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Dr. Fox: That is the closest that we get with this Prime Minister to any definition that remotely resembles the truth as the rest of the country would understand it. I am sure that my hon. Friend the Member for Eddisbury (Mr. O'Brien) will contribute to the debate and perhaps he will expand on that matter. It does not surprise me, however, because I believe that the Prime Minister would
say anything to get through Prime Minister's questions irrespective of the trouble stored up for later. To cope with the questions from the Leader of the Opposition on beds in the community, he started to count beds in people's homes simply to make more. In effect, he conjured up 30 million extra NHS beds overnight. I no longer believe anything that he may say.The Government have shown that they are committed to the increased funding for the NHS. I made it clear that we would match that funding, both for the NHS and, in the wider Department of Health budget, for personal social services. I hope that that has been absolutely clear.
In presenting the Bill, the Government have shown no grasp of the wider picture: how to maximise capacity, decentralise properly the model of health care, deal effectively with an ageing population, prepare for using new medical technologies to their best advantage, and maximise the use of the private and voluntary sectors. They talk about decentralising, but the Bill would bring far more power to the centre. It places too much trust in bureaucrats and too little in health professionals. It gives too much emphasis to management from the centre and too little to patient choice. They may be well intentioned, but they have failed to grasp the real problems of the health service. This is, par excellence, a missed opportunity.
4.58 pm
Mr. David Hinchliffe (Wakefield): This is a wide-ranging Bill containing a huge number of different elements that would implement significant and important parts of the national health service plan. It contains many positive measures, but also some that need to be given further thought, as hon. Members on both sides of the House have argued in interventions. I particularly welcome the continued efforts to encourage joint working between the NHS and social services, building on the important provisions in the Health Act 1999, which I also strongly welcomed.
To reiterate what I said in an intervention on my right hon. Friend the Secretary of State, I have long had a personal preference, as he made clear, for placing the health authority function in local government--where it was, to some extent, until the Conservative party removed it way back in 1974. In a number of ways, reverting to that arrangement would deal with certain key matters of concern that arise in the Bill.
For example, we could tackle the false division between health and social care. That fundamental problem has faced both major parties for many years. In my view, it would also unite the public health function. I am speaking in advance of any conclusions that the Select Committee on Health may reach with regard to public health, but I have long believed that it is more sensible to locate the public health function in local government than in health authorities, where it is separated from the central drivers of public health, such as the housing function.
Returning to the arrangement that obtained before 1974 would also democratise health and make possible democratic scrutiny at local level. I know that my right hon. Friend the Secretary of State firmly rejects that idea, and we differ over the point, but I will continue to argue for what I consider to be a sensible course of action. I hope that I may yet succeed in convincing my right hon. Friend. However, even if the Government are not going
to move in the direction that I prefer, the proposal for care trusts is a welcome step forward. The policy will address some of the problems at local level, and I will support it strongly.I am worried about a number of elements in parts I and IV of the Bill, and I hope that the Government will consider them further. Of particular concern are the proposals in clauses 7 to 14, regarding scrutiny and complaints. It is not often that I agree with the hon. Member for Woodspring (Dr. Fox), but I feel that there has not been adequate public consultation and discussion in respect of some of those proposals. Although the NHS plan contains some important and positive proposals, I get the distinct impression that the proposals regarding CHCs and scrutiny were something of an afterthought.
I am also concerned because the Bill introduces proposals regarding the wider issue of complaints before the project team in the Department of Health has completed its evaluation of complaints procedures. Clearly, the measures in the Bill--which will probably go into Standing Committee next week--have a bearing on the complaints procedures. The Government have put the cart before the horse, and it would be more sensible to await the departmental team's report before examining complaints procedures.
My right hon. Friend the Secretary of State knows that less than two years ago, the Health Committee considered in detail the handling of adverse incidents in the health service. We met hundreds of patients for whom things had gone wrong, and we were impressed by the extent of the suffering that health service incompetence had caused them. For example, some people had lost family members--although that was rare. The difficulties that people faced were made far worse when they tried to obtain some explanation or redress by making a complaint.
Members of the Health Committee met people who had been treated by Richard Neale, Christopher Ingolby and Rodney Ledward. They had been at the sharp end of some pretty difficult treatments, and I want to pass on some of the key messages that those people communicated to us about what scrutiny and complaints procedures should do, and how the Bill should go about changing those procedures.
Any complaints procedure must be independent, and must be seen to be so. The current system is not independent, as Ministers know. The procedure must be simple to understand, so that people have access to it and will know where they must go when they have a difficulty with a particular service. It also needs to be transparent and comprehensive. It must cover primary, secondary and tertiary care, and care in the community--all the areas in which treatment may have been given.
I appreciate that further thought has probably been given to some of the proposals in the Bill, but I am worried that the proposed system will not be independent, as it should be. The patient advocacy and liaison services will be trust-based and non-statutory. They will clearly be regarded as part of the health trusts, whether or not they are in fact.
In addition, as the Bill stands, the independent advocacy proposals will be commissioned by the health authority. I accept the remarks that were made earlier, but all hon. Members will have experience of complaints
directed at us that also relate, directly or indirectly, to the policies and practices of the complainant's health authority. I have received complaints against a trust for difficulties that have been blamed directly on the health authority. It is wrong to suggest that the Bill's proposals for independent advocacy should be commissioned by a health authority that may be the subject of a complaint.I accept that the Government are giving the matter further attention, and considering the possibility of advocacy relating to scrutiny of local government. That is a welcome step. I met the Minister of State earlier this week, and we had a very happy discussion. I appreciate the fact that he has listened to some of my concerns.
Dr. Brand: Does the hon. Gentleman agree that many complaints are appropriately dealt with internally, either within primary care or within the hospital trust sector? Patient advocacy and liaison services can be very helpful in the reaching of an agreed conclusion, but sometimes patients and carers will not be satisfied with an internal arrangement. In those instances we require a separate system, not run by a trust tribunal--or, indeed, serviced by PALs.
Mr. Hinchliffe: I entirely agree. The hon. Gentleman sat through the same evidence as I did, and the message was loud and clear. The patients whom we saw wanted complete independence and fairness, and I do not think that the proposed system offers the independence and fairness that I would like to think the Government want.
I feel that what is being proposed is somewhat clumsy and confusing. If I were a patient with no knowledge of the structure of the health service, rather than a Member of Parliament involved in health policy, I would like to know who did what in the complaints process. The Bill specifies a range of agencies and other bodies that I, as a patient, might or might not need to consult: the trust, the district health authority, PALS, the independent local advisory forums, the patients forum, the scrutiny committee, the National Clinical Assessment Authority, the ombudsman, and various professional regulatory organisations. People are baffled by the complexity of what is on offer now, and I think that we are making the system even more complex. I hope that it will be simplified in Committee, so that it makes sense to patients.
I also feel that what is proposed would fragment the scrutiny and complaints function. The patients forums and PALS will relate to just one element in the service--a trust. As I have said, many complaints that I--and, I am sure, other Members--have dealt with relate to more than one element. They may relate to primary care, secondary or tertiary care, and community care. It must be possible to look at the whole process, rather than focusing on only one aspect. I hope that that too will be considered in Committee.
I hold no particular brief for community health councils. I became a member of a CHC in 1974, and served as its vice-chair. I worked for many years on that CHC, which I considered to be a good one. I know, however, that the effectiveness of CHCs varies. Some are excellent, but some have not done the job required of them, and the voice of patients has not been heard. Such CHCs have been the poodles of local trusts and health
authorities. They have not stood up to be counted on occasions when patients' views should have been expressed loudly and clearly at local level.Nevertheless, I am not convinced that the new system will be better. Indeed, it may be worse. I am sorry to say that, because I welcome much of what the Government have done on health, and warmly commend Ministers for introducing so many positive measures, especially with regard to the relationship between health and social care. I feel, however, that further consideration is needed.
Shortly before Christmas I wrote to the Secretary of State suggesting a possible compromise. My suggestion, which may or may not have been helpful, was that we beef up the membership and powers of CHCs. I suggested that their powers should be extended to cover complaints in the context of primary care, and that--as the Health Committee proposed--they should have an advocacy function. If the Secretary of State wants a link with local authorities, he could easily increase the proportion of local authority appointees on local CHCs. That proportion is currently one third; the Secretary of State could make it a majority. Many Labour Members--they will not speak today, and they are not among the "usual suspects"--are deeply worried about what is being proposed. I hope that I have made my point constructively, and that the Government will consider the issue in Committee.
I genuinely welcome the Government's attempts in part IV to rectify the long-term care shambles that the Conservatives left them. I was amused yesterday to see the Leader of the Opposition launch his "Where has all the money gone?" campaign. It made me think about the amount of money that was sunk into private institutional care between 1981 and 1993, when community care changes came into effect. Some £10 billion was thrown at gross over-provision of private institutional care, when people were crying out for investment to support them in their homes. Tory MPs bleat about empty private care homes, but that is utter hypocrisy. They are empty because we provided too many beds, and the Government--thank goodness--are ensuring that people do not end up in institutional care.
We are supporting people in the community. That is a positive step, and the Government can be satisfied with that achievement. I think that we should look to Denmark, where housing-with-care schemes have replaced institutional care. The Government are right to emphasise in the Bill the need to restore and support older people's independence. I strongly welcome the new investment in community care.
I also welcome the proposal for free nursing care, but I regret the failure fully to implement the royal commission's proposal. We have not completely addressed that issue, and a difficult situation will develop. The royal commission's definition of personal care offered a sensible answer to the social nursing care issue that has dogged successive Governments for many years. The Government can develop assessment processes and local protocols until the cows come home, but I do not think that it will ever be possible to draw a clear boundary between personal care and nursing care. The previous Secretary of State admitted that, and I would I have to agree.
Today I received a letter about personal care and nursing care from a nursing home in West Yorkshire. Mr. Andrew Makin wrote about the
- specious and probably resource-led division between these two ideas . . . it is an entirely artificial and unnecessary construct . . . there is no such thing as a distinction between nursing and personal care in a care setting.
All care is directed at the well being of the client in an holistic sense, which by all modern accepted definitions is a nurse's role. Nursing looks at all the facets of a person's care and does not draw theoretical divisions between different aspects of it.
To conclude, I want to reinforce the fact that the Bill contains many positive proposals. I hope that other matters will be addressed in Committee. The Government have shown their willingness to listen to concerns, and I hope that they will continue to listen and amend the Bill in Committee, so that it makes more sense on Report.
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