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Mr. Kidney: The danger is not only that somebody has two bites at the cherry, but that other people who are no part of the scheme may still come in with litigation for the liability at common law.

Thirdly, the previous scheme was negotiated in an era when the legal profession, and more particularly the world of personal injury litigation, was very different from today's. In the world of no win, no fee arrangements, any admissions made are likely to generate further litigation, even where a no-liability agreement for some might at first sight appear reasonable. For example, my hon. Friend mentioned the estates of miners. Putting aside the question why I should think it fair to exclude a miner's claim when the miner has died and the estate wants to carry on claiming, if I negotiated an agreement that excluded them, there would be no reason why they should feel excluded from taking a case to court and still proving the liability at common law. Nothing would be gained, from my point of view, by making the agreement.

Nevertheless, let me say that the costs of the coal workers pneumoconiosis scheme did, and still do, prove significant. More than 91,000 claims have been made under that scheme since 1974, of which more than 83,000 have been successful in securing compensation. To date more than £154 million has been paid in compensation under that scheme. Put simply, we need to be certain of the reasons for reaching decisions. In my view, progression of the current litigation is the best way to achieve that clarity.

In our handling of these difficult issues, it is always important to remember that the Government are effectively standing in the shoes of the former British Coal Corporation as the employer. For compensation to be payable, it must be established that British Coal was legally negligent and/or in breach of statutory duty as an employer, and that the injuries suffered by their employees were caused by that negligence or breach. Furthermore, the Secretary of State's powers under the Coal Industry Act 1994 to pay money out in respect of the liabilities of the former British Coal are dependent upon such liability being established.

My hon. Friend the Member for Barnsley, West and Penistone mentioned the cost of litigation and my hon. Friend the Member for Blaydon (Mr. Anderson) asked questions about the fees paid to solicitors. I am alive to those issues. The Department is fully committed to applying the lessons from the experience of the VWF and COPD compensation schemes, based on our operational experience and the reviews conducted by the NAO and the PAC.

Mr. David Anderson: The Minister will not be surprised that I am disappointed by what he has said so far. It is not just about the costs of litigation. What about the impacts on the public purse? He mentioned reports from the NAO. The Legal Services Commission has also done a massive amount of work. There has been a huge cost to the public purse in addition to the legal implications the Minister has advanced, including payments to solicitors and barristers. That must surely be weighed in the balance against the sensible scheme advanced by my hon. Friend the Member for Barnsley, West and Penistone.

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Mr. Kidney: I understand that point. My hon. Friend the Member for Barnsley, West and Penistone mentioned the costs and the amount that we have paid to lawyers already for litigation on osteoarthritis of the knee. He is right. We have had to pay lawyers, particularly for document disclosure. He knows that disclosure is an important part of the process of establishing whether there is liability.

One key lesson learned by the Department in conducting the litigation is that we must understand the scale of potential claims for the compensation. Our estimates in the past for VWF and COPD were much lower than the amounts that were subsequently paid. My hon. Friend mentioned on a number of occasions some 10,000 claims for osteoarthritis of the knee. So far, under the group litigation order, there are about 900 claimants, and the claimants' lawyers have mentioned to us another 1,000 claims. Putting the matter in a broader context, we handled more than 170,000 claims under the VWF scheme and more than 590,000 for COPD. Collectively, that totals more than 750,000 claims.

Let us draw on the experience of the DWP. Following the introduction of the industrial injuries disablement benefit for miner's knee last year there have been more than 33,500 claims for the benefit to date. Claims are arriving now at the rate of 300 a week. I am pleased to report that more than 20,000 cases have been assessed and of those 9,234 former miners have already received payments of benefit. In addition, a further 6,085 have received an assessment of disablement, although their condition was not assessed as severe enough to give rise to a payment of benefit.

I welcomed the Department's decision to pay industrial injury disablement benefit to miners suffering from osteoarthritis of the knee, following on from the recommendations of the Industrial Injuries Advisory Council. My hon. Friend was a champion of that cause. However, the decision to introduce entitlement to benefit payments raises different issues to those involved in the litigation against the Department as the inheritor of the liabilities of the former British Coal Corporation. In particular, the IIAC report, which triggered the entitlement to claim benefits for miners suffering from osteoarthritis, fundamentally does not directly address the key issues in the litigation that the Department is defending, including establishing knowledge, taking reasonably appropriate preventive steps as the employer based on that knowledge, and the apportionment of other contributory factors, such as family history and other health factors.

It is important to recognise that recent medical knowledge now firmly demonstrates that osteoarthritis is caused by a range of factors, including family genetics and obesity, as well as employment-related factors. In my view it is therefore vital that, where such large amounts of taxpayers' money may be at stake if compensation is to be paid, particularly in the current economic climate, liability is properly established through the court process. In concluding, I assure my hon. Friend-

Mr. Martyn Jones (in the Chair): Order. We must move on to the next debate.

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NHS Expenditure (Reduction)

1 pm

Dr. Richard Taylor (Wyre Forest) (Ind): I am delighted to see the Minister in his place. I do not mean to imply that not all Ministers have his qualities, but I know that he is a receptive and thinking Minister. I am grateful that he will respond to my suggestions, which are intended to be helpful to the future of the national health service, which we all know is vital to our constituents and beloved by the large proportion of staff who work in it and the patients who receive treatment.

The extra money that has been provided has seen dramatic improvements, especially in cancer care, cardiac care and the increasing scope and success of the various treatments that are now available. A crisis therefore looms. The NHS Confederation estimates funding cuts of £8 billion to £10 billion in the next two or three years, and £15 billion in the next five years. The King's Fund has produced a useful document, "Windmill 2009: NHS response to the financial storm", which opens with the words:

I want to talk about ways of addressing that challenge without widespread cuts. A high proportion of NHS expenditure is on staff, so if there are cuts, they are likely to be in the number of staff, which would not be helpful as the numbers in some areas are already inadequate. By lucky coincidence, my medical colleague on the Health Committee, the hon. Member for Dartford (Dr. Stoate), started this debate on Friday last week, and I believe that the Minister responded to it. The hon. Gentleman made the point that it is estimated that increasing self-care of patients with minor ailments could save the NHS £2 billion.

I was joining the train at Kidderminster station at about the time when the ban on smoking in public places came in, and a member of staff who had drawn the short straw and was sweeping up the fag ends outside said, "We might be able to change policies, but it's a job to change people." That was extraordinarily perspicacious at that time, and it is absolutely true that it is extremely difficult to change people. We can easily write new policies, but we must change people and how they use the NHS.

The hon. Member for Dartford quoted the Proprietary Association of Great Britain, which has described five clear steps to ensure that self-care increases. Following on from that, a discussion paper that I found extremely useful was produced by the National Endowment for Science, Technology and the Arts. It is headed, "The Human Factor", and has a sub-heading, "How transforming healthcare to involve the public can save money and save lives". It was drawn to my attention recently, and was written by Laura Bunt and Michael Harris, and published by The Lab and NESTA.

In this short debate, I can only point the Minister to that discussion paper, and give a brief flavour of it. The authors considered long-term conditions in particular, and how to change the way people cope with such conditions by educating them. I am thinking particularly of diabetics who, if they know how to control their disease, need much less help. The paper recommends a
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mixture of redesigning care with user involvement and more effective prevention. User involvement is crucial, and the NHS constitution has picked that up.

One public responsibility on patients from the NHS constitution is this:

If NESTA's suggestions were taken up and led to a 10 per cent. reduction in the cost of treating long-term conditions, that could save £6.9 billion a year, which is not to be sneezed at.

I cannot resist giving one of my favourite quotations. I do not know whether you have read Sir Walter Scott recently, Mr. Jones-I have only just rediscovered him-but one of his last novels was "The Surgeon's Daughter". He was writing about the burgesses of a Scottish borough and said:

What a lesson for all of us. Has the national health service limited people's ability to look after themselves and spoiled them with the help that they receive. We must change that so that they have the help of medical and nursing staff-the clinicians-only when they really need it.

Bob Spink (Castle Point) (Ind): My hon. Friend has rightly, responsibly and caringly brought an important subject to the Chamber. He is approaching the matter from the viewpoint of taking personal responsibility, as well as that of clinical strategies, but he seemed to dismiss early in his speech the possibility of cutting staff. Will he address the possibility of cutting management teams because Government policy, defensive insurance strategies and so on have driven up the cost and number of management teams in the health service far too much?

Dr. Taylor: I thank the hon. Gentleman for his intervention, but I will not touch on that because this is such a short debate. In fact, very recently, reports in the papers have suggested that NHS trusts with more managers have performed better than the others. That must be taken into consideration.

Mr. Andrew Smith (Oxford, East) (Lab): I was drawn to this debate because of its interesting title, and the hon. Gentleman's background. I want to make two brief points. First, is it not important that he and others are careful when using phrases such as "age of austerity" when it comes to the NHS, in case the wrong signal is given to front-line staff-nurses and others-who often work in hard-pressed circumstances and who need a continuing period of stability, building on the welcome investment to which he referred? Secondly, on his point about prevention, does that not underline the critical importance of community health initiatives, community nursing and nurses in our schools? Will he say a word or two about that?

Dr. Taylor: I thank the right hon. Gentleman, who made many points in a short time. I cannot hope to address them all. On stability, I absolutely agree. I do
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not believe that anyone will try to reorganise the health service crucially in the near future, for which we will all be grateful.

Prevention is a huge subject, and I am afraid that I am taking that as read, because it is obvious that spending more money on prevention saves money in the long term. The huge problem is moving money out of acute care into prevention, but I am sure that the Minister will be well aware of that.

I have spoken about patients and the public, and what they should be doing to improve how they look after themselves. Now, I want to speak about the staff. I am the first to praise staff for their tremendous, hard work, but we must be realistic and ensure that they realise the problems afoot. I remind the Minister of the NHS Confederation's paper, "Dealing with the downturn", which was published in June 2009. It is useful because it lists first many bad ideas from history that do not work.

If waiting lists are allowed to grow, quality is diluted. Indiscriminate cuts in expenditure can focus on cost rather than on value, and pay could get out of line, training might be cut or we could fail to protect curative services. Those measures have all been tried and have failed. They are doubtful things such as centralising support functions, mergers, structural change or reducing staff. The document contains a useful quote about price competition, which states that

I believe that that has been one of the reasons behind the poor quality of out-of-hours care in some places.

Let me move on to the more positive points in this document. There are several pages of suggestions of ways to do things differently in order to improve how services work and improve patient safety and quality of care. Some of those things will save money, such as the productive ward, which I am sure the Minister knows all about. I have seen that initiative in several hospitals that I have visited, and it is a scheme whereby all staff, from health care workers to the sister to the cleaners, get together on a regular basis and talk about how they are doing things. That can lead to obvious alterations, such as moving all the things that are necessary to set up an intravenous drip to one place, so that staff do not have to dash from place to place picking things up. That leads to improvements in ways of feeding patients, and can reduce wastage of time over meals. It can lead to nurses doing the nursing rather than lots of admin, so that they can spend more time with the patient.

The document mentions the difficult matter of treatment prohibitions. However, as the National Institute for Health and Clinical Excellence has told us, relatively few treatments in use have no proof of effectiveness, so we cannot save billions of pounds by cutting out useless treatments. There is a mention of limiting the NHS package, which in my language is health care rationing. However, as is pointed out, that would require public debate and it would be difficult to sell to the public unless all other ways of saving had been exhausted.

Productive wards are an initiative from the NHS Institute for Innovation and Improvement, which sadly seems to have rather a low profile. That organisation was responsible for the better care, better value indicators,
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the first tranche of which came out several years ago, and I believe that there have been further tranches. The indicators compare the performance of the NHS with the performance figures for the top 25 per cent. regarding that treatment or method of carrying out a service. The productive opportunity from those indicators is, I am told, £3 billion-something worth looking for.

The King's Fund "Windmill" report makes specific recommendations for the Department of Health, regulators, strategic health authorities, commissioners and providers, and there are two interesting appendices. Appendix B apparently fell off the back of a lorry; it is a leaked Department of Health memo with a long list of possibilities for the emergency strategy committee to consider. That is encouraging as it shows that people at the Department of Health are using their brains and getting their staff to work on those sorts of things. Appendix C is a useful classified summary of the various approaches taken to reducing costs, improving efficiency and perhaps increasing income.

In addition to the papers from the King's Fund, NESTA and the NHS Confederation, I have had a host of letters over the past few days from organisations making suggestions. Action on Smoking and Health-ASH-points out the cost-effectiveness of measures taken to reduce smoking, which can be highly effective. The Royal College of Nursing mentions the huge benefits and cost savings from community nurses, particularly specialist nurses, who can save a vast amount of time and money. There were suggestions for isolated drug economies, and suggestions from the Alzheimer's Society.

I will return to my initial point: we must first change people by making them more informed and responsible for their own health care, not only for minor ailments but for long-term conditions. We must then change the workings of the NHS and give staff at all levels the chance to suggest innovation and better ways of working. I am conscious that I have not spoken much about prevention; there is no time for that, although it is a crucial matter.

I conclude with something that Disraeli said towards the end of his first spell as leader of the country:

1.15 pm

The Minister of State, Department of Health (Mr. Mike O'Brien): I congratulate the hon. Member for Wyre Forest (Dr. Taylor) on securing this debate on what will be one of the most challenging issues for the health service over the coming decade. I understand that the Health Committee is looking at this subject, and I look forward to the evidence that it produces.

As the hon. Gentleman said, over the past 12 years funding for the NHS has increased substantially and is now-as we promised-broadly on a par with the rest of Europe. The NHS has expanded and improved beyond any recognition, and as a consequence we now have a more capable and resilient service. Patient care has improved significantly, far fewer people now die from heart disease and cancer, and waiting times are the shortest they have ever been. Despite what some newspapers claim, patient satisfaction rates are extremely high.

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