Andrew Lansley, Shadow Secretary of State for Health, answers our selection of the questions that you asked here.
a-tracy: What do you suggest should happen in the future to doctors surgery hours, in order to facilitate improved service for workers and do you support forward bookings for non-emergency appointments to help with time off from work planning? or do you feel that opening from 0830 to 1700 with limited appointments over lunch periods Monday to Friday was a successful contract negotiation?
We do not want to micro-manage GPs by prescribing in detail their opening hours. Access and opening hours should be determined by GPs in response to their patients’ needs and choices. We will ensure there are no barriers to the opening of new surgeries, and would reward GPs who choose to deliver services in deprived areas. Patients should have greater scope to choose their GP and to exercise choice through their GP as budget-holder for their care.
Kate Bollinger: A lot of candidates campaign against the closure or transferral of services at big hospitals. Does this sometimes go against the party's decentralising principles?
No, on the contrary, giving patients and the public a real voice over the provision of local health services is at the heart of the party’s decentralising principles. If brought forward in legislation, our NHS Autonomy and Accountability White Paper would strengthen patient and public engagement through LINKs and ‘HealthWatch’ – a new national consumer voice for patients to impact upon policy-making and decision-making.
bluepatriot: Were you surprised when David Cameron told the Today programme that you would be Health Secretary in his first Cabinet?
It was encouraging to receive a public endorsement from David Cameron but it’s no cause for complacency. I work as part of a team that will continue to put pressure on the Government for their hapless mismanagement of the NHS and one which provides credible solutions to support patients and empower professionals.
Sally Roberts: What can we do to address the problems of Food Addiction?
Food addiction is part of a wider problem of tackling obesity. The Government’s approach is to take control away from individuals. This often creates a negative feed-back loop. For example, in order to improve school dinners, new food standards were introduced but this led to an uptake of unhealthier packed-lunches, so a new regulation was introduced to inspect school lunch boxes. Regulation overload is not the solution to public health problems which originate in the private sphere. We should be looking at ways to empower individuals through incentives and strong leadership.
Elvis: What is the Conservatives' stance on giving free votes to their MP's on the forthcoming HFE bill (Human Fertilisation and Embryology), which will also open up the abortion debate. It's rumoured (and if it's true it's a scandal) that the Government won't give their Labour MP's a free vote on these profound issues of conscience.
Conservative MPs will be given a free vote on matters of personal conscience during the passage of the Human Fertilisation and Embryology Bill. We asked the Government to grant their MPs a free vote but based on past form, it’s unlikely they’ll do so. In 2004 Labour denied their MPs a free vote on assumed consent of organ donations on the basis that, “It is not for this Parliament, by free vote or otherwise, to impose on individuals a requisition of their bodies after death for the use of the state. That is why there is no free vote. We are giving the freedom of conscience to the people of this country, and we are not prepared to work on the assumption that Parliament should dictate to them that their bodies belong to the state after death” (John Reid, former Health Secretary, 28 June 2004).
Now, less than four years later, a free vote is likely to be withheld again in order to achieve the opposite outcome. In keeping with Labour’s oscillating value-base, Gordon Brown has now endorsed opt-out. He has dictated a U-turn on an issue which should be debated on a free vote basis.
IRJMilne: A woman who contracted MRSA was recently awarded a seven-figure sum in damages. Whilst hospital infection rates are deplorable, how can such compensation payments be justified? Considering that the NHS has no shareholders and no profits, such compensation payments provide no incentive to improve care quality. The government says that centralising A&E services to specialist units would improve patient care and save lives. Why do the Conservatives disagree?
A far more effective way of incentivising hospitals to reduce healthcare associated infection levels is to reflect quality of care in the tariff. As hospitals are moving to a situation where hospitals will be paid on completion of the delivery of a service, healthcare commissioners should be enabled to withhold some of the tariff for treatments that have resulted in an Healthcare Associated Infection. On the centralisation of services, we have been very clear: there is a case for the centralisation of some specialist services but it should not preclude the provision of other local NHS services. Right across the country, Labour are allowing reconfigurations to take place without the necessary supporting evidence. This could have a detrimental impact on patient care.
Moral Minority: What are you going to do about the rip-off charges for parking and calling patients at NHS hospitals?
NHS treatment must be provided free of charge, except when expressly provided for in law (this is how prescriptions/sight tests are charged for). This means that all food and accommodation must be provided free of charge if staying in a hospital. It has never included the cost of phones/car parking because this is not clinically necessary. There is a wider issue here of hospitals being under severe financial pressure and having to raise funds by legitimate but sometimes controversial means. That said, the Government made a commitment in the NHS Plan in 2000 that, although private companies had started to provide bedside telephone services in hospitals, ‘normally there are no charges on children’s wards’. But there are still charges in children’s wards across the country.
Peter: What would it take to convince you that increasing amounts of judgement-free sex education and the easy availability of contraception in schools are actually contributing to teenage pregnancy, not reducing it?
Young people need to be empowered to make the right, safe choices and to stand up to negative peer pressure which normalises risky behaviour. Sex education is an important part of enabling young people to make the right decisions. School nurses also have an important role to play, especially in regard to the availability of contraception.
Jake: There are now effectively 4 separate NHS's. The NHS's of Scotland , Wales and NI have their own governments to shout for them plus they have a loud say in the British government. The English NHS has no representative body and is left to the cynical mercies of the British government which is dominated and led by Scots committed by oath to the paramountcy of Scotland eg Brown and Darling. What are you and your party planning to do about this fundamental discrimination against England?
I agree that the NHS in England has been subject to the cynical mercies of the Labour Government. However, health is a devolved issue and more expenditure does not mean better outcomes. The disappointing reality is that right across the NHS we are not getting value for money. In England, we spend the European average on healthcare but the outcomes - for example five-year cancer survival rates – are amongst the worst. We need to increase efficiency and improve outcomes, that’s why we brought forward the NHS Autonomy and Accountability White Paper.
601: The Conservatives have proposed that MPs would not be in control of running the NHS. How would you make the NHS accountable to voters? No system is perfect but your proposals would mean the N.H.S would have no accountability to taxpayers.
We have not proposed that MPs have no control in running the NHS. But we have proposed the removal of day to day political interference which is currently undermining professional judgement and patient choice. Under the current system, Labour ministers already cite ‘local decision-making’ as a reason to absolve themselves of responsibility. The trouble is that the local infrastructure is not in place to make this meaningful. Under our plans the Secretary of State would retain responsibility for the overall funding level of resources in the NHS and would agree the objectives with an NHS Board (amongst other responsibilities see this report). At the same time we would provide a framework which devolves powers to patients, professionals and local health bodies.
Damon Lambert: What would a Conservative government do to reduce the stigma surrounding mental illness?
At any one time, 630,000 people might be receiving mental health treatment in this country, but that is only a fraction of the number who will at some time in their lives have mental illness—probably one in four of the population will have mental illness at some time. For many, it is a very traumatic but temporary condition. Therefore, we should not treat people who have mental illness and recover any differently from those who have had a broken leg. People recover and move on. Even if people are on medication, perhaps on a more or less permanent basis, we should not treat them differently. We do not say to diabetics that because they take insulin their ability to work is necessarily compromised. We support such people, encourage them, help them into work and expect them to be integrated into society. The same should be true of people with mental health problems. Illnesses, whether physical, psychological or mental, should be treated in the same way.
Graham Doll: What do you think of the Government's plans to open polyclinics (otherwise known as Darzi clinics), duplicating the services already available at GP surgeries and A+E departments?
There are places where family doctor services are weak and a polyclinic could deliver better community access to services. But there are other areas of London where GPs are much stronger and there is no case for shutting down hundreds of local GPs' surgeries. Nor is there any sense in shipping out services from local district general hospitals if they are viable, successful and accessible.
Simon Wentworth: In 2006, the Government re-negotiated the GP contract to address perceived over-delivery concerns (GPs scored higher than the Government expected on performance-related pay, which would never do). At the time, GPs were assured that this issue had been addressed ONCE AND FOR ALL. Now, however, the Government are imposing further changes and are unilaterally altering the contract, having withdrawn from negotiations with the BMA. How will you restore the morale of GPs, and their badly damaged faith in the DoH and Government?
We do not want to micro-manage GPs by prescribing in detail their opening hours. The needs of patients vary. Access arrangements are not an ‘outcome’. The Quality and Outcomes Framework should aim to reward clinical quality, patient satisfaction and patient-reported outcomes, not dictate processes. We want GPs to take greater budgetary responsibility as commissioners of care for their patients. Current Government plans for Practice-Based Commissioning (PBC) are not progressing, as GPs do not have real budgets. There are also no incentives to make savings and re-invest for their patients’ benefit nor to innovate in contracts with healthcare providers.
Dr G Bointon: Please tell me that you hope to make radical changes or even abolish 'choose and book' in its current form. We struggle manfully to use it but fundamentally it doesn't end up truly benefiting the patient and takes so so much time. It has broken the nexus between consultant and GP and no-one really seems to think it any good.
The Government failed to consult adequately with GPs before the programme was rolled out and now we see the consequences of a costly, unworkable system plagued by software problems. We plan to conduct a review of the National Programme for Information Technology and will consult widely with the profession and other experts.
Geoff: Peter Viggers MP fought for years to keep the Royal Naval Hospital Haslar in Gosport open. That fight was finally lost last year and now there are no dedicated military hospitals left. Are there any plans for you to discuss with our Defence frontbenchers the merits of building dedicated military hospitals again?
We would not reinstate military acute hospitals in the UK. However, we are not convinced that the level of care given to recuperating Service personnel, reservists and veterans is sufficient. This has been highlighted by the ‘Honour the Covenant’ campaign being run by the Royal British Legion. A Conservative government will undertake a review of all aspects of care given to recovering personnel. This will include the locations at which care is provided to ensure that patients are looked after in a Service environment as well and as conveniently for them and their families as possible. We are not convinced that the closure of the Royal Hospital Haslar as a location for the provision of elements of military healthcare, training and research is appropriate and would look again at Labour’s plans as part of our review.
