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9.23 pm
Linda Perham (Ilford, North): I want to speak first about the clauses in the Bill that deal with patient and public involvement. I declare an interest as a former member of Redbridge CHC, and as the new secretary of the all-party group on community health councils. Indeed, the Under-Secretary of State for Health, my hon Friend the Member for Salford (Ms Blears), was my predecessor in that post.
I am aware of the continuing interest shown by my hon. Friend the Under-Secretary in the effective involvement of the public in the health service. In the short period of consultation on the Government's proposals, she attended regional events and received many representations. I appreciate her response to the views expressed to her, and believe that the Government have made a genuine attempt to accept changes and modifications to the Bill.
I still have concerns about the Bill. I am struck by the lack of detail in it, compared to what was contained in the consultation proposals. Much will be left to regulation, or will be "fleshed out in guidance", as the response to the listening exercise puts it.
My CHC has problems about the complexity and fragmentation of the arrangements of the new bodies. My area, which covers one London borough, will have five patients forums. My CHC also has concerns about imbalances in the system, with most of the CHCs' powers passing to the overview and scrutiny committees and their duties to the patients forums.
I welcome the Commission for Patient and Public Involvement in Health, particularly its responsibility for the setting and monitoring of standards to ensure consistency across the country. That is an issue of concern for many of us who attended meetings with Ministers during the passage of the Health and Social Care Act 2001.
I wonder about the commission's independence and the powers of the Secretary of State, which other right hon. and hon. Members have mentioned. I also share the concerns expressed by my hon. Friends the Members for Wakefield (Mr. Hinchliffe) and for Bedford (Mr. Hall)
about how the commission will operate locally. All in all, there are a lot of good intentions but much is left to regulation and guidance.I welcome the devolution of health service planning and commissioning from health authorities to primary care trusts. That will bring service delivery closer to the local community. It is entirely appropriate that family health provision should be administered at as local a level as practicable instead of at a more remote level, as at present. In my area, the health authority covers two very different London boroughs, with diverse populations and needs.
I am encouraged by my early contact with the chair and chief executive of Redbridge primary care trust. One example of an appropriate and timely response to local need is the calling of a meeting with parents and carers of children with special educational needs to discuss problems relating to the provision of speech and language therapy.
I also welcome the joint working with the Prison Service mentioned by my hon. Friends the Members for Wakefield and for Warrington, North (Helen Jones). Last year, as part of my secondment on the National Council for Voluntary Organisations scheme, I visited the prison health policy unit and Pentonville prison, and discussed social exclusion, drug abuse and the mental health problems of inmates. I am therefore very pleased with those joint working provisions.
Finally, I welcome the extension of the powers and constitution of the Commission for Health Improvement, and am pleased that it will produce an annual report on the quality of NHS services. The commission's recent report on clinical governance at my local hospital, King George, identified a number of areas for praise and concern and has enabled the trust to come up with an action plan to address its shortcomings.
This is a wide-ranging Bill with a raft of important changes which, taken as a whole, should put in place real improvements for the public in the delivery of a truly modern health service for the 21st century. I hope, however, that Ministers will listen and respond positively to the areas of concern raised in the debate.
9.28 pm
Mr. Simon Burns (West Chelmsford): Those who have been here throughout the debate will have been struck by two exceptional but very different speeches. The right hon. Member for Birkenhead (Mr. Field) spoke with clarity and thoughtfulness about the problems facing the House with regard to quangos and regulators, and the need for greater control and accountability to Parliament. I think that many Members will have agreed with his comments.
My right hon. Friend the Member for Charnwood (Mr. Dorrell) got it absolutely right when he said that the Bill epitomised the political class in denial. I agree with that sentiment; indeed, having listened to his speech, I think that the Secretary of State seems to be in perpetual denial. Frankly, he seemed to be living in a fantasy world, totally divorced from the reality of what everyone else in the House experiences in their dealings with constituents.
Sadly, in typical new Labour spin, the Secretary of State seeks to assure us that everything is rosy in the national health service. In reality, nothing could be further from the truth. In the past week alone, we have seen the latest figures for the treatment of patients fall by 0.1 per cent. That
seriously undermines the Government's target that, by next April, no one should be waiting more than 15 months. As Anthony Harrison of the King's Fund said:
- "The Government is in big trouble and they are just not getting activity up."
To add to those problems, the number of people waiting more than 18 months has risen from two in September of last year to 208 this year. For a Government who have constantly argued that patients should never be on a waiting list for more than 18 months, that massive increase is a disgrace.
The Minister of State, Department of Health (Mr. John Hutton): Will the hon. Gentleman tell the House how many times under the previous Administration that 18-month target was actually met?
Mr. Burns: May I explain to the right hon. Gentleman that the previous Prime Minister, John Major, concentrated from 1992 on targeting specific money on bringing down waiting lists to ensure that patients waited for shorter periods? The Minister really must grasp the point that his party has been in power for four and a half years; it is no longer good enough for Labour Members to get up, like parrots, and constantly repeat the refrain about what happened previously. Under the last Conservative Government, waiting lists were targeted for action to bring down waiting times. We brought down the times from more than 30 months to 24 months, towards the 18-month target.
Dr. Evan Harris: Will the hon. Gentleman give way?
Mr. Burns: No, I shall not give way for the moment.
The waiting list to get on a waiting list has continued to rise, as the latest figures show. However, even the Secretary of State could not manage that news properly. We have The Mirror to thank for news of the great e-mail debacle.
When the hospital waiting list figures were being issued, the Department of Health sent out an e-mail that would have tested the nerve of Jo Moore. It trumpeted the apparent fact that waiting lists had fallen by 3,500. Within three hours, embarrassed Department of Health officials had to send out another e-mail, entitled "Statistical Press Release—Corrected Version", to correct the fact that the waiting lists had not fallen at all: they had in fact risen by 3,500.
The Secretary of State is in danger of mistaking activity for action. The nation is crying out for action—action on the problems in health care facing our constituents up and down the country.
Flying out to Spain to recruit nurses for our NHS is no panacea for real action. As the Daily Express stated on 17 November—in view of the intervention made by the Minister of State, he should pay special attention to this point:
- "Labour cannot simply blame Tory Governments . . . It has had four years to address the problems but has only recently woken up to the scale of the crisis . . . If Mr. Milburn really wants to solve the NHS crisis he must understand exactly why working for it has become such a no go area and start doing something about it."
Ironically, we do not need the Chancellor to point out what everyone else has known for months; we have only to ask our constituents, who have had to endure endless waiting lists to see a consultant or to be treated, who wait to be seen at accident and emergency departments, who wait on trollies before being admitted to beds, or who have to wait to leave hospital to stop bed blocking. The situation is totally unacceptable. This Government's achievement—no Opposition Member would be proud of achieving it—is that new Labour is putting people on a waiting list to leave hospital, as well as putting them on a waiting list to go into hospital.
The Secretary of State has described the Bill as a great, decentralising initiative. Frankly, only this Secretary of State could reach such a conclusion. There are nine schedules and 40 clauses, 23 of which give the Secretary of State order-making powers—22 of them by the negative procedure. In toto, there are 58 opportunities for the Secretary of State to issue orders—58 ways in which the Secretary of State's powers can be gained, retained or enhanced, as my hon. Friend the Member for Woodspring (Dr. Fox) said.
Sadly, most of the Ministers were not here to listen to the excellent speech made by the right hon. Member for Llanelli (Denzil Davies). I am sorry to do this to the right hon. Gentleman, but his speech was very good, and even this Secretary of State might actually learn something if he reads the report of it tomorrow. The right hon. Gentleman explained in great detail just what a bureaucratic nightmare the Bill will produce in Wales and the shambles that it will cause to health care in the Principality.
As my hon. Friend the Member for Westbury (Dr. Murrison) said, the Bill will concentrate powers on the Secretary of State, and the less rubbish we hear from Ministers about its being a great decentralising measure the better.
A quarter of the Bill deals with probably the most far-reaching reforms to the NHS since 1974, if not before, with the replacement of the health authorities with strategic health authorities and the enhancement of the role of PCTs in the delivery of health care. However, my hon. Friend the Member for Macclesfield (Mr. Winterton) certainly does know what he is talking about, given his experience as a previous Chairman of the Select Committee on Health, and he said that the health service needs reform like it needs a hole in the head.
I am afraid that my hon. Friend is absolutely right, as is the hon. Member for Wyre Forest (Dr. Taylor) who, with his great experience of working in the health service all his life, said that changes are not needed because there is a crisis in the NHS and that the changes that have been made in past years need to bed down and to be made to work.
I cannot understand why the Government are in such a rush to engineer these reforms, and I question whether the structures that will be put in place are ready to work, without the whole edifice collapsing in confusion and disaster. The rush to change that the Government are pursuing reminds me of the old adage, "Reform in haste, repent at leisure". For example, the BMA has cautioned that the PCTs, where they exist, are relatively new organisations and that the demands that will rest on them may well be beyond their existing capabilities.
The BMA highlights the fact that existing PCTs already have difficulties in recruiting clinical staff and that those problems will be exacerbated. It is also concerned that the timetable for PCTs to be up and running is far too ambitious, especially as there are still approximately 100 PCGs, many of which have not even started to prepare for PCT status. Similarly, other contributors to the debate have quoted academics who said that the Bill would be rushed through given the Government's current timetable. Conservative Members share those concerns, because the Government are rushing headlong into the reforms.
In the Committee that considered the Bill that created the PCTs, the former Minister of State at the Department of Health, the right hon. Member for Southampton, Itchen (Mr. Denham), said that
- "it is important to emphasise that we"—
- "do not intend a headlong rush to be made into PCTs and that it is not part of our agenda to impose PCTs on the national health service."—[Official Report, Standing Committee A, 27 April 1999; c. 252-3.]
- "the most ill conceived, poorly thought out set of changes in decades."
The Bill reintroduces the measures to abolish the community health councils that the Government were unable to get through in the last Parliament. A host of Members on both sides of the House have spoken out against the measure. The knowledge of health of the hon. Member for Wakefield (Mr. Hinchliffe), the Chairman of the Select Committee on Health, is so great that one does not ignore his advice without being stupid. He is still root and branch against the Government's proposal.
My hon. Friend the Members for Broxbourne (Mrs. Roe) and my hon. the Members for Macclesfield are both former Chairmen of the Health Select Committee. They are totally opposed to the Government's plans as is the hon. Member for Pudsey (Mr. Truswell), a member of the governing party.
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