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10.40 pm
Dr. Fox: I oppose the motion on grounds of principle and of practice. In this Parliament, we have witnessed the rise of an already powerful Executive to new heights. It is the height of arrogance for the Minister to say that, in his view as the Minister who piloted the Health Act 1999 through its Committee stage, the time was not used effectively. Ministers are there to answer questions, to be subjected to scrutiny by the Opposition and--before the Government came to office--by Back-Bench Government Members. It is up to the House to decide whether the time is used effectively, and up to the Committee Chairman to determine whether contributions are in order or relevant. It is not up to the Minister, who seems to want to determine the process as well the measure.
As a former Whip, I believe that we are witnessing a terrible rise in the power of the Whips Office. That is unhealthy for democracy in the House. Doubtless I shall get a black mark from my hon. Friend the Member for Cheadle (Mr. Day), who is the Whip on duty, for saying that. However, dangerous trends are currently developing in the House. They may have existed for some time, but they are now being exacerbated to an unacceptable extent. Nowadays, the House of Commons is simply Downing street in Parliament, and we have little say in the running of our country.
Mr. John Gummer (Suffolk, Coastal): I ask my hon. Friend not to be so critical of the Whips Office. Much more serious is the fact that a Minister claims in the
House that the opinions of other hon. Members are not important. All Ministers believe that Opposition Members--and, indeed, hon. Members from their party, too--who disagree with them are taking up time that would be better spent in another way. I admit that after 16 years as a Minister, I too believed that. It was extremely good for me that the House of Commons reminded me that we are in a democracy, and that hon. Members should be there to hold Ministers to account. The procedure that the motion proposes is designed to stop Ministers from ever being held to account.
Dr. Fox: I agree with my right hon. Friend, except on one small point. He may be right to say that, in time, Ministers come to regard the views of other hon. Members as unimportant. The difference with this Government is that they believe that the House is unimportant. That is why we are treated with such contempt.
Mr. Bercow: My hon. Friend, with his beady eye and good ear, will have noted the absurdity of the Minister's claim that there was adequate time for considering the Bill while simultaneously failing to specify--because he does not yet know--how many hours would be available. Does my hon. Friend agree that it would be risible and unsatisfactory if the Health and Social Care Bill suffered the fate of the Vehicles (Crime) Bill, which requires us to consider 45 clauses, and a potential 100 amendments, over 23 hours in 10 sittings by 23 January? Does my hon. Friend agree that, on the strength of our experience of the Vehicles (Crime) Bill, it is important that the Programming Sub-Committee, which considers the total amount of time and the order of consideration, should meet in public, not in private, as the Government have decreed?
Dr. Fox: My hon. Friend makes a helpful suggestion. I would go further; I am sure that wiser and more experienced heads than ours, with the benefit of experience and hindsight, would agree that the quality of legislation is directly proportional to the time that we take to consider it. Some of the Bills that have been rushed through the House in recent years have turned into the legislation that has subsequently required the most change. When the Government force Bills through the House at such a pace, they cannot be considered properly by hon. Members and by outside bodies that wish to comment on them in order to guarantee legislation of the highest possible quality. There will be more flawed legislation from this Parliament than from any in living memory.
We need to ensure time to consider the drafting of the Bill and any changes that the Government may want to make. That is the same point as the argument about quality of legislation. I have been in this House only since 1992, but I can remember many Bills which, following considerable scrutiny over some time, the Government decided were fundamentally flawed and had to amend considerably. By such undue haste, with which they are also treating every other Bill, the Government are denying themselves the chance to look again at the Health and Social Care Bill.
Mr. Redwood: Has my hon. Friend noticed that the Government selected the deadline for the limited scrutiny of the measure before they had been able to hear the views
of the House on Second Reading? During that debate, many colleagues made some very powerful points, which will either prompt substantial amendment of the Bill, requiring time for consideration, or prolong difficult discussions in Committee. How can they possibly have chosen the right deadline when they did not know the power and range of the arguments?
Dr. Fox: I hesitate to say to my right hon. Friend that the Government are not interested in the views of the House. They did not care what hon. Members were going to say. Only two Labour Back Benchers supported the Bill on Second Reading; the Government got it through with the usual Lobby fodder and Whips' poodles whom we are used to seeing. The subject and quality of the debate did not matter. It would not have mattered if the Government had introduced fundamental changes; they would have determined the timetable in any case. It is ironic that it took them six months even to arrange a debate in the House on the national plan that the Bill introduces, yet we are to complete the passage of the legislation in an obscenely short period.
I seriously remind the Minister that, as a result of arguments during the legislative process, the Government have often had to table amendments to their legislation late in the day. With such a very short timetable, they are denying themselves the opportunity to do that, and that can only lead to poorer legislation.
Mr. Edward Leigh (Gainsborough): Turning a Government can take a bit of time. I have sat through all three debates on programme motions this week. On the first day, the Minister for Housing and Planning said nothing; he just moved the motion formally. On the second day, the Under-Secretary of State for Defence spoke for about 45 or 50 seconds. Today, the Minister graced the House with a speech of three or four minutes. I think that the penny is beginning to drop. Very slowly, the Government are realising that such matters are important and special, and that we need a reasonable debate. Perhaps what we have done over the past three days is important and is having an effect on the Government.
Dr. Fox: I would love to think that my hon. Friend was right, and that even this Government would have second thoughts--but, hand on heart, I must say that the Government are so completely arrogant and contemptuous of the democratic process that they will almost certainly force through whatever they want, whenever they want, irrespective of any argument, however valid or from whatever quarter.
This is a long Bill. It has 67 pages, 66 clauses and five schedules. It is a complex Bill; it introduces many detailed reforms. It is very centralising legislation which has profound implications for the way in which our health service is run and the process of government is developed. It confers a range of new powers on the Secretary of State, and it is important that we ensure that those powers will be exercised by the Executive reasonably and responsibly, with proper safeguards, transparency and accountability to the elected Parliament of this country.
The Bill will increase Whitehall's influence still further, yet it is Whitehall's influence and the influence of the Executive that are at the root of the problem that we are discussing on this motion. It will not only affect
the 1 million or so employees of the national health service, as it varies their terms and conditions and gives further powers to the Secretary of State, but will influence the millions of users of the NHS.Many outside bodies have already written to hon. Members to give their views, to express their worries, and sometimes to give their support to parts of the Bill. The Bill will inevitably evolve, as changes to one part will affect another part. Those outside groups are not being given a chance to see how the Bill develops. Instead, the Government are telling them that only their views at the outset are valid, and anything after that is irrelevant. That is grossly insulting to the many groups that take a close interest in health matters, to many of our constituents who have written to us on this subject, and to the many interest groups that come to see us, and that inform the all-party committees that take a close interest in the workings of health policy.
On Second Reading, many of the Government's own supporters accused them of undue haste, especially in their proposals to abolish community health councils. They said that the Government's plans had been evolving since they were first published. That tells me that the Government have not finished their thought process, yet we are not to be given time to accommodate any changes in approach to any areas of the Bill.
It is extraordinary that the Government believe that when they publish a Bill it is the apogee of wisdom, and nothing can possibly better what is set down in print--if anything did, it would be given scant consideration. The Minister said that everyone knew about these issues. That is one of the most ridiculous things that I have heard a Minister say in a long time. If everyone knew about the issues, we would not have to debate them in the House of Commons, and we would not have piles of paper from outside bodies advising us on the experience of interested and expert groups in the different areas of policy.
I imagine that all hon. Members have had briefings from the Consumers Association. Notwithstanding its initial support for clause 26, it says:
- However, we would like clarification on whether or not information on disqualified doctors is automatically referred to the Family Health Services Appeals Authority . . . or is it only when a health care worker appeals against their disqualification that the FHSAA is notified? This is particularly relevant to locums as due to the transitory nature of this work they frequently move between Health Authorities. It is important that if one Health Authority removes a GP or locum from the list that other Health Authorities are informed.
On pharmaceutical pilots, the association says:
- there is a need for more information about how these pilots will operate and about the measures that will be put in place to safeguard the interests of patients and the public. For example, what will be the exact status of the pharmaceutical pilots--if they are not NHS bodies will they be governed by the Care Standards Act?
The association goes on to say:
- We also require clarification about patients' right to redress should they have problems with services provided by these pilots. It is our view that these pilots should be part of the NHS and patients should have access to the full range of rights provided by the NHS.
Such problems occur in many other parts of the Bill. On Second Reading, I said that we agreed with many of the provisions in principle--but we require proper information before we can decide whether to give our support to the Bill in Committee clause by clause. That is not an unreasonable position for any Opposition to take.
On the expansion of prescribing rights, we said that there was a need to use all personnel at the ceiling of their ability, but that there were a number of things that we did not know. We wanted to know what the balance would be between doctors, practice nurses, other nurses and pharmacists after the expansion of prescribing. We wanted to know if any deregulation measures would be brought forward for categories of medicines. Those details are vital to the workability of ideas which are basically sound.
Who carries liability for prescribing? If I write a prescription for an hon. Member, as I do regularly for hon. Members on both sides--I do not do Prozac or Viagra--I carry my own liability. Who will carry liability for nurses who write prescriptions? Who will carry liability when pharmacists prescribe? Those are deeply important matters, which require much debate.
When we explore the clauses in detail in Committee, I am sure that the outside bodies that will be affected will want to speak to the Opposition and the Government, and, being far more expert in these matter than we are, they will want to consider all the implications as they see them. They will be denied that secondary input because of the short time scale.
On Second Reading, we talked about the potential for personal medical services. We welcome the development of personal medical services. We said that GMS had had its day and would gradually disappear; there is no difference between the two sides of the House there. However, it all comes down to the detail. What will a quality agenda mean? How much control will be exercised from the centre? How much autonomy will doctors have?
The British Medical Association and the Royal College of General Practitioners will have strong views on such topics, and they will want to tell us what they believe are the implications of any ministerial answers given in Committee. We shall have so little time that the chances are that by the time that they get back to us with their views on any potential flaws, we will be unable to change anything. That is a real tragedy, which could be avoided.
When I was a Government Whip, the Opposition were given adequate time when it was felt that they had a reasonable case. It is far better to carry forward legislation in the House with as much co-operation as possible, yet the Government are intent on using their big parliamentary majority to batter the House into submission, to treat us with contempt and not to give us the chance to scrutinise properly what is being proposed, which is part of our duties as elective representatives.
Another reason for our need for time is the Government's plan to force its model for change on the NHS. I do not have a problem with the progression of primary care groups to primary care trusts, or the establishment of care trusts. As my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) said on Second Reading, we have an open mind on the substantive issue, but we have a problem with our ability to trust the Government on the subject.
During consideration of a previous Bill in Committee, the Minister of State said that doctors would not be forced from a primary care group into a primary care trust against their will. But at the very first test case in Southend, the majority of doctors voted against moving to a primary care trust, yet were forced to by the Government. It is hard for us to trust the word of Ministers when we have seen that word broken so quickly in the past. We want time to scrutinise such cases and to look back at precedents to see when Ministers have said one thing in Committee and done something different in practice. That is crucial to our willingness to grant them any powers of discretion in any of the many areas dealt with in the Bill.
We want to consider the implications for supplementary lists. We want to consider the Government's plans to reward excellence. We want to explore with Ministers how their proposal fits with the programmes of other Departments, not least the Department for Education and Employment's approach to failing schools, as compared with how the Government intend to deal with failing hospitals. To consider such matters properly will require quite a lot of time. Members of the Select Committee on Health may not have been members of the Committees that considered the other Bills involved, and we shall want to talk to other groups that we have not yet consulted. All those things take time.
Having spent so much time in Opposition, the Minister and his colleagues should know better than anyone else that there is a huge difference in the amount of information that one can assimilate with the help of a full civil service and what the Opposition are capable of assimilating. It is doubly unfair to the Opposition to have their timetable curtailed to this extent. The Government have all the information at their fingertips and the Opposition always have to run to keep up, even on a Bill with a generous timetable, not to mention one that has been so ridiculously concertinaed.
We will want to explore new issues in Committee that we did not raise on Second Reading. For example, we want to see how the Government's proposals for the NCAA fit in with their wider plans for GMC reform, and to consider validation and other associated issues.
We will want to consider whether the Government might look favourably on time limits for disciplinary cases at the GMC, not least because of the manpower considerations of having a large--and ever increasing, it seems--number of doctors under investigation and unable to work. It would be much better if doctors could practise in the national health service. We will want to know Ministers' views on those matters. We could not touch on them on Second Reading, because we would have been out of order.
We will want to explore Ministers' ideas about an independent appointments body. We found it absolutely amazing that the Minister could claim that this was a decentralising Bill giving away his powers, when it is
exactly the opposite. We wanted a truly independent body for national health service appointments, free from the influence of the Secretary of State, so that we could avoid the possibility of any party appointing people to the NHS because of the loyalty that they might bring to their political masters rather than the experience that they might bring to the running of the health service.
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