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Indeed, it was the new Secretary of State, when he was a Minister, who made the decision. Where too is the principle that states the need to value NHS staff? In Committee, we will look to enshrine those and other principles in the legislation.

I note that we heard a speech from the hon. Member for Dartford (Dr. Stoate) who calls himself a practising GP and was concerned about the absence of GP-led commissioning as a principle. The doctor from Dartford made the biggest case yet to all his colleagues who wish to stop Members having a second job.

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As for quality accounts, there is no doubt that, as we move the NHS towards greater patient choice, patients should have good data with which to make their choices. As yet, the Government have given insufficient assurance that quality accounts will be substantive pieces of work rather than silver-tongued advertising. The example that the Government have published—that of Sunnyview hospital—hardly inspires confidence.

We heard, too, from the other doctor in the House, the hon. Member for Wyre Forest (Dr. Taylor), who made an impassioned speech about what quality of care really means and what a vocation to nurse really means. He had hoped that the constitution could help to ensure that that becomes much more of a reality.

We also heard a very important contribution from my hon. Friend the Member for Basingstoke (Mrs. Miller), who made a number of points that ranged right across the Bill. In addition to her comments on the effect of the cap on some of the services at her local hospital, she made a most interesting point, which I had not yet understood, about the concern that children’s trusts will not be required to have regard to the NHS constitution. That is of particular concern if children’s trusts effectively end up as commissioners for children’s services, with a legal footing equivalent to that of primary care trusts. My hon. Friend made an important contribution that will no doubt feature in our discussions in Committee.

On direct payments, it will be good to see those on the Government Benches going through the Division Lobby this evening in favour of this opportunity for greater patient choice. We are, of course, a little surprised to see that provision encapsulated in legislation, despite the fact that we have been calling for direct payments since 2004. The Government rejected them in 2006, in a debate on the White Paper “Our health, our care, our say”. The then Health Secretary—there have been a number of Health Secretaries—the right hon. Member for Leicester, West (Ms Hewitt), called them a

For the sake of the 15 million patients with long-term conditions and for the sake of our NHS, I am glad that the Government have changed their mind.

The hon. Member for Romsey (Sandra Gidley) made some important points about direct payments. She asked about direct payments for maternity care, and that is an issue we shall need to explore in Committee. It struck me as a little odd, as mothers are supposed to have choice already. As Liberal Democrat spokesperson, she showed important support for pilots. However, what matters is that the Government should for once move away from their addiction to pilots and use them to produce an assessment and a proper review before rolling them out, so that the benefits can be enjoyed by all rather than simply by some selected places.

Most interestingly, we heard a powerful speech from my right hon. Friend the Member for North-West Hampshire (Sir George Young), who has long experience in this area. He made the very important point that we needed clarity about where direct payments will have an impact in relation to the top-ups that have caused some inconsistency in approach. Again, I hope the Government will take that on directly in Committee and that they will ensure it is explored.

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We heard a powerful and impassioned speech by the right hon. Member for Makerfield (Mr. McCartney). He talked, among other things, about preventive health care—I think I heard him say that he did not believe that was a partisan point. He and I are London neighbours—just as he is a neighbour of the Secretary of State up in the north-west—and, as he said, he and I have in the past shared some of the great benefits of the NHS as well as some of the challenges that face its future.

Let me move on to innovation prizes. Like so much of the Bill, they arise from Lord Darzi’s next stage review of the NHS. An unspun reading of that document is “Things the Government have failed to do since 1997”. Supporting innovation in the NHS is one of those things. Lately, we have had the Health Innovation Council, created in October 2007, which has met only twice—the last time was in April 2008. The Government created the nine NHS innovation hubs in 2004, whose irrelevance might be linked with their coterminosity with regional development agencies. The NHS Institute for Innovation and Improvement and the National Innovation Centre were established in 2005.

It is common ground that well-motivated staff need no prizes for innovation. Those of us who have had experience outside this place—in my case, in manufacturing industry—know that company employees see it as part of their job. In the NHS, we have one of the most engaged, professional and hard-working work forces in the world. However, under this Government their morale has been perennially crushed and it is that demotivation, more than anything else, that stifles the sense of energy and optimism that is needed to fuel innovation, enthusiasm and an acceptance of new ideas and change. I was pleased to note that the Chairman of the Health Committee, the right hon. Member for Rother Valley (Mr. Barron), had some important points to make about trying to disentangle the idea of imposing a process from getting at what changes behaviour and motivates people not just to innovate but to have their innovations championed, accepted and implemented.

Although they may not look like it, the Government’s plans for trust special administrators are among the most worrying aspects of the Bill because they would change the nature of foundation trusts. Instead of final responsibility lying with foundation trust governors, and ultimately the independent regulator—Monitor—it will lie with the Secretary of State. That may sound like a good thing superficially, but what good is it for governance in any business and how is incentivisation to be accountable if people know that their bad decisions on risk will ultimately be bailed out by the Government?

There are also concerns about the power of the Secretary of State over trust special administrators, given that he can direct the meetings they hold. As my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) emphasised in a powerful opening speech, a transparent failure regime is required, so we shall need to look long and hard at those proposals in Committee.

The move to pharmaceutical needs assessments is welcome. It is clear that such questions should be determined locally rather than nationally. We shall, however, seek assurance from the Government in Committee that their proposals will not impede access
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to services from patients who currently benefit from dispensing GPs. Patient choice must be the priority in pharmaceutical needs assessments.

One of the arguments the Minister will no doubt use in favour of trust special administrators relates to the recent tragedies at Mid Staffordshire NHS Foundation Trust, but that is to shut the door after the horse has bolted. The real question that the new Secretary of State must answer is how the hospitals were ever given foundation trust status in the first place—ultimately solely the decision of the Secretary of State. Events at Mid Staffs and at Maidstone and Tunbridge Wells also inform the suspension clauses in the Bill. The Minister will have to answer questions about why those proposals were originally left out of the Government’s legislation. We shall seek assurances that the powers will not be abused—for example, by suspending people who ought to be fired. The speech of my hon. Friend the Member for Ilford, North (Mr. Scott), which drew a parallel with the provisions relating to doctors, was extremely well made.

Members on both sides of the House will have their own opinion about the tobacco clauses. Some will see them as too draconian and others will consider them too liberal. Each speaker in the debate touched on that part of the Bill. The right hon. Member for Makerfield made a particularly impassioned speech in that regard, but all Members made important contributions and the debate is to be joined.

It is clear that any action taken to reduce smoking must be based on solid evidence, and the Committee will provide a good opportunity to discuss the evidence base for the Government’s proposals. I hope the Government will consider how to enable evidence to be put to the Committee. Will they pursue the ideas for determining such matters handed down to us by the other place, such as restricting access to public area vending machines, or a bar or ban on their use, to prevent children from getting hold of cigarettes? We heard contributions on that point from the hon. Member for North-West Leicestershire (David Taylor), from the Chairman of the Health Committee and from my hon. Friends. If the evidence is weak, the emphasis must be more on the thoughts and feelings of Members, so we have given our side a free vote on that matter. I hope the Minister will confirm that his colleagues will be allowed a free vote, too.

Dispensing doctors have expressed concern about the move to pharmaceutical needs assessments. We must consider those concerns in Committee.

We have talked about the important aspect of adult social care in relation to clause 33. I hope we shall be able to cover it in Committee, too, but it is now 8 June and the Government promised the Green Paper on the subject in the spring. We thought that as carers week starts today, the Green Paper might be published today, but it is still not available. I hope the Minister responsible will be able to give us an indication about that.

A welcome amendment was made in the other place to enable the Secretary of State to support better NHS-funded care for patients in foundation trusts. However, Lord Warner told the other place that he repented of the sin of including the provision, which was, he said, only

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He pointed out that the cap is arbitrarily applied across the NHS. Important speeches showed that a change from what has been handed to this place for consideration would deny people certain services.

In a parallel contribution, my hon. Friend the Member for Ludlow (Mr. Dunne) made a powerful point about where the funding was for the resurrection of community hospitals and refurbishment in his and other areas. I hope that that issue will be considered.

Clause 35 relates to the difficulties with disclosure of information. The Secretary of State is aware that, since 2005, the Government’s actions in that area have been illegal. It was interesting to hear him say—but not in these words—that he would put matters on a better legal footing. That is one way of not having to admit what had gone before.

In supporting Second Reading, I hope we will make sure that we have the parliamentary time needed to scrutinise the Bill. I hope we will have the chance to debate some of its provisions not just in Committee but, if the Government have the necessary courage, on the stump in a general election.

9.45 pm

The Minister of State, Department of Health (Phil Hope): We have had a wide-ranging debate, with contributions from all parts of the House that touched on almost every aspect of the Bill. I do not think that I will be able to cover all those issues in my closing remarks, but I am glad that the main thrust of the Bill is broadly welcomed by all parties. It was almost a year ago that my noble Friend Lord Darzi produced the landmark next stage review of our national health service. That review was our opportunity to examine what we want for the NHS in the years and decades to come. I point out that that review emphasised the strong foundations that Labour’s record investment and reform in the NHS has achieved over the past 12 years. The NHS has gone from having a budget of some £35 billion in 1997 to one of almost £103 billion in 2009—a real-terms increase of more than 100 per cent. That is in stark contrast to the decades before.

We have gone from waiting times for operations of 18 months in the 1990s to the shortest waiting times ever recorded in the NHS. Some 2 million more operations are performed a year than in 1997. There have been dramatic reductions in the number of people dying from cancer, and virtually nobody now waits more than three months for a heart operation. The hon. Member for Wyre Forest (Dr. Taylor) acknowledged those massive improvements, and he reminded us that we also abolished prescription charges for cancer patients; he wanted us to go further. We are determined to go further. We want to build on that unique success of a Labour Government.

For the future of the national health service, we asked patients, the public and staff what they wanted from their health service in years to come. The result of that extensive, bottom-up consultation will be a health service that builds on that success and puts quality at the heart of its future. It will be a national health service where patients’ choice and patient experience is key to driving up the quality of services, and where power to shape and improve services is devolved to the lowest possible level. The Bill will provide the legal framework to achieve the ambition of the next stage review.

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We have debated the NHS constitution. The first ever national health service constitution provides an opportunity to safeguard the future of the NHS, reaffirming its core values and refreshing them for the 21st century. I can tell my hon. Friend the Member for Dartford (Dr. Stoate) that the Bill will ensure that the constitution is reviewed at least every 10 years. The Secretary of State will have the ability to revise it in the meantime, although we anticipate that those revisions will be relatively minor amendments to keep the constitution up to date.

I say to the hon. Member for Romsey (Sandra Gidley) that the Bill proposes a new legal duty for all NHS bodies, primary care services, and third-sector and independent providers of NHS services to have regard to the constitution in all their decisions and actions. To my right hon. Friend the Member for Rother Valley (Mr. Barron) I say: yes, the constitution does talk about patients and the public, and their responsibility for their own health and how they behave towards the NHS; that is in clause 2. For the benefit of the hon. Member for South Cambridgeshire (Mr. Lansley), I point out that the constitution includes staff, too. Clause 3 spells out the rights and responsibilities of NHS staff, and commits the NHS to ensuring that staff have clear roles and responsibilities, have personal development and training and line management support, and are engaged in decision making.

For the record, the hon. Member for South Cambridgeshire said that there were no new rights in the constitution; he could not be more wrong. There are three new legal rights in that constitution—the right to make choices about NHS care, the right to vaccines, as recommended by the Joint Committee on Vaccination and Immunisation, and the right to rational decisions about the funding of drugs and treatments. The handbook accompanying the constitutions sets out rights relating to whistleblowing—a point made by the hon. Member for Wyre Forest in his contribution.

The hon. Member for Romsey and other Liberal Democrat Members spoke about integrating health and social care. The hon. Lady is right. She will be pleased to know that we will shortly publish a care and support Green Paper. The issue has been debated in the other place, and a central part of the Green Paper will deal with integrating better health and social care.

The hon. Member for Romsey raised the question of people with visual impairments accessing information from and about the NHS. Yes, the NHS constitution sets out the right not to be discriminated against in the provision of NHS services on the grounds of disability—and yes, disability, which will include visual impairment, is one of the seven equality strands in the Equality Bill. Different parts of Government working together closely on both topics are making sure that the Equality Bill and the NHS constitution go hand in glove.

We spoke a great deal about quality accounts. Health care organisations are at the cutting edge of quality, and we recognise that public reporting can be a spur to the improvement of quality in the NHS. The Bill will place a duty on all providers of NHS services to produce a quality account, setting out information for patients, the public and staff on the quality of the services that they provide. That information will be easy for the patient and the public to understand. I want to assure
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the hon. Member for Ilford, North (Mr. Scott) that we are working closely with clinicians and others to develop the new measures so that robust quality data feed into those quality accounts.

Our aspiration is not just to achieve minimum standards in the NHS, but to strive for excellence and the highest quality of care for all. Quality accounts will make services more accountable to patients, carers, managers and clinicians, and will allow clinical teams to benchmark their performance, and commissioners and providers to agree on priorities for improvement. I say to the hon. Member for South Cambridgeshire that this is one of the issues that will come up for debate in Committee.

There is an extensive and inclusive process under way to design the content of quality accounts. All foundation trusts nationally and a variety of other organisations, including the East of England strategic health authority region, are involved. A full consultation will follow. It is right, as I hope the hon. Gentleman would agree, that quality accounts should include a core of nationally consistent information that reflects national priorities. Our ambition is that they go further and reflect local priorities to improve accountability to local people.

We debated direct payments this afternoon. During the consultation for the next stage review, people said clearly and consistently that they wanted greater control of and influence over their health and health care. The Bill will enable primary care trusts to pilot the use of direct payments for health care as part of our wider programme for personal health budgets. If successful, those direct payments may be rolled out nationally through secondary legislation, subject to the approval of Parliament. My right hon. Friends the Members for Rother Valley and for Makerfield (Mr. McCartney) stressed the importance of that. We must get it right, which is why we are piloting personal health budgets, with 70 pilots now approved across every strategic health authority area, covering a range of services and conditions, including long-term conditions, mental health—a point raised by the hon. Member for Romsey—end-of-life care, and services for those with learning disabilities.

The right hon. Member for North-West Hampshire (Sir George Young) made a thoughtful contribution about how personal health budgets and direct payments will work in practice and the longer-term impact on the national health service. They will include advocacy and support, as he suggested. The pilots were intended to tease out and explore all those issues before we move to secondary legislation. We will, of course, put in place independent evaluation and we will publish the findings. The evaluation will take place alongside the pilots, and we will roll out direct payments for health care only after a review of information gathered from the pilots.

The hon. Member for Eddisbury (Mr. O'Brien) mentioned innovation. We want to actively challenge people to develop new solutions to some challenging health problems, particularly in areas where innovation appears to be lacking, and we want to reward the best innovation when we find it.

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