Health and Social Care Bill

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Mr. Hammond: The Minister is expressing the Government's concern about discrimination against older people. Does he accept that one of the biggest problems faced by older people in our hospitals is the phenomenon of bed blocking and the reduction in the number of places in nursing and residential care homes? If that is a factor, will he tell us why the Department of Health website was abruptly changed before Christmas from saying that the final draft standards for residential care homes for the elderly would be published before Christmas, to saying that they would be published in the spring?

Mr. Denham: The reasons for introducing delays in some of the target dates on care standards were set out in a speech made by the Minister of State, Department of Health, my hon. Friend the Member for Barrow and Furness (Mr. Hutton), who is responsible for social care matters. I shall be happy to give the hon. Gentleman a copy of that speech, which I believe was made to a conference of independent health and social care providers. It was a public Department of Health statement.

Mr. Hammond: It was not in the House.

Mr. Denham: The Government cannot do everything through statements to Parliament, but there was clearly no intention to conceal the matter. I am fairly sure that a Department of Health press release was issued to accompany the speech, so charges of secrecy will not stick.

I agree that the massive loss of beds in the NHS under the previous Government has put huge pressure on our hospitals. It is undoubtedly a reason for the great difficulties. It is also a reason for our unprecedented investment in the NHS, which will enable us to increase bed numbers and make better provision in the community.

Lorna Fitzsimons (Rochdale): Does my hon. Friend the Minister acknowledge that the reduction in the number of beds in some of our constituencies was aided and abetted by the Liberal Democrats?

Mr. Denham: I am absolutely certain that my hon. Friend is correct.

Mr. Hammond: I will not attempt to score a point on that feeble attempt to deflect my previous intervention about the loss of care home beds. The Minister made a serious point in saying that he believed that a statement by the Minister of State, Department of Health, the hon. Member for Barrow and Furness, was covered in Department of Health press releases. He might be interested to know that my office asked the Department of Health press office whether it would be possible for Opposition Front-Bench Members to be on the mailing list for its press releases, and the answer was no. Will he see whether he can arrange for the Opposition Front-Bench health team, and, indeed, the Liberal Democrat health spokesman, to receive Department of Health press releases as a matter of routine?

Mr. Denham: I shall certainly look into that matter.

Now that I have dealt with the new clause, perhaps it will reassure the hon. Member for Sutton and Cheam—although not, therefore, the hon. Member for Runnymede and Weybridge—to learn that clause 16 and, to a degree, the related clauses, would allow appropriate action to be taken if an NHS organisation was clearly practising age discrimination, was acting outside the policy statement in the NHS plan or failing to uphold the national service framework. I shall not, unless the Committee presses me to do so, deal with each amendment individually.

I do not consider it necessary to amend clause 16 or the other relevant clauses in the way suggested to ensure that effective action is possible. That is not to say that the powers of intervention under clause 16 are the only or first measures that one would want to take if there was evidence of age discrimination. For example, if a trust was shown to be a red-light trust, and intervention from the regional office had increased, an action plan to deal with the problem might be produced. If the problem were solved, there would be no need to progress further. The wide-ranging powers under clause 16 would be the culmination of a series of other measures for tackling a problem.

Mr. Burstow: The Minister referred to the Commission for Health Improvement. Is it appropriate for that body's remit to include—preferably enshrined in law, for which this Bill could provide a vehicle—a brief to deal with age discrimination and age-based rationing in the NHS?

Mr. Denham: We discussed that issue in relation to the Health Bill in 1999. The hon. Gentleman will recall that we preferred not to draw up a long shopping list, which would no doubt grow longer over the years, of prescribed issues for examination by the Commission for Health Improvement. That remains our view.

Mr. Burstow: This has been a useful brief debate. I hope that it will be viewed as a template for debates on other amendments.

The amendments were intended to probe the Government's attitude. I regret the fact that the Government are not prepared to embrace the spirit of our amendments and—on the assumption that they are deficient in some way—table their own versions. I should correct one of my opening remarks. I said that 70 per cent. of dialysis and renal units denied access to treatment on the basis of age. That is incorrect. The right statistic is that as many as two thirds of kidney patients over 70 have been refused dialysis or transplants.

We said during the passage of the Health Act 1999 that CHI should have a specific role in the context that we are discussing. While there is clear legislation about discrimination based on gender, race or disability, we still lack a similar legislative framework to govern discrimination based on age. The Liberal Democrat view is that we need such a framework and the Bill presents an opportunity to establish one, at least in the context of services provided by the NHS. We want to substitute clinical judgment for decisions based on age. The evidence is that, too often, decisions are based on age. The amendments would address that.

We may want to return to this matter later, so I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr. Hammond: I beg to move amendment No. 62, in page 11, line 42, at end insert—

    `, but no such order under this section shall be made unless a draft of the order has been laid before, and approved by a resolution of, each House of Parliament.'.

The Chairman: With this it will be convenient to take amendment No. 41, in page 11, line 42, at end insert—

    `(1A) In making such an order the Secretary of State shall place a report in the Libraries of both Houses of Parliament detailing his reasons and the measures he proposes to take.'.

Mr. Hammond: I am glad that we are coming to the second debate just 40 minutes into our deliberations. I heard what the hon. Member for Sutton and Cheam said. If that was intended to be a nod in the direction of approval of the timetabling system, he should calculate that, at the current rate of progress and assuming we have stand part debates on each of the six clauses that we are scheduled to deal with, we will need 10 hours and 45 minutes to finish the business before us. I hope that hon. Members do not start to congratulate themselves too early on our rate of progress.

Mr. Burstow: I should not allow myself to be goaded by the hon. Gentleman. Given that he spoke at great length on just a few amendments at the first sitting of the Committee, his attempt to lecture others about speaking at great length is somewhat unfortunate.

Mr. Hammond: I was merely passing comment on what the hon. Gentleman said. All terms used are relative, and the hon. Gentleman has served with me on enough Committees to know that I did not go on at length last Thursday. I was a model of brevity. The hon. Member for Isle of Wight has had to leave his place, but I look forward to him emulating my example.

I welcome my hon. Friend the Member for New Forest, West (Mr. Swayne) to the Opposition Front Bench, to which he was appointed this morning by my right hon. Friend the Leader of the Opposition. We welcome him to the team, and look forward to his contribution.

We understand, although it is not evident from the Bill, that clause 16, together with clauses 2 and 3, proposes to create an elaborate grading system for health authorities and hospital trusts. That is controversial. The Secretary of State will be given significant powers under clauses 2 and 3, and can use the power to distribute money to ensure that hospitals and health authorities do what the Government want them to do.

Clause 16 is, I suppose, to be seen as the fall-back clause, to be brought into effect when the system put in place under clauses 2 and 3 has failed to deliver. It allows the Secretary of State to take direct control of health authorities or trusts, to sack the board, or individual members of it, and to replace members at will. It also allows him to delegate the functions of that health authority to a third party. There are serious concerns about the circumstances in which the clause might be used. A centralising power is being given to the Secretary of State. So far, there is no indication as to whether it is to be used sparingly, in the rarest and most exceptional cases, or whether the Secretary of State envisages using it more frequently.

In tabling the amendment, we seek to ensure that the power will be used only in the rarest of circumstances, when something in a health authority or a trust is clearly going badly wrong. In such circumstances, it would be necessary, under the amendment, for the prior approval of both Houses of Parliament to be given to the intervention order. That does not merely imply Parliament approving an intervention in a trust or health authority, it implies Parliament seeing in advance the terms of the intervention order, and approving them. It also implies the examination in advance of the Secretary of State's proposals for removing or replacing members of boards, and for farming out the responsibilities and duties of the authority or the trust. The arrangements proposed by the Secretary of State for monitoring the progress of the trust or health authority under the intervention order, and the proposed arrangements for that body earning its renewed autonomy and freedom of action, would also be subject to scrutiny and approval.

When the Minister addresses the Committee, we must ask him carefully to delimit the circumstances under which the Government intend to use the powers. As the powers appear in the Bill, they are extremely dangerous and potentially disruptive. I hope that the Minister will say that the powers under clause 16 will be limited to the most extreme cases. If that is the intention, I cannot see why a democratic Government would have difficulty bringing an extreme case of obvious need for intervention before both Houses of Parliament and arguing for an intervention order. It is a basic function of Parliament to scrutinise such draconian interventions, and arrangements are already in place for Parliament to scrutinise the governance of the NHS.

11.15 am

Government Back-Benchers must bear in mind the fact that the purpose of the clause is to hand over the management of failing NHS bodies to the private sector. That is padded out in a page and a half of verbiage, just as the concordat with the private sector that the Secretary of State signed amid great fanfares in the autumn was dressed up in a lot of verbiage about NHS doctors treating NHS patients in private sector hospitals, with the private sector merely providing the bricks and mortar and the equipment.

The meaningful clause in that concordat was the third of the three possibilities outlined—that NHS trusts were not merely empowered but fully authorised to purchase care from private sector providers if they believed that it was the most appropriate way to deliver services. We do not have a problem with that: it seems a sensible way of delivering the free-at-the-point-of-use health care that the NHS is committed to delivering. It is important, however, that Government Members are not distracted by the padding, the cotton wool and the warm friendly-sounding statements that we heard from the Secretary of State about preferring an NHS solution to the problem of failing trusts, and the waffle about green NHS organisations seconding staff to help those failing trusts.

The reality is that the traffic-light grading system that the Secretary of State proposes, whereby only 25 per cent. of the trusts and health authorities will be graded green, will introduce competition into the NHS—the competitiveness between hospitals and health authorities that the Minister and the Government said in debates on the Health Act 1999 they were committed to abolishing. What green NHS body, knowing that it was one of the 25 per cent. in the green category, would second its best staff to help another NHS body that was categorised as red? No green trust would do so. It would keep its key staff to ensure that it maintained its highly-coveted green status. That status is not merely an issue of prestige; it will also give green NHS bodies the freedom to use the available money as they wish.

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Prepared 23 January 2001