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5.38 pm

Mr. David Hinchliffe (Wakefield): I hope that my approach to the Bill will be a little more balanced than that shown in the previous contribution. I try to offer constructive criticism, and I hope that what I say today will be taken as constructive criticism. The Bill has many positive aspects, but the fact that I have only 10 minutes in which to speak does not leave me a great deal of time to expand on them, so I shall concentrate on the issues about which I have some concern. I hope that some of those issues will be addressed during the Bill's consideration.

The Secretary of State has talked about the way in which the Government are finally, as he put it, getting health and social care to work together. I wish I were as optimistic as he is. Frankly, looking at my own backyard, which he knows reasonably well, things are as bad as

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ever. Two weeks ago, I saw the figures on delayed discharges, which are very worrying. Although my right hon. Friend disagrees with my solution, he knows what it is. Perhaps we could engage in a dialogue during the Bill's passage through Parliament.

One of my concerns about the Bill is that it is too narrowly focused on health. Some of the structures proposed fail to take account of the crucial relationship with social care. I shall come to that in more detail shortly.

The Bill also accepts uncritically one of the central historical weaknesses of the NHS—its lack of democracy and lack of engagement and involvement with the people whom it serves. The Bill says that it seeks to involve the patients and the public in the NHS, but it will not let them run it. We should consider how we can ensure that we have a democratically elected health service that means that those who use the service are in the driving seat in a way that they have not been since the service was created in 1946. Another key problem relating to that is the lack of personal ownership of the health service by its users. That is why some people do not take care of the service that they use or regularly fail to turn up for appointments.

We hear much about joined-up government and I believe that the Government are, in some respects, genuinely trying to join up thinking. However, the Bill fails to relate to the growing debate in areas such as mine on the need for regional government. The new strategic health authorities provide an opportunity to draw together important policy strands in radical new ways and I genuinely welcome their introduction. As the Secretary of State is well aware, clear problems have arisen as a result of the lack of a strategic overview at a regional level. Local reconfigurations have suited one area but affected another, and no one has considered the big picture.

When the Secretary of State attended the Select Committee on Health the other week, I raised my concern about public health strategies. We need to ensure that the new regional bodies have a clear role in addressing health inequalities. I worry that the public health agenda is sliding slightly as a result of the changes that are taking place. I hope that I will be reassured on that point as the Bill goes through Parliament.

I welcome the new bodies, but they miss an opportunity in that they will not draw together strategic planning on health and social care. They will not be linked to democratic regional structures that could combine regeneration with public health and social care.

I welcome the proposal for joint working with the Prison Service, because there are two prisons in my area. I also welcome the proposal for the Council for the Regulation of Health Care Professionals but, as I have said before, why does it not regulate health and social care professionals? We have recently legislated on social care and, as we consider joint working and moving people closer together, it might be appropriate to include social care professionals in that umbrella organisation. I broadly support the proposals for strengthening the Commission for Health Improvement because it has made an important contribution to addressing quality issues.

On patient involvement, the Government have failed completely to produce a coherent argument to convince me and others of the need for the abolition of the community health councils. I am not a great fan of the

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CHCs; they leave a great deal to be desired. However, the Government have not convinced me that the proposals on offer in this or the previous Bill will be any better.

I pay tribute to the Under-Secretary, my hon. Friend the Member for Salford (Ms Blears). Over the past few weeks and months, she has worked extremely hard to try to come up with a coherent alternative. I praise the fact that she has been prepared to listen to people and to talk to them, but she has been landed with an impossible brief. I feel sorry because she has had to try to come up with a solution that will lead to the abolition of the CHCs.

I have considered the proposals in the Bill and I find them baffling. I honestly do not understand them. One of the key points is that the system should be easily understood, but the complexity of the proposals needs to be reconsidered so that the patient—the man or woman in the street—knows where to go and who does what. I have looked at the proposals and, frankly, do not understand who is going to do what. I look forward to hearing the Minister's response because that might explain to me—perhaps I am on the simple side—what the Government are getting at. I have tried desperately hard to understand what they are doing but, so far, they have not come up with any solutions.

I understand the role of the Commission for Patient and Public Involvement in Health and that local networks will support and co-ordinate patients forums, commission independent complaints advocacy and help community groups. We will also have outreach teams working from local premises and standing lay reference panels to guide the local work programme. The local networks will be the glue to bind other elements together. Frankly, if the system was not fractured we would not need glue. I am concerned, as I was about the previous proposals, that we should not have dislocated structures; we should, instead, have united structures.

What is missing is a function similar to that of the patients council to draw local separate elements together in a coherent way. The proposals are too narrowly focused. They fail to enable a collective organisation of members of a patients forum to develop an overall picture of the local health economy. Only last week, the Health Committee took evidence from Central Manchester CHC on the overall impact on its health economy of the local private finance initiative scheme. I do not understand how that bigger picture can be reflected in the new structures because they are not glued together as the CHCs are. I accept that the CHCs do not deal with primary care issues, but they could do, as the Secretary of State is aware. It would be easy for them to deal with those sectors that they have not been allowed to address. We need to modernise the CHC structure. I have no problem with getting rid of the CHCs, but I want a coherent alternative, which does not seem to be available at present.

I am also worried that the approach to the independent complaints advocacy service will be inconsistent. I am not aware where that important service will be located. I see that it will be related to the new body, but it might be situated in different parts of the local health structure across the country. We need consistency. I recall talking to the Secretary of State about my belief that the advocacy role should be placed within patients councils if we get rid of the CHCs. There should be one common place for advocacy so that people, wherever they are, know which body will offer them that advice, but that is not the case

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at the moment. From my experience of dealing with complaints and difficulties in the health service, I realise that that is a major problem with the Bill.

Overall, the Bill has many positive aspects and the correct steps have been taken. I hope that some of the points that I have raised will be considered in Committee so that I will understand fully on Report that the Government are offering something that is better than the present system.

5.48 pm

Dr. Evan Harris (Oxford, West and Abingdon): There is an old joke about a man who goes to see his doctor complaining that his brother thinks that he is a chicken. The doctor says, "Why don't you turn him in? He is clearly crazy", and the man says, "I would, but I need the eggs." The Secretary of State is that man and the Bill is his chicken. I suspect that he genuinely believes that he will deliver the NHS plan with a Bill that distracts the attention of people who work in the service while failing to give a sensible allocation of the resources—not just in funding terms, but in staffing and time terms—to deliver the plan. The fact that he has already left the Chamber suggests that he does not want to hear the diagnosis. He is all too willing to make claims about other people's unwillingness to accept reform, but unwilling himself to hear the diagnosis of his own failure.

The Bill is the emperor's new clothes. It reflects a desire to be seen to be active in making changes to the structure while the NHS continues to fail to deliver what patients deserve. That has been the story of this Labour Administration and the preceding one. There has been a lot of talk about radical reform and the abolition of the internal market. Indeed, the Secretary of State boasted about that in his opening remarks. The internal market separated commissioning from provision. That separation still exists, and it is right that it has not been abolished.

The market was described as the money following the patient, but as the Secretary of State said, that never happened—the patient simply followed the contract. In their previous reforms, the Government simply renamed contracts as service agreements, and now the patient follows the service agreement. The only instance in which money followed the patient was in extra-contractual referrals, and those were abolished in favour of out-of-area treatments, in which money does follow the patient, but two years late and too late to make life easy for those who plan specialised treatments.

We have a Government who are proud of claiming to reform when they are failing to reform at all. They talked about ending the two-tier system, claiming that there was a terrible gap between provision for patients of GP non-fundholders and provision for patients of GP fundholders, when in fact the major inequity is now between people who can afford to go private for treatment that is not available on the NHS or is available only after a long wait, and those who cannot. The effects of that two-tier system have got worse under this Government.

The Government seem to want to inflict on the health service reform for its own sake. Liberal Democrat Members are very keen to see reform when a case is made for it, but reform for its own sake is simply sabotage, and that we will not support. If there were evidence that these

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reforms were based on a master plan, which had widespread support, they would have more credence. We have yet to see the Government's response to the Kennedy report, so we do not know whether the reforms that it suggests, which have the full support of Liberal Democrats, will be implemented in full. That would be a sensible place to start with NHS reform.

The Government fail to take responsibility for their own mistakes. They have been very keen on blaming the last Government, although they now realise that they themselves were the last Government, so they talk about the Government before last. However, it was a Labour Government who raised expectations by claiming that they would save the NHS in 14 days, or at least within four years.

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