House of Commons
Prayers
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address to her majesty (diamond jubilee)
Mr Speaker
I must report that the House this day attended Her Majesty in Westminster Hall, with an Address on the occasion of Her Majesty's Diamond Jubilee; in reply to which Her Majesty was pleased to make a Most Gracious Speech.
I will ensure that my words in presenting the Address, and Her Majesty's reply, are entered in the Journals of the House.
Mr. Speaker presented the Address to Her Majesty in the following words:
Most Gracious Sovereign,
We Your faithful Commons are honoured to be here to commemorate and celebrate the sixty years of Your reign. We too are pleased to have contributed to the Jubilee Window to be revealed shortly and which will mark this occasion permanently. Time is better preserved in this historic place than in fallible human memory.
Time also tells its own story. Sixty years ago, rationing meant rather more than a short wait before the arrival of the latest electronic item. Sixty years ago, Britain had just emerged from a war of an intensity never seen before or since and had slipped into the shadow of the Korean conflict. Sixty years ago, a new “Elizabethan Era” was awaited with enthusiasm tinged with uncertainty about the challenges ahead for the country.
If, as Gandhi asserted, “the best way to find yourself is to lose yourself in the service of others”, then Your Majesty must have found Yourself countless times over the past six decades. You have dedicated Your life to others. The daily example that You set, mirrored by our courageous armed forces of which You are Commander-in-Chief, is extraordinary. Yet perhaps Your Majesty’s most profound contribution has been to the continuity that has made change manageable.
For transformation is inevitably turbulent. It has been Your singular accomplishment, Your unique capacity, to hold together that which could have been torn asunder. You have moved with the times and allowed the times to move around the rest of society.
This is a different Britain from 1952 but not one detached from then. We are in so many ways a much bigger, brighter and better United Kingdom. This is a land where men and women today are equal under the law and where Your people are respected, regardless of how they live, how they look or how they love. This is a nation of many races, faiths and customs, now beginning to be reflected in Parliament. All this progress has occurred during Your reign. You have become, to many of us, a kaleidoscope Queen of a kaleidoscope country in a kaleidoscope Commonwealth.
This gathering is one of many diverse events across these islands in tribute to You and this great anniversary. Our affection as a nation will rightly embrace the Duke of Edinburgh and other members of Your family. These will be moments striking for the sincerity expressed as much as for the scenery encountered. Sixty years of stability. Sixty years of security. Sixty years of certainty. Sixty years of sacrifice. Sixty years of service.
Gandhi also observed that “in a gentle way, you can shake the world”. Your Majesty, in a gentle way You have shaken this United Kingdom and the world for six decades. On behalf of all the members of the House of Commons, may I thank You wholeheartedly for all that You have done, are doing and will do for the good of our country.
Her Majesty's Reply
Oral Answers to Questions
(12 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Mark Spencer (Sherwood) (Con)
1. What recent progress he has made on proposals for a statutory register of lobbyists.
The Parliamentary Secretary, Cabinet Office (Mr Mark Harper)
We set out our initial proposals on 20 January. We are undertaking a wide-ranging consultation exercise. I have appeared at a number of meetings and will do so again. We will listen to everything that people have said and in due course we will lay out our proposals for legislation.
Mr Spencer
I have had a number of meetings with the voluntary sector over the past six months. Can the Minister reassure the House that the changes to the lobbying system that we may introduce will not bar small charities from making contact with their Members of Parliament?
Mr Harper
The hon. Gentleman raises a good point. Nothing that we intend to do is intended to stop people legitimately lobbying their Members of Parliament. Indeed, we have set out that lobbying is a good thing to make sure we are aware of the impact of our legislation. The important thing is that it is carried out transparently, and that is what we are aiming to achieve.
Lindsay Roy (Glenrothes) (Lab)
May I ask the Deputy Prime Minister what arrangements he has put in place to define lobbying?
Mr Harper
The hon. Gentleman may ask me, as I am answering the question. We are carrying out a consultation exercise, listening to the industry, to the public and to organisations campaigning for transparency. When we have done that, we will weigh up everything that has been said. We will then publish draft legislation for full pre-legislative scrutiny.
Duncan Hames (Chippenham) (LD)
The most recently published information describes all but two of the Chancellor’s meetings with external organisations as being for the purpose of general discussion. The other two are described as social. Does the Minister agree that for proper disclosure of lobbying activity, any register will need to go further than such broad descriptions?
Chris Bryant (Rhondda) (Lab)
I wholeheartedly support the idea of a statutory register of lobbyists, but surely it must include the full-time people who do it on behalf of their companies in-house. If we do not know whether the head of lobbying for BP, Shell or whoever else is coming in to see a Minister, we have not really brought about transparency, have we?
Mr Harper
The point that the hon. Gentleman makes about those who lobby for the companies they work for, as opposed to third parties, has been made by others and we will weigh that up. If a person from an individual company comes to see a Minister and the Minister discloses that they have had that meeting, as they do, it is clear on whose behalf they are lobbying. The situation that we are trying to deal with is one where we do not know on whose behalf someone is lobbying. That is the reason for our initial proposals.
Yvonne Fovargue (Makerfield) (Lab)
2. What steps he is taking to extend the powers of enforcement of electoral registration officers.
The Deputy Prime Minister (Mr Nick Clegg)
Electoral registration officers have the power to require any person to provide information about any aspect of a person’s eligibility to register. It is currently not an offence not to be registered to vote, but it is an offence not to provide information to an ERO when required to do so. Under our plans for individual electoral registration, we do not intend to criminalise people who fail to register when invited to do so. However, we are considering the merits of introducing a civil penalty for a non-response to an invitation to register, and will announce our decision when we bring forward the legislation.
Yvonne Fovargue
Does the Deputy Prime Minister agree that leaving electoral registration officers without the power to criminalise those who refuse to register to vote will effectively tie one of their hands behind their back?
The Deputy Prime Minister
I do not think that many electoral registration officers feel that it is necessary to put a new criminal offence on the statute book to deal with that issue, which is why we have been quite open about the fact that we want to keep the existing offences on the statute book but are considering a civil offence to ensure that the right information is provided to electoral registration officers.
Mr Philip Hollobone (Kettering) (Con)
Ian White and Heather Jackson at the electoral registration department of Kettering borough council, of which I am a proud member, do a superb job in registering local people on the electoral register. What can the Deputy Prime Minister do to encourage the dissemination of best practice, because clearly some electoral registration officers are not up to the job?
The Deputy Prime Minister
That is an excellent idea, and it is exactly one of the tasks of the Electoral Commission to find out where EROs are most effective and then ensure that their colleagues in other parts of the country are aware of best practice.
Mr David Ruffley (Bury St Edmunds) (Con)
3. What recent representations he has received on reform of the House of Lords.
The Deputy Prime Minister (Mr Nick Clegg)
The Government have received more than 250 representations since the publication of the White Paper and the draft House of Lords Reform Bill in May last year.
Mr Ruffley
Many of us are of the view that many Members of an elected upper House, elected by proportional representation, will be tempted to claim a mandate equal to that of hon. Members in this place. Why does the Deputy Prime Minister think that his rather squalid Bill will not undermine the primacy of this Chamber?
The Deputy Prime Minister
I do not think that anything in our plans would change the primacy of this Chamber or that there is an automatic link between changing the composition of the other place and changing the balance of power between the two Chambers. There are many bicameral systems around the world where both Chambers are either wholly or fully elected but there is a clear division of labour between them. The hon. Gentleman calls this a squalid proposal; it is a proposal to introduce a smidgen of democracy in the other place, which has been around for about 100 years, and I think that we should now get on with it.
Angela Smith (Penistone and Stocksbridge) (Lab)
On 21 April 2010 the Deputy Prime Minister described the House of Lords as being
“stuffed full of people who have basically done favours to other politicians.”
Is that how he would describe those Lib Dems who have been sent to the Lords since the general election?
The Deputy Prime Minister
For anyone who wants to defend the status quo, and it is unclear whether the hon. Lady does—the Labour party used to campaign proudly for reform of the bastion of privilege and inherited power but seems to have lost its historical vocation as a progressive force for political reform—I ask them to reflect on the fact that over 70% of all the people in the other place are there because of an act of political patronage. Is that really sustainable in the 21st century? I do not think so.
Sir Alan Beith (Berwick-upon-Tweed) (LD)
14. Has the Deputy Prime Minister received many representations from those who appear to believe that the way to uphold the supremacy of the elected House is to defy the supremacy of the elected House, which has already said that it wants to introduce some democracy to the other Chamber?
The Deputy Prime Minister
I strongly agree with my right hon. Friend. There is an odd sort of circularity in the argument that, notwithstanding the fact that this House has voted clearly in favour of either a wholly or largely elected Chamber, somehow to preserve the primacy of this House we should not allow any legitimacy into the other place. That seems to me to be a somewhat self-serving argument.
Sadiq Khan (Tooting) (Lab)
Major constitutional change that is successful is best done by parties trying to work together and then putting the case to the country via a referendum. We have seen devolution to the Scottish Parliament, the Welsh Assembly and London done in that way, and on 3 May we will see cities across the country choosing via referendums whether they should have elected mayors. Will the Deputy Prime Minister work with those of us who want to see the second Chamber reformed and then trust the British public on this major constitutional change via a referendum?
The Deputy Prime Minister
As the right hon. Gentleman knows, because he himself joined in the discussions, we had months and months of painstaking cross-party discussions about the content of the draft Bill, precisely because, as he quite rightly says, it is best to proceed with these important matters on a cross-party basis. All three parties, again as he knows, had in various shapes or sizes a commitment to a reformed House of Lords. It is something we have been discussing for a very long time as a country—close to a century.
There is an open debate to be had about when something is presented to the people via a referendum—or not. The Lords Committee that recently looked at the issue very clearly said that there should be a referendum if there is a proposal to abolish the House of Lords. That of course is not what we are proposing, because we are proposing to reform the composition of the House of Lords, so I do not share the right hon. Gentleman’s view that a referendum is justified in the way he describes, although I acknowledge that it was in his party’s manifesto at the last general election.
John Woodcock (Barrow and Furness) (Lab/Co-op)
4. What assessment he has made of the likely effect of bringing forward the annual canvass on levels of electoral fraud.
The Parliamentary Secretary, Cabinet Office (Mr Mark Harper)
The Government take combating electoral fraud very seriously. Following a recommendation from the Electoral Commission, I directed that this year’s annual canvass should be started and completed earlier so that the register to be used for police and crime commissioner elections in England and Wales outside London is the most accurate and up-to-date register possible.
John Woodcock
I thank the Minister for that answer, but does he believe it right that the nominations for police and crime commissioners and their subsequent elections should take place using different electoral registers?
Mr Harper
I think, in this particular case, that is perfectly fine. It does not deal with the hon. Gentleman’s question, however, which was about electoral fraud. The reason for bringing forward the canvass was to ensure that we were not using a register that was right at the end of its useful life, with significant numbers of people not being at the addresses on the register. That would have provided an opportunity for fraud, and we wanted to reduce that to the minimum.
Dr Julian Huppert (Cambridge) (LD)
Is the Minister aware that there are concerns from cities such as mine, which have a large number of students, about the impact of moving the dates forward, that students who have arrived will not be put on the register and students who have left will still be on the register for far too long? Will he look at ways of avoiding that problem?
Mr Harper
The hon. Gentleman makes a good point. One reason for issuing the direction to registration officers as early as possible was so that, in each area, they could think through the consequences for their particular registration and the challenges that they face, and then put in place procedures to ensure that the register used for police and crime commissioner elections is the most accurate and complete register necessary. If he has any specific concerns, I shall be very happy to discuss them with him.
Sir Robert Smith (West Aberdeenshire and Kincardine) (LD)
5. What recent progress the Government have made on devolution; and if he will make a statement.
The Deputy Prime Minister (Mr Nick Clegg)
The Scotland Bill is completing its passage through Parliament, implementing most of the recommendations of the Calman commission and resulting in the most significant transfer of powers to the Scottish Parliament since its establishment. We have also established the Silk commission on devolution in Wales and initiated the McKay commission on the consequences of devolution for the House of Commons. We have also devolved powers directly from Whitehall to local communities through the Localism Act 2011, providing for referendums on directly elected mayors in 10 cities on 3 May and for local referendums on a range of issues, and giving local authorities a general power of competence.
Sir Robert Smith
I thank the Deputy Prime Minister for that answer. Does he recognise that devolution is an ongoing process, whereas separation is a once-and-for-all decision? Does he agree that we need a single question on independence in the proposed referendum if we are to have a clear and decisive result from it?
The Deputy Prime Minister
I strongly agree, as I suspect do many Members on both sides of the House. It would be wrong to play cat and mouse with the Scottish people by confusing two entirely different issues: one is whether Scotland should leave the United Kingdom; the other is on the process by which we might provide greater devolved powers to Scotland. We cannot really address the second without first knowing whether the United Kingdom is going to remain intact, and that is why it is important to give a simple, clear question to the Scottish people to decide—through one question in the referendum.
Anas Sarwar (Glasgow Central) (Lab)
The Deputy Prime Minister will note that the Scottish National party Bench is bare this afternoon. Will he confirm that the West Lothian commission will include not only Scotland, but Wales, Northern Ireland and London?
The Deputy Prime Minister
It will consider in the round all the issues about how we manage business in this House in a more devolved United Kingdom. As the hon. Gentleman will know, the McKay commission will report in the next parliamentary Session.
Mr Edward Leigh (Gainsborough) (Con)
My right hon. Friend and I are already, in a sense, married politically—and very happily, at that—but as we have so much to do together on devolution, House of Lords reform and the Health and Social Care Bill, can we just leave it at that: as a partnership?
The Deputy Prime Minister
My hon. Friend is right that our in-tray is full, but, as I said before, I think it is a good thing that this partnership and this coalition is being as ambitious as we are.
Diana Johnson (Kingston upon Hull North) (Lab)
6. What recent discussions he has had on political donations arising from the proceeds of crime as part of his proposals for the reform of party funding.
The Deputy Prime Minister (Mr Nick Clegg)
The Government are committed to reform of party funding and believe that this is best achieved, where possible, through consensus. I recently wrote to party leaders asking them to nominate representatives for cross-party discussions. Arrangements for those discussions are being finalised, and I hope that they will commence shortly.
Diana Johnson
I am very pleased that the Deputy Prime Minister has answered this question. I want to ask him about the Proceeds of Crime Act 2002, which allows for the recovery of money from crime. Money stolen by fraudsters such as Michael Brown is surely tainted within the spirit of the Act, and as such it should be recovered, as I am sure the Deputy Prime Minister agrees. Will he apply the principles of the Act to his party funding reforms?
The Deputy Prime Minister
As the hon. Lady knows, the Electoral Commission looked in great depth at the donation made by Mr Brown five, six or seven years ago and concluded, as the watchdog that oversees these things, that the money was taken in good faith by the Liberal Democrats and all the reasonable checks were made by the party at the time.
Charlie Elphicke (Dover) (Con)
If we are going to talk about party donations being tainted, is it not important that we ensure that tax avoiders and non-domiciles who supported the Labour party are also dealt with?
The Deputy Prime Minister
It is quite gutsy of the hon. Member for Kingston upon Hull North (Diana Johnson) to raise this when prominent members of her own party such as Ken Livingstone seem to have very exotic tax arrangements, and when the Labour party now relies for 90% of its funding on trade unions that then write the parliamentary questions that Labour Members read out in this Chamber.
Mr Clive Betts (Sheffield South East) (Lab)
7. What recent representations he has received on individual electoral registration.
The Parliamentary Secretary, Cabinet Office (Mr Mark Harper)
We have received a number of representations on our proposals for individual electoral registration, including an excellent report from the Select Committee on Political and Constitutional Reform, to which we have responded.
Mr Betts
I am sure that the Minister agrees that if we are to avoid the prospect of many people leaving the electoral register when IER is introduced, we need a significant and robust system of data swapping. If that cannot be achieved in time for the date when the Government plan to introduce IER, will the Minister delay that date or run the risk of millions of people falling off the electoral register?
Mr Harper
I am sure that the hon. Gentleman has studied our response to the Select Committee’s report, so he will know that one of the things that arose from our data-matching pilots was that there is a good opportunity to use a pre-verification process to ensure that we, in effect, put a floor under electoral registers to reduce the risk of people falling off the register. We will test that further and no doubt debate it when the proposed legislation is going through the House. That can give us a great deal of confidence that we will not see the problems the hon. Gentleman mentions.
Mrs Eleanor Laing (Epping Forest) (Con)
9. Does the Minister agree that all rights should be exercised with responsibility and that where people have the right to vote they should exercise their personal responsibility of registering to vote, and thus, through the Minister’s introduction of individual electoral registration, the completeness and accuracy of the electoral register will be improved?
Mr Harper
I very much agree with my hon. Friend, who is a prominent member of the Select Committee that looked at this in great detail. I absolutely agree with her. Registering to vote and voting is an act of personal responsibility, but we are also looking to make sure that we reduce the risk of people falling off the register and increase the tools at the disposal of registration officers to ensure that the register is complete.
Mr Wayne David (Caerphilly) (Lab)
Does the Minister share my concern that the Electoral Commission said that its main conclusion about the Government’s data-matching pilot schemes is that they
“do not provide sufficient evidence to judge the effectiveness of data matching as a method for improving the accuracy and completeness of the electoral registers”?
If he shares my concern, what action will he take?
Mr Harper
Part of the reason for having the pilots was to learn some information. One thing that we found was that the data-matching pilots were less successful at improving completeness and accuracy, but very good at pre-verification, as I said to the hon. Member for Sheffield South East (Mr Betts). The hon. Member for Caerphilly (Mr David) will know that we plan to have further data-matching pilots, subject of course to parliamentary approval of the appropriate orders. That will build up further evidence, which will show Members that this system will be robust in improving the completeness and accuracy of the electoral register.
Mr Andy Slaughter (Hammersmith) (Lab)
8. What assessment he has made of the potential implications for the Parliament Acts of his proposals for House of Lords reform.
The Deputy Prime Minister (Mr Nick Clegg)
The Government’s proposals will maintain the primacy of the House of Commons and the Parliament Acts will continue to apply.
Mr Slaughter
It is easy to see why the Deputy Prime Minister is hooked on the Parliament Acts and on financial privilege, when the House of Lords has so far inflicted nine defeats on his Government on the Legal Aid, Sentencing and Punishment of Offenders Bill alone. Will he explain why every Lib Dem peer voted to cut social welfare legal aid the day after his conference voted for the
“protection of fair and equal access to justice”?
The Deputy Prime Minister
If my understanding is right, the hon. Gentleman campaigned at the last general election on a commitment in his manifesto to reform legal aid. There have been countless reviews—[Interruption.]
The Deputy Prime Minister
Countless reviews have been conducted on legal aid funding, which has ballooned out of all recognition in recent years. As on so many other issues, the Government have the guts to confront the difficult decisions that Labour ducked for 13 years.
Andrew Jones (Harrogate and Knaresborough) (Con)
T1. If he will make a statement on his departmental responsibilities.
The Deputy Prime Minister (Mr Nick Clegg)
As Deputy Prime Minister, I support the Prime Minister on the full range of Government policies and initiatives. I take special responsibility for the Government’s programme of political and constitutional reform.
Andrew Jones
There are reports in the media today of plans to publish tax statements, which will give people a detailed breakdown of how the Government spend their money. I welcome that proposal, which treats people with much more respect and makes government more open. The reports suggest that the scheme may start in 2014. As it is such a good idea, can it be brought forward to 2013?
The Deputy Prime Minister
I, too, think it is an excellent idea. It will provide citizens of this country with far greater transparency on how the money that they provide to those of us in government is spent. That goes to the heart of greater accountability in government. It will empower citizens to know where their money is spent. I am sure that the Chancellor will consider any opportunity to bring this good initiative forward, where it is feasible.
Ms Harriet Harman (Camberwell and Peckham) (Lab)
Last November, when talking about the top rate of tax on income over £150,000, the Deputy Prime Minister said:
“I do not believe that the priority…is to give a tax cut to a tiny, tiny number of people who are much, much better off than anyone else.”
If the Chancellor announces any cut in the top rate of tax, Opposition Members will vote against it: will he?
The Deputy Prime Minister
The right hon. and learned Lady will have to wait until the Chancellor announces his Budget tomorrow. The priority for me and for the whole coalition Government is to provide real help to people on middle and low incomes, who have faced higher prices and great difficulties because of the economic implosion that she and her colleagues presided over in government. Whatever changes there are to this bit of the tax system or that bit of the tax system, Government Members believe that the wealthy should pay more, because the broadest shoulders should bear the heaviest burden.
Ms Harman
We will see about that. Next month, low-income families will be hit by a massive cut to their tax credits, which the Lib Dems voted for. It is now clear that they will go along with a cut in the top rate of tax. I suppose that we should not be surprised after what they have done on VAT, the police and tuition fees. By signing up to cutting the top rate of tax, the Deputy Prime Minister is giving thousands of pounds to the very rich, while cutting tax credits for people who are struggling to make ends meet. Surely, even by Lib Dem standards, that is a step too far.
The Deputy Prime Minister
Next month, this Government will take more than 1 million people on low pay out of paying income tax altogether. Next month, we will deliver the largest cash increase in the state pension ever. There will be no more of Labour’s 75p pension insults. Next month, thousands of children from disadvantaged backgrounds will receive an uplift in the pupil premium to give them the head start in life that they never got under Labour. That is a record that I am proud of.
Mr Mark Spencer (Sherwood) (Con)
T2. The Deputy Prime Minister will be aware that many small businesses are struggling to gain access to credit, which is why I am delighted that the national loan guarantee scheme was introduced today. However, what can the Deputy Prime Minister do to ensure that small businesses with a turnover of less than £5 million can access the scheme?
The Deputy Prime Minister
The banks that are participating in the NLGS—the announcement on that has now been made—must use all their branches, and all their contacts with small and micro businesses in each area where they have branches, to make this new credit-easing facility available to the largest number of small businesses, for whom it has been very difficult to access credit on reasonable terms in recent times.
Steve Rotheram (Liverpool, Walton) (Lab)
T3. Deputy Prime Minister, in 2008, when you used to visit Liverpool, you categorically said:“Will I ever join a Conservative Government? No. I will never allow the Liberal Democrats to be a mere annex to another party’s agenda.”What do you regret the most: your betrayal on the 3,000 extra police you promised, your broken tuition fees pledge, your party’s support for the destruction of the NHS, or becoming a Tory?
Mr Speaker
Order. May I remind the hon. Gentleman that he should exclude me from that list of charges?
The Deputy Prime Minister
I am proud of the fact that we have stepped up to the plate to clean up the mess the hon. Member for Liverpool, Walton (Steve Rotheram) and his party colleagues left behind after 13 years in office. It is convenient for him to airbrush out of history the fact that when his party was in government it went on bended knee to Rupert Murdoch, yet now it will not even talk to his newspapers. It also let the banks get away with blue murder, but it now wants to tax them to the hilt. The country will not forget the mess it left the rest of us to clear up.
Stuart Andrew (Pudsey) (Con)
T6. I recently visited the Yorkshire College of Beauty Therapy, alas not for treatment—I feared there would not be enough time for that—but to see how successful its apprenticeship scheme has been. Members on both sides of the House are concerned about youth unemployment, so what are the Government doing to encourage employers to take on more young apprentices?
The Deputy Prime Minister
In the earlier list of proud achievements that I gave, I forgot to mention the fact that we are delivering more apprenticeships than have ever been delivered in recent times in this country. We are delivering 250,000 more apprenticeships during this Parliament than would have been delivered by a Labour Administration. My hon. Friend is absolutely right that the whole apprenticeship programme depends very heavily on companies and employers participating in the scheme and giving young people the opportunity to take up apprenticeship places. That is why in the youth contract, which will start in a matter of weeks, we are providing a £1,500 incentive to employers to take on young apprentices.
Dr Alan Whitehead (Southampton, Test) (Lab)
T4. On the emerging proposals for the reform of party finance, does the Deputy Prime Minister favour a £10,000 cap on contributions from wealthy donors, as proposed by the Committee on Standards in Public Life, or no cap at all, as proposed by the Prime Minister?
The Deputy Prime Minister
I strongly support a cap. We need to put a limit on the arms race in party funding. That, of course, must include a cap on donations. There is a range of opinions on where that cap should lie, and I think it should lie as low as possible. This issue is best addressed on a cross-party basis, which is why I hope the cross-party talks I have called for will now proceed in earnest.
Anna Soubry (Broxtowe) (Con)
T7. Being stalked must be a terrible experience, and it is calculated that there are about 120,000 such cases each year. I am delighted that the Government are going to make it a criminal offence. The people of Broxtowe—and no doubt those throughout the rest of the country —want to know when legislation will be introduced.
The Deputy Prime Minister
We will, of course, look for the earliest possible opportunity, to ensure—[Interruption.] The Deputy Leader of the House reminds me that that happened yesterday, so the offence is being put on to the statute book as quickly as possible, precisely because, as my hon. Friend says, it is incredibly unsettling for victims of stalking, and it is high time it was made a criminal offence.
Mr Michael McCann (East Kilbride, Strathaven and Lesmahagow) (Lab)
T5. Last year the NewsThump website awarded the Deputy Prime Minister the parliamentary April fools’ day prize for convincing a number of MPs that he intended to keep one of his pre-election promises. With April fools’ day 2012 fast approaching, will he confirm that he is a contender again, with the claim that tomorrow’s Budget will help those who are struggling?
The Deputy Prime Minister
My own view is that the tax proposal that I have championed for many years—that everyone who earns in this country should earn the first £10,000 entirely free of income tax—is one of the most radical tax policies to have been promoted in British politics for many, many years and would make a dramatic difference for people on middle and low incomes, who were abandoned by the Labour party and its punitive approach to tax. As I have said, from next month, with the steps that we have already announced, we will already be taking more than 1 million people on low pay out of paying any income tax whatever.
Karen Lumley (Redditch) (Con)
T9. In 2010-11 the average public spending purse per person in Wales was £9,947, and for the west midlands it was only £8,679. In the light of the fact that Welsh MPs can vote on matters that affect my constituents, how can I justify that discrepancy to the people of Redditch?
The Deputy Prime Minister
I know that this is a sensitive issue, but I do not think that at a time like this, when we are seeking to fill the black hole in the public finances, reopening the mind-numbingly complex issue of the Barnett formula should be our No. 1 priority. That does not mean that we cannot make progress on how fiscal devolution could proceed in the United Kingdom, which is why the Silk commission has been established to look, for instance, at the new fiscal powers that could possibly be devolved to Wales in the future.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
T8. This Government put back Labour’s universal broadband pledge by three years, with the result that we now have more than 2 million people without access to decent broadband. Now, the Deputy Prime Minister has decided that for the police commissioner elections, people will need decent broadband to know who to vote for. How can he possibly justify turning the digital divide that he created into a democratic deficit?
The Deputy Prime Minister
As the hon. Lady knows, the Government have committed hundreds of millions of pounds to investment in superfast broadband. She also knows that the Chancellor is due to make an announcement tomorrow on the 10 cities that will receive further support for improved broadband speeds, which of course are important not just for democratic participation but for a range of services that we want our citizens to be able to access.
Iain Stewart (Milton Keynes South) (Con)
T10. Has my right hon. Friend assessed the possibility that Orkney and Shetland could opt to remain part of the United Kingdom if the rest of Scotland voted for a separation?
The Deputy Prime Minister
That would be a popular proposal in the Liberal Democrat Whips Office, but I fervently hope that the issue will never arise, because I very much hope that the Scottish people will agree with the biggest body of opinion here and elsewhere, which is that we are stronger, safer and more prosperous as a United Kingdom.
Sheila Gilmore (Edinburgh East) (Lab)
T11. Last week the Deputy Prime Minister told the House that it was possible for a Government to do more than one thing at once. That was in relation to House of Lords reform. Does he agree, then, that it is possible to retain the 50p tax rate and introduce a tougher tax avoidance regime at the same time?
The Deputy Prime Minister
As I said, for me, the principles are very clear. First, the priority should be providing tax relief to people on middle and low incomes at a time when many people are feeling the pinch and struggling to make ends meet. Secondly, we should ensure that there is a progressive shift in the tax system, so that there is less tax on work, effort and enterprise, and more tax on wealth and the wealthy.
Simon Wright (Norwich South) (LD)
T15. I welcome the Deputy Prime Minister’s commitment to attend the Rio+20 conference on sustainable development later this year. Will he inform the House on which priorities he personally intends to lead during those vital discussions on the future well-being of our planet?
The Deputy Prime Minister
It is very important that this country continues to take a lead in the international discussions, not only so that we can confront together the overarching threat of climate change, which is such a potent threat to everybody across the globe, but so that we can work together to compare notes on how we can green our economies, which will be the specific focus of the Rio+20 summit. I think everybody now agrees that sustainable prosperous growth in the future has to be green as well.
Julie Hilling (Bolton West) (Lab)
T12. The president of the Liberal Democrats has said that in his opinion, the Health and Social Care Bill has gone from being “appalling” to being “pointless” over the past 12 months. Does the Deputy Prime Minister agree that over the same period, the Liberal Democrats have gone from being pointless to being appalling?
The Deputy Prime Minister
The only thing that is appalling is the Christmas cracker lines that Opposition Members dutifully read out. I really hope the hon. Lady will do a little better next time.
The Government are confronting a dilemma in our health care system that every Government in every developed economy and society must face. We have an increasing and ageing population, with an increasingly large number of people with long-term chronic conditions, who spend much more time in hospital than has ever been the case. That is why it is right to give people such as doctors and nurses, who know patients best, greater authority regarding how our health care system works. That remains the key reform in the Bill.
Steve Brine (Winchester) (Con)
Going back, if I may, to the topical issue of House of Lords reform, may I check with the Deputy Prime Minister whether he believes a 15-year senator who is unable to stand for re-election is more or less accountable than a current Member of the other place?
The Deputy Prime Minister
The key ambition of that reform is to ensure that the House of Lords is more legitimate. The simple principle that those who make the laws of the land should be elected by the people who have to obey the laws of the land is not an unfamiliar one across the democratic world. Of course, there is a legitimate debate on the length of the mandate for elected Members of the House of Lords, but the reason why we have opted for non-renewable terms—as in previous proposals, by the way—is precisely to enshrine the contrast between this Chamber and a reformed House of Lords.
Mr Andrew Love (Edmonton) (Lab/Co-op)
T13. Many will echo the Deputy Prime Minister’s earlier statement on House of Lords of reform—“Let’s get on with it.” After 100 years of waiting for reform, and after it was in all three party manifestos—although people would not know that from listening to some Members on the Government Benches—when will we have a Bill before the House? Sooner or later?
The Deputy Prime Minister
The Joint Committee that is examining our draft Bill is in the final stages of completing its work, and I hope it will publish its report shortly. The Government will then move as soon as we can to present a final draft Bill to the House.
Mr Peter Bone (Wellingborough) (Con)
It has taken 100 years to get Lords reform. It is an important matter and the Deputy Prime Minister is a great democrat. Will he give the House the assurance that this legislation for constitutional change will not be timetabled, but will go through the House at the appropriate pace?
The Deputy Prime Minister
It is a relief to be asked a question by my hon. Friend that is, for once, not related to the demise of his party leader. My hon. Friend is quite right to say that the Bill, given its importance, should be given adequate time. That is precisely what we will provide for it.
Valerie Vaz (Walsall South) (Lab)
T14. The Deputy Prime Minister is clearly at the heart of Government. Has he seen a copy of the legal advice on whether competition law applies to the Health and Social Care Bill, and the transition risk register, and will he publish it?
The Deputy Prime Minister
The reasons why we are withholding publication of the risk register are precisely the same as the reasons why the Labour Government withheld their consent for publication on three occasions—[Hon. Members: “Have you seen it?”] Yes, I have seen the risk register. As the hon. Lady knows, it is a very important tool to allow civil servants to give frank and fearless advice to Ministers. As champions of freedom of information such as The Guardian and The Independent have said, publishing the register would inhibit civil servants from providing such frank and fearless advice to Ministers in future.
Mr Alan Reid (Argyll and Bute) (LD)
Yesterday the Select Committee on Scottish Affairs published a report recommending the devolution of the Crown Estate, sea bed and foreshore rights in Scotland to local communities as far as possible. That would be a massive transfer of power from Whitehall to communities in the highlands and islands, exactly in line with the big society agenda. I hope that the Government support the recommendation.
The Deputy Prime Minister
I understand that those proposals were published just yesterday, so the Government have not had a great deal of time to consider them, but we will do so carefully.
Dr William McCrea (South Antrim) (DUP)
Will the Deputy Prime Minister tell the House, and my constituents, what the Government will do to help hard-pressed, hard-working, ordinary people throughout the United Kingdom facing exorbitant rises in fuel prices?
The Deputy Prime Minister
My own view is that the best way to help many, many families and the more than 20 million basic rate taxpayers in this country is to let them keep more of the money they earn. That is why the centrepiece tax policy in the coalition agreement is to lift the point at which people pay income tax to £10,000, so that everybody in the country receives a sizeable tax cut—because they will keep more of the money they earn.
Mr John Leech (Manchester, Withington) (LD)
Will my right hon. Friend tell the House what progress he and the cities Minister—the right hon. Member for Tunbridge Wells (Greg Clark)—have made in negotiating the city deals with the eight largest cities outside London?
The Deputy Prime Minister
My right hon. Friend and I have made significant progress on those city deals, and I am pleased to announce this afternoon that the negotiation with Greater Manchester has now been concluded. This deal is a huge step forward in our devolution-rebalancing agenda, and signals the Government’s genuine commitment to unlocking the great potential of our cities. It will enable Greater Manchester to shape its own future, including through an innovative approach to economic investment—the so-called “earn back” model—that has the potential to transform how cities are incentivised to drive growth. According to people in Manchester, this deal will create 6,000 new apprenticeships, strengthen Greater Manchester’s business growth hub, creating 3,800 new jobs, and commit us to a package of transport measures. Good news for Manchester.
Mr David Winnick (Walsall North) (Lab)
May I remind the Deputy Prime Minister that it was in fact a Labour Government who removed the large majority of hereditary peers from the House of Lords? Is it not quite obvious that there will be no progress on House of Lords reform, given the intense hostility from Conservative Members sitting behind him, unless the Parliament Act is used? I previously challenged him to a bet that there would not be such a change in this Parliament. Is he willing to take that bet?
The Deputy Prime Minister
My job is to deliver House of Lords reform, and to do so in as consensual a manner as possible. After all, all three main parties in the House committed themselves, in their manifestos, to reforming the House of Lords. Some say that this should not be a priority. I care about many things a whole lot more—such as a fairer tax system, the pupil premium and apprenticeships for young people. People defending the status quo should not elevate this issue to a status that it does not deserve. It has been debated for 100 years. Now let us get on with it.
Mr Speaker
Order. As usual, demand has exceeded supply. I apologise to colleagues who could not be accommodated, but we must now move on.
Nick Smith (Blaenau Gwent) (Lab)
1. What recent assessment he has made of the performance of the Serious Fraud Office.
The Attorney-General (Mr Dominic Grieve)
There has not been a recent independent assessment of the performance of the Serious Fraud Office, and for that reason, in consultation with the SFO director, I have requested Her Majesty’s Crown Prosecution Service inspectorate to carry out an inspection. It is intended that the inspection should assist the incoming director, and is timed accordingly. Furthermore, the SFO will continue to publish its annual performance information in its annual report.
Nick Smith
A KPMG report suggests that fraud is on the rise and estimates that more than £1 billion of Government money was stolen by fraudsters in 2011 alone. This financial year the SFO’s budget was a little over £30 million. Does the Attorney-General agree that that smacks of a false economy?
The Attorney-General
I have absolutely no doubt that if there is more money to spend, one may get greater results—but it is also worth pointing out that since the 2008 de Grazia review the SFO has been transformed. Investigation times have been significantly reduced, conviction rates remain high, and very substantial sums of money are being recovered from the proceeds of crime. From that point of view, the SFO is well fulfilling the mandate it has been set. However, I take the hon. Gentleman’s point: it is always possible to argue that priorities in government should be substantially altered, but if that is to be done, far more funds will have to be found.
Ann McKechin (Glasgow North) (Lab)
9. The Attorney-General will be aware that the Department for International Development’s annual review states that the Government’s record on investigating international corruption suffers from incoherent strategic direction. Can he tell the House how he will improve that record and increase the number of prosecutions?
The Attorney-General
It is worth bearing in mind that, so far as international corruption is concerned, the benchmark legislation is the legislation passed in 2011. As the hon. Lady will appreciate, for reasons that are obvious, that legislation is not retrospective. Therefore, although investigations are now under way into offences that have taken place from that time on, not many cases—or no cases—will have come to court. It is therefore a bit difficult at the moment to make an assessment of how successful this work will be. What I can tell the hon. Lady, however, is that between 40% and 50% of the Serious Fraud Office’s investigatory case load relates to bribery and corruption.
Chris Evans (Islwyn) (Lab/Co-op)
2. What assessment the Crown Prosecution Service has made of the effect of its Transforming through Technology programme on small firms of solicitors.
The Solicitor-General (Mr Edward Garnier)
The impact on defence firms of working digitally is discussed every fortnight when the chief executive of the Crown Prosecution Service, Mr Peter Lewis, meets the Law Society and other defence representatives to discuss progress on the programme.
Chris Evans
The criminal justice system goes digital next week. However, with less than half of publicly funded criminal defence firms able to receive CPS e-mails, with defence firms having no money to print evidence, and with the Government not even knowing how many sockets there are in courts to plug in the computers, is the Minister fearful that some problems may develop in the system?
The Solicitor-General
The hon. Gentleman paints a pretty gloomy picture—but then, he is in opposition, so I can fully understand it. The short point is that this is a rolling programme: it will be introduced incrementally. I can assure him that defence firms in his constituency and mine will come to terms with it and meet the challenges that they need to face.
Julie Hilling (Bolton West) (Lab)
3. What recent discussions he has had with the Secretary of State for the Home Department on reform of the UK’s extradition arrangements.
The Attorney-General (Mr Dominic Grieve)
I meet the Home Secretary regularly to discuss a wide range of issues of mutual interest. I know that my right hon. Friend is giving careful consideration to the recommendations in Sir Scott Baker’s review of extradition, and will make a further statement to Parliament detailing what action the Government propose to take as soon as is practicable.
Julie Hilling
As the Attorney-General has told the Select Committee on Home Affairs that he is not sure that changing the test applied in UK and US extradition cases would make any difference, does he regret his previous statement that our extradition laws are “one-sided” and should be rewritten?
The Attorney-General
It is worth bearing in mind that part of the problem for the first three years was that the last Government decided to implement the extradition treaty on a one-sided basis, so that we extradited to the US under the terms of our treaty at a time when the US would not carry out such extraditions. I think the hon. Lady will find that one of the reasons why I made that comment was that at the time of that debate, which took place in 2006, the United States had still not ratified the treaty. There are undoubtedly differences between the way in which the test that is required is applied, but having looked at the matter carefully. I do not think that the treaty as it stands at the moment can be described as one-sided. What can be said is that, as I explained to the Home Affairs Committee, there remain serious issues with public confidence in the way in which the extradition system with the United States operates.
Sir Menzies Campbell (North East Fife) (LD)
But is it not important to recognise why there are serious anxieties among the public about the nature of the system for extradition, and does not the question of the different standard of proof on each side of the Atlantic lie right at the very heart of that anxiety? The Attorney-General will be obliged to give legal advice to the Home Secretary. Will he give her advice that points to the fact that the two standards are different, and therefore that the political conclusion that the system is failing is a legitimate one?
The Attorney-General
I have to say to the right hon. and learned Gentleman that I do not think that, in practice, the difference between a test of “probable cause”, which we have to show in the United States, and a test of “reasonable suspicion”, which the United States has to show here, amounts to a very significant difference at all. As I mentioned to the Home Affairs Committee, in any event, the United States usually provides material to its own “probable cause” standard, so I have to say that I may disagree with him on this. Although I accept that there is an argument that this country could seek to move to a “probable cause” basis, to mirror that of the United States, in practice I do not think that that would make a very substantial difference to the way in which the extradition agreement with the US worked.
Keith Vaz (Leicester East) (Lab)
The Attorney-General will know that since his own appearance before the Home Affairs Committee, President Obama and the Prime Minister have announced a joint initiative to look into the operation of the treaty. In the light of that initiative, and the review that is now being conducted by the Home Secretary, does the Attorney-General agree that it would not be in the public interest for any British citizen to be extradited to the United States under the treaty until the review and the initiative have been concluded?
The Attorney-General
As the right hon. Gentleman knows, and as I explained to the Home Affairs Committee, the discretion for the Home Secretary, or any member of the Executive, to prevent an extradition from taking place is extremely limited under the current law. I am afraid that what the right hon. Gentleman is asking for would be impossible, unless Parliament were to enact fresh legislation.
Tom Brake (Carshalton and Wallington) (LD)
Has the Attorney-General had any discussions about the UK and US team that has been set up? What is its remit? Does it include only implementation, or could it also include issues such as the forum bar?
The Attorney-General
As the right hon. Gentleman knows, the matter was discussed by the Prime Minister and President Obama during the Prime Minister’s visit to the United States. The Prime Minister said that they would seek ways in which the treaty could be better operated in practice, and ways in which some of the public concerns could be addressed. At this stage that is probably all that I can reasonably say, but I can give the right hon. Gentleman an assurance that this is a matter that the Government and I take seriously.
John Cryer (Leyton and Wanstead) (Lab)
Does the Attorney-General think it entirely fair that the European arrest warrant can be used to extradite people from this country with no evidence whatever, and that the Home Secretary, who has absolutely no room for manoeuvre, simply has to hand those people over to other Governments, some of whom have a burden of proof that is quite dubious?
The Attorney-General
I agree with the hon. Gentleman that this subject causes disquiet, but it was his Government who enacted the necessary legislation to enable these circumstances to come about. The matter will come up for review, as part of the third pillar arrangements, by 2014.
Mr Philip Hollobone (Kettering) (Con)
4. What assessment he has made of the effect on prosecutions of the roll-out of the streamlined process in (a) Northamptonshire and (b) England in reducing police paperwork and in summarising key evidence to a high standard. [R]
The Attorney-General (Mr Dominic Grieve)
In 2011 the Crown Prosecution Service reviewed about 900 files across all 43 police force areas in England and Wales, including Northamptonshire, to assess compliance with the streamlining process. All CPS areas, and the police, have since been advised of what further work is required of them to reduce paperwork and ensure that key evidence is identified and summarised effectively.
Mr Hollobone
I declare my interest as a special constable with the British Transport police. The aim of the streamlining process is to reduce the police time required to prepare effective prosecution files while reducing the cost to the public purse. What steps can my right hon. and learned Friend take to highlight best practice, in order to encourage the police forces that are falling behind the curve?
The Attorney-General
First, I commend my hon. Friend for the work that he does as a special constable. The idea behind the streamlining process was precisely to achieve better practice. Performance in terms of the way in which the police have responded to it is variable. Some police forces have responded very well indeed, and the reviews suggest that they are applying the measures correctly; others appear to have more difficulty. If they have more difficulty, that means that they are spending unnecessary time over-preparing files. The Crown Prosecution Service is committed to working with every police force to try to ensure that best practice can be rolled out, and we will continue to do that, and to conduct periodic reviews to see how the process is progressing.
Tony Lloyd (Manchester Central) (Lab)
The Attorney-General has mentioned the huge variation between police forces, as did the National Audit Office last year. Is it possible to iron out those differences to ensure a common standard? Is any research being carried out to examine whether the process is leading to different outcomes—for example, in relation to guilty or not guilty pleas, or even to final sentencing?
The Attorney-General
In human affairs, achieving the complete elimination of all disparities might be rather difficult, but more could certainly be done to reduce them, and that is what we are striving to do. I will go away and check whether we can draw any specific conclusions from the process. Clearly, if people overburden themselves it will take up more time, and it could lead to a case not being properly presented, because the amount of material involved could hamper the presentation of the prosecution. I am afraid that I am not in a position to tell the hon. Gentleman whether statistics can show that the problem is leading to cases failing when they might otherwise have succeeded, for example—but it is clearly undesirable, and we must do what we can to help the police to make their lives easier.
Jim Shannon (Strangford) (DUP)
5. What recent progress he has made in increasing the rate of prosecutions for domestic violence.
The Solicitor-General (Mr Edward Garnier)
The number of domestic violence prosecutions in England and Wales has increased from 57,361 in 2006-07 to 82,187 in 2010-11. Prosecution in the hon. Gentleman’s constituency is, of course, a matter for the Public Prosecution Service for Northern Ireland.
Jim Shannon
Each year, many of those who suffer domestic violence return to the home where it all began. For them, legal aid is vital before a decision is made. Will the Minister urge his colleagues in the Ministry of Justice not to reverse the improvements in protection for victims of domestic violence that the Lords have made to the Legal Aid, Sentencing and Punishment of Offenders Bill?
The Solicitor-General
I will certainly make sure that my right hon. and hon. Friends in that Department have heard what the hon. Gentleman has had to say.
Rehman Chishti (Gillingham and Rainham) (Con)
On domestic violence, does the Solicitor-General agree that the programme of having independent domestic violence and sexual violence advisers supporting victims has improved conviction rates?
The Solicitor-General
Yes, my hon. Friend may well know that from his own experience as a criminal law practitioner, but it is certainly true for an observant Member of Parliament, too.
Meg Munn (Sheffield, Heeley) (Lab/Co-op)
Housing authorities in Sheffield have reported to me an increase in domestic violence, given the stress on families resulting from the economic situation. Will the Minister tell us what the Government are finding out about domestic violence generally, as he has reported an increase in prosecutions? Is domestic violence increasing overall, and what work is going on across Government to look at this issue, which still leads, week by week, to women being killed by current or former partners?
The Solicitor-General
My take on the matter is necessarily narrow, as it is to superintend the Crown Prosecution Service and its conduct of such prosecutions. Of course I am generally aware of the matter to which the hon. Lady refers, and it may well affect her constituents more than mine. The short answer is that the Government, and certainly my Department, will bear down on domestic violence—however it is caused or wherever it happens—so that women, in particular, can be protected and those who are guilty of it can be brought to justice.
Mr Tom Harris (Glasgow South) (Lab)
6. What recent assessment he has made of the role of special domestic violence courts in improving prosecution rates for domestic violence.
The Solicitor-General (Mr Edward Garnier)
Evaluations of specialist domestic violence courts, or SDVCs, in 2005 and 2008 clearly demonstrated that they had contributed to improving prosecution rates, as well as safety, for victims of domestic violence. There have been no further formal assessments since 2008.
Mr Harris
In the light of the truly disgraceful comments by the actor Dennis Waterman, does the Minister agree that now might be a good time to reassure the House that the vital services provided by domestic violence courts will be maintained, despite the court closure programme and the plan to close 23 of them? Will those vital services be protected during the transfer of services?
The Solicitor-General
Yes, they will. We need to distinguish between bricks and mortar and the service provided by the specialist courts. There will be a reduction in the court estate, but it is certainly my intention that there should be no reduction in the service provided for victims of domestic violence.
Zac Goldsmith (Richmond Park) (Con)
It is good news all round that stalking has been made a criminal offence, but there are countless examples of victims of stalking having been ignored for years by the authorities, despite the fact that the stalkers are already breaking the law. The law is one issue: enforcement is another. Will the Solicitor-General reassure the House that the new laws will be properly and robustly enforced?
The Solicitor-General
As soon as the new criminal law comes into effect, it will of course be up to the police to provide the Crown Prosecution Service with the evidence upon which prosecutions can be progressed, but my hon. Friend makes a good general point, which will be followed up.
Geraint Davies (Swansea West) (Lab/Co-op)
7. What recent assessment he has made of the performance of the Crown Prosecution Service.
The Attorney-General (Mr Dominic Grieve)
The Crown Prosecution Service operates a robust performance management framework with 10 key performance measures. They address case work outcomes, together with performance relating to finance, efficiency and people. Over the past 12 months, performance has improved according to nine measures and declined according to two.
Geraint Davies
Only one in 10 rapes are reported to the police, and only one in 15 of those reports lead to a conviction. How does the Attorney-General expect a 25% cut in resources for the CPS to increase the number of cases reported, or indeed the number of convictions?
The Attorney-General
I understand the hon. Gentleman’s question, but as I have told the House on numerous occasions, domestic violence and rape matters have remained a top priority for the CPS, and at present I have no reason to believe that the result of any changes in its funding will alter its ability to prosecute people successfully for such offences. If there are instances that the hon. Gentleman wishes to bring to my attention, I shall of course be happy to meet him.
Sir Alan Beith (Berwick-upon-Tweed) (LD)
Is my right hon. and learned Friend as concerned as I am about the conclusion of the inspectorate’s report that there is too large a pool of Crown advocates, that they are often under-prepared and that work is poorly allocated, which leads to cracked trials and unchallenged evidence?
The Attorney-General
Yes, I share the right hon. Gentleman’s concern. When we first came to office I devoted some attention to the issue, and particularly to the balance between work done by Crown advocates within the service and that done by the independent Bar. As the right hon. Gentleman will know, there have been some changes in the way in which that work is allocated, and I hope very much that the quality of both the work done by the independent Bar and that done in-house will improve as a result. The Director of Public Prosecutions takes this matter very seriously.
Emily Thornberry (Islington South and Finsbury) (Lab)
On 6 April it will be four years since the Corporate Manslaughter and Corporate Homicide Act 2007 came into force, but although between 250 and 300 people die at work each year—deaths which, according to the Health and Safety Executive, are usually avoidable—only two companies have ever been prosecuted under the Act. Does the Attorney-General know what is wrong, and if not, will he conduct urgent inquiries and make a statement to the House as soon as possible?
The Attorney-General
I shall be extremely happy to go away and seek the detailed views of the Director of Public Prosecutions, and to write to the hon. Lady and place the letter in the Library. I have discussed the matter with the DPP on occasion, particularly in view of my background as a health and safety practitioner.
Corporate manslaughter is the most serious offence for which people can be prosecuted, but prosecutions can sometimes be brought to cover similar sorts of offence within the health and safety laws. I know of no evidence to suggest that the Crown Prosecution Service is not correctly applying its approach to deciding when a prosecution for corporate manslaughter is appropriate, but in order to reassure the hon. Lady in response to what was a very sensible and pertinent question, I will endeavour to provide her with the information.
Hugh Bayley (York Central) (Lab)
8. What recent discussions he has had with the director of the Serious Fraud Office on penalties imposed on BAE Systems following the company’s conviction for offences connected with the sale of a radar system to Tanzania.
The Solicitor-General (Mr Edward Garnier)
I have regular meetings with the director of the Serious Fraud Office, and I discussed that issue with him recently. On Thursday 15 March the SFO announced that a memorandum of understanding between the Government of Tanzania, BAE Systems, the SFO and the Department for International Development had been signed, enabling a payment of £29.5 million plus accrued interest to be made to support educational projects in Tanzania.
Hugh Bayley
This is the first time that a British company convicted of financial crimes has been required by our courts to compensate victims in a developing country, but it has taken more than a year for the payment to be made. Do the Government intend to change the law to empower judges to impose penalties of this kind and to enforce quick payment, instead of relying on the voluntary agreement which led to the payment of compensation in this particular case?
The Solicitor-General
I hope that the hon. Gentleman will support me when, later in the current Parliament, I introduce deferred prosecution agreements to the criminal justice armoury. Such agreements will deal with penalty payments, but also, where appropriate, with the payment of compensation, and the payments will be made as a result of court orders.
Petition
John McDonnell (Hayes and Harlington) (Lab)
The petition relates to the Government consultation on the future of the Driver and Vehicle Licensing Agency that commenced in December. The Government are now proposing to close the local network of DVLA offices, with the loss of 1,200 staff and the consequential effects on local economies and the licensing regime itself. The petition was signed by 40,000 people and it states:
The Petition of DVLA staff and service users in numerous constituencies,
Declares that the Petitioners believe that the DVLA Office Network is a service which is needed throughout the UK; declares that the Petitioners feel that the decision to close the DVLA Office Network and centralise services is a devastating blow to local communities who rely on the services provided, as well as to the 1200 staff who will lose their jobs; and declares that the Petitioners believe that decision to close the service needs to be addressed so that staff and the public can get some reassurances of job and service security.
The Petitioners therefore request that the House of Commons urges the Government to consult with staff, users and trade unions further, and to take all possible action to save the DVLA Office Network.
And the Petitioners remain, etc.
[P001013]
Use of Powered Wheelchairs (Weight and Age Limit)
Mr Aidan Burley (Cannock Chase) (Con)
I beg to move,
That leave be given to bring in a Bill to increase the 150 kg weight limit for class 3 powered wheelchairs used on a public footway to 200 kg; to remove the lower age limit of 14 years on use of class 3 wheelchairs; and for connected purposes.
My Bill would amend the Road Traffic Act 1988. The amendment would remove the 150 kg weight limit and the lower age limit of 14 years on class 3 wheelchairs. That would in effect modernise the 1988 Act to adapt it to modern technology, enabling severely disabled children, including those under the age of 14, to use high-specification powered wheelchairs on a public footway.
I decided to introduce this Bill after learning of a remarkable campaign by an organisation in my constituency, the brilliantly named Newlife Foundation for Disabled Children. Newlife is a combination of charity, social enterprise and business, which exists to help children with disabilities. Founded by Sheila Brown OBE in 1991 as the Birth Defects Foundation, it has helped around 4,000 UK children and spent over £5.5 million on vital equipment such as wheelchairs and child safety seats. It has invested £11.3 million in medical research and runs a nurse helpline, calls to which grew by 300% last year.
Sadly, what Newlife has discovered over recent years is that wheelchair providers, usually primary care trusts or local authorities, have found a loophole in the current law to avoid having to fund high-specification powered wheelchairs, to both adults and children who need them. It is good news that more children today are surviving illnesses and cancers, but the sad news is that one in three will still go on to have a long-term disability as a result. With that increase in service users, eagle-eyed wheelchair managers are regularly refusing to provide a “sit to stand” wheelchair, or vouchers towards that equipment, for a child in their area, because their directors of risk have become aware of legislation that actually makes providing that equipment illegal, even for free through charities. That is then used as an excuse to save money in their budgets; they do not have to provide the expensive equipment needed. At the same time they prevent charities from providing it for free, at no cost to the taxpayer. PCTs are currently not balancing their books on the backs of the poor; they are balancing their books on the backs of the most severely disabled children, which I am sure the whole House would find abhorrent in a developed country such as ours.
Working with local lawyers in Staffordshire, Newlife's excellent campaign director, Susan Woodward, has established that the legislation that needs amending is the Road Traffic Act, or ROTA. In essence what has happened is that modern technology, which has been used to develop better, more appropriate and enabling wheelchairs, has also caused the equipment to increase in weight since ROTA was enacted. I do not believe for a moment that ROTA intended to discriminate against children getting the wheelchairs that they need. However, time and development of equipment have simply moved on and ROTA has not kept up. My Bill is therefore about modernising ROTA to take account of modern, appropriate and enabling wheelchairs and to end the absurd situation where disabled people’s mobility is impaired further. Modern wheelchairs have simply got heavier with adaptations such as motorised seats, communication equipment, more robust tyres, other aids and oxygen cylinders. Meanwhile, the legislation has stood still.
Under ROTA, wheelchairs are classified in three ways: class 1 manual wheelchairs, class 2 powered wheelchairs weighing not more than 113.4 kg or capable of reaching speeds above 4 mph, and class 3 high-specification powered wheelchairs. It is the conditions relevant to class 3 that cause the problem. ROTA states that class 3 wheelchairs must not be used by a person who is under the age of 14; that, when being used on a footway, the “invalid carriage”—the words of the legislation show how old it is—must not be driven at a speed greater than 4 mph; and that the unladen weight must not exceed 150 kg. Other regulations within ROTA include the means of stopping, lighting, speed indicators, horns, vision and rear view mirrors. Essentially what all that means is that several of the high-specification wheelchairs Newlife and other charities would like to provide have become illegal. That is because they would fail to meet the requirements for age, for weight and for certain wheelchair accessories such as lights, horns and rear view mirrors.
In essence, ROTA categorises very technologically advanced wheelchairs heavier than 150 kg as cars, which can be driven legally only by over-17s who hold a driving licence. Therefore, they cannot be provided to children under 17, as they are too young; but nor can they be provided to over-17s, as very few of the powered wheelchairs have lights, horns, rear view mirrors or a speed indicator. They are not cars; they are wheelchairs. The situation is clearly absurd.
I am aware that the Department for Transport recently undertook a consultation on possible reforms of highway mobility scooters and powered wheelchairs. The Under-Secretary of State for Transport, the hon. Member for Lewes (Norman Baker), whom I am delighted to see in his place, concluded that no changes should be made regarding speed limits, weight limit or the minimum age for using a class 3 vehicle. In a written statement, he said:
“I do not, at this stage, propose that there should be an alternative to the current arrangements for registering class 3 vehicles”.—[Official Report, 1 March 2012; Vol. 541, c. 44WS.]
He did decide, however, that the maximum weight of class 2 powered wheelchairs should be increased to 150 kg —a move welcomed by many disability charities, including Newlife.
I am not clear why the Department stopped short of amending provisions for class 3 wheelchairs, and only increased the weight of class 2 to match that of class 3. Such an approach is illogical: why have different classes if they contain the same weight? If class 2 has increased to 150 kg, surely it is logical that class 3 should increase by a similar amount. The weight restrictions for class 3 wheelchairs were devised more than 20 years ago, when wheelchairs were still called “invalid carriages” and were primitive compared with the designs available today. Modern designs provide for a “sit to stand or lie” facility and have longer battery life. They also provide for wider, more robust tyres that allow users to travel on difficult, uneven terrain. That is why they are heavier: they can do more things and help disabled people more. Nowadays, it is not the equipment that is holding people back, but outdated legislation.
The legislation does not allow any child under the age of 14 to use any mechanically propelled wheelchair over the weight of 150 kg. That is because it is a prescribed condition of class 3 “invalid carriages” that they are not used by people under the age of 14. However, that provision is now having the perverse effect of preventing severely disabled children under 14 from accessing high-specification wheelchairs, which could be of enormous benefit to them. Young kids with degenerative conditions and very complex postural requirements need these heavier and more sophisticated high-spec chairs to help with lung and other organ function. The age restrictions should therefore be removed to allow younger children to benefit from the use of chairs that accurately reflect their needs.
Of course we need to balance the safety of pedestrians and other road users with the mobility needs of users, but it is clear that the current legislation arbitrarily discriminates against children under 14. Why not choose 13 and a half or 14 and one month? This is a civil servant’s arbitrary measure. A much better basis would be a basic assessment of a child’s ability to use the relevant high-spec wheelchair, rather than an arbitrary age limit.
To conclude, the Road Traffic Act 1988 was written when wheelchairs were an aid to mobility. Today, wheelchairs provide disabled children with an aid to life. Children with the most disabling conditions rely on their wheelchair to meet their therapy and personal care needs, to prevent deterioration in their condition or the experiencing of pain, and to provide access to education and family life. For some children, their wheelchair lengthens their lifespan. The Act therefore discriminates against the children who have the greatest need for this equipment.
We all know in this House that ten-minute rule Bills rarely make it on to the statute book. I am already anticipating the cry from the hon. Member for Rhondda (Chris Bryant) of “House not sitting” when I read out the date for my Second Reading debate. However, I am honoured that both the Under-Secretary of State for Transport, the hon. Member for Lewes, and the Minister for disabled people, my hon. Friend the Member for Basingstoke (Maria Miller), are sat here listening from the Front Bench. I urge them when they leave this Chamber to work together to amend the legislation and use the opportunity to improve the lives of some of the most needy in our society. To disable our disabled community further by legislation is simply nonsensical. We have 21st-century equipment and 1980s law. This is an easy amendment for the Government to make. It will allow charities and statutory services to respond fully to need, instead of having a make-do, lesser alternative. Those are the reasons why we need the Bill, which I commend to the House.
Question put and agreed to.
Ordered,
That Mr Aidan Burley, Dame Anne Begg, Stephen Gilbert, Keith Vaz, Stephen Lloyd, Jeremy Lefroy, John Glen, Karen Bradley, Priti Patel, David Morris, Christopher Pincher and Mr Robert Buckland present the Bill.
Mr Aidan Burley accordingly presented the Bill.
Bill read the First time; to be read a Second time on Friday 27 April 2012 and to be printed (Bill 320).
Health and Social Care Bill
(12 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
17:12 - The House divided: - Ayes: 328 / Noes: 246 - Question accordingly agreed to.
Andy Burnham (Leigh) (Lab)
I beg to move,
That this House has considered the matter of whether the House should defer consideration of Lords Amendments to the Health and Social Care Bill until after disclosure of the NHS transitional risk register.
My right hon. Friends and I are grateful for your agreement to give the House this opportunity, Mr Speaker. On this of all days we should be celebrating what a much-valued social institution has done to bind our nation together throughout the 60 years of Her Majesty’s reign. Instead, we gather to dismantle it. A health service that is judged by international experts to be one of, if not the, best health service in the world is about to be inexplicably and unjustifiably broken apart by an ideological Bill ending 63 years of NHS history.
This is a difficult day, but what makes it all the harder to stomach for people watching is the manner in which things are happening. People outside will struggle to understand how Members of this House could make such momentous decisions without having carefully considered all the facts and all the evidence. The truth is that Members will go through the Lobby tonight without knowing the full implications of what it means for the NHS in their constituencies. How do they begin to justify that to their constituents, to patients who depend on the NHS and to staff who devote their lives to it? We have argued from the beginning that the Government’s decision to combine an unprecedented financial challenge in the NHS with the biggest ever top-down reorganisation has exposed the NHS to greater risk, and the truth is that we are beginning to see the effects of that. In our constituencies, they have already dismantled the existing structures of the NHS before the new ones are in place, leading to a loss of grip just when it was most needed. So we are seeing A and E waits getting longer, staff shortages leading towards A and E closures, and patients in our surgeries beginning to complain of treatments being restricted or of longer waits.
We have also heard from the health professions—from GPs, nurses, midwives and physios—who one by one have made clear their considered professional judgment that, on the balance of risks, it would be safer to abandon the Bill than to proceed with the upheaval of reorganisation. Ministers by their actions are putting the NHS at greater risk, but even today this House does not know the assessment that was given to Ministers or the precise nature and scale of those risks.
Andy Burnham
I do not plan to give way because I want other Members to have the chance to contribute to the debate.
Ministers want the House to back the gamble they are taking with the NHS without having the courtesy to tell it the odds. The Information Commissioner thinks we should see the risk register and so does the Information Rights Tribunal, which brought forward its ruling so that it could influence our proceedings. If the NHS starts to struggle because of all the change being thrown at it and if services in some parts of the country start to fail, how will Members of the House respond when people come to our surgeries and ask whether we did everything we could to anticipate the dangers? We will remind them of the truth—that Government Members put politics before the national health service and signed up to a reckless reorganisation without knowing all the facts.
Andy Burnham
I will give way once to the right hon. Gentleman and then I will finish my remarks.
Mr Redwood
I am very grateful. When Labour introduced private contractors to carry out NHS treatments, did that undermine the NHS?
Andy Burnham
No, because we brought down NHS waiting lists to their lowest ever levels and we left patient satisfaction at its highest ever level. Those same waiting lists are going up under the right hon. Gentleman’s Government and he should be ashamed of that. He will not publish the information about the risk to waiting times because he is frightened of putting it before the House and the public, but we will remind them of the truth.
The Government proclaimed that they were going to be the most open and transparent Government in history. Today, it still says on the Treasury website in a statement of the Government’s principles for risk management:
“Government will make available its assessments of risks that affect the public, how it has reached its decisions, and how it will handle the risk. It will also do so where the development of new policies poses a potential risk to the public.”
May I suggest that the Government take down that misleading statement of policy? Their actions have left it in tatters, together with the grand claims of openness and transparency. The tribunal, they will say today, has not given us its reasons. Ministers will try to argue that the public and Parliament’s right to know about the impact of their policy decisions is outweighed by the public interest in the preservation of a safe space for policy advice.
Those arguments were considered, first, by the Information Commissioner, and subsequently by the Information Rights Tribunal. They found the opposite to be the case: that the public interest lay in full disclosure. But it does not matter; Ministers are simply re-running the arguments of a case that they have lost. They have no leave to reopen the substance of that argument, but they are not the only arguments that they have lost.
In an attempt to rescue the Bill last year, the Prime Minister made a number of claims for it. They cover issues that we know are in the local and regional risk registers which have been published. First, he said the Bill was needed as the NHS does not
“deliver the patient-centred, responsive care we all want to see”.
He cited heart services and claimed that someone in this country is twice as likely to die from a heart attack as someone in France. That was before new research in January reported a 50% fall in heart attack deaths in the past decade.
Then the Prime Minister said that cancer services were failing people, compared with other countries. That was before new research in November 2011 which showed that the NHS in the past decade achieved the biggest drop in cancer deaths of any comparable health system in the world. Thirdly, the Prime Minister and all the Ministers on the Government Front Bench have routinely trotted out the same script for years—that NHS productivity has declined in the past decade. That was before new research on NHS productivity from Professor Nick Black published in February in The Lancet showed that, far from falling, NHS productivity increased in the past decade at the same time as the NHS achieved patient satisfaction.
One by one the Government’s arguments for the Bill have fallen apart. They have comprehensively lost the argument. They have convinced nobody and now they are running scared, resorting to the only remaining option of ramming the Bill through Parliament before they are required in law to publish the real assessment of their policies.
Alex Cunningham (Stockton North) (Lab)
I am sure my right hon. Friend will join me in wishing well 11-year-old Bailey Stark in my constituency as he and his family cope with his condition that means that he is unable to swallow. His mother is worried sick about the changes in the health service, which might mean that he will not get the treatment he requires in Newcastle. Does my right hon. Friend agree that that risk is all the more reason for publishing all risks, as we should know the truth about what is happening to our NHS? [Interruption.]
Andy Burnham
Members shout “Scaremongering” from the Government Benches, but the Government will not publish the evidence to back up their claims. We have read the local and regional risk registers which warn precisely of the case that my hon. Friend mentions—of damage to the continuity of care, risks to patient safety, longer waits for cancer patients, risks to child safeguarding. Those are the facts in the regional risk registers and they are the facts that Ministers are trying to withhold from the public.
Caroline Lucas (Brighton, Pavilion) (Green)
Does the right hon. Gentleman share my surprise and sadness that the Liberal Democrats, who were once the defenders of freedom of information, are now trooping through the Lobby in support of a dangerous Bill shrouded and protected by the restriction of information?
Andy Burnham
I am grateful to the hon. Lady for her point. The Liberal Democrats once derided the Freedom of Information Act as too weak. Today they cower behind it, trying to use any scrap of protection they can find within it to prevent the publication of the information that patients and the public deserve to have. That says everything that people need to know about today’s Liberal Democrat party.
Mr Stephen Dorrell (Charnwood) (Con)
Will the right hon. Gentleman give way?
Andy Burnham
I will not give way. I will now bring my remarks to a close.
We are clear that the risks in the Bill arise not just from the organisational turbulence that the Secretary of State is inflicting on the NHS, but from the specific policies in the Bill. Today we table a package of amendments in a last-ditch attempt to provide the necessary safeguards that the Liberal Democrats failed to secure in another place—
Andy Burnham
They are safeguards in light of the huge potential for the conflict of interests in the award of contracts under the “any qualified provider” provisions, which will not be addressed by a simple register of interests, and safeguards on a stronger local HealthWatch—the Government have watered that down since the Bill left this House of Commons. There are safeguards too—
Mr Dorrell
I am grateful to the right hon. Gentleman. Will he just clarify one issue of principle for the House? Are Labour Front Benchers now arguing that every Government Department should publish its strategic risk register? If not, can he justify his proposition that the Department of Health should do so uniquely?
Andy Burnham
I refer the right hon. Gentleman to the Information Commissioner’s ruling on the decision about a third runway at Heathrow. That is the precedent his Government should be following, but instead they have chosen to defy the commissioner. It was the Labour party that published the decision on a third runway at Heathrow, and I refer him to the ruling from the Information Rights Tribunal, which made a clear distinction between the strategic risk register, which covers all the uncontrollable risks that any Department will face, and the transition risk register, which deals specifically with the effects of Ministers’ decisions, in this case on the NHS. There is a real difference between the two. The tribunal said that the transition register should be published. His Government should respect the law and publish today.
We will table amendments to provide safeguards today, but in future it will not just be the cover-up of the risk register that we will have to worry about—that is just a taste of things to come in the new NHS. Members will have to get used to the words “commercial confidentiality” when inquiring about local services, because that is what they will find in the NHS that Ministers are creating. Let us look at the risks inherent in the proposed relaxation of the private patient income cap. One risk assessment that Ministers have published—the revised impact assessment—states that
“there is a risk that private patients may be prioritised above NHS patients, resulting in a growth in waiting times for NHS patients.”
That is all they have told us, but that alone is reason enough to oppose the Bill.
The only hope I can give people worried about the future of the NHS is that this might be the end of the Bill, but it is just the beginning of our campaign. The NHS will find a way of working around these changes and will not deteriorate overnight. We will be working to mitigate the worst effects of the Bill. This is the eleventh hour; our only hope would be a change of heart from the Liberal Democrats. We will call a vote on this motion and ask people to vote against it to show that we have not had enough time to debate these important issues.
I respect those Liberal Democrat Members who have had the courage to defy their orange book leadership, and I respect their grass-roots members who did the same at their spring conference, but the truth is that from today the Liberal Democrats will be remembered not only for tuition fees, but as the party that stole people’s votes in May 2012 in order to secure jobs for themselves and sell out the national health service. They could have stood up to the Prime Minister and enforced the coalition agreement, but they chose not to do so.
That brings us back to where we started: a Bill that nobody voted for, rammed through this place tonight in the teeth of near-universal professional opposition and in defiance of a major legal ruling; a Bill about which no Member of this House can look their constituents in the eye and say they have a mandate to support. Tonight Government Members will inflict this Bill on the NHS without knowing the potential damage it can do to the health service in their constituencies. They have made their choice; I have made ours. Although on a day like today it is hard for me to give any encouragement to people worried about what the Government are doing, I can at least say this: we will repeal this legislation at the first opportunity and restore the N in NHS. We have given this fight everything that we had. All I can say is that our fight will go on to protect and restore the Labour party’s finest achievement.
Mr Speaker
Order. The Secretary of State has indicated that he wishes to speak later in the debate—[Interruption.] Order. That is his absolute prerogative. In view of the level of interest in the debate, it will be helpful for the House to know at this point that a five-minute limit on Back-Bench speeches is to be imposed immediately. I call Dr Daniel Poulter.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
indicated dissent.
Mr Speaker
He was in, on the list and at the top. If he does not wish to speak, so be it.
Tony Baldry (Banbury) (Con)
I start by apologising to the House for making what I suspect may sound like a slightly portentous speech. It is not meant to sound portentous, but if it does I apologise.
Because of the effluxion of time, there are not many former Ministers on the Government Benches are, but there is, irrespective of the topic, an important point that needs to be made in the context of today’s debate. I urge every right hon. and hon. Member, before they vote at the end of this debate, to get a copy of House of Lords Hansard for yesterday’s debate, where this matter was debated. There are, in that Lords Hansard, two speeches that hon. Members would do well to read: those of Lord Wilson of Dinton and Lord Armstrong of Ilminster, both former heads of the civil service.
Lord Wilson was head of the civil service during the time of a Labour Government, and both he and Lord Armstrong made it very clear in their speeches yesterday that to release the risk register would be extremely bad news for the relationship between the civil service and Ministers generally. Irrespective of this issue, irrespective of the topic, if risk registers were to be released, officials would needlessly be politicised and thus be concerned about the advice that they gave to Ministers. Ministers would then find themselves being given verbal advice, fewer people would be involved and that would not help the machinery of government.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
Will the hon. Gentleman give way?
Tony Baldry
I will give way to the right hon. Lady in a moment.
Lord Wilson made it clear in his comments:
“Every day in government, Ministers consider policy issues and depend on the Civil Service for advice. Anyone who has been a Minister understands the private space in which civil servants give their best advice.” —[Official Report, House of Lords, 19 March 2012; Vol. 736, c. 643.]
It seems to me that this debate is really very much about a matter of principle: the relationship between civil servants and Ministers.
I understand the Opposition wishing to make some political points, but many of them, including the right hon. Lady to whom I am about to give way, have recently been Ministers, so I am sure they understand that point, and it does not behove the House, in its desire to make a political point, to seek to undermine a long-standing relationship between Ministers and officials.
Dame Joan Ruddock
Why therefore has the strategic health authority in London felt able to publish its risk register? There are 18 areas of risk, and those that were red are, after mitigation factors, still red, so we learn something very important. That is why we should have the risk register under discussion published.
Tony Baldry
I understand that point, but they are very different registers. The register to which the right hon. Lady refers is meant to be publicised. The two are of an entirely different nature, and that point has been explained to the House by my right hon. and hon. Friends on the Treasury Bench on a number of occasions.
We are discussing departmental risk registers and the advice that civil servants give to Ministers. All I am saying is that right hon. and hon. colleagues, before they vote, should at least take care to consider the advice of former heads of the civil service on the effect that publication would have on the relationship between civil servants and Ministers.
Tony Baldry
I can assure my hon. Friend that what I am saying is true. All he has to do is walk a few feet to the Vote Office and pick up a copy of Lords Hansard and read for himself the speeches of Lord Wilson of Dinton and Lord Armstrong of Ilminster. All I am saying to my hon. Friend—
Karl Turner (Kingston upon Hull East) (Lab)
Will the hon. Gentleman give way?
Tony Baldry
No.
All I am saying to my hon. Friend is that this is a debate about the relationship between civil servants and Ministers, a relationship that has worked very well and very effectively in this country.
Here we have heads of the civil service advising Parliament that this move, which the Opposition would seek to force upon us, is not in the best interests of the relationship between civil servants and Ministers and is not in the best interests of the good running of government.
Frank Dobson (Holborn and St Pancras) (Lab)
The national health service is probably the most precious institution in this country. It is vital to millions of our fellow citizens—its hospitals treated nearly 10 million people last year—and so no one should take risks with it. The Prime Minister decided to take such risks, he told a private meeting of Conservatives, because the NHS was in an “invisible crisis”. Well, all I can say to the Prime Minister is that it is invisible because there is not one. The NHS is not in crisis; it is doing remarkably well, and it needs to continue to improve. The Prime Minister also said that he was willing to “take a hit” in this regard. No Labour Member cares very much whether he does or not: what we are bothered about is that we do not want the national health service to take a hit; we do not want its precious, hard-working staff to take a hit; and we do not want its patients to take a hit.
Government Members—or those in the majority party—call themselves conservatives, but actually they are a party of chancers. Real conservatives recognise that the outcome of change is unpredictable, that the process of change can be troublesome, and that there are often unexpected consequences of change, and they therefore need convincing that there is a good case for the change. Clearly, the Government have not made such a case.
Mr David Evennett (Bexleyheath and Crayford) (Con)
Will the right hon. Gentleman give way?
Frank Dobson
No.
The Government have not made such a case for change. They have not convinced the 1 million-odd people in the national health service that these changes are needed, and if they cannot convince the people on whom the service is going to depend, they are taking a real chance with its future.
The Prime Minister attributes his commitment to competition, including outside competition, to some of the most worthless and shallow research that has ever been conducted at the London School of Economics—and that puts it in a pretty extreme category. The researchers said that they identified that hospitals they claimed competed with one another had achieved a 7% improvement in the period for which patients awaiting an operation had to wait once they got into hospital. A 7% improvement is a period of less than an hour. Then, without any justification whatever, they generalised from the particular and said that the hospitals they claimed competed with one other were 7% more efficient right across the board. It is on that basis that the Prime Minister says that he wants to introduce competition into our national health service.
Frank Dobson
No, I will not give way, even to the hon. Member for St Ives (Andrew George), who has made a very honourable contribution to these debates.
Across the board, we see the Government taking unjustified risks with our national health service. If they are not prepared to disclose to the rest of us what risks they have been advised they are bringing about, they are both cowardly and stupid. I do not think that the people of this country will ever forgive them for their reckless, chancy, dodgy, second-hand-car-salesman approach to the national health service.
John Pugh (Southport) (LD)
It is a sure sign of a deranged mind when one starts to repeat oneself. I have said previously that the Bill is a huge mistake, that not releasing the risk register merely creates further alarm, and that abandoning the Bill could be the safer option. I have also said that the Secretary of State’s intentions are noble and that the Opposition’s objections are—in part, at any rate—considered and compelling. However, I have clearly failed to persuade many of my parliamentary colleagues to share that point of view, as last night’s voting showed.
Karl Turner
I am grateful to the hon. Gentleman for giving way. He says that he has been opposed to the Bill from the outset. As he knows, I served on the Public Bill Committee with him. Why did he not vote against it? He had ample opportunity to make the Government drop the Bill.
John Pugh
If the hon. Gentleman checks Hansard carefully, he will find that there were occasions when I did. We must all agree, whether sadly or happily, that the vote in the Lords last night was conclusive, even if some, like Baroness Williams, were voting for legislation that they said they did not particularly like. That is in part because of the modifying genius—I put it as strongly as that—of Earl Howe.
There are risks attached to the legislation. The risks that I face are small in comparison with those faced by the Secretary of State. I risk being found out for having fears that are misplaced. I risk having my forebodings exposed. He risks a great deal more than that. The House does not need a risk register to find out what those risks are. If he proceeds rapidly at a time of huge upheaval in the NHS, he will actually promote that upheaval. If he goes ahead, he will be doing so at a time of austerity, in the teeth of wholesale professional opposition and in a climate of genuine legal uncertainty, with legislation that has, in part, been cobbled together. We will soon find out what has been scaremongering and what is plain scary. Crucial to mitigating the risks will be the pace and the extent of enactment and implementation. There will be a mopping-up phase. It will be crucial for the Government to woo back professional opinion. The risk register would have told us, to some extent, how easy or difficult that will be.
Already we hear that the Government are struggling with the central plank of the legislation: GP commissioning. We wait with interest to see the regulations on that. It is hard to see how GPs can commission basic out-of-hospital services in primary care, which is a central thrust of the Government’s legislation, and not be seen, as small businesses or associations of undertakings, to be benefiting themselves with public money. In the legislation, we have made the biggest provider the biggest commissioner as well. GPs will have no problem commissioning hospital services without any legal obstacle, but they will lack the expertise to do so. That is what primary care trusts found when they did the commissioning. The risk is that we will end up with GPs not being able to commission what they do understand, and being asked to commission what they do not understand. We therefore await the regulations with considerable interest.
I suggest that although Cabinet members have been banging the table today, they may well be banging their heads against the wall in the years to come.
John Healey (Wentworth and Dearne) (Lab)
This Standing Order No. 24 debate is an important statement from Parliament to the Government. We expect better from the Executive, and the public demand better, as they have shown in e-mails, surveys and petitions.
This afternoon, the House is being asked to agree to the longest ever NHS legislation and to back the biggest ever reorganisation of the NHS. We are being asked to accept that from Ministers who have lost twice in law and still keep secret the risks that they are running with our NHS. This is a legal and constitutional argument; it is not a political argument. This is not about being in favour of or against the Health and Social Care Bill; it is about the public’s right to know the nature and scale of the risks that the Government are running with their NHS, and it is about their elected Parliament’s right to know about those risks when it is asked to legislate—as we are being asked to do—on their behalf. We are elected to the House to legislate by the people, for the people.
Nothing is more precious to people than our NHS. We all need the NHS. We depend on it utterly when we are at our most vulnerable and fearful. The NHS in England employs more than 1.4 million people, treats 3 million patients each week and provides each of us, throughout our lives, with some of the best health care in the world, free at the point of need. That is why it matters so much, and that is why people mind so much about the plans for the NHS.
The NHS, as an institution, is exceptional, and the public interest in anything that puts it at risk is exceptional, too. The current reform plans are exceptional in their nature, scale, timing and speed, and concern about the risks to the NHS is exceptional. That was expressed by all NHS experts, professional groups and patients in the consultation on the White Paper, and it was expressed by the Health Committee in its reports in December 2010 and January 2011. Risk was, is and will continue to be at the heart of the concerns about the biggest ever internal NHS reorganisation. That is why I made my original FOI request for the transition risk register in November 2010. That is why I refused to accept the Department’s refusal to release it. That is why I went to court this month to help to argue the case against the Government’s appeal.
Good government demands that Ministers get the best and fullest policy advice from officials, and it requires some safe space in which to make major policy decisions, but I am not asking for the release of policy advice. Risk registers are management, not ministerial, documents. They do not contain policy advice or accounts of policy discussions. They derive from major policy decisions, and the White Paper of July 2010 set out the main policy decisions three and a half months before the first transition risk register was compiled.
Nor am I asking for the release of information that will bring to a halt the Government system of risk management. It did not do so in 2008 when we were forced to release the risk register for the runway at Heathrow. Nor am I asking for the routine disclosure of risk registers. I am asking for the non-routine disclosure of this risk register because of the exceptional case and the balance of public interest that is in favour of disclosure and not in favour of withholding, just as the Information Commissioner and now the Information Tribunal—both of whom have had the benefit of having seen this risk register—have decided.
We are at the very end of the eleventh hour of this Bill’s 14-month forced passage through this House. Beyond today, the Government must decide whether they will respect the law and release the risk register. This is part of the reason why the Government have lost the support of NHS staff and lost the confidence of NHS patients, and have now lost the trust of the British public.
Henry Smith (Crawley) (Con)
It is a great honour to take part once again in a debate on the Health and Social Care Bill. I first made a contribution to these debates in 2010 and, as the right hon. Member for Wentworth and Dearne (John Healey) said, since then there have been 14 months of detailed and careful consideration of the Bill’s provisions. That says a lot. There has been criticism both in this debate and previously that the Bill is ill-considered and has been rushed through, but given the consideration of it that there has been over such a long period, and with so much public involvement and comment, that is clearly not the case.
The right hon. Gentleman also said that our NHS is truly a precious institution for each and every one of us—our own family members as well as all our constituents—and I agree. People rely on the health service and hold it very dear, and it is therefore right for passionate feelings to be expressed about its future both in this Chamber and outside. I contend that because we have a changing demographic and magnificent advances in medical technology, the way our national health service is run cannot stay still.
Helen Jones (Warrington North) (Lab)
No one on the Opposition Benches has argued that the NHS does not need to continue to improve. That is not what we are discussing; we are discussing the risk register. Does the hon. Gentleman believe that the Government should abide by the tribunal’s decision, or does he believe they should continue to ignore that lawfully made decision?
Henry Smith
I think the biggest risk to the national health service is if we do not reform it and move it forward. It needs reform to stay relevant to the needs of all our constituents. I find the Opposition’s position strange—I would put it down to political opportunism, but I am happy to take another intervention if Opposition Members want to state their case—given what happened with the three requests made when the right hon. Member for Leigh (Andy Burnham) was Secretary of State and under his predecessor.
Andy Burnham
Does the hon. Gentleman understand the difference between a strategic risk register and a transition risk register?
Henry Smith
I believe I do understand the difference between the different types of risk register, but if we simply stand still and have inertia in our health service, it will become less relevant.
The right hon. Member for Holborn and St Pancras (Frank Dobson) accused members of my party of being chancers. I prefer to consider us as reformers, and only if we embrace reform will we be able to provide a better NHS.
Fiona Mactaggart (Slough) (Lab)
One reform that I imagine the hon. Gentleman will welcome is the Chancellor’s proposal, which we gather we will learn about tomorrow, that every taxpayer can find out where their taxes go. As the taxpayers have paid for the compiling of the risk register, why should they and we not be able to read it?
Henry Smith
I am a great supporter of transparency across all our public services, and the people of this country thirst for transparency about how their hard-earned money is spent.
The Health and Social Care Bill provides for the democratisation of the national health service. The experience of the NHS in my constituency over the past decade was the sad loss of the maternity department at Crawley hospital, followed four years later by the closure of its accident and emergency department. One reason why those two units and others were transferred from my constituents’ local hospital was that decisions about the national health service were made nowhere near where they took effect.
The Bill will allow local clinicians, in conjunction with their patients—and, I might add, with democratically elected local government—to have a much greater say in how the NHS is delivered and greater scrutiny of it. We will have a far more responsive health service. It has been almost decades since health decisions in Crawley were made by clinicians, patients and elected councillors. By repatriating many decisions, we will have a more transparent and responsive health service.
It was a great privilege to be able to open the new digital mammography unit at Crawley hospital a few weeks ago. That is a classic example of a health service that develops in line with technology and with the changing needs of our population. I am confident that the Bill will give local clinicians, patients and democratically elected local representatives the tools to provide a far safer and more relevant national health service to the people of my constituency and constituencies up and down the country.
In conclusion, after 14 months of careful consideration of the Bill, it is time we get on with the reform of the national health service, which goes hand in hand with the increased investment in it that the Government have guaranteed at least to the end of this Parliament. I might add that that is in stark contrast to what is happening in Wales, where Labour is in control of the NHS and where budgets have been cut. The people of Wales are feeling the result. I want to resist that happening to patients in England and therefore believe that it is time to get on and pass this legislation for the good of our NHS.
Mr David Anderson (Blaydon) (Lab)
This debate is about contempt—for the Information Commissioner, for the tribunal, for the people who signed the e-petition, for the public who have contacted hon. Members in their hundreds of thousands and for the principle of transparency. For years, we had lectures from the Conservatives and Liberal Democrats when they were in opposition, when they said that sunlight was the best light.
We should not be surprised, because the whole debate on this Bill has been about contempt, starting with the contempt for democracy. The Government have no mandate, no support and no truth—the Conservatives promised no top-down reorganisation. The Conservatives and Liberal Democrats were not straight with the people, but why not? I hate to disagree with my right hon. Friend the Member for Wentworth and Dearne (John Healey), but this debate is political. The Conservative party has always opposed the national health service, because it is the living example that collectivism works. Conservatives oppose the NHS because they are against collective provision.
The hon. Member for Southport (John Pugh), who has tried his best to make something out of this mess, was right when he told the Liverpool Daily Post a number of weeks ago:
“If the Conservatives had gone to the country at the last election and said ‘we want a market-based health system’ they would have lost the election badly.”
The Conservatives knew that, which is why they covered it up.
The Government have shown contempt for the House, because even before they reached for the pause button, changes were taking place. Before we have even agreed the Bill, they have all but abolished 151 primary care trusts, with tens of thousands of people being made redundant. They are being replaced by 279 clinical commissioning groups, and strategic health authorities have been set up.
The new national commissioning board, which has not yet been agreed in law, has already got a chief executive, a finance director and seven board members, recruited at salaries of up to £170,000. That is before we have even passed the Bill. If that is not contempt, what is?
Worst of all is the Government’s contempt for the people to whom we look to deliver our services. The Government say, “We know best,” but anybody who was in the Chamber last week to hear the Government’s contempt for the work of Dr Chand, who did his best to ensure that the House looked again at the Bill, will know how the Government feel about health workers in this country.
Who are these people who know so much better than the doctors, nurses, general practitioners, consultants, radiographers, occupational therapists and porters? What is their background? There are researchers, a teacher, and a sales and business manager. In the Lords there are former Army people, journalists, lobbyists, MEPs and researchers, and people who worked at Tory HQ. Do they all know so much better than the people to whom we and the people we represent turn every day of the year to take care of us?
Who is against the Bill? Almost everybody, including the British Medical Association, the Royal College of Nursing, the Royal College of Midwives, the Royal College of Radiologists, the Royal College of Physiotherapists, and the Royal College of Paediatricians and Child Health, the Faculty of Public Health and the GPs. I could be here all night going through the list, but the Conservatives and Liberal Democrats know it.
Susan Elan Jones (Clwyd South) (Lab)
There was one small omission from my hon. Friend’s list of the many opponents of the Bill: the agent of the right hon. Member for Bermondsey and Old Southwark (Simon Hughes), who is also deputy leader of the Liberal Democrats. Mr Gary Glover, on his Twitter account, said:
“Lib Dems have accomplished almost nothing on the NHS Bill.”
Surely the truth is that Lib Dems could accomplish rather a lot, because they could help us to defeat the Bill tonight.
Mr Anderson
My hon. Friend is absolutely right. As an eternal optimist, I continue to hope against hope that the Lib Dems will see the light tonight, but my guess is that they probably will not. They have shown contempt even for the democracy within their own party. They claim to be determined to be bound by the democratic decisions of their own party. They have not been. They have ignored their party. When they came to Gateshead two weeks ago, they said they would stand up to the Bill, but they have not. It is the double-talk and spin that we are all used to.
Two days ago, I visited my general practitioner, and on his practice nurse’s wall was a poem by Michael Rosen, the children’s poet laureate, who, in 2009, wrote a poem called “These Are The Hands”. It read:
“These are the hands
That touch us first
Feel your head
Find the pulse
And make your bed.
These are the hands
That tap your back
Test the skin
Hold your arm
Wheel the bin
Change the bulb
Fix the drip
Pour the jug
Replace your hip.
These are the hands
That fill the bath
Mop the floor
Flick the switch
Soothe the sore
Burn the swabs
Give us a jab
Throw out sharps
Design the lab.
And these are the hands
That stop the leaks
Empty the pan
Wipe the pipes
Carry the can
Clamp the veins
Make the cast
Log the dose
And touch us last.”
These are the people we should have been listening to. These are the people who have been ignored constantly by the Government parties. And these are the people who will never ever forgive them for what they are doing tonight. When the election comes, they will be thrown out where they belong.
Mr Stephen Dorrell (Charnwood) (Con)
Thank you for calling me, Mr Speaker, for what I hope will be a brief intervention prompted by the remarks of my hon. Friend the Member for Banbury (Tony Baldry) and the right hon. Member for Wentworth and Dearne (John Healey).
Later this evening, the House will consider—yet again, many of us would say—the Health and Social Care Bill, but the issue for consideration now is whether the Government should publish the transitional risk register on the Bill. The right hon. Member for Wentworth and Dearne was explicit that he was not arguing that all strategic risk registers should be published, and acknowledged the argument that there needed to be private space in which civil servants could give advice to Ministers secure in the knowledge that it would remain private, because there was an important interest of good government that that discipline and space should exist. That is an argument that he explicitly accepted and of which I am a strong supporter.
My hon. Friend the Member for Banbury reminded the House that only yesterday two retired former heads of the civil service told peers in the other place of the importance of the principle that Ministers must be able to receive advice from civil servants on policy issues, including the risks associated with them, without that advice later becoming public. The issue that the right hon. Member for Wentworth and Dearne did not cover but which is important is that there needs to be confidence within the civil service about which side of the line advice will fall. If civil servants can give advice to Ministers believing that it will remain confidential and if, after the advice is given, the line is moved and the advice falls to be published, we run the risk that across Whitehall the space that he advocates will, in truth, not exist, because there will not be the confidence that the advice will not later fall to be published.
Barbara Keeley (Worsley and Eccles South) (Lab)
The right hon. Gentleman is talking about advice. It has been made clear that this is not advice but a management assessment of risks relating to the Bill and the reorganisation. It is not about policy or advice, which is why it is important that it is released.
Mr Dorrell
It is an interesting debate whether a risk register about a transition related to a policy is advice about policy or advice about management. The issue is that there is doubt. If the Government surrender this line without arguing the case to its conclusion, there is space for doubt about whether these risk registers will remain confidential or whether they will be published. The important principle is certainty.
Mr Dorrell
I will give way to my hon. Friend in a moment.
The important principle—it is always an important principle in the law—is certainty: the certainty that people can be clear whether the advice or the register that is being given to a Minister will remain confidential or whether it will be published. My concern is that this motion is seeking to move that line retrospectively, in a way that two distinguished former heads of the home civil service clearly believe would prejudice the space that the right hon. Member for Wentworth and Dearne said was important.
Mr Dorrell
As I have quoted the right hon. Gentleman, I shall give way to him.
John Healey
The right hon. Gentleman is making an argument for blanket secrecy. However, this is less about his view or even mine; rather, the point is that the Information Commissioner and the judge, along with his two wing members on the tribunal, all of whom have seen and studied the risk register, have determined that, in their legal judgment, the balance of interest lies in publishing and not withholding it. Those are the facts of this case.
Mr Dorrell
The right hon. Gentleman is correct, but he does not go to the end of the process, because the reasons for that decision have not yet been published. The House is therefore being asked to make a decision on the basis of a judgment that has not yet been published, which cannot be right.
Andrew George
My right hon. Friend has argued the case on behalf of retired senior civil servants and Government Front Benchers. However, as the Chair of the Select Committee on Health, and therefore as someone who is deeply interested in effective scrutiny, does he not agree that if the Committee, of which I am a member, wishes properly to understand the potential impact of fragmentation, the conflicted nature of clinical commissioning groups, and so on, we need to find a way of getting behind the declaratory reassurances from the Front Bench?
Mr Dorrell
Of course I agree with the proposition in the way that my hon. Friend puts it. However, the proposition before the House is a rather more precise one: that a register drawn up in the expectation that it would remain private should retrospectively be put into the public space. The proposition that I am advancing to the House is that that is an area where we should proceed with care. We should embrace the principle that when advice is given to Ministers, it should be clear to those giving it whether it is being given confidentially or whether it will later be given over for publication. That is the simple principle that I wanted to set out.
Grahame M. Morris (Easington) (Lab)
I have got out of my sick bed to be here today, because this is a vital debate, and I am grateful for the opportunity to participate in it. I often feel that these debates are a bit like the siege of Stalingrad: we are rolling back the forces of oppression. I content myself, with my cough and sore throat, that at least the red army was victorious on that occasion.
In response to the point that the hon. Member for Banbury (Tony Baldry) and the right hon. Member for Charnwood (Mr Dorrell), who chairs the Health Committee, made about the ruling by the Information Commissioner, I think we should reflect on the fact that it was indeed a ruling. It was not advice that he was giving. Mr Christopher Graham has some expertise in this field, and although the detailed reasons have not been published, the arguments that were made by my right hon. Friend the Member for Wentworth and Dearne (John Healey) and the co-applicants from the Evening Standard—that it was in the public interest to publish the risk register—were obviously accepted.
If I may, I would like to remind the House of what the Information Commissioner said, which was upheld on appeal. Mr Graham said:
“Disclosure would significantly aid public understanding of risks related to the proposed reforms and it would also inform participation in the debate about the reforms”.
Earlier on, Government Members were shouting “Frit!” at Labour Members. I really did not understand what that meant—I am just a simple working-class lad from Easington—but I now understand that it means “You’re afraid”. However, if the Government have complete confidence in the direction of their reforms, surely it is they who are afraid, because they should have the confidence to publish the document.
Jim Dowd (Lewisham West and Penge) (Lab)
It is beyond doubt that the Information Commissioner considered all these matters before reaching his decision. Does my hon. Friend agree that, if the risk assessment had supported the Government’s case, the Government would have got it out like a shot? That they have not done so exposes the fact that they are playing fast and loose with one of the nation’s most treasured institutions, and that they are trying to hide that.
Grahame M. Morris
Absolutely; good point, well made. If the Government had nothing to hide and were not concerned, they would have published the contents of the risk register. We have had a flavour of the contents of the other risk registers that have been compiled at strategic and other levels, and I believe that the Government are concerned about them.
We know that the Bill will increase the risks to the national health service. Indeed, the chief executive of the NHS, Sir David Nicholson, told the Health Select Committee, of which I am a member:
“I’ll not sit here and tell you that the risks have not gone up. They have. The risks of delivering the totality of the productivity savings,”—
that is, the Nicholson challenge; the £20 billion—
“the efficiency savings that we need over the next four years have gone up because of the big changes that are going on in the NHS as whole.”
It is clear that local and national risk registers, as well as the strategic risk registers to which we have had access, have highlighted serious concerns with patient safety, increased costs, the break-up of care pathways—which we have seen on Health Select Committee visits—as well as competition harming integration, about which the Committee was very concerned, and the specific risks during the transition stage.
John Healey
Will my hon. Friend also confirm that, in that session on 23 November 2010, Sir David Nicholson stated that the scale of the proposed change was enormous, and that it was beyond anything that anyone in the public or private sector had witnessed? That is why the risks involved in the reorganisation are so great, as is the imperative for the House and the public to know about them.
Grahame M. Morris
Absolutely; I completely agree with my right hon. Friend. These are huge structural changes to a beloved organisation, and it is in the public interest that we know precisely what is in the transition risk register.
A little while ago, I tabled early-day motion 2659, which called on the Health Secretary
“to respect the ruling by the Information Commissioner and to publish the risk register associated with the Health and Social Care Bill reforms in advance of Report Stage in the House of Lords”,
so that we could have proper scrutiny in the Lords and in the House of Commons. We have not seen what is in the transition risk register, but we are aware of the existence of other risk registers. While the Health Secretary has been fighting tooth and nail to prevent the publication of the transition risk register and, in the process, hiding the risks to the NHS in England, other NHS bodies and clinical groups have been compiling their own risk registers into the impact of the Health and Social Care Bill.
One such body is the Faculty of Public Health, the body for specialists in public health, which is a joint faculty of the three Royal Colleges of Physicians of the United Kingdom. I am grateful to Professor Clare Bambra, from the north-east, and Professor John Ashton, from the north-west, for providing this information. In a letter to The Independent, Professor Lindsey Davies, the president of the Faculty of Public Health, outlined his concerns about the pressure that clinicians were now under from their employers for criticising the Government’s plans to reform the NHS. He wrote:
“Public health professionals have the right and duty to speak out on issues which they perceive as threatening the health of the population they serve”.
The bunker mentality of the Health Secretary, and his determination to silence clinical and public opposition, have astounded the country as a whole.
In response to the Department of Health’s refusal to publish its own strategic risk assessment of the impact of the Bill, the Faculty of Public Health has undertaken its own study, in which it has highlighted a number of significant risks, not least the potential for a postcode lottery. It states:
“Clinical Commissioning Group flexibility to determine services will lead to an increase in geographical variation in service provision.”
It identifies the possibility of costs being pushed up, and states that the
“development of more overt market mechanisms, and the greater role for the independent sector in the provision of healthcare is likely to increase the overall cost of providing healthcare.”
It also raises concerns about issues of quality as a consequence of the reforms. If the transition risk register indicates that, we should know about it.
The delaying tactics employed by the Secretary of State are, to my mind, holding Parliament in contempt. He should publish and employ no further delaying tactics. Reports that Tory-Lib Dem Cabinet members banged their Cabinet table in delight and glee at the prospect of the health Bill finally being rammed through and becoming law at the end of today leave a very sour taste in the mouth. I urge all Members to support this motion and get the risk register published.
Mr Speaker
I inform the House that there is a slight discrepancy between the clock time shown on the annunciator screen and that shown on the digital display panels on either side of the Chamber. For the avoidance of doubt, this debate began at 3.44 pm and has to end at or before 5.14 pm. For the purposes of deciding when we reach the end time, the Chair will use the time on the Chamber digital display panels. I hope that that is helpful. Given the level of interest in the debate, the time limit for Back Benchers will be reduced to three minutes with immediate effect.
Dr Sarah Wollaston (Totnes) (Con)
I have just been reading a kind of risk register—the risk register for Ibuprofen—and I have been reading it in the British National Formulary, which is a kind of recipe book and technical how-to-do manual for doctors and nurses. When I read it, I see that it is scary stuff. If I take this medicine, I might develop a fatal skin reaction, I might bleed to death from a stomach ulcer, I might develop kidney failure, I might collapse with pancreatitis, hepatitis and all sorts of things. Why on earth did I take this medicine—this potentially dangerous Ibuprofen?
Dr Wollaston
Listening to Labour and seeing the extreme shroud waving that has been going on is, frankly, enough to give anyone a headache. I took the Ibuprofen because of what I read in the impact assessment. The impact assessment presents a sensible, balanced portrayal of the realistic risks and benefits, and warns me of many points of which I need to take heed. It is far more likely that I am going to develop indigestion from taking Ibuprofen than that I am going to collapse from a fatal skin reaction.
Dr Wollaston
I am not trying to trivialise the issue; believe me, I understand how vital the NHS is to all our constituents and to patients. My view is that the transition risk register has been elevated to a status far out of proportion to what it merits. I completely understand the points made by Lord Wilson and Lord Armstrong—very experienced civil servants who tell us that they would feel constrained in giving full and frank advice. However, we have seen how any detail can be taken out of all proportion in this House; we are all partly responsible for that. As I said, some of the shroud waving over this Bill has been disgraceful, and I know of patients who have been genuinely frightened by it. I would be prepared to see the risk register published, but I accept the point of my right hon. Friend the Member for Charnwood (Mr Dorrell) that it has to be done on the basis of a clear understanding.
Andy Burnham
I am listening carefully to what the hon. Lady is saying. I remember, however, a comment that she made to The Guardian, I believe, at the start of this process, when she said that this Bill was like throwing a hand grenade into the NHS. What has changed?
Dr Wollaston
There we go—a deliberate misrepresentation. After I made those comments, I wrote to senior colleagues and told them that what I had said was completely different. I was deliberately misquoted on that statement and have been consistently misquoted by Labour Members. They should go back and look at the original.
I feel that it would be reasonable to present all the risks, but it would be crucial for Members of all parties to recognise that we are talking about a lasting change. We would also need to see a change in how risks are extrapolated out of all proportion to what they represent and an end to the deliberate frightening of patients into believing that they will have to pay for health care, which has been a consistent feature of how this Bill has been misrepresented by Labour Members.
Grahame M. Morris
In the context of her medicinal anecdote, does the hon. Lady not accept that members of the public at least have the right to read the little inserts in books of pills before they take them? Should we not have the same right to read the risk register?
Dr Wollaston
The equivalent of that is actually the impact assessment. However, as I have said, I would be prepared to allow the publication of the register, because, in this internet age, the misrepresentation of the Bill, and the extrapolation out of all proportion to the risks, has been a complete disgrace.
Dr Wollaston
I believe that by the time of the next election, our patients will still be going to see GPs. They will still be referred to the hospitals of their choice, that referral will still be free at the point of use, and it will still be based on their needs and not on their ability to pay. The only thing that will be missing will be an apology from the Labour party.
Caroline Lucas (Brighton, Pavilion) (Green)
I am pleased to follow the hon. Member for Totnes (Dr Wollaston), for whom I have great respect. I am glad that she recognises that the risk register should be published, and I greatly regret the fact that her Whips did not allow her on to the Bill Committee, where her views might have had more influence. However, I think that the coalition insults those of us who oppose the Bill by suggesting that we would mistake a worst-case scenario for a prediction. I think that opponents of the Bill know what a risk looks like, and I think that we could be trusted with the risk register. We want to be able to study the Bill with the benefit of that information, and to be able to represent our constituents properly on it.
This is a very sad day for our health service. Although the Bill returns to the Commons today following a tangle of more than 1,000 amendments, the Government have done little to alter its direction, which remains fixed on the ideology of driving commercialisation into almost every corner of the NHS. [Hon. Members: “Have you read it?” ] Yes, I have.
The risks were made plain at the weekend. Dramatic warnings by leading doctors featured in an assessment by the Faculty of Public Health, which was mentioned by the hon. Member for Easington (Grahame M. Morris). It has also read the Bill, and it represents more than 3,000 public health specialists in the NHS as well as local councils and academia. It says that the Bill poses
“significant risks… to patients and the general public”.
It goes on to say that the Bill could well damage people’s health and experience of care—[Interruption.]—and adds:
“It is likely that the most vulnerable who already suffer the worst health outcomes will be disadvantaged as a result of the enactment of the Bill.”
Let me repeat that. Members may not have been able to hear it over all their heckling. The poorest,
“the most vulnerable who already suffer the worst health outcomes will be disadvantaged as a result of the enactment of the Bill.”
That is precisely the point. That is why an extraordinarily wide cross-section of people are deeply concerned about the commercialisation that the Bill brings. Yet despite their concern, and despite two rulings demanding the release of the risk register, the Government maintain their arrogant dismissal and refuse to make the register public. Why? Because they know that were they to make it public, we would know what they already know, which is that it drives a nail into the coffin of the NHS. The Bill is hugely damaging, and that refusal to come clean speaks volumes.
So many parts of the Bill are still hugely flawed. The 49% private income cap and the fact that more and more beds will be used for the private sector will massively undermine our NHS. That is why so many constituents are writing to us: they are deeply concerned. However, this is not the end of the road, because the campaigning will continue throughout the country.
The Secretary of State for Health (Mr Andrew Lansley)
Your generosity of spirit is legendary, Mr Speaker, and you were characteristically generous in accepting the submission of the right hon. Member for Leigh (Andy Burnham) that there was an emergency warranting this debate. I regret that he has let you down. It turns out there was no emergency, there was no argument, and there was no point.
Ostensibly, the debate is to consider the Department of Health’s transition risk register. The House considered that on 22 February, and by a majority of 53 the House decided that it did not support the publication of the risk register. We further considered that matter in the debate on 13 March. I think that the views of this House should be respected.
Yesterday, in another place, Lord Owen proposed an amendment, the purpose of which was to delay consideration of Third Reading in the House of Lords until the publication of “reasons” by the first-tier tribunal and the Government’s response. That amendment was defeated by a majority of 115. I remind the House that the Government do not command a majority in the House of Lords. That proposal was defeated by a substantial majority on the balance of the argument.
I will not repeat what I said in the debate on 22 February, but let me just add three things. First, as my noble Friend Lord Howe told the House of Lords yesterday, the risks and other impacts of the Bill were fully disclosed, not least in the impact assessments—a 200-page document—published alongside the Bill; in the NHS operating frameworks; in transition letters from the NHS chief executive and others; and in the full description of the risk headings that Lord Howe set out to the House of Lords on 28 November. I regret to say that it sounds to me that no Labour Members—with, I suspect, the exception of the right hon. Members for Wentworth and Dearne (John Healey) and for Leigh (Andy Burnham)—have taken the trouble to read the debates in the House of Lords.
Secondly, as my hon. Friend the Member for Banbury (Tony Baldry) made clear, Lord Wilson of Dinton, a former Cabinet Secretary, told the House of Lords yesterday that he has deep concerns about the Information Commissioner’s decision and its negative impact on the safe space within which officials give frank advice and act as a “devil’s advocate” to Ministers.
John Healey
The right hon. Gentleman argues that one of the principal reasons why the Government have not accepted the decision to disclose the risk register is that information about risks has been disclosed to the public already. The Information Commissioner considered that. Will the right hon. Gentleman recognise that, in his legal decision, the Information Commissioner said that he did not accept the argument that the Government advanced, and that he considers that
“disclosure would go somewhat further in helping the public to better understand the risks associated with the modernisation of the NHS than any information that has previously been published”?
Mr Lansley
The right hon. Gentleman knows perfectly well that in the debate on 22 February we made it clear that we felt that our appeal to the tribunal was justified, and indeed it was, because we won at appeal on the question of the publication of the strategic risk register. The Government’s objection and my objection to the publication of the risk register is precisely that risk registers are not written for publication. They are written in that safe space within which officials give advice to Ministers.
Mr Lansley
No.
Risk registers do not represent a balanced view. They are not a prediction of the future. They set out a worst-case scenario to challenge decision making. My hon. Friend the Member for Totnes (Dr Wollaston) captured the understanding of what a risk register is very well. The point is that we have looked precisely at the balanced view in the impact assessment, which captures where the risks and the benefits of the Bill lie. However, publication of the risk register, as my right hon. Friend the Member for Charnwood (Mr Dorrell) made perfectly clear, would prejudice the frankness and integrity of the decision-making processes of government and the Government are opposed to their publication.
As I mentioned, we won on appeal in relation to the strategic risk register, but not on the transition risk register. In the absence of the reasons for those decisions by the tribunal, and given the nature of the overlap between the strategic risk register and the transition risk register, I cannot comment further on that, or indeed on what our response will be to the tribunal’s decisions.
Duncan Hames (Chippenham) (LD)
The Secretary of State consistently makes the distinction between policy development issues and operational matters in respect of risk registers and other plans that have been published. Once this Bill has become law and the NHS becomes engaged in the operational matter of implementing his reforms to the health service, will he then encourage NHS trusts to publish, in due course, the risk mitigation plans that they might have, in order to reassure the communities they serve?
Mr Lansley
As the House has noted, risk registers designed for publication form part of the papers prepared for the boards of trusts. Of course, the legislation further strengthens the openness of foundation trust boards, for example, in respect of meeting in public and publishing their documents. But, as my right hon. Friend the Member for Charnwood rightly pointed out, there is an enormous difference between the frank expression of officials’ worse-case scenarios to Ministers in order to challenge decision making—as I say, it was anticipated that that was not intended for publication—and the preparation of risk registers by NHS bodies and trusts, which are designed for publication. Indeed, the national risk register is also designed for publication on that basis. As I said, those in the House of Lords yesterday agreed, by a substantial majority when voting on an amendment, that not only had the consideration of the Bill received unprecedented scrutiny, but that they also had the information they required.
Thirdly, let me just remind the House that the right hon. Member for Leigh, as a Minister, refused to publish the Department’s risk register. He said:
“Whilst we are conscious that there will be public interest in the contents of the Strategic Risk Register being made freely available, we have also taken into account the public interest in preserving the ability of officials to engage in the discussions of policy options and risks without apprehension that suggested courses of action may be held up to public or media scrutiny before they have been fully developed or evaluated. We also take into account the fact that ministers and their officials need space in which to develop their thinking and explore options, and that this disclosure may deter them from being as candid in the future, which will lead to poorer quality advice and poorer decision-making. Having regard to all these factors, we have determined that the balance of public interest strongly favours withholding the information.”
I could not have put it better myself, because that is precisely the point. He talks about the difference between the strategic risk register and the transition risk register, but the one requested was a risk register at the point at which policy was being formulated, and there is a substantial overlap between the strategic risk register and the transition risk register.
The right hon. Gentleman did one thing when he was a Minister and he argues the opposite now. The same thing seems to be happening in so many other fields. When he was a Minister he said that he was in favour of clinical commissioning, and practice-based commissioning was in the Labour manifesto in 2005. In 2006, he said that his ambition was to introduce
“practice-based commissioning. That change will put power in the hands of local GPs to drive improvements in their area”.—[Official Report, 16 May 2006; Vol. 446, c. 861.]
Now he wants to block a Bill whose purpose is to give clinicians—doctors and nurses across the NHS—the power to commission and design services in their area. We just do not know the position. Once more, we heard nothing positive from him about what Labour would offer the health service; all we heard was a denigration of the performance of the NHS and a determination to block the Bill. We are still hearing from him about what Labour Members are opposed to; we just do not hear about anything he is in favour of.
The curious thing is that last Tuesday, on an Opposition day debate, I said, “We are hearing from Labour Members and Labour activists all over the country about their opposition to £20 billion of cuts.” Hon. Members will remember, because this happened only a week ago, that the right hon. Gentleman was shouting at me from the Labour Front Bench, “No, no, no. We are in favour of that.” I said to him, “Look, it is in the manifesto”, because Labour’s manifesto said that
“we will deliver up to £20 billion of efficiencies in the frontline NHS”.
Yesterday, the right hon. Gentleman turned up with his hon. Friends at the Department of Health to deliver a petition from Wigan and Leigh. It said:
“We the undersigned are opposed to the Government’s Health and Social Care Bill and £20 billion of ‘unmandated’ cuts in NHS funding”.
He sat there last Tuesday saying, “No, we are in favour of £20 billion of efficiencies”, yet he is wandering all around the country with his hon. Friends saying, “No, it is £20 billion of cuts.” Frankly, Mr Speaker, if I recall correctly, that is what you would have me describe as an erroneous view.
The NHS across the country is a service that not only will use reform positively but is using reform positively now. We are seeing the reforms being implemented. On 1 April, clinical commissioning groups will take responsibility for more than £60 billion-worth of delegated responsibility for commissioning. I am tired of hearing the right hon. Gentleman denigrate NHS performance when what we have, since the election, is the lowest ever number of patients being admitted to mixed-sex wards, with numbers down 95%; the lowest ever number of patients waiting more than six months for treatment, with numbers down from 100,000-plus to 70,000; the lowest ever number of patients waiting more than a year for treatment, with numbers down from more than 18,000 to below 6,000; and the lowest ever number of patients waiting more than 18 weeks from referral to treatment. In May 2010, that figure was 209,000 but the latest figure is down to 182,000. Also, fewer people than ever are acquiring infections in hospital, with methicillin-resistant Staphylococcus aureus down 36% and clostridium difficile down 25%.
I have searched in vain for a point to this debate. I think that the only point was so that the right hon. Gentleman and his friends could put out a press release about having 24 hours to save the NHS—I think I have heard that one before. The Labour party is never knowingly over-clichéd. Only the Daily Mirror bothered to notice the press release, putting it on page 6; if it had really thought that this was about saving the NHS, it might at least have put in on page 1. No, the truth is that this is political opportunism dressed up as principle. This is a debate for no purpose and the only effect of this one and a half hour debate is to delay the consideration by this House of the amendments made in another place. Given the full and constructive character of the debate in the Lords over 25 days, I think it is a disservice to the other place that this House’s time has been wasted on having this debate. The Labour party has shown that it is interested not in what is in the Bill, but only in the political opportunity of opposing it. We are interested not only in what is in the Bill but in the opportunity it presents—not for the sake of the Opposition’s politics but for the NHS to improve and strengthen in the future.
Andy Burnham
In the past few minutes, we have seen a perfect demonstration at the Dispatch Box of why the right hon. Gentleman has spent 20 months trying to sell this Bill to the country but has comprehensively failed to do so. He had nothing to say in response to the speeches of Opposition Members and he did not respond with appropriate seriousness to the points that we have put to the House, namely that it should not put through far-reaching changes to this country’s most valued institution without knowing all the facts. Not one Member can go through the Lobby and say that they know all the facts about what this Bill will do. Instead, what we have heard from the Secretary of State, the hon. Member for Banbury (Tony Baldry), the right hon. Member for Charnwood (Mr Dorrell) and the hon. Member for Totnes (Dr Wollaston) is a rerun of the arguments that were heard in detail by the Information Commissioner and the Information Rights Tribunal. I have news for them all—and, indeed, for the hon. Member for Broxtowe (Anna Soubry)—they lost. Those arguments have been heard, a ruling has been made and the Government should surely respect the law, and of all people, the hon. Member for Broxtowe should respect the law.
The Secretary of State said there was a very simple point—that the Government have a responsibility to respect the law. They are the Government who told us they would be the most open and transparent Government in history. What total nonsense. Our point is simple: he is passing a Bill with far-reaching implications for the NHS in England in defiance of a legal ruling that he should publish all the information about his Bill. He made three points that were simply wrong. He said that the transition risk register deals with the worst-case scenario. It does not. It deals with the likelihood of a range of events and the impact of those events, and gives a judgment about whether or not they can be mitigated and the likelihood of mitigation. Has he read his own risk register?
The Secretary of State made a point about the strategic and transition risk registers. Has he read the ruling from the Information Commissioner and has he understood the implications of what the Information Rights Tribunal said? They said that the Government should not publish the strategic risk register because it deals with uncontrollable risks that are outside the control of Ministers, but that the Minister should publish the transition risk register because that is what he is inflicting on the national health service.
Let us not forget that the Secretary of State has chosen to inflict the biggest ever top-down reorganisation on the national health service at this moment of greatest financial challenge. That was his decision. His right hon. Friend the Prime Minister ruled that out. He said that there would be no top-down reorganisation. The coalition agreement ruled it out, but the Secretary of State brought it forward. It was his decision and if he wants this Parliament to endorse his plan, he should have the courtesy of putting before Members all the information that he has seen, but he is not prepared to do that.
Why will the Secretary of State not publish this information? What has he got to hide? Is it the fact that it would prove that all the people who are lined up in opposition to his Bill are right—the doctors, the nurses, the midwives, the physios? Is it possible that they are right in their judgment that the Bill will cause more harm than good? Would not the pitiful levels of support that he still has for the Bill be wiped out by the publication of the risk register?
The Secretary of State made no argument today at the Dispatch Box. The Government are doing what they are doing in total defiance of the law, in the teeth of professional opposition. They do not have the permission of the people of this country to put the NHS through the biggest ever reorganisation in its history. They promised in their manifesto that they would not do it. The Prime Minister promised us that he would protect the NHS and there would be no top-down reorganisation, but the Government have introduced the biggest ever top-down reorganisation. They are making a catastrophic political mistake by doing so. We will remind them every day of the damage they have done to our national health service.
Question put.
Business without Debate
17:28 - The House divided: - Ayes: 316 / Noes: 246 - Question accordingly agreed to.
Lords Amendments | Time for conclusion of proceedings |
|---|---|
Nos. 1 to 10, 13 to 42, 54 to 60, 63 to 167, 242, 246, 248, 252, 287, 292 to 326, 328 to 332 and 335 to 365. | 8.00 pm at today’s sitting. |
Nos. 11, 12, 43 to 53, 61, 62, 168 to 241, 243 to 245, 247, 249 to 251, 253 to 286, 288 to 291, 327, 333, 334 and 366 to 374. | 10.00 pm at today’s sitting. |
Health and Social Care Bill
(12 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
18:39 - The House divided: - Ayes: 233 / Noes: 313 - Question accordingly negatived.
19:56 - The House divided: - Ayes: 235 / Noes: 313 - Question accordingly negatived.
22:00 - The House divided: - Ayes: 324 / Noes: 236 - Question accordingly agreed to.
Mr Speaker
I must draw the House’s attention to the fact that financial privilege is involved in Lords amendments 7, 21, 35, 132 to 141, 181, 189, 192, 198, 243, 244, 253, 265, 288, 290, 291, 319, 320 and 366. If the House agrees to any of these amendments, I shall ensure that the appropriate entry is made in the Journal.
Clause 1
Secretary of State’s duty to promote comprehensive health service
The Minister of State, Department of Health (Mr Simon Burns)
I beg to move, That this House agrees with Lords amendment 1.
Mr Speaker
With this we will consider the following:
Lords amendments 2 to 10 and 13 to 30.
Lords amendment 31, and amendment (a) thereto.
Lords amendments 32 to 42, 54 to 60, 74, 242, 246, 248, 252, 287, 292 to 294, 299 to 326, 328 to 332 and 335 to 342.
Mr Burns
The aim of this Bill is to secure a national health service that achieves results that are among the best in the world. Through it, the Government reaffirm their commitment to the values and principles of the NHS: a comprehensive service, available to all, free at the point of use and based on need, not ability to pay. However, we have always been prepared to listen and make changes to improve the Bill, and we have continued to do so in another place. The Lords amendments in this group fall within five main areas.
First, we recognised that concerns had been expressed about the Secretary of State’s accountability for the health service. Although it was never our intention in any way to undermine that responsibility, we have worked with Members of another place and the House of Lords Constitution Committee to agree Lords amendments 2 to 5, 17, 18, 24, 39, 40, 74, 246, 287 and 292. Those amendments put beyond doubt ministerial accountability to Parliament for the health service. In addition, they amend the autonomy duties on the Secretary of State and the NHS Commissioning Board, to make it explicit that the interests of the health service must always take priority. They also amend the intervention powers of the Secretary of State and the board, to clarify that they can intervene if they think a body is significantly failing to exercise its functions consistently with the interests of the health service. Finally, a new provision will make it explicit that the Secretary of State must have regard to the NHS constitution in exercising his functions in relation to the health service.
Although clinical commissioning groups will have autonomy in their individual decisions, Lords amendment 9 clarifies that CCGs must commission services consistently with the discharge by the Secretary of State and the board of their duty to promote a comprehensive health service, and with the objectives and requirements in the board’s mandate.
The Government also tabled amendments in response to the recommendations of the House of Lords Select Committee on Delegated Powers and Regulatory Reform, all of which we have accepted. Amendments 15 and 16 ensure that the requirements set out in the mandate, and any revisions to those requirements, must now be given effect by regulations.
Commissioning will be led by GPs, who know patients best. However, with that responsibility must come accountability. Therefore, further to the amendments made in the House requiring CCGs to have governing bodies, the other place has strengthened requirements in relation to CCGs’ management of conflicts of interest. We recognised how important it is to ensure the highest standards of probity in CCGs and accepted amendments 31, 300, 301 and 302, which were tabled by the noble Baroness Barker, and which require CCGs to make arrangements to ensure that members and employees of CCGs, members of the governing body, and members of their committees and sub-committees, declare their interests in publicly accessible registers.
The amendments also require CCGs to make arrangements for managing conflicts of interest and potential conflicts of interest in such a way as to ensure that they do not, and do not appear to, affect the integrity of the board’s decision-making processes. The board must issue statutory guidance on conflicts of interest, to which CCGs must have regard.
Taken together, those amendments provide certainty that there will be clear and transparent lines of accountability in the reformed NHS. However, I cannot support Opposition amendment (a) to Lords amendment 31. The Bill is clear that CCGs must manage conflicts of interest in a way that secures maximum transparency and probity. In most cases, that would mean that a conflicted individual withdraws from the decision-making process, but that might not always be possible, for instance when a CCG is commissioning for local community-based alternatives to hospital services, and determines that the most effective and appropriate way to secure them is to get them from all local GP providers within its geographic area. In that event, it would not be possible for every GP to withdraw from the decision-making process. We cannot, therefore, agree to a blanket ban.
Andrew George (St Ives) (LD)
Will the Minister clarify something in view of what he has just said about the conflict that all members of the board and the CCG will have with regard to decisions on the provision of new services? Does he share my fear that the structure of CCGs results in bodies that will continue to be conflicted? Does that continuing conflict not undermine that important structure within the health service?
Mr Burns
I appreciate the hon. Gentleman’s intervention, but I am afraid I do not share that view. I hope that what I shall go on to say will help to give him additional reassurance on that.
There will be additional safeguards in the Bill to ensure that those processes are transparent, including the regulations that Monitor will enforce on procurement practices and its accompanying guidance. In addition, the board must publish guidance for CCGs on their duties in relation to the management of conflicts of interest. Of course, the CCGs' commissioning intentions will have been set out in its commissioning plan, which is subject to consultation with both the public and the health and wellbeing boards.
The second area in which the other place has strengthened the Bill relates to the duties placed on commissioners to ensure a patient-focused NHS. It has always been the Government’s intention to put in place reforms that support the simple principle, “No decision about me without me.” To achieve that, commissioners will for the first time have a duty in relation to patient involvement in decisions. The House strengthened those duties following the listening exercise, and they were further improved by amendments 19, 32 and 33 in the other place, to make it explicit that the duty means promoting the involvement of patients in decisions relating to their own care or treatment.
Another core principle of the White Paper was the need to eliminate discrimination and reduce inequalities in care. The Bill will for the first time in the history of the NHS place specific duties on the Secretary of State and commissioners to have regard to the need to reduce health inequalities.
To reinforce that further, the other place agreed amendments 22, 23, 36, 37, 38 and 60. These ensure that the Secretary of State, the board and CCGs will be better held to account for the exercise of these duties through their annual reports, the board’s business plan and, in the case of CCGs, their commissioning plans and annual performance assessment by the board. However, improvements in quality, outcomes, and reduced inequalities will not happen unless we better integrate services for patients. That is why we placed duties on commissioners, again for the first time, to promote integration in new sections 13M and 14Y, and made clear, following the listening exercise, that competition will not take priority over integration.
Mr Robert Walter (North Dorset) (Con)
I met GPs and consultants in Tavistock in west Devon the other day. One of the great concerns that consultants have, particularly in the field of paediatrics, is the integration of children’s services. A great deal of work has gone into that. In dealing with these amendments, what assurance can my right hon. Friend give that the integration of children’s services will be particularly emphasised in these changes?
Mr Burns
I hope that my hon. Friend will be reassured by two points. First, the Bill contains far greater duties and responsibilities for integration over the whole provision of care within the NHS, and that will obviously include children’s services. Secondly and more precisely on the narrow issue that he raised, the children’s health outcomes strategy, published some time ago, will ensure that commissioners provide services to improve integration and that there is greater working together between the NHS, public health bodies and commissioners in securing an improved pathway of care and greater integration.
Lords amendment 320 ensures that the NHS continues to provide funds to local government for investment in community services at the interface between health and social care.
Thirdly, amendments in the other place have placed a greater emphasis on the duties of the Secretary of State and commissioners with regard to system-wide issues, such as education, training and research. Amendment 7 ensures that the Secretary of State will remain responsible for securing an effective system of education and training. Amendments 21, 26, 35 and 42 will place duties on the board and CCGs to have regard to the need to promote education and training, and the Government supported the noble Lord Patel’s amendment to ensure that providers of health services were required to participate in the planning, commissioning and delivery of education and training.
The Government have also listened further to concerns that the strength of the research duties on the Secretary of State, the board and CCGs did not properly reflect the importance of the NHS as a world leader in supporting research. Amendments 6, 20 and 34 have strengthened these to a more direct duty to promote research.
Fourthly, concerns were expressed in the other place about the treatment of charities, other voluntary sector organisations and social enterprises that provide or want to provide NHS services. We are committed to a fair playing field for all providers of NHS services, regardless of their size or organisational form. We see voluntary organisations and social enterprises as key to this vision. For example, they can play a key role in understanding the needs of local communities and delivering tailored services.
Amendment 8 commits the Secretary of State to undertake a thorough and impartial statutory review of the whole of the fair playing field for NHS-funded services. I can confirm that it will cover all types and sizes of provider, including charities, social enterprises, mutuals and smaller providers. It will consider the full range of issues that can act as barriers for providers, including access to and cost of capital, access to appropriate insurance and indemnity cover, taxation and access to the NHS pension fund. The Secretary of State will be required to keep consideration of these issues under review. As my noble Friend Earl Howe set out in another place, during preparation of the report there will be full engagement with all provider types, commissioners and other interested stakeholders to ensure their concerns are looked at.
Finally, I turn to the amendments relating to mental health services. I would like to thank my noble Friend Lord Mackay for his work in developing amendment 1, which inserts the words “physical and mental” into clause 1 in order to promote “parity of esteem” between physical and mental health services. In response to the Royal College of Psychiatrists’ concerns, I would like to offer the reassurance that the definition of “illness” in section 275 of the National Health Service Act 2006 would continue to apply to section 1, meaning, for example, that learning disabilities, mental disorders and physical disabilities would continue to be covered by the comprehensive health service.
Although our view is that the most important work in achieving genuine parity of esteem will be non-legislative—for example, through our recent mental health strategy, “No Health without Mental Health”—we recognise the symbolic significance of including these words in clause 1. Mental health is a priority for this Government, so I commit to considering further the role that the mandate, the NHS and public health outcomes frameworks can play in driving improvements in mental health services. Similarly, we decided not to oppose amendment 54 by the noble Lord Patel of Bradford relating to mental health aftercare services provided under section 117 of the Mental Health Act 1983, and tabled a number of consequential technical amendments.
I am grateful for the scrutiny that the Bill has received in another place. There is no doubt that it has been strengthened and improved as a result. It will help to ensure that the Secretary of State will remain accountable overall for the health service and provide a robust framework for holding commissioners to account. I urge hon. Friends and hon. Members to agree to the Lords amendments in this group, but to reject Opposition amendment (a) to Lords amendment 31.
Liz Kendall (Leicester West) (Lab)
There have been 1,000 Government amendments to this disastrous Health and Social Care Bill—374 in the other place alone—and it is unacceptable that elected Members in this House have been given so little time to debate amendments that will affect patients and the public in every constituency in England.
It is essential that we reach the second group of amendments, on parts 3 and 4 of the Bill, which deal with Monitor, foundation trusts and the Government’s plans to raise to 49% the private patient cap in foundation trusts, but I want to start with the Lords amendments to the Secretary of State’s duty to ensure a comprehensive service in the NHS. I will remind hon. Members where this all began.
On 10 February last year, my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) challenged the Secretary of State, in his evidence to the Commons Bill Committee, over why he was removing the Secretary of State’s responsibility to provide a comprehensive service in the NHS. He said:
“I have not... It is in the original language. It is reproduced the same way.”––[Official Report, Health and Social Care Public Bill Committee, 10 February 2011; c. 166, Q402 and 404.]
On 15 February, my hon. Friend the Member for Halton (Derek Twigg) challenged the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) about the removal of the Secretary of State’s duty to provide comprehensive NHS services. Again, this was categorically denied. The Minister said:
“Clause 1 retains the overarching…duty which dates from the original 1946 Act”.––[Official Report, Health and Social Care Public Bill Committee, 15 February 2011; c. 178.]
He also said that any amendments to the clause were “unnecessary”. Today the Government are being forced to eat their words.
For the record, it was the determination of Labour Members in the other place, not Liberal Democrat Members, that forced the Government to place the clauses relating to the Secretary of State’ duties on promoting a comprehensive service and on autonomy within the remit of the Lords Constitution Committee, chaired by the noble Baroness Jay of Paddington. The result of the Committee’s deliberations are the amendments before us today. The amendments do not deliver exactly the same duty as the National Health Service Act 2006, but they are a significant improvement. Pressed on this issue by Labour Members in both Houses and at every stage of the Bill, the Government have been forced to concede.
A similar thing has happened on education and training, which is the subject of Lords amendments 7, 21, 26, 35 and 42.
John Healey (Wentworth and Dearne) (Lab)
Before my hon. Friend moves on, will she pay tribute to our Labour colleagues in the Lords, who have worked across the House, but who, by dint of the way the House of Lords works, cannot always claim credit for the results they have achieved by working in that way?
Liz Kendall
I absolutely concur with my right hon. Friend. For the record in this House, I pay tribute to our colleagues in the Lords for their achievements and their efforts in securing some of the protections for the NHS that we are debating today.
There was absolutely no mention of education and training in the original Bill, despite the fact that the Bill abolishes strategic health authorities, which play a vital role in education and training—for example, by hosting deaneries. Labour Members raised this issue in the first Commons Committee stage. We also tabled an amendment on Report to place a duty on the Secretary of State to ensure a comprehensive education and training system for all professions in the NHS, which would have included continuing professional development. Labour Members in the other place then tabled amendments to address the issue. I should note, again for the record, that it was Labour and Cross-Bench Lords, not Liberal Democrat Lords, who argued for those important amendments and who forced the Government to introduce substantive new clauses placing duties in respect of education and training on the Secretary of State, the NHS Commissioning Board and clinical commissioning groups.
However, the critical issue that I want to focus on is how to deal with conflicts of interest in clinical commissioning groups. Clinical commissioning groups will be responsible for spending around £65 billion of taxpayers’ money. They will be made up of a majority of GPs—professionals who run businesses that are largely, and in many cases wholly, dependent on the NHS for their income. Clinical commissioning groups will commission NHS services, some of which will be provided by GPs who are members of the group, or—as is increasingly envisaged by the Government—by companies in which GP members may have a financial interest. The public must have confidence that clinical commissioning groups are making decisions based on patients’ and taxpayers’ best interests, not the financial interests of GPs.
Liz Kendall
I will finish this point.
However, under the Bill, clinical commissioning groups—the newest bodies in the NHS, and with the least experience—will have the weakest corporate governance of any public body in the country. They are required to have only two lay members. However, there has been no reassurance in this House or another place that those members will be independently appointed. The Government have not even given a reassurance that the chairs of clinical commissioning groups will be lay members. The Government have also failed, at every faltering stage of this Bill, to ensure robust protections against actual or perceived conflicts of interest in clinical commissioning groups.
Liz Kendall
No, I am going to proceed.
Let me remind hon. Members that the Bill started out without any requirement for GP consortia—as they were then called—even to have a board to govern their work, let alone any measures to deal with potential conflicts of interest. On 3 March last year, in the first Commons Committee stage, Labour Members called for effective corporate governance and robust measures to deal with conflicts of interests in clinical commissioning groups.
Liz Kendall
I am going to finish this point.
The Minister of State, the hon. Member for Sutton and Cheam (Paul Burstow), said that all and any changes to those provisions were “unnecessary”, and denied that there was any lack of effective governance. I would remind Liberal Democrat Members that the Minister argued that putting a board in place or dealing with conflicts of interest would mean that clinical commissioning groups would fail to be “liberated”. Those criticisms were among the many issues that were supposed to be dealt with when the Government embarked on their now infamous “pause” in the Bill’s progress last spring, but they were not. The Government were therefore forced to return to the issue in the other place. However, the amendments before us are still weak, incomplete and ineffective.
The Government say that clinical commissioning groups will have to include in their constitutions how they intend to manage conflicts of interest. However, I am afraid the Government are deluded if they think that the national NHS Commissioning Board will be able adequately to scrutinise whether hundreds of clinical commissioning groups are properly implementing the measures in thousands of contracts, particularly when the board has already taken on so many other huge responsibilities for managing the Government’s new system. Giving Monitor powers to scrutinise clinical commissioning groups is inadequate for the same reason. Saying that Monitor can deem a clinical commissioning group’s contract to be ineffective, if it thinks that conflicts of interest have not been dealt with, will in effect mean closing the stable door once the horse has bolted. Indeed, there could be huge problems on the ground, as a provider may have already started delivering services to NHS patients by the time Monitor takes its decision.
Labour’s Front-Bench team in the other place tabled a comprehensive amendment to deal with conflicts of interest in clinical commissioning groups. It would have ensured a code of conduct for how clinical commissioning groups register, manage and report on conflicts of interests among its members and employees, and imposed a duty on CCG members to abide by the code. The amendment would have ensured that no member of a clinical commissioning group could take part in discussion or decisions concerning any provider of services with which that person had a registrable interest, and allowed the Secretary of State to appoint an adjudicator to investigate complaints about any breaches of the code, with a range of financial and other sanctions available, including the ability to suspend or remove a person from the clinical commissioning group. However, the Government rejected that comprehensive amendment, saying that such sanctions were unnecessary.
The Government have agreed to Lords amendment 31, which at least says that there must be a register of interests for a group, along with its governing body, sub-committee and employees, and that the register must be kept up to date, with information updated within 28 days. That change is welcome, but it does not go anywhere near far enough in ensuring that conflicts of interest are robustly dealt with. That is why our amendment (a) to Lords amendment 31 would ensure that members of a clinical commissioning group would not be able to take part in discussions or decisions about services in which they had declared a registered interest, which is the same format as in local government.
Andrew George
Although we welcome Lords amendment 31, which was tabled by my noble Friend Baroness Barker in another place, the hon. Lady’s amendment (a) proposes to go a stage further. I personally welcome that, but did she notice that the Minister, in justifying the Government’s position that it would not practically be applicable, gave the example of a CCG commissioning from all its membership? Does that not fundamentally undermine the argument that clinical commissioning groups cannot be conflicted per se?
Liz Kendall
I am simply arguing in amendment (a) that the same robust mechanisms that exist in local government should apply in this case. The hon. Gentleman will have to have a conversation with his own Ministers about what they have said in response.
The potential for conflicts of interest under the Bill is so great, and the amount of public money being spent by clinical commissioning groups so substantial, that the Government should have put in place far tougher provisions to deal with conflicts of interest. The Deputy Prime Minister has failed to guarantee the integrity of clinical commissioning groups, as he claimed in his joint letter with the noble Baroness Williams to Liberal Democrat Members. The integrity of clinical commissioning groups cannot be guaranteed by having only two lay members who will not even be independently appointed, nor can it be guaranteed through guidance for GPs, which the General Medical Council is currently developing. Indeed, I would argue that the GMC’s role should be to ensure professional integrity in the treatment of individual patients, not with regard to organisational misconduct, which would be a complete change in its current role. Nor can the integrity of clinical commissioning groups be guaranteed by national bodies such as the NHS Commissioning Board and Monitor, which will be too distant, too remote and too busy dealing with the fallout from other aspects of the Government’s Bill to be able effectively to address the potential conflicts of interest that clinical commissioning groups will face every day.
This issue might not have received as much public or media attention as other aspects of the Bill, but it will become significant in future, as patients and taxpayers struggle to determine whether their best interests—not the financial interests of GPs—are at the heart of the NHS. Examples of that have already come to light. In October last year, the Haxby practice in York wrote to its patients to say that a range of minor treatments would no longer be available on the NHS, but that they could be carried out privately at a number of clinics, including one owned by the practice itself. Those treatments included the removal of skin tags, at a cost of £56.30, and the treatment of benign tumours at a charge of £243.20.
Dr Richard Vautrey, of the British Medical Association’s GP committee, has rightly said that
“the direction of travel in NHS policy, particularly combined with the financial situation, does increase the risk of conflicts of interest for GPs which is one of the reasons the BMA is so concerned about the Health and Social Care Bill.”
Similarly, the NHS Confederation and the Royal College of General Practitioners have felt forced to issue guidance to GPs on how they should manage conflicts of interest, because they believe that the arrangements will become more complex under the Government’s plans. The Lords amendments before us are not robust enough to deal with this. It is a real concern for GPs that they will be unable to deal with conflicts of interest. That is what they are saying, and they need to be protected. The Government should support our amendment, because that would enable that to happen.
Andrew George
I congratulate my noble Friends Baroness Jolly, Baroness Barker, Lord Marks, Baroness Williams, Baroness Tyler and Baroness Northover on putting in a tremendous amount of work during the Bill’s various stages to negotiate and table amendments to advance the arguments that my Liberal Democrat Friends and I have expressed concern about. I have already put on record the fact that, although some of those amendments represent important strides towards making the Bill less bad, the changes still do not satisfy me to the extent that I feel that the Bill should be entitled to go forward from this, the elected House, as a piece of legislation. Unfortunately, that is not an argument that I am going to win, but I wanted to put the point on record.
Lords amendment 31 represents an important step forward, but it will merely provide a sticking plaster in what will be a fundamentally challenging scenario. The clinical commissioning groups represent a crumbling pillar in the edifice of the legislation. The big weakness at the centre of the CCGs is the fact that their members will, collectively and individually, be conflicted in almost all circumstances, and they will be unable to escape from that.
The Minister emphasised that point further when he told the House why he could not accept the amendment tabled by those on the Labour Front Bench. He told us that members of a CCG should not take part in certain discussions and decisions, even though they had declared an interest, because the groups would, on occasion, be commissioning for all their members. In those circumstances, a CCG would be incapable of making a decision because none of its board members or general members could be brought in to help because they would all be conflicted. That demonstrates a fundamental weakness in the legislation. My noble Friend Baroness Barker tabled an excellently drafted amendment to deal with that problem, but she was working within very limited parameters. The amendment would simply provide a sticking plaster for a crumbling edifice that will be unable to hold up this policy. I have a fundamental concern about the way in which the legislation will work in this regard.
Grahame M. Morris (Easington) (Lab)
I want to make a few points on Lords amendment 2, which deals with the Secretary of State’s duties. This has been the subject of one of the most fundamental debates during the course of the Bill. The Lords still have grave concerns about whether the Secretary of State does indeed have a duty to
“provide or secure the effective provision”
of health services in England. In addition, concern remains over exactly what the Secretary of State will remain accountable to the House for.
In Committee, the Lords agreed not to amend clause 1, or clause 4, in regard to the duty to promote a comprehensive health service and the Health Secretary's accountability to Parliament. Instead, they preferred to engage in negotiations with the Minister with a view to bringing back proposals before the Report stage. The Lords Constitution Committee also proposed amendments on ministerial accountability for the NHS. The Committee’s concern was that, even after the months of debate here and in the other place and the amendments that had already been tabled, the Bill still posed an undue risk to maintaining adequate ministerial and legal accountability for the NHS. Given the number of amendments that had been tabled, it was a remarkable achievement still to have such uncertainty.
The wording of amendments remained an issue, and on 2 February 2012, the Government tabled 137 amendments to the Bill covering a range of areas, including changes to clarify the responsibility of the Secretary of State for the health service. There were two key amendments: one sought to ensure that the Secretary of State
“retains ministerial responsibility to Parliament for the provision of the health service in England”.
The other sought to place the duty to promote a comprehensive health service and to exercise functions to secure the provision of services above that of promoting autonomy.
Jim Shannon (Strangford) (DUP)
The hon. Member used the term “comprehensive health service”. Does he feel that the changes to the NHS will deliver a comprehensive health service, or does he feel that what we will see is some people being able to access services while others are not? Is that not the sort of health care service that he would be against and to which the people of this country would object?
Grahame M. Morris
I am grateful for that intervention and I share the hon. Gentleman’s concern that this amendment, which deals with the Secretary of State’s powers, and, indeed, the whole thrust of the Bill, are likely to lead to a fragmented service, when what we all want to see is co-operation and integration. I am concerned about the direction of travel in that respect.
The point about autonomy is relevant, because Lords amendment 2 reiterates that
“The Secretary of State retains ministerial responsibility to Parliament for the provision of”
health services. Lords amendments 4 and 17 would further amend clauses 4 and 20 in order to downgrade the duty to promote autonomy even more, through the idea that the Secretary of State must only
“have regard to the desirability of securing”
autonomy instead. When it comes to ministerial accountability for the Secretary of State, we have a yearly mandate to the NHS Commissioning Board, which will remove the Secretary of State—and therefore Parliament—from being involved in or interfering in the running of the NHS. In that case, I ask the Minister: what would be the point of Health questions? As private health care interests take over the provision of health services, they will not be subjected to freedom of information requests or other forms of accountability to which NHS providers are subjected.
Grahame M. Morris
I will in a moment, but I want to pose a few questions first. The Secretary of State clearly cannot answer for private companies that are exempt from FOI requests. He cannot answer for GP commissioning groups, which are essentially independent contractors and private bodies. Surely, it is clear that the Secretary of State is handing over a big chunk of the NHS budget to private GP commissioning groups, cutting himself and Parliament out of the loop. I therefore believe that it is a fantasy to say that the Secretary of State will remain accountable.
Mr Burns
There is almost—no, there is—an air of déjà vu to this part of the hon. Gentleman’s speech, as there always is. We discussed this in Committee, and I am a bit frustrated that he cannot quite get it. The fact is that at the moment there is virtually no transparency and no real accountability as to what a Secretary of State does with regard to the provision of health services. The fact is that the mandate will be published; it can be debated in this House either on a motion from the Government or from the Opposition; there will still be Question Time at which hon. Members will be able to ask questions; there will still be an opportunity for Adjournment debates, urgent questions and statements. There will be accountability.
Grahame M. Morris
Well, as Aneurin Bevan said, “You give your version of the truth, and I will give mine.” In my assessment, yes, there will certainly be a mandate, but this House’s power to scrutinise and hold Ministers to account will be severely diminished under the new arrangements. Writing down that the Secretary of State has the duty
“to exercise functions to secure the provision of services”
is thus rather perverse—one might even say ridiculous—when the rest of the Bill hands over those duties to other bodies, often private bodies outside the NHS such as the clinical commissioning groups. Indeed, the National Commissioning Board—the world’s biggest quango—will also secure provision through clinical commissioning groups, which will not be done through the Secretary of State. [Interruption.] I think the Minister is being extremely disrespectful, Madam Deputy Speaker, in the way he is gesticulating when I am trying to make my points.
In effect, the Secretary of State’s only duty seems to be to pass over the money or the resource and write one letter a year—this mandate—to the National Commissioning Board.
On the issue of the duty to promote a comprehensive health service and secure the provision of services as opposed to any duty to promote autonomy, this surely remains a conundrum, as they are virtually mutually exclusive. How the Secretary of State thought that those two competing principles could sit side by side or that he could balance the two is beyond me. This is the problem with the Bill as a whole. No matter how much tweaking is done to clauses 2, 4 or 20 by these amendments, we cannot escape this dilemma. That brings me back to my key point that this Bill’s driving ideological purpose remains to commercialise and privatise each and every service in the NHS.
Finally, let me return to the definition of autonomy—[Interruption.]—for the information of Conservative Members, who are shouting across the Chamber. According to the dictionary, autonomy means
“the condition of being autonomous; self-government or the right of self-government; independence”.
What we are talking about here is being autonomous or independent of the Secretary of State. My contention is that only central planning can deliver a comprehensive service. Otherwise, we will have postcode lotteries—identified in the risk registers we have discussed, such as the one from the Faculty of Public Health—and unprofitable services being cut back. Once the private sector is too big to control, what then?
Grahame M. Morris
I have concluded my remarks, so perhaps the Minister can address those points in his summing up.
Dr Poulter
I shall make some brief remarks, but I first want to welcome the renewed focus on integrated care, as outlined by the Minister this afternoon. He clearly outlined the importance of mental health services and clarified that the primary duty in commissioning will be to ensure that there is integrated care.
We all know the importance of dealing with the biggest challenge facing the NHS, which is how we are going to look after our ageing population. How are we going to improve the care for the increasing numbers of people living longer, which is a good thing but poses a big financial challenge for the NHS as well as a big human challenge in how to look after them? How are we going to address the challenge of looking after people living at home with diabetes, heart disease and dementia?
This Bill goes a long way towards meeting those challenges, and I believe that the renewed focus on integration is key and vital. It is only by different services and different parts of the NHS working together effectively—with primary care working effectively with hospitals, as well as with social services—that we are going to meet the big financial and human challenge of improving the care of older people. That is why I am reassured—I hope that my Liberal Democrat colleagues will also be reassured—by this renewed focus on integration, which is at the heart of the debate and at the heart of the way in which we will make our NHS meet future challenges.
Let me deal briefly with the Opposition amendment 31, which deals with what they believe is an inherent conflict between people involved in delivering care—health care providers or GPs—and others when it comes to involvement in the clinical commissioning groups. The amendment ignores the fact that, at present, good commissioning involves a partnership with primary care trusts that were set up by Labour when they were in government. GPs who are engaged in the provision of health care in local communities are involved in PCTs and involved in the Government arrangements for PCTs, working in partnership with local managers. So, if it was good enough to have that inherent partnership in the current structures set up by the previous Government, I do not see why, when we all believe that clinical leadership is a good thing in the NHS, a conflict of interest should suddenly be created under the Bill. That does not make sense; it is not intellectually coherent. For that reason, we must oppose the amendment.
We have before us more reassuring amendments to promote integrated care, to focus it on more joined-up thinking between the primary and secondary care sector, and to ensure that we do not have to deal with patients with mental health problems only when they get to the point of crisis. The focus on integrated care will mean that they are better supported in their communities. Opposition amendment 13 is, as I have explained, inconsistent with how they managed the NHS when they were in government.
Liz Kendall
The fundamental difference is that under the Bill only two lay people will be appointed as members of clinical commissioning groups, and no independence will be involved. Under the old system, lay members of primary care trusts were independently appointed. The degree of independence that provided checks and balances has gone.
Dr Poulter
I thank the hon. Lady for her intervention, but I will give way to my right hon. Friend the Minister before I respond to it.
Dr Poulter
I thank my right hon. Friend for that clarification. The Government are clearly committed to the value that lay members bring to commissioning groups, and, as my right hon. Friend has said, two is the minimum. I hope the hon. Lady will accept that it is very disingenuous to suggest that lay members who are appointed to boards of hospitals or primary care trusts, or indeed to commissioning boards, show a lack of genuine care for patients in the way in which they commission services.
Given that the Opposition have tabled a bad amendment, and given the renewed focus on a commitment to integrated care for the benefit of older patients and people with mental health problems, I believe that we should support the Government this evening.
Alex Cunningham (Stockton North) (Lab)
I support the amendment relating to Monitor and NHS foundation trusts. The Government seek to amend the Bill to allow—[Interruption.]
Madam Deputy Speaker (Dawn Primarolo)
Order. I think the hon. Gentleman will find that he is referring to the wrong group of amendments. The group that we are discussing is headed “Secretary of State, NHS Commissioning Board and CCGs”. We will be discussing the amendment to which he referred later, and I presume that for that reason he will now resume his seat.
Nicky Morgan (Loughborough) (Con)
I will speak very briefly. Let me begin by pointing out to the hon. Member for Leicester West (Liz Kendall), who said that we did not have enough time to consider all the amendments, that if we had not spent an hour and a half discussing the risk register yet again, we would have had more time to discuss the amendments.
I congratulate the Government on accepting Lords amendment 1, which relates to parity of esteem between physical and mental health. As the Minister said, genuine parity cannot be laid down in legislation, and the mental health framework will be very important to the achievement of it. However, research findings published by the Centre for Mental Health, which I mentioned to the Minister during health questions recently, show the link between physical and mental health conditions. As I am sure we all know from our constituency casework, when someone presents with a physical health condition, it may be clear that there is an underlying mental health condition which has been either undiagnosed or untreated, and which is therefore hampering the person’s physical health recovery.
The Minister spoke of the “symbolic significance” of including a reference to mental health. He is right, but I think that on a day when we have seen Her Majesty the Queen address Parliament, we should recognise that there is sometimes a place for symbolism, particularly when it comes to something that is as cherished on the Government Benches as the NHS. I know that the Opposition claim ownership of the NHS, but in fact it is cherished by all of us, and by our constituents.
I also thank the Government for accepting Lords amendments 19, 32 and 33, which concern the duty of commissioners and commissioning groups to provide patient-focused care—the “No decision about me without me” duty. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) rightly spoke of the importance of mental health care in that regard. I have certainly found, when listening to patients in the mental health system, that they want their doctors, consultants and everyone else in the system to ensure that they are involved in their own care. I am glad that the clinical commissioning groups will be given guidance on that, but I do not expect the very best CCGs and GPs to need to follow it. They are likely to know that treatment is more likely to succeed if patients are involved in it.
Having spent 10 weeks on the Public Bill Committee, and having been present during all the debates on the Floor of the House, I am especially pleased to be able to welcome the amendments.
John Pugh (Southport) (LD)
Let me begin by paying tribute to my colleagues in the House of Lords, who have improved the Bill significantly.
I want to raise two issues relating to conflicts of interest. Subsection (1) of the new section proposed in the amendment tabled by Baroness Barker states:
“Each clinical commissioning group must maintain one or more registers of the interests of—
(a) the members of the group,
(b) the members of its governing body,
(c) the members of its committees or sub-committees or of committees or sub-committees of its governing body, and
(d) its employees.”
I looked in vain for a paragraph (e) specifying “parties with which it is contracted for commissioning support”. I think that that is a live issue. There will be commissioning support organisations—some of which will be private institutions, and some of which will be allied with organisations that provide the clinical services that are commissioned—and there may be occasions when those advising the commissioners make recommendations that benefit some parties with which they are contracted. That model, involving the influence of the executive, will be fairly familiar to those who have been members of local authorities. Councillors, like doctors, are often very busy. They rely heavily on expert advice provided by officers, and they generally follow it.
The issue was raised in the House of Lords—I believe that it was raised by Lady Barker—but, when I read the report of that debate, I could not help feeling that it had been glossed over. I should welcome any enlightenment from the Minister on how such a quandary can be dealt with. Clearly it must be dealt with, because otherwise it will create general anxiety about how commissioning will proceed.
The second issue is a bigger one. I think that it is of particular interest to us all, because it affects the general position of the commissioning consortia themselves. There is a view that PCTs are more or less in the same legal boat as GP or clinical commissioning consortia would be. I disagree with what the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) said about that. The PCT, as a unit, is not built around general practices, which, as we have said several times in this place, are small businesses. It is possible to view a clinical commissioning consortium as an association of undertakings, which creates serious issues as to how it is able to use public money. If it used public money to benefit itself, that would obviously become a big issue immediately.
Madam Deputy Speaker (Dawn Primarolo)
Order. This is not just a conversation between the Government Front Bench and its supporters and the hon. Gentleman. If Members want to intervene to disagree with the hon. Gentleman, they should do so, rather than shouting at him while he is speaking.
John Pugh
The Minister could undoubtedly answer my query and deal with my anxiety. A significant regulatory issue is involved in the provision of regulations that will work for commissioners in the Department of Health, and he knows that that is the case. It is not a question of what we intend to do; it is a question of what those in the European legal system will make of the function and the nature of what we have set up. If they interpret it as an association of undertakings, that is exactly how they will treat it, regardless of what the Bill says or of what the Minister says at the Dispatch Box. This is a matter of concern that has been raised by people who are more knowledgeable about such matters than I am, and it genuinely needs to be addressed.
Lords amendment agreed to.
Lords amendments 2 to 10 and 13 to 30 agreed to, with Commons financial privileges waived in respect of Lords amendments 7 and 21.
Amendment (a) proposed to Lords amendment 3(1)—(Andy Burnham).
Question put, That the amendment be made.
The Minister of State, Department of Health (Paul Burstow)
I beg to move, That this House agrees with Lords amendment 63.
Madam Deputy Speaker (Dawn Primarolo)
With this it will be convenient to discuss the following:
Lords amendments 64 to 73 and 75 to 147.
Lords amendment 148, and amendments (a) and (b) thereto.
Lords amendments 149 to 167, 295 to 298 and 343 to 365.
Paul Burstow
The amendments cover Monitor, the regulation of NHS services and the governance of foundation trusts. Before I deal with them, I would like briefly to address some of the myths that have grown up around part 3 of the Bill. [Interruption.]
Madam Deputy Speaker
Order. I am sorry to interrupt the Minister, but I am having some difficulty hearing his response to these amendments. May I ask Members to leave the Chamber quietly, so that we can continue with this debate and hear his comments?
Paul Burstow
Thank you, Madam Deputy Speaker.
Part 3 is a key element of the Bill. As the Government have made clear, commissioners will decide whether, when and how to use competition to deliver services for patients. Where they decide to do so, part 3 will ensure that competition is regulated effectively and in the patient’s best interests. Under the Bill, Monitor will, in future, regulate all providers of NHS services, so that all patients are protected, irrespective of who supplies their treatment and care.
In the earlier debate, my hon. Friend the Member for Southport (John Pugh) asked about the applicability of competition law to the function of commissioning. I draw his attention to European case law, which makes it clear that commissioning is not subject to competition law. It is the function that matters when it comes to determining whether this is applicable—
Paul Burstow
I am responding to my hon. Friend and, if the hon. Gentleman does not mind, I am going to carry on doing so.
In addition, the Office of Fair Trading has published guidance that is consistent with the view that the Department has expressed on this matter. I will write to my hon. Friend with the detailed case law, so that I can quote the case reference for him.
Claims have also been made that part 3 does something else. Specifically, it has been suggested that it introduces competition and competition law into the NHS, as if that were the case for the first time. Part 3 does not do that, nor does anything else in the Bill. The NHS will, as a result of the Bill, be better insulated against the inappropriate application of competition law, particularly as it develops more integrated services, which are now embedded throughout this legislation. Without Part 3, the NHS would continue to be exposed to price competition and the preferential treatment of private providers introduced by the previous Labour Government. Indeed, Labour’s 2006 procurement regulations assume that public authorities will be securing services from a market—that will not always be appropriate in the NHS—and so, under the existing regulations from the 2006 legislation, commissioners are placed at greater risk of legal challenge whenever they decide to secure services without competition.
Karl Turner (Kingston upon Hull East) (Lab)
Will the Minister say whether Monitor will keep its role as an independent regulator of foundation trusts?
Paul Burstow
I am coming on to deal with a whole section of amendments that were made in the other House and which this Government have accepted, when I will address that very point. If the hon. Gentleman is patient, he will get an answer to his question.
Grahame M. Morris
I wish to seek a point of clarification on the Minister’s reference to what Earl Howe said about the Bill providing
“insulation against inappropriate application of competition law”.—[Official Report, House of Lords, 6 March 2012; Vol. 735, c. 1689-90.]
Concerns were raised in the Minister’s own party about American-style private health care interests being able to use these mechanisms to provide health care services. Will he give an example of how this “insulation” would protect an NHS trust from being taken over by a north American private health care company?
Paul Burstow
That shows a fundamental flaw in the hon. Gentleman’s argument and in his understanding of what the Bill actually does. I commend to him the contribution made by Earl Howe, the Minister in the other place, on 6 March 2012, when he set out in great detail—this can be found in column 1689—all the aspects relevant to how this Bill protects the NHS, creating insulation for it against the application of competition law under the current framework, as provided by the 2006 legislation, which does not offer those protections. It certainly does not give commissioners the ability to exercise their discretion over whether, when and if to use competition. In those circumstances, the measures give for the first time, because of the sector-specific regulator, the ability to decide which services will be exempt from competition altogether—something that does not exist as a result of Labour’s legislation. That is one reason why so many hon. Members in this House are concerned about the impact of competition—because they are seeing the NHS being exposed to competition under the 2006 Act. This Bill will sort those defects out.
Barbara Keeley (Worsley and Eccles South) (Lab)
Will the Minister give way?
Paul Burstow
No, I am going to make some progress and then I will be more than happy to give way. [Interruption.] I am sure there will be more opportunities and I will give way in a moment.
On how Monitor exercises its powers, the Government have supported amendments made in the House of Lords, which were tabled by my noble Friend Baroness Williams, providing that the Secretary of State can give Monitor guidance to help ensure it exercises its functions in a manner consistent with the Secretary of State’s duty to promote a comprehensive health service. The amendments also help to ensure that the Secretary of State can discharge effectively his responsibility for the health service in England and to ensure that Monitor carries out its functions to that end. I therefore commend the amendments to the House. Both this House and the Lords have stressed the need for Monitor to use its powers to support integrated services and co-operation between providers. The Government therefore tabled amendments in the other place to provide express powers for Monitor to set and enforce licence conditions that would enable integration and co-operation between providers.
On the detail of Monitor’s specific regulatory powers, Monitor would have powers to intervene proactively to support commissioners in ensuring continued access to NHS services if a provider became unsustainable. Amendments tabled by the Labour peer Lord Warner, which we agreed in the other place, provide that Monitor will have to identify and publish evidence where it identifies risk that it considers arises from unsustainable service configurations. Those amendments would require commissioners to act on that information where necessary. Hence, they make clear the expectation that commissioners will address problems proactively and ensure that patients continue to have sustainable access to the services they need. These are sensible provisions that had support from all parts of the House of Lords and I hope that this House will also agree to them.
I want to say a bit more about the powers and responsibilities of Monitor, which relate to further amendments made in the other place. The extent of the various matters that Monitor would have to take into account was the subject of considerable debate in this House and the other place. I want to be absolutely clear about where we are regarding the overarching duty that Monitor has to take into account. Monitor will have a single, unequivocal duty—to protect and promote the interests of patients by promoting provision of NHS services that is economic, efficient and effective and that maintains or improves the quality of services. Beyond that overarching duty there is no hierarchy. No preference is given to competition or integration because integration is clearly a responsibility that sits with commissioners and Monitor’s role is to support it.
Peers also raised concerns about proposals for the Competition Commission to undertake seven-yearly reviews of competition in the provision of NHS services. The Government were sympathetic to the arguments and were concerned that it might be taken to suggest that competition was being given a higher status than the interests of patients. In order to avoid that, we accepted an amendment tabled by my noble Friend Lord Clement-Jones that removed the provision in the Bill for Competition Commission reviews. We also supported other amendments tabled by my noble Friend Lord Clement-Jones requiring the Office of Fair Trading to seek advice from Monitor whenever it considers mergers or potential mergers involving foundation trusts. The amendments will help to ensure that benefits to patients are evaluated on an informed basis by a sector-specific regulator giving its expert advice to the OFT in the discharge of its responsibilities and as a paramount consideration.
Jim Shannon
Many hon. Members will probably have received correspondence from the Nuffield Trust saying that
“much of the behaviour of providers will in practice be shaped by detailed guidance and the work on pricing conducted by both Monitor and the NHS Commissioning Board. The two organisations have a major task ahead of them to ensure there is the necessary information, data exchange, contracting and payment tools to support patient choice, integrated care, efficiency and quality.”
How would the Minister respond to the Nuffield Trust on that question?
Paul Burstow
What I heard the hon. Gentleman set out was a rehearsal of the interrelationship that exists between the NHS Commissioning Board and Monitor, particularly in the area of setting NHS tariffs and prices. For the first time, as a result of this legislation, there will be greater transparency and requirements about consultation in the design of those tariffs. At the moment, that process is obscured within the bowels of the Department of Health without accountability or public scrutiny. For the first time, this Bill puts that on a footing that ensures that transparency. As a result, it will produce much better tariff design for the future.
On Monitor’s role as the regulator of foundation trusts, it is important to be clear about this important part of the legislation. Foundation trusts will remain the principal providers of NHS services. The Government do not expect that to change. Monitor must therefore be able to continue operating a compliance regime transparently to assess and manage the risks, intervening proactively to address problems where necessary. The Bill is designed to reflect this and for Monitor to protect patients’ interests by regulating foundation trusts so that they continue to be able to provide NHS services in line with their principal purpose. Where Monitor identifies significant risk to a foundation trust’s continued ability to provide NHS services, the Bill provides Monitor with powers to intervene proactively to ensure that the risk is addressed. The Government agreed amendments in the House of Lords to clarify that further. In particular, the amendments clarify that Monitor’s powers to direct foundation trusts to do, or not to do, things to maintain essential standards of governance, or to ensure their continued ability to provide NHS services, will not be transitional powers. We accept that that previously was not as clear as it needed to be and we have made it clear.
We think that the Bill has been improved as a result of the amendments that were made in the House of Lords in that regard. Under clause 94 in the latest version of the Bill, Monitor’s enduring powers will include the power to set and enforce requirements specifically on foundation trusts to ensure that they are well governed. Monitor does that now and those requirements will need to be differentiated for foundation trusts to reflect their unique role and legal status as public benefit corporations financed by the taxpayer with a principal purpose defined in statute as being
“to provide goods and services for the purposes”
of the NHS. Monitor will also have enduring powers to set and enforce requirements on foundation trusts to ensure that they remain financially viable and to protect NHS assets. These measures deal with one of the concerns that has often been rehearsed about the privatisation of the NHS. The Bill does not provide that opportunity, but it provides for the protection of NHS assets. Those are necessary conditions of a foundation trust’s continuing ability to provide NHS services; they are not transitional issues.
Grahame M. Morris
I would appreciate the Minister’s clarification about reports that have been made available as a result of freedom of information requests indicating that senior officials of Monitor have been meeting on a regular basis with representatives of the private health care consultancy, McKinsey. Is the Minister aware of the nature of those discussions and do they have any relevance to the assurances that have been given at the Dispatch Box that there is no conspiracy to privatise the health service?
Paul Burstow
Absolutely not; the reports to which the hon. Gentleman refers, which had a substantial exposé in The Mail on Sunday, really do not bear as close an examination as he would like of them. We know that the relationship that existed in terms of contracting McKinsey to provide services was one that the previous Government engaged in far more freely than the current Administration. The amounts that this Government have contracted and the nature of the relationships that this Government have are far smaller.
Barbara Keeley
I have asked the Secretary of State about McKinsey and Co. in this Chamber and through a written question, but neither he nor anybody in the Department seems able to confirm whether it has access to the risk register. It seems very strange to me that the Department is not able to answer the question of an hon. Member about what access that organisation has to those documents. It is a very strange set-up.
Paul Burstow
The hon. Lady says it is a strange set-up and refers to her endeavours to get an answer to the question. I have not seen details of her exchange with the Secretary of State, but I will look at that and write to her with an answer to the question.
Simon Hughes (Bermondsey and Old Southwark) (LD)
My hon. Friend is dealing with matters of great concern outside this place, and I am clear that all these amendments are a move in the right direction. Will he put it on the record that as a result of the Bill, first, it will not be possible in future for any hospital to move, as Hinchingbrooke did, from the public sector to the private sector, and, secondly, that the proportion of private sector business cannot be increased up to the 49% that has been mentioned and will be increased only if the hospital decides, according to the amendments, to increase it by the small percentage that the amendments now allow?
Paul Burstow
I am grateful to my right hon. Friend for his questions. Let me start with the issue of Hinchingbrooke, which is an important one. It is worth remembering that the vast majority of the process that led to that franchise arrangement was completed under the Labour Government, not by the current Administration, and was part of the arrangements put in place by the Labour Health Act 2006 and Health and Social Care Act 2008. The Bill makes sure that in future there can be no scope for sweetheart deals to incentivise new entrants into the NHS, it ensures that there cannot be price competition of the sort that was allowed under the 2006 Act, and it ensures a protection for commissioners to decide when and if it is appropriate to use competition. That is not a protection that they enjoy under the 2006 or the 2008 Acts.
Paul Burstow
I have answered the hon. Gentleman’s question. He should read Hansard later.
I was asked, finally, whether there is a cap of 49%. Let us go back to the deliberations in another place before Christmas, when the issue first came up. Our noble Friends were concerned to make sure that we put it beyond doubt that foundation trusts were protected from the full force of competition law and that those organisations would continue to have as their principal purpose their service of NHS patients. That is why we have further amendments, which I shall come to shortly, about how a 5% increase would trigger further consultations and votes by the governors.
Paul Burstow
No. I shall make some progress, if the hon. Lady does not mind.
In addition, Monitor could also, in exceptional circumstances, use the enduring powers that I was describing to direct a foundation trust to remove its directors or governors. In other words, a direct intervention power is preserved by the amendments and changes that we have made.
The Government’s ambition is that eventually foundation trusts should have more responsibility for their governance than they do under the current arrangements. This will depend, in particular, on strengthening the role of foundation trust governors in holding their boards to account. We have listened to the concerns about the pace of change. Hence, we have amended the Bill so that Monitor will also have, on a transitional basis, express powers to remove, suspend or replace directors or governors of a foundation trust directly, without the prospect of an appeal to the first-tier tribunal. We would expect Monitor to use these powers to address failure of governance, which puts the trust at risk of not meeting its licence conditions, such as the requirements that I have already described.
Karl Turner
Is it right that the only provision preventing privatisation is the requirement in clause 161 that foundation trusts must use the NHS more than they use private providers? Is that not, in effect, the 49% cap?
Paul Burstow
No, because the overarching duty is that the service remains free at the point of use. Also, there are protections—[Interruption.] The hon. Gentleman asks a question, but when I try to give him an answer, he shouts and screams at me. That does not help the debate. What I wanted to say was that when it comes to mergers and acquisitions, there are clear requirements to protect NHS assets from a transfer out of the NHS and out of the state sector. The powers that I was describing would be retained as long as Parliament considered necessary, and they could not be removed before 2016 at the earliest and would then be subject to criteria that Monitor determines, with the Secretary of State’s approval.
Barbara Keeley
I do not know whether I am alone in this—I do not think so—but the notion of foundation trust governors having to approve an increase in private patient income does not feel like much of a safeguard, especially as the governors are inclined to balance the books. It just means that the proportion of private patient income will slowly grow to 49%, rather than jump to it straight away. While we are thinking about this aspect of clause 163, I understand that the Department of Health still has an explicit target in the operating framework to increase the proportion of non-public sector provision purchased with NHS funding. There are so many pressures and drivers that the denial that it is privatisation and the influx of competition—[Interruption.] It is privatisation that will slowly grow to 49%.
Paul Burstow
Absolute nonsense. That is part of the rhetoric and fantasy that we have heard throughout the Bill’s passage. Let me deal directly with it by reference to examples of current practice. The Royal Marsden and the Royal Brompton and Harefield all earn very high levels of private income but are consistently rated highly as providers of NHS services. They use those resources to reinvest in NHS services.
Mark Simmonds (Boston and Skegness) (Con)
Will the Minister confirm that most of the foundation trusts that are interested in raising and removing the cap want to invest the money that they would generate from private income to improve services for NHS patients? [Interruption.]
Paul Burstow
That is exactly the point; those moneys have to be reinvested—[Interruption.]
Madam Deputy Speaker (Dawn Primarolo)
Order. Members will not keep shouting across the Chamber, from either Front Bench or elsewhere.
Paul Burstow
My hon. Friend’s point seems to have upset some hon. Members, but it was entirely—
Paul Burstow
Let me at least do my hon. Friend the courtesy of answering his point before taking another intervention.
It is absolutely right to make the point about the use of those resources. Indeed, that has been one of the benefits of the system, as we have seen in the performance that some of the trusts that have had historically high caps have delivered in NHS services. However, it is worth noting that it is not just in relation to foundation trusts that there have been concerns about caps, because NHS trusts have never had caps, and it has been entirely possible for NHS trusts to increase their income without any of the constraints or controls that foundation trusts have found themselves under. The Labour party, in crafting its manifesto, seemed to have understood that, but it has now decided to run away from that in order to paint a picture about privatisation that is not part of this legislation.
Madam Deputy Speaker (Dawn Primarolo)
Order. Minister Burns, I will chair the debate in this Chamber. You will not. Unless you want to sit here and allow me to take—
Paul Burstow
We have also clarified a foundation trust’s principal legal purpose to show that it must continue to earn the majority of its income from NHS activity and that that is its overriding priority. Revenue for treating NHS patients could absolutely not be used to cross-subsidise private care, and we would expect Monitor’s licensing regime to prohibit that categorically. The amendments provide important safeguards, so I urge the House to support them.
Finally, this group contains a number of minor and technical amendments, including those implementing recommendations from the Delegated Powers and Regulatory Reform Committee that provide for greater consultation and clarify various matters. I urge hon. Members to support the Lords amendments in this group and to reject the Opposition’s amendments to Lords amendment 148.
Andy Burnham
It is important to begin by setting out the background to many of the amendments in this group. Despite the pause that the Government ordered for the Bill, they failed to allay fears about the creation of a market based on a 1980s utility privatisation, with Monitor acting as an economic regulator—a parallel drawn last November not by me, but by the King’s Fund in a report it published. That, more than anything else, has been behind the huge professional disquiet about the Bill that we have seen over recent weeks and months, with respected professional organisations coming out one after another to express their concern about the damage that will be done to the health service if hospital is pitted against hospital, doctor against doctor. That is where we start.
The Minister began his remarks by talking about the myths relating to part 3 of the Bill and objecting to some of the interpretation that I have just given. I do not know who he had in mind when talking about those myths, but it might have been the noble Baroness Williams. I will quote from an article she wrote in The Guardian on Monday 13 February. It is important because it explains the genesis of one of the amendments that the House is considering tonight. She acknowledged that there were:
“fears among the public and within the medical profession that clinical commissioning groups might become dependent on advice from powerful private health companies, and that the imposition of UK and European competition laws, addressed to markets and not to social goals, might destroy the public service principles of the NHS. In plain terms, this is often described as a fear of privatisation. These are issues that must be addressed.”
When the Minister talked disparagingly about myths, did he have the noble Baroness in mind? I think that he must have done, because in the same article she went on to suggest that the answer to the concerns and fears that she had correctly identified was to drop the whole of part 3. She wrote:
“What that would mean for the bill would be dropping the chapter on competition, and retaining Monitor as the regulator of prices and of the foundation trusts.”
I am not privy to the internal machinations of the Liberal Democrats, but I think that there must have been some wrangling and soul searching in the two weeks following the publication of that article, because by 27 February a letter had emerged that was co-signed by the noble Baroness and no less a figure than her party leader, the Deputy Prime Minister. The call to drop part 3 of the Bill, which had been made so eloquently in The Guardian two weeks earlier, had in fact turned into something very different. The letter stated that they needed to go further to amend the Bill in order
“to rule out beyond doubt any threat of a US-style market”.
If what the Minister has said at the Dispatch Box this evening is true and all these fears are myths, why did his party leader and the noble Baroness send that letter? Indeed, why were there even concerns about the threat of a US-style market, which his party leader acknowledged on 27 February? They do not sound like myths to me; it sounds like they were very real threats indeed.
What I want to address this evening is the fact that when the package of amendments that were meant to put the Clegg-Williams package into the Bill finally emerged, they fell considerably short of what was promised in the letter. Indeed, we are dealing with some of those tonight. I will focus on Lords amendment 148 in particular, which deals with the private patient income cap. When the Minister spoke a moment ago, I did not find him reassuring at all. When he spoke about foundation trusts in the future he said that they would of course remain the principal providers of NHS services, but I do not find that at all reassuring. The exchange he had with the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) was very revealing. The right hon. Gentleman made a mistake that the noble Baroness made when she took on Polly Toynbee on the same issue. The right hon. Gentleman, like the noble Baroness, does not seem to understand the effect of the amendments he is agreeing to. He began by asking, “Wasn’t it the case that the 49% figure was now completely ruled out and wasn’t relevant?” No is the answer to that. All that the Minister has offered him is that if the increase is more than 5%, it then has to be passed by a vote. I find it incredible that a Member of his years and standing in this House has just revealed that he does not understand the amendments that have been signed up to in order to deliver the package set out in the Clegg-Williams letter. That is a terrifying state of affairs; I do not know what the Members in his party who voted against that might make of it.
Simon Hughes
I absolutely understand the amendment, as I am sure does the right hon. Gentleman. Given that 1%, 2% or 3% of most hospitals’ activity is private at the moment, as he well knows, it seems to me that it is a much better guarantee that we have a rule that says that no hospital can increase that by more than 5% of what it is now unless there is a decision made locally. That gives much more security than anything else previously in the Bill, and that is why it seems to me to be a very worthwhile amendment.
Andy Burnham
Let me answer that directly. The Financial Times has analysed the latest data on actual NHS income earned through the treatment of private patients and demonstrated that in the last year not a single hospital trust would have been caught by this so-called safeguarding amendment. It used the example of Great Ormond Street, which increased its income from private patients by 19% from 2009-10 to 2010-11, to £25 million. In percentage points, that increase was less than 1%. Given the small numbers in the cap which the right hon. Gentleman has just mentioned, he is agreeing to trusts being able to increase their income from private patients by multiples of hundreds of percentage points without any reference to their boards of trustees. Frankly, he has not addressed the point that he has failed to understand that the Bill still gives trusts the permission to increase it to 49%. They could go to the trustees and increase it to 49%. He might be reassured by that, but I most certainly am not.
Mark Simmonds
I draw the House’s attention to the Register of Members’ Financial Interests. Does the shadow Secretary—[Interruption.] Does the shadow Secretary of State—[Interruption.] Does the shadow Secretary of State object to NHS foundation trusts raising money through private income—therefore and thereby spending it on NHS patients?
Andy Burnham
No, I do not, is the answer—[Interruption.] Well, what has that proved? We had trusts earning income, but the foundation trust legislation set a cap: it allowed the principle but tightly controlled it for the vast majority of hospitals. That was its purpose. This Bill removes those tight controls. This Bill, supported all the way on that point by Liberal Democrats, now allows hospitals completely to change character over time. In time they can turn to US-style hospitals and devote half their facilities to the treatment of private patients—
Andy Burnham
It is not rubbish. They can earn 49% of their income, according to this Bill, from the treatment of private patients. That is a fact, and why the hon. Lady shouts “rubbish” I have no idea.
Andy Burnham
Non-foundation trusts were managed by the Department, and the Department’s policy, during our time in government, was to have a tight cap—[Interruption]. There was a tight cap on the income that trusts could earn, so the very fact of foundation trusts’ creation gave rise to the question of whether there should be a cap. The Minister is effectively abolishing that cap with his Bill.
Andy Burnham
I have answered the right hon. Gentleman’s question. It was an entirely different situation altogether.
On the suggestion that we are setting our face against reform, we have not said that, and I as Secretary of State initiated a review of the private patient cap, because the issue came up before the election. I was prepared to allow a modest relaxation of the cap if it could be demonstrated to benefit private patients, but I was talking about single percentage points: 1% or 2% becoming 2% or 3%. I was not in any way conceiving the possibility that 49% of a trust’s income might be made from the treatment of private patients—that half their theatre time, beds and car parking spaces could be turned over to the treatment of private patients.
Dr Poulter
I hope that the right hon. Gentleman will concede that those hospital trusts with a private patient cap that is set at perhaps 35%, such as the Royal Marsden hospital, do not necessarily do that much private work. The decision is at the hospital’s discretion, so the idea that raising the cap to 49% will mean that hospital trusts will per se undertake 49% private activity has been proven to be incorrect, on the facts as they stand at the moment in hospital trusts, because those trusts, the doctors and boards work for the benefit of their patients.
Andy Burnham
That is the ideological difference between us. The hon. Gentleman says that the decision should be at the hospital’s discretion, but the Bill essentially sets everybody on their own. Hospitals are being told, “You’re on your own. There’s none of the support from the centre any more, no bail-outs, as the White Paper said. That’s it, you’re out there, you’re competing in a market, and you’ve got to stand on your own two feet.” I differ from that opinion because I want systems regulation and a role for the centre in deciding whether a hospital should greatly increase its treatment of private patients.
This is not just a question of each individual hospital thinking about what it is going to do, because hospitals will have pressure on their bottom lines, as a colleague said earlier. They will be operating in a difficult financial context, and it might have a different effect on their individual interests. It might make sense for hospitals, individually, to increase the number of private patients, but it might not make sense for the NHS patients who live in that area, and that is the entire point: the Government are trading systems regulation for the individual decisions of local organisations, because that fits when we move to a competitive market in which every individual organisation is a competing business.
Dr Poulter
I am struggling to follow the coherence of the right hon. Gentleman’s argument. On the one hand he says that it was all right for non-foundation trusts, under the previous Government, to increase massively the amount of private work that they did, as long as the Department agreed with it; on the other hand he argues that it is very important to control the amount by which foundation trusts raise the private patient cap. He cannot have it both ways, and his argument is not intellectually coherent. Is this not about doing things for the benefit of patients and leaving it up to local hospitals to decide?
Andy Burnham
The hon. Gentleman should make a speech if he wants to make interventions of that length. We had a cap to protect the interests of private patients; he is getting rid of the cap, and he is going to have to explain to patients in his constituency, if waiting lists start getting longer, why that is happening. It is as simple as that. We had systems regulation, he is removing that with the Bill and we are moving to a more unregulated market, which is not what we want to see.
Grahame M. Morris
On a point of order, Mr Deputy Speaker. I wonder whether I might seek your advice in relation to a declaration of interest. The hon. Member for Boston and Skegness (Mark Simmonds) has made two interventions on the private patient cap and has made a declaration of interest. He is a director of Circle, a private health care company. Is it your ruling that every Member must make such a declaration if they speak during the course of this debate?
Mr Deputy Speaker (Mr Nigel Evans)
It is up to each individual Member to make whichever declaration of interest they wish during a debate, but ultimately it is up then to the Member and the Commissioner if the Member wished to take that further.
Andy Burnham
The amendment gives us no protection at all, and it gives us no protection from the NHS cross-subsidising private care. There is nothing in the Bill which says, “The whole costs of the provision of that care have to be reimbursed to the national health service”, as the Financial Times has again demonstrated, and that is why we object to what is happening. We are going back to the old days of the NHS, whereby patients are told, “You can go private or you can go to the back of the queue and wait longer.” That is the choice which we removed from the NHS during our 13 years in government, and we will not accept any return of it.
Simon Hughes
I do not think that I have any more support or encouragement for the private sector in the NHS than the right hon. Gentleman does. May I therefore get him to accept that what Lords amendment 148 does is to limit in relation to each hospital an increase to—
Simon Hughes
No, to 5% of its current figure—not 5% in total, but a 5% proportion. That is what the amendment says, and that gives Guy’s hospital, St Thomas’s hospital and King’s College hospital and patients the reassurance that I think they need. The right hon. Gentleman should read the amendment.
Andy Burnham
I am not going to debate that now. The right hon. Gentleman is going to have to defend himself on whether he has his facts right. I do not think that he has.
We need to put firmly on the record that there are real flaws in the Liberal Democrats’ proposal. They say that it is a safeguard to state, “The governors will decide and it is better done at a local level,” but the governors are going to be under pressure from the management of the hospital because of the pressure on the hospital’s finances. If they make a decision that is in the interests of that hospital, it does not mean that it is in the interests of everybody and of NHS patients.
Paul Burstow
The model that the right hon. Gentleman describes is one that he was only too happy to go through the Lobby and support during the introduction of foundation trusts in the first place. He has omitted to mention Monitor’s role in overseeing the situation through its powers of intervention to ensure the safeguarding of a comprehensive health service, and to mention the guidance that the Secretary of State will give Monitor in order to do just that.
Andy Burnham
I am afraid that I am not at all reassured by that, or in fact by anything the Minister says. The letter that we have from the Deputy Prime Minister spoke of insulating the NHS from European competition law, but I am still waiting to see the amendment that delivers that. As I understand it, one of the Minister’s noble Friends tabled an amendment and then withdrew it, because they did not have the courage to press it to a vote, and accepted a statement on the record instead. This is different from what the Minister keeps saying that we did in government, because he is envisaging a huge expansion of the role of any qualified provider and the putting out to tender of commissioning support units. He has overseen a situation in which three community services have been compulsorily tendered.
The truth is that the Clegg-Williams letter, with the amendments that followed, does not only fail to deliver but sells out the national health service, as does so much of what the Liberal Democrats have agreed to. Our amendments, particularly amendment (b), would provide a measure of systems regulation in the best interests of the NHS, and that is why we will seek to press amendment (b) to a vote.
Dr Poulter
I rise to speak in support of the Government, and of what the previous Government did for the NHS. When the shadow Secretary of State was Secretary of State for Health—the same was the case with many of his predecessors—there was a consistent policy whereby the private sector should be used where it could add value to patient care in the NHS. That was done very effectively by the previous Government to bring down waiting times for operations, but it was not effective when it was not done in an integrated way. Very often, it was done without regard to post-discharge planning for patients but, as we heard earlier, the renewed focus on integration should help to deal with those problems.
We have some of the very best hospitals not only in this country but in the world, including the Royal Marsden and Moorfields eye hospital, where a relatively high proportion of activity is carried out by the private sector. No one doubts those hospitals’ commitment to their NHS patients or that they still provide those patients with the very high standards of care of which health care systems in other countries are very envious. We are very proud of what those hospitals do, and the Government would like to give other hospitals the same opportunity and freedom to follow their example. The Government believe that it is absolutely appropriate that we should use the private sector where it can enhance value to NHS patients. That is absolutely consistent with the previous Government’s policies, for which many Labour Members campaigned at the last general election. This Government are also committed to those policies.
Andrew George
I understand and respect the sincerity of the principle that my hon. Friend is describing, but can he reassure me, particularly given his understanding of the NHS and health systems, that under these proposals it would not be possible for a foundation trust to drive some NHS patients towards the private arm of the activities that they undertake, particularly in the case of procedures that are exactly the same in the private and the public sector?
Dr Poulter
My hon. Friend makes a valid point, and he is right to raise it. That happened in the past when, under the previous Government, private sector providers were paid 11% more for the provision of services than NHS providers, which created an incentive for the private sector to be used ahead of NHS services. This Government are committed to ensuring that that does not happen. My hon. Friend the Minister and my right hon. Friend the Minister and Member for Cheltenham—[Interruption.] I mean Chelmsford; I apologise, particularly as I get the train through his constituency on the way home every Thursday night. They have clearly stated that the Bill is about making sure that we use the private sector when it adds value for money. The hospital that uses the private sector the most—the Royal Marsden—does not have a two-tier service for NHS patients and private patients. The involvement of the private sector at that hospital greatly enhances the work of the NHS and the quality of service and care available to its NHS patients because of the increased research that is performed, the high quality of care, and the high standard of clinicians who are attracted to work there. That works well for the private sector and for the NHS.
I agree with the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) that, where possible, we should be using NHS providers. The Royal Marsden, where there is a high potential cap on private sector involvement, does not use the full capacity of that cap, and there is less private sector activity than it could undertake. That is because the Royal Marsden says, in effect, “Yes, the private sector is good, but it is not only about maximising our cap and maximising our profits but taking into account the best interests of our local patients and striking a balance.” That works very well.
Andrew George
As I understand it, the majority of the private work at the Royal Marsden is in areas such as research and development that are not in any way similar to the services it provides to NHS patients. I asked my hon. Friend whether he agreed that where the private sector and public sector were providing the self-same services for NHS patients, there was a risk that patients might be driven from the NHS towards the private sector.
Dr Poulter
I hope I reassured my hon. Friend with my earlier answer. Yes, he is right that that has happened in the past. However, there is a presumption in the Bill—particularly for rural areas such as Cornwall and in Suffolk, which I represent—that the renewed focus on integrated care that we heard about earlier is the primary focus and purpose of commissioning, over and above the use of any willing provider or private sector providers. That has given me great reassurance regarding our ability to take on and deal with the big demographic challenges of looking after older people better.
I am reassured by what the Minister has said, and I urge Government Members to support the Government.
Alex Cunningham
I rise to support the amendment and to speak against anything that will allow 49% of the capacity of our local hospitals to be used for private patients.
Along with other measures in the Bill, the Government have accepted various amendments that will result in lengthening waiting lists for NHS patients. The Government’s relaxation of NHS waiting times targets means that hospitals are free to devote more theatre time to private patients, and they will have a clear incentive to do so in order to maximise income, given the move towards full financial independence and a “no bail-outs” culture whereby hospitals in financial trouble are allowed to go bust with no help from the Government.
The Health and Social Care (Community Health and Standards) Act 2003 placed a cap on the level of income that a foundation trust could earn from private patients. It was based on the level of a foundation trust’s private income in 2003—the year when foundation trusts first came into being—which was typically about 2%. The Bill in effect sets trusts free to deploy as much as 49% of that capacity to generate income from private patients who can afford the fees to jump the queues, which ordinary hard-working people, and the most vulnerable in our society, cannot do. This is not what patients want, not what the professionals want, and not what the NHS needs.
The Government amendments must be changed to ensure that any increase in the proportion of patient income has the approval of Monitor. Allowing individual trusts to make the decision alone means that there is no strategic overview, which Monitor would offer, and so in theory it would be possible for all the trusts in a locality to make that increase to 49% if their individual boards approved it. I wonder what that would mean on Teesside. We have two major hospitals, so half the capacity for NHS patients could go. Labour’s amendment would set a tougher cap on private patient income. Without the amendment, the NHS will take a huge step towards privatisation and we will fail to put in safeguards to ensure that the needs of the general public are met. Rather than the NHS being free at the point of delivery, more and more people will be pushed towards insurance schemes, thereby putting money in the pockets of the insurance industry and denying the exceptionally important right to have free, high-quality health care when it is needed.
Simon Hughes
I am absolutely clear that I was not sent to this place to force through the privatisation of the NHS, to force people from the public sector into the private sector, or to undermine great hospitals such as Guy’s, St Thomas’s and King’s College or the other hospitals in my constituency and my borough. Like colleagues from all parts of the House, I know what a fantastic service the NHS provides, not as a matter of policy but from personal experience. It saved the life of my younger brother and looked after my mother in her last days in the most fantastic way that anybody could wish for. I am clear about the commitment of the NHS.
I am therefore clear that we have to look at what the Bill says and what it will do. I have had an exchange about that with the shadow Secretary of State for Health. This is a really important issue outside this place. Clause 161 sets out the following principle:
“The principal purpose of an NHS foundation trust is the provision of goods and services for the purposes of the health service in England.”
That was not thought to be enough, so colleagues in the other place said, “Let’s for the first time ever make it clear that private activity can never be more than a minority activity.” That is why the 49% figure appeared.
However, that is not still enough—[Interruption.] Let me deal with this point. That is why Lords amendment 148 is before us. It states that if any foundation trust hospital in England proposes to increase its private income by 5% or more from its current level, which is usually about 2% or 3% of its income, the governors have to agree to the proposal by a majority. There will not be any great vote by the governors of Guy’s and St Thomas’s, King’s College or any other hospital, with the public participation in the debate that there would be, suddenly to increase their private sector activity. That is not the real world, because that is not what the British public want. There are one or two cases—
Simon Hughes
In a second. There are one or two cases, such as the Royal Marsden, which have historically had a higher percentage of private sector activity. Those hospitals have justified doing so, because they are specialist hospitals that have got money in from outside. However, I do not want us to leave this debate letting the public believe that there will now be the opportunity for all the hospitals in England suddenly to move, without any control, towards undertaking huge amounts of private sector activity.
Simon Hughes
I will give way to my hon. Friend and then to the shadow Secretary of State.
Paul Burstow
I am grateful to my right hon. Friend for setting out these issues again so clearly and for putting to rest the myths that are yet again being fanned by Opposition Members. I confirm that the Bill provides two further safeguards. First, Monitor will continue to have a direct oversight role in this regard. It will be able to intervene and use its licensing powers and other powers to deal with concerns if NHS services are put at risk by the decisions of a foundation trust. Secondly, there are the contractual relationships that commissioners have directly with these organisations.
Simon Hughes
I accept that. That is why the amendments tabled by the right hon. Member for Leigh (Andy Burnham) are not necessary. Monitor already has a control that it can exercise to ensure that what he calls strategic control or central control is retained, as well as local decision making.
I will end this point by saying that although, technically, there could be a vote of the governors of any hospital—in the right hon. Gentleman’s constituency or mine—every year to increase private income by more than 5%, that is not the real world. In the real world, the people of this country love their national health service, NHS staff love their national health service, and the governors of the hospitals that I represent love their national health service. Those people are not suddenly going to change their attitude after 60 years of the NHS.
In the post-war Parliament, when the Labour party, supported by the Liberal party, put through the plans drawn up by Beveridge, the Liberal, for the NHS, it accepted from the beginning that there would be some private sector activity. From the beginning, GPs and some dental services were in the private sector, and they have remained there.
I am clear that the Bill does not mean that there will suddenly be a market, a route or a tramway for privatisation. Others say I am wrong—I know that there is a lot of concern—so I am clear that when the Bill becomes an Act, we need to sit down with the health professionals who still have concerns—[Hon. Members: “Too late.”] No, it is not too late if people understand what is really in the Bill, rather than what some people say is in the Bill. It is not too late if people look at the wording of the legislation, and do not just listen to the arguments about it.
I say to the right hon. Member for Leigh, whom I respect in many ways, that he has often distorted what has happened in the past and what will happen now. He has ignored the facts that Labour forced privatisation on the health service in many parts of England and that Labour paid more to the private sector to carry out activities for the NHS. I am here to support these provisions in the Bill because I want to end the incentives for the private sector and to end the enforced privatisation of the health service. I will ensure that there is no chance of any hospital in my part of the world voting significantly to increase private sector activity, because the NHS wants to remain in the public sector and deserves to be supported by us to do so.
I refuse to be misrepresented by Labour colleagues who accuse us of doing something that we are not doing. We have a public national health service, paid for through our taxes. Everybody has an entitlement to the best care in the country. I will not do anything that undermines that. I hope that the right hon. Member for Leigh will not and that Ministers will not. I agree that we have some work to do to reassure people outside this place. I hope that, from today, the right hon. Gentleman will join me in telling the truth about the Bill and not tell untruths.
Lords amendment 63 agreed to.
Lords amendments 64 to 147 agreed to, with Commons financial privileges waived in respect of Lords amendments 132 to 141.
Clause 161
Goods and Services
Amendment (b) proposed to Lords amendment 148.—(Andy Burnham.)
Question put, That the amendment be made.
Paul Burstow
I beg to move, That this House agrees with Lords amendment 11.
Mr Deputy Speaker (Mr Nigel Evans)
With this we will consider Lords amendments 12, 43 to 53, 61, 62, 168 to 241, 243 to 245, 247, 249 to 251, 253 to 286, 288 to 291, 327, 333, 334 and 366 to 374.
Paul Burstow
This group encompasses a number of Lords amendments relating to public health, public involvement, local government, the Health and Care Professions Council, the National Institute for Health and Clinical Excellence and the NHS Information Centre.
We believe that the Bill has been improved as a result of the amendments made in the House of Lords. For example, the Government have directly addressed the concerns raised in this House and elsewhere about the status and security of directors of public health within local authorities. We have also introduced safeguards to ensure that local healthwatch organisations and HealthWatch England can operate effectively within the Care Quality Commission, and that the CQC can have better links with, and transparency to, local healthwatch organisations.
Throughout the Bill, we have emphasised the importance of public health. In particular, local directors of public health will have a leading role within their local authorities in ensuring that public health is a consideration across the full range of local government activity, not just its health responsibilities. For example, they will use their participation in health and wellbeing boards, alongside directors of adult social services, directors of children’s services and clinical commissioning groups, to find innovative solutions to local health needs.
To further strengthen the status of public health in local authorities, amendments tabled by my noble friend Earl Howe establish directors of public health as statutory chief officers of their local authorities. They also give the Secretary of State the power to issue guidance on the role of directors and other public health staff, to which local authorities must have regard. Along with the guarantee of chief officer status and statutory guidance, that is equivalent to the situation that currently applies to directors of children’s services and of adult social services.
Other Lords amendments will enable us to give directors of public health a key new role in considering applications for the licensing of premises for the sale of alcohol, and enable the national child measurement programme to continue once it is transferred to local authorities.
Beyond the provisions of the Bill, we have stated clearly that Public Health England will have a board with an independent, non-executive majority and an independent chair, to provide the chief executive and the Secretary of State with frank and expert challenge. Public Health England’s ability to undertake research and bid for external funding for health protection research in the same way as the Health Protection Agency is also provided for in the Bill as now drafted. Finally on public health, we have announced our intention, subject to consultation, to require the registration of non-medical public health specialists with the Health Professions Council.
We introduced safeguards in the other place to ensure that HealthWatch England could operate effectively within the CQC and have better links with, and transparency to, local healthwatch organisations. That will help to ensure that issues arising between them can be addressed, and local authorities and local healthwatch organisations will have to have regard to similar guidance. HealthWatch England will also exercise additional functions to assist local authorities with the arrangements that they make for local healthwatch. HealthWatch England may make recommendations of a general nature to local authorities about the making of those arrangements. When it is of the opinion that local healthwatch activities are not being properly carried out, it can draw that to the attention of the local authority.
The Lords amendments will ensure that regulations are able to, and in some cases must, make adequate and appropriate provision about HealthWatch England’s membership. That will include specifying that the majority of members must not be members of the CQC board, and setting out the procedures for selecting members or proposing persons for appointment as members. We listened to the concerns on that issue and have now undertaken a public consultation on the proposed regulations. The results are currently being carefully analysed.
A number of the amendments in this group apply to local healthwatch organisations. They will strengthen the statutory powers of those organisations, enabling them to become a powerful champion of patients’ interests locally. As a result of the Bill, they will have stronger and more wide-ranging powers than local involvement networks do under the current arrangements. The Government are ardent proponents of localism and of local authorities being able to take account of local needs and be accountable to their local population for the decisions that they make.
Simon Hughes
One thing that has got lost in all the noise about the Bill is the fact that there will be more opportunity for local authorities and local people in England to be engaged. Will my hon. Friend put on record how an ordinary constituent of his in Sutton, mine in Southwark or anywhere else—not a professional such as a GP or a nurse—will be able to get involved? I think there will be a much better system in future than there has been.
Paul Burstow
My right hon. Friend is absolutely right. Hard-wired throughout the Bill are requirements on patient and public involvement in clinical commissioning groups and health and wellbeing boards. Local healthwatch will provide a vehicle for delivering much wider engagement. One criticism that has often been levelled at past attempts at public and patient engagement has been the absence of hard-to-reach groups, which are seldom heard from in our health system. As a result, their voices have not helped to shape commissioning decisions. We need to ensure that they do, so that CCGs commission effectively for their whole population. That is a key part of what the Bill provides for.
As the Bill makes its way on to the statute book, Members of all parties will need to look closely at the opportunities for far wider public involvement that will result from how it has been improved. We have listened closely to groups such as the Richmond group, which has been a powerful advocate on behalf of a wide range of patients’ groups. It has talked about the importance of involving patients far more in co-production and commissioning decisions. That is an essential component of how we intend the Bill to be given effect in the months to come.
In tabling our amendments in the House of Lords, we wanted to ensure that local authorities had greater flexibility in the organisational form that local healthwatch takes. Local authorities are best placed to make decisions about the right way to commission a local healthwatch service for their area, but they cannot decide not to have a local healthwatch organisation, and we would not allow them to do that. It is essential that the voice of patients and carers is heard loud and clear in the decision-making processes of our NHS and social care services.
Andrew George
I am grateful to my hon. Friend, particularly for his last remark. I know that he will come on to Lords amendment 181, but I could not find anything in the debate in the House of Lords justifying the rationale behind the provisions relating to the establishment of local healthwatch organisations as statutory bodies corporate. I am sure that he is just about to provide that rationale.
Paul Burstow
I am grateful to my hon. Friend for the opportunity to do just that. First and foremost, I want to be absolutely clear that local authorities are under a statutory duty to ensure that local healthwatch arrangements are put in place. The Lords amendments do not change that one iota, and they do not in any way weaken the statutory functions conferred upon local healthwatch organisations. Nor do they enable local authorities in some way to limit, restrict or censor what local healthwatch organisations can do. Indeed, we tabled amendments to ensure there are better safeguards in relation to how local authorities carry out their role. The Secretary of State will be able to publish guidance relating to potential conflicts of interest between a local authority and its local healthwatch organisation, to which both sides must have regard. We have provided for HealthWatch England to make recommendations in that respect, but to be absolutely clear, local healthwatch has a statutory basis. All that has changed is that we want to enable local decisions about whether it is a social enterprise, a voluntary organisation or another format.
Grahame M. Morris
Will the Minister clarify that point and the issue raised earlier by the right hon. Member for Bermondsey and Old Southwark (Simon Hughes)? One Lords amendment allows a local authority to commission a community interest company, charity or other form of social enterprise that meets the prescribed criteria to be the local healthwatch for its area, and allows local healthwatch to make arrangements with others to carry out its functions—it effectively allows local healthwatch to delegate its functions to a community interest company. How does that address the concerns raised by the right hon. Gentleman? How would an individual constituent have their interests represented through a local healthwatch if it is no longer a statutory body?
Paul Burstow
The point is that the body will discharge a number of statutory functions. The models that the hon. Gentleman describes—community interest companies and other forms of mutual or social enterprise—are exactly the sort of organisations that are likely to engage more effectively with community interests and bring in a wider range of them. That is why we want that flexibility in the organisational form, against a set of criteria to safeguard the interests of the public. The public can tailor those organisational forms to meet the needs of their local community. That corporate envelope does not guarantee anything; the legislation still provides a statutory basis.
Simon Hughes
One last time—I am grateful to the Minister. Will he put on the record what constituents all over England can do if, for example, they hear that their hospital might want to close a ward for the mentally ill, or close accident and emergency services, or if it realises that there is no day care for people with mental illness? What power do they have to stop or start something?
Paul Burstow
Despite the noises off, the fact is that there is considerable scope for that sort of public shaping.
Let me talk my right hon. Friend through some of those changes. We are establishing local health and wellbeing boards, which are made up of clinical commissioning groups, elected local authority members, the various directors to which I just referred, and, importantly, local healthwatch organisations. They have the statutory responsibility for identifying population need for their area and for then framing the strategy to meet those needs. The local commissioner must evidence that the strategies for delivering that—the local commissioning plans—reflect the commissioning strategy that has been produced by the health and wellbeing board. That is the first opportunity to intervene and to help shape the nature of services that are being commissioned for a local population. Indeed, we made amendments that make it clear that health and wellbeing boards must involve their population in that work.
The next stage when people can be involved is when the clinical commissioning group produces its commissioning intentions and plan. CCGs have obligations to consult on their plans and to involve the public in their formulation. That is a further opportunity, but beyond it there is a role in commissioning decisions, or decisions to change or reconfigure a service, for the local authority’s health and overview scrutiny committee, which we are retaining and enhancing, so that, for the first time, NHS providers in the public sector or private providers providing NHS-contracted services can be held accountable for their decisions. That is a change from the arrangements under the previous Administration.
Those are just a few of the steps, but ultimately we have retained the provisions for a reference by the local authority to the Secretary of State to make decisions regarding major reconfigurations. There are a number of steps. I hope that that reassures my right hon. Friend and gives the lie to those who suggest that the provisions have been watered down—the contrary is the case.
We have committed to use the Secretary of State’s powers to specify the criteria that local healthwatch organisations must satisfy when it comes to strong involvement by volunteers and lay members, including in their governance and leadership. We want to ensure that local healthwatch organisations break out of existing models and find ways of reaching and involving far wider and more representative populations than hitherto.
I can confirm that there are a number of amendments, the majority of which are technical in nature, relating to the Health and Care Professions Council, NICE, and the NHS Information Centre. Part 7 of the Bill relates to the regulation of health and social care workers. The Government have made a technical alteration to the provisions amending article 12 of the Health Professions Order 2001 to enable the Health Professions Council to recognise training undertaken in Wales, Scotland and Northern Ireland as sufficient for admission to its register as a social worker. The amendments also give the council the power to assess training or professional expertise and experience in social work gained outside England but within the UK.
Part 8 of the Bill establishes the National Institute for Health and Care Excellence—I emphasise the word “care”—and extends its remit to adults’ and children’s social care. NICE will play a central role in driving quality improvement through the production of robust, evidence-based quality standards and other guidance across the NHS, social care and public health. That is yet another measure in the Bill that supports and drives greater integration of health and social care than has existed in the past. The Government have made minor and technical amendments to part 8 to avoid the potential for misinterpretation and to ensure that NICE’s functions can be exercised effectively in practice.
It is important that patients continue to have access to NICE-approved drugs and treatments in line with the NHS constitution and accompanying handbook, whether those fall within the future responsibilities of the NHS or of local authorities. We have therefore amended the regulation-making power in clause 234 of part 8 so that the provision in regulations to replicate the effect of the current funding direction for NICE technology appraisal recommendations may also be applied to local authorities in respect of the drugs and treatments that they may prescribe for public health purposes, such as smoking cessation aids.
Part 9 establishes for the first time the NHS Information Centre in primary legislation, setting out its powers in relation to the collection, analysis, publication or dissemination of information. The Government have made a number of amendments—to clauses 255 and 257—and inserted new clauses after clauses 252 and 257 that further strengthen the protection of individuals’ confidential personal information while ensuring that the wider benefits of safely and securely sharing information, which include improvements in the quality of services and treatments, can be realised.
The amendments will, for example, restrict the people who can require the centre to collect confidential, personal, identifiable information; clarify the circumstances in which the centre may require others to provide it with confidential, personal, identifiable information; and require a code of practice to be published, setting out how confidential information must be handled. That provides an essential safe haven that can provide a powerful driver to support research and quality improvement in the NHS.
To support these amendments, we have made a number of minor and technical amendments to part 9 and to schedule 19. Finally, we made a minor and technical amendment in part 11 relating to the transfer scheme, which is set out in clause 294. That provision allows for flexibility in how the Secretary of State holds his shares in any property company. That is normal for company structures and is in a form already used by the Secretary of State with his other companies.
I urge hon. Members to support these amendments, including amendment 181.
Liz Kendall
I start by sharing with hon. Members a letter to the Prime Minister on 13 March from Malcolm Alexander, who is the chair of the National Association of LINks Members, the national body representing 150 statutory independent local involvement networks that promote the public and patient voice in health and social care. The letter is about the amendments to HealthWatch that were made in the other place and are before us now. He wrote to register his
“strong objections to the government’s major policy change on Healthwatch—specifically your decision to abandon plans to establish statutory Local Healthwatch bodies…Instead of creating independent statutory bodies led by local people who can monitor, influence, involve the public, hold the local authority and NHS to account; the government plan to create weak bodies that will not be independent, but will be funded by and accountable to the local authority they are monitoring. There will be no genuine accountability to the public.”
He then makes this rather perceptive comment:
“Plans for a statutory Healthwatch body were probably the only part of the Health and Social Care Bill that had any public support.”
He continues:
“Your government’s ambition”—
not your Government, Mr Deputy Speaker, but the Prime Minister’s—
“to establish independent, statutory Healthwatch organisations that would help achieve equity and empowerment in relation to access to NHS and social care services, has been diminished to such a degree, that Healthwatch will have little impact…The aspiration to achieve equity and excellence in public involvement in health and social care, especially for the most vulnerable people, has been replaced by a model that has lost its central purpose of building effective patient and user led bodies that can influence the planning of health and social care.”
Andrew George
I am listening carefully to the hon. Lady’s arguments about the structure and funding of local healthwatch bodies and HealthWatch England. I ask this question not to be deliberately mischievous, but in view of her comments and criticisms: what is the preferred option of the Labour party for those scrutiny bodies?
Liz Kendall
I would encourage the hon. Gentleman to read the Opposition Front Bench amendment tabled in the House of Lords, which set out how we could have a separate independent, body with clear lines of accountability to local healthwatch organisations. That is the policy of the Opposition. Unfortunately, however, that amendment was not accepted.
National Voices represents 150 patient groups. I was interested that the Minister said that the Richmond Group of charities somehow supported everything that the Government were doing in this area. However, I should remind the House that National Voices includes groups such as Asthma UK, Arthritis Care, the British Heart Foundation, Breast Cancer Care, Carers UK, Cancer Research UK, Diabetes UK, Dementia UK, Mencap, Mind, Macmillan Cancer Support, Rethink Mental Illness, the Stroke Association and many others. Those groups are saying that the Government are setting HealthWatch up to fail, because it will not provide a strong enough voice for patients and the public.
Interestingly, officials within the Government’s own Department are saying the same thing. Hon. Members will know that the Government have refused to publish the transition risk register, but today I have been passed the risk register from the Department of Health’s programme board for HealthWatch. It is marked “Restricted”, and it sets out clearly what the Department’s officials see as the risks involved in the Government’s proposals on HealthWatch. It deals with high risk in terms of impact, as well as with likelihood, so it does involve prediction.
The risk register says that there is a high risk that
“existing LINks members and volunteers become disenchanted about the new arrangements for local HealthWatch and leave the system”
because of “insufficient consultation”. It goes on to say that there is a high risk that local authorities
“will not invest in establishing effective relationships with existing LINks and other community organisations”
because the process has been poorly managed. It states that there is a high risk that there will be a “narrow engagement group” and that HealthWatch
“doesn’t work effectively with providers and commissioners. HW is not fully representative.”
It identifies the cause for that as the engagement process having been “insufficiently inclusive”. It sees a further high risk in relation to HealthWatch England:
“The establishment of the HWE committee within CQC is either too isolated or too prescribed by DH/CQC plans.”
The cause is identified:
“Early design processes for establishing HWE do not engage broad range of partners resulting to ineffective regulations being laid.”
Those ineffective regulations are being laid by this Government, according to the risk register of the Department of Health’s own HealthWatch programme board.
Some of the Lords amendments in this group would make minor improvements to the Bill in relation to the National Institute for Health and Clinical Excellence and to the functioning of the information centre. I want to return to the Minister’s earlier claim that huge improvements would be seen in public health. Some amendments relate to the employment of public health professionals by local authorities. The trouble is that the Faculty of Public Health, the body that represents those people, opposes the Bill and wants it to be dropped. It has stated that the Bill will widen inequalities, increase health care costs and reduce the quality of care. It says that there are significant risks—[Interruption.] If hon. Members are making claims that their Bill will improve public health and that the amendments will improve arrangements for public health professionals, perhaps they should listen to the views of those public health professionals. The Faculty of Public Health has identified
“significant risks associated with the NHS structures, the new health system and environment that the Bill will enact.”
The right hon. Member for Bermondsey and Old Southwark (Simon Hughes) was, perhaps courageously, trying to get the Minister to set out what powers local authorities would have under the new system. He will know, however, that health and wellbeing boards will not have the final say over GP commissioning plans. They will not be able to stop them. The only course left to them will be to appeal to the NHS Commissioning Board. I would respectfully point out to the right hon. Gentleman that if he thinks that the NHS Commissioning Board will automatically agree to complaints from local authorities, his experience of the NHS is very different from mine. We need to be clear that there will be no sign-off by health and wellbeing boards.
Simon Hughes
These are important issues, but I hope the hon. Lady recognises that on the public health agenda, which Labour Members regularly say is so important, there is now—I think for the first time—written into legislation an obligation on the Secretary of State, and therefore on the NHS, to secure
“continuous improvement in the quality of services provided to individuals for or in connection with…the protection or improvement of public health.”
That must be reflected all the way down the tree; it will not stay only in the Department of Health office.
Liz Kendall
The right hon. Gentleman might think that that on its own will protect the system, but as he well knows, I am pointing out what public health professionals are saying. [Interruption.] What I am saying is that the Secretary of State’s interpretation of the Bill is not shared by those who work in public health who think that there are huge risks in it. I was also making the point that when it comes to the fundamental issue of the control or powers of the health and wellbeing boards, we should be very clear that they do not have sign-off. That was my point.
Steve Brine (Winchester) (Con)
I was unfairly chuntering from a sedentary position a minute ago, and I thought I would like to place something on the record. The hon. Lady refers to the Faculty of Public Health, and I have obviously heard its public comments about the Bill. However, it is right there in new section 1B in clause 3 that the Secretary of State has a duty “to reduce inequalities”. I heard an Opposition Member chuntering from a sedentary position earlier, too, to the effect that this is a matter of faith and trust, but this House’s job is to scrutinise and enact legislation. There it is in the Bill in black and white—on green —[Interruption.] Yes, for the first time in 13 years, as I do not recall seeing it in any national health Bill before.
Liz Kendall
The point is that the rest of the Bill absolutely trumps that. That is the concern of others—[Interruption.] Conservative Members groan, but people who work in the system say that the Bill—[Interruption.] The hon. Member for Winchester (Steve Brine)has not stumped me. He said that one phrase in a Bill is supposedly going to outweigh the rest of the implications in the Bill, which the Faculty of Public Health says will increase the postcode lottery and widen inequalities, without providing value for money or improving the quality of services. Conservative Members should listen to the concerns of the people who work in the system.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
Does my hon. Friend agree with me—
Ms Abbott
She will, you know. Does she agree that it is apparent over the years that it is one thing to see an intention built into a Bill, but quite another to see it implemented on the ground? It is the contention of Opposition Members that, worthwhile as the statements in the Bill are, in the context of this particular car crash of a Bill, some of those intentions around public health will be dead on arrival.
Liz Kendall
I thank my hon. Friend for her, as always, powerful and eloquent description of the realities of the Bill.
Liz Kendall
No, I am not giving way to the Minister.
Although I have said that a number of amendments in the group make minor improvements regarding NICE and the functioning of the information centre, they are overwhelmingly—
Liz Kendall
I have told the Minister that I am not giving way to him.
These amendments are overwhelmingly outweighed by the huge change put forward by the Government in abolishing an effective statutory model for healthwatch bodies locally, which was supposed to give patients and the public a strong and independent voice in the NHS. Labour Members cannot accept the Government’s removal of that statutory body, which they promised and have now betrayed. The amendments make a mockery of the Deputy Prime Minister’s claim in the letter he wrote with Baroness Williams to Liberal Democrat Members that the Bill will ensure “proper accountability” to the public. It makes a mockery, too, of the claims made by the Secretary of State and the Prime Minister that this Bill will put real power into the hands of patients and the public, and that there will be “No decision about me without me.” And, as the national body that represents patients and public involvement in the NHS has said, it is
“a betrayal of public trust”.
This is what has happened throughout the proceedings on a Bill for which the Government—Conservatives and Liberal Democrats—have no mandate, and for which they know they have no mandate. They promised that there would be no top-down reorganisation, but did not present any proposals for an independent regulator on the basis of the system that exists in the privatised utilities because they were worried about what people would say. Above all, on this fundamental issue, which concerns the say that the public and patients have in the NHS, the Government have—as the National Association of LINks Members said—betrayed people’s trust in what they promised, and for that reason we will not support the amendments.
Simon Hughes
These amendments—the last group that we shall consider tonight—contain important issues, including that of local community involvement, which was raised by the hon. Member for Leicester West (Liz Kendall). Like other Members, I have an interest in the subject, and have had throughout my time in politics. I happen to know Malcolm Alexander—who was cited by the hon. Lady—very well, because he was once secretary of Southwark community health council.
Let me present my honest opinion of the Bill to my friends on the Government Front Bench. It is not the Bill that I would have presented to Parliament. I think that it has gone much too far in its efforts to introduce top-down reorganisation, which is not what we told the public we would give them; and although there was a fine balance between the arguments in favour of primary care trusts and those in favour of the new structure that we have created, I believe that by changing what we said we would do we have caused more uncertainty, not least among health professionals.
Nevertheless, I am convinced that the process to which the Bill has been subjected has improved it hugely. I am convinced that a year ago my party colleagues performed a public service by setting out an agenda for change, and that we have helped to persuade the Government to amend the Bill in 2,000 different ways. That is not my figure, but one given by the Library in a note with which it provided us before the debate. Since the Bill returned to Committee about a year ago, 2,000 amendments have been tabled, many of them in the House of Commons after the Future Forum had done its work. Today we are considering—technically—374 amendments, all of which are going in the right direction.
It is interesting to observe that only three Labour amendments have been tabled today to the changes proposed by the House of Lords, and that two of them dealt with the same issue. Effectively, that means that the Labour Front Bench has sought to change only three of the many proposals made by the Lords. Of course the 374 amendments are not all substantive—some are consequential, and some are small—but we should not undermine or understate the substantive changes that have been made since the Bill left this place.
Many outside the House believe that there is an opportunity for Members of Parliament to vote on every Bill at the end of all its proceedings, and to deliver a final yes or no decision. There is not, although I think that there should be. I hope to persuade colleagues that we can change our procedure so that all public legislation, whether it starts in the Lords or the Commons, ends up in the Commons for Third Reading. I think that that would make for more democratically accountable decisions. We could then examine the Bill as amended by the Lords, and take a final view. However, we are not there yet; tonight we are considering all these amendments, and with them I thoroughly concur.
I have listened to the debate about accountability, and I accept that there is real disagreement on whether the new system proposed by the Government, at short notice, is an adequate substitute for the statutory HealthWatch. I remember a time—the hon. Member for Leicester West was not in the House then—when, from the Opposition Benches, I ferociously opposed the Labour Government’s proposal to abolish community health councils. I thought that it was a move in the wrong direction, as did my constituents. I still believe that any measure that does not empower my constituents— and the hon. Lady’s in Leicester—and enable them to become involved in decisions, consultations and processes will not be a good thing.
Ministers have been asked some perfectly proper questions today, and I am not 100% persuaded that their answers suggest that we will have the best possible system. Let me be absolutely honest: I believe that although, by and large, the amendments contain huge improvements, there is a great deal of unfinished business. Some will be dealt with in regulations, which will enable us to return to these matters, while some will be judged on the basis of experience.
I asked my hon. Friend the Minister of State to put on record the way in which the public can be more involved, because I am clear that there are significant additional opportunities for the public to become involved. That is why, in those areas, it is a good Bill. I am clear that local councils should have more involvement. He may remember that, as my party’s representative when the Bill setting up the Greater London authority was introduced, I argued that the GLA should have the power of the London strategic health authority, so that there would be a democratically accountable strategic health authority. I have always believed in more accountable local health services and in local councillors and councils having more say.
Liz Kendall
The right hon. Gentleman says that there is more to do and that that can be done in regulations, but that is not the case on the amendment that we are being asked to agree, which will abolish local healthwatch organisations as statutory bodies. That cannot be changed in regulations. Will he vote against that?
Simon Hughes
I understand that. I was not pretending that everything could be dealt with in regulations. I said to the hon. Lady, I hope fairly—I am trying to be fair—that I thought she made a good point that the proposal has come late in the day and does not have the support of the people leading the community involvement at the moment, one of whom she cited and whom I have known for many years. I do not think that the Government have yet given a full explanation of why the new proposals are better than the old ones. I understand why they have suggested that there should not be a one-size-fits-all approach, but I hope that in his winding-up speech the Minister will explain, because I think that Ministers have a case to answer.
Andrew George
My right hon. Friend will have heard me intervene on my hon. Friend the Minister of State on that issue, seeking the rationale behind the decision to remove the statutory basis for HealthWatch. As I understand it, his response was that there would be a statutory measure to achieve this—healthwatch organisations would be tied in with local authorities. Does my right hon. Friend agree that there is a potential weakness there? If we are seeking to integrate health and social care, a conflict of interest may arise if a body is tied in with the local authority but is also supposed to be scrutinising the activities of that authority.
Simon Hughes
I understand that point and share some of those concerns. I hope that the Minister will explain before the end of the debate why the more variegated model will not carry the risks that were alluded to by the hon. Lady when she read from the document earlier and by my hon. Friend.
I want to flag up two other things in relation to accountability, one of which is to do with the decisions made by the commissioning groups. Like many colleagues, I met a group of my local doctors again the other day. They had two areas of concern. First, they had concerns about the Bill. There is a lot of work to be done by Ministers and by all of us to allay concerns about the Bill when it becomes an Act—that is, on the basis of the facts, not the fiction. There is a huge amount of work to do. I do not think that we should underestimate that. Secondly, they have concerns about the system as it is now, before any measures have become law. I hope that Ministers have heard those concerns, some of which are not of this Government’s making but derive from previous legislation.
There is a concern that there is an excessive interest in some places in looking for private work and private contracts. There is a concern that the middle class and well heeled will speak more loudly and influence the commissioners in their interests, rather than in the interests of the poor and the vulnerable. That is a real issue in a constituency such as mine, where a lot of people are on low incomes and in need of a good public health system.
I want to put on the record that, although I understand the argument about getting rid of tiers of management and giving GPs the power to commission, and that is a good thing, it will not be a good thing if the decisions end up being taken not by GPs and the commissioning groups and the people who are meant to be taking them, but by the people they appoint to do the work for them. They may be private sector companies or somebody else. We have to make sure that it is health service professionals who make the decisions, in an open, accountable and transparent way, not people they employ, who may have a big vested interest in capturing more work for their own commercial gain.
Paul Burstow
Just to be absolutely clear, may I say that clinical commissioning groups cannot subcontract decision making about their commissioning functions—that is crucial to the effective delivery of this. On the issue of the local healthwatch organisations, the Bill makes it clear that local healthwatch has to exist in each locality, and that local authorities have to contract for it to exist and to provide the range of services that the Bill provides for it to undertake.
Simon Hughes
I absolutely understand both those points. I understand that commissioning groups cannot subcontract their decisions, but the point I am making to my hon. Friend and to other Ministers is that we have to ensure that the groups do not end up in the position where, although they retain the decision, they leave lots of the thinking about it to the people they employ to do the work. The decisions have to be made by the health professionals. In reply to the Labour amendment, the Minister rightly said that it is a safeguard that local authorities will have the decision on the local healthwatch. Where a local authority is concerned that it should remain in a particular format, it will be able to do so.
In conclusion, I am clear, as I have said to Labour’s Front-Bench team, to constituents and to my friends on the ministerial team, that our constituents still have a huge amount of concern about this Bill; I am clear that a lot of it has arisen because of misinformation and misrepresentation; and I am clear that this is not a privatisation Bill and not a “carve up the NHS” Bill. However, everyone, including Government Members, will need to continue to be vigilant and to continue to talk to the health professionals. I hope that the Government and the health professionals will start talking again very soon. We will also all need to make sure that we understand their concerns and pass them on. I know what my constituents want at the end of this debate; they do not actually want lots of conversations about structures of the health service.
Andy Burnham
I listened to what the right hon. Gentleman said about misrepresentation and I wonder who he had in mind. Did he have in mind the members of his own party who went to Gateshead and asked for the Lords not to support the Third Reading of the Bill, although they did so yesterday? Did he have in mind those people who raised the most serious concerns about this Bill? I am talking about his own party members, who overturned his party’s leadership. I will not sit here and have him suggest that the concerns exist only among those on this Front Bench, because that is not the case; they exist throughout the country, and he needs to acknowledge that.
Simon Hughes
Let me deal with both those points. I acknowledge that absolutely. On past occasions, the right hon. Gentleman has been to our party conference, although I do not think he came to the Gateshead conference. [Interruption.] It appears that one of his colleagues did. There were and are concerns in my party about this. My party wrote the plan for the NHS, which the good Labour post-war Government implemented, so of course we think we are as much the proprietors of the NHS as his party and of course there are concerns. There are many concerns—many colleagues are not happy with the Bill—and I am owning up to that.
I am absolutely clear about that, but do not let the right hon. Gentleman misrepresent what happened at Gateshead. My party is a democratic party. It is more democratic than his, thank God, and much more democratic than the Tory party. Our party voted to commend the Lords for the work they had done, but to suspend judgment on the Bill. My party neither voted to say that the Bill should not go ahead, nor to decide that the Bill should go ahead. That was what the debate, in the end, was about. There was not quite a majority saying, “Stop the Bill”; that was not the view of the conference, although there are many people in our party, as there are in his—this view is also shared by some in the Tory party and elsewhere—who would want the Bill to be stopped.
The Bill is not going to be stopped; it will become law. The Bill contains many good things. My concern now is to reflect what constituents, both health professionals and those who are not health professionals, come to talk to me about. They feel that there is a need to get back to concentrating on the things that really matter, such as making sure the wards are clean; making sure that the staff are of the highest quality; making sure that the waiting times go down; making sure that we can get decent care for the mentally ill; and making sure that our NHS is able to do better on all that it does. That is what the concerns are.
I want to make sure that Ministers understand that once the Bill is on the statute book there should be no cause for rejoicing, because this is not a matter for rejoicing. It is a matter of a challenge for Government to go back in humility to the health professionals and say, “We may not have got it all right—we may have got some of it wrong—but we are willing to listen, to learn and to work with you.” In the end it is collaboration between local authorities, local councillors, local people, Ministers, parliamentarians and those millions of fantastic people who work in the national health service who will make sure that the health service survives. It will survive and prosper in this country as a public health service—thank God—and we must all work together to respond to concerns, alleviate fears and not fan the flames. We must make sure that from now on we work on the basis of facts, not fiction, and that we work with those who have the concern, like we do, that the NHS should survive and prosper.
John Healey
I had not intended to speak in this part of the debate but I was so underwhelmed and unimpressed by the Minister that I felt moved to do so. It is interesting to follow the right hon. Member for Bermondsey and Old Southwark (Simon Hughes). I think he was offering his support to the Front-Bench team, but often it was not entirely possible to be certain. One thing he talked about was quite telling—the flaws in the systems we as a Government tried to put in place after we did away with community health councils. The Secretary of State and his colleagues were very critical about those arrangements when they sat on the Opposition Benches. One might have hoped that they would make their criticisms and learn the lessons and not repeat some of the mistakes that we certainly made in the arrangements for a strong patient voice and strong patient representation after the community health councils, but this evening’s debate and what we have been presented with in this final stage of the Bill make it quite clear that that is not the case.
At the heart of the proposal in the White Paper, which was co-signed by the Prime Minister and the Deputy Prime Minister in July 2010, was the proposition to put patients at the very heart of the NHS. That was common ground and was supported by many. It was a promise that really went to the heart of the proposition about the NHS changes. Despite that promise, it is clear that patients are not at the heart of the NHS but at the margins. The slogan for patients that there will be no decision about me without me is simply that—a slogan. I remember that early in the autumn of 2010 patient groups who were trying to come to terms with the plans were saying—quietly at first but more loudly later—that the arrangements in the White Paper and then in the Bill when it was first introduced in the House would lead to less involvement of patients in future, not more. Since that point, the Bill has had more than 1,000 amendments—some 374 amendments were made in the other place and we have four hours to consider those amendments tonight—but looking at the Bill now I can see very little difference from the position as it was first expressed almost 18 months ago, when it first caused concern to those patient groups.
In this area of all areas in which party politics should not be part of provision for a strong patient voice, representation and safeguarding, I want to take the Government at their word. They said that they wanted to set up at the heart of the NHS a strong independent voice for patients. The House needs to consider what that means, and to do that we need to go back to first principles.
It seems to me that there are four principles or characteristics which must serve as yardsticks by which to measure whether an organisation can be a strong, effective voice for patients. The first is independence. In order to function as a strong, fearless voice for patients, any organisation that acts on their behalf must be independent of commissioners, independent of providers and independent of regulators because part of its job on behalf of patients may well be to stand up to and criticise the providers, the commissioners or the regulators at some point in fulfilling its duties. The arrangements that the House is asked to approve tonight fail that first basic test of an effective organisation for patients.
The second principle or yardstick is representation. If the organisation is to be an effective representative voice for patients, clearly it must have some representation system and accountability to the people on whose behalf it acts and speaks. Again, on that test, the arrangements that we are asked to approve tonight fail. The third principle or test of an effective patient organisation is whether it is rooted or grounded in good local information and monitoring. Again, nothing in the arrangements and nothing I heard from the Minister, who has now left the Chamber in the middle of the debate that he opened, gave me any reassurance that that third principle or test is met in the arrangements.
The fourth test or principle for an effective, independent organisation surely must be adequate resources. There are serious questions over the nature, the level and the system for the resources that will allow such an organisation to do the job that we in the House are legislating for it to do on behalf of patients.
At a national level first, I say to the Secretary of State as his junior Minister is not present that setting up HealthWatch England as a sub-committee of the Care Quality Commission just does not cut it. It is implausible that a body can act impartially and fearlessly on behalf of patients if it is a sub-committee of the care regulator. How can it be, and equally important, how can it appear to be independent and authoritative, if it is set up within the administrative, organisational and financial embrace of the CQC? The CQC itself is clearly one of those organisations that HealthWatch England and local healthwatch bodies may need to stand up to and criticise.
There was an amendment in the other place to give the Government an opportunity to change their mind and set up HealthWatch England as an independent statutory body. That Labour-led, Labour-moved amendment was defeated in the other place, I am sad to say, by a combination of Conservative and Liberal Democrat peers.
Secondly, on the local healthwatch organisations, I think I understood what the Minister said earlier—that the Bill introduces a statutory duty on local authorities to set up a local healthwatch organisation. Placing a statutory duty on a local authority to carry out a particular activity is very different from creating a statutory basis for that organisation to operate in its own right. How will that arrangement at local level ensure independence, representativeness, good local links and resources—the four things that I would argue are the essential elements of an effective organisation on behalf of patients? On the fourth point, which is about resources, I may have missed something in today’s debate or in the debate at the other end of the building, but we still have not had clear answers to the following questions. I would be grateful if the Minister answered these questions when he deigns to return to the Chamber to respond to the debate, unless the Secretary of State will be doing that himself.
First, will local healthwatch organisations be funded directly by the Department of Health? Secondly, if funding will go via local authorities, what will the mechanism be for that funding? Thirdly, will funding for local healthwatch organisations be consistent across local areas so that patients, wherever they live, can be confident that they have a strong local representative organisation working on their behalf? Otherwise, this is legislation for a local lottery in patient representation and the strength of local patient voices.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
I congratulate my right hon. Friend on the many excellent points he is making. Is it his understanding, as it is mine, that all the local healthwatch activities could be carried out by private sector—and therefore, for-profit—bodies? Does he feel that providing the strong, independent, representative voice for local people should be a profitable activity for private sector organisations?
John Healey
My answer to my hon. Friend’s second question is no, and I do not know the answer to her first question, which should really be directed to the Minister. We need an explanation of how the system for setting up, or in effect franchising, local patient organisations will be carried out, what sort of framework that will take place in, and what standards, if any, will be required for the way they are set up and run.
Fiona O’Donnell (East Lothian) (Lab)
Does my right hon. Friend not find it incredible that after a pause, two Bill Committees and all the debates in this place and the other place, we still do not have answers on a matter that is so important to patients?
John Healey
I find it dismaying, because there are so many people who are committed to the health service, work in the health service or are dependent on the health service, as we all are, and they want answers to that question, but the Government are simply not giving them. To be honest, I think that this stems from the genesis of the legislation, something that was ruled out explicitly in the Conservative party manifesto and the coalition agreement but then sprung in a White Paper less than two months after the general election. That meant that the civil service, the health profession and the NHS were unprepared for this huge reorganisation and this huge Bill, so in many respects, beyond the main decisions set out in the White Paper in July 2010, all the evidence indicates that the Government are making it up as they go along. The fact that we have seen more than 1,000 amendments to the Bill since it was first introduced is a further indication of that.
Is the Minister coming back?
Nic Dakin (Scunthorpe) (Lab)
My right hon. Friend is making a very decisive set of points. I would like briefly to draw his attention to the local patient healthwatch group in north Lincolnshire, Who Cares, which has produced some hard-hitting reports on matters such as mental health and discharge from hospital. Does he feel that arrangements are being put in place that will allow that sort of independence of view and those hard-hitting reports that help to improve the quality of care in future?
John Healey
My hon. Friend hits right at the heart of the flaws in the arrangements proposed tonight, which I was going to move on to. I am sure that Who Cares has its ear to the ground, good local connections and strong representation, and I want to see that continue, as I am sure he does. The real question is whether those organisations can go beyond hard-hitting reports, and who then will be accountable for the action that might need to be taken to follow them up. Where are the enforcement powers that could ensure that any problems they identify on behalf of patients are properly dealt with? I will move on to that point in a moment.
In a sense, that links to the point I wish to put to Ministers now. In the arrangements before us it seems that if a local healthwatch organisation is not up to standard, is not doing the job and is somehow failing patients in an area or falling short of what is expected, we will be offered a new provision, a new power introduced by the Government through an amendment in the other place, for HealthWatch England to write a letter to the local authority, telling it that it must do better. Thinking of the two local authority leaders in the area that I am privileged to represent—Steve Houghton, the leader of Barnsley metropolitan borough council, and Roger Stone, the leader of Rotherham metropolitan borough council—I could not use language in this House that is likely to reflect their reaction. If I think of them, as elected local government leaders, receiving a letter from a sub-committee of a national quango responsible for regulating things that their local authorities have little or no responsibility for, telling them that they are not doing their job properly, I can just imagine their reaction. Quite frankly, “You’re having a laugh.” That is simply not a serious power of, or provision for, redress on behalf of patients when a local patients’ representative organisation is failing to do the job properly. So, no enforcement powers and no intervention powers, only the power to write a letter to the local authority.
In the end, that brings us to the point. At this stage, in the final hour, at the end of this extraordinary Bill’s passage through Parliament, we can see very clearly the truths at the heart of it. There is provision for an independent national commissioning board, an independent market regulator and independent hospital foundation trusts, but there is no provision for an independent patients’ organisation.
In this Bill there are powers to ensure strong action to guarantee competition, strong action to guarantee financial efficiency and strong action to guarantee professional concerns, but there are no powers to guarantee any sort of action, let alone strong action, on behalf of patients.
I listened very carefully to my hon. Friend the Member for Leicester West (Liz Kendall), who made a very good speech from our Front Bench. When she notes that the representative body, National Voices, says on behalf of patients and interests groups, “You’re setting us up to fail,” and reads the letter from Malcolm Alexander, the chair of the National Association of LINks Members, who says, “You’re creating weak bodies that will not be independent,” I think that we in this House should be worried. Such action is, to borrow a phrase, pennywise, pound foolish. The Government are cutting what to Ministers and civil servants might seem to be small corners, but there could be big consequences for patients.
I see a link—a common characteristic—between this debate and our earlier debate on the risk register. The Government will live to regret at length poor judgments and decisions made in haste and under pressure now. The Secretary of State will face the question of whether to release the transition risk register. If he insists on remaining resolute in refusing to disclose, and if he insists on keeping it secret, patients will ask, “What are they hiding from us?” In the future, in the months ahead, long after the Bill has received Royal Assent and is on the statute book, patients will rightly ask when things go wrong, “Did they know these risks were there, and why didn’t they tell us?”
The same applies to HealthWatch. When things go wrong, patients will find that they do not have the recourse and the representation that they may need to act and intervene on their behalf, and they may well find that the arrangements that we are invited to pass tonight are too weak to help them. I say to the Health Secretary, who is now on his own on the Front Bench, that this is likely to reinforce that lack of confidence and lack of trust in the notion that the Government’s huge upheaval in our NHS, and this huge piece of legislation before the House, really is in the best interests of the NHS and NHS patients.
Liz Kendall
On a point of order, Mr Deputy Speaker. Is it in order for the Minister who moved these particularly important amendments, which will abolish a statutory organisation, HealthWatch, to be absent from the debate? If it is in order, is it not a huge discourtesy to Members on both sides of the House?
Mr Deputy Speaker (Mr Nigel Evans)
I thank the hon. Lady for her point of order. It is in order for the Minister not to be here at this moment in time, and it is up to each Member’s judgment as to what to make of that.
Andrew George
It is a pleasure to follow the right hon. Member for Wentworth and Dearne (John Healey), who has taken us round a number of issues, particularly in relation to the public’s ability to scrutinise, through the proposed healthwatch organisations, the effective delivery of commissioning in their areas.
As my right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes) suggested, there is a desperate need for provision within our procedures whereby important Bills such as this, which have been significantly altered in another place, can be reviewed on Third Reading. Our earlier debate about the still unpublished transitional risk register was, in a sense, a proxy for that lack of a Third Reading debate.
This debate has placed public health and the role of HealthWatch, particularly local healthwatch, in the context of local health services being placed at risk. We have already discussed how clinical commissioning groups may be fundamentally conflicted. In my contribution to that debate, I posed questions about the conflicts that intrinsically exist within those organisations. I believe that HealthWatch should be there to provide scrutiny of those conflicts. Throughout the debates on the Bill, fundamental concerns have been expressed about the fragmentation of local health services. We need a strong and independent-minded local healthwatch in all our areas to be watching for that and looking out for opportunities to maintain the integration of local services.
I fear that one of the effects of such a major reorganisation of the health service nationally and locally will be to make it more difficult to deliver the £20 billion efficiency gain that the previous Government proposed and that the coalition Government intend should be delivered. That issue needs to be considered at national level, with HealthWatch, and at local level. I believe that we need an independent body that is capable of ensuring that efficiency gains are being achieved at local level and that keeps an eye on the commissioning and delivery of local health services.
The Royal College of Nursing has said today that there is a need to look carefully at staffing levels in front-line health services, including in acute hospitals. There is a debate about whether that should be mandatory. That has long been a concern of mine when looking at the delivery of local health services and it is identified by people when they visit hospitals. There are staff-to-patient ratios that, in my view, are barely tenable and barely safe. Qualified nurses are struggling to provide the support and care that patients require, simply because the staffing ratios are inadequate. The same ratios may have been adequate in the past when the throughput of patients and the acute status of patients were lower, but with the current turnaround of patients and their acute status, it is no surprise that the RCN’s survey has identified the need to review staffing levels in our wards.
The Secretary of State for Health (Mr Andrew Lansley)
In commenting on the level of nursing staff, will the hon. Gentleman observe that since the election, there has been a 5% improvement in the ratio of nurses to occupied beds in general and acute wards?
Andrew George
I am not in a position to doubt that figure. The question is whether the ratio is sufficient to ensure that there is safe staffing in our hospitals now, as the RCN identified after a recent survey. I understand the argument advanced by Ministers that it comes down to the management and the management of paperwork within hospitals, and is not just about staff-to-patient ratios. I do not want to have a debate just about staff -to-patient ratios, but that issue has been raised today and I believe that it resonates with people out there in the country, who can see that nurses in particular are struggling to provide adequate services within their hospitals. Those ratios have an effect on the level of care that nurses can provide, as has been found by a variety of reports. The problem is not down to the callousness of the nurses or untrained care assistants who provide the services—where that exists, it should clearly be rooted out of the service—but to whether staff resources are sufficient to maintain safe services on our hospital wards. I think the RCN is right to raise that issue.
That concern is relevant to ensuring that we have adequate local healthwatch services because it shows that we need independent scrutiny of the health service by a body that is not in the pocket of anyone, including the local authority, but that is able to scrutinise hospitals and speak out about staffing levels in its area. We cannot be dependent on the RCN reporting such matters to the Department and on there being top-down diktats that impose mandatory staffing levels that apply in all circumstances. Rather, there should be a local healthwatch that looks at the guidance and recommendations of the professional bodies and ensures that the services in its local hospitals are adequate to provide safe nursing and hospital care. That is why it is important to ensure that the local healthwatch bodies are, as far as is possible, independent of any external influences, whether from the Department, the NHS Commissioning Board, clinical commissioning groups or the local authority. That is where I shall take my arguments.
Fiona O'Donnell
I feel as if I have been here before, in that I agree with some of what Government Members are saying. Will the hon. Gentleman therefore vote with us tonight?
Andrew George
I shall sidestep that question at present and return to it later, because I first want to listen to the Minister’s winding-up speech. As I want to ensure that he has adequate time, I shall conclude my remarks as swiftly as possible.
I could, however, initiate a brief yah-boo interlude, such as by saying that the previous Government got rid of community health councils. Many people look back at the era of CHCs as the halcyon days of independent scrutiny of local provision. In creating local healthwatch, we should as far as possible mirror, and learn from, the excellent services provided by the CHCs.
Liz Kendall
On 26 October 2006, when the Secretary of State was the shadow Secretary of State, he set out his policies on HealthWatch. He said:
“I envisage it as an independent body with a separate funding stream and the right to decide its own agenda of work.”
Does the hon. Gentleman agree that that has been completely changed under this Bill?
Andrew George
Earlier, I asked a question about the rationale behind the last-minute change from having independent bodies to the situation now, under which, as a result of both a proposal we are debating this evening and an amendment tabled in the Lords, we are allowing local authorities to commission community interest companies or others to provide the healthwatch function in their areas. That ties the local healthwatch into the local authority. I believe we should devolve and localise, and empower local communities as far as possible, but this change does not achieve that. Instead, it empowers the local authority. If there is a genuine intention to ensure that we have integrated health and social care, then there is a problem here. If the local authority provides both the social care and the local scrutiny, I fear we may not have effective scrutiny of the work of the local authority in this regard.
Liberal Democrats in the Lords have done excellent work in advancing a large number of amendments to improve the Bill, and I am perplexed that the proposal before us tonight appears, in effect, to backpedal from that progress made in other areas. That is why I hope the Minister will reassure us on the rationale for this proposal, and assure us that the new body will be genuinely independent and genuinely effective. I shall therefore reserve judgment on the question of which way to vote tonight.
Grahame M. Morris
Although the HealthWatch issue is important, in the brief time available to me I want to talk about Lords amendments 249 to 283, dealing with the health and social care information centre and patient confidentiality. The amendments raise several issues about who would have access on a mandatory basis to the information provided by the centre as well as changes in the terminology used to refer to the persons who would be able to make such requests. There are important issues here about patient confidentiality and protections to ensure that the right checks and balances are in place. I am sure Ministers will be well aware of the arguments made in Committee about the issue, and I wish to seek some assurances and express some concerns. Perhaps the Minister may be able to address some of them.
One issue that was raised in Committee was the power of the Secretary of State to direct the information centre as he wishes. The Opposition think it is a good thing that the Secretary of State should discharge certain powers, particularly when failures happen, and be held to account for them by the House. Naturally, we support the view that people should have greater access to, and control over, their health and social care needs and the care that they receive. I am sure the whole House can subscribe to that idea. However, the opportunity to access health and social care records has to be tempered by protections for patient confidentiality and, equally importantly, protections to prevent the misuse of information by private bodies.
The Opposition have raised the issues of access to patient information and privatisation, and expressed concerns that sensitive information may find its way to organisations that will use it for commercial reasons. In Committee, my right hon. Friend the Member for Rother Valley (Mr Barron) spoke about the value to patients of anonymised data, which enable them to make relevant choices. It is not a huge leap of faith to imagine that those same data would be commercially valuable to pharmaceutical companies and commercial interests. I am concerned to hear from the Minister that adequate safeguards are in place in the Lords amendments.
Fiona O'Donnell
It is valuable to the debate that my hon. Friend is highlighting his concerns about confidentiality. Does he agree that a theme running through the Bill is that it will undermine the confidence that patients can have in the people who deliver services to them?
Grahame M. Morris
I do agree. Indeed, Professor Steve Field, whom the Government appointed to head up the listening exercise, agreed. He stated:
“Better information systems and the development of more integrated electronic care records will be a major enabling factor.”
Without better information sharing with patients, and between professionals across organisations, it will be quite difficult to provide better co-ordinated and integrated care, which we all want to see. As you will be aware, Mr Speaker, I represent a former coal mining area. One of the slogans on the miners’ banners in Durham is, “Knowledge is Power”. That is a true sentiment that can be applied equally to health policy.
The buck should stop with the Secretary of State. In Committee, we considered the possibility of failure in NHS organisations, and Ministers reassured us that the issue would be effectively addressed in amendments. I would like some reassurance this evening that Ministers can foresee patients gaining greater access to their records, and I would like some detail of how that might be achieved. In view of the current cuts to the service—[Interruption.] Not the new centre that has not been set up, the existing NHS Information Centre. In view of that, is the Minister setting out any red lines for accomplishing the ambitious targets that he has set out in the Bill?
A House of Commons Library briefing note defines the role of the health and social care information centre as a special health authority. It states that the NHS Information Centre will be
“a non-departmental public body. In its role collecting data to support central bodies in discharging their statutory functions, it will have powers to require data to be provided to it when it is working on behalf of the Secretary of State or the NHS Commissioning Board”.
The Minister said that he had not cut funding, but there have been cuts to funding this year to the NHS Information Centre, which is separate from the new body that is being set up by the Bill.
Chi Onwurah
I congratulate my hon. Friend on the important points he is making, particularly his last point on public health. He and I represent constituencies in the north of England that suffer from great health inequalities. Does he agree that knowing and understanding those health inequalities is an essential part of being able to address them?
Grahame M. Morris
I agree with my hon. Friend and am grateful for her intervention. Those points were exercised in a recent debate in Westminster Hall. The basic point that I seek to make—I will finish on this—is that in order to plan effective health interventions, we need an effective and reliable evidence base. I would like assurances from the Minister that the necessary funding will be in place to ensure that that is delivered as a consequence of that measure in the Bill.
Stephen Pound (Ealing North) (Lab)
May I trespass upon your good nature, Mr Speaker, to endeavour to speak on behalf of the House to praise my hon. Friend the Member for Easington (Grahame M. Morris), who is not well, but who has risen from his sick bed to join us today because this subject is of such importance?
Those of us who stood at the Bar in the other place listening to the debate—[Interruption.] Not that bar. Those of us who stood at the Bar of the other place listening to the debate on the Bill cannot help but to have been massively impressed by the breadth and depth of expertise that was displayed. We had past presidents of royal colleges and consultants, and people from every aspect of our glorious national health service, giving their expertise, passion and analysis.
I come from a slightly different perspective. I spent more than 10 years working in the national health service—this is specifically in relation to the issue of health and wellbeing boards, in case you are worried, Mr Speaker—before community health councils were established in 1974, when, frankly, the NHS was not run for patients, people or the local community, and when there was little or no consultation with democratically elected local authorities, let alone with special interest groups or people representing areas that were ill served by the NHS. Community health councils had not only statutory powers, but a budget. They enabled the voice of the people to be heard in wards, corridors and A and E departments throughout the national health service.
We have heard tonight an extraordinary, agonising attempt on the part of the junior section of the coalition to justify what had been for years their principled support of a public voice within the NHS. The Liberal Democrats say that they will scrutinise the measure having voted to destroy that for which they have stood for so long. It is like somebody setting fire to a house and saying that they will time how long the fire engine takes to get there—and then criticising it. It ill becomes Members to draw attention to the shortcomings of other Members, but one speaker reminded me of those people in Spain who, on Good Friday, flagellate themselves up and down mountains trying to display their agonies. All the time, the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) tries to show us that he is not enjoying this—he is in agony but that agony will not deter him, I fear, from voting against the amendments.
Helen Jones (Warrington North) (Lab)
I hate to disagree with my hon. Friend but is not the difference between the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) and the flagellants of Spain that they believe they have sins to expiate, whereas he believes that whatever position he adopts today, even if it is the opposite of yesterday’s, is entirely right and proper?
Stephen Pound
I yield to no one in my admiration for my hon. Friend and her knowledge of the slightly occult religious practices of south Spain—and possibly of parts of St Helens for all I know.
But we did not expect the Spanish inquisition. We expected a valid, proper, sensible voice to enable the people to engage with their national health service. The NHS must not be an isolated ivory tower dominated by the old consultant gods who used to run it. It must not be a matter of non-responsible bureaucrats in quangos sending letters of suggestion. The NHS must contain a proper mechanism for the people’s voice to be heard and, above all, for the involvement of the wider community. The NHS cannot be a stand-alone organisation; it has to be involved with local councils and local communities, but everything in the proposals for this mealy-mouthed, milquetoast healthwatch nonsense dilutes and destroys that.
All the proposal does is create a false illusion—a falsity; the suggestion that somehow the voice of the people will be heard through this mere sub-committee of the Care Quality Commission, a committee whose mighty weapons arrayed against the forces of reaction and conservatism consist of the ability to write a letter. Such a letter would have to be vast, powerful and extremely effective, and would have to do what no letter has ever done in the history of epistolatory warfare. It would somehow have to persuade people on this gentle nudge—I appreciate that there are those on the Government Benches much given to the modern, modish philosophy of the nudge, but there is nudging and there is fudging, and what we have heard tonight is a fudge-nudge.
Above all, however, there is a crucially significant and important point here.
Jim Shannon
Do the hon. Gentleman’s exhortations mean that the pen is not mightier than the sword?
Stephen Pound
I am not entirely sure, Mr Speaker, whether you would allow the debate to go down that line, but were anyone in Northern Ireland to suggest a model such as that being proposed tonight, they would get a very dusty answer—it might not be replied to with sword or pen alone, but it would certainly be responded to.
The NHS is not something that we choose to buy into or out of. It is something that we all subscribe to. For many people—I should think everyone in this Chamber except me—it is a part of their birthright. People have been born under the NHS, have lived with the NHS, have funded the NHS and have supported it, and their voices must be heard. What we have tonight does not represent a valid mechanism for people to engage with the NHS. That is the key point. It is simply not good enough to set up a sub-committee of a quango and imagine that it has any force. We must realise that, yes, people may have different political opinions and there might be different priorities, but we do not have differential rates of national insurance. We pay national insurance because it is our national health service, and we have a right to have our voices heard.
Fiona O'Donnell
Does my hon. Friend agree that part of the problem is that such a complex measure is before the House? The Government’s thinking was not developed in the early stages, and the Conservatives’ coalition partners have contributed nothing throughout our scrutiny in Committee. That is why, at this late stage, the Opposition are still left trying to amend and improve the Bill.
Stephen Pound
As ever, my hon. Friend makes an important point. In responding to it, I would like to ask the House to cast its mind back to the contribution of my right hon. Friend the Member for Wentworth and Dearne (John Healey). He rightly said that this is not an issue of party politics. The fact that we see party politics in its worst form—its most loathsome shape—forming before our very eyes, clouded in some foul, mephitic, stygian Hades, is to be deplored. We should all listen to my right hon. Friend and actually try to admit to ourselves that we do not know everything—that the people’s voice does deserve to be heard and that the national health service is just that: a national health service, for all people. Everybody has that right to have their voice heard.
Lilian Greenwood (Nottingham South) (Lab)
Does my hon. Friend agree that one of the deepest problems with this Bill is that the people’s voice has not been heard? These proposals were never put before the people in party manifestos. That is exactly why they feel so very angry.
Stephen Pound
I am grateful to my hon. Friend for her question. It is a great sadness and reflects ill on my personal life that I spend many a night browsing through Liberal Democrat and Conservative manifestos. I have searched; I have examined; I have deconstructed; I have applied the principles of Jacques Derrida to those manifestos. Have I found in there any smidgen, any suggestion, any hint or any implication that the NHS was to be fragmented, privatised and ultimately destroyed, and the connection between the people and the NHS to be ripped up, torn into shreds like the integrity of the Liberal Democrats, hurled from the window to flutter in the breeze of history, never, ever to be seen again? Had I found that, I would almost certainly have voted Labour—but as I did so anyway, that is neither here nor there. But the point that my hon. Friend makes is absolutely right. How can the people, who fund the NHS, who are born in the NHS, who live in the NHS and who will ultimately quit this mortal bourn in the NHS—when they depart this vale of tears, it will be with the comforting arm of the NHS about their shoulders—feel that they are best served by this organisation if their voice is not heard?
Fiona O'Donnell
If it is difficult for those people to imagine how they can rely on the NHS, surely they should take a lead from the Lib Dems at their spring conference and show Liberal Democrat Members that they need to listen to their members and vote with us this evening.
Stephen Pound
My hon. Friend tempts me down a partisan path. I hope she will forgive me if on this occasion I will not follow so closely behind her. All I will say is that Gateshead—that wonderful, glorious city—has been demeaned by the presence of those who spin endlessly before our eyes, desperately trying to justify their own appalling behaviour.
What we have this evening is a Bill that is inchoate in its extremities. There are so many different clauses. I challenge any individual to respond to a question on the total number of amendments that we have had to face before tonight. But above all, leaving aside all the numbers, the clauses, the subsections, there is at the heart of all this one basic irrefragable—
Mr Speaker
Order. [Hon. Members: “More!”] Whatever the views of Members, there is no time for more.
Mr Speaker
We come now to the petition. Before I call the hon. Member for Hayes and Harlington (John McDonnell), may I ask Members who are leaving the Chamber to do so quickly and quietly—
Mr Speaker
If Members wish to stay, they should stay. If they wish to leave, perhaps they can do so quickly and quietly, affording the hon. Member for Hayes and Harlington the courtesy that they would want to be extended to them in similar circumstances.
DVLA Office Network
John McDonnell (Hayes and Harlington) (Lab)
The petition relates to the Government consultation on the future of the Driver and Vehicle Licensing Agency that commenced in December. The Government are now proposing to close the local network of DVLA offices, with the loss of 1,200 staff and the consequential effects on local economies and the licensing regime itself. The petition was signed by 40,000 people and it states:
The Petition of DVLA staff and service users in numerous constituencies,
Declares that the Petitioners believe that the DVLA Office Network is a service which is needed throughout the UK; declares that the Petitioners feel that the decision to close the DVLA Office Network and centralise services is a devastating blow to local communities who rely on the services provided, as well as to the 1200 staff who will lose their jobs; and declares that the Petitioners believe that decision to close the service needs to be addressed so that staff and the public can get some reassurances of job and service security.
The Petitioners therefore request that the House of Commons urges the Government to consult with staff, users and trade unions further, and to take all possible action to save the DVLA Office Network.
And the Petitioners remain, etc.
[P001013]
Education Projects (Nigeria)
(12 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Bob Blackman (Harrow East) (Con)
I am grateful to you, Mr Speaker, for allowing me to initiate this debate.
Last month I had the honour of participating in a visit to Nigeria on behalf of the all-party parliamentary group on global education for all. I was accompanied by my hon. Friends the Member for Maidstone and The Weald (Mrs Grant) and for Ceredigion (Mr Williams). I hope that I have pronounced his constituency correctly.
Our visit was aimed at understanding how Nigeria is addressing major educational challenges, specifically in the education of girls and community involvement in education. We also took the opportunity to meet Nigerian politicians as well to see the impact of British involvement on the ground.
Nigeria has a population of about 165 million people and has 10% of the world’s children of primary age who are not in school. Most of those are girls. There are considerable barriers to girls accessing education. This is cultural and physical and both those challenges are being addressed. We also wished to examine the use of Department for International Development funding and to ensure that taxpayers’ money is being used wisely and that value for money results.
Before we went to Nigeria we had the opportunity to meet the Nigerian high commissioner and all of his team. I found that the high commissioner and I had attendance at the university of Liverpool in common, although not at the same time. We uncovered a number of the challenges facing Nigeria, including the problem of corruption, which is well known. Virtually all politicians mention that as endemic in Nigeria.
James Wharton (Stockton South) (Con)
In August last year, I was on a delegation that visited Tanzania with Oxfam. One of the things that was most encouraging was the work that DFID is doing to transfer its budget from supporting Government funding towards localised projects that are making a difference, minimising the opportunity for corruption, to which my hon. Friend referred. Did he find that that was the case during his visit to Nigeria, and, if so, does he welcome it?
Bob Blackman
I thank my hon. Friend for that intervention, and I will allude to what is going on in Nigeria later in my speech. In particular, I will address the changes that have taken place since our coalition Government started running the Department.
The challenge in Nigeria is, of course, to make sure that proper action is being taken to address corruption. An inquiry, chaired by Farouk Muhammad Lawan, is being undertaken into the operation of Nigeria’s oil industry. He is also the chairman of education in the Nigerian House of Representatives. A clear-up of the operation of the petroleum industry should follow, which I trust will include the exposure of any alleged corruption. Transfers of funds from the Federal Government of Nigeria do not always seem to reach the proper destination. That may be a problem of bureaucracy, but it makes the monitoring of DFID funding all the more important.
One of the key barriers to participation in education is that of fees and levies. It is clear that there are mixed messages about whether young people are required to pay fees and what happens if they are unable to afford them. The adequacy of teacher training and the qualifications of teachers are a severe challenge. My hon. Friend the Member for Ceredigion will doubtless refer to that issue later. Girls are particularly challenged, as traditionally they are not educated. They are often forced to marry when very young—even as young as 12. They are seen to be needed in the home or as part of the farming community, so families do not recognise the value of their education. The role of traditional rulers is key in promoting education, particularly that of girls. Where that happens, the results are dramatically improved.
Mrs Helen Grant (Maidstone and The Weald) (Con)
Does my hon. Friend agree that girls’ clubs, similar to the DFID-funded project we saw at the Yangoji school near Abuja, are key in empowering young women and helping them to deal with many of difficulties that keep them away from school, many of which he has mentioned? The clubs give young women support and encouragement from their peers.
Bob Blackman
I thank my hon. Friend for that intervention. Clearly, not only enabling young girls to go into education but supporting them while they are there is crucial. That is one of the key elements of DFID funding that I strongly support and I trust it will continue well into the future.
Most schools do not have proper sanitation or even fresh water, and that is a considerable barrier preventing girls from being educated. DFID funding is being used to provide these basic facilities, and I warmly welcome that. No mention of Nigeria can be complete without referring to the security situation. The attacks orchestrated by Boko Haram have created problems, particularly in the north of Nigeria, and we should all express sincere condolences to the family of Chris McManus who, sadly, was murdered by his kidnappers recently.
Jim Shannon (Strangford) (DUP)
I congratulate the hon. Gentleman on bringing this issue to the House tonight. He has talked about DFID and about all the other groups that are helping. Is he aware of the many churches that do tremendous work in Nigeria through their educational projects? In particular, I am thinking of the Elim missions in my constituency, which, through Kingsway International, run an educational project that provides teachers and teaching, food and meals for the day and the books for the schools. It is not Government-funded; it is done through the churches themselves. Such projects also do tremendously good work in Nigeria, alongside all the other people who do likewise.
Bob Blackman
I thank the hon. Gentleman for his intervention. Clearly the work of churches, charities, Comic Relief and other organisations is extremely valuable in promoting the educational opportunities that are required in these areas.
On our visit, we had the opportunity to visit schools in Abuja and Lagos. We saw at first hand that DFID funding can make a big difference on providing toilets and new classrooms. In Abuja, we saw a school where thieves had stolen the water pump that provided fresh water for the children. One can imagine spending all day in school without access to fresh water or even basic toilet facilities. In Lagos, we saw a school that had had a new toilet block installed with DFID funding. However, we expressed concern that the cost of that—£37,000—seemed excessive compared with the cost of building generally in Nigeria.
It is important to recognise that the overwhelming majority of the population earn less than a £1 a day. We inquired about that project, particularly the procurement costs and the process that had been followed. We believe that DFID should carefully consider how best to ensure value for money in such a country as Nigeria. The tendering process seems fraught with problems and might not be the best way of obtaining good value for money. Surely we should be negotiating down these prices to make our money go further.
On our school visits we met the school-based management committees, which are equivalent to our school governing bodies. The main problem they face is training members and developing their powers. We heard at first hand how one SBMC had used its power to embarrass local politicians to release much-needed funding for a project. It used Facebook to threaten the governor that it would refuse to support his re-election bid unless funding was released for new classrooms. The governor released the money in a matter of days. DFID money is channelled via the education sector support programme in Nigeria and the girls’ education project. DFID will assist more than 800,000 children to enter education, including 600,000 girls, over the next four years. There can be no doubt that the ministerial team at DFID has ensured that proper targets and value for money are at the heart of the Department’s work. They have truly been the wind of change required for the projects in Africa.
We also had the opportunity to meet many politicians and officials, which helped to promote the relationship between the UK and Nigeria. In my opinion, this type of bilateral relationship is crucial as we increase the UK’s influence in the world. Anyone visiting Nigeria will be shocked at the wide disparity in levels of wealth and income. They will also be surprised, if not frightened, when being driven by car. The normal behaviour of car drivers in Nigeria is to sound their horn and point the car where they want to go irrespective of who or what is in the way. I should also report that my name became the subject of much hilarity for many of the officials I met. I would be a very rich man indeed if I had £1 for every time someone said “Mr Blackman? But you are a white man.”
Nigerians have a great love of the UK. They love premier league football, they universally love the Queen, they are staunch allies of the UK and they are a key member of the Commonwealth. China and other countries have seen the opportunities for investment there and we need to ensure that we retain and improve our relationship with Nigeria. There can be little doubt that Nigeria will become the key economy in Africa very soon, so it is in our vital national interest to continue to invest in infrastructure projects in Nigeria and particularly to invest in education.
Mr Mark Williams (Ceredigion) (LD)
First, let me congratulate my hon. Friend the Member for Harrow East (Bob Blackman) on securing the debate. Harrow is a lot easier to pronounce than Ceredigion, but I thank him for his efforts and for allowing me to make a brief contribution to the debate.
My hon. Friend has covered much of the ground regarding our visit to Nigeria, but I just want to reflect briefly on the position of teachers in Nigeria and particularly on the opportunities for meaningful teacher training. The four schools we visited near Abuja and in Lagos were certainly characterised by enthusiastic young people but also by inadequate resources and old-style “chalk and talk” teaching delivered from the front of overcrowded classrooms rather than through engagement with young people. Despite that, the young people we met seemed captivated by the experience and willing to sit it out to progress and try to advance themselves. I shall not forget being taken to a library in one of the schools we visited and seeing a couple of shelves of books, most of which seemed to be redundant computer manuals relating to four redundant computers—redundant because the school had no electricity supply—in the corner of the room.
In addition to what my hon. Friend said in reporting back our experiences, my hope tonight is that DFID will ensure in its reflections on strategies to support teacher training that teachers have the skills they need to teach in a way that is participatory and responsive to individual young people. In other words, while we remain concerned about the scale of the challenge, with the 800,000 people whom DFID projects are going to help back into classrooms, including 600,000 young girls, I hope that quality will become a feature of the teaching debate, not just quantity.
Mr Williams
I am grateful for my hon. Friend’s intervention. I shall come on to that. In a previous life I used to be a primary school teacher. The prospect of teaching 36 children in a school in the west country or in rural Powys fades into insignificance when compared with the size of the classes that we saw in Nigeria.
My hon. Friend the Member for Harrow East will recall a conversation that he and I had in Abuja with Mrs Ozumba, the federal head of primary education, which revealed the problems that Nigeria clasically faces. She said that Nigeria does not have enough people willing to be teachers, especially in rural areas. The profession is not incentivised. There is minimal job security and there are instances of teachers not being paid at all. There is little focus on technical and vocational areas of the curriculum which could benefit the Nigerian economy. Only pre-service teacher training is available. There is little, if any, in-service teacher training, and there is a need to build and cascade down some semblance of a teacher training structure.
There is, as my hon. Friend mentioned, a severe shortage of female teachers, who are essential as role models for young girls in school, and to encourage girls to stay in school and to be allowed by their parents to remain in school. With reference to the conditions that teachers as well as children face, I also remember the Yangoji junior secondary school near Abuja, where there were 788 children with no water supply whatsoever, the borehole that did not yield any water, and the children sitting in classes of 70. That was an issue for the children, but it was an issue also for the teachers.
Despite all the problems, the scale of the problems, the estimated 8.5 million children out of school, the huge sensitivities in the northern territories, and the gender divide, there is vast potential. That is the word that stays in my mind from my first visit to Africa, to Nigeria—the huge potential for that country. It is being advanced through laudable DFID schemes, the awakening of civic society via the school-based management committees that we heard about this evening, and a healthy questioning of where money is being spent. The press in Nigeria is a free press, challenging politicians to account for the money that is being spent and challenging the federal Government to honour the spending commitments that they have made.
DFID’s work remains essential and is much appreciated. The infrastructure works, and sanitation and building projects are evidently succeeding, but I hope DFID will continue with the third sector and the Nigerian Government to look at the human investment required in education. I end with one harrowing piece of research, commissioned by DFID, which suggested that of 42,000 grade 3 teachers in Kwara state who were given a test that their young students should have passed, only 19 passed. In short, I hope we will continue to emphasise and build upon the quality of education, as well as the quantity.
The Minister of State, Department for International Development (Mr Alan Duncan)
I thank my hon. Friend the Member for Harrow East (Bob Blackman) for calling tonight’s debate. I am grateful to him and his colleagues, my hon. Friends the Members for Maidstone and The Weald (Mrs Grant) and for Ceredigion (Mr Williams) for visiting Nigeria last month to see at first hand the challenges in education and the work that the UK is supporting to tackle those challenges.
My right hon. Friend the Secretary of State for International Development, my hon. Friend the Under-Secretary of State and I are all grateful to my hon. Friend the Member for Harrow East and his colleagues from the all-party parliamentary group on global education for the insights that they shared with us after their visit to Nigeria. Indeed, my hon. Friend the Under-Secretary is at this moment boarding a plane to Nigeria to follow up on these issues.
As my hon. Friend the Member for Harrow East learned during his visit, primary education in much of Nigeria is extremely poor. As he said, there are an estimated 8.5 million children out of school in Nigeria. It therefore has more primary-aged children not in school than any other country in the world, and the problem is particularly acute in the north of the country.
Nigeria’s education policies and their implementation are poor, having suffered many years of decline under military dictatorships and mismanaged oil revenues. Financial releases to schools are erratic and education officials and teachers struggle to improve schools. The quality of teaching and learning is also extremely poor. A recent DFID study of primary and junior secondary teachers in government schools, as we have just heard, revealed that only 75 of 19,000 teachers surveyed achieved the minimum standards for teaching core subjects.
As my hon. Friends heard during their visit, there are three major educational challenges. The first challenge is simply to get more children into school. A national education data survey, partly funded by DFID, showed that only 61% of Nigerian children attend school. The situation in the north of the country, the poorest part, is particularly bad. Therefore, DFID’s efforts are focused on 10 of Nigeria’s 36 states, mainly in the north. We are working with the Federal Ministry of Education and state Governments to help address these regional disparities.
The second challenge is to close the gap between girls and boys. In many parts of the country, particularly the north, there are many fewer girls than boys in school. In the northern states, only 35% of girls attend primary school, compared with over 80% in the south of the country. That is of great concern to DFID, and we are working with our partners in the country to help close those geographic and gender gaps.
Jeremy Lefroy (Stafford) (Con)
As members of the International Development Committee have just seen during a visit to Malawi, one of the main problems for girls is the lack of adequate toilet facilities. Will the Minister outline what the Government, through DFID, are doing in that respect in Nigeria?
Mr Duncan
I am grateful to my hon. Friend, because he is right that we are indeed spending money on sanitation, and I am perturbed to hear from my hon. Friend the Member for Harrow East about the seemingly excessive cost of one particular structure. I can assure him and the House that we will investigate that as a matter of urgency to check that we have genuinely achieved value for money. However, as my hon. Friend the Member for Stafford (Jeremy Lefroy) rightly points out, girls are kept away from school if they do not have proper sanitation; they simply do not turn up. Therefore, sanitation is an essential part of making sure that girls have equal access to education.
International evidence from countries such as Malaysia and other Asian countries shows that educating girls is one of the best investments a country can make. Educating more girls improves family and child health and boosts economic growth by making young women more productive. DFID is therefore working with its Nigerian partners to help get more girls into school and improve their quality of education, their health and their economic contribution to society.
Mr Duncan
My hon. Friend, who has so much experience in this area, is absolutely right. One of DFID’s core objectives is to achieve later marriage by educating girls, and one of the most potent influences in achieving effective development is focusing on opportunities for girls in all the countries where we have programmes.
The third challenge, which I think properly addresses the concern of my hon. Friend the Member for Maidstone and The Weald, is to improve the quality of education. Getting children into school is just the first step; it is no good getting them into school if they do not receive any useful teaching once there. Too many Nigerian children leave school without the necessary knowledge and skills for a healthy and productive life. International research shows that the most effective way to improve the quality of education is to invest in teachers and the quality of teaching. Education systems need to attract good people to become teachers. They then need the right incentives, professional support and teaching materials for their classrooms.
Parents and communities also need support to hold teachers to account for their children’s learning. My hon. Friends heard directly from the DFID team in Nigeria about the projects that UK taxpayers’ money is supporting in order to respond to those education challenges. They heard also about the impressive results being achieved.
DFID has two major projects to increase access to education for Nigerian children, and to improve the quality of education they receive once they are in school. The first project, to which my hon. Friend the Member for Harrow East referred, is the education sector support programme in Nigeria, known as ESSPIN. It works with the federal Ministry of Education and six states of the federation to improve the planning, management, funding and provision of basic education. The overarching objective of the project is to ensure that Nigeria’s own public funds are used more effectively to improve education.
The ESSPIN project is managed by a contracted company to provide technical assistance to state education departments. It helps communities organise school-based management committees; it trains head teachers to plan and use their Government funds to improve their schools; and it provides small grants and small-scale infrastructure to upgrade facilities and teaching materials in schools where community-based management committees are working well.
A recent independent review of ESSPIN found that after almost three years the project was indeed making a real difference. The review concluded that the project
“has been effective in establishing a platform for basic education reform in six Nigerian States... Its pilot work in approximately 2000 schools and communities is sound. It is resulting in some early teaching and learning benefits.”
Building on those achievements, ESSPIN is now widening its coverage to approximately 10,500 schools in order to benefit an estimated 4.2 million children over the next three years.
The second project is the girls’ education project, known as GEP, which is funded by DFID and run by UNICEF. The project works with four state governments in the north of Nigeria to help get more girls into school, to encourage them to stay and to improve the quality of education that they receive in their school. The project identifies schools with low levels of enrolment by girls. It helps those schools to identify the local barriers to girls attending, and it supports teachers and communities in addressing those barriers. For example, the lack of women teachers discourages parents from sending their girls to school. The GEP therefore includes a scholarship scheme to help young women to become teachers in their own community. The UK has supported two phases of the girls’ education project since 2004, and we calculate that it has helped to get 423,000 girls into primary schools and helped the transition of 225,000 girls into junior secondary schools.
A new phase of the project is just starting, and as my hon. Friend said it will get an additional 800,000 children, 600,000 of them girls, into school by 2015. The project will expand to a total of six states in the next few years, and in response to the scale of Nigeria’s education challenges DFID is designing two new education projects. The first is looking at how DFID can help to improve the quality of teaching that children receive once they get into school. Teachers need training and support throughout their career, not just at the start. The project will therefore consider targeted support for teacher training colleges and for in-service training schemes.
The second project is looking at how to improve the quality of education in low-cost private schools. When my right hon. Friend the Secretary of State for International Development visited Nigeria in June last year, he noted that millions of Nigerian children are being educated outside the public sector and visited a community-based private school in the slums of Lagos, where more than 60% of primary children attend such schools. So DFID is looking at how to help those schools without undermining their independence or the strength of accountability between teachers and parents. The UK’s support for education is an important part of the UK’s overall support for Nigeria.
Nigeria matters to the UK and to the rest of the world. The country is an emerging power that is important to the coalition Government’s foreign and domestic policy interests and central to the UK’s prosperity, security and development agendas. Continued poverty, greater domestic conflict or religious radicalisation would damage the UK’s interests; and they could reduce growth and market opportunities, increase illegal migration and crime, and increase the potential for security threats to the UK. The rise of Islamist terrorism in the past year and the tragic hostage events earlier this month are harsh reminders of these threats.
Following the widely acknowledged, credible elections in April 2011, the coalition Government have been developing a more substantive and strategic relationship with Nigeria by stepping up our co-operation on prosperity, security and development. The coalition Government aim to build on the very warm relations established through the Prime Minister’s visit to Nigeria in July 2011 and the two visits by my right hon. Friend the Secretary of State for International Development last year. Given the challenges that Nigeria faces in securing stability, prosperity and development—not least in providing a better education for its children—I hope that the House will welcome the priority placed on Nigeria’s development by the coalition Government and the significant expansion of the UK’s development programme as a result of the bilateral aid review. Again, I thank my hon. Friend the Member for Harrow East and his colleagues for raising awareness of the critical importance of supporting Nigeria and supporting that country’s education.
Question put and agreed to.