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9.2 pm
Mr. Paul Burstow (Sutton and Cheam): The hon. Member for Cardiff, Central (Mr. Jones) suggested that piggy-backing Welsh clauses in a predominantly English Bill made it possible to suborn those on these Benches into supporting a measure that we have rejected in every other respect. I do not accept, and I do not believe my colleagues accept, that devolution means that colleagues in Wales can fetter us any more than we fetter them in terms of the exercise of their discretion and responsibilities in the Welsh Assembly. We will vote against Second Reading because we feel that our disagreement with the principle of the Bill justifies our doing so.
The Secretary of State's speech featured an exceedingly long preamble, followed by a relatively short discussion of the Bill. That, I think, underlined the lack of real substance. This is not a major, ground-breaking piece of legislation that will change the NHS fundamentally. The right hon. Member for Charnwood (Mr. Dorrell) conjured up a picture of a merry-go-round of reorganisation in the service from which he had finally dismounted, admitting that it was not doing any good in terms of delivery to our communities. Unfortunately, the current Secretary of State has climbed on to the merry-go-round, and is taking us on a few more circuits. That, more than anything else, is cause for concern.
I have spoken to health care professionals, and they have been struck by a sense of deja vu. The elements within organisations now being created in England can be given various labels—regional health authority, district health authority and so on. Perhaps they will re-emerge in due course, when there is yet another reorganisation.
I want to say something about the CHI and CHC proposals. I am glad that the CHI proposals will involve greater independence for the organisation: that will do much to build confidence in the good work that it is already doing. There is, however, the issue of its reach being extended into the private and voluntary sectors, and a consequent overlap with the work of the National Care Standards Commission. I hope that that will be discussed in detail in Committee, if the Bill reaches that stage, because Ministers should think about how such an overlap can be avoided and, indeed, consider the possibility of establishing a single agency to regulate and inspect care in all settings, not just the health service.
The House debated community health councils at great length during the passage of the Health and Social Care Bill earlier this year. The Secretary of State says that the
CHCs lack teeth, but as we know it is up to the Secretary of State to exercise his responsibilities to give them teeth. He says that they do not have a responsibility in terms of primary care. Why not? It is because he has not given them that responsibility. He says that they do not have a role in inspecting GPs—that is because the Government have chosen not to give them such a role. It has no formal representation in NHS organisations. Again, the Secretary of State has it within his means—he has the legislation before the House—to deal with those issues.Therefore, why not go down the reform path? It is a path that Liberal Democrats would have liked the Government to explore. We urged them to do so in the previous Parliament; sadly, they did not. As a consequence, they served up in the previous Parliament a dog's breakfast of legislation. There was no consultation and a lack of clarity. There was not even an organisation chart spelling out how the proposals would work.
What we have before us tonight perhaps goes a little further. We have had some consultation. We even have an organisation chart that gives some idea of how the different elements will hang together. In a way, we now have a dog's breakfast where we are told how to go about eating it. I hope that in responding to the debate the Minister can at least give us some information on how much it will cost, and how many staff will be put into place to facilitate the work of the new bodies. Work to analyse the costs of the plethora of new bodies that will replace community health councils suggests that significant sums of money will be needed. The hon. Member for Pudsey (Mr. Truswell) and my hon. Friend the Member for Romsey (Sandra Gidley) have alluded to that.
Community health councils currently spend about £22 million per annum. Next year, that is likely to rise to about £23 million. The pathfinders for PALS have been given £10 million this year. One analysis suggests that implementation of the proposals in the Health and Social Care Act 2001—PALS, the overview and scrutiny committees, and the independent complaints and advisory services—will put the costs up to about £84 million in 2002–03 and that that will rise to £109 million. This Bill will add still further to the costs: it will result in a bill in 2002–03 of £136 million rising to £227 million.
The explanatory notes to the Bill say that there will be no significant increases in costs, and that there will in fact be a £100 million saving as a result of all the musical chairs that the NHS is to go through. Where will the extra money come from to deliver the extra value that the Government tell us will result from the patient involvement initiatives?
The Liberal Democrats believe that those proposals are not well thought through and that they are incoherent, particularly in respect of patient and community involvement. My hon. Friend the Member for Romsey and, indeed, some Labour Members have identified the lack of independence of the Commission for Patient and Public Involvement in Health. It sits ill that, at the same time that the Government are about to give greater independence to the Commission for Health Improvement, they have not gone as far when it comes to patient involvement. Perhaps during the passage of the Bill the Government will consider that matter further and establish equality between the commissions, so that there
is greater confidence that the whole system will deliver greater and genuine patient involvement, with patients having a real say in how taxpayers' money is spent on delivering better health care in their area.A number of hon. Members have referred to the crisis in our health care system. The Bill goes nowhere near to dealing with that crisis. We have lost capacity in terms of long-term care, we have inadequate investment in prevention and there is inadequate capacity in relation to health care employees and staff. All those issues have been missed completely by the legislation, yet they are absolutely central to our constituents' daily experience and to the health service's problems. Hon. Members have described bed blocking as an issue, but I call it a symptom of the wider problems that I have just described.
I hope that the Government will think further on the comments not only of Opposition Members but of Labour Members, who have been particularly concerned about the patient and public involvement proposals, and that Ministers will come to the Committee with amendments that address those concerns and ensure that we have legislation that truly does empower the patient.
9.10 pm
Andy Burnham (Leigh): If NHS staff had the time to read debates in the House of Commons, as I am sure that they do not, I feel sure that they would share my disbelief at the sheer cheek of the Opposition parties reasoned amendments to the Bill. Anyone who had to work in the NHS when the ridiculous internal market was operating will find talk of "unnecessary structural change" and "increased bureaucracy" a bit rich to say the least. I was a researcher for Labour's Front-Bench health team between 1994 and 1997, and I then worked for the NHS Confederation. When I went to work in the health service, I was surprised to discover that the issues on which we campaigned while in opposition were entirely true.
The Conservative's reasoned amendment describes a "worsening health care crisis". I wonder whether any Opposition Member took the time to read the briefing that was prepared for this debate by the NHS Confederation, which states:
- "The NHS is improving. The new money for the NHS is being spent on increased quality of services, more services, new services . . . redesigning services around patients and making staff's lives more tolerable . . . Years of under-investment in the NHS"—
- "has meant that the NHS is cheap but it is not the NHS the public want."
- "The Bill allows doctors in both primary and secondary care to mould services so they are relevant to local patient need."
Primary care trusts offer a more finely tuned mechanism than health authorities to target areas and pockets of health inequality. By changing the flow of funding in the system so that it is from the bottom up, rather than from the top down, there is a real opportunity to reach and tackle the root causes of poor health.
I represent an area with historically high levels of illness and disease which are partly caused by its industrial past. Life expectancy in Leigh and Wigan is 16 per cent. lower than the national average and significantly lower than similarly sized towns such as Woking, Guildford and Winchester. In 2000, twice the proportion of people in Leigh died of trachea, bronchus or lung cancer than died of those diseases in Guildford or Winchester. The proportion of the local population dying from heart attacks was more than double that in Woking.
I know that the Department is reviewing the formula to allocate funding to PCTs, and that it does not need me to say that it is crucial that the formula is got right; I simply plead that the guiding principle for allocating resources is to target it on areas where health need is greatest.
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