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While we welcome the Government's commitment to increase philanthropy, they have gone quiet on moves to encourage philanthropy through the tax system. I am depending on the noble Lord, Lord Inglewood, to chase them on this matter. The Secretary of State has said that he intends to write to the 200 biggest philanthropic donors thanking them for their contributions. I am sure that they will be grateful and perhaps even flattered by this attention, but I suggest that the message might be seen as a little hollow when the Secretary of State's first contribution to the nation's great arts heritage has been to cut funding.
On the Olympic Games, the brilliant custodianship of my right honourable friend Tessa Jowell has ensured that this month's report on progress says that the 2012 London Olympics are on time and on budget. The Government have inherited much in arts and culture; they have inherited something that was working and working well. They need to provide reassurance that the budget cuts that they have proposed will not have an impact on the London Olympic Games in 2012.
I now turn to health. The House would expect me to look at the manifestos of the partners in the coalition Government, the coalition agreement and the gracious Speech, as well as, of course, the words of the partners in the past, to see how the Government will attempt to reconcile some interesting and occasionally diametrically opposed points of view. Let us start with the name of the Department of Health. The Conservatives said:
"We will turn the Department of Health into a Department for Public Health".
It is a small and relatively unimportant promise to break immediately, but what does it presage?
Here are some of the Conservative promises that do not appear to have survived the coalition negotiations. The Conservatives promised to scrap all central NHS
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It is important to put on the public record at the start of this Parliament that Labour has left the NHS in its strongest ever position. In 1997, the discussion was about whether the NHS would survive at all; today in 2010, the NHS is substantially rebuilt and renewed. I do not apologise for repeating the figures: waiting times are at an all-time low; infection rates are right down; patient satisfaction with the NHS is at an all-time high; there are 44,000 more doctors and 89,000 more nurses; waiting lists are down by over half a million; and 3 million more operations are done per year. Also, we have seen the biggest hospital-building programme in the history of the NHS, with 118 new hospital schemes completed. As George Osborne might say, we did fix the roof while the sun was shining.
That did not happen by chance. In the teeth of opposition-from some, if not all, of the Benches opposite but particularly from the new Secretary of State-we took the decisions that have left the NHS in this position. I put the Minister on notice that we shall be watching closely the Government's decisions and the effect that they have on the NHS. I urge the Minister's Liberal Democrat colleagues to do the same, because they supported many of our changes and they, too, will be held to account for what happens next.
Of course, where we support the work of the Government, the noble Earl can expect my support. He and I have a history of co-operation and friendship, which, for my part, I intend to continue.
I read the new Government's coalition agreement with great interest. I am astonished that the document seems to have been signed off by the now Secretary of State, who, in opposition, promised over and over again to,
Perhaps one of the Secretary of State's new officials told him that his plan to remove targets which have helped to deliver so many improvements for so many patients was "very bold, Minister"-but perhaps not.
Therefore, we await the detail, and of course we have no doubt that any detail will be presented to Parliament before it is published elsewhere. Reports have already suggested that the four-hour accident and emergency target and the 18-week referral to treatment target will be scrapped. I think that the Minister needs to come clean with this House. Are his Government going to change those standards? Are they going to keep the 18-week target? Are they going
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However, not everyone will be unhappy about the ditching of targets. The Financial Times has already reported, on 18 May, that:
"Private hospitals are expecting a rise in business if, as expected, the Conservatives go ahead with their promise to scrap Labour's waiting-time targets".
That choice of going private is one that many patients will remember. Before targets were in place, patients had a choice: wait in the NHS or pay and go private. It is something that we changed, and I am proud of that. I ask the Minister what mechanism the Government are going to use to ensure that waiting lists do not rise. With hospitals encouraged to make savings, what will the mechanism be to ensure that savings are not made by making people wait, as the party opposite has done in the past?
Can the Minister also tell us what will happen to NICE? What will happen to the investment that we proposed for cancer diagnosis? Just before our Government left office, we announced £200 million a year in funding for new diagnostic equipment for cancer. Can the noble Earl tell me whether that target will be met, or has this money been diverted into the Secretary of State's cancer drugs fund? Can he tell me which is most likely to save more lives: investing in early diagnosis or investing in cancer drugs unapproved by NICE? Can he also explain what relationship the new cancer drugs fund will have with NICE?
The Government have promised that the health budget will rise but they have also promised to make savings. Can the Minister say by how much the budget will rise? In opposition, the new Secretary of State managed to do two things. He complained that deprived areas did too well out of the NHS budget at the expense of areas with less deprivation but more older people, and he called for a change in the funding formula. At the same time, he called for more of the health budget to go to deprived areas in the form of a health premium. It was impressive, to say the least, to complain that deprived areas were overfunded and underfunded at the same time, but I wonder how that feat might roll out in government. If we take the Secretary of State's words at face value, which PCTs will gain and which will lose?
Another promise that seems to have been forgotten is the one made repeatedly by the Prime Minister, when he was leader of the Opposition, that he would have "no more pointless reorganisations" in the NHS. It now seems that the Government are planning one of the biggest reorganisations in the history of the NHS, with not only a new independent NHS board but, according to the Health Service Journal, the abolition of strategic health authorities. I am not sure that the Secretary of State is adopting the right way to deliver a reduction of costs by encouraging members of strategic health authorities to resign in protest. On that basis, it could take some time. The new Prime Minister once asked the question: are serious political issues too important to be left to unaccountable quangos? He has given his answer. The job of allocating the NHS
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I turn to social care. Noble Lords will not be surprised to learn that I was disappointed to see that the Government have decided not to take forward free personal care at home for those with the highest needs. I am sure that I am not as disappointed as the elderly and disabled people and their families and carers who stood to benefit from the legislation. I should like to join with Carers UK in asking the noble Earl what has happened to the £420 million of funding and what is it now being used for. What about the £130 million that was earmarked for reablement and what has happened to the commitment, supported across the House, for the delivery of portability of care packages to those most seriously disabled?
I was less disappointed that the Conservative proposal to create a new private insurance system to cover the costs of residential care has been dropped. It seems to have bitten the dust. That was a policy whose sums never added up.
The Government's new proposal of a commission on long-term care is certainly better than the old Conservative policy, and we will be happy to support that commission's work. I hope the Minister took note of the job application of my noble friend Lord Warner to serve on the commission, as he is definitely very well qualified to do so. I recommend the White Paper which we launched just before the election as a blueprint that that commission might consider.
At the end of this Queen's Speech debate, I wish to make some general remarks. I want to mention the economy because it is important to put such general remarks on the record. Our Government made the Bank of England independent and that was opposed by the Conservatives. We took tough decisions to get our national debt lower than that of France, Germany, America or Japan before this global financial crisis began. Our Government led the worldwide effort to stop global financial collapse into recession and into depression, in the face of bitter and wrong-headed opposition from the party opposite. Although the Government may now pray in aid the loyal support of the Governor of the Bank of England and the German finance ministry in advocating immediate and deflationary spending cuts to reduce the deficit faster this year, he and his Chancellor are out of step with worldwide opinion and run grave risks with our recovery, our jobs and our vital public services.
We shall be holding this new coalition to account, make no mistake about it. We shall take our responsibilities as a loyal Opposition seriously to probe, to question and to challenge and we shall use the tools at our disposal to do so. I disagree with the noble Lord, Lord Hill, when he said that he felt nothing much had changed since the last time he was in his position. Government in 2010 is not the same as the Government which the Conservative Party left in 1997. There are different terms of engagement these days. I have no fears for the noble Earl, Lord Howe, as a model of transparency and accountability, but he may need to have a quiet word with some of his fellow Ministers.
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We have had four days of wonderful, illuminating and considered debate. In closing, I congratulate all noble Lords on their contributions today and on the other days of this debate, particularly the maiden speeches that we have heard from new Members of your Lordships' House and the speeches by the maidens at both Dispatch Boxes. Your Lordships' wisdom and eloquence bodes well for our future debates.
7.14 pm
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, this has been a wide-ranging and most fascinating debate, marking, as it does, the conclusion of our deliberations on the gracious Speech. Having been given the privilege of responding, I can begin by expressing my appreciation for the congratulations extended to me and to my noble friend Lord Hill from around the House. I also thank all noble Lords who have spoken so well and so eloquently. Chief among those have been our four maiden speakers, who have provided us with truly splendid contributions. The first of those came from my noble friend, who referred in brief to the Government's programme for health.
In health, as in education, our desire is simple. It is to see standards driven up in response to those who are closest to the delivery of the service: the professionals and, in the health service, the patients whom they look after. Those are the people whom we wish to empower. In fulfilling that wish, we shall move away from centrally imposed targets which focus simply on process in favour of quality standards linked to results. Those quality standards will be defined by reference to clinical evidence. We will commission for quality care. We will pay for performance. We will put the patient at the centre of care by giving him information and choice, and we will encourage health and social care providers to be more efficient and effective at delivering quality and good value. I say to the noble Baroness, Lady Wall, that that does not mean that providers will no longer be held to account. Good regulation matters very much, but it has to be meaningful regulation.
That is a far-reaching programme. One of the key steps in setting the NHS free from central diktat will be the creation of the autonomous NHS board. I was grateful to the noble Lord, Lord Patel, for his remarks in that connection. The board will allocate resources; it will provide commissioning guidance; and it will support GPs to commission services on behalf of their patients.
For the first time, the NHS will be led not by politicians but by clinicians, who will be fully accountable for what they do. Despite the huge investment in the NHS in recent years and the improvements that we have seen-which I am the first to acknowledge-the fact is that costs have risen, productivity has fallen, bureaucracy has increased and outcomes have simply not kept pace. In many of the common cancers, our survival rates are the worst in the OECD. We are on the wrong side of the average in western Europe for infant mortality and for premature mortality from lung cancer and heart and respiratory disease. People are more than twice as likely to die from a heart attack in the UK than in France.
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We want our health outcomes to be among the best in Europe-indeed, among the best in the world. To achieve that, we have to set doctors, nurses and midwives free to do their job. It is a sobering statistic that the system now demands in the order of 250,000 separate data returns from trusts every year. We have to reduce that burden dramatically and trust the professionals on the ground to judge what is right for their patients.
If we are to match the best health outcomes in the world, we will have to improve our public health services alongside the NHS. That theme was pursued by the noble Baronesses, Lady Greengross and Lady Masham, my noble friend Lord Fowler, the noble Lords, Lord Kakkar and Lord Patel, and others. We will have to invest in prevention-to keep people healthy and prevent them getting ill in the first place. To do that, we shall give local communities greater control over public health budgets, with payments linked to the outcomes that they achieve. We will work more closely with local NHS organisations, local authorities and the voluntary and private sectors, and we will take more targeted action to reduce health inequalities.
That is where our health premium comes in. Like the pupil premium, it will directly tackle disadvantage and reduce inequalities, and it will make for a much fairer approach to public health. In the coming weeks, we will be publishing a White Paper which establishes our long-term strategy for reform of the NHS and we plan to introduce a health Bill in the autumn.
The right reverend Prelate the Bishop of Chichester spoke about the NHS workforce and asked who was included in that term. He was right to give me a prod on that. We will give all NHS doctors, nurses, allied health professions and other health professions back their professional autonomy. They need to be able to use their professional judgment about what is right for patients. He asked me specifically about chaplains. We very much value the work done by NHS chaplains, who play an important part in providing high-quality spiritual care services to patients and staff, and we are committed to ensuring that patients and staff in the NHS have access to the spiritual care that they want, whatever faith they may have.
The noble Baroness, Lady Greengross, asked about Monitor, which was also raised by the noble Baroness, Lady Murphy, who also asked me about the NHS board. In short, by creating an independent NHS board, we will make sure that funding decisions are made on the basis of need, that commissioning decisions are made according to evidence-based quality standards and that resources are allocated appropriately. We propose to develop the role of Monitor to establish an economic regulator with responsibility for ensuring that patients have access to essential services and that the money invested in the NHS achieves maximum value. The noble Lord, Lord Warner, was right in all that he said on that issue.
My noble friend Lord Colwyn, as he customarily does, spoke about his own subject: dentistry. We will introduce a new dentistry contract that will focus on achieving good health and increasing access to NHS dentistry. At this stage, we need to review the details of the system that we have inherited. Once we have done
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The noble Lord, Lord Mitchell, spoke about foetal alcohol syndrome, a subject about which he and I have spoken many times in the past. We want to improve labelling so that people are more aware of the amount of alcohol in drinks as well as of guideline limits. We want to see the necessary improvement in labelling information through a voluntary approach if we can, but we will consider all responses from the consultation that closed very recently-I think on 31 May-before we make any decisions on that matter.
The noble Lord, Lord Sutherland, chided the Government for setting up a royal commission on long-term care. He rightly pointed out that we have had many papers on this subject, not least the royal commission that he chaired in such a distinguished way. I simply say to him that this is an urgent matter. We are not pressing the reset button, as it were, on reform of long-term care. It is a hugely challenging issue, and the independent commission will consider the evidence and information gathered through the public debate over the past few years. We know that we must reform social care on a sustainable and long-term basis. A number of options have been put forward for funding a reformed system, so we just have to build on all this work and keep up the momentum of change. I welcomed what the noble Lord, Lord Warner, said on that subject.
The noble Baroness, Lady Masham, asked about the patient voice. We are going to give the public a strong and independent voice though Health Watch, which will be a statutory body with the power to investigate and support complaints. I hope that this will be music to the ears of my noble friend Lady Knight. Locally, we will strengthen the patient voice by having directly elected members of the public on the boards of PCTs. That will ensure that boards are balanced between locally accountable individuals and technical expertise. We will publish detailed data about the performance of healthcare providers online so that everybody will know who is providing a good service and who is falling behind. We will measure our success on the health results that really matter, such as improving cancer and stroke survival rates and reducing hospital infections.
The noble Lord, Lord Patel, asked me about preventive health measures, including those relating to alcohol, tobacco and nutrition. Lifestyle-linked health problems like those and the spread of infectious diseases are leading to soaring costs for the NHS. We will provide separate public health funding to local communities that will be accountable for and paid according to how successful they are in improving their residents' health.
The noble Baroness, Lady Thornton, asked me about targets. The service priorities for the NHS have to be based on evidence about their benefits for patients; that is, they should be focused on the outcomes that they achieve, rather than on chasing nationally mandated targets with incomplete clinical justification. We are going to remove the politically motivated process targets. I am looking at the list that we have inherited from the
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The noble Baroness asked me about creating a department of public health. The coalition agreement is not the entire sum of our policy, and we will announce further information in due course. As I have indicated already, we are committed to taking action on public health and encouraging behaviour to change, to help people to live healthier lives.
The noble Baroness, Lady Murphy, asked about foundation trusts. I apologise for being so brief, but can say that we are considering a number of options for all NHS providers to become foundation trusts, taking into account many of the issues that she rightly raised. We want to resolve issues of efficiency, issues of clinical sustainability and an explicit assessment of quality, as those are affecting the flow of trusts becoming foundation trusts, as she well knows. This is not easy, but we are determined to make progress.
The noble Lord, Lord Rea, criticised the purchaser/provider split, particularly in relation to the costs of running a commissioning system. I should say to him simply that before we created the division between purchasers and providers, we did not have an accurate idea of how much anything cost in the NHS. That was a very basic lacuna in budgetary control and service planning, so the split has been a helpful feature of our health system at a time when value for money is more important than ever.
The noble Lord also asked about the workability of patients being able to choose their own GP. We believe that patients should be able to choose their own GP practice and not have an arbitrary set of rules that dictate where they can register. If people want to be able to register near their work or near their home, or with a practice that offers better service, they should be able to do so. We know, incidentally, that these problems persist mainly in our most deprived communities, where patients have historically had less choice, yet these are the areas with the greatest health needs.
My noble friend Lord Addington asked about getting the population involved in sport-a subject on which he is a renowned expert. As part of delivering a health legacy for the 2012 Olympics, the legacy action plan aims to make 2 million more adults in England active by 2012-13 and will be measured by the number of adults aged 16 and over who participate in sport or undertake some form of physical activity.
My noble friend Lord Bridgeman spoke about hospices, which play a very valuable role in end-of-life care, particularly for cancer patients. The coalition's programme for government included a commitment to introduce a new per-patient funding system for all hospices and providers of palliative care. I am sure he knows that the responsibility for setting standards in palliative care training for nurses sits with the professional regulators, but I shall ensure that his remarks are brought to the attention of the Nursing and Midwifery Council.
My noble friend Lord Fowler spoke about the prevention of HIV and hepatitis B and C. These are priorities for us. The Joint Committee on Vaccination and Immunisation considered the hep B vaccination
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