14/06/2011 House of Commons

the beginning of this crisis. I would like to see the moderate

members of the regime to do so again. Interest has exceededlet the

time available. We must on. Urgent question Mr Jamie Reid. Thank you,

Mr Speaker. Can I ask the Secretary of State to update the House on the

government review of waste policy in England. Mr Speaker, I have laid

in the library copies of the waste review to which we received 1800

responses. The government's waste review looked at all aspect of

waste policy and delivery in England. We want to make it yesier

for people to do the right thing and recycle more. Today's are you

view is good news. We will make it easier for people to recycle and

tackle measures introduced by the last government, which encourage

councils specifically to cut the scope of collections. We will

remove the criminal sanctions applying to householders so that

households aren't menaced for simple mistakes. We also propose to

introduce a harm to local amenity to tackle neighbours from hell,

ensuring enforcement is targeted at those who deliberately break youth

law. The review is good for business. We are abolishing lotts

because they offer certainty about landfill tack tax. The escalator

will move from �8 to �0. We are announcing a voluntary agreement so

that recycling services can be better exercised. Energy from waste

will be a key technology in the future. Today's review is good for

the environment. It will start consulting on restricting wood

waste from landfill and go on to review the feasibility of bands on

metal, textiles and biodegradable wastes. The review changes the way

we look at waste by unlocking the economic opportunities of

transforming waste to resource. We have set out a clear direction for

cutting landfill, preventing waste and increasing recycling. It's

barely credible, no wonder DEFRA is seen as the political equivalent as

the mad woman in the attic. Today's announcement has been spun to the

media before it has been led before Parliament. Amongst the spin was

another broken promise, this time on weekly bin collections. Both the

Secretary of State for DEFRA spent their time in opposition promising

the public that weekly bin collections would be introduced.

Today, we discovered this is not the case. Before the election the

Secretary of State for Communities and Local Government said, to much

acclaim, amongst his own party, "it's a basic right for every

Englishman and woman to be able to put the remnants of their chicken

teebg ta masala in their bin without having to wait for two

weeks for to be it to be collected". Why is it that the government's

position has changed? Can she also explain to the House today, is she

happy that this waste review contains no recycling targets at

all for England. The UK's recycling comind under the European Union are

going to be met on the backs of recycling targets in Wales,

Northern Ireland and Scotland, is that right? Can she also tell us

why it is that she choose, on becoming Secretary of State, to

abandon the last Labour government's consultation on

stopping wood going to land fill, to waste a year and today

reintroduce it? Instead of taking the chance to reduce recycling and

reduesz waste this government aband Bann on the other hand's Labour's

target. There is more to do. Today's announcement fails to

establish a frame work for the green world that this country needs.

The Secretary of State should today explain why it took so long and

looks set to deliver so little. Speaker, first of all, I would like

to make it clear that the written ministerial statement was available

to members of the House before I spoke to the chartered institute of

waste management. Of course, the government will work with all

parties to increase recycling rates. The recycling target is a European

target of reducing by 50% by 2020. I'm confident we are on target.

This is a devolved matter also for the other nations. Mr Speaker, it's

a bit rich coming from the opposition, who had 13 years, to

get to grips with landfill. It could, if he had so wand wanted,

got on and banned wood and materials and textiles and metal fs

it had so choosen to do. I fear the opposition is in denial about the

dreadful economic legacy it has left to the government. Mr Speaker,

he asks about green growth. Mr Speaker, I have just spoken to the

chartered institute of waste management and shared with them the

fact we estimate that there will be a growth of 34 to 4% per annum in

green jobs through the waste industry because of the positive

frame work we are setting out to help people do what they want to do,

the right thing, waste less and recycle more. That the Secretary of

State laid before the House today, may I share with the Secretary of

State that the district council serving my part of North Yorkshire

will be on their way to making the target she has set. There will be

preverse implications of abolishing the LAX because rural communities

have done well out of. That could I ask the Secretary of State on

anarobic digestion, it is welcome it will be increased. It deals with

waste food, what are the implications from other energy -

from waste facilities going forward in the next few years? Well, Mr

THE SPEAKER:Er, I would like to thank the Chairman of the Select

Committee Warm Welcome to the government's waste review and the

recognition, I think, that LATS fulfiled a role. The landfill tax

has largely overtaken its impact in helping us reduce the amount that

goes to land fill. At the same time as publishing the waste review, I

have published the government's's die gection strategy. It's very

important. The Select Committee Chairman makes an important point.

Not just food waste that can be used as a feed stock, we must be

careful that food crops are not caught in as feed stock. We should

be using waste. Thank you Mr Speaker. I expect the Communities

Secretary eats more chicken tikkamasala than the DEFRA

secretary. Does she agree with me, however, that the chicken tikka

masala remains would be much better put into a food collection than

into a sack. Will she made progress on further recycling and what does

she think of the Friends of the Earth target, which I very much

support of, of halving black sack waste by 2020? I can tell the House

I have to feed the teenageres who are partial to chip chicken tikka

masala, there is very little left at the end of the day. We will make

it easier to make recycle and tackle measures which encourage

councils to cut the scope of collections and support them where

they wish to provide a weekly collection for smelly waste.

welcome the publication of the review today. Does my right

honourable friend agree with me, if we address the challenge of the

regularity of waste collection we need to, particularly look at pages

5 on wards of the report in relation to the management of food

waste. What will the government be doing to reassure people that, in

fact, we will meet targets to reduce food waste going into the

chain? THE SPEAKER: There is a lot of

interest, and little time. Speaker, I thank my honourable

friend for a question which shows he read the review. He will know it

contain as startling fact we currently waste �12 billion of food

waste. Something we can ill afford to do. We need to work with all of

those involved in food production and packaging to try and minimise

the amount of food waste. Why is she sparing the Community

Secretaries blushs wasn't it a nonsense to force local authorities

to re-introduce weekly collections. Would she confirm there a strong

core laition between high recycling rates and alternative weekly

collections? It's important we encourage councils to response to

what local people want and need. That is the very essence of

localism. Therefore, we will be proceeding with a new commitment

from councils to redouble their efforts to listen and respond to

the wishes of their residents in the matter of refuge collection.

is unacceptable to have rotting food waste hanging around for two

weeks in bins bins. Will she tell councils she would hope they would

have weekly collections so we don't have the danger and risk of that

situation? I said in response to an earlier question from the honably

lady we believe it's important to support local authorities that want

to provide a weekly collection of the smelly parts of the waste. And,

DEFRA will make available �10 million to assist them in that.

Secretary of State is adept at U- turns why is she hanging on to this

U-turn which she could have left the Communities Secretary have his

very own U-turn today? I might remind the honourable gentleman we

are a coalition government. A government of two parties and...

And he might... And he might like to read the coalition

agreementments commitment is that the government would work towards a

zero waste economy and encourage councils to pay people to recycle

and reduce littering and measures to produce a huge increase of

energy through waste, as set out out in our review today. I think

her for the flexibility, in contrast to my honourable friend

ahead of me. My local authority works with the private sector. They

provide a two-weekly service but a weekly food waste. The key factor

has been the flexibility of a good contract with the private sector.

Would she not agree that those local authorities who have been

dogmattic about not using competitive tendering should think

I agree that waste services are a matter for local authorities. The

Government believes that better procurement and joint working can

improve the efficiency of collections while improving the

front line services for the public in an affordable and practical

manner. Five years ago, the Conservatives in Newcastle and line

made the same promise then promptly broke it. Then they spend �2.5

million of their Liberal Democrat friends on a complicated recycling

scheme with 10 different bins, boxes and bags which has turned

Newcastle into a curiosity. We could not now afford to reinstate

that collections. Order! I did appeal for short questions. Isn't

the Government's pickle over this reflective... Mr Speaker, I think

the most important message is that the Government is trying to make it

easier for people to do the right thing, so whether you are at home

trying to do with your household refuse, at work, or on the go, we

need to make it easier for people to waste less and recycle more.

Does the Minister accept that developing technologies can turn

waste into bile fields and chemicals? Was she encourage such

plans and will she support those currently being put forward to?

am not aware of the specific technology being developed, but I

would be delighted to learn more about it. It is important that we

embrace all new technologies. I have mentioned anaerobic digestion

for which I have set out a strategy, but there are new technologies

coming out all the time to turn waste into resource. It is all very

well hiding behind the language of local choices, her government

promised they would bring back weakly been collections across that

country. Will she apologised to families who have been led up the

garden path by what she has said? made it clear that the coalition

consists of two parties who struck an agreement. This includes

provisions regarding a waste which we are fulfilling two days. I said

that out very clearly. In contrast to the strong-arm tactics of the

last government, in what way it do we have incentives to drive up

recycling rates? This is such an important point. The last

Government, with its punitive approach, lost the confidence of

the public by punishing a little old lady for making a genuine

mistake by putting it the wrong containers in a recycling bins.

Today, we restore a proportionate response to the penalties that

should apply, going after the rail waste criminals. There is not a

Liberal Democrat available to act as a human shield for the Secretary

of State! Can I ask the honourable lady what are the key issues at

local levels for Caen tonight for containment of -- for containment

of waste. Also, what do Sucha -- what does she suggest to a council

for this? There were incentives in the previous government, but it

actually deterred people. People will be we incentive rise to as

well councils, we want to help make it easier for small and medium-

sized enterprises to benefit. contrast to Cumbria's recycling

rate of 37%, Suffolk has over 60%, no doubt helped by regular weekly

collections of food. We are giving money to anaerobic digestion, will

she worked with me to make sure that more is available across the

country's? It is right to applaud householders in how they have

actively got involved in increasing recycling rates. That is what

people want to do. The Government's job is to make it easier for them.

That includes a collection for food waste. If that is what local people

want, we will support local authorities that do that. If the

cuts mean that councils cannot collect rubbish once a week, what

chance is there for the NHS or other services? I am not the

Secretary of State for Health, but I think the honourable gentleman,

just like everyone in his party, is in a complete state of denial about

the mess they left the nation's finances ins. I welcome the fact

that small businesses can now have the waste collected a, would she

therefore lobby her friends and hopefully introduce a renewable

obligation services Certificate for recycled kicking a which could be

used as a bio fuel. I will of course to discuss that possibility,

we work very closely together to draw together this review. I have

the largest incinerator in the country in my constituency. Which

reaches the end of its useful life in 2014. The replacement, and a row

about digest and it was cancelled because of PFI credits were

withdrawn. What reassurance can the honourable lady give my

constituents that your strategy will lead to the ending of

incineration in my constituency? have made it clear that energy from

waste has its place in turning waste into resource, but also I

made it clear today that the Government is committed to helping

local authorities that want to use anaerobic digestion and will make

funds available to achieve that. The Secretary of State, will she

congratulate Malvern Hills District Council and which he then District

Council, the former kept weekly been collections and the latter

moved to fortnightly collections. Both were recently elected for a

fourth term. That demonstrates that good local authorities that respond

to the wishes and needs of their resident, and supply refuse

collection services of good quality and sufficient frequency receive

their reward through the ballot box and I returned to it office. In the

Secretary of State's opinion, does the Prime Minister require a weekly

been collection to dump at the rubbish policies like the NHL's --

NHS reforms? I do not think that is it proper question with regard to

the waste review. The Prime Minister enjoys a very good refuse

collection service in his Oxfordshire constituency. The will

the Secretary of State explain why, if she wants to meet her waist

targets, the availability of feeding carrots have been reduced.

Why has she done that? That is more accurately a question for a

Government Minister from DC. With permission, Mr Speaker, and further

to the statement I made in the House earlier today, a wish to make

a statement on the Government's response to the NHS future forum.

We established it on sixth April under the chairmanship of Professor

Stephen Field to look at our proposals on them modernisation of

the NHS. Yesterday it published its proposals. I would like to thank

everyone who worked so hard these past eight weeks. I would also like

to thank more than 8,000 members of the public, health professionals

and representatives from some of 250,000 organisations. Also, the

thousands of people who wrote to us with their views. I would like to

thank the many officials in my department who supported this

unprecedented engagement across the country. I said two months ago to

the House that we would pause, listen reflect and improve our

plans. Our commitment to engage and improve the Bill has been genuine

and has been rewarded with an independent expert and valuable

recommendations from the future forum. We have allowed this for him

to continue its work, including implementing proposals on education

and training and public health. In the report, the NHS must change if

it is to respond to challenges and realise the opportunities of more

preventative, personalise and effective care. They said the

principles to NHS modernisation was to put patients at the heart of

care and to give clear initial -- clinicians a central role in

commissioning health services. In the form's work they set out to

make proposals for improving the Bill. To provide reassurance and

safeguards and to recommend changes when needed. As Professor Field put

it, they did it to embrace change guided by the values of the NHS and

their relentless focus on the provision of high-quality care and

improved outcomes for patientss. We will make significant changes to

implement those recommendations, and in some cases, offer for the

specific assurances which we know have been sold. There are many

proposed changes and we will publish are more detailed response

shortly. I would now like to tell the House for some of the main

changes we will make. The Bill will make clear that the Secretary of

State will have a duty to promote a comprehensive health service as in

the 1946 Act and be accountable for securing its provision and for the

oversight of the national bodies charged with doing so. We will

place duties on the Secretary of State to maintain a system of

professional education and training within the health service and a

duty to promote research. One of the most vital areas of

modernisation to get right is the commissioning of local services. It

must draw upon a wide range of the people when designing those

services, including clinicians, patience and patient groups, carers

and charities. Everybody will have two members, one body focusing on

the public and one focusing on key elements of government, such as

ordered, managing conflicts of interest. While we shall not

centrally prescribed the make-up of the Government body, it will need

to include at least one registered nurse and one register specialist

care doctor. To avoid conflict of interest, neither should be

employed by a local health provider. These governing bodies will meet in

public, and publish their minutes. Clinical commissioning groups will

need to publish details of all contracts they have with health

service providers. To support commissioning, the Independent NHS

commissioning Board will host commissioning senates providing

advice on that shape and fitness of health care across a wider area of

the country. They will develop existing clinical networks who will

advise on how specific services like cancer, mental health or

stroke can be better designed to provide integrated and effective

care. Building on this multi- professional involvement, clinical

commissioning groups will have a duty to promote integrated health

and social care around the needs of their users. To encourage greater

integration with social care and public health, the boundaries of

these groups should not cross the Borders of local authorities. If

they do so, the groups will need to demonstrate to the NHS

commissioning Board a clear rationale with regards to the

benefit of patients. I have always said that I do not want there to be

no decision without me about need for patience when it comes to their

care. -- patients. We will further clarify the duties on the NHS

commissioning Board and clinical commissioning groups to involve

patientss, carers and the public's. Commissioning groups will have to

consult the public and involve them on any changes which will affect

patient services. One of the main ways patients can influence the NHS

is by choice. The Bill will emphasise commissioners duty to

promote patient of toys. Choice of any qualified provider will be

limited to those areas where there is a national or local tariffs.

This tariff development, alongside a best value approach, will

safeguard against cherry picking. Monitor's core duty will be to

protect the interests of patients. We will remove its duty to promote

competition, instead it will be under a duty to support services

integrated around the needs of patients and the improvement of

quality. It will have power to tackle specific abuses and

restrictions of competition which act against patient interests.

Competition will be a means to buy high NHS commissions can improve

the quality of service. We will keep the existing competition rules

introduced by the last Government, the principles and rules for co-

operation and competition and give them a firmer statutory

underpinning. The corporation and competition panel will transfer to

Monitor and retain its distinct There must ab level playing field.

We will strengthen the role of health and wellbeing boards in

local councils making sure they will involved throughout the

kerbing process and local health service plans are aligned with

health and wellbeing strategies. We will make 9 timetable for change

more flexible to ensure no-one is forced to take on new

responsibilities before they are readying while enabling those who

are ready to make faster progress. If any of the remaining NHS Trust

ks not meet foundation trust criteria by 2014 we will support

them to achieve it subsequently. All NHS Trust will be required to

become foundation trusts as soon as feasible with an agreed deadline

for each trust. We will ensure a safe and robust transition. It's

vital change is introduced carefully and without creating

instability. We will take the time to get it right as the future forum

has recommended. We will give them a clear home within the NHS family.

On any qualified provider its extension will be phased carefully

to reflect and support the viability of choice for patients.

Strategic Health Authorities and Primary Care Trust also crease to

exist in April 2013. By April 2013 all GP practices will be members of

either a fully or partly authorised commissioning group or one in

shadow form. There will be no two tier NHS. However, individual

clinical commissioning groups will not be authorised to take over any

part of the commissioning budget until they are ready to do so.

Individual GPs need not take managerial responsibility in a

commissioning group if they don't want to April 2013 will not ab drop

dead date for the new commissioners. Where a clinical commissioning

group is not able to take on some or all aspects of commissioning,

the local arms of the NHS Commissioning Board will commission

on its baf. Those groups keen to press on will not in anyway be

prevented from becoming fully authorised as soon as they are

ready. Mr Speaker, I also told the House on 4th April that we would

secure proper scrutiny for any changes we made to the Bill. In

order to do this, and without trespassing on the House's time to

review the Bill as a whole at report, we will ask the House to

recommit the relevant parts of the Bill to a public Bill committee

shortly. Mr Speaker, through the recommendations to the NHS future

forum and our response, we have demonstrated our willingness to

listen and to improve our plans. To make... To make big changes, not to

abandon the principles of reform, which the forum them sestselves

said were supported across the service, to be clear the NHS is too

important and modernisation too vital for us not to be sure of

getting the legislation right. The service can adapt and improve as we

modernise and change, the legislation cannot be continuously

changed. On the contrary, it must be an enduring structure and

statement. So, it must reflect our commitment to the NHS constitution

and values. It must incorporate the safeguards and accountabilities

which we require. It must protect and enhance patients rights and

services. It must be crystal clear about the duties and priorities

which we will expect of all NHS bodies and in local government for

the future. Professor Field's report says it's time for the pause

to end. Strengthened now by the forum's report and recommendations,

we will now ask the House to reengage with delivering the

changes and the modernisation the NHS needs. I commend this statement

to the House. Spl speaker, can I thank the Secretary of State for

the copy of his statement before. Although I must say, I learnt more

before hand from the press kefrpbgs conference press did from the

statement this afternoon. Humilitating. The Health Secretary

has had health policy taken out of his hands. He spent the last nine

months telling anyone who criticised the government's health

plans that they were wrong, and that they didn't understand. Today,

he admits he's wrong. How can he argue for this latest blue plipbt

for the biggest reorganisation in NHS history? With any credibility

or integrity? The man who messed up so badly last year, telling us how

he's going to mess up next year too. Why no apology to NHS patients and

staff for the wasted year of chaos, confusion and incompetence? Why not

apology for breaking the coalition agreement to stop top down

reorganisations? Why no apology to patients who are already starting

to see the NHS go backwards again because of this reorganisation?

More than one in ten people now waiting 18 weeks for operations.

Three times the number of patients waiting over six weeks for tests.

Casualty waits at a six year high. Mr Speaker, this is the first Prime

Minister forced to ask 45 experts for a roar report on how to protect

the NHS from his own government policies. Now, he's reorganising

his reorganisation. The future forum report yesterday was a

demolition job on the government's misjudgements and mishandling of

the health service. Why is he wasting �800 million on redundancy

payments when some of the same people will be rehired to do the

same job? Why is he holding back �2 billion, promised for patient care,

when it could fund 55,000 nurses? Why is he ploughing on with the

Health Bill when what he announced today could largely be done without

legislation and without the risk and cost of the biggest

reorganisation in NHS history? Mr Speaker, this is a political fix,

not a proper plan for improving care for patients, or for a better

or more efficient NHS, which is able to meet the big challenges it

must face for the future. Make no mistake, these plans today will

mean the NHS mired in more complex bureaucracy, more confusion, and

more wasted cost in the years to come. In the battle of spin, with

all parts of the divided government claiming a win, the big losers will

be the NHS patients. We will judge and the public will judge the

government on what they do, not on what they say. You know, I lost

track of the bureaucracy that he announced in his statement today.

Will he admit that this reorganisation creates five new

national quangos, set to spend tens of billions of pounds? Will he

admit this reorganisation replaces one local body, the Primary Care

Trust, with at least five others all playing a part in

commissioning? Will he admit the plans still cut hospitals loose

from the NHS with no limits on treating private patients while NHS

patients wait longer no. Support from the NHS if they run into

financial trouble. No longer with the protection as a public service

from the full force of competition law? Mr Speaker, what was a very

bad Bill will still be a bad Bill. This House should be allowed to do

its proper democratic job, as the only elected House, and scrutinise,

in full, in committee the whole Bill. At its heart will still be

the Tory long-term plan to see the NHS set up as a full-scale market.

And the NHS broken up as a national public service, so patients will

increasingly see the services they depend on, the Lottery of where

they live. The public, Mr Speaker, have rumbled the Prime Minister.

They know they can't trust him with the NHS. Fewer than one in four now

trust him to keep his NHS promises, over half believe the Conservative

Party's plans for the NHS are just a way to privatise the health

service. Today, the government have recycled their plans for the NHS

with should have been scrapped. People are right to conclude they

can't trust the Tories with our NHS. Well, Mr Speaker, when we got

passed the abuse I was hoping at some point he would actually tell

us whether he agreed with the NHS future forum or not? He didn't

mention it. He welcomed the exercise in listening and

engagement he announced. He said it would be the right thing. He said

it would be good government to do it. When an independent group of

experts report and make recommendations he ignores them and

says he will oppose the Bill regardless much he didn't listen to

what the people in the NHS were saying. It's's shameful he

dismissed everything that happened over the last year as if it didn't

happen at all. A year in which we, in this coalition government, said

we would increase resources to the NHS, and we have done that. We are

committing to �11.5 billion extra to the NHS over the next four years.

Money which we will continue to remind the British public, money

that the Labour Labour Party told us we should not give to the NHS.

And, this is a coalition government which, in the last year, and in the

NHS across the country which implemented a cancer drug trust

with 2,500 patients benefiting from that. Which cut in the last four

months the breaches of the single sex rules by three quarters in four

months. Which has cut the number of hospital infected by 22%, and CJD

infections by 15%. Three quarters of a million more people accessing

dentistry. Where the waiting times for people waiting to go into

hospital compared to March 2010 have gone down. Where we said we

would reduce management costs, and we will do so, we have taken 3,800

managers out of the NHS since the election, while the number of

doctors has gone up. The right honourable gentleman six months ago

said he supported the principles of the reform and the Bill. All he

said today is sheer opportunism but it will come back to haunt him

because the NHS is going to benefit from the changes that we are

proposing today. The NHS is going to take ownership of its own

service to a greater extent, patients will be empourered.

Clinicians will be empowered. They will deliver better outcomes for

patients. When that happens, we will be able to say the Labour

Party would have denied the NHS the resources and they would have

denied the NHS the freedom and responsibility to deliver those

better outcomes. Is not the key challenge facing the NHS today the

need to reverse a decade of declining productivity which was

left to us by the party opposite? Does my honourable friend agree

that his statement today provides the basis for us to do that, based

on the evolution of effective commissioning engaging the entire

clinical community, which will address the fragmentation of

service and progress the intergration of service around the

needs of individual patients? I agree with my honourable friend.

It's that process of now engaging clinicians coming together to

design services around around the needs of patients which delivers

improving quality of services for patients that is at the heart of

the shift from Primary Care Trust and Strategic Health Authorities.

The Labour Party spent a decade presiding over declining

productivity, over declining productivity while the cost of

bureaucracy and management in the NHS doubled. We are going to be

embow -- empowered people in the NHS to deliver improving services

and reduce bureaucracy. THE SPEAKER: The opposition front

bench shouldn't be yelling at the Secretary of State. Order on both

sides. Whatever the passions you need feel, you need to simmer down

a little. A fine example of that calm can now be provided by the

honourable gentleman. Does the Secretary of State Iraq recognise

that enforcing the NHS to start implementing his changes, before

the law had been changed, has reresulted in vast expense to the

NHS, chaos in the services and to diverting the NHS staff from

treating patients? Does he also recognise that just cobbling

together a few amendments to this Bill will not make things better,

but make things worse? Won't he recognise...

THE SPEAKER: Last sentence, we must press on. Does the

THE SPEAKER: Order. I will have the question finished I don't require

any help from any member. Doesn't the Secretary of State recognise

that by pretending to produce a collaborative silk purse out of

competitive pig's ear will not It is slightly confusing because

his right honourable friend on the front bench was telling us we could

have done this without legislation. Now he is accusing us of proceeding

without legislation. It is not true. We're doing things that are

essential. To sustain the structure we inherited from the Labour Party

in terms of all of these Primary Care Trusts and strategic help the

authorities, it could never have happened. -- Strategic Health

Authorities. We had to empower clinicians in the service. We are

doing it now regardless of whether the legislation has made progress

or not. I welcome the statement. I have a list here of government

responses. It is seemingly not enough. It cannot be enough because

ironically it is a list of amendments tabled by the Labour

Party during the committee stage. Why does he think it is so hard to

build consensus? Why are the Labour Party being so pointlessly

churlish? I have to tell my honourable friend there are many

things that are beyond many of us to understand. One of them is the

Labour Party and the way in which they put policy. The fact is, the

Labour Party have no policy. They simply had opposition of four

opposition's sake. They just want is a two things. Questions and

answers must focus on the policy of the Government. That is the

Parliamentary position. Secondly, I want to a comedy at the level of

interest in the statement, but members must help me to help them

by being brief. -- I want to accommodate. The last Labour

Government left dissatisfaction with the NHS. How much has this

year's shambles cost the NHS and how much has it damaged patient

care? It has not damaged patient care. The right honourable

gentleman, he should not denigrate the NHS. In May 2010 at the last

election, patients waiting to be admitted for hospital waited 8.4

weeks. On the latest figures that went down to 7.9 weeks. May 2010,

it went down to 3.7 weeks, and that is in the midst of rising demand on

the NHS. This is clear evidence of a listening government. Does the

Secretary of State agree with me that what the NHS now needs is

consensus across all political parties and for everybody to put

their money where their mouth is and support the NHS and these

changes as we move forward? It I am grateful to my honourable friend.

The future forum itself made to the point that across the NHS what they

want it is for the certainty of knowing what the policy is and of

moving forward in making that happen. In view of the NHS Future

Forum's comments, and I quote, the importance and relevance of the NHS

constitution were in guiding their work. Does he accept that the

principles set out in the constitution were more effective in

protecting the NHS from a hostile government than the Prime

Minister's five pledges? No, I do not accept that. I think the Prime

Minister's commitments are absolutely what the public and

people working in the NHS expect and wish to see. I think they are

vital ones and ones which would not have been true under a Labour

government. He Labour government would not have increased resources

for the NHS and we can see, we can see the only part of the United

Kingdom further is now a Labour government is in Wales, and in

Wales, resources for the NHS are being cut this year by 5%. When I

went to North Wales during the midst of the recess, there was the

front page of the Liverpool Daily Post saying the number of patients

waiting for their operation was more than 36 weeks. It had gone

from a 16 to 989. I welcome these proposals, but could the Secretary

of State to detail the safeguards against it cherry-picking of the

kind which, if unchecked, could fatally undermine rural district

hospitals like the West Suffolk in my constituency. In order to be

brief, it essentially comes down to we have to make sure that

commissioners are increasingly able to use a tariff, and established

national or local price in order to determine the service that they

commissions. And that that it therefore does not allow the

private sector to come in and cherry-pick services by

undercutting on price. We also have to make sure that that price

reflects the cost of that condition to be treated, including complex

conditions. This is why we are committed to work with the Royal

Colleges in developing tariffs to make sure that is true. I welcome

the statement, not least because it pays tribute to the future

commitment -- future commission. Could the Secretary of State tell

me what he thinks the future of there Healthcare Commission is?

if I may interpret and relation to the NHS Future Forum, I freely

acknowledge that I wish we had instituted the NHS Future Forum

after the publication of the white paper last year. Although we had a

full and formal consultation process, I think the character of

the engagement that has been agreed over these last two months had been

superlative. As we make further progress, for example in relation

to education and training and the development of training proposals,

I want to ask the NHS Future Forum in that and other areas to continue

that process of engagement across the servers. I have a great deal of

time for most GPs, in particular the one sitting in front of me.

What part of this Bill will allow communities to rid themselves of

underperforming GP practices? answer to my honourable friend's

question is for it in order for that to happen, it is something

that would need to be initiated by the NHS commissioning Board. BNH is

commissioning Board would respond to their health and well-being

board of its local authority. Or indeed to the local clerical

commissioning group. My noble friend will have, in his area,

through the Health and well-being board the new and powerful means

from which the voice of the public can be heard. Can I just remind the

House that members who came into the chamber after the Secretary of

State began his statement, should not expect to be called.

Secretary of State must know that the bigger threat to the

destabilisation of the National Health Service is the introduction

of competition lot of clinical services. Will the clause that says

the mergers of NHS trusts are a matter for the office of Fair

Trading and competition be removed from the Bill? I think the right

honourable gentleman should be aware that the future forum has

recommended that those powers that are held by the office of Fair

Trading -- Trading and the Competition Commission should be

done because they believe it is in the interest of the NHS for those

powers to be exercised by a health service specific regulator,

sympathetic and understanding to NHS interests. Primary Care Trusts

and Strategic Health Authorities are part of a management structure

which led to waste and bureaucracy. Can my right honourable friend

reconfirm there will be abolished and the �5 billion they will save

will be ploughed back into his phone line medical services? I am

grateful to my honourable friend, I can do that. It is essential we

moved to a world weary reduce administration costs, where we have

relieved bureaucracy in the service, where we provide resources to

deliver improving care without the burden of bureaucracy, cost and

waste which was inflicted on them by a Labour government. Doesn't the

Secretary of State understand that when the Labour government was in

power, it increased the money from 33 billion to 111 billion in one

decade and now we are witnessing a new Frankenstein monster all to

pacify these tinpot liberals! have a mission for the honourable

gentleman, I think he should head to Wales. In England, this

coalition government has committed to increase NHS budget in real

terms in the life of this Parliament. In Wales, a Labour

Government is intending to reduce the NHS budget by over eight

present. I believe the very act of listening to patientss and the

public will have done a lot to improve these proposals. Once the

dust has settled, it will have done good for at the Health Secretary's

reputation as well. Given the requirement for greater local

accountability, would he make the same recommendation to local,

clinical commissioners in the changes they are yet to make for

health services in their area? grateful for four and his kind

remarks, I have to tell him, I do not think I am looking to achieve

anything in terms of reputation. I just want a positive outcome for

the NHS. I have said to the House before, it is about achieving for

the NHS, the opportunity to deliver better services for patients. This

point illustrates what it is we needed to do, and will now do in

response to the future form. Many people wanted to see, set out in

detail in the legislation, high patient and public will work in

these respective bodies. There is always a balance to be struck

between the degree of prescription any legislation and the degree of

freedom. Clearly, we now half the approval for putting a much more of

this detail into the Bill because they are clear they will engage the

patients and the public's. welcome the changes, most of the

changes that have been announced today. Could I just ask one point,

I am very concerned that the bureaucracy that is going to be

around after all these changes go through could actually be worse

than what we have got at the moment. I genuinely would like to be

I'm am grateful to the honourable lady. The bureaucracy will reduce

in the NHS as a result of all this because we are shifting the

ownership of commissioning and the responsibility for the design and

delivery of services from what is essentially a distant, managerial

organisation into one that is locked into clinical decision-

making of doctors and nurses across the service. This is about

delivering benefits to patientss by empowering the doctors and nurses

to care for them. Can the Secretary of State confirm that the

Government has no plans to decrease the Budget on the NHS, unlike the

plans of the party opposite to slash it by �30 billion.

honourable friend makes an important point, because if we had

listened to the Labour Party we would have cut the NHS and not

increased resources. The 20 billion power and efficiency savings that

is required for the NHS in order to respond to demand and cost would

have been a �30 billion. It would have been an unsupportable degree

of pressure on the NHS. We're giving the NHS, not only resources,

but the opportunity to deliver better care. After the white paper

was published in July, there were 6,000 representations from health

select committee reports and professionals asking the Secretary

of State to think again about breaking up the NHS. This listening

exercise is a waste of public money. I know the Secretary of State was

That was nonsense. We spnded postively to the consultation and

made changes then. What is clear, as the details of the Bill have

been coming forward, people are working out how they would make it

work in the future. They have been saying, we want to set out in the

legislation how it will work. There is no better way of making that

effective than to talk to people and engage gauge with people in the

NHS, listen to them and implement those changes. I'm sure the

Secretary of State will agree with me that the single biggest

challenging facing healthcare in the United Kingdom is dealing with

the health economic and human challenge, looking after our ageing

population. The key to this is better intergrating healthcare

services, better intergration hospital services with community

and social services these reforms are a good way of going about that?

Yes, I would very much do so. I think the future forum in the

report, particularly on clinical advice and leadership, is giving us

a robust structure for engaging across the range of professions

that are capable of deliver that more joined up and effective care.

Can the Secretary of State reassure us that no services or hospitals

will be taken over by the private sector? There are no plans in the

legislation or indeed in the future forums recommendations that would

lead to that. In particular, if I might just tell the lady, she will

see in the detail, published with the written ministerial statement,

we are proposing there should be no power in particular for Monitor,

for reasons of competition to allow the private sector to have access

to NHS facilities and taking those away from NHS providers. Mr Speaker,

we have a Prime Minister who loves the NHS. A Secretary of State who

is the most experienced member in this House. We have a coalition

government that has done something that the Labour government never

did, it listen and was willing to improve its Bill. It is a great day

for democracy. I congratulate the Secretary of State and for

referring it back to committee. If he is looking for volunteers for

the committee, I'm available. grateful. From my point of view, it

is because I believe in the NHS, also because I believe in the

people who work in the NHS, that I believe it's right to listen and to

engage. And, it's right to give them a much greater control of the

service they provide for patients. Mr Speaker, what can we conclude

from the fact that the Prime Minister isn't here with us this

afternoon, supporting the Secretary of State, who is involved in a PR

stunt at St Thomas's and Guys Hospital. Isn't it true, the reason,

is as was said across the Atlantic, you could put lipstick on a pig, at

the end of the day, it's Stig a pig. Isn't that the truth of the NHS

Bill? I'm starting to get into matter perhaps not of order, but of

any rate of taste. If you will forgive me, Mr Speaker, I don't

think I will gratify that question with an answer. Will he expand on

the report that organisations such as the Spinal Injuries Association

can expect through specialised commissioning? Yes. I believe that

the NHS Commissioning Board, under our proposals, will be aib to able

to give greater consistent cyst si to specialised commissioning. I

hope it will be true for people with spinal injuries. I know the

Association well. They have done terrific work. We have worked

closely with them to improve commissioning and services for

those injured with spinal injuries. It is disgraceful to see Lib Dems

and Tories scrapping to claim credit for this alleged listening

exercise. Will the Secretary of State come to the dispatch box and

apologise to me and my colleagues for not listening to us during the

Bill Committee? Mr Speaker, I give credit in relation to the changes

that we are now bringing forward. Yes, indeed, to some of my

colleagues, very much so, also to the Prime Minister, the Deputy

Prime Minister for their time and trouble they have taken in relation

to. This they have spent a great deal of time listening and engaging

with people across the health service. And, we will give credit

to the NHS future forum and to the thousands of people across the NHS

who have made their contribution now to the NHS's future. I think

they will be very disappointed to hear members opposite who just want

to denigrate that and make political capital out of it rather

than supporting the NHS in it is future objectives. Collectively

throughout Oxfordshire told the Field Commission they wanted to get

on with GP commissioning. They were committed to GP commissioning they

believed they could be better designed NHS services for local

people. When are GPS in Oxfordshire going to be able to get on with GP

commissioning? I can assure my honourable friend, I know his GPS

locally. They want to work with their colleagues, professionally,

across their area. They want to be able to get on with that now.