Dan Jarvis (Barnsley Central) (Lab):
The national health service is about people—those who work in the NHS and the patients for whom they care. It produces
9 May 2011 : Column 929
heroes on a daily basis. In the last year, I spent long nights at my late wife’s bedside as she battled against cancer. I am reminded of Andrew Agombar, the consultant surgeon who twice operated on my late wife, and of his relentless commitment to trying to save her and to serving the public. I am reminded of the conversations I have had in Barnsley hospital with doctors and nurses. I am reminded of the GPs who provide an integral part of the British way of life and I am reminded of the porters, cleaners and volunteers. They are all heroes and are all dedicated to the very best principles of our NHS.
In my family’s darkest days, we saw the true genius of the NHS—a genius based on care and compassion, commitment and dedication, principles and standards. The market can be a useful tool, but there are limits to its ability to deliver those values. There is a reason why Bupa does not do accident and emergency, and we must never allow an ideological free-market agenda to undermine all that is great about the NHS. That is what the Government are in danger of doing. I accept the need for fiscal responsibility and I acknowledge that the Secretary of State’s proposals have the purpose of moving health care more into the community and away from hospitals, but the patient, not the market, must always come first. The risk is that the British people will pay for these reforms three times over while patients see little or no improvement in their care.
The previous Labour Government delivered the biggest hospital-building programme in NHS history based on private finance initiative funding, which the then Opposition supported. Consequently, many trusts are now locked into 20 to 30-year fiscal plans. In order to realise the benefits of the investment that Labour put into the NHS, those trusts will require stable funding over this period. Without it, much of the existing investment could be wasted.
GP commissioning is another example of the Bill’s inefficiencies. The taxpayer could end up paying to fund the community or the private investor.
Ben Gummer (Ipswich) (Con): The hon. Gentleman has just given an eloquent explanation of why the market should be ignored in health care, but he has also said that the whole of health care spending should be fixed in stone for 30 years just to suit the PFI contracts signed by the previous Government.
Dan Jarvis: I did not say the market should be ignored. The point that I was making is that ultimately it is a matter of priorities.
What will be the cost of making NHS staff redundant, before the additional cost of rehiring by the GP commissioning bodies? To me, none of this makes sense, and it leads many health officials to question whether the Health Secretary fully understands what impact the reforms will have on the front line morally, economically and logistically, and in this confusion the NHS is placed at risk.
Why not use the facilities that the Labour Government spent £100 billion building over the past decade? Would it not be simpler to keep the PCTs? Surely it makes far more sense to increase GP involvement to allow for clinical oversight, and use the facilities and the staff base that we have spent the past decade investing in. Of
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course there are problems in the NHS which need solving, but the Government’s plans are not just a misguided attempt at privatisation by stealth; they fail to acknowledge that the past 13 years of reforms ever happened.
As well as issues of cost, the proposed reforms are a threat to the accountability of the NHS—at a local level, with the removal of the non-executive directors, and nationally, with the transfer of responsibility from Whitehall to the NHS board. How will we know whether we are getting value for money? What impact will the reforms have on local waiting times? If the Secretary of State genuinely believes in these reforms, what accountability mechanism is he introducing to judge how well they are working? The Department of Health has not explained how the reforms will address the challenges of longer life expectancy, advances in technology and greater public expectations.
Mr Graham Stuart: I am grateful to the hon. Gentleman, who is making a thoughtful speech. The incoming Government inherited an NHS which has had a massive increase in expenditure, yet has seen a 15% drop in productivity over time. Does he have any thoughts on what reforms do need to be made? Despite having money thrown at it, the NHS was not delivering in terms of productivity and was thereby letting patients down. What is his prescription to make the NHS stronger?
Dan Jarvis: Although I am new to this business, if hon. Members and the Secretary of State had such faith in the reforms, it is confusing to me why they were not put in the manifesto and the people of this country given the opportunity to vote on them at the general election.
GPs will be substituting the calculator for the stethoscope. That is bad for the NHS and bad for patients. Given how far we have come, would not the first year of the Secretary of State’s tenure in the Department of Health have been better spent, for example, on a concentrated investment of effort in cancer care? We must fight the war on bureaucracy, but not at the expense of the war on cancer.
Would not the Secretary of State have better spent his time learning from our European partners how to educate our constituents about the dangers of an unhealthy lifestyle—diet, drink and drugs—and their effect, particularly with regard to cancer treatment? We need to address why a cancer sufferer in Barnsley is less likely to survive than a sufferer in Barnet. These are the NHS reforms that would make a positive difference and that the country expects us to deliver. Instead, in my constituency, the scale and pace of the Government’s cuts are making it virtually impossible for Barnsley hospital to plan ahead. Budgets are being cut while patient numbers are going up.
The Government are proposing the biggest reorganisation of the NHS since its inception—
John Pugh (Southport) (LD) rose —
Dan Jarvis: I have almost finished so I shall keep going.
The reorganisation is one for which the Government have no mandate. That raises the question, as I said, of whether the Secretary of State deliberately chose not to
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include these drastic reforms in the manifesto because he knew how unpopular they would be. The NHS is the pride of its staff, its patients and our country. We all deserve better.
4.44 pm
Mr Stephen Dorrell (Charnwood) (Con): I do not agree with everything that the hon. Member for Barnsley Central (Dan Jarvis) has just said, but I congratulate him on a thoughtful speech and wish to pick up on two points with which I entirely agree. The first was his moving tribute to the NHS staff who provided the care for his late wife. The second point, which is of immediate concern to us, was his recognition that the health service, like all human institutions, must embrace the need for change.
The question before the House this afternoon is how we can ensure that the need for change that the health service faces can be embraced and made a force for good. I open my remarks on that point by agreeing with the shadow Health Secretary, who said only a few short months ago, on 20 January —his words have already been quoted to him—that
“these plans are consistent, coherent and comprehensive. I would expect nothing less from Andrew Lansley”
Nor would I. I agree that that is a fair description of my right hon. Friend the Secretary of State’s proposals. I particularly congratulate my right hon. Friend, and the Government at large, on the fact that, despite that being a fair description of their proposals, they are now engaged in a listening exercise, the purpose of which is to improve a set of proposals that were described by the shadow Health Secretary in the terms I have already quoted.
I particularly welcome the fact that my right hon. Friend and the Prime Minister have made it clear that this will be a listening exercise on the policy substance, not just a process of balancing political forces in order to cobble together a compromise. If we are to be true to our commitment to the health service, as my right hon. Friend is, we need to ensure that we focus on the problems it faces and put in place structures that will deliver solutions.
Mary Macleod (Brentford and Isleworth) (Con): Does my right hon. Friend agree that the Prime Minister has not broken any promises on the NHS, as the shadow Health Secretary has suggested, and that the Government are investing in the NHS and there is no question of privatising it?
Mr Dorrell: I entirely agree with my hon. Friend. The Prime Minister and the Secretary of State made clear during the listening exercise their determination to ensure that proposals are brought forward that improve the capacity of the structures of the health service to deliver the objectives my hon. Friend has just articulated.
Emma Reynolds (Wolverhampton North East) (Lab): Will the right hon. Gentleman give way?
Mr Dorrell: I will give way once more and will then have to make progress, because I have very limited time.
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Emma Reynolds: Does the right hon. Gentleman agree that it would have been possible to make the current structures work better? The coalition agreement states, on page 24:
“We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust”.
It is possible better to democratise the PCTs and give greater clinician involvement in them, so does he support some of the calls from the professionals to keep the cluster PCTs?
Mr Dorrell: I want to make my speech in my own way. The hon. Lady asked at the beginning of her intervention whether I agree that it would have been possible to introduce quite a lot of this without the need for a long Bill. She does not need to put that question to me, because the Health Secretary made the same point during the last health questions. We are seeking in the Bill to provide a holistic basis—a structure for the health service going forward, and that is an objective, starting from where we are, that it seems entirely reasonable to embrace.
I was seeking to identify the problem that my right hon. Friend’s measures must be designed to tackle, because as he and the Prime Minister have said repeatedly, no change is not an option. That should not be a matter of party political debate because the definition of the core problem facing the health service can be found in the NHS annual report for 2008-09, which was published 12 full months before the general election. I quote from it a single sentence:
“We should also plan on the assumption that we will need to release unprecedented levels of efficiency savings between 2011 and 2014—between £15 billion and £20 billion across the service over those three years.”
That is what we on the Health Committee referred to as the Nicholson challenge, because it was first articulated in the chief executive’s report a full 12 months before the election. That is the challenge that my right hon. Friend has to address, because it is the inescapable challenge in front of the national health service.
In point of fact, my right hon. Friend has made the challenge rather easier than it was in the days of the previous Labour Government, because there is a commitment to real-terms growth in the health budget throughout this Parliament, and because he has given the health service four years to respond to the Nicholson challenge, whereas the original articulation was focused on the three years ending in 2014.
But the substance of the need to deliver unprecedented efficiency gains out of the health service is the constant between the previous Government and the current Government. The articulation of it in the chief executive’s report was “£15 billion to £20 billion”; I have always preferred to articulate it as, “4% efficiency gain, four years running”.
That is what the health service has to deliver against the background of it never having delivered 4% efficiency in a single year, and of no health care system anywhere in the world having delivered a 4% efficiency gain, four years running. So, Sir David Nicholson, 12 months before the general election, was 100% right to say, “This is an unprecedented challenge,” and the challenge was embraced by the previous and current Governments.
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Grahame M. Morris: Will the right hon. Gentleman give way?
Mr Dorrell: Will the hon. Gentleman forgive me? I want to cover what I regard as important ground.
I have expressed the challenge as an efficiency target, but the same target can be looked at differently, and it is important for the House to understand that this is a matter not just of dry health economics, but of the way in which the health service delivers clinical care, because so often in such debates we imagine that the normal health service patient is a normally healthy person who goes to see the GP and is referred for an elective acute procedure. It is as well to remember, however, that such patients constitute 11% of NHS expenditure, and sometimes I wish that we would devote the same attention to the remaining 89%, because that includes emergency patients, with 75% being expenditure on patients with long-term complex conditions, most of whose care would be better delivered by integrated services in the community.
The challenge that we ought to address when we think about the future of the health service involves not just another discussion about bureaucratic structures, but how we deliver the change in the service’s clinical model to ensure that it delivers efficient and high-quality care to the patients who present for care, rather than to the patients as so often described in the policy pamphlets.
That is why it is so important that the structures that emerge from this listening exercise achieve more radical integration than we have yet achieved in the health service—of primary care, community care and social care. It is why the GPs have to be engaged in the process. Once again, that is not a matter of party political debate; the point is made in all the world-class commissioning documents that I do not have time to quote.
My message for the House is that this is an intensely depressing debate, because it is as if the past 20 years never happened. The reality, when we look through the torrent of rhetoric, is that this policy is not a great break from the past; it is a desire on the part of my right hon. Friend to take ideas that were expressed and pushed through by Labour Ministers between 1997 and 2010, and to seek to make them effective in the context of the challenge that I have defined.
4.54 pm
Grahame M. Morris (Easington) (Lab): I pay tribute to the thoughtful contribution by the right hon. Member for Charnwood (Mr Dorrell), who chairs the Select Committee on Health.
I come to this debate as, I believe, one of the longest-standing opponents of the Bill, both as a member of the Health Committee and as a member of the Health and Social Care Bill Committee. As such, I have consistently raised serious concerns about not only some of the detail contained in the Bill but the direction of travel charted by these reforms since they have developed from manifesto to coalition agreement to White Paper, and finally morphed into the Bill itself. I have become accustomed to the protestations and rebuttals of Health Ministers on every issue that I have raised, so I am somewhat sceptical about the listening exercise.
Those issues include the pace and scale of reform, the lack of a credible large-scale pilot to assess the impact of the changes, the conflicts of interest inherent throughout
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the Bill, as identified in the Channel 4 “Dispatches” TV documentary, and the threat of privatisation by stealth.
[
Interruption.
]
Despite the protestations and groans of Government Members, there is nothing in the Bill to rule that out. I can cite some examples, not least in relation to the prison health contract that was recently awarded to Care UK to provide health services for eight prisons in the north-east of England, resulting in 120 NHS staff being displaced and made redundant. There is a clear and present danger of privatisation of the service.
Perhaps the strongest advocate of the Bill, as it stands prior to any changes, has been the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who is no longer in his seat, and who was the Lib Dem steward of the Bill in Committee. On 10 March, he said in an interview in The Guardian:
“This is a change that liberals can embrace.”
On 17 November, in the Commons Chamber, he called Labour’s record on the NHS a “failed status quo” and wholeheartedly backed the Tory NHS reforms. This year, we found out that the Department of Health had at that time been trying to suppress an internal Ipsos MORI poll of public satisfaction with the NHS. That is interesting, because the poll shows record levels of public satisfaction. Perhaps even more disturbing are rumours that next year the Department intends to cancel the commissioning of such a survey. Rather than saying that Labour has failed on the NHS, the survey showed the highest ever levels of public satisfaction.
An even bigger supporter of the Bill, until now, has been the Deputy Prime Minister. On 23 January this year, on the “Andrew Marr Show” he was asked by Mr Marr, of the Health and Social Care Bill,
“Was that in the Liberal Democrat manifesto?”
The Deputy Prime Minister responded:
“Actually funnily enough it was. Indeed it was…I agree it’s an ambitious programme of reform—but over time I think it’ll leave patients with the feeling that they are at the centre of it.”
I am slightly perplexed by the hasty posturing and sudden synthetic explosion of anger by senior Liberal Democrats in the coalition, perhaps in the wake of the meltdown following last Thursday’s elections. I take those criticisms with a pinch of salt.
Tony Baldry (Banbury) (Con): The hon. Gentleman is a member of the Health Committee, so one would expect him to be well informed on these matters. I assume that he reads other reports of the House relating to health. I wonder what he would say about the report of the Public Accounts Committee that was recently published, under the chairmanship of one of his right hon. Friends, which says:
“The trend of falling NHS productivity will have to be reversed if the NHS is to deliver, by 2014-15, savings of up to £20 billion each year for reinvestment in healthcare.”
The PAC found that there were serious problems with productivity—
Madam Deputy Speaker (Dawn Primarolo): Order. Interventions, by their nature, must be brief, particularly when so many Members are waiting to speak.
Grahame M. Morris: I am grateful, Madam Deputy Speaker.
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Indeed, that was the point that I wanted to make when the right hon. Member for Charnwood was speaking about the level of the challenge faced by the NHS. Sir David Nicholson rightly pointed out that major efficiency savings have to be made and he identified the figure. However, he did not advocate massive organisational change on top of the drive for efficiencies in the system.
During the 28 sittings of the Public Bill Committee, I raised countless issues and made numerous interventions against the health reforms. Unfortunately, the Secretary of State was unwilling to take them earlier in this debate. I have followed this matter very closely. The hon. Member for Banbury (Tony Baldry) asked if I had read the Bill. As a matter of fact, I have read it inside out and could probably give some lessons to a few Members who are in the Chamber. My conclusion is that the policy has remained basically the same, and that only the public relations strategy and the spin has changed.
Mr Chuka Umunna (Streatham) (Lab): Will my hon. Friend give way?
Grahame M. Morris: I will give way just one more time.
Mr Umunna: My hon. Friend said that he sat on the Public Bill Committee and he is also a member of the Health Committee. Has any clarification been given during this reorganisation on the operation of the Transfer of Undertakings (Protection of Employment) Regulations 1981 and 2006 with regard to employees in the NHS?
Grahame M. Morris: That is a key point, and I know that whether TUPE will apply under the terms of the Bill is a legitimate concern of trade unions. However, I will leave it to the Minister to give a definitive response.
My argument is that we need an end to the gesture politics and a radical shift in policy. The Conservatives’ rhetoric and that of their coalition partners must match the reality on the ground. If the opportunity to
“pause, listen, reflect and improve”
is the Health Secretary’s chance to engage with NHS staff, the 98% vote of no confidence against him by the Royal College of Nursing must have been a major hiccup.
It seems to me that this week’s strategy is to let the Deputy Prime Minister flex his muscles. He said yesterday:
“Protecting the NHS, rather than undermining it, is now my number-one priority.”
Perhaps he can tell us what has changed since the White Paper was published in July last year. So far, we have heard that as a result of the listening exercise there may be tweaks to GP-led commissioning consortia to make them more inclusive and accountable, that scrutiny arrangements may be strengthened and that the pace of change from PCTs to GP consortia may be slowed. If that is all the Deputy Prime Minister can negotiate as No. 2 in the Government, it demonstrates, particularly to his own supporters, that he has prostituted his party and the NHS for a position in power.
The Deputy Prime Minister must take heed of the lesson from the Royal College of General Practitioners:
“Intensifying competition in the NHS will lead to the service breaking up, drive up costs, damage patient care, and mean less integration of services.”
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The future of the NHS requires him to put aside gesture politics and use his clout to force out the central privatising elements of the Bill; drop Monitor, the economic regulator of the health service; protect national pay terms and conditions for NHS staff; and limit the ability of private health care companies to enter the NHS at every level. He must ensure that the Government do not privatise the health budget, but bring GPs and other health professionals into PCTs to achieve clinical excellence in commissioning, without there being ulterior motives for private profit.
I know that time is short and that many Members wish to speak. My final point is that if the Deputy Prime Minister is serious about protecting the NHS and achieving substantial and significant changes to the reforms, he must force his coalition partners to drop the Bill and start again.
5.4 pm
Dr Sarah Wollaston (Totnes) (Con): I have no doubt that one of the main reasons I was elected to the House was that I promised to bring my clinical experience to bear on the health debate and to stand up for our NHS. I would therefore like to set aside party politics for a moment and give my personal take on the direction that I hope the proposed reforms will take and where we should go from here.
At the heart of the Bill lie issues of choice, competition and clinical commissioning. My right hon. Friend the Member for Charnwood (Mr Dorrell) set out clearly the huge funding challenges that face the NHS. We have always had rationing in the NHS, but we are squeamish about discussing it. In an ideal world with unlimited resources, unrestricted choice would of course be a good thing, but it is not deliverable. Because of the limited budget, we need to focus on getting the very best value while openly and honestly involving communities in how we do that fairly. If that happens locally, one person’s local commissioning becomes another person’s postcode lottery.
The central problem with unrestricted choice in the form of the “any willing provider” model is that it forces commissioners to act as bill payers and has the potential to undermine good commissioning. What is the point of commissioners designing high-quality, locally responsive clinical pathways that deliver good value for money for the whole community if patients have a free choice of any willing provider and commissioners have no choice but to write the cheques?
Mr Umunna: The hon. Lady has long experience of working in the sector. One of my concerns about the “any willing provider” model is how it will potentially disadvantage teaching hospitals. [Interruption.] The Minister of State, the right hon. Member for Chelmsford (Mr Burns), might want to listen to this, because one of the hospitals involved is St Thomas’s, which serves the House, and if he fell ill here he would probably go over there. One of my concerns is about how teaching hospitals will be able to compete with other providers given the extra burdens of training and supervising those who are learning to work in the NHS. Does the hon. Lady share that concern?
Dr Wollaston:
Of course, one of the greatest burdens on many hospitals is that of the private finance initiative, and I will come to the issue of training later. I am not
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opposed to competition in the NHS, but it should not be an end in itself. It can have a role in improving some services—take, for example, the provision of mental health services and talking therapies, on which I am repeatedly told that the voluntary sector delivers better results. If I were facing a long wait for an MRI scan, for example, I would not mind if it was provided by the private sector as long as it was free to me at the point of use as part of the NHS.
The point is that competition should be used only where there is evidence that it can deliver real benefits for patients and value for money for the whole patient community. If competition becomes an end in itself, that can actually increase costs and risk fragmentation. For that reason, I hope that as the Bill moves forward, there will be fundamental changes to the role of Monitor. The NHS cannot operate like a regulated industry, and I believe that concern about the proposed role of Monitor is the impassable barrier to co-operation from the professions, without which we will not achieve the great success that we need from these reforms.
We must return to the original promise of the reforms, which was about clinical commissioning and a focus on outcomes rather than targets. For years, commissioning has failed because decision making in primary care trusts has not been clinically led. The NHS has been dogged by illogical care pathways, top-heavy management and a target-driven mentality, often completely divorced from any evidence base. The idea that clinicians should be put at the heart of decision making is still very sound, and it has become divisive only because of the stipulation that GPs should hold all the cards and be the sole commissioners.
Where clinical commissioning is already successful, that is achieved through a collaborative process with multi-disciplinary input. I hope that as a result of the Government’s welcome listening exercise, the call to broaden the membership of commissioning consortia will be heeded, along with the need for a more graduated and phased introduction so that consortia are authorised only when they are ready. The same should apply to foundation trusts. They should take on functions only when it is right for that to happen.
If commissioning consortia are to achieve the best results for their patients, they will need to focus on the integration of health and social care, as my right hon. Friend the Member for Charnwood said. I pay tribute to Torbay, which was at the forefront of moves that were widely applauded nationally and internationally, including by the King’s Fund, and that achieved real results for patients, driving down unnecessary admissions and improving outcomes. The integration of health and social care is complicated to achieve, so perhaps Monitor could have a relevant role in it—not arbitrating in disputes about competition law, but driving down costs and facilitating integration. We know that splitting tariffs, for example, could benefit community hospitals. Again, that is complex to achieve, so perhaps Monitor could also help in that regard.
For consortia to succeed, not only do we need to focus on the make-up of their boards, but they must be geographically logical and, I am afraid, cater for geographically defined populations. Giving a free choice to register with any consortium risks encouraging consortia
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to cherry-pick their patients. One striking feature of the Bill is its sheer scope. All junior doctors will remember the fiasco of MTAS—the medical training application service. We currently have a successful model of deaneries in this country. I hope that we can retain them as the Bill goes forward, because they have a vital role to play in encouraging quality. Of course they are not perfect, and they need to look at regional variants, but we should keep our deaneries.
Speaking of quality, at present, PCTs play a vital role in maintaining what is called the performers list, on which all GPs have to be registered in order to practise in an area. As we move forward, we need to clarify who will take over that role. That is particularly important because we have a crisis with many doctors coming here, particularly from the European Union, who do not speak adequate English, as we saw in the case of Dr Ubani. We need to ensure that the person responsible for the performers list can get rid of this nonsense, so that all doctors not only have the necessary qualifications, clinical skills and experience, but have good spoken English.
I welcome this listening exercise, which I believe is genuine, and I hope that the Opposition will engage with it constructively. The public’s affection for the NHS is well justified. At its best, the NHS is outstanding. Where that is the case, it is not competition that has delivered those good results, but a relentless focus on what is right for patients. We need to do the same in this House.
5.12 pm
Valerie Vaz (Walsall South) (Lab): It is always a pleasure to follow the hon. Member for Totnes (Dr Wollaston) and to serve with her on the Select Committee on Health.
I welcome this debate, which is the first chance that the House has had to debate the NHS after the pause—the listening, reflecting and engaging exercise—since Second Reading of the Health and Social Care Bill. Something about this debate made me think of the words of The Beatles song “Hello, Goodbye”. Madam Deputy Speaker, you can imagine the discussion in No. 10 between the Secretary of State for Health and the Prime Minister: “You say stop, I say go. You say, ‘Why?’ I say, ‘I don’t know.’” I promise it sounds better when sung. We can see now why The Daily Telegraph said this Saturday that the Secretary of State was to get first aid from the No. 10 spin doctors.
It is right that the Government should take on board the voices in this House and outside—those of the experts, the patients, our constituents—not in reselling their proposals, but in fundamentally changing them. I wish to cover three main areas: accountability, costs and other concerns. On accountability, as a member of the Health Committee, which is so ably chaired by the right hon. Member for Charnwood (Mr Dorrell), we have heard evidence from expert after expert—from the BMA, which I promise was not whingeing, to GPs, nurses and public health clinicians—all of whom expressed concerns about the lack of detail on the ideas in the White Paper. Matters did not become much clearer even on Second Reading.
Our latest report, “Commissioning: further issues”, published on 5 April, said that there should be no doubt that the Secretary of State has ultimate responsibility,
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but that is not clear from the Bill. We have concerns about accountability and the governance arrangements for the consortia that will be responsible for £60 billion of public money, but that issue is not clear in the Bill. There are concerns that private and voluntary providers will not be covered by the Freedom of Information Act 2000, which is not dealt with in the Bill either. Concerns remain about conflicts of interest in respect of GPs who are commissioners and providers, but that is not clear in the Bill.
Some PCTs were working with clinicians to provide a more integrated service. A more evolutionary and cost-effective approach would be to remove the non-executive directors of the PCT boards and replace them with GPs. That would have been not a top-down reorganisation, but a progressive and less disruptive approach.
I am staggered by the uncertainty surrounding how much this reorganisation will cost the taxpayer. The proposals in the White Paper were neither costed nor explained, and the spending is not committed, so it must come out of revenue. Professor Kieran Walshe, of Manchester Business School, put the cost at £2 billion to £3 billion, but the Government’s figure is £1.4 billion. The redundancy costs alone amount to £852 million. Sir David Nicholson said that the running-cost envelope was £5.1 billion for the running of the current service and the development of the consortia. In an written parliamentary answer to me, the Minister said that the spend and operational arrangements of pathfinder consortia are not being monitored. That smacks of fiscal incompetence and a Department that has lost control of its budget. It is so out of control that the head of Monitor wrote to foundation trusts, telling them that the NHS must find savings of 6.5% rather than 4%. That is an extra £1.1 billion on top of the savings demanded by the Department.
Members will be interested to know that the head of Monitor compared the NHS under the Government’s proposals to privatised utilities. Does Ofgem have trouble regulating the utilities? It was ineffective in dealing with companies’ unfair pricing practices and companies that made large profits during the recent severe weather.
Lilian Greenwood (Nottingham South) (Lab): Does my hon. Friend agree that the Government’s plan to abolish the cap on income from private patients is a real concern when hospitals are starved of cash, because it could result in them putting private, fee-paying patients ahead of NHS patients?
Valerie Vaz: I absolutely agree with my hon. Friend.
We were told by Sir David Nicolson that very little work has been done on what will happen in 2013-14. Just for the record, the UK had the second-lowest debt in the G7 in 2007-08, before the global financial crisis. Which Government are out of control with their spending?
Finally, there are many unanswered questions. I have tried to obtain the legal advice on whether EU competition law applies to the provisions of the Bill from the Secretary of State, but apparently, it is in the public interest not to disclose that to the public. However, in a recent article in the British Medical Journal, Rupert Dunbar-Rees, a GP, and Robert McGough, a solicitor, say that
“the technical argument reinforces the logical argument that the reforms further open up the NHS to EU competition law.”
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Who will account for the training of doctors, and indeed health care professionals? That cannot be left at a local level. In A and E, an increased percentage of patients wait more than four hours, the maternity service in Maidstone has been closed despite GP opposition—
Madam Deputy Speaker (Dawn Primarolo): Order. I am very sorry to interrupt the hon. Lady, but the clock is not correct. If she is following that, she will not know that she does not have that much time left—the clock stopped and did not start again. I would advise her to take about another minute and a half only.
Valerie Vaz: At Barts specialist regional cancer care unit, 20% of staff have been cut in two weeks.
An Ipsos MORI poll found that 71% agree that the NHS is the best in the world and that 72% express satisfaction with the NHS, but that was published by the Department only under pressure.
Finally, there have been 6,000 responses to the White Paper. The people of England have given their proposals, but they have not given their verdict on the Bill. They want the Prime Minister to keep his promise. If he does not do so, they will be ready to give their verdict at the next general election.
Madam Deputy Speaker: Order. May I apologise to the hon. Lady for the error with the timing? It was very gracious of her to ensure that she stayed within the time, which allows others to speak, but I think she will find that she got her time anyway.
5.19 pm
John Pugh (Southport) (LD): This is déjà vu. In the last Parliament, it seemed like every other Opposition day debate was a health debate, normally called by the Secretary of State as the then Opposition spokesman. I trust that his enthusiasm for these debates is undimmed, although given that he has left us, possibly it is.
The Opposition allege that the Bill prepares the ground for the complete privatisation and fragmentation of the NHS through the introduction of an open market, pricing and competition regulation and the general disengagement of Government. However, the often very pained response of Ministers—this was certainly true in the Bill Committee—is that they are building and improving on previous policy, linking clinical decision making to cost control and adding a dimension of accountability that has not existed hitherto. All those statements are true. I noticed that in the Bill Committee, Ministers talked all the time about “refracting mirrors”, “Opposition fantasies” and “deliberate distortions”. In turn, the Opposition talk of “hidden agendas”.
On reflection, I have come to the conclusion that there has to be an explanation for this strange phenomenon, this persistent conflict between interpretations of the same legislation, this clear non-meeting of minds.
Grahame M. Morris: Will the hon. Gentleman give way?
John Pugh: I was just about to give the answer, but I will give way.
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Grahame M. Morris: Is there not a simple solution? It is the Government’s Bill, so why did they not explicitly rule out price competition in the Bill?
John Pugh: I have a different explanation, which is that both interpretations can be sustained by a reading of the Bill. It is a kind of Jekyll-and-Hyde thing. I have a vision of the Bill being drafted during the day by a sane, pragmatic Dr Jekyll-like Minister, but during the night some rabid-eyed Mr Hyde with right-wing ideology breaks into Richmond House and changes many of the sentences. That is the only way I can explain the fact that the explanatory notes to the Bill provided in Committee explained very little.
The House might know that I am a long-term critic of the Bill and the White Paper before it. At the annual Liberal Democrat conference in October, I and the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow) went around with a double act on the Bill—him for, me against. This is not, therefore, as the hon. Member for Easington (Grahame M. Morris) might think, a hissy fit following poor election results. Like nearly everyone in the House, I do not disagree with the Bill’s objectives: more clinical involvement, less bureaucracy and more local accountability. Like everyone else, I am concerned not about its objectives, but about its likely effects. I have met no one who takes issue with the Bill’s avowed intentions, but I have met many who dread its consequences.
According to one reading of the Bill—the Mr Hyde version—the eventual outcome of the Bill will be that the NHS opts out of direct health provision and becomes simply a funding body; NHS hospitals, services and clinics become indistinguishable from private ones; everyone competes on business terms for a slice of whatever funds the Government have allocated for health purposes; and what health care a person gets depends on what can be purchased on their behalf in a largely unconstrained, privately run health market. That is a perfectly consistent view of how a health service can be run, but in our country any party that advocates it commits political suicide. Furthermore, of course, it is likely to accentuate health inequalities and overall costs.
The question for us is this: what will prevent such a situation from arising out of a Bill that appoints a competition regulator along the lines of Ofgem to promote competition, that blurs many of the lines between private and public provision, and which removes the Government’s duty to provide a comprehensive health service? Hence the importance of today’s debate, which, knockabout apart, is crucial to the wider debate on the Bill. To be alarmed by the prospect I have set out is not to oppose competition in principle. The previous Government set up competition and collaboration panels to encourage a degree of challenge in the system. In fact, if hon. Members look at their record, they will see that they were knee-deep in competition initiatives. Neither is holding these concerns to be alarmed by the presence of private business in delivering NHS services. There is not a person here who has not used a private optician or a private pharmacist when they need it. There is a long tradition of involvement by the private sector in the NHS.
Rather, to be concerned about the proposals is to be alarmed by the fear of an unconstrained, uncontrolled market in health—this is a point that has been made
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previously—partly because it can lead to fragmentation, potential conflicts of interest, profiteering and so on, but mainly because identifying competition as the main engine of improvement in health care ignores the simply enormous gains in service quality, cost reduction, efficiency and patient experience that can be gained through co-operation, collaboration and integration of services.
The NHS is built on the principle of co-operation, in which we, the hale and hearty, make a moral compact to support the lame and the sick. To make commercial competition the main driver of improvement in the NHS, even if it is not competition on price, would be a serious mistake. It would be to subscribe to a perverse and misguided form of social Darwinism. Competition is a mechanism; it is not an end in itself. The role of competition in the NHS, as seen by the Government, is the real issue. The problem is made a lot worse by the hopeless lack of clarity over how European competition law will apply. We struggled with that issue in Committee. We did not resolve it, and I do not think that we will do so.
Owen Smith (Pontypridd) (Lab): Does the hon. Gentleman share my concern that in today’s debate, as in the long period we spent together in the Bill Committee, the Government have failed to clarify how competition law will apply? Indeed, they have sought repeatedly to imply that it will not bite any harder on the NHS. Does not that verge on disingenuousness from the Government, if not downright dissembling?
John Pugh: I think that that is a bit unkind to the Government. I have been to the Library and borrowed some very big books on EU competition law, and the main conclusion that I have drawn is that the law is not at all clear when it comes to the provision of public services. But that adds to the risks created by the legislation, and gives rise to the awful thought that the fate of our local services, about which we all care, could be decided not by the NHS, not by the Government and not by the public but by case law—European case law, at that—and in the courts.
If we subject clinical services to the same regime to which we have subjected non-clinical services, we will not get the innovative social enterprises strengthening existing provision that people would like to see; we will get large companies financed by private equity muscling in and challenging tendering processes, backed up by legal teams and looking for every weak link or failure to comply with EU regulations. Indeed, that is already happening with non-clinical services.
That is why there is a problem, and it is why private equity is licking its lips. We cannot additionally expect the private sector to come into this game to bid for the unprofitable, high-risk, complex work and not cherry-pick. That is not what businesses do. Good businesses pick cherries, because they need to make a profit. To suggest, as Clare Gerada of the Royal College of General Practitioners has done today, that there is not a problem of untrammelled competition in the legislation is entirely to miss the point. We are not anti-private sector, and we are not anti-competition; we want to see a level of robust pragmatism supported by those with a lifetime’s experience of running health services, and a recognition that good health care is essentially a collaborative exercise. If we cannot get that recognition and the acceptance of
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the professional bodies for what is embodied in the Bill, everything we say here and every amendment that we make will be utterly pointless.
Madam Deputy Speaker (Dawn Primarolo): Order. A large number of Members still wish to speak, and we simply will not get everyone in unless I reduce the time limit further, so that is precisely what I am going to do. The time limit for contributions to the debate from Back-Bench Members is now five minutes.
5.28 pm
Debbie Abrahams (Oldham East and Saddleworth) (Lab): It is a pleasure to follow the hon. Member for Southport (John Pugh). A lot of water has passed under the bridge since the middle of March, when we last debated the NHS. The Committee tasked with scrutinising the Health and Social Care Bill, on which I served—a baptism of fire—finished its deliberations at the end of March. I believe that it was the longest running Bill Committee since 2002, so it was a marathon stint in which we debated 280 clauses and 600 amendments. During those eight weeks, the Government did not accept a single amendment. Some hon. Members made exceptional speeches, dissecting the Bill in detail and arguing against it. I remember in particular a debate about regional specialist services and how they would be commissioned in future. I am afraid, however, that that was as far as it went when it came to changing the Bill. I was therefore nonplussed when, the day after the Committee finished its proceedings, the Prime Minister and the Deputy Prime Minister expressed their concerns about the Bill and announced a pause in its enactment.
At the same time as the Public Bill Committee was sitting, we saw growing public anxiety about what the Bill would mean to patients and their families. I was contacted by hundreds of my constituents and received a petition signed by nearly 300,000 people from across England. Perhaps that was the motivation for the Government’s change of heart, or was it just political rhetoric with the elections looming? There has certainly been no pause in NHS reorganisation in many areas, including my own, where, as I mentioned the other week, it has actually been brought forward.
The public are beginning to see an erosion of the considerable improvements made in the NHS under Labour, and this is what is fuelling public concern. In Greater Manchester, as Peter Thornborrow, one of my constituents found out to his cost, there are much stricter criteria for cataract surgery, as there are for hip and knee replacements.
Andrew Bridgen (North West Leicestershire) (Con): Recent OECD research shows that, despite the last Government’s spending splurge on the NHS, Britain still has the eighth worst record of all its members for preventable deaths—we are down there with Poland, the Czech Republic and Mexico. It also shows Britain has the seventh highest potential for efficiency savings in health care—that is, for improving patient outcomes without spending any more money. Is that not a damning indictment of the last Government’s health policy and does it not mean that reform is essential for the future of the NHS and for improving patient outcomes?
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Debbie Abrahams: How will breaking up the NHS improve that? The hon. Gentleman should be concerned that some of the measures PCTs are having to take are increasing the risks of cardiovascular disease for many patients. As for international comparison of our NHS, it is known to be one of the most cost-efficient health systems in the world.
Bariatric surgery provides another example of where the National Institute for Health and Clinical Excellence guidelines have been replaced with more stringent criteria, rationing access to care in order to balance the books. There are many other examples. According to one survey published last week, demands for bariatric surgery have risen by 17%, but approval for such surgery has fallen by 22%. These are the so-called efficiency savings, as we heard from the Secretary of State, of £20 billion nationally and 4% each year.
Guto Bebb (Aberconwy) (Con) We hear a lot about the effect of efficiency savings on the NHS in England. Under Labour party proposals, Wales is not suffering from efficiency savings, but from cuts of £435 million in the NHS budget this year and £1 billion in the next four years.
Debbie Abrahams: Does not the hon. Gentleman think that that is why we won the election in Wales?
The savings required are 4%, and if the Government get their way with the new economic regulator Monitor, they could go as high as 7% each year—far more than our NHS is capable of coping with.
My constituent, Peter, was refused a cataract operation, yet his vision was so poor that he was able to see the world only through a haze; as a precision engineer, furthermore, he was not able to do his job and faced the threat of redundancy. In other cases, non-compliance with NICE guidelines—on familial hypercholesterolaemia, for example—is leaving people at extreme risk of untreated cardiovascular disease.
Health professionals have almost without exception castigated the Bill for what it will do to the NHS in completely opening it up to the market, with competition law applying in full and allowing private health care providers to cherry-pick profitable services. A hospital medical director said last week that he did not know how his hospital could continue to provide care for unprofitable patients.
The unprofitable services for most hospitals are elderly care, mental health, paediatrics and maternity, which are essential services for all communities. Instead of service providers and commissioners working together to provide the best quality care they can for their patients, the trend is for hospital trusts to maximise income and compete against each other. We are already seeing that lack of co-operation when PCTs look at alternatives in commissioning. Trusts are reluctant to collaborate when they see that it might reduce their income, even if it improves the quality of patient care. Similarly, the Bill gives GPs a financial interest in restricting or refusing treatment in order to make savings and to get bonus payments from the NHS commissioning board.
Labour wants genuine savings that will enhance patient outcomes rather than produce the diminishing effect that we are currently seeing, and we believe that we can
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achieve that. We want hospital specialists and GPs to work together to deliver clinical care pathways that improve the quality of patient care and bring care closer to home. One local PCT is trying to introduce the use of drugs that are cheaper—and unlicensed—to treat age-related macular degeneration, but it is under severe pressure from the pharmaceutical industry. That is another way in which we could reduce costs.
There is no doubt in my mind that, unamended, the Bill threatens the founding principles and values of the NHS. It removes the duty to provide a comprehensive health service, and provides an opportunity for the new NHS commissioning board and GP consortia to charge for services. It involves a costly, ideologically driven reorganisation of the NHS that has no mandate from the British people, and no support from health professionals and that will mean the end of the NHS that we know and love. As I have said before, the NHS is not just an organisation that plans and provides our health care; it reflects the values of our society on which this country set such store.
I know that there are many members on this side of the House—
Madam Deputy Speaker (Dawn Primarolo): Order. The hon. Lady’s time is up.
5.36 pm
Tony Baldry (Banbury) (Con): When in government, the Labour party acknowledged that the NHS would have to make considerable efficiency savings over the next few years. My right hon. Friend the Member for Charnwood (Mr Dorrell), the Chairman of the Health Committee, has described that as the Nicholson challenge. The more I listen to speeches from Opposition Members, the more I am convinced that their opposition to the Bill is a cynical exercise. Given the Nicholson challenge, if at any time any hospital gets into difficulty, the Opposition will simply say, “That’s a consequence of the health reforms.”
All of us in the House want to ensure that we get the health reforms right. I suspect that for all Members of Parliament the NHS in their own constituencies is one of the most important political and, indeed, constituency issues, but for me one of the main issues was, for much of the last Parliament—and still is—the need to retain the full range of services at Horton general hospital in Banbury. If there are difficulties in the NHS, it is hospitals such as the Horton that will experience them first. It is therefore imperative, for me, that we get the reforms right, but I have every confidence that the Secretary of State and his ministerial team will get them right.
The Secretary of State, the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns), and pretty well every other health Minister has been to Banbury to visit the Horton. As the Secretary of State made clear to GPs in Banbury not so long ago, GP commissioning enables GPs to put their confidence in their local hospitals by commissioning services for them. In my county we will be replacing an Oxfordshire-wide PCT with an Oxfordshire-wide GP-led commissioning body, with GPs in the county working collaboratively.
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In the brief time I have to speak, I want to make two points to Ministers. While I am sure it is right for us to pause and listen, we should also recall that GPs are keen to get on with this task. I have had public meetings in my constituency that have been open to every GP on my patch, and the message that I have received from them is that they want to be catalysts for change: they want to be able to shape health services in Oxfordshire.
GPs throughout the county recently elected Dr Stephen Richards to lead the development of the Oxfordshire GP consortium. His first comment was this:
“GP practices are the bedrock of the NHS. Now, the whole GP community, from partners and sessional doctors through to GP trainees are in a unique position to reshape health care for the population of Oxfordshire.
The new Consortium Lead and the Locality Leads in OGPC”—
the Oxfordshire GP consortium—
“will have much greater influence over the improvement of patient care. These GPs will be accountable to their GP colleagues”
“to the public... I aspire to Oxfordshire leading the way in developing ‘Evidence Based Commissioning’. A new form of commissioning that offers contracts based on incentives and agreed improved patient outcomes.”
Andrew George: Will my hon. Friend give way?
Tony Baldry: No, I am not going to give way as I am conscious that many Members wish to speak, and Madam Deputy Speaker has already told me off this afternoon for taking too long.
Madam Deputy Speaker (Dawn Primarolo): Order. I was not telling the hon. Gentleman off; rather, I was reminding him of the convention.
Tony Baldry: I can recognise a chastisement when I see it!
GPs want to get on with things, and while it is important that we should pause and have a listening exercise, we also need to give GPs the confidence so that they continue to plan for GP-led commissioning.
The more I listen to the contributions in the debate, the clearer it becomes that each Member has their own agenda of changes that they wish to be made. Much has been made of the 98% vote against my right hon. Friend the Secretary of State by the Royal College of Nursing, but I listened to Peter Carter, chief executive and general secretary of the RCN, on “The World at One”, and I was so struck by what he said that I took down a transcript. Martha Kearney put it to him—
Madam Deputy Speaker (Dawn Primarolo): Order.
Tony Baldry: Am I out of time, Madam Deputy Speaker?
Madam Deputy Speaker: Yes. Thank you.
5.41 pm
Frank Dobson (Holborn and St Pancras) (Lab): The current situation is extraordinary: the Liberal Democrats originally denied our criticisms of the Bill, but they have now suddenly jumped on board, and all I can say is that they are very welcome.
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Both Lib Dem and Tory Ministers have claimed that the NHS is a failure, and the Secretary of State said today that he had inherited Labour’s mess. Labour’s mess was to leave the national health service in the best situation it has ever been in: more successful than ever before and improving rapidly, with waiting lists and waiting times reduced to the lowest they have ever been, and with massive improvements in survival rates. From listening to Opposition Members, people would never imagine that when we came to power 5.9 million operations were being carried out in NHS hospitals, yet when the current Government came to power we—or, rather, the people working in the national health service—had increased that to 9.7 million, which is a rise of 64%. For instance, the number of cataract operations carried out each year had increased from 165,000 to 346,000.
There have been massive improvements, and I personally do not give a toss what the OECD says. The national health service is more cost-effective than practically any other system, and it achieved that by making many different sorts of local changes—not structural changes, but by people going about their professional business trying to do things better. The Labour Government facilitated that in a body that is essentially co-operative in its organisation, ethic and culture. That is because it is based on the pooling of costs: all of us pay in, and if we get ill we get treated without having to pay. That is not going to happen any longer, because under the Bill’s provisions both the commissioning bodies and the hospitals will be able to decide to charge for some of the services that are currently free. The new chief executive at the Whittington hospital has told us all that.
There is not just a pooling of cost and risk in terms of patients. There is a pooling of risk and cost across the national health service, so that these co-operative organisations share the costs of providing treatment and care. That will not prevail if they are forced to compete with the private sector because, as the hon. Member for Southport (John Pugh) pointed out, the first, and only, legal priority of private sector organisations is to look after the interests of their shareholders. They will therefore concentrate on creaming off the profitable work, leaving the national health service to try to provide the services that are too expensive for the private sector.
I did not support the bits of privatisation that the previous Labour Government introduced so, unlike the Tories, I have been consistent. UnitedHealth took over three GP practices in my area not that long ago and that American-based company has just sold those three franchises to another supplier without any consultation with local people, patients or staff. It regards its function as taking part in a commercial set-up and a commercial transaction, and that is what we face if this Bill goes through.
The problem is that the transaction costs—the bureaucratic costs—will actually rise. Before the previous Tory Government introduced the internal market, the money spent on NHS bureaucracy was just 4%, but that has increased to 12%. I am willing to bet any Member on the Government Benches that the level will go well above 12%, because once legal contracts are required, once the lawyers, accountants and God knows who else gets involved and has to be paid, and once we end up with court actions, the transaction costs will rise. That is why these proposals are a disaster.
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5.46 pm
Andrew George (St Ives) (LD): It is a pleasure to follow the right hon. Member for Holborn and St Pancras (Frank Dobson) and I was glad that his speech contained an element of recognition of the excellent contribution made by my hon. Friend the Member for Southport (John Pugh), who set out far more articulately than I could many of the concerns about the Bill that underpin this evening’s debate. These concerns have been raised by Liberal Democrat Members and I know for a fact that a number of Conservative colleagues feel the same way about aspects of the reform, although that has not been articulated this evening.
I wish to get one piece of rough and tumble out of the way before I commence with the substantive comments I wish to make in the short time available to me. I will not be supporting Labour’s motion this evening because to do so would be to endorse Labour’s history of having introduced the following: independent treatment centres, which wasted hundreds of millions of pounds of taxpayers’ money; alternative providers of medical services enforced through primary care trusts; and many other top-down reorganisations, which Labour Members now pretend they are against. It would also mean endorsing their approach to the whole concept of top-down reorganisations, the billions that Labour wasted on NHS IT systems and Labour’s failure to address the unfair funding formula, which set back my part of the country significantly and left it in significant debt, from which it is still trying to escape.
I set out my position in the Second Reading debate on the Health and Social Care Bill, on 31 January, when I refused to support the Government because of the criticisms and concerns that I raised then. I do not need to repeat them now, but I also made it clear then, as I do now, that I would vote against the Government on Third Reading if the Bill were to look in any way like the measure that we saw come out of the Committee and that will come through to the Report stage. I therefore look forward to the outcome of the listening exercise, and hope that it is a genuine listening exercise and that substantial changes will be made to the Bill. The changes that I wish to see are so substantial that they would take the guts out of the Bill.
To the concept of commissioning proposed in the Bill and the idea of handing all that power to one narrow group of clinicians—GPs—there is, despite what the hon. Member for Banbury (Tony Baldry) said about GPs in his area, at best a resigned reluctance and at worst outright hostility about what GPs are being asked to do. I do not go along with the hon. Gentleman’s view that they are keen to get on with it. They are responsible people and responsible professionals; they recognise when they are being asked to do something and they will get on with it, but I must say that they will not do so with any enthusiasm.
Secondly, the substantial elephant in the room is not the risk of privatisation of the NHS, as the hon. Member for Easington (Grahame M. Morris), who is no longer in his place, described it, but the marketisation of the NHS. My hon. Friend the Member for Southport (John Pugh) put it well: the cherries will be picked by the private sector. Any decisions on commissioning could easily be unscrambled by a process whereby decisions that were intended to try to integrate services could be challenged because they were structured uncompetitively. Those are two fundamental failings in the Bill.
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This comes to the heart of what coalitions are about. No one gets their own way, as Labour knows from being in coalition in other places, and it is silly to be childish about that. In a coalition, the parties work together when they agree and seek a compromise where they fail to agree. I would argue that when they cannot come to any kind of agreement or compromise, they should allow Parliament to decide. What I do not like about what is happening is the fact that the Secretary of State is largely implementing this—
Madam Deputy Speaker (Dawn Primarolo): Order.
5.51 pm
Owen Smith (Pontypridd) (Lab): I am delighted to follow the hon. Member for St Ives (Andrew George) and to hear him say that, were this a Third Reading debate and the Bill had remained as it is, he would vote against it. He should not hold his breath, because we have not heard any indication from those on the Treasury Bench that they propose to listen to the reasoned and substantive opposition that we heard in the Public Bill Committee, of which I was a member and where the Government rejected all 250 to 300 suggested amendments, or to that in the rest of the country, where doctors and all the medical professions are united in opposing the Bill.
Earlier, those of us on the Opposition Benches were admonished for the sound and fury coming from us. Mr Speaker was right to admonish us for shouting, but that sound and fury is not born of cynicism; it comes from three things. The first is our outrage at how the history of what the Labour Government did in office is being rewritten and at the suggestion that this Bill represents an evolution of what we did with the NHS. It is not an evolution, but a revolution.
The second is the shameless way in which the Government are misrepresenting that which sits at the heart of the Bill. They present it as trying to bring about patient focus and GP-led improvements to the NHS, but in truth it is about competition and the Government’s belief that competition in health care, like in telecoms or the energy market, is the best way to drive improvements in the efficient allocation of resources, allowing consumer-driven demand to drive efficiency. We fundamentally contest that. We do not think that it is true in many aspects of life, but it is certainly not true in the NHS, a body built on collectivism, co-operation and integration. Those fundamental ethics—the ethos of the NHS—will be undermined by the Bill.
Thirdly, the Bill is a completely unnecessary intervention. We did not need a top-down reorganisation of the NHS, because we got record patient satisfaction and increased productivity in all the ways that matter, as described earlier by my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson). Crucially, we have a far more efficient and better-resourced system than previously. That prompts the question of why the Government are pursuing this change. They are doing so because they fundamentally believe that the way to drive the NHS forward is an unfettered market and greater deregulation.
That brings me to my substantive point. I want to rebut the notion which we have heard repeatedly from the Government that competition will not bite harder
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on the NHS as a result of the changes. The Government have told us repeatedly that nothing in the Bill says that competition will impact on the NHS to any great extent. As we all know, however, in 100 of the 300 clauses Monitor is established as an Office of Fair Trading-style competition overlord for the NHS, because as soon as the NHS is opened up to multiple entrants in the market and there are multiple providers of health care services in this country, we will no longer be able to argue that it is a state service that ought to be protected and therefore should not be subject to the vagaries of the market and EU competition law. As soon as we allow multiple health providers into the market, we will have to apply EU competition law, and European case law and arguments between lawyers will inevitably lead to the progressive fragmentation of the NHS.
There is one other point with which I want to take issue. Privatisation is a pretty difficult word to bandy about in politics, but I do not shy away from using it in this debate. We are going to see a progressive and creeping privatisation of the NHS. To argue about marketisation and privatisation is to argue about semantics. We will increasingly see many more aspects of the NHS either in the hands of or being delivered through the private sector. Earlier, the Secretary of State asked us to point out where in the Bill it showed that there would be an increased number of private providers in the NHS. My challenge to the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), who is now back in his place, is to point out to me where in the Bill it says that we will not see more private providers entering the marketplace. The Bill provides for that to happen and what will arise from that is the break-up, fragmentation and, eventually, privatisation of the NHS. Those on the Government Front Bench know that—
5.57 pm
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con): I agreed with very little of what the hon. Member for Pontypridd (Owen Smith) said when we were on the Public Bill Committee together, and I am afraid that I will not change my view after hearing what he has said today. He touched, however, on the important issue of health economics. In a thoughtful speech, the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) made some good points about health economics. Much as I would rather talk just about patient care, given my medical background, health economics are at the centre of the discussion about how we will reform and improve the NHS.
The comprehensive spending review announced that the NHS would see its funding rise by 0.4% in real terms over the next four years. Despite the current economic climate, the Government have stood by their commitment to increasing NHS funding over this Parliament—we are very proud of that—but, even so, it is the smallest increase in NHS funding for decades. Ever-increasing patient demand for health care coupled with Britain’s demographic time bomb means that over the next few years the NHS will have to achieve value for money for its patients on an unprecedented scale.
Our NHS needs to make efficiency savings just to stand still and to continue to deliver high-quality patient care. My right hon. Friend the Member for Charnwood
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(Mr Dorrell) hit the nail right on the head when he said that we need to think about not just the worried well but the 80% to 85% of patients who have serious medical co-morbidities or present as emergencies with acute medical problems in accident and emergency. That desire lies at the heart of the Government’s proposed reforms.
People are living longer, and as they do the number of people living with multiple medical co-morbidities also increases. The majority of people require their health care in the later stages of their lives and if we are to have an NHS that is truly responsive to the demographics of this country, we need to ensure better integration of health and social care. We must stop the silo working that often exists between local authorities and the NHS and ensure that we have a more locally responsive NHS. At the heart of the Bill is a desire to see better integration of adult social care and NHS care, which can only be a good thing in view of this country’s demographics and of the health economics of looking after people in the later years of their lives.
Debbie Abrahams: Does the hon. Gentleman share the concern that many councils that will be responsible for the delivery of public health are not ring-fencing the money and are using it to offset some of the cuts that they face?
Dr Poulter: I can only say that my Conservative-run, Suffolk council is doing exactly the opposite of what the hon. Lady describes. The Government have committed to putting almost £2 billion into adult social care, looking at the demographic time bomb and looking at better integrating health care with adult social care. I would be very concerned to see councils doing what she describes, because that is not what they are given that money for. If she has had a problem with that at her local authority, she needs to take it up with that authority.
The key to unlocking potential in the health sector lies in cutting the red tape and pointless form-filling that wastes the time of so many front-line staff. Of course, our NHS must have a level of regulation that ensures that products and services are thoroughly tested and that ensures patient safety. However, the over-excessive regulation introduced by the previous Government has been damaging not only to patient care but to staff morale. It has also diverted vital resources away from the front line and away from patients, who are, after all, what health care should be all about. This Government are rightly looking to take simple, obvious and positive steps in improving the overall efficiency of the NHS by scrapping the health quangos that waste £2 billion a year—money that could be much better spent on front-line patient care.
Another issue that I want to highlight in the time left to me is another area of wasteful spending in our NHS—management. Under the previous Government, the number of managers and unproductive non-medical staff increased in the past decade, with the number of managers and senior managers in the NHS almost doubling to 42,000. In many hospitals, more new managers than new nurses were recruited in that time. That cannot be right—it is bad for patients and money is being misspent. As I witnessed at first hand, NHS managers were rewarded at a better rate than front-line staff—at around 7%, compared with 1.8% pay rises for front-line medical staff. That is not a good thing.
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The Opposition are very concerned about staff morale, but let me tell them why staff morale is so low: it is because the contributions of front-line staff were badly undervalued by the previous Government while the contribution of managers were over-valued. I believe that what we and the Government need to do is make sure that more money goes into front-line patient care and front-line staff rather than being wasted on management and bureaucracy.
Dr Poulter: If the hon. Gentleman will forgive me I will not give way because time forbids it.
In conclusion, the NHS needs to be reformed and needs to improve the care it delivers to patients. We can no longer afford to sustain the amount of wasteful spending on management and bureaucracy that occurs in the NHS. We need a less bureaucratic NHS—a clinically led NHS that can once again put its patients first. The NHS has become obsessed with management and process but if we want to reform it, then it must be the patient who counts.
6.3 pm
Clive Efford (Eltham) (Lab): I must confess to being somewhat confused about where we have got to with the Bill. I have been here for 14 years and I cannot recall a Bill being halted after it had been through Committee so that we could go back and consult the public. I will be corrected by Members who have been here longer than me, but I cannot remember anything like this extraordinary situation.
Yesterday, I listened to the Deputy Prime Minister on the “Andrew Marr Show”. He said:
“Let me stress this, it’s not a gimmick, it’s not a PR exercise. We will make changes, we’ll make significant and substantive changes to the legislation”.
We have not heard any of that tonight. No one has got up and said, “We are listening,” or, “We are pausing,” or “We are reflecting and we are going to see substantial changes to this Bill.” The Secretary of State is in his place: I would like him to intervene on me and tell me that in relation to GP commissioning, the full £80 billion will be transferred to GPs, as he has frequently stated it would; that they will be in charge of commissioning and that we will not see that altered in any significant way as a result of the interventions of the Prime Minister or the Deputy Prime Minister. Members of the Government are trying to say that they are listening and that they are not responsible for all this, but I have here the White Paper that was published back in January, the foreword of which was signed by the Prime Minister, the Deputy Prime Minister and the Secretary of State for Health. They all signed up to it, but all of a sudden we are back to pausing, reflecting and listening.
What or who are we listening to? We have heard from the Secretary of State tonight that there are no cuts in the NHS, but let me tell hon. Members the story of Mrs Bell, a constituent of mine who was referred by her GP to a consultant last spring about cataract operations. She received the first operation within 18 weeks, and when she went back for a second consultation about the other eye she was referred for another operation. After 18 weeks, she rang the local health care trust to say that
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she had been waiting for her cataract operation for 18 weeks, but she was told that that was no longer a deliverable target. She ended up waiting more than 26 weeks for that cataract operation, so no one can tell my constituents or anyone else that we are not seeing cuts to the NHS and longer waiting times for patients.
What is fundamentally wrong with the Bill is that it places the market at the head of commissioning and planning services. The coalition document said that the coalition was going to introduce some element of democracy into primary care trusts, but PCTs got demolished as part of the proposals. My local PCT has been absolutely decimated, because although the Bill has not gone through Parliament yet, people are acting on it: they are voting with their feet and they have all gone. Currently, my area has no one who is responsible for the oversight and planning of our local health care services. Moreover, no one who will ultimately be accountable to local people is responsible for planning local services. All of that has been frittered away; it has disappeared. What we need is some form of democratisation of the commissioning process so that local people can know quite clearly who is accountable and who is not.
Tonight’s vote presents the Liberal Democrats—after we have paused and listened and reflected and after all they have said over the weekend about changes to the legislation—with an opportunity to send a message to the Government. This morning, the hon. Member for North Norfolk (Norman Lamb), the Parliamentary Private Secretary to the Deputy Prime Minister, said on the “Today” programme that there will be significant changes to the Bill. If the Liberal Democrats want to send a message to the Government, they should join the Opposition in the Lobby tonight and send the message that the Bill has to be changed. But I will tell them what will happen when it comes to Third Reading. The Whips will get to them, they will be as spineless as ever and they will go through the Lobby defending the Bill’s Third Reading—
Madam Deputy Speaker (Dawn Primarolo): Order.
6.8 pm
Jeremy Lefroy (Stafford) (Con): I would like to take this opportunity briefly to raise three matters and I hope that my right hon. Friends on the Front Bench will, in the spirit of the listening exercise, take note of them. I know from previous experience that these issues concern them. They arise in relation to the public inquiry that is going on at the Mid Staffordshire NHS Foundation Trust.
First, the motion refers to an NHS that refuses to tolerate unsafe care and that achieves quality and outcomes that are among the best. I do not think that any right hon. or hon. Member would disagree with either of those aims. One thing that has come out of the Mid Staffordshire inquiry is the whole problem of unsafe care, particularly the quality of care that elderly patients receive. Mid Staffordshire is by no means the only place for which that has been a problem. It has been highlighted in a recent report as being an issue for other parts of the country as well. For me, the key question is how patient care and safety can be upheld to the highest possible standards across the NHS. Occasionally people have cited the example of civil aviation in this country. Both
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the Civil Aviation Authority, which has a first-class safety record, and the NHS serve the public. The CAA emphasises continuous improvement and risk-based monitoring. I urge my right hon. Friends to look at the example and practices of the CAA and consider how those might be incorporated in the work of the NHS.
The Health and Social Care Bill contains helpful provisions on patient safety. GP commissioning will bring commissioning closer to patients. It will ensure that if there are problems, they will be heard about more quickly. The health and wellbeing boards will ensure greater local accountability and, again, problems should come to the attention of the authorities more quickly, which did not happen in my own trust. Healthwatch will be established and there will be more foundation trusts.
However, there is a risk of a fragmented approach to patient safety. We have the Care Quality Commission, but as hon. Members who served with me on the Public Bill Committee know, there are concerns about the additional work load that will be placed on the commission. Will it be able to cope with the volume of work? Will it be able to ensure that patient safety and quality of care are upheld across the NHS? I should like to hear the Minister of State’s comments on that. It has been suggested that the critical question of patient safety should be brought to the top of the NHS, perhaps with a directorate within the Department of Health reporting directly to the Secretary of State on patient safety. I should also be interested in his comments on that.
The second point that I wish to make is about foundation trusts, which were key under the previous Government and will continue to be so, but I am concerned about the level of training available to governors and directors. I should like to hear my right hon. Friend’s comments on that. I refer particularly to foundation trusts that are responsible for district general hospitals, which many hon. Members have in their constituency, as do I. Those are the trusts that will probably come under most pressure in the current constrained financial circumstances, and that would have been the case under any Government.
My third point relates to the length of contracts that are awarded. Whatever the position is with competition under the Bill on Report, it is clear that contracts, whether with NHS or outside providers, will be of the utmost significance. I am concerned that contracts are sometimes awarded for only a short period. Hence, a considerable amount of time is taken up with tendering and retendering. I ask for some comments on that.
In conclusion, the Francis inquiry, which we expect to report later this year, will be one of the most significant reports on the national health service in the past 20 or 30 years. I urge the Government to take good note of its conclusions and implement them as far as possible.
6.13 pm
Alex Cunningham (Stockton North) (Lab): At a time when the Health Secretary is being criticised from all sides, it is vital that the message gets through and the listening exercise works, but from what we have heard today there is grave doubt about whether there will be any real change.
The shadow Secretary of State told us about the warning from the Royal College of General Practitioners that the NHS could unravel if the Health and Social Care Bill goes ahead in its current form. The British
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Medical Association says that the plans are too extreme and too rushed, and will negatively impact on patient care. Nurses voted overwhelmingly for a vote of no confidence in the Health Secretary, and even the Tory-led Health Committee criticised the plans, saying that they were unlikely to improve patient care.
I attended a Save the NHS rally in my constituency on 30 April and spoke to local nurses, doctors and patients to hear their views. One of the GPs who was there to speak on behalf of the BMA stressed how worried they are that increased competition will lead to the fragmentation mentioned by so many other hon. Members. She also made it clear that although the Government boast that 90% of GPs have signed up to participate in a commissioning role, vast numbers of doctors have done so only because they feel they have no option. They know that it is a bad Bill, but feel the Government are imposing a way of working on them and they have no option but to co-operate.
Four weeks earlier I joined health service workers at another public event to demonstrate opposition to the Bill. Even policemen and women passing in their vans and cars were tooting in support of the demonstration, but we know that even the police have learned that the Government have no care for public services, whether health or policing. I also spoke to local nurses who feel that they are being sidelined by the Bill and want more involvement in decisions about the future of the NHS. I, for one, support them and wear my nurses day badge with pride, albeit a few days early.
Nurses certainly do not want a situation where GPs effectively control everything. Why, they ask, should GPs have such universal power? What about other clinicians? What about nurses? Are they not professionals with a tremendous knowledge of what our people need from their health care? I also question why local authorities and councillors who have extensive knowledge of the health needs of their communities are not to be involved in commissioning. Good local authorities work very closely with existing PCTs. Why are they being excluded?
On Teesside we have had nothing but bad news for the NHS since the coalition was formed. One of the first rounds of spending cuts saw plans for our much needed new hospital scrapped in June last year. I know that the North Tees and Hartlepool NHS Foundation Trust took the Government at their word when they said the trust had powers to raise the funding itself and it prepared a new business plan on that basis. To make it move from new business plan to new hospital, we need to remove the uncertainty in the NHS, particularly about privatisation and competition, and we need the Government to provide a loan guarantee to help keep borrowing costs down. Without that, some of our communities with the greatest health needs will have to make do at a time when budgets are under pressure.
More recently, people in Billingham in my constituency were told that their new £35 million community health centre would not be going ahead as the Government would not allow the public finance initiative credits for it. Under Labour we made good progress in reducing health inequalities. The new hospital and health centres were part of the strategy to build on that progress, but again the Government have shown their ignorance of the health needs of people in our less affluent communities. Jobs, too, are going—80 jobs from NHS Stockton over the next three years, with 42 jobs set to go at the North East ambulance service, and that is only the start.
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Unison, of which I am proud to be a member, has highlighted the fact that there will be more than 20,000 redundancies across the health service as a result of the reorganisation. This represents a personal tragedy for those affected and a colossal waste of talent and resources at a time when the NHS can ill afford it. Redundancy payments alone may be £l billion. To top it all, we know that waiting times are on the increase. According to the quarterly monitoring report from the King’s Fund, waiting times have hit a three-year high. What message does the Health Secretary have for the people in my area and patients waiting for operations, who know that they will have to wait much longer not only to escape continual pain, but to see their quality of life improved?
My message today is simple. The Government must take on board the criticisms that have been made and come back to the House with significant changes. As a priority, we must keep the NHS protected against the full force of competition law, drop plans for a free market NHS and give others their proper role in commissioning services.
6.18 pm
Emily Thornberry (Islington South and Finsbury) (Lab): This has been an interesting and important debate at an important time for our health service.
Emily Thornberry: I am being heckled already. I do not intend to make a habit of this—the hon. Member for Banbury (Tony Baldry) can heckle as much as he likes—but I will answer on this occasion. There is another draw this afternoon. My right hon. Friend the Member for Doncaster North (Edward Miliband) is speaking, but I understand that my hon. Friends will be coming in a moment.
We have heard a number of interesting and important speeches from Members who have shown great expertise and have been serving the community and the public through their work on Select Committees, including the Health Committee. We heard from my hon. Friends the Members for Easington (Grahame M. Morris), for Walsall South (Valerie Vaz), for Oldham East and Saddleworth (Debbie Abrahams) and for Pontypridd (Owen Smith), and from the hon. Members for Central Suffolk and North Ipswich (Dr Poulter) and for Stafford (Jeremy Lefroy). Listening to their contributions, we have had a taste of the quality of debate that took place in the Health and Social Care Public Bill Committee. It is a shame that the Government did not give an inch as a result of those debates.
We have heard from the Liberal Democrat representatives, including the hon. Member for Southport (John Pugh), who talked about the Jekyll and Hyde drafting of the Bill, and the hon. Member for St Ives (Andrew George), who said that he is likely to vote against it on Third Reading. We heard a characteristically passionate, robust and articulate speech from my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson). My hon. Friend the Member for Eltham (Clive Efford) asked a very simple question that I will repeat in the hope of getting an answer: what changes will be made as a result of the pause?
I hope that the Secretary of State was listening to my hon. Friend the Member for Stockton North (Alex Cunningham) because he brought a dose of reality to
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the debate by explaining the effect the reorganisation will have on his poor constituency and the redundancies it is suffering.
Andrew Bridgen: Will the hon. Lady not concede, perhaps even reluctantly, that the real reason her party is acting as a roadblock to essential NHS reform is that it pays far more attention to its union backers and paymasters than to NHS patients and taxpayers?
Emily Thornberry: The great strength of being in opposition, in many ways, is the opportunity it gives us to listen to interested groups of every type, including representatives of the work force, experts and the public, and to hear their concerns about the Bill. Those concerns translated into more than 300 amendments that we tabled in Committee and more than 100 votes. As I have said, the Government considered it wise not to give an inch. However, on the day after the Committee finished its considerations, the Government decided that there ought to be a pause so that they could think again. The very fact that they decided to think again tends to encourage us to think that we might have been right in the first place. What a shame it was that they did not listen to us earlier.
For the Health Secretary, it must seem a lifetime since the Prime Minister said about him:
“He is probably the Health Secretary in the last 20 years who has the greatest understanding and greatest passion for the NHS.”
His Deputy Prime Minister stated in the foreword to the NHS White Paper that the reforms were
“rooted in the coalition’s core beliefs”.
Patient groups, professional bodies and health experts gave the underlying principles of the White Paper a cautious welcome, but I ought to explain to the Secretary of State that there is a difference between giving a cautious welcome to the underlying principles of a White Paper or Bill and reading the Bill and realising that it will not deliver on those underlying core principles. That is why there has been an increasing chorus of opposition. Our difficulty is that, although there were more than 6,000 responses to the White Paper, those concerns were largely ignored. When the Bill was published, those concerns increased to alarm and the criticism became less diplomatic, less polite and more forthright, and yet the Secretary of State continues not to listen. More people began to join the Opposition’s side of the argument. Although at the beginning the Secretary of State might have felt encouraged that he had many people in his “liberate the NHS” team, as more people realised just what the Bill was about, more and more of them decided that they had been on the wrong side of the argument and that the Bill was wrong and so crossed the room.
I pray in aid the comments made by the hon. Member for Totnes (Dr Wollaston), who talked about throwing a hand grenade into the NHS, and those of the Royal College of Nursing, which passed a vote of no confidence in the Secretary of State, with 98% of the vote. Its general secretary said that the Bill
“could well turn out to be the biggest disaster in the history of our public services”.
The British Medical Association called for
“a halt to the proposed top-down reorganisation of the NHS”.
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When I listened recently to the hon. Member for North Norfolk (Norman Lamb), I was reminded of Luke 15.7 —there shall be more joy in heaven over one sinner who repenteth than over 99 just persons who do not need to repent. The number of people who are moving over to our side of the argument are becoming a flock. They say they realise that the Bill is not what they had first thought it was, that it needs to be fundamentally changed, and that if it is not fundamentally changed it needs to be scrapped.
“The coalition unexpectedly and inexplicably forged ahead with legislation for NHS reforms of staggering ineptitude.”
Lord Tebbit, who I believe is the Secretary of State’s former boss, has said:
“What worries me about the reforms, however, is the difficulty of organising fair competition between the state-owned hospitals and those in the private sector.”
I could go on. Michael Portillo has said of the Tories:
“They didn’t believe they could win an election if they told you what they were going to do because people are so wedded to the National Health Service.”
The whole of the Liberal Democrats have also crossed the room. Evan Harris has talked about the Bill being “disastrous”. Although I heard the right hon. Member for Charnwood (Mr Dorrell) say encouragingly that the Bill would give
“a holistic basis—a structure for the health service, going forward”,
the Health Committee’s report has not been so enthusiastic, if indeed what he said today could be characterised as enthusiastic. Lady Williams has said that the Bill is “completely misconceived”, and the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) has said that it needs “fundamental change”.
The Health Secretary must be feeling increasingly lonely. Perhaps the most deadly time was when the Chancellor of the Exchequer stated:
“I want changes too, and so does David Cameron”.
I appreciate that the Health Secretary has the Minister of State, the right hon. Member for Chelmsford (Mr Burns) and the Under-Secretary of State, the hon. Member for Guildford (Anne Milton) on his side, along with the hon. Member for Banbury (Tony Baldry). I respectfully suggest to the Health Secretary that he holds very tightly to the hand of the Minister of State, the hon. Member for Sutton and Cheam (Paul Burstow). It must seem a very long time ago that the Prime Minister said:
“I have been involved in designing these changes way back into opposition with Andrew Lansley. I take absolute responsibility with him for all the changes we are making.”
We will see just how long it is that the Prime Minister stands shoulder to shoulder with his Secretary of State.
There has been great excitement in SW1 bubble land on what effects the NHS reforms will have on the coalition and what the Lib Dems will do next, but the fundamental point is that it really does not matter what happens in SW1; what matters is what happens to our national health service. The Bill is a threat to our national health service. Leaving aside the political shenanigans and the saving of the Deputy Prime Minister or the Liberal Democrats’ soul, what is important is what happens to our national health service. We should be looking at the fundamental principles in relation to that. Everything else is just words, words, words. We are told that we must not rush GPs into consortia, but the
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majority of them have already been rushed into consortia and their PCTs are being abolished. If that is the extent of the fundamental reforms that the Liberal Democrats want, that would be very disappointing.
We in the Opposition have five tests: delete part 3 of the Bill; keep waiting time guarantees; ensure that consortia are not too small, involve wider expertise and require openness and accountability; ban GP bonuses, stop conflicts of interest and do not allow commissioning jobs to be done by the private sector; and keep a cap on the number of private beds. Let us do that, which would be a fundamental change to the Bill. Most importantly, let us delete part 3.
Instead of wasting time, energy and money on unnecessary top-down reorganisation, the Conservative party should have been building on Labour’s achievements. When we handed over the NHS to the Conservatives, we did so in trust. They should have built on our achievements. I am not saying that the NHS was perfect, but it was much better than it was when it was handed to us. These reckless, costly and ideologically driven reforms are not doing well for the health service. As the hon. Member for Totnes has said, while competition has a role, it is not an end in itself. If we allow competition to run rife within the NHS, it will fundamentally undermine its essence, which is that it is built on a culture of collaboration and co-operation. It is an expression of our fundamental commitment to equality.
6.28 pm
The Minister of State, Department of Health (Mr Simon Burns): At the instigation of the Opposition, we have spent the past three hours debating the future of the national health service, and yet in not one single speech from their Members did we hear any mention of what they would do for the future of the NHS. We heard from the right hon. Member for Holborn and St Pancras (Frank Dobson), who is always a joy to listen to. He objected to the Blair/Brown health service reforms and to our proposals to improve the NHS, apparently without fully understanding them. We heard speeches from the hon. Members for Pontypridd (Owen Smith) and for Easington (Grahame M. Morris) that were simply a continuation of what we had to listen to for eight long weeks in the Bill Committee.
We had a sensible and reasonable speech by my right hon. Friend the Member for Charnwood (Mr Dorrell). My hon. Friend the Member for Totnes (Dr Wollaston) made an interesting speech and was right—absolutely right—to encourage the greater integration and seamless provision of social care and health care, because that is so important.
We had an excellent speech from my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), which was based on his experiences of having worked in the national health service, and we had a good speech by my hon. Friend the Member for Stafford (Jeremy Lefroy), who raised a number of questions. Time does not permit me to answer them all, but I remind him that, because of my right hon. Friend the Secretary of State, the Care Quality Commission started an unannounced investigation of nursing in hospitals to look specifically at dignity, respect and safety.
During this debate there have been times when the facts seem to have been obscured, so it is time that we had a reality check: our population is ageing—in 20 years’
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time 2.5 million people will be over the age of 85; the cost of new medicines has almost doubled in the past 10 years, from £6.7 billion to £11.9 billion, rising last year alone by £600 million; and new surgical procedures are breathtakingly effective but expensive.
Those are the pressures facing the NHS at a time of economic turmoil inflicted on this country by the previous Labour Government. As a result, there are real challenges that the NHS must meet, so it does no one any good to scream “privatisation” as soon as we start exploring the best ways to safeguard the health of our children and of our children’s children. It is scaremongering of the lowest order, because this Government will never privatise the NHS. We have been, and we always will be, committed to an NHS free at the point of use for all eligible to use it.
In fact, when the Labour party was in government, it introduced private companies into the NHS on a scale that would have produced howls of outrage if we had done the same, but it was not privatisation then and it is not privatisation now. The previous Labour Government gave £4.7 billion to private companies in 2009-10 alone, and, unbelievably, to add insult to injury, £250 million of that money was given to private providers as payment for operations that never even happened.
We want to see a much fairer relationship, one that does not undermine the NHS but means increased choice for patients and better outcomes. That means saving thousands of lives every single year from conditions such as heart disease, respiratory disease and cancer. It means people with long-term conditions having their quality of life revolutionised with the seamless provision of care; the care that people receive being as good it possibly can be, based not on percentages or pie charts but on people’s real experiences; and the relationship between patients and doctors being humanised rather than seen as a means to an end—a relationship of equals based on trust, transparency and the best available treatment from the best available provider.
Every sensible-thinking person in the House knows that patient care can be improved if the NHS becomes more efficient. Efficient treatment is faster, cheaper and more effective. The previous Government knew that as well. We are carrying on their plans for £20 billion of efficiencies, plans that the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) brought in, whereby every penny saved will be reinvested in patient care.
To those who say that the plans are happening too fast, let me remind them that this coalition Government are giving the NHS an extra year to find those efficiencies, over and above what the Opposition would have allowed. On top of that, we are protecting front-line spending and, in fact, increasing the NHS budget overall in real terms.
We also want to see the quality of our clinical care improve so that a patient’s care will be among the best in the world, whatever they are being treated for. But these are not just pretty words and noble intentions; we are making real changes and patients can already see a real difference.
We are removing layers of unnecessary management so that clinicians have the freedom to look after in-patients rather than inboxes, and there are examples of improvements in care throughout the country. To look
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at just one, Oxford’s John Radcliffe hospital has invested in an electronic blood transfusion system that cuts the time taken by staff to deliver blood and reduces transfusion errors to improve services for patients. That saves the NHS £1 million every year to reinvest in patient care, because it is more efficient. That is the reality of efficiency, and it goes hand-in-hand with innovative, forward-thinking care.
Underpinning all our plans is the philosophy that a more integrated NHS is a better NHS—ending stop-start care and making sure that, from the point of diagnosis, every patient has seamless care that spans health care, social care, mental health care and, of course, a reliable support network afterwards so that patients can just concentrate on getting better.
We want GPs and other health care professionals, social care providers and local councils to come together to provide seamless services, whereby, for the patient, the lines drawn between those organisations fade to nothing. Giving autonomy to clinicians, in the form of consortia, will allow that to happen, and I hope that that reassures my hon. Friend the Member for Totnes.
Let us ask Dr Howard Stoate, who some Members might remember was Labour MP for Dartford until last May. [ Interruption. ] I know that the hon. Member for Islington South and Finsbury (Emily Thornberry) does not like this, but she will have to listen to it once again, because he is leading pathfinder consortia in Bexley. GPs such as Dr Stoate take a broader, more responsible view of care, working with others throughout the country and across primary, community and secondary care to manage, treat and refer their patients.
They are all in an ideal position to design services in collaboration with all the different strands of the NHS and, of course, with those beyond the NHS as well. Patients, who will have their own personal care budgets to spend how they like, will be involved every step of the way.
As I have said before, everyone knows that the NHS has to change. The noble Lord Warner, a Labour Health Minister for more than three years under the previous Government understands that point. [ Interruption. ] I am disappointed that the hon. Member for Leicester West (Liz Kendall) laughs, because at the time she thought that he was a valued Minister in the Department of Health. That point about change is in his book—a thoroughly good book, by the way, which I suggest she reads if she has not already done so. He says that reform is essential, because failure cannot be allowed to carry on taking taxpayers’ money and providing a sub-standard service to the public.
Reforming an organisation the size of the NHS is a big challenge, but it is also a big opportunity. What we propose is not simply to tread water or to be satisfied with the NHS just scraping by; we want to see it improve for the benefit of patients in every way.
There is no reason why we have to put up with care that is anything less than world-class, and our plans revolve around that happening: cutting down inefficiency; empowering clinicians; giving them—
Mr Alan Campbell (Tynemouth) (Lab) claimed to move the closure (Standing Order No. 36 ).
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Question put forthwith, That the Question be now put.
Main Question accordingly put.
The House divided:
Ayes 231, Noes 284.
[6.38 pm
AYES
Abbott, Ms Diane
Abrahams, Debbie
Alexander, rh Mr Douglas
Alexander, Heidi
Allen, Mr Graham
Anderson, Mr David
Ashworth, Jon
Austin, Ian
Bailey, Mr Adrian
Bain, Mr William
Balls, rh Ed
Banks, Gordon
Barron, rh Mr Kevin
Beckett, rh Margaret
Begg, Dame Anne
Bell, Sir Stuart
Benn, rh Hilary
Berger, Luciana
Betts, Mr Clive
Blackman-Woods, Roberta
Blears, rh Hazel
Blenkinsop, Tom
Blomfield, Paul
Blunkett, rh Mr David
Bradshaw, rh Mr Ben
Brennan, Kevin
Brown, Lyn
Brown, rh Mr Nicholas
Brown, Mr Russell
Bryant, Chris
Burnham, rh Andy
Byrne, rh Mr Liam
Campbell, Mr Alan
Campbell, Mr Ronnie
Caton, Martin
Chapman, Mrs Jenny
Clark, Katy
Clarke, rh Mr Tom
Clwyd, rh Ann
Coaker, Vernon
Coffey, Ann
Connarty, Michael
Cooper, Rosie
Cooper, rh Yvette
Corbyn, Jeremy
Creagh, Mary
Creasy, Stella
Cruddas, Jon
Cryer, John
Cunningham, Alex
Cunningham, Mr Jim
Cunningham, Tony
Curran, Margaret
Dakin, Nic
Danczuk, Simon
Darling, rh Mr Alistair
David, Mr Wayne
Davidson, Mr Ian
De Piero, Gloria
Denham, rh Mr John
Dobson, rh Frank
Docherty, Thomas
Donohoe, Mr Brian H.
Doran, Mr Frank
Dowd, Jim
Doyle, Gemma
Dromey, Jack
Dugher, Michael
Eagle, Ms Angela
Eagle, Maria
Edwards, Jonathan
Efford, Clive
Elliott, Julie
Ellman, Mrs Louise
Engel, Natascha
Esterson, Bill
Evans, Chris
Farrelly, Paul
Field, rh Mr Frank
Flint, rh Caroline
Flynn, Paul
Fovargue, Yvonne
Francis, Dr Hywel
Gapes, Mike
Gardiner, Barry
George, Andrew
Gilmore, Sheila
Glass, Pat
Glindon, Mrs Mary
Goggins, rh Paul
Goodman, Helen
Greatrex, Tom
Green, Kate
Greenwood, Lilian
Griffith, Nia
Gwynne, Andrew
Hain, rh Mr Peter
Hamilton, Mr David
Hamilton, Fabian
Hanson, rh Mr David
Harris, Mr Tom
Havard, Mr Dai
Healey, rh John
Hendrick, Mark
Hepburn, Mr Stephen
Hillier, Meg
Hilling, Julie
Hodge, rh Margaret
Hodgson, Mrs Sharon
Hoey, Kate
Hood, Mr Jim
Hopkins, Kelvin
Howarth, rh Mr George
Hunt, Tristram
Irranca-Davies, Huw
Jackson, Glenda
James, Mrs Siân C.
Jamieson, Cathy
Jarvis, Dan
Johnson, rh Alan
Johnson, Diana
Jones, Graham
Jones, Helen
Jones, Mr Kevan
Jones, Susan Elan
Jowell, rh Tessa
Joyce, Eric
Kaufman, rh Sir Gerald
Keeley, Barbara
Kendall, Liz
Khan, rh Sadiq
Lammy, rh Mr David
Lavery, Ian
Lazarowicz, Mark
Leslie, Chris
Lewis, Mr Ivan
Lloyd, Tony
Llwyd, rh Mr Elfyn
Lucas, Ian
Mactaggart, Fiona
Mahmood, Mr Khalid
Mahmood, Shabana
Mann, John
Marsden, Mr Gordon
McCabe, Steve
McCarthy, Kerry
McClymont, Gregg
McDonnell, John
McFadden, rh Mr Pat
McGovern, Alison
McGovern, Jim
McGuire, rh Mrs Anne
McKechin, Ann
McKinnell, Catherine
Meacher, rh Mr Michael
Mearns, Ian
Michael, rh Alun
Miliband, rh David
Miliband, rh Edward
Miller, Andrew
Mitchell, Austin
Moon, Mrs Madeleine
Morden, Jessica
Morrice, Graeme
(Livingston)
Morris, Grahame M.
(Easington)
Mudie, Mr George
Munn, Meg
Murphy, rh Paul
Murray, Ian
Nandy, Lisa
Nash, Pamela
O'Donnell, Fiona
Onwurah, Chi
Osborne, Sandra
Pearce, Teresa
Perkins, Toby
Phillipson, Bridget
Pound, Stephen
Qureshi, Yasmin
Raynsford, rh Mr Nick
Reed, Mr Jamie
Reeves, Rachel
Reynolds, Emma
Riordan, Mrs Linda
Robertson, John
Robinson, Mr Geoffrey
Rotheram, Steve
Roy, Mr Frank
Roy, Lindsay
Ruane, Chris
Ruddock, rh Joan
Sarwar, Anas
Seabeck, Alison
Sharma, Mr Virendra
Sheerman, Mr Barry
Shuker, Gavin
Skinner, Mr Dennis
Slaughter, Mr Andy
Smith, rh Mr Andrew
Smith, Nick
Smith, Owen
Spellar, rh Mr John
Straw, rh Mr Jack
Stringer, Graham
Stuart, Ms Gisela
Sutcliffe, Mr Gerry
Tami, Mark
Thomas, Mr Gareth
Thornberry, Emily
Timms, rh Stephen
Trickett, Jon
Turner, Karl
Twigg, Derek
Twigg, Stephen
Umunna, Mr Chuka
Vaz, rh Keith
Vaz, Valerie
Walley, Joan
Watson, Mr Tom
Watts, Mr Dave
Whitehead, Dr Alan
Wicks, rh Malcolm
Williams, Hywel
Williamson, Chris
Wilson, Phil
Winnick, Mr David
Winterton, rh Ms Rosie
Wood, Mike
Woodward, rh Mr Shaun
Wright, David
Wright, Mr Iain
Tellers for the Ayes:
Angela Smith and
Jonathan Reynolds
NOES
Adams, Nigel
Afriyie, Adam
Aldous, Peter
Amess, Mr David
Andrew, Stuart
Arbuthnot, rh Mr James
Bacon, Mr Richard
Baker, Norman
Baker, Steve
Baldry, Tony
Baldwin, Harriett
Barker, Gregory
Baron, Mr John
Barwell, Gavin
Bebb, Guto
Beresford, Sir Paul
Binley, Mr Brian
Birtwistle, Gordon
Blackman, Bob
Blackwood, Nicola
Blunt, Mr Crispin
Boles, Nick
Bone, Mr Peter
Bottomley, Sir Peter
Bradley, Karen
Brady, Mr Graham
Brake, Tom
Bray, Angie
Brazier, Mr Julian
Bridgen, Andrew
Brine, Mr Steve
Brokenshire, James
Browne, Mr Jeremy
Bruce, Fiona
Bruce, rh Malcolm
Buckland, Mr Robert
Burley, Mr Aidan
Burns, Conor
Burns, rh Mr Simon
Burstow, Paul
Byles, Dan
Cable, rh Vince
Cairns, Alun
Campbell, rh Sir Menzies
Carmichael, rh Mr Alistair
Carmichael, Neil
Carswell, Mr Douglas
Cash, Mr William
Clark, rh Greg
Clifton-Brown, Geoffrey
Coffey, Dr Thérèse
Collins, Damian
Colvile, Oliver
Cox, Mr Geoffrey
Crabb, Stephen
Crouch, Tracey
Davey, Mr Edward
Davies, David T. C.
(Monmouth)
Davies, Glyn
Davies, Philip
Davis, rh Mr David
Djanogly, Mr Jonathan
Dorrell, rh Mr Stephen
Dorries, Nadine
Doyle-Price, Jackie
Drax, Richard
Duddridge, James
Duncan, rh Mr Alan
Duncan Smith, rh Mr Iain
Ellis, Michael
Ellison, Jane
Ellwood, Mr Tobias
Elphicke, Charlie
Eustice, George
Evans, Graham
Evans, Jonathan
Evennett, Mr David
Fabricant, Michael
Fallon, Michael
Farron, Tim
Featherstone, Lynne
Field, Mr Mark
Foster, rh Mr Don
Fox, rh Dr Liam
Francois, rh Mr Mark
Freeman, George
Fuller, Richard
Gale, Mr Roger
Garnier, Mr Edward
Gauke, Mr David
George, Andrew
Gibb, Mr Nick
Gillan, rh Mrs Cheryl
Glen, John
Goldsmith, Zac
Goodwill, Mr Robert
Gove, rh Michael
Grant, Mrs Helen
Gray, Mr James
Green, Damian
Greening, Justine
Grieve, rh Mr Dominic
Gummer, Ben
Gyimah, Mr Sam
Halfon, Robert
Hames, Duncan
Hammond, Stephen
Hancock, Matthew
Hands, Greg
Harper, Mr Mark
Harris, Rebecca
Harvey, Nick
Haselhurst, rh Sir Alan
Heath, Mr David
Heaton-Harris, Chris
Hemming, John
Henderson, Gordon
Herbert, rh Nick
Hinds, Damian
Hoban, Mr Mark
Hollingbery, George
Hollobone, Mr Philip
Hopkins, Kris
Howarth, Mr Gerald
Howell, John
Hughes, rh Simon
Huhne, rh Chris
Hurd, Mr Nick
Jackson, Mr Stewart
James, Margot
Javid, Sajid
Johnson, Gareth
Johnson, Joseph
Jones, Andrew
Jones, Mr David
Jones, Mr Marcus
Kawczynski, Daniel
Kelly, Chris
Kirby, Simon
Kwarteng, Kwasi
Laing, Mrs Eleanor
Lamb, Norman
Lancaster, Mark
Lansley, rh Mr Andrew
Leadsom, Andrea
Lee, Jessica
Lee, Dr Phillip
Leech, Mr John
Lefroy, Jeremy
Leigh, Mr Edward
Leslie, Charlotte
Letwin, rh Mr Oliver
Lewis, Brandon
Lewis, Dr Julian
Liddell-Grainger, Mr Ian
Lidington, rh Mr David
Lloyd, Stephen
Lopresti, Jack
Loughton, Tim
Lumley, Karen
Macleod, Mary
Main, Mrs Anne
Maynard, Paul
McCartney, Jason
McIntosh, Miss Anne
McLoughlin, rh Mr Patrick
McPartland, Stephen
McVey, Esther
Menzies, Mark
Metcalfe, Stephen
Miller, Maria
Mills, Nigel
Milton, Anne
Mitchell, rh Mr Andrew
Moore, rh Michael
Mordaunt, Penny
Morgan, Nicky
Morris, Anne Marie
Morris, James
Mosley, Stephen
Mowat, David
Mundell, rh David
Munt, Tessa
Murray, Sheryll
Murrison, Dr Andrew
Neill, Robert
Newmark, Mr Brooks
Newton, Sarah
Nokes, Caroline
Norman, Jesse
Nuttall, Mr David
O'Brien, Mr Stephen
Ollerenshaw, Eric
Osborne, rh Mr George
Ottaway, Richard
Paice, rh Mr James
Parish, Neil
Patel, Priti
Paterson, rh Mr Owen
Pawsey, Mark
Penning, Mike
Penrose, John
Perry, Claire
Phillips, Stephen
Pickles, rh Mr Eric
Pincher, Christopher
Poulter, Dr Daniel
Prisk, Mr Mark
Raab, Mr Dominic
Randall, rh Mr John
Reckless, Mark
Redwood, rh Mr John
Rees-Mogg, Jacob
Rifkind, rh Sir Malcolm
Robathan, rh Mr Andrew
Robertson, Mr Laurence
Rogerson, Dan
Rosindell, Andrew
Rudd, Amber
Ruffley, Mr David
Russell, Bob
Rutley, David
Sandys, Laura
Scott, Mr Lee
Selous, Andrew
Sharma, Alok
Shelbrooke, Alec
Shepherd, Mr Richard
Simmonds, Mark
Simpson, Mr Keith
Skidmore, Chris
Smith, Miss Chloe
Smith, Julian
Smith, Sir Robert
Soames, Nicholas
Soubry, Anna
Spelman, rh Mrs Caroline
Spencer, Mr Mark
Stanley, rh Sir John
Stephenson, Andrew
Stevenson, John
Stewart, Bob
Stewart, Iain
Stewart, Rory
Streeter, Mr Gary
Stride, Mel
Stuart, Mr Graham
Stunell, Andrew
Sturdy, Julian
Swayne, Mr Desmond
Syms, Mr Robert
Tapsell, Sir Peter
Teather, Sarah
Timpson, Mr Edward
Tomlinson, Justin
Truss, Elizabeth
Turner, Mr Andrew
Tyrie, Mr Andrew
Uppal, Paul
Vara, Mr Shailesh
Vickers, Martin
Villiers, rh Mrs Theresa
Walker, Mr Charles
Walker, Mr Robin
Wallace, Mr Ben
Watkinson, Angela
Weatherley, Mike
Webb, Steve
Wharton, James
Wheeler, Heather
White, Chris
Whittaker, Craig
Whittingdale, Mr John
Wiggin, Bill
Willetts, rh Mr David
Williams, Stephen
Williamson, Gavin
Willott, Jenny
Wilson, Mr Rob
Wollaston, Dr Sarah
Wright, Jeremy
Wright, Simon
Young, rh Sir George
Zahawi, Nadhim
Tellers for the Noes:
Mark Hunter and
Mr Philip Dunne
Question accordingly negatived.
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9 May 2011 : Column 965
9 May 2011 : Column 966
Welfare Reform Bill (Instruction)
6.55 pm
The Parliamentary Under-Secretary of State for Work and Pensions (Maria Miller): I beg to move,
That it be an instruction to the Welfare Reform Bill Committee that it has power to make provision in the Bill to establish the Social Mobility and Child Poverty Commission.
This debate is focused on the motion and I do not intend to go through the purpose and effect of the proposed new clause in detail. Members will have the opportunity to debate the measure in full in the remaining stages of the Welfare Reform Bill, including in Committee. However, it may help hon. Members if I set out the Government’s reasons for this change.
We need to be sure that we have the right structures in place to hold the Government to account on child poverty. The previous Government attempted to do that by enshrining in law a child poverty commission. The commission was intended to provide independent scrutiny and to ensure that progress would continue to be made by Government. We supported and still support the concept of an arm’s length body to provide such an external challenge to Government. However, having considered carefully how best to establish the commission to ensure that it can fulfil that purpose, we do not believe that the child poverty commission, as currently defined in legislation, has the necessary remit or power to perform that function effectively.
Why do we want to change the commission? There are three reasons, which I will outline for the House. First, the commission cannot assess or comment on the progress made by Government on child poverty, meaning that it has no power to hold the Government to account. Secondly, we believe that the commission’s advisory role undermines accountability and provides Ministers with a means to delegate decision making to an arm’s length body. For a Government to consult on an important policy matter is absolutely proper, but responsibility should ultimately rest with Ministers. Finally, the scope of the commission is simply too narrow and does not cover issues that are crucially related to child poverty, such as life chances and social mobility. As I have said, this debate is not the place to go into the detail of the proposed new clause. It is intended to address the concerns that I have raised and to ensure that the commission has the functions and power that it needs to drive progress effectively and hold the Government to account.
It is appropriate to use the Welfare Reform Bill to make this change because helping people who are dependent on welfare to help themselves is one of its key aims. The reforms are designed to do that in two distinct ways. First, by ensuring that work always pays and is seen to pay, they will improve work incentives for people who are out of work. Secondly, by simplifying the benefits system, they will increase the take-up of benefits. It is therefore appropriate to use this Bill to make other legislative changes that allow the Government to take forward their new approach to tackling disadvantage, deprivation and welfare dependency in our society, such as these revisions to the child poverty commission.
Why is it necessary to make these changes now? We felt that it was important to consult stakeholders before making changes to the commission. We therefore decided to include our thoughts on the commission in our child
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poverty strategy consultation document, which was published in December last year. The consultation closed this February, after which it was necessary to consider the responses before deciding how the commission should be revised. Given that time scale, it was not possible to include the proposed new clause in the original version of the Welfare Reform Bill. Since then, we have set out clearly the changes that we wish to make to the commission and emphasised the need for it to be established as soon as possible. If we had waited for a second-Session Bill to put the required changes to the House, it is possible that a commission would not have been established until 2013, and we do not believe that delay is acceptable.
I restate that our intention is to move a new clause to the Bill, amending the Child Poverty Act 2010 by inserting a new section 8 and corresponding schedule. The new provisions will extend to England and Wales, Scotland and Northern Ireland. We believe that the motion will give us the opportunity to create a stronger and more effective commission, and I commend it to the House.
7 pm
Margaret Curran (Glasgow East) (Lab): I thank the Minister for her contribution, and I wish to make a few comments in response. On behalf of Labour I welcome the Government’s motion, and we look forward to the full debate in Committee about the substance of their proposals. However, we are disappointed that we must have that debate in the Welfare Reform Bill Committee, because as she will be aware, a child poverty strategy has been published and there have been a number of criticisms of it. It would perhaps have been better if the commission had been set up first, to inform that strategy. I will return to that point, because that situation perhaps explains why there have been so many comments that the child poverty strategy is insubstantial. I appreciate that the substance of those comments will be featured in Committee, but if I may I wish to make one or two points about issues that the Committee will cover as it examines the Government’s proposals.
The child poverty commission was a significant element of the Child Poverty Act 2010, which received cross-party support and was regarded as a landmark piece of legislation. It was to be a commission of status and influence, which would be evidence-led, examine different approaches, engage with those with direct experience, harness the experts’ views and, as the Minister indicated, work with the devolved Administrations. I hope that when the Committee has discussed the matter, she will ensure that the commission does exactly that.
I am sure the Minister is aware of the substantial point that some child poverty organisations have made in questioning the legality of the Government’s approach to date, given the status of the 2010 Act. They say that because the child poverty strategy has been produced before the setting up of the commission, the Government are acting illegally. I hope she will address that point.
The broadest point that needs to be made is about the Government’s decision to widen the scope of the commission from purely being about child poverty to also embracing social mobility. I appreciate the substance of the argument about social mobility, policy on which underpins any Government action. Of course there are links between child poverty and social mobility, and as I understand it the commission would already have had powers to examine those links. However, the Minister will appreciate that broadening the scope of the commission
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so far has raised many concerns among organisations, and indeed among many Labour Members. There are links between child poverty and social mobility, but they are not the same thing. There is deep concern that including social mobility means that the commission will lose its edge and its focus on dealing with child poverty. It may well dilute the urge to tackle child poverty.
I have a number of questions to put to the Minister. Given that the matter is now going to the Welfare Reform Bill Committee, may I ask that the commission be established urgently and that there be no further delay? Once its scope has been established, it should go ahead. Will the Minister consult the devolved Administrations on their wider child poverty strategies as a matter of urgency? May we have a guarantee that commitments on child poverty will not be delayed or watered down because of the extension of the commission’s scope to social mobility?
May we have clarity on what the Government’s child poverty targets actually are? The Minister will know that the Prime Minister made a categorical and unequivocal commitment to maintaining relative poverty income measurements. Can she guarantee that that will still be central to the Government’s proposals? Finally, can she guarantee that the commission will retrospectively examine the already published child poverty strategy so that its fundamental weaknesses can be addressed and we can have an altogether more substantial plan? I appreciate that the meat of the subject will be discussed in Committee, but given that we are making a decision this afternoon on whether to enable the Committee to establish the commission, it would be very helpful if she addressed those points.
7.5 pm
Kate Green (Stretford and Urmston) (Lab): I very much look forward to a full debate on the merits of the Government’s proposal in the remaining stages of the Welfare Reform Bill if the instruction is agreed to. However, I cannot wholly share the Minister’s reasoning on why it is appropriate to approach the expansion of the child poverty commission’s remit in this way.
The Minister said that allocating an advisory role to an arm’s length body would in some way weaken the Government’s accountability. I am confused about why advising should mean becoming responsible, and no doubt she will want to explain that. However, I welcome her acknowledgment of the importance of wide consultation. I hope that that will continue to be the case on the subject of the expanded remit that we are discussing.
I believe the Minister is mistaken to think that the planned child poverty commission would have had as limited a remit as she seemed to imply. As she acknowledged, the 2010 Act and the functions and remit of the commission had cross-party support, and the Act uses a wide understanding of what child poverty encompasses. That includes a number of the building blocks of social mobility, including on parenting, housing and education, that she seems to suggest would be missed. I hope that she can assure us that when the debate is passed on to the Welfare Reform Bill Committee, with its much narrower remit of considering employment and social security reforms, the vital focus on child well-being in its broadest sense will not be lost. That is what child poverty measures are fundamentally intended to address and improve.