The NHS lines, Prime Minister’s Questions 12.1.11

Ed Miliband, Leader Of The Opposition: “His health minister (Paul Burstow MP. Lib Dem) said in his surgery, ‘I don’t want you to trust David Cameron – he has values I don’t share’.”

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Nick De Bois MP: “The Prime Minister will recall his visit to my constituency hospital Chase Farm as part of supporting our campaign for a policy of no forced closures of A&E and consultant-led maternity services. Does he agree that we should keep to our policy of no forced closures, particularly given the fact that our local GPs in Enfield are opposed to it, as indeed are the residents?”

David Cameron PM: “My honourable friend makes a very good point. Let me say this. Any local changes to the NHS must meet four tests: they must have the support of local GPs; they must have strong public and patient engagement; they’ve got to be backed by strong clinical evidence and they’ve got to support patient choice. There were no tests under the last government, which had these top-down reconstructions. There are now tests, and they will be adhered to.

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Brandon Lewis MP: “Great Yarmouth has been approved as a pathfinder scheme for local GPs, and local health teams are excited by the prospects that offers. What support can the government give to ensure we deliver successfully on this project?

DC: “I’m delighted that his constituency is taking part in the pathfinder projects. Those people who say that somehow NHS reform is being introduced in one big start are completely wrong. There’s 25% of GPs are going forward to make this work; there’s huge enthusiasm among GPs to get this moving; and I think it will show real benefits in terms of patient choice.

“And what I would say to everyone in this House: the idea that there is somehow a simple choice of simple life when you just don’t reform the NHS when you have rising drug bills, rising treatment bills and frankly a record in this country where we are not ahead in Europe on cancer outcomes and stroke outcomes and heart outcomes is not a sensible option. It is right to make this modernisation. And it will be this coalition driving it forward and the party opposite that is just digging in and defending an unacceptable status quo”.

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Lindsay Roy MP: “Nye Bevan, a man of great vision and remarkable foresight, once said, ‘this Prime Minister has an absolute genius in translating flamboyant language and flamboyant labels into luggage’. Is his so-called Bonfire Of The Quangos one such example, because it’s turned out to be a damp squib?”

DC: “I don’t accept that for a moment. The Bonfire Of The Quangos is going to make sure that we rationalise all the non-governmental bodies there are, and it will save billions of pounds in the process. I has, I think, been carried out in a very sensible process of asking the question ‘what should be part of government and properly accountable to this House, and what doesn’t need to be done and can be taken away?’ – and as I say, it will save billions of pounds, and a very good thing too”.

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Henry Smith MP: “Will the PM join with me in congratulating the Crawley Hospital League Of friends in helping to secure a new mammogram machine for that hospital. Can the PM explain what other ways we can develop better cancer services in this country?”

DC: “I’m grateful for my Hon Friend’s question and I know that Hon Members across this house support their local League Of Friends in their constituencies to raise money for their hospitals to do extraordinary thigns with new equipment and better services and it’s a good moment to pay tribute to all those who take part.

“Today we are making an announcement about a new cancer plan that aims to save another 5,000 lives every year by the end of this Parliament. This is all about the early diagnosis that we need in the NHS, but I have to say to the Hon Gentleman, we wouldn’t be able to do this if we hadn’t made the right decision as a coalition government to protect the NHS spending – a decision completely opposed by the party opposite”.

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Interesting. PM David Cameron is increasingly developing what Michael White of The Guardian rightly identified as his 'Flashman tendencies' - and they could be a powerful weapon for use against him. There is a fine line between a good put-down and cruelty, and Cameron crossed it today, repeatedly.

The British do not like bullies. Blair equivocated, charmed, patronised, edited the actualite and repeatedly failed to answer the question - but he avoided bullying. There is a New Year's gift there for a smart Opposition.

To be an effective Opposition, Labour in general must up their game and sharpen their questions (although Ed Miliband perfomed at a better level today). In the urgent question asked on Swine Flu by shadow health secretary John Healey, there were good points made and some good follow-up questions - but they were too diffuse.

One key issue is long questions. Healey's first had good points, but one too many. The issue of the midwives' circular should have been left to a junior shadow minister. UPDATE Thank you to the well-infrmed reader who emailed to indicate that my knowledge of Parliamentary protocol on Urgent Questions is deficient: there is no opportunity for junior ministers to ask a supplementary, as I suggested. Oops.)

If he is to make an impact, Healey must also not allow Lansley to misquote his questions. The Liberator's reply contained the line, "It is pretty rich for the right hon. Gentleman and the Labour party to say that there should not have been any shortages", where Healey's actual line was the more accurate "With proper planning and preparation, we should not have seen GPs and pharmacies running out of the vaccine in some areas last week".

Planning is a big issue. The Conservative and Lib Dem reforms propose that there will be less centralised planning (although as we pointed out, there are big, hairy superpowers proposed for the Secretary Of State in wholly-undefined emergencies, which will create havoc as and when venture capitalists invest in NHS facilities).

And SOS Lansley is, to put it mildly, in two minds (at least) about the virtue of central planning: he also said, "there is clearly an issue to deal with regarding how this is properly managed ... Labour Members ... might wish to re-examine the 2007 flu review. It was conducted by the Department of Health under the previous Administration and recommended that there should be central procurement of flu vaccine in England, but the previous Administration did nothing about it".

So is centralised planning good, now?

The Liberator also made one corking assertion - "It is clear to me that, by abolishing the Health Protection Agency and bringing its responsibilities inside the Department of Health under the new Public Health England, we will have a more integrated and more effective system for responding to seasonal flu in future years" - which cried out for a follow-up. A smart response would have asked why the old system he was criticising and scrapping had avoided winter crises year after year?

The most effective supplementaries came from Labour backbenchers Kevin Brennan, Chris Leslie and Tony Perkins, who picked up on something I have banged on about before: Lansley's line of defence to questions is to tell the questioner that they are completely wrong. This could be as fruitful as Cameron's Flashman tendencies.

"Kevin Brennan (Cardiff West) (Lab): In his answer to my hon. Friend the Member for Walsall South (Valerie Vaz), the Secretary of State was clearly giving an after-the-fact justification for his failure to act on the winter awareness campaign earlier in the year. He is fond of telling anyone who ventures to criticise him that they are completely wrong. Will he admit that on this occasion, as far as the awareness campaign is concerned, he was the one who was completely wrong?

Mr Lansley: No, absolutely not. I was simply pointing out to Opposition Members that the principle that applied in 2009, which was that the point at which flu was circulating in the community was the point at which the "catch it, bin it, kill it" campaign was initiated, was precisely the same principle that I applied this year.

May I say in response to the hon. Member for Liverpool, Wavertree (Luciana Berger) that the supplies of vaccine provided to primary care trusts or GPs' surgeries from the national stockpile of swine flu vaccine will be provided free?

Chris Leslie (Nottingham East) (Lab/Co-op): To be absolutely clear on that answer, does the Secretary of State have any regrets whatsoever about not proceeding with the flu publicity campaign?

Mr Lansley: No. I have made it perfectly clear that the principle we applied is exactly the same and was based on the medical advice given to me, which was to pursue an awareness campaign on respiratory and hand hygiene at the point at which flu was circulating in the community. That is what I was asked and that is the decision I took".

"Toby Perkins (Chesterfield) (Lab): The biggest tragedy is that the Secretary of State has learned no lessons whatsoever from what has happened. As a result, it is likely that the same mistakes will be made in the future. His answers about the advertising campaign are completely unconvincing. Will he explain why he cancelled the advertising campaign, which GPs were demanding at the time, to increase the take-up of vaccinations?

Mr Lansley: I cancelled no campaign; I proceeded only with the awareness campaign on respiratory and hand hygiene. An advertising campaign aimed at the general population would not have been effective, and I was advised that there was no evidence that it would be effective. We knew who the at-risk groups were, and it was possible to reach them directly rather than engaging in wider advertising."