has waived his right to regulate in return for funding for Change4Life? Can he explain how 500 or more GP consortiums, all of whom will need administration and management, can be less bureaucratic than 152 primary care trusts?
Lastly, where are the public accountability and the accountability to this House? How will GPs be held to account for the £80 billion of public money for which they will be responsible and how will the new NHS commissioning board-the biggest quango in the world-be accountable to this House and to Members of Parliament?
In conclusion, this White Paper represents a roll of the dice that puts the NHS at risk-a giant political experiment with no consultation, no piloting and no evidence. It is the right hon. Gentleman at his confused and muddled worst, but the sadness is that he is taking an £80 billion gamble with the great success story that is our national health service today. At a stroke, he is removing public accountability and opening the door to unchecked privatisation. He is demoralising NHS staff at just the time we need them at their motivated best. For patients, it opens the door to a new era of postcode prescribing where services vary from street to street. It turns order into chaos, and we will oppose it.
Mr Lansley: I am just astonished that the shadow Secretary of State seems to have gone to the barricades for the primary care trusts. The primary care trusts and strategic health authorities are organisations that, under his watch as Secretary of State-for about a year-increased their management costs by 23%. In the year for which he was in charge, they spent £261 million on management consultants. Before the election, when it had a majority of Labour Members, the Select Committee on Health said that PCT commissioning was weak and that it was not delivering what was intended. He set up a programme called world class commissioning-it never worked. Central to delivering better commissioning in the health service is ensuring that those people who incur the expenditure-the general practitioners, on behalf of their patients-and who decide about the referral of patients are the same people who, through the commissioning process, determine the shape of the services in their area. It is more accountable.
How often have all of us, on both sides of the House, asked Labour Ministers about what primary care trusts are doing locally in terms of service change only to be told, "It's nothing to do with us; it's all happening locally"? We are going to be very clear about the accountability. One thing that the coalition programme has enabled us to do, as two parties bringing our programmes together, is to strengthen the accountability to local authorities. Local authorities, through their strategies that mesh NHS services, public health and social care, will ensure that major service changes and the design of services reflect the interconnection between those things. Those who have complaints and problems will be able to have them addressed through HealthWatch and through their local authority. We will be able, through local authorities, to ensure that the commissioning support to GP commissioning consortiums can be more effective.
The shadow Secretary of State talked about the Commonwealth Fund. I do not know whether he has even read the Commonwealth Fund report, but it said that the UK health care system was the second worst on hospital-acquired infections, that the UK delivers the poorest level of patient-centred care and that, on outcomes, we performed the second worst overall on mortality amenable to health care.
The right hon. Gentleman stood up and said that cancer mortality rates have improved. They have-since the 1970s, and all over the world. However, the issue is where we stand in relation to the rest of the world. If we were to meet the European average on cancer survivals, 5,000 more people would live each year rather than die. If we were to do the best in Europe, 10,000 more would live each year. For stroke, the figure is 9,000. We have to measure ourselves on the outcomes relative to the other health systems that are comparable to ours.
Nine years ago, the right hon. Gentleman's Prime Minister, Tony Blair, said that we must spend as much as Europe. Through this White Paper and the reforms that we will bring in, we are determined to achieve results for patients that are at least as good as those in the rest of Europe. It is not just about inputs and spending, but about the results we achieve. The right hon. Gentleman, on behalf of his party, has just abandoned the reforms that his Prime Minister, Tony Blair, put forward. In 2006, Tony Blair said that we must have patient choice, practice-based commissioning, the independent sector and foundation trusts-reforms that Labour failed to deliver and, indeed, undermined. We, as a coalition Government, are now determined to put those reforms in place to deliver results for patients.
Mr Stephen Dorrell (Charnwood) (Con): I congratulate my right hon. Friend on setting out a clear vision for the NHS that is committed to high-quality outcomes for patients and good value for money for the taxpayer. Does he agree that the delivery of that objective depends critically on effective commissioning? Does he recall that the last Labour Government said that engaging GPs with the commissioning process was the key to success? Does he recall that the White Paper setting out the plan for practice-based commissioning said that GP commissioning was not a new idea to the NHS? Indeed, it is not. He is to be congratulated on holding out the prospect that, at last, this idea can be made good and made powerful in the interests of patients.
Mr Lansley: I am grateful to my right hon. Friend for his comments. In his capacity as the Chairman of the Select Committee on Health, we will be responding to him very shortly regarding the Select Committee's report from before the election on commissioning in the NHS. What he has just said is absolutely right; we have to be able-this is a central task in commissioning-to bring together the responsibility for the management of patient care with the responsibility for the commissioning of services. The current situation is akin to a shopping trolley being pushed to the checkout while the primary care trust is standing there with a credit card, bleating about whether things should be taken out of the trolley. We have to ensure that the design of services follows the best clinical leadership in terms of the services that are required for patients. He and I very much agree on precisely that objective.
Mr Speaker: Order. More than 30 hon. and right hon. Members are seeking to catch my eye. As always, I would like to accommodate everybody, but what is required, both in questions and in answers, is brevity-a legendary example of which I am sure will now be provided by the right hon. Member for Don Valley (Caroline Flint).
Caroline Flint (Don Valley) (Lab): Thank you, Mr Speaker. Is it not already the case, in PCTs, that it is clinical directors, who are professionally trained as doctors, who lead in terms of providing services in conjunction with GPs at a local level? Can the Secretary of State assure the House that his proposals will make the system any better? I do not think so.
Mr Lansley: I am sorry, but when the right hon. Lady was a Minister, she should have talked to more GPs. Overwhelmingly, they would have told her that they do not feel that the PCTs listen to them. They feel that the PCTs tell them what to do and get in the way. We are going to empower GPs to deliver services for their patients.
David Tredinnick (Bosworth) (Con): I, too, congratulate my right hon. Friend on his statement. If he is going to get more choice for patients in treatment options, he will have to expand integrated health care so that herbal medicine, acupuncture, back treatments and homeopathy are more widely available across the country. Will he look at the American model of the consortium of 44 academies that has been considering integrated health care? Can he reassure me that his NHS commissioning board will not block options for integrated health care across the country?
Mr Lansley: The job of the NHS commissioning board will be to inform GP-led commissioning through scientific evidence, clinical evidence and guidelines, but it will be for GPs themselves, managing their budgets, to enable patients to exercise greater choice. The working out of what that choice looks like should not be dictated by politicians, but should be determined by patients and their clinical advisers.
Miss Anne Begg (Aberdeen South) (Lab): The Secretary of State has not answered the question of my right hon. Friend the Member for Leigh (Andy Burnham) about the future of the Food Standards Agency. The Scottish arm of the FSA is based in Aberdeen, and I wonder whether the Secretary of State has had any discussions with the Scottish Government about its future. If not, is this yet another example of the new relationship that is meant to be in place between Scotland and the rest of the UK?
Mr Lansley: The shadow Secretary of State will have had the chance to see that there is nothing in today's White Paper about the FSA-no such proposal.
Andy Burnham: You have been briefing about it.
Mr Lansley: I have not been briefing anything to anybody. [ Interruption. ] I have not. It is very straightforward. The FSA, along with other bodies associated with our public health responsibilities, will be the subject of a public health White Paper in the autumn. There is no proposal.
Andrew George (St Ives) (LD):
In seeking to reassure the House that this is not the top-down reorganisation that the coalition agreement derided, would my right hon. colleague reassure my constituents, who are quite excited by the idea of more patient and local authority involvement in local decision making, that where the
primary care trusts in which they are going to be appointed will be abolished, there will be more GP commissioning groups than PCTs at the end of the process?
Mr Lansley: Yes, I am grateful to the hon. Gentleman. The number of GP-commissioning consortiums will be determined not least by GPs themselves, deciding what makes sense in their locality. He and his Cornish colleagues have often been frustrated by the way in which a top-down bureaucracy has sought to dictate to the people of Cornwall, often in specific localities, at a considerable distance from their hospital services, what services should be provided locally in places such as Hayle and Penzance. He and his constituents can be really comforted by the thought that their clinical advisers and general practitioners in local consortiums can in future make those decisions about their services.
Hazel Blears (Salford and Eccles) (Lab): Despite the tremendous improvements that have been made in Salford and Eccles over the past few years in tackling cancer and heart disease, significant inequalities remain that require substantial resources. Will the Secretary of State confirm that in shifting commissioning powers to GPs and allowing the NHS commissioning board to allocate resources, the funding formula will still properly reflect the needs and deprivation factors in areas such as mine and right across the country?
Mr Lansley: The White Paper makes it clear that the NHS commissioning board will be required to allocate resources across the NHS in England on the basis, as far as possible, of seeking to secure equivalent access to NHS services. That will clearly be relative to the prospective burden of disease. In tackling health inequalities, the right hon. Lady will know that we need separately to allocate resources to local health improvement plans, which will be led through local authorities, and which will enable them to create local public health strategies to secure improvements in health outcomes and to reduce health inequalities.
Nadine Dorries (Mid Bedfordshire) (Con): May I congratulate the Secretary of State on what is a truly exciting White Paper? Will he confirm that in addition to GPs having responsibility for commissioning, there will be the opportunity for them to become actively involved in the provision of care and deciding what care is allocated to which patients?
Mr Lansley: Yes, my hon. Friend understands that GPs are often providers beyond their primary medical services responsibilities. One of the difficulties with fundholding was that there was an opportunity for that conflict of interest to arise and not be properly resolved, so we have made it clear that, in the commissioning framework that we will publish, we will set out consultation proposals on how we ensure that that conflict of interest is not allowed to arise. Where GPs wish to be providers, we do not constrain them, but how that contract is arrived at is transparent and open.
Mr Nick Raynsford (Greenwich and Woolwich) (Lab):
How can the Secretary of State, with a straight face, say that he opposes the culture of top-down bureaucracy and decisions being taken by politicians, when he himself,
in the past six weeks, has stopped the implementation of a clinically led and agreed programme for improving health care provision in south-east London, which was going ahead until he stopped it? Does he now accept that his words carry very little force for those of us who know what his actions indicate?
Mr Lansley: No is the answer. I set out on 21 May criteria on listening to patients and understanding what patient choice will be in future; on engaging the public, including local authorities, which are now following through on that accountability; on following the clinical evidence of what can best deliver outcomes; and on ensuring that GPs, as we have made clear, must be supportive and engaged. If any proposal in London is made at local level, such as the one the right hon. Gentleman refers to in Oxleas, that satisfies those criteria, which are bottom-up and locally led, there is no difficulty in its proceeding.
Mr Steve Brine (Winchester) (Con): I congratulate the Secretary of State on his statement, which many people outside the House will recognise is a breath of fresh air for our NHS, unlike the flagging leadership bid we heard earlier-the second this afternoon-from the Opposition.
Will the Secretary of State confirm that the new consortiums of GPs can regain responsibility for out-of-hours care, the provision of which is a great worry for many of the people I represent across Winchester and Chandler's Ford?
Mr Lansley: Yes. The commissioning responsibility will include urgent and out-of-hours care. I commend to my hon. Friend what the White Paper says about how we can deliver improvements in efficiency and effectiveness in terms of urgent care, 24 hours a day, seven days a week.
Mr Dennis Skinner (Bolsover) (Lab): Speaking as someone with a successful outcome, twice, under the national health service in recent times, could the Secretary of State explain to me why these private elements within the NHS-that is, the GP practices-which are getting another £80 billion to spend are not going to be watched over by the primary care trusts or, seemingly, anybody else? Who is going to watch them spend that money-the private sector?
Mr Lansley: I am astonished that Labour Members are still attacking general practice. I thought that shadow Ministers-former Ministers-had had enough of doing that. [ Interruption. ] I will answer the hon. Gentleman. GP practices will be accountable to patients who exercise choice; accountable to their local authority, through which a strategy is established; and accountable to Parliament and to Ministers through the NHS commissioning board with which they will have their contract.
Jacob Rees-Mogg (North East Somerset) (Con): In welcoming this statement, I wonder whether the Secretary of State will be able to put in place any interim measures for people such as a constituent of mine who have been prescribed life-prolonging cancer drugs such as Lapatinib but are being denied them.
Mr Lansley: I am pleased to be able to tell my hon. Friend that as part of the coalition programme we have said that we will implement a cancer drugs fund from April 2011. Indeed, my ministerial colleagues-not least the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Mr Burstow)-and I are looking urgently at what we can do in the meantime to try to ensure that we no longer continue with a situation where patients do not have access to cancer drugs that are routinely available in other countries.
Mr David Lammy (Tottenham) (Lab): Most people will recognise that GPs are at the cornerstone of the NHS, but also that since 1948 they have been independent practitioners running for-profit businesses. What safeguards has the Secretary of State put in place, and what is he doing about conflicts of interest? He said nothing about that in his statement. Is not what is proposed like asking pharmaceutical companies to be in charge of the NHS drugs bill?
Mr Lansley: I must not be unkind to the right hon. Gentleman, because he has not yet had a chance to read the White Paper-
Mr Lammy: It is here-I have read it.
Mr Lansley: That is my statement. When the right hon. Gentleman reads the White Paper, it will become obvious to him that, yes, we are looking to GPs to take responsibility for commissioning, but, unlike the problems that arose with fundholding, there will not be an opportunity for GPs to generate surpluses on their commissioning budget, and so money in their pocket. It will not work like that: there will be a clear separation between the commissioning budget and their personal budget. We will focus on the thing that really matters, which is GPs taking a commissioning responsibility in designing services.
Nicholas Soames (Mid Sussex) (Con): I welcome the Secretary of State's bold and imaginative statement on a White Paper that I am sure will be broadly welcomed in the NHS, not least because it will give people within the NHS the opportunity to give true vent to their creativity. Does he agree, however, that he is setting very demanding targets and challenges; and what time line does he envisage before this is finally implemented?
Mr Lansley: I am grateful to my hon. Friend. I will not go through the White Paper in detail now, but within it he will find that we look towards some GP commissioning consortiums taking an early adopter place from 2011-12, with consortiums generally taking, as it were, a shadow responsibility but not a legal responsibility in 2012-13, and then taking full responsibility, subject to the passage of the legislation to establish that, from April 2013 onwards-the point at which we anticipate that primary care trusts will be abolished.
Liz Kendall (Leicester West) (Lab): The Minister will know that about 80% of patient contact with the NHS is in primary care. Will GP commissioning groups be allowed to commission GP and other primary care services from themselves, and if so, how will they be held to account for that decision?
Mr Lansley: No, the NHS commissioning board will contract for the primary medical services provided by GPs themselves. GPs will commission for the additional services, including all the community and hospital services. There will be a combination of individual practices taking a responsibility, rewarded through their quality and outcomes framework for the service that they provide to their patients individually, and a general commissioning responsibility for those practices together with others in a local consortium.
Ben Gummer (Ipswich) (Con): Could the Secretary of State confirm what will happen to those trusts that have not yet achieved foundation trust status and those that are in the middle of applying for it?
Mr Lansley: I am grateful for that question, because what is important is that we have coherent reform in relation to both commissioners and providers. That means that by 2013-14, we should not only have energised the commissioning process and patient choice but set free the hospital providers. My objective, set out in the White Paper, is that by that time all NHS trusts should become foundation trusts. We will need to put in place measures to support them to do that.
Mr Geoffrey Robinson (Coventry North West) (Lab): Is the Secretary of State aware that those of us who listened to his speeches in opposition were much encouraged, but that with this first statement he has totally disillusioned everybody who believed that he was going to avoid the faults of the past? He has now introduced the biggest top-down, ill thought-through reorganisation that there has ever been in the NHS, and it has about as much chance of success as any previously introduced.
Mr Lansley: I would encourage the hon. Gentleman to go and talk to GPs in Warwickshire whom I have talked to, and to talk to those at Walsgrave about the freedoms that they want to enjoy.
I wish to make it absolutely clear to the hon. Gentleman that there is great consistency between what we said in opposition and what I am announcing today, but that there are some major improvements. Frankly, they have come about because of the conversations that I have had with my colleagues from the Liberal Democrat party. Not least, those conversations have enabled us to focus on the fact that instead of leaving what was a diminishing, residual role for primary care trusts, which withered on the vine, it is better and stronger for us to create a strategic responsibility for local authorities on public health and on joining up health and social care. That will allow us to remove the bureaucracy associated with PCTs, and it is more coherent and stronger than the proposals that we had in opposition.
Dr Sarah Wollaston (Totnes) (Con): My right hon. Friend recognises how toxic many targets were in the NHS, but they were not all bad. There were some that ensured that standards were maintained-for example the two-week wait for cancer referrals. How will he ensure that standards are maintained when targets are abolished?
I am grateful to my hon. Friend, who is absolutely right. That is why, as I said in my statement, not only will we be clear about what we are trying to achieve-for example, where cancer is concerned, one
and five-year survival rates at least as good as the European average and hopefully as good as any in Europe-but we will require the NHS to look towards clinically led, evidence-based quality standards that enable those working in the NHS to be clear about what constitutes quality. That will enable us to deliver those outcomes.
Glenda Jackson (Hampstead and Kilburn) (Lab): Some of the greatest health inequalities occur in areas of the greatest deprivation, which are not infrequently areas that are not attractive to GPs. We also have in London a very large number of people who have never registered, and will never register, with a GP. They tend to use accident and emergency departments. How will their medical needs be presented to this top-down body, the NHS commissioning agent, when there can be no input from GPs? If I read the Secretary of State's statement correctly, GPs' recommendations will be disregarded by the NHS commissioning board.
Mr Lansley: I do not recognise the hon. Lady's latter point. Some 7% of the population in London are not registered with a GP, which is one reason why commissioning consortiums of GPs will take responsibility for their locality, not just their registered patient population.
In relation to hospitals such as the Royal Free, one reason why the hon. Lady, I and other Members were campaigning against her Government before the election was that we recognised that we cannot shut down accident and emergency departments when patients are coming in the door by the tens of thousands because there is no alternative provision. The best way to design services in the community that better meet the needs of patients is through general practitioners designing them around the needs of their patients.
Mr John Baron (Basildon and Billericay) (Con): I very much welcome the White Paper's increased focus on improving outcomes, and particularly my right hon. Friend's comments about the introduction of one-year and five-year cancer survival rates, for which the all-party group on cancer has been pushing. How does he envisage GP commissioning of cancer services improving with the White Paper, given that part of the problem is that a typical GP will see only eight new cancer presentations a year?
Mr Lansley: I pay tribute to my hon. Friend's work. He will have noted that I deliberately said both one-year and five-year cancer survival rates-he made an important point about that. Clearly, there are many specialist commissioning services, which will become the NHS commissioning board's responsibility. To that extent, GPs should not be expected to commission specialised services-they have little experience of that. However, GPs as commissioning consortiums, like primary care trusts at the moment, are capable of having a relationship with their cancer networks to establish the services that they need for their patients. Indeed, that applies more to GPs because many of the patients and those who work in cancer services to whom I speak are critical of the lack of awareness on the part of PCT commissioners of the available services. Those who work in cancer services do not believe that PCT commissioners understand the service that they provide. Not every GP understands every aspect of cancer care, but they are much better placed to work with cancer specialists to design the services.
Mr Michael Meacher (Oldham West and Royton) (Lab): Given the transfer of £70 billion of NHS funds from PCTs to 500 GP consortiums, the vast majority of which have neither the expertise nor the inclination for such a huge administrative task and will have to buy in specialists from the private sector to do it for them, is not it clear that the real motive behind the reforms is to enable US multinational corporations, such as UnitedHealth, or UK corporations, such as BUPA or Virgin, to parcel out health care to the private sector on a vast scale?
Mr Lansley: No. That is completely wrong on all counts.
Dr Julian Lewis (New Forest East) (Con): I congratulate my right hon. Friend on his firm grasp of the subject and on taking an axe to the forest of bureaucracy. As he proposes to phase out the strategic health authorities, may I nominate the South Central strategic health authority-he knows what is coming-because that would ensure that it was no longer able to waste hundreds of thousands of pounds of our money on fighting a hopeless legal case to impose fluoridation on a population, three quarters of whom have indicated that they do not want it?
Mr Lansley: Yes, I am indeed aware of precisely what my hon. Friend says and will certainly take it into account.
Jeremy Corbyn (Islington North) (Lab): The Secretary of State has been asked by many Members about the accountability of GPs, and he has not answered. Some £80 billion is to be pumped through GPs, who will then buy in services. Who manages them? Who monitors them? Who checks on what they are doing? Will we get value for money or, as my right hon. Friend the Member for Oldham West and Royton (Mr Meacher) said, will the system in reality be administered by private health companies, just as GPs are private contractors in the NHS?
Mr Lansley: At the risk of repetition, let me say that GPs will be accountable to patients, who will exercise more control and choice. They will be accountable to the NHS commissioning board, which will hold their contracts, for financial control and for their performance, through the quality and outcomes framework. They will be accountable to their local authority for their strategy and for the co-ordination of public health services and social care.
Jason McCartney (Colne Valley) (Con): Thousands of patients in my constituency are desperate for specialist maternity care to be returned to Huddersfield royal infirmary, which was downgraded under the previous Government. Does the White Paper make the return of consultant-led maternity services to Huddersfield more likely?
Mr Lansley: The White Paper will enable GPs in an area, plus their local public and their local authority, to make decisions about the shape of services rather than its being done by ministerial diktat.
Alex Cunningham (Stockton North) (Lab):
The Secretary of State referred to delivering for the patient. Will he guarantee that patients such as those who need a new
knee or a new hip can expect their treatment in 18 weeks, or is it more likely to be 18 months under today's proposals, as it was under the previous Tory Government?
Mr Lansley: Ah! That was one of the Opposition Whips' handout questions, wasn't it? I will tell the hon. Gentleman that actually, patients are more likely to get their treatment more quickly. Let me give him an example. Patients with rheumatoid arthritis need rapid treatment, but they were losing out and suffering as a consequence of the 18-week target, because hospitals were hitting 18 weeks, but not providing the care needed by those patients in the light of their conditions. We must focus on what is in the best interests of patients, not on what is in the best interests of political grandstanding.
Bob Blackman (Harrow East) (Con): The Secretary of State's announcement will be warmly welcomed in my constituency. On Friday, I went to see a group practice of 12 GPs who are totally frustrated by the local PCT. They are concerned that when the reforms are introduced, they will also be frustrated by the GP consortiums. Will my right hon. Friend give me some assurances on how the GP consortiums will be formed? What will happen if some GPs disagree with how a consortium is set up?
Mr Lansley: I can tell my hon. Friend that I am looking to GPs in a locality to create GP commissioning consortiums that represent an area. They must decide on the geography of that and make proposals. It will not be possible for GPs simply to say, "This is nothing to do with us," because in future, we must expect GPs, who are senior professionals in public service and paid appropriately, to be responsible not only for the care of the individual patient in front of them, but collectively for the quality of care provided to their population at large.
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab): Prior to 1997, there was no cancer strategy and cancer was not a priority. The Secretary of State is absolutely right to make reaching European levels of one and five-year survival rates one of his priorities and an aspiration, but he knows very well that the one thing that is holding us back is the problem of early diagnosis. Precisely how does he think his abolition of targets and his woolly assurances will ensure early diagnosis? I will wager him that under his proposals, we will fall backwards rather than make progress.
Let me tell the hon. Lady that only just over 40% of those who were diagnosed with cancer actually came through the two-week wait process at all. She is right that it is very important that patients' signs and symptoms should be identified at an earlier point and that they should have earlier diagnosis. Whom does she imagine is best placed to identify signs and symptoms and to take action on them other than patients and the GPs who are responsible for their care? [ Interruption. ] If Opposition Members stop interrupting from a sedentary position, I can continue. Actually, patients need- [ Interruption. ] The shadow Secretary of State should understand this, having held responsibility for it. For early diagnosis, awareness of signs and symptoms on the part of patients is critical. Only 30% of members of the public had any idea what cancer signs and symptoms
were beyond the presence of a lump or swelling. We need to change such things and the responses of GPs to those early signs and symptoms.
Mr Speaker: Order. Members really should not chunter, witter or otherwise heckle from a sedentary position, because they thereby reduce their chances of getting in, or of their colleagues getting in.
Margot James (Stourbridge) (Con): Older people and people with long-term medical conditions have not been well served by the division between health and social care, which has lasted many years. I congratulate the Secretary of State on his plan to give local authorities control over local health improvement budgets. Can he say any more about how those reforms will break down the barriers between health and social care?
Mr Lansley: I am grateful for my hon. Friend's question. There is an unprecedented opportunity for local authorities and the NHS to create a much more integrated and effective strategy for health and social care working together. That is partly about focusing on outcomes, partly about listening to patients, and partly about extending personal budgets for patients, so that they themselves can break down such barriers. However, critically, it is also about local authorities exercising the responsibility that we will give them, plus their existing powers in relation to well-being right across their areas, to seal that working together, to deliver better public health and better integration between their social care responsibility and NHS commissioning plans.
Tony Lloyd (Manchester Central) (Lab): Without any shame, the Secretary of State is introducing an internal market in the health service. In that context, how will he guarantee that GPs will not look for cheaper medicine rather than better medicine?
Mr Lansley: Because patients will have increased choice-[Hon. Members: "How?"] Because patients will make their choices on the quality of service they receive, because the service will be free to them.
Dr John Pugh (Southport) (LD): The coalition agreement pledges to introduce true local democratic accountability through citizens actually being elected on to a health board. What can the Secretary of State do to persuade me-because he has not so far-that we will have local citizens, not doctors, making any decisions about the shape and configuration of local NHS services other than in public health, and will any of them be consulted about his structural changes or allowed to do things differently locally?
Yes. I feel very strongly that we have deliberately set out to improve local democratic accountability and we have found an effective mechanism for doing so. Local authorities will themselves have statutory powers to agree local strategies that encompass not only local health improvement, but the commissioning plans and the social care commissioning strategies locally. If a major service change is contemplated as a consequence, the commissioning consortiums will not be able to proceed without the agreement of the local authority through its joint strategic assessment. The White Paper makes it clear that if they do not agree, the local
authority will continue to have the capacity to send the proposals to the independent reconfiguration panel and, if necessary, to the Secretary of State.
Austin Mitchell (Great Grimsby) (Lab): May I tell the Secretary of State that north-east Lincolnshire has developed an effective care trust plus, which worked with the local authority to link care and health in exactly the way that he proposes, but the effect of his proposals on that trust will be to deprive it of most of its functions and cause it to issue redundancy notices to most of its staff. Has he heard of the old adage, "If it ain't broke, don't fix it"?
Mr Lansley: It is broke, and we are fixing it. We are fixing it because primary care trusts have not succeeded in delivering the outcomes that we are looking for, and they have consumed an enormous amount of money. I remind the hon. Gentleman that in the last year, at a time when we knew that there was a financial crisis facing the public sector and that the NHS would have to deliver more for less, the strategic health authorities and primary care trusts increased their management costs-not their spending on patients-by 23% in one year. It was outrageous.
Jeremy Lefroy (Stafford) (Con): I thank my right hon. Friend for his statement. As he will know, concerns were expressed about the role played by Monitor in the authorisation of the Mid-Staffordshire NHS Foundation Trust. Does he have any plans to beef up Monitor's role and ensure that it plays a better role in the future in the authorisation of trusts?
Mr Lansley: Yes, and hon. Members will see in the White Paper the way in which we can strengthen the role of Monitor. It is not just about the authorisation processes for foundation trusts, but a continuing responsibility for the quality and standard of care being provided in all our trusts, NHS trusts or foundation trusts. It is important to focus on quality, on what constitutes quality and on ensuring sufficient incentives to support quality. In addition, I hope that some of the lessons that will be learnt from the inquiry being conducted by Robert Francis QC will inform how we can put a better system in place.
Paul Flynn (Newport West) (Lab): How much will be created in additional bureaucracy and new costs by dumping on GPs tasks for which they are not trained?
Mr Lansley: The hon. Gentleman has not talked to GPs across England who are keen to take on this responsibility. In the process, we will reduce the costs of bureaucracy in the NHS by more than £1 billion a year.
Nick de Bois (Enfield North) (Con): Does the Secretary of State agree that where moratoriums are in place, practising GPs should be encouraged to seize the opportunity to determine the future of hospital accident and emergency departments, as with Chase Farm hospital in my constituency?
Mr Lansley: Yes, I very much agree. As he knows, his local GPs, patient representative groups and the local authority are already demonstrating how they can come together to devise the right solutions for the people of Enfield and the district around Chase Farm.
Valerie Vaz (Walsall South) (Lab): The Secretary of State talks about choice in the NHS, but could he confirm that GPs will be given the choice to join a consortium?
Mr Lansley: GP practices will all have to be members of a consortium, otherwise it will not be possible for them collectively to commission emergency and urgent care, and they will need to do that.
Clive Efford (Eltham) (Lab): The Secretary of State seems to misunderstand one thing. When patients go in to be treated by a GP, they expect to get the best possible treatment available. The Secretary of State said in an earlier answer that he would expect patients to have the knowledge of drugs to be able to determine whether a GP was supplying cheaper or better drugs. What local accountability will there be of GPs, what resources will be put into HealthWatch networks, what resources will be left available for local health improvement budgets, and what teeth will local authorities have to impose local health plans?
Mr Speaker: Order. That was four questions, to which one answer will suffice.
Mr Lansley: The answer is that I said no such thing as what the hon. Gentleman suggested, and the record will show that.
Harriett Baldwin (West Worcestershire) (Con): I welcome the fact that my right hon. Friend has said that an extra £20 billion will be going into patient care by 2014. Can he clarify how much more that is under our Budget, compared with Labour's Budget, which would have cut the NHS budget?
Mr Lansley: My hon. Friend is right. It appears that the Labour party's policy is to cut the NHS. Our policy is to do something that Labour never achieved: deliver greater efficiency and greater productivity in the NHS, not least through the reforms that I have announced. Every penny saved will be a penny reinvested to the benefit of patient care.
Meg Munn (Sheffield, Heeley) (Lab/Co-op): Sheffield is one of the areas that already has GP consortiums. They have been developing their relationships with the primary care trust and are now starting to make progress. What guarantee can the Secretary of State give to my constituents that today's unwanted change will not set back that process and not cause significant problems with the progress that has already been made?
Mr Lansley: It is not an unwanted change. All over the country, GPs themselves have resisted the concept that they do what the primary care trust tells them to do, when they are better placed to design services on behalf of their patients. They can, and I know that the GP commissioning consortiums in many places will want to take on board the key teams in primary care trusts that they think would help them deliver commissioning. However, GP commissioning consortiums will not be required to do so, although they will be required to deliver better outcomes for their patients.
Charlotte Leslie (Bristol North West) (Con): If hon. Members speak to GPs and professionals, who do not just sit here and talk about the NHS, but actually run it, day by day, they will find that it is not change or the White Paper that has caused demoralisation, but the machine-gun fire of targets and the monolith of management. The reason why that has caused so much demoralisation among the work force is that target box-ticking is so often different from the provision of quality care, as we have tragically seen in Staffordshire. Can my right hon. Friend reassure me that his reforms will mean that box-ticking is replaced by quality of care?
Mr Lansley: My hon. Friend is absolutely right and expresses her point superbly. The process is going to be about quality, not tick-box targets, and it is going to enable the front-line staff of the NHS to have not only access to the resources that they need, but the power to use them more effectively.
Fiona Mactaggart (Slough) (Lab): Who will have the legal responsibility for delivering the Secretary of State's welcome promise of a health care service free at the point of delivery? If we have expensive patients who are not being well treated by the GPs, what resource do we have, as Members of Parliament representing the interests of those patients?
Mr Lansley: The hon. Lady will see, in the White Paper and the subsequent legislation, the continuation of the existing legal framework, which does not allow additional charges to be levied inside the NHS.
Derek Twigg (Halton) (Lab): It is interesting that the Secretary of State said in the statement, "We will allow any willing provider to deliver services to NHS patients". Does he rule out any area of services in the NHS where private providers will be able to provide services?
Mr Lansley: I am adopting an any-willing-provider policy that was the policy of the hon. Gentleman's Government, until the shadow Secretary of State abandoned it in September 2009 at the behest of the trade unions. I am adopting a policy designed to achieve the best possible care for patients by giving them access to all those who will deliver NHS services within NHS prices.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con): Is my right hon. Friend aware that Hartismere hospital in my constituency was closed by Suffolk PCT, while at the same time, the PCT was able to afford to spend £500,000 on opening a new car park for managers? Does he agree that community hospitals such as Hartismere are still a valuable part of health care and that the White Paper might see a return to valuing them once again?
I am grateful to my hon. Friend for that question. I did in fact visit Hartismere hospital with his predecessor, and I entirely sympathise with his point. At that time, the primary care trust in his part of Suffolk was regarded as "initiative central". It had to pursue every initiative from the Department of Health, and the money just went out the door. Those initiatives lasted just a year or two and then disappeared. That is
not the basis on which to design the national health service. GPs are an excellent basis for this work because they are committed to their areas, and to the patients they look after, in the long term.
Alan Keen (Feltham and Heston) (Lab/Co-op): If the Secretary of State is correct in saying that we need clinicians and GPs to have more influence and even control over the commissioning process, will he explain why he does not simply legislate for them to take over the current trusts? That would achieve his aim immediately, and if any inefficiencies appeared and changes to the management commissioning structure were needed-whether in the present PCTs or following reorganisation-they could take place after a period of time. Instead, these slash and burn proposals are going to cost millions of pounds and cause a lot of disruption.
Mr Lansley: The simple answer is because GP commissioners want to create their own commissioning consortiums according to their own needs and local circumstances. They do not want to be saddled with the legislative structures and costs that currently bedevil primary care trusts.
Rachel Reeves (Leeds West) (Lab): In my constituency, a local charity called Healthy Living Network Leeds is commissioned by the PCT to provide health services in the most deprived areas, including among the Traveller community. What guarantee can the Secretary of State give to my constituents that those community-based health services will continue, and that they will be overseen to ensure that those treatments continue in the most deprived areas?
Mr Lansley: The answer is that GP commissioning consortiums will have a responsibility that goes beyond their registered patient population, and that when they set out their commissioning plans, those plans will have to be agreed by the local authority. In the hon. Lady's case, Leeds city council will have a responsibility to ensure, through its health improvement plan and through NHS commissioning, that the needs of groups such as Travellers are properly met.
Sajid Javid (Bromsgrove) (Con): My right hon. Friend will know that community hospitals, including The Princess of Wales community hospital in my constituency, have been under threat because of the policies of the previous Government. Does he agree that these new initiatives will make it more likely that local communities will take back control of their health care?
Mr Lansley: Yes, exactly. Last Thursday I was in Cumbria, and that is exactly what has happened there. The GP commissioners have collectively taken over responsibility for the Cockermouth community hospital. Instead of its being run down, as was intended, they have built it up as a base from which they are providing services for their area.
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