| Previous Section | Index | Home Page |
3 Mar 2010 : Column 277WH—continued
On the whole, the Isle of Wight PCT seems to be being penalised for its unique nature. Over and over again, we see the organisation contorting to fit into the inspection regime when it is the system that should adjust and adapt to the organisation's circumstances. Will the Minister review the level and type of regulations
for such a unique organisation and, in doing so, give scope for a more flexible approach? If we attempt to push inappropriate national criteria on a local organisation, we run the risk of undermining the benefits to local people.
While I have the Minister's ear, I should like to mention one other matter. On 4 November 2009, the Prime Minister gave me an assurance at Question Time that the excessive cost of guarding prisoners receiving health care outside prisons would be dealt with. I was surprised to hear from my local PCT that it has heard nothing further from the Government on the matter. Will the Minister kindly ensure that that, too, is followed up?
The Isle of Wight health service is full of dedicated professionals who want to be able to get on with what they are paid to do-caring for my constituents and visitors to the Isle of Wight, not filling in endless forms to meet meaningless targets.
11.11 am
The Minister of State, Department of Health (Mr. Mike O'Brien): I congratulate the hon. Member for Isle of Wight (Mr. Turner) on securing an important debate. Regulation is about ensuring that we maintain the quality and standards of the national health service throughout the country. We know very well that a failure to ensure that quality and standards are maintained can lead to problems such as those at Mid Staffordshire. We do not want a repeat of those problems anywhere in the country or, indeed, a repeat of the issues that we have seen at Basildon and one or two other hospitals, which, although they were not on the scale of the Mid Staffordshire debacle, were certainly worrying for the health service as a whole.
We have a health service that throughout the country provides, by and large, a good quality of care for patients. Individual examples of hospitals that fail always hit the headlines and may contribute to a disproportionate public perception of the NHS. However, as a result not only of the standards of professional competence for health professionals and managers in the health service, but also of regulation, by and large, the standard of the health service is good across the country as a whole. We need to ensure that we keep monitoring the quality of that health care and that we have the proper criteria and mechanisms to do that.
The country differs greatly. There are various local frameworks for the NHS and methods of organisation to which we cannot possibly address a national system of regulation. The Isle of Wight is in many ways almost unique in how it delivers health care. The hon. Gentleman is right that the standard of care provided on the Isle of Wight is in the category of excellent. The way in which it is delivered is a result of the particular circumstances. Like many people, I am familiar with the Isle of Wight from going on holiday there-I cannot remember on how many occasions, but it is a significant number. It needs to be recognised that because of that situation, the Isle of Wight has to deliver health care in a particular way, and it does so very well indeed.
I can well understand that the health professionals and managers and those who have to deal with NHS finance are concerned that the way in which regulation occurs on a national basis does not accommodate the Isle of Wight's particular circumstances. There is a
strong argument that that is the case and the hon. Gentleman has very eloquently put it. Other parts of the country might advance similar arguments that the way in which regulation occurs does not fit their circumstances. I am not sure that they are all quite as unique as the Isle of Wight. None the less, there are many different ways of doing these things. If we had a national system of regulation that was tailored to each area, we would be getting into a very expensive and complex system of regulation, and we cannot do that, but that does not mean that we cannot help the Isle of Wight. I shall come back to that issue in a moment.
The hon. Gentleman raised the key criteria by which regulation occurs-targets, for example-and asked whether there should be quite so many targets. We are conscious that some health professionals have said to us, "Look. Targets are important, but there are too many and you must not only put them in but, when they have done their time, take them out." We accept that and are examining some of the targets on waiting times. Some of those are, in a sense, bypassed because the waiting times are now so short that we have hit the target and gone well beyond. Therefore, the health service does not need some of those targets, but when we have a national health service, we do need to have national minimum standards across the health service as a whole, particularly on waiting times-four hours in A and E, 18 weeks for an operation and two weeks to see a cancer specialist after referral by a GP. Those are basic standards of health that the health service throughout the country should provide.
When we have gone through a period during which the taxpayer has put in vast amounts of extra money-it depends how we look at it, but there has virtually been a tripling of the budgets of the health service-it is important that the taxpayer knows that something tangible and measurable is coming out of that extra investment and that it meets a basic minimum standard and is better than what was provided in parts of the health service in the past. That is why I am a defender of targets. We now wish to move from managerial targets to guarantees for individuals, so that each individual would have the right to enforce a guarantee in their own case. I believe that we could do that in fairly short order if, perchance, we were to win the general election-a matter for the electorate. I am a strong defender of those measurements of what we, as taxpayers, are receiving for the extra investment and higher taxes, and it is higher taxes that we pay to ensure that the NHS is properly funded.
We are talking not just about the NHS: in areas such as the Isle of Wight, there are a number of other services, which are linked up, so a lot of targets end up being built up for the ambulance service, the hospitals and primary care services. I understand that, but we are putting in a lot of extra money. Therefore, there is a justification for those targets and for applying them on a national basis, so I make no apologies for saying to the Isle of Wight, "You, too, as an authority, need to comply with the basic minimum standards of the country as a whole."
The question then is how we ensure monitoring of compliance and the overall general standard of health care and other services provided, and whether the system
of regulation is proportionate to the particular circumstances in a place such as the Isle of Wight. I share the hon. Gentleman's concern that regulation, particularly in the area that he represents, should be proportionate and should recognise the particular local circumstances, but at the same time it needs to be national and should not become so diversified that it cannot properly compare services throughout the country. Everyone should know basically what is being regulated.
Our new regulator, the CQC, will cover a much broader range of services than previous regulators, so we have brought different aspects of regulation together. The CQC has adopted what is called the gate-keeping role, which requires it not to impose a whole series of regulation inspections and visits in a disjointed and ad hoc way, with different groups arriving at different times and disrupting everyone. Instead, it should take a reasonable and proportionate view of how it regulates the system as a whole. In a sense, it should also gate-keep itself so that it does not carry out inspections and reviews in a way that imposes a disproportionate burden on particular areas.
The CQC has become aware of the problems of the Isle of Wight. That is due in no small measure not only to representations from the various local health bodies, but to the fact that the hon. Gentleman has made sure that the concerns of the Isle of Wight are raised. The CQC will seek to apply the gate-keeping role and to be proportionate and reasonable in carrying out its regulation. I cannot guarantee the hon. Gentleman that there will not be a series of regulatory visits. That is mainly because different regulators regulate different things, so they cannot all turn up at the same time, do the same regulation and disappear at the same time.
There will therefore be a need to manage things in a way that is reasonable for both sides. That will allow regulators to take a view that there are particular circumstances in the Isle of Wight and that they need to gate-keep the regulatory burden to ensure that it is not disproportionate. On the other hand, it will allow people in the Isle of Wight to recognise that regulation in its different forms may impose a burden that is unwelcome, given that the Isle of Wight is in the excellent category, but that that needs to happen to ensure that there is national regulation.
One benefit of being in the excellent category, and one way in which we have changed things recently, is that regulation is much more risk based. Every hospital will have a visit every two years, but some will have visits more regularly-every few months-because they need them and are regarded as high risk. However, given that our approach to regulation is risk based, some hospitals will have fewer visits because they are in the excellent category. High-quality services of the kind that the CQC recognises, at this point at least, in the Isle of Wight should need less regulatory intervention than lower-quality services.
As we all know, services can change, so regulation must change with them. An excellent service can become a not-so-good service, so services must continue to be monitored and regulated. At the same time, where there is a level of excellence in a service, we need to ensure that the regulator can say, "We don't need to visit them quite so often. When we do visit, we can perhaps do it in a more appropriate way, because there is less of a problem there from what we already know." If things
changed, however, and the service deteriorated, the level of intervention and the unannounced visits and so on, which are needed if there is a problem, would necessarily increase. What I have said is not, therefore, an indefinite guarantee for the Isle of Wight; it simply recognises that if a service is seen as high quality and can demonstrate when visits take place that it remains high quality, the number of visits need not be as high as they would be otherwise.
That is a positive message for the Isle of Wight. It has developed a unique approach to the health service that is appropriate to it. As the hon. Gentleman said, 92 per cent. of patients admitted to St. Mary's hospital in Newport were happy with their treatment, although the figure that I have is 93 per cent. We can quibble over the 1 per cent., but the public seem very happy by and large with the way in which services are provided. I hope that the standard in the Isle of Wight will remain one that requires a proportionate system of regulation.
The hon. Gentleman asked me to take up the issue of guarding prisoners outside prison, and I will make some inquiries on his behalf about what is happening on that. Having set out some of the issues, however, I hope that I have dealt with most of the points that he raised. In those circumstances, I need not detain you any further, Mr. Cook.
11.26 am
Communications Allowance
[Frank Cook in the Chair]
2.30 pm
Keith Hill (Streatham) (Lab): It is a pleasure to serve under your chairmanship, Mr. Cook, as I have on a number of other occasions. As this is likely to be my final appearance in Westminster Hall, I am particularly pleased that you are chairing our debate. I am sure that you and other Members present share my sadness at the news of the death of Michael Foot, a former Labour party leader and a great parliamentarian.
Right hon. and hon. Members may have noticed the slightly convoluted history of the title of this general debate. Suffice it to say that the debate has been secured. I am pleased to see my hon. Friend the Deputy Leader of the House in her place, ready to respond to the debate. Although it appears that the House has consigned all power over MPs' communications expenditure to an outside body-the Independent Parliamentary Standards Authority-at least for the brief remainder of this Parliament my hon. Friend has ministerial responsibility for the winding up of the communications allowance, hence the title of the debate.
I find it surprising that the House should have given over responsibility for something so basic to the democratic process as a Member's communications with his or her constituents to an outside body-one that has relatively little experience of political struggle on the ground. We already know to all intents and purposes what that body has decided about the future of communications expenditure: it has trodden in the footsteps of Sir Christopher Kelly's Committee on Standards in Public Life in its, in my view, somewhat cursory treatment of the communications allowance. I shall say a little more about the Kelly report shortly.
The intentions of IPSA are set out in its recent consultation document. There will be no more communications allowance; expenditure will be allowed only on advertising for constituency meetings and advice surgeries and on contact cards. The document states:
"All other currently available types of communications expenditure will be excluded",
so there will be no more annual reports, and no more websites.
Mr. Graham Stuart (Beverley and Holderness) (Con): Will the right hon. Gentleman give way?
Keith Hill: Not at this early stage. I have plenty to say, and I shall yield the Floor to Opposition Members once I have developed my argument a little further.
The communications allowance was ushered in by the Puttnam Commission on the Communication of Parliamentary Democracy in 2005, introduced as recently as April 2007 and endorsed by the Senior Salaries Review Body less than a year ago. It has been used by about 600 Members of Parliament, including the majority of Conservative Members. Yet the communications allowance has cursorily been brushed aside-indeed, there will now be less funding for communications than existed prior to the introduction of the allowance. That is extraordinary.
It is clear to me that communications expenditure has become a victim of the backlash following the expenses scandals. In no way could that element be the object of personal financial gain, yet we Members of Parliament have allowed this to happen almost without process and, as far as I can see, almost without debate. Well, I protest, and this is the debate. IPSA has apparently carried out a consultation on expenses, including communications expenses. I trust that today's debate will form part of its consideration.
Mr. Stuart: The right hon. Gentleman says that the communications allowance could not be seen as being in the financial interests of Members. It may be some time since he was a candidate opposing a sitting Member of Parliament, but when he did so, that sitting MP did not have, in addition to all his staff funding, £10,000 a year to spend on self-congratulatory literature. By the sound of it, if he had his way, such literature would be going through people's letterboxes all the way to election day, thus distorting our democracy, supporting incumbents and not freeing up and allowing a fair playing field. That is why I turned up here today. The communications allowance is fundamentally corrupt and it cannot be got rid of too soon.
Keith Hill: I find that to be a somewhat predictable intervention. I shall deal with the points raised by the hon. Gentleman in due course.
Bob Spink (Castle Point) (Ind): Will the right hon. Gentleman give way?
Keith Hill: No. I think that the decision to scrap the communications allowance is wrong, and I want to explain why. The communications it funds between an MP and his or her constituents are of great importance to democratic accountability. What is more important at this time than the links of accountability between MPs and their constituents? In passing, the withdrawal of the communications allowance creates a particular difficulty in highly transient big city seats such as mine, where MPs have a huge challenge in trying to make electors aware of their activities.
In the absence of any effective limit on pre-election expenditure, the withdrawal of the communications allowance will severely and unfairly disadvantage incumbents facing highly funded campaigns by opposing candidates. I know that my audience has been waiting for this reference: I obviously think of the noble Lord Ashcroft and his works, but I assure the House that it does not end with him and I intend to show how.
Keith Hill: I shall not give way. The truth is that, against such well heeled campaigns, the communications allowance is not much, but it at least offers a line of defence against the attempted purchase of parliamentary seats. I remind the House that I make my case for the communications allowance-
David T. C. Davies (Monmouth) (Con):
On a point of order, Mr. Cook. May I establish whether that British citizen was warned that such a disgraceful reference
would be made to him? We know that the Labour party is quite happy to sell passports to people such as Lakshmi Mittal in return for donations. Can we be told whether or not-
Frank Cook (in the Chair): Order. I have the point. [Interruption.] Order. I will not allow this sitting to descend to the level of a bar-room brawl. Let us have some sense.
That was not a point of order. Furthermore, if right hon. and hon. Members were prepared to listen to what is being said, I might be able to hear it, too. Do not bring the behaviour of the main Chamber down to this Chamber, where we usually concentrate on having a fairly delicate, logical, clear and polite exchange of views. That is what Parliament is all about.
Mr. Graham Stuart: Further to that point of order, Mr. Cook. My understanding is that critical reference, and certainly reference in the strong terms used by the right hon. Gentleman, should not be made about a Member of the other place without notice being given. We cannot allow people to abuse the House in that way-
Frank Cook (in the Chair): Order. I have your point. It would appear that my rationale has not been understood. I stated that if right hon. and hon. Members were prepared to curb their standards of conduct, I might be able to hear what is being said. I will not allow any Member here, regardless of political complexion, to impugn anyone else in the House. That is all the more reason why everybody should be listening to what is being said-and allowing me to listen at the same time.
Keith Hill: I was about to remind the House that I make my case for the communications allowance on entirely disinterested grounds. Members may be aware that I announced some two years ago that I would retire at the general election, so I have no personal stake in the allowance. I make the case for it because it is right in democratic principle and because I believe its withdrawal could lead to injustice. I shall now give way to the hon. Member for Castle Point (Bob Spink), because I am particularly fond of him as an independent-minded Member. However, I propose to proceed with due haste thereafter.
Bob Spink: I am grateful to the right hon. Gentleman for giving way. I am grateful to him also for bringing this matter before the House. It is important to inform, engage and empower our constituents and any decent Member of Parliament will use and will have used the allowance to do just that-for example, to inform constituents about claiming pensions credit and changes to national insurance for carers from 1 April. The cynical and negative view of the communications allowance that we have just heard from Her Majesty's official Opposition is disgraceful, and that is what brings this House into disrepute.
Keith Hill: I am glad that I allowed the hon. Gentleman to intervene at that point.
| Next Section | Index | Home Page |