Amendments made: 205, page 165, line 25, for subsection (1) substitute—
‘(1) In section 65K of the National Health Service Act 2006 (Secretary of State’s decision on what action to take), in subsection (1), after “a final report under section 65I” insert “relating to an NHS trust”; and in consequence of that, for the title to that section substitute “Secretary of State’s decision in case of NHS trust”.
(1A) After that section insert—
“65KA Regulator’s decision in case of NHS foundation trust
(1) Within the period of 20 working days beginning with the day on which the regulator receives a final report under section 65I relating to an NHS foundation trust, the regulator must decide whether it is satisfied—
(a) that the action recommended in the final report would achieve the objective set out in section 65DA, and
(b) that the trust special administrator has carried out the administration duties.
(2) In subsection (1)(b), “administration duties” means the duties imposed on the administrator by—
(b) a direction under this Chapter, or
(c) the administrator’s terms of appointment.
(3) If the regulator is satisfied as mentioned in subsection (1), it must as soon as reasonably practicable provide to the Secretary of State—
(b) the report provided to the regulator by the Care Quality Commission under section 65D(3).
(4) If the regulator is not satisfied as mentioned in subsection (1), it must as soon as reasonably practicable give a notice of that decision to the administrator.
(5) Where the regulator gives a notice under subsection (4), sections 65F to 65J apply in relation to the trust to such extent, and with such modifications, as the regulator may specify in the notice.
(6) The regulator must as soon as reasonably practicable after giving a notice under subsection (4)—
(b) lay a copy of it before Parliament.
65KB Secretary of State’s response to regulator’s decision
‘(1) Within the period of 30 working days beginning with the day on which the Secretary of State receives the reports referred to in section 65KA(3), the Secretary of State must decide whether the Secretary of State is satisfied—
(a) that the persons to which the NHS foundation trust in question provides services under this Act have discharged their functions for the purposes of this Chapter,
(b) that the trust special administrator has carried out the administration duties (within the meaning of section 65KA(1)(b)),
(c) that the regulator has discharged its functions for the purposes of this Chapter,
(d) that the action recommended in the final report would secure the continued provision of the services provided by the trust to which the objective set out in section 65DA applies,
(e) that the recommended action would secure the provision of services that are of sufficient safety and quality to be provided under this Act, and
(f) that the recommended action would provide good value for money.
6 Sep 2011 : Column 272
(2) If the Secretary of State is not satisfied as mentioned in subsection (1), the Secretary of State must as soon as reasonably practicable—
(a) give the trust special administrator a notice of the decision and of the reasons for it;
(b) give a copy of the notice to the regulator;
(d) lay a copy of it before Parliament.
65KC Action following Secretary of State’s rejection of final report
‘(1) Within the period of 20 working days beginning with the day on which the trust special administrator receives a notice under section 65KB(2), the administrator must provide to the regulator the final report varied so far as the administrator considers necessary to secure that the Secretary of State is satisfied as mentioned in section 65KB(1).
(2) Where the administrator provides to the regulator a final report under subsection (1), section 65KA applies in relation to the report as it applies in relation to a final report under section 65I; and for that purpose, that section has effect as if—
(a) in subsection (1), for “20 working days” there were substituted “10 working days”, and
(b) subsection (3)(b) were omitted.
(3) If the Secretary of State thinks that, in the circumstances, it is not reasonable for the administrator to be required to carry out the duty under subsection (1) within the period mentioned in that subsection, the Secretary of State may by order extend the period.
(4) If an order is made under subsection (3), the administrator must—
(a) publish a notice stating the date on which the period will expire, and
(b) where the administrator is proposing to carry out consultation in response to the notice under section 65KB(2), publish a statement setting out the means by which the administrator will consult during the extended period.
65KD Secretary of State’s response to re-submitted final report
‘(1) Within the period of 30 working days beginning with the day on which the Secretary of State receives a final report under section 65KA(3) as applied by section 65KC(2), the Secretary of State must decide whether the Secretary of State is, in relation to the report, satisfied as to the matters in 65KB(1)(a) to (f).
(2) If the Secretary of State is not satisfied as mentioned in subsection (1), the Secretary of State must as soon as reasonably practicable—
(a) publish a notice of the decision and the reasons for it;
(b) lay a copy of the notice before Parliament.
(3) Where the Secretary of State publishes a notice under subsection (2)(a), subsections (4) to (8) apply.
(4) If the notice states that the Board has failed to discharge a function—
(a) the Board is to be treated for the purposes of this Act as having failed to discharge the function, and
(b) the failure is to be treated for those purposes as significant (and section 13Z1 applies accordingly).
(5) If the notice states that a clinical commissioning group has failed to discharge a function—
(a) the group is to be treated for the purposes of this Act as having failed to discharge the function,
(b) the Secretary of State may exercise the functions of the Board under section 14Z19(2), (3)(a) and (8)(a), and
(c) the Board may not exercise any of its functions under section 14Z19.
6 Sep 2011 : Column 273
(6) Where, by virtue of subsection (5)(b), the Secretary of State exercises the function of the Board under subsection (3)(a) of section 14Z19, subsection (9)(a) of that section applies but with the substitution for the references to the Board of references to the Secretary of State.
(7) If the notice states that the trust special administrator has failed to discharge the administration duties (within the meaning of section 65KA(1)(b))—
(a) the administration duties are to be treated for the purposes of this Act as functions of the regulator,
(b) the regulator is to be treated for the purposes of this Act as having failed to discharge those functions, and
(c) the failure is to be treated for those purposes as significant (and section 66 of the Health and Social Care Act 2011 applies accordingly, but with the omission of subsection (3)).
(8) If the notice states that the regulator has failed to discharge a function—
(a) the regulator is to be treated for the purposes of this Act as having failed to discharge the function, and
(b) the failure is to be treated for those purposes as significant (and section 66 of the Health and Social Care Act 2011 applies accordingly, but with the omission of subsection (3)).
(9) Within the period of 60 working days beginning with the day on which the Secretary of State publishes a notice under subsection (2)(a), the Secretary of State must decide what action to take in relation to the trust.
(10) The Secretary of State must as soon as reasonably practicable—
(a) publish a notice of the decision and the reasons for it;
(b) lay a copy of the notice before Parliament.”’.
206, page 166, line 8, leave out from ‘insert’ to ‘to’ in line 12 and insert ‘—
“(2A) For the purposes of subsection (1) in its application to the case of an NHS foundation trust, the reference to section 65K is to be read as a reference to section 65KD(9); and this section also applies in the case of an NHS foundation trust if—
(a) the Secretary of State is satisfied as mentioned in section 65KB(1) or 65KD(1) in relation to the trust, and
(b) the action recommended in the final report is to do something other than dissolve the trust.
(2B) For the purposes of subsection (2) in its application to the case of an NHS foundation trust—
(a) the reference to the Secretary of State is to be read as a reference’.
207, page 166, line 23, at end insert—
‘( ) After that section insert—
(a) the Secretary of State is satisfied as mentioned in section 65KB(1) or 65KD(1), and
(b) the action recommended in the final report is to dissolve the NHS foundation trust in question.
(2) This section also applies if the Secretary of State decides under section 65KD(9) to dissolve the NHS foundation trust in question.
(3) The regulator may make an order—
(b) transferring, or providing for the transfer of, the property and liabilities of the trust—
(i) to another NHS foundation trust or the Secretary of State, or
(ii) between another NHS foundation trust and the Secretary of State.
6 Sep 2011 : Column 274
(4) An order under subsection (3) may include provision for the transfer of employees of the trust.
(5) The liabilities that may be transferred to an NHS foundation trust by virtue of subsection (3)(b) include criminal liabilities.”
( ) For the cross-heading preceding section 65K substitute “Action by the Secretary of State and the regulator”.’.—(Mr Simon Burns)
Amendments made: 208, page 166, line 29, at end insert—
‘( ) In section 65N of that Act (power to issue guidance), after subsection (2) insert—
(2A) It must include guidance about the publication of—
(a) notices under section 65KC(4)(a);
(b) statements under section 65KC(4)(b).”’.
209, page 166, line 38, leave out ‘65K or 65L’ and insert ‘65L or 65LA’.
210, page 166, line 40, at end insert—
‘(ia) a copy of any notice published under section 65F, 65H, 65J, 65KA, 65KB or 65KD,’.
211, page 166, leave out line 42.
212, page 167, line 15, leave out ‘65K(4)’ and insert ‘65 (KC)(3)’.
213, page 167, line 15, before ‘and’, insert—
‘() after “65L(2) or (4)” insert “65LA(3)”,’.
214, page 167, line 21, leave out ‘65K’ and insert ‘65LA’.
215, page 167, line 23, at end insert—
‘(ia) a copy of any notice published under section 65F, 65H, 65J, 65KA, 65KB or 65KD,’.
216, page 167, leave out line 25.—(Mr Simon Burns)
Amendment made: 217, page 167, line 31, leave out clause 181.—(Mr Simon Burns)
Amendment made: 218, page 168, line 31, leave out paragraphs (b) and (c).—(Mr Simon Burns)
Amendments made: 219, page 169, line 2, after ‘liabilities)’ insert ‘; in consequence of that, omit section 95 of this Act (licences to provide health care services: NHS foundation trusts)’.
220, page 169, line 10, after ‘Act’ insert ‘, and section 95(1) and (2) of this Act,’.—(Mr Simon Burns)
6 Sep 2011 : Column 275
Amendment made: 366, page 367, line 31, at end insert—
‘Equality Act 2010 (c.15)
In Part 1 of Schedule 19 to the Equality Act 2010 (bodies subject to public sector equality duty), for the entry for the Independent Regulator of NHS Foundation Trusts substitute “Monitor”.’.—
(Mr Simon Burns)
Amendments made: 367, page 368, line 26, leave out from ‘section’ to end of line 27 and insert ‘56 (mergers of NHS foundation trusts)—
(a) in subsection (1)(b) (as amended by section171(1)(a)), omit “or an NHS trust established under section 25”’.
368, page 368, line 27, at end insert ‘, and
(b) in subsection (1A) (as inserted by section171(2)), omit “(that is an NHS foundation trust)”.’.
369, page 368, line 28, leave out from ‘section’ to end of line 30 and insert ‘56A (acquisitions of NHS foundation trusts) (as inserted by section172)—
(a) in subsection (1)(b), omit “or an NHS trust established under section 25”’.
370, page 368, line 30, at end insert ‘, and
(b) in subsection (2), omit “(that is an NHS foundation trust)”.’.
371, page 368, line 40, leave out paragraph 13 and insert—
13 (1) Omit section 65B (appointment of trust special administrator in relation to NHS trust).
(2) In consequence of that repeal, omit section 177(1A) of this Act.’.
372, page 368, line 43, at end insert—
13A Omit section 65C (suspension of directors of NHS trust).
13B (1) Section 65F (special administrator’s draft report) is amended as follows.
(2) In subsection (1), for “the Secretary of State”, in each place it appears, substitute “the regulator”.
(b) for “the Secretary of State” substitute “the regulator”.
(4) After subsection (2) insert—
“(2A) The administrator may not provide the draft report to the regulator under subsection (1)—
(a) without having obtained from each commissioner a statement that the commissioner considers that the recommendation in the draft report would achieve the objective set out in section 65DA, or
(b) where the administrator does not obtain a statement to that effect from one or more commissioners (other than the Board), without having obtained a statement to that effect from the Board.
(2B) Where the Board decides not to provide to the administrator a statement to that effect, the Board must—
(a) give a notice of the reasons for its decision to the administrator and to the regulator;
(c) lay a copy of it before Parliament.
6 Sep 2011 : Column 276
(2C) In subsection (2A), “commissioner” means a person to which the trust provides services under this Act.”
(5) In subsection (3), for “the Secretary of State” substitute “the regulator”.
(6) Omit subsections (4) to (7).
(7) In consequence of those repeals, omit section 178(2) of this Act.
13C In section 65G (consultation plan), in subsection (4), omit “In the case of an NHS foundation trust,”.
13D (1) Section 65H (consultation on draft report) is amended as follows.
(a) in paragraph (b), omit “goods or”, and
(b) in paragraphs (c) and (d), for “the Secretary of State” substitute “the regulator”.
(3) In subsection (10), for “The Secretary of State” substitute “The regulator”.
(4) After that subsection insert —
“(10A) The Secretary of State may direct the regulator as to persons from whom it should direct the administrator under subsection (10) to request or seek a response.”
(5) Omit subsections (12) and (13).
(6) In consequence of those repeals, omit section 178(5) of this Act.
13E (1) Section 65I (administrator’s final report) is amended as follows.
(2) In subsection (1), for “the Secretary of State”, in each place it appears, substitute “the regulator”.
(3) In subsection (3), for “the Secretary of State” substitute “the regulator”.
(5) In consequence of that repeal, omit section 178(6) of this Act.
13F (1) Section 65J (power to extend time limits) is amended as follows.
(2) In subsection (2), for “the Secretary of State”, in each place it appears, substitute “the regulator”.
(4) In consequence of that repeal, omit section 178(7) of this Act.
13G (1) Omit section 65K (decision on action to take in relation to the trust) and the preceding cross-heading.
(2) In consequence of those repeals, omit section 179(1) of this Act.
13H (1) Section 65KA (regulator’s decision in case of NHS foundation trust) is amended as follows.
(2) In subsection (1), omit “relating to an NHS foundation trust”.
(3) In subsection (5), for “the trust” substitute “the NHS foundation trust in question”.
(4) For the title to that section substitute “The regulator’s decision”.
(5) Before that section, insert as a cross-heading “Action by the regulator and the Secretary of State”.
13I (1) Section 65L (trusts coming out of administration) is amended as follows.
(a) for “65K” substitute “65KB(2) or 65KD(2) or (9)”, and
(b) for “the trust” substitute “the NHS foundation trust in question”.
(a) for “The Secretary of State” substitute “The regulator”, and
6 Sep 2011 : Column 277
(b) for “and directors” substitute “, directors and governors”.
(4) Omit subsections (2A), (2B) and (6).
(5) In consequence of the repeal of subsections (2A) and (2B) of that section, omit section 179(2) of this Act.
13J (1) Section 65M (replacement of special administrator) is amended as follows.
(2) In subsection (1), for “the Secretary of State”, in each place it appears, substitute “the regulator”.
(3) In subsection (2), for “the Secretary of State” substitute “the regulator”.
(5) In consequence of that repeal, omit section 180(1) of this Act.
13K (1) Section 65N (guidance) is amended as follows.
(2) In subsection (1), for “The Secretary of State” substitute “The regulator”.
(4) In consequence of that repeal, omit section 180(2) of this Act.’.—(Mr Simon Burns)
‘(1) Section 117 ceases to have effect in relation to an NHS foundation trust on 1 April 2016 unless—
(a) before that date, the Secretary of State provides by order for that section to continue to have effect in relation to the trust, or
(b) the trust was authorised after 1 April 2014.
(2) An order under this section may provide that section 117 is to continue to have effect for such period as is specified—
(a) in relation to all NHS foundation trusts, or
(b) in relation only to such NHS foundation trusts as are specified.
(3) But an order under this section may not apply to a trust in relation to which section 117 has, by virtue of a previous order under this section, ceased to have effect.
(4) A period specified for the purposes of subsection (2)—
(a) must begin with the day on which section117 would, but for the order, cease to have effect in relation to the trusts to which the order applies, and
(b) must not exceed two years.
(5) In the case of a trust to which an order under this section applies, and which was authorised on or before 1 April 2014, section 117 ceases to have effect in relation to the trust in accordance with that order or any subsequent orders under this section which apply to the trust.
(6) In the case of a trust which was authorised after 1 April 2014 (including a trust authorised on or after 1 April 2016 if, at the time it is authorised, section 117 still has effect), section 117 ceases to have effect in relation to the trust—
(a) if no order under this section is made before the end of the initial two-year period, at the end of that period;
(b) if an order under this section is made in reliance on subsection (2)(a) before the end of the initial two-year period, on whichever is the later of—
(i) the end of that period, and
(ii) the day on which that order or a subsequent order under this section ceases to apply to the trust;
(c) if an order under this section is made in reliance on subsection (2)(b) before the end of the initial two-year period, in accordance with section [Orders under section [Duration of transitional period] that apply to only some trusts](8) to (11).
(7) In this section and section [Orders under section [Duration of transitional period] that apply to only some trusts]—
6 Sep 2011 : Column 278
(a) “the initial two-year period”, in relation to an NHS foundation trust, is the period of two years beginning with the day on which the trust is authorised;
(b) a reference to being authorised is a reference to being given an authorisation under section 35 of the National Health Service Act 2006.
(8) Section 117 is repealed as soon as there are—
(a) no NHS foundation trusts in relation to which it has effect, and
(b) no NHS trusts in existence (whether because they had all ceased to exist without section182 having come into force or there are none continuing in existence by virtue of subsection (3) of that section).’.—(Paul Burstow.)
Brought up, and read the First time.
9 pm
The Minister of State, Department of Health (Paul Burstow): I beg to move, That the clause be read a Second time.
Madam Deputy Speaker (Dawn Primarolo): With this it will be convenient to discuss the following:
Government new clause 4—Orders under section [Duration of transitional period] that apply to only some trusts.
Government new clause 5—Repeal of sections [Duration of transitional period] and [Orders under section [Duration of transitional period] that apply to only some trusts].
Government amendments 88, 89 and 108 to 112.
Amendment 17, in clause 117, page 122, line 3, leave out subsection (12).
Government amendments 282 and 285.
Paul Burstow: These Government amendments will make important changes to extend Monitor’s intervention powers over all foundation trusts until 2016. This would give additional time for foundation trusts’ governors to build the capability that they need to be able to hold their boards to account.
As my right hon. Friend the Secretary of State has described, through part 3 of the Bill, Monitor as the sector regulator would have permanent intervention powers over all providers, including foundation trusts. These will allow it to fulfil its duty to protect and promote the patient’s interest and its functions include supporting commissioners in securing continuity of services. That is why we believe that Opposition amendment 17 is not only ineffective, based as it is on non-existent terms of authorisation, but also redundant.
My right hon. Friend the Secretary of State has already confirmed that we agree that it is essential that Monitor, as health sector regulator, can take action to secure patients’ continued access to NHS services, and our plans ensure this. Monitor would have powers under its licensing regime to require a provider to take specific actions if it gets into difficulties. These will be effective safeguards to protect patients’ and taxpayers’ interests, and will support commissioners in securing continued access to services that patients depend on for their care. I hope, therefore, that the hon. Members who tabled the amendment will not press it.
However, the NHS Future Forum raised concerns about the current readiness of foundation trust governors to take on the strengthened role that the Bill provides
6 Sep 2011 : Column 279
for them in holding foundation trusts to account as autonomous NHS providers. In response, the Government have agreed that Monitor’s intervention powers should apply to all foundation trusts until 2016, to allow time for their governance arrangements to become fully effective. The amendments provide for the transitional powers to continue until 2016. They also make corresponding amendments to clause 117 on licence conditions supporting use of the powers, and remove clause 116, about identifying which foundation trusts would be subject to the powers.
The amendments do not change the nature of the transitional intervention powers set out in clause 117. Monitor will continue to have the power to remove or suspend members of the board of directors or members of the council of governors. Monitor would also be able to direct a foundation trust to do or not to do specific things within a specified timetable. These powers are similar to those currently available to Monitor in its role as foundation trust regulator, and would allow Monitor to continue to protect the taxpayers’ interest in foundation trusts.
The powers go beyond those that Monitor would have over all providers, under part 3, as sector regulator. They will help to ensure a smooth transition from the current arrangements for NHS foundation trusts. The amendments would allow the Secretary of State to seek further parliamentary agreement to extend the powers beyond 2016 for all or some foundation trusts for up to two years at a time. That power could be used, for example, if there was a significant remaining concern about the governance of some foundation trusts.
If it were decided to extend the powers for some, but not all, foundation trusts, Monitor would be required to go through a process similar to that originally envisaged in clause 116. It would have to publish the criteria that it would use to decide which foundation trusts would remain subject to its intervention powers. Those criteria would be subject to consultation and would require approval from the Secretary of State. The amendments will ensure that the transitional regime proposed in the Bill provides a more secure safety net while foundation trust governors develop the skills and capabilities necessary to hold their boards to account.
The amendments would enable Monitor to rectify avoidable difficulties at a foundation trust while foundation trust governance arrangements developed, ahead of normal regulatory intervention through the licensing regime. They also provide for the extension of the powers, should that prove necessary. I commend them to the House.
Owen Smith: I do not intend to take long, because we must get on to the important next group of new clauses and amendments, which is on the private patient cap; there will be huge interest in that outside this place, and there is far too little time to discuss it. I shall say right at the outset that we will not press amendment 17, because we accept that, as the Minister said, it is effectively made redundant by other amendments that have been tabled.
In some respects, the amendments in the group before us tell the story of the Bill in microcosm. Throughout the progress of the Bill, the Government have responded in two ways. One has been to bolt endless obfuscation and compromise on to the Bill to obscure its true intentions. There was clarity at the outset, in the Bill’s
6 Sep 2011 : Column 280
first iteration; it clearly aimed to break up a publicly owned, collaborative NHS and replace it with a competitive, market-driven NHS. The Government have sought to obscure that throughout the Bill’s progress, and have done so relatively effectively. Certainly, more gullible Government Members, perhaps even including the Deputy Prime Minister, have bought into the double-speak about this now being a question of preventing anti-competition, as opposed to promoting competition, but we Labour Members still do not buy that.
Nor do we buy the idea that the other amendments that we have considered today add clarity. In truth, they add to the confusion—the chaos, indeed—that will follow the implementation of the Bill. As the Minister has outlined, the clauses that we are considering effectively extend Monitor’s existing compliance and regulatory roles over foundation trusts to all FTs through to 2016. That is what the Future Forum recommended to Ministers, but they did not do that last time, although they did get rid of the arbitrary 2014 deadline that they had introduced. They are now going a step further and extending Monitor’s compliance functions. That might not be such a bad thing, and perhaps many people will agree with the idea; certainly the Future Forum will. The trouble with it, of course, is that it extends the critical conflict of interest that is at the heart of Monitor’s role.
There is a conflict between what is clearly Monitor’s principal function—as an economic regulator, designed to prevent anti-competitive behaviour and facilitate the exit of providers, such as hospitals, from the marketplace—and its compliance role, which is ostensibly about allowing FTs to flourish, and making sure that they do not fail. How will the Government deal with that apparent contradiction? To use their own words as set out in the original explanatory notes, how will they
“mitigate and manage potential conflicts of interest”
between the transitional functions and Monitor’s new functions? Well, rest easy, because the Government have made a very simple suggestion as to how Monitor should square that circle, which I am sure all Members will find satisfactory, as I do. Clause 62(3), subtly amended by Government amendment 89, explains that Monitor must simply
“ignore the functions it has under section…117 when exercising…its functions”
relating to competition, price-setting, or the licensing of NHS services.
So there we go: in Monitor there are to be Chinese walls, as Ministers colourfully put it in Committee. Monitor retains its role in trying to keep FTs from failing, but it also takes on a role in exiting them from the market and helping other providers—Bupa, perhaps, or Helios, which we know are sniffing around the Department of Health right now—to step into the breach. Chinese walls, competition and confusion: those are the key words for this botched Bill.
New clause 3 accordingly read a Second time, and added to the Bill.
‘(1) Where the Secretary of State proposes to make an order under section [Duration of transitional period] in reliance on subsection (2)(b) of that section (“a section [Duration of
6 Sep 2011 : Column 281
transitional period](2)(b) order”), the Secretary of State must notify Monitor.
(2) Monitor, having received a notification under subsection (1), must set the criteria that are to be applied for the purpose of determining to which NHS foundation trusts the order should apply.
(3) Before setting criteria under subsection (2), Monitor must—
(a) consult the Care Quality Commission and such other persons as Monitor considers appropriate, and
(b) obtain the approval of the Secretary of State.
(4) If the Secretary of State approves the proposed criteria, Monitor must—
(b) determine, by applying the criteria, to which trusts the order should apply,
(c) notify the Secretary of State of its determination, and
(d) publish a list of the trusts concerned.
(5) If the Secretary of State does not approve the proposed criteria, Monitor must propose revised criteria; and subsections (3)(b) and (4) apply in relation to the proposed revised criteria as they apply in relation to the criteria previously proposed.
(6) If, having received a notification under subsection (1), Monitor proposes to set criteria the same as those it set on the last occasion it received a notification under that subsection, it need not comply with subsection (3)(a).
(7) A section [Duration of transitional period](2)(b) order—
(a) must apply to all the trusts that are determined under subsection (4)(b) as being the trusts to which the order should apply (and to no others);
(b) may specify the trusts to which it applies by reference to their inclusion in the list published under subsection (4)(d).
(8) Subsection (9) applies where —
(a) a section [Duration of transitional period](2)(b) order is in force at a time when there is in existence an NHS foundation trust authorised after 1 April 2014, and
(b) the initial two-year period in relation to that trust has yet to come to an end.
(a) determine, by applying the criteria it applied under subsection (4)(b), whether section 117 should continue to have effect in relation to the trust after the end of the initial two-year period,
(b) notify the Secretary of State of its determination, and
(c) publish its determination.
(10) If Monitor determines under subsection (9)(a) that section117 should so continue to have effect, the trust is to be treated as if it had been authorised on or before 1 April 2014 and as if the order referred to in subsection (7)(a) applied to it; and section [Duration of transitional period] (5) is accordingly to apply in relation to the trust.
(11) If Monitor determines under subsection (9)(a) that section 117 should not so continue to have effect, section 117 ceases to have effect in relation to the trust immediately after the end of the initial two-year period.’.—(Paul Burstow.)
Brought up, read the First and Second time, and added to the Bill.
‘(1) Sections [Duration of transitional period] and [Orders under section [Duration of transitional period] that apply to only some trusts] are repealed immediately after section 117 is repealed; and in consequence of that—
6 Sep 2011 : Column 282
(a) in section 62(2)(a), omit “or under sections 117 and [Orders under section [Duration of transitional period] that apply to only some trusts] of this Act (imposition of licence conditions on NHS foundation trusts during transitional period)”,
(c) in section 94(4), after paragraph (a) insert “and”,
(d) in section 94(4), omit paragraph (c) and the preceding “and”, and
(e) omit section 302(5)(e) and (8A).
(2) This section is repealed immediately after sections [Duration of transitional period] and [Orders under section [Duration of transitional period] that apply to only some trusts] are repealed.’.—(Paul Burstow.)
Brought up, read the First and Second time, and added to the Bill.
‘The Secretary of State must make regulations which provide for NHS Foundation Trusts to be prevented from providing services other than those of the health service in England within three years of Royal Assent of this Act.’.—(Andrew George.)
Brought up, and read the First time.
Andrew George: I beg to move, That the clause be read a Second time.
Madam Deputy Speaker (Dawn Primarolo): With this it will be convenient to discuss the following:
New clause 22—Private health care: rules—
‘(1) Section 44 of the National Health Service Act 2006 (Private healthcare) is amended as follows.
(2) Insert new subsection (A1) as follows—
“(A1) NHS Foundation Trusts must act in accordance with the following rules when carrying out their functions under this section—
(a) NHS Foundation Trusts are not permitted to operate NHS functions or contracts in a manner which promotes their private healthcare operation;
(b) any private healthcare service offered should only be within the provision of the services and procedures which are not also duplicated by the Trust’s NHS functions or contracts; and
(c) the Trust should at all times operate any private healthcare interest in a manner which in no way conflicts with its responsibility to provide unfettered access of its NHS patients to its NHS services.”’.
Amendment 1165, page 159, line 24, leave out clause 168.
Andrew George: The new clauses deal with a totemic issue that has bedevilled the debate throughout and raised concerns. The question whether to raise the cap or leave it where it is is a ham-fisted reaction to our current situation in the Report stage of a re-committed Bill. There should be an opportunity for further consideration, and I hope the issue will be examined in another place.
There has been much hyperbole about the privatisation of the NHS and other themes that have run through the debate. The general concern is that, as a result of various genies being let out of bottles and caps being lifted, we will end up with an NHS driven more by concern with private profit than by concern with matters of patient care. There is a slippery slope, of which that issue is symptomatic, throughout the Bill.
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The purpose of the new clauses is to address that issue and retain the cap to ensure that the matter is kept under appropriate control. The rough and tumble of political debate means that we will end up scoring points off each other and asking who introduced foundation trusts and so on. We have been through that playground before and I do not intend to go in that direction, but I want to make sure that we have an opportunity to explore the matter. We do not have much time so I will not detain the House unnecessarily.
The removal of the cap will give more scope for NHS trusts to compete in the market, which will make them more likely to be considered undertakings for competition law purposes, even in respect of NHS services which the hospitals claim their private work subsidises, thus allowing competition law to reach further and more firmly into the NHS. The Government briefing does not even dispute that fact, as far as I can see. Also, if NHS foundation trusts can muscle in on the private market, rather like the BBC, private providers will feel more justified in arguing for the right to compete for far more NHS services, and the courts may well agree.
New clause 19 recognises that pay beds in the NHS represent a challenge, both ethically—it is about how beds can be reserved for paying patients in the same hospitals where poorer patients with higher needs must wait—and with regard to competition law. It would phase out the reserving of beds for paying patients in NHS hospitals by 2015.
New clause 22 would put a bar on foundation trusts offering private services where that would compete with their NHS provision. I certainly know, having undertaken surveys of the NHS 12 years ago, that the specialties with the longest waiting times—I will not say which, but Members might guess—happened to be those in which the most private practice was going on. One might argue that the private practice resulted from the long waiting times, but the long waiting times could have been part of a system that enabled the private sector to flourish. I fully accept—to save the Minister a lot of time in his response—that the new clause is technically very deficient, so I will not press it to a vote, but I want to express my concern and probe the issue in debate.
I know that there are ethical considerations here and that the General Medical Council and others would not only frown on the kind of practices I am implying might go on, but would rule against them. The concern is that the trusts, or those working for them, might be seduced into behaving in ways that drive their NHS patients into the arms of their private wings. Once we go down that road, many conundrums will arise and will need to be sorted out. I do not believe that the Government entirely have a handle on the issue, which is why I believe that simply lifting the cap, despite all the justifications they have given, needs a serious rethink.
9.15 pm
I do not question Ministers’ intentions, which I think are honourable, but I do think that they have the wrong policy. I do not think that they, as some claim, want to push privatisation across the NHS, but I do think that this could end up being a catastrophic policy that unleashes something that, once it goes through, we will be able to regret at our leisure. On that basis, I simply
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wanted to raise these matters and ensure that we have an opportunity to debate them, primarily for the purposes of probing the issues.
Emily Thornberry: I would like to speak to amendment 1165, which stands in my name and those of my right hon. Friend the Member for Wentworth and Dearne (John Healey), my hon. Friends the Members for Leicester West (Liz Kendall), for Halton (Derek Twigg) and for Pontypridd (Owen Smith), and the hon. Members for St Ives (Andrew George), for Southport (John Pugh) and for Leeds North West (Greg Mulholland). It would delete clause 168, which abolishes the cap on the number of private patients who can be treated in foundation trust hospitals. There has been much interest in this issue, and we will seek a vote on the matter if possible.
Earlier, the Secretary of State assured us that the legislation would not result in a market free-for-all. “That will not happen if this Bill is passed,” he said. But close examination of the clause shows that we will certainly be getting a step closer. It will mean that our national health service, where people are tended by our NHS-trained doctors using our NHS equipment, will be full of private patients, who are able to pay more. Hard-pressed hospitals facing increasingly large shortfalls, desperately trying to balance their books, are bound to take in increasing numbers of private patients.
We have been here before. Many of us remember the last time the Conservatives were in power, when there was a two-tier health service: those who could pay got faster treatment and could skip the queue, while those who could not afford to go private had to wait, and many of them had to die.
I am pleased that the Secretary of State has seen the letter in The Times today. It is often concerning to see how he assimilates data, because he seems to listen only to some things and not to others; he listens to what he wants to hear. I hope that he has realised that in The Times today the doctors, nurses, midwives, psychiatrists, physiotherapists and occupational therapists have said that the Bill will destabilise the national health service. They are particularly concerned about the removal of the private patient cap. Why is that? The Government’s own impact assessment, at B156, acknowledges that
“there is a risk that private patients may be prioritised above NHS patients resulting in a growth in waiting lists and waiting times for NHS patients.”
We could not have put that better ourselves, and it is in the Government’s own impact assessment of the Bill.
If we lift the cap on the number of private patients in the time of crisis that the national health service is about to go into, as night follows day the number of private patients in hospitals will increase, forcing out national health service patients. As a result, waiting lists will go up, and what will the public make of that?
Dr Poulter: As the hon. Lady is well aware, the previous Government introduced the private sector in a number of hospitals, and at the moment the private sector works alongside the NHS, helping to cut down on waiting times and the like. She is concerned about the private sector working alongside the NHS in hospitals. Does she have any concerns at the moment based on what the previous Government did in introducing that side-by-side service?
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Emily Thornberry: What is extraordinary is that many people who used to go private felt that it was not necessary to do so under a Labour Government because they did not have to wait as they had to under the Conservative Government—that is one thing that I certainly remember. Yes, we have used the private sector as and when it has been necessary to reduce waiting lists, but we are not talking about that now. We are talking about whether there should be a cap on the number of private patients in national health service beds.
Dr Poulter: The hon. Lady is very kind to give way twice. She makes well the point about why the private sector is beneficial. We either agree that the private sector adds value to the NHS and patients or we say that it is a bad thing; it is either working at the moment for the benefit of patients and will work that way in future, or it is not and will not. Which way does the hon. Lady see it?
Emily Thornberry: I am sure that that contribution was of some use to someone in this debate, but I am not going to bother to respond to it.
Helen Jones (Warrington North) (Lab): Does my hon. Friend agree that the real difference between what was happening under the Labour Government and what is proposed in this Bill is that we used the private sector to treat people on the basis of need identified by the NHS, not ability to pay? This Government propose to allow more people to pay to jump the queue. In that sense, if waiting lists go up, that helps the private sector: there is no point in paying to jump the queue if there is no queue.
Emily Thornberry: Exactly; I am very grateful to my hon. Friend.
The Secretary of State, like the Minister of State, the right hon. Member for Chelmsford (Mr Burns), is fond of quoting the Future Forum. I have a quote from Professor Steve Field that I hope will be of assistance to the House when it comes to discussion of the cap. He said in evidence to the Committee:
“if you opened the cap, it made you more likely to be under attack from EU law, competition and Monitor”.––[Official Report, Health and Social Care (Re-committed) Public Bill Committee, 28 June 2011; c. 14, Q24.]
That is one of the arguments that he used. If the Future Forum is concerned about this being another reason why we should not lift the cap, I hope that the Minister will at least listen to its arguments.
As we heard in Committee, a number of criticisms have been made on both sides of the House about the details of the cap and how it is implemented. Indeed, it is common ground that there ought to be some changes to it. We have no problem about changing and modifying the cap and making it more appropriate, but we do not understand why, just because the cap needs changing, it is simply being lifted completely.
A parallel can be drawn with the carbon emissions cap. If I were working in the Potteries in Staffordshire, I am sure that I would believe that the carbon emissions cap was unfair and went against my personal business. One would need to look at the cap and change it as appropriate in order to make it work properly; one would not get rid of it completely just because there are criticisms of it, unless one had another agenda.
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The question is why on earth the Government are considering allowing as many private patients as wish to do so to go into our national health service at a time of crisis, pushing out national health service patients. [ Interruption. ] If the Minister believes that that is wrong, I will be interested to hear an intervention from him in which I hope he will be able to give us a complete assurance that that will not happen. The fact of the matter is that there are not the necessary safeguards. As we understand it, there will be absolutely no limit. We have no idea how foundation trusts are going to respond to the lifting of the cap. We do not know and neither, with great respect, does the Minister. Why is he allowing this great risk to be taken with our national health service? The clause needs to be looked at very carefully in this place, and I know that it will be looked at very carefully in another place.
Nicky Morgan: I am not sure whether the hon. Lady has seen a note from the Foundation Trust Network that was, I believe, circulated to all Members of the House and sets out six positive reasons why the private patient income cap has worked: it has allowed hospitals to build new units, to buy leading-edge technology, to extend mental health support, to offer fertility treatment, and to provide maternity services. There is also the fact that rental income is caught by the cap. There are some positive benefits in allowing private patients access to be treated by hospitals. In particular, at a time of financial crisis, bringing new technology into the NHS must be a good thing.
Emily Thornberry: I am grateful to the hon. Lady. I think that if we were to stop and walk away from party politics, we would be quite close on this matter. We do not have a problem with there being a cap; the problem is how it is implemented. I think that, deep down, she agrees with us. The difficulty is that her party wants to get rid of the cap completely, and that will have a completely different effect on the national health service. We are happy to sit down and talk to the agencies that will be affected and to make improvements in the working of the cap, but getting rid of it completely is behaving recklessly with our national health service.
Nicky Morgan: The misinformation and emotive language that has been used throughout the whole debate has been using patients at the heart of this. Everything we have heard so far on both sides of the House, perhaps prompted by the hon. Lady’s remarks, has been about how bringing in private patients is bad for the NHS. In fact there are some good aspects. I am pleased to hear that there can be some agreement between both sides of the House.
Emily Thornberry: That is why I have been relying on the Government’s impact assessment as perhaps the strongest part of my argument. I have also relied on what Professor Field has had to say. I would now like to turn to Baroness Williams, who wrote an article published on 4 September that I commend to the House, in which she says:
“One thing that remains…is the decision to lift the cap on private beds in foundation hospitals. Not only could that mean that many of our finest hospitals would gradually become private, it also means that inevitably foundation hospitals would be subject to European and British competition law.”
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Many organisations and people agree with us on this, and that is why the House should pause and think about what we will be doing to the national health service if we accept this clause. I also pray in aid the Royal College of Nursing’s briefing, which Members who are closely following this debate will have read, in which it says that it is against the removal of the cap and does not believe that it will not have an effect on NHS patients’ access to health care. The BMA has said the same thing.
In essence, the argument is about whether we should have a cap or not. If the House votes tonight to lift the cap, our constituents will ask how it can be that their representative has voted for a clause that allows private patients to fill up the national health service hospital paid for by those constituents’ taxes so that they will be pushed out of it.
9.30 pm
Mr Simon Burns: I am grateful to my hon. Friend the Member for Cornwall—I mean the hon. Member for St Ives (Andrew George)—for moving the new clauses and amendment, especially for the constructive and reasonable way in which he did so. He raised several issues and, if I understand him correctly, he sees the amendment as a probing amendment that also puts across several of his concerns about this issue. I hope to deal with the main thrust of his concern in my contribution.
I am also grateful to the hon. Member for Islington South and Finsbury (Emily Thornberry) for her contribution. Her amendment and indeed her comments were more controversial and I have far more disagreement with several of the contentious things that she said, although she will be unaware that I am saying that because she is not listening. She might argue that she is not missing much.
I shall start with a fact. It may have got lost in the telling, but I assume that the hon. Lady realises that there is no cap at the moment for NHS trusts. There is only a cap for foundation trusts. She has not seen the difficulties that she forecasts in NHS trusts, and I hope—although I am not confident of success—that I will convince her that her fears are unfounded.
The Government believe that keeping the cap would damage the NHS and patients’ interests. Removing it would allow foundation trusts to earn more income to improve NHS services, and I will address the safeguards that will be in place to ensure that the armageddon that the hon. Lady predicted will not happen and that my hon. Friend’s concerns are needless.
Removing the cap will enable foundation trusts to earn more money to improve NHS services, and those trusts are telling us that they must be freed from what is an unfair, arbitrary, unnecessary and blunt legal instrument. I do not want to go too far down memory lane, but I must remind the House that there was no intellectual case for bringing in the cap in the first place. It was introduced in 2002-03 in the relevant legislation as a sop to old Labour. The right hon. Member for Holborn and St Pancras (Frank Dobson) says that he has moved on, but he still has the Neanderthal tendencies of old Labour—[ Interruption. ] Before the Opposition Whip says anything, I should point out that the right hon. Gentleman takes that as a compliment. I am being very nice to him and probably enhancing his street cred. He would not thank the Whip for diminishing that.
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The point is that the cap was not brought in after some coherent intellectual argument about protecting the NHS or preventing private patients from overrunning the NHS. It was brought in because the then Health Secretary, Alan Milburn, and the then Prime Minister, Tony Blair, were having considerable problems with some of their Back Benchers on this issue. To avoid a defeat on the Floor of the House, they brought in the cap as a sop to those Back Benchers to buy them off. But it was not introduced consistently for both NHS trusts and foundation trusts—just for the latter.
The cap is arbitrary and unfair. Several NHS trusts that are not subject to the private patient income cap have private incomes well in excess of many foundation trusts. Last year, four of the top 10 private income earners were NHS trusts—that is, without a cap. A few FTs have high private incomes simply because they did a few years ago. The cap locks FTs into keeping private income below 2002-03 levels and means that last year about 75% of FTs were severely restricted by caps of 1.5% or less. Meanwhile, patients at the Royal Marsden benefit from its cap being 31%, and it has consistently been rated as higher performing by the Care Quality Commission.
Andrew George: The Minister is making an interesting point. Will he elaborate further on the proportions of the private work to which he refers? Is that private work for private patients or private work for research, innovation and training, which are important functions of hospitals but are often lost in the debate?
Mr Burns: The hon. Gentleman raises an important point, but the simple answer is that it is a combination of both.
The cap is unnecessary. I remind Opposition Members that the original proposal was not to have one. To suggest that NHS patients would be disadvantaged if the cap was removed, as the hon. Member for Islington South and Finsbury did, is pure and simple scaremongering. Existing and new safeguards will protect them. NHS commissioners will remain responsible for securing timely and high-quality care for NHS patients. The Bill will make FTs more accountable and transparent to their public and staff, allowing us to require separate accounts for NHS and private income and giving communities and governors greater powers to hold FTs to account in performing their main duty, which is to care for NHS patients.
Chris Leslie: Will the Minister give way?
Mr Burns: No, because others want to speak.
I can assure the House that FTs will retain their principal legal purpose—to serve the NHS. This means that the majority of their income will continue to come from the NHS. With no shareholders, any profit they make will have to be ploughed back into the FT, and so will support that purpose of caring for NHS patients. The vast majority of FTs have little, if any, potential to increase private income, never mind the desire to do so. For them, NHS activity will remain the overwhelming majority of the work they do, if not all of their work. It is extremely unlikely that even the most entrepreneurial FTs with international reputations would seek to test the boundaries. Their commissioners, public and NHS staff governors would hold them to account in fulfilling their duties and serving their NHS patients.
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For these FTs, however, the cap is a blunt instrument that harms NHS patients. FTs tell us that there is potential to bring extra non-NHS income into the NHS, for example, by developing the NHS’s intellectual property, from innovations such as joint ventures and by using NHS knowledge abroad. Additional demand and income can help organisations to bring in leading-edge technology faster, including in the important area of cancer treatment. I hope that that goes some way to helping my hon. Friend the Member for St Ives. Opposition amendment 1165 would harm the NHS, and new clauses 19 and 22 would stop FTs providing private health care altogether. Many of the other protections proposed would be almost as damaging and reduce income.
We want to ensure that safeguards are appropriate, not harmful. For example, a prohibition on FTs offering privately the same services that they offer on the NHS would rule out most of their current private health care. It could even create perverse incentives to stop providing some services for some NHS patients. We are confident that private income benefits NHS patients. On reflection, we are proposing to explore whether and how to amend the Bill to ensure that FTs explain how their non-NHS income is benefiting NHS patients. We will also ensure that governors of FTs can hold boards to account for how they meet their purpose and use that income. I believe that that is an important move forward.
Simon Hughes (Bermondsey and Old Southwark) (LD): Will the Minister give way?
Mr Burns: I hope that the right hon. Gentleman will forgive me, but I will not give way, because other hon. Members wish to speak and the debate finishes in 20 minutes.
To my mind, the private patient cap and the proposed new restrictions are both unnecessary and damaging. Indeed, I know that this will drive some Opposition Members potty, but the former Labour Minister responsible for the cap, Lord Warner, repented his sins in the other place, describing it as
“wrong and detrimental to the NHS.”—[Official Report, House of Lords, 12 May 2009; Vol. 710, c. 936.]
I urge Opposition Members not to repeat that mistake and to heed Lord Warner’s advice. I appreciate that the Opposition Benches are not full of champions of Lord Warner—particularly not at that end of the Chamber from which we heard the earlier comments about him—but he is a respected former Labour Health Minister and I would suggest that he knows what he is talking about.
Let me deal briefly with two final points that were made by the hon. Members for Islington South and Finsbury and for St Ives about the safeguards that are in place to offer protection and ensure that NHS patients would not lose out with the removal of the cap. First, the NHS commissioning board and clinical commissioning groups would be responsible for ensuring that NHS patients are offered prompt and high-quality care, and that good use is made of NHS resources, whoever provides care, through robust contracting arrangements. NHS patients will also maintain their right in the NHS constitution to start treatment within 18 weeks of referral. Secondly, as foundation trusts do not have shareholders and cannot distribute surpluses externally, and as their
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principal legal purpose will remain to serve the NHS, all proceeds from non-NHS work would be reinvested in the organisation, ultimately adding to the level and quality of the NHS service.
The Bill will make FTs more accountable and transparent to their public and NHS staff. Our commitment that FTs will produce separate accounts for their NHS and NHS private-funded services—as well as Monitor’s use of its regulatory powers to ensure a level playing field between providers—will also help to avoid any risk of NHS resources cross-subsidising private care, thereby protecting NHS money. I believe that those five safeguards will protect NHS patients and the NHS, and will not lead to the situation that the hon. Member for Islington South and Finsbury described in her speech.
Emily Thornberry: I do not mean in any way to suggest that the right hon. Gentleman does not believe what he has just said, but what if he is wrong? It is all very well for him to say, “We’re going to lift the private patient cap—we have these safeguards and I believe they’re sufficient to ensure that NHS patients won’t suffer,” and he may be right. However, the difficulty is that he may be wrong, so why are we taking this risk at a time like this? What is the point? What is the benefit?
Mr Burns: I do not think that this will come as a surprise to the hon. Lady, but I do not think that I am wrong, and I say that for the following reasons. First, there has never been a cap on NHS trusts, and the problems that she has speculated about during this debate have never occurred where there is not a cap. Secondly, the reasons that I have outlined would suggest to me that there will not be a problem, particularly as the one hospital that I singled out—the Royal Marsden—has an income cap of 30.7%. Nobody is suggesting that NHS patients are suffering as a result of that, and that is where a substantial income comes from non-NHS work. Finally, the five safeguards that I have highlighted will be powerful measures to ensure that what she describes will not happen.
For those reasons, I would be grateful if my hon. Friend the Member for St Ives did not press his new clause to a vote. I would also hope that, on reflection and having made her points, the hon. Member for Islington South and Finsbury will resist the temptation to press her amendment to a Division. I fear, however, that she is not going to heed my advice, and she will regret it.
Mr Speaker: Order. Four Members are seeking to catch my eye, and I should like to give the person who moved the new clause a couple of moments to speak. Members can do the arithmetic for themselves.
9.45 pm
Caroline Lucas:
New clauses 19 and 22 also have my name on them, and I should like to say a few more words in support of them as I have not been reassured by the Minister. I find it unacceptable that taxpayers’ money has ever been used to allow private patients to jump the queue and use NHS facilities. The history of the cap was all very interesting, but the bottom line is that it serves an important purpose, which is why it
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should stay. The Government argue that income from private patients is put back into the NHS and ultimately benefits the health service, but the reality is that when people become ill and need treatment, it is hard to justify asking them to wait longer because capacity in our NHS hospitals is being taken up by private patients. The bottom line is that an NHS hospital has to treat NHS patients, and I do not believe that we have adequate spare capacity sloshing about in the system to justify private queue-jumping.
Some Members will recall that foundation trusts were brought in after Alan Milburn visited the state-owned but privately run Fundación hospital in Madrid. The then Health Secretary was apparently impressed when he was told that the foundation hospital outperformed the Government-controlled hospitals. However, he ignored the argument put forward by the local unions that it was able to do so precisely because the more costly and difficult patients were sent to the fully public hospital nearby.
It is often argued that foundation trusts are about choice, but I would argue that such private treatment should be offered only when there is surplus provision in the system. It is one thing to talk about a choice of general goods and services, but it is enormously inefficient and massively costly to apply that mentality to the health service. Now, we see the present Government trying to use the model introduced by the previous one to allow foundation trusts to do as they please, and lifting the cap on the income that can be derived from private sources.
The hundreds of constituents who are contacting me about this do not want private queue-jumping; they want NHS services paid for from taxation. The future of the NHS should be about developing whole systems, not isolated institutions, and private health care in the NHS should be phased out. The NHS needs to be about building networks across professional and institutional boundaries, not about creating new barriers. It needs to be about IT and information sharing, not reducing connectivity, and about getting more people treated in the community and in primary care. The danger with this Bill is that it will do exactly the opposite and return us to the fragmentation of the time before the NHS.
John Pugh: I supported the amendment tabled by the hon. Member for Islington South and Finsbury (Emily Thornberry)—or, rather, I tabled it independently. I accepted at the time that it was not the most elegant way of dealing with the problem, but I recognise that there is a problem, as do foundation trusts. The cap as it stands has certain perverse consequences, and the NHS cannot fully profit from sources such as intellectual property. NHS profits help to subsidise public services. As the Minister has pointed out, there is no cap on non-foundation trusts, and the current format was to some extent a political compromise because Labour Members raised certain considerations during the passage of the legislation on foundation hospitals. That does not mean that their concerns were not valid at the time.
I am not concerned by the prospect of dramatic privatisation overnight; nor do I think that queue-jumping is the real danger. By abolishing the cap altogether, however, we run the risk that foundation trusts will run on the wrong side of state aid rules, and that their activity will be perceived as economic activity under EU
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competition law. The more they subsidise general NHS services, the more they will be perceived as engaging in economic activity.
I do not take a doctrinaire view on this issue. Very sensible people, such as Steve Field and the NHS Confederation, have raised the matter. The hon. Member for Leicester West (Liz Kendall) raised it, as did, if I recall correctly, the hon. Member for Islington South and Finsbury in a spirit of compromise in Committee, making the point—I think I am quoting her correctly—that the only alternative to a bad cap is not no cap at all.
There is a genuine fear, however, among people who are far more expert than most hon. Members in this field, which is caused by the blurring of the boundaries between public and private hospitals. We could end up theoretically with a private hospital that has 90% of its patients provided by the NHS. I know we cannot end up with an NHS hospital filled by 90% of private patients, but there is a threshold at which things could quite easily start to become complicated. This a critical issue, which will have to be dealt with in the House of Lords.
Emily Thornberry: The hon. Gentleman has quoted me, so let me clarify that I was quoting the Deputy Prime Minister when I said that the only alternative to a bad Bill was not no Bill at all. I was talking about a Bill as opposed to a cap.
John Pugh: I may not have paraphrased the hon. Lady correctly, but I believe that the sentiments I described were expressed by her in discussions of a particular amendment on this subject, but we can go and look at the Committee proceedings to find out whether I am right.
It seems to me that what has happened on this occasion is that the Secretary of State has rehearsed the arguments that we have already heard in Committee. That does not advance things massively. He has supplemented that by saying that better efforts should be made to explain how the cap operates by the foundation trusts themselves, which will be more accountable, as I think he said, to the governing body of the foundation trust. That is an explanation and good explanation is to be desired. The point is, however, that expert opinion—independent of this House— perceives this to be a problem, but it has not been addressed.
Chris Leslie: I intended to make only a short intervention, but given the Minister’s cap on interventions, I decided that I needed to find a brief opportunity to say that removing the private patient cap is the wrong thing to do. The Minister’s basic argument— “I do not think I’m wrong”—really does not cut it. Removing the cap will remove an incentive for reducing waiting lists. The two issues of waiting lists and waiting times and the degree of private business within the NHS cannot be separated: they go hand in hand.
In a sense, a bit of ancient history is required, because it is important to note that the previous Labour Administration reduced waiting times so much that many of the private health insurers were, frankly, complaining. Long waiting lists matter because they are also the lifeblood of the private medical industry. We need only look at the advertising slogans of many private medical insurers to see how they try to entice
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people with promises of “speedy service” and “getting your health situation sorted out quickly”. This, however, can happen in the context of NHS hospitals.
What we must do is ensure that we put the needs of NHS patients first. My worry about removing the private patient cap is that it changes the incentives relating to how the foundation trusts will work, putting revenue generation ahead of patient treatment. The allure of revenue will, of course, be there, but keeping waiting lists high is, in a sense, part of ensuring that revenue continues to come in. I want to see trusts focused absolutely and completely on reducing waiting times. That is incredibly important.
It has been interesting to hear some of the important points raised by some Government Members—and not just about state aid rules. To me, however, the issue of waiting times and, particularly, this Administration’s watering down of the targets set for them and the issue of removing the patient cap are two sides of the same coin. It is all about driving people to go in a direction that they often do not want to go. People might have some savings and feel they have no choice but to use them for private provision because of the fear of long waiting lists in future. That might be the only way people feel that they can get treated quickly. It is all part of the design to change the whole fabric and nature of the NHS. That is the wrong direction in which to head, and I hope that we can retain the private patient cap.
Diana Johnson: I support amendment 1165. Although I have a great deal of respect for the Minister, his comments did not persuade me. The proposal to remove the cap is an example of the shambolic way in which the Bill has been presented. There seems to me to be very little evidence to back up what the Minister thinks might happen. He thinks that everything will be OK, but the NHS has never been in the position of having to make £20 billion-worth of efficiency savings—or cuts, which is what they really are. I believe that when the cap is removed, trusts will want to increase the income that they can obtain from private patients. My hon. Friend the Member for Warrington North (Helen Jones) made the good point that when waiting lists lengthen—which we know they are already beginning to do—those who pay will do so in order to receive the medical treatment that they want.
After 1997, NHS waiting lists in Hull fell to their lowest ever level. A private hospital that sat in the middle of an NHS trust—it was then the Hull and East Riding acute trust—was sold to the NHS. It had not been getting enough business, because the NHS was doing so well. We have heard in today’s debate about the high level of support for the NHS and about the current high levels of satisfaction, and I do not think that we should take this step.
Earlier, I spoke of the lack of principles that the Liberal Democrats were exhibiting yet again in respect of the NHS. It was interesting to hear the hon. Member for Southport (John Pugh) say that he was not doctrinaire on the issue. So the hon. Gentleman has no principles, and is not doctrinaire either. I recall that, in 2010, the Liberal Democrats campaigned in my constituency on a platform of saving the NHS, not increasing the number of private patients. I think that when this measure
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reaches the House of Lords, Liberal Democrat peers must stand up and be counted, because it is a disgrace that Liberal Democrat Members should support it today.
My main concern relates to evidence. Where is the evidence that removing the cap will work? I do not think that the safeguards exist to ensure that NHS patients will be protected, and I know that waiting lists are rising, which means that people in my constituency, and in poorer parts of the country, will not be able to gain the access to health care that they deserve. I believe that removing the cap is entirely wrong.
Andrew George: It is a pleasure to follow the hon. Member for Kingston upon Hull North (Diana Johnson), but I do not think she did herself or her party any favours in trying to persuade my Liberal Democrat colleagues and me to follow her or her party’s lead by launching a completely unacceptable attack on my hon. Friend the Member for Southport (John Pugh).
The Minister seemed to be trying to win me over by describing me as “the hon. Member for Cornwall”. His description stimulated my Cornish imperialist tendencies, and I was tempted to change that to “Cornwall and bits of England”. However, I shall leave it for another Bill, perhaps one relating to boundary reviews.
In his response, the Minister said that the cap was a “blunt instrument”. I acknowledged that in my opening remarks: it is indeed a blunt instrument, which does not achieve what I think we all want it to achieve. However, although the current situation is not satisfactory, neither is the proposal to lift the cap. That too is a blunt instrument, as was made clear by many speakers this evening. I do not think the Minister entirely acknowledged that this is a conundrum that needs to be resolved. As I have said before, the Government are right to address the issue and are doing so with the best of intentions, but they have come up with the wrong answer. Indeed, lifting the cap is not an answer at all. Further work is needed, and deleting clause 168 would be a good start.
As I have said, mine are probing proposals. I will support amendment 1165, but I beg to ask leave to withdraw the motion.
Motion and clause, by leave, withdrawn.
10 pm
Proceedings interrupt ed (Programme Order, this day ).
Mr Speaker put forthwith the Questions necessary for the disposal of the business to be concluded at that time (Standing Order No. 83E).
Amendments made: 88, page 86, line 23, leave out from ‘sections’ to ‘transitional’ in line 24 and insert
‘117 and [Orders under section [Duration of transitional period] that apply to only some trusts] of this Act (imposition of licence conditions on NHS foundation trusts during’.
Amendment 89, page 86, line 27, leave out ‘116 and 117’ and insert
‘117 and [Orders under section [Duration of transitional period] that apply to only some trusts]’.—(Mr Simon Burns.)
6 Sep 2011 : Column 295
Amendment made: 108, page 120, line 10, leave out Clause 116.—(Mr Simon Burns.)
Amendments made: 109, page 121, line 7, leave out subsection (1).
Amendment 110, page 121, line 9, leave out ‘the’ and insert ‘an NHS foundation’.
Amendment 111, page 121, line 13, leave out ‘the designation expires’ and insert
‘this section ceases, by virtue of section [Duration of transitional period], to have effect in relation to the trust’.
Amendment 112, page 121, line 33, leave out subsection (7).—(Mr Simon Burns.)
Amendment proposed: 1165, page 159, line 24, leave out Clause 168.—(Emily Thornberry.)
The House divided:
Ayes 239, Noes 292.
[10.1 pm
AYES
Abbott, Ms Diane
Abrahams, Debbie
Ainsworth, rh Mr Bob
Alexander, rh Mr Douglas
Alexander, Heidi
Ali, Rushanara
Allen, Mr Graham
Anderson, Mr David
Ashworth, Jonathan
Austin, Ian
Bailey, Mr Adrian
Bain, Mr William
Banks, Gordon
Barron, rh Mr Kevin
Bayley, Hugh
Beckett, rh Margaret
Begg, Dame Anne
Bell, Sir Stuart
Benn, rh Hilary
Benton, Mr Joe
Berger, Luciana
Betts, Mr Clive
Blackman-Woods, Roberta
Blears, rh Hazel
Blenkinsop, Tom
Blunkett, rh Mr David
Brennan, Kevin
Brown, rh Mr Gordon
Brown, Lyn
Brown, rh Mr Nicholas
Brown, Mr Russell
Bryant, Chris
Buck, Ms Karen
Burden, Richard
Byrne, rh Mr Liam
Campbell, Mr Alan
Campbell, Mr Ronnie
Caton, Martin
Chapman, Mrs Jenny
Clark, Katy
Clwyd, rh Ann
Coaker, Vernon
Coffey, Ann
Connarty, Michael
Cooper, Rosie
Cooper, rh Yvette
Corbyn, Jeremy
Crausby, Mr David
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
Denham, rh Mr John
Dobbin, Jim
Dobson, rh Frank
Docherty, Thomas
Dodds, rh Mr Nigel
Donaldson, rh Mr Jeffrey M.
Donohoe, Mr Brian H.
Doran, Mr Frank
Dowd, Jim
Doyle, Gemma
Dromey, Jack
Durkan, Mark
Eagle, Ms Angela
Eagle, Maria
Edwards, Jonathan
Efford, Clive
Elliott, Julie
Ellman, Mrs Louise
Engel, Natascha
Esterson, Bill
Evans, Chris
Field, rh Mr Frank
Flello, Robert
Flint, rh Caroline
Flynn, Paul
Fovargue, Yvonne
Francis, Dr Hywel
Gardiner, Barry
George, Andrew
Gilmore, Sheila
Glass, Pat
Glindon, Mrs Mary
Goggins, rh Paul
Goodman, Helen
Greatrex, Tom
Green, Kate
Griffith, Nia
Gwynne, Andrew
Hain, rh Mr Peter
Hamilton, Mr David
Hamilton, Fabian
Hanson, rh Mr David
Harman, rh Ms Harriet
Harris, Mr Tom
Havard, Mr Dai
Healey, rh John
Hendrick, Mark
Hepburn, Mr Stephen
Heyes, David
Hillier, Meg
Hilling, Julie
Hodge, rh Margaret
Hodgson, Mrs Sharon
Hopkins, Kelvin
Horwood, Martin
Hunt, Tristram
Irranca-Davies, Huw
Jackson, Glenda
James, Mrs Siân C.
Jamieson, Cathy
Johnson, Diana
Jones, Helen
Jones, Mr Kevan
Jones, Susan Elan
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
Long, Naomi
Love, Mr Andrew
Lucas, Caroline
Lucas, Ian
MacShane, rh Mr Denis
Mactaggart, Fiona
Mahmood, Shabana
Mann, John
Marsden, Mr Gordon
McCabe, Steve
McCann, Mr Michael
McCarthy, Kerry
McClymont, Gregg
McCrea, Dr William
McDonagh, Siobhain
McDonnell, Dr Alasdair
McDonnell, John
McFadden, rh Mr Pat
McGovern, Alison
McGovern, Jim
McGuire, rh Mrs Anne
McKechin, Ann
McKenzie, Mr Iain
McKinnell, Catherine
Meacher, rh Mr Michael
Meale, Sir Alan
Mearns, Ian
Michael, rh Alun
Miliband, rh David
Miller, Andrew
Mitchell, Austin
Moon, Mrs Madeleine
Morrice, Graeme
(Livingston)
Morris, Grahame M.
(Easington)
Mudie, Mr George
Munn, Meg
Murphy, rh Mr Jim
Murphy, rh Paul
Murray, Ian
Nandy, Lisa
Nash, Pamela
O'Donnell, Fiona
Onwurah, Chi
Osborne, Sandra
Owen, Albert
Pearce, Teresa
Perkins, Toby
Pound, Stephen
Qureshi, Yasmin
Raynsford, rh Mr Nick
Reed, Mr Jamie
Reeves, Rachel
Reynolds, Emma
Reynolds, Jonathan
Riordan, Mrs Linda
Robertson, John
Robinson, Mr Geoffrey
Rotheram, Steve
Roy, Mr Frank
Roy, Lindsay
Ruane, Chris
Ruddock, rh Joan
Sanders, Mr Adrian
Sarwar, Anas
Seabeck, Alison
Shannon, Jim
Sheerman, Mr Barry
Sheridan, Jim
Shuker, Gavin
Simpson, David
Slaughter, Mr Andy
Smith, rh Mr Andrew
Smith, Angela
Smith, Nick
Smith, Owen
Spellar, rh Mr John
Straw, rh Mr Jack
Stringer, Graham
Stuart, Ms Gisela
Tami, Mark
Thomas, Mr Gareth
Thornberry, Emily
Timms, rh Stephen
Trickett, Jon
Turner, Karl
Twigg, Derek
Twigg, Stephen
Umunna, Mr Chuka
Vaz, Valerie
Walley, Joan
Watts, Mr Dave
Whitehead, Dr Alan
Wicks, rh Malcolm
Williams, Hywel
Williamson, Chris
Wilson, Phil
Wilson, Sammy
Winnick, Mr David
Winterton, rh Ms Rosie
Wood, Mike
Woodcock, John
Wright, David
Wright, Mr Iain
Tellers for the Ayes:
Graham Jones and
Lilian Greenwood
NOES
Adams, Nigel
Afriyie, Adam
Aldous, Peter
Alexander, rh Danny
Amess, Mr David
Bacon, Mr Richard
Baker, Norman
Baker, Steve
Baldry, Tony
Baldwin, Harriett
Barclay, Stephen
Barker, Gregory
Baron, Mr John
Barwell, Gavin
Beith, rh Sir Alan
Bellingham, Mr Henry
Benyon, Richard
Beresford, Sir Paul
Berry, Jake
Binley, Mr Brian
Birtwistle, Gordon
Blackman, Bob
Blackwood, Nicola
Blunt, Mr Crispin
Boles, Nick
Bone, Mr Peter
Bottomley, Sir Peter
Bradley, Karen
Brake, rh Tom
Bray, Angie
Brazier, Mr Julian
Brine, Mr Steve
Brokenshire, James
Bruce, Fiona
Buckland, Mr Robert
Burley, Mr Aidan
Burns, Conor
Burns, rh Mr Simon
Burrowes, Mr David
Burstow, Paul
Burt, Lorely
Byles, Dan
Cable, rh Vince
Cairns, Alun
Campbell, rh Sir Menzies
Carmichael, rh Mr Alistair
Carmichael, Neil
Carswell, Mr Douglas
Chishti, Rehman
Clappison, Mr James
Clark, rh Greg
Clarke, rh Mr Kenneth
Clifton-Brown, Geoffrey
Collins, Damian
Colvile, Oliver
Cox, Mr Geoffrey
Crockart, Mike
Crouch, Tracey
Davey, Mr Edward
Davies, Glyn
Davies, Philip
Davis, rh Mr David
de Bois, Nick
Dinenage, Caroline
Djanogly, Mr Jonathan
Doyle-Price, Jackie
Drax, Richard
Duncan, rh Mr Alan
Duncan Smith, rh Mr Iain
Dunne, Mr Philip
Ellis, Michael
Ellison, Jane
Ellwood, Mr Tobias
Elphicke, Charlie
Eustice, George
Evans, Graham
Evans, Jonathan
Evennett, Mr David
Fabricant, Michael
Fallon, Michael
Field, Mr Mark
Foster, rh Mr Don
Fox, rh Dr Liam
Francois, rh Mr Mark
Freeman, George
Freer, Mike
Fullbrook, Lorraine
Fuller, Richard
Garnier, Mr Edward
Garnier, Mark
Gauke, Mr David
Gibb, Mr Nick
Gilbert, Stephen
Gillan, rh Mrs Cheryl
Glen, John
Goldsmith, Zac
Grant, Mrs Helen
Grayling, rh Chris
Green, Damian
Greening, Justine
Griffiths, Andrew
Gummer, Ben
Gyimah, Mr Sam
Halfon, Robert
Hames, Duncan
Hammond, rh Mr Philip
Hammond, Stephen
Hancock, Matthew
Hands, Greg
Harper, Mr Mark
Harrington, Richard
Harris, Rebecca
Hart, Simon
Harvey, Nick
Haselhurst, rh Sir Alan
Hayes, Mr John
Heath, Mr David
Heaton-Harris, Chris
Hemming, John
Henderson, Gordon
Hendry, Charles
Hinds, Damian
Hoban, Mr Mark
Hollingbery, George
Hollobone, Mr Philip
Hopkins, Kris
Howarth, Mr Gerald
Howell, John
Huhne, rh Chris
Hunter, Mark
Hurd, Mr Nick
Jackson, Mr Stewart
James, Margot
Javid, Sajid
Johnson, Gareth
Johnson, Joseph
Jones, Andrew
Jones, Mr David
Kawczynski, Daniel
Kelly, Chris
Kirby, Simon
Knight, rh Mr Greg
Kwarteng, Kwasi
Laing, Mrs Eleanor
Lamb, Norman
Lancaster, Mark
Lansley, rh Mr Andrew
Latham, Pauline
Laws, rh Mr David
Leadsom, Andrea
Lee, Jessica
Lee, Dr Phillip
Lefroy, Jeremy
Leslie, Charlotte
Letwin, rh Mr Oliver
Lewis, Brandon
Lewis, Dr Julian
Liddell-Grainger, Mr Ian
Lidington, rh Mr David
Lilley, rh Mr Peter
Lloyd, Stephen
Lopresti, Jack
Lord, Jonathan
Loughton, Tim
Luff, Peter
Macleod, Mary
Main, Mrs Anne
Maude, rh Mr Francis
Maynard, Paul
McCartney, Jason
McCartney, Karl
McIntosh, Miss Anne
McLoughlin, rh Mr Patrick
McVey, Esther
Menzies, Mark
Mercer, Patrick
Metcalfe, Stephen
Mills, Nigel
Milton, Anne
Moore, rh Michael
Mordaunt, Penny
Morgan, Nicky
Morris, Anne Marie
Morris, David
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
Offord, Mr Matthew
Ollerenshaw, Eric
Opperman, Guy
Paice, rh Mr James
Parish, Neil
Paterson, rh Mr Owen
Penrose, John
Percy, Andrew
Perry, Claire
Phillips, Stephen
Pickles, rh Mr Eric
Pincher, Christopher
Poulter, Dr Daniel
Prisk, Mr Mark
Pritchard, Mark
Raab, Mr Dominic
Randall, rh Mr John
Reckless, Mark
Redwood, rh Mr John
Rees-Mogg, Jacob
Reevell, Simon
Rifkind, rh Sir Malcolm
Robathan, rh Mr Andrew
Robertson, Mr Laurence
Rosindell, Andrew
Rudd, Amber
Ruffley, Mr David
Russell, Bob
Rutley, David
Sandys, Laura
Scott, Mr Lee
Selous, Andrew
Shapps, rh Grant
Sharma, Alok
Shelbrooke, Alec
Simmonds, Mark
Simpson, Mr Keith
Skidmore, Chris
Smith, Miss Chloe
Smith, Henry
Smith, Julian
Soames, rh Nicholas
Soubry, Anna
Spencer, Mr Mark
Stephenson, Andrew
Stevenson, John
Stewart, Bob
Stewart, Iain
Stewart, Rory
Streeter, Mr Gary
Stride, Mel
Stuart, Mr Graham
Stunell, Andrew
Sturdy, Julian
Swayne, rh Mr Desmond
Swinson, Jo
Swire, rh Mr Hugo
Syms, Mr Robert
Teather, Sarah
Thurso, John
Timpson, Mr Edward
Tomlinson, Justin
Tredinnick, David
Truss, Elizabeth
Turner, Mr Andrew
Tyrie, Mr Andrew
Uppal, Paul
Vara, Mr Shailesh
Vickers, Martin
Villiers, rh Mrs Theresa
Walker, Mr Charles
Wallace, Mr Ben
Walter, Mr Robert
Ward, Mr David
Watkinson, Angela
Weatherley, Mike
Webb, Steve
Wharton, James
Wheeler, Heather
White, Chris
Whittaker, Craig
Whittingdale, Mr John
Wiggin, Bill
Willetts, rh Mr David
Williams, Mr Mark
Williams, Roger
Williamson, Gavin
Willott, Jenny
Wilson, Mr Rob
Wollaston, Dr Sarah
Wright, Jeremy
Wright, Simon
Young, rh Sir George
Zahawi, Nadhim
Tellers for the Noes:
James Duddridge and
Stephen Crabb
Question accordingly negatived.
6 Sep 2011 : Column 296
6 Sep 2011 : Column 297
6 Sep 2011 : Column 298
6 Sep 2011 : Column 299
Amendment made: 404, page 3, line 36, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—( Mr Simon Burns. )
Amendments made: 405, page 4, line 10, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
406, page 4, line 11, leave out ‘Commissioning consortia’ and insert ‘Clinical commissioning groups’.
407, page 4, line 12, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
408, page 4, line 14, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—( Mr Simon Burns. )
Amendments made: 409, page 6, line 3, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
410, page 6, line 8, leave out ‘consortium’ and insert ‘group’.
411, page 6, line 10, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
412, page 6, line 13, leave out ‘consortium’ and insert ‘group’.
413, page 6, line 14, leave out ‘consortium’s’ and insert ‘group’s’.
414, page 6, line 16, leave out ‘consortium’ and insert ‘clinical commissioning group’.
6 Sep 2011 : Column 300
415, page 6, line 18, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
416, page 6, line 21, leave out ‘consortium’ and insert ‘group’.
417, page 6, line 22, leave out ‘consortium’s’ and insert ‘group’s’.
418, page 6, line 25, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
419, page 6, line 35, leave out ‘consortia’ and insert ‘clinical commissioning groups’.—( Mr Simon Burns. )
Amendments made: 420, page 7, line 3, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
421, page 7, line 5, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
422, page 7, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—( Mr Simon Burns. )
Amendments made: 423, page 7, line 31, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
424, page 7, line 39, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—( Mr Simon Burns. )
Amendments made: 425, page 9, line 42, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
426, page 10, line 1, leave out ‘consortium’ and insert ‘group’.
427, page 10, line 11, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
428, page 10, line 22, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
429, page 10, line 24, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
430, page 10, line 35, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
431, page 10, line 41, leave out ‘consortium’ and insert ‘clinical commissioning group’.
432, page 11, line 1, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—( Mr Simon Burns. )
6 Sep 2011 : Column 301
Amendments made: 433, page 11, line 35, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
434, page 12, line 5, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
435, page 12, line 9, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—( Mr Simon Burns. )
Amendments made: 436, page 12, line 13, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
437, page 12, line 16, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
438, page 12, line 18, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
439, page 12, line 19, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
440, page 12, line 22, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
441, page 12, line 29, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
442, page 12, line 35, leave out ‘consortium’ and insert ‘clinical commissioning group’.
443, page 12, line 41, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
444, page 12, line 44, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
445, page 13, line 2, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
446, page 13, line 6, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
447, page 13, line 9, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
448, page 13, line 16, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
449, page 13, line 25, leave out ‘consortium’ and insert ‘clinical commissioning group’.
450, page 13, line 33, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
451, page 13, line 34, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
452, page 13, line 37, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
453, page 13, line 38, leave out ‘consortia’ and insert ‘clinical commissioning groups’.—( Mr Simon Burns. )
Amendments made: 454, page 14, line 29, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
6 Sep 2011 : Column 302
455, page 14, line 37, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—( Mr Simon Burns. )
Amendments made: 456, page 15, line 34, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
457, page 20, line 21, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
458, page 21, line 39, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
459, page 22, line 37, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—( Mr Simon Burns. )
Amendments made: 460, page 25, line 9, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
461, page 25, line 11, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
462, page 25, line 13, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
463, page 25, line 22, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
464, page 25, line 24, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
465, page 25, line 29, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
466, page 25, line 40, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
467, page 25, line 43, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
468, page 27, line 2, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—( Mr Simon Burns. )
Amendments made: 469, page 27, line 11, leave out ‘Commissioning consortia’ and insert ‘Clinical commissioning groups’.
470, page 27, line 12, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
471, page 27, line 13, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
472, page 27, line 17, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
473, page 27, line 20, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
474, page 28, line 6, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
6 Sep 2011 : Column 303
475, page 28, line 7, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
476, page 28, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
477, page 28, line 14, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
478, page 28, line 16, leave out ‘consortium’ and insert ‘group’.
479, page 28, line 23, leave out ‘consortium’ and insert ‘clinical commissioning group’.
480, page 28, line 31, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
481, page 28, line 40, leave out ‘consortium’ and insert ‘clinical commissioning group’.
482, page 28, line 43, leave out ‘consortium’ and insert ‘group’.
483, page 28, line 44, leave out ‘consortium’ and insert ‘group’.
484, page 29, line 2, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
485, page 29, line 5, leave out ‘consortium’ and insert ‘group’.
486, page 29, line 17, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
487, page 29, line 18, leave out ‘commissioning consortium’s’ and insert ‘clinical commissioning group’s’.
488, page 29, line 20, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
489, page 29, line 24, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
490, page 29, line 28, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
491, page 29, line 38, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
492, page 29, line 42, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
493, page 30, line 1, leave out ‘consortium’ and insert ‘clinical commissioning group’.
494, page 30, line 4, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
495, page 30, line 6, leave out ‘consortium’ and insert ‘group’.
496, page 30, line 7, leave out ‘consortium’ and insert ‘clinical commissioning group’.
497, page 30, line 11, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
498, page 30, line 17, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
499, page 30, line 18, leave out ‘consortia’ and insert ‘groups’.
500, page 30, line 19, leave out ‘consortium’ and insert ‘clinical commissioning group’.
501, page 30, line 21, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
502, page 30, line 23, leave out ‘consortium’ and insert ‘group’.
503, page 30, line 33, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
504, page 30, line 34, leave out ‘consortium’ and insert ‘group’.
6 Sep 2011 : Column 304
505, page 31, line 5, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
506, page 31, line 7, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
507, page 31, line 10, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
508, page 31, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
509, page 31, line 14, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
510, page 31, line 16, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
511, page 31, line 19, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
512, page 31, line 20, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
513, page 31, line 21, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
514, page 31, line 22, leave out ‘consortium’ and insert ‘group’.
515, page 31, line 24, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
516, page 31, line 27, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
517, page 31, line 31, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
518, page 31, line 33, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
519, page 31, line 34, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
520, page 31, line 35, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
521, page 31, line 37, leave out ‘consortium’ and insert ‘group’.
522, page 32, line 2, leave out ‘consortium’ and insert ‘clinical commissioning group’.
523, page 32, line 5, leave out ‘consortium’s’ and insert ‘group’s’.
524, page 32, line 8, leave out ‘consortium’ and insert ‘group’.
525, page 32, line 12, leave out ‘consortium’ and insert ‘group’.
526, page 32, line 15, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
527, page 32, line 19, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
528, page 32, line 25, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
529, page 32, line 29, leave out ‘consortium’ and insert ‘clinical commissioning group’.
530, page 32, line 34, leave out ‘consortium’s’ and insert ‘group’s’.
531, page 32, line 41, leave out ‘consortium’s’ and insert ‘group’s’.
532, page 32, line 42, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
533, page 32, line 44, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
534, page 33, line 2, leave out ‘consortium’ and insert ‘clinical commissioning group’.
6 Sep 2011 : Column 305
535, page 33, line 36, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
536, page 33, line 48, leave out ‘consortium’ and insert ‘clinical commissioning group’.—( Mr Simon Burns. )
Amendments made: 537, page 34, line 6, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
538, page 34, line 8, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
539, page 34, line 19, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
540, page 34, line 22, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
541, page 34, line 26, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
542, page 34, line 35, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
543, page 34, line 39, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
544, page 35, line 2, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
545, page 35, line 11, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
546, page 35, line 15, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
547, page 35, line 17, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
548, page 35, line 21, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
549, page 35, line 26, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
550, page 35, line 31, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
551, page 35, line 33, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
552, page 35, line 36, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
553, page 36, line 2, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
554, page 36, line 7, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
555, page 36, line 16, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
556, page 36, line 38, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
557, page 36, line 40, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
558, page 36, line 42, leave out ‘consortium’ and insert ‘clinical commissioning group’.
559, page 36, line 46, leave out ‘consortium’ and insert ‘group’.
560, page 37, line 2, leave out ‘consortium’ and insert ‘group’.
561, page 37, line 7, leave out ‘consortium’ and insert ‘group’.
562, page 37, line 10, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
6 Sep 2011 : Column 306
563, page 37, line 15, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
564, page 37, line 17, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
565, page 37, line 24, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
566, page 37, line 25, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
567, page 37, line 28, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
568, page 37, line 30, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
569, page 37, line 32, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
570, page 37, line 34, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
571, page 37, line 36, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
572, page 37, line 37, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
573, page 37, line 40, leave out ‘consortia’ and insert ‘groups’.
574, page 38, line 2, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
575, page 38, line 4, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
576, page 38, line 9, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
577, page 38, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
578, page 38, line 14, leave out ‘consortium’ and insert ‘group’.
579, page 38, line 16, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
580, page 38, line 17, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
581, page 38, line 19, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
582, page 38, line 23, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
583, page 38, line 25, leave out ‘consortium’ and insert ‘group’.
584, page 38, line 28, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
585, page 38, line 31, leave out ‘consortium’ and insert ‘group’.
586, page 38, line 33, leave out ‘consortium’ and insert ‘group’.
587, page 38, line 34, leave out ‘consortia’ and insert ‘clinical commissioning groups’.
588, page 38, line 37, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
589, page 38, line 40, leave out ‘consortium’ and insert ‘clinical commissioning group’.
590, page 39, line 1, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
591, page 39, line 3, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
592, page 39, line 4, leave out ‘consortium’ and insert ‘clinical commissioning group’.