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Mr. Speaker: Before I call the Minister to speak on Third Reading, I should announce that I have selected the amendment in the name of the Liberal Democrat party.
Mr. Edward Leigh (Gainsborough): On a point of order, Mr. Speaker. Do you think it adequate for the mother of Parliaments to give a Third Reading of just 15 minutes to an important Bill?
Mr. Speaker: Order. It must be adequate because I am proceeding according to the rules of the House. I call the Minister to speak.
9.46 pm
Mr. Denham: I beg to move, That the Bill be now read the Third time.
Had the hon. Member for Gainsborough (Mr. Leigh) been here earlier, he would have heard his colleagues argue that an hour was far too long to spend on Third Reading of a Bill of this sort. The House would welcome a little bit of co-ordination by Opposition Members.
As we approach the end of the Commons stage on the Bill, I want to make a few points. The Bill is vital to implement the NHS plan. As a Government, we inherited a fragmented and under-resourced NHS; buildings were crumbling and there were too few staff. We have already acted to end the internal market, to get the biggest ever hospital building programme under way, to set up primary care groups and trusts and to expand the training of staff. We are now seeing unprecedented investment in the NHS which, however, must be investment for modernisation. The measures in the Bill make sure that that will happen.
First, it is a decentralising and devolving Bill, which underpins the principle of earned autonomy for the best run parts of the health service, together with the principles of less performance management and greater financial freedom. It gives new powers to the NHS and local councils to work together at local level. They already have partnership powers; now they have the ability to create new joint organisations and a new level of partnership to provide a seamless care service for the elderly, the mentally ill and children. Those powers have been widely welcomed and sought. Unfortunately, not all right hon. and hon. Members have taken a close interest in the Bill, but it is no less important for that.
Dr. Lynne Jones: Will my right hon. Friend give way?
Mr. Denham: If my hon. Friend will forgive me, I should like to make a little progress.
As we have just discussed, the Bill provides more power for patients and increased democratic local scrutiny. It also enables us to tackle variations. The best of the NHS is extremely good, but the variations in the service are too wide. As we develop earned autonomy for the best parts of the system, we have more effective means to support and intervene in any part of the system in which performance is poor or trusts are failing. The Bill underlines the new performance management system and the performance fund that will be worth £250 million in two or three years' time. It gives us the power, if needed as a last resort, to tackle failing trusts.
The Bill gives us the power to tackle variations in primary care. The new unified budget will make it easier for health authorities to determine the expansion of GP numbers, attract more GPs to deprived areas and enable them to work in better premises. The Bill makes possible a new partnership to invest £1 billion in primary care premises and one-stop primary centres, starting in deprived areas. It therefore helps our commitment to tackle health inequalities.
The Bill also enables us to protect the quality of patient services. All GPs will be on health authority lists; there will be a new system of suspension, removal and appeal which means that, in the small number of cases in which it is needed, there will be a faster and more effective system to safeguard patients and a fairer system for GPs. It enables us to honour the agreement with the British Medical Association that, as GPs move on to lists, all of them will be able to join the NHS pension scheme. It will take some months to get the lists into place, but our aim is to backdate them to April this year. We rightly extend the list system to other health professionals.
The Bill protects patients and improves the quality of care in other ways, for example, by ensuring tight controls over the use of patient information and by enabling patients to have more information about their own personal care. The Bill backs innovation: it provides for new ways of providing pharmaceutical services, establishes new groups of health professionals able to prescribe prescription drugs, and creates new powers to ensure that the NHS can benefit properly and fairly from its own research and innovation.
The Bill brings new fairness to health care for the elderly. For the first time ever, NHS nursing care will be free wherever it is delivered. It ends the means test of health care in nursing homes. That is a huge step forward, which goes with the investment by 2004-05 of £1 billion in new and improved health and social care services for the elderly.
That means turning our back on Tory privatisation, on the cuts that they promised in social care, and on the cuts that they promised in health care to make up for the money that they would not raise from tobacco, and the money that they would waste on subsidising private health insurance. It reverses Tory plans to make people pay for hip operations, knee operations, cataract operations and hernias. It is an important Bill, which underpins the Government's commitment to the long-term future and modernisation of the NHS.
9.50 pm
Dr. Fox: I begin by correcting the first of a remarkable list of inaccuracies in the Minister's speech. He said that we did not want as much time as was allocated for Third
Reading. The point that we made at the beginning of the day was that we had very little time for all the remaining stages of the Bill, including the Government's new clauses and more than 120 amendments. It is a sad reflection on the new procedure in the House that we have been able to give so little consideration to the remaining stages. The one correct thing that the Minister said was that the Bill was extremely important.The Bill must be judged by whether it will improve the overall health care in this country and the running of the national health service. Almost any medical or nursing group that we speak to throughout the country speaks about morale in the NHS being at an all-time low, more people leaving the service than ever before, more doctors taking early retirement than ever before--
Maria Eagle: The hon. Gentleman is talking down the NHS again.
Dr. Fox: The hon. Lady says that I am talking the service down. Her Government have been in charge of the NHS for the past four years. More people are leaving the service than ever before. That is one thing for which she cannot blame the previous Government. This is the fourth winter that the Government have been in control of the health service, where morale among staff is clearly very poor. I wonder when the Government will take responsibility for anything that they are getting wrong.
Increased numbers of people are waiting to be treated in the service. The Government talk about the number by which they have reduced the in-patient waiting list. The Minister deprecates the private sector, but it is worth pointing out that since the Government came to office, 450,000 people have left the waiting list of their own volition to purchase treatment in the private sector with their savings. Had it not been for people being forced to use their savings by the waiting times overseen by the Government, the waiting lists would have risen by even more than they have.
Notwithstanding that huge reduction, as a result of the fact that people have been willing to pay, often for life-saving treatments, with their life savings, the total number of patients waiting in our system has gone up, if one adds together the in-patients and the waiting list for the waiting list, which has soared since the Government came to power.
Perhaps worse than that are the distorted priorities in the system. In the short time available to me, I will not go over the catalogue of horrors that we have heard in recent debates and which have been raised in the House during Question Time. When surgeons are asked to cancel waiting lists for surgery for cancer patients so that they can treat more minor cases, we must wonder about the ethical basis for our system. Under the Government's bizarre and distorted waiting list initiative, we have reached the point when we are debating whether to treat the sickest patients first. That is the background to the debate, and the level of distortion that now exists in the system.
Ministers have failed to tackle the most important thing of all--not the number of patients waiting, but what the service does. There is nothing in the Bill about outcome-based targets for a system and a country that has just slipped behind Turkey in life expectancy--down to 19th place in the world. In many priority areas, the NHS
fails to deliver outcomes that we might rightfully expect for the fourth wealthiest nation in the world, yet patients with in-growing toe nails and impacted wisdom teeth are being removed from the waiting list simply to make the figures look better for Ministers. That is a disgraceful way to run a service.Against that background, we are faced with the NHS plan and the Bill. The NHS plan is not a plan in the sense in which most people would understand that word. It is more of a wish list, as we see when we consider some of its particular aspects and scrutinise them in detail. Such aspects include the number of staff required. Medical bodies such as the British Medical Association and the royal colleges tell us not only that the Bill does nothing for the provision of staff, but that the numbers are greatly underestimated in the first place.
The Minister tells us that the Bill is a decentralising measure. He has many talents, but he has only recently turned his hand to comedy. The Bill could not be described as decentralising by any stretch of the imagination. It will reinforce all the micro-management tendencies of the current Government, who genuinely believe that a service that employs a million people can be managed from behind a single Minister's desk in Whitehall. There is constant interference with management and the Department is continually distributing circulars that make it impossible for anyone to set budgets for any length of time and which force those in NHS management to go chasing after packets of money for which they must compete by investing huge amounts of their time and energy. We need depoliticisation and decentralisation, but the Bill gives us increased centralisation.
That is not to say that the Opposition do not welcome some parts of the Bill. We welcome the extension of nursing care, which the Minister mentioned. We also welcome proper control of locums. From my personal experience, I think that that is long overdue in the NHS. We do not pretend for a minute that every aspect of the Bill is undesirable, but three major issues make it completely unpalatable.
The first issue is the abolition of community health councils, which we have recently addressed. Let me make the Opposition's position perfectly clear. We think that the new clauses introduced on Report will reduce the damage caused by the abolition of CHCs, but we do not accept them because we do not accept that policy. We will continue to press for retention and reform of CHCs as the Bill proceeds through the House of Lords. I believe that we will have the support of Liberal Democrats in the other place in carrying that process forward. There is no doubt that the abolition of CHCs is a completely unacceptable policy, as it removes an independent voice for patients, as well as their ability to use a single point of access into the system.
None of the questions that we asked earlier were answered. We had no answer about cost or about what would happen to the staff or to confidential information. We have debated the ownership and confidentiality of patient information, and have considered where it should rest. A huge volume of information about patients is contained in the records of CHCs throughout the country. Having spent time debating those matters, however, we have reached Third Reading and we do not yet know
where that information will go. As it may contain complaints about specific doctors or hospitals, it could potentially return to those doctors or hospitals.
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