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Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op): I have here a letter to the Prime Minister from Dr Clare Highton and Dr Haren Patel, the chairs of City and Hackney clinical commissioning group, who say that they want
“to add our voice to the call for the Bill to be withdrawn.”
Does my right hon. Friend agree that that underlines his point about the wide range of people who want it to be dropped?
Andy Burnham: I think that Government Members are misjudging the mood of the country, and particularly of health professionals, who have not given a knee-jerk political response to the Bill but have given it careful consideration since it began as a White Paper and then proceeded on its tortuous path through Parliament. They have come to the conclusion that it is better, even now, to abandon it and work back through the existing legal structures of the NHS rather than proceed with the new legal structure and all the upheaval that that entails.
Mr George Howarth (Knowsley) (Lab): Yesterday I was at a meeting with people with diabetes who expressed grave concern that they do not know what services would be available if the Bill were to go ahead. Is not that another good reason to take a pause and decide to drop the Bill until all these problems can be resolved?
Andy Burnham: I am aware of the concerns expressed by Diabetes UK and, indeed, by many other organisations representing people with long-term conditions, who have not been given the clarity that they need in order to give their support to these changes. [ Interruption. ] The Secretary of State says “Rubbish”, but I am afraid that those questions have not been answered, and that is not good enough.
Andy Burnham: I will not give way.
As I said, we need to see whether we can find common ground and put the NHS before party politics. That is the test that I set for the debate, and it is the spirit in which I wish to frame it. Today is not just an Opposition day but Merseyside derby day. Usually both occasions put me in a highly partisan mood, yet despite having double reason to be in tribal mode, I am going to take the unusual step of urging Labour Members not to vote for our motion but to consider the amendment tabled by the hon. Member for St Ives (Andrew George) and his Liberal Democrat colleagues. We will listen with interest to what he has to say. The amendment sets out a sensible way forward that we can all unite around. It sends out the simple message that the importance of the NHS to us all and to our constituents should trump any tribal loyalty. It is important to say that, because I fear that sheer gut loyalty, political pride and the need to save face are the only forces driving a deeply defective Bill towards the statute book.
George Freeman (Mid Norfolk) (Con):
I had the great privilege of working in biomedical research in and around the NHS for 15 years before coming to the House. Is it not the case that the challenges of an ageing population, the explosion of new biomedical treatments,
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diagnostics and devices, and the aspirations of modern patients demand reform? Did not the Labour party use to be the party of reform? Is not the right hon. Gentleman’s partisan posturing simply an illustration that Labour is no longer fit for Government?
Andy Burnham: Those factors demand service reform. I remind the hon. Gentleman that he stood at the election for a moratorium on such reform, which was a dishonest pledge that would have prevented the NHS from making the changes that it needs.
The NHS model that the hon. Gentleman and his colleagues seek to break with the Bill is judged to be the most efficient health care service in the world. The Secretary of State says today that that model is simply unsustainable in this century, with the ageing society and all the other pressures on it. I put it to the hon. Gentleman and the Secretary of State that that model is not the problem but the solution to the challenges of an ageing society, because it is proven to be the most fair and cost-effective way of delivering health care to the whole population.
We need to be honest with ourselves today. I mentioned the fact that it is just political pride and gut loyalty that are driving the Bill towards the statute book. Those motivations, however understandable and human they are and however familiar to politicians of every stripe, do not justify inflicting a sub-optimal legislative structure on our most cherished public service and making the already difficult job of health professionals even harder as they struggle to make sense of Parliament’s intentions.
Caroline Lucas (Brighton, Pavilion) (Green): Does the right hon. Gentleman agree that it is ideology, not evidence-based policy, that is driving ever greater competition in health care markets? Does he agree that the evidence suggests that that is the way to undermine our NHS, not to improve quality and equity?
Andy Burnham: I agree with the hon. Lady. It is that ideology that the NHS and health professionals are rejecting. They want to work in an essentially collaborative health service. They do not accept the vision that pits hospital against hospital and doctor against doctor.
Barely anybody has a good word to say about this busted flush of a Bill, which has lurched from one disaster to another. The unprecedented pause did not address the real concerns, but simply added bureaucracy and complexity. The 1,000-plus amendments are not a sign of improvement, but of confusion, complexity and contradiction. They have left a mess of a Bill that even the Health Secretary cannot recognise as his own. If that was not bad enough, an unfolding communications disaster has alienated the very people the Government are depending on to implement their Bill. A Downing street summit was called to discuss the implementation of a reform that is about clinical leadership, but doctors’ and nurses’ leaders were shut out of Downing street. It was hard to see how the situation could get any worse, but it just has.
First, on Friday, the Information Tribunal ruled against the Government and in favour of my right hon. Friend the Member for Wentworth and Dearne (John Healey). I pay tribute to the assiduous way in which he has pursued his principled case. The tribunal ruled against the publication of the strategic risk register, but in favour
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of the publication of the transition risk register, vindicating our position and dismissing the Prime Minister’s claims against my actions as Health Secretary.
Let us be clear about what that ruling represents. It is an incredible state of affairs for any Government to suffer such a serious legal reversal at this stage of a protracted parliamentary process. It is an indictment of the judgment, or lack of it, of the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) and others in the Department, in their handling of the Bill. Where is the Minister’s good grace in defeat? It is simple: my right hon. Friend the Member for Wentworth and Dearne won and the Government lost. What are they waiting for? They must publish the risk register today and give Parliament the courtesy of knowing all the relevant information on Ministers’ plans before they ask us to approve them. Instead, what do we get? Silence and playing for time. They are hoping to string it out until after 20 March. That is simply not good enough.
Bill Esterson (Sefton Central) (Lab): My right hon. Friend is, as ever, making the case for the NHS, not for the privatisation that the Tories and their Lib Dem friends are pursuing. We are talking about the future of the NHS, so let me quote Victoria Roberts, a student nurse from Merseyside, who starts her training in two weeks. She says:
“I am a student nurse due to start my training in 2 weeks. This is not the NHS I want to serve or work in, but rather will help only those who can pay the most.”
Does my right hon. Friend agree with that assessment of where the Tories are taking the NHS?
Mr Deputy Speaker (Mr Lindsay Hoyle): Order. We must have shorter interventions. A lot of people want to speak and we have got to get on with it.
Andy Burnham: I wish the Government would listen to voices such as the student nurse that my hon. Friend the Member for Sefton Central (Bill Esterson) quoted—people who want to dedicate their lives to the NHS. Frankly, their views are brushed aside by an arrogant Government.
It gets worse as the Bill enters a new crisis, with one of the coalition parties formally withdrawing permission from its peers to support the Bill. It is not at all clear what happens now—whether Lib Dem peers will defy the wishes of their party or their leader. Given the developments of the last few days, it is simply inconceivable that the Government can continue on their current course and present the discredited Bill here in seven days. The only responsible thing to do is listen to what Lib Dem Members are saying and support what the amendment tabled by the hon. Member for St Ives seeks to do. I will deal with that shortly.
Simon Hughes (Bermondsey and Old Southwark) (LD): Just so that the right hon. Gentleman is clear, the motion that the Liberal Democrats passed on Sunday did not tell the Lords that they should or should not support the Bill. It simply reserved our party members’ judgment until we see the work that the Lords are continuing to do. That is our position. I think that that is sensible and fair for the NHS and our party.
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Andy Burnham: I am afraid that I cannot read all the intricate smoke signals of a Lib Dem conference, but to my simple mind, removing permission from the motion for peers to endorse the Bill is a pretty clear signal that that permission has been withheld.
Before I deal with the amendment that the hon. Member for St Ives has tabled, I want to tackle directly the charge of scaremongering that has been levelled at Labour Members, and draw the House’s attention to evidence already emerging that supports our central concerns about the effect of the reorganisation. We have consistently said that it is the wrong time to reorganise the NHS—indeed, it is the worst time imaginable. The Government are asking the NHS to do too much. It is facing its toughest ever financial challenge. Combining that with the biggest ever reorganisation was a catastrophic misjudgment. The Government dismantled the existing structures of the NHS before the new ones were in place, leading to a loss of grip and focus at local level just when that was most needed.
We have now had two lost years in the NHS. When the system should have been getting to grips with the financial challenge, it has been distracted and destabilised by reorganisation. Information is now emerging that bears that out. The Nicholson challenge is a huge task for the NHS, but after only six months, we hear that it is already falling behind. New information provided from the Department to the Health Service Journal in response to a freedom of information request reveals how two out of three—68%—non-foundation trust acute trusts missed their savings targets for the first six months of the Nicholson challenge. At least five have made less than 20% of their planned savings for the year 2011-12. Overall, at the half-year point, the non-FT acute sector had a net deficit of £135 million. That is a real warning sign, which suggests that the Government are storing up huge problems for the future.
That is not conjecture. There is evidence that a destabilised NHS is losing its grip on finances and operational standards. For the tenth week in a row, the NHS last week missed the Secretary of State’s lowered standard for accident and emergency, with fewer than 95% of people seen within four hours. That is the main barometer of pressure on NHS hospitals. The figures clearly tell us that hospitals are not coping with the pressure that they are under, and that job losses and staff shortages are having a real impact.
Sajid Javid: Will the right hon. Gentleman give way?
Rather than just reel off statistics about elective waiting times, I ask the Secretary of State today to address A and E performance. Why does he think the NHS is missing his relaxed target and what steps is he taking to address that?
Another of our central concerns—
Sajid Javid: Will the right hon. Gentleman give way?
Andy Burnham: Just one second. I have said that I want to give hon. Members a chance to comment in the debate, and that is what I am going to do.
Alok Sharma (Reading West) (Con): Will the right hon. Gentleman give way?
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The Opposition have said that the plans will bring huge variation and a postcode lottery writ large, which is what we are beginning to see, with random rationing decisions across the system. Minor operations are being restricted, generic drugs are being prescribed, and procedures, for instance to remove varicose veins, are being withdrawn from patients.
More worryingly, we have seen the emergence of a new trend: trusts are restricting access to treatment and surgery based on body mass index levels or lifestyle factors such as smoking. Those have been dressed up as initiatives to improve public health, but many people see them as crude attempts to save money. It seems to me that that is a straightforward breach of the NHS constitution, and indeed of its founding values. Treatment should be according to need, not according to judgmental decisions by unaccountable health professionals. I put it to the House that that is a dangerous departure. Treatment according to need must mean what it says. There is no sign of Ministers intervening to say that that is unacceptable and that they will reverse those decisions. That is a worrying glimpse of the future, in which the NHS becomes a huge postcode lottery and people have limited chance to challenge decisions, and it takes us to one of people’s central worries about the Bill: that there is no longer a duty on local commissioners to provide comprehensive health services.
There is other evidence around the system of the concerns that the Opposition have raised. There is evidence of fragmentation, not integration, as clinical commissioning groups are ordered to run an “any qualified provider” tendering process on three community services; of damage to the doctor-patient relationship; and of hospitals, such as St Helier, which is in the constituency of the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), being destabilised by the effects of the emerging market, as clinical commissioning groups begin to withdraw services.
Those are not invented risks or scaremongering; they are there in black and white in local and regional risks registers, which Opposition Members have highlighted. We are now seeing those risks begin to materialise on the ground, which is why the difficult judgment that so many royal colleges have reached is that, even now, as difficult as it is, it is safer for the NHS to work back through the existing legal structures of the system than to proceed with the introduction of a new one.
I want to assure the House that “Drop the Bill” is not pure oppositional opportunism. I have always balanced the “Drop the Bill” call with the words, “And we will work with the Government to introduce GP-led commissioning.” I have never had any objection to doctors being more able to shape services, nor to more control and choice for patients, but the simple truth is that the Government did not need a new Bill to introduce those things. Indeed, the very fact that they have arrogantly already introduced those changes in advance of the Bill makes the argument that the Bill is simply unnecessary.
The Bill is a huge exercise in futility, but the reason we have one is that the Government want to go further on a misguided mission to rewrite the entire legal structure of the NHS to facilitate more competition and a market-based system. That, more than anything, is worrying people and why they are withholding support. That is the Government’s problem. They were not open and
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honest about those plans at the beginning, and have openly extolled the competition argument only in more recent weeks. That is why people are worried by the hidden agenda they see behind the Bill.
The amendment from the hon. Member for St Ives offers a way forward that can bring politicians and professionals back together, but, in urging the Opposition to support it, I wish to make something very clear: in supporting the amendment, the Opposition are offering no endorsement of the health policies in the coalition agreement. We are simply saying that if the Government were to stick to the precise terms of the coalition agreement, and specifically to the clear pledge of no top-down reorganisation, that would be a better position for the NHS and would represent real progress.
The talks could take as a starting point the stability plan proposed by the Faculty of Public Health. GP-led commissioning could be delivered by the clinical commissioning groups that the Secretary of State has created. Furthermore, to build confidence among clinicians, I offer to agree with him some principles by which important service change in the NHS could be introduced without every hospital being used as a political football at a local level. That is because the NHS needs service change, not structural reform. If we continue to play politics with hospital changes, we will do the NHS the ultimate disservice of condemning it to an outdated service model.
In conclusion, I am in politics to protect the things I care about, and the NHS comes top of that list. This is not about politics, as was claimed at the weekend. To be honest, it suits our narrow political objectives for the Government simply to plough on. The great irony is that dropping the Bill would be the right political decision for both coalition partners. Nevertheless, we desperately want them to do that, because if they do not, the damage to the NHS will be profound and possibly irreparable.
We have called this debate both to reflect the views of the e-petitioners and to try to find a way forward around which people can coalesce. We are ready to play a constructive part in that process. But I need to be clear with the Secretary of State: it would be a constitutional outrage were he to bring his discredited Bill back to this House in seven days. Put simply, he does not have the permission of the people of this country to proceed with his plans for the NHS. He is wrong to say that the NHS model we have known for 63 years is unsustainable in the face of the challenges of this century.
The NHS is the solution to those challenges, not the problem, having been judged the most efficient and fair system in the world. Those are truly great strengths, and my plea to the Secretary of State is to build on them, not throw them away. However, if he will not listen, the House can still intervene. Time is running out for the NHS. Tonight we have a final chance to put the NHS first and party politics second. The country wants us to do that. Let us rise to the occasion. I commend the motion to the House.
4.56 pm
The Secretary of State for Health (Mr Andrew Lansley): As a learned man, Mr Deputy Speaker, you will recall that Plato said that
“empty vessels make the loudest sound”.
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The right hon. Member for Leigh (Andy Burnham) has been a study in this: as his arguments have diminished, so his tone has become more strident. By the end of his speech, he was simply shouting slogans. I listened carefully to his speech, but in vain, for evidence of an argument, still less of an Opposition policy.
I ask the House to reject the motion, which is a desperate ploy from a desperate party. The House scrutinised and approved the Bill, with amendments. following a substantial and highly constructive engagement right across health and care services and with the independent NHS Future Forum. We accepted all their recommendations. The chairman of the British Medical Association Council said at the time that the recommendations
“address many of the BMA’s key concerns”.
Dr Clare Gerada, the chair of the Royal College of General Practitioners, said that
“we are reassured that things are moving in the right direction”.
Yes, things have moved in the right direction, including, apparently, Dr Gerada, encouraged by her council.
In the other place, things have moved in the right direction, too. We have had hours of constructive debate leading to further positive amendments, including amendments to put beyond doubt the Secretary of State’s responsibility and accountability with respect to a comprehensive health service, and a duty on the Secretary of State to have regard to the NHS constitution; amendments to make it clear that Monitor will have the power to require health care providers to promote integration of NHS services, enabling Monitor to use its powers to support integration and co-operation in the interests of patients; and amendments conferring new responsibilities on the NHS Commissioning Board and clinical commissioning groups to play an active role in supporting education and training, and requiring providers to co-operate with the Secretary of State when exercising his duty to secure an effective education and training system. All those amendments were positively accepted in the Lords.
Mr George Howarth: The Secretary of State quoted Plato earlier. Does he recall the advice that Cromwell gave to Members of the Long Parliament—that they had stayed in their place for too long and to no useful purpose? Is that not advice that he might take?
Mr Lansley: I do not think the right hon. Gentleman should quote Cromwell to a Cambridgeshire MP; I think I know more about Cromwell than he does. [Hon. Members: “Ooh!”] I might also tell him—
Michael Dugher (Barnsley East) (Lab): What do you know about the health service?
Mr Lansley: What do I know about the health service? I have been at the Government and Opposition Dispatch Boxes for nearly nine years speaking on behalf of the national health service. Before that I was on the Select Committee on Health, looking out for the interests of the health service, and before that my father was working—[ Interruption. ]
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Mr Deputy Speaker (Mr Lindsay Hoyle): Order. Front Benchers need to be a little calmer. A lot of Members want to be called, and we want to hear the Secretary of State.
Mr Lansley: Let me just say this to the hon. Member for Barnsley East (Michael Dugher), who is sitting on the Opposition Front Bench. There may be many things that we can debate in this House, including the policies, but I deeply resent any implication that I do not care about the national health service. I believe that I have demonstrated that I do; and his hon. Friends—and, to be fair, the right hon. Member for Leigh—have made that absolutely clear, time and again. Dr Clare Gerada, on behalf of the Royal College of General Practitioners, has said clearly that she recognises the Prime Minister’s and my passion and commitment and that of the Prime Minister to support the national health service.
Stewart Hosie (Dundee East) (SNP): The Secretary of State said some moments ago that the Bill had all been debated in this House, but of course it has not. Possibly the most damaging aspect financially to the NHS outside England is the increase in usage of the private sector in the NHS in England to 49%. That has never been debated in this House, has it?
Mr Lansley: I am afraid that the hon. Gentleman is completely wrong. The private income cap for foundation trusts was debated fully in Committee in this House, and it has been debated again in another place. The reason for the so-called 49% was simply that Members in another House said that they wanted to be absolutely clear that the principal legal purpose of foundation trusts is to provide services to the NHS, and therefore that, by definition, a foundation trust could not have more of its activity securing private income than NHS income, hence the 49%. But in truth, the safeguards that are built in make it absolutely clear that, whatever the circumstances and whatever their private income might be—from overseas activities or overseas patients coming to this country—foundation trusts must always demonstrate that they are benefiting NHS patients. That is why, I remind the House again, the foundation trust with the highest private income—27%—is the Royal Marsden, which delivers consistently excellent care for NHS patients.
Mrs Anne Main (St Albans) (Con): Does my right hon. Friend share my absolute astonishment at Labour Members’ collective amnesia when it comes to the 13 years of mixed-sex wards and rising levels of MRSA and C. difficile that they presided over, along with a failed patient record system that has cost billions?
Mr Lansley: My hon. Friend is absolutely right, and I will come to some of those points. However, I might just say that, in the space of the last few days, we have had an opportunity to demonstrate that Labour signed up to an enormous, centralised, top-down NHS IT scheme that was never going to deliver, was failing to deliver and was costing billions.
Karl Turner (Kingston upon Hull East) (Lab): Will the Secretary of State give way?
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In the space of under two years, my right hon. and hon. Friends at the Department and I have delivered a reduction approaching £2 billion in the cost of the NHS IT programme. That will enable us to empower services right across the country to be better users and deliver better IT systems.
Duncan Hames (Chippenham) (LD): Further to the list of changes to the Bill that the Health Secretary has outlined, will he confirm that it no longer imposes reviews by the Competition Commission on the NHS, therefore ensuring that it is not treated in the same way as any private industry would be?
Mr Lansley: That is indeed true, and my hon. Friend will also be aware—the Future Forum was clear about this—that the NHS benefits from the transfer of competition powers. The Bill does not create any new competition powers in the NHS; it transfers the exercise of competition powers from the Office of Fair Trading to Monitor, as a sector-specific regulator, as we agreed in the coalition agreement. That is what the Bill does, and that is a better protection for the NHS compared with what would otherwise be the application of competition rules, and before—[ Interruption. ] Labour Members mutter, but it has become apparent over recent weeks that in 2006, when the right hon. Member for Leigh was a Health Minister, it was their Government who received legal advice that demonstrated that their changes had introduced the application of EU competition rules into the NHS.
Simon Hughes: Will the Health Secretary amplify his answer to our Scottish National party colleague, the hon. Member for Dundee East (Stewart Hosie), and make it quite clear that both Government policy and, now, the construction of the Bill not only prevent private sector activity from going out of the health service in terms of finance, but restrict the method of expanding private sector activity? The controls are now in the Bill, even if they were not at the beginning.
Mr Deputy Speaker: Order. Interventions must be curtailed.
Mr Lansley: There is absolutely nothing in the Bill that promotes or permits the transfer of NHS activities to the private sector. Of course, NHS trusts are technically able to do any amount of private activity at the moment, with no constraint. The Bill will make absolutely clear the safeguard that foundation trusts’ governors must consent if trusts are to increase their private income by more than 5% in the course of one year, and that they must always demonstrate in their annual plan and their annual reporting how that private activity supports their principal legal purpose, which is to provide services to NHS patients.
Labour sought to oppose the Bill in another place, but its motion was defeated by 134 votes. We have reached a stage at which the Labour party, and the right hon. Member for Leigh in particular, having embraced opposition —for which they are well suited—now oppose everything.
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They even oppose the policies on which Labour stood at the election. Labour’s manifesto stated that
“to safeguard the NHS in tougher fiscal times, we need sustained reform.”
The trade unions have got hold of the Labour party in opposition, and it is now against reform. Its manifesto also stated that
“we will deliver up to £20bn of efficiencies in the frontline NHS, ensuring that every pound is reinvested in frontline care”.
I remind Labour Members, who are all wandering around their constituencies telling the public that there are to be £20 billion of cuts to the NHS, that that £20 billion was in their manifesto. Now they are talking about it as if it were cuts; it is not. We are the ones who are doing it, and they are the ones who are now opposing it. They scare people by talking of cuts—[ Interruption. ] They do not like to hear this. Actually, this year, the NHS has an increased budget of £3 billion compared with last year, and in the financial year starting this April there will be another increase of £3 billion compared with this year. The Labour manifesto also stated:
“Foundation Trusts will be given the freedom to expand their provision into primary and community care, and to increase their private services”.
John Pugh (Southport) (LD): The right hon. Gentleman has just mentioned reform. In 2009, he said in this place:
“Organisational upheaval and reform do not seem to correlate well.”—[Official Report, 19 November 2009; Vol. 501, c. 225.]
Mr Lansley: We know that it is necessary for us to reform in order to deliver the improvements that the NHS needs, as well as the sustainability that it needs. We are not even speculating about this; we can demonstrate that it is happening. This is in contrast to what the right hon. Member for Leigh said. He said that he was not scaremongering, then he got up and did just that. He scaremongered all over again. He went to a completely different set of data on the four-hour A and E provision, for example. He went to the faulty monitoring data, which are completely different from the ones that we have always used in the past—namely, the hospital episodes statistics data, which demonstrate that we are continuing to meet the 95% target.
When we look across the range of NHS performance measures, we can see that we have improved performance while maintaining financial control. The monitoring data from the NHS make that absolutely clear, and that is in contrast to what happened when the right hon. Gentleman was a Minister in the Department, when Labour increased the NHS budget and lost financial control. That happened when the hon. Member for Leicester West (Liz Kendall) was a special adviser in the Department. Now, we have financial control across the NHS and we have the NHS in financial surplus.
Let me return to the Labour manifesto—[ Interruption. ] Labour Members do not like to hear this. It stated:
“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs.”
Yes—choice and any qualified provider are in the Labour manifesto. We are doing what Labour said should be done in its manifesto—and it is now opposing it.
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Let us find out what it is that the right hon. Member for Leigh opposes in the Bill. I did not find that out in his speech; I heard generalised distortions, but I genuinely want to know. Let us take some examples. Is it the Secretary of State’s duty in clause 1 to promote a comprehensive health service free of charge, as now? No, he cannot possibly be against that. Is it that the Bill incorporates for the first time a duty on the Secretary of State to act to secure continuous improvement in quality—not just access to an NHS service, but putting quality at the heart of the NHS? Is he against that? No, surely not. Anyway, that approach began with Ara Darzi, and we have strengthened it.
Dame Joan Ruddock (Lewisham, Deptford) (Lab) rose —
Grahame M. Morris (Easington) (Lab) rose —
Mr Lansley: Let us try this one. For the first time the Bill introduces in clause 3 a duty that embeds the need to act to reduce inequalities firmly within the health system. After 13 years of widening health inequalities under Labour, surely he cannot be against that—or is he? No. Well, what about clinically led commissioning, with doctors and nurses who are responsible for our care given the leadership role in designing services? We heard earlier about one CCG, but 75 leaders of clinical commissioning groups wrote to The Times a fortnight ago. Let me quote them, because it is instructive of what is happening. They said:
“Since the…Bill was announced, we have personally seen more collaboration, enthusiasm and accepted responsibility from our GP colleagues, engaged patients and other NHS leaders than through previous ‘NHS re-organisations’”.
“Putting clinicians in control of commissioning has allowed us to concentrate on outcomes through improving quality, innovation and prevention”—
precisely the things that the NHS needs for the future.
Now the right hon. Gentleman says, “Oh, yes, we can do GP commissioning”, but let us recall that in 2005, practice-based commissioning was in the Labour manifesto, and that in 2006, he said he was in favour of it. He said that he was
“introducing practice-based commissioning. That change will put power in the hands of local GPs to drive improvements in their area”—[Official Report, 16 May 2006; Vol. 446, c. 861.]
Mr Lansley: I will give way in moment. The right hon. Gentleman said he was in favour of practice-based commissioning. In 2010, he was the Secretary of State and was in charge of the manifesto, yet practice-based commissioning disappeared out of the Labour manifesto —it was not there at all. After the election, he pops up and says, “Oh, we are in favour of it again”. The truth is that practice-based commissioning was always the right idea: the Labour Government did not do it; the primary care trusts suppressed it. The Bill makes it possible for clinical commissioning groups to take responsibility and for doctors and nurses to design and deliver better services. Because of this Bill, it will happen—and it will not be suppressed by a top-down bureaucracy.
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Andy Burnham: I made the Secretary of State an offer in my opening remarks. I said I would work with him to introduce his vision of clinically led commissioning, but he seems strangely silent about that and is pursing a very partisan tone. Will he confirm that he could introduce GP-led commissioning without any need for legislation—and without all the upheaval that is coming with his reorganisation?
Mr Lansley: The short answer to that is no. If one wishes to arrive at a place where the clinical commissioning groups have responsibility for budgets and proper accountability—including democratic accountability for what they do—legislation is required to get there. That is why we are putting legislation in place to make it happen.
Angie Bray (Ealing Central and Acton) (Con) rose —
Mr Lansley: I give way to my hon. Friend.
Angie Bray: I thank my right hon. Friend for that, and I thank him, too, for coming to Acton last week and spending a long evening in a room full of health professionals—doctors, dentists and pharmacists. Does he agree that there was a real desire in that room to engage constructively in discussion on the reforms rather than to turn their back on them, as the Labour party would?
Mr Lansley: I am grateful to my hon. Friend for her initiative in bringing doctors, dentists and nurses together to have that conversation. I really appreciated it, and I thought that it illustrated exactly what I have found—that, although not everybody in the room agreed with the Bill—[Laughter]—many did. Contrary to what I see on the Labour Benches, they all wanted to design better services for patients. They cared about patients and engaged in a proper debate about how to achieve that.
I am still trying to find out what it is in the Bill that the right hon. Member for Leigh is against. Is it the fact that the Bill strengthens the NHS constitution? He should be proud of that; he introduced it. For the first time, however, the Bill requires the Secretary of State to have regard to it and the NHS Commissioning Board and clinical commissioning groups to promote it. He is not against that, I presume.
What about the fact that, for the first time, the NHS Commissioning Board and commissioners will have a duty to promote integration throughout health and social care? Is the right hon. Gentleman against integrated care? I do not know. Let me try another question. What about the prohibition in clauses 146, 22 and 61 of discrimination in favour of private providers, which is in legislation for the first time? The right hon. Gentleman may be against that, because when his party was in office, that is what the Government did. They discriminated in favour of private sector providers, and we ended up with £250 million being spent on operations that never took place and the NHS being paid more for operations when it was not even allowed to bid for the work.
What about the creation of a strong statutory voice for patients through HealthWatch? The Labour Government destroyed the community health councils, they destroyed
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patient forums, and they left local involvement networks neutered. When they were in office, they were pretty dismissive of a strong patient voice. Well, we on the Government Benches are not, and the Bill will establish that patient voice. Is the right hon. Gentleman against all trusts becoming foundation trusts? The Bill will make that happen, and will support it—oh, no, I forgot: according to the Labour party manifesto, Labour wanted all trusts to become foundation trusts.
Let us keep moving through the Bill. Is the right hon. Gentleman against directly engaging local government in the commissioning of health services, integrating health and social care, and leading population health—public health—improvement plans? I ask the question not least because Labour local authorities throughout England are in favour of that. They want to improve the health of the people whom they represent. Is the right hon. Gentleman against local democratic accountability? The list could go on. Is he against the provision of a regulator—Monitor—whose duty is to protect the interests of patients by promoting quality, stopping anti-competitive practices that could harm patients, supporting the integration of services, and securing the continuity of services? Is he against that? It is in the coalition agreement, but I do not know whether the right hon. Gentleman is against it or not, because he does not say.
Is the right hon. Gentleman against statutory backing for the National Institute for Health and Clinical Excellence to support its work on quality? I do not know; we have not heard. Is he against developing the tariff so that it pays for quality and outcomes, not for activity? He knows that that has to happen, and he knows that it has been the right thing to do for the best part of a decade, but we have no idea whether he is against it now.
I cannot discover what the right hon. Gentleman is actually against. He sits there and says that he is against the Bill, but he is not against anything that is in the Bill. He is against the Bill because he has literally made up what he claims it says. He says that it is about privatisation—
Mr Lansley: All right, I will give way to the right hon. Gentleman one more time. Come on, then: let us find out what he is against.
Andy Burnham: I will tell the Secretary of State what I am against. I am against the rewriting of the entire legal structure of the national health service to plant market forces at the centre of the system, and to pit doctor against doctor and hospital against hospital. That is what I am against, it is what 170,000 people signed a petition against, and it is what the overwhelming consensus of health professionals is against. Would the Secretary of State not do well to listen to them for once?
Mr Lansley: So now we know, Mr Deputy Speaker. It is sheer invention. There is nothing in the Bill that creates a free-for-all. There is nothing in it that creates a market of that kind. The Bill means competition for quality, not price. It gives patients choice—and the Labour party’s manifesto was in favour of giving patients choice. Competition is not being introduced to the NHS by the Bill; it is being channelled in the interests of patients to support quality throughout the NHS.
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The Opposition talk about privatisation. As I said to my right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes), there is nothing in the Bill that allows any privatisation of NHS services. There is nothing in it that promotes such a privatisation.
The left-leaning papers talk about privatisation at Hinchingbrooke hospital because Circle is an independent mutual organisation. That is interesting, because the process for the franchising out of the management of Hinchingbrooke was started by the right hon. Gentleman when he was Secretary of State. So there we are: the only secret Tory plan that Labour can find turns out to be a Labour plan.
Paul Uppal (Wolverhampton South West) (Con): The real issue in the debate is between long-termism and short-termism. Is not the reality that the Labour Government went aggressively down the route towards private finance initiatives, burdening so many of our foundation trust hospitals with debt that was unnecessary?
Mr Lansley: My hon. Friend makes an important point. When Labour Members talk about the private sector in the NHS, they leave out of account the fact that not only did they give the private sector a sweetheart deal to get it into the independent sector treatment centres, but they have left us with 102 hospitals that were built by the private sector and £67 billion of debt to the NHS. They wandered around the country saying, “Look how we’re spending all your money to build all these new hospitals,” but they did not spend the money to build the new hospitals. They have left the NHS to have to deal with it now, which is why I am having to support hospitals that have unsustainable private finance initiative debt that the right hon. Member for Leigh and his colleagues did not deal with.
What do we have? We have policies that the right hon. Gentleman disowns, and we have nothing to replace them with. We have political opportunism, distortions dressed up as arguments, and a shameful campaign to scare people about a Bill that, in reality, is about strengthening the NHS for the benefit of patients.
Of course, if we want to see what Labour would do, we only have to look at the situation in Wales. I have to hand a Wales Audit Office bar chart; I shall hold it up so Opposition Members can see it. One bar shows rising real-terms expenditure on the NHS in England, and the blue bar shows rising real-terms expenditure on the NHS in Scotland, while the green bar shows the rate for Northern Ireland, where the rise is lower. Another bar, however, shows a very large real-terms cut in NHS spending in Labour-run Wales. Labour in Wales did not just agree with the right hon. Gentleman that it would be “irresponsible” to increase NHS spending; Labour in Wales went further, and cut spending.
In order to see the result of that, we must look at performance. In England, 91% of patients are seen and treated within 18 weeks, compared with just 68% in Wales. In England, only 1.4% of patients waited over six weeks for diagnostic tests; in Wales, 29% waited over six weeks. In Wales, Labour says it wants to insulate the NHS against reform. It ought to adopt it, however, because all that is happening in Wales is that the Labour party is, once again, putting politics before patients.
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It is patients who should be at the heart of the NHS —patients and those who care for them. This Bill is simply the support to a far more important set of changes, which make shared decision-making with patients the norm across the NHS, which bring clinical leadership to the forefront of the design and delivery of health and care services, which make local government central to planning for health and care, which strengthen the patient voice, and under which the NHS is open about the results we achieve and how to improve those results so we genuinely match the best in the world. We will continue to work with the royal colleges, and others with an interest in the future of the NHS, to implement our plans, so that we provide the best possible care for patients. The right hon. Gentleman’s motion and speech gave no credit to the NHS for what it is achieving, but I will.
We are proud of the services we deliver for patients: the lowest ever number of patients waiting over six months for treatment—[Interruption.] Labour Members do not like to listen to this, but it is the reality. Average time spent waiting for treatment is lower than at the last election. The number of patients waiting over a year for treatment has more than halved since the election. MRSA and C. difficile are at their lowest ever levels. There are more diagnostic tests—up by 300,000 over a year. There is more planned care, and there are fewer unplanned emergency admissions to hospital. Some 11,800 patients have benefited from the cancer drugs fund, and 990,000 more people have had access to NHS dentistry, while mixed-sex accommodation is down by 95%.
Andy Burnham: Will the Secretary of State give way?
Mr Lansley: No, because I am going to tell the right hon. Gentleman what he did not admit. Reform is going ahead. We are delivering efficiencies across the NHS.
Andy Burnham: Will the Secretary of State give way?
Mr Lansley: All right, I will give way, but the right hon. Gentleman might like to explain why in the year before the election the administration costs of the NHS rose by 23% and he added more than £320 million to the administration costs of primary care trusts and strategic health authorities, but in the year since, we have cut those costs. Absolutely contrary to what he said—because he was completely wrong—we are on track to deliver the Nicholson challenge. We delivered £2.5 billion in savings in the first six months of this year, having delivered £4.3 billion in savings during the course of the last financial year. Come on: explain that one.
Andy Burnham: I should just point out that the Secretary of State is trading on the successful legacy he inherited from Labour: the lowest ever waiting lists; the highest ever patient satisfaction. Let me leave that to one side, however. We on the Opposition Benches have noticed that he has not once mentioned his tribunal defeat on the NHS risk register, and all the achievements he just reeled off are at risk, are they not, because of this misguided reorganisation? I ask him to answer this point today: will he now comply with the ruling of the Information Tribunal, publish this risk register today, and let the public know the full truth about what he is doing to their national health service?
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Mr Lansley: I was right, was I not, that the weaker the right hon. Gentleman’s argument, the stronger the tone? My noble Friend Earl Howe answered a private notice question in the other place yesterday, and the position is absolutely as he described it: we were right to go to appeal, as the appeal demonstrated, because the tribunal agreed that we should not publish the strategic risk register. The decision of the tribunal was that it took the view that we should publish the transition risk register, but it did not publish its reasons. Given the simple fact that there is considerable overlap between the strategic register and the transition risk register, I find it extremely difficult to know what the tribunal’s reasons are, so we will see what its reasons are.
Mr Lansley: I will not give way.
Let me just make it absolutely clear that reform is happening and it will be supported by the Bill: nearly £7 billion has already been saved to reinvest in front-line care; we have 15,000 fewer non-clinical staff; we have 5,800 fewer managers and 4,100 more doctors—since the election, we have had more qualified clinical staff; there are 890 more midwives since the election and a record number in training; we have 240 clinical commissioning groups covering England, leading on commissioning from April on up to £60 billion-worth of services; and the ratio of nurses to beds in hospital has gone up.
Labour’s motion is politics masquerading as principle, and it is synthetic anger. I would take the right hon. Gentleman’s campaign more seriously if his own leader could have been bothered to turn up to his NHS rally, rather than taking a Rolls-Royce to a football game. This is empty rhetoric from an empty vessel; this is no policy, only politics; and this is a leader who treats his party’s campaign with disdain. The House should have no truck with them, and I ask it to reject the Labour motion.
5.26 pm
David Miliband (South Shields) (Lab): I rise today to make a simple point to Ministers and their supporters: however acute the embarrassment of giving up on the Health and Social Care Bill at this stage, it will pale into insignificance compared with the embarrassment, never mind the trauma and cost, of ploughing ahead with this health reform and making it the template for health policy for the rest of this Parliament.
The Bill has achieved a remarkable feat since we contributed to the Second Reading debate. First, it has taken the Government hostage. It is the political equivalent of the Stockholm syndrome: falling in love with your captor. The Prime Minister insists, in one breath, that he must have the Bill to save the NHS and, at the same time, at Prime Minister’s questions, he insists that 95% of the country has already had the benefit of the reforms that he claims the Bill will put through.
Secondly, in the real world—many miles from the claims of Ministers that they wanted an unprecedented consensus between politicians and professionals—this Bill is without friends. Even more remarkable, and shocking to me, is that it is a Bill that has lost friends at each and every stage of its passage through Parliament.
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Every compromise, every “concession” and every retrofit has cost the Bill coherence, cost the Bill support and raised levels of anxiety about the Bill.
The reason for that is simple: the Prime Minister, the Secretary of State and the Deputy Prime Minister have made it their calling card to say that the choice is between this Bill and inertia. I know that tactic, as I have written those speeches and those articles, but in this case the problem is that that is not true. The Leader of the Opposition and the shadow Secretary of State for Health have put forward practical proposals to achieve some of these aims that are shared across the House.
The Secretary of State will recognise that more reform is going on in the English health service than in any other health service in the world at the moment—that is the product of what was done under the previous Government. That is perhaps one reason why it is improving faster than those anywhere else. The choice is between good reform and bad reform, and this Bill is bad reform: it gives reform a bad name. In fact, it threatens to set back the cause of reform for a generation, and I want to explain why.
As amendment has been piled on amendment, the Bill has gone from being wrong to being the most half-baked, quarter-thought-out shambles that the NHS has ever seen. I want to give three examples that go to the heart of the issues raised by the Secretary of State and the Prime Minister in their speeches to launch the Bill. The first and most important is managing service change. That is most important, because everyone agrees that the health service has to change to deal with the challenges of demography, drug costs and medical technology, and that means changing in the way in which services are organised. Yet in its hatred of planning and confusion about competition the Bill makes change at a local level not more likely but less. Why? The levers of change have been neutered. Clinical commissioning groups are too small and weak as replacements for primary care trusts, the NHS Commissioning Board is too remote and gargantuan and, as the Palmer study of reorganisation in south-east London shows, market forces on their own will not reconfigure services in a coherent way.
Stella Creasy (Walthamstow) (Lab/Co-op): This weekend I met 80 women from Walthamstow who are desperately concerned because we do not have a sexual health service there, so we have very high levels of teenage pregnancy and repeat abortion, as there are doctors in the constituency who will not provide contraceptives. Does my right hon. Friend agree that the changes could make dealing with such problems harder, not easier?
David Miliband: My hon. Friend makes an important point. Far from driving the health service towards a coherent vision of the future, the Bill promises frenetic gridlock as professionals try to make the best of the bad job they have been left by the Health Secretary.
The second example is promoting efficiency. The Select Committee on Health stated:
“The reorganisation process continues to complicate the push for efficiency gains.”
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It is, of course, right. The story today that senior GPs are spending four days a week coping with reorganisation rather than treating patients is, I predict, only the first step on that road.
The third example is accountability. If there was a germ of an idea in the original Bill presented by the Secretary of State, it was to align clinical and financial responsibility. In May last year he said that the key question was to
“put the right people in charge”.
After a year, it is completely inexplicable who is in charge: not GPs, because they are overseen by the greatest behemoth of them all, the national NHS Commissioning Board; not hospital trusts, because they are answerable to Monitor and the competition authorities; not the sectoral replacements for strategic health authorities, because they are only temporary; not the managers, because they are being sacked just before they reapply for their old jobs, which now have new names; and not the clinical senates, because their purpose has not yet been defined.
In truth, the new system hardly deserves the title of a system at all. It is not just that people do not support what the Government are doing, but that they simply do not understand what the Government are doing. I warn the House that the real danger for the NHS is a perfect storm of rising costs, rising demand and opaque and inexplicable decision-taking structures.
The Government promised clarity but have delivered complexity. They promised devolution but have had to create the biggest quango of them all. They promised efficiency and they have delivered bureaucracy. The result is that at the end of this Parliament we will once again be back in a debate that I thought we had buried for ever, about whether a tax-funded health service free at the point of need could deliver for the whole population of Britain. That is the last debate we should be having, but it will be the product of the shambles now being created.
I believe the Secretary of State when he says he supports the NHS passionately, but by the end of this Parliament, when the structural flaws of the plan are clear, he will not be around to defend it. That is the true danger of this misconceived and unloved Bill, and that is why this Secretary of State, in his last act of kindness to the NHS, should kill the Bill.
5.33 pm
Mr Stephen Dorrell (Charnwood) (Con): It is a pleasure to follow the right hon. Member for South Shields (David Miliband) and it was notable that his hon. and right hon. Friends were listening to his words, rapt, possibly reflecting on what they had missed out on. The kernel of his argument for this side of the House appeared to be the offering of advice to us about where our party advantage lay. He will forgive me if I say that I think we should look elsewhere for advice about where our party advantage lies.
The right hon. Gentleman was raising a voice for Blairite reform of the NHS, and that is a theme to which I want to return. Some opponents of the Bill can claim the virtue of consistency. Some opponents of the Bill can claim that they always opposed the development of structures in the health services that encouraged flexibility and encouraged a focus on the patient voice
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and on general practitioners and the wider clinical community as an effective voice for patients in the health service.
Some can claim that they have always opposed having a health service open to private and independent sector provision alongside the national health service provision—that they have always preferred a centrally planned, state-provided service. The right hon. Member for Holborn and St Pancras (Frank Dobson), who is not in his place, can claim the virtue of consistency on that argument, but the shadow Health Secretary cannot claim that consistency because he, like the right hon. Member for South Shields, was once a Blairite. As my right hon. Friend the Secretary of State has shown with the quotations he gave from the shadow Health Secretary when he was at the Department, the shadow Health Secretary used to be an advocate of the policies that underlie this Bill. The Bill will deliver effective practice-based commissioning —a policy that the shadow Secretary of State used to espouse.
Andy Burnham: If this Bill simply continues our policy, why does it rewrite the entire legal structure of the national health service over 500 pages?
Mr Dorrell: The right hon. Gentleman knows that there is room for more than one view about the extent to which there is a need to rewrite the full statutory basis of the Bill, but that is not the issue now. The question is how, if we went down his route, had a summit and talked for another 12 months about what the institutional structure of the health service should be, that would serve the policy objective that he seeks to espouse, of greater clinical engagement in commissioning. How would it serve the policy objective of which he says he is in favour, of engaging local authorities and the wider political community in decisions that shape the future of the health service?
One issue that the right hon. Gentleman did not mention in his speech is the shift of public health out of the relatively narrow interpretation that is implicit when it is located in the national health service. Instead, public health can properly be understood as being part of the wider range of local government. Those changes do not justify some of the more ambitious rhetoric being used in support of the Bill but they certainly do not come close to justifying the rhetoric being used against it. If half the things being said about the Bill by Opposition Members were true, I and most of my right hon. and hon. Friends, and certainly my right hon. Friend the Secretary of State, would not support it.
Dame Joan Ruddock: In answer to a recent parliamentary question I asked about waiting lists, Ministers told me that they had no information on waiting lists for private patients. How does the right hon. Gentleman think it will be possible for NHS patients to believe that their waiting times are consistent with their need for treatment when there are no figures to indicate what happens in the private sector?
Mr Dorrell:
One of the effects of the Bill will be to integrate the private sector more fully in the delivery of public sector services in order to meet better standards for the national health service patient whose services are commissioned by the NHS commissioner. I should have thought the right hon. Lady would welcome the fact that there was greater opportunity for the national
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health service patient to enjoy the benefits that have previously been available on too exclusive a basis to the private sector patient. With a proper, open-minded commissioner, those benefits ought to be available, as the Blairite doctrine advocated when the Labour party believed in it, to all patients, including, pre-eminently, the vast majority of patients who rely on the national health service.
It is claimed by the Bill’s opponents that it is in favour of privatisation, but as my right hon. Friend the Secretary of State says, there is not a single provision in it that promotes privatisation. It is said to be a Bill that promotes fragmentation. The service already suffers too much fragmentation. The Bill writes into the law an obligation to deliver integrated, more collaborative, joined-up services. That addresses the problem that has been identified, which is attributed by its opponents to the Bill. It is said to be a Bill that promotes unbridled competition. That is absurd.
It is not only the shadow Secretary of State, the right hon. Member for Leigh, who can be quoted from the past. The hon. Member for Leicester West (Liz Kendall), who is seated alongside him, has said some very useful positive things in the past. I quote from the hon. Lady in 2010:
“I’ve always believed that there needs to be some competition and challenge in the system. . . I am also a strong champion of giving patients more voice and a greater say, not only over which hospital they go to but all aspects of their treatment and care.”
I am sure the hon. Lady was speaking on behalf of those on her Front Bench. The whole Labour party used to believe in that. We believe in that. That is what the Bill provides. It builds on the policy that the right hon. Gentleman used to believe in and used to advocate. He should have the courage of those convictions.
5.40 pm
Valerie Vaz (Walsall South) (Lab): It is always a pleasure to follow the right hon. Member for Charnwood (Mr Dorrell), the Chair of the Select Committee. He said that Members on our side were looking raptly at my right hon. Friend the Member for South Shields (David Miliband). Members of the right hon. Gentleman’s party were looking raptly at him, wishing he was the Secretary of State for Health.
It is an important day when both Houses are discussing the Health and Social Care Bill, and the Prime Minister is in America. When they meet, President Obama will remind him that he said the NHS was
“something that Brits take for granted—a health care system that ensures you don’t go bankrupt when you get sick”.
The President’s stepmother said that she owed her life to the NHS, without which she would not have been alive to see him become President.
There is a kind of double-speak about the Bill. If the Bill was so good in the first place and so necessary, why did we need to have a pause and a rethink, and why were there so many amendments—almost 2,000? The Secretary of State says that the GPs are in control. If the GPs are in control, why are there commissioning support groups? Who are they accountable to? Who voted for the GPs to be in control of a business dealing with public funds? If GPs are so happy about this, why did a GP in Walsall tell me that they are demoralised, disengaged and uninspired? Maybe because they were not consulted.
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Robert Flello (Stoke-on-Trent South) (Lab): Will my hon. Friend give way on that point?
Valerie Vaz: No, I am sorry. [Interruption.] Okay.
Robert Flello: I am most grateful to my hon. Friend. My persuasive charms work. Does my hon. Friend share the concerns of my constituents? They often find it difficult already to get a GP appointment. With GPs spending so much time with commissioning boards and more to come, will that not make it even harder to get time in front of a GP?
Valerie Vaz: My hon. Friend makes an important point. He should read the front page of the left-leaning newspapers, and he will see how much money is being spent on locums.
The GP in Walsall said that the pace of change is too fast. GPs are being forced into larger organisations. They have no experience of managing a business model. The Secretary of State says he wants to cut the numbers of managers. If the number of managers has been cut, why are the management consultants crawling all over the NHS? A group of consultants including McKinsey, KPMG and PricewaterhouseCoopers sealed a £7.1 million contract with 31 groups of GPs. Pulse found that four in 10 clinical commissioning groups across England have begun to enlist commissioning support from the private sector. That was the work that the PCTs did.
The Secretary of State says that change is happening anyway. So why have the Bill? The Secretary of State says that Monitor did not have a duty to promote competition. So why did the Government not approve the amendment tabled by Lord Clement-Jones that sought to designate the health service as
“a service of general economic interest”,
taking it out of EU competition law? That was not accepted.
The Government said that the role of Monitor is like that of Ofgem, Ofwat and Ofcom. David Bennett said:
“We did it in gas, we did it in power”.
Who are the shareholders? Look at Centrica. Its shareholders include Bank of New York Mellon, the Government of Singapore, the Government of Norway, the state of California, the Government of Saudi Arabia, and Goldman Sachs. The shareholders of the NHS are the people of Britain—but for how long?
The Secretary of State says he wants integration, but the Bill will effectively repeal the integration that started with the Health and Social Care Act 2001. Torbay is a classic example of that. What about the cost, which is £1.2 billion and counting?
Mr David Burrowes (Enfield, Southgate) (Con): Will the hon. Lady give way?
Valerie Vaz: I am sorry, but I have nearly finished my speech and must press on.
There was a chorus of disapproval from professionals when the White Paper was published, as they wanted more information. As Rogers and Walters say in the sixth edition of “How Parliament Works”, if there is pre-legislative scrutiny, Ministers have less political capital at stake and changes are not seen as defeats; the scrutiny of a Bill in draft gives higher quality legislation. That is
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not a description of the Health and Social Care Bill. The pre-legislative scrutiny was in the Secretary of State’s head, not in a draft Bill.
What about my constituent Stephen Wood, who went to his local GP’s surgery only to be told that doctors would only refer him to a consultant privately, not on the NHS, as he had apparently used up his budget?
Valerie Vaz: It is true. This has become personal. The NHS is an organisation in which miracles sometimes happen, which is why people are fighting to protect and save the very essence of its existence. Those who have paid their taxes do not want the Bill, and the health professionals do not want it. From all parties, professionals and patients in the NHS, we can say that we oppose the Bill, and when the NHS unravels, as it is now beginning to, we can say, “We told you so.” I support the motion.
5.46 pm
Andrew George (St Ives) (LD): I beg to move an amendment, to leave out from “Bill;” to end and add:
“declines to support the Bill in its current form; and calls for an urgent summit of the Royal Colleges, professional bodies, patients’ organisations and the Government to plan health reforms based on the Coalition Agreement.”
It is a pleasure to follow the hon. Member for Walsall South (Valerie Vaz), a fellow member of the Health Committee, who talks with great knowledge and, from the manner in which she handles herself in the Committee, is clearly very committed. The primary concern of us all in this debate is the future of the NHS; I do not question anyone’s motives as far as that is concerned. That is why I was particularly pleased when the right hon. Member for Leigh (Andy Burnham) opened the debate by reassuring us that we would have a non-tribal, non-partisan debate, and that is also why I feel rather saddened that the debate so quickly degenerated once again into tribalism, which I am sorry to say will seriously undermine our chances of coming forward with a rational solution to the intractable problem of what to do with the Bill.
Although the positions have become further entrenched by the debate, I am concerned about its outcome, because ultimately we will not defeat the Bill. This is not Second Reading, when Members could independently make up their mind on the issue outside the tribal mix. We should debate the matter in a manner that might assist the Government to reflect on where we are. I hope that ultimately they will withdraw the Bill, which is what many of us want them to do. As far as I can see, the Bill cannot be defeated by either House, so the power, and the fate of the Bill with it, lies pretty much entirely in the hands of the Government.
Although I understand that the Secretary of State is obliged to advance the arguments in the way he did today, I am concerned. Therefore, if we are to advance as I propose by withdrawing the Bill and, as set out in the amendment, calling a summit of those who want to take forward a lot of what I think is good in the Bill and in the coalition agreement, I am not sure how that could be achieved on the basis of what we have heard so far. Clare Gerada, the chair of the Royal College of General Practitioners, this morning talked about withdrawing the Bill in order to stabilise the NHS and ensure that we
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go forward without basing the future of the NHS on ideology, but we of course need to do that while ensuring that everyone is working together.
I agree with the Secretary of State’s approach to the issue, which is that no change is not an option and that change and reform are of course required in the NHS, but I think that it is better that we take this forward on a more consensual basis than the Government have achieved so far.
I already have only a little time left, so let me say something about the Secretary of State himself, because his commitment to the NHS has been questioned in today’s debate. Let me make it clear to my right hon. Friend—in this regard—that, as I said on Second Reading, I believe that he approaches the issue with the very best of intentions, and I would never question the sincerity of his commitment to the NHS over many years, which I highly respect, along with his knowledge of the subject; our disagreement is on the judgment of the legislation. I do not know whether that metaphorical embrace will damage his reputation among his Conservative colleagues, but I hope that it will not.
There are many failings in the current legislation.
Andy Burnham: I am listening very carefully to the hon. Gentleman, but may I push him a little? He says that the Bill cannot be defeated, because of parliamentary arithmetic, but what is his take on the points that his right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes) made? Is it not the hon. Gentleman’s understanding that the Lib Dem conference withdrew its permission for his peers to vote for the Bill? Does that not therefore take permission away from Liberal Democrat MPs to support it?
Andrew George: The right hon. Gentleman is aware that the conference was advisory on the issue. The motion before it actually congratulated our noble Friends in the House of Lords on having achieved significant amendments to the Bill. They have made the Bill less bad but not good enough to make it acceptable to myself—or indeed to many of my colleagues.
The right hon. Gentleman knows very well that Liberal Democrat Ministers and others cannot vote against the Government, so it is not very helpful of him to try to tease out such a situation. The pressure on those who are not so constrained has, however, been lifted.
Mr David Anderson (Blaydon) (Lab): For the purposes of clarification, would the summit that the hon. Gentleman’s amendment puts forward include the trade unions? If not, why not?
Andrew George: The summit should be as inclusive as possible—so that there is no sense of it being exclusive. The professional bodies and patient organisations in the amendment would be included as well, so I hope that the hon. Gentleman is reassured on that point.
I congratulate my colleagues in another place on what they have achieved, but underlying that is a concern about the role of the private sector. Serco in Cornwall provides an important out-of-hours service, but there are serious concerns about how the service is being run, and I have raised concerns about that over the past year. The Secretary of State has pointed out that the contract was let under Labour, but even so we can learn lessons
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from the previous Government’s failings on letting private sector contracts, and there are issues, which I shall take up with the Secretary of State, in that regard.
The purpose of the amendment is to ensure that the debate calms down and becomes less tribal, so that people can speak more freely and the Government can reflect on the fact that the Bill has less support than it did when it started. Support is ebbing away, and opposition to it is increasing even at this stage.
Mr Adrian Sanders (Torbay) (LD): Will my hon. Friend give way?
Andrew George: I cannot at this stage. I am sorry about that.
I urge the Government to reflect on this debate and on the opposition in the country, to withdraw the Bill and to allow such a summit to go ahead.
5.53 pm
Joan Walley (Stoke-on-Trent North) (Lab): I am grateful for the opportunity to follow the hon. Member for St Ives (Andrew George), and the House would do well to listen to what he says. The Secretary of State may feel that he can bluster his way through the debate, but people out there—our constituents—are listening. When I became a Member almost 25 years ago to the day, I made the point that the health of the people is the highest law, so even if we cannot deal with the Bill in this debate, we have three hours in which we can send a message. Although I came into the Chamber to support the motion in the name of my right hon. Friend the Member for Leigh (Andy Burnham), I have listened to what he has said and to what the hon. Member for St Ives has said, and I am quite content to back the amendment and to ask for an urgent summit—and for the trade unions to be involved as well.
Mr Burrowes: Will the hon. Lady give way?
I agree with the right hon. Member for Charnwood (Mr Dorrell), who chairs the Health Committee, that some aspects of the Bill are very worthy, particularly those on public health, and we do not want to lose them, but four issues need urgent clarification, and I hope the Minister will address them when he replies.
First, why are my constituents not entitled to know what is on the risk register? What is there to hide? Why can we not have it laid before us when we are making important decisions about the future of the NHS? I am quite content for there to be service changes, but not structural, top-down reform, which the Prime Minister himself, in one of his commitments before the general election, said he was not going to introduce.
The key issue for the House is whether the NHS will be subject to the full force of domestic and EU competition law, and that has not yet been clarified. The Government maintain that it will not, but the changes brought about by the Bill make certain that it will. In any event, it is not in the Government’s gift to decide, because the issue will be decided in the courts, so I genuinely believe that we are entitled to clarification on that issue—[
Interruption.
]
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I will not give way on that point. It is absolutely essential that the Government, not the law courts of this country, determine NHS policy.
Secondly, what safeguards are there against private companies using loss leaders to replace NHS services and then, once the NHS service has been eliminated, maximising profits by reducing quality? We have heard from the Secretary of State on that, but once the service is eliminated, the private companies that come in will surely have a free hand. The Government say that there will be no competition on price, but private companies will still be able to use loss-leader tactics by overloading a bid with quality for the specified price, so we must have regard to the real concerns about that.
Thirdly, how will the Government stop cherry-picking in practice? If they attempt to exclude private companies from bidding for a particular contract, will they not face court action, and in those circumstances will not services be put on hold while the courts deal with how NHS care is to be provided?
Finally, again when the Minister replies—
Mr Simon Burns: In 10 minutes?
Joan Walley: Yes, in 10 minutes, because we need time to sort out the NHS. What will the Government do about foundation trusts once they become unsustainable—once they have been undermined by cherry-picking and by loss leaders?
There are huge issues, our constituents’ health is at stake, and this is an important debate, one in which the Government need to take account of what we are saying so that Parliament can have a say in how the NHS goes forward.
5.58 pm
Chris Skidmore (Kingswood) (Con): It is an honour to speak in this debate.
I thought that I should set out the context of our discussion. Members on both sides of the House have talked about demand, in particular, and it is important to look at that question. Most importantly, we must admit that the NHS needs to adapt under new pressures. In 2001 the NHS treated 12 million patients. Today that figure is 17 million, so in other words the number of people accessing the NHS has risen over the past decade from 101 per minute to 124 per minute, resulting in the cost of drugs and prescriptions rising by more than 65%.
Mr Anderson: Will the hon. Gentleman give way?
Chris Skidmore: No, I will not. The right hon. Member for Leigh (Andy Burnham) did not give way to me, I am afraid, so I am not feeling too charitable.
Despite the coalition Government’s added investment of £12.5 billion over the course of this Parliament, demand will only rise further, with 1.6 million people turning 65 in the course of this Parliament and many living into their 80s and beyond. The number of 85-year-olds will double by 2030. The NHS is facing a perfect storm—an ageing population combined with a rise in chronic conditions, including an increase in diabetes, which will take up as much as 25% of the health budget.
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That is why we are reforming the NHS. Just as this Government are committed to dealing with the deficit so that future generations will not be burdened with debt racked up yesterday, we must be committed to reforming the NHS so that future generations can enjoy an NHS that is free at the point of delivery regardless of the ability to pay. I am sure that that is what everyone in this House is committed to.
By placing GPs rather than management in control of patient treatment, we will not only drive up standards of care, allowing patients access to more treatments under any the qualified provider scheme, but ensure that recurrent cost savings are made to be reinvested in the NHS to cope with the rising demand. Above all, this is an evolutionary measure. My right hon. Friend the Member for Charnwood (Mr Dorrell) touched on the Blairite doctrine. It was a pleasure that we had Professor Julian Le Grand come to the Health Committee, where he said that if Tony Blair were still Prime Minister and he were advising him, he would have urged him to undertake this measure. It is great to see the right hon. Member for South Shields (David Miliband) in his seat. It would have been fascinating to see what would have happened if he had become leader of the Labour party. I am sure that we would not have seen the rank tribalism that we have seen from those on his Benches today.
Andy Burnham: We are supporting the amendment.
Chris Skidmore: I am talking about the right hon. Member for South Shields, not the hon. Member for St Ives (Andrew George).
Professor Julian Le Grand stated on 28 February:
“With respect to the NHS bill, it is important that even those who generally prefer to rely upon their intuitions should avoid muddying the waters by accusing the bill of doing things that it does not, like privatising the NHS; and that all those involved should acknowledge the peer-reviewed evidence demonstrating that its provisions with respect to public competition…are likely to improve patient care.”
More hours have been given to debating this Bill than any other during this Session. Despite Labour’s message, which seems to be opposition for opposition’s sake, we are gradually learning what its policy will be for the next general election. It is interesting that at a rally in Manchester last week, the right hon. Member for Leigh stated, in front of his union faithful,
“And I will make you a promise today—if I am the health secretary after the next general election I will repeal this bill.”
According to the Opposition, this is the greatest reorganisation in history. Yet the Bill will save £4.5 billion straight away and then £1.5 billion recurrently, year on year, thereafter.
Mr Burrowes: All our constituents will be listening intently to the debate and will hear that following the health inequalities that have grown under the previous Government, the Opposition will oppose and repeal legislation that imposes a duty to tackle those inequalities. What will they think of that?
Chris Skidmore: We have already heard one Labour Member say that she welcomes the new measures on health inequalities, so it is a shame that the legislation could be repealed in its entirety.
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Last week, Labour Members committed themselves to re-establishing primary care trusts and strategic health authorities—to reconstituting the NHS as if time had stood still, with middle-level management holding the reins. It is remarkable that Labour is not the party of the NHS patient but has become the party of the PCT, the SHA and, above all, the NHS manager.
Grahame M. Morris: On the hon. Gentleman’s point about efficiency, costs and so on, I draw his attention to an article in The Guardian today which says that the cost of replacing with a locum GPs who are away on clinical commissioning duties is £123,000 a year, while one clinical commissioning group has reported that 15 local doctors are each spending two days a week away from their surgeries. How is that an efficient use of resources?
Chris Skidmore: We are reinvesting the billions of pounds saved on managers into front-line care, and that is why we have already seen over 5,000 new doctors working on front-line services this year. I understand where the hon. Gentleman is coming from in terms of the political spectrum, but I believe that he is referring to a TUC press release that The Guardian published in full.
In a previous debate, the right hon. Member for Leigh said that he would put a cap on private practice in “single figures”. That would take the NHS backwards from its current position, and it is an arbitrary cap based on ideology, not on what is in the best interests of NHS patients. Nor is it in the interests of some of our best-loved hospitals. Dr Jane Collins, the chief executive of Great Ormond Street hospital, has said:
“The lifting of the private patient cap would allow us as a Foundation Trust to treat more patients, but also, through re-investment, to help more NHS patients.”
So Labour has set its face against Great Ormond Street hospital: well done!
We need a constructive debate about what needs to be done for patients in the 21st century. The right hon. Member for Leigh should stop using the shroud-waving language that he used today in stating:
“Time is running out for the NHS.”
In December last year, he said that there were 72 hours to save the NHS. What happened? He should beware, above all, of becoming the boy who cried wolf. I believe that this Bill will improve the NHS. I sincerely urge him to base his argument not on intuition but on facts, and, for the sake of patients, not to turn his back on reform that he once believed in and should go back to believing in.
6.5 pm
Sir Gerald Kaufman (Manchester, Gorton) (Lab): If there are three letters in the English language that resonate in practically every household in this country, they are NHS. One need say no more than “Save the NHS” for the people of this country to know what one is about. The NHS is this country’s most precious national institutional asset. It is free at the point of use and available to all. It has saved lives, it has prolonged lives, it has improved the quality of lives, and it has done all those things by the million—and now this Government are in the process of destroying it.
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That is not surprising, I suppose, because, after all, when Aneurin Bevan brought to this House the Bill to create the national health service, the Conservatives voted against the creation of the national health service. Ted Heath accepted it as part of the national consensus. That consensus was breached by Margaret Thatcher, but even she never targeted the national health service. “The national health service is safe in my hands”, she said. It is all the more shameful that the Government are legislating in this way, because the Tory posters in the 2010 election featuring the current Prime Minister specifically featured the NHS—the Tories knew that that was their vulnerable point. It is now even more so, and it will destroy them.
This Government are the most right-wing Government that the country has had for three quarters of a century. They bring back the social neglect and the social damage of the era of Neville Chamberlain. They are creating mass unemployment, and particularly youth unemployment. They are harming our schools and destroying Sure Start, whose creation, of course, they also opposed. They are taking the police off the streets and provoking crime on the streets. They are inflicting irreparable harm on the universities and on higher education. They are harming pensioners, even down to the niggling theft from them of money from the winter fuel payment. They are creating homelessness. They are doing damage that it will take a generation to repair, even if they are thrown out at the next general election—and all without a mandate of any kind.
All this damage to my constituency and to every constituency in the country, including those of Government Members, is being done with the cynical complicity of the Liberal Democrats. Without them, none of this would be possible. Last night, I had the distasteful experience of refreshing my memory of their manifesto by reading it again, and there is nothing in it to justify what they are participating in today and will be as this Bill proceeds through the House of Commons.
The Liberal Democrats’ spring conference last weekend was a degrading spectacle. They even trundled on the nation’s favourite elder sister, Shirley Williams, to try to convince people that this appalling Bill and their complicity in it are tolerable. What a contrast that is with their facile promises in opposition, when they promised everything because they knew that they would not have to deliver. Now they have to deliver and they are damaging everything they touch. They could save the national health service by their votes this evening. If they do not, the nation will remember and the nation will never forgive.
6.10 pm
Andrew Selous (South West Bedfordshire) (Con): Like all Government Members, I am absolutely committed to the principles of the NHS: that it should be free at the point of need, irrespective of the ability to pay, and available to all those who need it. The NHS saved my life when I was 24-years-old. It was there for me and I always intend to be there for it, for my constituents and others who need it. I say to Opposition Members that on Saturday morning I spent two and a half hours in Dunstable market talking to more than 400 of my constituents on a wide range of issues, and not a single person raised concerns about the national health service.
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Chris Williamson (Derby North) (Lab): Will the hon. Gentleman give way?
Andrew Selous: I will make a little progress.
I also say to Opposition Members that the GPs of Bedfordshire are thoroughly behind these proposals. Dr Paul Hassan, a long-standing Dunstable GP, will be the leader of the clinical commissioning group in my area. He is an excellent GP who has the interests of his patients at heart and he will do an extremely good job.
Karl Turner: The hon. Gentleman says that he met 400 people in his constituency, not one of whom mentioned their opposition to the Bill. Has he had any communication from any health service professional who has concerns about the Bill? I and many Opposition Members have received numerous e-mails and a great deal of correspondence from such people, as well as from constituents.
Andrew Selous: I am aware of one GP in my constituency who has concerns about the reforms. The overwhelming majority of GPs are thoroughly behind them. I find it troubling that Opposition Members do not trust our nation’s GPs, with their wisdom, good sense and commitment to patients, to do the right thing by their patients. They will look at the powers in the Bill and use them for the good of their patients where it is wise and appropriate to do so.
I have to tell Opposition Members that the clinical commissioning group in Bedfordshire has already established a new team to deal with emergency calls from elderly people in care homes. That has resulted in a 40% reduction in hospital admissions and has enabled vulnerable elderly people to be treated at home. That is just one example of the sort of thing that we will see when doctors make use of the powers that they are given in the Bill.
I will cite a few areas of the NHS in which, if Opposition Members think honestly, they will recognise that there were problems when they left office. I will use three brief examples from my constituency. As we heard from the Chairman of the Health Committee and others, one of the important things that the Bill will do, under part 1, is to integrate health and social care. I am extremely grateful to the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns), who has been looking at the issue of delayed transfers of care at Luton and Dunstable hospital. The new structures that will be introduced under the Bill, with the full integration of health and social care, will be helpful in that area and will deal with the serious issue of delayed transfers of care.
Mr Sanders: One of the problems that my constituents have is that they have experienced integrated health care in Torbay since 2003, but it is having to be dismantled because of the Bill. It is difficult to explain to my constituents why what they have taken for granted and enjoyed under existing legislation requires this big Bill.
Andrew Selous: All I can say to the hon. Gentleman is that in my area the current structures are not dealing adequately with that issue. The powers in the Bill are permissive and I am hopeful that they will help.
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To move on to mental health and other NHS services, my biggest town, Leighton Buzzard, has a 16-bed unit for mental health patients. Many of those beds are empty at the moment and could be used for step-up, step-down care or intermediate care. By giving commissioning powers to doctors and fully integrating mental health with other NHS services, the Bill will open up the possibility of those beds being used for the people of Leighton Buzzard and the surrounding area.
If Opposition Members are serious about orthopaedics, which is a massive issue for the NHS, they will know that the standard of care varies widely and that we can do better. I have discussed this issue with the Chair of the Health Committee and my right hon. Friend the Minister of State. Professor Tim Briggs, who is the clinical director at the Royal National Orthopaedic hospital, and others have useful suggestions in this area that the Government are prepared to listen to.
I say to Opposition Members: look at the record so far. Ten thousand more people have had access to cancer drugs. There are 4,000 more doctors and 900 more midwives in the NHS. There are 15,000 fewer managers and administrators, and all the savings from that are going back to the front line, where they are needed by the hard-working staff of the NHS. Opposition Members should look at the money. The Government are committed to spending £12.5 billion more on the NHS in England, unlike in Wales where, under Labour’s stewardship, the NHS is being starved of funds.
We heard terrible stories about health inequalities from the right hon. Member for Manchester, Gorton (Sir Gerald Kaufman), who spoke before me. I wonder whether he has looked at clauses 22 and 25 of the Bill, which for the first time put in law the duty to deal with health inequalities. My goodness, that is needed, because under the previous Government health inequalities got worse and were in a state comparable with Victorian times.
Clause 116 will prevent discrimination in favour of the private sector. We have listened to a lot of concerns about the private sector. Perhaps Opposition Members have forgotten about the private sector treatment centres, which were paid £250 million for operations that they did not perform. Clause 116 will ensure that the higher tariffs that have been paid to private sector providers cannot happen in future.
The involvement of local authorities in public health is another vital thing that did not happen under the previous Government. If Opposition Members think honestly about what local authorities can do fully to involve schools, children’s centres and care homes in the national health service, they will agree that there are real possibilities.
My plea to Opposition Members is to look at the facts, to look at what is in the Bill, and to look at the improvements that have happened already, such as the greater number of doctors and midwives and the £12.5 billion extra that is going into the NHS, under this Government.
6.17 pm
Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op): I will speak in favour of the Government dropping this truly awful piece of legislation.
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Before I do so, I will say a few words about my constituent, Dr Kailash Chand, who began the e-petition against the Bill, which has reached 174,000 signatures. Kailash has been a GP in my area for 27 years. He has been awarded an OBE for his work and in 2009 he was named north-west GP of the year. He has dedicated his life to public health. At times he has spoken out against Government policy, whoever has been in charge. His motivation in creating the e-petition was solely his love for and belief in the NHS. We should be grateful for such public servants. I am delighted that he is here to listen to this debate.
Mr Simon Burns: So that everyone fully understands the background, will the hon. Gentleman confirm that this same doctor wants to be a Labour MP, has been appointed by the leader of the Labour party to review Labour party policy on older people, and has worked for the right hon. Member for Wentworth and Dearne (John Healey) in a research capacity?
Jonathan Reynolds: The Government are just not willing to listen to the people who will be affected by the Bill. Kailash is not alone in opposing it. If I read out the name of every organisation that opposes the Bill, I would run out of time.
Mr Burns: Will the hon. Gentleman give way?
Jonathan Reynolds: No, sit down and listen for once.
It is clear that the majority of non-biased, objective opinion is against the Bill proceeding. Never in the field of public policy have so many opposed so much and been listened to so little.
Should the Government not be asking themselves this: if the Health Secretary cannot convince the people who he wants to devolve power to, and if the Deputy Prime Minister cannot convince his own party members to support the Bill, maybe—just maybe—there is not that much going for it? The Health Secretary cannot even visit an NHS hospital, so low has his reputation sunk.
As has been said, the people who oppose the Bill, whether the royal colleges or Opposition Members, do not oppose all reform. Of course, NHS services will have to change over time, particularly in the provision of specialist services. The Labour Government introduced reforms, which used the private sector to the advantage of the NHS. The Bill does the opposite and uses the NHS for the benefit of the private sector. The problem is not reform, but these reforms. To say that anyone who opposes the Bill is against all reform is crass and simplistic.
Let us please put an end to the nonsense that the reforms are just an evolutionary approach following what has happened in the past. If that were the case, would there be an unprecedented groundswell of opinion against them? Once the Bill is passed, the primary care trusts and the strategic health authorities will be gone, and clinical commissioning consortia will be responsible for the whole NHS budget. Local authorities will take public health, and Monitor and the NHS Commissioning Board, not the Department of Health, will be responsible for the health system. That is a fundamental, top-down restructuring of the NHS, and no one wants it.
To justify that revolution, the Government started by rubbishing the success of the NHS. It began with the cancer survival rates and carried on from there, and
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every time the Government’s case has been knocked down. The King’s Fund, the respected health think-tank, in its review of NHS performance since 1997, clearly showed dramatic falls in waiting times; lower infant mortality; increased life expectancy across every social group; cancer deaths steadily declining; infection rates down, and in mental health services, access to specialist help, which is considered among the best in Europe. Again, I put it to the Government that they have no justification for the revolution that the Bill brings about.
The Government’s other justification has been that the NHS has too many managers, yet their reforms create a structure so confusing that, when an organogram of the new structure was published, it became a viral hit on the internet because it looked so ludicrous. What do the experts in the King’s Fund say about this? The myths section about the Bill on its website says:
“If anything, our analysis seems to suggest that the NHS, particularly given the complexity of health care, is under-rather than over-managed”.
Lyn Brown (West Ham) (Lab): During the Bill’s passage, it has struck me just how vulnerable my constituents will be to doctors who are not as good as many of those who currently serve them well. One of our opportunities in Newham with a decent PCT was to deal with doctors who did not provide the right care. Is my hon. Friend , like me, concerned about the vulnerability of many of our constituents if the Bill is passed?
Jonathan Reynolds: I agree with my hon. Friend. If the Bill is passed, perhaps one of the biggest changes will be to the relationship between doctor and patient. Every time a patient is not referred for some sort of specialist treatment, they will wonder whether that is on clinical grounds or because their GP has one eye on the budget. Whatever the basis for those fears, GPs will be in a difficult position, and because NICE guidance will no longer be compulsory, the problem will be compounded when people compare their experience with that of others, using the internet or other means.
However, the most worrying aspect derives from the stories that we hear from parts of the country where individual GPs might have a financial interest in the services that they now commission. Such a relationship would not only destroy the trust at the heart of the system, but provide perverse incentives for how it might develop in future.
Mr Jim Cunningham (Coventry South) (Lab): Government Members have said that the Government will spend an extra £12.5 billion on the NHS. Yet University hospital in Coventry must make further cuts of £28 million this year. The Government boast about the increase in the number of doctors, but it takes seven years to train a doctor. Who, therefore, was responsible for training those doctors? The Labour Government.
Jonathan Reynolds: My hon. Friend is, as ever, correct. He knows that the problem that all parts of the health service face is that they have been given money to justify claims from Ministers to Parliament, but they must ring-fence some of it to pay for the reorganisation—£16 million in the case of my PCT.
The story of the Bill is the story of British politics at its absolute worst. We have a weak and unpopular measure, opposed by nearly everyone, pushed through
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by two out-of-touch party leaders because they are worried that they will look weak if they perform a U-turn. Even worse, whatever Government Members might say, we all know that, had the Downing street operation been up to speed from the beginning of this Government—if, for instance, they had had a policy team in the centre of Government—the Bill would never have got through. After all, why, after spending so much time and so much money convincing the public that they could trust the Tories on the NHS, and after making a commitment that there would not be a further top-down reorganisation of the NHS, have the Government embarked on a deeply unpopular and unwanted top-down reorganisation of the NHS? The Bill has confirmed every swing voter’s nagging fear—you simply cannot trust the Tories on the NHS.
We have the Bill for two reasons: the vanity of the Secretary of State for Health and the naivety of the Prime Minister. Neither is a good enough reason for proceeding. It is time to drop the Bill.
6.24 pm
John Pugh (Southport) (LD): I was cut off when I previously spoke on the subject. Perhaps that was welcome, because I was quoting a strangely prophetic entry in Chris Mullin’s diary. It was a conversation with a Labour Member, whom he describes as a “mild-mannered” Yorkshireman—surely an oxymoron—who said in 2005:
“I think we will lose the next election. The Tories will come to some sort of understanding with the Lib Dems and we’ll find we’ve opened the door to the market in health and in education. And when we protest they will reply, ‘But this is your policy; you started it.’”
That is the story of our debate.
Critics of the Bill often fail to realise how far Labour had exposed the NHS to all sorts of market forces such as EU competition law, encouraged and subsidised the private sector, and imposed “any willing provider” in all sorts of places where it might not have been appropriate. Essentially, Labour set up the building blocks for a market system.
The Bill continues that process. To put it bluntly, no one in this House regards the Bill as anything but risky. Even the Whips, who are normally the most cheerful about legislation, can barely summon a smile when dragooning Members into voting for it. Why? There is a simple explanation. It is the combination of the biggest ever organisational upheaval and the biggest ever financial pressure: the £20 billion Nicholson challenge.
The Bill is also considered risky because the confidence of staff and the public is low, concern is justifiably high, and, to quote Donald Rumsfeld, there are too many “known unknowns”—about the interaction with EU law, how GPs can commission themselves legally, and what the law actually means. Nigel Crisp, the former chief executive of the NHS, recently described the Bill as “confused and confusing”.
There is also a lack of trust. To some, the thrust of the Bill seems essentially unchanged. As the Secretary of State warned us in 2009—I repeat his words in case people missed them in the earlier intervention:
“Organisational upheaval and reform do not seem to correlate well.”—[Official Report, 19 November 2009; Vol. 501, c. 225.]
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The Bill also represents a significant generator of future over-regulation and, to some extent, a perpetuation of micro-management. There is no essential difference between a Government imposing AWP and telling everyone what to commission and when, regardless of local circumstances, and instructing everyone to have a Darzi clinic, as the Labour party did.
We are considering a strange spectacle—a sort of paradox. We genuinely have gradual improvement of legislation, but simultaneously there is increasing professional detachment and disillusionment. That is possibly because people view the Bill as big government; as a centralising measure. The right hon. Member for South Shields (David Miliband) was right to point out that a huge quango had been set up— “the biggest quango in the land”, in the words of my hon. Friend the Member for North Norfolk (Norman Lamb), who is now a Minister.
There are alternatives. Life without the Bill is possible. However, with or without it, the gap between professional and political opinion is fatal. The gap between ideology and evidence is fatal. The gap between what the Prime Minister thinks he needs—not to look weak—and what the NHS needs, which is a two-way dialogue, is also fatal. We must find some way of bridging those gaps. My hon. Friend the Member for St Ives (Andrew George) has tried to find a particular way.
Spin and propaganda will not get any of us out of this. The reality will be played out in the next year and the subsequent year in hospitals, surgeries and homes. Spin will not help because, across the land, reality will kick in—and reality has a horrible habit of trumping spin.
6.29 pm
Barbara Keeley (Worsley and Eccles South) (Lab): I want to speak in support of the motion, which notes the e-petition and declines to support the Bill in its current form. As has been said but deserves repeating, the Conservative-led Government have no democratic mandate for the Bill; quite the opposite, given the Prime Minister’s promise that
“with the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures”
of the NHS. Yet this reckless and unnecessary top-down reorganisation will cost £3.5 billion, which could be spent on patient care.
Already in my local area and many others, patients are losing services, waiting longer and receiving poorer treatment than before. Salford primary care trust has ended its active case management service for people with long-term conditions—the service had been both popular and effective. NHS budget cuts have meant that a community matron service was ended in a local area.
The Select Committee on Health recently dealt with the impact of the NHS reorganisation in its report on public expenditure—my right hon. Friend the Member for South Shields (David Miliband) quoted it. The report concluded:
“The reorganisation process continues to complicate the push for efficiency gains...it more often creates disruption and distraction that hinders the ability of organisations to consider…effective ways of reforming service delivery and releasing savings.”
Cuts are having a direct effect on treatment. A staff member of the local branch of the Parkinson’s Disease Society told me recently that NHS cuts mean that GPs
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and pharmacists are switching to cheaper brands of drugs for patients with Parkinson’s, many of which are much less effective. One person was admitted to hospital. She became ill following a switch to a cheaper, less effective medicine. The hospital staff told her that she should be “firm with her GP” and insist on the more expensive brand.
The Bill brings competition into the NHS at a level that is unhealthy and unwanted. The PIP breast implants saga showed us the dangers for the NHS of a vast increase in private provision when regulation of medical products for use in surgery is so poor. In January, 14 consultants, GPs and public health experts wrote a letter to The Times about the expansion of private provision and the issues arising from PIP implants. They warned that the Health and Social Care Bill
“provides much less protection for patients should their provider fail than is available to people booking package holidays”.
With PIP implants and private surgery, there was a strong marketing sell to patients of the benefits of surgery but little information about risks, and little or no interest in aftercare. That is an important warning. We know that there are potential health issues with metal-on-metal hip implants, yet there will be pressure on patients waiting for a hip or knee replacement to go for private surgery to avoid the waiting lists that we know are building up.
The Bill risks creating a two-tier NHS and a return to the long waiting lists experienced under Conservative Governments in the 1990s—the Government have already watered down guarantees on NHS waiting times. I recall meeting a patient in 1997 who had been waiting up to two years for vital heart surgery, yet more recently in my constituency I have met people whose lives have been saved in a matter of days by the rapid diagnosis and treatment of cancers.
A number of local GPs have written to me calling on the Government to drop the Bill because they feel it undermines the bond of trust between doctor and patient. One GP told me:
“The reforms are being made on the cheap. GPs are being asked to do the work of the PCTs with half of the funding and all of the blame when problems arise. The Bill drives a wedge between primary and secondary care.”
That GP actually supports the theory of clinicians being given more input and supports a reduction in bureaucracy, but says that the Bill “does the exact opposite” because it introduces new layers of bureaucracy such as the clinical senate. He says that people coming in
“are doing so at different levels of understanding…leading to confusion.”
“it will be the patients who will suffer…no one has asked the patients what they want.”
Bill Esterson: My hon. Friend describes a GP in her constituency, but a GP in mine described his concern to me. He said that he is there to be a doctor and wants to care for patients, and that he does not have the expertise to be a manager. That is the overwhelming concern of his colleagues around the country. Does she agree that that is the danger of that part of the Bill?
Barbara Keeley:
I very much agree. Only quite recently have GPs expressed such concern. I have never known GPs to come to their MPs in numbers, as they are doing,
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to complain about the implementation issues they are already finding. As I said, the GP I quoted supported the idea of GPs being more involved with decisions about patients, but he now thinks that the Bill is
“simply a mask for a cost cutting exercise…a way to deal with the NHS on the cheap. A way of farming out support systems…e.g. clinical support, into the private sector.”
“More money will be taken out of the NHS and put into the private sector.”
The hon. Member for South West Bedfordshire (Andrew Selous) asked us to trust the wisdom of our GPs. That is a damning indictment by a Salford GP, and one that I believe is echoed by GPs up and down the country. Trusting the wisdom of my local GP, I urge hon. Members to support the motion.
6.35 pm
Nicky Morgan (Loughborough) (Con): I rise tonight to oppose the motion and the amendment. The motion is clear on the e-petition, on calling on the Government to drop the Health and Social Care Bill, and on declining to support the Bill in its current form. I see no mention of the risk register, yet when we debated it several weeks ago the shadow Secretary of State did not want to talk about it; he wanted to talk about the Bill. I shall come to the very confused position of the Opposition on this issue.
I will obviously not support the amendment—that will come as no great surprise to the hon. Member for St Ives (Andrew George)—but I agree with his reference to patients’ organisations. Such references have been missing from the speeches of Opposition Members. I would prefer a reference to patients and service users, because my first point is that the voice of patients has not been heard. Those are not my words, but those of somebody who gave evidence to the all-party parliamentary group on mental health last week. We have not heard the voices of patients in the debate so far—[ Interruption. ] Opposition Members are welcome to stand to correct me, but I have heard no mention from them of the words and views of patients.
Karl Turner: I am obliged to the hon. Lady for giving way. The mere fact that more than 170,000 people have signed the e-petition surely must speak volumes to her.
Nicky Morgan: If the hon. Gentleman wants to talk about maths or numbers—
Karl Turner: I am not talking about maths.
Nicky Morgan: We could talk about the number of people who have taken part in the Royal Colleges petitions.
Karl Turner: I am talking about the 170,000 people who signed the petition. What are you talking about?
Nicky Morgan: Well, 175,000 have signed the petition, but there are nigh on 60 million people in this country.
Madam Deputy Speaker (Dawn Primarolo): Order. Mr Turner, do not shout over the Chamber. Either intervene or listen to the points that are being made. You do not have to agree with them; you just have to be quiet.
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Nicky Morgan: Thank you, Madam Deputy Speaker. After many, many weeks on the Health and Social Care Bill Committee, there is no danger of the hon. Gentleman agreeing with any of the points that I make, but that will not stop me making them.
My hon. Friend the Member for South West Bedfordshire (Andrew Selous) talked about mental health. Those who spent time on the Public Bill Committee will know that I am particularly involved and interested in mental health, and I hope that we will have a debate on mental health in the Chamber soon, but what has struck me in discussions of the Bill is that mental health service users want to be involved in decisions about the commissioning of their services. They have that opportunity in the Bill through the health and wellbeing board, HealthWatch, the clinical commissioning groups, the involvement of the voluntary sector, and, as hon. Members have said, the integration of health and social care services. The Secretary of State talked about shared decision making. It is incredibly important that that is allowed to flourish under the Bill.
My next point—a damning and depressing one for a Member of Parliament to make—is the misinformation that has been perpetuated about the Bill. Tonight, we heard the shadow Secretary of State say that time is running out for the NHS. An hon. Member said that the shadow Secretary of State spoke in December of our having 72 hours to save the NHS, and another said that their constituents are worried about the services that will be on offer. All that is scaremongering, and it is unfair on those who do not have the time, capacity or inclination to read the Bill. We need to talk about the reality.
Grahame M. Morris: On the charges of scaremongering, is the hon. Lady aware that the George Eliot hospital in Nuneaton is engaged in conversations with two private sector providers—Serco and Circle—on taking over that provision? In my 30-odd years involved in the NHS, I have never known that to happen.
Nicky Morgan: I thank the hon. Gentleman for his point and the measured way in which he made it. That is welcome in the debate on the Bill. As a midlands MPs, I am aware of what is happening in Nuneaton, but it is not my constituency so I will refrain from saying too much. I will say only that the hospital management have asked in other providers because they are concerned and want to ensure the best possible care. Is that not what we want?
Grahame M. Morris: They are private providers.
Nicky Morgan: That could be the voluntary sector or the community sector. They are all private. If someone has a physio appointment, it could be with a private provider. At the end of the day, we want the best care for patients and constituents. That is what we all want.
Dan Byles (North Warwickshire) (Con): The hon. Member for Easington (Grahame M. Morris) will be aware that the George Eliot hospital is on the edge of my constituency and serves my constituents. There are six people on the shortlist of people it is talking to—six people who have asked to be spoken to. It is wrong to imply that the George Eliot has gone out and spoken to only two private providers. The rest are all NHS providers.
Nicky Morgan: I am grateful to my hon. Friend for clarifying that.
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The shadow Secretary of State talked about trying to be constructive. I am unclear whether he supports his own motion. Is he calling for the Bill to be dropped or for a conversation? This reflects the position of the Royal College of General Practitioners, which says that it now wants to work with the Government to implement the Bill, having previously opposed it. That is because the people in the NHS are beginning to recognise that implementation is critical if we really care about patient care and service users. There has been talk about how people in the House have stopped listening. I suggest that it is the Opposition who have stopped listening. I am fed up with receiving repeat e-mails. When I reply, making this point and trying to engage in a debate, all I get is another standard e-mail telling me about privatisation and how the NHS will not exist in its current form. That is not correct and not fair on the patients who rely on the NHS.
As my hon. Friend the Member for South West Bedfordshire said, implementation is already happening in many parts of the country, and that is to be welcomed. In Leicestershire, I have three excellent clinical commissioning groups and a health and wellbeing board being set up. I salute the public health professionals in Leicestershire who are working hard on implementation, the secondary care providers, the patient participation groups and everybody else who has taken part. The trouble is that implementation is being hampered by this ongoing political debate. I have a real feeling of groundhog day every time I come in and speak on this. We are going round and round in circles, and I repeat that the people who are missing out are patients and service users. Loughborough has taken the difficult decision to move our walk-in centre, but the GPs have taken that decision, and although I did not agree with it, they are clear that it will result in better urgent care services, and they are spending more money on them. I am willing to trust their judgment.
Members want to talk about the vote of the RCGP. It is interesting to note that out of 97,000 professionals, only 4,700 have taken part in the debate on the Bill. That should tell us something. We need to get on with the Bill now.
6.42 pm
John Healey (Wentworth and Dearne) (Lab): It is good to follow the hon. Member for Loughborough (Nicky Morgan). Hers was an heroically loyal attempt to fill time on the Government Benches. But she is wrong. The Government have lost the confidence of the NHS to make further changes, and they have lost the trust of the British people to oversee those changes. Why no apology from Ministers? Why no apology to the 1.4 million NHS staff for the last wasted year of chaos, confusion and incompetence? Why no apology to the millions of patients who are starting to see services cut and waiting times get longer? And why no apology to the British people for breaking the promise in the coalition agreement to stop the top-down reorganisations of the NHS that have got in the way of patient care?