Health and Social Care (Re-committed) Bill

Tuesday 6th September 2011 Commons Chamber

[1st Allocated Day]

Consideration of Bill, as amended in the Public Bill Committee

[Mr Speaker]

Before the House embarks on the Bill, it may help if I deal with a matter that has been raised with me concerning the 715 virtually identical Government amendments changing the phrase “commissioning consortia” to “clinical commissioning groups”. These are the fourth group on today’s selection list. It has never been the practice of the House or its Committees to allow a single global amendment to make a series of identical or very similar amendments. The rule that any substantive change to the text of the Bill must be done by an amendment is designed for the protection of the rights of all Members and the integrity of the legislative process. I do understand that in this case it leads to a particularly bulky amendment paper. The fact that a practice is long-standing does not, in my view, mean that it is sacrosanct. Any hon. Member who wishes is of course free to ask the Procedure Committee to inquire into this matter. I hope that that is helpful.

I should also inform the House that amendment 781, which is printed on page 2985, should appear on page 3051, and amendments 945 and 946, which are printed on page 3138, should appear on page 3068. That has no material effect on today’s proceedings, but I know that the House will have wanted me to share those crucial nuggets of information with it.

[Sir Peter Bottomley (Worthing West) (Con)]

On a point of order, Mr Speaker. The House will have noted your comments about the repetitive amendments. Are we to take it that we have to go through quite a lengthy procedure in order just to be able to list the places where the words would be substituted? Is it not possible—is it not in your power or that of the Leader of the House—to make the change without having to go through weeks and weeks of Committees and other consideration? I do not necessarily need an answer now, but that is a consideration to which I would have thought a reforming Speaker might have found a solution.

[Mr Speaker]

I thought that I had found a very satisfactory way forward—one that should appease the hon. Gentleman and perhaps mollify him, putting him in a better frame of mind. There will be a grouping. If he is inquiring of me whether a separate Division will be required to give effect—

[Sir Peter Bottomley]

indicated dissent.

[Mr Speaker]

The hon. Gentleman is shaking his head from a sedentary position to indicate that that is not the burden of his proposition, in which case I am not sure what is. I can nevertheless assure him that no separate Division will be required. I think that at the end of our proceedings he will be in the good humour to which we know he is accustomed.

[Sir Peter Bottomley]

Further to that point of order, Mr Speaker. The point was the one that you have made, which is that the amendment has to be repeated, with different pages and lines. I suggest that an amendment might be tabled setting out a list of the pages and lines where it applied.

[Mr Speaker]

What I am saying is what I have already said, which is that there is no provision for a global amendment. An amendment is required to be made in each case. That does not entail a separate Division or what the hon. Gentleman in his first point of order described with some trepidation as a “lengthy procedure”. There will be no requirement for a lengthy procedure. Ministers seem sanguine; so am I—so, I think, should the House be. Perhaps we can now proceed to the business before us.

New Clause 2

Conditions relating to the continuation of the provision of services etc.

‘(1) The things which a licence holder may be required to do by a condition under section 104(1)(i)(i) include, in particular—

(a) providing information to the commissioners of services to which the condition applies and to such other persons as Monitor may direct,

(b) allowing Monitor to enter premises owned or controlled by the licence holder and to inspect the premises and anything on them, and

(c) co-operating with such persons as Monitor may appoint to assist in the management of the licence holder’s affairs, business and property.

(2) A commissioner of services to which a condition under section 104(1)(i), (j) or (k) applies must co-operate with persons appointed under subsection (1)(c) in their provision of the assistance that they have been appointed to provide.

(3) Where a licence includes a condition under section 104(1)(i), (j) or (k), Monitor must carry out an ongoing assessment of the risks to the continued provision of services to which the condition applies.

(4) Monitor must publish guidance—

(a) for commissioners of a service to which a condition under section 104(1)(i), (j) or (k) applies about the exercise of their functions in connection with the licence holders who provide the service, and

(b) for such licence holders about the conduct of their affairs, business and property at a time at which such a condition applies.

(5) A commissioner of services to which a condition under section 104(1)(i), (j), or (k) applies must have regard to guidance under subsection (4)(a).

(6) Monitor may revise guidance under subsection (4) and, if it does so, must publish the guidance as revised.

(7) Before publishing guidance under subsection (4) or (6), Monitor must obtain the approval of—

(a) the Secretary of State, and

(b) the National Health Service Commissioning Board.’. —(Mr Lansley.)

Brought up, and read the First time.

16:22

[The Secretary of State for Health (Mr Andrew Lansley)]

I beg to move, That the clause be read a Second time.

[Mr Speaker]

With this it will be convenient to discuss the following:

Government new clause 6—Objective of trust special administration.

Amendment 10, page 83, line 5, leave out part 3.

Amendment 1225, in clause 57, page 83, line 13, leave out ‘monitor’ and insert ‘Integrated Health Service Regulator (elsewhere referred to in this Bill as “Monitor”)’.

Amendment 1226, in clause 58, page 83, line 20, at end insert ‘and

(c) is sufficiently integrated so as to reduce any risk to patient care and to provide continuity of service.’.

Amendment 1207, page 83, line 23, after ‘preventing’, insert ‘competitive or, as the case may be,’.

Amendment 1227, in clause 59, page 84, line 42, at end insert ‘bearing in mind that it should be balanced with ensuring the protection of health service integration.’.

Amendment 1228, page 85, line 2, at end insert—

‘(3A) “Integration”, in relation to health services, means the provision or commissioning of health services in a manner to ensure the viability of the full range of health and social care facilities which a community might reasonably expect from the NHS, including the provision of complex and commercially less attractive and difficult to provide emergency and other acute services which require to be provided on a site or in a manner which benefits from its collaboration with other acute health specialities or services.’.

Government amendment 87.

Amendment 1205, in clause 61, page 86, line 14, at end insert—

‘(n) the need to avoid existing NHS services, including but not restricted to, emergency care, intensive care, chronic and complex care, teaching, training and research, becoming unviable or unstable due to an unplanned reduction in income or case-load.’.

Government amendment 90.

Amendment 1208, in clause 70, page 92, line 7, after ‘in’, insert ‘competitive or, as the case may be,’.

Amendment 1209, page 92, line 8, at end insert—

‘(d) protect and promote the integration of health services and health and social care services,

(e) improve the equality of access to NHS services and healthcare outcome,

(f) do not undermine the stability of existing NHS services, including but not restricted to, emergency care, intensive care, chronic and complex care, teaching, training and research.’.

Amendment 1229, page 92, line 8, at end insert—

‘(d) do not act in a manner which risks undermining the viability of maintaining essential or designated core health services or the essential integration between health services.’.

Amendment 1219, in clause 74, page 94, line 22, leave out subsections (1) to (3) and insert—

‘(1) Part 3 of the Enterprise Act 2002 (mergers) applies (in so far as it would not otherwise) where two or more enterprises have ceased to be distinct enterprises and specifically the activities of one or more NHS foundation trusts and the activities of one or more businesses have ceased to be distinct activities.’.

Amendment 1220, page 94, line 29, leave out ‘subsections (2) and (3)’ and insert ‘subsection (1)’.

Government amendments 91 to 107.

Amendment 28, page 117, line 22, leave out clause 110.

Government amendments 113 to 115.

Amendment 44, in clause 119, page 123, line 30, at end insert—

‘(10A) A description for the purposes of subsection (9)(b) may be framed by reference to—

(a) the level of workforce training undertaken by the provider, and

(b) the extent to which the provision of its service leads to consequential costs for other providers.’.

Government amendments 116 to 136.

Amendment 29, in clause 130, page 132, line 34, at end insert—

‘(5AA) Regulations under this section must ensure that where transfers of property or liabilities occur, they can only be transferred to another NHS body.’.

Government amendments 137 to 164.

Amendment 30, in clause 134, page 136, line 26, leave out ‘licence holder’ and insert ‘NHS body’.

Government amendments 165 to 180.

Amendment 19, page 156, line 38, leave out clause 166.

Government amendments 181 to 184.

Amendment 1166, page 159, line 2, leave out clause 167.

Government amendments 185 to 187.

Amendment 20, page 163, line 14, leave out clause 176.

Government amendments 188 to 217.

Amendment 8, page 168, line 6, leave out clause 182.

Government amendment 218.

Amendment 9, page 168, line 39, leave out clause 183.

Government amendments 219, 220 and 366 to 372.

[Mr Lansley]

Our plans for modernising the NHS are focused not only on improving the quality of care of patients today, but on ensuring that the NHS is fit to face the challenges of tomorrow—to ensure that the NHS is always there, always improving and always based on the needs of patients, not their ability to pay. Parts 3 and 4 of the Bill are an integral part of achieving that aim. They take forward our commitment to protecting patients’ interests, by establishing a comprehensive system of regulation in part 3, and to promoting high quality services, by supporting all NHS trusts to become foundation trusts in part 4.

The regulatory framework that we inherited from the previous Government simply did not do enough to protect patients. It lacked a way to protect patients’ interests in relation to all types of provider. The previous Government set up two regulators—Monitor for foundation trusts and the Care Quality Commission—but forgot, or neglected, to create an explicit link between the two. They also left independent providers outside much of that regulatory oversight. We have proposed the development of Monitor as a health sector-specific regulator, establishing equivalent safeguards to protect patients’ interests in relation to all types of provider.

By contrast, let us look at Labour’s proposed amendment—amendment 10, in this group—which would delete all of part 3. That would leave the NHS in a position in which inconsistent regulation as between NHS trusts and foundation trusts undermined accountability and performance, in which independent providers were not regulated effectively, in which the Labour Government’s preferential treatment of independent sector providers could carry on, and in which politicians would continue to second-guess regulatory decisions, creating a double jeopardy for providers. On the Government side of the House, however, we recognise the needs of the NHS. We recognise the fact that patients’ interests must be protected, irrespective of the type of organisation providing their NHS services, in a clear, consistent, transparent framework.

These parts of the Bill have been scrutinised in the Bill’s two Committee stages and by the NHS Future Forum. I should like once again to thank Professor Steve Field and the members of the NHS Future Forum for their work in making recommendations on how to improve our plans. We then took those recommendations forward in the recommittal stage. As a result of the listening exercise, we made changes to introduce stronger safeguards, to ensure that fears of a market free-for-all could not happen. Monitor’s core duty has been changed to make it clear that it is there to protect and promote patients’ interests, and that it will not be required to promote competition as if that were an end in itself.

[Chris Leslie (Nottingham East) (Lab/Co-op)]

Do not the right hon. Gentleman’s changes to the Bill still emphasise far too much the supposed read-across with competition law, treating health provision as though it were simply another utility? With regard to mergers and changes, for example, the Office of Fair Trading will be the arbiter on competition duties. Why has he chosen the OFT as arbiter in such cases?

[Mr Lansley]

I am not sure that the hon. Gentleman has followed this closely enough. We do not do any of those things. We are very clear that, through the Bill, we are creating, in Monitor, a health sector-specific regulator that will be able to exercise competition powers in a way that is entirely sensitive to the duties that it has for sustaining high-quality NHS services. As I will explain later, there will be a role for the OFT. Indeed, it has a role now. Labour Members should know that the application of competition law inside the NHS at the moment is exactly the same as it will be after the Bill. However, instead of it being done through the OFT as principal competition authority, it will—with the exception of mergers, which I will talk about later—be done through the concurrent powers of Monitor. The NHS Future Forum helpfully discussed these matters at length with people throughout the country, and concluded that it would be in the interests of the NHS for the legislation to create concurrent competition jurisdiction for Monitor, thereby ensuring that the application of competition rules—which is not changed in its extent by this legislation—is achieved in a health-specific context.

[Nick Smith (Blaenau Gwent) (Lab)]

Why will Monitor have no duty to promote collaboration, as recommended by the Future Forum?

[Mr Lansley]

I am sure that the hon. Gentleman will want to look at clause 20, which is very clear about Monitor’s responsibilities. I am sorry—it is not clause 20; I will find it later. Monitor’s duties are very clear, and they include support for the integration of services and for the continuous improvement of quality of services. Across the NHS there is existing legislation making it clear that there is a responsibility for collaboration. As we have made clear in response to the NHS Future Forum’s report on the listening exercise, we are taking an evolutionary approach. The competition and co-operation panel was established under the Labour Government in January 2009. At that time, the panel made it absolutely clear that there should be a health basis for the implementation of competition and procurement rules in the NHS. That panel is now to be incorporated as part of Monitor. As its name implies, it examines both competition and collaboration. Monitor, like other bodies, has a duty to promote the integration of services.

Now, as I said, we have introduced safeguards against privatisation. This Bill, for the first time, stops the Secretary of State—and, indeed, Monitor or the NHS commissioning board—from trying deliberately to increase the market share of a particular type of provider. If the previous Labour Government had put such a requirement in law when they were office, hundreds of millions of pounds would not have been paid to independent sector treatment centres to carry out operations that were not required and never took place. If the Opposition had their way this afternoon, the safeguards that we intend to put in place would not be available.

16:30

In its response to the opportunity provided by Report stage, the Labour party is being not progressive but reactionary, while the trade unions are being misleading in the presentation of their campaign. To be specific, the trade unions and other proxy organisations such as 38 Degrees have gone to some trouble to misrepresent the Bill in order to attack it.

[Toby Perkins (Chesterfield) (Lab)]

I am grateful to the Secretary of State for giving way. Does he think that the British Medical Association, too, is misrepresenting the position when it says that even after Report stage there will still be too much emphasis on using market forces to shape health services? Is the BMA misrepresenting the truth as well, or is it just the Labour party?

[Mr Lansley]

I was interested to read this morning a letter whose lead signatory was Hamish Meldrum, the chairman of the BMA council, whom I know well. It was curious because his objection to the Bill, which he wants to be amended, was about the introduction and extension of the role of “any qualified provider”. However, that extension is not in the Bill. It is not occasioned by the Bill; it is a consequence of the way in which commissioners—[Interruption.] No, it does not. If there were no Bill, it would be open to strategic health authorities and primary care trusts to extend “any qualified provider” and patient choice in the NHS to whatever extent they wished. The Bill does not make that happen.

The point is that under the legislation there is a stronger safeguarding process, because the commissioners—

[Toby Perkins]

rose—

[Mr Lansley]

I will finish answering the hon. Gentleman before letting him intervene again.

The safeguard structure will be stronger, because commissioners must ensure, for example, that they meet their duty of continuous improvement of quality, their duty of safety and their duty of integration of services and other duties, including a duty to promote patient choice—but of course they have to balance those duties. Whether they extend “any qualified provider” is a matter of judgment. If they took the view that the extension of patient choice would be inimical to the integration of services and the improvement of quality, they would not go ahead with it. The hon. Gentleman and his colleagues should recall that they have put in an NHS constitutional right for patients to exercise choice, so if the commissioners think it is possible to promote choice and improve quality by extending the any qualified provider remit, they can do it, but the Bill is not what enables it. It is therefore curious that the Bill should be attacked on that basis.

[Toby Perkins]

I am grateful to the right hon. Gentleman for giving way a second time. That was a very long answer to a short question, but I understand the Secretary of State to be saying that the BMA is wrong and the Labour party is wrong. Everyone I meet in the health service tells me that it is the Secretary of State who has got it wrong. He has come back here once again, confirming that he is not listening to what people are saying to him. He thinks the BMA is misleading people, but is it possible that he is the one who has got it wrong?

[Mr Lansley]

I will give the hon. Gentleman a shorter answer this time: he does not talk to enough people in the NHS.

Let me return to the important point that I was about to make. I was saying that criticism of the Bill has typically developed to the point of literally misrepresenting the facts in order to attack the Bill, as was the case with 38 Degrees. I am indebted to my hon. and learned Friend the Member for Sleaford and North Hykeham (Stephen Phillips) for sharing with me a letter that he prepared for the better information of his constituents. He looked at the legal opinion obtained by 38 Degrees and concluded that it did not support the views that those behind the 38 Degrees website evidently wished it did.

For example, 38 Degrees claims that the Bill removes the Secretary of State’s duty to provide a comprehensive health service. However, its own legal advice makes it clear that the Secretary of State has never had a duty to provide a comprehensive health service—only a duty to “promote” a comprehensive health service, which is exactly reproduced in clause 1.

Clause 1 also makes it clear that the Secretary of State must secure the provision of that service. The “duty to provide” certain services to which 38 Degrees refers is a duty that I, as Secretary of State, currently delegate to primary care trusts. In future, the Bill will—in exactly the same way—pass that duty of the Secretary of State to the NHS commissioning board and to clinical commissioning groups. In other words, the situation will be legally unchanged. The Secretary of State has a duty, and discharges it through organisations to which he or she delegates that power. Strictly speaking, they have more direct statutory duties, but the duty to provide will not change.

38 Degrees also claims that the Bill opens up the NHS to competition law, but its own legal advice—which it obviously did not like—made it clear that there would be no change between the present competition regime and that which would operate if and when the Bill became law.

I am very grateful to my hon. and learned Friend, whose forensic analysis accords with our own view. The provision, under the Bill, of a comprehensive NHS is watertight, and it is equally clear that the Bill does not change the extent of the application of competition law and EU procurement rules. The 38 Degrees campaign should be seen for the distorting and misleading political propaganda that it is.

[Andrew George (St Ives) (LD)]

I entirely endorse the Secretary of State’s point about the biased way in which the last Government advanced the private sector, but may I make a point about the changes that have resulted from the listening exercise? The Secretary of State has sought to reassure the House about Monitor’s role of integration and promoting collaboration. Would he be prepared to respond to, and perhaps even accept, amendments that I have tabled—for example, amendment 1226—which propose, I think reasonably and in a balanced way, that promoting the importance and the role of integration should be among the principal duties?

[Mr Lansley]

As we said in our response to the recommendations of the NHS Future Forum, we recognise the importance of integrating health and social care services—while concentrating on the needs of patients and their families—to the achievement of our aims. However, I do not believe that we would further those aims by changing Monitor’s name, as amendment 1225 suggests. Although I agree with the aims of my hon. Friend the Member for St Ives (Andrew George), we have an alternative approach.

Rather than making it explicit that the Secretary of State could impose requirements on commissioners in key areas through regulations, as my hon. Friend suggests in amendment 1209, the Bill proposes that commissioners should have clear statutory duties to reduce inequalities between patients, in relation to both access and outcomes. That is covered in clauses 20 and 23. Commissioners would also have to promote integration of services in carrying out those duties. That is covered in clause 20, which inserts new section 13M of the National Health Service Act 2006, and in clause 23, which inserts new section 14Y. Those clauses refer respectively to the NHS commissioning board and to clinical commissioning groups.

The Bill would also establish clear duties for Monitor to allow the integration of health care services and the integration of health care with other relevant services, including social care. We have already amended the Bill to make it clear that Monitor should not promote competition for competition’s sake: this is all about quality. However, integration can only ever be a means to that end, not an end in itself. Integration, like competition, is designed to secure continuous improvement in the quality of services and a reduction in inequalities, as clauses 20 and 23 make clear.

Although I understand the point that my hon. Friend is making, I ask him to not to press amendments 1225 to 1228 when we reach the appropriate moment.

[Frank Dobson (Holborn and St Pancras) (Lab)]

The Secretary of State has pleaded the legal view of one of his Back Benchers in rebutting the case made by others about the impact of the changes in his duties. Will he tell us what advice he received from the Department’s lawyers or the Law Officers of the Crown?

[Mr Lansley]

It is not the practice of Ministers to publish their internal legal advice, but what I will say to the right hon. Gentleman is very straightforward, because I have said it time and again: our legal advice clearly sets out the duty of the Secretary of State to promote a comprehensive health service and to secure the provision of a comprehensive health service, and that is also clearly set out in the Bill and our amendments to it. We are clear, too, that the Bill does not change the extent of the application of competition law and EU public procurement rules. I have taken the liberty of referring to the comments of my hon. and learned Friend the Member for Sleaford and North Hykeham on the basis that they entirely agree with the legal advice on which we have based our view.

[Several hon. Members]

rose—

[Mr Lansley]

I had better give way to the hon. Member for Pontypridd (Owen Smith) first, as no Opposition Front-Bench has previously intervened.

[Owen Smith (Pontypridd) (Lab)]

Is it not disingenuous of the Secretary of State to keep repeating that the application of competition law is not expanded or changed by the Bill? We know that the change in the architecture of the NHS—the use of competition law, the writing of competition law into the architecture of the NHS, and the entry of lots of other providers into a genuine marketplace—will lead to competition law increasingly being used by people who wish to provide NHS services, breaking up the NHS. Labour Members have repeatedly stated that, and it has been confirmed by independent legal advice. That is our point. It is straightforwardly the case, and I suggest that it is disingenuous to say competition law does not apply.

[Mr Lansley]

I did not say that competition law does not apply; if the hon. Gentleman is going to attack me, he might at least get what I said right. I said that the Bill does not change the extent of the application of competition law. The House should know that the debate about the extent to which competition law, and in particular EU competition law, is applicable within the NHS is a matter of debate among lawyers. That is because it has not been tested in courts, but it was always going to be tested in courts and it is much more likely to be tested in them if we do not pass this measure, which not only gives Monitor a responsibility to be the concurrent competition jurisdiction, but, through its licensing powers, allows it to take ex-ante steps. The hon. Gentleman therefore misses the point; the point is that by introducing the private sector into the NHS before the last election, his party’s Government inevitably extended the application of EU competition law in respect of NHS providers—not NHS commissioners, I might add. To that extent, he has therefore missed the point. EU procurement rules have applied, and continue to apply. We cannot change that.

[Several hon. Members]

rose—

[Mr Lansley]

I will not give way again, or Mr Deputy Speaker will chide me for not addressing the substance of the amendments.

During the listening exercise, we heard concerns about how we would secure continued access to NHS services in the event that a provider fails clinically or financially. We promised then to strengthen our proposals and bring back changes at the next possible parliamentary stage, and we have done that.

What should happen in the NHS when things go wrong has long been the subject of debate in this House, often without satisfactory resolution. Those of us who were in the House when my predecessor stood at this Dispatch Box and said that what happened at Maidstone and Tunbridge Wells was the responsibility of local managers, and that what happened at Mid Staffs was all a local issue, will recall how difficult it was then, and over the recent past, to know what the Secretary of State’s accountability for the NHS actually meant.

In 2003 the Labour Government said that they would put in place a legislative framework for dealing with the failures of foundation trusts. They then failed to do that. The Health Act 2009 regime was contradictory in respect of interventions, but in response to failure it simply enabled foundation trusts to be de-authorised, thereby undermining the integrity of foundation trust status and demonstrating a lack of confidence in foundation trust regulation. Evidence does not support that lack of confidence, however. Monitor has generally handled financial stability more effectively in foundation trusts than strategic health authorities have done in NHS trusts. Putting these measures clearly into legislation is necessary not because providers are more likely to fail—on the contrary, we are putting in place measures that make it less likely that they will fail—but because, as when writing a contract, in writing legislation one must be clear about what happens when things go wrong.

16:44

Our plans are comprehensive and detailed, and there are a considerable number of amendments. So that the House can see and understand the detail, I published last week a document setting out the Government’s approach, as well as detailed briefing notes explaining the effect of each of the amendments. We have revised our plans for ensuring continuity of services with three principles in mind. The first is to protect patients’ interests and improve outcomes; patients must be able to get the high-quality services they need. The second is to maintain local decision making and enhance democratic legitimacy; local authorities would have scrutiny of proposed service changes. The third is to deliver value for money. I am confident these revised proposals will deliver on those principles.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

Did not the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) say in Committee that under the relevant clause,

“the OFT could make a reference to the Competition Commission to review foundation trust mergers to test whether they gave rise to a substantial lessening of competition”––[Official Report, Health and Social Care Public Bill Committee, 17 March 2011; c.885.]?

Does that not undermine the democratic element that the Secretary of State has just tried to explain?

[Mr Lansley]

I said that I would come on to the continuing role of the OFT in relation to mergers, and I will.

Returning to this substantial group of Government new clauses and amendments, the purpose of which is to set out the regime for the continuity of services, our new proposals focus on five particular changes. Together, the proposed changes significantly improve upon the existing situation. First, the Bill puts clinically led commissioning at the heart of securing high-quality services for local populations. It is therefore right that commissioners should have a leading role when continuing access to services is threatened. Our amendments therefore strengthen the role of commissioners. For the first time, commissioners will have an explicit role in working with Monitor to agree plans to secure continuity of services.

There will also be an oversight role for the NHS commissioning board. Where issues involve more than one clinical commissioning group, it will be the board’s role to co-ordinate agreement so that a joint plan is agreed. Secondly, commissioners will need to be supported in acting with providers to ensure that they have access to the scope, quality and choice of services they need. It is about promoting high-quality, effective and integrated services, as set out in clause 58. This will be the task of Monitor.

If need be, when continued access to services is threatened because of failure occurring in a particular provider, Monitor will have a range of actions it can take. For example, it could take action to secure sustainability of essential services by adjusting prices. This would be necessary where a provider is otherwise unable to cover the costs of essential services—for example, because of lower patient volumes in more remote areas of the country. That was included in the Bill from the outset, and our amendments strengthen the provisions by ensuring that Monitor must agree the methodology with the NHS commissioning board.

[Rosie Cooper (West Lancashire) (Lab)]

Will the Secretary of State be clear on this issue? Can the enhanced tariff that I think he is suggesting Monitor can use to save a provider apply to private companies as well as the NHS?

[Mr Lansley]

It would apply in any circumstances where it was necessary in order to secure continued access to essential services for patients, so a methodology would be in place. As I have described, the intention is to have a regime through which, although specific mechanisms will be applied to foundation trusts and to other providers—of course, the overwhelming majority of activity is in the hands of foundation trusts—the principles of intervention will be the same between the two sets of providers. We want to arrive, wherever possible, at a consistent application of failure rules. Why? Our concern is to make sure that we deal with this, which has not been the case in the past. Under Labour’s regime, if a private sector or independent sector provider failed financially, there was no appropriate mechanism for intervention and continuity of services.

[Mark Simmonds (Boston and Skegness) (Con)]

Will my right hon. Friend confirm that the additional funding he is describing will not be used to bail out, in the traditional way, inefficient and ineffective health providers, but will be used to ensure that services continue to be provided, particularly in rural areas, where the cost base may, necessarily, be more than it is in the metropolitan cities?

[Mr Lansley]

Yes, I understand that and I think that my hon. Friend makes entirely the right point. This is not about a bail-out; the commissioning board and Monitor will need to agree the methodology, because neither side will wish to undermine the integrity of the regulatory structure and the price structure that Monitor is responsible for, nor will the NHS commissioning board and commissioners want to pay any more for services than is necessary to secure continued access. None the less, continuing access to quality services for patients is the essential principle, and so there will be circumstances, particularly where it has become evident that in the absence of this there would be an unacceptable deterioration in or failure of services, in which it is necessary for the methodology to add to the tariff price.

[Fiona Mactaggart (Slough) (Lab)]

The right hon. Gentleman will recall that very shortly after Monitor had approved the granting of foundation trust status to my local district general hospital, Wexham Park hospital, it ended up in very serious financial difficulty, and I was grateful to him when he arrived with a loan to ensure the continuation of service. What I am not clear about in the regime that he proposes is who will be able to provide those kinds of resources when something as important as the district general hospital’s future is at risk.

[Mr Lansley]

I am grateful to the hon. Lady for that. I will deal with that matter in a moment, because subsequent amendments in this group continue the capacity of the Department of Health, for example, to make a loan in those circumstances—that would not change.

Of the five principal changes that I was talking about—

[Grahame M. Morris (Easington) (Lab)]

rose—

[Mr Lansley]

I have reached the third of them, so I will carry on for a moment, if I may.

Thirdly, if a provider gets into significant difficulties, we have provided Monitor with powers to be able to try to turn around the provider. The aim would always be to support the recovery of the provider, wherever this was possible. Specifically, the amendments require Monitor to maintain an ongoing assessment of risk to the continued supply of NHS services. Monitor must then intervene proactively to help a provider to address problems and, where necessary, agree contingency plans with commissioners. New clause 2 and amendments 100 to 104 achieve this.

Fourthly, we have put in place provisions to deal with the rare event of a provider no longer being sustainable in its current form. In that instance, the priority must be to secure continued access to the services patients need. This protection is particularly important in relation to foundation trusts, which of course are the principal providers of acute, emergency and specialist hospital services.

So we have put forward amendments that would build and improve on the previous Government’s regime established under the Health Act 2009. The improvements would ensure that foundation trusts do not revert to being NHS trusts and that commissioners take the lead in securing continued access to NHS services, and they would increase democratic legitimacy by allowing the Secretary of State to intervene in individual cases to protect patients’ interests. At the same time, we are retaining Bill provisions to allow Monitor proactively to regulate to secure continued access of NHS services delivered by companies and social enterprises, through provisions on the health special administration regime, should these providers become unsustainable. New clause 6 and amendments 107, 188 to 193, 195 to 204, 217, 218 and 371 to 372 achieve this.

Fifthly, it is essential that political accountability runs through what hon. Members will all know is central to our responsibilities to our constituents. Our plans therefore strengthen political accountability at both the local and national level. At a local level, the amendments enhance democratic legitimacy by extending local authority scrutiny to all NHS services. That is in contrast to previous proposals, where only designated services would have been subject to such scrutiny. At a national level, we will establish a process for the Secretary of State to veto proposals, in individual cases relating to unsustainable foundation trusts, if he decides that they do not secure continued access to NHS services and, as a last resort, to intervene where he believes that the NHS commissioning board or Monitor has failed to discharge its functions. This veto will ensure that the Secretary of State retains all the powers needed to retain his role—

[Grahame M. Morris]

Will the Secretary of State give way?

[Mr Lansley]

In a moment. I want to complete the five points; otherwise people might not see them in their entirety.

The veto will ensure that the Secretary of State retains the powers needed to fulfil his role in promoting a comprehensive health service. Amendments 205 to 207 and 208 to 216 achieve this.

[Grahame M. Morris]

Will the right hon. Gentleman clarify an issue to do with the Secretary of State’s powers to intervene in the event of failure? I am thinking in particular of the reports about freedom of information requests that appeared in The Guardian earlier in the week, which said that Department of Health officials had been in discussions with Helios about a potential transfer of between 10 and 20 NHS hospitals to the private sector. Is that a scenario in which the Secretary of State would use his powers?

[Mr Lansley]

I do not recognise such a scenario and in any case there will be no transfer of NHS-owned organisations and the estate and property of such to the private sector. We are not engaging in privatisation, so to that extent the question does not arise.

I must also make it clear that the implication of the proposals I have just described—

[Clive Efford (Eltham) (Lab)]

Will the Secretary of State give way?

[Mr Lansley]

No.

The implication of these proposals is that we are not continuing with our previous proposals to have a system of prior designation. We are also withdrawing our proposals to apply insolvency law, including the health special administration procedure, to foundation trusts, so I hope that Opposition Members will not press amendments 29 and 30.

I hope that that explanation of the purpose of the substantive group of Government amendments will help the House. In a moment, I shall turn to some of the additional amendments that have been presented by other colleagues.

[Owen Smith]

Let me clarify a remark that the Secretary of State just made to my hon. Friend the Member for Easington (Grahame M. Morris). The Secretary of State said that there would be no instances where NHS properties might be transferred to private companies, but he will know that under schedule 23 there is provision for precisely that. Such companies are described there as a “qualifying company”. A licence holder could be a private company to which NHS material—even staff—and other liabilities might be transferred. Is that not right?

[Mr Lansley]

The point I am making is that we are not transferring foundation trusts or NHS trusts into the private sector. We are not planning to do that. The particular case to which the hon. Member for Easington (Grahame M. Morris) referred was misrepresented as a proposal to transfer the ownership of NHS organisations. There is no such proposal; we are not planning to do that.

As I have described, the Bill would establish a comprehensive system of regulation focused on protecting and promoting patients’ interests and applicable to all providers of NHS services. The purpose of part 3 is to protect our health services from the unrestrained operation of market forces—otherwise, why would we want this structure of regulation? That is why it is there. The provisions will ensure that services are not destabilised or undermined and will protect the public and patients’ interests.

Let us consider the implications of the Labour party’s amendment 10, which would remove part 3 of the Bill. The impact of removing part 3 would be to expose the NHS to the full force of competition law, as I described earlier, without the safeguard of a health sector regulator and without any sensitivity to the needs of patients, health services and our NHS. It should not be beyond the wit of Opposition Members to recall the impact on the health service and, in particular, on pharmacy services, when the Office of Fair Trading undertook an inquiry into the provision of pharmacy services from a competition perspective without any reference to the health perspective.

[Grahame M. Morris]

Will the Secretary of State give way?

[Mr Lansley]

No.

That is what happened in the past and it is important that it does not happen in the future. We must have a health sector-specific regulator to see the health-related aspects of such matters.

Labour’s amendment 10 would potentially expose the NHS to practices that we do not wish to see. That would include paying over the odds for private sector services, as the previous Government did when they paid £250 million extra to the independent sector for operations that were never carried out; the cherry-picking of easier operations by the private sector, which is an issue in the NHS because the previous Labour Government let it happen; unreformed payment by results, losing the focus on outcomes and integration; and the retention of a system of payment based on price. We are not introducing payment by results; we are reforming it. Payment by results, as implemented by the Labour party, was simply payment for price and volume, not for quality.

Amendment 10 would leave independent sector providers of NHS-funded services, which serve hundreds of thousands of patients a year, unregulated by Monitor and unprotected if the service in which they are being treated gets into financial difficulty. So Opposition Members will wish to consider whether all of those things are what they want to be voting for when they walk through the Lobby later on.

17:00

[Margot James (Stourbridge) (Con)]

Does my right hon. Friend think that the previous Government set up the system for private companies so that they could fail without any redress on the part of the Government precisely because the companies had such a favourable financial regime bestowed on them that they could not possibly fail?

[Mr Lansley]

My hon. Friend is right in relation to the independent treatment centre contracts. They were constructed in a way that effectively removed most of the financial risk from the operators. For other private sector operators in the NHS that is not necessarily true. For example, most of us would recognise that private sector providers are instrumental to continued access to many NHS diagnostic services. There are providers who could fail and at the moment no regulatory structure is in place for that.

Let us continue down the path of the implications of the removal of part 3, which the Labour party proposes. Part 3 includes clause 60. I am sure that Opposition Members are familiar with clause 60, their having served in Committee for so long. It is the means by which, if the hon. Member for Islington South and Finsbury (Emily Thornberry) recalls, we can consider the application of Monitor’s functions to adult social care. So precisely when we are legislating to be able to consider whether the implications of an issue such as that at Southern Cross are such that there should be an additional prudential regulatory regime, the Labour party would take away that opportunity.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Does the Secretary of State agree that it is unfortunate that the Government have not had an opportunity to table detailed amendments on how they would deal with situations such as Southern Cross? To table an amendment that simply says, “At some stage in the future, the Government may be able to do something about a failing organisation such as Southern Cross”, is not necessarily adequate. Although there will be a White Paper on social care next spring, we understand that there are unlikely to be any further details until that point.

[Mr Lansley]

I am confused. I understood that the hon. Lady was a member of the Bill Committees. [Hon. Members: “She was.”] She does not seem to have learned what is going on in the Bill. Clause 60 was not an amendment; it was in the Bill from the outset. It was not introduced as a result of what happened at Southern Cross. We had anticipated the need to address the extent to which Monitor’s functions in relation to the health sector—

[Emily Thornberry]

Will the Secretary of State give way?

[Mr Lansley]

No. I will answer her question. The functions that it exercises in relation to health care include assessing viability and taking action if access to services or the interests of patients or care users are threatened. The Government can consider that by virtue of clause 60. It was not an amendment. So the idea that the measure could not be scrutinised is absurd. It has been in the Bill through all the 100 hours in Committee. If the hon. Lady never said anything about it, that is her own fault and as the shadow care services Minister she should have been more on the ball.

[Emily Thornberry]

Will the Secretary of State give way?

[Mr Lansley]

No. She can sit down.

Let me come to the other Opposition amendments. Amendment 10 would delete all of part 3, which would be absurd. Some of the other Opposition amendments are equally absurd. Amendment 28 envisages that part 3 would remain in place, but that Monitor would license providers of NHS services. However, it then takes away any means of enforcement. Perhaps the Labour party has forgotten that in government if you create obligations it is rather helpful to create a means by which they can be enforced.

Opposition amendment 44 would take the Bill down a slippery slope by trying to prescribe the range of factors that Monitor should reflect in setting prices for NHS services. Such a list could never be exhaustive and would inevitably suggest that some factors were more important than others. It would undermine our ability to hold Monitor to account for setting prices that promote patients’ interests. We must focus Monitor on its duties to promote the quality, efficiency and effectiveness of NHS services, not on trying to prescribe in legislation how it goes about it.

Labour Members have tabled amendments to part 4 that indicate that they either do not understand the Bill, or have abandoned their previous, repeated commitment to supporting all NHS trusts in becoming foundation trusts. They gave that commitment back in 2003, when they passed the necessary legislation, and repeated it in about 2006, when they said that trusts should all be foundation trusts by 2008. The Labour party manifesto from last year—2010—said:

“All hospitals will become Foundation Trusts, with successful FTs given the support and incentives to take over those that are under performing”.

Compare our programme for such hospitals as those in Trafford and Carlisle. The manifesto continued:

“Failing hospitals will have their management replaced. Foundation Trusts will be given the freedom”—

additional freedoms—

“to expand their provision into primary and community care, and to increase their private services”.

We will debate that later today, but I should complete the quote, or I might be accused of being selective:

“where these are consistent with NHS values, and provided they generate surpluses that are invested directly into the NHS.”

That is exactly what we are proposing.

The Labour party appears utterly confused. Does it support foundation trusts or not? The NHS Future Forum said that all NHS trusts should continue to work towards achieving FT status by 2014. It was right: achieving FT status is about demonstrating clinical and financial stability, and we think that all NHS providers should be expected to do that, in the interests of NHS patients and staff. If we maintained the NHS trust legislative model in statute, we would risk losing the change in mindset and the momentum that is being demonstrated by prospective foundation trusts.

Our consequential amendments 219, 220 and 367 to 370 will simply remove references to NHS trusts when they no longer exist—and not, of course, until then. For the hon. Member for Pontypridd, I add that our amendments 185 to 188 make it clear that—sadly for those in Wales—a foundation trust cannot merge with or acquire a Welsh NHS trust.

The Opposition want to take the retrograde step of de-authorising foundation trusts, retaining NHS trusts under the Secretary of State’s direct control, and having them dependent on the layers of bureaucracy that go with that. There would be all the regulatory requirements for foundation trusts and independent providers, and all the bureaucracy that has accompanied NHS trusts and strategic health authorities. That would undermine the FT regulatory regime and the objective of all NHS trusts becoming FTs. Opposition Members who voted in favour of the original legislation establishing foundation trusts in 2003 can have no credibility in supporting Labour now, because the very purpose of that legislation was to give hospitals greater autonomy.

Other Opposition amendments would simply result in duplication and reduced coherence in the Bill. For example, amendments 1166 and 19 seek to retain controls on goods and services, and borrowing and property, but that would duplicate Monitor’s powers through the licensing regime. Deleting clause 166, as the Opposition propose would undermine our intention of increasing transparency in the public financing of foundation trusts. I am looking for the hon. Member for Slough (Fiona Mactaggart); this would have been her moment. Through our amendments, we can show how we can maintain support for FTs, if necessary, in a transparent fashion, including through a requirement, which the Labour party apparently wants to delete, on the Secretary of State to publish an annual report showing what form of financial support has been given to foundation trusts.

I turn to the amendments tabled by my Liberal Democrat friends below the Gangway, who expressed their intention of improving NHS services and ensuring sustainable access for patients. We all share those aims, but I believe that we have in place alternative approaches to meeting those aims. The hon. Member for St Ives tabled a series of amendments emphasising the need to secure sustainability in the provision of NHS services. Securing sustainable access to meet patients’ needs is fundamental to good commissioning. We would expect the board to ensure that there was sufficient competency over issues when it authorised clinical commissioning groups to take on their new responsibilities, and when holding them to account for doing that job.

As the Government have said many times, our focus is on outcomes, including ensuring that patients have access to the services that they need when they need them. That the outcomes must be sustainable is obviously implied, but that is not necessarily the same as saying that commissioners must ensure the sustainability of particular providers or particular services, as amendments 1205 and 1209 suggest when referring to the sustainability of “existing NHS services”. In some cases it will not be in the interests of patients to maintain the status quo—for example, where those services may be unable to improve in line with new standards of clinical best practice, or where there is clear evidence that centralising specialist services on fewer sites would improve health outcomes, as we have seen in examples relating to cardiac, stroke and trauma services. So although I agree with the intention behind these amendments regarding the role of commissioners, I must urge the hon. Member for St Ives not to press them.

I addressed earlier the hon. Gentleman’s amendments about integration and collaboration. On integration, we agree with the conclusion of the NHS Future Forum that integrating services around the needs of patients and giving patients greater choice over who provides those services are not mutually exclusive. As the NHS Future Forum made clear, this is a false dichotomy. As the NHS Future Forum’s report stated:

“If commissioners want to commission integrated care they will only succeed in doing this by creating a new market in integrated care services and stopping the current commissioning of episodic services from different NHS organisations.”

As the hon. Member for St Ives will recognise, his amendments 1207 and 1208 are based upon that dichotomy, so I ask him to withdraw them.

[Andrew George]

Will the Secretary of State give way?

[Mr Lansley]

No. I do not want to intrude on the time of other Members.

Amendments 1219 and 1220 tabled by my hon. Friend the Member for Southport (John Pugh) would apply the Enterprise Act 2002 to mergers of the activities of foundation trusts with businesses, but would exclude from these arrangements mergers between foundation trusts. I have given careful thought to this proposal, but I am not convinced that it would address two of the problems of the existing regime.

There is currently legal uncertainty as to when and where the 2002 Act would apply to mergers of foundation trusts. As a result, under the current arrangements for the review of mergers involving foundation trusts by the Co-operation and Competition Panel, there is always a potential risk of duplication—or worse still, double jeopardy. The risk arising from a separate regime for foundation trusts would be increased where a trust’s activities extended beyond Monitor’s remit—for example, where a foundation trust provided social care or supplied goods. Consolidating oversight of foundation trust mergers under the Enterprise Act, as proposed by the Bill, would avoid the risk of double jeopardy and eliminate the uncertainty of the current approach.

Mergers are a specialist area. Hence, we think it is right to maintain existing responsibilities and expertise within the Office of Fair Trading and the Competition Commission, rather than resource a further body to consider potential mergers in health care. It may reassure my hon. Friend if I say that the OFT and the Competition Commission would consult Monitor to ensure that they had a full understanding of the health care issues involved.

[Tom Blenkinsop]

Will the Secretary of State give way?

[Mr Lansley]

No.

The OFT and the Competition Commission would obtain Monitor’s view on how a proposed merger would affect competition in the sector and whether it would bring benefits for patients. These views would then be considered, along with other evidence. However, the OFT would have discretion not to refer, where patient benefits outweighed any adverse impacts on competition—further illustration of the fact that competition law is not about promoting competition as an end in itself.

In conclusion—

[Fiona O'Donnell (East Lothian) (Lab)]

Will the Secretary of State give way?

[Mr Lansley]

No.

I return to the choice offered in this group of amendments between the Government and Opposition Members. The Government are putting forward a range of amendments to protect patients’ interests and to safeguard them when providers run into difficulties and access to services is threatened. The amendments show that the Government have listened and improved the Bill. These amendments are on top of the changes made at earlier stages to strengthen the safeguards and protections offered by Monitor as a new provider regulator.

The Opposition simply want to delete the whole of that part—delete the safeguards to stop price competition, delete the means to stop cherry-picking, delete the means to enable NHS providers to work on a level playing field. The Government’s new clauses and amendments move us forward with the right safeguards in place. Labour would take us back. I urge the House to support the Government new clauses and amendments in this group—specifically, new clauses 2 and 6 and amendments 90 to 107, 113 to 220, and 366 to 372.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

The Secretary of State has insisted that the amended Health and Social Care Bill shows that the Government are listening, but despite their reassurances there are many reasons why the Bill remains a threat to the future of the NHS. Central to the reforms is the proposal to increase competition across the NHS by opening it up to providers, particularly those from the private sector. The Government claim that increasing competition drives down costs and improves quality, but overwhelming international evidence suggests that this simply is not the case in health care.

17:15

[Chris Skidmore (Kingswood) (Con)]

Is the hon. Lady placing on the record her party’s opposition to any form of competition in the NHS?

[Debbie Abrahams]

As we have shown, we are not opposed to private sector involvement in the UK’s health system. What is important is that it should add value and capacity. The Government’s proposals are a completely different ball game.

[Mark Simmonds]

Will the hon. Lady give way?

[Debbie Abrahams]

No, I will make some progress.

The listening exercise failed to register the concern of many health professionals. Despite what the Government say, many health professionals feel very concerned about the amended Bill. Instead, the Government changed Monitor’s duty from one of promoting competition, as set out in the first version of the Bill, to one of preventing anti-competitive practice. The lawyers will have an absolute field day with that one. The Government talk of reducing bureaucracy, but I think we will see even more bureaucracy as a result of this.

[Fiona O'Donnell]

Does my hon. Friend recall, as I do, that time and again in the recommitted Bill Committee we asked Ministers and Professor Field what the impact of that change would be? We are still waiting for a satisfactory answer.

[Debbie Abrahams]

There are many unanswered questions about the Bill, which makes it particularly dangerous.

By opening up competition under the guise of increasing patient choice and clinician-led commissioning, the Government are trying to increase both demand and supply for these services, but the implication for a single-payer health system with a fixed budget, such as the NHS, is that this will inevitably lead to financial meltdown. The only way this can be avoided is by injecting extra capital into the system and the Bill achieves this in many ways. We need to look at not only this cluster of amendments but all the amendments and clauses in the Bill as a whole, because they are interrelated.

First, the Bill allows foundation trusts to borrow money from the City to invest. This is supported by the opening up of EU competition law. Foundation trusts are currently social enterprises and are exempt from part of EU competition, but this opening up will open the flood gates. It means that the trusts will have to compete for tenders with private health care companies. They will have to repay the money they have borrowed by treating more and more patients, including private patients, which will be aided by the abolition of the cap on income from private patients. However, many foundation trusts will still struggle, so the Bill introduces a new insolvency regime to enable private equity companies to buy NHS facilities and asset-strip them, which has direct parallels with the demise of Southern Cross.

Secondly, waiting lists will go up. We are already seeing that across the country, including in my constituency. We have seen that already because unrealistic efficiency measures mean that cash-strapped primary care trusts are rationing access to treatment such as cataract surgery and hip replacements.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Does the hon. Lady not accept that waiting lists have not gone up in England but have gone up in Wales, where Labour is in control of the NHS?

[Debbie Abrahams]

It is very interesting that the Government have changed how they measure waiting lists and now use an average, so those indicators are a movable feast.

As waiting lists go up, new health insurance products on the market are enticing people to believe that all their treatment and care can be met fully by the private sector. This will be complemented by new insurance markets set up for top-ups and co-payments. We know from the United States that people on low incomes will be less able to afford these products directly, which will impact on the existing health inequalities that the Secretary of State has stressed his commitment to reducing. Why are we doing this? It will increase and exacerbate the inequalities that already exist in accessing care.

Finally, the Bill allows both the national commissioning board and clinical commissioning groups to make charges. I foresee that in the next Parliament there will be more direct patient charges if this Government get in again. As the NHS budget is fixed, the drive for excess capacity will drain that budget rapidly. That will result in clinical commissioning consortia increasingly becoming rationing bodies. As waiting lists increase, they will attempt to manage the issue by reducing the number of core services. That will drive foundation trusts into further debt, forcing closures, mergers and private management takeovers, and we are already seeing that.

[Tom Blenkinsop]

On the point about foundation trust mergers, when was the last time the Office of Fair Trading was in charge of a merger of one foundation trust and another? Was it not in fact the Co-operation and Competition Panel, which, according to the Bill, will sit within Monitor?

[Debbie Abrahams]

I am grateful to my hon. Friend for drawing that to my attention. He is absolutely right.

The Secretary of State’s duty to secure and provide a comprehensive health service is a key issue and needs protecting in full. It should not be changed at all. Why are we changing it if is already acceptable? I am sure that we will revisit the matter tomorrow.

Although the Government have supposedly made concessions, recognising that attempting to privatise the NHS, just as the utilities were privatised in the 1980s would not be acceptable to the public, they have changed tack, not direction. Opening up the NHS to EU competition law may dramatically increase the amount of capital available to bring into our health service, but ultimately that capital will flow back to investors at a profit, at the expense of patients and the UK taxpayer. That will only increase income and health care inequalities even further—another way in which the Secretary of State’s duty will not be met. It is clear that the NHS cannot survive the Bill. The NHS needs appropriate reform and proper accountability, but definitely not an opening up of the market in this way.

[Caroline Lucas (Brighton, Pavilion) (Green)]

Does the hon. Lady acknowledge that when her party introduced foundation trusts back in 2003, many of us warned that it would lead to precisely the kind of privatisation that is now being threatened? Does she now regret that?

[Debbie Abrahams]

Fortunately, I was not a Member of Parliament at that time. As I said earlier, I have no problem with the private sector’s being part of our health system when it adds capacity and value, but the Bill is a whole new ball game.

[Tom Blenkinsop]

There is a fundamental difference between this Bill and any other on the health service. The Government are writing the Enterprise Act 2002 directly into the Bill, which means that it refers to foundation trusts as enterprises and businesses. That extends the ability to merge with business, not just within the NHS framework. That means that the Government have potentially opened up the NHS to European and UK competition law, and they know that full well.

[Debbie Abrahams]

I thank my hon. Friend for that contribution.

[Dan Byles (North Warwickshire) (Con)]

What does the hon. Lady say to Professor Stephen Field, who was the chairman of the independent NHS Future Forum? He told the Bill Committee:

“When we spoke to the Government and…a lot of senior staff at the Department of Health…we did not, at any time, pick up any feeling that anyone wanted a free open market where people could come in and privatise the NHS, as some people have said in the press.”––[Official Report, Health and Social Care (Re-committed) Public Bill Committee, 28 June 2011; c. 15, Q26.]

[Debbie Abrahams]

I would be happy to forward to the hon. Gentleman a British Medical Journal article that reproduced in full the concerns of health care professionals that were not included in that account. Unfortunately, there is an element of bias in how they have been reported.

[Frank Dobson]

Steve Field was a great asset to the Government when he was president of the Royal College of General Practitioners and overwhelmingly welcomed everything that they were proposing. That was probably why he was replaced by a new president who does not do that.

[Debbie Abrahams]

I thank my right hon. Friend.

When I raised these issues in the recent recommitted Bill Committee, the Minister suggested that I was scaremongering and, with the rest of those on the Government side, refused to accept any of our amendments—not a single one. Given what recent revelations are proving, perhaps he would like to withdraw some of his comments and concede that I have not been scaremongering.

I urge Liberal Democrat MPs who have felt compelled to support this Bill and their Front-Bench colleagues but whose conscience tells them that it is wrong to vote against the amendments and the Bill. This is not what they signed up to.

[Mr Stephen Dorrell (Charnwood) (Con)]

I welcome the amendments that the Government have tabled for consideration. I also welcome the very detailed way in which my right hon. Friend the Secretary of State introduced what is, as I am sure he will acknowledge, a substantial group of amendments. He emphasised that their purpose is to give effect to the undertaking that the Government gave when they set up the NHS Future Forum to ensure that the findings of that forum are reflected in the legislation, and that the Bill, when it reaches the statute book, is built on the work of Professor Field and his colleagues.

One purpose of the amendments is to respond to many of the points that have been made, throughout the passage of the Bill, about the role of Monitor. I completely agree with my right hon. Friend that many of those observations about the supposed role of Monitor have been based on a misunderstanding, whether deliberate or otherwise, of the intention behind the Bill when it was first introduced. Whether the misunderstanding was deliberate or accidental, the Government are responding to virtually all those points in order to make it clear that, in the context of the Bill, the central purpose of Monitor is not to be a blind economic regulator based on the assumption that the health service is simply another utility. Various loose words have been used that bear that construction—but never by Ministers, and the implications of those observations have never been accepted by Ministers. As I have understood it—this is why I have supported the Bill throughout its passage—the Government’s intention has always been to ensure that the new NHS envisaged by the Bill gives effect to the basic commitment on which the Government were elected to ensure that the health service secures equitable access to high-quality health care for all patients regardless of their ability to pay.

[Fiona O’Donnell]

The right hon. Gentleman referred to a misunderstanding of the original Bill. The Secretary of State said that that arose because he was a poor communicator. Do so many organisations still oppose the amended Bill because he is still a bad communicator or because it is still a bad Bill?

[Mr Dorrell]

In considering these amendments, it is important to refer to the individual functions of Monitor envisaged in the amended Bill and test them against the assertions that have been made, throughout the passage of the Bill, about what Monitor is there for. We must also test them against the Future Forum’s recommendations about how the role of Monitor should be clarified in order to remove these misunderstandings.

First—I warmly welcome this—it is made clear in the Bill as amended and the supporting documentation from the Department that although the Government intend to continue, as did their predecessor, to encourage the conversion of NHS trusts to foundation trusts, there will be no reduction in the standards required to qualify for the status of foundation trust. The registration principles established by Monitor, which are broadly welcomed throughout the health service, are intended to justify the independence that comes with foundation trust status. Those standards will continue as a gold standard under the new NHS, and achieving them, rather than meeting some artificial deadline, is the key determinant of whether a trust achieves foundation trust status. I welcome the fact that the Government have made that clear. It responds to a specific recommendation by the Future Forum, and it is exactly right.

17:30

Secondly, the Future Forum also envisaged that the role of Monitor should not come to an end on the day that a trust achieves foundation trust status. There should continue to be, on behalf of the taxpayer and of patients, an oversight role to ensure that organisations that have achieved foundation trust status continue to meet those standards and to deliver the quality of care required by patients and commissioners. That is now set out clearly in the Government’s supporting paperwork. It is part of the role of Monitor, and I welcome the fact that—having established that there will be no diminution of standards in the achievement of foundation trust status—it will have continuing oversight to ensure that those standards continue to be met.

The third point that was highlighted by the Future Forum—once again, it was accepted by the Government in these amendments—is the need to ensure that not only will there be continuing oversight of the achievement of those standards by foundation trusts, but Monitor will have the power to intervene if a threat emerges to the achievement of those standards by a foundation trust. Patients can be confident not only that there will be oversight, but that Monitor—on behalf of the taxpayer and of patients—has the capacity to intervene to ensure that action is taken if management in post at a foundation trust is not delivering the standards required.

[Mark Simmonds]

As always, my right hon. Friend is making an extremely powerful speech. Does he accept the need for Monitor to ensure that foundation trusts not only continue to meet basic standards but continue to improve those standards year on year, and thereby improve patient outcomes?

[Mr Dorrell]

I absolutely agree with my hon. Friend. One of the further important clarifications in their position is the stress that the Government have placed—rightly—on the importance of the link between Monitor and the Care Quality Commission to ensure that standards in foundation trusts are not just about the achievement of financial targets, but are about standards of care quality delivered to patients. The link between the two regulators—one of quality and the other of financial standards—is an important part of the regulatory structure that the Government are introducing.

[Andrew George]

I entirely endorse the point that my right hon. Friend makes about the need to uphold standards and the role of Monitor in that respect. However, with regard to the Secretary of State’s response to me about the sustainability of essential services—acute emergency trauma centres—does he agree that Monitor must safeguard those services and not allow them to be eroded by the competitive environment in which they will operate?

[Mr Dorrell]

I agree that the sustainability of essential services—or, in the Government’s wording, the continuity of essential services—is a key role of Monitor. If I may interpret what my right hon. Friend the Secretary of State said, the patient’s interest is continuity of service, but not necessarily from the same provider for ever more. There has to be a commitment to sustain the service, and if there is to be a change of provider, the service has to be sustained through the change of provider, but the service does not necessarily have to be sustained by the same provider. Nor has there ever been such sustained service. There are not many people who rely on the service once provided by the Westminster hospital, as it is now a block of flats. I believe, however, that the service delivered to patients in this part of London is better as a consequence of the change that resulted from that decision.

[Grahame M. Morris]

As always, the Chairman of the Health Select Committee, is making a powerful contribution. He has really hit the nail on the head. The fundamental point, as evidenced in the Bill, is not that the provider could change—that has happened in the past, as he said, although the provider has always been a public sector provider, either in an NHS trust or an NHS foundation trust—but that, under the Bill, the provider could well be a private sector provider.

[Mr Dorrell]

I am grateful to the hon. Gentleman, who is a member of the Select Committee, because he provides me with a link to my next point—I was beginning to wonder how I was going to get on to it.

The health service has not always provided services from a public sector provider. Until this Bill and the powers it gives to Monitor, regulatory bodies in the public sector had not had the opportunity to inquire into the sustainability of services provided by private sector providers. My right hon. Friend the Secretary of State made the point that the role of Monitor under the Bill is to ensure first—if I may repeat myself—that foundation trusts are of a high quality when they are launched; secondly, that they are accountable for retaining their high standards; thirdly, that we intervene early if they start to go off the rails; and, fourthly, that if they get into serious difficulty, we have the capacity, through Monitor, to continue to deliver continuity of service to those who rely on public health provision, whether from an NHS foundation trust or, as a result of the Bill, for the first time from the private sector. I regard that as a significant step forward in the delivery of continuity of care for NHS patients, whether provided, as the vast majority still will be, by public sector institutions or by some of the independent sector treatment centres introduced by the previous Government.

[Rosie Cooper]

Does the right hon. Gentleman think that standards can be maintained, and be seen to be maintained, in foundation hospitals if they are allowed to do what they are currently doing, which is not to disclose all information relating to, for instance, complaints procedures or whatever? Furthermore, does he not think that board meetings should be held in public?

[Mr Dorrell]

My understanding is that the Government have clarified that foundation trust board meetings should be held in public and that, in future, it will be a requirement of licensing by Monitor. On the much broader point, I absolutely agree—the hon. Lady, who is another member of the Select Committee, knows that I agree—that providers of care to NHS patients, whether public or private, ought to have an obligation to provide information on the outcomes that they achieve and certainly on any complaints and other processes initiated by patients about the care they receive. That was one of the strong recommendations that the Select Committee made following its work on complaints. I think that that obligation ought to rest on all providers of care to NHS patients, whether they are foundation trusts or any other form of provider.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Will the right hon. Gentleman provide some clarification? I think that he said “should” and not “must”. For other functions, particularly relating to local government, the Government seem to be into dropping standards and codes of conduct—that is certainly the case in local councils—but surely trusts “must” have meetings in public, not “should”.

[Mr Dorrell]

Ministers can correct me, but my understanding is that, under the obligation being introduced, they “must” meet in public. I have no authority to speak for the Government, but I believe that that is what the Government intend. For myself, as a patient of a trust or other NHS provider, whether in the public or private sector, my interest lies in ensuring that the information about my—

[The Minister of State, Department of Health (Mr Simon Burns)]

Will my right hon. Friend give way?

[Mr Dorrell]

Of course.

[Mr Burns]

I am grateful to my right hon. Friend for giving way and allowing me to clarify the point. Let me reassure him that, yes, such meetings must be held in public.

[Mr Dorrell]

I am grateful to my right hon. Friend, who answers the hon. Member for Worsley and Eccles South (Barbara Keeley) with very much more authority than is at my disposal.

I want to make one final point and it is a direct response to the hon. Member for Oldham East and Saddleworth (Debbie Abrahams). Of all the misrepresentations about the intentions of this Bill that we have listened to since the White Paper was published over a year ago, the most persistent is that this is somehow a Bill—a ramp—for the privatisation of the health service.

I was first a Health Minister more than 21 years ago. Throughout that period I have listened to speeches directed first at my right hon. and learned Friend the current Justice Secretary, when he was Health Secretary, and subsequently at all his Labour and Tory successors, including me, although probably excluding the right hon. Member for Holborn and St Pancras (Frank Dobson). All their legislative and other proposals to introduce more flexible and patient and standards-oriented structures in the health service were opposed by somebody or other on the grounds that they were going to privatise the health service. If that was the purpose of those policy initiatives, the one thing that they all have in common is that they have been singularly unsuccessful. If it is the policy purpose of this Bill to privatise the health service—which I do not for one moment believe it is—it will, I am sure, be as unsuccessful as all the other measures that went before it.

[Frank Dobson]

I begin with a reminder. I was one of those Labour people who voted against the establishment of foundation trusts and the setting up of Monitor. In doing so, I was supported by those on the Conservative Front Bench, so I do not think that the Conservatives should claim any consistency in these matters.

My second point is that although one would never dream it was true from listening to Ministers or their supporters, it is quite clear that the national health service is now working very well and is more popular than ever; and yet we are told that it needs a radical overhaul. However, the popularity of the national health service at the time of the last general election probably explains why both the Conservative party and the Liberal Democrats promised that there would be no top-down reorganisation of it. However, if neither the Bill as originally produced nor the post-pausal Bill that we have now is top-down change, God knows how one would define it.

The whole purpose of this Bill is to shift us away from the basic collaborative approach to the provision of health care in this country and to substitute a large amount of competition, gradually involving more and more of the private sector and, I believe, privatisation. In order to put things in perspective, it is worth pointing out that when the right hon. Member for Charnwood (Mr Dorrell), ceased to be the Secretary of State for Health, the national health service was performing 5.7 million operations a year in its hospitals. When Labour left office, it was performing 9.7 million operations a year, an increase of 58%. That was the result of improved working practices developed by—

[Dr Poulter]

Will the right hon. Gentleman give way?

[Frank Dobson]

No, not for the minute.

That change was the result of improved working practices developed by the people working in the national health service, not the result of any structural changes. It was also partly the result of the biggest hospital building programme in history, as well as a lot more new and better equipment, newer GP surgeries, 78,000 extra nurses and 27,000 extra doctors. Those were among the reasons that the NHS became so much more popular. It is popular because, for most people in most parts of the country most of the time, it is already doing a very good job. However, that is now going into decline, because many people working in the NHS carrying out pre-legislative preparatory work on the proposed changes are having to divert their efforts into bringing about structural change. That is one of the reasons waiting lists and waiting times are going up—something that the Government deny is happening.

17:45

[Lyn Brown (West Ham) (Lab)]

Bearing in mind the lack of popularity of the proposals among our constituents, is my right hon. Friend as worried as I and my constituents are about the £850 million that is being spent on redundancies and the projected £2 billion of primary care trusts’ budgets that is being held back from patient care to cover the risks and costs associated with the reorganisation?

[Frank Dobson]

I entirely agree. Nobody could possibly claim that redundancy payments constitute money being spent on improving services for our constituents. That is just money down the drain as far as patient care is concerned.

The fundamental problem behind the proposals is that the Government are, in effect, proposing a further major fragmentation of the national health service. In the past, up to the point at which the previous Tory Government introduced an internal market, the spending on administration in the NHS amounted to 4% of the total. That was largely because great big slugs of money were transferred round the system, and I am prepared to accept that there might be some disadvantages in that arrangement. Since then, however, under that Government and the Labour Government, the system has changed to one in which the money follows the patient. That has led to the creation of all sorts of exceptionally expensive systems to bring about individualised transactions, which has resulted in the cost of administering the national health service rising to 12% of the total—an increase of 8%. The NHS is spending about £100 billion a year at the moment, so an extra £8 billion that should have been spent on patient services is now being spent on the administration of the semi-fragmented system. What is now being proposed will involve yet further fragmentation, and I shall explain why I believe we will end up spending yet more money, but not on patients.

[Chris Skidmore]

The right hon. Gentleman has mentioned the £8 billion being spent on administration in the NHS. I assume that he therefore welcomes the coalition Government’s decision to cut the administration budget by £5 billion by 2015. In his speech so far, however, he seems to be suggesting that the status quo is acceptable. I believe that it is unacceptable. Does he welcome the fact that we will be putting an extra £12.5 billion into the NHS?

[Frank Dobson]

If the hon. Gentleman—and, for that matter, the Secretary of State and the Chair of the Health Select Committee—had ever listened to what I say, they would know that I think that we need change. We need organic change, however, rather than structural change, because structural change generally costs more than it provides. If the hon. Gentleman thinks that introducing a system in which virtually every transaction will be a legally binding document, with herds of lawyers grasping their share of proceedings, will reduce the amount spent on administration, he obviously believes in Father Christmas and various other mythical figures.

[Barbara Keeley]

Before we get into any more claims of more being spent, I want to touch on two examples of cuts, caused by the cuts and efficiency savings, which I raised with the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow). The most deprived ward in my constituency is losing its NHS walk-in centre and all the people with long-term conditions are losing active case management. I raised those two cuts made by Salford PCT with the Minister in an Adjournment debate, to which I have received no answer. There is no answer. People in the most deprived wards with the greatest health inequalities are suffering from these cuts. I will not hear any more about more investment being made, because all I see as a constituency MP is less investment.

[Frank Dobson]

I agree entirely with my hon. Friend. A further point is that I doubt whether there is a single constituency anywhere in the United Kingdom of Great Britain and Northern Ireland that has seen more change in health provision than mine. There are not many places where a virtually trouble-free amalgamation of two major and famous teaching hospitals into one has taken place successfully. There are not very many places that have seen more small GP practices getting together in one location and improving their performance. Those things have always been done with my strong support, even when on some occasions, at least at the outset, the ideas were not popular with some local people. Therefore, I do not accept that I do not believe in change. I believe in sensible change, not stupid change, but stupid change is what we seem to be getting.

[Mr Stewart Jackson (Peterborough) (Con)]

I admire the right hon. Gentleman’s chutzpah, but I wonder whether he was missing in action during the last Parliament. Some of us were saying in 2008 that the imposition of independent sector treatment centres—Darzi centres—would have a direct impact on the budget of primary care trusts and would cause the development of structural deficits that would impact directly on poorer areas with smaller primary care facilities. Where was the right hon. Gentleman then, when it came to attacking his own Government on that specific issue?

[Frank Dobson]

I was attacking them! I am sorry if the hon. Gentleman did not notice, but I believe I was the first person to expose the fact that on average the private sector was paid 11% more per operation than the NHS was getting for the equivalent operation. I shall take no lessons from anybody when it comes to opposing some of the daft things that went on. I did oppose them and I am proud to have done so. What is being proposed now, however, goes far beyond that. As my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), who has a great deal of knowledge in these matters, has pointed out, there is scarcely any evidence from anywhere in the world to show that a competitive system delivers better health care than a collaborative system.

To ask the essentially collaborative health care system in this country to turn over to being competitive is a bit like asking the Meat and Livestock Commission to promote vegetarianism: it is simply not what people want to do; it is not their approach and nor should it be. It remains the case that Monitor is still rigged in favour of promoting competition. Let me point out—hopefully without putting my glasses on—that clause 58(3) states:

“Monitor must exercise its functions with a view to preventing anti-competitive behaviour in the provision of health care services for the purposes of the NHS which is against the interests of people who use such services.”

However, it does not say that “Monitor must exercise its functions with a view to preventing competitive behaviour in the provision of health care services which may be against the interests of the people who use such services”. Apparently, then, there is a basic, intrinsic and fundamental assumption that competition must be beneficial and non-competition must be harmful. If the Government say that Monitor is neutral, it should be given a neutrality in respect of competition and non-competition. As I think the hon. Member for Peterborough (Mr Jackson) would agree, the unfair competition of some of the independent treatment centres was harmful to and threatened the services provided by neighbouring NHS hospitals. There is clear evidence here of problems within the private sector.

I recall that, a few years ago, United Health—a subsidiary of the US United Health—took over three GP services in my constituency. It bid that it could provide the range of services for less than the local GPs, so it got the contracts. It has not complied with all the conditions that were set, but the primary care trust decided that it could not take it to court because it would be such a lengthy and expensive exercise and it feared that the PCT might not win. Not content with that, United Health recently announced that it was selling the franchise to another private outfit. It did not consult the staff. It did not consult any elected local representatives—neither me nor councillors. Above all, it never consulted the patients. These private sector outfits regard patients as part of the chattels that they can dispose of to maximum benefit and maximum profit.

That illustrates the fact that if we are to have contract-based provision of services, a huge amount of lawyer effort will be put into trying to draw up watertight contracts. What one lawyer thinks is a watertight contract, another lawyer will make a leaky contract by puncturing a hole in it, and we will go over to the system in the United States, where zillions of dollars are spent on court challenges or settlements with the providers of health care.

Furthermore, there is virtually no major American supplier of health care that has not been indicted for defrauding federal taxpayers, city taxpayers, state taxpayers, doctors or patients—and sometimes all five. I thus asked the Secretary of State whether he would rule out giving any NHS contracts to any organisation that had been indicted for defrauding people in another country. He gave me about a page-long answer, which could be summarised as, “No, he would not rule them out.”

We are thus talking about the possibility of European competition law being used to force our Secretary of State to allow people to give contracts to American companies whose greatest claim to fame is that they have defrauded innumerable Americans. I think that that is intolerable. I would have thought that all these anti-EU Conservatives found it rather embarrassing to think that European law was going to be used to allow fraudulent Americans to get contracts working in our national health service. All those things, however, will be possible under the system proposed by the Secretary of State.

18:00

Many people—including, possibly, me in this speech—will find it quite difficult to mount an entirely logical and coherent response to this collection of amendments, given their nature, scale and variety. Let me return to a point that I made when the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), was introducing the ludicrous programme motion. I believe that to make such fundamental changes to the national health service—changes whose consequences are, at the very least, unpredictable—by means of 1,000 amendments, albeit some of them trivial, and to say to people in the national health service, “Your sovereign elected House of Commons has seriously considered all the changes that the Government are proposing and has exposed them to scrutiny”, is to treat the people who work in the service, and their patients, with contempt.

[Grahame M. Morris]

May I take up my right hon. Friend’s point about effective scrutiny and the assurances that Ministers have given the House? The knives prevented us from debating two of the Bill’s most significant clauses in terms of costs and implications, clauses 29 and 30, which deal with the abolition of strategic health authorities and primary care trusts. The redundancy costs will amount to more than £1,000 million.

[Frank Dobson]

I entirely agree with my hon. Friend. I think that nowadays those who call themselves members of the Conservative party only purport to be Conservatives. The basic Conservative approach in this world is, broadly speaking, not to make great changes without being absolutely certain that substantial benefits will result from them. A proper Conservative recognises the problems that arise during the process of change, and the unpredictability of things in human life. What we have now, certainly in relation in health and possibly in other spheres, is a Government who are going ahead with something which—good God!—cannot be regarded as well thought out, given that they have tabled 1,000 amendments on Report.

[Barbara Keeley]

I winder whether my right hon. Friend heard the Leader of the House say to the Hansard Society that

“it has simply become too easy for the Government to sideline Parliament; to push Bills through without adequate scrutiny; and to see the House more as a rubber-stamp than a proper check on executive authority.”

He also said that, in the Government’s view,

“a strong Parliament leads to a better Government.”

Does my right hon. Friend believe that the Bill, and the very shortened debate on its recommittal, constitute a good illustration of that?

[Frank Dobson]

In fairness, I think that given the accuracy of the present Government’s aim, if they tried to rubber-stamp something they would probably miss.

[Dan Byles]

In view of the speech that the right hon. Gentleman is making and his definition of a “proper Conservative”, I wonder whether he has just come out of the closet as a proper Conservative himself.

[Frank Dobson]

People have described me as old Labour, but I have moved on from that. I am now heritage Labour. Part of our heritage, however, is the national health service, and it is not the Tories’ heritage either. Those who play with the national health service—which is what I think the Government are doing, purely for ideological reasons—do us a disservice in two ways. They threaten the likely performance of the national health service and the people working in it, and they threaten the relationship between the British people and the national health service.

[Fiona O'Donnell]

Will my right hon. Friend give way?

[Frank Dobson]

No, I will not.

I believe that the national health service is popular for two reasons: because, in most parts of the country and for most of the time, it does a good job for people; and because people value the thought that it not only looks after them but looks after their families, looks after their neighbours, and looks after all of us. I believe that, in many ways, that is its most important function.

We live at a time when everyone is filled with growing concern about the divisive elements in our society, and the national health service, along with the feeling that people have for it as a collaborative organisation, is one of the few exceptions to that. The health service does not just bind the wounds of people in this country, but helps to bind us together. That, I believe, is why it is so dangerous that the Government are going against its basic principles, thus risking not only its performance, but its relationship with us and its binding function in our increasingly divided society.

[John Pugh (Southport) (LD)]

I wish to speak to my amendments 1219 and 1220, and against amendment 10. The House is right to be sceptical about the blessings of the internal market in health. It is right to be worried about price competition, which everyone thinks is a race to the bottom. It is right to be concerned about the reckless extension of “any willing provider”, and it is correct in fearing that health services will be increasingly exposed to competition law, including EU competition law. It should fear the huge transactional costs that will be incurred in the hardening of the commissioner-provider split. It should fear the threat to integration, and it should fear cherry-picking, particularly in a narrow tariff system based on payment by results. It should also fear the blurring of the difference between public and private hospitals, and the financial incentives given to the private sector under the banner of choice.

That is why I dislike the greater part of what Tony Blair did to the NHS. Those who are now Opposition Members voted for all that, and that is where we are now: it is the default position. As one Opposition Member said, Labour has put all the bricks in place. A few moments ago we witnessed the strange anomaly of the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) complaining about a feature of foundation trusts—their ability to borrow on the private market—which I consider to be a direct consequence of Labour legislation.

The choice for the House is not between Aneurin Bevan’s NHS and the Bill, but between Blair’s NHS and Secretary of State’s version. If I were to sum it up neatly, I would say that the Secretary of State’s version most closely resembled Blairism with clearer and more equitable rules. First, there is an overt sector regulator instead of the powerful covert regulating body, the Co-operation and Competition Panel, which has been making all the decisions that Monitor will make in a more overt way. Secondly, there is the outlawing of subsidy to the private sector, which is perfectly possible: the Secretary of State is not minded to take such action at present, but current legislation does not prohibit him from doing so. Thirdly, as Members must acknowledge, the Bill makes a clear attempt to forfend cherry-picking and protect clinical networks by safeguarding integrated provision. It is possible to have an argument about how well that is done, but there is certainly an explicit intention to do it—as, to be fair, there was in some of the activities of the CCP, although in that instance the constraints were somewhat weaker.

Fourthly, since the pause a clear attempt has been made to ensure that Monitor merely regulates, without performing a strategic role in promoting much except the interests of patients. It functions as a regulator and adjudicator on what it is intended to do, rather than occupying an unaccountable strategic role in promoting competition. Clearly much will depend on the mandate that it continues to be given and on its personnel: that will vary over time, and we should be watchful in that regard.

I recently had the benefit—as I think other Members have, too—of the legal advice of 38 Degrees, which is in danger of rapidly becoming the provisional wing of the “Evan Harris organisation.” I carefully read what Mr Roderick said, and I would like to share the details of his comments with the House. He says:

“contracting out services to the private sector is anything but a novel proposition in the NHS”

and

“the government has for some years rolled out the policy of Any Qualified Provider”.

Presumably, that is a reference to the previous Government, not the current one.

Mr Roderick also says:

“the application of procurement law is not by any means new to the NHS”.

Referring again to Labour party principles, he says:

“the current internal Principles and Rules for Cooperation and Competition”—

which were set up by Labour—

“seek to inject…promotion of choice and competition principles into the operation of the NHS”.

On the thorny subject of the definition of “undertaking”, which we debated ad nauseam in Committee, he has this to say:

“The NHS has already developed a structure whereby it is more likely than not that NHS Trusts are undertakings for the purposes of competition”.

Mr Roderick is often cited by Labour Members as representing independent legal advice, but that is what he says. He concludes by saying that Labour’s

“recent reforms…have done much to alter”

the basic

“landscape, even in the absence of legislative change.”

As we have both commissioning and a mixed economy—people are not saying that we ought not to have such an economy—there is a chance that there will be challenges from disappointed providers, and we must try to understand how that would go. In terms of EU law it does not matter how many providers there are out there, as even one will do, and it does not even have to be in the UK. The law can be applied in such circumstances. If these issues are to be taken up by providers who are disappointed in one context or another, it is better for that to be handled by a sector regulator such as Monitor than by the Office of Fair Trading, which would be the default situation.

[Diana Johnson (Kingston upon Hull North) (Lab)]

I have been listening carefully to the hon. Gentleman’s contribution. He has been talking a lot about Labour party principles—but I wondered about Liberal Democrat principles, and whether he feels completely relaxed about the opening up of the NHS to privatisation.

[John Pugh]

Perhaps the hon. Lady has not understood the point that I was making. Her own Government were responsible for the opening up that she talks about and fears, and most Labour Members voted for it. I did not vote for foundation trusts, nor did many of my party colleagues. Clearly Labour Members did, however, and we will return to that.

It is a fair point to say that if we have Monitor, that does not take us out of the whole legal web, as it cannot stop other legal processes, or a disappointed provider going further. However, it dramatically lessens the impact, and dramatically reduces the probability of that happening. We can only escape this legal web effectively if we take Mr Roderick’s advice and re-examine each and every element and characteristic of the NHS structure—or, to put it simply, if we reverse Blairism.

18:15

Sadly, I have come to the conclusion that anyone who claims certainty in respect of this area of EU law is probably a fool. There are two reasons for that. First, as Mr Roderick advises me, the definition of “undertaking” in EU law is changing. Secondly, he thinks that schedule B services, which are of some concern to people who are interested in this sort of thing, are under review by the European Community.

I was genuinely impressed by the hon. Member for Leicester West (Liz Kendall) when she summed up the Labour party’s problem in this area in Committee. I circulated her words to my colleagues so that they could survey the argument as expressed in its strongest form. She said:

“I am not arguing, as Ministers have claimed the Opposition have, that the Bill extends the scope of competition law. My argument is that the Bill extends the applicability of competition law to the NHS. It is not just the clauses we are discussing today that will make that happen; so will other clauses, such as those that abolish the private patient cap on foundation trusts, and aspects of the Government’s policy, particularly requiring commissioners to consider any qualified provider for all services”—

which is not in the legislation. She continued:

“All those things will guarantee that the NHS will be considered and treated as a full market, and that the providers of NHS services will for the first time be treated as undertakings for the purposes of competition law.” ––[Official Report, Health and Social Care (Re-Committed) Public Bill Committee, 12 July 2012; c. 400.]

We simply do not know how the EU will define “undertaking”—we do not have that level of certainty—and my view is that we do not currently know much about the applicability of EU law. I am not as pessimistic as Mr Roderick, the 38 Degrees adviser, about what we can do about the situation we are in, however. He claims that the Bill cannot limit the application of competition law:

“nothing in the Bill…can have the effect of preventing the application of competition law.”

So this may all be going to happen regardless of whether we accept this Bill.

I accept that this is an extraordinarily difficult area that interests many health anoraks ad nauseam, but probably loses the general public. However, what makes it difficult is not the Bill per se, but all the changes in the NHS over previous years, on which those on the Treasury Benches and those on the Opposition Benches have usually been at one. However, my contention is that it is clearly better if Monitor takes on the role of carrying out whatever regulation or adjudication will be necessary.

I want briefly to turn to amendments 1219 and 1220 in my name. The motivation for moving them stemmed from the Committee stage, which I am happy to say was a thoroughly congenial occasion that all Members thoroughly enjoyed. Through that process we were convinced—as I have tried to convince Members today—of the benefits of a sector regulator: Monitor. However, we then reached clause 71, where we discovered the strange anomaly that mergers of foundation trusts go to the OFT, which has no experience and little inclination, might be disposed to treating hospitals purely as businesses, and which, if it gets involved, will make reconfiguration a lot more complex and difficult.

Given the appalling problems that we shall have in the acute sector over the next few months and years, I certainly would not want to see the OFT wading in and overruling decisions that are sensible rationalisations. In a sense this is slightly ludicrous. If one foundation trust is a public body and the other is also a public body, they are both essentially owned by “UK plc”. Where, then, would we refer that decision? If Marks and Spencer owned those institutions, it would merge them and there would be no issue with which the OFT need detain itself. However, if we accept that such issues should go to a regulator, why this regulator? Why the OFT? Why not instead leave it, as most people supposed would happen, to Monitor?

A variety of answers were given in Committee. One was that such a merger would have to go to the OFT because there could be a combined turnover of more than £70 million. However, then it became apparent that it was not just that revenue or budget threshold that determined whether such matters went to the OFT, because non-foundation trusts, regardless of size, would not go to the OFT. I therefore still ponder where we can go with this.

I heard the Secretary of State say that the problem is that if, as my amendments propose, we take out the reference to foundation trust mergers going to the OFT—which would be a sane and sensible thing to do—we may still fall foul of other bits of legislation. We may also risk double jeopardy. I understand that that is a real problem, which we would want to avoid. The difficulty I have is that if, as the Secretary of State says, this is a very uncertain field legally, it is probably not wholly justifiable to put formally into the Bill the application of part 3 of the Enterprise Act 2002. It is probably better to get the legal situation a bit clearer, and I am fairly confident that that is the view that their lordships will take when they examine this Bill.

[Grahame M. Morris]

I am privileged to have the opportunity to speak in this debate on an issue close to my heart. A number of Opposition Members—and perhaps Members across the whole of the House—have taken advantage of the opportunity to spend a day with the NHS to see at first hand some of the issues and problems and to discuss with staff and patients their concerns. Many Members have received e-mails and letters from constituents and from various interest groups, and the issues we are considering this evening are very important.

As my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) said during his contribution, the NHS holds a very special place in people’s affections. In many respects it is viewed not unlike a religion, in so far as it is loved and cherished. Members who have had the opportunity to travel to other countries and see different health systems will no doubt be well aware of the high esteem in which our own health service is held throughout the world. It is a real exemplar—a model of a publicly funded, publicly provided health service. As an aside, I point out as a member of the Select Committee on Health that we have a very frugal Chairman, and the furthest we have travelled is to Hackney. My knowledge is therefore based on reading and on evidence submitted to the Committee.

Let us consider the problem we face with the Bill and the amendments and new clauses. I listened carefully to the Secretary of State’s statement, and the real concern among patients, the public and the Opposition is, what are the motivations behind these reforms? I worked in the health service for a dozen years or more and have taken the trouble to look into the various options in some detail. Ministers have said that there are precedents for Bills of this complexity, but I would be staggered to find that there are. It is incredibly complicated and has been subject to numerous amendments. As members of the Bill Committee who are in the Chamber this evening know, many of the arguments originally made by Government Front Benchers were turned on their heads in Committee, and some of those that were rubbished by the Opposition were taken up and rehashed as part of the Future Forum.

[Nicky Morgan (Loughborough) (Con)]

I am listening very carefully to the hon. Gentleman, as I did in Committee. Indeed, those of us who served on both Committees—the original and the re-committal—deserve a badge of honour. He talks about the Bill being complex. Does he not think that the process has been made more complex by the use of misinformation and emotive language, and by campaigners obscuring the Bill and needlessly causing patients to worry about their ability to access the health service once the Bill has been passed? The point is that free access at the point of need is not changing, and that is what most patients care most about. Does he not agree?

[Grahame M. Morris]

I am afraid I do not agree with the hon. Lady, as she might expect. The Secretary of State said that it was a question of communication, but I suspect that part of the problem with the Bill is that, far from there being additional clarity, the more that Members of Parliament, the medical profession, health care workers, members of the public and informed commentators have examined the proposals in detail, the greater the number of concerns that have arisen.

If the Secretary of State had been open and honest about the direction of travel and the motivation for these health reforms, perhaps we could have avoided some of the confusions that have arisen. There is no electoral mandate for a huge structural review and reorganisation. I suspect that there is something seriously wrong with the whole privatising agenda and philosophy, which the Secretary of State denies.

[Rosie Cooper]

Does my hon. Friend believe that misinformation and emotive language almost began and ended when the Prime Minister said that the NHS was safe in his hands? The misinformation began when he fooled the British public into thinking that the NHS was safe. This is the result.

[Grahame M. Morris]

I am grateful to my hon. Friend for raising that issue, which I will return to later. There were assurances that there would be no top-down reorganisations, but we should note the scale and complexity of this huge, top-down reorganisation. The Government alluded in Committee to the costs of administration, as did other members of the Committee. During Health questions and in Committee, I raised the question of the huge costs of administering Monitor, which have grown exponentially. We have had various estimates from the Government about the true cost, but over the lifetime of a Parliament it could be as much as £500 million, once we know the full extent of the legal challenges that Monitor will be expected to defend. That is a colossal sum.

I wanted to intervene when the Secretary of State referred to clause 60 of the original Bill and the intention to extend the duties of Monitor into the social care element of health and social care, but he would not allow me to do so. I wanted to ask whether any estimate has been made of the cost of such an extension of Monitor’s remit, which I suspect will be considerable.

[Pat Glass (North West Durham) (Lab)]

The Secretary of State mentioned 38 Degrees, which clearly has touched a raw nerve. Quite apart from the people from 38 Degrees who have contacted me, huge numbers of my constituents have contacted me to express real worries about this issue. Given the concerns of the Opposition, the press and, most importantly, the voting public, how does my hon. Friend think that we all got so out of step with the Prime Minister and the Secretary of State?

[Grahame M. Morris]

I am grateful to my hon. Friend for expressing that concern, which many people share—even among the Government, although perhaps they conceal it. Such concerns are not restricted just to 38 Degrees and Opposition politicians. Lord Tebbit of Chingford, an outspoken man who could hardly be described as a left-wing agitator, raised real concerns about what he described as these privatising reforms. He said that there is something seriously wrong, and that

“What worries me about the reforms…is the difficulty of organising fair competition between the state-owned hospitals and those in the private sector. In my time I have seen many efforts to create competition between state-owned airlines, car factories and steel makers. They all came unstuck. The unfairnesses were not all one way and they spring from the fact that state-owned and financed businesses and private sector ones are different animals”.

I have rarely found myself in agreement with Lord Tebbit, but on this occasion his analysis is extraordinarily insightful. His comments underline many of the basic contradictions in the Bill and in the subsequent amendments, which number more than 1,000.

[Fiona O'Donnell]

Apart, perhaps, from his warm comments about Lord Tebbit, my hon. Friend is, as ever, making a well-informed and considered contribution. We face a lack of information, inaccuracy and changing numbers. Does he therefore agree that what we also need, given the concerns raised by many hon. Members about the potential for an increased health inequality gap in this country, is an equality assessment of the Bill?

18:30

[Grahame M. Morris]

I am grateful for my hon. Friend’s contribution, as that is an excellent point. If hon. Members will bear with me, I shall discuss new clause 6 and what I believe the implications of the Government’s proposal would be for the Bill and for health inequalities. I was intrigued by the Secretary of State’s assurances in his opening statement about the responsibilities being conferred on him in the Bill that did not apply when Labour was in power. I believe he said that those powers were devolved to primary care trusts, but if PCTs are disappearing or clustering and strategic health authorities are disappearing over time or being clustered, surely it is right that the Secretary of State, as an accountable politician, should have these powers clearly defined in the Bill. I did not mean to digress, Mr Deputy Speaker. Those remarks related to clause 1 and I shall confine myself to the provisions before us.

As I have said, many concerns have been raised about the approach being taken to this cherished institution, not least those set out by my right hon. Friend the Member for Holborn and St Pancras about patient perception.

[Jim Shannon (Strangford) (DUP)]

Is the hon. Gentleman aware of the survey carried out among the 50,000 members of the Chartered Society of Physiotherapy? It indicated that 81% do not agree with the proposals for NHS reform—that touches on the issue that he just raised. It also indicated that 89%—almost nine out of 10 of those who work in the health service—believe that patient care will suffer and that 84% do not believe that the Government have considered these changes. Does he believe that the level of concern among those workers in the health service, and among the general public, means that whenever the vote takes place tonight hon. Members should be very careful and should oppose the Bill?

[Grahame M. Morris]

I am grateful for that information. I know that other hon. Members have spent a day with the health service and I am sure that Ministers take soundings, but I can honestly say that what the hon. Gentleman describes is the feedback I have received from talking to health professionals, patients and so on. I recognise that the Secretary of State has said on numerous occasions that a substantial body of GPs support this approach. When I tuned in to this morning’s “BBC Breakfast” I saw Professor Chris Ham of the King’s Fund being interviewed. He is an eminent and respected commentator on health service issues who has given evidence to the Public Bill Committee and the Health Committee. He gave his view that it was a small cohort of GPs who were signed up and committed to these reforms. I agree with his assessment.

These provisions deal with the role of Monitor, the relevant implications and changes to the failure regime. A “Panorama” documentary on the BBC featured Sir Gerry Robinson, who has some standing in the business community and for previous journalistic investigations into the NHS. The conclusion of his report was that he thought that these reforms could mean

“the end of the NHS.”

That is his conclusion. Even after meeting the Secretary of State he remained unconvinced of the value of the reforms.

The Secretary of State has failed to persuade the public and he has failed to persuade NHS staff of his approach. That has been illustrated by various surveys, through the British Medical Association, by personal contacts and in other ways. Even elements of the business community recognise the level of public opposition and concern. It seems that the principal backers are overseas US-style private health groups, whose interest is not philanthropic. They see the prospect of substantial profits and unprecedented access to billions of pounds soon to be available from NHS coffers. We hear Ministers and Government Members saying that the NHS was open to private sector providers under the previous Administration, and a very small figure—5% or so—was cited in the Public Bill Committee proceedings.

[Frank Dobson]

My hon. Friend may like to know that even in the final year of the Labour Government just 2.1% of operations were carried out by the private sector.

[Grahame M. Morris]

I am grateful that that information has been put on the record.

[Andrew Gwynne (Denton and Reddish) (Lab)]

My hon. Friend is right to talk about the potential role for overseas health companies. He might have seen the article in The Guardian yesterday stating:

“A German company has been in talks to take over NHS hospitals, the first tangible evidence that foreign multinationals will be able to run state-owned acute services”.

That has become apparent only through freedom of information requests. Does my hon. Friend think that this is the slippery slope that this Bill is going to usher in?

[Grahame M. Morris]

That point was raised during the Secretary of State’s earlier remarks. [Interruption.] Well, it came in response to a freedom of information request. I thought that his response was illuminating, as he assured us that that would not involve the transfer of NHS real estate, although he did not rule out the possibility that private sector providers would take over the running of these things. The report that I saw said that they would take responsibility for the management and staff, and he gave no rebuttal of that report.

[Mr Simon Burns]

rose—

[Grahame M. Morris]

I will give the Minister an opportunity to do that, if he so wishes.

[Mr Burns]

There is an air of déjà vu to this debate now, although I am delighted to be taking part in a debate with the hon. Gentleman yet again. May I point out that the only example of what he is saying relates to Hinchingbrooke hospital? What happened there was started by the previous Labour Government—his Government.

[Grahame M. Morris]

I do not wish to labour the point, but the report in The Guardian said that freedom of information requests to the Department of Health indicated that discussions were taking place between officials in respect of the transfer of between 10 and 20 NHS units—[Interruption.] I am simply reporting what I have read in the paper.

[Mr Burns]

May I say to the hon. Gentleman that that report is unadulterated claptrap? The trouble is that it was a misunderstanding of the contents of the e-mails. [Laughter.] The right hon. Member for Holborn and St Pancras (Frank Dobson) may think that that is funny, but the e-mails were not about these bodies taking over NHS hospitals; the e-mails were about discussing what their views are on hospitals that are struggling. The e-mails were part of an information-gathering mechanism to find out how policy in the NHS could be improved to deal, within the NHS, with hospitals that might be struggling as part of the foundation trust pipeline.

[Grahame M. Morris]

I do not find this at all funny. I would find it really worrying if this report is an indication of what is in store. It is rather ironic that the Secretary of State quoted from the Labour party manifesto. Perhaps it might be instructive if I were to quote from the Conservative party manifesto. It said that the Conservatives would

“defend the NHS from Labour’s cuts and reorganisations”.

If this Bill is not the biggest reorganisation that we have ever seen—[Interruption.] Well, it is, even though the Conservatives said that they would not proceed with any such huge reorganisation.

[Mr Kevan Jones (North Durham) (Lab)]

Would not the Secretary of State be able to clear that up tonight by giving a categorical assurance that no hospital will be transferred to or run by a foreign entity?

[Grahame M. Morris]

I am happy to give way to the Minister, if he wishes to give that assurance from the Dispatch Box. It would reassure staff and members of the public. Perhaps we can read something into the Minister’s reluctance to give such an assurance.

The Government, despite the spin, are delivering one of the most radical reorganisations ever and in the view of many Opposition Members it will undermine the basic principles of the NHS. When the Health Secretary was shadow spokesman for the then Opposition, at no point did he explain his plan to apply 1980s-style privatisation mechanisms to the NHS. I am an avid follower of health policy and the idea of creating an economic regulator—as we have discovered through a series of parliamentary questions, the costs of Monitor could be £500 million in a single Parliament—is again ironic when we hear the Government talk about waste and bureaucracy.

As for exposing the NHS to competition law, I accept the point made by the hon. Member for Southport (John Pugh), which was also made by my own Front Benchers, that it is not the provisions on the face of the Bill but the changes to the architecture of the NHS that will expose the NHS to European competition law—the same law, as we have heard, as applies to the utility companies. Health would be considered a commodity and £60 billion of the NHS budget would be handed over to private bodies, by which I mean those bodies that were the GP commissioning consortia, now renamed clinical commissioning groups. Despite the assurances about openness, transparency and accountability, those would be private-sector companies and my understanding is that they would not be open to FOI requests. That must be of huge concern to people who champion civil liberties, freedom and transparency. Over the past six years or so, we had no indication from the Secretary of State that he was planning such a radical change.

On the subject of the new failure regime, as set out in the amendments, having sat through the Public Bill Committee on the initial Bill as well as that on the re-committed Bill and having listened intently to the arguments, I cannot decide even now whether this is a U-turn or a side-step. I have read this huge document—the weighty tome that makes up the Bill, with all its various chapters and parts—as well as the impact study and the whole justification behind the Ministers’ arguments was that the NHS needed a market and a failure regime to boost productivity. Has that whole idea been left by the wayside?

[Dr Poulter]

Does the hon. Gentleman accept, however, that the previous Government failed to put in place any adequate failure regime to deal with situations such as that which occurred at Stafford hospital and that the Bill is a step towards providing a proper overview of what to do when trusts fail and let down patients?

[Grahame M. Morris]

I am not suggesting in any way, shape or form that every NHS organisation—be it an NHS hospital trust or a community-based organisation—is incapable of improvement. My philosophy, as someone with a bit of a scientific background, has always been that we should assemble an evidence base, pilot a proposal in one area, establish best practice, see where the faults lie, tweak it if necessary and then, if it works, roll it out. This leap-in-the dark approach is flawed and will end in tears. The service is hugely important and touches everybody’s life in this country at one time or another. The whole concept of the Bill is flawed and the way it has been prosecuted is compounding the problem.

18:45

As for a number of the new clauses and the changes to the failure regime that we are dealing with, in the recommitted Public Bill Committee we tried on numerous occasions to tease out from those on the Government Front Bench precisely what they had in mind. I was shocked when I saw that there were 1,000 amendments. Admittedly, the Minister said that 715 are so-called technical amendments—

[Mr Simon Burns]

Changing the name.

[Grahame M. Morris]

Absolutely. At this late stage in the process, however, these are huge and significant changes.

[Nicky Morgan]

Just to help the hon. Gentleman, a number of the amendments relate to the continuity of services, which his party and those on his Front Bench asked to have considered by this House on Report rather than being left to the Lords. I am sure that the Ministers can help, but if that subject was not included, I suspect that the number of amendments would be significantly smaller. It is right that they should be considered in this House at this time—does he not agree?

[Grahame M. Morris]

That is a fair and reasonable point and I concede that.

[Diana Johnson]

Does my hon. Friend agree that if this Bill had been properly drafted in the first place and there had been proper pre-legislative scrutiny, we would not have to have this cartload of amendments brought in at the last moment?

[Grahame M. Morris]

Again, that is a really good point. An incredible number of complex and detailed changes have taken place during the passage of the Bill, including the listening exercise and the consideration of a series of complex amendments, and even they did not address every issue that had been raised. Essentially, I am trying to say in a clumsy kind of way that the Bill is poorly thought out. I think it is a bad Bill, and if it is implemented it will cause real problems for the service and the people who use it.

[Nic Dakin (Scunthorpe) (Lab)]

I do not think my hon. Friend is making a clumsy speech at all; he is making a lot of very good points. His point about the Bill being badly drafted and set out is why I have been inundated over the past few days with messages from a range of professionals and service users who are very concerned about where things are going. I applaud my hon. Friend’s approach.

[Grahame M. Morris]

I am grateful to my hon. Friend for his point and for his kind words. My contention is that the problem with all these reforms is that they tend to unravel once there is an opportunity for not just Members of Parliament but health care professionals and the broader public properly to scrutinise them. Once people have the chance to consider the proposals in detail, there is an outcry such as that described by my hon. Friend.

I have tried to understand the thinking behind the Government’s changes and amendments. As I mentioned earlier, many of the changes fly in the face of the logic of the arguments originally made in Committee and when the Bill was first published. The obvious logical conundrum, if that is the term, can be seen in the fact that the original impact assessments, which were very comprehensive, said that it was essential to create a functioning market to gain the benefit of the reforms. A whole section of the impact study explained why “market exit” was fundamental to reforming the NHS. I heard what the Minister said earlier and I have read the Government’s amendments, but I am not quite convinced—perhaps I am a bit of a cynic—that this is a real concession. If we follow the Government’s logic, that makes the Bill as a package at best inconsistent and at worst it removes the possible benefits that Government Members may wish to promote in terms of the costs of any market system. Instead, we are subject to a strange system. The Secretary of State initially mentioned creating a level playing field to allow access for private health care firms as well as existing NHS and public providers. There are therefore some basic contradictions in the rationale behind some of the reforms, if there was any merit in the arguments initially.

[Tom Blenkinsop]

Is my hon. Friend concerned, as I am, that 2% of PCT budgets—approximately £2 billion—is being used for this reorganisation? There is a direct effect on my community and the Redcar and Cleveland PCT, where almost £4 million has been taken from health inequality budgets, which could have been used on the front line.

[Grahame M. Morris]

I am making rather slow progress, but I did want to get on to health inequalities. My hon. Friend makes an excellent and important point. We touched on it briefly in the Bill Committee and it relates to new clause 6. I was concerned about the reports that in the allocations to PCTs and SHAs, the element set aside for addressing health inequalities had been reduced. That should concern us all, especially those who represent areas that suffer high levels of health inequality and deprivation.

It is a bit of an achievement that the Government could take the NHS at its most successful point and turn it around. Government Members have highlighted particular failings, but the NHS had a record number of doctors and nurses and a hospital building programme. There had been a transformation from waiting times of 18 months for routine operations such as knee and hip replacements or removal of cataracts to only a few weeks. The previous Government should be given some credit for that. The improvement was confirmed in patient satisfaction surveys and it is a great shame that the Government have decided not to commission the Department of Health to conduct such studies in the future. I suspect their motives in that regard.

[Dr Poulter]

Will the hon. Gentleman give way?

[Grahame M. Morris]

I give way to my hon. Friend from the Committee.

[Dr Poulter]

That is a good point. Under the previous Government cataract and hip operations were done more quickly, but that was because the Labour Government commissioned private providers. The unfortunate thing was that the providers cherry-picked services and did not provide the integrated health care that this Bill will provide.

[Grahame M. Morris]

We had this exchange many times in the Committee on a variety of clauses. We need to give some credit to the previous Government. I am old enough to remember when people routinely waited a year, 18 months or longer for life-changing operations such as knee and hip replacements. It is a real quality-of-life issue if someone has cataracts and has to wait a long time for an operation. I accept that Labour used the private sector. I am a socialist and make no apology for that, and I want the provision to be public sector. I was not a Member of Parliament and did not vote for the commissioning of private providers, but I acknowledge that the private sector played a role in bringing extra capacity and some innovation to the service.

[Barbara Keeley]

My hon. Friend is making a wonderful speech. I wanted to make this point when my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) was speaking about the number of operations and the improvements during Labour’s term of office.

In the 1997 general election when I was campaigning in Wythenshawe and Sale, East constituency, I met someone who had been told that he had to wait two years for vital surgery and was desperately worried that he would die while he was waiting. I met someone in my constituency in last year’s general election campaign who received a diagnostic test on Monday, found he had cancer on Tuesday, went into hospital on Wednesday and was operated on on Thursday and his life was saved. From two years to four days—I thought that was the best testament to the improvement that Labour had brought about in the NHS.

[Grahame M. Morris]

I am grateful for that example. It illustrates the importance of that improvement, the value that people place on it and how critical it is to people’s health and well-being.

I know that we shall come later to the clauses that lift the cap on private patient work, which the Minister mentioned in his opening remarks. If the cap on private patient work in NHS foundation trusts is lifted and those trusts are under financial pressure—those of us who are in touch with our hospital trusts know that they are under financial pressure, with the reductions in the tariff and other issues—the level of private sector involvement in NHS trusts will increase.

[Rosie Cooper]

The hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who is also a member of the Select Committee, pointed out that Labour reduced waiting lists and private providers were involved. Does my hon. Friend agree that the general public now face longer waiting lists and more private providers?

[Grahame M. Morris]

This is the danger. Labour Members have attempted to highlight it, and people are increasingly aware of it.

[Frank Dobson]

Does my hon. Friend accept that if we want to look at how best to increase the number of people who are treated, the best thing to do is go to the people who do the treatment? When I was Health Secretary, the NHS was doing 160,000 cataract operations a year. Following discussions with the experts, some changes were made—no structural changes—and in the last year for which figures are available the NHS did 346,000 cataract operations a year. The private sector’s contribution averaged 6,000 a year.

[Grahame M. Morris]

I am grateful to my right hon. Friend for putting those important statistics on the record. Government Members often raised these issues in the Bill Committee so it is helpful to have that clarified with such precision.

I want to deal in more detail with health inequalities, if that is in order, Mr Deputy Speaker. While serving on the Bill Committee and as a member of the Health Select Committee, I have always tried to champion the cause of reducing health inequalities. In the Bill Committee, Opposition Members pushed for greater duties to reduce health inequalities to be placed on the new bodies being created by the Bill.

I am conscious that there has been some movement in this direction. New clause 6 is relevant to the special administration of services and makes references to health inequalities. I would be grateful if the Minister gave some clarification in respect of the point that I wish to make. I am delighted that the Government have recognised that a market system in health care will only worsen health inequalities. My rationale in making that statement is that at least new clause 6 says that services must be kept open where closure would adversely impact on or increase health inequalities. Opposition Members are not convinced that the safeguards are strong enough, that the safeguards could not be overturned or that inherent health inequalities that areas such as mine suffer from so terribly, largely reflecting socio-economic patterns in society, would not be exacerbated.

[Jeremy Lefroy (Stafford) (Con)]

I have been listening carefully to the hon. Gentleman. Will he accept and welcome the fact that clause 3 imposes on the Secretary of State a duty to reduce inequalities? Is that duty not a welcome innovation in legislation that he expects the Secretary of State to apply with rigour?

18:59

[Grahame M. Morris]

That is a good point. Like the curate’s egg, the Bill is good in parts—and bad in parts. I am prepared to acknowledge the commitment on health inequalities but, as I have mentioned, there are contradictions in the Bill, and that is what I seek to highlight. My concern is that the new structures proposed in the Bill move us away from a co-ordinated health service and towards a competition-based health service. Failure has been touted by Ministers as a driver of improvement, but following the latest U-turn, that commitment seems to have been dropped. I would welcome Ministers’ views on that.

Our concern is that the health service will be left to the worst elements of privatisation, without the supposed benefits of market competition. Members have referred to the British Medical Association and its calls for a co-operative and co-ordinated environment, which an open market would make impossible. When Dr Clare Gerada, the chair of the Royal College of General Practitioners, gave evidence to the Bill Committee, she raised a number of concerns about the clauses that we are discussing—concerns

“about the duplication of care and fragmentation…the under-provision of care once competition starts kicking in, the pace and extent of change, and the capability capacity and competence of GPs”

to deal with the extent of health needs. Most importantly, she said that

“the Bill risks widening health inequalities and could lead to worse patient care”.––[Official Report, Health and Social Care Public Bill Committee, 8 February 2011; c. 43, Q94.]

[Julian Sturdy (York Outer) (Con)]

The hon. Gentleman talks about health inequalities, but does he accept that under the current system primary care trusts have brought about a number of health inequalities? Certainly in my area of north Yorkshire, the PCT has brought about a number of health inequalities, and I think that that is the case in other areas, too. The system is already delivering that; that is why we need the change.

[Grahame M. Morris]

The picture is incredibly variable. We should consider many of the policies that the Government are pursuing, not least that on public health observatories, which collect the evidence on which many public health interventions are based. The sustained cuts to their budgets—there is a cut of 30% this year, and 30% next year—are exacerbating the situation. Some PCTs are performing well in this regard, and some are not performing as well. If there are measures that can strengthen our performance, they ought to be welcomed.

We have in the past mentioned some of the public health issues. As far back as 1977, the Department of Health and Social Security’s chief scientific adviser, Sir Douglas Black, commissioned a report on the extent of health inequalities in the UK. The Black report, published in 1980, brought about a sea change in how Governments would respond to health inequalities and reduce their worst effects, particularly for the lower social classes. It is generally acknowledged in more recent reports by Professor Sir Michael Marmot that the NHS can only do so much to address the situation. There are general issues that must be addressed through a whole plethora of Government policies—child benefit, improvements in maternity allowances, more pre-school education, an expansion of child care, and better housing. I mention that in relation to the amendments that we are discussing to highlight the stark danger of a reversal in relation to health inequalities, which are not only influenced by decisions of the Health Secretary, but greatly influenced by decisions taken across Government.

I shall draw my remarks to a conclusion. I am sure that Government Members will be relieved to hear that. [Interruption.] Well, I could go on for longer if they want; I have another six pages. I draw the House’s attention to the real concerns that the general public, the medical profession, staff who work in the service and patients have about particular details—about the new and expanded role of Monitor, and about the implications for the new NHS. It will not necessarily be Monitor that decides the future of failing services; in the end, that will be decided in the courts. Finally, in parts 3 and 4, we are dealing with some of the most contentious issues in the Bill, and I urge Members to consider the issues very carefully and to think about what is at stake, before deciding how to vote on the amendments.

[Mark Simmonds]

I draw the House’s attention to the Register of Members’ Financial Interests.

I congratulate the hon. Member for Easington (Grahame M. Morris) on a thoughtful, balanced and considered contribution, albeit somewhat lengthy. Some of the key points that he made are worthy of comment. He is absolutely right to highlight the importance of the issue of health inequalities, and it is absolutely right to make sure that the House understands that the Secretary of State and his Ministers are absolutely determined to narrow those inequalities; that is why the Secretary of State has ensured that that is in the Bill.

The hon. Member for Easington is also right to point out that health inequalities are determined not just by health policy. A whole range of factors influence health inequalities, and the best synthesis and summary that I have seen—if he has not read it, he should—is in a report by Professor Marmot.

[Grahame M. Morris]

indicated assent.

[Mark Simmonds]

The hon. Gentleman has read it, which is very good; I see him nodding his head. He also asked a key question about the Government’s motivation for bringing forward the Bill.

[Grahame M. Morris]

rose—

[Mark Simmonds]

I shall finish this point, and then I will happily give way to the hon. Gentleman, because he was extremely generous in giving way. Let me summarise the Government’s motivation in five areas. The first is to improve patient care; the second is to drive up the quality of services; the third is to improve patient outcomes; the fourth is to ensure better value for taxpayers’ money; and the fifth, and perhaps most important, is to ensure that our much-loved national health service has a successful future as a service that is free at the point of need, and a service that is based on requirement, not ability to pay. There should be continued equity of access and, even more importantly, excellence for all.

With the honourable exception of the hon. Gentleman’s contribution, all the contributions from Labour Members, including those on the Front Bench, have completely misrepresented the Bill. There is a degree of complacency creeping into the Labour party. The view that it puts forward—that there is nothing wrong with the national health service, and that it is a perfect, utopian service—is clearly not correct. Its view that no reform or innovation is required is not correct. Its view that no productivity improvements can be made is clearly not correct. The view that there is no problem with patient outcomes across a whole range of clinical indicators compared with the outcomes in our developed-world comparators is clearly not correct. The Labour party’s view that there is no need to reduce the cost of administration and get more resources to front-line patient care is clearly not correct; nor is it correct that there is no need for greater clinical involvement in commissioning and for greater patient choice. The Labour party’s position is purely political. It is not clinical and it does not have the best interests of patients at heart. I urge the Secretary of State and his ministerial team to reject the amendments tabled by Labour.

[Valerie Vaz (Walsall South) (Lab)]

Does the hon. Gentleman recall these words—“NHS” and “no top-down reorganisation”, said by one David Cameron, leader of the Conservative party?

[Mark Simmonds]

I do remember that. The changes outlined in both the original Bill and the amendments that have been tabled as a result of the considered and very professional work of Professor Field and his team demonstrate the desire of the coalition Government to make sure that the national health service survives for future generations as a taxpayer-funded service free at the point of need. All the changes set out in the Bill are determined by that.

The hon. Member for Leicester West (Liz Kendall), who spoke for Labour in the programme motion debate, should be wary of praying in aid the BMA. Not only did it object back in the 1940s to the setting up of the national health service, but just prior to the last election, it said that the Labour party was the enemy of the national health service. We need to engage with all the clinical groups within the national health service to ensure that we deliver the best possible patient outcomes for the amount of resources that we can put in.

I am slightly surprised at the repetitive nature of the debate. I have been told by my hon. Friends who sat on the Bill Committee that many of the points that were made in Committee have been made again today. The Government amendments that we are discussing are a direct result of the forum chaired by Professor Steve Field. I thought it unedifying of the right hon. Member for Holborn and St Pancras (Frank Dobson) to try to undermine Professor Field, who does excellent work in a very socio-economically deprived part of Birmingham. If the right hon. Gentleman has not visited Professor Field and seen the excellent work that he does, I suggest he does so.

[Several hon. Members]

rose—

[Mark Simmonds]

I give way first to the hon. Member for Worsley and Eccles South (Barbara Keeley).

[Barbara Keeley]

The speech of my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) is one of the best I have heard in the Chamber, as I think Opposition Members would agree. People outside the Chamber are saying that too.

On repetitiveness in the points that are being made, Report stage allows Members who did not serve on the Committee to say the things that they want to say. It is our chance right across the House to comment on the Bill, so that is not a valid criticism of what is going on in the debate.

[Mark Simmonds]

I hope the hon. Member for Easington has a better intervention to make.

[Grahame M. Morris]

Can we agree on one thing—that opinions should be evidence-based? I was amazed that when Professor Steve Field was asked whether the Future Forum had taken independent legal advice on the contentious issue of whether European competition law would apply as a result of the reforms—the matter was raised in the Bill Committee or the Select Committee—he said no, he had not taken independent legal advice. That was a major omission.

19:15

[Mark Simmonds]

I will not get into the nuances and the legal battles that other hon. Members have raised. Professor Steve Field and his team did an excellent job thoroughly and comprehensively in a relatively short time. To be fair to the Secretary of State and his team, they looked carefully at the suggested changes and have incorporated some of them in the clauses before us. I agree with many of them, and I highlighted some of these points on Second Reading—a greater emphasis on integration, wider engagement with a broader range of clinical commissioning teams, and greater protection for services which, in financial or quality terms, may not be providing the service that patients expect. All those have been changed in the Bill.

Almost all the Members on the Government Benches would not support the Bill if it was about privatisation of the national health service. It is not. It tries to ensure that the national health service has a future, and that the organisation that is in the best position to provide a particular service in a particular geographical locality has the ability to do so. That is not just the private sector; it is the voluntary sector, the charitable sector, the not-for-profit sector and the social enterprise sector. The mantra coming from the Opposition seems to dictate that those organisations should not be allowed to provide health care—that unless health care is provided by the state, it should not be allowed. That clearly is wrong. What is important is not the delivery mechanism, but patient outcomes and the quality of service provided.

I shall deal specifically with new clause 2 and amendments 100 to 104, 106 and the subsequent related amendments. They ensure that equity of access continues, irrespective of whether the provider is in a good financial state or not. My right hon. Friend the Member for Charnwood (Mr Dorrell) put his finger on exactly the right point, as he so often does. What matters is continuity of service, but not necessarily from the same provider.

The national health service has always changed in that way. It has always reconfigured services to make sure that the patient receives care of the best possible quality. New clause 2 puts in place an essential mechanism to ensure continued access for patients to NHS services. It is right that the Government are putting in place safeguards to protect patients and taxpayers, but the clause does more than that. It also enables commissioners to replace services with higher quality and better value options. Among the major failures of the last decade in which Labour was in charge of the national health service was not only the decline in productivity, but the fact that there was insufficient decommissioning of poor services and insufficient replacement and improvement of poor-quality service provision. Nowhere is that more marked than in Tunbridge Wells and Stafford.

The primary purpose is to enable Monitor to support commissioners to access services and place conditions on a licence holder. Some of those conditions are set out in the Bill. All hon. Members know that there is considerable variation in performance of organisations within the national health service. Providers who are providing excellent services should be allowed to thrive, innovate and drive the quality of clinical care. Those that are under-performing will require challenging, and support where necessary. Ultimately, if they cannot respond to that support and that challenge, they should be replaced by an alternative provider. That should apply both to the independent sector and to state sector provision. It is not acceptable that, purely because a service is provided by the state, it should be allowed to continue as a substandard service.

Some of the key changes in the new clauses and amendments allow that to happen. They make sure that funding is much more transparent. The existing framework has allowed hidden bail-outs to take place, which all too often have hidden poor management, poor service provision, and the need for clinically appropriate and evidence-driven reorganisation. All too often that has not happened, to the detriment of patient care.

I was pleased to see that the Secretary of State had allowed a safety valve in this part of the Bill, which would enable tariffs to be topped up, particularly for the provision of services in rural areas, such as my constituency in Lincolnshire. This must not be seen as an opportunity for the Department of Health to support and subsidise inefficient management and service provision. All too often there are inefficient cost bases and money could be transferred instead to front-line patient care.

I would be grateful if the Minister, when winding up, confirmed some specific points relating to new clause 2 and the subsequent amendments. Will he confirm that the new system will ensure that innovation is not inhibited—that providers and clinicians will have to configure services not only to satisfy patients, but to improve the quality and productivity of services, which, as we all know, have been very poor in the past decade or so? Will he confirm that the structure set out in the new clauses will enable Monitor to intervene early to ensure that the service provided is safe and provides good-quality, patient-centric services?

Will the Minister also confirm that the proposals build on the system set out in the Health Act 2009, which is in line with the Secretary of State’s consistent assertion that the Bill is about evolution, not revolution? Ministers must not allow the importance of integrated services, vital though they are, to be an excuse to maintain poor-quality providers. In the interests of patients, underperforming incumbents must be challenged and continued innovation must be facilitated and incentivised.

If the Minister has time when winding up, I would like him to address the point that I made to my right hon. Friend the Member for Charnwood, which is that the new clauses seem to ensure that Monitor will maintain minimum-based standards, particularly as they relate to acute foundation hospital trusts. We need commissioners, the Care Quality Commission and Monitor to work together to ensure that there is continuing improvement in patient care and continuing determination and drive to make sure that services are better the next year than they were the previous year. It is unclear from the amendments who will be responsible for co-ordinating that effort to drive up standards continually.

I have two final questions. What will happen if Monitor has to step in to provide advice, shore up a service or provide an alternative service provider, but the commissioners cannot agree on who should be the subsequent service provider? Who will resolve disputes between two commissioning consortia? Will it be the NHS commissioning board, Monitor or the Department of Health? Where a provider delivers a service to more than one commissioner, and one of the commissioning groups has access to an alternative provider already in existence but not another, who decides who will provide the service that has failed?

I will draw my remarks to a close. I am, as I believe are most Government Members, an avid supporter of the national health service. I defer to no other group more than I do to those who work tirelessly in the NHS to provide the excellent care that, more often than not, is delivered, and not only in the state service but across the range of NHS providers. However, if we are to continue the NHS, free at the point of delivery and based on need, not ability to pay, it must reform and change. We cannot allow it to stand still. I believe that these clauses and amendments provide an essential framework to ensure continuity of access to service, value for money for taxpayers and better quality patient care.

[Rosie Cooper]

Members of the public listening to Government Members this afternoon might wonder whether we were having this debate in a parallel universe, because they have heard the Prime Minister promise that there would be no top-down reorganisation of the NHS, and what did we get? We got the biggest reorganisation in the history of the NHS. The Prime Minister said only recently that everyone was on board and behind the Bill, and yet we find that clinicians, professionals and the public are far from being on board. The Government talk about the protection of services, but the public will have read only yesterday that the Government are meeting McKinsey about the possible transfer, albeit a slow transfer, of up to 20 hospitals.

[Mr Simon Burns]

indicated dissent.

[Rosie Cooper]

The Minister keeps saying no, but the reality is that, as I told the Secretary of State, you may very well be fooling yourselves, but you are not fooling the public, and the Bill was wrong. That was followed by a pause, and when you admitted that you had got various bits of it wrong, you then said—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. The hon. Lady must desist from using the word “you”, as it refers to the Chair.

[Rosie Cooper]

I apologise, Mr Deputy Speaker. Each time I said “you”, I meant the Secretary of State.

The Secretary of State simply threw the Bill at the British public after the Prime Minister had promised that this would not happen. I have been very clear in the speeches I have made so far on the Bill that the only people the Secretary of State is fooling are those in the Tory party. He has made changes to the Bill, but we are now beginning the great mix-up and going back to exactly where we were.

The hon. Member for Boston and Skegness (Mark Simmonds) said that Labour did not want progress and good value, and that the coalition programme was all about ensuring that the NHS survived and getting a good return for the taxpayer. Let me tell him that I am absolutely passionate about the NHS. I expect value for money, cutting-edge treatment, efficiency and the best possible care for everyone in this country. The lives of every taxpayer and every family depend on the care they get from the NHS. Second rate will not do for me at all.

However, I do not believe that throwing a grenade into the NHS systems will achieve that. Even breaking big promises will not achieve that, because that will break the trust. I suggest to the Conservative party that the Great British public gave tentative support during the general election and will now withdraw that support rapidly as the Bill progresses. The Conservatives expect the public to believe that the party that promised no top-down reorganisation and then broke that promise can be trusted when it says that there will be no privatisation of the NHS, yet evidence comes to light via freedom of information requests that that is not the case.

What are patients out there actually experiencing? Again, Conservative Members can fool themselves. When they went to accident and emergency units they saw that the four-hour waiting time was being exceeded, so they abolished it. It is already taking longer to treat fewer people, which does not strike me as particularly efficient or good value for money. It took 13 years of a Labour Government to rebuild the NHS after what the previous Conservative Government did to it. Labour reduced waiting lists from two years to 18 weeks. It has taken the coalition Government less than a year to wreck it all again. Broken promises are leading us to an NHS that is broken again.

Let us look at what is currently happening in the NHS. There are two different processes at work: financial efficiency gains and structural reform. The idea was to ask the system to make efficiency gains of 4% each year for four years. On top of that there is the reorganisation, which a Conservative Member has likened to tossing a grenade into the system. We have had muddle, pause, fog and are now effectively back to where we were some time ago.

The reforms do not address the financial challenges, especially the Nicholson challenge. This is costly—making people redundant, throwing organisations into disarray and telling people, “You don’t have a future, you might have a future,” “Let’s have a cluster, let’s not have a cluster,” “Where are you going to work?”, “It’s all going to disappear by 2013,” “There are no PCTs—well, they’re there really, but clusters will do the work,” “No, we don’t have strategic health authorities—well, okay, we’ll keep four of them.” The Marx brothers would be proud of the stops, turns, U-turns, pauses and muddle that there have been. But the bottom line is that the great British public have to watch those antics and are worried about their health service.

19:30

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Does my hon. Friend have any idea of how much the reorganisation is going to cost? The hon. Member for Boston and Skegness (Mark Simmonds) made a very reasonable speech, but I noticed that he was confessing at the end that he did not know how some of the central parts would work, and he posed those questions. Does my hon. Friend have any idea of how it is all going to work at this stage, and what it will cost? If not, does she think it conceivable that enough members of the public can know, and have any confidence in the changes?

[Rosie Cooper]

I can categorically say that we have asked the questions over and again and we do not get any answers.

[Mr Burns]

The impact assessment.

[Rosie Cooper]

How much? I will give way if the Minister tells me exactly how much it is all going to cost. I shall happily sit down; there you go. [Interruption.]

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. This is not a conversation but a debate. I do not think that the Minister indicated that he wished to intervene.

[Rosie Cooper]

Thank you, Mr Deputy Speaker. You will forgive me; my lip reading was obviously slightly wrong. He looked as if he was trying to tell me something, and I hoped that it might be the answer.

In all such situations I always say, “Follow the money.” What is actually going to happen? If this is costing a lot of money—there is a lot of muddle—it has to be really clear that the driver of the reforms cannot be, as the Secretary of State has previously said, the idea that the NHS is unaffordable; we seem to be able to afford a lot of other things. If the reason is not financial efficiency, it has to be purely ideological.

I understand that 85% of respondents to the NHS Confederation survey were very clear: the hardest job that they could have is to deliver both NHS changes and savings simultaneously. That makes it harder for them to deliver objectives for improving efficiency and quality—but that is what I am told that Government Members are all about; the Bill is supposed to improve efficiency and quality.

Who is going to deliver the health care? The Royal College of Nursing suggests that 27,000 front-line jobs, equivalent to nine Alder Hey children’s hospitals, will disappear. I asked the NHS Confederation whether we would see hospital closures, and it is clear that we will; we are seeing that in various reports. The Bill is three times longer than the Act that created the NHS, and it leaves more questions than answers. I say to the Government that if they believe that the great British public will be fooled by any of this, they are sadly wrong.

I do not normally make personal statements about anybody, but Roy Lilley, a former NHS professional, writes a blog in which he refers to the Secretary of State as “LaLa”; I am sure the Secretary of State has seen it. I have been hearing “La la” all afternoon. This is just nonsense. Just because the Secretary of State or the Tory party says that the world is square, that does not mean that it is. They are insulting the public if they think that they will go along with them.

Monitor makes decisions about the future sustainability of individual services and the patterns of local health services under the failure regime. It is unclear how those decisions would be made, and how and to whom Monitor is accountable. Technically it is an independent body and it should be responsible to Parliament and the Secretary of State, but perhaps the Secretary of State will clarify that.

As the economic regulator, Monitor is given a whole series of powers that ultimately focus on enforcing competition in the NHS. There are still fundamental gaps in how that organisation will be held to account. There is a lack of clarity about how health services can engage with and influence the work of Monitor. Having been chair of a foundation trust hospital, albeit only for a month—because I stood for Parliament and had to resign—I can say that Monitor was a law unto itself. And before the Health Committee, Monitor likened the NHS to utility companies, which does not give me any confidence whatever.

I want to talk about Monitor not consulting commissioners on changes to enhance tariff. Private providers can apply to Monitor for an enhanced tariff to preserve the services that they, as private businesses, are providing to the NHS.

[Tom Blenkinsop]

One essential point that we have to raise about Monitor is that it is a replica of an economic regulator of the utilities. The four to six companies in the energy sector have just raised gas prices by 18% and electricity by 11%. How does my hon. Friend think Monitor will be able to cope with private companies and health?

[Rosie Cooper]

I would suggest that it is a failing model, and not one that we should be looking at.

I should like to look at the idea of risk pooling, in which Monitor will have a role. Monitor will be required to top-slice the budgets of foundation trust hospitals to obtain that pool of money. The problem is that if the trust is already in financial difficulty, the fact that Monitor needs to top-slice the FT hospital’s budget could tip it into being unsustainable, and then Monitor would have to act. Does that not seem back to front? It needs looking at. If the foundation trust is unsustainable, Monitor has a duty to take action, yet Monitor may well have precipitated the situation; there seems to be a conflict at the core of that relationship. There is no clarity about how top-slicing will be calculated, or what it will involve. Will the Secretary of State please comment on that?

I shall bring my comments to a close with a quotation that I used in a speech I gave a while ago. In “This Week”, Michael Portillo was asked by Andrew Neil why the Government had not told us before the general election about their plans for the NHS. He replied:

“Because they didn’t believe they could win the election if they told you”—

the public—

“what they were going to do. People are so wedded to the NHS. It’s the nearest thing we have to a national religion—a sacred cow.”

He could not have been more clear. The Government intended to misrepresent their position and mislead voters. I believe that this is the latest stage of that misrepresentation, and the Government must be held to account if they force the Bill through in its current form.

[Dr Poulter]

I was hoping to begin on a more consensual note, picking up on a few things that have been said around the Chamber on which I thought we could all agree. However, I will first remind the hon. Member for West Lancashire (Rosie Cooper) of why the Government are introducing this Bill. We do have problems in the NHS. Far too much money—about £5 billion a year—is wasted on bureaucracy and could be much better spent on front-line patient care. Over the past 10 years, the number of managers in the NHS has doubled, going up six times as fast as the number of front-line nurses; the hon. Lady is very concerned about that. A lot of things need to change in the NHS so that the service can become more patient-focused and patient-centred. That is why we are making these changes and why the reforms in this Bill have to go through the House.

Particularly important—this has come out of the pause for reflection and the Future Forum report—has been an increased focus on one of the key challenges for the health service and for adult social care: better care of our growing older population. People are living a lot longer and living longer with multiple medical conditions, or co-morbidities as they would be termed in medical parlance. That is a very big human challenge for the NHS, and also a very big financial challenge. We must have a service that better meets and better responds to those challenges. The pause for reflection has led to much more focus on improved integration of care, and that will be very much to the benefit of the older patients and frail elderly whom we all care about.

We have had a lot of discussion about the benefits, or otherwise, of using the private sector. The case for the private sector may have been made much more eloquently by Labour Members than by members of the Government. The hon. Member for Easington (Grahame M. Morris) argued that because the previous Government used the private sector to reduce waiting times, it was effectively used to improve patient care for patients with cataracts and for those needing hip operations or waiting for heart operations. That, in itself, was a good thing, but the problem was that the previous Government used the private sector far too much in a way that allowed it to make profits but not to look towards the integrated care that Government Members would like to see as a result of these health care reforms. As regards looking after the frail elderly, for example, there was cherry-picking of hip operations as part of orthopaedics but without the follow-up care that was required—the physiotherapy, occupational therapy and social services that those older people so badly needed. Yes, the private sector can bring value and benefits to the NHS, as the previous Government recognised, but it has to be done in an integrated way, and that is what we will do as a result of these health care reforms.

Why else do we need to reform the NHS? Are we really happy with the status quo?

[Steve McCabe]

Before the hon. Gentleman moves on, I want to make sure that I have understood him. Is he saying that under these plans the private sector is to be given a bigger share—a more total share—of areas of care and that it will not be isolated as a bit of expanded capacity to reduce waiting lists? Is he saying that it will have a broader role involving a total package of care for particular sectors? Is that the aim?

[Dr Poulter]

The aim is consistent with that of the previous Government in bringing in the private sector—to improve patient care. Where the private sector can deliver high-quality patient care—for example, by reducing waiting times—that is a good thing. The private sector can deliver high-quality care but in an integrated way. That is particularly important in the elderly care setting and in rural communities. That is absolutely consistent with what the hon. Gentleman’s Government did and what this Government are trying to build on and develop as a part of this package of reforms.

Are we really happy with the status quo—with the NHS as it stands? I have alluded to some of the waste and bureaucracy and the £5 billion that could be better spent on front-line patient care, but that would be a simplistic view of why we need to improve the NHS. We have heard the names of various bodies being bandied around today. However, on-the-ground surveys of front-line doctors and nurses show, as in a survey conducted in 2009, that in the current NHS the majority of health care staff in hospitals do not believe that looking after patients is the main priority of their NHS trust. What could be more important to a hospital than looking after its patients? The reason for that finding is that the bureaucracy in the processes of health care has often got in the way of delivering good care. Recently, a number of CQC reports throughout my part of the world—the east of England—have indicated failings, particularly in elderly care. The main focus of those reports was that staff were too bogged down with bureaucracy and paperwork and unable to look specifically at the needs of the patients right in front of them.

19:45

[Barbara Keeley]

I think that a few Labour Members are quite surprised by what the hon. Gentleman has said, and the Hansard writers might ask him where it came from. He cannot get away with making a statement like that and not saying where it came from—he should be quoting it. He is saying that the majority of people working in the NHS surveyed in 2009 did not put patient care at the top of the list, and he should quote where that information comes from.

[Dr Poulter]

The point is—I speak as a front-line doctor who still practises in the NHS—that far too often we see form-filling that gets in the way of our doing our job as doctors in hospitals, and that is not for the benefit of patients.

[Barbara Keeley]

Will the hon. Gentleman give way?

[Dr Poulter]

No, sit down. The hon. Lady should listen to this, because it is important. The point is that doctors and nurses need to be allowed to get on and do their jobs.

A key focus is not just about putting more money into front-line patient care but making sure that we have clinical leadership of services. Form-filling for the sake of it does not benefit patients; what benefits patients is allowing doctors to treat those in front of them. Under the perverse incentives that were created previously, the four-hour wait in A and E means that a patient with a broken toe is just as much of a priority as someone with potentially life-threatening chest pain. That is the problem with the service that we have, and that is why the clinical leadership and focus that this Bill is bringing will be so important.

[Valerie Vaz]

rose—

[Dr Poulter]

I am going to make a little progress. Other speakers want to contribute, so I hope that the hon. Lady will forgive me for not taking her intervention.

The Bill focuses on integration and looks to improve the care particularly of our frail elderly. There is too much silo working in the health service—in primary care, in secondary care and in adult social services. The Bill seeks to integrate services through the role provided by Monitor in helping to provide an overarching view of value for the patient and through the setting up of health and wellbeing boards at local level. That is intended to provide better integration of adult social care with NHS care, which has not happened in all parts of the country.

The hon. Member for Easington made a very good speech in which he said that care was hugely variable throughout different parts of England. That is because in many areas we do not have properly joined-up thinking about how things are done. For example, hospitals are paid on payment by results, but there is no incentive necessarily to reduce admissions and to provide much more focused community care, which would be so important in improving the care of the frail elderly in their communities and in their homes. The Bill is starting to take the first steps towards that sort of joined-up thinking.

If Labour Members are concerned about this, the point was well made by Lord Warner in his recent comments as part of the Dilnot report. The right hon. Member for Holborn and St Pancras (Frank Dobson) laughs, but he served alongside Lord Warner in the previous Government.

[Frank Dobson]

rose—

[Dr Poulter]

The right hon. Gentleman did not give way to me, but I will give way to him in a moment and listen to what he has to say. He sat alongside Lord Warner as a member of the Government, and Lord Warner has said that the previous Government did not pay enough attention to how we are better to integrate services and provide adult social care in the context of the NHS and other services.

[Frank Dobson]

I am glad that when I was Secretary of State for Health, Norman Warner did not get anywhere the Department of Health. I can report, on behalf of my London colleagues, that when he became an arbiter of the future of health care in London he must have been about the most unpopular person who has ever had that job.

[Dr Poulter]

The right hon. Gentleman was a part of the party of Government at that time. Lord Warner was a leading member, and it is fair to point out that he has come forward with some good cross-party recommendations that we very much welcome. The recommendations point to the fact that the key challenge for the NHS is better integrating services and providing high-quality patient care, especially in elderly care and adult social care. That has not happened as effectively as it should have done in the last 10 years and we need to ensure that it does happen. That is why this Bill is a good thing.

Members on both sides of the House have generally welcomed the use of the private sector where it can add value to the NHS, especially for patients. That has to be a good thing, but we need to ensure—as the Bill does—that we do not have the cherry-picking that we saw in the past. We need to ensure that we have a health service that provides better value for money, better care and more integrated adult social care and health care for the frail elderly.

[Liz Kendall (Leicester West) (Lab)]

This is a crucial part of the debate that we will have over the next couple of days. Parts 3 and 4 of the Bill are at the heart of the Government’s proposals for the NHS and of the concerns that professional bodies, patient groups, members of the public and Members—at least on this side of the House—have about those proposals. These parts will introduce a new economic regulator for the NHS, modelled on the same lines as those for gas, electricity and railways. They also enshrine UK and EU competition law into primary legislation on the NHS for the first time.

We have also been discussing crucial new amendments that, despite what the Secretary of State says, have not been scrutinised by the Future Forum, about the Government’s new failure regime. That essentially addresses which local services and hospitals—such as we all have in our constituencies—will be allowed to fail.

Each of these subjects should be subject to separate and far longer debates, because they are of such importance to our constituents, our local NHS staff and our local services. However, because the House has been given so little time and the Government have tabled so many amendments, we have been forced to take these huge issues together—[Interruption.] As always, the Minister of State groans from a sedentary position, but Members have a right to question the Government on their proposals for local hospitals and services, and three or four hours is not sufficient. I hope that the other place will take that into account.

The Bill establishes Monitor as an economic regulator, modelled on the same lines as those for gas, electricity and railways. The explanatory notes make this explicit. Page 85 states that clauses in part 3 are based

“upon precedents from the utilities, rail and telecoms industries”.

Indeed, in an interview with The Times earlier this year, David Bennett, the new chairman of Monitor, confirmed that that was the Government’s plan, saying that Monitor’s role would be comparable with the regulators of the gas, electricity and telecoms markets.

Labour Members have consistently argued that such a model is entirely wrong for our NHS. People’s need for health care is not the same as their need for gas, water or telecoms. There is a fundamental difference between needs, ability to benefit, the complexity of services and the fact that they are far more interlinked. The NHS is not a normal market. It is not like a supermarket, or like gas or the railways. There are much more important issues at stake.

The Government have made some minor amendments to Monitor’s duties, but they will not ensure the integration and collaboration that many hon. Members recognise is vital to improving health, especially for patients with long-term and chronic conditions. As my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) said, the duties still rig Monitor in favour of competition. It is not only Monitor’s duties that do that. Chapter 2 of part 3 contains 12 clauses that explicitly introduce competition law into primary legislation on the NHS for the first time. The clauses give Monitor sweeping powers to conduct investigations into NHS services; to disqualify senior staff in hospitals and other NHS services; and to impose penalties for breaches of competition law, including the power to fine services that are found to have broken the law up to 10% of their turnover. Not only that, but third parties, including competitors, can bring damage claims against those services.

The Government claim, as the Secretary of State did earlier, that somehow those provisions will not change anything. In that case, why bother to have the clauses in the Bill? As the hon. Member for Southport (John Pugh) said, Labour Members have argued not that the Bill extends the scope of competition law, but that it extends the applicability of competition law to the NHS. It is not just the clauses on Monitor and competition law that do this, but others such as those that abolish the private patient cap on foundation trusts, and other Government policies, such as that of “any qualified provider”.

[Andrew George]

I hope that the hon. Lady shares my disappointment that, despite the fact that we have debated this issue for four hours and that I have tabled nine selected amendments, I have not had the opportunity to explain the purpose of those amendments—even though the Secretary of State referred to them in his opening remarks. Does she accept, for example, that amendment 1207 relates to clause 58(3) and balancing competition versus anti-competitive behaviour? The other amendments seek to give integration a greater priority for the regulator to enforce.

[Liz Kendall]

I understand why the hon. Gentleman tabled those amendments and I understand his concerns. Opposition Members have consistently argued that the Bill threatens to pit doctor against doctor and service against service when they should be working together in the best interests of patients. Our view is that a far better approach than seeking to amend the Bill would be to delete part 3, because it is a fundamentally wrong way to treat our NHS. A few small changes to Monitor’s duties would not alter what the Bill seeks to do, and that is why amendment 10 proposes deletion of part 3.

The Bill will guarantee that the NHS will be treated as a full market, and the providers of services will, for the first time, be treated as undertakings for the purpose of competition law. The Secretary of State said that the Bill would not increase the applicability of competition law, but the Minister of State confirmed it when he told the Committee:

“UK and EU competition laws will increasingly become applicable…in a future where the majority of providers are likely to be classed as undertakings for the purposes of EU competition law, that law…will apply.”––[Official Report, Health and Social Care Public Bill Committee, 15 March 2011; c. 718.]

If the Government wish to claim that that would not be the effect of the Bill, they should publish any legal advice they have taken. Again, we have two different stories. The Minister of State says that the Government have taken legal advice, but in answers to parliamentary questions we hear that the Government have not taken legal advice. Members deserve to know what the advice is about the implications of this Bill.

NHS staff, patient groups and members of the public have very real fears about the consequences of the Government’s proposals and the full market that is envisaged in the Bill. The previous Government saw that giving patients more choice and a greater say in their treatment, and bringing different providers into the system—including from the private and voluntary sectors—can bring real benefits, including improving outcomes and efficiency, especially in elective care. But we always did that using clear national standards that this Government are abolishing and with the ability to manage the consequences that choice and competition bring.

20:00

One of the problems with this part of the Bill is that it does not recognise what some hon. Members have talked about—the interdependency of services. If we remove one service from a hospital, it has a knock-on effect on others. The ability to get the benefits of diversity and competition without destabilising services is a tricky balance, but the Bill does not acknowledge that balance. I am not just talking about the clauses we are discussing now. The Government are also abolishing key organisations, including primary care trusts and, in particular, strategic health authorities, which have an important role in managing the consequences of choice and competition in the system. The two biggest challenges facing the NHS are to specialise and centralise some services in specialist hospitals and to shift other services from district general hospitals out into the community. These changes will have consequences for hospitals. The Bill will make the changes harder to make, and the clauses that we are discussing will prevent the kind of close working and involvement of patients, the public and elected representatives that we need in order to make these changes happen.

The clauses also have consequences and implications for taxpayers. We come to the issue of Monitor’s costs. Chris Ham, the head of the King’s Fund, the well-respected health think tank, wrote in a British Medical Journal article in February that

“the government’s proposals run the risk of replacing the bureaucracy of performance management with the red tape of economic regulation. Monitor will need to employ large numbers of economists, lawyers, accountants, and managers to deal with competition issues, providers who fail, price setting, licensing providers, and other work.”

That is not just a risk; it is a reality. The Minister of State kept changing his position in Committee. Initially he told us that the costs of Monitor would rise from £21 million a year at present to £130 million a year, but he then revised that figure down to £80 million. Of course, however, because the Government have not bothered to publish their impact assessment for the Bill, we have no idea what the costs of setting up this huge new regulatory body will be. It is not just Monitor that will end up having to employ lawyers, accountants and managers; clinical commissioning groups in hospitals will probably need to do it too. They could even be forced to take out expensive insurance in case they are fined, taken to court or even sued because they have fallen foul of competition law.

It is for all those reasons that we are so concerned about the Bill: because we do not think that the NHS should be remodelled along the same lines as the privatised utilities; because we think that competition is not the panacea that the Government think; and because we think that there are very real risks that the legislation will stop hospitals working together and developing their own community services because it could be seen as anti-competitive behaviour.

I turn to Government new clauses 2 and 6 and the series of Government amendments on their new failure regime. It is important that we are clear from the start about the purpose of these amendments, even though we have had only a very brief time to look at them—none of the professional bodies, health experts or managers has had a chance to scrutinise them properly. The Government claim that they are about securing continued access to services for NHS patients. That is an admirable attempt to spin what this is about. In fact, it is a fundamental part of the Government’s plan to create a market in which more services will be likely to fail because it is a way of getting new people into the system. That is the reality of what is happening. The future of local services and whether they will be allowed to fail will be determined not by local clinicians, not by local patients and the public and not by locally elected representatives—I shall explain to the Secretary of State in a moment why his own policies will not do that—but by the new economic regulator, Monitor. I do not believe that this is what people want for their NHS, and it is not supported by Labour Members.

We have heard a lot from some Government Members about how bail-outs and bungs to NHS services have to end. I would just say that many services have received money because we want those services to continue. In my own constituency, Leicester hospitals are facing challenges and problems, and it would be useful to know whether, if their current £11 million deficit was covered by money found within the local health economy, it would be considered a bail-out or bung that would not be allowed under this system. I would be interested to hear from the Secretary of State whether that would be the case. Some Members will have an entire hospital in their constituency at risk of failing financially. We know this because Sir David Nicholson, the chief executive of the NHS, told the Public Accounts Committee on 25 January that there were 20 failing trusts—trusts that cannot become foundation trusts. I have asked the Minister repeatedly for a list of these trusts so that hon. Members who have patients who use those hospitals will know which ones they are and what the Government’s plans for them are. Once again, however, the Government have failed to be open about that, which is a mistake because difficult changes can be made only if the Government genuinely engage with patients, the public and Members of the House on the decisions being taken.

The Bill also proposes removing the ability for foundation trusts to revert to NHS status and the ability to transfer assets and staff from the NHS, including to the private sector. Far from ending cherry-picking, as Government Members claim, it allows Monitor to vary prices for NHS services, including to private providers. That is what these new amendments state. The Government have made much of their claims to the Future Forum that cherry-picking will be ended. We did not get to discuss the cherry-picking amendments, and the new amendments now allow Monitor to do just that, which is a matter of great concern. These issues have not been scrutinised by doctors, nurses, managers, other NHS staff or local councils—and not even by the economic regulator, Monitor, which is running the process, or the Future Forum. It will therefore fall to Members of the other place to ensure that they hear the views and concerns of those bodies when they are scrutinising the Bill.

The situation is even more concerning because of the Government’s poor track record—that is a polite way of putting it—on this issue. They got it badly wrong the first time round with their proposals for Monitor to designate which services are essential for patients and which would be allowed to fail. In the first Bill Committee, we argued against designation because it failed to ensure proper local democratic accountability; because it failed to understand that allowing one NHS service to fail would have a knock-on effect; because it failed to recognise the in-depth local knowledge required to make these decisions; and because it was a cumbersome and bureaucratic process. Above all, we argued that the process was wrong because it should be driven not by the economic regulator, Monitor, which is unelected and unaccountable, but by local people, patients and staff. The Government refused to listen, denying that any of our concerns were valid. I am glad that when the Future Forum made the same arguments as Labour Members, the Government put aside political prejudice and agreed to delete their designation clauses. However, they are making the same mistakes again. The new failure regime will be driven not by clinicians but by the economic regulator, Monitor. It will not give patients and the public a strong voice and it will not ensure effective local democratic accountability.

In reality, Monitor will take the lead in deciding which services are essential for local people and therefore whether they should continue in any form; whether and how it should intervene to try to prevent services from failing; and, if a service cannot improve and needs to close, what will be put in its place. The NHS Confederation says in its briefing for this debate:

“under these proposals Monitor will make fundamental decisions affecting the sustainability and future of individual services…the pattern of local NHS provision and we are concerned that it is unclear how Monitor will take decisions and how it will be held accountable.”

[John Pugh]

Is there not a big difference between making fundamental decisions, as we accept Monitor will sometimes have to do, and what the hon. Lady has just described, which is about taking the lead in the integration and sourcing out of services, which presumably is what the commissioners do? If she has read the other bits of the Bill, as I am sure she has thoroughly, she will be aware that the commissioners have a pivotal role in determining the shape, structure and character of local services.

[Liz Kendall]

I should add that, as the hon. Gentleman will see, page 6 of the briefing notes that the Government published on the Bill says that clause 104 would

“give Monitor discretion in determining where it is appropriate to include standard licence conditions for the purposes of securing continuity of services”.

As the NHS Confederation asks, how will Monitor have the local information and intelligence to make such complex judgments? How should patients and the public be involved? Monitor then has to keep the level of risk of the service under review, as well as taking decisions about whether and how to set differential prices for providers, to ensure the continuity of the process. How it is supposed to do that and how Members of this House, patients, the public or local councils are meant to hold it to account for that process is far from clear.

My biggest concern about the proposals is that they leave Monitor to intervene proactively to prevent services from reaching the point of failure. None of us wants such an outcome, but it is completely unclear when or how Monitor would do that. Page 10 of the technical annexe to the proposals said that the Government would

“expect Monitor to establish transparent and objective tests to determine when intervention is necessary and what level of support a provider would require”,

and claims that

“This would provide certainty to patients and providers”.

However, we have seen none of those details, and nor do we have any way of changing or influencing what Monitor does about the process, which is a real issue for hon. Members. Even under this Government’s flawed approach, it is astonishing that they say that they would only “expect” Monitor to publish criteria for early intervention. Why is that not in the legislation? Why is Monitor not required to publish and widely consult?

I want briefly to set out a couple of other concerns about the process. If it ends up not being possible to prevent a service from failing, what happens next? A trust special administrator will be appointed to take control of the hospital and report to Monitor and then to the Secretary of State. However, there is nothing in the legislation to say that local clinicians, let alone locally elected representatives, have to agree or sign off such proposals. Indeed, page 15 of the technical annexe says that “where possible”, the trust special administrator should

“secure agreement from clinical senates and clinical advisers”.

The idea is that clinicians would not be required to sign off the decision—the trust special administrator might also consult the health and wellbeing board, for example—about which I know many Government and Opposition Members have been concerned. There is nothing in the proposals to say that Monitor has to look at the impact of decisions in one part of a hospital or service on either the rest of the hospital or the wider health community. With the abolition of strategic health authorities, which take that regional view, that becomes a real concern.

The reason these proposals are so important is that there is a risk that there will be more failing services in future, and not only because of the financial squeeze that the NHS is facing—many hon. Members have talked about the real issue out there, which is that services are struggling to keep going, experiencing problems in balancing books and keeping on NHS staff—but as a direct result of Government policy to drive a full market into every part of the service, albeit without any ability to manage the consequences. In fact, the Government’s own documents make it clear that that is the point of competition. Paragraph B112 of the explanatory notes to the Bill states:

“For competition to work effectively, less effective providers must be able to…exit the market entirely”.

The Secretary of State likes to try to explain his way out of this system, but he cannot have it both ways. Either he wants that—for services to fail and new providers to be brought into the system—or he does not.

20:15

I want briefly to talk about two of our key sets of amendments in this group. Amendment 30 seeks to remove the provisions allowing NHS staff and property to be transferred outside the NHS in the insolvency process for failing providers, while our amendments 8, 9, 19, 20 and 116 would maintain the existing regime, by not removing the NHS trust safety net.

The challenge for the Secretary of State is that he likes to argue two different things to two different audiences. On the one hand, he likes to say that he is the champion of competition, diversity, not bailing out failing services and allowing services that are ineffective—however that is defined—to fail. On the other hand, he wants to convince staff, members of the public, constituents and some Members of this House that what he really wants is integration and collaboration—that he wants to give clinicians, patients, the public and locally elected democratic representatives the final say over services, not the market. He cannot have it both ways, and Opposition Members know what the truth is. He wants to see a system in our NHS that would pit doctor against doctor, and service against service—one that would let the market rip without any ability to manage the consequences that choice and competition bring. Opposition Members do not believe that to be the right approach for our NHS or the people we represent. That is why we have tabled our amendments to this part of the Bill, and why we will be opposing it.

[Andrew George]

rose—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. If the hon. Gentleman will resume his seat, let me say that the knife comes down at 8.30 pm and I would like the opportunity to give the Secretary of State five minutes at the end of this debate. I would therefore be grateful if the hon. Gentleman would watch the clock and bear that in mind.

[Andrew George]

No pressure, then. I will be as brief as I can. I tabled nine of the amendments in this group, and I had hoped to spend a little more time on them than I have been given this evening. I accept new clause 2, which I shall be supporting; the purpose of that proposal is primarily to rearrange the deckchairs on the Titanic, so that they do not get in the way of the lifeboats. I am happy to support new clause 2, although I have already made clear my views on the Bill and the general direction of the Government’s policy. I am not persuaded by many aspects of the Bill; indeed, I am very unhappy about them. I was very persuaded by the coalition agreement and felt that the balance of policy proposals in it was pretty much right. There were a number of debating points about the role and dynamics of “any willing provider”, but apart from that the themes were absolutely right. However, they were not reflected in the White Paper.

That said, the purpose of my amendments—the right hon. Member for Holborn and St Pancras (Frank Dobson) articulated this point far better, I am sure, than I am about to—is primarily to ensure that Monitor’s role to ensure that anti-competitive behaviour is kept in its box is balanced by looking at the impact of competitive behaviour that might undermine the ability of NHS services to collaborate.

The underlying purpose of amendments 1207 and 1208 is to neutralise or balance the new duty on Monitor to prevent anti-competitive practices that are against the interests of the people who use the services—in other words, patients—by also applying a duty to prevent anti-collaborative practices that would have the same effect. The Government say that that would result in Monitor preventing all practices that were against the interests of patients, but I disagree. Some unsafe practices would be neither competitive nor anti-competitive. The amendments would result in there no longer being a focus mainly on dealing with anti-competitive practices. I believe that that would strengthen the role of the regulator. This is a question of putting competition in its box, and it is important to ensure that it is put properly in its box, properly defined, and that the lid is put on. The purpose of the amendments is to achieve that outcome.

The Secretary of State told me, in response to an intervention relating to amendments seeking to secure a far better ability for Monitor to regulate the integration of services, that it should not be Monitor’s role simply to sustain services that are presumably otherwise unsustainable. The problem with that, in relation to my amendments 1205, 1209, 1229 and others, is that we need to ensure that we sustain the essential services. The important point here, which others have articulated, is that certain services clearly need to integrate. An example is acute emergency trauma centres. If the orthopaedic, paediatric or ophthalmology services were removed from such essential centres, their ability to deal with a wide range of emergencies would be fundamentally undermined. They serve populations of between 250,000 and 500,000 people—sometimes more—and they are absolutely essential. We must ensure that we do not end up with a regulator that allows them to be undermined by imposing a duty on them not to act in an anti-competitive manner.

The purpose of the amendments is to probe these issues, but the Government have made it clear that the NHS will no longer be the preferred provider, which leaves a question mark over the future of those essential and acute services. I will sit down now in order to give the Secretary of State more time than you requested for him, Madam Deputy Speaker, but I want to emphasise that I shall support the Government’s new clause. My amendments are probing amendments, but I wish that we had more time to debate these issues. This is very frustrating.

[Madam Deputy Speaker]

Order. I just remind the hon. Gentleman that the timetable for the debate was not set by me. I am merely assisting the House to meet its deadlines.

[Mr Lansley]

I am grateful to my hon. Friend the Member for St Ives (Andrew George) for the additional time, and I appreciate what he said in his speech. On securing continuing access to essential services, we are in exactly the same place. If a service is essential, it will be the responsibility—and, indeed, the objective—of the commissioners of that service to make it clear that they expect the regulator, or the administrator on the regulator’s behalf, to secure access to those services.

That was one of the three points that the hon. Member for Leicester West (Liz Kendall) mentioned. I thought that she made rather a good speech, but its basic premises were flawed. She also said that Monitor would be responsible for making decisions on what happened to services in the event of a failing or failed provider, but that is simply not true. The whole point of this group of amendments, including new clause 6 and amendments 198 and 199, is to make it clear that commissioners will lead in those circumstances. The proposed structure in the event of failure, through the administrator and the regulator, must be led and approved by the commissioners, who will be clinically led. The fact that the hon. Lady can look at the consultation with, for example, clinical advisors and clinical senates, does not preclude the fact that it will be local clinicians leading the process. Nor does it preclude the fact that local authorities will have an opportunity to intervene, through the scrutiny powers that the amendments will bring in. Indeed, even the Secretary of State will have the opportunity to intervene. It will not simply be a matter of Monitor doing this; the process will be led by commissioners and clinicians, and local people will have the opportunity to intervene.

The hon. Lady also mentioned competition. The Labour party seems somehow to have turned against competition, in a complete shift from where it was in 2006. My hon. Friend the Member for Southport (John Pugh) said that we were bringing in Blairite health reforms-plus, but I think that we are doing something altogether more coherent, purposeful and positive. I would far rather that the comparison involved the focus on quality that the noble Lord Darzi brought in when he was a Health Minister. In so far as Mr Blair pursued these objectives when he was Prime Minister, I think that we are doing it much better.

The amendments, and the Bill, will not allow discrimination in favour of the private sector in the way that the last Labour Government did. We are going to stop that. We are going to stop cherry-picking, because variation in price could not be by virtue of the specific characteristics of the provider. Clause 58(10) makes it clear that Monitor cannot discriminate in favour of the private sector. When the hon. Lady’s predecessor as Member for Leicester West, a previous Secretary of State, set a target for the private sector’s proportion of activity in the NHS, she was wrong. We are not going to do that. The only objective is to secure providers that deliver the best quality for patients. That is what we are all about.

I am grateful to other colleagues for their contributions to the debate, to which I cannot do justice. My hon. Friend the Member for Boston and Skegness (Mark Simmonds) asked whether commissioners would lead improvements in quality. The commissioning board will sort out disagreements, monitoring the commissioners, and together they must draw up plans to deal with providers that have failed.

My hon. Friend the Member for Southport asked whether Monitor or the Office of Fair Trading would deal with mergers. If we were to decide that it should be Monitor, the OFT would still have jurisdiction through its merger regime, so we would be duplicating that regime. I can assure my hon. Friend that, when the OFT is involved in any FT mergers, it will seek sectoral advice from Monitor, and that patient’s interests will always be central to the considerations during the merger.

The hon. Member for Easington (Grahame M. Morris) and other Labour Members were going on about the takeover of failing hospitals by foreign companies. Let me make it clear to them that the last Government, in the National Health Service Act 2006, enabled the franchising of an NHS trust to a private company. That is the legislation under which the last Government initiated the franchising of management at Hinchingbrooke hospital. The last Labour Government then passed legislation in the form of the Health Act 2009, which would have enabled exactly the same thing to be done for foundation trusts, following de-authorisation. Our proposals would specifically prevent that, because we prevent de-authorisation in that way and we are withdrawing the 2006 legal framework for NHS trusts, which, in the long run, of course, will cease to exist.

This group of amendments is part of ensuring that the NHS is and always will be there when we need it. Through this Bill, we will strengthen our confidence in continued access to the services patients need. By contrast, the Opposition would leave the NHS stranded; they would take it back; they are by turns reactionary and opportunist. I invite the Opposition to withdraw their amendments and, if not, I invite the House to reject them. I understand the positive intentions of my hon. Friends who have tabled amendments, but I also ask them to withdraw them. Strengthened by our continuing commitment to listen and to respond, I invite the House to agree to the Government new clauses and amendments.

Question put, That the clause be read a Second time.

The House proceeded to a Division.

[Madam Deputy Speaker (Dawn Primarolo)]

I ask the Serjeant at Arms to investigate the delay in the Aye Lobby.

20:29

Division 336

Ayes: 304

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Conservative: 254
Liberal Democrat: 49

Noes: 231

---

Labour: 217
Democratic Unionist Party: 6
Plaid Cymru: 3
Social Democratic & Labour Party: 2
Alliance: 1
Green Party: 1
Independent: 1

New clause 2 read a Second time.

20:47

Proceedings interrupted (Programme Order, this day).

The Deputy Speaker put forthwith the Questions necessary for the disposal of the business to be concluded at that time (Standing Order No. 83E).

New clause 2 added to the Bill.

New Clause 6

Objective of trust special administration

‘After section 65D of the National Health Service Act 2006 insert—

“65DA  Objective of trust special administration

(1) The objective of a trust special administration is to secure—

(a) the continued provision of such of the services provided for the purposes of the NHS by the NHS foundation trust that is subject to an order under section 65D(2), at such level, as the commissioners of those services determine, and

(b) that it becomes unnecessary for the order to remain in force for that purpose.

(2) The commissioners may determine that the objective set out in subsection (1) is to apply to a service only if they are satisfied that the criterion in subsection (3) is met.

(3) The criterion is that ceasing to provide the service under this Act would, in the absence of alternative arrangements for its provision under this Act, be likely to—

(a) have a significant adverse impact on the health of persons in need of the service or significantly increase health inequalities, or

(b) cause a failure to prevent or ameliorate either a significant adverse impact on the health of such persons or a significant increase in health inequalities.

(4) In determining whether that criterion is met, the commissioners must (in so far as they would not otherwise be required to do so) have regard to—

(a) the current and future need for the provision of the service under this Act,

(b) whether ceasing to provide the service under this Act would significantly reduce equality between those for whom the commissioner arranges for the provision of services under this Act with respect to their ability to access services so provided, and

(c) such other matters as may be specified in relation to NHS foundation trusts in guidance published by the regulator.

(5) Monitor may revise guidance under subsection (4)(c) and, if it does so, must publish the guidance as revised.

(6) Before publishing guidance under subsection (4)(c) or (5), the regulator must obtain the approval of—

(a) the Secretary of State;

(b) the Board.

(7) The Board must make arrangements for facilitating agreement between commissioners in determining the services provided by the trust under this Act to which the objective set out in subsection (1) is to apply.

(8) Where commissioners fail to reach agreement in pursuance of arrangements under subsection (7), the Board may make the determination (and the duty imposed by subsection (1)(a), so far as applying to the commissioners concerned, is to be regarded as discharged).

(9) In this section—

“commissioners” means the persons to which the trust provides services under this Act, and

“health inequalities” means the inequalities between persons with respect to the outcomes achieved for them by the provision of services that are provided as part of the health service.”’.—(Mr Lansley.)

Brought up, read the First and Second time.

Part 3

Regulation of health and adult social care services

Amendment proposed: 10, page 83, line 5, leave out Part 3.—(Liz Kendall.)

Question put, That the amendment be made.

20:48

Division 337

Ayes: 232

---

Labour: 219
Democratic Unionist Party: 6
Plaid Cymru: 3
Social Democratic & Labour Party: 2
Alliance: 1
Green Party: 1
Independent: 1

Noes: 302

---

Conservative: 254
Liberal Democrat: 47

Clause 60

Power to give Monitor functions relating to adult social care services

Amendment made: 87, page 85, line 14, at end insert—

‘( ) Any regulations under this section must apply in relation to England only.’.—(Mr Simon Burns)

Clause 62

Conflicts between functions

Amendment made: 90, page 86, line 30, leave out paragraph (b).—(Mr Simon Burns)

Clause 79

Designation of services

Amendment made: 91, page 97, line 34, leave out clause 79.—(Mr Simon Burns)

Clause 80

Complaint about grant of application for designation

Amendment made: 92, page 99, line 20, leave out clause 80.—(Mr Simon Burns)

Clause 81

Complaint about refusal of application for designation

Amendment made: 93, page 100, line 4, leave out clause 81.—(Mr Simon Burns)

Clause 82

Reviews and removals of designations

Amendment made:94, page 100, line 22, leave out clause 82.—(Mr Simon Burns)

Clause 83

Complaint about grant of application for removal of designation

Amendment made: 95, page 101, line 26 leave out Clause 83.—(Mr Simon Burns)

Clause 84

Complaint about refusal of application for removal of designation

Amendment made: 96, page 102, line 1, leave out clause 84. —(Mr Simon Burns)

Clause 85

Complaints: general provisions

Amendment made: 97, page 102, line 31, leave out clause 85.—(Mr Simon Burns)

Clause 86

Designations affecting more than one commissioner

Amendment made: 98, page 103, line 8,leave out clause 86. —(Mr Simon Burns)

Clause 87

Guidance

Amendment made: 99, page 103, line 25, leave out clause 87.—(Mr Simon Burns)

Clause 103

Limits on Monitor’s functions to set or modify licence conditions

Amendment made: 100, in clause 103, page 111, line 3, leave out ‘designated services’ and insert ‘health care services for the purposes of the NHS’.—(Mr Simon Burns)

Clause 104

Conditions: supplementary

Amendments made: 101, in page 112, line 5, leave out ‘designated services’ and insert ‘one or more of the health care services that the licence holder provides for the purposes of the NHS’.

102, page 112, line 8, leave out ‘designated service’ and insert ‘health care service for the purposes of the NHS’.

103, page 112, line 12, leave out ‘designated services’ and insert ‘health care services for the purposes of the NHS’.

104, page 112, line 14, leave out ‘designated services’ and insert ‘health care services for the purposes of the NHS’.—(Mr Simon Burns)

Clause 108

Standard condition as to transparency of certain criteria

Amendment made: 105, in clause 108, page 116, line 39, at end insert—

‘( ) The following powers must not be exercised so as to omit the condition mentioned in subsection (1) from any licence under this Chapter—

(a) the powers conferred on Monitor by sections 105, 106(7) and paragraph 7(2) of Schedule 10 to modify the standard conditions applicable to all licences, or to licences of a particular description,

(b) the power conferred on the Competition Commission by paragraph 8(5) of that Schedule to modify those conditions, and

(c) the power conferred by section107 on the Office of Fair Trading, Competition Commission and Secretary of State to modify those conditions.’.—(Mr Simon Burns)

Clause 109

Power to require documents and information

Amendments made: 106, page 117, line 19, leave out ‘Chapter 3 and’.

107, in clause 109, page 117, line 21, at end insert ‘, and

(d) Chapter 5A of that Part of that Act (trust special administration)’.—(Mr Simon Burns)

Clause 119

The national tariff

Amendments made: 113, page 122, line 28, at end insert ‘, and

(d) the method used for deciding whether to approve an agreement under section127 and for determining an application under section128 (local modifications of national prices).’.

114, page 123, line 13, at end insert—

‘() the application of the method specified under subsection (1)(d),’.

115, page 123, line 24, leave out paragraph (a).—(Mr Simon Burns)

Clause 121

Consultation on proposals for the national tariff

Amendments made: 781, page 124, line 44, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

116, page 125, line 8, at end insert ‘, and

(d) the method it proposes to use for deciding whether to approve an agreement under section127 and for determining an application under section128 (local modifications of national prices).’.

117, line 28, at end insert—

‘() the application of the method specified for the purposes of subsection (3)(d);’.

118, page 125, line 39, after ‘(b)’, insert ‘or (d)’.

119, page 125, line 39, after second ‘method’, insert ‘, and such guidance on the application of the method specified for the purposes of subsection (3)(d) as is included for the purposes of subsection (6) is only such guidance,’.

120, page 125, line 40, after ‘specified’, insert ‘and included’.

121, page 125, line 41, after ‘specified’, insert ‘and included’.

122, page 125, line 43, after ‘specified’, insert ‘and the guidance that will be so included’.—(Mr Simon Burns)

Clause 127

Local modifications of prices of designated services: agreements

Amendments made: 123, page 130, line 4, leave out from beginning to ‘may’ and insert ‘The commissioner and the provider of a health care service’.

124, page 130, line 5, after ‘service’, insert ‘for the purposes of the NHS’.

125, page 130, line 16, after ‘if’, insert ‘, having applied the method specified under section119(1)(d),’.

126, page 130, line 21, after ‘to’, insert ‘the Secretary of State and’.

127, page 130, line 26, at end insert—

‘( ) If the Secretary of State considers that the modification gives or may give rise (or, where it has yet to take effect, would or might give rise) to liability for breach of an EU obligation, the Secretary of State may give a direction to that effect; and the modification is (or is to be) of no effect in so far as it is subject to the direction.’.

128, page 130, line 27, leave out subsections (9) to (11).—(Mr Simon Burns)

Clause 128

Local modifications of prices of designated services: applications

Amendments made: 129, page 130, line 33, leave out ‘designated’ and insert ‘health care’.

130, page 130, line 35, after ‘service’, insert ‘for the purposes of the NHS’.

131, page 130, line 41, after ‘if’, insert ‘, having applied the method under section119(1)(d),’.

132, page 131, line 9, after ‘to’, insert ‘the Secretary of State and’.

133, page 131, line 14, at end insert—

‘( ) If the Secretary of State considers that the modification gives or may give rise (or, where it has yet to take effect, would or might give rise) to liability for breach of an EU obligation, the Secretary of State may give a direction to that effect; and the modification is (or is to be) of no effect in so far as it is subject to the direction.’.

134, page 131, line 15, leave out subsection (9).

135, page 131, line 19, leave out subsections (10) to (12).—(Mr Simon Burns)

Clause 130

Application of insolvency law to NHS foundation trusts

Amendment made: 136, page 132, line 3 leave out Clause 130.—(Mr Simon Burns)

Clause 131

Health special administration orders

Amendments made: 137, page 133, line 20, at end insert—

‘( ) A health special administrator of a company—

(a) is an officer of the court, and

(b) in exercising functions in relation to the company, is the company’s agent.

( ) A person is not to be the health special administrator of a company unless the person is qualified to act as an insolvency practitioner in relation to the company.’.

138, page 133, line 33, leave out ‘in the case of a provider which is a company,’.

139, page 133, line 35 , leave out ‘company’ and insert ‘provider’.

140, page 133, line 40, after ‘section’ insert ‘—

(a) a reference to a person qualified to act as an insolvency practitioner in relation to a company is to be construed in accordance with Part 13 of the Insolvency Act 1986 (insolvency practitioners and their qualifications);

(b) ’.

141, page 134, line 4, leave out paragraph (a).

142, page 134, line 12, leave out ‘, in relation to a company,’.

143, page 134, line 15, leave out from ‘means’ to end of line 16 and insert ‘a company which is providing services to which a condition included in the company’s licence under section104(1)(i), (j) or (k) applies;’.—(Mr Simon Burns)

Clause 132

Objective of a health special administration

Amendments made: 144, page 134, line 21, leave out from ‘of’ to ‘, and’ in line 23 and insert ‘such of the health care services provided for the purposes of the NHS by the company subject to the health special administration order, at such level, as the commissioners of those services determine by applying criteria specified in health special administration regulations (see section133)’.

145, page 134, line 28 , leave out ‘NHS foundation trust or’.

146, page 134, line 32, leave out ‘licence holder’ and insert ‘person’.

147, page 134, line 33, leave out ‘NHS foundation trust or’.

148, page 134, line 35, leave out ‘licence holders’ and insert ‘persons’.

149, page 134, line 38, leave out ‘in the case of a company’.

150, page 135, line 1, leave out ‘NHS foundation trust or’.

151, page 135, line 4, leave out ‘trust or’.

152, page 135, line 6, leave out ‘trust’s or’.

153, page 135, line 9, leave out ‘in the case of a company,’.

154, page 135, line 10, leave out ‘its’ and insert ‘the company’s’.—(Mr Simon Burns)

Clause 133

Health special administration regulations

Amendments made: 155, page 135, line 33, at end insert—

‘( ) Health special administration regulations may in particular make provision about the publication and maintenance by Monitor of a list of relevant providers.’.

156, page 135, line 33 at end insert—

‘( ) Health special administration regulations may in particular—

(a) require Monitor to publish guidance for commissioners about the application of the criteria referred to in section132(1)(a);

(b) confer power on Monitor to revise guidance published by virtue of paragraph (a) and require it to publish guidance so revised;

(c) require Monitor, before publishing guidance by virtue of paragraph (a) or (b), to obtain the approval of the Secretary of State and the National Health Service Commissioning Board;

(d) require commissioners, when applying the criteria referred to in section132(1)(a), to have regard to such matters as Monitor may specify in guidance published by virtue of paragraph (a);

(e) require the National Health Service Commissioning Board to make arrangements for facilitating agreement between commissioners in their exercise of their function under section132(1)(a);

(f) confer power on the Board, where commissioners fail to reach agreement in pursuance of arrangements made by virtue of paragraph (e), to exercise their function under section132(1)(a);

(g) provide that, in consequence of the exercise of the power conferred by virtue of paragraph (f), the function under section132(1)(a), so far as applying to the commissioners concerned, is to be regarded as discharged;

(h) require a health special administrator to carry out in accordance with the regulations consultation on the action which the administrator recommends should be taken in relation to the provider concerned.’.

157, page 135, line 42, leave out paragraph (c).

158, page 136, line 5, at end insert—

‘() the power to make rules in relation to Scotland is exercisable by the Secretary of State;’.—(Mr Simon Burns)

Clause 134

Transfer schemes

Amendments made: 159, page 136, line 19 , leave out ‘licence holder’ and insert ‘person’.

160, page 136, line 21 , at end insert ‘, and

() for modifications made to a transfer scheme by virtue of paragraph (b) to have effect from such time as Monitor may specify (which may be a time before the modifications were made).’.

161, page 136, line 23, at end insert—

‘(za) for the transfer of rights and liabilities under or in connection with a contract of employment from a company subject to a health special administration order to another person,’.

162, page 136, line 24, leave out ‘rights and liabilities’ and insert ‘or rights and liabilities other than those mentioned in paragraph (za)’.

163, page 136, line 24, leave out ‘an NHS foundation trust or’ and insert ‘a’.

164, page 136, line 26, leave out ‘licence holder’ and insert ‘person’.

165, page 136, line 26, leave out ‘(including’ and insert—

‘() for the transfer of’.—(Mr Simon Burns)

Clause 137

Duty to establish mechanisms for providing financial assistance

Amendments made: 166, page 137, line 10, after ‘to’, insert ‘—

(a) ’.

167, page 137, line 11, at end insert ‘, or

(b) an order under section 65D(2) of the National Health Service Act 2006 (trust special administration for NHS foundation trusts).’.

168, page 137, line 16, after ‘135’, insert ‘or under section 65D(11) of the National Health Service Act 2006’.

169, page 137, line 27, leave out subsection (6).—(Mr Simon Burns)

Clause 139

Applications

Amendments made: 170, page 138, line 16, leave out ‘health’.

171, page 138, line 17, leave out ‘health’.

172, page 138, line 27, leave out ‘health’.

173, page 138, line 32, leave out ‘health’.

174, page 139, line 5, leave out from ‘Chapter’ to end of line 6 and insert ‘—

(a) “special administrator” means—

(i) a person appointed as a health special administrator under Chapter 6, or

(ii) a person appointed as a trust special administrator under section 65D(2) of the National Health Service Act 2006, and

(b) references to being in special administration are to be construed accordingly.’.—(Mr Simon Burns)

Clause 140

Grants and loans

Amendments made: 175, page 139, line 11, leave out ‘designated services’ and insert ‘one or more of the health care services that it provides for the purposes of the NHS’.

176, page 139, line 17, leave out ‘health’.—(Mr Simon Burns)

Clause 141

Power to impose charges on commissioners

Amendment made: 177, page 139, line 32, leave out ‘designated services’ and insert ‘health care services for the purposes of the NHS’.—(Mr Simon Burns)

Clause 146

Amount payable

Amendment made: 178, page 143, line 19, leave out ‘health’.—(Mr Simon Burns)

Clause 147

Investment principles and reviews

Amendment made: 179, page 144, line 12, after ‘6,’ insert—

‘() the procedure for trust special administration for NHS foundation trusts under Chapter 5A of Part 2 of the National Health Service Act 2006,’.—(Mr Simon Burns)

Clause 153

Interpretation and consequential amendments

Amendment made: 180, page 147, leave out line 34.—(Mr Simon Burns)

Clause 166

Financial powers etc.

Amendments made: 181, page 156, line 39, leave out subsections (1) and (2).

182, page 157, leave out lines 7 to 11 and insert—

“(6) In relation to each exercise of the power under that subsection during the year to which the report relates, the report must specify the amount of the loan, issue of public dividend capital, grant or other payment and—

(a) in the case of a loan, the amount (if any) outstanding at the end of the year and the other terms on which the loan was made,

(b) in the case of an issue of public dividend capital, the terms on which it was issued (or, where a decision under section 42(3) is made in relation to it during that year, the terms so decided as those on which it is treated as having been issued), and

(c) in the case of a grant or other payment, the terms on which it was made.’.

183, page 157, line 17, at end insert—

“(7A) A report under subsection (5) must, in relation to each NHS foundation trust, specify—

(a) the amount of the public dividend capital of that trust at the end of the year to which the report relates, and

(b) the conditions on which it is held.’.

184, page 157, line 21, leave out paragraph (a).—(Mr Simon Burns)

Clause 171

Mergers

Amendment made: 185, page 160, line 24, after ‘(1)’, insert ‘—

(a) in paragraph (b), after “NHS trust” insert “established under section 25”, and

(b) ’.—(Mr Simon Burns)

Clause 172

Acquisitions

Amendment made: 186, page 161, line 8, after second ‘trust’, insert ‘established under section 25’.—(Mr Simon Burns)

Clause 175

Supplementary

Amendment made: 187, page 163, line 12, at end insert—

‘( ) In section 271(3)(b) of that Act (territorial limit of exercise of functions under Chapter 5), for “Part 1” substitute “Part 2”.’.—(Mr Simon Burns)

Clause 176

Repeal of de-authorisation provisions

Amendment made: 188, page 163, line 17, leave out subsection (2) and insert—

‘(2) Omit sections 53 to 55 of, and Schedule 9 to, that Act (voluntary arrangements and dissolution); and in consequence of that—

(a) in section 57 of that Act (as amended by section175 of this Act)—

(i) in subsection (3)(a), for “the persons mentioned in section 54(4)” substitute “another NHS foundation trust, an NHS trust established under section 25 or the Secretary of State”,

(ii) omit subsection (3)(b), and

(iii) in subsection (4), for “any of the bodies mentioned in section 54(4)(a) or (c)” substitute “another NHS foundation trust or an NHS trust established under section 25”,

(b) in section 64(4) of that Act (as amended by section 175 of this Act), omit paragraph (b) (but not the following “or”), and

(c) omit section 18(2) to (6) and (11) of the Health Act 2009.’.—(Mr Simon Burns)

Clause 177

Trust special administrators

Amendments made: 189, page 163, line 39 , at end insert—

‘(1A) For the title to section 65B of that Act substitute “NHS trusts: appointment of trust special administrator”.

190, page 164, line 6, after ‘trust.’, insert—

“(3) As soon as reasonably practicable after the making of an order under subsection (2), the Care Quality Commission must provide to the regulator a report on the safety and quality of the services that the trust provides under this Act.’.

191, page 164, line 12, leave out ‘(but not the “and” following it)’.

192, page 164, line 12, at end insert—

‘() in paragraph (c), omit “goods or”’.

193, page 164, line 12, at end insert ‘, and

() after paragraph (c) insert “, and

(d) the Care Quality Commission.”’.

194, page 164, line 26, at end insert—

“(8A) A person appointed as a trust special administrator under this section must manage the trust’s affairs, business and property, and exercise the trust special administrator’s functions, so as to achieve the objective set out in section 65DA as quickly and as efficiently as is reasonably practicable.’

195, page 164, line 34, leave out ‘The Secretary of State’ and insert ‘The regulator’.

196, page 164, line 35, leave out ‘the Secretary of State’ and insert ‘the regulator’.—(Mr Simon Burns)

Clause 178

Procedure etc.

Amendments made: 197, page 164, line 42 , leave out from ‘(2)’ to end of line 43 and insert ‘—

(a) before paragraph (a) insert—

“(za) the Board,”, and

(b) omit paragraph (a) (but not the following “and”).’.

198, page 165, line 4, after ‘regulator.’, insert—

“(5) In the case of an NHS foundation trust, the administrator may not provide the draft report to the regulator under subsection (1)—

(a) without having obtained from each commissioner a statement that the commissioner considers that the recommendation in the draft report would achieve the objective set out in section 65DA, or

(b) where the administrator does not obtain a statement to that effect from one or more commissioners (other than the Board), without having obtained a statement to that effect from the Board.

(6) Where the Board decides not to provide to the administrator a statement to that effect, the Board must—

(a) give a notice of the reasons for its decision to the administrator and to the regulator;

(b) publish the notice;

(c) lay a copy of it before Parliament.

(7) In subsection (5), “commissioner” means a person to which the trust provides services under this Act.’.

199, page 165, line 4, at end insert—

‘( ) At the end of section 65G of that Act (consultation plan) insert—

(4) In the case of an NHS foundation trust, the administrator may not make a variation to the draft report following the consultation period—

(a) without having obtained from each commissioner a statement that the commissioner considers that the recommendation in the draft report as so varied would achieve the objective set out in section 65DA, or

(b) where the administrator does not obtain a statement to that effect from one or more commissioners (other than the Board), without having obtained a statement to that effect from the Board.

(5) Where the Board decides not to provide to the administrator a statement to that effect, the Board must—

(a) give a notice of the reasons for its decision to the administrator and to the regulator;

(b) publish the notice;

(c) lay a copy of it before Parliament.

(6) In subsection (4), “commissioner” means a person to which the trust provides services under this Act.”’.

200, page 165, line 5, leave out from ‘(7)’ to end of line 7 and insert ‘—

(a) before paragraph (a) insert—

“(za) the Board,”,

(b) omit paragraph (a),

(c) in paragraph (b), omit “, if required by directions given by the Secretary of State”, and

(d) after paragraph (c) insert “;

(d) any other person specified in a direction given by the Secretary of State.”’.

201, page 165, line 8, leave out from ‘section,’ to end of line 10 and insert ‘omit paragraphs (a) to (d)’.

202, page 165, line 10, at end insert—

‘( ) In subsection (9) of that section—

(a) after “representatives of” insert “the Board and”, and

(b) for “(7)(a) or (b)” substitute “(7)(b), (c) or (d)”.’.

203, page 165, line 13, after ‘trust’, insert ‘—

(a) in subsection (7)(b), the words “goods or” are to be ignored, and

(b) in subsections (7)(d) and (10),’.

204, page 165, line 14, after ‘regulator.’, insert—

“(13) In the case of an NHS foundation trust, the Secretary of State may direct the regulator as to persons from whom it should direct the administrator under subsection (10) to request or seek a response.’.—(Mr Simon Burns)

Clause 179

Action following final report

Amendments made: 205, page 165, line 25, for subsection (1) substitute—

‘(1) In section 65K of the National Health Service Act 2006 (Secretary of State’s decision on what action to take), in subsection (1), after “a final report under section 65I” insert “relating to an NHS trust”; and in consequence of that, for the title to that section substitute “Secretary of State’s decision in case of NHS trust”.

(1A) After that section insert—

“65KA Regulator’s decision in case of NHS foundation trust

(1) Within the period of 20 working days beginning with the day on which the regulator receives a final report under section 65I relating to an NHS foundation trust, the regulator must decide whether it is satisfied—

(a) that the action recommended in the final report would achieve the objective set out in section 65DA, and

(b) that the trust special administrator has carried out the administration duties.

(2) In subsection (1)(b), “administration duties” means the duties imposed on the administrator by—

(a) this Chapter,

(b) a direction under this Chapter, or

(c) the administrator’s terms of appointment.

(3) If the regulator is satisfied as mentioned in subsection (1), it must as soon as reasonably practicable provide to the Secretary of State—

(a) the final report, and

(b) the report provided to the regulator by the Care Quality Commission under section 65D(3).

(4) If the regulator is not satisfied as mentioned in subsection (1), it must as soon as reasonably practicable give a notice of that decision to the administrator.

(5) Where the regulator gives a notice under subsection (4), sections 65F to 65J apply in relation to the trust to such extent, and with such modifications, as the regulator may specify in the notice.

(6) The regulator must as soon as reasonably practicable after giving a notice under subsection (4)—

(a) publish the notice;

(b) lay a copy of it before Parliament.

65KB Secretary of State’s response to regulator’s decision

‘(1) Within the period of 30 working days beginning with the day on which the Secretary of State receives the reports referred to in section 65KA(3), the Secretary of State must decide whether the Secretary of State is satisfied—

(a) that the persons to which the NHS foundation trust in question provides services under this Act have discharged their functions for the purposes of this Chapter,

(b) that the trust special administrator has carried out the administration duties (within the meaning of section 65KA(1)(b)),

(c) that the regulator has discharged its functions for the purposes of this Chapter,

(d) that the action recommended in the final report would secure the continued provision of the services provided by the trust to which the objective set out in section 65DA applies,

(e) that the recommended action would secure the provision of services that are of sufficient safety and quality to be provided under this Act, and

(f) that the recommended action would provide good value for money.

(2) If the Secretary of State is not satisfied as mentioned in subsection (1), the Secretary of State must as soon as reasonably practicable—

(a) give the trust special administrator a notice of the decision and of the reasons for it;

(b) give a copy of the notice to the regulator;

(c) publish the notice;

(d) lay a copy of it before Parliament.

65KC Action following Secretary of State’s rejection of final report

‘(1) Within the period of 20 working days beginning with the day on which the trust special administrator receives a notice under section 65KB(2), the administrator must provide to the regulator the final report varied so far as the administrator considers necessary to secure that the Secretary of State is satisfied as mentioned in section 65KB(1).

(2) Where the administrator provides to the regulator a final report under subsection (1), section 65KA applies in relation to the report as it applies in relation to a final report under section 65I; and for that purpose, that section has effect as if—

(a) in subsection (1), for “20 working days” there were substituted “10 working days”, and

(b) subsection (3)(b) were omitted.

(3) If the Secretary of State thinks that, in the circumstances, it is not reasonable for the administrator to be required to carry out the duty under subsection (1) within the period mentioned in that subsection, the Secretary of State may by order extend the period.

(4) If an order is made under subsection (3), the administrator must—

(a) publish a notice stating the date on which the period will expire, and

(b) where the administrator is proposing to carry out consultation in response to the notice under section 65KB(2), publish a statement setting out the means by which the administrator will consult during the extended period.

65KD Secretary of State’s response to re-submitted final report

‘(1) Within the period of 30 working days beginning with the day on which the Secretary of State receives a final report under section 65KA(3) as applied by section 65KC(2), the Secretary of State must decide whether the Secretary of State is, in relation to the report, satisfied as to the matters in 65KB(1)(a) to (f).

(2) If the Secretary of State is not satisfied as mentioned in subsection (1), the Secretary of State must as soon as reasonably practicable—

(a) publish a notice of the decision and the reasons for it;

(b) lay a copy of the notice before Parliament.

(3) Where the Secretary of State publishes a notice under subsection (2)(a), subsections (4) to (8) apply.

(4) If the notice states that the Board has failed to discharge a function—

(a) the Board is to be treated for the purposes of this Act as having failed to discharge the function, and

(b) the failure is to be treated for those purposes as significant (and section 13Z1 applies accordingly).

(5) If the notice states that a clinical commissioning group has failed to discharge a function—

(a) the group is to be treated for the purposes of this Act as having failed to discharge the function,

(b) the Secretary of State may exercise the functions of the Board under section 14Z19(2), (3)(a) and (8)(a), and

(c) the Board may not exercise any of its functions under section 14Z19.

(6) Where, by virtue of subsection (5)(b), the Secretary of State exercises the function of the Board under subsection (3)(a) of section 14Z19, subsection (9)(a) of that section applies but with the substitution for the references to the Board of references to the Secretary of State.

(7) If the notice states that the trust special administrator has failed to discharge the administration duties (within the meaning of section 65KA(1)(b))—

(a) the administration duties are to be treated for the purposes of this Act as functions of the regulator,

(b) the regulator is to be treated for the purposes of this Act as having failed to discharge those functions, and

(c) the failure is to be treated for those purposes as significant (and section 66 of the Health and Social Care Act 2011 applies accordingly, but with the omission of subsection (3)).

(8) If the notice states that the regulator has failed to discharge a function—

(a) the regulator is to be treated for the purposes of this Act as having failed to discharge the function, and

(b) the failure is to be treated for those purposes as significant (and section 66 of the Health and Social Care Act 2011 applies accordingly, but with the omission of subsection (3)).

(9) Within the period of 60 working days beginning with the day on which the Secretary of State publishes a notice under subsection (2)(a), the Secretary of State must decide what action to take in relation to the trust.

(10) The Secretary of State must as soon as reasonably practicable—

(a) publish a notice of the decision and the reasons for it;

(b) lay a copy of the notice before Parliament.”’.

206, page 166, line 8, leave out from ‘insert’ to ‘to’ in line 12 and insert ‘—

“(2A) For the purposes of subsection (1) in its application to the case of an NHS foundation trust, the reference to section 65K is to be read as a reference to section 65KD(9); and this section also applies in the case of an NHS foundation trust if—

(a) the Secretary of State is satisfied as mentioned in section 65KB(1) or 65KD(1) in relation to the trust, and

(b) the action recommended in the final report is to do something other than dissolve the trust.

(2B) For the purposes of subsection (2) in its application to the case of an NHS foundation trust—

(a) the reference to the Secretary of State is to be read as a reference’.

207, page 166, line 23, at end insert—

‘( ) After that section insert—

“65LA Trusts to be dissolved

(1) This section applies if—

(a) the Secretary of State is satisfied as mentioned in section 65KB(1) or 65KD(1), and

(b) the action recommended in the final report is to dissolve the NHS foundation trust in question.

(2) This section also applies if the Secretary of State decides under section 65KD(9) to dissolve the NHS foundation trust in question.

(3) The regulator may make an order—

(a) dissolving the trust, and

(b) transferring, or providing for the transfer of, the property and liabilities of the trust—

(i) to another NHS foundation trust or the Secretary of State, or

(ii) between another NHS foundation trust and the Secretary of State.

(4) An order under subsection (3) may include provision for the transfer of employees of the trust.

(5) The liabilities that may be transferred to an NHS foundation trust by virtue of subsection (3)(b) include criminal liabilities.”

( ) For the cross-heading preceding section 65K substitute “Action by the Secretary of State and the regulator”.’.—(Mr Simon Burns)

Clause 180

Sections 177 to 179: supplementary

Amendments made: 208, page 166, line 29, at end insert—

‘( ) In section 65N of that Act (power to issue guidance), after subsection (2) insert—

(2A) It must include guidance about the publication of—

(a) notices under section 65KC(4)(a);

(b) statements under section 65KC(4)(b).”’.

209, page 166, line 38, leave out ‘65K or 65L’ and insert ‘65L or 65LA’.

210, page 166, line 40, at end insert—

‘(ia) a copy of any notice published under section 65F, 65H, 65J, 65KA, 65KB or 65KD,’.

211, page 166, leave out line 42.

212, page 167, line 15, leave out ‘65K(4)’ and insert ‘65 (KC)(3)’.

213, page 167, line 15, before ‘and’, insert—

‘() after “65L(2) or (4)” insert “65LA(3)”,’.

214, page 167, line 21, leave out ‘65K’ and insert ‘65LA’.

215, page 167, line 23, at end insert—

‘(ia) a copy of any notice published under section 65F, 65H, 65J, 65KA, 65KB or 65KD,’.

216, page 167, leave out line 25.—(Mr Simon Burns)

Clause 181

Repeal of Chapter 5A of Part 2 of the National Health Service Act 2006

Amendment made: 217, page 167, line 31, leave out clause 181.—(Mr Simon Burns)

Clause 182

Application of NHS trusts in England

Amendment made: 218, page 168, line 31, leave out paragraphs (b) and (c).—(Mr Simon Burns)

Clause 183

Repeal of provisions on authorisation for NHS foundation trusts

Amendments made: 219, page 169, line 2, after ‘liabilities)’ insert ‘; in consequence of that, omit section 95 of this Act (licences to provide health care services: NHS foundation trusts)’.

220, page 169, line 10, after ‘Act’ insert ‘, and section 95(1) and (2) of this Act,’.—(Mr Simon Burns)

Schedule 13

Part 3: minor and consequential amendments

Amendment made: 366, page 367, line 31, at end insert—

‘Equality Act 2010 (c.15)

In Part 1 of Schedule 19 to the Equality Act 2010 (bodies subject to public sector equality duty), for the entry for the Independent Regulator of NHS Foundation Trusts substitute “Monitor”.’.—(Mr Simon Burns)

Schedule 14

Abolition of NHS trusts in England: consequential amendments

Amendments made: 367, page 368, line 26, leave out from ‘section’ to end of line 27 and insert ‘56 (mergers of NHS foundation trusts)—

(a) in subsection (1)(b) (as amended by section171(1)(a)), omit “or an NHS trust established under section 25”’.

368, page 368, line 27, at end insert ‘, and

(b) in subsection (1A) (as inserted by section171(2)), omit “(that is an NHS foundation trust)”.’.

369, page 368, line 28, leave out from ‘section’ to end of line 30 and insert ‘56A (acquisitions of NHS foundation trusts) (as inserted by section172)—

(a) in subsection (1)(b), omit “or an NHS trust established under section 25”’.

370, page 368, line 30, at end insert ‘, and

(b) in subsection (2), omit “(that is an NHS foundation trust)”.’.

371, page 368, line 40, leave out paragraph 13 and insert—

13 (1) Omit section 65B (appointment of trust special administrator in relation to NHS trust).

(2) In consequence of that repeal, omit section 177(1A) of this Act.’.

372, page 368, line 43, at end insert—

13A Omit section 65C (suspension of directors of NHS trust).

13B (1) Section 65F (special administrator’s draft report) is amended as follows.

(2) In subsection (1), for “the Secretary of State”, in each place it appears, substitute “the regulator”.

(3) In subsection (2)(b)—

(a) omit “goods or”, and

(b) for “the Secretary of State” substitute “the regulator”.

(4) After subsection (2) insert—

“(2A) The administrator may not provide the draft report to the regulator under subsection (1)—

(a) without having obtained from each commissioner a statement that the commissioner considers that the recommendation in the draft report would achieve the objective set out in section 65DA, or

(b) where the administrator does not obtain a statement to that effect from one or more commissioners (other than the Board), without having obtained a statement to that effect from the Board.

(2B) Where the Board decides not to provide to the administrator a statement to that effect, the Board must—

(a) give a notice of the reasons for its decision to the administrator and to the regulator;

(b) publish the notice;

(c) lay a copy of it before Parliament.

(2C) In subsection (2A), “commissioner” means a person to which the trust provides services under this Act.”

(5) In subsection (3), for “the Secretary of State” substitute “the regulator”.

(6) Omit subsections (4) to (7).

(7) In consequence of those repeals, omit section 178(2) of this Act.

13C In section 65G (consultation plan), in subsection (4), omit “In the case of an NHS foundation trust,”.

13D (1) Section 65H (consultation on draft report) is amended as follows.

(2) In subsection (7)—

(a) in paragraph (b), omit “goods or”, and

(b) in paragraphs (c) and (d), for “the Secretary of State” substitute “the regulator”.

(3) In subsection (10), for “The Secretary of State” substitute “The regulator”.

(4) After that subsection insert —

“(10A) The Secretary of State may direct the regulator as to persons from whom it should direct the administrator under subsection (10) to request or seek a response.”

(5) Omit subsections (12) and (13).

(6) In consequence of those repeals, omit section 178(5) of this Act.

13E (1) Section 65I (administrator’s final report) is amended as follows.

(2) In subsection (1), for “the Secretary of State”, in each place it appears, substitute “the regulator”.

(3) In subsection (3), for “the Secretary of State” substitute “the regulator”.

(4) Omit subsection (4).

(5) In consequence of that repeal, omit section 178(6) of this Act.

13F (1) Section 65J (power to extend time limits) is amended as follows.

(2) In subsection (2), for “the Secretary of State”, in each place it appears, substitute “the regulator”.

(3) Omit subsection (5).

(4) In consequence of that repeal, omit section 178(7) of this Act.

13G (1) Omit section 65K (decision on action to take in relation to the trust) and the preceding cross-heading.

(2) In consequence of those repeals, omit section 179(1) of this Act.

13H (1) Section 65KA (regulator’s decision in case of NHS foundation trust) is amended as follows.

(2) In subsection (1), omit “relating to an NHS foundation trust”.

(3) In subsection (5), for “the trust” substitute “the NHS foundation trust in question”.

(4) For the title to that section substitute “The regulator’s decision”.

(5) Before that section, insert as a cross-heading “Action by the regulator and the Secretary of State”.

13I (1) Section 65L (trusts coming out of administration) is amended as follows.

(2) In subsection (1)—

(a) for “65K” substitute “65KB(2) or 65KD(2) or (9)”, and

(b) for “the trust” substitute “the NHS foundation trust in question”.

(3) In subsection (2)—

(a) for “The Secretary of State” substitute “The regulator”, and

(b) for “and directors” substitute “, directors and governors”.

(4) Omit subsections (2A), (2B) and (6).

(5) In consequence of the repeal of subsections (2A) and (2B) of that section, omit section 179(2) of this Act.

13J (1) Section 65M (replacement of special administrator) is amended as follows.

(2) In subsection (1), for “the Secretary of State”, in each place it appears, substitute “the regulator”.

(3) In subsection (2), for “the Secretary of State” substitute “the regulator”.

(4) Omit subsection (3).

(5) In consequence of that repeal, omit section 180(1) of this Act.

13K (1) Section 65N (guidance) is amended as follows.

(2) In subsection (1), for “The Secretary of State” substitute “The regulator”.

(3) Omit subsection (4).

(4) In consequence of that repeal, omit section 180(2) of this Act.’.—(Mr Simon Burns)

New Clause 3

Duration of transitional period

‘(1) Section 117 ceases to have effect in relation to an NHS foundation trust on 1 April 2016 unless—

(a) before that date, the Secretary of State provides by order for that section to continue to have effect in relation to the trust, or

(b) the trust was authorised after 1 April 2014.

(2) An order under this section may provide that section 117 is to continue to have effect for such period as is specified—

(a) in relation to all NHS foundation trusts, or

(b) in relation only to such NHS foundation trusts as are specified.

(3) But an order under this section may not apply to a trust in relation to which section 117 has, by virtue of a previous order under this section, ceased to have effect.

(4) A period specified for the purposes of subsection (2)—

(a) must begin with the day on which section117 would, but for the order, cease to have effect in relation to the trusts to which the order applies, and

(b) must not exceed two years.

(5) In the case of a trust to which an order under this section applies, and which was authorised on or before 1 April 2014, section 117 ceases to have effect in relation to the trust in accordance with that order or any subsequent orders under this section which apply to the trust.

(6) In the case of a trust which was authorised after 1 April 2014 (including a trust authorised on or after 1 April 2016 if, at the time it is authorised, section 117 still has effect), section 117 ceases to have effect in relation to the trust—

(a) if no order under this section is made before the end of the initial two-year period, at the end of that period;

(b) if an order under this section is made in reliance on subsection (2)(a) before the end of the initial two-year period, on whichever is the later of—

(i) the end of that period, and

(ii) the day on which that order or a subsequent order under this section ceases to apply to the trust;

(c) if an order under this section is made in reliance on subsection (2)(b) before the end of the initial two-year period, in accordance with section [Orders under section [Duration of transitional period] that apply to only some trusts](8) to (11).

(7) In this section and section [Orders under section [Duration of transitional period] that apply to only some trusts]—

(a) “the initial two-year period”, in relation to an NHS foundation trust, is the period of two years beginning with the day on which the trust is authorised;

(b) a reference to being authorised is a reference to being given an authorisation under section 35 of the National Health Service Act 2006.

(8) Section 117 is repealed as soon as there are—

(a) no NHS foundation trusts in relation to which it has effect, and

(b) no NHS trusts in existence (whether because they had all ceased to exist without section182 having come into force or there are none continuing in existence by virtue of subsection (3) of that section).’.—(Paul Burstow.)

Brought up, and read the First time.

21:00

[The Minister of State, Department of Health (Paul Burstow)]

I beg to move, That the clause be read a Second time.

[Madam Deputy Speaker (Dawn Primarolo)]

With this it will be convenient to discuss the following:

Government new clause 4—Orders under section [Duration of transitional period] that apply to only some trusts.

Government new clause 5—Repeal of sections [Duration of transitional period] and [Orders under section [Duration of transitional period] that apply to only some trusts].

Government amendments 88, 89 and 108 to 112.

Amendment 17, in clause 117, page 122, line 3, leave out subsection (12).

Government amendments 282 and 285.

[Paul Burstow]

These Government amendments will make important changes to extend Monitor’s intervention powers over all foundation trusts until 2016. This would give additional time for foundation trusts’ governors to build the capability that they need to be able to hold their boards to account.

As my right hon. Friend the Secretary of State has described, through part 3 of the Bill, Monitor as the sector regulator would have permanent intervention powers over all providers, including foundation trusts. These will allow it to fulfil its duty to protect and promote the patient’s interest and its functions include supporting commissioners in securing continuity of services. That is why we believe that Opposition amendment 17 is not only ineffective, based as it is on non-existent terms of authorisation, but also redundant.

My right hon. Friend the Secretary of State has already confirmed that we agree that it is essential that Monitor, as health sector regulator, can take action to secure patients’ continued access to NHS services, and our plans ensure this. Monitor would have powers under its licensing regime to require a provider to take specific actions if it gets into difficulties. These will be effective safeguards to protect patients’ and taxpayers’ interests, and will support commissioners in securing continued access to services that patients depend on for their care. I hope, therefore, that the hon. Members who tabled the amendment will not press it.

However, the NHS Future Forum raised concerns about the current readiness of foundation trust governors to take on the strengthened role that the Bill provides for them in holding foundation trusts to account as autonomous NHS providers. In response, the Government have agreed that Monitor’s intervention powers should apply to all foundation trusts until 2016, to allow time for their governance arrangements to become fully effective. The amendments provide for the transitional powers to continue until 2016. They also make corresponding amendments to clause 117 on licence conditions supporting use of the powers, and remove clause 116, about identifying which foundation trusts would be subject to the powers.

The amendments do not change the nature of the transitional intervention powers set out in clause 117. Monitor will continue to have the power to remove or suspend members of the board of directors or members of the council of governors. Monitor would also be able to direct a foundation trust to do or not to do specific things within a specified timetable. These powers are similar to those currently available to Monitor in its role as foundation trust regulator, and would allow Monitor to continue to protect the taxpayers’ interest in foundation trusts.

The powers go beyond those that Monitor would have over all providers, under part 3, as sector regulator. They will help to ensure a smooth transition from the current arrangements for NHS foundation trusts. The amendments would allow the Secretary of State to seek further parliamentary agreement to extend the powers beyond 2016 for all or some foundation trusts for up to two years at a time. That power could be used, for example, if there was a significant remaining concern about the governance of some foundation trusts.

If it were decided to extend the powers for some, but not all, foundation trusts, Monitor would be required to go through a process similar to that originally envisaged in clause 116. It would have to publish the criteria that it would use to decide which foundation trusts would remain subject to its intervention powers. Those criteria would be subject to consultation and would require approval from the Secretary of State. The amendments will ensure that the transitional regime proposed in the Bill provides a more secure safety net while foundation trust governors develop the skills and capabilities necessary to hold their boards to account.

The amendments would enable Monitor to rectify avoidable difficulties at a foundation trust while foundation trust governance arrangements developed, ahead of normal regulatory intervention through the licensing regime. They also provide for the extension of the powers, should that prove necessary. I commend them to the House.

[Owen Smith]

I do not intend to take long, because we must get on to the important next group of new clauses and amendments, which is on the private patient cap; there will be huge interest in that outside this place, and there is far too little time to discuss it. I shall say right at the outset that we will not press amendment 17, because we accept that, as the Minister said, it is effectively made redundant by other amendments that have been tabled.

In some respects, the amendments in the group before us tell the story of the Bill in microcosm. Throughout the progress of the Bill, the Government have responded in two ways. One has been to bolt endless obfuscation and compromise on to the Bill to obscure its true intentions. There was clarity at the outset, in the Bill’s first iteration; it clearly aimed to break up a publicly owned, collaborative NHS and replace it with a competitive, market-driven NHS. The Government have sought to obscure that throughout the Bill’s progress, and have done so relatively effectively. Certainly, more gullible Government Members, perhaps even including the Deputy Prime Minister, have bought into the double-speak about this now being a question of preventing anti-competition, as opposed to promoting competition, but we Labour Members still do not buy that.

Nor do we buy the idea that the other amendments that we have considered today add clarity. In truth, they add to the confusion—the chaos, indeed—that will follow the implementation of the Bill. As the Minister has outlined, the clauses that we are considering effectively extend Monitor’s existing compliance and regulatory roles over foundation trusts to all FTs through to 2016. That is what the Future Forum recommended to Ministers, but they did not do that last time, although they did get rid of the arbitrary 2014 deadline that they had introduced. They are now going a step further and extending Monitor’s compliance functions. That might not be such a bad thing, and perhaps many people will agree with the idea; certainly the Future Forum will. The trouble with it, of course, is that it extends the critical conflict of interest that is at the heart of Monitor’s role.

There is a conflict between what is clearly Monitor’s principal function—as an economic regulator, designed to prevent anti-competitive behaviour and facilitate the exit of providers, such as hospitals, from the marketplace—and its compliance role, which is ostensibly about allowing FTs to flourish, and making sure that they do not fail. How will the Government deal with that apparent contradiction? To use their own words as set out in the original explanatory notes, how will they

“mitigate and manage potential conflicts of interest”

between the transitional functions and Monitor’s new functions? Well, rest easy, because the Government have made a very simple suggestion as to how Monitor should square that circle, which I am sure all Members will find satisfactory, as I do. Clause 62(3), subtly amended by Government amendment 89, explains that Monitor must simply

“ignore the functions it has under section…117 when exercising…its functions”

relating to competition, price-setting, or the licensing of NHS services.

So there we go: in Monitor there are to be Chinese walls, as Ministers colourfully put it in Committee. Monitor retains its role in trying to keep FTs from failing, but it also takes on a role in exiting them from the market and helping other providers—Bupa, perhaps, or Helios, which we know are sniffing around the Department of Health right now—to step into the breach. Chinese walls, competition and confusion: those are the key words for this botched Bill.

Question put and agreed to.

New clause 3 accordingly read a Second time, and added to the Bill.

New Clause 4

Orders under section [Duration of transitional period] that apply to only some trusts

‘(1) Where the Secretary of State proposes to make an order under section [Duration of transitional period] in reliance on subsection (2)(b) of that section (“a section [Duration of transitional period](2)(b) order”), the Secretary of State must notify Monitor.

(2) Monitor, having received a notification under subsection (1), must set the criteria that are to be applied for the purpose of determining to which NHS foundation trusts the order should apply.

(3) Before setting criteria under subsection (2), Monitor must—

(a) consult the Care Quality Commission and such other persons as Monitor considers appropriate, and

(b) obtain the approval of the Secretary of State.

(4) If the Secretary of State approves the proposed criteria, Monitor must—

(a) publish the criteria,

(b) determine, by applying the criteria, to which trusts the order should apply,

(c) notify the Secretary of State of its determination, and

(d) publish a list of the trusts concerned.

(5) If the Secretary of State does not approve the proposed criteria, Monitor must propose revised criteria; and subsections (3)(b) and (4) apply in relation to the proposed revised criteria as they apply in relation to the criteria previously proposed.

(6) If, having received a notification under subsection (1), Monitor proposes to set criteria the same as those it set on the last occasion it received a notification under that subsection, it need not comply with subsection (3)(a).

(7) A section [Duration of transitional period](2)(b) order—

(a) must apply to all the trusts that are determined under subsection (4)(b) as being the trusts to which the order should apply (and to no others);

(b) may specify the trusts to which it applies by reference to their inclusion in the list published under subsection (4)(d).

(8) Subsection (9) applies where —

(a) a section [Duration of transitional period](2)(b) order is in force at a time when there is in existence an NHS foundation trust authorised after 1 April 2014, and

(b) the initial two-year period in relation to that trust has yet to come to an end.

(9) Monitor must—

(a) determine, by applying the criteria it applied under subsection (4)(b), whether section 117 should continue to have effect in relation to the trust after the end of the initial two-year period,

(b) notify the Secretary of State of its determination, and

(c) publish its determination.

(10) If Monitor determines under subsection (9)(a) that section117 should so continue to have effect, the trust is to be treated as if it had been authorised on or before 1 April 2014 and as if the order referred to in subsection (7)(a) applied to it; and section [Duration of transitional period] (5) is accordingly to apply in relation to the trust.

(11) If Monitor determines under subsection (9)(a) that section 117 should not so continue to have effect, section 117 ceases to have effect in relation to the trust immediately after the end of the initial two-year period.’.—(Paul Burstow.)

Brought up, read the First and Second time, and added to the Bill.

New Clause 5

Repeal of sections [Duration of transitional period] and [Orders under section [Duration of transitional period] that apply to only some trusts]

‘(1) Sections [Duration of transitional period] and [Orders under section [Duration of transitional period] that apply to only some trusts] are repealed immediately after section 117 is repealed; and in consequence of that—

(a) in section 62(2)(a), omit “or under sections 117 and [Orders under section [Duration of transitional period] that apply to only some trusts] of this Act (imposition of licence conditions on NHS foundation trusts during transitional period)”,

(b) omit section62(3),

(c) in section 94(4), after paragraph (a) insert “and”,

(d) in section 94(4), omit paragraph (c) and the preceding “and”, and

(e) omit section 302(5)(e) and (8A).

(2) This section is repealed immediately after sections [Duration of transitional period] and [Orders under section [Duration of transitional period] that apply to only some trusts] are repealed.’.—(Paul Burstow.)

Brought up, read the First and Second time, and added to the Bill.

New Clause 19

NHS Foundations Trusts: phasing out of provision of private health care

‘The Secretary of State must make regulations which provide for NHS Foundation Trusts to be prevented from providing services other than those of the health service in England within three years of Royal Assent of this Act.’.—(Andrew George.)

Brought up, and read the First time.

[Andrew George]

I beg to move, That the clause be read a Second time.

[Madam Deputy Speaker (Dawn Primarolo)]

With this it will be convenient to discuss the following:

New clause 22—Private health care: rules—

‘(1) Section 44 of the National Health Service Act 2006 (Private healthcare) is amended as follows.

(2) Insert new subsection (A1) as follows—

“(A1) NHS Foundation Trusts must act in accordance with the following rules when carrying out their functions under this section—

(a) NHS Foundation Trusts are not permitted to operate NHS functions or contracts in a manner which promotes their private healthcare operation;

(b) any private healthcare service offered should only be within the provision of the services and procedures which are not also duplicated by the Trust’s NHS functions or contracts; and

(c) the Trust should at all times operate any private healthcare interest in a manner which in no way conflicts with its responsibility to provide unfettered access of its NHS patients to its NHS services.”’.

Amendment 1165, page 159, line 24, leave out clause 168.

[Andrew George]

The new clauses deal with a totemic issue that has bedevilled the debate throughout and raised concerns. The question whether to raise the cap or leave it where it is is a ham-fisted reaction to our current situation in the Report stage of a re-committed Bill. There should be an opportunity for further consideration, and I hope the issue will be examined in another place.

There has been much hyperbole about the privatisation of the NHS and other themes that have run through the debate. The general concern is that, as a result of various genies being let out of bottles and caps being lifted, we will end up with an NHS driven more by concern with private profit than by concern with matters of patient care. There is a slippery slope, of which that issue is symptomatic, throughout the Bill.

The purpose of the new clauses is to address that issue and retain the cap to ensure that the matter is kept under appropriate control. The rough and tumble of political debate means that we will end up scoring points off each other and asking who introduced foundation trusts and so on. We have been through that playground before and I do not intend to go in that direction, but I want to make sure that we have an opportunity to explore the matter. We do not have much time so I will not detain the House unnecessarily.

The removal of the cap will give more scope for NHS trusts to compete in the market, which will make them more likely to be considered undertakings for competition law purposes, even in respect of NHS services which the hospitals claim their private work subsidises, thus allowing competition law to reach further and more firmly into the NHS. The Government briefing does not even dispute that fact, as far as I can see. Also, if NHS foundation trusts can muscle in on the private market, rather like the BBC, private providers will feel more justified in arguing for the right to compete for far more NHS services, and the courts may well agree.

New clause 19 recognises that pay beds in the NHS represent a challenge, both ethically—it is about how beds can be reserved for paying patients in the same hospitals where poorer patients with higher needs must wait—and with regard to competition law. It would phase out the reserving of beds for paying patients in NHS hospitals by 2015.

New clause 22 would put a bar on foundation trusts offering private services where that would compete with their NHS provision. I certainly know, having undertaken surveys of the NHS 12 years ago, that the specialties with the longest waiting times—I will not say which, but Members might guess—happened to be those in which the most private practice was going on. One might argue that the private practice resulted from the long waiting times, but the long waiting times could have been part of a system that enabled the private sector to flourish. I fully accept—to save the Minister a lot of time in his response—that the new clause is technically very deficient, so I will not press it to a vote, but I want to express my concern and probe the issue in debate.

I know that there are ethical considerations here and that the General Medical Council and others would not only frown on the kind of practices I am implying might go on, but would rule against them. The concern is that the trusts, or those working for them, might be seduced into behaving in ways that drive their NHS patients into the arms of their private wings. Once we go down that road, many conundrums will arise and will need to be sorted out. I do not believe that the Government entirely have a handle on the issue, which is why I believe that simply lifting the cap, despite all the justifications they have given, needs a serious rethink.

21:15

I do not question Ministers’ intentions, which I think are honourable, but I do think that they have the wrong policy. I do not think that they, as some claim, want to push privatisation across the NHS, but I do think that this could end up being a catastrophic policy that unleashes something that, once it goes through, we will be able to regret at our leisure. On that basis, I simply wanted to raise these matters and ensure that we have an opportunity to debate them, primarily for the purposes of probing the issues.

[Emily Thornberry]

I would like to speak to amendment 1165, which stands in my name and those of my right hon. Friend the Member for Wentworth and Dearne (John Healey), my hon. Friends the Members for Leicester West (Liz Kendall), for Halton (Derek Twigg) and for Pontypridd (Owen Smith), and the hon. Members for St Ives (Andrew George), for Southport (John Pugh) and for Leeds North West (Greg Mulholland). It would delete clause 168, which abolishes the cap on the number of private patients who can be treated in foundation trust hospitals. There has been much interest in this issue, and we will seek a vote on the matter if possible.

Earlier, the Secretary of State assured us that the legislation would not result in a market free-for-all. “That will not happen if this Bill is passed,” he said. But close examination of the clause shows that we will certainly be getting a step closer. It will mean that our national health service, where people are tended by our NHS-trained doctors using our NHS equipment, will be full of private patients, who are able to pay more. Hard-pressed hospitals facing increasingly large shortfalls, desperately trying to balance their books, are bound to take in increasing numbers of private patients.

We have been here before. Many of us remember the last time the Conservatives were in power, when there was a two-tier health service: those who could pay got faster treatment and could skip the queue, while those who could not afford to go private had to wait, and many of them had to die.

I am pleased that the Secretary of State has seen the letter in The Times today. It is often concerning to see how he assimilates data, because he seems to listen only to some things and not to others; he listens to what he wants to hear. I hope that he has realised that in The Times today the doctors, nurses, midwives, psychiatrists, physiotherapists and occupational therapists have said that the Bill will destabilise the national health service. They are particularly concerned about the removal of the private patient cap. Why is that? The Government’s own impact assessment, at B156, acknowledges that

“there is a risk that private patients may be prioritised above NHS patients resulting in a growth in waiting lists and waiting times for NHS patients.”

We could not have put that better ourselves, and it is in the Government’s own impact assessment of the Bill.

If we lift the cap on the number of private patients in the time of crisis that the national health service is about to go into, as night follows day the number of private patients in hospitals will increase, forcing out national health service patients. As a result, waiting lists will go up, and what will the public make of that?

[Dr Poulter]

As the hon. Lady is well aware, the previous Government introduced the private sector in a number of hospitals, and at the moment the private sector works alongside the NHS, helping to cut down on waiting times and the like. She is concerned about the private sector working alongside the NHS in hospitals. Does she have any concerns at the moment based on what the previous Government did in introducing that side-by-side service?

[Emily Thornberry]

What is extraordinary is that many people who used to go private felt that it was not necessary to do so under a Labour Government because they did not have to wait as they had to under the Conservative Government—that is one thing that I certainly remember. Yes, we have used the private sector as and when it has been necessary to reduce waiting lists, but we are not talking about that now. We are talking about whether there should be a cap on the number of private patients in national health service beds.

[Dr Poulter]

The hon. Lady is very kind to give way twice. She makes well the point about why the private sector is beneficial. We either agree that the private sector adds value to the NHS and patients or we say that it is a bad thing; it is either working at the moment for the benefit of patients and will work that way in future, or it is not and will not. Which way does the hon. Lady see it?

[Emily Thornberry]

I am sure that that contribution was of some use to someone in this debate, but I am not going to bother to respond to it.

[Helen Jones (Warrington North) (Lab)]

Does my hon. Friend agree that the real difference between what was happening under the Labour Government and what is proposed in this Bill is that we used the private sector to treat people on the basis of need identified by the NHS, not ability to pay? This Government propose to allow more people to pay to jump the queue. In that sense, if waiting lists go up, that helps the private sector: there is no point in paying to jump the queue if there is no queue.

[Emily Thornberry]

Exactly; I am very grateful to my hon. Friend.

The Secretary of State, like the Minister of State, the right hon. Member for Chelmsford (Mr Burns), is fond of quoting the Future Forum. I have a quote from Professor Steve Field that I hope will be of assistance to the House when it comes to discussion of the cap. He said in evidence to the Committee:

“if you opened the cap, it made you more likely to be under attack from EU law, competition and Monitor”.––[Official Report, Health and Social Care (Re-committed) Public Bill Committee, 28 June 2011; c. 14, Q24.]

That is one of the arguments that he used. If the Future Forum is concerned about this being another reason why we should not lift the cap, I hope that the Minister will at least listen to its arguments.

As we heard in Committee, a number of criticisms have been made on both sides of the House about the details of the cap and how it is implemented. Indeed, it is common ground that there ought to be some changes to it. We have no problem about changing and modifying the cap and making it more appropriate, but we do not understand why, just because the cap needs changing, it is simply being lifted completely.

A parallel can be drawn with the carbon emissions cap. If I were working in the Potteries in Staffordshire, I am sure that I would believe that the carbon emissions cap was unfair and went against my personal business. One would need to look at the cap and change it as appropriate in order to make it work properly; one would not get rid of it completely just because there are criticisms of it, unless one had another agenda.

The question is why on earth the Government are considering allowing as many private patients as wish to do so to go into our national health service at a time of crisis, pushing out national health service patients. [Interruption.] If the Minister believes that that is wrong, I will be interested to hear an intervention from him in which I hope he will be able to give us a complete assurance that that will not happen. The fact of the matter is that there are not the necessary safeguards. As we understand it, there will be absolutely no limit. We have no idea how foundation trusts are going to respond to the lifting of the cap. We do not know and neither, with great respect, does the Minister. Why is he allowing this great risk to be taken with our national health service? The clause needs to be looked at very carefully in this place, and I know that it will be looked at very carefully in another place.

[Nicky Morgan]

I am not sure whether the hon. Lady has seen a note from the Foundation Trust Network that was, I believe, circulated to all Members of the House and sets out six positive reasons why the private patient income cap has worked: it has allowed hospitals to build new units, to buy leading-edge technology, to extend mental health support, to offer fertility treatment, and to provide maternity services. There is also the fact that rental income is caught by the cap. There are some positive benefits in allowing private patients access to be treated by hospitals. In particular, at a time of financial crisis, bringing new technology into the NHS must be a good thing.

[Emily Thornberry]

I am grateful to the hon. Lady. I think that if we were to stop and walk away from party politics, we would be quite close on this matter. We do not have a problem with there being a cap; the problem is how it is implemented. I think that, deep down, she agrees with us. The difficulty is that her party wants to get rid of the cap completely, and that will have a completely different effect on the national health service. We are happy to sit down and talk to the agencies that will be affected and to make improvements in the working of the cap, but getting rid of it completely is behaving recklessly with our national health service.

[Nicky Morgan]

The misinformation and emotive language that has been used throughout the whole debate has been using patients at the heart of this. Everything we have heard so far on both sides of the House, perhaps prompted by the hon. Lady’s remarks, has been about how bringing in private patients is bad for the NHS. In fact there are some good aspects. I am pleased to hear that there can be some agreement between both sides of the House.

[Emily Thornberry]

That is why I have been relying on the Government’s impact assessment as perhaps the strongest part of my argument. I have also relied on what Professor Field has had to say. I would now like to turn to Baroness Williams, who wrote an article published on 4 September that I commend to the House, in which she says:

“One thing that remains…is the decision to lift the cap on private beds in foundation hospitals. Not only could that mean that many of our finest hospitals would gradually become private, it also means that inevitably foundation hospitals would be subject to European and British competition law.”

Many organisations and people agree with us on this, and that is why the House should pause and think about what we will be doing to the national health service if we accept this clause. I also pray in aid the Royal College of Nursing’s briefing, which Members who are closely following this debate will have read, in which it says that it is against the removal of the cap and does not believe that it will not have an effect on NHS patients’ access to health care. The BMA has said the same thing.

In essence, the argument is about whether we should have a cap or not. If the House votes tonight to lift the cap, our constituents will ask how it can be that their representative has voted for a clause that allows private patients to fill up the national health service hospital paid for by those constituents’ taxes so that they will be pushed out of it.

21:30

[Mr Simon Burns]

I am grateful to my hon. Friend the Member for Cornwall—I mean the hon. Member for St Ives (Andrew George)—for moving the new clauses and amendment, especially for the constructive and reasonable way in which he did so. He raised several issues and, if I understand him correctly, he sees the amendment as a probing amendment that also puts across several of his concerns about this issue. I hope to deal with the main thrust of his concern in my contribution.

I am also grateful to the hon. Member for Islington South and Finsbury (Emily Thornberry) for her contribution. Her amendment and indeed her comments were more controversial and I have far more disagreement with several of the contentious things that she said, although she will be unaware that I am saying that because she is not listening. She might argue that she is not missing much.

I shall start with a fact. It may have got lost in the telling, but I assume that the hon. Lady realises that there is no cap at the moment for NHS trusts. There is only a cap for foundation trusts. She has not seen the difficulties that she forecasts in NHS trusts, and I hope—although I am not confident of success—that I will convince her that her fears are unfounded.

The Government believe that keeping the cap would damage the NHS and patients’ interests. Removing it would allow foundation trusts to earn more income to improve NHS services, and I will address the safeguards that will be in place to ensure that the armageddon that the hon. Lady predicted will not happen and that my hon. Friend’s concerns are needless.

Removing the cap will enable foundation trusts to earn more money to improve NHS services, and those trusts are telling us that they must be freed from what is an unfair, arbitrary, unnecessary and blunt legal instrument. I do not want to go too far down memory lane, but I must remind the House that there was no intellectual case for bringing in the cap in the first place. It was introduced in 2002-03 in the relevant legislation as a sop to old Labour. The right hon. Member for Holborn and St Pancras (Frank Dobson) says that he has moved on, but he still has the Neanderthal tendencies of old Labour—[Interruption.] Before the Opposition Whip says anything, I should point out that the right hon. Gentleman takes that as a compliment. I am being very nice to him and probably enhancing his street cred. He would not thank the Whip for diminishing that.

The point is that the cap was not brought in after some coherent intellectual argument about protecting the NHS or preventing private patients from overrunning the NHS. It was brought in because the then Health Secretary, Alan Milburn, and the then Prime Minister, Tony Blair, were having considerable problems with some of their Back Benchers on this issue. To avoid a defeat on the Floor of the House, they brought in the cap as a sop to those Back Benchers to buy them off. But it was not introduced consistently for both NHS trusts and foundation trusts—just for the latter.

The cap is arbitrary and unfair. Several NHS trusts that are not subject to the private patient income cap have private incomes well in excess of many foundation trusts. Last year, four of the top 10 private income earners were NHS trusts—that is, without a cap. A few FTs have high private incomes simply because they did a few years ago. The cap locks FTs into keeping private income below 2002-03 levels and means that last year about 75% of FTs were severely restricted by caps of 1.5% or less. Meanwhile, patients at the Royal Marsden benefit from its cap being 31%, and it has consistently been rated as higher performing by the Care Quality Commission.

[Andrew George]

The Minister is making an interesting point. Will he elaborate further on the proportions of the private work to which he refers? Is that private work for private patients or private work for research, innovation and training, which are important functions of hospitals but are often lost in the debate?

[Mr Burns]

The hon. Gentleman raises an important point, but the simple answer is that it is a combination of both.

The cap is unnecessary. I remind Opposition Members that the original proposal was not to have one. To suggest that NHS patients would be disadvantaged if the cap was removed, as the hon. Member for Islington South and Finsbury did, is pure and simple scaremongering. Existing and new safeguards will protect them. NHS commissioners will remain responsible for securing timely and high-quality care for NHS patients. The Bill will make FTs more accountable and transparent to their public and staff, allowing us to require separate accounts for NHS and private income and giving communities and governors greater powers to hold FTs to account in performing their main duty, which is to care for NHS patients.

[Chris Leslie]

Will the Minister give way?

[Mr Burns]

No, because others want to speak.

I can assure the House that FTs will retain their principal legal purpose—to serve the NHS. This means that the majority of their income will continue to come from the NHS. With no shareholders, any profit they make will have to be ploughed back into the FT, and so will support that purpose of caring for NHS patients. The vast majority of FTs have little, if any, potential to increase private income, never mind the desire to do so. For them, NHS activity will remain the overwhelming majority of the work they do, if not all of their work. It is extremely unlikely that even the most entrepreneurial FTs with international reputations would seek to test the boundaries. Their commissioners, public and NHS staff governors would hold them to account in fulfilling their duties and serving their NHS patients.

For these FTs, however, the cap is a blunt instrument that harms NHS patients. FTs tell us that there is potential to bring extra non-NHS income into the NHS, for example, by developing the NHS’s intellectual property, from innovations such as joint ventures and by using NHS knowledge abroad. Additional demand and income can help organisations to bring in leading-edge technology faster, including in the important area of cancer treatment. I hope that that goes some way to helping my hon. Friend the Member for St Ives. Opposition amendment 1165 would harm the NHS, and new clauses 19 and 22 would stop FTs providing private health care altogether. Many of the other protections proposed would be almost as damaging and reduce income.

We want to ensure that safeguards are appropriate, not harmful. For example, a prohibition on FTs offering privately the same services that they offer on the NHS would rule out most of their current private health care. It could even create perverse incentives to stop providing some services for some NHS patients. We are confident that private income benefits NHS patients. On reflection, we are proposing to explore whether and how to amend the Bill to ensure that FTs explain how their non-NHS income is benefiting NHS patients. We will also ensure that governors of FTs can hold boards to account for how they meet their purpose and use that income. I believe that that is an important move forward.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

Will the Minister give way?

[Mr Burns]

I hope that the right hon. Gentleman will forgive me, but I will not give way, because other hon. Members wish to speak and the debate finishes in 20 minutes.

To my mind, the private patient cap and the proposed new restrictions are both unnecessary and damaging. Indeed, I know that this will drive some Opposition Members potty, but the former Labour Minister responsible for the cap, Lord Warner, repented his sins in the other place, describing it as

“wrong and detrimental to the NHS.”—[Official Report, House of Lords, 12 May 2009; Vol. 710, c. 936.]

I urge Opposition Members not to repeat that mistake and to heed Lord Warner’s advice. I appreciate that the Opposition Benches are not full of champions of Lord Warner—particularly not at that end of the Chamber from which we heard the earlier comments about him—but he is a respected former Labour Health Minister and I would suggest that he knows what he is talking about.

Let me deal briefly with two final points that were made by the hon. Members for Islington South and Finsbury and for St Ives about the safeguards that are in place to offer protection and ensure that NHS patients would not lose out with the removal of the cap. First, the NHS commissioning board and clinical commissioning groups would be responsible for ensuring that NHS patients are offered prompt and high-quality care, and that good use is made of NHS resources, whoever provides care, through robust contracting arrangements. NHS patients will also maintain their right in the NHS constitution to start treatment within 18 weeks of referral. Secondly, as foundation trusts do not have shareholders and cannot distribute surpluses externally, and as their principal legal purpose will remain to serve the NHS, all proceeds from non-NHS work would be reinvested in the organisation, ultimately adding to the level and quality of the NHS service.

The Bill will make FTs more accountable and transparent to their public and NHS staff. Our commitment that FTs will produce separate accounts for their NHS and NHS private-funded services—as well as Monitor’s use of its regulatory powers to ensure a level playing field between providers—will also help to avoid any risk of NHS resources cross-subsidising private care, thereby protecting NHS money. I believe that those five safeguards will protect NHS patients and the NHS, and will not lead to the situation that the hon. Member for Islington South and Finsbury described in her speech.

[Emily Thornberry]

I do not mean in any way to suggest that the right hon. Gentleman does not believe what he has just said, but what if he is wrong? It is all very well for him to say, “We’re going to lift the private patient cap—we have these safeguards and I believe they’re sufficient to ensure that NHS patients won’t suffer,” and he may be right. However, the difficulty is that he may be wrong, so why are we taking this risk at a time like this? What is the point? What is the benefit?

[Mr Burns]

I do not think that this will come as a surprise to the hon. Lady, but I do not think that I am wrong, and I say that for the following reasons. First, there has never been a cap on NHS trusts, and the problems that she has speculated about during this debate have never occurred where there is not a cap. Secondly, the reasons that I have outlined would suggest to me that there will not be a problem, particularly as the one hospital that I singled out—the Royal Marsden—has an income cap of 30.7%. Nobody is suggesting that NHS patients are suffering as a result of that, and that is where a substantial income comes from non-NHS work. Finally, the five safeguards that I have highlighted will be powerful measures to ensure that what she describes will not happen.

For those reasons, I would be grateful if my hon. Friend the Member for St Ives did not press his new clause to a vote. I would also hope that, on reflection and having made her points, the hon. Member for Islington South and Finsbury will resist the temptation to press her amendment to a Division. I fear, however, that she is not going to heed my advice, and she will regret it.

[Several hon. Members]

rose—

[Mr Speaker]

Order. Four Members are seeking to catch my eye, and I should like to give the person who moved the new clause a couple of moments to speak. Members can do the arithmetic for themselves.

21:45

[Caroline Lucas]

New clauses 19 and 22 also have my name on them, and I should like to say a few more words in support of them as I have not been reassured by the Minister. I find it unacceptable that taxpayers’ money has ever been used to allow private patients to jump the queue and use NHS facilities. The history of the cap was all very interesting, but the bottom line is that it serves an important purpose, which is why it should stay. The Government argue that income from private patients is put back into the NHS and ultimately benefits the health service, but the reality is that when people become ill and need treatment, it is hard to justify asking them to wait longer because capacity in our NHS hospitals is being taken up by private patients. The bottom line is that an NHS hospital has to treat NHS patients, and I do not believe that we have adequate spare capacity sloshing about in the system to justify private queue-jumping.

Some Members will recall that foundation trusts were brought in after Alan Milburn visited the state-owned but privately run Fundación hospital in Madrid. The then Health Secretary was apparently impressed when he was told that the foundation hospital outperformed the Government-controlled hospitals. However, he ignored the argument put forward by the local unions that it was able to do so precisely because the more costly and difficult patients were sent to the fully public hospital nearby.

It is often argued that foundation trusts are about choice, but I would argue that such private treatment should be offered only when there is surplus provision in the system. It is one thing to talk about a choice of general goods and services, but it is enormously inefficient and massively costly to apply that mentality to the health service. Now, we see the present Government trying to use the model introduced by the previous one to allow foundation trusts to do as they please, and lifting the cap on the income that can be derived from private sources.

The hundreds of constituents who are contacting me about this do not want private queue-jumping; they want NHS services paid for from taxation. The future of the NHS should be about developing whole systems, not isolated institutions, and private health care in the NHS should be phased out. The NHS needs to be about building networks across professional and institutional boundaries, not about creating new barriers. It needs to be about IT and information sharing, not reducing connectivity, and about getting more people treated in the community and in primary care. The danger with this Bill is that it will do exactly the opposite and return us to the fragmentation of the time before the NHS.

[John Pugh]

I supported the amendment tabled by the hon. Member for Islington South and Finsbury (Emily Thornberry)—or, rather, I tabled it independently. I accepted at the time that it was not the most elegant way of dealing with the problem, but I recognise that there is a problem, as do foundation trusts. The cap as it stands has certain perverse consequences, and the NHS cannot fully profit from sources such as intellectual property. NHS profits help to subsidise public services. As the Minister has pointed out, there is no cap on non-foundation trusts, and the current format was to some extent a political compromise because Labour Members raised certain considerations during the passage of the legislation on foundation hospitals. That does not mean that their concerns were not valid at the time.

I am not concerned by the prospect of dramatic privatisation overnight; nor do I think that queue-jumping is the real danger. By abolishing the cap altogether, however, we run the risk that foundation trusts will run on the wrong side of state aid rules, and that their activity will be perceived as economic activity under EU competition law. The more they subsidise general NHS services, the more they will be perceived as engaging in economic activity.

I do not take a doctrinaire view on this issue. Very sensible people, such as Steve Field and the NHS Confederation, have raised the matter. The hon. Member for Leicester West (Liz Kendall) raised it, as did, if I recall correctly, the hon. Member for Islington South and Finsbury in a spirit of compromise in Committee, making the point—I think I am quoting her correctly—that the only alternative to a bad cap is not no cap at all.

There is a genuine fear, however, among people who are far more expert than most hon. Members in this field, which is caused by the blurring of the boundaries between public and private hospitals. We could end up theoretically with a private hospital that has 90% of its patients provided by the NHS. I know we cannot end up with an NHS hospital filled by 90% of private patients, but there is a threshold at which things could quite easily start to become complicated. This a critical issue, which will have to be dealt with in the House of Lords.

[Emily Thornberry]

The hon. Gentleman has quoted me, so let me clarify that I was quoting the Deputy Prime Minister when I said that the only alternative to a bad Bill was not no Bill at all. I was talking about a Bill as opposed to a cap.

[John Pugh]

I may not have paraphrased the hon. Lady correctly, but I believe that the sentiments I described were expressed by her in discussions of a particular amendment on this subject, but we can go and look at the Committee proceedings to find out whether I am right.

It seems to me that what has happened on this occasion is that the Secretary of State has rehearsed the arguments that we have already heard in Committee. That does not advance things massively. He has supplemented that by saying that better efforts should be made to explain how the cap operates by the foundation trusts themselves, which will be more accountable, as I think he said, to the governing body of the foundation trust. That is an explanation and good explanation is to be desired. The point is, however, that expert opinion—independent of this House— perceives this to be a problem, but it has not been addressed.

[Chris Leslie]

I intended to make only a short intervention, but given the Minister’s cap on interventions, I decided that I needed to find a brief opportunity to say that removing the private patient cap is the wrong thing to do. The Minister’s basic argument— “I do not think I’m wrong”—really does not cut it. Removing the cap will remove an incentive for reducing waiting lists. The two issues of waiting lists and waiting times and the degree of private business within the NHS cannot be separated: they go hand in hand.

In a sense, a bit of ancient history is required, because it is important to note that the previous Labour Administration reduced waiting times so much that many of the private health insurers were, frankly, complaining. Long waiting lists matter because they are also the lifeblood of the private medical industry. We need only look at the advertising slogans of many private medical insurers to see how they try to entice people with promises of “speedy service” and “getting your health situation sorted out quickly”. This, however, can happen in the context of NHS hospitals.

What we must do is ensure that we put the needs of NHS patients first. My worry about removing the private patient cap is that it changes the incentives relating to how the foundation trusts will work, putting revenue generation ahead of patient treatment. The allure of revenue will, of course, be there, but keeping waiting lists high is, in a sense, part of ensuring that revenue continues to come in. I want to see trusts focused absolutely and completely on reducing waiting times. That is incredibly important.

It has been interesting to hear some of the important points raised by some Government Members—and not just about state aid rules. To me, however, the issue of waiting times and, particularly, this Administration’s watering down of the targets set for them and the issue of removing the patient cap are two sides of the same coin. It is all about driving people to go in a direction that they often do not want to go. People might have some savings and feel they have no choice but to use them for private provision because of the fear of long waiting lists in future. That might be the only way people feel that they can get treated quickly. It is all part of the design to change the whole fabric and nature of the NHS. That is the wrong direction in which to head, and I hope that we can retain the private patient cap.

[Diana Johnson]

I support amendment 1165. Although I have a great deal of respect for the Minister, his comments did not persuade me. The proposal to remove the cap is an example of the shambolic way in which the Bill has been presented. There seems to me to be very little evidence to back up what the Minister thinks might happen. He thinks that everything will be OK, but the NHS has never been in the position of having to make £20 billion-worth of efficiency savings—or cuts, which is what they really are. I believe that when the cap is removed, trusts will want to increase the income that they can obtain from private patients. My hon. Friend the Member for Warrington North (Helen Jones) made the good point that when waiting lists lengthen—which we know they are already beginning to do—those who pay will do so in order to receive the medical treatment that they want.

After 1997, NHS waiting lists in Hull fell to their lowest ever level. A private hospital that sat in the middle of an NHS trust—it was then the Hull and East Riding acute trust—was sold to the NHS. It had not been getting enough business, because the NHS was doing so well. We have heard in today’s debate about the high level of support for the NHS and about the current high levels of satisfaction, and I do not think that we should take this step.

Earlier, I spoke of the lack of principles that the Liberal Democrats were exhibiting yet again in respect of the NHS. It was interesting to hear the hon. Member for Southport (John Pugh) say that he was not doctrinaire on the issue. So the hon. Gentleman has no principles, and is not doctrinaire either. I recall that, in 2010, the Liberal Democrats campaigned in my constituency on a platform of saving the NHS, not increasing the number of private patients. I think that when this measure reaches the House of Lords, Liberal Democrat peers must stand up and be counted, because it is a disgrace that Liberal Democrat Members should support it today.

My main concern relates to evidence. Where is the evidence that removing the cap will work? I do not think that the safeguards exist to ensure that NHS patients will be protected, and I know that waiting lists are rising, which means that people in my constituency, and in poorer parts of the country, will not be able to gain the access to health care that they deserve. I believe that removing the cap is entirely wrong.

[Andrew George]

It is a pleasure to follow the hon. Member for Kingston upon Hull North (Diana Johnson), but I do not think she did herself or her party any favours in trying to persuade my Liberal Democrat colleagues and me to follow her or her party’s lead by launching a completely unacceptable attack on my hon. Friend the Member for Southport (John Pugh).

The Minister seemed to be trying to win me over by describing me as “the hon. Member for Cornwall”. His description stimulated my Cornish imperialist tendencies, and I was tempted to change that to “Cornwall and bits of England”. However, I shall leave it for another Bill, perhaps one relating to boundary reviews.

In his response, the Minister said that the cap was a “blunt instrument”. I acknowledged that in my opening remarks: it is indeed a blunt instrument, which does not achieve what I think we all want it to achieve. However, although the current situation is not satisfactory, neither is the proposal to lift the cap. That too is a blunt instrument, as was made clear by many speakers this evening. I do not think the Minister entirely acknowledged that this is a conundrum that needs to be resolved. As I have said before, the Government are right to address the issue and are doing so with the best of intentions, but they have come up with the wrong answer. Indeed, lifting the cap is not an answer at all. Further work is needed, and deleting clause 168 would be a good start.

As I have said, mine are probing proposals. I will support amendment 1165, but I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.

22:00

Proceedings interrupted (Programme Order, this day).

Mr Speaker put forthwith the Questions necessary for the disposal of the business to be concluded at that time (Standing Order No. 83E).

Clause 62

Conflicts between functions

Amendments made: 88, page 86, line 23, leave out from ‘sections’ to ‘transitional’ in line 24 and insert

‘117 and [Orders under section [Duration of transitional period] that apply to only some trusts] of this Act (imposition of licence conditions on NHS foundation trusts during’.

Amendment 89, page 86, line 27, leave out ‘116 and 117’ and insert

‘117 and [Orders under section [Duration of transitional period] that apply to only some trusts]’.—(Mr Simon Burns.)

Clause 116

Designation Of NHS Foundation Trusts During Transitional Period

Amendment made: 108, page 120, line 10, leave out Clause 116.—(Mr Simon Burns.)

Clause 117

Imposition Of Licence Conditions On Designated NHS Foundation Trusts

Amendments made: 109, page 121, line 7, leave out subsection (1).

Amendment 110, page 121, line 9, leave out ‘the’ and insert ‘an NHS foundation’.

Amendment 111, page 121, line 13, leave out ‘the designation expires’ and insert

‘this section ceases, by virtue of section [Duration of transitional period], to have effect in relation to the trust’.

Amendment 112, page 121, line 33, leave out subsection (7).—(Mr Simon Burns.)

Clause 168

Private Health Care

Amendment proposed: 1165, page 159, line 24, leave out Clause 168.—(Emily Thornberry.)

22:01

Division 338

Ayes: 239

---

Labour: 223
Democratic Unionist Party: 6
Plaid Cymru: 3
Liberal Democrat: 3
Social Democratic & Labour Party: 2
Alliance: 1
Green Party: 1
Independent: 1

Noes: 292

---

Conservative: 255
Liberal Democrat: 36

Clause 6

The NHS Commissioning Board

Amendment made: 404, page 3, line 36, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Clause 7

Commissioning Consortia

Amendments made: 405, page 4, line 10, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

406, page 4, line 11, leave out ‘Commissioning consortia’ and insert ‘Clinical commissioning groups’.

407, page 4, line 12, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

408, page 4, line 14, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 10

Duties of consortia as to commissioning certain health services

Amendments made: 409, page 6, line 3, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

410, page 6, line 8, leave out ‘consortium’ and insert ‘group’.

411, page 6, line 10, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

412, page 6, line 13, leave out ‘consortium’ and insert ‘group’.

413, page 6, line 14, leave out ‘consortium’s’ and insert ‘group’s’.

414, page 6, line 16, leave out ‘consortium’ and insert ‘clinical commissioning group’.

415, page 6, line 18, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

416, page 6, line 21, leave out ‘consortium’ and insert ‘group’.

417, page 6, line 22, leave out ‘consortium’s’ and insert ‘group’s’.

418, page 6, line 25, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

419, page 6, line 35, leave out ‘consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Clause 11

Power of consortia as to commissioning certain health services

Amendments made: 420, page 7, line 3, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

421, page 7, line 5, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

422, page 7, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 12

Power to require Board to commission certain health services

Amendments made: 423, page 7, line 31, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

424, page 7, line 39, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Clause 14

Other services etc. provided as part of the health service

Amendments made: 425, page 9, line 42, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

426, page 10, line 1, leave out ‘consortium’ and insert ‘group’.

427, page 10, line 11, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

428, page 10, line 22, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

429, page 10, line 24, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

430, page 10, line 35, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

431, page 10, line 41, leave out ‘consortium’ and insert ‘clinical commissioning group’.

432, page 11, line 1, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 16

Regulations relating to EU obligations

Amendments made: 433, page 11, line 35, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

434, page 12, line 5, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

435, page 12, line 9, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 17

Regulations as to the exercise of functions by the Board or consortia

Amendments made: 436, page 12, line 13, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

437, page 12, line 16, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

438, page 12, line 18, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

439, page 12, line 19, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

440, page 12, line 22, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

441, page 12, line 29, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

442, page 12, line 35, leave out ‘consortium’ and insert ‘clinical commissioning group’.

443, page 12, line 41, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

444, page 12, line 44, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

445, page 13, line 2, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

446, page 13, line 6, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

447, page 13, line 9, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

448, page 13, line 16, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

449, page 13, line 25, leave out ‘consortium’ and insert ‘clinical commissioning group’.

450, page 13, line 33, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

451, page 13, line 34, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

452, page 13, line 37, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

453, page 13, line 38, leave out ‘consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Clause 19

Exercise of public health functions of the Secretary of State

Amendments made: 454, page 14, line 29, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

455, page 14, line 37, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 20

The NHS Commissioning Board: further provision

Amendments made: 456, page 15, line 34, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

457, page 20, line 21, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

458, page 21, line 39, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

459, page 22, line 37, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 21

Financial arrangements for the Board

Amendments made: 460, page 25, line 9, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

461, page 25, line 11, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

462, page 25, line 13, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

463, page 25, line 22, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

464, page 25, line 24, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

465, page 25, line 29, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

466, page 25, line 40, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

467, page 25, line 43, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

468, page 27, line 2, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 22

Commissioning consortia: establishment etc.

Amendments made: 469, page 27, line 11, leave out ‘Commissioning consortia’ and insert ‘Clinical commissioning groups’.

470, page 27, line 12, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

471, page 27, line 13, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

472, page 27, line 17, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

473, page 27, line 20, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

474, page 28, line 6, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

475, page 28, line 7, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

476, page 28, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

477, page 28, line 14, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

478, page 28, line 16, leave out ‘consortium’ and insert ‘group’.

479, page 28, line 23, leave out ‘consortium’ and insert ‘clinical commissioning group’.

480, page 28, line 31, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

481, page 28, line 40, leave out ‘consortium’ and insert ‘clinical commissioning group’.

482, page 28, line 43, leave out ‘consortium’ and insert ‘group’.

483, page 28, line 44, leave out ‘consortium’ and insert ‘group’.

484, page 29, line 2, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

485, page 29, line 5, leave out ‘consortium’ and insert ‘group’.

486, page 29, line 17, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

487, page 29, line 18, leave out ‘commissioning consortium’s’ and insert ‘clinical commissioning group’s’.

488, page 29, line 20, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

489, page 29, line 24, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

490, page 29, line 28, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

491, page 29, line 38, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

492, page 29, line 42, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

493, page 30, line 1, leave out ‘consortium’ and insert ‘clinical commissioning group’.

494, page 30, line 4, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

495, page 30, line 6, leave out ‘consortium’ and insert ‘group’.

496, page 30, line 7, leave out ‘consortium’ and insert ‘clinical commissioning group’.

497, page 30, line 11, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

498, page 30, line 17, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

499, page 30, line 18, leave out ‘consortia’ and insert ‘groups’.

500, page 30, line 19, leave out ‘consortium’ and insert ‘clinical commissioning group’.

501, page 30, line 21, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

502, page 30, line 23, leave out ‘consortium’ and insert ‘group’.

503, page 30, line 33, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

504, page 30, line 34, leave out ‘consortium’ and insert ‘group’.

505, page 31, line 5, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

506, page 31, line 7, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

507, page 31, line 10, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

508, page 31, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

509, page 31, line 14, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

510, page 31, line 16, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

511, page 31, line 19, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

512, page 31, line 20, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

513, page 31, line 21, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

514, page 31, line 22, leave out ‘consortium’ and insert ‘group’.

515, page 31, line 24, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

516, page 31, line 27, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

517, page 31, line 31, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

518, page 31, line 33, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

519, page 31, line 34, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

520, page 31, line 35, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

521, page 31, line 37, leave out ‘consortium’ and insert ‘group’.

522, page 32, line 2, leave out ‘consortium’ and insert ‘clinical commissioning group’.

523, page 32, line 5, leave out ‘consortium’s’ and insert ‘group’s’.

524, page 32, line 8, leave out ‘consortium’ and insert ‘group’.

525, page 32, line 12, leave out ‘consortium’ and insert ‘group’.

526, page 32, line 15, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

527, page 32, line 19, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

528, page 32, line 25, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

529, page 32, line 29, leave out ‘consortium’ and insert ‘clinical commissioning group’.

530, page 32, line 34, leave out ‘consortium’s’ and insert ‘group’s’.

531, page 32, line 41, leave out ‘consortium’s’ and insert ‘group’s’.

532, page 32, line 42, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

533, page 32, line 44, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

534, page 33, line 2, leave out ‘consortium’ and insert ‘clinical commissioning group’.

535, page 33, line 36, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

536, page 33, line 48, leave out ‘consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 23

Commissioning consortia: general duties etc.

Amendments made: 537, page 34, line 6, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

538, page 34, line 8, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

539, page 34, line 19, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

540, page 34, line 22, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

541, page 34, line 26, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

542, page 34, line 35, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

543, page 34, line 39, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

544, page 35, line 2, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

545, page 35, line 11, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

546, page 35, line 15, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

547, page 35, line 17, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

548, page 35, line 21, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

549, page 35, line 26, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

550, page 35, line 31, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

551, page 35, line 33, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

552, page 35, line 36, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

553, page 36, line 2, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

554, page 36, line 7, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

555, page 36, line 16, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

556, page 36, line 38, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

557, page 36, line 40, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

558, page 36, line 42, leave out ‘consortium’ and insert ‘clinical commissioning group’.

559, page 36, line 46, leave out ‘consortium’ and insert ‘group’.

560, page 37, line 2, leave out ‘consortium’ and insert ‘group’.

561, page 37, line 7, leave out ‘consortium’ and insert ‘group’.

562, page 37, line 10, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

563, page 37, line 15, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

564, page 37, line 17, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

565, page 37, line 24, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

566, page 37, line 25, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

567, page 37, line 28, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

568, page 37, line 30, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

569, page 37, line 32, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

570, page 37, line 34, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

571, page 37, line 36, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

572, page 37, line 37, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

573, page 37, line 40, leave out ‘consortia’ and insert ‘groups’.

574, page 38, line 2, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

575, page 38, line 4, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

576, page 38, line 9, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

577, page 38, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

578, page 38, line 14, leave out ‘consortium’ and insert ‘group’.

579, page 38, line 16, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

580, page 38, line 17, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

581, page 38, line 19, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

582, page 38, line 23, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

583, page 38, line 25, leave out ‘consortium’ and insert ‘group’.

584, page 38, line 28, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

585, page 38, line 31, leave out ‘consortium’ and insert ‘group’.

586, page 38, line 33, leave out ‘consortium’ and insert ‘group’.

587, page 38, line 34, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

588, page 38, line 37, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

589, page 38, line 40, leave out ‘consortium’ and insert ‘clinical commissioning group’.

590, page 39, line 1, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

591, page 39, line 3, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

592, page 39, line 4, leave out ‘consortium’ and insert ‘clinical commissioning group’.

593, page 39, line 5, leave out ‘consortium’ and insert ‘clinical commissioning group’.

594, page 39, line 10, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

595, page 39, line 14, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

596, page 39, line 17, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

597, page 39, line 19, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

598, page 39, line 27, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

599, page 39, line 28, leave out ‘consortium’ and insert ‘group’.

600, page 39, line 31, leave out ‘consortium’ and insert ‘group’.

601, page 39, line 37, leave out ‘consortium’ and insert ‘clinical commissioning group’.

602, page 39, line 39, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

603, page 39, line 41, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

604, page 40, line 3, leave out ‘consortium’ and insert ‘clinical commissioning group’.

605, page 40, line 9, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

606, page 40, line 13, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

607, page 40, line 16, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

608, page 40, line 20, leave out ‘consortium’ and insert ‘group’.

609, page 40, line 23, leave out ‘consortium’ and insert ‘group’.

610, page 40, line 27, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

611, page 40, line 28, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

612, page 40, line 30, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

613, page 40, line 32, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

614, page 40, line 35, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

615, page 40, line 38, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

616, page 40, line 40, leave out ‘consortium’ and insert ‘group’.

617, page 41, line 2, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

618, page 41, line 4, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

619, page 41, line 6, leave out ‘consortium’ and insert ‘group’.

620, page 41, line 9, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

621, page 41, line 10, leave out ‘consortium’ and insert ‘group’.

622, page 41, line 16, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

623, page 41, line 20, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

624, page 41, line 22, leave out ‘consortium’ and insert ‘clinical commissioning group’.

625, page 41, line 24, leave out ‘consortium’ and insert ‘clinical commissioning group’.

626, page 41, line 32, leave out ‘consortium’ and insert ‘clinical commissioning group’.

627, page 41, line 38, leave out ‘consortium’ and insert ‘clinical commissioning group’.

628, page 41, line 39, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

629, page 41, line 43, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

630, page 42, line 3, leave out ‘consortium’ and insert ‘group’.

631, page 42, line 16, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

632, page 42, line 21, leave out ‘consortium’ and insert ‘clinical commissioning group’.

633, page 42, line 24, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

634, page 42, line 25, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

635, page 42, line 29, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

636, page 42, line 31, leave out ‘consortium’ and insert ‘group’.

637, page 42, line 35, leave out ‘consortium’ and insert ‘clinical commissioning group’.

638, page 42, line 37, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

639, page 42, line 39, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

640, page 42, line 41, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

641, page 43, line 1, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

642, page 43, line 2, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

643, page 43, line 4, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

644, page 43, line 6, leave out ‘consortium’ and insert ‘clinical commissioning group’.

645, page 43, line 8, leave out ‘consortium’ and insert ‘group’.

646, page 43, line 16, leave out ‘consortium’s’ and insert ‘clinical commissioning group’s’.

647, page 43, line 17, leave out ‘consortium’ and insert ‘group’.

648, page 43, line 30, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

649, page 43, line 32, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

650, page 43, line 41, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

651, page 43, line 43, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

652, page 44, line 1, leave out ‘consortium’ and insert ‘group’.

653, page 44, line 13, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

654, page 44, line 15, leave out ‘consortium’ and insert ‘group’.

655, page 44, line 16, leave out ‘consortium’ and insert ‘group’.

656, page 44, line 21, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

657, page 44, line 27, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

658, page 44, line 29, leave out ‘consortium’ and insert ‘clinical commissioning groups’.

659, page 44, line 31, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

660, page 44, line 33, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

661, page 44, line 35, leave out ‘consortium’ and insert ‘clinical commissioning group’.

662, page 44, line 39, leave out ‘consortium’ and insert ‘clinical commissioning group’.

663, page 44, line 40, leave out ‘consortium’ and insert ‘group’.

664, page 45, line 2, leave out ‘consortium’s’ and insert ‘clinical commissioning group’s’.

665, page 45, line 7, leave out ‘consortium’ and insert ‘clinical commissioning group’.

666, page 45, line 13, leave out ‘consortium’ and insert ‘clinical commissioning group’.

667, page 45, line 16, leave out ‘consortium’ and insert ‘clinical commissioning group’.

668, page 45, line 18, leave out ‘consortium’ and insert ‘clinical commissioning group’.

669, page 45, line 19, leave out ‘consortium’ and insert ‘clinical commissioning group’.

670, page 45, line 20, leave out ‘consortium’ and insert ‘group’.

671, page 45, line 23, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

672, page 45, line 25, leave out ‘consortium’ and insert ‘group’.

673, page 45, line 28, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

674, page 45, line 29, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

675, page 45, line 30, leave out ‘consortium’ and insert ‘group’.

676, page 45, line 32, leave out ‘consortium’ and insert ‘clinical commissioning group’.

677, page 46, line 3, leave out ‘consortium’ and insert ‘clinical commissioning group’.

678, page 46, line 5, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

679, page 46, line 23, leave out ‘consortium’ and insert ‘clinical commissioning group’.

680, page 46, line 26, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

681, page 46, line 43, leave out ‘consortium’s’ and insert ‘clinical commissioning group’s’.

682, page 47, line 8, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

683, page 47, line 9, leave out ‘consortium’ and insert ‘group’.

684, page 47, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

685, page 47, line 17, leave out ‘Commissioning consortia’ and insert ‘Clinical commissioning groups’.—(Mr Simon Burns.)

Clause 24

Financial arrangements for consortia

Amendments made: 686, page 47, line 18, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

687, page 47, line 21, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

688, page 47, line 22, leave out ‘consortium’ and insert ‘group’.

689, page 47, line 23, leave out ‘consortium’ and insert ‘group’.

690, page 47, line 25, leave out ‘consortium’ and insert ‘clinical commissioning group’.

691, page 47, line 27, leave out ‘consortium’ and insert ‘clinical commissioning group’.

692, page 47, line 32, leave out ‘consortium’ and insert ‘clinical commissioning group’.

693, page 47, line 33, leave out ‘consortium’ and insert ‘group’.

694, page 47, line 37, leave out ‘consortium’ and insert ‘clinical commissioning group’.

695, page 47, line 39, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

696, page 48, line 3, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

697, page 48, line 7, leave out ‘consortium’ and insert ‘clinical commissioning group’.

698, page 48, line 9, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

699, page 48, line 10, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

700, page 48, line 21, leave out ‘consortium’ and insert ‘clinical commissioning group’.

701, page 48, line 24, leave out ‘consortium’ and insert ‘clinical commissioning group’.

702, page 48, line 26, leave out ‘consortium’ and insert ‘clinical commissioning group’.

703, page 48, line 28, leave out ‘consortium’ and insert ‘group’.

704, page 48, line 30, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

705, page 48, line 34, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

706, page 48, line 36, leave out ‘commissioning consortium’s’ and insert ‘clinical commissioning group’s’.

707, page 48, line 37, leave out ‘consortium’s’ and insert ‘group’s’.

708, page 48, line 39, leave out ‘commissioning consortium’s’ and insert ‘clinical commissioning group’s’.

709, page 48, line 40, leave out ‘consortium’s’ and insert ‘group’s’.

710, page 48, line 42, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

711, page 49, line 1, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

712, page 49, line 8, leave out ‘consortium’ and insert ‘clinical commissioning group’.

713, page 49, line 12, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

714, page 49, line 13, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

715, page 49, line 16, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

716, page 49, line 19, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

717, page 49, line 37, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

718, page 50, line 20, leave out ‘consortium’ and insert ‘clinical commissioning group’.

719, page 50, line 25, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

720, page 50, line 26, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

721, page 50, line 27, leave out ‘consortium’ and insert ‘group’.

722, page 50, line 30, leave out ‘consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 25

Requirement for primary medical services provider to belong to consortium

Amendments made: 723, page 50, line 44, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

724, page 51, line 3, leave out ‘consortium’ and insert ‘clinical commissioning group’.

725, page 51, line 7, leave out ‘consortium’ and insert ‘clinical commissioning group’.

726, page 51, line 17, leave out ‘consortium’ and insert ‘clinical commissioning group’.

727, page 51, line 39, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

728, page 51, line 43, leave out ‘consortium’ and insert ‘clinical commissioning group’.

729, page 51, line 48, leave out ‘consortium’ and insert ‘clinical commissioning group’.

730, page 52, line 9, leave out ‘consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 36

After-care

Amendments made: 731, page 69, line 13, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

732, page 69, line 18, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

733, page 69, line 32, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

734, page 69, line 38, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

735, page 69, line 40, leave out ‘consortium’ and insert ‘group’.

736, page 69, line 44, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

737, page 70, line 9, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

738, page 70, line 11, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

739, page 70, line 17, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

740, page 70, line 24, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

741, page 70, line 26, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 41

Notification of hospitals having arrangements for special cases

Amendments made: 742, page 72, line 38, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

743, page 72, line 40, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

744, page 72, line 42, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 42

Role of the Board and consortia in respect of emergencies

Amendments made: 745, page 73, line 8, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

746, page 73, line 9, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

747, page 73, line 10, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

748, page 73, line 14, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

749, page 73, line 17, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

750, page 73, line 28, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

751, page 73, line 41, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

752, page 73, line 43, leave out ‘consortium’ and insert ‘group’.—(Mr Simon Burns.)

Clause 45

Primary care services: directions as to exercise of functions

Amendments made: 753, page 76, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

754, page 76, line 15, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

755, page 76, line 17, leave out ‘consortium’ and insert ‘group’.

756, page 76, line 22, leave out ‘consortium’ and insert ‘clinical commissioning group’.

757, page 76, line 25, leave out ‘consortium’ and insert ‘group’.

758, page 76, line 26, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

759, page 76, line 28, leave out ‘consortium’s’ and insert ‘group’s’.

760, page 77, line 13, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

761, page 77, line 17, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 58

General Duties

Amendment made: 762, page 84, line 9, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Clause 70

Requirements as to procurement, patient choice and competition

Amendment made: 763, page 91, line 45, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Clause 71

Requirements under section 70: investigations, declarations and directions

Amendments made: 764, page 92, line 24, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

765, page 92, line 27, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

766, page 92, line 30, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

767, page 92, line 33, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

768, page 92, line 45, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

769, page 93, line 8, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 72

Requirements under section 70: undertakings

Amendments made: 770, page 93, line 32, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

771, page 93, line 39, leave out ‘consortium’ and insert ‘clinical commissioning group’.

772, page 94, line 1, leave out ‘consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 101

Standard conditions

Amendment made: 773, page 109, line 38, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 102

Special conditions

Amendment made: 774, page 110, line 15, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Clause 105

Modification of standard conditions

Amendment made: 775, page 112, line 41, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 106

Modification references to the Competition Commission

Amendments made: 776, page 114, line 45, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

777, page 115, line 5, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Clause 107

Modification of conditions by order under other enactments

Amendment made: 778, page 116, line 4, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 109

power to require documents and information

Amendment made: 779, page 117, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 115

Notification of enforcement action

Amendment made: 780, page 120, line 1, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Clause 123

Responses to consultation

Amendments made: 782, page 127, line 6, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

783, page 127, line 13, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

784, page 127, line 21, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Clause 127

Local modifications of prices of designated services: agreements

Amendment made: 785, page 130, line 21, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Clause 128

Local modifications of prices of designate services: applications

Amendment made: 786, page 131, line 9, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Clause 129

Correction of mistakes

Amendment made: 787, page 131, line 31, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 144

Consultation

Amendment made: 788, page 141, line 24, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 191

Annual reports

Amendment made: 789, page 179, line 14, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 193

Scrutiny functions of local authorities

Amendments made: 790, page 180, line 34, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

791, page 180, line 36, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 195

Joint strategic needs assessments

Amendments made: 792, page 183, line 13, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

793, page 183, line 16, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

794, page 183, line 17, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

795, page 183, line 22, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

796, page 183, line 25, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

797, page 183, line 28, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

798, page 183, line 38, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

799, page 183, line 42, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

800, page 183, line 43, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

801, page 184, line 5, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

802, page 184, line 7, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 196

Joint health and wellbeing strategies

Amendments made: 803, page 184, line 15, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

804, page 184, line 16, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

805, page 184, line 19, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

806, page 184, line 22, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

807, page 184, line 27, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

808, page 184, line 33, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

809, page 184, line 39, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

810, page 185, line 1, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

811, page 185, line 8, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

812, page 185, line 11, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

813, page 185, line 20, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Clause 197

Establishment of Health and Wellbeing Boards

Amendments made: 814, page 185, line 36, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

815, page 186, line 5, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

816, page 186, line 8, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

817, page 186, line 14, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

818, page 186, line 31, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

819, page 186, line 32, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 199

Other functions of Health and Wellbeing Boards

Amendment made: 820, page 187, line 31, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Clause 203

Care Trusts

Amendments made: 821, page 189, line 14, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

822, page 190, line 30, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

823, page 190, line 33, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 237

Quality Standards

Amendment made: 824, page 225, line 31, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 253

Powers to publish information standards

Amendment made: 825, page 233, line 19, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 257

Powers to direct Information Centre to establish information systems

Amendment made: 826, page 235, line 2, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 283

Special notices of births and deaths

Amendment made: 827, page 247, line 14, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Clause 284

Provision of information by Registrar General

Amendment made: 828, page 247, line 32, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 286

Provision of statistical information by Statistics Board

Amendments made: 829, page 248, line 41, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

830, page 249, line 26, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 297

Advice or assistance to public authorities in the Isle of Man or Channel Islands

Amendments made: 831, page 254, line 37, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

832, page 254, line 42, leave out ‘consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Clause 300

Transfer schemes: supplemental

Amendment made: 833, page 257, line 39, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Schedule 1

The National Health Service Commissioning Board

Amendments made: 834, page 267, line 33, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

835, page 268, line 13, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Schedule 2

Commissioning consortia

Amendments made: 836, page 269, line 4, leave out ‘Commissioning consortia’ and insert ‘Clinical commissioning groups’.

837, page 269, line 6, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

838, page 269, line 8, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

839, page 269, line 10, leave out ‘consortium’ and insert ‘clinical commissioning group’.

840, page 269, line 11, leave out ‘consortium’ and insert ‘group’.

841, page 269, line 12, leave out ‘consortium’ and insert ‘group’.

842, page 269, line 13, leave out ‘consortium’ and insert ‘group’.

843, page 269, line 16, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

844, page 269, line 21, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

845, page 269, line 23, leave out ‘commissioning consortium’ and insert ‘group’.

846, page 269, line 26, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

847, page 269, line 29, leave out ‘consortium’ and insert ‘group’.

848, page 269, line 31, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

849, page 269, line 34, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

850, page 269, line 36, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

851, page 269, line 37, leave out ‘consortium’ and insert ‘group’.

852, page 270, line 1, leave out ‘commissioning consortium in the exercise of the consortium’s’ and insert ‘clinical commissioning group in the exercise of the group’s’.

853, page 270, line 3, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

854, page 270, line 5, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

855, page 270, line 19, leave out ‘consortium’ and insert ‘clinical commissioning group’.

856, page 270, line 28, leave out ‘consortium’ and insert ‘clinical commissioning group’.

857, page 270, line 36, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

858, page 270, line 41, leave out ‘consortium’ and insert ‘clinical commissioning group’.

859, page 271, line 6, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

860, page 271, line 8, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

861, page 271, line 9, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

862, page 271, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

863, page 271, line 15, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

864, page 271, line 16, leave out ‘consortium’ and insert ‘group’.

865, page 271, line 17, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

866, page 271, line 22, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

867, page 271, line 26, leave out ‘consortium’ and insert ‘clinical commissioning group’.

868, page 271, line 31, leave out ‘consortium’s’ and insert ‘clinical commissioning group’s’.

869, page 271, line 34, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

870, page 271, line 37, leave out ‘consortium’ and insert ‘clinical commissioning group’.

871, page 272, line 2, leave out ‘consortium’ and insert ‘clinical commissioning group’.

872, page 272, line 3, leave out ‘consortium’ and insert ‘group’.

873, page 272, line 5, leave out ‘consortia’ and insert ‘groups’.

874, page 272, line 6, leave out ‘consortia’ and insert ‘groups’.

875, page 272, line 7, leave out ‘consortium’ and insert ‘group’.

876, page 272, line 8, leave out ‘consortium’ and insert ‘group’.

877, page 272, line 9, leave out ‘consortia’ and insert ‘groups’.

878, page 272, line 10, leave out ‘consortia’ and insert ‘groups’.

879, page 272, line 11, leave out ‘consortium’ and insert ‘clinical commissioning group’.

880, page 272, line 12, leave out ‘consortia’ and insert ‘groups’.

881, page 272, line 13, leave out ‘consortium or any of the consortia’ and insert ‘group or any of the groups’.

882, page 272, line 16, leave out ‘consortium’ and insert ‘clinical commissioning group’.

883, page 272, line 17, leave out ‘consortia’ and insert ‘groups’.

884, page 272, line 29, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

885, page 272, line 31, leave out ‘consortium’ and insert ‘group’.

886, page 273, line 3, leave out ‘consortium’ and insert ‘clinical commissioning group’.

887, page 273, line 5, leave out ‘consortium’ and insert ‘clinical commissioning group’.

888, page 273, line 14, leave out ‘consortium’ and insert ‘clinical commissioning group’.

889, page 273, line 19, leave out ‘consortium’ and insert ‘clinical commissioning group’.

890, page 273, line 25, leave out ‘consortium’ and insert ‘clinical commissioning group’.

891, page 273, line 26, leave out ‘consortium’ and insert ‘clinical commissioning group’.

892, page 273, line 29, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

893, page 273, line 31, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

894, page 273, line 34, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

895, page 273, line 37, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

896, page 274, line 6, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

897, page 274, line 10, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

898, page 274, line 18, leave out ‘consortium’ and insert ‘clinical commissioning group’.

899, page 274, line 21, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

900, page 274, line 26, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

901, page 274, line 32, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

902, page 274, line 38, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

903, page 275, line 2, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

904, page 275, line 7, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

905, page 275, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Schedule 3

Pharmaceutical remuneration

Amendments made: 906, page 276, line 14, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

907, page 276, line 20, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

908, page 276, line 24, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

909, page 276, line 29, leave out ‘consortium’ and insert ‘clinical commissioning group’.

910, page 276, line 3, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

911, page 276, line 33, leave out ‘consortium’ and insert ‘group’.

912, page 276, line 35, leave out ‘consortium’ and insert ‘group’.

913, page 277, line 1, leave out ‘consortium’ and insert ‘clinical commissioning group’.

914, page 277, line 5, leave out ‘consortium’ and insert ‘clinical commissioning group’.

915, page 277, line 6, leave out ‘consortium’ and insert ‘group’.—(Mr Simon Burns.)

Schedule 4

Amendments of the National Health Service Act 2006

Amendments made: 916, page 277, line 35, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

917, page 278, line 7, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

918, page 278, line 12, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

919, page 278, line 26, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

920, page 279, line 3, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

921, page 279, line 19, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

922, page 279, line 39, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

923, page 279, line 41, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

924, page 280, line 3, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

925, page 280, line 7, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

926, page 280, line 16, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

927, page 280, line 33, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

928, page 281, line 2, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

929, page 281, line 19, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

930, page 282, line 12, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

931, page 283, line 6, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

932, page 283, line 11, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

933, page 283, line 22, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

934, page 283, line 31, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

935, page 283, line 34, leave out ‘consortium’ and insert ‘clinical commissioning group’.

936, page 283, line 36, leave out ‘consortium’ and insert ‘group’.

937, page 283, line 38, leave out ‘consortium’ and insert ‘group’.

938, page 283, line 39, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

939, page 284, line 8, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

940, page 284, line 12, leave out ‘consortium’ and insert ‘clinical commissioning group’.

941, page 284, line 14, leave out ‘consortium’ and insert ‘group’.

942, page 284, line 16, leave out ‘consortium’ and insert ‘group’.

943, page 284, line 31, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

944, page 284, line 34, leave out ‘consortium’ and insert ‘clinical commissioning group’.

945, page 284, line 39, leave out ‘consortia’ and insert ‘clinical commissioning groups’.

946, page 286, line 14, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

947, page 287, line 18, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

948, page 299, line 24, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

949, page 299, line 30, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

950, page 299, line 35, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

951, page 299, line 37, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

952, page 300, line 1, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

953, page 300, line 10, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

954, page 300, line 31, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

955, page 301, line 5, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

956, page 301, line 25, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

957, page 301, line 30, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

958, page 301, line 34, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

959, page 302, line 5, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

960, page 302, line 10, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

961, page 302, line 13, leave out ‘consortium’ and insert ‘clinical commissioning group’.

962, page 302, line 28, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

963, page 302, line 34, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

964, page 302, line 35, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

965, page 302, line 38, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

966, page 303, line 33, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

967, page 303, line 42, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

968, page 304, line 28, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

969, page 304, line 31, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

970, page 304, line 33, leave out ‘consortium’ and insert ‘clinical commissioning group’.

971, page 304, line 36, leave out ‘consortium’ and insert ‘clinical commissioning group’.

972, page 305, line 4, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

973, page 305, line 7, leave out ‘consortium’ and insert ‘clinical commissioning group’.

974, page 305, line 10, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

975, page 306, line 4, leave out ‘“commissioning consortium” means a commissioning consortium’ and insert ‘“clinical commissioning group” means a body’.

976, page 306, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Schedule 5

Part 1: amendments of other enactments

Amendments made: 977, page 307, line 11, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

978, page 307, line 18, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

979, page 307, line 22, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

980, page 307, line 30, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

981, page 307, line 32, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

982, page 307, line 38, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

983, page 308, line 18, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

984, page 308, line 23, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

985, page 308, line 35, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

986, page 308, line 40, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

987, page 309, line 7, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

988, page 309, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

989, page 309, line 26, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

990, page 309, line 38, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

991, page 310, line 7, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

992, page 310, line 28, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

993, page 310, line 41, leave out ‘“commissioning consortium” means a commissioning consortium’ and insert ‘“clinical commissioning group” means a body’.

994, page 311, line 17, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

995, page 311, line 27, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

996, page 312, line 3, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

997, page 312, line 7, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

998, page 312, line 9, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

999, page 312, line 13, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1000, page 312, line 23, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1001, page 312, line 31, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1002, page 313, line 23, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1003, page 313, line 33, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1004, page 313, line 38, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1005, page 314, line 26, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1006, page 315, line 4, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1007, page 315, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1008, page 315, line 19, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1009, page 315, line 26, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1010, page 315, line 33, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1011, page 315, line 41, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1012, page 316, line 1, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1013, page 316, line 8, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1014, page 316, line 18, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1015, page 316, line 21, leave out ‘consortium’ and insert ‘clinical commissioning group’.

1016, page 316, line 25, leave out ‘“commissioning consortium” means a commissioning consortium’ and insert ‘“clinical commissioning group” means a body’.

1017, page 316, line 39, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1018, page 316, line 46, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1019, page 318, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1020, page 318, line 18, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1021, page 319, line 3, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1022, page 319, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1023, page 319, line 23, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1024, page 319, line 32, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1025, page 319, line 38, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1026, page 320, line 2, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1027, page 320, line 8, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1028, page 320, line 39, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1029, page 321, line 1, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1030, page 321, line 6, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1031, page 321, line 11, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1032, page 321, line 14, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1033, page 321, line 19, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1034, page 321, line 28, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1035, page 321, line 36, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1036, page 321, line 40, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1037, page 322, line 14, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1038, page 322, line 35, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1039, page 323, line 3, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1040, page 323, line 11, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1041, page 323, line 28, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1042, page 323, line 32, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1043, page 323, line 41, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1044, page 324, line 9, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1045, page 325, line 23, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1046, page 325, line 27, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1047, page 325, line 29, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1048, page 325, line 39, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1049, page 326, line 8, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1050, page 326, line 21, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1051, page 326, line 29, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

1052, page 326, line 39, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1053, page 327, line 6, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1054, page 327, line 16, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1055, page 329, line 5, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1056, page 329, line 15, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1057, page 329, line 39, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1058, page 330, line 7, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1059, page 330, line 9, leave out ‘consortium’ and insert ‘clinical commissioning group’.

1060, page 330, line 15, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1061, page 330, line 33, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1062, page 331, line 2, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1063, page 331, line 30, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1064, page 331, line 41, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1065, page 332, line 10, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1066, page 332, line 21, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

1067, page 332, line 25, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

1068, page 332, line 31, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1069, page 333, line 7, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1070, page 333, line 13, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1071, page 333, line 21, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1072, page 333, line 23, leave out ‘consortium’ and insert ‘clinical commissioning group’.

1073, page 333, line 35, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1074, page 333, line 40, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1075, page 334, line 6, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1076, page 334, line 20, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1077, page 334, line 26, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1078, in schedule 22, page 334, line 42, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

1079, in schedule 5, page 335, line 9, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1080, page 335, line 39, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1081, page 336, line 12, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1082, page 336, line 22, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Schedule 6

Part 1: transitional provision

Amendments made: 1083, page 338, line 3, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1084, page 338, line 6, leave out ‘consortium’ and insert ‘group’.

1085, page 338, line 8, leave out ‘consortium’ and insert ‘group’.

1086, page 338, line 13, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1087, page 338, line 14, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1088, page 338, line 15, leave out ‘consortium’ and insert ‘group’.

1089, page 338, line 16, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1090, page 338, line 20, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1091, page 338, line 36, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1092, page 338, line 38, leave out ‘consortium’ and insert ‘clinical commissioning group’.

1093, page 338, line 39, leave out ‘consortium’ and insert ‘group’.

1094, page 338, line 43, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1095, page 339, line 1, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1096, page 339, line 5, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1097, page 339, line 8, leave out ‘consortium’ and insert ‘group’.

1098, page 339, line 13, leave out ‘commissioning consortium under which the consortium’ and insert ‘clinical commissioning group under which the group’.

Schedule 22

Amendments relating to relationships between the health services

1099, page 408, line 28, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

1100, page 411, line 21, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1101, page 412, line 5, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

1102, page 412, line 9, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

1103, page 412, line 18, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

1104, page 412, line 27, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

1105, page 412, line 33, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.

1106, page 412, line 38, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1107, page 414, line 16, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1108, page 414, line 22, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1109, page 414, line 26, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1110, page 414, line 36, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1111, page 414, line 41, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1112, page 415, line 7, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1113, page 416, line 34, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Schedule 23

Property transfer schemes

Amendments made: 1114, page 417, line 10, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1115, page 417, line 29, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Schedule 24

Staff transfer schemes

Amendments made: 1116, page 419, line 7, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.

1117, page 419, line 22, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.—(Mr Simon Burns.)

Title

Amendment made: 403, line 2 leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.—(Mr Simon Burns.)

Bill to be further considered tomorrow.