NHS Reform and Health Care Professions Bill

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Mr. Burns: I am extremely grateful for that guidance, Miss Widdecombe, because it helps me make the point that life has moved on and that issue is no longer relevant. I hope that the Minister will not offer the hackneyed arguments to which I have referred, but will instead advance an intellectually coherent argument against the amendment—I am sure that he does not accept it—based on reasons why the negative, rather than the affirmative, resolution should be used.

You have graciously and kindly said, Miss Widdecombe, that our debate can go slightly wider, but I shall be careful not to abuse your generosity. As you would have realised had you been here this morning, and as anyone who has studied the clause will realise, it sets up an important new or reformed structure in our health care system. We have argued time and again this morning and this afternoon—I can assure the Minister that we will do so again in respect of clause 2—that the Government are rushing far too quickly into imposing the new structure on the health service. In a spirit of helpfulness, we are urging a more cautious approach that ensures that proper foundations exist on which to build their aims. One way to do that is to accept the amendment, which would reverse the onus to enact secondary legislation through the negative procedure.

This morning, my hon. Friend the Member for North-East Hertfordshire pointed out to the Minister that in one particular Session, there were more than 2,000 negative resolution statutory instruments, of which only 30 or 31 were debated in Parliament. Putting legislation into the negative format gives the Government carte blanche. The way in which the system works in terms of secondary legislation means that it is extremely difficult to find parliamentary time for such matters, especially if the Government are determined to restrict and hamper the Opposition's ability to express an opposing view in Parliament.

It is important for democracy, and it is important for the NHS, that we have affirmative procedures, in which case the order setting up the SHAs would have to be debated in both Houses of Parliament. There would be an opportunity for Members, and those in another place, to scrutinise line by line, as we are doing to the Bill, a far-reaching proposal, which would ensure that the Government have got it right. Even at that late stage, they would have the opportunity to advise or warn the Government if they discovered that there were faults and flaws in their proposals. Once the Government recognised the strength of the case, they would have the opportunity to rectify the problem before inflicting a flawed piece of legislation onto the NHS.

Mr. Peter Atkinson (Hexham): My hon. Friend points out an important aspect of the Bill. In clause 1, the Secretary of State is taking substantial powers to

    ``vary the area of a Strategic Health authority . . . abolish a Strategic Health authority . . . establish a new Strategic Health Authority''.

If that were done against the will of local people there would be an enormous argument. If, for example, the Secretary of State decided that Chelmsford should be welded into east London, many of my hon. Friend's constituents would become angry. That could be imposed without representation being made unless the Secretary of State was to accept a prayer against that resolution. That is wholly undemocratic.

Mr. Burns: My hon. Friend is right, and he anticipates a point that I was seeking to move onto during the course of my remarks. Clause 1 contains substantial powers for the Secretary of State, and he can exercise those powers notwithstanding the Minister's generous concession during our debate on the last group of amendments. It would be a step forward if, on Report, the Minister were to come up with proposals that were acceptable to the House, and they were embodied in the Bill; what a paradox.

The Minister is in a conciliatory mood today, and he has listened to my arguments and those of my hon. Friend the Member for North-East Hertfordshire and the hon. Member for Leigh. He has seen that there is reason to look further, and he may come forward with amendments on Report. It is unusual for the Government to concede a point in Committee to the Opposition, and it is very unusual for a Government Back Bencher to contribute to the debate. However, when such a Back Bencher hits the jackpot and comes up with an idea that the Minister thinks is worthy, that is a bonus, so it must have merit.

The Minister could go away and return with a set of proposals that, for the sake of argument, we might find acceptable. If they were then included in the Bill, the Minister will have increased the powers of consultation on a number of issues that are vital to local people, communities and organisations that are directly affected or which have an interest in strategic health authorities and health care in their region.

5.45 pm

That would be a step forward, but the contradiction is that the powers in the same Bill allow the Secretary of State to ride roughshod over the results of any local consultation carried out in good faith if he is not minded to accept the advice or the views that are thrown up during the consultation process. That seems extraordinary. We must be consistent; the consistent approach, given the Minister's earlier statement, is that the Secretary of State should be held to account.

The affirmative resolution procedure could be described as consultation because a Committee of Members of Parliament—reflecting all views and parties, and able to be consulted—have the opportunity to contribute to the debate and decide whether to vote for the order to become law so that the SHAs can be established as the Secretary of State has specified. Alternatively, it could be thrown out--a statutory instrument cannot be amended--and the Secretary of State could be told to look at the matter again because he has got it wrong or is acting in contradiction of the views of local people following the consultation. He could then start again from scratch and return to the matter in the House and in another place.

Mr. Heald: Does my hon. Friend agree that the section 60 power in the Health Act 1999, which provides wide order-making powers in health matters, has recently been used successfully to allow consultation and the views of those who are not Members of Parliament to be heard? The draft Nursing and Midwifery Order and the draft Health Professions Order were considered yesterday and representatives of the nursing profession, the midwifery profession, health visitors and so on with particular views were able to express them and to lobby Members of Parliament. The same applied to chiropodists and podiatrists who were unhappy with aspects of the Health Professions Order. If such bodies have concerns, it is better, when the time comes for a decision to be made, if they can make representations. The Royal College of Nursing and the BMA both have worries, so would that not be the best approach?

Mr. Burns: Again, my hon. Friend is absolutely right and I hope that the Minister was listening carefully to the powerful way in which he made his case. It is important that not only Members of Parliament, but outside organisations connected with health care and the national health service have the opportunity to input their views on the proposals in draft legislation, whether primary or secondary legislation. It is equally important that they believe that their views have been considered and given a fair chance. If the Government do not agree with their views, and if both Houses of Parliament do not share those views, it is only right that the orders should go on to the statute book. However, there must be that power to determine whether the Government are right. I warn the Minister that this is the first of several debates about this issue, because most of the order-making powers in the Bill are subject to the negative resolution procedure and most deal with important matters. I hope that he will think carefully about that.

Mr. Peter Atkinson: It has suddenly occurred to me that my hon. Friend's advice to the Minister is not in the best interests of the Opposition. Most Members of Parliament know that once they interfere in local politics, they are likely to get their hands bitten hard. In this case, the Secretary of State will become a referee between several warring factions who think that boundaries should be somewhere other than where he has decided. Ultimately he will have to adjudicate, thereby becoming deeply unpopular. If he followed my hon. Friend's advice, he would at least avoid some of that flak.

Mr. Burns: I fully understand my hon. Friend's point and would not want to be a Secretary of State placed in the position that he describes. However, I am afraid that, on this occasion, I cannot agree with my hon. Friend. Democracy, proper consultation and the opportunity fully to debate and consider legislation is more important than the situation in which an individual Secretary of State might find himself.

Too much legislation, especially secondary legislation, is going through the House on the nod. That does a disservice not only to the bodies and organisations that are directly affected by it, but to the working of this place. It also builds up the frustration of interested parties whose lives are affected either by the work that they do in those organisations or through the representative role that they play. Many organisations feel that they are being ignored, bypassed and sidelined on issues that are crucial to many people.

In the light of that, I hope that the Minister will have an open mind and be prepared to think again. I leave him with one thought. When Labour in opposition between 1992 and 1997, many of his colleagues who were then on the Front Bench—I am ashamed to say that I do not remember if he was one of them—made the same speech in Committee against my Government that I have made today against his Government. They spoke passionately and with conviction and belief, but they were frustrated. The Minister must know what we are going through, and I hope that he will want to try to stop that ping-pong effect between the Government and the Opposition.

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Prepared 27 November 2001