---

Health Care Prioritisation

I agree with my hon. Friend about most things to do with the health service. He is absolutely right. It is important to understand that we spend large amounts of taxpayers' money on health. Health is a massive concern to every voter and citizen. The notion that comes from some clinicians—I do not think it comes from the hon. Member for Wyre Forest—that politicians should butt out entirely of decisions about the national health service is disingenuous. We have to define appropriately the respective responsibilities of the different players in our national health service and its relationship with other bodies. I will come to that in a moment. What is the responsibility of the Department of Health nationally, of Ministers and senior officials in terms of policy, and of strategic health authorities and primary care trusts? What are the responsibilities of front-line clinicians and other NHS staff? What power—and accountability—should we give to individual patients, users and carers, as well as local communities, when it comes to influencing decisions that affect the NHS and social care in their areas? We know that there has been an increasing role for overview and scrutiny committees and local authorities, and we want to see that role expand. What is the proper place for local elected members to have some sort of influence? I am not sure that we want to have a stale debate about whether local government should run the NHS or whether the NHS should take over social care, because inevitably we will then get into debates about organisational restructuring, which could lead us down a road that we do not need to go down. However, as the hon. Member for Wyre Forest said, we have to address honestly accountability, respective responsibilities and relationships among the different players. I was talking about shifting resources from acute care to early intervention and prevention. It is important that people do not see this as ideology, because it is also about patients' choice and expectations. The vast majority of people want to remain in their own homes for as long as possible. Medical and technological advances—the hon. Gentleman referred to this—mean that there is no rhyme or reason as to why many treatments that have historically and traditionally been undertaken in hospitals need to take place in a hospital building. Equally, we need to reassure the public that our investment in primary and social care, and community-based health provision, will be put in place so that the shift in resources does not lead to a diminution in services, but results in things being done differently, with a stronger approach on patient care. In the context of finite resources, we have a responsibility to consider health inequality. It cannot be doubted that the family into which citizens are born and the postcode area in which they happen to live can have a dramatic impact on their quality of life, life expectancy, and health and well-being. Part of being honest and transparent in the debate—Nye Bevan would be proud of a Labour Minister saying this in 2007—is not apologising for recognising that in any funding allocation system, it is entirely appropriately to focus a significantly greater proportion of resources on those in the greatest need. We need to make it clear that people in the greatest need can be living in relatively affluent areas, so the way in which we target additional resources to address health inequality is also a challenge. There is a question about the relationships among the national health service, local government, social care, public health and the wider range of services that contribute towards citizens' well-being in local communities. If we are going to move towards prevention and early intervention, and recognise that the ability to have a job has a direct impact on many people's health and that their ability to access education and training contributes to their well-being, we will need a step change in the integration of local government, the NHS, the voluntary sector and the private sector in every local community. Over time, we need a more integrated approach on not only the commissioning of services, but their planning and, in many cases, co-location. I say gently to the hon. Gentleman that it is important that the NHS understands that many of its objectives will be achieved only through its connectivity with local government, the third sector and the private sector. Practice-based commissioning will be incredibly important. On the basis of a population needs assessment, we will be giving practices a lot more power to commission services. That is another vehicle to ensure equity of access as well as quality of care. The priorities in the NHS operating framework obviously determine the view of the chief executives of PCTs and provider trusts on what is important when allocating resources and focusing on delivery. The operating framework is crucial, as are the outcome framework for the NHS and the new performance and outcome framework for local government. It is important that we try to secure synergy in a world in which we are trying to achieve more of our policy objectives through local area agreements. Such agreements bring local agencies on the ground together around shared objectives, shared accountability and shared responsibility. I urge the hon. Gentleman and my hon. Friend the Member for Bristol, North-West (Dr. Naysmith), as members of the Select Committee on Health, to start conducting serious analysis on the new performance framework locally and its implications for securing the health and well-being of a local population. All of us—Ministers, officials, Health Committee members and parliamentarians—need to start looking holistically at the health and well-being of citizens and local populations. We will be able to do that only if we examine not only connectivity among the NHS, local government, the voluntary sector and the private sector, but the power, control and choice that we put in the hands of patients, users and carers. Lord Darzi is undertaking tremendous work in the other place on the next stage in the national health service's transformation. The question is how we move from having fixed the NHS and rebuilt its foundations—the Government are proud of that—to creating a world-class, cutting edge national health service. A couple of weeks ago, my noble Friend Lord Darzi became probably the first Minister in history to have saved two lives in 48 hours. I cannot think of many politicians who have been praised for saving one person's life, but to save two in 48 hours must be a historic achievement. Lord Darzi is a massive asset to our ministerial team and to our development of national health policy. His views and aspirations are based on his everyday experience; the same is true of the hon. Member for Wyre Forest. Lord Darzi is a world-class clinician in his field, so it is important that he is at the heart of what we are doing, and is working closely with an excellent Secretary of State to make sure that we go from having fixed the NHS to creating a world-class system. The Secretary of State has asked me to lead the work on the case for an NHS constitution. The notion of a constitution is exciting because it would be an important vehicle allowing us to enshrine the rights and responsibilities of patients in the NHS, the relationship between central Government and the NHS regionally and locally, and the NHS's connectivity with other agencies on health and well-being. I have been asked to examine the issue. We will talk to people, and I invite the hon. Gentleman to submit any ideas that he has on whether we ought to have a constitution, and if so, on what the content ought to be. I hope that his contribution will be slightly more constructive than that of Her Majesty's official Opposition. They produced a constitution that they said would give clinicians independence, and said that they were creating a board that was at arm's length from Government. When they were asked to whom the board would be accountable, the answer was the Secretary of State for Health—a curious notion of independence and transparency. The debate on whether we ought to have a constitution, and what should be in it, gives us an opportunity to address some of the legitimate points that the hon. Gentleman has raised. The hon. Gentleman spoke about patient, carer or user pressure. In a healthy democracy, there will always be such pressure. It is the responsibility of the elected Government and parliamentarians to absorb it, to listen to the heartfelt views of people who feel passionately about causes and to make decisions that are in the best collective interest. That is at the heart of the responsibility of an elected Government in a democratic society, and at the heart of how responsible parliamentarians ought to behave. I am delighted to say that we will never live in a country in which pressure groups have stopped fighting for the things that they care about most. Sectors may still feel that they are the Cinderella, including the mental ill-health and learning disability sector, and historically, to some extent, the child health sector. Carers increasingly tell me that the health service does not treat with sufficient respect care partners who look after older or disabled people. We should not be afraid of patient pressure; we should welcome it. Our job is to weigh up all those views and all that passion, and to welcome and encourage it, but then to make the difficult judgment calls that elected politicians are charged with making. The Government are proud to have created the national health service. We are proud of the fact that we have rebuilt its foundations and rescued the NHS. One of our fundamental values and principles is that the NHS must remain free at the point of use, irrespective of means, and funded through general taxation. That is non-negotiable—there can be no compromise or dilution—but I believe that we can retain that fundamental set of values and principles while addressing responsibly and seriously the legitimate concerns voiced by the hon. Member for Wyre Forest about the changing nature of society and the massive medical and technological advances that have taken place and will continue to take place. As part of the Lord Darzi process, I look forward to ensuring that we have the building blocks in place to move from an NHS whose foundations have been rebuilt to a world-class national health service. Question put and agreed to.