The Minister of State, Department of Health (Mr. Ben Bradshaw): This has been a wide-ranging, well informed and constructive debate. I am pleased that the main provisions of the Bill appear to enjoy broad support across the House, and I look forward to debating them with hon. Members in more detail in Committee. I will try to respond to as many of the points raised during the debate as possible, but if I omit some I will endeavour to write to hon. Members with the answers to their questions.
My right hon. Friend the Member for Rother Valley (Mr. Barron), who is Chairman of the Health Committee, made an interesting speech based not only on his chairmanship of the Committee but on his long-standing membership of the General Medical Council. I listened with great care to what he said and hope to use a lot of it when dealing with the detail in Committee. I am pleased that he welcomed the broad thrust of the Bill. He also welcomed the move to an integrated regulator. I entirely agree that that transition needs to be handled with care, as other hon. Members said. I also noted his welcome for the reform of professional regulation based on his GMC experience. I agreed with everything that he said about that. He rightly pointed to the important role of responsible officers. They were not explicitly mentioned in Dame Janet Smiths inquiry, but, in response to a point made by the Opposition spokesman, I can say she dealt with what they will deliver in her recommendations. As my right hon. Friend alluded to, having responsible officers should mean that we can avoid the situation where many cases that could be managed and resolved locally have to go to the top. I hope that we all welcome that.
My hon. Friend the Member for Blackpool, North and Fleetwood (Mrs. Humble), who is the chair of the all-party group on this matter, spoke with a great deal of expertise about social care. She welcomed much that was in the Bill, such as health in maternity grants and the direct payments, although she wanted those to be handled with care, as did the hon. Member for Tiverton and Honiton (Angela Browning). I absolutely agree with her about that. She raised a concern that several other hon. Members raised, and the Commission
for Social Care Inspection has raised it with me at several meetings. I hope that I have reassured the commission that the integration of the three regulators will not mean that it or the mental health body are overwhelmed by the health body. Both now and in Committee I hope to give my hon. Friend the reassurances she seeks. She is absolutely right about the need to handle carefully the integration of the different cultures involved. She was right when she said that the social care sector brings something new to the partysomething from which the health sector can learn. I will take on board her remarks when the Bill passes into Committee.
My hon. Friend used the term light touch, and it was used by one or two other hon. Members as well. I prefer to use the term risk-based and proportionate. Having read the Bill, she may have noted clause 2. I hope that it will reassure her on the issue of vulnerable people because it makes it clear that the new regulator must pay heed to the safeguarding of vulnerable adults and children in the fulfilment of its duties. She also asked about self-funders. I have discussed that matter with the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), and we recognise the issue. We are considering how we can use the regulatory powers in the Bill to address the matter as it passes through the House.
The hon. Member for Worthing, West (Peter Bottomley) made a very positive contribution on public health, and on how the health in pregnancy grant needed to be seen in the context of public health more generally, including pre-conception health. I entirely agree with that. He pretty much supported the changes that will be made to regulation. He raised a point that was made by Liberty. I am afraid that I have not had sight of that, but I will find out about it, and write to the hon. Gentleman and Opposition Front Benchers about the role of magistrates and detention. I assure him that the consultation will be genuine.
My hon. Friend the Member for North-West Leicestershire (David Taylor) spoke largely about the role of citizens councils. I hope that the new regulatory regime in the Bill will provide him with the reassurance he seeks, but I shall reflect on the suggestion that he made about the role of citizens councils, particularly under the auspices of the Council for Healthcare Regulatory Excellence. I am sure that he realises that the lay membership of the CHRE is being reduced because the overall membership is being reduced. The regulatory representatives are leaving because we do not want it to be a body that is made up of such representatives; we want it to fulfil a slightly different function. It will be smaller, and I shall certainly look at his idea. The CHRE has a duty under the proposals to consult the public and organisations representing patients interests, so there may be scope for considering it.
The hon. Member for Preseli Pembrokeshire (Mr. Crabb) was critical, slightly unfairly, of the health in pregnancy grant. Other grants are already available that address some of the issues he referred to in relation to early pregnancy, and they are means-tested. There is evidence to suggest that mothers, particularly the less well-off, spend money that they are given in the interests of their children, both born and unborn. There is evidence from countries that grant similar helpFinland, Belgium and Francethat it addresses the serious problem of low-weight babies, which, I am
afraid to say, we still have in this country. We do not have a very good record on that. His point about termination was another argument for making the grant at 25 weeks, if I may put it like that.
My hon. Friend the Member for Dartford (Dr. Stoate) raised wider issues of obesity, most of which are outside the scope of the Bill, but it was still a good speech. I agreed with almost everything he said. As a former chairman of the all-party group on cycling, he would expect no less. I hope that some of the issues that he raised will be addressed more comprehensively when we come to publish our forthcoming obesity strategy.
On the issue of pharmacy and the global sum, which was also mentioned by the hon. Member for Romsey (Sandra Gidley), I hope that I can reassure my hon. Friend that PCTs will not simply be able to siphon off the funding for pharmaceutical services or to vary nationally negotiated fees and allowances for essential and advanced services. They will continue to be set nationally. I am intensively engaged with the pharmaceutical representatives, as is my right hon. Friend the Minister of State. When we come to publish the White Paper there will be huge possibilities for pharmacy and for pharmacists, particularly in primary care, to deliver the vision that is shared by both sides of the House.
The hon. Member for Wyre Forest (Dr. Taylor) welcomed the move to an independent regulator. He said that we were short on listing its duties but I refer him to clause 2, which lists those duties fairly comprehensively. A balance must be struck when setting up an independent body as to how much one can dictate its duties and how it is expected to fulfil them. We have struck a good balance with the duties that we expect the regulator to fulfil and how it should go about them. We do not want to put it in too much of a straitjacket, because that would compromise its independence. We are trying to strike the right balance.
The hon. Gentleman managed to spot an important element of the Bill that was not spotted by anyone else. That was the role that the commission will play in PCTs and commissioning, which is vital if the new independent body is to have the role that we think that it needs. The current body does not have that role. The hon. Gentleman was right to highlight the importance of that.
We dealt with LINks during the hon. Gentlemans speech. LINks do not come within the scope of the Bill, as they are already on the statute book. We have told the Healthcare Commission that we expect the new regulatory body to work closely with LINks on inspections and on how it goes about its work. The body should consult LINks and work closely with them. The commission will have a duty to have a panel made up of patients representatives to advise it. I have not had sight of the TUPE issues, but I shall find out about them and write back to him.
The hon. Gentleman also talked about complaints, as did a number of other hon. Members. I think that I share their concerns. There should be recognition from all parties that the way in which a lot of health organisations on the ground handle complaints is not great. We want to try to reduce the number of complaints that are not handled well locally. The
ombudsmanwe should say ombudswoman in this instancewill deal with second stage complaints. We have discussed capacity with her and she is satisfied that she will not be overburdened, but we will have to deal with those issues carefully.
We did not want to burden or slow down the work of the important new regulatory body, whose main priority will be safety and quality for patients, by making it deal with complaints. That should force us alland the health service in generalto do a better job of dealing with complaints. Of course, the new care quality commission will have a role in deciding whether organisations deal with complaints properly. Nothing will stop a patient from making a complaint as in the example of Cornwall. That led to an important and far-reaching inquiry.
The hon. Member for Broxbourne (Mr. Walker) rightly recognised the important role that the care quality commission will play in helping to continue to drive down health care-acquired infections. The hon. Member for Caernarfon (Hywel Williams) asked about a number of Welsh issues. I am assured by my officials that they have worked closely with Welsh colleagues and that we have agreement with Welsh Ministers on those issues on which we will need to agree. I am assured that we have been taking the Welsh language issues seriously, too. I shall write to the hon. Gentleman with clarification on the other detailed points about the Welsh perspective that he mentioned.
I do not begrudge the fact that the hon. Member for Tiverton and Honiton was late. She made an important contribution as always, based on her long personal experience, about the need for seamless service and a seamless system of inspection. It is right that we should focus on that when we discuss the issues in more detail in Committee. She also mentioned complaints, which I have dealt with. She supported direct payments, which I was pleased to hear, but she thought that best practice needed to be learned from. I agree entirely. The new regulator may want to consider how practice can be improved across the piece to bring the performance of those local authorities that are not as good up to the level of the rest.
The hon. Member for Romsey, who speaks from the Front Bench for the Liberal Democrats, broadly welcomed the Bill but did not believe that there should be a one-size-fits-all approach. I agree. The new commission needs to take a proportionate, risk-based approach that takes on the strengths of the three existing organisations. It needs to be sensitive to their strengths and differences. I hope that I can reassure her through my comments on Second Reading and in Committee that fears of health domination are not justified. When the Bill was published, we held intensive discussions with all three organisations and they broadly welcomed it.
I was disappointed when the hon. Lady described the health in pregnancy grant as a bit of a gimmick. It is not. Some people may think that £190 is not much, but it means a great deal to many women in my constituency. It will be an enormous help to them in those last few months of pregnancy when they have to make difficult choices about spending priorities. I am sure that the hon. Lady did not mean to suggest the contrary.
I will write to the hon. Lady about body mass index. I understand that we are considering the matter. One
difficulty is that many people do not understand what body mass index means whereas they understand height and weight. We are also considering the follow-up for parents to give the provision more substance.
Someone mentioned the Human Rights Act 1998 and independent sector homes. We hope to be in a position to tackle that in the forthcoming Green Paper on the British Bill of Rights and duties, which would allow us to deal with the matter in the wider context of the public authority definition. Including that definition in the Bill causes a problem because it is so vast. However, we will strengthen the regulatory powers in the measure to ensure that the care quality commission can enforce the requirements in line with the relevant provisions of the Human Rights Act.
The hon. Member for South Cambridgeshire (Mr. Lansley) asked about the independence of the appointments system for members of the care quality commission. I assure him that the Bill proposes no change. The Secretary of State already has such a power but he devolves it to the Appointments Commission. We have made it clear that that will continue.
We have heard a little from the Conservatives today about their alternative Bill. We welcome some of their suggestionsindeed, we are already implementing them. We especially welcome their professed conversion at last to a taxation-funded NHS free at the point of need. However, their alternative is also deeply flawed. It professes to support devolution to the local level, yet Conservatives want to stop all local reorganisations of services, whatever their clinical merits. They call it a moratorium on reconfigurations; I call it a moratorium on saving lives. They talk about local and national accountability, but want to hand the big decisions to an unelected quango of bureaucrats.
Since 1997, we have put record investment into the NHS, making genuine improvements in care, slashing waiting times, saving lives and boosting quality of life. Reform has come with that investment, driving up standards, giving patients genuine choice and improving efficiency. There have been continued real-terms increases in investment in health. The Bill will build on those achievements, leading to fewer quangos, less bureaucracy, better safety and quality, more transparency and genuine accountabilitya health service fit for the aspirations of the British people. I commend the measure to the House.
That the following provisions shall apply to the Health and Social Care Bill:
1. The Bill shall be committed to a Public Bill Committee.
Proceedings in Public Bill Committee
2. Proceedings in the Public Bill Committee shall (so far as not previously concluded) be brought to a conclusion on Thursday 24th January 2008.
3. The Public Bill Committee shall have leave to sit twice on the first day on which it meets.
Consideration and Third Reading
4. Proceedings on consideration shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the day on which those proceedings are commenced.
5. Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day.
6. Standing Order No. 83B (Programming committees) shall not apply to proceedings on consideration and Third Reading.
7. Any other proceedings on the Bill (including any proceedings on consideration of Lords Amendments or on any further messages from the Lords) may be programmed. [Liz Blackman.]
That, for the purposes of any Act resulting from the Health and Social Care Bill, it is expedient to authorise
(1) the payment out of money provided by Parliament of
(a) any sums payable by virtue of the Act as health in pregnancy grant under the Social Security Contributions and Benefits Act 1992 or the Social Security Contributions and Benefits (Northern Ireland) Act 1992,
(b) any other expenditure incurred under or by virtue of the Act by a Minister of the Crown or by a government department, and
(c) any increase attributable to the Act in the sums payable under any other Act out of money so provided, and
(2) payments into the Consolidated Fund. [Liz Blackman.]
That Helen Jones be discharged from the Administration Committee and Mr John Heppell be added.
That Joan Ryan be discharged from the Children, Schools and Families Committee and Mrs Sharon Hodgson be added. .
That Mr Ronnie Campbell be discharged from the Health Committee and Stephen Hesford be added.
That John Battle be discharged from the Northern Ireland Affairs Committee and Stephen Pound be added.
That Mr Andy Slaughter be discharged from the Regulatory Reform Committee and Judy Mallaber be added. [Rosemary McKenna, on behalf of the Committee of Selection.]
Ian Lucas (Wrexham) (Lab): I am pleased to have secured this debate on the important issue of the flying of the Union flag on Government buildings. The Government are currently consulting on the flying of the Union flag and, more broadly, the consideration of the United Kingdoms national culture and citizenship are very much to the fore. The Governments consultation document says: