|Previous Section||Index||Home Page|
What I and the people who contribute so much hard work to the success of the CHCs cannot understand is the decision to abolish a tried-and-tested system that people understand. They know that the CHCs are independent bodies that represent them in their complaints against the health service and about the provision of health care. It is foolish to abolish them for the sake of it and to come up with a system that no one understands and that no one believes will be independent.
People think that the Government are simply acting out of spite because CHCs have had the audacity to have had considerable success in highlighting the failures of the Government's delivery of health care. If the Government really thought that there needed to be improvements in patient representation, why did they not reform those aspects of CHCs with which they are not happy to make them even more effective?
The Bill is a fig-leaf of a policy for the problems facing the NHS. It is irrelevant to the problems facing all our constituents, with waiting list delays, postcode lottery provision of health care and a policy run more by spin and by reaction to adverse media coverage than according to a rational and realistic approach to facing up to the challenges caused by the inexorable rise in the need for more patient care.
While the Chancellor expresses anger and exasperation at the Health Secretary's failures, morale among staff plummets and our constituents become more and more disillusioned with the Government's performance. The Health Secretary fiddles around as a lackey to No. 10, tampering at the edges rather than addressing the real problems facing real patients in the real world. It is for that failure that I urge my hon. Friends to join me in the No Lobby to vote against a Bill that is irrelevant to the task of improving the health care of this nation.
The Minister of State, Department of Health (Mr. John Hutton): We have had a good debate. Some 26 Members contributed to it and we heard some excellent speeches. In that regard, I agree with the hon. Member for West Chelmsford (Mr. Burns). We had the benefit of hearing from a former Secretary of State for Health, the right hon. Member for Charnwood (Mr. Dorrell). We also heard from hon. Members who have worked in, and dedicated their lives to, the NHS, including the hon. Members for Westbury (Dr. Murrison) and for Romsey (Sandra Gidley) and my hon. Friends the Members for Dartford (Dr. Stoate) and for Crawley (Laura Moffatt). We are all the better for hearing what they had to say.
As always, my hon. Friend the Member for Wakefield (Mr. Hinchliffe) made a good speech on this subject. There are issues on which we disagree, and I am sure that he is aware of them. He was wrong to say that we have ignored social care issues. He will be aware, as will other hon. Members, of the provisions that we introduced in the Health Act 1999 and the Health and Social Care Act 2001. The right hon. Member for North-West Hampshire (Sir G. Young) served on the Committee that considered the latter Act and addressed many of the concerns about the need for health and social care services to work closely together. The emphasis in the Bill on primary care trusts will strengthen the NHS's links to social care. My hon. Friend will know that the Government's arrangements for PCTs make a point of ensuring that there are close connections between them and local authorities, which provide social services.
Some hon. Members, including the hon. Member for Westbury and my hon. Friend the Member for Wakefield, expressed concern about how the public health function will end up as a result of the reforms. The Bill will strengthen it by pushing it closer to the front line in primary care trusts. Each PCT will have a director of public health. There will be a strong overview of that and close links to the chief medical officer.
My hon. Friends the Members for Wakefield, for Pudsey (Mr. Truswell), for Ilford, North (Linda Perham) and for Bedford (Mr. Hall) were worried about patient and public involvement. We look forward to considering sensible proposals that they might have on how we can strengthen that aspect of the Bill. We look forward to dealing with the detail in Committee.
I tried hard to take a note of the speech of the hon. Member for Oxford, West and Abingdon (Dr. Harris), but it was difficult. He said much about the need for more doctors in the NHS, so I made an effort to check what he said in the Liberal Democrat manifesto for the 2001 general election. I was surprised to find that his party promised 4,600 extra doctors. That is not enough. It is not what the Government are committed to securing. He chided us about a number of things and made a lot of noise, but none of it made much sense, and much was simply inaccurate. I remain in the dark about whether he favours abolition or maintenance of community health councils. Perhaps we will hear from him on that in Committee.
I am glad that we have support for the clauses that relate to Wales. I am happy to acknowledge that my hon. Friend the Member for Bridgend (Mr. Griffiths) played an important part in developing those important reforms.
The hon. Member for Broxbourne (Mrs. Roe) spoke well about the work being done by her community health councils and the positive way in which they are looking to the future. We look forward to working with her and
My right hon. Friend the Member for Birkenhead (Mr. Field) expressed his concerns about the proposal to establish the Council for the Regulation of Health Care Professionals. We shall consider any sensible proposals to improve those clauses and, in particular, the accountability arrangements to which he drew attention.
The right hon. Member for Charnwood made a very good speech and, as always, I enjoyed listening to him. He said that he felt that there was no outside interest in the Bill. Obviously, he has not spoken to the British Medical Association, the Royal College of Nursing, the NHS Alliance or the NHS Confederation, which have expressed close interest in the Bill and strong support for many of its important aspects. Like most Labour Members, I am fascinated to hear former Tory Health Secretaries pose a series of questions about how we could successfully reform the NHS. The questions that the right hon. Gentleman asked today were obviously those that he failed to answer during his period of office, and I am sure that he would have the good grace to acknowledge that, but a bit of soul searching never did anyone any harm.
My hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) spoke about her personal support for the NHS, which I know will be echoed in most parts of the House. She accurately described the Bill as effective, and I made a note of that expression because I am sure that it will amply qualify her to serve on the Standing Committee.
Most of the remarks of the right hon. Member for North-West Hampshire, who takes a close interest in these issues, were directed not at the Bill but at the financial problems experienced by his local NHS organisation. He talked particularly about the problem of deficits in his local health service, and I simply say that the accumulated deficit in the NHS is now substantially lower than it was when we came to office in 1997, although I acknowledge that there are local problems that we need to tackle.
The hon. Member for North Thanet (Mr. Gale) spoke about issues related to the regulation of health care professionals rather than those that are directly relevant to the Bill. He made several points about health visitors and chiropodists. The Standing Committee that is to discuss those orders will meet next week, and I am sure that we can thrash out some of the issues then.
My hon. Friend the Member for Warrington, North (Helen Jones) spoke about the important need to identify the interests of front-line staff and to consult them. PCTs will be able to do that, which is why their role in the Bill is so important.
I am sorry that I did not catch the contribution of the hon. Member for Wyre Forest (Dr. Taylor). I understand that he is against decentralisation and very much in favour of central direction, which is a peculiar position for him, of all people, to take on these issues.
My hon. Friend the Member for Bedford identified concerns about patient and public involvement. The Under-Secretary of State for Health, my hon. Friend the Member for Salford (Ms Blears), and I look forward to working with him to discuss those issues.
I was disappointed by the tone of the hon. Member for Westbury and his comments on reform. He seemed to be against effective regulation and inspection, particularly in primary care, and he was largely against any wider role for patients in the NHS. I am sure that he will take the opportunity to explain that to his constituents in due course. My hon. Friend the Member for Dartford talked much common sense, as he always does on these issues.
The hon. Member for Macclesfield (Mr. Winterton) made a typically gracious speech to which I listened with close interest. He expressed his nostalgia for the Macclesfield health board. I am sure that its passing is still mourned in Macclesfield and that the subject comes up regularly in his surgeries, although I am glad that I am not present for any of those conversations. He also talked about the NHS being set up with cross-party support. It is my recollection that the Conservatives voted against the establishment of the NHS, but perhaps he and I can reflect on that in the weeks ahead.
The hon. Gentleman made one important point, saying that he thought that there could be conflict between PCTs, acute trusts and other NHS trusts. I do not believe that such conflict will arise, and the role of the strategic health authorities will be very important in ensuring that it does not. There is a huge commonality of interest in ensuring that local health services are improved and, as the commissioning body, the PCT will play a central role in that.
The hon. Member for Sutton and Cheam (Mr. Burstow) made one of his typical NHS speeches; to my knowledge, he has made the same one at least half a dozen times. He made the case for no change in the NHS and preserving the status quo; that is the Liberals for you. He expressed a novel constitutional principle in that he hoped that the Bill would reach Committee, but wanted it to be rejected on Second Reading. I do not think that there is any way of doing that, but one never knows.
I have spent a long time trying to respond to points that hon. Members made in our debate, and in the few minutes remaining to me I wish to make some comments about the Bill and its importance. First, it will make the NHS less bureaucratic and more flexible. Under our proposals in clauses 1 to 10, the centre of gravity, as my right hon. Friend the Secretary of State said, will shift from Whitehall to local doctors and nurses. Local communities will have more involvement in, and say over, their local services. Most importantly, more resources will go directly to the front line, giving local staff the freedom to innovate and to develop and improve local services. I believe, as I hope that all my hon. Friends do, that those are essential reforms if the service is to meet the challenges that lie ahead.
Secondly, under the proposals that we are asking the House to endorse tonight, the balance of power in the NHS will shift decisively in favour of the patient. If public services are to command public confidence, they have to give greater control and more choice to the people who use them[Interruption.]