Mr.
Mike O'Brien: Amendments 113 and 114 would allow the
Secretary of State to address the impact of the handbook on national
health services, including dentistry, audiology and podiatry, during
the first three-yearly review of the handbook, and to assess the cost
savings made as a result of the constitution during each three-yearly
review. The
hon. Member for Eddisbury set out on a general rant about the NHS. Let
me remind him that the NHS now has the shortest waiting lists since its
records began. Across England, the NHS has met its target to treat
patients within a maximum of 18 weeks from referral by their GP to
consultant, including audiology
patients referred to ENT departments. The hon. Gentleman mentioned
audiology: the NHS is also ensuring that patients do not wait a long
time to access a non-consultant-led audiology service, and the median
waiting time from referral to direct access to audiology treatment is
now just 4.6 weeks. He mentioned podiatry: foot care services for older
people have been reviewed as part of the prevention package announced
in May 2008. The package is due to be launched later this year, with
the publication of guidance for commissioners and providers of foot
care services for older people, and self-care guidance for the
public. The
hon. Members for Isle of Wight and for Eddisbury mentioned dentistry
services. There are a number of issues in relation to those services
and the hon. Member for Isle of Wight raised a particular point. I am
not sure that the handbook is the way to address it, and I hope he
forgives me for not going down the route he invites me to take. In
general terms, we have invested a record £2 billion in dentistry
and set up a national access programme. We have also commissioned an
independent review of NHS dentistry led by Professor Jimmy Steele. The
review will report later in the summer and give an independent view of
how we should further develop dentistry in the coming years.
Amendment 115
would oblige the Secretary of State to consult on reviews in relation
to the handbook and the statement of accountability. The Conservatives
ask how the constitution will be a cost-saving exercise, but it is not
intended to be a cost-saving exercise. All too often, the Conservatives
are obsessed with how to make cuts in the NHS. They have recently made
statements that indicate how they want to make cuts across the
board—
Mr.
Stephen O'Brien: Anything but.
The
Chairman: Order. The Minister has got away with enough so
far.
Mr.
O'Brien: I can but try, Mr. O’Hara. You
quite rightly bring me back to order.
The aim of
the reviews is not to cut costs; it is to empower patients and staff
through greater understanding of their rights and responsibilities. We
do not want to single out particular areas or services in the
reviews—they must be looked at as a whole. As the hon. Member
for Romsey pointed out, if we start picking services, we could leave
others off the list. She rightly identified some services that the
Conservatives have left off their
list.
Sandra
Gidley: The Minister reads his briefing notes very well,
but I must admit that his mention of podiatry rather incensed me,
because podiatry services are non-existent in some parts of the
country. I am sure that he wants to get out and about to meet people,
so I invite him to Hampshire to witness podiatry services—I
would not quite use the phrase “in action”. He will see
that there is a problem. It is not the thrust of the Bill, but after we
have finished our deliberations on it, it might be nice for him to get
out a little
more.
Mr.
O'Brien: I welcome the hon. Lady’s offer to take me
out, but I will decline for the moment. I remind her that the aim is to
launch a podiatry services package
later this year, with the publication of guidance for commissioners and
providers of foot care services. When that happens, perhaps she will
see that the Government are focused on the issue as she would
like. Amendment
114 would be out of kilter with the purpose of the reviews of the
handbook. It is not designed to go further than assessing the
helpfulness of the document itself. A review is not a broad review of
every service, and the measure is about looking at the document and
determining whether it fulfils the role that was intended for
it.
On amendment
115, the Secretary of State may make minor changes to the handbook at
any time to bring it into line with current departmental policy or
changes in the law, to ensure that the handbook is always up to date.
It would not be appropriate to impose a requirement on the Secretary of
State to consult on such changes. The handbook is not intended to be a
legal document as such; it is merely guidance for the general public.
Any changes to the law or to departmental policy that are more
significant would, in themselves and by their very nature, trigger
consultation requirements, either by virtue of statute, or to comply
with the Government’s code of practice on consultation, or
because we would be expected to consult. We have therefore decided not
to include that as part of the
requirement. When
reviewing the handbook, we will certainly continue informally to
involve patients, the public and other groups and parties who have
contributed to its development. However, we do not want to impose a
formal duty to consult every time that there is a minor change. It is
important that the handbook is regularly updated. On the statement of
accountability, as I have previously mentioned, it is a public-facing
and factual document that explains roles, responsibilities and
accountability in the NHS. To require the Secretary of State to consult
on it would be inappropriate, and the changes would merely bring it in
line with the current structure of the NHS. Such changes, not the
document itself, should be the subject of consultation. I hope that
those explanations will lead to the withdrawal of the
amendment.
Mr.
Stephen O'Brien: I listened to the Minister with some
care. He was unusually opportunistic in suggesting that I am obsessed
with cost savings. I will not go down the wholly inappropriate and
erroneous route that that he went down. The Government have been keen
to reverse the declining productivity in the NHS, and we thought that
it would be helpful to discuss
that. I
would also like to draw attention—I could do this during the
stand part debate, but I might as well cover it now—to something
that is not the subject of an amendment. Paragraph 86 on page 18 of the
explanatory notes centres on clause 5 and mentions how the Department
intends to use the reports on the effect of the NHS constitution to
assess what further measures are required. I am a little concerned by
the use of the word “Department”, because normally it is
either the Government or the Secretary of State who are involved. I
will not press the issue—I dare say that there is an
explanation—but I wanted to ensure that it was
highlighted. I
am particularly grateful to my hon. Friend the Member for Isle of Wight
for highlighting the situation of members of an island community who do
not want
to have to travel by ferry to access services. It is important that that
is seen as a community interest that needs to be supported by public
services. He also made the important point about access to NHS
dentistry services. We want to ensure access to services, rather than
simply concentrate on the quantity of particular people’s visits
and the absence of access by
others. I
am also pleased that the Minister made a semi-announcement that
Diabetes UK’s campaign on podiatry services will bear some fruit
and that an announcement will be made later this year. That will be
extremely welcome news to Diabetes UK and the many others who have
vigorously and rightly campaigned for such a focused and strategic
uplift of such services.
I remain
concerned that we have not received the strong answer for which I had
hoped in response to the amendments. Indeed, I had hoped that the
Minister would adopt the
amendments.
Mr.
Mike O'Brien: Perhaps I could strengthen my answer by
mentioning a point that I did not refer to earlier. The total cost from
the inception to the completion of the constitution was just under
£1
million.
Mr.
O'Brien: I am grateful for that, because it means that I
will not have to ask that question again. The figure is useful and is
now on the record. I also want to address the implied criticism from
the hon. Member for Romsey when she said that she did not fancy the
word “may”. It would not be appropriate for the
Government, as the Bill’s promoters, or for my hon. Friend the
Member for Hemel Hempstead and I, as the amendment’s proposers,
to bind the hands of any kind of review. Inevitably, that is in the
conditional, or the subjunctive to be more precise, and it is important
to note that it is about guidance, rather than legal force. I made the
clear distinction of saying that there were three items, but that is
inclusive—it was not intended to be exclusive. I thought that
those were three good examples that would help to highlight the matter.
In considering that we should flag up our intent, perhaps for no other
reason than emphasis, and despite recognising that the Minister has
given some partial answers, I would like to press the amendment to a
vote. 6.30
pm Question
put, That the amendment be
made. The
Committee divided: Ayes 5, Noes
9.
Division
No.
3] Question
accordingly negatived.
Clause
5 ordered to stand part of the Bill.
Clause
6Report
on effect of NHS
Constitution
Mr.
Stephen O'Brien: I beg to move amendment 116, in
clause 6, page 4, line 26, at
end insert— ‘(1A) The
Secretary of State must report every year on the delivery of the
pledges in the NHS
constitution.’.
The
Chairman: With this it will be convenient to discuss the
following: amendment 117, in clause 6, page 4,
line 27, after ‘report’, insert ‘(a)
under subsection
(1)’. Amendment
14 , in
clause 6, page 4, line 27, leave
out ‘5 July 2012’ and insert ‘31 March
2010’. Amendment
118, in
clause 6, page 4, line 27, at
end insert— ‘(b) under
subsection (1A) must be published not later than 31 January
2010.’.
Mr.
O'Brien: The clause
states: “The
Secretary of State must publish a report every 3 years on how the NHS
Constitution has affected patients, staff, carers and members of the
public, since the last report was produced under this
subsection.” Were
the amendments to be made, the clause would require the Secretary of
State to report every year on the delivery of the pledges in the NHS
constitution, and that the first report must be published not later
than 31 March 2010, or, under proposed subsection (1A), not
later than 31 January 2010. The amendments are designed to strengthen
the review of the NHS constitution.
Amendment 116
takes issue with the concept of a pledge in the constitution, which is
rather weakly indicated by the word “pledge” in brackets.
How effective would the US constitution be if it stated, “We the
people establish this constitution for the United States of America
(pledge)?” Surely a constitution is something one either does or
does not do. What place do pledges have? I hope that the Minister will
be able to give us the benefit of the thinking that lies behind that,
because “pledge” in this context is a relatively weak
word, although in other contexts it is not.
It seems
fitting that the Secretary of State should have to report every year on
the delivery of the pledges, which would be achieved by amendments 117
and 118, which propose that the date for the first report should by 31
January, one year after the constitution was signed with great flourish
in Downing street by the Prime Minister before it appeared in the Bill,
and indeed before consideration by either House of
Parliament. Amendment
14 seeks to have the first review undertaken and published on or before
31 March 2010 rather than 5 July 2012. Clearly, that is
designed to make real what is contained in the Bill and to ensure that
there is public accountability in advance of the general election. That
date has been chosen to ensure that the matter is not shuffled off
until after a general election and that the accountability that is
envisaged under the Bill is produced in time for the public to have
their say in the general election, which we all know must be no later
than June
2010.
Sandra
Gidley: I have no problem in principle with amendments 116
and 117, but I was curious about amendments 14 and 118. I am glad that
the hon. Member for Eddisbury has explained that the intention is for
this to take place ahead of a general election. I think that is the
wrong approach to take because, yet
again, it makes the NHS a political football at a time when Conservative
Members keep telling us the NHS is too politicised. There seems to be
some contrary thinking on those Benches.
My major
objection to the proposed date is that it is far too early to have a
realistic review. I would support a little bit of electioneering if I
felt that it was fair to the NHS staff, but it takes a little while for
something to bed in, so any date that is within a year of the enactment
of the Bill is too early and any information gleaned would be of
limited value. There will be far more important debates to be had at
the general election than the NHS
constitution.
Mr.
Mike O'Brien: To some extent the point has already been
made by the hon. Member for Romsey, but the situation is even worse
than she has suggested. The duty in the Bill with regard to the
constitution is not expected to come into force until January 2010,
subject to its progress through the House, so the Conservatives appear
to be proposing that the NHS should undertake a new layer of
bureaucracy so that, a mere two months after the duty on the
organisation comes into force, it has to review and publish an
examination of its effect. They are not even allowing time for the
constitution to be read and digested by those who work for the NHS,
never mind having to perform the significant administrative task of
reporting back.
We do not
want to place an excessive administrative and regulatory burden on the
NHS, as the Conservative proposal would do. Reporting once every three
years will maintain momentum while still allowing time for the
constitution to embed and to gather some meaningful evidence. The
amendment is mere political opportunism by the Conservatives, who think
they will perhaps get something out of it when, in fact, they would be
imposing an administrative burden on the NHS.
As for
amendments 116 and 118, there is no need to create a separate reporting
process for the pledges. That would again create an unnecessary
bureaucratic burden on the NHS. Three-yearly reports will cover the
pledges as well as every other part of the constitution. We must not
forget that the pledges represent existing departmental policy. Many of
them therefore have their own reporting requirements, such as waiting
times and cleanliness pledges. We know what they are. Why impose an
extra bureaucratic burden? If the Conservative Front Benchers want to
talk about regulation, let them look at the mote in their own eye; they
are creating more administrative regulation than the NHS can stand. Let
us deal with these issues in a much more sensible way and not try to
use them for mere political opportunism.
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