19:29 - The House divided: - Ayes: 260 / Noes: 314 - Question accordingly negatived.
19:44 - The House divided: - Ayes: 258 / Noes: 314 - Question accordingly negatived.
Andy Burnham
No. I have been listening to the strictures from the Chair, and I want to get into my speech so that Back-Bench colleagues have a chance to contribute.
That takes us straight to the heart of the predicament in which we find ourselves. There is huge concern in the country about the Bill, but the Government and Parliament—
The Secretary of State for Health (Mr Andrew Lansley)
Will the right hon. Gentleman give way?
Andy Burnham
I will in a moment.
There is huge concern in the country about the Bill, but the Government and Parliament are seen simply not to be listening. I give way to the Secretary of State, and I hope that he might prove us wrong.
Mr Lansley
I am grateful to the right hon. Gentleman, but before we move beyond that point will he confirm that Dr Chand is an adviser to the Labour party, which inspired the petition? Further, given that Dr Chand has called on the British Medical Association to take strike action against the Bill, does the right hon. Gentleman share that view, or will he disown him?
Andy Burnham
Dr Chand is not an adviser to the Labour party, and the Secretary of State, in seeking to inject that party political note so early on in today’s debate and to claim that the petition of 170,000 people is a political petition, continues, it suggests to me, to misread the mood of this country on his unnecessary Bill.
The Minister of State, Department of Health (Mr Simon Burns)
Will the right hon. Gentleman give way?
Andy Burnham
No, I will not.
We have arrived at a dangerous moment, not only for the NHS but for our democracy. To recap, this is a Bill for which nobody voted at the general election and which does not have a mandate, a Bill ruled out by the coalition agreement, and a Bill that has been so heavily amended in another place that in effect the unelected Chamber has written a new legal structure for the national health service that we are being asked to rubber-stamp. Yet despite all that, it could be rammed through this House in just seven days’ time, in defiance of an outstanding legal ruling from the Information Tribunal and in the teeth of overwhelming professional and public opposition.
This is an intolerable situation, and it is no way to treat our country’s most valued institution. Far-ranging changes to the NHS of the kind proposed by the Secretary of State can be made only by public consent and professional consensus, and it is plain for all to see that the Government have achieved neither of those things.
The Secretary of State for Health (Mr Andrew Lansley)
As a learned man, Mr Deputy Speaker, you will recall that Plato said that
“empty vessels make the loudest sound”.
The right hon. Member for Leigh (Andy Burnham) has been a study in this: as his arguments have diminished, so his tone has become more strident. By the end of his speech, he was simply shouting slogans. I listened carefully to his speech, but in vain, for evidence of an argument, still less of an Opposition policy.
I ask the House to reject the motion, which is a desperate ploy from a desperate party. The House scrutinised and approved the Bill, with amendments. following a substantial and highly constructive engagement right across health and care services and with the independent NHS Future Forum. We accepted all their recommendations. The chairman of the British Medical Association Council said at the time that the recommendations
“address many of the BMA’s key concerns”.
Dr Clare Gerada, the chair of the Royal College of General Practitioners, said that
“we are reassured that things are moving in the right direction”.
Yes, things have moved in the right direction, including, apparently, Dr Gerada, encouraged by her council.
In the other place, things have moved in the right direction, too. We have had hours of constructive debate leading to further positive amendments, including amendments to put beyond doubt the Secretary of State’s responsibility and accountability with respect to a comprehensive health service, and a duty on the Secretary of State to have regard to the NHS constitution; amendments to make it clear that Monitor will have the power to require health care providers to promote integration of NHS services, enabling Monitor to use its powers to support integration and co-operation in the interests of patients; and amendments conferring new responsibilities on the NHS Commissioning Board and clinical commissioning groups to play an active role in supporting education and training, and requiring providers to co-operate with the Secretary of State when exercising his duty to secure an effective education and training system. All those amendments were positively accepted in the Lords.
Mr George Howarth
The Secretary of State quoted Plato earlier. Does he recall the advice that Cromwell gave to Members of the Long Parliament—that they had stayed in their place for too long and to no useful purpose? Is that not advice that he might take?
Mr Lansley
I do not think the right hon. Gentleman should quote Cromwell to a Cambridgeshire MP; I think I know more about Cromwell than he does. [Hon. Members: “Ooh!”] I might also tell him—
Michael Dugher (Barnsley East) (Lab)
What do you know about the health service?
Mr Lansley
What do I know about the health service? I have been at the Government and Opposition Dispatch Boxes for nearly nine years speaking on behalf of the national health service. Before that I was on the Select Committee on Health, looking out for the interests of the health service, and before that my father was working—[Interruption.]
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Front Benchers need to be a little calmer. A lot of Members want to be called, and we want to hear the Secretary of State.
Mr Lansley
Let me just say this to the hon. Member for Barnsley East (Michael Dugher), who is sitting on the Opposition Front Bench. There may be many things that we can debate in this House, including the policies, but I deeply resent any implication that I do not care about the national health service. I believe that I have demonstrated that I do; and his hon. Friends—and, to be fair, the right hon. Member for Leigh—have made that absolutely clear, time and again. Dr Clare Gerada, on behalf of the Royal College of General Practitioners, has said clearly that she recognises the Prime Minister’s and my passion and commitment and that of the Prime Minister to support the national health service.
Stewart Hosie (Dundee East) (SNP)
The Secretary of State said some moments ago that the Bill had all been debated in this House, but of course it has not. Possibly the most damaging aspect financially to the NHS outside England is the increase in usage of the private sector in the NHS in England to 49%. That has never been debated in this House, has it?
Mr Lansley
I am afraid that the hon. Gentleman is completely wrong. The private income cap for foundation trusts was debated fully in Committee in this House, and it has been debated again in another place. The reason for the so-called 49% was simply that Members in another House said that they wanted to be absolutely clear that the principal legal purpose of foundation trusts is to provide services to the NHS, and therefore that, by definition, a foundation trust could not have more of its activity securing private income than NHS income, hence the 49%. But in truth, the safeguards that are built in make it absolutely clear that, whatever the circumstances and whatever their private income might be—from overseas activities or overseas patients coming to this country—foundation trusts must always demonstrate that they are benefiting NHS patients. That is why, I remind the House again, the foundation trust with the highest private income—27%—is the Royal Marsden, which delivers consistently excellent care for NHS patients.
Mrs Anne Main (St Albans) (Con)
Does my right hon. Friend share my absolute astonishment at Labour Members’ collective amnesia when it comes to the 13 years of mixed-sex wards and rising levels of MRSA and C. difficile that they presided over, along with a failed patient record system that has cost billions?
Mr Lansley
My hon. Friend is absolutely right, and I will come to some of those points. However, I might just say that, in the space of the last few days, we have had an opportunity to demonstrate that Labour signed up to an enormous, centralised, top-down NHS IT scheme that was never going to deliver, was failing to deliver and was costing billions.
Karl Turner (Kingston upon Hull East) (Lab)
Will the Secretary of State give way?
Mr Lansley
No.
In the space of under two years, my right hon. and hon. Friends at the Department and I have delivered a reduction approaching £2 billion in the cost of the NHS IT programme. That will enable us to empower services right across the country to be better users and deliver better IT systems.
Duncan Hames (Chippenham) (LD)
Further to the list of changes to the Bill that the Health Secretary has outlined, will he confirm that it no longer imposes reviews by the Competition Commission on the NHS, therefore ensuring that it is not treated in the same way as any private industry would be?
Mr Lansley
That is indeed true, and my hon. Friend will also be aware—the Future Forum was clear about this—that the NHS benefits from the transfer of competition powers. The Bill does not create any new competition powers in the NHS; it transfers the exercise of competition powers from the Office of Fair Trading to Monitor, as a sector-specific regulator, as we agreed in the coalition agreement. That is what the Bill does, and that is a better protection for the NHS compared with what would otherwise be the application of competition rules, and before—[Interruption.] Labour Members mutter, but it has become apparent over recent weeks that in 2006, when the right hon. Member for Leigh was a Health Minister, it was their Government who received legal advice that demonstrated that their changes had introduced the application of EU competition rules into the NHS.
Simon Hughes
Will the Health Secretary amplify his answer to our Scottish National party colleague, the hon. Member for Dundee East (Stewart Hosie), and make it quite clear that both Government policy and, now, the construction of the Bill not only prevent private sector activity from going out of the health service in terms of finance, but restrict the method of expanding private sector activity? The controls are now in the Bill, even if they were not at the beginning.
Mr Lansley
There is absolutely nothing in the Bill that promotes or permits the transfer of NHS activities to the private sector. Of course, NHS trusts are technically able to do any amount of private activity at the moment, with no constraint. The Bill will make absolutely clear the safeguard that foundation trusts’ governors must consent if trusts are to increase their private income by more than 5% in the course of one year, and that they must always demonstrate in their annual plan and their annual reporting how that private activity supports their principal legal purpose, which is to provide services to NHS patients.
Labour sought to oppose the Bill in another place, but its motion was defeated by 134 votes. We have reached a stage at which the Labour party, and the right hon. Member for Leigh in particular, having embraced opposition —for which they are well suited—now oppose everything. They even oppose the policies on which Labour stood at the election. Labour’s manifesto stated that
“to safeguard the NHS in tougher fiscal times, we need sustained reform.”
The trade unions have got hold of the Labour party in opposition, and it is now against reform. Its manifesto also stated that
“we will deliver up to £20bn of efficiencies in the frontline NHS, ensuring that every pound is reinvested in frontline care”.
I remind Labour Members, who are all wandering around their constituencies telling the public that there are to be £20 billion of cuts to the NHS, that that £20 billion was in their manifesto. Now they are talking about it as if it were cuts; it is not. We are the ones who are doing it, and they are the ones who are now opposing it. They scare people by talking of cuts—[Interruption.] They do not like to hear this. Actually, this year, the NHS has an increased budget of £3 billion compared with last year, and in the financial year starting this April there will be another increase of £3 billion compared with this year. The Labour manifesto also stated:
“Foundation Trusts will be given the freedom to expand their provision into primary and community care, and to increase their private services”.
John Pugh (Southport) (LD)
The right hon. Gentleman has just mentioned reform. In 2009, he said in this place:
“Organisational upheaval and reform do not seem to correlate well.”—[Official Report, 19 November 2009; Vol. 501, c. 225.]
What did he mean by that?
Mr Lansley
We know that it is necessary for us to reform in order to deliver the improvements that the NHS needs, as well as the sustainability that it needs. We are not even speculating about this; we can demonstrate that it is happening. This is in contrast to what the right hon. Member for Leigh said. He said that he was not scaremongering, then he got up and did just that. He scaremongered all over again. He went to a completely different set of data on the four-hour A and E provision, for example. He went to the faulty monitoring data, which are completely different from the ones that we have always used in the past—namely, the hospital episodes statistics data, which demonstrate that we are continuing to meet the 95% target.
When we look across the range of NHS performance measures, we can see that we have improved performance while maintaining financial control. The monitoring data from the NHS make that absolutely clear, and that is in contrast to what happened when the right hon. Gentleman was a Minister in the Department, when Labour increased the NHS budget and lost financial control. That happened when the hon. Member for Leicester West (Liz Kendall) was a special adviser in the Department. Now, we have financial control across the NHS and we have the NHS in financial surplus.
Let me return to the Labour manifesto—[Interruption.] Labour Members do not like to hear this. It stated:
“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs.”
Yes—choice and any qualified provider are in the Labour manifesto. We are doing what Labour said should be done in its manifesto—and it is now opposing it.
Let us find out what it is that the right hon. Member for Leigh opposes in the Bill. I did not find that out in his speech; I heard generalised distortions, but I genuinely want to know. Let us take some examples. Is it the Secretary of State’s duty in clause 1 to promote a comprehensive health service free of charge, as now? No, he cannot possibly be against that. Is it that the Bill incorporates for the first time a duty on the Secretary of State to act to secure continuous improvement in quality—not just access to an NHS service, but putting quality at the heart of the NHS? Is he against that? No, surely not. Anyway, that approach began with Ara Darzi, and we have strengthened it.
Mr Lansley
Let us try this one. For the first time the Bill introduces in clause 3 a duty that embeds the need to act to reduce inequalities firmly within the health system. After 13 years of widening health inequalities under Labour, surely he cannot be against that—or is he? No. Well, what about clinically led commissioning, with doctors and nurses who are responsible for our care given the leadership role in designing services? We heard earlier about one CCG, but 75 leaders of clinical commissioning groups wrote to The Times a fortnight ago. Let me quote them, because it is instructive of what is happening. They said:
“Since the…Bill was announced, we have personally seen more collaboration, enthusiasm and accepted responsibility from our GP colleagues, engaged patients and other NHS leaders than through previous ‘NHS re-organisations’”.
They continued:
“Putting clinicians in control of commissioning has allowed us to concentrate on outcomes through improving quality, innovation and prevention”—
precisely the things that the NHS needs for the future.
Now the right hon. Gentleman says, “Oh, yes, we can do GP commissioning”, but let us recall that in 2005, practice-based commissioning was in the Labour manifesto, and that in 2006, he said he was in favour of it. He said that he was
“introducing practice-based commissioning. That change will put power in the hands of local GPs to drive improvements in their area”—[Official Report, 16 May 2006; Vol. 446, c. 861.]
Mr Lansley
I will give way in moment. The right hon. Gentleman said he was in favour of practice-based commissioning. In 2010, he was the Secretary of State and was in charge of the manifesto, yet practice-based commissioning disappeared out of the Labour manifesto —it was not there at all. After the election, he pops up and says, “Oh, we are in favour of it again”. The truth is that practice-based commissioning was always the right idea: the Labour Government did not do it; the primary care trusts suppressed it. The Bill makes it possible for clinical commissioning groups to take responsibility and for doctors and nurses to design and deliver better services. Because of this Bill, it will happen—and it will not be suppressed by a top-down bureaucracy.
Andy Burnham
I made the Secretary of State an offer in my opening remarks. I said I would work with him to introduce his vision of clinically led commissioning, but he seems strangely silent about that and is pursing a very partisan tone. Will he confirm that he could introduce GP-led commissioning without any need for legislation—and without all the upheaval that is coming with his reorganisation?
Mr Lansley
The short answer to that is no. If one wishes to arrive at a place where the clinical commissioning groups have responsibility for budgets and proper accountability—including democratic accountability for what they do—legislation is required to get there. That is why we are putting legislation in place to make it happen.
Angie Bray
I thank my right hon. Friend for that, and I thank him, too, for coming to Acton last week and spending a long evening in a room full of health professionals—doctors, dentists and pharmacists. Does he agree that there was a real desire in that room to engage constructively in discussion on the reforms rather than to turn their back on them, as the Labour party would?
Mr Lansley
I am grateful to my hon. Friend for her initiative in bringing doctors, dentists and nurses together to have that conversation. I really appreciated it, and I thought that it illustrated exactly what I have found—that, although not everybody in the room agreed with the Bill—[Laughter]—many did. Contrary to what I see on the Labour Benches, they all wanted to design better services for patients. They cared about patients and engaged in a proper debate about how to achieve that.
I am still trying to find out what it is in the Bill that the right hon. Member for Leigh is against. Is it the fact that the Bill strengthens the NHS constitution? He should be proud of that; he introduced it. For the first time, however, the Bill requires the Secretary of State to have regard to it and the NHS Commissioning Board and clinical commissioning groups to promote it. He is not against that, I presume.
What about the fact that, for the first time, the NHS Commissioning Board and commissioners will have a duty to promote integration throughout health and social care? Is the right hon. Gentleman against integrated care? I do not know. Let me try another question. What about the prohibition in clauses 146, 22 and 61 of discrimination in favour of private providers, which is in legislation for the first time? The right hon. Gentleman may be against that, because when his party was in office, that is what the Government did. They discriminated in favour of private sector providers, and we ended up with £250 million being spent on operations that never took place and the NHS being paid more for operations when it was not even allowed to bid for the work.
What about the creation of a strong statutory voice for patients through HealthWatch? The Labour Government destroyed the community health councils, they destroyed patient forums, and they left local involvement networks neutered. When they were in office, they were pretty dismissive of a strong patient voice. Well, we on the Government Benches are not, and the Bill will establish that patient voice. Is the right hon. Gentleman against all trusts becoming foundation trusts? The Bill will make that happen, and will support it—oh, no, I forgot: according to the Labour party manifesto, Labour wanted all trusts to become foundation trusts.
Let us keep moving through the Bill. Is the right hon. Gentleman against directly engaging local government in the commissioning of health services, integrating health and social care, and leading population health—public health—improvement plans? I ask the question not least because Labour local authorities throughout England are in favour of that. They want to improve the health of the people whom they represent. Is the right hon. Gentleman against local democratic accountability? The list could go on. Is he against the provision of a regulator—Monitor—whose duty is to protect the interests of patients by promoting quality, stopping anti-competitive practices that could harm patients, supporting the integration of services, and securing the continuity of services? Is he against that? It is in the coalition agreement, but I do not know whether the right hon. Gentleman is against it or not, because he does not say.
Is the right hon. Gentleman against statutory backing for the National Institute for Health and Clinical Excellence to support its work on quality? I do not know; we have not heard. Is he against developing the tariff so that it pays for quality and outcomes, not for activity? He knows that that has to happen, and he knows that it has been the right thing to do for the best part of a decade, but we have no idea whether he is against it now.
I cannot discover what the right hon. Gentleman is actually against. He sits there and says that he is against the Bill, but he is not against anything that is in the Bill. He is against the Bill because he has literally made up what he claims it says. He says that it is about privatisation—
Mr Lansley
All right, I will give way to the right hon. Gentleman one more time. Come on, then: let us find out what he is against.
Andy Burnham
I will tell the Secretary of State what I am against. I am against the rewriting of the entire legal structure of the national health service to plant market forces at the centre of the system, and to pit doctor against doctor and hospital against hospital. That is what I am against, it is what 170,000 people signed a petition against, and it is what the overwhelming consensus of health professionals is against. Would the Secretary of State not do well to listen to them for once?
Mr Lansley
So now we know, Mr Deputy Speaker. It is sheer invention. There is nothing in the Bill that creates a free-for-all. There is nothing in it that creates a market of that kind. The Bill means competition for quality, not price. It gives patients choice—and the Labour party’s manifesto was in favour of giving patients choice. Competition is not being introduced to the NHS by the Bill; it is being channelled in the interests of patients to support quality throughout the NHS.
The Opposition talk about privatisation. As I said to my right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes), there is nothing in the Bill that allows any privatisation of NHS services. There is nothing in it that promotes such a privatisation.
The left-leaning papers talk about privatisation at Hinchingbrooke hospital because Circle is an independent mutual organisation. That is interesting, because the process for the franchising out of the management of Hinchingbrooke was started by the right hon. Gentleman when he was Secretary of State. So there we are: the only secret Tory plan that Labour can find turns out to be a Labour plan.
Paul Uppal (Wolverhampton South West) (Con)
The real issue in the debate is between long-termism and short-termism. Is not the reality that the Labour Government went aggressively down the route towards private finance initiatives, burdening so many of our foundation trust hospitals with debt that was unnecessary?
Mr Lansley
My hon. Friend makes an important point. When Labour Members talk about the private sector in the NHS, they leave out of account the fact that not only did they give the private sector a sweetheart deal to get it into the independent sector treatment centres, but they have left us with 102 hospitals that were built by the private sector and £67 billion of debt to the NHS. They wandered around the country saying, “Look how we’re spending all your money to build all these new hospitals,” but they did not spend the money to build the new hospitals. They have left the NHS to have to deal with it now, which is why I am having to support hospitals that have unsustainable private finance initiative debt that the right hon. Member for Leigh and his colleagues did not deal with.
What do we have? We have policies that the right hon. Gentleman disowns, and we have nothing to replace them with. We have political opportunism, distortions dressed up as arguments, and a shameful campaign to scare people about a Bill that, in reality, is about strengthening the NHS for the benefit of patients.
Of course, if we want to see what Labour would do, we only have to look at the situation in Wales. I have to hand a Wales Audit Office bar chart; I shall hold it up so Opposition Members can see it. One bar shows rising real-terms expenditure on the NHS in England, and the blue bar shows rising real-terms expenditure on the NHS in Scotland, while the green bar shows the rate for Northern Ireland, where the rise is lower. Another bar, however, shows a very large real-terms cut in NHS spending in Labour-run Wales. Labour in Wales did not just agree with the right hon. Gentleman that it would be “irresponsible” to increase NHS spending; Labour in Wales went further, and cut spending.
In order to see the result of that, we must look at performance. In England, 91% of patients are seen and treated within 18 weeks, compared with just 68% in Wales. In England, only 1.4% of patients waited over six weeks for diagnostic tests; in Wales, 29% waited over six weeks. In Wales, Labour says it wants to insulate the NHS against reform. It ought to adopt it, however, because all that is happening in Wales is that the Labour party is, once again, putting politics before patients.
It is patients who should be at the heart of the NHS —patients and those who care for them. This Bill is simply the support to a far more important set of changes, which make shared decision-making with patients the norm across the NHS, which bring clinical leadership to the forefront of the design and delivery of health and care services, which make local government central to planning for health and care, which strengthen the patient voice, and under which the NHS is open about the results we achieve and how to improve those results so we genuinely match the best in the world. We will continue to work with the royal colleges, and others with an interest in the future of the NHS, to implement our plans, so that we provide the best possible care for patients. The right hon. Gentleman’s motion and speech gave no credit to the NHS for what it is achieving, but I will.
We are proud of the services we deliver for patients: the lowest ever number of patients waiting over six months for treatment—[Interruption.] Labour Members do not like to listen to this, but it is the reality. Average time spent waiting for treatment is lower than at the last election. The number of patients waiting over a year for treatment has more than halved since the election. MRSA and C. difficile are at their lowest ever levels. There are more diagnostic tests—up by 300,000 over a year. There is more planned care, and there are fewer unplanned emergency admissions to hospital. Some 11,800 patients have benefited from the cancer drugs fund, and 990,000 more people have had access to NHS dentistry, while mixed-sex accommodation is down by 95%.
Mr Lansley
No, because I am going to tell the right hon. Gentleman what he did not admit. Reform is going ahead. We are delivering efficiencies across the NHS.
Mr Lansley
All right, I will give way, but the right hon. Gentleman might like to explain why in the year before the election the administration costs of the NHS rose by 23% and he added more than £320 million to the administration costs of primary care trusts and strategic health authorities, but in the year since, we have cut those costs. Absolutely contrary to what he said—because he was completely wrong—we are on track to deliver the Nicholson challenge. We delivered £2.5 billion in savings in the first six months of this year, having delivered £4.3 billion in savings during the course of the last financial year. Come on: explain that one.
Andy Burnham
I should just point out that the Secretary of State is trading on the successful legacy he inherited from Labour: the lowest ever waiting lists; the highest ever patient satisfaction. Let me leave that to one side, however. We on the Opposition Benches have noticed that he has not once mentioned his tribunal defeat on the NHS risk register, and all the achievements he just reeled off are at risk, are they not, because of this misguided reorganisation? I ask him to answer this point today: will he now comply with the ruling of the Information Tribunal, publish this risk register today, and let the public know the full truth about what he is doing to their national health service?
Mr Lansley
I was right, was I not, that the weaker the right hon. Gentleman’s argument, the stronger the tone? My noble Friend Earl Howe answered a private notice question in the other place yesterday, and the position is absolutely as he described it: we were right to go to appeal, as the appeal demonstrated, because the tribunal agreed that we should not publish the strategic risk register. The decision of the tribunal was that it took the view that we should publish the transition risk register, but it did not publish its reasons. Given the simple fact that there is considerable overlap between the strategic register and the transition risk register, I find it extremely difficult to know what the tribunal’s reasons are, so we will see what its reasons are.
Mr Lansley
I will not give way.
Let me just make it absolutely clear that reform is happening and it will be supported by the Bill: nearly £7 billion has already been saved to reinvest in front-line care; we have 15,000 fewer non-clinical staff; we have 5,800 fewer managers and 4,100 more doctors—since the election, we have had more qualified clinical staff; there are 890 more midwives since the election and a record number in training; we have 240 clinical commissioning groups covering England, leading on commissioning from April on up to £60 billion-worth of services; and the ratio of nurses to beds in hospital has gone up.
Labour’s motion is politics masquerading as principle, and it is synthetic anger. I would take the right hon. Gentleman’s campaign more seriously if his own leader could have been bothered to turn up to his NHS rally, rather than taking a Rolls-Royce to a football game. This is empty rhetoric from an empty vessel; this is no policy, only politics; and this is a leader who treats his party’s campaign with disdain. The House should have no truck with them, and I ask it to reject the Labour motion.
Valerie Vaz
I am sorry, but I have nearly finished my speech and must press on.
There was a chorus of disapproval from professionals when the White Paper was published, as they wanted more information. As Rogers and Walters say in the sixth edition of “How Parliament Works”, if there is pre-legislative scrutiny, Ministers have less political capital at stake and changes are not seen as defeats; the scrutiny of a Bill in draft gives higher quality legislation. That is not a description of the Health and Social Care Bill. The pre-legislative scrutiny was in the Secretary of State’s head, not in a draft Bill.
What about my constituent Stephen Wood, who went to his local GP’s surgery only to be told that doctors would only refer him to a consultant privately, not on the NHS, as he had apparently used up his budget?
Valerie Vaz
It is true. This has become personal. The NHS is an organisation in which miracles sometimes happen, which is why people are fighting to protect and save the very essence of its existence. Those who have paid their taxes do not want the Bill, and the health professionals do not want it. From all parties, professionals and patients in the NHS, we can say that we oppose the Bill, and when the NHS unravels, as it is now beginning to, we can say, “We told you so.” I support the motion.
Joan Walley
No, I will not.
I agree with the right hon. Member for Charnwood (Mr Dorrell), who chairs the Health Committee, that some aspects of the Bill are very worthy, particularly those on public health, and we do not want to lose them, but four issues need urgent clarification, and I hope the Minister will address them when he replies.
First, why are my constituents not entitled to know what is on the risk register? What is there to hide? Why can we not have it laid before us when we are making important decisions about the future of the NHS? I am quite content for there to be service changes, but not structural, top-down reform, which the Prime Minister himself, in one of his commitments before the general election, said he was not going to introduce.
The key issue for the House is whether the NHS will be subject to the full force of domestic and EU competition law, and that has not yet been clarified. The Government maintain that it will not, but the changes brought about by the Bill make certain that it will. In any event, it is not in the Government’s gift to decide, because the issue will be decided in the courts, so I genuinely believe that we are entitled to clarification on that issue—[Interruption.] I will not give way on that point. It is absolutely essential that the Government, not the law courts of this country, determine NHS policy.
Secondly, what safeguards are there against private companies using loss leaders to replace NHS services and then, once the NHS service has been eliminated, maximising profits by reducing quality? We have heard from the Secretary of State on that, but once the service is eliminated, the private companies that come in will surely have a free hand. The Government say that there will be no competition on price, but private companies will still be able to use loss-leader tactics by overloading a bid with quality for the specified price, so we must have regard to the real concerns about that.
Thirdly, how will the Government stop cherry-picking in practice? If they attempt to exclude private companies from bidding for a particular contract, will they not face court action, and in those circumstances will not services be put on hold while the courts deal with how NHS care is to be provided?
Finally, again when the Minister replies—
Joan Walley
Yes, in 10 minutes, because we need time to sort out the NHS. What will the Government do about foundation trusts once they become unsustainable—once they have been undermined by cherry-picking and by loss leaders?
There are huge issues, our constituents’ health is at stake, and this is an important debate, one in which the Government need to take account of what we are saying so that Parliament can have a say in how the NHS goes forward.
Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)
I will speak in favour of the Government dropping this truly awful piece of legislation.
Before I do so, I will say a few words about my constituent, Dr Kailash Chand, who began the e-petition against the Bill, which has reached 174,000 signatures. Kailash has been a GP in my area for 27 years. He has been awarded an OBE for his work and in 2009 he was named north-west GP of the year. He has dedicated his life to public health. At times he has spoken out against Government policy, whoever has been in charge. His motivation in creating the e-petition was solely his love for and belief in the NHS. We should be grateful for such public servants. I am delighted that he is here to listen to this debate.
Mr Simon Burns
So that everyone fully understands the background, will the hon. Gentleman confirm that this same doctor wants to be a Labour MP, has been appointed by the leader of the Labour party to review Labour party policy on older people, and has worked for the right hon. Member for Wentworth and Dearne (John Healey) in a research capacity?
Jonathan Reynolds
The Government are just not willing to listen to the people who will be affected by the Bill. Kailash is not alone in opposing it. If I read out the name of every organisation that opposes the Bill, I would run out of time.
Jonathan Reynolds
No, sit down and listen for once.
It is clear that the majority of non-biased, objective opinion is against the Bill proceeding. Never in the field of public policy have so many opposed so much and been listened to so little.
Should the Government not be asking themselves this: if the Health Secretary cannot convince the people who he wants to devolve power to, and if the Deputy Prime Minister cannot convince his own party members to support the Bill, maybe—just maybe—there is not that much going for it? The Health Secretary cannot even visit an NHS hospital, so low has his reputation sunk.
As has been said, the people who oppose the Bill, whether the royal colleges or Opposition Members, do not oppose all reform. Of course, NHS services will have to change over time, particularly in the provision of specialist services. The Labour Government introduced reforms, which used the private sector to the advantage of the NHS. The Bill does the opposite and uses the NHS for the benefit of the private sector. The problem is not reform, but these reforms. To say that anyone who opposes the Bill is against all reform is crass and simplistic.
Let us please put an end to the nonsense that the reforms are just an evolutionary approach following what has happened in the past. If that were the case, would there be an unprecedented groundswell of opinion against them? Once the Bill is passed, the primary care trusts and the strategic health authorities will be gone, and clinical commissioning consortia will be responsible for the whole NHS budget. Local authorities will take public health, and Monitor and the NHS Commissioning Board, not the Department of Health, will be responsible for the health system. That is a fundamental, top-down restructuring of the NHS, and no one wants it.
To justify that revolution, the Government started by rubbishing the success of the NHS. It began with the cancer survival rates and carried on from there, and every time the Government’s case has been knocked down. The King’s Fund, the respected health think-tank, in its review of NHS performance since 1997, clearly showed dramatic falls in waiting times; lower infant mortality; increased life expectancy across every social group; cancer deaths steadily declining; infection rates down, and in mental health services, access to specialist help, which is considered among the best in Europe. Again, I put it to the Government that they have no justification for the revolution that the Bill brings about.
The Government’s other justification has been that the NHS has too many managers, yet their reforms create a structure so confusing that, when an organogram of the new structure was published, it became a viral hit on the internet because it looked so ludicrous. What do the experts in the King’s Fund say about this? The myths section about the Bill on its website says:
“If anything, our analysis seems to suggest that the NHS, particularly given the complexity of health care, is under-rather than over-managed”.
The Minister of State, Department of Health (Mr Simon Burns)
I agree with my hon. Friend the Member for Witham (Priti Patel), who observed in her vigorous and punchy speech that there was an element of déjà vu in the debate.
I was delighted to listen to the speech of the right hon. Member for South Shields (David Miliband). As I listened to it, and to the speech of the right hon. Member for Leigh (Andy Burnham), I reflected on how odd changes in political fortunes are. Those two were the über-Blair reformers, but it was clear from their speeches—both thoughtful in their different ways—that they had turned away from their reforming zeal. I can only put that down to “what a difference a leadership election makes”.
I congratulate my right hon. Friend the Member for Charnwood (Mr Dorrell) on another good and compelling contribution. I also congratulate my hon. Friends the Members for Kingswood (Chris Skidmore), for South West Bedfordshire (Andrew Selous), for Loughborough (Nicky Morgan) and for Witham, as well as the hon. Member for Burnley (Gordon Birtwistle). It seems that in his part of the world they call a spade a spade.
I must also mention the speech of the hon. Member for Walsall South (Valerie Vaz), which was at times fanciful, that of the hon. Member for Stoke-on-Trent North (Joan Walley), that of the right hon. Member for Manchester, Gorton (Sir Gerald Kaufman), which was passionate but, I fear, misguided, and that of the hon. Member for Stallybridge—[Hon. Members: “Stalybridge!”] I mean the hon. Member for Stalybridge and Hyde (Jonathan Reynolds). I am afraid that I am from the south. I was disappointed that the hon. Gentleman did not answer my question about the political allegiance of Dr Chand, whom he prayed in aid, given that Dr Chand has had aspirations to become a Labour candidate. Indeed, I think he even had aspirations to fight the seat that the hon. Gentleman fought, so it was very generous of the hon. Gentleman to mention him.
Let me make clear to the House that no party has a monopoly on caring for the NHS. We all care for the NHS passionately, and I find it distressing when Opposition Members seek to misrepresent the position by accusing us of trying to privatise it. Let me tell them that this party, my party—this Government, the coalition Government—will never privatise the NHS, and let me tell my hon. Friends to reinforce that message. Clause 1 of the Bill gives the Secretary of State a duty to provide a comprehensive health service, and subsection (3) gives a commitment—just as Nye Bevan did in his original Act—that it will be free at the point of use.
Let me tell Opposition Members that what they are saying is scaremongering, that it is unfair, and that it is a gross distortion of the facts. Let me also tell them that shroud-waving does not do them any credit. Pulling out examples that have no basis in proof and are simply intended to misguide and mislead the public is a disgrace—
Mr Burns
No, because I have no time. I have only five minutes.
The right hon. Gentleman was seductive in his speech. He came across as trying to be eminently reasonable by saying that he did not want this to be a party political football. I must say to him, however, that it is he and his friends who have turned the NHS into a party political football, and I must say to them that the NHS is too precious to be turned into a party political football simply for the purpose of trying to gain votes.
Our reforms will help to prepare the NHS for the future, making it more balanced and better suited to the demands of the 21st century so that it has a long and healthy life based on its founding principles. First, our reforms will give patients more choice, enabling them to choose where to go, see who they want to see, and influence the kind of services that they want in their communities. Secondly, they will give doctors more freedom to commission care for their patients, so that they can shape the NHS around the needs of their local communities. Thirdly, they will reduce bureaucracy so that money—£4.5 billion of it between now and 2015—can be saved and reinvested in front-line services. Those are the basic premises and that is the basic ethos of the Bill.
Not once during the speech of the shadow Secretary of State, and not once during the speeches of any of his right hon. and hon. Friends, did we hear a single answer to the question of what they would do. I do not know how many Members saw the right hon. Gentleman being interviewed on “Newsnight” by Jeremy Paxman two weeks ago. Some of us live in fear of that experience, while some of us come to enjoy it. Five times during that brief one-to-one interview, Mr Paxman asked the right hon. Gentleman “What would you do?” and answer came there none. That was because the right hon. Gentleman is prepared to criticise and try to scare people in order to win votes, but he is not prepared to confront, in a realistic and meaningful way, the challenges facing the NHS and the way in which it must move forward.
What we need is less carping, less criticism, and more constructive engagement. When the right hon. Gentleman says in his flowery way that he is prepared to engage in all-party discussions there is a hollowness in his claim, because he has no policies to discuss, and can identify no positive way in which to resolve the problems of the NHS and enable it to evolve to meet the pressures to which it is subject.
This Bill, which has been discussed at length in this House and in another place, is the Bill that will move the NHS forward and enable it to meet the challenges of an ageing population and an escalating drugs spend. I urge my hon. Friends to reject the motion and to reject the Liberal Democrats’ amendment if it is pressed to a vote, because neither is in the interests of the health service or those of the country.
Question put, That the amendment be made.