The Bill will allow local clinicians, in conjunction with their patients—and, I might add, with democratically elected local government—to have a much greater say in how the NHS is delivered and greater scrutiny of it. We will have a far more responsive health service. It has been almost decades since health decisions in Crawley
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were made by clinicians, patients and elected councillors. By repatriating many decisions, we will have a more transparent and responsive health service.
It was a great privilege to be able to open the new digital mammography unit at Crawley hospital a few weeks ago. That is a classic example of a health service that develops in line with technology and with the changing needs of our population. I am confident that the Bill will give local clinicians, patients and democratically elected local representatives the tools to provide a far safer and more relevant national health service to the people of my constituency and constituencies up and down the country.
In conclusion, after 14 months of careful consideration of the Bill, it is time we get on with the reform of the national health service, which goes hand in hand with the increased investment in it that the Government have guaranteed at least to the end of this Parliament. I might add that that is in stark contrast to what is happening in Wales, where Labour is in control of the NHS and where budgets have been cut. The people of Wales are feeling the result. I want to resist that happening to patients in England and therefore believe that it is time to get on and pass this legislation for the good of our NHS.
4.26 pm
Mr David Anderson (Blaydon) (Lab): This debate is about contempt—for the Information Commissioner, for the tribunal, for the people who signed the e-petition, for the public who have contacted hon. Members in their hundreds of thousands and for the principle of transparency. For years, we had lectures from the Conservatives and Liberal Democrats when they were in opposition, when they said that sunlight was the best light.
We should not be surprised, because the whole debate on this Bill has been about contempt, starting with the contempt for democracy. The Government have no mandate, no support and no truth—the Conservatives promised no top-down reorganisation. The Conservatives and Liberal Democrats were not straight with the people, but why not? I hate to disagree with my right hon. Friend the Member for Wentworth and Dearne (John Healey), but this debate is political. The Conservative party has always opposed the national health service, because it is the living example that collectivism works. Conservatives oppose the NHS because they are against collective provision.
The hon. Member for Southport (John Pugh), who has tried his best to make something out of this mess, was right when he told the Liverpool Daily Post a number of weeks ago:
“If the Conservatives had gone to the country at the last election and said ‘we want a market-based health system’ they would have lost the election badly.”
The Conservatives knew that, which is why they covered it up.
The Government have shown contempt for the House, because even before they reached for the pause button, changes were taking place. Before we have even agreed the Bill, they have all but abolished 151 primary care trusts, with tens of thousands of people being made redundant. They are being replaced by 279 clinical commissioning groups, and strategic health authorities have been set up.
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The new national commissioning board, which has not yet been agreed in law, has already got a chief executive, a finance director and seven board members, recruited at salaries of up to £170,000. That is before we have even passed the Bill. If that is not contempt, what is?
Worst of all is the Government’s contempt for the people to whom we look to deliver our services. The Government say, “We know best,” but anybody who was in the Chamber last week to hear the Government’s contempt for the work of Dr Chand, who did his best to ensure that the House looked again at the Bill, will know how the Government feel about health workers in this country.
Who are these people who know so much better than the doctors, nurses, general practitioners, consultants, radiographers, occupational therapists and porters? What is their background? There are researchers, a teacher, and a sales and business manager. In the Lords there are former Army people, journalists, lobbyists, MEPs and researchers, and people who worked at Tory HQ. Do they all know so much better than the people to whom we and the people we represent turn every day of the year to take care of us?
Who is against the Bill? Almost everybody, including the British Medical Association, the Royal College of Nursing, the Royal College of Midwives, the Royal College of Radiologists, the Royal College of Physiotherapists, and the Royal College of Paediatricians and Child Health, the Faculty of Public Health and the GPs. I could be here all night going through the list, but the Conservatives and Liberal Democrats know it.
Susan Elan Jones (Clwyd South) (Lab): There was one small omission from my hon. Friend’s list of the many opponents of the Bill: the agent of the right hon. Member for Bermondsey and Old Southwark (Simon Hughes), who is also deputy leader of the Liberal Democrats. Mr Gary Glover, on his Twitter account, said:
“Lib Dems have accomplished almost nothing on the NHS Bill.”
Surely the truth is that Lib Dems could accomplish rather a lot, because they could help us to defeat the Bill tonight.
Mr Anderson: My hon. Friend is absolutely right. As an eternal optimist, I continue to hope against hope that the Lib Dems will see the light tonight, but my guess is that they probably will not. They have shown contempt even for the democracy within their own party. They claim to be determined to be bound by the democratic decisions of their own party. They have not been. They have ignored their party. When they came to Gateshead two weeks ago, they said they would stand up to the Bill, but they have not. It is the double-talk and spin that we are all used to.
Two days ago, I visited my general practitioner, and on his practice nurse’s wall was a poem by Michael Rosen, the children’s poet laureate, who, in 2009, wrote a poem called “These Are The Hands”. It read:
“These are the hands
That touch us first
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Feel your head
Find the pulse
And make your bed.
These are the hands
That tap your back
Test the skin
Hold your arm
Wheel the bin
Change the bulb
Fix the drip
Pour the jug
Replace your hip.
These are the hands
That fill the bath
Mop the floor
Flick the switch
Soothe the sore
Burn the swabs
Give us a jab
Throw out sharps
Design the lab.
And these are the hands
That stop the leaks
Empty the pan
Wipe the pipes
Carry the can
Clamp the veins
Make the cast
Log the dose
And touch us last.”
These are the people we should have been listening to. These are the people who have been ignored constantly by the Government parties. And these are the people who will never ever forgive them for what they are doing tonight. When the election comes, they will be thrown out where they belong.
4.30 pm
Mr Stephen Dorrell (Charnwood) (Con): Thank you for calling me, Mr Speaker, for what I hope will be a brief intervention prompted by the remarks of my hon. Friend the Member for Banbury (Tony Baldry) and the right hon. Member for Wentworth and Dearne (John Healey).
Later this evening, the House will consider—yet again, many of us would say—the Health and Social Care Bill, but the issue for consideration now is whether the Government should publish the transitional risk register on the Bill. The right hon. Member for Wentworth and Dearne was explicit that he was not arguing that all strategic risk registers should be published, and acknowledged the argument that there needed to be private space in which civil servants could give advice to Ministers secure in the knowledge that it would remain private, because there was an important interest of good government that that discipline and space should exist. That is an argument that he explicitly accepted and of which I am a strong supporter.
My hon. Friend the Member for Banbury reminded the House that only yesterday two retired former heads of the civil service told peers in the other place of the importance of the principle that Ministers must be able
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to receive advice from civil servants on policy issues, including the risks associated with them, without that advice later becoming public. The issue that the right hon. Member for Wentworth and Dearne did not cover but which is important is that there needs to be confidence within the civil service about which side of the line advice will fall. If civil servants can give advice to Ministers believing that it will remain confidential and if, after the advice is given, the line is moved and the advice falls to be published, we run the risk that across Whitehall the space that he advocates will, in truth, not exist, because there will not be the confidence that the advice will not later fall to be published.
Barbara Keeley (Worsley and Eccles South) (Lab): The right hon. Gentleman is talking about advice. It has been made clear that this is not advice but a management assessment of risks relating to the Bill and the reorganisation. It is not about policy or advice, which is why it is important that it is released.
Mr Dorrell: It is an interesting debate whether a risk register about a transition related to a policy is advice about policy or advice about management. The issue is that there is doubt. If the Government surrender this line without arguing the case to its conclusion, there is space for doubt about whether these risk registers will remain confidential or whether they will be published. The important principle is certainty.
Andrew George: Will my right hon. Friend give way?
Mr Dorrell: I will give way to my hon. Friend in a moment.
The important principle—it is always an important principle in the law—is certainty: the certainty that people can be clear whether the advice or the register that is being given to a Minister will remain confidential or whether it will be published. My concern is that this motion is seeking to move that line retrospectively, in a way that two distinguished former heads of the home civil service clearly believe would prejudice the space that the right hon. Member for Wentworth and Dearne said was important.
Mr Dorrell: As I have quoted the right hon. Gentleman, I shall give way to him.
John Healey: The right hon. Gentleman is making an argument for blanket secrecy. However, this is less about his view or even mine; rather, the point is that the Information Commissioner and the judge, along with his two wing members on the tribunal, all of whom have seen and studied the risk register, have determined that, in their legal judgment, the balance of interest lies in publishing and not withholding it. Those are the facts of this case.
Mr Dorrell: The right hon. Gentleman is correct, but he does not go to the end of the process, because the reasons for that decision have not yet been published. The House is therefore being asked to make a decision on the basis of a judgment that has not yet been published, which cannot be right.
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Andrew George: My right hon. Friend has argued the case on behalf of retired senior civil servants and Government Front Benchers. However, as the Chair of the Select Committee on Health, and therefore as someone who is deeply interested in effective scrutiny, does he not agree that if the Committee, of which I am a member, wishes properly to understand the potential impact of fragmentation, the conflicted nature of clinical commissioning groups, and so on, we need to find a way of getting behind the declaratory reassurances from the Front Bench?
Mr Dorrell: Of course I agree with the proposition in the way that my hon. Friend puts it. However, the proposition before the House is a rather more precise one: that a register drawn up in the expectation that it would remain private should retrospectively be put into the public space. The proposition that I am advancing to the House is that that is an area where we should proceed with care. We should embrace the principle that when advice is given to Ministers, it should be clear to those giving it whether it is being given confidentially or whether it will later be given over for publication. That is the simple principle that I wanted to set out.
4.37 pm
Grahame M. Morris (Easington) (Lab): I have got out of my sick bed to be here today, because this is a vital debate, and I am grateful for the opportunity to participate in it. I often feel that these debates are a bit like the siege of Stalingrad: we are rolling back the forces of oppression. I content myself, with my cough and sore throat, that at least the red army was victorious on that occasion.
In response to the point that the hon. Member for Banbury (Tony Baldry) and the right hon. Member for Charnwood (Mr Dorrell), who chairs the Health Committee, made about the ruling by the Information Commissioner, I think we should reflect on the fact that it was indeed a ruling. It was not advice that he was giving. Mr Christopher Graham has some expertise in this field, and although the detailed reasons have not been published, the arguments that were made by my right hon. Friend the Member for Wentworth and Dearne (John Healey) and the co-applicants from the Evening Standard—that it was in the public interest to publish the risk register—were obviously accepted.
If I may, I would like to remind the House of what the Information Commissioner said, which was upheld on appeal. Mr Graham said:
“Disclosure would significantly aid public understanding of risks related to the proposed reforms and it would also inform participation in the debate about the reforms”.
Earlier on, Government Members were shouting “Frit!” at Labour Members. I really did not understand what that meant—I am just a simple working-class lad from Easington—but I now understand that it means “You’re afraid”. However, if the Government have complete confidence in the direction of their reforms, surely it is they who are afraid, because they should have the confidence to publish the document.
Jim Dowd (Lewisham West and Penge) (Lab):
It is beyond doubt that the Information Commissioner considered all these matters before reaching his decision. Does my hon. Friend agree that, if the risk assessment
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had supported the Government’s case, the Government would have got it out like a shot? That they have not done so exposes the fact that they are playing fast and loose with one of the nation’s most treasured institutions, and that they are trying to hide that.
Grahame M. Morris: Absolutely; good point, well made. If the Government had nothing to hide and were not concerned, they would have published the contents of the risk register. We have had a flavour of the contents of the other risk registers that have been compiled at strategic and other levels, and I believe that the Government are concerned about them.
We know that the Bill will increase the risks to the national health service. Indeed, the chief executive of the NHS, Sir David Nicholson, told the Health Select Committee, of which I am a member:
“I’ll not sit here and tell you that the risks have not gone up. They have. The risks of delivering the totality of the productivity savings,”—
that is, the Nicholson challenge; the £20 billion—
“the efficiency savings that we need over the next four years have gone up because of the big changes that are going on in the NHS as whole.”
It is clear that local and national risk registers, as well as the strategic risk registers to which we have had access, have highlighted serious concerns with patient safety, increased costs, the break-up of care pathways—which we have seen on Health Select Committee visits—as well as competition harming integration, about which the Committee was very concerned, and the specific risks during the transition stage.
John Healey: Will my hon. Friend also confirm that, in that session on 23 November 2010, Sir David Nicholson stated that the scale of the proposed change was enormous, and that it was beyond anything that anyone in the public or private sector had witnessed? That is why the risks involved in the reorganisation are so great, as is the imperative for the House and the public to know about them.
Grahame M. Morris: Absolutely; I completely agree with my right hon. Friend. These are huge structural changes to a beloved organisation, and it is in the public interest that we know precisely what is in the transition risk register.
A little while ago, I tabled early-day motion 2659, which called on the Health Secretary
“to respect the ruling by the Information Commissioner and to publish the risk register associated with the Health and Social Care Bill reforms in advance of Report Stage in the House of Lords”,
so that we could have proper scrutiny in the Lords and in the House of Commons. We have not seen what is in the transition risk register, but we are aware of the existence of other risk registers. While the Health Secretary has been fighting tooth and nail to prevent the publication of the transition risk register and, in the process, hiding the risks to the NHS in England, other NHS bodies and clinical groups have been compiling their own risk registers into the impact of the Health and Social Care Bill.
One such body is the Faculty of Public Health, the body for specialists in public health, which is a joint faculty of the three Royal Colleges of Physicians of the
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United Kingdom. I am grateful to Professor Clare Bambra, from the north-east, and Professor John Ashton, from the north-west, for providing this information. In a letter to
The Independent
, Professor Lindsey Davies, the president of the Faculty of Public Health, outlined his concerns about the pressure that clinicians were now under from their employers for criticising the Government’s plans to reform the NHS. He wrote:
“Public health professionals have the right and duty to speak out on issues which they perceive as threatening the health of the population they serve”.
The bunker mentality of the Health Secretary, and his determination to silence clinical and public opposition, have astounded the country as a whole.
In response to the Department of Health’s refusal to publish its own strategic risk assessment of the impact of the Bill, the Faculty of Public Health has undertaken its own study, in which it has highlighted a number of significant risks, not least the potential for a postcode lottery. It states:
“Clinical Commissioning Group flexibility to determine services will lead to an increase in geographical variation in service provision.”
It identifies the possibility of costs being pushed up, and states that the
“development of more overt market mechanisms, and the greater role for the independent sector in the provision of healthcare is likely to increase the overall cost of providing healthcare.”
It also raises concerns about issues of quality as a consequence of the reforms. If the transition risk register indicates that, we should know about it.
The delaying tactics employed by the Secretary of State are, to my mind, holding Parliament in contempt. He should publish and employ no further delaying tactics. Reports that Tory-Lib Dem Cabinet members banged their Cabinet table in delight and glee at the prospect of the health Bill finally being rammed through and becoming law at the end of today leave a very sour taste in the mouth. I urge all Members to support this motion and get the risk register published.
Mr Speaker: I inform the House that there is a slight discrepancy between the clock time shown on the annunciator screen and that shown on the digital display panels on either side of the Chamber. For the avoidance of doubt, this debate began at 3.44 pm and has to end at or before 5.14 pm. For the purposes of deciding when we reach the end time, the Chair will use the time on the Chamber digital display panels. I hope that that is helpful. Given the level of interest in the debate, the time limit for Back Benchers will be reduced to three minutes with immediate effect.
4.45 pm
Dr Sarah Wollaston (Totnes) (Con): I have just been reading a kind of risk register—the risk register for Ibuprofen—and I have been reading it in the British National Formulary, which is a kind of recipe book and technical how-to-do manual for doctors and nurses. When I read it, I see that it is scary stuff. If I take this medicine, I might develop a fatal skin reaction, I might bleed to death from a stomach ulcer, I might develop kidney failure, I might collapse with pancreatitis, hepatitis and all sorts of things. Why on earth did I take this medicine—this potentially dangerous Ibuprofen?
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Steve McCabe (Birmingham, Selly Oak) (Lab) rose —
Dr Wollaston: Listening to Labour and seeing the extreme shroud waving that has been going on is, frankly, enough to give anyone a headache. I took the Ibuprofen because of what I read in the impact assessment. The impact assessment presents a sensible, balanced portrayal of the realistic risks and benefits, and warns me of many points of which I need to take heed. It is far more likely that I am going to develop indigestion from taking Ibuprofen than that I am going to collapse from a fatal skin reaction.
Dr Wollaston: I am not trying to trivialise the issue; believe me, I understand how vital the NHS is to all our constituents and to patients. My view is that the transition risk register has been elevated to a status far out of proportion to what it merits. I completely understand the points made by Lord Wilson and Lord Armstrong—very experienced civil servants who tell us that they would feel constrained in giving full and frank advice. However, we have seen how any detail can be taken out of all proportion in this House; we are all partly responsible for that. As I said, some of the shroud waving over this Bill has been disgraceful, and I know of patients who have been genuinely frightened by it. I would be prepared to see the risk register published, but I accept the point of my right hon. Friend the Member for Charnwood (Mr Dorrell) that it has to be done on the basis of a clear understanding.
Andy Burnham: I am listening carefully to what the hon. Lady is saying. I remember, however, a comment that she made to The Guardian, I believe, at the start of this process, when she said that this Bill was like throwing a hand grenade into the NHS. What has changed?
Dr Wollaston: There we go—a deliberate misrepresentation. After I made those comments, I wrote to senior colleagues and told them that what I had said was completely different. I was deliberately misquoted on that statement and have been consistently misquoted by Labour Members. They should go back and look at the original.
I feel that it would be reasonable to present all the risks, but it would be crucial for Members of all parties to recognise that we are talking about a lasting change. We would also need to see a change in how risks are extrapolated out of all proportion to what they represent and an end to the deliberate frightening of patients into believing that they will have to pay for health care, which has been a consistent feature of how this Bill has been misrepresented by Labour Members.
Grahame M. Morris: In the context of her medicinal anecdote, does the hon. Lady not accept that members of the public at least have the right to read the little inserts in books of pills before they take them? Should we not have the same right to read the risk register?
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Dr Wollaston: The equivalent of that is actually the impact assessment. However, as I have said, I would be prepared to allow the publication of the register, because, in this internet age, the misrepresentation of the Bill, and the extrapolation out of all proportion to the risks, has been a complete disgrace.
John Pugh: Does the hon. Lady recall saying that the absence of an intermediary body between small GP commissioning and the National Commissioning Board was a serious flaw in the Bill? Clearly that flaw is still there.
Dr Wollaston: I believe that by the time of the next election, our patients will still be going to see GPs. They will still be referred to the hospitals of their choice, that referral will still be free at the point of use, and it will still be based on their needs and not on their ability to pay. The only thing that will be missing will be an apology from the Labour party.
4.52 pm
Caroline Lucas (Brighton, Pavilion) (Green): I am pleased to follow the hon. Member for Totnes (Dr Wollaston), for whom I have great respect. I am glad that she recognises that the risk register should be published, and I greatly regret the fact that her Whips did not allow her on to the Bill Committee, where her views might have had more influence. However, I think that the coalition insults those of us who oppose the Bill by suggesting that we would mistake a worst-case scenario for a prediction. I think that opponents of the Bill know what a risk looks like, and I think that we could be trusted with the risk register. We want to be able to study the Bill with the benefit of that information, and to be able to represent our constituents properly on it.
This is a very sad day for our health service. Although the Bill returns to the Commons today following a tangle of more than 1,000 amendments, the Government have done little to alter its direction, which remains fixed on the ideology of driving commercialisation into almost every corner of the NHS. [Hon. Members: “Have you read it?” ] Yes, I have.
The risks were made plain at the weekend. Dramatic warnings by leading doctors featured in an assessment by the Faculty of Public Health, which was mentioned by the hon. Member for Easington (Grahame M. Morris). It has also read the Bill, and it represents more than 3,000 public health specialists in the NHS as well as local councils and academia. It says that the Bill poses
“significant risks… to patients and the general public”.
It goes on to say that the Bill could well damage people’s health and experience of care—[Interruption.]—and adds:
“It is likely that the most vulnerable who already suffer the worst health outcomes will be disadvantaged as a result of the enactment of the Bill.”
Let me repeat that. Members may not have been able to hear it over all their heckling. The poorest,
“the most vulnerable who already suffer the worst health outcomes will be disadvantaged as a result of the enactment of the Bill.”
That is precisely the point. That is why an extraordinarily wide cross-section of people are deeply concerned about the commercialisation that the Bill brings. Yet despite
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their concern, and despite two rulings demanding the release of the risk register, the Government maintain their arrogant dismissal and refuse to make the register public. Why? Because they know that were they to make it public, we would know what they already know, which is that it drives a nail into the coffin of the NHS. The Bill is hugely damaging, and that refusal to come clean speaks volumes.
So many parts of the Bill are still hugely flawed. The 49% private income cap and the fact that more and more beds will be used for the private sector will massively undermine our NHS. That is why so many constituents are writing to us: they are deeply concerned. However, this is not the end of the road, because the campaigning will continue throughout the country.
4.54 pm
The Secretary of State for Health (Mr Andrew Lansley): Your generosity of spirit is legendary, Mr Speaker, and you were characteristically generous in accepting the submission of the right hon. Member for Leigh (Andy Burnham) that there was an emergency warranting this debate. I regret that he has let you down. It turns out there was no emergency, there was no argument, and there was no point.
Ostensibly, the debate is to consider the Department of Health’s transition risk register. The House considered that on 22 February, and by a majority of 53 the House decided that it did not support the publication of the risk register. We further considered that matter in the debate on 13 March. I think that the views of this House should be respected.
Yesterday, in another place, Lord Owen proposed an amendment, the purpose of which was to delay consideration of Third Reading in the House of Lords until the publication of “reasons” by the first-tier tribunal and the Government’s response. That amendment was defeated by a majority of 115. I remind the House that the Government do not command a majority in the House of Lords. That proposal was defeated by a substantial majority on the balance of the argument.
I will not repeat what I said in the debate on 22 February, but let me just add three things. First, as my noble Friend Lord Howe told the House of Lords yesterday, the risks and other impacts of the Bill were fully disclosed, not least in the impact assessments—a 200-page document—published alongside the Bill; in the NHS operating frameworks; in transition letters from the NHS chief executive and others; and in the full description of the risk headings that Lord Howe set out to the House of Lords on 28 November. I regret to say that it sounds to me that no Labour Members—with, I suspect, the exception of the right hon. Members for Wentworth and Dearne (John Healey) and for Leigh (Andy Burnham)—have taken the trouble to read the debates in the House of Lords.
Secondly, as my hon. Friend the Member for Banbury (Tony Baldry) made clear, Lord Wilson of Dinton, a former Cabinet Secretary, told the House of Lords yesterday that he has deep concerns about the Information Commissioner’s decision and its negative impact on the safe space within which officials give frank advice and act as a “devil’s advocate” to Ministers.
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John Healey: The right hon. Gentleman argues that one of the principal reasons why the Government have not accepted the decision to disclose the risk register is that information about risks has been disclosed to the public already. The Information Commissioner considered that. Will the right hon. Gentleman recognise that, in his legal decision, the Information Commissioner said that he did not accept the argument that the Government advanced, and that he considers that
“disclosure would go somewhat further in helping the public to better understand the risks associated with the modernisation of the NHS than any information that has previously been published”?
Mr Lansley: The right hon. Gentleman knows perfectly well that in the debate on 22 February we made it clear that we felt that our appeal to the tribunal was justified, and indeed it was, because we won at appeal on the question of the publication of the strategic risk register. The Government’s objection and my objection to the publication of the risk register is precisely that risk registers are not written for publication. They are written in that safe space within which officials give advice to Ministers.
Dame Joan Ruddock: Will the right hon. Gentleman give way?
Risk registers do not represent a balanced view. They are not a prediction of the future. They set out a worst-case scenario to challenge decision making. My hon. Friend the Member for Totnes (Dr Wollaston) captured the understanding of what a risk register is very well. The point is that we have looked precisely at the balanced view in the impact assessment, which captures where the risks and the benefits of the Bill lie. However, publication of the risk register, as my right hon. Friend the Member for Charnwood (Mr Dorrell) made perfectly clear, would prejudice the frankness and integrity of the decision-making processes of government and the Government are opposed to their publication.
As I mentioned, we won on appeal in relation to the strategic risk register, but not on the transition risk register. In the absence of the reasons for those decisions by the tribunal, and given the nature of the overlap between the strategic risk register and the transition risk register, I cannot comment further on that, or indeed on what our response will be to the tribunal’s decisions.
Duncan Hames (Chippenham) (LD): The Secretary of State consistently makes the distinction between policy development issues and operational matters in respect of risk registers and other plans that have been published. Once this Bill has become law and the NHS becomes engaged in the operational matter of implementing his reforms to the health service, will he then encourage NHS trusts to publish, in due course, the risk mitigation plans that they might have, in order to reassure the communities they serve?
Mr Lansley:
As the House has noted, risk registers designed for publication form part of the papers prepared for the boards of trusts. Of course, the legislation further strengthens the openness of foundation trust boards, for example, in respect of meeting in public and publishing their documents. But, as my right hon. Friend
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the Member for Charnwood rightly pointed out, there is an enormous difference between the frank expression of officials’ worse-case scenarios to Ministers in order to challenge decision making—as I say, it was anticipated that that was not intended for publication—and the preparation of risk registers by NHS bodies and trusts, which are designed for publication. Indeed, the national risk register is also designed for publication on that basis. As I said, those in the House of Lords yesterday agreed, by a substantial majority when voting on an amendment, that not only had the consideration of the Bill received unprecedented scrutiny, but that they also had the information they required.
Thirdly, let me just remind the House that the right hon. Member for Leigh, as a Minister, refused to publish the Department’s risk register. He said:
“Whilst we are conscious that there will be public interest in the contents of the Strategic Risk Register being made freely available, we have also taken into account the public interest in preserving the ability of officials to engage in the discussions of policy options and risks without apprehension that suggested courses of action may be held up to public or media scrutiny before they have been fully developed or evaluated. We also take into account the fact that ministers and their officials need space in which to develop their thinking and explore options, and that this disclosure may deter them from being as candid in the future, which will lead to poorer quality advice and poorer decision-making. Having regard to all these factors, we have determined that the balance of public interest strongly favours withholding the information.”
I could not have put it better myself, because that is precisely the point. He talks about the difference between the strategic risk register and the transition risk register, but the one requested was a risk register at the point at which policy was being formulated, and there is a substantial overlap between the strategic risk register and the transition risk register.
The right hon. Gentleman did one thing when he was a Minister and he argues the opposite now. The same thing seems to be happening in so many other fields. When he was a Minister he said that he was in favour of clinical commissioning, and practice-based commissioning was in the Labour manifesto in 2005. In 2006, he said that his ambition was to introduce
“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.]
Now he wants to block a Bill whose purpose is to give clinicians—doctors and nurses across the NHS—the power to commission and design services in their area. We just do not know the position. Once more, we heard nothing positive from him about what Labour would offer the health service; all we heard was a denigration of the performance of the NHS and a determination to block the Bill. We are still hearing from him about what Labour Members are opposed to; we just do not hear about anything he is in favour of.
The curious thing is that last Tuesday, on an Opposition day debate, I said, “We are hearing from Labour Members and Labour activists all over the country about their opposition to £20 billion of cuts.” Hon. Members will remember, because this happened only a week ago, that the right hon. Gentleman was shouting at me from the Labour Front Bench, “No, no, no. We are in favour of that.” I said to him, “Look, it is in the manifesto”, because Labour’s manifesto said that
“we will deliver up to £20 billion of efficiencies in the frontline NHS”.
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Yesterday, the right hon. Gentleman turned up with his hon. Friends at the Department of Health to deliver a petition from Wigan and Leigh. It said:
“We the undersigned are opposed to the Government’s Health and Social Care Bill and £20 billion of ‘unmandated’ cuts in NHS funding”.
He sat there last Tuesday saying, “No, we are in favour of £20 billion of efficiencies”, yet he is wandering all around the country with his hon. Friends saying, “No, it is £20 billion of cuts.” Frankly, Mr Speaker, if I recall correctly, that is what you would have me describe as an erroneous view.
The NHS across the country is a service that not only will use reform positively but is using reform positively now. We are seeing the reforms being implemented. On 1 April, clinical commissioning groups will take responsibility for more than £60 billion-worth of delegated responsibility for commissioning. I am tired of hearing the right hon. Gentleman denigrate NHS performance when what we have, since the election, is the lowest ever number of patients being admitted to mixed-sex wards, with numbers down 95%; the lowest ever number of patients waiting more than six months for treatment, with numbers down from 100,000-plus to 70,000; the lowest ever number of patients waiting more than a year for treatment, with numbers down from more than 18,000 to below 6,000; and the lowest ever number of patients waiting more than 18 weeks from referral to treatment. In May 2010, that figure was 209,000 but the latest figure is down to 182,000. Also, fewer people than ever are acquiring infections in hospital, with methicillin-resistant Staphylococcus aureus down 36% and clostridium difficile down 25%.
I have searched in vain for a point to this debate. I think that the only point was so that the right hon. Gentleman and his friends could put out a press release about having 24 hours to save the NHS—I think I have heard that one before. The Labour party is never knowingly over-clichéd. Only the Daily Mirror bothered to notice the press release, putting it on page 6; if it had really thought that this was about saving the NHS, it might at least have put in on page 1. No, the truth is that this is political opportunism dressed up as principle. This is a debate for no purpose and the only effect of this one and a half hour debate is to delay the consideration by this House of the amendments made in another place. Given the full and constructive character of the debate in the Lords over 25 days, I think it is a disservice to the other place that this House’s time has been wasted on having this debate. The Labour party has shown that it is interested not in what is in the Bill, but only in the political opportunity of opposing it. We are interested not only in what is in the Bill but in the opportunity it presents—not for the sake of the Opposition’s politics but for the NHS to improve and strengthen in the future.
5.7 pm
Andy Burnham:
In the past few minutes, we have seen a perfect demonstration at the Dispatch Box of why the right hon. Gentleman has spent 20 months trying to sell this Bill to the country but has comprehensively failed to do so. He had nothing to say in response to the speeches of Opposition Members and he did not respond with appropriate seriousness to the points that we have put to the House, namely that it should not put through
20 Mar 2012 : Column 679
far-reaching changes to this country’s most valued institution without knowing all the facts. Not one Member can go through the Lobby and say that they know all the facts about what this Bill will do. Instead, what we have heard from the Secretary of State, the hon. Member for Banbury (Tony Baldry), the right hon. Member for Charnwood (Mr Dorrell) and the hon. Member for Totnes (Dr Wollaston) is a rerun of the arguments that were heard in detail by the Information Commissioner and the Information Rights Tribunal. I have news for them all—and, indeed, for the hon. Member for Broxtowe (Anna Soubry)—they lost. Those arguments have been heard, a ruling has been made and the Government should surely respect the law, and of all people, the hon. Member for Broxtowe should respect the law.
The Secretary of State said there was a very simple point—that the Government have a responsibility to respect the law. They are the Government who told us they would be the most open and transparent Government in history. What total nonsense. Our point is simple: he is passing a Bill with far-reaching implications for the NHS in England in defiance of a legal ruling that he should publish all the information about his Bill. He made three points that were simply wrong. He said that the transition risk register deals with the worst-case scenario. It does not. It deals with the likelihood of a range of events and the impact of those events, and gives a judgment about whether or not they can be mitigated and the likelihood of mitigation. Has he read his own risk register?
The Secretary of State made a point about the strategic and transition risk registers. Has he read the ruling from the Information Commissioner and has he understood the implications of what the Information Rights Tribunal said? They said that the Government should not publish the strategic risk register because it deals with uncontrollable risks that are outside the control of Ministers, but that the Minister should publish the transition risk register because that is what he is inflicting on the national health service.
Let us not forget that the Secretary of State has chosen to inflict the biggest ever top-down reorganisation on the national health service at this moment of greatest financial challenge. That was his decision. His right hon. Friend the Prime Minister ruled that out. He said that there would be no top-down reorganisation. The coalition agreement ruled it out, but the Secretary of State brought it forward. It was his decision and if he wants this Parliament to endorse his plan, he should have the courtesy of putting before Members all the information that he has seen, but he is not prepared to do that.
Why will the Secretary of State not publish this information? What has he got to hide? Is it the fact that it would prove that all the people who are lined up in opposition to his Bill are right—the doctors, the nurses, the midwives, the physios? Is it possible that they are right in their judgment that the Bill will cause more harm than good? Would not the pitiful levels of support that he still has for the Bill be wiped out by the publication of the risk register?
The Secretary of State made no argument today at the Dispatch Box. The Government are doing what they are doing in total defiance of the law, in the teeth
20 Mar 2012 : Column 680
of professional opposition. They do not have the permission of the people of this country to put the NHS through the biggest ever reorganisation in its history. They promised in their manifesto that they would not do it. The Prime Minister promised us that he would protect the NHS and there would be no top-down reorganisation, but the Government have introduced the biggest ever top-down reorganisation. They are making a catastrophic political mistake by doing so. We will remind them every day of the damage they have done to our national health service.
The House divided:
Ayes 328, Noes 246.
[5.12 pm
AYES
Adams, Nigel
Afriyie, Adam
Aldous, Peter
Alexander, rh Danny
Amess, Mr David
Andrew, Stuart
Bacon, Mr Richard
Baker, Norman
Baker, Steve
Baldry, Tony
Baldwin, Harriett
Barclay, Stephen
Barker, Gregory
Baron, Mr John
Barwell, Gavin
Bebb, Guto
Beith, rh Sir Alan
Bellingham, Mr Henry
Benyon, Richard
Beresford, Sir Paul
Berry, Jake
Bingham, Andrew
Binley, Mr Brian
Birtwistle, Gordon
Blackman, Bob
Blunt, Mr Crispin
Boles, Nick
Bone, Mr Peter
Bottomley, Sir Peter
Bradley, Karen
Brady, Mr Graham
Brake, rh Tom
Bray, Angie
Brazier, Mr Julian
Brine, Steve
Brokenshire, James
Browne, Mr Jeremy
Bruce, Fiona
Bruce, rh Malcolm
Buckland, Mr Robert
Burley, Mr Aidan
Burns, Conor
Burns, rh Mr Simon
Burrowes, Mr David
Burstow, Paul
Burt, Alistair
Burt, Lorely
Byles, Dan
Cable, rh Vince
Cairns, Alun
Cameron, rh Mr David
Carmichael, rh Mr Alistair
Carmichael, Neil
Carswell, Mr Douglas
Cash, Mr William
Chishti, Rehman
Chope, Mr Christopher
Clappison, Mr James
Clark, rh Greg
Clarke, rh Mr Kenneth
Clegg, rh Mr Nick
Clifton-Brown, Geoffrey
Coffey, Dr Thérèse
Collins, Damian
Colvile, Oliver
Cox, Mr Geoffrey
Crockart, Mike
Crouch, Tracey
Davey, rh Mr Edward
Davies, David T. C.
(Monmouth)
Davies, Glyn
Davies, Philip
Davis, rh Mr David
de Bois, Nick
Dinenage, Caroline
Djanogly, Mr Jonathan
Dorrell, rh Mr Stephen
Doyle-Price, Jackie
Drax, Richard
Duddridge, James
Duncan, rh Mr Alan
Duncan Smith, rh Mr Iain
Dunne, Mr Philip
Ellis, Michael
Ellison, Jane
Ellwood, Mr Tobias
Elphicke, Charlie
Eustice, George
Evans, Graham
Evans, Jonathan
Evennett, Mr David
Fabricant, Michael
Fallon, Michael
Foster, rh Mr Don
Fox, rh Dr Liam
Francois, rh Mr Mark
Freeman, George
Freer, Mike
Fullbrook, Lorraine
Fuller, Richard
Gale, Sir Roger
Garnier, Mr Edward
Garnier, Mark
Gauke, Mr David
Gibb, Mr Nick
Gilbert, Stephen
Gillan, rh Mrs Cheryl
Glen, John
Goldsmith, Zac
Goodwill, Mr Robert
Gove, rh Michael
Graham, Richard
Grant, Mrs Helen
Gray, Mr James
Grayling, rh Chris
Green, Damian
Greening, rh Justine
Grieve, rh Mr Dominic
Griffiths, Andrew
Gummer, Ben
Gyimah, Mr Sam
Hague, rh Mr William
Halfon, Robert
Hames, Duncan
Hammond, rh Mr Philip
Hammond, Stephen
Hancock, Matthew
Hands, Greg
Harper, Mr Mark
Harrington, Richard
Harris, Rebecca
Hart, Simon
Harvey, Nick
Haselhurst, rh Sir Alan
Hayes, Mr John
Heald, Oliver
Heath, Mr David
Heaton-Harris, Chris
Hemming, John
Henderson, Gordon
Hendry, Charles
Herbert, rh Nick
Hinds, Damian
Hoban, Mr Mark
Hollingbery, George
Hollobone, Mr Philip
Hopkins, Kris
Horwood, Martin
Howarth, Mr Gerald
Howell, John
Hughes, rh Simon
Huhne, rh Chris
Hunt, rh Mr Jeremy
Hunter, Mark
Hurd, Mr Nick
Jackson, Mr Stewart
James, Margot
Javid, Sajid
Jenkin, Mr Bernard
Johnson, Gareth
Johnson, Joseph
Jones, Andrew
Jones, Mr David
Jones, Mr Marcus
Kawczynski, Daniel
Kelly, Chris
Kirby, Simon
Knight, rh Mr Greg
Kwarteng, Kwasi
Laing, Mrs Eleanor
Lamb, Norman
Lancaster, Mark
Lansley, rh Mr Andrew
Latham, Pauline
Laws, rh Mr David
Leadsom, Andrea
Lee, Jessica
Lee, Dr Phillip
Lefroy, Jeremy
Leigh, Mr Edward
Leslie, Charlotte
Letwin, rh Mr Oliver
Lewis, Brandon
Liddell-Grainger, Mr Ian
Lidington, rh Mr David
Lilley, rh Mr Peter
Lloyd, Stephen
Lopresti, Jack
Lord, Jonathan
Loughton, Tim
Lumley, Karen
Macleod, Mary
Main, Mrs Anne
Maude, rh Mr Francis
May, rh Mrs Theresa
Maynard, Paul
McCartney, Jason
McCartney, Karl
McIntosh, Miss Anne
McLoughlin, rh Mr Patrick
McPartland, Stephen
McVey, Esther
Mensch, Louise
Menzies, Mark
Mercer, Patrick
Metcalfe, Stephen
Miller, Maria
Mills, Nigel
Mitchell, rh Mr Andrew
Moore, rh Michael
Mordaunt, Penny
Morgan, Nicky
Morris, Anne Marie
Morris, David
Morris, James
Mosley, Stephen
Mowat, David
Mundell, rh David
Munt, Tessa
Murray, Sheryll
Neill, Robert
Newmark, Mr Brooks
Newton, Sarah
Nokes, Caroline
Norman, Jesse
Nuttall, Mr David
O'Brien, Mr Stephen
Offord, Mr Matthew
Ollerenshaw, Eric
Opperman, Guy
Osborne, rh Mr George
Ottaway, Richard
Paice, rh Mr James
Parish, Neil
Patel, Priti
Pawsey, Mark
Penning, Mike
Penrose, John
Percy, Andrew
Perry, Claire
Phillips, Stephen
Pincher, Christopher
Poulter, Dr Daniel
Prisk, Mr Mark
Raab, Mr Dominic
Randall, rh Mr John
Reckless, Mark
Redwood, rh Mr John
Rees-Mogg, Jacob
Reevell, Simon
Reid, Mr Alan
Robathan, rh Mr Andrew
Robertson, Hugh
Robertson, Mr Laurence
Rogerson, Dan
Rosindell, Andrew
Rudd, Amber
Ruffley, Mr David
Russell, Sir Bob
Rutley, David
Sandys, Laura
Scott, Mr Lee
Selous, Andrew
Shapps, rh Grant
Sharma, Alok
Shelbrooke, Alec
Shepherd, Mr Richard
Simmonds, Mark
Simpson, Mr Keith
Skidmore, Chris
Smith, Miss Chloe
Smith, Henry
Smith, Julian
Smith, Sir Robert
Soames, rh Nicholas
Soubry, Anna
Spelman, rh Mrs Caroline
Spencer, Mr Mark
Stanley, rh Sir John
Stephenson, Andrew
Stevenson, John
Stewart, Bob
Stewart, Iain
Stewart, Rory
Streeter, Mr Gary
Stride, Mel
Stuart, Mr Graham
Sturdy, Julian
Swales, Ian
Swayne, rh Mr Desmond
Swinson, Jo
Swire, rh Mr Hugo
Syms, Mr Robert
Teather, Sarah
Thurso, John
Timpson, Mr Edward
Tomlinson, Justin
Tredinnick, David
Truss, Elizabeth
Turner, Mr Andrew
Tyrie, Mr Andrew
Uppal, Paul
Vaizey, Mr Edward
Vara, Mr Shailesh
Vickers, Martin
Villiers, rh Mrs Theresa
Walker, Mr Charles
Walker, Mr Robin
Wallace, Mr Ben
Watkinson, Angela
Weatherley, Mike
Webb, Steve
Wharton, James
Wheeler, Heather
White, Chris
Whittingdale, Mr John
Wiggin, Bill
Willetts, rh Mr David
Williams, Mr Mark
Williams, Roger
Williams, Stephen
Williamson, Gavin
Wilson, Mr Rob
Wollaston, Dr Sarah
Wright, Jeremy
Wright, Simon
Young, rh Sir George
Zahawi, Nadhim
Tellers for the Ayes:
Stephen Crabb and
Jenny Willott
NOES
Abbott, Ms Diane
Abrahams, Debbie
Ainsworth, rh Mr Bob
Alexander, rh Mr Douglas
Alexander, Heidi
Allen, Mr Graham
Anderson, Mr David
Ashworth, Jonathan
Austin, Ian
Bailey, Mr Adrian
Bain, Mr William
Balls, rh Ed
Barron, rh Mr Kevin
Bayley, Hugh
Benn, rh Hilary
Berger, Luciana
Betts, Mr Clive
Blackman-Woods, Roberta
Blenkinsop, Tom
Blomfield, Paul
Blunkett, rh Mr David
Bradshaw, rh Mr Ben
Brennan, Kevin
Brown, rh Mr Gordon
Brown, Lyn
Brown, rh Mr Nicholas
Brown, Mr Russell
Bryant, Chris
Buck, Ms Karen
Burden, Richard
Burnham, rh Andy
Byrne, rh Mr Liam
Campbell, Mr Alan
Campbell, Mr Gregory
Campbell, Mr Ronnie
Caton, Martin
Chapman, Mrs Jenny
Clark, Katy
Clarke, rh Mr Tom
Clwyd, rh Ann
Coffey, Ann
Connarty, Michael
Cooper, Rosie
Cooper, rh Yvette
Corbyn, Jeremy
Creagh, Mary
Creasy, Stella
Cruddas, Jon
Cryer, John
Cunningham, Alex
Cunningham, Mr Jim
Cunningham, Tony
Curran, Margaret
Dakin, Nic
Danczuk, Simon
Darling, rh Mr Alistair
David, Mr Wayne
Davidson, Mr Ian
Davies, Geraint
De Piero, Gloria
Denham, rh Mr John
Dobbin, Jim
Dobson, rh Frank
Docherty, Thomas
Dodds, rh Mr Nigel
Donaldson, rh Mr Jeffrey M.
Donohoe, Mr Brian H.
Doran, Mr Frank
Dowd, Jim
Doyle, Gemma
Dromey, Jack
Dugher, Michael
Durkan, Mark
Eagle, Ms Angela
Eagle, Maria
Edwards, Jonathan
Efford, Clive
Elliott, Julie
Ellman, Mrs Louise
Engel, Natascha
Esterson, Bill
Evans, Chris
Farrelly, Paul
Field, rh Mr Frank
Fitzpatrick, Jim
Flello, Robert
Flint, rh Caroline
Flynn, Paul
Fovargue, Yvonne
Francis, Dr Hywel
Gapes, Mike
Gardiner, Barry
Gilmore, Sheila
Glass, Pat
Glindon, Mrs Mary
Goodman, Helen
Greatrex, Tom
Green, Kate
Greenwood, Lilian
Griffith, Nia
Gwynne, Andrew
Hain, rh Mr Peter
Hamilton, Mr David
Hamilton, Fabian
Hanson, rh Mr David
Harman, rh Ms Harriet
Harris, Mr Tom
Healey, rh John
Hendrick, Mark
Hepburn, Mr Stephen
Hermon, Lady
Heyes, David
Hillier, Meg
Hilling, Julie
Hodge, rh Margaret
Hodgson, Mrs Sharon
Hoey, Kate
Hood, Mr Jim
Hopkins, Kelvin
Hosie, Stewart
Hunt, Tristram
Irranca-Davies, Huw
Jackson, Glenda
James, Mrs Siân C.
Jamieson, Cathy
Jarvis, Dan
Johnson, rh Alan
Johnson, Diana
Jones, Helen
Jones, Susan Elan
Jowell, rh Tessa
Kaufman, rh Sir Gerald
Keeley, Barbara
Kendall, Liz
Khan, rh Sadiq
Lammy, rh Mr David
Lavery, Ian
Lazarowicz, Mark
Leslie, Chris
Lloyd, Tony
Llwyd, rh Mr Elfyn
Long, Naomi
Love, Mr Andrew
Lucas, Caroline
Lucas, Ian
MacNeil, Mr Angus Brendan
Mactaggart, Fiona
Mahmood, Mr Khalid
Mahmood, Shabana
Malhotra, Seema
Mann, John
Marsden, Mr Gordon
McCabe, Steve
McCann, Mr Michael
McCarthy, Kerry
McClymont, Gregg
McCrea, Dr William
McDonagh, Siobhain
McDonnell, John
McFadden, rh Mr Pat
McGovern, Alison
McGovern, Jim
McGuire, rh Mrs Anne
McKechin, Ann
McKenzie, Mr Iain
McKinnell, Catherine
Meacher, rh Mr Michael
Mearns, Ian
Michael, rh Alun
Miliband, rh David
Miliband, rh Edward
Miller, Andrew
Mitchell, Austin
Moon, Mrs Madeleine
Morden, Jessica
Morrice, Graeme
Livingston)
Morris, Grahame M.
(Easington)
Munn, Meg
Murphy, rh Mr Jim
Murphy, rh Paul
Murray, Ian
Nandy, Lisa
Nash, Pamela
O'Donnell, Fiona
Onwurah, Chi
Osborne, Sandra
Owen, Albert
Paisley, Ian
Pearce, Teresa
Perkins, Toby
Pound, Stephen
Raynsford, rh Mr Nick
Reed, Mr Jamie
Reeves, Rachel
Reynolds, Emma
Reynolds, Jonathan
Riordan, Mrs Linda
Robertson, Angus
Robertson, John
Robinson, Mr Geoffrey
Rotheram, Steve
Roy, Mr Frank
Roy, Lindsay
Ruane, Chris
Ruddock, rh Dame Joan
Sarwar, Anas
Seabeck, Alison
Shannon, Jim
Sharma, Mr Virendra
Sheerman, Mr Barry
Sheridan, Jim
Shuker, Gavin
Skinner, Mr Dennis
Slaughter, Mr Andy
Smith, rh Mr Andrew
Smith, Angela
Smith, Nick
Smith, Owen
Straw, rh Mr Jack
Stringer, Graham
Stuart, Ms Gisela
Sutcliffe, Mr Gerry
Tami, Mark
Thornberry, Emily
Timms, rh Stephen
Trickett, Jon
Turner, Karl
Twigg, Derek
Twigg, Stephen
Umunna, Mr Chuka
Vaz, rh Keith
Vaz, Valerie
Watson, Mr Tom
Weir, Mr Mike
Whiteford, Dr Eilidh
Whitehead, Dr Alan
Wicks, rh Malcolm
Williams, Hywel
Winnick, Mr David
Winterton, rh Ms Rosie
Wishart, Pete
Wood, Mike
Woodcock, John
Woodward, rh Mr Shaun
Wright, David
Wright, Mr Iain
Tellers for the Noes:
Phil Wilson and
Graham Jones
Question accordingly agreed to.
20 Mar 2012 : Column 681
20 Mar 2012 : Column 682
20 Mar 2012 : Column 683
20 Mar 2012 : Column 684
That this House has considered the matter of whether the House should defer consideration of Lords Amendments to the Health and Social Care Bill until after disclosure of the NHS transitional risk register.
Business without Debate
Delegated Legislation
Motion made, and Question put forthwith (Standing Order No. 118(6)),
That the draft Public Bodies (Abolition of the National Endowment for Science, Technology and the Arts) Order 2012, which was laid before this House on 19 January, be approved.—(Mr Newmark.)
Motion made, and Question put forthwith (Standing Order No. 118(6)),
That the draft Industrial Training Levy (Engineering Construction Industry Training Board) Order 2012, which was laid before this House on 27 February, be approved.—(Mr Newmark.)
Motion made, and Question put forthwith (Standing Order No. 118(6)),
That the draft Industrial Training Levy (Construction Industry Training Board) Order 2012, which was laid before this House on 27 February, be approved.—(Mr Newmark.)
20 Mar 2012 : Column 685
Health and Social Care Bill (Programme) (No. 4)
Motion made, and Question put forthwith , (Standing Order No. 83A(7 ) ),
That the following provisions shall apply to the Health and Social Care Bill for the purpose of supplementing the Order of 31 January 2011 (Health and Social Care Bill (Programme)), as supplemented by the Order of 21 June 2011 (Health and Social Care Bill (Programme) (No. 2)) and varied by the Order of 6 September 2011 (Health and Social Care Bill (Programme) (No. 3)):
Consideration of Lords Amendments
1. Proceedings on consideration of Lords amendments shall (so far as not previously concluded) be brought to a conclusion at 10.00 pm at today’s sitting.
2. The proceedings shall be taken in the order shown in the first column of the following Table.
3. The proceedings shall (so far as not previously concluded) be brought to a conclusion at the times specified in the second column of the Table.
Subsequent stages
4. Any further Message from the Lords may be considered forthwith without any Question being put.
5. The proceedings on any further Message from the Lords shall (so far as not previously concluded) be brought to a conclusion one hour after their commencement.—(Mr Newmark.)
The House divided:
Ayes 316, Noes 246.
[5.28 pm
AYES
Adams, Nigel
Afriyie, Adam
Aldous, Peter
Amess, Mr David
Andrew, Stuart
Bacon, Mr Richard
Baker, Norman
Baker, Steve
Baldry, Tony
Baldwin, Harriett
Barclay, Stephen
Barker, Gregory
Baron, Mr John
Barwell, Gavin
Bebb, Guto
Beith, rh Sir Alan
Bellingham, Mr Henry
Benyon, Richard
Beresford, Sir Paul
Berry, Jake
Bingham, Andrew
Binley, Mr Brian
Birtwistle, Gordon
Blackman, Bob
Boles, Nick
Bone, Mr Peter
Bottomley, Sir Peter
Bradley, Karen
Brady, Mr Graham
Brake, rh Tom
Bray, Angie
Brazier, Mr Julian
Brine, Steve
Brokenshire, James
Browne, Mr Jeremy
Bruce, Fiona
Bruce, rh Malcolm
Buckland, Mr Robert
Burley, Mr Aidan
Burns, Conor
Burns, rh Mr Simon
Burrowes, Mr David
Burstow, Paul
Burt, Alistair
Burt, Lorely
Byles, Dan
Cable, rh Vince
Cairns, Alun
Cameron, rh Mr David
Carmichael, rh Mr Alistair
Carmichael, Neil
Carswell, Mr Douglas
Cash, Mr William
Chishti, Rehman
Chope, Mr Christopher
Clappison, Mr James
Clark, rh Greg
Clarke, rh Mr Kenneth
Clifton-Brown, Geoffrey
Coffey, Dr Thérèse
Collins, Damian
Colvile, Oliver
Cox, Mr Geoffrey
Crockart, Mike
Crouch, Tracey
Davey, rh Mr Edward
Davies, David T. C.
(Monmouth)
Davies, Glyn
Davies, Philip
Davis, rh Mr David
de Bois, Nick
Dinenage, Caroline
Djanogly, Mr Jonathan
Dorrell, rh Mr Stephen
Doyle-Price, Jackie
Drax, Richard
Duncan, rh Mr Alan
Duncan Smith, rh Mr Iain
Dunne, Mr Philip
Ellis, Michael
Ellison, Jane
Ellwood, Mr Tobias
Elphicke, Charlie
Eustice, George
Evans, Graham
Evans, Jonathan
Evennett, Mr David
Fabricant, Michael
Fallon, Michael
Foster, rh Mr Don
Fox, rh Dr Liam
Francois, rh Mr Mark
Freeman, George
Freer, Mike
Fullbrook, Lorraine
Fuller, Richard
Garnier, Mr Edward
Garnier, Mark
Gauke, Mr David
George, Andrew
Gibb, Mr Nick
Gilbert, Stephen
Gillan, rh Mrs Cheryl
Glen, John
Goldsmith, Zac
Goodwill, Mr Robert
Gove, rh Michael
Graham, Richard
Grant, Mrs Helen
Gray, Mr James
Grayling, rh Chris
Green, Damian
Greening, rh Justine
Grieve, rh Mr Dominic
Griffiths, Andrew
Gummer, Ben
Gyimah, Mr Sam
Hague, rh Mr William
Halfon, Robert
Hames, Duncan
Hammond, rh Mr Philip
Hammond, Stephen
Hancock, Matthew
Hands, Greg
Harper, Mr Mark
Harrington, Richard
Harris, Rebecca
Hart, Simon
Harvey, Nick
Haselhurst, rh Sir Alan
Hayes, Mr John
Heald, Oliver
Heath, Mr David
Heaton-Harris, Chris
Hemming, John
Henderson, Gordon
Herbert, rh Nick
Hinds, Damian
Hoban, Mr Mark
Hollingbery, George
Hollobone, Mr Philip
Hopkins, Kris
Horwood, Martin
Howarth, Mr Gerald
Howell, John
Hughes, rh Simon
Huhne, rh Chris
Hunt, rh Mr Jeremy
Hunter, Mark
Hurd, Mr Nick
Jackson, Mr Stewart
James, Margot
Javid, Sajid
Jenkin, Mr Bernard
Johnson, Gareth
Johnson, Joseph
Jones, Andrew
Jones, Mr David
Jones, Mr Marcus
Kawczynski, Daniel
Kelly, Chris
Kirby, Simon
Knight, rh Mr Greg
Kwarteng, Kwasi
Laing, Mrs Eleanor
Lamb, Norman
Lancaster, Mark
Lansley, rh Mr Andrew
Latham, Pauline
Leadsom, Andrea
Lee, Jessica
Lee, Dr Phillip
Leech, Mr John
Lefroy, Jeremy
Leigh, Mr Edward
Leslie, Charlotte
Letwin, rh Mr Oliver
Lewis, Brandon
Liddell-Grainger, Mr Ian
Lidington, rh Mr David
Lilley, rh Mr Peter
Lloyd, Stephen
Lopresti, Jack
Lord, Jonathan
Loughton, Tim
Lumley, Karen
Macleod, Mary
Main, Mrs Anne
May, rh Mrs Theresa
Maynard, Paul
McCartney, Jason
McCartney, Karl
McIntosh, Miss Anne
McLoughlin, rh Mr Patrick
McPartland, Stephen
McVey, Esther
Mensch, Louise
Menzies, Mark
Mercer, Patrick
Metcalfe, Stephen
Miller, Maria
Mills, Nigel
Mitchell, rh Mr Andrew
Moore, rh Michael
Mordaunt, Penny
Morgan, Nicky
Morris, Anne Marie
Morris, David
Morris, James
Mosley, Stephen
Mowat, David
Mundell, rh David
Munt, Tessa
Murray, Sheryll
Neill, Robert
Newmark, Mr Brooks
Newton, Sarah
Nokes, Caroline
Norman, Jesse
Nuttall, Mr David
O'Brien, Mr Stephen
Offord, Mr Matthew
Opperman, Guy
Ottaway, Richard
Paice, rh Mr James
Parish, Neil
Patel, Priti
Pawsey, Mark
Penning, Mike
Penrose, John
Percy, Andrew
Perry, Claire
Phillips, Stephen
Pincher, Christopher
Poulter, Dr Daniel
Prisk, Mr Mark
Pugh, John
Randall, rh Mr John
Reckless, Mark
Redwood, rh Mr John
Rees-Mogg, Jacob
Reevell, Simon
Reid, Mr Alan
Robathan, rh Mr Andrew
Robertson, Hugh
Robertson, Mr Laurence
Rogerson, Dan
Rosindell, Andrew
Rudd, Amber
Ruffley, Mr David
Russell, Sir Bob
Rutley, David
Sanders, Mr Adrian
Sandys, Laura
Scott, Mr Lee
Selous, Andrew
Shapps, rh Grant
Sharma, Alok
Shelbrooke, Alec
Simmonds, Mark
Simpson, Mr Keith
Skidmore, Chris
Smith, Miss Chloe
Smith, Henry
Smith, Julian
Smith, Sir Robert
Soames, rh Nicholas
Soubry, Anna
Spelman, rh Mrs Caroline
Spencer, Mr Mark
Stanley, rh Sir John
Stephenson, Andrew
Stevenson, John
Stewart, Bob
Stewart, Iain
Stewart, Rory
Streeter, Mr Gary
Stride, Mel
Stuart, Mr Graham
Stunell, Andrew
Sturdy, Julian
Swales, Ian
Swayne, rh Mr Desmond
Swinson, Jo
Swire, rh Mr Hugo
Syms, Mr Robert
Teather, Sarah
Thurso, John
Timpson, Mr Edward
Tomlinson, Justin
Tredinnick, David
Turner, Mr Andrew
Tyrie, Mr Andrew
Uppal, Paul
Vara, Mr Shailesh
Vickers, Martin
Villiers, rh Mrs Theresa
Walker, Mr Charles
Walker, Mr Robin
Wallace, Mr Ben
Watkinson, Angela
Weatherley, Mike
Webb, Steve
Wharton, James
White, Chris
Whittingdale, Mr John
Wiggin, Bill
Williams, Mr Mark
Williams, Roger
Williamson, Gavin
Wilson, Mr Rob
Wollaston, Dr Sarah
Wright, Jeremy
Wright, Simon
Young, rh Sir George
Zahawi, Nadhim
Tellers for the Ayes:
Stephen Crabb and
Jenny Willott
NOES
Abbott, Ms Diane
Abrahams, Debbie
Ainsworth, rh Mr Bob
Alexander, rh Mr Douglas
Alexander, Heidi
Allen, Mr Graham
Anderson, Mr David
Ashworth, Jonathan
Austin, Ian
Bailey, Mr Adrian
Bain, Mr William
Balls, rh Ed
Banks, Gordon
Barron, rh Mr Kevin
Bayley, Hugh
Benn, rh Hilary
Berger, Luciana
Betts, Mr Clive
Blackman-Woods, Roberta
Blenkinsop, Tom
Blomfield, Paul
Blunkett, rh Mr David
Bradshaw, rh Mr Ben
Brennan, Kevin
Brown, rh Mr Gordon
Brown, Lyn
Brown, rh Mr Nicholas
Brown, Mr Russell
Bryant, Chris
Buck, Ms Karen
Burden, Richard
Burnham, rh Andy
Byrne, rh Mr Liam
Campbell, Mr Alan
Campbell, Mr Gregory
Campbell, Mr Ronnie
Caton, Martin
Chapman, Mrs Jenny
Clark, Katy
Clarke, rh Mr Tom
Clwyd, rh Ann
Coffey, Ann
Connarty, Michael
Cooper, Rosie
Cooper, rh Yvette
Corbyn, Jeremy
Creagh, Mary
Creasy, Stella
Cruddas, Jon
Cryer, John
Cunningham, Alex
Cunningham, Mr Jim
Cunningham, Tony
Curran, Margaret
Dakin, Nic
Danczuk, Simon
Darling, rh Mr Alistair
David, Mr Wayne
Davidson, Mr Ian
Davies, Geraint
De Piero, Gloria
Denham, rh Mr John
Dobbin, Jim
Dobson, rh Frank
Docherty, Thomas
Dodds, rh Mr Nigel
Donaldson, rh Mr Jeffrey M.
Donohoe, Mr Brian H.
Doran, Mr Frank
Dowd, Jim
Doyle, Gemma
Dromey, Jack
Dugher, Michael
Durkan, Mark
Eagle, Ms Angela
Eagle, Maria
Edwards, Jonathan
Efford, Clive
Elliott, Julie
Ellman, Mrs Louise
Engel, Natascha
Esterson, Bill
Evans, Chris
Farrelly, Paul
Field, rh Mr Frank
Fitzpatrick, Jim
Flello, Robert
Flint, rh Caroline
Flynn, Paul
Fovargue, Yvonne
Francis, Dr Hywel
Gapes, Mike
Gardiner, Barry
Gilmore, Sheila
Glass, Pat
Glindon, Mrs Mary
Goodman, Helen
Greatrex, Tom
Green, Kate
Greenwood, Lilian
Griffith, Nia
Gwynne, Andrew
Hain, rh Mr Peter
Hamilton, Mr David
Hamilton, Fabian
Hanson, rh Mr David
Harman, rh Ms Harriet
Harris, Mr Tom
Healey, rh John
Hendrick, Mark
Hepburn, Mr Stephen
Hermon, Lady
Heyes, David
Hillier, Meg
Hilling, Julie
Hodge, rh Margaret
Hodgson, Mrs Sharon
Hoey, Kate
Hood, Mr Jim
Hopkins, Kelvin
Hunt, Tristram
Irranca-Davies, Huw
Jackson, Glenda
James, Mrs Siân C.
Jamieson, Cathy
Jarvis, Dan
Johnson, rh Alan
Johnson, Diana
Jones, Helen
Jones, Susan Elan
Jowell, rh Tessa
Kaufman, rh Sir Gerald
Keeley, Barbara
Kendall, Liz
Khan, rh Sadiq
Lammy, rh Mr David
Lavery, Ian
Lazarowicz, Mark
Leslie, Chris
Lloyd, Tony
Llwyd, rh Mr Elfyn
Long, Naomi
Love, Mr Andrew
Lucas, Caroline
Lucas, Ian
MacNeil, Mr Angus Brendan
Mactaggart, Fiona
Mahmood, Mr Khalid
Mahmood, Shabana
Malhotra, Seema
Mann, John
Marsden, Mr Gordon
McCabe, Steve
McCann, Mr Michael
McCarthy, Kerry
McClymont, Gregg
McCrea, Dr William
McDonagh, Siobhain
McDonnell, John
McFadden, rh Mr Pat
McGovern, Alison
McGovern, Jim
McGuire, rh Mrs Anne
McKechin, Ann
McKenzie, Mr Iain
McKinnell, Catherine
Meacher, rh Mr Michael
Mearns, Ian
Michael, rh Alun
Miliband, rh David
Miliband, rh Edward
Miller, Andrew
Mitchell, Austin
Moon, Mrs Madeleine
Morden, Jessica
Morrice, Graeme
(Livingston)
Morris, Grahame M.
(Easington)
Munn, Meg
Murphy, rh Mr Jim
Murphy, rh Paul
Murray, Ian
Nandy, Lisa
Nash, Pamela
O'Donnell, Fiona
Onwurah, Chi
Osborne, Sandra
Owen, Albert
Paisley, Ian
Pearce, Teresa
Perkins, Toby
Pound, Stephen
Raynsford, rh Mr Nick
Reed, Mr Jamie
Reeves, Rachel
Reynolds, Emma
Reynolds, Jonathan
Riordan, Mrs Linda
Robertson, Angus
Robertson, John
Robinson, Mr Geoffrey
Rotheram, Steve
Roy, Mr Frank
Roy, Lindsay
Ruane, Chris
Ruddock, rh Dame Joan
Sarwar, Anas
Seabeck, Alison
Shannon, Jim
Sharma, Mr Virendra
Sheerman, Mr Barry
Sheridan, Jim
Shuker, Gavin
Skinner, Mr Dennis
Slaughter, Mr Andy
Smith, rh Mr Andrew
Smith, Angela
Smith, Nick
Smith, Owen
Straw, rh Mr Jack
Stringer, Graham
Stuart, Ms Gisela
Sutcliffe, Mr Gerry
Tami, Mark
Thornberry, Emily
Timms, rh Stephen
Trickett, Jon
Turner, Karl
Twigg, Derek
Twigg, Stephen
Umunna, Mr Chuka
Vaz, rh Keith
Vaz, Valerie
Watson, Mr Tom
Weir, Mr Mike
Whiteford, Dr Eilidh
Whitehead, Dr Alan
Wicks, rh Malcolm
Williams, Hywel
Winnick, Mr David
Winterton, rh Ms Rosie
Wishart, Pete
Wood, Mike
Woodcock, John
Woodward, rh Mr Shaun
Wright, David
Wright, Mr Iain
Tellers for the Noes:
Phil Wilson and
Graham Jones
Question accordingly agreed to.
20 Mar 2012 : Column 686
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20 Mar 2012 : Column 688
20 Mar 2012 : Column 689
20 Mar 2012 : Column 690
Health and Social Care Bill
Consideration of Lords amendments
Mr Speaker: I must draw the House’s attention to the fact that financial privilege is involved in Lords amendments 7, 21, 35, 132 to 141, 181, 189, 192, 198, 243, 244, 253, 265, 288, 290, 291, 319, 320 and 366. If the House agrees to any of these amendments, I shall ensure that the appropriate entry is made in the Journal.
5.42 pm
The Minister of State, Department of Health (Mr Simon Burns): I beg to move, That this House agrees with Lords amendment 1.
Mr Speaker: With this we will consider the following:
Lords amendments 2 to 10 and 13 to 30.
Lords amendment 31, and amendment (a) thereto.
Lords amendments 32 to 42, 54 to 60, 74, 242, 246, 248, 252, 287, 292 to 294, 299 to 326, 328 to 332 and 335 to 342.
Mr Burns: The aim of this Bill is to secure a national health service that achieves results that are among the best in the world. Through it, the Government reaffirm their commitment to the values and principles of the NHS: a comprehensive service, available to all, free at the point of use and based on need, not ability to pay. However, we have always been prepared to listen and make changes to improve the Bill, and we have continued to do so in another place. The Lords amendments in this group fall within five main areas.
First, we recognised that concerns had been expressed about the Secretary of State’s accountability for the health service. Although it was never our intention in any way to undermine that responsibility, we have worked with Members of another place and the House of Lords Constitution Committee to agree Lords amendments 2 to 5, 17, 18, 24, 39, 40, 74, 246, 287 and 292. Those amendments put beyond doubt ministerial accountability to Parliament for the health service. In addition, they amend the autonomy duties on the Secretary of State and the NHS Commissioning Board, to make it explicit that the interests of the health service must always take priority. They also amend the intervention powers of the Secretary of State and the board, to clarify that they can intervene if they think a body is significantly failing to exercise its functions consistently with the interests of the health service. Finally, a new provision will make it explicit that the Secretary of State must have regard to the NHS constitution in exercising his functions in relation to the health service.
Although clinical commissioning groups will have autonomy in their individual decisions, Lords amendment 9 clarifies that CCGs must commission services consistently with the discharge by the Secretary of State and the board of their duty to promote a comprehensive health service, and with the objectives and requirements in the board’s mandate.
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The Government also tabled amendments in response to the recommendations of the House of Lords Select Committee on Delegated Powers and Regulatory Reform, all of which we have accepted. Amendments 15 and 16 ensure that the requirements set out in the mandate, and any revisions to those requirements, must now be given effect by regulations.
Commissioning will be led by GPs, who know patients best. However, with that responsibility must come accountability. Therefore, further to the amendments made in the House requiring CCGs to have governing bodies, the other place has strengthened requirements in relation to CCGs’ management of conflicts of interest. We recognised how important it is to ensure the highest standards of probity in CCGs and accepted amendments 31, 300, 301 and 302, which were tabled by the noble Baroness Barker, and which require CCGs to make arrangements to ensure that members and employees of CCGs, members of the governing body, and members of their committees and sub-committees, declare their interests in publicly accessible registers.
The amendments also require CCGs to make arrangements for managing conflicts of interest and potential conflicts of interest in such a way as to ensure that they do not, and do not appear to, affect the integrity of the board’s decision-making processes. The board must issue statutory guidance on conflicts of interest, to which CCGs must have regard.
Taken together, those amendments provide certainty that there will be clear and transparent lines of accountability in the reformed NHS. However, I cannot support Opposition amendment (a) to Lords amendment 31. The Bill is clear that CCGs must manage conflicts of interest in a way that secures maximum transparency and probity. In most cases, that would mean that a conflicted individual withdraws from the decision-making process, but that might not always be possible, for instance when a CCG is commissioning for local community-based alternatives to hospital services, and determines that the most effective and appropriate way to secure them is to get them from all local GP providers within its geographic area. In that event, it would not be possible for every GP to withdraw from the decision-making process. We cannot, therefore, agree to a blanket ban.
Andrew George (St Ives) (LD): Will the Minister clarify something in view of what he has just said about the conflict that all members of the board and the CCG will have with regard to decisions on the provision of new services? Does he share my fear that the structure of CCGs results in bodies that will continue to be conflicted? Does that continuing conflict not undermine that important structure within the health service?
Mr Burns: I appreciate the hon. Gentleman’s intervention, but I am afraid I do not share that view. I hope that what I shall go on to say will help to give him additional reassurance on that.
There will be additional safeguards in the Bill to ensure that those processes are transparent, including the regulations that Monitor will enforce on procurement practices and its accompanying guidance. In addition, the board must publish guidance for CCGs on their duties in relation to the management of conflicts of
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interest. Of course, the CCGs' commissioning intentions will have been set out in its commissioning plan, which is subject to consultation with both the public and the health and wellbeing boards.
The second area in which the other place has strengthened the Bill relates to the duties placed on commissioners to ensure a patient-focused NHS. It has always been the Government’s intention to put in place reforms that support the simple principle, “No decision about me without me.” To achieve that, commissioners will for the first time have a duty in relation to patient involvement in decisions. The House strengthened those duties following the listening exercise, and they were further improved by amendments 19, 32 and 33 in the other place, to make it explicit that the duty means promoting the involvement of patients in decisions relating to their own care or treatment.
Another core principle of the White Paper was the need to eliminate discrimination and reduce inequalities in care. The Bill will for the first time in the history of the NHS place specific duties on the Secretary of State and commissioners to have regard to the need to reduce health inequalities.
To reinforce that further, the other place agreed amendments 22, 23, 36, 37, 38 and 60. These ensure that the Secretary of State, the board and CCGs will be better held to account for the exercise of these duties through their annual reports, the board’s business plan and, in the case of CCGs, their commissioning plans and annual performance assessment by the board. However, improvements in quality, outcomes, and reduced inequalities will not happen unless we better integrate services for patients. That is why we placed duties on commissioners, again for the first time, to promote integration in new sections 13M and 14Y, and made clear, following the listening exercise, that competition will not take priority over integration.
Mr Robert Walter (North Dorset) (Con): I met GPs and consultants in Tavistock in west Devon the other day. One of the great concerns that consultants have, particularly in the field of paediatrics, is the integration of children’s services. A great deal of work has gone into that. In dealing with these amendments, what assurance can my right hon. Friend give that the integration of children’s services will be particularly emphasised in these changes?
Mr Burns: I hope that my hon. Friend will be reassured by two points. First, the Bill contains far greater duties and responsibilities for integration over the whole provision of care within the NHS, and that will obviously include children’s services. Secondly and more precisely on the narrow issue that he raised, the children’s health outcomes strategy, published some time ago, will ensure that commissioners provide services to improve integration and that there is greater working together between the NHS, public health bodies and commissioners in securing an improved pathway of care and greater integration.
Lords amendment 320 ensures that the NHS continues to provide funds to local government for investment in community services at the interface between health and social care.
Thirdly, amendments in the other place have placed a greater emphasis on the duties of the Secretary of State and commissioners with regard to system-wide issues,
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such as education, training and research. Amendment 7 ensures that the Secretary of State will remain responsible for securing an effective system of education and training. Amendments 21, 26, 35 and 42 will place duties on the board and CCGs to have regard to the need to promote education and training, and the Government supported the noble Lord Patel’s amendment to ensure that providers of health services were required to participate in the planning, commissioning and delivery of education and training.
The Government have also listened further to concerns that the strength of the research duties on the Secretary of State, the board and CCGs did not properly reflect the importance of the NHS as a world leader in supporting research. Amendments 6, 20 and 34 have strengthened these to a more direct duty to promote research.
Fourthly, concerns were expressed in the other place about the treatment of charities, other voluntary sector organisations and social enterprises that provide or want to provide NHS services. We are committed to a fair playing field for all providers of NHS services, regardless of their size or organisational form. We see voluntary organisations and social enterprises as key to this vision. For example, they can play a key role in understanding the needs of local communities and delivering tailored services.
Amendment 8 commits the Secretary of State to undertake a thorough and impartial statutory review of the whole of the fair playing field for NHS-funded services. I can confirm that it will cover all types and sizes of provider, including charities, social enterprises, mutuals and smaller providers. It will consider the full range of issues that can act as barriers for providers, including access to and cost of capital, access to appropriate insurance and indemnity cover, taxation and access to the NHS pension fund. The Secretary of State will be required to keep consideration of these issues under review. As my noble Friend Earl Howe set out in another place, during preparation of the report there will be full engagement with all provider types, commissioners and other interested stakeholders to ensure their concerns are looked at.
Finally, I turn to the amendments relating to mental health services. I would like to thank my noble Friend Lord Mackay for his work in developing amendment 1, which inserts the words “physical and mental” into clause 1 in order to promote “parity of esteem” between physical and mental health services. In response to the Royal College of Psychiatrists’ concerns, I would like to offer the reassurance that the definition of “illness” in section 275 of the National Health Service Act 2006 would continue to apply to section 1, meaning, for example, that learning disabilities, mental disorders and physical disabilities would continue to be covered by the comprehensive health service.
Although our view is that the most important work in achieving genuine parity of esteem will be non-legislative—for example, through our recent mental health strategy, “No Health without Mental Health”—we recognise the symbolic significance of including these words in clause 1. Mental health is a priority for this Government, so I commit to considering further the role that the mandate, the NHS and public health outcomes frameworks can play in driving improvements in mental health services. Similarly, we decided not to oppose amendment 54 by the noble Lord Patel of Bradford relating to mental health aftercare services provided
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under section 117 of the Mental Health Act 1983, and tabled a number of consequential technical amendments.
I am grateful for the scrutiny that the Bill has received in another place. There is no doubt that it has been strengthened and improved as a result. It will help to ensure that the Secretary of State will remain accountable overall for the health service and provide a robust framework for holding commissioners to account. I urge hon. Friends and hon. Members to agree to the Lords amendments in this group, but to reject Opposition amendment (a) to Lords amendment 31.
Liz Kendall (Leicester West) (Lab): There have been 1,000 Government amendments to this disastrous Health and Social Care Bill—374 in the other place alone—and it is unacceptable that elected Members in this House have been given so little time to debate amendments that will affect patients and the public in every constituency in England.
It is essential that we reach the second group of amendments, on parts 3 and 4 of the Bill, which deal with Monitor, foundation trusts and the Government’s plans to raise to 49% the private patient cap in foundation trusts, but I want to start with the Lords amendments to the Secretary of State’s duty to ensure a comprehensive service in the NHS. I will remind hon. Members where this all began.
On 10 February last year, my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) challenged the Secretary of State, in his evidence to the Commons Bill Committee, over why he was removing the Secretary of State’s responsibility to provide a comprehensive service in the NHS. He said:
“I have not... It is in the original language. It is reproduced the same way.”––[Official Report, Health and Social Care Public Bill Committee, 10 February 2011; c. 166, Q402 and 404.]
On 15 February, my hon. Friend the Member for Halton (Derek Twigg) challenged the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) about the removal of the Secretary of State’s duty to provide comprehensive NHS services. Again, this was categorically denied. The Minister said:
“Clause 1 retains the overarching…duty which dates from the original 1946 Act”.––[Official Report, Health and Social Care Public Bill Committee, 15 February 2011; c. 178.]
He also said that any amendments to the clause were “unnecessary”. Today the Government are being forced to eat their words.
For the record, it was the determination of Labour Members in the other place, not Liberal Democrat Members, that forced the Government to place the clauses relating to the Secretary of State’ duties on promoting a comprehensive service and on autonomy within the remit of the Lords Constitution Committee, chaired by the noble Baroness Jay of Paddington. The result of the Committee’s deliberations are the amendments before us today. The amendments do not deliver exactly the same duty as the National Health Service Act 2006, but they are a significant improvement. Pressed on this issue by Labour Members in both Houses and at every stage of the Bill, the Government have been forced to concede.
A similar thing has happened on education and training, which is the subject of Lords amendments 7, 21, 26, 35 and 42.
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John Healey (Wentworth and Dearne) (Lab): Before my hon. Friend moves on, will she pay tribute to our Labour colleagues in the Lords, who have worked across the House, but who, by dint of the way the House of Lords works, cannot always claim credit for the results they have achieved by working in that way?
6 pm
Liz Kendall: I absolutely concur with my right hon. Friend. For the record in this House, I pay tribute to our colleagues in the Lords for their achievements and their efforts in securing some of the protections for the NHS that we are debating today.
There was absolutely no mention of education and training in the original Bill, despite the fact that the Bill abolishes strategic health authorities, which play a vital role in education and training—for example, by hosting deaneries. Labour Members raised this issue in the first Commons Committee stage. We also tabled an amendment on Report to place a duty on the Secretary of State to ensure a comprehensive education and training system for all professions in the NHS, which would have included continuing professional development. Labour Members in the other place then tabled amendments to address the issue. I should note, again for the record, that it was Labour and Cross-Bench Lords, not Liberal Democrat Lords, who argued for those important amendments and who forced the Government to introduce substantive new clauses placing duties in respect of education and training on the Secretary of State, the NHS Commissioning Board and clinical commissioning groups.
However, the critical issue that I want to focus on is how to deal with conflicts of interest in clinical commissioning groups. Clinical commissioning groups will be responsible for spending around £65 billion of taxpayers’ money. They will be made up of a majority of GPs—professionals who run businesses that are largely, and in many cases wholly, dependent on the NHS for their income. Clinical commissioning groups will commission NHS services, some of which will be provided by GPs who are members of the group, or—as is increasingly envisaged by the Government—by companies in which GP members may have a financial interest. The public must have confidence that clinical commissioning groups are making decisions based on patients’ and taxpayers’ best interests, not the financial interests of GPs.
Chris Skidmore (Kingswood) (Con) rose —
Liz Kendall: I will finish this point.
However, under the Bill, clinical commissioning groups—the newest bodies in the NHS, and with the least experience—will have the weakest corporate governance of any public body in the country. They are required to have only two lay members. However, there has been no reassurance in this House or another place that those members will be independently appointed. The Government have not even given a reassurance that the chairs of clinical commissioning groups will be lay members. The Government have also failed, at every faltering stage of this Bill, to ensure robust protections against actual or perceived conflicts of interest in clinical commissioning groups.
Chris Skidmore: Will the hon. Lady give way?
Liz Kendall: No, I am going to proceed.
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Let me remind hon. Members that the Bill started out without any requirement for GP consortia—as they were then called—even to have a board to govern their work, let alone any measures to deal with potential conflicts of interest. On 3 March last year, in the first Commons Committee stage, Labour Members called for effective corporate governance and robust measures to deal with conflicts of interests in clinical commissioning groups.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con) rose —
Liz Kendall: I am going to finish this point.
The Minister of State, the hon. Member for Sutton and Cheam (Paul Burstow), said that all and any changes to those provisions were “unnecessary”, and denied that there was any lack of effective governance. I would remind Liberal Democrat Members that the Minister argued that putting a board in place or dealing with conflicts of interest would mean that clinical commissioning groups would fail to be “liberated”. Those criticisms were among the many issues that were supposed to be dealt with when the Government embarked on their now infamous “pause” in the Bill’s progress last spring, but they were not. The Government were therefore forced to return to the issue in the other place. However, the amendments before us are still weak, incomplete and ineffective.
The Government say that clinical commissioning groups will have to include in their constitutions how they intend to manage conflicts of interest. However, I am afraid the Government are deluded if they think that the national NHS Commissioning Board will be able adequately to scrutinise whether hundreds of clinical commissioning groups are properly implementing the measures in thousands of contracts, particularly when the board has already taken on so many other huge responsibilities for managing the Government’s new system. Giving Monitor powers to scrutinise clinical commissioning groups is inadequate for the same reason. Saying that Monitor can deem a clinical commissioning group’s contract to be ineffective, if it thinks that conflicts of interest have not been dealt with, will in effect mean closing the stable door once the horse has bolted. Indeed, there could be huge problems on the ground, as a provider may have already started delivering services to NHS patients by the time Monitor takes its decision.
Labour’s Front-Bench team in the other place tabled a comprehensive amendment to deal with conflicts of interest in clinical commissioning groups. It would have ensured a code of conduct for how clinical commissioning groups register, manage and report on conflicts of interests among its members and employees, and imposed a duty on CCG members to abide by the code. The amendment would have ensured that no member of a clinical commissioning group could take part in discussion or decisions concerning any provider of services with which that person had a registrable interest, and allowed the Secretary of State to appoint an adjudicator to investigate complaints about any breaches of the code, with a range of financial and other sanctions available, including the ability to suspend or remove a person from the clinical commissioning group. However, the Government rejected that comprehensive amendment, saying that such sanctions were unnecessary.
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The Government have agreed to Lords amendment 31, which at least says that there must be a register of interests for a group, along with its governing body, sub-committee and employees, and that the register must be kept up to date, with information updated within 28 days. That change is welcome, but it does not go anywhere near far enough in ensuring that conflicts of interest are robustly dealt with. That is why our amendment (a) to Lords amendment 31 would ensure that members of a clinical commissioning group would not be able to take part in discussions or decisions about services in which they had declared a registered interest, which is the same format as in local government.
Andrew George: Although we welcome Lords amendment 31, which was tabled by my noble Friend Baroness Barker in another place, the hon. Lady’s amendment (a) proposes to go a stage further. I personally welcome that, but did she notice that the Minister, in justifying the Government’s position that it would not practically be applicable, gave the example of a CCG commissioning from all its membership? Does that not fundamentally undermine the argument that clinical commissioning groups cannot be conflicted per se?
Liz Kendall: I am simply arguing in amendment (a) that the same robust mechanisms that exist in local government should apply in this case. The hon. Gentleman will have to have a conversation with his own Ministers about what they have said in response.
The potential for conflicts of interest under the Bill is so great, and the amount of public money being spent by clinical commissioning groups so substantial, that the Government should have put in place far tougher provisions to deal with conflicts of interest. The Deputy Prime Minister has failed to guarantee the integrity of clinical commissioning groups, as he claimed in his joint letter with the noble Baroness Williams to Liberal Democrat Members. The integrity of clinical commissioning groups cannot be guaranteed by having only two lay members who will not even be independently appointed, nor can it be guaranteed through guidance for GPs, which the General Medical Council is currently developing. Indeed, I would argue that the GMC’s role should be to ensure professional integrity in the treatment of individual patients, not with regard to organisational misconduct, which would be a complete change in its current role. Nor can the integrity of clinical commissioning groups be guaranteed by national bodies such as the NHS Commissioning Board and Monitor, which will be too distant, too remote and too busy dealing with the fallout from other aspects of the Government’s Bill to be able effectively to address the potential conflicts of interest that clinical commissioning groups will face every day.
This issue might not have received as much public or media attention as other aspects of the Bill, but it will become significant in future, as patients and taxpayers struggle to determine whether their best interests—not the financial interests of GPs—are at the heart of the NHS. Examples of that have already come to light. In October last year, the Haxby practice in York wrote to its patients to say that a range of minor treatments would no longer be available on the NHS, but that they could be carried out privately at a number of clinics,
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including one owned by the practice itself. Those treatments included the removal of skin tags, at a cost of £56.30, and the treatment of benign tumours at a charge of £243.20.
Dr Richard Vautrey, of the British Medical Association’s GP committee, has rightly said that
“the direction of travel in NHS policy, particularly combined with the financial situation, does increase the risk of conflicts of interest for GPs which is one of the reasons the BMA is so concerned about the Health and Social Care Bill.”
Similarly, the NHS Confederation and the Royal College of General Practitioners have felt forced to issue guidance to GPs on how they should manage conflicts of interest, because they believe that the arrangements will become more complex under the Government’s plans. The Lords amendments before us are not robust enough to deal with this. It is a real concern for GPs that they will be unable to deal with conflicts of interest. That is what they are saying, and they need to be protected. The Government should support our amendment, because that would enable that to happen.
Andrew George: I congratulate my noble Friends Baroness Jolly, Baroness Barker, Lord Marks, Baroness Williams, Baroness Tyler and Baroness Northover on putting in a tremendous amount of work during the Bill’s various stages to negotiate and table amendments to advance the arguments that my Liberal Democrat Friends and I have expressed concern about. I have already put on record the fact that, although some of those amendments represent important strides towards making the Bill less bad, the changes still do not satisfy me to the extent that I feel that the Bill should be entitled to go forward from this, the elected House, as a piece of legislation. Unfortunately, that is not an argument that I am going to win, but I wanted to put the point on record.
Lords amendment 31 represents an important step forward, but it will merely provide a sticking plaster in what will be a fundamentally challenging scenario. The clinical commissioning groups represent a crumbling pillar in the edifice of the legislation. The big weakness at the centre of the CCGs is the fact that their members will, collectively and individually, be conflicted in almost all circumstances, and they will be unable to escape from that.
The Minister emphasised that point further when he told the House why he could not accept the amendment tabled by those on the Labour Front Bench. He told us that members of a CCG should not take part in certain discussions and decisions, even though they had declared an interest, because the groups would, on occasion, be commissioning for all their members. In those circumstances, a CCG would be incapable of making a decision because none of its board members or general members could be brought in to help because they would all be conflicted. That demonstrates a fundamental weakness in the legislation. My noble Friend Baroness Barker tabled an excellently drafted amendment to deal with that problem, but she was working within very limited parameters. The amendment would simply provide a sticking plaster for a crumbling edifice that will be unable to hold up this policy. I have a fundamental concern about the way in which the legislation will work in this regard.
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6.15 pm
The solution would be to go back to the coalition agreement. I have advanced that argument before. Although no such amendment is before us today, I suggest that we revert to the idea of a much more wide-ranging commissioning body, perhaps based on the infrastructure of the old—or, in some cases, existing—primary care trusts. In so doing, we could get rid of the Government-placed people who come through the Appointments Commission, and instead graft in clinical representatives. The Government are absolutely right to ensure that clinicians play a central role in providing good clinical advice on the decision making and the awarding of contracts. Such a structure would also ensure that the voices of the community, the local authority and patients’ representatives would be heard. Unfortunately, we do not have such a pillar in place, and we are now trying to achieve iterations that, I am sorry to say, will not go far enough in addressing the fact that clinical commissioning groups will be fundamentally, endemically conflicted, and there will be no escape from that.
Grahame M. Morris (Easington) (Lab): I want to make a few points on Lords amendment 2, which deals with the Secretary of State’s duties. This has been the subject of one of the most fundamental debates during the course of the Bill. The Lords still have grave concerns about whether the Secretary of State does indeed have a duty to
“provide or secure the effective provision”
of health services in England. In addition, concern remains over exactly what the Secretary of State will remain accountable to the House for.
In Committee, the Lords agreed not to amend clause 1, or clause 4, in regard to the duty to promote a comprehensive health service and the Health Secretary's accountability to Parliament. Instead, they preferred to engage in negotiations with the Minister with a view to bringing back proposals before the Report stage. The Lords Constitution Committee also proposed amendments on ministerial accountability for the NHS. The Committee’s concern was that, even after the months of debate here and in the other place and the amendments that had already been tabled, the Bill still posed an undue risk to maintaining adequate ministerial and legal accountability for the NHS. Given the number of amendments that had been tabled, it was a remarkable achievement still to have such uncertainty.
The wording of amendments remained an issue, and on 2 February 2012, the Government tabled 137 amendments to the Bill covering a range of areas, including changes to clarify the responsibility of the Secretary of State for the health service. There were two key amendments: one sought to ensure that the Secretary of State
“retains ministerial responsibility to Parliament for the provision of the health service in England”.
The other sought to place the duty to promote a comprehensive health service and to exercise functions to secure the provision of services above that of promoting autonomy.
Jim Shannon (Strangford) (DUP):
The hon. Member used the term “comprehensive health service”. Does he feel that the changes to the NHS will deliver a comprehensive health service, or does he feel that what
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we will see is some people being able to access services while others are not? Is that not the sort of health care service that he would be against and to which the people of this country would object?
Grahame M. Morris: I am grateful for that intervention and I share the hon. Gentleman’s concern that this amendment, which deals with the Secretary of State’s powers, and, indeed, the whole thrust of the Bill, are likely to lead to a fragmented service, when what we all want to see is co-operation and integration. I am concerned about the direction of travel in that respect.
The point about autonomy is relevant, because Lords amendment 2 reiterates that
“The Secretary of State retains ministerial responsibility to Parliament for the provision of”
health services. Lords amendments 4 and 17 would further amend clauses 4 and 20 in order to downgrade the duty to promote autonomy even more, through the idea that the Secretary of State must only
“have regard to the desirability of securing”
autonomy instead. When it comes to ministerial accountability for the Secretary of State, we have a yearly mandate to the NHS Commissioning Board, which will remove the Secretary of State—and therefore Parliament—from being involved in or interfering in the running of the NHS. In that case, I ask the Minister: what would be the point of Health questions? As private health care interests take over the provision of health services, they will not be subjected to freedom of information requests or other forms of accountability to which NHS providers are subjected.
Mr Simon Burns: Will the hon. Gentleman give way?
Grahame M. Morris: I will in a moment, but I want to pose a few questions first. The Secretary of State clearly cannot answer for private companies that are exempt from FOI requests. He cannot answer for GP commissioning groups, which are essentially independent contractors and private bodies. Surely, it is clear that the Secretary of State is handing over a big chunk of the NHS budget to private GP commissioning groups, cutting himself and Parliament out of the loop. I therefore believe that it is a fantasy to say that the Secretary of State will remain accountable.
Mr Burns: There is almost—no, there is—an air of déjà vu to this part of the hon. Gentleman’s speech, as there always is. We discussed this in Committee, and I am a bit frustrated that he cannot quite get it. The fact is that at the moment there is virtually no transparency and no real accountability as to what a Secretary of State does with regard to the provision of health services. The fact is that the mandate will be published; it can be debated in this House either on a motion from the Government or from the Opposition; there will still be Question Time at which hon. Members will be able to ask questions; there will still be an opportunity for Adjournment debates, urgent questions and statements. There will be accountability.
Grahame M. Morris:
Well, as Aneurin Bevan said, “You give your version of the truth, and I will give mine.” In my assessment, yes, there will certainly be a mandate, but this House’s power to scrutinise and hold
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Ministers to account will be severely diminished under the new arrangements. Writing down that the Secretary of State has the duty
“to exercise functions to secure the provision of services”
is thus rather perverse—one might even say ridiculous—when the rest of the Bill hands over those duties to other bodies, often private bodies outside the NHS such as the clinical commissioning groups. Indeed, the National Commissioning Board—the world’s biggest quango—will also secure provision through clinical commissioning groups, which will not be done through the Secretary of State. [Interruption.] I think the Minister is being extremely disrespectful, Madam Deputy Speaker, in the way he is gesticulating when I am trying to make my points.
In effect, the Secretary of State’s only duty seems to be to pass over the money or the resource and write one letter a year—this mandate—to the National Commissioning Board.
On the issue of the duty to promote a comprehensive health service and secure the provision of services as opposed to any duty to promote autonomy, this surely remains a conundrum, as they are virtually mutually exclusive. How the Secretary of State thought that those two competing principles could sit side by side or that he could balance the two is beyond me. This is the problem with the Bill as a whole. No matter how much tweaking is done to clauses 2, 4 or 20 by these amendments, we cannot escape this dilemma. That brings me back to my key point that this Bill’s driving ideological purpose remains to commercialise and privatise each and every service in the NHS.
Finally, let me return to the definition of autonomy—[Interruption.]—for the information of Conservative Members, who are shouting across the Chamber. According to the dictionary, autonomy means
“the condition of being autonomous; self-government or the right of self-government; independence”.
What we are talking about here is being autonomous or independent of the Secretary of State. My contention is that only central planning can deliver a comprehensive service. Otherwise, we will have postcode lotteries—identified in the risk registers we have discussed, such as the one from the Faculty of Public Health—and unprofitable services being cut back. Once the private sector is too big to control, what then?
Grahame M. Morris: I have concluded my remarks, so perhaps the Minister can address those points in his summing up.
Dr Poulter: I shall make some brief remarks, but I first want to welcome the renewed focus on integrated care, as outlined by the Minister this afternoon. He clearly outlined the importance of mental health services and clarified that the primary duty in commissioning will be to ensure that there is integrated care.
We all know the importance of dealing with the biggest challenge facing the NHS, which is how we are going to look after our ageing population. How are we going to improve the care for the increasing numbers of people living longer, which is a good thing but poses a big financial challenge for the NHS as well as a big human challenge in how to look after them? How are
20 Mar 2012 : Column 702
we going to address the challenge of looking after people living at home with diabetes, heart disease and dementia?
This Bill goes a long way towards meeting those challenges, and I believe that the renewed focus on integration is key and vital. It is only by different services and different parts of the NHS working together effectively—with primary care working effectively with hospitals, as well as with social services—that we are going to meet the big financial and human challenge of improving the care of older people. That is why I am reassured—I hope that my Liberal Democrat colleagues will also be reassured—by this renewed focus on integration, which is at the heart of the debate and at the heart of the way in which we will make our NHS meet future challenges.
Let me deal briefly with the Opposition amendment 31, which deals with what they believe is an inherent conflict between people involved in delivering care—health care providers or GPs—and others when it comes to involvement in the clinical commissioning groups. The amendment ignores the fact that, at present, good commissioning involves a partnership with primary care trusts that were set up by Labour when they were in government. GPs who are engaged in the provision of health care in local communities are involved in PCTs and involved in the Government arrangements for PCTs, working in partnership with local managers. So, if it was good enough to have that inherent partnership in the current structures set up by the previous Government, I do not see why, when we all believe that clinical leadership is a good thing in the NHS, a conflict of interest should suddenly be created under the Bill. That does not make sense; it is not intellectually coherent. For that reason, we must oppose the amendment.
We have before us more reassuring amendments to promote integrated care, to focus it on more joined-up thinking between the primary and secondary care sector, and to ensure that we do not have to deal with patients with mental health problems only when they get to the point of crisis. The focus on integrated care will mean that they are better supported in their communities. Opposition amendment 13 is, as I have explained, inconsistent with how they managed the NHS when they were in government.
6.30 pm
Liz Kendall: The fundamental difference is that under the Bill only two lay people will be appointed as members of clinical commissioning groups, and no independence will be involved. Under the old system, lay members of primary care trusts were independently appointed. The degree of independence that provided checks and balances has gone.
Dr Poulter: I thank the hon. Lady for her intervention, but I will give way to my right hon. Friend the Minister before I respond to it.
Mr Burns: The hon. Lady may not fully appreciate this, but the regulations refer to a minimum of two lay members. There is nothing to stop a clinical commissioning group from appointing more than two.
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Dr Poulter: I thank my right hon. Friend for that clarification. The Government are clearly committed to the value that lay members bring to commissioning groups, and, as my right hon. Friend has said, two is the minimum. I hope the hon. Lady will accept that it is very disingenuous to suggest that lay members who are appointed to boards of hospitals or primary care trusts, or indeed to commissioning boards, show a lack of genuine care for patients in the way in which they commission services.
Given that the Opposition have tabled a bad amendment, and given the renewed focus on a commitment to integrated care for the benefit of older patients and people with mental health problems, I believe that we should support the Government this evening.
Alex Cunningham (Stockton North) (Lab): I support the amendment relating to Monitor and NHS foundation trusts. The Government seek to amend the Bill to allow—[Interruption.]
Madam Deputy Speaker (Dawn Primarolo): Order. I think the hon. Gentleman will find that he is referring to the wrong group of amendments. The group that we are discussing is headed “Secretary of State, NHS Commissioning Board and CCGs”. We will be discussing the amendment to which he referred later, and I presume that for that reason he will now resume his seat.
Nicky Morgan (Loughborough) (Con): I will speak very briefly. Let me begin by pointing out to the hon. Member for Leicester West (Liz Kendall), who said that we did not have enough time to consider all the amendments, that if we had not spent an hour and a half discussing the risk register yet again, we would have had more time to discuss the amendments.
I congratulate the Government on accepting Lords amendment 1, which relates to parity of esteem between physical and mental health. As the Minister said, genuine parity cannot be laid down in legislation, and the mental health framework will be very important to the achievement of it. However, research findings published by the Centre for Mental Health, which I mentioned to the Minister during health questions recently, show the link between physical and mental health conditions. As I am sure we all know from our constituency casework, when someone presents with a physical health condition, it may be clear that there is an underlying mental health condition which has been either undiagnosed or untreated, and which is therefore hampering the person’s physical health recovery.
The Minister spoke of the “symbolic significance” of including a reference to mental health. He is right, but I think that on a day when we have seen Her Majesty the Queen address Parliament, we should recognise that there is sometimes a place for symbolism, particularly when it comes to something that is as cherished on the Government Benches as the NHS. I know that the Opposition claim ownership of the NHS, but in fact it is cherished by all of us, and by our constituents.
I also thank the Government for accepting Lords amendments 19, 32 and 33, which concern the duty of commissioners and commissioning groups to provide patient-focused care—the “No decision about me without me” duty. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) rightly spoke of
20 Mar 2012 : Column 704
the importance of mental health care in that regard. I have certainly found, when listening to patients in the mental health system, that they want their doctors, consultants and everyone else in the system to ensure that they are involved in their own care. I am glad that the clinical commissioning groups will be given guidance on that, but I do not expect the very best CCGs and GPs to need to follow it. They are likely to know that treatment is more likely to succeed if patients are involved in it.
Having spent 10 weeks on the Public Bill Committee, and having been present during all the debates on the Floor of the House, I am especially pleased to be able to welcome the amendments.
John Pugh (Southport) (LD): Let me begin by paying tribute to my colleagues in the House of Lords, who have improved the Bill significantly.
I want to raise two issues relating to conflicts of interest. Subsection (1) of the new section proposed in the amendment tabled by Baroness Barker states:
“Each clinical commissioning group must maintain one or more registers of the interests of—
(a) the members of the group,
(b) the members of its governing body,
(c) the members of its committees or sub-committees or of committees or sub-committees of its governing body, and
(d) its employees.”
I looked in vain for a paragraph (e) specifying “parties with which it is contracted for commissioning support”. I think that that is a live issue. There will be commissioning support organisations—some of which will be private institutions, and some of which will be allied with organisations that provide the clinical services that are commissioned—and there may be occasions when those advising the commissioners make recommendations that benefit some parties with which they are contracted. That model, involving the influence of the executive, will be fairly familiar to those who have been members of local authorities. Councillors, like doctors, are often very busy. They rely heavily on expert advice provided by officers, and they generally follow it.
The issue was raised in the House of Lords—I believe that it was raised by Lady Barker—but, when I read the report of that debate, I could not help feeling that it had been glossed over. I should welcome any enlightenment from the Minister on how such a quandary can be dealt with. Clearly it must be dealt with, because otherwise it will create general anxiety about how commissioning will proceed.
The second issue is a bigger one. I think that it is of particular interest to us all, because it affects the general position of the commissioning consortia themselves. There is a view that PCTs are more or less in the same legal boat as GP or clinical commissioning consortia would be. I disagree with what the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) said about that. The PCT, as a unit, is not built around general practices, which, as we have said several times in this place, are small businesses. It is possible to view a clinical commissioning consortium as an association of undertakings, which creates serious issues as to how it is able to use public money. If it used public money to benefit itself, that would obviously become a big issue immediately.
20 Mar 2012 : Column 705
John Pugh: The Minister says “No”, but I tabled a question recently in which I asked him whether he had taken advice from the European Commission. He told me that he had not. [Interruption.] We are talking about European law—
Madam Deputy Speaker (Dawn Primarolo): Order. This is not just a conversation between the Government Front Bench and its supporters and the hon. Gentleman. If Members want to intervene to disagree with the hon. Gentleman, they should do so, rather than shouting at him while he is speaking.
John Pugh: The Minister could undoubtedly answer my query and deal with my anxiety. A significant regulatory issue is involved in the provision of regulations that will work for commissioners in the Department of Health, and he knows that that is the case. It is not a question of what we intend to do; it is a question of what those in the European legal system will make of the function and the nature of what we have set up. If they interpret it as an association of undertakings, that is exactly how they will treat it, regardless of what the Bill says or of what the Minister says at the Dispatch Box. This is a matter of concern that has been raised by people who are more knowledgeable about such matters than I am, and it genuinely needs to be addressed.
Lords amendments 2 to 10 and 13 to 30 agreed to, with Commons financial privileges waived in respect of Lords amendments 7 and 21.
Amendment (a) proposed to Lords amendment 3(1)—(Andy Burnham).
Question put, That the amendment be made.
The House divided:
Ayes 233, Noes 313.
[6.39 pm
AYES
Abbott, Ms Diane
Abrahams, Debbie
Ainsworth, rh Mr Bob
Alexander, rh Mr Douglas
Alexander, Heidi
Allen, Mr Graham
Anderson, Mr David
Ashworth, Jonathan
Austin, Ian
Bailey, Mr Adrian
Bain, Mr William
Balls, rh Ed
Banks, Gordon
Barron, rh Mr Kevin
Bayley, Hugh
Benn, rh Hilary
Berger, Luciana
Betts, Mr Clive
Blackman-Woods, Roberta
Blenkinsop, Tom
Blomfield, Paul
Bradshaw, rh Mr Ben
Brown, rh Mr Gordon
Brown, Lyn
Brown, rh Mr Nicholas
Brown, Mr Russell
Bryant, Chris
Buck, Ms Karen
Burden, Richard
Burnham, rh Andy
Byrne, rh Mr Liam
Campbell, Mr Alan
Campbell, Mr Gregory
Campbell, Mr Ronnie
Caton, Martin
Chapman, Mrs Jenny
Clark, Katy
Clarke, rh Mr Tom
Clwyd, rh Ann
Coffey, Ann
Connarty, Michael
Cooper, Rosie
Cooper, rh Yvette
Corbyn, Jeremy
Creagh, Mary
Creasy, Stella
Cryer, John
Cunningham, Alex
Cunningham, Mr Jim
Cunningham, Tony
Curran, Margaret
Danczuk, Simon
Darling, rh Mr Alistair
David, Mr Wayne
Davidson, Mr Ian
Davies, Geraint
De Piero, Gloria
Denham, rh Mr John
Dobbin, Jim
Dobson, rh Frank
Docherty, Thomas
Dodds, rh Mr Nigel
Donaldson, rh Mr Jeffrey M.
Donohoe, Mr Brian H.
Doran, Mr Frank
Dowd, Jim
Doyle, Gemma
Dromey, Jack
Dugher, Michael
Durkan, Mark
Eagle, Ms Angela
Eagle, Maria
Edwards, Jonathan
Efford, Clive
Elliott, Julie
Ellman, Mrs Louise
Engel, Natascha
Esterson, Bill
Evans, Chris
Farrelly, Paul
Fitzpatrick, Jim
Flello, Robert
Flint, rh Caroline
Flynn, Paul
Fovargue, Yvonne
Francis, Dr Hywel
Gapes, Mike
Gardiner, Barry
George, Andrew
Gilmore, Sheila
Glass, Pat
Glindon, Mrs Mary
Goodman, Helen
Greatrex, Tom
Green, Kate
Greenwood, Lilian
Griffith, Nia
Gwynne, Andrew
Hain, rh Mr Peter
Hamilton, Mr David
Hamilton, Fabian
Hanson, rh Mr David
Harman, rh Ms Harriet
Healey, rh John
Hepburn, Mr Stephen
Hermon, Lady
Heyes, David
Hillier, Meg
Hilling, Julie
Hodge, rh Margaret
Hodgson, Mrs Sharon
Hoey, Kate
Hopkins, Kelvin
Hunt, Tristram
Irranca-Davies, Huw
Jackson, Glenda
James, Mrs Siân C.
Jamieson, Cathy
Jarvis, Dan
Johnson, rh Alan
Johnson, Diana
Jones, Graham
Jones, Helen
Jones, Susan Elan
Jowell, rh Tessa
Kaufman, rh Sir Gerald
Keeley, Barbara
Kendall, Liz
Khan, rh Sadiq
Lammy, rh Mr David
Lavery, Ian
Lazarowicz, Mark
Leslie, Chris
Lloyd, Tony
Llwyd, rh Mr Elfyn
Long, Naomi
Love, Mr Andrew
Lucas, Caroline
Lucas, Ian
Mactaggart, Fiona
Mahmood, Shabana
Malhotra, Seema
Mann, John
Marsden, Mr Gordon
McCabe, Steve
McCann, Mr Michael
McCarthy, Kerry
McClymont, Gregg
McCrea, Dr William
McDonagh, Siobhain
McDonnell, John
McFadden, rh Mr Pat
McGovern, Jim
McGuire, rh Mrs Anne
McKechin, Ann
McKenzie, Mr Iain
McKinnell, Catherine
Meacher, rh Mr Michael
Mearns, Ian
Michael, rh Alun
Miliband, rh David
Miliband, rh Edward
Miller, Andrew
Mitchell, Austin
Moon, Mrs Madeleine
Morden, Jessica
Morrice, Graeme
(Livingston)
Morris, Grahame M.
(Easington)
Mulholland, Greg
Munn, Meg
Murphy, rh Mr Jim
Murphy, rh Paul
Murray, Ian
Nandy, Lisa
Nash, Pamela
O'Donnell, Fiona
Onwurah, Chi
Osborne, Sandra
Owen, Albert
Pearce, Teresa
Perkins, Toby
Pound, Stephen
Raynsford, rh Mr Nick
Reed, Mr Jamie
Reeves, Rachel
Reynolds, Emma
Reynolds, Jonathan
Riordan, Mrs Linda
Robertson, John
Robinson, Mr Geoffrey
Rotheram, Steve
Roy, Mr Frank
Roy, Lindsay
Ruane, Chris
Ruddock, rh Dame Joan
Sanders, Mr Adrian
Sarwar, Anas
Seabeck, Alison
Shannon, Jim
Sharma, Mr Virendra
Sheerman, Mr Barry
Sheridan, Jim
Shuker, Gavin
Skinner, Mr Dennis
Slaughter, Mr Andy
Smith, rh Mr Andrew
Smith, Angela
Smith, Nick
Smith, Owen
Straw, rh Mr Jack
Stringer, Graham
Stuart, Ms Gisela
Sutcliffe, Mr Gerry
Tami, Mark
Thornberry, Emily
Timms, rh Stephen
Trickett, Jon
Turner, Karl
Twigg, Derek
Twigg, Stephen
Umunna, Mr Chuka
Vaz, rh Keith
Vaz, Valerie
Whitehead, Dr Alan
Wicks, rh Malcolm
Wilson, Phil
Winnick, Mr David
Winterton, rh Ms Rosie
Wood, Mike
Woodcock, John
Woodward, rh Mr Shaun
Wright, David
Wright, Mr Iain
Tellers for the Ayes:
Nic Dakin and
Mark Hendrick
NOES
Adams, Nigel
Afriyie, Adam
Aldous, Peter
Alexander, rh Danny
Amess, Mr David
Andrew, Stuart
Bacon, Mr Richard
Baker, Norman
Baker, Steve
Baldry, Tony
Baldwin, Harriett
Barclay, Stephen
Baron, Mr John
Barwell, Gavin
Bebb, Guto
Beith, rh Sir Alan
Bellingham, Mr Henry
Benyon, Richard
Beresford, Sir Paul
Berry, Jake
Bingham, Andrew
Binley, Mr Brian
Birtwistle, Gordon
Blackman, Bob
Blunt, Mr Crispin
Boles, Nick
Bone, Mr Peter
Bottomley, Sir Peter
Bradley, Karen
Brady, Mr Graham
Brake, rh Tom
Bray, Angie
Brazier, Mr Julian
Bridgen, Andrew
Brine, Steve
Brokenshire, James
Browne, Mr Jeremy
Bruce, Fiona
Bruce, rh Malcolm
Buckland, Mr Robert
Burley, Mr Aidan
Burns, Conor
Burns, rh Mr Simon
Burrowes, Mr David
Burstow, Paul
Burt, Lorely
Byles, Dan
Cable, rh Vince
Cairns, Alun
Carmichael, rh Mr Alistair
Carmichael, Neil
Carswell, Mr Douglas
Cash, Mr William
Chishti, Rehman
Chope, Mr Christopher
Clappison, Mr James
Clark, rh Greg
Clifton-Brown, Geoffrey
Coffey, Dr Thérèse
Collins, Damian
Colvile, Oliver
Cox, Mr Geoffrey
Crabb, Stephen
Crockart, Mike
Crouch, Tracey
Davey, rh Mr Edward
Davies, David T. C.
(Monmouth)
Davies, Glyn
Davies, Philip
Davis, rh Mr David
de Bois, Nick
Dinenage, Caroline
Djanogly, Mr Jonathan
Dorrell, rh Mr Stephen
Doyle-Price, Jackie
Drax, Richard
Duncan, rh Mr Alan
Duncan Smith, rh Mr Iain
Dunne, Mr Philip
Ellis, Michael
Ellison, Jane
Ellwood, Mr Tobias
Elphicke, Charlie
Eustice, George
Evans, Graham
Evans, Jonathan
Evennett, Mr David
Fabricant, Michael
Fallon, Michael
Foster, rh Mr Don
Fox, rh Dr Liam
Francois, rh Mr Mark
Freeman, George
Freer, Mike
Fullbrook, Lorraine
Fuller, Richard
Garnier, Mr Edward
Garnier, Mark
Gauke, Mr David
Gibb, Mr Nick
Gilbert, Stephen
Gillan, rh Mrs Cheryl
Glen, John
Goldsmith, Zac
Goodwill, Mr Robert
Gove, rh Michael
Graham, Richard
Grant, Mrs Helen
Gray, Mr James
Grayling, rh Chris
Green, Damian
Greening, rh Justine
Grieve, rh Mr Dominic
Griffiths, Andrew
Gummer, Ben
Gyimah, Mr Sam
Hague, rh Mr William
Halfon, Robert
Hames, Duncan
Hammond, rh Mr Philip
Hammond, Stephen
Hancock, Matthew
Hands, Greg
Harper, Mr Mark
Harrington, Richard
Harris, Rebecca
Hart, Simon
Harvey, Nick
Haselhurst, rh Sir Alan
Hayes, Mr John
Heald, Oliver
Heath, Mr David
Heaton-Harris, Chris
Hemming, John
Henderson, Gordon
Herbert, rh Nick
Hinds, Damian
Hoban, Mr Mark
Hollingbery, George
Hollobone, Mr Philip
Hopkins, Kris
Horwood, Martin
Howarth, Mr Gerald
Howell, John
Hughes, rh Simon
Huhne, rh Chris
Hunt, rh Mr Jeremy
Hunter, Mark
Jackson, Mr Stewart
James, Margot
Javid, Sajid
Jenkin, Mr Bernard
Johnson, Gareth
Johnson, Joseph
Jones, Andrew
Jones, Mr David
Jones, Mr Marcus
Kawczynski, Daniel
Kelly, Chris
Kirby, Simon
Knight, rh Mr Greg
Kwarteng, Kwasi
Laing, Mrs Eleanor
Lamb, Norman
Lancaster, Mark
Lansley, rh Mr Andrew
Latham, Pauline
Laws, rh Mr David
Leadsom, Andrea
Lee, Jessica
Lee, Dr Phillip
Leech, Mr John
Lefroy, Jeremy
Leigh, Mr Edward
Leslie, Charlotte
Letwin, rh Mr Oliver
Lewis, Brandon
Liddell-Grainger, Mr Ian
Lidington, rh Mr David
Lloyd, Stephen
Lopresti, Jack
Lord, Jonathan
Loughton, Tim
Lumley, Karen
Macleod, Mary
Main, Mrs Anne
Maude, rh Mr Francis
May, rh Mrs Theresa
Maynard, Paul
McCartney, Jason
McCartney, Karl
McIntosh, Miss Anne
McLoughlin, rh Mr Patrick
McPartland, Stephen
McVey, Esther
Mensch, Louise
Menzies, Mark
Metcalfe, Stephen
Miller, Maria
Mills, Nigel
Moore, rh Michael
Mordaunt, Penny
Morgan, Nicky
Morris, Anne Marie
Morris, David
Morris, James
Mosley, Stephen
Mowat, David
Mundell, rh David
Munt, Tessa
Murray, Sheryll
Neill, Robert
Newmark, Mr Brooks
Newton, Sarah
Nokes, Caroline
Norman, Jesse
Nuttall, Mr David
O'Brien, Mr Stephen
Offord, Mr Matthew
Ollerenshaw, Eric
Opperman, Guy
Ottaway, Richard
Paice, rh Mr James
Parish, Neil
Patel, Priti
Pawsey, Mark
Penning, Mike
Penrose, John
Percy, Andrew
Perry, Claire
Phillips, Stephen
Pincher, Christopher
Poulter, Dr Daniel
Prisk, Mr Mark
Randall, rh Mr John
Reckless, Mark
Redwood, rh Mr John
Rees-Mogg, Jacob
Reevell, Simon
Reid, Mr Alan
Robertson, Hugh
Robertson, Mr Laurence
Rogerson, Dan
Rosindell, Andrew
Rudd, Amber
Ruffley, Mr David
Russell, Sir Bob
Rutley, David
Sandys, Laura
Scott, Mr Lee
Selous, Andrew
Shapps, rh Grant
Sharma, Alok
Shelbrooke, Alec
Shepherd, Mr Richard
Simmonds, Mark
Simpson, Mr Keith
Skidmore, Chris
Smith, Miss Chloe
Smith, Henry
Smith, Julian
Smith, Sir Robert
Soubry, Anna
Spelman, rh Mrs Caroline
Spencer, Mr Mark
Stanley, rh Sir John
Stephenson, Andrew
Stevenson, John
Stewart, Bob
Stewart, Iain
Stewart, Rory
Streeter, Mr Gary
Stride, Mel
Stunell, Andrew
Sturdy, Julian
Swayne, rh Mr Desmond
Swinson, Jo
Swire, rh Mr Hugo
Syms, Mr Robert
Teather, Sarah
Thurso, John
Timpson, Mr Edward
Tomlinson, Justin
Truss, Elizabeth
Turner, Mr Andrew
Tyrie, Mr Andrew
Uppal, Paul
Vaizey, Mr Edward
Vara, Mr Shailesh
Vickers, Martin
Villiers, rh Mrs Theresa
Walker, Mr Charles
Walker, Mr Robin
Wallace, Mr Ben
Watkinson, Angela
Weatherley, Mike
Webb, Steve
Wharton, James
Wheeler, Heather
White, Chris
Whittingdale, Mr John
Wiggin, Bill
Willetts, rh Mr David
Williams, Mr Mark
Williams, Roger
Williams, Stephen
Williamson, Gavin
Wilson, Mr Rob
Wollaston, Dr Sarah
Wright, Jeremy
Wright, Simon
Young, rh Sir George
Zahawi, Nadhim
Tellers for the Noes:
James Duddridge and
Jenny Willott
Question accordingly negatived.