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Mr. Milburn: I very much agree with my hon. Friend. One of the functions that we shall be locating with the new commission is to ensure that, so far as is possible, we have better representation in the national health service of the patient and the public voice. I think that we are all aware that wherever appointments are made in the NHS or in other public services, in some senses, although there is an independent appointments system, those who come up for appointment tend to be self-selecting. We need to get a better balance, to ensure that precisely the type of people whom the national health service serves are themselves serving in decision-making capacities in the health service.
Unless we improve the NHS's governance and make it more representative of the local communities that it serves, we shall never reach the position at which local services are responding to the needs of local communities. By giving the commission the tangible function of broadening the scope of representation in former NHS structures, it will be able to perform a very important function in democratising the NHS and the way in which it is run locally.
Dr. Liam Fox (Woodspring): Perhaps the Secretary of State can answer a question that was not satisfactorily answered in Committee. When the CHCs are abolished, what will happen to all the information, including confidential patient information, that they hold? Who owns that information and where will it go?
Mr. Milburn: I am sure that those issues will be discussed again in Committee—
Mr. Milburn: The hon. Gentleman is chuntering away—[Interruption.] I am glad that he has apologised.
We shall have to get right the transition from the old structure to the new one in relation to staff who are currently employed in the CHCs. Many of them will have a new function and a new job within the new structures. The hon. Gentleman has made an important point on the available information. It would be tragic if we lost the wealth of information that is available on individual patient problems and on more general problems in the
local health service. We have to find a way of transporting that information into the new structures. There will be a formal transition process to do precisely that.
Clive Efford (Eltham): Does my right hon. Friend accept that community health councils have said all along that they recognise the need to change and become more responsive and more representative locally of the broader health service? As for the point on local accountability and local representation, the concern is precisely that patient health forums are self-selecting. We can choose to appoint to a forum the last person to get off the bus outside the local hospital, but unless that person has some expertise he or she cannot effectively represent the local community. We need that expertise. As I understand it, the CHCs will be abolished when the Bill is enacted, assuming that it is. Can my right hon. Friend say whether, before the Bill receives Royal Assent, the transitional advisory committee will reach some conclusions on the CHCs and their expertise?
Mr. Milburn: The transitional advisory committee is currently working on precisely the issues that the hon. Member for Woodspring (Dr. Fox) and my hon. Friend have raised. I pay tribute to the work of the very many CHC staff and to local community representatives who have served on local CHCs and done a very good job of work. It is important not to lose that body of expertise and knowledge.
The first point that my hon. Friend the Member for Eltham (Clive Efford) made is very important. We need to ensure that the patients forums are not only representative of the local community but can express expertise on behalf of that local community. Consequently, as a result of consultation that we have been conducting in recent weeks, the Bill's proposals are different from those that we put out to consultation. We have now lodged with the national Commission for Patient and Public Involvement in Health the duty of appointing patient forum representatives, precisely to ensure that the commission, as an independent patient organisation, can feel satisfied that the people being appointed locally are up to doing the job on behalf of the local communities that they serve. I hope that my hon. Friend will take some comfort from that change.
The third main measure in the Bill is the strengthening of independent regulation. As the Kennedy report highlights all too clearly, for almost 50 years there was confusion at the heart of the NHS about where regulatory responsibilities began and ended. Indeed, it is only in the past few years that national standards have been put in place in the NHS alongside the means to implement them. The system of professional self-regulation has been changing too, and I pay tribute in particular to the leadership of the medical profession for responding to public concerns about a perceived lack of accountability and transparency in the old arrangements. The Bill builds on those changes.
The Bill takes its cue from the Kennedy report in introducing a new Council for the Regulation of Health Care Professionals to which all of the individual professional regulators will become accountable. It will have a majority of lay people and people appointed from the NHS. The council will be independent of the Government and it will, instead, report to Parliament.
The Bill will also strengthen the role of the Commission for Health Improvement. It will give the commission a new function of carrying out inspections of the quality of local health services. Where it identifies significant failings in the way services are being run, the commission will report and recommend any special measures that might need to be taken. Its independence will be strengthened too, not least by being required to make an annual report to Parliament on the quality of NHS services. From next year it will be the CHI, through the new Office for Information on Health Care Performance—called for in the Kennedy report—rather than the Department of Health that will be responsible for assessing the clinical and organisational performance of each part of the NHS.
Together, those changes will provide a powerful incentive for local health services to raise standards. What motivates people working in the NHS is the desire to improve the care they provide to patients. Just as we are tackling the postcode lottery in prescribing, so the Bill addresses the postcode lottery in performance. Just as we have made appointments to NHS boards independent, so we are now making independent the assessment of NHS performance. A strengthened NHS independent regulator will leave the Department of Health to concentrate on what it should properly do in an accountable public service—provide resources, set standards and hold the overall system to account.
The Bill marks a decisive shift in the centre of gravity in the NHS. It moves towards regulation that is the hands of independent regulators rather than Ministers or the health service. It moves towards resources that are in the hands of front-line staff and towards power that is in the hands of patients. It is opposed, as I see from the amendments tabled by the Conservatives and the Liberal Democrats, every step of the way by the two main Opposition parties. They are two sides of the same coin. The Tories have their hostility to investment; the Liberal Democrats have their hostility to reform.
The Conservatives, who for two decades did so much to damage the NHS then, have the nerve to talk of an NHS crisis now. They scaled up bureaucracy and scaled down investment. They had the wrong policies then, but they have no policies now. Just as the Conservatives would starve the NHS of investment, the Liberal Democrats would starve it of reform. The hon. Member for Oxford, West and Abingdon makes policy by ducking every difficult issue, avoiding every harsh decision and appeasing every lobby group. Theirs is a policy of oppositionalism and opportunism.
Only the Labour party and this Government have the will to make the necessary investment and the necessary reforms to improve the health service. The Bill is about decentralisation and decreasing bureaucracy. It is about increasing the power of the patient and decreasing the power of Whitehall. It represents the biggest devolution of power in the history of the NHS. It will provide the basis for a health service rebuilt and renewed; a health service with its principles strengthened and its performance improved; and a health service capable of meeting the expectations of the people that it serves. I commend the Bill to the House.
5.19 pm
Dr. Liam Fox (Woodspring): I beg to move, To leave out from 'That' to the end of the Question, and to add instead thereof:
- 'this House declines to give a Second Reading to the National Health Service Reform and Health Care Professions Bill because it is irrelevant in the face of a worsening health care crisis; will lead to increased bureaucracy; increases political interference by augmenting the role of the Secretary of State; fails to deal with the downward spiral of morale afflicting health professionals; imposes unnecessary structural change which will further detract from patient care; and abolishes the community health councils, which have served the interests of patients and communities.'
Many charges can be made against the Bill, the most serious being that it is irrelevant to the crisis currently facing the NHS. It is a centralising Bill that pretends to be decentralising. It is highly bureaucratic, it is being rushed in far too quickly and it diverts activity and money away from patient care. Its provisions are unclear and confusing and it does nothing to increase patient choice.
To understand how irrelevant the Bill is, we need only take a quick look at what is happening in the NHS. Despite all the promises made by the Prime Minister and his Ministers at two general elections, patients in Labour's NHS are waiting longer in accident and emergency departments and to see their GPs. They are also waiting longer for their hospital operations.
Only last week, a poll commissioned by the BBC showed that six out of 10 people questioned thought that Labour had made no difference to the NHS, while 62 per cent. were not confident that the Government would improve the service in the next four years. Moreover, 27 per cent. of those questioned believed that the standard of care was getting worse.
It is little wonder that people should respond in that way: the recent Audit Commission report showed that, although investment had increased and the number of doctors had risen faster than the rise in patient numbers, patients were still waiting longer to be seen, or to be admitted to hospital from casualty. Fortunately, Ministers' blushes were spared, because the Audit Commission did not delve into the murkier aspects of modern casualty management. For example, it did not investigate the way in which targets for trolley waits are being reached by keeping some patients waiting in ambulances rather than in casualty departments. That tactic allows hospitals to pick up one of the Secretary of State's precious stars.
In the NHS today, patients wait longer for treatment. After a bit of a mix-up as they tried to work out whether the figures had risen or fallen, Ministers had to admit a couple of weeks ago that the number of patients waiting more than 12 months for in-patient treatment in English health authorities has risen by 63 per cent. since March 1997. That is the proud boast of the Government's record.
Much of the difficulty arises from the number of beds in our hospitals that are blocked because patients cannot be discharged somewhere else. In Buckinghamshire, 17 per cent. of beds are officially blocked. The figures for Hillingdon and Birmingham are 18 per cent and 15 per cent., respectively. Goodness knows what the real figures
are, given that what we have are subjected to the mathematical ethnic cleansing of the spin doctors in the Department of Health.Why has the problem arisen? In September, Laing and Buisson published the 2001 market survey "Care of Elderly People". It revealed that, by April 2001, there were an estimated 525,900 places in residential settings for the long-stay care of elderly and physically disabled people across all sectors.
That should be of interest to the Minister of State, the hon. Member for Redditch (Jacqui Smith), who the other day said that the Opposition's figures were wrong. The estimate in the survey represents a fall of 49,700 places since the peak level. That is why so many beds are blocked. There is no point in Ministers talking about the record of the previous Government. This is a disaster entirely of their making: during the passage through the House of the Bill that became the Care Standards Act 2000, they were warned about what would happen, given the Government's approach to local government funding. They would not listen, but every Opposition prediction has come about—the blocked beds, the increased waits for operations, and the delays in accident and emergency departments.
The list of failure goes on. Today's Daily Express talks about huge NHS waste and, in the latest chapter of Labour's internal war, even the Chancellor of the Exchequer's men have described the Secretary of State as useless.
What is the Government's response? It is the one thing that nobody working in the profession suggested—wholesale reorganisation yet again. The respected health academics Kieran Walshe and Judith Smith have voiced concerns, saying that the NHS does not need fundamental reform. They point out that the opening paragraph of the Secretary of State's White Paper "Shifting the Balance" states that
- "everything possible should be done to minimise disruption if the NHS is to remain focused on the delivery of the NHS Plan."
The Government have changed their tune. I wonder who said:
- "The last thing the NHS needs is a programme of wholesale reform . . . The imposition of further change and upheaval could not be justified in terms of cost alone and more importantly, it would be confusing for the public and grossly unfair on doctors, nurses and other NHS staff."
In the true Orwellian double-think so beloved by new Labour, the Bill is described as decentralising. It is nothing of the sort. It contains 58 powers for the Secretary of State for Health, either gained, retained or enhanced. I wonder whether Labour Back Benchers actually understand what is involved when the Secretary of State determines the level of allocation for every primary care trust in the country. I ask them to consider the trouble
that arises over the local government financial allocation. Multiplying that by as big a number as they can gives an idea of what their postbags will look like. Very decentralising.This supposedly decentralising Bill will set up the strategic health authorities, each one of which will have its own chief executive. Let us guess who will be appointing the chief executives—the head of the civil service at the Department of Health, who also happens to be the head of the NHS executive. So the personal appointments will lie, very neatly, in the Secretary of State's office. How very decentralising.
The Bill will appoint a council to oversee the regulatory bodies. However, there will always be a majority of one, appointed by—guess who?—the Secretary of State. Calling this a decentralising Bill is a fantasy.
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