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The route to financial health for Buckinghamshire, as for all parts of the NHS, lies not in questioning the funding formula, although I have heard the points made by the Opposition, but in radical action to improve the quality and effectiveness of local services. The NHS has faced long-standing financial pressures locally; that point has been made and I recognise it. However, it has told me that it is working to address those issues. Both the hospital trust and the PCT are working to break even for 2009-10. They believe that they are on the front foot in re-engineering health services; they have formed a Healthy Buckinghamshire leaders group-a joint plan of action to deal with current financial problems; and their summit plan is already making a difference. The new Buckinghamshire-wide out-of-hours service is already up and running, not least in the constituency of the hon. Member for Chesham and Amersham, and there
are plans for a new GP-led centre based in Wycombe hospital. The hospital trust tells me it expects a 15 per cent. drop in demand for out-patient services in the next few years as care is increasingly-and rightly-delivered by GPs and other community services, as the hon. Member for Aylesbury remarked.
The way patients use NHS services means that demand drops for some out-patient services, and it is not a good idea to run half-empty clinics. That is why clinicians across the NHS in Buckinghamshire are exploring how to combine out-patient clinics to make the best use of available resources. A smarter NHS will mean more services coming out of hospitals and into the home or the community, although I recognise the points about concerns over rural ambulance services. I understand that the review is taking place in Buckinghamshire, and the final report will be presented to the South Central health overview and scrutiny committee in January 2010.
A point was also made about psychological therapies. The PCT's professional executive committee, led by clinicians, agreed the recommendation to refocus psychological therapy resources, totalling more than £4 million, on evidence-based therapies. As the Minister responsible for mental health I can tell the hon. Member for Guildford (Anne Milton) that a 50 per cent. increase in funding for mental health services since 2001- a £2 billion increase-is remarkable and puts this country's mental health services at the forefront of those in Europe.
I have tried not to be too party political in this debate, but other hon. Members have made it so, and I therefore conclude by saying that when the Conservative party left office in 1997 the NHS was on its knees. The hon. Member for North Norfolk (Norman Lamb) was right. In the past 12 years the Conservative party voted against every Budget, with record increases in NHS spending that brought benefits not least to Buckinghamshire. Finally, the Conservatives are approaching the general election pledged to abandon key criteria for waiting times, and to create an austerity Britain, with smaller Government. From what we have heard today it appears they intend to reintroduce tax breaks for private insurance schemes and abandon deprivation formula in the funding allocations.
Mrs. Gillan: On a point of order, Mr. Atkinson. Is it in order that when the Minister himself thought there was little time for the debate he should reduce it to a political diatribe although he has not answered the question of what will happen to my constituents in the event of a flu epidemic, given their straitened circumstances?
Phil Hope: It was also a skilful attempt to use up time, as I describe the options at the next general election, which will be, for the people of Buckinghamshire, a fundamental choice between going back to the bad days when the Conservatives ran down the NHS, or looking forward to a period of further investment to support the health service in Buckinghamshire and across the country.
Mark Fisher (Stoke-on-Trent, Central) (Lab): This debate will focus on the excellent report produced by my hon. Friend the Member for Cannock Chase (Dr. Wright). Sadly, he cannot be here today because he is chairing a meeting of the Public Administration Committee; we would have benefited from his contribution.
Credit for setting up the Select Committee on Reform of the House of Commons should go to the Prime Minister and the Leader of the House, and particularly so for appointing exactly the right person to chair it. My hon. Friend does a superb job in chairing the PAC, and he did so yet again when chairing the Committee on Reform of the House of Commons and reporting in such short order. It demonstrates what a clever and shrewd man he is.
It is a measured report. It is well argued and well thought out. It is pragmatic. Without solving all the problems that confront us, it will undoubtedly take us firmly in the right direction. Reform of the House is badly needed.
Mr. Elfyn Llwyd (Meirionnydd Nant Conwy) (PC): I was a member of the Committee, and I too pay tribute to the Chairman and the other members of the Committee here today. However, I would be a bit careful about complimenting the Prime Minister and the Leader of the House until they have implemented the report.
Mark Fisher: I shall come to that later, but of course the hon. Gentleman is right. Nevertheless, pending what happens to the report, the Government deserve some credit. We have been hoping for and arguing for such a report for the 26 years during which I have been a Member of the House. We have taken some steps forward, but as the hon. Gentleman said, now is the crucial moment. Will we see the report implemented-and will it implemented in the bold way that it should be?
Bob Spink (Castle Point) (Ind): I accept all that the hon. Gentleman says. He brings an important matter before the House today. Does he not accept, however, that the report does not go far enough in that it does not tackle the abuse of MPs having second jobs? Being an MP in today's environment is a full-time job. One of the greatest abuses that has been perpetrated is MPs having two, three or four-some of them even nine or 10-remunerated additional employments. We cannot do the job, retaining public confidence in the House and its Members, if MPs are going to moonlight. It simply ain't on.
Mark Fisher: The hon. Gentleman makes a valid point, but the report correctly focuses on the political reforms necessary in the House. Plenty of behavioural reforms are necessary; and this year's events, with the concentration on allowances and expenses, shows that the public are impatient with Members. Much needs to be put right, and I hope that it will be put right. However, the report is about political reform and what we need to do to strengthen Parliament, so that it can fulfil its central responsibility of scrutinising legislation and holding the Government to account. That is the heart of the matter.
The hon. Gentleman is right about expenses and double jobs, but the debate is about our job here and how we do these things. What we are doing is a political matter. The report is excellent. It gives us a blueprint for a better and more effective Parliament.
Mark Fisher: Absolutely not party political. No, I mean the political work that we do here in holding the Government to account. That is what we are about. Party politics is a very different matter. I mean political with a small p.
Mr. Andrew Turner (Isle of Wight) (Con): I do not have another job, but it seems to be thought perfectly practical for someone on the Government Front Bench to fill two jobs-one in this House and one on the Front Bench.
Mark Fisher: If the hon. Gentleman is making a case for the separation of powers between the Executive and the legislature, as happens under the American political system, he would find certain Members of the House-including some members of the Committee-most sympathetic. However, I believe that separating powers will bring more problems. We might achieve stronger scrutiny, but we would have less effective government because the Executive would not be rooted in the democratic process. Almost inevitably, they will be appointees. They might be clever, but they would not have roots in the public or in our democratic structures, which I believe has always been a strong characteristic of the House.
Dr. Andrew Murrison (Westbury) (Con): Does the hon. Gentleman agree that what is important is the quality of the work done by hon. Members? The report makes some useful comments along those lines, and on how quality might be improved. In the event of MPs' quality of work improving, especially in holding the Government to account, does the hon. Gentleman agree that we could seriously consider reducing the number of MPs, perhaps bringing us more in line with the American legislature that he cites?
Mark Fisher: I agree with all of that. I see no reason why the House needs more than 400 Members. We would probably do a better job at focusing our attention on our work if there were fewer of us. The report was about rebuilding the House, not about casting a new constitutional settlement, although we may well come to that in the fairly near future. I am sympathetic to what the hon. Gentleman says, but that is not what the Committee was about. We need to focus on how to improve and rebuild the House, which is badly in need of it.
David Taylor (North-West Leicestershire) (Lab/Co-op): I congratulate my hon. Friend on securing this debate. Many newspapers, having seen the disillusion, distaste and disgust with MPs among the wider electorate, have suggested a substantial trimming in the number of Members. There may be something in that, but it can be done only in parallel with a substantial extension and improvement of services such as citizens advice and community law services, as they will be needed to pick up the casework. Four hundred Members simply could not handle the work load that we are experiencing now. We have to find some way to satisfactorily transfer that work.
Mark Fisher: We are probably going rather wide of the subject. However, I have great sympathy with my hon. Friend's view. Indeed, one necessary aspect of that would not be the strengthening of citizens advice, desirable though that would be, but a strengthening of local government, which has lost much of its autonomy and powers. It is now an agent for central Government rather than an entity in itself.
The report gives us a blueprint for a better, more effective Parliament. That would allow us to do what we are sent here to do. We are sent here to do two things. The first is to raise grievances in return for voting the Government Supply. The second is to hold the Government to account. Those have been the defining characteristics and responsibilities of the House for the past 800 years. They have not changed.
Natascha Engel: I am sorry to labour the point, but are we not here also to represent political parties? Apart from some hon. Members-they are the exception rather than the rule-we were all elected to represent those political parties. We would not be here unless we stood on the political party ticket.
Mark Fisher: That is self-evident. Those of us who think that we personally are being elected will find when we stand for re-election, in May or June or whenever it is, that it is our party that will be re-elected. Of course, the hon. Lady is absolutely right.
We are sent here to be a check and a balance on Government, which is in the interests of both the public and the Government. If we do our job properly and rigorously, it makes for better government. Sadly, however, we are failing in our duty. Over the past 100 years, Parliament has been getting steadily weaker and more enfeebled, and government has been getting stronger and more almighty, and that is not in the interests of Parliament, good government or the House.
Parliament, therefore, is not working. At the moment, the Government decide everything that happens in this place: when we come here, what we debate, what we can vote on and what substantive motions are put down on the Order Paper. We in this House are the creatures of Government. We come here when we are called, go away when we are told to, debate the subjects that the Government think are proper and vote when we are asked to do so. How we vote is a different matter. Parliament has lost the sense of its own identity. Its identity is distinct from that of Government; the Executive and the legislature have two totally different roles, and there is no longer a clear distinction between the two.
Mr. Mark Field (Cities of London and Westminster) (Con): Although I recognise such symptoms and believe them to be undesirable, does not part of the problem stem from the fact that Members of Parliament view their role fundamentally differently from the one of 20 or 30 years ago? Too many Members of Parliament see themselves as super-councillors, who take up issues that should be handled by citizens advice bureaux and local law centres, rather than as representatives who hold the Government to account, which is a particularly important role for Back Benchers in Government.
Mark Fisher: Yes, but those roles are not alternatives. It is the fascination, complexity and difficulty of our job that we are, quite rightly, expected to do both. We have to be very involved with our communities, respond to them and learn from them. All of our e-mails and mail bags are a political education on a daily basis; we understand and learn what is happening in our country and what the effect is of Government legislation on our constituents. We have a very strong local root, and if we fail in that role, then holding the Government to account in some lofty way on a national forum will be ill-informed.
My hon. Friend the Member for North-East Derbyshire (Natascha Engel) raised an interesting point about party politics. It is a paradox and contradiction that as Back Bench Government MPs, we are here not only to be loyal to our party-we love our party and want it to do well-but to hold the Government to account. At times, that causes tension, which was seen most acutely during the vote on the Iraq war. Tension crops up almost every week in some form, and that makes this job demanding, interesting and very difficult to reform.
I do not disregard or belittle the party political element; it is very important and it is why we are all here. However, we must step aside from that and hold the Government to account regardless of our party affiliations. If we allow our party affiliations to dominate how we scrutinise and hold the Government to account, we become the rubber stamps of Government, which is poor value for the electorate and bad for this House. Such matters are not easy; if they were we would not have the difficulty of this report. They are both important and paradoxical.
"Government should get its business, the House should get its scrutiny and the public should get listened to".
I would amend that slightly. The Government should have the time to get their business through the House. Government have no God-given right to get any business they choose, but having had a mandate from the public, they must have sufficient time to put their business in front of the House, argue for it, and hope to convince the House that their business is good. So, the Government must have time; that is essential to efficient and practical government. The House should have the time and the facilities rigorously to scrutinise the programme, and the public must get the feeling that they are listened to and that their concerns are being reflected on the Floor of the House.
Time is very precious, and the hon. Gentleman is right to say that the Government must be given time to get their programme through so that they can fulfil the manifesto on which they have been elected. None the less, does he not agree that there has been a
huge waste of time at the behest of this Government, particularly in relation to so-called topical debates, which have simply become a vehicle for the Government to bring forward matters that are obliging to them on a political level, rather than to deliver things of real topicality? Does the hon. Gentleman not agree that that is a matter for the House rather than the Government if we are to continue with topical debates?
Mark Fisher: One of the really impressive things about this report, which reflects well on the Chairman and the all-party members of the Committee, is that the Committee did not allow itself to get diverted by micro-matters such as that-important though they are. It kept to the high ground of what the principles were and the foundation stones that we need to put in place if we are to rebuild the House.
The first such foundation stone is the control of business. As the hon. Member for Meirionnydd Nant Conwy said, if we are to implement this report, we must give the Government confidence that this is not some way of subverting them. They have a mandate; they have been elected and must have the time to put their programme through. By reassuring the Government that that is the case, the Committee is completely right, and that is essential if we are effectively to rebuild the House. I am talking here about the Government's control over their programme for which they have a mandate. I am not saying that the Government have the right to control the whole business of this House. When we look at what happens on the Floor of the House, we find that only half of the time is devoted to Government business. The rest of it is devoted to scrutiny, questions, and private Members', Back-Bench and Opposition business. It is about a 50:50 split between Government time-the time that they need to get their programme introduced and scrutinised-and our time. This is our House and it is absurd that we should be dependent on the Government for how we use that time. We are elected to this House; it is our House of Parliament. They are the Government and have a totally different responsibility. They have the responsibility to take executive action on behalf of this country and to introduce legislation and taxation. They need to get such things through, but they do not need to dominate and run the detailed day-to-day business of this House.
Natascha Engel: Will my hon. Friend explain to me what he thinks the difference is between a proposal for a Back-Bench business committee and a proposal for a House business committee? When we talk about who controls time, it is important to distinguish between Government and Back-Bench time. Will he make that distinction a bit clearer for me?
Mark Fisher: I hope that I have made it clear. The time that is properly the Government's is the time that they need to get through the programme on which they were elected and have a mandate for from the public. They have to introduce legislation and have it scrutinised and enacted. All other time is the House's business. If I have a criticism of this report it is that the distinction to which my hon. Friend refers is not made clear.
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